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Table of Content

    20 September 2010, Volume 5 Issue 09
    主编手记
    In Community
    WANG Yong-Jun
    2010, 5(09):  695-696. 
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    述评
    Intensive Early Intervention and Emphasis on Stroke Prevention for Community Groups
    WANG Wen-Zhi
    2010, 5(09):  697-699. 
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    论著
    Epidemiological Investigation of Overweight and Obesity Inhabitants Aged over 50 in Changsha
    ZENG Feng;LIU Yun-Hai;YANG Qi-Dong;et al.
    2010, 5(09):  700-705. 
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    Objective To study the general characteristics of the over 50-year old populations withoverweight and obesity in Changsha; to further provide the basis in exploring interventionmeasures accordingly.Methods Using stratified cluster random sampling, 20 communities were selected from TianxinDistrict of Changsha as the investigation subjects. In each sample, the correlation study ofoverweight and obesity were conducted among the over 50-year old permanent residents, and thehypertensive distribution in different body weight groups of the population was investigated atthe same time.Results The prevalence rate of overweight was 38.9%, and with male being 46.8%, female being33.1%, and that of obesity was 6.1%, with male being 7.1%, female being 5.3%, respectively. Theprevalence rate between men and women in terms of overweight and obesity demonstrated astatistical significance. The prevalence rate of overweight in 60-69 years old group was higherthan that in 50-59 and 70-90 years old groups(P =0.032, 0.005). As multiple linear regressionshowed that age, gender, labor intensity, smoking, drinking were significantly associated withbody mass index(BMI), which was positively correlated with hypertension.Conclusion The prevalence of overweight and obesity in Changsha showed higher among theelder populations. especially in male. Age, sex, labor, smoking and drinking are predominantinfluences in BMI which implies that a comprehensive intervention should be taken to decreaseoverweight and obesity in populations, it plays an important role in the incidence of hypertensionreduction.
    Study on Early Warning for Stroke in Community-based Population in Beijing
    LIU Hong-Mei;WANG Wen-Zhi;WU Sheng-Ping;et al.
    2010, 5(09):  706-711. 
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    Objective The purpose of this study was to observe and evaluate the feasibility on the earlywarning for stroke in the community populations by using cerebral vascular hemodynamicindexes (CVHI) detection technology.Methods CVHI score, a key indicator of CVHI detection technique, was used in early warningfor stroke by examination of CVHI. This study was a prospective cohort study.Local residentsaged ≥40 and no stroke history were selected by cluster sampling in two communities in Beijing.Questionnaire survey and examination of CVHI were carried out. The incidence of stroke wereregistered during the 2.5 follow-up year. Observing the incidence of stroke and according toCVHI baseline data ,the preliminary conclusions can be drawn. In this period, no interventionmeasure was taken in the cohort. A strict quality control measurement was made to ensure theaccuracy and reliability of the information.Results (1)2910 residents were included in this study on baseline. In a 2.5-year follow-up period,40 stroke events occurred. 1590 patients’ CVHI score were <75, which accounted for 54.64% ofthe cohort. (2)In 40 patients with new stroke, the percentage of ischemic stroke was 90%, andhemorrhagic stroke 10%. 75% of patients with stroke whose CVHI score were <75. (3)50% ofpatients with stroke were over 70 years. In patients over 70 years old, 90% of patients whoseCVHI score were <75.Conclusion The CVHI score decreased with the age increased, and meanwhile the incidence ofstroke increased. The CVHI detection technique was a useful screening tool in early warning forstroke in the community populations.
    Investigation of Stroke Rehabilitation Knowledge and Needs of Family Caregivers in Chengdu Community
    YANG Mi;LI Feng;LUO Ming-Dan;et al.
    2010, 5(09):  712-715. 
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    Objective To study the stroke rehabilitation knowledge and needs of family caregivers inChengdu community.Methods Questionnaires were designed to investigate the demographic characters, knowledgeof rehabilitation services and demands in 200 family caregivers of stroke patients at societies inChengdu.Results Most family caregivers were female(59%), mainly in the middle-aged and the elderly(44% for each), 57.5% were spouses caregivers; the rehabilitation knowledge of most caregiverswas shortage. The scores of the questionnaire about knowledge of rehabilitation were much moresignificantly related to their education degree and age (P <0.01); There were 81% caregivers haddemand for rehabilitation services in Chengdu community.Conclusion The know1edges of rehabilitation in family caregivers of stroke patients need to beimproved. It is necessary to promote community-based rehabilitation to meet the urgent needs forrehabilitation services.
    Survey and Intervention Study on the Cognitive Level of Stroke-Related Knowledge among Beijing Community Medical Staff
    CHEN Sheng-Yun;SUN Hai-Xin;ZHAO Xing-Quan;et al.
    2010, 5(09):  716-722. 
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    Objective The purpose of this study was to investigate the cognitive level of community medicalstaff on the stroke-related knowledge in Beijing communities and to evaluate the trainingintervention of community medical staff about the stroke-related knowledge.Methods Fangzhuang health service center of Fengtai District in Beijing was selected as ourresearch site. An unified questionnaire-type survey of medical staff was used on the baselinesurvey before the intervention. The investigation included: (1) community medical staff bysex, age, education background and other general informations; (2) stroke-related knowledge,including knowledge of stroke risk factors, the intervention of high risk groups of stroke,stroke prevention and control knowledge, stroke identification and referral knowledge of earlysymptoms occurrences. The intervention study was that the community medical staff was trainedabout the expertise of stroke. The same questionnaire study to further investigate was used afterthe end of the training. The cognitions of stroke knowledge before and after the survey werecompared to evaluate the intervention.Results Fifty community medical staff were included in the study. (1) The awareness percentageof stroke risk factors was 66% to 100%.After training, the awareness percentage was 94% to100%. The awareness percentage of prevention and control of risk factors, such as hypertension,diabetes, obesity was 70% to 96%. After training, the awareness percentage was 92% to 100%.(2) The awareness percentage of identification of high risk groups of stroke was 84% to 100%.The awareness rate was 98% to 100% after training. The awareness percentage of communityintervention for high stroke risk groups was 86% to 96%. The awareness rate was 94% to 98%after training. The awareness percentage of stroke prevention and control knowledge was 90% to100%, after training the awareness rate was 94% to 100%. (3) The awareness percentage of earlyidentification of stroke symptoms was 82% to 96%. The awareness rate was 94% to 100% aftertraining. The awareness percentage of referral after occurrence of early stroke symptoms was88% to 98%. The awareness rate was 96% to 100% after training.Conclusion Currently, community medical staff lack knowledge of stroke risk factors,identification of early stroke symptoms, prevention and control of community interventionfor high risk groups of stroke in Beijing. After some hours of training on stroke expertise, theawareness percentage was better. We should strengthen the stroke-related training to communitymedical staff regularly.
    Safety of Low-Dose Heparin for Intracranial Stent-Assisted Angioplasty: ARandomized Controlled Pilot Study
    GAO Feng;DU Bin;XU Xiao-Tong;et al.
    2010, 5(09):  723-729. 
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    Objective To access the safety of low-dose heparin in comparison to a high-dose regimen inpatients undergoing intracranial stent-assisted angioplasty.Methods We performed a prospective random, double-blind, comparative study from Oct2004 to Mar 2006. The patients undergoing intracranial stent-assisted angioplasty in our centerwere randomly assigned to receive low dose of heparin (2000 IU plus 500 IU/h) or high doseof heparin (3000 IU plus 800 IU/h) during the procedure. The groups were compared for thefollowing primary endpoints until hospital discharge: target lesion acute thrombosis, intracranialhemorrhage (ICH) and death. The activated clotting time (ACT) was measured.Results The overall angioplasty success rate was 93% (65/70 lesions). Stents were placed in94.7% (36/38) and 90.6% (29/32) of patients in the low-dose and high-dose groups, respectively(P =0.65). The low dose of heparin group did not increase target-lesion thrombosis (3.0% vs 3.2%,P =1.00) and had a low risk of intracranial hemorrhage (3.0% vs 12.9%, P =0.19). However, thisdifference was not statistically significant.Conclusion The use of a low-dose heparin regimen did not increase the incidence of target lesionthrombosis. Intraoperative low-dose heparin seems to be safe for patients undergoing intracranialstent-assisted angioplasty, but these data should be confirmed in a larger trial.
    Investigation of Clinical Manifestation and Magnetic Resonance in Patients with Posterior Circulation Infarction
    FAN Fu-Qiang;LIU Mei-Ping;LIU Zhi-Hui;et al.
    2010, 5(09):  730-734. 
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    Objective To study the imaging characters, etiopathogenisis, risk factors, clinical manifestations,vascular lesions and prognosis of posterior circulation infarction.Methods Fifty-three patients with posterior circulation ischemic stroke were admitted to ourdepartment from September 2007 to March 2010 and they were analyzed retrospectively. Allpatients undertake magnetic resonance imaging(MRI) on admission and responsible lesionswere identified in the posterior circulation territories. The patients’ clinical symptoms and signswere evaluated and the relationships between lesion locations and clinical characteristics wereanalyzed. We subdivided the posterior circulation infarcts into proximal, middle, distal andmixed infarcts referring to NEMC-PCR study. The patients were evaluated by modified Rankinscale(mRS) to investigate the relationships between risk factors, lesion locations and prognosis.Results The common symptoms of posterior circulation ischemic stroke were vertigo(52.8%),nausea and vomiting(43.4%), limb paralysis(39.6%), speech difficulty(32.1%);the commonsigns of posterior circulation ischemic stroke were central facial or lingual palsy(58.5%), limbweakness(39.6%), limb sensory loss(32.1%), ataxia(28.3%). The most common risk factors werehypertension, diabetes, smoking, alcohol overuse, cardiopathy, hyperlipemia. The most commonlocation of infarcts was in the middle segment(39.6%), following by distal segment(24.5%), mixed(18.9%) and proximal (17.0%). About 34. 0% of cerebral infarction in posterior circulation havepoor outcome referring to mRS.Conclusion The clinical features of patients with posterior circulation ischemic stroke werecomplex. Predominant symptoms can help to diagnose the posterior circulation ischemic stroke.The most common location of infarcts was in the middle segment. Majority of the patients withposterior circulation ischemic stroke have good prognosis.
    A study of Plasma Homocystein in Patients with Parkinson’s Disease and its Clinical Significance
    YAN Zhao-Fen;GAO Jun-Hua;LIU Zhuo;et al.
    2010, 5(09):  735-740. 
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    Objective To conduct a comparsion study on the change of plasma homocystein (Hcy) in patientswith Parkinson’s disease (PD) and cerebral infarction , and to explore its clinical significance.Methods We examined the levels of plasma Hcy, folic acid and vitamin B12 of patients among PD,cerebral infarction and control group. The levels of plasma Hcy, folic acid and vitamin B12 of PDpatients were analyzed. The relationships among Hcy level and PD severity, PD duration, clinicaltypes, mood status, cognitive function and Madopar treatment were analyzed.Results 1 Hcy levels in patients with PD, cerebral infarction and control group were 20±11μmol/L, 16±7 μmol/L and 11±3 μmol/L, respectively. Hcy levels in patients with PD and cerebralinfarction were all significantly higher than that of control group (P <0.05 or P <0.01, respectively).Hcy level in PD patients was significantly higher than that of patients with cerebral infarction(P <0.01); 2 The levels of plasma folic acid and vitamin B12 in PD patients were 6±5 μg/L and 514±345ng/L; it was negatively correlated (r =-0.453, P <0.01) between the level of Hcy and folic acid inPD patients; and there was no significant correlation between Hcy level and the level of vitaminB12 (r =-0.268, P >0.05); 3 Hcy levels in PD patients with mild, moderate and severe degreesevaluated by Hoehn-Yahr staging were significantly different (16±8 μmol/L, 21±9 μmol/L and35±3 μmol/L, respectively, P <0.05); 4 There were no relationships among Hcy level and PDduration, clinical types, mood status, cognitive function and Madopar treatment.Conclusion Hcy level in PD patients was significantly elevated, which was closely correlatedwith disease severity. Hcy level and folic acid level was negatively correlated.
    Correlation Associated to Poststroke Depression in Patients with Hypertensive Intracerebral Hemorrhage
    ZHOU Jian;ZHAO Xing-Quan;HOU Xin-Yi;et al.
    2010, 5(09):  741-745. 
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    Objective To investigate the determinants of poststroke depression (PSD) in patients withhypertensive intracerebral hemorrhage (ICH).Methods Sixty-five patients suffered from acute hypertensive intracerebral hemorrhage withrelated clinical materials such as gender, age, neurological deficit severity scale ( NIHSS) aswell as the brain computer tomography(CT) findings were screened prospectively. All patientswere evaluated at day 14 and 3 months after ICH onset for poststroke depression and quality oflife with the Hamilton Depression Rating Scale (HDRS) and the modified Rankin Scale (mRS),respectively. Univariate analysis and multivariate stepwise logistic regression were used toanalyze the relationships between clinical materials and CT features and PSD.Results Fifty-seven of sixty-five patients completed the assessment at day 14 and 53 patientscompleted the follow-up at 3 months. About thirty-five percent and thirty-eight percentrespectively reported the HDRS score greater than 7 at day 14 and 3 months after ICH onset,indicating at least a minor degree of poststroke depression. Univariate analysis showed thatthere was a relationship between first NIHSS score and PSD at day 14 after ICH onset (P =0.027).Gender, hemorrhage location and ICH volume were correlated with PSD at 3 months after ICHonset. Compared with the non-PSD, male patients in the PSD group were less (P =0.038) and theproportion of hemorrhage located in basal ganglia was greater (P =0.031) as well as the averageof ICH volume was larger (P =0.046). Multivariate analysis demonstrated that ICH volume was apredictor of PSD at 3 months after ICH onset (P =0.049).Conclusion NIHSS score and CT features may be used to assess poststroke depression inpatients with intracrebral hemorrhage, CT characteristics together with neurological deficit severity scale can provide objective evidence for comprehensive treatment of hypertensiveintracerebral hemorrhage.
    Changes of CT Perfusion Imaging in Patients with Hyperacute Cerebral Infarction after Thrombolytic Therapy
    LIU Zhi-Hui;GENG Jian-Hong;LIU Mei-Ping;et al.
    2010, 5(09):  746-750. 
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    Objective To investigate the changes of computed tomography perfusion imaging(CTPI) inpatients with hyperacute cerebral infarction before and after thrombolytic therapy.Methods Forty-five patients with acute cerebral infarction within 6 hours after onset wererandomly divided into thrombolytic group and control group. CTPI was performed on all patientsbefore and after thrombolytic therapy in thrombolytic group, and to observe the changes ofrelative cerebral blood flow(rCBF), relative cerebral blood volume(rCBV) and relative meantransit time(rMTT) on ischemic area, and to evaluate the changes of neurological function deficitscale before and after thrombolytic therapy . Compared these results between thrombolytic groupand control group.Results Abnormal perfusion changes corresponding to clinical symptoms were all found intwo groups, including CBF and CBV decreased, MTT delayed, which indicate there was anischemic penumbra. Follow-up CTPI showed that the cerebral perfusion improved in most casesof thrombolytic group, there was no significant difference of rCBF and rCBV on infarction corecompared to that before thrombolytic(P >0.05), the rCBF was significantly increased(P <0.01)andrMTT was significantly decreased(P <0.01)on ischemic penumbra after thrombolytic therapy. TherCBF and rCBV were significantly decreased and rMTT was significantly increased on ischemicpenumbra in control group after routine therapy(P <0.01). After therapy, the rCBF and rCBVof ischemic penumbra were significantly increased and rMTT was significantly decreased in thrombolytic group than that in the control group(P <0.01). Improvement of national institutes ofhealth stroke scale(NIHSS)in thrombolytic group was higher than that in control group.Conclusion The rCBF is increased and rMTT is decreased in patients with hyperacute cerebralinfarction after thrombolytic therapy, and the NIHSS is decreaed.
    编者按
    Prehospital Delay of Stroke
    WAGN Wen-Zhi
    2010, 5(09):  751-751. 
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    专题论坛
    Early Identification of Stroke and Prehospital Screening
    SUN Hai-Xin;WANG Wen-Zhi
    2010, 5(09):  752-757. 
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    Factors Associated with Prehospital Delay of Sroke Patients and Intervention Measures
    SUN Hai-Xin;WANG Wen-Zhi
    2010, 5(09):  758-762. 
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    病例讨论
    A Case of the Clinical Significance of Transcranial Doppler in the Subtype Diagnosis of Ischemic Stroke
    FAN Ping;CHEN Tian
    2010, 5(09):  763-765. 
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    指南与规范
    Stroke: Working Toward a Prioritized World Agenda
    GUO Xu;WANG Chun-Yu
    2010, 5(09):  766-769. 
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    综述
    Carotid Atherosclerotic Stenosis and Ischemic Stroke
    RU Xiao-Juan;WANG Wen-Zhi.
    2010, 5(09):  770-774. 
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    Most of the carotid artery stenosis are caused by carotid atherosclerotic plaque withhigh prevalence. Carotid atherosclerosis is not only the systemic atherosclerosis, but also the mostimportant cause and risk factor of ischemic stroke. This article reviews the prevalence of carotidartery stenosis and the risk of ischemic stroke caused by it.
    Establishment and Application of the New Generation of Stroke Electronic Medical Record
    LIN Lin;WANG Tao.
    2010, 5(09):  775-777. 
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    Patient follow-up and scientific research data are very important to clinicians inthe stroke therapy. However, due to the medical records always have a huge amount of contentin paper form, these data of stroke medical records cannot be used in the clinical research andteaching. The point is to design the stroke electronic medical record (EMR). The electronicmedical record system which adapt to stroke treatment and research should be created.
    S100B and Ischemic Stroke
    YUAN Yuan;GAO Xu-Guang.
    2010, 5(09):  778-781. 
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    Serum S100B has been widely studied as a biomarker in acute ischemic stroke,to help the doctor make a fast diagnosis of ischemic stroke. This paper reviewed the publishedliterature on S100B. The main objective is to determine its clinical applicability. The reviewinclude nerve biomarkers, the mechanism of S100B protein increasing in acute ischemic stroke,the limitation of S100B and the future of S100B.
    教学园地
    "Problem-Based Learning" in the Teaching of Cerebrovascular Disease
    PENG Bin;NI Jun;XU Wei-Hai;et al
    2010, 5(09):  782-784. 
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