Correlation of memory impairment and cerebral perfusion in patients with vertebral-basilar artery stenosis / 中华行为医学与脑科学杂志

Objective To evaluate the correlation between cerebral blood flow perfusion and memory impairment in patients with severe stenosis of vertebral basilar artery (VBA).Methods 62 cases of patients with VBA stenosis diagnosed by digital subtraction angiography(DSA) in Beijing Tiantan Hospital from September 2016 to March 2017 were enrolled.Mental State Examination (MMSE),Clinical Memory Scale (CMS) test and CT perfusion(CTP) was performed.All patients were divided into memory normal group(n=24,including 1 excellent case,6 above normal cases,and 14 normal cases) and memory impairment group(n =38,including 18 below normal cases,12 periphery cases,8 impaired cases) according to CMS.The ratios of side-to-side period were compared between bilateral mesial temporal lobe and anterior circulation area.The relative time to peak (rTTP),relative mean transit time(rMTY),relative cerebral blood flow(rCBF) and relative cerebral blood volume (rCBV) were calculate.Results The incidence of CTP decompensation in the medial temporal lobe was higher than that in the patients with memory impairment(P＜0.05).The difference of rTTP and rMTT value between the two groups in the bilateral medial temporal lobes was statistically significant (rTFP:(1.131 ±0.037),(1.437±0.139),t=10.520,P＜ 0.05);rMTT:(1.081 ±0.059),(1.281 ±0.174),t=5.423,P＜0.05).Conclusion The patients with VBA severe stenosis are more likely to get memory impairment due to cerebral hypoperfusion.

Efficacy and adverse reactions of repetitive transcranial magnetic stimulation on general anxiety disorder: a meta-analysis / 中华行为医学与脑科学杂志

Objective Repetitive transcranial magnetic stimulation (rTMS) has gradually been used in the treatment of generalized anxiety disorder (GAD).The efficacy and adverse reactions of repetitive transcranial magnetic stimulation on general anxiety disorder are assessed in the review.Methods Searched databases such as Pubmed,Cochrane library,OVID,CNKI,VIP by computer,and researched published randomized controlled trials (RCTs) focused on repetitive transcranial magnetic stimulation on general anxiety disorder.Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs were included,involving 732 general anxiety disorder patients.The were divided into two subgroups,one group is effect observation,the other group is the improvement of curative effect in the treatment process.The effectiveness of intervention of rTMS follow up is better than that of the control group (WMD =-5.02,95％ CI=-6.84--3.20,P＜0.01).The intervention of rTMS group can early ameliorate the symptom of anxiety.The results of low frequency and high frequency rTMS intervention is (WMD =-1.34,95％ CI=-1.97--0.71,P＜0.01;WMD =-2.65,95％ CI=-3.51--1.79,P＜0.01).The adverse reactious of the intervention of rTMS group is less than that of the control group(WMD =-7.04,95％ CI=-11.64--2.43,P＜0.01).Conclusion rTMS intervention in the treatment of GAD patients at the end of the treatment and short-term follow-up efficacy is better,rTMS intervention after the onset of rapid intervention,the intervention group adverse reactions are rare.

Poststroke Depression between Men and Women 2 Weeks after Ischemic Stroke in China / 中国康复理论与实践

@#Objective To analyze the features of poststroke depression (PSD) between men and women after acute ischemic stroke in China. Methods A total of 1917 ischemic stroke patients were enrolled from the Prospective Cohort Study on Incidence and Outcome of Patients with Poststroke Depression in China. The incidence of PSD and the features were compared between male and female patients. The factors related with PSD of every gender were extracted with Logistic regression analysis. Results The incidence of PSD was higher in women than in men (32.9% vs. 26.6%, P<0.01). There was no difference in the stroke score between women and men (P>0.05). The score of Hamilton Depression Scale was higher in the women than in the men, and the features were similar. Logistic regression analysis indicated that the history of heart disease, history of mental disorders and stroke score related with PSD in women, while the age, history of mental disorders, smoking and stroke score in men. Conclusion The incidence and related factors of PSD 2 weeks after ischemic stroke are different between men and women.

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.

An analysis of risk factors and their prognostic effects on Chinese women's outcomes after ischemic stroke / 中华内科杂志

Objective To explore the risk factors and their prognostic value in Chinese female patients with ischemic stroke.Methods A total of 4 442 female patients with ischemic stroke were enrolled in the study from the Chinese National Stroke Registry System.According to the modified Rankin Scale (mRS) score,patients were divided into the group A (with good outcomes,mRS =0-2) and the group B (with bad outcomes,mRS =3-6),with the follow-up for 12 months.The risk factors were collected at month 3 and month 12,including age,family history,body mass index (BMI),hypertension,diabetes mellitus (DM),hyperlipidemia,atrial fibrillation (AF),coronary heart disease (CHD),smoking and moderate or heavy alcohol intake.The multivariate logistic regression was performed to determine the prognostic value of those risk factors.Results Patients in the group B were older than those in the group A [month 3:(71.3 ± 11.4) years oldvs (65.5±11.8) years old and month 12:(71.9±11.3) years old vs (65.1 ±11.6)years old,with both P ＜0.001].Patients in the group B were found to have higher ratio of BMI ＜25 kg/m2(66.3％ vs 62.0％,P =0.006;66.6％ vs 61.8％,P =0.002) and more likely to have the history of DM (27.0％ vs 23.3％,26.6％ vs 23.6％,respectively; both P ＜ 0.05),A F (18.0％ vs 6.2％,17.9％ vs 6.3％,respectively; both P ＜0.001) and CHD (21.4％ vs 14.4％,21.8％ vs 14.2％,respectively; both P ＜ 0.001) than those in the group A.The multivariate logistic regression analysis showed that women's age (OR =1.04,1.05,95％ CI 1.03-1.05,1.04-1.06,respectively),the histories of DM (both OR =1.35,95％ CI 1.15-1.58,respectively) and AF (OR =2.91,2.84,95％ CI 2.33-3.64,2.27-3.56,respectively) were significantly associated with the bad outcomes at month 3 and month 12.The history of CHD was associated with the bad outcomes at month 12 (OR =1.20,95％ CI 1.00-1.43),while the history of hyperlipidemia might improve the outcome at month 12 (OR =0.75,95％ CI 0.60-0.94).Conclusions The risk factors may have different prognostic value in female patients with ischemic stroke.The diagnosis and treatment for DM,AF and CHD may be helpful to improve the prognosis in Chinese female patients with ischemic stroke.

The association between plasma neurotransmitters levels and depression in acute hemorrhagic stroke / 中华内科杂志

Objective To explore the relation between plasm neurotransmitters (Glutamic acid,GAA; γ-aminobutyric acid,GABA; 5-hydroxytryptamine,5-HT; and noradrenaline,NE) and depression in acute hemorrhagic stroke.Methods Objectives were screened from consecutive hospitalized patients with acute stroke.Fasting blood samples were taken on the day next to hospital admission,and neurotransmitters were examined by the liquid chromatography-high resolution mass spectrometry (LC-HRMS).The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅳ) was used to diagnose depression at two weeks after onset of stroke.The modified Ranking Scale (mRS) was followed up at 1 year.Pearson test was used to analyse the correlation between serum concentration of neurotransmitters and the Hamilton Depression scale-17items (HAMD-17) score.Logistic regression was used to analyse the relation of serum concentration of neurotransmitters and depression and outcome of stroke.Results One hundred and eightyone patients were included in this study.GABA significantly decreased [6.1 (5.0-8.2) μg/L vs 8.1 (6.3-14.7) μg/L,P ＜ 0.05] in patients with depression in hemorrhagic stroke,and there was no significant difference in GAA,5-HT,or NE.GABA concentration was negatively correlated with HAMD-17 score (r =-0.131,P ＜ 0.05) ; while concentration of serum GABA rose by 1 μg/L,risk of depression in acute phase of hemorrhagic stroke was reduced by 5.6％ (OR 0.944,95％ CI 0.893-0.997).While concentration of serum GAA rose by 1 μg/L,risk of worse outcome at 1 year was raised by 0.1％,although a statistic level was on marginal status (OR 1.001,95％ CI 1.000-1.002).Conclusions In patients with depression in the acute phase of hemorrhagic stroke,there was a significant reduction in plasm GABA concentration.GABA may have a protective effect on depression in acute phase of hemorrhagic stroke.Increased concentrations of serum GAA may increase the risk of worse outcomes at 1 year after stroke.

Imaging findings and cognitive impairment in patients with leukoaraiosis / 国际脑血管病杂志

Leukoaraiosis (LA) is a group of clinical syndrome caused by multiple etiologies.It belongs to one of the types of cerebral small vessel diseases.Studies have shown that LA usually can lead to different degrees of cognitive impairment.In recent years,with the development of imaging techniques,the studies about correlation between maging findings and cognitive impairment in LA patients and cognitive impairment are increasing gradually and have drawn some new conclusions.And thus,the understanding of the clinical significance of LA has been further deepened.This article mainly reviews the advances in research on the correlation between imaging findings and cognitive impairment in LA patients.

Acute ischemic stroke in the very elderly outcome and predictive factors / 中华内科杂志

ObjectiveTo investigate the clinical characteristics,3-month outcome and predictive factors in the very elderly patients with ischemic stroke.MethodsA total of 305 acute ischemic patients aged 65 years and over were enrolled in the study.They were divided into two subgroups by age:80 years old and over(n =78),65-79 years old(n =227).The clinical outcome was assessed by the modified Rankin Scale (mRS) on (90 ± 7 ) days after stroke,and categorized as good ( scoring 0-2 ) or poor( scoring 3-6) outcome.Results Significantly lower BMI [ ( 23.62 ± 4.92 ) kg/m2 vs ( 25.08 ± 3.69 ) kg/m2,P =0.005],lower frequency of dyslipidemia(56.41％ vs 71.13％,P =0.006) and alcohol intake (0％ vs 6.61％,P =0.043 )were found in the very elderly group.The rates of poor functional outcome in the ≥ 80years group and the 65-79 years old group were 56.41％ (44/76) and 41.40％ (94/224) respectively,with a P value of 0.015.Multivariate logistic regression analysis showed that higher National Institute of Health stroke scale (NItISS) total score (OR 1.48,95％ CI 1.19-1.83 ) and lower albumin level (OR 0.73,95 ％ CI 0.55 -0.95 ) were associated with poor outcome in ≥ 80 year old,whereas higher NIHSS total score ( OR 1.38,95％ CI 1.24-1.53) and complications during hospital stay ( OR 2.58,95％ CI 1.07-6.19 ) were predictive factors in the 65-79 years old group.ConclusionOur study suggests that NIHSS scores,albumin level and complications during hospitalization are useful predictive factors for the short-term poor functional outcome in the patients of ≥65 years old and ≥80 years old patients have a worse prognosis.

Blood pressure management for primary prevention of stroke in the very elderly / 国际脑血管病杂志

The population of the very elderly is growing steeply with prolonged life expectancy.Age is an independent risk factor for stroke.Naturally,the very elderly become the high risky population.Hypertension is the most common and modifiable risk factor of stoke in the very elderly.Results of studies conducted during these 20 years have been reported to explore and investigate the relationship between stroke primary prevention and antihypertensive treatment,some of which are regarded as landmarks trials,providing essential evidences for blood pressure management in the very elderly.

Meta-analysis of Shuxuening Injection in the Treatment for Cerebral Infarction / 中国康复理论与实践

@#Objective To evaluate the efficacy of Shuxuening Injection on cerebral infarction with meta-analysis. Methods The literaturesabout the clinical trials of Shuxuening Injection for the cerebral infarction published domestically between 1999 and 2009 were retrieved,the selected literatures were metaanalyzed. Results 14 articles were included in the systemic evaluation, and 12 of them wereabout the clinical efficacy, the total samples were 1016 cases, the value of odds ratio (OR) was 0.33 with the 95% confidence interval from0.23 to 0.46 (P<0.001). The consistency of the literature was well. Conclusion Shuxuening Injection is effective on cerebral infarction.

Effects of rt-PA Combined with Mild Hypothermia on Hemorrhagic Transformation after Ischemic Stroke in Rats / 中国康复理论与实践

@#Objective To investigate the effects of recombinant tissue-type plasminogen activator (rt-PA) combined with mild hypothermia on the hemorrhagic transformation after cerebral ischemia-reperfusion within or out of the therapeutic time window in rats.Methods The focal cerebral ischemia-reperfusion 3 and 4 hours models of rats were established by middle cerebral artery occlusion (MCAO) 3 or 4 hours. The rats were randomly divided into the normal saline group (group NS), normothermia rt-PA group (group rt-PA), rt-PA combined with hypothermia group (group rt-PA +HT), and sham-operation group. Brain mild hypothermia was achieved after ischemia reperfusion and maintained 3 hours. Rats were sacrificed 24 h after ischemia reperfusion, and the amount of bleeding was measured.Results The amount of bleeding significantly reduced in the group rt-PA+HT compared with group rt-PA, which obviously increased in the group rt-PA compared with group NS ( P<0.05); there was a significant difference between rt-PA groups MCAO 3 hours and 4 hours ( P<0.05).Conclusion rt-PA can increase hemorrhagic transformation volume; hemorrhagic transformation volume is higher if treated by rt-PA within 3 h therapeutic time window than treated beyond the time window; mild hypothermia should possibly prevent the development of hemorrhagic transformation and prolong the therapeutic time window of thrombolytic intervention in ischemic stroke.

Effects of BPI-1095 on Caspase-3 in Middle Artery Occlusion Rats / 中国康复理论与实践

@#Objective To investigate the effect of BPI-1095 on caspase-3 protein expression in middle artery occlusion(MCAO) rats.Methods Cerebral ischemia was induced with MCAO in adult male SD rats.Rats were randomly subjected into 6 groups with 15 rats in each group.Each rat has been given tested medication of different dosage and was sacrificed 24 h after treatment.The area of infarction was measured on each slice by image analysis system.Meanwhile,immunohistochemistry staining was used to identify caspase-3 expression in ischemic brain tissue.Results The infarcted area were significantly decreased in big and moderate dose treated rats(P<0.05,vs the placebo group).The expression of caspase-3 protein decreased in contralateral and ipsilateral hemisphere areas.The caspase-3 positive cell was significantly decreased in rats treated with big doses compared with placebo-or ASA-treated rats.Conclusion BPI-1095 shows neuroprotection in MCAO rats,which may related with the inhibition of caspase-3 expression resulting in apoptosis in penumbra.

Neuroprotective Effects of different doses of BPI-1095 in Focal Cerebral Ischemia Rats / 中国康复理论与实践

@#ObjectiveTo investigate the neuroprotective effects of different doses of BPI-1095 on infarct volume and neurological outcome in middle cerebral artery occlusion(MCAO) rats.MethodsCerebral ischemia model was induced with MCAO in adult male SD rats. 10 minutes after surgery, rats were randomly subjected into six groups with 15 rats in each group. Each rat has been given different dosage tested medication and was sacrificed 24 h after treatment. Neurological functional behaviour tests were performed 4 h and 24 h after treatment. After the final behaviour test, 7 or 8 rats (remain 5 rats for brain tissue stain) were randomly picked up from each group. Their infarction volume was measured with image analysis system after 2% triphenyl-tetrazolium chloride (TTC) stain. ResultsHigh dose (240 mg/kg) and moderate dose (80 mg/kg) of BPI-1095 were able to improve the neurological deficit in MCAO rats (P<0.05, vs vehicle-treated group), as well as they decrease the infracted volume (P<0.05, vs the vehicle-treated group ) 24 h after ischemia.Conclusion80～240 mg/kg BPI-1095 is able to improve neurological deficit effectively and reduce infarct volume significantly.

Intravenous administration of rat bone marrow derived endothelia cells in rats after stroke / 中国康复理论与实践

@#ObjectiveTo observe the therapeutic benefit of administration of endothelial cells derived from rat bone marrow cells in ischemic stroke rats and to explore the related mechanism.MethodsPrepared endothelial cells from bone marrow stromal cells (BMSC) of rats, which were multiplied and differentiated in the medium with 400ng/ml rhGM-CSF in vivo. Rats were subjected to permanent cerebral middle artery occlusion (MCAO) models(n=45). Injected intravenously via tongue vein with 3×106 endothelial cells 24 h after stroke for test groups(n=15); injected same amount PBS for control group 1(n=15); control groups without any intervention after stroke (n=15). Neurologic functional behaviour tests (postural reflex test, limb use asymmetrical test and corner test) were performed before transplantation and 1,3,5,7,14 d after stroke. Meanwhile, immunohistochemistry staining was used to identify for vascular endothelial growth factor (VEGF) and its receptor FLK-1 expression in ischemic brain tissue.ResultsSignificant recovery of neurological function was detected in rats treated with endothelial cells on the 7th day and 14th day after stroke, compared with control group 1 and group 2(P<0.05);The number of positive cells of VEGF, FLK-1 were significant more in the peri-ischemic tissue and ipsilateral cortex, compared with non-ischemic hemisphere. The maximum number of positive cells was in the test group which was treated with endothelial cells(P<0.05);VEGF was mainly expressed at neurons, glial cells and part of endothelial cells; FLK-1 was mainly expressed at endothelial cells and part of neurons and glial cells;capillary hyperplasia was demonstrated more at the ischemic hemisphere in the rats treated with endothelial cells, compared with control group 1 or 2.ConclusionEndothelial cells derived from bone marrow cells in rats could improve neurological outcome in rats with ischemic stroke. The effect starts to be significant on the 7th day after transplantation and it shows more significant effect on the 14th day. Endothelial cells transplantation will enhance VEGF, FLK-1 expression at ischemic area and increases capillary hyperplasia formation, which may relate to the potential mechanism of neurological outcome improvement post stroke in rats.

Stem cell transplantation: a new strategy for treatment of nervous system diseases / 中国组织工程研究

OBJECTIVE: Transplantation of stem cell, especially neural stem cell, has been proven effective in treating nervous system diseases in animal models,which provides new hopes for recovery of nerve functions in patients suffering from various nervous system diseases. Multiple studies have been conducted on the role of neural stem cells in repairing nerve functions, and several hypotheses have been proposed to explain how the stem cells or neural stem cells acts to recover nerve function.DATA SOURCES: We searched Medline for English articles from January 1997 to August 2003 with stem cell, neural stem cell, bone marrow stromal cell, stroke, ischemic injury, nervous system disease, and neurotrophic factor as the keywords. We also searched Wangfang database for Chinese articles with the same keywords from January 2003 to December 2004.STUDY SELECTION: The articles found in these two databases were primarily screened with the inclusion criteria as follow: the subjects should be animals or human; and the study should be the basic and/or clinical researches on(neural) stem cells.DATA EXTRACTION: Totally 72 English and Chinese articles were found in the two databases, among which 14 articles were closely associated with the present study and 10 were indirectly related. Eight articles were excluded for repetition in the contents. Finally 16 articles were included for analysis.DATA SYNTHESIS: The full text of the articles were reviewed and summarized. The results of these articles suggest that neural stem cells are valuable in treating cerebral vascular diseases, brain and spine injury, nerve degeneration diseases, and peripheral nerves diseases.CONCLUSION: Stem cells, especially neural stem cells, play active roles in treating nervous systeme diseases such as differentiation promotion, nerves nourishing, and nerve substitute.

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.

New theory and new practice of Statins in the management of ischemic stroke / 中国实用内科杂志

Nowadays,statin has been one of the key medications for the prevention and treatment of cardiovascular and cerebrovascular diseases.Over the past years,lost of studies related to statins in preventing and treat ischemic cerebrovascular disease have been carried out.For clinical practice,this paper reviewed the clinical evidences of statins on primary prevention and secondary prevention for ischemic stroke as well as the safety of statins.

Cognitive Dysfunction in Vascular Dementia / 中国心理卫生杂志

Objective: To evaluate the cognitive dysfunction of patients with vascular dementia (VD) Method: A cross-sectiona l investigation was done in 32 pat ients with VD and 26 normal control All of them were tested with MMSE, ADL (ac t ivity of daily life), DS (digit span), and HAMD Results: (1) M MSE result, compared with control, patient's time orientation (244?119/47 3?0 60, t=915, p