Isolated vertigo due to vascular mechanisms manifests as vertigo, dizziness or imbalance only. Due to the lack of focal neurological symptoms or signs, it is often misdiagnosed as peripheral vestibular disease, resulting in serious adverse consequences. This article reviews the lesion location, cerebrovascular basis, clinical evaluation, and imaging examination of isolated vertigo caused by vascular mechanisms.

Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture.Methods From January 2012 to October 2018,the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed,including 26 males and 2 females,aged 24-61 years with an average of 38.6 years.All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries.There were 16 cases of traffic injuries,8 falling injuries,2 heavy object injuries and 2 sprains.Among the 28 patients,17 were talus neck fractures,and according to Hawkins talus neck fracture classification,there were 1 case of type Ⅰ,12 type Ⅱ,and 4 type Ⅲ.There were 11 cases of talus fracture,which were classified according to Sneppen talus fracture types:2 cases of type Ⅰ,8 cases of type Ⅱ and 1 case of type Ⅴ.Among them,2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures.The time from injury to operation for 3 patients with open fracture was 3-6 hours.25 cases of closed fracture injuries took 2-10 hours to operate,with an average time of 5.6 hours.All patients were fixed with cannulated screws through the anteromedial ankle approach.The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery.The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score.Results All 28 patients were followed up for 23 to 82 months,with an average of 37.5 months.All fractures healed.The healing time of talus neck fracture was 3.5-8 months,with an average of 5 months.The healing time of talus fracture was 3-7 months,averaging 4.5 months.At the latest follow-up,AOFAS score ranged from 68 to 100,with an average of 82.5 points,including excellent in 15 cases,good in 8 cases,fair in 4 cases and poor in 1 case,with the excellent and good rate of 82.1％ (23/28).There were no signs of fracture displacement,malunion,loosening and prolapse of internal fixation,fracture and ischemic necrosis of talus after operation.Traumatic arthritis occurred in 9 patients,with an incidence rate of 32.1％ (9/28).Tibial joint was involved in 5 cases,talus joint in 3 cases,tibialis in 1 case and talus joint in 1 case.Among them,traumatic arthritis occurred in 2 cases of open injury.Nine patients (32.1％) suffered from traumatic arthritis 6-10 months after operation,with an average of 8 months.According to conservative treatments such as weight control,ankle immobilization,physiotherapy,anti-inflammatory and analgesic,nutrition of articular cartilage drugs,joint traction and plasty were given.The patients' conditions improved to different degrees and could tolerate walking and normal life and work.Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries,clear exposure for direct reduction,low rate of necrosis of talus and satisfactory curative effect.

Cervical artery dissection (CeAD) is characterized by an intramural hematoma of the internal carotid artery or the vertebral artery.CeAD is the major cause of ischemic stroke in young adults.Carotid artery dissection is a major cause of stroke.Early recognition and treatment of CeAD is important for the prevention of ischemic stroke.

Objective To investigate the effects of resveratrol on the first and double oxygen-glucose deprivation (OGD) primary cortical neuron silent information regulator 1 (SIRT1), AMP-activated protein kinase (AMPK) activity and ATP content, and its possible neuroprotective mechanism. Methods Cortical neurons were taken from the embryos of 18-day Wistar rats. An in vitro repeated ischemia model was induced by the double OGD after the success of primary culture. Trypan blue stalning was used to detect the cel survival rate. Western blot was used to detect the SIRT1 and phospho-AMPK expression. Deacetylase fluorescence assay was used to detect the SIRT1 activity. Bioluminescence assay was used to detect the ATP content. Results Compared with the control group, resveratrol (0. 5 μmol/L) preconditioning significantly increased the survival rates after the single and double OGD (al P < 0. 001), ATP content (al P = 0. 004), SIRT1 activity (single: P = 0. 001; double: P = 0. 002), and the expression levels of SIRT1 (single: P = 0. 029; double: P = 0. 023) and phospho-AMPK (al P = 0. 001). Conclusions Resveratrol has the neuroprotective effect for the first and double OGD cortical neurons. Its mechanism may be associated with upregulating the SIRT1/AMPK signaling pathways and decreasing the energy requirements.

Adenosine monophosphate-activated protein kinase (AMPK) is a serine/threonine protein kinase,which is a energy regulation switch in the cells of the body.In the case of nutritional deficiencies and ischemia,AMPK system is activated as the metabolism and stress signal transduction component to regulate the expression of downstream target proteins.After acute ischemic stroke,AMPK is activated and aggravates neuronal apoptosis,and giving AMPK inhibitor may reduce cerebral ischemic injury.The activation of AMPK after stroke may result in the upregulation of brain-derived neurotrophic factor expression and the activation of endothelial nitric oxide synthase,and they play the protective roles for neuronal regeneration and repair.This article reviews the advances in research on the roles of AMPK in experimental cerebral ischemia.

Objective To explore the clinical effect of microendoscopic discectomy through posterior approach in old patients with multilevel lumber spinal stenosis and analyze the influence factors that related to clinical effect .Methods 64 old patients with multilevel lumber spinal stenosis were selected and divided into microendoscopic group and open group based on different operation method ,each group contained 32 patients .Comparison was made between two groups in respects of operation time ,amount of bleed-ing ,hospital time post-operation and Nakai scores .Analyzed the influence factors that related to clinical effect .Results The opera-tion time ,amount of bleeding ,hospital time post-operation in microendoscopic group were lower than open group ,the differences had statistical significance .Based on the Nakei score ,the curative effect in microendoscopic group was slightly lower than open group ,but the differences had no statistical significance .The JOA score pre-operation ,walking distances and complication were rela-tive factors that could influence the clinical effect of microendoscopic discectomy through posterior approach method .Conclusion Microendoscopic discectomy through posterior approach in old patients with multilevel lumber spinal stenosis had quicker postoper-ative recovery than conventional operation ,and the JOA score pre-operation ,walking distances and complication were relative fac-tors that could influence the clinical effect of microendoscopic discectomy through posterior approach method .

Objective To investigate the relationships between the levels of plasma soluble CD40 ligand (sCD40L),fetuin-A and pregnancy-associated plasma protein A (PAPP-A) and carotid plaque in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled in the study.Carotid arteries were assessed by using carotid artery ultrasound.The patients were divided into either a carotid artery plaque group or a non-carotid artery plaque group according to the assessment results.The former were further divided into a stable plaque sub-group and an unstable plaque sub-group according the nature of plaque.Enzyme-linked immunosorbent assay was used to detect the levels of plasma sCD40L,fetuin-A and PAPP-A.The demography,previous history,complications,laboratory tests and plasma inflammatory biomarkers between the carotid artery plaque group and the non-carotid artery plaque group and between the stable plaque subgroup and the unstable plaque subgroup were compared.Multivariate logistic regression analysis was used to investigate the relationship between plasma inflammatory biomarkers and carotid plaques.Results A total of 200 patients with acute ischemic stroke were included.Among them,78 were females and 122 were males (aged 33 to 87 years,mean 60.1 ± 10.3 years); 139 patients were in the carotid artery plaque group and 61 were in the non-plaque group; 43 were in the stable plaque subgroup and 96 were in the unstable plaque subgoup.The mean age of the carotid artery plaque subgroup was significantly greater than that in the non-plaque subgroup (63.2 ± 8.7 years vs.50.3 ± 9.5 years; t ＝ 10.179,P =0.000),the constituent ratios of men (68.3％ vs.44.3％;x2＝ 10.336,P＝ 0.001),hypertension (71.2 vs.54.1％;x2=5.540,P=0.019),diabetes (46.8％ vs.29.5％ ;x2 =5.199,P =0.023),and hyperlipidemia (78.4％ vs.37.7％ ;x2 =31.31,P =0.000)in patients of carotid plaque group were significantly higher than those of the non-carotid plaque group.The levels of total cholesterol (5.7 ± 1.1 mmol/L vs.5.3 ± 1.0 mmol/L; t =2.433,P =0.016),low-density lipoprotein cholesterol (4.5 ± 1.0 mmol/L vs.4.1 ±0.9 mmol/L; t =2.683,P =0.008),fasting glucose (7.5 ±2.5 mmol/Lvs.6.4±2.1 mmol/L; t=3.002,P＝0.003),sCD40L (151.4 ± 55.8 pg/mlvs.102.8 ±65.9 pg/ml; t =5.360,P=0.000),fctuin-A (390.1 ± 80.6 μg/ml v.s.352.9 ± 98.6 μg/ml; t =2.591,P =0.011),and PAPP-A (11.49 ±4.67 mIU/L vs.8.46 ± 3.99 mIU/L; t =4.409,P =0.000) were significantly higher than those of the non-carotid plaque group.Multivariate logistic regression analysis showed that hyperlipidemia (odds ratio [OR] 6.582,95％ confidence interval [CI] 2.321-18.662; P =0.000),sCD40L (OR6.372,95％ CI 2.174-18.670;P=0.010),and fetuin-A (OR 4.101,95％ CI 1.012-16.619; P=0.048) were the independent predictors for carotid artery plaques in patients with acute ischemic stroke.The mean age of the stable plaque subgroup was significantly lower than that of the unstable plaque subgroup (59.6 ± 9.3 years vs.64.1 ± 7.2 years; t =3.231,P =0.002).The constituent ratio in patients with hypertension was significantly lower than that of the unstable plaque subgroup (55.8％ vs.78.1％ ; x2 =7.213,P =0.007).The levels of total cholesterol (5.4 ±0.9 mmol/L vs.6.0 ± 1.1 mmol/L; t =3.136,P =0.002),low-density lipoprotein cholesterol (4.0 ± 1.2 mmol/L vs.5.7 ± 1.0 mmol/L; t =8.696,P =0.000),fasting glucose (7.1 ± 2.3 mmol/L vs,7.9 ± 1.9 mmol/L; t =2.147,P =0.034),sCD40L (135.3 ±74.3 pg/ml vs.176.5 ±64.5 pg/ml; t =3.319,P ＝0.001),and PAPP-A (10.96 ± 5.02 mIU/L vs.13.98 ±4.63 mIU/L; t =3.463,P =0.001) were significantly lower than those of the unstable plaque subgroup,while the level of high-density lipoprotein cholesterol was significantly higher than that of the unstable plaque subgroup (1.2 ± 0.2 mmol/L vs.1.1 ± 0.3 mmol/L; t =2.314,P=0.022).Multivariate logistic regression analysis showed that HDL-C (OR 0.234,95％ CI0.060-0.906; P =0.022) was an independent protective factor for unstable plaques,while sCD40L (OR 5.290,95％ CI 1.613-17.351; P =0.029) and PAPP-A (OR4.125,95％ CI 1.281-13.283; P =0.021) were the independent predictors for unstable plaques.Conclusions The levels of sCD40L,PAPP-A,and fetuin-A were associated with the existence and stability of carotid artery plaque.The increased plasma sCD40L and fetuin-A were the independent predictors for carotid artery plaques in patients with acute ischemic stroke,and the increased levels of plasma sCD40L and PAPP-A were the independent predictors for carotid artery plaque instability in patients with acute ischemic stroke.

Resveratrol is a polyphenolic compounds in many plants.It has many effects inchuding antioxidation,anti-inflammation,inhibiting apoptosis,and scavenging free radicals.Resveratrol preconditioning has neuroprotective effect in ischemia-reperfusion in rats by activating silent information regulator 2 homolog 1.This effect is similar to brain ischemic preconditioning.In addition,resveratrol can also attenuate the brain infraction volume of cerebral ischemia/reperfusion in mice and improve neurological function.This article reviews the neuroprotective effect of resveratrol and its mechanisms in cerebral ischemia.

Objective To investigate the correlation between interleukin 18 (IL-18) gene promoter -137 G/C polymorphism and plasma levels of IL-18 and cerebral infraction.Methods A total of 218 Han patients with acute cerebral infarction in northern China were recruited and 218 sex- and age-matched health subjects were used as control group. Enzyme-linked irnmunosorbent assay was used to detcet the level of IL-18. Sequence specific primer-polymerase chain reaction was used to detect IL-18 gene promoter - 137 G/C polymorphism. Results The plasma IL-18 levels (1 47. 47 ±29. 79 ng/L vs. 78. 78 ± 16. 42 ng/L; t =29. 816, P ＜0. 01)and the frequency of - 137 GG genotype (79. 8％ vs. 67. 0％;x2 =8. 563, P =0. 032) in the acute cerebral infarction group were significantly higher than those in the control group. The risk of cerebral infarction in individuals with - 137GG genotype was 1.95 times higher than that in individuals without - 137GG genotype (odds ratio 1.95, 95％ confidence interval 1. 263-3. 012,P =0. 002); plasma IL-18 levels in patients with CG genotype were significantly higher than those in patients with CG +CC genotype (150. 00 ±27. 26 ng/L vs. 118. 47 ±21.62 ng/L, t =8. 222, P ＜0. 01). Conclusions The IL-18 gene promoter - 137 G/C polymorphism correlates with cerebral infarction in Han population in north China. The risk of cerebral infarction in individuals with GG genotype is significantly higher, and it may be associated with its influence on plasma level of IL-18.

Pregnancy-associated plasma protein-A (PAPP-A),a high-molecular-weight zinc-binding metrix metalloproteinase,is expressed abundantly in the ruptured atherosclerostic plaque. PAPP-A can be used as a novel biological marker of plaque instability and cardiovascular events in patients with acute coronary syndrome. However,the role of PAPP-A in iscbemic stroke remains unclear. This article reviews the value of VAPP-A in predicting the risks of ischemic stroke events.