Chinese Journal of Stroke

Cognition of Taoism

WANG Yong-Jun

2016, 11(09): 717-719. DOI: 10.3969/j.issn.1673-5765.2016.09.001

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Psychological Intervention Therapy for Post-stroke Anxiety and Depression Disorders

LIU Song-Huai

2016, 11(09): 721-728. DOI: 10.3969/j.issn.1673-5765.2016.09.002

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Study on Biofeedback Therapy in the Treatment of Post-stroke Insomnia Associated with Anxiety

DU Xiao-Xia, XU Shu, SONG Lu-Ping

2016, 11(09): 729-732. DOI: 10.3969/j.issn.1673-5765.2016.09.003

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Objective To explore the safety and effectiveness of biofeedback therapy on insomnia associated with anxiety and depression in the period of rehabilitation of stroke. Methods Post stroke patients with insomnia associated with anxiety and depression were enrolled into study. All the patients were treated with biofeedback therapy, which were administered 30 min/ day, 5 times/week with autonomic nervous system rehabilitation exercises. Pittsburgh Sleep Quality Index Scale (PSQI), Sleep time and Patient Health Questionnaire (PHQ-9), Hamilton Depression (HAMD), Hamilton Anxiety (HAMA), Modified Barthel Index (MBI), Mini-mental State Examination (MMSE), Fugle-Meyer Scale (FMS), National Institutes of Health Stroke Scale (NIHSS) were taken before and after the exercise and the sleep time of patients were recorded, so as to comparatively analyze the changes of score and sleep time before and after the exercise. Results The data of 30 patients were used for analysis. Sleep time after treatment was significantly improved compared with that of before treatment ([4.81±1.58] h vs [7.30±1.34] h, P <0.001]). HAMA([17.50±8.41] vs [9.00±7.01]) and HAMD ([19.53±7.82] vs [9.23±4.42]) scores were significantly improved (P <0.001). After four weeks of training, the MMSE scores, Fugle-Meyer scores and Barthel index got increased, but didn’t have statistical significance. NIHSS score was lower, which had significant difference (P =0.033).

Conclusion Biofeedback therapy in treatment of stroke patients with insomnia can improve the quality of sleep, relieve anxiety and depression, and improve the rehabilitation outcome.

The Correlation between Electroencephalography Mental Evaluation and Anxiety and
Depression Emotional Evaluation of Rehabilitation Patients with Brain Injury

LIANG Zhi-Feng, HONG Ye, ZHANG Xiao-Ying, et al.

2016, 11(09): 733-737. DOI: 10.3969/j.issn.1673-5765.2016.09.004

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Objective To explore the effect of electroencephalography mental activity evaluation system applied to the mental evaluation of the patients with brain injury. Methods A total of 52 inpatients with brain injury were evaluated with 10 indexes of anxiety depression status and electroencephalography mental activity status by psychological professionals. The Spearman correlation index from SPSS 13.0 was used to analyze the correlations between each 10 indexes of electroencephalography mental activity status and the anxiety depression emotion of the 52 patients with brain injury. Results There were significant differences between various anxiety levels and the global index of electroencephalography mental evaluation (χ 2=21.843, P =0.009), and the levels of anxiety status were in significantly negative correlation with the global index of electroencephalography mental evaluation (R =-0.311, P =0.025). There weren’t significant differences between various depression levels and the global index of electroencephalography mental evaluation (χ 2=6.622, P =0.676), neither had statistic correlation (R =0.143, P =0.310). The anxiety status level was in significantly positive correlation with the energy consumption of brain (R =0.397, P< 0.001), brain fatigue (R =0.239, P =0.004). The depression status level was in significantly positive correlated with the energy consumption of brain (R =0.239, P =0.004), brain fatigue (R =0.173, P =0.039), inner focus (R =0.187, P =0.025) and brain fatigue (R =0.220, P =0.008) from the electroencephalography mental

evaluation of the patients with brain injury; also was in significantly negative correlation with the outer focus (R =-0.165, P =0.039) from the electroencephalography mental evaluation of the patients with brain injury. Conclusion Some of the indexes of electroencephalography mental activity evaluation system could reflect the change of anxiety and depression emotional status of the patients with brain injury. The electroencephalography mental activity evaluation system could assist to evaluate the emotional status of the patients with brain injury who have speech and cognitive functional disorders.

A Control Study on the Effects of Galvanic Skin Response Biofeedback Therapy in Patients of Post-stroke Depression

LIN Xiao-Ling, SONG Lu-Ping

2016, 11(09): 738-742. DOI: 10.3969/j.issn.1673-5765.2016.09.005

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Objective To explore the effect of the galvanic skin response (GSR) biofeedback treatment therapy on mood of patients with post-stroke depression (PSD) through randomized GSR and false biofeedback training and comparison of changes of depression symptoms and physical signs before and after training. Methods A total of 24 patients with post-stroke depression were randomly divided into GSR feedback group (N=11) and control group (N=13). All the patients were given routine rehabilitation therapy and medication therapy, while patients in GSR feedback group were given additional galvanic skin response biofeedback therapy and control group patients carried out the experiment by the computer software without feedback signal (40 minutes 3 times a week for 4 weeks). The effects were evaluated by Hamilton Depression Scale (HAMD) before and after treatment respectively. The changes of physiological indicators were tracked by using a multi-channel biofeedback instrument during baseline and pressure stress tests before and after treatment respectively. Results After treatment, the anxiety and somatization symptoms score (P =0.034), cognitive score (P =0.019) and depression total score (P =0.011) of GSR feedback group in the HAMD were significantly improved compared with the control group. After treatment, the value of galvanic skin response in GSR group was obviously reduced ([0.94±2.38]μV vs [0.59±0.33]μV, P =0.023). Conclusion GSR biofeedback can improve mood symptoms and physiological indicators of PSD

A Comparative Study of Cerebral Infarction between Young Adults and the Elderly

LI Zhen-Hua, YANG Qing-Cheng, ZHANG Jian-Gang, et al.

2016, 11(09): 743-746. DOI: 10.3969/j.issn.1673-5765.2016.09.006

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Objective To investigate the differences of risk factors and etiology among different age groups of youth and middle aged & elderly people. Methods A total of 148 cases of youth cerebral infarction inpatients were separated into two groups: 18 to 35 years old group and 36 to 45 years old group. And 232 cases of middle aged & elderly inpatients (older than 45 years) in the same period were collected as control group, the distribution of risk factors and stroke subtypes were compared statistically among groups. Results (1) In 18 to 35 years old group, the top three risk factors were hyperhomocysteinemia (HHcy) (66.7%), hyperlipemia (40.7%) and hypertension (33.3%). In 36 to 45 years old group, the three most frequent risk factors were hypertension (59.5%), HHcy (56.2%) and hyperlipemia (47.1%). In the elderly group, the three most common risk factors were hypertension (72.4%), HHcy (54.7%) and hyperlipemia (48.7%). (2) The frequencies of hypertension and diabetes in elderly group were observed to be higher than that in 18 to 35 years old group (P <0.001, P =0.014) and 36 to 45 years old group (P <0.001, P <0.001), which was lower in 18 to 35 years old group than in 36 to 45 years old group (P =0.009, P <0.001). The exposure of heavy smoking was significantly lower in 18 to 35 years old group than that in 36 to 45 years old group (P =0.006) and elderly group (P <0.001). (3) The proportion of undetermined etiology was highest in 18 to 35 years old group, significantly higher than in elderly group (37.0% vs 27.6%, P =0.013). The proportion of large artery atherosclerosis was highest in 36 to 45 years old group and elderly group (50.4% and 58.2%), were significantly higher

than that (25.9%) in 18 to 35 years old group (P =0.021, P =0.014). Conclusion Similar to the elderly group, the top three risk factors are hypertension, HHcy and hyperlipemia in 36 to 45 years old group, and large artery atherosclerosis is the leading cause of stroke. The difference is that HHcy, hyperlipemia and hypertension are the former three risk factors in 18 to 35 years old group, and most of patients are of unknown etiology

Effect Analysis of Continuous Quality Improvement in Ischemic Stroke Care

ZHANG Xuan,CHENG Tao, ZHANG Wei-Yan, et al.

2016, 11(09): 747-751. DOI: 10.3969/j.issn.1673-5765.2016.09.007

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Objective To evaluate the changes of medicare quality before and after the continuous quality improvement (CQI) intervention in ischemic stroke care. Methods A total of 261 inpatients who was diagnosed with cerebral ischemic stroke (CIS) at neurology department of Shanxi Cardiovascular Hospital during October, 2013 to March, 2014 were enrolled as the baseline group, and 218 patients with CIS who were treated after the implementation of CQI between April, 2014 and November, 2014 were enrolled as intervention group. The 12 key performance indexes (KPIs) and one comprehensive performance indicator of two groups were compared. Results The comprehensive performance index of experimental group had an significant improvement compared to the control group (92.53% vs 81.52%, P <0.001). Different degrees of improvement in 12 individual KPIs have been observed in experimental group after the CQI intervention had been applied. Among the 12 individual KPIs, dysphagia screening (99.54% vs 96.55%, P =0.03), rehabilitation intervention (88.07% vs 68.22%, P <0.001), statin treatment (98.62% vs 77.01%, P <0.001), anticoagulation for patients with atrial fibrillation (66.67% vs 20.00%, P =0.02) had obvious improvement with statistical significance. Conclusion The standardized continuous quality improvement intervention is capable of improving the quality of ischemic stroke care, which is deserved of further popularization and application.

The Significance of Contrast Transcranial Doppler Combined with Transesophageal Echocardiography in the Differential Diagnosis of Cryptogenic Stroke with Pulmonary Arteriovenous Fistula and Patent Foramen Ovale

DONG Pei, PAN Hua

2016, 11(09): 752-757. DOI: 10.3969/j.issn.1673-5765.2016.09.008

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Objective To explore the significance of contrast transcranial Doppler (cTCD) combined with transesophageal echocardiography (TEE) in the differential diagnosis of cryptogenic stroke with pulmonary arteriovenous fistula and patent foramen ovale. Methods Detailed clinical information were collected. TEE and cTCD were performed in 4 patients with cryptogenic stroke (2 patients with pulmonary arteriovenous fistula [PAVF] and 2 patients with patent foramen ovale [PFO]) to compare the difference in test results. Results cTCD in 2 patients with PAVF showed the following characteristics: detection of massive microembolic signals (curtain pattern) during regular breathing, and not influenced by Valsalva maneuver (VM). TEE showed large number of microbubbles appeared in the left atrium at 5th cardiac cycle after VM. cTCD in 2 patients with PFO showed: detection of none or 4 signals during regular breathing, and curtain pattern of signals after VM. TEE with color Doppler imaging showed left-to right shunt and several microbubbles appeared in the left atrium at 2nd-3rd cardiac cycle after VM. Conclusion cTCD combined with TEE is useful for differential diagnosis of PFO and PAVF due to high sensitivity and easy operation. The main identification points is that whether there are lots of massive microembolic signals and whether it will be influenced by VM at cTCD during regular breathing.

Clinical Primary Screening of Cerebral Small Vessel Disease: an Application Discussion of Digital Ocular Fundus Photography

ZENG Jing, REN Li-Jie, CHEN Li-Fang

2016, 11(09): 758-763. DOI: 10.3969/j.issn.1673-5765.2016.09.009

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Objective To explore digital fundus photography technology applications in clinical screening of cerebral small vessel disease (CSVD), so as to provide basis for community clinical primary screening of CSVD. Methods A total of 36 cases (72 eyes) of patients who were diagnosed as CSVD from April 2015 to April 2016 were selected as the observation group, and the other 30 cases (60 eyes) of the healthy volunteers who had normal head MRI results in the same time were selected as control group. There were statistical comparisons of general clinical information, fundus changes and carotid plaque between the two groups. Results Compared with control group, in the observation group, incidence of arteriovenous crossing sign (77.78% vs 23.33%), total incidence of fundus changes (88.89% vs 56.67%), and retinal arteriosclerosis grade 3 (30.56% vs 0) were higher (P <0.001, P =0.003, P =0.002). Logistic multivariate regression analysis showed that, arteriovenous crossing sign was an important risk factor of CSVD (odds ratio[OR] 10.678, 95% confidence interval[CI ] 2.943-38.742, P <0.001). In the observation group, the incidence of carotid plaque and the average of carotid plaque of patients with fundus changes (n =32) were higher than that of patients without fundus changes (n =4) (P =0.01, P =0.013). Conclusion In the study, more than half of CSVD patients with arteriovenous crossing sign, and digital ocular fundus photography may be used as one of the CSVD clinical primary screening methods.

Primary Analysis of the Multiple Mode of Endovascular Treatments for Progressively Acute Cerebral Venous Sinus Thrombosis

MO Da-Peng, LUO Gang, WANG Yi-Long, et al.

2016, 11(09): 764-768. DOI: 10.3969/j.issn.1673-5765.2016.09.010

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The Study on Reliability and Validity of Patient Health Questionnaire-15 in Stroke Outpatient

ZHENG Ting, CAI Hong-Bin, WU Yin-Ping, et al.

2016, 11(09): 769-772. DOI: 10.3969/j.issn.1673-5765.2016.09.011

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Objective To investigate the reliability and validity of Patient Health Questionnaire-15 (PHQ-15) in patients with stroke. Methods A total of 107 stroke patients were assessed with Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9 (PHQ-9), Hamilton Depression Rating Scale (HDMA), Hamilton Anxiety Rating Scale (HAMA) and the Self-report Symptom Inventory, Symptom Checklist-12 (SCL-12). Internal consistency reliability was tested by Cronbach’s coefficient alpha and quantitative item analyses. Correlation analyses of BAI, HAMA and PHQ-15 and that of PHQ-9, HDMA and PHQ- 15 were used to test the construct validity. Correlation analysis of SCL-12 and PHQ-9 was used to test the criteria validity. Results (1) Cranach’s coefficient α=0.811 indicated relatively good internal consistency reliability; (2) The correlation coefficient of 15 items and total score was 0.275-0.763 (All P <0.001) which indicated relatively good internal consistency of the scale; (3) The validity and criteria of PHQ- 15 was 0.768 (P <0.001) which indicated relatively good validity and criteria of the scale; (4) The structure validity and criteria validity were evaluated by correlation analysis. Results indicated that scores on the PHQ-15 were significantly related to BAI, PHQ-9, HDMA, and HAMA (r =0.602, r =0.654, r =0.769, and r =0.793, respectively. P <0.001). Conclusion PHQ-15 has good reliability and validity and is eligible for psychological assessment

criteria, which could be be used as a good tool to assess somatic symptom in stroke outpatient

Comparative Study on Risk Factors of Patients with Anterior and Posterior Circulation Infarct and Its Prognosis

ZOU Xin-Ying, GONG Xi-Ping, PAN Yue-Song, et al.

2016, 11(09): 773-777. DOI: 10.3969/j.issn.1673-5765.2016.09.012

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Objective To investigate the differences of risk factors and one year prognosis in patients with anterior and posterior circulation infarct. Methods The acute ischemic stroke patients in the Chinese National Stroke Registry (CNSR) were categorized according to Oxfordshire Community Stroke Project (OCSP). Anterior circulation infarct (ACI) was defined as both total and partial anterior circulation. The patients with posterior circulation infarct (PCI) were compared with the ACI group in baseline information, and also recurrent stroke, death and poor outcome (modified Rankin Scale, mRS≥3) in 1- year follow-up after onset. Results Totally, 8099 patients with acute ischemic stroke were recruited in this study, including 6415 anterior circulation infarct (ACI) subject and 1684 posterior circulation infarct (PCI) subject. Compared with PCI group, the ACI subject were elder, had higher risk of atrial fibrillation, and higher National Institutes of Health Stroke Scale (NIHSS) score on admission (P <0.001, respectively). PCI group had more male patients, higher risk of hypertension and diabetes mellitus (P <0.001, respectively). Multi-variables analysis showed, compared with PCI group, the ACI group had lower death risk on discharge (odds ratio [OR] 0.534, 95%confidence interval [CI ] 0.396-0.718, P <0.001), in 3-month (OR 0.592, 95%CI 0.472-0.744, P <0.001), 6-month (OR 0.636, 95%CI 0.516-0.785,

P <0.001) and one-year follow-up (OR 0.719, 95%CI 0.591-0.876, P =0.001). The incidence of severe disability at discharge in ACI were significantly higher than PCI (OR 1.272 95%CI 1.075-1.505, P =0.005), while no significant differences were found between the two groups in 3-, 6-, and 12-month follow-up. The recurrent stroke rates in PCI were similar to those of ACI in 3-, 6-, and 12-month follow-up. Conclusion Comparing to anterior circulation stroke, posterior circulation stroke has a higher rate of all cause death during 1-year follow up. The rate of severe disability and recurrent stroke are similar between the anterior and posterior circulation stroke.

Study on Effects of the Stenting and Medical Therapy for Middle Cerebral Artery Stenosis by Using Transcranial Doppler Ultrasound

LIU Hai-Ping, ZHU Hui

2016, 11(09): 778-782. DOI: 10.3969/j.issn.1673-5765.2016.09.013

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Objective To retrospectively review and compare the hemodynamic effect of cerebral artery stenosis with single medical management or medical management plus percutaneous transluminal angioplasty and stenting (PTAS) by using transcranial Doppler ultrasound (TCD). Methods Selected patients whose middle cerebral artery (MCA) were in accordance with the requirement of digital subtraction angiography (DSA) to be moderate or severe stenosis were enrolled into study. There were 23 cases meeting the requirement, including 10 patients who received medical management plus PTAS and 13 patients who received single medical management. The hemodynamic effects of the two therapies were analyzed by using TCD. Results (1) The flow velocity of diseased vessels of the patients who only received medical treatment had no significant change in difference after an average follow-up time of 223.00 days. The flow velocity of stent vessels were increased and had significant difference (P =0.013) after an average follow-up time of 496.10 days. (2) The flow velocity of medical management plus PTAS group was slower than the single medical management group at the last follow-up time point which had significant difference. (3) The flow velocity of medical management plus PTAS group had a slight declining trend (P =0.042) at the first month follow-up and there were no significant differences. It increased quickly in the period of 1 to 3 months (P =0.002) and 6 to 12 months (P =0.020). Conclusion (1) From the view of hemodynamics, single medical management can effectively

prevent the degradation of stenosis. (2) Although the stenosis is aggravated after PTAS, the blood flow is still better than the single medical management group eventually. The reconstruction of PTAS has long-term effectiveness.

The Historical Evolution of Stroke Classification

John H.Zhang

2016, 11(09): 783-784. DOI: 10.3969/j.issn.1673-5765.2016.09.014

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