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Objective:To investigate the correlation between basilar artery (BA) dolichosis and clinical outcome of patients with acute isolated pontine infarction.Methods:Consecutive patients with acute isolated pontine infarction within 7 d after onset admitted to the Department of Neurology, the Affiliated Hefei Hospital of Anhui Medical University were enrolled. The demographic, clinical and MRI data were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after the onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. A binary multivariate logistic regression model was used to analyze the correlation between BA dolichosis and clinical outcome of the patients. Results:A total of 116 patients with acute isolated pontine infarction were enrolled. There were 69 (59.5%) males and 47 (40.5%) females, with a median age of 65 years (interquartile range: 57-76 years). There were 39 patients (33.6%) in BA dolichosis group and 77 (66.4%) in non-BA dolichosis group. The BA diameter ( P=0.021), theoretical length (basilar artery length, BAL) ( P<0.001), bending length (BL) ( P<0.001) and the proportion of patients with BA bending ( P<0.001) in the BA dolichosis group were significantly higher than those of the non-BA dolichosis group. There were 93 (80.2%) patients in good outcome group and 23 (19.8%) in poor outcome group. The baseline National Institute of Health stroke scale (NIHSS) score ( P<0.001), approximate length of BA ( P=0.007), BAL ( P=0.020), BL ( P=0.005) and the proportion of patients with BA dolichosis ( P=0.002) and bending ( P=0.008) in the poor outcome group were significantly higher than those in the good outcome group. Spearman correlation analysis showed that the approximate length of BA was significantly positively correlated with BL ( r=0.597, P<0001). Multivariate logistic regression analysis showed that BA dolichosis (odds ratio 5.441, 95% confidence interval 1.814-16.320; P=0.003) and the higher baseline NIHSS score (odds ratio 1.696, 95% confidence interval 1.291-2.228; P<0.001) were the independent risk factors for poor outcomes in patients with acute isolated pontine infarction. Conclusion:BA dolichosis is common in patients with acute isolated pontine infarction. BA dolichosis may be an independent risk factor for poor outcome in patients with acute isolated pontine infarction at 3 months after onset.
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Objective To investigate the correlation between ipsilateral posterior cerebral artery laterality (PCAL) and the outcomes in patients with ischemic stroke in the middle cerebral artery (MCA) territory. Methods From June 2015 to December 2016, patients with acute ischemic stroke in the MCA territory admitted to the Second People's Hospital of Hefei were enrolled. Magnetic resonance angiography (MRA) was used to assess PCAL. The outcome was evaluated by the modified Rankin scale at 3 months after onset. 0-2 was defined as good outcome and > 2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results A total of 111 patients with ischemic stroke in MCA territory were enrolled, including 47 (42. 3％) PCAL and 30 (27. 0％) poor outcomes. The baseline NIHSS score in the PCAL group was significantly lower than that in the non-PCAL group (5. 13 ± 3. 29 years vs. 7. 03 ± 5. 676 years, t = 2. 058; P = 0. 042). There were significantly differences in the proportion of diabetes mellitus (29. 6％ vs. 10. 0％; χ2 = 4. 583, P = 0. 032), PCAL (51. 9％ vs. 16. 7％;χ2 = 11. 101, P = 0. 001) and smoking (25. 9％ vs. 13. 3％; χ2 = 4. 943, P = 0. 026), as well as age (63. 9 ± 11. 8 years vs. 71. 0 ± 6. 7 years; t = 2. 688, P = 0. 007), baseline diastolic blood pressure (89 ± 13 mmHg vs. 82 ± 10 mmHg; t = -2. 249, P = 0. 025; 1 mmHg = 0. 133 kPa) and baseline NIHSS score (5. 02 ± 3. 67 vs. 9. 47 ± 6. 20; t = 3. 883, P < 0. 001) between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that PCAL was associated independently with good outcome (odds ratio [OR] 0. 272, 95％ confidence interval [CI] 0. 083-0. 888; P = 0. 031), while advanced age (OR 1. 088, 95％ CI 1. 022-1. 157; P = 0. 008) and high baseline NIHSS score (OR 1. 224, 95％ CI 1. 077-1. 391; P = 0. 002) were associated independently with poor outcome. Conclusion PCAL is associated independently with good outcome in patients with ischemic stroke in MCA territory.
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Objeetive To investigate the clinical and imaging features in patients with clinically confirmed acute ischemic stroke and negative diffusion-weighted imaging (DWI).Methods The clinical and imaging data in patients with clinically confirmed acute ischemic stroke and initial negative DWI were collected retrospectively.According to the repeat DWI findings,they were divided into either a persistentnegative DWI group or a faise-negative DWI group.The demographics,and data of clinical and imaging at baseline between the 2 groups were compared,and the causes of the initial negative DWI were analyzed.Results A total of 15 patients with clinically confirmed acute ischemic stroke and initial negative DWI were enrolled,including 9 in the persistent-negative DWI group (9/15,60.0％) and 6 in the false-negative DWI group (6/15,40.0％),and 8 with minor stroke (National Institute of Health Stroke Scale score ≤3;8/15,53.3％).The time from onset to admission ranged from 1 to 48 h.The time from onset to initial DWI examination ranged from 5 to 65 h.The time from onset to repeat DWI ranged from 38 to 190 h.There were no significant differences in demographics,and data of clinical and imaging at baseline between the 2 groups.In 6 patients with false-negative DWI findings,5 were posterior circulation stroke (5/6,83.3％) and 1 was anterior circulation stroke (1/6,16.7％);1 might have a second infarct,1 might be associated with shorter examination time (5 h after onset),1 was associated with not reaching the diffusion limited threshold and the influence of MRI artifact before symptom aggravation,and the remaining 3 might be associated with smaller lesions and locating in the posterior circulation.The causes of 9 patients with persistent-negative DWI ffndings were unknown.Conclusions There were no significant differences in features of clinical and imaging at baseline between persistent-negative and false-negative DWI findings.False-negative DWI findings in acute ischemic stroke can be mainly seen in patients with posterior circulation stroke and minor stroke.
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Objective To investigate the correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction.Methods The clinical data in patients with acute isolated pontine infarction were collected retrospectively. Diffusion weighted imaging (DWI) was used to identify the lesion patterns. The correlation between the lesion pattern and etiological subtype was analyzed. Results A total of 146 patients with acute isolated pontine infarction were enrolled in the study, including 136 unilateral infarctions and 8 bilateral infarctions. The DWI lesion pattern analysis showed that there were 98 patients with paranasal infarction, 11 with anterolateral infarction, 18 with tegmentum infarction, and 19 with multiple infarction. Among all the etiological subtypes, basilar artery branch disease (BABD) accounted for the greatest proportion (n = 72, 49.3%), followed by large arterial occlusive disease ( n = 32, 21.9%), small arterial occlusive disease ( n = 25, 17.1%), and other causes/unknown causes ( n = 12, 8.2%). Cardioembolism was minimal (n =5, 3.4%). The distribution patterns of DWI lesions in acute isolated pontine infarction were significantly correlated with the etiological subtypes (C = 0.516, P < 0.001). Among them, 60 patients with paramedian infarction ( χ2 =16.915, P <0.001), 1 with anterolateral infarction ( χ2 =7.701, P = 0.006), 1 with tegmentum infarction ( χ2 =17.401, P <0.001) were closely associated with BABD; 9 patients with paramedian infarction ( χ2 =12.534, P <0.001), 6 with anterolateral infarction ( χ2 =24.365, P <0.001), and 10 with tegmentum infarction ( χ2 =18.312, P < 0.001) were significantly associated with small arterial occlusive disease. Conclusions There are significant correlation between the lesion pattern and etiological mechanism in acute isolated pontine infarction. The cause of acute isolated pontine infarction can be predicted in early stage by DWI revealed infarction distribution characteristics.
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Objective To explore the role of HIF-1 and its downstream SDF-1α/CXCR4 and VEGF/VEGFR pathway in mediating MSC mobilization with DMOG .Methods Male SD rats were randomly divided into five groups:Normal saline control group , DMOG group, YC-1 group, AMD3100 group, SU5416 group.We used CFU-F assay and flow cytometry to determine the number of MSCs in rat bone marrow ( BM ) and peripheral blood ( PB ) in each group , respectively.The concentrations of SDF-1αand VEGF both in BM and PB serum in each group were detected by ELISA . Western blotting was used to test protein levels of HIF-1α, SDF-1αand VEGF in BM.Results Compared with NS group, the number of CFU-Fs as well as the percentage of CD 45 -CD90 +cells increased in DMOG group ( P <0.05);Compared with DMOG group, the number of CFU-Fs as well as the percentage of CD 45 -CD90 +cells decreased in YC-1 group, AMD3100 group and SU5416 group (P <0.05).Compared with DMOG group, the concentration and protein expression of HIF-1αdecreased significantly in YC-1 group ( P <0.05 ) , the concentration and protein expression of SDF-1αdecreased significantly in AMD 3100 group ( P <0.05 ) , the concentration and protein expression of VEGF decreased significantly in SU5416 group ( P <0.05 ).Conclusion DMOG can induce MSCs mobilization possibly via up-regulating the expression of HIF-1αand activating its downstream SDF-1α/CXCR4 and VEGF/VEGFR pathway .
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Objective To analyze the distribution and clinical characteristics of gastrointestinal virus infection in infants with acute diarrhea.Methods Stool samples and clinical data were collected from 900 infants (≤5 years old) with acute diarrhea in outpatient department of Beilun District People' s Hospital during July 2012 and July 2013.Specimens were tested for 5 gastrointestinal virus including group A/B/C rotavirus (RV),adenovirus (AdV),astrovirus (AstV),sapovirus (SV) and norovirus (NV) by the multiplex PCR assay.Chi-square test was performed to compare the positive rates of virus infection among children with different genders and ages.Results Among 900 stool samples,369 were positive of gastrointestinal virus,of which 291 were positive for single virus and 78 for mixed virus.In single virus infection,NV was detected with the highest positive rate of 19.4％ (4.9％ for G Ⅰ and 14.6％ for G Ⅱ),followed by RV-A (8.2％),SV (2.9％),AstV (1.0％) and AdV (0.8％).RV-B and C type were not found.In 78 cases with mixed infections,RV-A plus NV infection was the most common one with a prevalent rate of 5.8％.The positive rate in age group ≤2 years old was 51.0％,which was significantly higher than that of age group ＞ 2-5 years old (22.1％,x2 =70.404,P ＜ 0.01).In 369 children with positive gastrointestinal virus,fever was present in 24.1％,and vomit in 35.2％ of children.Fever,vomit and fever plus vomit was more common symptoms in children with mixed infections (x2 =17.878,21.869 and 14.155,P ＜ 0.01).Conclusion NV and RV-A are the most common pathogens in infants with acute diarrhea in Beilun district,especially in children younger than 2 years old.
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Objective To explore the allergic status and allergen composition in children with acute Henoch-Schonlein Purpura in Wuxi by allergen detection, thereby to establish appropriate therapeutic strategies. Methods Two hundred and forty-six patients with Henoch-Schonlein Purpura in their acute phase were examined for serum concentrations of total IgE and specific IgE using Germany AllergyScreen system. Results The positive rate of allergen-specific serum IgE was 48.7% (120/246) ,of which,positive reactions to two or more than two allergens were found in 86 cases (34.9%) and that to one kind of allergen were found in 34 cases (13.8%)The positive rate of total serum IgE was 78.9% (194/246). In inhalation allergen group, positive reaction to allergen was found in 134 cases (54.5%). The most common allergen was dust mite/flour mites (19.1%) ,and came the next were house dust(17.1%) and Penicillium notatum/Alternaria alternata(10.2%). In food allergen group,positive reaction to allergen was found in 77 cases (31.3%). The most common allergen was fish (6.5%),and came the next were egg (5.7%) and mutton (5.3%). We found no significantly different allergen positive rates between inhalation allergens group and food allergens group (χ2 = 2.59, P ＞ 0.05). Conclusions The combined allergens attacks were more common in children patients with acute Henoch-Schonlein Purpura by serum allergen detection. Various types of the allergens are associated with the occurrence of acute Henoch-Schonlein Purpura. To reduce the harmness of allergens,it is necessary to avoid touching these allergens.