Predictors of death after endovascular mechanical thrombectomy in patients with acute vertebrobasilar occlusive stroke / 国际脑血管病杂志

Objective@#To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS).@*Methods@#Patients with acute VBOS treated with EMT in Wuhan No. 1 Hospital were enrolled retrospectively. The demographic and clinical data were collected. According to whether the patients died at 90 d after procedure, they were divided into survival group and death group. The demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.@*Results@#A total of 47 patients were enrolled. The median age was 62 years, 34 were males (72.3%), the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, 42 patients (89.4%) had recanalization (modified Thrombolysis in Cerebral Infarction[mTICI] 2b/3 grade), and 12 (25.5%) died within 90 d after procedure. Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs. 12 [5-23]; Z=-3.165, P=0.002), percentage of neutrophil (81.61% ±11.82% vs. 72.20% ±12.09%; t=-2.137, P=0.033), neutrophil/lymphocyte ratio (10.54±7.17 vs. 4.98±3.57; t=-2.393, P=0.017), and incidence of sICH (25.0% vs. 2.9%; χ2=5.627, P=0.018) in the death group were significantly higher than those in the survival group, while the percentage of lymphocyte (12.00%±9.04% vs. 20.67%±10.39%; t=-2.429, P=0.015) was significantly lower than that of the survival group. Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243, 95% confidence interval [CI] 1.046-1.318; P=0.038), high neutrophil/lymphocyte ratio (OR 1.278, 95% CI 1.002-1.630; P=0.049) and symptomatic intracranial hemorrhage (OR 5.088, 95% CI 1.065-38.718; P=0.046) were the independent predictors for death.@*Conclusion@#High baseline NIHSS score, high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.

Predictors of death after endovascular mechanical thrombectomy in patients with acute vertebrobasilar occlusive stroke / 国际脑血管病杂志

Objective To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS).Methods Patients with acute VBOS treated with EMT in Wuhan No.1 Hospital were enrolled retrospectively.The demographic and clinical data were collected.According to whether the patients died at 90 d after procedure,they were divided into survival group and death group.The demographic and clinical data were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.Results A total of 47 patients were enrolled.The median age was 62 years,34 were males (72.3％),the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16,42 patients (89.4％) had recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2b/3 grade),and 12 (25.5％) died within 90 d after procedure.Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs.12 [5-23];Z=-3.165,P=0.002),percentage of neutrophil (81.61％ ± 11.82％ vs.72.20％ ± 12.09％;t =-2.137,P =0.033),neutrophil/lymphocyte ratio (10.54 ±7.17 vs.4.98 ±3.57;t =-2.393,P=0.017),and incidence of sICH (25.0％ vs.2.9％;x2 =5.627,P=0.018) in the death group were significantly higher than those in the survival group,while the percentage of lymphocyte (12.00％ ± 9.04％ vs.20.67％ ±10.39％;t =-2.429,P=0.015) was significantly lower than that of the survival group.Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243,95％ confidence interval [CI] 1.046-1.318;P =0.038),high neutrophil/lymphocyte ratio (OR 1.278,95％ CI 1.002-1.630;P =0.049) and symptomatic intracranial hemorrhage (OR 5.088,95％ CI 1.065-38.718;P =0.046) were the independent predictors for death.Conclusion High baseline NIHSS score,high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.

The preliminary analysis of double stent-retriever thrombectomy for acute internal carotid artery occlusion / 中华神经科杂志

Objective To explore the safety and efficacy of Solitaire AB double stents in acute occlusions in bifurcation of cerebral artery (including the ends of internal carotid artery and middle cerebral artery M1 segment).Methods The clinical and imaging data of six cases treated with the double stent retriever technique using the Solitaire AB system in Wuhan No.1 Hospital from January to November 2017 were retrospectively analyzed.And the therapeutic effect and postoperative complications of them were analyzed.Results One patient took the double stents directly,whereas five patients were treated with double stent-retriever thrombectomy after the failure of single stent thrombectomy.All of the six patients achieved recanalization successfully (modified thrombolysis in cerebral infarction (mTICI) 3 in five patients,mTICI 2b in one).All patients had no intracranial hemorrhage immediately after thrombectomy.In the 24 hours,7 days and 2 weeks,the median NIHSS score was 10 (3-17),3 (1-15) and 1 (0-15),respectively.During perioperative period,one patient had asymptomatic cerebral hemorrhage,one died of symptomatic cerebral hemorrhage within 48 hours,and one was complicated with pulmonary infection.Five patients were followed up by outpatient visit,and four patients showed good outcome (modified Rankin Scale score ≤2).Conclusion In the emergency revascularization of acute cerebral artery occlusion at arterial bifurcation,double stent-retriever is better at increasing the efficacy of thrombectomy and is safe compared with single stent mechanical thrombectomy.

Outcomes of endovascular treatment for acute anterior circulation ischemic stroke: Intracranial atherosclerotic versus cardioembolic stroke / 国际脑血管病杂志

Objective To compare the outcomes of endovascular treatment between intracranial large artery atherosclerosis stroke (LAA) and cardioembolic stroke (CE) in Chinese patients with acute anterior circulation ischemic stroke.Methods Patients with acute anterior circulation ischemic stroke treated with the Solitaire stent retriever were enrolled.The patients were divided into either a LAA group or a CE group according to etiological subtype.The outcomes were compared between 2 groups.Multivariable logistic regression analysis was used to determine the independent risk factors for poor outcome (defined as the modified Rankin Scale score ＞2 at 90 d after onset).Results A total of 126 patients were enrolled in the study,including 62 (49.2％) in the LAA group and 64 (50.8％) in the CE group.The proportions of poor outcome at 90 d (59.0％ vs.41.0％;x2 =5.482,P =0.019) and symptomatic intracerebral hemorrhage at 72 h (12.5％ vs.1.6％;Fisher exact test P =0.033) in the CE group were significantly higher than those in the LAA group.Multivariate logistic regression analysis showed that high baseline National Institutes of Health Stroke Scale scores was independently associated with poor outcome (odds ratio [OR] 1.119,95％ confidence interval [CI] 1.026-1.221;P =0.011),good collateral circulation was was independently associated with good outcome (OR 0.227,95％ CI 0.097-0.788;P =0.016),and etiological subtype was not independently associated with outcome (OR 1.280,95％ CI O.454-3.633;P =0.630).Conclusion Etiological subtype is not associated with outcome in patients with acute anterior circulation ischemic stroke treated with the Sofitaire stent retriever.

Cytotoxicity of cyflumetofen on SH-SY5Y cells and possible mechanism / 中国药理学与毒理学杂志

OBJECTIVE To investigate the cytotoxicity of cyflumetofen for SH-SY5Y cells and the mechanism. METHODS SH-SY5Y cells treated with cyflumetofen 0.03, 0.06, 0.125, 0.25, 0.5, 1, 2, 2.6, 4, 6, 8 and 16 mmol·L-1 for 48 h. Cell survival was measured with MTT assay. The reactive oxygen species (ROS) was determined with the DCFH- DA probe, and mitochondrial membrane potential (MMP) was detected by JC-1 staining. The morphological changes in cell nuclei were observed with Hoechst33258 staining. Cell cycle and apoptosis were determined by flow cytometry. The protein levels of phosphorylated Jun Kinase (p-JNK) and p-P38 were measured by Western blotting. RESULTS Compared with solvent (DMSO) control group, cyflumetofen (≥0.06 mmol · L- 1) inhibited the proliferation of SH- SY5Y cells obviously (P<0.05), and the IC50 was 2.6 mmol·L-1. MMP declined and ROS levels increased significantly in cyflumetofen 1, 2, 4 and 6 mmol·L- 1 groups (P<0.01). Cyflumetofen 2, 4 and 6 mmol·L- 1 induced nucleic accumulation, nuclear shrinkage and disintegration in SH-SY5Y cells. Apoptosis rates of cyflu? metofen 2, 4 and 6 mmol·L- 1 groups increased from (0.7±0.1)% in DMSO control group to (6.7±0.1)%, (72.4±8.6)% and (90.7±3.2)% (P<0.01). Cyflumetofen 4 and 6 mmol·L- 1 induced G1 phase cell cycle arrest (P<0.01). In addition, Western blotting showed that cyflumetofen 4 and 6 mmol·L-1 up-regulated the expression of p-JNK (P<0.01), while the level of p-P38 in SH-SY5Y cells was increased in cyflumetofen 6 mmol · L- 1 group (P<0.01). CONCLUSION Cyflumetofen induces cell damage, apoptosis and G1 phase cell cycle arrest in SH- SY5Y cells. The mechanism may be associated with oxidative damage, and activation of P38 and JNK stress-response pathways.

Analysis of clinical characteristics and prognosis of meningovascular syphilis / 医学研究生学报

Objective Meningovascular syphilis is the intima inflammation of blood vessels caused by the syphilitic infec-tion, which is associated with the occurrence of ischemic stroke.The study analyzed the clinical, imaging features and prognosis for meningovascular syphilis so as to improve its diagnosis and treatment. Methods 14 patients diagnosed with meningovascular syphilis were collected prospectively from December 2007 to March 2015 in the neurological department of Jinling Hospital.The patients were followed for a period of 21.5(range 10.2~37.9)months,and the prognosis were evaluated. Results Patients with meningovascular syphilis presented with dizziness, hemiplegia, hemidysesthesia and cognitive decline.Lesions showed multiple, scattered on MR ima-ging, intracranial vascular stenosis was seen in the CTA/MRA, and the laboratory examination had characteristic changes.With a large dose and sufficient courses of penicillin treatment, meningovascular syphilis may hopefully get predominant effects.78.57%patients got good prognosis(modified Rankin Scale ,mRS≤2)at 3 months and 85.71% patients got goodlong-term prognosis(mRS≤2). Conclusion Meningovascular syphilis was usually presented as acute onset, lacks the specific clinical and neuroimaging manifesta-tions.Most patients has favourable prognosis after treatment of syphilis with full course of penicillin.

Cognitive impairment in patients with moyamoya disease / 国际脑血管病杂志

Moyamoya disease (MMD) is a cryptogenic and chronically progressive cerebrovascular disease.It is known for the bilateral distal internal carotid artery and its main branch progressive stenosis and occlusion,and the formation of smoky compensatory vascular network in the skull base.In recent years,with the continuous improvement of the medical technology and clinical research level,the cognitive impairment of the patients with MMD is increasingly receiving attention.The related research results continue to appear.This article reviews this in order to provide reference for clinical practice.

Hyperintense vessel sign on FLAIR maybe associated with cerebral collateral circulation in patients with acute ischemic stroke or transient ischemic attack: a retrospective case series study / 国际脑血管病杂志

Objective To investigate the possible formation mechanism and imaging features of the hyperintense vessel sign (HVS) on fluid attenuated inversion recovery (FLAIR) in patients with ischemic stroke or transient ischemic attack (TIA).Methods The baseline data of the patients with middle cerebral artery (MCA) ischemic stroke or TIA with digital subtraction angiography (DSA) showing the lesions of MCA M1 segment in clinical practice were retrospectively retrieved from Nanjing Stroke Registry Program from January 2010 to July 2011.FLAIR was used to observe HVS,and DSA was used to evaluate the degree of vascular stenosis and cerebral collateral circulation.Results A total of 101 patients were enrolled,76 (75.2％) were males,and their mean age was 53.94 ± 13.47 years; 90 patients (89.1％) with ischemic stroke and 11 patients (10.9％) with TIA; 55 patients (54.5％) were HVS negative and 46 (45.5％) were HVS positive.Among the patients whose MCA stenosis ＜50％,50％-70％,70％-90％ and ≥90％,the positive rates were 0％ (0/8),25.0％ (3/12),17.6％ (3/17),and 62.5％ (40/64),respectively.There were significant differences (Z=-4.479,P＜ 0.001).The leptomeningeal collateral circulation of the HVS positive group was significantly more than that of the HVS negative group (Z =-6.196,P ＜ 0.001).Multivariate logistic regression analysis showed that the degree of MCA stenosis was an independent risk factor for influencing the formation of HVS (odds ratio 3.943,95％ confidence interval 2.03-7.659; P ＜0.001).Conclusions The formed intracranial leptomeningeal colhteral circulation after severe intracranial vascular stenosis or occlusion is a major pathophysiological basis of HVS formation on FLAIR sequences in patients with ischemic stroke or TIA.

Mechanical thrombectomy for acute ischemic stroke / 国际脑血管病杂志

At present,intravenous thrombolysis within 4.5 h is still the most effective method in treatment of acute ischemic stroke.For those who do not meet the criteria of intravenous thrombolytic therapy,do not have significant improvement after intravenous thrombolysis and even worse,endovascular interventional therapy is a safe alternative treatment method.Arterial mechanical thrombectomy devices can achieve rapid and complete recanalization and provide more treatment options for patients with acute ischemic stroke.This article reviews the related technical evolution and clinical trials of mechanical thrombectomy devices.

Patients selection for endovascular therapy in acute ischemia stroke / 国际脑血管病杂志

Currently,intravenous tissue plasminogen activator within 4.5 hours of stroke onset is the only proven treatment for acute ischemic stroke.However,recanalization rate within 24 hours after the administration of intravenous tissue plasminogen activator is low,especially when the occlusion site involves a large intracranial artery.The low recanalization rate has prompted the development of endovascular therapy.Nevertheless,all treatment is binary,there is no best but most suitable treatment.In this article we review available researches on endovascular therapy and patients selection for endovascular therapy.

The study of the perceived stress scale's applicability in medical college students / 中华行为医学与脑科学杂志

Objective To explore the applicability of the Perceived Stress Scale(PSS) in Chinese medical students.Methods 773 medical students completed the PSS and the Depression Anxiety Stress Scale (DASS).The reliability and validity of the PSS were analyzed.Results The exploratory factor analysis showed that two factors were extracted from the scale,which could explain 53.74％ of the total variance.The confirmatory factor analysis verified that the structure of the PSS was two-dimensional (x2/df =2.863,CFI =0.943,TLI =0.924,GFI =0.951,AGFI =0.921,RMSEA =0.07).The internal consistency coefficient of the PSS,the perceived stress subscale and the perceived coping ability subscale were 0.858,0.852 and 0.750.The relationship between the PSS and the DASS was significant,which demonstrated that the PSS had a good criterion-related validity.In addition,t-test showed that girls had a higher level of the perceived stress than boys (t =-2.574,P =0.01),and students who lived in rural had a higher level of the perceived stress than students who lived in urban (t =2.788,P =0.005).Conclusion The study indicates that the PSS has a high level of the reliability and validity,and it is worthy of exploring the perceived stress in medical students.

The value of hyperintense vessel signs on fluid-attenuated inversion recovery imaging for assessing the patterns of collateral blood flow in adult moyamoya disease / 中华神经科杂志

Objective To investigate the value of hyperintense vessel signs (HVS) on fluidattenuated inversion recovery (FLAIR) sequence for assessing the patterns of collateral blood flow in adult moyamoya disease (MMD).Methods Forty-one adult patients with non-hemorrhagic MMD retrieved from Nanjing Stroke Registry Program between August 2008 and January 2011 were identified by digital cerebral angiography and performed the examination of FLAIR sequence in Jinling hospital.According to the different sites of HVS located in the territory of the middle cerebral artery,the patterns of HVS were classified into grades 0-3: Grade 0,absence of HVS ; Grade 1,HVS limited in the cerebral sulci of temporal lobe and Sylvian fissure ; Grade 2,HVS in the cerebral sulci of frontal and parietal lobe regions and Sylvian fissure;and Grade 3,HVS in the combined territories of Grade 1 and Grade 2.According to the intracerebral collateral blood flow,steno-occlusions of the arteries were classified into three types: Type 1,residual antegrade flow across steno-occlusive lesions; Type 2,retrograde flow via leptomeningeal vessels; Type 3,the combined collateral blood flow of Type 1 and Type 2.The relationship between the patterns of intracerebral collateral blood flow and the location of HVS was analyzed.Results Of 41 adult patients with non-hemorrhagic MMD,there were 3 patients presented with unilateral vascular lesions and 38 with bilateral vascular lesions,so the total number of vascular lesions of the cerebral hemispheres was 79.Because three patients showed the absence of HVS in bilateral hemispheres,the total number of the presence of HVS of the cerebral hemispheres was 73.Therefore,the percentage of the presence of HVS was 92.4％ (73/79) in vascular lesions of the cerebral hemispheres.Importantly,the patterns of slow collateral blood flow corresponding to Grade 1 HVS were all antegrade (7/7) ; the collateral patterns corresponding to Grade 2 HVS were mainly retrograde leptomeningeal flow (95.0％,19/20) ; and the patterns corresponding to Grade 3 HVS were mainly slow combined collateral blood flow(84.8％,39/46).Furthermore,with the changing sites of HVS from the cerebral sulci of temporal lobe to the cerebral sulci of frontal and parietal lobe regions,the directions of collateral flow changed with a shift from antegrade to retrograde,which was statistically significant.Conclusion The different locations of HVS can reflect the different patterns of collateral blood flow,and the locations of HVS may predict the directions of intracerebral collateral blood flow in adult MMD patients.

Relationship between serum levels of vascular endothelial growth factor and matrix metalloproteinase-9 and Suzuki' s grading in adult moyamoya disease / 中华神经科杂志

Objective To investigate the relationship between serum levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) and Suzuki' s grading system in adult moyamoya disease (MMD).Methods Fifty-two adult patients with MMD,who were diagnosed in Jinling hospital between April 2009 and January 2010,were retrieved from the Nanjing Stroke Registry Program (NSRP).Sixteen sex- and age-matched healthy individuals with MMD patients consisted of the control group.Using enzyme-linked immunosorbent assay,serum concentrations of VEGF and MMP-9 were compared between adult MMD patients and healthy individuals.By Suzuki' s six-grading system,patients were divided into different subgroups,and the correlation of serum levels of VEGF and MMP-9 corresponding to different subgroup and Suzuki's grading was respectively analyzed.In addition,the correlation of serum levels of VEGF and MMP-9 was also evaluated.Results Serum VEGF concentrations in ischemic and hemorrhagic MMD patients was respectively ( 289.4 + 69.2 ) pg/ml and ( 324.3 ± 95.6 ) pg/ml and were significantly higher compared to those in healthy controls ( ( 63.5 ± 7.6 ) pg/ml; F =69.43,P ＜ 0.01 ).Similar findings were observed for MMP-9 ( ( 499.4 ± 76.2 ) ng/ml and ( 531.2 + 100.2 ) ng/ml versus (257.1 ±30.7) ng/ml; F =66.023,P ＜0.01 ).With the increase of Suzuki' s grading,serum levels of VEGF and MMP-9 respectively showed a high trend ( r =0.879,P ＜ 0.01:r =0.838,P ＜ 0.01 ).In addition,a positive correlation between serum levels of VEGF and MMP-9 was found in the MMD group( r =0.590,P ＜0.01 ).Conclusion The results show that serum levels of VEGF and MMP-9 in adult MMD are higher than those in healthy controls,which may play a role in neovascularization in MMD,and moreover,serum levels of VEGF and MMP-9 show a high trend with the progression of MMD,which suggest that serum levels of VEGF and MMP-9 can reflect the severity of MMD.

Patterns of collateral distribution in adult moyamoya disease / 中华神经科杂志

Objective To study the patterns of collateral circulation in adults moyamoya disease (MMD). Methods One hundred and nineteen consecutive adult patients with MMD (ischemic or hemorrhagic type) were identified by digital cerebral angiography in Nanjing Stroke Registry Program of Jinling Hospital between August 2004 and January 2010.The extracranial and (or) intracranial collateral circulations ipsilateral to stroke hemisphere were regarded as the research objects,and furthermore,these collateral circulations were divided into three different grades:Grade 1 collateral (anterior cerebral artery (ACA) → meningeal arteries (MLA) → middle cerebral artery (MCA) ),Grade 2 collateral ( dilating and extensing anterior choroidal artery beyond choroid fissure,patent posterior communicating artery → posterior cerebral artery→MLA→ ACA and(or) MCA,posterior cerebral artery→MLA→ACA and (or) MCA and posterior choroidal artery → posterior pericallosal arteries → ACA ) and Grade 3 collateral (collateral originating from the external carotid artery supplying to cerebral blood flow). The relationship between collateral distribution patterns in adult MMD and Suzuki' s classification was analyzed.Results In 117 assessed vessel units of the collateral circulation ipsilateral to stroke hemisphere,there were a total of 200 collateral circulations.The percentage of numbers in Grade 1,Grade 2 and Grade 3 collateral was 11.5％(23/200),52.0％ (104/200) and 36.5％ (73/200),respectively.The distribution percentage of Grade 1 was gradually decreased from Suzuki's Ⅰ to Ⅵ,mainly distributed in the early stage of MMD ( Suzuki's Ⅰ -Ⅱ ) and accounted for 91.3％ (21/23; Z =- 7.270,P ＜ 0.01 ).The distribution percentage of Grade 3 was gradually increased from Suzuki' s Ⅰ to Ⅵ,especially in the late stage of MMD ( Suzuki' s Ⅴ-Ⅵ) and accounted respectively for 37.0％ (27/73) and 63.0％ (46/73; Z =-7.270,P ＜0.01 ).Compared with the total distribution of Grade 1 and 3 collateral circulation,the distribution percentage of Grade 2 was 6.7％ (7/104),7.7％ (8/104),15.4％ ( 16/104),40.4％ (42/104),14.4％ (15/104)and 15.4％ (16/104) from Suzuki' s Ⅰ to Ⅶ.Although there was not significant difference,Grade 2 mainly distributed in the medium stage of MMD ( Suzuki' s Ⅲ-Ⅳ ).Conclusions The patterns of collateral distribution is various,changing with the progression of MMD. Grade 2 collateral circulation accounts for a higher proportion,especially in the medium stage of the disease,which suggests that these collaterals play an important compensatory role of blood flow.

Association study of 5-HTR2A promoter region gene polymorphisms with unipolar depression and paroxetine treatment response in northwest Chinese Han population / 中华行为医学与脑科学杂志

Objective To explore the association between the 5-HTR2A (-1438A/G)promoter region gene polymorphisms and unipolar depression and effcacy of antidepressant drugs in northwest Chinese Han population.Methods Polymerase chain reaction (PCR) was used to detect the distributive frequency of serotonin 2A receptor promoter region polymorphisms of 136 unipolar depression patients( patient group) and 160 normal people tween the patient group and the control group.The frequency of AG,GG genotypes; and G allele in patients was phisms of 5-HT2AR promoter region were correlated with SSRIs treatment response(F= 6.317, P= 0.013 ).There was significant difference of the effective power at the end of week 2 ( x2 = 5.878, P= 0.015 ).The effective power of AA, AG genotype was much higher than that of GG genotype and the effective power in the group with AA genotype was higher than that with AG genotype( each 87.8% ,57.6% ,53.7% ).Conclusion The frequency of GG genotype of 5-HTR2A( 1348A/G)may be associated with episode of unipolar depression in northwest Chinese Han population and A allele may be correlated with well response to paroxetine.

A meta-analysis of the biomarkers associated with coronary artery lesions secondary to Kawasaki disease in Chinese children / 华中科技大学学报（医学）（英德文版）

The biomarkers associated with coronary artery lesions (CAL) secondary to Kawasaki disease (KD) in Chinese children were investigated by using Meta-analysis. We searched documents published from January 1997 to December 2009 from medical electronic databases. According to inclusion and exclusion criteria, eligible full-text papers were identified. We conducted a comprehensive quantitative analysis by using Stata10.0 statistical software package to assess the heterogeneity among the documents, calculated the summary effect and analyze publication bias and sensitivity. A total of 92 documents and 16 biomarkers were identified. All documents were case-control studies, and included 2398 patients in CAL group and 5932 patients in non-CAL (NCAL) group. The Meta-analysis showed that the levels of platelet count, platelet hematocrit (PCT), neutrophils count, platelet distribution width (PDW), mean platelet volume (MPV), erythrocyte sedimentation rate (ESR), cardiac troponin I (cTnI), and endothelin-1 (ET-1) in CAL group were significantly higher than those in NCAL group, and serum albumin (Alb) and hemoglobin (Hb) levels were significantly lower in CAL group (all P<0.05). White blood cell (WBC) count, serum sodium, matrix metalloproteinase 9 (MMP-9), total cholesterol (TC), hematocrit (HCT) and CD3+T lymphocytes percentage had no statistically significant difference between the two groups. In conclusion, our results indicated that the 10 biomarkers including platelet count, neutrophils count, PCT, PDW, MPV, ESR, cTnI, ET-1, Alb and Hb were associated with CAL, and may be involved in the pathogenesis of CAL. The biomarkers of WBC count, serum sodium, MMP-9, TC, HCT, and CD3+T lymphocytes percentage bore no relationship with the development of CAL among Chinese children with KD.

Lesion patterns of 72 cases of hemorrhagic type of moyamoya disease / 中华神经科杂志

Objective To study the lesion patterns of hemorrhagic type of moyamoya disease (MMD) in adults. Methods Seventy-two consecutive cases of hemorrhagic type of MMD, confirmed by digital cerebral angiography in Jinling hospital between January 2004 and February 2010, were retrieved from the Nanjing Stroke Registry Program. MMD patients were classified according to the hemorrhagic sites into 4 types: non-thalamic parenchymal, thalamic, primary ventricular and subarachnoid. The ipsilateral anterior choroidal artery and posterior communicating artery (AChA-PComA) were evaluated by the modified Morioka's 3-points grading system: normal or mild to moderate dilation, severe dilation with abnormal extension and non-visualization. The relationship between lesion patterns and the angiographic findings was analyzed. Results In the stage of normal or mild to moderate dilation of AChA-PComA, non-thalamic parenchymal hemorrhage was the more frequent type (51.6%, 16/31 ;Z = -3.266,P =0.001 ), and there was a high incidence of intrastriatal hemorrhage occurred (22.6%, 7/31 ). In the stage of severe dilation with abnormal extension, intraventricular hemorrhage was most common ( 58.8%, 20/34 ;Z = -2.696 ,P =0.008). In addition, posterior circulation subarachnoid hemorrhage (SAH) was associated with a higher grade of AChA-PComA than anterior circulation SAH (Z = -4.655 ,P ＜ 0.01 ). Furthermore, posterior circulation SAH was the only type of SAH in the stage of non-visualization(9.7% ,7/72; x2 =42.999,P ＜0.01 ). Conclusion In adult patients with MMD, different subtypes of hemorrhagic stroke were associated with angiographic changes of AChA-PComA, and the angiographic characteristics may predict the location of hemorrhage.

Prognostic value of GCS and NIHSS in patients with acute top of basilar syndrome / 中国神经精神疾病杂志

Objective To assess the effectiveness of initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) as predictors for clinical outcomes in patients with top of the basilar syndrome (TOBS).Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program (NSRP). Initial GCS and NIHSS were retrospectively evaluated by reviewing patients' records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale (mRS) score. Patients were categorized as favorable outcome group (mRS 0-3) and unfavorable outcome group (mRS 4-6).Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3 (P<0.01) and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group (P=0.011). In multivariate logistic regression analysis, after adjusting for age, gender and treatment approaches, the GCS OR was 0.301(95% CI 0.167～0.542), NIHSS OR was 1.436(95% CI 1.147～1.796), and both of them turned out to be the independent predictors of outcome at 30 days. ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%. NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome. GCS cutoff point is more strongly predictive of outcome than that of NIHSS.

Exploring the Intellective Apparatus for Measuring the Intensity of Pressure on Dermal Sears / 中国医学物理学杂志

Objective:To explore the method of measuring the intensity of pressure on dermal scars.Methods:The testing inductor to taste intensity of pressure (being forced by such as elastic bandages enswathements ,etc.) was by way of the pressing transducer.The pressure signal (degree mv) of the transducer was magnified and transferred to tiny controls where A/D switch happened.All of processions were accomplished by soft wares of C language and results were displayed by LED.Results and Conclusions:The apparatus can measure the intensity of pressure basing on different intensities (such as kgf/cm2 or mmHg or kPa,etc).The results were credible and the operations were simple.

Changes in homocysteine levels in patients with ischemic cerebral disease and obstructive sleep apnea-hypopnea syndrome / 中华神经科杂志

Objective To investigate the relationship between obstructive sleep apnea-hypopnea syndrome(OSAHS)and plasma homocysteine(Hcy)levels in patients with ischemie cerebrovascular disease(ICVD).Methods Seventy-six patients with ICVD were monitored with polysomnography(PSG) for 7-8 hours during sleeping.The levels of fibrinogen(FBG),high density lipoprotein cholesterol(HDLC),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG)and plasma Hey were assessed.Results Of the 76 ICVD patients,57 showed apnea symptom during sleeping,of which 53(69.7%)were diagnosed with OSAHS and 4 with central sleep apnea,According to the mean apnea-hypopnea index (AHI),the severity of apnea was classified as no apnea symptom(19 cases with mean AHI of 2.38±0.96 and Hey level of(8.78 ±2.01)μmol/L),mild apnea(21 cages with mean AHI of 14.14 ±4.37 and Hcy level of(12.91 ±3.00)μmol/L),moderate apnea(24 cases with mean AHI of 29.62±5.81 and Hcy level of(14.85 ±4.15)μmol/L)and severe apnea(8 cases with mean AHI of 46.75±2.82 and Hcy level of(19.30±4.82)μmol/L).The level of Hcy was statistical significant among these 4 groups(F=40.32,P<0.01)and correlated with the mean AHI(r=0.598,P<0.01).Conclusion Patients with ICVD have a high morbidity of OSAHS,mainly suffering from mild to moderate apnea;The plasma Hcy level elevates in the ICVD patients with OSAHS and is correlated with the severity of apnea.