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1.
Chinese Journal of Neurology ; (12): 508-513, 2021.
Article in Chinese | WPRIM | ID: wpr-885453

ABSTRACT

Cardiac stroke is a stroke that occurs when a heart mural thrombus falls off and embolizes in the cerebral arterial system caused by various causes of heart disease, accounting for about 30% of all ischemic strokes. At present, in order to find evidence that emboli may originate from the heart, a large number of auxiliary examinations are needed. Good blood biomarkers are essential for the rapid identification of ischemic stroke in the emergency department. However, there is no breakthrough in this area. Brain natriuretic peptide is secreted in ventricular muscle and hypothalamus. It may be an important bridge between brain and heart diseases. However, the application of brain natriuretic peptide in the diagnosis and treatment of cardiogenic stroke is still very limited. This article reviews the current research status of brain natriuretic peptide levels and cardiogenic stroke and proposes further research trends and prospects.

2.
Article in Chinese | WPRIM | ID: wpr-877598

ABSTRACT

OBJECTIVE@#To observe the clinical therapeutic effect of electroacupuncture (EA) combined with tamsulosin hydrochloride sustained release capsule on chronic prostatitis (CP) of damp and heat stasis.@*METHODS@#A total of 70 patients with CP of damp and heat stasis were randomized into an acupuncture plus medication group (35 cases, 4 cases dropped off) and a medication group (35 cases, 5 cases dropped off). In the medication group, tamsulosin hydrochloride sustained release capsule was given orally, 0.2 mg a time, once each night. On the basis of treatment in the medication group, EA was applied at Guanyuan (CV 4), Sanyinjiao (SP 6) and Yinglingquan (SP 9), with disperse-dense wave, 5 mA in intensity for 30 min. Treatment for 30 days was as one course, and totally 3 courses were required in both groups. Before treatment, 1, 2, 3 months into treatment and at the follow-up of 2 months after treatment, the TCM syndrome score and National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) score were observed, and the clinical efficacy was evaluated in both groups.@*RESULTS@#Compared before treatment, the TCM syndrome scores of 3 months into treatment and follow-up were decreased in the acupuncture plus medication group (@*CONCLUSION@#Acupuncture combined with medication can improve the clinical symptoms in patients with CP of damp and heat stasis, and its therapeutic effect is superior to simple western medication.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Chronic Disease , Hot Temperature , Humans , Male , Prostatitis/drug therapy , Treatment Outcome
3.
Article in Chinese | WPRIM | ID: wpr-849695

ABSTRACT

Objective To compare the prognostic value of electronic SOFA (eSOFA) scores and simplified SOFA (sSOFA) scores in evaluating the prognosis of patients with sepsis. Methods A retrospective analysis was conducted of clinical data of 245 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital from August 2016 to August 2019. Clinical end points were survival status 28 days after hospital admission. eSOFA score, sSOFA score, qSOFA score and SOFA score were evaluated to predict patient prognosis using the area under the receiver operating characteristic curve (AUC). Results AUC of eSOFA score, sSOFA score, qSOFA score and SOFA score for predicting the prognosis of the patients was 0.757 (95% CI 0.686-0.828), 0.721 (95% CI 0.665-0.787), 0.662 (95% CI 0.586-0.738), 0.806 (95% CI 0.747-0.866, respectively. The eSOFA score was superior to the sSOFA score (Z=2.317, P=0.021) in terms of AUC. Conclusions The eSOFA and sSOFA scores have predictive value for the prognosis of sepsis, and eSOFA score is better than sSOFA score.

4.
Neurology Asia ; : 269-277, 2020.
Article in English | WPRIM | ID: wpr-877226

ABSTRACT

@#Background and Objectives: Stroke mimics are medical conditions producing stroke-like symptoms but eventually get diagnosed as non-stroke diseases. Epileptic seizure is a common type of stroke mimic. The purpose of this study is to investigate the application of emergency multimodal computed tomography (CT) in the diagnosis of epileptic seizure. Methods: We retrospectively reviewed the case group of patients with suspected stroke in the emergency stroke care service of the First Affiliated Hospital of Suzhou University from September 2017 to October 2019. We included those who underwent multimodal CT, including non-contrasted cranial CT, CT perfusion with CT angiography, and were ultimately diagnosed as epileptic seizures. Ten patients with acute anterior circulation ischemic stroke were assigned as controls. Results: A total of five cases met the inclusion criteria. Multimodal CT was completed within 2.25 to 3.50h from symptom onset. On CT perfusion, hyperperfusion was shown in four cases and slightly increased perfusion in one case with epileptic seizures. Cerebral blood flow and cerebral blood volume were significantly increased, while time to peak and mean transit time decreased in the regions of interest of the epileptic hemisphere when compared to either the non-affected hemisphere or the ischemic area in the control group (P<0.05). The abnormal perfusion areas did not follow vascular territory supply and CT angiography did not show vessel occlusion in the case group. Conclusion: Emergency multimodal CT could be used effectively to differentiate epileptic seizure from stroke.

5.
Chinese Journal of Neurology ; (12): 55-63, 2020.
Article in Chinese | WPRIM | ID: wpr-798980

ABSTRACT

Wake-up stroke (WUS) is clinically defined as ischemic stroke that is associated with neurological deficits on awakening, accounting for approximately one in five individuals presenting with an acute ischemic stroke. At present, the mechanism of WUS onset is still unclear, and whether circadian mechanisms are involved deserves further exploration. Previously, these patients were missed the opportunity of reperfusion therapy due to unknown onset time. Recent studies have changed this concept. Intravenous thrombolysis or mechanical thrombectomy can be performed in appropriate patients after imaging evaluation, thus improving the prognosis of some patients with WUS. This article summarizes the latest research in recent years.

6.
Article in English | WPRIM | ID: wpr-827231

ABSTRACT

Three new indole alkaloids, flueindolines A-C (1-3), along with nine known alkaloids (4-12), were isolated from the fruits of Flueggea virosa (Roxb. ex Willd.) Voigt. Compounds 1 and 2 are two new fused tricyclic indole alkaloids possessing an unusual pyrido[1, 2-a]indole framework, and 3 presents a rare spiro (pyrrolizidinyl-oxindole) backbone. Their structures with absolute configurations were elucidated by means of comprehensive spectroscopic analysis, chemical calculation, as well as X-ray crystallography. Chiral resolution and absolute configuration determination of the known compounds 4, 10, and 11 were reported for the first time. The hypothetical biogenetical pathways of 1-3 were herein also proposed.

7.
Chinese Journal of Neurology ; (12): 687-693, 2020.
Article in Chinese | WPRIM | ID: wpr-870869

ABSTRACT

Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.

8.
Chinese Journal of Neurology ; (12): 55-63, 2020.
Article in Chinese | WPRIM | ID: wpr-870765

ABSTRACT

Wake-up stroke (WUS) is clinically defined as ischemic stroke that is associated with neurological deficits on awakening,accounting for approximately one in five individuals presenting with an acute ischemic stroke.At present,the mechanism of WUS onset is still unclear,and whether circadian mechanisms are involved deserves further exploration.Previously,these patients were missed the opportunity of reperfusion therapy due to unknown onset time.Recent studies have changed this concept.Intravenous thrombolysis or mechanical thrombectomy can be performed in appropriate patients after imaging evaluation,thus improving the prognosis of some patients with WUS.This article summarizes the latest research in recent years.

9.
Article in Chinese | WPRIM | ID: wpr-773557

ABSTRACT

OBJECTIVE@#To investigate the relationship between Toll-like receptor 4 (TLR4) and collateral circulation in patients with acute cerebral infarction (AIS) after thrombolytic therapy.@*METHODS@#This retrospective, observational cohort study was conducted among 65 patients with AIS receiving thrombolytic therapy, who were divided according to findings by computed tomographic angiography (CTA) into good collateral circulation (group A, = 34) and poor collateral circulation (group B, = 31). Serum samples were collected from all the patients and the levels of TLR4 were measured with ELISA.@*RESULTS@#The patients in group A had significantly better outcomes than those in group B. The NIHSS scores at 24 h and 30 days after thrombolytic therapy, mRS scores at 90 days and serum TLR4 levels were significantly lower in group A than in group B ( < 0.05); the percentages of patients with symptomatic intracerebral hemorrhage were comparable between the two groups. The serum levels of TLR4 were negatively correlated with the rMLC score ( < 0.05). Multivariate logistic regression analysis showed that a high level of TLR4 was associated with a poor collateral circulation after thrombolysis.@*CONCLUSIONS@#Good collateral circulation can increase the benefit of intravenous thrombolysis in patients with ACI, and the level of TLR4 is a predictive factor for the compensation of collateral circulation following ACI.


Subject(s)
Biomarkers , Brain Ischemia , Cerebral Infarction , Cerebrovascular Circulation , Cohort Studies , Collateral Circulation , Fibrinolytic Agents , Humans , Retrospective Studies , Stroke , Metabolism , Therapeutics , Thrombolytic Therapy , Toll-Like Receptor 4 , Metabolism , Treatment Outcome
10.
Article in Chinese | WPRIM | ID: wpr-776048

ABSTRACT

Objective To explore the effects of cathepsin B(CTSB)on the activation of nucleotide-binding domain and leucine-rich-repeat-containing family and pyrin domain-containing 3(NLRP3)inflammasome via transient receptor potential mucolipin-1(TRPML1)in cell oxidative stress model and specific gene silencing cell model. Methods BV2 cells cultured in vivo were treated separately or simultaneously with hydrogen peroxide(HO),calcium-sensitive receptor agonist gadolinium trichloride(GdCl),and CTSB inhibitor CA-074Me,and interleukin-1(IL-1)beta and caspase-1 protein were detected by enzyme-linked immunosorbent assay.The growth activity of BV2 cells in each group was measured by MTT.BV2 cells were treated with different concentrations of HO.Cystatin C mRNA and TRPML1 mRNA in BV2 cells were detected by real-time quantitative polymerase chain reaction and the proteins of TRPML1,CTSB,cathepsin D(CTSD),cathepsin L(CTSL)and cathepsin V(CTSV)were detected by Western blot.Specific small interfering RNA was designed for TRPML1 gene target sequence.TRPML1 gene silencing cell lines(named Tr-si-Bv2 cells)were established in BV2 cells and treated with or without HO.TRPML1,CTSB and transcription factor EB(TFEB)proteins in Tr-si-Bv2 cells or control cells were detected by Western blot. Results After treatment with HO,the expression of caspase-1 protein and NLRP3 mRNA in BV2 cells was increased,and IL-1beta protein in BV2 cells was significantly increased after treatment with GdCl(P=0.0036).After treatment with CA-074Me,the doses of NLRP3 mRNA(P=0.037),caspase-1(P=0.021),and IL-1β(P= 0.036)were significantly reduced.Cells in the HO group and HO+GdCl group grew more slowly.The expressions of CTSB mRNA and TRPML1 mRNA,or CTSB and TRPML1 proteins in BV2 cells in the treatment group with 200 μmol/L of HO concentration were similar.HO-induced CTSB protein expression was inhibited after silencing TRPML1 gene.The changes of other cathepsins were not affected for the different concentration of HO.In the BV2 cells treated with TRPML1 gene silencing,the expression of CTSB protein was significantly reduced and the difference was statistically significant(P=0.021)between the HO +siRNA treatment group and the HO treatment group.Conclusion CTSB regulates the activation of NLRP3 inflammasome in the oxidative stress model of microglia cells,probably mediated by calcium channel protein TRPML1.


Subject(s)
Animals , Cathepsin B , Metabolism , Cell Line , Gene Silencing , Hydrogen Peroxide , Inflammasomes , Metabolism , Interleukin-1beta , Mice , Microglia , NLR Family, Pyrin Domain-Containing 3 Protein , Metabolism , Oxidative Stress , Pyrin Domain , Transient Receptor Potential Channels , Metabolism
11.
Chinese Journal of Geriatrics ; (12): 1344-1347, 2019.
Article in Chinese | WPRIM | ID: wpr-800378

ABSTRACT

Objective@#To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS).@*Methods@#This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3rd, 7th, 14thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization.@*Results@#The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3rd [(3.4±1.2) vs.(4.2±1.4)], 7th[(3.0±1.8) vs.(4.1±1.6)] and 14thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P<0.01). Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05).@*Conclusions@#Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS.

12.
Chinese Journal of Neurology ; (12): 1022-1030, 2019.
Article in Chinese | WPRIM | ID: wpr-800365

ABSTRACT

Objective@#Symptomatic intracranial hemorrhage (sICH) is one of the severe complications of ischemic stroke thrombolysis. Several prognostic scales have been developed to predict the risk of sICH. The performance of seven scales was compared in a single center cohort.@*Methods@#Data of patients with consecutive ischemic stroke who received 0.9 mg/kg intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis within 4.5 h time window from stroke onset were collected. Seven scales that can provide an estimate of risk of sICH were identified and evaluated: Hemorrhage After Thrombolysis (HAT), blood Sugar, Early infarct signs, (hyper) Dense cerebral artery sign, Age, National Institutes of Health (NIH) Stroke Scale (SEDAN), Stroke Prognostication using Age and NIH Stroke Scale (SPAN)-100, Safe Implementation of Thrombolysis in Stroke (SITS), Total Health Risks In Vascular Events (THRIVE), Glucose at presentation, Race (Asia), Age, Sex (male), systolic blood Pressure at presentation, and Severity of stroke at presentation (NIH Stroke Scale; GRASPS) and Multicenter Stroke Survey (MSS). The area under the receiver operating characteristic curve (AUROC) was calculated and Logistic regression and the Hosmer-Lemeshow test were also performed.@*Results@#The current study included 293 patients, of whom 7.85% (23/293) had sICH by National Institute of Neurological Disorders and Stroke (SICHNINDS), 5.46% (16/293) by Europe Cooperative Acute Stroke Study Ⅱ (SICHECASSⅡ) and 4.44% (13/293) by Safe Implementation of Thrombolysis in Stroke (SICHSITS) criteria. SEDAN had the highest AUROC for predicting sICH: sICHNINDS: AUROC=0.843, OR=3.167, 95%CI 2.106-4.762, P<0.01; sICHECASSⅡ: AUROC=0.797, OR=2.509, 95%CI 1.652-3.812, P<0.01; sICHSITS: AUROC=0.784, OR=2.172, 95%CI 1.405-3.357, P<0.01. And SPAN-100 had the lowest AUROC among all the seven scales and was only associated with risk of SICHNINDS in regression analysis. Furthermore, when sub-grouped the cohort into anterior circulation infarction and posterior circulation infarction, regression analysis suggested that all the seven scales were however not associated with sICH risk in patients with posterior circulation infarction.@*Conclusions@#SEDAN constantly had the highest predictive power, SPAN-100 had the worst. The seven scales studied could not predict sICH in posterior circulation infarction.

13.
Chinese Journal of Geriatrics ; (12): 1344-1347, 2019.
Article in Chinese | WPRIM | ID: wpr-824565

ABSTRACT

Objective To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS).Methods This was a prospective,open-label,controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA,n=46) and a control arm (CA,n=48).The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3rd,7th,14th day after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization.Results The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1 ±0.7)].However,there were significant differences in the NI HSS score on 3 rd [(3.4 ± 1.2) vs.(4.2 ± 1.4)],7th [(3.0 ± 1.8) vs.(4.1±1.6)] and 14th day [(2.5±2.0) vs.(3.4± 1.6)],respectively,between the TA group and the CA group.Furthermore,the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS,0-2),compared with the CA group (71.7% vs.35.4%,P<0.01).Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group,and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05).Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P >0.05).Conclusions Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END,IH,or recurrence of IS.

14.
15.
Article in Chinese | WPRIM | ID: wpr-753004

ABSTRACT

Severe acute pancreatitis (SAP) has a severe attack and high incidence of case fatality rate.Almost all the SAP patients would undergo some different immune status including systemic inflammatory response syndrome,compensatory anti-inflammatory response syndrome and mixed antagonistic response syndrome.With more acknowledgement of the pathophysiology of SAP,come researches have revealed that a few SAP patients may gradually come into a terribly and durably consumptive phase,and ultimately progress to persistent inflammation-immunosuppression catabolism syndrome (PICS).Now the morbidity of PICS has increased in recent years,therefore,it is helpful to recognize PICS early and improve the prognosis by discussing the pathophysiology deeply.Based on the new research progress at home and abroad,this article reviewed the diagnostic criteria,occurrence and development,and treatent of PICS in SAP,in order to offer treatment strategy for the SAP.

16.
Chinese Journal of Neurology ; (12): 209-215, 2019.
Article in Chinese | WPRIM | ID: wpr-745915

ABSTRACT

Objective To investigate the relationship between total cerebral small vessel disease (CSVD) burden and intracranial hemorrhage transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods One hundred and fifty-four patients who suffered from ischemic stroke within 4.5 hours of onset and received recombinant tissue plasminogen activator thrombolytic therapy in the emergency green channel of the First Affiliated Hospital of Soochow University from August 2016 to January 2018 were enrolled.HT examined by computed tomography scan within 24 hours after thrombolysis was included.The magnetic resonance imaging examination was performed within 48 hours.The patients were divided into two groups:HT group and control group according to the presence or absence of HT.Periventricular white-matter hyperintensities (WMH) with Fazekas score of 3 or deep WMH with Fasekas score of 2 or 3 was recorded as 1 point,MRI of cerebral microbleeds (CMBs) or lacunar infarction (LI) was recorded as 1 point respectively,and peripheral vascular space (PVS) in basal ganglia graded 2-4 (≥11)was counted 1 point.Single-factor analysis was used to compare total CSVD burden score,baseline data and clinical data between the two groups.Multivariate Logistic regression analysis was performed to explore the relationship between total CSVD burden score and HT.Results The age of the 154 patients was 66.00(59.00,74.25) years,males accounted for 66.9% (103/154),onset to treatment time (OTT) was 174.50 (131.50,200.00) minutes and the NIHSS score before thrombolytic therapy was 6.00 (3.00,10.25).There were 43 cases (27.9%) with moderate to severe WMH,35 cases (22.7%) with CMBs,52 cases (33.8%) with PVS graded 2-4,and 96 cases (62.3%) with LI.There were 21 enrolled patients (13.6%) who suffered from HT.Symptomatic intracranial hemorrhage occurred in nine cases (5.8%).In the multivariate Logistic regression model,the results demonstrated that baseline diastolic pressure (OR=1.072,95%CI 1.027-1.118,P=0.001)and atrial fibrillation (OR=28.564,95%CI 6.217-131.241,P=0.000) were independently associated with HT.After using the mild CSVD burden score as a reference,moderate CSVD burden (OR=0.810,95% CI 0.154-4.257,P=0.804) was not associated with HT after thrombolysis,and severe CSVD burden (OR=8.429,95% CI 1.643-43.227,P=0.011) was independently associated with HT.Conclusions The severity of total CSVD burden in patients with AIS was closely related to HT after thrombolysis.Severe CSVD was an independent risk factor for HT after thrombolysis.

17.
Article in Chinese | WPRIM | ID: wpr-742994

ABSTRACT

Ischemic stroke has the characteristics of high disability,high mortality,and high recurrence rate,and the abundant collateral circulation is an independent predictor of good outcomes in stroke.This article mainly elaborates the cytological and molecular mechanisms of vascular remodeling process after ischemic stroke in order to provide new ideas and targets for the treatment of ischemic stroke.

18.
Article in Chinese | WPRIM | ID: wpr-838142

ABSTRACT

Acute ischemic stroke (AIS) is the most common cerebrovascular disease with high morbidity, mortality and disability. The imaging evaluation of ischemic penumbra has great clinical implication for early diagnosis and reperfusion therapy of AIS. Here, we reviewed the evaluation methods, advangtages and disadvangtages of computed tomography (CT) and magnetic resonance imaging for ischemic penumbra, and discussed the advantages of one-stop multi-modal CT.

19.
Article in Chinese | WPRIM | ID: wpr-696976

ABSTRACT

Objective To evaluate the effective e measures of the prevention and treatment of venous thrombosis in hospital and evaluate the effect of"antibolt work"in patients with multidisciplinary cooperation. Methods Compare the level of venous thromboembolism (VTE) incidence, average hospital day, patient satisfaction and the level of knowledge of medical staff in the high risk department of VTE. Results After intervention in high-risk departments staff VTE related knowledge level improved, 2013 high- risk departments medical staff about the basic knowledge, risk assessment, VTE prevention knowledge of three dimensional awareness were 34.7% (26/75), 49.3% (37/75), 32.0% (24/75), respectively, 2016 were 56.0%(42/75), 69.3%(52/75), 90.7%(68/75), respectively, two groups compare the difference was statistically significant (χ2=6.887, 6.217, 54.423, P<0.01 or 0.05). Reduced incidence of VTE 2 groups, 2013 annual incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) were 31.7% (38/120), 11.7% (14/120), respectively, in 2016 the annual incidence of DVT and PE were 14.2%(17/120), 4.2%(5/120), respectively, two groups compare the difference was statistically significant (χ2 =10.402, 4.630, P<0.01 or 0.05). VTE in 2016 patients with high-risk departments the average hospitalization time significantly below 2013, 2013 was (18.3 ± 3.5) days while 2016 was (12.7 ± 2.9 )days, two groups compare the difference was statistically significant (t = 13.496, P < 0.01). In 2016, the satisfaction rate of patients with VTE was higher than that in 2013, 77.5%(93/120) in 2013, 90.8%(109/120) in 2016, and the difference between the two groups was statistically significant (χ2=8.004, P=0.005). Conclusion The prevention and control of venous thrombosis based on multi-disciplinary integration is effective in preventing the occurrence of thrombosis in hospitalized patients and is worthy of clinical promotion.

20.
Chinese Journal of Neurology ; (12): 105-110, 2018.
Article in Chinese | WPRIM | ID: wpr-710937

ABSTRACT

Objective To explore the immunopathological mechanism for the imbalance between the positive signal mediated by inducible costimulator (ICOS) and the negative signal mediated by programmed death-1 (PD-1) in patients with myasthenia gravis (MG).Methods Eighty-two patients with MG,56 healthy controls (HC) and 20 non-MG (NMG) patients,collected in the First Affiliated Hospital of Suzhou University from February 2014 to December 2016,were chosen to participate in the study.The expression of ICOS and PD-1 on peripheral blood mononuclear cells was detected by immuno-fluorescence staining and flow cytometry.The levels of soluble programmed death-1 (sPD-1),soluble programmed death ligand 1 (sPD-L1),IL-4 and other cytokines were detected by enzyme-linked immunosorbent assay.Results (1) Flow cytometry analysis:The co-expression of PD-1,ICOS on CD4 + T cells from MG group (9.64% (8.82%)) was higher than in HC (1.81% (2.10%),Z =-7.389,P <0.05) and NMG group (2.86% (1.49%),Z =-4.636,P < 0.05).The expression of ICOS on CD4 + T cells,ICOS ligand (ICOSL) on CD14+ monocytes and CD19+ B cells were increased in MG group comparing with that of the control groups.The proportion of PD-1 + CD4 + T cells (MG group 16.82% (10.66%),HC 9.34% (9.18%),Z =-4.345,P<0.05;NMG group 7.07% (3.40%),Z=-4.594,P<0.05) and PD-1 Ligand (PD-L1) + CD14+ monocytes was higher in MG patients.All of these were detected by flow cytometry.(2) ELISA analysis:Serum sPD-1 expression significantly increased in MG group compared with that in the control groups (MG group (1.87 ± 0.64) ng/ml,NMG group (1.49 ± 0.70) ng/ml,t =2.04,P < 0.05;HC (1.05 ± 0.50)ng/ml,t =2.08,P < 0.05),while for serum sPD-L1,there was no significant difference between MG and control groups.(3) Serum cytokines detection:The expression of IL-4 was increased in MG patients (MG group (61.88 ±5.15) pg/ml,HC (32.03 ±1.84) pg/ml,t=2.50,P<0.05;NMG group (42.62± 3.31) pg/ml,t =2.34,P <0.05),and there was a negative correlation between the expression of sPD-1 and the concentration of IL-4.Conclusions The increased expression of PD-1 + ICOS + CD4 + T cells suggested the subset involved in the pathological progress of MG.sPD-1 might disturb the ligation of PD-1 on T cells and PD-L1 on antigen presenting cells,while the ligation of ICOS and ICOSL passed positive signal,leading to over activity of the subsets and the progression of disease.

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