Impaired Spatial Learning Memory after Isoflurane Anesthesia or Appendectomy in Aged Mice is Associated with Microglia Activation.

Postoperative cognitive dysfunction (POCD) has been one of the most common problems in elderly patients following surgery. But the specific mechanism of POCD is still not clear. To further understand the reason of these postoperative behavioral deficits, we evaluated the spatial learning memory of both adult (3 months) and aged (18 months) male mice, 3 or 28 days after isoflurane (Iso) exposure for two hours or appendectomy (App). Hippocampal microglia activation and IL-1ß, TNF-α, and IFN-γ expression were also evaluated at day 3, day 14 and day 28 after Iso exposure or appendectomy. Results showed that spatial learning memory of aged, but not adult, mice was impaired after Iso exposure or appendectomy, accompanied with more hippocampal microglia activation and IL-1ß, TNF-α, and IFN-γ overexpression. These findings suggest that the cognitive deficits of elderly patients who have undergone surgeries are quite possibly caused by hippocampal microglia overactivation and the subsequent inflammation.

Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry.

BACKGROUND: In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke. METHODS: From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke. RESULTS: There were 39 741 patients screened, 14 526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% (1826) had in-hospital medical complications. The most common complication was pneumonia (1373; 11.9% of patients), followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR = 6.946; 95%CI 5.181 to 9.314), at 3 months (adjusted OR = 3.843; 95%CI 3.221 to 4.584), 6 months (adjusted OR = 3.492; 95%CI 2.970 to 4.106), and 12 months (adjusted OR = 3.511; 95%CI 3.021 to 4.080). Having multiple complications strongly increased the death risk of patients. CONCLUSION: Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.

[A survey on cerebral infarction/transient ischemic attack inpatients compliance with secondary stroke prevention and follow-up 90 days].

OBJECTIVE: Poor compliance with evidence-based-medicine guidelines could significantly influence the effect of stroke prevention strategies. The objectives of this survey are to investigate the current status in Beijing of cerebral infarction/TIA (transient ischemic attack) inpatients' adherence to the evidence-based-medicine secondary prevention and behavior modifications both at the discharge and at 90-day follow up. METHODS: The survey included cerebral infarction/TIA patients successively admitted from 1, Oct 2006 to 1, May 2007, used ACEI/ARB, Statin, anti-platelet agents therapy, accepted carotid endarterctomy or angioplasty or stent, and modified behaviors to stop smoking and control weight. Data of patients during hospitalization were obtained from the medical documents in the inpatient department of 7 centers. The detailed information included the medicine therapy, lifestyle modifications, patients' social demographic background (age, sex, education and way of payment), major risk factors for stroke, and ischemic event subtypes (TIA or cerebral infarction). Above information of part of patients were collected through telephone interview at 90-day follow-up if the patients were not able to visit the clinic. RESULTS: 708 cerebral infarction/TIA inpatients who didn't have contraindications were included. Among them, the patents who haven't used anti-platelet agents, nor taken statin, nor accepted ACEI/ARB were about 0.4%, 41.8% and 63.6% respectively. Neither 27% of the patients have accepted the instructions on stop smoking. While about 588 patients suitable to drug therapy were followed up at 90 days, but the percentage of these patients who haven't compliance on anti-platelet agents, statin, ACEI/ARB was 26.9%, 52.6% and 59.4% respectively. Only 66.9% of the smoking patients have received the doctor instructions on smoking cessation. CONCLUSION: Stroke recurrence rate in China is higher than that of average figures in western countries. One of the key reasons of high recurrence of stroke in China is the poor adherence to stroke secondary prevention guidelines. Thus, investigate current status of secondary prevention among hospitals in capital of China and promote strategies to enhance the adherence to the guidelines and fill the gap between the clinical practice and evidence-based medicine in China, which is able to lower the stroke recurrence and save lives are urgently needed. Physician should take great care of the patient's compliances on the evidenced-based-medicine secondary prevents and behavior modifications, and take effective measures to improve the compliances.

[A study on drug compliance in secondary prevention of ischemic stroke].

OBJECTIVE: The aim of the present study is to determine the rate of compliance with secondary stroke prevention one year after ischemic stroke and to identify the reasons for poor compliance. METHODS: The proportion of patients compliant with prevention of risk factors (hypertension, diabetes, hyperlipidemia) was evaluated through structured telephone interviews. RESULTS: Of the consecutive patients admitted to the neurological department of Tiantan Hospital between Oct. 2002 and Apr. 2003, 374 patients were involved in this investigation and 296 (79.1%) were finally evaluated. In the 296 (79.1%) patients, the rate of antithrombotic drug compliance was 35.1%. Of the patients with hypertension, diabetes, and hyperlipidemia, 77.9%, 80.2%, and 48.4% were still treated for their respective risk factors. Influence factors for drug compliance, such as medical insurance and free medical care (OR 2.117, 95% CI 1.174-3.821) can promote the drug compliance in stroke patients, while the use of antithrombotic drugs other than aspirin (OR 0.352, 95% CI 0.153-0.812) and a lower living ability (62.5 +/- 13.3) (Mann-Whitney-P = 0.000) could decrease the drug compliance. CONCLUSIONS: Long-term compliance with secondary prevention in patients with ischemic stroke is poor in the setting of our study. Poor compliance with antithrombotic therapy such as incorrect discontinuation or change and reduction of dosage was noted. Means of payment, income levels, categories of antithrombotic drugs and personal living ability of patients are associated with compliance. Doctors should attach importance to secondary prevention and provide stroke patients detailed guidelines for the use of preventive drugs.

Assessment of the early effectiveness of a stroke unit in comparison to the general ward.

BACKGROUND: Stroke unit is the most effective treatment method to benefit stroke patients. Our study is to evaluate the early effectiveness of a hospital stroke unit (SU). METHODS: Three hundred and ninety-two patients who had suffered from acute strokes and who were admitted to our hospital between December 2001 and January 2003 were recruited for this controlled study. All patients were sent at random to either the SU or the general ward (GW) for treatment. The following indices were measured by: Barthel Index (BI), National Institute of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS). RESULTS: The mean change in BI score between the day of admission and the day of discharge was 20.00 +/- 24.36 for the SU group and 10.63 +/- 23.59 for the GW group. A difference that is statistically significant (P = 0.000). The mean change in NIHSS score was -2.01 +/- 6.61 for the SU group and 0.55 +/- 7.44 for the GW group. A difference that is also statistically significant (P = 0.000). Finally, the mean change in OHS score was -0.74 +/- 1.04 for the SU group and -0.28 +/- 0.98 for the GW group, also a statistically significant difference (P = 0.000). Among SU patients, patient satisfaction was higher (P = 0.000), the rehabilitation success rate was higher (P = 0.000), and there were fewer complications (P = 0.000). CONCLUSION: Compared to GW patients, stroke patients treated in a special SU were able to return to normal daily activities earlier, with better social abilities, and have reduced neurological defects, without increasing the overall economic burden.

[The impact of stroke unit on early outcome of cerebral infarction patients].

OBJECTIVE: To investigate the early therapeutic effect of stroke unit on cerebral infarction patients. METHODS: 285 of acute cerebral infarction were admitted into our department from December 2001 to January 2003. All the patients were assigned either into stroke unit (SU) or general ward (GW) randomly to receive treatment and the data of the patients of the two groups were compared. The key indexes recorded were mortality and hospitalization time and other aprameters observed were Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS). All the patients or their family members were asked to have the Visual Analogue Scales (VAS), which reflects patient satisfaction, at the time of discharge. All these data, incorporated with cost and effect, were analyzed with SPSS soft packs. RESULTS: There was no statistical difference between the two groups, but the mean gap scores between the day of admission and discharge demonstrated significant difference (P < 0.01) in BI (SU 21.01 +/- 24.4, GW 8.49 +/- 22.39), NIHSS (SU -2.53 +/- 5.73, GW 0.27 +/- 6.80) or OHS (SU -0.79 +/- 0.95, GW -0.23 +/- 0.97). Mortality rate was less (P < 0.05) and patient satisfaction higher in SU than in GW (P < 0.01). The ratio of rehabilitation was higher (P < 0.01) and complications less in SU than in GW (P < 0.01). Moreover, the cost of hospitalization was less in SU. CONCLUSION: For cerebral infarction patients, SU is able to improve the daily activities in early stage, reduce neurological defects and restore social abilities with less expenses.