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Background@#and Purpose Non-high-density lipoprotein cholesterol (non-HDL-C), which represents the total cholesterol content of all pro-atherogenic lipoproteins, has recently been included as a new target for lipid-lowering therapy in high-risk atherosclerotic patients in multiple guidelines. Herein, we aimed to explore the relationship between non-HDL-C level and the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in preventing stroke recurrence. @*Methods@#This study comprised a post hoc analysis of the CHANCE-2 (Ticagrelor or Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial, from which 5,901 patients with complete data on non-HDL-C were included and categorized by median non-HDL-C levels, using a cutoff of 3.5 mmol/L. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days. @*Results@#Ticagrelor-aspirin significantly reduced the risk of recurrent stroke in patients with low non-HDL-C (71 [4.8%] vs. 119 [7.7%]; adjusted hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.40–0.74), but not in those with high non-HDL-C (107 [7.3%] vs. 108 [7.6%]; adjusted HR, 0.88; 95% CI, 0.67–1.16), compared with clopidogrel-aspirin (P for interaction=0.010). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin for recurrent stroke decreased as non-HDL-C levels increased. No significant differences in the treatment assignments across the non-HDL-C groups were observed in terms of the rate of severe or moderate bleeding (5 [0.3%] vs. 8 [0.5%] in the low non-HDL-C group; 4 [0.3%] vs. 2 [0.1%] in the high non-HDL-C group; P for interaction=0.425). @*Conclusion@#CHANCE-2 participants with low non-HDL-C levels received more clinical benefit from ticagrelor-aspirin versus clopidogrel-aspirin compared to those with high non-HDL-C, following minor ischemic stroke or transient ischemic attack.
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OBJECTIVE@#To analyze the feature of horizontal semicircular canal function at high and low-frequencies in Meniere's disease.@*METHOD@#Thirty patients suffering from unilateral Meniere's disease were included in the research from 2013 June to 2014 June. Caloric test and video head impulse test were performed to evaluate the high low-frequency function of horizontal semicircular canal.@*RESULT@#these patients were devided by the severity of unilateral weakness in caloric test. The gain value in video head impulse test, which reflects the high-frequency function of semicircular canal, were not different between the normal and mild abnormal group (P > 0.05), but were obviously different between the normal and mild-severe abnormal group, slight abnormal and mild-severe abnormal group (P 0.05).@*CONCLUSION@#A part of Meniere's disease may have normal high, low-frequency function of horizontal semicircular canal. As patient suffering slight injury of low-frequency function, the high-frequency function keeps normal. As the injury of low-frequency function become mildly to severely, the damage of high-frequency function appears, but the symmetry still keeps balance.
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Humanos , Pruebas Calóricas , Prueba de Impulso Cefálico , Enfermedad de Meniere , Canales SemicircularesRESUMEN
Objective To explore the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) with bilateral positive Dix-Hallpike test.Methods This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012.Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis.Results Among all the patients,55 (11.2％) of them presented with bilateral nystagmus by the provocative test.According to the type of nystagmus provoked by DixHallpike maneuver,the 55 patients can be divided into the following four categories.(1) Bilateral geotropic (n =16) and apogeotropic nystagmus (n =5):all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver.(2) Bilateral predominant down-beating nystagmus (n =2):patients in this group were diagnosed with anterior canal BPPV,and got recovered after Kim maneuver.(3) Bilateral torsional up-beating geotropic nystagmus (n =20):after a lying-down test,6 of the patients manifested as vertical up-beating nystagmus and 14 patientsremained torsional up-beating nystagmus.The formerwere diagnosed with bilateral posterior canal BPPV,and were cured after bilateral PRM therapy,and the latter were diagnosed with horizontal canal BPPV,who were cured after Barbecue maneuver.(4) Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side (n =12).The down-beating nystagrnus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver.These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy.Conclusions It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test.The diagnoses should be made by the types of nystagmus provoked step by step before maneuver therapy.
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Objective To study improvement of neural function by stereotaxic transplantation of adipose-derived stem cells (ADSC) into lateral cerebral ventricle after intracerebral hemorrhage in rats and its mechanism. Methods ADSC were cultured and proliferated in vitro, which had been marked with Brdu for 48 h before transplantation. The rat caudate nucleus hemorrhage (ICH) models were divided into 2 groups. ADSC were stereotaxically transplanted into the right lateral ventricles in ADSC group, and equal volume of saline was transplanted into control group. The score of neurological behavior were evaluated at modeling and 1, 3, 7, 14, 28 days after transplantation respectively.Double-staining immunofluorescence technique was used to detect Brdu-positive cells and the differentiation of neurons and astrocytes. In accordance with the instructions of TUNEL kit, cell apoptosis, and the expression of VEGF and angiogenesis were assayed. Results In vitro ADSC expressed undergo osteogenic and adipogenic differentiation. Compared with the control group, ADSC group had better motor function at 3, 7, and 14 days (P＜0. 05). Double-staining immunofluorescence showed mostly grafted Brdu-reactive ADSC had migrated to the hematoma zone, and some survivedand expressed Neun of Gfap. TUNEL analysis revealed that, 3 days after transplantation, the number of apoptotic cells in ADSC group was significantly less than in the control group (P＜0. 05). Three days after transplantation, VEGF expression levels in ADSC group were significantly higher than in the control group (P＜0. 05). Conclusion ADSC stereotaxially transplanted into the lateral ventricle can survive and differentiate into neuron-like cells. ADSC transplantation may reduce apoptosis and secret VEGF to promote the angiogenesis, and improve neural functional in intracerebral hemorrhage rats.
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Adipose tissue is a readily available source of adult stem cells with multipotent properties suitable for tissue engineering and regenerative medical applications. Peptide hydrogel is a novel biomaterial which provides three-dimensional microenvironments for a variety of cells for tissue grafting. In this study, adipose-derived stem cells (ADSCs) were isolated from rats, seeded into the peptide hydrogel polymer scaffolds and cultured in Neurobasal (NB) media supplemented with B27, basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF). Ten days after the culture, some cells were expanded into clonal populations in which the expression of both Nestin and Brdu was detected but only Brdu expression was detected in the cells that were not expanded into clonal populations. Our results suggested that ADSCs in peptide hydrogel polymer scaffolds can be induced to differentiate into cells capable of expressing the neuron-associated markers, self-renewal and self-propagation.