Delirium is a common complication after acute stroke.It usually indicates the poor outcome,higher mortality,longer hospital stay and increased dementia risk of patients.Therefore,the early detection and intervention of delirium after acute stroke have an important significance.This article reviews the pathogenesis,risk factors,diagnosis,assessment,treatment and outcome of delirium after stroke.

Objeaive To investigate the impact of serum uric acid concentration on short-term outcome in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were collected.According to the modified Rankin scale (mRS) scores at discharge,the patients were divided into either a good outcome group (mRS score 0 to 2) or a poor outcome group (mRS score 3 to 6).The baseline National Institutes of Health Stroke Scale (NIHSS) scores,serum uric acid (SUA) levels and other demographic and clinical data in both groups were compared.Results A total of 311 patients with acute ischemic stroke were enrolled in the study.There were 185 patients in the good outcome group and 126 in the poor outcome group.The patients' constituent ratios of the baseline NIHSS scores (median [interquartile range]) (7 [4-11] vs.3[2-4] ; Z =9.858,P =0.001),previous type 2 diabetes mellitus (29.4％ vs.14.1％ ;x2 =10.877,P =0.001) and history of TIA (27.8％ vs.17.8％ ;x2 =4.335,P =0.037) were significantly higher than those in the poor outcome group,while the patients' constituent ratio of the SUA levels (331.984±118.995 mmol/Lvs.363.276±100.743 mmol/L;t =2.497,P=0.013) and the NIHSS score ＜9 (63.5％ vs.96.8％ ;x2 =59.562,P =0.000) were significantly lower than those in the good outcome group.The baseline NIHSS and mRS scores at discharge were higher in the SUA lower quartile group (all P ＜0.01).Multivariate logistic regression analysis showed that the increased SUA was an independent protective factor for short-term outcome in patients with acute ischemic stroke (odds ratio 0.997,95％ confidence interval 0.995-0.999; P =0.016).Conclusions The increased SUA is an independent protective factor for short-term outcome in patients with acute ischemic stroke.

Objective To study the prevalence and subtype of hemorrhagic transformation (HT ) among patients with different subtypes of acute cerebral infarction ,and investigate its clinical significance .Methods 977 patients with acute cerebral infarction from January 2008 to December 2011 were divided into groups according to the stroke subtypes :large-artery atherosclerosis(LAA) , cardioembolism(CE) ,small-artery occlusion(SAO) ,undetermined cause(UND) ,and other determined cause(OC) .HT included hemorrhagic infarction (HI) and parenchymal hematoma (PH) .The baseline data were registered and the prevalence and subtype of HT between different groups were compared .Results The rates of hypertension were the highest in LAA ,The rate of diabetes was the highest in SAO ,The rate of atrial fibrillation was the highest in CE .The rates of hyperlipidemia had no significant difference a-mong different subtypes of CI .The HT incidence of LAA ,CE ,SAO ,OC ,UND were 12 .8% ,31 .1% ,6 .6% ,4 .5% ,5 .5% respec-tively ,the difference was statistically significant (χ2 =61 ,P<0 .01) .As to the subtype of HT ,PH was more common in CE group (χ2 =31 ,P<0 .01) .Conclusion Distribution of risk factors ,HT prevalence and classification are different in different subtypes of acute cerebral infarction ,the differences might be related to the distribution of different risk factors .

Idebenone is a synthetic analogue of coenzyme Q10. As a potent antioxidant,idebenone operates under low oxygen tension situations, protects cell membranes and mitochondria from oxidative damage through inhibiting lipid peroxidation, thereby protects against cerebral ischemia and nervous system damage. Idebenone also interacts with the mitochondrial electron transport chain and maintains the formation of ATP under ischemic conditions. Because idebenone has a good tolerability and safety, it is expected as a neuroprotective agent for the treatment of acute ischernic stroke. Studies in recent years have showed that idebenone has a certain therapeutic effect in a variety of nervous system diseases involving mitochondrial dysfunction and oxidative stress damage, such as mitochodrial encephalomyopathy, lactic acidosis, stroke-like episodes syndrome, Friedreich's ataxia, Alzheimer's diseases, Leber's hereditary optic neuropathy, and Duchenne muscular dystrophy. At present, some clinical trials in the mitochondria-related diseases and neuromuscular diseases are underway, and their results are expected to further expand the indications of idebenone.

Iron is an essential nutrient element for human, but has potential toxicity. Under physiological conditions, the processes of iron absorption, transportation, cellular uptake and utilization, storage, release, excretion as well as regulation of iron metabolism maintain the iron homeostasis. However under pathological conditions, the iron metabolism changes and is associated with the pathological states. In order to realize the relationship between the critical illness status and the iron metabolism, we start with an analysis of the basic processes of iron metabolism in human and the toxicity of iron, followed by summary on the alteration of iron metabolism in the settings of pathological conditions, such as inflammation, infection and anemia, which often occur in critical illness. Then, we discuss the relationship between the prognosis and the parameters of iron metabolism. Moreover, we review the current researches on treatments related to iron metabolism, which involve the iron supplementation, iron chelation and agents regulating iron metabolism.

Objective To summarize PET?MRI and pathologic characteristics of heroin spongiform leukoencephalopathy(HSLE). Methods Clinically, 28 cases underwent CT and MRI analysis,in which 2 cases had brain autopsies and 8 cases had brain biopsies. HE, GFAP, Loyez and Congo Red staining were made and observation done through electronic microscope. 4 cases underwent PET analysis. Results The PET, MRI and pathologic characteristics of HSLE showed (1) Spongiform vacuoles degeneration of white matter was pathologically the main morphological change. (2) All the 28 cases had a history of inhalation of heated heroin vapor and abstained from durg. (3) Most cases were described with acute onset characterized by cerebellar signs. (4) PET shows the cortex of the parietal lobe, occipital lobe and cerebellum became thin in 4 cases, while the cerebral white matter had enlarged. (5) Brain CT and MRI revealed extensive symmetric white matter lesions in cerebra and cerebellum. Conclusions Brain CT and MRI revealed extensive symmetric white matter lesions in cerebra and cerebellum. PET has more advantage in judging progress of patient's condition and therapeutic effecacy than MRI. Spongiform vacuoles degeneration of white matter was the main pathological change.

Objective To investigate the relationship between apolipoprotein B (ApoB),apolipoprotein A Ⅰ (ApoA Ⅰ) and their ratios and intracranial cerebral atherosclerotic stenosis (ICAS) in patients with acute ischemic stroke.Methods The patients with large artery atherosclerotic stroke were enrolled retrospectively.The patients were divided into either an ICAS group or a non-ICAS group based on their vascular imaging data.The blood pressure,blood lipids,blood glucose,ApoB,ApoA Ⅰ,and ApoB/ApoA Ⅰ ratios and demographic data were collected.The differences of the above indicators were compared between the two groups.Results A total of 360 patients with large artery atherosclerotic stroke were enrolled.There were 177 patients in the ICAS group (49.2％) and 183 in the non-ICAS group (50.8％).There were significant differences in the constituent ratios of the patients with hypertension,diabetes and coronary heart disease,as well as the levels of low-density lipoprotein cholesterol,ApoB and ApoA Ⅰ and ApoB/ApoA Ⅰ ratios between the 2 groups (all P ＜0.05).Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 1.75,95％ confidence interval [CI] 1.04-2.93; P =0.035),diabetes mellitus (OR 2.09,95％ CI 1.31-3.32; P =0.002),coronary heart disease (OR 2.68,95％ CI 1.09-6.57; P =0.031),ApoB ≥ 0.84 g/L (0.84-1.00 g/L:OR 2.68,95％ CI 1.30-5.56; 1.00-1.16 g/L:OR 3.95,95％ CI 1.87-8.40; ＞ 1.00 g/L:OR 6.41,95％ CI 2.82-14.49) and ApoB/ApoA Ⅰ ratio ≥0.60 (0.60-0.73:OR 1.92,95％ CI 1.14-3.24; 0.74-0.91:OR 1.79,95％ CI 1.06-3.02; ＞0.91:OR 3.30,95％ CI 1.92-5.67) were the independent risk factors for ICAS,while ApoA Ⅰ ＞ 1.28 g/L was an independent protective factor for ICAS (OR 0.39,95％ CI 0.16-0.98; P=0.044).Conclusions The increased ApoB level and ApoB/ApoA Ⅰ ratio are the independent risk factors for ICAS,and the increased ApoA Ⅰ level is an independent protective factor for ICAS in patients with acute ischemic stroke.The ApoB/ApoA Ⅰ ratio can be used as a biomarker of ICAS in patients with ischemic stroke in Chinese population.

Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin (PCT) level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level (the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission) were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis
classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group (66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup) and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale (GCS) score, and PCT level between the bacterial pneumonia group and the non-infection group (P < 0. 05 ). Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L (odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P < 0. 01), GCS score ≤8 (OR 11. 361, 95% CI 2. 175 - 59. 352; P < 0. 01), and PCT level ≥0. 050 ng/ml (OR 16. 715, CI 5. 075 - 55. 049; P < 0. 01) were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level (median; interquartile range) in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup (0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P < 0. 01 ). ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 (CI 0. 806 - 0. 924, P < 0. 01); PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 (CI 0. 672 - 0. 858; P < 0. 01). Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.

Objective To analyze quantitatively the safety and efficacy of statin therapy in acute phrase for acute ischemic stroke with the method of meta-analysis.Methods We performed a systematic literature search including the Cochrane Library,MEDLINE and EMBASE for published trials about statin therapy and the outcomes of acute ischemic stroke.Then we performed a meta-analysis with included studies to investigate the association between statin therapy and clinical outcome and mortality.All of the data were pooled and meta-analyzed by Cochrane Collaboration RevMan 5.3 meta-analysis software.Statistical heterogeneity between studies was evaluated by the chi-square and I-square tests.Forest plots were used to summarize study data and Egger tests were used to assess publication bias.Results A total of 27 studies including 52 034 patients,comprising 19 212 statin users and 32 822 non-statin users met the inclusion criteria,4 studies were randomized controlled trials (RCTs),and 23 were observational trials (OTs).Both pre-or post-stroke statin use was associated with reduced mortality.Statin use is associated with favorable functional outcome at hospital discharge and on the ninetieth day regardless of initiation time for pre-stroke group and post-stroke group.The results from observational trials were consistent with randomized controlled trials.There was no evidence of publication bias for all comparisons by Egger tests.Conclusions Statin therapy before or after AIS is safe and effective.