Clinical Cerebrovascular Disease Research Articles

Change in EEG-EMG synchronization reflecting abnormal functional corticomuscular coupling following stroke: A pilot study

Stroke is a common clinical cardiovascular and cerebrovascular disease, which can cause severe motor dysfunction. Therefore, it is an important topic to investigate the abnormality mechanism of the cerebral cortex and the corresponding muscles after stroke. In this study, we investigated the functional corticomuscular coupling (FCMC) at specific frequencies by analyzing differences between stroke patients and healthy controls in hand movements. The transfer spectral entropy (TSE) method was used to analyze simultaneous electroencephalography (EEG) and electromyography (EMG) in the right-hand steady state force task. The results illustrated that healthy subjects had the highest TSE values at the beta band in the EMG→EEG and EEG→EMG directions, and the TSE value in the EEG→EMG direction was higher than that in the EMG→EEG direction. In contrast, for stroke patients, beta band coupling was weakened, and there was a notably higher enhancement of alpha and gamma bands in the EMG→EEG direction relative to the EEG→EMG direction. Further analysis found significant correlations between TSE area values at beta2 and gamma2 bands and clinical rating scales. This study demonstrates the frequency specificity properties of FCMC estimated by TSE can assess the rehabilitation status of stroke patients and contribute to our comprehension of the potential mechanism of motor control systems.

Spiral time-of-flight magnetic resonance angiography for intracranial vascular imaging: performance compared to conventional Cartesian angiogram.

Computed tomography angiography (CTA) and digital subtraction angiography (DSA) usually raise the risk of potential malignancies with cumulative radiation doses. Current time-of-flight magnetic resonance angiography (TOF-MRA) (dubbed as cTOF), which is based on Cartesian sampling mode, may show limited diagnostic conspicuity at sinuous or branching regions. It is also prone to relatively high false positive diagnoses and undesirable display of distal intracranial vessels. This study aimed to use spiral TOF-MRA (sTOF) as a noninvasive alternative to explore possible improvement, such that the application of magnetic resonance angiography (MRA) can be extended to facilitate clinical examination or cerebrovascular disease diagnosis and follow-up studies. Initially, 37 patients with symptoms of dizziness or transient ischemic attack were consecutively recruited for suspected intracranial vascular disease examination from Zhongshan Hospital of Xiamen University between July 2020 and April 2021 in this cross-sectional prospective study. After excluding 1 patient with severe scanning artifacts, 1 patient whose scanning scope did not meet the requirement, and 1 patient with confounding tumor lesions, a total of 34 participants were included according to the inclusion and exclusion criteria. Each participant underwent intracranial vascular imaging with both sTOF and cTOF sequences on a 3.0 T MR scanner with a conventional head-neck coil of 16 channels. Contrast CTA or DSA was also performed for 15 patients showing pathology. Qualitative comparisons in terms of image quality and diagnostic efficacy ratings, quantitative comparisons in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel length, and sharpness were evaluated. Pair-wise Wilcoxon test was performed to evaluate the imaging quality derived from cTOF and sTOF acquisitions and weighted Cohen's Kappa was conducted to assess the rating consistency between different physicians. Compared to cTOF, sTOF showed better performance with fewer artifacts. It can effectively alleviate false positives of normal vessels being misdiagnosed as aneurysm or stenosis. Improved conspicuity was observed in cerebral distal regions with more clearly identifiable vasculature at finer scales. Quantitative comparisons in selected regions revealed significant improvement of sTOF in SNR (P<0.01 or P<0.001), CNR (P<0.001), vessel length (P<0.001), and sharpness (P<0.001) as compared to cTOF. Besides, sTOF can depict details of M1 and M2 segments of middle cerebral artery (MCA) at metallic implant region, showing its resistance to magnetic susceptibility. The sTOF shows higher imaging quality and lesion detectability with reduced artifacts and false positives, representing a potentially feasible surrogate in intracranial vascular imaging for future clinic routines.

CROSS SECTIONAL RETROSPECTIVE ANALYTICAL STUDY OF MORPHOMETRY OF INTERNAL CAROTID ARTERY

Background: The internal carotid artery (ICA) is essential for diagnosing and treating cerebrovascular diseases and plays a significant role in the human head and neck circulatory system. Traditional techniques of ICA research have their limitations, but more recent developments in medical imaging—particularly retrospective angiography—offer more thorough evaluation options. Objective: This study aimed to investigate variations and morphometry of the ICA using 2D digital subtraction angiography (DSA) images, with a focus on age and gender-related differences. Methods: The 149 individuals with subarachnoid hemorrhage who had cerebral angiography were included in the research. Analysis was done on 2D ICA pictures without any obvious pathology. PACS imaging techniques were used to measure morphometric characteristics such as the length, angle, and diameter of the ICA segments. Results: According to the study, ICA length and direction were not substantially affected by age, but segment diameters were highly associated with age, indicating that segment diameters decreased with age. However, gender indicated statistically significant variations in several segment sizes, with males typically having greater diameters than females. Gender had little effect on length and orientation. Conclusion: This study sheds light on ICA changes and morphometry, emphasizing age-related diameter decreases and gender-related variations in segment diameters. These findings highlight the need to take age and gender into account when conducting clinical evaluations and cerebrovascular disease therapies.

Value of inflammatory mediator profiles and procalcitonin in predicting postoperative infection in patients with hypertensive cerebral hemorrhage.

Hypertensive cerebral hemorrhage (HICH) is a common clinical cerebrovascular disease and one of the most serious complications of hypertension. Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH. Changes in the levels of inflammatory mediators, which are closely related to the occurrence and development of postoperative infection, and procalcitonin (PCT), which is a sensitive indicator for diagnosing bacterial infections, are widely used in clinical practice. To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH. A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection (n = 80) and non-infection (n = 191) groups according to whether postoperative infection occurred. The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed. Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups, pre- and postoperatively. A total of 109 strains of pathogenic bacteria were detected in the infection group, including 67 strains (61.47%) of gram-negative bacteria, 32 strains (29.36%) of gram-positive bacteria, and 10 strains (9.17%) of fungi. The main infection site of the patients in the infection group was the respiratory system (63.75%). Preoperative interleukin (IL)-4, IL-6, IL-10, tumor necrosis factor-α, interferon-γ, and PCT levels were higher in the infection group than in the non-infection group (P < 0.05), and there were no significant differences in the IL-2 Levels between the two groups (P > 0.05). The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively (P < 0.05), and were higher than those in the non-infection group (P < 0.05). Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection (P < 0.05). Operating characteristic curve analysis results showed that the area under the curve (AUC) values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824, respectively. The AUC value of joint detection was 0.866, which was significantly higher than that of the single index (P < 0.05). Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH. Their detection is clinically significant for early identification of patients at high risk for postoperative infection.

Application of transcranial Doppler in cerebrovascular diseases.

Transcranial Doppler (TCD) is a rapid and non-invasive diagnostic technique that can provide real-time measurements of the relative changes in cerebral blood velocity (CBV). Therefore, TCD is a useful tool in the diagnosis and treatment of clinical cerebrovascular diseases (CVDs). In this review, the basic principles of TCD and its application in CVD were outlined. Specifically, TCD could be applied to evaluate occlusive CVD, assess collateral circulation in patients with ischemic stroke, and monitor cerebral vascular occlusion before and after thrombolysis as well as cerebral vasospasm (VSP) and microembolization signals after aneurysmal subarachnoid hemorrhage (SAH). Moreover, TCD could predict short-term stroke and transient cerebral ischemia in patients with anterior circulation occlusion treated with endovascular therapy and in patients with anterior circulation vascular occlusion. Additionally, TCD not only could monitor blood velocity signals during carotid endarterectomy (CEA) or carotid artery stenting (CAS) but also allowed earlier intervention through early recognition of sickle cell disease (SCD). Presently, TCD is a useful prognostic tool to guide the treatment of CVD. On the one hand, TCD is more commonly applied in clinical research, and on the other hand, TCD has an increasing role in the management of patients. Collectively, we review the principles and clinical application of TCD and propose some new research applications for TCD.

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage.

Background Cerebral hemorrhage, also known as hemorrhagic stroke, is a common clinical cerebrovascular disease, accounting for about 10%-30% of stroke, with high morbidity and mortality. Objective To observe the effect of optimal management of hyperglycemia and intensive nursing on blood glucose control level and complications in patients with postoperative cerebral hemorrhage. Methods One hundred and eight patients with postoperative cerebral hemorrhage comorbid with stress hyperglycemia admitted to our neurosurgery department from February 2019 to February 2022 were selected and divided into a general group of 54 cases and an optimized group of 54 cases by simple random method. The general group was managed with conventional care, while the optimized group developed optimized management of hyperglycemia for intensive care. The indexes related to blood glucose control, electrolytes, National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI) scores, and time to achieve blood glucose standard, insulin pumping time, patient satisfaction, and prognosis were compared between the two groups. Results Before intervention, there was no statistical significance in the comparison of blood glucose control-related indicators and electrolytes between the two groups (P > 0.05). After 7 d and 14 d of intervention, the fasting blood glucose and 2 h postprandial blood glucose in the two groups were lower than before, while K+ and Na+ were higher than before (P < 0.05). The blood glucose indexes at the same time point in the optimized group were found to be lower than those in the general group by statistical analysis, but electrolytes were not statistically significant when compared with the general group (P > 0.05). In the optimized group, the time to achieve blood glucose standard (6.59 ± 1.94) d and insulin pumping time (7.14 ± 1.89) d were shorter than those in the general group [(7.48 ± 2.12) d and (8.58 ± 2.14) d], insulin dosage (748.85 ± 63.61) U was less than that in the general group (923.54 ± 84.14) U, and the incidence of hypoglycemia (3.70%) was lower than that in the general group (16.67%), and the satisfaction rate (92.59%) was higher than that of the general group (77.78%), which was statistically significant (P < 0.05). Before intervention, there was no significant difference in NIHSS score and BI score between the two groups (P > 0.05). After 7 d and 14 d of intervention, the NIHSS scores of the two groups were lower than before, while the BI scores were higher than before, and the NIHSS scores of the optimized group at the same time point were all lower than those of the general group, and the BI scores were higher than those of the general group (P < 0.05). The incidence of pulmonary infection (11.11%) and rebleeding (7.41%) in the optimized group were lower than those in the general group (25.93% and 22.22%), while deep vein thrombosis, multiple organ dysfunction syndrome (MODS), and death within 28 d was not statistically significant when compared with the general group (P > 0.05). Conclusion Optimal management of hyperglycemia and intensive nursing can effectively control the blood sugar level of patients after cerebral hemorrhage, reducing insulin dosage, and the occurrence of hypoglycemia, pulmonary infection, and rebleeding.

A Network Meta-Analysis of the Clinical Efficacy and Safety of Commonly Used Chinese Patent Medicines in the Auxiliary Treatment of Poststroke Depression.

Background Poststroke depression (PSD) is a serious complication of clinical cerebrovascular disease. Patients not only have depression-related emotional symptoms but also have physical symptoms, such as autonomic dysfunction. At the same time, patients with varying degrees of depression will delay the neurological function of stroke patients. The recovery time of cognitive function and limb function will increase the risk of accidental death and even aggravate the mortality of cerebrovascular disease. Through combining data analysis and related literature, seven types of Chinese patent medicines (CPMs) widely used in the clinical treatment of PSD have been screened out. These herbs exhibit some clinical comparability under the conditions that the syndrome type and dosage form are relatively uniform. Therefore, in this study, the network meta-analysis method was used to evaluate the safety and efficacy of the seven CPMs screened out, and the probability ranking was performed to screen the best clinical auxiliary treatment plan of CPM. Methods We searched the Chinese databases, including CNKI, WANFANG, and VIP, as well as the English databases, including the Cochrane Library, EMBASE, and PubMed, from inception to May 31, 2020, to identify randomized controlled trials (RCTs) on seven kinds of CPMs that were the subjects of the clinical research. The bias risk and quality of the included studies were analyzed with the Cochrane Handbook (version 5.1), ADDIS, and R software, and the results were compared in a network meta-analysis (NMA). Results In terms of clinical effectiveness, the seven kinds of CPMs all improved clinical curative effects, with Jieyu Anshen capsule adjuvant treatment having the most significant effect [odds ratio (OR) = 5.00, 95% CI (1.72–9.48)]. Wuling capsule AT can effectively reduce the score index of scale factors for the HAMD score, NIHSS score, and TESS score [mean difference (MD) = −3.95, 95% CI (−4.88–3.00); OR = −3.25, 95% CI (−5.46)–1.05); OR = 0.22, 95% CI (0.05–0.79), resp.]. Conclusion The mechanisms of seven CPMs in the adjuvant treatment of PSD have advantages. In terms of safety and efficacy, the CPMs had better clinical adjuvant treatment performance. Although this study concluded that the Jieyu Anshen capsule is the preferred drug for clinical treatment, a clear conclusion still needs to be verified in a high-quality randomized controlled study. In clinical practice, accurate selection and application can be carried out according to the specific characteristics of patients.

Relationship between recurrent ischemic events in cerebrovascular disease and cytochrome P450 2C19 gene polymorphism on the basis of thrombelastography.

Recurrent ischemic events in cerebrovascular disease present a difficult problem in clinical practice. The predictive value of cytochrome P450 2C19 (CYP2C19) gene polymorphism and high platelet reactivity for recurrent ischemic events in cerebrovascular disease is not clear. A total of 295 patients with acute ischemic cerebrovascular disease admitted to the cerebrovascular disease center of Northern Theater General Hospital between January 1, 2020 and February 2, 2021 were enrolled in this study. Thrombelastography (TEG) was used to detect platelet reactivity and CYP2C19 gene polymorphism. Among the 118 noncarriers, 97 had normal platelet reactivity and 21 had high platelet reactivity. Of the 177 carriers, 120 showed normal platelet reactivity and 57 showed high platelet reactivity. The area under the curve (AUC) of CYP2C19 gene polymorphism in predicting recurrent ischemic events was 0.66. The regression coefficients of hypertension, stroke history, carriers, and high platelet reactivity with recurrent ischemic events were 0.341, 0.402, 0.358, and 0.281, respectively, with significant positive correlation (P<0.05). Hypertension, stroke history, carriers, and high platelet reactivity are all independent risk factors for recurrent ischemic events. CYP2C19 gene polymorphism and high platelet reactivity can be used as effective predictors of recurrent ischemic events in clinical cerebrovascular disease.

Fatty liver and cerebrovascular disease: plausible association and possible mechanisms.

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity and has wide ranging extrahepatic manifestations, including through cardiometabolic pathways. As such, there is growing interest in the impact of NAFLD on cerebrovascular disease and brain health more broadly. In this review, we assess recent research into understanding the association between NAFLD and brain health while highlighting potential clinical implications. Mechanistically, NAFLD is characterized by both a proinflammatory and proatherogenic state, which results in vascular inflammation and neurodegeneration, potentially leading to clinical and subclinical cerebrovascular disease. Mounting epidemiological evidence suggests an association between NAFLD and an increased risk and severity of stroke, independent of other vascular risk factors. Studies also implicate NAFLD in subclinical cerebrovascular disease, such as carotid atherosclerosis and microvascular disease. In contrast, there does not appear to be an independent association between NAFLD and cognitive impairment. The current literature supports the formulation of NAFLD as a multisystem disease that may also have implications for cerebrovascular disease and brain health. Further prospective studies are needed to better assess a temporal relationship between the two diseases, confirm these early findings, and decipher mechanistic links.

Reader Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players

Schwab et al.1 rigorously describe postmortem neuropathology in 35 elite athletes. Brain tissue from well-characterized cases remains scarce, demanding creative approaches to data collection. The inadequacy of web-based methods alone is evident in the authors' inability to define their primary exposure, career duration, as well as incomplete characterization of isolated traumatic brain injury (TBI). Open-ended questions yielded 0% prevalence of more severe TBI—a stark contrast to population-based studies that report >20% prevalence of TBI with loss of consciousness.2 The authors assumed, but did not quantify mild TBI exposure, suggesting an accommodation of rigor to data available. That lifetime head trauma exposure is so poorly enumerated obscures investigation into the contributions of isolated TBI to the neuropathology of repetitive trauma and the exposure thresholds that confer elevated neurodegenerative disease risk. The value of a structured TBI screening tool cannot be understated,3 particularly for identification of remote events. Retrospective family interview is sometimes the best, and often the only method for postmortem characterization, and has contributed greatly to our understanding of clinical dementia and cerebrovascular disease.4,5 Common Data Elements for postmortem characterization of TBI exposure are now under development; their adoption will invite replication of this study's results with more complete data and an even greater scientific impact.

Icaritin Alleviates Glutamate-Induced Neuronal Damage by Inactivating GluN2B-Containing NMDARs Through the ERK/DAPK1 Pathway

Excitatory toxicity due to excessive glutamate release is considered the core pathophysiological mechanism of cerebral ischemia. It is primarily mediated by N-methyl-D-aspartate receptors (NMDARs) on neuronal membranes. Our previous studies have found that icaritin (ICT) exhibits neuroprotective effects against cerebral ischemia in rats, but the underlying mechanism is unclear. This study aims to investigate the protective effect of ICT on glutamate-induced neuronal injury and uncover its possible molecular mechanism. An excitatory toxicity injury model was created using rat primary cortical neurons treated with glutamate and glycine. The results showed that ICT has neuroprotective effects on glutamate-treated primary cortical neurons by increasing cell viability while reducing the rate of lactate dehydrogenase (LDH) release and reducing apoptosis. Remarkably, ICT rescued the changes in the ERK/DAPK1 signaling pathway after glutamate treatment by increasing the expression levels of p-ERK, p-DAPK1 and t-DAPK1. In addition, ICT also regulates NMDAR function during glutamate-induced injury by decreasing the expression level of the GluN2B subunit and enhancing the expression level of the GluN2A subunit. As cotreatment with the ERK-specific inhibitor U0126 and ICT abolishes the beneficial effects of ITC on the ERK/DAPK1 pathway, NMDAR subtypes and neuronal cell survival, ERK is recognized as a crucial mediator in the protective mechanism of ICT. In conclusion, our findings demonstrate that ICT has a neuroprotective effect on neuronal damage induced by glutamate, and its mechanism may be related to inactivating GluN2B-containing NMDAR through the ERK/DAPK1 pathway. This study provides a new clue for the prevention and treatment of clinical ischemic cerebrovascular diseases.

A comparative analysis framework of 3T and 7T TOF-MRA based on automated cerebrovascular segmentation.

High field strength 3T and 7T Time-Of-Flight Magnetic Resonance Angiography (TOF- MRA) achieves better visualization of intracranial vessels, so it attracts much attention. However, quantitative comparison between 3T and 7T MRA is lacking in the aspects of image quality and the practical application of cerebrovascular diseases. In this paper, a quantitative framework of 3T and 7T TOF-MRA comparison is proposed, which contains two steps including the automated cerebrovascular segmentation and statistical analysis. Firstly, the whole vascular structures on both 3T and 7T TOF-MRA images are segmented automatically, especially those small blood vessels in 7T MRA. The skeleton extraction-based automatic seed point detection is implemented to ensure the segmented vascular structure complete and precise. Secondly, the statistical analysis of the differences between 3T and 7T MRA is carried out in the aspects of image quality and the characteristics of some important vessels. The objects of statistical analysis are achieved and analyzed automatically without needing the time- consuming human beings' participation, therefore, it is efficient and objective. The comparison experiments on seven pairs of 3T and 7T TOF MRA images validated that about image quality, the contrast-to-noise ratio of 7T MRA was about 4.53 ± 0.95 times as much as that of 3T MRA. About the cerebrovascular information, small vessels were more abundant in 7T MRA compared with 3T MRA (branches number: 462.0 ± 58.5 vs 393.1 ± 63.3). The proposed framework can segment the whole cerebrovascular structure automatically and compare TOF-MRA with different field strengths objectively and quantitatively. It is helpful for clinical cerebrovascular disease, especially cerebral small vessel diseases.

Naoluo Xintong capsule ameliorates apoptosis induced by endoplasmic reticulum stress in rats with cerebral ischemia/ reperfusion injury

Naoluo Xintong (NLXT) capsuleis a newly developed drug recorded in the Chinese Pharmacopoeia. It is derived from traditional Chinese medicine (TCM) NLXT decoction, and has been widely used to treat cerebrovascular diseases in clinic. However, it is currently unknown whether it improve cerebral ischemia reperfusion (I/R) injury. The effect of NLXT on regional cerebral blood flow (rCBF) was examined using Laser Doppler flower. The Terminal deoxyribonucleotide transferase-mediated Nick end labeling (Tunel) assay was performed to determine the effects of NLXT on apoptosis. Subsequently, cerebral water content and TTC staining were measured to assess cerebral edema and infarct volume, respectively. The protein expression levels were analyzed with Immunofluorescence and western blot assays. The results indicated that NLXT ameliorated MCAO-induced cerebral I/R injury by decreasing infract volume, inhibition of apoptosis, and upregulation rCBF. In addition, it decreased the expression of key protein involved endoplasmic reticulum (ER)-stress, including glucose-regulated protein 78 (GRP78), C/EBP-homologous protein (CHOP) and Caspase-12 at 24 h following reperfusion. This was accompanied reduced degradation level of TRPC6 and increased phosphorylation of cAMP/Ca2+ response elementbinding protein (p-CREB), and decreased calpain-specific αII-spectrin breakdown product (SBDP145) activity. Interestingly, inhibition of mitogen-activated protein kinase (MEK) activity abolished the effect of NLXT on CREB activity. Collectively, the results indicated that NLXT can improve I/R injury therapy by activating TRPC6/MEK/CREB signaling pathway to attenuate ER-stress related neuronal apoptosis.

Network meta-analysis of Chinese patent medicine adjuvant treatment of poststroke depression.

Background:Poststroke depression is one of the common complications of clinical cerebrovascular diseases. It is commonly seen in 3 to 6 months after the onset of stroke. The incidence rate is 22% to 75%. The patient not only has depression-related emotional symptoms, but also are accompanied by autonomic nervous disorders and other physical symptoms. It will also delay the recovery time of patients’ neurological function, cognitive function, and limb function due to different degrees of depression, and even further aggravate the mortality and risk of accidental death of cerebrovascular disease. In recent years, Chinese patent medicine combined with western medicine has been widely used in the treatment of this disease. Many clinical practices have proved that the adjuvant treatment of pure Chinese herbal medicine can effectively alleviate the poststroke depression state and reduce the neurological deficits. The author has sorted out the relevant literature and data analysis to screen out the seven most representative and commonly used Chinese patent medicine preparations in clinical treatment of poststroke depression, which have certain clinical comparability when the dosage form and syndrome type are relatively unified. The network meta-analysis method is used to select the best clinical treatment plan, so as to provide reference value and evidence-based medicine evidence for the clinical optimization of drug selection.Methods:Using computer retrieval technology, comprehensive retrieval of CNKI, VIP, CBM, and WANFANG Chinese electronic database and the Cochrane Library, PubMed, Web of Science and EMBASE foreign electronic database. Search the clinical randomized controlled trials of these 7 kinds of Chinese patent medicines for adjuvant treatment of poststroke depression, and set a period of time is from the establishment of the database to May 31, 2020. The 3 authors will screen the literatures that meets the inclusion criteria, extract the data independently according to the predesigned rules, and evaluate the literature quality and bias risk of the included research according to the Cochrane 5.1 manual standard. R and the Aggregate Data Drug Information System software were used for data consolidation and network meta-analysis to evaluate the ranking probability of all interventions.Results:This network meta-analysis and probability ranking will identify the best Chinese patent medicine adjuvant treatment for poststroke depression.Conclusion:This study will provide systematic evidence-based medicine evidence for Chinese patent medicine adjuvant treatment for poststroke depression, and help clinicians, patients with poststroke depression and decision-makers to make more effective, safer, and economic optimal treatment plan in the decision-making process.PROSPERO registration number:CRD42020164543

β-Glucuronidase- and OATP2B1-mediated drug interaction of scutellarin in Dengzhan Xixin Injection: A formulation aspect.

Scutellarin is the major and active constituent of Dengzhan Xixin Injection (DZXX), a traditional Chinese medicine prepared from the aqueous extract of Erigeron breviscapus and widely used for the treatment of various cerebrovascular diseases in clinic. In present study, the possible pharmacokinetic differences of scutellarin after intravenous administration of scutellarin alone or DZXX were explored. Additional, the potential roles of β-glucuronidase (GLU) and OATP2B1 in drug-drug interaction (DDI) between scutellarin and constituents of DZXX were further evaluated in vitro. The plasma concentration, urinary and biliary excretion of scutellarin in rats after administration of DZXX, were significantly higher than those received scutellarin, while pharmacokinetic profile of Apigenin 7-O-glucuronide (AG) in rats was similar no matter AG or DZXX group. Furthermore, higher concentration in brain and plasma, however, lower level of scutellarin in intestine were observed after intravenous administration of DZXX. Finally, AG and caffeoylquinic acid esters were found to significantly inhibit GLU and OATP2B1 in vitro, which might explain, at least in part, the pharmacokinetic DDI between scutellarin and other chemical constituents in DZXX. The findings provided deep insight into the prescription-formulating principle in DZXX for treating the cerebrovascular diseases.

Retinal Vascular Signs and Cerebrovascular Diseases.

Cerebrovascular disease (CeVD), including stroke, is a leading cause of death globally. The retina is an extension of the cerebrum, sharing embryological and vascular pathways. The association between different retinal signs and CeVD has been extensively evaluated. In this review, we summarize recent studies which have examined this association. We searched 6 databases through July 2019 for studies evaluating the link between retinal vascular signs and diseases with CeVD. CeVD was classified into 2 groups: clinical CeVD (including clinical stroke, silent cerebral infarction, cerebral hemorrhage, and stroke mortality), and sub-clinical CeVD (including MRI-defined lacunar infarct and white matter lesions [WMLs]). Retinal vascular signs were classified into 3 groups: classic hypertensive retinopathy (including retinal microaneurysms, retinal microhemorrhage, focal/generalized arteriolar narrowing, cotton-wool spots, and arteriovenous nicking), clinical retinal diseases (including diabetic retinopathy [DR], age-related macular degeneration [AMD], retinal vein occlusion, retinal artery occlusion [RAO], and retinal emboli), and retinal vascular imaging measures (including retinal vessel diameter and geometry). We also examined emerging retinal vascular imaging measures and the use of artificial intelligence (AI) deep learning (DL) techniques. Hypertensive retinopathy signs were consistently associated with clinical CeVD and subclinical CeVD subtypes including subclinical cerebral large artery infarction, lacunar infarction, and WMLs. Some clinical retinal diseases such as DR, retinal arterial and venous occlusion, and transient monocular vision loss are consistently associated with clinical CeVD. There is an increased risk of recurrent stroke immediately after RAO. Less consistent associations are seen with AMD. Retinal vascular imaging using computer assisted, semi-automated software to measure retinal vascular caliber and other parameters (tortuosity, fractal dimension, and branching angle) has shown strong associations to clinical and subclinical CeVD. Other new retinal vascular imaging techniques (dynamic retinal vessel analysis, adaptive optics, and optical coherence tomography angiography) are emerging technologies in this field. Application of AI-DL is expected to detect subclinical retinal changes and discrete retinal features in predicting systemic conditions including CeVD. There is extensive and increasing evidence that a range of retinal vascular signs and disease are closely linked to CeVD, including subclinical and clinical CeVD. New technology including AI-DL will allow further translation to clinical utilization.

Efficacy and safety of oral traditional Chinese patent medicine for chronic cerebral circulation insufficiency patients: A protocol for a systematic review and network meta-analysis.

Background:Chronic cerebral circulation insufficiency (CCCI) is a common clinical cerebrovascular disease, especially among middle-aged and elderly patients, which seriously endangers their quality of life and physical and mental health. At present, Oral traditional Chinese patent medicine (OTCPM) is widely used in the treatment of CCCI in China, but its actual efficacy and safety lack of evidence-based evidence. Therefore, we will screen out the most effective OTCPM through a systematic review and network meta-analysis to provide a reliable theoretical basis for clinical decisions.Methods:We will search electronic databases to collect relevant RCT studies from inception to October 2019. Those electronic databases include PubMed, Cochrane Library, Web of Science, EMBASE, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan-fang database. Only randomized clinical trials (RCTs) concerned any OTCPM treatments for CCCI will be collected. The included studies will no restrictions on language or publication year. There were no publication year or language for the included literature. Risk bias tools will assess the quality of the included literature. A Bayesian NMA will be performed to combine the direct and indirect comparisons of TCPMs interventions. The surface under the cumulative ranking curve (SUCRA) will be drawn to display the hierarchy of each TCPMs treatment. All statistical analyses will be implemented using R v3.5.2. and GeMTC v1.4.3.We will publish this systematic review in academic journals. Since this literature review will not involve directly contacting patients, ethical approval and informed consent are not required.Trial registration number:CRD42019123878.

The research progress of clinical prophylaxis with aspirin

Aspirin is a non-steroidal anti-inflammatory drug, has good antipyretic and analgesic effects, but also inhibits platelet aggregation and antithrombotic effects, commonly used in clinical coronary heart disease and cerebrovascular disease in first grade, two grade prevention.The need to pay attention to the medication time, interaction, the risk of bleeding, medication use in special populations in the process, to ensure the reasonable clinical medication of aspirin.This review summarizes the research progress of aspirin prophylaxis. Key words: Aspirin; Application; Safety

Mortality in patients with atrial fibrillation and common co-morbidities – a cohort study in primary care

Objective: To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation.Methods: The study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45–64, 65–74 and ≥75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities.Results: During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45–64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65–74 year old men and the 45–64 year old women. Low HRs were found for hypertension among women ≥75 years of age.Conclusions: In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution.KEY MESSAGESWe found congestive heart failure and cerebrovascular diseases to be consistently associated with mortality in both women and men.We found hypertension to be associated with lower mortality risk among women ≥75 years of age, although this finding must be interpreted with caution.Depression was found to be associated with increased mortality risk among men and women aged 65–74 years of age.

The application of Web-based PBL in clinical teaching cerebrovascular disease of integration traditional Chinese and Western

Objective To explore the effects of WPBL teaching pattern on cerebrovascular disease clinical education. Methods The subjects were 40 students from June 2015 to December 2015 in the affiliated TCM-Integrated Hospital of Shanghai University of Traditional Chinese Medicine for resident standardization training and were randomly divided into study group and control group, with 20 students for each group. Network PBL teaching and traditional teaching were used to combine traditional Chinese medicine with western medicine in the clinical teaching of cerebrovascular disease. After the teaching, the two groups of students were assessed with clinical knowledge and skills, and a questionnaire survey was conducted. SAS 9.2 software was used for statistical analysis, and the data comparison was performed by t test. Results The clinical knowledge score of the study group (93.35±2.60) was significantly higher than that of the control group (85.25±3.10), and the difference was statistically significant (P=0.000). The clinical skill score of the study group (93.50±2.11) was significantly higher than the control group (82.50±1.82), and the differ-ence was statistically significant (P=0.000); 80% students thought it was helpful to improving the mastery of theoretical knowledge and clinical skills, 90% of the students considered it helpful for communication and teamwork, and 95% of them thought it would help to analyze and solve clinical problems. Conclusions The Web-based PBL can effectively improve the clinical teaching effects of cerebrovascular disease of integration traditional Chinese and Western. Key words: Web-based PBL; Cerebrovascular disease; Integration traditional Chinese and Western medicine; Clinical education