Chinese Journal of Stroke

Stroke: Glance Back 2016

WANG Yong-Jun

2017, 12(01): 1-11. DOI: 10.3969/j.issn.1673-5765.2017.01.001

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The Evolution and Interpretation of Diagnositic Creteria of Vascular Cognitive Impairment

SUN Yu,HAN Ying, DAI Jian-Ping

2017, 12(01): 13-17. DOI: 10.3969/j.issn.1673-5765.2017.01.002

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The Study on Influencing Factors of Vascular Cognitive Impairment no Dementia

MA Hong-Ying, LI Yu-Xia, LI Yong-Qiu, et al.

2017, 12(01): 18-22. DOI: 10.3969/j.issn.1673-5765.2017.01.003

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Objective To investigate the influencing factors of vascular cognitive impairment no dementia (VCIND). Methods Patients with VCIND in Tangshan Gongren Hospital from January 2014 to January 2016 were recruited into the study group and patients with no cognitive impairment were enrolled into the control group. The differences of vascular risk factors, laboratory data and thyroid hormone were compared between two groups. Logistic regression analysis was used to analyze the independent risk factor. Results There were 115 cases in the study group with VCIND and 147 in the control group. The proportion of hypertension (73.9% vs 53.1%, P =0.001), history of stroke (60.9% vs 34.7%, P <0.001) in the VCIND group was significantly higher than that in the control group. The level of fasting blood glucose (Glu)(P <0.001), homocysteine (Hcy)(P <0.001) and triglyceride (P =0.022) in the VCIND group were significantly higher than that of the control group. The free triiodothyronine (FT3) in the VCIND group was proved lower than that in the control group ([2.80±0.39] pg/ ml vs [2.90±0.27] pg/ml, P =0.043]. Multivariate Logistic regression analysis showed: history of stroke (odds ratio[OR ] 6.461, 95% confidence interval [CI ] 2.835-14.725, P <0.001), Hcy [OR 15.726, 95%CI 7.198-34.358, P <0.001], blood Glu [OR 1.864, 95%CI 1.367-2.541, P <0.001] were independent risk factors of VCIND, and FT3 [OR 0.351, 95%CI 0.192-0.647, P <0.001] were the protective factors of VCIND. Conclusion History of stroke, Hcy and high blood Glu level are independent risk factors of VCIND, while FT3 is the protective factor of VCIND.

Study on the Correlation between Polymorphism of 5,10 Methylenetetrahydrofolate Reductase Gene and Carotid Atherosclerosis in Patients with Cerebral Infarction

ZHOU-Hao, WEI Shou-Chao, ZHAO Xing-Jun, et al.

2017, 12(01): 23-28. DOI: 10.3969/j.issn.1673-5765.2017.01.004

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Objective To investigate the correlation between plasma homocysteine (Hcy) metabolism enzyme 5,10-methylenetetrahydrofolate reductase C677T gene polymorphism and carotid atherosclerosis in patients with cerebral infarction. Methods The newly onset anterior circulation of large artery atherosclerotic infarction patients were enrolled into study group and patients without cerebral infarction during the clinical physical examination were taken as the control group. The level of plasma Hcy was measured by fluorescence polarization immunoassay; color Doppler ultrasound examination of two groups of bilateral extracranial carotid artery atherosclerosis was used to determine whether there was a plaque and the nature of the plaque; and automatic gene chip was used to detect target population MTHFR C677T gene type. Results A total of 150 patients with newly onset anterior circulation cerebral infarction were enrolled into the study group and 100 cases were enrolled in the control group. ①The frequency of C677T MTHFR mutation (TT) genotype and T allele in the cerebral infarction group were significantly higher than that in the control group (48.0% vs 19.0%, χ 2=22.067, P <0.001; 64.0% vs 45.5%, χ 2=6.907, P =0.009); ②The mutation of C677T C MTHFR and T gene in cerebral infarction group was positively correlated with the degree of carotid artery atherosclerosis stenosis (r =0.353, P <0.001); ③The frequency of C677T MTHFR mutation (TT) genotype and T allele were significantly higher in the unstable plaque group than in the stable plaque group in the cerebral infarction group (66.2% vs 34.1%, χ 2=14.587, P <0.001; 77.5% vs 60.2%, χ 2=6.978, P =0.008) . Conclusion MTHFR T gene mutation in C677T C site may be the risk factor of carotid atherosclerotic plaque instability and stenosis degree.

The Analysis of Clinical Characteristics and Cause of Magnetic Resonance Imaging Diffusion-weighted
Imaging Negative Stroke

CHEN Lei, ZHU Xuan, ZHANG Ping, et al.

2017, 12(01): 29-33. DOI: 10.3969/j.issn.1673-5765.2017.01.005

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Objective To identify the different clinical characteristics between diffusion-weighted imaging negative and positive stroke treated with intravenous thrombolysis and analyse the cause of diffusion-weighted imaging (DWI) negative stroke. Methods Retrospective analysis was made upon data of patients with ischemic stroke who received intravenous thrombolysis during September 2013 and February 2015. The patients were divided into DWI positive group and DWI negative group based on head magnetic resonance imaging (MRI). The differences in baseline data, risk factors for cerebral vascular diseases, clinical manifestation and outcome at discharge were compared between the two groups. Results Among 119 patients, there were 94 cases of DWI positive and 25 cases of DWI negative with 21% of DWI negative rate. There were no obvious differences between the baseline characteristics of DWI negative stroke versus DWI positive stroke, including gender, age and risk factor for cerebral vascular diseases. No inter-group differences in NIHSS score were noted at admission NIHSS. The discharge NHISS of DWI negative stroke was 0 (0, 1) which was obviously lower than that of DWI positive group's 1 (0, 4) (P =0.02). The discharge mRS of DWI negative stroke was 0 (0, 1) while DWI positive stroke was 1 (1, 3) (P <0.001). There were significantly statistical differences between them. The hemorrhagic transformation rate (2.1%) and mortality rate (1.1%) of DWI positive stroke were relatively low, and there were no hemorrhagic transformation or death occurring in DWI negative group. There were no obvious differences in hemorrhagic transformation or death outcome. Conclusion DWI negative stroke is milder and recover better than DWI positive stroke. As the intracranial hemorrhage rate and mortality are low in either DWI positive or negative stroke, rt-PA intravenous thrombolysis is safe in stroke.

Perioperative Management of Transcatheter Closure of Atrial Septal Abnormalities in Patients with Ischemic Stroke

HAN Li-Jun, LI Jing-Wei

2017, 12(01): 34-38. DOI: 10.3969/j.issn.1673-5765.2017.01.006

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Objective To summarize the perioperative clinical characteristics and management experience of transcatheter closure of atrial septal abnormalities (patent foramen ovale[PFO], atrial septal defect[ASD]) in patients with ischemic stroke. Methods Ischemic stroke patients who underwent transcatheter closure of atrial septal abnormalities at Beijing Tiantan Hospital between May 2015 and May 2016 were enrolled. The blood pressure and heart rate of patients with ischemic stroke complicated with ASD before, during and after transcatheter closure of PFO/ASD were analyzed. Results Interventional occlusion was successfully performed in 27 patients. The patients were discharged in average 2 days after the operation. All patients had no symptoms and the occluder were in good position. No occluder malposition and thrombus, no neurological recurrences were observed. There were no statistically significant differences in blood pressure before, during and after treatment; there were statistically significant differences in heart rate before, during and after treatment (70.72±9.18 beats/min, 77.48±8.69 beats/min, 67.69±8.73 beats/min, P <0.01). Conclusion Perioperative management of transcatheter PFO or ASD closure can help to reduce postoperative complications and improve the success rate of operation.

Progress of Magnetic Resonance Imaging Research in Vascular Cognitive Impairment

ZHANG Zhong-Min, SUN Yu

2017, 12(01): 40-44. DOI: 10.3969/j.issn.1673-5765.2017.01.007

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Vascular cognitive impairment (VCI) is lacking of standard imaging diagnosis criteria at present. Recent magnetic resonance imaging (MRI) technology could contribute to provide potential imaging biomarkers for early detection of VCI. This paper reviewed multi-modal MRI studies including diffusion tensor imaging, magnetic resonance spectroscopy, susceptibility weighted imaging and functional MRI to summarize the imaging characterization of VCI. The combination of multi-modal MRI technique would help to elevate the clinical diagnosis accuracy and direct further treatment of VCI, which could provide assistance for further treatment.

Study Progress of Neuropsychological Profiles of Vascular Cognitive Impairment

LIU Chun-Yan,XING Yan

2017, 12(01): 45-50. DOI: 10.3969/j.issn.1673-5765.2017.01.008

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Vascular cognitive impairment (VCI) is the common cause of cognitive dysfunction and dementia. Unlike Alzheimer's disease, VCI is preventable and treatable particularly at early stage of the disease. Accurate neuropsychological scales for assessment of cognitive impairment could improve the detection rate at early stage. The clinical manifestation of VCI is predominated with executive function impairment. It has heterogeneity. There are still no universally accepted scale, and the current scale requires further verification and improvement.

Research Advances in Structure Imaging of Vascular cognitive impairment: a Review

2017, 12(01): 51-54. DOI: 10.3969/j.issn.1673-5765.2017.01.009

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Vascular cognitive impairment (VCI) include all levels of cognitive loss from mild deficits in one or more cognitive domains to a broad dementia syndrome due to cerebral vessel disease or the risks of vascular diseases. Cerebral vascular disease could manifest corresponding cerebral imageological changes, however, the conclusion of association study between those changes and cognitive injury are still in discrepancy. The structural imaging research of VCI mainly uses structure magnetic resonance imaging, diffusion-weighted imaging and diffusion tensor imaging technology to study on VCI induced changes in brain microstructure and its relationship with cognition through the aspects of the position of stroke, morphological changes of the brain and the changes of cerebral white matter structure. Here is to make a review of the structure imaging research advances in VCI.

Q&A by Working Group of Multi-item Endovascular Treatment Study on Highly Effective Reperfusion Evaluation: Doubts about Endovascular Treatment for Acute Ischemic Stroke

YANG Zhong-Hua

2017, 12(01): 56-57. DOI: 10.3969/j.issn.1673-5765.2017.01.010

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JAMA The Time Window for Endovascular Treatment for Acute Ischemic Stroke is 7.3 h

YANG Zhong-Hua

2017, 12(01): 58-58. DOI: 10.3969/j.issn.1673-5765.2017.01.011

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Traditional Chinese Medicine Serve as a Predecessor in Treatment of Stroke II—Integration of Chinese and Western Theory

John H.Zhang

2017, 12(01): 59-60. DOI: 10.3969/j.issn.1673-5765.2017.01.012

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Gender Differences in Risk Factors and Four Risk Scores of Ischemic Stroke

XUE Yang, ZHONG Di,LI Guo-Zhong

2017, 12(01): 73-79. DOI: 10.3969/j.issn.1673-5765.2017.01.015

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Gender differences lie in the occurrence risk of stroke, which is associated with some physiological factors, as well as different stroke susceptibilities to the same risk factor between male and female. Frequently used stroke risk scores are mostly based on risk factors, whereas gender has not been included in most scores, which might lead to gender bias of predictive validity. Therefore, this paper reviews gender differences in risk factors and evaluative validity of the four typical risk predictive scores of ischemic stroke [including CHADS2 (Congestive heart failure, Hypertension, Age≥75, Diabetes, Stroke) score, CHA2DS2-VASc (Congestive heart failure, Hypertension, Age≥75, Diabetes, Stroke, Vascular disease, Age 65-74, Sex category) score, Essen Stroke Risk score (ESRS) and ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) score].

Advance in the Forming Mechanism of Mitochondrial Calcium Overloaded after Subarachnoid Hemorrhage

ZHANG Tong-Yu, LI Yu-Chen, DAI Jia-Xing, et al.

2017, 12(01): 80-84. DOI: 10.3969/j.issn.1673-5765.2017.01.016

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Under the condition of mitochondrial calcium overloaded, Ca2+ concentration in the mitochondria of cells increases abnormally which leads to a series of biological systemic disorder and causes the irreversibility of cell damage. This process widely exists in the early brain injury (EBI) caused by subarachnoid hemorrhage (SAH). We have understood the molecular structure of the mitochondria, but the knowledge about the molecular mechanisms of mitochondrial calcium overloaded is still little. Therefore, in this review we aim to discuss the progress of the mechanisms of the mitochondrial membrane receptors in the forming process of mitochondrial calcium overloaded. And it will give reference for solving the problem of EBI after SAH.

New Implications of Anti-oxidative Stress Therapy for Atherosclerotic Cardiovascular Diseases

ZENG Yan

2017, 12(01): 85-88. DOI: 10.3969/j.issn.1673-5765.2017.01.017

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Many studies have shown that oxidative stress, immunology and inflammation are associated with each other, playing an important role in arteriosclerosis. As an emerging therapy, anti-oxidative stress therapy can further improve the treatment of atherosclerosis. Antioxidants can be divided into natural antioxidants and synthetic antioxidants. Probucol is a synthetic antioxidant, which has a strong antioxidant capacity and plays an important role in reducing vascular restenosis and cardiovascular and cerebrovascular events.

Research Progress of the Effects of Hypoxia Inducible Factor -1α on Endogenous Neural Stem Cells after Cerebral Infarction

LIN Ya-Hang, CHEN Ming, DUAN Shu-Rong

2017, 12(01): 89-93. DOI: 10.3969/j.issn.1673-5765.2017.01.018

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Neural stem cell has been used in the treatment of cerebral infarction because of its unique functions and advantages.Treatment of cerebral infarction with neural stem cells (NSCs) has no time window limit, no bleeding risk, and the transplanted cells can secrete a large number of nerve growth factors to improve the microenvironment, inhibit inflammatory response, reduce apoptosis, promote nerve regeneration, and rebuild the damaged neural network. Hypoxia-inducible factor-1α (HIF-1α) is a key factor in the protective effects of cerebral ischemia and hypoxia, and its role in promoting the regeneration of NSCs after cerebral infarction is extensive and complex. In this paper, we will systematically review the important role of HIF-1α in promoting endogenous NSCs proliferation, migration and differentiation in the brain after cerebral ischemia and hypoxia injury, indicating that it may become the effective target of clinical treatment of cerebral infarction.

Application of Case-based Learning Combined Classical Learning Methods for Training of 5-years- Clinical Interns in Cerebrovascular Disease

CHE Feng-Li, ZHAO Xing-Quan, DU Hui-Shan, et al

2017, 12(01): 94-96. DOI: 10.3969/j.issn.1673-5765.2017.01.019

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Objective To explore the effect of case-based learning (CBL) combined classical learning methods on training of 5-years-clinical interns in cerebrovascular disease. Methods There were 60 cases of 5-years-clinical interns whom were randomized into CBL combined classical methods group and classical methods group with the ratio of 1:1 during September 2015 and September 2016 in Beijing Luhe Hospital of the Capital Medical University. CBL combined classical methods and classical methods were applied separately in teaching of patients with acute cerebrovascular diseases. The effects of these teaching methods were evaluated by questionnaire survey, basic theoretical knowledge examination, practice examination including physical examination and case analysis among these students. Results There were no significant difference in basic theory knowledge examination. The result of physical examination and case analysis of CBL combined classical teaching method were much higher than that of the control group [(89.10±2.99) vs (86.60±3.41), P =0.015]. Compared with the classical teaching method, CBL combined classical methods could significantly improve interns’ abilities in initiative learning ability, analytical skill, problem solving, expression and communication, expansion of professional knowledge and team cooperation. Conclusion CBL combined classical methods can significantly improve the ability of interns in mastering the knowledge of cerebrovascular disease.

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