Embolic stroke of undetermined source ( ESUS ) refers to non-lacunar brain infarcts without definite proximal arterialstenosis or major cardioembolic sources.Paroxysmal atrial fibrillation may be the most important cause of ESUS, thus anticoagulation may be more effective than antiplatelet therapy for secondary stroke prevention to this group of patients.This paper reviews the latest progress on the definition, epidemiology, diagnostic approach, relation to atrial fibrillation and management of ESUS.

Objective Research the effect of anti-inflammatory and anti-oxidation drugs on acute stroke patients. Methods 128 patients with acute ischemic stroke are divided into two groups- combined treatment group (71) and control (57). Test serum biomarkers and evaluate neurological function and living ability before and after therapy, compare between groups and intra-group. To observe the effects of combined therapy on serum biomarkers and prognosis in acute stage. Results ( 1 ) MMP-9 of combined treatment group (3.23 ±0. 99) ng/L is higher than control (2. 82 ± 4. 21 )ng/L before therapy (P ＜0. 05). (2) The level of pre-treatment ox-LDL-Ab in combined treatment group ( 0. 08 ± 0. 01 ) U/ml higher than posttreatment (0. 07 ±0. 01 ) U/ml (P ＜ 0. 05 ). The level of pre-treatment NIHSS in control group (5.76 ±6.61) score higher than post-treatment (4.22 ±5.45) score,P＜0.05. Conclusion Combined treatment can degrade serum MMP-9 and ox-LDL in acute ischemic stroke patients, but it can't obviously improve the earlier prognosis.

Objective To evaluate the nutrition status and the prognosis of acute stroke patients with hy-pothyroidism during hospitalization. Methods The clinical data of 28 acute stroke patients with hypothyroidism (study group) and 28 stroke patients with normal thyroid function (control group) were retrospectively analyzed.Results After (10±4) days of hospitalization, hemoglobin and serum albumin levels in study group significantlydecreased ( P < 0. 05 ). The requirement of calories and protein, incidence of pulmonary infections, alimentarytract hemorrhage and diarrhea, and hospital stays were significantly higher in study group than in control group (P < 0. 05 ). Conclusion The nutrition status is poor in acute stroke patients with hypothyroidism, who were more easier to be suffered from clinical complications and worse prognosis.

ObjectiveTo investigate the influence of carotid artery stenosis on the incidence of neurological complication in patients undergoing off-pump coronary artery bypass grafting.MethodsWe prospectively analyzed 176 consecutive patients ≥60 years old undergoing selective off-pump coronary artery bypass grafting (from June 2010 to July 2011 ).Carotid duplex ultrasound screening was used to determine the presence and severity of carotid artery before surgery. Neurological complications 7 days after surgery were compared between the patients with ( ≥75％ ) and without severe carotid artery stenosis ( ＜ 70％ ).Multivariate analysis was used to determine the predictor of severe carotid artery disease.ResultsSixteen patients (9.1％ ) were found to have severe carotid artery stenosis before surgery. Thirty-seven patients (20.8％ ) had single or multiple neurological complications:1 (0.6％ ) had stroke; 12 (6.7％) had hypoxic-metabolic encephalopathy; 21 ( 11.8％ ) had cognitive dysfunction; 3 ( 1.7％ ) had depression.When compared with the counterparts,patients with severe carotid artery stenosis had a higher rate of neurological complications (43.8％ vs 18.8％ ; P =0.044).In multivariate analysis,significant predictive factor for severe carotid artery stenosis was prior stroke ( OR:4.04 ; 95％ CI 1.22-13.37 ).Conclusion Severe carotid artery stenosis alone is a risk factor for neurological complication after off-pump coronary artery bypass grafting and prior stroke is a predictor for sever carotid artery disease.

AIM : To explore the effects of ASODN targeting survivin on apoptosis in HL 60 cells. METHODS : The cell proliferation was tested by MTT assay, the cell morphological transformation was observed by inverted microscope, the cell apoptosis index was examined by TUNEL, the cell apoptosis rate was precisely detected by flow cytometry, and the expression of survivin mRNA was detected by reverse transcriptase PCR. RESULTS : 5-20 ?mol?L -1 of survivin ASODN showed obviously inhibitory effect on the cell proliferation of HL 60 cells, and the inhibitory effect correlated with time and dosage. The cell apoptosis rate and the expression inhibitory rate of survivin gene in ASODN groups were obviously higher than that in the control group. Effects of antisense oligonucleotide targeting survivin on apoptosis in HL 60 cells$$$$ QI Shi mei, BI Fu yong Department of Biochemistry, Wannan Medical College, Wuhu 241001, Anhui, China ABSTRACT AIM : To explore the effects of ASODN targeting survivin on apoptosis in HL 60 cells. METHODS : The cell proliferation was tested by MTT assay, the cell morphological transformation was observed by inverted microscope, the cell apoptosis index was examined by TUNEL, the cell apoptosis rate was precisely detected by flow cytometry, and the expression of survivin mRNA was detected by reverse transcriptase PCR. RESULTS : 5-20 ?mol?L -1 of survivin ASODN showed obviously inhibitory effect on the cell proliferation of HL 60 cells, and the inhibitory effect correlated with time and dosage. The cell apoptosis rate and the expression inhibitory rate of survivin gene in ASODN groups were obviously higher than that in the control group. [WTHZ CONCLUSION : ASODN targeting survivin can effectively inhibit the expression of survivin mRNA and induce the cell apoptosis, and it indicates that survivin plays an important role in maintaining the proliferation of tumor cells.

Objective To investigate the clinical features of stroke in young adults with infective endocarditis (IE).Methods This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients).Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases (11.7％) were complicated with stroke.Among them,21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation),9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0％ (35/35) vs 86.4％ (229/265),P =0.02;22.8％ (8/35) vs 6.4％ (17/265),P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95％ CI 1.626-15.072),and the OR of stroke for death was 8.387 (95％ CI 1.997-35.225),respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.

Objective To study the postoperative cognitive dysfunction (POCD) in elderly patients after off‐pump coronary artery bypass grafting (OPCABG)and its risk factors ,and the association between cerebrovascular function assayed by 320 dynamic volume CT and POCD .Methods Two hundred and thirteen elderly patients selected for OPCABG were divided into patients group (n=28) and control group (n=185) .The patients underwent 320 dynamic volume CT to show their cerebrovascular ,neurological and cognitive functions .The patients were assessed on day 14 after operation .The risk factors for POCD and the association between CT perfusion imaging parame‐ters and POCD w ere comparatively analyzed .Results T he incidence of cerebrovascular disease , diabetes mellitus ,CTA‐detected severe cerebrovascular stenosis and abnormal cerebral pufusion was significantly higher in patients group than in control group (P< 0 .01) .Logistic regression analysis showed that cerebrovascular disease history and abnormal cerebral pufusion were the in‐dependent risk factors for POCD (OR= 1 .837 ,95% CI:1 .075 -3 .141 ,P= 0 .026 ;OR= 3 .224 , 95% CI:2 .073-5 .013 ,P=0 .000) .Conclusion Early detection of abnormal cerebrovascular ste‐nosis ,poor cerebral perfusion and maintainence of stable blood glucose play an important role in reducing the incidence of POCD in elderly patients after OPCABG .

[Objective]Microsurgical lumbar discectomy(MSLD)and microendoscopic discoectomy(MED)were compared in methods and curative effect for providing the experience and therapy evidence of lumbar disc herniation(LDH).[Method]It was retrospectively analyzed that mono-segment lumbar disc herniation were treated in minimal invasion in our hospital.MSLD was 45 cases and MED was 32 cases.Operation time,operation information,complication,hospital time and curative effect were compared.[Result]The satisfactory rate of two groups were both beyond 90% and no significant deviation was found.The incision of MED was obviously shorter than MSLD and the operation time of MED was longer than latter.[Conclusion]The curative effects of two minimal invasion methods are satisfactory.But the indication of MED is limited obviously and the method has not obvious predominance by compared with MSLD.MSLD is an more ideal minimal invasion operation at present.

Objectives　To investigate the relationship between homocysteine (Hcy), folic acid, vitamin B12(VitB12),lipids and the carotid artery atherosclerosis(CAAs) and the significance of their levels in predicting cardiac and cerebral vascular events of older patients. Methods　Both sides of the common carotid artery and internal carotid artery were measured by B-mode ultrasound in 74 examinees in A, B, C, and D groups and a control group. With fasting serum, cholesterol, triglyceriade, apolipoprotein AI(Apo AI), apolipoprotein B (Apo B), lipoprotein (a) ［Lp(a)］, creatinine, glucose, folic acid, Vit B12 and Hcy were detected. Results　When carotid artery atherosclerosis became severer, serum Hcy was higher. The levels of the control and A, B, C, D groups were (10.2±3.6) μmol/L, (11.5±4.4) μmol/L, (17.9±4.5) μmol/L, (24.7±10.3) μmol/L, and (41.4±22.3) μmol/L respectively. SNK test showed a significant difference between D and other groups (P>0.05). Folic acid and Vit B12 were negatively correlated with the severity of carotid artery atherosclerosis, but only A and D groups showed statistical significance. Spearman correlation coefficient showed that serum Hcy had significant negative correlation with folic acid and Apo AI(P=0.035 and P=0.000).Multiple linear regression analysis between CAAs and various risk factors showed Apo AI had negative correlation, but Apo B, Lp(a) and Hcy had positive correlation with CAAs, especially Hcy(P=0.009).Conclusion　Hyperhomocysteinaemia is an important risk factor of artery atherosclerosis and the degree of CAAs is highly correlated with Hcy concentration. Hcy, Apo AⅠ,Apo B, Lp(a) are sensitive and reliable indexes for evaluating and predicting CAAs.