Objective To investigate the correlation between the red blood cell distribution width (RDW) with risk and and severity of noncardiac ischemic stroke.Methods The patients with acute noncardiac ischemic stroke were enrolled retrospetively and were used as a case group,and the non-stroke patients admitted to the Department of Neurology at the same period were served as a control group.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the baseline neurological deficits.The NIHSS score ＜ 8 was defined as mild stroke and ≥ 8 was defined as moderate to severe stroke.The demographics,clinical data,and RDW were collected and compared.Multivariate logistic regression analysis was used to identify the independent risk factors for the risk of disease and severity of stroke in noncardiac ischemic stroke.Receiver operator characteristic (ROC) curve was used to analyze the predictive value of RDW for acute noncardiac ischemic stroke and its severity.Results A total of 1 173 patients with acute noncardiac ischemic stroke were enrolled.Over the same period,996 non-stroke patients were hospitalized in the Department of Neurology.The RDW in the case group was significantly higher than that in the control group (13.1％ ± 1.0％ vs.12.7％ ±0.7％;t=9.545,t ＜0.001).Multivariatelogistic regression analysis showed that RDW (odds ratio [OR] 9.920,95％ confidence interval [CI] 6.286-15.655,P＜ 0.001) was an independent risk factor for acute noncardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting acute noncardiac ischemic stroke was 12.55％,the area under the ROC curve was 0.611 (95％ CI 0.588-0.635),the sensitivity was 73.3％,the specificity was 43.7％,the positive predictive value was 60.5％,the negative predictive value was 58.2％,and the accuracy was 59.7％.RDW in the moderate to severe stroke subgroup was significantly higher than that in the mild stroke subgroup (13.7％ ± 1.6％ vs.12.9％ ± 0.6％,t =-13.794,P＜ 0.001).Multivariate logistic regression analysis showed that RDW (OR 3.835,95％ CI 3.002-4.899,P ＜ 0.001) was an independent risk factor for the severity of acute non-cardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting moderate to severe non-cardiac ischemic stroke was 13.45％,the area under the ROC curve was 0.713 (95％ CI 0.674-0.752),the sensitivity was 47.7％,the specificity was 86.1％,the positive predictive value was 49.8％,the negative predictive value was 85.1％,and the accuracy was 77.6％.Conclusions RDW is an independent risk factor for acute non-cardiac ischemic stroke.Increased RDW is associated with the severity of acute non-cardiac ischemic stroke.

Objective To study the damage of hyperhomocysteinemia (HHcy) and asymmetric dimethylarginine (ADMA) on the structure of rats cerebral vessels,and to explore the treatment effect of probucol,folic acid and vitamin B12.Methods Totally,70 male Sprague-Dawley(SD) rats were randomly divided into seven groups:normal control (A),HHcy model (B),low-dose-probucol (C),middle-dose-probucol (D),high-dose-probucol (E),folic-acid plus vitamin B12 (F),folic-acid plus vitamin B12 plus probucol(G)group.Group A was fed plain feedstuff and water.Other groups were fed homomethionin feedstuff and water,probucol (340,510,680 mg· kg-1 · d-1),folic acid and vitamin B12,folic acid plus vitamin B12 plus probucol respectively.The plasma concentrations of homocysteine(Hcy) and ADMA were assayed by high-performance liquid chromatography method (HPLC) at the beginning,and at the end of 8 and 12 weeks.The analysis of rats cerebral vessels was performed with electron microscope at the end of 12 weeks.Results (1) After adding high concentrations of methionine feedstuff for 8 weeks,the levels of Hcy in group B (60.4±11.9) μmol/L were significantly raised compared with group A(7.1±1.4) μmol/L.Meanwhile,ADMA levels in group B(1.3±0.4)μmol/L were higher than group A(0.4±0.1) μmol/L.At the end of 12 week,the levels of Hcy and ADMA were lower in groups C[(49.9±11.4)μmol/L,(1.0±0.2)μmol/L],D [(46.8± 10.9)μmol/L,(0.9±0.1)μmol/L],E[(44.3±11.4)μmol/L,(0.9±0.1)μmol/L],F [(16.3 ± 4.9)μmol/L,(0.7 ± 0.2)μmol/L] compared with group B [(69.5 ± 11.4)μmol/L,(1.6 ±0.5)μmol/L],but higher than group A[(6.7±1.3)μmol/L,(0.5±0.1)μmol/L].The levels of Hcy and ADMA in group G[(8.9±1.9) μmol/L,(0.6±0.2) μmol/L]were also lower than those in group B (P＜0.05],but they did not show statistically significant differences compared with group A(P＞0.05).(2) According to correlative analysis,Hcy levels were positively correlated with ADMA levels (P＜0.05).(3) On electron microscope,we observed that the cerebral artery and cerebral cortex of group B were seriously damaged.After the intervention with probucol,folic acid and vitamin B12,the structure of rats cerebral vessels were improved in group C,D,E,F and G as compared with group B,and group G were especially improved more obviously.Conclusions The HHcy and ADMA could damage the structure of rats cerebral vessels.Probucol,folic acid and vitamin B12 may alleviate the cerebral vascular damage by decreasing the levels of Hcy and ADMA,and the effect is more significant by the combined drug regimens of Probucol,folic acid and vitamin B12.

Objective Investigating the relationship between the incidence of Primary Acute Cerebral Infarction (PACI) and seasonal variation to employ measures to prevent PACI with climate change. Methods A retrospective analysis of patients diagnosed with PACI between 2009 and 2013 in the department of Neurology of Second hospital of Tian Jin Medi-cal University (n=1 198 patients) was carried out. Combined with the general clinical data, we analyzed seasonal, monthly and weekly variation among PACI incidents. Results The incidence of PACI increases over years between 2009 to 2013 (P ＜ 0.01). Significant difference of incidents of PACI was observed between each season (P=0.047). Incidence of PACI peaked in winter(30.33 ± 9.63/month), while bottomed in spring(21.83 ± 5.36/month). Significant difference of incidents of PACI was also observed between each months(P=0.010). The monthly incidence was highest in January and February (33.25 ± 9.62/month)and lowest in March and April(20.75 ± 4.89/month). The seasonal variation was only found in the pa-tients who are complicated with pulmonary infection (P＜0.01) regardless of the presence or absence of other risk factors, such as smoking, drinking ,hypertension, coronary heart disease, and diabetes mellitus. The weekly variation of PACI was on-ly significant in patients younger than 65 years old(P=0.043). The peak incidence among a week was Monday(17.86%),and incidence bottomed on Friday (13.36%). Conclusion Our study revealed that the incidence of PACI increase over year be-tween 2009 to 2013 and it shew a characteristic variation with respect to season, month and week. Based on these results, we can formulate prevention measures accordingly.

Objective To observe the effect of levocarnitine and trimetazidine on left ventricular mass index in patients with maintenance hemodialysis (MHD),and to explore the safety and efficacy of the two drugs when used in combination.Methods 48 cases of MHD were randomly divided into control group and treatment group,24 cases in each group.On the basis of routine treatment,treatment group was treated with L -carnitine 1.0g by intravenous, 3 times per week,and trimetazidine tablets 20mg,3 times daily at the end of each dialysis.The control group was only treated with L -carnitine.The course of treatment was 12 months.The left atrial diameter (LAD),left ventricular end diastolic diameter (LVDD),left ventricular end diameter (LVDS),interventricular septal thickness (IvST),left ventricular posterior wall thickness (LVPWt),left ventricular ejection fraction (LVEF),stroke volume (SV),left ventricular mass index calculation were detected and compared before and after treatment in the two groups.Results After treatment,the LAD,LVDd,LVDs,IvST,LVPWt in the control group were (40.25 ±1.73)mm,(51.16 ± 3.17)mm,(32.52 ±2.86)mm,(11.16 ±1.23)mm,(10.23 ±1.19)mm,which were decreased compared with before treatment [(42.63 ±1.82)mm,(53.71 ±3.26)mm,(35.83 ±3.12)mm,(12.51 ±1.39)mm,(11.76 ± 1.37)mm],and the LAD,LVDd,LVDs,IvST,LVPWt in the treatment group were (37.61 ±1.86)mm,(47.53 ± 3.18)mm,(29.71 ±2.93)mm,(10.46 ±1.32)mm,(9.14 ±1.32)mm,which were decreased compared with beforetreatment [(42.89 ±1.91 )mm,(54.18 ±3.29)mm,(35.76 ±3.27)mm,(12.49 ±1.35 )mm,(11.73 ± 1.41)mm](t control group =4.643,2.747,3.831,3.563,4.130,t treatment group =9.702,7.120,6.750,5.209, 6.569,all P <0.05 ),and each index of the treatment group was significantly lower than the control group (t =5.091,3.961,3.362,2.901,3.005,all P <0.05 ).The LVMI of the control group and treatment group was (121.63 ±7.16)g/m2 ,(115.49 ±7.91)g/m2 after treatment,which were decreased compared with before treatment [(127.32 ±7.51)g/m2,(126.87 ±7.28)g/m2 ](t =2.686,5.186,all P <0.05).The EF and SV of the control group were (58.16 ±4.35)%,(43.61 ±4.72)mL after treatment,which were increased compared with before treat-ment[(55.32 ±4.17)%,(40.52 ±4.13)mL](t =2.686,5.186,all P <0.05).The EF and SV of the treatment group were (61.26 ±4.13)%,(46.25 ±4.17)mL after treatment,which were increased compared with before treat-ment[(55.28 ±4.51)%,(40.81 ±4.96)mL](t =4.791,4.113,all P <0.05).After treatment,LVMI in the treat-ment group was lower than that in the control group,SV and EF were higher than those in the control group (t =2.819,2.532,2.053,all P <0.05).Conclusion Compared with single levocarnitine,the therapy of levocarnitine and trimetazidine can better reduce left ventricular mass index in MHD patients and improve the cardiac structure and function,which is safe and effective.

Objective To investigate the sleep quality and the risk factors for sleep disorders in population at high-risk for stroke:.Methods A cross-sectional survey was conducted in population at highrisk for stroke:in Water Park and Wangdingdi Communities,Nankai District,Tianjin in March 2016.The residents were divided into either a good sleep group or a sleep disorder group according to the Pittsburgh Sleep Quality Index (PSQI).Multivariate logistic regression analysis was used to determine the risk factors affecting sleep quality.They also divided into a stroke history group and a non-stroke history group according to the high-risk population with or without previous history of stroke.The sleep quality was compared between the 2 groups,and the correlation between sleep disorders and stroke outcomes was analyzed.Results A total of 565 residents at high-risk for stroke were enrolled in the study,and 178 01.5％) had sleep disorders.The age in the sleep disorder group was significantly older than that in the good sleep group (66.70 ±8.97 years vs.62.87 ±9.46 years;t =4.540,P＜0.001).The proportions of female (68.0％ vs.49.1％;x2 =16.190,P ＜ 0.001),hypertension (69.7％ vs.57.9％;x2 =7.154,P =0.005),ischemic heart diseases (48.9％ vs.35.4％;x2 =9.253,P =0.002),history of previous stroke or transient ischemic attack (TIA) (30.9％ vs.18.9％;x2 =10.080,P =0.001),and carotid plaques (71.9 vs.53.7％;x2 =16.688,P ＜0.001) in the sleep disorder group were higher than those in the good sleep group.Multivariate logistic regression analysis showed that after adjusting for age and sex,the history of previous stroke or TIA (odds ratio [OR] 1.712,95％ confidence interval [CI] 1.105-2.653;P =0.016),and carotid plaques (OR 1.583,95％ CI 1.003-2.498;P =0.048) were the dependent risk factors for sleep disorders.The total score of PSQI in patients with previous stroke was significantly higher than that in patients without previous stroke (7.25 ±4.71 vs.6.13 ±4.20,t =-2.578,P =0.010).The sleep latency score (1.24 ± 1.06 vs.0.95 ± 1.02;t =-2.868,P =0.004) and sleep disorder score (1.23 ± 0.63 vs.1.07 ± 0.61;t =-2.622,P =0.009) in patients with previous stroke history were significantly higher than those without.According to the modified Rankin Scale scores,the patients with a history of stroke were divided into a good outcome group (0-2) and a poor outcome group (＞2),including 105 (82.0％) and 23 patients (18.0％),resectively.The proportion of patients with sleep disorders (78.3％ vs.35.2％;x2 =14.251,P＜0.001) and the PSQI score (median and four percentile interval:6 [3-8] vs.12 [8-18];Z =-4.392,P ＜0.001) in the poor outcome group were significantly higher than those in the good outcome group.Conclusions The incidence of sleep disorder is high in the high-risk population,the previous stroke or TIA history and carotid plaques are the independent risk factors for sleep disorder in the high-risk population,and sleep disorder is associated with the poor outcomes of strokes.Therefore,attention should be paid to the sleep quality of this stroke high-risk population and control the risk factors of causing sleep disorders,especially for those with a history of stroke.This will help reduce the risk of stroke.

Objective To inves1tigate the needs and influencing factors of patients with cerebrovascular disease and their caregivers in rural areas.Methods An online questionnaire designed by World Stroke Organization for stroke patients and their caregivers was used,and modified appropriately according to China's national conditions.A questionnaire survey about general situation,and needs for psychological support,stroke-related knowledge,diagnosis and nursing,social support,and functional recovery in inpatients with cerebrovascular disease and their caregivers in rural areas was performed.Results A total of 514 patients with stroke and their caregivers (n =514) completed the questionnaires.93.0％ of the patients had the needs for mental support,followed by clinical diagnosis and nursing (84.8％),stroke knowledge (74.7％),social support and functional recovery (53.5％);95.1％ of the caregivers had the needs for mental support,followed by stroke knowledge (89.9％),clinical diagnosis and nursing (84.0％),social support,and functional recovery (66.3％).The degree of need for stroke knowledge,social support,and functional recovery in caregivers was higher than that in the patients (all P ＜ 0.05).Multiple linear regression analysis showed that age,gender,degree of education,the National Institutes of Health Stroke Scale score,and the time from the first stroke onset were the influencing factors of needs for patients with cerebrovascular disease and their caregiver.Conclusions Many needs have not been met in patients with cerebrovascular disease and their caregivers,especially the psychological demand.The regional and individual services should be provided according to the different demands in patients with cerebrovascular disease and their caregivers,enhance the awareness of the prevention and treatment of stroke,and continuously improve the construction of rural health service system.

Platelets contain a large number of microRNAs (miRNAs),for example,miR-223,miR-126,and miR-191 are highly expressed in platelets,affecting platelet reactivity through different targets.Platelet-associated miRNAs are involved in platelet activation and are associated with the onset risk and outcome of ischemic stroke,and may be a novel marker for early diagnosis and prognostic evaluation of ischemic stroke and provide new therapeutic targets for ischemic stroke.Moreover,platelet-associated miRNAs may play a regulatory role in platelet function and gene expression,and have potential role in evaluating the efficacy of antiplatelet drugs,especially in screening high on-treatment platelet reactivity and high-risk patients as early as possible to guide individualized treatment of antiplatelet drugs.

Objective To investigate the medical and pharmaceutical knowledge of patients with chronic diseases and analyse the influence factors of rational administration in patients ,to provid data to support the establishment of pharmaceutical service mode . Methods 386 cases of patients with chronic diseases were asked to finish the questionnaires for the medical and pharmaceutical knowledge ,and factors affecting the rational drug were analyzed by single factor and multiple factors Logistic regression analysis . Results Among the 386 patients ,cardiovascular and celebralvascular disease ratio was the highest(53 .3% ) ,followed by respiratory system diseases(13 .8% ) and the musculoskeletal system diseases (11 .50% );The averaged score of 386 patients was 1 .76 ± 0 .78 , medication knowledge was at a general level;single factor analysis results showed that there was significant difference(P<0 .05) between rational drug-use and abuse of drugs among patients in number ,form of payment ,marital status ,income ,education level , taking drug knowledge lectures ,combined treatment .Multivariate Logistic regression analysis showed that education level ,partici-pation in lectures ,drug combination ,disease species had a significant impact on the rational drug use among patients with chronic disease(P<0 .05) .Conclusion The pharmaceutical knowledge that patients with chronic disease mastered is unsatisfactory ;and unreasonable behavior of medication is common scence .Education level ,participation in lectures ,drug combination ,the number of diseases have great influence on the rational use of drugs in patients with chronic diseases .A kind of effective pharmaceutical service mode should be established for patients with chronic diseases by clinical pharmacists .This is a very meaningful work for rational ad-ministration .

Objective: To investigate the predictive value of mean platelet volume/platelet count ratio (MPV/PC) for short-term outcome in patients with acute noncardioembolic stroke. Methods: Patients with acute noncardioembotic stroke admitted to the Department of Neurology, the Second Hospital of Tianjin Medical University from April 2018 to April 2019 were retrospectively enrolled. According to the modified Rankin Scale (mRS) score at discharge or 14 days after onset, patients were divided into the good outcome group (mRS 0-2) and the poor outcome group (mRS >2). The demographic, baseline clinical data, laboratory findings were collected and compared between the good outcome group and the poor outcome group. MPV/PC values were calculated according to the average platelet volume and platelet count in blood routine. Multivariate logistic regression analysis was used to determine the independent predictive factors of poor outcome. Receiver operating characteristic (ROC) curves analysis was used to evaluate the predictive value of MPV/PC for poor outcome. Results: A total of 596 patients with acute noncardioembolic stroke were enrolled, including 391 (65.60%) with good outcome and 205 (34.40%) with poor outcome. MPV/PC in the poor outcome group was significantly higher than that in the good outcome group (0.06±0.08 vs. 0.04±0.03; t=-4.392, P<0.001). Multivariate logistic regression analysis showed that MPV/PC was an independent predictive factor for the poor outcome (odds ratio 1.088, 95% confidence interval 1.042~1.137; P<0.001). ROC curve analysis showed that the best cut-off value for MPV/PC to predict poor oucotme was 0.050, the area under the curve was 0.772 (95% confidence interval 0.732~0.812), the sensitivity was 62.1%, the specificity was 81.6%, the positive predictive value was 86.3%, and the negative predictive value was 92.2%. Conclusion MPV/PC is an independent predictive factor for poor short-term outcome in patients with acute noncardioembolic stroke, and has certain predictive value.

Objective To investigate the correlation between white blood cell count to mean platelet volume ratio (WMR) in peripheral blood and short-term prognosis of large artery atherosclerotic stroke (LAA).Methods From March 2015 to March 2018,patients with acute ischemic stroke admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University were enrolled retrospectively.According to the TOAST etiological classification criteria,they were divided into LAA group and non-LAA group.According to the modified Rankin scale (mRS) score at 14 d after onset,they were divided into short-term good outcome group (0-2) and short-term poor outcome group (＞2).The clinical data,routine laboratory results and WlMR were collected and compared.Multivariatelogistic regression analysis was used to determine the independent risk factors for LAA and its short-term poor outcome.Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of WMR for LAA short-term poor outcome.Results A total of 873 patients with acute ischemic stroke were enrolled,including 447 in the LAA group and 400 in the non-LAA group.WMR in the LAA group was significantly higher than that in the nonLAA group (0.96 ±0.16 vs.0.94 ±0.05;t =-2.397,P =0.017).Multivariate logistic regression analysis showed that WMR was not an independent risk factor for LAA (odds ratio 1.150,95％ confidence interval 0.999-1.325;P =0.052).WMR in the LAA short-term poor outcome group was significantly higher than that in the LAA short-term good outcome group (1.04 ± 0.129 vs.0.87 ± 0.146;t =-13.338,P ＜ 0.001).Multivariate logistic regression showed that WMR was an independent risk factor for LAA shortterm poor outcome (odds ratio 1.242,95％ confidence interval 1.025-1.504;P=0.027).ROC curve analysis showed that the optimal cutoff value of WMR in predicting LAA short-term poor outcome was 0.89,the area under the curve (AUC) was 0.799 (95％ confidence interval 0.755-0.843),the sensitivity was 85％,the specificity was 77.7％,the positive predictive value was 74.04％,and the negative predictive value was 86.93％.Conclusion The increased level of WMR are not independent risk factor for LAA,but are independent associated with poor short-term outcomes in LAA.