Table of Content

20 May 2018, Volume 13 Issue 05

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Challenge the History

WANG Yong-Jun

2018, 13(05):  415-419.  DOI: 10.3969/j.issn.1673-5765.2018.05.001

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Ticagrelor Application in Department of Neurology: Where the Future Lies? — Thoughts about Platelet Reactivity Study in High Risk Group of Acute Non-Disabling Ischemic Cerebrovascular Events

CHEN Wei-Qi, WANG Yi-Long, WANG Yong-Jun

2018, 13(05):  420-422.  DOI: 10.3969/j.issn.1673-5765.2018.05.002

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“Competitions between Humans and Computers” in Imaging Diagnosis of Neurological Diseases Kicked off Publicity Department of Beijing Tiantan Hospital

2018, 13(05):  423-424.  DOI: 10.3969/j.issn.1673-5765.2018.05.003

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Impact of Stroke Nurses on Treatment Efficiency of Acute Ischemic Stroke

ZHANG Ping, ZHANG Ting-Ting, YU Long-Juan, HU Min, LI Dong-Mei, GAN Li-Fen, ZHANG Ling-Juan, CHEN Lei, ZHU Xuan, ZHANG Yong-Wei, WU Tao, DENG Ben-Qiang, LIU Jian-Min

2018, 13(05):  425-429.  DOI: 10.3969/j.issn.1673-5765.2018.05.004

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Objective To explore how to optimize the emergency diagnosis and treatment working flow for acute ischemic stroke and the impact of nurse on treatment efficiency when nurses were taken as the first responder at the emergency preview platform and involved in the whole process of thrombolysis and thrombectomy green channel. Methods A total of consecutive 208 cases having completed thrombolysis and/or endovascular treatment of acute cerebral infarction in stroke center of Changhai hospital from April 1 2016 to March 31 2017 were analyzed retrospectively. The patients were divided into stroke nurses group (43 cases) and no stroke nurses group (165 cases). The in-hospital time delay of the two groups were compared including door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN),imaging-to-puncture (ITP), door-to-puncture (DTP), the rate of reaching standard (DTN≤60 min, DTP≤90 min) and the rate of modified Rankin score (mRS)≤2. Results The median of DTN was reduced from 39 minute to 27 minute after the involvement of stroke nurses (Z =-5.422, P <0.001); the median of DTP was reduced from 105 minute to 68 minute (Z=-2.707, P =0.007); the median of ITN was reduced from 21 minute to 8 minute (Z=-5.981, P <0.001); the median of ITP was reduced from 78.5 minute to 45 minute (P =0.013). The rate of reaching the standard of DTN 60 min were different (97.67% vs 90.97%, P <0.001). The rate of reaching the standard of DTP 90 min were different (100% vs 35.62%, P <0.001). The rate of mRS ≤2 in stroke nurse group was significantly higher than that in no stroke nurse group at discharge and 3 months (62.79% vs 49.09%; 69.77% vs 50.91%, all P <0.001). Conclusion The stroke nurses taken as the first responders at the emergency preview platform and involving the entire Green Channel can significantly shorten the DTN and ITP time in thrombolysis in acute stroke patients with DTN and ITP time, increase the rescue efficiency, and improve the prognosis of patients.

Meta-analysis of Safety and Efficacy of Early Antithrombotic Therapy in Patients with Acute Ischemic Stroke after Intravenous Alteplase Thrombolysis

LI Xin, TONG Xu, LI Jing-Jing, PEI Hong-Fei, WANG Yong-Jun, WANG Yi-Long, ZHENG Hua-Guang, YU Ping, CAO Yi-Bin

2018, 13(05):  430-436.  DOI: 10.3969/j.issn.1673-5765.2018.05.005

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Objective To explore the safety and efficacy of antithrombotic therapy in patients with acute ischemic stroke (AIS) in 24 hours after receiving intravenous alteplase thrombolytic therapy. Methods Literature search was carried out in PubMed, Cochrane Library (as of the 10th issue of 2017), EM base and Web of Science data base up to October 2017, for cohort studies on curative effect observation of comparing early antithrombotic therapy (within 24 h) with standard antithrombotic therapy (after 24 h) after altipase thrombolysis in AIS patients in randomized controlled trials, matched controlled trials and non-randomized controlled trials. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed by using Stata 14.0, to compare the 90-day favorable outcome and mortality, and symptomatic intracranial hemorrhage (sICH) between the two groups. Results A total of 11 cohort studies (including 4 randomized controlled trials, 2 matched controlled trials and 5 non-randomized controlled trials) were finally included involving 2082 cases. The early antithrombotic group had 1219 cases (58.5%) and standard antithrombotic group had 863 cases (41.5%). The results of meta-analysis showed that the proportion of 90-day favorite outcome in early antithrombotic group was higher than in standard antithrombotic group [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73, P =0.001)]. However, there were no significant difference in sICH (OR 1.08, 95%CI 0.63-1.86, P =0.78) and 90-day mortality between both groups (OR 1.13, 95%CI 0.81-1.57, P =0.48). Conclusion Patients in early antithrombotic group(within 24 hours) after receiving intravenous alteplase thrombolytic therapy had a higher proportion of 90-day favorable outcome than in standard antithrombotic group (after 24 hours), and the risk of sICH and 90-day mortality had no difference between the both groups.

Analysis of Association between Ultraearly Hematoma Growth and Outcome after Acute Spontaneous Intracerebral Hemorrhage

WANG Wen-Juan, LU Jing-Jing, CHEN Sheng-Yun, ZHANG Jia, WANG Yu, ZHANG Xiao-Li, ZHAO Xing-Quan

2018, 13(05):  437-443.  DOI: 10.3969/j.issn.1673-5765.2018.05.006

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Objective To investigate the association of ultraearly hematoma growth (UHG) with the hematoma growth (HG) and clinical outcomes in patients with acute spontaneous intracerebral hemorrhage (ICH). Methods Acute ICH patients who went for consultation within 6 hours after onset were enrolled into study consecutively. Patients underwent baseline and 24-hour computed tomography (CT) scans. The clinical data and outcome were recorded. UHG was defined as the relation between baseline ICH volume/onset-to-imaging time (OIT). Hematoma enlargement was defined as HG volume >33% or >6 ml at 24 hours after onset. And poor outcome was defined as modified Rankin Scale score >2 at 90 days and 1 year after onset. The multivariable logistic regression analysis was used to investigate the association of UHG with HG and clinical outcomes after ICH. Results A total of 148 patients with acute (<6 h) ICH were enrolled. The median speed of UHG was 5.3 (interquartile range 2.3-12.9) ml/h. The UHG was significantly faster in patients who scanned earlier (P <0.001), as well as in patients who experienced HG (P =0.019), 90-day poor outcome (P <0.001) and 1-year poor outcome (P <0.001). UHG>4.7 ml/h was an independent risk factor for 1-year poor outcome (odds ratio 17.5; 95% confidence interval 1.44-21.23, P =0.025). For UHG to predict 1-year poor outcome, the sensitivity, specificity, positive predictive value and negative predictive value were 61.5%, 65.1%, 68.4% and 58%, respectively. Conclusion UHG was an independent risk factor for 1-year poor outcome after acute ICH.

Effect of Plasma Oxidized Low Density Lipoprotein on Prognosis in Acute Ischemic Stroke Patients with Different Levels of Renal Function

REN Yan-Hui, SUN Yuan, LYU Wei, MENG Xia, WANG Cui-Lan, YANG Bin, SHI Qiu-Yan

2018, 13(05):  444-449.  DOI: 10.3969/j.issn.1673-5765.2018.05.007

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Objective To investigate the correlation between functional prognosis and plasma oxidized lowdensity lipoprotein (oxLDL) in acute ischemic stroke (AIS) patients with different levels of renal function. Methods All subjects were recruited from the Study of Oxidative Stress in Patients With Acute Ischemic Stroke (SOS-Stroke). Plasma level of ox-LDL was measured by enzyme-linked immuno sorbent assay (ELISA). Patients were stratified by the calculated glomerular filtration rate, and followed up at 1 year after stroke onset to assess the modified Rankin Scale (mRS) score. Analysis of the relationship between oxLDL and poor prognosis (modified Rankin scale ≥3 points) in patients with different levels of renal function were performed. Results A total of 3284 patients were enrolled in this study, of whom 877 (26.71%) had poor functional outcomes. After grouping according to renal function, there were 1241 cases of normal control, 924 cases of mild abnormality, and 242 cases of moderate-severe abnormality. Patients of poor prognosis in all groups were respectively 344 (21.70%) cases of normal group, 371 (28.65%) cases of mild abnormal group, and 162 cases (40.10%) of moderate-severe abnormal group. The plasma level of oxLDL had a significant effect on 1-year mRS score in the patients with normal and mild damage renal function: in normal renal function group, the mRS score increased by 0.12 points for each standard deviation increase in oxLDL [OR 0.12, 95%CI 0.05-0.19, P =0.0009], and the risk of poor prognosis increased by 20% (OR 1.20, 95%CI 1.02-1.40, P =0.0271); in mild renal impairment group, the mRS score increased by 0.16 points for each standard deviation increase in oxLDL. (OR 0.16, 95%CI 0.07-0.25, P =0.0007), and the risk of poor prognosis increased by 21% (OR 1.21, 95%CI 1.03-1.41, P =0.0190); however, in moderate-severe renal impairment group, plasma oxLDL levels did not significantly affect the mRS score. Conclusion The increased of plasma oxLDL levels in AIS patients with normal renal function and mild renal impairment are associated with the poor prognosis within 1 year.

Characteristics and Risk Factors of Intra-/extracranial Artery Stenosis in Patients with Peripheral Artery Disease

ZHAO Ying-Ying, WU Shan-Shan, CHEN Jun, DING Yong-Qin, GAO Feng-Ling Gao, ZHANG Wei, ZHAO Jing-Jie, LI Ji-Mei

2018, 13(05):  450-454.  DOI: 10.3969/j.issn.1673-5765.2018.05.008

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Objective To investigate the incidence, risk factors and clinical symptoms of peripheral artery disease (PAD) complicated by intra-/extractranial artery stenosis. Methods A total of 155 patients with PAD from July 2016 to July 2017 were selected and the clinical data of the patients were collected for the study. The clinical symptoms of PAD were classified according to Fontaine classification: stage I, without symptoms; stage II, intermittent claudication, stage III, resting pain; stage IV, toe ulcers and gangrene. The degree of intra-/ extracranial artery stenosis was divided into non-stenosis, mild to moderate stenosis (<70%), and severe stenosis or occlusion (≥70%) by TCD. The incidence and the risk factors of intra-/ extracranial artery stenosis in PAD patients, and the correlation between lower limb ischemia and intra-/extracranial artery stenosis were analyzed. The effect of intra-/extracranial artery stenosis on the occurrence of perioperative stroke was elucidated. Results A total of 99 (63.9%) PAD patients had intracranial and/or extracranial artery stenosis, including 66 cases (42.6%) of extracranial artery stenosis and 67 cases (43.2%) of intracranial artery stenosis, respectively. 27 PAD patients (17.4%) had severe stenosis or occlusion of extracranial artery, and 4 PAD ones (2.6%) with severe stenosis or occlusion of intracranial artery. Age (OR 1.041, 95%CI 1.004-1.080, P =0.030) and smoking (OR 2.728, 95%CI 1.125-6.619, P =0.026) were risk factors for PAD patients with extracranial artery stenosis. Diabetes (OR 2.196, 95%CI 1.079-4.470, P =0.030) was a risk factor for PAD patients with intracranial artery stenosis. Smoking (OR 3.57, 95%CI 1.078-11.411, P =0.037) was a risk factor for PAD patients with severe stenosis of intra-/ extracranial artery. Severe ischemic symptoms of lower extremity (stage II and III), were more likely to occur in PAD patients with intracranial artery stenosis (P =0.032). Comparing with mild to moderate extracranial artery stenosis, PAD patients with severe stenosis or occlusion were more prone to occurring perioperative stroke (P =0.006). Conclusion The incidence of intra-/extracranial artery stenosis in PAD patients is relatively high. The clinical symptoms of PAD patients with intracranial artery stenosis were more serious. Severe stenosis or occlusion of extracranial artery may increase the incidence of perioperative stroke.

Differences in Related Factors of Intracranial and Extracranial Atherosclerosis

PU Yue-Hua, ZOU Xin-Ying, WANG Yi-Long, PAN Yue-Song, XIANG Xiang-Long, Yannie Oi-Yan SOO, Thomas Wei-hong Leung, ZHAO Xing-Quan, WANG Chun-Xue, WONG Ka Sing, WANG Yong-Jun, LIU Li-Ping

2018, 13(05):  455-462.  DOI: 10.3969/j.issn.1673-5765.2018.05.009

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Objective To explore the differences in Related factors between intracranial and extracranial atherosclerosis. Methods From the Chinese Intracranial Atherosclerosis Study (CICAS), all the enrolled patients were divided into four groups: no significant intracranial or extracranial atherosclerosis group, only intracranial atherosclerosis group, only extracranial atherosclerosis group, and intracranial and extracranial atherosclerosis group. With no significant intracranial or extracranial atherosclerosis group as control, the logistic regression analysis was used to assess the possible factors associated with intracranial or extracranial atherosclerosis. Results Of 2864 patients, 1388 (48.5%) had no significant intracranial or extracranial atherosclerosis, 1074 (37.5%) had only intracranial atherosclerosis, 141 (4.9%) had only extracranial atherosclerosis, and 261 (9.1%) had intracranial and extracranial atherosclerosis. Multi-factors analysis showed that independent factors associated with intracranial atherosclerosis were white matter lesions [odds ratio (OR) 1.359, 95% confidence interval (CI) 1.109-1.666, P =0.0031], leukocyte count (OR 1.045, 95%CI 1.007-1.084, P =0.0210), fasting blood glucose (OR 1.054, 95%CI 1.009-1.101, P =0.0182), and high density lipoprotein (OR 0.644, 95%CI 0.480-0.864, P =0.0034); Independent factors associated with extracranial atherosclerosis were senior age (OR 1.047, 95%CI 1.026-1.069, P <0.0001), smoking (OR 1.887, 95%CI 1.212-2.937, P =0.0050), previous history of ischemic cerebrovascular disease (OR 2.260, 95%CI 1.352-3.778, P =0.0019), and leukoaraiosis (OR 0.603, 95%CI 0.394-0.922, P =0.0196). Senior age (OR 1.022, 95%CI 1.006-1.039, P =0.0064), diabetes mellitus (OR 1.494, 95%CI 1.053- 2.118, P =0.0244) and family history of stroke (OR 1.964, 95%CI 1.302-2.961, P =0.013) were the independent factors of intracranial and extracranial atherosclerosis. Hyperhomocysteinemia was a common independent factor in the three groups. Conclusion The related factors may have differences between intracranial and extracranial atherosclerotic lesions. Leucocyte count, fasting blood glucose, and high-density lipoprotein are associated with intracranial atherosclerotic lesions; while age, smoking and history of ischemic cerebrovascular disease are associated with extracranial atherosclerosis. Hyperhomocysteinemia is the common independent factor of intra-and extracranial lesions.

Effect of Mild Hypothermia Combined with Dl-3n-butyphthalide on Prognosis in Patients with Acute Middle Cerebral Artery Occlusion beyond Thrombolysis Time

LIU Xuan-Jun, YANG Guo-Shuai, LIN Hai-Li, ZHOU Yan-Hui, CHENG Qi-Hui, ZHOU Lyu, ZHANG Yan-Jun, HU Yu-Jie, HAO Hai-Zhen, WANG Qiang

2018, 13(05):  463-468.  DOI: 10.3969/j.issn.1673-5765.2018.05.010

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Objective To investigate the effect of mild hypothermia (MHT) combined with dl-3n-butyphthalide (NBP) on collateral circulation and short-term prognosis of patients with acute middle cerebral artery occlusion (MCAO) and progressive motor deficit (PMD) beyond thrombolysis time. Methods Patients with acute MCAO and PMD beyond thrombolysis time were recruited consecutively. They were randomized into the conventional treatment group, the MHT group and the MHT+NBP group. The parameters between the three groups, including baseline clinical data, the Fugl-Meyer motor function scores at Day 14, collateral circulation, the National Institute of Health Stroke Scale (NIHSS) scores, the hemorrhagic transformation, the anterior communicating artery (ACoA), the posterior communicating artery (PCoA), the ipsilateral and contralateral systolic peak flow velocity ratio of anterior cerebral artery (RVaca) and posterior cerebral artery (RVpca), the modified Rankin scale (mRS) scores at Day 90, the rate of mortality at Day 90, were compared. Results A total of 69 patients having completed follow-up were recruited in the study, including 23 in the conventional treatment group, 21 in the MHT group, and 25 in the MHT+NBP group. The Fugl-Meyer motor function scores at Day 14, the anterior communicating artery (ACoA), the posterior communicating artery (PCoA), RVaca, RVpca in the MHT+NBP group were respectively higher than that in the MHT group and conventional treatment group (all P <0.05). The NIHSS scores at Day 14, the mRS scores at Day 90 in the MHT+NBP group were respectively lower than that in the MHT group and CT group (all P <0.05). The hemorrhagic transformation at Day 14 in the MHT+NBP group was lower than in the conventional treatment group (P <0.05). The RVaca at Day 14, and the mRS scores at Day 90 in the MHT group were lower than that in the conventional treatment group (all P <0.05). There were no significant difference in 90-day mortality rate among the three groups. Conclusion MHT combined with NBP could improve collateral circulation and short-term prognosis in patients with acute MCAO and PMD beyond thrombolysis time.

Why Should We Focus on Non-Disabling Ischemic Cerebrovascular Events and Its Definition

CHEN Wei-Qi, MA Lin, JING Jing, WANG Yi-Long, WANG Yong-Jun

2018, 13(05):  470-472.  DOI: 10.3969/j.issn.1673-5765.2018.05.011

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Non-Disabling Ischemic Cerebrovascular Events (NICE) has a large population base in China. The NICE group includes transient ischemic attack (TIA), minor ischemic stroke (NIHSS ≤3 or 5), rapid remission and unimpaired stroke. Patients with minor stroke and TIA are similar in clinical manifestations, clinical prognosis and epidemiological characteristics, so it is recommended to conduct a unified diagnosis and treatment. In view of Chinese economic development status, public health awareness and current stroke prevention tasks, the NICE people are the most important target objects within the best window of prevention and control of cerebrovascular diseases.

Epidemiology and Prognosis of Non-Disabling Ischemic Cerebrovascular Events

ZHOU Meng-Yuan, CHEN Wei-Qi, JING Jing, WANG Yong-Jun, WANG Yi-Long

2018, 13(05):  473-476.  DOI: 10.3969/j.issn.1673-5765.2018.05.012

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The percentage of non-disabling ischemic cerebrovascular events (NICE), including transient ischemic attack (TIA) and minor stroke, in ischemic cerebrovascular diseases has been rising as well as the epidemiological trend of it. High risk of early occurrence coming along with low awareness, low diagnosis and treatment and low hospitalization rate make it important to improve the definition of TIA and establish optimum strategy to prevent early stroke of NICE. In recent years, with the deepening of people's understanding of TIA and minor stroke, and the improvement of medical standards, the incidence of TIA and the risk of stroke recurrence have declined in developed countries.

Definition and Prediction Models for High-Risk Non-Disabling Ischemic Cerebrovascular Events

HAN Chong, CHEN Wei-Qi, JING Jing, WANG Yi-Long, WANG Yong-Jun

2018, 13(05):  477-482.  DOI: 10.3969/j.issn.1673-5765.2018.05.013

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The patients who have high risk non-disabling ischemic cerebrovascular events are in unstable state, and they have high risks of early recurrent stroke. At present, different clinical scoring systems are widely used, with the development of the imaging and molecular biology, these technology can be used to predict recurrent stroke risk, so that early intervention and individual therapy can be provided for patients. It could improve prognosis and reduce the disability rate and burden of stroke. This paper aims to discuss the definition of HR-NICE and predictors of clinical, imaging and molecule for recurrent stroke prediction models according to recent studies, so as to provide reference for clinical work.

Evidence-based Treatment of High Risk Non-Disabling Ischemic Cerebrovascular Events

MA Lin, CHEN Wei-Qi, JING Jing, WANG Yong-Jun, WANG Yi-Long

2018, 13(05):  483-488.  DOI: 10.3969/j.issn.1673-5765.2018.05.014

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The incidence and recurrence rate of high risk of disabling ischemic cerebrovascular events (HR-NICE) are high. The guidelines of both home and abroad suggest that the early comprehensive evaluation, intervention and establishing NICE management system will obtain great benefit. Several studies have revealed the efficacy and safety of antiplatelet medication, and choosing anticoagulation or thrombolysis treatment according to different cause, which may improve the prognosis. This article briefly reviews the evidence-based medicine in management of HR-NICE.

The Individualized Therapy for High Risk Non-Disabling Ischemic Cerebrovascular Events

CHEN Wei-Qi, MA Lin, JING Jing, WANG Yi-Long, WANG Yong-Jun

2018, 13(05):  489-493.  DOI: 10.3969/j.issn.1673-5765.2018.05.015

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Molecular markers could help physicians make more accurate clinical diagnosis, risk stratification, treatment plan and prognosis evaluation for patients with high risk non-disabling ischemic cerebrovascular events (HR-NICE). However, race/ethnic difference may influence the stroke etiology and gene locus, so that the effect of aggressive antiplatelet therapy is distinct with different varieties. Due to the different genotyping and protein, patients may gain different benefit from the drug therapy, so that individualized treatment should be adapted to the differences. New anticoagulants and antiplatelet agents can work directly, which may provide new direction for the future.

Strategy Selection of Antiplatelet Therapy for Ischemic Stroke in terms of the Ethnic Differences between Easterners and Westerners

Wang Yi-Long

2018, 13(05):  494-499.  DOI: 10.3969/j.issn.1673-5765.2018.05.016

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Stroke has become a global disease burden. Antiplatelet therapy is a necessary method for secondary prevention of ischemic stroke. However, there are differences between Easterners and Westerners on features of disease, which may lead to different antiplatelet therapy. Through the analysis of difference in disease characteristics, risk of recurrence and bleeding, and variability of platelet response, this review will explore the appropriate antiplatelet therapy for ischemic stroke patients in Asia.

Stroke: When Aspirin Antiplatelet Therapy Fails ······

YANG Zhong-Hua

2018, 13(05):  500-500.  DOI: 10.3969/j.issn.1673-5765.2018.05.017

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Short Story about Stroke: Bonet Was the First to Collect and Analyze the Stroke Cases

John H.Zhang

2018, 13(05):  501-503.  DOI: 10.3969/j.issn.1673-5765.2018.05.018

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Integrated Cognition and Behavior Therapy for a Patient with Post-Stroke Depression and Insomina

ZHU Mei-Fang, WANG Chun-Xue

2018, 13(05):  504-507.  DOI: 10.3969/j.issn.1673-5765.2018.05.019

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Two Cases Report of Cerebral Air Embolism

LU Qing-Shan, LOU Ping

2018, 13(05):  508-512.  DOI: 10.3969/j.issn.1673-5765.2018.05.020

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Dual Antiplatelet Therapy May Increase the Risk of Non-intracranial Haemorrhage in Patients with Minor Strokes

2018, 13(05):  513-514.  DOI: 10.3969/j.issn.1673-5765.2018.05.021

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Reduce the Dosage of Intravenous Tissue Plasminogen Activator for Acute Ischaemic Stroke in Asians? LI Shu-Juan

2018, 13(05):  514-515.  DOI: 10.3969/j.issn.1673-5765.2018.05.022

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Progress of Imaging Evaluation of Cerebral Collateral Circulation

ZHAO Ting-Ting, LI Guo-Zhong, ZHONG Di, CHEN Hong-Ping

2018, 13(05):  516-520.  DOI: 10.3969/j.issn.1673-5765.2018.05.023

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This review is to introduce the features of cerebral collateral circulation, imaging evaluation methods of collateral circulation and its advantage and limitation. It mainly includes transcranial Doppler, magnetic resonance angiography, computed tomography angiography, computered tomography perfusion, digital subtraction angiography and multiphase computed tomography angiography. These methods might help clinicians choose appropriate imaging methods which assess collateral circulation status at the early stage of disease and guide the treatment decision-making and prognosis.

Application of Bedside Transcranial Doppler in Monitoring of Severe Cerebrovascular Diseases

MI Dong-Hua, YANG Zhong-Hua, YANG Bo, WANG Yong-Jun, LIU Li-Ping

2018, 13(05):  521-526.  DOI: 10.3969/j.issn.1673-5765.2018.05.024

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Transcranial Doppler (TCD) is a kind of convenient noninvasive ultrasound equipment. Its 2 MHz ultrasonic probe can pass through the skull weak parts and monitor blood flow velocity real-timely, so that the cerebral hemodynamic parameters are obtained, which is applied widely in the field of severe cerebrovascular diseases. TCD is also a useful tool for bedside diagnosis of subarachnoid hemorrhage. However, TCD diagnosis of vascular spasm for evaluating clinical prognosis faced some challenge. Now it is the era of endovascular treatment, and the bedside TCD can be used in early diagnosis of hyperperfusion syndrome after endovascular recanalization, and can be used to assess the therapeutic effect of vascular recanalization in followup. The indication function of TCD for non-invasive intracranial pressure monitoring needs an internationally accepted and repeatable mathematical model.

Progress on Pregnancy-Associated Cerebral Venous Sinus Thrombosis

WANG Qing, YUAN Jun-Liang

2018, 13(05):  527-531.  DOI: 10.3969/j.issn.1673-5765.2018.05.025

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Cerebral venous sinus thrombosis (CVST) is a rare type of cerebrovascular disease, with the features of obstruction of cerebrospinal fluid and elevated intracranial pressure. It is a rare disorder with a relative higher mortality. It is also an important cause of stroke in female adults, especially at the stage of perinatal period and with oral contraceptive. There are some difficulties in early diagnosis of CVST in pregnant females, because of multiple risk factors and complex pathogenesis. This review mainly focuses on the etiology, pathophysiology, clinical manifestation, assist examination and treatment of CVST so as to diagnose at early stage, reduce mortality, optimize the therapeutic protocol, and provide important reference for clinical diagnosis and treatment.

Standardized Patients Teaching Model in National Continuing Education Program - National Aphasia and Dysphagia Training Course

ZHANG Yu-Mei, JIA Wei-Li, SUN Hai-Xin Sun, LI Lei, HUANG Hai-Tao, ZHOU Yun, WANG Yong-Jun

2018, 13(05):  532-534.  DOI: 10.3969/j.issn.1673-5765.2018.05.026

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Objective To explore the effect of standardized patients teaching model on aphasia and dysphagia after stroke. Methods Those who received the standardized patients teaching model among the students of the National Continuing Education Program-National Aphasia and Dysphagia Training Course were assigned to the experimental group. Those not receiving the standardized teaching model as the control group, and a questionnaire on teaching satisfaction was conducted. Statistical analysis was performed on the eight questions of the questionnaire, to compare the teaching effects of the experimental group and the control group. Results The satisfaction with the training ability of the teachers, the degree of mastery of the training content, the recognition of the teachers' teaching ability and the content of the teaching material, the recognition of the practical content of the experts' lecture, the depth of the content of the experts' lecture, and the comprehensive evaluation of the training courses, etc. in the experimental group were all higher than that of the control group and the differences were statistically significant. Conclusion The standardized patients teaching method has a significant teaching effect in the National Continuing Education Progrom-National Aphasia and Dysphagia Training Course. This teaching mothod is worthy of recommendation.