Table of Content

20 November 2015, Volume 10 Issue 11

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Eternal Shining Socrates

WANG Yong-Jun

2015, 10(11):  913-914. 

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Endovascular Treatment of Intracranial Dissecting Aneurysms under Positive and Steady Way

LIU Ai-Hua, JI Wen-Jun, LI You-Xiang

2015, 10(11):  915-917. 

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Endovascular Treatment of Unruptured Posterior Cerebral Artery Dissecting Aneurysms

JI Wen-Jun, KANG Hui-Bin, SUN Li-Qian, et al.

2015, 10(11):  918-922. 

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Objective To explore the clinical characteristics and clinical effect of endovascular treatment of unruptured posterior cerebral artery dissecting aneurysms. Methods We consecutively enrolled 20 cases with unruptured posterior cerebral artery dissecting aneurysm in department of interventional neuroradiology of Beijing Tiantan Hospital from January 2012 to December 2014. Clinical data were collected and we followed up the cases by imaging and telephone. Results For 20 cases of posterior cerebral artery dissecting aneurysms, male in 11 cases (55.0%), female in 9 cases (45.0%), age (46.2±15.5) years. 4 cases were in P1 segment (20.0%), 12 cases were in P2 segment (60.0%), 2 cases were in P1-2 segment (10.0%), 2 cases were in P3 segment (10.0%). Embolization only by coils was for 3 cases (15.0%), and parent artery occlusion was for 11 cases (55.0%), stent-asissted coiling was for 6 cases (30.0%). Instant imaging results by Raymond scale (class1 to class 3): class 1 in 15 cases (75%), class 2 in 5 cases (25.0%). Ischemic events occurred in 2 cases (10.0%) after procedures and recovered after 3 months of antisypotomatic treatment. Imaging was followed up in 16 cases for 10.5 (6.5) months. Imaging results of follow-up by Raymond scale: class 1 in 13 cases (81.3%) and class 2 in 2 cases (12.5%). 1 case (class 3, 6.2%) was recurrent and received the second endovascular treatment with stent-assisted coiling, the case was not recurrent in 6 months follow-up. Clincal follow-up was carried out in 20 cases for 12 (9.3)months, mRS 0 was in 9 cases (45.0%), mRS 1 was in 5 cases (25.0%), mRS 2 was in 5 cases (25.0%), mRS 3 was in 1 case (5.0%), rate of good prognosis was 95.0%. Conclusion Unruptured posterior cerebral artery dissecting aneurysms ware mainly located in P2 segment, embolization based on location, the clinical results were satisfactary.

Relationship between Cerebral Small Vessel Disease and Outcome of Ischemic Stroke

ZHANG Chang-Qing, WANG Yi-Long, WANG Chun-Xue, et al.

2015, 10(11):  923-929. 

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Objective To investigate the relationship between cerebral small vessel disease and the outcome of ischemic stroke. Methods Overall, 791 patients within 7 days of their first-ever non-cardiogenicischemic stroke were enrolled consecutively. Demographic information, vascular risk factors were recorded. We evaluated cranial magnetic resonance imaging includingseverity of leukoaraiosis, number of silent lacunar infarction(SLI), etiologic subtype of ischemic stroke, and topographic patterns of acute cerebral infarcts. Factors associated with the outcome of ischemic stroke were analyzed. Results A total of 14 patients (1.8%) died, and 38 patients (4.8%) developed recurrence of ischemic stroke or transient ischemic attack(TIA) in one year after stroke onset. In multivariable logistic regression analysis, presence of SLI, and presence of acute cortical cerebral infarction, without antithromboticsat admission, without statins at discharge were predictors of death in one year, while leukoaraiosis had no influence on death in one year.Coronary heart disease,admission National Institute of Health stroke scale <4, responsible artery stenosis ≥70%, and without antithrombotics at discharge were risk factors associated with recurrence of ischemic stroke or TIA in 1 year, while leukoaraiosisand SLI had no impacts on recurrence of ischemic stroke or TIA in 1 year.Conclusion Presence of SLI werepredictors of death at one year after stroke. However, leukoaraiosis and SLI had no influence on the recurrence of ischemic stroke or TIA in 1 year.

Trend Analysis on the Mortality of Cerebrovascular Diseases among Residents in Jing’an District of Shanghai from 1975 to 2014

ZHANG Xin, YANG Xiao-Ming, CHU Xiao-Ting, et al.

2015, 10(11):  930-934. 

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Objective To analyze the trend of the mortality of cerebrovascular diseases among residents in Jing’an District of Shanghai from 1975 to 2014, and to provide scientific evidence for developing effective prevention and control strategies. Methods Based on the death surveillance data of Jing'an District residents of Shanghai from 1975 to 2014, to calculate the crude mortality, standardized mortality rate, and to explore the trend of mortality and average age of death of cerebrovascular diseases. Results The crude mortality of cerebrovascular diseases was 16 560/105, the standardized mortality rate was 12 054/105, and there is no significant difference between genders. There was an increasing tendency of crude mortality of cerebrovascular diseases from 1975 to 2014 (χ 2=10.58, P <0.01), and the standardized mortality rate decreased linearly. Take time-series linear trend fitting with AUTOREG process of SAS system. The regression model is meaningful(t =32.13, P <0.01). The trend of average age of death of cerebrovascular diseases increased linearly.Take time-series linear trend fitting with AUTOREG process of SAS system. The regression model is meaningful(t =260.46, P <0.01). Conclusion The results of this study suggest that the incidence of cerebral vascular disease will continue to increase. But the high disability rate and high recurrence rate of cerebral vascular disease, and the survival age rising year after year indicates that they will bring a heavy burden of disease. Therefore, the government should further strengthen the first grade prevention of cerebral vascular disease, and the average expectancy life will be improved, so the average health life.

Characteristics of Oligodendrocytes Regeneration Dysfunction in Vascular CognitiveImpairment Mice

LI Hai-Long, ZHENG Hui-Wen, LIU Min, et al.

2015, 10(11):  935-940. 

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Objective To observe the neurogenesis in subventricular zone and regeneration of oligodendrocyte in dentate gyrus of hippocampus in a mice model of vascular cognitive impairment(VCI). Methods Adult CD1 males mice were randomly divided into model group and sham group with 24 mice in each group. Mice in model group were subjected to repeated bilateral carotid artery occlusion and reperfusion to establish the animal model of VCI. Mice in sham group were conducted the same surgery expect occluding carotid artery. All mice were administrated 5-bromine deoxidization uracil nucleoside (150 mg/kg, intraperitoneal injection, qd) from the post operation day(POD) 4 to 6. On POD 14 and 28, 12 mice from each group were deeply anesthetized and transcardially perfused with phosphate buffered saline(PBS) respectively. Brain frozen sections were prepared for immunohistochemical and immunofluorescence double staining to observe the new cell proliferation and neuronal regeneration in subventricular zone on POD 14 and POD 28, and the regeneration of oligodendrocytes and expression of newborn astrocytes in dentate gyrus on POD 28. Results On POD 14 and 28, there were both significant differences in the number of newborn cells in subventricular zone between two groups (P <0.001). Compared with sham group, on POD 28, thenumber of newborn neuron in subventricular zone of mice from model group increased significantly (P <0.001). Compared with sham group, the number of oligodendrocytes progenitor cells in dentate gyrus was significantly increased in model group on POD 28 (P <0.001), with pre-oligodendrocytes reduced (P =0.006) and mature oligodendrocytes decreased but with no statistically significant difference (P =0.161). Compared with sham group, the number of new born astrocytein the dentate gyrus increased significantly in model group (P =0.015). Conclusion There was endogenous neurogenesis in VCI mice, but the regeneration of mature oligodendrocytes in dentate gyrus was dysfunction, which might be the cause of white matter hyperintensities displayed in magnetic resonance imaging(MRI) of patients with VCI.

Meta Analysis for the Clinical Differences Between Branch Atheromatous Disease and Lacunar Infarction

LIU Guang-Zhi, CAO Jiang-Hui, MEI Bin, et al.

2015, 10(11):  941-946. 

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Objective To make a further comparison for the clinical differences between branch atheromatous disease(BAD) and lacunar infarction(LI). Methods We searched the Chinese and foreign language databases for relevant studies. Statistical analysis were performed by RevMan 5.2 software. Results In China, BAD patients were younger than LI patients(MD -2.70, 95%CI -4.29~-1.11, P <0.01); In Japan, BAD patients were older than LI patients(MD 2.58, 95%CI 0.75~4.41, P <0.01). Hyperlipidaemia affected more BAD patients(OR 1.26, 95%CI 1.03~1.55, P =0.03). After the sensitivity analysis, diabetes mellitus(OR 1.28, 95%CI 1.02~1.61, P =0.03), initial national institutes of health stroke scale(NIHSS score)(MD 0.76, 95%CI 0.50~1.02, P <0.01) and prognosis (OR 0.54, 95%CI 0.38~0.77, P <0.01) showed significant differences between BAD and LI. Conclusion Hyperlipidaemia and diabetes mellitus affected more BAD patients, compared to LI patients. The nerve functional and prognosis of BAD patients were worse than LI patients. The characteristic of age distribution in Chinese BAD and LI patients was contrary to Japanese.

Analysis of Factors Correlated with Early Prognosis of Minimal Invasive Hematoma Aspiration and Fibrinolysis

YANG Bo, WANG Jing, WEN Miao, et al.

2015, 10(11):  947-952. 

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Objective To investigate the prognosis of supratentorial intracerebral hemorrhage afterminimal invasive hematoma aspiration and fibrinolysis and find out the influential factors. Methods Patients who were diagnosed as supratentorial intracerebral hemorrhage and underwent minimal invasive hematoma aspiration and fibrinolysis in Beijing Tiantan Hosipital were enrolled from July 2010 to February 2014. Clinical data such as: risk factors of stroke, chemical examination of blood, clinical features and information of surgical procedure were collected. The prognosis (Glasgow score, GCS) at 30-day after operation/discharge from hospital were followed up, and Logistic regression analysis was used to find out factors that influence early prognosis. Results Total 94 patients were enrolled in this study (60 were male), aged from 23 to 84 years (mean age 54.85±12.70). Sixty-two patients were alertness or mild consciousness disorders(GCS 13-15) (65.9%) at 30 day after operation/discharge from hospital, 32 patients were death or GCS≤12(34.1%). Logistic regression analysis showed that age, preoperative GCS were the independent predictors of prognosis. Conclusion Minimal invasivehematoma aspiration and fibrinolysis is a better minimally invasive method which deserves popularizing.

Research Progress on Imaging of Intracranial Arterial Dissection

XU Wen-Juan, KANG Hui-Bin, JI Wen-Jun, et al.

2015, 10(11):  954-957. 

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Intracranial artery dissection is a major factor of the youth’s stroke. It mainly causes subarachnoid hemorrhage or posterior circulation ischemia. The rate of disability and mortality of intracranial artery dissection are quite high. Due to the lack of specific symptoms and signs, intracranial artery dissection is often neglected or made a wrong diagnosis by the doctors. We need to develop a unified standard of the disease’s diagnosis based on clinical imaging and classification. This paper is to investigate the recent status and related progress of the studies of intracranial arterial dissection imaging.

Research Progress on Mechanisms in Intracranial and Extracranial Arterial Dissection and Dissecting Aneurysms

LI Xiu-Zhen, JI Wen-Jun, KANG Hui-Bin, et al.

2015, 10(11):  958-961. 

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Intracranial and extracranial arterial dissection and dissecting aneurysm prevail in young patients, more occur spontaneously, and etiology is not clearly understood. The physiopathological mechanism is unreversable inner membrane and internal elastic layer injuries of arterial wall. High resolution magnetic resonance imaging(MRI) increases the occurrence of intracranial and extracranial arterial dissection and dissecting aneurysm and implies a new study trend. This paper reviews the etilogy, physiopathological mechanisms, pathological classification and current status and prospective of extracranial arterial dissection and dissecting aneurysm.

A Case of Balloon Occlusion Treatment for Unruptured Vertebral Artery Dissecting Aneurysm Involving the Posterior Inferior Cerebellar Artery

KANG Hui-Bin, JI Wen-Jun, LIU Ai-Hua, et al.

2015, 10(11):  962-965. 

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Guidelines for the Primary Prevention of Stroke:A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association (Part 10)

XU Sheng-Yuan,SONG Zhe, WANG Li-Feng, et al.

2015, 10(11):  966-973. 

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Progress of Studies Relevant to the Roles of Micro Ribonucleic Acids in Ischemic Stroke

LI Hai-Long, BI Xiao-Ying

2015, 10(11):  974-979. 

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Recent years, it has been found that micro ribonucleic acids(miRNAs) is a type of RNA proteins which has special role in the regulation of gene expression. Recent studies also found that a few of miRNAs performed unique roles in the etiology, diagnosis, and treatment of ischemic stroke. We summarized researches on the roles of miRNAs related to multiple risk factors, biological marker, and treatment of ischemic stroke, in order to provide reference and helpfor future basic and clinical studies on stroke relevant to miRNAs.

Application of Role-Playing Teaching Method for Training of Refresher Physician in the Vascular Neurology

LI Zi-Xiao, WANG Yi-Long, ZHAO Xing-Quan, et al.

2015, 10(11):  980-982. 

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Objective To explore the effect of role-playing teaching method (RPTM) on training of refresher physicians in the vascular neurology. Methods Role-Playing Teaching Method (RPTM) and classical methods were applied separately in teaching of patients with acute cerebrovascular diseases among 20 refresher physicians who were randomized into 2 groups and the effects of these teaching methods were evaluated by questionnaire survey among these students. Results Compared with the classical teaching method, RPTM method could significantly improve refresher physicians’ abilities in independent learning, finding problems, solving problems, medical practice, holistic treatment, communicating between doctors and patients, working as a team, extending medical knowledge. Conclusion The ability of refresher physicians in holistically treating patients with acute cerebrovascular diseases has been statistically improved by the application of RPTM.

Problem-based Learning in the Teaching of Dizziness Diagnostics for Further-studying Physicians

JIAN Fan, PAN Hua, ZHANG Ning, et al.

2015, 10(11):  983-985. 

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Objective To explore the value of problem-based learning (PBL) in the teaching of dizziness diagnostics for further-studying physicians of neurology. Methods Twenty further-studying neurologists at Beijing Tiantan Hospital were randomized into PBL group and traditional lecture-based learning (LBL) group. After the courses, an examination was performed to compare teaching effect between groups. Results The PBL group achieved a significantly (P <0.05) higher score than the LBL group for case analysis and total points. The performance in theoretical knowledge tests was slightly better for the PBL students, but without statistical difference between groups (P >0.05). Conclusion PBL is effective in teaching of dizziness diagnostics for further-studying physicians, which can foster clinical thinking and problem-solving ability of students. A preparatory training in literature retrieval and basic knowledge maybe further improve the quality of PBL teaching practice.

The promotion of Humanistic Quality of Postgraduate Students Major in Vascular Neurology from Concerning The affective Disorders in Patients with Stroke ——Introduction to Teaching Experience of Post-stroke Depression

WANG Chun-Xue, SHI Yu-Zhi, ZHANG Ning

2015, 10(11):  986-988. 

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Objective To investigate the effectiveness of the teaching of post-stroke depression (PSD) on promotion of humanistic quality of postgraduate students major in vascular neurology. Methods Evaluation the humanities quality of postgraduate students major in vascular neurology in Beijing Tiantan Hospital, Capital Medical University before and after the teaching of PSD and activities of concerning on emotion disorders in patients with stroke. Results Through the teaching of PSD, post-graduate students paid more attention to emotional disorders in patients with stroke, and had communication skills and physician-patient relationship improved. Conclusion Humanistic quality of postgraduate students major in vascular neurology was well prompted through the teaching of post-stroke depression.