Objective To study the relationship between serum homocysteine level and acute type 2 diabetes mellitus complicated with cerebral infarction.Methods Patients were divided into three groups:acute diabetic cerebral infarction group including 87 patients,diabetes mellitus including 72 patients and control group including 67 healthy persons.The HCY,folic acid,VitB12 and serum lipid were determined.The data was analyzed and the relationship was discussed.Results The level of HCY in diabetic cerebral infarction group[(15.7 ±9.7)nmol/L]was much higher than that in the other two groups[(11.9±7.2)nmol/L and(13.5±6.1)nmol/L].Conclusion HCY maybe participate in occurrence and development of diabetes and pathological changes of blood vessels.It was an independent risk factor of acute cerebral infarction.

0.05).The degree of angiostegnosis:1-grade stenosis in MSCTA was higher than that in DSA.The 2-grade,3-grade and 4-grade stenosis in DSA were higher than that in MSCTA(all P

Objeclive To investigate the relationship between carotid atheroselemtic(CAS)plaque and homocysteine(HCY),C-reactive protein(CRP)and ischemie eerebrovasclar desease(ICVD).Methods 468 patients with ICVD and 456 patients without eerebrovaseular disease(control group)were detected by carotid color duplex in IMI,number,size and character of carotid atherosclerosis(CAS) plaque and thelevels of HCY and CRP were evaluated,and compared with normal control group.Results(1)Compare with control group,the IMT,prevalence of CAS plaque,the rates of soft plaque in ICVD group were significantly higher(all P＜0.05).(2)The levels of HCY and CRP in ICVD were significantly higher than those in control group(P＜0.05),and in ICVD with plaque subgroup were significantly higher than those in ICVD without plaque subgroup(P＜0.05).(3)The prevalence of CAS plaque and IMT were positively correlated with the levels of HCY and CRP(r=0.32,0.30 repectively,P＜0.05).Condusion ICVD patients show increased IMT and hJish prevalence of CAS plaque.CAS plaque and hyperhomocystoinemia is an independent risk factor for ICVD.The level of CRP is an important biological marker to evaluate the severity and prognosis of ICVD.

Objective To explore the changes and the clinical signficance in serum myocardial zymogram of patients with intracerebral be hemorrhage(ICH).Methods To estimate the serum myocardial zymogram.Serum aspartate aminotrasferase(AST),lactate dehychogenase (LDH),creatine kinas (CK) in patients with ICH were measured in 3 days,then to make comparison with control group.Results The serum myocardial zymogram in ICH group were higher than that of control group(P <0.05).There were different changes in serum myocardial zymogram of various parts.The serum myocardial zymogram in group with temporal lobe damage was higher than that of group without temporal lobe damage (P < 0.05).The serum myocardial zymogram of group with colliculus brain damage was higher than that of group without colliculus brain damage(P <0.05) ,the serum myocardial zymogram of group with disorder of consciousness was higher than that of group wakefulness(P < 0.05).Conclusion There are significant changes in the serum myocardial zymogram of patients with ICH.The incidence of the serum myocardial zymogram in ICH was close]y correlated to the severity area and part of ICH,consciousness disorder.To estimate serum zymogram is helpful to judge patients' state and prognosis.

Objective To explore the associated factors and clinical significance of acute renal injures in cerebral stroke.Methods The renal function,BUN,CR,UA patients with acute stroke in 7 days were estimated their neurologic impairment by the scardinanvian stroke scare(SSS) were assessed at the same time,then were compared with control group.Results The incidence of acute renal injure of intracerebral hemorrhage(ICH) group and cerebral infarction(CI) group were both higher than that of control group(P

Objective To study the variation of acute blood pressure in different subtypes of first ischemic stroke,and investigate the influence on the prognosis.Methods A total of 710 patients with first ischemic stroke were selected.The blood pressure levels were monitored during the initial 7 hospital days.Clinical outcome was based on the combined analysis of Barthel index and the National Institute of Health Stroke Scale (NIHSS) score on the 180th day.In the subtypes of large artery atherothrombosis(LAA),cardioembolism (CE),small artery disease occlusion (SAO) were 400,160,150 cases.Logistic regression model was used to estimate the influencing factors on the prognosis.Results An U-shaped effect was observed in different subtypes between blood pressure on admission,average acute blood pressure and prognosis.In the subtypes of LAA and CE,those who had a basehne systolic blood pressure (SBP) of 140-159 mm Hg (1 mm Hg =0.133 kPa) or a baseline diastolic blood pressure (DBP) of 90-99 mm Hg on admission got good prognosis.In the subtypes of SAO,those who had a baseline blood pressure of 130/95 mm Hg on admission got good prognosis.In all subtypes,the average blood pressure of 150/95 mm Hg got good prognosis.In the subtypes of LAA and CE,those who had a baseline SBP of 120-159 mm Hg or a baseline DBP of 80-99 mm Hg within 7 d after admission got good prognosis.In the subtypes of SAO,those who had a baseline blood pressure of 140/90 mm Hg within 7 d after admission got good prognosis.In all subtypes,the average blood pressure of 140/90 mm Hg within 7 d after admission got good prognosis.Logistic regression analysis revealed that the decrease of blood pressure during the first 24 hours,deterioration within 7 d after admission,acute complication,NIHSS score on admission were the independent risk factors of prognosis,while antihypertensive therapy in the acute phase was the independent protection factor in the subtypes of LAA and CE.In the subtypes of SAO,acute complication was the independent risk factor of prognosis.Conclusions An U-shaped effect is observed in different subtypes between blood pressure on admission and prognosis.In the subtypes of LAA and CE,the decrease of blood pressure during the first 24 hours,deterioration within 7 d after admission,acute complication,NIHSS score on admission are the independent risk factors of prognosis.

Objective To investigate the correlation of the plasma homocysteine level and serum B/apolipoprolionAl(ApoB/ApoAl) radio with cerebral vascular stenosis in patients with cerebral infarction.Methods 184 patients with cerebral infarction experienced cerebral digital substraction angiography (DSA) were selected.Among them,158 patients with cerebrovascular stenesis and 26 patients without stenosis were included.Three groups were categorized by distribution of artery lesion sites:isolated intracranial artery stenesis ( n =48 ),isolated extracranial artery stenosis( n =60) co-existing of intracranial and extracranial artery stenosis( n =50).The correlation analysis was made between the levels of Hcy and ApoB/ApoAl with cerebral vascular stenosis in patients with cerebral infarction.Results ( 1 ) The proportion of subjects with high level of plasma homocysteine was significantly higher in patients with cerebrovascular stenosis than those without[( 16.9 ±8.1 ) μmol/L vs (8.6 ±4.6) μmol/L,P ＜0.001 ;40％ vs 0,P ＜0.01].The proportion of subjects with high level of ApoB and ApoB/ApoA1 ratio was significantly higher in patients with cerebrovascular stenosis than those without ApoB [( 1.02 ± 0.25 ) vs ( 0.86 ± 0.22 ) g/L,P ＜ 0.01],ApoB/ApoAl ratio [( 0.94 ± 0.50) vs ( 0.64 ± 0.21,P ＜ 0.01 )].(2) For the different groups of artery lesion sites,the proportion of subjects with high level of plasma homocysteine was not significantly different[( 16.1 ± 8.5 )mml/L、( 17.0 ± 8.9 ) mmol/L、( 16.7 ± 8.7 ) mmol/L,P ＞ 0.05],the proportion of subjects with ApoB/ApoAl ratio was not significantly different [0.98 ± 0.45,0.93 ± 0.48,0.96 + 0.50,P ＞ 0.05].(3) Based on multivariable stepwise Logistic regression model,the increased level of Hcy( OR =1.146,95％ CI:1.021 ～ 1.287 ;P =0.021 ),the increased level of ApoB/ApoAl ( OR =4.71,95 ％ CI:1.70 ～ 14.20,P =0.005 ),the increased level of ApoB ( OR =4.50,95 ％ CI 为 1.62 ～ 12.80,P =0.007),the increased level of Cho ( OR =2.406 ;95％ CI:1.145 ～ 5.055 ; P =0.023 ),the decresed level of HDL( OR =0.089,95％ CI:0.014 ～ 0.551,P =0.017 ) were all risk factors.Conclusion High level of plasma homocysteine and ApoB/ApoAl were both independent risk factors for cerebral vascular stenosis.

Objective To explore the risk factors of the recurrence of ischemic stroke and to supply theoretical basis for secondary prevention.Methods 612 patients with ischemic stroke were enrolled in the study and they were followed-up for 2 years to record the stroke recurrence.According to whether the recurrent stroke occurred,all the patients were divided into the recurrent group and the non-recurrent group.Logistic regression model was used to analyze the risk factors.Results Of 612 patients,90 patients suffered from recurrent stroke and the recurrence rate after 2 years was 14.7％.In the recurrent group,age,smoking,hypertension,diabetes,fibrillation atrial history and homocysteine level were significantly higher than those in non-recurrent group (P ＜ 0.05),compliance of anti-platelet drugs was significantly lower than that in non-recurrent group (P ＜ 0.01).Multivariate analysis suggested that age,smoking,hypertension,diabetes,atrial fibrillation history,homocysteine level and compliance of anti-platelet drugs were associated with recurrence of ischemic stroke (OR value =11.14,47.38,53.11,111.12,53.11,40.98,90.12,all P ＜ 0.05).Conclusion Age,smoking,hypertension,diabetes,atrial fibrillation history,homocysteine level and compliance of anti-platelet drugs are the independent risk factors of recurrent stroke.To enhance the interference of these risk factors are helpful for preventing the recurrence of stroke.

Objective To understand the erythromycin resistance rate and the erythromycin resistant gene spectrum in Streptococcus pyogenes strains isolated in Shanghai.Methods The outpatient children who were diagnosed with scarlatinal in the Children's Hospital of Fudan University from November 2004 to June 2006 were enrolled and 100 strains of Streptococcus pyogenes were isolated by pharyngeal swab culture.The distributions ofermA,ermB,mefA genes were determined by polymerase chain reaction(PCR)amplification.The relationship between ermA,ermB,mefA genes and erythromycin resistance were also analyzed.Results The erythromycin and clindamycin resistance rates of Streptococcus pyogenes in Shanghai were 98%and 95%,respectively;the concordance rate of these two drugs was 97%.Among 100 strains of Streptococcus pyogenes,94 strains(94%)contained ermB gene,with 100%of erythromycinresistance rate.Sixteen(16%)contained mefA gene,with 100% of erythromycin resistance rate.ermA was not detected inall the 100 strains.The ermB and mefA genes were not found in 5 strains,among which,2 were susceptible to erythromycin and 3wereresistant to erythromycin.Only 1%of isolates was mefA genesingle positive.Conclusions There is a high erythromycin resistance rate of Streptococcus pyogenes strains isolated inShanghai,and the cross resistance to clindamycin is high.TheermB gene is important erythromycin resistancedeterminants of Streptococcus pyogenes in Shanghai.

Objective The aim of this study was to study the antibiotic resistance and resistance genes of methicillin-resistant Staphylococcus aureus (MRSA) in children from Shanghai area,and to determine the relationship between phenotypic and genotypic resistance profiles.Methods In this study,a total of 37 MRSA strains isolated from clinical specimens of hospitalized patients in Children's Hospital of Fudan University from March 2009 to November 2011 were collected.The mecA,ermA,ermB,ermC,aac (6') /aph (2),aph (3')-Ⅲ,ant (4',4),and qacA genes were detected by polymerase chain reaction (PCR).Resistance to antibiotics was detected by agar dilution tests.The data analysis was done by chi square test.Results Among the 37 MRSA isolates,all (100.0 ％) were mecA gene positive,9 (24.3％) were ermB gene positive,none was ermA/C gene positive,21 (56.8％) were aac (6')/aph (2) gene positive,10 (27.0％) were aph (3')-Ⅲ gene positive,6 (16.2％) were ant(4',4) gene positive,and 9 were qacA gene positive (24.3％).The positive rate of aac(6')/aph(2) in hospital acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) was significantly higher than that of community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) (85.7％ vs18.8％,x2=60.340,P=0.000).Among the 37 MRSAisolates,37 (100.0％) were resistant to penicillin,ampicillin-sulbactam,cefazolin,cefoxitin and cefuroxime.The 37 isolates were all susceptible to teicoplanin,vancomycin,and linezolid.The resistant rates to gentamicin,erythromycin,clindamycin,sulfamethoxazole,fosfomycin,rifampicin,and levofloxacin were 51.4％ (19/37),81.1％ (30/37),51.4％ (19/37),16.2％ (6/37),27.0％ (10/37),37.8％ (14/37) and 54.0％ (20/37),respectively.Compared with CA-MRSA,HAMRSA isolates had significantly higher resistance rates to gentamicin (12.5％ vs 81.0％; x2 =17.033,P=0.000),levofloxacin (31.2％ vs 71.4％; x2 =5.903,P=0.017),and rifampin (6.2％ vs 61.9％; x2=11.959,P=0.001).The rate of gentamicin resistance in aac(6')/aph(2) gene carrying strains was significantly higher than strains not carrying the gene (x2 =29.757,P=0.000).Conclusions MRSA in children carry a variety of drug-resistant genes,showed multi-drug resistance.HA-MRSA carries more resistance genes,and has higher rates resistance to antimicrobials than CA-MRSA.