Anticoagulation is one of the important approaches in the prophylaxis and treatment of iSCheroic stroke.However.it may increase the risk of bleeding events in reducing the risk of recurrent stroke at the same time.This article reviews the status of anticoagulants in the prophylaxis and treatment of ischemic stroke by retrospecting their application in the prevention and treatment of ischemic stroke and the study of new anticoagulants.

Objective To investigate the differences of platelet membrane glycoprotein PAC-1 and CD62P expression in patients with cerebral small vessel disease and its subtype and large artery atherosclerotic stroke and to compare the traditional platelet activation markers and inflammatory chemokine platelet factor 4(PF4).Methods Peripheral blood platelet PAC-1,CD62P positive rates and serum PF4 concentration in 30 patients with large artery atherosclerotic stroke,45 patients with cerebral small vessel disease and 30 controls were detected using flow cytometry and enzyme-linked immunosorbent assay.The differences between the groups were compared.Results The PAC-1,CD62P positive rates and serum PF4 concentration in the large artery atherosclerotic stroke group were 63.21% ± 9.78%,55.91% ± 8.17%,and 30.55 ± 15.56 ng/ml,respectively.They were significantly higher than 40.65% ± 17.42%,36.49% ± 14.60%,and 12.59 ±5.57 ng/mlin the cerebral small vessel disease group(all P=0.000),and the latter was still higher than 13.55% ± 3.14%,9.00% ± 2.32%,and 4.95 ±2.82 ng/ml in the control group(all P = 0.000).There were significant differences in all the subtypes groups of cerebral small vessel disease between the PAC-1,CD62P positive rates and serum PF4 concentration.The leukoaraiosis with lacunar infarction group(n = 15;47.72% ±15.52%,43.75% ± 12.54%,and 13.96 ± 5.23 ng/ml)and the simple lacunar infarction group (n = 15;49.87% ± 14.65%,43.98% ± 10.55%,and 14.41 ± 5.53 ng/ml)was significantly higher than the simple lacmar infarction group(n = 15;24.44% ± 8.45%,21.74% ± 7.19%,and 9.40 ±4.99 ng/ml)(P =0.000,0.000,and 0.013,respectively).There was no significant difference between the forrner 2 groups(P = 0.658,0.952,and 0.858,respectively).The peripheral blood platelet PAC-1 positive rate had significant correlation with CD62P positive rate in patients with ischemic cerebral disease(r= 0.964,P= 0.000),and the serum PF4 concentration showed linier correlation with the PAC-1(r =0.846,P =0.000)and CD62P(r =0.857,P =0.000)positive rates.Conelusions The platelet membrane glycoprotein PAC-1 and CD62P expression showed linear correlation,and they were consistent with the changes of PF4 concentration.This sugested that platelet activation and its mediated inflammatory mechanisms played an important pathophysiological role in the processes of atherosclerosis and thrombosis.This mechanism had significant difference between the different lesion types.

Objective To explore the relationship between age-related cerebral white matter changes (ARWMC) and cognitive function, observe the features of cognitive impairment in ARWMC patients, and provide evidences for preventing and treating cognitive impairment in elderly people.Methods Fifty patients with ARWMC were divided into mild-to-moderate group (n= 26, ARWMC score 1-10) and severe group (n= 24, ARWMC score＞ 10) based on the ARWMC scale of CT/MRI scans. Twenty healthy elderly people, who underwent physical examination in hospital, were selected as control group. The cognitive function was evaluated using Montreal Cognitive Assessment (MoCA,Beijing version). Cognitive functions were compared between patients with ARWMC at different extents and the controls. The correlation between severity of ARWMC and cognitive function, the characteristics of cognitive impairment in patients with ARWMC were analyzed. Results The cognitive function in patients with ARWMC was impaired significantly (the MoCA scores were 26.60±1.23 in control group, 23. 19±2. 62 in mild-to-moderate group and 19.83±3. 09 in sever group, F =39. 930, P = 0. 000). The severity of ARWMC was negatively related with MoCA score (r =-0. 476, P=0. 000). The patients showed cognitive impairment especially in the visuoconstructional and executive functions (F= 13. 189, P＜0.05), delayed recall (F=32.340, P＜0.05) and orientation (F= 15.813, P＜0. 05). Conclusions ARWMC is related with cognitive impairment.The severity of white matter changes is correlated with worse cognitive function.

Objective To investigate the roles of interleuldn (IL)-17,IL-10,and matrix metalloproteinase12 (MMP-12) in the pathogenesis of atherosclerosis and further to understand the intervention mechanism of atorvastatin for atherosclerosis.Methods Eighteen Japanese white rabbits were randomly divided into 3 groups:control,model and intervention groups (n =6 in each group).The control group,model group and intervention group were fed basic diet,high-fat diet,and high-fat diet plus atorvastatin (5 mg/(kg·d),respectively for 12 weeks.The levels of serum total cholesterol (TC) and triglyceride (TG) were determined by enzymatic colorimetric method; the levels of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were determined by selective precipitation method; the levels of IL-17,IL-10,and MMP-12 were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA); the pathological morphology changes of atherosclerotic plaque was observe by HE staining; and the thickness of the intima,intima/media ratio,plaque area,and plaque proportion were calculated by image analysis software.Results The expression levels of serum TC,TG,LDL-C,and IL-17,as well as those of IL-17 and MMP-12 of the intervention group were significantly lower than those of the model group (all P ＜0.05),but they were still higher than the control group (all P ＜0.05),while there was no significant difference in the level of HDL-C.The level of serum IL-10 of the intervention group was higher than that of the model group and the control group (all P＜0.05).The thickness of intima,intima/media ratio,plaque area,and plaque proportion of the intervention group were all significantly lower than those of the model group (all P ＜0.05).Correlation analysis showed that the plaque proportion was significantly positively correlated with IL-17 (r =0.847,P =0.001) and MMP-12 (r =0.839,P =0.001),and was negatively correlated with IL-10 (r =0.794,P =0.002); IL-17 was significantly positively correlated with MMP-12 (r =0.709,P=0.001),and was significantly negatively correlated with IL-10 (r =0.738,P＜0.001).MMP-12 was significantly negatively correlated with IL-10 (r =0.563,P =0.015).Conclusion The increased levels of IL-17 and MMP-12,as well as the decreased level of IL-10 illustrate that inflammatory factors play an important pathological role in the pathogenesis of atherosclerosis.In addition to lipid-lowering effect,atorvastatin may decrease the degree of chronic arterial inflammatory response and play a role in anti-atherosclerosis by decreasing the expression of IL-17 and MMP-12,as well as increasing the expression of IL-10.

Endothelial progenitor cells (EPCs) are a precursor cell of endothelium that has the ability of differentiation and proliferation. In given conditions, EPCs can be mobilized to the ischemic tissue to participate in repairing the injured blood vessels and angiogenesis, and EPCs are regarded as a marker of vascular reparative capacity. Studies in recent years have indicated that the changes of EPC number play an important role in the occurrence and prognosis of cerebral ischemia. As a potential therapeutic strategy, EPCs may be used in ischemic cerebrovascular disease. This article reviews the application progress of EPCs in ischemic cerebrovascular disease.

Objective: To study the chemical constituents of Dendrobium officinale in order to provide more scientific basis for its development and utilization of medicinal resources. Methods: The compounds were isolated and purified by repeated column chromatography with silica gel and ODS column, and semi-preparative HPLC. Their structures were identified by spectroscopic data. Results: Fourteen compounds were isolated from the 70% ethanol extract of D. officinale and identified as: benzyl-O-β-D- glucopyranoside (1), isorhamnetin-3-O-α-L-rhamnopyranosyl (1→2)-β-D-glycopyranoside (2), conicaoside (3), 3,4,5-trimethoxyphenyl- 1-β-D-glucopyranoside (4), 2,6-dimethoxy-4-hydroxyphenol-1-O-β-D-glucoside (5), 4-(3'-hydroxypropyl)-2,6-dimethoxy-phenol- 3'-O-β-D-glcoside (6), thymidine (7), syringin (8), 4-allyl-2,6-dimethoxyphenyl glucoside (9), (+)-syringaresinol (10), syringaresinol- 4'-O-β-D-monoglucoside (11), naringenin (12), p-hydroxybenzoic acid (13), and 4,4'-dihydroxy-3,5-dimethoxybibenzyl (14). Conclusion: The compouds 1-6 are isolated from the species of Dendrobium Sw. for the first time, and 7-8 are isolated from D. officinale for the first time.

Objective To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) of right hemisphere on the rehabilitation of aphasia in patients with acute cerebral infarction. Methods Forty right-handed patients with acute cerebral infarction on the left hemisphere complicated with aphasia were randomly allocated into either a treatment group (n=20) or a control group (n=20). There was no significant difference in the ages between the patients in both groups. They all received routine drug treatment and appropriate language training. The patients in the treatment group also received a course of low frequency rTMS at language area of right hemisphere 7 days after the symptom onset, once a day for 10 days. Their language function was evaluated by the Aphasia Battery in Chinese (ABC) before and after the treatment, and at day 90 after the onset. The National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) were used to evaluate their overall neurological function and activities of daily living. Results There were no significant differences in the ABC, NIHSS and BI scores between the control group and the treatment group before and after rTMS; at day 90 after the onset, the ABC scores were improved significantly in the treatment group (P＜ 0.05), however, there was still no significant difference between the NIHSS and BI scores.There were significant differences between the ABC scores before and after the rTMS in the treatment group (P＜0.01), and there was no significant difference between the NIHSS and ABC scores, however, the 3 scores were improved more significantly than those before and after the treatment at day 90 after the onset (P ＜0.01). There were no significant difference in the 3 scores before and after the treatment in the control group, and at day 90 after the onset the 3 scores were improved more significantly than those before and after rTMS (P＜0.01).Conclusions The early low-frequency rTMS of the right hemisphere contributes to the rehabilitation of language function in patients with acute cerebral infarction complicated with aphasia.

Objective To study the application of intensive reduction of blood pressure to the treatment of acute cerebral hemorrhage in elderly patients. Method From January 2006 to December 2007, 40 elderly patients with acute cerebral hemorrhage were enrolled in a randomized and controlled study. Patients were randomly divided into intensive blood pressure reduction group and control group in equal number ( n = 20). The antihyper-tensive agent was used intravenously to reduce the systolic blood pressure to the level lower than 140 mmHg within 1 hour after treatment in patients of intensive blood pressure reduction group, and then the blood pressures was maintained for 7 days.The blood pressure of patients in control group was reduced to that just under 180 mmHg. The size of the haematoma was measured before and 3 days after treatment. The Stroke Scale set by the American National Institutes of Health (NHISS) was assessed before and 7 days and 28 days after treatment,separately. The modified Rankin Scale (mRS) was used to assess the patients 90 days after treatment. The outcomes were statistically analyzed with SPSS version 16.0 software. Measurement data were analyzed with t -test while numeration data were analyzed with chi-square test. Results Before and 3 days after treatment, there was significant difference in size hematoma between two groups (P < 0.05) . Between before and 7 days after treatment, there was significant difference in NHISS scale in intensive blood pressure reduction group (P < 0.05), but there was no significant difference in control group (P > 0.05). Before and 28 days after treatment, there was significant difference in variance of NHISS scale between two groups ( P < 0.05) . Nineth days after treatment, there was significant difference in mild disability and severe disability between two groups ( P < 0.05) . Conclusions Intensive reduction of blood pressure is valid for the treatment of elderly patients with acute cerebral hemorrhage.