Ischemic stroke is a very complex disorder with many intracellular and extracellular factors such as excitatory amino acids, free radicals, calcium overload, apoptotic genes and inflammation involved in its pathophysiological mechanisms. It has been reported that neuronal death mainly derives from necrosis and/or apoptosis after cerebral ischemia. Those neurons in the ischemic core usually suffer from necrosis, however, apoptosis (also referred to as delayed neuronal death) occurs in the ischemic penumbra, which has been the major therapeutic target in the ischemic stroke.

Objective To study the best dose of batroxobin that protects forebrain ischemia reperfusion injury in gerbils.Methods 80 gerbils were randomly assigned to receive different dose of batroxobin (1 BU/kg, 2 BU/kg, 4 BU/kg, 8 BU/ kg, 16 U/kg or 32 BU/kg) in treatment group, NS in control group or nothing in sham-operation group. There were 10 gerbils in each group. NS (control group) or batroxobin (treatment group) was given intraperitoneally three hours before establishment of forebrain ischemia reperfusion model. Apoptotic cells were detected by TUNEL technique and the number of apoptotic cells in the hippocampal CA 1 territory was counted using Olympus microscope.Results The apoptotic cells in the treatment groups (8 BU/kg, 16 BU/kg, 32 BU/kg) markedly decreased than those in the control group and the other treatment groups (1 BU/kg, 2 BU/kg, 4 BU/kg) (all P0.05). Conclusions Batroxobin has a role of reducing neuron apoptosis after cerebral ischemia. The best dose of batroxobin that protects forebrain ischemia reperfusion injury in gerbils is 8 BU/kg.

Objective To investigate the prevalence of orthostatic hypotension in hypertensive patients aged 80 or over and associated risk factors at level A tertiary hospitals.Methods A multicenter cross-sectional study was conducted among very old hypertensive patients (≥ 80 years) at 28level A tertiary hospitals by using questionnaire-based surveys.A total of 1298 hypertensive subjects aged between 80 and 101 years were enrolled in this study.Blood pressures was measured in the supine position and the upright position within three minutes of standing,and 316 patients were assigned to the orthostatic hypotension(OH) group and the other 982 patients to the non-orthostatic hypotension(NOH) group.Additional information was acquired through patients' medical records and the questionnaire.Results The prevalence of OH was 24.3％ (316 cases) There were no significan different betueen OH patienl with NOHones in gender and age.OH patients had higher supine systolic and diastolic blood pressure(P=0.003 and 0.000,respectively),lower standing systolic and diastolic blood pressure(P=0.000 and 0.000,respectively),and higher rates of past coronary heart disease,stroke and renal abnormalities (P =0.037,0.001 and 0.014,respectively) than NOH patients.Logistic regression analysis showed that the prevalence of OH in the patients was positively correlated with supine systolic blood pressure(OR=1.196,CI:1.153-1.242,P=0.000) and supine diastolic blood pressure (OR =1.740,CI:1.602-1.885,P =0.000) and was negatively correlated with standing systolic blood pressure(OR =0.824,CI:0.795-0.855,P=0.000) and standing diastolic blood pressure (OR =0.584,CI:0.539-0.634,P =0.000).Conclusions The prevalence of orthostatic hypotension is high in hypertensive patients aged 80 years or over at level A tertiary hospitals.Poor blood pressure control may increase the risk of orthostatic hypotension.

Objective To observe the effects of anti depression therapy on post stroke and neurological rehabilitation in the elderly. Methods There were 178 post stroke depression (PSD) cases. They were divided into 3 groups: 64 cases taking Prozac once every morning about 20 80 mg daily; 58 cases taking amitriptyline twice everyday about 50 100 mg daily and 56 cases taking placebo as control group. All of them were on the regular treatment of cerebrovascular disease. All the cases were evaluated according to the HAMD score, neurological function impairment and ADL before treatment and 1 st , 2 nd , 4 th , 8 th week and 3 rd , 6 th , 12 th month after the treatment. Results At the 2 nd week, HAMD score dropped obviously from 27 7?6 9 to 17 3?5 9 in Prozac group, from 26 9? 6 9 to 15 7?4 2 in amitriptyline group, with significant difference vs pre treatment and the control groups ( P

Objective To explore the mechanism,clinic features and treatment of type Ⅳ cardiorenal syndrome.Methods The clinical data of one patient with cardiorenal syndrome characterized with chest distress was analyzed.Results After combination treatment,the symptoms were relieved,the amount of physical activity was increased,and the functions of heart and kidney were improved.Conclusions Active,prompt and rational multidisciplinary care can control the progression of cardiorenal syndrome,increase survival rate and improve life quality.

Objective To investigate the relationship between serum homocysteine (Hcy) level and heart rate variability (HRV) in patients with acute cerebral infarction.Methods A retrospective study was conducted in 76 elderly patients with acute cerebral infarction in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016,and the patients were monitored by 24 hours electrocardiogram within three months.According to age and Hcy level,the patients were divided into three groups:normal Hcy low age group (5-15μmol/L,60-80 years old),high Hcy low age group (＞ 15μmol/L,60-80 years old),high Hcy high age group (＞15μmol/L,≥80 years old).The correlation between Hcy and HRV was analyzed.Results The standard deviation of the normal-to-normal RR intervals (SDNN),the mean standard deviation of 5-minute RR intervals means (SDANN),the root mean square of successive differences in RR intervals (RMSSD),adjacent RR intervals greater than 50 ms (PNN50) in the high Hcy low age group were (108.75 ±34.18)ms,(97.63 ±31.34) ms,(22.04 ±6.97) ms,(3.78 ± 4.07) ％,respectively,which in the high Hcy high age group were (81.43 ± 27.68) ms,(71.46 ±25.45) ms,(23.82 ± 7.59) ms,(3.95 ± 3.56) ％,respectively,which were significantly lower than those in the normal Hey low agc group[(127.21 ± 22.21) ms,(114.75 ± 23.55) ms,(29.17 ± 9.71) ms,(7.68 ± 6.17) ％](t =2.219,2.140,2.920,2.585,t =6.502,6.328,2.227,2.722,all P ＜ 0.05).The levels of SDNN and SDANN in the high Hcy low age group were lower than those in the high Hcy low age group (t =3.185,3.322,all P ＜ 0.05).The low frequency (LF) and high frequency (HF) values in the high Hcy low age group were (11.86 ± 5.39) ms,(8.47 ± 3.25) ms,respectively,which in the high Hcy high age group were (9.29 ± 4.98) ms,(71.46 ± 25.45) ms,respectively,which were lower than those in the normal Hcy low age group[(15.15 ±4.56) ms,(11.36 ±4.36) ms] (t =2.281,2.612,t =4.392,2.900,all P ＜ 0.05).The LF/HF value of high Hcy high age group (1.09 ± 0.3) was lower than (1.42 ± 0.36) in normal Hcy low age group and (1.41 ± 0.40) in the high Hcy low age group (t =3.569,3.339,all P ＜ 0.05).Logistic regression analysis showed that SDNN,SDANN,RMSSD,nocturnal HF and nocturnal LF/HF were correlated with hyperhomocysteinemia (r =-0.037,-0.132,-0.087,-0.468,-3.746,all P ＜ 0.05).Conclusion Hyperhomocysteinemia with acute cerebral infarction in elderly patients is more likely to have cardiac autonomic nerve dysfunction.And clinically we should strengthen HRV detection of elderly patients with acute cerebral infarction and hyperhomocysteinemia.