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Objective:To investigate the predictive value of systemic inflammatory response index (SIRI) for early neurological deterioration (END) and clinical outcome in patients with branch atherosclerotic disease (BAD).Methods:Consecutive patients with BAD admitted to the Department of Neurology, Jiangyin People’s Hospital Affiliated to Southeast University from September 2021 to September 2022 were retrospectively included. The clinical data were collected and SIRI was calculated. The calculation method of SIRI was neutrophil count × monocyte count/lymphocyte count. END was defined as an increase of ≥2 in the total score of the National Institutes of Health Stroke Scale (NIHSS) or an increase of ≥1 in the motor function score within 1 week of onset. The modified Rankin Scale was used for outcome evaluation at 3 months after onset, with a score >2 were defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between SIRI and END, as well as poor outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SIRI for poor outcome. Results:A total of 125 patients with BAD were included, of which 62 (49.6%) had END and 32 (25.6%) had poor outcome. The multivariate logistic regression analysis showed that intravenous thrombolysis (odds ratio [ OR] 1.083, 95% confidence interval [ CI] 1.082-1.240; P=0.043) and high SIRI ( OR 1.465, 95% CI 1.150-3.676; P=0.028) were independent risk factors for END in patients with BAD; END ( OR 1.130, 95% CI 1.032-1.384; P=0.006), high baseline NIHSS score ( OR 1.571, 95% CI 1.184-2.101; P=0.003) and high SIRI ( OR 2.062, 95% CI 1.152-3.672; P=0.01) were independent risk factors for poor outcome in patients with BAD. ROC curve analysis showed that the area under the curves for SIRI, baseline NIHSS score, and the both combined prediction of poor outcome were 0.66 (95% CI 0.54-0.78), 0.70 (95% CI 0.58-0.81), and 0.83 (95% CI 0.74-0.93), respectively. Conclusions:High SIRI is an independent risk factor for END and poor outcome in patients with BAD. The SIRI and baseline NIHSS scores have certain predictive value for poor outcome in patients with BAD, and their combined diagnostic value is higher.
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Objective:To explore any effect of using extracorporeal shockwave therapy (ESWT) on the gastrocnemius muscle or the myotendinous junction on spasticity and the walking ability of stroke survivors.Methods:A total of 84 stroke survivors were randomly divided into a control group, a muscle belly group, and a myotendinous junction group, each of 28. In addition to conventional rehabilitation, the muscle belly and myotendinous junction groups received ESWT applied to the belly of the gastrocnemius muscle or the myotendinous junction. Before as well as one, two and three weeks after the treatment, all were evaluated using the Modified Ashworth Scale (MAS), passive range of motion (PROM), a visual analogue scale (VAS) for pain rating, and 10m maximum walking speed (10m MWS). Stride frequency and length were also measured and compared among the 3 groups.Results:After three weeks of ESWT treatment the average MAS, PROM and VAS scores of the belly and the junction group were significantly improved compared to before the treatment. The average MAS, PROM and VAS scores of the belly group and the average MAS score of the junction group were then significantly superior to the control group′s averages, and the average VAS score of the belly group was significantly better than that of the junction group. After one and two weeks of treatment, the average 10MWSs of the belly and junction groups were significantly better than the control group′s average, and after 3 weeks the belly group′s average speed was significantly better than the junction group′s. The stride frequency of the belly group had improved significantly compared with the control group after 2 weeks, and after 3 weeks both experimental groups had significantly better frequency than the control group. The average stride length of both the belly and junction groups was significantly better than the control group′s average throughout the testing.Conclusion:ESWT applied to the belly of the gastrocnemius muscle or the myotendinous junction can relieve muscle spasticity and pain and improve walking ability. Applying ESWT to the muscle belly is superior to on the myotendinous junction in terms of therapeutic efficacy.
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Objective:To detect the changes in mental arithmetic competence and the related influencing factors in patients with early Parkinson's disease(PD)by using mental arithmetic task behavioral experiment.Methods:Thirty-one patients with early PD and 40 healthy controls were enrolled in this study.The cognitive functions were tested by mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA). The differences of mental arithmetic competence between the two groups were measured by behavioral experiment.Results:There was no significant difference in correct rate, reaction time and post-corrected reaction time while performing baseline tasks and easy mental arithmetic tasks between the two groups( P>0.05). The reaction time had no significant difference between the two groups after adjusting some confounding factors( P>0.05). However, the correct rate while performing difficult mental arithmetic tasks was significantly lower( t=-2.232, P=0.029)and the reaction time was significantly longer( t=2.149, P=0.035)in PD group than in the controls, and the significant difference in reaction time persisted even after adjusting some confounding factors( t=3.139, P=0.003). In PD group, the correct rate of difficult mental arithmetic tasks was positively associated with MoCA scores( r=0.561, P=0.004), and negatively associated with age( r=-0.532, P=0.008). The reaction time and post-corrected reaction time while performing difficult metal arithmetic task were negatively associated with MoCA scores( r=-0.525, P=0.01; r=-0.554, P=0.005)and positively associated with age( r=0.485, P=0.037; r=0.514, P=0.012)in PD group. Conclusions:The difficult mental arithmetic competence is impaired in early PD patients, which is statistically significantly correlated with cognitive function and age.
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Objective To investigate the relationship between two single nucleotide polymorphisms (rs356219,rs356165 sites) and cognitive dysfunction in Parkinson disease.Methods 236 patients with Parkinson's disease were randomly selected from November 2014 to November 2017.According to the results of MoCA cognitive function evaluation,the patients were divided into group A (cognitive dysfunction group)and group B (normal cognition group).At the same time,65 patients were randomly selected as group C (Health control group).The allele frequency and genotype distribution of rs356219 and rs356165 were compared,and the differences among the three group were compared.Results In the rs356165 allele frequency,group A (G:57.14％,A:42.86％),group B (G:56.45％,A:43.55％) and group C (G:52.31％,A:47.69％) had no statistical significance (P＞ 0.05).In the rs356165 genotype,G/G (21.43％) and A/A (14.29％) in group A were higher than group C (G/G:4.62％,A/A:1.54％),G/G (22.58％) in group B and A/A (14.52％) were higher than group C G/G (4.62％) and A/A (1.54％) (P＜ 0.05).In the rs356219 allele frequency,group A (G:64.29％,A:64.29％) and group B (G:64.52％,A:35.486％) and group C (G:46.15％,A:53.85％) was statistically significant (P＜0.05),but no statistical significance between group A and group B (P＞0.05);In the rs356219 genotype,group A (G/G:35.71％,A/A:21.43％,A/G:42.86％),group B (G/G:35.48％,A/A:22.58％,A/G:41.94％) and group C (G/G:30.77％,A/A:26.15％,A/G:43.08％) had no statistical significance (P＞ 0.05),and there was no statistical significance between group A and group B (P＞0.05).Conclusions The polymorphism of rs356219 and rs356165 sites in rho-synaptic nucleoprotein plays an important role in the pathogenesis of Parkinson disease.However,there was no correlation with cognitive dysfunction in patients with Parkinson disease.
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Objective To detect the impairment of response inhibition and working memory in patients with alcohol dependence.Methods A total of forty-eight alcohol dependent patients and fifty age,gender,IQ,education matched controls were recruited.Neuropsychological tests were applied to measure the differences of response inhibition and working memory between the two groups.Results In the response inhibition task,the patient group had more commission errors ((7.02± 3.48) vs (3.45± 1.52)) and longer reaction time ((605.45 ± 142.56)ms vs (435.72±51.18)ms) compared to the control group (t=6.534,P=0.000; t=7.781,P=0.000).In the spacial working memory task,the patient group also had more commission errors ((4.58± 3.45) vs (0.43± 0.88)) and longer reaction time((10566.16±2455.61) ms vs (9185.44±2677.52) ms) than control (t=8.085,P =0.000; t=2.657,P=0.009).Conclusion There are significant deficiencies in response inhibition and working memory in patients with alcohol dependence.
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Objective To investigate the influnce factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic stroke .Methods One hundres and twenty stroke patients without history of diabetes were divide into large artery atherosclerotic stroke (LAA), small arterial occlusive stroke(SAO), cardiac embolic stroke(CES), undeterminined etiology stroke (UND) subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classfication.The patients were tested oral glucose tolerance test (OGTT) one week later after stroke. The impaired glucose regulation ( IGR ) and diabetes patients called the abnormal glucose metabolism group ,compare related indicators and make multivariate Logistic regression analysis .Results There were 68 patients(56.7%) with normal metabolism, 52 patients (43.3%) with abnormal glucose metabolism.Among them, 38 cases were IGR (31.7%), 14 cases were diabetes (11.7%).The rate of abnormality of impaired glucose metabolism in LAA subgroup(63.8%) was significantly higher than the other subgroups (27.3%-31.4%)(all P<0.05).There was no statistically significant difference between the other subgroups .Compared with normal glucose metabolism group, age, the rate of hyperlipidemian and family history of diabetes were significant higher in abnormal glucose metabolism group (P<0.05 -0.01).Multivariate logistic regression analysis showed that hyperlipidemia ( OR=1.671,95%CI:1.208 -2.311,P=0.012), family history of diabetes (OR =1.421,95%CI:1.114 -1.813,P=0.042) and LAA(OR=2.825,95%CI:1.706-4.674,P=0.023) were independent risk factors of new diagnosed abnormal glucose metabolism in ischemic stroke .Conclusion There is a high prevalence of new diagnosed abnormal glucose metabolism in ischemic stroke .Hyperlipidemia , family history of diabetes and LAA are independent risk factors of it .
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Objective To investigate the clinical effect of botulinum toxin type A (BTX-A) injections guided by electromyography in combination with electrical stimulation in the treatment of upper limb spasticity poststroke.Methods Forty-five patients with upper limb spasticity following stroke were recruited.They received multiple intra-muscular BTX-A injections guided by electromyography and electrical stimulation.Rehabilitation training was administered after the BTX-A injections.The results were assessed using the modified Ashworth scale (MAS),the Fugl-Meyer upper limb assessment (FMA),active range of movement (AROM) and the modified Barthel index (MBI).All the assessments were performed at the baseline,and then 1 week,2 weeks,1 month,and 3 months after the injections.Results Compared with the baseline scores the MAS,FMA,AROM and MBI results had all obviously improved by 2 weeks after the BTX-A injections.Compared with 2 weeks after the injections,the FMA and AROM scores at 1 month were significantly higher and there were further significant improvements at 3 months.No patient demonstrated obvious side effects from the therapy.Conclusion BTX-A injection guided by electromyography and electrical stimulation is safe and has definite beneficial effects on upper limb spasticity after stroke.
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ObjectiveTo detect the fiber structure and volume differences in frontal lobe between patients with amnestic mild cognitive impairment (aMCI) and normal control.MethodsT1 -weighted magnetic resonance imaging and diffusion tensor imaging were obtained in 28 aMCI patients and 25 normal controls.Volumes,fiber fractional anisotropy (FA),fiber apparent diffusion coefficient (ADC),fiber number,and average fiber length of frontal lobe in the two groups were measured.ResultsVolumes of left frontal lobe ( ( 337.35 ± 20.45 ) cm3 ) in aMCI group were smaller than control ( (358.54 ± 27.26) cm3 ) ( t =- 3.223,P =0.002 ).Numbers of short range fiber in left frontal lobe ( 16985 ± 892) were significantly increased relative to control ( 16387 ±752) ; while numbers of long range fiber (3214 ± 185 ) were reduced compared with control (3425 ± 277 ),and ADC values increased ( t =2.621,P =0.012; t =-3.714,P =0.001 ; t =17.595,P=0.000).In aM CI group,numbers of long range fiber in right frontal lobe were reduced (2895 ± 343 vs.3451 -± 230,t =- 7.011,P =0.000),and ADC values were increased ( t =4.443,P =0.000).In aMCI group,numbers of long range fiber in left frontal lobe were positively correlated with scores of mini-mental state examination ( MMSE ) ( r =0.457,P =0.015 ),while ADC values of long range fiber in left frontal lobe were negatively correlated with scores of MMSE ( r=-0.415,P=0.028).ConclusionThe structure and fiber connectivity are affected in aMCI patients and the lesion of connectivity in left frontal lobe are related to the severity of symptom.
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Objective To investigate any changes in motor functional connectivity in the brains of acute ischemic stroke patients after low frequency electrical stimulation.Methods Twenty-five ischemic stroke patients were given low frequency electrical stimulation in addition to their conventional rehabilitation treatment.Another 20 patients received only conventional treatment as a control group.Resting-state functional magnetic resonance imaging (rs-fMRl)was employed to assess motor function connectivity in the brains of all 45 subjects before and after treatment.Any differences in functional impairment,extremity motor function or ability in the activities of daily living were also recorded before and after treatment.Results In both groups,average scores on the Canadian neurological scale (CNS)and the National Institutes of Health stroke scale (NIHSS) had been reduced significantly after treatment and FuglMeyer assessment (FMA) and modified Barthel index (MBI) scores had significantly increased.The average improvements in terms of FMA and MBI scores were significantly greater in the observation group.Compared with before treatment,the coefficient of functional connectivity of the bilateral motor cortex had decreased significantly after treatment in both groups.In the observation group the changes were significantly correlated with the improvements in FMA scores.Conclusion Neural functional impairment after ischemic stroke can be reduced significantly and extremity motor function and ability in the activities of daily living can be significantly improved by low frequency electrical stimulation.
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Objective To investigate the influence of transforming growth factor ? 1 to expression of tumor necross factor ?(TNF ?) after cerebral ischemic reperfusion injury.Methods Using thread embolism method to develop the model of focal cerebral ischemic reperfusive injury in rats, different dose of TGF ? 1 or 0 9% NaCl was injected intracerebroventricularly.Neurological functional dificit scales in the different dose of TGF ? 1 groups and the expression of TNF ? were observed Results In both big and small dose of TGF ? 1 groups,the expression of TNF ? decreased after cerebral ischemic reperfusion,and the neurological functional dificit scales were significantly lower than those of the control.There was no significant difference between the group of big and small dose of TGF ? 1 Conclusion TGF ? 1 may have a protective effect on cerebral ischemic reperfusive injury by inhibiting expression of TNF ?,and it may be irrelative with the dose
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Objective To investigate the clinical and imaging features of aortic dissection(AD) with damage in nervous system.Methods The clinical data were retrospectively analyzed in 14 cases of AD with damage in nervous system.Results 13 patients(92.9%) were over age 40.All cases were acute onset and 9 cases had history of hypertensive disease.During onset,the blood pressure was elevated in 9 cases,decreased in 3 cases and could not be measured in 2 cases.The clinical manifestations of patients presented severe pectoralgia in 5 cases,chest-back complaint in 4 cases,bellyache,lumbago with emesia in 2 cases,shock in 2 cases.The appearances of nervous system:circumgyration in 5 cases,conscious disturbance in 4 cases,hemiparalysis in 2 cases,barylalia in one case,paraplegina in 2 cases and hypesthesia in 3 cases(meta-body in 1 case,below T 4 or T6 in 2 cases).The breast and abdominal part CT and CTA of all cases showed clearly the true and false lumens,the position of intimal slit(according Debakeys,2 cases were typeⅠ,7 cases were typeⅡ,5 cases were type Ⅲ) and mural thrombosis.The breast and abdominal part MRI in 8 cases could show conspicuous true and false lumens.The true lumen was presented flow and inane signals but the false lumen was presented higher signals in T1 and T2 WI.Conclusions The clinical manifestations of AD with damage in nervous system are main the ischemic impaired symptoms and signs of brain and spinal cord.Both CT and MRI can show the false lumen and vascular intimal slit of AD.