An Integrated Analysis of Risk Factors of Cognitive Impairment in Patients with Severe Carotid Artery Stenosis

Objective To investigate cognitive dysfunction in patients with carotid artery stenosis(CAS) and potential risk factors related to cognitive-especially memory-dysfunction. Methods Forty-seven patients with carotid artery stenosis were recruited into our study cohort. The Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) were adopted to assess cognitive function, the Wechsler Memory Scale(WMS) to assess memory function, high-resolution MRI and enhanced ultrasound to evaluate carotid plaques, and computed tomography perfusion(CTP) imaging to evaluate intracranial blood perfusion. Single-factor analysis and multiple-factor regression analysis were used to analyze potential risk factors of cognitive impairment. Results Mini-Mental State Examination test results showed that 22 patients had cognitive impairment, and MoCA test results showed that 10 patients had cognitive impairment. Analysis of various risk factors indicated that the average memory quotient of female patients was higher than that of males(P = 0.024). The cognitive and memory performance of those with an educational background above high school were significantly better than those of participants with high school or lower(P = 0.045). Patients with abnormal intracranial perfusion performed worse on the MMSE test(P = 0.024), and their WMS scores were significantly lower(P = 0.007). The MMSE scores and the memory quotients were significantly lower in patients with a history of cerebral infarction(MMSE, P = 0.047, memory quotient score, P = 0.018). Conclusion A history of cerebral infarction and abnormal cerebral perfusion are associated with decline in overall cognitive function and memory in patients with carotid stenosis. Being female and having an educational background above high school may be protective factors in the development of cognitive dysfunction.

Relationship of Post-Stroke Aphasic Types with Sex, Age and Stroke Types

Aim: To explore what is the relationship of the types of post-stroke aphasia with sex, age and stroke types. Methods: Retrospective analysis was administrated on data of 421 patients with acute stroke. Western battery aphasia was used to measure aphasiac type and aphasia quotient (AQ) score. The patients were divided into three age groups: young, middle-aged and elderly. The stroke types were classified into cerebral infraction (CI) and intracerebral hemorrhage (ICH). Results: All subjects were right-handed, which males and females accounted for 69.60% and 30.40%, respectively. There were 116 cases of Broca’s aphasia (85 males), 35 cases of Wernicke’s aphasia (20 males), 15 cases of conductive aphasia (10 males), 63 cases of transcortical motor aphasia (50 males), 11 cases of transcortical sensory aphasia (8 males), 27 cases of transcortical combined aphasia (13 males), 73 cases of anomic aphasia (47 males) and 81 cases of global aphasia (60 males). Male patients (69.60%) have a significantly higher morbidity of aphasia than that of females (30.40%) after stroke (χ2 = 11.57, P = 0.003), especially those under 65 years old (73.38%). For people 65 years and older, the morbidity of female (42.97%) tends to increase with age. Sex has no significant influence on the types of aphasia (χ2 = 13.84, P = 0.054). Broca’s aphasia is the most common type inboth male and female (29.01%, 24.22%, respectively). The distribution of aphasic types has no obvious difference among three age groups (χ2 = 14.94, P= 0.382). Aphasia induced by CI (306 cases) is more common than that by ICH (115 cases), but there was no difference in distribution of types of aphasia (χ2 = 13.23, P = 0.067). Conclusions: Male patients have a significantly higher level of morbidity of aphasia than females after stroke and a lower average age of onset than females. Broca’s aphasia is the most common one in both male and female. Broca’s aphasia, global and anomic aphasia are the most common aphasic types in both CI and ICH patients, except the female with ICH.

The biogenesis and biological roles of tRNA-derived short RNAs

In recent years, next-generation sequencing (NGS) technologies targeting the microRNA (miRNA)transcriptome revealed the existence of tRNA-derived short RNAs: tRNA halves (tiRNAs) and tRNA-derived fragments (tRFs). These small RNAs represent a novel type of small non-coding RNAs (sncRNAs), which are heterogeneous in size, nucleotide composition and biogenesis, and have been suggested to be involved in translation, cell proliferation, priming of viral reverse transcriptases, regulation of gene expression, modulation of the DNA damage response, tumor suppression and neurological disorders. Herein, we review the mechanism of their biogenesis and discuss in detail the regulatory roles they play in cell physiology. We also point out that the biological function of tRNA-derived short RNAs will be understood better as research moves forward, and that this knowledge will find its way into clinical application in the near future.

Shuxuetong for Prevention of recurrence in Acute Cerebrovascular events with Embolism(SPACE)trial:rationale and design

Backgrounds Embolic stroke is one of the main mechanisms of ischaemic stroke.Even if treated with recommended antithrombotic agents,stroke recurrence remains high.The Shuxuetong injection,a purified extract of traditional Chinese medicine widely used for thrombus diseases in clinical practice in China,could be a promising agent to prevent stroke recurrence.Aims To describe the design of the Shuxuetong injection for prevention of recurrence in acute ischaemic stroke with embolism mechanisms.Design The Shuxuetong for Prevention of recurrence in Acute Cerebrovascular events with Embolism(SPACE)trial is a multicentre,randomised,double-blind,placebo-controlled,parallel-group,superiority trial to evaluate the efficacy and safety of Shuxuetong injection in reducing recurrence or silent new ischaemic lesions on patients with acute embolic stroke within 10 days.An estimated 2416 patients with embolic stroke within 72 hours of symptom onset from 80 hospitals will be randomly assigned to one of two groups receiving Shuxuetong injection or placebo injection for 10 days.The primary endpoint is symptomatic or asymptomatic new cerebral infarction within 10 days after randomisation.Conclusion The SPACE Trial will provide valuable evidence for the efficacy and safety of Shuxuetong injection for the prevention of stroke recurrence in patients with imaging-defined embolic stroke.

Cerebral ischemia at early postoperative period of direct revascularization for moyamoya disease: a case report and literature review

Hypoperfusion and hyperperfusion could be causes of early postoperative complications that lead to neurological deterioration in patients with moyamoya diseases (MMD) after superficial temporal artery (STA) and middle cerebral artery (MCA) anastomosis. Here, the authors described a case of child-onset bilateral MMD that manifested transient cerebral ischemia in the contralateral hemisphere after left STA-MCA bypass in young adulthood. A new onset of cerebral ischemia in the contralateral hemisphere and transient neurological deterioration suggested the fragile hemodynamics of MMD during early perioperative period. Serial evaluation of postoperative cerebral hemodynamics and perfusion might facilitate targeted management in patients with unstable or advanced MMD.

Effects and safety of aspirin use in patients after cerebrovascular bypass procedures

Object Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is the most effective treatment for Moyamoya disease(MMD).In this study,we aimed to assess whether aspirin improves STA-MCA bypass patency and is safe in patients with MMD.Methods We performed a retrospective medical record review of patients with ischaemic-onset MMD who had undergone STA-MCA bypass at two hospitals between January 2011 and August 2018,to clarify the effects and safety of aspirin following STA-MCA bypass.The neurological status at the last follow-up(FU)was compared between patients with FU bypass patency and occlusion.Results Among 217 identified patients(238 hemispheres),the mean age was 41.4±10.2 years,and 51.8%were male;the indications for STA-MCA bypass were stroke(48.2%),followed by a transient ischaemic attack(44.0%).Immediate bypass patency was confirmed in all cases.During the FU period(1.5±1.5 y),15 cases were occluded at FU imaging,resulting in an overall cumulative patency rate of 94%.The patency rates were 93%and 94%in the short-term FU group(n=131,mean FU time 0.5±0.2 years)and long-term FU group(n=107,mean FU time 4.1±3.5 years),respectively.The STA-MCA bypass patency rate in the aspirin group was higher than that in the non-aspirin group(98.7%vs 89.7%;HR 1.57;95%CI 1.106 to 2.235;p=0.012).No significant difference in the FU haemorrhagic events was observed between the aspirin and non-aspirin groups.Conclusions Among adult patients with ischaemic-onset MMD undergoing STA-MCA bypass procedures,aspirin might increase the bypass patency rate,without increasing the bleeding risk.FU bypass patency may be associated with a better outcome.Additional studies,especially carefully designed prospective studies,are needed to address the role of aspirin after bypass procedures.

A New Technique for Transvenous Embolization of Brain Arteriovenous Malformations in Hybrid Operation

To the Editor:Eliminating a nidus was deemed to be the key to curing brain arteriovenous malformations (bAVMs).When conducting interventional embolization,it was suggested to superselect the microcatheter close to the nidus before injecting embolic agents.The traditional embolization was conducted via arterial approaches,which required the accessibility of arterial feeders.Difficulties and risks increased in the cases with lesions with narrow calibers,tortuous courses,or "en passage" arterial supplies.Transvenous approaches were proved to be safe and effective accesses in bAVM embolization without the limitations of arteries, The current transvenous approaches were established through femoral and cervical veins.

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery:a prospective single-center study

Background:We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation.Methods:Patients with complex cerebral arteriovenous malformations seen in our neurosurgery department from January 2016 to December 2017 were prospectively enrolled.The hybrid surgery protocol included“angiographic diagnosis,surgical resection,and intraoperative angiographic evaluation”and“angiographic diagnosis and embolization,surgical resection,and intraoperative angiographic evaluation”.The patients were randomly stratified into intensive care group and routine care group.After surgery,intensive or routine care was provided,and the prognosis of patients was evaluated,with a subsequent comparative analysis.Results:A total of 109 cases were divided into the routine nursing group(n=54 cases)and intensive nursing group(n=55 cases).There were no significant differences between the two groups in baseline data before surgery.Postoperative lung infection in the intensive nursing group was significantly less frequent than those in the routine nursing group(5.5%vs.18.5%,P=0.039)with pulmonary infection and lower extremity venous thrombosis(5.5%vs.24.1%,P=0.006).The average hospital stay in the intensive nursing group was 14.4±5.78 days,which was significantly lower than that in the routine nursing group(19.3±6.38 days,P=0.013).At 3 months’follow-up after surgery,the Generic Quality of Life Inventory-74(GQOLI-74)dimension score and GQOLI-74 total score in the enhanced group were significantly better than those in the routine nursing group(P=0.017 and 0.023,respectively).Conclusions:Intensive postoperative nursing can improve the safety of patients after hybrid surgery,reduce the postoperative complications and the average length of hospital stay,and improve the quality of life of patients.

Carotid endarterectomy for treatment of carotid in-stent restenosis:longterm follow-up results and surgery experiences from one single centre

Objective Few studies have reported the surgical treatment of carotid in-stent restenosis(ISR),more data and longer follow-up are needed.We describe the surgical treatment of ISR by standard carotid endarterectomy(CEA)with stent removal,including long-term follow-up in 10 patients from our centre.Methods Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed,including nine symptomatic and one asymptomatic ISR of at least 70%with mean age 67.3,the median time between carotid artery stenting and CEA was 17 months(range,2-54 months).results Standard CEA with stent removal was performed in all 10 patients without much technical difficulty(9 male and 1 female,mean age 67.3).Two cases were performed in hybrid operation room.There were a total of three complications that happened in three patients(30%)respectively.An asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without intervention.In the second case,dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography,and another stent was implanted.The patient sustained temporary hypoglossal nerve dysfunction postoperatively.The third patient suffered cerebral hyperperfusion with complete recovery when discharged.No neurological complications occurred in other seven patients.After follow-up of 25 months(range,11-54 months),one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation;in one patient occurred recurrent symptomatic restenosis(90%)1 year later;all other patients remained asymptomatic and without recurrent restenosis(>50%)by follow-up carotid ultrasound or CT angiography.conclusion It seems that CEA with stent removal is a reasonable choice,by experienced hand,for symptomatic ISR with higher but acceptable complications.The indication of stent removal for asymptomatic ISR needs further observation.

Classification of brain arteriovenous malformations located in motor-related areas based on location and anterior choroidal artery feeding

Objective Surgical management of arteriovenous malformations(AVMs)involving motor cortex or fibre tracts(M-AVMs)is challenging.This study aimed to construct a classification system based on nidus locations and anterior choroidal artery(AChA)feeding to pre-surgically evaluate motor-related and seizure-related outcomes in patients undergoing resection of M-AVMs.Methods and materials A total of 125 patients who underwent microsurgical resection of M-AVMs were retrospectively reviewed.Four subtypes were identified based on nidus location:(I)nidus involving the premotor area and/or supplementary motor areas;(II)nidus involving the precentral gyrus;(III)nidus involving the corticospinal tract(CST)and superior to the posterior limb of the internal capsule;(IV)nidus involving the CST at or inferior to the level of posterior limb of the internal capsule.In addition,we divided type IV into type IVa and type IVb according to the AChA feeding.Surgical-related motor deficit(MD)evaluations were performed 1 week(short-term)and 6 months(long-term)after surgery.Results The type I patients exhibited the highest incidence(62.0%)of pre-surgical epilepsy among the four subtypes.Multivariate analysis showed that motor-related area subtypes(p=0.004)and diffuse nidus(p=0.014)were significantly associated with long-term MDs.Long-term MDs were significantly less frequent in type I than in the other types.Type IV patients acquired the highest proportion(four patients,25.0%)of long-term poor outcomes(mRS>2).Type IVb patients showed a significantly higher incidence of post-surgical MDs than type IVa patients(p=0.041).The MDs of type III or IV patients required more recovery time.Of the 62 patients who had pre-surgical seizures,90.3%(56/62)controlled their seizures well and reached Engel class I after surgery.Conclusions Combining the consideration of location and AChA feeding,the classification for M-AVMs is a useful approach for predicting post-surgical motor function and decision-making.

Glutamate Impairs Mitochondria Aerobic Respiration Capacity and Enhances Glycolysis in Cultured Rat Astrocytes

Objective To study the effect of glutamate on metabolism, shifts in glycolysis and lactate release in rat astrocytes. Methods After 10 days, secondary cultured astrocytes were treated with 1 mmol/L glutamate for 1 h, and the oxygen consumption rates （OCR） and extra cellular acidification rate （ECAR） was analyzed using a Seahorse XF 24 Extracellular Flux Analyzer. Cell viability was then evaluated by MTT assay. Moreover, changes in extracellular lactate concentration induced by glutamate were tested with a lactate detection kit. Results Compared with the control group, treatment with 1 mmol/L glutamate decreased the astrocytes’ maximal respiration and spare respiratory capacity but increased their glycolytic capacity and glycolytic reserve. Further analysis found that 1-h treatment with different concentrations of glutamate （0.1-1 mmol/L） increased lactate release from astrocytes, however the cell viability was not affected by the glutamate treatment. Conclusion The current study provided direct evidence that exogenous glutamate treatment impaired the mitochondrial respiration capacity of astrocytes and enhanced aerobic glycolysis, which could be involved in glutamate injury or protection mechanisms in response to neurological disorders.

Quantitative angiographic haemodynamic evaluation of bypasses for complex aneurysms: a preliminary study

Objective Open microsurgery,often with bypass techniques,is indispensable for complex aneurysms.To date,it remains unknown whether arterial anatomy or quantitative blood flow measurements can predict insufficient flow-related stroke(IRS).The present study aimed to evaluate the risk factors for IRS in patients treated with open microsurgery with bypass procedures for complex internal carotid artery aneurysms.Methods Patients with complex aneurysms undergoing bypass surgery were retrospectively reviewed.The recipient/donor flow index(RDFI)was preoperatively evaluated using colour-coding angiography.RDFI was defined as the ratio of the cerebral blood volume of the recipient and donor arteries.The sizes of the recipient and donor arteries were measured.The recipient/donor diameter index(RDDI)was then calculated.IRS was defined as the presence of new postoperative neurological deficits and infarction on postoperative CT scans.We assessed the association between RDFI and other variables and the IRS.Results Twenty patients(38±12 years)were analysed.IRS was observed in 12 patients(60%).Patients with postoperative IRS had a higher RDFI than those without postoperative IRS(p<0.001).RDDI was not significantly different between patients with and without IRS(p=0.905).Patients with RDFI>2.3 were more likely to develop IRS(p<0.001).Conclusion Quantitative digital subtraction angiography enables preoperative evaluation of cerebral blood volume.RDFI>2.3,rather than RDDI,was significantly associated with postoperative IRS.This preoperative evaluation allows appropriate decisions regarding the treatment strategy for preventing postoperative IRS.

Recommendations for the diagnosis and treatment of paroxysmal kinesigemc dyskinesia: an expert consensus in China

Paroxysmal dyskinesias are a group of neurological diseases characterized by intermittent episodes of involuntary movements with different causes.Paroxysmal kinesigenic dyskinesia(PKD)is the most common type of paroxysmal dyskinesia and can be divided into primary and secondary types based on the etiology.Clinically,PKD is characterized by recurrent and transient attacks of involuntary movements precipitated by a sudden voluntary action.The major cause of primary PKD is genetic abnormalities,and the inheritance pattern of PKD is mainly autosomal-dominant with incomplete penetrance.The proline-rich transmembrane protein 2(PRRT2)was the first identified causative gene of PKD,accounting for the majority of PKD cases worldwide.An increasing number of studies has revealed the clinical and genetic characteristics,as well as the underlying mechanisms of PKD.By seeking the views of domestic experts,we propose an expert consensus regarding the diagnosis and treatment of PKD to help establish standardized clinical evaluation and therapies for PKD.In this consensus,we review the clinical manifestations,etiology,clinical diagnostic criteria and therapeutic recommendations for PKD,and results of genetic analyses in PKD patients performed in domestic hospitals.

Temporal trends and rural-urban disparities in cerebrovascular risk factors,in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015:a nationwide serial cross-sectional survey

Background Stroke is the leading cause of mortality in China,with limited evidence of in-hospital burden obtained from nationwide surveys.We aimed to monitor and track the temporal trends and rural-urban disparities in cerebrovascular risk factors,management and outcomes from 2005 to 2015.Methods We used a two-stage random sampling survey to create a nationally representative sample of patients admitted for ischaemic stroke in 2005,2010 and 2015.We sampled participating hospitals with an economic-geographical region-stratified random-sampling approach first and then obtained patients with a systematic sampling approach.We weighed our survey data to estimate the national-level results and assess changes from 2005 to 2015.Results We analysed 28277 ischaemic stroke admissions from 189 participating hospitals.From 2005 to 2015,the estimated national hospital admission rate for ischaemic stroke per 100000 people increased(from 75.9 to 402.7,Ptrend<0.001),and the prevalence of risk factors,including hypertension,diabetes,dyslipidaemia and current smoking,increased.The composite score of diagnostic tests for stroke aetiology assessment(from 0.22 to 0.36,Ptrend<0.001)and secondary prevention treatments(from 0.46 to 0.70,Ptrend<0.001)were improved.A temporal decrease was found in discharge against medical advice(DAMA)(from 15.2%(95%CI 13.7%to 16.7%)to 8.6%(8.1%to 9.0%);adjusted Ptrend=0.046),and decreases in in-hospital mortality(0.7%in 2015 vs 1.8%in 2005;adjusted OR(aOR)0.52;95%CI 0.32 to 0.85)and the composite outcome of in-hospital mortality or DAMA(8.4%in 2015 vs 13.9%in 2005;aOR 0.65;95%CI 0.47 to 0.89)were observed.Disparities between rural and urban hospitals narrowed;however,disparities persisted in in-hospital management(brain MRI:rural-urban difference from−14.4%to−11.2%;cerebrovascular assessment:from−20.3%to−16.7%;clopidogrel:from−2.1%to−10.3%;anticoagulant for atrial fibrillation:from−10.9%to−8.2%)and in-hospital outcomes(DAMA:from 2.7%to 5.0%;composite outcome of in-hospital mortality or DAMA:from 2.4%to 4.6%).Conclusions From 2005 to 2015,improvements in hospital admission and in-hospital management for ischaemic stroke in China were found.A temporal improvement in DAMA and improvements in in-hospital mortality and the composite outcome of in-hospital mortality or DAMA were observed.Disparities between rural and urban hospitals generally narrowed but persisted.

Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort

Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.Methods:We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study.Follow-up assessments were performed at the following time points after stroke:in person,2 weeks,3 months,6 months,and 1 year;by telephone,5 years.National Institutes of Health Stroke Scale (NIHSS) score on admission,recurrence,disability,depression,QoL,and chronic complications were recorded.Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders.QoL was measured using short form-12 (SF-12).Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.Results:Of the 801 patients evaluated in this study,80 had persistent depression.The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]:0.48;95% confidence interval [CI]:0.29-0.81) and disability at 5 years (OR:0.34;95% CI:0.23-0.49) were associated with poor MCS scores at 5 years.Old age,a high NIHSS score on admission,disability at 5 years,and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.Conclusions:Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up.The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.

The Third China National Stroke Registry (CNSR-Ⅲ) for patients with acute ischaemic stroke or transient ischaemic attack: design, rationale and baseline patient characteristics

Background and purpose Stroke is the leading cause of mortality and disability in China.Precise aetiological classification,imaging and biological markers may predict the prognosis of stroke.The Third China National Stroke Registry(CNSR-Ⅲ),a nationwide registry of ischaemic stroke or transient ischaemic attack(TIA)in China based on aetiology,imaging and biology markers,will be considered to clarify the pathogenesis and prognostic factors of ischaemic stroke.Methods Between August 2015 and March 2018,the CNSR-Ⅲrecruited consecutive patients with ischaemic stroke or TIA from 201 hospitals that cover 22 provinces and four municipalities in China.Clinical data were collected prospectively using an electronic data capture system by face-to-face interviews.Patients were followed for clinical outcomes at 3 months,6 months and 1-5 year annually.Brain imaging,including brain MRI and CT,were completed at baseline.Blood samples were collected and biomarkers were tested at baseline.Results A total of 15166 stroke patients were enrolled,among which 31.7%patients were women with the average age of 62.2±11.3 years.Ischaemic stroke was predominant(93.3%,n=14146)and 1020(6.7%)TIAs were enrolled.Conclusions CNSR-Ⅲis a large scale nationwide registry in China.Data from this prospective registry may provide opportunity to evaluate imaging and biomarker prognostic determinants of stroke.

Chinese Stroke Center Alliance:a national effort to improve healthcare quality for acute stroke and transient ischaemic attack:rationale,design and preliminary findings

Background In June 2015,the Chinese Stroke Association(CSA)initiated the Chinese Stroke Center Alliance(CSCA)to establish the national hospital-based stroke care quality assessment and improvement platform.This article outlines its objectives,operational structure,patient population,quality improvement(QI)intervention tools,data elements,data collection methodology and current patient and hospital data.Methods The CSCA is a national,hospital-based,multicentre,voluntary,multifaceted intervention and continuous QI initiative.This multifaceted intervention includes stroke centre development,written care protocols,workshops and a monitoring/feedback system of evidencebased performance measures.The data coordinating centre of the CSCA resides at the China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital.results As of July 2017,1576 hospitals in China have contributed detailed clinical information to serve as a benchmark for the stroke care quality of 433264 patients with acute stroke/transient ischaemic attacks(TIA),including 352572(81.38%)acute ischaemic stroke,30362(7.01%)TIA,42080(9.71%)spontaneous intracranial haemorrhage,5505(1.27%)subarachnoid haemorrhage and 2745(0.63%)not specified stroke.Conclusion The CSCA programme is designed to establish a continuous national stroke registry and help healthcare providers develop stroke centres and treat patients in a consistent manner in accordance with accepted national guidelines and,ultimately,improve patient outcomes.It supports the CSA mission to reduce stroke burden in China.

Unique MicroRNAs Signature of Lymphocyte of Yang and Yin Syndromes in Acute Ischemic Stroke Patients

Objective: To identify the differentially expressed microRNAs (miRNAs) profiles of yang and yin syndromes in patients with acute ischemic stroke, and to provide the molecular basis of the classification of these two syndrome types in acute ischemic stroke patients. Methods: A microarray assay was performed to assess the expression pattern of miRNAs in the lymphocyte of acute ischemic stroke patients. Target genes for the deregulated miRNAs were predicated using the online bioinformatic algorithms and functional annotation via Kyoto encyclopedia of genes and genomes pathway analysis for miRNAs predicted targets was carried out. Based on the predicted target genes of differentially expressed miRNAs, the miRNA-gene-network and miRNA-pathway network were constructed. Results: Yang score based on tongue texture, urine, dejecta, and appearance, etc. showed that clinical symptoms were distinct between yang and yin syndromes. There were significantly higher total leukocyte number and lower total protein level in patients with yang syndrome compared with those in patients with yin syndrome (P<0.05). Comprehensive miRNA analysis identified 36 unique down-regulated miRNAs in yang syndrome group, and 20 unique down-regulated and 2 unique up-regulated miRNAs in yin syndrome group. The key regulatory miRNAs, gene, and pathways in the yang syndrome were hsa-miR-93-5p and -320b, enabled homolog, the metabolic pathways and mitogen-activated protein kinase signaling pathways, respectively, while those in the yin syndrome were hsa-miR-424-5p and -106b-5p, CNOT4, hepatitis B and pathways in cancer, respectively. Conclusion: These results offered insight into the molecular basis underlying the different pathogenesis of yang or yin syndrome, providing clues for the individualized therapeutic strategies of acute ischemic stroke.

White matter connection's damage,not cortical activation, leading to language dysfunction of mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes

Mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS) is a metabolic disorder characterized by hyperlactic acidemia and stroke-like symptoms.

A Comparison of Brain Death Criteria between China and the United States

Background： Criteria for determining brain death （BD） vary between China and the United States. We reported the results of an investigation designed to compare procedures to determine BD in two countries. Methods： The latest criteria in the United states were published in 2010. The latest criteria in China were published in 2009. We used these two types of BD criteria to evaluate patients who were considered to be BD. The time, cost, and accuracy of the diagnosis were compared. Results： From January 1, 2012 to October 8, 2013, there were 37 patients which were applied for BD evaluation in the Neurological Intensive Care Unit of Beijing Tiantan Hospital. The cause of coma were known as subarachnoid hemorrhage （18 patients, 48.6%）, intracerebral hemorrhage （8 patients, 21.6%）, cerebral ischemia （9 patients, 24.3%）, brain stem tumor （1 patient, 2.7%）, and intracranial infection （1 patient, 2.7%）. The clinical examinations were done for all of the patients except 1 patient who had low blood pressure. Three patients had hrainstem reflexes that were excluded from BD. Twenty-five patients had apnea tests, and 20 tests were completed that were all positive. Confirmatory tests were completed differently： Transcranial Doppler （30 patients, positive rate 86.7%）, electroencephalogram （25 patients, positive rate 100%）, and somatosensory evoked potential （16 patients, positive rate 100%）. Thirty-three patients were diagnosed BD by criteria of the United States. Only 9 patients were diagnosed BD by Chinese criteria. The use of time and money in the USA criteria was obviously fewer than those in Chinese criteria （P = 0.000）. Conclusion： Compared with BD criteria of the United States, Chinese criteria were stricter, lower positive rate, more cost in money and time, and more reliable by families and doctors.