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Objective:To evaluate the short-term efficacy and safety of Apollo stent in the treatment of symptomatic basilar artery stenosis.Methods:Patients with symptomatic basilar artery stenosis admitted to the Fourth Affiliated Hospital of China Medical University from January 2017 to May 2020 were selected and treated with Apollo stent implantation. The changes of clinical symptoms and the success rate of operation were evaluated. Postoperative complications included symptomatic intracranial hemorrhage, hyperperfusion, and new ischemic stroke, and follow-up results were evaluated 3 to 6 months later.Results:A total of 96 patients were included in this study, and all of them were confirmed by angiography to have severe basilar artery stenosis corresponding to the symptoms. Among them, 88 patients received stent implantation, with a success rate of 100%. Among the 88 patients, 86 received Apollo stent implantation, and 2 patients received self-Peng stent implantation. Among 86 patients with Apollo stent implantation, the lesions were located in the proximal segment in 73 cases (84.88%), in the middle segment in 10 cases (11.63%), and in the distal segment in 3 cases (3.49%). The degree of stenosis was (93.72±3.86)%, the length of stenosis was (8.50±2.65)mm, the residual stenosis rate was (1.76±4.87)%, and Mori type A lesions in 80 cases, type B lesions in 3 cases, and type C lesions in 3 cases. Among 86 patients with Apollo stent implantation, the incidence of perioperative neurological complications was 6.98%(6/86), including 1 case in the proximal part of the basilar artery (vascular rupture), 3 cases in the middle part of the basilar artery (perforating artery occlusion in 1 case, acute thrombosis artery occlusion in 2 cases), and 2 cases in the distal part (both acute vascular occlusion). Alteplase was injected into the microcatheter during the operation, and contact thrombolysis was performed. Immediately digital subtraction angiography (DSA) showed that the blood vessels were opened, and 1 case with neurological deficit was left. No hyperperfusion occurred in all patients. All patients were followed up for three months after operation. Among them, 58 patients had a good prognosis in the proximal segment of the basilar artery, 18 patients had a good prognosis in the middle segment, 4 patients had a good prognosis in the distal segment, and 6 patients had a bad prognosis (1 patient died). Postoperative stent restenosis occurred in 5 cases (5.81%), recurrent stroke in 3 cases (3.49%), and disabling stroke in 1 case (1.16%).Conclusions:Apollo stent is safe and effective in the treatment of symptomatic basilar artery stenosis, with good short-term prognosis, and long-term prognosis needs to be further studied.
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@#Objective To evaluate cerebral perfusion through brain computed tomography perfusion imaging (CTP) in order to investigate the relationship between cerebral perfusion and vascular cognitive impairment (VCI).Methods A total of 103 patients with ischemic stroke were recruited, who received thrombolytic therapy and CTP test in the Fourth Affiliated Hospital of China Medical University from December, 2016 to May, 2017. The patients were divided into normal cognitive function group (control group, n=43), vascular cognitive impairment-no dementia group (VCIND group, n=48), and vascular dementia group (VD group, n=12) according to the degree of impairment in cognitive function after the assessment of Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). The characteristics of cerebral blood flow perfusion in region of interest of brain CTP were analyzed.Results There was difference in incidence of diabetes among three groups (χ2=7.556, P<0.05). The rate of diabetes was higher in VCIND group and VD group than in the control group. Age and diabetes were the independent risk factors for VCI (OR>1, P<0.05). There was difference in cerebral blood volume (CBV) in frontal lobe, temporal lobe, and parietal lobe among three groups (F>3.216, P<0.05). CBV in frontal lobe, temporal lobe, and parietal lobe reduced in VD group than in the control group (P<0.05), while CBV in frontal lobe and temporal lobe reduced in VD group than in VCIND group (P<0.05). There was difference in mean transit time (MTT) in left temporal lobe, left parietal lobe, and centrum semiovale among three groups, while there was difference in left occipital lobe in time to peak (TTP) among three groups (F>3.116, P<0.05). MTT and TTP were higher in VD group than in the control group and VCIND group (P<0.05). There was no difference in cerebral blood flow (CBF) in both left and right brain, and MTT and TTP in right brain among three groups (P>0.05). CBV in frontal lobe, parietal lobe and right temporal lobe demonstrated positive relationship with the scores of MMSE (r>0.203, P<0.05). CBV in parietal lobe and left frontal lobe also demonstrated positive relationship with the scores of CDT (r>0.214, P<0.05).Conclusion The cerebral blood flow perfusion reduced in different levels of VCI, especially in frontal lobe, temporal lobe and parietal lobe. Cerebral blood flow perfusion reduced with the progress of cognitive impairment, and the left hemisphere injured earlier than the right one. Brain CTP may be applied in the early recognition of VCI.
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Hypoxia inducible factor-1αis a kind of hypoxia response factor. Acute cerebral ischemia and anoxia can induce up-regula-tion of hypoxia inducible factor-1α, and the downstream genes, which plays a role in both the energy metabolism and collateral circulation after cerebral ischemia. Neural stem and progenitor cells regeneration also benefit the functional outcome after ischemic stroke. Hypoxia in-ducible factor-1αmay induce proliferation and differentiation of neural stem and progenitor cells through Notch, Wnt/β-catenin pathways, etc., in the ischemic stroke model.
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Objective To investigate whether apathy during the acute stage of stroke was related to glycated hemoglobin and homocysteine(Hcy) and functional disability,and to elucidate possible factors that are related to poststroke apathy (PSA).Methods Totally 298 patients with acute cerebral infarction who met the inclusion and exclusion criteria were recruited from the Fourth Affiliated Hospital of China Medical University.The control group of 298 volunteers was recruited from medical center in our hospital during the same period.The apathy scale (AS) was used to assess PSA within 2 weeks after stroke.Patients with an AS score≥ 14 points were defined as PSA,and the patients were divided into apathy group (A group) and non-apathy group (NA group) according to AS score.Modified Rankin Scale (mRS) was used to assess functional disability.Functional disability in daily living activities was assessed with the Barthel Index(BI).Serum levels of Hcy,glycated hemoglobin A1C (HbA1 c),lipid series and fibrinogen of patients were determined.Results The prevalence of PSA in patients was significantly higher than the control group (P ＜ 0.01).In the case group,A group had an older age,higher mRS score,higher Hcy level,lower educational level,lower BI score,and lower HbA1C level than the NA group(P ＜0.05).In the A group,the mRS score was positively correlated with the AS score(B =1.508,P =0.003),serum Hcy level was positively correlated with the AS score(B =0.170,P =0.013),the HbA1C level was negatively correlated with the AS score(B =-0.872,P =0.031).Conclusions The serum Hcy level,HbA1C level and functional disability are closely related to apathy during the acute stage of ischemic stroke.
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@# Objective To explore the relationship between apathy and lesion location and serum homocysteine during the acute stage of ischemic stroke. Methods 152 patients with acute cerebral infarction were recruited. 152 volunteers from medical center were as control group. The Apathy Scale (AS) was used to assess poststroke apathy (PSA). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was used to evaluate the lesion location. Modified Fazekas Scale was used to assess leukoaraiosis. The serum levels of homocysteine of patients were determined. Results The prevalence of PSA was significantly higher in the patients than in the control group (P<0.001). Multivariate logistic regression demonstrated that frontal lesion (P=0.001), basal ganglia lesion (P=0.006), pons lesion (P=0.002) and higher homocysteine level (P<0.001) significantly related with PSA. Conclusion Frontal lesion, basal ganglia lesion, pons lesion and higher homocysteine level may be predictors for apathy in acute stage of ischemic stroke.
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Objective To explore the relationship between apathy and lesion location and serum homocysteine during the acute stage of ischemic stroke. Methods 152 patients with acute cerebral infarction were recruited. 152 volunteers from medical center were as control group. The Apathy Scale (AS) was used to assess poststroke apathy (PSA). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was used to evaluate the lesion lo-cation. Modified Fazekas Scale was used to assess leukoaraiosis. The serum levels of homocysteine of patients were determined. Results The prevalence of PSA was significantly higher in the patients than in the control group (P<0.001). Multivariate logistic regression demon-strated that frontal lesion (P=0.001), basal ganglia lesion (P=0.006), pons lesion (P=0.002) and higher homocysteine level (P<0.001) signifi-cantly related with PSA. Conclusion Frontal lesion, basal ganglia lesion, pons lesion and higher homocysteine level may be predictors for apathy in acute stage of ischemic stroke.
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OBJECTIVE: We investigated the development of the studying of bone marrow mesenchymal stem cells (MSCs) and elucidated the feasibility of gene therapy for Parkinson's disease. DATA SOURCES: Using the key terms "mesenchymal stem cells, Parkinson disease, gene transfer", we searched the MEDLINE database for the articles published in English from January 2000 to December 2005. Meanwhile, Wanfang database was retrieved for the relevant articles published during the same period, with the keywords of "Parkinson's disease, gene therapy, gene transfer, mesenchymal stem cells" in Chinese. STUDY SELECTION: All articles were selected firstly and those were relevant to gene therapy of Parkinson disease, differentiation of MSCs into nerve stem cells, or the therapy of MSCs transplantation for Parkinson disease. DATA EXTRACTION: A total of 158 articles including 32 Chinese and 126 English were collected, finally 30 articles of them were included. DATA SYNTHESIS: Parkinson disease is a very normal disorder of central nerve systematic degeneration, which pathological change is the damage of dopamine neuron in substantia nigra. Nowadays the systematic study of Parkinson disease indicates that transplantation of MSCs has a potential prospective application. Due to the autospecific superiority, MSCs become an engineering cell of Parkinson disease therapy. In recent years there are a lot of researches on genetic modification about MSCs that involved in gene therapy as an ideal target cell. MSCs can improve the dopamine synthesis and decrease the death of dopaminergic neuron. Target gene encoding enzymes in the route of dopamine synthesis, such as Tyrosine Hydroxylase, Aromatic L-Aminoacid Decarboxylase and neural protective molecule including neurotrophic factor and anti-apoptosis protein, is in the state of animal experiments, which provide great space for treating neurodegenerative disease-Parkinson disease. CONCLUSION: As MSCs are the plentiful sources of engineering cells, which have an extensive prospective application, it has potential clinical value in treating Parkinson disease, especially in gene therapy of Parkinson's disease.