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Objective Toinvestigatethechangesofcognitiveimpairmentandcerebralhemodynamics inpatientswithacutelacunarcerebralinfarctionwithin2weeksafteronset.Methods Nineteenpatients with lacunar cerebral infarction (a patient group)were consecutive enrolled in the study. Twenty-three sex-and age-matched inpatients without ischemic cerebrovascular disease or healthy volunteers of outpatient department over the same period were used as a control group. The cerebral hemodynamic features were evaluated with transcranial Doppler (TCD)breath-holding test and single photon emission computed tomography (SPECT)resting + adenosine stress imaging. Simultaneously,the neuropsychological tests were performed,the Montreal cognitive assessment (MoCA)was performed including executive capacity, structural capacity,memory (including auditory memory,visual memory,and logic memory ),information processing speed,and visual-spatial ability. Results (1 )There were no significant differences in the years of education,hypertension,diabetes,hyperlipidemia,coronary heart disease,and smoking between the 2 groups (all P>0. 05). Compared with the control group,there were significant differences in the MoCA score,visual memory,executive function,structural capacity,and information processing speed of the patient group (all P<0. 05). (2)19 patients completed the SPECT resting + load test (12 in the control group and 7 in the patient group). There were significant differences in the uptake ratio (UR)in the right basal ganglia (8. 91[-2. 48 - 5. 87]and -6. 21 [-10. 39 - 5. 42 respectively])and left frontal lobe UR (11. 62 [2. 93-16. 87]and 1. 04 [-10. 17- 3. 82]respectively)between the patient group and the control group (P<0. 05). (3)26 patients completed the breath-holding test + head-up tilt table test (n=13 in each group]. The vascular motor reactivities were 13 ± 5 on the left and 21 ± 7 on the right, and the breath-holding indexes were 0. 66 ± 0. 26 on the left and 1. 0 ± 0. 4 on the right in the patient group;the vascular motor reactivities were 24 ± 11 on the left and 30 ± 9 on the right,and the breath-holding indexes were 1. 21 ± 0. 57 on the left and 1. 5 ± 0. 4 on the right in the control group. There were significant differencesbetweenthe2groups(P<0.05).Conclusion Attheearlystageoflacunarinfarction,the patients have presented varying degrees of cognitive impairment and the changes of cerebral hemodynamics.
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Objective Toinvestigatetherelationbetweenserumneuron-specificenolase(NSE), bilirubinandcerebraldysfunction,prognosisafterlarge-arteryatheroscleroticstroke.Methods According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST)criteria,all the 73 patients with large artery atherosclerotic stroke were divided into the test group (41 cases ) and control group (32 cases ) according to the elevated or normal levels of serum NSE and total bilirubin. At the first day of their hospitalization,the National Institutes of Health Stroke Scale (NIHSS)score was conducted,their serum NSE,bilirubin (total bilirubin,direct bilirubin,indirect bilirubin)levels were detected,and were compared with the reevaluation of 7 and 14 days of their hospitalization and reexamination results. The modified Rankin Scale (mRS)was use to assess the recovery of their neurological function at day 30 after onset/admission. The prognosis of the patients was followed up at 1 year after onset/admission. The Kaplan-Meier product-limit method was used to conduct the analysis of the good outcome rate,and the good outcomes of both groups/interlayers (different bilirubin and NSE levels)were tested with Log-rank test. Results (1)The NIHSS scores,the levels of serum bilirubin and NSE at day 1,7,and 14 in the test group were significantly higher than those of a control group (all P<0. 01). The levels of serum bilirubin and NSE at day 7 and 14 were lower than those at day 1. (2)The mRS score at day 30 between the test group and the control group was singnificantly different (Z =3. 286,P =0. 001). (3)At day 1,the CT detection rate of large area cerebral infarction of the test group was significantly higher than that of the control group (56. 1%[n=23]vs. 28. 1%[n=9]). There was significant difference (χ2 =5. 712,P=0. 017). (4)The analysis result of Kaplan-Meier showed that there was no significant difference in its good outcome no matter grouped by the test or by serum NSE level stratification of the patients on admission (the accurateχ2valueswere4.063and4.685respectively,P=0.044and0.030respectively).Conclusion Early high-level serum NSE and hyperbilirubinemia can be used as the indexes of early identification of poor prognosis in patients with large-artery atherosclerotic stroke.
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ObjectiveToinvestigatethecorrelationofobstructivesleepapnea(OSAS)andsilentbrain infarction (SBI) in elderly population. Methods A total of 1658 old subjects aged 60 in Beijing and Qingdao w ere screened. Polysomnography (PSG) w as used to conduct the diagnosis and grade of OSAS. MRI w as used to diagnose SBI. Results In al elderly subjects, the prevalences of OSAS and SBI w ere 32.1% and 22.4%. There w ere significant differences in the constituent ratio of the patients w ith hypertension and diabetes, as w el as apnea-hypopnea index (AHI), oxygen desaturation index (ODI), mean oxygen saturation and the low est oxygen saturation betw een the patients w ith OSAS of different severity and the control group. With the increased severity of OSAS, the incidence of SBI increased significantly. The incidences of patients w ith non-OSAS and mild, moderate and severe patients w ith OSAS w ere 13.2%, 30.5%, 43.5%, and 68.8%, respectively. There w as a significant difference betw een the 2 groups ( χ2 =13.365, P=0.004). Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 2.254, 95%confidence interval [CI] 1.325 to 8.347;P=0.002), diabetes melitus (OR 1.893, 95%CI1.471-8.432;P=0.003) and AHI ≥15 times/h (OR 3.106, 95%CI 1.583-12.571; P<0.001) were the independent risk factors for SBI in elderly population. Conclusions The incidence of OSAS w as higher in the elderly population aged over 60. The incidence of SBI in patients w ith OSAS w as significantly higher than that in patients w ith non-OSAS, and w ith the aggravation of OSAS, it show ed an increasing trend. Moderate to severe OSAS w as an independent risk factor for SBI in elderly population.
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Objective Tofollowupandanalyzetheoccurrenceofcerebrovascularischemiceventsin patientswithinternalcarotidarteryocclusion(ICAO).Methods Atotalof144consecutivepatients with ICAO admitted to the Department of Neurology,the Air Force General Hospital from January 2007 to January 2012 were enrolled retrospectively. All patients were confirmed as unilateral ICAO with DSA and they were divided into either a symptomatic group (n=74)or an asymptomatic group (n=70)according to whether they had the symptoms of ischemic cerebrovascular disease or not. Both patients of the 2 groups were followed up for at least 2 years. Their transient ischemic attack (TIA)and endpoint events were observed,including new symptomatic cerebral infarction,death from any cause,as well as patency of collateral circulation,andthefollow-upresultsbetweenthetwogroupswerecompared.Results Twenty-one patients (28. 4%)of the symptomatic group had new attack of cerebral infarction,10 cases (13. 5%)had TIA,and 4 cases (5. 4%)died;9 patients (12.9%)of the asymptomatic group had new attack of cerebral infarction,4 cases (5 . 7%)had TIA,and no patients died. Risk of recurrent stroke in patients of the symptomatic group was higher than that of the asymptomatic group (P=0. 025). Kaplan-Meier curves showed that the incidence of endpoint event of the symptomatic group was higher than that of the asymptomatic group (χ2 =8. 428,P =0. 004). There was significant difference in the patent ratio of the primary collateral circulation between the symptomatic group and the asymptomatic group (64. 9%[48/74] vs. 91. 4%[64/70];P=0. 000);the patent ratio of the primary collateral circulation in patients with new cerebral infarction was significantly lower than that in patients without new cerebral infarction (60. 0%[18/30]vs.82.5%[94/114];P=0.013).Conclusion ThepatientswithsymptomaticICAOaremore likely to have cerebral infarction,and they are likely to die. After ICAO,the primary collateral circulation patent has a significant effect on the prognosis.
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Objective Toinvestigatetherelationshipbetweendifferenttypesofinternalwatershed infarctionandtandemstenosesofinternalcarotidartery(ICA).Methods Atotalof55patientswith internal watershed infarction confirmed by head MRI and diffusion-weighted imaging (DWI )examination were enrolled. They all underwent the extracranial internal carotid artery (ICA ) ultrasonography and intracranial cerebral artery MR angiography (MRA)examinations. According to the findings of imaging,the 55 patients with internal watershed infarction were divided into a simple internal watershed infarction (IWSI)group and an internal watershed infarction accompanied with ipsilateral cortical watershed infarction (C-IWSI)group. The relationship between the two types of internal watershed infarction and tandem stenoses of ICA was analyzed. Results (1 ) Of the 55 patients with internal watershed infarction,24 cases (43. 6%)were in the internal watershed infarction group and 31 cases (56. 4%)were in the C-IWSI group. The ipsilateral vascular stenosis were ICA 20 cases (36. 4%,including extracranial segment 11 cases and intracranial segment 17 cases),middle cerebral artery (MCA)44 cases (80. 0%), and tandem stenoses of ICA 15 cases (27. 3%). (2)Ipsilateral tandem stenoses of ICA:2 cases were in the IWSI group (intracranial ICA+MCA 2 cases);13 cases were in the C-IWSI group (extracranial ICA+intracranial ICA +MCA 4 cases,extracranial ICA + intracranial ICA 1 case,extracranial ICA + MCA 2 cases,and intracranial ICA+MCA 6 cases). (3)Compared with the IWSI group,the incidences of ipsilateral ICA stenosis and tandem stenoses of ICA in patients of the C-IWSI group were higher (54. 8%[n=17]vs. 12. 5%[n=3],41. 9%[n=13]vs. 8. 3%[n =2]),and there were significant differences(P =0. 001, 0.006]). The incidences of extracranial and intercranial ICA stenosis were higher than those of the IWSI group (35. 5%[n=11]vs. 0,45. 2%[n=14]vs. 12. 5%[n=3]),and there were significant differences (P=0.003,0.009).Conclusion Inthedifferenttypesofinternalwatershedinfarction,theincidenceof tandem stenoses of ICA is different. The IWSI patients with ipsilateral cortical watershed infarction often accompany by tandem stenoses of ICA.
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Objective Toinvestigatetheeffectoffolicacidonplasmahomocysteine(Hcy)levels and vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia. Methods Thisstudywasaprospectivecontrolledtrial.Atotalof112elderlylacunarinfarction patients with high hyperhomocysteinemia admitted to the Department of Neurology,Nanjing Municipal Government Hospital from November 2012 to October 2013 were enrolled. The patients were divided into two groups according to the method of random number table. The patients of both groups received the conventional drug treatment of ischemic stroke at the same time. Fifty-six patients were in group A,and they were treated with folic acid 20 mg,once a day;56 patients were in group B,and they did not treat with folic acid. The Hcy levels on admission and after 24 weeks treatment were measured. Brachial artery flow-mediated endothelium-dependent dilation (FMD)was measured by high resolution ultrasound,and nitric oxide (NO), nitricoxidesynthase(NOS),andendothelin(ET)weredetectedatthesametime.Results Twenty-four weeks after treatment,the plasma Hcy level in group A was significantly decreased as compared with prior treatment (12. 2 ± 4. 2 vs. 22. 6 ± 3. 7μmol/L;P<0. 05),moreover,it was lower than the level of group B at the same period (12. 2 ± 4. 2 vs. 21. 8 ± 4. 0μmol/L;P <0. 05 ). The FMD level of group A was significantly higher than that of prior treatment and group B (11. 2 ± 3. 6 vs. 9. 2 ± 3. 3,9. 3 ± 3. 3;P<0. 05). The NO and NOS levels of group A at 24 weeks after treatment were significantly higher than those of prior treatment and group B at the same period (76. 2 ± 9. 4 vs. 49. 2 ± 9. 0,50. 0 ± 9. 1μmol/L,47. 6 ± 9. 5 vs.38. 4 ± 7. 5,37. 8 ± 8. 8 kU/L;P<0.05). The ET level of group A was decreased as compared with that of prior treatment and group B at the same period (81. 3 ± 20. 5 vs. 105. 6 ± 25. 2,105. 3 ± 21. 8 ng/L;P<0.05).NoadversereactionwasfoundduringthetreatmentingroupA.Conclusion Alargerdoseof folic acid can significantly reduce the plasma Hcy level,decrease the FMD level,and ameliorate vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia.
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Objective Toinvestigatethecorrelationsofthelevelsofplasmasolublereceptorfor advanced glycation end product (sRAGE )with the National Institutes of Health Stroke Scale (NIHSS ), grade of white matter lesions,and risk factors for cerebral vascular disease in patients with acute cerebral infarction.Methods Atotalof120patientswithacutecerebralinfarctionwereenrolledretrospectively. They all underwent head MRI. The plasma sRAGE levels of the acute cerebral infarction group and 120 healthy subjects were detected with enzyme-linked immunosorbent assay (ELISA)and were compared. According to the interquartile range (P25 =540 ng/L,P50 =1030 ng/L,P75 =1400 ng/L ),the plasma sRAGE levels were divided into 4 quartiles (Q1 to Q4). Q1:sRAGE1400 ng/L (n =30 ). The plasma sRAGE levels in the acute cerebral infarction group and the healthy control group were compared using the Wilcoxon rank sum test. Multiple linear regression analysis was used to analyze the correlations of the sRAGE levels with NIHSS scores,grade of cerebral white matter lesions,and cerebrovascular risk factors. Results (1 )The median level of plasma sRAGE was 870 (540.0,1403. 8)ng/L in the acute cerebral infarction group,which was lower than 1032 (727. 5,1721. 5) ng/L in the healthy control group. There was significant difference (P<0. 05). (2)Single factor analysis showed that the smoking rate,NIHSS scores,the types of deep white matter hyperintensity (DWMH),and the estimated glomerular filtration rate(eGFR)among Q1,Q2,Q3 and Q4 quartiles were significant different (all P<0.05). The smoking rate,ratio of patients with high NIHSS score,incidence of severe DWMH and percentage of the patients with normal eGFR in Q1 (n=29)were 62. 1%(n=18), 44. 8%(n=13),55.2%(n=16)and 51. 7%(n=15),respectively,and they had a higher trend than other quartiles. (3)Multiple linear regression analysis showed that the smoking,NIHSS score,eGFR,and severity of DWMH were the influence factors of the levels of plasma sRAGE in patients with acute cerebral infarction.Thereweresignificantdifferences(allP<0.05).Conclusion Theexpressionlevelsofthe plasma sRAGE in patients with acute cerebral infarction group is significantly lower than those in the healthy subjects,and smoking,neurological defect,eGFR,and severity of DWMH are associated the low level of sRAGE. sRAGE may be used as a reference index for predicting the conditions of acute cerebral infarction.
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Objective To explore the effects of leukoaraiosis on cognitive function in elderly patients after acute cerebral infarction.Methods From May 2010 to August 2011,a total of 147 elderly patients with acute cerebral infarction were enrolled,including 96 patients with leukoaraiosis and 51 patients without leukoaraiosis.The Montreal Cognitive Assessment (MOCA) and the correlative factors of cognitive function were assessed in all patients.Results There was no statistical difference in general information between patients with and without leukoaraiosis.There were significant differences in the MoCA scores between patients with and without leukoaraiosis (x2 =19.15,P＜0.01),as well as between the vital and non-vital positions of cerebral infarction (x2=21.41,P＜0.01).The Logistic regression analysis showed that the vital position of infarction and leukoaraiosis were related to the cognitive impairment (OR=12.27,6.60,both P＜0.01),while the area of infarction and the type of cerebral infarction in Oxford County Community Stroke Project (OCSP) had no effects on cognitive impairment.Pearson correlation analysis showed that there was a positive relationship between the degree of white matter lesions and the decline in cognitive function (r=-0.87,P＜0.01).Conclusions The position of acute cerebral infarction and leukoaraiosis are independent risk factors for cognitive function after acute cerebral infarction,and the former plays a more important role than does the latter.
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Bone marrow stromal cells are a class of multipotent stem cells.They have self-renewal and multilineage differentiation potential and provide a basis for cell and gene therapy in a variety of diseases.Many experimental studies shown that bone marrow stromal cell transplantation has a significant therapeutic effect for cerebral infarction.This article reviews the method and effect of bone marrow stromal cells in treatment of cerebral infarction in recent years.