梗阻性低位直肠癌保肛手术可行性探讨

目的:探讨梗阻性低位直肠癌保肛治疗(直肠癌前切除术(dixon手术))的可行性及术后肠瘘的防治。方法:回顾性分析我科2009年1月-2012年1月梗阻性低位直肠癌的保肛治疗(dixon)24例手术患者(梗阻性保肛组)临床资料及非梗阻性低位直肠癌保肛治疗(dixon)的24例患者(非梗阻性保肛组)临床资料,比较梗阻性与非梗阻性低位肠梗阻保肛治疗的临床疗效,分析梗阻性低位肠梗阻保肛治疗的可行性。结果:梗阻性保肛组住院天数:11.9天,非梗阻性肠梗阻保肛组8.7天P0.05;梗阻性保肛组发生肠瘘:4例(16.7%),非梗阻性肠梗阻保肛组发生肠瘘:1例(4.2%)P0.05,经充分引流后肠瘘愈合,无1人死亡,两组术后至出院期间死亡人数:0例;梗阻性保肛组肠功能恢复(以排气排便为指标):5.1天,非梗阻性保肛组肠功能恢复:3.8天,P0.05;术后6个月腹泻便秘患者两组相同为24人;术后6个月梗阻性保肛组肿瘤复发6人(25%),非梗阻性保肛组肿瘤复发5人(20.8%),P0.05。结论:梗阻性低位肠梗阻保肛治疗住院期疗效较非梗阻性保肛组差,中远期疗效无明显差异。梗阻性低位直肠癌可行保肛治疗。     

Expressive Aphasia as a Presentation of Encephalitis with Bartonella henselae Infection in an Immunocompetent Adult

Objective: To show the first clinically reported case of Cat Scratch Disease (CSD) presenting as a focal neurologic deficit in an immunocompetent adult.Patient: 59-year-old male with a history of a previous stroke.Results: Examination showed an expressive aphasia, word substitution errors, and impaired repetition. A head CT and MRI showed no acute changes. The EEG findings were non-focal and did not show any epileptiform activity. The patient had a history of contact with stray kittens and previous axillary lymphadenopathy. Bartonella henselae serology titers were IgG positive 1:1024 (< 64) and IgM positive 1:20 (< 16). After antibiotic administration, the patient’s symptoms and aphasia resolved.Conclusions: Focal presentations concerning for stroke or partial seizure activity may have underlying infectious etiology. We recommend consideration of CSD in the differential diagnosis of any adult with a history of lymphadenopathy, fever, and recent contact with a cat who presents with neurologic complications.     

脑卒中后失语患者认知电位N400的研究

目的：探讨卒中后失语患者高级语言认知功能的改变。方法：利用事件相关电位N400探讨15例脑卒中后失语患者（观察组）及15例正常人（对照组）图片一词语语义一致（匹配）与语义不一致（不匹配）时的语言加工过程。结果：与对照组相比脑卒中后失语患者N400潜伏期有统计学差异,但相关性分析N400的波幅没有统计学差异。结论：1．卒中后失语患者存在语言加工过程的延迟2．额叶以及顶叶可能在语义生成的过程中起重要作用3．是否能将认知电位N400作为评估卒中后语言障碍的一项指标还有待进一步探讨。     

The TT genotype of methylenetetrahydrofolate reductase 677C>T polymorphism increases the susceptibility to pediatric ischemic stroke: meta-analysis of the 822 cases and 1,552 controls

The 677C>T polymorphism within methylenetetrahydrofolate reductase (MTHFR) gene is related to an elevated level of homocysteine. Thus it may be considered as a genetic risk factor in ischemic stroke. Apparently studies of this type of polymorphism in childhood stroke have shown conflicting results. We performed meta-analysis of all the data that are available in relation with MTHFR polymorphism and the risk of ischemic stroke in children. We searched PubMed (last search dated December 2010) using "MTHFR polymorphism", "ischemic stroke" "child", "children", "pediatric stroke" as keywords and reference lists of studies and reviews on the topic. Finally, 15 case-control studies corresponded to the inclusion criteria for meta-analysis. These studies involved the total number of 822 children and adolescents after ischemic stroke and 1,552 control subjects. Fixed or random effects models were used depending on the heterogeneity between the studies. The association between ischemic stroke and 677C>T polymorphism within MTHFR gene was observed in three of the studies. The pooled analysis showed that TT genotype of MTHFR gene is more common in stroke patients than in controls (p = 0.0402, odds ratio = 1.57, 95 % confidence interval 1.02-2.41). The Egger's test did not reveal presence of a publication bias. The results based on a sizeable group of cases and controls have proved that the 677C>T polymorphism in MTHFR gene is associated with the development of ischemic stroke in children.     

梗阻性低位直肠癌保肛手术可行性探讨

目的：探讨梗阻性低位直肠癌保肛治疗（直肠癌前切除术（dixon手术））的可行性及术后肠瘘的防治。方法：回顾性分析我科2009年1月．2012年1月梗阻性低位直肠癌的保肛治疗（dixon）24例手术患者（梗阻性保肛组）临床资料及非梗阻性低位直肠癌保肛治疗（dixon）的24例患者（非梗阻性保肛组）临床资料,比较梗阻性与非梗阻性低位肠梗阻保肛治疗的临床疗效,分析梗阻性低位肠梗阻保肛治疗的可行性。结果：梗阻性保肛组住院天数：11．9天,非梗阻性肠梗阻保肛组8．7天P〈0．05;梗阻性保肛纽发生肠瘘：4例（16．7％）,非梗阻性肠梗阻保肛组发生肠瘘：1例（4.2％）P〈0．05,经充分引流后肠痿愈合,无1人死亡,两组术后至出院期间死亡人数：0例;梗阻性保肛组肠功能恢复（以排气排便为指标）：5．1天,非梗阻性保肛组肠功能恢复：3．8天,P〈0．05;术后6个月腹泻便秘患者两组相同为24人;术后6个月梗阻性保肛组肿瘤复发6人（25％）,非梗阻性保肛组肿瘤复发5人（20．8％）,P〉0．05。结论：梗阻性低位肠梗阻保肛治疗住院期疗效较非梗阻性保肛组差,中远期疗效无明显差异。梗阻性低位直肠癌可行保肛治疗。     

R-carrying genotypes of serum paraoxonase (PON1) 192 polymorphism and higher activity ratio are related to susceptibility against ischemic stroke

The polymorphic gene of serum paraoxonase (PON1) and its activity involved in atherosclerosis. The purpose of the study was to analyze PON1 192 Q/R polymorphism and the enzyme activities in ischemic stroke. The polymorphism as the most common polymorphism in PON1 gene coding sequence is associated with variation in the enzyme activity and vascular disease. The study included 85 stroke patients and 71 control subjects. PON1 192 polymorphism was genotyped using PCR protocol. Paraoxonase activity (Para) and arylesterase activity (Aryl) were determined spectrophotometrically using paraoxon and phenylacetate as the substrates. The QR and RR genotypes were more frequent in stroke population compared to controls, resulting in a higher frequency of the R allele in patients (0.24 vs 0.18, OR?=?1.41). Patients had significantly higher Para/Aryl ratio than that of controls (P?=?0.016). In stroke patients, Para/Aryl and Para/HDL ratios increased with this order: QQ?<?QR?<?RR. Hypertension significantly increased the risk of ischemic stroke by 15-fold among R-containing people, while this was significantly increased 4-fold for QQ homozygotes. Smoking increased the risk of having ischemic stroke in both QQ homozygote and QR?+?RR group (OR?=?2.84 and OR?=?2.33, respectively). In conclusion, these data highlight the importance of PON1 192 R allele and high Para/Aryl ratio in susceptibility to ischemic stroke in the population. The presence of the 192 R allele potentiates the risk of stroke especially in hypertensive people. Decreased Aryl and increased Para/Aryl, Para/HDL and Aryl/HDL ratios may be markers indicated the increased susceptibility to ischemic stroke in the population.     

Cerebral glucose transporter: The possible therapeutic target for ischemic stroke

Hyperglycemia is considered to be associated with poor outcomes of ischemic stroke. However, it is controversial about the blood glucose-lowering therapy in patients with stroke. According to the current reports, hyperglycemia is an indicator of severe stroke and cannot increase cerebral glucose content but promotes further ischemia in brain. Consequently, cerebral glucose control is significant to maintain the energy homeostasis. Compared with blood glucose level, the cerebral glucose content, controlled by glucose transporters (GLUTs), is more directly and important to maintain the energy supply in brain, especially to the patients with ischemic stroke. Some active materials, such as Glucagon-like peptide-1, progesterone, tPA and N-acetylcysteine, have been found to ameliorate ischemic stroke by regulating GLUTs expression. Therefore, this review discusses the significance of cerebral glucose level and GLUTs. Additionally, cerebral GLUTs and their actions in ischemic stroke are detailed in order to promote research on GLUTs as a possible therapeutic target for ischemic stroke.     

VCTDSA联合CT灌注成像在急性缺血性卒中诊断运用探究

目的：探讨64层容积CT数字减影血管造影（Volume computed tomography digital subtraction angiography, VCTDSA）联合CT灌注成像在急性缺血性卒中诊断价值。方法：回顾性分析45例临床确诊为急性缺血性卒中患者的临床资料,分别给予VCTDSA与CT灌注成像处理,分析这两种技术对急性缺血性卒中患者的诊断敏感性和特异性。结果：45例患者检查有颅内有不同部位出血灶,多见于脑室,均伴有不同程度的异常血管网形成,其中VCTDSA图像质量优于CT灌注成像,VCTDSA较DSA可准确显示和测量动静脉瘘口大小,VCTDSA与MRA在瘤体长轴、瘤颈的比较中无显著性差异。结论：与其他减影CTA比较,VCTDSA联合CT灌注成像在急性缺血性卒中患者的诊断中具有优势。     

Quantification of volume of tissue damage in stroke using T2- weighed MRI images

We have developed a quantitative technique for scoring of the severity of ischemic damage of the brain using quantitative data of the T2-weighted MRI images of brain in stroke. The principle of the method is the assumption that T2 signal increases proportionally to the severity of ischemic damage of cerebral tissue up to the level equal to intraventricular liquor signal in the case of postinfarction cystic degeneration. Depicting the mean T2-signal from the intraventricular liquor region as Iliq, the signal from ischemic brain area as Iinsult, and from the intact brain as Inorm, obviously, the volume quota of damaged tissue in the total volume of the stroke region is represented by the ratio (Iinsult - Inorm)/(Iliq - Inorm). The total volume of damaged tissue (VDT, cub.cm) in the stroke region is then the following sum taken over all slices i, where the stroke damage can be: VDT = sigma i d.Si.[(Iinsult - Inorm)/(Iliq - Inorm)]i, where d is the slice thickness, Si--area of the ischemic region in the slice i. The quota of damaged tissue in the physical volume of the stroke region is henceforth the following ratio: Q = [sigma i d.Si.[(Iinsult - Inorm)/(Iliq - Inorm)]i]/[sigma i d.Si]. The technique was applied in retrospective analysis of routine MRI studies in 15 patients referred because of acute ischemic stroke. The studies were performed using low-field MRI tomograph Magnetom-Open (Siemens Medical) with field strength 0.22 T. In patients studied during the first day after occurrence of ischemic insult with the minimal degree of acute neurologic deficit, who later have demonstrated clinically full recovery, the VDT was below 20 cm3, and Q was below 10%. In cases with VDT > 25 cm3 and Q > 20% the full regress was not observed in any patient. Henceforth, the quantification of cerebral damage in stroke using quantitative indices based on measurement of T2-parameters over ischemic and intact zones of the brain are of independent prognostic clinical value and improve clinical usefulness of the MRI in ischemic brain stroke.     

Circulatory microRNA-145 expression is increased in cerebral ischemia

Cerebral ischemia or ischemic stroke is mainly attributed to vascular and circulation disorders. Among protein biomarkers, RNA profiles have also been identified as markers of ischemic stroke. MicroRNA-145 expression is ostensibly recognized as marker and modulator of vascular smooth muscle cell phenotype; however, expression levels in ischemic stroke had not been investigated. Employing real-time quantitative PCR, we examined the expression profile of circulatory microRNA-145 in healthy control subjects (N = 14) and ischemic stroke patients (N = 32). Circulatory microRNA-145 expression was significantly higher in ischemic stroke patients than in control subjects. This demonstrates that hemostatic mechanisms are affected by ischemic stroke. We conclude that circulating microRNA-145 has potential as a biomarker for ischemic stroke.     

Some epidemiologic and clinical problems in ischemic cerebral stroke

The study involved 739 patients with the ischemic cerebral stroke into two groups: with reversible and irreversible ischemic cerebral stroke. General characteristics of patients (incidence, sex, age etc.) was similar to the characteristics of patients from other centres. Morbidity rate for ischemic cerebral strokes was 93.9, including reversible stroke 21.3 and other 72.6; mortality factor 47.2, and mortality rate 29.6%. An increase in morbidity for irreversible stroke in women over 80 years of age is striking. The authors suggest that the classification of cerebral strokes should include reversible strokes whereas progressive stroke should not be considered distinguished entity.     

Plasma desmoplakin I biomarker of vascular recurrence after ischemic stroke

Stroke patients have a high risk of vascular recurrence. Biomarkers related to vascular recurrence, however, remain to be identified. The aim of the study was to identify, through proteomic analysis, plasma biomarkers associated with vascular recurrence within one year after the first ischemic stroke. This is a substudy (n = 134) of a large prospective multicenter study of post-stroke patients with an ischemic stroke. Plasma samples were obtained at inclusion. Among the identified proteins, only plasma levels of desmoplakin I were associated with protection against a new vascular event (Odds ratio: 0.64; 95% CI: 0.46-0.89; p = 0.009) after adjustment for hypercholesterolemia, statins and previous atherothrombotic stroke subtype. A greater number of patients without vascular recurrence had been treated with statins within three months of the recent ischemic stroke. Only patients who had been taking statins for 3 months after the ischemic stroke and did not suffer vascular recurrence over a follow-up year, have higher levels of desmoplakin I at the time of inclusion (Odds ratio 0.49; 95% CI: 0.28-0.86; p = 0.013). Increased desmoplakin I levels, determined within 1-3 months of the first ischemic stroke, could be a biomarker for statin responsiveness against a new vascular event in post-ischemic stroke patients taking statins early (1-3 months) after the ischemic stroke.     

The Taxonomy Statistic Uncovers Novel Clinical Patterns in a Population of Ischemic Stroke Patients

In this paper, we describe a simple taxonomic approach for clinical data mining elaborated by Marczewski and Steinhaus (M-S), whose performance equals the advanced statistical methodology known as the expectation-maximization (E-M) algorithm. We tested these two methods on a cohort of ischemic stroke patients. The comparison of both methods revealed strong agreement. Direct agreement between M-S and E-M classifications reached 83%, while Cohen’s coefficient of agreement was κ = 0.766(P < 0.0001). The statistical analysis conducted and the outcomes obtained in this paper revealed novel clinical patterns in ischemic stroke patients. The aim of the study was to evaluate the clinical usefulness of Marczewski-Steinhaus’ taxonomic approach as a tool for the detection of novel patterns of data in ischemic stroke patients and the prediction of disease outcome. In terms of the identification of fairly frequent types of stroke patients using their age, National Institutes of Health Stroke Scale (NIHSS), and diabetes mellitus (DM) status, when dealing with rough characteristics of patients, four particular types of patients are recognized, which cannot be identified by means of routine clinical methods. Following the obtained taxonomical outcomes, the strong correlation between the health status at moment of admission to emergency department (ED) and the subsequent recovery of patients is established. Moreover, popularization and simplification of the ideas of advanced mathematicians may provide an unconventional explorative platform for clinical problems.     

急性缺血性脑卒中患者入院时血浆BNP水平与梗死部位关系

目的：分析急性缺血性脑卒中患者入院时血浆脑钠肽（BNP）水平与缺血性脑卒中梗死部位的关系。方法：随机入选88例急性缺血性脑卒中患者,按梗死部位,将其分为前循环病灶组（66名）和后循环病灶组（22名）两组进行比较。测定入院时血浆脑钠肽（BNP）水平进行比较。两组脑卒中病人的危险因素血糖、糖化血红蛋白、血脂全套,肝肾功能分析对比,并将急性缺血性脑卒中患者梗死部位相关的多个变量采用单因素logistic回归分析。结果：前循环病灶组血浆脑利钠肽水平的中位数是225.90 pg/mL,四分位数间距为596.00 pg/mL;后循环病灶组的中位数是750.95 pg/mL,四分位数间距为907.00 pg/mL。后循环病灶组血浆脑利钠肽水平要显著高于前循环病灶组血浆脑利钠肽水平,两个部位间入院时的脑利钠肽水平有统计学差异（P=0.004）。通过入院时脑利钠肽水平与缺血性脑卒中梗死部位的关系的ROC曲线,得出截点299.50 pg/mL。入院时血浆脑利钠肽水平≥299.50 pg/mL可以作为后循环病灶组的预测指标,其敏感性72.72%,特异性62.12%。结论：急性缺血性脑卒中患者入院时血浆BNP水平可作为急性期区别前后循环脑梗死的预测因子。     

Endogenous granulocyte colony-stimulating factor: a biomarker in acute ischemic stroke

Granulocyte colony-stimulating factor (G-CSF) may protect ischemic brain injury either in animal or human. No studies have reported that endogenous G-CSF (enG-CSF) level is related to the severity of ischemic stroke. This study was designed to assess the severity of ischemic patients correlated with the alteration of enG-CSF on the 1st day after an ischemic event. Patient's plasma enG-CSF and scoring of National Institute of Health Stroke Scale were measured on the 1st day after ischemic stroke. The acute ischemic stroke could significantly induce enG-GCF secretion as compared with healthy control group (16.77 vs. 22.86 μg/L, p = 0.001). Elevated enG-CSF concentration was positively correlated with the severity of stroke patients on day 1 after the event (p = 0.006; Spearman correlation coefficient = 0.268). The enG-CSF is a good biomarker for prediction of severity of acute ischemic stroke.     

Prediction Factors of Recurrent Ischemic Events in One Year after Minor Stroke

Background

The risk of a subsequent stroke following a minor stroke is high. However, there are no effective rating scales to predict recurrent stroke following a minor one. Therefore, we assessed the risk factors associated with recurrent ischemic stroke or transient ischemic attack (TIA) within one year of minor stroke onset in order to identify possible risk factors.

Methods

Eight hundred and sixty-three non-cardioembolic ischemic stroke patients in the Chinese IntraCranial AtheroSclerosis Study that presented with minor stroke, defined as an admission National Institutes of Health stroke scale (NIHSS) score of ≤3, were consecutively enrolled in our study. Clinical information and imaging features upon admission, and any recurrent ischemic stroke or TIA within one year was recorded. Cox regression was used to identify risk factors associated with recurrent ischemic stroke or TIA within the year following stroke onset.

Results

A total of 50 patients (6.1%) experienced recurrent ischemic stroke or TIA within one year of minor stroke onset. Multivariate Cox regression model identified lower admission NIHSS score (HR, 1.75; 95% CI, 1.32 to 2.33; P<0.0001), history of coronary heart disease (HR, 2.62; 95% CI, 1.17 to 5.86; P = 0.02), severe stenosis or occlusion of large cerebral artery (HR, 4.68; 95% CI, 1.87 to 11.7; P = 0.001), and multiple acute cerebral infarcts (HR, 2.61; 95% CI, 1.01 to 6.80; P = 0.05) as independent risk factors for recurrent ischemic stroke or TIA within one year.

Conclusions

Some minor stroke patients are at higher risk for recurrent ischemic stroke or TIA. Urgent and intensified therapy may be reasonable in these patients.     

Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

Objective

Metabolic syndrome has emerged as a novel risk factor in cardiovascular disease due to its potential for predicting stroke in population-based studies. We investigated the relationship of metabolic syndrome with stroke recurrence.

Methods

This was a retrospective analysis of Chinese patients enrolled in the prospective Abnormal gluCose Regulation in patients with acute strOke acroSS China (ACROSS-China) study after their first ischemic stroke. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria. Vascular risk factors were assessed. Outcome was defined as recurrence of stroke within one year after the index ischemic stroke. Cox proportional hazards regression was performed to identify potential predictors of stroke recurrence.

Results

The prevalence of metabolic syndrome among 2639 ischemic stroke patients was 51.35%. During the one-year follow-up, 195 strokes (7.4%) recurred. The multivariate hazard ratio (95% CI) of stroke recurrence was 1.94 (1.39–2.73) for metabolic syndrome. After adjustment for components, metabolic syndrome lost its association with stroke recurrence; in this model, high fasting plasma glucose (IDF definition) was a predictor for stroke recurrence.

Conclusion

Metabolic syndrome may not be predictive for stroke recurrence beyond its component individual factors for Chinese ischemic stroke patients.     

Association of Lp‐PLA2 G994T gene polymorphism with risk of ischemic stroke in Chinese population

The association between lipoprotein‐associated phospholipase A2 (Lp‐PLA2) G994T gene polymorphism and the risk of ischemic stroke is unclear. The aim of this study is to investigate the influence of Lp‐PLA2 G994T genetic variant on the pathogenesis of ischemic stroke in Chinese population. A total of 348 patients with a clinical diagnosis of ischemic stroke and 260 gender‐matched control subjects under physical examination were recruited from hospitals and genotyped for G994T gene polymorphism. The results showed that there was a significant difference in the genotype distribution between the two groups and people with GT or TT genotype were associated with the higher risk of ischemic stroke even after adjusting the effects of potential confounding factors. In addition, both ischemic stroke patients and control subjects carrying T allele showed relatively lower Lp‐PLA2 activity and higher oxLDL level. Therefore, Lp‐PLA2 G994T gene polymorphism may be an independent risk factor of ischemic stroke in Chinese population.     

Seasonal Variation in Ischemic Stroke Incidence and Association with Climate: A Six‐Year Population‐Based Study

Questions about the seasonality of stroke remain controversial. Using a nationwide population‐based dataset, this study presents a time series analysis of seasonal patterns in ischemic stroke occurrence, along with their association with climate in Taiwan. Using data from the Taiwan National Health Insurance Research Database, a total of 168,977 visits to emergency departments between 1998 and 2003 for ischemic stroke were identified for patients ranging between 20 and 84 yrs of age. Monthly stroke incidences were calculated for 72 months, by sex and stroke subtype, and for the age groups 20–54, 55–64, 65–74, and ≥75 yrs per 100,000 of the population. We performed auto‐regressive integrated moving average (ARIMA) analysis to investigate the presence of seasonality and any association with climate for acute ischemic stroke events. We found no significant seasonal variation in the incidence of ischemic stroke for any age or sex groups. Furthermore, after adjusting for seasonality, month, and trend, the ARIMA regression model revealed only associations between ischemic stroke incidence and atmospheric pressure. We conclude that seasonality of ischemic stroke does not exist in Taiwan. Ischemic stroke incidence is, however, significantly related to atmospheric pressure.     

Apolipoprotein A5 polymorphisms in Turkish population: association with serum lipid profile and risk of ischemic stroke

Atherosclerosis, a major cause of ischemic stroke, may be associated with variability of triglyceride (TG) levels. Apolipoprotein A5 (APOA5) genetic polymorphisms are associated with altered TG levels. The objective of this study was to investigate the coding region polymorphisms S19W (rs3135506) and G185C (rs2075291) and the promoter region polymorphism ?1131T>C (rs662799) of the APOA5 gene as risk factors for ischemic stroke in Turkish population. Study group consisted of 272 ischemic stroke patients and 123 controls. Genotypes were determined by real-time polymerase chain reaction (PCR) for S19W and PCR-restriction fragment length polymorphism analysis (PCR–RFLP) for ?1131T>C and G185C. 19W allele frequency was 0.090 in stroke patients and 0.062 in controls (P = 0.191). Minor allele frequencies of ?1131T>C and G185C in patients were 0.106 and 0.004, respectively, and were nearly the same in controls. Total cholesterol and LDL-cholesterol levels were significantly higher for stroke patients having at least one 19W allele compared to non-carriers. A significant difference was also found for LDL-cholesterol levels of stroke patients; higher in ?1131C allele carriers compared to wild type patients. There was a trend for higher frequency of ischemic stroke among ?1131C allele carrier hypertensive, diabetic or obese subjects compared to non-carriers. However, APOA5 genotypes were not associated with the risk of ischemic stroke by logistic regression analysis. The present study demonstrated that carrying rare alleles of APOA5 S19W, ?1131T>C and G185C alone do not constitute a risk for ischemic stroke in the studied Turkish subjects.