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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 Abstract （8091）      PDF （2089KB）（9284）       Knowledge map    Save Reference | Related Articles | Metrics

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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 Abstract （4981）      PDF （19848KB）（5966）       Knowledge map    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. Related Articles | Metrics

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Experts Consensus on Multidisciplinary Management of Stroke-related Non-motor Symptoms Writing Committee of This Consensus Chinese Journal of Stroke    2023, 18 (03): 315-334.   DOI: 10.3969/j.issn.1673-5765.2023.03.011 Abstract （4319）      PDF （1810KB）（958）       Knowledge map    Save Related Articles | Metrics

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Chinese Expert Consensus on Full Course Management of Stroke-Related Pain in Older Patients Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, Community Committee of Chinese Association of Rehabilitation Medicine (Writers: HE Jieying, OU Jibing, JIA Jie) Chinese Journal of Stroke    2022, 17 (10): 1041-1050.   DOI: 10.3969/j.issn.1673-5765.2022.10.002 Abstract （4136）      PDF （2235KB）（409）       Knowledge map    Save Reference | Related Articles | Metrics

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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 Abstract （3179）      PDF （2046KB）（1486）       Knowledge map    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.  Related Articles | Metrics

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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 Abstract （3098）      PDF （10805KB）（1210）       Knowledge map    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.  Related Articles | Metrics

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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 Abstract （3095）      PDF （4110KB）（964）       Knowledge map    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.  Related Articles | Metrics

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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 Abstract （2848）      PDF （7327KB）（1587）       Knowledge map    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.  Related Articles | Metrics

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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 Abstract （2758）      PDF （4260KB）（879）       Knowledge map    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. Related Articles | Metrics

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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 Abstract （2565）      PDF （1886KB）（133）       Knowledge map    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.  Reference | Related Articles | Metrics

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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 Abstract （2488）      PDF （4777KB）（83）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （2465）      PDF （16638KB）（121）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （2424）      PDF （15602KB）（183）       Knowledge map    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. Reference | Related Articles | Metrics

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Advances in Correlation of Imaging Markers of Cerebral Small Vessel Disease with Spontaneous Hypertensive Intracerebral Hemorrhage ZHENG Zhanjun, ZHAO Xingquan Chinese Journal of Stroke    2022, 17 (12): 1396-1402.   DOI: 10.3969/j.issn.1673-5765.2022.12.019 Abstract （2398）      PDF （1650KB）（213）       Knowledge map    Save Many patients with cerebral small vessel disease (CSVD) in clinical practice developed spontaneous hypertensive intracerebral hemorrhage, and many CSVD patients had CSVD imaging markers. This article reviewed the progress of clinical correlation of spontaneous intracerebral hemorrhage with CSVD. Most studies suggested that the severity of white matter hyperintensity was positively correlated with the risk of intracerebral hemorrhage recurrence, and increased mortality and poor prognosis; the total number of microbleeds was significantly correlated with hematoma enlargement, and could predict the poor prognosis of patients. There are few studies on the correlation of enlarged perivascular space or lacunar infarction with spontaneous hypertensive intracerebral hemorrhage, and the evidence on their relationship is insufficient. For patients with multiple CSVD imaging features, the higher the total score of CSVD load, the higher the risk of poor functional prognosis and intracerebral hemorrhage recurrence. Reference | Related Articles | Metrics

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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 Abstract （2381）      PDF （6696KB）（81）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （2336）      PDF （8660KB）（1232）       Knowledge map    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.  Reference | Related Articles | Metrics

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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 Abstract （2237）      PDF （6708KB）（160）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （2139）      PDF （4312KB）（134）       Knowledge map    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.  Reference | Related Articles | Metrics

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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 Abstract （2107）      PDF （7770KB）（158）       Knowledge map    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. Reference | Related Articles | Metrics

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Stepped Wedge Cluster Randomized Trials WANG Meng, WANG Chunjuan, LI Zixiao, GU Hongqiu Chinese Journal of Stroke    2023, 18 (01): 114-122.   DOI: 10.3969/j.issn.1673-5765.2023.01.013 Abstract （2097）      PDF （4458KB）（626）       Knowledge map    Save The stepped wedge cluster randomized trial (SW-CRT) is a kind of new cluster randomized controlled trial design, mostly applied in the field of service delivery and policy evaluation. No control groups are specifically established in SW-CRTs. At the initial time of SW-CRT, no cluster is exposed to the intervention; whereafter, one random cluster will receive the intervention at regular observation intervals until all the clusters cross to the intervention groups. In this review, we summarized the rationale, types, study design, sample size calculation, statistical methods and the reporting standards of the SW-CRT, to provide reference for carrying out SW-CRTs in the future.  Reference | Related Articles | Metrics

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ANGEL-ASPECT: Chinese Protocol of Endovascular Therapy for Acute Ischemic Stroke with a Large Infarct Core WU Chuanjie, JI Xunming Chinese Journal of Stroke    2023, 18 (03): 247-249.   DOI: 10.3969/j.issn.1673-5765.2023.03.002 Abstract （2092）      PDF （1952KB）（442）       Knowledge map    Save Reference | Related Articles | Metrics

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Mechanism of Buyanghuanwu Decoction in Treatment of Cerebral Infarction Mice Based on High-Throughput RNA Sequencing Technology LIU Yajie, LI Yudi, LI Kaifeng, CHEN Zhefeng, LING Li Chinese Journal of Stroke    2022, 17 (11): 1238-1246.   DOI: 10.3969/j.issn.1673-5765.2022.11.014 Abstract （2090）      PDF （2656KB）（109）       Knowledge map    Save Objective  To explore the mechanism of buyanghuanwu decoction (BYHWD) in treating cerebral infarction mice based on high-throughput RNA sequencing technology. Methods  The mouse cerebral infarction model of middle cerebral artery occlusion (MCAO) was established by electrocoagulation. The MCAO mice were randomly divided into BYHWD treatment group and control group (n=6, each group). From 1 day after MCAO, 18.59 g/kg BYHWD or equivalent volume distilled water were administered by gavage for consecutive 7 days. Another 6 mice were selected as sham operation group. The modified neurological severity scores (mNSS) was used to evaluate the neurological function of mice in the three groups before treatment and at 7 days after MCAO. High-throughput RNA-sequencing technology was used to analyze the expression profile of differential genes of mice brain tissues in the three groups at 7 days after MCAO operation. Six differential genes were randomly selected and verified by quantitative reverse transcriptase-mediated PCR (qRT-PCR). The differential genes were analyzed by gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway methods to identify the potential biological process and related signaling pathways of genes dysregulation after MCAO and reversed by BYHWD. Results  Before treatment, there was no statistical difference in the mNSS score between the BYHWD and control groups [5.00 (4.00-5.25) vs. 5.00 (4.00-6.00), P>0.017]. At 7 day after MCAO, the mNSS score in BYHWD group decreased compared with the control group [3.00 (2.75-4.00) vs. 5.00 (4.00-6.00), P<0.017]. Compared with the sham operation group, 134 genes were up-regulated after MCAO and down-regulated by BYHWD treatment, while 19 genes were down-regulated after MCAO and up-regulated by BYHWD treatment. The mRNA expression of Myd88, Map3k8, Il1r1, Lamc2 and Tlr9 increased in control group and decreased in BYHWD group, while Cxcl10 was on the contrary, which were consistent with the results of high-throughput sequencing. GO and KEGG analysis showed that the up-regulated genes after MCAO and reversed by BYHWD treatment were mainly enriched in the biological processes and signaling pathways related to inflammation and cell death, such as “acute inflammatory response, immune regulation, cell death, autophagy” and “IL-17 signaling pathway, Tod-like receptor signaling pathway, chemokine signaling pathway and NF-Kappa B signaling pathway”, etc. The down-regulated genes after MCAO and reversed by BYHWD treatment were mainly enriched in the biological processes and signaling pathways related to neural plasticity, such as “pyramidal neuron differentiation, positive regulation of synaptic plasticity, synaptic vesicle circulation, neurotransmitter transport” and “retrograde endocannabinoid signal transduction, calcium signal transduction, longevity regulation pathway, long-term enhancement”, etc. Conclusions  The level of gene expression in ischemic brain tissue of mice changed significantly after acute cerebral infarction. BYHWD can alleviate brain damage and promote neuroplasticity by acting on multiple molecular targets closely related to inflammatory response and neural plasticity, and thus improve neurological function of acute cerebral infarction mice. Reference | Related Articles | Metrics

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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 Abstract （2052）      PDF （3197KB）（165）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （2047）      PDF （1738KB）（831）       Knowledge map    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. Related Articles | Metrics

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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 Abstract （2042）      PDF （2022KB）（139）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （1970）      PDF （1914KB）（67）       Knowledge map    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.  Reference | Related Articles | Metrics

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Neuregulin 1β Improves Cerebral Ischemia Reperfusion Injury by Inhibiting Autophagy via Sirt1 Signaling Pathway in Rats LIANG Xiaoyan, HOU Feng, LIU Xiaoqing, NI Qinshuai, GUO Yunliang, ZHANG Rui Chinese Journal of Stroke    2023, 18 (03): 301-314.   DOI: 10.3969/j.issn.1673-5765.2023.03.010 Abstract （1957）      PDF （19301KB）（122）       Knowledge map    Save Objective  To investigate whether neuregulin 1β (NRG1β) can alleviate middle cerebral artery occlusion reperfusion (MCAO/R) injury in rats by inhibiting autophagy, and whether this effect is mediated by the silent information regulator protein 1 (Sirt1) signaling pathway. Methods  A total of 210 healthy male SD rats were randomly divided into sham group (sham group), model group (MCAO/R group), treatment group (NRG1β group), agonist group (SRT501 group) and agonist combined with treatment group (SRT501+NRG1β group), inhibitor group (EX527 group) and inhibitor combined with treatment group (EX527+NRG1β group), with 30 rats in each group. The MCAO/R model was established by the modified thread occlusion method to occlude the initial part of middle cerebral artery. After 2 hours of ischemia, cerebral blood flow was restored for 22 hours. EX527 (5 mg/kg) and SRT501 (100 mg/kg) were injected intraperitoneally 30 minutes before surgery, and NRG1β (2 μg/kg) was injected into the internal carotid artery with a microsyringe after restoration of reperfusion. Neurological behavioral function was evaluated by modified neurological severity score (mNSS) at 2 hours after cerebral ischemia and 22 hours after reperfusion. The proportion of cerebral infarction volume in rats was calculated by TTC staining. Morphological changes of neurons were observed by hematoxylin-eosin (HE) staining. The western blot (WB) and immunofluorescence (IF) were used to detect the expression of Sirt1, LC3 and P62 proteins in ischemic penumbra of the frontal cortex. Results  The mNSS [(10.0±0.8) vs. (12.8±0.6), P<0.001] and TTC staining results [(23.78%±3.52%) vs. (40.24%±1.55%), P<0.001] in NRG1β group were better than those in MCAO/R group. Compared with MCAO/R group, mNSS in NRG1β group, SRT501 group, SRT501+NRG1β group all decreased in different degree, and the proportion of TTC-stained infarct volume reduced. The mNSS and the proportion of infarct volume were the lowest in SRT501+NRG1β group, while they were the highest in EX527 group among these groups. HE staining showed that the morphological and structural damage of neurons in NRG1β group improved compared with that in MCAO/R group and EX527 group. The WB results showed that the expression of Sirt1 [(0.81±0.01)vs. (0.67±0.02), P<0.001] and P62 [(0.92±0.01) vs. (0.78±0.02), P<0.001] in NRG1β group were higher than those in MCAO/R group, and the LC3 expression [(0.49±0.02) vs. (0.94±0.03), P<0.001] was lower than that in MCAO/R group. The IF results showed that Sirt1 positive cell index (PCI) [(0.67±0.01) vs. (0.52±0.02), P<0.001] and P62 PCI [(0.52±0.02) vs. (0.37±0.01), P<0.001] in NRG1β group were higher than those in MCAO/R group, and LC3 PCI [(0.38±0.01)vs. (0.50±0.01), P<0.001] was lower than that in MCAO/R group. The WB and IF results showed that the expression trend of Sirt1 and P62 was consistent as follows, their expression in NRG1β, SRT501 and SRT501+NRG1β groups were higher than that in MCAO/R group, with the highest expression in SRT501+NRG1β group and the lowest expression in EX527 group; the expression trend of LC3 protein was contrary to that of Sirt1 and P62, and the expression of LC3 protein in NRG1β, SRT501 and SRT501+ NRG1β groups were lower than that in MCAO/R group, with the lowest expression in SRT501+NRG1β group and the highest expression in EX527 group. Conclusions  NRG1β plays a neuroprotective role in MCAO/R rats by activating Sirt1 signaling pathway to inhibit autophagy.  Reference | Related Articles | Metrics

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Highlights in Neurointervention in 2022 HUO Xiaochuan, SUN Dapeng, JIA Baixue, GAO Feng, MA Ning, MO Dapeng, MIAO Zhongrong Chinese Journal of Stroke    2023, 18 (02): 133-144.   DOI: 10.3969/j.issn.1673-5765.2023.02.002 Abstract （1914）      PDF （4283KB）（385）       Knowledge map    Save Reference | Related Articles | Metrics

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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 Abstract （1896）      PDF （5588KB）（201）       Knowledge map    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. Reference | Related Articles | Metrics

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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 Abstract （1833）      PDF （1718KB）（140）       Knowledge map    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. Reference | Related Articles | Metrics

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Cerebro-Metabolic Disease: Concept, Method, Challenge and Future Directions XU Jie, WANG Yongjun Chinese Journal of Stroke    2023, 18 (06): 617-627.   DOI: 10.3969/j.issn.1673-5765.2023.06.001 Abstract （1811）      PDF （1963KB）（466）       Knowledge map    Save Metabolic risk factors are important causes of cardiovascular and cerebrovascular diseases. There is already a definite concept and comprehensive management system for cardio-metabolic disease. While the incidence rate of stroke is higher and exhibit greater heterogeneity in China, and lacks a concept of cerebro-metabolic disease currently. Therefore, we reviewed the metabolic risk factors of stroke, proposed the concept and classification of cerebro-metabolic disease, elucidated the interdisciplinary and multi-organ level research methods based on multi-omics technology, introduced the characteristics of recently emerged metabolic drugs with cardiovascular benefits and the challenges and future directions. We aimed to provide a theoretical basis for the comprehensive management of cerebro-metabolic disease. Reference | Related Articles | Metrics

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Advances in Clinical Classification of Moyamoya Disease HAN Guangsong, NI Jun Chinese Journal of Stroke    2022, 17 (10): 1120-1126.   DOI: 10.3969/j.issn.1673-5765.2022.10.014 Abstract （1804）      PDF （1727KB）（303）       Knowledge map    Save Moyamoya disease (MMD) is a cerebrovascular disease characterized by progressive stenosis of internal carotid arteries and their proximal branches with abnormal vascular network at skull base, which is clinically divided into ischemic, hemorrhagic and asymptomatic types. With the progress of diagnosis and treatment technology, the understanding of epidemiological characteristics of different clinical classification of MMD has developed. The majority of adult patients are ischemic type and the asymptomatic type is gradually increasing. The age of onset, genetic background, pathophysiological mechanism, collateral vascular compensation, distribution of involved vessels and prognosis of MMD were significantly different among different types. This article summarized the historical evolution of epidemiological characteristics, the possible genetic background, pathophysiological mechanism and imaging manifestations of different clinical classification of MMD, to provide new ideas for clinical treatment strategy of MMD. Reference | Related Articles | Metrics

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Highlights in Cerebral Small Vessel Disease in 2022 WANG Yilong, CHEN Weiqi, YE Jinyi, ZHOU Mengyuan, JIANG Lingling, LIU Dong, QIU Baoshan, GAO Ying, ZHAO Yilong, WANG Zan, LI Pengfei Chinese Journal of Stroke    2023, 18 (01): 17-41.   DOI: 10.3969/j.issn.1673-5765.2023.01.002 Abstract （1778）      PDF （17003KB）（513）       Knowledge map    Save Reference | Related Articles | Metrics

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Correlation of Serum Alanine Aminotransferase with Clinical Outcomes in Acute Ischemic Cerebrovascular Disease ZONG Lixia, WANG Xianwei, LI Zixiao, ZHAO Xingquan, LIU Liping, LI Hao, MENG Xia, WANG Yilong, WANG Yongjun Chinese Journal of Stroke    2023, 18 (02): 185-193.   DOI: 10.3969/j.issn.1673-5765.2023.02.008 Abstract （1772）      PDF （2186KB）（193）       Knowledge map    Save Objective   To investigate the correlation of serum alanine aminotransferase (ALT) level with poor clinical outcomes in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients. Methods  Patients with AIS or TIA and having serum ALT level < 120 U/L from the China National Stroke RegistryⅡ(CNSRⅡ) were included in the current analysis.The clinical outcomes included recurrent stroke (including ischemic stroke, intracranial hemorrhage and subarachnoid hemorrhage), composite endpoint events, all-cause death and poor functional outcome within one year. Composite endpoint included recurrent stroke and all-cause death. Poor functional outcome was defined as a mRS score of 3-6. Multivariable logistic regression analysis was used to evaluate the correlation of serum ALT level with the risk of 1-year all-cause death, recurrent stroke, composite endpoint and poor functional outcome, according to the sex-specific quintile of serum ALT level.  Results  A total of 17 178 patients were included, with a mean age of 64.8±11.9 years old and 6368 females (37.1%). Compared with the lowest ALT (corresponding to the lowest serum ALT level), the adjusted odds ratio with 95% confidence interval of the highest quintile were 0.55 (0.43-0.70) for all-cause mortality (P＜0.01）, 0.61 (0.45-0.83) for recurrent stroke (P＜0.01）, 0.62 (0.49-0.77) for composite endpoint (P＜0.01）, and 0.67 (0.56-0.80) for poor functional outcome (P＜0.01）. There was no significant interaction of ALT with age, sex, diabetes, dyslipidemia and alcohol consumption for all outcomes.   Conclusions  The serum ALT level may be negatively correlated with the risk of 1-year all-cause mortality, recurrent stroke, and poor functional outcome in AIS or TIA patients.  Reference | Related Articles | Metrics

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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 Abstract （1710）      PDF （2224KB）（117）       Knowledge map    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. Reference | Related Articles | Metrics

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Highlights in Hemorrhagic Stroke in 2022 BIAN Liheng, JU Yi, XIONG Yunyun, WANG Wenjuan, WANG Jinjin, LIU Lijun, LI Guangshuo, LIN Yijun, ZHAO Xingquan Chinese Journal of Stroke    2023, 18 (01): 42-53.   DOI: 10.3969/j.issn.1673-5765.2023.01.003 Abstract （1691）      PDF （3143KB）（848）       Knowledge map    Save Reference | Related Articles | Metrics

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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 Abstract （1571）      PDF （3300KB）（75）       Knowledge map    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. Reference | Related Articles | Metrics

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Effects of Environmental Enrichment on Cognitive Function in Patients with Vascular Dementia after Stroke ZHOU Tiantian, SU Wenjie, LIAN Songyong, LIN Youcong Chinese Journal of Stroke    2022, 17 (12): 1343-1349.   DOI: 10.3969/j.issn.1673-5765.2022.12.010 Abstract （1567）      PDF （2110KB）（85）       Knowledge map    Save Objective  To investigate the effects of environmental enrichment on cognitive function of patients with vascular dementia after stroke. Methods  This study prospectively enrolled the consecutive patients with vascular dementia after stroke who were admitted in 910th Hospital of PLA Joint Logistic Support Force from January 2020 to March 2022. All the included patients were randomly divided into conventional treatment group and enriched environment group. The conventional treatment group received conventional treatment including drug therapy and rehabilitation training, while the enriched environment group received enriched environment intervention including music therapy, jigsaw puzzle and exercise therapy on the basis of conventional treatment, 30 minutes each time, once a day, 5 days a week, for 8 weeks. Cognitive function, activities of daily living, depression state and quality of life were assessed by MMSE, modified Barthel index (MBI), Hamilton depression scale (HAMD) and stroke-specific quality of life (SS-QOL) before treatment, 4 weeks and 8 weeks after treatment. The above indexes were compared between the two groups before and after treatment. Results  A total of 60 patients were enrolled in the study, with 30 patients in each group. There were no statistical differences in baseline clinical information and the above four scores between the two groups before treatment. The MMSE, MBI and SS-QOL scores in two groups increased at 4 and 8 weeks after treatment compared with those before treatment, while HAMD score decreased, with all the above differences having statistical significance. For comparisons between the two groups at 4 and 8 weeks after treatment, MMSE (15.83±2.97 vs. 14.07±2.70, P=0.019; 16.73±2.07 vs.14.97±2.31, P=0.003), MBI (55.67±10.81 vs. 49.67±10.58, P=0.034; 63.33±8.24 vs. 57.50±9.80, P=0.015) and SS-QOL scores (88.70±9.00 vs. 79.13±9.34, P<0.001; 93.60±8.27 vs. 85.83±8.60, P=0.001) in enriched environment group were higher than those in conventional treatment group, and HAMD score (8.40±2.74 vs. 10.00±3.21, P=0.042; 7.40±2.79 vs. 9.13±2.21, P=0.010) was lower than that in conventional treatment group. Conclusions  Environmental enrichment can significantly improve the cognitive function, activities of daily living, depressive emotion and quality of life of patients with vascular dementia after stroke. Reference | Related Articles | Metrics

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Consensus of Chinese Experts on Assessment and Management of Stroke-related Sleep Disorders 2023 Sleep Disorders Committee of Beijing Neurology Association (BNA), Committee of Neuropsychiatry and Clinical Psychology, BNA, Chinese Association of Geriatric Sleep Science, Chinese Stroke Association of Sleep Medicine Chinese Journal of Stroke    2023, 18 (02): 221-239.   DOI: 10.3969/j.issn.1673-5765.2023.02.013 Abstract （1563）      PDF （2091KB）（758）       Knowledge map    Save Reference | Related Articles | Metrics

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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 Abstract （1481）      PDF （2129KB）（109）       Knowledge map    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. Reference | Related Articles | Metrics