误诊为缺血性脑卒中的代谢性脑病原因分析

目的提高对误诊为缺血性脑卒中的代谢性脑病的识别度,降低代谢性脑病的临床误诊率。方法回顾性分析2018年1月—2020年12月初诊为缺血性脑卒中后证实为代谢性脑病3例的临床资料。结果3例均以意识障碍或肢体活动不利等卒中样发作起病,病初均诊断为缺血性脑卒中,后经过详细问诊、完善的实验室检查、影像学支持及基因检测确诊为代谢性相关肝性脑病1例、线粒体脑肌病伴高乳酸血症和脑卒中疾病样发作1例、高钙血症相关卒中模拟病1例。经对症治疗后3例症状均得到改善。结论代谢性脑病可出现卒中样表现,临床可与缺血性脑卒中混淆。全面分析临床资料、完善相关实验室检查和MRI评估对于提高代谢性脑病诊断正确率至关重要。

急性脑血管病并发感染临床分析

目的 :探讨感染与急性脑血管病的关系。方法 :收集 1995年 1月至 1999年 12月住院的 5 96例急性脑血管病病人的临床资料 ,对起病前后感染进行回顾性调查分析。结果 :①病前近期感染 2 6例 ,中青年 2 1例 (81.7% )。脑梗塞 19例 (73.1% )。病后医院感染 115例 ,平均年龄 5 2 .3± 16 .8岁 ,脑出血 6 1例 (5 3.0 % )。②感染以呼吸道为主 (6 7.8% ) ,泌尿道次之 (15 .7% )。③感染与病变部位无明显关系。与年龄、出血量、梗塞面积、病情轻重、抗菌素不合理使用有关。结论 :感染是中青年脑梗塞的重要危险因素。感染是造成急性脑血管病病情加重及死亡的主要原因。

氯吡格雷联合神经节苷脂对血管性痴呆患者认知功能及生活质量的影响

目的 探讨氯吡格雷联合神经节苷脂对血管性痴呆患者临床疗效、认知功能及生活质量的影响.方法 将101例血管性痴呆患者按照随机数字表法分为观察组(51例)和对照组(50例).两组均予以常规治疗,在此基础上对照组给予氯吡格雷治疗,观察组予以氯吡格雷联合神经节苷脂治疗,观察3个月.于治疗前后采用简易精神状态量表及简明健康状况调查量表评定认知功能、生活质量,并比较两组的临床疗效及不良反应发生状况.结果 观察组总有效率为98.0％,对照组为84.0％,观察组显著高于对照组(P<0.05).治疗后两组简易精神状态量表及简明健康状况调查量表评分均较治疗前显著提高(P<0.01),观察组显著高于对照组(P<0.01).观察组不良反应总发生率为21.6％,对照组为14.0％,两组比较差异无统计学意义(P>0.05).结论 氯吡格雷联合神经节苷脂治疗血管性痴呆疗效显著,可有效改善患者的认知功能及生活质量,且安全性高.

无症状脑梗塞

无症状脑梗塞(SBI)是指无卒中病史而由神经影像学或尸检发现的梗塞。其症状可能未被认识或被病人遗忘或只有短暂缺血症状。SBI很常见,在无症状颈动脉病变的病人中,约15％的病人CT发现有梗塞;短暂性单眼盲病人中约25％及短暂性半球卒中病人中的相当比率的病人在CT检查时发现有短暂体征性脑梗塞(CITS);约10％的症状性卒中患者CT发现还有与其无关的其它梗塞。MRI检测SBI较CT更具敏感性,3组TIA病人中,103例SI病人中75％是由MRI检出的,相比之下,由CT发现的仅27％。许多SI小而部位深,较大的SI更多见于右半球。在CITS病人中,当TIA发作超过1h且恢复缓慢者,梗塞较常见。在颈动脉闭塞的病人中SI与狭窄的严重程度相关,而在颈动脉溃疡性损伤的患者中SI可能更常见。栓塞(包括心原性和动脉原性)和腔隙梗塞也许是SI的两个最常见发病机制。SI病人在危险因素方面与TIA病人和症状性脑梗塞病人差不多。SBI和症状性脑梗塞的存在,给临床医师提供一些关于病人脑血管病的自然病史信息。脑血管疾病患者的特征取决于下列几点:(1)症状(无、短暂性视网膜性、半球性、偏盲性、脑干/小脑或卒中);(2)脑的状态(正常、功能异常、梗塞);及(3)引起或可能引起卒中的心血管-血液疾病的性质、部位和严重程度。

正常灌注压突破影响因素的探讨

正常灌注压突破（ＮＰＰＢ）是颅脑血管性病变治疗中严重的并发症，因其极高的死亡率和致残率而倍受关注。本研究以Ｗｉｓｔａｒ鼠为实验对象，应用伊文氏蓝渗漏染色技术及血流动力学测定等手段，就高血压、巴比妥酸盐对此“高灌注突破”的影响进行了初步探讨。其结果为现有理论提供了更多的实验依据，并对临床的诊治作出了有益的启示。

脑微出血与血管性认知损害

脑微出血是一种脑小血管病变，在不同人群中的检出率为4．5％～84．9％。血管性认知损害是各种脑血管病及其危险因素所致程度不一的认知损害的总称。研究显示，脑微出血与血管性认知损害关系密切。文章对不同人群、不同程度及不同部位脑微出血与血管性认知损害的关系进行了综述。

Targeting histone deacetylases： perspectives for epigenetic-based therapy in cardio-cerebrovascular disease

Although the pathogenesis of cardio-cerebrovascular disease （CCVD） is multifactorial, an increasing number of experimental and clinical studies have highlighted the importance of histone deacetylase （HDAC）-mediated epigenetic processes in the development of cardio-cerebrovascular injury. HDACs are a family of enzymes to balance the acetylation activities of histone acetyltransferases on chromatin remodeling and play essential roles in regulating gene transcription. To date, 18 mammalian HDACs are identified and grouped into four classes based on similarity to yeast orthologs. The zinc-dependent HDAC family currently consists of 11 members divided into three classes （class I, II, and IV） on the basis of structure, sequence homology, and domain organization. In comparison, class III HDACs （also known as the sirtuins） are composed of a family of NAD＋-dependent protein-modifying enzymes related to the Sir2 gene. HDAC inhibitors are a group of compounds that block HDAC activities typically by binding to the zinc-containing catalytic domain of HDACs and have displayed an- ti-inflammatory and antifibrotic effects in the cardio-cerebrovascular system. In this review, we summarize the current knowledge about classifications, functions of HDACs and their roles and regulatory mechanisms in the cardio-cerebrovascular system. Pharmacological tar- geting of HDAC-mediated epigenetic processes may open new therapeutic avenues for the treatment of CCVD.

ANALYSIS OF RISK FACTORS IN 3901 PATIENTS WITH STROKE

Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry. Methods Data from a total of 3901 patients, consisting of 3525 patients with CI and 376 patients with ICH were pros-pectively coded and entered into a computerized data bank. Results Hypertension and smoking were the most prominent factors affecting overall stroke followed by mild internal carotid artery stenosis (< 50%), hypercholesterolemia, transient ischemic attacks (TIAs), diabetes mellitus, and cardiac ischemia. Univariate analysis showed that factors in male significantly associated with CI versus ICH were old age, a family history of stroke, and intermittent claudication; whereas in female the factors were oral contraception and migraine. By multivariate analysis, in all patients, the factors significantly associated with CI as opposed to ICH were smoking, hyperch-olesterolemia, migraine, TIAs, atrial fibrillation, structural heart disease, and arterial disease. Hypertension was the only significant factor related with ICH versus CI.Conclusions The factors for ischemic and hemorrhagic stroke are not exactly the same. Cardiac and arterial disease are the most powerful factors associated with CI rather than ICH.

Women and exercise in aging

Aging is associated with physiological declines, notably a decrease in bone mineral density （BMD） and lean body mass, with a concurrent increase in body fat and central adiposity. Interest in women and aging is of particular interest partly as a result of gender specific responses to aging, particularly as a result of menopause. It is possible that the onset of menopause may augment the physiological decline associated with aging and inactivity. More so, a higher incidence of metabolic syndrome （an accumulation of cardiovascular disease risk factors including obesity, low-density lipoprotein cholesterol, high blood pressure, and high fasting glucose） has been shown in middle-aged women during the postmenopausal period. This is due in part to the drastic changes in body composition, as previously discussed, but also a change in physical activity （PA） levels. Sarcopenia is an age related decrease in the cross-sectional area of skeletal muscle fibers that consequently leads to a decline in physical function, gait speed, balance, coordination, decreased BMD, and quality of life. PA plays an essential role in combating physiological decline associated with aging. Maintenance of adequate levels of PA can result in increased longevity and a reduced risk for metabolic disease along with other chronic diseases. The aim of this paper is to review relevant literature, examine current PA guidelines, and provide recom- mendations specific to women based on current research.

Cardiovascular care for older adults： hypertension and stroke in the older adult

1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.

Clinical value of multi-slice helical CT angiography in diagnosis of cerebral vascular diseases

Objective: To evaluate the clinical value of multi-slice helical CT angiography (MSCTA) in diagnosis of cerebral vascular diseases. Methods: 52 patients with cerebral vascular diseases were examined with GE Light Speed 4-slice and 16-slice helical CT. Pitch: 0.5–3, slice thickness: 0.625–1.25 mm, adult injection dosage: 90–100 mL, children injection dos- age: 2 mL/kg, injection rate: 2.5–4.0 mL/s, delay time: 15–22 s. Intelligent track scan (Smart prep Rx) were adopted in parts of these cases. Three-dimensional cerebral vascular images were processed at ADW 3.1 and ADW 4.2 workstation. Results: MSCTA could clearly display spacious anatomic details of cerebral aneurysm, including its origin, size, neck width, and trend etc. MSCTA results of 19 cases were consistent with those of operations. The diameter of the smallest cerebral aneurysm shown in our research was about 3 mm. As a non-invasive examination, MSCTA could also be applied in post-operational evaluation of cerebral aneurysm by observing the location of silver clip and the distant vessels. Besides, MSCTA could be used to diagnose arteriovenous malformation and moyamoya disease. Of all the three-dimentional imaging methods, volume rendering (VR) is the best means to display the cerebral vascular diseases. Conclusion: As a non-invasive examination, MSCTA plays an important role in detection, pre-operational and post-operational evaluation of cerebral vascular diseases.

EFFECTS OF PHYCOCYANIN ON EXPRESSION OF CytC mRNA AND CASPASE-3 mRNA AFTER FOCAL CEREBRAL ISCHEMIA/REPERFUSION IN RATS

Objective To study the effects of phycocyanin on the expression of Cytochrome C (CytC)genes and Caspase-3 genes after focal cerebral ischemia/reperfusion in rats. Methods A rat middle cerebral ar-tery occlusion (MCAO)/reperfusion model was produced using the intraluminal filament method. The rats were di-vided into three groups: sham operation group, model control group and phycocyanin group. After MCAO, the neu-robehavioral testing of all rats was made. The infarction area was evaluated with the method of 2,3,7-triphenyltet-razolium chloride (TTC) staining. The expression of CytC mRNA and Caspase-3 mRNA were determined by in situhybridization. Results In the sham operation group and the model control group, there was only a few CytC-positive cells were seen in the normal cerebral tissue. In the model control group, the upregulation of CytC mRNAbegan 6h after ischemia, reached a maximum at 12h (cortex) -24h (striatum) , then subsided gradually, but stillin high level. In the phycocyanin group, CytC-positive cells were also mainly in cortex and striatum, but the numberof the cells was significantly lower than the number of the model control group. The time-phase pattern of CytCmRNA in the phycocyanin group was similar to the pattern of the model control group. In the sham operation groupand the model control group, there was only a few Caspase-3-positive cells were seen in the normal cerebral tissue.In the model control group, the upregulation of Caspase-3 mRNA began 6h after ischemia, reached a maximum at24h and subsided at 48h, but still in high level. In the phycocyanin group, Caspase-3-positive cells were also mainlyin the penumbral area, but the number of the cells were significantly lower than the number of the model controlgroup. The time-phase pattern of Caspase-3 mRNA in the phycocyanin group was similar to the pattern of the modelcontrol group. Conclusion The over-expression of CytC mRNA and Caspase-3 mRNA might play a key role inischemic cerebral injury after MCAO. Phycocyanin could inhibit the over-expression of CytC mRNA and Caspase-3mRNA in the cerebral cortex, and might play an important role in the protection of ischemic neurons.

Effect of glutarnate on inflammatory responses of intestine and brain after focal cerebral ischemia

AIM: To study the modulation of glutamate on post-ischemic intestinal and cerebral inflammatory responses in a ischemic and excitotoxic rat model.METHODS: Adult male rats were subjected to bilateral carotid artery occlusion for 15 min and injection of monosodium glutamate intraperitoneally, to decapitate them at selected time points. Tumor necrosis factor alpha (TNF-α) level and nuclear factor kappa B (NF-κB) activity were determined by enzyme-linked immunosorbant assay (ELISA) and electrophoretic mobility shift assay (EMSA), respectively.Hemodynamic parameters were monitored continuously during the whole process of cerebral ischemia and reperfusion.RESULTS: Monosodium glutamate (MSG) treated rats displayed statistically significant high levels of TNF-α in cerebral and intestinal tissuess within the first 6 h of ischemia. The rats with cerebral ischemia showed a minor decrease of TNF-α production in cerebral and intestinal tissuess. The rats with cerebral ischemia and treated with MSG displayed statistically significant low levels of TNF-α in cerebral and intestinal tissues. These results correlated significantly with NF-κB production calculated at the same intervals. During experiment, the mean blood pressure and heart rates in all groups were stable.CONCLUSION: Glutamate is involved in the mechanism of intestinal and cerebral inflammation responses. The effects of glutamate on cerebral and intestinal inflammatory responses after ischemia are up-regulated at the transcriptional level,through the NF-κB signal transduction pathway.

Influence of age on prevalence rates of chronic complications of hospitalized aged patients with hypertension -- analysis of 17,682 cases

Objective To understand the relationship between age and chronic complications in hospitalized aged patients with hypertension, to provide evidence for hypertension prevention and control. Methods To retrospectively analyze the clinical and laboratory data on 17,682 patients with essential hypertension during Jan 1 s,, 1993-Dec 12th, 2008 in PLA general hospital. Results 1） Among all of the inrolled cases, those aged 60-64 account for 27.87%, 65-69 years group account for 26.55%, 70-74 years group accounted for 23.96%, 75-79 years group accounted for 14.14%, 80-84 years group accounted for 5.26%, 85-89 years group accounted for 1.69%, 〉 90 years accounted for 0.41%. 2） The prevalence rate of chronic complications in 60-69 years group were 31.3-31.2% for diabetes and,22.6-27.0% for cerebrovascular disease, 9.5-11.1% for myocardial infarction, 6.7-9.1% for heart failure, 5.8-6.0% for renal dysfanction 4.9-6.8% for atrial fibrillation, 0.1-0.3% for multiple organ dysfunction syndrome （MODS） in the elderly（P 〈0.05 ）. 3） The first four complications of hypertension were diabetes（33.5%）, cerebrovascular disease （31.9%）, myocardial infarction（13.2%） and heart failure（12.3%） in 70-74 years group （P〈0.05）, cerebrovascular disease （42.8%）, diabetes （32.8%）, heart failure （16.5%） and myocardial infarction（15.9%） in 75-79 years group （P〈0.05）, cerebrovascular disease （45.4%）, diabetes （35.0%）, heart failure （21.1%） and myocardial infarction（l 5.9%） in 80-84 years group （P〈0.05）, cerebrovascular disease（42.5%）, diabetes （35.8%）, heart failure （23.1%） and renal dysfanction （17.7%） in 85-89 years group（P〈0.05 ）,and cerebrovascular disease （45. 2%）, heart failure（31.5%） , diabetes （26.0%） and renal dysfanction （20.5%） in patients more than 90 years group （P〈0.05）. Conclusions The prevalence rate and kinds of chronic complications in hospitalized aged patients with hypertension were changed with the increasing age, and the first kind of complication is cerebrovascular disease. It is of more importance to prevent the occurrence of renal dysfanction and heart failure in those hypertension patients who were more than 80 years old.

Carotid endoarterectomy for extracranial cerebrovascular disease in 26 patients

To evaluate the effects of carotid endoarterectomy in the treatment of extracranial cerebrovascular disease, 26 cases with internal carotid stenosis were performed by three different kinds of surgical endoarterectomy. The satisfactory results were achieved in all the patients, with no complications and mortality occurring. Endoarterectomy is the effective way to treat the extracranial cerebrovascular disease.

Establish Albumin-creatinine Ratio Reference Value of Adults in the Rural Area of Hebei Province

Objective To establish albumin-creatinine ratio （ACR） reference value of the rural population in Hebei province. Methods This study enrolled 5154 participants. By excluding subjects with hypertension, diabetes, dyslipidemia, cardiovascular and cerebrovascular diseases, kidney diseases, and overweight condition, as well as those with an estimated glomerular filtration rate （eGFR）（60 ml/（min· 1.73 m^2）, apparently healthy subjects （1168） were selected. Urine albumin was measured by using the immunoturbidimetic method, serum creatinine was measured by using Jaffe＇s kinetic method on a morning spot-urine sample, and ACR was calculated. The 95th percentile of ACR in the healthy subjects was used as the normal upper limit. Results The normal upper limit of ACR was 28.71 mg/g （3.25 mg/retool） for males and 31.85 mg/g （3.60 rag/retool） for females. Based on this ACR reference value, the age-gender standardized prevalence of albuminuria in the rural areas of Hebei province was 12.9%. Conclusion The ACR reference value in the rural of Hebei province is higher than that of the Western population.

EFFECT OF ELECTROACUPUNCTURE ON GENE EXPRESSION OF α- SUBUNIT OF Go-PROTEIN IN THE HIPPOCAMPUS OF RATS WITH HYPERTENSIVE CEREBRAL HEMORRAGE

Objective: To observe the effect of electroacupuncture (EA) on gene expr ession o f α subunit of Go-protein in the brain of rats with hypertensive cerebral hem or rage and study its underlying mechanisms of EA in ameliorating cerebral hemorrag e. Methods: A total of 130 SD rats were randomly divided into nor mal control gro up (n=10), sham operation group (n=40), model group (n=40) and EA group (n=40). The latter 3 groups were further divided into 6 h, 24 h, 48 h and 72 h (tim e course s) subgroups, with 10 rats being in each subgroup. The hypertensive cerebral hem orrage model was induced by injecting 1 μL of collagenase (0.5 U/μL collagena se Type Ⅶ) and heparin (7 U/μL) into the caudate nucleus in rats with renovascul ar hypertension (by clipping the bilateral renal arteries). The gene expression of α subunit of Go-protein in the hippocampus tissue of rats was detected with No rthern blotting hybridization analysis. EA (continuous waves, 120 pulses/min in frequency, 1 mA in intensity and duration of 30 min) was applied to "Shuigou" (水沟 GV 26), bilateral "Neiguan"(内关 PC 6) and bilateral "Housanli"(Zusanl i, 足三里 ST 36). Results: The gene expression of α subunit of Go-protein in th e hippocampus tis sue of the rats was obviously downregulated in hypertensive cerebral hemorrage m odel group and significantly upregulated after EA treatment wit h the extension of time. Conlusion: EA may relieve cerebral hemorr age by regulating the gene transcription of α subunit of Go-protein and incre asing the expression of Go-α protein. This may be one of the molecular mechani sm s of EA in improving hypertensive cerebral hemorrhage.

Status of Clinical Application of Yufeng Ningxin Preparations and the Meta-Analysis of Its Efficacy and Safety in the Treatment of Cardiovascular and Cerebrovascular Diseases

Objective The objective of this study was to analyze the status of the clinical application of Yufeng Ningxin(YFNX)preparations and systematically evaluate their efficacy and safety in the treatment of cardiovascular and cerebrovascular diseases.Methods Through searching databases of China National Knowledge Infrastructure,Wanfang,SinoMed,VIP,PubMed,Embase,and the Cochrane Library,the literature of clinical research on YFNX preparations in treating malignant tumors of cardiovascular and cerebrovascular diseases from the establishment of the databases to February 2021 was collected.The clinical randomized controlled trials and case-control studies of cardiovascular and cerebrovascular diseases treated with these preparations were analyzed.Two reviewers independently screened literature,extracted data,and assessed the risk of bias in the included studies,and meta analysis was performed by using ReMan 5.3 software to analyze the eficacy and safety of YFNX preparations in the treatment of cardiovascular and cerebrovascular diseases.Results A total of 29 clinical studies were finally included.The dosage forms were dropping plls,tablets,capsules,and granules.The preparations were used for the treatment of coronary heart disease,hypertension,neuropathic headache,etc.This study systematically evaluated the efficacy and safety of YFNX preparations in the treatment of coronary heart disease,hypertension,and nervous headache.A total of 1,162 cases were included in 13 studies,582 cases of the YFNX preparation group and 580 cases of the Western medicine group.The results of meta-analysis showed that the clinical efficacy of YFNX preparations combined with the Western medicine group in the treatment of coronary heart disease and hypertension,improving electrocardiogram and reducing the frequency and duration of angina attacks,was better than that of the simple Western medicine group,and the difference was statistically significant.Conclusion YFNX preparations are effective for coronary heart disease,hypertension,and neuropathic headache,and the adverse reactions are few.

A review on function of the Naoxintong Capsule in anti atherosclerosis and protection of vascular endothelium

Atherosclerosis(As) is the common pathological basis of cardiovascular and cerebrovascular diseases, it starts with the injury of vascular endothelial. The Naoxintong Capsule, a modern patent traditional Chinese medicine, is composed of Huangqi, Danshen, Quanxie, Shuizhi and other sixteen herbs. It is extensively used to treat coronary heart disease, stroke and other cardiovascular and cerebrovascular diseases, with the activity of anti-coagulation, anti-inflammatory, protecting endothelial cells, anti-atherogenic and plaque stabilization.