Yingqi Xing

Compensatory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis: a high-resolution MRI and microemboli monitoring study

Abstract Objective: To investigate the existence of an association between compensatory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis with high-resolution magnetic resonance imaging (HR MRI) and transcranial color Doppler monitoring of microembolic signals (MESs). Methods: A total of 36 consecutive patients with symptomatic middle cerebral artery atherosclerotic stenosis underwent MES monitoring by transcranial color Doppler and 3-T HR MRI. Proton density-weighted cross-sectional images with submillimeter voxel size were obtained. The remodeling patterns and plaque morphology of the sites of maximal luminal narrowing were analyzed in terms of their association with the MES data. Results: Positive remodeling (PR) was found in 16 lesions (44·4%). The remodeling index was 1·11±0·05 in the PR group and 0·99±0·05 in the non-PR group (P<0·0001). Compared with the non-PR group, the PR group had a greater vessel area (19·97±1·42 mm2 versus 18·23±1·23 mm2) and greater wall area (16·93±1·47 mm2 versus 14·93±1·52 mm2; both P<0·0001) at the sites of maximal luminal narrowing. Finally, MESs were observed more frequently in the PR group than in the non-PR group (62·5% versus 15·0%, P = 0·003). Conclusions: In patients with symptomatic middle cerebral artery atherosclerotic stenosis, MESs were observed more frequently in the PR group than in the non-PR group.

Clinical and electrophysiological features of the 2007 Guillain-Barré syndrome epidemic in northeast China.

Guillain–Barré syndrome (GBS) generally presents sporadically. Epidemics of GBS are unusual. We reviewed the medical records of 26 patients hospitalized for GBS during the 2007 GBS epidemic in northeast China. The objective was to determine whether there were clinical and electrophysiological characteristics. All patients had drunk unboiled water, and the illness was preceded by diarrhea in 19 (73%) patients. Only 1 patient had a Campylobacter jejuni infection, whereas 14 (54%) patients exhibited features of acute motor axonal neuropathy (AMAN). The most common electrophysiological findings in early GBS included decreased compound muscle action potential (CMAP) amplitude (62%), abnormal F waves (73%), and abnormal H reflexes (62%). This epidemic of GBS appears to have been associated with consumption of contaminated water. The main subtype was AMAN, which was associated with a longer duration of illness and a worse prognosis. Electrodiagnostic evaluations are helpful for diagnosis in the primary stages of GBS. Muscle Nerve, 2010

Electrophysiological subtypes and prognosis of Guillain–Barré syndrome in Northeastern China

The purpose of this study was to assess the electrophysiological subtypes and prognosis of Guillain–Barré syndrome (GBS) in northeastern China.

Ultrasonography Assessments of Optic Nerve Sheath Diameter as a Noninvasive and Dynamic Method of Detecting Changes in Intracranial Pressure

Importance The crtierion standard method for monitoring intracranial pressure (ICP) can result in complications and pain. Hence, noninvasive, repeatable methods would be valuable. Objective To examine how ultrasonographic optic nerve sheath diameter (ONSD) correlated with noninvasive and dynamically monitored ICP changes. Design, Setting, and Participants The ONSD was measured before the lumbar puncture (LP) in 60 patients on admission. Patients with elevated ICP were divided into group 1 (200 < LP ⩽ 300 mm H2O) and group 2 (LP > 300 mm H2O). Patients underwent follow-up ONSD and LP measurements within 1 month. We analyzed the correlations between the ONSD and ICP on admission and between the changes in ONSD and ICP, which were the respective changes in ONSD and ICP from admission to follow-up. Main Outcomes and Measures The ultrasonographic ONSD and ICP were measured on admission and follow-up. The correlations between the ONSD and ICP on admission and between the changes in ONSD and ICP were analyzed using Pearson correlation analyses. Results For 60 patients (Han nationality; mean [SD] age, 36.2 [12.04] years; 29 [48%] female) on admission, the ONSD and ICP values were strongly correlated, with an r of 0.798 (95% CI, 0.709-0.867; P < .001). Twenty-five patients with elevated ICP who completed the follow-up were included. The mean (SD) ONSD and ICP on admission were 4.50 (0.54) mm and 302.40 (54.26) mm H2O, respectively. The ONSD and ICP values obtained on admission were strongly correlated , with an r of 0.724 (95% CI, 0.470-0.876; P < .001). The mean (SD, range) changes in ICP and ONSD were 126.64 (52.51 mm H2O, 20-210 mm H2O) (95% CI, 106.24-146.07) and 1.00 (0.512 mm, 0.418-2.37 mm) (95% CI, 0.83–1.20), respectively. The change in ONSD was strongly correlated with the change in ICP, with an r of 0.702 (95% CI, 0.425–0.870; P < .001). The follow-up evaluations revealed that the elevated ICP and dilated ONSD had returned to normal, and no evidence of difference was found in the mean ONSDs between group 1 (3.49 mm; 95% CI, 3.34–3.62 mm) and group 2 (3.51 mm; 95% CI, 3.44–3.59 mm) (P = .778) at follow-up. Conclusions and Relevance The dilated ONSDs decreased along with the elevated ICP reduction. Ultrasonographic ONSD measurements may be a useful, noninvasive tool for dynamically evaluating ICP.

Ultrasonographic Evaluation of Optic Nerve Sheath Diameter among Healthy Chinese Adults.

The aim of the work described here was to establish the range for optic nerve sheath diameter (ONSD) and potential factors influencing ONSD in healthy Chinese adults. Both ONSDs were measured twice in the sagittal and transversal planes by two observers. The final ONSD value for each participant was the average of 16 measurements of both eyes. The ONSD range (N = 3680) among 230 participants was 2.65-4.30 mm. The upper ONSD limit was lower than those in previous studies in Caucasian and African samples. Simple linear regression analyses revealed that the ONSD was correlated with sex, body mass index and waistline and head circumference. After adjustment for potential confounds between these factors, sex (coefficient = 0.225, p < 0.001) and body mass index (coefficient = 0.042, p < 0.001) were independently associated with ONSD. Underweight women had the smallest ONSD. These results suggest that racial, sex, and body mass index differences should be noted when assessing ultrasonographic criteria.

Prevalence of stroke and associated risk factors: a population based cross sectional study from northeast China

Objectives Epidemiological studies aimed at stroke and its risk factors can help identify persons at higher risk and therefore promote stroke prevention strategies. We aimed to explore the current prevalence of stroke and its associated risk factors in northeast China. Design Population based cross sectional study. Setting Data were collected using a structured precoded questionnaire designed by the Stroke Screening and Prevention Programme of the National Health and Family Planning Commission of China, between January and March 2016. Participants 4100 permanent residents, aged 40 years or older, who had lived in Dehui City of Jilin Province for more than 6 months volunteered to participate in the survey, with a response rate of 92.2%. For the purpose of the present analysis, 48 subjects were excluded due to missing values, giving a total of 4052 people included in this analysis. Main outcome measure The questionnaire included demographic characteristics, stroke related behavioural factors, personal and family medical history of stroke, physical examination and laboratory testing. Results The overall prevalence of stroke in Jilin Province was 7.2% (95% CI 6.3% to 8.2%). Of all stroke cases, 91.7% (95% CI 87.4% to 94.6%) were ischaemic stroke and 8.3% (95% CI 5.4% to 12.6%) were haemorrhagic stroke. The prevalence rates of dyslipidaemia, smoking and hypertension were ranked as the top three cerebrovascular risk factors and were 62.1%, 61.8% and 57.3%, respectively. We found that hypertension, dyslipidaemia and lack of exercise were associated with ischaemic stroke. However, only hypertension (OR=4.064, 95% CI 1.358 to 12.160) was significantly associated with haemorrhagic stroke. Conclusions The prevalence of stroke, especially ischaemic stroke, and associated cerebrovascular risk factors among adults aged 40 years or older in northeast China were high. A higher regional prevalence of hypertension, dyslipidaemia and lack of exercise may be responsible.

COMPARISON OF DIFFERENT METHODS OF VALSALVA MANEUVER FOR RIGHT-TO-LEFT SHUNT DETECTION BY CONTRAST-ENHANCED TRANSCRANIAL DOPPLER

We evaluated 298 patients for right-to-left shunt (RLS) detection by contrast-enhanced transcranial Doppler at rest state (RS), during the conventional Valsalva maneuver (CM), and during the modified Valsalva maneuver (BM: blowing into the connecting tube of a sphygmomanometer at 40 mm Hg for 10 s) in random order, and the degree of RLS along the time of the first microbubble occurrence was recorded. The positive rates were 21.8%, 36.9% and 47.3% for RS, CM and BM, respectively (p < 0.001). BM resulted in a significantly higher positive rate (p = 0.010), and there was a significant difference between the two different methods of VM in terms of the degree of RLS detection (p < 0.001). Further, the first microbubble occurred later during BM than CM (10.22 ± 3.77 s vs. 9.44 ± 4.36 s, p < 0.05). This modified maneuver is an alternative to the conventional one, especially for those who cannot perform the conventional maneuver adequately, but are highly suspected of having RLS.

Hypertension prevalence, awareness, treatment, and control in northeast China: a population-based cross-sectional survey

Hypertension has been recognized as a major risk factor for cardiovascular disease. We aimed to analyze the current prevalence, awareness, treatment, and control of hypertension in northeast China. This cross-sectional survey adopted the multistage stratified random cluster sampling method to obtain a representative sample of adults aged 40 years or older in the general population of northeast China. Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mm Hg, or diastolic blood pressure (DBP) ≥ 90 mm Hg, or self-reported use of antihypertensive medications in the last 2 weeks irrespective of BP. Altogether 4052 participants were included with weighted prevalence of hypertension of 57.3%. Among them, 47.4% were aware of their condition; 78.8% took antihypertensive medication, but only 10.2% had their blood pressure controlled. Individuals who were overweight/obesity, with dyslipidemia, or diabetes were at a higher risk of hypertension; these people also more likely to be aware of their condition. Subjects with a personal history of stroke were more inclined to receive antihypertensive medication, but that did not necessarily translate to well-controlled hypertension. Moreover, dyslipidemia (OR = 0.600; 95% CI: 0.375, 0.960) were associated with poor hypertension control. Subjects using combination of antihypertensive medications (OR = 2.924; 95% CI: 1.606, 5.325) or with a family history of coronary heart disease were more likely to have their blood pressure controlled. Our study identified a high prevalence of hypertension in northeast China. Although awareness and treatment rates improved over the last decade, the control rate remained disproportionately and unacceptably low.

Microembolic Signals Predict Recurrence of Ischemic Events in Symptomatic Patients with Middle Cerebral Artery Stenosis

Middle cerebral artery (MCA) stenosis is a common cause of ischemic stroke in Asian populations. We sought to determine whether microembolic signals (MESs) can predict the occurrence or recurrence of ischemia in symptomatic and asymptomatic patients with MCA stenosis. The symptomatic group had a significantly higher incidence of MES (30% vs. 16.2%, p < 0.05), as well as higher incidences of cerebral infarction and transient ischemic attack (TIA) (infarction, 13.0% vs. 4.4%, OR 3.123 [95% CI, 1.049-9.294], p < 0.05; TIA, 21.0% vs. 2.9%, OR = 7.108 [95% CI, 1.808-27.949], p < 0.001) than the asymptomatic group. After a follow-up period of 0.5-4.5 y, the subgroup of MES-positive (MES+) symptomatic patients had a significantly higher incidence of TIA (36.7% vs. 14.3%, OR = 1.623 [95% CI, 1.166-2.258]; p < 0.001) than the subgroup of MES-negative (MES-) symptomatic patients. The likelihood of the early occurrence of an endpoint event was also higher in the subgroup of MES+ symptomatic patients. In the group of asymptomatic patients with MCA stenosis, no significant differences were identified between the MES+ and MES- subgroups.

Prevalence and risk factors for diabetes and impaired fasting glucose in Northeast China: Results from the 2016 China National Stroke Screening Survey

AIMS To explore the current prevalence and risk factors for diabetes and impaired fasting glucose in Northeast China. METHODS This study adopted the multistage stratified random cluster sampling method to obtain a representative sample of adults aged 40 years or older in Dehui City, Jilin Province, Northeast China. Diabetes and impaired fasting glucose were defined according to the 1999 World Health Organization criteria. RESULTS A total of 4052 participants were included, with prevalence of diabetes in Northeast China of 11.2% (95% confidence interval [CI], 10.1-12.4%); that of diagnosed, 5.9% (95% CI, 5.1-6.8%); and that of impaired fasting glucose, 6.9% (95% CI, 6.0-8.0%). Among them, 52.9% were aware of their condition, 47.7% were receiving antidiabetic medication, and 75.9% had their diabetes controlled. Rural residents were more likely to have diabetes but were less inclined to be aware of and report antidiabetic treatment and to have their diabetes controlled than urban residents. CONCLUSION Diabetes and impaired fasting glucose were highly prevalent among adults in Northeast China. However, awareness and treatment rates remained relatively low compared with those of developed countries. Health policymakers should put more basic medical and healthcare into rural areas in the future.