Minutes of the 24th National Conference of Neurology of Chinese Medical Association / 中华神经科杂志

The 24th National Conference of Neurology of Chinese Medical Association was held in Zhuhai City, Guangdong Province during September 23-26,2021.The conference adopted a combination of online and offline methods, with a total of 2 plenary meetings, 20 special seminars, 284 invited reports, 382 papers exchanged at the conference and 1 088 papers exchanged on the wall. The conference focused on cerebrovascular diseases, epilepsy, cognitive disorders, myopathy, peripheral neuropathy, neurodegenerative diseases, nerve infectious diseases, demyelinating diseases, neuroimmune diseases, genetic and metabolic nerve diseases, nerve rehabilitation, anxiety and depression, headache, sleep disorders, nerve nursing, nerve intervention, neuroimaging, neuroelectrophysiology, translational medicine, precision medicine and other related nervous system diseases. There were more than 7 000 participants who attended this conferece.

The association of lipid profile and bleeding in patients with minor stroke or transient ischemic attack on antiplatelet therapy: subgroup analysis of CHANCE / 中华内科杂志

Objective Abnormalities of lipid profile were considered as risk factors of hemorrhage after ischemic stroke. We aimed to determine the relationship between lipid levels and bleeding in minor stroke or transient ischemic attack (TIA) patients receiving antiplatelet therapy. Methods Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride were tested in a subgroup of 3044 consecutive patients from Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Patients were randomized to clopidogrel plus aspirin group or single aspirin group. The primary endpoint was any bleeding within 90 days. The secondary endpoint was severe bleeding according to the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) definition. Cox proportional hazards models were used to assess the associations of lipid levels and outcomes. Results A total of 59 (1.9％) bleeding events occurred at 90 days. High-density lipoprotein cholesterol (adjusted HR=2.16; 95％CI 1.17-4.00, P=0.014) and age (adjusted HR=1.04;95％CI 1.01-1.06, P=0.006) were significantly associated with any bleeding. High-density lipoprotein cholesterol was also associated with severe bleeding (adjusted HR=3.05;95％CI 1.39-6.68, per 1 mmol/L increase). No correlations between outcomes and levels of total cholesterol, low-density lipoprotein cholesterol and triglyceride were found. There was no interaction of any lipid component level with randomized antiplatelet therapy. Conclusions Elevated high-density lipoprotein cholesterol is independently associated with any bleeding and severe bleeding in the patients with acute minor stroke or high-risk TIA on antiplatelet therapy.

The post cingulate's role in triggering voluntary swallowing / 中华物理医学与康复杂志

Objective To investigate the function of the post cingulate in triggering voluntary swallowing by examining the activated areas in the brain of dysphagic patients with and without delayed pharyngeal swallowing using magnetoencephalography.Methods Videofluoroscopy was used to detect the latency of pharyngeal swallowing of 6 dysphagic patients.Magnetoencephalography (MEG) was used to monitor the whole course of voluntary swallowing,and an equivalent current dipole was applied to the activated areas of the brain 2500 ms before the subconscious electromyographic signals appeared.Magnetic resonance imaging (MRI) was performed just after the magnetoencephalography.A magnetic source image (MSI) was generated by overlaying the MRI and MEG results.Results The MSIs of five of the patients were derived.Three had delayed initiation of pharyngeal swallowing (with the latency being 0.03-0.12 s) and the other two showed normal latency during pharyngeal swallowing.In the former 3 patients,the post cingulate was activated at 1426 ms,1138 ms and 1675 ms before the burst of electromyography signals,which was later than that of the anterior cingulate and the insular cingulate.The 2 patients without delayed pharyngeal swallowing had their post cingulate activated at 1971 ms and 2483 ms before or at almost the same time as the anterior cingulate and insular.Conclusion Post cingulate activation occurs later than that of the anterior cingulate and insular in patients with delayed pharyngeal swallowing,the reverse of normal swallowing.This result indicates that the post cingulate may play an important role in triggering voluntary swallowing.

Plasma S100B as a predictor for short-term outcome of aneurysmal subarachnoid hemorrhage(aSAH)and in hospital complications / 中国神经精神疾病杂志

Objective To study the ability of S100B to predict the clinical outcomes and complications after aneu?rysmal subarachnoid hemorrhage (aSAH). Method This study is a one-center and consecutive recruitment. Plasma S100B levels were measured by enzyme-linked immune-sorbent assay (ELISA) within 72 hours after onset. The charac?teristics, treatment patterns, complications and outcomes of patients were also analyzed. Results The S100B levels of aSAH patients were higher than that of health controls(28.55 pg/mL vs. 21.20 pg/mL, P<0.001). S100B levels (P=0.05), Hunt-Hess higher scales (P<0.001), delayed cerebral ischemia (P<0.001) and hydrocephalus (P=0.028) were associated with poor outcomes. S100B also can predict complications in hospital. Conclusions The levels of S100B rise during acute phase of aSAH and S100B may be a useful biomarker to predict functional outcomes and complications in hospital.

Relationship between Lesion Sites of Stroke and Swallowing Function / 中国康复理论与实践

Objective To explore the relationship between lesion sites of stroke and swallowing function. Methods Ischemic stroke pa-tients consecutively admitted into the stroke unit were screened in this study. The new and previous lesion sites of stroke, dysphagia and aspi-ration under videofluoroscopy (VF) were recorded and their relation was analyzed. Results 211 patients were included and 169 patients had completed the MRI and VF examination. 159 patients had dysphagia and 94 had aspiration under VF. 72 patients (9 missing) were found dis-order in oral phase and 150 in pharyngeal phase. There was no significantly difference in dysphagia under VF and in aspiration among differ-ent lesion sites (P>0.05). Patients with stroke in medulla tended to happen aspiration (P=0.056). Stroke sites above the tentorium of cerebel-lum (P=0.028) or above medulla (P=0.005) may cause disorder in oral phase. Conclusion The stroke injury in brain cortex, white matter, brainstem and cerebellum or hemisphere could lead to dysphagia and aspiration. The injury of medulla may cause aspiration. Lesion of brain hemisphere or above the medulla could result disorder in oral phase of swallowing.

Risk Factors and Early Unfavourable Prognosis Factors of Cerebral Venous Sinus Thrombosis / 中国康复理论与实践

Objective To analyze the risk factors and early prognosis factors of cerebral venous sinus thrombosis (CVST). Methods 68 patients with CVST were analyzed retrospectively. The patients were divided into early favorable prognosis group and early unfavorable prognosis group according to modified Rankin Scale (mRS). The clinical data and prognosis were analyzed by univariate analysis and multi-variate logistic regression analysis. Results and Conclusion On discharge, there were 37(54.4%) cases and 31(45.6%) cases in the early fa-vorable prognosis group and the early unfavorable prognosis group respectively. Univariate analysis showed that 8 factors, including preg-nancy-associated factors, central nervous system infection, hyperhomocysteinemia, ocular symptoms, disturbance of consciousness, limb pa-ralysis, secondary cerebral infarction and ventricular compression/midline shift/encephaledema were associated with the early prognosis. Multivariate logistic regression analysis showed that pregnancy-associated factors, central nervous system infection, hyperhomocysteinemia, disturbance of consciousness and ventricular compression/midline shift/encephaledema were the independent factors.

The impact of in-hospital pneumonia on the risk of in-hospital and long-term mortality in patients with acute ischemic stroke / 中华内科杂志

Objective To observe the short-term and long-term impacts of in-hospital pneumonia on outcomes of patients hospitalized with acute ischemic stroke.Methods All consecutive patients older than 18 years with acute ischemic stroke were prospectively recruited to this study,including 132 clinical centers in 32 provinces and 4 municipalities (including Hong Kong region) in China from September 2007 to August 2008.Case report form was designed.Data of pneumonia and survival outcomes at baseline ; discharge ; 3,6 and 12 months after admission were recorded.Multivariable logistic regression was used for statistical correlation analysis.Results A total of 1373 (11.88％) patients from 11 560 acute ischemic stroke patients were notified with in-hospital pneumonia.The case fatality rate was 14.4％ (1664 patients) within 12 months after stroke onset.The fatality rate in patients with pneumonia was higher than that of patients without pneumonia.In-hospital pneumonia was an independent risk factor for death at discharge (adjusted OR =5.916 ; 95％ CI 4.470-7.831),at 3 months (adjusted OR =3.641 ; 95％ CI 3.035-4.367),6 months (adjusted OR =3.445 ; 95％ CI 2.905-4.086),and 12 months (adjusted OR =3.543 ; 95％ CI 3.016-4.161) after onset.Conclusion In-hospital pneumonia is an adverse factor for the short-term and longterm survival of acute ischemic patients in China.

Post-marketed re-evaluation of fleabane injection and Dengzhan Shengmai capsule study on treatment in patients with ischemic stroke / 中国中药杂志

<p><b>OBJECTIVE</b>To verify the efficacy and safety of post-marketed fleabane injection combined with Dengzhan Shengmai capsules in the treatment of ischemic stroke (IS).</p><p><b>METHOD</b>A multicentre, prospective, practical, randomized controlled study was carried out to compare the efficacy and safety of Dengzhan group (n = 343) and western medicine group (n = 335), appling "clinical study central stochastic system". The treatment of Dengzhan group is using fleabane injection in acute stage and Dengzhan Shengmai capsules in convalescence. The primary indexes of effect evaluation are the important outcome events in 360 days' follow-up, including mortality, recurrence, disability and quality of life to reflect the effect of clinical study. The indexes of safety evaluation involve laboratory examination results and incidence of adverse events.</p><p><b>RESULT</b>After 360 days' follow-up, 4 people died of IS in Dengzhan group, and the mortality rate of which is 1.17%, while 16 died in Western medicine group (WM group), and the mortality rate is 4.78%, suggesting that the mortality rate of Dengzhan group is significantly lower than WM group (P<0.05). Eleven cases recurred in Dengzhan group, and the recurrence rate of which is 3.21%, while 12 recurred in WM group, and the recurrence rate is 3.59%, indicating that the recurrence rate of Dengzhan group is slightly lower than WM group. The disability rate of Dengzhan group is 39.53%, among which the rate of severely disabled cases are 1.49%, while the disability rate of WM group is 40.13%, among which the rate of severely disabled cases are 3.13%, suggesting that the disability rate of Dengzhan group is lower and the severity of disability is also lighter than WM group. In the field of quality of life, the activity ability and the upper limb function store of stroke patients in Dengzhan group improved far much better than WM group (P<0.05). Analysis of safety suggested that, adverse events occurred in 11 cases in Dengzhan group, among which 4 cases is related with the drug treatment, the incidence of adverse events of which is 1.17%, and the main manifestations involve fever and chilling, rash, nausea, dizziness, palpitation, etc. which were all appeared after the treatment of fleabane injection, and disappeared 1 to 2 days after drug withdrawal. 13 cases occurred abnormal liver function and 2 cases abnormal kidney function in Dengzhan group. According to the judgment of clinical physicians, 3 case of ALT abnormality is possibly related to the treatment, the others are all unrelated with the treatment.</p><p><b>CONCLUSION</b>Fleabane injection and Dengzhan Shengmai capsules are all safe and effective TCM in the treatment of ischemic stroke.</p>

Post-marketing re-evaluation of Kudiezi injection study on early treatment in patients with ischemic stroke / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effect and safety of Kudiezi injection on patients with acute ischemic stroke.</p><p><b>METHOD</b>Seven hundreds patients were divided into two groups by central randomization system. The study group, 346 cases, was treated with kudiezi injection plus traditional Chinese medicine (TCM) synthesis rehabilitation project, and the control group, 354 cases, was treated with synthetic rehabilitation project. The patients were treated for 10 to 21 days. Before treatment and at the 7th, 14th and 21th day of treatment, the indexes include NIHSS used for evaluating the neurological deficit degree and the motor function score (Fugl-Meyer) for evaluating motor function were observed. The safety index is defined by adverse observation event and laboratory test. The incidence of adverse events and laboratory tests results were observed before and after treatment at the same time.</p><p><b>RESULT</b>Application of generalized estimating equation model, we found that as the treatment time, NIHSS score and FMI score of the two groups showed a trend of improvement. And at the 14th days and 21th days of treatment, compared to the control group the treatment group showed significant statistical difference on the impact of NIHSS and FMI (P<0.05). No serious adverse events were observed.</p><p><b>CONCLUSION</b>Kudiezi injection plus TCM rehabilitation project of ischemic stroke showed some superiority to western medicine rehabilitation program on improving the neurological deficit and motor function. Kudiezi injection is safe and effective in the treatment of acute ischemic stroke.</p>

Comparison of Prognosis of Acute Subarachnoid Hemorrhage within or without Clinical Standardized Pathway / 中国康复理论与实践

@#ObjectiveTo compare the prognosis of patiens with acute(within 72 hours) subarachnoid hemorrhage (SAH) within or without the clinical standardized pathway(CSP).Methods123 acute SAH cases were collected before CSP established meanwhile another 146 cases after CSP established from 2005 to 2009 in neurological intensive care unit of our hospital. Information such as age, gender, Hunt-Hess and CT-Fisher grade, timing and result of digital subtraction arteriography, treating time of aneurysm, and Modified Rankin Scale(MRS) at different time were recorded. Rehaemorrhagia, complications, mortality, prognosis and average stay were compared between two groups.ResultsThere was a significant difference between two groups in rehaemorrhagia, vasospasm，hydrocephaly, mortality, prognosis and average stay.ConclusionCSP is helpful to improve the prognosis of aneurysm subarachnoid hemorrhage.

Clinical analysis of 53 cases of cerebral venous sinus thrombosis / 中国综合临床

Objective To analyze the clinical characteristics of cerebral venous sinus thrombosis(CVST)and evaluate the diagnosis and treatment.Methods All the medical records,including age,mode of onset,clinical manifestations,findings of neuro-imaging and prognosis were analyzed.retrospectively in 53 cases with CVST from August 2003 to May 2008 in Beijing Tian Hospital.Results Of the 53 cases(22 men,31 women),aged from 15 to 52(mean 34.92±9.69)years.Acute or sub-acme onset accounted mostly.The principal clinical characteristics were headache and vomit,weak sight,diplopia,focal deficit,conscious disturbance and seizures.The neuro-imaging findings of CVST were venous sinus occlusion and local infarction,sometimes accompanied by capillary hemorrhage or haematoma.The major treatment involve dehydration,anticoagulation,and thrombolysis or stent implanted.After the treatment,12 cases recovered completely,37 improved,2 invalided,and 2 cases discharged for herniation of brain.Conclusion Improvement in awareness of CVST and prompt MRI in combination with MRV examination is the key to accurate diagnosis and timely therapy.The treatment of CVST should be based on anticoagulatin,and acompanyed.by thrombolysis or stent implanted in cerebral venous sinus on the baisis of effect.

The relationship between metabolism of dopamine transporter and levodopa-responsiveness in Parkinon's disease patients of Hohen-Yahr Ⅱ / 中国综合临床

Objective To investigate the relationship between metabolism of dopamine transporter and levodopa-responsiveness in patients with Parkinson's disease(PD).Methods Thirteen patients with PD of Hohen-Yahr stage Ⅱ were enrolled in this study.The acute consecutive levedopa/benserazide (50.0/12.5 mg,100.0/25.0 mg,150.0/37.5 mg)tests were used to assess the patients' motor responses.The dopamine transporter binding were assessed with 11C-CFT PET specific in putamen,eaudate nucleus and occipital cortex.The correlation between the improvement of UPDRS Ⅲ and 11C-CFT PET the uptaking capability was analyzed.Results The marked reduction of 11 C-CFT uptake was observed in posterior putamen in patients with PD.The reduction of tracers uptake in posterior putamen contralateral to onset side was more significant than the posterior putamen ipsilateral to onset side (P＜0.01 ).There was significant correlation between 11C-CFF uptake in posterior putamen contralateral to onset side and the improvement of UPDRS motor subscale in test with levedopa/benserazide 100.0/25.0 mg or 150.0/37.5 mg(r=0.513,r=0.572,P＜0.01 ).There was also significant correlation between 11C-CFT uptake in posterior putamen ipsilateral to onset side and the improvement of UPDRS motor subscale in test with levedopa/benserazide 100.0/25.0 mg or 150.0/37.5 mg (r=0.452,r=0.478,P＜0.01 ).There was no correlation between 11C-CFT uptake in basal ganglia and the improvement of UPDTRS motor subscale in test with levedopa/benserazide 100/25mg or 150/37.5 mg(P＞0.05 ).Conclusion There is correlation between metabolism of dopamine transporter and levedopa responsiveness in PD patients of Hoben-Yahr Ⅱ ,which is helpful for the investigation of the pathophysiology.

Comparison of cerebral glucose metabolism between Alzheimer's disease and dementia with lewy bodies / 中国综合临床

Objective To investigate the feature of cerebral glucose metabolism of Alzheimer's disease (AD)and dementia with lewy bodies (DLB).Methods 28 patients with AD and 25 patients with DLB underwent positron emission tomography (PET)with 18 F-fluorodeoxyglucose (18F-FDG)showing glucose metabolism.The region of interest (ROI)was selected from frontal cortex,temporal cortex,parietal cortex,occipital cortex,cerebellum cortex and corpora striata.The 18 F-FDG metabolism ratios between various cerebral regions and cerebellum cortex were compared as an indicator of regional cerebral glucose metabolic patterns.Results The FDG metabolism ratio of parietal cortex and temporal cortex decreased similarly in AD.The FDG metabolism ratio of frontal cortex,parietal cortex,temporal cortex,occipital cortex,dorsal caudate putamen and caudate nucleus in AD was [(0.861 ± 0.173),(0.625 ± 0.149),(0.598 ± 0.185 ),(0.914 ± 0.214),( 1.030 ± 0.084)and ( 0.997 ± 0.102 )].The FDG metabolism ratio of frontal cortex,parietal cortex,occipital cortex,temporal cortex and corpus striatum decreased similarly in DLB.The FDG metabolism ratio of frontal cortex,parietal cortex,temporal cortex,occipital cortex,dorsal caudate putamen and candate nucleus in DLB was [ (0.538 ±0.147),(0.615 ±0.138),( 0.587 ±0.142),(0.415 ±0.107 ),(0.685 ± 0.094)and (0.547 ± 0.103 )].The FDG metabolism ratio of frontal cortex,occipital cortex and corpus striatum decreased more significantly in DLB than in AD (P＜0.01 ).Conclusion There are discrepancies in cerebral glucose metabolism between AD and DLB.These features may be useful in differential diagnosis of these two kinds of dementia.

Expression and significance of ERβ and surviving in thyroid tumors / 肿瘤研究与临床

Objective To investigate the expression and clinical significance of the estrogen receptor beta isoforms and survivin in thyroid tumors. Methods The pathological data of 125 patients with thyroid tumors were, collected from june 2003 to june 2007 in our institution, including thyroid carcinoma (86 cases), thyroid follicular adenoma (39 cases) and normal thyroid tissue (10cases). SP immunohistochemistry was used to measure the expressions of ERβ and survivin in the thyroid tumors. Results ERβ not only was detected in the thyroid epithelial cell plasma and nuclear, but also in the stroma. The positive rate of ERβ in cases with thyroid carcinoma, adenoma and normal thyroid tissue were 83.72 %, 51.28 % and 20.00 % respectively. There was significant difference between carcinoma and the adenoma or normal thyroid tissue (P<0.05). The positive rate of survivin in cases with carcinoma, adenoma and normal thyroid tissue were 59.30 %, 17.95 % and 0 respectively. There was significant difference between carcinoma and the adenoma or normal thyroid tissue (P<0.05). The expressions of ERβ and survivin correlated with TNM staging and lymph node metastasis of thyroid carcinoma (P<0.05). Conclusion ERβ may play a role in accelerating proliferation in the occurrence of the thyroid carcinoma. The expressions of ERβ and survivin are related to invasion and metastasis of thyroid carcinoma.

Etiology of Headache after Aneurismal Subarachnoid Hemorrhage / 中国康复理论与实践

@# Objective To explore the etiology of headache after aneurismal subarachnoid hemorrhage (SAH) and find clinical features of various kinds of headache.Methods All of the 107 patients with SAH and intracranial aneurysm diagnosed upon CT scan and angiographic demonstration within 24 hours after onset were evaluated by numeric rating scales (NRS) 1,2,3,5,7,10 and 14 days after SAH. Patients suffered from moderate-severe headache were examined by cranial CT scan and transcranial Doppler (TCD) to find the reason, and their diversities were analyzed.Results 86.9% (93/107) patients with SAH suffered from moderate-severe headache. 9.7% (9/93) of them were caused by rebleeding of untreated aneurysm and the pain always occurred abruptly, always followed by conscious disturbance/new neurological signs. CT scan found hydrocephalus in 16.1% (15/93) patients with headache, they could aggravated with time but sometimes released spontaneously; TCD found intracranial vasospasm in 12.9% (12/93) of patients, their clinical features were no more than other 61.3% (57/93) patients with negative results, but patient's condition could exacerbate caused by later brain ischemia or even infarction.Conclusion Majority of SAH patients suffer from headache.

Functional Localization of Human Swallowing Motor Cortex / 国际脑血管病杂志

The localization of human swallowing cortical area remains unclear,which prevents the understanding of pathophysiologic change of peripheral swallowing apparatus and the development of swallowing rehabilitation.Animal experiments have found that the non-human primates, premotor cortex,sensorimotor area,frontal,parietal and temple operculum,orbitofrontal cortex and cingulate cortex are associated with swallowing function.Recently,by using the advanced techniques such as functional MRI,position emission tomography and magnetoencephalography,it was found that a number of encephalic regions participated in the human swallowing,mostly concentrated in primary sensorimotor cortex,premotor cortex,cingule,insular lobe,and parietal-occipital area.However,the exact functions and roles of various encephalic regions and their correlations between various encephalic regions remain unclear.Further studies are needed to identify them.

Linguistic analysis of primary progressive aphasia / 中国组织工程研究

BACKGROUND: Primary progressive aphasia is a degenerative disease of nervous system clinically characterized by the progressive decrease of speech ability and the relatively reserved memory. OBJECTIVE: To investigate the characteristics of speech dysfunction and the clinical features of primary progressive aphasia we by reported onel patient with primary progressive aphasia. DESIGN: A case analysis. SETTING: Department of Neurology, Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences. PARTICIPANT: One male patient of 56 years old with primary progressive aphasia was selected from the Department of Neurology, Beijing Tiantan Hospital in March 2004, he had got education in senior middle school. The patient had been unable to tell the names of daily living objects at the beginning of 2001. Not only his ability of listening comprehension had gradually declined, but his characters had gradually changed except that his memory had not been affected obviously since 2003. Although he was able in self-care now, he could not normally work. METHODS: ① The spoken fluent types of the patient were evaluated with the standards for the fluency of spoken language in Aphasia battery of Chinese. Western battery aphasia was used to assess the type of aphasia of the patient. Boston diagnostic aphasia examination severity grading standard was applied to grade the severity of aphasia. ② The cognitive psychological tests of visual character-figure matching, denomination for figures and oral reading were used to judge whether the patient had verb-noun dissociation. ③The memory of the patient was assessed with clinical memory scale. MAIN OUTCOME MEASURES: ① spoken fluency, the type and grade of aphasia; ② condition of verb-noun dissociation for the patient; ③ memory of the patient. RESULTS: ① Examination of aphasia: The patient presented the spontaneous talking that named the fluent type, there were wrong meanings in his talks so that he was diagnosed as sensory aphasia. The severity of aphasia was separated into grade 3 levels. ② Cognitive psychological test: The correct rates of verbs and nouns in the test of denomination for figures were 15% and 53% respectively, and there was obvious difference (t=0.231, P ＜ 0.05). ③ Clinical memory scale: The memory quotient was 111,and the clinical memory grade was higher than normal. CONCLUSION: The most outstanding clinical characteristics of patients with primary progressive aphasia is speech dysfunction, and there is verb specific injury.

Effects of transcranial magnetic stimulation on motor function after acute cerebral infarction / 中国康复理论与实践

@#ObjectiveTo investigate the effects of transcranial magnetic stimulation(TMS)on motor function after acute cerebral infarction.Methods60 patients who suffered acute cerebral infarction were assigned to experiment group and control group(30 cases each group). Both groups received rehabilitation theropy. Meanwhile,experiment group received TMS. Fugl-Meyer Assessment(FMA), National Institute of Health Scale of Stroke(NIHSS), Barthel Index(BI) were used to measure the outcome.ResultsThe scores of FMA and BI increased significantly(P<0.05) while that of NIHSS decreased significantly(P<0.05) in both groups after treatment. However, these scores in experiment group improved more compared with those of control group(P<0.05).ConclusionTMS is helpful to improve the motor function, ability of daily living and neurological function.

Observation of Pattern Changes of Syndrome in TCM of 258 Cases of Acute Stroke and Therapeutic Effect Evaluation of Small Compound Prescriptions in Stroke Unit with Treatment Based on Syndrome Differentiation / 中华中医药杂志

Objective: To investigate into the etiological factor,distribution of syndrome(patterns),pathogenesis features as well as the curative effects of small compound prescriptions of(Traditional) Chinese Medicine(TCM) in the treatment of acute stroke in stroke unit.Methods:(Cases) corresponding to diagnosis standards were randomly divided into control group(102 cases) and treatment group(156 cases).Conventional treatment methods were given to cases in control group.On the base of control group,small compound prescriptions were added to in treatment group,successively 14-21 days.The relation between types and time and TCM scale(TCMS),the NIH stroke scale(NIHSS) and Barthel index(BI) were observed in the two groups.Results: Stroke was age-related,the older,the more stroke patients.Stroke was closely related to hypertension.Ascending hyperactivity of liver yang was main type in the previous three days,this type(decreased) with the time going on.On the contrary,the type of wind phlegm and blood stasis was secondly main type in the previous three days,it increased with the time going on.Types of ascending hyperactivity of liver yang,wind phlegm and blood stasis as well as phlegm heat and constipation covered 95 per cent of all patients in the previous 21days.In the two groups,the mean scale of TCM and NIH decreased,and BI increased after treatment,this statistical difference could also be seen between the two groups.Conclusion: Excessive types are main types in the acute stage of stroke.Types of ascending hyperactivity of liver yang,wind phlegm and blood stasis as well as phlegm heat and constipation are its main types.Transferring of ascending hyperactivity of liver yang into endogenous wind may be trigger of reaction link of wind,fire,phlegm and blood stasis in TCM theory.Small compound prescriptions of TCM aiming to clearing away liver fire to stop wind,to activate blood for removing blood stasis and phlegm,to removing phlegm and heat from discharge can reduce scale of TCM and NIH,increase BI in the treatment of patients in stroke unit,which provide beneficial proofs for evaluation of effects of TCM.

Brain edema and nervous system injury due to cerebral hemorrhage / 中国组织工程研究

OBJECTIVE: Functional deterioration of the nerves following cerebral hemorrhage is associated with cerebral hemorrhage-induced brain edema and involves multiple pathways of nerve injuries, now recognized as a complex pathophysiological process involving the interactions between multiple factors. Elucidation of the mechanisms of nervous system injury after cerebral hemorrhage may provide theoretical basis for implementing effective rehabilitative interventions for cerebral hemorrhage.DATA SOURCES: A computer-based search in the Medline database for related articles published between January 1991 and December 2003 was conducted using the combinations of the searching words of "emorrhagic stroke, cerebral hemorrhage, brain edema, and nervous system injury", with the language of the articles limited to English. A search in Wanfang database was also conducted using the key words of "cerebral hemorrhage, brain edema, nervous system injury" (in Chinese) for related Chinese articles published between January 2004 and January 2005.STUDY SELECTION: Total 85 original articles were selected after elimination of the irrelevant ones. Inclusion criteria: reports of animal experiments and clinical trials on cerebral hemorrhage following brain edema and mechanisms of nervous system injury were selected, particularly those focusing on brain edema after cerebral hemorrhage.DATA EXTRACTION: Of the 85 articles, 22 were found closely related to the subject concerned and 18 were indirectly relevant. Nine were excluded for duplicated reports, so that 31 articles were finally selected for analysis.DATA SYNTHESIS: Analysis of the literature suggested that secondary edema around the hematoma and nervous system injury were important indicators for poor prognosis of patients with cerebral hemorrhage. Multiple factors participated in the process of secondary brain edema and nerve injuries,such as the hydrostatic pressure during formation of the hematoma and clot retraction, activation of blood coagulation cascade, generation of thrombin,erythrocytolysis and the toxicity of hemoglobin, the activation of the complement system, space-occupying effects, rupture of the blood-brain barrier,secondary ischemia around the hematoma, inflammatory reaction of the neurons around hematoma and cell apoptosis.CONCLUSION: Effective protective interventions for brain edema after cerebral hemorrhage and complex pathophysiological changes may attenuate nervous system injuries following cerebral hemorrhage and improve the prognosis of functional recovery.