Chinese Journal of Stroke

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WANG Yong-Jun

2017, 12(11): 983-984. DOI: 10.3969/j.issn.1673-5765.2017.11.001

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High Attention Should be Paid to Clinical Diagnosis and Treatment of Hypoperfusion Vascular Cognitive Impairment

DENG Yi-Ming, MIAO Zhong-Rong

2017, 12(11): 985-986. DOI: 10.3969/j.issn.1673-5765.2017.11.002

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Clinical Study of Using Toyota Production System to Shorten the Door-to-needle Time for Acute Ischemic Stroke

XU Dong-Juan, LU Xiao-Rong, LI Hong-Fei

2017, 12(11): 987-990. DOI: 10.3969/j.issn.1673-5765.2017.11.003

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Objective To investigate using Toyota Production System (TPS) to shorten patients’ door-toneedle time (DNT) and increase the proportion of patients with DNT≤60 minutes. Methods The patients with acute ischemic stroke who underwent recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis from June 2012 to December 2013 were taken as the control group, and the patients who were admitted from January 2014 to June 2015 via TPS formula were taken as the study group. The DNT time and the proportion of patients with DNT≤60 minutes were compared. Results The study included 68 patients in the control group and 87 patients in the study group. There was a significant statistical difference on the average DNT between the control group and the study group (P =0.002), and the average DNT in the control group and the study group were (92.27±16.98) minutes and (63.52±11.86) minutes respectively. The proportion of patients with DNT≤60 minutes was significantly increased from 6.11% to 51.09% (P =0.001). Conclusion Multi-discipline TPS team was helpful for optimizing process of administering thrombolytic therapy on acute ischemic stroke, reducing the delay time of rt-PA intravenous thrombolysis in the hospital, shortening DNT, and increasing the proportion of patients with DNT ≤ 60 minutes.

Study on Ischemic Demyelinating Cerebral White Matter Lesions Related Risk Factors in Desertification Areas

PENG Wei, ZHANG Zhao-Yun, YIN Xiu-Ping, WANG Yu-Mei

2017, 12(11): 991-994. DOI: 10.3969/j.issn.1673-5765.2017.11.004

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Objective To study the risk factors of ischemic demyelinating cerebral white matter lesions in Wuwei desert area retrospectively, so as to provide a theoretical evidence for the clinical prevention of occurrence of ischemic demyelinating cerebral white matter lesions in desert area . Methods A total of 500 patients with ischemic cerebrovascular diseases were selected from the department of neurology of wuwei people's hospital from January 2011 to December,2015. The screened cases were analyzed according to different living places and different risk factors. Multivariate logistic regression was used to analyze the risk factors associated with ischemic demyelinating white matter lesions. Results In desert group, ischemic demyelinating brain white matter disease incidence rate was 62.4%;while in plain group, the ischemic demyelinating leukoencephalopathy incidence rate was 49.6%. In desert group, cerebral white matter severe lesions was 22.4%; in plain group , cerebral white matter severe lesions was 8.4%. Multivariate analysis showed that desertification weather, smoking, alcohol consumption, diabetes mellitus, hypertension, lipid metabolism abnormality, carotid atherosclerosis and homocysteine were risk factors for aggravation of ischemic brain white matter lesions. Conclusion The incidence of ischemic demyelinating white matter lesions in desert areas was higher than that in plain areas, and majority of them were severe lesions.

Study on Natural History of Adult Patients with Hemorrhagic Moyamoya Disease

LIU Xing-Ju,KANG Shuai, ZHANG Dong, WANG Rong, ZHANG Yan, ZHANG Qian, ZHAO Ji-Zong

2017, 12(11): 995-999. DOI: 10.3969/j.issn.1673-5765.2017.11.005

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Objective To explore the risk factors related with the long term natural history and outcome of adult patients with hemorrhagic moyamoya disease (MMD). Methods A retrospective analysis was made upon the clinical data of 115 cases of adult patients (age>17) with hemorrhagic MMD. Long-term follow-up study was conducted on 40 patients who received conventional therapy. The main observation indexes were newly onset cerebral hemorrhage and death event. Results Among 40 patients, who received conventional therapy, 6 cases were losted and 34 cases were followed up cumulatively for 398.7 person-years. The median follow-up time was (11.7±4.6) years. During 398.7 person-years, 15 patients experienced (44.1%) twenty-one episodes of rebleeding, rendering an average annual incidence of 5.3%. Among them, 5 patients (33.3%) died from rebleeding and 4 patients had serious disability (modified Ranking Scale ≥3; 26.6%). The annual risk of rebleeding increased gradually from 2.6% in the first five years to 7.9% after 10 years after the first bleeding. Patients older than 35 years sustained a higher risk of rebleeding than ones under the age of 35 [hazard ratio (HR) 2.8, 95% confidence interval (CI) 1.1-7.7, P =0.04]. Gender, bleeding location, DSA stage, hypertension, family history of MMD and whether there were complication with aneurysm were not associated with the risk of rebleeding. Conclusion The risk of rebleeding of adult patients with hemorrhagic MMD obviously increased as time went on; and patients older than 35 years had a higher risk of rebleeding.

Gene Microarray Analysis of Astrocytes in Acute Ischemic Stroke Mice Based on Gene Expression Omnibus

DONG Wen, WANG Yong-Jun

2017, 12(11): 1000-1004. DOI: 10.3969/j.issn.1673-5765.2017.11.006

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Objective To explore the signal pathway which played a key role in astrocytes following cerebral ischemia/reperfusion by microarray, and to analyze the key genes which might involve in the activation process of astrocytes. Methods Data of 8 chips of astrocytes from mouse brain of Affymetrix Gene Chip Mouse Genome 430 2.0 arrays were collected from Gene Expression Omnibus (GEO) database. Eight mice were divided into two groups: Experimental group (Ischemia with 60 min MCAO plus 24 h reperfusion, n =4) and Sham operation group (n =4). The differentially expressed genes were detected, then the signal pathways were analyzed to screen the key signal pathway and analyze the genes which played an important role in regulation. Results A total of 1966 genes were determined as differential genes in astrocytes from acute ischemia/reperfusion mice, among which, 1210 genes expression were up regulated and 756 genes were down regulated. Pathway analysis determined 154 differential pathways. Further analysis found that four pathway including mitogen-activated protein kinases (MAPK) pathway, apoptosis, cell cycle and p53 pathway, which played an important role in activation process of astrocytesfollowing ischemia/reperfusion. Moreover, Flnc1 and Ccnd1 were key genes in activation process of astrocytes in response to ischemia/reperfusion. Conclusion Acute cerebral ischemia/reperfusion resulted in abundant differential expressed genes that played important roles in activation process of astrocytes. Through analyzing the differential genes, the new targets which potentially play the important regulation role in ischemia/reperfusion injury could be screened.

Prognosis Evaluation of Patients with Symptomatic Isolated Intracranial Arterial Stenosis of Ischemic Cerebrovascular Disease

SHAO Xiao-Jun, YANG Jing, WANG Xia, ZHANG Chen

2017, 12(11): 1005-1009. DOI: 10.3969/j.issn.1673-5765.2017.11.007

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Objective To explore the influence factors of one-year stroke recurrence in patients with ischemic cerebrovascular disease of symptomatic isolated intracranial arterial stenosis. Methods A total of 86 patients with symptomatic isolated intracranial atherosclerotic stenosis confirmed by the digital subtraction angiography (DSA) were followed up for 1 year. The major outcome was stroke events. The characteristics of distribution of intracranial arterial stenosis were analyzed. The multiple Cox regression analysis was used to evaluate the association between the risk factors including age, gender, hypertension, diabetes, smoking, drinking alcohol, high sensitive creative protein (hsCRP), number of arteriostenosis, stenosis degree, anterior and posterior circulation, ischemia types, history of atherosclerosis of coronary artery, ischemic cerebrovascular diseases, and the outcome. Results The results showed that intracranial artery stenosis mostly occurred in the middle cerebral artery (35.51%). A total of 80 patients who met the criteria were followed up for 1 year. Multifactors Cox regression analysis showed that age≥60 years old [risk ratio (RR) 2.628, 95% confidence interval (CI) 1.066-6.478, P =0.036], female (RR 2.645, 95%CI 1.133-6.178, P =0.025), National Institutes of Health Stroke Scale (NIHSS) score >1 (RR 3.644, 95%CI 1.280-10.369, P =0.015) and multiple intracranial arterial stenosis (RR 2.712, 95%CI 1.048-7.019, P =0.040) were risk factors of endpoint events .

Conclusion Age, gender, NIHSS score and the number of intracranial arterial stenosis of patients with ischemic cerebrovascular disease of symptomatic isolated intracranial arterial stenosis may be the predictors of stroke recurrence within one year.

Clinical Efficacy Observation of Butylphthalide Injection on Patients with Acute Ischemic Stroke

LI Chun-Xiang, ZHAO Li-Xia, Qin Hua-Hong

2017, 12(11): 1010-1012. DOI: 10.3969/j.issn.1673-5765.2017.11.008

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Objective To observe and explore the efficacy of butylphthalide injection on patients with acute cerebral infarction. Methods A total of 128 patients who were diagnosed with acute cerebral infarction and hospitalized in our hospital from February 2013 to December 2014 were randomly selected as study subjects. There were 75 cases in conventional group and 53 cases in the group of conventional therapy combined with butylphthalide peptide sodium chloride injection. The neurological impairment, the level of high sensitivity C-reactive protein (hsCRP) and lysophosphatidic acid (LPA) in two groups before and after treatment were compared. Results There was no significant difference in National Institutes of Health stroke scale (NIHSS) between two groups before treatment. The scores of NIHSS of two groups after treatment both decreased significantly comparing with that of respective group before treatment. The NIHSS score of treatment group was significantly lower than that of conventional group. The hsCRP and LPA levels of two groups after treatment decreased significantly than that of respective group before treatment, and the levels in treatment group were significantly lower than that in conventional group. Conclusion Butyphthalide injection combined therapy had better effect in reducing neurological deficit, hsCRP level and LPA level in patients with acute cerebral infarction comparing with conventional therapy.

Study Progress of Hypoperfusion Vascular Cognitive Impairment

DENG Yi-Ming, GAO Feng,ZHANG Xue-lei, XU Hai-Feng, PENG Guang-Ge, WANG Zheng-Yang, MIAO Zhong-Rong

2017, 12(11): 1014-1022. DOI: 10.3969/j.issn.1673-5765.2017.11.009

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Vascular cognitive impairment (VCI) is the common cause for cognitive dysfunction and dementia. As an important subtype, hypoperfusion VCI can be treated and prevented, so it has become a research focus in the field of cognitive impairment. This article, will discuss the concept, pathologic physiology, clinical feature, imaging examination and treatment of hypoperfusion VCI according to recent studies.

Anterior Circulation Intra- and extracranial Artery Stenosis and Cognitive Impairment

QIU Li-Jun,JING Ping

2017, 12(11): 1023-1032. DOI: 10.3969/j.issn.1673-5765.2017.11.010

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Anterior circulation intra- and extracranial artery stenosis is one of the risk factors for ischemic stroke. Recent research had proven that anterior circulation intra- and extracranial artery stenosis might cause cognitive function decline through a variety of mechanism. Its treatment methods included drug therapy, interventional therapy and surgical treatment.This paper reviewed the mechanism of cognitive impairment caused by anterior circulation intra- and extracranial artery stenosis, and its clinical manifestation and treatment, so as to provide reference for clinical work.

Neurology: Recognize New Risk Factors of Stroke: Carotid Artery Web

YANG Zhong-Hua

2017, 12(11): 1033-1034. DOI: 10.3969/j.issn.1673-5765.2017.11.011

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Stroke Treatment IV: Blood and Tears on the Road of Statins

John H.Zhang

2017, 12(11): 1035-1037. DOI: 10.3969/j.issn.1673-5765.2017.11.012

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Chinese Experts Consensus on Imaging Evaluation for Endovascular Treatment of Acute Ischemic Stroke

2017, 12(11): 1041-1056. DOI: 10.3969/j.issn.1673-5765.2017.11.014

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Research Progress of Etiology of Stroke in Young Adult

ZHENG Bo-Wen, LI Yi, SHEN Qing-Yu,TANG Ya-Mei

2017, 12(11): 1057-1060. DOI: 10.3969/j.issn.1673-5765.2017.11.015

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Stroke in patient between 18 and 45 is defined as stroke in young adult. There is great difference in etiology composition and ratio between young adult and middle-aged and elder adult. This article summarized the characteristics of different etiology of stroke in young adults from the aspect of vascular disease, cardiac disease, hereditary and metabolic disease, hematologic disease and other diseases based on recent literature, and compared the difference between young adult and middle-aged and elder adult in the same cause. Recommendations were given to investigate the etiology in young adult with stroke in clinical practice, based on characteristics of different etiologies. There are many controversies in etiology research of stroke in young adult, which is worth further investigation.

Research Advance in Neurogenic Inflammation Induced by Subarachnoid Hemorrhage

WANG Yong-Peng, ZHANG Tong-Yu, ZHANG Guang, XU Shan-Cai, ZHENG Bing-Jie, SHI Huai-Zhang

2017, 12(11): 1061-1066. DOI: 10.3969/j.issn.1673-5765.2017.11.016

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Aneurysmal subarachnoid hemorrhage (aSAH) was a common cerebrovascular disease. With the improvement of clinical surgical technology, the aneurysms can be treated and the mortality caused by rehaemorrhagia decreased, while there were few effective therapeutic measures in allusion to subarachnoid hemorrhage. It was known that neuroinflammation response played a critical role in pathological process after subarachnoid hemorrhage. Studies had shown that inflammation was associated with vasospasm and brain injury. Many preclinical studies had been conducted to explore the correlation between neuroinflammation and aSAH, and the researchers found that inflammatory mediator played an important role in this process. This article provided an overview of the neuroinflammation after aSAH and its pathogenic mechanism.

Application of Problem Advance in based Learning Combined with Case-Based Learning in Neurology Teaching for Refresher Physicians

ZHANG Gui-Li, PAN Hua

2017, 12(11): 1067-1069. DOI: 10.3969/j.issn.1673-5765.2017.11.017

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Objective To investigate the effect of problem-based learning (PBL) combined with case-based learning (CBL) on neurology teaching for refresher physicians. Methods A total of 40 refresher neurologists at Beijing Tiantan hospital were randomly divided into experimental group (n =20) and control group (n =20). The refresher neurologists in experimental group were taught by PBL combined with CBL while those in control group were taught by traditional teaching method. Questionnaires and theory examination were used to evaluate the teaching effect. Results Learning interest, clinical thinking, problem-solving skills, capabilities of language expression and communications in experimental group were better than those in control group. The exam score in experimental group was also higher than that in control group. Conclusion PBL combined with CBL could stimulate the refresher neurologists’ interest in neurology and self-learning ability, and improve their exam results, which enhanced the effect of teaching quality in neurology.

Application of Problem-based Learning in Teaching how to Differentiate Parkinson’s Disease and Vascular Parkinsonism

MA Hui-Zi, WU Shuo-Lin, WANG Chun-Xue

2017, 12(11): 1070-1072. DOI: 10.3969/j.issn.1673-5765.2017.11.018

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Objective To compare the effect of problem-based learning (PBL) with the traditional method in teaching how to differentiate Parkinson’s Disease (PD) and Vascular Parkinsonism (VPN). Methods Based on randomized numbers, all the students were divided into 2 groups: traditional method group and PBL group. Results Before the teaching course, the familiarity for PD and VPN were tested in two groups and there was no statistic difference between the two groups. After the total course, the objective and subjective examination scores as well as the acceptance for the teaching in PBL group were all higher than that in traditional method group (All P <0.05). Conclusion Students can gain more benefit from the teaching method of PBL in differentiating PD and VPN.

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