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 .

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.

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.

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.

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.

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 establish a standardized middle cerebral artery occlusion (MCAO) model with suture method in rabbits and to investigate the value of the assessment for cerebral ischemia with amplitudeintegrated electroencephalogram (aEEG).Methods A total of 34 male New Zealand white rabbits were randomly assigned to either an MCAO group (n =29) or a sham operation goup (n =5).A model of MCAO was induced with intraluminal suture method and the cerebral function monitor was performed.According to 2,3,5-triphenyltetrazolium chloride staining,the MCAO group was further divided into cortex + basal ganglia infarction,basal ganglia infarction,subarachnoid hemorrhage,and non-lesion subgroups.The differences among the physiological indicators,weight,thread end diameter,and insertion length were compared before and after modeling in all subgroups.Results The success rate of MCAO modeling with suture method in rabbits was 62.07％ (18/29),in which 37.93％ (11/29) involved in the cortex and basal ganglia,24.38％ (7/29) only involved in the basal ganglia,17.24％ (5/29) complicated by subarachnoid hemorrhage,and 20.69％ (6/29) had no infarction.There were no significant differences in the body temperature,heart rate,mean arterial pressure and arterial blood pH,oxygen partial pressure,and CO2 partial pressure among all the subgroups before and after modeling.The weight in the non-lesion subgroup was 2.36 ± 0.10 kg,it was significantly lower than 2.55 ± 0.09 kg in the cortex + basal ganglia infarction subgroup (P =0.001) and 2.50 ± 0.12 kg in the basal ganglia infarction subgroup (P =0.017).The length of suture placement in the cortex+basal ganglia infarction subgroup was 5.59 ± 0.24 cm,and it was significantly less than 6.00 ± 0.50 cm in the subarachnoid hemorrhage subgroup (P =0.036).However,it was significantly longer than 5.20 ± 0.50 cm in the non-lesion subgroup (P =0.033).After modeling there were significant differences in aEEG among all subgroups (F =14.059,P =0.000).Compared to before modeling,aEEG decreased 50.02％ (t =9.573,P ＜ 0.001) and 14.20％ respectively after modeling in the cortex + basal ganglia infarction subgroup and the ganglia infarction subgroup (t =2.908,P =0.027).Conclusions A standardized MCAO model in rabbits may be successfully established with suture method.The significantly decreased aEEG indicates that the MCAO model is successful and the lesions involve in the cortex.

Objective To investigate the risk factors for leukoaraiosis (LA). Methods The clinical and imaging data in patients with stroke were collected retrospectively. LA was divided into periventricular LA and subcortical LA according to the findings of MRI, and they were scored and classified. Results A total of 113 patients with stroke were included. There were 39 women and 74 men (mean age 61.33 ± 1.32 years). The age (65.52 ± 12. 56 vs.47. 96 ±9. 23 years, t =5. 634, P =0. 000), hypertension (68. 60% vs. 29. 63% ,x2 = 12. 932,P =0. 000), diabetes (30. 23% vs. 3.70%, x2 = 7. 953, P = 0. 005), systolic blood pressure (SBP) (147. 42 ± 2. 78 mm Hg vs. 134. 00 ± 22. 45 mm Hg,t = 2. 862, P = 0. 004), glucose (6. 54 ± 3. 48 mmol/L vs. 5. 35 ± 1.37 mmol/L, t = 2. 808, P = 0. 005), and total cholesterol (TC) level (5. 17±0.89 mmol/L vs. 4.59±0.61 mmol/L, t=3. 152, P=0. 002) in patients with periventricular LA (n = 86) were significantly higher than those without periventricular LA (n =27). The age (66. 44 ± 11.33 vs. 47. 96 ±9. 23 years, t =4. 768, P =0. 000), hypertension (74. 29% vs. 34. 88%, x2 = 17. 134, P = 0. 000), SBP (85.46 ± 9. 80 mm Hg vs. 69. 81 ±8. 74 mm Hg, t =2. 999, P=0. 003), diastolic blood pressure (DBP) (85.46 ±9. 80 mm Hg vs.69. 81 ±8.74 mm Hg, t =2. 999, P =0. 003), and TC level (5.22±0.99 mmol/L vs. 4.91 ±0. 75 mmol/L, t =3. 330, P =0. 001) in patients with subcortical LA (n =70) were significantly higher than those without subcortical LA (n =43). Spearman correlation analysis showed that the periventricular LA classification was significantly correlated with the age (rs = 0. 606, P =0. 000), drinking (rs = -0. 257, P = 0. 006), hypertension (rs = 0. 428, P = 0. 000), diabetes (rs =0. 236, P =0. 012), SBP (rs =0. 382, P =0. 000), and DBP (rs =0. 258, P =0. 006). The subcortical LA classification was significantly correlated with the age (rs = 0.488, P = 0. 000),hypertension (rs = 0. 416, P = 0. 000), SBP (rs = 0. 386, P = 0. 000), DBP (rs = 0. 326, P =0. 006), and TC level (rs =0. 231, P =0. 014). Multivariate logistic regression analysis showed that the age (odds ratio[OR] = 1.071, 95% confidence interval [CI] 1.009-1. 137; P=O. 024), hypertension (OR =4. 106, 95% CI 1. 657-10. 174; P =0. 002), and SBP (OR =1. 049,95% CI 1. 162-7. 013; P = 0. 022) were independently correlated with LA. Conclusions The age, hypertension, and SBP are the independent risk factors for LA, in which the age is an uncontrollable factor, and the aggressive prevention and treatment of hypertension may reduce the occurrence of LA.