Effects of butylphthalide combined with hyperbaric oxygen therapy on post-stroke cognitive impairment / 中国基层医药

Objective:To investigate the clinical efficacy of butylphthalide combined with hyperbaric oxygen therapy on post-stroke cognitive impairment in patients with acute ischemic stroke.Methods:A total of 90 patients with post-stroke cognitive impairment who were hospitalized within 72 hours of onset in Suining County People's Hospital from December 2019 to November 2020 were included in this study. They were randomly divided into a control group and an observation group ( n = 45/group). The control group was given conventional treatment and the observation group was given butylphthalide combined with hyperbaric oxygen therapy in addition to conventional treatment. The National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score were compared between the two groups before and after treatment. Results:Before treatment, there were no significant differences in the National Institutes of Health Stroke Scale score, Montreal Cognitive Assessment score, and Activities of Daily Living score between the two groups (all P > 0.05). At 14 days and 1 month after surgery, the National Institutes of Health Stroke Scale scores in the observation group were (4.02 ± 2.18) points and (3.21 ± 2.03) points, which were significantly lower than (5.21 ± 2.24) points and (4.62 ± 2.68) points in the control group ( t =2.55, 2.81, both P < 0.05). At 1 and 3 months after treatment, the Montreal Cognitive Assessment score in the observation group were (19.79 ± 5.67) points and (23.69 ± 2.67) points, which were significantly higher than (16.88 ± 5.12) points and (19.74 ± 2.29) points in the control group ( t = 2.56, 7.53, both P < 0.05). At 1 and 3 months after treatment, Activities of Daily Living scores in the observation group were (54.85 ± 5.69) points and (74.38 ± 4.98) points, which were significantly higher than (46.78 ± 6.24) points and (63.21 ± 5.24) points in the control group ( t = 6.41, 9.76, both P < 0.05). Conclusion:Butylphthalide combined with hyperbaric oxygen therapy for the treatment of post-stroke cognitive impairment in patients with acute ischemic stroke can alleviate neurologic deficits, and improve cognitive function and the ability of daily life.

Effects of butylphthalide combined with ozagrel sodium on National Institutes of Health Stroke Scale score, activities of daily living score, and coagulation function in patients with acute cerebral infarction / 中国基层医药

Objective:To investigate the effects of butylphthalide combined with ozagrel sodium on the National Institutes of Health Stroke Scale (NIHSS) score, activities of daily living (ADL) score, and coagulation function in patients with acute cerebral infarction.Methods:Ninety-four patients with acute cerebral infarction who were admitted to Gujiao Medical Group Central Hospital from January 2019 to November 2021 were included in this study. They were randomly assigned to undergo treatment with either ozagrel sodium (control group, n = 47) or butylphthalide combined with ozagrel sodium (observation group, n = 47) for 14 consecutive days. Before and after treatment, NIHSS score, ADL score, coagulation function (thrombin time, prothrombin time, D-dimer, activated partial thrombin time), bilateral middle cerebral artery blood flow status (mean blood flow velocity (Vm), resistance index, pulsatility index), brain tissue damage factor (brain natriuretic peptide, neuron-specific enolase, S100 β protein) and the incidence of adverse drug reactions were compared between the two groups. Results:Before treatment, there were no significant differences in NIHSS and ADL scores between the two groups (both P > 0.05). After treatment, the NIHSS score was significantly lower in the observation group than that in the control group [(8.70 ± 1.62) points vs. (9.45 ± 1.2) points, t = 2.51, P < 0.05]; the ADL score was significantly higher in the observation group than that in the control group [(65.15 ± 7.41) points vs. (61.20 ± 6.32) points, t = 2.78, P < 0.05]. Before treatment, there were no significant differences in thrombin time, prothrombin time, D-dimer, and activated partial thrombin time between the two groups (all P > 0.05). After treatment, thrombin time, prothrombin time, and activated partial thrombin time were significantly higher in the observation group than those in the control group ( t = 4.34, 3.00, 2.63, all P < 0.05). After treatment, D-dimer level in the observation group was significantly lower than that in the control group ( t = 3.39, P < 0.05). Before treatment, mean blood flow velocity, resistance index, and pulsatility index were similar between the two groups (all P > 0.05). After treatment, the mean blood flow velocity in the observation group was significantly higher than that in the control group ( t = 3.23, P < 0.05). The pulsatility index and resistance index were significantly lower in the observation group than those in the control group ( t = 2.14, 3.16, both P < 0.05). Before treatment, there were no significant differences in brain natriuretic peptide, neuron-specific enolase, and S100 β protein levels between the two groups (all P > 0.05). After treatment, brain natriuretic peptide, neuron-specific enolase, and S100 β protein levels in the observation group were significantly lower than those in the control group ( t = 3.09, 2.18, 3.33, all P < 0.05). There was no significant difference in incidence of adverse reactions between the observation and control groups [6.38% (3/47) vs. 2.13% (1/47), P > 0.05]. Conclusion:Butylphthalide combined with ozagrel sodium for the treatment of acute cerebral infarction can reduce neurological dysfunction and brain tissue injury, and improve coagulation function, hemodynamic state of the middle cerebral artery, and activities of daily life, without increasing adverse reactions.

The output efficiency of the National Science Foundation′s rehabilitation funding from 2009 to 2018 / 中华物理医学与康复杂志

Objective:To analyze and compare rehabilitation research funded by China′s National Natural Science Foundation (NSFC) with that funded by America′s National Institutes of Health (NIH) so as to provide references for future funding.Methods:Articles reporting rehabilitation research funded by the NSFC and the NIH were retrieved from the NSFC′s Science Output Service website and the NIH′s Project Report website and analyzed.Results:From 2009 to 2018 the NSFC funded 421 rehabilitation studies which resulted in a published report while the NIH funded 312. In 2018, the NSFC budget (US$3.89 million) was 8.46 times that of 2009 (US$460, 000), while the NIH′s grant budget (US$36.08 million) was 2.17 times that of 2009 (US$16.62 million). The number of published papers resulting from the Chinese and American studies was 1111 and 2571 respectively. Their impact factors mainly ranged between 0 and 3 points. Among the journals with an impact factor of 6 or more, published papers from the United States (297) were much more numerous than those from China (18). The number of SCI papers per million US dollars increased by 2.25 times in China and 0.05 times in the US.Conclusions:Both China and the United States have been investing more in rehabilitation medicine research, and that has resulted in more published papers. There is still a gap in funding and output between the two countries.

The clinical study of chronic graft-versus-host disease followinghaploidentical transplantation combined infusion with a third party cord blood / 中华器官移植杂志

Objective:To investigate the incidence, risk factors and survival of cGVHD patients in combination of a haploidentical donor supported with an unrelated umbilical cord blood for hematopoietic stem cells transplantation (haplo-cord-HSCT).Methods:300 hematological malignancies individuals who received dual transplantation were enrolled in the study between January 2012 and July 2016 at the department of Hematology in the First Affiliated Hospital of Soochow University. The clinical diagnosis and scoring the severity of cGVHD syndromes according the National Institutes of Health (NIH) consensus conference in the 2014 update. Cox proportional hazards regression was used to identify risk factors associated with transplant outcomes.Results:During follow-up with a median time of 26.4 months (range 0.2-61.8) post transplantation, the 1-year, 3-year and 5-year cumulative incidence of cGVHD was 26.3 % (95 % confidence interval [CI], 23.5 %~29.1 %), 30.3 % (95 % CI, 27.3 %~33.3 % ) and 32.2 % (95 % CI, 28.7 %~35.7 %). For all 73 patients with cGVHD, first-line or second-line treatment were given. During the follow-up period, 53 patients survived, and 20 patients died. In multivariate analysis, the cGVHD overall survival (GOS) were associated with thrombocytopenia(<100×109/L)(HR=0.103, 95 % CI 3 %-36.1 %, P<0.001). Conclusions:Our data suggest that, the 5-year cumulative incidence of cGVHD was 32.2 % after haplo-cord-HSCT with hematological malignancies. Thrombocytopenia (<100×109/L)was independent risk factors for GOS.

Association between Metabolic Syndrome and Severity of Depression Scored with Patient Health Questionnaire-9 in Men Older Than 50 Years

BACKGROUND: This study aimed to evaluate the association between metabolic syndrome and depression severity based on the Patient Health Questionnaire 9 (PHQ-9) score in men aged >50 years.METHODS: In this study, we used data of 1,230 individuals from the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VII-1) 2016 conducted by the Korea Centers for Disease Control and Prevention. We diagnosed metabolic syndrome in accordance with National Cholesterol Education Program-Adult Treatment Panel III guidelines using waist circumference, blood pressure, fasting serum triglyceride level, high-density lipoprotein cholesterol level, and fasting glucose level in men aged >50 years (mean±standard deviation: 64.6±8.8 years), and their PHQ-9 scores were classified as mild and severe (cutoff, 10).RESULTS: The mean waist circumference, fasting glucose level, triglyceride level, and high-density lipoprotein cholesterol level were 87.1±8.2 cm, 109.8±28.3 mg/dL, 155.9±123.9 mg/dL, and 46.5±12.2 mg/dL, respectively. The mean systolic and diastolic blood pressures were 124.7±15.9 mmHg and 76.2±10.7 mmHg, respectively. The mean body mass index, was 24.2±2.9 kg/m². The prevalence of metabolic syndrome was 43.7%. The mean PHQ-9 score was 2.0±3.3. The prevalence of severe depression with a score of >10 was 4.2%. Metabolic syndrome and depression were related (P<0.05). The adjusted odds ratio for metabolic syndrome was 0.5 (95% confidence interval [CI], 0.3–0.9). However, age (95% CI, 0.9–1.0), sleep duration during weekdays (95% CI, 0.9–1.0), and sleep duration during weekends (95% CI, 0.9–1.0) were not related.CONCLUSION: Metabolic syndrome was associated with depression in men aged >50 years in this study.

Compartilhamento de dados de pesquisa em saúde: iniciativas do National Institutes of Health (NIH) / Sharing health research data: National Institutes of Health (NIH) initiatives / Compartición de datos de investigación en salud: iniciativas de los National Institutes of Health (NIH)

Este artigo apresenta um levantamento e uma análise das políticas e infraestruturas de compartilhamento de dados de pesquisa em saúde adotadas pelos institutos e centros que compõem o NIH ­ National Institutes of Health (Institutos Nacionais de Saúde), organismo norte-americano de pesquisa biomédica. A partir de pesquisa bibliográfica sobre definições e conceitos abordados neste estudo, o trabalho empírico consistiu na realização de buscas, nos sites dos institutos, centros e escritório central do NIH, de iniciativas de abertura e compartilhamento de dados de pesquisa. Localizaram-se no escritório central no NIH áreas responsáveis por essas ações, e foram identificados políticas e repositórios de compartilhamento de dados cadastrados no diretório de busca da NLM ­ U.S. National Library of Medicine (Biblioteca Nacional de Medicina dos Estados Unidos). Como resultado, foram feitas análises sobre cada uma dessas iniciativas, considerando: as principais políticas de dados adotadas e seus principais objetivos, tipos e níveis de acesso e de publicação dos dados, formas de inserção e contribuição de dados, existência ou não de códigos de conduta, principais áreas de pesquisa envolvidas, tipos de repositórios (temáticos ou institucionais). As considerações finais fornecem subsídios para debates sobre diferentes tipos e abordagens de abertura e compartilhamento de dados de pesquisa científica, indicando questões pertinentes aos desdobramentos futuros da pesquisa

This paper presents a review and an analysis of health research data sharing policies and frameworks adopted by the institutes and centers of the National Institutes of Health (NIH), an American medical research agency. From a literature study of definitions and concepts approached in this study, the empirical research consisted in searches on the internet sites of the institutes, centers and the Office of the Director (central office at NIH) of initiatives to open access and sharing of research data. The responsible areas for these actions were located at the NIH Office of the Director and data sharing policies and repositories were identified in the National Library of Medicine (NLM) search directory. Then, an analysis of each one of these initiatives were carried out taking account: the main data policies adopted and their main objectives, kinds and levels of access and of published data, forms of insertion and contribution of data, whether or not codes of conduct are observed, main research areas involved, kinds of repositories (thematic or institutional). Final considerations provide inputs for discussions about different kinds and approaches to open access and scientific research data sharing, indicating suitable issues for future research developments

Este artículo presenta un levantamiento y el análisis de las políticas e infraestructuras de compartición de datos de investigación en salud adoptadas por los institutos y centros que componen el National Institutes of Health (NIH), agencia de investigación médica de los Estados Unidos. A partir de la investigación bibliográfica sobre definiciones y conceptos abordados en este estudio, el trabajo empírico consistió en la realización de búsquedas en los sitios de internet de los institutos, centros y oficina central de los NIH, de iniciativas de acceso abierto y compartición de datos de investigación. Se ubicaron en la oficina central de los NIH áreas responsables de esas acciones, y se identificaron políticas y repositorios de compartición de datos registrados en el directorio de búsqueda de la National Library of Medicine (NLM). Como resultado, se realizaron análisis sobre cada una de esas iniciativas, considerando: las principales políticas de datos adoptadas y sus principales objetivos, tipos y niveles de acceso y de publicación de los datos, formas de inserción y contribución de datos, existencia o no de normas de conductas, principales áreas de investigación involucradas, tipos de repositorios (temáticos o institucionales). Las consideraciones finales proporcionan contribuciones para debates sobre diferentes tipos y enfoques de acceso abierto y compartición de datos de investigación científica, indicando cuestiones pertinentes a los desdoblamientos futuros de la investigación

The clinical effects and prognosis evaluation of enhanced external counterpulsation on acute cerebral ischemic stroke / 中国神经精神疾病杂志

Objective To explore the therapeutic effect and prognosis of enhanced external counterpulsation (EECP)on acute cerebral ischemic stroke,to provide clinical evidence for the treatment of patients with acute cerebral ischemic stroke.Methods Total171 patients with acute cerebral ischemic stroke were enrolled and measured the NIHSS and mRS,before EECP,after36 hours EECP,and 3-month after attack.Then contrast the difference of these indicators.Result Compare with the control group,after EECP treatment and after 3-month attack,the scores of NIHSS were statistically significant,(after EECP:44.1％ vs 31.5％;after 3-month attack:55.6％ vs 40.5％),(P＜ 0.05).Compare with the control group,after 3-month attack,the score of mRS in EECP group was declined statistically significant,and the rate of favourable prognosis rise obviously (P＜0.05).Conclusion EECP can effectively improve neurological function and promote health and improve prognosis in the patients with acute cerebral ischemic stroke.

Correlation between serum vitamin D level and prognosis in patients with acute cerebral infarction / 中国医师进修杂志

Objective To investigate the relationship between serum vitamin D level and prognosis in patients with acute cerebral infarction. Methods One hundred patients with acute cerebral infarction within 48 h and 60 healthy subjects were selected. The serum 25-hydroxy-vitamin D level was measured. The patients with acute cerebral infarction were divided into vitamin D sufficient group, vitamin D insufficient group and vitamin D deficiency group according to the serum 25- hydroxy- vitamin D level. The National Institutes of Health stroke scale (NIHSS) before treatment and 14 d after treatment was evaluated, and this result reflected short- term prognosis; the long- term prognosis was evaluated by modified Rankin scale (mRS) 3 months after treatment. Results The serum 25-hydroxy-vitamin D level in patients with acute cerebral infarction was significantly lower than that in healthy subjects:(14.21 ± 0.98)μg/L vs. (22.43 ± 1.01)μg/L, and there was statistical difference (t=3.95, P=0.012). The patients with acute cerebral infarction were divided into 3 groups according to the serum 25- hydroxy-vitamin D level:vitamin D sufficient group (19 cases), vitamin D insufficient group (28 cases) and vitamin D deficiency group (53 cases). The NIHSS before treatment and 14 d after treatment in vitamin D sufficient group was significantly lower than that in vitamin D insufficient group and vitamin D deficiency group: (7.03 ± 1.82) scores vs. (10.21 ± 2.03) and (14.35 ± 2.96) scores, (2.04 ± 1.86) scores vs. (5.21 ± 2.28) and (10.38 ± 2.34) scores, and that in vitamin D insufficient group was significantly lower than that in vitamin D deficiency group, and there were statistical differences (P<0.01). The Pearson correlation analysis result showed that the serum 25- hydroxy- vitamin D level was negatively correlated with NIHSS scores (r = -1.738, P = 0.031). The short- term total effective rate in vitamin D sufficient group was significantly higher than that in vitamin D insufficient group and vitamin D deficiency group:17/19 vs. 67.9% (19/28) and 47.2% (25/53), and that in vitamin D insufficient group was significantly higher than that in vitamin D deficiency group, and there were statistical differences (P<0.05). The long- term good prognosis rate in vitamin D sufficient group was significantly higher than that in vitamin D insufficient group and vitamin D deficiency group:18/19 vs. 75.0%(21/28) and 50.9%(27/53), and that in vitamin D insufficient group was significantly higher than that in vitamin D deficiency group, and there were statistical differences (P<0.05). Conclusions The serum vitamin D level is significantly decreased in patients with acute cerebral infarction. It is negatively correlated with NIHSS scores. And it is important to judge prognosis.

Clinical Study on Transcutaneous Acupoint Electrical Nerve Stimulation for Post-stroke Fatigue / 上海针灸杂志

Objective To observe the clinical efficacy of transcutaneous acupoint electrical nerve stimulation (TEAS) in treating post-stroke fatigue.Method A total of 80 patients with post-stroke fatigue were randomized into a treatment group and a control group, 40 cases in each group. The control group was intervened by conventional post-stroke treatment, while the treatment group by TEAS in addition to the intervention given to the control group. The treatment was given once a day, 7 d as a treatment course, successively for 2 treatment courses with 1-d interval between the two courses. The National Institutes of Health Stroke Scale (NIHSS) and Fatigue Severity Scale (FSS) were observed before and after the treatment.Result After 2 treatment courses, the NIHSS and FSS scores in the treatment group were significantly different from those before the treatment (P<0.05). The NIHSS and FSS scores in the treatment group were significantly different from those in the control group after 2 treatment courses (P<0.05). Conclusion TEAS can effectively alleviate the symptoms of post-stroke fatigue and promote the recovery.

Clinical effect of three dimensional human body scanning system BurnCalc in the evaluation of burn wound area / 中华烧伤杂志

Objective@#To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area.@*Methods@#A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test.@*Results@#(1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm2, respectively, and there was no statistically significant difference among them ( F=1.55, P>0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm2, respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of limbs of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). There was no statistically significant difference in the wound area of front torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc (F=0.33, P>0.05). The wound area of side torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (169±88), (150±80), and (169±86) cm2, respectively. There was no statistically significant difference in the wound area of side torso of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of side torso of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). (3) The time for getting information of wounds of patients by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (77±14), (10±3), and (9±3) s, respectively. The time for getting information of wounds of patients by transparency tracing method was longer than that by NIH Image J method and three dimensional human body scanning system BurnCalc (with P values below 0.05). The time for getting information of wounds of patients by three dimensional human body scanning system BurnCalc was close to that by NIH Image J method (P>0.05).@*Conclusions@#The three dimensional human body scanning system BurnCalc is stable and can accurately evaluate the wound area on limbs and torso of burn patients.

A Retrospective Study of Branch Atheromatous Disease: Analyses of Risk Factors and Prognosis / 华中科技大学学报（医学）（英德文版）

The theory of branch atheromatous disease (BAD) has been commonly underused in clinical practice and research since it was proposed in 1989.In this study,we sought to explore clinical characteristics of its substypes and biomarkers for prognosis of BAD.A total of 176 consecutive patients with BAD were classified into two groups:paramedianpontine artery group (PPA group,n=70) and lenticulostriate artery group (LSA group,n=106).Bivariate analyses were used to explore the relationship between white matter hyperintensities (WMHs),National Institutes of Health Stroke Scale (NIHSS) scores and prognosis evaluated by the modified Rank Scale (mRS) at 6th month after stroke.The differences in prevalence of diabetes mellitus and a history of ischemic heart disease were statistically significant between PPA group and LSA group (x2=8.255,P=0.004;x2=13.402,P＜0.001).The bivariate analyses demonstrated a positive correlation between NIHSS and poor prognosis in patents with BAD and in the two subtype groups,and a positive correlation between WMHs and poor prognosis in the PPA group.It is concluded that a significantly higher prevalence of diabetes mellitus and a history of ischemic heart disease exist in the PPA group than in the LSA group.In addition,high grades of NIHSS scores imply poor prognosis in patients with BAD and in the two subtype groups.Moreover,WMHs are a positive predictor for poor prognosis in patients in the PPA group.

De los hospitales u hospicios a los modernos institutos nacionales de salud / From the medieval hospitals hospices to modern National public Health Institutes

Resumen: Desde las épocas más antiguas la instalación de hospitales y progresos de la clínica avanzaron pari passu. Hallamos ejemplos de tal aserto tanto en regiones propiamente griegas como en ciudades griegas de ultramar. Así, pues, en el periodo renacentista convergieron en Italia grandes figuras de aquel tiempo: el genial Leonardo da Vinci (1452-1519) y León Battista Alberti (1404-1472), humanista e innovador de la arquitectura. Michelangelo Buonarroti (1475-1564) y los artistas, sus contemporáneos, efectuaron disecciones anatómicas para perfeccionar su arte con el estudio de las formas del cuerpo humano. Los estudios anatómicos florecieron en la Universidad de Padua, impulsados por el flamenco Andreas Wesel, quién enseñó ahí esta disciplina desde 1437 hasta 1543. Los grandes anatomistas italianos del siglo XVI fueron discípulos directos o indirectos del maestro flamenco. Preparados por el estudio riguroso del sustrato anatómico resplandecieron, en el siglo XVII, los estudios concernientes a la función de las estructuras orgánicas ya conocidas. Dicho siglo se inició con la revelación de la circulación sanguínea mayor, por el médico inglés William Harvey, egresado de la Universidad de Padua, y se continuaron con la descripción de la circulación menor o pulmonar por autores antiguos o contemporáneos y de las conexiones periféricas entre el sistema arterial y el venoso (Marcello Malpigni, 1661). Todos estos investigadores, y otros más, eran miembros de la universidad patavina, en donde persistía la influencia benéfica de las enseñanzas de Galileo. En los siglos siguientes, junto con la anatomía normal y la embriología, la anatomía patológica, sistematizada por G.B. Morgagni, se impuso como piedra de toque de la clínica. Y el modelo de los antiguos hospitales evolucionó hacia el de los Institutos nacionales de salud, auspiciados por el maestro Ignacio Chávez.

Abstract: Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the XVII century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez.

Association between hemoglobin concentration and stroke severity on admission in ischemic stroke with-out diabetes / 中国综合临床

Objective To evaluate the association between hemoglobin concentration and stroke severity on admission in ischemic stroke without diabetes. Methods Based on the China National Stroke Registry,the information of acute stroke patients were collected by trained research coordinators and investigators with the methods of review clinical records or interview. Demography, disease history, behavior and habits, hemoglobin concentration,and NIHSS score on admission were collected in this study. The iIncluded patients with the integri?ty of the information of non diabetes,3 h to the hospital,no gastrointestinal bleeding and Hb concentration and NIHSS score at admission. Hemoglobin concentration was classed according to quintiles and the outcome was grouped into ≤3 and >3 groups. The method of logistic regression was used to explore the association between hemoglobin and NIHSS. Results A total of 1 419 individuals was included in this study,including 883 males and 536 females. The mean age was 67. 24±12. 46 years old and the proportion of NIHSS>3 was 67. 51% (958/1419). With respect to non?minor stroke (NIHSS>3),the odds rations and 95% confident intervals of patients with hemoglobin ≤121. 0 g/L(Q1),>122. 1-≤132. 0 g/L(Q2),>141. 0-≤152. 0 g/L(Q4),≥152. 1 g/L (Q5) were 1. 84(95%CI 1. 21-2. 79,P=0. 004),1. 24(95%CI 0. 83-1. 86,P=0. 294),1. 32(95%CI 0. 88-1. 96,P=0. 178) ,1. 52( 95%CI 1. 01-2. 28,P=0. 044) respectively,compared with hemoglobin between 132. 0 and 141. 0 g/L( Q3) . Conclusion Stroke severity is associated with lower and higher hemoglobin concentration in acute ischemic stroke without diabetes.

Prognostic value of copeptin combined with National Institutes of Health stroke score and modified Rankin score in patients with acute cerebral infarction / 中国医师进修杂志

Objective To investigate the disease assessment and prognosis value of serum copeptin level in patients with acute cerebral infarction (ACI). Methods One hundred first diagnosed ACI patients were selected as ACI group. According to the National Institutes of Health stroke score (NIHSS), the ACI patients were divided into mild (NIHSS15 scores). Sixty cases of healthy subjects were selected as control group. The serum copeptin level was measured by double antibody sandwich enzyme linked immunosorbent assay method in control group and ACI group (onset within 24 h). The NIHSS, Alberta stroke program early CT score (ASPECTS) and modified Rankin score (mRS) onset within 24 h and 14 d were evaluated in patients with ACI, and the mRS 90 d and 180 d after ACI were evaluated. The neurological impairment was assessed by mRS 180 d after ACI, mRS ≤ 2 scores was good prognosis, ≥ 3 scores was poor prognosis. The correlation was analyzed. Results Among the 100 patients with ACI, mild was in 52 cases, moderate in 34 cases, and severe in 14 cases; good prognosis was in 79 cases and poor prognosis in 21 cases. The serum copeptin levels within 24 h of ACI in mild, moderate and severe patients of ACI group were significantly higher than that in control group:(4.82 ± 1.25), (6.39 ± 2.21) and (9.28 ± 3.82) pmol/L vs. (1.95 ± 0.28) pmol/L. The serum copeptin level within 24 h of ACI in moderate patients was significantly higher than that in mild patients, in severe patients was significantly higher than that in moderate patients, and there were statistical differences (P<0.05). Within 24 h of ACI , the ASPECTS in moderate and severe patients were significantly lower than that in mild patients:(10.02 ± 2.10) and (6.24 ± 3.05) scores vs. (12.16 ± 0.84) scores, in severe patients was significantly lower than that in moderate patients, and there were statistical differences (P<0.05). The NIHSS in moderate and severe patients were significantly higher than that in mild patients:(10.68 ± 3.14) and (16.20 ± 4.26) scores vs. (4.35 ± 1.52) scores, in severe patients was significantly higher than that in moderate patients, and there were statistical differences (P<0.05). The serum copeptin levels within 24 h of ACI and NIHSS in each time point in good prognosis patients were significantly lower than those in poor prognosis patients:(3.52 ± 1.26) pmol/L vs. (8.68 ± 3.06) pmol/L and (5.68 ± 2.11) scores vs. (15.36 ± 3.25) scores, (4.85 ± 1.86) scores vs. (12.60 ± 3.89) scores, (3.68 ± 1.21) scores vs. (6.35 ± 2.96) scores, (2.16 ± 0.75) scores vs. (5.21 ±1.96) scores, and the ASPECTS within 24 h of ACI was significantly higher than that in poor prognosis patients:(11.38 ± 2.21) scores vs. (7.86 ± 2.49) scores, and there were statistical differences (P<0.05). The single factor Logistic regression analysis results showed that the age, ASPECTS, NIHSS and serum copeptin level were the influencing factors of severity of illness in patients with ACI (OR = 1.21, 5.36, 5.61 and 6.62;95%CI 0.99-1.39, 3.34-9.21, 2.86-7.52 and 1.38-12.64;P=0.04, 0.01, 0.01 and 0.00), and the influencing factors of poor prognosis (OR=1.32, 5.21, 4.86 and 6.82;95%CI 0.84-1.43, 3.52-8.39, 2.62-5.35 and 2.67-11.85;P=0.04, 0.01, 0.01 and 0.00). ROC analysis results showed that the area under curve of NIHSS, serum copeptin level and ASPECTS in predicting poor prognosis in patients with ACI were 0.926, 0.863 and 0.624. In the mild, moderate and severe patients, the serum copeptin level was negative correlated with ASPECTS ( r=-0.682,-0.594 and-0.572;P<0.01), and the serum copeptin level was positively correlated with NIHSS ( r = 0.652, 0.614 and 0.586; P<0.01). Conclusions The serum copeptin level in patients with ACI is significantly elevated. The serum copeptin level is positively correlated with neurologic impairment severity and prognosis in patients with ACI, and it has important significance in evaluating pathogenetic condition and prognosis.

Therapy effect analysis of Urinarykallid on acute cerebral infarction patients with different ages / 中国综合临床

Objective To investigate the effect of Urinarykallid for different ages patients with acute cerebral infarction cases.Methods Ninety-five cases with acute cerebral infarction were divided into high age group(n=48) and middle age group(n=47).Patients in the two groups were both given the Urinarykallid therapy combined with routine treatment.After 1 courses of treatment(3 weeks),American National Institutes of Health Stroke Scale(NIHSS) were performed before and after the treatment.The adverse reactions occurred in the process of scoring were compared.Results The total effective rate in the high age group was 83.33％,lower than the middle age group(89.36％),but the difference was not statistically significant(P=0.391).The NIHSS scores of patients in the two group after treatment were both significantly reduced compared with that in before treatment (high age grou:(9.81±2.37) vs.(6.79± 0.82),middle age group:(9.75 ± 2.46) vs.(3.04±0.58;P=0.004,P=0.001).Meanwhile,the NIHSS in the middle age group decrease significantly than the high age group(P=0.000).No obvious adverse reactions occurred in both two groups,the treatment was proved with safe and reliable.Conclusion Urinarykallid treatment is showed with better therapy effect on acute cerebral infarction patients with different age,and it is safety with improving patients NIHSS score level.Meanwhile,the better efficacy is showed in patients with lower age.

Polymorphism of Nitric Oxide Synthase 1 Affects the Clinical Phenotypes of Ischemic Stroke in Korean Population

OBJECTIVE: To investigate whether four single nucleotide polymorphisms (SNPs) rs2293054 [Ile734Ile], rs1047735 [His902His], rs2293044 [Val1353Val], rs2682826 (3'UTR) of nitric oxide synthase 1 (NOS1) are associated with the development and clinical phenotypes of ischemic stroke. METHODS: We enrolled 120 ischemic stroke patients and 314 control subjects. Ischemic stroke patients were divided into subgroups according to the scores of the National Institutes of Health Stroke Survey (NIHSS, <6 and ≥6) and Modified Barthel Index (MBI, <60 and ≥60). SNPStats, SNPAnalyzer, and HelixTree programs were used to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. Multiple logistic regression models were performed to analyze genetic data. RESULTS: No SNPs of the NOS1 gene were found to be associated with ischemic stroke. However, in an analysis of clinical phenotypes, we found that rs2293054 was associated with the NIHSS scores of ischemic stroke patients in codominant (p=0.019), dominant (p=0.007), overdominant (p=0.033), and log-additive (p=0.0048) models. Also, rs2682826 revealed a significant association in the recessive model (p=0.034). In allele frequency analysis, we also found that the T alleles of rs2293054 were associated with lower NIHSS scores (p=0.007). Respectively, rs2293054 had a significant association in the MBI scores of ischemic stroke in codominant (p=0.038), dominant (p=0.031), overdominant (p=0.045), and log-additive (p=0.04) models. CONCLUSION: These results suggest that NOS1 may be related to the clinical phenotypes of ischemic stroke in Korean population.

Hallazgos clínicos y oftalmológicos en niños con neurofibromatosis 1 / Clinical and ophthalmological findings in children with type 1 neurofibromatosis

Este trabajo tuvo por objetivos determinar la incidencia en nuestro medio de los criterios diagnósticos del National Institutes of Health (NIH) en niños con Neurofibromatosis 1 (NF1), comparar con estadísticas publicadas, analizar los hallazgos oftalmológicos, el valor de los estudios complementarios y establecer criterios de seguimiento. Métodos: Se trata de un estudio retrospectivo que incluyó 245 pacientes que ingresaron al Hospital de Pediatría Garrahan entre los años 1988 y 2010. Se diagnosticó NF1 en la primera consulta multidisciplinaria, utilizando los criterios de NIH, efectuándose en algunos niños neuroimágenes y potencial evocado visual (PEV). Resultados: El 92% de los pacientes presentó manchas café con leche; 40.8% neurofibromas, 75.5% nódulos de Lisch; 38.8% efeliloides; 16.3% glioma del nervio óptico; 16.3% displasia esquelética y 49% fueron hereditarios. Evidenciamos 1.76 miopías por cada hipermetropía. Conclusiones: Las frecuencias halladas coinciden con reportes previos, a excepción de las efeliloides, con incidencia menor. Realizamos de elección resonancia magnética nuclear (RMN), aún en pacientes asintomáticos, repitiéndolas bianualmente y examen oftalmológico cada seis meses hasta los ocho años. No indicamos actualmente PEV (AU)

The objective of this study was to determine the incidence of the National Institutes of Health (NIH) diagnostic criteria in children with Neurofibromatosis type 1 (NF1) in our setting, to compare them with the published statistical data, ophthalmological findings, the importance of complementary studies, and to establish follow-up criteria. Methods: We conducted a retrospective study including 245 patients that were admitted to the Pediatric Hospital Garrahan between 1988 and 2010. NF1 was diagnosed at the first multidisciplinary visit, using the NIH criteria. Neuroimaging and visual evoked potentials (VEP) were performed in some of the children. Results: 92% of the patients had café au laity spots; 40.8% neurofibromas; 75.5% Lisch nodules; 38.8% ephelides; 16.3% optic-nerve glioma; and 16.3% skeletal dysplasia. The disorder was hereditary in 49%. For each hypermetry,1.76 myopias were observed. Conclusions: These rates found were according to previous reports, except for ephelides, which were less common. Elective magnetic resonance imaging (MRI ) was performed, even in asymptomatic patients, and was repeated biannually and ophthalmological examination was done every six months until nine years of age. Currently, we do not indicate VEP

Clinical observation of edaravone associated with early rehabilitation on treating ischemic str oke / 中国基层医药

Objective To explore the effect of the joint edaravone in early rehabilitation on the prognosis of patients with ischemic stroke.Methods The general branch of Kailuan group of patients with ischemic stroke who were conformed to the 1995 national conference on the 4th cerebrovascular diagnostic criteria with head CT or MRI imaging diagnosis,were collected from January 2012 to December 2014.A total of 324 cases were the first onset,who had been treated with conventional drugs,and were randomly divided into the observation group(edaravone associated with early rehabilitation)and the control group(early rehabilitation)with 162 cases in each group.Patients of the observation group were given venous application of edaravone and received the standardized rehabilitation treatment within 48 hours.The control group were given standard rebabilitation therapy at 2 weeks after attacked.NIHSS and MMSE scores of the two groups of patients were evaluated at the beginning of the rehabilitation course,4 weeks and 12 weeks of the treatments.Results There were no statistically significant difference and the clinial manifestations of the lesion site between the two groups of patients on admission.At the beginning of the rehabilitation,the NIHSS and MMSE score of control group were statistically significant different from that of observation group [NIHSS:(14.8 ±5.3)vs.(16.1 ±5.1),PNIHSS =0.049;MMSE:(15.9 ±6.3)vs.(14.2 ±6.2),PMMSE =0.041].The sec-ond and third evaluation were respectively conducted at 4 weeks[NIHSS:(10.1 ±6.3)vs.(8.2 ±5.7),MMSE:(17.7 ±5.5)vs.(20.9 ±5.9)]and 12 weeks[NIHSS:(6.6 ±4.9)vs.(4.7 ±3.6),MMSE:(21.0 ±4.8)vs. (24.6 ±4.9)].The results of the observation group were significantly better than the control group(P4W NIHSS =0.036,P4W MMSE =0.035;P12W NIHSS =0.006,P12W MMSE =0.003),and the differences were statistically significant. Conclusion Edaravone associated with early rehabilitation can obviously improve the prognosis of patients with ischemic stroke.

Quantity Change of Peripheral Blood Dendritic Cells Subtypes in Patients with Stroke / 中国康复理论与实践

Objective To explore the change of proportion of peripheral blood dendritic cells (DCs) in patients with stroke. Methods 56 patients (30 cases of cerebral infarction and 26 cases of cerebral hemorrhage) in Beijing Bo'ai hospital from June to September, 2014 and 14 healthy controls were investigated. The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS). Flow cy-tometry analysis was employed to detect the proportion of DCs subtypes in the peripheral blood. Results No obvious difference was found in DCs between the stroke patients and the controls. Compared to the control group, the percentages of peripheral blood myeloid dendritic cells (mDCs) decreased in the cerebral hemorrhage and the cerebral infarction subgroups (P7 subgroup. The percentages of pDCs in the cerebral hemorrhage and the cerebral infarction patients were significantly lower in the NIHSS>7 subgroup than in the NIHSS≤7 subgroup (P7 subgroups in the percentages of mDCs in the cerebral hemorrhage and cerebral infarction patients. Conclusion The proportion of DCs subtypes in the peripheral blood in stroke patients changed significantly, indicating inflamma-tion responds play a role in stroke.

The evaluation value of modified USA National Institutes of Health Stroke Scale score combined with bedside transcranial Doppler ultrasonography on the early prognosis of ischemic stroke / 中国医师进修杂志

Objective To explore the evaluation value of modified USA National Institutes of Health Stroke Scale (mNIHSS) score combined with bedside transcranial Doppler ultrasonography (TCD) on the early prognosis of ischemic stroke (AIS).Methods One hundred and thirty-six anterior circulation AIS patients were collected,mNIHSS score was evaluated on admission,and emergency bedside TCD examination was performed to evaluate vascular anomalies.After active treatment after discharge,the modified Rankin scale (mRS) score was recorded to evaluate 90 d prognosis.The value of mNIHSS score combined with TCD examination analysis on the prognosis was analyzed.Results If the mNIHSS score ＞ 8 scores was judged to be poor prognosis,the sensitivity was 0.684,the specificity was 0.806,the positive predictive value was 0.578,the negative predictive value was 0.868.If related macro vascular abnormalities in bedside TCD examination were evaluated for clinical prognosis,the sensitivity was 0.736,the specificity was 0.643,the positive predictive value was 0.444,the negative predictive value was 0.863.If both,the specificity was 0.918,the positive predictive value was 0.714,the positive likelihood ratio was 6.41 ;and the two were not available,the negative predictive value was 0.928,negative likelihood ratio was 0.20.Conclusion mNIHSS score combined with TCD examination in evaluating the prognosis of AIS patients can improve the positive or negative predictive value.