Objective To investigate the correlation between the indicators of common carotid artery mechanical dynamics, a circumferential wal tension (CWT) and a shear stress (SS), and cerebral smal vessel disease (SVD). Methods The neurological outpatients without obvious cardiovascular disease were enrol ed consecutively. The inner diameters of carotid arteries and blood flow velocity of the patients w ere measured by ultrasound examination, and their CWT and SS w ere calculated. Lacunar infarction and/or leukoaraiosis w ere determined according to the findings of MRI. Results A total of 296 patients w ere enrol ed, 163 of them had lacunar infarction and 132 had leukoaraiosis. Univariate analysis show ed that there w ere significant differences in the distributions of age, hypertension, diabetes, systolic blood pressure, diastolic blood pressure, CWT, and SS betw een the lacunar infarction group and the non-lacunar infarction group, as wel as between the leukoaraiosis group and the non-leukoaraiosis group (al P<0.05). After adjusting for relevant risk factors, multivariate logistic regression analysis show ed that the peak systolic CWT (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.48-8.30) and end diastolic CWT (OR 1.22, 95%CI 1.21-1.25) w ere the independent risk factors for lacunar infarction, w hile the peak systolic SS (OR 0.90, 95%CI 0.75-0.95 ) and end diastolic SS ( OR 0.87, 95%CI 0.84-0.98 ) w ere the independent protective factors for lacunar infarction; the peak systolic CWT (OR 4.67, 95%CI 2.05-10.52) and end diastolic CWT (OR 1.25, 95%CI 1.22-1.47) were the independent risk factors for leukoariosis, w hile the peak systolic SS (OR 0.93, 95%CI 0.75-0.94) and end diastolic SS (OR 0.91, 95%CI 0.85-0.98) w ere the independent protective factors for leukoaraiosis. Conclusions The common carotid artery mechanical stress w as associated w ith the occurrence of SVD.

Apoptosis is one of the important forms during cerebral ischemia.Phosphoinositide-3 kinase (PI3K)/serine/threonine kinase (Akt) is the important cell survival signaling pathway,while c-jun N-terminal kinase (JNK) is the important pro-apoptotic signaling pathway.The dynamic equilibrium of the two signal transduction pathways maintains cell survival and apoptosis under the physiological state.Stimulation during cerebral ischemia breaks this physiological balance and results in the apoptosis of massive neurons.A variety of proved neuroprotective factors are associated with the amplification of enhancement of cell survival signal or inhibition of apoptosis signal,and thrus maintain the balance between the two signal pathways.

Objective Cerebral small vessel disease is closely related to kidney disease .Chronic kidney disease ( CKD) may increase the risk of hemorrhage stroke .However, its impact on hemorrhage-prone small vessel disease represented by cerebral microb-leeds( CMBs) remains unclear .The purpose of this study was to investigate the relationship of CKD with the presence and location of CMBs in patients with acute lacunar stroke . Method Consecutive patients with acute lacunar stroke within 7 days from onset were enrolled retrospectively from January 2014 to July 2016 and scanned by gradient-echo T2*-weighted imaging (GRE-T2*WI).Their demographic, clinical, laboratory and imaging data were collected .Estimate glomerular filtration rate (eGFR) was calculated individu-ally by the following chronic kidney disease epidemiology collaboration (CKD-EPI) equation for the Asian population .CKD was defined as the level of eGFR<60 mL/min/1.73 m2. Results Finally, 308 patients (mean age:65.79±8.67 years; median NHISS:3(2-5);42.2%Female) with lacunar ischemic stroke were enrolled in the final analysis .Among these patients, CMBs were present in 116 patients ( 37.7%) and CKD in 62 patients ( 20.1%) .Patients were divided into CKD group and normal group according to GFR level . The result of univariate analysis showed that patients with CKD had higher prevalence of diabetes ( P=0.014) and higher degrees of CMBs (P=0.001) compared with normal group.CMBs were refined by its location .The result of multivariable analysis showed that CMBs in deep brain [ OR=7.61, 95%CI 4.18-16.55, P=0.001] were sig-nificantly associated with CKD incidence , while no significant rela-tionship was found in CKD incidence and CMBs in the lobe and mixed location of brain . Conclusion The CKD incidence in patients with acute lacunar stroke is in dependent relationship with CMBs in deep brain and without significant correlation with CMBs in the lobe and mixed location of brain .

Objective To investigate the relationship between total burden of cerebral small vessel disease (cSVD) on brain MR imaging and circumferential wall tension (WT) in patients with acute lacunar stroke.Methods A total of 227 patients with first-ever acute lacunar stroke,admitted to our hospital from September 2010 to December 2012,were recruited in the study.All patients underwent conventional imaging sequences and susceptibility-weighted imaging sequences of 1.5T MRI system.The presences of each marker of cSVD,including asymptomatic lacunar infarct,white matter lesion,cerebral microbleed,and enlarged perivascular space,were scored on brain MRI.Internal diameters of the common carotid artery,and circumferential WT were measured.Logistic regression analysis was performed to determine the associations between WT levels and an increasing total burden of cSVD.Results According to cSVD scores,five groups of patients were concluded:6 with 0 point,37 with one point,103 with 2 points,61 with 3 points and 20 with 4 points;systolic WT in them were (5.79±0.24)×104 dyne/cm2,(5.70±0.49)×104 dyne/cm2,(5.89±0.71)×104 dyne/cm2,(7.12±i.19)×104 dyne/cm2 and (6.63± 0.76)×104 dyne/cm2,and diastolic WT in them were (3.37±0.31)×104 dyne/cm2,(3.29±0.26)×104 dyne/cm2,(3.50±0.43)×104 dyne/cm2,(3.99±0.49)×104 dyne/cm2 and (4.30±0.85)×104 dyne/cm2.Univariate analysis suggested that age,hypertension,diabetes,intemal diameters of the common carotid artery,diastolic WT and systolic WT had significant differences among the five groups (P＜0.05).After adjustment for confounding parameters,higher systolic WT (OR:1.555,95％CI:1.203～2.479) and higher diastolic WT (OR:5.287,95％CI:2.713～10.302) were associated with an increasing total burden of cSVD.Conclusions WT is associated with total burden of cSVD.

Objective To investigate the relationship between intracranial arterial calcification and prognosis after mechanical thrombectomy in patients with acute large vessel occlusion stroke.Methods A total of 147 patients with acute large vessel occlusion stroke who underwent mechanical thrombectomy were enrolled in this study.The length,density,and location of intracranial arterial cal-cification were evaluated by CT.Based on the intracranial arterial calcification status,patients were di-vided into three groups:symptomatic intracranial arterial calcification group(n=42),asymptomatic intracranial arterial calcification group(n=24),and no intracranial arterial calcification group(n=81).Multivariate Logistic regression analysis was performed to explore the relationship between in-tracranial arterial calcification and clinical outcomes after mechanical thrombectomy.Results Com-pared with patients in the asymptomatic and no intracranial arterial calcification groups,patients in the symptomatic intracranial arterial calcification group,had older age,a higher proportion of hypertension,and required more rescue angioplasty or stenting after mechanical thrombectomy(P＜0.05).There was a statistically significant difference in the location of calcification between the symptomatic and asymptomatic intracranial arterial calcification groups(P＜0.05),but no significant differences in the length and density of calcification between the two groups were observed(P＞0.05).Multivariate Logistic regression analysis revealed that symptomatic intracranial arterial calcification was an independent risk factor for failed revascularization(adjusted OR=8.67,95％CI,2.39 to 15.68,P＜0.001),the need for rescue interventional therapy(adjusted OR=6.46,95％CI,2.26 to 14.29,P＜0.001),and poor neurological recovery(adjusted OR=3.91,95％CI,1.38 to 10.16,P=0.023)after adjusting for potential confounding factors.Conclusion Symptomatic in-tracranial arterial calcification is closely associated with poor clinical outcomes after mechanical thrombectomy in patients with acute large vessel occlusion stroke.Preoperative assessment of in-tracranial arterial calcification is crucial for selecting revascularization strategies in these patients.

Objective To investigate the relationship between intracranial arterial calcification and prognosis after mechanical thrombectomy in patients with acute large vessel occlusion stroke.Methods A total of 147 patients with acute large vessel occlusion stroke who underwent mechanical thrombectomy were enrolled in this study.The length,density,and location of intracranial arterial cal-cification were evaluated by CT.Based on the intracranial arterial calcification status,patients were di-vided into three groups:symptomatic intracranial arterial calcification group(n=42),asymptomatic intracranial arterial calcification group(n=24),and no intracranial arterial calcification group(n=81).Multivariate Logistic regression analysis was performed to explore the relationship between in-tracranial arterial calcification and clinical outcomes after mechanical thrombectomy.Results Com-pared with patients in the asymptomatic and no intracranial arterial calcification groups,patients in the symptomatic intracranial arterial calcification group,had older age,a higher proportion of hypertension,and required more rescue angioplasty or stenting after mechanical thrombectomy(P＜0.05).There was a statistically significant difference in the location of calcification between the symptomatic and asymptomatic intracranial arterial calcification groups(P＜0.05),but no significant differences in the length and density of calcification between the two groups were observed(P＞0.05).Multivariate Logistic regression analysis revealed that symptomatic intracranial arterial calcification was an independent risk factor for failed revascularization(adjusted OR=8.67,95％CI,2.39 to 15.68,P＜0.001),the need for rescue interventional therapy(adjusted OR=6.46,95％CI,2.26 to 14.29,P＜0.001),and poor neurological recovery(adjusted OR=3.91,95％CI,1.38 to 10.16,P=0.023)after adjusting for potential confounding factors.Conclusion Symptomatic in-tracranial arterial calcification is closely associated with poor clinical outcomes after mechanical thrombectomy in patients with acute large vessel occlusion stroke.Preoperative assessment of in-tracranial arterial calcification is crucial for selecting revascularization strategies in these patients.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.