The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient(ADC), cannot reveal microstructural changes in different locati...The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient(ADC), cannot reveal microstructural changes in different locations or the degree of infarction. This prospective observational study was reviewed and approved by the Institutional Review Board of Xiamen Second Hospital, China(approval No. 2014002).Diffusion kurtosis imaging(DKI) was used to detect 199 lesions in 156 patients with acute ischemic stroke(61 males and 95 females), mean age 63.15 ± 12.34 years. A total of 199 lesions were located in the periventricular white matter(n = 52), corpus callosum(n = 14), cerebellum(n = 29), basal ganglia and thalamus(n = 21), brainstem(n = 21) and gray-white matter junctions(n = 62). Percentage changes of apparent diffusion coefficient(ΔADC) and DKI-derived indices(fractional anisotropy [ΔFA], mean diffusivity [ΔMD], axial diffusivity [ΔD_a], radial diffusivity ΔDr, mean kurtosis [ΔMK], axial kurtosis [ΔK_a], and radial kurtosis [ΔK_r]) of each lesion were computed relative to the normal contralateral region. The results showed that(1) there was no significant difference in ΔADC, ΔMD, ΔD_a or ΔD_r among almost all locations.(2) There was significant difference in ΔMK among almost all locations(except basal ganglia and thalamus vs. brain stem; basal ganglia and thalamus vs. gray-white matter junctions; and brainstem vs. gray-white matter junctions.(3) The degree of change in diffusional kurtosis in descending order was as follows: corpus callosum > periventricular white matter > brainstem > gray-white matter junctions > basal ganglia and thalamus > cerebellum. In conclusion, DKI could reveal the differences in microstructure changes among various locations affected by acute ischemic stroke, and performed better than diffusivity among all groups.展开更多
Brain magnetic resonance imaging （MRI） of the elderly often reveals white matter changes （WMCs） with substantial variability across individuals. Our study was designed to explore MRI features and site-specific fac...Brain magnetic resonance imaging （MRI） of the elderly often reveals white matter changes （WMCs） with substantial variability across individuals. Our study was designed to explore MRI features and site-specific factors of ischemic WMCs. Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed. Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations. Analyses of variance （ANOVAs） were used to detect regionally specific differences in lesions. We found that lesion distribution differed significantly across five cerebral areas, with lesions being predominant in the frontal lobe and parieto-occipital area. To explore WMCs risk factors, after adjusting for gender, diabetes mellitus, and hypertension, only age （P〈0.01）, creatinine （P=0.01）, alkaline phosphatase （ALP） （P=0.01） and low-density lipoprotein cholesterol （LDL-C） （P=0.03） were found to be independently associated with severe WMCs. Age （P〈0.001） was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia （P=0.048） or infratentorial area （P=0.016）. In conclusion, MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area. The infratentorial area was least affected by WMCs. Typically, age-related WMCs were observed in the frontal lobes, while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.展开更多
Objective The purpose of this study is to investgate changes of cTnI in myocardial ischemic and reperfusion injury during correction of cardiac defects in children. Methods From June, 1999 to May,2000,45 children (30 ...Objective The purpose of this study is to investgate changes of cTnI in myocardial ischemic and reperfusion injury during correction of cardiac defects in children. Methods From June, 1999 to May,2000,45 children (30 male, 15 female) undergoing correction of cardiac defects were divided into three groups randomly: group Ⅰ no myocardial ischemia,group Ⅱ myocardial ischemia less than 60 minutes, group Ⅲmyocardial ischemia 】 60 minutes. There were no significant differences in the three groups in age, sex ratio, C/T ratio, or left ventricular function. Blood samples for analysis were collected before skin incision and at time intervals up to 6 days postoperatively. Analysis of creatine kinase MB.LDH and cardiac-specific troponin I was used for the detection of myocardial damage. Meantime, the ECG was checked for myocardial infarction. After the reperfusion, myocardial tissue was obtained from the free wall of right ventricle myocardial structure studies. Results The level of cTnI was increased展开更多
At present, the only FDA approved treatment for ischemic strokes is intravenous administration of tissue plasminogen activator within 4.5 hours of stroke onset. Owing to this brief window only a small percentage of pa...At present, the only FDA approved treatment for ischemic strokes is intravenous administration of tissue plasminogen activator within 4.5 hours of stroke onset. Owing to this brief window only a small percentage of patients receive tissue plasminogen activator. Transcranial laser therapy has been shown to be effective in animal models of acute ischemic stroke, resulting in significant improvement in neurological score and function. NEST-1 and NEST-2 clinical trials in human patients have demonstrated the safety and positive trends in efficacy of transcranial laser therapy for the treatment of ischemic stroke when initiated close to the time of stroke onset. Combining intravenous tissue plasminogen activator treatment with transcranial laser therapy may provide better functional outcomes. Statins given within 4 weeks of stroke onset improve stroke outcomes at 90 days compared to patients not given statins, and giving statins following transcranial laser therapy may provide an effective treatment for patients not able to be given tissue plasminogen activator due to time constraints.展开更多
Transient ischemic attack（TIA） is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiogra...Transient ischemic attack（TIA） is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiography（TEE） in patients with TIA are sparse.Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA（i.e.,transient neurological symptoms without evidence of infarction）.During a 4-year period（2011–2014）,1071 patients（mean age,70 ± 13 years;female,49.7%） with TIA were included in a prospective study and evaluated.Of 1071 consecutive patients suffering from TIA,288 patients（27%） underwent TEE.The median time between admission and TEE was 6 days.Patients with TIA who were evaluated by TEE were younger（67 vs.71 years,P 〈 0.001） than those who were not evaluated by TEE.They had a higher rate of sensibility disturbance as a TIA symptom（39% vs.31%,P = 0.012） but a lower rate of previous stroke（15% vs.25%,P = 0.001） and atrial fibrillation（2% vs.21%,P 〈 0.001） than those who did not.Foramen ovale was detected in 71 patients（25.7%）,atrial septal aneurysm in 13 patients（4.6%）,and severe atherosclerotic plaques（grade 4 and 5） in the aortic arch in 25 patients（8.7%）.One patient（0.3%） had a fibroma detected by TEE.In 17 of the 288 patients（6%） who underwent TEE,the indication for anticoagulation therapy was based on the TEE results,and 1 patient with fibroma underwent heart surgery.During hospitalization,7 patients experienced a subsequent stroke,and 27 patients had a recurrent TIA.At 3 months following discharge,the rates of readmission,stroke,recurrent TIA,and death were 19%,2.7%,4.2%,and 1.6%,respectively.The rates of mortality（0.9% vs.1.8%,P = 0.7）,stroke risk（1.9% vs.3.0%,P = 0.8）,and recurrent TIA（5.0% vs.3.9%,P = 0.8） were similar in patients who underwent TEE and in those who did not.Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation.展开更多
Objective:To investigate the effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke.Methods: One hundred cases of ischemic stroke admitted in our hos...Objective:To investigate the effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke.Methods: One hundred cases of ischemic stroke admitted in our hospital from February 2015 to January 2017 were randomly divided into control group and observation group. The control group was given routine treatment. The observation group was given Shuxuetong injection on the basis of the control group. The changes of platelet function, hemorheology and cerebral blood flow before and after treatment were detected in both groups.Results: After treatment, the whole blood viscosity, plasma viscosity and fibrinogen level in both groups were significantly lower than those before treatment. The whole blood viscosity, plasma viscosity and fibrinogen level in the observation group were (4.18±0.05) mPa?s, (1.66±0.12) mPa?s and (3.45±0.08) g/L, respectively, which were significantly lower than the control group;After treatment, the levels of MCA, ACA and PCA in both groups were significantly increased. MCA, ACA and PCA levels in the observation group were (70.82±4.13) cm/s, (60.62±3.55) cm/s and (54.11±2.36) cm/s, which were significantly higher than those in the control group;After treatment, the maximum platelet aggregation rate, PLT, MPV and PDW levels in the two groups significantly decreased. The maximum platelet aggregation rate, PLT, MPV and PDW levels in the observation group were (27.93±1.44)% and (155.32±13.46)×109/L, (9.42±0.32) fL and (9.12±0.24) fL, respectively, which were significantly lower than those in the control group. Conclusions: Shuxuetong injection can effectively improve the patient's hemorheology and platelet function, improve the level of cerebral blood flow in patients with significant effect, it is worth further clinical application.展开更多
Objective: To observe the effects of re-mote ischemia on cognitive function and neuronal patho-logical damage in rats with cognitive impairment induced by bilateral common carotid artery occlusion(BCAO).Methods:Male S...Objective: To observe the effects of re-mote ischemia on cognitive function and neuronal patho-logical damage in rats with cognitive impairment induced by bilateral common carotid artery occlusion(BCAO).Methods:Male SD rats were selected to establish the cognitive impairment model induced by cerebral isch-emia reperfusion caused by BCAO.The tests included three groups of rats:a sham group,a model group with vascular cognitive impairment (VCI) , and a remote ischemic conditioning (RIC) group (VCI + RIC group). From 24 h after operation, both hind limbs of rats in VCI + RIC group were treated with RIC. After 28 d, Morris water maze test and HE staining was used to observe the pathological changes of white matter and hippocampus in each group.Results: After 3 d mice in VCI group began to improve gradually. The recovery of rats in the VCI + RIC group was relatively slow,but they started to recover rapidly 2 d after the operation.Morris water maze test showed that the escape latency of rats in VCI group and VCI+RIC group was longer than that in the sham group, and the score of VCI+RIC group was better than that of the VCI group, but there was a significant difference be-tween the two groups(P<0.05).The space exploration experiment was performed at 7 d and 28 d after the oper-ation;the VCI+RIC group outperformed the VCI group in both trials;the difference between the two groups was statistically significant (P<0.05).In the target quadrant exploration time, the difference between the VCI group (33.5±11.3 s) and the VCI+RIC group (41.2±9.7 s) was statistically significant (P<0.05).Results from the he-matoxylin and eosin(HE)staining showed that compared with VCI group, cortical cells in VCI + RIC group had loose stroma, thinner nerve fibers, fewer broken cells, and slightly shrunken cells. Compared with VCI group, neu-rons in VCI + RIC group had a little vacuolar degenera-tion and slightly shrunken cell volume.Conclusion:Ce-rebral ischemia-reperfusion injury can cause learning and memory impairment in rats, leading to VCI. RIC can sig-nificantly improve VCI and play a neuroprotective role.展开更多
基金supported by the Science and Technology Planned Project from Xiamen Science and Technology Bureau,China,No.3502Z20154065(to LHZ)the Joint Project for Xiamen Key Diseases from Xiamen Science and Technology Bureau,China,No.3502Z20149032(to GG)
文摘The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient(ADC), cannot reveal microstructural changes in different locations or the degree of infarction. This prospective observational study was reviewed and approved by the Institutional Review Board of Xiamen Second Hospital, China(approval No. 2014002).Diffusion kurtosis imaging(DKI) was used to detect 199 lesions in 156 patients with acute ischemic stroke(61 males and 95 females), mean age 63.15 ± 12.34 years. A total of 199 lesions were located in the periventricular white matter(n = 52), corpus callosum(n = 14), cerebellum(n = 29), basal ganglia and thalamus(n = 21), brainstem(n = 21) and gray-white matter junctions(n = 62). Percentage changes of apparent diffusion coefficient(ΔADC) and DKI-derived indices(fractional anisotropy [ΔFA], mean diffusivity [ΔMD], axial diffusivity [ΔD_a], radial diffusivity ΔDr, mean kurtosis [ΔMK], axial kurtosis [ΔK_a], and radial kurtosis [ΔK_r]) of each lesion were computed relative to the normal contralateral region. The results showed that(1) there was no significant difference in ΔADC, ΔMD, ΔD_a or ΔD_r among almost all locations.(2) There was significant difference in ΔMK among almost all locations(except basal ganglia and thalamus vs. brain stem; basal ganglia and thalamus vs. gray-white matter junctions; and brainstem vs. gray-white matter junctions.(3) The degree of change in diffusional kurtosis in descending order was as follows: corpus callosum > periventricular white matter > brainstem > gray-white matter junctions > basal ganglia and thalamus > cerebellum. In conclusion, DKI could reveal the differences in microstructure changes among various locations affected by acute ischemic stroke, and performed better than diffusivity among all groups.
基金This work was supported by grants from Scientific Research Project of Health and Family Planning of Hubei Province （No. WJ2015MB056）, Natural Science Foundation of Hubei Province （No. 2015CFB572）, and Clinical Research Physician Program of Tongji Medical College, HUST.
文摘Brain magnetic resonance imaging （MRI） of the elderly often reveals white matter changes （WMCs） with substantial variability across individuals. Our study was designed to explore MRI features and site-specific factors of ischemic WMCs. Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed. Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations. Analyses of variance （ANOVAs） were used to detect regionally specific differences in lesions. We found that lesion distribution differed significantly across five cerebral areas, with lesions being predominant in the frontal lobe and parieto-occipital area. To explore WMCs risk factors, after adjusting for gender, diabetes mellitus, and hypertension, only age （P〈0.01）, creatinine （P=0.01）, alkaline phosphatase （ALP） （P=0.01） and low-density lipoprotein cholesterol （LDL-C） （P=0.03） were found to be independently associated with severe WMCs. Age （P〈0.001） was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia （P=0.048） or infratentorial area （P=0.016）. In conclusion, MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area. The infratentorial area was least affected by WMCs. Typically, age-related WMCs were observed in the frontal lobes, while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.
文摘Objective The purpose of this study is to investgate changes of cTnI in myocardial ischemic and reperfusion injury during correction of cardiac defects in children. Methods From June, 1999 to May,2000,45 children (30 male, 15 female) undergoing correction of cardiac defects were divided into three groups randomly: group Ⅰ no myocardial ischemia,group Ⅱ myocardial ischemia less than 60 minutes, group Ⅲmyocardial ischemia 】 60 minutes. There were no significant differences in the three groups in age, sex ratio, C/T ratio, or left ventricular function. Blood samples for analysis were collected before skin incision and at time intervals up to 6 days postoperatively. Analysis of creatine kinase MB.LDH and cardiac-specific troponin I was used for the detection of myocardial damage. Meantime, the ECG was checked for myocardial infarction. After the reperfusion, myocardial tissue was obtained from the free wall of right ventricle myocardial structure studies. Results The level of cTnI was increased
文摘At present, the only FDA approved treatment for ischemic strokes is intravenous administration of tissue plasminogen activator within 4.5 hours of stroke onset. Owing to this brief window only a small percentage of patients receive tissue plasminogen activator. Transcranial laser therapy has been shown to be effective in animal models of acute ischemic stroke, resulting in significant improvement in neurological score and function. NEST-1 and NEST-2 clinical trials in human patients have demonstrated the safety and positive trends in efficacy of transcranial laser therapy for the treatment of ischemic stroke when initiated close to the time of stroke onset. Combining intravenous tissue plasminogen activator treatment with transcranial laser therapy may provide better functional outcomes. Statins given within 4 weeks of stroke onset improve stroke outcomes at 90 days compared to patients not given statins, and giving statins following transcranial laser therapy may provide an effective treatment for patients not able to be given tissue plasminogen activator due to time constraints.
文摘Transient ischemic attack（TIA） is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiography（TEE） in patients with TIA are sparse.Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA（i.e.,transient neurological symptoms without evidence of infarction）.During a 4-year period（2011–2014）,1071 patients（mean age,70 ± 13 years;female,49.7%） with TIA were included in a prospective study and evaluated.Of 1071 consecutive patients suffering from TIA,288 patients（27%） underwent TEE.The median time between admission and TEE was 6 days.Patients with TIA who were evaluated by TEE were younger（67 vs.71 years,P 〈 0.001） than those who were not evaluated by TEE.They had a higher rate of sensibility disturbance as a TIA symptom（39% vs.31%,P = 0.012） but a lower rate of previous stroke（15% vs.25%,P = 0.001） and atrial fibrillation（2% vs.21%,P 〈 0.001） than those who did not.Foramen ovale was detected in 71 patients（25.7%）,atrial septal aneurysm in 13 patients（4.6%）,and severe atherosclerotic plaques（grade 4 and 5） in the aortic arch in 25 patients（8.7%）.One patient（0.3%） had a fibroma detected by TEE.In 17 of the 288 patients（6%） who underwent TEE,the indication for anticoagulation therapy was based on the TEE results,and 1 patient with fibroma underwent heart surgery.During hospitalization,7 patients experienced a subsequent stroke,and 27 patients had a recurrent TIA.At 3 months following discharge,the rates of readmission,stroke,recurrent TIA,and death were 19%,2.7%,4.2%,and 1.6%,respectively.The rates of mortality（0.9% vs.1.8%,P = 0.7）,stroke risk（1.9% vs.3.0%,P = 0.8）,and recurrent TIA（5.0% vs.3.9%,P = 0.8） were similar in patients who underwent TEE and in those who did not.Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation.
文摘Objective:To investigate the effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke.Methods: One hundred cases of ischemic stroke admitted in our hospital from February 2015 to January 2017 were randomly divided into control group and observation group. The control group was given routine treatment. The observation group was given Shuxuetong injection on the basis of the control group. The changes of platelet function, hemorheology and cerebral blood flow before and after treatment were detected in both groups.Results: After treatment, the whole blood viscosity, plasma viscosity and fibrinogen level in both groups were significantly lower than those before treatment. The whole blood viscosity, plasma viscosity and fibrinogen level in the observation group were (4.18±0.05) mPa?s, (1.66±0.12) mPa?s and (3.45±0.08) g/L, respectively, which were significantly lower than the control group;After treatment, the levels of MCA, ACA and PCA in both groups were significantly increased. MCA, ACA and PCA levels in the observation group were (70.82±4.13) cm/s, (60.62±3.55) cm/s and (54.11±2.36) cm/s, which were significantly higher than those in the control group;After treatment, the maximum platelet aggregation rate, PLT, MPV and PDW levels in the two groups significantly decreased. The maximum platelet aggregation rate, PLT, MPV and PDW levels in the observation group were (27.93±1.44)% and (155.32±13.46)×109/L, (9.42±0.32) fL and (9.12±0.24) fL, respectively, which were significantly lower than those in the control group. Conclusions: Shuxuetong injection can effectively improve the patient's hemorheology and platelet function, improve the level of cerebral blood flow in patients with significant effect, it is worth further clinical application.
基金Natural Science Foundation of Inner Mongolia Au-tonomous Region(2021MS08169).
文摘Objective: To observe the effects of re-mote ischemia on cognitive function and neuronal patho-logical damage in rats with cognitive impairment induced by bilateral common carotid artery occlusion(BCAO).Methods:Male SD rats were selected to establish the cognitive impairment model induced by cerebral isch-emia reperfusion caused by BCAO.The tests included three groups of rats:a sham group,a model group with vascular cognitive impairment (VCI) , and a remote ischemic conditioning (RIC) group (VCI + RIC group). From 24 h after operation, both hind limbs of rats in VCI + RIC group were treated with RIC. After 28 d, Morris water maze test and HE staining was used to observe the pathological changes of white matter and hippocampus in each group.Results: After 3 d mice in VCI group began to improve gradually. The recovery of rats in the VCI + RIC group was relatively slow,but they started to recover rapidly 2 d after the operation.Morris water maze test showed that the escape latency of rats in VCI group and VCI+RIC group was longer than that in the sham group, and the score of VCI+RIC group was better than that of the VCI group, but there was a significant difference be-tween the two groups(P<0.05).The space exploration experiment was performed at 7 d and 28 d after the oper-ation;the VCI+RIC group outperformed the VCI group in both trials;the difference between the two groups was statistically significant (P<0.05).In the target quadrant exploration time, the difference between the VCI group (33.5±11.3 s) and the VCI+RIC group (41.2±9.7 s) was statistically significant (P<0.05).Results from the he-matoxylin and eosin(HE)staining showed that compared with VCI group, cortical cells in VCI + RIC group had loose stroma, thinner nerve fibers, fewer broken cells, and slightly shrunken cells. Compared with VCI group, neu-rons in VCI + RIC group had a little vacuolar degenera-tion and slightly shrunken cell volume.Conclusion:Ce-rebral ischemia-reperfusion injury can cause learning and memory impairment in rats, leading to VCI. RIC can sig-nificantly improve VCI and play a neuroprotective role.
