Ischemic cerebrovascular disease accounts for about 70％ of all types of stroke,and large vessel occlusive stroke is a major subtype of ischemic stroke.Currently,endovascular revascularization has been widely used in the treatment of large vessel occlusive stroke.The development of multi-modal neuroimaging has provided technical support to this.This article reviews the roles of neuroimaging in endovascular recanalization in patients with ischemic stroke.

AIM:To develop a high performance liquid chromatography-electrospray ionization-mass spectrometry(HPLC-EMI-MS)analysis approach of Alisma orientalis(Sam.)Juzep.METHODS:A Zorbax SB-C_ 18 column was used under the gradient elution condition with acetonitrile-H_2O.The MS detection was performed on an Agilent ion trap mass spectrometer with an elctrospray ionization source under the positive ion detection mode.RESULTS:Alisol B,alisol B-23-aceate,alisol C-23-aceate,alisol C,16-oxoalisol A and 11-deoxyalisol C were identified by their MS and MS2 fragments.The MS2 fragments of the 6 compounds were completed.CONCLUSION:The total ion current chromatogram of Alisma orientalis(Sam.)Juzep.was more characteristic than of the UV chromatogram.6 bioactive compounds can be simultaneously analyzed by the HPLC-EMI-MS method established in this experiment and it is a good quality control of Alisma orientalis(Sam.)Juzep.

Objective To investigate the effect of butylphthalide on cerebrovascular reactivity (CVR) in patients with severe intracranial internal carotid stenosis.Methods The patients with severe intracranial internal carotid stenosis diagnosed by cerebral angiography in Nanjing Stroke Registry Program from January 2010 to November 2010 were randomly divided into either the butylphthalide group or the control group.All patients received the oral drugs for ischemic cerebrovascular disease that met the guideline criteria,and butylphthalide 20 mg,3 times a day orally was added in the butylphthalide group.The CVR was evaluated by transcranial Doppler and CO2 inhalation challenge test,and reexamined 3 months after treatment.Results A total of 81 patients met the inclusion criteria,11 (13.6％) were lost to follow-up,and finally 70 (n =35 in each group) were included in the analysis.The mean age of the patients was 55.2 ± 9.0 years,47 of them were male and 23 were female.The degree of vascular stenosis was 72％ to 99％ (mean 79.4％ ± 9.5％).The CVR was improved significantly after 3 months of treatment in the butylphthalide group than that in the control group (P =0.007),but it was not improvedsignificantly in the control group (P =0.330).All the patients did not have ischemic stroke events during the medication.No serious adverse reactions occurred in the butylphthalide group.Conclusions Butylphthalide may improve the CVR in patients with severe intracranial internal carotid stenosis.

Endovascular therapy has become a research focus for the treatment of acute ischemic stroke,mainly including intra-arterial thrombolysis,combined intravenous and intra-arterial thrombolysis,mechanical recanalization,angioplasty and stenting,etc.This article reviews the evidence of evidence-based medicine of endovascular therapy in patients with acute ischemic stroke.

Objective To evaluate Alberta stroke programme early CT score on diffusion-weighted imaging (DWI-ASPECTS)and clot burden score on MR angiography (MRA-CBS)in predicting hemorrhagic transformation(HT) in acute anterior circulation cerebral infarction after thrombolysis in diffusion-weighted imaging Alberta stroke program.Methods A total of 37 consecutive patients with acute anterior circulation cerebral infarction were treated with thrombolysis.The clinical information , score of DWI-ASPECTS before thrombolysis , score of MRA-CBS before thrombolysis and images of enhanced gradient echo T 2*-weighted angiographywithin ( ESWAN) 24 hours before and after thrombolysis were all collected.The interval between onset and the two MRI scans were recorded respectively.We identified HT according to the images of ESWAN scanned after thrombolysis , and divided patients into 2 groups:with HT(14 cases) and without HT (23 cases).Differences of clinical data and imaging indicators between the two groups were compared by using Fisher′s exact test and Wilcoxon rank sum test.Logistic regression analysis was performed by taking HT as the dependent variable , and the scores of NIHSS , DWI-ASPECTS and MRA-CBS at admission were taken as independent variables.The variables which were statistically significant in logistic regression analysis were enrolled in receiver operating characteristic analysis.Results In HT group, the scores of NIHSS, DWI-ASPECTS and MRA-CBS were 15.00 ±5.30, 6.00(4.75,7.00) and 7.00(0.75,8.50) respectively.In the other group without HT, these scores were 7.00 ±4.80, 9.00(8.00,10.00)and 10.00(6.00,10.00) respectively.Compared with patients without HT , patients with HT had a higher baseline NIHSS score ( Z=-3.72,P<0.01), a lower DWI-ASPECTS (Z=-4.13,P<0.01) and a lower MRA-CBS (Z=-2.00, P<0.05).Logistic regression analysis showed that the scores of DWI-ASPECTS ( OR 0.42,95%CI 0.21-0.87,P <0.05 ) and NIHSS ( OR 1.22, 95%CI 1.00-1.48, P <0.05 ) at baseline predicted HT development independently.Receiver operating characteristic analysis showed that the optimal cut -off point of DWI-ASPECTS to predict the development of HT was≤7.Its sensitivity, specificity and area under ROC curve were 92.9%, 78.3% and 0.902 respectively ( P<0.01 ).Conclusions ASPECTS on DWI is of great value in predicting HT after thrombolysis in acute cerebral infarction.CBS on MRA can provide additional information for predicting HT.

Moyamoya disease is a chronic progressive cerebrovascular disease which is characterized by progressive stenosis or occlusion at bilateral terminal portions of the internal carotid artery and its large branch vessels,and with an abnormal formation of new vascular network in skull base.As a noninvasive method,magnetic resonance imaging (MRI) plays an important role in the diagnosis and evaluation of moyamoya disease.This article reviews the application of MRI in the identification,diagnosis and treatment evaluation of the stroke subtypes in patients with moyamoya disease.

Objective To discuss spinal fusion effect of lumbar intertransverse process in rabbits by using bone marrow stromal stem cells(MSCs)in conjunction with bone morphogenetic protein(BMP)and freeze-dried demineralized bone matrix(FDBM)as scaffold.Methods To separate and cultivate MSCs in vitro,with FDBM as scaffold,osteogenesis was induced by BMP.Sixty Japan white rabbits were randomly divided into three groups.Group A was MSCs+FDBM+BMP,group B was FDBM,group C was autogenous ilium cancellous bone(AIB).Lumbar intertransverse process was fused in lumbar five to six.Rabbits were killed at 8 weeks after operation.The general observation and imageology were used to assess the fusion condition.To estimate the implantation using DR image.Gray scale analysis of DR image caculated the osteogenic density and acreage.The CT scan and three-dimensional reconstruction was used to observe the fusion configuration of lumbar intertransverse process.Results The fusion mass character in group A and C was hard,the morphology was not regulation.The fusion mass was almost absorbed in group B beside little tissue approach transverse process.There were high density image between intertransverse processes,osteogenic density were nonuniform in group A and C.There were nonunion in group B.Consistent callus were existed between intertransverse process in group A and C.There were not consistent callus in group B.Group A was similar to group C in osteogenesis density and acreage.Group B was the worst.There were cartilage and newly born bone trabecular formation in group A and group C.Between transverse process were mainly fiber tissue in group B.Conclusion MSCs in conjunction with BMP and FDBM has the similar osteogenic capability to the AIB and better osteogenic capability than that of FDBM alone when spinal fusion of lumbar intertransverse process is performed in rabbits.

Objective To investigate the correlation between ABCD2 scores and vertebrobasilar artery stenosis in patients with posterior circulation transient ischemic attack (TIA).Methods The patients with posterior circulation TIA who performed cerebral angiography were enrolled in the study,and their ABCD2 scores and imaging data were analyzed.Results A total of 108 patients with posterior circulation TIA were enrolled.There were significant differences in the main trunk stenosis degree of vertebrobasilar artery with different ABCD2 scores in patients with posterior circulation TIA (P =0.005).The overall degree of stenosis increased with the increase of ABCD2 score (P =0.000).After adjustment for other vascular risk factors,ABCD2 score had significant predictive ability for whether had posterior circulation stenosis (odds ratio [OR]1.771,95％ confidence interval [CI] 1.234-2.542; P =0.002) and moderate to severe stenosis (OR 2.083,95％ CI 1.336-3.176; P =0.001).Its receiver operating characteristic area under the curve was 0.693(95％ CI 0.586-0.800) and 0.755 (95％ CI 0.661-0.849) respectively.When the ABCD2 score was ≥3,the sensitivity and specificity of predicting posterior circulation stenosis were 62.6％ (95％ CI 53.4％-71.7％) and 70.6％ (95％ CI62.0％-79.1％) respectively,and the sensitivity and specificity of predicting posterior circulation stenosis ＞ 50％ were 78.7％ (95％ CI 70.9％-86.4％) and 67.5％ (95％ CI58.7％-76.3％) respectively.Conclusions In patients with posterior circulation TIA,the stenosis degree of vertebrobasilar arterial trunk increases with the increase of ABCD2 score.In a certain extent,ABCD2 score may predict whether the main trunk of the posterior circulation has stenosis and whether has moderate to severe stenosis.

Objective To investigate the job stressors and burnout of senior nurses, and explore the possible strategies for alleviating stress and reduction of demission rate of senior nurses. Methods Two hundred and thirty head nurses and senior nurses were included in this study. Nurse Job Stressors Inventory (NJSI) and Maslach Burnout Inventory (MBI) were applied to evaluate the burnout and work-related stress of nurses with the combination of convenience sampling and cluster sampling. Results The NJSI scores of senior nurses and head nurses were (2.62 ± 0.56) points, (2.45 ± 0.47) points, the two scores were significantly different (t=-2.465,P<0.05); the scores of three dimensions of MBI in senior nurses were (30.01±11.86) points, (8.01±5.74) points, (35.35±9.57) points, while the scores in head nurses were (21.65±10.39) points, (5.14±3.37) points, (38.81±8.45) points. Statistically significant difference was seen between the two groups (t=-5.261,-4.705, 2.691,P<0.05). There was a higher positive correlation between job stressors and burnout of senior nurses (r=0.521) than head nurses (r=0.432). Conclusions The level of job burnout is higher in senior nurses than head nurses, attributing to the higher controllability of head nurses. It is suggested to reduce the job burnout of senior nurses and to keep senior nurses in the profession fields, based on the theory of magnetic hospital.