Alterações na cinemática da marcha hemiparética: um estudo comparativo / Changes in the kinematics of hemiparetic gait: a comparative study

O objetivo principal deste estudo foi analisar as alterações da marcha de adultos com hemiparesia após acidente vascular encefálico (AVE) e comparar com sujeitos saudáveis. A amostra foi composta por 14 participantes do grupo AVE e 14 participantes pareados do grupo-controle (CON). Foi realizada uma análise tridimensional da marcha mediante um sistema de cinemetria. Os parâmetros analisados foram a velocidade, o comprimento da passada, a largura da passada, a cadência e o tempo da passada, sendo utilizado o teste t independente para as comparações entre os grupos e considerando p < 0,05 como critério de decisão. Os participantes do grupo AVE apresentaram valores médios significantemente inferiores em todos os parâmetros analisados. Além disso, os pacientes do grupo AVE também tiveram valores muito inferiores quando comparados aos de outros estudos com pacientes pós-AVE, possivelmente devido ao curto período entre o AVE (média de 14,14 meses) e a avaliação da marcha.

The main objective of this study was to analyze the gait alterations of adults with hemiparesis after cerebrovascular accident (CVA) and compare it with healthy subjects. The sample consisted of 14 participants from the stroke group and 14 matched participants from the control group (CON). A three-dimensional gait analysis was performed using a kinemetry system. The parameters analyzed were velocity, stride length, stride width, cadence, and stride time, using the independent t test for comparisons between groups and considering p < 0.05 as a decision criterion. Participants in the stroke group had significantly lower mean values in all analyzed parameters. In addition, patients in the CVA group also had much lower values when compared to other studies with post-CVA patients, possibly due to the short period between the CVA (mean of 14.14 months) and the gait assessment.

Investigation of the risk assessment ,prevention and management for perioperative stroke in elderly patients with hip fractures / 中华老年医学杂志

Objective To investigate the risk assessment ,prevention and management for perioperative stroke in elderly patients with hip fractures. Methods A total of 179 patients aged 65 years and older were admitted to our department due to hip fracture. In managements of perioperative stroke ,the preoperative risk assessment and the management of stroke ,identifying the risk population for stroke prevention ,controlling risk factors of the preoperative stroke ,intraoperative monitoring , postoperative treatment ,etc.were studied retrospectively.The incidence of perioperative stroke was recorded and analyzed. Results Of 179 patients with hip fracture ,overviews of diagnosis and treatment were as follows.Twenty-four (24/179 ,13.41% ) cases did not receive operative treatments.Head and neck CT angiography(CTA)-showed severe stenosis or occlusion of intracranial artery and internal carotid artery were in 9(5.03% ,9/179)patients ,of whom the 5(2.79% ,5/179) cases underwent cerebrovascular digital subtraction angiography (DSA ) ,balloon dilation and stent implantation ,then received the operation for hip fracture 10 days later ,finally were discharged uneventfully.1 (0.56% ,1/179 ) patient underwent orthopaedic surgery due to the results of DSA showing no indication of interventional therapy ,and was discharged unevenfully.3 (1.68% ,3/179 ) patients refused to receive the further DSA examination or interventional therapy ,strongly demanded for orthopaedic surgery and would take the surgical risk ,and were discharged uneventfully.2(1.12% , 2/179)patients were found to have cerebral aneurysm diagnosed by CTA and DSA ,and underwent surgery for hipfracture without special treatment.2(1.12% ,2/179)patients were diagnosed as new occurrence of cerebral infarction before the operation ,and received head and carotid stenting at the department of cerebrovascular surgery ,followed by combined antithrombotic therapy of aspirin , clopidogrel and low molecular weight heparin for 4 weeks ,then underwent orthopaedic surgery for hip fracture.2 (1.12% ,2/179 ) patients were diagnosed as new cerebral infarction after orthopaedic surgery ,then were transferred to the department of neurology for treatment. Conclusions The thorough preoperative risk assessment and management of stroke ,reasonable perioperative antiplatelet and anticoagulation therapy ,intense intraoperative monitoring and active postoperative complications management make it possible for high-risk and new ischemic stroke patients with hip fractures to receive early orthopaedic treatment.

Combination Cell Therapy with Mesenchymal Stem Cells and Neural Stem Cells for Brain Stroke in Rats

OBJECTIVES: Brain stroke is the second most important events that lead to disability and morbidity these days. Although, stroke is important, there is no treatment for curing this problem. Nowadays, cell therapy has opened a new window for treating central nervous system disease. In some previous studies the Mesenchymal stem cells and neural stem cells. In this study, we have designed an experiment to assess the combination cell therapy (Mesenchymal and Neural stem cells) effects on brain stroke. METHOD AND MATERIALS: The Mesenchymal stem cells were isolated from adult rat bone marrow and the neural stem cells were isolated from ganglion eminence of rat embryo 14 days. The Mesenchymal stem cells were injected 1 day after middle cerebral artery occlusion (MCAO) and the neural stem cells transplanted 7 day after MCAO. After 28 days, the neurological outcomes and brain lesion volumes were evaluated. Also, the activity of Caspase 3 was assessed in different groups. RESULT: The group which received combination cell therapy had better neurological examination and less brain lesion. Also the combination cell therapy group had the least Caspase 3 activity among the groups. CONCLUSIONS: The combination cell therapy is more effective than Mesenchymal stem cell therapy and neural stem cell therapy separately in treating the brain stroke in rats.

A Novel Cell Therapy Method for Recovering after Brain Stroke in Rats

BACKGROUND: Nowadays, stroke leads to a significant part of the adult mortality and morbidity and also it could result in some neurological deficits in the patients' lives. Cell therapy has opened a new approach to treat the brain ischemia and reduce its terrible effects on the patients' lives. There are several articles which show that the cell therapy could be beneficial for treating brain stroke. In this study, we have planned to present a new cell therapy method for stroke by administration of Mesenchymal stem cells and differentiated neural stem cells without astrocytes. METHOD AND MATERIALS: The Mesenchymal stem cells were isolated from tibia and femur of a 250~300 g rat and they were cultured in DMEM/F12, 10% fetal bovine serum, 1% Pen/Strep. Neural stem cells were isolated from 14 days rat embryo ganglion eminence and were cultured in NSA media containing Neurobasal, 2% B27, bFGF 10 ng/ml and EGF 20 ng/ml after 5 days they formed some neurospheres. The isolated neural stem cells were differentiated to neural lineages by adding 5% fetal bovine serum to their culture media. After 48 hours the astrocytes were depleted by using MACS kit. RESULTS: The group that received Mesenchymal stem cells systemically and differentiated neural stem cells without astrocytes had the best neurological outcomes and the least infarct volume and apoptosis. It could be understood that this cell therapy method might cause almost full recovery after brain stoke. CONCLUSION: Using combination cell therapy with Mesenchymal stem cells and differentiated neural stem cells with removed astrocyte could provide a novel method for curing brain stroke.

Accidente vascular encefálico en recién nacidos de término y pretérmino tardíos / Brain strokes in late preterm and term newborns

Background: Brain strokes are uncommon in term and late preterm newborns. Nevertheless, they can appear and may be diagnosed when suspected. Appropriate diagnostic techniques, available nowadays, allow a better etiologic and therapeutic approach. Objective: To report late preterm and term newborns who presented an hemorrhagic or ischemic brain stroke. Methods: Retrospective analysis of clinical charts at the Neonatology Service of Clínica Las Condes, Santiago-Chile, between January 2001 and March 2008. Results: 0.07 percent (8/10639) of these newborns presented brain stroke; 6 hemorrhagic and 2 ischemic strokes. 2 cases were diagnosed as congenital thrombophylia. No deaths were found in this survey. Conclusions: No differences in frequency were found in relation to data reported. Seizures can be the first clinical manifestation; however, subtle forms must lead to diagnostic suspicion. Appropriate diagnostic techniques may allow an accurate diagnosis and integral therapeutic approach of these patients.

Introducción: Los Accidentes Vasculares Encefálicos (AVE) no constituyen un diagnóstico frecuente en el grupo de Recién Nacidos de término (RNT) y pretérmino tardíos (PTT). A pesar de esto, tampoco es una situación inusual y su diagnóstico dependerá en forma importante del grado de sospecha. El uso de las apropiadas técnicas diagnósticas ha permitido una mejor caracterización de estos eventos, lo que permite en ocasiones llegar a un diagnóstico etiológico con la consiguiente optimización en el manejo. Objetivo: Caracterizar el AVE en recién nacidos de término y pretérmino tardíos. Método: Análisis retrospectivo de la ficha clínica de los pacientes RNT y RNPTT con diagnóstico de AVE nacidos entre Enero del año 2001 a Marzo del año 2008 en el Servicio de Neonatología de la Clínica Las Condes, Santiago. Resultados: Se incluyeron 8 casos, lo que corresponde al 0,07 por ciento de la muestra estudiada (n= 10 639), 6 de ellos presentaron AVE hemorrágico y los 2 restantes se trataron de AVE isquémicos. En 2 casos de la serie se pesquisó trombofilia congénita. No hubo mortalidad asociada en los casos analizados. Conclusiones: La frecuencia fue similar a la de diferentes series anteriormente publicadas. La crisis convulsiva puede ser la primera manifestación clínica, pero hay otras manifestaciones clínicas más sutiles que pueden hacer sospechar el diagnóstico. El uso apropiado de las actuales técnicas diagnósticas puede llevar a un diagnóstico de certeza facilitando el manejo integral del paciente.

The principle and clinical application of diffusion-weighted MR imaging / 医学研究生学报

Different from conventional MRI, Diffusion-weighted(DW) magnetic resonance(MR)imaging is dependent on the molecular motion of water, and provides information on the physiologic state of the brain. In the diagnosis of acute cerebral infarction,the sensitivity is 94% and specificity is 100%. On MRDW imaging, the epidermoid tumors and cerebrospinal fluid or arachnoid cysts, subdura effusions and subdural empyemas,abscess cavities or empyemas and necrotic tumors could be differentiated accurately. MRDW imaging also provides adjunctive information for the diagnosis and evaluation of other cerebral diseases including neoplasms, intracranial infections, traumatic brain injury, and demyelinating processes. As a valuable technique, diffusion-weighted MR imaging should be considered an essential sequence on the diagnosis of brain stroke, and its use in most brain MR studies is recommended.

The Cognitive Function in the Elders with First Acute Ischemic Stroke / 中国医师杂志

Objective To investigate the change of cognitive function in the elders with first acute ischemic brain stroke.Methods The cognitive function was determined using senile cognitive function(SECF) scale in 110 senile patients with first ischemic brain stroke and 60 healthy elders.According to different sites of cerebral infarction identified by CT imaging,their cognitive functions were compared,respectively.Results The cognitive function obviously decayed in the elders after the first acute ischemic stroke and had the relation with age and site of the infarction.Conclusion The elders with first ischemic stroke have obvious disorder of cognitive function and could directly influence the recoveries of the patients.So,the therapy should include both somatic and cognitive function treatment.

Comparison of ADC Map with Trace Map in the Normal and Infarct Areas of the Brains of Stro ke Patients

PURPOSE: To compare ADC mapping with trace mapping in normal and infarct areas of the brains of strokepatients. MATERIALS AND METHODS: Eighteen patients diagnosed on the basis of clinical and brain MRI examinationsas suffering from brain infarction were included in this study (hyperacute-1, acute-4, subacute-12, chronic-1).Diffusion weighted images of three orthogonal directions of a patient's brain were obtained by means of a singleshot EPI pulse sequence, using a diffusion gradient with four serial b-factors. Three ADC maps were thenreconstructed by post-image processing and were summed pixel by pixel to yield a trace map. ROIs were selected inthe normal areas of white matter, gray matter and CSF of one hemisphere, and other ROIs of the same size wereselected at the same site of the contralateral hemisphere. ADC and trace values were measured and right/leftratios of ADC and trace values were calculated. Using these values, we then compared the ADC map with the tracemap, and compared the degree of anisotropic diffusion between white matter, gray matter and CSF. Except for three,whose infarct lesions were small and lay over white and gray matter, patients were divided into two groups. Thosewith infarct in the white matter (n=10)were assigned to one group, and those with in-farct in the gray matter(n=5) to the other. ROIs were selected in the infarct area and other ROIs of the same size were selected at thesame site of the contralateral hemisphere. ADC and trace values were measured and infarct/contralateral ratioswere calculated. We then compared ADC ratio with trace ratio in white matter and gray matter infarct. RESULTS: Innormal white matter, the Dxx ratio was 0.980 +/-0.098, the Dyy ratio 1.019 +/-0.086, the Dzz ratio 0.999 +/-0.111,and the trace ratio 0.995 +/-0.031. In normal gray matter, the Dxx ratio was 1.001 +/-0 . 0 5 8 , the Dyy ratio0.996 +/-0.063, Dzz ratio 1.005 +/-0.070, and the trace ratio 1.001 +/-0.028. In CSF, the Dxx ratio was 1.002+/-0.064, the Dyy ratio 1.023 +/-0.055, the Dzz ratio 0.999 +/-0.060 and the trace ratio 1.007 +/-0 . 0 2 1. Becausethe standard deviation of trace ratios (0.05), the trace ratio is moreaccurate representative value. The standard deviation of white matter is greater than that of gray matter or CSF(p<0.05), the degree of anisotropic diffusion in white matter is therefore more severe than in gray matter andCSF. The difference between the ADC ratios and trace ratio is greater in an infarct involving white matter than inone involving gray matter (p<0.05). CONCLUSION: Because a trace map overcomes the anisotropic diffusions of ADCmaps, the former offers better post-image processing. The deviation of ADC ratios owing to the direction ofdiffusion gradient is greater in white matter than in gray matter, and the trace map is thus superior forevaluation of an infarct involving white matter.

Measure or RBC-GSH and Plasma MDA in Brain Stroke / 临床神经病学杂志

The authors have studied the changes in the concentration of glutathione of the red blood cell (RBC-GSH) and plasma malondialdehyde (MDA) in 54 patients with acute brain stroke. The results indicated that the concentration of RBC-GSH reduced obviously and that of plasma MDA increased markedly within 72 hours after illness. However, there is no obvious difference between the cases of hemorrhagic cerebrovascular diseases and cerebral infarction group. The RBC-GSH level rised again in the 7th day, while the plasma MDA still remained higher level, they were normal during the convalescent period. The pathological basis of the change may be the response of the free radicals in human body.

Risk factors of ischemic brain stroke in Korean diabetic patients: a retrospective study

In order to investigate the risk factors of ischemic brain stroke (IBS) in diabetic patients, we analyzed 416 cases selected from 6239 diabetic patients admitted to Severance Hospital from Jan. 1983 to Dec 1987. Two hundred and eight cases had IBS. The other 208 cases without IBS were selected as a control group by a stratified random sampling method. The two groups were compared using various clinical characteristics of diabetes mellitus (DM) and known risk factors of IBS. In diabetics with IBS, the duration of DM was longer (9.2 +/- 7.1 years), hypertension was more frequently associated (68.2%) and the serum cholesterol level was higher (213.0 +/- 55.2 mg/dl) than in diabetics without IBS (7.6 +/- 7.1 years, 32.1% and 192.1 +/- 44.8 mg/dl, respectively). By means of Stepwise Logistic Regression Analysis (SLRA), it was found that the strong risk factors were hypertension and serum cholesterol level. The serum triglyceride level, type of DM and response to diabetes treatment were also thought to be risk factors of IBS by the retrial of SLRA of residuals after exclusion of hypertension and serum cholesterol level. IBS was not significantly related to the duration of DM, fasting blood glucose level, body weight, glycosylated hemoglobin value, and serum high-density lipoprotein-cholesterol level.

Risk factors of ischemic brain stroke in Korean diabetic patients: a retrospective study

In order to investigate the risk factors of ischemic brain stroke (IBS) in diabetic patients, we analyzed 416 cases selected from 6239 diabetic patients admitted to Severance Hospital from Jan. 1983 to Dec 1987. Two hundred and eight cases had IBS. The other 208 cases without IBS were selected as a control group by a stratified random sampling method. The two groups were compared using various clinical characteristics of diabetes mellitus (DM) and known risk factors of IBS. In diabetics with IBS, the duration of DM was longer (9.2 +/- 7.1 years), hypertension was more frequently associated (68.2%) and the serum cholesterol level was higher (213.0 +/- 55.2 mg/dl) than in diabetics without IBS (7.6 +/- 7.1 years, 32.1% and 192.1 +/- 44.8 mg/dl, respectively). By means of Stepwise Logistic Regression Analysis (SLRA), it was found that the strong risk factors were hypertension and serum cholesterol level. The serum triglyceride level, type of DM and response to diabetes treatment were also thought to be risk factors of IBS by the retrial of SLRA of residuals after exclusion of hypertension and serum cholesterol level. IBS was not significantly related to the duration of DM, fasting blood glucose level, body weight, glycosylated hemoglobin value, and serum high-density lipoprotein-cholesterol level.