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Antiepileptic drugs (AEDs) are the main treatments of epilepsy, but their use is usually limited by adverse reactions, among them psychiatric and behavioral ones including aggressive behavior. Levetiracetam , perampanel, and topiramate , which have diverse mechanisms of action, have been associated with aggressive behavior. 5-HT and γ-aminobutyric acid (GABA), especially glutamate [via α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate receptor (AMPA) receptor] seem to play key roles. Other mechanisms involve hormones, epigenetics and alternative psychosis. Neurological and/or mental health disorders tend to increase aggressive behavior sensitivity. The adverse reactions caused by AEDs are getting more and more attention. Clinicians may identify and manage this side effect as early as possible, if the risk factors and underlying mechanisms of aggressive behavior induced by antiepileptic we find. This article will explain the possible mechanisms.
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Ischemic stroke is the most common type of cerebrovascular disease, which has the characteristics of high morbidity, high disability, and high mortality. Sleep disorder is a common complication after ischemic stroke, which can increase the risk of stroke recurrence and seriously affect the outcome of patients. This article reviews the classification and mechanism of post-stroke sleep disorders, the impact on the outcome of patients, the changes in sleep structure of patients with stroke, and the diagnosis and treatment of post-stroke sleep disorders, in order to improve clinicians' understanding of post-stroke sleep disorders.
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Objective To investigate the incidence and related factors of sexual dysfunction in Chinese Han women with epilepsy (WWE).Methods A total of 112 cases of Han married WWE were continuously recruited from January 2015 to December 2017 in the Affiliated Hospital of Yangzhou University,and 120 matched non-epileptic healthy Han married women served as controls.The 112 WWE were classified as focal or comprehensive onset epilepsy and were treated with antiepileptic drugs (AEDs) for one year or more.Data collection was performed with a form inquiring about the participants' demographic parameters,including age,duration of marriage,education level,employment,monthly family income per capita,history of infertility and irregular menses.Details of epilepsy in WWE were investigated,including age of onset,duration of illness,seizure frequency,medication adherence.All participants were submitted to relevant scales and questionnaires (Female Sexual Function Index,Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale).In addition,WWE were evaluated by the 8-Item Morisky Medication Adherence Scale and the National Hospital Seizure Severity Scale.Chi-square test,t test and binary Logistic regression were used for statistical analysis.Results A high rate (70.5％,79/112) of sexual dysfunction was detected in WWE,whereas 24.2％ (29/120) in controls (x2=50.061,P＜0.01).Sexual dysfunction affected all dimensions:desire (85.7％,96/112),arousal (56.3％,63/112),lubrication (47.3％,53/112),orgasm (66.1％,74/112),satisfaction (58.9％,66/112) and pain (41.1％,46/112).Elevated rates of anxiety (40.2％,45/112),depression (33.0％,37/112) and poor medication adherence (31.3％,35/112) were also found in WWE.Binary Logistic regression showed that family economic status (monthly family income per capita ＜1 500 Yuan (OR=8.852,95％CI:1.469-53.346,P=0.017),monthly family income per capita 1 500-2 500 Yuan (OR=6.438,95％CI:1.439-28.796,P=0.015)),anxiety (OR=1.202,95％CI:1.050-1.375,P=0.008) and medication adherence (OR=0.371,95％CI:0.155-0.890,P=0.026) were associated with sexual dysfunction.Conclusions The associated factors of sexual dysfunction in Chinese Han WWE are multifactorial.WWE have higher levels of anxiety,poor family economic status and poor medication adherence.Medical professionals should not only better control seizures,but also evaluate and improve patients' sexual function,so as to improve the quality of life of WWE.
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Objective@#To investigate the correlation between sexual dysfunction(SD)and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE).@*Methods@#A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University, and 120 matched healthy women were taken as the control group.WWE were treated with antiepileptic drugs (AEDs) for one year or more.The Chinese version of female sexual function index (FSFI) was used to investigate the sexual function of the subjects.The chemiluminescence method was used to detect the sex hormones levels such as prolactin(PRL), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene polymorphism.Chi-square test, t-test and binary logistic regression were used for statistical analysis.The differences of the sexual function, sex hormone, ER genotype, and allele frequency were compared between the two groups.And the correlation between SD and ER gene polymorphism was analyzed.@*Results@#(1) The proportion of SD in Chinese Han WWE was 70.5%(79/112), while that was 24.2%(29/120) in the control group.The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2.072, P=0.039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0.001; P=0.001). (3) Binary logistic regression analysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR=6.074, 95%CI: 1.257-29.352, P=0.025; OR=0.412, 95%CI: 0.201-0.842, P=0.015).@*Conclusion@#ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE, and PvuII CC genotype may be the risk genotype of SD in WWE.
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Objective To analyze the risk factors of hemorrhage after thrombolysis for mild cerebral infarction and the curative effect of low-dose alteplase.Methods 375 patients with mild cerebral infarction whose onset time was less than 4.5 hours from January 2013 to May 2017 in our hospital were selected as the research objects.Those undergoing low-dose alteplase thrombolysis were included in the thrombolysis group (n =195) while those without thrombolysis were included in the non-thrombolysis group (n =180).The therapeutic effects were analyzed.Patients with intracerebral hemorrhage in the thrombolysis group at 14 days after thrombolysis were included in the observation group while those without hemorrhage were included in the control group.Related data were compared between the two groups.The single factors and independent risk factors of hemorrhage after thrombolysis in patients with mild cerebral infarction were analyzed.Results National Institute of Health Stroke Scale (NIHSS) scores of the thrombolysis group at 1 week,1 month and 3 months after treatment were significantly lower than those of the non-thrombolysis group (P ＜0.05).Serum neuron specific enolase (NSE) and C-reactive protein (CRP) levels in the thrombolysis group were lower than those in the non-thrombolysis group after treatment (P ＜ 0.05).The prognosis of the thrombolysis group was better than that of the non-thrombolysis group after treatment (P ＜ 0.05).In this study,30 patients undergoing thrombolysis had intracerebral hemorrhage within 14 days after thrombolysis,and the incidence of intracranial hemorrhage was 15.38％ (30/195).Univariate and multivariate logistic regression analysis showed that age,history of heart failure,door to needle time (DNT),systolic blood pressure (SBP) in 12 hours after thrombolysis and leukoaraiosis change were risk factors for hemorrhage in patients with mild cerebral infarction after thrombolysis (P ＜ 0.05).Conclusions Using low-dose alteplase for treating patients with mild cerebral infarction can achieve good thrombolytic effects.Age,history of heart failure,DNT,SBP in 12 hours after thrombolysis and leukoaraiosis change are influencing factors of intracranial hemorrhage,which should be paid attention to.
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Objective To investigate the correlation between sexual dysfunction( SD) and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University,and 120 matched healthy women were taken as the control group. WWE were treated with antiepileptic drugs ( AEDs) for one year or more. The Chinese version of female sexual function index ( FSFI) was used to investigate the sexual function of the subjects. The chemiluminescence method was used to detect the sex hormones levels such as prolactin ( PRL),follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene poly-morphism. Chi-square test,t-test and binary logistic regression were used for statistical analysis. The differ-ences of the sexual function,sex hormone,ER genotype,and allele frequency were compared between the two groups. And the correlation between SD and ER gene polymorphism was analyzed. Results ( 1) The pro-portion of SD in Chinese Han WWE was 70. 5%(79/112),while that was 24. 2%(29/120) in the control group. The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2. 072,P=0. 039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0. 001;P=0. 001). (3) Binary logistic regression a-nalysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR= 6. 074, 95% CI: 1. 257-29. 352, P= 0. 025; OR= 0. 412, 95% CI: 0. 201-0. 842, P= 0. 015 ). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE,and PvuII CC genotype may be the risk genotype of SD in WWE.
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The most important harms of atrial fibrilation are stroke and the embolic events of the systemic circulation. The latest data have show n that the etiology of up to 1/3 of stroke patients w as atrial fibrilation. The stroke morbidity and mortality caused by atrial fibrilation are higher than other types of stroke. So the prevention of stroke is very important for patients with atrial fibrilation. The anticoagulant therapy is the core strategy for stroke prevention in patients with atrial fibrilation. This article reviews the advances in research on the safety and compliance of anticoagulation therapy in patients w ith atrial fibrilation.
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Objective To investigate the correlation between hemorrhagic transformation (HT) and each parameter of blood pressure variability (BPV) in patients with massive cerebral infarction caused by cardioembolic middle cerebral artery occlusion. Methods The patients with massive cerebral infarction caused by unilateral cardioembolic middle cerebral artery occlusion admitted to hospital within 24 h after onset were selected. For patients without revealing HT with head MRI on admission were analyzed retrospectively. According to the results of MRI rescan within 7 days after onset, they were divided into either a HT group or a non-HT group. Al specific parameters of blood pressure were compared and analyzed between the 2 groups, specificaly including initial value (initial), mean value ( mean), maximum value (max), minimum value (min), maximum-minimum difference (max-min), standard deviation (sd), successive variation (sv), and maximum value of sv (svmax) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results A total of 146 patients were enroled in the analysis, and 77 (52. 7% ) had HT within 7 d after onset. Al the blood pressure parameters were grouped by quartiles. Multivariate logistic regression analysis showed that after adjusting for age, admission time, baseline National Institutes of Health Stroke Scale score, congestive heart failure, antiplatelet therapy, initial blood glucose, prothrombin time, and international normalized ratio of the patients, SBPmin , SBPmax-min , SBPsv , SBPsvmax , DBPinitial, DBPsd , DBPmax , DBPmax-min , DBPsv , and DBPsvmax had significant independent association with and HT (likelihood ratio test of trend, al P < 0. 05). Conclusions Higher BP level and variability may increase the risk of HT in patients with massive cerebral infarction after cardioembolic middle cerebral artery occlusion. A smooth and slow antihypertensive treatment may need for these patients.
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Objective To investigate the predictive value of early diffusion-weighted imaging (DWI) for early neurological deterioration (END) after acute isolated basal ganglia infarct.Methods Patients with acute isolated basal ganglia infarct in middle cerebral artery perforators completed head MRI examination at 24 h after onset were analyzed retrospectively.According to the axial DWI revealed lesion size,the maximum diameters were divided into ＜ 15 mm,15-30 mm,and ＞ 30 mm.END was defined as an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥2 or the motor score of NIHSS ≥ 1 at any time within the first 72 h after admission compare with the baseline scores.Results A total of 336 patients were enrolled,including 126 patients (37.5％) with END.There were significant differences in the constituent ratios of the sex (P =0.044),maximum diameter of the lesion (P =0.001),and guilty artery stenosis (P =0.006),as well as baseline NIHSS score (P =0.001),high-density lipoprotein cholesterol (HDL-C) (P =0.033),and C-reactive protein (P =0.039) between the END group and the non-END group.Multiple logistic regression showed that the maximum diameter of the lesions 15-30 mm (odds ratio [OR] 2.360,95％ confidence interval [CI] 1.370-4.066;P =0.002),female (OR 1.660,95％ CI 1.024-2.691;P =0.040),and guilty large artery stenosis (OR 1.713,95％ CI 1.036-2.833;P =0.036) were the independent risk factors for patients occurring END,while the high HDL-C (OR 0.355,95％ CI 0.141-0.894;P =0.028) was an independent protective factor of occurring END.Conclusion Early DWI revealed that the maximum diameter of the lesions may have certain clinical value for prediction of the occurrence of END in patients with acute isolated basal ganglia infarct.
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Objective To investigate the clinical and imaging characteristics of isolated pontine infarction as well as the influencing factors for early progressive motor deficits (PMD) and short-term prognosis.Methods A total of 86 patients with isolated pontine infarction who admitted in hospital within 24 hours of symptom onset were analyzed retrospectively.The patients were divided into paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI) according to the maximal diameter of the lesions and the locations of infarction.They were divided into either a PMD group or a non-PMD group according to the early status of PMD.They were also divided into a poor outcome group (mRS score ＞ 2) and a good outcome group (mRS score ≤ 2) according to the modified Rankin Scale (mRS) scores at discharge.The clinical and imaging features of the different patient groups were compared.Results The patients' constituent ratios of hyperlipidemia (57.14％ vs.33.33％;x2 =4.80,P=0.028),hemiplegia (97.14％ vs.72.55％;x2 =8.718,P=0.003),basilar artery stenosis (45.71％ vs.17.65％;x2=7.930,P=0.005) and poor outcome at discharge (54.29％ vs.31.37％ ; x2 =4.515,P =0.034),and the baseline National Institutes of Health Stroke Scale (NIHSS) scores (6.00 ± 2.39 vs.4.61 ± 3.41; t =2.087,P =0.040) in the PPI group (n =35) were significantly higher than those in the LPI group (n =51).The constituent ratios of the baseline diastolic blood pressure levels (97.82 ± 15.61 mm Hg vs.89.55 ± 12.23 mm Hg,1 mm Hg=0.133 kPa; t =2.258,P =0.031),PPI (63.64％ vs.32.81％ ;x2 =6.445,P =0.011) and basilar artery stenosis (59.10％ vs.18.75％ ;x2 =12.922,P =0.000) in the PMD group (n =22) were significantly higher than those in the non-PMD group (n =64).The baseline NIHSS scores (6.80 ± 2.63 vs.3.73 ± 2.55; t =5.426,P =0.000),fasting blood glucose levels (9.40 ±5.15 mmol/L vs.6.56 ±2.69 mmol/L; t =2.985,P=0.004) and the constituent ratios of PPI patients (54.29％ vs.31.37％ ;x2 =4.515,P =0.034) in the poor outcome group (n =35) were significantly higher than those in the good outcome group (n =51).Multivariate logistic regression analysis showed that basilar artery stenosis was an independent risk factor for the onset of PPI (odds ratio [OR] 3.801,95％ confidence interval [CI] 1.357-10.646; P =0.011) and the early PMD of isolated pontine infarction (OR 4.571,95％ CI 1.214-17.214; P=0.025).The baseline NIHSS score ≥ 5 was its independent predictor for poor outcome (OR 4.277,95％ OR 1.505-12.151; P =0.006).Conelusions PPI is mainly associated with the lesions in the branches of basilar artery.The baseline NIHSS score ≥ 5 may be an independent predictor for short-term poor outcome of isolated pontine infarction.Its early PMD and short-term poor outcome may be associated with the basilar artery lesions.
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Phosphoglycerate mutase (PGAM) is a key enzyme in glycolytic pathways. With PCR technique based on an EST identified in our lab, a novel gene named SjPGAM (GenBank Accession No. EU374631) was cloned. Sequence analysis revealed that the ORF of SjPGAM gene contained 753 nucleotides, encoding 250 amino acids, and the molecular weight was about 28.26 kD. Real-time PCR analysis showed that the mRNA level of SjPGAM was much higher in the 14 days and 19 days schistosomula than other stages, suggesting that the gene was a schistosomula stage differential expression gene. The SjPGAM cDNA fragment was subcloned into an expression vector pET-28a (+) and transformed into Escherichia coli BL21 cells. In the presence of IPTG, the 31 kD fusion protein was expressed in included bodies. Western blotting revealed that the fusion protein could be recognized by the rabbit serum anti-Schistosoma japonicum adult worm antigen preparation. The study provides important basis for investigating the mechanism of the PGAM in the glycolytic pathways of Schistosoma japonnicum.