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Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.
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Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.
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Objective To investigate the related factors and prognosis of pulmonary hypertension (PAH) in hemodialysis (HD) patients for early diagnosis and intervention of PAH.Methods A retrospective cohort study was conducted in 183 long-term hemodialysis patients with complete follow-up data from January 1,2010 to December 30,2015 from the blood purification center of the Third Affiliated Hospital of Sun Yat-sen University.The follow-up deadline was December 30,2017,and the endpoints were death and cardiovascular events.The clinical data,laboratory examinations,cardiac color Doppler ultrasound parameters and prognosis of patients with and without PAH were compared.Multivariate logistic regression was used to analyze the risk factors for PAH in HD patients.The survival rates were calculated by Kaplan-Meier method,and the survival curves were compared by Log-rank test between the two groups.A multivariate Cox proportional hazard regression model was used to examine the association between PAH and all-cause mortality in HD patients.Results Of the 183 hemodialysis patients,79(43.2％) were female,104(56.8％) were male,and the age was (56.1±16.9) years,of which 72(39.3％) were complicated with PAH.Compared with the non-PAH group,patients in the PAH group was older and had a longer duration of dialysis (both P ＜ 0.05).The left atrial diameter (P=0.002) and the proportion of valvular calcification (P=0.004) were significantly higher in the PAH group than that in the non-PAH group.Logistic regression analysis showed increased age (OR=1.027,95％ CI 1.001-1.053,P=0.041) and increased duration of dialysis (OR=1.129,95％ CI 1.004-1.269,P=0.042) were risk factors for PAH in HD patients.After a median follow-up of 27.8 months,Kaplan-Meier survival analysis showed that all-cause mortality was higher in the PAH group than that in the non-PAH group ~x2=5.636,P=0.018).The main cause of death in two groups was cardiovascular event.Afteradjusting for age,diabetes mellitus,duration of dialysis,valvular calcification,and hypertension,Cox regression showed that PAH increased the risk of all-cause mortality in HD patients (HR=1.894,95％ CI 1.083-3.313,P=0.025).Conclusions HD patients complicated with PAH are more common and the prognosis is poor.Increased age and increased duration of dialysis may be risk factors for PAH in HD patients.Regular color Doppler echocardiography is helpful for early detection and diagnosis of PAH.
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Objective@#To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.@*Methods@#From January 2013 to September 2017, patients undergoing vertebral artery stenting in the Department of Neurology, Jinling Hospital were enrolled prospectively. They were divided into agatraban group and heparin group by random number table method. The argatroban group received argatroban anticoagulation during the procedure, and was continuously used for 5 d after procedure; while the heparin group underwent heparin anticoagulation during the procedure, and used saline as placebo after procedure. Clinical follow-up was performed at 1, 3, and 6 months after procedure. Digital subtraction angiography, CT angiography, or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels. The primary endpoints included intraoperative safety, in-stent restenosis after procedure, and any clinical events that occurred during the follow-up period, including stroke, cardiovascular events, and death. Major safety events included bleeding from various organs, allergic reactions, liver dysfunction, and embolism events. Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.@*Results@#A total of 105 patients were enrolled in the analysis, including 53 in the argatroban group and 52 in the heparin group. During the periprocedural period, no hemorrhagic events, allergic reactions, liver dysfunction or embolism events occurred in both groups. There were no significant differences in preoperative vertebral artery stenosis degree, postoperative residual stenosis degree, and stenosis degree at 6 months after procedure between the two groups, but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56%±26.41% vs. 4.25%±15.76%; P=0.031). There was no significant difference in the incidence of stroke recurrence (P=1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.@*Conclusions@#It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting. Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.
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Objective To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.Methods From January 2013 to September 2017,patients undergoing vertebral artery stenting in the Department of Neurology,Jinling Hospital were enrolled prospectively.They were divided into agatraban group and heparin group by random number table method.The argatroban group received argatroban anticoagulation during the procedure,and was continuously used for 5 d after procedure;while the heparin group underwent heparin anticoagulation during the procedure,and used saline as placebo after procedure.Clinical follow-up was performed at 1,3,and 6 months after procedure.Digital subtraction angiography,CT angiography,or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels.The primary endpoints included intraoperative safety,in-stent restenosis after procedure,and any clinical events that occurred during the follow-up period,including stroke,cardiovascular events,and death.Major safety events included bleeding from various organs,allergic reactions,liver dysfunction,and embolism events.Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.Results A total of 105 patients were enrolled in the analysis,including 53 in the argatroban group and 52 in the heparin group.During the periprocedural period,no hemorrhagic events,allergic reactions,liver dysfunction or embolism events occurred in both groups.There were no significant differences in preoperative vertebral artery stenosis degree,postoperative residual stenosis degree,and stenosis degree at 6 months after procedure between the two groups,but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56％ ±26.41％ vs.4.25％ ± 15.76％;P =0.031).There was no significant difference in the incidence of stroke recurrence (P =1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.Conclusions It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting.Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.
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Objective To investigate the influencing factors and clinical significance of high-resolution magnetic renounce imaging (HR-MRI) plaque enhancement in patients with symptomatic intracranial atherosclerotic (ICAS) stenosis.Methods Patients with symptomatic ICAS stenosis confirmed by digital subtraction angiography and examined by HR-MRI were enrolled prospectively.The demographic data,vascular risk factors,laboratory tests,and imaging features of plaques were compared according to whether the plaques were enhanced or not.They were randomly divided into an ischemic stroke group and a transient ischemic attack (TIA) group according to the results of diffusion-weighted imaging.The relationship between plaque enhancement and ischemic stroke was analyzed.Results Thirty-fiwe patients with symptomatic ICAS stenosis were enrolled.Their mean age was 53 ± 13 years and 25 were males.There were 21 patientswith ischemic stroke and 14 patients with TIA;22 had plaque enhancement and 13 did not have.The leukocyte count ([7.50±2.30] × 109/L vs.[5.80± 1.00] × 109/L;t=2.487,P=0.018) and proportion of severe stenosis (86.4％ vs.53.8％;P =0.040) of the plaque enhancement group were significantly higher than those of the non-enhancement group.The proportion of smoking was significantly lower than the non-enhancement group (13.6％ vs.46.2％;P=0.050).The plaque enhancement rate of the ischemic stroke group was higher than that of the TIA group (71.4％ vs.50.0％;P =0.288),but there was no significant difference.Conclusions In patients with symptomatic ICAS,the degree of vascular stenosis and the leukocyte level were associated with plaque enhancement.In addition,there was no significant correlation between plaque enhancement and the occurrence of ischemic stroke in patients with symptomatic ICAS.
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Objective To investigate the symptom,esophageal motility characteristics and the prevalence of gastroesophageal reflux disease(GERD)in patients with typeⅠ,Ⅱand Ⅲ gastroesophageal junction (EGJ)diagnosed by high resolution esophageal manometry(HREM).Methods From 6th January to 27th December in 2012,the clinical data of 171 patients with reflux symptoms and received HREM were retrospectively analyzed.According to the Chicago classification V.3.0,the patients were divided into EGJ type Ⅰ,Ⅱ and Ⅲ groups.The age,body mass index(BMI),GERD related symptoms,esophageal motility parameters and the incidence of GERD were compared among the three groups.Chi-square test, t test and analysis of variance were used for statistical analysis.Relationship between EGJ types and other variables were analyzed by Spearman rank correlation.Results In 171 patients,136 cases(79.5%)with type Ⅰ EGJ,22 cases(12.9%)with type Ⅱ EGJ and 13 cases(7.6%)with type Ⅲ EGJ.The age of patients with type Ⅱ EGJ was significantly older than that of patients with type Ⅰ EGJ((56.5 ± 2.3) years vs(48.6 ± 1.0)years,t=2.992,P=0.003),however the differences were not statisticant when compared with type Ⅲ EGJ patients((51.2 ± 3.8)years,P> 0.05).The BMI of patients with typeⅢ EGJ was higher than that of typeⅠand typeⅡEGJ patients((26.0 ± 1.3)kg/m2vs(21.9 ± 0.3)kg/m2and (23.5 ± 0.6)kg/m2),and the difference was statistically significant(t=4.082 and 2.108,both P<0.05). The resting pressure of lower esophageal sphincter(LES)of patients with type Ⅱ and Ⅲ EGJ were lower than that of typeⅠEGJ((10.6 ± 1.5)mmHg(1 mmHg=0.133 kPa)and(3.4 ± 0.7)mmHg vs(17.1 ± 0.7)mmHg),and the resting pressure of LES of type Ⅲ EGJ was lower than that of type Ⅱ EGJ((3.4 ± 0.7)mmHg vs(10.6 ± 1.5)mmHg),and the differences were all statistically significant(t= -3.882,-6.411 and -2.769,all P< 0.01).The amplitude of contraction at 11 cm above LES and distal contractile integral(DCI)of patients with type Ⅲ EGJ were both lower than those of patients with typeⅠ EGJ((32.2 ± 5.4)mmHg vs(48.5 ± 2.5)mmHg,and(392.0 ± 94.1)mmHg·s·cm vs(805.1 ± 61.4)mmHg·s·cm),and the differences were statistically significant(t= -2.580 and -2.041,both P<0.05).The incidences of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ were 68.4%(93/136), 77.3%(17/22)and 10/13,respectively,and the difference was not statistically significant(χ2 =1.021, P=0.600).EGJ types were positively correlated with age and BMI(r= 0.214 and 0.290,both P<0.01).However,EGJ types were negatively correlated with the LES resting pressure,contraction amplitudes at 7 cm and 11 cm above the LES,and DCI(r= -0.474,-0.182,-0.333 and -0.191,all P<0.05).Conclusions Aging,overweight and obesity are risk factors of the LES and crural diaphragm separation.EGJ types are not predictable based on symptoms.The esophageal motility seems to decrease in patients with type Ⅱ and Ⅲ EGJ,the incidence of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ are all high.
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Objective To discuss the effects of acupuncture therapy on resting state functional magnetic resonance imaging (fMRI) in patients with ischemic stroke; To explore the central mechanism of acupuncture therapy.Methods Ten is chemic stroke patients with hemiplegia limbs and ten matched control subjects were included. Treatment group was given anti-platelet aggregation, anticoagulation, and nutrition brain cell therapy. At the same time, acupuncture therapy was given, taking Jianyu, Quchi, Shousanli, Waiguan, Hegu, Zusanli, Fenglong, Yanglingquan, Sanyinjiao, and Taichong, with even reinforcing-reducing method, and retaining the needle 30 min, manipulating needle every 10 min, once a day, 5 times a week, needle stopping for 2 d, for continuous 30 d. The health group did not undergo any treatment. BOLD-fMRI imaging technique was used, and based on RSET1.8 software, the parameters of brain activity before and after treatment were observed by amplitude of low frequency fluctuation (ALFF) method. The Results were compared with healthy group. Results Before treatment, the ALFF value of left caudate nucleus, putamen and globus pallidus in the treatment group was lower than that in the health group, and the ALFF value of bilateral precentral and postcentral gyrus, left grus frontalis superior, gyrus frontalis medius, gyrus temporalis medius and precuneus was higher than the health group (P<0.05). After treatment, the ALFF value in left caudate nucleus, putamen and globus pallidus in the treatment group was higher than that before treatment, and the ALFF value in left gyrus frontalis superior, gyrus frontalis medius and precuneus decreased than before group (P<0.05).Conclusion In the resting state of the ischemic stroke patients with hemiplegia limbs, the principal injured brain regions are caudate nucleus, putamen and globus pallidus. Acupuncture has a regulatory role for these brain areas, presumably may be the central mechanism of efficacy.
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Objective To investigate the relationships among distal contractile integral (DCI), ineffective esophageal motility (IEM)and gastroesophageal reflux through high resolution manometry (HRM)in patients with gastroesophageal reflux disease (GERD).Methods A total of 69 patients with GERD were enrolled.All patients received HRM and 24 hour pH and impedance monitoring examination. Pearson correlation analysis was performed to analyze the correlation between DCI,number of invalid swallowing and DeMeester score.All the patients were divided into three groups according to the number of invalid swallowing in 10 times of 5 mL liquid swallowing test.Patients with 5 to 10 invalid swallowing was in IEM group (n=21),one to four was in abnormal motility group (n=19),and zero was in normal motility group (n=29).The t test was performed for comparison of average DCI,average DCI of residual effective swallowing,DeMeester score,acid reflux time,bolus exposure time and proximal reflux times among the three groups.Results Among the 69 patients with GERD,there was negative correlation between DCI and DeMeester score (r=-0.363,P =0.003)in 10 times of 5 mL liquid swallowing test;the number of invalid swallowing was positively correlated with DeMeester score (r=0.374,P =0.002). The mean DCI in 10 times of 5 mL liquid swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96±545 .10),(986.48 ±577.50)and (288.50 ±167.25 )mmHg·s·cm, respectively,and that of IEM group was lower than normal motility group and abnormal motility group (t =-11 .42 and -2.12,both P <0.05).The average DCI of residual effective swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96 ± 545 .10 ),(1 187.90 ± 669.40)and (450.78 ±350.73 )mmHg ·s ·cm,respectively,and that of IEM group was also lower than normal motility group and abnormal motility group (t = -8.05 and -5 .27,both P <0.01 ).The DeMeester score of IEM group (15 .42±8.79)was higher than that of normal motility group (6.34±3.45),and the difference was statistically significant (t=2.43,P <0.05).The acid reflux time and bolus exposure time of IEM group were (54.93 ± 37.07 )min and (0.64 ±0.49 )%,respectively,which were longer than abnormal motility group ((37.37±22.66)min,(0.52 ±0.24)%)and normal motility group ((21 .22 ± 13.98)min,(0.39 ±0.14)%),and the differences were statistically significant (t =2.36,2.17,2.60 and 2.54,all P <0.05).The total number of reflux of IEM group and abnormal motility group were 67.10± 32.94 and 57.26±38.90,which were both more than that of normal motility group (44.61 ±23.84),and the differences were statistically significant (t =2.48 and 2.17,both P <0.05 ).Conclusions DCI and the number of invalid swallowing can predict reflux condition of GERD patients in a certain degree.The contraction strength of esophageal body was the weakest and esophageal clearance was the worst in IEM group.
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Objective Clinical studies show that the level of C-reactive protein ( CRP ) markedly increases in the acute phase of cerebral hemorrhage .However , the correlation of the CRP level with early neurological deterioration ( END) in patients with basal ganglia hemorrhage remains unclear .This study investigated the correlation between CRP and END in basal ganglia hemorrhage . Methods This study included 142 cases of basal ganglia hemorrhage diagnosed by cranial CT between Jan 2010 and Dec 2012 .END was defined as any decrease in Canadian Stroke Scale ( CSS) score≥1 point in the first 48 hours after stroke onset .We compared the baseline data between the END and non-END patients and evaluated the correlation between CRP and END by logistic regression analy -sis. Results END was found in 31 (21.8%) of the 142 patients.Univariate analysis of the END versus non-END cases showed that hyperglycemia (29.03 vs 11.71%, P=0.018), neutrophil count ([11.8 ±1.2] vs [7.8 ±7.7] ×109/L, P=0.019), CRP (P=0.001), hematoma expansion (54.83 vs 19.81%, P=0.001), hematoma volume ([23.6 ±21.9] vs [14.8 ±12.7] mL, P=0.005), and intraventricular hemorrhage (68.75 vs 28.83%, P<0.001) were significantly associated with END .Logistic regression a-nalysis indicated that the CRP level (OR=1.072, 95%CI:1.034-1.112, P=0.001), intraventricular hemorrhage (OR=4.162, 95%CI: 1.498 -11.564, P =0.006), and hematoma expansion (OR=5.297, 95%CI:1.906-14.723, P=0.001) were correlated with END in the patients during their hospital stay .ROC analysis man-ifested the predictive value of the CRP level for END in basal ganglia hemorrhage (OR=0.812, 95%CI: 0.732 -0.891, P <0.001). Conclusion The elevated level of CRP is significantly correlated with END in patients with basal ganglia hemorrhage and therefore can be re-garded as a predictive factor for this condition .
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Objective Cerebral microbleeds (CMBs) are important indicators of cerebral small vessel disease .However, it is still unclear whether endothelial dysfunction is involved in CMBs .The aim of this study is to investigate the correlation between CMBs and soluble E-selectin (sE-selectin) in patients with acute ischemic stroke . Methods Based on the results of MRI (3.0 T) susceptibility weighted imaging , we divided patients with first acute ischemic stroke into a CMBs group ( n=63 ) and a non-CMBs group (n=63), and recruited another 45 volunteers with normal MRI findings as controls .We collected and conducted comparative a-nalysis on the demographic data , biochemical variables ( including the sE-selectin level ) , vascular risk factors , and the number of CMBs of the patients . Results Ordinal logistic regression analysis showed a significantly positive correlation between sE -selectin and the number of CMBs (OR=1.062, 95%CI:1.023-1.103, P=0.002), higher systolic blood pressure associated with more CMBs (OR=1.014, 95%CI:1.002-1.025, P=0.021). Conclusion Serum sE-selectin is significantly positively correlated with and can be used as a biological marker for the severity of CMBs .
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Objective To investigate the effect of progressive neurological deterioration ( PND) of cerebral watershed infarction on early prognosis. Methods The consecutive patients with cerebral watershed infarction admitted in the Department of Neurology,Jinling Hospital,Nanjing University School of Medicine and their cerebral watershed infarctions confirmed by the imaging examination from March 2009 to March 2014 were enrolled. The clinical features, laboratory indicators and imaging features of internal watershed infarction,cortical-type watershed infarction,and mixed watershed infarction were identified and analyzed. The National Institutes of Health Stroke Scale was used to score neurological deficit. The modified Rankin scale ( mRS) was used to score the prognosis of patients. Single factor analysis was used to compare the differences between the groups. At the same time,the correlation between PND and poor prognosis of cerebral watershed infarction at day 90 was analyzed by multivariable Logistic regression analysis. Results A total of 89 patients with cerebral watershed infarction were enrolled,including 43 cortical-type watershed infarctions,36 internal watershed infarctions, and 10 mixed watershed infarctions. Single factor analysis indicated that the incidences of PND of internal watershed infarction and mixed watershed infarction were significantly higher than the cortical-type watershed infarction (36. 1% [n=13],50. 0% [n=5], and 16. 3% [n=7],respectively;P=0. 018). At day 90,28 patients had poor prognosis,and mRS was (3.4±1. 0) scores at day 90. There was significant difference in the types of infarction between the patients with poor prognosis and patients with good prognosis (P<0. 05). In patients with poor prognosis, most of them were internal watershed infarctions,accounting for 50. 0% (14/28),while in patients with good prognosis,most of them were cortical-type watershed infarctions(57. 4% [35/61]). The incidence of PND in patients with poor prognosis was significantly higher than that in patients with good prognosis (57.1% [16/28] vs. 14. 8% [9/61];P<0. 05). The result of multivariate Logistic regression analysis showed that after adjustment for confounding factor, PND was independently associated with the poor prognosis of cerebral watershed infarction at day 90 (OR 6. 969,95%CI 2. 451-19. 869;P<0. 01). Conclusion Compared with the cortical-type watershed infarction, the patients with internal watershed infarction is more prone to have PND, and PND is independently correlate with the poor prognosis at day 90.