Acute Cerebral Infarction Patients Research Articles

Effects of occupational therapy on the cognitive function and event-related potentials of patients with acute cerebral infraction

Objective To explore the effect of occupational therapy on the cognitive function and P300 event-related potentials (ERPs) of patients with acute cerebral infraction.Methods Ninety-eight acute cerebral infarction patients with cognitive impairment were selected using the mini-mental state examination (MMSE).They were randomly divided into an observation group (n =49) who received occupational therapy plus routine rehabilitation treatment and a control group (n =49) who received only the routine rehabilitation treatment.Before and after 8 weeks of treatment,the patients' cognitive function and their ability in the activities of daily living(ADL) were evaluated using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the modified Barthel index (MBI),respectively.P300 ERPs were also detected.Results There was no significant difference between the two groups with regard to various scores before the treatment (P ＞ 0.05).After 8 weeks of treatment,the LOTCA and MBI scores and the latency and amplitude of ERPs were significantly better than those before treatment in both groups (P ＜ 0.05).In the observation group,the scores of LOTCA (99.4 ± 8.4),MBI (80.7 ± 5.9) and the latency and amplitude of ERPs [(373.45 ± 52.13) ms and (5.87 ± 2.63) μV,respectively] were significantly better than those in the control group(P ＜ 0.05).Conclusion Occupational therapy program based on conventional rehabilitation training can promote the ADL ability and cognitive function of patients with acute cerebral infraction.It is worth applying in clinical practice. Key words: Occupational therapy; Cerebral infraction; Cognitive impairment; Event-related potential

Low-energy laser irradiation of the head after acute cerebral infarction: Effect on self-care and related factors

Objective To observe the effect on prognostic factors of low-energy helium-neon laser irradiation of functional areas of the head in patients with acute cerebral infarction.Methods Three-hundred fifty-eight acute cerebral infarction patients were randomly divided into a regular group (120 cases),a treatment group (118 cases) and a control group (120 cases).The patients in the regular group were given the conventional neurological treatment,while those in the treatment group and control group were treated using helium-neon laser and normal red light.The functional areas of the head were irradiated at 72 h after the incidence of disease on the basis of the conventional regimen.The hemorheology,blood lipid and homocysteine (HCY) levels of patients in all 3 groups were measured before treatment,1 month afterward(M1) and 3 months afterward (M3).Their ability in activities of daily living (ADL) was also evaluated using Barthel Index (BI) at 3 months after the treatment.Results At M1 and M3 the average whole blood viscosity at high shear rate,plasma viscosity,fibrinogen triglyceride (TG),high-density lipoprotein cholesterol (HDL-C) and HCY in the treatment group were significantly lower than in the regular and control group (P ＜ 0.05).At M1,the average whole blood viscosity at low shear rate (6.41 ± 0.58 mpa * s) in the treatment group was also significantly lower than that in the other 2 groups (P ＜ 0.05).At M3,the average total cholesterol (TC) in the treatment group (4.20 ± 0.18 mmol/L) was significantly lower compared with that in the regular and control group (P ＜ 0.05).According to the average BI scores,ADL in the treatment group (27 cases of independence/48 cases of mild dependence) were significantly better than that in the regular group (18/35 cases) and the control group (20/32 cases).Conclusions Low-energy helium-neon laser irradiation of the head's functional regions may promote the recovery of neurological function for cerebral infarction patients,and can be an adjuvant therapy in clinical practice. Key words: He-Ne laser; Acute cerebral infarction; Head functional areas; Activity of daily living

Imaging characteristics of basilar artery hypoplasia

To determine the imaging characteristics of basilar artery hypoplasia (BAH). From October 2009 to August 2013, 10 193 magnetic resonance angiogram (MRA) and 31 716 magnetic resonance imaging (MRI) consecutive cases were retrospectively retrieved from our institutional Picture Archiving and Communication System (PACS) database. BAH was defined as a continuous diameter reduction all over artery and a basilar artery diameter ≤ 2 mm. The same cut-off value was applied for vertebral artery hypoplasia (VAH). We measured the diameters of basilar and vertebral arteries with PACS in all patients according to source imaging and IMP construction of MRA. The carotid arterial computed tomography angiogram (CTA) profiles were reviewed in 50 patients. The fetal-type posterior circle of Willis (FTP) was assessed. The diagnosis of acute cerebral infarction was based on clinical symptoms, signs and a high signal on diffusion-weighted imaging (DWI). Acute cerebral infarction was divided into anterior circulation stroke (ACS) and posterior circulation stroke (PCS). A total of 210 BAH were identified among 10 193 consecutive patients. BAH was more common in females (56.7%) than males (43.3%) in the patient group. They had a fetal-type of posterior cerebral artery (FTP) (175 bilateral (83.3%), 35 unilateral (16.7%)). 99.5% patients had V4 VAH and 56.0% (28/50) V1-V3 VAH. Among 210 BAH, there are 74 patients (mean age 64 years, average 25-91 years, 44 males) with a diagnosis of acute cerebral infarction (ACI). The males were predominant in ACI (59.5% in males vs 40.5% in females, P = 0.021). The frequency of BAH was detected in 74 (2.2%) among 3 294 ACI patients. As a relatively rare vascular abnormality, BAH has always unilateral or bilateral FTP and V4 VAH.

Relationship between high sensitive C-reactive protein and stroke subtype according to Chinese Ischemic Stroke Subclassification criteria in patients with acute cerebral infarction

By analyzing the clinical data of 216 cases of acute cerebral infarction (ACI) from 2012 January to 2013 June retrospectively, we found that the serum levels of high sensitive C-reactive protein (hs-CRP) in patients were significantly higher than those in 186 controls (P 8 were higher than that in those with NIHSS score ≤8 (P<0.05). The hs-CRP level of patients of large artery atherosclerosis were (6.32±4.12) mg/L and the positive rate of hs-CRP was 85.7%(84/98). All were respectively higher than those in patients of penetrating artery disease [(1.97±0.86) mg/L, 7/71], cardiogenic stroke [(3.70±2.76) mg/L, 14/24], undetermined etiology [(3.43±3.52) mg/L, 5/11] and other etiologies [(3.41±3.25) mg/L, 5/12] (all P<0.05). Logistic regression analysis was performed for the risk factors of ACI. The correlative factors of ACI included hypertension, diabetes mellitus, atrial fibrillation, smoking, total cholesterol, homocysteine and high sensitive C-reactive protein (OR=1.56, 1.19, 1.23, 1.17, 3.08, 1.34, 1.25, all P<0.01). The serum levels of hs-CRP increased significantly in ACI patients and were correlated with the degree of neural function defect. Key words: Cerebral infarction; C-reactive protein; Homocysteine; Chinese Ischemic Stroke subclassification

血浆同型半胱胺酸和D-二聚体水平与急性期脑梗死各亚型的关系

Purpose-To study plasma homocysteine(Hcy)/D-dimer levels in patients with differernt subtype of acute cerebral infarction for early etiology diagnosis. Methods: The subjects were 246 acute cerebral infarction patients in the first 24 hours of stroke onset at our hospital. We divided them into large –artery atherosclerosis(LAA) group(n=66), small artery occlusion(SAO) group(n=76), cardio embolism(CE) group(n=40),stroke of other demonstrated etiology(SOE) group (n=11)and stroke of other undemonstrated etiology(SUE) group(n=51) according to the TOAST classification. Plasma homocysteine and D-diamer were determined within the first 24 hours of admission, the differences in subgroups and control group(n=121) were analyzed. Results : Plasma homocysteine levels in LAA group were signficantly higher than other groups( P &lt;0.05), no differences in non-LAA groups( P &gt;0.05);Plasma D-diamer levels in CE group were significant higher than other groups( P &lt;0.05), no differences in non-CE groups( P &gt;0.05). Conclusions: Plasma homocysteine and D-diamer level are associated with subtypes of acute cerebral infarction, and it contributed to early classification diagnosis and individual treatment of patients with acute cerebral infarction.

Levels of histone H3 acetylation in peripheral blood mononuclear cells of acute cerebral infarction patients

To observe the co-variation of acetylated histone H3 levels of peripheral blood mononuclear cells (PBMCs) and onset time of acute ischemic stroke and examine the histone H3 acetylation levels in PBMCs of acute cerebral infarction patients with different stroke subtypes and injury degrees. The peripheral blood samples 2 ml from patients at different timepoints (1, 3, 5, 7, 14 d) from April 2013 to July 2013 and normal controls were collected to observe the dynamic change of Ac-H3 levels of PBMCs in cerebral infarction patients. Also between April 2013 and October 2013, blood samples from 103 patients within 7 d after acute ischemic stroke were collected. Global histone was extracted by assay kit and differential histone H3 acetylation levels were determined by Western blot. All patients were measured by the Oxfordshire Community Stroke Project (OCSP) classification and National Institutes of Health Stroke Scale (NIHSS) score. The levels of acetylated histone H3 in PBMCs of acute cerebral infarction patients started to decrease as early as 1 d and remained below those normal controls for at least 7 d after stroke. It fulfilled the minimum at 3 d after infarction (P < 0.001). Acetylated histone H3 levels of PBMCs differed in OCSP classification (P < 0.05) and reached a nadir in TACI group. Histone H3 acetylation levels of PBMCs were major affecting factors of neurological injury severity and negatively correlated with it through multiple regressive analysis (β = -0.297, P = 0.001). Histone H3 acetylation level in PBMCs of acute cerebral infarction patients is lower than healthy persons. And it decreases markedly in TACI group and patients with severe neurological dysfunction.

Impact of Glucose Fluctuation on Acute Cerebral Infarction in Type 2 Diabetes

This study aimed to describe the frequency and temporal profile of acute cerebral infarction (ACI) using a continuous glucose monitoring system (CGMS) in patients with and without type 2 diabetes mellitus (T2DM) and explore the impact of blood glucose fluctuations on the short-term prognosis of ACI. The subjects were divided into four groups: T2DM with acute cerebral infarction (DMCI, Group A, n=56); T2DM without acute cerebral infarction (DM-NCI, Group B, n=36); Acute cerebral infarction patients without T2DM (NDM-CI, Group C, n=54); Healthy control group (NG, Group D, n=36). The National Institutes of Health Stoke Scale (NIHSS) and modified Rankin scale (mRs) were collected in Group A and C. All subjects were monitored for 72 hours using the CGMS. Indices such as fasting blood glucose (FBG) and mean amplitude of glycemic excursions (MAGE) were calculated. Glycemic excursions were compared between Group A, B, C and Group D, respectively. Multiple linear regression analysis and logistic analysis was applied. MAGE is related to NIHSS, homocysteine (HCY), HOMA-IR, FBG, CRP and IMT, while NIHSS is related to CRP, HCY, HOMA-IR, IMT. The factors impacting the short-term prognosis of ACI were NIHSS, HBA1C and MAGE. Larger glucose fluctuations are associated with more stroke risk factors and are associated with a poorer short-term prognosis. More attention should be paid to glucose fluctuations in patients with ACI and a history of T2DM.

Identification of miRNA-21 and miRNA-24 in plasma as potential early stage markers of acute cerebral infarction.

This study investigated the role of microRNA-21 (miR-21) and microRNA-24 (miR-24) in the pathological processes that follow cerebral ischemic injury and examined the potential use of miR-21 and -24 in stroke diagnostics as sensitive plasma biomarkers. An oxygen-glucose deprivation (OGD) model was constructed using mouse N2A neuroblastoma cells (N2A). Western blot analysis and quantitative polymerase chain reaction (qPCR) were employed to detect protein and miRNA expression levels. miR-21 and miR-24 were analyzed in the plasma from 68patients with acute cerebral infarction (ACI) and 21healthy individuals. In the present study, it was identified that plasma miR-21 and miR-24 were lower in ACI patients than in the controls (P<0.05). A positive correlation was demonstrated between plasma miR-21 and miR-24, and a negative correlation was revealed between miR-21, miR-24 and the National Institutes of Health Scales Score (NIHSS) within the first day following stroke. In addition, the expression of miR-21 and miR-24 was upregulated by 3.3- and 4.9-fold, respectively, when the reoxygenation time persisted up to 24h following 3h of OGD. The expression of Bcl-2 was upregulated following gain of miR-21 function, while X-linked inhibitor of apoptosis protein (XIAP) was downregulated after gain of miR-24 function in N2A cells. The data suggested that miR-21 may have an antiapoptotic effect in N2A neuroblastoma cells following OGD and reoxygenation, while miR-24 may have a pro-apoptotic effect. Therefore, these microRNAs may be potential therapeutic targets for the treatment of post-ischemic injury and may act as diagnostic markers during the early stage of ACI.

Evaluating the diagnostic value of vWF:Ag, D-D and FDP in patients with acute cerebral infarction using ROC curves.

Cerebral infarction is usually associated with arteriosclerosis, vascular endothelial cell injury and blood flow through the vascular system. The diagnostic value of markers, including von Willebrand factor antigen (vWF:Ag), D-dimer (D-D) and fibrinogen/fibrin degradation product (FDP), have not been studied in patients with acute cerebral infarction. Thus, the aim of the present study was to use receiver operating characteristic (ROC) curves to evaluate the diagnostic significance of vWF:Ag, D-D and FDP in 94 cases of acute cerebral infarction. The results revealed that vWF:Ag and D-D concentrations were significantly higher in acute cerebral infarction patients as compared with the normal controls (P<0.01), whereas no statistically significant difference in FDP was observed between the groups (P>0.01). Plasma vWF:Ag and D-D concentrations significantly correlated with the National Institute of Health Stroke Scale (NIHSS) scores (r=0.625 and 0.582, respectively; P<0.01). In addition, the vWF:Ag concentration significantly correlated with the D-D concentration (r=0.320; P<0.01), whereas FDP concentration did not correlate with D-D or vWF:Ag concentrations or the NIHSS scores (r=0.172, 0.188 and 0.065, respectively; P>0.05). The area under the ROC curve using vWF:Ag as a diagnostic marker in patients with acute cerebral infarction was 0.900, while for D-D the area was 0.795 and for FDP the area was 0.465. Logistic regression analysis revealed that the odds ratios of vWF:Ag and D-D were 16.727 and 2.324, respectively, which were statistically significant (P<0.001 and 0.023, respectively). These results indicated that using vWF:Ag as a diagnostic marker is likely to significantly improve the sensitivity of diagnosing patients with acute cerebral infarction. The diagnostic value of vWF:Ag concentration was significantly higher compared with D-D and FDP levels.

Effect of system care on acute cerebral infarction patients' neurological function and motor function

Objective To analyze the effect of system care on acute cerebral infarction patients' neurological function and motor function.Methods In our hospital hospitalized patients with acute cerebral infarction as research subjects were given routine care and nursing intervention system to compare with neurological conditions and motor function before and after care.Results ① After receiving care intervention,the patients of two groups with neurological deficit scores lower than that before the intervention (P ＜ 0.05),the mean neurological function score of observation group and heavy proportion of patients with neurological deficits were significantly lower than those of the control group of patients (P ＜ 0.05); ② after receiving care intervention,the patients' intervention of motor function scores were all higher than before (P ＜ 0.05),an average motor function score was significantly higher in patients (P ＜ 0.05),and the proportion of patients completely needing help for life was significantly less than that the control patients (P ＜ 0.05).Conclusion The system can effectively improve the nursing intervention in patients with acute cerebral infarction and neurological motor function,and promote their recovery. Key words: Acute cerebral infarction; System Care; Nervous function; Motor function

Ox-LDL Influences Peripheral Th17/Treg Balance by Modulating Treg Apoptosis and Th17 Proliferation in Atherosclerotic Cerebral Infarction

Background: CD4⁺CD25⁺ regulatory T (Treg) cells and T-helper 17 (Th17) cells play important roles in acute cerebral infarction (ACI). Our previous findings have suggested that oxidized low-density lipoprotein (Ox-LDL) could influence Treg/Th17 ratio in ACI patients. However, the mechanisms are still not clear. Methods and Results: We evaluated the effects of ox-LDL on Th17/Treg cell apoptosis and proliferation in vitro. Our results demonstrated that with increased ox-LDL concentrations, the frequency and suppressive function of Treg cells was decreased while the frequency of Th17 cells was elevated in control subjects. In addition, AnnexinV⁺ apoptotic rate, Fas/Fas ligand (FasL) expression, and Caspase-3 activity were escalated in Treg cells while were no significant changes in Th17 cells. Simultaneously, 5-Bromo-29-Deoxyuridine (BrdU) and 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyl Tetrazolium Bromide (MTT) incorporation of Th17 cells was elevated accompanied by upregulated nuclear factor-κB (NF-κB) activity. However, Th17 proliferation was decreased when pre-incubated with Pyrrolidine dithiocarbamate (PDTC, inhibitor of NF-κB activation). Furthermore, there were significant changes induced by ox-LDL in Treg apoptosis, Fas/FasL/Caspase-3 expression of Treg cells, and Th17 proliferation, NF-κB activation of Th17 in ACI patients than in patients with transient ischemic attack (TIA) and control subjects (P<0.01, P<0.05 respectively). Conclusion: These data support that ox-LDL may influence the Th17/Treg balance by modulating Fasmediated Treg apoptosis and NF-κB-associated Th17 proliferation. Ox-LDL also induced a more significant alteration of Treg and Th17 in ACI patients than in TIA and control groups, suggesting a novel role in the pathogenesis of ACI.

Relationship between eNOS gene polymorphism and cerebral infarction of young and middle-aged Chinese Han population.

To discuss the relationship between the acute cerebral infarction of differently aged population and the variable number tandem repeat polymorphism of endothelial nitric oxide synthase (eNOS) gene. The genotypes of 129 acute cerebral infarction patients and 100 healthy control subjects were determined by PCR and polyacrylamide gel electrophoresis (PAGE). In the patient group, the frequency of allelic gene a was higher than that in the control group (13.56 % vs 3 %, p < 0.01), and the frequencies of the patients followed the descending order from young through middle-aged to elderly (42.31 % vs 17.2 % vs 5.8 %). The frequencies of the young, middle-aged and elderly population in the control group differed significantly (5.55 % vs 2.94 % vs 2.63 %), and those of the young and middle-aged population in the two groups also differed statistically significantly. The ab genotype of eNOS 4th intron is correlated with the acute cerebral infarction of young and middle-aged Chinese Han population that may involve allelic gene a as an independent risk factor (Tab. 3, Fig. 3, Ref. 13).

Association between ischemic stroke and migraine in elderly Chinese: a case–control study

BackgroundRecent observations suggest that migraine and cerebrovascular disease are comorbid conditions. However, the association of migraine with cerebrovascular disease in the population of elderly Chinese has not been established. This prospective case–control study aimed to investigate the prevalence and lesion characteristics of migraine in elderly Chinese patients with acute cerebral infarction (ACI).MethodsA total of 968 ACI patients aged 55–70 years and 1024 sex- and age-matched control subjects were recruited between January, 2003 and July, 2009. Migraine was determined based on the International Headache Society’s Classification of Headache Disorders, together with past medical records and admission examination results, following an initial questionnaire screening at the first hospital visit. Prevalence rates of overall migraine, migraine with aura and migraine without aura in both ACI patients and control subjects, the stroke subtypes classified according to the Chinese Ischemic Stroke Subclassification (CISS) system and brain locations of the ischemic lesions in ACI patients were analyzed.ResultsThe overall prevalence rate of migraine was 17.15% (166/968) in patients with ACI but only 3.9% (40/1024) in control subjects (P < 0.01). In both subject groups, over 80% of migraine cases were migraine without aura. In the 166 ACI patients with comorbid migraine, large artery atherosclerosis was the most frequent subtype of ischemic lesion (65.06%), followed by cardiogenic stroke (23.50%), and all other lesion subtypes were each less than 10%. Ischemic infarctions were located predominantly in the anterior circulation in the brain in both ACI patients with and without migraine.ConclusionsThe prevalence rate of migraine is significantly higher in ACI patients than non-ACI subjects in the population of elderly Chinese. Migraine without aura is the major form of migraine in both ACI patients and non-ACI subjects. In ACI patients, regardless of migraine, infarction lesions were predominantly located in the anterior cerebral circulation.

Effect of Rosuvastatin on OX40L and PPAR-γ Expression in Human Umbilical Vein Endothelial Cells and Atherosclerotic Cerebral Infarction Patients

Atherosclerotic cerebral infarction (ACI) is characterized by extremely high fatality and disability rate. Recent studies indicate that co-stimulatory signal of tumor necrosis factor superfamily OX40/OX40L contributes to the atherosclerosis effect in ACI patients. However, it remains unclear the mechanism underlying the anti-atherosclerosis process. So this study aims to investigate the effects of rosuvastatin on the expression of OX40L, peroxisome proliferator-activated receptors gamma (PPAR-γ) in human umbilical vein endothelial cells (HUVEC), and human peripheral blood lymphocytes. Different concentration of rosuvastatin and oxidized low-density lipoprotein (OX-LDL) co-intervene HUVEC to observe the expression of OX40L and PPAR-γ using real-time quantitative RT-PCR (Q-RTPCR) and Western-blot. Furthermore, we examined the level changes of plasmic sOX40L and hs-CRP in acute atherosclerotic cerebral infarction patients. The results demonstrated that concentration-dependent and time-dependent OX-LDL remarkably stimulate the expression of OX40L and inhibit the expression of PPAR-γ in vitro. But concentration-dependent rosuvastatin can reverse the impact of OX-LDL, suggesting that rosuvastatin can prevent the expression of OX40L, and the process may be associated with mevalonate pathway. In vivo, acute atherosclerotic cerebral infarction patients taking 20 mg rosuvastatin exhibited significantly reduced expression of OX40L in peripheral blood lymphocyte, sOX40L in blood plasma, and hs-CRP compared with before treatment. Our studies identified rosuvastatin as an effective medicine in controlling atherosclerosis process in ACI by inhibiting OX40L and stimulating PPAR-γ expression.

Cost-effectiveness analysis of clinical pathway for different TOAST subtypes of patients with acute cerebral infarction

Objective To evaluate the cost-effectiveness of clinical pathway for different Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes of patients with acute cerebral infarction (ACI). Methods ACI clinical pathway was developed according to the characteristics of our hospital. A total of 1036 ACI patients were recruited. They were divided into control (n=472) and pathway (n=564) groups. The hospitalization time, hospitalization expenses and clinical outcomes between two groups of different TOAST subtypes were compared. Good clinical outcome was defined as a modified Rankin Score (mRS) of 0-2. Results Compared to control group, the lengths of stay for ACI patients in pathway group were significantly shorter (P=0.004) while those with good clinical outcomes were significantly higher (P=0.002). Furthermore, the lengths of stay for large artery atherosclerosis (LAA) subtype patients in pathway group were shorter (P=0.000), both total hospital charges and medication costs were significantly reduced (P=0.044, 0.036) while those with good clinical outcome were significantly higher (P=0.002); the differences among other four subtypes of small artery occlusion (SAO), cardioembolism (CE), stroke of other etiology (SOE) and stroke of undetermined etiology (SUE) were not statistically significant. Conclusion The implementation of clinical pathway may offer more benefits to LAA subtype ACI patients than other subtypes. Key words: Cerebrovascular Accident; Clinical pathways; Prognosis

Reduced Serum Levels of Triglyceride, Very Low Density Lipoprotein Cholesterol and Apolipoprotein B in Parkinson’s Disease Patients

BackgroundPrevious studies have shown a lower incidence of stroke in Parkinson’s disease (PD) patients. The role of the lipids and lipoproteins as risk factors for stroke is uncertain in the lower prevalence of stroke in PD patients.ObjectivesTo explore the lipids and lipoproteins serum levels in PD patients.MethodsA retrospective study was performed on 110 PD patients (PD group), 130 controls with non-cerebrovascular neurological diseases (OD group), 140 acute intracerebral hemorrhage patients (ICH group) and 140 acute cerebral infarction patients (CI group). The records about serum levels of lipids and lipoproteins were analyzed.ResultsThere were significant differences for the serum level of triglyceride (F = 5.031, p=0.002), very low density lipoprotein cholesterol (F = 5.313, p=0.001), apolipoprotein B (F = 16.038, p<0.0001) in the four groups. PD group had a significantly lower serum level of triglyceride (TG) than the OD (p=0.032), ICH (p=0.00047) and CI (p=0.001) groups. Very low density lipoprotein cholesterol (VLDL-C) serum level was significantly lower in PD group than in OD (p=0.039), ICH (p=0.00021) and CI (p=0.001) groups. There was a significantly lower serum level of apolipoprotein B (apo B) in PD group than in OD (p=0.002), ICH (p<0.0001) and CI (p<0.0001) groups.ConclusionsThere are reduced serum levels of TG, VLDL-C and apo B in PD patients, which may be related to the decreased prevalence of stroke in PD patients.

The lower safety level of blood pressure evaluated by123I-IMP single-photon emission computed tomography in acute cerebral infarction patients

SUMMARY Aims: At the acute phase of cerebral infarction, the autoregulation of cerebral blood flow (CBF) is compromised. In this study, we explored the lower safety level of blood pressure (BP) for maintaining optimal CBF in acute cerebral infarction patients. Patients & methods: Acute middle cerebral artery territorial infarctions were screened. Patients who had single-photon emission computed tomography performed within 7 days following onset were enrolled (n = 30). The CBF ratio (ischemic:intact) was calculated at the border zone of the middle cerebral artery. Vascular lesions were assessed by magnetic resonance angiography. Results: The lowest BP level that maintained the CBF ratio ≥0.6 was 109 mmHg in patients with mild-to-moderate stenosis and 142/79 mmHg in patients with occlusion at the lesion side and stenosis at the intact side by the linear regression analysis. Conclusion: BP control should be carefully managed in acute stroke patients with occlusion and stenosis in the main arteries of the brain.

Evaluation of a new method and instrument for detection platelet aggregation function and its clinical application

This study was purpose to evaluate a new method and instrument for detecting platelet aggregation function, establish the reference intervals for PL-11 platelet analyzer, and evaluate its clinical application. The evaluation was based on the guidelines of Clinical and Laboratory Standards Institute (CLSI or NCCLS) and Clinical Laboratory Improvement Amendment 88. Intravenous blood samples anticoagulated with sodium citrate were detected by PL-11 platelet analyzer. The reference intervals were defined after statistic analysis. The clinical diagnostic significance of the PL-11 platelet analyzer was evaluated by testing the change rate of platelet maximum aggregation rate (MAR) of acute cerebral infarction (ACI) patients in the department of Neurology who took clopidogrel 7 d before and after. The result showed that all the parameters meet the standard of CLIA'88. The platelet MAR of 247 healthy volunteers which was induced by PLR-06, PLR-07, PLR-09 and PLR-10, was detected by the PL-11 platelet analyzer, respectively. The MAR is 58.8 ± 10.1 (%), 61.2 ± 11.8 (%), 51 ± 10.2 (%), 53.1 ± 9.2 (%), respectively. The MAR of ACI patients is significantly lower than that after taking clopidogrel. It is concluded that the PL-11 platelet analyzer is an ideal platelet function detector for early warning and diagnosis of thromboembolic disease, which is worthy to be extended and applied.

Quantitative Evaluation of Movement Disorders by Specified Analysis According to Actigraphy Records

Aim: To evaluate whether the specified analytical objective scale represents disease severity for neurological movement disorders according to the physical activity of the patients. Methods: Eighty-one patients with Parkinsonʹs disease (PD) and sixty-one patients with acute cerebral infarction (ACI) combined with upper limb motor function disorder at the Shuguang hospital, affiliated with the Shanghai TCM university. PD patients and ACI patients were treated according to the international medication guiding principle for PD or ACI respectively. We analysed the power-law exponent (PLE) and the detrended fluctuation analysis (DFA) of the actigraphy records, which were taken on 2 occasions (before drug administration for two groups, 24-38 days for PD patients and 28 days for ACI patients). Efficacy was evaluated by the Unified Parkinson Disease Rating Scale (UPDRS) for PD and by Fugl-Meyer Assessment (FMA) and the Functional Independence Measure (FIM) for ACI patients. We also evaluated the correlation between any changed rates of UPDRS scores and PLE for PD patients, and FMA and FIM scores and DFA for ACI patients. Results: The UPDRS scores and PLE values for PD, and the FMA and FIM scores with the DFA score for ACI were improved after the drug administration; they yielded a linear correlation coefficient of 0.699 and 0.823 between the improvement rates of the total UPDRS scores and the PLE values, and between the UPDRS Part III score and the PLE values, while it yielded a linear correlation coefficient of 0.638 and 0.712 between the improvement rates of the FMA scores and the DFA, and the FIM scores and the DFA respectively. There was no correlation between the UPDRS scores and the DFA values for the PD patients or between the FIM score or the FMA score and the PLE values for ACI patients. Conclusion: Actigraphy records and the analysis of its PLE or DFA might provide useful objective and specific information for controlling PD or ACI patients and for monitoring drug administration respectively.

Relation Between Left Atrial Enlargement and Stroke Subtypes in Acute Ischemic Stroke Patients

ObjectiveIncreased atrial size is frequently seen in ischemic stroke patients in clinical practice. There is controversy about whether left atrial enlargement (LAE) should be regarded as a risk factor for cerebral infarction. We investigated the association between indexed left atrial volume (LAVI) and conventional stroke risk factors as well as stroke subtypes in acute ischemic stroke patients.MethodsOne hundred eighty two acute cerebral infarction patients were included in this study. Brain magnetic resonance imaging and transthoracic echocardiography were done for all patients within 30 days of diagnosis of acute cerebral infarction. Echocardiographic LAE was identified when LAVI was more than 27 mL/m2. Stroke subtypes were classified by the Trial of Org 10171 in acute stroke treatment classification.ResultsThere were significant differences between subjects with normal and increased LAVI in prevalence of stroke risk factors including atrial fibrillation (p = 0.001), hypertension (p = 0.000), valvular heart disease (p = 0.011) and previous stroke (p = 0.031). An increased LAVI was associated with cardioembolic subtype with an adjusted odds ratio was 6.749 (p = 0.002) compared with small vessel disease.ConclusionIncreased LAVI was more prevalent in those who had cardiovascular risk factors, such as atrial fibrillation, hypertension, valvular heart disease and history of previous stroke. LAE influenced most patients in all subtypes of ischemic stroke but was most prevalent in the cardioembolic stroke subtype. Increased LAVI might be a risk factor of cerebral infarction, especially in patients with cardioembolic stroke subtype.