scholarly journals Capsular Warning Syndrome: Clinical Analysis and Treatment

2019 ◽  
Author(s):  
Lanying He ◽  
Ronghua Xu ◽  
Jian Wang ◽  
Lili Zhang ◽  
Lijuan Zhang ◽  
...  

Abstract Background: Capsular warning syndrome (CWS) was a rare clinical syndrome, which was defined as recurrent transient lacunar syndromes. The mechanism and clinical management of CWS were not clear. The purpose of this study was to discuss the clinical characteristics, treatment and prognosis of the CWS. Methods: This was a multicenter retrospective study that involved three medical centers, we collected clinical data from patients with CWS between January 2013 and December 2018. We analyzed the clinical characteristics of the CWS. Patients with CWS were divided into two groups: rt-PA and no rt-PA groups. We analyzed the therapeutic effects and prognosis between different groups. Results: This study included 72 patients, 27 in rt-PA group, 45 in no rt-PA group, hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before an irreversible neurological impairment or the symptoms completely disappeared was 5 times(3-11). 59 (81.94%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (76.38%,55), followed by the thalamus and pons. The difference in therapeutic effects between rt-PA, single and double antiplatelet groups was not significant(P>0.05). A good prognosis was observed in 61 (84.72%) patients at 3-month, 23 (23/27, 85.19%) patients in rt-PA group and 38 (38/45,84.44%) patients in no rt-PA group(P>0.05). After 3 months of follow-up, 2 patients had recurrent ischemic stroke. Conclusions: The most effective treatment of CWS remains unclear. Despite the high incidence of infarction in CWS patients, more than 80% patients had favorable functional prognosis

2019 ◽  
Author(s):  
lanying he ◽  
Ronghua Xu ◽  
Jian Wang ◽  
Lili Zhang ◽  
Lijuan Zhang ◽  
...  

Abstract Background: Capsular warning syndrome (CWS) was a rare clinical syndrome, which was defined as recurrent transient lacunar syndromes. The mechanism and clinical management of CWS were not clear. The purpose of this study was to discuss the clinical characteristics, treatment and prognosis of the CWS. Methods: This was a multicenter retrospective study that involved three medical centers, we collected clinical data from patients with CWS between January 2013 and December 2018. We analyzed the clinical characteristics of the CWS. Patients with CWS were divided into two groups: rt-PA and no rt-PA groups. We analyzed the therapeutic effects and prognosis between different groups. Results: This study included 72 patients, 27 in rt-PA group, 45 in no rt-PA group, hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before an irreversible neurological impairment or the symptoms completely disappeared was 5 times(3-11). 59 (81.94%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (76.38%,55), followed by the thalamus and pons. The difference in therapeutic effects between rt-PA, single and double antiplatelet groups was not significant(P>0.05). A good prognosis was observed in 61 (84.72%) patients at 3-month, 23 (23/27, 85.19%) patients in rt-PA group and 38 (38/45,84.44%) patients in no rt-PA group(P>0.05). After 3 months of follow-up, 2 patients had recurrent ischemic stroke. Conclusions: The most effective treatment of CWS remains unclear. Despite the high incidence of infarction in CWS patients, more than 80% patients had favorable functional prognosis


BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lanying He ◽  
Ronghua Xu ◽  
Jian Wang ◽  
Lili Zhang ◽  
Lijuan Zhang ◽  
...  

Abstract Background Capsular warning syndrome (CWS) is a rare clinical syndrome, which is defined as a recurrent transient lacunar syndrome. The mechanism and clinical management of CWS remain unclear. The aim of the study was to discuss the clinical characteristics of CWS and evaluate the different outcome between rt-PA and no rt-PA therapy. Methods The present multicenter retrospective study involved three medical centers, and the clinical data were collected from patients with CWS between January 2013 and December 2018. The clinical characteristics of CWS were analyzed. Patients were divided into two groups: rt-PA and no rt-PA groups. The therapeutic effects and prognosis of these two groups were analyzed. A good prognosis was defined as 3-month modified Rankin Scale (mRS) ≤ 2. Results Our study included 72 patients, 27 patients were assigned to rt-PA group, 45 in no rt-PA group. Hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before irreversible neurological impairment or the symptoms completely disappeared was five times (range: 3–11 times). A total of 58 (80.55%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (41,70.69%), followed by the thalamus and pons. The difference in therapeutic effects between the rt-PA, single and double antiplatelet groups was not statistically significant (P > 0.05). A good prognosis was observed in 61 (84.72%) patients after 3 months, in which 23 (23/27, 85.19%) patients were from the rt-PA group and 38 (38/45,84.44%) patients were from the no rt-PA group (P > 0.05). After 3 months of follow-up, two patients had recurrent ischemic stroke. Conclusion The most effective treatment of CWS remains unclear. Intravenous thrombolysis is safe for CWS patients. Regardless of the high frequency of infarction in CWS patients, more than 80% patients had a favorable functional prognosis.


2019 ◽  
Vol 19 (21) ◽  
pp. 1878-1901 ◽  
Author(s):  
Yue Zhou ◽  
Jian Wang ◽  
Zhuo Meng ◽  
Shuang Zhou ◽  
Jiayu Peng ◽  
...  

Chronic Heart Failure (CHF) is a complex clinical syndrome with a high incidence worldwide. Although various types of pharmacological and device therapies are available for CHF, the prognosis is not ideal, for which, the control of increased Heart Rate (HR) is critical. Recently, a bradycardic agent, ivabradine, is found to reduce HR by inhibiting the funny current (If). The underlying mechanism states that ivabradine can enter the Hyperpolarization-activated Cyclic Nucleotide-gated (HCN) channels and bind to the intracellular side, subsequently inhibiting the If. This phenomenon can prolong the slow spontaneous phase in the diastolic depolarization, and thus, reduce HR. The clinical trials demonstrated the significant effects of the drug on reducing HR and improving the symptoms of CHF with fewer adverse effects. This review primarily introduces the chemical features and pharmacological characteristics of ivabradine and the mechanism of treating CHF. Also, some expected therapeutic effects on different diseases were also concluded. However, ivabradine, as a typical If channel inhibitor, necessitates additional research to verify its pharmacological functions.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiahong Tan ◽  
Jinfeng Wu ◽  
Wujun Jiang ◽  
Li Huang ◽  
Wei Ji ◽  
...  

Abstract Background Bronchiolitis is a clinical syndrome commonly encountered in practice, particularly among infants and young children. To investigate the prevalence of pathogens in hospitalized children with bronchiolitis and study the clinical characteristics of bronchiolitis with or without coinfections. Methods We investigated the respiratory specimens and clinical data of 1012 children with bronchiolitis who were treated at the Children’s Hospital of Soochow University between November 2011 and December 2018. The nasopharyngeal aspirates were examined to detect viruses by direct immunofluorescence assay or polymerase chain reaction (PCR). Mycoplasma pneumoniae (MP) was tested by PCR and enzyme-linked immunosorbent assay. Results Of the 1134 children less than 2 years with bronchiolitis, 122 were excluded by exclusion criteria. Causative pathogen was detected in 83.2% (842 of 1012). The majority of these (614 [72.9%] of 842) were single virus infection. The most common pathogens detected were respiratory syncytial virus (RSV) (44.4%), MP (15.6%), and human rhinovirus (HRV) (14.4%). Coinfection was identified in 13.5% (137 of 1012) of the patients. Coinfection included mixed virus infection and virus infection with MP infection. Children with single virus infection had a higher rate of oxygen therapy compared with single MP infection. Conclusions The most common pathogen detected in children with bronchiolitis is RSV, followed by MP and HRV. Coinfection leads to a longer period of illness, increased severity of the symptoms and increased risk of hypoxemia.


Author(s):  
Margaret C. Fang ◽  
Alan S. Go ◽  
Priya A. Prasad ◽  
Jin-Wen Hsu ◽  
Dongjie Fan ◽  
...  

AbstractTreatment options for patients with venous thromboembolism (VTE) include warfarin and direct oral anticoagulants (DOACs). Although DOACs are easier to administer than warfarin and do not require routine laboratory monitoring, few studies have directly assessed whether patients are more satisfied with DOACs. We surveyed adults from two large integrated health systems taking DOACs or warfarin for incident VTE occurring between January 1, 2015 and June 30, 2018. Treatment satisfaction was assessed using the validated Anti-Clot Treatment Scale (ACTS), divided into the ACTS Burdens and ACTS Benefits scores; higher scores indicate greater satisfaction. Mean treatment satisfaction was compared using multivariable linear regression, adjusting for patient demographic and clinical characteristics. The effect size of the difference in means was calculated using a Cohen’s d (0.20 is considered a small effect and ≥ 0.80 is considered large). We surveyed 2217 patients, 969 taking DOACs and 1248 taking warfarin at the time of survey. Thirty-one point five percent of the cohort was aged ≥ 75 years and 43.1% were women. DOAC users were on average more satisfied with anticoagulant treatment, with higher adjusted mean ACTS Burdens (50.18 v. 48.01, p < 0.0001) and ACTS Benefits scores (10.21 v. 9.84, p = 0.046) for DOACs vs. warfarin, respectively. The magnitude of the difference was small (Cohen’s d of 0.29 for ACTS Burdens and 0.12 for ACTS Benefits). Patients taking DOACs for venous thromboembolism were on average more satisfied with anticoagulant treatment than were warfarin users, although the magnitude of the difference was small.


Cardiology ◽  
2020 ◽  
pp. 1-5
Author(s):  
Ang Li ◽  
Dan Yin ◽  
Xupei Huang ◽  
Lixin Zhang ◽  
Tiewei Lv ◽  
...  

<b><i>Background:</i></b> Our aim is to analyze the correlation between severe thrombocytopenia and the diameter of patent ductus arteriosus (PDA) and residual shunt after PDA closure. <b><i>Methods:</i></b> The patients with severe thrombocytopenia (platelet count &#x3c;50 × 10<sup>9</sup>/L) following transcatheter occlusion of a PDA from January 2010 to December 2018 in the Children’s Hospital of Chongqing Medical University were collected. And the high-risk factors, diagnosis, treatment, and prognosis of severe thrombocytopenia were analyzed. <b><i>Results:</i></b> A total of 1,581 children with transcatheter occlusion of a PDA were collected; 22 (1.39%) of the enrolled patients had severe thrombocytopenia. Further data analysis showed that the median diameter of PDA (6.7 [IQR: 1.63]) mm in children with severe thrombocytopenia was significantly larger than that in children without severe thrombocytopenia (3.6 ± 1.7 mm, <i>p</i> &#x3c; 0.001). Furthermore, the incidence of thrombocytopenia in children with residual shunt after operation (10.9%) was significantly higher than that in children without residual shunt (0.2%, <i>p</i> &#x3c; 0.001). The mean time of thrombocytopenia was found to be 2.4 ± 1.3 days after intervention. All patients with thrombocytopenia were treated by methylprednisolone with or without platelet transfusion and recovered without major organ hemorrhage. <b><i>Conclusions:</i></b> Severe thrombocytopenia following transcatheter occlusion of a PDA may be related to the larger diameter of PDA and residual shunt. If early detection of severe thrombocytopenia is obtained, our study supports a good prognosis if appropriate measures are implemented.


2016 ◽  
Vol 44 (6) ◽  
pp. 1462-1473 ◽  
Author(s):  
Wan-jun Sun ◽  
Jia-jia Zhang ◽  
Na An ◽  
Men Shen ◽  
Zhong-xia Huang ◽  
...  

Objectives To investigate the clinical characteristics, survival and prognosis of patients with multiple myeloma (MM) and head extramedullary plasmacytoma (EMP). Methods Forty MM patients were enrolled in the study (18 men, 22 women; median age, 55 years). Results Median overall survival (OS) and progression-free survival (PFS) were 24 (5–78) months and 17 (2–36) months, respectively. The 2-, 3- and 5-year OS rates were 51%, 20% and 7%, respectively. The 2-year PFS was 15%. Median OS and PFS in patients administered velcade were 26 (18–50) and 22.5 (5–78) months, compared with 20 (10–30) and 13.5 (2–36) months in patients without velcade, respectively. Median OS was 23.5 (5–50) months in patients with EMP at MM diagnosis ( n = 25) and 36 (22–78) months in patients with head EMP diagnosed during the disease course ( n = 15). Sixteen MM patients had EMP invasion of the head only and 24 had invasion at multiple sites. Median OS was 25 (22–78) months in patients with EMP of the head only and 22 (5–78) months in patients with EMP invasion at multiple sites. Conclusion MM patients with head EMP show a more aggressive disease course and shorter OS and PFS. The prognosis of these patients is poor, especially in patients with head EMP at MM diagnosis, though combined chemotherapy and radiotherapy may prolong survival.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 345.1-345
Author(s):  
M. Morita ◽  
S. Masuyama ◽  
M. Mizui ◽  
Y. Isaka

Background:Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by the production of autoantibody and systemic tissue damages including glomerulonephritis. Immune responses mediated by autoreactive T-cells, as well as by autoantibody, is involved in the development and progression of end-organ damages1. Biologic agents which manipulate T-cell function such as CTLA4-Ig and anti-CD40L have been revisited and tried to treat human SLE, however, both of them failed to demonstrate efficacy.A mouse specific anti-CD3ε mAb, clone 145-2C11 (2C11) is known to be immunosuppressive by down-modulation of TCR and depletion of T-cells2. Administration of Fc-deleted 145-2C11 F(ab’)2to lupus-prone mice was reported to reduce lymphadenopathy and prolong survival, but had no significant effect on anti-DNA antibody titer3. The mechanisms by which 2C11 ameliorates lupus are still unclear.In this study, we used non-mitogenic Fc-modified silent 145-2c11 (2C11S), which disables interaction between target cells and Fc receptor-bearing cells, abolishes antibody directed cytotoxicity, and has longer half-life than F(ab’)2. 2C11S is expected to exert its effect in safe and stable as compared with functional parent-2C11 (2C11P) antibody.Objectives:The purpose of our study is to clarify the difference between 2C11S and 2C11P and to examine their therapeutic effects against murine lupus-prone (NZB/W F1) mice.Methods:20 μg of 2C11P (absolute antibody), 2C11S (absolute antibody), or isotype control immunoglobulin G1 κ (IC)(BioLegend) were administered intraperitoneally to C57BL6 mice. The difference of their action on T-cells were evaluated in a time series from peripheral blood. Plasma cytokine levels were measured within 24 hours after antibody administration.In NZB/W F1 mice from weeks 10 or 20, 2C11P, 2C11S, and IC were administered (100 μg / week, 4 times, intraperitoneally). Plasma anti-dsDNA antibody titer, spleen and kidney blood cell subpopulation, and histology of renal tissue were evaluated before and/or after treatment.Results:Duration of reduced TCR expression in 2C11S group was approximately twice as long as that in 2C11P group, and the levels of plasma TNF-α was not increased in 2C11S group while significant increase was observed in 2C11P group (IC; mean 48.3 ± SD 16.7 pg/ml, 2C11S; 57.9 ± 6.12, 2C11P; 168 ± 50.6, IC VS 2C11S; p>0.99, IC VS 2C11P; p=0.03, ANOVA).In NZB/W F1 mice, the number of follicular helper T (Tfh) cells in spleen significantly decreased in 2C11S group (IC; median 9.0*104[interquartile range 8.5*104], 2C11S; 1.8*104[1.0*104], 2C11P; 1.0*105[9.4*104], IC VS 2C11S; p=0.03, IC VS 2C11P; p>0.99, Kruskal-Wallis). The number of germinal center B (GCB) cells in spleen also decreased in 2C11S group (IC; 1.2*105[1.7*105], 2C11S; 9.0*103[2.3*104], 2C11P; 8.0*104[2.3*105], IC VS 2C11S; p=0.03, IC VS 2C11P; p>0.99). The number of infiltrating CD4+T-cells in kidney significantly reduced in 2C11S group (IC; 3.4*103[1.0*104], 2C11S; 6.4*102[8.8*102], 2C11P; 1.2*103[4.4*103], IC VS 2C11S; p=0.048, IC VS 2C11P; p=0.23). In addition, the rate of increase in anti-dsDNA IgG titers significantly decreased in 2C11S group (IC; 2.3 [1.3], 2C11S; 0.9 [1.0], 2C11P; 1.3 [1.4], IC VS 2C11S; p=0.03, IC VS 2C11P; p=0.24). Finally, glomerular hypercellularity was markedly alleviated only in 2C11S group (IC; 4.4*10 [8.4], 2C11S; 3.8*10 [1.1], 2C11P; 3.9*10 [8.2], IC VS 2C11S; p=0.02, IC VS 2C11P; p=0.57).Conclusion:2C11S did not induce cytokine release with maintaining longer effect on TCR down-modulation. 2C11S reduced autoantibody production by suppressing GCB differentiation, possibly through down-regulation of Tfh cell number. Consequently, 2C11S ameliorated lupus nephritis. On the other hand, 2C11P did not show therapeutic effect.References:[1]George C Tsokos. et al. Nat. Rev. Rheum (2016) 12: 716-730.[2]Kuhn C. et al. Immunotherapy (2016) 8: 889-906.[3]Henrickson M. et al. Arthritis Rheum (1994) 37: 587-589.Disclosure of Interests: :None declared


2021 ◽  
Author(s):  
Yanrong Wang ◽  
Shaohua Chang ◽  
Xiaomin Ma ◽  
Jiying Li ◽  
Ruixia Zhang ◽  
...  

Abstract We examined the relationship between facial morphological features and clinical characteristics of adolescents with obsessive-compulsive disorder (OCD). The enrolled study sample comprised 40 adolescents diagnosed with OCD using the Obsessive Compulsive Inventory Child Version (OCI-CV) and 38 healthy controls (HCs). Facial photos, 21 facial diameters, and nine facial angles were collected using image software. In males, lower lip red height was significantly lower in OCD patients than in HCs (P < 0.05); no significant differences were observed in other facial indicators (all P > 0.05). In females, the nasolabial angle was smaller in OCD patients than in HCs (P < 0.05); no significant differences were observed in other facial indicators (all P > 0.05). The difference in lower lip red height between the OCD group and HC group was positively correlated with mental neutralization symptoms (r = 0.401, P < 0.05). Our findings highlight the relationship between facial and clinical characteristics in OCD patients.


2021 ◽  
pp. 112067212110556
Author(s):  
Xu Hou ◽  
Xinxing Guo ◽  
Zhili Cui ◽  
Yusheng Wang ◽  
Jian Zhou ◽  
...  

Aim To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment. Methods We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed. Results The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced. Conclusions The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.


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