Objective To investigate the clinical effect of prophylactic low dose of escitalopram in patients with depressive symp-toms and overall symptoms of Parkinson′s .Methods 40 patients were divided into single drug group used alone Piribedil and com-bined treatment group used Piribedil and escitalopram ,20 cases in each group .Hamilton depression scale (HAMD) ,Parkinson′s disease questionnaire composite score standard (UPDRS) and 39 Parkinson′s disease questionnaire score (PDQ-39) prior treatment were used to assess the changes of the patients′degree of depression and the Parkinson′s overall symptoms .Results Compared with prior treatment ,the HAMD score in single drug group after two weeks treatment had no significant difference (P> 0 .05) , while in combined treatment group ,the HAMD score decreased significantly (P<0 .05) .Compared with prior treatment ,both in single drug group and the combined treatment group ,the UPDRS scores and PDQ-39 rating decreased significantly (P<0 .05) ,but without significant difference between the two groups(P>0 .05) .After six weeks treatment ,Compared with prior treatment ,both in single drug group and combined treatment group ,the HAMD score ,UPDRS score and PDQ-39 score had significantly decreased (P<0 .05) ,but without significant differences between the two groups (P<0 .05) .Conclusion Prophylactic low dose of escitalo-pram may be early control of symptoms of Parkinson′s patients with mild depression .It can also be used to improve the overall symptoms of Parkinson′s patients ,which propose new ideas for the clinical treatment of Parkinson′s disease .

Objective To compare the clinical efficacy of minimally invasive removal of intracranial hematomas and medical con-servative treatment for hypertensive cerebral hemorrhage .Methods A total of 75 patients with hypertensive cerebral hemorrhage were collected and randomly divided into two groups according to the treatments :38 patients treated with conservative medicine and 37 patients treated with minimally invasive removal of intracranial hematomas based on standard drug therapy .Neurological impair-ment and recovery of self-care ability of patients in both groups before and after three weeks and six weeks of treatment were scored by National Institute of Health Stroke Scale (NIHSS) .Changes of diffusion tensor imaging before treatment and after two weeks of treatment were evaluated by fractional anisotropy value (FA) .Results There was no significant difference between neurological im-pairments of the patients in two groups before treatment .But the recovery degree of functional impairment and muscle nerve in min-imally traumatic treatment group was more significant than those in the conservative medical treatment group after treatments . There was significant difference between two groups (P< 0 .05) .Conclusion Minimally traumatic of hematomas is an effective method of treating hypertensive intracerebral hemorrhage .

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.