BACKGROUND: The number of dementia patients ceaselessly increases with the extension of the life expectancy and the ageing of the population; hence the survival rate of patients with post-stroke dementia(PSD) has become an important issue of public health. Although it is generally believed that dementia could shorten human life expectancy, there is rare report regarding the impact of PSD on the survival rate of the patients in developing countries.OBJECTIVE: To investigate the impacts of ischemic dementia on the survival rate of the patients to explore the risk factors that would affect the survival rate of patients after cerebral infarction(CI).DESIGN: A prospective randomized controlled study based on patients.SETTING: The second department of neurology of a field surgery institute in a military university hospital of Chinese PLA.PARTICIPANTS: Totally 619 cases of acute CI including 313 males and 306 females aged between 55 and 85 years old[mean of (70. 3 ±9.5) years old] were selected form the Department of Neurology of the Daping Hospital of the Third Military Medical University of Chinese PLA between 1st May 1998 and 28th December 1999.INTERVENTIONS: Data including human factor, vascular factor and CI characters of 619 cases of ischemic cerebral stroke were collected and they also received neuropsychological test. Dementia was diagnosed in CI patients at admission and 3 months after CI according to DSM-Ⅳ criteria. Two-year follow up was conducted for the analysis of survival rate in PSD patients and survival-correlated predicting factors.and survival rate in CI patientsRESULTS: Totally 146 total patients(23.6% ) were diagnosed as PSD at 3 month after CI, of which 39 cases were pre-stroke dementia and 107 cases were CI-correlated dementia. The survival rate of PSD patients was 49.3%after(19.4 ±8.3) months of follow-up. The survival rate of patients with CI-correlated dementia was 53.7% while the non-dementia patients was 92.0% after(21.3 ± 9.1 ) months of follow-up. There was significant correlation between PSD and survival rate as indicated by multifactor analysis ( RR = 4. 91, 95% CI = 3.85 - 13.49) . The rest predicting factors included age(RR=1. 12, 95% CI=1.06-1.18), BarthelIndex(BI, RR=1.63,95% CI=1.15-2.31), auricular fibrillation(AF, RR=1.47, 95%CI = 1.17 - 1.85) and CI history( RR = 2. 81, 95% CI = 1.53 - 5.16).CONCLUSION: Dementia could reduce the survival rate of CI patients and it could be set as a predicting factor for post-infarction survival rate.

BACKGROUND:Recently, the number of elder patients with femoral neck fracture increased. It is controversial if patients aged over 75 years should receive total hip replacement or hemiarthroplasty. To select a reasonable surgical manner is of great significance for increasing surgical safety, improving hip joint function, elevating quality of life, decreasing postoperative complications, and reducing revision rate.
OBJECTIVE:To retrospectively analyze data of patients aged over 75 years after hip replacement, to compare the advantages and disadvantages, and to find a precise indication.
METHODS:Case data of 171 patients undergoing total hip replacement (observation group) (n=51) or hemiarthroplasty (control group) (n=120) were included. Their differences were compared using basic diseases, operation time, bleeding amount, postoperative complications, postoperative hospitalization day, Harris score at 1 week and 3 months after operation.
RESULTS AND CONCLUSION:Patients in both groups were fol owed up for 3 to 39 months (averagely 23 months). No significant difference in basic diseases, average age, postoperative complications, postoperative hospitalization day, and Harris score at 1 week was detected between the two groups (P>0.05). Harris score and excellent and good rate at 3 months were better in the total hip replacement group than that in the hemiarthroplasty group (P<0.05). Results indicated that strict choice of indication achieved good short-period efficiency in two groups. Thus, hip function of elder patients was early recovered. Quality of life was obviously elevated. The recovery of hip function was relatively better at 3 months in observation group. The incidence of postoperative complications did not increase obviously. These results suggested that besides sufficient preparation, total hip replacement should be the first choice for elder patients.

Science and technology innovation is an important quality of young talents in the new period requirements and training objectives,as well as hospital's driving force and source of the future sustainable development.Under the innovation-driven strategy,characterized by cultivating young talents of science and technology innovation,with the efforts to develop and improve young talents cultivation way,our hospital aim to accelerate the development of young talent as soon as possible.By setting up a hospital's fund,we gradually formed a stable funding system including the four directions of clinical,nursing,management,education.With the development purposes of young researchers as the main body,adhere to improve the quality of hospital funds is the key,we aim at forming a reasonable fund scale.Through the top level design,strict process management,implementation of opening argument and a series of strong measures to ensure project quality,we promote youth science and technology innovation talents effectively.

Aim To study the expression of β-NGF gene in the mammlian cells and the biological activity of its expression products. Methods The β-nerve growth factor (β-NGF) cDNA which obtained from the plasmid pGEM-β-NGF by enzyme digestion analysis was cloned into the expression vector pcDNA3 to construct the recombinant plasmid pcDNA3-β-NGF. COS-7-cell line grown to log phase was transfected using lipofectamine reagent. The expression level of β-NGF mRNA and the biological activity were analyzed by Northern blot and observation of neurite outgrowth of PC12 cell line stimulated by supernatant, respectively. Results The β-NGF gene was expressed successfully in COS-7 cell lines. The culture supernatant of the positive COS-7 cells transfected with pcDNA3-β-NGF could stimulate the neurite outgrowth of PC12 cell line. Conclusion The target gene expressed successfully in the transfected COS-7 cell line and had good biological activity.

Objective To evaluate the effect of vertebral artery kinking on cerebral hemodynamics. Methods The patients with vertebral artery kinking on digital subtraction angiograph (DSA) were selected from 223 patients with vertebral-basilar artery transient ischemic attack, then the changes of vertebral artery hemodynamics were evaluated using transcranial color Doppler (TCD). Results There were 84 patients with vertebral artery kinking among 223 patients with vertebral-basilar artery transient ischemic attack. Patients with vertebral artery kinking were older and had more vascular risk factors than patients without vertebral artery kinking. Compared with the control group, patients showed decreased blood flow rate such as peak velocity (Vp) and mean velocity (Vm), increased pulsatility index (PI) and resistant index (RI) in vertebral artery kinking group. Conclusions Vertebral artery kinking is common abnormal artery among patients with vertebral-basilar artery transient ischemic attack, it leads to hemodynamic changes. Age and vascular risk factors are potential causes of vertebral artery kinking.

Objective To analyze the data from Online Mendelian Inheritance in Man (OMIM) to understand more about it, and provide reference to researchers using this database.Methods 19414 mutations which have definite relevant phenotypes from OMIM were obtained, then these mutations with three databases (1000 Genome Project,GO-ESP,ExAC) which record the mutation frequency in different population were compared.Results Most of the phenotype-related mutations from OMIM are rare mutations whose mutation frequency is less than 1%:18866 in 1000 Genome Project, 18981 in GO-ESP, 18979 in ExAC.The number of mutation whose frequency is more than 1% is 548433435 in 1000 Genome Project, GO-ESP, ExAC, respectively.And there are 320 mutations whose frequency is more than 1% in all databases.In all phenotypes, there are 127 polymorphism phenotypes, 584 susceptibility phenotypes, while in 320 ( 1.6%) phenotypes with common mutations, there are 62 polymorphism phenotypes, 88 susceptibility phenotypes and occupies 48.8%, 15.1%, respectively.Conclusion Approximately 97.5% mutations in OMIM are rare mutations.Polymorphism and susceptibility enrich in common mutations, especially in the mutation whose frequency is more than 10%.

BACKGROUND: The presence of cognitive impairment following stroke onset strongly indicates poor prognosis of the patients surviving the crisis.Understanding of the incidence of cognitive impairment after ischemic stroke and its confidence interval has practical significance in preventing is occurrence in stroke patients and its differentiation from age-related cognitive impairment.OBJECTIVE: To study the incidence of cognitive impairment in patients with the first onset of ischemic stroke.DESIGN: Single-factor analyses of the cases followed up for 3 months SETTING: Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA.PARTICTPANTS: Totally 434 inpatients with acute cerebral infarction [218 male and 216 female, aged 55 to 85 with a mean of (70.3±9.5) years]admitted within 48 hours after the onset in Department of Neurology, Daping Hospital of Third Military Medical University from May 8, 1999 to December 31, 2000. All patients participated in this study voluntarily.METHODS: The general background and clinical data of the patients were collected at the time of admission. A simplified intelligence test was performed both 7 to 10 days of the onset and 3 months after discharge. The scale employed for the test included 20 questions with a total of 30 items divided to test 5 aspects of the patients' cognition, namely orientation ability, memory, calculation ability, memory recall and linguistic ability (1 point was given for a correct answer, and 0 for an wrong one or an answer of "I don't know", with the total score of 30 for all items). A score of the simplified intelligence test less than the score of demarcation (specifically,below 17 for illiterate patients, below 20 for those receiving an education no more than 6 years, and below 24 for those having an education for no less than 7 years) for 3 months after cerebral stroke was regarded as the diagnostic criteria for cognitive impairment.MAIN OUTCOME MEASURES: The incidence of cognitive impairment was recorded 3 months after hospital discharge and single-factor analysis of the scores of simple intelligence test.RESULTS: All the 434 patients were included in result analysis. Totally 161 (37.1%) patients were diagnosed as having cognitive impairment, and 273 (62.9%) had normal cognitive function 3 months after hospital discharge. The mean age of the patients with cognitive impairment was significantly higher than that of the patients with normal cognitive function [(73.0±7.0) years vs (64.5±6.6) years, t=2.626, P ＜ 0.01]. The proportion of patients with cognitive impairment receiving education for no more than 6 years was significantly higher than that among patients with normal cognition (45.3% vs 22.7%, OR=2.823, with 95% confidence interval of 1.855 -4.297), and the score of simple intelligence test was significantly lower in the former patient group (16.3±8.7 vs 23.4±4.2, t=3.352, P ＜ 0.001).CONCLUSION: The incidence of cognitive impairment in this cohort is relatively high. The patients with cognitive impairment following cerebral infarction have obviously older age and poorer education, suggesting significant synergetic effect of age and education with cognitive impairment following cerebral infarction.

BACKGROUND: Pro-inflammatory cytokines can promote the expression nof intercellular adhesion molecule-1 (ICAM-1), and the adhesion of white cells to intravascular endothelium, thereby involving in the developing ischemic stroke.OBJECTIVE: To investigate the prognostic value of soluble intercellular adhesion molecule-1 (sICAM-1) and its relative factors in the developing ischemic stroke.DESIGN: Randomized controlled study based on patients.SETTING: Department of neurology, the field surgery research institute in a military hospital of Chinese PLA.PARTICIPANTS: Between January 1st and December 31st 2000, total 238patients with ischemic stroke received treatment at the Neurological Department of the Third Affiliated Hospital, the Third Military Medical University of Chinese PLA, including 117 males and 121 females, amongst which 186cases were confirmed of none-developing ischemic stroke and 52 cases developing ischemic stroke.INTERVENTIONS: After hospitalization, patients were subject to daily neurological examination, Canada stroke score(CSS), temperature and white blood cell(WBC) counting, sICAM was examined at 1, 3 and 7 days after hospitalization.correlative factors between developing ischemic stroke and non-developing ischemic stroke at 24 hours 3 days and 7 days after the onset of stroke.RESULTS: Within 24 hours from the onset of stroke, the number of WBC was[(8.4 ± 1.2) × 109 L-1] in developing ischemic stroke group, with blood glucose of[ (45.8 ± 5.1) g/L], fibrinogen of[ (64. 6 ± 5. 1) g/L] and sICAM-1 of[ (261.4 ± 9. 7) μg/L], which were obviously higher than the corresponding[(6.7±1.3) ×109 L-1, (36.2±5.5) g/L, (44.0±6.2) g/L,(223. 1 ± 8.4) μg/L] in non-developing ischemic stroke group, the difference was of statistical significance( t = 2. 368 - 2. 387, P ＜ 0. 01 ) . The results of multiple factor analysis on developing ischemic stroke indicated that serum sICAM-1 was a risk factor independent of higher blood glucose,fibrinogen and CSS, and was obviously correlated with developing ischemic stroke( OR =2.9, 95% CI= 1.4 -6. 3) . There was significant change in sICAM-1, the number of WBC, blood glucose and fibrinogen at 24 hours, 3days and 7 days, as well as the scores for CSS at hospitalization in developing ischemic stroke group, which were significantly different from non-developing ischemic group( t = 2. 345 - 2. 878, P ＜ 0.01 ).CONCLUSION: sICAM-1 was proved obviously correlated with developing ischemic stroke, and can be used as a prognostic factor.

BACKGROUND:With the trend of population aging,the morbidity of cognitive dysfunction has been gradually increased.People start to pay attention to the impact of smoking to cognitive dysfunction. OBJECTIVE:To investigate the effects of smoking on cognitive dysfunction in elder people,and explore the possibility of intervention. DESIGN:Randomized cluster sampling. SETTING:Neurology Department of a hospital. PARTICIPANTS:A total of 3 012 old people aged above 60 year were selected from two resident committees by drawing from Gaoxin district,Yubei district and Yuzhong district of Chongqing in which there were 1 668 males and 1 344 females. METHODS:Mini mental state examinate(MMSE) was used to assess cognitive function.t test and Logisitc regression were used to analyze the information. RESULTS:MMSE assessment was conducted to 3 012 people,the total smoking rate was 35% .The abnormality rate of cognitive function in aged people of Chongqing was 11.95% .Among smoking population,11.8% of the currently smoking people and 4.5% of previously smoking people suffered from the cognitive dysfunction while 5.3% of the non smoking people got cognitive dysfunction. CONCLUSION:Smoking is closely correlated with cognitive dysfunction(χ 2=6.59,P=0.047) and education background, age, occupation and sex are the influencing factors of cognitive dysfunction.Current smoking people get higher risk to suffer cognitive dysfunction(RR=2.33,95% CI=1.37- 5.82).Smoking is an important risk factor for cognitive dysfunction in aged people so that it will be an effective strategy for aged people to reduce the incidence of cognitive dysfunction by quitting smoking.

Objective To investigate the efficacy of intra-arterial thrombolysis with stenting for acute cerebral infarction. Methods Using a prospective case-control design, 24 patients with acute cerebral infarction who remained angiostegnosis ( ＞ 50%) after intra-arterial thrombolysis were randomly divided into stent treatment group and drug treatment group. They were treated with stenting + drug treatment and conventional drug treatment. The rates of vascular complete revascularization and residual stenosis, and the modified Rankin scale scores at 3 months in both groups were evaluated. Results The rate of complete revascularization in the stent treatment group was significantly higher than that in the drug treatment group (54. 5% vs.0%,χ2 =6.382, P ＜0. 001), and the rate of residual stenosis was significantly lower than that in the drug treatment group ([4.5 ±5.2]% vs. [82. 5 ±10. 5]%, t =7.464, P＜0.001). The rate of favorable clinical outcome in the stent treatment group was significantly higher than that in the drug treatment group (100% vs. 76. 9%,χ2 = 14. 263, P = 0.038). Conclusion The efficacy of intra-arterial thrombolysis with stenting in the treatment of acute cerebral infarction is superior to that in the drug treatment group, and it is safer.