Cholesterol, stroke risk, and stroke prevention

Serum cholesterol traditionally has been considered a poor predictor of total stroke risk; however, it is associated positively with ischemic stroke risk and associated negatively with hemorrhagic stroke risk. Although studies failed to demonstrate stroke reduction using older cholesterol-lowering medications, recent study of the statin class of medications shows both consistent stroke and other cardiovascular benefits. Ischemic stroke and coronary heart disease share similar underlying mechanisms, likely explaining much of the therapeutic benefit from statins. Current research is directed at further determining groups of patients most likely to benefit from lipid reduction in stroke prevention. In the interim, patients with established atherosclerosis should be treated with a statin to achieve a low-density lipoprotein cholesterol level less than 100 mg/dL.     

院内卒中

患者在住院期间发生的卒中与各种基础疾病和治疗有关,常导致患者病情加重和预后不良,容易引起医疗纠纷。院内卒中诊断和治疗的时效性在理论上优于院外卒中,但在实际诊疗过程中仍然普遍存在延误的现象。文章对院内卒中的可能原因和机制进行了综述,旨在提高院内卒中的防范意识,预防和消除发生院内卒中的潜在危险。     

Cardioembolic stroke

Cardiac sources of emboli account for over one quarter of all ischemic strokes. Strokes due to cardioembolism are in general severe and prone to early and long-term recurrence. Nonvalvular atrial fibrillation remains the most common cause of cardioembolic stroke. Despite the proven efficacy of oral anticoagulation, it is prescribed for less than half of the patients with risk factors for embolism and no contraindications for anticoagulation. The embolic risk of patent foramen ovale is low except when combined with an atrial septal aneurysm. Aortic arch atheroma as an independent risk factor for ischemic stroke is the subject of ongoing debate. As the risk of embolism is heterogeneous for the various potential cardioembolic conditions, accurate definition of stroke mechanism is very important to guide the most effective therapy.     

院内卒中

患者在住院期间发生的卒中与各种基础疾病和治疗有关,常导致患者病情加重和预后不良,容易引起医疗纠纷.院内卒中诊断和治疗的时效性在理论上优于院外卒中,但在实际诊疗过程中仍然普遍存在延误的现象.文章对院内卒中的可能原因和机制进行了综述,旨在提高院内卒中的防范意识,预防和消除发生院内卒中的潜在危险.

Abstract：

The occurrence of stroke in patients and a variety of underlying diseases during the hospitalization are associated with the treatment, they often result in the aggravation of disease, poor prognosis, and medical disputes. Theoretically, the timeliness of diagnosis and treatment of in-hospital strokes are superior to those outside hospitals, but it still has the widespread delay in the actual diagnosis and treatment. This article reviews the possible causes and mechanisms of in-hospital stroke in order to raise awareness of prevention of in-hospital stroke, prevent and eliminate the potential risks of in-hospital stroke.     

醒后卒中

醒后卒中约占所有新发缺血性卒中的25％,很多醒后卒中患者因发病时间不确定而不能接受溶栓治疗.最近的研究显示,多模式影像学可筛选出适合早期溶栓治疗的醒后卒中患者.     

醒后卒中

醒后卒中约占所有新发缺血性卒中的25％,很多醒后卒中患者因发病时间不确定而不能接受溶栓治疗.最近的研究显示,多模式影像学可筛选出适合早期溶栓治疗的醒后卒中患者.     

Lipid lowering and recurrent stroke: another stroke paradox?

The meta-analysis of over 90 000 patients included in statintria ls shows a significant 21% reduction of stroke with noheterogeneity between trials and no increase in haemorrhagicstroke.¹ Because the link between total cholesterol and incidentstroke has never been clearly established in epidemiologicalstudies,² it is surprising to see, in the meta-analysis, thatthe larger the between-group LDL level difference the greaterthe stroke risk reduction.¹ Indeed, we calculated that LDL reductioncould explain 35–80% of the benefit of statins on strokerisk reduction, leaving room for other non-lipid lowering effectsof statins, the so-called pleiotropic effects, but the maineffect is through LDL reduction.¹ New results from randomizedtrials since this meta-analysis, have confirmed that LDL lowering     

醒后卒中和发病时间不明卒中的再灌注治疗

醒后卒中和发病时间不明卒中因发病时间不确定而往往被排除在溶栓治疗之外.然而,许多临床研究显示,多模式影像学技术可有效指导醒后缺血性卒中和发病时间不明卒中患者进行静脉溶栓,其血管内治疗也取得了一定的进展.文章主要对醒后卒中和发病时间不明卒中患者的影像学表现、静脉溶栓和血管内治疗进行了综述.     

自噬与卒中

自噬是广泛存在于真核细胞的一种生命现象,其贯穿于细胞的正常生长、发育和生理病理学过程.近年来的研究表明,自噬参与了卒中后的病理学过程,并且影响神经细胞的生存和死亡.文章对自噬的分类、形成过程、分子机制、检测及其与卒中的关系做了综述,旨在为卒中的临床治疗提供新的方向.     

Pathology of stroke

Large cerebral infarctions were caused by atherosclerosis with or without thrombosis in the proximal circumflex (cortical) cerebral arteries. Hypertension, hypercholesterolemia, hypoxidosis, and vasospasm were considered to induce endothelial cell injuries, which might be the primary events not only in atherosclerosis, but also in arteriosclerosis and arteriosis formation. Morphogenesis of atherosclerosis and causes of associated thrombosis were also discussed. Small cerebral infarcts were produced not only by arteriosclerosis, arteriosis, and atherosclerosis, but also by arterionecrosis-derived microaneurysms occluded by thrombi in the distal penetrating (perforating) cerebral arteries. Pathogenesis and morphogenesis of the arterial lesions were discussed. Recent increase of the arterionecrosis occluded by thrombosis in the pathogenesis of small infarcts (lacunes) was noted. The direct cause of hypertensive cerebral hemorrhage was the rupture of arterionecrosis-derived microaneurysms in the distal penetrating cerebral arteries. The primary change of the arterionecrosis was the medial muscle cell necrosis, the causes of which were considered to be hypertension, aging, poor diet low in cholesterol, vasospasm, and the congenitally poor wall structure of the arteries. The development and healing of experimental arterionecrosis in hypertensive rats were also reported.