Chinese Journal of Stroke

China Stroke Statistics 2019 (2)

WANG Yong-Jun, LI Zi-Xiao, GU Hong-Qiu, ZHAI Yi, JIANG Yong,ZHAO Xing-Quan, WANG Yi-Long, YANG Xin, WANG Chun-Juan, MENG Xia, LI Hao, LIU Li-Ping, JING Jing,WU Jing, XU An-Ding, DONG Qiang, David Wang

2020, 15(11): 1145-1155. DOI: 10.3969/j.issn.1673-5765.2020.11.001

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Higher Framingham Stroke Risk Increased Inflammatory Response and Adverse Prognosis in Patients with Coronavirus Disease 2019

LIU Ming-Zhu, SUN Dong, LI Huang-Gang, LI Zeng, MEI Bin, LIU Yu-Min

2020, 15(11): 1162-1167. DOI: 10.3969/j.issn.1673-5765.2020.11.003

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Objective To investigate the effects of Framingham stroke risk on the circulating inflammation and prognosis in coronavirus disease 2019 (COVID-19) patients. Methods This was a single-center retrospective study which enrolled 158 COVID-19 patients. According to Framingham score for 10-year stroke risk, all subjects were divided into low-risk group (10-year stroke risk <10%), medium-risk group (10%-20%) and high-risk group (>20%). The levels of serum inflammation biomarkers including CRP, IL-6 and procalcitonin (PCT) in all patients were collected once a week for four consecutive weeks. The prognosis was defined as death within 4 weeks, hospitalization at 4 weeks and recovery. The prognosis and inflammation biomarkers level at different time point among three groups were compared, and multivariate logistic regression analysis was used to determine the relationship between Framingham stroke risk and the prognosis at 4 weeks. Results There was no statistical difference in inflammation biomarkers level among three groups at the first week. The serum IL-6 and PCT levels at the second, third and fourth week were significantly different among three groups, and serum CRP level at the second, third week was also significantly different among three groups. The serum CRP and IL-6 levels gradually decreased after the second week in low-risk group, while the PCT level was relatively stable. The IL-6 and PCT levels began to increase obviously at the fourth week in high-risk group. Compared with the high-risk group, the low-risk group had a lower risk of death (OR 0.062, 95%CI 0.004-0.772, P =0.031), the low-risk group (OR 0.117, 95%CI 0.031-0.396, P =0.001) and medium-risk group (OR 0.108, 95%CI 0.025- 0.501, P =0.004) had a lower risk of hospitalization. The mediation effect model showed that the higher level of serum IL-6 can partly explain the relationship between Framingham stroke risk and the poor prognosis of COVID-19 patients (death: β decreased by 13.7%, OR 0.071, 95%CI 0.005-0.815; hospitalization: β decreased by 19.1%, OR 0.128, 95%CI 0.034-0.452). Conclusions Higher Framingham stroke risk increased circulatory inflammatory response and poor prognosis in COVID-19 patients.

Study on the Mechanisms of Cerebrovascular Disease Caused by Coronavirus Disease 2019

GU Cong,WU Xue-Chun, CAO Yong-Jun, LIU Chun-Feng, ZHANG Xia

2020, 15(11): 1168-1174. DOI: 10.3969/j.issn.1673-5765.2020.11.004

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Coronavirus disease 2019 (COVID-19) with a wide epidemic, high probability of deterioration and mortality, has become one of the biggest challenges for human society. It was reported that the prevalence of stroke in COVID-19 patients was 0.5%, with embolism and atherosclerosis as its main pathogenesis. There seemed to be more large-vessel stroke in COVID-19 patients. The interaction between the virus and ACE2 receptor, inflammation and coagulopathy played important roles in the pathogenesis of stroke in the COVID-19 patients. Therefore, this article aimed to summarize the relationship between severe acute respiratory syndrome coronavirus 2 and cerebrovascular diseases, to better guide the clinical diagnosis and treatment.

Central Nervous System Complications in Patients with Coronavirus Disease 2019

KANG Zhi-Ming, NIE Chuang, WU Xiang-Bo, MEI Bin

2020, 15(11): 1175-1182. DOI: 10.3969/j.issn.1673-5765.2020.11.005

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Coronavirus disease 2019, following severe acute respiratory syndrome virus and Middle East respiratory syndrome virus, is another coronavirus that caused a global pandemic. It mainly affects the respiratory system, but can also involve multiple systems including the central nervous system due to the wide distribution of receptors of the virus. The mechanisms of this virus involving central nervous system included direct invasion, activating inflammatory response and inducing autoimmune response, leading to a series of complications like encephalitis, acute myelitis, encephalopathy, epilepsy, and cerebrovascular disease, which seriously affected the prognosis of patients. This review summarized the above complications according to the literatures lately, to provide the reference for clinical practice.

The Efficacy of Mirror Therapy for Improving Hemiplegic Lower Extremity Motor Poststroke: A Meta Analysis

LIU Gao, ZHOU Lu, WANG Lei, HE Yi-Xian, CAI En-Li

2020, 15(11): 1183-1191. DOI: 10.3969/j.issn.1673-5765.2020.11.006

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Objective To systematically evaluate the effects of mirror therapy on hemiplegic lower extremity motor function, gait and balance in stroke patients. Methods Randomized controlled trials (RCT) of mirror therapy on the improvement of lower extremity motor function after stroke were searched in APTA, PEDro, Embase, PubMed, CINAHL, Cochrane Library, China Biomedical Literature (CBM), Wanfang Data, VIP and China National Knowledge Infrastructure (CNKI) System from 2004 May to 2019 May. The data were screened strictly according to the inclusion and exclusion criteria, and the meta-analysis of standard RCTs was performed using RevMan 5.3 software. Results A total of 14 RCTs were included. Meta analysis showed that mirror therapy improved lower extremity Fugl-Meyer assessment score [standardized mean difference (SMD) 3.20, 95%CI 1.52- 4.88, P <0.001], improved the ankle joint motion range (SMD 1.20, 95%CI 0.71-1.69, P <0.001), and improved the lower extremity Brunstrom stage [mean difference (MD) 0.55, 95%CI 0.28-0.82, P <0.001], compared with control treatment. There is no evidence that mirror therapy can improve muscle tension of the lower extremities; mirror therapy can improve 10 meter walk test score (SMD 0.08, 95%CI 0.03-0.13, P <0.001), but showed no obvious advantage in improving the functional ambulation category scale (P >0.05); mirror therapy can improve the Berg balance scale score (SMD 0.98, 95%CI 0.42-1.53, P <0.001), but not improve the overall stability of the lower extremity balance. Conclusions Compared with the control treatment, mirror therapy can enhance the lower limbs recovery, improve the lower limb motor function and gait in stroke patients, but the improvement of balance ability still needs further verification.

Impact of Hyperhomocysteine on Short-Term Outcome in Acute Cerebral Infarction Patients with Non-Valvular Atrial Fibrillation

CHEN Qian-Mei, LIU Fang, Sheng Can, WU Da-Peng, LIU Jia-Qi

2020, 15(11): 1192-1197. DOI: 10.3969/j.issn.1673-5765.2020.11.007

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Objective To explore the impact of hyperhomocysteine on short-term outcome in acute cerebral infarction (ACI) patients with non-valvular atrial fibrillation (AF). Methods This prospective study consecutively enrolled ACI inpatients within 48 hours of stroke onset and with no-valvular AF. Baseline clinical data and relevant laboratory test results were collected. The primary outcome was a mRS score at 90 days. Good outcome was defined as a mRS score of 0-2. Multivariate logistic regression analysis was performed to determine the independent risk factors for 90-day outcome. Results A total of 112 patients were included, with 46 males (41.4%) and a mean age of 76.23±9.02 years old (range: 45-92 years old). 53 (47.3%) patients had good prognosis. Multivariate logistic regression analysis showed that higher NIHSS score at admission (OR 1.632, 95%CI 1.185-2.250, P =0.03), hyperglycemia (OR 1.360, 95%CI 1.052-1.758, P =0.019) and higher homocysteine (OR 1.702, 95%CI 1.133-2.557, P =0.010) were independent risk factors for 90-day clinical outcome. Conclusions Hyperhomocysteine may be an independent risk factor for 90-day outcome in ACI patients with non-valvular AF.

Effect of Vertebral Artery Morphological Anomaly on the Duration of Symptoms in Patients with Posterior Circulation Transient Ischemic Attack

JIN Ge, WANG Jun-Wei, CHEN Liang, YANG Yong-Tao, ZHENG Fang-Shuo,ZHANG Yu, ZHAN Qun-Ling

2020, 15(11): 1198-1203. DOI: 10.3969/j.issn.1673-5765.2020.11.008

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Objective To investigate the effect of vertebral artery (VA) morphological anomaly on the duration of symptoms in patients with posterior circulation TIA. Methods The data of patients with posterior circulation TIA who underwent head and neck DSA or CTA from Chongqing Renji Hospital, University of Chinese Academy of Sciences between October 2015 to March 2018 were retrospectively analyzed. According to the duration of symptoms, patients were divided into three groups: duration of symptoms <10 minutes, 10-59 minutes and ≥60 minutes. The differences of subtypes of VA morphological anomaly were compared among the three groups. The association between morphological anomaly of VA and the duration of symptoms of TIA was determined by multivariable logistic regression analysis. Results A total of 237 patients were included, there were 109 (45.99%), 71 (29.96%), and 57 (24.05%) patients in the group of duration of symptoms <10 minutes, 10-59 minutes and ≥60 minutes, respectively. There were statistical differences in sex and the rate of stenosis ≥50% in VA and basilar artery (P <0.05) among the three groups. For VA morphological anomaly, VA atherosclerotic stenosis among the three groups had statistical difference (P =0.004); while there were no statistical differences in unilateral VA tortuosity, bilateral VA tortuosity, unilateral dominance, unilateral dominance plus tortuosity and origin abnormality among the three groups (all P >0.05). The multivariate logistic regression analysis showed that VA stenosis (OR 2.500, 95%CI 1.381-4.525, P =0.002) and basilar artery stenosis ≥50% (OR 12.066, 95%CI 1.446-100.668, P =0.021)were independent influencing factors for the duration of symptoms of posterior circulation TIA. Conclusions VA stenosis and basilar artery stenosis ≥50% are independent risk factors for the duration of symptoms in posterior circulation TIA.

Analysis of Clinical Value of Acute Ischemic Stroke-Associated Pneumonia Score

LI Fang, XU Li-Hua, JI Rui-Jun,YU Kai, YANG Hong-Na, YAN Ying-Lin,GAO Su-Ying

2020, 15(11): 1204-1209. DOI: 10.3969/j.issn.1673-5765.2020.11.009

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Objective To evaluate the clinical value of acute ischemic stroke-associated pneumonia score (AIS-APS) for predicting in-hospital stroke-associated pneumonia after AIS, and to provide a suitable tool for early screening of stroke-associated pneumonia. Methods Data of AIS patients from stroke registry database of Renqiu Kangjixintu Hospital from January 20, 2014 to August 31, 2016 were retrospectively analyzed. All patients were evaluated using AIS-APS, the area under the ROC curve (AUC) was used to determine the sensitivity and specificity of this score. The predictive value of the ISAN score, A2DS2 score, Kwon score for stroke-associated pneumonia were also evaluated. Results A total of 3104 patients were included, and stroke-associated pneumonia occurred in 100 (3.2%) patients. The AUC of AIS-APS for predicting pneumonia was 0.737 (95%CI 0.721-0.753), the sensitivity was 0.800, the specificity was 0.611, and the Youden index was 0.411. The best cutoff value was 5 points. Comparing the ISAN, A2DS2, and Kwon score, the AIS-APS had the highest sensitivity and AUC, and the ISAN score had the highest specificity (0.759). Conclusions The AIS-APS is valuable for predicting stroke-associated pneumonia, which can be used for early screening of stroke-associated pneumonia.

A Mouse Cerebral Ischemia Model of Distal Middle Cerebral Artery Thrombosis Induced by Ferric Chloride

CHEN Qing-Fang, ZHAO Shun-Ying, DONG Wen, GONG Ting, CHEN Wen-Tao, LIU Xiang-Rong

2020, 15(11): 1210-1217. DOI: 10.3969/j.issn.1673-5765.2020.11.010

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Objective To establish a stable mouse cerebral ischemia model of distal middle cerebral artery (MCA) thrombosis induced by ferric chloride, and evaluate the severity of neurological deficit after cerebral ischemic injury. Methods C57BL6/J male mice were randomly divided into cerebral ischemia group and sham group. In cerebral ischemia group, 10% ferric chloride solution was used to induce thrombosis in right distal MCA. Right cerebral and MCA blood flow were measured before operation, 10 minutes after operation, day 1 and 7 after operation. TTC staining was used to evaluate cerebral infarction on day 1 after operation. Three neurological scores (mGS, mNSS and NES) and adhesive removal test were used to evaluate neurological function deficit of mice on day 1, 3, 5 and 7 after operation. On day 7, neuronal nuclei were observed by immunofluorescence staining to evaluate cerebral injury, and CD16/32, CD206 and Iba1 were stained to evaluate glial cells expression. Results Compared to sham group, the following changes occurred in ischemia group: right cerebral blood flow and MCA blood flow all decreased at 10 minutes, day 1 and 7 after operation; obvious cerebral infarction occurred on day 1 after operation and persisted on day 7; three neurological scores and adhesive removal test all indicated different degrees of neurological impairment of mice in ischemia group; the expression of M1 and M2 glial cells around cerebral infarction increased on day 7. Conclusions A stable mouse cerebral ischemia model can be established by using Ferric chloride solution. The following changes can be observed in mouse models: the cerebral blood flow and MCA blood flow on surgical side decreased; cerebral cortex infarct and neurological function deficit appeared; the expression of glial cells around the infarction up-regulated.

Cerebral Blood Flow Autoregulation Assessment in Patients with Idiopathic Intracranial Hypertension

CHEN Jie,LIU Jia, DONG Pei, DONG Ke-Hui, MO Da-Peng, WANG Yi-Long, ZHAO Xing-Quan, GONG Xi-Ping

2020, 15(11): 1218-1222. DOI: 10.3969/j.issn.1673-5765.2020.11.011

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Objective To investigate the capacity of cerebral blood flow autoregulation in patients with idiopathic intracranial hypertension (IIH). Methods This study consecutively enrolled patients with IIH from Beijing Tiantan Hospital, Capital Medical University and age-matched health volunteers as control from December 2018 to March 2019. The spontaneous fluctuation in arterial blood pressure and cerebral blood flow velocity were analyzed using transfer function analysis to assess cerebral blood flow autoregulation. Results A total of 10 patients with IIH and 13 control subjects were included. 46 middle cerebral arteries (MCAs) were detected, including 20 MCAs in cerebral hemisphere with high cranial pressure and 26 normal ones. Compared to control group, MCA blood flow in IIH group decreased significantly [(0.64±0.35)%/% vs (0.37±0.20)%/%, P =0.004], the phase of cerebral blood flow in IIH group also declined significantly (58.80±20.86º vs 39.16±23.79º, P =0.005). The rate of cerebral blood flow recovery per second in IIH group was lower than that in control group, but without statistical significance [(26.34±43.29)%/s vs (38.81±20.16)%/s, P =0.240]. Conclusions Cerebral blood flow autoregulation in patients with IIH was significantly impaired.

Welcoming New Guidelines for AI Clinical Research

Translator: XIONG Yun-Yun, LI Zi-Xiao, DING Ling-Ling,GU Hong-Qiu, WANG Chun-Juan, WANG Chun-Xue, WANG Yong-Jun

2020, 15(11): 1223-1227. DOI: 10.3969/j.issn.1673-5765.2020.11.012

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Guidelines for Clinical Trial Protocols for Interventions Involving Artificial Intelligence: the SPIRIT-AI Extension

Translator: XIONG Yun-Yun, LI Zi-Xiao, DING Ling-Ling, GU Hong-Qiu, WANG Chun-Juan, WANG Chun-Xue,ZHAO Xing-Quan, WANG Yong-Jun

2020, 15(11): 1228-1238. DOI: 10.3969/j.issn.1673-5765.2020.11.013

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Application of Nicergoline in Cerebrovascular Disease

CHEN Chen, WANG Kai

2020, 15(11): 1239-1243. DOI: 10.3969/j.issn.1673-5765.2020.11.014

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Nicergoline is an ergot derivative, which is widely used in the treatment of cognitive impairment in patients with cerebrovascular disease. Preclinical studies suggested the mechanisms of nicergoline in improving cognitive deficits may be related to the following factors: improve cerebral blood flow, promote neurotransmitters releasing, neurotrophic and antioxidant effect. Current studies suggested that nicergoline can improve post-stroke depression, vascular cognitive impairment and dementia. Nicergoline has a good safety profile, and up to now none of the studies reported any incidence of fibrosis or ergotism after taking nicergoline. This article reviewed the mechanism, clinical efficacy and safety of nicergoline in nervous system, to provide reference for clinical application.

Application of Objective Structured Clinical Examination in Evaluating Communication Skill for Neurology Residents

YUAN Xue-Jiao, REN Yi

2020, 15(11): 1244-1247. DOI: 10.3969/j.issn.1673-5765.2020.11.015

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Objective To investigate the clinical application of objective structured clinical examination (OSCE) in evaluating clinical competency and communication skill of neurology residents. Methods OSCE were used for annual assessment of neurology residents. OSCE included six assessment aspects: clinical knowledge and 5 aspects in clinical skills including analyzing clinical examinations, clinical reception of patients, medical record writing, clinical operation skills, and communication skill. The scores of the six aspects in neurology residents were evaluated and analyzed. Results A total of 102 residents were evaluated, including 15 residents and 87 postgraduate students. There were 32, 31 and 39 residents in grade 1, 2, 3, respectively. The total score of grade 3 [256.3 (95%CI 246.9-261.4)] was higher than that of grade 1 [236.5 (95%CI 227.3-244.9)] and grade 2 [246.6 (95%CI 232.8-256.2)], and the score of clinical reception of grade 2 was higher than that of grade1 (all P <0.05). The score percentage of communication skill in OSCE was significantly lower than that of the other 5 aspects. The score of communication skill was positively correlated with the scores of clinical practice, clinical operation practice and medical record writing. Conclusions OSCE could well evaluate the communication skill of neurology residents. The communication skill of residents still needs to improve.

Analysis of Doctoral General Entrance Examination Results in Cerebrovascular Disease

MENG Shi-Jiao, WU Jun, XIAO Jia-Lin, REN Yi

2020, 15(11): 1248-1250. DOI: 10.3969/j.issn.1673-5765.2020.11.016

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Objective To discuss the current status and problems of entrance examination for doctoral students, and the significance of the scores analysis of doctoral entrance examination based on grey correlation analysis. Methods To calculate grey relational grade between the initial test scores, the retest scores and total scores of the doctoral general entrance examination in cerebrovascular disease from 2014 to 2018. Results Compared with the initial test score, the retest score was more associated with the total score of the general entrance examination for doctoral students from 2014 to 2018 in both neurosurgery and neurology. Conclusions The comprehensive ability of students in the retest had a greater impact on the doctoral general entrance examination, so it should be paid more attention to the scientific quantification of the retest in the universities.

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