Table of Content

20 July 2021, Volume 16 Issue 07

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Research on Lockchain Technology and Artificial Intelligen-Driven Cerebrovascular Disease Diagnosis and#br# Treatment and Quality Management Decision Paradigm#br#

WANG Meng, HAN Ying, LI Zi-Xiao

2021, 16(07):  639-642.  DOI: 10.3969/j.issn.1673-5765.2021.07.001

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Artificial Intelligence in Clinical Medicine: Typical Application and Challenges

SUN Yue-Chuan, GAO Jian-Dong, WU Ji

2021, 16(07):  643-648.  DOI: 10.3969/j.issn.1673-5765.2021.07.002

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Application of Artificial Intelligence Imaging in Diagnosis and Treatment of Stroke

WU Yun-Yang, GAO Jian-Dong, WU Ji

2021, 16(07):  651-656.  DOI: 10.3969/j.issn.1673-5765.2021.07.003

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Multi-modality imaging is an important means to evaluate the occurrence and development of ischemic stroke. For complex and amounts of information inside the imaging, the imaging data analysis has certain difficulty. The traditional computer vision methods rely on manual extraction of information, which made the performance limited and the generality poor in dealing with complex tasks. Artificial intelligence (AI) imaging technology mainly refers to using AI to deal with computer vision tasks, including image classification, lesions localization, detection, imaging segmentation and etc. AI imaging analysis software can capture multidimensional imaging information, so AI imaging, combing with clinical information, can be applicated in many fields such as early screening, lesions recognition, diagnosis, and prognosis prediction of stroke. The preliminary application and deep research in the above fields are being carried out. AI imaging technology has showed certain value in rapid and precise imaging analysis and assisting in standardized diagnosis and treatment of stroke, while it has some deficiency in clinical validation and translation. At present, AI imaging technology still faces many challenges in clinical application.

Safety and Efficacy of 50 mg Enteric Sustained-Release Aspirin Tablet in Secondary Prevention of Mild Ischemic#br# Stroke/Transient Ischemic Attack#br#

YU Feng-Chun, QI Yan-Yan, ZHANG Jing, GAO Bing, WANG Xue-Hong, ZHAO Feng-Li, WANG Su-Li, FANG Zhi-Yong, QIAO Shu-Dong, BI Qi

2021, 16(07):  657-663.  DOI: 10.3969/j.issn.1673-5765.2021.07.004

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Objective To investigate the efficacy and safety of 50 mg enteric sustained-release aspirin tablet in secondary prevention of mild ischemic stroke/TIA. Methods This was a multicenter, randomized, open, parallel control, non-inferior and prospective

clinical study, which enrolled mild ischemic stroke/TIA patients with onset of 21days to 90 days

from 21 domestic centers. All the patients were randomly divided into observation group (Aspirin enteric-coated sustained release tablet 50 mg once every night) and control group (enteric-coated Aspirin 100 mg once every night). Both groups were treated and followed up for 52 weeks. The recurrence of stroke (ischemic stroke, hemorrhagic stroke and TIA), major adverse cardiovascular events (MACE), all-cause death and adverse events were compared between the two groups. Results A total of 567 patients were enrolled in the study, including 287 patients in observation group and 280 patients in control group. The difference in recurrence rate of stroke and/or TIA (4.53% vs 4.29%, P =0.8454), the incidence of MACE (1.05% vs 1.07%, P =1.0000) and all-cause death (0 vs 0.36%, P =0.4938) between the two groups had no statistical significance. The difference in recurrence rate of stroke and/or TIA between the two groups was -0.0011 (95%CI -0.0300-0.0278) in noninferior test. The difference in incidence of bleeding events between the two group had no statistical significance (observation vs control: 2.09% vs 3.21%, P =0.4045), and one case of gastric ulcer bleeding occurred in the control group. The difference in severe adverse events between the two group also had no statistical significance (observation vs control: 0 vs 0.71%, P =0.2434), including 1 case of fracture and 1 case of death after recurrent stroke both in the control group. Conclusions 50 mg enteric sustained-release aspirin tablets are effective in secondary prevention of mild ischemic stroke/TIA, and the incidence and degree of adverse events are relatively mild. The overall efficacy of secondary prevention of stroke/TIA of 50 mg enteric sustained-release aspirin tablets is not inferior to that of 100 mg aspirin enteric-coated tablets.



Relationship between Hypersensitive C-reaction Protein and Intracerebral Hemorrhage

WANG Dan-Dan, WANG Jing, WANG An-Xin, ZHANG Yi-Jun, ZHAO Xing-Quan

2021, 16(07):  664-669.  DOI: 10.3969/j.issn.1673-5765.2021.07.005

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Objective To investigate the relationship between hs-CRP level and intracerebral hemorrhage (ICH). Methods This study enrolled the participants from June 2006 to October 2007 in Kailuan study, and all the subjects finished the questionnaire, physical examination and laboratory examinations at the baseline. The face-to-face follow-up were conducted every two years. The new ICH events during the follow-up were recorded until December 31, 2017, and the subjects were divided to new ICH group and control group according to ICH occurring or not . The baseline data including hs- CRP level between the two groups were compared. Cox regression analysis was used to analyze the effect of hs-CRP level on new ICH event. The effect of hs-CRP level on the new ICH event in different gender sub-groups was analyzed as well. Results A total of 87 242 participants were finally included in this study, and new ICH event occurred in 829 participants. Cox regression analysis showed that high hs-CRP level was an independent risk factor for ICH in women subgroup (HR 1.199, 95%CI 1.040-1.383, P =0.0125). Conclusions High hs-CRP level may increase the risk of ICH event, especially in women.



Clinical Characteristics and Treatment of Patients with Coronavirus Disease 2019 and Hemorrhagic Cerebrovascular#br# Disease#br#

HU Jun-Xian, HU Yue-Yun, LI Xiao-Hua, XIONG Gang, LI Hai-Tao, LIU Chang-Ya, XIONG Zhi-Yong, HU Xue-Bin

2021, 16(07):  670-674.  DOI: 10.3969/j.issn.1673-5765.2021.07.006

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Objective To analyze the clinical characteristics and treatment experience of the patients with coronavirus disease 2019 (COVID-19) and hemorrhagic cerebrovascular disease. Methods The data of patients with COVID-19 and hemorrhagic cerebrovascular disease from 6 hospitals in Wuhan between January 13, 2020 and March 13, 2020 were retrospectively analyzed. The clinical characteristics and treatment of the patients were described, and the clinical characteristics and postoperative tracheotomy rate were compared between the patients with hypertensive intracerebral hemorrhage who received minimally invasive treatment and craniotomy. Results A total of 82 patients, aged 43-78 years and 40 men (48.78%), were included in the

study. There were 37 cases (45.12%) with mild pneumonia and 45 cases (54.88%) with severe

pneumonia; 56 cases (68.29%) with hypertensive cerebral hemorrhage, 25 cases (30.49%) with ruptured intracranial aneurysm hemorrhage, 1 cases (1.22%) with hemorrhagic moyamoya disease. 59 patients (71.95%) received surgical treatment for cerebral hemorrhage, including 38 patients (64.41%) with hypertensive cerebral hemorrhage, 21 patients (35.59%) with ruptured intracranial aneurysms, and 31 patients (52.54%) with tracheotomy. For the patients with hypertensive intracerebral hemorrhage, 15 cases (39.47%) in craniotomy group and 23 cases (60.53%) in minimally invasive surgery group. There were no statistically significant differences in age, gender distribution, severity of pneumonia and GCS score between the two groups, but the ratio of postoperative tracheotomy in craniotomy group was higher than that in minimally invasive surgery group (93.33% vs 30.43%, P <0.001). Conclusions For the patients with COVID-19 and hypertensive intracerebral hemorrhage requiring surgical treatment, the ones who received minimally invasive surgery had a lower tracheotomy rate than those who received craniotomy.



Application of Cerebrospinal Fluid Oligoclonal Bands, 24-hour Intrathecal IgG Synthesis Rate and IgG Index in#br# the Diagnosis of Meningovascular Syphilis#br#

HE Yan-Qun, XU Dong-Mei, WANG Ya-Jie, LI Jing-Jing, HUANG Yu-Ming

2021, 16(07):  675-679.  DOI: 10.3969/j.issn.1673-5765.2021.07.007

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Objective To investigate the value of cerebrospinal fluid (CSF) oligoclonal bands, 24-hour intrathecal IgG synthesis rate and IgG index in the diagnosis of meningovascular syphilis. Methods Clinical data of patients with meningovascular syphilis hospitalised in the Department of Neurology, Beijing Ditan Hospital, Capital Medical University from June 2014 to June 2019 were retrospectively analyzed, and the positive (abnormal) rate, false negative rate of CSFTRUST, oligoclonal bands, 24-hour intrathecal IgG synthesis rate and IgG index in patients with meningovascular syphilis were analyzed. Results A total of 102 patients with meningovascular syphilis were enrolled. The positive (abnormal) rates of CSF oligoclonal bands, 24-hour intrathecal IgG synthesis rate and IgG index were 93.1%, 93.1% and 91.2%, respectively, which were all significantly higher than that of TRUST (71.6%) (all P <0.001). The false negative rates of CSF oligoclonal bands, 24-hour intrathecal IgG synthesis rate and IgG index were 6.9%, 6.9% and 8.8%, respectively, which were all lower than that of CSF-TRUST (28.4%) (all P <0.001). Conclusions The CSF oligoclonal bands, 24-hour intrathecal IgG synthesis rate and IgG index can

be used in the diagnosis of meningovascular syphilis, and the sensitivity and false negative rates of

the above indexes were better than that of CSF-TRUST.



Clinical Features and Prognosis of Remote Parenchymal Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke

WANG Zhen, XU Wei, HE Guo-Hua, HU Jue, FENG Tie-Qiao, TONG Yang-Ping, XU Gui-Lan, XIAO Hui, YI Hai-Bo, SONG Zhi

2021, 16(07):  680-686.  DOI: 10.3969/j.issn.1673-5765.2021.07.008

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Objective To investigate the clinical features and prognosis of remote parenchymal hemorrhage (rPH) after intravenous thrombolysis in acute ischemic stroke. Methods A retrospective analysis of patients with rPH after intravenous thrombolysis from Changsha Central Hospital between January 2016 and April 2020 was performed. The clinical features, imaging characteristics and 90-day functional outcome (a favorable outcome was defined as mRS score <2 at 90 days) of patients with rPH were analyzed. Results A total of 376 patients received intravenous thrombolysis, and hemorrhagic transformation (HT) occurred in 31 patients (8.2%), including 10 patients with rPH. The incidence of rPH in all thrombolysis patients was 2.7%, and 32.3% in all HT patients. For 10 rPH patients, 9 cases (90.0%) were men, the mean age was 69.5±8.6 years, the baseline NIHSS score before thrombolysis was 4.5 (3~9). 6 rPH patients had old ischemic lesions on CT scan before thrombolysis; 5 rPH patients had moderate to severe leukoaraiosis on MR FLAIR imaging; severe stenosis at the initial segment of internal carotid artery contralateral to the bleeding lesions were observed in 2 rPH patients; the fibrinogen concentration after thrombolysis reduced significantly in 2 rPH patients. 8 patients had

lobar rPH, and 2 patients had deep rPH. There were 6 rPH cases with bleeding <5 mL, 2 rPH cases

with 6-10 mL and 2 rPH cases with bleeding >10 mL. For 8 patients with rPH-1 type, 6 (60.0%) had a favorable outcome at 90 days, and the other two (20.0%) had a poor outcome (mRS: 3 and 4); for 2 patients with rPH-2 type, they both (20.0%) died. Conclusions rPH is an uncommon complication after intravenous thrombolysis in acute ischemic stroke. The pathogenesis of rPH may be different from hemorrhagic transformation within infarct lesions. Most of rPH were lobar rPH. Patients with rPH-2 type usually had poor prognosis and high mortality.



Analysis on the Predictive Value of Modified Cincinnati Prehospital Stroke Severity Scale for Acute Large Vessel Occlusion in Anterior Circulation

LIU Ting, LIAO Juan, LIU Li, ZHAO Li-Bo, LIU Shu-Dong, XU Lu, ZHOU Ting, YANG De-Yu

2021, 16(07):  687-693.  DOI: 10.3969/j.issn.1673-5765.2021.07.009

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Objective To modify Cincinnati prehospital stroke severity scale (CPSSS) by adding atrial fibrillation (AF), and evaluate the predictive value of modified CPSSS (mCPSSS) for large vessel occlusion (LVO) in anterior circulation. Methods This retrospective analysis enrolled the patients with acute ischemic stroke in anterior circulation in Comprehensive Stroke Center, Yongchuan Hospital of Chongqing Medical University between May 2019 and April 2020. Univariate and multivariate logistic regression analysis were used to analyze the association of the items of CPSSS and AF with LVO, and the mCPSSS containing CPSSS and AF was formed. ROC curve and the area under the curve (AUC) were used to evaluate the predictive ability for LVO in anterior circulation of the mCPSSS, CPSSS and other stroke assessment scales such as vision, aphasia, neglect (VAN), 3 item stroke scale (3I-SS) and

rapid arterial occlusion evaluation (RACE).

Results A total of 263 patients were included in this study. Gaze deviation, consciousness and response, upper limb weakness and AF were independent predictors of LVO in anterior circulation. When the point value of AF was defined as 1 point, the AUC of mCPSSS was 0.955; when defined as 2 points, the AUC was 0.950. For mCPSSS, the optimal cut-off value for predicting LVO was 2 points, with a sensitivity of 90.16% and a specificity of 94.33%. The capability of predicting LVO in anterior circulation of mCPSSS was superior to CPSSS, VAN, 3I-SS and RACE scales (all P <0.05, Delong’s test). Conclusions For predicting LVO in anterior circulation, the mCPSSS was superior to the other common stroke scales, which can be used for pre-hospital identification, emergency and in-hospital triage of acute LVO in anterior circulation.



Incidence, Risk Factors and In-hospital Outcome of Venous Thromboembolism in Neurocritical Patients

GAO Hao-Ran, WANG Yan, DUAN Yu-Qing, XU Shan-Shan, MIAO Ming-Yue, CHENG Kun-Ming, ZHOU Jian-Xin, ZHANG Lin-Lin

2021, 16(07):  694-698.  DOI: 10.3969/j.issn.1673-5765.2021.07.010

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Objective To explore the incidence and risk factors of venous thromboembolism (VTE) in neurocritical patients, and the influence of VTE on in-hospital outcomes. Methods The data of the neurocritical patients in Beijing Tiantan Hospital from October 2019 to September 2020 were retrospectively analyzed. According to the presence of VTE or not after SAH during ICU hospitalization, the patients were divided into VTE group and non-VTE group. The incidence of VTE was calculated. The differences in mortality, the length of ICU stay and hospital stay, and the cost of hospitalization were compared between the two groups. Multivariate logistic regression analysis was used to identify the risk factors of VTE in neurocritical patients. Results A total of 723 patients were included in this study, with a median age of 52 years old and 383 males (53.0%), and 330 patients (45.6%) had VTE. Multivariate logistic regression analysis showed that the age (OR 1.078, 95%CI 1.053-1.104), BMI (OR 1.082, 95%CI 1.013-1.156), and D-dimer level (OR 1.042, 95%CI 1.006-1.079) were independent risk factors for VTE. The inhospital mortality between the two groups had no statistical difference (4.8% vs 3.6%, P =0.388). However, compared with non-VTE group, the length of hospital stay (21 d vs 18 d), the length of

ICU stay (8 d vs 5 d) and the cost of hospitalization (121 358 CNY vs 93 717 CNY) increased in

VTE group (all P <0.001). Conclusions The incidence of VTE in neurocritical patients was 45.6%. The elder age, BMI and increased D-dimer level may be independent risk factors for VTE. Additionally, VTE might increase the length of hospital stay, the length of ICU stay and hospitalization cost.



Predictors of Tracheostomy Decannulation in Patients with Severe Acquired Brain Injury

SONG Lu, WANG Yong, LI Hai-Dong, LIU Jie, LI Zheng, ZHANG Wen-Jing, GAO Ya-Li, LIU Yue-Wei, LU Min-Jie

2021, 16(07):  699-704.  DOI: 10.3969/j.issn.1673-5765.2021.06.011

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Objective To identify the predictors for tracheostomy decannulation in patients with severe acquired brain injury (sABI). Methods This retrospective study enrolled sABI patients with tracheostomy tubes who underwent rehabilitation in Rehabilitation Medicine Center, Fuxing Hospital from October 2017 to October 2019. All the subjects were divided into the decannulation group and non-decannulation group based on successful decannulation. The collected data included baseline information, consciousness state, reflex cough ability, swallowing function, oxyhemoglobin saturation (SPO2>95%), tracheostomy tube capping for 24 hours, and endoscopic assessment of airway patency (lumen diameter>50%). Univariate and multivariate analysis were used to analyze the factors associated with successful tracheostomy decannulation. Results A total 160 sABI patients were included, with a mean age of 56.13±12.87 years and 116 males (72.5%). Decannulation was performed in 85 patients (53.1%). Multivariate logistic regression analysis showed that successful decannulation was associated with consciousness state (minimal conscious state: OR 5.668, 95%CI 1.270-25.301; out of minimal conscious state: OR 34.670, 95%CI 2.570-467.705), airway patency (OR 45.851, 95%CI 3.290-638.914), tracheostomy tube capping for 24 hours (OR 96.069, 95%CI 9.799-941.897).

Conclusions The consciousness state, tracheostomy tube capping for 24 hours and airway patency

were independent predictors for the successful tracheostomy decannulation in sABI patients.

Consensus on Evaluation and Improvement of Healthcare Quality of Acute Ischemic Stroke Reperfusion Therapy

National Center for Healthcare Quality Management in Neurological Diseases, Chinese Stroke Association

2021, 16(07):  705-715.  DOI: 10.3969/j.issn.1673-5765.2021.07.012

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Chinese Consensus on Diagnosis and Therapy of Cerebral Small Vessel Disease 2021

Cerebral Small Vessel Disease Professional Committee Consensus Writing Group, Chinese Research Hospital Association

2021, 16(07):  716-726.  DOI: 10.3969/j.issn.1673-5765.2021.07.013

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Interpretation for Chinese Consensus on Branch Atheromatous Disease

WANG Yi-Long

2021, 16(07):  728-729.  DOI: 10.3969/j.issn.1673-5765.2021.07.014

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Bridging Therapy for Hyperacute Cerebral Thrombosis Caused by Papillary Cardiac Myxoma: A Case Report

FU Wen-Hua, QU Qian-Qian, LYU Hai-Dong

2021, 16(07):  730-733.  DOI: 10.3969/j.issn.1673-5765.2021.07.015

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A Case of Hereditary Diffuse Leukoencephalopathy with Spheroids Characterized by Persistent Diffusion-Limited Lesions

WANG Jing, LIU Zhong-Zhong, LU Qing-Li, LIU Pei, CHANG Qiao-Qiao, LIU Yan, LIN Xue-Mei, WANG Fang, WU Song-Di

2021, 16(07):  734-738.  DOI: 10.3969/j.issn.1673-5765.2021.07.016

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Progress of Effects of New Hypoglycemic Drugs on Cardio- and Cerebrovascular Events in Patients with Type 2 Diabetes Mellitus

LIN Jian-Rui, CUI Xiang-Li, MI Dong-Hua, LI Zi-Xiao, ZHAO Xing-Quan, WANG Yong-Jun

2021, 16(07):  739-745.  DOI: 10.3969/j.issn.1673-5765.2021.07.017

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Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardio- and cerebrovascular diseases. Cardiovascular disease is also one of the main causes of death in T2DM patients. So it is important for T2DM patients to find new hypoglycemic drugs which also have cardio- and cerebrovascular protective effect. The recent studies about new hypoglycemic agents showed that glucagon-like peptide 1 receptor agonists (GLP-1 RA) may be beneficial for preventing cardio- and cerebrovascular events in T2DM patients. The clinical evidences showed that sodiumglucose cotransporter 2 inhibitor (SGLT2I) can reduce the risk of cardiovascular events and heart failure in T2DM patients, but the benefit evidence in cerebrovascular events is insufficient. There is no clear evidence that dipeptidyl peptidase 4 inhibitor (DPP-4I) can reduce the risk of cardioand cerebrovascular events. More researches were needed to provide the evidence of the effects of new hypoglycemic agents on cardio- and cerebrovascular events, especially for the occurrence and functional prognosis of stroke.



Discussions on Pathophysiological Mechanism of Delayed Cerebral Ischemia after Subarachnoid Hemorrhage

GUO Jia-Huan, ZHAO Xing-Quan

2021, 16(07):  746-751.  DOI: 10.3969/j.issn.1673-5765.2021.07.018

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Subarachnoid hemorrhage (SAH), one of the most threatening cerebrovascular diseases, is characterized by high mortality and high disability rate, which is difficult to be treated. Delayed cerebral ischemia (DCI) is a common complication after SAH and is related to poor functional outcome. Thus, it is important to understand the pathophysiological mechanisms of DCI for preventing and treating DCI. Cerebral vasospasm was thought to be the only reason of DCI in the past, while this hypothesis has been widely questioned in the recent years. Studies have supported the notion of a multifactorial pathophysiological process of DCI. This review aimed to summarize the main pathophysiological mechanisms of DCI at present, to help to explore the methods of identifying the high-risk patients early and develop a novel therapeutic strategy

Progress of Mitophagy in Subarachnoid Hemorrhage

ZHANG Yong-Zhi, LIU Bin-Bing, TIAN Yang, SHI Huai-Zhang

2021, 16(07):  752-756.  DOI: 10.3969/j.issn.1673-5765.2021.07.019

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As a kind of selective autophagy, mitophagy is mainly involved in the regulation of mitochondrial homeostasis, the removal of damaged mitochondria and the prevention of cell death under physiological conditions, various acute stress and chronic diseases. Mitophagy is also involved in multiple neurological diseases. However, there are few studies about the role of mitophagy in subarachnoid hemorrhage. This article reviewed the classic pathways of mitophagy, the mechanism of mitophagy action in subarachnoid hemorrhage, and the impact on the prognosis.