Risk Factor For Cerebral Infarction Research Articles

Spotlight on the October 9 Issue

Older persons in a clinical-pathologic study rated adverse childhood experiences; 192 subsequently died and underwent a uniform neuropathologic examination. Higher level of childhood emotional neglect was associated with an increased likelihood of chronic cerebral infarction, suggesting that chronically feeling unloved may be a risk factor for cerebral infarction. See p. 1534; Editorial, p. 1524 The study population consisted of 1,031 Finnish men aged 46 to 65 years, with a total of 67 strokes (50 ischemic) during 12.1 follow-up years. High serum concentrations of lycopene, as a marker of tomato and tomato-based product intake, were …

Stroke due to anemia after severe menstrual bleeding caused by a uterine myoma: the title is self-explanatory

To the Editor,Cerebral infarction results from acute impairment of oxy-genated blood flow either due to a thrombotic or embolicocclusion. Aside from several likely contributing factors[1], anemia is an overlooked risk factor for cerebralinfarction. Although the relationship between anemia andcerebral infarction has not been well established, severalresearchers reported an association between these twoconditions [2–4].Likewise, we report a patient who had acute cerebralinfarction associated with severe anemia following severeblood loss due to a uterine myoma.A 43-year-old woman was admitted for a sudden onsetof weakness on her left side. Her medical history did notdisclose any risk factor like systemic hypertension, vas-cular malformation, coagulopathy, hyperlipidemia, smok-ing, diabetes mellitus, prior stroke history or positivefamily history. Her cardiac examination including elec-trocardiography and echocardiography was also normal.The laboratory findings were as follows: hemoglobin (Hb):5.7 g/dL (12.8 g/dL 1 month ago), hematocrit (Hct): 21.0,serum iron: 11.9 mg/dL (50–150) and platelet count:594,000/lL. Cranial magnetic resonance imaging (MRI)showed an infarction in the middle cerebral artery suppliedarea (Fig. 1). Overall, the patient was diagnosed to have anischemic cerebral infarction associated with severe anemia.Thereafter, she was given anti-thrombolytic treatment andblood transfusion twice for anemia. Further evaluationsregarding etiology were not contributory except hypo-chromic microcytic anemia. On detailed questioning, shedeclared that her complaints started within the 2 days aftera major bleeding during menstruation. She added that sheusually had similar menstrual bleedings before as well.Upon consultation to the gynecology department, she wasdiagnosed with a huge uterine myoma. She was thenscheduled for hysterectomy in a week after hemodynamicstabilization. After a 2-week rehabilitation program, thepatient discharged was almost independent in her dailyliving.In the previous literature, there are a few anecdotalreports on the association between bleeding, anemia andcerebral infarction [2–4]. Although the relationship amongthem was unclear, Akins et al. [5] presented patients withsevere iron deficiency anemia in whom reactive thrombo-cytosis led to thrombus formation and thus cerebralinfarction. Likewise, Kim et al. [6] also consideredbleeding and subsequent anemia to be a precipitant forcerebral infarction. In that study, they have also reportedthrombocytosis, especially in patients with chronic irondeficiency anemia. In another study whereby patients withanemia—due to acute blood loss—but without iron defi-ciency were enrolled, Tsai et al. [2] mentioned that acuteanemia could induce cerebral blood flow insufficiency anddecreased oxygen-carrying capacity, with an eventual tis-sue hypoxia especially at the most vulnerable regions.Selective decrease in hematocrit has also been reported to

Japanese Society for Dialysis Therapy Guidelines for Management of Cardiovascular Diseases in Patients on Chronic Hemodialysis

Hideki Hirakata, Kosaku Nitta, Masaaki Inaba, Tetsuo Shoji, Hideki Fujii, Shuzo Kobayashi, Kaoru Tabei, Nobuhiko Joki, Hiroki Hase, Masato Nishimura, Shigeyuki Ozaki, Yuji Ikari, Yoshitaka Kumada, Kazuhiko Tsuruya, Shouichi Fujimoto, Tohru Inoue, Hiroyoshi Yokoi, Sumio Hirata, Kazuaki Shimamoto, Kiyotaka Kugiyama, Takashi Akiba, Kunitoshi Iseki, Yoshiharu Tsubakihara, Tadashi Tomo, and Tadao Akizawa

Emotional neglect in childhood and cerebral infarction in older age

The purpose of the study was to test the hypothesis that a higher level of childhood adversity is associated with increased risk of cerebral infarction in old age. Older participants in a longitudinal clinical-pathologic study rated adverse childhood experiences (e.g., emotional neglect, parental intimidation and violence) on a previously established 16-item scale. During a mean of 3.5 years of follow-up, there were 257 deaths, with 206 brain autopsies (80.2). Number of chronic cerebral infarcts (gross plus microscopic; expressed as 0, 1, or >1) was determined in a uniform neuropathologic examination, which had been completed in 192 individuals at the time of these analyses. Childhood adversity scores ranged from 0 to 31 (mean = 8.3, SD = 6.4). In an ordinal logistic regression model adjusted for age, sex, and education, higher adversity was associated with higher likelihood of chronic cerebral infarction. In analyses of childhood adversity subscales, only emotional neglect was associated with infarction (odds ratio [OR] = 1.097; 95% confidence interval [CI] 1.048-1.148). The likelihood of infarction was 2.8 times higher (95% CI 2.0-4.1) in those reporting a moderately high level of childhood emotional neglect (score = 6, 75th percentile) vs a moderately low level of neglect (score = 1, 25th percentile). Results were comparable in subsequent analyses that controlled for lifetime socioeconomic status, cardiovascular risk factors, and an anxiety-related trait. Emotional neglect in childhood may be a risk factor for cerebral infarction in old age.

Prevalence and risk factors for cerebral infarction and carotid artery stenosis in peripheral arterial disease

ObjectiveThe purpose of the study was to examine the prevalence and risk factors for cerebral infarction (CI) and carotid artery stenosis (CAS) in patients with peripheral arterial disease (PAD) compared with normal controls. MethodA cross-sectional analysis was performed in 857 subjects (PAD: 543, controls: 314). CI and lacunar infarction (LI) were evaluated using brain computed tomography. Intima-media thickening (IMT) and CAS were measured with ultrasound. ResultsThe prevalences of CI and LI were higher in patients with PAD than in controls (15.0% vs. 9.8%, 41.0% vs. 13.4%, respectively, p < 0.05). In multiple logistic analysis, CI was associated with diabetes mellitus, low HDL cholesterol and CAS ≥ 70% (p < 0.05). LI was associated with age, PAD, diabetes mellitus, and estimated glomerular filtration rate (p < 0.05). The prevalences of CAS ≥ 70% and CAS ≥ 50% were higher in patients with PAD than in controls (5.2% vs. 0.6%, 17.6% vs. 3.8%, respectively, p < 0.01). Mean and max IMT differed significantly between the two groups (PAD vs. controls: 1.01 ± 0.45 vs. 0.90 ± 0.28, 2.67 ± 2.00 vs. 1.73 ± 1.05 mm, respectively, p < 0.001). CAS ≥ 70% correlated with high LDL cholesterol, and CAS ≥ 50% with age and PAD. IMT was positively correlated with PAD, high LDL cholesterol, age, and hypertension (p < 0.05). ConclusionsPrevalences of CI and CAS were markedly higher in patients with PAD than in controls, indicating that PAD is a meaningful risk factor for CI, LI, and CAS. This suggests that screening for CI and CAS is important for managements in PAD, as with screening for PAD in patients with stroke.

The Risk Factors for Elderly Patients With Bipolar Disorder Having Cerebral Infarction

Patients with bipolar disorder are at high risk of developing strokes in the older life. Silent cerebral infarctions (SCIs) could be common in the elderly patients with bipolar disorder, but only small sample size reports are available. The purpose of this study was to assess the proportion of SCIs and determine the risk factors for cerebral infarction in elderly patients with bipolar disorder. We recruited 43 patients with bipolar disorder over the age of 60 to undergo whole-brain magnetic resonance imaging (MRI). We divided them into 2 groups depending on whether infarction was present, and compared the potential variables of these 2 groups. There were 28 elderly patients with bipolar disorder (65.1%) having MRI-proven cerebral infarction. The SCIs were detected in 59.5% (N = 22) of 37 patients without a history of stroke, including 61.3% of 13 patients with late-onset age (>50 years) and 46.7% of 30 patients with typical-onset age (<50 years). Logistic regression revealed that comorbidity with metabolic diseases (95% confidence interval [CI] for odds ratio [OR] = 1.24-40.59) was most strongly associated with cerebral infarction. The leukocyte counts (95% CI for OR = 1.10-3.93) and fasting blood sugar (95% CI for OR = 1.00-1.07) during the most recent acute psychiatric admission may be substituted as the risk factors. Cerebral infarctions tend to be neglected in more than half of the elderly patients with bipolar disorder, regardless of their age at onset. Metabolic abnormality and systemic inflammation may be the risk factors.

Late-Life Bipolar Disorder

As our society ages, it is critical that we expand our understanding of how best to provide care and services for the growing population of elderly patients with bipolar disorder (BD). For many years, there was a dearth of publications focused on the topic of late-life BD. Indeed, the current literature base on geriatric BD is still insufficient to address critical questions regarding etiology, assessment, treatment, and prognosis. In this special issue, we focus on BD in later life and present a series of articles that we believe will be of interest to clinicians and researchers. In the first article, Al Jurdi and colleagues used data from the National Institute of Mental Health-funded Systematic Treatment Enhancement Program for BD (STEP-BD) and compared the presence and severity of acute mood elevation (mania and hypomania) and acute depression symptoms between younger (20-59 years old) and older individuals ( 60 years old). With the exception of distractibility, all acute depression symptoms presented with comparable frequency and severity between younger and older individuals. Huang and colleagues examined the rate of silent cerebral infarctions and risk factors for cerebral infarction in 43 elderly patients with BD using whole-brain magnetic resonance imaging. Their analyses focus on the relationships between cerebral vascular disease, metabolic illness, and bipolarity. Their analyses support the understanding that there are shared neuroprogressive pathways that underlie vascular medical comorbidity, cognitive dysfunction, and mood dysregulation in BD. Lala and Sajatovic summarize the literature on comorbidity in bipolar adults aged >50 years. Psychiatric comorbidity rates appear lower than in younger BD populations, with the most common concurrent illnesses being anxiety and substance use disorders. While older adults with BD have on average of 3 to 4 medical comorbid conditions, medical condition rates appear similar among geriatric patients with and without BD. Avari and Young present a case report of BD in a patient with antiphospholipid syndrome (APS). They present this case in the context of one previous case report and literature linking APS-related immune markers to various neuropsychiatric disorders. They discuss potential vascular and direct mechanisms pertinent to an association of APS with BD, if demonstrated. They encourage additional case descriptions and suggest possible systematic studies. Bhalerao and colleagues report on mortality risk with use of atypical antipsychotics in geriatric BD. US national data from the Department of Veterans Affairs included registry information on 4717 patients 65 years and identified 6-month mortality rates with a new start of an atypical antipsychotic or valproic acid and derivatives during fiscal years 2001 to 2008. The authors report differences in mortality risks among individual antipsychotic agents, a finding that clearly demonstrates the need for continued investigation on currently used psychotropic agents in bipolar elders. Gildengers and colleagues present a secondary analysis from clinical trial data on correlates of treatment response in depressed older adults with BD. They are interested in whether an agent such as lamotrigine that appears to reduce oxidative stress is particularly effective in patients with high vascular medical comorbidity in the context of depressive illness. They present an approach to target treatment to those individuals who may respond most robustly to this type of intervention. Using a novel imaging technique, phosphorus magnetic resonance spectroscopy, Forester and colleagues examine bioenergetic pathways related to bipolar depression in older adults. They look at whether the forward rate constant of creatine kinase (kfor) is altered in older adults with bipolar depression and whether CoEnzyme Q 10, known to have properties that enhance mitochondrial function, increases kfor in older bipolar individuals compared with untreated ageand sex-matched controls. Their study builds on the growing interest in dysfunctional mitochondrial energy metabolism in BD. Rej and Shulman present a systematic review of all studies pertaining to the effects of lithium on the kidney in older adults. They note that age-specific studies are few and conclude that there is no compelling evidence for general avoidance of use of lithium in elderly individuals based on concerns about renal effects. They suggest guidelines for the approach to lithium management in elderly individuals. Finally, Al Jurdi and colleagues conducted a secondary analysis based upon the baseline data from 100 bipolar elderly individuals participating in a pharmacologic treatment Journal of Geriatric Psychiatry and Neurology 25(1) 4-5 a The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0891988712439691 http://jgpn.sagepub.com

Abstract 3781: Harm Avoidance: A Novel Risk Factor for Cerebral Infarction

BACKGROUND: Harm avoidance, a trait indicative of behavioral inhibition, is associated with disability and dementia in old age, but the basis of these associations is uncertain. OBJECTIVE: To test the hypothesis that higher level of harm avoidance is associated with increased risk of cerebral infarction. METHODS: Longitudinal clinical-pathologic cohort study. Subjects were from the Rush Memory and Aging Project. As part of this longitudinal study, 1,082 older persons without dementia completed a standard measure of harm avoidance: the 35-item Harm Avoidance Scale from Cloninger’s Temperament and Character Inventory. During a mean of 3.5 years of follow-up, 258 individuals died of whom 206 (80%) underwent brain autopsy, the results of which are currently available in 192. Main Outcome Measures: Number of chronic gross and microscopic cerebral infarctions (each expressed as 0,1, or &gt;1) identified on a uniform neuropathologic examination. RESULTS: Trait scores ranged from 0 to 32 and were approximately normally distributed (mean 11.6 ± 7.0 SD). On postmortem examination, chronic microscopic infarction was found in 45 (28 with 1, 17 with &gt;1) and chronic gross infarction was found in 66 (31 with 1, 35 with &gt; 1). In a Bivariate Dale Model adjusted for age, sex, and education, higher harm avoidance was associated with higher likelihood of both microscopic (estimate = -0.08, SE = 0.02, p = 0.002) and gross (estimate = -0.06, SE = 0.02, p = 0.011) cerebral infarction. A high level of the trait (score=17, 75th percentile) was associated with an approximate doubling of the likelihood of each type of infarction (2.4- fold increase for microscopic, 1.8-fold increase for gross) compared to a low level of the trait (score = 6, 25th percentile). These associations persisted in subsequent models that controlled for cognitive and motor function, cardiovascular risk factors and conditions, or neuroticism, and it was stronger for subcortical than cortical infarction. CONCLUSIONS: Higher level of the harm avoidance trait may be a risk factor for cerebral infarction, both gross and microscopic. The mechanism appears independent of known cardiovascular risk factors and warrants further study.

The potent different risk factors for cerebral infarction in young patients with and without type 2 diabetes: Subanalysis of the Young Cerebral Infarction Study (YCIS)

BackgroundTo compare risk factors, stroke characteristics, and short-term prognosis between diabetic and nondiabetic young ischemic stroke patients to provide information for patient management, counseling, and future research in these patient groups. MethodsAll consecutive patients between the ages of 18 and 45 years with first-ever cerebral infarction during 2001–2010 were recruited to participate in the study. Using multivariate logistic regression modeling, demographic characteristics, cerebrovascular risk factors, clinical events, stroke subtypes, and outcome in ischemic stroke patients with and without diabetes were compared. ResultsLogistic regression analysis adjusted for confounders confirmed the following independent susceptibility markers: in a substudy of young patients with and without diabetes, the predictors of short-term outcome were more likely to be TOAST subtype, initial stroke severity and serum uric acid, and age at onset, dyslipidemia, initial stroke severity and serum fibron levels correlate with a higher risk for incident stroke in young with diabetes. ConclusionOur findings suggest that diabetic and nondiabetic ischemic stroke patients exhibit a distinct risk-factor and etiologic profile and may help clinicians to assess prognosis more accurately.

Cerebral Infarction in Adults with Bacterial Meningitis

To evaluate clinical features and prognostic factors of cerebral infarctions in adults with community-acquired bacterial meningitis. An observational cross-sectional study, including 696 patients of whom 174 had cerebral infarction, from a prospective nationwide cohort of community-acquired bacterial meningitis (period, 1998-2002), confirmed by culture of cerebral spinal fluid (CSF) in patients aged over 16 years. Two investigators independently determined the presence of infarction. Cerebral infarction occurred in 174 episodes (25%), with a high inter-rater agreement for determining the presence of cerebral infarction (kappa 0.95). Cerebral infarctions occurred in 128 of 352 patients (36%) with pneumococcal meningitis, in 22 of 257 (9%) with meningococcal meningitis and in 24 of 87 patients (28%) with meningitis caused by other bacteria. Patients with infarctions were older (P < 0.001) and often presented with predisposing conditions, such as otitis and/or sinusitis (P = 0.001) or an immunocompromised state (P = 0.003) compared to those without infarction. Patients with infarctions presented with lower scores on the Glasgow Coma Scale (P < 0.001), lower CSF white cell counts (P = 0.001), and higher serum erythrocyte sedimentation rate (ESR) (P < 0.001). Unfavorable outcome occurred in 108 (62%) patients with infarctions. In a multivariate analysis, infarction was related with unfavorable outcome (odds ratio 3.37; 95% confidence interval 2.19-5.21; P < 0.001). We identified lower CSF white cell counts and high ESR to be independent risk factors for cerebral infarction. Cerebral infarction is a common and severe complication in adults with community-acquired bacterial meningitis. Preventing cerebral infarctions will be important in reducing the high morbidity and mortality rate in adults with community-acquired bacterial meningitis.

American Childhood Football as a Possible Risk Factor for Cerebral Infarction

Three adolescent football players who had ischemic stroke associated with football practice and play are described. The literature on stroke associated with childhood sports and football in particular is reviewed, and the multiple mechanisms by which football can contribute to ischemic stroke are discussed.

Effect of anti-Helicobacter pylori on the prognosis in patients with acute cerebral infarction

To investigate the effect of anti-Helicobacter pylori on the inflammation mediators and prognosis in patients with acute cerebral infarction. Routine urease test was carried out in patients with acute cerebral infarction in our hospital. The acute cerebral infarction patients with positive urease test were randomly divided into a treatment group (conventional therapy+anti-Helicobacter pylori therapy) and a control group (conventional therapy). C-reactive protein, triglycerides, and fibrinogen changes were examined before and after the treatment, symptoms of acute cerebral infarction conditions were observed,and 6-months and 1- year cerebral infarction readmission rates were measured in the 2 groups. Compared with before the treatment,the C-reactive protein, triglycerides, and plasma fibrinogen decreased significantly in the treatment group, while there was no significant change in the control group. The 6-months and 1-year cerebral infarction readmission rates were significantly lower than those in the control group. H. pylori infection may be a risk factor for cerebral infarction. A positive anti-Helicobacter pylori infection treatment can significantly improve the efficiency of cerebral infarction and reduce the short-term readmission rate.

糖尿病患者の脳梗塞の危険因子としてのLp (a) の意義

糖尿病患者の脳梗塞の危険因子としてのLp (a) の意義

Aspirina frente a anticoagulación en pacientes jóvenes con infarto cerebral secundario a síndrome antifosfolípido primario

The primary antiphospholipid syndrome (PAS) is an independent risk factor for cerebral infarction. AIM. To evaluate the risk of recurrence, to compare different treatments and determine the risk factors associated with recurrence and hemorrhagic complications in patients with cerebral infarction and PAS. Prospectively collected data from 92 patients under 45 years (71% female, mean age 33.8 ± 8.9 years) with confirmed diagnoses of cerebral infarction and PAS, treated with anticoagulants (n = 54) or aspirin (n = 38) were retrospectively analyzed. Clinical follow-up was obtained by neurological examination every 6 to 12 months. Outcome measures were: recurrence of CI, symptomatic intracerebral hemorrhage, and minor bleeding. During a median follow-up of 54 months (range: 12-240 months), there were 8 (9%) recurrent cerebral infarctions, with no difference between treatment with aspirin (n = 0) or anticoagulants (n = 8). The annual rate of recurrence was 0,014 person-years of follow-up. The history of previous thrombosis and spontaneous abortions were more frequent in patients with recurrence. Aspirin-treated patients more frequently came from rural areas. Four anticoagulated patients developed bleeding complications, two minor bleeding and two subdural hematomas. 76% of the cases evolved with good outcome (modified Rankin scale: 0-2). With the limitations of a nonrandomized study, our data suggest that the risk of recurrent arterial cerebral infarction in young patients with cerebral infarction secondary to PAS is low, probably non-uniform and independent of the type of antithrombotic.

A clinical follow-up study on the risk of cerebral infarction in Chinese aging overweight and obese population

The current studies have shown that overweight and obesity are possible risk factors for cerebral infarction, but variety of weight status in the role of the mechanism of cerebral infarction is not yet fully understood. In our research, a prospective cohort follow-up study of 8 years (2002-2009) was used to analyze the correlation of weight, cerebral infarction and other factors in 1170 Han retired employees from KaiLuan Group. The study included enrolling with questionnaire survey, medical examination, brain CT scan and so on, based on the changes in body mass index from the beginning to the end of the follow-up study, the subjects were divided into eight groups: stay normal weight group (n = 364), stay overweight group (n = 171), development from overweight into obesity group (n = 95), stay obesity group (n = 37), development from normal weight into overweight group (n = 365), development from normal weight into obesity group (n = 63), overweight improved group (n = 55) and obesity improved group (n = 20). We found that the incidence of cerebral infarction in the stay overweight group was higher than in the stay obese and stay normal weight groups (25.15%, 18.92%, 19.23%, P < 0.05) during the last medical examination in the end of follow-up study, and relative risk was 1.31, 0.98, 1, and population attributable risk was 0.10, -0.002, 0, respectively. But there was no difference of the incidence of cerebral infarction between stay obesity group and stay normal weight group (P > 0.05). The incidence of hypertension in the development of normal weight into obesity group and stay obesity group was higher than stay overweight group and stay normal weight group (63.49%, 56.76%, 48.54%, 36.54%, P < 0.05), while the aggregated incidence of risk factors in above mentioned four groups was 75%, 64%, 63%, 55% (P < 0.05), respectively. In logistic regression analysis of correlative factors to cerebral infarction, waist circumference in the last checkup, diabetes, development from normal weight to overweight status, etc were selected (P < 0.01), and odds ratio (OR) values were 0.98, 6.51, 4.13 (P < 0.05), respectively. The incidence of cerebral infarction in overweight improved and obesity improved groups were 29.09%, 45.00%, relative risk values were 1.51, 2.34, the aggregated incidence of risk factors were 48%, 65%. This study showed that Chinese aging population who has overweight with a significant overweight stable phase and with no overweight stable phase but progressing to obesity had different risks of diseases. The former was at high risk of cerebral infarction, the latter was susceptible to hypertension. In the aging population of overweight and obesity, the aggregated incidence of cerebral infarction related risk factors were significantly increased, and weight-loss treatment did not reduce the incidence of cerebral infarction. Thus, the aging patients with obesity should be actively treated to eliminate hypertension and other risk factors, rather than an appetite for weight-loss treatment.:

The related influential factors for cerebral infarction among community residents in Dongguan

Objective To explore the influential factors for cerebral infarction and provide scientific support for the prevention and control of cerebral infarction (CI). Methods A case-control study on 150 pairs was conducted. The investigation included medical history, family history, and environmental factors. All the data were analyzed by the SPSS 13.0. Results Logistic regression analysis showed physical exercise, history of hypertension, financial burden, and high triglyceride levels were the influential factors for CI. Physical exercise (OR = 0.050) was a protective factor for cerebral infarction while history of hypertension (OR = 4.336), financial burden (OR = 3.516), and high triglyceride levels (OR = 3.787) were the risk factors for CI. Conclu- sions History of hypertension, financial burden, and high triglyceride levels were the risk factors for CI among community residents in Dongguan city, and CI can be prevented by aggressive prevention and treatment of hypertension and by development of a healthy lifestyle. Key words: Cerebral infarction; Community residents; Influential factors

Analysis of the factors affecting activities of daily life of patients with cerebral infarction

Objective To study the factors affecting the activities of daily life (AOL) of patients after the first stroke of cerebral infarction in order to formulate the intervention strategy for improving the capability of ADL of patients. Method A total of 149 patients with the first stroke of cerebral infarction admitted from Oct. 2008 to Dec.2008 were enrolled in this study. The demographics of patients, cerebral infarction risk factors, apopletic score as per National Institute of Health stroke scale (NIHSS), white blood cell count (WBC) and plasma glucose (PG) were recorded on the first day of admission, and many other laboratory examinations were done on the next morning. The occurrences of infection in lung and urinary tract, and atrial fibrillation were recorded during hospi-talization. The NIHSS score and score of Glasgow Coma Scale (GCS) were taken within 24 hours after admission, on the 14th day and at the end of the third month after cerebral infarction respectively. Barthel index (BI) was taken in the second week as well as at the end of third month by follow-up in the OPD or by telephone. The correlation analysis and multiple linear stepwise regression analysis were used to find the risk factors. Results The PG level, WBC count and NIHSS score were independently associated with ADL in the second week as well as at the end of the third month after cerebral infarction. Besides, the urinary tract infection during hospital stay was also independently associated with ADL at the end of the third month after cerebral infarction. Conclusions The plasma glucose level, WBC count, NIHSS score and urinary tract infection are the risk factors. Positive measures should be taken to control these risk factors so as to improve the capability of ADL of the patients after cerebral infarction. Key words: Cerebral infarction; Barthel index; Activites of daily life; Multiple linear stepwise regression analysis

Analysis of risk factors for cerebral infarction after hip arthroplasty

To investigate the independent risk factors for cerebral infarction so as to provide a theoretical basis for the prevention of cerebral infarction after total hip arthroplasty. A retrospective analysis of 571 patients for hip arthroplasty was conducted from January 2003 to September 2008. Twenty-three patients were found with cerebral infarction postoperatively. Single-factor and multi-factor correlation analyses were tested for the patients with cerebral infarction after hip arthroplasty. The single-factor analysis for hip arthroplasty revealed that age (P = 0.001) and femoral neck fracture (P = 0.008) were the main factors for cerebral infarction. Furthermore, age was considered a risk factor for cerebral infarction after hip arthroplasty in multi-factor analysis (P = 0.029, OR = 1.054, 95%CI: 1.005 - 1.105). Advanced age (> 70 yr) and femoral neck fracture are the main independent risk factors for cerebral infarction after hip arthroplasty.

Accumulation of Gene Polymorphisms Related to Plaque Disruption and Thrombosis Is Associated With Cerebral Infarction in Subjects With Type 2 Diabetes

OBJECTIVEIt is believed that disruption of vulnerable atherosclerotic plaque and subsequent thrombus formation play critical roles in the pathogenesis of cerebral infarction. We simultaneously determined four relatively common genetic variants related to plaque rupture or subsequent local thrombus formation and evaluated the combined effect on cerebral infarction.RESEARCH DESIGN AND METHODSWe enrolled 3,094 Japanese type 2 diabetic subjects (62.7% male; aged 61.5 ± 8.4 years) and determined their genotypes regarding matrix metalloproteinase 9 C-1562T, coagulation factor XII (F12) C46T, von Willebrand factor (VWF) G-1051A, and plasminogen activator inhibitor (PAI-1) 675 4G/5G polymorphisms. The diagnosis of cerebral infarction was performed based on history, physical examination, and neuroimaging.RESULTSThe single association analysis revealed that there were no statistically significant associations between each polymorphism and the prevalence of cerebral infarction. Interestingly, the prevalence of cerebral infarction was higher with the increase of the total number of four concomitant unfavorable proatherothrombotic alleles in each subject (P value for linear trend = 0.004). Furthermore, a multiple logistic regression analysis showed that the number of proatherothrombotic alleles was a risk factor for cerebral infarction independently of conventional risk factors (odds ratio for one-point increase in the number of proatherothrombotic allele 1.15 [95% CI 1.05–1.26], P = 0.004).CONCLUSIONSAccumulation of gene polymorphisms related to plaque rupture and thrombus formation is likely associated with the prevalence of cerebral infarction in type 2 diabetic patients, suggesting that the combined information about these variants is useful to assess the risk of cerebral infarction.

Fibrinogen gene polymorphism (Bβ-148C/T) in Uygur patients with cerebral infarction

Objective: To explore the frequency distribution of the fibrinogen gene polymorphism (Bβ-148C/T) and its relationship with plasma fibrinogen (Fg) level in Uygur patients with cerebral infarction in Xinjiang.Methods: The frequency distribution of FgBβ-148C/T was analysed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in the Uygur cerebral infarction group (n=62) and the Uygur control group without cerebral infarction (n=64). Plasma fibrinogen levels were measured by the automatic coagulation analyser.Results: The frequency of the T allele in the cerebral infarction group was significantly higher than that of the control group (0.31 versus 0.19, p<0.05). The plasma fibrinogen level of the cerebral infarction group was also significantly higher than that of the control group (4.19 ± 1.29 g/l versus 3.08 ± 0.56 g/l, p<0.01). The plasma fibrinogen levels in both CT and TT genotype subgroups in patients with cerebral infarction were higher than those in the CC genotype subgroups (p<0.01). They were also higher than those in the CT and TT genotype subgroups within the control group (p<0.05).Conclusion: The fibrinogen gene polymorphism (Bβ-148C/T) affects plasma fibrinogen concentration. T allele, alone or cooperating with other risk factors, increases the plasma fibrinogen level. Thus, the fibrinogen gene polymorphism (Bβ-148C/T) may be related with cerebral infarction. T allele may be a risk factor for cerebral infarction by increasing the plasma fibrinogen level. The above conclusion is in accordance with similar studies on the Han nationality in China.