Epidemiology of stroke and its risk factors in Shandong province, China / 中华神经科杂志

Objective@#To investigate the stroke burden (prevalence, incidence, and mortality) and its risk factors for men and women, urban and rural residents at the provincial level in Shandong province.@*Methods@#This study formed part of the National Epidemiological Survey of Stroke in China (NESS-China). This population-based study included 25 190 adults living in Shandong province and was conducted in 2013. The data were derived from eight disease surveillance points (DSPs). They were located in Qingdao Shibei district, Zaozhuang Xuecheng district, Yantai Zhifu district, Laiwu Laicheng district, Yantai Penglai, Weifang Gaomi, Zaozhuang Yiyuan, Linyi Junan. All living subjects who had suffered a stroke by August 31, 2013 were considered as having a prevalent stroke. Incident stroke was defined as a first-ever stroke (both fatal and non-fatal) between September 1, 2012 and August 31, 2013. Fatal cases of incident strokes were used to estimate stroke mortality rate. Stroke cases were subcategorized as follows: ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Stroke cases with no brain imaging within the first week of stroke onset or cases where the results of imaging were not available were classified as stroke of undetermined pathological type (UND).@*Results@#Of the 25 190 participants, 449 had experienced a prevalent stroke, 118 participants were diagnosed as having an incident stroke, 33 fatal cases were identified over the 12-month period. The crude rate of prevalence, incidence and mortality were 1 782.5 per 100 000 people, 468.4 per 100 000 person-years and 131.0 per 100 000 person-years. The age-standard rate of prevalence, incidence and mortality were 1 059.0 per 100 000 people, 279.7 per 100 000 person-years, and 76.0 per 100 000 person-years. Compared to women, the prevalence of stroke was markedly higher among men (1 463.3 per 100 000 people vs 2 265.0 per 100 000 people). Compared to urban residents, the prevalence of stroke was markedly higher among rural residents (563.7 per 100 000 people vs 2 203.6 per 100 000 people). Among all prevalent cases, there were 348 people suffering from IS, 75 cases suffering from ICH, 6 cases suffering from SAH, and 20 cases of UND. The prevalece rates of IS, ICH, SAH and UND were 1 385.5 per 100 000 people, 301.7 per 100 000 people, 23.8 per 100 000 people and 79.4 per 100 000 people, respectively. The three most prevalent risk factors in stroke cases were hypertension (66.4%), current smoking (26.1%), and alcohol drinking (24.9%).@*Conclusions@#Stroke was highly prevalent in Shandong province, China. The prevalence and incidence rates of stroke were significantly greater for men than women. Large geographical variations in the stroke burden were also observed in Shandong province, with a greater stroke burden observed in rural areas.

Epidemiology of stroke and its risk factors in Shandong province, China / 中华神经科杂志

Objective To investigate the stroke burden (prevalence, incidence, and mortality) and its risk factors for men and women, urban and rural residents at the provincial level in Shandong province. Methods This study formed part of the National Epidemiological Survey of Stroke in China (NESS?China). This population?based study included 25 190 adults living in Shandong province and was conducted in 2013. The data were derived from eight disease surveillance points (DSPs). They were located in Qingdao Shibei district, Zaozhuang Xuecheng district, Yantai Zhifu district, Laiwu Laicheng district, Yantai Penglai, Weifang Gaomi, Zaozhuang Yiyuan, Linyi Junan. All living subjects who had suffered a stroke by August 31, 2013 were considered as having a prevalent stroke. Incident stroke was defined as a first?ever stroke (both fatal and non?fatal) between September 1, 2012 and August 31, 2013. Fatal cases of incident strokes were used to estimate stroke mortality rate. Stroke cases were subcategorized as follows:ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Stroke cases with no brain imaging within the first week of stroke onset or cases where the results of imaging were not available were classified as stroke of undetermined pathological type (UND). Results Of the 25 190 participants, 449 had experienced a prevalent stroke, 118 participants were diagnosed as having an incident stroke, 33 fatal cases were identified over the 12?month period. The crude rate of prevalence, incidence and mortality were 1 782.5 per 100 000 people, 468.4 per 100 000 person?years and 131.0 per 100 000 person?years. The age?standard rate of prevalence, incidence and mortality were 1 059.0 per 100 000 people, 279.7 per 100 000 person?years, and 76.0 per 100 000 person?years. Compared to women, the prevalence of stroke was markedly higher among men (1 463.3 per 100 000 people vs 2 265.0 per 100 000 people). Compared to urban residents, the prevalence of stroke was markedly higher among rural residents (563.7 per 100 000 people vs 2 203.6 per 100 000 people). Among all prevalent cases, there were 348 people suffering from IS, 75 cases suffering from ICH, 6 cases suffering from SAH, and 20 cases of UND. The prevalece rates of IS, ICH, SAH and UND were 1 385.5 per 100 000 people, 301.7 per 100 000 people, 23.8 per 100 000 people and 79.4 per 100 000 people, respectively. The three most prevalent risk factors in stroke cases were hypertension (66.4%), current smoking (26.1%), and alcohol drinking (24.9%). Conclusions Stroke was highly prevalent in Shandong province, China. The prevalence and incidence rates of stroke were significantly greater for men than women. Large geographical variations in the stroke burden were also observed in Shandong province, with a greater stroke burden observed in rural areas.

Carotid stenting for progressive cerebral watershed infarction patients with ipsilateral internal carotid stenosis or occlusion / 国际脑血管病杂志

Objective To investigate the effectiveness and safety of carotid stenting for progressive cerebral watershed infarction (PCWI) patients with ipsilateral internal carotid stenosis or occlusion during the progressive stage. Methods The clinical data of 23 PCWI patients with ipsilateral internal carotid stenosis or occlusion treated with carotid stenting during the progressive stage were analyzed retrospectively. Among them, 18 were severe internal carotid artery stenosis, and 5 were carotid artery occlusion. Carotid artery stenting were performed in patients with severe internal carotid artery stenosis. The first-stage angioplasty and second-stage stenting were performed in patients with internal carotid artery occlusion. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale (mRS) were used to evaluate preoperative and postoperative neurologic deficits. Results Twenty-two of 23 patients were stented successfuly, the Thrombolysis In Myocardial Infarction (TIMI) flow grade was 3, and the technical success rate was 95. 7% . None of the patients demonstrated hyperperfusion in the ipsilateral hemisphere. At day 30 postprocedure, the NHISS scores were significantly improved compared with before procedure (4. 41 ± 1. 88 vs. 10. 00 ± 1. 47; t = 11. 234, P < 0. 001). The preprocedural TIMI flow grade was 3 in 12 patients (52. 2% ). Proportion of patients with TIMI flow grade 3 after procedure was significantly increased compared with before procedure (95. 7% vs. 52. 2% ; χ2 = 11. 274, P = 0. 002). The proportion of patients with mRS scores 0-2 at day 90 after procedure was significantly increased compared with before procedure (69. 6% vs. 0% ; χ2 = 24. 533, P < 0. 001). Conclusions Carotid stenting during the progressive stage is safe and it may improve the prognosis in PCWI patients with ipsilateral internal carotid stenosis or occlusion.

Change of MicroRNA-134, CREB and p-CREB expression in epileptic rat

Objective: To To investigate the changes of MicroRNA-134, CREB and p-CREB expression in epileptic rat brains in order to elucidate the molecular mechanisms of epilepsy, providing new ideas for clinical treatment. Methods: Sixty-four Spraque-Dawley (SD) rats were divided into groups randomly, including control group, six hours after seizure group, 24-hour group, three-day group, one-week group, two-week group, four-week group, and eight-week group. All groups were placed under a pilocarpine-induced epilepsy model except the control group, and all rats were decapitated in different points of time. Brain specimens were taken for quantitative PCR experiments, immunohistochemistry and Western blot experiments. The results of the epilepsy model groups and the control group were compared. Results: There were no significant differences between the six hours after seizure group, the 24-hour group and the control group about the MicroRNA-134 levels. MicroRNA-134 in the hippocampus tissue of the three-day group significantly reduced compared with the control group; same result was observed with the one-week, two-week, four-week and eight-week groups. The CREB and p-CREB levels in the three-day group’s rat hippocampus significantly increased compared with the control group; and the high levels of CREB and p-CREB were constantly maintained in the one-week, two-week, four-week and eight-week groups. Conclusions: The MicroRNA-134 level of the epileptic rat hippocampus is significantly lower than normal after three days, and continues to maintain a low level; while CREB and p-CREB levels are rsignificantly increased after three days, and continue to remain at a high level. MicroRNA-134 plays a role in inhibiting synaptic plasticity by inhibiting CREB and p-CREB expressions.

Dynamic changes of kinesin family member 17 protein expression in the pilocarpine-induced rat model / 中华神经科杂志

Objective To investigate the kinesin family member 17 (KIF17) expression and cellular localization in the hippocampus and temporal lobe cortex in the rat lithium-pilocarpine model of epilepsy,and discuss its function in the epilepsy pathogenesis.Methods The animal model was established by lithiumpilocarpine induction in rats.Totally 49 adult healthy male Wistar rats were randomly divided into control group (n =7) and experimental group (n =42).The experimental group included 6 subgroups (n =7)according to sacrifice time (24 h,72 h,7 d,14 d,1 month and 2 months).The expression and localization of KIF17 were examined by western blot and double-label immunofluorescence,respectively.Results In rat hippocampus,the expression of KIF17 protein increased after the onset of seizure (the ration of KIF17/β-actin were:24 h 0.516 ± 0.196,72 h 0.742 ± 0.313),reached its peak in 7 days (0.888 +0.319)and then slowed down (14 d 0.770 ± 0.271,1 month 0.742 ± 0.261,2 months 0.714 ± 0.271),all of which were significantly higher than that in the control group (0.495 ± 0.203).And all the differences had statistical significance (t =7.051,4.974,7.419,8.795,8.264,6.676,all P ＜ 0.05).In rat cortex of temporal lobe,the expression of KIF17 protein increased after the onset of seizure and reached its peak in 30 d.The optical density ration in the experimental groups were higher than that in the control group.Doublelabel immunofluorescence disclosed that the KIF17 localized in the neurons,including excitable neurons and inhibitory neurons,but not in the astrocytes which were performed with anti-microtubule-associated protein 2,anti-brain-specific Na-dependent inorganic phosphate cotransporter,anti-glutamate decarboxylase 1 and anti-glial fibrillary acidic protein,respectively.Conclusion KIF17 may play a potential role in the pathogenetic mechanisms of the rat lithium-pilocarpine model of epilepsy.

Clinical and pathological characteristics of microsporidian encephalitis / 中华神经科杂志

Objective To study the clinical and pathological manifestations of microsporidian encephalitis.Methods The clinical findings and the brain pathological features of a patient with microsporidian encephalitis hospitalized in 2004 were studied.Results The onset was subacute or chronic. The body temperature was usually normal or below 37.5℃,but it rose when patient's condition deteriorated and coma appeaxed.The patient had hypoimmunity but without human immunodeficiency virus infection. Multifocal lesions in the whole brain,signs of meningeal irritation and infective myelogram were observed. Rheumatoid factor increased in the early stage and indirect bilirubin,proteins in cerebrospinal fluid(CSF), and immunoglobulin IgG,IgA increased in the middle stage.Cytological examination of CSF showed lymphocyte reaction.Blood routine test showed normal eosinophil granulocyte count.The patient was found to have pleurisy,peritonitis and cystitis.Brain magnetic resonance image(MRI)manifested plaque-like isometric T1 weight image and long T2 weight image signal in white matter of bilateral cerebral hemisphere and cerebella where FLAIR sequence showed hyperintensity.No apparent mass was identified.Contrast- enhanced MRI scan showed patchy and ring-like intensification.The neural system impairments were permanent and not improved after treatment.The pathology of brain tissue showed neuronal degeneration, karyopycnosis and Derivasculitis.The infectious agents were observed in the cytoplasm of neurons.Wister rats had muhiple organ inflammatory reaction 2 weeks after intraperitoneal inoculation of the patient's CSF and a large quantity of pathogens were found in the peritoneal lavage fluid.Conclusions The patient was PAS staining method is useful for detecting the pathogen in neurons and the rate can be raised by animal intraperitoneal cultivation

Bone marrow stem cells and neuroregeneration / 基础医学与临床

Stem cells in bone marrow are considered as an ideal sources of seed cells with the advantage of being isolation and easy proliferated in vitro,which is a prerequisite for the autotransplantation. Studies show that the cells can differentiate into neurons. However,this opinion challenges the traditional conception of cell differentiation and therefore the dispute arises. Here we review the results of research on dedifferentiation of bone marrow cells.