Objective To investigate the risk factors for early neurological deterioration (END) in patients with ischemic stroke. Methods The consecutive patients with new acute ischemic stroke within 24 h were enrol ed. They were divided into either an END or a non-END group. Their relevant medical history, baseline clinical data, imaging examinations and laboratory test results in both groups were compared. Results A total of 95 patients with acute ischemic stroke were enrol ed, including 32 in the END group and 63 in the non-END group. There were significant differences in the proportion of patients in diabetes mel itus (χ2 =6. 081, P=0. 014), baseline National Institutes of Health Stroke Scale (NIHSS) score >15 (χ2 =9. 851, P=0. 002), baseline infarct volume >30 cm3 (χ2 =10. 815, P=0. 001), and fever (χ2 =6. 642, P=0. 010), as wel as the fasting glucose (t=2. 632, P=0. 010), homocysteine (t =2. 997, P=0. 003), C-reactive protein (t=2. 349, P=0. 021), baseline NIHSS (Z=497. 5, P=0. 001), and baseline infarct volume (Z=544. 5, P<0. 001) between the 2 groups. Furthermore, there were significant differences in the proportions of patients in large artery atherosclerotic stroke (χ2 =24. 539, P<0. 001 ) and smal arterial occlusive stroke (χ2 = 27. 913, P< 0. 001 ) in the TOAST classification, as wel as the total anterior circulation stroke (χ2 =7. 578, P<0. 006) and partial anterior circulation stroke (χ2 =4. 818, P<0. 028) in the OSCP classification. Multivariate logistic regression analysis showed that fasting glucose >6. 0 mmol/L (odds ratio [OR] 6. 951, 95%confidence interval [CI] 2. 159-22. 348; P=0. 001), homocysteine >15 μmol/L (OR 3. 301, 95% CI 1. 028-10. 595; P=0. 045), NIHSS score >15 (OR 4. 174, 95% CI 1. 772-14. 870;P=0. 028), infarct volume >30 cm3 (OR 4. 996, 95% CI 1. 334-18. 717; P=0. 017), and fever (OR 4. 528, 95% CI 1. 334-15. 372;P=0. 015) were the independent risk factors for occurring END in patients with acute ischemic stroke. Conclusions The baseline glucose, NIHSS score, infarct volume, homocysteine, and increased body temperature are the independent risk factors for occurring EDN in patients with acute ischemic stroke.

Objectives To observe the effect of continuous positive airway pressure (CPAP)for the treatment of patients with acute cerebral infarction combined with obstructive sleep apnea syndrome (OSAS)and to investigate the influence of CPAP therapy on the recovery of neurological function in patients. Methods From April 2014 to September 2015,68 consecutive patients with acute cerebral infarction combined with OSAS admitted to the Department of Neurology,General Hospital of Wanbei Coal and Electricity Group were enrolled retrospectively. According to whether received the CPAP therapy,they were divided into an observation group (n = 31)and a control group (n = 37). The control group was treated with conventional therapy,and on the basis of the treatment plan of the control group,the observation group was also treated with CPAP therapy. They were all the patients with cerebral infarction who were treated for 14 d. The oxygen desaturation index (ODI),lowest oxygen saturation (LS a O2 ),oxidized low-density lipoprotein (ox-LDL),and superoxide dismutase (SOD)concentration,National Institute of Health Stroke Scale (NIHSS)scores and Barthel index (BI)scores,and the modified Rankin scale (mRS)scores after 3 months before and after the therapy in the patients of both groups were documented. The total effective rate was assessed. Results (1)The ODI and LS a O2 in the observation group and the control group after treatment were better than those before treatment. There were significant differences between the 2 groups (ODI:16 ± 6% vs. 35 ± 21%,26 ± 15% vs. 36 ± 21 %;LS a O2:88 ± 6% vs. 75 ± 11%,80 ± 8% vs. 75 ± 11%;all P < 0. 05). (2)After treatment,ox-LDL of the observation group was lower than that of the control group. There was significant differences between the 2 groups (ox-LDL:487 ± 90 μg/ L vs. 548 ± 77 μg/ L,SOD:111 ± 10 kU/ L vs. 94 ± 15 kU/ L,all P < 0. 01). (3)After treatment,the NIHSS and BI scores of the observation group and the control group were better than those before treatment. There were significant differences (the NHISS scores:5. 2 ± 2. 2 vs. 12. 9 ± 3. 9;7. 6 ± 3. 1 vs. 12. 5 ± 4. 2;the BI scores:88 ± 10 vs. 52 ± 30;81 ± 4 vs. 58 ± 30;all P < 0. 01). The NIHSS and BI scores of observation group were better than those of the control group. There were significant differences (all P < 0. 01). They were followed up for 3 months,the mRS score (1. 3 ± 0. 4)of the observation group was lower than that of the control group (2. 0 ± 1. 1). There was significant difference between the 2 groups (t = 3. 362,P <0. 01). (4)The total effective rate of the observation group and control group was 74. 2% (23 / 31)and 48. 6% (18 / 37)respectively. There was significant difference between the 2 groups (χ2 = 4. 598,P <0. 05). Conclusion The CPAP therapy can alleviate the oxidative stress levels in patients with acute cerebral infarction combined with OSAS in short term and improve the neurological function of patients.

Objective To investigate the relationship between Helicobacter pylori (Hp) infection and carotid atherosclerosis (CAS) progression in patients with high risk of stroke,and to provide clinical evidence for the primary prevention of stroke.Methods Three hundred and thirty-two patients with high risk of stroke were screened from 2 800 people who were consecutively selected and had health examination from June to December 2014 in the Department of Medical Center,General Hospital of Wanbei Coal and Electricity Group.Their clinical information was collected.A total of 267 patients whose carotid ultrasound examinations showed plaques and stenosis were selected for the study.Two hundred and three of the 267 patients who met the screening conditions and completed the follow-up were selected as study subjects.The Hp infection status was detected by the 14C urea breath test and the dynamic progression of CAS was observed.The risk factors of CAS progression were also analyzed.Results Hp infection was found in 170 of 332 patients with high risk of stroke.Among the 267 patients who prompted plaques and stenosis in carotid ultrasound in 2014,203 patients were followed up for 1 year,and 133 patients (65.5％,133/203) were found infected by Hp.Forty-six patients had suggestive carotid stenosis and stenosis aggravating in 2015,31 (67.4％,31/46) of which were found infected by Hp.Logistic regression analysis showed that smoking (OR =1.632,95％ CI 1.275-1.940,P =0.011),systolic blood pressure (OR =1.343,95％ CI 1.105-1.632,P =0.019),low density lipoprotein (OR =1.590,95％ CI 1.188-2.005,P =0.005),oxidative low density lipoprotein (OR =1.732,95％ CI 1.325-2.170,P =0.000) and Hp infection (OR =1.672,95％ CI 1.180-2.154,P =0.016) were independent risk factors for carotid atheroslerosis progression.Conclusions Hp infection was found closely related to CAS progression in patients at high risk of stroke.Positive and effective prevention of Hp infection,advocating smoking cessation and controlling blood pressure and blood fat can effectively reduce the incidence of stroke.

Objective To measure the endogenous metabolites in synovial tissues of rheumatoid arthritis (RA) rabbits with cold syndrome;To investigate the specificity mechanisms of heat-reinforcing needling for RA. Methods A total of forty healthy purple blue rabbits were randomly allocated to normal group, model group, reinforcing-reducing needling group (RRN), twirling-reinforcing needling group (TRN) and heat-reinforcing needling group (HRN) 8 rabbits in each group. Arthritis rabbits cold model was made with ovalbumin and freezing. Except for normal groupand model group, RRN was given acupuncture of reinforcing-reducing needling at Zusanli (ST36), TRN was given acupuncture of twirling-reinforcing needling at Zusanli (ST36), HRN was administrated acupuncture of heat-reinforcing needling at Zusanli (ST36), once a day and retaining 30 min, a total of seven days. Fresh synovial tissues of rabbits knee joints were extracted after the intervention, then GC-Q/TOF-MS technology were employed to evaluate metabolic profiles. Results The synovial tissues metabolites of TCA cycle, carbohydrate and fatty acid metabolism in model group mainly increased compared with normal group (P<0.05); The synovial tissues metabolites of various kinds above-mentioned decreased compared with model group in all intervention of acupuncture group (P<0.05), and the metabolites of TCA cycle and carbohydrate metabolism in HRN were obviously less than that of RRN and TRN (P<0.05). Conclusion The specificity of heat-reinforcing needling for RA manifests in regulation of TCA cycle and carbohydrate metabolism.

Cryptogenic stroke refers to ischemic stroke that is not clear to the cause of the disease through routine examinations. With the development of medical technology, studies have found that most cryptogenic stroke is caused by embolism.Therefore,the concept of embolic stroke of undetermined source (ESUS) is proposed. The main causes of ESUS include subclinical atrial fibrillation, patent foramen ovale, aortic arch atherosclerotic plaque, non-stenotic complex carotid atherosclerotic plaques, and tumor-related embolism, etc. This article reviews the etiology and secondary prevention of ESUS.

Objective To observe the effects of electroacupuncture on intestinal flora and serum inflammatory factors in rabbit model with rheumatoid arthritis(RA);To explore the mechanism of its therapeutic effect on RA.Methods RA model rabbits were established by ovalbumin induction combined with Freund's complete adjuvant,and the rabbits after successful modeling were randomly divided into model group,probiotic group and electroacupuncture group,with 6 rabbits in each group.Another 6 rabbits were set as the normal group.The electroacupuncture group received electroacupuncture at the bilateral"Zusanli"and"Dubi"for 30 minutes,the probiotic group was given probiotic capsules solution(14.5 mg/kg)by gavage,once a day,for two consecutive weeks.The knee joint circumference and pain threshold of rabbits were measured,histopathological morphological changes of colonic tissue and synovial tissue ws observed by HE staining,16S rDNA sequencing was used to analyze structural changes of intestinal flora,the contents of TNF-α,IL-1β and IL-6 in serum were detected by ELISA.Results Compared with the normal group,the circumference of knee joint of rabbits in the model group increased significantly,the pain threshold was significantly decreased(P<0.01);the colonic mucosal damage was serious,the goblet cells were missing,a large number of inflammatory cells were infiltrate;the joint capsule synovial surface was rough,the synovial cell layer was hyperplasia and thickening,the synovial tissue inflammatory cell infiltration was obvious;the number and evenness of gut microbiota species decreased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes decreased(P<0.05,P<0.01),the relative abundance of Desulfobacteria increased(P<0.01),while the relative abundance of Campylobacter,Lawsonella,and Pseudomonas increased(P<0.01),while the relative abundance of Heshanomonas and Herbaspirillum decreased(P<0.01);the contents of serum TNF-α,IL-1β and IL-6 increased(P<0.01).Compared with the model group,the knee joint circumference of the probiotic group and the electroacupuncture group decreased,the pain threshold increased(P<0.01,P<0.05);the degree of intestinal mucosal damage was reduced,the goblet cells were basically arranged neatly,the inflammatory cell infiltration was reduced;synovial cells proliferation and thickening decreased,with a small amount of inflammatory cell infiltration;the number and evenness of gut microbiota species increased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes increased(P<0.05,P<0.01),the relative abundance of Desulfobacteria decreased(P<0.01),while the relative abundance of Campylobacter,Lawsonella and Pseudomonas decreased(P<0.01),the relative abundance of Heshanomonas and Herbaspirillum increased(P<0.05,P<0.01);the contents of serum TNF-α,IL-1β and IL-6 significantly decreased(P<0.01).Conclusion Electroacupuncture can significantly improve the symptoms of RA rabbits and reduce the inflammatory reaction in synovial tissue of joint,and the mechanism may be related to the regulation of intestinal flora structure.

OBJECTIVETo compare the efficacy differences between heat-reinforcing needling and conventional treatment of western medicine on Kashin-Beck disease (KBD) with cold-dampness blocking collaterals syndrome.

METHODSSixty KBD patients of cold-dampness blocking collaterals syndrome were randomly assigned into a heat-reinforcing needling group and a western medication group, 30 cases in each one. In the heat-reinforcing needling group, the heat-reinforcing needling was applied at local painful sites, combined with the acupoints based on the syndrome differentiation and the distal acupoints on the affected meridians. Acupuncture was given 30 min per time, once a day, the treatment of 5 days made 1 session; there was an interval of 2 days between two sessions. In the western medication group, sodium selenite tablets were prescribed for oral administration after meals, 2 tablets each time, once a day; ibuprofen sustained release capsules were prescribed for oral administration, 1 capsule each time, twice a day; vitamin C tablets were prescribed for oral administration, 2 tablets each time, three times a day. Four-week treatment was given in the two groups. The Western Ontaraio and Mcmaster Universities Osteoarthritis Index (WOMAC) was adopted to assess the involved joints; the safety was assessed in the process of treatment; the efficacy was analyzed, and the follow-up visit was conducted 3 months and 6 months after treatment, respectively.

RESULTSAfter 4-week treatment, the total effective rate was 96.7%(29/30) in the western medication group, which was superior to 90.0% (27/30) in the heat-reinforcing needling group (<0.05). However, the safety in the heat-reinforcing needling group was superior to that in the western medication group (<0.05). The improvements of joint function in 3-month and 6-month follow-up visits in heat-reinforcing needling group were superior to those in western medication group (both<0.05).

CONCLUSIONSThe heat-reinforcing needling for KBD is safe and effective with less adverse reactions. The short-term effect of heat-reinforcing needling isinferior to western medication, but the long-term efficacy is remarkably superior to western medication.

OBJECTIVETo compare the effects of different acupuncture methods on urine metabolites in rheumatoid arthritis (RA) rabbits, and to explore the specificity mechanism of heat-reinforcing acupuncture for RA.

METHODSA total of 40 clean purple-blue rabbits were randomly allocated to a normal group, a model group, a mild reinforcing-reducing needling (MRRN) group, a twirling-reinforcing needling (TRN) group and a heat-reinforcing needling (HRN) group, 8 rabbits in each one. Except the normal group, the rabbits in the remaining groups were treated with ovalbumin and freezing to establish RA model. The rabbits in the MRRN group, TRN group and HRN group were treated with MRRN, TRN and HRN at "Zusanli" (ST 36), respectively, 30 min per treatment, once a day for seven days. After treatment, 24-h urine was collected. The rabbits were sacrificed to collect synovial tissues of knee to perform morphology observation; the liquid chromatography quadrupole time-of-flight mass spectrometry (LC-Q/TOF-MS) was applied to measure urine metabolites. All the data were analyzed by principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA).

RESULTSCompared with the normal group, the leucine-related metabolites, as main urine metabolites, were decreased in the model group (<0.05), while the purine-related metabolites and tryptophane-related metabolites were increased (<0.05). Compared with the model group, the leucine-related metabolites, as main urine metabolites, were increased in the three needling groups after treatment (<0.05), while the tryptophan-related metabolites andpurine-related metabolites were decreased (<0.05), moreover, the leucine-related metabolites in the HRN group were obviously higher than those in the MRRN group and TRN gruop (<0.05).

CONCLUSIONSMRRN, TRN and HRN can regulate the pathway of leucine metabolism (energy metabolism), purine metabolism (oxidative damage) and tryptophane metabolism (immune regulation) for RA, The specificity of HRN for RA focuses on regulation of leucine metabolism (energy metabolism).

Objective:To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods:The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed. The average age was 67.9 (40-87) years old, and the average body mass index was 24.56 (15.12-35.94) kg/m 2. The average PSA was 41.07 ng/ml, including 48 cases<10 ng/ml, 98 cases 10-20 ng/ml, and 412 cases>20 ng/ml. There were 123, 214, 118, 89, and 14 cases with biopsy Gleason 6-10 score, respectively. The clinical stage : 90 cases in ≤T 2b, 273 cases in T 2c, and 195 cases in ≥T 3 . 558 cases underwent radical prostatectomy, including 528 robotic-assisted laparoscopic surgery, 25 laparoscopic surgery, and 5 open-surgery. The risk factors for postoperative biochemical recurrence were analyzed by Cox regression. Results:A total of 63 patients had postoperative pathological stage pT 2a, 32 patients had pT 2b, 241 patients had pT 2c, and 222 patients had ≥pT 3. A total of 210 cases developed biochemical recurrence after surgery, and the mean time to biochemical recurrence was 33.3 (3-127) months after the radical prostatectomy. The biochemical recurrence rates at 1, 3, and 5 years were 9.7% (54/558), 21.5% (120/558), and 31.7% (177/558), respectively. Among pT 2a and pT 2b patients, 7 (11.1%) and 4 (12.5%) cases developed biochemical recurrence, respectively. Among pT 2c stage patients, 145 (60.17%) cases had positive cut margins, treated with androgen-deprivation therapy (ADT) after surgery. 68 (28.21%) cases of pT 2c stage patients had biochemical recurrence at mean 36.1 (3-106)months after the radical prostatectomy. Among ≥pT 3 patients, 147 patients with positive margins, perineural invasion, seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy (ADT) + radiotherapy. 98 of 147 patients (66.67%) had biochemical recurrence, and the average time to biochemical recurrence was 30.6 (24-98) months.75 patients of ≥pT 3 without positive margins, perineural invasion, seminal vesicle invasion or positive pelvic lymph nodes, were treated with postoperative ADT. 33 of them (44%) had biochemical recurrence, and the average time to biochemical recurrence was 32.5 (21-106) months. 5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05% (187/210) and 78.09% (164/210) respectively, 5- and 10-year tumor-specific survival rates were 92.57% and 87.69%, respectively. 46 of 210 cases died, of which 31 (67.39%) died from prostate cancer, and 15 cases (32.61%) died from cardiovascular and cerebrovascular diseases. Multifactorial Cox regression analysis showed that patient's age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7 were independent risk factors for biochemical recurrence. Conclusions:After radical prostatectomy, patients were treated according to their pathological stage and surgical margins. Patients with positive margins have a higher risk of biochemical recurrence. The independent risk factors for biochemical recurrence included age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7.

OBJECTIVETo compare the efficacy differences between manual acupuncture (MA) and electroacupuncture (EA) in the treatment of hemiplegia after acute ischemic stroke.

METHODSSixty-eight patients of hemiplegia after acute ischemic stroke were randomized into a MA group (34 cases) and an EA group (34 cases). The routine western medication and bilateral Dingnieqianxiexian (MS 6) were adopted in the two groups. The needles were retained for 30 min. In the MA group, the even-needling technique was used for 3 times during the needle retaining, 1 min each time. In the EA group, on the basis of manual stimulation, EA therapy was added, with disperse-dense wave, 5 Hz/20 Hz. The treatment was given once every day, 6 treatments a week, totally for 2 weeks. US National Institutes of Health stroke scale (NIHSS) score, the simplified Fugl-Meyer motor function (FMA) score and Barthel index (BI) were observed before and after treatment in the two groups. The clinical efficacy was compared between the two groups.

RESULTSNIHSS score was reduced apparently after treatment in the two groups (both<0.01). The score in the EA group was lower than that in the MA group (<0.05). After treatment, FMA score and BI score were all increased apparently in the two groups (all<0.01) and the scores in the EA group were higher than those in the MA group (both<0.01). The total effective rate was 94.1% (32/34) in the EA group and was 85.3% (29/34) in the MA group. The efficacy in the EA group was better than that in the MA group (<0.05).

CONCLUSIONSEA acts on the rehabilitative effect on nerve defect function in the patients of hemiplegia after acute ischemic stroke. It improves limb motor function and the ability ofdaily life activity. The efficacy is better than that of MA.