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Objective To investigate the changes of the levels of sonic hedgehog (SHH) and vascular endothelial growth factor (VEGF) in serum and its relationship with collateral circulation in patients with symptomatic middle cerebral artery stenosis. Methods From January 2015 to January 2018, a total of 268 patients with acute ischemic stroke confirmed as unilateral middle cerebral artery M1 segment (MCA-M1) severe stenosis or occlusion by digital subtract angiography (DSA) were enrolled. The baseline clinical data were collected. According to the establishment of collateral circulation shown by DSA, they were divided into good collateral circulation group (152 patients) and poor collateral circulation group (116 patients). The levels of SHH and VEGF in serum were detected by enzyme linked immunosorbent assay (ELISA), the expression characteristics of SHH and VEGF in serum and the relative factors influencing the establishment of collateral circulation were analyzed. Results The levels of serum SHH and VEGF in good collateral circulation group were significantly higher than those in poor collateral circulation group (P < 0.01). Pearson correlation analysis showed that there was a positive correlation between SHH and VEGF (r=0.758, P < 0.01). Multivariate Logistic regression analysis showed that the levels of serum SHH ( OR=0.310, 95% CI 0.117-0.819, P=0.018) and VEGF ( OR=0.361, 95% CI 0.147-0.887, P=0.026) were independent protective factors for the establishment of collateral circulation. Diabetes ( OR=3.094, 95% CI 1.321-7.245, P=0.009) was independent risk factor for the establishment of collateral circulation. Conclusions The levels of serum SHH and VEGF are closely related to the formation of collateral circulation and they are independent protective factors. SHH may be involved in the establishment of cerebral collateral circulation by regulating the expression of VEGF and diabetes is not conducive to the formation of collateral circulation.
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Objective To explore the relationship between the serum anticardiolipin antibody (ACA),vascular endothelial grow factor (VEGF) concentration and cognitive impairment in patients with ischemic stroke.Methods Totally 128 cases with acute ischemic stroke were admmitted in stroke unit ward of our hospital during June 2014 to December 2014.According to the score of Montreal cognitive assessnent (MoCA),128 patients with ischemic stroke were divided into groups A (53 cases with cognitive impairment) and group B (75 cases without cognitive impairment).The concentrations of serum ACA,VEGF were quantitatively determinated by ELISA.The differences of serum ACA,VEGF concentrations were compared between the two groups.Results Compared with normal cognitive function group,the cognitive impairment patients had significantly higher ACA concentration ((0.86±0.16) mg/L vs (0.52±0.08) mg/L,P＜0.01),and lower VEGF concentration ((197.60±7.48) pg/ml vs (205.80±8.52) pg/ml,P＜0.05).Logistic regression revealed that ACA and VEGF were independent effect factors for cognitive impairment (ACA:B =2.841,OR =0.33,95 ％ CI =0.118-0.926,P=0.025.V EGF:B =-1.674,OR =4.99,95％ CI =1.688-4.741,P=0.034).Conclusion ACA and VEGF may play an important role in cognitive impairment after ischemic stroke.
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Objective To investigate the relationship between serum anticardiolipin antibody-immune globulin G (ACA-IgG),interleukin-10 (IL-10 ),IL-17 levels and intracranial large-artery atherosclerotic stenosis in patients with ischemic stroke. Methods From March 2014 to March 2015,a total of 176 consecutive patients with the first-ever ischemic stroke admitted to the Department of Neurology,Liaocheng People′s Hospital,Shandong Province,China,and performed DSA were enrolled prospectively. Seven of the patients with cardiogenic embolism,5 with moyamoya disease,8 with arteritis,2 with artery dissection,9 with autoimmune diseases or acute and chronic inflammation were excluded,21 with extracranial arterial stenosis were not enrolled,and finally 124 were enrolled in the study. According to the findings of DSA,the degrees of intracranial large artery stenosis were divided into a stenosis-free group (n = 34),a mild-stenosis group (n = 30),a moderate-stenosis group (n = 32),and a severe-stenosis group (n = 28). The differences of serum ACA-IgG,IL-10,IL-17 levels and baseline factors of the 4 groups were compared,and multivariate logistic regression analysis was used to analyze several factors that affected intracranial large-artery stenosis. Results There were no significant differences in sex,age,alcohol consumption rate,smoking rate,and incidence of hyperlipidemia among the 4 groups of patients (all P >0. 05). Compared with the stenosis-free group,there were significant differences in the incidences of hypertension and diabetes among the mild-stenosis,moderate-stenosis and severe-stenosis groups (the incidence of hypertension,80. 0% [n = 24],93. 8% [n = 30],89. 3% [n = 25]vs. 55. 9% [19 cases];χ2 = 8. 271,8. 920,and 10. 877,respectively;P = 0. 038,0. 032,and 0. 014,respectively). The incidences of diabetes were 33. 3% (n = 10),43. 8% (n = 14),60. 7% (n = 17)vs. 8. 8% (n = 3),(χ2 = 7. 960, 8. 733,and 9. 285,respectively;P = 0. 043,0. 035,and 0. 027,respectively). Incidence of diabetes of the severe-stenosis group was higher than that of the mild-stenosis group (χ2 = 9. 348,P = 0. 025). There were no significant differences in the incidences of hypertension and diabetes among other groups (all P >0. 05). There were significant differences in ACA-IgG levels (23 ± 5,39 ± 8,51 ± 9,and 65 ± 10 kU/ L);IL-10 levels (108 ± 33,85 ± 25,77 ± 21,and 62 ± 19 ng/ L),and IL-17 levels (38 ± 10,58 ± 22,63 ± 31, and 75 ± 26 ng/ L)among the stenosis-free,mild,moderate and severe-stenosis groups (F = 17. 754,9. 827, and 12. 656;respectively;all P 0. 05). The results of logistic regression analysis showed that hypertension, diabetes,ACA-IgG level,and IL-17 level were the risk factors for intracranial large-artery stenosis (OR, 3. 043,95% CI 1. 606 -5. 875,P = 0. 003;OR,2. 912,95% CI 1. 513 -5. 824,P < 0. 01;OR,1. 837,95% CI 2. 057-3. 416,P = 0. 037;OR,1. 453,95% CI 1. 346 -2. 721,P = 0. 014). Conclusion ACA-IgG and IL-17 may play an important role in the occurrence and development processes of intracranial large-artery atherosclerotic stenosis.
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Objective To evaluate the efficacy of i-scan endoscopy in detecting small colorectal precancerous lesions.Methods A total of 127 patients were randomized into 2 groups to underwent conventional colonoscopy and i-scan endoscopy respectively.The findings were compared with pathologic examinations.Results A total of 84 lesions were detected by conventional endoscopy in 64 patients,while 147 lesions were found in 63 patients with high resolution detection only,which was increased to 259 with i-scan,including 102 flat lesions.With respect to histology,adenomatous lesions could be predicted with a high sensitivity (80％) and a high specificity ( 100％ ) by i-scan endoscopy.Conclusion More small colorectal lesions can be detected by i-scan endoscopy,which can distinguish neoplasm from non-neoplasm colorectal lesions.
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ObjectiveTo evaluate digital chrome endoscopy (I-Scan) and confocal laser endomicroscopy (CLE) for diagnosis of Barrett esophagus (BE).MethodsFrom July 2010 to July 2011,a total of 878 outpatients who had upper gastrointestinal symptoms underwent routine endoscopy and I-Scan examination,screened patients with suspected Barrett's epithelial were further referred to CLE and endoscopy.The detection rate and image features of BE between routine endoscopy and I-Scan,and the diagnosis of BE between pathology and CLE,were compared respectively.ResultsSuspected BE was diagnosed in 46 patients (5.2％) by routine endoscopy,and in52 (5.9％) by I-Scan,and there was no significant difference in detection rate between 2 methods (x2 =0.533,P ＞ 0.05 ).The detection rate of paliform blood vessels between SCJ and GEJ was higher using I-Scan (35/52,67.3％ ) than routine endoscope (21/46,45.7％,P ＜0.05).A total of 19 suspected BE underwent CLE and biopsy,and BE was diagnosed by CLE with a sensitivity of 93％ and a specificity of 100％.ConclusionI-Scan is capable of identifying paliform blood vessels between SCJ and GEJ,and can improve the detection rate of suspected BE.CLE is able to provide in-vivo histological diagnosis of BE with a high sensitivity and specificity.