Objective To investigate the differences of the plasma homocysteine (Hcy) between the patients with acute cerebral infarction and the normal controls, and the relationship between the levels of plasma Hcy and folic acid, vitamin B_(12) and lipids, and the relationship between clinical symptoms in patients with acute cerebral infarction. Methods A total of 91 patients with first-ever acute cerebral infarction and 100 controls without cerebrovascular accident were included. Their ratio factors such as age, sex, hypertension and diabetes did not have significant differences. Enzymatic cycling was used to detect plasma Hcy levels. Chemiluminescence was use to detect folic acid and vitamin B_(12) levels. Biochemical analyzer was used to measure lipid levels. The patients with acute cerebral infarction were evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results The plasma Hcy level was significant higher in the acute cerebral infarction group than that in the control group (21.22 ±7.29 μmol/L vs. 13.19 ± 2.13 μmol/L) (P ＜ 0.05); the plasma Hcy level in the acute cerebral infarction group was significantly negatively correlated with folic acid (r = - 0.307,P ＜0.05) and vitamin B_(12) (r = - 0.270, P ＜0.05). It was significantly positively correlated with low-density lipoprotein (r =0.282, P ＜0.05), and it was significantly negatively correlated with high-density lipoprotein (r = -0.219, P ＜0.05). The mean value of the plasma Hcy in acute cerebral infarction group increased with the increase of NIHSS scores. Conclusions Hyperhomocysteinemia is an independent risk factor for acute cerebral infarction. The levels of folic acid and vitamin B_(12) decreased with the increase of Hcy levels. The higher the Hcy levels,the more serious the clinical symptoms are. Hcy may increase the risk of ischemic cerebrovascular disease by influencing the lipid metabolism.

Objective To evaluate the diagnostic and prognostic value of the serum procalcitonin ( PCT ) level in the non-acquired immune deficiency syndrome ( AIDS ) immunocompromised critically ill patients suspected to have infection. Methods A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluationⅡ( APACHEⅡ) score at admission, and clinical records including baseline and peak levels of temperature, white blood count ( WBC ), PCT, and survival rate within 28 days, infection focus, infectious agents ( bacterial, fungi or mixed infection ), and the severity of infection ( sepsis, severe sepsis, or septic shock ) were recorded. Receiver operating characteristic ( ROC ) curve was plotted, and the diagnostic and protective value of above parameters was evaluated. Results A total of 98 patients ( 43 male and 55 female ) were enrolled in the study with a median age of 44 ( 28, 52 ) years old and a median APACHEⅡscore of 17 ( 11, 20 );47 with malignant hematological tumor, 45 with autoimmune diseases, and 6 post solid organ transplantation. Among them 53 patients ( 54.1%) died within 28 days. Twenty-seven patients were diagnosed as systemic inflammatory response syndrome ( SIRS ) without infection. Among 71 patients with infection, 45 were diagnosed as bacterial infection, 10 with fungal infection, and 16 with mixed infection. Sepsis was diagnosed in 7 patients, severe sepsis in 32 patients , and septic shock in 32 patients .①There was no statistical significance in the baseline and peak levels of PCT and WBC, or baseline level of temperature between the groups of SIRS patients without infection and infected patients. The peak level of temperature was significantly higher in the patients with infection as compared with that of the SIRS without infection patients [℃:39.4 ( 38.9, 40.0 ) vs. 38.8 ( 37.8, 39.2 ), Z=-3.268, P=0.001 ]. It was showed by subgroup analysis that in patients with hematological malignant disease or autoimmune diseases, higher level of body temperature was found in infection group compared with non-infection SIRS group [℃:39.5 ( 39.0, 40.0 ) vs. 39.0 ( 38.4, 39.4 ), Z=-2.349, P=0.019;39.0 ( 38.4, 39.5 ) vs. 38.2 ( 37.0, 38.9 ), Z=-2.221, P=0.026 ].②The baseline level of PCT (μg/L ) were 0.54 ( 0.20, 4.19 ), 2.78 ( 0.50, 9.54 ), 1.00 ( 0.45, 6.89 ), and 0.22 ( 0.07, 1.86 ) in non-infection SIRS patients or the patients with bacterial, fungal, and mixed infection, respectively. The peak level of PCT (μg/L ) were 4.19 ( 1.95, 13.42 ), 12.37 ( 3.82, 45.89 ), 1.82 ( 0.49, 17.86 ), and 5.14 ( 2.66, 12.62 ), respectively, in each subgroup. When the comparison was conducted among the patients with different infectious agent, the baseline level of PCT in patients with bacterial infection was significantly higher than that in SIRS patients without infection ( P=0.026 ) and mixed infection patients ( P=0.001 ), and the peak level of PCT was significantly higher than that in the SIRS patients without infection ( P=0.009 ) and the patients with fungal infection ( P=0.016 ). ROC curve showed that the higher value was found in the baseline and peak levels of PCT for diagnosis of septic shock in all patients [ area under ROC curve ( AUC ) of baseline level = 0.681±0.054, P = 0.001; AUC of peak level = 0.690±0.054, P=0.002 ], and the same value was also found in the baseline and peak levels of PCT for diagnosis of bacterial infection in the patients with malignant hematological tumor ( AUC of baseline level=0.687±0.080, P=0.008;AUC of peak level=0.697±0.079, P=0.021 ).③The peak level of PCT (μg/L ) were 4.05 ( 0.53, 31.22 ), 5.78 ( 2.14, 16.68 ), and 11.64 ( 2.94, 58.14 ) in subgroup of patients with sepsis, severe sepsis and septic shock, respectively, and they showed no statistical significance among subgroups ( P>0.05 ). A high serum level of peak PCT strongly indicated the presence of septic shock ( AUC=0.646±0.060, P=0.019 ), especially in the subgroup of patients with systemic autoimmune disease ( AUC=0.689±0.081, P=0.035 ).④The peak level of PCT (μg/L ) in the APACHEⅡ>18 group ( 38 cases ) was significantly higher than that of APACHEⅡ≤18 group [ 60 cases, PCT (μg/L ):11.64 ( 3.36, 39.39 ) vs. 4.42 ( 1.32, 14.70 ), P=0.016 ];there was a certain correlation between the peak level of PCT and the severity of the disease.⑤The peak level of PCT in death group was significantly higher than that of the survival group [μg/L:9.07 ( 3.05, 33.09 ) vs. 4.19 ( 1.26, 14.61 ), P=0.043 ]. ROC curve showed that the peak level of PCT might be valuable in predicting the prognosis in immunocompromised patients ( AUC=0.619±0.057, P=0.043 ). Conclusions The serum level of PCT is found to be a reliable marker for the diagnosis of bacterial infection in immunocompromised critical patients, especially in those with hematologic malignancy. Additionally, PCT provides a useful tool for evaluating the severity of infection and the prognosis of critically ill patients.

Objectives To find out the effects of estrogen and clomiphene on behavior of epileptic rats induced by kainic acid (KA) and probe into some mechanisms. Methods Ovariectomized Sprague-Dawley female rats were treated with estrogen (E) or estrogen and clomiphene (C). Their behaviors when they were induced seizures were observed and compared. Indirect immunofluorescence method was used to measure the alterations of gamma-aminobutyric acid (GABA) immunoreactive cells and ?1 subunits of GABA_A receptors in the hippocampus of all groups. Results The latency and time at reaching 4/5 degrees in KA+E group ((24.63?11.44) minutes and (41.50?16.22) minutes, respectively) were reduced greatly than KA group ((46.75?14.61) minutes and (65.13?12.99) minutes), while the latency of (KA+)E+C group (adding estrogen and clomiphene, (43.50?5.75) minutes) became prolonged significantly than in KA+E group. Conclusion High-level estrogen should be proconvulsant and the clomiphene might have some antiepileptic effects, which may be related with some alterations of GABA energic function in the brain.

0.05).Conclusion The maximal slow-phase velocity induced by bithermal caloric test failed to decline with aging,implying that the functions of the horizontal semicircular didn't decline with aging.

OBJECTIVE Comparison of the maximum slow-phase velocity of cold and warm air with different stimulated sequence.METHODS Forty normal cases and 229 vertigo cases with bithermal caloric testing during 2004 to 2006 were randomly divided into two groups:20 normal cases and 101 vertigo cases were stimulated with cold air first,and the other cases with warm air first.According to the canal paresis(CP)≥20%,each patients group was subdivided into the normal semicircular canal(SC) function group and the paresis SC function group. The maximal slow-phase velocity(MSV)during the strongest 10 seconds was counted,and compared among the subgroups.RESULTS Except the normal cases with warm air first,the differences between the subgroups were statistically significant.The cold air first group presented stronger MSV with cold air and the warm air first group presented stronger MSV with warm air.CONCLUSION The MSV stimulated by warm air was as the same as that stimulated by the cold air.With different stimulated sequence,the first stimulation induced stronger response.In normal cases,the cold air firstly stimulated induced much more vestibular adaption.

Objective:To evaluate the clinical efficacy of treatment of sudden deafness using hyperbaric oxygenation, and to provide guidance for its treatment. Methods:The studies about sudden deafness treated with hyperbaric oxygenation combined with drug were retrieved in Cochrane Library, PubMed , MEDLINE, Wanfang Database and CNKI up to July 2016.RavMan 5.3 provided by Cochrane was used for Meta-analysis.Results:Thirty-nine studies which were randomized controlled trials (RCTs)were included, a total of 4 599 cases,of which 2 418 cases received hyperbaric oxygenation therapy combined with drug treatment as treatment group and 2 181 cases received drug treatment alone as control group.A total of 36 studies about the comparison of clinical efficacy between treatment group and control group were included in the Meta-analysis, the result showed that treatment group had a significant clinical efficacy than control group(RR:1.26,95%CI:1.22-1.30,P<0.0001).A total of 6 studies about the improvement of the pure tone average(PTA)in the two groups were included in the Meta-analysis, the PTA gain was significant better in hyperbaric oxygenation group(WMD:11.8,95%CI:4.77-18.83,P<0.000 1).A total of 11 studies about the stage of using hyperbaric oxygenation therapy were included in the Meta-analysis, the result suggested that the early use of hyperbaric oxygenation therapy had better effect than the late use of hyperbaric oxygenation (RR:1.42,95%CI:1.31-1.53,P<0.000 01).Conclusion:The clinical efficacy of hyperbaric oxygenation combined with drug therapy is better than drug therapy alone, the PTA gain is significantly improved and the introduction of hyperbaric oxygenation therapy at the earlier stage shows better results.

The effects of FeSO_4 upon the physiologicproperties were studied with isolated guinea pig a-trium. The FeSO_4 0. 2mmol/L, makes the contrac-tility of the atrium muscle decrease from 100% ofcontrol to 67 ? 9%. The concentration ofepinephrine inducing automaticity increased andthe duration-intensity curve was shifted to theright. The functional refractory period (FRP) wasprolonged from 298 ? 26 ms to 402 ? 43 ms. Thenegative inotropism and the inhibition of the auto-maticity suggest that FeSO_4 may influence Ca~(2+)movement, while the excitability of suppressionand prolongation of FRP indicate that it may bedue to its inhibition of Na~+ influx.

Disease Management ; Humans ; Tinnitus ; therapy

Objective To observe the effect of case-based learning (CBL) applied in ward-round on residents training. Methods A total of 33 residents trained with routine ward-round and CBL ward-round in the neurological department were investigated with questionnaire. Results 30 effective answers were recalled. More of them reported that CBL ward-round was very significant in improving clinical thinking, mastering the specialized knowledge, developing autonomous learning and improving the communication with patients and their family members (P<0.05). Conclusion CBL ward-round is effective on improving the comprehensive professional abilities of residents.

Objective To study the changes of motor cortex in patients with amyotrophic lateral sclerosis(ALS)while executing sequential finger tapping movement by using blood oxygenation level dependent(BOLD)functional MRI.Methods Fifteen patients with definite or probable ALS and 15 age and gender matched normal controls were enrolled in the BOLD study,and all the subjects were right-handed with no other diseases or any recent medication history.A 3.0 T MR scanner was employed and gradient echo EPI(GRE-EPI)sequence was used to acquire the functional images.Subjects executed sequential finger tapping movement at a frequency of 1-2 Hz during a block design task.fMRI data were analyzed by using statistical parametric mapping(SPM)2.Volume of activated brain areas was compared with the use of a Student's t-test.Results Bilateral primary sensorimotor cortex(PSM),bilateral posterior aspect of premotor area(PA),bilateral supplementary motor area(SMA),contralateral inferior lateral premotor area (ILPA),bilateral parietal region(PAR),and ipsilateral cerebellum showed activation in both ALS patients and normal controls when executing the same motor task.The activation areas in bilateral PSM and bilateral posterior aspect of PA(right hand ipsilateral activation:ALS(924.5±141.1)mm3,control(829.9±98.4)mm3,P=0.05;right hand contralateral activation:ALS(9143.8±702.8)mm3,control(8638.8±506.4)mm3,P＜0.05;left hand ipsilateral activation:ALS(1162.5±357.4)mm3,control(902.5±184.2)mm3,P＜0.05;left hand contralateral activation:ALS(8255.2±870.2)mm3,control (5934.6±616.4)mm3,P＜0.05),bilateral SMA(right hand bilateral activation:ALS(6564.3±720.6)mm3,control(4710.7±416.3)mm3,P＜0.05;left hand bilateral activation:ALS(6970.5±961.8)mm3,control(3688.9±672.3)mm3,P＜0.05),and ipsilateral cerebellum(right hand ipsilateral activation:ALS(2720.0±1154.2)mm3,control(254.3±84.4)mm3,P＜0.05;left hand ipsilateral activation:ALS(4794.4±1237.0)mm3,control(1689.0±719.6)mm3,P＜0.05)were significantly larger in ALS patients than in normal controls.Extra activation areas including ipsilateral ILPA,contralateral cerebellum and bilateral posterior limb of internal capsule were only detected in ALS patients.Conclusions Similar activation areas were seen in both groups while executing the same motor task,but the activated areas were more prominent in ALS group.The increased activation areas in ALS patients may represent neural reorganization.while the extra activation areas in ALS patients may indicate functional compensation.