Infarct morphology assessment in patients with carotid artery/middle cerebral artery occlusion using fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH).

We aim to evaluate the value of fast fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) in assessing infarct morphology in patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions. Magnetic resonance (MR) diffusion-weighted imaging (DWI) FLAIR sequences, and carotid/cerebral magnetic resonance angiography of 102 patients with symptomatic ICA or MCA occlusions were evaluated. The location and score of FVH were determined using Olindo's method; patients were classified as having Low or High FVHs based on FVH score, and either Distal or Proximal FVH based on FVH location. The differences between infarct morphologies were analyzed. FVH were detectable in 62 patients with High FVH and in 40 patients with Low FVHs based on the Olindo's scale. There were no statistically significant differences in age, gender, hypertension, diabetes, hyperlipidemia, smoking history, and vascular occlusive site between High and Low FVHs patients, except for infarct morphology (P<0.01). Patients with Distal FVH presented with significant (P<0.01) perforating artery and border zone infarcts, whereas those with Proximal FVH had significant (P<0.01) large territorial infarcts. The scores and locations of FVH could be a predictive imaging marker for infarct morphology in patients with symptomatic ICA or MCA occlusion.

The effect of IGF2BP2 gene polymorphisms on pioglitazone response in Chinese type 2 diabetes patients.

BACKGROUND: Genome-wide association studies identified that insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2) genetic polymorphisms are related to type 2 diabetes mellitus (T2DM) in several populations. This study aimed to investigate whether the IGF2BP2 gene rs1470579 and rs4402960 polymorphisms were associated with T2DM and pioglitazone efficacy in Chinese T2DM patients. METHODS: A total of 281 T2DM patients and 111 healthy volunteers were enrolled to identify the IGF2BP2 gene rs1470579 and rs4402960 polymorphisms; 86 patients were randomly selected and given a 12-week pioglitazone treatment (30 mg/day). Fasting plasma glucose, postprandial plasma glucose (PPG), glycated hemoglobin, serum triglycerides (TG), total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol (HDL-C) were determined before and after pioglitazone treatment. RESULTS: The results showed that the IGF2BP2 gene rs1470579 and rs4402960 polymorphisms were associated with T2DM in a Chinese population (OR = 2.002, 95% CI 1.170-3.426, p < 0.05; OR = 1.879, 95% CI 1.110-3.182, p < 0.05). The effect of pioglitazone on PPG (p < 0.05), TG (p < 0.01) and HDL-C (p < 0.05) was lower in patients with the rs1470579 AC+CC genotypes than in AA genotype carriers. Its effect on PPG level was also lower in patients with the GT+TT genotypes of rs4402960 than in patients with the GG genotype (p < 0.05). CONCLUSIONS: The IGF2BP2 gene rs1470579 and rs4402960 polymorphisms were associated with T2DM and therapeutic efficacy of pioglitazone in this Chinese population.

[Effects of metabolic syndrome on multi-vessel lesions of symptomatic intracranial atherosclerosis].

OBJECTIVE: To explore the effects of metabolic syndrome (MS) on multi-vessel lesions of symptomatic intracranial atherosclerosis. METHODS: During April 2009 and October 2010, a total of 139 consecutive hospitalized patients with symptomatic intracranial atherosclerosis were recruited to undergo magnetic resonance angiography (MRA) or/and CT angiography (CTA) or/and digital subtraction angiography (DSA) to measure the stenotic degree and numbers of intracranial atherosclerosis. They were divided into 2 groups according to lesion numbers: single and multi-vessel lesions. MS was defined by the criteria of the Adult Treatment Panel III to examine the incidences of MS. The risk factors were analyzed for multi-vessel lesions of symptomatic intracranial atherosclerosis to explore the relationship between MS and multi-vessel lesions. RESULTS: Among them, 210 intracranial atherosclerotic lesions were documented. Fifty-nine (42.4%) patients had two or more lesions (group with multi-vessel lesions). The incidence of MS was 70.5%. The rates of MS in groups of single and multi-vessel lesions were 56.3% and 89.8% respectively. And statistical significance existed between two groups (P < 0.001). Moreover, the number of MS components increased gradually with the number of lesions (P < 0.001). For the analysis of individual criteria for MS, only abnormal glycemia was found to be associated with multi-vessel lesions (P = 0.002). And multiple Logistic regression analysis showed that MS was associated with multi-vessel lesions of intracranial atherosclerosis (P = 0.001). CONCLUSIONS: MS is an independent predictor for multi-vessel lesions of intracranial atherosclerosis. And its intervention may be an important preventive strategy for intracranial multi-vessel atherosclerosis.

[Effect of lesion length on in-stent restenosis after intracranial stenting].

OBJECTIVE: To evaluate the effect of lesion length on in-stent restenosis (ISR) after intracranial stenting. METHODS: Between March 2004 and September 2009, 65 patients with symptomatic intracranial arterial stenosis were successfully implanted with single bare metal balloon-mounted stent. All received a conventional angiographic follow-up. The patients were divided into three groups according to lesion length: short lesions (< 5 mm), medium lesions (5-10 mm) and long lesions (> 10 mm). ISR was defined as > 50% stenosis within stent or absolute luminal loss > 20%. The influence of different lesion lengths on ISR was evaluated. Furthermore, the independent predictive factors for ISR were selected. RESULTS: There were short lesions (n = 28), medium lesions (n = 29) and long lesions (n = 8). The median interval of angiographic follow-up was 7 months with a range of 5-30 months. Of 65 patients, 19 (29.2%) had ISR. The ISR rates were 14.3%, 37.9% and 50% in short lesions, medium lesions and long lesions respectively (P = 0.045). Multivariate Cox regression analysis showed that lesion length (HR = 1.210; 95%CI = 1.011-1.446; P = 0.037) and diabetes (HR = 2.630; 95%CI = 1.032-6.705; P = 0.043) were associated with ISR. CONCLUSION: Lesion length and diabetes are two independent predictors for ISR after intracranial stenting.

[A research of migrating motor complex in patients with irritable bowel syndrome].

OBJECTIVES: To compare the migrating motor complex (MMC) in irritable bowel syndrome (IBS) patients with that in healthy controls. To explore whether discrete clustered contractions (DCC) are connected with abdominal pain in IBS patients. To improve the method of measuring gastroenteric motility (esp. jejunum). METHODS: By using 16-channel water-perfused catheter and manometry instruments, MMC in 16 cases of IBS with constipation (IBS-C), 18 cases of IBS with diarrhea (IBS-D) and 18 cases of healthy controls were monitored. RESULTS: The MMC durations of IBS-C and IBS-D patients were (127.5 +/- 25.5) min and (74.5 +/- 18.7) min, respectively. Comparision with those in the control group [(87.5 +/- 24.2) min] showed significant differences (P < 0.001). The contraction amplitudes of stage III in different sites of IBS-C patients decreased significantly as compared with those in the controls [jejunum, (39.8 +/- 11.7) mm Hg vs. (61.1 +/- 14.1) mm Hg, P < 0.001, 1 mm Hg = 0.133 kPa]. The propagation velocities of stage III in different sites of IBS-C patients also decreased significantly as compared with those in the controls [jejunum, (1.8 +/- 0.9) cm/min vs. (2.6 +/- 0.8) cm/min, P < 0.01]. The contraction amplitudes of stage III in different sites of IBS-D patients increased significantly as compared with those in the controls [jejunum, (69.7 +/- 20.5) mm Hg vs. (61.1 +/- 14.1) mm Hg, P < 0.01]. The propagation velocities of stage III in different sites of IBS-D patients also increased significantly as compared with those in the controls [jejunum, (4.1 +/- 2.5) cm/min vs. (2.6 +/- 0.8) cm/min, P < 0.01]. DCC incidences of IBS-C and IBS-D were 87.5% and 88.8%, respectively. Comparision with those in the normal group (83.3%) did not show significant difference (P > 0.05). The prevalences of abnormal stage III contractions (include disturbances and interferences of stage III contractions) in IBS-C and IBS-D patients were 68.8% and 66.7%, respectively; there were no significant differences between the two groups (P > 0.05). However abnormal stage III contractions did not exist in healthy controls. CONCLUSIONS: (1) The MMC of IBS-C and IBS-D patients are changed, as compared with that in healthy people; this implies that small intestinal motility dysfunction is one of the pathogenetic factors of IBS. The abnormal stage III contractions in jejunum may be a predominant change in IBS gastroenteric motility. (2) No apparent connection is found between DCC and pain in IBS. (3) By using 16-channel water-perfused catheter, we first carried out the method of monitoring jejunum contractions in China. Parameters of MMC in Chinese healthy people were investigated, esp. those of jejunum.

[The deficit of decision-making in Parkinson's disease].

OBJECTIVE: To investigate the characteristics of decision-making impairment in Parkinson's disease (PD) patients. METHODS: A total of 20 individuals with idiopathic PD were compared with matched health controls on the Iowa Gambling Task, A series of battery including the assessment working memory, visual spatial ability and verbal fluency was also administered. The severity of disease was assessed based on the Hohen and Yahr scale. RESULTS: The results showed that PD group impaired on verbal fluency, working memory and decision-making task. In Iowa gambling task, the PD group selected more disadvantageous cards than health controls (51.6 +/- 5.8, 46.8 +/- 8.2 respectively), the difference between two groups is significant (t((38)) = 2.12, P = 0.04). A 2 (group) x 5 (block) ANOVA (analysis of variance) on the scores of advantageous from the gambling task revealed a significant main effect of group (F((1, 38)) = 6.16, P = 0.01). The ANOVA also revealed a significant main effect of block (F((4, 152)) = 2.43, P = 0.04). The results showed that health controls gradually shifted their selections toward the good decks as the game progresses, but the PD group did not exhibit this stable advantageous shift in decision-making. Meanwhile, the study indicated the total number of disadvantageous cards for PD was positive correlation to the degrees of severity to clinical symptom. CONCLUSION: The present study suggests that the decision-making impairment might be in early PD. The deficit of decision-making for PD might be attributed to the dysfunction of the orbito-frontal cortex.

[The impact of rabeprazole treatment on the quality of life in patients with reflux esophagitis and non-erosive reflux disease].

OBJECTIVE: To compare the health-related quality of life (HRQL) in the patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD) treated with rabeprazole in the multi-center open study. METHODS: All patients were treated with rebaprazole (10 mg, bid, ac) for eight weeks from Dec. 2002 to June 2003. 74 patients with RE; and 37 patients with NERD defined as negative endoscopic finding, the Demeester scores of 24 h pH monitoring of esophagus > 14.27 and reflux symptoms score > 6, were enrolled in. The impacts on HRQL (SF-36 questionnaire) and GERD-HRQL were assessed before and after therapy. RESULTS: At baseline, HRQL in NERD patients was impaired greater than in RE patients. After therapy, the symptoms were improved significantly in both groups. The quality of life was improved in 7 subscales in RE patients. However it was much lower in NERD patients. The scale of GERD-HRQL decreased significantly in RE patients than in NERD patients. CONCLUSIONS: NERD causes a more significant impairment in the quality of life than RE, which can be attenuated partly after 8 w rabeprazole therapy, unlike the satisfactory results favored in RE. Further research is needed to more completely understand the value of rabeprazole therapy for NERD.

[A clinical study of non-erosive reflux disease].

OBJECTIVE: [corrected] To investigate the differences and similarities between non-erosive reflux disease (NERD) and reflux disease (RE). METHODS: This study covered 30 patients who were grouped by endoscopy into the cases of NERD (n=17) or RE (n=13). The two groups' symptom, mentality, and damage to life quality were compared. Biopsy was performed at 3 cm above LES in oesophagus. The patients were placed under ambulatory 24-h oesophageal pH and Bilitec2000 monitoring. And their responses to the same anti-reflux treatment were evaluated. RESULTS: (1) The proportion of female (58.82%) in NERD group was much higher than that (15.38%) in RE group (P<0.05). (2) There was no remarkable difference in symptom, damage to life quality between the NERD and RE groups (P>0.05). But in respect to mentality, the NERD group had significantly higher anxiety and depression scores than did the RE group (P<0.05). (3) No noticeable difference in the pathological results of biopsy was seen between the NERD and RE groups (P>0.05). (4) The NERD group had less abnormal reflux, compared with the RE group (P<0.05). (5) The NERD group gave less response to treatment, compared to the RE group (P<0.05). CONCLUSION: NERD may be a kind of reflux disease different from RE.

Effect of a single oral dose of rabeprazole on nocturnal acid breakthrough and nocturnal alkaline amplitude.

AIM: To study the effect of rabeprazole (RAB) on nocturnal acid breakthrough (NAB) and nocturnal alkaline amplitude (NAKA) and to compare it with omeprazole (OME) and pantoprazole (PAN). METHODS: By an open comparative study, forty patients with active peptic ulcer were randomly assigned to receive one of the three PPIs (proton pump inhibitor) with a single oral dose. They were divided into RAB group (10 mg), OME group (20 mg) and PAN group (40 mg). Twenty healthy volunteers were enrolled to the control group (without taking any drug). Intragastric pH monitoring was then performed 1 hour before and 24 hours after the dose was given. RESULTS: No clinically undesirable signs and symptoms possibly attributed to the administration of RAB or OME and PAN were recognizable throughout the study period. All subjects completed the study according to the protocol. All data were processed by a computer using the Student t test or t' test followed by an analysis of covariance. P<0.05 was considered to have statistical significance. The intragastric pH of NAB was significantly higher in RAB group (1.84+/-0.55) than in either OME group (1.15+/-0.31) or PAN group (1.10+/-0.30) (both P<0.01). RAB produced a longer sustaining time (4.65+/-1.22 h) on NAKA than OME (3.22+/-1.89 h) (P<0.05), PAN (3.15+/-1.92 h) (P<0.05), and the sustaining time of NAKA in RAB group was longer than that in the healthy control group (P<0.01) too. In addition, RAB produced a much higher pH on NAKA (6.41+/-0.45) in comparison with PAN (6.01+/-0.92) (P<0.05). CONCLUSION: A single oral dose of 10 mg RAB may increase the pH of NAB and shorten the sustaining time of NAB, and it may increase the pH of NAKA as well as prolong the sustaining time of NAKA.

Assessment of duodenogastric reflux by combined continuous intragastric pH and bilirubin monitoring.

AIM: To assess the diagnostic value of a combination of continuous intragastric pH and bilirubin monitoring in the detection of duodenogastric reflux (DGR), and the effects of diet on the bilirubin absorbance. METHODS: 30 healthy volunteers were divided into two groups: standard diet group (Group 1) 18 cases, free diet group (Group 2)12 cases. Each subjects were subjected to simultaneous 24-hour intragastric pH and spectrophotometric bilirubin concentration monitoring (Bilitec 2000). RESULTS: There was no difference of preprandial phase bilirubin absorbance between two groups. The absorbance of postprandial phase was significantly increased in group 2 than group 1. There was no difference between preprandial phase and postprandial phase absorbance in group 1. Postprandial phase absorbance was significantly higher in group 2. In a comparison of bile reflux with intragastric pH during night time, there were 4 types of reflux: Simultaneous increase in absorbance and pH in only 19.6%, increase in bilirubin with unchanged pH 33.3%, pH increase with unchanged absorbance 36.3%, and both unchanged in 10.8%. Linear regression analysis showed no correlation between percentage total time of pH<4 and percentage total time of absorbance>0.14, r=0.068 P<0.05. CONCLUSION: Because of the dietary effect, high absorbance fluids or foods should be avoided in detection. Intragastric pH and bilirubin monitoring separately predict the presence of duodenal (and/or pancreatic) reflux and bile reflux. They can not substitute for each other. The detection of DGR is improved if the two parameters are combined simultaneously.