Table of Content

20 July 2018, Volume 13 Issue 07

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A Continuous Driving Force

WANG Yong-Jun

2018, 13(07):  645-646.  DOI: 10.3969/j.issn.1673-5765.2018.07.001

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Imageology Advance of Vascular Cognitive Impairment

ZHAO Wei-Na, HAN Ying

2018, 13(07):  647-650.  DOI: 10.3969/j.issn.1673-5765.2018.07.002

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Risk Factors of Cerebral Microbleeds and Its Correlation with Cognitive Impairment

LU Chang-Feng, YUAN Jun-Liang

2018, 13(07):  651-655.  DOI: 10.3969/j.issn.1673-5765.2018.07.003

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Objective To examine the clinical characteristics and correlative factors of cognitive dysfunction in patients with cerebral microbleeds (CMBs). Methods A total of 30 patients with SVD and 30 age, sex and education-matched control subjects were recruited consecutively from department of neurology, Beijing Tongren hospital. The cognitive function of all participants were evaluated by neuropsychological tests, including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA). The severity of white matter lesions was evaluated by the Fazekas scale, and the severity of CMBs by the microbleed anatomical rating scale (MARS). The correlation between the severity of CMBs and white matter lesions/ cognitive function were analyzed. Results We found that CMBs was related to global cognitive function deficits. The severity of CMBs was positively related to the severity of white matter lesions (r =0.431, P =0.03). The severity of CMBs was negatively related to the score of MoCA (r =-0.52, P =0.02). Conclusion CMBs was closely related to cognitive impairment. The severity of CMBs was negatively related to the score of MoCA, and the severity of CMBs was positively related to the severity of white matter lesions.

Analysis of Related Factors of 1-year Outcome of Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage

WANG Wen-Juan, LIU Li-Ping, YANG Zhong-Hua, YANG Bo, LI Jin-Xin, Du Yang, ZHAO Xing-Quan

2018, 13(07):  656-661.  DOI: 10.3969/j.issn.1673-5765.2018.07.004

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Objective To study 1-year clinical outcomes after minimally invasive catheter evacuation followed by urokinase for clot removal in patients with acute supratentorial spontaneous intracerebral hemorrhage (ICH) and determine the factors associated with the 1-year outcome. Methods Supratentorial spontaneous ICH patients who had undergone minimally invasive catheter evacuation followed by urokinase for clot removal during January 2014 and September 2016 were collected . Patients' demographic and clinical information, surgery information and one-year modified Rankin scale (mRS) were recorded. The main clinical outcome was poor outcome, defined as mRS score >3 at 1 year. The multi-factor logistic regression analysis was used to determine factors associated with 1-year clinical outcome after ICH. Results A total of 117 patients with supratentorial spontaneous ICH and having undergone minimally invasive surgery were enrolled in the study. The mean age was (56.5±12.5) years and the mean baseline hematoma volume was (59.0±28.5) ml. 59 (50.4%) ICH patients had 1-year poor outcome after surgery. Multi-factor Logistic regression analysis revealed that baseline hematoma volume 20-50 ml [odds ratio (OR) 0.161, 95% confidence interval (CI) 0.034-0.748, P =0.020] and age≤60 years (OR 0.169, 95%CI 0.055-0.515, P =0.002) were independent protective factors of 1-year poor outcome. Conclusion Baseline hematoma volume and age were independent predictors of 1-year outcome in acute ICH patients who had undergone minimally invasive surgery, which could allow better selection of ICH patients appropriate for minimally invasive surgery.

The Distribution Characteristics of Neovascularization in Carotid Plaques in Type 2 DM Patients Complicated with Ischemic Stroke by CEUS

NING Bin, HE Wen, ZHANG Dong, YU Teng-Fei, KAN Yan-Min, WEI Shi-Ji,YU Hai-Ge, LIU Meng-Ze

2018, 13(07):  662-666.  DOI: 10.3969/j.issn.1673-5765.2018.07.005

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Objective To determine the distribution characteristics of neovascularization in carotid plaques in type 2 DM patients complicated with acute ischemic stroke (AIS) by contrast-enhanced ultrasound (CEUS). Methods The case group included 40 hospitalized AIS patients diagnosed with type 2 diabetes in our hospital (not taking hypoglycemic drugs), with ipsilateral carotid plaque formation. The control group consisted of 32 sex-age-matched patients without DM and stroke history and with carotid plaque, selected from the outpatients in the same period. The patients diagnosed with aortic arch plaque and intracranial arterial lesions by CTA and those with patent foramen ovale (PFO) and atrial fibrillation (AF) were all excluded from this study. All patients were examined by conventional ultrasound (US) and CEUS, with plaque surface morphology, size and plaque echo observed by conventional US, and neovascularization in plaque by CEUS. The CEUS imaging results were divided into two groups: echo enhancement (neovascularization) and no echo enhancement near the intima in plaques. Results The thickness and echo of carotid plaques between two groups had no statistical difference. The results of CEUS showed that echo enhancement near the intima in carotid plaques were found in 34 cases (85%) in case group and 12 cases (37.5%) in control group. There was statistically significant difference between two groups (χ 2=17.38, P <0.01).

 Conclusion Neovascularization near the intima in carotid atherosclerotic plaques in type 2 DM patients with AIS and without taking antihyperglycemic drugs was more than that in nondiabetic patients, which indicates neovascularization in carotid plaque is related to hyperglycemia.

Risk Factors of Recent Stroke Recurrence in Non-cardiogenic Ischemic Stroke Patients

DU Qing-Xia, WANG Yu, DING Ning, ZHANG Yun, WANG Yong

2018, 13(07):  667-670.  DOI: 10.3969/j.issn.1673-5765.2018.07.006

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Objective To explore the related risk factors of recent stroke recurrence in non-cardiac ischemic stroke patients with good compliance with secondary preventive medication. Methods Patients with non-cardiac ischemic stroke who were admitted into our hospital from January 2014 to April 2016 were included in the retrospective cohort study, and the recurrence group and the control group were divided according to the follow-up period of 1 year. Multi-factors regression analysis was used to analyze the related factors. Results A total of 258 patients with ischemic stroke were enrolled, of all patients, 27 ones (10.5%) had recurrent stroke. Multi-factors regression analysis showed that age [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.28-2.13, P <0.001], hypertension (OR 3.23, 95%CI 2.27-3.92, P <0.001), diabetes (OR 2.23, 95%CI 2.11-3.01, P <0.001), coronary atherosclerotic heart disease (OR 1.36, 95%CI 1.17-2.09, P =0.043), chronic obstructive pulmonary disease (OR 1.42, 95%CI 1.11-2.09, P =0.031), obstructive sleep apnea hypopnea syndrome (OR 2.86, 95%CI 2.22-3.56, P <0.001), glycosylated hemoglobin (OR 2.67, 95%CI 2.21-3.31, P <0.001), C reactive protein (OR 1.32, 95%CI 1.36-1.66, P =0.046), homocysteine (OR 2.52, 95%CI 2.05-3.55, P <0.001) and activities of daily living (OR 2.10, 95%CI 1.87-2.53, P <0.001) were related to the recurrence of ischemic stroke. Conclusion Senior age, hypertension, diabetes, coronary atherosclerotic heart disease, chronic obstructive pulmonary disease, obstructive sleep apnea hypopnea syndrome, decreased daily living ability, high glycosylated hemoglobin, high C reactive protein, high homocysteine, are the independent risk factors for the recurrence of ischemic stroke.

Early Enteral Nutrition Supports the Effects of Nutrition Indicators, Inflammatory Factors and Prognosis of Patients with High Grade Aneurysmal Subarachnoid Hemorrhage

JI Peng, ZHOU Heng

2018, 13(07):  671-675.  DOI: 10.3969/j.issn.1673-5765.2018.07.007

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Objective To investigate the effects of early enteral nutrition support on nutrition indicators, inflammatory factors and prognosis in patients with high grade aneurysmal subarachnoid hemorrhage. Methods A total of 100 cases with high grade aneurysmal subarachnoid hemorrhage in ICU from December 2015 to December 2016 were included and randomly divided into control group (n =50) and observation group (n =50). In control group, patients were given conventional treatment after admission, with enteral nutrition (EN) support given on days 5-7; in observation group, patients were given EN support within 24 hours after admission. Nutrition indicators, inflammatory factors and consciousness recovery [Glasgow coma scale (GCS)] before treatment, at 7th and 14th day after treatment of two groups were compared. Results At admission, there were no significant differences in the nutrition indicators and inflammatory factors between two groups. At 7th day after treatment, the hemoglobin (Hb) (110.23±12.98) g/L, albumin (ALB) (34.28±3.02) g/L, total protein (TP) (59.94+3.47) g/L in observation group were significantly higher than that in control group: Hb (102.48+10.75) g/L (P =0.01), ALB (30.03+2.75) g/L (P =0.02), TP (54.32+3.49) g/L (P =0.01). At 14th day after treatment, the Hb (112.4+12.74) g/L, ALB (35.41+3.10) g/L and TP (60.25+4.39) g/L in observation group were significantly higher than that in control group: Hb (104.4+12.43) g/L (P =0.01), ALB (32.21+2.53) g/L (P =0.03), TP (57.34+3.90) g/L (P =0.02). The triceps skin-fold thickness (TSF) and arm muscle circumference(AMC) of male and female patients in two groups at 7th and 14th day after treatment decreased significantly comparing to that of them on admission. The interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in observation group were significantly lower than that of control group at 7th and 14th day. The 14th day GCS score in observation group was significantly higher than that of control group [(10.03±2.34) vs (8.48±2.01), P <0.001]. Conclusion EN can effectively improve the nutritional status of patients with high grade aneurysmal subarachnoid hemorrhage, significantly reduce the patient's inflammatory response and improve prognosis.

Correlation Between Depression, Anxiety and Other Symptoms in Vascular Parkinsonism Patients

MA Hui-Zi, ZHANG Xiao-Ying, ZHANG Ning

2018, 13(07):  676-680.  DOI: 10.3969/j.issn.1673-5765.2018.07.008

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Objective To investigate the prevalence rates of mood disorders (MD) including anxiety and depression in vascular parkinsonism (VP) patients and their relationships with motor symptoms and other non-motor symptoms. Methods VP patients were consecutively enrolled and divided into MD group and non-MD group based on the scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD).

The motor function was compared between the two groups based on the Movement Disorder Society-Sponsored Revision Unified Parkinson’s Disease Rating Scale section III (MDS-UPDRS III), and the non-motor functions including cognition and sleeping were compared according to the results of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Epworth Sleeping Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). Patients were divided into mild, moderate, and severe VP according to Hoehn-Yahr staging, and the prevalence rates of MD in these three groups were compared. Finally, the potential correlations of the HAMA and HAMD scores with the above motor function scores and other non-motor function scores were analyzed. Results A total of 60 cases of VP were enrolled. Of all, there were 46 patients (76.67%) in MD group and 14 (23.33%) in non-MD group. The scores of Hoehn-Yahr staging [2.0 (2.0, 3.0) vs 2.0 (2.0, 2.2), P =0.04], UPDRS-III [(51.91±8.67) vs (39.72±7.84), P =0.02], PSQI [(14.77±4.56) vs (9.28±5.33), P =0.04] scores were significantly higher in MD group than in non-MD group. According to Hoehn- Yahr staging, there were 32, 18 and 10 patients in mild, moderate, and severe VP groups respectively, and the prevalence rates of MD were significantly higher in moderate and severe VP group than in mild VP group. The HAMA score and HAMD score of VP patients were positively correlated with the MDS-UPDRS III score, ESS score, and PSQI score. Conclusion The prevalence of MD in VP patients is relatively high, especially in patients with severe VP. Both motor symptoms and non-motor symptoms are more severe in VP patients with MD.

Association between Ideal Cardiovascular Health Index and Carotid Arthrosclerosis

LIU Qing-Xiang, CHEN Sheng-Yun, LIU Yan-Fang, WANG Dan-Dan, ZHANG Jia, ZHAO Xing-Quan

2018, 13(07):  681-685.  DOI: 10.3969/j.issn.1673-5765.2018.07.009

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Objective To investigate the influence of ideal cardiovascular health (ICVH) index on carotid intima-media thickness (CIMT), so as to find a new direction for the primary prevention of carotid and cardiovascular diseases, through physical examination screening in large community. Methods Those who participated in the 2015 National Stroke Screening and Intervention Program in Beiqijia Community Service Center and met the criteria of aged above 40 years old and without history of stroke were selected. The participants’ general clinical data including height, weight, history of smoke and medical diseases, etc, and their baseline blood pressure, fast glucose, lipid levels and CIMT were collected. The number of ICVH indexes in every one was recorded. The participants were divided into CIMT abnormal and normal group. The ICVH index number of everyone was calculated. The complete carotid vascular ultrasound and CIMT were recorded. Logistic regression analysis were used to analyze the the basic characteristics between two groups, and the influence of general clinical data and ICVH index of two groups on CIMT. Results A total of 4387 subjects were enrolled in our study, with 654 in CIMT abnormal group and 3733 in CIMT normal group. In CIMT abnormal group, older age [62 (56, 69) vs 58 (52, 64), P <0.001] and smoking (23.8% vs 14.4%, P <0.001) were higher than CIMT normal group; and female (50.5% vs 69.2%, P <0.001), ideal blood pressure (15.7% vs 22.0%, P <0.001) and ideal glucose (52.6% vs 65.7%, P <0.001) were lower than CIMT normal group. In the multifactors logistic analysis, ICVH index number was obviously lower in CIMT abnormal group. After adjusting the gender and age, the difference still existed [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.68-0.98, P =0.029]. Conclusion The ICVH index number is lower in CIMT abnormal group than that of CIMT normal group, which is the protective factor for CIMT.

Current Status of Medication Compliance in Secondary Prevention for Ischemic Stroke or Transient Ischemic Attack

CHEN Yan-Xue, JIANG Yue, LI Zi-Xiao, PAN Yue-Song, JI Rui-Jun, WANG Yi-Long, WANG Yong-Jun, WANG Chen

2018, 13(07):  686-691.  DOI: 10.3969/j.issn.1673-5765.2018.07.010

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Objective To investigate the status of medication compliance in secondary prevention for ischemic stroke (IS) or transient ischemic attack (TIA). Methods From June 2012 to January 2013, 25 018 patients with acute ischemic stroke (AIS) or TIA were admitted in the China National Stroke Registry II (CNSR II). The data of patients’ demographics, clinical features and medications use in secondary prevention at 3, 6 and 12 months were collected. Medication persistence at 3, 6 and 12 months was defined as continuation of prescribed medications from discharge to every follow-up point. According to the drug compliance at 12 months, these patients were divided into compliance and noncompliance groups. The factor feature of both groups were compared, and multifactor analysis was conducted to identify the influence factors of drug compliance. Results 16 489 patients who completed 1-year follow-up were analyzed. The rate of secondary prevention medications compliance at 3, 6 and 12 months were 47.0%, 44.5% and 34.9%, respectively. Drugs compliance at 12 months after discharge as follows: the best compliance was diabetes drugs (63.86%), followed by antihypertensive drugs (61.9%), antiplatelet drugs (57.58%), warfarin (44.92%), and statins (24.36%). Multi-factor analysis showed that elder age, female, history of diabetes mellitus, and TIA of cerebrovascular events were influence factors of poor compliance to secondary prevention drugs treatment, while patients with history of stroke had better compliance to secondary prevention drugs. Conclusion The compliance of secondary prevention medications within 12 months in patients with IS and TIA were relatively low, and declined gradually over time.

Effect and Mechanism of Butyphthalide Injection on Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage

LIU Chang-Ya, HU Xue-Bin, XIONG Zhi-Yong, ZHENG Jin, LIU Yang, YAO Fan

2018, 13(07):  692-695.  DOI: 10.3969/j.issn.1673-5765.2018.07.011

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Objective To investigate the effect and mechanism of Butyphthalide injection on early brain injury in patients with aneurysmal subarachnoid hemorrhages (aSAH). Methods From August 2017 to December 2017, a total of 66 patients with acute aSAH were enrolled in the study. They were all treated by interventional embolization after aneurysm ruptured. They were randomly divided into observation group and control group, and 33 cases in each group. The control group received routine medication and symptomatic support treatment. The observation group was given intravenous Butyphthalide injection in addition, 100 ml, Q12 h. All the patients were treated continuously for 7 days. The levels of serum nitric oxide (NO), serum endothelin-1 (ET-1), serum neuron specific enolase (NSE), serum C reactive protein (CRP), serum intercellular adhesion molecule-1 (ICAM-1) and serum interleukin-1β (IL-1β) were determined on day 1, 3 and 7 after onset in both groups, and delayed cerebral infarction and modified Rankin scale (mRS) score were observed in all patients of two groups. Results The levels of NO in observation group were higher than that in control group on day 3 and 7, while the levels of ET-1, NSE, CRP, ICAM-1and IL-1β were all lower than that in control group on higher than that in control group, with statistical significance. There was no significant difference in delayed cerebral infarction incidence between two groups. Conclusion Using Butyphthalide after aSAH can reduce early brain injury, improve the prognosis of such patients. Decreasing inflammatory factors production using Butyphthalide may play a role on amelioration of focal brain injury.

Progress of Vascular Cognitive Impairment and Its Functional Imageology

HE Meng-Fei, YIN Chang-Hao, CAO Wen-Hui, SUN Weng-Qiang, ZHAO Wei-Na

2018, 13(07):  697-700.  DOI: 10.3969/j.issn.1673-5765.2018.07.012

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The prevalence of vascular cognitive impairment (VCI) is increasing year by year, and it has become the main cause of disability among the elderly. However, there are still in lack of effective treatment. In recent years, magnetic resonance technology has developed rapidly, especially functional imageology, such as blood oxygen level dependent function magnetic resonance imaging (BLOD-fMRI), magnetic resonance spectroscopy (MRS), and perfusion weighted imaging (PWI), which can evaluate the patient’s brain function with the advantages of high resolution, non-traumatic and so on. It provides an imaging evidence for early recognition, differential diagnosis and prognosis evaluation of vascular cognitive impairment, etc.

Advances of Multimodality Magnetic Resonance Imaging in the Diagnosis of Vascular Cognitive Impairment

ZHAN Yang, CUI Wen-Tao, HAN Ying

2018, 13(07):  701-705.  DOI: 10.3969/j.issn.1673-5765.2018.07.013

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Vascular cognitive impairment (VCI) includes impaired cognition of various degrees from mild cognitive impairment to dementia, with changes in brain structure and brain function. As a widely used diagnostic tool, magnetic resonance imaging (MRI) can non-invasively observe changes in brain tissue of patients. Combining automatic segmentation algorithms to classify the acquired MRI data has broad application prospects in identifying vascular cognitive impairment. This article reviewed recent advances in MRI in the diagnosis of vascular cognitive impairment.

Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2018

Chinese Stroke Association, Chinese Interventional Neuroradiology Society, Intervention Group of Committee of Stroke Prevention and Control of Chinese Preventive Medicine Association

2018, 13(07):  706-729.  DOI: 10.3969/j.issn.1673-5765.2018.07.014

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Neurology: Patients with Dementia should be Excluded from Thrombolysis of Acute Ischemic Stroke?

YANG Zhong-Hua

2018, 13(07):  730-730.  DOI: 10.3969/j.issn.1673-5765.2018.07.015

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Short Story about Stroke: Rise and Fall of Endovascular Stroke Therapy

John H.Zhang

2018, 13(07):  731-737.  DOI: 10.3969/j.issn.1673-5765.2018.07.016

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A Case Report on POEMS Syndrome with the Onset of Transient Ischemic Attack

FENG Chun-Hua, LIU Wei, BI Xiao-Ying

2018, 13(07):  738-742.  DOI: 10.3969/j.issn.1673-5765.2018.07.017

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A Case Report on Endovascular Intervention for Cardiopulmonary Arrest Caused by Acute Basilar Artery Occlusion

LI Wen-BO, WEI Li-Ping, ZHANG Yao-Hui, PANG Hong-Li, RUAN Chun-Yun, LI Yuan-Hui, HE Yu-Qing

2018, 13(07):  743-747.  DOI: 10.3969/j.issn.1673-5765.2018.07.018

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New Hope for Improving Cognitive and Neurological Functions of Acute Ischemic Stroke: Ginkgo Biloba Extract Plus Aspirin may Play a Key Role

XU Yun

2018, 13(07):  749-750.  DOI: 10.3969/j.issn.1673-5765.2018.07.019

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The Structural and Functional Disconnection of Subcortical Vascular Cognitive Impairment

BAI Feng

2018, 13(07):  751-752.  DOI: 10.3969/j.issn.1673-5765.2018.02.020

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Progress of Association between Red Blood Cell Distribution Width and Ischemic Stroke

ZHANG Xing, CHEN Wei-Qi, WANG Yong-Jun

2018, 13(07):  753-758.  DOI: 10.3969/j.issn.1673-5765.2018.07.021

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Red blood cell distribution width (RDW) is an index reflecting the heterogeneity of erythrocyte volume distribution, which is closely related to various kinds of anemia. In recent years, more and more studies have revealed that RDW is related to cardiovascular diseases and stroke. It can help to predict the probability of AIS, assess the severity of patients with acute ischemic stroke (AIS) and predict their prognosis. This article reviews the relationship between RDW and AIS in the terms of incidence, severity of illness, and prognosis.

The Mode of Medical Service Efficiency Improvement of Aneurysmal Subarachnoid Hemorrhage Based on Case-Consultation System—A Sustainable Effective Way of Continous Education for Cerebrovascular Physicians

WANG Chun-Juan, LI Zi-Xiao, DONG Ke-Hui, LIU Li-Ping, ZHAO Xing-Quan, CHEN Sheng-Yun, ZHANG-Dong,LIU Ai-Hua, WANG Yong-Jun

2018, 13(07):  759-761.  DOI: 10.3969/j.issn.1673-5765.2018.07.022

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Objective To explore the continuous education effect of aneurysmal subarachnoid hemorrhage (aSAH) medical service improvement model based on case-consultation system for cerebrovascular physicians. Methods The education model of aSAH treatment efficiency improvement based on the caseconsultation system for cerebrovascular physicians was applied in Beijing Tiantan Hospital, Capital Medical University since July 2013. The treatment rates improvement of interventional embolization/surgical clipping and the mean time from door to treatment were compared between two stages of Jan. 2013-June.2013 and July 2017- Dec. 2017 in patients with aSAH within 72 hours after onset. Results The treatment efficiency for aSAH patients was significantly improved by the continuous education based on the case-consultation system [The treatment rate within 72 hours was 83.6% vs 55.3%, P <0.001; time from door to treatment was (45.0±31.3)h vs (78.6±51.8)h, P <0.001]. Conclusion The aSAH medical service improvement model based on the case-consultation system is a continuous and highly effective education way for cerebrovascular physicians.

Training Demands for Clinical Research Methods in Medical Undergraduates

JIANG Yong

2018, 13(07):  762-764.  DOI: 10.3969/j.issn.1673-5765.2018.07.023

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Objective To understand the views and specific requirements of medical undergraduates on the training course of clinical research methodology, and to provide a basis for better and targeted training of clinical research methodology. Methods Using typical sampling method to select two undergraduate classes from two Beijing medical universities as participants, take a self-administered questionnaire to evaluate medical undergraduates’ views and demands for clinical research methodology training. Results Of all 120 questionnaires, 118 (98.3%) students believed that clinicians should master fundamental clinical research methods, 24 (20%) students had received systematic clinical research training, 113 students (94.2%) believed that it was necessary to offer courses on clinical research methods during undergraduate education, 34 (29.1%) students thought that clinical research methods course should be set as the required courses, 42 (35.0%) students thought that it should be set as optional courses, and 34 (29.1%) students thought that it should be set as a series of academic lectures, only 8 (6.8%) students suggested that such courses can be set as a form of multi-media self-learning. Conclusion There are strong demands for clinical research methodology training in medical undergraduates .