Posterior circulation ischemic stroke (PCIS) is caused by the infarction of the blood supply area of vertebrobasilar artery system, accounting for about 20% of all ischemic strokes. The clinical manifestations of PCIS are different and usually lack specificity. The commonly used pre-hospital stroke scale can not fully reflect signs and symptoms of PCIS, and even imaging examination is not easy to detect PCIS. As a result, it is difficult to correctly identify PCIS in the early stage in emergency settings, and the rates of misdiagnosis and missed diagnosis are significantly higher than those of the anterior circulation ischemic stroke. Early and correct identification of PCIS is of great significance to improve the prognosis of patients. By summarizing the relevant literature at home and abroad, this article discusses the diagnostic error factors of PCIS in emergency room from different angles, and summarizes the strategies and methods to improve the speed and accuracy of PCIS recognition and early management.

Objective: To investigate the value of Baduanjin combined with balance pad exercise in improving the balance ability and motor function of elderly Parkinsonundefineds patients. Methods: Totally 120 elderly patients with Parkinsonundefineds disease admitted in our hospital from March 2017 to March 2018 were divided into two groups according to different exercise methods: the balance pad training group (60 cases) and the Baduanjin combined balance pad group (60 cases). After 2 months of continuous exercise, Fugl-Meyer lower limb motor function scale and Berg Balance Scale (BBS) were used to evaluate the recovery of lower limb motor ability and the changes of somatic balance control. Before training and 2 months after training, Parkinsonundefineds Scale (UPDRS) was used to evaluate the motor impairment of the patients. Results: There were no significant differences between the two groups in the Fugl-Meyer score, BBS score, 6mWD and UPDRS scores before training (P>0.05). After 2 months of training, the BBS score of the observation group was (45.5±4.0) points and Fugl-Meyer score. (25.5±3.2) points and 6mWD scores (362.2±44.9) points, the control group was (42.3±3.8) points, (22.7±3.6) points, (337.3±51.0) points, the difference was statistically significant (t=4.493, 4.503, 2.839, P<0.05). After 2 months of training, the UPDRSII and III scores of the observation group were (11.8±3.0) points and (15.8±1.9) points, respectively, which were significantly better than the control group (14.7±2.6) points, (17.2 ± 1.4) points, the difference was statistically significant (t=5.658, 4.595, P<0.05).; the observation group patients had a fall rate of 16.67% (10/60), no fracture cases, the control group was 41.67% (25/60), 6.67% (4/60), the difference was statistically significant (χ²=9.076,-, P<0.05). Conclusion Bazuanjin combined with balance pad training can significantly improve lower limb motor function, restore gait, improve body balance control and improve quality of life in elderly patients with Parkinsonundefineds disease.

Objective To evaluate the relationship between short-term blood pressure variability and poor outcome and hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke.Methods The Databases such as Wanfang,CNKI,Cochrane,Pubmed,EMBASE,and Web of Science were retrieved.The randomized controlled trials,cohort studies and case-control studies about blood pressure monitoring after intravenous thrombolytic therapy in patients with acute ischemic stroke and calculation and analysis of blood pressure variability were enrolled.The deadline for retrieval was December 2017.STATA 13.0 software was used to conduct Meta-analysis.Results A total of 9 non-randomized controlled trials with 19 161 patients were included.Four of them were prospective studies and 5 were retrospective studies.The relationship between short-term blood pressure variability and poor outcome (defined as a modified Rankin scale score ＞2) were investigated in 8 studies (a total of 19 045 patients).The relationship between short-term blood pressure variability and hemorrhagic transformation were investigated in 6 studies (with 18 456 patients).The results of Meta-analysis showed that short-term systolic blood pressure variability (every 10 mmHg change;1 mmHg =0.133 kPa) and poor outcome (odds ratio [OR] 1.55,95％ confidence interval [CI] 1.22-1.86;P ＞0.001),hemorrhagic transformation (OR 2.39,95％ CI 1.71-3.35;P =0.025),and symptomatic intracranial hemorrhage (OR 2.49,95％ CI 1.39-4.39;P =0.048) had significant correlations.Conclusion The increased short-term blood pressure variability after intravenous thrombolysis in patients with acute ischemic stroke is associated with poor outcome,hemorrhagic transformation,and symptomatic intracranial hemorrhage.

Purpose To explore the value of diffusion weighted imaging monoexponential and biexponential modelsin differentiating benign and malignant solitary pulmonary tumors.Materials and Methods Seventy-seven patients with pathologically confirmed solitary pulmonary tumors were enrolled in this study,a total of 96 lesions were studied,48 benign ones and 48 lung cancers (LC),including 19 cases of squamous cell carcinomas (SCC) and 28 cases of adenocarcinomas (Adeno-Ca).Apparent diffusion coefficient (ADC),slowapparentdiffusion coefficient (Dslow),fast apparentdiffusion coefficient (Dfast) and fast diffusion ratio (f) were calculated with monoexponential and biexponential models for all the pulmonary tumors.Results The ADC and Dslow values of benign masses [ADC (1.37 ± 0.48)× 10-3 mm2/s;Dslow (1.34 ± 0.45)× 10-3 mm2/s] were both significantly higher than those of Adeno-Ca [ADC (1.19±0.23)×10-3 mm2/s;Dslow (1.12±0.35)×10-3 mm2/s] and SCC [ADC (1.13±0.28)×10-3 mm2/s;Dslow (1.02 ± 0.32)× 10-3 mm2/s].There was no significant difference in ADC and Dslow values between Adeno-Ca and SCC (P＞0.05).The Dfast and f values of malignant masses were higher than benign ones,but the difference was not statistically significant (P＞0.05).Dslow were both significantly higher in accuracy (72.2％) and sensitivity (91.3％) than other imaging indicators (accuracy:55.5％-68.0％;sensitivity:41.3％-78.3％;all P＜0.01) in discriminating LC from benign masses showed by receiver operating characteristic curve analysis.Conclusion DWI biexponential model-derived Dslow shows greater accuracy than ADC in differentiating benign and malignant solitary pulmonary lesions.

ObjectiveToinvestigatethecorrelationbetweenbloodpressurevariabilityandcognitive impairment in ischemic stroke. Methods The inpatients with acute ischemic stroke were enroled. The demographic and clinical data were colected. The coefficient of variation of blood pressure within 7 days after onset w as calculated. Montreal Cognitive Assessment w as used to evaluate the cognitive function at three month after onset. Multivariate logistic regression analysis w as used to identify the relationship betw een the coefficient of variation of blood pressure w ithin 7 days and the cognitive impairment at 3 months after onset. Results A total of 708 patients w ith acute ischemic stroke w ere enrol ed in the study. At 3-month folow-up, 510 patients (72.0%) had cognitive impairment and 198 (28.0%) had normal cognitive function. The coefficient of variation for systolic blood pressure ( 8.3 ±1.2 vs.8.7 ±1.4; t= -3.299, P=0.001) and coefficient of variation for diastolic blood pressure ( 7.8 ±1.3 vs.8.0 ±1.5; t= -2.529, P=0.012) in the cognitive impairment group w ere significantly higher than those in the normal cognitive function group. With the first quintile as a reference, after adjusting other confounding factors, multivariate logistic regression analysis show ed that cognitive impairment at 3 months after onset w as significantly associated w ith coefficient of variation for systolic blood pressure. The odds ratios and 95 % confidence intervals for the 2-5 quantile groups w ere 2.33 (1.18-4.6), 2.31 (1.15-4.66), 2.70 (1.29-5.65), and 4.82 (1.92-12.1), respectively ( al P<0.05 ). Conclusion Systolic blood pressure variability in the acute phase of ischemic stroke is associated w ith cognitive impairment.

Objective To observe toxic symptoms and signs , toxic damage extents and reversibility in rats after oral administration of Tangwang Mingmu granules .Methods Four dose groups with 40 rats in each group were designed in this study, including control group fed with distilled water and three groups at different dosages of the test drug .Tangwang Mingmu granules were orally administered to SD rats at the dosage of 8.4, 4.2 and 2.1 g/kg for 3 weeks and 14.0, 8.4 and 4.2 g/kg for 23 weeks, for 26 consecutive weeks .The general state of the rats was observed every day , while body mass and food consumption were calculated once a week .Halfway through and at the end of the administration (13 and 26 weeks) and after four weeks of recovery, parameters of body mass, hematology, hematological biochemistry, organ/body mass ratio and histopathology were measured .Results Compared with the control group at the same time-point, body mass of male rats in the other three groups was slightly reduced .Food consumption in high and medium dose groups was reduced (P<0.05), MCHC, ALT, TBIL and Na +in high dose group were decreased (P<0.05), TP, ALB and D-BIL were increased (P<0.05), the mean body mass and relative organ weight of thymus in medium dose male rats were decreased (P<0.05), relative organ weight of the liver and kidney in high dose male rats was increased (P<0.05), and focal chronic inflammation to different extent was observed in the liver , kidney and prostate gland .No dose-effect relationship was found in these perturbations that were all within the normal range of animals .No significant drug-related pathological changes were found.Conclusion The NOAEL of Tangwang Mingmu granules is considered to be 14.0 g/kg body mass/day (equal to 50 times the proposed clinical adult dosage ) for the 26-week repeated dose oral toxicity study in male andfemale rats.

PurposeAlteration of the regional cerebral flow and cerebrovascular reserve (CVR) caused by cerebral artery stenosis or occlusion is an essential risk factor for ischemic stroke. This study aims to assess the CVR in patients with severe middle cerebral artery (MCA) stenosis or occlusion by using MR perfusion-weighted imaging (PWI) with CO2 inhalation stress test. Materials and MethodsPWI were performed before and after CO2 inhalation stress on 28 patients with severe middle cerebral artery stenosis or occlusion and 10 healthy volunteers. The regions of interest (ROI) were put on the affected hemisphere of the MCA blood supply area and the contralateral side in both groups. The relative cerebral blood volume (rCBV), relative mean transit time (rMTT), relative cerebral blood flow (rCBF) and CVR were measured.Results① The rCBV, rCBF and rMTT of the affected side were 149.16±33.01, 18.04±5.24, 8.65±1.81 before CO2 inhalation stress, and 156.23±21.60, 23.77±8.77, 8.72±3.01 after CO2 inhalation stress. The rCBV, rCBF and rMTT were signiifcantly increased (t=1.238, 2.561 and 2.647, P<0.05) after CO2 inhalation stress. The rCBV, rCBF and rMTT of the contralateral side were 176.22±40.12, 22.43±5.74, 8.10±3.71 before CO2 inhalation stress, and 198.54±39.87, 27.64±7.22, 8.03±2.97 after CO2 inhalation. The rCBV, rCBF was significantly increased (t=1.780 and 1.665,P<0.05) while rMTT was signiifcantly decreased (t=2.871,P<0.05) after CO2 inhalation.②The CVR of the affected side, contralateral side and control group were 18.9%, 26.8%, and 39.1%, respectively. There were significantly differences (t=1.604, 2.321 and 1.874,P<0.05) between the affected and contralateral side, the affected side and control group, the contralateral side and control group.ConclusionPWI with CO2 inhalation stress test is valuable in assessing the cerebrovascular reserve in patients with severe middle cerebral artery stenosis or occlusion.

Objective To study the impact of Paeoniflorin (PF) on α-synuclein degradation pathway. Methods PC12 cells were treated with or without MPP+ (0.5mM) for 24 h, then treated with Paeoniflorin (50 uM) or Rapamycin (0.2 μg/ml) for 24 h. The proliferative activity of cells was detected with the MTT method , and then the protein expression levels of α-synuclein, microtubule-associated protein light chain 3 (LC3-II) and E1 were detected by Western Blot. The expressions of α-synuclein and LC3 were detected by confocal microscopy. Results (1) CAT and SOD activity were significantly decreased after PF and RAPA treatment compared with MPP+ (P < 0.001). (2)MPP+ activated both LC3-Ⅱand E1. MPP+ promoted the increase ofLC3-Ⅱ but inhibited E1. PF significantly upregulated both LC3-Ⅱ (autophagy) and E1 expression (ubiquitin-proteasome pathway) (P < 0.001), promoted degradation of α-synuclein, and reduced cell damage. (3) MPP+enhanced immunofluorescence signal of intracellular α-synuclein and LC3. Fluorescence intensity of α-synuclein decreasedafter PF treatment. Conclusion PF may significantly upregulate both autophagy and ubiquitin proteasome pathways, promote the degradation of α-synuclein and reduce cell damage. These findings suggest Paeoniflorin may be a potential therapy for neurodegenerative diseases.

OBJECTIVE: Differences in clinical features, especially facial nerve canal leision between cholesteatoma in external auditory meatus and middle ear were compaired. METHOD: A retrospective clinical analysis was made. Clinical data included 125 cases of middle ear cholesteatoma with facial nerve canal leision and 28 cases of cholesteatoma occurred in external auditory canal from 2003-01-2014-08 in our hospital. RESULT: Clinical course of cholesteatoma in external auditory canal was 4.97 ± 7.51 years, course of middle ear cholesteatoma was 16.60 ± 14.42 years (P < 0.01). 21 cases (75%) of external auditory canal cholesteatoma were manifested as pneumatic mastoid and 110 cases (88%) of middle ear cholesteatoma were manifested as diploic mastoid respectively. 22 cases (78.6%) of facial nerve canal damage-in mastoid segment in cholesteatoma of external auditory meatus and 76 cases (60.8%) of facial nerve canal damage in tympanic segment in cholesteatoma of middle ear were observed (P < 0.01). The incidence rate of ossicular errosion in middle ear chol-esteatoma was significantly higher than that in external auditory meatus (P < 0.01). The incidence of semicircular canal defects in middle ear cholesteatoma (30.4%), was significantly higher when comparing to the incidence (10.7%) in cholesteatoma of external auditory meatus (P < 0.05). CONCLUSION The site of facial nerve canal lesion in middle ear cholesteatoma and cholesteatoma of external auditory meatus were different. More attention should be paid before and during operation to avoid facial nerve injury, including physical examinations, especial otologic exams, radiological reading and careful operation.
Cholesteatoma, Middle Ear ; diagnosis ; pathology ; Ear Canal ; pathology ; Ear, Middle ; pathology ; Facial Nerve Injuries ; complications ; Humans ; Incidence ; Mastoid ; pathology ; Retrospective Studies ; Semicircular Canals ; pathology

BACKGROUNDCigarette smoke induced airway inflammation plays a role in pathogenesis of airway inflammation. Resolvin-D1 derived from omega-3 polyunsaturated fatty acids is an endogenous anti-inflammatory and proresolving lipid mediator. Resolvin-D1 ameliorated inflammatory responses in lung injury, asthma, peritonitis and atherosclerosis. We investigated whether resolvin-D1 suppressed the productions of chemokines and oxidative stress induced by cigarette smoke extract (CSE) in vitro and its possible mechanism.

METHODSWe examined the proinflammatory chemokine interleukin-8 and hydrogen peroxide (H2O2) productions induced by CSE in 16 human bronchial epithelial (16HBE) cells after resolvin-D1 treatment and their mechanisms. 16HBE cells were treated with resolvin-D1 at up to 10 nmol/L, for 30 minutes before CSE up to 16% (v/v) exposure. Release of interlukin-8 proteins was assessed by enzyme linked immunosort assay (ELISA) and its mRNA level by RT-PCR. We evaluated extracellular H2O2 expression in the supernatant. Phosphorylation of NF-κB/p65 and degradation of I-κB in 16HBE cells were determined by Western blotting analysis and NF-κB DNA binding activity by electrophoretic mobility shift assay (EMSA).

RESULTS16HBE cells treated with 8% CSE showed significantly higher interlukin-8 production. Resolvin-D1 pretreatment inhibited CSE induced interlukin-8 production (mRNA and protein) in a dose and time dependent manner. Extracellular H2O2 level decreased after resolvin-D1 treatment. Resolvin-D1 attenuated CSE triggered I-κB degradation and NF-κB/p65 activation dose dependently and inhibited NF-κB DNA binding activity.

CONCLUSIONResolvin-D1 inhibits CSE induced interlukin-8 and H2O2 production in 16HBE cells by modulating NF-κB activation and has therapeutic potential for pulmonary inflammation.

Blotting, Western ; Cell Line ; Cell Survival ; drug effects ; Docosahexaenoic Acids ; pharmacology ; Electrophoretic Mobility Shift Assay ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hydrogen Peroxide ; metabolism ; Interleukin-8 ; metabolism ; NF-kappa B ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Smoking ; adverse effects