Risk assessment of ischemic stroke associated pneumonia.

BACKGROUND: Cerebral stroke is a disease with a high disability rate and a high fatality rate. This study was undertaken to assess the risk of stroke associated pneumonia (SAP) in patients with ischemic stroke using A2DS2 score. METHODS: Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows: age ≥75 years=1, atrial fibrillation=1, dysphagia=2, male sex=1; stroke severity: NIHSS score 0-4=0, 5-15=3, ≥16=5. The patients were divided into three groups according to A2DS2 score: 620 in score 0 group, 383 in score 1-9 group, and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows: newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection: (1) fever ≥38 °C; (2) newly occurred cough, productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain; (3) signs of pulmonary consolidation and/or wet rales; (4) peripheral white blood cell count ≥10×10(9)/L or ≤4×10(9)/L with or without nuclear shift to left, while excluding some diseases with clinical manifestations similar to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease, pulmonary edema, pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data. RESULTS: The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1-9 and score 0 groups (71.7% vs. 22.7%, 71.7% vs. 3.7%, respectively), whereas the mortality in the score≥10 group was significantly higher than that in the score 1-9 and score 0 groups (16.7% vs. 4.96%, 16.7% vs. 0.3%, respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were significantly higher than those in the SAP group and in the non-SAP group (35.1% vs.10.1%, 11.4% vs. 7.5%, respectively). The incidence of non-fermentative bacteria infection was significantly increased in the score≥10 group. CONCLUSIONS: A2DS2 score provides a basis for risk stratification of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.

[Screening of key genes and inflammatory signalling pathway involved in the pathogenesis of HLA-B27-associated acute anterior uveitis by gene expression microarray].

OBJECTIVE: To investigate the genes and signalling pathways located upstream of the inflammatory processes in human leukocyte antigen (HLA)-B27-associated acute anterior uveitis by gene expression microarray. METHODS: Experimental study. HLA-B27-positive and-negative monocytes isolated from human peripheral blood were stimulated with Vibrio cholera lipopolysaccharide (LPS). Gene expression microarrays were used to identify the differentially expressed genes. Differentially expressed (DE) genes were testified by real-time PCR and analyzed by a series of bioinformatics-based techniques such as Gene Ontology, Kyoto Encyclopedia of Genes and Genomes. RESULTS: Gene expression microarray analysis revealed marked differences between HLA-B27-positive acute anterior uveitis (AAU) and HLA-B27-negative healthy control peripheral monocytes in the genes that were upregulated in response to LPS stimulation with 1105 genes and 25 genes respectively. Gene Ontology enrichment and pathway analysis indicated that genes participating in protein transport and folding were essential to the inflammatory process. The LPS receptor-Toll-like receptor (TLR)4 induced TLR signalling pathway and pathway related to Vibrio cholerae infection were located upstream of the network and contribute to the overall response. Among the DE genes, PIK3CA, PIK3CB, AKT3, and MAPK1 might play critical roles in inflammation. CONCLUSIONS: Equivalent LPS stimulation induces a different response in HLA-B27-positive peripheral monocytes compared to normal control, suggesting that the TLR pathway is involved in the pathogenesis of HLA-B27-associated AAU.

Enhancement of axonal regeneration of retinal ganglion cells in adult rats by etomidate: involvement of protein kinase C.

PURPOSE: To investigate the effect of etomidate (ET) on axonal regeneration of retinal ganglion cells (RGCs) in adult rats. METHODS: The optic nerve was transected intraorbitally at 1 mm from the optic disc, and an autologous peripheral nerve was transplanted onto the ocular ON stump in adult rats. Then the animals were treated with ET, Gö6976, ET combined with Gö6976, phorbol-12-myristate-13-acetate (PMA), or ET combined with PMA. Four weeks after grafting, the number of regenerating RGCs labeled retrogradely with neuronal retrograde tracer was counted in all animals, and the activity of membrane protein kinase C (mPKC) and cytoplasmic PKC (cPKC) was measured in ET-treated animals. RESULTS: The number of regenerating RGCs significantly increased when the dose of ET was increased from 2 mg/kg to 6 mg/kg, whereas the ratio of mPKC activity to cPKC activity significantly decreased in ET-treated animals. Gö6976, a potent conventional PKC inhibitor, also significantly increased the number of regenerating RGCs. However, the number of regenerating RGCs in animals treated with Gö6976 alone was significantly lower than in those treated with ET at 6 mg/kg. Combined treatment with ET at 6 mg/kg and Gö6976 did not increase the number of regenerating RGCs. In contrast, PMA, a potent PKC activator, partially abolished the positive effect of ET on the axonal regeneration of axotomized RGCs. CONCLUSIONS: These results suggest that ET promotes axonal regeneration of RGCs in adult rats, in part by inhibiting conventional PKC.

[Anatomy of the sphenoidal sinus in transsphenoidal approach through a single nostril].

OBJECTIVE: To study the anatomy of the sphenoid sinus for safe pituitary adenoma resection via transsphenoidal approach through a single nostril. METHODS: Eight fresh adult cadavers and the magnetic resonance images (MRI) of the sphenoidal sinus of 5 adults were observed. In anteroposterior axes, the root of the nasal columella was defined as the point O, the inferior border of the sphenoidal sinus anterior wall as point B, the superior border of the spheniodal sinus anterior wall as point C, and the midpoint of the sellar floor as point D. Line OA ran through the point O in parallel with the maxillary alveolar process. Angle AOB', angle AOC' and angle AOD' were the supplementary angles of angle AOB, angle AOC and angle AOD respectively, and angle AOB', angle AOC', angle AOD', OB, and BC were measured. RESULTS: In the 8 fresh adult cadavers, angle AOB', angle AOC', angle AOD', OB, and BC were (43.2+/-4.3) degrees, (22.9+/-3.0) degrees, (35.4+/-4.1) degrees, 66.3+/-3.6 mm, and 20.9+/-1.5 mm, respectively, with 2 cases having ethmoid cell superior to the sphenoid bone; in the MRI of 50 adults, the measurements were (44.1+/-5.5) degrees, (25.7+/-6.4) degrees, (34.2+/-5.9) degrees, 68.7+/-4.9 mm, and 23.3+/-3.1 mm, respectively, with 15 cases having ethmoid cell superior to the sphenoid bone. Two independent-sample t test and Chi-square test revealed no significant differences in the measurements between the two groups (P>0.05). CONCLUSION: Preoperative MRI facilitates safe opening of the anterior wall of the spheniodal sinus and the sellar floor, and the best angle between the axis of the speculum and line OA was 39 degree.