Table of Content

20 December 2022, Volume 17 Issue 12

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The Advances in Real-World Studies in Cerebrovascular Disease in China

PU Shanyu, ZHOU Qi, PAN Yuesong

2022, 17(12):  1289-1292.  DOI: 10.3969/j.issn.1673-5765.2022.12.001

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Real-World Studies in Cerebrovascular Disease

PAN Yuesong

2022, 17(12):  1293-1293. 

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Key Points of Real-World Research Protocol Design and Statistical Analysis

JIN Feifei, YAN Xiaoyan, DONG Chongya, WANG Tianbing, YAO Chen, YE Jingjing

2022, 17(12):  1294-1298.  DOI: 10.3969/j.issn.1673-5765.2022.12.002

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National regulatory authorities and experts have published a series of guidelines and studies on real-world data and real-world evidence, but there is still no clear document guidance on the detailed protocol and statistical analysis methodology of real-world research. We comprehensively reviewed various documents and studies related to real-world data, based on the experience of research protocol design, and developed the research design key points and statistical analysis based on real-world data. The protocol of real-world research needs to explain the applicability of real-world data, comprehensively explain data governance methods from the aspects of data source, data relevance, data integrity, data accuracy and data extraction methods, and evaluate data quality. Statistical analysis methods are used to analyze the reliability and robustness of real-world research conclusions, thus to produce high-quality real-world evidence.

Pragmatic Clinical Trials: A Randomized Trial in Real-World Studies

ZHANG Yanli, JIN Aoming, PAN Yuesong

2022, 17(12):  1299-1303.  DOI: 10.3969/j.issn.1673-5765.2022.12.003

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Pragmatic clinical trials (PCT), as a important component of real-world research, attracted more and more attention in clinical study design. However, there exists some confusions in understanding and application of PCT. Therefore, this article provided technical specifications of PCT in terms of the concept, study planning and design, purpose, design types and core features, to make readers have a comprehensive and correct understanding of PCT; in addition, the application scope, basic statistical analysis principles, analysis requirements for various types of study design, and the report standards of PCT were also elaborated.



Control of Confounders and Covariates in Real-World Studies: Cerebrovascular Diseasebased Cases Explanation

FENG Yuting, LIU Zhihan, CHAI Qianyun, LUO Minjing, GAO Yicheng, TAO Liyuan, FEI Yutong

2022, 17(12):  1304-1309.  DOI: 10.3969/j.issn.1673-5765.2022.12.004

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Real-world studies have increasely become the focus in the field of clinical research because their findings are closer to the real world. However, real-world study is not a specific type of research design parallel with observational studies and experimental studies, and the control of confounding factors and covariates in the data analysis of real-world studies should be paid more attention. Correct identification of confounding factors/covariates and reasonable application of statistical methods can effectively improve the accuracy and authenticity of research conclusions. This article introduced the common methods of confounding factors/covariates control in real-world studies, including hierarchical analysis, analysis of covariance, multi-factor regression, propensity score, disease risk score and instrumental variable analysis, and cases analysis combined with clinical research application of cerebrovascular disease, so as to provide reference for understanding and applying the relevant methods.



Application of Propensity Score in Clinical Research on Cerebrovascular Disease

JIN Aoming, PAN Yuesong

2022, 17(12):  1310-1313.  DOI: 10.3969/j.issn.1673-5765.2022.12.005

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Real-world studies, originating from pragmatic clinical trials, evaluate the effectiveness and safety of interventions in real clinical practice, as a supplement for randomized controlled trials to evaluate the effectiveness of intervention measures in real clinical environment. However, the control of confounding factors is particularly important as this type of study lacks randomization. The propensity score method, which can adjust for multiple confounders/covariates, is an important analysis method for controlling confounders in real world studies. This article introduced four methods of propensity score and discussed their advantages and disadvantages; and introduced the application of propensity score method in the real-world research on cerebrovascular disease through case studies, combined with the characteristics of clinical research on cerebrovascular disease.



The Correlation of Serum Inflammatory Factors and Cerebrovascular Reactivity with Cognitive Impairment in Patients with Transient Ischemic Attack

MA Junwen, BAI Chengping

2022, 17(12):  1314-1320.  DOI: 10.3969/j.issn.1673-5765.2022.12.006

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Objective  To investigate the correlation of inflammatory factors and cerebrovascular reactivity with cognitive impairment in TIA patients.

Methods  This study prospectively enrolled 35 TIA inpatients in Qinghai University Affiliated Hospital as case group and 35 healthy subjects in health management center of this hospital as control group. The levels of serum soluble vascular cell adhesion molecule 1 (sVCAM-1) and lipoprotein-associated phospholipase A2 (Lp-PLA2) in the two groups were detected. Transcranial Doppler ultrasound (TCD) was used to evaluate cerebrovascular reactivity (CVR), and the main index is the breath-holding index (BHI). In addition, the Cambridge neuropsychological test automated battery (CANTAB) was used to evaluate cognitive function such as working memory, executive function and attention. The above indexes of the two groups were compared, and the correlation of two inflammatory factors and CVR with cognitive function in TIA patients were further analyzed.
Results  (1) The levels of sVCAM-1 (310.04±38.34 ng/mL vs. 208.12±31.10 ng/mL, P<0.001)and Lp-PLA2 (174.90±16.37 μg/L vs. 132.48±14.90 μg/L, P<0.001) in TIA group were higher than those in control group. (2) BHI in TIA group was lower than that in control group (1.08±0.65 vs. 1.40±0.42, P=0.024). (3) Compared with the control group, delayed matching to sample (DMS) total correct (DTC) and DTC in the patter of delay (DTCdelay) of working memory in TIA group were lower than those in control group [DTC: 28.00 (23.75-32.00) vs. 30.00 (28.00-33.00), P=0.041; DTCdelay: 18.63±4.81 vs. 21.23±3.10, P=0.016], DMS errors (DE) and DMS prob error given error (DPEGE) of working memory in TIA group were higher than that in control group [DE: 6.90±2.59 vs. 5.67±2.14, P=0.049; DPEGE: 0.34%±0.16% vs.0.26%±0.10%, P=0.038]. The stockings of cambridge (SOC) mean initial thinking time (SMITT) and SOC mean moves (SMM) of executive function in TIA group were higher than those in control group [SMITT: 2505.22±1031.03 ms vs. 1306.93.1±719.74 ms, P<0.001; SMM: 4.0 (3.0-5.0) vs. 3.0 (2.0-4.0), P=0.008]; the simple reaction time (SRT) mean latency (SML) in attention was higher than that in control group (606.83±222.34 ms vs. 483.18±130.52 ms, P=0.012). (4) DMS mean choices to correct (DMCTC) and DPEGE of working memory in TIA group were positively correlated with sVCAM-1 level; DTC, DTCdelay and DMS percent correct (DPC) of working memory in TIA group were negatively correlated with sVCAM-1 level. In TIA group, SMITT of executive function was positively correlated with the levels of sVCAM-1and Lp-PLA2, SRT total omission errors (STOE) in attention was positively correlated with Lp-PLA2 level; SMITT of executive function, STOE and SML in attention were negatively correlated with BHI; BHI was negatively correlated with the levels of sVCAM-1 and Lp-PLA2 in TIA group.
Conclusions  TIA patients have attention deficit, and declined working memory and executive function. For TIA patients, the cognitive impairment including working memory, attention and executive function is associated with the higher levels of inflammatory factors, and the decreased executive function and attention are associated with poor cerebrovascular reactivity.




MRI-Guided Thrombolysis beyond Time Window in Acute Ischemic Stroke in a County-Level Hospital: A Case-Control Study

LU Yan, YANG Baorong, HUANG Xiangping, YANG Guangui, CHEN Shengwen, LI Jianrong, ZENG Xiaoming

2022, 17(12):  1321-1326.  DOI: 10.3969/j.issn.1673-5765.2022.12.007

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Objective  To explore the safety and efficacy of MRI-guided thrombolysis beyond time window in patients with acute ischemic stroke in a county-level hospital in China.
Methods  The consecutive patients with first acute ischemic stroke who underwent intravenous thrombolysis guided by MRI (mismatch of high signal on DWI-equal signal on FLAIR) in Xingguo People’s Hospital, Jiangxi Province from July 2021 to January 2022 were enrolled in this prospective study. The patients who underwent intravenous thrombolysis beyond time window (>4.5 hours) were selected as the observation group, and the patients who underwent intravenous thrombolysis within 4.5 hours of onset were selected as the control group. The primary efficacy outcome was a good functional outcome (defined as a mRS score of 0 to 1) at 3 months. The primary safety outcome was symptomatic hemorrhagic transformation within 36 hours (defined as an increase of 4 score in NIHSS from baseline and MRI-based intracranial hemorrhage). The efficacy and safety of thrombolysis were compared between the two groups. The NIHSS scores at different time points (baseline, at 24 hours after thrombolysis and at discharge) were compared in each group.
Results  A total of 39 cases were included in the observation group, with a mean age of 69.6±10.4 years and 23 males; and 60 cases in the control group, with a mean age of 66.1±11.0 years and 39 males. There was no statistical difference in the percentage of 90-day good functional outcome between the two groups (observation vs. control: 64.1% vs. 76.7%, P=0.175); and there was also no statistical difference in the percentage of symptomatic hemorrhagic transformation between the two groups (observation vs. control: 0 vs. 1.7%, P=0.418). The NIHSS scores at 24 hours [3.0 (2.0-5.0)] and at discharge [1.0 (0-5.0)] improved compared to the baseline NIHSS [4.0 (3.0-8.5)] in the observation group, and the NIHSS score at discharge [0 (0-2.0)] improved compared to the baseline NIHSS [4.0 (2.0-8.3)] in the control group, with all the above differences having statistical significance.
Conclusions  The MRI-guided intravenous thrombolysis beyond time window in patients with ischemic stroke is feasible and safe in county-level hospitals in China.




The Efficacy of Auricular Acupuncture Pressing for Post-Stroke Dysphagia: A Meta-Analysis

CHU Yueqi, ZHOU Kaiyun, WANG Tianyan, WANG Jiongbin, LI Zhen

2022, 17(12):  1327-1334.  DOI: 10.3969/j.issn.1673-5765.2022.12.008

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Objective  To evaluate the efficacy of auricular acupuncture pressing for post-stroke dysphagia (PSD) through meta-analysis.
Methods  The randomized controlled trials (RCTs) on auricular acupuncture pressing for treating PSD were retrieved from the databases including PubMed, Web of Science, Embase, CINAHL, Cochrane Library, CNKI, Wanfang, VIP, and CBMdisc from inception to May 2022. The outcome indexes included swallowing outcome [the effective rate, standardized swallowing assessment (SSA), and water swallow test (WST)], life quality [swallowing quality of life (SWAL-QOL)], nutrition condition (albumin level and incidence of malnutrition) and incidence of aspiration pneumonia. Literature screening, data extraction and quality evaluation were performed by 2 researchers, and RevMan 5.3 software was used for meta-analysis.
Results  A total of 12 RCTs involving 874 patients were included in this meta-analysis. The results showed that after the intervention, the effective rate (RR 1.25, 95%CI 1.16-1.35, P<0.001) , the scores of SSA (MD -4.45, 95%CI -6.81--2.10, P<0.001) and WST (MD -0.99, 95%CI -1.11--0.88, P<0.001) in auricular acupuncture pressing group were better than that in the control group; the score of SWAL-QOL in the intervention group was higher than that in the control group (MD 15.50, 95%CI 4.15-26.85, P=0.007); the albumin level in the intervention group was higher than that in the control group (MD 4.39, 95%CI 0.82-7.97, P=0.020), the incidence of malnutrition was lower than that in the control group (RR 0.22, 95%CI 0.12-0.40, P<0.001); and the incidence of aspiration pneumonia in the intervention group was lower than that in the control group (RR 0.31, 95%CI 0.20-0.50, P<0.001).
Conclusions  For patients with PSD, auricular acupuncture pressing can improve the swallowing function, quality of life, and nutrition condition of patients, and reduce the incidence of aspiration pneumonia.




A Novel BAOPS-MRA Score Predicts Outcome in Nonsevere Basilar Artery Occlusion

WANG Kaiwen, LU Baoquan, WU Xiuling, MA Jiali

2022, 17(12):  1335-1342.  DOI: 10.3969/j.issn.1673-5765.2022.12.009

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Objective  To evaluate the predictive value of a new basilar artery occlusion prognosis score based on MRA the basilar artery occlusion prognosis score on magnetic resonance angiography (BAOPS-MRA) for the 90-day functional prognosis of patients with non-severe basilar artery occlusion.
Methods  We proposed the scoring method based on MRA of BAOPS-MRA score. This prospective cohort enrolled the consecutive patients with posterior circulation ischemic stroke diagnosed with basilar artery occlusion and NIHSS ≤15 from January 2019 to December 2020. According to the follow-up results at 3 months of stroke onset, the patients were divided into good prognosis (mRS≤2) group and poor prognosis (mRS >2) group. Based on MRA results at admission, the BAOPS-MRA score, and the basilar artery and collateral circulation score on MRA (BACS-MRA) score were evaluated. Multivariate logistic regression analysis was performed to analyze the relationship between baseline data, BAOPS-MRA, BACS-MRA and 90-day prognosis. The ROC curve was used to evaluate the predictive efficacy of the two scores for 90-day prognosis, and the predictive value of the two scores was compared. Spearman correlation analysis was used to analyze the correlation of BAOPS-MRA and BACS-MRA with 90-day mRS.
Results  A total of 99 patients were included, including 65 in good prognosis group and 34 in poor prognosis group. The BAOPS-MRA score was 7.0 (2.0-16.0) in good prognosis group and 2.5 (0-12.0) in poor prognosis group. Multivariate analysis showed that BAOPS-MRA (OR 1.577, 95%CI 1.238-2.008, P=0.001), BACS-MRA (OR 1.488, 95%CI 1.193-1.857, P=0.001), NIHSS (OR 0.786, 95%CI 0.670-0.923, P=0.003) were independent predictors of functional outcome at 3 months. ROC curve analysis showed that the cut-off value of BAOPS-MRA score for predicting 90-day prognosis was 5, the area under the curve (AUC) was 0.850 (95%CI 0.765-0.936), the sensitivity was 0.794, and the specificity was 0.754; the cut-off value of BACS-MRA for predicting 90-day prognosis was 4, the AUC was 0.747 (95%CI 0.641-0.852), the sensitivity of 0.765, and the specificity was 0.585. BAOPS-MRA was better than BACS-MRA in predicting 90-day functional prognosis of patients with basilar artery occlusion. BAOPS-MRA (rs=0.580, P<0.001) and BACS-MRA (rs=0.409, P<0.001) were positively correlated with 90-day good prognosis.
Conclusions  The BAOPS-MRA score can independently predict the 90-day functional prognosis of patients with non-severe basilar artery occlusion, which has a certain clinical value.





Effects of Environmental Enrichment on Cognitive Function in Patients with Vascular Dementia after Stroke

ZHOU Tiantian, SU Wenjie, LIAN Songyong, LIN Youcong

2022, 17(12):  1343-1349.  DOI: 10.3969/j.issn.1673-5765.2022.12.010

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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.




Individualized Management of Blood Pressure and Liquid Control for Moyamoya Patients with Hyperperfusion Syndrome after Extracranial-Intracranial Bypass

GUI Jinmin, XUE Rui, LI Na, LIU Qinglin, ZHAO Donghong

2022, 17(12):  1350-1354.  DOI: 10.3969/j.issn.1673-5765.2022.12.011

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Objective  To explore the effect of blood pressure and liquid control in moyamoya disease (MMD) patients with cerebral hyperperfusion syndrome after extracranial-intracranial (EC-IC) bypass.
Methods  The MMD patients with hyperperfusion complication within 1 week after EC-IC bypass in Beijing Tiantan Hospital, Capital Medical University between September 2019 and January 2022 were prospectively enrolled in this study. Participants were randomly divided into control group and observation group. The control group received routine nursing care, while the observation group received individualized nursing with dynamic management of blood pressure and liquid control based on routine nursing. The mRS, Barthel index (BI), and Newcastle satisfaction with nursing scale (NSNS) were used to evaluate the functional prognosis and nursing satisfaction at discharge. The favorable prognosis was defined as a mRS score of 0-1.
Results  A total of 112 eligible patients were included, with 56 cases in each group. There was no statistical difference in baseline data between the two groups. The percentage of favorable prognosis in observation group was higher than that in control group (48.2% vs. 26.8%, P=0.036). The BI in observation group at discharge was higher than that in control group (82.5±7.1 points vs. 78.2±9.5 points, P=0.007). Nursing satisfaction in observation group was higher than that in control group (96.4% vs. 83.9%, P=0.026).
Conclusions  Individualized management of blood pressure and liquid control for MMD patients with hyperperfusion syndrome after direct revascularization can improve the patients’ functional prognosis, and enhance their activities of daily living.




Digital Subtraction Angiography Evaluation of Collateral Compensation in Asymptomatic Middle Cerebral Artery Occlusion

LI Rujuan, YANG Chuan, MA Xiaohui, HOU Huanfeng, FU Huijie, MA Xiaodan, FANG Juntao, JIN Jinling, YANG Jinbo

2022, 17(12):  1355-1359.  DOI: 10.3969/j.issn.1673-5765.2022.12.012

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Objective  To observe the collateral compensation based on DSA in patients with asymptomatic middle cerebral artery (MCA) occlusion.
Methods  This retrospective study enrolled the consecutive inpatients with asymptomatic MCA occlusion diagnosed by DSA in Xingtai Ninth Hospital from October 2018 to February 2022, which were taken as asymptomatic occlusion group; the acute symptomatic MCA occlusion inpatients based on DSA who underwent endovascular treatment at the same time period were enrolled as the control group (symptomatic occlusion group). The baseline information of the two groups were collected. Collateral circulation were assessed using the American Society of Interventional and Therapeutic Neuroradiology (ASITN) / Society of Interventional Radiology (SIR) based on DSA. Differences in ASITN/SIR scores of the two groups were compared.
Results  A total of 39 patients were enrolled, with 17 in asymptomatic occlusion group and 22 in symptomatic occlusion group. The proportion of hyperhomocysteinemia in symptomatic occlusion group was higher than that in asymptomatic occlusion group, and there were no statistical differences in the other baseline data between the two groups. In the asymptomatic occlusion group, 2 cases (11.76%) with ASITN/SIR grade 2, 6 cases (35.29%) with grade 3, 9 cases (52.94%) with grade 4; in the symptomatic occlusion group, 3 cases (13.36%) with ASITN/SIR grade 0, 8 cases (36.4%) with grade 1, 6 cases (27.3%) with grade 2, 3 cases (13.6%) with grade 3, 2 cases (9.1%) with grade 4, with statistical differences between the two group, which indicated that the asymptomatic group had a better collateral compensation ability.
Conclusions  The patients with asymptomatic MCA occlusion have a better collateral compensation than patients with symptomatic MCA occlusion.




Epidemiological Survey on the Risk Factors of Cardio-Cerebrovascular Diseases among Residents in Handan and Influencing Factors of Awareness, Treatment and Control Rate of Hypertension

SONG Yanli, LIN Jie, WU Yiping, LI Xiaojing, LIU Gaifen, XIA Wenjing, ZHANG Yuying, ZHANG Xiaolin, LYU Chenran, ZHOU Hong, LI Kai, XUE Bin, CHEN Lingling, ZHANG Zhongbo, PENG Xiao

2022, 17(12):  1360-1365.  DOI: 10.3969/j.issn.1673-5765.2022.12.013

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Objective  To explore the epidemiological status of risk factors of cardio-cerebrovascular diseases among residents in Handan city, and analyze the influencing factors of awareness, treatment and control rate of hypertension.
Methods  Through non-random cluster sampling, the cross-sectional survey was conducted on residents at least 40 years old in 7 communities in Handan city from June to September 2019. The questionnaire, physical examination and laboratory examination results were collected, and the distribution of risk factors of cardio-cerebrovascular diseases among them was analyzed.
Results  A total of 3933 subjects were included in this survey analysis. Among them, the proportion of smoking, deficient exercise, unreasonable diet, overweight and fat, living alone, history of stroke, history of cardiovascular disease, history of hypertention, taking antihypertensive drugs, taking hypoglycemic drugs, taking lipid-lowering drugs, hypertension, dyslipidemia and diabetes were 24.97%, 13.42%, 45.61%, 66.64%, 6.20%, 19.32%, 16.45%, 34.63%, 18.56%, 2.67%, 3.74%, 43.17%, 32.16% and 17.34%, respectively. The awareness, treatment and control rate of hypertension among 1698 patients with hypertension were 66.96%, 42.99% and 14.96%, respectively, and those of females were more than that of males (all P<0.001). Multivariate logistic regression analysis showed that age, male, dyslipidemia and BMI were common factors affecting the awareness, treatment and control rate of hypertension.
Conclusions  The control of the risk factors of cardio-cerebrovascular diseases among residents in Handan was poor, and the strategy for prevention and control of these risk factors should be further enhanced and implemented.




The Efficacy of Kinesthetic Motor Imagery Therapy for Hand Function Rehabilitation of Stroke Patients

WU Yuqian, ZHANG Yumei, FAN Xiaowei, WANG Anxin, PANG Wenbin

2022, 17(12):  1366-1371.  DOI: 10.3969/j.issn.1673-5765.2022.12.014

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Objective  To investigate the efficacy of kinesthetic motor imagery therapy in the recovery of hand function in stroke patients with upper-limb hemiparesis.
Methods  This study prospectively enrolled the patients with ischemic stroke within one month of onset who were treated in Department of Rehabilitation Medicine and Outpatient Department of Rehabilitation of Beijing Tiantan Hospital, Capital Medical University from January 2021 to January 2022. The patients were randomly divided into observation group (Kinesthetic motor imagery group) and control group (routine rehabilitation group). The observation group received kinesthetic motor imagery therapy based on routine rehabilitation once a day, 30 minutes each time, 5 days a week and for 4 weeks. The control group received routine rehabilitation twice a day, 30 minutes each time, 5 days a week and for 4 weeks. Before treatment, MoCA scale was used to assess cognitive function, chaotic motor imagery assessment battery (CMIA) and kinesthetic and visual imagery questionnaire (KVIQ) were used to assess motor imagery ability, and Hamilton depression scale (HAMD) was used to assess depression state. Before treatment and at one month of treatment, Fugl-Meyer assessment-upper extremity (WMFT), Wolf motor function test (FAM-UE) and action research arm test (ARAT) were used to assess hand function, activity of daily living (ADL) scale was used to assess daily living ability. The differences of the above indexes between the two groups were compared before and after treatment.
Results  A total of 67 patients were enrolled in the final analysis, with 33 patients in control group and 34 patients in observation group. There were no statistical differences in the baseline data between the two groups. At one month of treatment, the scores of FMA-UE [50 (40-58) vs. 37 (24-56), P=0.017], WMFT [53 (41-64) vs. 42 (32-57), P=0.013], ARAT [45 (35-50) vs. 35(16-48), P=0.005], ADL [80 (70-85) vs. 65 (60-85), P=0.008] were higher in observation group than those in control group. However, there was no statistical difference in WMFT operation time between the two groups.
Conclusions  Compared with conventional rehabilitation, kinesthetic motor imagery therapy can significantly improve the recovery of hemiplegic hand function and daily living activities ability of stroke patients.




Science Mapping Analysis of Artificial Intelligence Applied in Stroke Research

JIANG Lin, LI Jing

2022, 17(12):  1372-1380.  DOI: 10.3969/j.issn.1673-5765.2022.12.015

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Objective  To construct and visualize the knowledge structure and development trend of artificial intelligence (AI) application in stroke research based on a science mapping analysis.
Methods  Web of Science Core Collection was retrieved for the literatures on AI and stroke from January 1985 to March 2022. The publication date, countries or regions, institutions, authors, and research domains were analyzed. CiteSpace was used to perform bibliometrics analysis including key words co-occurring, co-citation and cluster analysis, to generate visualized science mapping.
Results  A total of 924 articles from 73 countries or regions were included in this analysis, published from 1999 to 2022. The countries that published the most were USA (n=274, 29.7%) and China (n=255, 27.6%). Of the top 10 institutions publishing papers, 6 were from USA and 2 from China. The research of AI application in stroke increased rapidly since 2012, which involved multiple disciplines and fields, including engineering and computer science, as well as neurology, surgery, radiology and etc. Based on the science mapping analysis, the main research in the field of stroke were the application of AI in stroke classification, treatment decision, prognosis and rehabilitation. The application of AI can stimulate the development of AI theory and technology. Applying more advanced and appropriate AI to improve the basic and clinical research of stroke was the research trend in this field.
Conclusions  The visualized science mapping analysis can help researchers and physicians better understand the development tread of AI application in stroke research, to provide reference for future research in the field of stroke.




One Case of Recurrent Posterior Circulation Infarction Caused by Vertebral Artery Stump Syndrome and Literature Review

MENG Yiran, WANG Wei

2022, 17(12):  1381-1384.  DOI: 10.3969/j.issn.1673-5765.2022.12.016

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Progress of the Relationship between Aquaporin 4 and Post-Stroke Cognitive Impairment

LIANG Xiao, QIAN Haibing

2022, 17(12):  1385-1390.  DOI: 10.3969/j.issn.1673-5765.2022.12.017

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Post-stroke cognitive impairment is one of the main sequelae of stroke, which can be divided into vascular, degenerative and mixed cognitive impairment. Aquaporin 4 is widely distributed in the central nervous system and is involved in the pathological process of cognitive impairment and multiple nervous system diseases. However, the specific mechanism of aquaporin 4 in post-stroke cognitive impairment is not clear. This article reviewed the possible important role of aquaporin 4 in post-stroke cognitive impairment by involvement in the regulation of neuroinflammation, synaptic plasticity, and the accumulation and clearance of β-amyloid.

The Effect of Obesity on Prognosis of Stroke

WU Xiaoli, LIU Lixu

2022, 17(12):  1391-1395.  DOI: 10.3969/j.issn.1673-5765.2022.12.018

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Obesity is considered as a risk factor for stroke, but its effect on the prognosis of stroke is still unclear, even there is a “obesity paradox”. That is, there is an inverse relationship between the BMI and mortality of stroke patients. Understanding the effect of obesity on the prognosis of patients with stroke is helpful for clinicians to formulate individualized treatment and guide stroke prevention. Therefore, this article mainly reviewed the progress of the effect of obesity on stroke prognosis, and analyzed the possible factors affecting the conclusions, such as the definition standard of obesity, type of stroke, stroke course and severity, prognosis and other factors, to provide reference for the future research.

Advances in Correlation of Imaging Markers of Cerebral Small Vessel Disease with Spontaneous Hypertensive Intracerebral Hemorrhage

ZHENG Zhanjun, ZHAO Xingquan

2022, 17(12):  1396-1402.  DOI: 10.3969/j.issn.1673-5765.2022.12.019

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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.

Cluster Randomized Trials

ZHU Zhikai, GU Hongqiu, JIANG Yong

2022, 17(12):  1403-1409.  DOI: 10.3969/j.issn.1673-5765.2022.12.020

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Cluster randomized trials are widely used in clinical research, which use clusters as random unit, and all individuals in a cluster receive the same intervention. Therefore, compared with randomized controlled trials with individuals as random unit, cluster randomized trials can reduce "contamination", which is easier to organize, and is very suitable for public health measures evaluation and medical quality improvement research. However, cluster randomized trials have a design effect and poor comparability between clusters, and need a larger sample size. This article provided a comprehensive overview of cluster randomized trials in terms of history, basic concept, study design, application scenarios, cases analysis, and reporting standards, in order to help clinical researchers understand and master this type of study design.