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Objective:To analyze the clinical characteristics that affect the early outcomes of the elderly patients with transient ischemic attack(TIA) and provide the guidance for the prediction of disease recurrence.Methods:From January 2016 to December 2019, 315 TIA patients over 60 years old based on the time-clinical definition who were admitted to the department of neurology in Beijing Shijitan Hospital were divided into recurrence cerebrovascular events group(RCVEs group) and non-recurrence cerebrovascular events group(non-RCVEs group) according to the recurrence at 1 month after onset. The clinical characteristics of the two groups were compared by Logsitic regression analysis.Results:There were 29 cases in the RCVEs group and 286 cases in the non-RCVEs group. Compared to the non-RCVEs group, patients in RCVEs group were more likely have higher prevalence of hypertension history(14/15, 83/203), moderate or severe intracranial artery stenosis(21/8, 132/154), carotid stenosis(22/7, 107/179), DWI positive, motor symptoms, carotid artery stenting and higher times of TIA episodes(2(2, 3), 2(1, 2)), fasting blood glucose and glycosylated hemoglobin levels(8.86(8.17, 9.56)mmol/L, 5.82(5.27, 6.33)mmol/L). Logistic regression analysis showed that patients in RCVEs group had a DWI positive( B=1.634, OR=5.124, 95% CI: 2.898-9.059, P=0.000) and higher prevalence of moderate to severe stenosis of carotid artery( B=0.572, OR=1.773, 95% CI: 1.050-2.993, P=0.032). Conclusion:DWI positive and moderate to severe carotid stenosis may influence the early poor prognosis in patients with TIA.
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Objective To explore risk factors for upper gastrointestinal bleeding in acute cerebral infarction. Method We enrolled continuously a total of 350 patients with acute cerebral infarction. Among them, 33 cases occurred upper gastrointestinal bleeding, accounting for 9.4%, and 317 cases without upper gastrointestinal bleeding, accounting for 90.6%. The incidence of various risk factors was compared between the two groups, and the independent risk factors of stress upper gastrointestinal bleeding were finally determined. Results National Institute of Health stroke scale (NIHSS) was significantly higher in the upper gastrointestinal bleeding group than in the control group [20 (2,32) vs. 5 (0,31)](P<0.001). The incidence of upper gastrointestinal bleeding was significantly increased in patients with posterior circulation infarct (POCI) (36.4% vs. 16.7%) and bilateral infarction (33.3% vs. 8.9%) (P<0.01). Only high NIHSS (OR=1.256, P<0.001) and bilateral infarction (OR=9.452,P<0.001) were independent risk factors for upper gastrointestinal bleeding in acute cerebral infarction. Conclusion More attention should be paid to patients with high NIHSS and bilateral infarction to avoid the occurrence of upper gastrointestinal hemorrhage, thereby reducing the negative influence on the prognosis of patients with cerebral infarction.
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Objective This study aimed to investigate the clinical characteristics of cryptogenic stroke as the first manifestation of occult systemic malignancy (OSM) and to determine whether plasma D-dimer levels and lesions in multiple vascular regions could predict occult systemic malignancy in patients with cryptogenic stroke. Methods Data from 83 patients including 9 patients with OSM and 74 patients without OSM were extracted from the stroke database of Beijing Shijitan Hospital. Clinical variables were analyzed between cryptogenic stroke patients with OSM and without OSM. The relationshiop between plasma D-dimer levels or lesions in multiple vascular regions and OSM were analyzed by multiple logistic regression analysis. Results Compare to patients without OSM, patients with OSM was older (66.8± 7.5 vs.56.4±15.7,P=0.004)and had lower hemoglobin levels (127.9±19.8 vs.143.6±17.7,P=0.015),higher conut score [3(1,3) vs. 1(0,2), P=0.011], higher plasma D-dimer levels (77.7% vs. 13.5%, P<0.001) and more common lesions in multiple vascular regions(100% vs.23.0%, P<0.001).Multiple logistic regression analysis revealed that high plasma D-dimer levels are independent risk factors for OSM (OR=26.250,95%CI:3.041-226.604,P=0.003).Conclusions Patients with OSM are elderly people and have poorer nutritional status, higher plasma D-dimer levels and more common lesions in multiple vascular regions. High plasma D-dimer levels can be useful to predict OSM in patients with cryptogenic stroke at earlier stages.
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Objective To describe the clinical features and magnetic resonance imaging (MRl) findings of brainstem infarction producing internuclear ophthalmoplegia (INO) as an predominant clinical manifestation.Methods The clinical data of 9 patients diagnosed with brainstem infarction presenting with INO by angiography and MRI diagnosis in our hospital were collected from January 2010 to October 2016.The clinical features and imaging findings of these patients were analysed,and the pathogenesis mechanisms was analysed by literature research.Results The median age of the 9 patients was 56 years old,and there were 5 young and middle aged cases (under 60 years old),accounted for 55.6％.Among them,8 cases (88.9％) with INO typically presenting with horizontal diplopia,the most common accompanied symptom was dizzness (accounted for 55.6％),and most of them (accounted for 77.8％) were unilateral.A total of 6 cases were anterior INO,3 cases were both anterior and posterior INO.Five cases (55.6％) retained converging movement.The MRI showed that paramedian ventral infarcts located in the the cerebral aqueduct were responsible for INO in 1 case,and paramedian dorsal infarcts located in the pons were responsible for INO in 8 cases.The magnetic resonance angiography (MRA) indicated that vascular occlusion or stenosis was found in posterior circulation in 6 patients,there were 5 cases with stenosis of the posterior cerebral artery which was the most common.The ocular symptoms,including diplopia and blurred vision,of 6 cases (66.7％) disappeared during their hospital stay (range:13-23 d,median:14 d).During following up,ocular symptoms of 1 case finally disappeared within 3 months.Conclusion Brainstem infarction presenting with INO is mainly caused by paramedian dorsal infarcts located in the pons,and most of the patients complicated with posterior circulation atherosclerotic lesions.The pathogenesis varies,and the patients have a good clinical prognosis.For the young and middle-aged patients presenting with diplopia as an initial symptom,it should pay more attention to differential diagnosis.
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Objective To explore the clinical characteristics and risk factors of strokeassociated pneumonia (SAP) in patients with acute cerebral hemorrhage.Methods A total of 375 patients with acute cerebral hemorrhage were selected from the department of neurology and neurosurgery during January 2013 to December 2015 in our hospital.According to the incidence of SAP,they were divided into the observation group (complicated with SAP,n =79) and control group (not complicated with SAP,n =296).Clinical data were collected,and clinical characteristics and related risk factors of SAP complicated with acute cerebral hemorrhage were analyzed.Results Among all the 79 SAP patients in observation group,there were 38 cases with gram-negative bacterial infections,25 cases with gram-positive bacterial infections,16 cases with mixed infections.The SAP incidence in patients with massive hemorrhage was higher than that in patients with nonmasive hemorrhage (x2 =11.301,P＜ 0.01),and was higher in patients with cerebellum,brainstem,ventricle,thalamus and multifoeal hemorrhage than that in patients with basal ganglion and brain lobe hemorrhage(x2 =4.023,P＜0.05).The hospitalization days of the observation group was longer than that of the control group [(32.7 ± 16.2) versus (17.3 ± 6.7),t=2.93,P＜ 0.01].The mortality of the observation group was higher than that of the control group (24.1％ versus 3.7％),(x2 =8.720,P＜ 0.01).Multivariate Logistic regression analysis showed that age≥ 65 (OR =4.87),underlying lung diseases (OR =5.30),bulbar paralysis (OR =7.39),disorder of consciousness (OR=4.11),NIHSS score ＞ 4 (OR =3.96),invasive airway operations (OR=3.78),gastric tube (OR =4.37),H2-receptor blocking agents application (OR =2.09) were independent risk factors for SAP in acute intraerebral hemorrhage patients.Conclusions Gram-negative bacteria are the main pathogens of SAP in patients with acute cerebral hemorrhage.The patients complicated with SAP after acute cerebral hemorrhage have poor prognosis including prolonged hospitalization period and higher mortality.SAP in acute intraerebral hemorrhage patients is closely related to the following factors:age≥65,underlying lung diseases,bulbar paralysis,disorder of consciousness,NIHSS score ＞ 4,invasive airway operations,gastric tube,H2-receptor blocking agents.
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Objective To compare the performance of Lung Imaging Reporting and Date System (Lung-RADS)with National Lung Screening Trail (NLST)in pulmonary nodules screening.Methods 1 5 3 patients with pulmonary nodules were analyzed retro-spectively,including,baseline screening and after baseline screening.We compared the sensitivity,false-positive result rate,positive predictive value,and negative predictive value in two methods of screening.Results In baseline screening of all patients with pulmo-nary nodules,the sensitivity,false positive rate and positive predictive value and negative predictive value of Lung-RADS and NLST were 83.9%,13.2%,6.5%,99.7% and 92.5%,26.9%,3.8%,99.8% respectively.In after baseline screening,the sensitivity, false positive rate and positive predictive value and negative predictive value were 79.6%,5.5%,11.5%,99.8% and 93.5%,22.8%, 3.5%,99.9% respectively.Conclusion Lung-RADS classification can reduce the false positive rate in screening of pulmonary nod-ules,which reduced the screening of lower risk nodules.
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ObjectiveTo objectively evaluate the clinical efficacy of three-step acupuncture-cupping therapy for cervicogenic headache.MethodSixty patients were randomly allocated to treatment and control groups. The treatment group received three-step acupuncture-cupping therapy and the control group, conventional acupuncture based on “Acupuncture Therapeutics”. Both groups were treated for three courses (10 days as acourse with two days of rest between two courses) and then the clinical therapeutic effects were evaluated. The evaluation included the overall therapeutic effect on the symptoms, the VASscore and the follow-up recurrence rate at six months after treatment.ResultThe total efficacy rate was 96.7% in the treatment group and 83.3% in the control group; there was a statistically significant difference between the two groups (P<0.01). A follow-up of six months after treatment in the two groups showed that the recurrence rate was 16.7% in the treatment group and 46.7% in the control group;there was a statistically significant difference between the two groups (P<0.05).ConclusionThree-step acupuncture-cupping therapy has a definite effect on cervicogenic headache. Its immediate and long-term effects are superior to those of conventional acupuncture. The recurrence rate in six months is lower in this therapy than in conventionalacupuncture.
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Aim To optimize extraction of polysaccha-rides from Dendrobium officinale ( DOP ) and investi-gate the effects of DOP on the expression of Bax and Bcl-2 in vascular endothelial cell of human umbilical vein ( HUVEC) by the induction of high sugar. Meth-ods Response surface methodology ( RSM ) was em-ployed to optimize the conditions for extraction of DOP on the basis of single factor experiment. The HUVEC cells were divided into the blank control group, the normal blood sugar group, the high sugar stimulation group and different drug concentration group plus the high sugar stimulation group. The growth condition of cells was examined by methyl thiazolyl tetrazolium ( MTT) , and RT-PCR was used to detect the expres-sion of Bcl-2 Assaciated X protein ( Bax ) and B-cell lymphoma-2 ( Bcl-2 ) in vascular endothelial cells after 24 and 48 hours. Results The optimal extraction time was 2 h and the optimal liquid-solid ratio was 15. 75∶1 ( mL/g ) , and the optimal extraction frequency was 2. 8. Under these optimized conditions, the extraction rate of polysaccharides was 25. 1%, while the experi-mental extraction rate was 24. 9%, which was highly fit with the regression model. Compared with normal sugar group, high sugar group reduced the growth of cells and enhanced the expression of Bax, and inhibi-ted the expression of Bcl-2 . DOP promoted the growth of cells in high sugar induction, inhibited the expres-sion of Bax, and enhanced the expression of Bcl-2. Conclusions The process optimized through RSM has the extraction effect, and has certain practical signifi-cance. Through the down-regulation of the expression of Bax in vascular endothelial cells and the up-regula-tion of the expression of Bcl-2 by the induction of high sugar, DOP can restrain HUVEC, which could prevent and cure diabetic angiopathy to some extent.
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Objective To investigate the association between the presence of cerebral microbleeds and chronic kidney disease in patients with ischemic stroke.Methods Patients with ischemic stroke within 1-6 months were consecutively recruited.Cranial MRI was taken within two weeks after recruitment.Cerebral microbleeds were assessed using Microbleed Anatomical Rating Scale on gradient echo MRI.Demographics including sex,age and risk factors were obtained.Chronic kidney disease was defined and classified according to National Kidney Fundation-Kidney Disease Outcome Quality Initiative Guideline.Glomerular filtration rate (GFR) was estimated by using the abbreviated Modification of Diet in Renal Disease equation.Results Of the 636 patients included,mean age was (59.8 ± 10.1) years,435 (68.4％) were male.Sixty-six had decreased estimated GFR (eGFR; ＜ 60 ml · min-1 · 1.73 m-2).Two hundred and one (31.6％) patients had cerebral microbleeds,which were most commonly located in deep or infratentorial location (133/201,66.2％).The presence of cerebral microbleeds was much higher in patients with decreased eGFR than the others (48.5％ (32/66) vs 29.6％ (169/570),x2 =9.709,P =0.002).Age,history of hypertension and decreased eGFR were associated with the presence of cerebral microbleeds in univariate analysis.In multivariate analysis,decreased eGFR was independently associated with the presence of cerebral microbleeds in deep or infratentorial location (OR =1.457,95％ CI 1.044-2.034,P =0.027),but not associated with the presence of cerebral microbleeds in pure lobe.Conclusion Impaired kidney function is associated with the presence of cerebral microbleeds in deep or infratentorial regions in patients with ischemic stroke.
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Objective To assess the reproducibility of long-term blood pressure variability in ischemic stroke and the association between the variability and cerebral microbleeds.Methods Patients with ischemic stroke at the previous 1-6 months were consecutively recruited and followed up 12-18 months.Blood pressure measurements were taken at every interview.Blood pressure variability indicated visit-to visit variability and was quantified by calculating the maximum ( Max),standard deviation (SD) and coefficient of variation (CV).For these variability might positively correlated with mean of blood pressure,the additional variability measure,SD independent of mean (SDIM),was also calculated.To determine the reproducibility of mean and variability measurements,the intraclass correlation (ICC) was also calculated.MRI was performed at baseline and the end of the study.Cerebral microbleeds were rated using Microbleed Anatomical Rating Scale (MARS).Multiple Logistic regression was used to assess the association between the visit-to-visit blood pressure variability and cerebral microbleeds.Results A total of 720 patients were recruited,of whom 595 (82.6％) subjects were present for 14 blood pressure readings during follow-up.The visit-to-visit blood variability measurements were moderately reproducible according to the ICC:0.46-0.72 for systolic blood pressure (SBP) and 0.42-0.69 for diastolic blood pressure ( DBP),respectively,P ＜0.01 for all measures.Patients with cerebral microbleeds were more likely to have higher mean blood pressure and variability for both SBP and DBP regardless the distribution of cerebral microbleeds.Being SBP Max,SBP SD,SBP CV,SBP SDIM(OR=1.036,95％ CI l.021-1.052,P=0.000; OR=1.060,95％CI 1.001-1.122,P =0.046; OR =1.084,95％ CI 1.000-1.175,P =0.049; OR =1.065,95％ CI 1.002-1.132,P =0.044) and DBP SD,DBP CV ( OR =1.111,95％ CI 1.000-1.233,P =0.049;OR =1.091,95％ CI 1.001-1.190,P =0.047) were the independently risk factors of cercbral microbleeds at deep region; SBP Max( OR =1.049,95％ CI 1.029-1.068,P =0.000) and DBP SD、DBP CV(OR =1.236,95％ CI 1.107-1.379,P=0.000;OR =1.188,95％ CI 1.087-1.298,P=0.000)independently associated with cerebral microbleeds at infratentorial location.There was no significant relation between the long-term variability of blood pressure and cerebral microbleeds at lobar region. Conclusions This study indicates that long-term blood pressure variability is substantial and independently associated with cerebral microbleeds in deep or infratentorial but not with that in lobar region.The different relations between the variability and cerebral microbleeds might indicate the heterogenic mechanisms of cerebral microbleeds.
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Objective To investigate the application effect of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital. Methods The first-time qualification rate of cleaning,packaging and sterility test and incidence rate of nosocomial infection before and after the application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital.The application effect was comprehensively evaluated. Results The first-time qualification rate of cleaning,packaging and sterility test after the application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center were significantly increased.The incidence rate of nosocomial infection was 1.5％ before and 5.5％ after the application of cleaning packaging of surgical medical apparatus and instruments,the difference was significant. Conclusions Application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center can effectively control the cleaning and packaging quality,guarantee the thoroughness of subsequent disinfection and sterilization,decrease the incidence rate of nosocomial infection caused by poor quality of surgical medical apparatus and instruments.It creates reliable medical environment for patients and obtain good social and economic benefit,which is worthy of wide application.
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Objective To explore the way to reduce the absorption of irrigating fluid during PCNL. Methods The amount of absorbed fluid during PCNL in 20 cases (13 males and 7 females)was monitored by ethanol method. The average age was 40 years old. The maximum diameter of calculi by average was 25 mm. Heart rate and mean arterial pressure were monitored during operation.Haemoglobin concentration, serum Na+, K+, Cl-, carbon dioxide-combining power and serum creatinine were measured before and after operation. The amount of irrigating fluid, the duration of operation, and the intrapelvic pressure were recorded. Results The absorbed volume of irrigating fluid in 20 cases was from 50. 2 to 685.0 ml. There was no significant difference in heart rate, mean arterial pressure, serum Na+ , K+ , Cl- and serum creatinine between pre-operation and post-operation(P>0.05), but the postoperative haemoglobin concentration (130.4±16.3 g/L) and carbon dioxide-combining power (24.1±3.2 mmol/L) were lower than that before operation( 142.6±15.6 g/L,26.4±2.0 mmol/L), the differences were significant (P<0. 05). The mean volume of absorbed irrigating fluid in patients with the cumutative time of the intrapelvic pressure higher than 30 mm Hg >10 min,the duration of operation >1 h, or the amount of irrigating fluid >10000 ml was 381. 1, 301.6,261.6 ml respectively, which was higher than that in the other cases (142.9, 136.4, 130.2 mi), the differences were significant (P<0.05). Conclusions The ethanol method is simple, convinent,safe, valid, and is suitable for patients with compromised cardiorespiratory or renal function, who are more likely to develop volume overload because of fluid absorption.
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@#Objective To investigate the incidence and risk factors of cerebral microbleeds(CMB) in ischemic stroke patients.Methods Patients with cerebral infarction for 1～6 months were recruited.Clinical data were recorded.MRI was reviewed blindly to determine the number of CMB and lacunar infarcts and the white matter lesions(WML).The independent risk factors of CMB were analyzed with the Logistic multivariable regression.Results 636 subjects were included.CMB were found in 250 cases(39.3%).The incidence of CMB in patients of ≤50,50～65 and >65 years old were 27.2%,38.1% and 47.6% respectively(P<0.05).CMB was more frequent in patients with more lacunar infarcts(P<0.05).The incidence of CMB in patients with negative,mild,moderate and severe WML were 21.9%,33.8%,46.9%and 63.1% respectively(P<0.05).Logistic regression analysis showed that history of hypertension(OR=1.523,95% CI 1.019～2.276),severity of WML(OR=1.535,95% CI 1.258～1.874) and lacunar infarcts(OR=1.517,95% CI 1.087～2.118) were the independent risk factors for presence of CMB.Conclusion CMB was frequent in ischemic stroke.The frequency of CMB increased with aging,grade of lacunar infarcts and WML.History of hypertension,severity of WML and lacunar infarcts were the independent risk factors for CMB presence.
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Objective To evalute perioperative whole course cerebral protection for patients undergoing carotid endarterectomy (CEA) Methods From 2002 to 2004, 20 patients received CEA in our hospital using whole course perioperative cerebral protection Preoperatively carotid angiography was performed in only one patient, while Doppler ultrasonography and CTA were applied to all patients Measures of intraoperative cerebral protection included general anaesthesia, selective shunting, and transcranial Doppler monitoring (TCD), followed by postoperative delayed removal of tracheal cannula, brain ice bag, maintaining blood pressure and appropriate use of diuretics under the guidance of TCD Results Shunt was used in 7 cases (35%), 15 patients (85%) underwent patch angioplasty There were no postoperative cranial nerves related complications Mortality was 0% Conclusion Perioperative whole course cerebral protection could effectively decrease postoperative cranial nerves related complications in patients undergoing carotid endarterectomy