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Objective:To characterize clinical and neuroimaging features, etiologies, and mechanisms of bilateral middle cerebellar peduncle (MCP) infarctions.Methods:Consecutive patients with bilateral MCP infarctions treated in the Beijing Tiantan Hospital, Capital Medical University between January 1, 2020 and April 30, 2022 were enrolled in this retrospective study. The demographic data, vascular risk factors, clincial manifestations and the National Institutes of Health Stroke Scale (NIHSS) scores were collected. Brain diffusion-weighted imaging was used to assess the regions of cerebral infarction, and the extracranial and intracranial segments of the vertebrobasilar artery were evaluated using magnetic resonance angiography, or computed tomography angiography. The stroke etiology and underlying mechanism were evaluated according to the Chinese Ischemic Stroke Subclassification.Results:Ten patients with bilateral MCP infarctions (8 men and 2 women) were analyzed ultimately. The onset age were 51.0-86.0 (64.8±11.4) years. NIHSS scores were 2.0-12.0 (4.9±2.9) points at admission. All patients had vascular risk factors, most of which were hypertension (10 cases) and dyslipoproteinemia (8 cases). The most common clinical manifestations were vertigo (10 cases), followed by ataxia (9 cases) and dysarthria (8 cases). Four cases were isolated bilateral MCP infarctions, while 6 patients were combined with other vertebrobasilar artery infarctions, 4 of which were combined with cerebellar hemisphere infarctions, consistent with the clinical symptoms. The etiology in all patients was large atherosclerosis (severe stenosis or occlusion of V4 segment of vertebral artery and anterior inferior cerebellar artery; 9 cases). Five patients were classified as hypoperfusion/impaired emboli clearance, while 4 patients were considered as artery-to-artery embolism, and 1 was considered as the parent artery (plaque or thrombosis) occluding penetrating artery.Conclusions:Bilateral MCP infarctions are an extremely rare cerebrovascular disease characterized by vertigo, ataxia, and dysarthria. Cerebral infarction can be isolated or often combined with cerebellar hemisphere infarction. The etiology was mostly stenosis or occlusion of V4 segment of vertebral artery and anterior inferior cerebellar artery.
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Objective@#To investigate the efficacy and outcome of transcatheter patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS).@*Methods@#Sixty consecutive patients with cryptogenic stroke who undertook transcatheter PFO closure between May 2015 and September 2017 in Beijing Tiantan Hospital were enrolled in this prospective study.Transcranial Doppler (TCD) bubble test was performed and right-left shunt(RLS) was confirmed in all patients.Closure success rate,effective closure rate, complications, recurrence of ischemic stroke and new onset atrial fibrillation were evaluated.@*Results@#A total of 60 patients (42 male,age range 24-68 (47±11)years) were included in the study.PFO size (motionless state) was (1.6±0.6)mm.RLS before closure was graded and 11 patients had moderate RLS and 48 patients had large RLS (include 41 patients who experienced shower or curtain effect).Closure success rate was 100% (60/60).No severe complications were observed.At 6 months,45 patients completed TCD bubble test.Of these, 4 patients suffered from moderate to large residual and thus effective closure rate was 91%(41/45).The mean follow-up period was 2-29 (median 12) months. During the follow-up, only 1 patient experienced recurrent cerebral infarction.New onset atrial fibrillation was not detected.@*Conclusion@#Transcatheter PFO closure is effective,safe and related with a good outcome in reduction of recurrent CS for patients with PFO.
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Objective To evaluate the efficacy and safety of anticoagulant therapy with low-molecularweight heparin after cerebral hemorrhage combined with deep vein thrombosis of lower extremity.Methods One hundred and fifty-three cases of deep vein thrombosis of lower extremity after intracerebral hemorrhage were collected of Beijing Tiantan Hospital,Capital Medical University from June 2014 to June 2016.According to whether accepted anticoagulant therapy with low-molecular-weight heparin,the patients were divided into treatment group (n =79) and control group(n =74).Compared the head CT images and the ultrasound of lower extremity venous in the day when admissed to hospital and in the 7th day after treatment.The measurement data was adopted by t test,Chi-square test was adopted in the count data.Results Before the low-molecular-weight heparin therapy,the average bleeding volume in intracerebral was (1.38 ± 0.45) ml for the anticoagulant therapy group.After 7 days of low-molecular-weight heparin therapy,the average bleeding volune in intracerebral was (1.01 ± 0.54) ml,there was no increasing cerebral hemorrhage,with a statistically significant difference (P =0.000).The bleeding volume in intracerebral was(1.47 ± 0.47) ml of control group cases,and after 7 days it became (1.17 ± 0.52) ml,with a statistically significant difference (P =0.000),all these showed that cerebral hemorrhage had significantly absorbed.There was no statistically significant difference between the treatment group and the control group (P =0.123).It explained that anticoagulation was not increased intracranial hemorrhage with low-molecular-weight heparin.ultrasound showed that the lower extremity venous thrombosis was stable or decreased before and after anticoagulant therapy,and the difference was statistically significant (P =0.000),indicating that the anticoagulant therapy was effective.Conclusions It is safe and effective in low-molecular-weight heparin anticoagulant therapy for deep vein thrombosis of lower extremity after intracerebral hemorrhage.But patients need strict screening,and follow the individualized treatment.
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Objective To explore the clinical value of serum procalcitonin(PCT)and C-reactive protein(CRP)combination detec-tion in early diagnosis of liver cirrhosis complicating spontaneous bacterial peritonitis(SBP).Methods The peripheral blood sam-ples were collected from 30 cases of liver cirrhosis complicating SBP,30 cases of simple ascites liver cirrhosis (non-SBP)and 45 healthy subjects as control group.The serum PCT level was detected by the dry immunofluorescence quantitation method and the serum CRP level was detected by the immunoturbidimetry.The sensitivity and specificity of PCT,CRP and PCT combined with CRP in diagnosing liver cirrhosis complicating SBP were compared and the relationship between PCT levels and prognosis was ana-lyzed.Results Compare with the healthy control group and the non-SBP group,the serum PCT and CRP levels in the SBP group were markedly increased(P <0.05).The sensitivity of PCT,CRP and PCT combined with CRP in diagnosing liver cirrhosis compli-cating SBP was 93.3%,90.0% and 96.6% respectively,and the specificity was 90.0%,75.0% and 95.0% respectively.Conclusion The combination detection of serum PCT and CRP can increase the sensitivity and specificity of the diagnosis and has more clini-cal value in early diagnosing liver cirrhosis complicating SBP.
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One hundred and fifty patients with 70 percent or more of carotid steno-ocelusion confirmed by digital subtraction angiography were selected to analyze risk factors for its clinical symptoms.Results of analysis showed that risk for clinical symptom increased with severity of unilateral carotid stenosis (OR = 3.546,95% CI 1.515-8.300,P = 0.004).Whereas presence of "functional complete circle of Willis" was a protective factor for it (OR = 0.208,95 % CI 0.045-0.962,P = 0.045).
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Objective To establish an anti-hepatitis E virus (HEV) enzyme-linked immunosorbent assay (ELISA) one-step assay based on seven glutathione S-transferase (GST)-fusion recombinant proteins derived from different HEV genotypes and subtypes. Methods Concentration of the coating antigen was optimized by block titration. The cut-off values were determined for anti-HEV IgG and IgM, respectively. Assay sensitivity, specificity and reproducibility were investigated using samples with confirmed anti-HEV positive. Results An optimal concentration of mixture of recombinant proteins (Mix166) was 1.5 mg/L for antigen coating. Coefficient of variations (CV) of anti-HEV within-run and between-run were 8.67% and 10.85%, respectively. CV of anti-HEV IgM within-run and between-run were 4.56% and 5.99%, respectively. Positive rates of anti-HEV IgG and IgM were both 94% for 50 HEV-polymerase chain reaction (PCR) positive sera tested with the one step assay. Using one-step assay to detect 674 serum samples from healthy people, 52 samples were found anti-HEV IgG positive and 3 samples were anti-HEV lgM positive. A series of serum specimens collected at different time points until 76 weeks from a chimpanzee challenged with HEV Mexican strain were anti-HEV IgM positive during week 1--6 and anti-HEV IgG positive during week 2--76 determined by the one step ELISA. However, import ELISA kits were lack of both the IgM and lgG reactivity to all of the serial chimpanzee sera. Conclusions The sensitivity and specificity of anti-HEV ELISA one-step assay based on the Mix166 antigen are high and could be used for the diagnosis of HEV infection.
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Objective To investigate short-term hemodynamic changes in selected patients with middle cerebral artery(MCA) stenting by transcranial Doppler sonography(TCD).Methods Stenting was given to 29 cases (31 MCAs) of patients with moderate and severe MCA stenosis if they had recurred symptoms during the standard antiplatelet therapy.TCD was applied to assess the hemodynamic changes in the stenosis segment and stenotic distal segment before stenting, 1 h and 3 d after stenting. Results Angiography showed that the rate of post-procedure residual stenoses of MCA were less than 20%.Compared with the pre-stentinng peak systolic velocity [PSV, (273±77)cm/s], the post-stenting PSV significantly decreased,which was (162±38) cm/s (P＜0.01) at 1 hour and (168±45)cm/s ( P＜0.01)at 3 days, respectively.Three cases (3 MCA) experienced recurrent stenosis-like spectra at stenosis segments 3 d after stenting and brain CT showed that 2 out of 3 cases suffered intracranial hemorrhage,which was potentially induced by hyperperfusion; PSV doubled in the stenotic distal segment in at least 28.6% patients.There was no statistic difference between pre- and post-stenting in the contralateral MCA (P＞0.05).Conclusions Stenting can dramatically improve the hemodynamic compromise of stenosis segments and their distal segments in selected patients with symptomatic MCA stenosis, however, potential hyperperfusion risk might he taken into consideration after MCA stenting.
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@#Objective To study the clinical features and prognosis in patients with severe basilar artery disease.Methods The clinical features and damaged location in 48 patients with serious stenosis or occlusion in basilar artery were assessed and followed-up 3 months later.The correlation between the clinical features and poor outcome was analysed.Results 19 patients had poor outcome and 4 patients died during 3 months.The most patients suffered from vertigo attack.12 patients presented conscious disturbance within 72 h after onset,and most of them had poor outcome(P<0.05).Conclusion The prognosis of basilar artery stenosis or occlusive disease is not as grave as previously thought.Vertigo occurs frequently,but dose not relate with poor outcome significantly.Consciousness in the initial stage maybe relate to outcome significantly.