Chinese Journal of Stroke

Art of Solution

WANG Yong-Jun

2016, 11(11): 903-903. DOI: 10.3969/j.issn.1673-5765.2016.11.001

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Stroke and Sleep Disorders

YU Feng-Chun, ZHOU Zheng-Hong

2016, 11(11): 905-911. DOI: 10.3969/j.issn.1673-5765.2016.11.002

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Correlation Analysis of Obstructive Sleep Opnea and Wake-up Stroke

LIU Wei, ZHOU Zheng-Hong, SHI Dong-Mei, et al.

2016, 11(11): 912-917. DOI: 10.3969/j.issn.1673-5765.2016.11.003

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Objective To explore the relationship between obstructive sleep apnea (OSA) and wake-up stroke (WUS). Methods The clinical data of patients with ischemic stroke accompanied with OSA were analyzed retrospectively. The patients received sleep monitoring examination at night and were divided into WUS group and non wake-up stroke (non-WUS) group. The differences of the clinical data, National Institutes of Health Stroke Scale (NIHSS) score, etiology and the slee respiratory parameters were compared between the two groups. Results A total of 96 patients were included, among whom, there was 74 cases in non-WUS group and 22 cases in WUS group. The body mass index (BMI) (P =0.030), apnea-hypopnea index (AHI) (P =0.001), and oxygen desaturation index (ODI) (P =0.001) in WUS group were higher than those in non-WUS group. The mean blood pulse oxyhemoglobin saturation (P =0.002) in WUS group was lower than which in non-WUS group. Binary logistic regression analysis indicated that the independent risk factor for WUS was AHI (odds ratio [OR ] 1.162, 95% confidence interval [CI ] 1.007~1.341). Conclusion BMI, AHI, ODI and mean blood pulse oxyhemoglobin saturation are associated with WUS. AHI is an independent risk factor for WUS.

Correlation of Daytime Sleepiness and Acute Ischemic Stroke

XIE Zi-Zhen, LI Chang-Hong,MENG Xiao-Mei, et al.

2016, 11(11): 918-922. DOI: 10.3969/j.issn.1673-5765.2016.11.004

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Objective By analyzing the relationship between daytime sleepiness and neurological function prognosis in patients with acute stroke, to explore the relationship between daytime sleepiness and acute ischemic stroke. Methods Patients with acute ischemic stroke within 48 hours were consecutively enrolled from Beijing Haidian Hospital during June 2015 to September, 2015. And data were collected including demographics, chronic disease history, National Institutes of Health Stroke Scale (NIHSS) on admission and the 14th day, and Epworth Sleepiness Scale (ESS) on admission. ESS 1 month before admission, which is the premorbid ESS, were retrospectively evaluated. The correlation between premorbid ESS with demographics, chronic disease history, NIHSS on admission and the 14th day, delta NIHSS (the result of NIHSS on admission minus NIHSS of the 14th day) and ESS on admission were analyzed. According to premorbid ESS, patients were divided into sleepiness group and non-sleepiness group, compared NIHSS on admission and the 14th day, delta NIHSS and ESS on admission between two groups. Results One hundred and six patients were consecutively enrolled. The results showed that ① Premorbid ESS had positive correlation with admission NIHSS, the 14th day NIHSS and admission ESS. Pearson correlation coefficient were 0.199, 0.276 and 0.407, and P values were 0.041, 0.004 and <0.001. Premorbid ESS had negative correlation with delta NIHSS. Pearson correlation coefficient was -0.189 and P value was 0.042. ② In daytime sleepiness group, admission NIHSS, the 14th NIHSS and admission ESS were significantly higher than in non-daytime sleepiness group. P values were 0.033, 0.043 and <0.001 respectively. In daytime sleepiness group, delta NIHSS was significantly lower than in non-daytime sleepiness group. P value was 0.046. Conclusion Premorbid daytime sleepiness patients will be more severely on admission and in 14th day, meanwhile their prognosis in the acute phase is worse. The degree of daytime sleepiness will aggravate when ischemic stroke happens.

Correlation of Sleep Quality, Life Event with Cerebral Infarction

ZENG Si-Lin, GUO Yi,CAI Zhi-Li, et al.

2016, 11(11): 923-929. DOI: 10.3969/j.issn.1673-5765.2016.11.005

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Objective To explore the impact of life event stimulation and sleep quality on the incidence of cerebral infarction, and to further study its impact on the severity of cerebral infarction and poststroke mood disorder. Methods The patients with cerebral infarction and subjects without cerebral infarction were enrolled into the study. The general clinical data of two groups were compared to analyze the risk factors of cerebral infarction. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the 1-month sleep quality before cerebral infarction and life event stimulation assessment was performed by using Life Event Scale (LES). The Hamilton Depression Scale and the Hamilton Anxiety Scale were used in the first week of hospitalization to evaluate the emotional disorder. National Institutes of Health Stroke Scale (NIHSS), and Activity of Daily Living Scale (ADL) were used to evaluate the severity of the illness.

Results A total of 95 patients were enrolled in the cerebral infarction group and 85 patients were enrolled in the control group. Univariate analysis showed that the scores of LES in the cerebral infarction group were significantly higher than those in the control group [6.00 (14.00) vs 0.00 (6.25), P <0.001] and cerebral infarction group scored significantly higher than those in the control group on negative life event [6.00 (16.00) vs 0.00 (3.25), P <0.001]. The cerebral infarction group scored significantly higher than those in the control group on the total scores of PSQI [8.50 (7.00) vs 6.00 (6.5), (P =0.007)] and five factors of sleep quality, which were subjective sleep quality (P =0.021), sleep latency (P =0.034), sleep duration (P =0.002), sleep disturbances (P =0.023) and daytime dysfunction (P =0.012); Unconditional logistic regression analysis showed negative life event (odds ratio [OR] 1.054, 95% confidence interval [CI ] 1.003-1.108, P =0.038), sleep duration (OR 1.601, 95%CI 1.33-2.264, P =0.008) and diastolic blood pressure (OR 1.037, 95%CI 1.006-1.069, P =0.019) were the risk factors of cerebral infarction. In addition, the Hamilton Depression Scale score was significantly higher in patients with sleep disorders than in those without sleep disorders [9.00 (15.00) vs 0.00 (8.00), P =0.047]. Conclusion Life event and poor sleep quality have impact on the incidence of cerebral infarction. Negative life event, sleep duration and diastolic blood pressure are the independent risk factors of cerebral infarction. Sleep disorders before the onset of cerebral infarction may lead to more severe symptoms of post-stroke depression.

The Research of Endogenous Formaldehyde and Inflammatory Medium in the Pathogenesis of Vascular Dementia

WU Hai-Yan, MA Li, ZHANG Li, et al.

2016, 11(11): 930-933. DOI: 10.3969/j.issn.1673-5765.2016.11.006

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Objective To evaluate the correlation of inflammatory medium (interleukin-2, IL-2 and tumor necrosis factor-α, TNF-α) and vascular dementia (VaD), so as to provide the biochemical markers for clinical early diagnosis of VaD. Methods A total of 42 patients in outpatient and wards with VaD were taken as experimental group, and 54 cases in the community without cognitive impairment were taken as control group. The level of IL-2 and TNF-α in serum and the formaldehyde concentration (FA) in urine were detected. The FA/Cr was used as rectified concentration to compare the differences in above mentioned indexes between two groups. Results The concentration of urine formaldehyde is observably higher in VaD than in the control group (6.31±0.53 vs 4.40±0.31), which had statistical significance (P =0.007). Conclusion The concentration of urine formaldehyde in VaD patients was significantly increased. The increased formaldehyde concentration in the urine is expected to be one of the biomarkers in the diagnosis of VaD.

The Influence of Hyperglycemia at Acute Phase of Aneurysmal Subarachnoid Hemorrhage on One-year Mortality

HOU Zong-Gang, TAO Xiao-Gang, TIAN Run-Fa, et al.

2016, 11(11): 934-941. DOI: 10.3969/j.issn.1673-5765.2016.11.007

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Objective To investigate the glucose level at acute phase of aneurysmal subarachnoid hemorrhage (aSAH) on long-term outcome of patients. Methods Patients who were diagnosed as aSAH without history of diabetes and admitted within 3 h after onset by Beijing Tiantan Hospital, Capital Medical University were enrolled to assess fasting glucose on admission, day 14 and their variation. Multivariate Cox regression analysis was used to assess risk factors for 1-year mortality. Results A total of 239 aSAH patients without history of diabetes were enrolled and followed up in this study. Admission glucose levels were found to be positively associated with 1-year mortality (hazard ratio [HR] 1.415, 95% confidence interval [CI ] 1.166-1.718). Within 14 days after onset of disease, there were 85 cases of patients had increased blood glucose level compared with that of on admission and there were 146 cases of patients had decreased or unchanged level of blood glucose compared with that of on admission. The blood glucose increased group had obviously increased mortality rate compared with the decreased and unchanged group (61.54% vs 33.66%, P =0.006). In addition, higher blood glucose levels were also associated with an elevated 1-year mortality (HR 1.317, 95%CI 1.132-1.532). Conclusion Fasting glucose levels at admission and their variation within 14 d after aSAH are predictive factors of an elevated 1-year mortality rate.

The Change of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness

WANG Shu-Ran, QU Yuan-Zhen, YANG Liu

2016, 11(11): 942-946. DOI: 10.3969/j.issn.1673-5765.2016.11.008

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Objective To evaluate the changes of peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) thickness, RNFL defect and GCC loss rate. Methods Patients with unilateral severe stenosis (≥70% on angiography) or occlusion of internal carotid artery (ICA) who were diagnosed and treated in Beijing Tiantan Hospital from July, 2015 to July, 2016 were taken as study group and their data were retrospectively studied. Those who had no obvious stenosis by carotid artery ultrasound examination were taken as control group. Thicknesses of pRNFL and GCC and prevalence of RNFL defects and GCC loss measured by optical coherence tomography (OCT) in the eyes ipsilateral to ICA stenosis were compared with the contralateral eyes and with the eyes of control group. Results Fifty six patients with unilateral severe stenosis of ICA and 56 normal controls were analyzed. Mean thicknesses of pRNFL and GCC in the ipsilateral eyes (99.44±14.60 μm, 92.61±10.63 μm) of study group were significantly thinner than those of the contralateral eyes (107.01±9.96 μm, 96.48±9.73 μm, P =0.008, P =0.047) and the control group (110.47±6.48 μm, 96.86±5.00 μm, P =0.001, P =0.013). A higher prevalence of RNFL defects and GCC loss were found in eyes ipsilateral to ICA (33.9%, 53.6%) compared with contralateral side (12.5%, 26.8%, P =0.007, P =0.004). Conclusion Thicknesses of pRNFL and GCC decrease in patients with severe stenosis of ICA. RNFL and GCC assessed by OCT may be helpful in early detection of hypoperfusion induced by ICA stenosis.

Study on Effect of Ginkgo Ketone on Inflammatory Response and Cognitive Function in Patients with Acute Ischemic Stroke

CHENG Hong-Yu, ZHANG Xin-Jiang, LI Shan-Shan, et al.

2016, 11(11): 947-953. DOI: 10.3969/j.issn.1673-5765.2016.11.009

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Objective To investigate the effect of Ginkgo ketone ester dispersible tablets on the inflammatory reaction and cognitive function after ischemic stroke and its clinical significance. Methods This study was a prospective, multi-center, clinical randomized and controlled trial. Patients with acute ischemic stroke from Neurological Department in Nanjing Drum Tower Hospital and Yangzhou First People's Hospital during October 2012 to June 2014 were recruited and randomly divided into therapeutic group (Ginkgo ketone ester dispersible tablets (0.15 tid) combined with aspirin group (0.1 qd) and control group (aspirin group (0.1 qd), medication 180 d). Fresh blood was harvested before treatment and 13±1 days after treatment from enrolled patients. Serum inflammatory cytokines (IL-1β, IL-6, IL-15, IL-17A, IL-23 and TNF-α) were detected by Milliplex Map multiple detection techniques. National Institutes Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Mini-Metal State Examination (MMSE) and Montreal Cognitive

Assessment (MOCA) were applied to evaluate neurological deficits and cognitive decline before treatment and (13±1) d, (30±7) d, (90±7) d, (180±7) d after treatment, and to compare scale scores changes in two groups before and after treatment. Results A total of 60 patients were enrolled into study. Among whom, 8 cases were excluded due to non-eligible blood specimen; 27 cases of study group and 25 cases of control group were taken into statistical analysis. Treatment of (13±1) d, the serum IL-1 beta IL-1β ([1.55±0.43] pg/ ml vs [2.05±0.74] pg/ml, P <0.001), IL-15 ([1.88±0.82] pg/ml vs [3.17±1.93] pg/ml, P <0.001), IL-6 ([5.57±4.96] pg/ml vs [8.81±8.00] pg/ml, P =0.042), IL-17A ([5.11±1.51] pg/ml vs [6.67±2.24] pg/ ml, P <0.001), IL-23 ([0.42±0.88] pg/ml vs [0.67±0.98] pg/ml, P <0.001), TNF-alpha ([15.12±6.97] pg/ml vs [18.31±6.61] pg/ml, P =0.009) levels in therapeutic group were decreased significantly than that before treatment; while in the control group, only IL-15 ([2.01±0.72] pg/ml vs [2.53±1.20] pg/ml, P =0.036) level was significantly decreased compared with that of before treatment. After treatment (30±7) d, (90±7) d, (180±7) d in the therapeutic group, MMSE and MOCA scores were improved more significantly than that before treatment compared with the control group (P =0.036, 0.012 and 0.048), though the two scores were of no significant differences in two groups. Conclusion The combination of Ginkgo ketone ester dispersible tablets and aspirin can more obviously reduce serum inflammatory cytokines and improve their cognitive function compared with using aspirin alone in ischemic stroke patient.

Prognostic Value of Homocysteine, Hypersensitive C-Reactive Protein in One-Year Outcome of Acute Ischemic Stroke with Middle Cerebral Artery Stenosis

ZOU Xin-Ying, GONG Xi-Ping, PU Yue-Hua, et al.

2016, 11(11): 954-959. DOI: 10.3969/j.issn.1673-5765.2016.11.010

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Objective To investigate the correlation of inflammatory mediators, such as homocysteine (HCY) and hypersensitive C-reactive protein (hs-CRP), and the prognosis in acute ischemic stroke with middle cerebral artery stenosis. Methods The patients with acute noncardioembolic ischemic stroke with middle cerebral artery (MCA) stenosis were recruited, analyzed by MRA as none to mild (<50%), moderate (50%-69%), severe (70%-99%), or occlusive (100%). The peripheral levels of HCY and hs-CRP were recorded. All patients were assessed of 1-year outcome by modified Rankin Scale (mRS). Results Totally 977 patients satisfied the inclusion criteria and 952 of those carried out 1-year follow-up. The levels of HCY and hs-CRP had no significant differences in patients with categorized MCA stenosis. Compared to the patients with favorable outcome (248 subjects), those with unfavorable outcome (704 subjects) had higher levels of HCY and hs-CRP, but only hs-CRP was an independent predictor of unfavorable outcome (odds ratio [OR ] 1.060, 95% confidence interval [CI ] 1.027-1.093, P =0.0003). The combination of increased hs-CRP (>3 mg/L) and HCY

(>15 μmol/L) had higher power in predicting 1-year unfavorable outcome than the single elevated mediator (OR 4.487, 95%CI 1.994-10.098, P =0.0003). Methods Elevated hs-CRP independently predicts 1-year poor outcome in acute stroke. The combination of increased hs-CRP and HCY has a stronger predictive value in poor outcome than individual elevated mediator.

Johann Jakob Wepfer Stroke Prize

John H.Zhang

2016, 11(11): 960-960. DOI: 10.3969/j.issn.1673-5765.2016.11.011

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Situation Analysis of Time Delay of Pre-hospital and In-hospital of Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

LI Jing-Jing, TONG Xu, CAO Yi-Bin

2016, 11(11): 991-996. DOI: 10.3969/j.issn.1673-5765.2016.11.017

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Recombinant tissue plasminogen activator (rt-PA) with alteplase is the first choice to treat acute ischemic stroke (AIS) patients. There is a time limit for intravenous thrombolysis (IVT). Related studies showed that pre-hospital and in-hospital time delay was a major obstacle for AIS patients to receive intravenous thrombolytic therapy. This paper aimed to explore the current situation and influence factors of pre-hospital and in-hospital delay in the treatment of IVT, improvements to reduce the delay time, so as to establish standardized thrombolysis system and enhance service quality.

The Mode of Continuous Quality Improvement of Thrombolysis Based on the Green Channel
in Emergency Department —— a New Effective Way of Continuing Education for Vascular
Neurologists

WANG Chun-Juan, WANG Yi-Long, LI Zi-Xiao, et al.

2016, 11(11): 997-999. DOI: 11.3969/j.issn.1673-5765.2016.11.018

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Objective To investigate the educational effectiveness of the mode of continuous quality improvement (CQI) of thrombolysis based on the green channel in emergency department. Methods Continuing education and training were given to all the vascular neurologists who participated in the acute stroke team in 2012 and 2014 by the mode of CQI of thrombolysis based on the green channel. The rate difference of intravenous thrombolysis between the two periods was evaluated. Results Through the continuing education and training by the mode of CQI of thrombolysis based on the green channel, the rate of intravenous thrombolysis was significantly improved (33.5% vs 15.3%, P＜0.001). Conclusion The mode of CQI of thrombolysis based on the green channel in emergency department is an effective new way of continuing education and training for vascular neurologists.

Practice Analyses of Rapid Prototype Model-Assisted Medical Imaging Technology in Clinical
Teaching for Neurosurgery Postgraduates of the Teaching Hospital

WANG Hao, YE Xun,ZHAO Yuan-Li

2016, 11(11): 1000-1002. DOI: 11.3969/j.issn.1673-5765.2016.11.019

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Objective To analyze the effect of 3-D printing model-assisted traditional medical imaging technology in clinical teaching for neurosurgery postgraduates and explore new education teaching methods. Methods We taught junior neurosurgery postgraduates typical cases by using traditional medical imaging technology. The 3-D printing model-assisted traditional medical imaging technology was used in secondary teaching. We evaluated the new method by questionnaires and direct questions after teaching course. Results Students generally reflected that the sensory understanding and spatial recognition of the disease had a very big promotion after integrating the two technologies. However, the problems existing in current 3-D printing technology, such as low printing speed and shortness of simulation were the obstacles to the further understanding of diseases for students. Conclusion In the teaching field of neurosurgery postgraduates, 3-D printing model-assisted traditional medical imaging technology is a great potential method. With the development of 3-D printing technology, the advantage will become even more apparent.

Teaching Experience of Medical Clinical Postgraduates of Cardiovascular Disease

GAO Jie

2016, 11(11): 1003-1004. DOI: 11.3969/j.issn.1673-5765.2016.11.020

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The cultivation of postgraduates in clinical practice is crucial for the cultivation of surgery system, in particular to the postgraduates in the department of cardiovascular surgery. The positive working attitude, professional morality, clinical skills and operation procedures, technical innovation, clinical research, etc are the fundamental elements to become an excellent surgeon of cardiovascular diseases. At present, most of medical universities and colleges adopt the same cultivation system and model to cultivate clinical medical postgraduates. However, the factors of patient’s disease severity, high risk for operation and personal characteristics of each postgraduate should be taken into consideration of teaching. The education about strengthening professional value, operation skills, science and technology innovation, responsibility to patients, self-confidence could bring certain degree of help for the growth of postgraduates.

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