Edaravone administration and its potential association with a new clinical syndrome in cerebral infarction patients:Three case reports

BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone.Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions.Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction,clinicians’knowledge is the key element in recognizing this phenomenon.

Effect of ultraviolet blood irradiation and oxygenation on nerve function and function of the red blood cell membrane pump in patients with acute cerebral infarction

BACKGROUND： Ultraviolet blood irradiation and oxygenation （UBIO） has obtained better clinical effect in treating acute cerebral infarction, but the mechanism underlying this effect remains unclear. OBJECTIVE： To observe the effect of UBIO on the nerve function and activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase activities on the red blood cell （RBC） membrane of patients with acute cerebral infarction. DESIGN： A randomized and controlled study.SETTING： Department of Neurology, Xiangfan Central Hospital.PARTICIPANTS： From January 2000 to December 2001, excluding those above 70 years old, 58 cases of 700 patients with acute cerebral infarction admitted in the Department of Neurology, Xiangfan Central Hospital, were recruited and divided into two groups according to the random number table： UBIO treated group （n=28）, including 17 males and 11 females, aged 40-68 years; and control group （n=30）, including 20 males and 10 females, aged 44-69 years. All the patients agreed to participate in the therapeutic program and detected items. The general informations were comparable without obvious differences between the two groups （P 〉 0.05）.METHODS： ① The patients in both groups received routine treatments, besides, those in the UBIO treated group were given UBIO treatment by using the XL-200 type therapeutic apparatus produced in Shijiazhuang, whose ultraviolet wave was set at 253.7 nm with the energy density of 0.568 J/m^2 per second, UBIO treatment started from the second day after admission, once every other day, with a single course consisting of 5-7 treatments. ② In the UBIO treated group, the venous blood was sampled before and after the first, third and the completion of the treatment course respectively, the venous blood was taken at each corresponding time point in the control group. After centrifugation of the blood at 10 000 rounds per minute, the RBC membrane was separated and then the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase were detected by means of phosphorus determination.③ The nerve function was scored before and after treatment in both groups with European stroke scale, which included 13 items, the total score was 0-100 points, the higher the score, the better the nerve function. MAIN OUTCOME MEASURES ：①Score of European stroke scale before and after treatment in both groups.② Comparison of the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase on RBC membrane between the two groups before treatment and after the first, third and the completion of the treatment. RESULTS： All the 58 patients with cerebral infarction were involved in the analysis of results.① The score of European stroke scale had no obvious difference between the two groups [（49.31±11.48）, （50.58±12.63）, P 〉 0.05], and it was obviously higher in the UBIO treated group than in the control group after treatment [84.66±13.75）, （77.05±11.17）, P 〈 0.05].②The activity of K^＋-Na^＋-ATPase on RBC membrane in the UBIO treated group was significantly increased after the first and third treatment as compared with before treatment [（31.56±19.25）, （27.64±15.83）, （17.67±13.83）, P 〈 0.01], it was still higher after the completion of the treatment than before treatment without obvious difference [（20.86±14.53）, P 〉 0.05]. After the first and third treatment, it was obviously higher in the UBIO treated group than in the control group [19.31±11.88）, （17.44±10.42）, P 〈 0.01]. ③ In the UBIO treated group, Ca2^＋-Mg2^＋-ATPase activity on RBC membrane significantly increased after the first treatment and remained higher than the pre-treatment level throughout the treatment [（27.49±14.72）, （17.41±4.82）, P 〈 0.01]. The activity of Ca2^＋-Mg2^＋-ATPase on RBC membrane was markedly higher in the UBIO treated group than in the control group after after the first, third and the completion of treatment respectively [（24.83±12.88）, （17.70±5.69）; （28.08±13.44）, （16.32±5.29）; （17.42±6.04）, P〈 0.05-0.01]. CONCLUSION： The effect of UBIO treatment against acute cerebral infarction may be mediated by the increased K^＋-Na^＋ ATPase and Ca2^＋-Mg2^＋-ATPase activities on RBC membrane, which enhances the RBC transformation ability so as to lower RBC aggregation and correct high blood viscosity.

Correlation of diseased region and area with neglect and other neuropsychological dysfunctions in patients with cerebral infarction

BACKGROUND: Previous studies reported that frontal-temporal-parietal-occipital pathological changes and diseased range in the right cerebral hemisphere were closely correlated with neglect. But studies on the correlation of neglect with diseased region and area in patients who suffer from initial attack of single focus of cerebral infarction (CI) in left and right cerebral hemispheres are few. OBJECTIVE: To observe the status of neglect in patients who suffer from single focus of CI in cerebral hemisphere, and analyze the correlation of neglect with diseased region and area of CI. DESIGN: Case analysis. SETTING: Treatment Center for Cardiocerebrovascular Disease, Second Hospital of Xiamen city; Department of Neurology, First Hospital Affiliated to Baotou Medical College. PARTICIPANTS: All the CI patients hospitalized in the Department of Neurology, First Hospital Affiliated to Baotou Medical College from June 1998 to May 2001 were retrieved. Inclusive criteria: ① Patients who suffered from initial attack of CI, which was confirmed by skull CT or MRI within 24 hours after onset and presented single focus in cerebral hemisphere. ② be conscious and could cooperate in the examination. ③ did not receive formal education, but could do accounts and some simple writing and reading. ④Patients with homonymous hemianopia were excluded through the examination of perimeter. ⑤ Informed consents were obtained from all the patients. Among 67 patients who met the inclusive criteria, 33 suffered from CI in the left cerebral hemisphere and 34 in the right cerebral hemisphere. METHODS: ① Patients received neglect supplement examination and Chinese aphasia examination within 2.5 to 3 months after the attack of CI . The diagnostic criteria of neglect in the tests of line cancellation, line bisection and copying the figures were as follows: In the line cancellation test based on the method of Albert, patients who could not cancel one or more lines were regarded as abnormal. In the line bisection test based on the method of Peter, patients who left deviated 1.16% or right deviated 2.51% were regarded as abnormal. In the test of copying the figures, round-shape, square, cruciform and other shapes were asked to be copied, defect appeared in the figure was regarded as abnormal. The diagnostic criteria of aphasia were according to the diagnostic method of Chinese aphasia examination and type identification flow-sheet of aphasia. Infarct area was calculated based on Palisino formula: infarct area=π/6×the longest diameter of infarct area×the widest diameter of infarct area×the number of CT positive layer. ② Chi-square test was used for comparing the difference of measurement data. MAIN OUTCOME MEASURES: Diseased region and area of CI and their correlations with neglect. RESULTS: Sixty-seven patients were involved in result analysis. ① The correlation of the occurrence of neglect with the diseased regions of CI: Neglect was not found in 33 patients with CI in left cerebral hemisphere, but was found in 7 of 34 patients with CI in right cerebral hemisphere. The diseased regions involved right temporoparietal region, temporal-parietal-occipital region, frontal-temporal-parietal region, frontal-temporal-parietal-occipital region, temporoparietal basal nucleus, basal nucleus and dorsal caudate putamen. ②The correlation of the occurrence of neglect with diseased area: infarct area ≤ 30 cm3 was found in 2 patients with neglect (12.5%), infarct area at 31 to 60 cm3 in 1 patient with neglect (14.3%),infarct area ≥ 61 cm3 in 4 patients with neglect (36.4%). There was no significant difference in infarct area among groups (P > 0.05). CONCLUSION: ① Right cerebral hemisphere takes advantage in spatial attention. ② Neglect is more possibly caused by the combined pathological changes in temporal and parietal lobe. Temporal and parietal lobes may not cause neglect independently, but the occurrence of neglect is not directly correlated with infarct area.

Effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life

Objective:To investigate the clinical effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and its impact on quality of life.Methods:60 elderly patients with dysphagia caused by acute cerebral infarction were randomly divided into rTMS group and control group,30 cases in each group.Both groups received routine drug therapy and swallowing function training.rTMS group was additionally treated by ultra-low frequency(10mHZ)repetitive transcranial magnetic stimulation for 14 days.The changes of NIHSS score andADL score and NSE serum level and Wa Tian drinking water experiment and Fujishima Ichiro dysphagia scale score and SWAL-QOL score and SF-36 score were observed between the two groups before and after treatment.The clinical effect was evaluated by Wa Tian drinking water experiment.Results:After treatment,The clinical effective rate in rTMS group was significantly higher compared with that in the control group(P<0.05),NIHSS score and serum NSE level were significantly lower compared with the control group(P<0.05),ADL score and Fujishima Ichiro dysphagia score and SWAL-QOL score and SF-36 scores were significantly higher compared with the control group(P<0.05).After treatment,SF-36 total score(or SWAL-QOL Score)was negatively correlated with NSE serum level and NIHSS score,which was positively correlated with ADL score and Fujishima Ichiro dysphagia scale score score.Conclusion:Ultra-low frequency rTMS therapy can reduce NSE level,effectively improve dysphagia in elderly patients with acute cerebral infarction and significantly improve the elderly patients'life quality.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Comparison of the level of thrombus precursor protein in blood plasma between patients with acute cerebral infarction and healthy persons at different time

BACKGROUND： Thrombus precursor protein （TpP） is the index of thrombus activity level, and it is also early referencing index in detecting thrombus diseases. OBJECTIVE： To dynamically observe the changes of TpP level in blood plasma of patients with acute cerebral infarction at different time after onset, and to compare the differences of plasma TpP level between patients with acute cerebral infarction and healthy persons who received health examination. DESIGN： Controlled observation SETTING： Department of Neurology, Affiliated Hospital of Xuzhou Medical College PARTICIPANTS： Totally 58 patients with acute cerebral infarction who received the treatment in the Department of Neurology, Affiliated Hospital of Xuzhou Medical College between September 2004 and March 2005 were recruited in this study. They all met the diagnostic criteria revised by the 4^th National Conference of Cerebrovascular Disorders in 1995 and were diagnosed by clinical and skull CT and （or） MRI examinations. The patients included 33 male and 25 female aged from 36 to 87 years. Time to onset 〈 6 hours, 6 to 11 hours, 12 to 23 hours, 24 to 48 hours and 〉 48 hours were found in 10,11,14,10 and 13 patients respectively. Another 51 persons who homeochronously received the health body examination in our hospital were recruited, including 34 male and 17 female, aged 38 to 85 years, serving as control group. Patients with cardio-cerebrovascualr diseases or liver and kidney diseases were excluded. All the involved subjects were informed of the detected items. METHODS： About 4 mL venous blood was respectively taken from patients admitted to the hospital within 6 hours, 6 toll hours, 12 to 23 hours, 24 to 48 hours and more then 48 hours after onset, and healthy persons when receiving health examination. The level of TpP in blood plasma was measured with enzymelinked immunosorbent assay. MAIN OUTCOME MEASURES： ① Comparison of the level of plasma TpP between patients and controls;② Comparison of the level of plasma TpP of patients with acute cerebral infarction at different time after onset. RESULTS： Totally 58 patients with acute cerebral infarction and 51 persons who received health examination participated in the result analysis. ①Comparison of plasma TpP level between patients and controls： The plasma TpP level of patients with acute cerebral infarction was significantly higher than that of control group [（16.12±3.28）vs （5.38±1.36） mg/L, t= 20.993, P〈 0.01 ]. ② Comparison of plasma TpP level of patients with acute cerebral infarction at different time after onset： The level of plasma TpP was （12.06±3.06） mg/L within 6 hours, （15.11±3.42） mg/L at 6 to 11 hours, （20.63±4.05） mg/L at 12 to 23 hours, （16.15±3.50） mg/L at 24 to 48 hours and （11.88±3.11） mg/L at more than 48 hours after onset. It increased from the 6^th hour, reached the peak at the 12^th to 23^rd hours, maintained at very high level at the 48= hour and then gradually decreased and recovered to the level within 6 hours after onset. The level of plasma TpP of patients with acute cerebral infarction was signiticantly higher at the 12^th to 23^rd hours after onset and the 24^th to 48^th hours after onset than within 6 hours after onset （t = 13.385, P 〈 0.05）. CONCLUSION： ①The level of plasma TpP of patients with acute cerebral infarction is significantly higher than that of persons who received health examination.② Plasma TpP levels of patients with acute cerebral infarction change in wave manner at the different time after onset.

Risk factors of posttraumatic cerebral infarction in patients with severe and extremely severe head injury

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case-fatality. Methods Gender,age,Glasgow coma scale (GCS) ,the presence or absence of basicranial fracture,cerebral hernia or infection,surgical modality,hypotension,and the use of diuretics

Relationship between glutathione and malonaldehyde levels in erythrocytes and the deformation index of erythrocyte in patients at various periods following acute cerebral infarction

BACKGROUND： Glutathione, as an in vivo free radical scavenger, plays an important role in the anti-oxidation defense mechanism in patients with acute cerebral infarction. OBJECTIVE： To observe the relationship between the levels of glutathione （GSH） and malonaldehyde （MDA）, the metabolite of lipid peroxidation, in erythrocyte and deformation index of erythrocyte in patients at various periods following acute cerebral infarction. DESIGN： Controlled observation.SETTING： Qilu Hospital of Shandong University and Institute of Cerebrovascular Disease of Qingdao Medical College. PARTICIPANTS： We chose 98 inpatients with acute cerebral infarction from Department of Neurology, Qilu Hospital of Shandong University from January to December 2000 , serving as cerebral infarction group, including 50 male and 48 female, with mean age of （62±7）years. There were 23 cases found on the 1^st day after onset; 25 cases on the 3^rd day after onset; 25 cases on the 7^th day after onset; 25 cases on the 14th days after onset, and they were all confirmed by craniocerebral CT or MRI. Another 30 homeochronous inpatients with neurosis, cervical syndrome, lumbar intervertebral disc herniation and motor neuron disease were chosen as control group, including 20 male and 10 female, with mean age of （52±8）years . There was no significant difference in age and gender distribution between two groups （P 〉 0.05）. Patients in the two groups were informed of detected index.METHODS：①Ulnar venous blood was chosen from the patients who were fasted on the 1^st, 3^rd,7^th and 14^th days after onset. Deformation index of erythrocyte was measured with BL88-CKX laser diffraction erythrocyte deformeter and photographing was performed. GSH level in erythrocyte was measured with DTNB assay introduced by Beu-tler. MDA level in erythrocyte was measured with modified thiobarbituric acid colorimetric method.②At each sample collecting , according to the criteria accepted by the Fourth National Conference of Cerebrovascular Disease, intergrant of neurologic impairment 〈 15 points was regarded as mild （n=46）, 15 to 30 points as moderate （n=40）and, 〉 30 points as severe （n=12）. ③ t test was used to compare data between two groups , and linear correlation analysis was used in relationship analysis among indexes. MAIN OUTCOME MEASURES ：① Comparison of erythrocyte GSH and MDA levels and deformation index of erythrocyte at various periods between patients with acute cerebral infarction and controls. ②Correlation of erythrocyte GSH level with erythrocyte MDA level and with deformation index of erythrocyte in patients with cerebral infarction . ③ Relationship between erythrocyte GSH level and severity of disease in patients with acute cerebral infarction. RESULTS： Totally 98 patients with acute cerebral infarction and 30 controls all entered the stage of result analysis. ① Erythrocyte GSH level and deformation index of erythrocyte were lower on the 1^st, 3^rd, 7^th and 14^th days after onset in cerebral infarction group than in control group （P 〈 0.05-0.01）, and erythrocyte MDA level was significantly higher in cerebral infarction group than in control group （P 〈 0.05-0.01）. The three indexes changed most significantly on day 3 after onset in patients, and began to recover or decrease on day 7 after onset and inclined to be normal on day 14 after onset. ② Erythrocyte GSH level was significantly negatively correlated with erythrocyte MDA level in patients with acute cerebral infarction on the 1^st, 3^rd, 7^th and 14^th days after onset （r=-0.534, -0.713, -0.645, -0.656, respectively, P 〈 0.05-0.01 ） ,and significantly positively correlated with erythrocyte deformation index （t-=0.502, 0.560, 0.455, 0.504, respectively, P 〈 0.05）. ③Erythrocyte GSH level was significantly lower in moderate or severe patients with acute cerebral infarction than in mild patients[（0.215±0.088）,（0.192±0.102）, （0.281±0.090） g/L, P〈 0.05]. CONCLUSION：①Erythrocyte GSH and MDA levels and deformation index of erythrocyte change significantly on the 3^rd day following acute cerebral infarction. Index detection results gradually tended to be normal on from the 7^th day to 14^th days day after onset. ② Change of erythrocyte GSH level can reflect the severity of disease of patients with acute cerebral infarction.③Decrease of erythrocyte GSH level in patients with acute cerebral infarction is one of reasons that result in the decrease of deformation ability of erythrocyte.

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

BACKGROUND:Three-dimensional diffusion tensor tract(DTT)is the newest imaging to describe the structure of white matter fiber in three-dimensions,it has great significance in dividing the concrete anatomic site of gray and white matter lesions,displaying the correlation with fibrous band and judging clinical prognosis,which is incomparable by other imagings.OBJECTIVE:To observe the conditions of corticospinal tract(CST)in acute cerebral ischemic stroke patients,and analyze the relationship between motor function and the severity of CST injury.DESIGN:A case-control observation.SETTING:Department of Medical Imaging,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS:Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005.They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent,and were conformed by CT or MRI.There were 9 males and 6 females,aging 16-87 years old,the median age was 51.7 years,and all were right handed.Fifteen right-handed normal subjects,who were matched by age and sex with the patients in the cerebral infarction group,were selected from the relatives of patients and physicians of the Imaging Department as the control group.All the subjects were informed and agreed with the study.METHODS:The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging(DTI)with GE 1.5 T nuclear magnetic resonance system,fiber tracking with the software of dTV-Ⅱ.Fractional anisotropy(FA)maps and three-dimensional tractography of bilateral CST of all patients were created.Displacement,continuity and destroy of fibrous bands were observed.At the same time,muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard.The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis.MAIN OUTCOME MEASURES:①FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction;②CST manifestations in the patients with cerebral infarction and the control group.RESULTS:All the 30 testees were involved in the analysis of results.①The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones(t=4.570,P<0.001).②In the control group,bilateral CST were reconstructed,they originated from precentral gyrus,went downwards to internal capsule,and extended to pontine and medulla oblongata,each fiber had good uniformity in continuous form.In the patients with cerebral infarction,the forms of contralateral CST were consistent with those in the control group with good continuity.Due to the involvement by the infarcted site to different extents,the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form.The CST involvements were divided into three grades:integrated CST for grade 1(n=2);integrated CST but compressed or displaced for grade 2(n=5);interrupted CST for grade 3(n=8).③The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand(r=0.888,P<0.05).CONCLUSION:①CST is injured to different extents in patients with acute cerebral infarction,and the severity of injury is associated with muscle strength.It is indicated that it can be used to judge the prognosis of rehabilitative treatment.②DTT can directly display the status of pyramidal tract more three-dimensionally.

Changes of biochemical indexes in patients with acute cerebral infarction after treatment with simvastatin

BACKGROUND: At present, it is believed that the important causes of cerebral infarction are the disorders of lipid metabolism and endothelial function, and the outcomes of clinical treatment can be improved by regulating serum lipids and antiinflammation, etc. OBJECTIVE: To observe the effect of simvastatin, inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, on the levels of serum lipids, serum enzymic indexes and inflammatory metabolic indexes in patients with cerebral infarction. DESIGN: A comparative observation. SETTING: Department of Geriatrics, Longquanshan Hospital of Liuzhou City. PARTICIPANTS: Forty-eight patients with acute cerebral infarction were selected from the Department of Geriatrics of Longquanshan Hospital of Liuzhou from March 2004 to February 2006, including 24 males and 24 females, the mean age was (54±12) years, average disease course was (10.0±4.5) days. They were all accorded with the diagnostic standard for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1999, and cerebral hemorrhage was excluded by cranial CT scanning. The 48 patients were randomly divided into control group (n =24) and treatment group (n =24). Informed consents were obtained from all the participants. METHODS: ① All the patients were treated according to the symptoms, besides those in the treatment group were given simvastatin (Harbin Pharm. Group Sanjing Pharmaceutical Shareholding, Co.,Ltd., No. H20010454; Batch number: 20040218; 5 mg/tablet). The initial dosage was 10 mg per day for 4 weeks, and then increased to 30 mg per day for another 4 weeks. ② Before treatment and within 1 week after treatment, the total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), creatine kinase and C reactive protein in serum were determined with Beckman-cx7 automatic biochemical analytical apparatus in both groups. ③ The differences of intergroup and intragroup data were compared with the independent-samples t test and paired samples t test. MAIN OUTCOME MEASURES: Changes of total cholesterol, triglyceride, HDL-C, LDL-C, AST, creatine kinase and C reactive protein before and treatment in both groups. RESULTS: All the 48 patients with cerebral infarction were involved in the analysis of results. ① Changes of serum lipids: The levels of serum lipids were close between the two groups before treatment (P > 0.05). After treatment, the HDL-C level in the treatment group was obviously higher than that in the control group and that before treatment [(1.34±0.12), (0.92±0.33), (0.93±0.21) mmol/L, t =7.922, 11.699, P < 0.01], and the levels of total cholesterol, triglyceride and LDL-C were obviously lower than those in the control group and those before treatment (t =2.780-7.591, P < 0.01). ② Changes of serum enzymic indexes and C reactive protein in serum: The levels of enzymes and C reactive protein in serum had no obvious differences between the two groups before treatment (P > 0.05). The levels of AST, creatine kinase and C reactive protein in serum after treatment were obviously lower than those before treatment in both groups (t =7.259-17.996, P < 0.01). The levels of levels of creatine kinase and C reactive protein in serum after treatment in the treatment group were obviously lower than those in the control group [(3.061±0.522) μkat/L, (4.6±3.1) mg/L; (4.348±0.580) μkat/L, (12.3±4.8) mg/L, t =7.910, 6.463, P < 0.01]. CONCLUSION: Compared with common treatment according to symptoms, the additional administration of simvastatin is better for improving the serum lipids, serum enzymic indexes of patients with cerebral infarction at acute period, and benefit for repairing their inflammatory damages.

Regional cerebral blood flow imaging assessment of brain function reconstruction in elderly hemiplegia patients by body weight support treadmill training

The mechanism underlying body weight support treadmill training in elderly hemiplegic stroke patients is largely unknown. This study aimed to elucidate the changes of cortical blood flow in seven elderly patients with post-stroke hemiplegia before and after body weight support treadmill training by semi-quantitative analysis of regional cerebral blood flow assessed by single photon emission computed tomography. Body weight support treadmill training for 6 months was effective in improving cerebral blood flow and promoting the walking speed and balance recovery in elderly patients with post-stroke hemiplegia.

Electrocardiogram changes in acute cerebral infarction patients

BACKGROUND： Comparison of different stroke locations had been focused in past researches in electrocardiogram （ECG） changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history. OBJ ECTIVE： To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people. DESIGN： Contrast observation SETTING： Shanghai Ninth People＇s Hospital PARTICIPANTS ： A total of 57 patients with cerebral infarction ware selected from the Neurological Department of Ninth People＇s Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4^th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9 in frontal lobe and 14 in other parts. According to their infarction size （plus size in every different scan）, they were divided into three different groups： large-size group （n = 10） with size larger than 3.5 cm^3, medium-size group （n = 13） with size between 1.5-3.5 cm^3, and small-size group （n = 34） with size smaller than 1.5 cm^3. Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40- 82 years. All these cases knew and agreed of the examination. METHODS ： Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups. MAIN OUTCOME MEASURES： The ECG changes and differences in two hemispheres, in different infarction lo- cations and sizes. RESULTS： All 57 patients and 50 healthy subjects ware involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with opposite T wave of infarction group compared with control group （P 〉 0.05）. PR and QTc [（0.167±0.010）, （0.383±0.029） s] in infarction group were longer than those in control group [（0.159±0.008）, （0.361±0.022） s, t = 1.982, 2.363, P 〈 0.05, 0.01]. ST changes cases were 77% （44/57）, which was more than those in control group [46% （23/50）, x^2= 11.072, P 〈 0.01]. ② Comparison of infarction in two hemispheres. HR, PR interval, QRS time, cases with opposite T wave and ST changes showed no differences （P 〉 0.05）, and QTc interval in right hemisphere infarction was longer than left one [（0.391±0.054）, （0.380±0.034） s, t=1.673, P 〈 0.05]. ③ ECG changes in different infarction locations. HR, PR interval, QTc interval, QRS time, cases with opposite T wave and ST changes showed no statistically significantly differences （P〉 0.05）. ④ ECG changes in different infarction sizes. HR, PR interval, QRS time showed no differences （P〉 0.05）. QTc interval in large size group was longer than the others [（0.399±0.044）, （0.388±0.073）t （0.378±0.124） s, F= 3.19, P 〈 0.05]. Cases with opposite T wave and ST changes in large size group were 80% （8/10）, 100% （10/10）, which were higher than those in medium size group [46% （6/13）, 69% （9/13）] and small size group [44% （15/34）, 35% （12/34）, x^2 = 8.495, 10.538, P 〈 0.05, 0.01]. CONCLUSION ： ① PR interval and QTc interval prolonged in cerebral infarction patients. Furthermore, QTc interval was more obvious in large size infarction group and right hemisphere infarction group. ② Infarction location did not affect the changes of ECG.

Spontaneous rupture of liver metastasis tumors with disturbance of consciousness and progression of hemiplegia as the first manifestation:a case report

Objective:rupture of liver metasta-ses with disturbance of consciousness accompanied by aggravation of hemiplegia is very rare.We describe the clinical features of a case of spontaneous rupture of liver metastasis tumors with disturbance of consciousness and progression of right limb hemiplegia.Methods:collect the patient's medical history,conduct a detailed physi-cal examination,timely improve the relevant laboratory and imaging examination,formulate a comprehensive treatment plan,and track the changes of the disease and the treatment effect.Results:the patient presented with blurred consciousness,hemiplegia of the right limb,and epigastric tenderness when admitted to the hospital.No evident new lesions were found on cranial computed to-mography(CT).Blood routine examination showed that hemoglobin decreased significantly compared with be-fore.Abdominal CT showed tumor rupture and bleeding.The patient in critical condition did not have operation conditions,but improved after conservative treatment.Conclusion:when patients with liver metastasis tumors suddenly have a disturbance of consciousness and prog-ress of hemiplegia,they should not only be considered to have acute cerebrovascular diseases,but also the possi-bility of rupture of liver metastasis tumors.If only treated according to acute stroke,it will endanger their lives.For the liver metastasis tumor rupture,if there is no oppor-tunity for embolotherapy,timely conservative treatment with drugs can also achieve good results.

Use of acupuncture to treat cerebral infarction in the last 10 years A Scopus-based literature analysis

OBJECTIVE： To identify global research trends in the use of acupuncture to treat cerebral infarction. DATA RETRIEVAL： We performed a bibliometric analysis of studies on the use of acupuncture to treat cerebral infarction published during 2002-2011, retrieved from Scopus, using the key words of acupuncture and cerebral infarction or ischemic stroke. SELECTION CRITERIA： Inclusion criteria： peer-reviewed articles on the use of acupuncture to treat cerebral infarction indexed in Scopus and published between 2002 and 2011; types of publications were original research articles, reviews, meeting abstracts, proceedings papers, book chapters, editorial material, and news items. Exclusion criteria： articles that required manual searching or telephone access; documents that were not published in the public domain; and corrected papers. MAIN OUTCOME MEASURES： （a） Annual publication output; （b） language of publication; （c） type of publication; （d） key words of publication; （e） publication by research field; （f） publication by journal （g） publication by country and institution; （h） publication by author; （i） most-cited papers between 2002 and 2006; and （j） most-cited papers between 2007 and 2011. RESULTS： A total of 160 publications on the use of acupuncture to treat cerebral infarction from 2002-2011 were retrieved from Scopus. The number of publications increased gradually over the 10-year study period; most were written in Chinese or English. Articles and reviews constituted the major types. The most frequent key word used was acupuncture. The most prolific journals in this area were Zhongguo 7hen Jiu and the Chinese Journal of Clinical Rehabilitation. Of the 160 publications retrieved, half came from Chinese authors and institutions. Tianjin University of Traditional Chinese Medicine was the most prolific research institute. Two papers were cited 30 times; they were published in 2002 and 2009, respectively. CONCLUSION： In the field of neuroscience, there is little literature on acupuncture for cerebral infarction. The most-cited papers were cited 30 times in the past 3 years. We believe that, with advances in the study of mechanisms in neurobiology, research on acupuncture will also advance and will become the concern of more scholars.

Disappearance of unaffected motor cortex activation by repetitive transcranial magnetic stimulation in a patient with cerebral infarct

The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke （Jang, 2011）. Because stroke patients who had shown recovery by this mechanism usually showed poorer motor function, compared with patients who showed recovery by other mechanisms, several researchers have considered this mechanism as a maladaptive plasticity （]ang, 2013）.

Effect of Ligustrazine on Nitric Oxide Contents in Cerebrospinal Fluid and Plasma of Patients with Cerebral Infarction

Objective: To probe into the significance of Nitric Oxide (NO) in ischemic cerebral damage and effect of ligustrazine on it. Methods: The NO contents in cerebrospinal fluid (CSF) and plasma of 20 controls and 62 patients with arteriosclerotic thrombotic cerebral infarction (ligustrazine group and common treatment group) were determined with Griess method before and after treatment. Results:The NO content in CSF before treatment was higher in severe type, it was higher than that in moderate type, and than that in mild type,again higher than that in control group (all P < 0. 05) and was positively correlated with the size of infarction (P < 0. 01 ). There was no significant difference between the plasma NO content of patients and that of control group (P < 0. 05), but there was a trend that plasma NO content decreased as the patient's condition worsened. After treatment, the curative effect and plasma NO content of ligustrazine group were both markedly higher than those of common treatment group (P < 0. 05, 0. 05 ).There were no significant differences between CSF NO contents of the two groups, respectively, and that of control group (P > 0. 05,0. 05). Conclusion: Excessive NO produced in brain tissue and insufficient plasma NO participate the course of ischemic brain damage.Ligustrazine could increase the contents of plasma NO selectively.Original article on CJIM(Chin) 1998; 18(6). 342

Acupuncture method of“Huoxue Sanfeng,Shugan Jianpi ” for morning blood pressure in patients with cerebral infarction combined with essential hypertension: a randomized controlled trial

Objective To observe the clinical effects of acupuncture method of'Huoxue Sanfeng,Shugan Jianpi'(activating blood and eliminating wind,soothing liver and strengthening spleen)on morning blood pressure in patients with cerebral infarction combined with essential hypertension.Methods Sixty-eight patients were randomly divided into an observation group and a control group,34 cases in each one.The patients in the

Impact of Acupuncture Therapy in Postoperative Aortic Dissection Patients with Cerebral Infarction:A Case Study

Aortic dissection is a life-threatening disease that can produce a variety of symptoms and complications. Patients at high risk for mortality, such as individuals with aortic regurgitation, cardiac tamponade, or myocardial infarction, should be treated by surgery as soon as possible, especially in cases with acute ascending aortic dissections （Stanford type A）. However, patients with aortic dissection may suffer adverse outcomes that lead to mortality and morbidity, such as stoke, re-dissection, myocardial infarction, and heart failure. Patients with surgically treated acute type A aortic dissection show an 18.2% likelihood of stroke in early morbidity.

基于Beers标准的某院高血压并脑梗死老年患者潜在不适当用药分析

目的保障高血压并脑梗死老年患者的用药安全。方法使用医院信息系统提取医院2020年高血压并脑梗死老年(≥65岁)患者的用药医嘱,采用老年患者潜在不适当用药(PIM)Beers标准(2019版)分析患者PIM发生情况,通过多因素Logistic回归法分析患者(PIM)发生的独立危险因素。结果纳入患者115例,发生PIM 109例(94.78%)、334例次。PIM分类以使用老年患者应慎用药物的发生例次最高(180例次,53.89%),其次为与药物相关(121例次,36.23%);发生PIM频次较高的药品主要有阿司匹林肠溶片(78例,23.35%)、呋塞米(31例,9.28%)、螺内酯片(29例,8.68%)等;21例次PIM与疾病或症状有关,其中95.23%有肾功能不全病史;12例次PIM涉及药物相互作用,主要包括非甾体抗炎药与皮质类固醇联用,2种肾素-血管紧张素系统(RAS)抑制剂联用,以及1种RAS抑制剂与保钾利尿剂联用。多因素Logistic回归分析显示,仅用药种类>9种是患者PIM发生的独立危险因素[OR=10.056,95%CI(3.053,33.117),P<0.001]。结论高血压并脑梗死患者PIM较多,建议药师开展临床药学工作时,将Beers标准与临床实际相结合以判断用药安全风险。

通督调神针法治疗阴虚动风型脑梗死偏瘫疗效及对患者血清Hcy、CRP水平的影响

目的:探讨通督调神针法治疗阴虚动风型脑梗死偏瘫患者疗效及对患者血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平的影响。方法:选取脑梗死偏瘫患者76例,1∶1随机分为观察组(西医治疗+通督调神针法)与对照组(常规西医治疗)各38例。持续治疗1个月后,评估两组临床疗效,比较两组治疗前后中医证候积分、血清炎症因子(Hcy、CRP)水平、运动功能[Fugl-Meyer评定量表(FMA)]、平衡功能[Berg平衡量表(BBS)]和移动功能[功能性步态评价表(FGA)]变化情况,并记录两组不良事件发生率。结果:观察组总有效率更高(P<0.05);观察组治疗后中医证候积分降低程度比对照组更明显(P<0.05)。观察组治疗后FMA、FGA和BBS评分升高水平均比对照组更明显(P<0.05),观察组治疗后Hcy、CRP水平下降程度均比对照组更明显(P<0.05)。治疗期间两组均无不良事件发生。结论:阴虚动风型脑梗死偏瘫患者应用通督调神针法联合常规西医治疗具有较好的增益效果,可有效提高临床疗效,缓解患者临床症状,提高运动、平衡和移动能力,降低炎症反应。