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Epidemiological studies have evaluated the association between the C7673T polymorphism in apolipoprotein B (apoB) gene and ischemic stroke (IS), but the results are still debatable even in the Chinese population. This meta-analysis was therefore designed to clarify these controversies.All of the relevant studies were identified from PubMed, Embase, Chinese National Knowledge Infrastructure database and Chinese Wanfang database up to 31 October 2014. Statistical analyses were conducted with Revman 5.2 and STATA 12.0 software. Odds ratio (OR) with 95% confidence interval (CI) values were applied to evaluate the strength of the association. A fixed or random effect model was selected for pooling data based on the heterogeneity test. Publication bias was assessed by Begg's test and Egger's test.A significant association was found between the C7673T polymorphism in apoB gene and IS under the heterozygous genetic model (OR = 1.868, 95% CI = 1.160-3.007) and the allelic genetic model (OR = 1.742, 95% CI = 1.294-2.346), respectively. In the subgroup analysis by the geographic region, T allele could increase the risk of IS in northern Chinese (OR = 2.359, 95% CI: 1.425-3.907), but not in southern Chinese individuals (OR = 1.485, 95% CI: 0.778-2.832). Further stratification for source of controls showed that statistical significance was found among the population-based studies.Our meta-analysis revealed that C7673T polymorphism in apoB gene was significantly associated with increased IS risk in the Chinese population.

Stroke is one of the leading causes of death and long-term disability worldwide. Mitochondrial DNA (mtDNA) is a potential contributor for the sex differences of ischemic stroke heritability. Although mtDNA haplogroups were associated with stroke onset, their impacts on stroke outcomes remain unclear. This study aimed to evaluate the impacts of mtDNA haplogroups on short-term outcomes of neurological functions in patients with ischemic stroke. A total of 303 patients were included and their clinical data and mtDNA sequences were analyzed. Based on the changes between baseline and 14-day follow-up stroke severity, our results showed that haplogroup N9 was an independent protective factor against neurological worsening in acute ischemic stroke patients. These findings supported that mtDNA variants play a role in post-stroke neurological recovery, thus providing evidences for future pharmacological intervention in mitochondrial function.

An adaptive tracking algorithm is developed to achieve quantum system control field designs. The adaptive algorithm has the advantage of operating noniteratively to efficiently find desirable controls, and has the feature of high stability by suppressing the influence of disturbances from tracking singularities. The core of the adaptive tracking control algorithm is a self-learning track switch technique which is triggered by monitoring of the evolving system trajectory. The adaptive tracking algorithm is successfully tested for population transfer.

This paper explores the use of laboratory closed loop learning control to suppress the effects of decoherence in quantum dynamics. Simulations of the process are performed in multilevel quantum systems strongly interacting with the environment. A genetic algorithm is used to find an optimal control field which seeks out transition pathways to achieve a minimum influence of decoherence upon the system at a target time. The simulations suggest that decoherence may be optimally managed in the laboratory through closed loop operations with a suitable cost that is sensitive to the coherence of the dynamics. The case studies of dimension N=4 and N=10 with strong system–environment coupling indicate that the additional complexity with increasing system dimension can make it more difficult to manage decoherence.

Optimal control within the density matrix formalism is applied to the production of desired non-equilibrium distributions in condensed phases. The time evolution of a molecular system modeled by a displaced harmonic oscillator is assumed to be described by the Markoffian master equation with phenomenological relaxation parameters. The physical objectives of concern are the creation of a specified vibronic state, population inversion and wave packet shaping. The effects of an initial thermal distribution and dissipation on these targets are examined. In order to transfer a large amount of population (i.e., the strong-field regime) to a target wave packet in an electronic excited state, it is shown that creating a shaped packet in the ground state is often required to achieve high yield. This control pathway cannot be taken into account within the weak-field approximation, and is especially important when the target state includes vibrational states that are weakly accessible from the initial state or that have preferential indirect excitation paths from the initial state. Although relaxation effects usually reduce the control efficiency, under certain conditions, the bath-induced dynamics can help to create an objective state.

This article reviews the procedures for attaining laser optimal control fields to manipulate the dynamics of quantum systems. Optimal control theory, whether implemented as a computational technique or directly in the laboratory, is the most general means to achieve precise control of quantum systems. In the case of theoretical control design, a class of monotonically convergent iteration algorithms are presented, which can reduce the computational effort involved. Implementation of optimal control field design can provide physical insight into the feasibility and mechanism of control, even for quantum systems whose Hamiltonian might contain some degree of uncertainty. Moreover, optimal quantum control fields may be directly determined in the laboratory by an analogous procedure with the molecule subject to manipulation acting as an analog computer to guide the discovery of successful controls. To facilitate this process closed-loop iteration is set up with the loop consisting of the laser, the molecular sample, and a learning algorithm to recognize patterns in the control fields giving rise to successful experimental outcomes. Theoretical design and laboratory learning can act in tandem with each other to achieve the best control and reveal information on how the control process occurs. © 2003 Wiley Periodicals, Inc. Int J Quantum Chem, 2003

Background and Purpose— The relationship between chronic kidney disease and cerebral small vessel disease (cSVD), especially enlarged perivascular spaces (EPVS), has not been fully understood. This study aimed to investigate the association of chronic kidney disease and EPVS, as well as the total burden of cSVD on magnetic resonance imaging, expressed by the simultaneous presence of multiple markers of cSVD, among patients with first-ever lacunar stroke. Methods— Four hundred and thirteen consecutive patients were prospectively enrolled. Centrum semiovale and basal ganglia EPVS on T2-weighted magnetic resonance imaging, as well as other imaging markers of cSVD, including lacune, white matter lesions, and cerebral microbleeds, were rated using validated scales. Chronic kidney disease was defined as either reduced estimated glomerular filtration rate or the presence of proteinuria. Results— After adjustments for potential confounders by logistic regression, proteinuria and impaired estimated glomerular filtration rate were correlated with the severity of EPVS in both centrum semiovale (odds ratio [OR] 2.59; 95% confidence interval [CI] 1.19–5.64 and OR 2.37; 95% CI 1.19–4.73) and basal ganglia (OR 5.12; 95% CI 2.70–12.10 and OR 4.17; 95% CI 2.08–8.37). A similar association was also found between proteinuria and low estimated glomerular filtration rate levels and the comprehensive cSVD burden (OR 2.13; 95% CI 1.10–4.14 and OR 5.59; 95% CI 2.58–12.08). Conclusions— Proteinuria and impaired estimated glomerular filtration rate are associated with increasing EPVS severity and, furthermore, accumulated magnetic resonance imaging burden of cSVD in patients with first-ever acute lacunar stroke.

Background The correlation between cerebral atherosclerosis and white matter lesions (WMLs) in the elderly was controversial in the published articles, where the stenosis was often evaluated by ultrasonography, computed tomography angiography, or magnetic resonance angiography and collaterals were seldom considered. We hypothesized that collaterals influence WMLs. Our study was to explore the relationship between the circle of Willis and WMLs in a retrospective, hospital-based cohort of patients with carotid atherosclerosis. Methods Two hundred eighty-six patients with carotid atherosclerosis were enrolled from the Nanjing Stroke Registry. They underwent magnetic resonance imaging evaluating WMLs and digital subtraction angiography evaluating both carotid atherosclerosis and collateral capacity of the circle of Willis. We tested the association between severe carotid atherosclerosis, the circle of Willis, and WMLs by logistic regression analysis. Results Severity of carotid atherosclerosis was not significantly associated with either periventricular or deep WMLs ( P = .656 and .566, respectively). Number of carotid arteries with severe stenosis was not associated with the severity of either periventricular or deep WMLs ( P = .721 and .263, respectively). Patency of the communicating arteries (CoA) was not associated with periventricular or deep WMLs ( P = .561 and .703, respectively). Advanced age and hypertension were associated with periventricular WMLs ( P = .001 and .008, respectively). Advanced age, hypertension, and prior stroke were associated with deep WMLs ( P = .049, .048, and .001, respectively). Conclusions The circle of Willis and severe carotid atherosclerosis may not be related to WMLs. Further larger studies are warranted to confirm or refute our findings.

Objective: To perform a meta-analysis of prospective studies to evaluate the relation between dietary protein intake and stroke risk. Methods: Relevant studies were identified by searching PubMed and Embase through November 2013, and by reviewing the reference lists of retrieved articles. We included prospective cohort studies that reported relative risks (RRs) with 95% confidence intervals (CIs) for the association between dietary protein intake and stroke risk. Results: The meta-analysis included 7 prospective studies involving 254,489 participants. The pooled RR of stroke for the highest compared with the lowest dietary protein intake was 0.80 (95% CI 0.66–0.99). Dose-response analysis indicated that a 20-g/d increment in dietary protein intake was associated with a 26% reduction in stroke risk. Stratifying by protein type, the RR of stroke for animal protein was 0.71 (95% CI 0.50–0.99). Sensitivity analysis restricted to studies with control for common risk factors yielded similar results, and omission of any single study did not change the overall result. Conclusion: These findings suggest that moderate dietary protein intake may lower the risk of stroke.

Summary SEW2871, a selective sphingosine-1-phosphate type 1 receptor (S1P1) agonist, has been shown to be effective in protecting kidneys against ischaemia–reperfusion injury by reducing CD4+ T cell infiltration in mice. However, the effects of SEW2871 on colitis remain unclear. The aim of this study was to investigate the effects of SEW2871 on established colitis in interleukin (IL)-10 gene-deficient (IL-10–/–) mice, a murine model of Crohn's disease (CD). SEW2871 was administered by gavage at a dose of 20 mg/kg/day for 2 weeks to IL-10–/– mice. Severity of colitis, serum amyloid A, tissue myeloperoxidase (MPO), T cells in blood and colon lamina propria (LP) and proinflammatory cytokine productions were evaluated. Furthermore, the phospho-signal transducer and activator of transcription (STAT)-3 (p-STAT-3) expression in lymphocytes isolated from colon LP was also assessed. The 2-week administration of SEW2871 ameliorated established colitis in IL-10–/– mice, associated with a reduction of serum amyloid A concentration, a decreased colon MPO concentration, a depletion of the peripheral CD4+ CD45+ T cells and a reduction of the homing of T cells into colon LP. Moreover, typical cytokines of T helper type 1 (Th1) and Th17 cells and p-STAT-3 expression were also suppressed by SEW2871 treatment. SEW2871 treatment ameliorates established experimental colitis in IL-10–/– mice, which may provide a new therapeutic approach for human CD therapy.

An optimal control procedure is presented to design a field that transfers a molecule into an objective state that is specified by the expectation values of multiple target operators. This procedure explicitly includes constraints on the time behavior of specified operators during the control period. To calculate the optimal control field, we develop a new monotonically and quadratically convergent algorithm by introducing a quadruple space that consists of a direct product of the double (Liouville) space. In the absence of the time-dependent constraints, the algorithm represented in the quadruple-space notation reduces to that of the double-space notation. This simplified formulation is applied to a two dimensional system which models intramolecular vibrational energy redistribution (IVR) processes in polyatomic molecules. An optimal pulse is calculated that exploits IVR to transfer a specific amount of population to an optically inactive state, while the other portion of the population remains in the initial state at a control time. Using trajectory plots in quantum-number space, we numerically analyze how the control pathway changes depending on the amount of the excited population.

This paper presents a direct potential surface inversion algorithm for multidimensional quantum systems based on combining probability density and energy spectral data. The algorithm expresses the ...

This paper reviews recent theoretical and experimental developments aimed at controlling molecular motion using tailored laser fields. Emphasis is given to seeking optimal designs for the laser controls and optimal implementation of the controls in the laboratory. Optimization on both counts provides a rigorous, flexible, and physically attractive means for obtaining the best possible control over molecular motion under any specified conditions. The theoretical design and laboratory implementation of control are best effected by a closed-loop process that draws on observations of the evolving molecular sample to steer it toward the desired target. Going beyond control, similar closed-loop laboratory learning concepts may lead to automated molecular monitors for inversion to systematically identify details of molecular Hamiltonians.

A noniterative quantum mechanical algorithm is presented to extract the dipole function from time dependent probability density and external electric field data. The algorithm determines the dipole function as the solution of an exact linear integral equation without the need to solve the Schrodinger equation. The inversion in regular regions of the dipole is accurate and stable under perturbations from noisy data. The regular regions of the dipole are automatically identified by the algorithm, and Tikhonov regularization is employed. There is much freedom in the external electric field with the best choices generally producing broad excitations of many eigenstates. Field designs may be estimated from the Hamiltonian or through closed loop learning techniques in the laboratory. The inversion algorithm is tested in a simulation for O−H, which shows that the algorithm is very reliable. Since the inversion algorithm is fast, it is argued that closed loop laboratory learning techniques may be applied to optim...

Aim Mesenteric hypertrophy has been recognized as an indicator of the complicated course of Crohn's disease. The aim of this study was to investigate whether the visceral fat area (VFA) is associated with postoperative clinical and endoscopic recurrence. Method Computed tomography was used to measure the subcutaneous fat area and VFA, and the mesenteric fat index (MFI) was defined as the ratio of the VFA to the subcutaneous fat area. Associations between body mass index, subcutaneous fat area, VFA and MFI and postoperative clinical and endoscopic recurrence were investigated. Results The factors associated with postoperative endoscopic recurrence at 6 months after surgery were a high VFA value (P = 0.019) and MFI values above the median (P = 0.008). VFA values were significantly correlated with endoscopic recurrence (r = 0.895, P = 0.040) and endoscopic lesions (r = 0.617, P

Background/Aims: Restenosis following extracranial artery stenting is a limitation that affects long-term outcomes. Effective and satisfying pharmacological strategies in preventing restenosis have not been established. This study aimed to evaluate whether argatroban, a direct thrombin inhibitor, could reduce the risk of in-stent restenosis after extracranial artery stenting. Methods: One hundred and fourteen patients hospitalized between August 2010 and August 2011 were enrolled. Patients were randomly assigned to argatroban (n = 58) and blank control groups (n = 56). The patients in the argatroban arm were treated with 10 mg of intravenous argatroban twice daily 2 days before and 3 days after the stenting procedures. Patients were followed for 12 months after the procedure. During follow-up, restenosis and target revascularization were analyzed. Recurrent cerebrovascular and cardiovascular events and deaths were also compared between the groups. Results: One patient in the stenting group withdrew immediately after the procedure due to unsuccessful stenting. Restenosis occurred in 4 patients (7.4%) in the argatroban group and in 11 patients (21.6%) in the control group during the 6- to 9-month angiographic follow-up period (p = 0.032). Nine months after the procedures, argatroban-treated patients had a trend towards a lower incidence of target revascularization compared with the controls (5.4 vs. 13.7%, p = 0.188). No major bleeding events or other adverse events occurred in the argatroban group. Conclusion: This pilot clinical trial is the first that uses argatroban to prevent restenosis in ischemic cerebrovascular disease, and suggests that intravenous administration of argatroban is effective and safe in preventing restenosis after extracranial artery stenting. Larger randomized controlled clinical trials are warranted.

Background Cerebral microbleeds (CMBs) are the important indicators of cerebral small vessel disease. However, it is still unclear whether endothelial dysfunction is involved in CMBs. In this study, we performed a prospective study to investigate the correlation between sE-selectin (soluble E-selectin) or adiponectin and the prevalence of CMBs. Methods We recruited 133 consecutive patients with first-ever ischemic stroke for this study. Finally, 126 patients were analyzed. The number and presence of CMBs were detected and evaluated on susceptibility-weighted magnetic resonance imaging within two weeks after symptom onset. We assessed the serum levels of adiponectin and sE-selectin for patients. Results CMBs were detected in 63 subjects (50%) within 126 patients and more prevalent in mixed brain regions (55.6%). In binary logistic regression analysis, each 1SD-increase in adiponectin level was significantly conversely associated with the prevalence of CMBs after adjusting for age, sex and cardiovascular risk factors (OR = 0.55; 95% CI: 0.36–0.84); but sE-selectin was significantly positively associated with the prevalence of CMBs (OR = 1.09; 95% CI: 1.02–1.15). Furthermore, partial correlation analyses showed that sE-selectin remained significantly associated with and correlated conversely to adiponectin (r = − 0.452, p = 0.001). Conclusions Endothelial injury may play a role in the pathogenesis of CMBs, and serum levels of adiponectin and sE-selectin were closely related to CMBs. Adiponectin might be protective for the prevalence of CMBs.

Objective Little is known about the impact of cerebral microbleeds on cognitive function. This study investigated the distribution of cerebral microbleeds and their impact on cognitive function, in patients with lacunar infarct. Methods Patients with lacunar infarct were enrolled prospectively. Cerebral microbleeds were classified as absent, mild, moderate or severe, based on magnetic resonance imaging findings. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) questionnaire, with a total score of Results Of the 85 patients included in the study, 35 (41.2%) had cerebral microbleeds. They were more frequently observed in mixed and deep brain regions, but rarely in the cerebral lobes. Multiple logistic regression analysis demonstrated that presence of cerebral microbleeds (odds ratio [OR] 5.320), duration of education (OR 0.938) and age (OR 1.464) were independent predictors of cognitive impairment. There was a significant correlation between cerebral microbleed severity and MoCA score. Conclusion The number and location of cerebral microbleeds were both closely associated with cognitive impairment, in patients with lacunar infarct.

A numerical method was proposed to propagate the quantum system with a time‐dependent Hamiltonian. The propagator is composed of the time‐independent‐Hamiltonian‐type multisplit forms, which becomes possible by realizing that the evolution operator has a close link with the time‐shift operator. The present algorithm can achieve a high order of accuracy through the recurrence of multisplit forms with predetermined coefficients, and it has the advantage that only the Hamiltonian itself at different time instants is involved, while other currently available schemes need to perform either a time integration or a time differential of the Hamiltonian. This essential difference has made our proposal highly competitive. A one‐dimensional model system is considered to verify the accuracy and efficiency of the numerical scheme.

The present paper developed two kinds of new time‐dependent methods in quantum scattering calculation. One method is to combine a split‐operator method with a differential method to achieve better convergent property than a pure differential method and better adaptive property in a multidimensional case than the pure split‐operator method. Another method is to adopt a desired time‐dependent variational principle to achieve variational correction in numerical calculations, which can improve the result from direct numerical evaluation with little additional consumed time.

Background and Purpose: Craniocervical artery stenosis is an important etiology for transient ischemic attack (TIA). We hypothesized ABCD and ABCD2 scores can predict craniocervical artery stenosis in patients with TIA. Methods: ABCD and ABCD2 scores were calculated in a total of 479 consecutive first-ever TIA patients in Nanjing Stroke Registry Program and compared with angiographic imaging derived from MRI or invasive catheter-based angiography. Results: Overall craniocervical artery (O-CA) stenosis was found in 197 (41.1%) patients. Extracranial craniocervical artery (E-CA) and intracranial craniocervical artery (I-CA) stenosis was found in 101 (21.1%) and 110 (23%) cases, respectively. ABCD and ABCD2 scores with similar accuracy for O-CA (AUCABCD 0.71, AUCABCD2 0.70), E-CA (AUCABCD 0.72, AUCABCD2 0.72) and I-CA stenosis (AUCABCD 0.62, AUCABCD2 0.62) were both independent predictors for various categories of artery stenosis after being adjusted for non-ABCD2 parameters. The cut-off points were equally 4 in both predicting rules. For ABCD, sensitivity was 57.4, 65.3 and 52.7% and specificity 77.0, 70.4 and 67.5% for O-CA/E-CA/I-CA, respectively. For ABCD2, sensitivity was 61.9, 69.3 and 58.2% and specificity 72.3, 65.6 and 63.1%. Conclusions: In patients with TIA, despite an association between ABCD and ABCD2 scores and underlying craniocervical artery stenosis, the clinical utility was limited by unsatisfactory sensitivity and specificity.

Aim Loop ileostomies are widely used in colorectal sur-gery to reduce the consequences of distal anastomoticfailure. The optimal surgical technique for their closurehas yet not been defined. A meta-analysis was per-formed to compare the outcome after stapled or handsutured ileostomy closure.Method An electronic literature search of EMBASE,PubMed and the Cochrane Library was undertaken toidentify studies reporting stapled and hand suturedileostomy closure. End-points included postoperativesmall bowel obstruction (SBO), anastomotic leakage,wound infection, overall postoperative complications,operation time, hospital stay and surgery-related cost.Results Fourteen studies including 5084 patients wereidentified. Meta-analysis showed that stapled closurewas associated with a lower rate of SBO overall(OR = 0.56, P < 0.00001) and early (within 30 days ofclosure) SBO (OR = 0.51, P < 0.00001). This differ-ence persisted for direct ileostomy closure (OR = 0.62,P = 0.02) or closure with bowel resection and handsewn anastomosis (OR = 0.44, P < 0.00001). Stapledclosure required a shorter inpatient stay (mean differ-ence 1.22, P < 0.0001) and operating time (meandifference 11.21, P = 0.01). No significant differencewas noted between the two techniques in terms of anas-tomotic leakage, wound infection, overall complicationsor cost.Conclusion Stapled side-to-side anastomosis is associ-ated with fewer complications, especially SBO, thanhand sewn ileostomy closure by direct suture or resec-tion and anastomosis. It is quicker to perform and asso-ciated with fewer postoperative bowel obstructions.Keywords Loop ileostomy, closure, stapled, sutured,complications

Observational studies suggest an association between dietary fiber consumption and risk of stroke, but the results are inconclusive. The authors conducted a meta-analysis of prospective cohort studies to evaluate the relation between dietary fiber consumption and stroke risk and mortality. Relevant studies were identified by searching PubMed, Embase, and ISI Web of Science through February 2013. We included prospective studies that reported relative risks (RRs) with 95 % confidence intervals (CIs) for the association between dietary fiber consumption and stroke risk and mortality. Both fixed- and random-effects models were used to calculate the summary risk estimates. Eleven prospective studies involving 325,627 participants were included in the meta-analysis. The pooled RR of stroke for the highest compared with the lowest dietary fiber consumption was 0.83 (95 % CI 0.74, 0.93). In addition, the increment in dietary fiber consumption was associated with decreased stroke risk in a dose–response manner. Sensitivity analysis restricted to studies with control for conventional risk factors yielded similar results, and omission of any single study had little effect on the combined risk estimate. Moreover, there was a trend toward an inverse association between higher fiber consumption and stroke mortality (RR 0.85; 95 % CI 0.60, 1.20), although it is not significant. This meta-analysis indicated that dietary fiber consumption is inversely associated with stroke risk, and the effect is probably independent of conventional risk factors. Our results support recommendations for higher consumption of fiber-rich foods to prevent stroke.

Polymorphisms of PDGFRB, MMP-3, TIMP-2, RNF213, TGFB1, Raptor and eNOS genes have been associated with Moyamoya disease (MMD) separately in studies, but their interactions on MMD have never been evaluated in one study. This study enrolled 96 MMD patients and 96 controls to evaluate the contributions and interactions of these polymorphisms on MMD in Chinese Hans. After genotyping, five polymorphisms loci were deemed suitable for analysis, rs3828610 in PDGFRB, rs3025058 in MMP-3, rs8179090 in TIMP-2, rs112735431 and rs148731719 in RNF213. Interactions of different loci on MMD were evaluated by multifactor dimensionality reduction (MDR) method. Significantly higher frequencies of A allele and G/A genotype of rs112735431 in RNF213 were observed in MMD patients compared with controls (P=0.011; P=0.018, respectively). In the dominant model, G/A genotype of rs112735431 was associated with increased risk of MMD (P=0.018). A higher frequency of G allele and G/G genotype of rs148731719 in RNF213 gene in patient than control group (P0.001; P0.01, respectively) was also detected. No significant association between MMD and other three loci (P0.05) was detected. MDR analysis failed to detect any significant interaction among these five loci in the occurrence of MMD (P0.05), but the combination of three loci (rs112735431 in RNF213, rs3828610 in PDGFRB, rs3025058 in MMP-3) could have the maximum testing accuracy (57.29%) and cross-validation consistency (10/10). The results indicated that RNF213 rs112735431 and rs148731719 may exert a significant influence on MMD occurrence. Compared with this overwhelming effect, the influences of PDGFRB, MMP-3, and TIMP-2 on MMD may be unremarkable in Chinese Hans. There may be no prominent interaction among these five gene polymorphisms on the occurrence of MMD.

To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center.The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications.Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect.The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases.Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases.

There are some controversial results on the relationship between cerebral atherosclerosis and leukoaraiosis in the published papers, where cerebral atherosclerosis was often evaluated by ultrasonography, CTA or MRA. We analyzed data in which patients underwent both MRI and DSA to explore the above relationship in the aged people.Three hundred and thirty-three patients were enrolled in the study from the Nanjing Stroke Registry. They underwent both cerebral DSA and MRI. Age, sex, and vascular risk factors were collected. Atherosclerosis was scored from grade 0 to 4. Leukoaraiosis was scored from grade 0 to 3.Cerebral artery stenosis was not correlated with the presence of leukoaraiosis. There were no correlations between the number of cerebral moderately or more severely stenotic arteries and the severity of leukoaraiosis in periventricular, deep, or whole white matter (P = .747, .268, and .608, respectively). Old age (odds ratio = 1.103, P = .027) and hypertension (odds ratio = 2.748, P = .003) were correlated with leukoaraiosis in the periventricular white matter. Old age (odds ratio = 1.073, P = .031) and prior stroke (odds ratio = 2.678, P = .002) were correlated with leukoaraiosis in the deep white matter.No apparent correlation exists between cerebral artery stenosis and the presence and severity of leukoaraiosis.

Background: Hyperintense vessels (HVs) on fluid-attenuated inversion recovery (FLAIR) are frequently observed in acute ischemic stroke (AIS). The presence of HVs represents altered blood flow from collaterals distal to arterial occlusion or stenosis. This study aimed to evaluate the prognostic value of HVs in AIS. Methods: Fifty-four consecutive patients with acute middle cerebral artery occlusion were enrolled in the study. The location and extent of the HVs was determined by FLAIR. Clinical data were obtained and compared between patients with different grades of HVs. Additionally, the relationship between distal HVs and leptomeningeal collaterals (LMCs) was assessed using angiography. Results: HVs were observed in 41 (75.9%) of the 54 patients enrolled. The initial NIHSS score was lower (p < 0.001) and the infarction volume was smaller (p < 0.001) in patients with distal HVs. Adjusting of other factors, regression analysis revealed that distal HVs are an independent predictor of a favorable outcome at 90 days (p = 0.006; OR 0.049; 95% CI 0.006–0.420). Furthermore, the presence of distal HVs was correlated with the presence of LMCs. Conclusion: Distal HVs may be a marker for LMCs and act as a predictor of a favorable clinical outcome for patients with AIS.

Objective: To determine the procedural feasibility and safety of carotid angioplasty and stent placement of carotid artery dissection (CAD) patients who had failed antithrombotic therapy in acute dissection. Methods: A series of 33 con secutive patients (mean age, 40.21 years; 29 men and 4 women) who underwent angioplasty and stent placement for symptomatic carotid artery dissection (sCAD) from May 2005 to December 2010 in the Nanjing Stroke Registry Program (NSRP) was retrospectively reviewed. All the included patients had been diagnosed definitively based on catheter angiography, and had failed to respond to medical therapy during the course of initial hospital admission. The baseline and followed up data of these patients were collected and analyzed. Results: Of all the 33 included patients, 32 patients had achieved technical success without any intraoperative complications. Two patients manifested ipsilateral Horner sign on the next day after stenting, and one of them suffered from recurrence of transient ischaemic attack (TIA) during the course of follow up, but completely remission via antithrombotic therapy. Conclusion: Endovascular stenting is a feasible and safe therapeutic strategy of CAD patients who have failed medical therapy.

This study aimed to evaluate the efficacy and safety of stereotactic aspiration combined with subsequent thrombolysis in treating moderate thalamic hemorrhage (TH).A total of 105 patients with TH were nonrandomly assigned to the conservative treatment group (n = 60) or to the aspiration group (n = 45). Patients in the aspiration group were treated with stereotactic aspiration plus subsequent thrombolysis for removal for their hematomas.The 30-day mortality in the conservative group was significantly higher than that in the aspiration group (28.3% (17/60) vs. 11.2% (5/45), P = 0.032). The rank of the 30-day Glasgow outcome scale in the conservative group was significantly lower than that in the aspiration group (P = 0.041), and the mean 30-day National Institutes of Health Stroke Scale score of the survivors in the conservative group was significantly higher than that in the aspiration group (16.5 ± 4. 2 vs. 14.2 ± 3.9, P = 0.012). There were a greater reduction in TH volume in the aspiration group than in the conservative group from day 1 to day 3 (-0.24% and 39.28%, respectively, P0.0001) and from day 1 to day 7 (26.58% and 63.26%, respectively, P0.0001). The rank of 90-day Glasgow outcome scale was significantly lower in the conservative group than that in the aspiration group (P = 0.015). Eighteen of 60 patients (30.0%) had a favorable outcome in the conservative group, whereas 23 of 45 patients (51.1%) had a favorable outcome in the aspiration group, and this difference was significant (P = 0.028). The 90-day cumulative mortality rate in the conservative group was significantly higher than that in the aspiration group (33.3% (20/60)) vs. 15.6% (7/45), P = 0.039).Stereotactic aspiration plus subsequent thrombolysis is effective and safe for moderate TH.

Objective: The 5-lipoxygenase catalyzed formation of leukotriene lipid mediators is a mediator for inflammatory response in arteries. The present study investigated the relationship between atorvastatin and the 5-lipoxygenase pathway in an atherosclerotic rabbit model. Methods: Thirty male New Zealand White Rabbits were randomized into negative control, positive control and atorvastatin groups. At week 4, the rabbits were subjected to carotid balloon-dilation injury or carotid balloon-dilation injury, followed by treatment with atorvastatin. At week 12, all the animals were sacrificed. Plasma lipids, LTD4, and 15-epi-lipoxin A4 were measured using the enzymatic endpoint method and ELISA, respectively. RT-PCR was performed to detect the gene expression of 5-lipoxygenase-activating protein and cysLT1R in rabbit carotid arteries. Finally, histological analysis was used to evaluate the pathophysiological changes of rabbit carotid arteries. Results: The results showed atorvastatin markedly lowered serum lipids and LTD4 levels compared with the control group. Similarly, mRNA expression of 5-lipoxygenase-activating protein and cysLT1R was significantly inhibited by atorvastatin. Decreased carotid plaque instability was evident in atorvastatin-treated animals, as demonstrated by a thickened elastic layer, less neointima hyperplasia and macrophage proliferation. Conclusions: Atorvastatin may stabilize carotid plaque by regulating the 5-lipoxygenase pathway in atherosclerotic rabbits and delay the progression of atherosclerosis by exerting anti-inflammatory effects.

Background Matrix metalloproteinases (MMPs) play important roles in the development and destabilization of atherosclerotic plaques. It is known that montelukast inhibits neointimal hyperplasia. However, the underlying mechanisms for the inhibitory effects of montelukast on neointimal formation have been poorly defined. Methods Thirty-six male New Zealand White rabbits were randomized as normal control, placebo (0.9% NaCl, 1.5 ml/kg/day, via intraperitoneal injection), atorvastatin (atorvastatin, 1.5 mg/kg/day, orally) and montelukast groups (montelukast, 1.5 mg/kg/day, via intraperitoneal injection). Atherosclerosis was induced by balloon-injury and high-cholesterol (HC) diet. Serum lipids were measured at 0, 8 and 12 weeks. After 12 weeks, the rabbits were sacrificed and histopathological changes examined. Immunohistochemistry and reverse transcription-polymerase chain reaction were used to measure the expression of MMP-2 and MMP-9 in the plaques. Results It was found that montelukast reduced neointimal formation, decreased macrophage accumulation, and increased smooth muscle cells. It also attenuated the expression of MMP-2 and MMP-9 in atherosclerotic plaques, but it had no effect on plasma lipid levels. Conclusion These data indicate that montelukast inhibits neointimal hyperplasia in association with decreased expression of MMP-2 and MMP-9 independent of plasma lipid levels in atherosclerotic plaques after vascular injury in hyperlipidemic rabbits.

Mild cognitive impairment (MCI) is a prodrome for dementia. Alcohol drinking patterns may affect cognitive functions and the effects may accumulate to a significant level at an advanced age. This study investigated the relationship between alcohol consumption and risks for dementia in a cohort of elderly patients with MCI.Patients with suspected cognitive impairment were screened. One hundred and seventy-six patients who met the MCI criteria were enrolled. Lifetime and daily alcohol consumptions were assessed at baseline using a self-report questionnaire answered by patients and their caregivers. Patients were classified according to alcohol consumptions as abstainers, light-moderate and heavy drinkers. Global cognitive functions were assessed periodically with Mini-Mental State Examination (MMSE). Enrolled patients were followed for 2 years.Of the 176 patients diagnosed as having MCI, 15 (8.5%) died, 13 (7.4%) were lost to follow up, and 66 (37.5%) developed dementia during follow up. Light-moderate alcohol drinkers had better MMSE performance than abstainers (P0.05) and heavy drinkers (P0.01) 2 years after MCI diagnosis. Patients who consumed a total ofor=300 kg alcohol prior to MCI diagnosis had less cognitive decline than patients who consumed no (P0.05) or300 kg alcohol (P0.01). Heavy drinkers had a higher risk for dementia than abstainers (P0.05) and light-moderate drinkers (P0.05) 2 years after MCI diagnosis.A J-shaped relationship may exist between alcohol consumption and cognitive decline in MCI patients. Light-moderate alcohol drinking may be associated with decreased risks for dementia in elderly patients with MCI.

Background The effect of neurotrophic factors in enhancing stroke-induced neurogenesis in the adult subventricular zone (SVZ) is limited by their poor blood-brain barrier (BBB) permeability. Intranasal administration is a noninvasive and valid method for delivery of neuropeptides into the brain, to bypass the BBB. We investigated the effect of treatment with intranasal transforming growth factor-β1 (TGF-β1) on neurogenesis in the adult mouse SVZ following focal ischemia. The modified Neurological Severity Scores (NSS) test was used to evaluate neurological function, and infarct volumes were determined from hematoxylin-stained sections. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) labeling was performed at 7 days after middle cerebral artery occlusion (MCAO). Immunohistochemistry was used to detect bromodeoxyuridine (BrdU) and neuron- or glia-specific markers for identifying neurogenesis in the SVZ at 7, 14, 21, 28 days after MCAO. Results Intranasal treatment of TGF-β1 shows significant improvement in neurological function and reduction of infarct volume compared with control animals. TGF-β1 treated mice had significantly less TUNEL-positive cells in the ipsilateral striatum than that in control groups. The number of BrdU-incorporated cells in the SVZ and striatum was significantly increased in the TGF-β1 treated group compared with control animals at each time point. In addition, numbers of BrdU- labeled cells coexpressed with the migrating neuroblast marker doublecortin (DCX) and the mature neuronal marker neuronal nuclei (NeuN) were significantly increased after intranasal delivery of TGF-β1, while only a few BrdU labeled cells co-stained with glial fibrillary acidic protein (GFAP). Conclusion Intranasal administration of TGF-β1 reduces infarct volume, improves functional recovery and enhances neurogenesis in mice after stroke. Intranasal TGF-β1 may have therapeutic potential for cerebrovascular disorders.

The aim of this study was to assess extra-and intracranial arterial stenosis in first-ever stroke patients and to analyse the relationship between arterial stenosis and the Oxfordshire Community Stroke Project (OCSP) classification. Chinese patients ( n = 817) were classified according to OCSP criteria, and arterial abnormalities were evaluated in 342 of the patients by digital subtraction angiography. Prevalence of significant stenosis in the extracranial internal carotid artery was highest among total anterior circulation infarct patients and lowest among patients with lacunar infarct. There was no evidence that the frequency of patients with intracranial arterial significant stenosis was different among OCSP subtypes. The results suggest that extracranial internal carotid artery stenosis was significantly related to OCSP subtype and that patients with total anterior circulation infarct were more likely to have extracranial internal carotid artery stenosis than patients having partial anterior circulation infarct, posterior circulation infarct or lacunar infarct.

This study evaluated the safety and efficacy of batroxobin in treating hyperfibrinogenemia for secondary stroke prevention. Patients with ischemic stroke or transient ischemic attack (TIA) were measured for plasma fibrinogen levels. Selected participants had concomitant hyperfibrinogenemia (plasma fibrinogenor = 3.0 g/l). Patients enrolled between 1 July 2003 and 31 December 2004 were treated with batroxobin; patients enrolled between 1 January 2002 and 30 June 2003 were treated without batroxobin. Batroxobin was administered intermittently via intravenous injection at 3-monthly intervals. Patients in both groups were followed for 1 year. Any cerebrovascular events and suspected adverse events were recorded. In total, 112 ischemic stroke/TIA patients with concomitant hyperfibrinogenemia were enrolled, 52 being treated with batroxobin and 60 without batroxobin. Six patients (11.5%) with batroxobin and 16 patients (26.7%) without batroxobin had recurrent cerebral ischemic events during follow-up. Stroke/TIA recurrence in patients without batroxobin was higher than that in patients with batroxobin (P0.05). Two patients with batroxobin and two patients without batroxobin developed hemorrhagic stroke during follow-up. There were five deaths (9.6%) in the batroxobin group, and seven deaths (11.7%) in the nonbatroxobin group during follow-up (P0.05). Intermittent intravenous injection of batroxobin can efficiently reduce the risk for stroke/TIA recurrence in patients with concomitant hyperfibrinogenemia.

Background Low socioeconomic status (SES) is associated with increased mortality after stroke in developed countries. This study was performed to determine whether a similar association also exists in China. Methods A total of 806 patients with first-ever ischemic stroke were enrolled in our study. From August 1999 to August 2005, the three-year all-cause mortality following the stroke was determined. Level of education, occupation, taxable income and housing space were used as indicators for SES. Stepwise univariate and multivariate COX proportional hazards models were used to study the association between the SES measures and the three-year mortality. Results Our analyses confirmed that occupation, taxable income and housing space were significantly associated with three-year mortality after first-ever stroke. Manual workers had a significant hazard ratio of 5.44 (95% CI 2.75 to 10.77) for death within three years when compared with non-manual workers. Those in the zero income group had a significant hazard ratio of 5.35 (95% CI 2.95 to 9.70) and those in the intermediate income group 2.10 (95% CI 1.24 to 3.58) when compared with those in the highest income group. Those in two of the three groups with the smallest housing space also had significant hazard ratios of 2.06 (95% CI 1.16 to 3.65) and 1.68 (95% CI 1.12 to 2.52) when compared with those in group with the largest housing space. These hazard ratios remained largely unchanged after multivariate adjustment for age, gender, baseline cardiovascular disease risk factors, and stroke severity. The analyses did not confirm an association with educational level. Conclusion Lower SES has a negative impact on the outcome of first-ever stroke in Nanjing, China. This confirms the need to improve preventive and secondary care for stroke among low SES groups.

Background: Morbidity and mortality of stroke have been investigated extensively in Western populations, while data concerning case fatality and cause of death after stroke are very limited in mainland China. This study aimed to analyze the 1-year survival and predictors of case fatality in Chinese patients with first-ever stroke. Methods: Subjects are patients registered in the Nanjing Stroke Registry Program. Information concerning cardiovascular risk factors and stroke characteristics were collected, and patients were followed after registration. Ischemic strokes were classified according to TOAST criteria as large-artery atherosclerosis (LAA), cardiac embolism stroke (CES), small-vessel stroke (SVS), or other determined and undetermined causes (UND). One-year case fatality was analyzed by the Kaplan-Meier method, and predictors of case fatality were evaluated by the Cox proportional hazards model. Results: A total of 752 patients with first-ever stroke were included, of which 142 (18.9%) were identified as intracerebral hemorrhage (ICH), 120 (16.0%) as LAA, 123 (16.4%) as SVS, 160 (21.3%) as CES and 216 (28.7%) as UND. The overall survival rate was 86.4% at the end of the 1-year follow-up. Patients with SVS have the highest survival rate (92.7%), followed by UND (89.4%), CES (88.1%) and LAA (84.2%). Patients with ICH have the lowest survival rate (76.8%). Survival rates of patients with different subtypes of stroke presented a significant difference (χ2 = 19.3, p < 0.001). For patients deceased during the first year after the index stroke, 33.3% of deaths were caused by the first stroke, 18.6% by recurrent stroke, 16.7% by cardiovascular comorbidities, 14.7% by nonvascular conditions and 16.7% died of undetermined causes. Advanced age, hypertension, hyperlipidemia, diabetes mellitus (DM), atrial fibrillation (AF), history of transient ischemic attack and cigarette smoking were associated with an increased risk of death 1 year after stroke. Conclusions: The case fatality rate and predictors for mortality of Chinese patients with first-ever stroke are similar to those reported for other populations. The significant influence of cardiovascular disease on the first-year survival rate emphasizes the importance of acute stroke management and control of hypertension, DM, AF and other predictors for decreasing case fatality and improving prognosis.