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Table of Content

    20 March 2012, Volume 7 Issue 03
    主编手记
    Exploration
    WANG Yong-Jun
    2012, 7(03):  155-157. 
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    述评
    Exploration of New Ideas for Stroke Prevention:Blood Pressure Control and Blood Vessel Benefits
    ZHANG Zhuo
    2012, 7(03):  159-162. 
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    论著
    Change in High Blood Pressure and its Relation with Prognosis of Acute Ischemic Stroke According to TOAST Criteria
    YU Li;YUAN Jian-Xin;LI Ren-Zi.
    2012, 7(03):  163-171. 
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    Objective To clarify the change in high blood pressure(BP) and its relation with prognosis of acute ischemic stroke with no antihypertensive therapy.Methods Consecutive patients who were hospitalized within 48 hours and were diagnosed as acute ischemic stroke were registered prospectively. All patients were divided into four groups refer to the improved Trial of Org10172 in Acute Stroke Treatment(TOAST) criteria of ischemic stroke type. To study the BP levels during the initial 14 hospital days. Death and dependency were assessed at 3 months. Relationship between BP in different time periods and death/dependency rate of three month was analyzed. Spearman's correlation analysis was used to analyze factors relations to death/independent rate.Results The systolic blood pressure(SBP) and diastolic blood pressure(DBP) course and decrease in mean BP in patients of these four groups have no significant differences. This best BP in patients of these four groups has not significant difference. And the correlation of the average of BP and death/dependency rate of three month was not statistically different. However the risk factors relations to death/independent rate at 3 months after onset were different, SBP decreased within 24 hours of admission were significantly associated with death/dependency rate at 3 months after onset in atherosclerosis type and cardioembolism type.Conclusions BP change in different causes of acute ischemic stroke are almost no statistical different. SBP decreased within 24 hours of admission were significantly associated with death/dependency rate at 3 months after onset in atherosclerosis type and cardioembolism type.
    Clinical Effect of the Nifedipine Controlled Release Tablets on Geriatric Patients with Mild or Moderate Essential Hypertension
    WANG Jun;LI Yun-Ming;XUAN Bing;WANG Jian.
    2012, 7(03):  172-177. 
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    Objective To explore the clinical effect of Nifedipine controlled release tablets on geriatric patients with mild or moderate essential hypertension.Methods Systolic/diastolic blood pressures, and blood pressures variability were compared before and after treatment by self-control design; the quality of life and depression of geriatric patients were evaluated before and after medication using the Medical Outcomes Study Short Form Health Survey(SF-36) and Geriatric Depression Scale(GDS).Results The total effective rates of the mild and moderate essential hypertension geriatric patients were 84.38% and 77.36%. The systolic and diastolic blood pressure of geriatric patients with mild or moderate essential hypertension after treatment were lower than the systolic and diastolic blood pressure before treatment(P<0.01, P<0.01), and the 24h systolic and diastolic blood pressure variability after treatment were lower than before the treatment(P<0.01, P<0.01). The scores of physical functioning(PF), bodily pain(BP), general health(GH), vitality(VT), role-emotional(RE), mental health(MH) of geriatric patients after 8 weeks treatment were higher than before the treatment(P=0.03, P=0.01, P<0.01, P<0.01, P=0.04, P<0.01, P<0.01, P<0.01, P<0.01, P<0.01, P=0.01, P<0.01). The scores of GDS were lower than before the treatment (P<0.01, P=0.02). Six cases of essential hypertensive patients had adverse reactions in observation period.Conclusions The Nifedipine controlled release tablets on geriatric patients with mild or moderate essential hypertension have a good clinical effect of lowering blood pressure. This study indicatesthe Nifedipine controlled release tablets may have a clinical effect of improving quality of life, and relieving the symptoms of depression.
    Developing Clinical/Multimodal Computed Tomography Score and Predicting Clinical Outcome in Acute Ischemic Stroke
    WANG Xiao-Chun;GAO Pei-Yi;XUE Jing;MA Li.
    2012, 7(03):  178-184. 
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    Objective To develop a clinical/multimodal computed tomography score(CMCTS) system based on National Institute of Health Stroke Scale(NIHSS) and multimodal CT scores(MCTS), which was used to guide clinical treatment and clinical assessment of functional recovery after 90 days.Methods Multimodal CT examination including non-contrast enhanced CT(NCCT), CT Perfusion(CTP), CT angiography(CTA) were performed in 49 patients with symptoms of stroke less than 9 hours. The Alberta Stroke Program Early CT Score(ASPECTS) were analyzed on NCCT, arterial phase CT perfusion source images(ACTP-SI) and venous phase CTP-SI(VCTP-SI) then the follow up imaging ASPECTS. Thrombolysis in Cerebral Ischemia Scale(TICI) were analyzed on CTA, Baseline NIHSS and 90 days modified Rankin Scale(mRS) were assessed in each patient with the 90 days good clinical functional recovery(mRS<2) as a standard, Application of receiver operating characteristics(ROC) to determine the threshold of NIHSS and CT parameters;in accordance with the threshold score obtain multi-mode CT scoring system, the baseline NIHSS score join multi-mode CT scoring system obtain clinical/multi-mode CT score. Finally, application of ROC curve analysis efficacy of each model predicting clinical outcome.Results The optimal threshold measured on CMCTS, MCTS, NCCT ASPECTS, arterial phase CTP-SI, venous phase ASPECTS, CTA TICI and NIHSS were>1, >1, >9, >6.5, >8.5, >1 and ≥7, respectively. The parameter that most accurately describes good clinical outcome 3 months after stroke is the CMCTS(area under the curve is 0.873, 95% confidence interval is 0.75-0.95). The next turn is MCTS, ACTP-SI, VCTP-SI, NIHSS, NCCT and CTA, there was a significant statistical significance(P<0.05) for each parameter with CMCTS, except for the ACTP-SI(P=0.226) and NIHSS(P=0.174).Conclusion The CMCTS based on NIHSS and multimodal CT is superior to NIHSS, MCTS, NCCT, CTA, and CTP in predicting clinical outcome in acute stroke.
    Comparison of Depressive Symptoms Between Subcortical Ischemic Depression and Subcortical Ischemic Dementia
    MI Jian-Hua;CAO Wen-Wei;XU Qun;et al
    2012, 7(03):  185-190. 
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    Objective To compare the depressive symptoms between patients with subcortical ischemic depression and patients with subcortical ischemic dementia.Methods According to the diagnostic standards of depression and dementia, 17 items-Hamilton Rating Scale for Depression(HRSD) and Mini-Mental State Examination(MMSE), 70 patients with subcortical ischemic vascular disease were divided into 4 groups such as without depression or dementia(29), with depression(19), with dementia(12), as well as with depression and dementia(10). Their prevalence of different depressive symptoms and cluster of items of Hamilton Depression Rating Score were assessed and compared each other with HRSD.Results Four groups of patients had no significant differences in age, gender, socio-economic factors, and vascular risk factors. In depression group, the most common symptoms were the depressed mood(17 cases, 89.5%) ,mental anxiety(16 cases, 84.2%), physical anxiety(15 cases, 78.9%) and in patients with dementia ,were retardation(8 cases, 66.6% and 9 cases, 90.0%, respectively). Except sleeping disorders, the most serious symptoms in depression group were anxiety/somatization[0.8(0.2, 2)] and in patients with dementia were retardation[1(0.3, 1.8) and 1.1(0.3, 2)] . The symptoms of depressed mood and anxiety/ somatization in patients with depression were more serious than patients with depression and dementia(P=0.026 and P<0.01).Conclusion There are some differences in the characteristics of emotional damage in patients with subcortical ischemic depression or subcortical ischemic dementia or their coexistence. Relatively, the mood disorders of subcortical ischemic depression were caused more by the classical depression, and the latter more prefer to subcortical ischemic pathological change.

    Combined Closed-cell Self-expanding Stents and Postdilatation in Patients with Severe Calcified Carotid Lesions
    MA Ning;HAN Jin-Tao;LIU Yan-Wei.
    2012, 7(03):  191-196. 
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    Objective To assess the efficacy and safety of carotid artery stenting(CAS) with closed-cell self-expanding stents and postdilatation for calcified carotid atherosclerotic lesions.Methods Between April 21 and November 17, 2011, CAS by using combined closed-cell self-expanding stents and postdilatation was performed in 4 patients with carotid artery atherosclerosis accompanied by plaque calcification. The stenosis degree of the responsible carotid arteries in the 4 patients ranged from 90% to 99% before CAS. The angiographic outcomes immediately after CAS, and the intra- and postoperative neurological symptoms and circulation status were recorded. Short-term follow-up was conducted.Results There were no shedding plaques in the embolic protective device in all 4 cases. CAS was successful in all 4 patients, with residual stenosis ranging from 10% to 20%. No patient developed a neurological deficit during the perioperative period of CAS. The hemodynamic status during the procedure was stable in all 4 cases. During the short-term follow-up, no patient experienced stroke or in-stent restenosis.Conclusion CAS with closed-cell self-expanding stents and postdilatation is an effective and safe alternative treatment in severely calcified carotid atherosclerosis.
    Study on Detection and Clinical Significance of t-PA, PAI-1 in Acute Cerebrovascular Disease
    WU Chun-Yan;YUE Kui-Tao;LI Hua;et al
    2012, 7(03):  197-201. 
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    Objective To explore the change of some factors tissue-type plasminogen activator(t-PA) and plasminogen activator inhibitor-1(PAI-1) in the patients with acute cerebrovascular disease and to provide some theorical evidences for the clinical treatment.Methods The level of t-PA, PAI-1 antigen in the 78 patients with acute cerebral hemorrhage, cerebral infarction and transient ischemic attack(TIA) was determined by enzyme-linked immunosorbnent assay(ELISA) from October 2007 to September 2008. These data were compared with control group, which contains 22 patients.Results To the cerebral hemorrhage, the level of t-PA of experimental group was higher than those of the control group(P<0.001). The level of PAI-1 antigen was lower than those of the control group(P<0.001). The differences between the experimental group and the control group were significant. To the cerebral infarction, the level of t-PA and PAI-1 antigen of experimental group was higher than those of the control group(P<0.001). In TIA, the level of PAI-1 antigen in experimental group was higher than those in control group(P<0.001). The level of t-PA was lower(P=0.006). The differences between the experimental group and the control group were significant(P<0.001).Conclusion To the patients with acute cerebrovascular diseases, there is disturbance of blood coagulation, anticoagulation and fibrolysis.
    专题论坛
    Blood Pressure Management in Stroke
    张茁
    2012, 7(03):  203-209. 
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    Influence of Nifedipine Gastrointestinal Therapeutic System in the Prevention of Ischemic Stroke in Patients with Hypertension
    WANG Shi-Chao;WU Wei;LIU Fang;et al
    2012, 7(03):  210-213. 
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    Advantage of Nifedipine Gastrointestinal Therapeutic System in Hypertension Treatment
    ZHANG Jie-Yin;GUAN Quan-Sheng
    2012, 7(03):  214-216. 
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    病例讨论
    One Case of Carotid Artery Occlusive Patients with Arterial Thrombolysis and Mechanical Embolectomy
    LIU Dong-Tao;ZHOU Li-Chun;LI Tong;et al
    2012, 7(03):  217-220. 
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    指南与规范
    ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly (part 1)
    WU Shuo-Lin;SHEN Dong-Chao;YU Yang;et al
    2012, 7(03):  221-230. 
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    综述
    Regulation of Blood Pressure in Patients with Acute Ischemic Stroke
    WU Li-E;SUN Liang.
    2012, 7(03):  231-235. 
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    Hypertension is an independent risk factor for cerebrovascular disease. Blood pressure in patients with ischemic stroke directly affect the prognosis, especially the blood pressure management of acute phase of ischemic stroke, there are a lot of controversy. This paper describes the effects on blood pressure of ischemic stroke and the debates of acute phase, focusing on domestic and international research findings and future research directions, to make sure the clinical significance on the blood pressure control of acute ischemic stroke.
    New Grading Scales of Intracerebral Hemorrhage
    LU Jing-Jing;ZHAO Xing-Quan.
    2012, 7(03):  236-241. 
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    Since the first grading scale was introduced by Hemphill in 2001, its efficiency has been confirmed by external validations. Because the original intracerebral hemorrhage(oICH) score was originally intended to predict 30-day mortality and does not include factors that have been strongly associated with outcome following intracerebral hemorrhage(ICH), its accuracy of predicting functional outcome is poor. A number of new ICH clinical grading scales have been developed to predict various outcome measures following ICH. We extensively reviewed the academic and social backgrounds, study methodologies, scale definitions and external validations of existing new generation grading scales in this article. Our purpose is to elucidate range of application and validating intensity of different grading scales of ICH.
    Status Quo of Researches about Etiology and Mechanism of Supertentorium
    YANG Xiao-Meng;LIU Li-Ping;JING Jing;et al
    2012, 7(03):  242-246. 
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    Supertentorium subcortical infarction is an important type of cerebral infarction. Precise understanding of the concept, comprehension of its classification, potential etiology and mechanism is helpful to identify them in clinical practice and intervene effectively according to their difference to improve the outcome and prognosis. This article will have a brief discussion about its classification together with the etiology and mechanism of partial types of infarction.