Chinese Journal of Stroke

Face the Future

WANG Yong-Jun

2018, 13(10): 1005-1007. DOI: 10.3969/j.issn.1673-5765.2018.10.001

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The History and Outlook of Diagnosis and Treatment of Intracranial Aneurysms

LU Wang-Sheng, LYU Ming

2018, 13(10): 1009-1011. DOI: 10.3969/j.issn.1673-5765.2018.10.002

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Mechanism and Effect of Inflammatory Cytokines on Activation of Astrocytes and Expression of sPLA2-IIA

LI Xue-Fen, CHEN Wen-Wu, LI Qing, GUO An-Chen, WANG Yong-Jun, WANG Qun

2018, 13(10): 1012-1018. DOI: 10.3969/j.issn.1673-5765.2018.10.003

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Objective To explore the effect of inflammatory cytokines on the activity of astrocytes and the expression of sPLA2-IIA secreted by astrocytes, and the possible mechanism. Methods On the basis of primary cell culture of rat cerebral cortical astrocytes in vitro, the fourth generation of cultured cells were used for the experiment, which were randomly divided into experimental group and control group. The experimental group included: 10 ng/ml IL-1β subgroup, 100 ng/ml IL-1β subgroup, 10 ng/ml TNF-α subgroup, 100 ng/ml TNF-α subgroup, 10 ng/ml IL- 1β plus 10 ng/ml TNF-α subgroup, 100 ng/ml IL-1β plus 100 ng/ml TNF-α subgroup. 24 hours later, cell viability was detected by CCK-8 assay. Then the 10 ng/ml IL-1β plus 10 ng/ml TNF-α subgroup was selected to continue the experiment. The expression of sPLA2-IIA was detected by qRT-PCR and ELISA, and the mRNA changes of IKKα, IKKβ and NF-κB were detected by qRTPCR. Results Through the separation and purification, the typical rat cortical astrocytes were obtained. The morphology of astrocytes was irregular, the neurites were longer and radial. Glial fibrillary acidic protein (GFAP) staining showed that the purity of astrocytes was over 95%. The activity of astrocytes in experimental group was higher than that in control group. Among them, the activity of astrocytes in 100 ng/ml IL-1β subgroup, 100 ng/ml TNF-α subgroup, 10 ng/ml IL-1β plus 10 ng/ml TNF-α subgroup and 100 ng/ml IL-1β plus 100 ng/ml TNF-α subgroup were significantly higher than that in control group (t =0.07, 0.12, 0.53, 0.39, P <0.05). Compared with the control group, the mRNA and protein expression of sPLA2-IIA significantly increased (t =9.615, 11.635, P <0.05), and the mRNA expression of IKKα, IKKβ and NF-κB in 10 ng/ml IL-1β and 10 ng/ml TNF-α subgroup significantly increased as well (t =4.015, 4.719, 6.509, P <0.05). Conclusions The combined application of inflammatory cytokines IL-1β and TNF-α can stimulate the activation of astrocytes, and promote the expression of sPLA2-IIA, which may be related to NF- κB pathway.

Analysis of Related Factors of Leukoaraiosis Based on Data Mining

Nadire·Aiziretiaili, FENG Hong-Liang, ZHANG Shuai-Mei, WANG Mei-Yao, LIU Yu-Min

2018, 13(10): 1019-1024. DOI: 10.3969/j.issn.1673-5765.2018.10.004

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Objective To analyze the related factors of leukoaraiosis by using data mining technology. Methods The clinical data of 1197 inpatients who were eligible for inclusion criteria in Zhongnan Hospital during April 2015 to February 2017 were included in the study. Among the data mining technology, 4 kinds of prediction models and chi square test based feature selection method were used to analyze the related factors of leukoaraiosis. Results Among the 4 kinds of data mining models, the logistic regression model had the best prediction performance (the number of features is 9, AUC=0.825±0.012). Feature selection methods were used to select the top 9 features as related factors of leukoaraiosis. Decision tree model (the number of features was 4, AUC=0.788±0.017) was used to obtain the visual result graph of the decision tree. Conclusions According to data mining methods in this paper, the positive relevant factors of leukoaraiosis were age, history of hypertension, arteriosclerosis, anemia, type 2 diabetes mellitus, creatinine, red blood cell count, and red blood cell distribution width; and the negative relevant factors were red blood cell count and hemoglobin concentration.

Correlation of Blood Pressure Variability and Prognosis in Patients with Aneurysmal Subarachnoid Hemorrhage

WANG Chu-Han, DUAN Wan-Ying, LI Shu-Ya, LIU Li-Ping

2018, 13(10): 1025-1028. DOI: 10.3969/j.issn.1673-5765.2018.10.005

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Objective To investigate the effect of blood pressure variability on the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods This retrospective study included 123 aSAH patients caused by primary intracranial aneurysm rupture confirmed by DSA from Beijing Tian Tan Hospital from November 2015 to November 2016. A single factor analysis of age, gender, National Institutes of Health stroke scale (NIHSS) score on admission, Glasgow coma scale (GCS) score on admission, Hunt-Huss scale, Fisher scale, World Federation of Neurosurgical Societies (WFNS) scale and blood pressure variability (BPV) was made. The prognosis was evaluated by 90-day modified Rankin scale (mRS) score, with good prognosis defined as mRS 1-3 score and poor prognosis defined as mRS 4-5 score.

Results The 3-month follow-up result showed that 106 patients (106/123) had good prognosis and there were significant difference in NIHSS score on admission (P =0.007), GCS score on admission (P =0.001), WFNS grade (P =0.001) and BPV (P =0.001) between the two groups. The single factor regression analysis showed that only BPV were associated with 3-month prognosis of aSAH patients. Spearman correlation analysis showed that BPV, GCS score on admission and WFNS grade were associated with 3-month prognosis.

Conclusions BPV is an important factor affecting the prognosis of aSAH patients. Keeping blood pressure relatively stable is an important way of improving the prognosis of aSAH patients.

Observational Study on Fingers Dysfunction due to Small Cortical Infarction

FU Sheng-Qi, ZHANG Jie-Wen, YANG Dong-Dong, SHI Bao-Yang, LI Hao-Ran, ZHANG Hong-Tao, ZHANG Shu-Ling

2018, 13(10): 1029-1034. DOI: 10.3969/j.issn.1673-5765.2018.10.006

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Objective Simple fingers weakness caused by small cortical infarction is rarely found in clinical practice. This study aimed to investigate the pathogenesis mechanism, clinical presentation and imaging features of such cases.

Methods Outpatients with the main manifestation of fingers dysfunction caused by small cortical infarcts from Zhengzhou People’s Hospital from July 2009 to December 2016 were included in this study. The analyzed clinical data included sensory and moter functions in fingers, muscle strength of fingers (bending, stretching, adduction and outreach), and the possible pathogenesis mechanism or etiology in medical records. According to the predominant impaired fingers, the patients were divided into ulnar-lateral group and radial-lateral group. The locations of cerebral infarction were identified by diffusion weighted imaging. Based on the imaging, the distance from cerebral falx to lesion core (B) and distance from cerebral falx to the lateral margin of brain (A) were measured and the ration of B/A were calculated.

Results A total of 13 cases with small cortex infarction were included, with 6 ones in ulnar-lateral group and 7 ones in radial-lateral group. B/A in ulnar-lateral group was (0.50±0.07), while B/A in radial-lateral group was (0.71±0.06), and the difference between the two groups had statistical significance (t =-5.67, P <0.05). The possible pathogenesis mechanism or etiology in ulnar-lateral group were as follows: large artery stenosis/impaired clearance of emboli in 5 cases and unexplained embolism in 1 case; and that in radial-lateral group were the following: artery-to-artery embolism in 4 cases, cardiogenic embolism in 2 cases, and Moyamoya disease in 1 case.

Conclusions The simple impaired finger function is associated with small cortical infarction. The ulnar-lateral finger impairment is associated with medial cortex infarction, which may be associated with hypoperfusion. The radial-lateral finger impairment is associated with lateral cortex infarction, which may be associated with embolism.

Correlation between Normal Homocysteine Levels and Recurrent Cerebral Infarction

JIANG Li-Min, YANG Jia-Lei, LI Xiao-Gang

2018, 13(10): 1035-1038. DOI: 10.3969/j.issn.1673-5765.2018.10.007

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Objective To investigate the relationship between normal homocysteine (Hcy) levels and recurrent cerebral infarction.

Methods 600 patients with acute cerebral infarction from the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from June 2015 to June 2017 were included in this study. According to the pathogenesis, all the patients were divided into large artery atherosclerosis group, cerebral embolism group and cerebral small artery occlusion group. According to medical history, the patients were divided into first stroke group and recurrent stroke group. 200 inpatients without acute cerebrovascular diseases during the same period were selected as control group. The plasma Hcy levels of different groups were compared. The proportion of high-normal Hcy level (10 μmol/L < Hcy < 15 μmol/L) in the first and recurrent stroke groups were compared.

Results The level of Hcy in large artery atherosclerosis group, cerebral embolism group, cerebral small artery occlusion group were significantly different with that in control group (P <0.05). The proportion of high-normal Hcy level in first stroke group (25.4%) was lower than that in recurrent stroke group (35.1%), and the difference was statistically significant (χ 2=6.171, P =0.013). Multivariate logistic regression analysis showed that high-normal Hcy level and hypertension were independent risk factors of recurrent cerebral infarction.

Conclusions The high-normal Hcy level is one of risk factors of recurrent cerebral infarction. Effective control of Hcy level in patients with cerebral infarction is a new approach of secondary prevention for ischemic stroke.

Analysis of Dyslipidemia and Its Risk Factors in Community Population with High-risk of Stroke at Fengtai District of Beijing

LU Yu-Qiao, KONG Jun-Hui, ZHANG Zhi-Chen, ZHANG Ye, ZHANG Wei-Dong, LIU Xue-Mei

2018, 13(10): 1039-1043. DOI: 10.3969/j.issn.1673-5765.2018.10.008

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Objective To investigate dyslipidemia and its related risk factors in community population aged >40 years old and with high-risk of stroke at Fengtai district of Beijing.

Methods A total of 5401 subjects were included in this study. According to the level of blood lipid, all the subjects were divided into dyslipidemia group (n =4174) and normal plasma lipid group (n =1209). After a single factor analysis of possible risk factors, body mass index (BMI), diabetes, smoking, hypertension, obesity, tasting greasy food, lack of dairy were screened and included in multifactor Logistic regression analysis to analyze the risk factors of dyslipidemia.

Results The prevalence, awareness and drug taking rate of dyslipidemia were 77.54%, 67.23% and 23.50%, respectively. Diabetes and smoking were correlated with dyslipidemia (P <0.05), and BMI, hypertension, obesity, lack of dairy were strongly associated with dyslipidemia (P <0.01). Diabetes [odds ratio (OR) 1.187, 95% confidence interval (CI) 1.025-1.374], BMI (OR 1.097, 95%CI 1.076-1.118) and lack of dairy (OR 1.147, 95%CI 1.006-1.308) were independent risk factors of dyslipidemia (P <0.05).

Conclusions The prevalence of dyslipidemia in community population with high risk of stroke was high, and diabetes, BMI, lack of dairy and low awareness rate were independent risk factors of dyslipidemia.

Effect of Multidisciplinary Management in Community on Secondary Prevention of Cerebral Infarction

WANG Wen-Ke, WANG Zhi-Qiang, YUAN Wei-Hong, YU Yan, ZHAO Lin, WANG Ying, LIU De-Yuan, LU Yue-Hui

2018, 13(10): 1044-1049. DOI: 10.3969/j.issn.1673-5765.2018.10.009

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Objective To study the effect of multidisciplinary management in community on secondary prevention in patients with cerebral infarction during recovery period.

Methods A total of 172 discharged patients with cerebral infarction were randomly divided into management group (n =90) and control group (n =82). The neurologists, physical therapist, psychiatrists and nurses all got involved in multidisciplinary management of patients with cerebral infarction in community. The multidisciplinary management was performed in management group, and discharge instructions were performed in control group. The follow-up period was 6 months. The primary observation indictor was ischemic stroke recurrence, the secondary indictors included statin use, antiplatelet therapy, hypertension and diabetes treatment, the control rate of LDL-C, blood pressure and blood glucose, the NIHSS score and moderate-to-severity disability, post-stroke depression occurrence and the awareness rate of health education knowledge.

Results Ischemic stroke recurrence had no significant difference between the two groups (P =0.196). The secondary indictors of the management group were all better than that of the control group (P <0.05).

Conclusions The key of this multidisciplinary management model was that patients with cerebral infarction who discharge and return to the community bring standardized secondary prevention, rehabilitation and care programs to the community general practitioners, and thereby this promotes the formation of an patient-centered and interactive management model between specialists and general practitioners. Although this management model did not obviously reduce ischemic stroke recurrence, it could improve secondary prevention compliance and the control rate of risk factors, and improve the effect of secondary prevention.

Influence of Flow Diverter Implantation on Hemodynamics in Intracranial Aneurysms Treatment

CHEN Jun-Fan, YANG Xin-Jian, LIU Jian

2018, 13(10): 1051-1056. DOI: 10.3969/j.issn.1673-5765.2018.10.010

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Flow diverter (FD) is a kind of new device for endovascular treatment of complex intracranial aneurysms. FD is designed to reconstruct parent artery by removing aneurysms from circulatory system through blood flow remodeling. This concept innovation brings new ideas and methods for treating complex aneurysms. It is reported that the complete occlusion rate of aneurysms using FD could achieve over 90%, so currently the FD application is becoming increasingly wider. This article reviewed that the effect of using FD on hemodynamics in treating intracranial aneurysms, and effect of this treatment approach on outcome of intracranial aneurysms, to provide reference for aneurysms treatment decision-making.

Application of High Resolution Magnetic Resonance Imaging in Risk Assessment of Intracranial Aneurysms Rupture

LIU Peng, LI You-Xiang, LYU Ming

2018, 13(10): 1057-1062. DOI: 10.3969/j.issn.1673-5765.2018.10.011

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Although the pathogenesis of intracranial aneurysms remains unclear, the hemodynamic changes and inflammation may play an important role in the evolution process of intracranial aneurysms. The degeneration of aneurysmal wall is the final common pathway of various influencing factors. Currently clinical evaluation methods, such as computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, which are based on the imaging of blood flow, can not reflect the architectural details of aneurysm wall. In recent years, with the development of magnetic resonance equipment and field strength, as well as molecular contrast agents, high resolution magnetic resonance imaging (HR-MRI) plays an increasingly important role in evaluating vascular inflammation and nourishing vascular proliferation. This article reviewed the progress of HR-MRI was applied in assessing the risk of intracranial aneurysms rupture.

Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force

Translator: LI Jin-Xin, LI Ning, GAO Ting, LIU Li-Jun, JU Yi, ZHAO Xing-Quan

2018, 13(10): 1063-1071. DOI: 10.3969/j.issn.1673-5765.2018.10.012

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Transfer Function Analysis of Dynamic Cerebral Autoregulation: A White Paper from the International Cerebral Autoregulation Research Network

HAN Ke, WANG Cheng-Yen, CHI Nai-Fang, HU Han-Hwa

2018, 13(10): 1072-1085. DOI: 10.3969/j.issn.1673-5765.2018.10.013

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One Case of Weber Syndrome and Claude Syndrome with Vertebrobasilar Dolichoectasia

MA Can-Can, XU Yao, ZHANG Xi-Bin

2018, 13(10): 1089-1094. DOI: 10.3969/j.issn.1673-5765.2018.10.016

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Clinical Features of Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like Episodes: A Report of 4 Cases

LI Xiao-Chun

2018, 13(10): 1095-1098. DOI: 10.3969/j.issn.1673-5765.2018.10.017

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Opening Already Occluded Middle Cerebral Artery, Internal Carotid Artery or Other Cerebral Arteries: Opportunity and Challenge?

WANG Yong-Jun, David Wang

2018, 13(10): 1099-1100. DOI: 10.3969/j.issn.1673-5765.2018.10.018

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Advances in Imageology of Intra- and Extracranial Coexisting Atherosclerotic Plaques

LIU Yang, HAN Hua-Lu, ZHAO Xi-Hai, WANG Wei

2018, 13(10): 1103-1108. DOI: 10.3969/j.issn.1673-5765.2018.10.020

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Intra- and extracranial coexisting atherosclerotic plaques (coexisting plaques) are very common in Asian populations, which has been demonstrated to be closely related to ischemic stroke. Therefore, it is important to identify the coexisting plaques for stroke prevention. Currently many imaging modalities are applied in the diagnosis of coexisting plaques, of which highresolution magnetic resonance vessel wall imaging has showed high value in assessing coexisting plaques. The article summarized the current progress in imageology of coexisting plaques.

Relationship between Left Ventricular Wall Motion Abnormalities and Cerebral Infarction

LI Qian, YUAN Xia

2018, 13(10): 1109-1113. DOI: 10.3969/j.issn.1673-5765.2018.10.021

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Cerebral infarction is a common cerebrovascular disease with high morbidity, mortality, disability and high recurrence rate, which is the leading cause of mortality in China. Exploration on the etiology of cerebral infarction never stopped, and the latest research found that left ventricular wall motion abnormalities have a significant correlation with the occurrence, recurrence and prognosis of cerebral infarction. The risk factors of abnormal left ventricular motion, the pathogenesis of cerebral infarction caused by abnormal left ventricular wall activity and the intervention measures are discussed in this article.

Pay Attention to Post-stroke Depression, Improve the Humanistic Quality of Graduate Students in Neurology

ZHANG Ping, LI Tao-Ran, WANG Hao-Liang, YAN Hai-Qing, GUI Yong-Kun, SONG Jing-Gui

2018, 13(10): 1118-1121. DOI: 10.3969/j.issn.1673-5765.2018.10.023

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Objective To explore the feasibility and application effect of standardized patients (SP) in the teaching of post-stroke depression (PSD) in neurological graduate students.

Methods A total of 20 neurological graduate students who studied in the first affiliated hospital of Xinxiang medical college in 2017 participated in this study. They were required to study PSDrelated knowledge on their own. The neurological attending doctors severed as SP of PSD, each student communicated with the SP, and then students experienced by playing "patients" or "doctors" mutually by themselves. Applying the clinical communication ability scale and the evaluation of students from "SP" doctors, the assessment were made before and after teaching respectively.

Results A total of 40 valid questionnaires were collected. The score of overall communication ability of students was (75.20±5.06) before teaching and (91.70±7.31) after teaching, and the difference was statistically significant (P <0.001). The scores of each evaluation aspect after teaching were higher than that before teaching, especially the difference in harmonious relation establishment, effective listening and judgment accuracy of PSD had significant difference (P <0.001). This style of teaching enabled students to learn better and improved the comprehensive quality of all students.

Conclusions The application of SP teaching significantly improved students' interest in learning PSD, professional skills and communication skills, which obviously improved the humanistic quality of neurological graduate students in the teaching of PSD.

Application of New Media in Teaching and Management of Continuing Medical Education in Cerebrovascular Diseases

YE Yu-Mei, REN Yi, XU Rong, WANG Lei

2018, 13(10): 1122-1126. DOI: 10.3969/j.issn.1673-5765.2018.10.024

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Objective Continuing education is an important part of medical education. Beijing Tian Tan Hospital has rich experience in continuing medical education (CME), and has made reform and innovation in teaching and management of CME to keep up with the needs of medical development. This article summarized the form and function of new media, and its application in CME in Beijing Tian Tan Hospital.

Methods Data of new media in Beijing Tian Tan Hospital were collected to summarize the application efficacy of new media in CME. Data of 39 refresher neurological physicians having completed CME, including basic information, test scores and satisfaction survey, were collected and analyzed.

Results New media has four main characteristics. The new media technology which are mainly WeChat, online courses, some softwares and etc, significantly improved the quality and efficiency of teaching and management of CME, and also greatly improved the refresher physicians’satisfaction with CME.

Conclusions The application of new media in teaching and management of CME is very effective, which deserves extensive application.

Progress in Relationship between Acute Ischemic Stroke and Glycemic Fluctuation

CAO Feng-Ya, DENG Jiang-Shan, ZHAO Yu-Wu

2018, 13(10): 1114-1117. DOI: 10.3969/j.issn.1673-5765.2018.10.022

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Stress hyperglycemia can occur in 30%-40% of patients with acute ischemic stroke, which is associated with poor prognosis, especially those without diabetes. Intensive hyperglycemia management didn’t improve the outcome of such patients, and increased the risk of hypoglycemia instead. Glycemic fluctuation can lead to vascular endothelial cell apoptosis through oxidative stress and inflammatory reaction. Stress hyperglycemia occurring soon after acute ischemic stroke may be just an interesting and special phenomenon of glycemic fluctuation, which still needs further research in the future.

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