Objective:To explore the impact of treatment duration with human urinary kallidinogenase (HUK) on the efficacy and safety of acute ischemic stroke (AIS).Methods:In this subgroup analysis of RESK study, a total of 990 AIS patients recruited from 65 centers in China between August 2015 and June 2020 were included and divided into short medication group (HUK for 8 days, n=185) or long medication group (HUK for 15 days or 21 days, n=805). The proportions of patients with modified Rankin Scale (mRS) score of 0, 0-1, 0-2 at 90 days, National Institutes of Health Stroke Scale (NIHSS) score change from baseline to 22 days, the proportions of patients with Barthel index (BI)≥95 at 90 days, and the incidences of adverse events were analyzed. Comparisons between groups were conducted using chi-square test, single factor and multivariate Logistic regression analysis, etc. Results:Multivariate regression analysis showed that the proportions of patients with 90-day mRS score of 0-2 [74.1% (137/185) vs 75.0% (604/805); OR=1.047, 95% CI 0.676-1.620, P=0.838] and 22-day NIHSS score change from baseline (4.60±2.00 vs 4.26±2.80; OR=-0.390, 95% CI -1.125-0.344, P=0.297) showed no statistically significant difference between the short medication and long medication groups; the proportions of patients with 90-day mRS score of 0-1 [48.1% (89/185) vs 59.1% (476/805); OR=0.674, 95%CI 0.463-0.983, P=0.041] and 90-day BI≥95 [43.6% (79/181) vs 55.1% (442/802); OR=0.614, 95%CI 0.420-0.897, P=0.012] were significantly lower in the short medication group than in the long medication group. There was no statistically significant difference in the incidences of adverse events between these 2 groups. Conclusions:In AIS patients, consecutive 8-day dosing of HUK improved immediate (22-day NIHSS score) and long-term outcome (90-day mRS score 0-2) and was safely tolerated. When applicable, extended duration of HUK could improve long-term disability-free rate (90-day mRS score 0-1) and quality of life (90-day BI) without increasing the risk of adverse events.

Obstructive sleep apnea hypopnea syndrome(OSAHS)is one of the most common sleep disorders in both adults and the elderly.A large number of studies in recent years have shown that OSAHS may increase the risk of cognitive impairment.This article summarizes the latest research findings on cerebrospinal fluid and plasma biomarkers associated with Alzheimer disease(AD)in patients with OSAHS,as well as how various treatment methods for OSAHS can relief the symptoms of OSAHS and alter the levels of AD biomarkers simultaneously,so as to emphasize the importance of treating OSAHS symptoms to prevent and delay the development and progression of AD.

The term of vascular cognitive impairment (VCI) has been constantly evolved and updated. The latest definition refers to the contribution of stroke and subclinical vascular brain injury that resulted from vascular pathology and its risk factors, to the cognitive impairment syndrome involving at least one domain, ranging from mild cognitive impairment to dementia, as well as mixed cognitive impairment, including Alzheimer′s disease. This article presents the epidemiology, etiology, pathogenesis, classification, clinical manifestations, auxiliary examination, diagnosis, prevention and treatment of VCI.

Neuroimaging is of great value in the diagnosis and differentiation of Alzheimer′s disease. Structural imaging, especially structural magnetic resonance, can show the characteristic changes of brain atrophy in patients with Alzheimer′s disease, and effectively identify lesions in the brain. Functional imaging, mainly the molecular imaging of positron emission tomography can achieve intracranial retention of tracer that binds to the β-amyloid, which is of great value for the pathophysiological diagnosis of Alzheimer′s disease. This article introduces the application value of structural and functional magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography and other imaging examinations in the diagnosis and differentiation of Alzheimer′s disease.

Objective:To evaluate and quantify the degree of language impairment by obtaining the cerebral blood flow in the main language functional areas of aphasia patients after stroke with arterial spin labeling sequence, so as to make aphasia evaluation more objectively, accurately and effectively.Methods:From May 2016 to October 2019, 22 patients with aphasia after stroke and 22 healthy controls were collected from the Department of Neurology, the First Affiliated Hospital of Zhejiang University, for multimode MR scanning, and the patients were evaluated by aphasia scale during hospitalization. The classic language related brain area and potential language related brain area were selected as the regions of interest to extract the local mean cerebral blood flow. The differences of cerebral blood flow between the two groups were compared, and the correlation between the cerebral blood flow of each region of interest and the sub items of multiple language scales was analyzed.Results:Compared with the control group, the cerebral blood flow of the inferior parietal gyrus （AAL-11，(39.18±3.85) ml·100 g -1·min -1vs (50.41±1.93) ml·100 g -1·min -1， t=2.605）, angular gyrus （AAL-13，(39.90±3.29) ml·100 g -1·min -1vs (47.86±1.93) ml·100 g -1·min -1, t=2.087） in the patients was obviously decreased; In the relevant brain areas of listening comprehension, the cerebral blood flow of the inferior parietal gyrus (AAL-61, (33.86±4.15) ml·100 g -1·min -1vs (44.31±2.39) ml·100 g -1·min -1, t=2.179), superior marginal gyrus (AAL-63, (36.49±4.40) ml·100 g -1·min -1vs（50.17±2.26） ml·100 g -1·min -1, t=2.765), and angular gyrus (AAL-65, (35.56±4.24) ml·100 g -1·min -1vs(48.98±2.32) ml·100 g -1·min -1, t=2.777), Heschl gyrus (AAL-79, (47.30±5.11) ml·100 g -1·min -1vs（62.54±2.45） ml·100 g -1·min -1, t=2.689) and superior temporal gyrus (AAL-81, (43.56±4.82) ml·100 g -1·min -1vs (56.29±2.06) ml·100 g -1·min -1, t=2.429) of the patients was also decreased to different degrees ( P<0.05). In addition, the cerebral blood flow of the left insula (AAL-29, (46.59±3.76) ml·100 g -1·min -1vs (55.74±2.12) ml·100 g -1·min -1, t=2.120) and the rolandic island (AAL-17, (39.71±3.81) ml·100 g -1·min -1vs (52.48±2.01) ml·100 g -1·min -1, t=2.968)cover in the patients was also lower than that in the control group significantly ( P<0.05). The results of correlation analysis showed that there was a significant positive correlation ( P<0.05) between the brain blood flow of the left inferior frontal gyrus, the triangle of inferior frontal gyrus, the insular lobe, the inferior parietal lobe, the bilateral superior marginal gyrus and the sub item scores of the language scale in the patients. Conclusions:The decrease of cerebral blood flow is the potential cause of the decrease of language function in aphasia patients after stroke. The decrease of cerebral blood flow in six brain regions, including the frontal inferior gyrus, the frontal inferior gyrus triangle, the insular lobe, the left and right superior marginal gyrus and the inferior parietal lobe, can be used as an objective quantitative index to reflect the level of naming function.

Currently,the ideal anesthetic approach for the endovascular treatment of acute ischemic stroke remains unknown.Most retrospective studies and meta-analysis report worse outcomes from general anesthesia than from conscious sedation during endovascular treatment.However,series of randomized controlled trials have not shown the advantages of conscious sedation.The choice of anesthetic strategy should continue to be individualized in clinical practice.In order to provide references for clinician,the advantages and disadvantages of general anesthesia and conscious sedation for the endovascular treatment of acute ischemic stroke were reviewed.

Arterial spin labeling (ASL) technology is a popular technique for evaluating and studying cerebral perfusion in recent years. It can sensitively detect the abnormal cerebral perfusion and effectively avoid the potential risks caused by exogenous contrast agents in other tests. Detection of the abnormal cerebral blood flow perfusion by ASL technology can early predict cognitive decline in normal elderly, explore the pathogeneses of mild cognitive dysfunction and Alzheimer's disease, and evaluate the cerebral blood flow around the ischemic focus and the establishment of collateral circulation in patients with aphasia after stroke. At the same time, it is verified that the decrease of cerebral blood flow perfusion is another precipitating factor of primary progressive aphasia except cortex atrophy. Although there are still some limitations, the ASL technology has a good prospect in the application of cognitive disorders.

Adult ; Biomarkers ; analysis ; Brain Injuries, Traumatic ; metabolism ; Humans ; Persistent Vegetative State ; metabolism ; Proteins ; metabolism ; Tears ; metabolism

Facial autologous fat transplantation is a common aesthetic procedure.Although this procedure is generally regarded as safe,several patients have experienced acute cerebral infarction after fat particles were incorrectly injected into the blood vessel.We report two cases of cerebral infarction following facial autologous fat transplantation:one patient suffered massive cerebral infarction due to the occlusion of internal carotid artery by fat embolus and died of stroke related complication,the other young women experienced acute ischemic stroke and ophthalmic artery embolism during this procedure and remained permanent blindness of right eye.Therefore,when a patient presents abrupt mental change,hemiplegia,blindness during autologous fat particle injection,doctors must consider the complication of cerebral infarction.