Objective To explore the relationship between the serum anticardiolipin antibody (ACA),vascular endothelial grow factor (VEGF) concentration and cognitive impairment in patients with ischemic stroke.Methods Totally 128 cases with acute ischemic stroke were admmitted in stroke unit ward of our hospital during June 2014 to December 2014.According to the score of Montreal cognitive assessnent (MoCA),128 patients with ischemic stroke were divided into groups A (53 cases with cognitive impairment) and group B (75 cases without cognitive impairment).The concentrations of serum ACA,VEGF were quantitatively determinated by ELISA.The differences of serum ACA,VEGF concentrations were compared between the two groups.Results Compared with normal cognitive function group,the cognitive impairment patients had significantly higher ACA concentration ((0.86±0.16) mg/L vs (0.52±0.08) mg/L,P＜0.01),and lower VEGF concentration ((197.60±7.48) pg/ml vs (205.80±8.52) pg/ml,P＜0.05).Logistic regression revealed that ACA and VEGF were independent effect factors for cognitive impairment (ACA:B =2.841,OR =0.33,95 ％ CI =0.118-0.926,P=0.025.V EGF:B =-1.674,OR =4.99,95％ CI =1.688-4.741,P=0.034).Conclusion ACA and VEGF may play an important role in cognitive impairment after ischemic stroke.

Objective To evaluate outcome of injection of botulinum toxin A to treat post-stroke muscle spasm under color doppler ultrasound guide. Methods 15 stroke patients following spasm in upper limb were chosen. Under the guidance of ultrasound, botulinum toxin A was accurately injected in biceps, brachialis, deep flexor muscle of fingers, superficial flexor muscle of fingers, musculus flexor carpi ulnarista, thumb-muscle, palmaris longus muscle, musculus pronator teresta, and quadrate pronator muscle. All patients went on rehabilitation training after injection. Upper limb function was evaluated by using modified Ashworth(MAS) and Fugl-Meyer scores before injenction, two weeks and four weeks after injection. Results Recovery of muscle spasm and scores of the upper limb motor function were better than that before injection.Conclusion Under color doppler ultrasound guidance, injectionof the botulinum toxin A can treat post-stroke muscle spasm with accurate location.

Objective To observe the effects of low frequency ultrasound on carotid artery plaque and artery stenosis. Methods 156 patients with carotid atherosclerosis were divided into treatment group (n=80) and control group (n=76). The control group was administered routine medicine, while the treatment group accepted low frequency ultrasound therapy in addition. The size and shape of carotid artery plaque, severity of stenosis and the level of lipid were observed before and after treatment, and the side-effects were recorded. Results The intima-media thickness (IMT), diameter of plaque, plaque score decreased after treatment in both groups, and decreased more in the treatment group than in the control group (P<0.05); while the frequence of moderate stenosis and severe stenosis was less (P<0.05). The levels of low density lipoprotein- cholesterol and total cholesterol decreased in both groups after treatment (P<0.05), and decreased more in the treatment group than in the control group (P<0.05). No serious side-effect was observed. Conclusion Low frequency ultrasound can reduce the atherosclerotic plaques in carotid artery and relieve the stenosis.

Objective To investigate the relationship between serum anticardiolipin antibody-immune globulin G (ACA-IgG),interleukin-10 (IL-10 ),IL-17 levels and intracranial large-artery atherosclerotic stenosis in patients with ischemic stroke. Methods From March 2014 to March 2015,a total of 176 consecutive patients with the first-ever ischemic stroke admitted to the Department of Neurology,Liaocheng People′s Hospital,Shandong Province,China,and performed DSA were enrolled prospectively. Seven of the patients with cardiogenic embolism,5 with moyamoya disease,8 with arteritis,2 with artery dissection,9 with autoimmune diseases or acute and chronic inflammation were excluded,21 with extracranial arterial stenosis were not enrolled,and finally 124 were enrolled in the study. According to the findings of DSA,the degrees of intracranial large artery stenosis were divided into a stenosis-free group (n = 34),a mild-stenosis group (n = 30),a moderate-stenosis group (n = 32),and a severe-stenosis group (n = 28). The differences of serum ACA-IgG,IL-10,IL-17 levels and baseline factors of the 4 groups were compared,and multivariate logistic regression analysis was used to analyze several factors that affected intracranial large-artery stenosis. Results There were no significant differences in sex,age,alcohol consumption rate,smoking rate,and incidence of hyperlipidemia among the 4 groups of patients (all P >0. 05). Compared with the stenosis-free group,there were significant differences in the incidences of hypertension and diabetes among the mild-stenosis,moderate-stenosis and severe-stenosis groups (the incidence of hypertension,80. 0% [n = 24],93. 8% [n = 30],89. 3% [n = 25]vs. 55. 9% [19 cases];χ2 = 8. 271,8. 920,and 10. 877,respectively;P = 0. 038,0. 032,and 0. 014,respectively). The incidences of diabetes were 33. 3% (n = 10),43. 8% (n = 14),60. 7% (n = 17)vs. 8. 8% (n = 3),(χ2 = 7. 960, 8. 733,and 9. 285,respectively;P = 0. 043,0. 035,and 0. 027,respectively). Incidence of diabetes of the severe-stenosis group was higher than that of the mild-stenosis group (χ2 = 9. 348,P = 0. 025). There were no significant differences in the incidences of hypertension and diabetes among other groups (all P >0. 05). There were significant differences in ACA-IgG levels (23 ± 5,39 ± 8,51 ± 9,and 65 ± 10 kU/ L);IL-10 levels (108 ± 33,85 ± 25,77 ± 21,and 62 ± 19 ng/ L),and IL-17 levels (38 ± 10,58 ± 22,63 ± 31, and 75 ± 26 ng/ L)among the stenosis-free,mild,moderate and severe-stenosis groups (F = 17. 754,9. 827, and 12. 656;respectively;all P < 0. 01). Compared with the stenosis-free group,the ACA-IgG and IL-17 levels of the patients in the mild,morderate,and severe stenosis groups increased significantly (ACA-IgG level:t =2. 307,2. 559,and 3. 374,respectively;P = 0. 026,0. 014,and 0. 001,respectively,the IL-17 levels:t =2. 183,2. 549 and 3. 159,respectively;P = 0. 037,0. 013,and 0. 002,respectively),while the IL-10 level decreased significantly. There were significant differences among the groups (t = 2. 036,2. 351,and 2. 762, respectively;P = 0. 042,0. 023,and 0. 006,respectively). Compared with the mild-stenosis group,the ACA-IgG and IL-17 levels of the severe stenosis group increased significantly (t = 3. 154 and 2. 976 respectively;P = 0. 002 and 0. 004 respectively). There were no significant differences among the pairwise comparisons of other groups (P >0. 05). The results of logistic regression analysis showed that hypertension, diabetes,ACA-IgG level,and IL-17 level were the risk factors for intracranial large-artery stenosis (OR, 3. 043,95% CI 1. 606 -5. 875,P = 0. 003;OR,2. 912,95% CI 1. 513 -5. 824,P < 0. 01;OR,1. 837,95% CI 2. 057-3. 416,P = 0. 037;OR,1. 453,95% CI 1. 346 -2. 721,P = 0. 014). Conclusion ACA-IgG and IL-17 may play an important role in the occurrence and development processes of intracranial large-artery atherosclerotic stenosis.

Objective To observe the effect of dual-task interference on postural sway and hand flexibility of patients with early Parkinson's disease (PD).Methods Twenty-tree patients with early PD and twcnty-three healthy,sex-and age-matched control subjects were examined.Postural sway was measured with an accelerometer at the centre of mass at the lower spine.Two parameters of postural sway were computed from the acceleration signals including root mean square acceleration (RMS) and jerkiness of sway (JERK).Purdue pegboard test,single-task tests and dual-task test were performed respectively to record the numbers of nails inserted with left hand,right hand and both hands within 30 seconds.Results In the usual conditions,no significant differences of postural sway parameters were found between the control group and PD group in eye open and eye closed condition.In dualtask condition,PD patients showed an increase of RMS values (eye open conditions:PD group (0.156±0.112) m/s2,control group (0.086±0.026) m/s2;eye closed conditions:PD group (0.204±0.162)m/s2,control group (0.095±0.023)m/s2) of sway acceleration,compared with control subjects (P＜0.01).These differences reached significance during cognitive task performance in eye open and eye closed with dual task.PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance(P＜0.05).The number of pegs inserted within 30 s in patients with PD (17.33±4.87)was significantly lower than that in controls (20.77±4.13) (P＜0.05).Conclusion The hand flexibility of patients with early PD obviously decrease.The balance of patients with early PD may deteriorate when their attention is diverted or reduced because of attempting to perform cognitive tasks.

Objective To report a pedigree with late-onset Pompe' s disease complicated with cerebral vascular diseases as to summarize their clinical,pathological and molecular genetic characteristics.Methods We investigated the clinical and pathological data of the two affected siblings with late-onset Pompe' s disease complicated with cerebral vascular diseases.All the 5 members of this pedigree accepted the GAA gene analysis.ResultsBoth affected siblings had progressive pelvic girdle muscle weakness from young adult age,and recently developed vertigo and ataxia.Brain imaging of them revealed multiple cerebral hemorrhage,infarction and diffuse ischemic white matter lesions.The brother had multiple aneurysms and stenoses of cerebral arteries revealed by brain CTA.However,his sister was only found to have multi-beaded stenoses of cerebral arteries.The muscle pathology of the brother showed typical vacuolar degeneration and glycogen storage in muscle fibers. The GAA enzyme activity of 2 siblings were dramatically lower than normal.A heterozygous 19 bp-deletion (c.1388-c.1406,exon 9) were found in GAA gene in the 2 siblings and their healthy mother. Conclusions Cerebrovascular involvement should be a special phenotype of Pompe' s disease.A novel heterozygous mutation c.1388del19 in GAA gene was found in this pedigree,but the relationship between the mutation and the rare clinical phenotype needs further study.

Objective To observe the clinical effect of lansoprazole enteric -coated tablets combined with flupentixol and melitracen in the treatment of erosive gastritis with anxiety .Methods Eighty patients with erosive gastritis complicated with anxiety were selected , and they were randomly divided into control group ( n =40 ) and observation group( n=40) according to the digital table .The control group was treated with lansoprazole enteric -coa-ted tablets.The observation group received lansoprazole enteric -coated tablets combined with flupentixol and melitra-cen.Hamming anxiety scale ( HAMA ) and Hamilton depression scale ( HAMD ) were used to evaluate in the two groups before and after treatment .The changes of HAMA and HAMD scores were compared between the two groups .Results Before treatment,the scores of abdominal pain ,bloating,pantothenic acid and belching had no statistically significant differences between the two groups (all P>0.05).After treatment for 4 weeks,the scores of abdominal pain,bloating, pantothenic acid and belching in the observation group were ( 0.63 ±0.12 ) points, ( 0.43 ± 0.11)points,(0.30 ±0.11)points and (0.31 ±0.14)points,respectively,which were lower than those in the control group [(1.42 ±0.18)points,(1.08 ±0.15)points,(0.79 ±0.16)points,(0.98 ±0.25)points] (t=15.396, 13.285,16.758,17.492,all P<0.05).The scores of HAMA and HAMD in the observation group were (12.15 ± 2.51)points and (14.32 ±2.51) points,respectively,which were lower than those in the control group [(19.84 ± 2.65)points,(19.84 ±3.17)points](t=20.151,21.841,all P<0.05).There was no statistically significant differ-ence in the incidence rate of adverse reactions between the two groups after treatment for 4 weeks (P >0.05) .Conclusion Lansoprazole enteric -coated tablets combined with flupentixol and melitracen in the treatment of erosive gastritis with anxiety can relieve anxiety and depression ,improve clinical symptoms and treatment effect .

Stroke is an important cause of global population death and long-term disability. The incidence, disability, and mortality of ischemic stroke are high, which brings a heavy social and economic burden to society and families. MiRNA is involved in a variety of biological processes, such as proliferation, differentiation, metabolism, synaptic formation, angiogenesis, apoptosis, and so on. MiRNA plays an indispensable regulatory role in the risk factors of a variety of cerebrovascular diseases. In particular, some circulating miRNA have significant changes in the peripheral blood of patients with acute stroke, which may become an important biomarker for rapid diagnosis and treatment of stroke. Intervention on stroke risk factors provides an important way for the prevention of cerebrovascular disease. In this review, the studies on the expression and mechanism of miRNA related to common stroke risk factors, including hypertension, diabetes, coronary heart disease, atherosclerosis, carotid stenosis, depression, age, and stimulating hormones, were summarized to provide new ideas for disease prevention and diagnosis.

Objective To investigate the clinical effect of low frequency ultrasound on middle cerebral artery (MCA) atherosclerosis acute ischemic stroke.Methods One hundred patients with symptomatic atherosclerotic MCA atherosclerosis acute ischemic stroke were randomly divided into low frequency ultrasound group (n=50) and control group (n=50).The patients of the control group were administered routine medicine,while the patients of the low frequency ultrasound group accepted low frequency ultrasound besides routine medicine.The main observation indexes included National Institutes of Health Stroke Scale (NIHSS) scores,peak systolic velocity of the MCA stenosis segment,microemboli signal and serum high-sensitivity C-reactive protein (hs-CRP) concentrations before and after the treatment.Results Fourteen days after treatment,the NIHSS scores of the low frequency ultrasound group (3.70±4.88) were significantly lower than those in the group (4.68±5.49,P＜0.05);the peak systolic velocity of the MCA stenosis segment in the low frequency ultrasound group after treatment was (158.60±34.33) cm/s,which was significantly lower than that before treatment,namely (189.94± 28.21) cm/s (P＜0.05);7 and 14 days after treatment,the microemboli positive rate of the low frequency ultrasound group (17.00％ and 6.00％) was significantly lower than that in the control group (67.00％ and 8.30％,P＜0.05);serum hs-CRP concentration of the low frequency ultrasound group and control group after treatment was significantly lower than that before treatment (P＜0.05),and that in the low frequency ultrasound group was significantly lower than that in the control group (P＜0.05).Conclusion Low frequency ultrasound assisted therapy can lower serum hs-CRP level,improve hemodynamic MCA stenosis segment,inhibit MCA stenosis segment origin microemboli,and promote neurological recovery in patients with MCA stenosis.

OBJECTIVETo explore the diagnostic value of magnetic resonance (MR) diffusion tensor imaging (DTI) in detecting brain white matter (WM) damage of patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and evaluating their cognitive dysfunction.

METHODSThirteen patients with DEACMP and thirteen age- and sex-matched volunteers underwent DTI using 1.5T MR scanner. FA and ADC values of 16 WM regions of interests (ROIs) were measured on DTI by two experienced radiologists independently with double blind methods, cognitive functions were evaluated by another experienced neurologist blinded to patient's medical history using the Montreal cognitive assessment (MoCA). ADC and FA values in DEACMP patients, and their correlations with cognitive dysfunction were analyzed.

RESULTSADC values of DEACMP patients increased significantly in all ROIs (P < 0.05) in comparison with the corresponding ROIs of healthy controls, whereas FA values were significantly decreased in all ROIs (P < 0.05) in comparison with that in controls except the bilateral optic radiations, anterior and posterior internal capsules. MoCA scores were positively correlated with FA values of bilateral lower frontal (r(L) = 0.736, P = 0.011; r(R) = 0.762, P = 0.003) lobe, temporal lobe (r(L) = 0.605, P = 0.016; r(R) = 0.559, P = 0.021) and total average WM (r(A) = 0.688, P = 0.001), however it inversely correlated with ADC values of bilateral lower frontal WM (r(L) = -0.674, P = 0.007; r(R) = -0.681, P = 0.019).

CONCLUSIONDTI can quantitatively reveal WM microstructure damage of DEACMP patients, indicate the severity of cognitive dysfunctions, and provide important information for pathogenesis and pathological study for DEACMP.

Brain ; pathology ; Brain Diseases ; diagnosis ; etiology ; Carbon Monoxide Poisoning ; complications ; Cognition ; Cognition Disorders ; Diffusion Magnetic Resonance Imaging ; Diffusion Tensor Imaging ; Double-Blind Method ; Humans ; White Matter ; pathology