Clinical Focus

Progress in diagnosis and treatment of embolic stroke of undetermined source

Xu Bingdong， Mai Hongcheng， Wu Zhengdong， Zhu Peizhi， Liang Yubin， Zhang Yusheng

2018, 33(3): 185-188,193. doi:10.3969/j.issn.1004-583X.2018.03.001

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Embolic stroke of undetermined source(ESUS) is a special type of cryptogenic stroke.The most important underlying causes of ESUS are paroxysmal atrial fibrillation and patent foramen ovale. Since the concept of ESUS was put forward in 2014， more and more researches have been reported， especially in the progress of the secondary prevention of ESUS. The epidemiology， clinical features， diagnostic criteria， secondary prevention strategies and prognosis of ESUS were reviewed.

Management of complications of endovascular treatment for acute ischemic stroke

Yang Bing， Guan Min， Qiao Hongyu， Zhang Yusheng， Xu Anding

2018, 33(3): 189-193. doi:10.3969/j.issn.1004-583X.2018.03.002

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Bridging intravascular therapy is the priority recommendation for acute anterior ischemic stroke caused by large vascular occlusion. There is very little literature on the complications of periprocedural period. Procedural complications include: hemorrhagic transformation, iatrogenic embolization, artery dissection, vasospasm, in situ thrombosis，groin complications. The purpose of this article is to review the clinical relevance and management of procedurerelated complications of bridging intravascular therapy.

Advances in the study of ischemic stroke and gut microbiome

You Chao， Yin Jia

2018, 33(3): 194-198. doi:10.3969/j.issn.1004-583X.2018.03.003

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Ischemic stroke is the most common type of cerebrovascular disease and is the first cause of death in Chinese population. In recent years， gut microbiota and its metabolites were found to be constant engaged in the pathophysiology process of strokerelated risk factors， such as hypertension， diabetes and atherosclerosis. Preclinical evidence illustrated that the gut microbiota affect stroke outcomes by modulating the migration of intestinal IL17 + γδT cells to the meninges. Further study demonstrated that strokeassociated pneumonia was caused by gutderived bacteria. In summary， current researches have reported the influence of gut microbiota on the occurrence and prognosis of stroke. In this review， we outline the association between gut microbiota and the risk factors of stroke， the occurrence of stroke events and strokerelated complications.

Classification and diagnosis of singlegene hereditary cerebrovascular disease

Yu Yanyan1， Hong Daojun1,2

2018, 33(3): 199-207. doi:10.3969/j.issn.1004-583X.2018.03.004

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Cerebrovascular disease is a disorder with high incidence， high disability and high mortality. The most common risk factors associated with cerebrovascular disease include aging， hypertension， diabetes， atrial fibrillation， dyslipidemia， bad living habits and so on. It is currently believed that about 5%10% of cerebrovascular diseases can be attributed to monogenic hereditary diseases. Such patients often show ischemic or hemorrhagic stroke with onset of middleaged and young age， often accompanied by multisystem involvements. In this paper， we classified the monogenic hereditary cerebrovascular diseases from the perspective of the pathophysiology， and then review the representative hereditary cerebrovascular diseases.

Risk factors and progress in prevention and cure of stroke in young adults

Feng Rongfang， Han Ning， Wang Jianhua

2018, 33(3): 208-213. doi:10.3969/j.issn.1004-583X.2018.03.005

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The incidence of stroke in young adults appears to be increasing year by year. The list of potential stroke etiologies is extensive so that a thorough history，examination， and tailored workup are essential. Traditional vascular risk factors，including hypertension， diabetes mellitus， dyslipidemia， tobacco abuse and excessive drinking are prevalent in young stroke patients. Whereas cervical artery dissections， patent foramen ovale(PFO)， thrombophilias are potential causes of stroke in young adults. To investigate the etiologies and risk factors is veryimportant for prevention and cure the disease at an early development stage.

Psychiatrists' knowledge and clinical practice in tardive dyskinesia

Sun Zhenxiao1， Sun Yuxin2， Yu Xiangfen1

2018, 33(3): 214-216,220. doi:10.3969/j.issn.1004-583X.2018.03.006

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Objective To explore the psychiatrists' knowledge and clinical practice in tardive dyskinesia(TD). Methods Investigations were conducted with a selfmade questionnaire of psychiatrists' knowledge and attitude in tardive dyskinesia in 106 psychiatrists.Results The psychiatrists' basic knowledge in TD was not enough comprehensive from clinical manifestations(86.79%) to pathogenesis (56.60%).The municipal psychiatrists' basic knowledge in TD was better than the county level psychiatrists(P<0.01). A total of 98.11% of psychiatrists agreed that there should be a training in diagnosis and treating of TD， a total of 81.13% of psychiatrists had a training in diagnosis and treating of TD，a total of 62.79% of psychiatrists had accepted a training of formal course. A total of 34.92% of psychiatrists were not in confidence about diagnosis and treating of TD. Totally， 91.51% of psychiatrists approved that psychiatrists should discuss the risk of TD before prescribing antipsychotics，however， 76.42% of psychiatrists routinely discussed the risk of TD before prescribing antipsychotics.Totally，98.11% of psychiatrists approved that psychiatrists should monitor abnormal movements in patients with antipsychotics，however， 74.52% of psychiatrists routinely monitored abnormal involuntary movements and 53.77% of psychiatrists routinely documented the outcome of monitoring. Totally， 65.10% of psychiatrists approved that TD should be a cause for medical disputes and litigation， however， 76.41% of psychiatrists approved that antipsychotics should not be prescribed for a longterm time with unlicensed indications without the patient's consent.Conclusion Psychiatrists should strengthen the training of knowledge of TD， and strictly provide information to patients in the risk of TD and routinely monitor in clinical work.

Effects of parathyroid adenectomy on sleep quality of patients with severe secondary parathyroid hyperthyroidism

Du Shutonga， Wang Ziqianga， Ma Weihuaa， Fang Xiaofanga， Li Weidongb

2018, 33(3): 217-220. doi:10.3969/j.issn.1004-583X.2018.03.007

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Objective The maintenance hemodialysis patients with parathyroidectomy were followed up to investigate the effects of parathyroid adenectomy on the quality of sleep.Methods Sixteen hemodialysis patients were selected for parathyroidectomy due to secondary hyperparathyroidism.Followup was performed one month before and one year after surgery.The changes in Ca， P， and parathyroid hormone were observed before and after surgery.Pittsburgh Sleep Index (PSIQ) was used to assess the quality of sleep before and after surgery.Results One year after parathyroidectomy， the quality of sleep was significantly improved（PSQI 17.48±5.13 vs 3.17±2.63，P<0.05）.The number of patients with bone pain and itchy symptoms also decreased significantly.Blood calcium， phosphorus and iPTH levels also decreased significantly. Conclusion Parathyroid hormone level plays a critical role in the sleep problems of patients with maintenance hemodialysis. Parathyroidectomy can significantly improve the quality of sleep in maintenance hemodialysis patients.It could improve the sleep quality and prognosis of patients， and promote the reintegration of patients with uremia.

Expression of inflammatory factors in serum of patients with acute bronchial asthma

Wu Yunping， Wang Caiyun， Liu Wei

2018, 33(3): 221-223,227. doi:10.3969/j.issn.1004-583X.2018.03.008

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Objective To investigate the changes of inflammatory factors in the serum of patients with acute bronchial asthma.Methods Totally 92 patients with bronchial asthma were divided into two groups according to the degree of severity of acute bronchial asthma， including healthy people as the controls. Lung function and serum interleukin (IL)6， IL17， tumor necrosis factor α(TNFα) and interferon gamma (IFNγ)， transforming growth factor β2 (TGFβ2) level were detected.Results Compared with the control group， the IL6， IL17 and TNFα in the asthma group were significantly increased， while IFNγ was significantly lower (P<0.01)， and there was no significant difference between the 3 groups of TGFβ2 (P>0.05). There were positive correlations between the severity of asthma and IL6， TNFa and IL17 (r=0.970， 0.868， 0.723，P<0.05). Severity of asthma was negatively correlated with FEV1/FVC and IFN gamma (-0.957，-0.934，P<0.05)， and not correlated with TGFB2 (r=0.321，P>0.05).Conclusion The increase of serum inflammatory factors in patients with bronchial asthma is closely related to the incidence of asthma， and it is of certain reference value for the assessment of the severity of asthma.

Comparative research of laboratory data in ketoacidosisonset diabetes patients

Qiu Junlin， Zeng Yunxian， Su Huixuan， Chen Wen

2018, 33(3): 224-227. doi:10.3969/j.issn.1004-583X.2018.03.009

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Objective To better understand the ketoacidosisonset fulminant type 1 diabetes（FT1DM）patients. Methods A total of 93 cases of ketoacidosisonset patients were divided into three groups according to diabetes type， including group A: type 2 diabetes; group B: type 1 diabetes without fulminant type 1 diabetes; group C: fulminant type 1 diabetes（FT1DM）. Age， glucose， serum sodium， serum potassium， glycated hemoglobin and pH value were compared among groups. Results Compared with the type 2 diabetes， FT1DM showed high levels of glucose and serum potassium and low levels of glycated hemoglobin， serum sodium and arterial pH. There was no statistical significant difference in serum sodium， arterial pH with shorter diabetic course. Compared with the group B， FT1DM showed higher level of glucose， serum potassium and lower levels of glycated hemoglobin. There was no statistical significant difference in serum sodium and arterial pH. Conclusion The ketoacidosisonset fulminant type 1 diabetes patients should be given more attention as they shared higher level of serum glucose and potassium. Not only the diabetes types， the time span from the onset of hyperglycemic symptoms to the ketoacidosis may affect the the laboratory data.

Risk factors of paroxysmal sympathetic hyperactivity after moderate or severe traumatic brain injury and impact on prognosis

Wang Wen， Hu Fangbao， Dou Hongjie， Ling Lin

2018, 33(3): 228-231,235. doi:10.3969/j.issn.1004-583X.2018.03.010

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Objective To analyze the risk factors on paroxysmal sympathetic hyperactivity(PSH) after moderate or severe traumatic brain injury (TBI) and its impact on prognosis. Methods The subjects were patients with moderate or severe TBI treated in the hospital . The demographic information and clinical information were collected. The subjects were divided into two groups， PSH group (n=27) and control group (n=99) according to whether being diagnosed as PSH. The risk factors of PSH and its impact on prognosis of TBI were analyzed by logistic regression. Hospital stay time， ICU time，Glasgow Outcome Scale(GOS) were analyzed.Results In 126 subjects (male n=82; female n=44)， 27 subjects were diagnosed as PSH(21.4%). The potential risk factors of PSH included systolic blood pressure >140 mmHg at admission (OR=3.21，95%CI=1.317.87， P=0.011)，GCS score<8 (OR=4.34， 95%CI=1.7310.93， P=0.002)， with cerebral contusion and laceration(OR=4.29，95%CI=2.558.26，P<0.001)， the volume of intracranial hemorrhage ≥50 ml (OR=2.33，95%CI=1.425.13， P=0.003） and with hydrocephalus (OR=3.57， 95%CI=1.369.37， P=0.010). Moreover， PSH was associated with protracted hospital stays (OR=5.21，95%CI=2.887.42， P=0.002) and lower GOS (OR=1.75，95%CI=1.243.78， P=0.009). Conclusion PSH is a common complication in patients after moderate or severe TBI. The risk factors of PSH included higher systolic blood pressure >140 mmHg at admission， lower GCS score， with brain contusion and with hydrocephalus. The patients with PSH after moderate or severe TBI may stay more days in hospital and have bad prognosis.

Influence of lipoic acid on serum 8isoprostaglandin F2α level in type 2 diabetic patients with lower venous extremity

Qiu Xuan1， Sun Jianpu2， Cai Sijia1， Xu Xiaomeng1， Liu Kuanzhi1

2018, 33(3): 232-235. doi:10.3969/j.issn.1004-583X.2018.03.011

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Objective To investigate the influence of lipoic acid on the serum 8isoprostaglandin F2α (8isoPGF2α) level in type 2 diabetic patients with lower venous extremity. Methods This study recruited `288 patients with type 2 diabetes， including 191 patients with only type 2 diabetes (T2DM group) and 97 type 2 diabetic patients with peripheral artery disease (LVED group) in accordance with anklebrachial index (ABI). The LVED group was divided into two groups: conventional therapy group received conventional therapy and the other lipoic acid group was given lipoic acid 0.6 g a day for two weeks on the basis of conventional therapy. An age and sexmatched group of 100 healthy subjects were also recruited. The serum 8isoPGF2α level was measured. The painless walking distance and the maximum walking distance before and after treatment were recorded. Results The serum 8isoPGF2α level in T2DM group was significantly higher than that in control group (P＜0.05). The serum 8isoPGF2α level in LVED group was significantly higher than that in T2DM group (P＜0.05). The serum 8isoPGF2α level was positively correlated with the severity of LVED. After two weeks treatment， the serum 8isoPGF2α level in conventional therapy group and lipoic acid group both decreased， and that in lipoic acid group was significantly lower (P＜0.05). In addition， the painless walking distance and the maximum walking distance in conventional therapy group and lipoic acid group significantly increased (P＜0.05)， and those in lipoic acid group were significantly longer (P＜0.05). Conclusion The serum 8isoPGF2α level is correlated with the severity of LVED. Lipoic acid could decrease the serum 8isoPGF2α level and improve the clinical symptoms in type 2 diabetic patients with LVED.

Clinical features of complete Kawasaki disease and incomplete Kawasaki disease in a single centre

Liu Ding， Yang Fang

2018, 33(3): 236-239. doi:10.3969/j.issn.1004-583X.2018.03.012

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Objective To review 50 cases of complete Kawasaki disease and 16 cases of incomplete Kawasaki disease and analyze the clinical features and laboratory results， so as to provide evidences for early diagnosis and treatment of Kawasaki disease. Methods The data of 16 patients with incomplete Kawasaki disease (IKD group) and 50 patients with complete Kawasaki disease (CKD group) were analyzed from March， 2013 to July， 2017， and the clinical manifestations， laboratory indicators， and incidence of coronary artery lesion (CAL) were compared. Results ① There were significant differences between IKD group and CKD group in the days of fever from diagnosis and age (P<0.05); ② In IKD group， the incidences of the clinical manifestations including erythematous rash，lymphadenectasis of neck， lips and tongue changes， and edema induratum and desquamation in fingers and toes were lower than those in CKD group（P<0.05）； ③ There were significant differences in glutamicpyruvic transaminase (ALT)， lactate dehydrogenase (LDH)， aspartate aminotransferase (AST) between IKD group and CKD group (P<0.05); ④ The incidence of coronary artery dilation was 40.0% vs 81.3% in CKD group and IKD group， respectively (P<0.05). Conclusion The morbidity of incomplete Kawasaki disease is higher among younger boys; the incidence of coronary artery dilation is significantly higher in incomplete Kawasaki disease than in complete Kawasaki disease.

Curative effect of CAG regimen compared with CAG combined with decitabine regimen in elderly patients with acute myeloid leukemia

Bai Xue， Xiao Xia， Li Yuming， Zhao Mingfeng， Deng Qi

2018, 33(3): 240-243. doi:10.3969/j.issn.1004-583X.2018.03.013

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Objective To compare the curative effect of CAG regimen and CAG combined with decitabine regimen in elderly patients with acute myeloid leukemia(AML). Methods Seventysix de novo elderly patients with AML who were diagnosed in our hospital were analyzed by a retrospective analysis. The 76 cases were divided into groups with CAG group and CAG+DAC group according to different chemotherapies. We compared the differences of complete remission rate， overall response rate， median overall survival and median relapsefree survival in two groups. Results CAG group of 49 cases：CR rate was 51.0%， ORR was 61.2%; CAG+DAC group of 27 cases: CR rate was 59.3%， ORR was 77.8%. The statistics analysis showed no significant differences in CR rate and ORR between two groups(P>0.05). There were differences in median OS (10.0 months vs 12.0 months) and median RFS (8.0 months vs 11.0 months ) in two groups(P>0.05). But in the highrisk group of patients， CR rate and ORR of the CAG+DAC group were higher than those of CAG group，respectively (57.1% vs 15%; 71.4% vs 25%)， the difference was statistically significant(P<0.05). CAG+DAC group was better than CAG group in median OS and median RFS， respectively (6.0 months vs 10.0 months) and (4.0 months vs 7.0 months)(P>0.05). Conclusion CAG regimen is similar with CAG+DAC regimen in the clinical curative effect， but CAG+DAC regimen is better in the elderly patients with AML with poor prognosis.

A metaanalysis of unrelated cord blood transplantation versus HLAmismatched unrelated donor transplantation in hematological malignancies

Su Wensi1，Yuan Jiaojiao1，Lu Ying2

2018, 33(3): 244-250. doi:10.3969/j.issn.1004-583X.2018.03.014

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Objective To compare the efficacy of unrelated cord blood transplantation(UCBT) and human leukocyte antigen mismatched unrelated donor transplantation(HLAMMUDT) in treatment of adult hematological malignancies.Methods Published studies of UCBT and MMUDT were collected from PubMed，EMBASE，Cochrane Central Register of Controlled Trials(CENTRAL) of the Cochrane Library，China Biology Medicine(CBM)，China National Knowledge Infrastructure(CNKI)，WANFANG database and VIP information.References of retrieved articles were also identified.Data analysis was performed with RevMan5.3.Results Seven studies were selected，which included 1 275 patients treated with UCBT and 751 patients treated with MMUDT.Metaanalysis results showed that the incidence of acute graftversushost disease and chronic graftversushost disease in UCBT group was significantly lower than MMUDT group(RR=0.89，95%CI=0.800.99，P=0.03;RR=0.63，95%CI=0.500.79，P＜0.01).However， infectionrelated mortality in UCBT group was significantly higher than MMUDT group(RR=1.23，95%CI=1.051.46，P=0.01).There was no significant difference in relapse，transplantationrelated mortality，overall survival and disease free survival between two groups，respectively(RR=0.85，95%CI=0.651.11，P=0.23; RR=0.95，95%CI=0.781.17，P=0.51; HR=1.01，95%CI=0.901.13，P=0.87;HR=1.04，95%CI=0.911.20，P=0.56). Conclusion UCBT and MMUDT had emerged as an effective stem cell source to treatment hematological malignancies for patients lacked of HLAmatched related or unrelated donor. MMUDT had a certain advantage for the patients who had the greater risk of infection and lacked of HLAmatched donor compared with UCBT.

Comparison of videoassisted thoracic surgery and posterolateral thoracotomy for pulmonary sequestration: a metaanalysis

Li Yuanyuan， Zhang Bo， Zhou Dengfeng， Chen Fan， Lei Yu， Lu Qiaofa

2018, 33(3): 251-254. doi:10.3969/j.issn.1004-583X.2018.03.015

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Objective To evaluate the effectiveness of videoassisted thoracic surgery (VATS) and thoracotomy for pulmonary sequestration. Methods We searched PubMed， EMBASE， and CNKI up to August 20， 2017 and collected clinic trials involving treatment outcomes of pulmonary sequestration using VATS compared with thoracotomy. The RevMan 5.3 software was used for metaanalysis. Results A total of five cohort studies involving 191 patients were included. The results of metaanalysis showed that VATS could shorten operative time and reduce volume of intraoperative blood loss compared with thoracotomy. However，no statistically significant difference was found in postoperative hospital stay， chest tube duration， chest drainage amount， and postoperative complications between the two groups. Conclusion VATS could decrease operative time and blood loss.

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