Caracterización de pacientes con enfermedad cerebrovascular isquémica atendidos en el Hospital General Docente Guillermo Domínguez de Las Tunas

Fundamento: las enfermedades cerebrovasculares constituyen un problema de salud a nivel mundial y una de las principales causas de mortalidad y discapacidad global. Objetivo: caracterizar clínicamente a los pacientes con enfermedad cerebrovascular isquémica ingresados en el Servicio de Medicina Interna del Hospital General Docente Guillermo Domínguez López en el período comprendido entre mayo de 2019 y mayo de 2021. Método: se realizó un estudio descriptivo de corte transversal en el Servicio de Medicina Interna del Hospital General Docente Guillermo Domínguez López en el municipio Puerto Padre en la provincia Las Tunas en el período comprendido entre mayo de 2019 y mayo de 2021. La población de estudio estuvo conformada por 184 pacientes con diagnóstico de enfermedad cerebrovascular isquémica. La muestra coincidió con el universo al estudiar el total de pacientes. Se caracterizaron las siguientes variables: edad, sexo, factores de riesgo, formas clínicas de presentación, complicaciones y supervivencia al egreso. Se utilizó estadística descriptiva. Los resultados se presentaron en cuadros de distribución de frecuencias para su mejor comprensión y análisis. Resultados: predominaron los pacientes de sexo masculino (53,80 %) y el grupo etáreo de 65 a 74 años con un 33,15 %. El principal factor de riesgo fue la hipertensión arterial (58,29 %) y predominó el infarto cerebral aterotrombótico con un 47,83 % como forma clínica de presentación. Las infecciones respiratorias (28 %) fueron las de mayor incidencia en cuanto a complicaciones. El 92,93 % de los pacientes egresaron vivos. Conclusiones: predominaron los hipertensos mayores de sesenta años, ingresados con infarto cerebral aterotrombótico.

Background: cerebrovascular diseases are a global health problem and one of the main causes of mortality and global disability. Objective: to clinically characterize patients with ischemic cerebrovascular disease admitted to the Internal Medicine Service of the Guillermo Domínguez López General Teaching Hospital in the period between May 2019 and May 2021. Method: a descriptive cross-sectional study was carried out in the Internal Medicine Service of the Guillermo Domínguez López General Teaching Hospital in the Puerto Padre municipality in Las Tunas province in the period between May 2019 and May 2021. The study population consisted of 184 patients diagnosed with ischemic cerebrovascular disease. The sample coincided with the universe when studying the total number of patients. The following variables were characterized: age, sex, risk factors, clinical forms of presentation, complications, and survival to discharge. Descriptive statistics were used. The results were presented in frequency distribution tables for better understanding and analysis. Results: male patients (53.80 %) and the age group of 65 to 74 years with 33.15 % predominated. The main risk factor was arterial hypertension (58.29 %) and atherothrombotic cerebral infarction prevailed with 47.83 % as the clinical form of presentation. Respiratory infections (28 %) were the ones with the highest incidence in terms of complications. 92.93 % of the patients were discharged alive. Conclusions: hypertensive patients over sixty years of age, admitted with atherothrombotic cerebral infarction, predominated.

Adverse psychological state and its influencing factors in patients with dysphagia after cerebral stroke / 中华健康管理学杂志

Objective:To analyze the adverse psychological state and its influencing factors in patients with dysphagia after cerebral stroke.Methods:In this cross-sectional survey, 120 patients with dysphagia after cerebral stroke in the Department of Neurology, Stroke Center in Henan Provincial People′s Hospital from January 2021 to March 2022 were selected with convenience sampling method for questionnaire survey. The depression anxiety stress scale-21 (DASS-21), family adaption partnership growth affection resolve index (APGAR) and social support rating scale (SSRS) were used to evaluate the adverse psychological state, family care degree and social support in those patients. And general data of the patients were collected too. A total of 120 questionnaires were sent out and reclaimed, among them 116 were valid. One patient withdrew from the study on his own. Finally, 115 patients were included as research objects. Analysis of variance and LSD-t test were used to compare the adverse psychological state of patients with different characteristics, Pearson correlation analysis was used to analyze the correlation between adverse psychological state and family care and social support. The multivariate linear regression analysis was used to analyze the influencing factors of adverse psychological state in patients with dysphagia after cerebral stroke. Results:The total DASS-21 score in the 115 patients with dysphagia after stroke was (43.32±6.58) points, of which, it was (16.02±3.45) points in the depression dimension, (14.55±3.27) points in anxiety dimension, (12.75±4.01) points in stress dimension; the total score of APGAR was (5.15±0.87) points, the total score of SSRS was (28.75±5.16) points. Family care and social support were both negatively correlated with adverse psychological state in those patients ( r=-0.514, -0.433, both P<0.05). Marital status, per capita monthly income, number of complications, family care and social support were the influencing factors of adverse psychological state in patients with dysphagia after cerebral stroke (β′=0.501, -0.365, 0.234, -0.269, -0.372, all P<0.05). Conclusions:Patients with dysphagia after cerebral stroke have a higher degree of adverse psychological state. Marital status, per capita monthly income, complications, family care and social support can affect the mental health in those patients.

Cuidados de enfermería para reducir el riesgo de hemorragia en pacientes con trombolisis por ICTUS isquémico

Objetivo: Describir las intervenciones de enfermería en pacientes con trombolisis en ictus isquémico para reducir el riesgo de hemorragia. Metodología: Investigación secundaria, revisión; integrativa. Se realizó una pregunta con la estrategia PICO: ¿Cuáles son las intervenciones de enfermería en pacientes con trombolisis en ictus isquémico para reducir el riesgo de hemorragia antes, durante y después de trombolizar al paciente? Se construyó una ecuación de búsqueda utilizando booleanos, DeCS/MeSH para facilitar la búsqueda en bases de datos. Los artículos encontrados fueron leídos críticamente y clasificados por nivel de evidencia y grados de recomendación. Estudio sin riesgo ético por ser de tipo documental. Se respetaron los derechos de autor de acuerdo con la Ley 44 de 1993. Resultados: Con las 14 unidades de análisis finales fueron construidos 3 dominios que realzan la importancia de los conocimientos y el actuar del personal de enfermería en la reducción del riesgo de hemorragia en pacientes con ictus isquémico. Dichos dominios son: 1) control y monitorización de la tensión arterial; principal cuidado de enfermería antes, durante y después de la trombolisis, 2) terapia combinada; disminución de riesgos hemorrágicos - aumento de la ventana terapéutica, 3) dosificación segura de alteplasa en situaciones contraindicadas. Conclusiones: La intervención de enfermería más significativa durante esta terapia es la monitorización y control de las cifras tensionales, debido a que su aumento mayor a 185/110 mmHg es el factor de riesgo más significativo en la aparición de hemorragias.

Objective: Describe nursing interventions in patients with thrombolysis in ischemic stroke to reduce the risk of bleeding. Methodology: Secondary research, type of review; integrative. A question was asked with the PICO strategy: What are the nursing interventions in patients with thrombolysis in ischemic stroke to reduce the risk of bleeding before, during, and after thrombolyzing the patient? A search equation was constructed using Boolean, DeCS / MeSH to facilitate database searching. The articles were critically read and classified by level of evidence and degrees of recommendation. Study without ethical risk because it is documentary type, copyright was respected according to Law 44 of 1993. Results: With the 14 final analysis units, 3 domains were constructed that highlight the importance of knowledge and the actions of the nursing staff in reducing the risk of bleeding in patients with ischemic stroke. These domains are: 1) control and monitoring of blood pressure; main nursing care before, during, and after thrombolysis, 2) combined therapy; decreased bleeding risks - increased therapeutic window, 3) safe dosage of alteplase in contraindicated situations. Conclusions: The most significant nursing intervention during this therapy is the monitoring and control of blood pressure figures, since and increase larger than 185/110 mmHg is the most significant risk factor in the appearance of bleeding.

Endarterectomía carotídea, resultados a mediano y largo plazo / Carotid endarterectomy, medium to long-term results

Resumen Introducción: Entre el 50% al 80% de los pacientes con un ictus, presentan lesión de la arteria carótida común o interna, de estos un 15% a 30% quedan con discapacidad severa, y el 20% requiere de institucionalización. Objetivo: Analizar las variables epidemiológicas involucradas en la estenosis carotídea y los resultados a mediano-largo plazo de la endarterectomía carotídea. Materiales y Método: Estudio observacional, descriptivo y retrospectivo, donde se analizan 103 endarterectomías carotídeas sucesivas, realizadas en 97 pacientes, en un período de 12 años (2007 a 2018), en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo masculino 64,9%, edad promedio 70,2 años, sintomáticos 65,9%, presentación clínica más frecuente el ataque isquémico transitorio (48,4%), morbilidad global inmediata del procedimiento 20,3%, AVE perioperarorio 3,9% (ninguno discapacitante), disfunción de nervios periféricos 5,8%, mortalidad operatoria 70% y cuando se efectúa en un plazo menor a 2 semanas del evento isquémico. Conclusión: La endarterectomía carotídea sigue siendo el procedimiento quirúrgico de elección para tratar la estenosis carotídea severa; realizada en centros con experiencia, es un procedimiento seguro y eficaz en la prevención del infarto cerebral.

Introduction: Between 50 and 80% of patients with a stroke, have lesions of the common or internal carotid artery, of these 15 to 30% are severely disabled, and 20% require institutionalization. Aim: To analyze the epidemiological variables involved in carotid stenosis, and the medium to long-term results of carotid endarterectomy. Materials and Method: Observational, descriptive and retrospective study, analyzed 103 successive carotid endarterectomies procedures in 97 patients, in a period of 12 years (2007 to 2018), in the Surgery Department of the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Male sex 64.9%, average age 70.2 years, symptomatic 65.9%, most frequent clinical presentation, transient ischemic attack (48.4%), immediate global morbidity of the procedure 20.3%, peri-operative AVE 3.9% (none disabling), peripheral nerve dysfunction 5.8%, operative mortality 70%, and when performed within a period less than 2 weeks of the ischemic event. Conclusion: Carotid endarterectomy remains the surgical procedure of choice, to treat severe carotid stenosis, performed in experienced centers, it is a safe and effective procedure in the prevention of cerebral ischemia.

Clinical Effect of Modified Ditantang Combined with Acupuncture on Syndrome of Phlegm and Blood Stasis Blocking Collaterals of Dysphagia After Apoplexy / 中国实验方剂学杂志

Objective:To explore the clinical efficacy of modified Ditantang combined with acupuncture in the treatment of dysphagia after apoplexy （DAS） syndrome of phlegm and blood stasis blocking collaterals. Method:One hundred and eight patients were randomly divided into control group （54 cases） and observation group （54 cases） by number table. Both groups underwent nutritional management，rehabilitation training and acupuncture. Patients in control group additionally took Tongluo Huatan capsules， 3 granules/time， 3 times/day， while patients in observation received modified Ditantang. Both groups had two weeks of treatment. The Kubota's drinking water test， swallowing contrast examination （VFSS）， and standard swallowing function assessment （SSA） were conducted. Swallowing disorder specific quality of life scale （SWAL-QOL） and sputum collateral stasis syndrome were scored before and after treatment. The levels of brain-derived neurotrophic factor （BDNF）， nerve growth factor （NGF） and neuron-specific enolase （NSE） before and after treatment. The occurrence of pneumonia， malnutrition， dehydration and aspiration were then recorded. Result:The clinical effective rate was （47/49） 95.92%in the observation group， higher than （41/50） 82.00% in the control group's （<italic>χ</italic>²=4.854，<italic>P</italic><0.05）. The grade of Kubota's drinking water test in observation group was lower than that in the control group（<italic>Z</italic>=2.211，<italic>P</italic><0.05）. VFSS swallowing dysfunction in observation group was lighter than that in control group（Z=1.969，<italic>P</italic><0.05）. The scores of Kubota's drinking water test， SSA and phlegm and blood stasis blocking collateral syndrome in the observation group were all lower than those in the control group（<italic>P</italic><0.01）， while the VFSS score was higher than that in control group （<italic>P</italic><0.01）. The swallowing symptom score， other symptom scores and total SWAL-QOL scores of the observation group were higher than those of the control group（<italic>P</italic><0.01）. The levels of BDNF and NGF in the observation group were higher than those in the control group （<italic>P</italic><0.01）， but the NSE level was lower than that in the control group（<italic>P</italic><0.01）. The complication rate in the observation group was （6/49）12.24%， which was lower than （15/50）30.00% in the control group（<italic>χ</italic>²=4.668，<italic>P</italic><0.05）. Conclusion:On the basis of nutrition management and rehabilitation training， modified Ditantang combined with acupuncture can reduce the risk of dysphagia and aspiration， improve the degree of neurological deficits， improve the quality of life， and reduce complications in treatment of DAS syndrome of phlegm and blood stasis， with significant clinical efficacy.

Enfermedad cardioembólica cerebral a partir de un tumor primario de cavidades cardíacas izquierdas / Cerebral cardioembolic disease from a primary tumor of the left heart chambers

Introducción: De los tumores cardiacos primarios, el 75 por ciento son benignos y más de la mitad corresponde a mixomas. Pueden ser asintomáticos o generar manifestaciones cardíacas, sistémicas o embólicas, estas últimas frecuentes. Objetivo: Divulgar la importancia de tener presente el tumor primario cardiaco como causa de enfermedad embólica cerebral. Caso clínico: Hombre de 53 años de edad, con mareos, cefalea, malestar general, decaimiento, dolores articulares, palpitaciones, disnea y ortopnea. Sufrió pérdida de la conciencia y posteriormente pérdida de la fuerza muscular del hemicuerpo izquierdo debido a un accidente vascular encefálico de tipo embólico. Con el ecocardiograma transtorácico, se confirmó el diagnóstico de un tumor primario cardiaco. Después de la operación, se comprobó en anatomía patológica, que era un mixoma. Conclusiones: El mixoma es un tumor que puede producir fenómenos cardioembólicos y se debe tener presente en pacientes como el que se presenta(AU)

Introduction: Of the primary cardiac tumors, 75 percent are benign and more than half correspond to myxomas. They can be asymptomatic or generate cardiac, systemic or embolic manifestations, the latter frequent. Objective: To remark the importance of considering the primary cardiac tumor as a cause of cerebral embolic disease. Clinical case: 53-year-old man with dizziness, headache, general malaise, weakness, joint pain, palpitations, dyspnea and orthopnea. He suffered loss of consciousness and later loss of muscle strength in the left half of the body due to an embolic-type stroke. With the transthoracic echocardiogram, the diagnosis of a primary cardiac tumor was confirmed. After the operation, it was verified in pathological anatomy, that it was a myxoma. Conclusions: Myxoma is a tumor that can produce cardioembolic phenomena and must be taken into account in patients like the one presented(AU)

Síndrome de Ogilvie asociado a hospitalización prolongada en un paciente con evento vascular cerebral isquémico. Reporte de un caso / Ogilvie Syndrome Associated with Prolonged Hospitalization in a Patient with an Ischemic Cerebrovascular Event. Case Report

Resumen Introducción: El síndrome de Ogilvie o seudoobstrucción colónica aguda es la dilatación aguda del colon, sin evidencia de obstrucción mecánica, y se atribuye a un desbalance autonómico de la inervación motora del colon. Es común en pacientes hospitalizados con comorbilidades importantes. Su manejo es escalonado, reservando el manejo quirúrgico para los casos refractarios al manejo médico inicial o con presencia de complicaciones como perforación y datos de sepsis. Caso clínico: Presentamos el caso de un paciente del sexo masculino, de 69 años de edad, quien acudió al servicio de urgencias en el contexto de evento vascular cerebral, quien cursó con intubación prolongada, iniciado a los 17 días de su ingreso, con distensión abdominal refractaria a manejo médico, con dilatación colónica importante, corroborada por tomografía de abdomen, por lo que se decidió manejo quirúrgico. Conclusiones: Es importante hacer diagnóstico precoz de este síndrome para evitar complicaciones propias de la enfermedad, así como de la cirugía. Importante hacer diagnóstico con otras causas de oclusión y tener un alto índice de sospecha al tratarse de un diagnóstico de exclusión.

Abstract Introduction: Ogilvie's syndrome or acute colonic pseudo-obstruction is the acute dilation of the colon without evidence of mechanical obstruction and is attributed to an autonomic imbalance of motor innervation of the colon. It is common in hospitalized patients with significant comorbidities. Its management is staggered, reserving surgical management for cases refractory to initial medical management or with the presence of complications such as perforation and sepsis data. Case report: We present the case of a 69-year-old male patient who went to the emergency service in the context of a cerebral vascular event. He underwent prolonged intubation, which began 17 days after his admission with abdominal distention refractory to medical management, with significant colonic dilation corroborated by abdominal tomography, so it was decided to manage it surgically. Conclusions: It is important to make an early diagnosis of this syndrome to avoid complications of the disease, as well as surgery. It is important to make a differential diagnosis with other causes of occlusion and have a high index of suspicion since it is a diagnosis of exclusion.

Distributions of MTHFR C677T gene polymorphism among cerebral stroke patients in southern Anhui province / 中国临床药理学与治疗学

AIM: To investigate and analyze the distribution characteristic of 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism among cerebral stroke patients and to provide prevention and treatment for stroke patients in southern Anhui Province. METHODS: A total of 114 patients with cerebral stroke in the Second Affiliated Hospital of Wannan Medical College from January 2018 to October 2019 were included. The MTHFR C677T genotype was performed by fluorescence in situ hybridization analysis. The MTHFR C677T gene polymorphism distribution data of the cerebral stroke population in southern Anhui Province was compared with the reported gene distribution data of Han Chinese stroke population in other parts of China. RESULTS:The frequencies distribution of TT, CT and CC genotypes of MTHFR C677T were 28.90%, 50.00%, 21.10%. The frequencies of C and T alleles were 53.95% and 46.05%. There was no gender difference in the distribution of this gene. There were significant difference in CC genotype between Chongqing area, Heilongjiang area and Guangzhou area (P<0.05). There were significant difference in TT genotype between Chongqing area, northern Henan area and Heilongjiang area (P<0.05). CONCLUSION: The distribution of MTHFR C677T gene polymorphism in the Han population of southern Anhui Province is different from other areas. It can provide a scientific basis for the prevention and treatment of cerebral stroke in high-risk population in southern Anhui Province by genetic testing technology.

Efficacy, prognosis and causes of recurrent epileptic seizures after antiepileptic drug monotherapy and combination therapy for senile post-stroke seizures / 中国基层医药

Objective To investigate the effect of single antiepileptic drugs(AEDs) and combination therapy on the effect of seizure after stroke,prognosis and recurrent seizures.Methods From November 2013 to December 2017,280 patients with epilepsy and epilepsy that had been included in the epilepsy course and AEDs course for ＞6 months in Shaoxing Central Hospital were divided into early-onset epilepsy group and late-onset epilepsy group according to the patients' condition,with 140 cases in each group.According to different AEDs treatment regimens,they were further divided into monotherapy group(valproate) and combination therapy group(valproate,oxcarbazepine combined with levetiracetam).Results The proportion of monotherapy in the early-onset epilepsy group was significantly higher than that of the late-onset epilepsy group,and the proportion of the late-onset epilepsy group was significantly higher than that of the early-onset epilepsy group(x2 =22.857,P ＜ 0.0001).The incidence and effectiveness of epilepsy patients after single-agent and combination therapy in the early-onset epilepsy group had statistically significant differences [onset rate:40.0％ (36/90) vs.16.0％ (8/50),x2 =8.591,P =0.003;effective rate:88.9％(80/90) vs.100.0％ (50/50),x2 =5.983,P =0.014].The incidence and effectiveness of single-agent and combination therapy in the late-onset epilepsy group had statistically significant differences [seizure rate:40.0％(20/50) vs.82.2％ (74/90),x2 =25.974,P =0.000;effective rate:64.0％ (32/50) vs.87.8 ％ (79/90),x2 =1 1.065,P =0.000].Conclusion The time of post-stroke epilepsy is not related with the site,type and risk factors of stroke;early epilepsy usually manifested partial seizures and had better curative effect of AEDs,and late epilepsy usually manifested overall tonic clonic seizure;there were no obvious difference in curative effect and recurrence rate of early and late epilepsy on single and combined AEDs treatment.

Efficacy, prognosis and causes of recurrent epileptic seizures after antiepileptic drug monotherapy and combination therapy for senile post-stroke seizures / 中国基层医药

Objective@#To investigate the effect of single antiepileptic drugs(AEDs) and combination therapy on the effect of seizure after stroke, prognosis and recurrent seizures.@*Methods@#From November 2013 to December 2017, 280 patients with epilepsy and epilepsy that had been included in the epilepsy course and AEDs course for>6 months in Shaoxing Central Hospital were divided into early-onset epilepsy group and late-onset epilepsy group according to the patients' condition, with 140 cases in each group.According to different AEDs treatment regimens, they were further divided into monotherapy group(valproate) and combination therapy group(valproate, oxcarbazepine combined with levetiracetam).@*Results@#The proportion of monotherapy in the early-onset epilepsy group was significantly higher than that of the late-onset epilepsy group, and the proportion of the late-onset epilepsy group was significantly higher than that of the early-onset epilepsy group(χ2=22.857, P<0.0001). The incidence and effectiveness of epilepsy patients after single-agent and combination therapy in the early-onset epilepsy group had statistically significant differences[onset rate: 40.0%(36/90) vs.16.0%(8/50), χ2=8.591, P=0.003; effective rate: 88.9%(80/90) vs.100.0%(50/50), χ2=5.983, P=0.014]. The incidence and effectiveness of single-agent and combination therapy in the late-onset epilepsy group had statistically significant differences [seizure rate: 40.0%(20/50) vs.82.2%(74/90), χ2=25.974, P=0.000; effective rate: 64.0%(32/50) vs.87.8%(79/90), χ2=11.065, P=0.000].@*Conclusion@#The time of post-stroke epilepsy is not related with the site, type and risk factors of stroke; early epilepsy usually manifested partial seizures and had better curative effect of AEDs, and late epilepsy usually manifested overall tonic clonic seizure; there were no obvious difference in curative effect and recurrence rate of early and late epilepsy on single and combined AEDs treatment.

Effects of different intensity aerobic exercise on coagulation function in stroke patients / 国际检验医学杂志

Objective T he effects of different intensity aerobic exercise on the coagulation function of stroke were investigated by detection coagulation index of stroke patients before and after different intensity of aerobic training.Methods 120 patients with neurological initial stroke were enrolled from January to Decem-ber in 2016.According to the cardiopulmonary exercise test,the patients were divided into medium-intensity aerobic exercise group,low-intensity aerobic exercise group and control group.The control group maintained the basic medical treatment of neurological primary stroke.The medium-intensity aerobic exercise group and low-intensity aerobic exercise group were on the basis of the control group with different intensity by stampe-ding power bike training.The plasma fibrinogen(FIB),D-Dimer(D-D),activated partial thromboplastin time (APTT),prothrombin time(PT),international normalized ratio(INR)and thrombin time(TT)were detected and analyzed before and after exercise training.Results The results showed there were no significant differ-ence in coagulation index between the three groups before exercise training(P>0.05).The levels of FIB and D-D in medium-intensity aerobic exercise group after the training were significantly lower than before the training(P<0.05).The levels of FIB in low-intensity aerobic exercise group after the training were signifi-cantly lower than before the training(P<0.05).There were no significant difference between in others coagu-lation index between two groups(P>0.05).There were no significant difference in coagulation index between before and after the basic treatment in control group(P>0.05).After exercise training,the levels of FIB in the moderate intensity group was significantly lower than the low intensity group(P<0.05),and then the low intensity group was significantly lower than control group(P<0.05).Conclusion The medium and low-intensity aerobic exercise could influence the coagulation function of stroke patients,particularly in the medi-um-intensity.It provided the scientific basis for individual aerobic exercise combined with drugs to prevent stroke recurrence.

Clinical Observation of Abdominal and Wrist-ankle Acupuncture plus Rehabilitation for Hemiplegia After Ischemic Cerebral Stroke / 上海针灸杂志

Objective By taking rehabilitation as the control, to observe the effect of abdominal and wrist-ankle acupuncture plus rehabilitation in restoring the motor and neurological function in hemiplegia due to ischemic cerebral stroke, and to optimize the treatment protocol. Method By adopting a randomized controlled clinical design, a hundred patients diagnosed with hemiplegia after ischemic cerebral stroke were randomized into a treatment group (50 cases) and a control group (50 cases) regarding their visiting sequence. The patients all received basic symptomatic treatment to control blood pressure, improve cerebral circulation, stabilize vital signs and prevent complications. In addition, the treatment group received abdominal and wrist-ankle acupuncture plus kinesiotherapy; the control group received rehabilitation training. The two groups were evaluated for therapeutic efficacy after 2 courses of treatment. Before and after the intervention, the recruited patients were tested by Fugl-Meyer Assessment (FMA), China Stroke Scale (CSS) and Berg Balance Scale (BBS), and the level of homocysteine (Hcy) was also detected. Result The FMA, CSS and BBS scores all showed significant changes after the intervention in the two groups (P<0.05); after the treatment, the FMA, CSS and BSS scores in the treatment group were significantly different from those in the control group (P<0.05), and there were significant between-group differences in comparing the score differences of FMA,CSS and BBS (P<0.05). The two groups both showed decrease of Hcy, (11.68±4.53)μmol/L in the treatment group versus (13.53±4.01)μmol/L in the control group, and the between-group difference was statistically significant (P<0.05). Conclusion Compared to rehabilitation alone, abdominal and wrist-ankle acupuncture plus kinesiotherapy can produce a more significant efficacy in treating hemiplegia due to ischemic cerebral stroke.

Effect of Contralateral Acupuncture on Motor Function in Acute Stroke Patients / 上海针灸杂志

Objective To investigate the clinical efficacy of contralateral acupuncture in treating motor dysfunction in patients with acute ischemic stroke.Methods Sixty patients with acute ischemic stroke were randomized to treatment and control groups, 30 cases each. Both group received electroacupuncture in addition to conventional rehabilitation training. Besides, the treatment group received electroacupuncture at points on the healthy side in the morning and on the affected side in the afternoon and the control group, electroacupuncture at points on the affected side in both the morning and afternoon. Motor function was assessed using the Fugl-Meyer Assessment (FMA), the modified Barthel Index (MBI), integrated electromyography (iEMG) and median frequency (MF) in the two groups of patients before and after treatment.Results There were statistically significant pre-/post-treatment differences in the FMA score, the MBI score, iEMG and MF in the two groups (P<0.01). There were statistically significant post-treatment differences in the FMA score, the MBI score and iEMG between the treatment and control groups (P<0.01,P<0.05).ConclusionContralateral and healthy side acupuncture can markedly improve motor function in acute stroke patients.

Effect of Acupuncture plus Rehabilitation Training on Upper Limb Functional Recovery in Stroke Patients / 上海针灸杂志

Objective To investigate the effect of acupuncture plus rehabilitation training on upper limb functional recovery in convalescent stroke patients.Methods One hundred and three convalescent stroke patients with upper limb motor dysfunction were randomized to a treatment group (54 cases) and a control groups (49 cases). Both group received conventional rehabilitation training. In addition, the treatment group received along-meridian syndrome differentiation-based acupuncture and the control group, sham acupuncture. Upper limb Fugl-Meyer Assessment (U-FMA) score, the Wolf Motor Function Test (WMFT) score, the modified Barthel Index (MBI) score and the 36-Item Short Form Health Survey (SF-36) score were recorded in the two groups of patients before and at the end of treatment and at the 3-month follow-up.Results In the two groups there were statistically significant differences in the U-FMA score, the WMFT score and the MBI score at the end of treatment and the 3-month follow-up compared with before (P>0.05 orP<0.01). At the end of treatment and the 3-month follow-up there were statistically significant differences in the U-FMA score, the WMFT score and the MBI score between the treatment and control groups (P<0.05 orP<0.01). The scores of SF-36 items except social functioning and bodily pain had statistically significant differences within the two groups at the end of treatment and the 3-month follow-up compared with before and between the two groups at the end of treatment and the 3-month follow-up (P<0.01 orP<0.05).Conclusion Acupuncture plus rehabilitation training can markedly improve upper limb function in stroke patients.

Proteomics analysis on brain cortex of ischemic cerebral stroke in rats / 复旦学报（医学版）

Objective To explore brain cortex proteomics changes during ischemic cerebral stroke (ICS),and to seek the biomarkers associated with ICS.Methods A total of 42 male SD rats were randomly divided into sham group (n =12) and ICS group (n =30).ICS model was induced by distal middle cerebral artery occlusion.Brain cortex tissues were collected at 1,6,24 and 48 h after ICS,respectively,after cerebral ischemia.Samples from different groups were subjected to tandem mass tag (TMT)-based quantitative proteomics analysis for identification of differentially expressed proteins.Gene Ontology enrichment analysis was utilized to classify the differentially expressed proteins.Western blot was used to verify the quantitative proteomics results.Results Compared with sham group,25 proteins were considered to be differentially expressed in ICS group.Gene Ontology enrichment analysis revealed that the differentially expressed proteins were related to acute-phase response,inflammatory response,lipoprotein metabolic process,complement activation,classical pathway and innate immune response.The expression change of heat shock protein 27 (HSP27) was basically consistent with the quantitative proteomics results.Conclusions These 25 differentially expressed proteins may serve as potential biomarkers for ICS.

Caracterización de pacientes geriátricos con demencia vascular. Sancti Spíritus / Characterization of geriatric patients with vascular dementia. Sancti Spíritus

Fundamento: La demencia vascular constituye una afección incapacitante en la senectud. Objetivo: Caracterizar los pacientes geriátricos que sufren demencia vascular, atendidos en la consulta de enfermedad cerebrovascular del Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus. Metodología: Se realizó un estudio descriptivo en 102 pacientes con demencia vascular, de una población de 621 ancianos desde enero de 2008 a diciembre del 2012. Se determinó el tiempo de evolución entre la enfermedad cerebrovascular y la aparición de la demencia, topografía del infarto, extensión y grado de dependencia; así como la edad y el color de la piel. Resultados: Predominaron los pacientes masculinos (66,7 %) y los de piel negra (81,4 %). Hubo ligero influjo en los que desarrollaron la enfermedad entre 3 y 5 años (46,1 %). Los infartos corticales (77,5 %) y múltiples (75,5 %) fueron la mayoría, y predominaron los pacientes con afectación del validismo (56,9 %). Conclusiones: El espectro clínico constituye la herramienta fundamental en el diagnóstico y manejo de los pacientes con demencia vascular, donde el tiempo de evolución y la raza son relevantes, no así los estudios imaginológicos que requieren investigaciones más detalladas.

Background: Vascular dementia is a disabling condition in aged. Objective: To characterize the geriatric patients suffering from vascular dementia, attended at the cerebrovascular disease clinic of the General Provincial Hospital Camilo Cienfuegos from Sancti Spíritus. Methodology: A descriptive study was carried out in 102 patients with vascular dementia from a population of 621 aged from January 2008 to December 2012. The time of evolution between cerebrovascular disease and the appearance of dementia was determined. Topography of the stroke, extent and degree of dependence; as well as the age and color of the skin. Results: Male patients (66.7 %) and those with black skin (81.4 %) predominated. There was a slight influx in those who developed the disease between 3 and 5 years (46.1 %). Cortical (77.5 %) and multiple (75.5 %) strokes were the majority, and patients with validation impairment predominated (56.9 %). Conclusions: The clinical spectrum is the fundamental tool in the diagnosis and management of patients with vascular dementia, where the time of evolution and race are relevant, but not the imaging studies that require more detailed investigations.

Analysis on value of combined detection of Hcy,hs-CRP and Lp-PLA2 in diagnosis of ischemic cerebral stroke / 国际检验医学杂志

Objective To analyze the significance of levels and combined detection of plasma homocysteine(Hcy),high-sensitivity C reactive protein(hs-CRP) and lipoprotein-associated phospholipase A2(Lp-PLA2) in patients with ischemic cerebral stroke(ICS).Methods A total of 140 patients with ICS were selected into ICS group,and 100 healthy individuals were recruited in the control group.The plasma levels of Hcy,hs-CRP,Lp-PLA2 were examined,then the positive rates of them were statistically analyzed.Analyzed the value of the levels and joint detection of Hcy,hs-CRP and Lp-PLA2.Results The plasma levels and the positive rates of Hcy,hs-CRP and Lp-PLA2 in ICS group were statistically higher than those in the control group(P<0.05).The area under the receiver-operating characteristic curve of combined detection of Hcy,hs-CRP and Lp-PLA2 in diagnosis of ICS was 0.949,the sensitivity was 0.850,and the specificity was 0.807,which were higher than Hcy,hs-CRP and Lp-PLA2 alone.Conclusion The plasma levels of Hcy,hs-CRP and Lp-PLA2 increase in ICS patients,and the combined detection of the three indicators might improve the early diagnostic value of ICS.

Dual effect of microglia on ischemic stroke: a review / 中国药理学与毒理学杂志

Ischemic brain injury is the main cause of high mortality,high disability and high recurrence rates in ischemic stroke.The activation and differentiation of microglia are associated with inflammatory responses of ischemic brain injury,playing an important role in the occurrence,development and outcome of ischemic stroke.In addition,there is no effective treatment for ischemic stroke.Thus,it is of clinical significance to investigate regulatory mechanisms of microglia for ischemic stroke treatment.This review introduces the dual effect of microglia on ischemic stroke and research progress in associated treatment for ischemic stroke,hoping to provide new ideas for investigating targeted intervention therapies.

Function of N-Methyl-D-Aspartic Acid Receptors in Cerebral Stroke / 中国药学杂志

Cerebral stroke is caused by the interrupt of blood supply either by the blockage or by the rupture of the brain blood vessels. After the activation of the ischemic cascades, a series of neurochemical reactions might occur which involves the excess release of the excitatory amino acids. The ionotropic glutamate receptor of N-methyl-D-aspartic acid subtype (NMDA receptor) has been proven to play dual roles in the ischemic insults. On one hand, NMDA receptor has been proven to initiate the ischemic impairment, leading to the neuronal death. On the other hand, NMDA receptor is involved in the endo-neurogenesis process after the ischemic onset. Herein, we summarized the recent studies about the structures and functions of NMDA receptor in ischemic stroke pathogenesis.

Clinical Observation of Acupuncture at Acupoints Selected byNa Jia Method for Lower-limb Spastic Hemiplegia after Cerebral Stroke / 上海针灸杂志

Objective To observe the effect of acupuncture at acupoints selected byZi Wu Liu Zhu Na Jia point-selection card invented by professor ZHOU Ming-xin method (midnight-noon ebb-flow) in improving lower-limb spastic hemiplegia after cerebral stroke.Method Eighty-four patients with lower-limb spastic hemiplegia after cerebral stroke were randomized into a treatment group, a control group, and a blank group by using random number table method, 28 cases in each group. The blank group was only given rehabilitation; the control group was treated with ordinary acupuncture in addition to rehabilitation; the treatment group was intervened by acupuncture at acupoints selected byZi Wu Liu Zhu Na Jia method in addition to the intervention given to the control group. The Ashworth Scale, Activities of Daily Living (ADL) in Barthel Index (BI) and simplified Fugl-Meyer Assessment (FMA) of lower-limb function were observed before and after the intervention. Result After the treatment, the simplified FMA scores were changed significantly in the three groups (P<0.01). After the treatment, the between-group differences in comparing the simplified FMA score were statistically significant (P<0.01), and the treatment group was superior to both the control group and blank group (P<0.01), while the difference between the control group and blank group was statistically insignificant (P>0.05). The ADL from BI and Ashworth scores were significantly changed after the treatment in the three groups (P<0.01,P<0.05). After the treatment, the between-group differences in comparing the ADL score and Ashworth grading were statistically significant (P<0.01), and the therapeutic efficacy was the best in the treatment group (P<0.01,P<0.05).Conclusion Acupuncture at acupoints selected byZi Wu Liu Zhu Na Jia method plus ordinary acupuncture and rehabilitation is effective in improving muscular tension, enhancing lower-limb motor function and the quality of life; theZi Wu Liu Zhu point-selection card is easy-to-operate and has a high accuracy, thus suitable for application and promotion in clinic.