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Cryptogenic stroke refers to ischemic stroke that is not clear to the cause of the disease through routine examinations. With the development of medical technology, studies have found that most cryptogenic stroke is caused by embolism.Therefore,the concept of embolic stroke of undetermined source (ESUS) is proposed. The main causes of ESUS include subclinical atrial fibrillation, patent foramen ovale, aortic arch atherosclerotic plaque, non-stenotic complex carotid atherosclerotic plaques, and tumor-related embolism, etc. This article reviews the etiology and secondary prevention of ESUS.
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Objective To investigate the relationship between Helicobacter pylori (Hp) infection and carotid atherosclerosis (CAS) progression in patients with high risk of stroke,and to provide clinical evidence for the primary prevention of stroke.Methods Three hundred and thirty-two patients with high risk of stroke were screened from 2 800 people who were consecutively selected and had health examination from June to December 2014 in the Department of Medical Center,General Hospital of Wanbei Coal and Electricity Group.Their clinical information was collected.A total of 267 patients whose carotid ultrasound examinations showed plaques and stenosis were selected for the study.Two hundred and three of the 267 patients who met the screening conditions and completed the follow-up were selected as study subjects.The Hp infection status was detected by the 14C urea breath test and the dynamic progression of CAS was observed.The risk factors of CAS progression were also analyzed.Results Hp infection was found in 170 of 332 patients with high risk of stroke.Among the 267 patients who prompted plaques and stenosis in carotid ultrasound in 2014,203 patients were followed up for 1 year,and 133 patients (65.5％,133/203) were found infected by Hp.Forty-six patients had suggestive carotid stenosis and stenosis aggravating in 2015,31 (67.4％,31/46) of which were found infected by Hp.Logistic regression analysis showed that smoking (OR =1.632,95％ CI 1.275-1.940,P =0.011),systolic blood pressure (OR =1.343,95％ CI 1.105-1.632,P =0.019),low density lipoprotein (OR =1.590,95％ CI 1.188-2.005,P =0.005),oxidative low density lipoprotein (OR =1.732,95％ CI 1.325-2.170,P =0.000) and Hp infection (OR =1.672,95％ CI 1.180-2.154,P =0.016) were independent risk factors for carotid atheroslerosis progression.Conclusions Hp infection was found closely related to CAS progression in patients at high risk of stroke.Positive and effective prevention of Hp infection,advocating smoking cessation and controlling blood pressure and blood fat can effectively reduce the incidence of stroke.
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Objectives To observe the effect of continuous positive airway pressure (CPAP)for the treatment of patients with acute cerebral infarction combined with obstructive sleep apnea syndrome (OSAS)and to investigate the influence of CPAP therapy on the recovery of neurological function in patients. Methods From April 2014 to September 2015,68 consecutive patients with acute cerebral infarction combined with OSAS admitted to the Department of Neurology,General Hospital of Wanbei Coal and Electricity Group were enrolled retrospectively. According to whether received the CPAP therapy,they were divided into an observation group (n = 31)and a control group (n = 37). The control group was treated with conventional therapy,and on the basis of the treatment plan of the control group,the observation group was also treated with CPAP therapy. They were all the patients with cerebral infarction who were treated for 14 d. The oxygen desaturation index (ODI),lowest oxygen saturation (LS a O2 ),oxidized low-density lipoprotein (ox-LDL),and superoxide dismutase (SOD)concentration,National Institute of Health Stroke Scale (NIHSS)scores and Barthel index (BI)scores,and the modified Rankin scale (mRS)scores after 3 months before and after the therapy in the patients of both groups were documented. The total effective rate was assessed. Results (1)The ODI and LS a O2 in the observation group and the control group after treatment were better than those before treatment. There were significant differences between the 2 groups (ODI:16 ± 6% vs. 35 ± 21%,26 ± 15% vs. 36 ± 21 %;LS a O2:88 ± 6% vs. 75 ± 11%,80 ± 8% vs. 75 ± 11%;all P < 0. 05). (2)After treatment,ox-LDL of the observation group was lower than that of the control group. There was significant differences between the 2 groups (ox-LDL:487 ± 90 μg/ L vs. 548 ± 77 μg/ L,SOD:111 ± 10 kU/ L vs. 94 ± 15 kU/ L,all P < 0. 01). (3)After treatment,the NIHSS and BI scores of the observation group and the control group were better than those before treatment. There were significant differences (the NHISS scores:5. 2 ± 2. 2 vs. 12. 9 ± 3. 9;7. 6 ± 3. 1 vs. 12. 5 ± 4. 2;the BI scores:88 ± 10 vs. 52 ± 30;81 ± 4 vs. 58 ± 30;all P < 0. 01). The NIHSS and BI scores of observation group were better than those of the control group. There were significant differences (all P < 0. 01). They were followed up for 3 months,the mRS score (1. 3 ± 0. 4)of the observation group was lower than that of the control group (2. 0 ± 1. 1). There was significant difference between the 2 groups (t = 3. 362,P <0. 01). (4)The total effective rate of the observation group and control group was 74. 2% (23 / 31)and 48. 6% (18 / 37)respectively. There was significant difference between the 2 groups (χ2 = 4. 598,P <0. 05). Conclusion The CPAP therapy can alleviate the oxidative stress levels in patients with acute cerebral infarction combined with OSAS in short term and improve the neurological function of patients.
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Objective To investigate the risk factors for early neurological deterioration (END) in patients with ischemic stroke. Methods The consecutive patients with new acute ischemic stroke within 24 h were enrol ed. They were divided into either an END or a non-END group. Their relevant medical history, baseline clinical data, imaging examinations and laboratory test results in both groups were compared. Results A total of 95 patients with acute ischemic stroke were enrol ed, including 32 in the END group and 63 in the non-END group. There were significant differences in the proportion of patients in diabetes mel itus (χ2 =6. 081, P=0. 014), baseline National Institutes of Health Stroke Scale (NIHSS) score >15 (χ2 =9. 851, P=0. 002), baseline infarct volume >30 cm3 (χ2 =10. 815, P=0. 001), and fever (χ2 =6. 642, P=0. 010), as wel as the fasting glucose (t=2. 632, P=0. 010), homocysteine (t =2. 997, P=0. 003), C-reactive protein (t=2. 349, P=0. 021), baseline NIHSS (Z=497. 5, P=0. 001), and baseline infarct volume (Z=544. 5, P6. 0 mmol/L (odds ratio [OR] 6. 951, 95%confidence interval [CI] 2. 159-22. 348; P=0. 001), homocysteine >15 μmol/L (OR 3. 301, 95% CI 1. 028-10. 595; P=0. 045), NIHSS score >15 (OR 4. 174, 95% CI 1. 772-14. 870;P=0. 028), infarct volume >30 cm3 (OR 4. 996, 95% CI 1. 334-18. 717; P=0. 017), and fever (OR 4. 528, 95% CI 1. 334-15. 372;P=0. 015) were the independent risk factors for occurring END in patients with acute ischemic stroke. Conclusions The baseline glucose, NIHSS score, infarct volume, homocysteine, and increased body temperature are the independent risk factors for occurring EDN in patients with acute ischemic stroke.
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Objective To evaluate the uniformity of different diagnosis criteria of metabolic syn-drome in patients with type 2 diabetes, especially the criteria that suit for metabolic syndrome in type 2 dia-betes patients.Methods The patients with type 2 diabetes, aged from 20~74 years, who were treated at Department of Endocrinology , the Third Affiliated Hospital , Qiqihar Medical University from January 2008 to November 2009 were enrolled.Four hundred and twenty one patients with integral data were analyzed . Waistline, hip line, height, body mass, blood pressure and so on were surveyed , and according to waistline and hip line the waist-to-hip ratio was calculated .On the basis of body mase/height body mass index ( kg/m2 ) was calculated .The blood sugar was detected with the hexokinase method .The blood cholesterol , tria-cylglycerol , the high density lipoprotein cholesterol were determined with the biochemistry method .Urinates the micro albumin level was determined with chemistry to try the belt technology .Diagnosis standards of WHO (1999), NCEP-ATPⅢ(2001),ACCE(2003),EGIR(1999),the Chinese CDS(2007) suggestion metabolism synthesis drafts , the triacylglycerol-waistline standard of Blackburn P forecast cardiovascular e-vent(2003) were applied to calculate prevalence rate of metabolism synthesis .Results The 421 enrolled testees were involved in the result analysis .⑴Prevalence rates of type 2diabetes and metabolism synthesis in various single component: In the investigation population the differences in body of obesity , hypertension and hypertriacylglycerolemia , the low and high density lipoprotein cholesterol blood sickness between the men and women were insignificant , but the overload (66.1%) in males was remarkably higher than that in females (49.7%).The prevalence rate in abdomen obese in males (74.0%) was remarkably higher than that in females(59.9%).⑵Abnormal distribution of metabolism in patients with type 2 diabetes: Preva-lence rate of one kind of abnormal metabolism was 27.2%.Prevalence rate of two kinds of or above two kinds of above abnormal metabolism was 61.0%.Prevalence rate of three kinds of above abnormal metabo-lism was 26.1%,and the prevalence rate in females was not higher than that of males ( P >0.05 ) .⑶After age and sex lamination ,prevalence rates of metabolism synthesis and it's the correlated disease:The preva-lence rates of the high hypertriacylglycerolemia , hypertension , metabolism synthesis had the tendency of in-creasing along with the age .Prevalence rates of abdominal obesity and the low and high density lipoprotein cholesterol blood sickness had the increased tendency in females , but it was not obvious in males .Except that 35~44 years old of age group prevalence rate of the high hypertriacylglycerolemia in males ( 62.1%) was remarkably higher than that in females ( 29.2%) ( P <0.005 ) , and the 20~35 years old age group prevalence rates of metabolism synthesis in males (41.2%)were remarkably higher than outside the females (20.0%)( P <0.05).In other various age groups ,there was insignificant difference in prevalence rate between males and females .⑷The prevalence rate of WHO diagnosis standard for metabolism synthesis (62.9%) had good concordance with the prevalence rate of the Chinese CDS diagnosis standard for metabo -lism-synthesis ( 66.7%) .The prevalence rate of ACCE diagnosis standard for metabolism synthesis (88.8%) had good concordance with the prevalence rate of the EGIR diagnosis standard for metabolism synthesis (86.6%).The prevalence rate of Blackburn P forecast cardiovascular event (20.9%),which was distanced from the result of the diagnosis standards ( P <0.005 ) .Conclusion ⑴Patients with type 2 di-abetes have high metabolism syndrome proportion rate , and the abnormal metabolism proportion rate in sin-gle group is also higher.⑵WHO (1999) metabolism syndrome diagnosis standard and CDS (2007)sugges-tion standard are suitable for Chinese metabolism -synthesis in type 2 diabetic patients .⑶The metabolism syndrome diagnostic standards of EGIR and ACCE are similar in proportion rate in Chinese patients with type 2 diabetes , which is accorded with the findings of former literatures .Whether that can be used widely deserves further study .⑷The diagnostic criteria of triacylglycerol waistline is not suitable for Chinese type 2diabetic patients.