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Table of Content

    20 April 2012, Volume 7 Issue 04
    主编手记
    Imprint of the Years
    WANG Yong-Jun
    2012, 7(04):  247-248. 
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    会议报道
    Research Progress of International Stroke Conference 2012
    LIAO Xiao-Ling;XU Jie;BIAN Li-Heng;et al
    2012, 7(04):  249-259. 
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    述评
    Current Status and Future Prospectives of Stroke in Young Adults
    BI Qi;ZHANG Peng
    2012, 7(04):  260-263. 
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    论著
    Analysis of the Risk Factors and Etiology of Stroke in Young Adults
    ZHANG Peng;BI Qi
    2012, 7(04):  264-270. 
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    Objective To investigate the risk factors and imaging results of stroke in young adults, and to explore the risk factors and etiological characteristics of stroke in young adults.Methods We retrospectively collected the medical records of stroke in young adults(18-44 years old) hospitalized in the department of Neurology, Beijing Anzhen Hospital, Capital Medical University during the period from Jan 2002 to Dec 2010, enrolled a total of 274 cases. And stratified random sample of middle-aged stroke patients(aged 45 and above) in the same period, enrolled a total of 300 cases. Then we analyzed their risk factors and etiology characteristics.Results ①In the young stroke group, a total of 229 cases of ischemic stroke(83.58%), men accounted for 211 cases(77.01%); The age of 40 to 44 years old patients with a total of 160 cases(58.39%); ②In the young stroke group,hypertension is 179 cases(65.33%), smoking is 162 cases(59.12%), alcohol is 123 cases(44.89%), Hyperhomocysteinemia is 100 cases(39.84%), obesity is 86 cases(31.39%), compared with the elderly age group, the difference was statistically significant(P<0.05); 156 cases of hyperlipidemia(56.93%) was no statistically significant between the two groups(P>0.05); ③Typing of ischemic stroke according to TOAST etiology, large artery atherosclerosis is 100 cases(44.25%) and small artery atherosclerosis is 66 cases(29.20%) in the young stroke group, compared with the elderly age group, the difference was statisticallysignificant(P<0.05); ④Intracranial and extracranial blood vessels of stroke in young adults is better than the older group,the ratio(26.55%) of those the main arterial are abnormal was higher than the older group(15.79%), the mild to moderate and severe arterial stenosis rate of the young group(46.02% and 7.96%) is lower than the elderly age group(50.20% and 17.81%), the difference between the two groups was statistically significant(P<0.05).Conclusions ①Stroke in young adults is more common in ischemic stroke and male, patients aged 40 to 44 accounted for more than 1/2; ②The main risk factors for stroke in young adults followed by hypertension, smoking, hyperlipidemia, alcohol consumption, Hyperhomocysteinemia and obesity; In addition, the percentages of hypertension,smoking, hyperlipidemia,Hyperhomocysteinemia are increasing year by year; ③The main causes for ischemic stroke in young adults the large artery atherosclerosis, followed by small artery occlusion; The other causes are diversified. ④Intracranial and extracranial blood vessels of stroke in young adults are better than the elderly age group.
    Correlational Study Among the Polymorphism of MTHFR Gene , the Plasma tHcy Levelsand Acute Ischemic Stroke in Young Adults
    ZHANG Peng;GUO Xu;BI Qi
    2012, 7(04):  271-277. 
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    Objective To investigate the correlation among the metabolizing enzymes MTHFR of the homocysteine(Hcy), tHcy levels and acute ischemic stroke in young adults.Methods Case-control method, 40 cases of acute ischemic stroke in young adults and 40 healthy persons were analyzed, we recorded their medical history and relevant laboratory examination data, measured the plasma tHcy levels with high performance liquid chromatography, determined the polymorphism of MTHFR C677T, A1298C by polymerase chain-restriction fragment length polymorphism(PCR-RFLP).Results ①The mutation rate and the T allele frequency of MTHFR C677T in case group were 77.5% and 53.8%, control group were 75.0% and 50.0%, and the change rate was no statistically significant between the two groups(P>0.05). ②The mutation rate and the C allele frequency of MTHFR A1298C in case group were 32.5% and 17.5%, control group were 17.5% and 8.8%, and the change rate was no statistically significant between the two groups(P>0.05). ③The distribution difference of the plasma tHcy concentration during the MTHFR C677T genotypes was statistically significant(P<0.05).Conclusions ①The gene polymorphism of Hcy metabolism enzymes MTHFR C677T, A1298C was confirmed. ②The gene mutation(especially the TT homozygous) of MTHFR C677T canincrease the plasma tHcy concentration significantly. ③There is no direct correction between the gene polymorphism of MTHFR C677T, A1298C and acute ischemic stroke in young adults.
    Peripheral Nerve Electrophysiological Studies of Post Stroke Shoulder Pain
    WANG Qing-Qing;LI Tie-Shan;YAN Wen-Jing;et al
    2012, 7(04):  278-283. 
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    Objective To analyze the electrophysiological features of peripheral nerve in upper extremity of post stroke shoulder pain.Methods Forty stroke patients were divided into shoulder-pain group(26 patients) and without shoulder-pain group(14 patients). Standard motor and sensory nerve conduction studies were performed with 40 stroke patients, including nerve conduction velocity and needle electromyography(EMG).Results The motor nerve conduction velocity in axillaris nerve, musculocutaneous nerve, medianus nerve of shoulder-pain group were evaluated, we found that the compound muscle action potential(CMAP) amplitudes were significantly decreased compared with the without shoulder-pain group(P=0.000, 0.001, 0.000). The CMAP amplitude of ulnaris nerve was significantly lower on the affected side than that on the unaffected side in without shoulder-pain group(P=0.000). The sensory nerve action potential(SNAP) amplitude of ulnaris nerve was significantly smaller on the hemiplegic side in shoulder-pain group than that in without shoulder-pain group(P=0.000). The incidence of spontaneous electrical potential of the deltoid and biceps in shoulder-pain group were significantly higher than those in without shoulder-pain group(P=0.044, 0.044).Conclusion Peripheral nerve damage was found in post stroke shoulder pain, injury to motor neuro may be important for development of neuropathic pain.
    Clinical Study about Cerebral Blood Perfusion of Vascular Cognitive Impairment
    GAO Wei-Wei;XUE Rong;CHENG Yan
    2012, 7(04):  284-289. 
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    Objective To investigate the significance of diagnose in vascular cognitive impairment(VCI) with single photon emission computed tomography. To analyze the relationship with decrease of regional cerebral blood perfusion and the specified domain of cognitive impairment.Methods The patients were collected from either the ward or clinic in Tianjin general hospital from April 2009 till April 2010. We divided all the patients into 3 groups according to the level of their cognition. The 3 groups are the control group, the vascular cognitive impairment not dementia(VCIND) group and the vascular dementia(VaD) group. We compared the change of regional cerebral blood flow(rCBF) in each area of cerebrum within 3 groups and analyzed the relationship with decrease of regional cerebral blood perfusion and score of the Montreal cognitive assessment(MoCA). We compared the difference of perfusion image and morphological image and analyzed the relationship with decrease of regional cerebral blood flow and the specified domain of cognitive impairment.Results The rCBF of the left temporal lobe, thalamus and hippocampus of VaD and VCIND is lower than the control group. There is difference in statistics among these 3 groups(F=8.232, 6.237, 6.136; P=0.002, 0.006, 0.000). The rCBF of the left temporal lobe, thalamus and hippocampus has positive collection with the score of MoCA through the spearman analysis(r=0.421、0.355、0.323; P=0.011, 0.023, 0.029). The rCBF of the left temporal lobe has the positive relationship in the domain of calculation(Beta=0.445, P=0.020), and the rCBF of the right temporal lobe and hippocampus have the positive relationship in the domain of orientation(Beta=0.626, 0.740, P=0.035, 0.023).Conclusion The low rCBF in the temporal lobe, thalamus and hippocampus supply the evidence to the conclusion that the performance in pathology of VCI is low perfusion of the temporal lobe, thalamus and hippocampus. The change in perfusion may have the tendency of performing earlier than the change in morphology.
    Meta-Analysis of the Association between Chromosome 9p21 Polymorphisms and Atherosclerotic Ischaemic Stroke
    GAO Yi-Lu;ZHANG Yong-Bo;LI Ji-Mei
    2012, 7(04):  290-300. 
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    Objective Ischemic stroke(IS) is a multi-genes disease and closely related to the genetic factors. Genome-wide association studies(GWAS) which have single nucleotide polymorphisms(SNP) for the genetic markers system found that chromosome 9p21 polymorphism is an independent atherosclerotic risk factor, and associated to the susceptibility to atherosclerotic IS. However, due to the small sample size, there is no significant differences between the case group and the control group through comparing the allele frequency distribution, which highlights the need for larger-scale study. This study is to confirm the association between SNP type of chromosome 9p21 and the susceptibility to atherosclerotic IS by doing meta-analysis on all related published data after strict quality control, and to evaluate its risk of the disease.Methods We searched all the case-control studies referring to the association between chromosome 9p21 polymorphisms and atherosclerotic IS and formulated strict inclusive and exclusive quality control criteria. And we used the special software RevMan5.0 which provided by internationalCochrane Collaboration to do mete-analysis on the data. RevMan5.0 shows the odds ratio(OR) value and 95% confidence interval(CI) of each study and the combined statistical OR value and 95%CI by the forest plots. To evaluate the different frequency distribution of SNPs of chromosome 9p21 which confer risk of atherosclerotic IS between the cases and the controls systematically, and to analyze statistical significance of the association between Chromosome 9p21 polymorphisms and atherosclerotic IS.Results Meta-analysis included six multi-centers clinical case-control studies which across Europe and North America. Meta-analysis selected seven SNPs of chromosome 9p21:rs7044859, rs496892,rs564398, rs7865618, rs1537378, rs2383207, rs10757278. Five SNPs:rs564398, rs7865618, rs1537378,rs2383207, rs10757278 have statistically significant correlation with atherosclerotic IS and confer risk of the susceptibility to atherosclerotic IS. While neither rs7044859 nor rs496892 has.Conclusion The study discovered five SNPs(rs564398, rs7865618, rs1537378, rs2383207, rs10757278) of chromosome 9p21 associated to the susceptibility to atherosclerotic IS. Variants on chromosome 9p21 are considered to be an independent atherosclerotic risk factor and the candidate gene of atherosclerotic IS.
    专题论坛
    Hyperhomocysteinemia and Stroke in Young Adults
    ZHANG Peng;BI Qi
    2012, 7(04):  302-307. 
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    The Etiology of Stroke in Young Adults ZHANG Peng, BI Qi
    ZHANG Peng;BI Qi
    2012, 7(04):  308-311. 
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    病例讨论
    Cerebral Infarction as a Manifestation of Standford Type A Acute Aortic Dissection for a Young Patient
    GUO Xu;TANG Yong-Hong;BI Qi
    2012, 7(04):  312-316. 
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    指南与规范
    ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly (part 2)
    WU Shuo-Lin;SHEN Dong-Chao;YU Yang;et al
    2012, 7(04):  317-339. 
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    综述
    Risk Factors and Etiology for Ischemic Stroke in Young Adults at Home and Abroad
    GUO Xu;BI Qi;TANG Yong-Hong
    2012, 7(04):  340-348. 
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    As the increasing knowledge in risk factors and etiology among stroke in young people, this paper reviewed not only modified and unmodified factors, but also causes for cardioembolism, haematological disorders and monogenic cerebral vascular diseases, so that aimed at providing the new clues for the further studies in risk factors and etiology among young adults suffered ischemic stroke.
    教学园地
    Application of Problem-based Learning Method in Establishing the Association between Neurological Symptoms and Renal Diseases
    LUO Yang;GAN Hong-Bing;GENG Pei-Hong;et al
    2012, 7(04):  349-351. 
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