Publications (3)3.93 Total impact
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ABSTRACT: Leukoaraiosis (LA) is the increase in fluid in cerebral white matter with hyperintensity on T2-weighted MR imaging that occurs in 25% of individuals over 65 years of age and in Alzheimer's disease. Age, hypertension, diabetes mellitus and cardiac disease are the major risk factors for LA. Ischaemia is considered to be the cause of LA, but the aim of the present study is to assess whether changes in arterioles in LA could impede perivascular lymphatic drainage of interstitial fluid from the cerebral white matter. We quantified arteriolosclerosis and immunohistochemical changes in the extracellular matrix in arterioles of cerebral white matter in 20 hypertension autopsy cases with LA and in 10 controls. The ratio of the area immunoreactive for collagen types I, III, V and VI to the cross-sectional area of arterioles was significantly higher in LA patients compared with controls (P < 0.001). Changes were observed in collagen IV and laminin. The walls of white matter arterioles in LA were significantly thicker (P < 0.01), and lumina were significantly smaller (P < 0.01). Arterioles had a significantly higher sclerotic index [1 - (internal/external diameter)] in LA than in adjacent cortex or control white matter (P < 0.01). Our results show that thickening and sclerosis of the walls of arterioles in cerebral white matter in LA are associated with the accumulation of extracellular matrix components. Although these changes may result in decreased perfusion, they could also impede perivascular lymphatic drainage of interstitial fluid from white matter in LA.
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ABSTRACT: Objective: To observe the efficacy and safety of combined thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) and urokinase (UK) on patients with acute cerebral infarction. Method: Eighty-one patients with acute cerebral infarction (< 6 hours from onset) were recruited and randomly allocated into four groups: combined thrombolysis group (n = 20), rt-PA group (n = 22), UK group (n=18), and control group (n = 21). The patients in combined thrombolysis group received rt-PA 20 mg and UK 300 000 - 500 000 IU; the patients in rt-PA group received rt-PA 0.9 mg/kg intravenously; the patients in UK group received UK 10 000 - 20 000 IU/kg (patients with body weight > 75 kg received the same dose of medication as 75 kg), and the maximum dose of UK was 1 500 000 IU; the patients in the control group received to no thrombolytic drugs. The outcome score were evaluated according to the National Institute of Health Stroke Scale (NIHSS) before treatment and four weeks after symptom onset, and to evaluate hemorrhagic transformation, recurrent infarction, and death as the safety indicators. Results: 1Before treatment the NIHSS scores in the combined thrombolysis, rt-PA, UK, and control groups were 18.1 ± 3.6, 17.9 ± 3.6, 18.0 ± 3.4, and 17.3 ± 4.0, respectively, and after treatment they were 9.1 ± 5.6, 8.8 ± 5.5, 9.6 ± 5.2, and 14.1 ±4.6, respectively. There were significant differences in each group before and after treatment (P <0.01), and also between the 3 thrombolysis groups and the control group (P < 0.01); but there were no significant differences between each other of the 3 thrombolysis groups. 2The total effective rates in the 4 groups but were 85.0% (17/20), 86.4% (19/22), 83.3% (15/18), and 42.9% (9/21), respectively. As compared between the 3 thrombolysis groups with the control group, there were significant differences (P < 0.05); and there were no significant differences among the 3 thrombolysis groups (P >0. 05). 3One patient had new attack of cerebral infarction, and 1 patient had hemorrhagic transformation within 24 hours after thrombolytic therapy in the combined thrombolytic group; 3 patients had hemorrhagic transformation in the rt-PA group; 1 patient had new attack of cerebral infarction in the UK group; 2 patients had hemorrhagic transformation, and 1 of them died. One patient had new attack of cerebral infarction, and 1 patient was died in the control group. Conclusion: The combined thrombolytic therapy with low-dose rt-PA and UK for the treatment of acute cerebral infarction is safe and effective.
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ABSTRACT: Objective: To investigate the difference of the risk factors between male and female patients with cerebral infarction. Methods: A total of 1633 inpatients with acute cerebral infarction (female 640, male 993) aged 18-94 years old from 33 grade A class III hospitals in China in 2006 were analyzed retrospectively. A standardized questionnaire was designed, including demographic data (gender, age, residence, education and working state), past history and risk factors, etc. Results: 1 The proportion of inpatients with cerebral infarction in females and males was 1:1.55; the age of female patients was older than that of the males (66 ± 12 vs. 65 ± 12). 2 The incidence of cerebral infarction of male young adults(aged 18 to 45 years) was significantly higher than that in females, and they were 74.39% and 25.61% , respectively. In the other age periods the incidence of cerebral infarction in males was also higher than the females, but there were no significant differences (P > 0.05). 3 Most patients in both groups lived in urban areas. The educational level of most male patients with stroke was higher than that of most female patients, and there was significant difference (χ2 = 137.8, P = 0. 000). The prevalence rate of cerebral infarction in unemployed females were higher than males, but in the male retirees were higher than females, there was significant difference (χ2 = 124.2, P = 0. 000). 4 The risk factors for males were hypertension (60.8%), advanced age (41.7%), smoking (21.1%), and diabetes mellitus (20.1%), respectively; the risk factors for females were hypertension (63.9%), advanced age (44.4%), diabetes mellitus (24.4%), and heart disease (24.2%), respectively. The incidences of diabetes mellitus and heart disease in females were higher than those in males, while the incidences of atherosclerosis, smoking and alcohol consumption in males were higher than those in females, and there were significant differences (P < 0.05). 5 Multiple logistic regression analysis showed that smoking and alcohol consumption increased the risk of obesity (OR = 3. 059, 95% CI 1. 978 - 4. 731 and OR = 2. 330, 95% CI 1. 221 - 4.445, respectively). Conclusions: The prevalence rate of cerebral infarction in all age groups in males were higher than that in females. Hypertension was the primary risk factor of cerebral infarction in all patients. Smoking, alcohol consumption or coexistence of multiple risk factors may be the main cause of the high incidence of cerebral infarction in males, especially in young males. Females with lower educated level and professionless has higher incidence of cerebral infarction.
Third Military Medical UniversityCh’ung-ch’ing-shih, Chongqing Shi, China