Collateral circulation actively enables or generates new blood vessels in order to ensure blood supply to the tissues of body when the normal feeding arteries are stenosis or occlusion.This article mainly reviews the assessment methods of collateral circuhtion in ischemic stroke.

OBJECTIVE To explore the risk factors in aged patients with ventilator-associated pneumonia(VAP) and to provide the corresponding clinical prevention strategies. METHODS The ages,underlying diseases,mechanical ventilation method,use of antibiotics,and pathogenic bacteria of the VAP patients were investigated and analyzed. RESULTS Totally 155 VAP of elderly patients had serious underlying diseases,and treated with broad-spectrum antibiotics,tracheal intubation or trachea incision.Most pathogenic bacteria were mutiple-resistant. CONCLUSIONS The prevention of VAP was in priority for control of VAP patients.In order to control the occurrence and spread of VAP,clinicians should cut the time of ventilator,pay more attention to sterilization and isolation,and strengthen the tend of the patients.

Cerebral venous thrombosis (CVT) refers to thrombosis of the intracranial veins and sinuses, which is a rare type of cerebrovascular disease.Due to this highly variable and nonspecific clinical presentations, CVT can be difficult to diagnose.Understanding the pathophysiology and etiology of CVT helps to understand its clinical symptoms and imaging findings and guide the treatment.This article reviews the related advances in the pathophysiology and etiology of CVT.

OBJECTIVE:To determine the content of plumbm(Pb) and cadmium(Cd) in the roots of Arachniodes exilis.ME-THODS:The samples were treated with microwave digestion.Graphite furnace atomic absorption spectrometry was adopted for the content determination of Pb and Cd in samples.RESULTS:The contents of Pb and Cd were 2.209 mg?kg-1 and 0.215 mg?kg-1 in the roots of A.exilis.CONCLUSION:Harmful heavy metals have been detected in the roots of A.exilis,which is in line with the limitation stated in the Green Trade Standard for Medicinal Plant and Preparations.This method is simple,accurate and reliable for the content determination of practical samples.

Objective:To study the effects of glutamine on the rehabilitation and the immune function in patients with acute stroke. Methods: The study included 57 patients with cerebral ischemia and 29 patients with brain hemorrhage.Nutritional and immune function parameters were evaluated at admission and after 2 weeks following stroke respectively.Neurological deficit was also evaluated by the Chinese Stroke Scale at admission and after 28 days following stroke.The infective complications were investigated. Results:At the same duration after acute stroke,the extent of neurological deficit recovery was significantly lower in the control group than the glutamine group.The rate of the infective complications was significantly higher and it's duration was significantly longer in the control group than the glutamine group.The degree of nutriture and immune function deteriorating was significantly severer in the control group than the glutamine peptide group. Conclusion:Parenteral glutamine supplements is helpful for the rehabilitation and in preventing deterioration of nutrition status and immune function following acute stroke.

Objective:To observe the effect of ginsenoside Rd pretreatment on the expressions of N-methyl-D-aspartate(NMDA)receptor subunit NR2 B protein and endonuclease G(EndoG)in basal ganglia region after cerebral focal ischemia-reperfusion in rats and to investigate possible mechanism of ginsenoside Rd in the treatment of ischemic stroke.Methods:A rat model of middle cerebral artery occlusion(MCAO)was induced by intraluminal filament method.The expressions of NR2B and EndoG in basal ganglia region for focal cerebral iSChemia 1 hour,and 1,6,24 and 72 hours reperfusion were detected by immunohistochemical staining and image analysis method.The effects of ginsenoside Rd on the expressions of FaxioG and NR2B and the volume of cerebral infarction were evaluated.Results:The positive expression of NR2B in basal ganglia region on the ischemic side in ischemia-reperfusion group was increased significantly.The expression of EndoG in the nucleus was notable;the positive expressions of NR2B and EndoG at different reperfusion time points in ginsenoside Rd pretreatment group were decreased significantly(P<0.05 or P<0.01),and the volume of cerebral infarction was reduced significantly(P<0.01).Conclusions:The expressions of NMDA receptor subunit NR2B protein and apoptosis-inducing factor EndoG were increased significantly after cerebral focal ischemia reperfusion;ginsenoside Rd pretreatment may significantly reduce the expressions of NR2B and EndoG.It reduces the volume of cerebral infarction by inhibiting excitatory neurotoxicity and blocking neuronal apoptosis,and thus plays a role in neuroprotection.

Objective To investigate the effects of aquaporin4 (AQP4) on the brain injury after cerebral ischemic reperfusion and to search the new method that can prevent and cure the injury. Methods Locally injection of naked DNA ( pcNDA3.1/Zeo), which carries AQP4 gene and reporter gene green fluorescent protein(GFP), in the brain was performed 12 h before ischemic challenge to up-regulate the AQP4 expression. The expressed level of AQP4, the infarction size and neurological deficit scores were estimated in three groups. Results (1) Exogenous AQP4 expression in the brain did not affect the healthy rat neurological deficit score; (2) Rat neurological deficit scores were 7.9?0.7, and 7.1?0.9 respectively in 12 h and 24 h after reperfusion in AQP4 injected group, which were lower than that in plasmid control group when both groups were challenged with reperfusion after ischemia; (3) Expression of AQP4 in the brain was higher in AQP4 injected group than plasmid control group and control group in early stage after reperfusion; (4) Expression of exogenous AQP4 in the brain increased the cortex and striatum infarction size 24 h after reperfusion, which were (261.0?18.2) mm 3 and (21.9?1.9) mm 3, respectively, in AQP4 injected group more than plasmid control group. Conclusions (1) Increased local AQP4 expression in brain does not affect neurological function in the healthy rat; (2) Pre-expression of AQP4 increase infarction size and neuro-functional injury; (3) Modification of AQP4 activity and regulation of AQP4 expression level would be the new strategy for the prevention of cerebral edema and the reduction of cerebral injury after stroke.

Objective To investigate the impact of internal carotid artery stenosis on cognitive function of patients and the improvement of cognitive function after internal carotid artery stenting. Methods The clinical data of 92 patients with asymptomatic internal carotid artery stenosis on segment C1 segment diagnosed by cerebral angiography at the Department of Neurology,Urumqi General Hospital of Lanzhou Military Hospital from May 2007 to June 2013 were analyzed retrospectively,including 49 with moderate stenosis and 43 with severe stenosis. Thirty-one patients had stenting. The enrolled patients were evaluated with the Montreal Cognitive Scale (MoCA)score and the National Institutes of Health Stroke Scale (NIHSS) score,and the improvement of the MoCA score at 3 month after stenting was evaluated. Results (1)The MoCA score of the severe stenosis group was lower than that of the moderate stenosis group(22. 6 ± 2. 9 vs. 27. 4 ± 2. 3,P<0. 01). The patients with the MoCA score <26 was 83. 7%(36/43). It was significantly higher than 22. 4% in the moderate stenosis group (11/49). There was significant difference between the 2 groups (P<0. 01). (2)In the severe stenosis group,there was no significant difference in the preoperative MoCA score between the stenting group (22. 9 ± 3. 0)and the non-stenting group (21. 9 ± 2. 4)(P>0.05);3 months after stenting,the MoCA score (25. 4 ± 2. 7)of the stenting group was significantly better than that of the non-stenting group (22. 2 ± 2. 8). There was significant difference (P<0. 01);and after stenting,the proportion of patients with the MoCA score <26 (48. 4%,15/31)was significantly lower than those of the non-stenting (83. 3%,10/12,P=0. 037). Conclusion Severe stenosis of internal carotid artery may cause cognitive dysfunction. Carotid artery stenting is conducive to improve cognitive function in patients with severe stenosis.

ObjectiveTo explore the best treatment method of cerebral artery dissection.Methods This study included eight patients who were definitely diagnosed as cerebral artery dissection by the cerebral angiography in our department of neurology during Oct.2009 and Nov.2011.They were all treated by the anticoagulation or anti-platelet methods.Some patients received the stent therapy.All patients' were followed for at least three months. The treatment effect was assessed by NIHSS,mRS and by the cerebral angiography.ResultsSix patients had carotid artery dissection,2 had vertebral artery dissection.Four patients were given anticoagulant therapy and the other 4 were given anti-platelet therapy. The reexamination by angiography 10-14 days after admission showed that in 3 patients,the stenosis was aggravated or the infarction occurred.They were diagnosed as having repeated transient ischemic attack (TIA) during pharmacotherapy and received stents for treatment.There was no TIA and cerebral infarction in the follow-up period after individualized therapy.Mean NIHSS scores of 8 patients between pre and post treatment were 5.9,1.6 respectively. Mean mRS scores pre and post treatment were 2.5,0.9respectively.Conclusion The treatment for patients with cerebral artery dissection should be individuated.The patients in acute stage should get anticoagulation,anti-platelet therapy and angiography re-examination.According to the clinical manifestation and cerebral angiography,the next step for the treatment should be done.

Objective To observe the effect of tetrahydroxy stilbene glucoside (TSG) on the behavior on rat model and the expressions of autophagy-associated protein Beclin-1 and LC3- Ⅱ induced by Aβ1-42 Methods Eighty rats were equally randomized into 4 groups (n =20):The control group,the sham operated group,the model group and the TSG group.The behavior of rats was measured by using Y-maze and Morris water maze.The expression of Beclin-1 and LC3- Ⅱ in rats hippocampus was detected by Western blot and RT-PCR at the time points.Results The number of electric-stimulus in hippocampus significantly increased and the Morris water maze test showed that the escape latency prolonged,swimming distance increased and the times of crossing the exact former platform location decreased both in the model and TSG groups after 21 days compared with those in control group.The mRNAs and protein expressions of Beclin-1 (0.51 ±0.03)and LC3-Ⅱ (0.68 ± 0.04) in model group were higher than that in control group (0.31 ± 0.01,0.31 ± 0.02) at that time point ( Beclin-1:t =28.2843,P ＜ 0.05 ; LC3- Ⅱ :t =37.0000,P ＜0.05).Compared to model group,the expression of the Beclin-1 and LC3- Ⅱ was decreased at 21 d in TSG group (Beclin-1:t =9.8387,P ＜ 0.05 ; LC3- Ⅱ :t =16.2698,P ＜ 0.05 ).Conclusions Autophagy self-regulated system is started through the increased expressions of Beclin-1 and LC3- Ⅱ after Aβ deposition in rats,so as to attenuate cerebral injury caused by Aβ neurotoxicity.Autophagy pathway is possible one of the mechanisms in Aβ neurotoxic injury. Tetrahydroxy stilbene glucoside from polygonum multiflorum has protective effect on it.