Prasugrel is a member of the thienopyridine class of oral antiplatelet agents.A single oral administration of prasugrel produced a dose-related inhibition of platelet aggrega-tion in rats that was approximately 10 and 100 fold more potent than that of clopidogrel and ticiopidine, respectively. The antiaggregatory effect of prasugrei was evident at 30 minutes and lasted until 72 hours after dosing, indicating fast onset and long duration of action. Combined administration of prasugrel with aspirin produced substantially greater inhibition of both platelet aggregation and thrombus formation compared with each agent alone. Clinical studies in patients with cardiovascular disease confirmed the potent antiplatelet effect of prasugrel compared with ciopidogrel. Prasugrei is a highly effective antiplatelet and antithrombotic agent and is anticipa-ted to be effective in the treatment of atherothrombotic and other ischemic vascular diseases.

The incidence of warfarin-associated intracerebral hemorrhage is increasing gradually. Its early mortality is as high as 50%. The risk factors include advanced age, international normalized ratio > 3.5, hypertension, previous stroke, leukoaraiosis, cerebral amyloid angiopathy, and concomitant antiplatelet therapy, etc. Its prognosis was poor and there is no optimal treatment.

BACKGROUND: Primary progressive aphasia syndrome(PPA) is an unusual type of dementia, and the relevant reports are very rare in China.OBJECTIVE: To describe a Chinese PPA patient with non-fluent aphasia as the main clinical characteristic.DESIGN: An observed trial and a case analysis based on patients.SETTING: Department of Neurology in a hospital of a university and a general hospital of a military area command of Chinese PLA.PARTICIPANT: The patient was a 64-year-old and right-handed man, who hospitalizated in First Clinical Medical College, Harbin Medical University in April 2002.METHODS: Neuropsychological assessment, head structural computed tomograph and magnetic resonance imaging and functional single photon emission computed tomography(SPECT) imaging were used in this patient.ing results.RESULTS: Neuropsychological testing revealed predominantly non-fluent aphasia, anomia was the earliest symptom. CT scan and MRI revealed atrophy of left temporal convexities and enlarged sylvian fissures. SPECT exhibited hypoperfusion in the left temporal, frontal, and partially parietal areas.CONCLUSION: The clinical symptoms, the neuropsychological and neuroimaging findings fit the diagnosis of PPA.

BACKGROUND: In addition to physical disability, stroke may also result in psychological impairments usually manifested by depression and anxiety.Regardless of the primary or secondary onset of anxiety, anti-depressants should be given for treatment of the anxiety and depression besides routine treatment of the primary condition underlying the symptoms.OBJECTIVE: To compare the effect of different treatment protocols with or without anti-depressants and different anti-depressants on poststroke anxiety and depression as well as the neurological functions.DESIGN: Randomized controlled double-blind clinical trial.SETTING: Departments of Psychiatry and Neurology of the Second Hospital Affiliated to Lanzhou University.PARTICIPANTS: Ninety patients aged 41-72 years with post-stroke anxiety and depression, who were admitted in the Departments of Psychiatry and Neurology of the Second Hospital Affiliated to Lanzhou University between July 1999 and December 2002, were enrolled in this study and randomized equally into Paxil group, imipramine group and control group.METHODS: After emergency management for 1-2 weeks in the acute stage, the stroke patients showed clear consciousness and stable life signs without any understanding problems. Patients in the control group received conventional treatment combined with rehabilitative training, while patients in the other two groups were given additional Paxil (20 mg/day) or imipramine (50-150 mg/day) for totally 12 weeks. The neurological deficits and capacity for independent living of the patients were assessed with Hamilton Depression Scale (24 items) and Hamilton Anxiety Scale (14items) at 2, 4, 8, and 12 weeks during the treatment. A reduction of the score for Hamilton anxiety and depression scale by over 75% suggested a cure of depression and anxiety, 50% but ＜ 75% obvious improvement,25% but ＜ 50% improvement, and ＜ 25% non-response. Basically recovered neurological function was indicated by a reduction of neurological deficit score by 90%-100%, remarkable improvement by 46%-89%, improvement by 18%-45%, and non-response or exacerbation by a reduction less than 17%.MAIN OUTCOME MEASURS: ① Neurological function recovery of recovery of the patients after treatment; ② Poststroke anxiety and depression status before and after treatment; ③ Therapeutic effects on depression,neurological functions, severity of neurological deficit, and capacity of independent living. ④ Adverse events and side effects.RESULTS: One patient in Paxil group and 3 in the control group failed to be available for follow-up study, and 3 patients in imipramine group withdrew from the study due to adverse events, so that 83 cases were analyzed.At 2 and 4 weeks in the treatment, the scores for neurological deficits and capacity for independent living exhibited obvious changes (P ＜ 0.01),which gradually stabilized at 8 and 12 weeks (P ＜ 0.05), and significantly greater improvement in the neurological function and capacity for independent living was observed in Paxil group than in the control group (P＜ 0.01), but the differences between imipramine group and the control group and between Paxil group and imipramine group were not statistically significant (P ＞ 0.05). The scores for Hamilton Depression Scale and Hamilton Anxiety Scale were obviously lower in Paxil group and imipramine group at 2, 4, 8 and 12 week than those in the control group (P＜ 0.01-0.001), but similar between the former two groups at 12 weeks (P＞ 0.05). Paxil and imipramine on resulted in curative rates of anxiety and depression of 86.6% and 85.1%, respectively, which were obviously higher than that of the control group (46.6%); the improvement rate ofneurological function in Paxil group, imipramine group and control groupwas 89.6%, 70.3% and 56.6%, respectively, with that of Paxil groupsignificantly higher than that of the control group (P ＜ 0.01), but the difference between imipramine group and control group was not signifi cant (P ＞ 0.05).CONCLUSION: Patients with poststroke anxiety and depression shouldreceive appropriate interventions with anti-depressants in addition to treat ment of neural function impairment. Paxil and imipramine haye similar effect in treating anxiety and depression, but the former can be for its less side effects, better compliance on the part of patients and good effect inpromoting neurological function recovery.

Objective To compare the clinical results of endovenous laser treatment(EVLT),radiofrequency endovenous occlusion(RFO)and conventional stripping combined with transilluminated powered phlebectomy(TIPP)for lower extremity varicose vein.Methods From Jun 2004 to Jan 2007,200 cases(232 limbs)were treated by EVLT with TIPP,80 cases(88 limbs)by RFO with TIPP,and 180 cases(202 limbs)by conventional stripping with TIPP.Operation time,number of the incision made,intraoperative bleeding,postoperative hospital stay,complications,and one-year recurrence rate were compared with each other. Results Operation time was longer(41±8)min in RFO group than that in other two groups.Postoperative hospital stay was shorter in EVLT group(1.2±0.4 d)and RFO group (2.1±0.8 d)than that in stripping and TIPP group(P＜0.05).Patients in stripping group also suffered from more intra-operative bleeding more often incidental nervus saphenus injury and more incision numbers when compared with other two groups(P＜0.05).There was no significant difierence in one-year recurrence rate among patients in the three groups. Conclusions The clinical efficacy is almost the same among the three groups in terms of eradication of the varicose veins.EVLT and RFO are safe and minimal invasive for the treatment of lower extremity varicose vein.

Objective To preliminarily investigate the clinical features and efficacy of surgical treatment of moyamoya syndrome in patients w ith hyperthyroidism. Methods From December 2002 to April 2013, 41 patients w ith moyamoya syndrome based on the disease of hyperthyroidism admitted to the Department of Neurosurgery, the 307th Hospital of PLA w ere analyzed retrospectively. The clinical data w ere colected, including sex, age of onset, initial symptoms, progress symptoms, imaging features, Suzuki staging, and surgical efficacy, and they w ere compared w ith the clinical data of the patients w ith moyamoya disease treated at the same time. Results The ratio of male to female w as about 1∶4 in moyamoya syndrome patients w ith hyperthyroidism. The peak age of onset w as 25 to 34 years old. Compared w ith the patients w ith moyamoya disease at the same period, the proportion of patients w ith cerebral infarction as initial symptom w as higher in the moyamoya syndrome group ( 39.0% vs.24.2%; χ2 = 4.796, P =0.029), more patients had symptomatic progression (46.3% vs.25.4%; χ2 =9.207, P =0.002), and the proportion of of patients w ith cerebral hemorrhage as initial symptom w as low er ( 2.4% vs.14.6%; χ2 = 4.829, P =0.028). Thirty-seven patients w ho received encephalo -duro-arterio-synangiosis (EDAS) w ere folow ed up for 43 ± 19 months. The results show ed that the clinical symptoms of 31 patients had different degrees of improvement. Conclusions Moyamoya syndrome of hyperthyroidism is more common in w omen. The risk of cerebral infarction is higher and more prone to have disease progression. The efficacy of EDAS is better for controling the progression of moyamoya syndrome in patients w ith hyperthyroidism.

OBJECTIVETo analyze the value of ovarian reserve markers for predicting ovarian response in women undergoing in vitro fertilization-embryo transfer.

METHODSAccording to the ovarian response, 331 patients undergoing oocyte retrieval cycles were divided into of normal, poor, and high response groups. Serum anti-Mvllerian hormone (AMH) was determined using AMH ELISA kit on day 3 of the menstrual cycle, antral follicle count (AFC) was measured using vaginal ultrasound, and basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E(2)) levels were detected using chemiluminescence method.

RESULTSSerum AMH and FSH levels, FSH/LH ratio, AFC, and the patients age, but not the basal E(2) level (P>0.05), were correlated with the number of oocytes collected (×1000/ampules of Gn) (P<0.001). AFC and serum AMH were the strongest single predictors for low ovarian response, with the areas under curve (AUC) of 0.855 (0.787-0.924) and 0.832 (0.764-0.900) (P<0.05), and cutoff values of ≤9 and ≤1.88 ng/ml, respectively. AFC was the strongest single predictor for high ovarian response, with an AUC of 0.787 (0.728-0.847) and the cutoff value of ≥15. Logistic regression model found that the combination of AFC, serum AMH and FSH improved the predictive power for poor ovarian response, but not for high ovarian response.

CONCLUSIONAFC, serum AMH, FSH, FSH/LH, and age are all predictors of ovarian response, among which AFC is the strongest single predictor. A multivariable model can improve the predictive power for low ovarian response but not for high ovarian response.

Adult ; Age Factors ; Anti-Mullerian Hormone ; blood ; Embryo Transfer ; Estradiol ; blood ; Female ; Fertilization in Vitro ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Middle Aged ; Oocytes ; cytology ; Ovarian Follicle ; cytology ; metabolism ; Ovary ; cytology ; metabolism ; Ovulation Induction ; methods ; Young Adult

OBJECTIVETo investigate the association of anti-Mullerian hormone (AMH) levels in the follicular fluid and serum with the outcomes of in vitro fertilization-embryo transfer (IVF-ET) cycles in patients with polycystic ovarian syndrome (PCOS).

METHODSSerum and follicular fluid samples were obtained from 30 patients with PCOS and 34 healthy women (control) undergoing IVF/ICSI-ET in our center between October, 2007 and January, 2008. All the subjects received treatment with long luteal-phase down-regulation and controlled ovarian hyperstimulation protocol in IVF cycles, and their clinical characteristics were analyzed. The AMH levels in the serum and follicles fluid samples collected on the day of oocyte retrieval were assayed using an enzyme-linked immunosorbent assay (ELISA) kit.

RESULTSThe two groups showed no significant differences in the mean age, baseline levels of sex hormones, rate of high-quality embryos, implantation rate, pregnancy rate, abortion rate or ongoing pregnancy rate (P>0.05). Despite a significantly lower total gonadotropin dose, PCOS group had a significantly greater number of antral follicles than the control group (P<0.05). The recovery rates of oocytes in PCOS group were significantly lower than that in the control group (P<0.05). AMH levels in the serum and follicle fluid was significantly higher in PCOS group than in the control group (P<0.05), and in both groups, AMH levels in the follicular fluid were significantly higher in pregnant women than in non-pregnant women (P<0.05). AMH level in the follicular fluid was significantly correlated with the implantation rate in both PCOS and control groups (P<0.05).

CONCLUSIONAMH level in the serum and follicle fluid on the day of oocyte retrieval is predictive of the treatment outcome of controlled ovarian hyperstimulation in POCS patients but not of pregnancy outcomes after IVF-ET.

Adult ; Anti-Mullerian Hormone ; blood ; metabolism ; Case-Control Studies ; Female ; Fertilization in Vitro ; methods ; Follicular Fluid ; metabolism ; Humans ; Polycystic Ovary Syndrome ; blood ; metabolism ; therapy ; Pregnancy ; Pregnancy Outcome

Objective:To evaluate and quantify the degree of language impairment by obtaining the cerebral blood flow in the main language functional areas of aphasia patients after stroke with arterial spin labeling sequence, so as to make aphasia evaluation more objectively, accurately and effectively.Methods:From May 2016 to October 2019, 22 patients with aphasia after stroke and 22 healthy controls were collected from the Department of Neurology, the First Affiliated Hospital of Zhejiang University, for multimode MR scanning, and the patients were evaluated by aphasia scale during hospitalization. The classic language related brain area and potential language related brain area were selected as the regions of interest to extract the local mean cerebral blood flow. The differences of cerebral blood flow between the two groups were compared, and the correlation between the cerebral blood flow of each region of interest and the sub items of multiple language scales was analyzed.Results:Compared with the control group, the cerebral blood flow of the inferior parietal gyrus （AAL-11，(39.18±3.85) ml·100 g -1·min -1vs (50.41±1.93) ml·100 g -1·min -1， t=2.605）, angular gyrus （AAL-13，(39.90±3.29) ml·100 g -1·min -1vs (47.86±1.93) ml·100 g -1·min -1, t=2.087） in the patients was obviously decreased; In the relevant brain areas of listening comprehension, the cerebral blood flow of the inferior parietal gyrus (AAL-61, (33.86±4.15) ml·100 g -1·min -1vs (44.31±2.39) ml·100 g -1·min -1, t=2.179), superior marginal gyrus (AAL-63, (36.49±4.40) ml·100 g -1·min -1vs（50.17±2.26） ml·100 g -1·min -1, t=2.765), and angular gyrus (AAL-65, (35.56±4.24) ml·100 g -1·min -1vs(48.98±2.32) ml·100 g -1·min -1, t=2.777), Heschl gyrus (AAL-79, (47.30±5.11) ml·100 g -1·min -1vs（62.54±2.45） ml·100 g -1·min -1, t=2.689) and superior temporal gyrus (AAL-81, (43.56±4.82) ml·100 g -1·min -1vs (56.29±2.06) ml·100 g -1·min -1, t=2.429) of the patients was also decreased to different degrees ( P<0.05). In addition, the cerebral blood flow of the left insula (AAL-29, (46.59±3.76) ml·100 g -1·min -1vs (55.74±2.12) ml·100 g -1·min -1, t=2.120) and the rolandic island (AAL-17, (39.71±3.81) ml·100 g -1·min -1vs (52.48±2.01) ml·100 g -1·min -1, t=2.968)cover in the patients was also lower than that in the control group significantly ( P<0.05). The results of correlation analysis showed that there was a significant positive correlation ( P<0.05) between the brain blood flow of the left inferior frontal gyrus, the triangle of inferior frontal gyrus, the insular lobe, the inferior parietal lobe, the bilateral superior marginal gyrus and the sub item scores of the language scale in the patients. Conclusions:The decrease of cerebral blood flow is the potential cause of the decrease of language function in aphasia patients after stroke. The decrease of cerebral blood flow in six brain regions, including the frontal inferior gyrus, the frontal inferior gyrus triangle, the insular lobe, the left and right superior marginal gyrus and the inferior parietal lobe, can be used as an objective quantitative index to reflect the level of naming function.

We report 3 cases of successful pregnancies in women with a history of surgeries for gynecological malignancies and postoperative infertility, achieved by in vitro fertilization-embryo transfer (IVF-ET) with controlled ovarian hyperstimulation. All the 3 patients had clinical pregnancies without cancer recurrence. In such cancer survivors with infertility, the ovarian reserve is severely impaired by cancer therapies and assisted reproductive techniques should be the primary option.
Embryo Transfer ; Female ; Fertilization in Vitro ; Gynecologic Surgical Procedures ; adverse effects ; Humans ; Infertility, Female ; therapy ; Neoplasms ; surgery ; Pregnancy ; Reproductive Techniques, Assisted