The effect of treatment duration with human urinary kallidinogenase on the efficacy and safety of acute ischemic stroke: a subgroup analysis of RESK study / 中华神经科杂志

Objective:To explore the impact of treatment duration with human urinary kallidinogenase (HUK) on the efficacy and safety of acute ischemic stroke (AIS).Methods:In this subgroup analysis of RESK study, a total of 990 AIS patients recruited from 65 centers in China between August 2015 and June 2020 were included and divided into short medication group (HUK for 8 days, n=185) or long medication group (HUK for 15 days or 21 days, n=805). The proportions of patients with modified Rankin Scale (mRS) score of 0, 0-1, 0-2 at 90 days, National Institutes of Health Stroke Scale (NIHSS) score change from baseline to 22 days, the proportions of patients with Barthel index (BI)≥95 at 90 days, and the incidences of adverse events were analyzed. Comparisons between groups were conducted using chi-square test, single factor and multivariate Logistic regression analysis, etc. Results:Multivariate regression analysis showed that the proportions of patients with 90-day mRS score of 0-2 [74.1% (137/185) vs 75.0% (604/805); OR=1.047, 95% CI 0.676-1.620, P=0.838] and 22-day NIHSS score change from baseline (4.60±2.00 vs 4.26±2.80; OR=-0.390, 95% CI -1.125-0.344, P=0.297) showed no statistically significant difference between the short medication and long medication groups; the proportions of patients with 90-day mRS score of 0-1 [48.1% (89/185) vs 59.1% (476/805); OR=0.674, 95%CI 0.463-0.983, P=0.041] and 90-day BI≥95 [43.6% (79/181) vs 55.1% (442/802); OR=0.614, 95%CI 0.420-0.897, P=0.012] were significantly lower in the short medication group than in the long medication group. There was no statistically significant difference in the incidences of adverse events between these 2 groups. Conclusions:In AIS patients, consecutive 8-day dosing of HUK improved immediate (22-day NIHSS score) and long-term outcome (90-day mRS score 0-2) and was safely tolerated. When applicable, extended duration of HUK could improve long-term disability-free rate (90-day mRS score 0-1) and quality of life (90-day BI) without increasing the risk of adverse events.

Neuroprotective effects of Zhenzhu Tongluo Pills on the cerebral ischemia reperfusion injury in rats / 国际中医中药杂志

Objective:To explore the protective effects of Zhenzhu Tongluo Pills on cerebral ischemia reperfusion injury in rats.Methods:Totally 15 healthy SD rats were randomly divided into sham-operation group, model group and TCM group according to random number table method, with 5 rats in each group. Except for the sham-operation group, cerebral ischemia models in the other two groups were induced by temporary middle cerebral artery occlusion. After the establishment of ischemia models, the TCM group was administered Zhenzhu Tongluo Pills solutions (1 ml/100 g) intragastrically at a dose of 0.5 g/(kg·d), and the sham-operation group and model group were treated with normal saline, for 14 consecutive days. Neurological deficit score was used to evaluate the degree of neurological deficit in cerebral ischemia rats. TTC staining were used for determining the infarct weights. The nerve cell damage was observed using HE staining method. Immunohistochemistry staining was used to observe the expression levels of GFAP, Nestin, and NeuN.Results:Compared with that at the 3 hours after reperfusion, the Bederson score in the TCM group decreased at the 30 minutes after the last administration ( P<0.05); compared with the model group, the infarction ratio of rats in the TCM group decreased ( P<0.05); the NeuN staining of neurons around the ischemic lesion in the model group rats was light, while Nestin and GFAP staining were deep; the Nestin and GFAP staining of neurons in the TCM group was light, while NeuN staining was deeper. Conclusion:Zhenzhu Tongluo Pills can improve the symptom of neurological deficits, reduce the volume of infarction, and protect neurons from injury in rats with cerebral ischemia.

Focusing on vascular cerebral dysfunction / 中国脑血管病杂志

Vascular cerebral dysfunction refers to a brain dysfunction syndrome caused by cerebrovascular etiologies and diseases that lead to disorders of sensorimotor function,cognitive function and neuro-psychiatry. In the past decades,with the maturity of diagnostic concepts and advances of brain imaging technology,the detection of vascular burden in brain dysfunction has progressed remarkably. However,in daily practice,the definitive diagnosis of vascular brain dysfunction is still challenging. Because of the interindividual heterogeneity, very few general therapeutic principles which are applicable to all patients exist. Individualized therapeutic decision must be made from existing methods, including symptomatic treatment, supportive care and vascular risk factors management. It is hoped that there will be targeted etiological treatment in the future.

Application value of high-resolution magnetic resonance imaging in the etiological diagnosis of head and neck artery occlusion / 中国脑血管病杂志

Objective To discuss the value of high-resolution magnetic resonance imaging (HR-MRI) in the etiological diagnosis of patients with head and neck artery occlusion.Methods From December 2015 to February 2017,25 consecutive patients with acute head and neck artery occlusion in Xuanwu Hospital,Capital Medical University were enrolled prospectively.The 32-channel head-neck combined coils were used to conduct head-neck integrated HR-MRI.The characteristics of proximal vascular wall of the occluded vascular segments and the signal features of thrombi in the middle and distal segments of occlusion were analyzed.The evaluation of the occlusive etiology was performed by two neurologists according to the clinical history,laboratory examinations,and imaging examinations of the patients,and the accuracy of conventional lumen imaging and conventional lumen imaging combined with HR-MRI in etiological classification were compared.Results Twenty-five patients with acute head and neck artery occlusion completed HR-MRI examinations.A total of 31 segments of the occluded vessels were diagnosed,and 21 of these were diagnosed with the conventional luminal imaging,30 were diagnosed with the conventional luminal imaging+HR-MRI,including 24 segments of atherosclerotic occlusion (n=19),4 segments of arterial dissecting occlusion (n=4),and 3 segments of arteritis occlusion (n=2).(2) In patients with atherosclerotic occlusion,the eccentric thickening was observed in the proximal wall of occlusive segment;the typical double-lumen or crescent-shaped hyperintense hematoma were observed in occlusive arterial dissection;long-segment annular thickening and enhancement were observed in the segment of arteritis occlusion.(3) The accuracy of the cause classification diagnosis of conventional luminal imaging and conventional luminal imaging+HR-MRI were 67.7% (21/31) and 96.8% (30/31) respectively (P<0.01).Conclusions Compared with the luminal imaging,the head and neck combined HR-MRI can reveal the arterial wall characteristics of the initial segment of occlusion.It has certain advantages in the interpretation of the causes,such as atherosclerosis,arterial dissection and arteritis.

Analysis of influencing factors of renal insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation / 中国脑血管病杂志

Objective To observe the incidence and the influencing factors of kidney insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation. Methods From January 2013 to January 2015,266 consecutive acute cerebral infarction patients with non-valvular atrial fibrillation admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. Renal function was assessed by the estimated glomerular filtration rate (eGFR),eGFR 0. 05). (2)Multiple Logistic regression analysis showed that the age (≥65 years)was an independent risk factor for the occurrence of renal insufficiency in acute cerebral infarction patients with atrial fibrillation (OR,1. 147,95% CI 1. 087 -1. 209;P < 0. 01),and the histories of hypertension (OR,0. 870,95% CI 0. 362-2. 089;P = 0. 755),diabetes mellitus (OR,1. 078,95% CI 0. 403 -2. 883;P = 0. 882 ), and hyperlipidemia (OR,1. 666,95% CI 0. 645 - 4. 302;P = 0. 292 )were not associated with renal insufficiency in cerebral infarction patients with atrial fibrillation. Conclusions The incidence of renal insufficiency in cerebral infarction patients with atrial fibrillation is higher. Age (≥65 years)is an independent risk factor for renal insufficiency in this type of patients.

Application value of carotid artery ultrasonography,CT angiography and DSA in the diagnosis of carotid artery dissection / 中国脑血管病杂志

Objective To investigate the diagnostic value of carotid artery ultrasonography,CT angiography (CTA)and digital subtraction angiography (DSA)for carotid artery dissection. Methods The image data of carotid artery ultrasonography,CTA,and DSA of 24 patients with carotid artery dissection were analyzed retrospectively. Results Twenty-four,16,and 21 patients were examined with DSA,CTA,and carotid artery ultrasonography respectively. The detection rates of carotid artery dissection with DSA,CTA, and carotid artery ultrasonography were 95. 8%,75.0%,and 71. 4% respectively. The DSA mostly showed the line-like sign (n=12,50 %). CTA and carotid artery ultrasonography mostly showed the double lumen sign;they were 37. 5%(n=6)and 52. 4%(n=11)respectively. Compared with DSA,the concordance rates of carotid artery ultrasonography and CTA were 66. 7% and 81. 3% respectively. There was no significant difference (Kappa=0. 39,P=0. 08 and Kappa=0. 43,P =0. 22 respectively). The concordance rate of ultrasonography in combination with CTA and DSA reached 87. 5%(n=15,Kappa=0. 67,P =0.047). There was significant difference. Conclusion DSA is a gold standard for the diagnosis of carotid artery dissection,and it is irreplaceable. Carotid artery ultrasonography in combination with CTA can improve the diagnostic rate. Carotid artery ultrasonography can be used as a screening method for carotid artery dissection.

Clinical, neuroimage, and neuropsychological profiles of semantic dementia / 中华神经科杂志

Objective To explore the clinical,neuroimage,and neuropsychological profiles of semantic dementia (SD).Methods Detailed medical history were collected on 18 SD patients.Brain MRI scans were administered.Neuropsychological evaluation taping semantic memory (things naming),overall cognitive function ( Mini-mental State Examination,MMSE),visuoconstructive skill ( Clock Drawing Test,CDT), daily functional ability (Activities of Daily Living, ADL), neuropsychiatric symptoms (Neuropsychiatric Inventory,NPI),and disease severity (Frontotemporal Lobar Degeneration Modified Clinical Dementia Rating Scale,FTLD-CDR) were performed on all patients.Results The mean age at onset was (60.6 ± 8.5 ) years,with 5 cases over 65. All patients developed progressive word-finding difficulty and anomic speech.Ten patients complained significant memory impairment and 14 experienced behavioral disturbance.Five patients were previously diagnosed as Alzheimer' s disease (AD) and 1 as schizophrenia.All patients developed marked semantic memory impairment both for living things and nonliving things.The mean score on MMSE was 10.94 ± 8.86,with 16 cases performed incorrectly on naming.Mean score on CDT copy was 4.61 ±0.85,with 14 cases scored normally.Mean score on ADL was 29.72 ± 8.75.Cases with a 5-year course showed a significant overall decline.Fourteen cases presented behavior symptoms and scored 8.00 ± 7.22 on NPI.All patients scored worst on language domain among all the domains evaluated in FTLD-CDR.Atrophy,typically involving the left anterior temporal was shown on MRI scans.However,predominantly right temporal atrophy was observed in one patient.Atrophy confined to the temporal lobe in patients with early stage and extended to the contralateral temporal,frontal lobe,and parietal lobe as disease progression. Conclusions Current study suggested that SD tend to develop in presenile age.However,about 1/3 cases develop the disease after 65 years. Deficit in language is the earliest and most prominent symptom. Behavior change is prevalent as well. Patients are commonly misdiagnosed as AD or lack a definite diagnosis.Visuoconstructive skill and other abilities are relatively preserved in the early stage.With progression into the 5th years,overall decline comes inevitably.Brain scans can reflect the disease characteristics and progression. Of note,there exists individual with right dominant atrophy.

PRNP mutations in a series of apparently sporadic neurodegenerative dementias in China.

Mutations in prion protein gene (PRNP) may lead to genetic prion disease, which usually has a broad range of phenotypic presentations that overlap with other neurodegenerative dementias. In this study, we screened the PRNP gene to evaluate the frequency of PRNP mutations and their correlations with clinical phenotype in 185 sporadic neurodegenerative dementia cases and 310 control subjects. Samples of DNA from each subject underwent polymerase chain reaction (PCR) amplification and direct sequencing of PRNP. The clinical characteristics of patients carrying PRNP mutations were detailed. We identified five different PRNP mutations in five patients, of which three were novel (S97N, F198V, and R208C) and two were known (D178N-129M and M232R). The rate of PRNP mutation was 2.70% in our sample. Though future studies confirming the correlation between PRNP mutations and clinical phenotype need to be undertaken, PRNP genotyping may be a valuable tool to differentiate between prion disease and other neurodegenerative dementias.

A clinical analysis of methylmalonic addenda in adolescents / 中华内科杂志

Objective To investigate the clinical characteristics of methylmalonic academia in adolescence cases. Methods 4 cases were diagnosed methylmalonic academia by gas chromatography- masss pectrogram whose clinical, manifestations and treatment process were analyzed. Results The main clinical manifestations in 4 cases with methylmalonic academia were intellect impairment,epilepsy, pyramid signs; 2 of them suffered with hypopsia and optic atrophy, one of them suffered with papilledema. Symptoms were improved after treated with cobamamide and L-carnitine in all the 4 cases 1 months later. Conclusions The main clinical characteristics of methylmalonic academia in adolescence were intellect impairment, epilepsy and pyramid signs. The symptoms could be improved after treatment.