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    Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023
    Chinese Stroke Association, Chinese Interventional Neuroradiology Society, Intervention Group of Committee of Stroke Prevention and Control of Chinese Preventive Medicine Association
    Chinese Journal of Stroke    2023, 18 (06): 684-711.   DOI: 10.3969/j.issn.1673-5765.2023.06.010
    Abstract6932)      PDF (2089KB)(7325)       Save
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt)——Chapter Four Clinical Management of Ischaemic Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (8): 910-933.   DOI: 10.3969/j.issn.1673-5765.2023.08.009
    Abstract4143)      PDF (19848KB)(4045)       Save
    The incidence of stroke in the Chinese population is still on the rise, accounting for nearly one-fourth of the global annual stroke cases. Among adults aged 40 or above in China, ischaemic stroke (IS) accounted for approximately 86.8% of all strokes. Since the publication of the 2019 Chinese Stroke Association guidelines, notable advancements have emerged in acute-phase reperfusion therapy and antiplatelet treatments for secondary prevention in IS. The guidelines have provided updated recommendations on evaluation and diagnosis of acute phase of ischaemic stroke, reperfusion therapy, antiplatelet therapy, other treatments in the acute phase, general supportive treatment and complications management, early evaluation and diagnosis of aetiology and pathogenesis, interventions targeting aetiology and pathogenesis, risk factors management, and long-term intervention.
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt)——Chapter Six Clinical Management of Subarachnoid Hemorrhage
    CHENG Xin, ZHONG Weiyi, DONG Yi, LI Qi, NI Wei, GU Hongqiu, GU Yuxiang, DONG Qiang, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (9): 1024-1029.   DOI: 10.3969/j.issn.1673-5765.2023.09.008
    Abstract2911)      PDF (4110KB)(559)       Save
    SAH is one of common hemorrhagic cerebrovascular diseases with severe complications. Many survivors are left with persistent neurological deficit and reduced quality of life. Researchers at home and abroad have been committed to exploring effective diagnosis and treatment of SAH to improve the clinical outcomes of patients. This guideline has formed evidence-based recommendations in comprehensive management of SAH, especially in diagnosis and severity assessment, multidisciplinary collaboration, measures to prevent rebleeding and complication managements, in order to provide standardized guidance for clinical practice of SAH in China. 
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt)——Chapter Eight Cerebrovascular Disease Rehabilitation Management
    ZHANG Tong, ZHAO Jun, LI Xueping, BAI Yulong, WANG Baojun, QU Yun, LI Bingjie, MEI Liping, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (9): 1036-1048.   DOI: 10.3969/j.issn.1673-5765.2023.09.010
    Abstract2901)      PDF (10805KB)(761)       Save
    Stroke is characterized by high morbidity, high mortality and high disability. Rehabilitation for stroke patients can improve dysfunctions and activities of daily living (ADL), and potentially prevent stroke-related complications. Therefore, surviving patients could return to their families and fit into the world. Standardized rehabilitation procedures and programs are particularly critical. This guideline will introduce the stroke rehabilitation management model, the tertiary stroke rehabilitation network. Recommendations were formed on the assessment and rehabilitation of specific functional disorders (motor dysfunction, sensory impairment, dysphagia, dysarthria, aphasia, cognitive disorder, cardiopulmonary dysfunction, psychological disorder), rehabilitation of ADL and social participation disorders, vocational rehabilitation, assessment and rehabilitation of complications (skin breakage, contracture, deep vein thrombosis, intestinal and bladder incontinence, hemiplegic shoulder pain, shoulder-hand syndrome, central pain, osteoporosis), and rehabilitation nursing. 
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition)(Excerpt)—Chapter One Overview
    TAN Zefeng, LIU Liping, XU Anding, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (07): 817-821.   DOI: 10.3969/j.issn.1673-5765.2023.07.012
    Abstract2698)      PDF (2046KB)(765)       Save
    The Second Edition of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases is an updated and enhanced version of the first edition, which was first published in 2019. This latest edition has been meticulously compiled by a panel of authoritative experts from the Chinese Stroke Association, incorporating recent breakthroughs and novel evidence within the field of cerebrovascular diseases. The guideline provides a comprehensive overview of clinical management strategies for cerebrovascular diseases, including structured stroke care, management of high-risk populations, therapeutic interventions for both ischemic and hemorrhagic strokes, clinical management of cerebral venous sinus thrombosis, and stroke rehabilitation management. The primary objective is to provide guidance for professionals and social workers engaged in stroke prevention, care, and rehabilitation, as well as governmental agencies, healthcare administrators, pharmaceutical companies, healthcare providers, and other stakeholders. 
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt)——Chapter Seven Clinical Management of Cerebral Venous Thrombosis
    FAN Yuhua, DANG Chao, YU Jian, CHEN Hongbing, DUAN Jiangang, MO Dapeng, ZHU Wenhao, OUYANG Fubing, WANG Bo, ZENG Jinsheng, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (9): 1030-1035.   DOI: 10.3969/j.issn.1673-5765.2023.09.009
    Abstract2625)      PDF (4260KB)(537)       Save
    The incidence of CVT is low, but the rate of clinical missed diagnosis and misdiagnosis is high. Improving understanding of CVT, timely diagnosis and treatment can help improve the prognosis of patients with CVT. This chapter presents recommendations for the diagnosis and treatment of CVT, including the application of imaging diagnostic technology, the selection and treatment course of anticoagulants, the selection of intravascular treatment, and the prevention and treatment of complications.
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    Relationship between Intracranial Atherosclerotic Stenosis and Cognition
    SI Qianqian, CHENG Anqi, FAN Xiaoyuan, ZHANG Xiaoqian, LI Mingli, FENG Feng, LIU Caiyan, XU Weihai
    Chinese Journal of Stroke    2023, 18 (04): 418-427.   DOI: 10.3969/j.issn.1673-5765.2023.04.007
    Abstract2539)      PDF (1886KB)(109)       Save
    Objective  To evaluate the cognitive function changes in patients with intracranial atherosclerotic stenosis (ICAS) . 
    Methods  The patients diagnosed with ICAS (stenosis>50%) in Department of Neurology of Peking Union Medical College Hospital from December 2021 to December 2022 were consecutively enrolled in this study. Based on the presence or absence of previous ischemic stroke or transient ischemic attacks (TIA) caused by ICAS, they were classified into symptomatic or asymptomatic ICAS group. The healthy people matched for age and education were included in the control group. Global cognition and four cognitive domains (including memory, executive function, language function, visuospatial function) were evaluated in all the subjects. The differences in traditional cerebrovascular risk factors and cerebrovascular disease burden, brain atrophy and apolipoprotein E (ApoE) genotype were compared among the three groups, to screen the possible cognitive influencing factors. The global cognition and average Z-score of each cognitive domain were compared among the groups by covariance analysis controlling the confounders. 
    Results  A total of 170 patients with ICAS, including 103 patients with asymptomatic ICAS [52 males, mean age of (55.86±11.78) years] and 67 patients with symptomatic ICAS [44 males, mean age of (57.49±10.75) years], and 91 controls [39 males, mean age of (56.21±9.70) years] were included in this study. Compared with patients with asymptomatic ICAS, patients with symptomatic ICAS had a higher incidence of posterior circulation stenosis (40.3% vs. 22.3%, P=0.016) , especially vertebral artery stenosis (22.4% vs. 9.7%, P=0.028) , as well as higher incidence of white matter hyperintensities (Fazekas grade≥2) (40.3% vs. 16.5%, P=0.001) and medial temporal lobe atrophy [medial temporal atrophy (MTA) grade≥2] (17.9% vs. 5.8%, P=0.020) . 
    After adjusting for age, gender, education years, cerebrovascular risk factors (hypertension, diabetes, hyperlipidemia, coronary heart disease and smoking) , white matter hyperintensities and medial temporal lobe atrophy, patients with asymptomatic and symptomatic ICAS had  lower MoCA score (25.79±0.30 vs. 27.15±0.36, P=0.017; 24.18±0.39 vs. 27.15±0.36, P<0.001) and Z-score of language function (0.60±0.12 vs. 1.10±0.14, P=0.030; 0.02±0.15 vs. 1.10±0.14, P<0.001) compared with the controls; patients with symptomatic ICAS had lower MoCA score (24.18±0.39 vs. 25.79±0.30, P=0.003) and Z-score of language (0.02±0.15 vs. 0.60±0.12, P=0.006) and executive function (-0.45±0.15 vs. 0.12±0.11, P=0.006) than those with asymptomatic ICAS. 
    Conclusions  Patients with symptomatic or asymptomatic ICAS  presented with  declined global cognition and language function, and patients with symptomatic ICAS also showed declined executive function. The patients with symptomatic ICAS had more severe cognition decline, independent of traditional cerebrovascular risk factors, white matter hyperintensities, and medial temporal lobe atrophy. 
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt) ——Chapter Five Clinical Management of Intracerebral Hemorrhage
    ZHANG Qian, JI Ruijun, ZHAO Meng, WANG Wenjuan, LU Jingjing, LI Na, LIU Yanfang, BIAN Liheng, YU Songlin, LI Hao, ZHANG Qian, WU Jianwei, WANG Dandan, WANG Jing, LI Zhaoxia, JIANG Ruixuan, KANG Kaijiang, XUE Yimeng, YA Xiaolong, HE Qiheng, MO Shaohua, ZHAO Xingquan, ZHAO Jizong, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases ( Contributed equally)
    Chinese Journal of Stroke    2023, 18 (9): 1014-1023.   DOI: 10.3969/j.issn.1673-5765.2023.09.007
    Abstract2533)      PDF (7327KB)(968)       Save
    Spontaneous intracerebral hemorrhage represents a severe subtype of stroke, accounting for approximately 23.4% of stroke cases in China. It is characterized by its rapid onset, swift disease progression, and high rates of mortality and disability. Given the urgency and complexity in managing intracerebral hemorrhage, this guideline aims to provide systematic and comprehensive recommendations for its clinical management. This chapter covers all key aspects ranging from pre-hospital evaluation and medical intervention to secondary prevention and rehabilitation. With respect to specific recommendations, this guideline offers exhaustive guidance based on varying levels of evidence for early diagnosis, imaging assessments, acute-phase interventions, medical and ICU management, surgical interventions, and secondary prevention strategies, with the ultimate aim of enhancing the scientific rigor and systematic quality of spontaneous intracerebral hemorrhage management. 
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    Analysis of Language Impairment Characteristics in Patients with Post-Stroke Broca's Aphasia
    YUAN Zinan, LI Siqi, CHEN Xinya, ZHANG Yumei
    Chinese Journal of Stroke    2023, 18 (11): 1238-1247.   DOI: 10.3969/j.issn.1673-5765.2023.11.004
    Abstract2391)      PDF (15602KB)(136)       Save
    Objective  The aim of this study was to analyze the language impairment characteristics in patients with post-stroke Broca’s aphasia (PSBA) using the Chinese aphasia language battery (CALB).
    Methods  Patients with PSBA who attended the Neurology Center and Department of Rehabilitation Medicine of Beijing Tiantan Hospital, Capital Medical University, from March 2021 to December 2022 were consecutively enrolled and divided into mild, moderate and severe groups according to the aphasia quotient. Normal controls (NC) with matching age and education level in the same time period were also recruited. CALB was used to assess language function. To compare the differences in CALB scores between the PSBA group and the healthy control group, as well as the mild, moderate, and severe groups of PSBA patients.
    Results  Totals of 35 PSBA patients (15 mild, 12 moderate and 8 severe) and 36 NC were included in this study. ①PSBA group performed significantly worse than normal controls on subtasks of the naming battery, except for the tone recognition task. Patients in the mild, moderate, and severe groups differed significantly on the confrontation naming (high-frequency and low-frequency words) and repetition (non-word and word repetition) tasks. PSBA patients performed significantly better with high-frequency words in naming and understanding than low-frequency words, especially in the overall analysis and in the mild group. No statistically significant differences were found in the performance of different categories of nouns (animals, clothing, body parts, fruits and vegetable, tools, and colors). The analysis of nouns and verbs revealed that PSBA patients performed better with nouns than verbs in terms of naming and understanding, but the statistical differences were not significant in any of the groups. The analysis of verbs revealed that patients performed better on intransitive verbs than on transitive verbs, and the worst naming and understanding of three-argument verbs was found in the performance of verbs with different argument structures. ②PSBA patients’ performance on the assessment of verbs and sentences was lower than normal controls on all tasks. Patients with PSBA of different severity levels had performance differences in verb naming, argument structure and sentence production. In terms of argument structure production, it was found that verbs with more complex argument structure, PSBA patients showed lower correct rate compared to verbs with less complex entries. This was particularly evident in the overall analysis and in the mild group.
    Conclusions  PSBA patients have varying degrees of impairment in the overall language processing pathway, with the voice input pathway being less impaired than the output pathway. In terms of different category lexical performance, patients had greater difficulty in processing verbs than nouns, lower frequency lexical processing impairment in nouns was heavier than high frequency nouns. With verbs, the more arguments structure that a verb had, the worse the patients' performance was.
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    Development and Validation of a Predictive Model for In-Hospital Recurrence Risk in Ischemic Stroke Patients
    CHEN Siding, JIANG Yingyu, WANG Chunjuan, YANG Xin, LI Zixiao, JIANG Yong, WANG Yongjun, GU Hongqiu
    Chinese Journal of Stroke    2023, 18 (12): 1397-1404.   DOI: 10.3969/j.issn.1673-5765.2023.12.009
    Abstract2172)      PDF (6708KB)(120)       Save
    Objective  Develop a predictive model for in-hospital recurrence risk of ischemic stroke patients based on machine learning algorithms and externally validate it to provide insights for related research.
    Methods  The development cohort was the China Stroke Center Alliance (CSCA) research cohort, and ischemic stroke patients in this cohort were randomly divided into training and internal validation sets in an 8∶2 ratio. The validation cohort was the Third China National Stroke Registry (CNSR-Ⅲ) research cohort. A list of candidate predictive factors was determined based on guidelines, literature, and data, followed by selection using least absolute shrinkage and selection operator (LASSO) regression. A predictive model for the in-hospital recurrence risk of ischemic stroke patients was developed using logistic regression and machine learning algorithms[random forest model, eXtreme gradient boosting (XGBoost) model, light gradient boosting machine (LightGBM) model]. Model evaluation primarily focused on discrimination (C-statistic) and calibration (Brier score). 
    Results  The CSCA research cohort included 1 587 779 cases of ischemic stroke patients, with 99 085 cases of in-hospital recurrence (6.2%). The CNSR-Ⅲ research cohort included 14 146 cases of ischemic stroke patients, with 623 cases of in-hospital recurrence (4.4%). LASSO feature selection revealed that age, gender, stroke history, hypertension, diabetes, lipid metabolism disorders, atrial fibrillation, heart failure, coronary artery heart disease, peripheral vascular disease, LDL-C, fasting blood glucose, serum creatinine and in-hospital anticoagulation therapy were important predictive factors for predicting in-hospital recurrence of ischemic stroke patients. In internal validation, the discrimination of each model was around 0.75, with XGBoost model slightly outperforming other models (AUC 0.765, 95%CI 0.759-0.770), and the Brier scores for all models were around 0.05. In external validation, the predictive performance of all models was relatively low (AUC<0.60), with Brier scores for all models less than 0.08. 
    Conclusions  In the limited context of the number and dimensions of predictive factors, the efficacy of logistic models and machine learning algorithms in predicting the recurrence risk of stroke was relatively low. Future exploration should involve more investigation into predictive factors and algorithm models.
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Except) ——Chapter Three Management of Patients at Hige-risk of Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (8): 898-909.   DOI: 10.3969/j.issn.1673-5765.2023.08.008
    Abstract2145)      PDF (8660KB)(759)       Save
    Early intervention to manage the risk factors of cerebrovascular disease is the most effective way to reduce the harm of cerebrovascular diseases. This chapter presents recommendations for the management of populations at high risk for cerebrovascular disease, including control of non-interventionable and interventionable vascular risk factors, the use of aspirin in the primary prevention of ischaemic stroke, and the risk assessment of first-time stroke. 
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    Advances in Clinical Research of Neuropsychology and Imaging of Vascular Cognitive Impairment
    CHENG Anqi, LIU Caiyan, XU Weihai
    Chinese Journal of Stroke    2023, 18 (11): 1222-1227.   DOI: 10.3969/j.issn.1673-5765.2023.11.002
    Abstract2059)      PDF (7770KB)(119)       Save
    Vascular cognitive impairment (VCI) is a decline in cognitive function caused by cerebrovascular disease and its risk factors, which has gradually become a major public health problem in the society. Neuropsychology and imaging findings are well-recognized standards of diagnosis and classification of VCI. This paper reviewed the advances in neuropsychology and imaging in clinical applications to accurately diagnose and predict the progression of VCI. In addition to post-stroke cognitive impairment and subcortical ischemic VCI, this paper also discussed the research advances in hypoperfusion cognitive impairment and mixed cognitive impairment.
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    Study on Predictive Model of Cerebral Hemorrhage during Hospitalization in Patients with Acute Ischemic Stroke Treated with rt-PA Intravenous Thrombolysis
    CHEN Hui, CHEN Siding, ZHU Zhikai, YU Weiran, JIANG Yong, WANG Yongjun
    Chinese Journal of Stroke    2023, 18 (05): 547-555.   DOI: 10.3969/j.issn.1673-5765.2023.05.009
    Abstract2034)      PDF (3197KB)(144)       Save
    Objective  To predict the incidence of cerebral hemorrhage in patients with acute ischemic stroke (AIS) or TIA undergoing intravenous thrombolytic therapy with rt-PA based on machine learning algorithm, and explore the risk factors affecting the incidence of cerebral hemorrhage after rt-PA thrombolytic therapy.  
    Methods  A total of 74 654 patients who were initially diagnosed as AIS or TIA and received rt-PA intravenous thrombolytic therapy were enrolled in the Chinese Stroke Center Alliance (CSCA) from January 2016 to December 2020, with an average age of (65.55±12.14) years. Among them, 48 493 were male patients, accounting for 64.96%, and 2038 were cerebral hemorrhage patients during hospitalization, accounting for 2.73%. The data is divided into training sets and test sets by year, that is, the registered patients in 2016—2019 are divided into training sets, and the registered patients in 2020 are divided into test sets. The positive and negative samples of the training set data are 77∶100 balanced using the prototype selection down-sampling technology, and the logistic regression, extreme gradient boosting (XGBoost), random forest, gradient boosting decision tree (GBDT) and categorical boosting (CatBoost) are five models to predict the outcome of intracerebral hemorrhage, and use AUC, sensitivity, specificity, Brier score and other indicators to evaluate and compare the prediction effect of the model, and use SHAP chart to analyze the interpretability of the features screened by the machine learning model. 
    Results  The AUC values of XGBoost, GBDT, CatBoost, logistic regression and random forest were 0.770 (95%CI 0.745-0.774), 0.766 (95%CI 0.753-0.786), 0.765 (95%CI 0.752-0.766), 0.758 (95%CI 0.747-0.761) and 0.757 (95%CI 0.739-0.759) respectively, the sensitivity was 0.624 (95%CI 0.574-0.672), 0.606 (95%CI 0.555-0.655), 0.570 (95%CI 0.519-0.620), 0.557 (95%CI 0.506-0.607) and 0.585 (95%CI 0.534-0.635) respectively, the specificity was 0.780 (95%CI 0.773-0.786), 0.785 (95%CI 0.778-0.791), 0.790 (95%CI 0.783-0.796), 0.805 (95%CI 0.799-0.811) and 0.769 (95%CI 0.762-0.776) respectively, and the Brier score was 0.157, 0.154, 0.156, 0.160 and 0.161 respectively. Through the SHAP diagram, we found that the characteristics of high NIHSS score, old age, high fasting blood glucose level, history of atrial fibrillation, low platelet count, long time window between onset and thrombolytic therapy, low BMI, and high NIHSS score at the time of visit were risk factors affecting the incidence of cerebral hemorrhage during the hospitalization of rt-PA thrombolytic therapy.  
    Conclusions  The prediction model based on machine learning can predict the occurrence of intracerebral hemorrhage in AIS patients undergoing rt-PA thrombolytic therapy during hospitalization. This study has certain exploration value for the application of machine learning technology in the field of intracerebral hemorrhage prediction in the future.
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    Study on the Relationship between Hypersensitive C-reactive Protein, Asymptomatic Carotid Artery Stenosis and Cognitive Impairment in Chinese Community Adults
    SHEN Yuan, WANG Jing, WANG Anxin, ZHAO Xingquan
    Chinese Journal of Stroke    2023, 18 (05): 556-563.   DOI: 10.3969/j.issn.1673-5765.2023.05.010
    Abstract2029)      PDF (2022KB)(104)       Save
    Objective  To explore the relationship between hs-CRP, asymptomatic carotid stenosis (ACS) and cognitive impairment based on a Chinese community study.
    Methods  This study is based on a cross-sectional analysis of the follow-up data of asymptomatic polyvascular abnormalities community (APAC) study in 2012. The Chinese MMSE was used as the cognitive screening scale, and less than 24 is considered cognitive impairment. After adjusting for confounding factors such as sex, age, BMI, education, smoking, alcohol consumption, physical activity, history of hypertension, hyperlipidemia, diabetes, and stroke, the logistic regression model was used to analyze the correlation between hs-CRP, ACS and cognitive impairment. 
    Results  A total of 3925 subjects (including 1688 women, accounting for 43.01%) were included in the study. Logistic regression analysis showed that hs-CRP≥3 mg/L had no significant difference in the effect with or without ACS on cognitive impairment without adjusting for relevant factors (without ACS: OR 0.67, 95%CI 0.30-1.45; with ACS: OR 0.86, 95%CI 0.58-1.28). After adjusting for confounding factors, hs-CRP≥3 mg/L also had no significant difference in the effect with or without ACS on cognitive impairment (without ACS: OR 0.65, 95%CI 0.24-1.75; with ACS: OR 0.97, 95%CI 0.59-1.60). 
    Conclusions  The levels of hs-CRP has no significant impact on cognitive impairment in patients with or without ACS. Therefore, regardless of whether patients have ACS or not, hs-CRP may not be significantly associated with early cognitive decline.
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    Construction and Verification of Short-term Malnutrition Prediction Model for Patients with Acute Ischemic Stroke without Basal Metabolic Diseases
    ZHANG Lan, SHEN Xiaofang, JIN Jin, XU Ji, ZHANG Jing
    Chinese Journal of Stroke    2023, 18 (04): 428-433.   DOI: 10.3969/j.issn.1673-5765.2023.04.008
    Abstract1961)      PDF (1914KB)(57)       Save
    Objective  To analyze the influencing factors of short-term malnutrition in patients with acute ischemic stroke (AIS) without basal metabolism disease, and construct a clinical prediction model of short-term malnutrition in AIS. 
    Methods  The AIS patients without basal metabolism diseases from Department of Neurology of Suzhou Ninth People’s Hospital from March 2019 to June 2021 were retrospectively included as the modeling cohort. The mini-nutritional assessment short-form (MNA-SF) , BMI and albumin (Alb) were used to evaluate for nutrition condition at 2 weeks after admission. The malnutrition was defined as the MNA-SF score < 8, BMI < 18.5 kg/m2 and Alb < 35.0 g/L, then the patients were divided into malnutrition group and non-malnutrition group. A prediction model was constructed based on the variables screened by multivariate logistic regression analysis. The discrimination was evaluated by ROC curve, and the calibration was evaluated by goodness of fit test. AIS patients without underlying metabolic diseases in Department of Neurology of Suzhou Ninth People’s Hospital from August 2021 to June 2022 were selected as the validation cohort of the model. 
    Results  The modeling cohort included 924 AIS patients, with the mean age of 55.0±14.3 years and 544 males (58.9%) .72 cases (7.8%) of malnutrition were screened at 2 weeks after admission. Multivariate analysis showed that advanced age (OR 2.059, 95%CI 1.132-3.743, P=0.018) , drinking history (OR 1.747, 95%CI 1.076-2.835, P=0.024) , nutritional risk at admission (OR 2.951, 95%CI 1.485-5.859, P=0.002) , no nutritional support in hospital 
    (OR 1.870, 95%CI 1.065-3.284, P=0.029) , low admission Caiteng's grade (OR 0.226, 95% CI 0.079-0.652, P=0.006) , and high admission NIHSS score (OR 1.556, 95%CI 1.057-2.289, P=0.025) were independent influencing factors of short-term malnutrition in AIS patients without underlying metabolic diseases. According to the influencing factors, the prediction model equation is: logit (P) = 0.722 × age + 0.558 × drinking history + 1.082 × nutritional risk at admission + 0.626 × no nutritional support in hospital-1.483 × Caiteng grade + 0.442 × NIHSS score + 0.479-31.187. The AUC of this model for predicting short-term malnutrition was 0.863 (95% CI 0.811-0.914) . The sensitivity and specificity of the maximum Youden index (0.703) were 87.50% and 83.90%, respectively. Goodness of fit test χ2=2.754, P=0.498. The validation cohort included 126 AIS patients without underlying metabolic diseases. The sensitivity, specificity and accuracy of the validation cohort-based model for predicting malnutrition were 86.96%, 83.50% and 84.13%, respectively. 
    Conclusions  Advanced age, drinking history, nutritional risk at admission, no nutritional support in hospital, low Caiteng grade and high NIHSS score at admission were the influencing factors of short-term malnutrition in AIS patients without underlying metabolic diseases. The clinical prediction model based on the above indicators has good prediction performance. 
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    Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition)(Excerpt)—Chapter Two Stroke Organized Management
    LOU Min, DING Jing, ZHANG Yusheng, HU Bo, WAN Yan, ZHANG Kemeng, FEI Beini, XU Bingdong, TAN Zefeng, XU Anding, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases
    Chinese Journal of Stroke    2023, 18 (07): 822-828.   DOI: 10.3969/j.issn.1673-5765.2023.07.013
    Abstract1880)      PDF (1738KB)(501)       Save
    Stroke is a leading cause of mortality and disability among adults in China, imposing a substantial burden on both patients and societal development. The organizational management method can improve the medical quality of stroke to some extent. However, the heterogeneity of logistics support capacity in medical institutions brings uncertain effects on the effectiveness of stroke organizational management. In order to  improve the organized management model of stroke and enhance the scientific and systematic nature of stroke treatment, this guidelines has formed recommendations on the coordination of pre-hospital emergency systems and stroke care facilities, multidisciplinary collaboration within emergency settings, the continuous quality improvement of green channels, the organizational management of stroke units and stroke clinics, development of regional stroke center networks, as well as medical quality assessment and enhancement initiatives.
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    Challenges in Clinical Practice of Post-Stroke Cognitive Impairment 
    LIU Caiyan, CHENG Anqi, XU Weihai
    Chinese Journal of Stroke    2023, 18 (11): 1215-1219.   DOI: 10.3969/j.issn.1673-5765.2023.11.001
    Abstract1865)      PDF (5588KB)(164)       Save
    Post-stroke cognitive impairment (PSCI) refers to any severity of cognitive impairment within six months after a stroke. Because stroke usually leads to aphasia, apraxia and agnosia, neuropsychological assessment of PSCI should be different from general assessment battery, and appropriate examination should be chosen to avoid overestimation of the severity of cognitive impairment. The etiology of PSCI is complex and needs to be comprehensively considered. In addition to the etiology of stroke, the background of brain pathology related to brain reserve should also be considered, such as cerebral small vessel disease and neurodegene-rative diseases. For the treatment of PSCI, etiological and symptomatic treatment, drug and non-drug treatment are very important.
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    Sleep Disorder and Non-drug Therapy in Patients with Vascular Cognitive Impairment
    ZHANG Xinyi, CHEN Chuxin, DONG Jianyu, ZHANG Ning, WANG Chunxue
    Chinese Journal of Stroke    2023, 18 (05): 601-609.   DOI: 10.3969/j.issn.1673-5765.2023.05.017
    Abstract1808)      PDF (1718KB)(114)       Save
    Patients of vascular cognitive impairment often suffered from all kinds of sleep problems, which further reduced their quality of life, improved risk of cerebrovascular events and increased their caregiver’s burden. Effective treatment of sleep disorders can not only improve the quality of life of patients, but also have positive effects on the cognitive and functional rehabilitation of patients. In this article, we reviewed the common sleep problems in patients of vascular cognitive impairment, elaborated on the present research results of non-pharmacological treatments to these problems, and discussed the future research fields and application prospects of non-pharmacological therapy for sleep disturbance of vascular cognitive impairment patients.
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    Prediction Models of Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review
    YANG Jiaxin, HE Chunyu, LIU Lei, CHEN Wenbo, XIE Yan
    Chinese Journal of Stroke    2024, 19 (1): 76-86.   DOI: 10.3969/j.issn.1673-5765.2024.01.011
    Abstract1670)      PDF (2224KB)(72)       Save
    Objective  To systematically evaluate the prediction models of symptomatic intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke and to provide a reference for clinical decision-making of intravenous thrombolysis.
    Methods  CNKI, WanFang Data, VIP, PubMed, Embase, Web of Science, and The Cochrane Library databases were searched to collect relevant studies, with a timeframe for searching the database from the establishment of the database to December 18, 2022. Two researchers independently screened the literature, extracted the data, assessed the risk of bias, and then systematically evaluated the basic characteristics and methodology of the included models. 
    Results  Twenty studies were included, with a total of 30 prediction models. The AUC of the included models ranged from 0.42 to 0.94. The overall predictive performance of the 24 (80%) prediction models was good, with significant differences in model differentiation across outcome definitions and algorithms. The most common predictors were NIHSS score, age, imaging signs or scores of infarction, blood glucose, systolic blood pressure, and antiplatelet drugs.
    Conclusions  In recent years, the prediction models of symptomatic intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke have shown the characteristics of diversified modeling algorithms, better model performance, and diversified predictors. However, the overall risk of bias was high, and future studies need to calibrate the models further. More attention should be paid to updating and externally validating the models to improve extrapolation and clinical utility and utilize the models’ clinical practice implications.
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    Objective  To assess the efficacy and safety of drug treatment of vascular parkinsonism (VP) using network meta-analysis.
    CUI Yating, QU Yan, HUO Yuan, LI Xiaohong
    Chinese Journal of Stroke    2023, 18 (10): 1143-1153.   DOI: 10.3969/j.issn.1673-5765.2023.10.007
    Abstract1643)      PDF (16638KB)(101)       Save
    Objective  To assess the efficacy and safety of drug treatment of vascular parkinsonism (VP) using network meta-analysis.
    Methods  A computerized search of randomized controlled trials of VP drug treatment in CNKI, Wanfang, VIP, PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library was conducted from the inception each database to January 1, 2023. Two researchers independently performed literature screening, data extraction, and quality evaluation of the included studies. R was applied to perform a network meta-analysis of the data.
    Results  Twenty studies were included, including butylphthalide in combination with levodopa, edaravone in combination with levodopa, pramipexole dihydrochloride in combination with levodopa and levodopa alone. The overall literature quality level is medium. The results of the network meta-analysis showed that: (1) in terms of total treatment effectiveness, the surface under the cumulative ranking curve (SUCRA) showed that butylphthalide in combination with 
    levodopa > edaravone in combination with levodopa > pramipexole dihydrochloride in combination with levodopa > levodopa alone. (2) In terms of unified Parkinson's disease rating scale (UPDRS) scores, the SUCRA showed that butylphthalide in combination with 
    levodopa > edaravone in combination with levodopa > pramipexole dihydrochloride in combination with 
    levodopa > levodopa alone. (3) In terms of adverse reactions, the SUCRA showed that butylphthalide in combination with levodopa > levodopa alone > pramipexole dihydrochloride in combination with  levodopa > edaravone in combination with levodopa.
    Conclusions  Butylphthalide in combination with levodopa had the highest efficiency, the most significant improvement in UPDRS scores, and the best safety profile for the treatment of VP, and no significant increased risk of adverse effects was observed. However, the methodological quality of the included studies was generally low, so the conclusions remain to be further validated by studies with larger samples and high quality.
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    Differences between Clinical Features and White Matter Hyperintensities between Vascular Parkinsonism and Parkinson′s Disease
    CHEN Baixi, WANG Wanyi, ZHAN Cuijing, GAO Yuyuan, NIE Kun, ZHANG Yuhu, WANG Lijuan
    Chinese Journal of Stroke    2023, 18 (8): 859-866.   DOI: 10.3969/j.issn.1673-5765.2023.08.002
    Abstract1624)      PDF (6696KB)(55)       Save
    Objective  The study of the differences in clinical features and white matter hyperintensities (WMH) between vascular parkinsonism (VP) and Parkinson’s disease (PD) can provide some basis and ideas for studying the pathogenesis of VP.
    Methods  According to the clinical practice, the number of healthy subjects was matched at a ratio of 1:2. VP patients meeting the inclusion criteria and PD patients and healthy volunteers matching their age, gender and education level were retrospectively screened, and healthy volunteers were selected as the healthy control (HC) group. Collected their general clinical data and biochemical indicators, evaluated the clinical symptoms of patients, collected head MRI parameters and made statistical analyses of the data of the three groups of subjects. 
    Results  A total of 26 VP patients, 26 PD patients and 13 HC were enrolled in this study. Compared with the PD group, VP group had worse overall cognition and mental state: HAMA score was higher (P=0.025), MMSE score (P=0.001) and MoCA score (P=0.008) were lower; more vascular risk factors: a higher proportion of patients had a history of hypertension (P=0.012) and stroke (P<0.001); more severe white matter damage in motion-related brain regions: WMH total score (P<0.001), deep white matter hyperintensities (DWMH) total score (P=0.001), periventricular hyperintensities (PVH) total score (P=0.002), PVH scores in motion-related brain regions [frontal horn cap white matter hyperintensities score (P=0.002), lateral ventricular belt white matter hyperintensities score (P=0.018)], DWMH scores in motion-related brain regions [frontal deep white matter hyperintensities score (P<0.001), parietal deep white matter hyperintensities score (P=0.007)], basal ganglia white matter hyperintensities score (P=0.002), putamen white matter hyperintensities score (P=0.029) were higher. All were statistically significant (all P<0.05).
    Conclusions  A history of hypertension, a history of stroke, and white matter damage in motion-related brain regions may play an important role in the pathogenesis of VP.
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    Advances of Imaging in the Differential Diagnosis of Vascular Parkinsonism
    ZHANG Dongling, WU Tao
    Chinese Journal of Stroke    2023, 18 (8): 867-872.   DOI: 10.3969/j.issn.1673-5765.2023.08.003
    Abstract1601)      PDF (4777KB)(59)       Save
    Vascular parkinsonism is a common secondary parkinsonism. At present, the accuracy of diagnosis and differential diagnosis of vascular parkinsonism is low, which affects its treatment and prognosis. Imaging is commonly used in clinical practice to diagnose vascular parkinsonism. In recent years, the advance of multimodal MRI and molecular imaging and analysis technology has provided objective methods to improve the accuracy of diagnosis and differential diagnosis of vascular parkinsonism. This paper reviews the latest progress of various cutting-edge imaging techniques in the differential diagnosis of vascular parkinsonism from idiopathic Parkinson’s disease and other atypical parkinsonisms, hoping to provide new ideas for the diagnosis and differential diagnosis of vascular parkinsonism.
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    Estimation of Individualized Treatment Effect Using Bayesian Additive Regression Trees with Applications
    LIANG Baosheng, ZHOU Jiangjie, WANG Shengfeng
    Chinese Journal of Stroke    2023, 18 (07): 770-779.   DOI: 10.3969/j.issn.1673-5765.2023.07.005
    Abstract1558)      PDF (3300KB)(48)       Save
    Individualized treatment effects mainly refer to the differences in outcomes between the treated and non-treated status for a same patient, regardless of whether the patient actually received treatment or did not receive treatment. By evaluating the effects of individualized treatment based on the characteristics of patients, it is possible to assign the treatment plan with the greatest individual benefit to each patient. This paper introduces the estimation and statistical inference of individualized treatment effects based on Bayesian additive regression tree, and introduces the evaluation of the significance of individual treatment effects, the identification of subgroups with heterogeneous treatment effects, and demonstrate the application through a simple case of Alzheimer's disease.
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    The Association between Stress Hyperglycemia and Early Prognosis after Successful Recanalization with Thrombectomy in Acute Anterior Circulation Large Artery Occlusion
    CHEN Liujing, ZHU Kaiqi, CAI Xueli
    Chinese Journal of Stroke    2023, 18 (04): 410-417.   DOI: 10.3969/j.issn.1673-5765.2023.04.006
    Abstract1469)      PDF (2129KB)(97)       Save
    Objective  To investigate the association between stress hyperglycemia and early neurological prognosis after successful recanalization with thrombectomy in acute anterior circulation large artery occlusion. 
    Methods  Patients with acute anterior circulation large artery occlusion after successful recanalization with thrombectomy in Lishui Municipal Central Hospital were enrolled in this retrospective analysis. Patients were divided into low stress hyperglycemia ratio (SHR) group and high SHR group according to median of SHR. Successful recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) 2b to 3. Primary outcome was poor functional outcome at discharge (defined as a mRS score of 4-6) and secondary outcome was malignant cerebral edema (MCE) within 72 hours after thrombectomy. The association between SHR and mRS increase at discharge was analyzed by ordinal logistic regression, and the association of SHR with poor functional outcome and MCE was analyzed by multivariate logistic regression. 
    Results  A total of 312 patients were enrolled in the final analysis, with 156  patients in each group. The median SHR was 0.953 (0.817-1.100) , intravenous thrombolysis accounted for 48.1%, median admission NIHSS score was 14 (11-18) , 74 patients developed MCE within 72 hours, and 196 patients had poor functional outcome at discharge. Compared to the low SHR group, the high SHR group had higher admission NIHSS score (16 vs. 14, P=0.031) , higher proportion of MCE within 72 hours (33.3% vs. 14.1%, P<0.001) and poor functional outcome at discharge (72.4% vs. 53.2%, P<0.001) . The multivariate logistic regression showed that high SHR was an independent predictive factor for mRS increase (OR 1.910, 95%CI 1.257-2.904, P=0.002) , poor functional outcome at discharge (OR 2.064, 95%CI 1.223-3.482, P=0.007) and MCE within 72 hours (OR 2.746, 95%CI 1.532-4.922, P=0.001) . Subgroup analysis based on basal diabetes and long-term glucose control level showed that high SHR was associated with poor functional outcome at discharge (OR 2.132, 95%CI 1.175-3.868, P=0.013) and MCE within 72 hours (OR 3.079, 95%CI 1.540-6.155, P=0.001) in non-diabetes patients, and high SHR was associated with poor functional outcome at discharge (OR 1.925, 95%CI 1.082-3.424, P=0.026) and MCE within 72 hours (OR 2.869, 95%CI 1.459-5.642, P=0.002) in patients with glycosylated hemoglobin (HbA1c) ≤ 6.5% . Interaction test and subgroup analysis showed that high SHR was strongly associated with poor functional outcome at discharge in patients with age ≤ 80 years old (OR 2.074, 95%CI 1.165-3.690, P=0.013) , TC>3.81 mmol/L (OR 2.763, 95%CI 1.267-6.026, P=0.011) , admission ASPECTS score of 8-10 (OR 1.865, 95%CI 1.023-3.401, P=0.042) , admission NIHSS score ≤ 14 (OR 2.926, 95%CI 1.400-6.115, P=0.004), time from stroke onset to recanalization of 6-12 h (OR 2.088, 95%CI 1.062-4.103, P=0.033) and large artery atherosclerotic stroke subtype (OR 4.151, 95%CI 1.880-9.169, P<0.001) . 
    Conclusions  High stress hyperglycemia ratio was associated with MCE within 72 hours and poor functional outcome at discharge in patients with acute anterior circulation large artery occlusion after successful recanalization with thrombectomy.
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    Cognitive Function and Brain Structure Changes in Patients with Symptomatic Intracranial Atherosclerotic Stenosis
    SI Qianqian, CHENG Anqi, FAN Xiaoyuan, ZHANG Xiaoqian, LI Mingli, FENG Feng, LIU Caiyan, XU Weihai
    Chinese Journal of Stroke    2023, 18 (11): 1228-1237.   DOI: 10.3969/j.issn.1673-5765.2023.11.003
    Abstract1389)      PDF (13419KB)(63)       Save
    Objective  This study was aimed to evaluate the cognitive function and brain structure changes in patients with symptomatic intracranial atherosclerotic stenosis (ICAS), and to provide reference for the prevention and treatment of symptomatic ICAS related cognitive impairment.
    Methods  Patients diagnosed with ICAS related stroke or TIA were consecutively recruited in Department of Neurology of Peking Union Medical College Hospital from December 2021 to December 2022. A control group with matching age and educational background was also recruited. Participants went through clinical data collection, packaged cognitive function assessment (including global cognition and four cognitive domains: memory, executive, language and visuospatial structure function), and 3D structural T1 MRI examination. Software DPABISurf was used to preprocess the brain imaging data. The volume of each brain region (including total cortex, total white matter, thalamus, putamen, caudate nucleus, globus pallidus, hippocampus, amygdala) and estimated total intracranial volume were obtained. The inter-group differences of cognitive function, brain structure and its correlation with cognitive function were compared.
    Results  A total of 60 patients with symptomatic ICAS [40 males, mean age of (57.68±10.95) years], including 48 patients with stroke [13 patients had infarcts in the key areas of cognition (i.e., thalamus or the basal ganglia), and 35 patients had infarcts not in the key areas of cognition] and 12 patients with TIA were recruited. 51 normal controls [36 males, mean age of (59.33±6.87) years] were recruited. Among the participants, 34 patients with symptomatic ICAS and 51 normal controls completed 3D structural T1 MRI examination. The result of comparation were the following. ①Cognitive function status: after adjusting age, educational background, gender and cerebrovascular disease risk factors, it was found that the MMSE, MoCA scores and Z scores of memory, executive, language and visuospatial structure function of the symptomatic ICAS group were lower compared with the controls (P<0.05). Subgroup analysis showed that the MMSE, MoCA scores and Z scores of executive, language function of the group with infarction at the key areas of cognition were lower compared with the controls; the MMSE, MoCA scores and Z score of language function of the group with infarction not at the key areas of cognition were lower compared with the controls; the Z score of language function of the TIA group was lower compared with the controls (multiple comparison corrected, P<0.05). ②Brain structures changes: after adjusting for confounding factors, it was found that patients with symptomatic ICAS showed brain volume reduction of bilateral cortex, white matter, thalamus, putamen, globus pallidus, hippocampus and amygdala compared with the controls (P<0.05). ③Correlations between brain structures and cognitive function: left cortex volume had a positive correlation with MMSE score (r=0.784, P<0.001), MoCA score (r=0.649, P=0.001) and Z score of visuospatial structure function (r=0.761, P<0.001); left white matter volume was positively correlated with MMSE score (r=0.593, P=0.004) and Z score of visuospatial structure function (r=0.655, P=0.001); left thalamus volume was positively correlated with Z score of visuospatial structure function (r=0.574, P=0.007); left globus pallidus volume was positively correlated with MMSE score (r=0.562, P=0.006); left hippocampus volume had a positive correlation with MMSE score (r=0.744, P<0.001), MoCA score (r=0.632, P=0.002), Z score of executive function (r=0.574, P=0.008) and visuospatial structure function (r=0.790, P<0.001).
    Conclusions  Patients with symptomatic ICAS had different degrees of declined cognitive function. Symptomatic ICAS patients showed extensive bilateral cortical, white matter, and subcortical brain structural changes. The left brain atrophy was correlated with significant decline in cognitive function.
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    Application of Machine Learning in Genomic Data Analysis of Cerebrovascular Diseases
    JIANG Yingyu, CHEN Siding, QIU Xin, GU Hongqiu
    Chinese Journal of Stroke    2023, 18 (07): 751-757.   DOI: 10.3969/j.issn.1673-5765.2023.07.003
    Abstract1353)      PDF (2285KB)(79)       Save
    With the advent of the era of precision medicine, genomics research is gradually gaining widespread attention in the field of cerebrovascular diseases. Due to the high-dimensional and complexity of genomics data, machine learning is now an effective tool for analyzing genomics data. This article introduced the basic concepts of machine learning, the main steps, the classification of algorithms and the application of each algorithm of machine learning in genomics research in the field of cerebrovascular diseases, in order to provide a reference for future genomics research in cerebrovascular diseases.
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    Progress and Prospects of Clinical Prediction Models for Risk of Stroke Recurrence in Ischemic Stroke
    GU Hongqiu, YANG Kaixuan, JIANG Yingyu, DU Kejin, RAO Zhenzhen, YANG Xin, WANG Chunjuan, XIONG Yunyun, JING Jing, LI Zixiao
    Chinese Journal of Stroke    2023, 18 (07): 731-739.   DOI: 10.3969/j.issn.1673-5765.2023.07.001
    Abstract1331)      PDF (2175KB)(265)       Save
    In the era of big data and precision medicine, clinical prediction models are increasingly important in precise risk stratification, personalized diagnosis, and management. However, existing ischemic stroke recurrence risk prediction models vary significantly in terms of the population used for development, predictive factors, predicted outcomes, development methods, and predictive performance. Additionally, limitations in development methods, reporting, external validation, and model impact research have limited their clinical applicability. Therefore, future research on clinical prediction models should prioritize the validation and evaluation of existing models, while also adhering to methodological standards when developing new prediction models. This includes selecting predictive factors, model fitting, presentation methods, and reporting results, with the aim of enhancing predictive performance.
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    Progress in Clinical Research of Vascular Parkinsonism
    LIU Genliang, FENG Tao
    Chinese Journal of Stroke    2023, 18 (8): 853-857.   DOI: 10.3969/j.issn.1673-5765.2023.08.001
    Abstract1279)      PDF (4312KB)(114)       Save
    Vascular parkinsonism (VP) is a secondary parkinsonism. With the increase of aging population and the increase in patients with cerebrovascular diseases in China, the prevalence of VP will be further increased. To date, the pathogenesis of VP is still unclear, and the clinical manifestations are heterogeneous, so further studies are needed. In order to better guide clinical practice, this paper will summarize and analyze the epidemiology, clinical manifestations, imaging features, diagnosis and management of VP. 
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    Common Misconception in Clinical Prediction Model Research
    WANG Haoyue, WANG Junfeng
    Chinese Journal of Stroke    2023, 18 (07): 758-769.   DOI: 10.3969/j.issn.1673-5765.2023.07.004
    Abstract1244)      PDF (1951KB)(122)       Save
    Taking the inappropriate practices in existing research pointed out by a leading expert in clinical prediction models as examples, this paper introduced common misunderstandings in clinical prediction model research, explained why specific practices will jeopardize the model quality, and how to avoid repeating the same mistakes in future studies. The feasibility of using ChatGPT to provide methodological guidance is discussed by evaluating the answers given by ChatGPT.
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    Research Progress of Insomnia after Stroke
    YANG Hangmei, HAN Meirong, JIANG Xuelong, HE Zhongming, HAN Fang
    Chinese Journal of Stroke    2023, 18 (05): 527-533.   DOI: 10.3969/j.issn.1673-5765.2023.05.006
    Abstract1229)      PDF (2229KB)(165)       Save
    Post stroke insomnia (PSI) is a group of clinical syndromes that first appear after a stroke and meet the diagnostic criteria for insomnia. Similar to common clinical insomnia, the main manifestations are abnormal sleep depth and average sleep time less than 6 hours per night. Meta-analysis showed that 32.5%, 34.8% and 37.1% of patients in acute, subacute and convalescent stages of stroke met the diagnostic criteria for insomnia disorders, respectively. PSI not only increases the risk of stroke death and recurrence, but also has adverse effects on stroke rehabilitation and prognosis. This paper reviews the incidence, pathogenesis, and treatment of insomnia after stroke, in order to provide information for clinical practice and provide targeted intervention and treatment measures for insomnia after stroke. 
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    Construction and Application of Polygenic Risk Score in Stroke
    CHEN Siding, JIANG Yong, XU Zhe, SHI Yanfeng, CHENG Si, GU Hongqiu, WANG Yongjun
    Chinese Journal of Stroke    2023, 18 (07): 741-750.   DOI: 10.3969/j.issn.1673-5765.2023.07.002
    Abstract1220)      PDF (2120KB)(76)       Save
    Stroke is a complex disease caused by genetic and environmental factors. The development of human genetics had provided new opportunities for individualized prevention and treatment of stroke. Polygenic risk score (PRS) is an estimate of an individual's genetic liability to a trait or disease, calculated according to their genotype profile and relevant genome-wide association study (GWAS) data. PRS is a complementary method to GWAS in genetic research. PRS can stratify the risk of patients for personalized management, thus contributing to accurate prediction, prevention, and control of complex diseases such as stroke. Based on this, this review describes the development of PRS and its application in stroke research, aiming to provide insights for relevant domestic studies.
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    Stroke-related Sleep Disorder
    ZHANG Ya'nan, WANG Zan
    Chinese Journal of Stroke    2023, 18 (05): 497-501.   DOI: 10.3969/j.issn.1673-5765.2023.05.002
    Abstract1188)      PDF (1810KB)(232)       Save
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    Application of Problem-based Learning Combined with Virtual Reality Technology in Clinical Teaching of Post-stroke Sleep Disorder
    GUO Zhenni, ZHANG Han, FU Yuli, WANG Zan, YANG Yi, DENG Fang
    Chinese Journal of Stroke    2023, 18 (05): 534-537.   DOI: 10.3969/j.issn.1673-5765.2023.05.007
    Abstract1000)      PDF (2639KB)(74)       Save
    Objective  To explore the effect of problem-based learning (PBL) combined with virtual reality (VR) into neurology clinical teaching on post-stroke sleep disorder. 
    Methods  A total of 70 postgraduates who underwent training in the Department of Neurology of the First Hospital of Jilin University from September 2022 to January 2023 were included and randomly divided into the experimental group and the control group, 35 in each group. The control group adopted PBL teaching method, and the experimental group adopted PBL combined with VR teaching method. The teaching content was about the anatomical basis of post-stroke sleep disorder. After the course, two groups were assessed with test papers and questionnaires, and the assessment results were compared. 
    Results  Students in the experimental group had higher scores in basic theory (46.03±1.76 vs. 43.69±1.91), case analysis (42.11±2.19 vs. 39.57±2.56) and total score (88.14±2.55 vs. 83.26±3.55)than the control group, and the difference was statistically significant (P<0.001); students in the experimental group had higher evaluations on the role of this course in stimulating motivation (2.63±0.49 vs. 2.11±0.47), improving learning efficiency (2.57±0.50 vs. 1.97±0.57), improving self-learning ability (2.54±0.51 vs. 2.00±0.42) and cultivating clinical thinking (2.51±0.51 vs. 1.94±0.42) than the control group, and the difference was statistically significant (P<0.001).
    Conclusions  Application of PBL combined with VR in neurology clinical teaching improves effectiveness of teaching on clinical education of post-stroke sleep disorder.
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    Research Progress of Antiplatelet Drugs for Secondary Prevention of Cerebrovascular Disease
    JIN Aoming, PAN Yuesong
    Chinese Journal of Stroke    2023, 18 (06): 628-632.   DOI: 10.3969/j.issn.1673-5765.2023.06.002
    Abstract961)      PDF (1781KB)(406)       Save
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    Spatial Statistical Analysis based on Fiber Tracerto Study the Changes of Brain Microstructure in Patients with Cerebral Small Vessel Disease Combined with Obstructive Sleep Apnea
    ZENG Huixing, LI Jinbiao, WANG Meng, OUYANG Fubing, YU Lei, YI Ming, GUO Jiayu, NI Ruichen, CUI Liqian, FAN Yuhua
    Chinese Journal of Stroke    2023, 18 (05): 503-513.   DOI: 10.3969/j.issn.1673-5765.2023.05.003
    Abstract950)      PDF (3737KB)(108)       Save
    Objective  To investigate the characteristics of brain microstructural changes in patients of cerebral small vessel disease (CSVD) combined with obstructive sleep apnea (OSA) by tract-based spatial statistics (TBSS) based on diffusion tensor imaging (DTI). 
    Methods   The study included patients with CSVD who were hospitalized in the Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University from September 2018 to June 2020. Data on demographic information, clinical characteristics, scores of cognitive function assessment scale and sleep quality scale, CSVD routine imaging, DTI, polysomnography (PSG) parameters were collected. According to the apnea hypopnea index (AHI), they were divided into OSA group (AHI≥5) and non-OSA group (AHI<5). The different regions in cerebral white matter between two groups as well as their fractional anisotropy (FA) and mean diffusivity (MD) values were calculated by TBSS. The correlation between MD and PSG parameters, cognitive function scores, CSVD imaging markers, and CSVD burdens were also analyzed. 
    Results  A total of 39 CSVD patients were included, of which 7 were excluded due to the lack of MRI data/parameter inconsistency/poor image quality, therefore 32 were eventually included. OSA group included 21 patients with an average age of (64.14±11.57) years old and 18 males (85.7%) while 11 patients without OSA was (67.64±8.95) years old, including 6 males (54.5%). TBSS showed that MD value of OSA group was increased in the bilateral anterior thalamic radiation, bilateral corticospinal tract, bilateral cingulate gyrus, bilateral hippocampus, forceps major and forceps minor, bilateral inferior fronto-occipital fasciculus, bilateral inferior/superior longitudinal fasciculus and bilateral uncinate fasciculus compared with non-OSA group (P<0.001). Bivariate correlation analysis showed that MD increase in OSA group was positively correlated with white matter hyperintensity (WMH) (r=0.646, P<0.05) and Fazekas grade 2 to 3 (r=0.458, P<0.05), and negatively correlated with Montreal cognitive assessment (MoCA) (r=-0.374, P<0.05). There was no significant correlation with mini-mental state examination (MMSE), Alzheimer's disease assessment scale (ADAS-cog), sleep quality assessment scale, AHI, PSG parameters, other CSVD imaging markers and CSVD burdens (P>0.05). 
    Conclusions  CSVD patients with OSA have more extensive white matter fiber damage, and extensive brain microstructure damage is closely related to high white matter signal and cognitive dysfunction.
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    Study of Biomarkers of Stroke with Obstructive Sleep Apnea Syndrome
    HUANG Zhencan, ZHANG Ya’nan, SUN Qingqing, WU Xiaodan, WANG Zan
    Chinese Journal of Stroke    2023, 18 (05): 514-519.   DOI: 10.3969/j.issn.1673-5765.2023.05.004
    Abstract853)      PDF (1910KB)(68)       Save
    Obstructive sleep apnea syndrome (OSAS) is one of the most common chronic disorders, with an independent risk factor for stroke, poor recovery after stroke, and recurrent stroke. 60%-70% of patients with stroke have sleep apnea in the acute stage, of which OSAS is the most common. The current diagnostic criteria for OSAS is polysomnography, but the operation process is cumbersome, requires a large number of medical staff, and the examination is expensive, which delays the diagnosis and treatment of OSAS. Some out-of-hospital screening devices for OSAS have been developed, but their accuracy needs to be improved. Therefore, it is of great significance to find a simple, fast and effective diagnostic method and regularly screen potential OSAS. At present, biomarkers of OSAS may become an ideal method for screening OSAS and provide a reference for predicting stroke prognosis. This paper reviews the research progress of biomarkers of OSAS in the pathogenesis and physiology of stroke, hoping to help clinicians improve the diagnosis, treatment, disease prevention and prognosis of patients with stroke with OSAS.
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    Research Advances on Mechanisms of Increased Stroke Risk by Circadian Rhythm Disruption
    JIA Hui, WANG Di, SUO Rui, WEI Xinya, ZHU Yulan
    Chinese Journal of Stroke    2023, 18 (05): 520-526.   DOI: 10.3969/j.issn.1673-5765.2023.05.005
    Abstract836)      PDF (1913KB)(139)       Save
    The causes of circadian rhythm disorders mainly including internal factors: internal circadian rhythm sleep-wake disorders, as well as external factors: social jet lag, shift work, artificial light during night, travel across time zones, stay up late, irregular diet, etc. Internal/external factors can lead to central and peripheral circadian clock disorder. Circadian clock genes regulate the expression of almost the entire genome. Circadian clock disorder leads to glucose-insulin metabolic disorder, hypertension, dyslipidemia, immune activation, obesity, premature aging, which are risk factors of stroke. The relationship between the circadian rhythm disturbance in addition to its caused above-mentioned risk factors and the risk of stroke is attracting increasing attention in recent years. This article reviews the research progress on the mechanism of circadian rhythm disturbance increasing the risk of stroke. 
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    Real World Study on the Current Status and Influencing Factors of Antiplatelet Aggregation Drugs Use among People Aged 40 and above in Baotou, Inner Mongolia
    YU Wenlong, BAI Ruyu, YU Yanxue, GUO Xia, WU Lie
    Chinese Journal of Stroke    2023, 18 (06): 651-659.   DOI: 10.3969/j.issn.1673-5765.2023.06.006
    Abstract767)      PDF (1924KB)(89)       Save
    Objective  To clarify the use of antiplatelet aggregating drugs in people aged 40 years and above in Baotou area of Inner Mongolia in the real world, and the factors influencing the rate of taking drugs in different populations.  
    Methods  A multilevel, whole-group, random sampling method with neighborhood and village committees was used to draw permanent residents aged 40 years and above in Baotou area from June 2021 to September 2022. A questionnaire was used to collect general information, past medical history and the use of anti-platelet aggregating drugs from the study population. The subjects were divided into three groups according to the presence or absence of cardio cerebrovascular diseases  (CVD) and the presence of CVD risk factors: CVD group (with previous CVD), CVD risk factor group (no history of CVD, with one or more of the following CVD risk factors: hypertension, diabetes mellitus, hyperlipidemia, history of smoking, history of alcohol consumption, obesity), the healthy control group (no history of CVD, no risk factors for CVD). The differences in general information between the 3 groups were compared. The subjects in the CVD group and the CVD risk factor group were divided into the medication group and the non-medication group according to whether they were taking antiplatelet aggregation drugs or not, and the relevant factors affecting medication taking in the two groups were investigated using univariate and multifactorial analyses. 
    Results  ①A total of 2100 validated subjects were included in the study, including 298 cases (14.2%) in the CVD group, 1040 cases (49.5%) in the CVD risk factor group, and 762 cases (36.3%) in the healthy control group.The rates of taking antiplatelet aggregation drugs in the three groups were 51.68% (154 cases), 33.46% (348 cases), and 6.69% (51 cases), respectively, with statistically significant differences between groups (P<0.001). ②Multifactorial analysis showed that higher education (primary school education or less as the baseline, high school OR 2.429, 95%CI 1.277-4.619, P=0.007, undergraduate education or above OR 8.500, 95%CI 1.015-12.165, P=0.048) and combined diabetes mellitus (OR 2.820, 95%CI 1.377-5.777, P=0.005) were more likely to apply anti-platelet aggregation drugs in the CVD group; the rate of anti-platelet aggregation drug application in the CVD risk factor group was affected by personal economic income (baseline<10 000/year, >50 000/year, OR 18.547, 95%CI 8.948-38.444, P<0.001), education (primary school education or less as the baseline, bachelor's degree and above, OR 5.512, 95%CI 1.736-17.495, P=0.004), smoking history (OR 0.712, 95%CI 0.541-0.936, P=0.015), normal BMI (compared to low BMI patients, OR 5.640, 95%CI 1.172-27.144, P=0.031), obesity (OR 8.440, 95%CI 1.684-42.293, P=0.009), having hypertension (OR 246.029, 95%CI 112.44-538.337, P<0.001), having diabetes (OR 117.689, 95%CI 51.041-271.367, P<0.001) were independently influenced by other factors. ③The reasons for taking medication in the CVD and CVD risk factor groups were the highest among physician prescriptions, 83.12% and 79.60%, respectively; the reasons for taking medication in the healthy control group were, in descending order, consciously should take it (47.06%), introduced by friends and relatives (29.41%), advertised media (13.73%), and physician prescription (9.80%).
    Conclusions  The use of antiplatelet aggregation drugs for primary and secondary prevention of CVD among people aged 40 years and above in Baotou, Inner Mongolia is not satisfactory, and the factors influencing the use of drugs vary among different groups, and there are cases of irregular or even incorrect use of drugs among healthy people.
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    Highlights in Stroke in 2023
    WANG Yongjun, XIONG Yunyun, LI Guangshuo, CAO Zhixin, WANG Wenjie, YAN Ran, WANG Liyuan, LU Zhengzhao, HAO Manjun
    Chinese Journal of Stroke    2024, 19 (1): 1-21.   DOI: 10.3969/j.issn.1673-5765.2024.01.001
    Abstract713)      PDF (4004KB)(753)       Save
    Cerebrovascular clinicians from different countries all over the world made great progress in the diagnosis and treatment of cerebral vascular diseases in recent years. Numerous high-quality clinical studies cover multiple fields and hotspots of cerebral vascular disease, such as thrombectomy/thrombolysis in the acute phase of ischemic stroke, intervention for atrial fibrillation, blood pressure management and other acute phase intervention measures, providing solid and reliable evidence-based medical evidence for clinical diagnosis and treatment in cerebral vascular disease, and promoting the reduction of cerebral vascular disease burden. This paper reviews the important clinical research progress in the field of cerebral vascular disease in 2023, helping readers better understand the advantages and great significance of these clinical studies, and looking forward to more and better cerebral vascular disease clinical studies in the future. 
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    Chinese Expert Consensus 2023 on Endovascular Treatment for Acute Large Vessel Occlusion with Mild Stroke
    Chinese Interventional Neuroradiology Society of Chinese Stroke Association
    Chinese Journal of Stroke    2023, 18 (12): 1429-1449.   DOI: 10.3969/j.issn.1673-5765.2023.12.013
    Abstract426)      PDF (17993KB)(841)       Save
    Chinese Expert Consensus 2023 on Endovascular Treatment for Acute Large Vessel Occlusion with Mild Stroke is a summary and analysis of the new progress and new evidence obtained from the recent studies on endovascular treatment for acute large vessel occlusion with mild stroke by the experts organized by the Chinese Interventional Neuroradiology Society of Chinese Stroke Association. This expert consensus covers the definition of mild stroke, and intravenous thrombolysis and endovascular treatment for acute large vessel occlusion that begins with mild stroke. The aim is to provide guidance for professionals and social workers engaged in stroke prevention and treatment, especially the endovascular treatment, care and rehabilitation of acute ischemic stroke, as well as relevant governmental agencies, healthcare administrators, pharmaceutical companies, healthcare demand parties, and other stakeholders. 
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