Objective Clinical studies show that the level of C-reactive protein ( CRP ) markedly increases in the acute phase of cerebral hemorrhage .However , the correlation of the CRP level with early neurological deterioration ( END) in patients with basal ganglia hemorrhage remains unclear .This study investigated the correlation between CRP and END in basal ganglia hemorrhage . Methods This study included 142 cases of basal ganglia hemorrhage diagnosed by cranial CT between Jan 2010 and Dec 2012 .END was defined as any decrease in Canadian Stroke Scale ( CSS) score≥1 point in the first 48 hours after stroke onset .We compared the baseline data between the END and non-END patients and evaluated the correlation between CRP and END by logistic regression analy -sis. Results END was found in 31 (21.8%) of the 142 patients.Univariate analysis of the END versus non-END cases showed that hyperglycemia (29.03 vs 11.71%, P=0.018), neutrophil count ([11.8 ±1.2] vs [7.8 ±7.7] ×109/L, P=0.019), CRP (P=0.001), hematoma expansion (54.83 vs 19.81%, P=0.001), hematoma volume ([23.6 ±21.9] vs [14.8 ±12.7] mL, P=0.005), and intraventricular hemorrhage (68.75 vs 28.83%, P<0.001) were significantly associated with END .Logistic regression a-nalysis indicated that the CRP level (OR=1.072, 95%CI:1.034-1.112, P=0.001), intraventricular hemorrhage (OR=4.162, 95%CI: 1.498 -11.564, P =0.006), and hematoma expansion (OR=5.297, 95%CI:1.906-14.723, P=0.001) were correlated with END in the patients during their hospital stay .ROC analysis man-ifested the predictive value of the CRP level for END in basal ganglia hemorrhage (OR=0.812, 95%CI: 0.732 -0.891, P <0.001). Conclusion The elevated level of CRP is significantly correlated with END in patients with basal ganglia hemorrhage and therefore can be re-garded as a predictive factor for this condition .

Objective Cerebral microbleeds (CMBs) are important indicators of cerebral small vessel disease .However, it is still unclear whether endothelial dysfunction is involved in CMBs .The aim of this study is to investigate the correlation between CMBs and soluble E-selectin (sE-selectin) in patients with acute ischemic stroke . Methods Based on the results of MRI (3.0 T) susceptibility weighted imaging , we divided patients with first acute ischemic stroke into a CMBs group ( n=63 ) and a non-CMBs group (n=63), and recruited another 45 volunteers with normal MRI findings as controls .We collected and conducted comparative a-nalysis on the demographic data , biochemical variables ( including the sE-selectin level ) , vascular risk factors , and the number of CMBs of the patients . Results Ordinal logistic regression analysis showed a significantly positive correlation between sE -selectin and the number of CMBs (OR=1.062, 95%CI:1.023-1.103, P=0.002), higher systolic blood pressure associated with more CMBs (OR=1.014, 95%CI:1.002-1.025, P=0.021). Conclusion Serum sE-selectin is significantly positively correlated with and can be used as a biological marker for the severity of CMBs .

Objective To investigate the predictive value of early diffusion-weighted imaging (DWI) for early neurological deterioration (END) after acute isolated basal ganglia infarct.Methods Patients with acute isolated basal ganglia infarct in middle cerebral artery perforators completed head MRI examination at 24 h after onset were analyzed retrospectively.According to the axial DWI revealed lesion size,the maximum diameters were divided into ＜ 15 mm,15-30 mm,and ＞ 30 mm.END was defined as an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥2 or the motor score of NIHSS ≥ 1 at any time within the first 72 h after admission compare with the baseline scores.Results A total of 336 patients were enrolled,including 126 patients (37.5％) with END.There were significant differences in the constituent ratios of the sex (P =0.044),maximum diameter of the lesion (P =0.001),and guilty artery stenosis (P =0.006),as well as baseline NIHSS score (P =0.001),high-density lipoprotein cholesterol (HDL-C) (P =0.033),and C-reactive protein (P =0.039) between the END group and the non-END group.Multiple logistic regression showed that the maximum diameter of the lesions 15-30 mm (odds ratio [OR] 2.360,95％ confidence interval [CI] 1.370-4.066;P =0.002),female (OR 1.660,95％ CI 1.024-2.691;P =0.040),and guilty large artery stenosis (OR 1.713,95％ CI 1.036-2.833;P =0.036) were the independent risk factors for patients occurring END,while the high HDL-C (OR 0.355,95％ CI 0.141-0.894;P =0.028) was an independent protective factor of occurring END.Conclusion Early DWI revealed that the maximum diameter of the lesions may have certain clinical value for prediction of the occurrence of END in patients with acute isolated basal ganglia infarct.

Post-stroke depression (PSD) is a common neuropsychological complication in patients with stroke, which seriously affects the recovery of neurological function and the quality of work and life. In recent years, repetitive transcranial magnetic stimulation (rTMS), as a noninvasive neuromodulation technique, has been applied to the rehabilitation of stroke, and it has also been studied in the treatment of PSD. This article reviews the efficacy, possible mechanism and limitations of rTMS in the treatment of PSD.

Objective To investigate the effect of blood pressure variability on early neurological deterioration (END) in patients with acute minor stroke or high-risk transient ischemic attack (TIA).Methods Consecutive patients with acute minor stroke or high-risk TIA admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University between March 2017 and December 2018 were enrolled prospectively. Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS)score ≤3, and high-risk TIA was defined as ABCD2 score ≥4. The blood pressure monitored within 72 h after admission was analyzed. The mean, maximum (max), range (max-min), standard deviation (SD), and coefficient of variation (CV) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated. END was defined as highest NIHSS score increase ≥ 2 at re-evaluation within 72 h after admission compared with the baseline score. Multivariate logistic regression analysis was used to determine the independent correlation between blood pressure variability parameters and END. Results A total of 123 patients were enrolled in the study, including 54 females (43. 90％) and 69 males (56. 10％), aged (63. 74 ± 11. 94) years. Thirty-nine (31. 71％) of them were high-risk TIA, 84 (68. 29％) were minor strokes. END occurred in 33 patients (26. 8％) within 72 h on admission. Univariate analysis showed that there were significant differences in age, gender, white blood cell count, C-reactive protein, and SBPmax-min , SBPSD ,SBPCV, DBPmax-min , DBPSD , and DBPCV between the END group and the non-END group (all P < 0. 05).Multivariate logistic regression analysis showed that after adjusting for confounding factors, SBPmax-min (odds ratio [OR] 1. 019, 95％ confidence interval [CI] 1. 001-1. 038), SBPSD (OR 1. 099, 95％ CI 1. 005-1. 201),SBPCV(OR 1. 320, 95％ CI 1. 124-1. 550), DBPmax-min (OR 1. 065, 95％ CI 1. 017-1. 114), DBPSD (OR 1. 492,95％ CI 1. 186-1. 877), and DBPCV(OR 1. 543, 95％ CI 1. 263-1. 886) were the independent risk factors for END within 72 h on admission in patients with acute minor stroke or high-risk TIA. Conclusion Multiple blood pressure variability parameters are significantly independently correlated with the risk of END in patients with acute minor stroke or high-risk TIA.

Objective: To investigate the correlation between sexual dysfunction(SD)and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods: A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University, and 120 matched healthy women were taken as the control group.WWE were treated with antiepileptic drugs (AEDs) for one year or more.The Chinese version of female sexual function index (FSFI) was used to investigate the sexual function of the subjects.The chemiluminescence method was used to detect the sex hormones levels such as prolactin(PRL), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene polymorphism.Chi-square test, t-test and binary logistic regression were used for statistical analysis.The differences of the sexual function, sex hormone, ER genotype, and allele frequency were compared between the two groups.And the correlation between SD and ER gene polymorphism was analyzed. Results: (1) The proportion of SD in Chinese Han WWE was 70.5%(79/112), while that was 24.2%(29/120) in the control group.The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2.072, P=0.039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0.001; P=0.001). (3) Binary logistic regression analysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR=6.074, 95%CI: 1.257-29.352, P=0.025; OR=0.412, 95%CI: 0.201-0.842, P=0.015). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE, and PvuII CC genotype may be the risk genotype of SD in WWE.

Objective To investigate the correlation between poststroke depression (PSD) in acute phase of ischemic stroke and stroke recurrence at 1 year.Methods Consecutive patients with acute ischemic stroke were enrolled prospectively.Hamilton Depression Rating Scale and 1 year follow-up were conducted.Multivariate logistic regression was used to identify the independent correlation between stroke recurrence and PSD.Results A total of 331 patients with acute ischemic stroke were enrolled,in which 115 patients (34.7％) with PSD,37 (11.2％) had stroke recurrence in 1 year follow-up period.There were no significant differences in demography and baseline clinical data between the PSD group and the non-PSD group.The age (66.9 ± 11.7 years vs.59.7 ± 11.7 years;t =3.621,P＜0.001),systolic blood pressure (140.0 [133.5-150.0] mmHgvs.135 [127.0-146.0] mmHg;Z=2.302,P=0.021),as well as the proportions of patients with atrial fibrillation (24.3％ vs.9.5％;x2=7.251,P=0.007),diabetes (51.4％ vs.28.6％;x2=7.956,P=0.005) andPSD (17.4％ vs.7.9％;x2=6.852,P=0.009) in the stroke recurrence group were significantly higher than those in the non-recurrent group.Multivariate logistic regression analysis showed that PSD was an independent predictor of stroke recurrence after adjusting for age,systolic blood pressure,total cholesterol,atrial fibrillation,and diabetes (odds ratio 2.15,95％ confidence interval 1.19-5.45;P=0.016).Conclusion PSD in acute phase of ischemic stroke is independently correlated with stroke recurrence at 1 year.

Objective To investigate the risk factors for unruptured intracranial aneurysms (UIA) in patients with acute cerebral infarction and whether the UIA affect early prognosis in patients with acute cerebral infarction.Methods Inpatients with acute cerebral infarction diagnosed at the Affiliated Hospital of Yangzhou University from January 2009 to August 2017 were retrospectively collected.Diagnosis of acute cerebral infarction and UIA was established by emergency magnetic resonance imaging and three dimensional time of flight magnetic resonance angiography screening.All patients with acute cerebral infarction were divided into the group with no intracranial aneurysm (A) and the group with UIA (B).Baseline materials such as demographics and cerebrovascular risk factors were used to analyze the comorbidity and risk factors of acute cerebral infarction and UIA.According to the modified Rankin scale (mRS) scores after 90 days,the patients were divided into a good prognosis group (mRS score ≤2) and a poor prognosis group (mRS score ≥3).The influence of the location,size,number of UIA and different treatments in the acute phase on the early prognosis of the two comorbidities was analyzed,and the relevant risk factors affecting prognosis were screened out.Results Of the 3 917 patients with acute cerebral infarction,3 641 patients met the inclusion criteria,and 237 patients (6.51％) had UIA.The proportion of age,women,smoking and hypertension in group B was significantly higher than that in group A.Multivariate regression analysis showed that women (odds ratio (OR)=1.691,95％ confidence interval (CI) 1.249-2.290,P=0.001),age (OR=1.023,95％ CI 1.010-1.036,P=0.000),smoking (OR=1.942,95％ CI 1.413-2.670,P=0.000),hypertension (OR=1.539,95％ CI 1.025-2.309,P=0.037) were significandy correlated with acute cerebral infarction complicated with UIA.There were 2 346 cases (64.43％) in the good prognosis group and 1 295 cases (35.57％) in the poor prognosis group after 90 days of onset.No statistically significant difference was found in the presence of UIA between the two groups (x2=0.002,P=0.967).There was no significant correlation between location,size and number of treatments,treatment patterns,the Trial of Org 10172 in Acute Stroke Treatment classification and patient outcome.Further Logistic regression analysis showed age (OR=1.009,95％CI 1.003-1.016,P=0.003),diabetes (OR=1.235,95％ CI 1.076-1.418,P=0.003),history of previous stroke (OR=1.544,95％ CI 1.324-1.801,P=0.000) and National Institutes of Healthy Stroke Scale (NIHSS) score at admission (OR=1.037,95％ CI 1.020-1.054,P=0.000) were significantly associated with poor outcomes in patients with acute cerebral infarction.Conclusions Female,age,smoking and hypertension were found to be risk factors for comorbidity of acute cerebral infarction and UIA.The location,size,and different treatments of UIA were not found to have a significant effect on early prognosis in patients with acute cerebral infarction;age,diabetes,previous stroke history,and baseline NIHSS score were high risk factors affecting early prognosis in patients with acute cerebral infarction with or without UIA.

Objective To investigate the correlation between early blood pressure variability and early neurological deterioration (END) in patients with acute ischemic stroke.Methods Inpatients with acute ischemic stroke were collected prospectively.The blood pressure values of the enrolled patients were recorded continuously for 72 h after admission.The mean value (mean),maximum value (max),differences betw een the maximum and minimum (max-min),standard deviation (SD),and coefficient of variation (CV) for the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.END was as an increase of at least 2 in the highest score of the National Institute of Health Stroke Scale (NIHSS) compared to the baseline.Multivariate logistic regression analysis was used to identify the independent correlation between the different blood pressure variability parameters and END following acute ischemic stroke after adjusting the confounding factors.Results A total of 128 patients with acute ischemic stroke were enrolled,including 53 females and 75 males,and their mean age was 63.30 ± 11.82 years.After standard treatment,35 patients (27.34％) developed END within 72 h after admission.There were significant differences in age,sex,diabetes mellitus,baseline NIHSS,C-reactive protein and SBPmax,SBP in,SBPSD,SBPCv,DBPmax,DBP max-min,DBPsD,and DBPCv between END group and non-END group (all P ＜0.05).Multivariate logisticregression analysis showed that SBPmax-min(odds ratio [OR] 1.040,95％ confidence interval [CI] 1.014-1.067,SBPsD(OR 1.191,95％ CI 1.052-1.347),SBPCv(OR 1.317,95％ CI 1.100-1.578),DBP max-min(OR 1.076,95％ CI 1.018-1.138),DBPsD(OR 1.508,95％ CI 1.128-2.016),and DBPCv(OR 1.338,95％ CI 1.093-1.638) in blood pressure variability indices were the independent risk factors for END in patients with acute ischemic stroke.Conclusion Blood pressure variability is significantly associated with END within 72 h after admission in patients with acute ischemic stroke.

Objective To investigate the possibility of P-wave dispersion parameters of 12-lead ECG in predicting paroxysmal atrial fibrillation (PAF) in patients with embolic stroke of undetermined source (ESUS).Methods Patients with ESUS admitted to the Department of Neurology,the Affiliated Hospital of Yangzhou University from January 2017 to December 2018 were enrolled.According to the findings of 24 h dynamic ECG monitoring,they were divided into PAF group and non-PAF group.The maximum P-wave duration (Pmax),minimum P-wave duration (Pmm) and P-wave dispersion (Pd) in the conventional 12-1ead ECG were documented.Multivariate logistic regression analysis was used to determine the independent correlation between different P-wave dispersion parameters and PAF in patients with ESUS.Results A total of 87 patients with ESUS were enrolled,including 40 females and 47 males,with an average age of 68.53 ± 10.68 years.PAF was detected in 17 patients (19.54％).There were significant differences in age,baseline NIHSS score,Pmax,Pd,and left atrial diameter (LAD) between the PAF group and the non-PAF group (all P ＜0.05).Multivariate logistic regression analysis showed that Pd Was the only independent predictor of PAF in patients with ESUS (odds ratio,1.279,95％ confidence interval 1.048-1.561,P =0.015).Conclusion Pd is an independent predictor of PAF in patients with ESUS.