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    20 August 2009, Volume 4 Issue 08
    Evidence and Imagination
    WANG Yong-Jun
    2009, 4(08):  613-615. 
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    Wisdom Gets Brighter in Debate, Thoughts Get Improved via Communication-----A Brief Report of Graduate Salon's Inaugural Meeting, Department of Neurology,Beijing Tiantan Hospital,Capital Medical University
    CHEN Pan;DU Wan-Liang
    2009, 4(08):  616-616. 
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    Plasma Fibrinogen and Atherosclerosis: Pay Close Attention to a Therapeutic Target for Ischemic Stroke
    LIU Chun-Feng
    2009, 4(08):  617-620. 
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    Relationship between the Level of Plasma Fibrinogen and Carotid Atherosclerosis in Patients with Anterior Circulation Infarction/Transient Ischemic Attack
    SUN Ya-Ming;CAO Yong-Jun;QIAN Ju-Fen;LIU Hui-Hui;LIU Chun-Feng
    2009, 4(08):  621-625. 
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    【Abstract】 Objective To analyze carotid atheromatous plaque in patients with anterior circulation infarction/transient ischemic attack (TIA) and explore the relationship between carotid atherosclerosis and the levels of plasma fibrinogen. Methods In sixty-nine cases with anterior circulation infarction/TIA, the location, number, characteristic of carotid atheromatous plaque and diameter of carotid artery and Intima-media thickness (IMT) of bifurcation of common carotid artery were assessed by Doppler ultrasonography, and other related indexes, such as blood pressure, NIHSS, the level of plasma fibrinogen and D-Dimer were evaluated. Results The atheromatous plaques were most in bifurcation of common carotid artery (52.29%).The level of plasma fibrinogen in the group of IMT≥0.9&#8197;mm was obviously higher than that in the group of IMT<0.9&#8197;mm (P<0.05). The numbers of carotid atheromatous plaque and IMT in the group of high level fibrinogen (≥3.0&#8197;g/L) were obviously higher than that in the group of low level fibrinogen (P<0.01), and the level of plasma D-Dimer between the both groups also has significant difference (P<0.01). The IMT of bifurcation of common carotid artery was directly associated with the systolic pressure, diastolic pressure and level of plasma fibrinogen(r=4.92, 5.26, 6.68, all P<0.05). Conclusion As one of the most important risk factors of ischemic stroke, the level of plasma fibrinogen was directly associated with carotid atherosclerosis in patients with anterior circulation infarction/TIA.

    Effect of Fibrinogen and Fibrin(ogen) Degradation Products on the Growth Behavior of Vascular Smooth Muscle Cells in Coculture
    LI Rui-Xia;CAO Yong-Jun;TONG Tong;et al.
    2009, 4(08):  626-633. 
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    Abstract】 Objective To investigate the effect of fibrinogen(Fg) , Fibrin(Fb) and Fibrin(ogen) degradation products(FDPs) in different concentration on the proliferation and migration of vascular smooth muscle cells(SMCs) in coculture. Methods The rabbit aorta endothelial cells(ECs)/SMCs coculture system on Transwell membranes was established. Using different concentration of Fg, Fb and FDPs were used to interfere in the coculture system. The protein synthesis and the expression of proliferating cell nuclear antigen were observed by means of bicinchoninic acid(BCA) method and Western blotting respectively. Migration assays were performed using the wounding model and the transwell cell culture apparatus. Results The higher concentration of Fg(≥3.0g/L) could obviously promote the expression of proliferating cell nuclear antigen(PCNA), the protein synthesis and migration of SMCs; Fb could enhance the protein synthesis of SMCs from 0.5g/L. Fb can obviously up-regulate the expression of PCNA dose-dependently in the range between 1.5g/L to 4.5g/L, on the contrary, the exorbitant concentration of Fb could inhibit that. Fb stimulated the chemotaxis of SMCs dose-dependently in the range between 3.0g/L to 6.0g/L, and from 1.5g/L, Fb obviously enhance the migration of SMCs. FDPs promote the expression of PCNA, the protein synthesis and migration of SMCs dose-dependently in the range between 0.5g/L to 6.0g/L. Conclusion Fg, Fb and FDPs, in some range of concentration, could promote the proliferation of SMCs and influence on the process of chemotaxis and migration, which involved in the pathogenesis of atherosclerosis.

    Effect of Small Vessel Diseases on the Outcome and Complications of Acute Cerebral Infarct Patients
    LIN Lang;ZHANG Wei-Wei;ZHAO Xiu-Xin;et al.
    2009, 4(08):  634-639. 
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    Abstract】 Objective To determine the effect of small vessel diseases on the clinical outcome and relative complications of acute ischemic stroke patients. Methods Between January 2007 and January 2008, 323 consecutive patients with acute brain infarction were studied prospectively. Leukoaraiosis was defined as moderate or severe white matter hyperintensities and lacunes were counted into none (0 lacune), few (1-2 lacunes), and many (3 or more lacunes). The stroke outcome and incidence of complications during a period of three months after the onset of stroke were assessed. Backward stepwise logistic regression was used to identify the independent predictors of adverse outcome and complications after stroke. Results During the fellow-up, 128 patients (39.63%) had adverse outcomes (death or disability) and 69 patients (21.36%) developed pneumonia. Leukoaraiosis was an independent predictor of adverse outcome and pneumonia (for adverse outcome: OR 3.971, 95%CI 1.954-8.073; for pneumonia: OR 1.809, 95%CI 1.220-2.681) while no association between lacunes and adverse outcome or any complications after stroke was found. Conclusion Leukoaraiosis but not lacunes was independent predictor of adverse outcome and pneumonia for acute ischemic stroke patients. The difference between the effects of lacunes and leukoaraiosis may reflect the heterogeneity of such two main aspects of small vessel diseases.

    Predictors of Poor Nutritional Status in Acute Stroke Patients
    YU Ling;LI Yan-Sheng.
    2009, 4(08):  640-644. 
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    【Abstract】 Objective To identify important predictors of poor nutritional status in acute stroke patients. Methods Consecutive hospitalized patients with acute first-ever stroke were recruited. The risk factors for malnutrition defined as the level of serum albumen below 35g/l were analyzed. Results Among 286 acute strokes, the prevalence of malnutrition at admission was 5.9%. This figure increased to 19.9% at two weeks later. A logistic regression analysis showed that age, serum albumen level and swallow ability at admission independently predicted malnutrition during hospitalization (OR was 1.05, 1.39 and 3.16, respectively). Conclusion The elder stroke patients with baseline malnutrition or dysphagia were more likely to be malnutrition.

    The Heterogeneity of Dopa-responsiveness in Vascular Parkinsonism Subtypes: a Cohort Study
    FENG Tao;LU Lin-Long;LI Wei;et al.
    2009, 4(08):  645-649. 
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    【Abstract】 Objective To investigate the heterogeneity of dopa-responsiveness in vascular Parkinsonism subtypes in a perspective cohort. Methods Forty one patients with vascular parkinsonism (VP) and forty five patients with Parkinson’s disease (PD) underwent acute levodopa test to assess the dopa-responsiveness at baseline and two years later. The patients with VP were divided into subtypes according to vascular lesion on Magnetic resonance imaging (MRI). The dopa-responsiveness was compared between VP subtypes and those with PD. Results The magnitude of dopa-responsiveness and positive rate of levodopa test in VP subtype of basal ganglia lacunes were significantly higher than those of VP subtype of white matter hyperintentisty (WMH) at baseline and two years later (P<0.05). The magnitude of dopa-responsiveness in VP subtype of basal ganglia lacunes decreased significantly from baseline to two years later (P<0.05).There was no significant change in VP subtype of WMH in same period of follow-up (P>0.05). The outcomes of levodopa test in baseline had concordance with those of two years later (Kappa=0.438, P<0.05). The positive predictive value (PPV) and negative predictive value (NPV) was 0 and 100% in VP subtype of WMH. The PPV and NPV was 14.3% and 100% in VP subtype of basal ganglia lacunes. Conclusion These results suggest the different change of dopa-responsiveness in VP subtype according to vascular lesion.

    Preliminary Study of Stroke Topographic Patterns in Patients with Internal Carotid Artery Stenosis or Occlusion on MRI
    DUAN Yong-Wei;WANG Yong-Jun.
    2009, 4(08):  650-650. 
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    【Abstract】 Objective To investigate lesion patterns on magnetic resonance imaging in acute cerebral ischemic stroke patients with internal carotid artery(ICA) stenosis or occlusion and to discuss the mechanisms of stroke in ICA. Methods Atherosclerotic ICA vessels with ≥70% symptomatic stenosis or occlusion but without significant middle cerebral artery(MCA) stenosis were selected by digital subtraction angiography(DSA). We investigated topographic patterns on MRI and fluid-attenuated inversion recovery(FLAIR) sequences in cerebral infarct patients with ICA occlusive disease. Patients with potential cardiac sources of embolism were excluded. Results Among the 94 patients with acute ischemic strokes, 45 met the criteria for atherosclerotic ICA stenosis and 49 met the criteria for ICA occlusion. The topographic patterns of the ischemic lesions seen on MRI were subdivided into group: territory infarcts, subcortical infarcts, border-zone infarcts, and several disseminated small infarcts. The incidence ratio of territory l infarcts was greater in the ICA occlusion group than in the ICA stenosis group (47% vs 22%; P<0.05). The incidence ratio of border-zone infarcts was greater in the ICA stenosis group than in the ICA occlusion group (42% vs 22%; P<0.05). Conclusion Territory infarcts were more seen in atherosclerotic ICA occlusion. Border-zone infarcts were more seen in atherosclerotic ICA severe stenosis.

    Changes of sCD40L and Expressive Rate of NF-κB for Patients with Acute Progressive Cerebral Infarction and the Intervenient Role of Deng Zhan Sheng Mai
    MAO De-Jun;TANG Yong-Chun;GUO Rui-You;et al.
    2009, 4(08):  656-660. 
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    Objective To explore the peripheral serum soluble CD40 ligand(sCD40L) level and the expressive rate of nuclear factor-κB(NF-κB)p65 in peripheral blood mononuclear cells(PBMC) cellular nucleus of patients with acute progressive cerebral infarction(APCI) and the intervenient role of Deng Zhan Sheng Mai capsule in the process. Methods One hundred patients getting with acute progressive cerebral infarction less than 24h of the onset were randomly divided into routine and experimental group. Each group had fifty cases Fifty patients getting with acute cerebral infarction admitted to our hospital at the same time were selected as the control. All patients were treated under the general way; while the patients in the experimental group were given an extra intervenient treatment of Deng Zhan Sheng Mai capsule in addition to the general treatment. The change of China Stroke Scale (CSS) in routine and experimental group, the infarction focal volume, peripheral serum sCD40L level and the expressive rate of NF-κB p65 in PBMC cellular nucleus of patients in routine, experimental group and control were measured minutely before and after treatment. Results After treatment, the progressive degree of CSS and infarction focal volume in the experimental group were obviously lower than that in the routine group (P<0.05). The peripheral serum sCD40L level and the expressive rate of NF-κB p65 in PBMC cellular nucleus of patients at each course of disease were obviously higher in experimental or routine group than those in control (P<0.05), and the same changes of molecular biological level were obviously lower in experimental group than those in routine group (P<0.05). Only slight side effects occurred during the whole course of the treatment. Conclusion The inflammatory and apoptotic mechanism mediated by excessive increase of CD40-CD40L signaling pathway and NF-κB expression in PBMC nuclear might be the progressive factors in molecular biology for patients with APCI. Deng Zhan Sheng Mai capsule could improve the prognosis of patients with APCI by reducing these molecular biological factors.

    Preliminary Experience on Retractable Self-expandable Stent Combined with Coils for Embolization of Wide-necked Anterior Communicating Artery Aneurysms
    ZHANG Jing-Bo;LI You-Xiang;WU Zhong-Xue;et al.
    2009, 4(08):  661-663. 
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    【Abstract】 Objective To obtain the preliminary experience on retractable self-expandable stent (LEO) combined with coils for embolization of wide-necked anterior communicating artery aneurysms. Methods Ten wide-necked anterior communicating artery aneurysms were embolized with LEO stent in combination with detachable coils. Six cases were male, and four cases were female. All patients were from 19 to 78 years old, with mean age was 58±6 years old. Six cases were treated by staged release of the LEO stent. Stent delivery cross the aneurismal neck after endovascular coiling of aneurysms was performed in two cases. In another two cases, aneurysms were coiled endovascularly after LEO stent released. The delivery system was advanced inside the Vasco+ microcatheter. The LEO stent was sent back and forth until it was precisely across the neck of the aneurysm. Results Nine aneurysms were embolized completely with stent-coil technique, and one case was partially occluded . There was a thrombo-embolic event following the deployment of the LEO stent in one patient with acute subarachnoid hemorrhage, whom was cured without complications. Conclusion The LEO stent can be deployed accurately within the cerebral vascular vessels. It is a feasible, secure and effective system in treating wide-necked anterior communicating artery aneurysm. Furthermore, its combination with coiling embolization offers a promising therapeutic alternative in the treatment of wide-necked anterior communicating artery aneurysms.

    Special Forum :Fibrinogen and Atherosclerosis
    LIU Chun-Feng
    2009, 4(08):  664-664. 
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    Hyperfibrinogenmia
    LI Rui-Xia;ZHANG Yan-Lin;CAO Yong-Jun
    2009, 4(08):  665-669. 
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    Inflammatory Reaction Pathway and Modulation of Fibrin/ Fibrinogen in Atherosclerosis
    CAO Yong-Jun;ZHANG Yan-Lin;LI Rui-Xia;et al
    2009, 4(08):  670-674. 
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    A Report on Arteriovenous Malformation of Cervicothoracic Spinal Cord
    XIAO Guo-Dong;CAO Yong-Jun;JIN Yong;et al.
    2009, 4(08):  675-677. 
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    Post-Traumatic Infarction Carotid Artery Embolic Source
    QIAO Xing-Mao
    2009, 4(08):  678-681. 
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    Evidence-based Practice Guidelines for the Assessment of Absolute Cardiovascular Disease Risk
    LI Jian-Feng;LUAN Jing-Yu;QIN Hai-Qiang
    2009, 4(08):  683-686. 
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    Summary of Acupuncture and Rehabilitation Treatment of Post-stroke Dysphagia
    LIU Kong-Jiang;SHAO Jia-Jia;LIU Bao-Xin-Zi
    2009, 4(08):  687-691. 
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    Recent literature of acupuncture treatment and rehabilitation of post-stroke dysphagia were analysed. Acupuncture combined with rehabilitation is the best treatment of dysphagia following post-stroke pseudobulbar,which paly an important role in reducing disability and improving the quality of life for patients with dysphagia

    Clinical Research of Chinese and Western Medicine on Post-Stroke Depression
    JIANG Chao;XU Yong-Cheng;ZHANG Qiu-Juan
    2009, 4(08):  692-698. 
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    Post-stroke depression (PSD) is one of the common complications of stroke, which may negatively influence the positivity in the healing training of patients and delay the recovery as well as go against the improvement of living quality. This article summarized the clinical research on treating PSD in both Chinese medicine and western medicine so as to probe into the curative effect, mechanism and its further development of PSD in the way of Chinese medicine combined with western medicine.

    Make Use of Various Teaching Methods ,Improving Teaching Quality of Vascular Neurology
    WANG Xin-Gao;YANG Zhong-Hua;ZHANG Ya-Qing;et al
    2009, 4(08):  699-700. 
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