Table of Content

20 June 2007, Volume 2 Issue 06

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论著

The Clinical Characteristics and Risk Factors of Subcortical Ischemic Vascular Disease

XU Qun;LIN Yan;GENG Jie-li;et al

2007, 2(06):  14-17. 

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Objective To investigate the prevalence, characteristics and risk factors of subcortical ischemicvascular disease(SIVD) among patients with ischemic stroke.Methods 526 consecutive patients, 3 months after an ischemic stroke were recruited in thisstudy. Multiple neuropsychological, functional rating scales and neuroimaging assessmentwere administrated on the patients. Demographic information, vascular risk factors and strokecharacteristics were also documented.Results Of the 526 patients, 20.9% of patients fulfilled neuroimaging defined diagnostic standardof SIVD(n=110), with 61.8% of them were male and average age was 66.8±10.5. Hypertension(80.0%) was the most frequent risk factor among these patients, followed by dyslipidemia(52.7%) and cigarette smoking history (40.9%). Furthermore, 57.3% of SIVD had more than tworisk factors. Among the patients, 32.7% of them were depressed. Fifty-three patients (48.0%)had impaired instrumental activities of daily living(IADL) function as measured by Lawton’sFunctional Activities Questionnaire(FAQ) scale and 14 patients (12.8%) had impaired activities ofdaily living(ADL) function as measured by Barthel index (BI). Forty-nine patients (44.5%) werediagnosed as vascular cognitive impairment(VCI) and 26 (23.6%)of them as vascular dementia.Conclusion About one fifth ischemic stroke patients suffer from SIVD. They often have cognitiveimpairment, depression, impaired IADL and multiple vascular risk factors.

Prognostic Methods for 30-day Mortality in Patients with Spontaneous Intracerebral Hemorrhage

PU Yue-hua;WANG Yong-jun;ZHAO Xing-quan;et al.

2007, 2(06):  21-27. 

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Objective To explore the prognostic factors and model of early outcome (30-day mortality) inpatients with spontaneous intracerebral hemorrhage (SICH).Methods We prospectively collected the clinical data of 300 consecutive patients admittedfor SICH. Univariate and multiple logistic regression analyses were performed to determineindependent predictors and prognostic model of early mortality.Results There were five significant and independent predictors of early mortality, GlasgowComa Scale(GCS) score(X8, OR 2.046, 95%CI 1.138-3.679), National Institutes of Health StrokeScale(NIHSS) score(X15, OR 2.590, 95%CI 1.226-5.470), complications(X16, OR 4.820, 95%CI1.877-12.377), dysphagia(X17, OR 7.912, 95%CI 1.280-48.901), and midline shifting(X22, OR13.969, 95%CI 4.760-40.990). The prognostic model was Logit(P )=-12.005 + 0.716X8 + 0.952X15 +1.573X16+2.068X17 + 2.637X22, with correct rate 87.3%.Conclusion GCS score, NIHSS score, complications, dysphagia, and midline shifting areimportant predictors of early mortality in patients with SICH.

Aricept Preserves Brain Presenilin-1 Expression in Chronic CerebrovascularInsufficiency in Rat

ZHANG Cai-ping;XU Jun;DI Qing;et al.

2007, 2(06):  28-31. 

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Objective To evaluate the effects of Aricept on the presenilin-1 (PS-1) expression in rathippocampus during chronic cerebrovascular insufficiency (CVI).Methods Total 90 male Wistar rats were randomly assigned to pseudo-operation control group,CVI group, and CVI plus Aricept group. The CVI model was set up by the permanent of bilateralocclusion of both common carotid arteries (2-VO). The subgroups were determined by thesacrifice time on the first day, first week, and first month after 2-VO. PS-1 positive neuronalcells were observed by immunoelectron microscopy. The amyloid β42 (Aβ42) and PS-1 level ofhippocampus tissues were analyzed by Western Blotting.Results Compared with control group, CVI group had less survived rats than Aricept group (Firstday 7 vs 8, first week 5 vs 7). Compared to CVI group, Aricept group had much less chronicischemic impairment exhibitions, more PS-1 positive gold particles, and better endoplasmicreticulum structure. The time course study by Western blotting showed that in CVI group PS-1substantially increased at the first day after operation, and achieved the peak almost 2.3 foldersthan pseudo-operation group at the first week, then went down to lower level of pseudo-operationgroup at the first month. Aricept group showed sub-acute upregulation that PS-1 increasedmoderately at the first day, and kept slightly going up, then increased to the peak around twofolders than pseudo-operation group at the first month. Aβ42 of CVI group increased with theischemic duration and was 3.5 folders than pseudo-operation group. Contrastly, Aβ42 of Ariceptgroup increased more slowly and was significantly less than CVI group’s (P <0.01).Conclusion It is concluded that Aricept has neuroprotective effect against CVI in PS-1 positiveneuronal cells and can decrease Aβ42 production after cerebral ischemia.

The Preliminary Study of Risk Factors in Patients with Symptomatic Intracranial Stenosis

WANG Yan;WANG Yi-long;WU Di;et al.

2007, 2(06):  32-36. 

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Objective To investigate the risk factors of symptomatic intracranial stenosis.Methods Total 136 consecutive patients with acute ischemic stroke were enrolled during Aprilto December in 2006 at Tiantan hospital. All stenosis vessels were found by digital subtractionangiography (DSA) or transcranial Doppler (TCD) and magnetic resonance angiography (MRA)examination. Of the 136 patients, 63(46%) were found to have the evidence of intracranial medianstenosis (defined as case group), 73(54%) patients had no obvious stenosis(defined as controlgroup). Risk factors of cerebrovascular disease were comparatively investigated between the 2groups. The variables included the demographic characteristics, past medical history, such ashypertension, diabetes, lipid disorders, homocysteine, ischemic cardiac disease, atrial fibrillation,smoking, alcohol drinking, prolonged sitting lifestyle and body mass index (BMI).Results Univariate analysis showed that there were significant differences between 2 groupsin hypertension, lipid disorders, ischemic cardiac disease and smoking. Multivariable logisticstepwise regression analysis found the hypertension (OR=2.631, 95%CI 1.124-6.160, P =0.026)and lipid disorders(OR=2.255, 95%CI 1.060-4.797, P =0.035) were independent risk factors ofsymptomatic intracranial stenosis with acute ischemic stroke.Conclusion The study suggests that hypertension, lipid disorders may be independent risk factorsof sympotomatic intracranial stenosis, and we need large cohort studies to confirm it.

综述

Fibromuscular Dysplasia

DU Wan-liang

2007, 2(06):  83-87. 

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Fibromuscular dysplasia is a noninflammatory, nonatherosclerotic, segmental,multifocal disease of the arteries, mainly involving the medium-sized arteries. Being animportant risk factor of stroke in youth, it may lead to arterial stenosis, occlusion, aneurysm or dissection. The origin of the disease is still unknown. The diagnosis relies on angiography, by which characteristic "string-of-beads" pattern may be found. Serious cases may be treated withsurgical or interventional therapy.

Complications of Carotid Artery Stenting and Management Strategies

DONG Hong;LOU Yong-zhong;LI Bin.

2007, 2(06):  88-90. 

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Carotid artery stenting(CAS)is a selectable methods for treating carotid stenosis and stroke prevention. Its clinical application is continuously increasing. But it also has many risk factors and complications during the perioperation, such as hemodynamic abnormalities, cerebralvasospasm , cerebral infarction, in-stent thrombosis, artery occlusion, hyperperfusion syndrome,deformation , restenosis. This article reviews some main complications and their management.

Mechanism of Urinary Kallidinogenase in improving the cerebrovascular reserve capacity

GONG Xi-ping

2007, 2(06):  91-94. 

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Cerebrovascular reserve capacity includes cerebral perfusion reserve, functionalreserve, structure reserve, chemical reserve and metabolic reserve. Cerebrovascular reservecapacity plays an important role during onset, progress and prognosis in patients with stroke.Urinary Kallidinogenase (human urinary kallikrein) is a positive regulatory substance inKallikrein-Kinin system(KKS) which could improve the cerebral perfusion and energymetabolism. Urinary Kallidinogenase might improve prognosis for stroke patients by increaingthe cerebrovascular reserve capacity.