Table of Content

20 August 2021, Volume 16 Issue 08

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Dilemma in Anticoagulation Field: Stroke Prevention after Anticoagulation-Related Hemorrhage in Patients with Atrial Fibrillation

SUN Wei, ZHANG Yu-Sheng

2021, 16(08):  757-761.  DOI: 10.3969/j.issn.1673-5765.2021.08.001

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Diagnosis and Treatment of Cardiogenic Stroke

ZHANG Yu-Sheng

2021, 16(08):  762-762. 

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Current Status of Anticoagulant Therapy in Acute Ischemic Stroke Patients with Atrial Fibrillation in Jiaxing

ZHANG Dan-Feng, QIU-Gang, YU Guo-Shen, XI Zhen-Hua, PAN Wen-Liang, MA Xiao-Dong

2021, 16(08):  763-769.  DOI: 10.3969/j.issn.1673-5765.2021.08.002

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Objective To investigate the current status of anticoagulant therapy in acute ischemic stroke (AIS) patients with atrial fibrillation (AF) in Jiaxing. Methods This retrospective analysis enrolled the AIS inpatients with AF in Jiaxing between January 2016 and December 2020 from the Computer Analysing System to Improve Stroke Management Quality Evaluation-Ⅱ (CASE-Ⅱ) stroke registration database. The patients were divided into anticoagulation group and non-anticoagulation group according to whether they received anticoagulants or not at discharge. The baseline characteristics of the two groups were compared, and multivariate logistic regression analysis was used to determine the influencing

factors for using anticoagulants at discharge. The influencing factors for using anticoagulants in the

patients with AF and high stroke risk (CHA2DS2-VASc≥2 points) were analyzed. Results A total of 2005 patients were included, with a mean age of 77±8 years old and 979 (48.8%) males. The median baseline NIHSS was 5 (2-13). 83.9% (1525/1817) of them received antithrombotic drugs at discharge, of which 41.3% (750/1817) received anticoagulants. Age (OR 0.964, 95%CI 0.952-0.976), baseline NIHSS score (OR 0.935, 95%CI 0.920-0.951), the length of hospital stay (OR 1.045, 95%CI 1.025-1.066), deep vein thrombosis (OR 2.797, 95%CI 1.472- 5.311), any intracranial hemorrhage during hospitalization (OR 0.085, 95%CI 0.038-0.188), gastrointestinal hemorrhage (OR 0.503, 95%CI 0.257-0.985) and pneumonia (OR 0.646, 95%CI 0.488-0.856) were independent influencing factors for receiving anticoagulation at discharge. Only 16.0% (153/954) of the AF patients with high stroke risk received anticoagulation, and younger (OR 0.957, 95%CI 0.938-0.975), lower systolic blood pressure (OR 0.985, 95%CI 0.977-0.993) and history of stroke/TIA (OR 2.773, 95%CI 1.954-3.936) were independent protective factors for receiving anticoagulation in the AF patients with high stroke risk. Conclusions The anticoagulation rate of AIS patients with AF in Jiaxing was low. Yonger, lower baseline NIHSS score, longer length of hospital stay, and deep vein thrombosis were positive influencing factors for anticoagulation, and any intracranial hemorrhage during hospitalization, gastrointestinal hemorrhage and pneumonia were negative influencing factors for anticoagulation.

A Case of Cerebral Embolism Induced by Atrial Myxoma

XU Jia-Min, LIU Rong-Rong, SUN Wei, WANG Ling, ZHANG Yu-Sheng

2021, 16(08):  770-773.  DOI: 10.3969/j.issn.1673-5765.2021.08.003

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Cerebral Hemorrhage and Multiple Organ Infarction in Infective Endocarditis: A Case Report

XU Yi, CHEN Shu-Fen, HAN Xiang

2021, 16(08):  774-778.  DOI: 10.3969/j.issn.1673-5765.2021.08.004

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 Machine Learning Models for Predicting In-hospital Death in Patients with Acute New Ischemic Stroke Based onUnbalanced Data

CHEN Si-Ding, GU Hong-Qiu, HUANG Xin-Ying, LIU Huan, JIANG Yong, WANG Yong-Jun

2021, 16(08):  779-786.  DOI: 10.3969/j.issn.1673-5765.2021.08.005

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Objective To explore the value of machine learning based on unbalanced data to predict inhospital death in patients with acute new ischemic stroke, and compare the predictive performance of machine learning model and traditional logistic model. Methods Data of patients with new acute ischemic stroke from the multi-center registry database of Chinese Stroke Center Alliance (CSCA) were selected, to construct the prediction models of inhospital death based on machine learning [XGBoost, CatBoost, random forest and support vector machine (SVM)] and traditional logistic method, respectively. According to the ratio of 7:3, all the data were randomly divided into training set (to construct the prediction model) and test set

(to evaluate the prediction model). The unbalanced data of death outcome were dealed with the

undersampling and balancing weight methods. The AUC of the discrimination index and the Brier score of the calibration index were used to evaluate the models. Results A total of 601 466 eligible patients were included, including 231 235 females (38.45%) and 2206 in-hospital deaths (0.37%). The AUC of the logistic model, XGBoost model, CatBoost model, random forest model and SVM model to predict in-hospital death were 0.913±0.000, 0.921±0.000, 0.919±0.001, 0.925±0.000 and 0.900±0.001, respectively. The XGBoost model (P =0.0002), CatBoost model (P =0.0094) and random forest model (P <0.0001) had better prediction performance than the logistic model, and the logistic model was better than the SVM model (P =0.0029). The Brier scores of the logistic model, XGBoost model, CatBoost model, random forest model, and SVM model were 0.115±0.001, 0.096±0.001, 0.093±0.001, 0.084±0.000 and 0.045±0.001, respectively. The calibration of machine learning models was all better than the logistic model, and all the differences were statistically significant. Conclusions After balancing the data, machine learning models and the traditional logistic model all had a good and stable performance in predicting the risk of in-hospital death in patients with acute new ischemic stroke. Among them, the random forest model had the best predictive performance and the SVM model had the best calibration.



Clinical Characteristics and 1-Year Prognosis of Patients with Acute Recurrent Cerebral Infarction in Xi’an

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

2021, 16(08):  787-792.  DOI: 10.3969/j.issn.1673-5765.2021.08.006

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Objective To investigate the clinical characteristics and 1-year prognosis of patients with acute recurrent cerebral infarction (ARCI) in Xi’an. Methods Through the Xi’an Stroke Registry, patients with acute cerebral infarction admitted to four Ⅲ-A hospitals in Xi’an from January to December 2015 were enrolled in this study. These patients were divided into the acute first-ever cerebral infarction (AFECI) group and ARCI group according to having previous history of cerebral infarction or not. The basic clinical characteristics and 1-year prognosis (stroke recurrence, poor functional outcome and death) between the two groups were compared. Poor functional outcome was defined as a mRS score >2 points. Results A total of 2230 patients were enrolled, with a median age of 65.0 (56.0-74.0) years and 1400 males (62.8%), 666 cases in ARCI group and 1564 in AFECI group. The average age,proportion of vascular risk factors (hypertension, diabetes, hyperlipidemia and peripheral vascular disease), premorbid mRS score, NIHSS score on admission, proportion of strokeassociated pneumonia and parenteral nutrition were higher and the level of lipids (TC, TG, HDL-C and LDL-C) and proportion of smoking were lower in the ARCI group than those in the AFECI

group, all the above differences were statistically significant. After adjusting for related confounders,

multivariate logistic regression analysis showed that the risk of 1-year stroke recurrence (OR 1.62, 95%CI 1.05-2.52, P =0.031), poor functional outcome (OR 1.40, 95%CI 1.06-1.85, P =0.017) and death (OR 1.51, 95%CI 1.02-2.23, P =0.037) in patients with ARCI all significantly increased. Conclusions The risk of 1-year stroke recurrence, poor functional outcome and death in patients with ARCI in Xi’an was all high, which suggested that clinicians should pay attention to the screening of the causes and prevention of stroke, to reduce the risk of poor prognosis of such patients in Xi’an.



Microstructural Changes of Limbic System in Patients with Mild Cognitive Impairment Induced by Cerebral Small Vessel Disease

LIU Hui-Lin, LIU Dong-Tao, BU Qiao, LI Kun, PAN Zhen-Yu, FAN Xiao-Wei, ZHOU Li-Chun

2021, 16(08):  793-798.  DOI: 10.3969/j.issn.1673-5765.2021.08.007

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Objective To investigate the microstructural changes of limbic system in patients with mild cognitive impairment (MCI) induced by cerebral small vessel disease (CSVD). Methods The patients with CSVD who were evaluated by MoCA scale were retrospectively analyzed. The patients with MoCA<26 points were included in the CSVD-MCI group, and the other patients were taken as the control group. Cingulate gyrus, hippocampus and parahippocampal gyrus were selected as regions of interest. Routine MRI sequences and diffusion kurtosis imaging (DKI) were performed in two groups. The baseline information, anxiety and depression status and DKI parameters of the two groups were compared. DKI parameters included mean diffusion (MD), fractional anisotropy (FA), axial kurtosis (AK), mean kurtosis (MK) and radial kurtosis (RK). Results A total of 80 patients were included in this study, with 55 cases in the MCI group and 25 in the control group. Compared to the control group, the CSVD-MCI group had lower education level

(P =0.003), higher proportion of smoking (P =0.044) and drinking (P =0.025), and higher prevalence

of diabetes (P =0.014) and hypertension (P =0.004). Compared to the control group, DKI image of the limbic system in the CSVD-MCI group showed the following changes: MD increased (P =0.032), FA, AK, MK and RK decreased (P =0.046, P =0.001, P <0.001, P =0.002, respectively) in the right anterior cingulate gyrus, AK decreased (P =0.049) in the left anterior cingulate gyrus; MD increased (P =0.030) and AK decreased (P =0.014) in the right posterior cingulate gyrus, FA increased (P =0.036) in the left posterior cingulate gyrus; and FA, MK and RK decreased in the left hippocampus (P =0.006, P =0.002, P =0.010, respetctively). Conclusions The limbic systems, such as cingulate gyrus and hippocampus, have microstructural changes in the patients with MCI induced by CSVD.



Correlation between Sleep Duration, Sleep Quality and Post-Stroke Depression

WANG Xue, YU Ping, CHEN Tian-Yong

2021, 16(08):  799-804.  DOI: 10.3969/j.issn.1673-5765.2021.08.008

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Objective To investigate the correlation between sleep duration, sleep quality and post-stroke depression. Methods This prospective study consecutively enrolled stroke inpatients in the Department of Neurology, General Hospital of Tianjin Medical University from July 2017 to May 2019. The patients were divided into depression group and non-depression group according to self-rating depression scale (SDS) and Hamilton depression scale-17 (HAMD-17) scores. Sleep duration and sleep quality were assessed based on a self-report. According to the sleep duration, the patients were divided into 5 groups (<7 h, 7-<8 h, 8-<9 h, 9-<10 h and ≥10 h). The sleep quality was divided into 3 grades (good, average and poor). The demographic, lifestyle, BMI, disease history and other information of the patients were collected by self-designed questionnaire. Results A total of 836 stroke patients were enrolled, including 453 (54.2%) in depression group and 383 (45.8%) in non-depression group. The sleep quality of depression group was worse than

that of non-depression group (P <0.001), but there was no statistical difference in sleep duration

between the two groups. In addition, the international physical activity questionnaire (IPAQ) score was lower (P <0.001), the proportion of female was higher (P =0.034), and the proportion of patients with chronic disease history was higher (P =0.006) in depression group than that in non-depression group. Logistic regression analysis showed that general sleep quality (OR 1.729, 95%CI 1.232-2.428, P =0.002) and poor sleep quality (OR 1.817, 95%CI 1.250-2.640, P =0.002) increased the risk of depression, compared with good sleep quality; sleep duration had no significant effect on depression. Conclusions Stroke patients are a high risk group of depression, and sleep quality is an independent predictor of post-stroke depression.

Correlation between D-dimer to Fibrinogen Ratio and Carotid Plaque in Young Patients with Acute Cerebral Infarction

HOU Rui-Hua, LYU Mai-Kou, WEN Hui-Jun

2021, 16(08):  805-809.  DOI: 10.3969/j.issn.1673-5765.2021.08.009

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Objective To explore the relationship between D-dimer to fibrinogen ratio (DFR) and carotid plaque in young acute cerebral infarction (YACI) patients. Methods The first-onset YACI patients who underwent contrast enhanced ultrasound (CEUS) from February 2014 to September 2020 were retrospectively collected and taken as the observation group. The healthy young people with normal carotid ultrasound results in physical examination during the same period were selected as the control group. According to the results of CEUS, carotid plaque was divided into 1-4 grades. According to NIHSS score, the neurological deficits were divided into mild, moderate and severe grades. The demographic information, vascular risk factors and laboratory examination results of the two groups were collected, and DFR was calculated. The differences of the above indexes between the two groups were compared. The correlation of DFR with carotid plaque grade and the severity of neurological deficit in the observation group were analyzed. Results 96 cases in the observation group and 67 cases in the control group were included in this study. The DFR value of the observation group was higher than that of the control group [(102.06±13.05)×10-3 vs (71.35±18.13)×10-3, P =0.019] . In the observation group, DFR was positively correlated with NIHSS score (r =0.716, P =0.038) and CEUS grade of carotid plaque (r =0.879, P =0.032) .

Conclusions The DFR value of YACI patients was positively correlated with CEUS carotid plaque

grade and NIHSS score. The DFR maybe a potential marker for evaluating carotid plaques stability and stroke severity in YACI patients.



Correlation between Age and 1-Year Prognosis of Patients with Acute Cerebral Infarction

GAO Su-Ying, QIN Yi-Fan, ZHANG Hui-Ling, YU Kai, WANG Yong-Jun, JI Rui-Jun

2021, 16(08):  810-815.  DOI: 10.3969/j.issn.1673-5765.2021.08.010

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Objective To explore the correlation between age and 1-year prognosis of the patients with acute cerebral infarction (ACI). Methods The eligible ACI patients admitted to Department of Neurology, Renqiu Kangjixintu Hospital from January 2014 to November 2018 were enrolled in this retrospective analysis, and all the subjects were divided into the young and middle-aged group (<60 years old) and the elderly group (≥60 years old) according to the age. The clinical data of both groups were compared. Multivariate logistic regression analysis was used to determine the relationship between age and 1- year death, poor prognosis (mRS >2 points) and stroke recurrence. Results A total of 3996 ACI patients were included, with an average age of 64.83±11.28 years old (range: 22-98 years) and 2481 males (62.09%). 1214 cases (30.38%) were in the young and middleaged group, and 2782 cases (69.62%) in the elderly group. The proportion of male, educational level, excessive drinking, diabetes and intravenous thrombolysis during hospitalization, was

lower in the elderly group than in the young and middle-aged group, as well as the diastolic blood

pressure, fasting blood glucose, TG, TC, LDL-C, white blood cell counts and pressure ulcer score. While the proportion of smoking, atrial fibrillation, coronary heart disease, stroke history, carotid stenosis, new pneumonia, new gastrointestinal bleeding and proton pump inhibitor treatment during hospitalization were higher in the elderly group than in the young and middle-aged group, as well as the level of systolic blood pressure, HDL-C, Hcy, Cystatin-C, fibrinogen, NIHSS score on admission and fall score. All the above differences were statistically significant. Multivariate logistic regression analysis showed that the elderly group had higher risk of 1-year death (OR 2.770, 95%CI 1.479-5.189, P =0.001), poor prognosis (OR 1.721, 95%CI 1.301-2.275, P <0.001) and stroke recurrence (OR 1.396, 95%CI 1.011-1.927, P =0.043). Conclusions The elderly ACI patients has a higher risk of 1-year death, poor prognosis and stroke recurrence. The screening and intervention of stroke risk factors in elderly ACI patients should be strengthened to improve their prognosis.



Clinical Characteristics and Medical Care Situation of Ischemic Stroke in Children in China

DENG Ya-Xian, ZHANG Gui-Tao, WANG Lei, YAO Chun-Mei, XU Juan-Yu, LIU Gai-Fen, ZHAO Cheng-Song

2021, 16(08):  816-821.  DOI: 10.3969/j.issn.1673-5765.2021.08.011

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Objective To investigate the clinical presentation, risk factors, causes and medical care situation of ischemic stroke in children in China. Methods The data of inpatients with ischemic stroke aged from 1 month to 18 years from hospitals in Beijing (excluding army hospital) from January 2018 to December 2018 were retrospectively analyzed. The clinical information included demographics, clinical presentation, risk factors, examination results, complications after admission, treatment in acute phase, secondary prevention and neurologic deficits at discharge. Results A total of 172 children patients were included, with a median age of 9.0 years old (range: 6.0-11.2 years old) and 103 boys (59.88%). The proportion of patients aged 7-10 years old and aged over 10 years old were relatively high, 34.30% and 31.40%, respectively. The most common clinical symptom was hemiplegia (n =160, 93.02%), the next one was speech disturbance (n =43, 25.00%), and the other symptoms included consciousness disturbance and headache. In

addition, 29 patients (16.86%) had seizure. 159 patients (92.44%) had at least one risk factor, and

cerebrovascular disease was the main cause (n =133, 77.3%), among which the most common was Moyamoya disease (n =118, 68.60%), 14 patients (8.14%) had heart disease and no clear causes were found in 13 patients (7.56%). 30 patients (17.44%) received antithrombotic therapy, and 9 patients (5.23%) received anticoagulant therapy in the acute phase. 11 patients (6.40%) received antithrombotic therapy, and 2 patients (1.16%) received anticoagulant therapy for secondary prevention at discharge. Conclusions The peak onset of ischemic stroke in children is 7-10 years old. Hemiplegia is the most common clinical presentation, and the main cause of ischemic stroke is Moyamoya disease. Antithrombotic therapy was insufficient in acute phase and secondary prevention for ischemic stroke children.

Clinical Study of Asymptomatic Middle Cerebral Artery Occlusion

LI Ru-Juan, MA Xiao-Dan, YANG Chuan, MA Xiao-Hui, YANG Jin-Bo

2021, 16(08):  822-827.  DOI: 10.3969/j.issn.1673-5765.2021.08.012

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Objective To analyze the clinical and imaging features of the patients with asymptomatic middle cerebral artery (MCA) occlusion. Methods A retrospective analysis of the data of inpatients with asymptomatic MCA occlusion who underwent head MRA from January 2016 to January 2019 was performed, to analyze the clinical and imaging features of all the included patients. Results Totals of 3967 patients underwent head MRA examination, and among them, 23 cases (0.58%) with asymptomatic MCA occlusion. For the 23 subjects, the mean age was 61.2±11.2 years (range: 34-80 years), and 14 were male (60.87%) and 9 were female (39.13%). Among them, there were 14 cases with a history of hypertension (60.87%), 12 with hyperlipidemia (52.17%), 6 with a history of stroke (26.09%), 8 with hyperhomocysteinemia (34.78%), 6 with diabetes (26.09%) and 4 with a history of smoking (17.39%). MRA imaging showed 10 cases (43.48%) with left MCA occlusion, 10 cases (43.48%) with right MCA occlusion and 3 cases (13.04%) with bilateral MCA occlusion. During the follow-up of 3 months to 3 years, none had symptoms of new cerebral infarction. Conclusions MCA occlusion can exist in isolation without corresponding clinical symptoms and cerebral infarction lesions, which is worthy of further study.



Endovascular Therapy for Spontaneous Cavernous Sinus Dural Arteriovenous Fistula

ZHAO Shang-Feng, WANG Wei, LIANG Xi-Hong, ZHANG Jia-Liang, SUN Si, SONG Gui-Dong, KANG Jun

2021, 16(08):  828-833.  DOI: 10.3969/j.issn.1673-5765.2021.08.013

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Objective To investigate the clinical characteristics of spontaneous cavernous sinus dural arteriovenous fistula (CSDAVF) and the efficacy of interventional embolization for CSDAVF. Methods From September 2017 to January 2020, the data of patients with CSDAVF diagnosed by DSA and treated with interventional embolization in Department of Neurosurgery of Beijing Tongren Hospital were retrospectively analyzed. After DSA evaluation, the patients were embolized through venous or arterial approach, with Onyx glue or combined with coils. The patients were followed up with DSA one year after the operation, and the degree of embolization and 1-year prognosis of the two methods were compared. Results A total of 25 cases were included, with a median age of 40 years old (range: 21-72 years old). 6 patients (24.0%) were embolized with Onyx glue alone, and 19 patients (76.0%) with Onyx glue combined with coil. 17 cases were treated through venous approach, and 8 cases

through arterial approach. DSA at the end of the procedure showed complete embolization in 12

cases (70.6%), subtotal embolization in 4 cases (23.5%) and partial embolization in 1 case (5.9%) in venous approach group; meanwhile, complete embolization in 7 cases (87.5%) and subtotal embolization in 1 case (12.5%) in arterial approach group. DSA at 1-year follow up showed complete embolization in 12 cases (70.6%), subtotal embolization in 4 cases (23.5%), and partial embolization in 1 case (5.9%) in venous approach group; and complete embolization in 5 cases (62.5%), subtotal embolization in 2 case (25.0%) and partial embolization in 1 case (12.5%) in arterial approach group. At 1- year follow up, in venous approach group, 11 cases (64.7%) were cured, 5 cases (29.4%) improved and 1 case (5.9%) showed no improvement; in arterial approach group, 6 cases (75.0%) were cured, and 2 cases (25.0%) improved. There was no statistical difference in the prognosis between the two groups. Conclusions Intravascular therapy for CSDAVF is safe and effective. It’s similar for transvenous approach or transarterial approach embolization in embolization rate at the end of and one year after the procedure.



Influence of Coronavirus Disease 2019 on Cognitive Function and Psychological State of Stroke Inpatients

GONG Xi-Ping, LI Yi, CHAI Ming-Dong, YU Ping, ZHAO Xing-Quan, WANG Yong-Jun, DONG Ke-Hui

2021, 16(08):  834-838.  DOI: 10.3969/j.issn.1673-5765.2021.08.014

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Objective To analyze the influence of coronavirus disease 2019 (COVID-19) on cognitive function and psychological state of stroke inpatients. Methods In this retrospective study, inpatients with stroke admitted to Department of Neurology of Beijing Tiantan Hospital, Capital Medical University during COVID-19 pandemic from January 1 to April 30, 2020 were included as the observation group, and inpatients with stroke in the same department from January 1 to April 30, 2019 were included as the control group. MoCA and the 9-item patient health questionnaire (PHQ-9) scale to screen depression were used in the patients of both groups. The 2-item patient health questionnaire (PHQ-2) was used in all the included patients to screen depression at 3-month follow up. Results A total of 106 patients in observation group and 180 in control group were included in this study. Compared to control group, the proportion of patients with a history of atrial fibrillation

in observation group was higher (13.21% vs 4.44%, P =0.01) and the proportion of patients with a

history of myocardial infarction was lower (0 vs 5.56%, P =0.01). There was no statistical difference in MoCA score between the two groups, but PHQ-9 score of the observation group [13 (11-16) vs 7 (4-11), P <0.01] was higher. With PHQ-9 score ≥10 points as a criterion for diagnosing depression, the proportion of post-stroke depression patients in observation group was higher than that in control group (39.62% vs 35.00%, P <0.01). At 3-month follow-up, PHQ-2 score in observation group was also higher than that in control group [4 (3-5) vs 3 (2-5), P <0.01]. Conclusions Inpatients with stroke were more prone to become depressed during the COVID-19 epidemic, and appropriate psychological interventions should be given to improve the patients’ mental health.



Interpretation for Practice Guideline for Management of Brain Arteriovenous Malformations in Eloquent Areas

HE Qi-Heng, ZENG Chao-Fan, WANG Ming-Ze, JIAO Yu-Ming, CAO Yong, ZHAO Ji-Zong

2021, 16(08):  839-842.  DOI: 10.3969/j.issn.1673-5765.2021.08.015

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A Case of Trousseau's Syndrome Secondary to Lung Cancer with the Feature of Cerebral Infarction InvolvingMultiple Territory

CAO Xiang-Qi, HUO Kang, SONG Wen-Feng, LUO Guo-Gang, QU Qiu-Min

2021, 16(08):  843-849.  DOI: 10.3969/j.issn.1673-5765.2021.08.016

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Progress of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in the Treatment of Ischemic Stroke

DENG Qi-Le, WU Jie-Hong, CHEN Ji-Xiang

2021, 16(08):  850-854.  DOI: 10.3969/j.issn.1673-5765.2021.08.017

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Dyslipidemia is closely related to atherosclerosis development and ischemic stroke, and lower level of LDL-C can effectively reduce the risk of cardiovascular and cerebrovascular diseases. Proprotein convertase subtilisin/kexin type 9 (PCSK 9) is a novel therapeutic target for reducing LDL-C level. PCSK 9 inhibitors can significantly reduce the level of LDL-C, and inhibit the progression of atherosclerosis. Clinical studies have shown that the PCSK9 inhibitors can significantly reduce the incidence of atherosclerotic cardiovascular events and ischemic stroke, and the genetic polymorphism of PCSK9 is closely related to hypercholesterolemia, atherosclerosis and ischemic stroke.

Progress of Transcranial Direct Current Stimulation in Rehabilitation of Post-Stroke Dysphagia

LI An, XIA Yan-Qiu, FU Jian-Ling, YUAN Meng, GUO Xin-Yu, CUI Li-Jun

2021, 16(08):  855-860.  DOI: 10.3969/j.issn.1673-5765.2021.08.018

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Post-stroke dysphagia may be caused by the damage of swallowing cortical center, descending cortical fibers, medullary swallowing center, and extrapyramidal system. So far, there is no specific treatment for dysphagia, and the main interventions are rehabilitation such as direct and indirect training. Transcranial direct current stimulation (tDCS) is a neurostimulation treatment that modifies neuroplasticity and cortical excitability through direct current stimulation, to improve a variety of neurological and psychiatric disorders. In recent years, researchers have gradually paid attention to the regulatory and physiological effects of tDCS on brain activity, and been exploring the mechanism of tDCS in stimulating neural networks. This review elaborated the research progress of tDCS from the aspects of neural mechanism, stimulation parameters and poststimulation effects of tDCS, to provide the basis for the current and future research to find effective rehabilitation methods for post-stroke dysphagia.

Application of Practice-Oriented Teaching Method in Cerebrovascular Disease Teaching

FU Sheng-Qi, ZHANG Shu-Ling, YU Meng, REN Ya-Fang

2021, 16(08):  861-863.  DOI: 10.3969/j.issn.1673-5765.2021.08.019

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Practice-oriented teaching method is a common teaching method in cerebrovascular disease teaching at present, which mainly includes case teaching, simulation teaching and thinking impact method. Compared with traditional teaching method, the practice-oriented teaching method has more advantages in improving students' teaching participation and clinical thinking, and it also has higher requirements for the teachers' teaching ability and students' active learning ability. In clinical teaching, the teaching effect of practice-oriented teaching method should be improved by improving teachers' teaching level and increasing comprehensive teaching evaluation system.

Meta Analysis on Efficacy Comparison between Problem-Based Learning and Lecture-Based Learning inCerebrovascular Disease Clinical Teaching in China

MENG Shi-Jiao, ZHUO Zi-Ze, XU Rong, REN Yi

2021, 16(08):  864-872.  DOI: 10.3969/j.issn.1673-5765.2021.08.020

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Objective To systematically evaluate the efficacy of problem-based learning (PBL) and traditional lecture-based learning (LBL) in cerebrovascular disease clinical teaching in China. Methods Randomized controlled trials (RCTs) of PBL and LBL in cerebrovascular disease clinical teaching were retrieved from Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Information Chinese Journal Service Platform) from inception to May 2021. Revman 5.4 and Stata 15.0 were used for meta analysis and publication

bias detection. By using standard mean difference (SMD) or RR and 95%CI , the teaching efficacy

of PBL and LBL were compared through examination scores (theoretical knowledge, case analysis and skill operation), questionnaire scoring items (medical knowledge development, doctor-patient communication ability, clinical practice ability, clinical thinking ability, team cooperation ability, autonomous learning ability) and teaching satisfaction. Results A total of 25 RCTs involving 1493 participants were included, of them, 747 in PBL group and 746 in LBL group. The examination scores of theoretical knowledge (SMD 1.41, 95%CI 0.79- 2.02, P <0.001), case analysis (SMD 1.74, 95%CI 0.84-2.64, P <0.001) and skill operation (SMD 3.35, 95%CI 1.09-5.60, P =0.004) in PBL group were superior to those in LBL group (P <0.001). The questionnaire scores of medical knowledge development (SMD 1.08, 95%CI 0.53-1.62, P <0.001), doctor-patient communication ability (SMD 3.07, 95%CI 2.07-4.07, P <0.001), clinical practice ability (SMD 2.55, 95%CI 1.33-3.78, P <0.001), clinical thinking ability (SMD 3.02, 95%CI 0.99- 5.06, P =0.004), team cooperation ability (SMD 1.64, 95%CI 1.19-2.08, P <0.001), autonomous learning ability (SMD 2.35, 95%CI 1.20-3.50, P <0.001) in PBL group were superior to that in LBL group. The teaching satisfaction (RR 1.18, 95%CI 1.10-1.26, P <0.001) in PBL group was also superior to that in LBL model. Except for the homogeneity of teaching satisfaction (P =0.23, I 2=29%), the other outcome indicators were heterogeneous (P ≤0.1 or I 2≥50%). There was no statistical significance of publication bias for theoretical knowledge score, case analysis score, skill operation score, teaching satisfaction and questionnaire score of medical knowledge development, while there was statistical significance of publication bias for other outcome indicators. Conclusions Based on the existing evidence, PBL method was more effective than LBL method in cerebrovascular diseases clinical teaching in China. However, the risk of bias and heterogeneity of included studies should not be ignored, and more higher quality multicenter studies are needed to further confirm the above conclusions.