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Table of Content

    20 October 2010, Volume 5 Issue 10
    论著
    Study of the Correlative Factors of Post-stroke Depression and Quality of Life and the Evaluation of the Therapetic Effects of Two Methods
    QIAN Min;SUN Mei-Zhen;FAN Hui-Qin
    2010, 5(10):  791-797. 
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    Objective We studied the influencing factors and the qulity of life of post-stroke depressionpatiants. We also compared the therapetic effects of mental healing only or fluoxetine together tothe patients in different depression level.Methods We collected 70 patients who suffered from acute post-stroke depression, and investigatedthe patients’information, such as age, gender, marital status, career, character, education, address,Month income, Social Support, family relationship, stroke pattern, stroke times, carotid arterystenosis and accompanying diseases (including high blood pressure, diabetes, heart disease andBlood fats metabolic disorder). We divided the patients into two groups after admission. The firstgroup was given mental healing only. And the other group was given mental healing and fluoxetinetogether. We carried on grading to all patients with Hamilton Depression Rating Scales-21, SocialSupport Rating Scales, Chinese Strok Clinical Nerve Deficiency Scales and Quality of Instrumentsfor stroke patients (QOLISP 1.0).Results 1. In the patients with post-strok depression, mild despondent patients account for 57.1%,the ratio of moderate depression patients for 4.3%, and severe depression patients for 8.6%. 2. Afteranalysing by using logistic regression method, we found that the depression level was correlated with age, family relationship, stroke times and the numbers of accompanying diseases. 3. Afteranalysing by using stepwise multi-elemental regression analysis, we found that the qulity of lifeof patients with post-stroke depression was correlated with depression level, neurological deficit,career, character, stroke times and age. 4. After analysing by using the repeating survey method,wefound that the nerve function obviously restored and the quality of life obviously improved bytreatment. But the patients with mild depression showed better neurological function recovery thanthe patients with moderate or severe depression; For qulity of life, the patients with moderate orsevere depression showed the same improvement with the patients with mild depression. 5. Usingnon-parameter method to compare the therapeutic effect, we found two treatment methods showedno different effect in the patients with mild depression, but obviously different effect in the patientswith moderate or severe depression. Obviously the effect of union treatment was better than that of mental healing only.
    Cross-sectional Survey on Proportion and Treatment of Depression after Neurological Diseases in China
    WANG Yi-Long;ZHANG Ning;ZHANG Tong;et al.
    2010, 5(10):  798-800. 
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    Objective To investigate the proportion and treatment situation in neurology patients withdepression symptoms in general hospital.Methods A total of 1281 patients from neurology department were consecutively enrolled. HospitalAnxiety and Depression (HAD) Scale was used to evaluate the symptoms.Results 44.0% of patients in neurology department were stroke patients, but only 6.7% of themand 17.4% of non-stroke patients were treated with antidepressants. However, 50.0% of strokepatients and 47.7% of non-stroke patients were diagnosed with depression. Sertraline was the mostfrequently used in treatment.Conclusion There were high incidence of neurology patients with depression symptoms, especiallypost-stroke depression (PSD), but little of them were diagnosed in the past, which should be takenseriously.
    Incidence and Related Factors of Anxiety Disorders In Non-aphasia patients After Acute Stroke—Cross-sectional Survey for 130 Patients
    ZHOU Juan;WANG Chun-Xue. ZHANG Ning;et al.
    2010, 5(10):  807-813. 
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    Objective To survey the incidence of anxiety disorder within 14 days after stroke and to analysisits related factors.Methods One hundred and thirty inpatients which were selected from May 2009 to September2009 in the department of Neurology in Beijing Tiantan Hospital, were evaluated with the HamiltonAnxiety Scale (HAMA) and analyzed the factors such as age, gender, literacy and the type, sides orthe National Institutes of Health Stroke Scale (NIHSS) of stroke.Results All the 130 patients completed HAMA scale assessments within 14±2 days, the incidenceof anxiety disorder was 30% (N=39). Forty patients had possible anxiety disorders, 32 patientshad probable anxiety disorders, and 7 patients had apparent anxiety disorders probably. The scoreof spiritual anxiety was 5.00 (1.75~9.00), and physical anxiety was 3.00 (1.00~6.00). The patientswho beyond 45 years old had higher incidence of anxiety disorder (P <0.05), the olders had moreserious spiritual and physical anxiety than the youngers. The patients graduated from the university had higher incidence of anxiety than the others (university 50%vs senior school 28.6%vs juniorsdhool 27.1%vs primary sdhool 25%vs iliteracy33.3%). In the anxiety patients, the probableanxiety disorders patients were more common in the olders, but the female was more obvious. Thecorrelation between NIHSS score and the incidence of anxiety was positive (R2=0.034). There wereno significant differences between the cadence and the type or sides of stroke. Less than 1/3 patientswith anxiety disorders were given drug intervention which mainly used selective serotonin reuptakeinhibitors (SSRIs).Conclusion About 1/3 patients had anxiety disorders in the acute phase post stroke. The age andneurological impairments were the risk factors of anxiety disorders, and the age could influencethe extent of anxiety disorders. The education might influence the incidence of anxiety disordersin some extent. At present, the intervention or treatment to the anxiety disorders was not enough incomprehensive hospitals.
    Validation of a Predictive Outcome Score of Cerebral Vein and Dural Sinus Thrombosis
    ZHENG Hua-Guang;ZHAO Zhi-Ru;LI Yi;et al.
    2010, 5(10):  814-819. 
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    Objective The purpose of this study was to determine the short-term prognosis of patients withcerebral venous thrombosis (CVT) and to validate a predictive outcome score for CVT.Methods We retrospectively investigated consecutive patients who were diagnosed as having CVTadmitted to one stroke center in this observational study. Demographic data, symptoms and signsfrom onset to diagnosis, imaging methods used, location of the thrombus and therapy were retrievedwith case report form by a neurologist. Patients were followed up on the day before discharged.Primary outcome was independent as assessed by modified Rankin Scale (mRS) score ≤2 at theend of follow-up. Sensitivity, specificity, positive predictive values, negative predictive values,negative likely ratio and positive likely ratio were calculated to validate the previous predictiveoutcome score. Receiver operating characteristic (ROC) curves were used to analyze the accuracy.Results From May 2000 to May 2010, we recruited 168 adult patients with CVT. 165 patientswere evaluated with CVT predict score on 17d (8~45d) from onset. At the end of follow-up, 130patients (78.8%) were independent by mRS ≤2. Using the risk score with a cut-off of ≥3 points,sensitivity, specificity and C statistics were 0.75 (95% confidence interval (CI) 0.67~0.82), 0.38(95%CI 0.22~0.55) and, 0.56 (95%CI 0.45~0.68) respectively. And 0.85 (95%CI 0.78~0.91); 0.35(95%CI 0.19~0.51) and 0.60 (95%CI 0.49~0.71, P =0.074>0.05) respectively with a cut-off of ≥4 points.Conclusion The prognosis of CVT is relative benign A subgroup (21.2%) of CVT patients is atincreased risk of bad outcome. The CVT risk score showed poor predictive value in our study andneed to be evaluated prospectively.
    Changes of Left Ventricular Diastolic Function in Patients of Acute Cerebral Infarction with Impaired Glucose Tolerance and Its Influence on Prognosis
    DOU Shou-Tan;ZHONG Chi;WANG An-Ning;et al.
    2010, 5(10):  820-825. 
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    Objective To observe the changes of left ventricular diastolic function in patients of acute cerebralinfarction with impaired glucose tolerance and its impact on stroke prognosis.Methods One hundred and six patients with acute cerebral infarction were undergone 75g oralglucose tolerance test (OGTT) at two weeks after infarction. According to the results of OGTT, thepatients were divided into normal glucose tolerance group (NGT, 33), impaired glucose tolerancegroup (IGT, 35) and diabetes mellitus group (DM, 38). Glycosylated hemoglobin, myocardialenzymes, blood lipids, liver function, kidney function and other biochemical parameters were testedon the morning after admission in the fast state. All patients were undergone echocardiographyinvestigation to measure left ventricular ejection fraction, E velocity, A velocity and other indicatorsof cardiac function. Ninety days after stroke, the patients will be followed up using modifiedRankin Scale (mRS).Results (1) The E/A ratio<1 reflects impaired left ventricular diastolic function. The proportionof subjects with an E/A ratio<1 was 63.6%, 85.37% and 84.2% in NGT, IGT and DM groupsdifferently. The E/A ratio<1 in IGT group and DM group were higher than that in NGT group, thedifference were statistically significant (χ2=4.42, P =0.036; χ2=3.95, P =0.047). (2) 90 days afterstroke, the level of mRS was negatively related with E/A ratio (r =-0.452, P =0.000), stroke volume(r =-0.228, P =0.020), left ventricular ejection fraction (r =-0.328, P =0.001), fractional shorting(r =-0.301, P =0.002) and E velocity (r =-0.321, P =0.001).Conclusion Impaired left ventricular diastolic function is closely related with the level of bloodglucose in patients with acute cerebral infarction. In the stage of IGT, it has emerged decreased leftventricular diastolic function and affected nerve function recovery after cerebral infarction.
    Clinical Study of the Pattern of Aneurysmal Subarachnoid Hemorrhage
    LU Xin-Bing;WANG Chang-Jiang;YIN Lian-Hu;et al.
    2010, 5(10):  826-832. 
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    Objective To evaluate the morphological features of aneurysmal subarachnoid hemorrhage oncomputed tomography (CT) scan, then to forcast the location of intracranial ruptured aneurysms onthe basis of the CT results.Methods The manifestation of CT and digital subtraction angiography (DSA) in eighty-twopatients with aneurysmal subarachnoid hemorrhage were analyzed. The relationship between thesubarachnoid hemorrhage morphology and the location of the intracranial aneurysm was found.Results The distribution of the hemorrhage caused by ruptured aneurysms located on the anteriorcerebral artery (ACA), anterior communicating artery (ACoA) and middle cerebral artery (MCA)are special. The hemorrhage mainly distributes on the anterior longitudinal cistern, sylvian cistern.Sometimes there are hematomas on those cisterns. That caused by ruptured aneurysms locatedon the internal cerebral artery (ICA) and posterior communicating cerebral artery (PCoA) arevarious. But the typical hemorrhage distribute on the super-sellar cistern and sylvian cistern. Thehemorrhage pattern of ruptured aneurysms on the posterior cerebral circulate such as the posteriorcerebral artery (PCA), basic artery (BA), vertebral artery (VA) and anterior inferior cerebellumartery (AICA) has its own characteristics, but it’s difficult to be distinguished with the nonaneurysmalhemorrhage around the brain-stem. The hemorrhage distribute on the interpeduncularcistern, ambient cistern, quadrigeminal cistern, superior and under cerebellar tentorium, prepontinecistern and lateral cerebellomedullary cistern.Conclusion We can predict some ruptured aneurysms located on ACoA, ACA and MCAaccording to the quantity and distribution of subarachnoid hemorrhage on CT scan. It’s difficultto distinguished the non-aneurysmal hemorrhage around the brain-stem with the aneurysmalhemorrhage caused by ruptured PCA, VA, BA and AICA aneurysms. It isn’t accurate to predict theruptured ICA and PCoA aneurysms because of the various hemorrhage morphology.
    The Application of Modified Movat Pentachrome Stain in the Study of Atherosclerosis
    ZHAO Li-Hong;HE Zhi-Li;TENG Liang-Hong;et al.
    2010, 5(10):  833-835. 
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    Objective To explore a modified method of dyeing to improve the defect of Weigert's resorcinfuchsinstaining in incomplete staining of intimal elastic lamina.Methods Six segments of each elastic and muscular arteries were selected from the autopsycases of atherosclerosis in varying degrees. Routin paraffin section techniques and HE stain wereperformed on these tissues. Verhoeff method was applied to show elastic fibers in the arteriesinstead of Weigert's resorcin-fuchsin stain in the Movat pentachrome stain.Results Elastic fibers, proteoglycans, collagen fibers, smooth muscle fibers and, fibrin/red bloodcells were stained black, blue, yellow, red, and bright red respectively.Conclusion Modified Movat pentachrome stain can show both the artery structure andatherosclerotic plaque morphology more clearly.
    综述
    Advances in Research on Pathogenesis for Patients with Post-Stroke Depression
    HOU Jing-Jing;ZHANG Ning;CHEN Li-Yun;et al.
    2010, 5(10):  852-856. 
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    Post-stroke depression (PSD) is a common complication of cerebrovascular disease.The pathogenesis of PSD is complex, which refers to many factors just like neurobiology, anatomy,sociology and psychology. This article reviews the advances in the research on pathogenesis ofneurotransmitters and neuroanatomy, so as to strengthen understanding and recognition of PSD.
    Development of Diagnosis for Depression Disorders in Stroke Patients With Aphasia.
    ZHOU Juan;ZHANG Ning;WANG Chun-Xue;et al.
    2010, 5(10):  857-863. 
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    Post-stroke depression is the common mood disorders, and it affects the quality oflife and the prognosis. About 1/3 patients can’t be getting the message because of communicationdisorders, whether they have post-stroke depression or not can’t be evaluated exactly. Themethods are the key to evaluate the post-stroke depression and its level. There are many toolsto estimate post-stroke depression, but the standard is still deficiency. The tool and methods toevaluate depression disorders in aphasic patients are very important.
    Perinatal Stroke
    JIANG Wei;JIANG Bin.
    2010, 5(10):  864-871. 
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    Perinatal stroke has 3 common types of arterial ischemic stroke (AIS), cerebralvenous sinus thrombosis (CVST) and hemorrhagic stroke (HS). Perinatal period is a specialtime in a life with higher risk of stroke, with estimated incidence of 17-43.4/100 000 live birthsin AIS, 41/100 000 in CVST and 6.7/100 000 in HS. Seizure is the most common clinicalpresentation in acute stage of perinatal stroke; cognitive and sensory impairments, cerebral plasy,and epilepsy may present in some cases in following stage. Because of no typical or specifiedclinical presentation, diagnostic evaluation for the perinatal stroke is mainly dependent on cranialultrasound and neuro-imaging of computed tomography/magnetic resonance imaging. Lack ofknowledge on perinatal stroke in epidemiology, pathogenic mechanism, diagnosis, treatment,prevention and rehabilitation calls for further study.
    Progress in Stroke Biomarkers of Laboratory
    JIA Nan;KANG Xi-Xiong.
    2010, 5(10):  872-876. 
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    In the pathophysiology of stroke, some correlative biomarkers will play an importantrole in early diagnosis, severity, prognostic evaluation and so on. The aim of this review is topresent the research and development of relevant indicators in the laboratory recently.