Objective To study the effect of leech powder on mortality and disability of acute intracerebral hemorrhage at 30 days and 1 year. Methods In a Case-control study,we analyzed the 30-day and 1-year mortality and disability with respect to leech powder treatment status in 59 patients consecutively admitted within one week of intracerebral hemorrhage onset. Confounding factors were compared between treated and nontreated patients. Results About two thirds of the patients received oral leech powder as part of their routine treatment,mean dosage was (2.22?0.42)g/d and mean duration was (10.12?3.39)d. The mortality was 2.4% versus 16.7% (P =0.08) at 30 days and 17.1% versus 44.4% (P=0.03) at 1 year in the leech powder treated and nontreated groups,respectively. Modified Rankin score 5-6 was 43.9% (61.1% in nontreated groups,P =0.45) at 30 days and 17.1% (50% in nontreated groups,P =0.03) at 1 year in treated groups,respectively. Leech powder treatment effect was adjusted for Glasgow Coma Scale,hyperglycemia,creatinine and smoker in logistic regression models. Depending on the factors entered into the model,either no effect or harm could be attributed to leech powder. Conclusions Based on the results of this study,no recommendations can be made on the use of leech powder in acute intracerebral hemorrhage. And properly randomized,controlled trials should be performed to come to a final conclusion.

OBJECTIVETo investigate the metabolic changes on proton magnetic resonance spectroscopy (¹H-MRS) in patients with first left basal ganglia infarction and their relationship with depression.

METHODSTwenty-two patients with first left basal ganglia infarction and 10 matched healthy controls were recruited in the study. Patients and controls underwent (1)H MRS scan and the spectrum of N-acetyl aspartic acid (NAA), choline (Cho) and creatinine (Cr) was recorded at the first week (D7) and 1 month after onset (M1), respectively. National Institutes of Health Stroke Scale (NIHSS), Ability of daily life (ADL), Hamilton Depression Scale (HAMD) were evaluated at D7, M1 and M6 after onset. The patients were classified into two groups: post-stroke depression (PSD) and non-post-stroke depression (NPSD) according to the result of HAMD.The differences of (1)H-MRS between these two groups were compared and their relationship with NIHSS and ADL was analyzed.

RESULTSAmong 22 patients 10 were diagnosed as PSD and 12 were NPSD. Compared to controls, NAA/Cr was significantly lower and Cho/Cr was significantly higher (P <0.05)in left prefrontal white matter and left basal ganglia in patients with infarct. Patients with PSD showed a lower NAA/Cr and higher Cho/Cr than NPSD patients (P <0.05). At M1 after onset, NAA/Cr in the left prefrontal white matter was significantly correlated with NIHSS (r=-0.551, P =0.032), while Cho/Cr was correlated with ADL (r=0.682, P=0.005)in PSD patients.

CONCLUSIONMetabolic changes shown on (1)H-MRS in patients with basal ganglia infarction may predict the occurrence of PSD.

Adult ; Basal Ganglia ; pathology ; Case-Control Studies ; Cerebral Infarction ; complications ; Depression ; diagnosis ; etiology ; metabolism ; Female ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Male ; Middle Aged ; Protons

Objective:To investigate the relationship between different types of hemorrhagic transformation and serum uric acid in patients with acute cerebral infarction.Methods:The clinical data of 365 patients with acute cerebral infarction in Jinhua Central Hospital of Zhejiang Province from June 2018 to December 2020 were retrospectively analyzed. The clinical data and the serum uric acid level at the time of admission were recorded, and the occurrences of hemorrhagic infarction (HI) and cerebral parenchymal hematoma (PH) were counted. The risk factors of HI and PH in patients with acute cerebral infarction were analyzed by multivariate Logistic regression analysis.Results:Among 365 patients, 328 cases had no hemorrhagic transformation (control group); 37 cases (10.1%) had hemorrhagic transformation, with 20 cases of HI (HI group) and 17 cases of PH (PH group). The uric acid in PH group was significantly lower than that in control group and HI group: (243.59 ± 61.49) μmol/L vs. (307.84 ± 80.12) and (305.45 ± 94.99) μmol/L, and there was statistical difference ( P<0.05); there was no statistical difference in uric acid between control group and HI group ( P>0.05). The patients was divided into 3 groups according to the tertiles of serum uric acid, uric acid ≤ 264.9 μmol/L was in 121 cases (Ⅰ group), 265.0 to 338.8 μmol/L was in 122 cases (Ⅱ group) and ≥338.9 μmol/L was in 122 cases (Ⅲ group). The rate of PH in Ⅲ group was significantly lower than that in Ⅰ group: 0.8% (1/122) vs. 8.3% (10/121), and there was statistical difference ( P<0.05). Taking patients without hemorrhage transformation as a reference, multivariate Logistic regression analysis result showed that diabetes, atrial fibrillation and large-area infarction were independent risk factors of HI in patients with acute cerebral infarction ( P<0.01); the age, large-area cerebral infarction, thrombolytic therapy, platelet count and uric acid were independent risk factors of PH in patients with acute cerebral infarction ( P<0.05 or <0.01). Conclusions:In patients with acute cerebral infarction, higher serum uric acid is independently correlated with lower PH, and has no correlation with HI. Serum uric acid level has certain value in predicting PH.

Objective: To explore the feasibility of remote intravenous thrombolysis guidance based on WeChat platform in patients with acute cerebral infarction. Methods: From January 2017 to January 2019, 26 acute cerebral infarction patients treated with remote intravenous thrombolysis guidance based on WeChat platform in 3 primary hospitals (Jindong District Traditional Chinese Medical Hospital of Jinhua City, Zhejiang Province; Wucheng District People′s Hospital of Jinhua City, Zhejiang Province; Hospital of China Water Resources and Hydropower Bureau No.12 Company Limited) were selected as observation group, and 28 acute cerebral infarction patients treated with intravenous thrombolysis who transferred to Jinhua Hospital of Traditional Chinese Medical, Affiliated to Zhejiang Chinese Medicine University by these 3 primary hospitals were selected as control group. The onset-to-door time (ODT), onset-to-needle time (ONT) and door-to-needle time (DNT) were recorded; National Institutes of Health Stroke scale (NIHSS) was recorded before treatment and 7 d after treatment; 90 d after treatment, the prognosis was evaluated by modified Randkin scale (mRS); the safety was evaluated by the incidence of intracerebral hemorrhage within 24 h and the mortality of 90 d after treatment. Results: The ODT and ONT in observation group were significantly shorter than those in control group: (67.88 ± 20.57) min vs. (100.57 ± 20.11) min and (131.46 ± 27.76) min vs. (151.32 ± 31.51) min, the DNT was significantly longer than that in control group: (63.58 ± 15.49) min vs. (50.75 ± 13.17) min, and there were statistical differences (P<0.01 or <0.05); there was no statistical differences in NIHSS score before treatment and 7 d after treatment between 2 groups (P>0.05); there were no statistical difference in the incidences of intracerebral hemorrhage and mortality between 2 groups (P>0.05). Ninety days after treatment, the rate of good prognosis in observation group was better than that in control group: 69.2% (18/26) vs. 39.3% (11/28), and there was statistical difference (P<0.05). Conclusions Remote guidance intravenous thrombolysis based on WeChat platform in patients with acute cerebral infarction can improve the thrombolysis rate, shorten ONT and significantly improve the long-term prognosis. But compared with that of advanced stroke centers, the thrombolysis process of primary hospital needs to be optimized.