Objective To investigate the relationship between obstructive sleep apneahypopnea syndrome (OSAHS) and carotid stenosis in patients with ischemic cerebrovascular disease (ICVD) and to provide reference for developing the intervention strategy of carotid stenosis. Methods Eighty-seven patients with ICVD were screened from Nanjing Stroke Registry Program. The patients were divided into without (n=21), mild(n=24), moderate (n=27) and severe (n = 11) OSAHS groups according to the apnea-hypopnea index (AHI); in addition, the patients were divided into with (n =34) and without carotid stenosis (n=49) groups according to the results of digital subtraction angiography (DSA). The effects of the risk factors for cerebrovascular diseases and OSAHS on carotid stenosis in patients with ICDV were analyzed.Results There were significant differences in the proportions of alcohol consumption (χ2=8.56, P =0. 036), hypertension (χ2 = 13.20, P =0. 004) and carotid stenosis (χ2 =22.97, P =0. 006) between the no OSAHS and the mild, moderate and severe OSAHS groups. The univariate analysis showed that age (OR = 1. 066, 95% CI 1. 023- 1.112; P = 0. 003),hypertension (OR =3.587, 95% CI 1. 294- 9. 949; P =0. 014), alcohol consumption (OR =5.275,95% CI 1.855-15.001; P= 0.002) and OSAHS (OR= 1.073, 95% CI 1.033-1.115; P = 0. 000) were the risk factors for carotid stenosis. The multivariate logistic regression analysis showed that age (OR = 1. 113, 95% CI 1. 047-1. 182; P =0. 001), OSAHS (OR = 1. 096, 95% CI 1. 034-1. 160; P = 0. 000), and alcohol consumption (OR = 4. 292,95% CI 1. 217-15. 139; P = 0. 024) were the independent risk factors for carotid stenosis.Spearman rank correlation analysis suggested that the AHI levels were positively correlated with the degree of carotid stenosis (r = 0. 435, P = 0. 000). There were significant differences among the without stenosis (n =34), unilateral stenosis (n =22), and bilateral stenosis (n=27)groups (12.97 ± 10.04 vs. 21.40 ± 16.38 vs. 29.33 ± 13.81, F= 11.64, P<0.01).Conclusions OSAHS is an independent risk factor for carotid stenosis and it was positively correlated with the severity of carotid stenosis. AHI may reflect the degree of carotid stenosis and the range of neck vascular involvement to some extent.

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.

Objective To investigate the effects of the distribution characteristics of cerebral artery stenosis and the associated risk factors in patients with ischemic cerebrovascular disease.Methods The demographic data and vascular risk factors in patients with ischemic cerebrovascular disease who performed aortic arch and cerebral angiography were analyzed retrospectively.The patients were divided into intracranial lesion,extracranial lesion and extra-and intracranial lesion groups according to the lesion sites.The demographic data and vascular risk factors in all groups were compared.Results A total of 1272 patients were enrolled,and 1028 (80.8％) had cerebral artery stenosis or occlusion,in which 342 (33.3％) were intracranial lesions,330(32.1％) were extracranial lesions,and 356 (34.6％) were extra-and intracranial lesions.The mean age of the intracranial lesion group was significantly lower than that of the other 2 groups (F =41.995,P =0.000).There were significant differences in the constituent ratios of sex (x2 =10.602,P =0.005),hypertension (x2 =11.316,P =0.003),and diabetes (x2 =13.465,P =0.001) among all groups.There were significant differences in the distribution of extra-and intracranial artery stenosis among different age groups (P =0.001).Intracranial lesions were mainly in the youth and middle-aged groups,and extra-and intracranial lesions in the old age group were more common.Multivariate logistic regression analysis showed that age,hypertension,diabetes and history of transient ischemic attack were associated with the simple intracranial lesions and extra-and intracranial lesions,and the simple extracranial lesions were only associated with advanced age and hypertension.The 1028 patients with vascular stenosis or occlusion affected 2732 vessels,including 1759 vessels (64.4％) in anterior circulation and 973 (35.6％) in posterior circulation.The mild,moderate and severe stenosis in anterior circulation were most common in extracranial internal carotid artery,and the occlusion was most common in middle cerebral artery.The various degrees of lesions in posterior circulation were most common in extracranial internal carotid artery.Conclusions There were significant differences in patients with cerebrovascular lesions at different sites in sex,age,as well as in the incidences of hypertension and diabetes.Age,hypertension,diabetes and the history of transient ischemic attack were the independent predictive factors for the distribution of cerebral atherosclerotic lesions.

Objective To investigate the correlation between cognitive function and cerebral microbleeds (CMBs) in patients with small artery occlusive stroke (SAO).Methods The patients with SAO in Nanjing Stroke Registration Program were recruited from January 2011 to May 2011.The Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive evaluation.At the same time,conventional MRI sequences and susceptibility-weighted imaging (SWI) were used to detect CMBs.Results A total of 70 patients with SAO were included in the study,48 of them had abnormal MoCA scores ( ＜26 points) and 22 of them had normal MoCA scores (≥26).The age of patients (t =-2.237,P =0.023),years of education (t =2.297,P =0.029),history of hypertension (x2 =2.297,P =0.025 ),severity of white matter hyperintensities (Z =-3.263,P =0.001) and presence of CMBs (P =0.001) were associated with the abnormal MoCA scores in patients with SAO.Logistic regression analysis showed that after adjusting for age,sex,white matter lesions,hypertension,diabetes and coronary heart disease,the presence of CMBs (odds ratio 5.648,95％ confidence interval 1.105-28.869; P =0.038) was still an independent risk factor for abnormal MoCA scores.The more serious of CMBs,the lower the MoCA scores (r =- 0.532,P ＜ 0.001 ).In patients with CMBs,the cognitive domain,such as the total MoCA score (t =5.180,P ＜ 0.001 ),visuospatial/executive function (t =3.924,P ＜ 0.001 ) and attention (t =4.309,P ＜ 0.001 ) were impaired significantly.The CMBs at different parts resulted in cognitive impairment in the related fields.Conclusions The numbers of CMBs and their locations were closely associated with cognitive impairment in patients with SAO.

Objective To investigate the efficacy of endovascular stenting complicating other craniocervical artery stenosis (OCAS) in patients with atherosclerotic subclavian artery stenosis/occlusion (SASO).Methods The clinical data of receiving endovascular stenting therapy in patients with atherosclerotic SASO were analyzed retrospectively,including demographic characteristics,vascular risk factors,complicating OCAS,as well as stenting for SASO and follow-up results.Results A total of 65 patients with SASO were included in the study,47 of them were males and 18 were females (mean age of 64 ± 9 years).Forty-six patients (70.8％ ) complicated OCAS.The overall technical success rate was 95.4％,in which the patients with stenosis (n =58) were 98.1％ and those with complete occlusion (n =7) were 71.4％.The complications occurred in 4 patients.There were no intervention-related serious stroke and death.Mean follow-up was 24 ± 19 months,6 patients with restenosis and 10 with clinically relevant events were found.They mainly occurred in patients with OCAS.The first angioplasty patency rates were 94.5％,81.8％ and 81.8％,respectively at 12 and 24 months after procedure and at the end of follow-up.The survival rates of no clinically relevant events were 92.9％,74.6％ and 68.3％,respectively.Conclusions Endovascular stenting can safely and effectively treat the SASO patients complicating OCAS.Its overall clinical outcome may be affected to some extent by OCAS.

Objective To study the effect of hyperbaric oxygen preconditioning management on the expression of MMP-2,MMP-9 and Cx43 in a rat abdominal skin flap model of ischemia-reperfusion injury.Methods Eighteen male adult SD rats,weight ranged from 220-250 g,were randomly divided into three groups:sham group (SH),ischemia-reperfusion group (IR) and hyperbaric oxygen preconditioning group (HBO).All the rats in HBO group received hyperbaric oxygen treatment twice each day,apart 12 hours,during the last three days before operation.Abdominal skin flap with superficial epigastric artery as pedicle was established.In HBO and IR group,3 hours of ischemia was performed.On the 3rd postoperative day,samples were taken to assess the expression of MMP-9,MMP-2 and Cx43 by immunohistochemical staining and Western blot.Results Compared with IR group,the expression of Cx43 was significantly increased (IR 15.03±3.66;HBO 36.01±4.12) and the ex pression of MMP-9 and MMP-2 was decreased (MMP 2:IR 12.01±1.23;HBO 5.98±1.48;MMP9:IR 16.77±2.01;HBO 11.48±1.77).Conclusions Hyperbaric oxygen preconditioning for the rat abdominal skin flap model of ischemia-reperfusion injury has inhibitory effect on the expression of MMP-9 and MMP-2,and stimulative effect on the expression of Cx43.

ObjectiveTo explore the status and influencing factors of electric bicycle （e-bike）-related traffic injury in Songjiang District of Shanghai， and to provide reference for prevention and control of the injury. MethodsA self-designed questionnaire was used to investigate the community residents over 16 years old who rode e-bike in Songjiang Western Industrial Zone. The survey included general demographic characteristics， physical and psychological conditions， e-bike use， accidents and injuries. Descriptive analysis， chi-square test and Fisher's exact probability method were used to explore the influencing factors of traffic injury by e-bike in Songjiang District. Results1 030 questionnaires were distributed and 1 013 valid questionnaires were recovered. The effective rate of the questionnaire was 98.35%. From June 2020 to May 2021， the incidence of e-bike traffic accidents in Songjiang Western Industrial Zone was 17.47% and the incidence of injuries was 12.64%. The difference between e-bike accident group and non accident group was statistically significant （P<0.05） in the following factors： gender， registered residence， educational level， sleeping time， fatigue， violation of traffic regulations including speed limit 25 km‧h^-1 and crossing of red traffic lights， riding after alcohol drinking， riding speed higher than 30 km‧h^-1， riding on the phone， wearing headset， turning without prompting signal， riding on the lane of motor vehicles，and e-bike life. The top three injured body parts were limb pelvis （48.10%）， body surface （27.85%） and head （13.92%）. The nature of injury was mainly contusion / abrasion （82.03%）， followed by fracture （17.19%）. ConclusionThe incidence of e-bike traffic accidents in Songjiang District is high. We should strengthen the traffic safety education of e-bike riders， strengthen the road traffic control， and reduce the occurrence of e-bike road traffic accidents in Songjiang District.

Objective: To investigate the efficacy and safety of cuboid stereotactic aspiration of necrotic brain tissue for treating malignant middle cerebral artery infarction in the elderly patients. Methods: Sixteen elderly patients with malignant middle cerebral artery infarction were selected from June 2017 to January 2019 in our hospital. Patients were followed up for 6 months to evaluate the efficacy of stereotactic aspiration of necrotic brain tissue using the modified Rankin Scale (mRS). Results: The 30-day mortality was 18.75%. Among the 16 elderly patients, 6 (37.5%) had an mRS score of 3 (defined as moderate disability), 6 (37.5%) had an mRS score of 4 (defined as moderate to severe disability), 1 (6.25%) had an mRS score of 5 (defined as severe disability), and 3 (18.75%) had an mRS score of 6. The probability of 6-month favorable outcome, defined as an mRS score of ≤3, was 37.5%, and the 6-month mortality was 18.75%. Conclusions It is a simple, minimally invasive, effective and safe method to treat malignant middle cerebral artery infarction in the elderly patients with cuboid stereotactic aspiration of necrotic brain tissue, which needs to be confirmed by further randomized controlled studies.

BACKGROUND: China bears the biggest atrial fibrillation (AF) burden in the world. However, little is known about the incidence and predictors of AF. This study aimed to investigate the current incidence of AF and its electrocardiographic (ECG) predictors in general community individuals aged over 60 years in China. METHODS: This was a prospective cohort study, recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District, Shanghai, China. The subjects were then followed up from 2015 to 2019 annually. Data on sociodemographic characteristics, medical history, and the resting 12-lead ECG were collected. Kaplan-Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF. Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models. RESULTS: This study recruited 18,738 subjects, and 351 (1.87%) developed AF. The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years. Multivariable Cox regression analysis indicated age (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.06-1.09; P < 0.001), male (HR, 1.30; 95% CI: 1.05-1.62; P = 0.018), a history of hypertension (HR, 1.55; 95% CI: 1.23-1.95; P < 0.001), a history of cardiac diseases (HR, 3.23; 95% CI: 2.34-4.45; P < 0.001), atrial premature complex (APC) (HR, 2.82; 95% CI: 2.17-3.68; P < 0.001), atrial flutter (HR, 18.68; 95% CI: 7.37-47.31; P < 0.001), junctional premature complex (JPC) (HR, 3.57; 95% CI: 1.59-8.02; P = 0.002), junctional rhythm (HR, 18.24; 95% CI: 5.83-57.07; P < 0.001), ventricular premature complex (VPC) (HR, 1.76; 95% CI: 1.13-2.75, P = 0.012), short PR interval (HR, 5.49; 95% CI: 1.36-22.19; P = 0.017), right atrial enlargement (HR, 6.22; 95% CI: 1.54-25.14; P = 0.010), and pacing rhythm (HR, 3.99; 95% CI: 1.57-10.14; P = 0.004) were independently associated with the incidence of AF. CONCLUSIONS The present incidence of AF was 5.2/1000 person-years in the studied population aged over 60 years in China. Among various ECG abnormalities, only APC, atrial flutter, JPC, junctional rhythm, short PR interval, VPC, right atrial enlargement, and pacing rhythm were independently associated with AF incidence.
Humans ; Male ; Middle Aged ; Aged ; Atrial Fibrillation/epidemiology* ; Prospective Studies ; Incidence ; Atrial Flutter/complications* ; Risk Factors ; China/epidemiology* ; Electrocardiography