Chinese Journal of Stroke

Perception-Motor Intermodulation in Elderly Stroke

JIA Jie

2022, 17(10): 1037-1039. DOI: 10.3969/j.issn.1673-5765.2022.10.001

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Rehabilitation of Sensory Impairment after Stroke

JIA Jie

2022, 17(10): 1040-1040.

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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)

2022, 17(10): 1041-1050. DOI: 10.3969/j.issn.1673-5765.2022.10.002

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Effects of Brain-Computer Interface Training on Motor Function Recovery in Patients with Post-Stroke Sensory Impairment: An Exploratory Study

FU Jianghong, CHEN Shugeng, SHU Xiaokang, JIANG Zewu, WEI Dongshuai, JIA Jie

2022, 17(10): 1051-1057. DOI: 10.3969/j.issn.1673-5765.2022.10.003

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Objective To investigate the effects of brain-computer interface (BCI) training on motor function recovery in stroke patients with sensory impairment.

Methods The stroke subjects with upper limb sensory and motor function impairment were prospectively enrolled in this study, and all the subjects were randomly divided into experimental group and control group. The experimental group received the robot-assisted graspping and opening brain-computer interface training based on motor attempt, 5 days a week, once a day, 30 minutes each time, for 4 weeks, while the control group received the graspping and opening task-oriented training, 5 days a week, once a day, 30 minutes each time, for 4 weeks. Fugl-Meyer assessment upper extremity scale (FMA-UE) and action research arm test (ARAT) were used to evaluate the upper limb motor function of patients before and after the intervention, and Fugl-Meyer Scale upper limb sensory score was used to evaluate sensory function. The modified Ashworth scale (MAS) was used to evaluate muscle tone. The modified Barthel index (MBI) to evaluate the activity of daily living. The improvement of the above indexes after treatment were compared between the two groups, and the difference of the above indexes after treatment were compared between the two groups.

Results A total of 12 eligible stroke patients were included, with 6 cases in each group. The FMA-UE score improved in the experimental group [19.00 (16.50-42.25) vs. 10.00 (7.75-23.25), P=0.028] and the control group [13.00 (10.50-27.50) vs. 9.00 (8.50-21.00), P=0.042] after intervention compared with that before intervention. The ARAT [4.00 (3.50-10.50) vs. 2.00 (1.00-14.00), P=0.042] and MBI scores [75.00 (58.75-87.5) vs. 57.50 (50.00-67.50), P=0.041] in experimental group after intervention also improved compared with those before intervention. The MBI score after intervention in experimental group was higher than that in the control group [75.00 (58.75-87.5) vs. 45.00 (45.00-55.00), P=0.023], and there were no satistical differences in other indexes. The improvements of FMA-UE [9.50 (6.75-15.25) vs. 4.50 (3.00-8.25), P=0.030] and flexion MAS scores [-0.50 (-1.00-0.00) vs. 0.00 (0.00-0.50), P=0.020] in the experimental group were better than those in the control group.

Conclusions For patients with impaired sensory function, brain-computer interface intervention can promote the recovery of motor function and activity of daily living.

Progress on Upper Limb Sensory Impairment Rehabilitation after Stroke Based on Closed-Loop Theory

LI Chong, TU Shuting, LIN Jiaying, LIU Xiangyun, TIAN Shiliu

2022, 17(10): 1058-1064. DOI: 10.3969/j.issn.1673-5765.2022.10.004

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Post-stroke patients have upper extremity somatosensory disorders, including superficial sensory disorders, profound sensory disorders and compound sensory disorders. As a new theory of post-stroke rehabilitation, the "central-peripheral-central" closed-loop theory has been gradually applied in the rehabilitation of upper extremity sensory disorders after stroke. Based on the common central interventions - transcranial direct current stimulation, transcranial magnetic stimulation, mirror therapy, brain-computer interface and head acupuncture, this article introduced the progress of these central interventions combined with different peripheral rehabilitation training for post-stroke upper limb sensory disorders. The current studies have demonstrated that different modalities of "central-peripheral-central" closed-loop therapy are effective in the rehabilitation of upper extremity sensory disorders after stroke. However, the temporal effectiveness of the combination of central and peripheral interventions and the clinical mechanisms of different closed-loop modalities are still unclear, which need to further research to elucidate.

Clinical Characteristics and Risk Factors of Infection in Patients with Acute Stroke during Hospitalization

CHENG Shi, LI Jing, GUO Junping, HU Aixiang, YU Xinwei, HAN Wei, LIANG Ying, ZHANG Yuewei, JI Ruijun

2022, 17(10): 1065-1070. DOI: 10.3969/j.issn.1673-5765.2022.10.005

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Objective To investigate the clinical characteristics and risk factors of infection in patients with acute stroke during hospitalization, and to provide clinical guidance for the infection prevention strategies.

Methods The patients with either ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) who were admitted to Beijing Tiantan Hospital from June 2019 to June 2021 were included in this retrospective study. According to having post-stroke infection or not during hospitalization, patients were divided into infection group and non-infection group. The clinical characteristics, infection sites and time distribution were compared between two groups. Univariate and multivariate logistic regression analysis were used to determine the risk factors for post-stroke infection.

Results A total of 2884 patients with acute stroke were enrolled, including 2138 (74.1%) males, 2049 patients with IS, 531 patients with ICH, and 304 patients with SAH. 426 (14.8%) patients developed infection during hospitalization, with a median infection time of 4 (1-7) days after stroke. The infection rates were 10.8%, 21.3% and 29.9% in patients with IS, ICH and SAH, respectively, showing a significant increasing trend. Lung was the highest and earliest infection site in patients with acute stroke. Multivariate analysis showed that increasing age (OR 1.038, 95%CI 1.026-1.050, P<0.001), heart failure (OR 2.339, 95%CI 1.197-4.572, P=0.013), chronic obstructive pulmonary disease (OR 3.297, 95%CI 1.676-6.486, P=0.001), ICH (OR 2.162, 95%CI 1.548-3.021, P<0.001), SAH (OR 8.271, 95%CI 5.591-12.236, P<0.001), increased NIHSS score at admission (OR 1.162, 95%CI 1.132-1.193, P<0.001) and prolonged hospital stay (OR 1.138, 95%CI 1.109-1.168, P<0.001) were risk factors for infection during hospitalization in patients with acute stroke.

Conclusions Infection is one of the most common complications in patients with acute stroke, and pulmonary infection had a high incidence and the onset time was early. Patients with advanced age, heart failure, chronic obstructive pulmonary disease, and severe neurological impairment usually had an increased incidence of infection. Patients with ICH and SAH had an increased incidence of infection, compared with patients with IS.

Effects of Probiotics Combined with Early Enteral Nutrition on Intestinal Function in Patients with Severe Stroke: A Meta-Analysis

WANG Zhenzhen, LI Wenrui, ZHANG Zhigang, HANG Xinyi, MA Xiujuan, ZHANG Caiyun

2022, 17(10): 1071-1081. DOI: 10.3969/j.issn.1673-5765.2022.10.006

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Objective To evaluate the effects of probiotics combined with early enteral nutrition on intestinal function in patients with severe stroke using meta-analysis.

Methods The Cochrane Library, PubMed, Web of Science, Embase, CNKI, VIP, Wanfang and Chinese Biomedical literature database were retrieved for the literatures on the effects of probiotics combined with early enteral nutrition on nutritional status and intestinal function of stroke patients. Two researchers independently evaluated the literature quality. RevMan5.4 statistical software was used for meta-analysis.

Results Twenty-one literatures were included, including 1838 subjects, with 920 cases in the observation group and 918 in the control group. Meta-analysis results showed that probiotics combined with early enteral nutrition can improve the nutritional status of patients with severe stroke, Which can increase the level of albumin (SMD 1.01, 95%CI 0.75-1.27, P<0.001), hemoglobin (SMD 0.96, 95%CI 0.60-1.32, P<0.001), increase midarm muscle circumference (SMD 0.60, 95%CI 0.28-0.92, P=0.003); and reduce the level of diamine oxidase (SMD -1.22, 95%CI -1.50--0.95, P<0.001) and D-lactic acid (SMD -1.89, 95%CI -2.42--1.36, P<0.001), repair intestinal mucous barrier function; reduce diarrhea (OR 0.24, 95%CI 0.14-0.43, P<0.001), abdominal distension (OR 0.35, 95%CI 0.22-0.58, P<0.001), constipation (OR 0.37, 95%CI 0.15-0.91, P=0.030) and other gastrointestinal complications.

Conclusions Probiotics combined with early enteral nutrition can improve the nutritional status of patients with severe stroke, repair intestinal mucosal barrier function, reduce the occurrence of gastrointestinal complications such as diarrhea, abdominal distension, and constipation, which has a positive effect on intestinal function of patients.

Influencing Factors of False Differentiating Simple Hemorrhage from Calcification by Signal Intensity of Cerebral Lesions on SWI Phase Image

SU Lu, GAO Peiyi

2022, 17(10): 1082-1088. DOI: 10.3969/j.issn.1673-5765.2022.10.007

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Objective To investigate the influencing factors for false differentiating simple hemorrhage from calcification by cerebral lesion signal intensity on SWI phase image.

Methods This retrospective analysis enrolled the consecutive patients with simple calcifications and/or microhemorrhage on head SWI phase image at Beijing Tiantan Hospital, Capital Medical University between 2016 and 2019. Follow-up CT scan was taken as the gold standard. The evaluation standard on right handed SWI phase image: low and high intensity signal sign for hemorrhage and calcification, respectively. The clinical and imaging parameters included gender, age, lesion side, location, diameter, single or multiple lesions, lesion nature, CT value, T1WI and T2WI signal, lesion signal intensity on SWI phase image, left- or right-handed MR image. Multivariate logistic regression analysis was used to analyze the influencing factors for false differentiating the lesions.

Results A total of 339 lesions from 41 cases were analyzed, including 157 hemorrhage lesions and 182 calcification lesions. 234 lesions were correctly diagnosed and 105 lesions were incorrectly diagnosed, and the false diagnosis rate was 30.97% by the signal intensity on SWI phase image. Multivariate logistic regression analysis showed that equal or mixed signal intensity (OR 97.263, 95%CI 28.746-329.096, P<0.001) and high signal intensity (OR 5.684, 95%CI 2.042-15.819, P=0.001) on SWI phase image, low or mixed signal intensity on T2WI (OR 5.024, 95%CI 2.391-10.558, P<0.001), lesion diameter larger than 4 millimeter (OR 2.437, 95%CI 1.168-5.084, P=0.018), CT value among 91-300 Hu (OR 2.710, 95%CI 1.023-7.180, P=0.045) were independent influencing factors for false diagnosis.

Conclusions The patients with mixed or high signal intensity on SWI phase image, low or mixed signal intensity on T2WI, lesion diameter larger than 4 millimeter, CT value among 91-300 Hu are prone to leading to false diagnosis of simple hemorrhage and calcification by lesion signal intensity on SWI phase image.

The Application of Blockchain-Based Digital Identity in Clinical Data Management of Cerebrovascular Diseases

XIAO Ruizhu, LI Lei, WANG Meng, JIANG Yong, GUO Jingpeng, ZHU Haogang

2022, 17(10): 1089-1096. DOI: 10.3969/j.issn.1673-5765.2022.10.008

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Objective To explore the application and prospect of blockchain-based digital identity in medical data management of cerebrovascular diseases.

Methods Blockchain technology was used to decentralize cerebrovascular disease medical digital identities through the roles of issuer, controller, parser, prover and personal identity data account. A total of 200 subjects were selected to test the practicality and feasibility of the system based on the data exchange and medical imaging data.

Results In the test of data exchange, for a single user, the average response time between saving and returning to save page of responsible directory was 1.261 seconds. For viewing the responsible directory, the average response time is 0.08 seconds. The average response time of submitting the data catalog and returning the page is 1.269 seconds. The system operated stably during the test, and can automatically resume services after network interruption and restoration. In the test of medical imaging data, the write flux was 9090 times per second, the average response time was 14.98 seconds, and an average of 9012 pieces of data are traversed per second. The reliability of the system was feasible, with the fault-tolerant capacity of 1/3 node.

Conclusions Blockchain-based digital identity can ensure data security and promote data sharing and exchange, which has a promising prospect in the field of diagnosis, treatment and management of cerebrovascular diseases.

The Frequency and Influencing Factors of Asymmetrical Prominent Veins Sign on Susceptibility-Weighted Imaging in Acute Ischemic Stroke

XIANG Wei, XU Luyao, ZHANG Manman, WEI Hongchun, LIANG Zhigang

2022, 17(10): 1097-1102. DOI: 10.3969/j.issn.1673-5765.2022.10.009

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Objective To investigate the related factors leading to asymmetrical prominent veins sign (APVS) on SWI in patients with acute ischemic stroke (AIS).

Methods This prospective study enrolled the consecutive patients with AIS admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University between July 2021 and March 2022. All patients completed multimodal MRI within 72 hours of symptoms onset, including DWI, SWI and MRA sequences. Patients were divided into APVS positive and negative groups according to having APVS on SWI or not. The baseline clinical data and 90-day poor prognosis (mRS>1) were collected. Multivariate logistic regression analysis was used to determine the factors affecting the presence of APVS.

Results A total of 80 patients were enrolled, with APVS on SWI occurring in 28 patients (35%). Univariate analysis showed that the NIHSS score [8 (4-11) vs. 2 (10-6), P<0.001], the proportion of severe intracranial large artery stenosis or occlusion (57.1% vs. 3.8%, P<0.001), anterior circulation infarction (92.9% vs. 65.4%, P=0.007), and poor prognosis (71.4% vs. 30.8%, P<0.001) in APVS positive group were higher than those in APVS negative group. Multivariate logistic regression analysis showed that anterior circulation infarction (OR 7.665, 95%CI 1.089-53.959, P=0.041), and severe intracranial large artery stenosis or occlusion (OR 20.928, 95%CI 3.420-128.056, P=0.001) were independent influencing factors of the occurrence of APVS.

Conclusions Patients with anterior circulation infarction and severe intracranial large artery stenosis or occlusion were more likely to have APVS on SWI.

A Case of Ventricular Hemorrhage Combined with Massive Cerebral Infarction and Literature Review

LUO Qiuyan, HUANG Wenli, FENG Huiyu, CHEN Ling, ZHOU Hongyan

2022, 17(10): 1103-1107. DOI: 10.3969/j.issn.1673-5765.2022.10.010

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A Case of Carotid Artery Stenting in a Patient with Contrast Allergy without Angiography

ZHANG Liang, HE Xiongjun, LI Kaifeng, ZHOU Hongxing, HU Ming, LIU Yajie

2022, 17(10): 1108-1111. DOI: 10.3969/j.issn.1673-5765.2022.10.011

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The Infarction Should be Described by Area or Volume?

YANG Jinbo, ZHANG Yingkui

2022, 17(10): 1112-1113. DOI: 10.3969/j.issn.1673-5765.2022.10.012

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Progress of Diffusion Tensor Imaging in Evaluating Motor Function Prognosis of Patients with Ischemic Stroke

ZHAO Yongrui, LIU Zhanhui

2022, 17(10): 1114-1119. DOI: 10.3969/j.issn.1673-5765.2022.10.013

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Motor dysfunction is one of the most common sequelae of ischemic stroke. Applying imaging technology to evaluate the prognosis of motor function in stroke patients is becoming a new research direction. This paper reviewed that diffusion tensor imaging was used, from the aspects of evaluating damage degree of corticospinal tract and alternative motor pathways, the integrity of microstructure of normal white matter, and so on, to evaluate the motor function prognosis of stroke patients.

Advances in Clinical Classification of Moyamoya Disease

HAN Guangsong, NI Jun

2022, 17(10): 1120-1126. DOI: 10.3969/j.issn.1673-5765.2022.10.014

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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.

Seeking Medical Services Decision-Making Status and Relevant Influencing Factors in Patients with Acute Ischemic Stroke: A Review

ZHANG Boyu, GUO Yucheng, CUI Yuxia, LI Yingli, LYU Yumei

2022, 17(10): 1127-1132. DOI: 10.3969/j.issn.1673-5765.2022.10.015

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Pre-hospital delay is the main cause of missing reperfusion opportunity in patients with acute ischemic stroke, which is often caused by unreasonable seeking medical services decision-making. Previous studies mostly discussed the external factors such as delay in medical treatment and transport, and rarely analyzed the patient and family's own factors. Therefore, this article summarized the concept, status and influencing factors of seeking medical service decision-making for stroke patients and their families, analyzed the existing problems of seeking medical services decision-making, discussed the influence and cause of cognitive, environmental and psychological factors on patients' seeking medical service decision-making, to provide reference for making out the corresponding measures.

Application of “Internet Plus” in Emergency Care of Acute Ischemic Stroke

WU Tingting, LIU Yafei, YAN Shixi, WU Yiping, ZHANG Zhongbo, ZAHNG Hanfei, FANG Pinping

2022, 17(10): 1133-1138. DOI: 10.3969/j.issn.1673-5765.2022.10.016

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With the advent of "internet plus" era, the application of internet technology is increasing in global healthcare system, and also does in acute ischemic stroke care. The internet-based terminal equipment such as mobile phone make acute ischemic stroke care more efficient, convenient and practical, while we should pay attention to the ethical issues in its application. This study reviewed the application of "internet plus" in pre-hospital emergency care, pre-hospital and in-hospital connection, and in-hospital fast tract of acute ischemic stroke, to provide preference for constructing the new model of "internet plus" stroke care.

The Concept and Framework of Syncretic Stroke Unit

DONG Yi, ZHANG Yanrong, CAO Wenjie, CHENG Xin, DONG Qiang, GU Yuxiang

2022, 17(10): 1139-1143. DOI: 10.3969/j.issn.1673-5765.2022.10.017

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The development of cerebrovascular disease diagnosis and treatment technology facilitated more and more relevant disciplines mutual cooperation. Moreover, the stroke unit-based cooperation model requires further collaboration between more disciplines. For example, the reperfusion treatment in superacute stage of stroke requires the collaboration of neurology, neurosurgery, emergency, neurointensive care unit, neurointervention, radiology and rehabilitation disciplines. On the stage of stroke secondary prevention, it is emphasized on nutrition support and rehabilitation exercise in acute and subacute stroke patients. As the upgraded model of stroke unit, syncretic stroke unit is aimed to promote the in-depth cooperation of neurology, neurosurgery, rehabilitation departments with different cooperation patterns in multiple links of stroke diagnosis and treatment, to take any chance and carry out best clinical practice for better outcomes, so as to provide reference for multi-disciplines collaboration of stroke care in different medical institutions.

Design and Interpretation of Novel Clinical Trials

2022, 17(10): 1144-1144.

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