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Table of Content

    20 December 2009, Volume 4 Issue 12
    主编手记
    Communication
    WANG Yong-Jun
    2009, 4(12):  943-944. 
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    述评
    急性重症缺血性卒中的评价和处理
    LI Shu-Juan;HU Wen-Li
    2009, 4(12):  945-949. 
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    论著
    Observation of the Effect of Human Albumins in Acute Severe Cerebral Infarction Patients
    SUN Feng-Hui;LI Shu-Juan;LIU Yue-Yang;et al.
    2009, 4(12):  951-955. 
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    Objective To appraise the effect of Human Albumins in the acute severe cerebral infarction patients.Methods Eighty acute severe cerebral infarction patients were divided into 2 groups. Conventional therapy was applied in the 2 groups, and Human Albumins was used conventionally in treatment group(n=44), whereas it was used in control group(n=36) only when serum albumin was less than 25g/L. Following treatment for 2 weeks, Scandinavian Stroke Scale and Glasgow Coma Scale were evaluated, and the incidence of complications was compared in the 2 groups.Results After treatment, clinical neurologic impairment score of treatment group was significantly lower than that of control group(P<0.05). Coma scale of treatment group was significantly higher than that of control group(P<0.05). The incidence of complications, such as pulmonary infection, renal dysfunction, stress, ulcer and hypoproteinemia, was all higher than that of control group(P<0.05).Conclusion Human Albumins was significant effective for acute severe cerebral infarction patients and could decrease the incidence of complications of severe cerebral infarction patients.
    Predictors in the Ventilator Weaning Process for Patients with Acute Ischemic Stroke
    LI Shu-Juan;SUN Feng-Hui;LIU Yue-Yang;et al.
    2009, 4(12):  956-960. 
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    Objective To evaluate the effects of predictors in the ventilator weaning process for patients with acute ischemic stroke.Methods Thirty acute ischemic stroke patients fulfilled the criteria of discontinuing ventilation have been evaluated by the screening test and spontaneous breathing trial. The patients were continuously observed and successful weaning was defined if the patient did not need ventilation after 48 hours. Failed weaning was assured if the patients were ventilated again in 48h and were evaluated 24 hours after the first weaning. Glasgow Coma Scale, vital signs, traditional weaning predictors, rapid shallow breathing index(RSBI) and their dynamic changes were collected before ventilation and ventilator weaning.Results Totally 38 weaning processes were carried out in 30 patients, with failed rate of 26.3%. Univariate analysis showed the average age, gastrointestinal hemorrhage, pulmonary infection, dynamic changes of GCS before and after ventilation were significantly associated with ventilation weaning in stroke patients(P<0.05). The successful group had lower RSBI and higher PaCO2 than the failed group before ventilation, and showed higher GCS, phosphorus, albumin, oxygen saturated index and lower temperature, dilated blood pressure, blood glucose and RSBI before weaning compared with the failed group. Logistic regression analysis showed RSBI, pulmonary infection and ΔGCS were the significant variables of weaning. By combining the three predictors, the sensitivity, specificity and accuracy were 85.7%, 70%, and 81.6% respectively.Conclusion RSBI, pulmonary infection and ΔGCS are valuable and accurate predictors in the weaning process for patients with acute ischemic stroke.
    The Relationship Between Serum Uric Acid and Carotid Stenosis in Patients with Ischemic Stroke
    YANG Song;ZHOU Xiao-Hui;ZHOU Zhi-Ming;et al.
    2009, 4(12):  961-964. 
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    Objective To study the relationship between serum uric acid(SUA) level and carotid stenosis in patients with ischemic stroke.Methods Patients with ischemic stroke were examined with subtraction and diagnosed as with(112) and without carotid stenosis(50). Patients with stenosis were further grouped as slight(45), moderate(39) and severe stenosis(28). There were 62 patients with unilateral and 50 patients with bilateral carotid stenosis.Results The level of SUA was significantly higher in patients with carotid stenosis(343±111μmol/L) than in patients without(287±67μmol/L)(P<0.01). SUA was significantly higher in patients with severe stenosis(408±112μmol/L) than in patients with moderate stenosis(351±100μmol/L)(P=0.025) and mild stenosis(296±99μmol/L)(P<0.01), significantly higher in patients with moderate stenosis than in patients with mild stenosis(P=0.017), significantly higher in patients with bilateral stenosis group(378±128μmol/L) than in unilateral stenosis(314±85μmol/L)(P=0.003). Logistic regression analysis showed that SUA level was not an independent risk factor of carotid stenosis(P=0.239). Spearman rank correlation analysis showed that SUA level and the degree of carotid stenosis was positively correlated(r=0.401, P<0.01).Conclusion SUA level may be an important but not independent risk factor for carotid stenosis. There was a correlation between SUA level and the severity of the carotid stenosis.
    Relationship between Ankle Brachial Index and Intracal Artery Stenosis in Patients with Ischemic Cerebrovascular Disease
    SONG Xin-Jie;HUANG Ke-Fei;WANG Yong-Jun.
    2009, 4(12):  965-968. 
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    Objective Observe the usefulness of ankle brachial index to predict the extent of intracranial artery stenosis.Methods Ankle brachial index were measured in 243 patients with ischemic cerebrovascular disease received cerebral angiograpathy.Their data including general information, medical history were collected.Results Abnormality of ankle brachial index, plaque of carotid atherosclerosis, history of stroke and age were associated with the number of intracranial artery stenosis in patients with ischemic cerebrovascular disease. Multiple logistic regression analysis showed: age and ankle brachial index were independent risk factors for the number of artery stenosis. Ankle brachial index was negative correlation with the number of intracranial artery stenosis(rs=-0.233, P<0.01). Linear trend analysis showed linear trend between them.Conclusion Ankle brachial index was associated with the number of intracal artery stenosis.
    The Value of PWI-DWI Mismatch to Guide Thrombolytic Therapy with Broadened Therapeutic Window for Cerebral Infarction
    LI Xin;WANG Ya-Qiong;QIU Shi-Xiong.
    2009, 4(12):  969-973. 
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    Objective To explore the value of magnetic resonance perfusion-weighted imaging(PWI) -diffusion-weighted imaging(DWI) mismatch to guide thrombolytic therapy beyond the time window(>6h) in patients with acute cerebral infarcts.Methods 40 patients with acute cerebral infarcts which were imaged by magnetic resonance and(PWI-DWI)/DWI×100%>30% within 12 hours after symptom onset were divided into thromobolytic group and control group. The patients in thromobolytic group were treated with intravenous rt-PA(0.6-0.9mg/kg), the controls were received common therapy. The two groups were scored with National Institutes of Health Stroke Scale(NIHSS)/Activities of Daily Living(ADL) score respectively at pre-thrombolysis, 1W, 2W and 3M after thrombolysis.Results The NIHSS score of the thromobolytic group at 1W, 2W and 3M after thrombolysis is lower than that of the control group(P<0.01), the ADL score of the thromobolytic group at 2W and 3M after thrombolysis is higher than that of the control group significantly(P<0.01).Conclusion Guided by PWI>DWI image, extending the time window for thrombolytic treatment of acute ischemic stroke is beneficial and feasible.
    The Preliminary Study of Clinical Predictive Model of Swallowing Function of Aspiration Pneumonia Based on Swallowing Function in Dysphagia Ischemic Stroke Patients
    ZHANG Jing;YANG Ya-Qin;YU Dan-Dan;et al.
    2009, 4(12):  974-977. 
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    Objective To establish the clinical predictive model of aspiration pneumonia based on swallowing function in ischemic stroke inpatients.Methods Total 105 stroke patients had the clinical assessment of swallowing and videofluoroscopy swallowing study. Patients who had aspiration pneumonia were recorded. χ2 analysis and logistic regression analysis were used to select the associated predictors of aspiration pneumonia.Results Coughing after swallowing food, weakness of the tongue, residue food in the mouth after swallow, invalid swallow and voice change after swallow were associated with aspiration pneumonia during admission. Invalid swallow could predict aspiration pneumonia, the OR was 7.700 and the predictive accuracy was 83.8%.Conclusion Invalid swallow detected by clinical assessment of swallowing was the independent predictor of aspiration pneumonia.
    Analysis of Predictors Correlated with the Prognosis 90 Days After Hypertensive Cerebral Hemorrhage
    LIU Yan-Fang;ZHAO Xing-Quan.
    2009, 4(12):  978-983. 
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    Objective To identify the predictors correlated with the prognosis 90 days after hypertensive cerebral hemorrhage.Methods 73 spontaneous hypertensive cerebral hemorrhage patients within 3 hours after onset were enrolled into our study during January 2006 to October 2007. The demographic data, past history and laboratory examination were recorded. We assessed the neurologic deficit at several time spot using the U.S National Institutes of Health Stroke Scale(NIHSS), Glasgow Coma Scale(GCSe and modified Rankin Scale(mRS). Computed tomography scans at baseline, 24±3hours, and 72±3hours were performed separately. All factors correlated with 90 days’ prognosis and hematoma volume in baseline were analyzed.Results Among all recruit patients, Independent-Samples T Test revealed those factors including lactate dehydrogenase(P=0.026), erythrosedimentation(P=0.001), blood sedimentation(P=0.001), creatinine(P=0.036), glasgow coma scale(GCS) at baseline(P=0.001), fibrinogen(P=0.012), medlineshift, infection, NIHSS(P=0.002), GCS(P=0.001), infection while hospitalization (P=0.001), operation(P=0.014), hematoma size(P<0.01), absolute edema size(P<0.01), hematoma enlargement in 24 hours(P=0.002), bleeding ruptured into ventricular system(P=0.001), medline shift(P=0.003) were correlated with 90 days outcome.Conclusion In this study, we found factors including hematoma volume, absolute perihemotoma edema, blood ruptured into ventricular system, hyperfibrinogenemia, creatinine, lactate dehydrogenase, erythrosedimentation medlineshift, infection, NIHSS, GCS correlated to the poor outcome. In clinical treatment, we should focus on the primary lesions so to improving the outcome.
    The Impact of Prehypertension on Carotid Artery Intima-Media Thickness in the Middle-Aged and Elderly Community Population
    HONG Hua;WANG Hong-Xuan;LIAO Huan-Quan;et al.
    2009, 4(12):  984-988. 
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    Objective To study the impact of prehypertension on carotid artery intima-media thickness (IMT) in the middle-aged and elderly population.Methods We studied 942 residents in a community of Guangzhou, China by questionnaires, physical examinations, blood chemistry tests and bilateral carotid ultrasonography. Carotid artery IMT of common carotid artery, carotid bifurcation and internal carotid artery as well as mean carotid artery IMT were compared among the three populations of normotension (NT), prehypertension (Pre-HT) and hypertension (HT), which were stratified by the JNC-7 classification of blood pressure.Results Pre-HT and HT were associated with the risk factors such as older age, male gender, dyslipidemia, obesity and smoking. IMT of the three carotid segments and mean IMT was thicker in Pre-HT than in NT (P<0.001). Adjusting for relevant risk factors, IMT of common carotid artery and mean carotid IMT was still significantly thicker in the Pre-HT than in NT (P<0.05). However, significant difference between the IMT of carotid bifurcation and internal carotid artery in Pre-HT and NT could not be found (P=0.082 and P=0.133). IMT of the common carotid and carotid bifurcation as well as mean IMT was thicker in HT than in Pre-HT or in NT (all P<0.05).Conclusion There was significant target-organ damage such as thickening of the carotid artery IMT in the prehypertension status in middle-aged and elderly population.
    Effect of Urinary Kallidinogenase on Hemodynamics of Cerebral Circulation in Patients with Acute Cerebral Infarction
    WANG Yu-Hui;ZHANG Wen-Bo;ZHENG Yun-Yun;et al.
    2009, 4(12):  989-993. 
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    Objective To observe the effect of urinary kallidinogenase on recovery of neurological function and hemodynamics of cerebral circulation in patients with acute cerebral infarction(ACI) of internal carotid artery system.Methods Seventy-eight patients with acute cerebral infarction of unilateral carotid artery system were randomly divided into urinary kallidinogenase treatment group(39 cases) and control group(39 cases). All the patients were received routine treatment including antiplatelet drugs. Patients in the urinary kallidinogenase treatment group were additionally received urinary kallidinogenase for 14 days. Before treatment and 14 days after treatment, the degrees of neurological impairment of the two groups were evaluated with National Institutes of Health Stroke Scale(NIHSS), the cerebrovascular dynamics indexes(CVDI) of both groups were detected. The changes of NIHSS scales and CVDI after treatment in each group and between the two groups were analyzed.Results The neurological functional recovery of the kallidinogenase treatment group was notably surpassed that of the control group, and there were significant difference of total effective rate and the NIHSS score between the two groups(P<0.05). The minimum velocity(Vmin), mean velocity(Vmean), minimum quantity(Qmin) and mean quantity(Qmean) of affected carotid artery in the two groups after treatment were significantly increased(P<0.05, P<0.01) and the cerebrovascular resistance(R) was notably decreased than that before treatment(P<0.01), and the changes of these indexes in the urinary kallidinogenase treatment group were more significantly than that in the control group(P<0.01). The characteristic impedance(Zc) in the trearment groups was remarkably decreased after treatment(P<0.01).Conclusion Urinary kallidinogenase could improve CVDI of ACI patients, decrease the cerebrovascular resistance, increase cerebral blood velocity and flow, and effectually promote the recovery of neurological functions.
    病例讨论
    One Case Report of Moyamoya disease was Misdiagnosted as Viral Encephalitis
    HUANG Guang;TANG Yu;ZHAO Han;et al
    2009, 4(12):  994-996. 
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    综述
    Application of Sensory Stimulation Program in Coma
    SUN Feng-Hui;LI Shu-Juan;QIN Wei;et al.
    2009, 4(12):  997-1000. 
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    Sensory Stimulation Program(SSP) is a treatment of improving the level of consciousness using one or many sensory stimulus, which including auditory, visual, olfactory, gustatory, tactile and kinesthetic stimulation. It is used more commonly in traumatic brain injury(TBI) now. The aim of this artical is to review the contents and clinical application of SSP, and to provide exact and effective information for clinicians and family members of patients.
    Detection of the Cerebrovascular Reactivity
    ZHU Hui-Min;ZHOU Zhi-Ming;XU Ge-Lin;et al.
    2009, 4(12):  1001-1007. 
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    The evaluation of the cerebrovascular reactivity(CVR) is very essential for the management and prevention of the cerebrovascular diseases. The major measurement for the CVR include positron emission tomography(PET), single photon emission computed tomography(SPECT), Xenon computed tomography, perfusion weighted imaging(PWI), transcranial Doppler(TCD), blood oxygenation level-dependent(BOLD) magnetic resonance imaging, near-infrared spectroscopy(NIRS) and so on. At present, cerebrovascular reactivity were mainly measured by CO2 inhalation, acetazolamide administration or refined breath-holding test. The aim of this article is to review the major methods used for detecting CVR.
    The Pathogenesy and Clinical Features of Cerebrocardiac Syndrome
    CHE Feng-Li;QIN Hai-Qiang;ZHAO Xing-Quan.
    2009, 4(12):  1008-1012. 
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    Some cardiovascular manifestations could be found in acute stroke patiens, which is called cerebrocardiac syndrome(CCS).We could also observe some abnormalities in Electrocardiography(ECG) and creatine kinase-MB elevation. However, such abnormalities will be gradually recovering with the improvement of stroke.
    教学园地
    Investigation of Integrated and Case-Based Teaching Method in Developing Clinical Thinking for Intern in Department of Neurology
    XU Jun;ZHANG Ying-Dong;SHI Jing-Ping;et al
    2009, 4(12):  1013-1015. 
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