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    20 March 2019, Volume 14 Issue 03
    Reward
    WANG Yong-Jun
    2019, 14(03):  191-194.  DOI: 10.3969/j.issn.1673-5765.2019.03.001
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    Cerebral Autoregulation: From Theory to Clinical Translation and Operation Procedure Standardization
    HAN Ke, HU Han-Hwa
    2019, 14(03):  195-206.  DOI: 10.3969/j.issn.1673-5765.2019.03.002
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    Association of Serum Uric Acid Level with Stroke Severity and Prognosis in Patients with Acute Ischemic Stroke
    WANG Yun-Yun, XIE Xiao-Hua, REN Li-Jie, YANG-Mei, PAN Lu, YAN Feng-Xian, ZHANG Jian, DENG Li-Ping,XIONG Xiao-Yun
    2019, 14(03):  207-212.  DOI: 10.3969/j.issn.1673-5765.2019.03.003
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    Objective To investigate the relationship between serum UA level and stroke severity and prognosis of acute ischemic stroke (AIS). Methods Data of consecutive AIS patients from Shenzhen Second People's Hospital during January 2014 to December 2017 were retrospectively collected. According to UA tertile levels, all patients were divided into three groups: low-level group (3.85-298.80) μmol/L, moderate-level group (299.80-398.00) μmol/L and high-level group (402.30-702.10) μmol/L. Multivariate regression analysis was used to analyze the risk factors of stroke severity and prognosis in AIS patients. Stratified analysis was used to analyze the relationship between serum UA levels and stroke severity and clinical prognosis in different risk stratification subgroups. Results Among the total 227 patients, 75 cases in low-level group, 72 cases in moderate-level group and 80 cases in high-level group. After adjusting the confounding factors, comparing with the lowlevel group, the NIHSS score at admission decreased by 2.16 points (β -2.16, 95%CI -3.53- -0.78,P =0.002) and the rate of early neurological deterioration (END) decreased by 60% (OR 0.40, 95%CI 0.16-0.97, P =0.042) in the high-level group. Stratified analysis result showed that with the increase of serum UA level, the NIHSS score at admission (stroke severity) decreased and the short-term clinical prognosis were better in male and newly diagnosed stroke patients. Conclusions The serum UA level was associated with stroke severity and END in AIS patients, especially in male and newly diagnosed stroke patients.

    Evaluation of Stroke Risk Profile and Its Correlation with Related Risk Factors in Middle-aged and Eldly Male Population
    YU Yang, HAO Chun-Yan, WANG Lu, YANG Li-Jun, LI Fang, LI Bo, LIU Jie, LIU Ju-Wei, MA Jin-Kui
    2019, 14(03):  213-218.  DOI: 10.3969/j.issn.1673-5765.2019.03.004
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    Objective To evaluate stroke risk profile using cerebral vascular functional accumulative scores (CVFAS) and analyze the relationship between the score and exposure level of risk factors in middle- aged and old male population. Methods A total of 280 male people aged more than 45 years who had completed health checkup and cerebral hemodynamic examination from People's Liberation Army General Hospital No. 8 Medical Center from February 2016 to November 2016 were included in this study.All subjects were divided into two groups according to the cut off point of CVFAS, high-risk group (CVFAS<75 score, n =82) and low-risk group (CVFAS≥75 score, n =198). To analyze the change of CVFAS and the detection rate of high-risk individuals of stroke in different age groups, compare the exposure level of risk factors between the two groups, and analyze the correlation between CVFAS and risk factors of stroke. Results The CVFAS score gradually decreased with age, the detection rate of high-risk individuals of stroke was 29.3% (82/280), this rate increased with age and reached up to 60.0% in people over 70 years. Compared with low-risk group, the proportion of smoking, hypertension, diabetes were all much more higher in high-risk group (all P <0.05), in addition, the levels of age, waist circumference (WC), body fat (BF), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), TC, LDL-C, Hcy, brachial-ankle pulse wave velocity (baPWV), carotid intimamedia thickness (CIMT) were also far more higher in high-risk group, but HDL-C were much lower in high-risk group (P <0.05). Correlation analysis showed a negative correlation between CVFAS and age (r =-0.314, P =0.007), WC (r =-0.295, P =0.009), BF (r =-0.324, P =0.006), SBP (r =-0.387, 0.005), DBP (r =-0.327, P =0.006), TC (r =-0.219, P =0.014), LDL-C (r =-0.325, P =0.006), FPG (r =-0.289, P =0.009), Hcy (r =-0.216, P =0.014), baPWV (r =-0.349, P =0.005), CIMT (r =-0.209, P =0.013) and a positive correlation with HDL-C (r =0.258, P =0.011). Logistic regression analysis revealed that age (OR 1.257, 95%CI 1.118-1.359, P =0.001), hypertention (OR 1.524, 95%CI 1.259-1.894, P <0.001), BF (OR 1.493, 95%CI 1.214-1.876, P =0.001), SBP (OR 1.897, 95%CI 1.684-2.697, P =0.001), FPG (OR 1.356, 95%CI 1.214-1.651, P =0.001), LDL-C (OR 1.675, 95%CI 1.327-1.956, P <0.001), Hcy (OR 1.295, 95%CI 1.158-1.413, P =0.001), baPWV (OR 1.258, 95%CI 1.149-1.524, P =0.002] were independent risk factors of CVFAS abnormality. Conclusions The decreased CVFAS (CVFAS<75 score) was closely correlated with the exposure levels of risk factors in high-risk individuals of stroke. Using CVFAS to screen the high-risk individuals of stroke is a convenient and feasible method, which is helpful to early prevention of stroke.

    Imaging Characteristic and Risk Factors of Gait Disorders in Cerebral Small Vessel Disease
    CHAI Xiang-Ting, WANG Xiang-Xiang, ZHANG Rui-Xia, MA Ling-Li, XIAO Xing, WANG Yan, TAN Lan
    2019, 14(03):  219-224.  DOI: 10.3969/j.issn.1673-5765.2019.03.005
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    Objective To investigate the imaging characteristics of gait disorders in cerebral small vessel disease (CSVD). Methods This study consecutively enrolled patients with CSVD from neurology department of People’s Hospital of Qingdao West Coast New Area from July 2018 to September 2018. Baseline data were collected including gender, age, chief complaints, smoking, hypertention, hyperlipidemia (HLP), HbA1c, silent brain infarction, periventricular white matter hyperintensities (PWMHs), deep white matter hyperintensities (DWMHs), cortex atrophy (sylvian fissure ratio), subcortex atrophy (caudate head interval ratio), hippocampus atrophy (interuncal distance ratio). Impaired gait was defined as the Holden functional ambulation classification (FAC) score ≤3, and all patients were divided into low risk of falling group (LRF) and high risk of falling group (HRF). Univariate analysis and multivariate Logistic regression analysis were used to identify the independent risk factor of severe gait disorders. Results A total of 102 CSVD patients were identified, including 59 cases (57.8%) in HRF group. Univariate analysis showed that age (P <0.001), HbA1c (P =0.007), PWMHs (P =0.002), DWMHs (P <0.001), sylvian fissure ratio (P <0.001), caudate head interval ratio (P =0.003) and hippocampus interuncal distance ratio (P <0.001) were correlated with tumble. Multivariate Logistic regression analysis showed that age (OR 1.173, 95%CI 1.053-1.306, P =0.004), DWMHs (OR 8.883, 95%CI 2.674-29.512, P <0.001) and sylvian fissure ration (OR 1.433, 95%CI 1.028-1.999, P =0.034) were independent risk factors of tumble in CSVD. Conclusions Advanced age, high score of DWMHs and obvious cortex atrophy were independent risk factors of tumble in CSVD, and patients with such risk factors should be paid more attention to prevent tumble.

    The Effect of Butylphthalide Combined with Alteplase Thrombolysis in Patients with Ischemic Stroke
    HOU Yuan-Yuan, LIANG Zhi-Gang, SUN Xu-Wen, YANG Shao-Wan, LI Bing, HU Yin-Bao
    2019, 14(03):  225-230.  DOI: 10.3969/j.issn.1673-5765.2019.03.006
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    Objective To investigate the clinical effect of butylphthalide in ischemic stroke patients with intravenous thrombolysis. Methods A retrospective analysis of 205 ischemic stroke patients treated by intravenous thrombolysis from Yantai Yuhuangding Hospital Affiliated to Qingdao University was performed. The patients were divided into combination group (n =112, rt-PA+butylphthalide) and rt-PA group (n =93). Clinical efficacy was assessed by the NIHSS scores immediately after thrombolysis, the NIHSS scores at 14 days after thrombolysis and the mRS scores at 90 days after thrombolysis. The difference in clinical efficacy among different TOAST subtypes were also analyzed. The safety outcome was evaluated by intracranial hemorrhage within 14 days and mortality at 90 days. The difference of clinical efficacy and safety between the two groups were compared. Results (1) There was no statistical difference in the NIHSS score immediately after thrombolysis between two groups. The NIHSS score at 14 days in combination group significantly decreased than that in rt-PA group [(4.82±0.44) vs (6.40±0.66), P =0.041]. The good prognosis (mRS ≤2 score) rate at 90 days was higher in combination group than that in rt-PA group (72.3% vs 55.9%, P =0.014).Of all TOAST subgroups in combination group, the clinical efficacy (14-day NIHSS score and 90- day mRS score) in large-artery atherosclerosis (LAA) subgroup was best and significantly better than that in rt-PA group. (2) There were no statistical difference in safety outcome between the two groups. (3) Multiple-factor analysis showed butylphthalide was protective factor (OR 0.425, 95%CI 0.216-0.835, P =0.013) for prognosis in ischemic stroke patients, and age >60 years (OR 2.233, 95%CI 1.047-4.766, P =0.038), systolic blood pressure>160 mm Hg at admission (OR 2.295, 95%CI 1.126-4.679, P =0.022), and NIHSS score >10 before thrombolysis (OR 9.354, 95%CI 4.049- 21.610, P <0.01) were independent risk factors for prognosis in stroke patients with intravenous thrombolysis. Conclusions Butylphthalide injection used in ischemic stroke patients with intravenous thrombolysis can further improved short-term prognosis comparing with only intravenous thrombolysis, especially in LAA subgroup.

    Compromised Dynamic Cerebral Autoregulation in Patients with Epilepsy
    LYU Shan, GUO Zhen-Ni, JIN Hang,SUN Xin, JIA Mei-Yan, MA Hong-Yin, LYU Yu-Dan, QIU Quan-Li, LIU Jia, YANG Yi
    2019, 14(03):  231-239.  DOI: 10.3969/j.issn.1673-5765.2019.03.007
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    Objective The aim of this study is to analyze dCA in patients with epilepsy. Methods One hundred patients with epilepsy and 100 age- and sex-matched healthy controls were recruited. Noninvasive continuous cerebral blood flow velocity of the bilateral middle artery and arterial blood pressure were recorded. Transfer function analyses were used to analyze the autoregulatory parameters (phase difference and gain). Results The overall phase difference of patients with epilepsy was significantly lower than that of the healthy control group (P =0.046). Furthermore, patients with interictal slow wave had significant lower phase difference than the slow-wave-free patients (P =0.012). There was no difference in overall phase between focal discharges and multifocal discharges in patients with epilepsy. Simultaneously, there was no difference in mean phase between the affected and unaffected hemispheres in patients with unilateral discharges. In particular, interictal slow wave was an independent factor that influenced phase difference in patients with epilepsy (P =0.016). Conclusions Our study documented that dCA is impaired in patients with epilepsy, especially in those with interictal slow wave. The impairment of dCA occurs irrespective of the discharge location and type. Interictal slow wave is an independent factor to predict impaired dCA in patients with epilepsy. Clinical Trial Identifier This trial is registered with NCT02775682.

    The Impact of Variational Primary Collaterals on Cerebral Autoregulation
    GUO Zhen-Ni, SUN Xin, LIU Jia,SUN Hui-Jie, ZHAO Ying-Kai, MA Hong-Yin, XU Bao-Feng, WANG Zhong-Xiu, LI Chao, YAN Xiu-Li,ZHOU Hong-Wei, ZHANG Peng, JIN Hang, YANG Yi (Translator: WANG Yan)
    2019, 14(03):  240-246.  DOI: 10.3969/j.issn.1673-5765.2019.03.008
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    T he i n?uence o f t he a nterior a nd p osterior c ommunicating a rtery (ACoA a nd PCoA) on dCA is largely unknown. In this study, we aimed to test whether substantial differences in collateral anatomy were associated with differences in dCA in two common types of stenosis according to DSA: either isolated basal artery and/or bilateral vertebral arteries severe stenosis/ occlusion (group 1A: with bilateral PCoAs; and group 1B: without bilateral PCoAs), or isolated unilateral internal carotid artery severe stenosis/occlusion (group 2A: without ACoA and with PCoA; group 2B: with ACoA and without PCoAs; and group 2C: without both ACoA and PCoA). The dCA was calculated by transfer function analysis (a mathematical model), and was evaluated in MCA and/or PCA. Of a total of 231 non-acute phase ischemic stroke patients who received both dCA assessment and DSA in our lab between 2014 and 2017, 51 patients met inclusion criteria based on the presence or absence of ACoA or PCoA, including 21 patients in the group 1, and 30 patients in the group 2. There were no signi?cant differences in gender, age, and mean blood pressure between group 1A and group 1B, and among group 2A, group 2B, and group 2C. In group 1, the PCA phase difference values (autoregulatory parameter) were signi?cantly higher in t he s ubgroup w ith p atent P CoAs, c ompared t o t hose w ithout. I n g roup 2 , t he M CA p hase difference values were higher in the subgroup with patent ACoA, compared to those without. This pilot study found that the cross-?ow of the ACoA/PCoA to the affected area compensates for compromised dCA in the affected area, which suggests an important role of the ACoA/PCoA in stabilizing cerebral blood ?ow.

    Application of Thigh Cuffs Release Test in the Evaluation of Cerebral Autoregulation
    HU Ming-Yi, HUANG Yan-Lu, KE Cheng-Ming, JIANG Zhen-Wei, HAN Ke
    2019, 14(03):  248-254.  DOI: 10.3969/j.issn.1673-5765.2019.03.009
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    The thigh cuffs release test (TCRT) is a common method of evaluating dCA. The test method is as follows: in?ating the above-knee cuffs at first, subsequently de?ating the cuffs rapidly, which causes a sudden fall of arterial blood pressure (ABP)and cerebral blood flow velocity (CBFV), the changes of ABP and CBFV are recorded to evaluate the dCA. This method is cheap, simple and convenient, non-invasive and repeatable, because of these advantages, it is widely used in the evaluation of dCA in patients with acute ischemic stroke, severe head trauma and severe preeclampsia. This article reviewed the present status of application of TCRT in the evaluation of dCA .

    Dynamic Cerebral Autoregulation in Resting State: Measurement Method and Clinical Application
    JI Nai-Fang,WANG Zheng-Yan, HAN Ke, HU Han-Hwa
    2019, 14(03):  255-259.  DOI: 10.3969/j.issn.1673-5765.2019.03.010
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    Cerebral autoregulation is a kind of physiological mechanism to maintain constant cerebral blood flow. There are many methods to measure cerebral autoregulation. this article introduced the method of dynamic cerebral autoregulation in resting state, which is measured by using transfer function analysis to calculate the phase difference in low frequency between the waveforms of peripheral arterial blood pressure and cerebral blood flow. Cerebral autoregulation is associated with the outcome of cerebrovascular diseases, so it has the potential to be a diagnostic tool in the future.

    Application of Valsalva Maneuver in Cerebral Autoregulation
    JIANG Zhen-Wei, HU Ming-Yi, HUANG Yan-Lu,KE Cheng-Ming, HAN Ke
    2019, 14(03):  260-264.  DOI: 10.3969/j.issn.1673-5765.2019.03.011
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    CA is a complex multi-factor process during which cerebral blood flow can still remain relatively stable when arterial blood pressure (ABP) and cerebral perfusion pressure (CPP) occur changes. Cerebral autoregulation is related to the occurrence, development and clinical prognosis of some nervous system diseases, such as cerebrovascular disease, Parkinson's disease, headache, autonomic nervous dysfunction. There are several methods of evaluating and measuring cerebral autoregulation. Observing the change of blood pressure induced by Valsalva maneuver are more operable and standardized, which is applicable to all kinds of people. Valsalva maneuver is widely used in cerebral autoregulation because of its safety, simplicity and accuracy. This article reviewed the application of Valsalva maneuver in cerebral autoregulation.

    Stroke: No-Reflow Phenomenon Postrecanalization Assessed by TCD in Acute Ischemic St
    YANG Zhong-Hua
    2019, 14(03):  265-265.  DOI: 10.3969/j.issn.1673-5765.2019.03.012
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    Neurology: Bow Hunter Syndrome Diagnosed by TCD
    YANG Zhong-Hua
    2019, 14(03):  266-266.  DOI: 10.3969/j.issn.1673-5765.2019.03.013
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    Dynamic Cerebral Autoregulation: An Independent Functional Outcome Predictor of Mild Acute Ischemic Stroke
    HAN Ke
    2019, 14(03):  267-267.  DOI: 10.3969/j.issn.1673-5765.2019.03.014
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    Dynamic Cerebral Autoregulation: A Measurement Method of Blood Flow of Extracranial Segment of Internal Carotid Artery
    JI Nai-Fang
    2019, 14(03):  268-268.  DOI: 10.3969/j.issn.1673-5765.2019.03.015
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    Kety Created Cerebral Blood Flow Determination Method
    John H.Zhang
    2019, 14(03):  269-275.  DOI: 10.3969/j.issn.1673-5765.2019.03.016
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    A Case Report of Cerebral Venous Thrombosis Admitted through Stroke Fast Track
    WANG Hui-Qin,LIU Kang-Ding, JIN Hang, WANG Shou-Chun, XING Ying-Qi
    2019, 14(03):  276-279.  DOI: 10.3969/j.issn.1673-5765.2019.03.017
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    Utility of Current Thrombophilia Screening in Young Patients with Stroke and TIA
    LIU Yan-Fang
    2019, 14(03):  280-282.  DOI: 10.3969/j.issn.1673-5765.2019.03.018
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    Novel Predictor of Hematoma Expansion in Primary Intracerebral Hemorrhage Patients: Iodine Sign or Spot Sign
    LIU Da-Cheng
    2019, 14(03):  284-286.  DOI: 10.3969/j.issn.1673-5765.2019.03.019
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    Peri-operative Neurological Complications in the Eldly People
    ZHEN Zhuo, WANG Hui
    2019, 14(03):  287-292.  DOI: 10.3969/j.issn.1673-5765.2019.03.020
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    Peri-operative neurological complications are the major cause of poor prognosis and death in patients, and the occurrence risk of complications is closely related with the increasing age. With the population aging, the proportion of elderly patients with surgery increased, perioperative neurological complications in the aged gradually aroused more attention. This article summarized the mechanism and risk factors of perioperative stroke and postoperative cognitive function impairment, and the prevention of brain injury and cerebral protection strategies, to provide a reference for clinical practice.

    Advance in Protective Factors and Biochemical Risk Factors of Post-stroke Disability
    HE Yu-Di, LYU Yu-Mei
    2019, 14(03):  293-296.  DOI: 10.3969/j.issn.1673-5765.2019.03.021
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    Stroke is a common disease which is harmful to human health, with a high incidence, mortality and disability. This article reviewed that the main protective factors and biochemical risk factors of post-stroke disability. The protective factors were discussed from three aspects: biological factors, psychological and behavioral factors and environmental factors, to provide theoretical basis and reference for establishing effective intervention measures and health management model for post-stroke disabled patients.

    Progress in Neuroimaging of Mild Cognitive Impairment
    HU Rui-Hong, FAN Cun-Xiu, BI Xiao-Ying
    2019, 14(03):  297-300.  DOI: 10.3969/j.issn.1673-5765.2019.03.022
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    Mild cognitive impairment (MCI) is an transition state between the cognitive changes of normal aging and clinical dementia, which is characterized by mild impairment of memory and intelligence. The general cognitive function and social ability in MCI patients remain intact and MCI doesn't meet the diagnostic criteria of dementia, while it has a high risk of developing dementia. Therefore, early detection, early diagnosis and early treatment are crucial for MCI. In the specific diagnosis of mild cognitive dysfunction, neuroimaging diagnosis has an important clinical diagnostic value, which plays a critical role in the early diagnosis of MCI and prevention of Alzheimer's disease. This article reviewed the methods and application of neuroimaging in the diagnosis of MCI, to provide a reference for clinical diagnosis and treatment of MCI.

    Application of Standardized Patients Combined with Multimedia Teaching in Cerebrovascular Diseases Teaching
    LIAO Xiao-Ling, ZHANG Ning, WANG Chun-Xue, ZHAO Xing-Quan
    2019, 14(03):  301-302.  DOI: 10.3969/j.issn.1673-5765.2019.03.023
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