Comparison of therapeutic effects between double traction-assisted reduction internal fixation and open reduction internal fixation for tibial plateau fractures / 中华骨科杂志

Objective:To explore the clinical efficacy of double traction-assisted reduction internal fixation and open reduction internal fixation in treating tibial plateau fractures.Methods:Data of patients with tibial plateau fracture admitted to West China Hospital of Sichuan University from January 2016 to December 2021 were retrospectively analyzed, and patients were divided into two groups according to treatment method: double traction-closed reduction internal fixation group (referred to as double traction group) and open reduction internal fixation group (referred to as open group). The double traction group included 21 patients, with 15 male and 6 female patients, with a mean age of 56.14±9.24 years (range, 45-72 years). Schatzker classification of fractures: 1 type I, 2 type II, 2 type III, 5 type IV, 6 type V, and 5 type VI. The open group included 29 patients, with 20 male and 9 female patients, with a mean age of 58.97±4.84 years (range, 47-70 years). Schatzker classification of fractures: 2 type I, 4 type II, 8 type III, 4 type IV, 5 type V, and 6 type VI. The surgical time, incision length, intraoperative blood loss, length of hospital stays, fracture healing time, postoperative time to full weight bearing, Rasmussen score, Hospital for Special Surgery (HSS) knee score, and complications were compared between the two groups of patients.Results:Both groups were followed up for 24 to 36 months, with an average of 30 months. There were significant differences in the operation time (92.61±6.22 min vs. 47.92±9.53 min), incision length (4.54±0.56 cm vs. 6.26±0.51 cm), and intraoperative blood loss (47.05±9.72 ml vs. 156.82±4.62 ml) between the group treated with closed reduction and double traction and the group treated with open reduction, with statistical significance ( t=18.83, 10.78, 53.24, P<0.001). There were also significant differences in the hospitalization time (5.35±0.41 d vs. 5.84±0.78 d), fracture healing time (3.72±0.74 months vs. 4.22±0.42 months), and time to full weight-bearing after surgery (11.29±1.10 weeks vs. 15.07±1.96 weeks) between the two groups, with statistical significance ( t=2.30, P=0.026; t=3.38, P<0.001; t=7.96, P<0.001). The HSS score at 6 months after surgery in the group treated with closed reduction and double traction was 81.61±2.32 points, which was higher than the score in the group treated with open reduction (77.66±4.01 points), with statistical significance ( t=4.07, P<0.001); at 12 months after surgery, the Rasmussen score in the group treated with closed reduction and double traction was 16.71±1.00 points, which was higher than the score in the group treated with open reduction (13.79±1.42 points), with statistical significance ( t=8.05, P<0.001). There was no fracture malunion or compartment syndrome occurred in both groups. The incidence of complications was 5% (1/21) in the group treated with closed reduction and double traction, and 10% (3/29) in the group treated with open reduction, with statistical significance (χ 2=0.52, P=0.473). Conclusion:The advantages of double traction-assisted reduction and internal fixation for tibial plateau fractures include minimal trauma, minimal bleeding, early mobilization, and shorter fracture healing time. It is a safe and reliable treatment method.

Relationship between total burden of cerebral small vessel disease and recurrent ischemic stroke / 中风与神经疾病杂志

@#Objective To investigate the relationship between the total burden of cerebral small vessel diseases(CSVD) and recurrent ischemic stroke. Methods We included 704 patients with acute ischemic stroke with complete clinical data admitted to our hospital from June 2019 to December 2020.They were scored for the total CSVD burden. After follow-ups of 90 days and one year,they were divided into recurrence group and non-recurrence group according to whether there was a recurrent ischemic stroke. The clinical data and imaging data of the two groups were compared. The risk factors for recurrent ischemic stroke were determined by Logistic regression analysis. The predictive value of the total CSVD burden for stroke recurrence was evaluated using the area under the receiver operating characteristic curve(AUC). Results At the 90-day follow-up,there were 25(3.55%) cases in the recurrence group and 679(96.45%) cases in the non-recurrence group. The two groups differed significantly in age,the use of antiplatelet drugs,cerebral artery stenosis,total CSVD burden,white matter hyperintensities(WMH),cerebral microbleeds(CMB),and lacunes. The Logistic regression analysis showed that cerebral artery stenosis and the total CSVD burden were independent risk factors for recurrent ischemic stroke,while the use of antiplatelet drugs was an independent protective factor against stroke recurrence. At the one-year follow-up,there were 100(14.20%) cases in the recurrence group and 604(85.80%) cases in the non-recurrence group,with significant differences in age,hypertension,diabetes,fasting blood glucose level,the use of antiplatelet drugs,the use of lipid-regulating drugs,cerebral artery stenosis,the total CSVD burden,WMH,CMB,and lacunes. The Logistic regression analysis showed that the independent risk factors for stroke recurrence included hypertension,diabetes,cerebral artery stenosis,the total CSVD burden,WMH,and CMB,while the use of antiplatelet drugs was the independent protective factor. The AUC of the total CSVD burden was 0.823 at the 90-day follow-up and 0.746 at the 1-year follow-up,indicating moderate predictive value of the total CSVD burden for 90-day and 1-year stroke recurrence. Conclusion The total CSVD burden is associated with recurrent ischemic stroke. It is an independent risk factor for recurrent ischemic stroke,which can be a predictive indicator for ischemic stroke recurrence.

Correlation of enlarged perivascular spaces with post-stroke cognitive impairment in patients with acute mild stroke / 中华神经医学杂志

Objective:To investigate the relations between enlarged perivascular spaces (EPVS) and cognitive impairment in patients with acute mild ischemic stroke.Methods:A total of 234 patients with acute mild ischemic stroke admitted to our hospital from October 2019 to June 2021 were chosen in our study. According to the Montreal Cognitive Assessment (MoCA) scores 7 d after admission, these patients were divided into normal cognitive function group (MoCA scores≥26) and cognitive impairment group (MoCA scores<26). The clinical data and imaging data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was used to determine the independent influencing factors for post-stroke cognitive impairment (PSCI). Spearman correlation analysis was performed to analyze the correlations of severity degrees of EPVS of basal ganglia with MoCA total scores and each cognitive domain scores in patients from cognitive impairment group.Results:Among the 234 patients, 73 (31.2%) had normal cognitive function and 161 (68.8%) had cognitive impairment. As compared with normal cognitive function group, patients from cognitive impairment group had significantly older age, significantly less years of education, statistically higher fasting blood glucose level, significantly higher proportion of patients with moderate and severe basal ganglia EPVS, and significantly higher proportion of patients with white matter lesion (WML) grading 2 and 3 ( P<0.05). Multivariate Logistic regression analysis showed that age, years of education, basal ganglia EPVS and WML grading were independent influencing factors for PSCI ( OR=1.049, 95%CI: 1.007-1.093, P=0.021; OR=0.910, 95%CI: 0.832-0.995, P=0.039; OR=0.760, 95%CI: 1.176-2.637, P=0.006; OR=2.270, 95%CI: 1.219-4.228, P=0.010). Correlation analysis showed that the severity degrees of basal ganglia EPVS were negatively correlated with MoCA scores, and scores of visual space and executive ability scale, attention scale, language scale and delayed recall scale ( P<0.05). Conclusion:Acute mild ischemic stroke patients with older age, less years of education, severer basal ganglia EPVS and higher WML grading trends to have cognitive impairment; basal ganglia EPVS mainly affects the cognitive domains of visual space and executive ability, attention, language, and delayed recall.

Enlarged perivascular spaces and post-stroke cognitive impairment / 国际脑血管病杂志

Enlarged perivascular spaces (EPVS) are one of the early characteristic imaging manifestations of cerebral small vessel disease. Studies have shown that EPVS may be an early independent risk factor for post-stroke cognitive impairment (PSCI), and it plays an important role in the occurrence and development of cognitive impairment. This article reviews the correlation between EPVS and PSCI.

Effect of silent cerebral small vessel disease on outcome of patients with intracerebral hemorrhage / 国际脑血管病杂志

Silent cerebral small vessel disease is a series of imaging and pathological syndromes caused by intracranial small vessel disease. It is named for the lack of clinically recognizable stroke symptoms. Its imaging characteristics are mainly cerebral microbleeds, white matter hypertensities, lacune, and enlarged perivascular space. Recent studies have shown that patients with intracerebral hemorrhage often have varying degrees of cerebrovascular disease imaging changes, which seriously affect the clinical outcome of patients. This article reviews the relationship between silent small vessel disease and outcome in patients with intracerebral hemorrhage.

Cerebral hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting / 国际脑血管病杂志

Cerebral hyperperfusion syndrome is a rare but life-threatening complication after carotid endarterectomy and carotid artery stenting. If it is not identified and adequately treated in time, it may cause severe neurological impairment or even death due to cerebral edema or cerebral hemorrhage. This article reviews the risk factors, pathophysiological mechanisms, clinical manifestations, imaging diagnosis and treatment of cerebral hyperperfusion syndrome.

Relation between total burden of cerebral small vessel disease and post stroke depression / 中华神经医学杂志

The total burden of cerebral small vessel disease (CSVD) is recently proposed to estimate the full impact of CSVD on the brain, and the evaluated method is to calculate the scores of MR imaging features of four kinds of CSVD, which includes white matter hypertensity, cerebral microbleeds, lacune and enlarged perivascular space. Patients with post stroke depression (PSD) often have different imaging features of CSVD. Recent research shows that the total burden of CSVD is closely related to PSD. This article reviews the relation between total burden of CSVD and PSD.

Effects of cerebral small vessel disease on neurological function and recurrence of stroke in cerebral infarction patients caused by large artery atherosclerosis / 中华神经医学杂志

The term,cerebral small vessel disease (CSVD),describes a syndrome of neuroimaging,pathological,and associated clinical features caused by small intracranial vascular lesions.Recent studies have found different MRI features of CSVD in patients with ischemic strokes caused by large artery atherosclerosis (LAA),significantly influencing the stroke outcomes.This paper reviews the effects of CSVD on clinical outcomes of cerebral infarction patients caused by LAA and their mechanisms.

Correlation between total burden of cerebral small vessel disease and outcomes in large artery atherosclerotic stroke / 国际脑血管病杂志

Objective To investigate the relationship between the total burden of cerebral small vessel disease (CSVD) and the outcomes in patients with large artery atherosclerotic (LAA) stroke.Methods From June 2016 to January 2018,patients with LAA stroke treated at the Department of Neurology,the Affiliated Hospital of Qingdao University were enrolled retrospectively.The overall burden of CSVD was evaluated according to MRI findings.The National Institute of Health Stroke Scale (NIHSS) was used to evaluate theseverity of stroke.The modified Rankin scale (mRS) was used to evaluate the outcomes at day 90 after the onset.The mRS score 0-2 was defined as good outcome,and ＞2 was defined as poor outcome.Results A total of 148 patients with LAA stroke were enrolled,including good outcome in 72 (48.65％) and poor outcome in 76 (51.35％).There were significant differences in the proportions of hypertension (69.44％ vs.85.52％;x2 =5.519,P =0.019),taking antihypertensive drugs before the onset (48.61％ vs.69.74％;x2 =6.845,P =0.009),white matter hyperintensity (18.06％ vs.39.47％;x2 =8.228,P =0.004),enlarged perivascular space (33.33％ vs.60.53％;x2 =10.968,P =0.001),as well as the baseline NIHSS scores (3.00 [2.00-4.00] vs.7.0 [5.0-10.0];Z =-8.159,P =0.001),baseline systolic blood pressure (149.40± 15.80mmHgvs.157.21± 14.05mmHg;t=3.180,P=0.002;1 mmHg=0.133 kPa),fasting glucose (5.91 ±2.06 mmol/L vs.6.92 ±2.65 mmol/L;t =2.595,P =0.010),and the proportions of total CSVD scores 0,1,2,3,and 4 (Z =-4.927,P =0.001) between the 2 groups.After adjustment for the confounding factors,such as hypertension and fasting glucose,multivariate regression analysis showed that the total CSVD score (odds ratio 4.457,95％ confidence interval 1.768-11.236;P =0.002) and baseline NIHSS score (odds ratio 2.070,95％ confidence interval 1.580-2.710;P ＜ 0.001)were the independent risk factors for the poor outcomes in patients with LAA stroke.Conclusions The total CSVD burden was closely associated with the outcomes in patients with LAA stroke.Higher CSVD total score and baseline NIHSS scores were independently associated with the poor outcome at 90 d in patients with LAA stroke.

Cognitive impairment in patients with minor stroke/TIA: a follow-up study / 国际脑血管病杂志

Objective To investigate the changes of cognitive impairment with disease progression in patients with minor stroke/transient ischemic attack (TIA).Methods Consecutive patients with minor stroke/TIA were enrolled prospectively.Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive function assessment within 7 d of the onset (baseline),at 1 and 3 months,respectively.Compared with the baseline,the total scores of MoCA in patients increased by ≥2 at 3 months were cognitive function improvement and increased <2 were no cognitive function improvement.Multivariate logistic regression analysis was applied to identify the independent risk factors for no cognitive improvement.ResultsA total of 112 patients with minor stroke/TIA were enrolled in the study,including 63 patients (56.2%) with TIA and 49 (43.8%) with minor stroke.At baseline,1 month,and 3 months,77 (68.8%),72 (64.3%) and 60 (53.6%) patients had cognitive impairment.At 3 months after the onset,the cognitive function of 25 patients (22.3%) were improved,in which 19 (76.0%) and 6 (24.0%) patients had TIA/minor stroke respectively;87 (77.7%) did not have any improvement.Compared with the improvement group,the level of education was significantly lower (3.29±3.48 years vs.5.63±4.26 years;t=2.814,P=0.006),the level of glycosylated hemoglobin was significantly higher (6.35%±1.26% vs.7.21%±1.26%;t=-3.088,P=0.003) in the no improvement group,and the proportions of patients with minor stroke (49.4% vs.24.0%;χ2=5.101,P=0.024),hypertension (52.9% vs.24.0%;χ2=6.509,P=0.011),hyperlipidemia (51.7% vs.24.0%;χ2=6.019,P=0.014),diabetes (41.4% vs.16.0%;χ2=5.448,P=0.020),and coronary heart disease (32.2% vs.8.0%;χ2=5.792,P=0.016) were significantly higher.Multivariate logistic regression analysis showed that the level of education (odds ratio [OR] 1.364,95% confidence interval [CI] 1.059-1.756;P=0.016),atrial fibrillation (OR 2.509,95% CI 1.020-6.167;P=0.045),and higher glycosylated hemoglobin level (OR 1.586,95% CI 1.021-2.034;P=0.030) were the independent risk factors for no cognitive function improvement at 3 months after the onset of minor stroke/TIA.As time went on,the MoCA score and visual spatial execution,memory,abstract and directional scores were increased significantly (P<0.001),while there were no significant differences in naming,attention,and language scores.Conclusion s About 2/3 patients with minor stroke/TIA had cognitive impairment,and as time went on,they were improved.The lower education level,atrial fibrillation and higher baseline glycated hemoglobin were the independent risk factors for affecting no cognitive impairment improvement after monor stroke/TIA.

Circle of Willis variants and white matter lesions / 国际脑血管病杂志

Circle of Willis is the most important intracranial collateral circulation system,it has many types of variation.Circle of Willis variants reduce intracranial blood perfusion and increase the risks of ischemic cerebrovascular diseases and white matter lesions.White matter lesions are white matter damage caused by a variety of causes.With the wide application of neuroimaging technology,the detection rate of white matter lesions is significantly higher,and it is closely associated with the ischemic cerebrovascular disease.This article reviews the correlation between circle of Willis variants and white matter lesions.

Vertebrobasilar dolichoectasia and posterior circulation cerebral infarction / 中华神经医学杂志

Vertebrobasilar dolichoectasia (VBD) as a distinct arterial disease is not rare.Posterior circulation cerebral infarction was one of the most frequent events and the primary cause of death in patients with VBD.The clinicoradiologic features and the pathophysiological mechanism of ischemic stroke in VBD remained unclear and required further investigation.We aimed to provide a review of advanced studies.

Risk factors of primary benign paroxysmal positional vertigo / 中华全科医师杂志

Benign paroxysmal positional vertigo (BPPV) is the most common kind of vertigo,which can be divided into idiopathic and secondary types.Head trauma,surgery,and inner ear diseases may induce the secondary BPPV,but the etiology and pathogenesis of idiopathic BPPV is still unknown.Recent studies indicate that multiple factors are associated with idiopathic BPPV;in this article we will review the risk factors of idiopathic BPPV.

Cognitive impairment in patients with transient ischemic attack and minor stroke / 中华行为医学与脑科学杂志

Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.

Application of the Montreal Cognitive Assessment in vascular cognitive impairment / 国际脑血管病杂志

Vascular cognitive impairment has been a research hotspot in the field of neurology in recent years.The Montreal Cognitive Assessment is a rapid screening tool for detecting mild cognitive impairment.Now it has been widely used in the evaluation of vascular cognitive impairment.This article reviews the content,features,application status,and development prospects of the Montreal Cognitive Assessment.

Cognitive impairment in patients with transient ischemic attack and minor stroke / 国际脑血管病杂志

Vascular cognitive impairment in patients with severe stroke has attracted wide attention of clinicians in recent years,and the cognitive impairments of transient ischemic attack (TIA) and minor stroke are often overlooked because of their mild symptoms and short duration.This article reviews the advances in research on cognitive impairment in patients with TIA and minor stroke in recent years in order to increase the degree of attention of clinicians and improve the overall prognosis of patients.

Ischemic postconditioning alleviates cerebral ischemia-reperfusion injury in rats by upregulating brain-derived neurotrophic factor and tyrosine receptor kinase B / 国际脑血管病杂志

ObjectiveToinvestigatetherolesofbrain-derivedneurotrophicfactor(BDNF)and tyrosine receptor kinase B (TrkB) in ischemic postconditioning. Methods Wistar rats w ere randomly assigned to three groups:a sham operation (9 rats), an ischemic postconditioning, and an ischemia-reperfusion group. According to the reperfusion time, the latter 2 groups w ere redivided into 6, 12, 24, 48, and 72 h subgroups (9 rats in each subgroups). A middle cerebral artery occluded by suture method for a cerebral ischemia-reperfusion model. Triphenyl tetrazolium staining w as used to detect infarct volume (P=4). Immunohisto-chemical staining w as used to detect the expression levels of BDNF and TrkB proteins (P=5). Results The infarct volumes in the ischemic postconditioning group w ere reduced significantly compared w ith those in the ischemia-reperfusion group (6 h:143.3 ±8.7 mm3 vs.166.8 ±7.5 mm3, t=4.104, P=0.006;12 h:151.7 ±7.8 mm3 vs.171.6 ±9.1 mm3, t=3.314, P=0.016; 24 h: 159.2 ±9.3 mm3 vs.177.1 ± 7.6 mm3, t=3.000, P=0.024;48 h:166.9 ±9.6 mm3 vs.184.9 ±9.0 mm3, t=2.732, P=0.034;72 h:172.0 ±9.1 mm3 vs.198.1 ±8.2 mm3, t=2.640, P=0.039), and the positive cel numbers of BDNF (6 h:23.98 ±4.07 vs.18.63 ±2.5, t=2.479, P=0.038;12 h:27.64 ±3.18 vs.22.01 ±3.14, t=2.817, P=0.023;24 h:34.82 ±4.17 vs.28.46 ±4.05, t=2.446, P=0.040; 48 h:34.30 ±3.27 vs.26.29 ± 3.26, t=3.872, P=0.005;72 h:28.77 ±3.53 vs.23.64 ±3.54, t=2.297, P=0.051) and TrkB (6 h:33.83 ±3.90 vs.21.51 ±3.86, t=5.012, P<0.001; 12 h:38.59 ±4.84 vs.23.41 ±3.67, t=5.586, P<0.001;24 h:46.07 ±3.06 vs.28.78 ±3.61, t=8.169, P<0.001; 48 h:47.90 ±3.30 vs.29.51 ± 3.81, t=8.160, P<0.001; 72 h:42.78 ±4.07 vs.27.46 ±3.19, t=6.623, P<0.001) per high-pow er field at each time point in the ischemic postconditioning group w ere significantly more than those in the ischemia-reperfusion group. Conclusions Ischemic postconditioning upregulates the expressions levels of BDNF and TrkB proteins after ischemia-reperfusion and reduces cerebral infarct volumes. BDNF/TrkB may play an important neuroprotective effect in ischemic postconditioning.

Prognostic predictors of minor stroke / 国际脑血管病杂志

Minor stroke is characterized by the mild symptom and rapid recovery,and does not easily cause disability,but a part of patients with minor stroke are the high risk population of recurrent stroke,and can cause disability,cognitive impairment,and emotional disorders.Early prediction of the prognosis in patients with minor stroke,screening for the high risk population of recurrent stroke and disability,and giving appropriate treatment may prevent recurrent stroke and improve the prognosis of patients.This article reviews the predictors of prognosis in patients with minor stroke.

Stroke risk and treatment of asymptomatic carotid artery stenosis / 国际脑血管病杂志

The optimal therapeutic regimen for patients with asymptomatic carotid artery stenosis (ACS) has been controversial.Early research suggests that carotid endarterectomy (CEA) is effective for the treatment of patients with severe ACAS.In recent years,as a minimally invasive treatment,carotid artery stenting (CAS) is as effective as CEA.It has a trend of replacing CEA.In recent 10 years,medicine standardized treatment has made great progress.Recent studies have shown that the risk of stroke is lower using the optimal medical treatment in patients with ACAS compared with CEA and CAS.The key of choosing optimal therapeutic regimen is to identify the high risk patients with stroke.

Screening for asymptomatic carotid artery stenosis / 国际脑血管病杂志

Patients with asymptomatic carotid stenosis (ACS) are the potentially high-risk population of stroke.Screening for high-risk patients with ACS and giving them appropriate interventions may have great significance for the prevention of the occurrence of stroke.This article reviews the advances in research of ACS screening in recent years.