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Early hematoma enlargement is one of the main factors of early neurological deterioration in patients with intracerebral hemorrhage. The correlation between blood lipid and hematoma enlargement is a research hotspot at present. This article reviews the relationship between blood lipid and hematoma enlargement and outcomes in patients with intracerebral hemorrhage, as well as the correlation between statin treatment and hematoma enlargement.
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The early mortality of spontaneous intracerebral hemorrhage is higher. Hematoma enlargement is the main determinant of early neurological deterioration and poor outcome in patients with intracerebral hemorrhage. The use of non-contrast computed tomography (NCCT) signs to predict hematoma enlargement and poor outcome after cerebral hemorrhage is a current research focus. This article reviews the predictive value of various NCCT signs for hematoma enlargement and poor outcome in patients with acute cerebral hemorrhage, including liquid level, hypodensity, blend sign, swirl sign, black hole sign, satellite sign, and island sign.
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Objective To investigate the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in Chinese patients with ischemic stroke . Methods In this multi‐center study ,2 310 continuously inpatients with ischemic stroke diagnosed in 20 stroke screening and prevention project base hospitals from June 2015 to M ay 2016 were enrolled . Carotid ultrasonography and transcranial color‐coded sonography or transcranial Doppler were performed in all patients to confirm the presence of cerebral artery stenosis or occlusion . According to the distribution of lesions ,the subjects were divided into 2 groups :the simple intracranial artery stenosis group and the simple extracranial artery stenosis group . T he difference of risk factors between the two groups was compared . Results Of the 2 310 patients with ischemic stroke ,1 516 ( 65 .6% ) had simple intracranial artery stenosis and 794 ( 34 .4% ) had simple extracranial artery stenosis . T he incidence of anterior circulation artery stenosis was higher in the group of intracranial artery stenosis than that in the extracranial artery stenosis group ( 68 .1% vs 48 .7% , P ＜0 .001) . Posterior circulation artery stenosis and combined anterior with posterior circulation artery stenosis were more common in patients with extracranial artery stenosis group than those in intracranial artery stenosis group ( 36 .4% vs 22 .1% ,14 .9% vs 9 .8% ;all P ＜0 .001) . Univariate analysis of risk factors for stroke showed that patients with intracranial arterial stenosis had a higher prevelence of hypertension , diabetes ,obesity ,and family history of stroke ,and their systolic blood pressure ,diastolic blood pressure , body mass index ( BM I) ,fasting blood‐glucose ,glycosylated hemoglobin ,triacylglycerol ,total cholesterol , and low‐density lipoprotein cholesterol were significantly higher than those in the extracranial arterial stenosis group ( all P ＜ 0 .05 ) . T he proportion of elderly ( ≥ 65 years old ) ,male and smokers in the extracranial arterial stenosis group was significantly higher than that in the intracranial arterial stenosis group ( all P ＜0 .05) . Multivariate logistic regression analysis showed that elderly ( ≥65 years old) ,male , and smoking history were independent risk factors for extracranial arterial stenosis ( OR＝ 2 .012 ,1 .637 , 1 .325 ,respectively ;all P ＜0 .05) . While hypertension ,diabetes ,less physical activity ,and high BM I levels were independent risk factors for simple intracranial arterial disease ( OR ＝ 1 .301 ,1 .252 ,1 .248 ,1 .030 , respectively ;all P ＜0 .05) . Conclusions There are significant differences in the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in patients with ischemic stroke in China .
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Objective To investigate the differences of distribution characteristics and risk factors of large artery lesions in patients with ischemic cerebrovascular disease in different age groups in order to provide the basis for the prevention and treatment of stroke in different age groups.Methods From June 2015 to May 2016,a total of 10 711 consecutive inpatients with transient ischemic attack (TIA) and ischemic stroke from 20 centers nationwide were enrolled.Each 10 years was used as an age group from 40 years.All the patients were divided into 5 age groups.The differences of the different risk factors for cerebrovascular disease among the 5 groups were compared.All patients were separated by gender.The chi square test was used to compare the incidences of large artery stenosis of the intracranial and external and anterior and posterior circulation,and the number of vascular lesions in the same sex in different age groups.Results (1) The risk factors of elderly patients were mainly hypertension,diabetes mellitus,and atrial fibrillation (χ2=61.938,χ2=13.349,and χ2=55.940;all P<0.01).The smoking history,family history of cerebrovascular disease,and obesity were more frequent among the young and middle-aged people (χ2=131.505,χ2=7.298,and χ2=100.911,all P<0.01).(2) The linear trend chi square test results showed that the proportion of multivessel diseases in female and male extracranial arterial lesions increased gradually with the increase of age.(χ2=54.799,χ2=161.370,all P<0.01).The proportion of multivessel diseases in the intracranial artery in female decreased gradually (χ2=5.328,P=0.021),and that in male did not have obvious trend of change (χ2=0.289,P=0.591).(3) The linear trend chi square test results showed that the incidence of simple intracranial arterial stenosis in female and male intracranial arterial stenosis decreased gradually with the increase of age (χ2=20.090,χ2=42.351,all P<0.01),and the incidence of simple extracranial arterial stenosis increased gradually (χ2=40.311,χ2=90.698,all P<0.01).The incidence of both intracranial and extracranial artery stenoses increased gradually (χ2=12.077,χ2=45.887,all P<0.01).The incidence of simple posterior circulation vascular stenosis increased gradually in female (χ2=16.434,P<0.01),but that did not have obvious trend of change in male (χ2=1.701,P=0.192).The incidence of stenosis of both anterior and posterior arteries in female and male increased gradually (χ2=4.587,P=0.032;χ2=35.156,P<0.01).Conclusions The distribution of atherosclerotic lesions in ischemic cerebrovascular disease of the different age groups was different.No matter female or male patients,the majority of the young and middle-aged patients were intracranial artery lesions,and the elderly patients were mainly extracranial artery lesions.The majority of elderly women had posterior circulation artery lesions.Understanding the characteristics in patients with intracranial arterial lesion in different age groups will help to develop individualized stroke prevention and treatment strategies for the population of different age groups.
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Objective To investigate the effect of serum lipid level on carotid artery stenosis in patients with ischemic cerebrovascular disease.Methods Using a multi-center cross-sectional study,10 711 consecutive inpatients with transient ischemic attack (TIA) or ischemic stroke diagnosed clearly in 20 stroke screening and prevention project base hospitals from June 2015 to May 2016 were enrolled.According to the results of carotid ultrasonography,1 560 patients with extracranial carotid artery stenosis rate≥50% screened were enrolled in the study.They were divided into a severe stenosis group (70%-99%) and a mild-moderate stenosis group (5.80 mmol/L (7.3%[43/586]vs.0.4%[4/974]) and LDL-C>3.12 mmol/L (26.3%[154/586]vs.10.0%[97/974]) in patients of the severe stenosis group were higher than those in the mild-moderate stenosis group (26.3%[154/586]vs.10.0%[97/974]).Conclusion The high LDL-C and TC levels may increase the incidence of severe carotid artery stenosis or occlusion.
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Objective To analyze the correlation between smoking and occurrence of intracranial artery stenosis.Methods From June 2015 to May 2016,a total of 10 711 inpatients with transient ischemic attack (TIA) or ischemic stroke from 20 basel hospitals of nationwide were enrolled using a cross-sectional study,76 patients with unknown smoking and smoking cessation years were excluded.Finally,a total of 10 635 patients were enrolled.Transcranial color coded sonography and/or transcranial Doppler were used evaluate the intracranial artery stenosis lesions.The basic risk factors for cerebrovascular disease (age,sex,smoking and smoking years,whether smoking cessation and years,hypertension,diabetes,hyperlipidemia,atrial fibrillation,and family history of stroke) were recorded.According to the different smoking years,the smoking years were divided into five groups:non-smoking,smoking time ≤10-year,11 to 20-year,21 to 30-year,and >30-year groups for trend chi square test.According to the different smoking cessation years in the smokers,the smoking cessation years were divided into four groups:non-cessation,cessation time 1 to 10-year,11 to 20-year,and >20-year groups for trend chi square test.The effects of different smoking years and different smoking cessation years on the occurrence of intracranial arterial stenosis were analyzed.Results The incidence of intracranial artery stenosis in the smokers (40.4%[1 433/3 547]) was significantly higher than that in the non-smoking patients (29.4%[2 085/7 088]).There was significant difference (χ2=128.850,P<0.01),and the incidence of cerebral infarction in the smokers (91.6%[3 250/3 547]) was significantly higher than the non-smokers (85.0%[6 027/7 088]).There was significant difference (χ2=92.328,P<0.01).Smoking was an independent risk factor for intracranial artery stenosis (OR,1.603;95%CI 1.456-1.765;P<0.01).With the increase of smoking years,the detection rate of intracranial arterial stenosis increased gradually (trend χ2=115.437,P<0.01).Whether giving up smoking had no significant effect on the incidence of intracranial artery stenosis in patients with ≥20 years of smoking (trend χ2=1.043,P=0.307).Conclusions Smoking is an independent risk factor for affecting intracranial artery stenosis;the risk of disease increases with the number of smoking years.Long-term smokers (≥20 years) cannot reduce the effect on intracranial artery stenosis,even if they give up smoking.
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Objective To study the inhibitory effect and mechanism of citrusinol on proliferation of human hepatocellular carcinoma cells HepG2.Methods The inhibitory rate of HepG2 cells cultured in vitro was measured by MTT assay.The morphology and distribution of the ceils were observed by HE and acridine orange staining.The cell division cycle was detected by flow cytometry.The expression of F-actin protein was observed by fluorescent chromogenic method.Results Citrusinol could inhibit the growth of HepG2 cells,and the IC50 of the inhibitory rate was 76.46 μmol/L.Citrusinol could make the HepG2 cells shrink,arrest the cell division cycle to G2/M,and inhibit the expression of F-actin.Conclusion Citrusinol can prevent cell proliferation by arresting cell division cycle in G2/M phase and inhibiting the formation of cytoskeleton,thus inhibiting the growth of G2/M.
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Intracranial aneurysms are mainly caused by the local arterial wal defects and the increased intraluminal pressure. Usualy, the unruptured smal aneurysms are asymptomatic, and the ruptured aneurysms can cause subarachnoid hemorrhage. So far, the etiology and pathogenesis of intracranial aneurysms are not fuly understood. A lot of evidence has showed that intracranial aneurysms are a complex disease of environmental factors and multi-gene interaction. This article reviews the correlation between polymorphisms of elastin and colagen type Ⅰ α2 genes and intracranial aneurysm.
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Objective To investigate the correlation between carotid intraplaque neovascularization and acute ischemic cerebrovascular disease. Methods The patients examined with contrast-enhanced ultrasound were enroled and divided into either a symptomatic group or an asymptomatic group according to their cerebral ischemic symptoms. The patients were also divided into a low-echo group, an equal-echo group, and an heterogeneous echo group according to the plaque echo characteristics on conventional ultrasound. The carotid intraplaque neovascularization was evaluated with contrast-enhanced ultrasound. Multivariate logistic regression analysis was used to identify the correlation between carotid intraplaque neovascularization and acute ischemic cerebrovascular disease. Results A total of 73 patients with acute ischemic cerebrovascular disease were enroled, 32 patients in the symptoms group (19 ischemic stroke, 13 transient ischemic attack), 41 patients in the asymptomatic group. Plaque echo characteristics: low-echo 15, equal-echo 41, and heterogeneous echo 17. The proportions of the patients with plaque enhancement (84. 4% vs. 61. 0% ; χ2 = 4. 802, P = 0. 028) and enhanced intensity (21. 78 ± 8. 50 dB vs. 15. 93 ± 8. 82 dB; t = 2. 440, P = 0. 018) in the symptomatic group were significantly higher than those in the asymptomatic group. The proportions of the patients with enhanced plaque in the low-echo, equal-echo and heterogeneous echo group were 93. 3% , 58. 5% , and 82. 4% , respectively (χ2 = 7. 826, P = 0. 020 ). The low-echo group and heterogeneous echo group were significantly higher than the equal-echo group (al P 0. 05). The intraplaque enhanced intensities in the low-echo group, equal-echo group, and heterogeneous echo group were 22. 62 ± 9. 33 dB, 14. 38 ± 8. 02 dB, and 18. 15 ± 9. 64 dB, respectively (F = 3. 877, P = 0. 027). The low-echo group was significantly higher than the equal-echo group (P = 0. 024 ). Multivariate logistic regression analysis showed that carotid intraplaque neovascularization (odds ratio 3. 456, 95% confidence interval 1. 103 - 10. 828; P = 0. 033) was independently associated with acute ischemic cerebrovascular disease. Conclusions Carotid intraplaque neovascularization is closely associated with acute ischemic cerebrovascular disease.
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The annual incidence of aneurysmal subarachnoid hemorrhage (aSAH) is 9.0/100000.Although it only accounts for 5％ of all strokes,its prognosis is poor.Among the aSAH survivors,46％ of them do not completely recover within 1 year,50％ have progessive memory impairment,14％ have language disorders,and 39％ have emotional disorders.Because the social and family responsibilities shouldered by the relatively young patients,the demand for quality of life,as well as the lack of about the prognostic data of aSAH in China,all these are particularly important for the study of the prognosis of cognitive function,quality of life,and the ability of returning to work in patients with aSAH.
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Objective To study the best diagnostic imaging procedure after acute stroke.Methods 53 patients with acute stroke were recruited within 72 hours after symptom onset.CT was performed in all patients firstly, then T1 weighted-imaging( T1 WI), T2 weighted-imaging( T2WI ), gradient recalled echo T2 * weighted-imaging( GRE-T2 * WI) and diffusion-weighted imaging(DWI) were examined at 1.5T.Furthermore 15 patients with ischemic stroke received perfusion-weighted imaging(PWI) examination.Results 15 patients with acute cerebral hemorrhage and one patient of hemorrhagic brain tumor appeared clear on GRE-T2 * WI.3 patients with transient ischemic attack(TIA) were normal on T1WI ,T2WI ,GRE-T2* WI and DWI.18 cases with cerebral infarction appeared normal on GRE-T2 * WI within 6 hours after symptom onset, and 7 cases of them underwent PWI examination, the signal intensity of 3 cases were PWI ≥ DWI and of 4 cases were PWI = DWI.14 patients appeared hyperintense on GRE-T2 * WI within 6 ～72 hours after symptom onset.8 patients of them underwent PWI examination,the signal intensity of 6 cases were PWI≥DWI and of 2 cases were PWI = DWI.Of 14 patients,7 patients appeared as 1 ～ 18 dot or patchy hypointense whose diameter was about 2 ～ 5mm on GRE-T2 * WI.Another case of headache with hemiplegia and the side of the limb didnt show abnormalities on the CT, but showed a low signal in ambient cistern on T2 * WI and was proved to be subarachnoid hemorrhage.Conclusion After acute stroke,multi-sequence MRI enables the "one-stop shopping" imaging of cerebral hemorrhage,cerebral infarction and TIA in a shorter time,makes the state of micro-bleeding clear,determines ischemic penumbra,and even guides for thrombolytic treatment.
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Objective The method transcranial Doppler (TCD)and end-tidal carbon dioxide partial pressure (ETCO2 ) was used to investigate the cerebrovascular reserve capacity in patients with intracranial artery stenosis.Including the cerebral vasodilator reserve,contracted reserve and the overall reserve.Methods The 72 cases were enrolled in this study,include of 42 patients with one or two sides middle cerebral artery (MCA) stenosis,or other intracranial artery stenosis and 30 normal persons. All the patients were routinely examined with TCD,and the TCD QL software was used to evaluate the cerebrovascular reserve. Hypercapnia was induced by inhaling the CO2 who breathed himself,and hypocapnia was induced by voluntary hyperventilation. The changes of velocities were recorded in both side of MCA,and the ETCO2 was recorded by the external measuring device. Results ( 1 ) The cerebral vasodilator reserve of one side of MCA stenosis group ( ( 3.65% ± 2. 62% )/mm Hg),the heavier side of multi-vessel stenosis group ( ( 1.99% ± 2. 78% )/mm Hg ),and normal control group ( left ( 3.54% ± 1.66% )/ mm Hg; right (3. 81% ± 1.63% )/mm Hg) had significant difference( F = 3. 755 ,P ＜ 0. 05 ). The heavier side of multivessel stenosis group' s cerebral vasodilator reserve were significantly lower than normal control group ( t =- 2. 546,P ＜ 0. 05 ). (2) The overall reserve of one side of MCA stenosis group ( ( 3.22% ± 1. 27% )/mm Hg),the heavier side of multi-vessel stenosis group( (2. 30% ± 1.14% )/mm Hg),and normal control group(left (3. 19% ±0. 81% )/mm Hg;right (3. 23% ±0. 70% )/mm Hg)had significant difference(F=5. 894,P ＜0. 01 ). The heavier side of multi-vessel stenosis group' s overall reserve were significantly lower than normal control group( t = - 3. 357,P ＜ 0. 01 ) and they were also significantly lower than one side of MCA stenosis group (t = 2.471,P ＜ 0. 05 ). (3) The extent of vascular disease correlated inveresely to the cerebral vasodilator reserve( r = - 0. 322,P ＜ 0. 05 ) and the overall reserve( r = - 0. 364,P ＜ 0. 05 ) in the heavier side of patients who have vascular disease.Conclusions ( 1 ) TCD with ETCO2 is a simple,economic and effective method for assessing CVR. (2)The capacity of cerebrovascular reserve was reduced in patients with intracranial artery stenosis.
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Aortic arch atheroma is one of the causes of embolic stroke. With the deepening of research on aortic arch atheroma, its relationship with stroke is more and more clear, particularly the aortic arch plaque thickness ≥4 mm, is associated with cryptogenic stroke, stroke recurrence, and other vascular events. Although aortic arch atheroma and clinical features of stroke have been further understood, there are still many doubts.
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The severity of carotid atherosclerosis and the levels of serum matrix metalloproteinase-9(MMP-9)in patients with obstructive sleep apnea syndrome(OSAS)increase with the severity of apnea,and that MMP-9 plays an important role in the progression of carotid atherosclerosis.This article reviews the relationship between carotid atherosclerosis and serum MMP-9 so as to analyze the possible mechanism of developing carotid atherosclerosis in patients with OSAS.
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Matrix metalloproteinases (MMPs) degrade extracellular matrix,participate in the atherosclerosis (As) formation and plaque rupture.They are associated with the stability of plaque.Tissue inhibitor of metalloproteinase (TIMP) is a specific natural MMP inhibitor.The disequilibrium between MMPs and TIMP is closely associated with the formation and development of AS.Therefore,it is a new approach for the prevention and treatment of cardiocerebrovascular diseases by regulating the equilibration between MMPs and TIMP, delaying the development of AS and preventing plaque rupture.
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Objective To investigate the intracranial vascular stenosis and risk factors in different types of ischemic stroke. Methods 525 patients with ischemic stroke were assessed by a transcranial Doppler. Lipids including total cholesterol (CHO),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were examined. Results Intracranial vascular stenosis in diabetic and non-diabetic groups of patients,hypertension and non-hypertension groups of patients showed significantly difference (P