Chinese Journal of Stroke

The Missing of New Technology

WANG Yong-Jun

2010, 5(08): 595-597.

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Transcranial Doppler Diagnosis Report Specification

高山

2010, 5(08): 598-607.

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Clinical Applications of Transcranial Doppler Monitoring During Carotid Endarterectomy

ZHOU Li-xin;GAO Shan;HU Ying-Huan;et al.

2010, 5(08): 608-612.

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Objective The purposes of our study are to detective middle verebral artery (MCA) blood flowvelocity changes and microembolism during carotid endarterectomy(CEA) by transcranialDoppler(TCD) monitoring and to examine the suitability of intraoperative TCD monitoring.Methods Eighteen patients with internal carotid artery stenosis (>70%) or occlusive underwentCEA under TCD monitoring of peak systolic blood f low velocity, pulsatility index andmicroembolic signals in the ipsilateral middle cerebral artery.Results (1) Only one patient has got left ophthalmic artery embolism after CEA. (2) MCAvelocity and plusatility index increase significantly during period of cross release and woundclosure(P <0.01). 44.4% of patients with MCA velocity decrease over 60% at cross-clamping.77.8% of patients receive shunting. 33.3% of patients with MCA velocity increase over 100%at cross release. (3) Microembolic signal (MES) in 100% of patients was detected during CEA.The amount of MES are between 11 to 150, which the mean MES are 60±42. More MES weredetected at shunting and cross release.Conclusion Intraoperative TCD monitoring provides online surveillance of both hemodynamicchanges and cerebral microembolism in the middle cerebral artery on aspects of surgery, whichcan predict perioperative stroke effectively and optimize operation.

Transcranial Doppler Combined with Breathing-holding Test for EvaluationCerebrovascular reactivity in Healthy smoking Men

LI Su-Mei;LI Guang-Xia;HAN Qiu;et al

2010, 5(08): 613-615.

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Objective To use transcranial doppler (TCD) combined with breathing-holding test for evaluatingmiddle cerebral artery reactivity in healthy smoking men.Methods Forty-six healthy smoking men (group A) and 42 healthy non-smoking men (group B)were enrolled. Before and after breathing, the peak systolic velocity (PSV) of middle cerebralartery was monitored by TCD, meanwhile the pulsatility index (PI) and resistance index (RI)were detected, the difference before and after the breathing-holding test and the change ratebetween two groups were calculated.Results After breathing-holding test, the PSV of the two groups were both increased, the PI andRI were both decreased, there was significant difference between before and after breathingholdingtest, P<0.05; The change rate of PSV in group A was (23±7)%, group B was (37±9)%, andthe change rate between the two groups was statistically significant (P <0.05). The change rate ofPI in group A was (19±5)%, group B was (25±8)%, and the change rate between the two groupswas statistically significant (P <0.05). The change rate of RI in group A was (21±6)%, group Bwas (35±7)%, and the change rate between the two groups was statistically significant (P <0.05).Conclusion The cerebrovascular reactivity of healthy smoking men was lower than healthy nonsmokingmen, smoking can result in diminution of cerebrovascular reactivity. TCD combinedwith breathing-holding test can assess the cerebrovascular reactivity.

Changes of Blood Coagulation, Anti-Coagulation Activity and Hemorheology after Acute Cerebral Infarction

ZHAO Hui;ZHAO Yun-Zhuan;WANG Ya-Jie.

2010, 5(08): 616-618.

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Objective To study the changes of blood coagulation activity, anti-coagulation activity andhemorheology in patients with acute cerebral infarction.Methods Venous blood samples were collected from 40 patients with acute cerebral infarctionand 30 healthy individuals, to examine the levels of Fib, AT-III:α with blood coagulation analyzerand hemorheology indexes with automatic hemorheology instrument and to compare thedifferences between the two groups.Results Fibrinogen(Fib) of the acute cerebral infarction group(4.3±1.6g/L) are higher than thatof the control group(2.9±1.4g/L), which has significant difference(P <0.01). The whole bloodviscosity, plasma viscosity, hematocrit (HCT) and erythrocyte sedimentation rate (ESR) of theacute cerebral infarction group are higher than those of the control group,which has significantdifference (P <0.05), AT-III:α decreases obviously at acute stage of cerebral infarction, whichhas significant difference also(P <0.01).Conclusion After acute cerebral infarction, Fib and blood viscosity increase, blood coagulantactivity increases and anticoagulant activity decreases.

Risk Factors of Malnutrition in Hospitalized Patients with Acute Stroke

CHEN Sheng-Yun;WANG Yong-Jun;ZHAO Xing-Quan.

2010, 5(08): 619-625.

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Objective To find out the malnutrition incidence rate and distribution of hospitalized patientswith acute stroke. To investigate the important factors which were related to malnutrition inpatients with acute stroke.Methods Two hundreds and three consecutive patients admitted to hospital with a recent strokewere enrolled. The method of cross-sectional study was used. The main nutrition index was thelevel of serum prealbumin. The diagnosis standard of malnutrition was that the level of serumprealbumin is lower than 200 mg/L. Data on nutritional status, clinical complications and theseverity of nerve functions losses were collected in after hospitalization. The changes of thelevel of serum prealbumin were observed. The correlations between the baseline data, clinicalcomplications and malnutrition were studied. The SPSS 11.5 software was used for statisticalanalysis.Results With the extension of hospital stay, the serum prealbumin levels decreased at differenttime points (P <0.05). There were 110 patients complicated with malnutrition. The incidencerate of malnutrition in hospitalized patients with acute stroke was 54.2% in our research and itincreased with the lasting of the length of stay. Sex, age, infection, alimentary tract hemorrhage,fever, abrosia or gastrointestinal decompression, enteral nutrition, the National Institutesof Health Stroke Scale(NIHSS) scales, cognition disorder, depression after stroke onset andswallowing difficulties were related to malnutrition (P <0.05). After adjustmnet for the otherfactors, age(OR=1.723,95%CI :2.204-15.498), the NIHSS(OR=1.159,95%CI :1.020-1.316) scales and depression (OR=4.604, 95%CI 1.952-10.860) were independent risk factors of malnutrition inpatients with acute stroke.Conclusion There was high incidence rate of malnutrition in hospitalized patients with acutestroke in our research and it increased with the lasting of the length of stay. Age, the NIHSSscales and depression were independent risk factors of malnutrition in patients with acute stroke.

Effects of Antiplatelet Drugs on Plasma Lysophosphatidic Acid in Patients with Acute non-cardiogenic Cerebral Infarction

SHI Fu-Ming;CHEN Shu-Ge;LI Xian-Feng;et al.

2010, 5(08): 626-629.

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Objective To observe the effect of antiplatelet drugs aspirin and clopidogrel on Plasmalysophospholipids acid levels (LPA) in patients with acute non-cardiogenic cerebral infarction.Methods A total of 180 patients with cerebral infarction (cerebral infarction group) and 50healthy adults (control group) were tested for LPA level, and 180 patients with cerebral infarctionwere randomly assigned to aspirin group (n=90) and clopidogrel group (n=90). Aspirin groupbased on routine therapy combined with bayaspirin, once a day, 0.1g; clopidogrel group based onroutine therapy combined with clopidogrel, once a day, 75mg. Two groups were tested for the LPAlevel respectively before and after the first 12-14 days of the treatment.Results The LPA level in cerebral infarction group is significantly higher than that of the controlgroup(3.80±0.87μmol/L vs 2.85±0.65μmol/L, P <0.01). The LPA level after the treatment aresignificantly reduced compared with former treatment in both aspirin group and clopidogrelgroup (3.26±0.50μmol/L vs 3.79±0.83μmol/L, P <0.01; 3.06±0.69μmol/L vs 3.82±0.90μmol/L,P <0.01). The LPA level in clopidogrel group is lower than that of the aspirin group(P <0.01).Conclusion Plasma LPA in patients with acute cerebral infarction is higher than that of thenormal ; Antiplatelet drugs aspirin and clopidogrel can significantly reduce the LPA level ofpatients with acute cerebral infarction, and the effect of clopidogrel is more obvious than that ofaspirin.

Survey of Understanding Status of Stroke Knowledge Among CommunityResidents in Fengtai District, Beijing

SUN Hai-Xin;WANG Wen-Zhi;CHEN Sheng-Yun;et al.

2010, 5(08): 630-634.

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Objective To investigate the cognitive level of community residents with stroke-relatedknowledge in Fengtai district, Beijing.Methods Using Systematic sampling, 670 families were selected in Fangzhuang and Puhuangyucommunities, Fengtai district, Beijing. Every family select one member to fill the self-designedquestionnaire. Uniform training of community physicians were given before the survey, thecommunity physicians completed the survey by face to face indoor-investigation. A questionnaireinclude: (1) general information on community residents, including gender, age, educationallevel, et al; (2) stroke-related knowledge, including stroke risk factors, early symptoms of stroke,methods of transportation stroke patients to hospital and sources of knowledge about stroke.Results The investigation showed that(1)the awareness percentage of the stroke risk factors are48.1%-84.8%; (2)the awareness percentage of the early symptoms of stroke are 62.8%-82.8%;(3)50.3% of residents reported that they would call 120/999 once stroke symptom onset; (4)themain sources of the stroke knowledge are television (91.3%), newspapers (76.6%), communitymedical offers / doctors (62.8%) and magazines (51.0%).Conclusion At present, the residents are lack of the knowledge about stroke risk factors incommunity, Fengtai district, Beijing. We should strengthen health education by television,newspapers, doctor’s lectures, magazines and so on.

Urinary Kallidinogenase for the Treatment of Acute Cerebral Infarction

LIU Peng;CHONG Li;TANG Peng;et al.

2010, 5(08): 635-638.

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Objective To evaluate the therapeutic effects of urinary kallidinogenase for acute cerebralinfarction.Methods Sixty patients with acute cerebral infarction were randomly divided into normaltreatment plus Urinary Kallidinogenase (UK, n=30) or normal treatment (Control, n=30). NationalInstitutes of Health Stroke Scale (NIHSS) and Barthel index of all patients were assessed beforeand 14d after the treatment, Barthel index was followed up 90d after the treatment. The adverseeffects were also recorded.Results After 14d, NIHSS of both UK and control groups were decreased as compared with thepretreatment(UK, 8.57±2.25 vs 15.32±2.16, P =0.003; control, 9.23±0.96 vs 14.76±1.93, P =0.012).The decrease of NIHSS in UK group was more significant than that in control group (P =0.023).No obvious change in Barthel index in two groups were identified. After 90d, Barthel index ofboth UK and control group were decreased as compared with the pretreatment(UK, 83.05±2.11 vs47.75±1.52, P =0.004; Control, 72.15±2.22 vs 50.25±0.23, P =0.022). The decrease of Barthel indexin UK group was more significant than that in control group (P =0.034). No obvious side effectsrelated to UK treatment were observed.Conclusion Urinary kallidinogenase can obviously improve neurologic impairment andprognosis of acute cerebral infarction with good tolerability.

Experimental Studies on Liposome-Mediated Gene Transfer of Transforming Growth Factor-β1 after Transient Focal Cerebral Ischemia in Rats

LIU Xiang-Ming;ZHENG Hua-Guang;ZHANG Zhong;et al.

2010, 5(08): 639-645.

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Objective To investigate whether neuroprotective effect can be achieved by liposome mediatedtransforming growth factor-β1(TGF-β1) gene transfer to rat brain after transient focal cerebralischemia.Methods Transient focal cerebral ischemia in a rat model was produced by middle cerebral arteryocclusion (MCAO) for 1 hour. Reliable behavioral parameters were employed to detect successfulocclusion of the middle cerebral artery. The complex of plasmid contained LacZ marker geneand cationic liposomes were injected directly into the cerebrospinal fluid (CSF) of one group ofcontrol animals (n=18) immediately after MCAO. The other group of animals (n=18) was injectedwith liposome-TGF-β1 complexes. Five days after transfection, behavioral tests were employedto evaluate the neurologic deficits. Expression of β-galactosidase and TGF-β1 gene productswere detected by immunohistochemistry, reverse transcription polymerase chain reaction (RTPCR)and western blot analysis. Infarct volume and TUNEL-positive cells were counted. SemiquantitativeRT-PCR was used to examine the difference of caspase-3 mRNA between the twogroups.Results Liposome-mediated gene transfer of LacZ and TGF-β1 into the ischemic brain providedeffective expression of transgene. Compared with the control group, the neurologic functionof the rats injected with liposome-TGF-β1 complexes was significantly improved(P <0.01);infarct volume was smaller significantly(P <0.01); TUNEL-positive cells decreased significantly (P<0.01)and the expression of caspase-3 mRNA also decreased significantly.Conclusion Liposome-mediated gene transfer into the ischemic brain provided effectiveexpression of transgene after transient focal cerebral ischemia. Neuroprotective effect can beachieved by liposome mediated TGF-β1 gene tranfer which led to the inhibition of the activity ofcaspase-3. Gene transfer mediated by liposome may be a promising approach for the treament ofcerebral ischemia.

Study on the Association Between Helicobacter pylori Infection and Ischemic Stroke Subtypes

YANG Xu;ZHAO Xiao-Li;ZHENG Zhi-Dong;et al.

2010, 5(08): 646-651.

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Objective The aim of our study was to investigate the association between helicobacter pylori (Hp)infection and ischemic stroke Subtypes.Methods Total of 123 patients with ischemic stroke were enrolled. Analyses were stratifiedfor etiologic stroke subtypes according to 2007 modified TOAST criteria: 94 patients withatherothrombosis (AT), 14 patients with cardioembolism (CE), 12 patients with small arterydisease (SAD). 131 control subjects without clinical and instrumental evidence of atherosclerosisdiseases were randomly selected from clinic. All subjects were recorded potential risk factorsfor Hp infection and traditional risk factors for IS. The serumal specific antibody IgG of Hp wasdetected by enzyme-linked immunosorbent assay (ELISA). Conditional logistic regression wasused.Results Hp-IgG-positive rate of patient group was higher, but the difference was not statisticallysignificant (69.1% vs 61.8%, OR =1.381, P =0.223). This result remained no significant afteradjusting for potential risk factors for Hp infection and known risk factors for IS (OR 1.284,95%CI 0.705-2.338, P =0.413). Subgroup analyses yielded similar results in all etiologic strokesubtypes (univariate analysis: AT: OR 1.455, 95%CI 0.827-2.561, P =0.193; CE: OR 1.111, 95%CI0.352-3.504, P =0.857; SAD: OR 1.852, 95%CI 0.478-7.167, P =0.366; Multivariate analysis: AT:OR 1.441, 95%CI 0.726-2.861, P =0.297; CE: OR 0.894, 95%CI 0.249-3.211, P =0.864; SAD: OR1.836, 95%CI 0.396-8.503, P =0.437).Conclusion Our case-control study does not provide evidence of any strong association betweenHp chronic infection and IS. There is still need for large case-control and mainly prospective studies to investigate the contribution of Hp infection to IS risk particularly subgroups.

Clinical Applications of Transcranial Doppler

GAO Shan

2010, 5(08): 652-652.

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Transcranial Doppler Sonography in the Diagnosis of Cerebral Arteriosclerosis

GAO Qing-Chun;FU Xian

2010, 5(08): 653-656.

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Research Advances in Intracranial Arterial Stenosis or Occlusion Diagnosis with Transcranial Doppler Ultrasound

XING Ying-Qi;GAO Shan

2010, 5(08): 657-665.

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Function Transcranial Doppler

YOU Yong

2010, 5(08): 666-671.

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Transcranial Doppler Monitoring during Carotid Artery Stenting helps Evaluation and Treatment of Hyperperfusion Syndrome-----A Case Report

YAO Ming;NI Jun;GAO Shan

2010, 5(08): 672-675.

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Moyamoya Disease Diagnosed by Transcranial Doppler-----A Case Report

WANG Wei;PAN Su-Yue;YUAN Hui-Juan;et al

2010, 5(08): 676-678.

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GStroke: Working Toward a Prioritized World Agenda

GUO Xu;WANG Chun-Yu

2010, 5(08): 679-684.

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Clinical Applications of Transcranial Color-coded Duplex Sonography in AdultPatients

SUN Wei;ZHOU Zhi;HUANG Yi-Ning.

2010, 5(08): 685-691.

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Transcranial color-coded duplex sonography (TCCS) is a non-invasive ultrasoundexamination that adds frequency-based color Doppler imaging to Doppler spectrum analysisand B-mode imaging, it combines both imaging of intracranial vessels and cerebral parenchymalstructures. TCCS can depict the anatomical location, configuration, course and blood flowdirection of cerebral vessels, and analyze the Doppler spectrum and f low velocity at thesame time. This paper reviews the clinical applications of TCCS in adult patients with stroke,arteriovenous malformations, arteriovenous fistula, intracranial aneurysm, cerebral venousthrombosis and other related diseases, and discusses its benefits and limitations.

Practice and Understanding of Normative Training of Neurology Specialist in Hospital

JU Yi;LIN Jing;ZHANG Xing-Hu;et al

2010, 5(08): 698-700.

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