The pathogenesis of cerebral ischemia is extremely complicated.In vitro models have better controllability.They have important significance for the study of the pathogenesis.This article reviews the commonly used In vitro models and provides references for the future study of the pathogenesis of cerebral ischemia.

Remote ischemic postconditioning (RIP) refers to a transient and non-lethal ischemic adaptation in non-vital organs after the vital organs having experienced long-term lethal ischemic injury. Relative to the remote ischemic preconditioning (RIPC),RIP has more value in clinical application. However,RIP is still in the cognitive stage of research. This article reviews the advances in research on RIP of each system.

With the wide development of intra-arterial thrombolysis,the risk factors and the occurrence mechanism of hemorrhagic transformation have drawn great attention.Hemorrhagic tramformation is the most dangerous complication of intra-arterial thrombolysis.The understanding of the occurrence mechanism of hemorrhagic transformation from macroscopic tO microscopic,it is attributed ultimately to the destruction of vascular wall structure or function.The related mechanisms include oxidative stress reaction,leukocyte infiltration and inflammatory reaction,vascular reaction,and extracellular proteolysis.

Objective To investigate the changes of ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP)in acute phase of cerebral infarction. Methods From March 2011 to June 2012,95 patients with early cerebral infarction from the Neurology Clinic,the Emergency Department and the Cerebral Apoplexy Screening Project Base,and the Neurology Ward of Renhe Hospital were used as an infarction group;61 non-stroke subjects received physical examination in the Physical Examination Center of our hospital in the same period were used as a control group. The cerebral infarction group and the patients with cerebral infarction in different onset of time groups (an onset < 12 h group and an onset 12-24 h group),the different National Institutes of Health Stroke Scale (NIHSS)score groups (NIHSS 0 -4 group and NIHSS 5 -19 group),and the levels of UCH-L1 and GFAP in the control group were measured and compared among the groups. The receiver operating characteristic (ROC)curve was established. The cut-off values of the relevant parameters in the diagnosis of cerebral infarction,and the sensitivity and specificity of diagnosis were obtained. Results The UCH-L1 and GFAP values of the cerebral infarction group were all higher than those of the normal control group (0. 13[0. 09,0. 21]μg/ L vs. 0. 05[0. 02,0. 13]μg/ L,0. 030[0. 008,0. 130]μg/ L vs. 0. 004[0. 004,0. 020]μg/ L,Z values were 3. 62 and 4. 95 respectively;all P < 0. 01). The UCH-L1 and GFAP values of the NIHSS score 5 -19 group were higher than those of the NIHSS score 0 -4 group (0. 12[0. 08,0. 21]vs. 0. 09[0. 08,0. 18],0. 07 [0. 01,0. 11]vs. 0. 04[0. 01,0. 10];all P < 0. 05). There was no significant difference in the UCH-L1 and GFAP values between the onset 12 -24 h group and the onset < 12 h group (0. 12[0. 08,0. 21]μg/ L vs. 0. 09[0. 08,0. 18]μg/ L,0. 030[0. 010,0. 110]μg/ L vs. 0. 040[0. 008,0. 100]μg/ L;all P > 0. 05). The analysis results of ROC curve of UCH-L1 and GFAP for diagnosis of acute cerebral infarction showed that when the plasma UCH-L1 was ≥0. 18 μg/ L,the sensitivity and specificity of UCH-L1 were 68% and 74%respectively;When the plasma GFAP was ≥0. 11 μg/ L,the sensitivity and specificity of GFAP were 70% and 86% respectively. The area under the ROC curve of UCH-L1 and GFAP diagnosis of cerebral infarction were 0. 64 and 0. 71 respectively. Conclusions UCH-L1 and GFAP have obvious change in acute phase of cerebral infarction. UCH-L1 and GFAP may have certain correlation with the severity of stroke.

Objective To investigate the therapeutic method and effect of thrombolysis via super-selective ophthalmic artery catheterization treating central retinal artery occlusion (CRAO). Methods 9 patients with CRAO were treated by urokinase infusion via super-selective ophthalmic artery catheterization with Seldinger technique. Results In the 9 patients, the visual acuity was improved to different extent in 8, and remained unchanged in 1. No complications was found during the treatment in any patients. Conclusions Thrombolysis via super-selective ophthalmic artery catheterization for CRAO can improve the visual acuity of most of the patients in different degrees. No positive relation exists in clinical therapeutic effect, time of onset, quantity of urokinase and the visual acuity before the treatment. The method of thrombolysis via super-selective ophthalmic artery catheterization for CRVO is safe and reliable.

Objective To discuss the individualizing schedule of endovascular treatment for intracranial venous sinus thrombosis based on the clinical feature and the stage of the disease.Methods Forty-three patients diagnosed with intracranial venous sinus thrombosis in Xuanwu Hospital,Capital University of Medical Sciences and in Zhongshan Hospital Xiamen University during period of August 2010 to August 2011 were treated with endovascular therapy designed individually based on the clinical stage of the disease development.Of all 43 cases,22 cases with acute onset (＜ 1 week after the onset) were treated with standard anticoagulant therapy ; 11 cases who failed to respond to anticoagulant therapy and 8 cases with subacute onset (1 week to 1 month) received intravenous thrombolysis and mechanical thrombus maceration;and 13 cases with chronic course (＞ 1 month) were given mechanical thrombus maceration combined with balloon dilation vascular surgery or stent-assisted venous sinus surgery,with taking anticoagulant for 12months.The patients were followed up for 3 to 6 months (mean 4.5 months).Results Their symptoms and signs were all significantly improved,with headache relief in 29 cases(67.4％),vision improvement in 28cases (28/31,90.3％),cerebrospinal fluidpressure decrease to normal level in 32 cases(32/43,74.4％) ;no improvement in 1 case,and a complication of subdural hematoma in 1 case.Three months follow-up of 39 patients,symptoms disappeared,the pressure cerebrospinal fluid in 36 cases returned to normal (94.3％),the papilledema in 37 cases subsided (94.9％).After 6 months,16 patients were followed up with an angiography; 8 of them were found venous sinus clear,5 were found partial recanalization of venous sinus trunk,cortical veins and deep venous was partially compensation,and 3 cases with stent-assisted venous sinus surgery were found the stent not shifted or collapsed,and venous sinuses maintained patency.Conclusions Endovascular treatment for patients with intracranial venous sinus thrombosis should be treated with individually designed therapy based on their clinical features and the stage of the disease.The individualized treatment was effective and safe.

This article summarizes the methods of making rat cerebral ischemia models and comments the advantages and disadvantages of various methods in order to provide references for the selection of animal models in the basis and appfication research of cerebral ischemia.

Objective To investigate the satlsfaction of senior outpatients over 60 years old,and explore the factors associated with their satisfaction so as to provide scientific references for improving quality of care at the hospital Methods A questionnaire survey was made by random sampling at the hospital.The outcomes subject to Ordinal regress Results The general satisfaction was as high as 82.77％ among these outpatients.Results of the Ordinal regression model showed seven factors significantly affecting such satisfaction rate,namely waiting time for registration,correct statement of medicine information,patience to hear patient's concerns,carefulness of inspection,time for doctor-patient communication,request for comments on therapy,and outpatient clinic seating conditions.Conclusion Senior outpatients tend to emphasize medical skills and medical service than waiting time at the hospital.This suggests better medical skills and service attitude as key to higher general satisfaction rate of senior outpatients.

Although thrombolytic therapy is the only method recommended by the Food and Drug Administration(FDA)for acute ischemic stroke,the time window limits its application.Thus,neuroprotective research,which has a wider application become the focus.This article summarizes the neruoprotective methods in animal researches and clinical trials.

As an endogenous organism protective measure in vivo, preconditioning/ postconditioning in the process of ischemia/reperfusion may play common protective mechanisms, such as reducing the generation of oxygen free radicals, activating adenosine receptor, increasing endogenous nitric oxide and heat shock protein, inhibiting immune inflammatory response and neuronal apoptosis, activating intracellular signal transduction pathways, opening mitochondrial ATP-sensitive potassium channels, as veil as closing mitochondrial permeability transition pores. Investigating the common target of these mechanisms may provide a new theoretical basis for developing new drugs and reducing ischemia/reperfusion injury.