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Ischemic stroke in young adults has attracted more and more attention due to the diversity of its etiology. Although atherosclerosis is the most common cause of stroke in young adults, other or unknown causes are not uncommon . To improve clinicians′ understanding of the etiological diagnosis of stroke in young adults, this article reports a case of ischemic stroke in the First Affiliated Hospital of Jinan University. The patient was a 22-year-old male with acute onset who was diagnosed with acute ischemic stroke based on clinical presentation, physical examination, and magnetic resonance imaging of the brain. After actively searching for the cause, laboratory and genetic tests revealed that the patient had inherited thrombophilia (protein C and protein S deficiency), and cardiac magnetic resonance imaging examination found that the patient had noncompaction of the ventricular myocardium.
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Uric acid is an end product of purine metabolism. A large number of clinical studies have shown that high-level serum uric acid is a good predictor of outcome in patients with acute ischemic stroke. Oxidative stress is the main mechanism of cerebral ischemia-reperfusion injury. As a potent antioxidant, uric acid is considered to have a potential neuroprotective effect in the vascular recanalization treatment, but its specific mechanism remains unclear. This article reviews the neuroprotective mechanism of uric acid in cerebral ischemia-reperfusion injury in order to provide ideas for future research and clinical practice.
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Post-stroke depression (PSD) is a common non-somatic disorder in stroke patients,and the pathogenesis has not been clarified.The PSD can reduce the quality of life and social function for the stroke patients,and shorten the life span of stroke patients.With the development of imaging technology,the new MR imaging techniques and the computeraided whole brain MRI image analyses have been widely used to study the structure,function and metabolic changes of the brain recently.These new techniques and methods can help the scholars to explore the risk factors and related mechanisms of PSD from various perspectives,which is of great significance to understand the PSD.The applications of MRI in PSD were reviewed in this article.
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Objective To analyze the clinical effects of thrombolytic therapy in patients with ischemic in-hos-pital stroke (IHS). Methods The clinical data were collected from patients with ischemic IHS in the last five years. The patients were divided into thrombolysis group and non-thrombolysis group, according to the use of recombinant tissue plasminogen activator (r-tPA) treatment. The clinical outcomes were measured by the modified Rankin scale (mRS) at discharge. Results There were a total of 121 patients in this study. There were 6 patients in thrombolysis group and 115 patients in the non-thrombolysis group, respectively. Six patients (100%) in the thrombolysis group achieved favor-able outcomes (mRS 0~2) at discharge whereas only 42 patients (36.5%) in the non-thrombolysis group achieved fa-vourable outcomes. The rate of favorable outcomes was significantly higher in the thrombolysis group than in the non-thrombolysis group (P<0.05). Conclusions R-tPA thrombolytic therapy can improve the prognosis of patients with ischemic IHS.
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After ischemic stroke, secondary damages such as neuron loss, gliosis, and axonal degeneration occur in the nonischemic remote brain regions that have synaptic connections with the primary infarction site.These secondary damages in the remote brain regions may affect the recovery of neurological function.Several advanced neuroimaging techniques have been used to detect these secondary damages.This article reviews the research progress in this field.
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Clopidogrel is an essential drug for the treatment of ischemic stroke.It has been recommended by the multinational stroke treatment guidelines and has been widely used in clinical practice.Many patients with ischemic stroke may still have stroke recurrence after the standard treatment of clopidogrel; therefore,we must pay attention to the phenomenon of clopidogrel resistance.This article reviews the biochemical mechanisms,gene polymorphism,laboratory testing,and response measures of clopidogrel resistance.
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The manifestation of clinical symptoms of cerebral small-vessel disease (SVD) is cognitive disorders. Its pathological changes are manifested as leukoaraiosis and/or lacunar infarction. However, it is not clear whether cognitive disorders caused by SVD is correlated with the severity of white matter damage. Magnetic resonance spectroscopy analysis can noninvasively detect metabolite concentrations of brain tissue in vivo and directly reflect cerebral metabolism; Diffusion-tensor imaging is a novel noninvasive technique for specific observation of white matter through different parameters such as mean diffusivity and anisotropy for quantitative evaluation of the abnormalities of fine structure of white matter. The combination of magnetic resonance spectroscopy analysis and diffusion-tensor imaging may more sensitively reveal the severity of white matter damage, and provide a research tool for cognitive disorders caused by SVD.resonance imaging
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Objective To explore statin dosages for targeting goal of LDL-C lowering on the basis of stroke risk stratification and the dosage-effective relation of statin and LDL-C lowering in Chinese patients with ischemic stroke and transient ischemic attack (TIA).Methods This is a prospective and open clinical trial patients with ischemic stroke/TIA within 6 months were enrolled and the dosages of atorvastatin were calculated based on risk stratification according to "Chinese Consensus for Prevention of Ischemic Stroke/TIA with Statin" (Chinese Consensus).A dose of 10 mg of atorvastatin daily to target LDL-C goal was takenas the standard dosage targeting goal (SDTG).Patients taking this dosage of atorvastatin constituted a SDTG group.Those who needed a daily dose of 20 mg or more of atorvastatin were randomized into an intensive dosage targeting goal (IDTG) group ( atorvastatin 20-80 mg/d) and a standard dosage non-targeting goal (SDNTG) group (atorvastatin 10 mg/d without targeting goal).All patients took atorvastatin for 12 weeks.The primary outcome was the rate of targeting goal for LDL-C lowering at 2,4 and 12 weeks,respectively and the secondary outcome was the occurence of recurrent stroke and other vascular events within 12 weeks.The main safety endpoint was serial adverse events including symptomatic intracranial hemorrhage.Results Altogether 102 cases were enrolled and 99 cases were followed up for 12 weeks.According to the Chinese Consensus,the rate of high risk,very high risk- Ⅰ and very high risk- Ⅱ was 44% ,28% and 28%,respectively.Targeting rate for LDL-C lowering was 77% -85% at each time point in the SDTG and IDTG groups ,being significantly higher than those in the SDNTG group ( 12% -16%,P < 0.01 ).No significant difference was found concerning the occurrence of recurrent stroke,other vascular events and safety endpoints among the three groups.The amplitude of LDL-C lowering was 32%-35% ,46%-49% ,51%-52% and 60%-65% with corresponding to daily dosage of 10 mg,20 mg,d0 mg and 80 mg atorvastatin.Conclusions At least more than half of the patients after iscbemic stroke/TIA need intensive statin therapy to target the LDL-C lowering goal.The dosage- effective relation of atorvastatin and LDL-C lowering in Chinese is similar to the reported data in other races.
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Anticoagulation, which has been used in clinical practice since 1940's, is one of the important measures in the prevention and treatment of cerebrovascular diseases. This article reviews the progress in anticoagulation for ischemic cerebrovascular diseases by introducing a series of large, important, international, randomized controlled clinical trials in the past 20 years (particularly in the recent 10 years).
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BACKGROUND: Endothelin(ET) -1 is a peptide with potent actions on blood vessels and nerve system. Its expression increases in the central nervous system(CNS) in a variety of pathological conditions, inducing harmful effects on the nervous tissue. However it is not clearly elucidated whether the over-expressed ET-1 can directly induce neuronal apoptosis.OBJECTIVE: To investigate whether ET-1 can directly induce apoptosis in primarily cultured brain neurons of rat, and which ET receptor subtype(s) is involved in this action.DESIGN: Completely randomized and controlled experimental study based on cells.SETTING: Neurological department in a university hospital, pathological department of a university and laboratory center of tissue transplantation and immunology, life science and technology college.MATERIALS: This study was completed in the Pathology Department, the Institute of Tissue Transplantation and Immunology, the Life Science and Technology College of Jinan University. The subjects were primarily-cultured neurons obtained from cerebral cortex of newborn rats that were provided by the Experimental Animal Center of the Medical College, Sun Yat-sen University.INTERVENTIONS: After culturing for five days, the neurons were treated with ET-1 (0. 2 nmol/L and 20 nmol/L) for 24 hours. Apoptotic neurons were semi-quantitatively measured with Annexin V and Hoechst 33258 staining respectively. ET-1(20 nmol/L), with BQ123(a selective antagonist for ET receptor A, 1 mmol/L) or with BQ788(a selective antagonist for ET receptor B, 1 mmol/L), was added respectively into the cultures simultaneously. And the apoptotic neurons were quantitatively measured with flow cytometry 24 hours later. Equal amount of PBS, instead of ET-1, waw added into the control subjects.MAIN OUTCOME MEASURES: The effect of ET-1 on apoptosis rate of cultured rat cortical neurons, and the ET receptor subtypes involved in this action.RESULTS: Twenty-four hours after treated with 0.2 nmol/L ET-1, the Annexin-V, and Hoechest 33258 positive stained cell rates[ (23.00 ± 9.96)%,(9.82 ±0.95)% ] were of no difference as compared with those of the controls[ (13.50 ± 3.35)%, (8.21 ± 2. 17)% ]. By contrast, after incubation with the higher dose of ET-1 (20 nmol/L), significant higher rate of apoptosis was measured in Annexin V staining[(50.50 ± 10.78)%, P=0.01, n=4] and Hoechest 33258 staining[(13.78±1.52)%, P= 0. 000, n = 8] . Analyzed with flow cytometry, the apoptosis rate was (0.20±0. 15)% in the control group, (26. 11 ±3.28)% in 20 nmol/LET-1 group, and(13.58 ±4. 92)% in BQ123 +ET-1 and(9.99 ±3.30)% in BQ788 +ET-1 respectively, indicating that BQ123 and BQ788 partially-blocked the apoptosis effect of ET-1 on. cultured neurons(BQ123 + ET-1 vs ET-1, P = 0. 005; BQ788 + ET-1 vs ET-1, P = 0. 001, n = 4, respectively).CONCLUSION: The higher dose of ET-1 (20 nmol/L) can directly induce apoptosis of primarily-cultured cerebral neurons of rats. The effect of ET-1 inducing neuronal apoptosis may be mediated via both ET receptors A and B.
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Training quality postgraduates in clinical neurology differs from in neuroscience. Combined with the features of clinical neurology, this article discussed the training processes for quality postgraduates in clinical neurology as following: individual training plan; clinical training in multiple academic directions and subjects; keeping the update ability for clinical neurology; improving the English skill in neurology and the ability to develop clinical researches.
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Objective To study the relationship between the diabetic autonomic neuropathy (DAN) and the cerebrovascular disease. Methods The heart rate variability (HRV) was measured in 77cases of type 2 diabetes 〔49 men, 28 women, age (63.1?11.4)years〕. Forty-one cases suffered from DAN (group A), 36 cases without DAN (group B) according to the results of HRV. All the cases received the examination with transcranial Doppler ultrasonography (TCD). Results Compared with group B, the abnormality detected with TCD was higher in group A, cerebrovascular compliance was commonly decreased and cerebrovascular stenosis was also extensively observed. Conclusion DAN seems to be one of the risk fcators in inducing cerebrovascular disease.
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AIM: To investigate the effect of hypoxia on glyceraldehyde-3-phosphate dehydrogenase (GAPDH), ?-actin and endothelin-converting enzyme (ECE)-2 mRNA levels in cultured mouse brain astrocytes (AC). METHODS: AC from neonatal mouse brain was incubated for 24 h in serum-free medium under hypoxic or normoxic conditions. The amount of transferred RNA was estimated using ethidium bromide stained 28S rRNA and 18S rRNA. The levels of tested mRNA were evaluated by Northern blot RNA hybridization. RESULTS: The GAPDH mRNA was up-regulated to 503.0% of the normoxic controls in hypoxic AC (n=10. P