Objective To study the efficiency,safety,and its impact on the functional rehabilitation of the selective 5-serotonin reuptake inhibitor(SSRI) drugs paroxetine in treatment patients with poststroke depression and anxiety.Methods The acute stroke patients at our Neurology department and old-age cadres department were selected,in which have 88 cases of poststroke patients with depression and anxiety,which were divided into paroxetine group and the control group.Paroxetine group was given Seroxat 20 ng,1 time/d + conventional treatment of cerebrovascular disease.The control group was gaven conventional treatment of cerebrovascular disease only.After 4 weeks,6 weeks of treatment,we assessed Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Scale(HAMA),neurological deficit and the state of living ability were assessed.Results There were significant differences in improvenent of depression and anxiety,neurological deficit and the capacity of the state of life between the Paroxetine group and the control group the control group of 4 weeks treatment compared with before treatment(all P＜0.05);Compared with before treatment,the control group of 6 weeks treatment compared with before treatment(all P＜0.05);Paroxetine group of 4 weeks treatment compared with before treatment(all P＜0.05);Paroxetine group of 6 weeks treatment compared with before treatment(all P＜0.05),and Paroxetine group control is obvious Improved(all P＜0.05).Conclusion Using Paroxetine to treat poststroke patients with depression and anxiety,not only could significantly improve symptoms of depression and anxiety,but also speed up the rehabilitation of limb function,efficacy reliable,and had no significant adverse reactions.So,it was an ideal medcine for poststroke patients with depression and anxiety.

ObjectiveTo observe the changes of serum homocysteine acid ( Hcy),interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP)and elucidate the clinical significance in patients with acute stroke. MethodsA total of 126 acute stroke patients were enrolled in the investigation. Based on the MESS,patients were divided into different groups according the severity and prognosis, and 108 physically healthy subjects were selected as controls. The concentration of serum Hcy, IL-6, and hs-CRP were determined in all cases after being attacked at day 3,day 14 and day 28 respectively. Results①The levels of Hcy, IL-6, hs-CRP in patients with acute stroke were significantly higher than controls ( (58.24 ±9.86) μmol/L vs. ( 17.12 ±4.23) μ mol/L, (59.64 ±13.82) ng/L vs. (18.46 ±4.62) ng/L,(19.78 ±6.12) mg/L vs. (2.28 ±0.82) mg/L,all P＜0. 01 ). ②The levels of Hcy,IL-6, hs-CRP in patients with mild, moderate and severe acute stroke were significantly higher than controls (P ＜ 0.01 ) at 3 day after the onset; and the Hcy, IL-6, hs-CRP were also significantly lower in mild cases with acute stroke compared with moderate and severe cases (P ＜ 0. 01 ). At day 14 ,the moderate and severe patients had significantly higher levels of Hcy, IL-6, hs-CRP than mild cases and controls (P ＜ 0.01 ). At day 28 the severe patients had significantly higher levels of Hcy, IL-6, hs-CRP than mild and moderate cases and controls (P ＜ 0.01 ) ③At day 28, the levels of Hcy, IL-6, hs-CRP in basically recovered and remarkably improved cases were significantly lower than unrecovered cases [ ( 16.12 ± 4.74) μmol/L, ( 1 8.42 ± 5.02) μ mol/L vs. ( 48.69 ± 7.89)μmol/L; ( 19.52 ± 5.67 ) ng/L, ( 20. 74 ± 6. 13 ) ng/L vs. ( 51.26 ± 11.66 ) ng/L, ( 3.21 ± 1.36) mg/L,(3.24 ± 2.51 ) mg/L vs. ( 8.86 ± 1.32 ) mg/L respectively, all P ＜ 0. 01 ]. ConclusionsThe levels of serum Hcy, IL-6, hs-CRP are significant biomarkers to evaluate the severity and prognosis of acute stroke.

Objective To investigate the frequency distribution of proprotein convertase subtilisin/kexin 9 (PCSK9) gene I474V polymorphisms and their relationship with patients with ischemic stroke (IS)of Uygur and Han ethnic groups in Xinjiang Uygur Autonomous Region.Methods The I474V polymorphism was identified by polymerase chain reaction-restriction fragment length polymorphism (PCRRFLP) in 407 patients with IS(including 219 Hans and 188 Uygurs)and 425 health controls (including 255 Hans and 170 Uygurs),and some specimens were sequenced.Results (1) Between IS group and control group,the genotypes Ⅱ and Ⅳ had no statistically significant differences in the levels of triglycerides (TG),high-density lipoprotein cholesterol (HDL-C) ; Total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C) levels had statistically significant differences; LDL-C levels had also statistically significant differences.Between IS and control groups,TC,LDL,HDL-C levels of genotype Ⅱ showed statistically significant difference.In the IS group,TC,LDL-C levels of Ⅳ genotype were significantly higher than the control group,the difference being statistically significant.(2) There was statistically significant difference in the genotype distribution between IS and control groups (9.5％ (77/814) vs 4.5％ (38/850),x2 =16.09,P =0.000).And the distribution of allele frequency was statistically different (18.9％ (77/407) vs 8.9％ (38/425),x2 =17.38,P =0.000).(3) The differences of I474V loci Ⅳ genotype frequency distribution in Xinjiang Uygurs and Hans were statistically significant (27.7％ (52/188) vs 11.4％ (25/219),x2 =17.40,P =0.000; 12.9％ (22/170) vs 6.3％ (16/255),x2 =5.57,P =0.018) ; So did the Ⅴ allele frenquency distribution (13.8％ (52/376) vs 5.7％ (25/438),x2 =15.58,P =0.000; 6.5％ (22/340) vs 3.1％ (16/510),x2 =10.44,P =0.001).(4) There was statistically significant difference in the genotype distribution and allele frenquency distribution between IS group and control group in the Xinjiang Uygurs (27.7％ (52/188) vs 12.9％ (22/170),x2 =11.79,P =0.001 ; 13.8％ (52/376) vs 6.5％ (22/340),x2 =10.44,P =0.001) ; But there was no statistically significant difference in the Hans.Conclusions Ⅱ and Ⅳ genotypes are dominant in the I474V polymorphism loci of PCSK9 gene.The genotype of PCSK9 gene I474V polymorphism is correlated with increasing serum levels of TC and LDL-C.I474V polymorphism is associated with cerebral IS course in Xinjiang region.There is statistically significant difference in the genotype I474V distribution between Uygur and Han groups.I474V polymorphism has a relationship with the occurrence of IS in Xinjiang Uygurs.Ⅳ may be a susceptible genotype and Ⅴ may be a genetic susceptible allele of the Xinjiang Uygurs.

10.3969/j.issn.1008-9691.2013.03.012

Objective To understand the prevalence and distribution features of mild cognitive impairment(MCI)among elderly in Xinjiang Uygur and Han ethnic groups so as to provide evidence for etiological study and prevention. Methods From July 2007 to October 2008, according to the criteria of DSM-IV for MCI,a randomized, stratified and cluster sampling procedure was used in the Uygur and Han elder people aged ≥60 years in south Xinjiang, east Xinjiang and Urumchi region. Results A total of 2986 people were surveyed, including 1519 Uygur people and 1467 Han people, and 1435 males and 1551 females. (1) According to the age composition of national census in 2000, the total crude prevalence rate of MCI was 10.21%, and the total standardized prevalence rate of MCI was 10.58% in Uygur and Han elder people. In general Uygur and Han population, the crude prevalence rates of MCI were 9.61% and 10.84%, and the standardized prevalence rates of MCI were 10.29%and 10.86%, respectively. The prevalence of MCI was higher in Han population than in Uygur population, but there was no statistical difference(χ~2 = 1.225, P>0.05). (2) In males and females, the crude prevalence rates of MCI were 9.34% and 11.03%, and the standardized prevalence rates of MCI were 9.26% and 11.62%, respectively. There was no difference in prevalence rate between different sex populations(χ~2 =2.314,P>0.05). (3) In elder people aged 60～69, 70～79 and≥80 years, the MCI prevalence rates were 6.83%, 13.22% and 22.22% in Uygur population and 8.64%, 12.50% and 19.30% in Han population, respectively, and the prevalence rate of MCI was increased with aging in the two thnic roups(χ_(for trend)~2=34.753, 14.081, both P<0.05). (4)There were statistical differences in prevalence rates of MCI among different education levels, and it was decreased with enhancement of education levels in Uygur and Han population(χ_(for trend) = 14.785, 21.059, both P<0.05). Conclusions In Xinjiang Uygur and Han ethnic elderly people, the prevalence rates of MCI are significantly different among elderly with different ages and education levels, and it is increased with aging, but is decreased with enhancement of education levels.

Objective To explore the influence of the combination therapy of probucol with atorvastatin on levels of serum high sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoproteins (ox-LDL), and marix metallopro? teinase-9 (MMP-9) and resolution of carotid plaque in patients with acute cerebral infarction (ACI). Methods One hun? dred-six patients with acute cerebral infarction who had carotid artery color Doppler ultrasound-confirmed atherosclerot? ic plaques , were included in the present study. The patients were randomly divided into two groups: conventional treat? ment group ( 40 cases) which received atorvastatin (20mg/d) and co-treatment group (40 cases) which received Atorvas? tatin (20mg/d) and Probucol (500mg/d). Levels of hs-CRP, ox-LDL and MMP-9 were detected in all patients before treat? ment and 1, 6 and 12 months after drug therapy. The Intima-media thickness, area and numbers of carotid plaques were evaluated by using Doppler ultrasonography during a 12 months follow-up period. Results ① Serum hs-CRP and MMP-9 levels were significantly decreased at 1, 6 and 12 months after treatment, (conventional treatment group:t =14.662, 23.586, 28.179 and co-treatment group:t =47.023, 50.239, 50.774,P <0.01). The ox-LDL levels was obviously de? creased in the combined treatment group (t =4.592, 5.011, 5.892,P <0.01) but not in conventional treatment group (P > 0.05) at 1, 6 and 12 months after treatment. Serum hs-CRP, ox-LDL and MMP-9 levels were significantly lower in com? bined treatment group than in the conventional treatment group at all time points after treatment (t =7.655, 5.271, 2.492, t =4.927, 3.772, 4.673 andt =16.862, 4.251, 2.045.P <0.01 orP <0.05). ②There were not statistically differences in the IMT, plaque area and plaque numbers between these two groups before treatment (P >0.05). The IMT, plaque area and plaque numbers were significantly smaller in combined treatment group than in conventional treatment group (t =6.117, 3.290, 2.158,P <0.05). Conclusions The combination therapy of probucol with atorvastatin can greatly reduce levels of serunl hs-CRP,ox-LDL and MMP-9, indicating that the combination therapy has a strong anti-oxidant function, thereby reversing and stabilizing the atherosclerosis plaque.

A total of 192 poststroke patients with depression and anxiety were assigned randomly into study group (n =96) and control group (n =96).The study group received both capsules Shugan-jieyu and paroxetine while the control group paroxetine alone.Compared with the control group,scores of both Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were significantly different at the end of week 2 and 6 in the study group (P ＜ 0.05).The HAMD and HAMA deduction rate and the scores of mangled extremity severity,mini-mental state examination and modified Barthel index at the end of week 6 of the study group were better than those of the control group (all P ＜ 0.05).The combined use of capsules Shugan-jieyu and paroxetine could improve symptoms of depression and anxiety,offer a higher safety and accelerate the rehabilitation of extremity function.

Objective Platelet-to-lymphocyte ratio(PLR) has been proved to be a new biomarker of inflammation in various diseases. The purpose of this study was to explore the relationship between PLR and early neurological deterioration(END) in patients with acute ischemic stroke(AIS). Methods We retrospectively analyzed the clinical and laboratory data of 1 116 patients with AIS admitted to the Department of Neurology of Shanghai Yangpu District Central Hospital from May 2018 to October 2020.The patients were grouped for analysis according to whether END occurred within 72 hours. They were also grouped by the quartiles of PLR(platelet count divided by lymphocyte count). Univariable and multivariable logistic regression analyses were used to explore independent factors influencing END in patients with AIS. The predictive ability of PLR for the occurrence of END was evaluated by using a receiver operating characteristic(ROC) curve. Results A total of 1 116 patients with AIS were included in the study,with 125 patients(11.2%) in the END group and 991 patients(88.8%) in the non-END group. The univariable analysis showed that PLR in the END group was significantly higher than that in the non-END group(151.68 vs 132.89,P<0.05). The multivariable analysis showed that the risks of END in the PLR Q3 and Q4 groups were 2.172 times[odds ratio(OR)=2.172,95% confidence interval(CI) 1.201-3.929,P=0.01)]and 2.571 times(OR=2.571,95%CI 1.441-4.589,P=0.001) that of the PLR Q1 group. According to the ROC curve,the area under the curve for PLR predicting END was 0.587(95%CI 0.536-0.639,P< 0.001),and the optimal critical value was 119.40,with a sensitivity of 77.6% and a specificity of 39.4%. Conclusion PLR is an independent risk factor for END in patients with AIS. The increase of PLR is associated with a higher risk of END,which demonstrates certain predictive ability of PLR for the occurrence of END.

Objective To observe the incidence of malnutrition, the therapeutic effect of nutritional support and the prognosis of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV) in patients with different traditional Chinese medicine (TCM) syndrome types and discuss the relationships between these indicators and the differentiation of cold-heat/deficiency-excess syndrome. Methods One hundred and three patients with COPD and MV admitted to Zhuji Hospital of TCM from September 2015 and July 2017 were enrolled, according to the different TCM syndromes, they were divided into an excess-heat syndrome group 42 cases and an asthenia-cold syndrome group 61 cases, and the differences in nutrition indexes and prognosis between the two groups were compared. Results The acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, nutritional risk screening 2002 (NRS2002) score and the incidence of malnutrition in excess-heat syndrome group were significantly lower than those in the asthenia-cold syndrome group, while the body mass index (BMI) in excess-heat syndrome group was obviously higher than that in the asthenia cold syndrome group [APACHE Ⅱ score: 20.1±5.4 vs. 22.0±3.4,NRS2002 score: 5.2±0.6 vs. 6.2±0.8, incidence of malnutrition: 61.9% (26/42) vs. 80.3% (49/61), BMI (kg/m2): 22.6±3.8 vs. 19.9±4.8, all P < 0.05]. The levels of albumin (Alb), prealbumin (PA) and transferrin (TF) of the excess-heat syndrome group were higher than those in the asthenia-cold syndrome group, and the differences between the two groups were statistically significant on the 7th day under MV [Alb (g/L): 36.14±2.97 vs. 34.40±3.37, PA (mg/L): 237.67±28.01 vs. 185.34±30.86, TF (g/L): 2.13±0.38 vs. 1.95±0.12, all P < 0.05]. In the excess-heat syndrome group, the percentage of weaning from MV was higher than that of the asthenia-cold syndrome group [85.7% (36/42) vs. 65.6% (40/61)], the 28-day mortality [14.3% (6/42) vs. 31.1% (19/61)] and ICU stay time (days: 9.21±2.96 vs. 11.13±3.96) were lower than those of the asthenia cold syndrome group (all P < 0.05). Conclusion The analysis of TCM differentiation of cold-heat/deficiency-excess syndrome has a certain reference value to realize the changing rules in nutritional status and prognosis of patients with COPD under mechanical ventilation.

Objective:To evaluate the effect of intrathecal insulin-like growth factor-1 (IGF-1) on chemotherapy-induced neuropathic pain (NP) in mice.Methods:Forty clean-grade healthy male C57 mice, aged 7-9 weeks, weighing 22-24 g, were divided into 4 groups ( n=10 each) using a random number table method: control group (group C), chemotherapy-induced NP group (group CIPN), low-dose IGF-1 group (group I1) and high-dose IGF-1 group (group I2). In CIPN, I1 and I2 groups, oxaliplatin 5 mg/kg was intraperitoneally injected for 5 consecutive days to establish chemotherapy-induced NP model.Normal saline 0.2 ml was given in group C. After measurement of the pain threshold at 10 days after establishment of the model, IGF-1 0.5 and 1.0 μg were intrathecally injected in group I1 and group I2, respectively.Normal saline 5 μl was intrathecally injected in C and CINP groups.Mechanical withdrawal threshold (MWT) was measured at 3, 5, 8, 10, 11, 13 and 15 days after establishment of the model.After measurement of the pain threshold at 15 days after establishment of the model, the expression of spinal IGF-1, IGF-1receptor (IGF-1R), interleukin (IL)-17A, IL-1β and tumor necrosis factor (TNF)-α was detected, and IGF-1 positive cells were counted using immunofluorescence. Results:Compared with group C, MWT was significantly decreased, the expression of spinal IGF-1 was down-regulated, the count of IGF-1 positive cells was decreased, and expression of IL-17A, IL-1β and TNF-α was up-regulated at 3-25 days after establishment of the model in CINP, I1 and I2 groups ( P<0.05). Compared with group CIPN, MWT was significantly increased at 15 days after establishment of the model in group I1, and MWT was increased, the expression of spinal IGF-1 was up-regulated, the count of IGF-1 positive cells was increased, and expression of IL-17A, IL-1β and TNF-α was down-regulated at 13 and 15 days after establishment of the model in group I2 ( P<0.05). Compared with group I1, the count of IGF-1 positive cells in spinal dorsal horn was increased in group I2 ( P<0.05). There was no significant difference in the expression of spinal IGF-1R among the 4 groups ( P>0.05). Conclusion:Intrathecal IGF-1 can alleviate chemotherapy-induced NP, and the mechanism may be related to inhibiting the inflammatory responses in spinal cord of mice.