Patients with asymptomatic carotid stenosis (ACS) are the potentially high-risk population of stroke.Screening for high-risk patients with ACS and giving them appropriate interventions may have great significance for the prevention of the occurrence of stroke.This article reviews the advances in research of ACS screening in recent years.

Objective To evaluate the value of PLD associated with O 3 injection for the treatment of lumbar disc heniation.Methods Lateral decubitus position on healthy side under the direction of DSA, a working pipe was inserted from the back lateral way to damage the disc contents through multiple angles followed by extirpation of the nucleus pulposus and then injecting O 2-O 3 10 ml into the lumbar disc space and near by area of the inter vertebral foramina. As for patients with L4-5 and L5-S1 protrusions the main lumbar discs can be treated in the same way, but for another minor one, the injection of O 2-O 3 10 ml into the lumbar disc and the nearby intervertebral foramina and ethanol through a 21G needle would be properly promising. Results Puncture and technical opertaion were performed successfully in all the patients with excellent results in 63, good in 27, and poor in 10. 120 cases with injection of O 2-O 3 into the lumbar discs showed the figure of lumbar space displaying clear in 37 cases, less clear in 35 cases, only gas entering lumbar disc at the needling point with lumbar space displaying unclear in 30 cases and lots of gas entering the front space of canalis vertebralis cavitas epiduralis in 18 cases. Conclusions PLD associated with O 3 injection is the advantageous supplement mutually posscessing safety and efficancy.

Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.

In recent years, multicenter studies have confirmed that intra-arterial thrombolysis is an effective approach in the treatment of acute cerebral infarction. This article reviews the study status quo of the time window, pretreatment assessment, and selection of patients and drugs for intra-arterial thrombolysis.

Objective To study the optimization of extraction technology for total flavonoid-aglycone from Scutellaria baicalensis after enzymatic hydrolysis. Methods With three factors of alcohol concentration, dosage and speed of percolation as the indexes, orthogonal experiment was performed. Concentrations of Baicalein, Wogonin and oroxylin-A were analyzed by HPLC. Results The optimal extraction technology is A2B3C2: extracting the medical material by 10 times(V) 95 % alcohol, the speed being 6 mL/kg per min. Conclusion Under optimal extraction technology, extraction rate of total flavonoid-aglycone is very considerable and the concentration is high to 60 % .

Vascular cognitive impairment has been a research hotspot in the field of neurology in recent years.The Montreal Cognitive Assessment is a rapid screening tool for detecting mild cognitive impairment.Now it has been widely used in the evaluation of vascular cognitive impairment.This article reviews the content,features,application status,and development prospects of the Montreal Cognitive Assessment.

Objective To investigate the changes of cognitive impairment with disease progression in patients with minor stroke/transient ischemic attack (TIA).Methods Consecutive patients with minor stroke/TIA were enrolled prospectively.Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive function assessment within 7 d of the onset (baseline),at 1 and 3 months,respectively.Compared with the baseline,the total scores of MoCA in patients increased by ≥2 at 3 months were cognitive function improvement and increased <2 were no cognitive function improvement.Multivariate logistic regression analysis was applied to identify the independent risk factors for no cognitive improvement.ResultsA total of 112 patients with minor stroke/TIA were enrolled in the study,including 63 patients (56.2%) with TIA and 49 (43.8%) with minor stroke.At baseline,1 month,and 3 months,77 (68.8%),72 (64.3%) and 60 (53.6%) patients had cognitive impairment.At 3 months after the onset,the cognitive function of 25 patients (22.3%) were improved,in which 19 (76.0%) and 6 (24.0%) patients had TIA/minor stroke respectively;87 (77.7%) did not have any improvement.Compared with the improvement group,the level of education was significantly lower (3.29±3.48 years vs.5.63±4.26 years;t=2.814,P=0.006),the level of glycosylated hemoglobin was significantly higher (6.35%±1.26% vs.7.21%±1.26%;t=-3.088,P=0.003) in the no improvement group,and the proportions of patients with minor stroke (49.4% vs.24.0%;χ2=5.101,P=0.024),hypertension (52.9% vs.24.0%;χ2=6.509,P=0.011),hyperlipidemia (51.7% vs.24.0%;χ2=6.019,P=0.014),diabetes (41.4% vs.16.0%;χ2=5.448,P=0.020),and coronary heart disease (32.2% vs.8.0%;χ2=5.792,P=0.016) were significantly higher.Multivariate logistic regression analysis showed that the level of education (odds ratio [OR] 1.364,95% confidence interval [CI] 1.059-1.756;P=0.016),atrial fibrillation (OR 2.509,95% CI 1.020-6.167;P=0.045),and higher glycosylated hemoglobin level (OR 1.586,95% CI 1.021-2.034;P=0.030) were the independent risk factors for no cognitive function improvement at 3 months after the onset of minor stroke/TIA.As time went on,the MoCA score and visual spatial execution,memory,abstract and directional scores were increased significantly (P<0.001),while there were no significant differences in naming,attention,and language scores.Conclusion s About 2/3 patients with minor stroke/TIA had cognitive impairment,and as time went on,they were improved.The lower education level,atrial fibrillation and higher baseline glycated hemoglobin were the independent risk factors for affecting no cognitive impairment improvement after monor stroke/TIA.

Objective:Atherosclerotic reanal artery stenosis(RAS) exists as one manifestation of more generalized atherosclerosis.It is important to find RAS in the population of carotid artery stenosis.The aim of the present study was to evaluate the prevalence of RAS in patients with carotid artery stenosis and to identify the risk factors for RAS.Methods:A total of 126 patients were carried out renal artery angiography after cerebral angiography.A univariate and multivariate Logistic regression analysis was performed to investigate the association of the clinical variables with RAS.Results: Renal artery stenosis was identified in 23(21.4%) patients.Multivariate predictors included coronary artery disease(OR=6.34,95%CI: 2.20-18.26) and peripheral vascular disease(OR=3.67,95%CI: 1.29-10.46). Conclusion: Coronary artery disease and peripheral vascular disease may be clinical predictors for RAS.

Objective There is little research focusing on the expression and function of bradykinin 1 receptor ( B1R ) and bradykinin 2 receptor ( B2R) after cerebral ischemia/reperfusion on the basis of diabetes .The aim of this study was to compare the ex-pression difference and function change of B 1R and B2R in non-dia-betic and diabetic rats . Methods The cerebral ischemia/reperfu-sion model was established on 41 non-diabetic and type 2 diabetic rats, the weight and the biochemical index were measured on these two types of rats .8 non-diabetic rats and 8 diabetic rats were respec-
tively assigned to two groups according to random number tables:control group and I/R 24 h group, 4 in each group.Real-time PCR was performed to observe the expressions of two receptors at 24 h after reperfusion .Then, 33 non-diabetic rats and 33 diabetic rats were randomly divided into 4 groups respectively, including sham group (n=6), saline group (n=9), B1R antagonist group (n=9) and B2R antagonist group (n=9).At 24 hours after cerebral I/R, neurological deficiency was evaluated by neurological severity scores ( NSS);infarct volume was observed by TTC staining;cell apoptosis was determined by TUNEL staining;neuron degeneration was de-tected by Fluoro-Jade C staining. Results Glucoses of diabetics at 3, 7, 14 d after model establishment [(23.45 ±5.01), (23.71 ±4.87), (22.72 ±4.11) mmol/L] were obviously elevated compared with non-diabetics [(5.77 ±0.75), (6.05 ±0.69), (7.15 ±1.09) mmol/L];blood cholesterin [(4.59 ±3.43) mmol/L] and insulin [(67.26 ±12.02) pmol/L] at 14 d after model establishment were evidently incresaed in comparison to those in non-diabetics [(1.58 ±0.37) mmol/L, (25.34 ±4.88) pmol/L] (P<0.05), while no significant difference was found in the blood triglyceride of diabetics between them (P>0.05).Compared with non-diabetics, diabetics suffered from more apparent up-regulation of B1R mRNA (P<0.01) but relatively less B2R mRNA (P<0.05) at 24 h after I/R.NSS score, infarction volume, damaged and apoptotic cells in B2R antagonis-treated non-diabetic rats at 24 h after I/R conspicuously decreased compared with saline-treated non-daibetic rats.Those indicators in B1R antagonis-treated diabeics were strikingly lessened compared with saline-treated daibetics . Conclusion I/R induced distinct up-regulation of B2R mRNA in non-diabetics and inhibiton of B 2R effectively ameliorated the infarct volume and cell injury after I/R in non-diabetics; I/R induced more notable up-regulation of B1R mRNA in diabetics and B1R antagonist exerted neuroprotective effects instead of B 2R antagonist af-ter I/R in diabetics.

Objective:To analyze the independent and comprehensive effects of the sites and mechanisms of middle cerebral artery(MCA)occlusion on cerebral infarction patterns and the National Institutes of Health Stroke Scale (NIHSS)scores andto investigate the possible related mechanisms and their potential values to the selection of patieras for thrombolysis.Methods:Sixty-six patients with new cerebral infarction caused by MCA occlusion were enrolled.The sites of MCA occlusion were classified into the origin of the MCA(type Ⅰ),the MCA trunk distal to the lenticulostriate arteries(type Ⅱ)and the branches of the MCA(type Ⅲ):the mechanisms of cerebral infection were categorized as thrombotic and embolic.Cerebral infarction lesion patterns were determined according to diffusion-weighted image(DWI).NIHSS scores were evaluated within 24 hours after stroke onset.The independent and comprehensive effects of the sites and mechanisms of MCA occlusion on cerebral infarction lesion patterns and the NIHSS were analyzed.Results:Cerebral infarction involved a larger range and NIHSS scores were higher in patients with occlusion at the origin of MCA and embolic occlusion of the MCA trunk distal to the lenticulostriate arteries.The analysis of the combination of the sites and mechanisms of occlusion could conduct further stratification for patients with cerebral infarction caused by MCA occlusion compared with univariate analysis.Conclusion:The analysis of the combination of the sites and mechanisms of occlusion better stratifies patients with cerebral infarction caused by MCA occlusion.It may be help to select patients for thrombolytic therapy.