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Objective:To explore the differential diagnostic value of abdominal diffusion-weighted imaging (DWI) combined with serum alpha fetoprotein (AFP), des-gamma-carboxyprothrombin (DCP), and the ratio of γ-glutamyl transpeptidase to alanine transaminase (GTP/ALT) in the diagnosis of benign and malignant liver tumors.Methods:Ninety liver tumor patients admitted to the Chenzhou First People′s Hospital from February 2020 to May 2022 were selected, including 48 malignant tumors and 42 benign tumors, and were divided into malignant group and benign group. The imaging findings of routine magnetic resonance imaging (MRI) and DWI examination were analyzed for two groups of patients. We compared the apparent diffusion coefficient (ADC) values, serum AFP, DCP levels, and GTP/ALT between two groups of patients. The diagnostic value of DWI, individual and combined detection of various serological indicators for malignant tumors was analyzed using receiver operating characteristic (ROC) curves.Results:There were significant differences in MRI and DWI imaging manifestations between the malignant and benign groups of patients. The ADC values and ADC index of patients in the malignant group at different b values of 50, 400, and 800 s/mm 2 were lower than those in the benign group, and the differences were statistically significant (all P<0.05). The serum AFP, DCP, and GTP/ALT of patients in the malignant group were higher than those in the benign group, and the differences were statistically significant (all P<0.05). The ROC curve analysis results showed that the sensitivity and specificity of DWI combined with serum AFP, DCP, and GTP/ALT in diagnosing liver malignant tumors were higher than those of DWI alone and each serological indicator alone. Conclusions:The combination of DWI, serum AFP, DCP, and GTP/ALT has high sensitivity and specificity in diagnosing liver malignant tumors, and has certain clinical value in distinguishing between benign and malignant liver tumors.
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Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.
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Objective:To investigate the long-term death of patients with ischemic stroke and its influencing factors.Methods:Based on the data of patients with ischemic stroke in the multi-center oral fibrinogen-lowering drug secondary prevention database, the follow-up patient information and the cause of death were registered through the epidemiological investigation method, and then compared with the baseline data of patients in the original database.Results:A total of 278 patients completed the follow-up, and 166 were in lumbrokinase group and 112 were in control group. There were 124 deaths (44.6%) within 10 years, of which 92 (74.2%) were vascular deaths. In the lumbrokinase group, 74 patients (44.6%) died of all causes and 55 (33.1%) died of vascular diseases; in the control group, 50 (44.6%) died of all causes and 37 (33.0%) died of vascular diseases. Cox proportional risk model analysis showed that lumbrokinase treatment had no significant effect on the 10-year survival rate of patients with ischemic stroke. The analysis of death influencing factors showed that the baseline international normalized ratio (INR) was significantly associated with the 10-year non-vascular death risk of patients (hazard ratio [ HR] 1.98, 95% confidence interval [ CI] 1.21-3.25; P=0.006). The greater the decrease of tissue plasminogen activator (tPA) within half a year, the lower the 10-year all-cause mortality risk ( HR 0.94, 95% CI 0.90-0.99; P=0.011); the greater the decrease in INR within one year , the lower the 10-year vascular death risk ( HR 0.41, 95% CI 0.17-0.96; P=0.040); the greater the decrease of D-dimer within one year , the higher the risk of the 10-year vascular death ( HR 1.37, 95% CI 1.02-1.83; P=0.034). The greater the decrease of INR in patients with ischemic stroke within one year, the higher the 10-year non-vascular death risk ( HR 2.15, 95% CI 1.29-3.59; P=0.004). Conclusions:The 10-year mortality rate of patients with ischemic stroke is higher, and about 3/4 are vascular deaths. The fibrinogen-lowering treatment in the acute stage has no significant effect on the 10-year all-cause mortality of patients with ischemic stroke. The greater the decrease of tPA in half a year, the lower the all-cause mortality; the greater the decrease of D-dimer level at baseline and within 1 year, the higher the 10-year vascular death; the greater the decrease of INR at baseline and within 1 year, the higher the 10-year non-vascular death risk.
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Objective:To investigate the correlation between peripheral blood renal function indexes and brain frailty imaging score in patients with mild ischemic stroke or transient ischemic attack (TIA).Methods:Patients with mild ischemic stroke or transient ischemic attack (TIA) admitted to the Department of Neurology, the Second Affiliated Hospital of Soochow University from March 2018 to August 2019 were enrolled retrospectively. General clinical data and peripheral blood renal function indexes, including urea, uric acid and estimated glomerular filtration rate (eGFR), were collected. eGFR <60 ml/(min·1.73 m 2) was used to reflect chronic kidney disease. According to the findings of MRI examination, the imaging score of cerebral frailty was performed. When there were white matter lesions, brain atrophy and lacunar infarction/lacuna, 1 point was given, and the total score was 3. Ordinal multi-class logistic regression analysis was used to evaluate the relationship between renal function indexes and brain frailty imaging score in patients with mild ischemic stroke or TIA. Binary logistic regression analysis was used to evaluate the relationship between renal function indexes and brain frailty imaging score >1. Results:A total of 204 patients with mild ischemic stroke or TIA were enrolled during the study. Their average age was 64.82 years old and 78 (38.2%) were females. There were 28 cases (13.73%), 70 cases (34.31%), 63 cases (30.88%) and 43 cases (21.08%) with brain frailty imaging scores of 0, 1, 2, and 3, respectively. One hundred and six patients (51.96%) were in the brain frailty imaging score >1 group and 98 (48.04%) were in the ≤1 group. Univariate analysis showed that there were significant differences in age, diabetes mellitus, eGFR, eGFR classification, homocysteine, intracranial vascular stenosis, stroke etiology classification and vascular distribution between the group with brain frailty imaging score >1 and those with brain frailty imaging score ≤1 (all P<0.05). Ordinal multi-class logistic regression analysis showed that urea (odds ratio [ OR] 0.67, 95% confidence interval [ CI] 0.51-0.89, P=0.005) and eGFR ( OR 0.98, 95% CI 0.96-0.99; P=0.004) were significantly and independently correlated with brain frailty imaging score. Binary logistic regression analysis showed that eGFR was significantly and independently correlated with brain frailty imaging score >1 ( OR 0.98, 95% CI 0.96-1.00; P=0.016). However, urea, uric acid and eGFR classification were not independently correlated with brain frailty imaging score or brain frailty imaging score >1. Conclusion:Blood urea and eGFR are correlated with the brain frailty imaging score in patients with mild ischemic stroke or TIA.
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Intracerebral hemorrhage is a cerebrovascular disease with higher mortality and disability. Compared with ischemic stroke, there is less research on cognitive impairment related to intracerebral hemorrhage. Cognitive impairment related to intracerebral hemorrhage can be divided into cognitive impairment before intracerebral hemorrhage and acute-term and long-term cognitive impairment after intracerebral hemorrhage. This article reviews the incidence, risk factors, possible pathogenesis and treatment of cognitive impairment related to intracerebral hemorrhage.
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Objective:To investigate the risk factors for 90 d death after endovascular mechanical thrombectomy (MT) in patients with acute anterior circulation large-artery occlusive stroke.Methods:From October 2015 to March 2018, patients with acute anterior circulation large-artery occlusive stroke treated with MT in People's Hospital of Shanghai Pudong New Area and the Second Affiliated Hospital of Soochow University were enrolled retrospectively. The primary outcome events were defined as death within 90 d after operation. Univariate and multivariate logistic regression models were used to identify the independent risk factors for death within 90 d after operation. Results:A total of 116 patients were enrolled, 23 (19.8%) of them died within 90 d after operation. Univariate analysis showed that there were significant differences in age, baseline National Institutes of Health Stroke Scale (NIHSS) score, the Alberta Stroke Program Early CT Score (ASPECTS), and the proportion of the baseline NIHSS score classification (≤8, 9-15, ≥16), ASPECTS ≤7, the number of attempts to pass >3 times, modified Thrombolysis in Cerebral Infarction (mTICI) blood flow grade 2b/3, hemorrhagic transformation (HT), and symptomatic HT in the death group compared with the survival group (all P<0.05). Multivariate analysis showed that after adjusting for age, fasting blood glucose, baseline NIHSS score, number of attempts to pass >3, and mTICI grade 2b/3, lower ASPECTS (odds ratio [ OR] 0.647, 95% confidence interval [ CI] 0.456-0.917; P=0.014), longer time from onset to vascular recanalization ( OR 1.004, 95% CI 1.000-1.007; P=0.046) and symptomatic HT ( OR 13.522, 95% CI 2.719-67.258; P=0.001) were the independent predictors of death within 90 d. Conclusion:The ASPECTS, time from onset to recanalization, and symptomatic HT were the independent risk factors for death within 90 d after MT in patients with acute anterior circulation large-artery occlusive stroke.
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Objective:To investigate the predictive value of plasma lipocalin-2 (LCN2) for the clinical outcome of patients with acute minor ischemic stroke (MIS).Methods:Consecutive patients with acute MIS admitted to the Department of Neurology, Shengze Hospital Affiliated to Nanjing Medical University from October 9, 2017 to August 17, 2018 were selected prospectively. On the day of admission, the National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological impairment. The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after the onset, and 0-1 was defined as a good outcome. Multivariate logistic regression model was used to analyze the correlation between plasma LCN2 and clinical outcome. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of plasma LCN2 for the clinical outcome of patients. Results:A total of 71 patients (68.99±11.24 years old) were enrolled in the study. Forty-six patients were male (64.8%). The median plasma LCN2 was 117.7 μg/L (interquartile range, 61.2-738.4 μg/L). Fifty-six patients (78.9%) had good outcomes, and 15 (21.1%) had poor outcomes. The age, baseline NIHSS score, plasma C-reactive protein and LCN2 of the good outcome group were significantly lower than those of the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that plasma LCN2 ≤117.7 μg/L (odds ratio 8.574, 95% confidence interval 1.755-41.874; P=0.008) and lower baseline NIHSS scores (for increasing by 1 point: odds ratio 0.396, 95% confidence interval 0.214-0.732; P=0.003) were independently related to good outcome. ROC curve analysis showed that the area under the curve for plasma LCN2 to predict a good outcome was 0.814 (95% confidence interval 0.709-0.918); the best cut-off value was 128.55 μg/L, and the corresponding sensitivity and specificity were 69.6% and 80.0%, respectively. Conclusions:Plasma LCN2 had a good predictive value for the clinical outcome of patients with acute MIS at 90 d after the onset.
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Objective To comparatively analyze the safety and efficacy of direct mechanical thrombectomy and bridging therapy for patients with acute anterior circulation large-artery occlusive stroke.Methods A total of 116 patients with acute anterior circulation large-artery occlusive stroke,admitted to our hospitals from October 2015 to March 2018,were chosen in our study;their clinical data were analyzed retrospectively.Among them,63 patients accepted direct mechanical thrombectomy and 53 accepted bridging therapy.The preoperative baseline data and the diagnoses and treatments of the two groups were analyzed;the degrees of modified thrombolysis in cerebral infarction (mTICI),incidences of hemorrhage transformation and symptomatic intracranial hemorrhage,and modified Rankin scale (mRS) scores and mortality rate 90 d after operation were compared between the two groups.Results The preoperative Alberta stroke program early CT scale (ASPECTS) and Glasgow Coma Scale (GCS) scores of the direct mechanical thrombectomy group were significantly lower than those of the bridge therapy group (P＜0.05),and the time from onset to admission was significantly longer than that of the bridging therapy group (P＜0.05).The incidence of postoperative hemorrhage transformation in the direct mechanical thrombectomy group was significantly higher than that in the bridging therapy group (34.9％ vs.17.0％,P＜0.05),but there were no significant differences in the effective recanalization rate (69.8％ vs.79.3％),intracranial symptomatic hemorrhage rate (15.9％ vs.7.6％),favorable outcome rate (28.6％ vs.35.9％) and mortality (22.2％ vs.17.0％) between the two groups (P＞0.05).Conclusion The clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for patients with acute anterior circulation large-artery occlusive stroke are similar.
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Objective:To explore the influencing factors for intracranial hemorrhage (ICH) in patients with acute large vessel occlusion stroke (ALVOS) of anterior circulation after mechanical thrombectomy (MT).Methods:From October 2015 to March 2018, the clinical data of 116 patients with ALVOS of anterior circulation accepted MT were analyzed retrospectively in our hospitals. These patients were divided into ICH group ( n=31) and non-ICH group ( n=85) according to whether there was ICH after operation. Univariate and multivariate Logistic regression models were used to analyze the independent influencing factors for ICH after MT. Results:Univariate analysis showed that there were significant differences in preoperative Alberta Stroke Program Early CT (ASPECT) scores, baseline systolic pressure, and preoperative blood glucose level between ICH group and non-ICH group ( P<0.05). Multivariate analysis showed that after adjusting baseline Glasgow coma scale scores, preoperative ASPECT scores ( OR=0.770, 95%CI: 0.610-0.0.971, P=0.027), baseline systolic pressure ( OR=1.029, 95%CI: 1.005-1.054, P=0.017), preoperative blood glucose level ( OR=1.177, 95%CI: 1.010-1.372, P=0.036) were independent influencing factors for ICH. Conclusion:The patients with low preoperative ASPECT scores, high baseline systolic pressure, and high blood glucose are prone to have ICH after MT in patients with ALVOS of anterior circulation.
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Objective To compare and analyze the etiology,clinical manifestations and imaging differences of bilateral pontine infarction (BPI) and unilateral pontine infarction (UPI),and investigate the possible independent risk factors for BPI.Methods Consecutive patients with pontine infarction admitted to the Department of Neurology,the First People's Hospital of Kunshan from January 2015 to December 2017 were enrolled retrospectively.They were divided into BPI group and UPI group.The risk factors,laboratory findings,National Institutes of Health Stroke Scale (NIHSS) scores,clinical manifestations,and basilar artery lesions were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for BPI relative to UPI.Results A total of 131 patients with pontine infarction were enrolled,aged 66.22 ± 12.29 years,97 patients (72.52％) were male;14 (10.69％) were BPI,and 117 (89.31％) were UPI.In terms of clinical symptoms,consciousness disorder (35.71％ vs.6.83％;x2 =8.657,P =0.003),quadriplegia (50.00％ vs.5.12％;x2 =30.202,P ＜ 0.001),and dysphagia (71.42％ vs.29.91％;x2 =7.804,P =0.005) in the BPI group were more common than those in the UPI group.In terms of etiological classification,vertebrobasilar large artery disease (VLAD) was more common in the BPI group (85.71％ vs.27.35％;x2 =16.567,P ＜ 0.001),while small artery disease (SAD) was more common in the UPI group (49.57％ vs.7.14％;x2 =7.460,P =0.006).In addition,the baseline NIHSS scores (12.43 ±11.1 vs.3.78 ±3.98;t=2.873,P=0.013),white blood cell count ([9.21±2.81] ×109/L vs.[6.92± 2.40] ×109/L;t=3.191,P=0.002),baseline systolic blood pressure (170.57 ±31.21 mmHg vs.156.75 ±23.50 mmHg,1 mmHg =0.133 kPa;t =2.004,P =0.047),as well as the proportion of patients with severe stenosis or occlusion in basilar artery (78.57％ vs.8.55％;x2 =40.49,P ＜ 0.001) and with other site infarction (78.57 ％ vs.11.11％;x2 =33.652,P ＜ 0.001) in the BPI group were significantly higher than those in the UPI group.Multivariate logistic regression analysis showed that severe basilar artery stenosis or occlusion (odds ratio [OR] 20.195,95％ confidence interval [CI]2.308-176.703;P =0.007),baseline NIHSS score (OR 1.147,95％ CI 1.019-1.292;P =0.023),and infarction at other sites (OR 19.483,95％ CI 2.969-127.868;P =0.002) were independently associated with BPI.Conclusion Compared with UPI,patients with BPI had more severe clinical symptoms and most of them with other site infarction.Severe stenosis or occlusion of the basilar artery was an independent risk factor for BPI.
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Objective To study the relationship between climatic factors and cerebral hemorrhagic disease.Methods A total of 1125 cerebral hemorrhage patients were included in this study.The relationship between the onset time of cerebral hemorrhage and daily climatice factors (including temperature,humidity,atmospheric pressure,wind direction and rainfall volume) was analyzed and the onset time of cerebral hemorrhage in each patient was analyzed according to the X2 test for goodness of fit.Results The number of male cerebral hemorrhagy patients was greater than that of female cerebral hemorrhage patients.The mean age of femalc cerebral hemorrhage patients was older than that of male cerebral hemorrhage patients (P＜0.01).The incidence of cerebral hemorrhage accounted for 11％ in January in a greatest number of such patients,accounted for 5.0％ in September in a smallest number of such paticnts,and was the highest at h 4-8 AM and at h 16-20 FM in ≤45 years old cerebral hemorrhage patients.Univariate correlation analysis showed that cerebral hemorrhage was negatively related with daily mean temperature,daily mean maximal and minimal temperature (r=-0.157,r =-0.163,r=-0.156,P＜0.05),positively related with daily mean atmospheric pressure (r=0.157,P＜0.05).Multivariate linear stepwise analysis showed that cerebral hemorrhage was related with daily mean temperature,maximal and minimal temperature,and daily mean atmospheric pressure (P＜0.05,P＜0.01).Conclusion The incidence of cerebral hemorrhage differs in seasons and months,is higher in winter and lower in summer,and is thus related with temperature,atmospheric pressure and wind direction.
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Objective The study aimed to evaluate the effects of web-problem-based learning (WPBL) in the application of Fundamental Nursing.Methods The sample was purposively selected.172 students in School of Nursing in Tianjin were recruited as the control group (n=83) and the intervention group (n=89).Traditional teaching method and WPBL was implemented in the control group and the intervention group,respectively.The teaching effectiveness of the two groups was measured by the examination and learning initiative evaluation scale and the teaching effect evaluation questionnaire,and the teaching satisfaction questionnaire was implemented among the intervention group.SPSS 18.0 was used and t test was performed to analyze the comparison between groups.Results In the theoretical examination,the scores of comprehensive analysis of the nursing students in the intervention group were better than those in the control group,and the difference was statistically significant (P＜0.05).In the evaluation of active learning after school,the scores of control learning in the intervention group were higher than those in the control group,and the difference was statistically significant ([14.78 ± 2.16),vs.(13.58 ± 2.16),t=-3.58,P=0.000].83 effective questionnaires of intervention group nursing students' teaching satisfaction were recovered.73 of them (88％) thought that WPBL could improve the students' ability of independent learning,71 students (85.5％) found that WPBL could enhance the ability of information processing,73 students (88％) thought they could communicate well with their classmates in WPBL and cooperate well to complete the task.Conclusion WPBL which is on the basis of PBL and make full use of the network,could promote the ability of autonomous learning,information processing and communication with classmates and good cooperation,but in the application process,it needs teachers to organize reasonably,perfect the supervision mechanism,and reduce taking up students' spare time.
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ObjectiveTo investigate clinical features and outcomes in acute ischemic stroke patients with remote symptomatic intracranial hemorrhage (sICHr) after intravenous thrombolysis.MethodsThe acute ischemic stroke patients with sICHr after intravenous thrombolysis therapy were enrolled retrospectively.The clinical data were collected and the related literature was analyzed and summarized.ResultsA total of 6 acute ischemic stroke patients with sICHr were enrolled, including 4 males.Three patients had a history of using antiplatelet agents, 2 with atrial fibrillation, 4 with hypertension, 3 with previous stroke history, 4 with smoking history, and 4 had sICHr at 2 h after intravenous thrombolysis.Of the 14 hemorrhagic foci (except in the infarct areas), 10 were in the cerebral cortex.Three patients died within 1 week, and 1 was in a persistent vegetative state.Conclusions SICHr after intravenous thrombolysis in patients with acute ischemic stroke is mainly located in the cerebral cortex.The outcomes in acute ischemic stroke patients with SICHr after intravenous thrombolysis are poor, and the mortality is high.
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Objective To investigate the impact of short-term exposure to atmospheric particulates (PM10/PM2.5) on stroke risk.Methods The literature databases were retrieved.A Meta-analysis of the literature on atmospheric particulate matters and stroke onset met the inclusion criteria was conducted.Results A total of 42 articles were included.Meta-analysis showed that the PM10 increase per 10 μg/m3,the short-term risk of stroke increased 0.6％ (odds ratio [OR] 1.006,95％ confidence interval [CI] 1.003-1.009);PM2.5 increase per 10 μg/m3,the short-term risk of stroke increased 1.3％ (OR 1.013,95％ CI 1.006-1.019).Subgroup analysis showed that the PM10 exposure was only associated with the increased risk of ischemic stroke (OR 1.025,95％ CI 1.010-1.041),and the PM2.5 exposure was only associated with the increased risk of hemorrhagic stroke (OR 1.031,95％ CI 1.010-1.052).Conclusions In the short term,the increased PM10 or PM2.5 concentration is associated with the increased risk of stroke.PM2.5 caused the risk of stroke onset is higher than that of PM10.
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Objective To investigate the impact of short-term exposure to atmospheric particulates (PM10/PM2.5) on stroke risk.Methods The literature databases were retrieved.A Meta-analysis of the literature on atmospheric particulate matters and stroke onset met the inclusion criteria was conducted.Results A total of 42 articles were included.Meta-analysis showed that the PM10 increase per 10 μg/m3,the short-term risk of stroke increased 0.6％ (odds ratio [OR] 1.006,95％ confidence interval [CI] 1.003-1.009);PM2.5 increase per 10 μg/m3,the short-term risk of stroke increased 1.3％ (OR 1.013,95％ CI 1.006-1.019).Subgroup analysis showed that the PM10 exposure was only associated with the increased risk of ischemic stroke (OR 1.025,95％ CI 1.010-1.041),and the PM2.5 exposure was only associated with the increased risk of hemorrhagic stroke (OR 1.031,95％ CI 1.010-1.052).Conclusions In the short term,the increased PM10 or PM2.5 concentration is associated with the increased risk of stroke.PM2.5 caused the risk of stroke onset is higher than that of PM10.
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Objective To analyze the basal conditions of 5 patients with cerebrovascular fibromuscular dysplasia (FMD),and explore the clinical presentation,imaging features,therapies and outcomes of cerebrovascular FMD.Methods Five patients with cerebrovascular FMD,admitted to our hospital from January 2012 to April 2013,were chosen in our study; their medical history and imaging features were collected,and their clinical presentation,imaging features,therapies and outcomes were retrospectively analyzed when combining with literature review.Results Five patients all presented with stroke,including four having hemiplegia as the initial symptom,and one having headache with nausea and vomiting as the main performance.One was diagnosed as having subarachnoid hemorrhage by CT scan,and four had different infarction lesions in lobes and basal ganglia on MRI.Artery dissection was discovered in all patients by cerebral digital substraction angiography,including two with right internal carotid artery dissection,one with right vertebral artery dissection combined with aneurysm in anterior communicating artery associated with "string-of-beads" appearance on C1 segment of right internal carotid artery and left vertebral artery,one with bilateral vertebral artery dissection,and the last one with bilateral internal carotid artery dissection and moyamoya disease-like vessels.No abnormality was discovered in two patients by renal artery angiography.The patient with anterior communicating artery aneurysm was treated with endovascular aneurysm embolization,having poor prognosis.In the remaining 4 patients with cerebral infarction,two were treated with carotid artery stenting,and the other 2 were only given antiplatelet therapy.No patient suffered cerebrovascular accidents during the 12-month follow-up.Conclusions Cerebrovascular FMD is a rare cause of young stroke,and patients with cerebrovascular FMD often manifest headache,neck bruit,carotid artery dissection and stroke.It is particularly important to make definitive diagnosis by performing cerebrovascular imaging examinations and give treatment accordingly.The long term outcome of FMD is not clear now.
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Objective To investigate the effect of cystatin C (CysC) concentration on outcome of intravenous thrombolysis in patients with acute ischemic stroke.Methods The consecutive patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled retrospectively.They were divided into a good outcome group (≤2) and a poor outcome group (＞2) according to the Rankin scale.They were also divided into a hemorrhagic transformation (HT) group and a non-HT group according to whether they had HT or not.Their demographic data and clinical data were compared.Results A total of 103 patients with acute ischemic stroke treated with intravenous thrombolysis were enrolled,44 in the good outcome group,59 in the poor outcome group; 23 in the TH group,and 80 in the non-HT group.The age (62.34 ± 13.41 years vs.68.09 ± 9.74 years; t-2.521,P =0.013),baseline CysC concentration (1.008±0.28 mg/L vs.1.27±0.86 mg/L; t=2.237,P=0.027),incidence of HT (14％ vs.34.9％; x2 =6.016,P =0.014) and National Institutes of Health Stroke Scale (NIHSS) score (10.39 ± 3.11 vs.18 ±2.65; t =13.35,P ＜0.001) in the good outcome group were significantly lower than those in the poor outcome group.Multivariate logistic regression analysis showed that there was no significant independent correlation between CysC and clinical outcome (odds ratio 1.783,95％ confidence interval 0.443-7.185 ; P =0.416).The baseline CysC concentration (1.41 ± 0.54 mg/L vs.0.96± 0.18 mg/L; t =3.941,P=0.001) and the NIHSS score (15.96 ± 3.7 vs.13.05 ±4.87; t =3.017,P =0.004) in the non-HT group were significantly lower than those in the HT group.Multivariate logistic regression analysis showed that the plasma CysC concentration ＞ 1.03 mg/L (odds ratio 9.050,95％ confidence interval 2.384-34.359; P =0.001) was an independent risk factor for HT.Conclusions The increased baseline plasma CysC concentration was associated with the occurrence of HT in patients with acute ischemic stroke after intravenous thrombolysis therapy,but it was not associated with the outcomes.
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ObjectiveToanalyzetheclinicalandimagingcharacteristicsinpatientswithcarotidsteal syndrome ( CSS ) and to investigate its compensatory pathw ays, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were colected. Their vascular lesions, colateral circulation, treatment, and prognosis w ere analyzed. Results A total of 11 patients w ith CSS (8 males and 3 females, mean age 66.7 ±5.1 years) were enroled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) ( n=9, 81.8%), posterior circulation infarction ( n=1, 9.1%), and anterior circulation TIA ( n=1, 9.1%). A total of 19 pathological arteries w ere found:12 (63.1%) w ith occlusion, 2 (10.5%) w ith subtotal occlusion, 4 (21.0%) w ith severe stenosis and 1 (5.2%) w ith artery dissection. Seven patients (63.6%) w ere bilateral internal carotid artery lesions, 3 (27.2%) w ere unilateral bilateral internal carotid artery lesions, and 1 (9.1%) w as bilateral common carotid artery occlusion. Eleven patients had primary col ateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary col ateral circulation and 1 (9.1%) had tertiary col ateral circulation. Al patients w ere treated w ith medication on the basis of the management of risk factors. Three patients w ere treated w ith stenting and tw o were treated with carotid endarterectomy. No stroke occurred in al patients during folow -up til September 2014. Conclusions The vascular lesions of patients w ith CSS often occur in the extracranial segment of internal carotid artery. Usual y the compensatory blood is through the circle of Wil is. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated w ith surgery or endovascular intervention.
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<p><b>BACKGROUND</b>Autophagy has been found to be involved in animal and cell models of atherosclerosis, but to date, it lacks general observation in human atherosclerotic plaques. Here, we investigated autophagy in smooth muscle cells (SMCs), endothelial cells (ECs), and macrophages in human atherosclerotic plaques via transmission electron microscopy (TEM), western blotting, and immunohistochemistry analysis.</p><p><b>METHODS</b>The histopathologic morphology of these plaques was observed via hematoxylin and eosin staining. The ultrastructural morphology of the SMCs, ECs, and macrophages in these plaques was observed via TEM. The localization of microtubule-associated protein 1 light chain 3 (MAP1-LC3), a relatively special maker of autophagy, in plaques was observed by double fluorescent immunochemistry and western blotting.</p><p><b>RESULTS</b>All of these human atherosclerotic plaques were considered advanced and unstable in histologically observation. By double fluorescent immunochemistry, the expression of LC3-II increased in the SMCs of the fibrous cap, the macrophages, and the microvascular ECs of the plaque shoulders. The protein level of LC3-II by western blotting significantly increased in plaques compared with normal controls. In addition, TEM observation of plaques revealed certain features of autophagy in SMCs, ECs, and macrophages including the formation of myelin figures, vacuolization, and the accumulation of inclusions in the cytosol. These results indicate that autophagy is activated in SMCs, ECs, and macrophages in human advanced atherosclerotic plaques.</p><p><b>CONCLUSIONS</b>Our study is to demonstrate the existence of autophagy in human atherosclerotic plaques by different methods, which may contribute to the development of pharmacological approaches to stabilize vulnerable and rupture-prone lesions.</p>
Assuntos
Humanos , Aterosclerose , Metabolismo , Autofagia , Fisiologia , Células Endoteliais , Patologia , Técnicas In Vitro , Microscopia Eletrônica de Transmissão , Proteínas Associadas aos Microtúbulos , Metabolismo , Miócitos de Músculo Liso , Patologia , Placa Aterosclerótica , MetabolismoRESUMO
Atherosclerosis is the major cause of ischemic stroke.Given the importance of the early diagnosis and intervention of atherosclerotic plaques,the use of molecular imaging techniques for early diagnosis of atherosclerosis has become a research focus in recent years.This article reviews the advances in research on molecular imaging in the aspect of early diagnosis of atherosclerosis.