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Zhou Q, Xu Z, Duan Y, Tang H, Zhang H, Liu H. MTHFR C677T, hyperhomocysteinemia, and their interactions with traditional risk factors in early neurological deterioration in Chinese patients with ischemic stroke. Heliyon 2024; 10:e31003. [PMID: 38784530 PMCID: PMC11112322 DOI: 10.1016/j.heliyon.2024.e31003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aimed to investigate the relationship between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and early neurological deterioration (END) in patients with acute ischemic stroke (AIS) and any possible interactions between specific MTHFR alleles and traditional risk factors among a Han Chinese cohort. Methods 434 AIS patients were consecutively recruited between January 2017 and June 2019, including 129 END and 305 non-END cases. A candidate gene association study design was used to analyze the association between MTHFR gene polymorphism and END risk. The polymerase chain reaction-restriction fragment length polymorphism (RFLP) method was employed to genotype the MTHFR C677T polymorphism. The interactional analyses were performed using the multifactor dimensionality reduction test. Results Hyperglycemia (odds ratio [OR]: 2.410, 95 % confidence interval [CI]: 1.436-4.046, p = 0.001), neurological function impairment (NIHSS score >5) (OR: 2.158, 95%CI: 1.337-3.484, p = 0.002) on admission, and hyperhomocysteinemia (HHcy) (OR: 2.570, 95%CI: 1.229-5.376, p = 0.012) were independently associated with END. The TT genotype (OR: 1.710, 95%CI: 1.021-2.863, p = 0.043) and T allele (OR: 1.710, 95%CI: 1.021-2.863, p = 0.043) of this C677T polymorphism were associated with susceptibility to END, and the TT genotype was more common in the subjects with HHcy (OR: 2.525, 95%CI: 1.111-5.739, P = 0.023). In addition, we also found interactions for END risk between the C677T polymorphism and traditional risk factors for END, including: hyperglycemia on admission, drinking, and moderate to severe neurological deficits (OR 1.237, 95 % CI 0.227-6.734), although the results were not statistically significant (p = 0.806). Conclusions Our results show a possible association between MTHFR C677T polymorphism and gene-environment interactions with END susceptibility in a Han Chinese cohort.
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Affiliation(s)
- Qiang Zhou
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Zhiyao Xu
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Yuanyuan Duan
- Department of Neurology, the People's Hospital of Mianyang, Mianyang, Sichuan 621000, PR China
| | - Hui Tang
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Haitao Zhang
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Hua Liu
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
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Zhou D, Qin H, Miao L, Xu Y, Yu L, Wang J. Predictive value of glycoprotein DKK3 for early neurological deterioration after ischemic stroke. Clinics (Sao Paulo) 2024; 79:100360. [PMID: 38678874 PMCID: PMC11066595 DOI: 10.1016/j.clinsp.2024.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To explore the value of serum Dickkopf-3 (sDKK3) in predicting Early Neurological Deterioration (END) and in-hospital adverse outcomes in acute ischemic stroke (AIS) patients. METHODS AIS patients (n = 200) were included and assessed by the National Institutes of Health Stroke Rating Scale. Serum Dkk3 levels were assessed by ELISA. END was defined as an increase of ≥ 4 points in NIHSS score within 72h. The biological threshold of sDKK3 level and END occurrence were predicted based on X-tile software. Primary outcomes were END and all-cause death, and the secondary outcome was ICU admission during hospitalization. The logistic regression model and Cox risk regression model were applied to evaluate the relationship between DKK3 level and END incidence, all-cause in-hospital mortality, and in-hospital adverse outcomes (ICU admission). RESULTS During hospitalization, the incidence of END in patients with AIS was 13.0 %, and the mortality rate within 7 days after END was 11.54 % (3/26). In patients below the serum DKK3 cutoff (93.0 pg/mL), the incidence of END was 43.5 % (20/48). Patients with lower sDKK3 levels were associated with a 1.188-fold increased risk of developing END (OR = 1.188, 95 % CI 1.055‒1.369, p < 0.0001). However, there was no significant association with admission to the ICU. sDKK3 below the threshold (93.0 pg/mL) was a risk factor for death. CONCLUSION Predictive threshold levels of serum DKK3 based on X-tile software may be a potential predictive biomarker of in-hospital END in patients with AIS, and low levels of DKK3 are independently associated with increased in-hospital mortality.
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Affiliation(s)
- DongLiang Zhou
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - HongWei Qin
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - Lei Miao
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - Ying Xu
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - Lan Yu
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
| | - JianMin Wang
- Department of Neurology, Renhe Hospital of Baoshan District, Shanghai City, China
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Ahlskog JE. Levodopa, homocysteine and Parkinson's disease: What's the problem? Parkinsonism Relat Disord 2023; 109:105357. [PMID: 36922273 DOI: 10.1016/j.parkreldis.2023.105357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Elevated circulating homocysteine levels have been associated with cognitive impairment and cardio-cerebro-vascular events. Levodopa treatment of Parkinson's disease tends to further elevate circulating homocysteine levels due to the metabolism of levodopa via catechol-O-methyltransferase (COMT). COMT co-factors are vitamins B12, B6 and folic acid. Accumulating deficiencies of these vitamins are presumed to be the substrate for the homocysteine elevation. B-vitamin therapy reduces homocysteine levels. This begs the question of whether Parkinson's disease patients on levodopa should be concurrently treated with ongoing B-vitamin therapy (versus long-term monitoring of B-vitamins/homocysteine). There is a substantial literature on this topic that has accumulated over the last quarter-century, and this topic is still debated. This review summarizes the relevant literature with the aim of approximating closure on this issue. Also, noteworthy is that Parkinson's disease patients with renal insufficiency may not tolerate cyanocobalamin, the standard oral B12 supplement due to facilitation of renal decline; alternatives are discussed.
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Affiliation(s)
- J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA.
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Zhang T, Zhang L, Nie K, Yang J, Lou H, Wang J, Huang S, Gu C, Yan M, Zhan R, Pan J. Admission Homocysteine as a Potential Predictor for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. Front Surg 2022; 8:813607. [PMID: 35211499 PMCID: PMC8861177 DOI: 10.3389/fsurg.2021.813607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background Delayed cerebral ischemia (DCI) is a primary cause of poor prognosis after aneurysmal subarachnoid hemorrhage (aSAH) and needs close medical attention in clinical practice. Homocysteine (Hcy) has been implicated in cerebrovascular diseases. This study aimed to investigate whether serum Hcy could help to predict the occurrence of DCI in aSAH patients, and compare its diagnostic value with traditional methods. Methods We enrolled 241 aSAH patients in this study. Serum Hcy levels were collected from each patient. The baseline information was reviewed and analyzed. The binary logistic regression was used to explore the relation of serum Hcy levels with occurrence of DCI, and diagnostic performance of serum Hcy for predicting DCI was evaluated using a receiver operating characteristic (ROC) curve. Results The admission serum Hcy levels were found significantly higher in aSAH patients with DCI than those without (P < 0.001). The serum Hcy levels were positively correlated with the World Federation of Neurosurgical Societies (WFNS) scores, modified Fisher scores as well as Hunt and Hess scores at admission. Multivariate analysis revealed that occurrence of DCI was associated with serum Hcy levels (Odds Ratio [OR] = 1.257; 95% Confidence Interval [CI], 1.133–1.396, P < 0.001), modified Fisher scores (OR = 1.871; 95%CI, 1.111–3.150, P = 0.018) and Hunt and Hess scores (OR = 2.581; 95%CI, 1.222–5.452, P = 0.013) after adjusting for the significant variables in univariate analysis. Meanwhile, serum Hcy levels achieved good performance for DCI prediction (area under the curve [AUC], 0.781; 95%CI, 0.723–0.831, P < 0.001). Conclusion Serum homocysteine might have the potential to be a useful and cost-effective biomarker for predicting the occurrence of DCI in aSAH patients.
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Affiliation(s)
- Tiesong Zhang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Luyuan Zhang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Kehui Nie
- Neusoft Medical System, Shanghai, China
| | - Jun Yang
- Neusoft Medical System, Shanghai, China
| | - Haiyan Lou
- Department of Radiology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jincheng Wang
- Department of Radiology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Sicong Huang
- Department of Hepatobiliary and Pancreatic Surgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenjie Gu
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Min Yan
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Renya Zhan
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianwei Pan
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Jianwei Pan
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Kunces LJ, Keenan J, Schmidt CM, Schmidt MA. Molecular Deficits Relevant to Concussion Are Prevalent in Top-Ranked Football Players Entering the National Football League Draft. J Strength Cond Res 2021; 35:3139-3144. [PMID: 34533486 DOI: 10.1519/jsc.0000000000004131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Kunces, LJ, Keenan, J, Schmidt, CM, and Schmidt, MA. Molecular deficits relevant to concussion are prevalent in top-ranked football players entering the National Football League draft. J Strength Cond Res XX(X): 000-000, 2021-Characterization of blood variants in athletes entering the highly competitive contact environment of professional football can help us understand the risk for brain injury. When coupled with longitudinal follow-up of future concussion incidence and trajectory, it may provide additional insight into factors that influence brain injury. We observed the metabolic phenotype of collegiate football players entering the 2016 National Football League (NFL) draft. The principal aims were to characterize the molecular status of individual athletes and quantify the prevalence of athletes with multiple concurrent molecular deficits. Blood was taken from 30 elite American collegiate football players 7 weeks before the NFL scouting combine and 15 weeks before entering the NFL draft. Average results revealed suboptimal values in Omega-3 Index (avg ± std, 4.66 ± 1.16%), arachidonic acid:eicosapentaenoic acid fatty acid ratio (29.13 ± 10.78), homocysteine (11.4 ± 3.4 µmol·L-1), vitamin D (30 ± 11.4 ng·ml-1), and red blood cell magnesium (4.1 ± 0.8 mg·dl-1). Using sport-optimized reference ranges from previously published research, 10% presented with 3, 40% presented with 4, and 50% of athletes presented with 5 suboptimal values at once. We conclude molecular deficits in this cohort entering the NFL draft were common, with a significant number of athletes presenting with multiple suboptimal levels. The significant commonality of the suboptimal biomarkers is relevance to brain health and function. This data warrant extensive metabolic phenotyping and consideration of prophylactic precision nutrition countermeasures by the multidisciplinary staff for athletes entering contact environments.
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Affiliation(s)
- Laura J Kunces
- Onegevity Health, New York, New York; Thorne HealthTech, Summerville, South Carolina; EXOS, Phoenix, Arizona; and Advanced Pattern Analysis & Countermeasures Group, Boulder, Colorado
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Xiao W, Ye P, Wang F, Cao R, Bai Y, Wang X. Plasma Homocysteine Is a Predictive Factor for Accelerated Renal Function Decline and Chronic Kidney Disease in a Community-Dwelling Population. Kidney Blood Press Res 2021; 46:541-549. [PMID: 34365457 DOI: 10.1159/000514360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Whether elevated plasma total homocysteine (tHcy) is a risk factor for the progression of kidney disease in general population has not been well established. The purpose of this study was to investigate the prognostic properties of plasma tHcy for renal function decrement and early chronic kidney disease (CKD) in community-dwelling populations with normal renal function at baseline. METHODS A total of 1,426 participants were enrolled and followed for a median of 4.8 years (interquartile range, 4.5-5.2), and estimated glomerular filtration rate (eGFR) was evaluated. One main outcome was the rapid eGFR decline defined as a decline in eGFR of >3 mL/min per 1.73 m2 per year; the other was the new incidence of CKD. RESULTS At the end of follow-up, the incidence of rapid eGFR decline and new-onset CKD was 20.7 and 5.6%, respectively. In multivariate linear regression analysis, age, central pulse pressure, fasting blood glucose, and concentration of tHcy were independent determinants of the change in eGFR. There was a graded association between tHcy quartiles and eGFR decline. Compared with participants with the lowest quartile of tHcy levels, those with the highest quartile had significantly increased risk for rapid eGFR decline (adjusted odds ratio [aOR] = 1.81; 95% confidence interval [CI]: 1.25-2.94) and new onset of CKD (adjusted hazard ratio = 4.29; 95% CI: 1.42-12.99) after adjusting for various confounders. Similarly, significant associations were also found when baseline tHcy was classified as hyperhomocysteinemia (>15 μmol/L) versus normal tHcy level (≤15 μmol/L). However, there was only association between the change in tHcy levels and new occurrence of CKD but not with rapid eGFR decline (aOR = 0.99, p = 0.613). CONCLUSIONS In this prospective cohort of individuals from community-based population, elevated plasma tHcy emerged as an independent predictor of renal function decline and incident CKD, which might support selection of at-risk individuals.
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Affiliation(s)
- Wenkai Xiao
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fan Wang
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ruihua Cao
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaona Wang
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
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Khan TA, Zameer S, Muhammad WW, Zahid MA. Migrainous Middle Cerebral Artery Infarction With Ipsilateral Hemiparesis. Cureus 2020; 12:e11557. [PMID: 33364085 PMCID: PMC7749801 DOI: 10.7759/cureus.11557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Migrainous infarction is a complication of migraine that accounts for 0.5-1.5% of all cerebral infarcts, usually seen in the posterior circulation and in young women. In this case report, we report a case of a right-sided middle cerebral artery ischemic stroke in a young male presenting with migraine, photophobia and phonophobia lasting for more than 60 minutes and followed by ipsilateral hemiparesis, which is a very unusual presentation. The provisional diagnosis of ischemic infarction of the right middle cerebral artery was made that was confirmed on radio imaging. A high index of suspicion is always required while dealing with patients with migraine especially in atypical presentations as in this case.
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Wu X, Zhou Q, Chen Q, Li Q, Guo C, Tian G, Qie R, Han M, Huang S, Li Y, Yang X, Zhao Y, Feng Y, Liu D, Qin P, Hu D, Zhang M. Association of homocysteine level with risk of stroke: A dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis 2020; 30:1861-1869. [PMID: 32912796 DOI: 10.1016/j.numecd.2020.07.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/30/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Homocysteine (Hcy) level has been increasingly linked with stroke and ischemic stroke (IS). However, a dose-response meta-analysis of prospective cohort studies of the association is lacking. We aimed to explore the quantitative dose-response association of Hcy level with stroke and IS in a meta-analysis of prospective cohort studies. METHODS AND RESULTS We performed a systematic search of PubMed, Embase and Web of Science databases up to April 25, 2019 for prospective cohort studies assessing the association of Hcy level with stroke and IS. We used random-effect models to estimate the pooled relative risk (RRs) (with 95% confidence intervals [CIs]) for the association of Hcy with risk of stroke and IS. Restricted cubic splines were used to evaluate possible linear or nonlinear association of Hcy level with stroke and IS. We included 10 prospective cohort studies (7 articles) with 11,061 participants in the meta-analysis. Hcy level was associated with increased risk of stroke (RR = 1.58, 95% CI 1.25-2.00, I2 = 39.5%) and IS (RR = 1.54, 95% CI 1.21-1.97, I2 = 36.4%) for the highest versus the lowest categories. We found a linear association between Hcy level and stroke (Pnonlinearity = 0.660) and IS (Pnonlinearity = 0.981). For each 1-μmol/L increase in Hcy, the pooled RR was 1.06 (95% CI 1.01-1.12, I2 = 59.0%) for stroke and 1.05 (95% CI 1.00-1.11, I2 = 58.6%) for IS. CONCLUSION This meta-analysis indicated that elevated Hcy level was associated with increased risk of stroke and IS.
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Affiliation(s)
- Xiaoyan Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Qionggui Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Qing Chen
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Minghui Han
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Shengbing Huang
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Yang Li
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Pei Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China; Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, People's Republic of China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Ming Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
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Zhang W, Qin Z, Xian K, Tang S. Assessment of plasma homocysteine levels in patients with craniocerebral injury and prognosis. J Int Med Res 2019; 48:300060519882202. [PMID: 31852292 PMCID: PMC7607269 DOI: 10.1177/0300060519882202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the effect of plasma homocysteine (Hcy) and C-reactive protein
(CRP) levels in patients with craniocerebral injury. Methods A retrospective analysis of data from patients with craniocerebral injury who
underwent surgery. Patients were stratified according to the extent of the
craniocerebral injury into severe, moderate and mild craniocerebral injury
groups. Serum Hcy and CRP levels were determined at admission, at 7 days
after treatment and at 3 months after injury. Univariate and multivariate
Cox regression analyses were undertaken to identify prognostic factors. Results The study enrolled 96 patients: 29 patients with mild injury; 33 patients
with moderate injury; and 34 patients with severe injury. Serum Hcy and CRP
levels at admission were significantly higher in the severe craniocerebral
injury group than in the other two groups; and they were significantly
higher the moderate craniocerebral injury group compared with the mild
craniocerebral injury group. Serum Hcy and CRP levels of the three groups of
patients were significantly lower after 7 days of treatment than those
before treatment. The levels of Hcy and CRP were positively correlated in
all three groups. Conclusion Serum Hcy and CRP levels in patients could be used to monitor the condition
and prognosis of patients with craniocerebral injury.
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Affiliation(s)
- Wenjia Zhang
- Department of Neurosurgery, Guigang People's Hospital, Guigang City, Guangxi Zhuang Autonomous Region, China
| | - Zhongqiao Qin
- Department of Neurosurgery, Guigang People's Hospital, Guigang City, Guangxi Zhuang Autonomous Region, China
| | - Kecong Xian
- Department of Neurosurgery, Guigang People's Hospital, Guigang City, Guangxi Zhuang Autonomous Region, China
| | - Shuhong Tang
- Department of Neurosurgery, Guigang People's Hospital, Guigang City, Guangxi Zhuang Autonomous Region, China
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Hu X, Ma S, Yang C, Wang W, Chen L. Relationship between senile osteoporosis and cardiovascular and cerebrovascular diseases. Exp Ther Med 2019; 17:4417-4420. [PMID: 31105781 PMCID: PMC6507516 DOI: 10.3892/etm.2019.7518] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Abstract
The relationship between senile osteoporosis and cardiovascular hypertension, coronary heart disease and cerebral infarction was investigated. A retrospective study on 428 elderly patients hospitalized in Harrison International Peace Hospital from June 2014 to January 2017 was conducted. There were 207 cases of coronary heart disease, 102 cases of hypertension and 119 cases of cerebral infarction. According to bone density measurement results, the subjects were divided into the osteoporosis group and the non-osteoporosis group. Risk factors for osteoporosis were analyzed, and the incidence of osteoporosis in hypertension, coronary heart disease, and cerebral infarction populations of different severity was analyzed. Hypertension, coronary heart disease and cerebral infarction were the main risk factors for osteoporosis in the elderly. Incidence of osteoporosis in the double-vessel disease group and the three-vessel disease group was significantly higher than that in the single-vessel disease group. Incidence of osteoporosis was significantly higher in the three-vessel disease group than that in the double-vessel disease group (P<0.05). Incidence of osteoporosis was significantly higher in the moderate hypertension and severe hypertension groups than that in the mild hypertension group. Incidence of osteoporosis was significantly higher in patients with severe hypertension than that in the moderate hypertension group (P<0.05). Incidence of osteoporosis in patients with moderate cerebral infarction and severe cerebral infarction was significantly higher than that in the mild cerebral infarction group (P<0.05). Incidence of osteoporosis in patients with severe cerebral infarction was significantly higher than that in the moderate cerebral infarction group (P<0.05). The results indicated that there is a close correlation between senile osteoporosis and hypertension, coronary heart disease and cerebral infarction. Osteoporosis can be used as a predictor of early screening for hypertension, coronary heart disease and cerebral infarction in the elderly population.
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Affiliation(s)
- Xiaoying Hu
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Shucan Ma
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Caixia Yang
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Weiwei Wang
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
| | - Liman Chen
- The First Department of Geriatric Medicine, Harrison International Peace Hospital, Hengshui, Hebei 053000, P.R. China
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Anniwaer J, Liu MZ, Xue KD, Maimaiti A, Xiamixiding A. Homocysteine might increase the risk of recurrence in patients presenting with primary cerebral infarction. Int J Neurosci 2019; 129:654-659. [PMID: 30215548 DOI: 10.1080/00207454.2018.1517762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Although hyperhomocysteinemia (Hhcy) is a risk factor for cerebral infarction, its effect on recurrent cerebral infarction is less-defined. We aimed to investigate the association of Hhcy and increased risk of recurrent cerebral infarct. MATERIALS AND METHODS From 2011 to 2013, we recruited 231 primary cerebral infarct patients that were divided to a Hhcy group (n = 105) and a control group (n = 126) according to plasma homocysteinemia (Hcy) levels exceeding 15 μmol/L. In this prospective study, risk factors such as gender, age, blood lipid and glucose levels, history of diabetes, high blood pressure, smoking habits and plasma Hhcy levels were determined. A three-year follow-up compared differences in cerebral infarction recurrence rates. Statistical analyses identified whether plasma Hhcy levels were an independent risk factor for recurrent cerebral infarction. RESULTS Triglyceride and low-density lipoprotein (LDL) levels in the Hhcy group were significantly higher than controls, and cerebral infarct recurrence rates in the Hhcy group exceeded control subject rates through the three-year follow-up (p = .021, p = .036 and p = .025). Cox proportional hazards modeling showed that elevated Hhcy levels (hazard ratio [HR] = 3.062, p < .001), increased age (HR = 1.069, p < .01), circulating triglyceride levels (HR = 1.686, p = .048), and relative National Institutes of Health Stroke (NIHSS) score (HR = 1.068, p = .016) were risk factors for recurrent cerebral infarction. CONCLUSIONS Level of Hhcy was a risk factor for recurrent cerebral infarction. Further, particular demographic and clinical outcomes including age, relative NIHSS scores, and circulating triglyceride levels were markedly associated with the occurrence of cerebral infarction.
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Affiliation(s)
- Jianati Anniwaer
- a Department of Critical Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Meng-Zhuang Liu
- b Department of General Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Ke-Dong Xue
- a Department of Critical Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Abuduzhayier Maimaiti
- b Department of General Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
| | - Aersilan Xiamixiding
- a Department of Critical Medicine , The People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , China
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Wei B, Liu Y. Clinical significance and efficacy analysis of atorvastatin in the treatment of patients with cerebral infarction and aspiration pneumonia. Exp Ther Med 2018; 16:5144-5148. [PMID: 30542469 PMCID: PMC6257107 DOI: 10.3892/etm.2018.6829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/06/2018] [Indexed: 12/24/2022] Open
Abstract
Therapeutic efficacy of the use of oral atorvastatin in the treatment of patients with aspiration pneumonia complicated with cerebral infarction was investigated. Three hundred and fourteen cerebral infarction patients complicated with aspiration pneumonia who were admitted to the emergency department of Beijing Chaoyang Hospital Jingxi Branch from May 2015 to July 2017 were retrospectively analyzed. Among them, 160 patients who took atorvastatin were treated as observation group, and the remaining 154 patients were the control group. Patients were given basic treatment after diagnosis, and atorvastatin was also used for patients in the observation group. Venous blood was extracted to detect blood lipids and inflammatory cytokines. Patients were followed up for a period of six months, and the mortality was recorded. After treatment, blood lipid function and inflammatory factors in both groups were significantly improved (P<0.05). Hospital stay in the observation group (86.88%) was significantly shorter than that in the control group (76.33%) (P<0.01). After treatment, levels of TC, LDL, TG and CRP in the observation group (86.25%) were significantly lower than those in the control group (76.32%) (P=0.01). However, after treatment, level of HDL-C in the observation group (11.88%) was significantly higher than that in the control group (23.38%) (P=0.01). After treatment, levels of IL-6, IL-8 and TNF-α in the observation group were significantly lower than those in the control group (P<0.01). Total effective rate in the observation group was significantly higher than that of the control group (P=0.01). Total death rate in the observation group was significantly lower than that in the control group (P=0.02). In conclusion, atorvastatin is effective in the treatment of cerebral infarction patients complicated with aspiration pneumonia.
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Affiliation(s)
- Bing Wei
- Department of Emergency Medicine, Beijing Chaoyang Hospital Jingxi Branch, Capital Medical University, Beijing 100043, P.R. China
| | - Yugeng Liu
- Department of Emergency Medicine, Beijing Chaoyang Hospital Jingxi Branch, Capital Medical University, Beijing 100043, P.R. China
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13
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Gungor L, Polat M, Ozberk MB, Avci B, Abur U. Which Ischemic Stroke Subtype Is Associated with Hyperhomocysteinemia? J Stroke Cerebrovasc Dis 2018; 27:1921-1929. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/05/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022] Open
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14
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Wang F. Continuous improvement of nursing quality in patients with cerebral infarction and dyspepsia. Shijie Huaren Xiaohua Zazhi 2018; 26:537-542. [DOI: 10.11569/wcjd.v26.i8.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To study the effect of continuous improvement of nursing quality on negative emotions, digestive system symptoms, and quality of life in patients with cerebral infarction and dyspepsia.
METHODS Ninety-two patients with cerebral infarction complicated with dyspepsia treated at our hospital from June 2015 to August 2017 were selected and randomly divided into a control group (n = 46) and a study group (n = 46). Both groups were given routine nursing care, and the study group was additionally given continuous improvement of nursing quality. Both groups were nursed for 1 mo. The scores of negative emotions [depression (SDS) and anxiety (SAS)], quality of life (GQOLI-74) scores, digestive system symptoms (nausea, loss of appetite, abdominal distension, belching, and early satiety scores) before and after nursing and the degree of satisfaction with nursing were compared between the two groups.
RESULTS After 1 mo of nursing, the scores of SDS and SAS in both groups decreased significantly compared with those before nursing, and the scores were significantly lower in the study group than in the control group (P < 0.05); GQOLI-74 scores in both groups were higher than those before nursing, and the score was significantly higher in the study group than in the control group (P < 0.05); and the scores of appetite, nausea, bloating, belching, and early fullness in both groups were lower than those before nursing, and the scores were significantly lower in the study group than in the control group (P < 0.05). The degree of satisfaction with nursing was significantly higher in the study group than in the control group (93.48% vs 76.09%, P < 0.05).
CONCLUSION Continuous improvement of nursing quality in patients with cerebral infarction complicated with dyspepsia can effectively alleviate negative emotions, improve their quality of life, reduce digestive system symptoms, and effectively improve the satisfaction with nursing care.
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Fan H, Yang S, Li Y, Yin J, Qin W, Yang L, Yuan J, Hu W. Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction. Eur Neurol 2017; 79:54-62. [PMID: 29208848 DOI: 10.1159/000484893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although increasing evidence has demonstrated that elevated homocysteine (Hcy) levels may be an important contributor for the development of cerebral infarction, rare studies focused on its diagnostic and early prognostic roles in acute lacunar infarction. METHODS A total of 197 patients with acute lacunar infarction and 192 to form the control group were prospectively recruited between January 2013 and February 2017. Early neurological deterioration was defined as an increase of ≥2 points in National Institutes of Health Stroke Scale or the decrease in Barthel index (BI) score at discharge. RESULTS Univariate and multivariate logistic regression analyses revealed that higher levels of fibrinogen and Hcy were independently clinical predictors associated with lacunar infarction. Receiver operating characteristic curves analysis demonstrated that the diagnosis value of Hcy was superior to fibrinogen, with the area under the curve of 0.881 and 0.688 respectively. Using the optimal cutoff value of 15.5 μmol/L of Hcy, a sensitivity of 65% and a specificity of 100% were achieved for predicting lacunar infarction. Hcy was only significantly related with BI reduction in the males (30.5 [15.5-65.5] vs. 18 [15-24], p = 0.034) in the univariate analysis but not in the females and the multivariate analysis. CONCLUSIONS Serum Hcy may be an independent diagnostic and not an early prognostic biomarker for patients with acute lacunar infarction.
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Sobczyńska-Malefora A, Cutler J, Rahman Y. Elevated homocysteine with pseudo-homozygosity for MTHFR677T as predisposing factors for transient ischemic attacks: a case report. Metab Brain Dis 2016; 31:1205-8. [PMID: 27431289 DOI: 10.1007/s11011-016-9875-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
A 21 year old male presented with a history of intermittent, transient neurological events. A brain MRI showed an area of restricted diffusion in keeping with an infarct, and an angiogram demonstrated an intracranial stenosis in the internal carotid artery, consistent with atherosclerosis. Laboratory investigations revealed a highly elevated plasma homocysteine, with low plasma folate and 5-methyltetrahydrofolate and methionine at the lower end of the normal ranges. The homocysteine normalized following treatment with folic acid. Molecular analysis found heterozygosity for the common MTHFR c.665C > T (aka 677C > T) variant and heterozygosity for a c.3G > C nucleotide substitution, which result in the lack of translation from this allele. It is proposed that the loss of p. Met1, coupled with folate deficiency, may be significant for the remethylation process, and may have contributed to the neurological events in this patient. If the two genetic variants are on alternate alleles, the patient would present with pseudo-homozygosity for MTHFR677T. It is probable that the combination of pronounced dietary folate deficiency, an MTHFR 'null allele' and the 677 T variant is sufficient to explain both the moderate hyperhomocysteinaemia and the clinical presentation in this patient. This case highlights the need to investigate other possible mutations in MTHFR, particularly in the absence of homozygous MTHFR 677C > T status in premature cardiovascular events.
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Affiliation(s)
- A Sobczyńska-Malefora
- The Nutristasis Unit, Haemostasis & Thrombosis, Viapath, St. Thomas' Hospital, London, UK.
| | - J Cutler
- Molecular Haemostasis Laboratory, Haemostasis & Thrombosis, Viapath, St. Thomas' Hospital, London, UK
| | - Y Rahman
- Inherited Metabolic Disease Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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