[Age features of pure leukoaraiosis in non-demented outpatients].

OBJECTIVE: To investigate the aging features of pure leukoaraiosis (LA) in non-demented outpatients. METHODS: The outpatients with age older than 40 years, without taking cholesterol lowering and B vitamin medications and with mini-mental state examination more than 24 scores were selected from July 2008 to December. 2009 in Beijing Tiantan Hospital. LA was defined with MRI. Patients were classified into two groups i.e. LA group consisting of 138 patients with leukoaraiosis but without lacunar lesions and cortical infarcts and a control group consisting of 124 patients without any lesion in brain. Age and other vascular risk factors were also investigated. RESULTS: Age of the patients in the LA group was significantly higher than that in the control group (P<0.001). Multivariable logistic regression analysis showed that age was independently associated with pure LA (OR 1.080, 95%CI 1.042-1.120), after adjusting sex, vascular risk factors and presence of atherosclerosis in cervical arteries. If age-stratification was further considered, logistic regression analysis showed that OR (95%CI) for LA was 2.693 (95%CI 1.103-6.575) in a 60-69 year group and 13.527 (95%CI 3.319-55.131) in a ≥70 year group as compared with a 40-49 year group. CONCLUSION: Age is a determining risk factor for pure LA and patients with age older than 60 years are at high risk of LA.

[Effects of probucol, aspirin and atorvastatin combination therapy upon atherosclerosis].

OBJECTIVE: To investigate the effects of probucol, aspirin and atorvastatin (PAS) combination therapy upon atherosclerosis. METHODS: A total of 436 patients with coronary artery disease were selected and randomly divided into control group (aspirin 100 mg, atorvastatin 10 mg daily) and PAS group (aspirin 100 mg, atorvastatin 10 mg and probucol 0.25 g daily). After a 1-year treatment course, 378 cases remained in the study (201 in control group vs. 177 in PAS group). These patients were followed for throughout the study course and their serum levels of high density lipoprotein (HDL), ox-LDL, TXB2 and MMP-9 were measured at 6 and 12 months respectively. Twenty cases were diagnosed with carotid artery plaque by carotid ultrasound and 16 cases remained in the PAS group. They were followed with ultrasound for plaque thickness. RESULTS: In the control group, the pre-treatment level of MMPs and ox-LDL were not statistically different from the post-treatment level (P > 0.05). In the PAS group, the pre-treatment level of ox-LDL was (23.46 +/- 0.01) mmol/L and the post-treatment level (16.13 +/- 0.02) mmol/L. There was a decrease of 31.7% (P < 0.05). The pre-treatment level of MMPs and MMP-9 in the control group was not statistically different from the post-treatment level. The pre-treatment level of MMP-9 in the PAS group was (7.15 +/- 0.01) mmol/L and the post-treatment level (4.19 +/- 0.02) mmol/L. There was a decrease of 42.4% (P < 0.05). During the course of follow-up, the hospitalization rate, angina recurrence rate, myocardial infarction rate and mortality rate for the control group were 23 (11.4%), 28 (13.9%), 4 (2.0%) and 2 (1.0%) respectively. In the PAS group, the corresponding values were 6 (3.4%), 13 (7.3%), 1 (0.6%) and 0 respectively. All parameters of adverse events showed a significant decrease in the PAS group (P < 0.05). Among the cases with carotid plaque, the pretreatment measurements of intima thickness and plaque thickness were (0.103 +/- 0.002) cm and (0.248 +/- 0.001) cm while the post-treatment corresponding measurements (0.097 +/- 0.001) cm and (0.209 +/- 0.002) cm respectively. There was a significant difference between the PAS group and the control group (P < 0.05). CONCLUSION: Antioxidant probucol significantly inhibits the generation of ox-LDL and MMP-9. PAS therapy also reduces the plaque thickness and decreases the rate of adverse event in patients with atherosclerosis. Antioxidants can be considered as a new adjunct therapy in the treatment of atherosclerosis.

[Role of probiotics in the prevention of neonatal necrotizing enterocolitis: A case-control study].

OBJECTIVE: To assess the role of probiotics in the prevention of neonatal necrotizing enterocolitis (NEC) and to investigate the risk factors for NEC. METHODS: A total of 2528 hospitalized neonates between January 2002 and May 2005 were assigned into either receiving prophylactic use of probiotics bifoco (Prevention group, n=1182) or without probiotics supplementation (Control group, n = 1346). The incidence of NEC was compared between the two groups. The risk factors for NEC were investigated by conditional logistic regression multifactorial analysis. RESULTS: There were 19 cases of NEC in the Control group (1.41%), but only 6 cases in the Prevention group (0.51%) (P < 0.05). Gestational age (OR = 5.521), hypoxicdouble ended arrowischemic encephalopathy (OR = 3.887), specticemia (OR = 4.854) and critical illness scores (OR = 5.989) were the risk factors for NEC, while the prophylactic use of probiotics was an independent protective factor for NEC (OR = 0.255). CONCLUSIONS: The prophylactic use of probiotics may reduce the incidence of NEC in neonates.

[TOAST subtyping of acute ischemic stroke].

OBJECTIVE: To determine the etiological characteristics of ischemic stroke in Chinese people on the basis of Trial of Org 10 172 in Acute Stroke Treatment (TOAST) criteria. METHODS: 300 patients with ischemic stroke were recruited into this study. Ischemic stroke was classified into five subtypes based on clinical manifestations, MRI, MRA and DSA. RESULTS: Of all the ischemic stroke patients, 12.3%, 40.0%, 31.3%, 5.0%, and 11.4% were classified as cardio embolism, large-artery atherosclerotic, lacunare, of other demonstrated etiology and of undetermined etiology. CONCLUSIONS: The statistical comparison between male and female of each subtype is not significant. The relative incidence of large-artery atherosclerosis in Chinese patients is higher than that of all the other four subtypes.

[Biodiv Ysio stent for symptomatic stenosis of middle cerebral artery].

OBJECTIVE: To assess the safety and feasibility of Biodiv Ysio stent for patients with symptomatic M1 stenosis of middle cerebral artery (MCA). METHODS: Forty-three patients with forty-five M1 stenoses, ranged from 50% to 99% in diameter reduction and refractory to medical therapy, were enrolled in this study between March 2002 and November 2003. The lesions were situated at M1 trunk (n = 19), M1 origin (n = 12) and M1 bifurcation (n = 14), respectively. RESULTS: The technical successful rate was 97.8% (44/45) for all the lesions. The rate of complicating subarachnoid hemorrhage was 7.0% (3/43 patients) and the rate of death was 2.3%. During a follow-up of 7.0 months (median), there was no recurrence of transient ischemic attack or stroke in 41 available patients. Six-month angiographic follow-up was obtained in 6 patients (7 vessels), demonstrating good patency in 6 stenting vessels and restenosis in one vessel. CONCLUSIONS: Angioplasty associated with Biodiv Ysio stent appears to be a safe and feasible for the patients with symptomatic M1 stenosis of MCA, under strict control of periperformeral project. Further study is, however needed.

Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients.

OBJECTIVE: To assess the safety and clinical efficacy of stenting for patients with symptomatic M1 stenosis of middle cerebral artery (MCA), and to assess the significance of classification based on location, morphology, and access of intracranial stenosis (LMA classification) in MCA stenting. METHODS: Forty patients with 42 symptomatic M1 stenoses refractory to medical therapy were enrolled in this study. The lesions were situated at M1 trunk (n=13), M1 origin (n=12), and M1 bifurcation (n=17), respectively, which were classified into type N (nonbifurcation lesions, n=13) and type A (prebifurcation, n=11), B (postbifurcation, n=14), C (lesion across the nonstenotic ostium of its branch, n=1), D (across the stenotic ostium of its branch, n=2), F (combinative lesions of prebifurcation and its small branch ostium, n=1) locations, morphologically into type A (n=15), B (n=23) and C (n=4) lesions, and into type I (mild-to-moderate tortuosity and smooth access, n=17), II (severe tortuosity and/or irregular arterial wall, n=18), and III (excessively severe tortuosity, n=7) accesses. RESULTS: The technical successful rate was 97.6% for total lesions and 100%, 100%, and 85.7% for types I, II, and III accesses, respectively. The total complication rate was 10%. The mortality was 2.5% (1/40 patients), and 0%, 0%, and 25% for types A, B, and C lesions, respectively. During the median 10 months follow-up, there was no recurrence of transient ischemic attack or stroke in 38 available patients. Among 8 stenting vessels of seven patients with six-month follow-up angiography, 7 showed good patency and one showed restenosis. CONCLUSIONS: Stenting appears to be an effective and feasible therapy for symptomatic M1 stenoses, but also appears to have the higher periprocedural complications, which need strict procedural and periprocedural management to reduce the mortality and morbidity. The LMA classification seems to be helpful to work out the individual therapy and predict the results of stenting. A further study is needed to confirm the benefits of stenting of MCA stenosis.

[Symptomatic intracranial artery stenosis: angiographic classifications and stent-assisted angioplasty].

OBJECTIVE: To assess the safety and efficacy of stent-assisted angioplasty (SAA) for symptomatic intracranial artery stenosis, and to evaluate preliminarily the significance of classification of location, morphology and access (LMA classification) of intracranial artery stenosis in SAA. METHODS: Forty-two patients with symptomatic intracranial artery stenosis (diameter reduction: 50% - 74%, n = 15; >or= 75%, n = 27), located in middle cerebral artery (n = 27), intracranial internal carotid artery (n = 4), intracranial vertebral artery (n = 7) and basilar artery (n = 4) respectively, refractory to medical therapy were enrolled in this study. RESULTS: LMA classification: 23 of the forty-two lesions (54.8%) located at the site of bifurcation, which were classified according to the location into type A (n = 8), B (n = 11), C (n = 2), D (n = 1) and F (n = 1) respectively. Type A, B and C lesions were 19, 19 and 4 respectively in the light of morphologic classification. Type I, II and III accesses were 15, 23 and 4 respectively in the light of access classification. TECHNIQUE: The technical successful rate of SAA was 95.2% (40/42) for the group overall, and 100% (15/15), 94.7% (22/23), and 75% (3/4) for type I, II, III accesses, respectively. The rate of periprocedural complication and death was 9.5% (4/42), including acute occlusion (n = 1) and high perfusion syndrome (n = 3). After emergency measures, 3 patients were cured completely, and the remaining one with severe MCA trunk stenosis of type C lesion died of subarachnoid hemorrhage (2.4%). During a clinical follow-up period ranging from 1 to 18 months (median 8 months), 39 patients receiving SAA have been still free from ischemic events. There was no restenosisfound angiographically 6 months (n = 7) and 12 months (n = 4) after SAA. CONCLUSIONS: Our results suggest that under rigorous control of procedural and periprocedural measures, SAA appears to be a safe and effective therapy for symptomatic intracranial stenoses of type A and B lesions, but it is not risk-free for type C lesions. The LMA classification is helpful for predicting the results of SAA and to design the procedure. However, further study is needed.