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    20 December 2011, Volume 6 Issue 12
    主编手记
    Quality Supporting Life
    WANG Yong-Jun
    2011, 6(12):  931-934. 
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    述评
    T3 Stage Should Be Paid Attention to Translational Medical Research of Cerebrovascular Diseases in China
    WANG Yi-Long;WANG Chun-Xue;WANG Yong-Jun
    2011, 6(12):  935-937. 
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    论著
    Epidemiological and Medical Profile of Inpatients with Cerebrovascular Disease in Beijing (2007-2009)
    LIU Gai-Fen;WANG Yi-Long;ZHOU Yong;et al
    2011, 6(12):  938-942. 
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    Objective To understand the epidemiological and medical risk profile of inpatients with cerebrovascular disease in Beijing, e.g., distribution of age, gender, stroke subtype, and prognosis, disease burden and medical quality, and provide evidence for make strategy for cerebrovascular disease prevention and treatment, and to evaluate the effectiveness of its prevention and treatment.Methods The data was obtained from "The Database of Inpatient Record from Level 2 and 3 hospitals" administered by Beijing Public Health information Center. Data of cerebrovascular disease in 2007-2009 were analyzed on demographic, disease characteristics, prognosis and health economic indicators through description analysis. Furthermore, the trend on changes over years was statistically tested.Results In the year of 2007, 2008 and 2009, there were 87 729, 99 369 and 109 829 inpatients diagnosed as cerebrovascular disease, respectively. The average age was (65.29±13.56), (65.29±13.47) and (65.26±13.68)years old for 2007, 2008 and 2009 with no significant difference (F=0.13, P=0.81). However, the proportion of patients aged from 45 to 60 showed significantly increased(Z=10.11, P<0.01).There were 59.58%, 58.6% and 58.7% of male in 2007, 2008 and 2009, respectively. As for the proportion of stroke subtype, the top five were ischemic stroke(50.0%), transient ischemic attack(20.0%), intracerebral haemorrhage(8.3%), sequelae of cerebrovasculardisease(3.0%) and subarachnoid haemorrhage(1.6%) in order. The in hospital case-fatality was 3.6%, 3.2% and 2.8% in 2007, 2008 and 2009 respectively, with a significant decreasing trend(Z=11.10, P<0.05). The median of length of hospital stay was 15-16 days, and the median of total medical cost per-person ranged from 8848 in 2007 to 9824 in 2009.Conclusion There is huge number of inpatient with cerebrovascular disease in Beijing, which leads to very heavy disease burden. Compared to developed countries, the proportion of stroke subtype is similar, whereas the average age of inpatients is much younger, and the length of hospital stay is longer. The in hospital case-fatality decreased over years. These findings would provide realizable evidence to make strategies to prevent and treatment cerebrovascular disease in Beijing, and to evaluate its effectiveness.

    Value of Computed Tomography Angiography Source Images Spot Sign Forecasting Hematoma Enlargement in Acute Hypertensive Intracerebral Hemorrhage
    HOU Xin-Yi;GAO Pei-Yi
    2011, 6(12):  943-946. 
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    Objective To explore the spot sign on computed tomography angiography source image(CTA-SI) in order to assist in individualizing therapeutic decisions for patients by possibly forecasting hematoma enlargement.Methods Fifty-three patients with spontaneous intracerebral hemorrhage(ICH) were examined by non-contrast computed tomography(CT) and computed tomography angiography(CTA) within 6 hours after symptom onset. CTA-SI was reviewed by 3 neuroradiologists to make sure presence or absence of the spot sign. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images.Results Thirteen patients(24.5%) present of spot sign. Hematoma expansion occurred in 15 patients(28.3%) on follow-up. In which 12 patients present of spot sign. Sensitivity, specificity, positive predictive value, and negative predictive value for expansion were 80.0%, 97.4%, 92.3%, 92.5%, respectively. In patients with the spot sign, hematoma volume has significant difference in first and second CT images(P<0.05). In patients without the spot sign, hematoma volume has no significant difference in first and second CT images(P>0.05).Conclusions In acute ICH patients, CTA spot sign provided more radiological information that maybe assisted in individualizing therapeutic decisions for patients by possibly forecasting hematoma enlargement.
    Study of Blood Pressure Variability in Acute Cerebral Infarction with Obstructive Sleep Apnea Syndrome
    YU Feng-Chun;LIU Yong-Zhen;TANG Xiao-Mei;et al
    2011, 6(12):  947-953. 
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    Objective To assess the blood pressure variability(BPV) in acute infarction with obstructive sleep apnea syndrome(OSAS), and to explore the relationship between BPV and stroke.Methods We studied patients with acute cerebral infarction. All of the patients were admitted to the department of neurology, Beijing Haidian Hospital, from Jan. 2009 to Jun. 2010. Overnight polysomnography(PSG) and 24-hour ambulatory blood pressure monitoring recordings were performed on all patients within the first week from the onset of the ischemic stroke. According to the PSG, patients were divided into OSAS group(n=126) and non-OSAS group(n=51) except the patients with central and mixed sleep apnea syndrome and taking anti-hypertension drugs. BPV was expressed as the standard deviation of blood pressure(BP) during a 24 period. The aim of study is to determine the relationships in BP, BPV, the National Institutes of Health Stroke Scale(NIHSS), and so on between groups. Data was analyzed by spss11.5. We used for nominal variables the χ2 test or t test. Singnificance was set at P<0.05. The correlations between the baseline data, clinical complications and recurrent stroke were studied.Results There were significantly higher daytime systolic(138.9±17.8 mmHg vs 131.4±15.8 mmHg, and P-value is less than 0.01), nighttime BPV(12.1±4.7 mmHg vs 8.8±3.7 mmHg, and P-value is less than 0.01) in the OSAS group as compared to the non-OSAS group. There were significantly differences in NIHSS and the number of recurrence stroke between two groups. Hypertention, diabetes mellitus, OSAS, apnea hypopnea index(AHI) and nighttime BPV were related to recurrent stroke(P<0.05). After adjustment for the other factors, nighttime BPV(OR 0.910, 95%CI 0.855-0.969, P=0.003) was a independent risk factor of recurrent stroke.Conclusion The nighttime-BPV was higher in the OSAS group as compared to the non-OSAS group. The BPV was one of the reasons of recurrence of stroke in patients with OSAS.
    Role of Critical Closing Pressure on Cerebral Blood Regulation on Rats
    GAO Qing-Chun;LU Lin;LI Zhen-Dong;et al
    2011, 6(12):  954-959. 
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    Objective To validate the role of the model of critical closing pressure(CCP) on cerebral blood regulation.Methods After renovascular hypertensive rats(RHR) were made, the cerebral blood flow velocity(CBFV) and artery blood pressure were monitored simultaneously. The values of CCP and arteriolar resistance were worked out according to CCP theory. The difference of indexes between RHR and control were compared. The relationship between hemodynamics parameters and the association between hemodynamics and arteriolar morphological indexes were evaluated.Results The effective cerebral perfusion pressure(CPPe) and resistance-area product(RAP) in RHR(100.8±26.4 mmHg, 2.94±0.85) increase more following artery blood pressure rising, compared with those in control(67.3±13.1 mmHg, 2.30±0.59)(P<0.001, P=0.003), while CBFV is steady and cerebral vascular resistance(CVR) increase slightly. RAP correlates with arteriolar luminal radius negatively(rs=-0.610, P=0.001) and CCP associates with arteriolar media thickness positively(rs=0.554, P=0.006) whilst CVR has both correlations with luminal radius(rs=-0.463, P=0.023) and media thickness(rs=0.678, P=0.000).Conclusion The cerebral blood regulation on rats can be more effectively evaluated by dynamic adjusting of CCP and RAP comparing with CVR.
    Research on the Risk Factors for White Matter Lesions in Ischemic Stroke
    WEI Na;SHEN Dong-Chao;ZHANG Yu-Mei;et al
    2011, 6(12):  960-966. 
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    Objective To evaluate the situation and risk factors of cerebral white matter lesions in ischemic stroke patients to decrease the prevalence.Methods Four hundred and eighty-three consecutive inpatients from Aug. 2007 to Oct. 2008 with acute ischemic stroke were enrolled into our study that was divided into two groups (with and without white matter lesions). Incidence and risk factors of white matter lesions were evaluated. Logistic regressions were applied to analyze related independent influencing factors.Results Of all the 483 patients, white matter lesions presented in 58.3%, the prevalence and severity of white matter lesions increasing with age(P<0.01). Logistic regression analysis indentified advanced age(OR=1.03, 95%CI 1.00-1.05, P<0.05), history of hypertension(OR=1.77, 95%CI 1.07-2.91, P<0.05), history of stroke(OR=1.71, 95%CI 1.02-2.88, P<0.05), the level of glucose(OR=1.07, 95%CI 1.00-1.15, P<0.05) and lacunar infarction(OR=1.89, 95%CI 1.17-3.06, P<0.05) as being significantly and independently associated with presence of white matter lesions.Conclusion The prevalence and severity of white matter lesions increasing with age. The presence of white matter lesions is significantly associated with age, history of hypertention and stroke, the level of glucose and lacunar infarction.
    专题论坛
    Comparative Effectiveness Research and China's Health Reform
    WANG Yi-Long;WANG Xian-Wei;XU Jie;et al
    2011, 6(12):  968-970. 
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    Impact of the Health Insurance Portability and Accountability Act on Clinical Research
    YAN Na;WANG Yi-Long;LI Zi-Xiao;et al
    2011, 6(12):  971-974. 
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    病例讨论
    Study on a Case with Left Subclavian Artery Stent Fracture and In-Stent Thrombosis
    CAO Yi-Bin;WANG Hai-Ying;YAO Hai-Xin;et al
    2011, 6(12):  975-978. 
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    指南与规范
    Practice Standards for Transcranial Doppler (TCD) Ultrasound.Part II. Clinical Indications and Expected Outcomes
    CHEN Jie;GAO Shan
    2011, 6(12):  979-987. 
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    综述
    Development of Registry for Quality of Stroke Care and Continuous Quality Improvement in the United States
    LI Zi-Xiao;WANG Yi-Long;David Wang;et al
    2011, 6(12):  988-992. 
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    Stroke is the second commonest cause of death and leading cause of adult disability worldwide. Healthcare systems throughout the world including America face the vexing problem of improving healthcare quality while at the same time confronted with ever-increasing costs. Over recent years, several healthcare organizations and entities in the United States have undertaken initiatives related to measuring and improving the quality of care provided to patients with stroke patients. We make a review about these main initiatives to provide a reference for current initiatives of measuring and improving the quality of stroke care in China.
    Quality Stroke Care, Its History, Current Status and Challenges in the USA
    David Wang;WANG Yong-Jun
    2011, 6(12):  993-1000. 
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    Stroke affects the whole world. To access to quality stroke care is challenging in every country. According to the situation, this review introduces history of healthcare quality improvement and stroke care quality improvement initiative in the US, then challenges the US faces in quality stroke care are described. Finally, the review makes some thoughts about the challenges of providing quality stroke care in China.
    教学园地
    Application of Problem-Based Learning Method in Clinical Practice of Neurology
    PAN Hua;ZHANG Xing-Hu;ZHANG Zai-Qiang;et al
    2011, 6(12):  1001-1002. 
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