Impact of early refined nursing program on prognosis of middleaged and elderly patients with cognitive dysfunction combined with cerebral infarction

BACKGROUND Cerebral infarction is a local or extensive necrosis of brain tissue.Subsequently,the corresponding neurological deficits appear.The incidence of cerebrovascular diseases in China is increasing gradually.After the onset of cerebrovascular disease,the most common sequelae include movement disorders,language disorders,and cognitive dysfunction.AIM To investigate the effect of early refined nursing program on the prognosis of middle-aged and elderly patients with cerebral infarction combined with cognitive dysfunction.METHODS A retrospective study was conducted to divide 60 patients with cerebral infarction and cognitive impairment into an experimental group(n=32)and a control group(n=28).The experimental group received early intensive care every day,and the control group received daily routine care.The scores of the Mini-Mental State Examination(MMSE)and the Trail Making Test(TMT),as well as the latency and amplitude of the event-related potential P300,were used as main indicators to evaluate changes in cognitive function,and changes in BDNF,TGF-β,and GDNF expression were used as secondary indicators.RESULTS Both groups experienced notable enhancements in MMSE scores,with the experi-mental group demonstrating higher scores than the control group(experimental:28.75±2.31;control:25.84±2.87).Moreover,reductions in TMT-A and TMT-B scores were observed in both groups(experimental:TMT-A 52.36±6.18,TMT-B 98.47±10.23;control:TMT-A 61.48±7.92,TMT-B 112.63±12.55),with the experimental group displaying lower scores.P300 Latency decreased(experimental:270.63 ms±14.28 ms;control:285.72 ms±16.45 ms),while amplitude increased(experimental:7.82μV±1.05μV;control:6.35μV±0.98μV)significantly in both groups,with superior outcomes in the experimental cohort.Additionally,the levels of the growth factors BDNF,TGF-β1,and GDNF surged(experimental:BDNF 48.37 ng/mL±5.62 ng/mL,TGF-β152.14 pg/mL±4.28 pg/mL,GDNF 34.76 ng/mL±3.89 ng/mL;control:BDNF 42.58 ng/mL±4.73 ng/mL,TGF-β146.23 pg/mL±3.94 pg/mL,GDNF 30.25 ng/mL±2.98 ng/mL)in both groups,with higher levels in the experimental group.CONCLUSION For middle-aged and elderly patients with cerebral infarction and cognitive dysfunction,early refined nursing can significantly improve their cognitive function and prognosis.

A case of essential thrombocythemia accompanied by acute myocardium infraction and gastrointestinal bleeding

INTRODUCTION Essential thrombocythemia （ET） belongs to a family of related disorders characterized by uncontrolled cell growth, named myeloprolifer- ative diseases （MPD）, including polycythemia- vera （PV） and primary myelofibrosis （PMF）. The presenting features of ET canrange from being asymptomatic to thrombohemorrhagic complications. Here, we report a case of ET accompanied by acute myocardium infraction （AMI） and gastrointestinal bleeding. The diag- nosis and treatment of ET will also be discussed.

Myocardial ischemic changes of electrocardiogram in intracerebral hemorrhage: A case report and review of literature

BACKGROUND Cardiac injury may occur after acute pathology of central nervous system(CNS)without any evidence of primary cardiac diseases.The resulting structural and/or functional changes are called cerebrocardiac syndrome(CCS).The great majority of studies have been performed in patients with subarachnoid hemorrhage(SAH),while CCS data after intracerebral hemorrhage(ICH)are rare.It may cause diagnostic and therapeutic pitfalls for the clinician due to a lack of specific clinical manifestations and diagnostic methods.Understanding the underlying pathophysiological and molecular mechanism(s)following cerebrovascular incidents will help to implement prevention and treatment strategies to improve the prognosis.CASE SUMMARY A 37-year-old man with a history of hypertension presented to our department on an emergency basis because of a sudden dizziness and left limb weakness.Cerebral computed tomography(CT)suggested ICH in the occipital and parietal lobes,and the chosen emergency treatment was hematoma evacuation.Left ventricular(LV)dysfunction occurred after the next 48 h and the electrocardiogram(ECG)showed non-ST elevation myocardial infarction.CCS was suspected first in the context of ICH due to the negative result of the coronary CT angiogram.CONCLUSION Misinterpretation of ischemic-like ECGs may lead to unnecessary or hazardous interventions and cause undue delay of rehabilitation after stroke.Our objective is to highlight the clinical implications of CCS and we hope the differential diagnoses will be considered in patients with acute CNS diseases.

Myocarditis presenting as typical acute myocardial infarction: A case report and review of the literature

BACKGROUND Myocarditis refers to a variety of myocardial inflammatory lesions. A variety of factors such as infection and physical and chemical factors can cause myocarditis.Depending on the severity of myocardial damage, myocarditis patients can manifest heart failure, cardiogenic shock, and even sudden death. Here we present a case of viral myocarditis that mimicked acute coronary syndrome.CASE SUMMARY A middle-aged male patient presented with chest pain and elevated troponin I after a flu-like infection. This patient had a history of hypertension and a habit of alcohol and tobacco use. Electrocardiography showed typical changes in acute myocardial infarction, with the T-wave increasing. Coronary angiogram revealed no stenosis. Cardiac magnetic resonance imaging revealed edema of the middle and apical septal and apical anterior walls on T2-weighted images and the T1 mapping. Late gadolinium enhancement of the middle and apical septal and apical anterior walls could be found. Rubella virus immunoglobulin G and immunoglobulin M antibodies were abnormally elevated. The patient was given antiviral and antibiotic treatments, and serum biomarkers and electrocardiograph returned to normal after 5 d of treatment. After one-year follow-up, the patient showed no symptoms, and cardiac magnetic resonance showed that myocardial thickness was significantly thinner than before, and fibrosis was less than before.CONCLUSIONThis case illustrates the utility of cardiac magnetic resonance for diagnosis of infarction-like myocarditis when the angiogram is normal.

CLINICAL OBSERVATION ON TREATMENT OF 198 CEREBRAL INFARCTION PATIENTS WITH OPPOSING AND NON-OPPOSING NEEDLING METHODS

198 cases of cerebral infarction diagnosed clinically.by means of CT scan wereselected, and the therapeutic effects obtained with the methods of opposing and non-opposing needlingwere compared, The primary points included Head-Linqi(GB 15) and Zhengying(GB 17) (penetra-tion needling), Fengchi(GB 20), Neiguan (PC 6), qnd Yinlingquan (SP 9). While the supplemen-tary points were Jiquan (HT 1 ), Xiaohai (SI 8), Huantiao (GB 30), Yinmen (BL 37), Sanyinjiao(SP 6), and Taixi (KI 3). It was found that the radical cure rate in the group treated with opposingneedling was 57%, while that in the group with non-opposipg needling was 34%. The difference oftherapeutic effects between the two groups was of statistical significance (P【0.01 ). It indicates thatopposing needling is superior to non-opposing needling in elevating cure rates and reducing sequelae.

Unexplained huge liver infarction presenting as a tumor with bleeding: A case report

BACKGROUND Liver infarction is a rare necrotic lesion due to the dual blood supply consisting of the hepatic artery and portal vein.The absence of specific clinical manifestations and imaging appearances usually leads to misdiagnosis and poor prognosis.Thus,the precise diagnosis of liver infarction always requires imaging studies,serum studies,and possible liver biopsy.CASE SUMMARY We report a case of 31-year-old man who developed a huge liver infarction.Persistent right upper abdominal pain and intermittent fever were the main symptoms in this patient.Computed tomography revealed a huge irregular lesion with a maximum diameter of 12.7 cm in the right lobe of the liver.Threedimensional reconstruction was performed and no significant interruption of the main hepatic vessels was observed.The lesion was initially considered to be a malignant tumor with internal bleeding.Laparoscopic right hepatectomy was performed,and pathology indicated a rare liver infarction.The patient recovered well and was discharged on postoperative day 21.No fever or abnormal liver function were reported in the subsequent 6 mo.CONCLUSION In patients with a huge liver infarction,early surgical intervention may be beneficial.

Pregnancy associated spontaneous coronary artery dissection:A case report and review of literature

BACKGROUND Pregnancy-associated spontaneous coronary artery dissection(PSCAD)is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women.Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection.The etiology,pathogenesis,and incidence of PSCAD are not known.CASE SUMMARY We present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection.She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.CONCLUSION Most patients with PSCAD can be managed conservatively with medical management and have good outcomes.Patients with high-risk presentations benefit from the invasive approach.Coronary artery bypass graft may be required in select few patients based on angiography findings.Due to the risk of recurrent spontaneous coronary artery dissection,subsequent pregnancies are discouraged.

Before the Jury Is out on Cinacalcet’s Cardiovascular Effects in Hemodialysis Patients: Is Troponin a Missing Link?

Raised levels of the cardiac biomarker, Troponin I, are frequently encountered in hemodialysis patients and appear to be prognostic indicators for cardiovascular risk. Though evidence suggests that control of secondary hyperparathyroidism may reduce cardiac endpoints, the effect of the calcimimetic agent, cinacalcet, remains controversial. This retrospective study aimed at evaluating troponin levels in hemodialysis patients with severe secondary hyper parathyroidism (SHPT) who are on cinacalcet vs controls on conventional treatment. In addition, clinical outcomes including all-cause, cardiovascular morbidity and mortality were compared among both groups. A decline in Troponin I levels was observed in the cinacalcet group, this however was not translated clinically into improved survival. In fact, all-cause and cardiac mortality was similar in the two groups. Conversely, comparison of the incidence of cardiovascular events revealed lower rates in the cinacalcet group including cardiac, cerebral and peripheral vascular complications. Given some of our study limitations, further long-term, placebo-controlled trials are necessary to definitively establish the effect of cinacalet on cardiac biomarkers and ultimately its impact on clinical outcomes.

Characteristics of neurovascular compression in facial neuralgia patients by 3D high-resolution MRI and fusion technology

Objective:To evaluate the anatomical characteristics and patterns of neurovascular compression in patients suffering trigeminal neuralgia,using 3D high-resolution magnetic resonance imaging methods and fusion technologies.Methods:The analysis of the anatomy of the facial nerve,brain stem and the vascular structures related to this nerve was made in 100 consecutive patients for TN.3D high resolution MRI studies(3D SPGR,T1 enhanced 3D MP-RAGE and T2/T1 3D FIESTA) simultaneous visualization were used to assessed using the software 3D DOCTOR. Results:In 93 patients(93%),there were one or several locals of neurovascular compression (NVC).The superior cerebellar artery was involved in 71 cases(76%),the other vessels including the antero-inferior cerebellar artery,the basilar artery,the vertebral artery,and some venous structures.The mean distance between NVC and nerve origin site in the brainstem was(3.76±2.90) mm).In 39 patients(42%),the vascular compression was located proximally and in 42(45%) the compression was located distally.Nerve dislocation or distortion by the vessel was observed in 30 cases(32%).Conclusions:This 3D high resolution MRI and image fusion technology could be useful for diagnostic and therapeutic decisions in TN.

Comparison between magnitude reconstruction and phase-sensitive mR imaging in the detection of myocardial infarction

Objective:To determine the deference between phase sensitive magnetic resonance(MR) imaging and magnitude reconstruction to detect infracted myocardium.Methods:Twenty patients(16 men;4 women;mean age,56 years),experienced Q-wave myocardial infarction 2 weeks earlier were examined with a 3.0-T MR system 10 minutes after administration of 0.1 mmol/kg body weight gadobenate dimeglumine.To determine the optimal TI,a TI scout sequence was used.A segmented 2D IR true fast imaging with steady-state precession(trueFISP) sequence that produces both phase-sensitive and magnitude-reconstructed images were used at TI values of 200-600 msec(TI values were varied in 100-msec steps) and at optimal TI(mean value,330 msec).Contrast- noise ratios(CNRs) of normal and infarcted myocardium and the area of infarcted myocardium were determined.Two-tailed unpaired sample Student t test was used to compare CNRs,and area of infarction.Results:MMean CNR phase-sensitive and magnitude-reconstructed images at optimal TI(mean value,330 msec) were 6.2,and 6.1,respectively.For a TI of 200 msec,CNR values were 5.5,and 4.2,respectively;for TI of 600 msec,CNR values were 5.8 and 4.3,respectively.Area of infarcted myocardium was underestimated on magnitude-reconstruction images(P = 0.002-0.03) for short TI values(ie.,200 msec) but not on phase sensitive reconstructed when compared with IR tureFISP images obtained at optimal TI.Conclusions: LPhase-sensitive image reconstruction results in reduced need for precise choice of TI and more consistent image quality.

Antioxidant and antihyperlipidemic activity of Costus speciosus against atherogenic diet-induced hyperlipidemia in rabbits

Objective: An extract of Costus speciosus(CSE), a herb widely used in folk medicine, was evaluated for its antioxidant, antihyperlipidemic and ameliorating effects on histopathological changes in atherogenic rabbits.Methods: Twenty-four male rabbits(Oryctolagus cuniculus) were divided into 4 groups. Three groups were fed a diet containing 3% saturated fat and 1.3% cholesterol for 40 d. One of these was sacrificed on the 40 th day and was called the pathogenic(P) group; the other two groups received treatment for another 30 d as follows: one received 0.8 g/(kgád) of CSE and the other was given 0.01 g/(kgád) of simvastatin. The normal group was sacrificed on the 70 th day and used as a control.Results: CSE showed radical-scavenging ability. Administration of CSE for a 30-day period resulted in a significant decrease in total cholesterol, triacylglycerol, low-density lipoprotein and aspartate aminotransferase compared to the P group, while levels of hemoglobin, packed corpuscular volume and red blood cells were elevated. With respect to studies performed on the heart, a decrease in malondialdehyde and an increase in reduced glutathione were noted. Total protein increased in the liver, heart and aorta after treatment with CSE and also a marked improvement in histopathological parameters was demonstrated.Conclusion: The present findings indicate that the C. speciosus rhizome possesses antiatherogenic and antioxidant properties which may provide protective effects against oxidative stress in atherosclerotic rabbits.

Acute Cerebral Infarction in the Elderly

This case report describes the presentation,diagnosis,and management of a 70-year-old male with acute cerebral infarction in the right portion of the pons.The patient presented with left limb weakness,numbness,nausea,headache,and unstable walking,prompting immediate medical attention within 13 hours of symptom onset.Diagnosis according to clinical symptoms and signs,and several diagnostic tests,including computed tomography and magnetic resonance imaging,revealed a discrete infarction in the right pons region.The patient underwent a multidisciplinary treatment approach,including pharmacological intervention and rehabilitation.This case highlights the critical importance of timely diagnosis and intervention for pontine infarction,particularly in the geriatric population.Insights gained from this case contribute to the evolving understanding of cerebrovascular events in elderly patients.