Table of Content

20 September 2022, Volume 17 Issue 09

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Diagnosis and Treatment of Stroke in Young Adults: No Overtreatment

XU Weihai, LI Shun, CHENG Anqi

2022, 17(09):  915-918.  DOI: 10.3969/j.issn.1673-5765.2022.09.001

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Prevention and Treatment of Stroke in Young Adults

2022, 17(09):  919-919. 

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Advances in Genetics of Stroke in Young Adults

CHENG Anqi, XU Weihai

2022, 17(09):  920-924.  DOI: 10.3969/j.issn.1673-5765.2022.09.002

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The incidence of stroke in young adults is on the rise, and the discovery of preclinical biomarkers would be of great clinical value. In addition to rare stroke-related monogenic diseases, many studies on the genetic susceptibility have shown that stroke in young adults is of multifactorial inheritance. In the past two decades, genome wide association study (GWAS), validation studies and meta-analysis have been applied to genetics research of stroke in young adults. This article reviewed the genetics evidence, related single gene and candidate genes mutation of stroke in young adults, to provide references for the clinical diagnosis and treatment.

Carotid Artery Geometry: A Potential Predictor for Intracranial Atherosclerosis in People at Age 60 or Less than 60 Years without Traditional Vascular Risk Factors

LIU Yitong, HUANG Yanqi, LI Mingli, FENG Feng, GAO Shan, XU Weihai

2022, 17(09):  925-931.  DOI: 10.3969/j.issn.1673-5765.2022.09.003

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Objective  To evaluate the association between carotid artery geometry and middle cerebral artery (MCA) atherosclerosis in patients at age 60 or less than 60 years old without traditional vascular risk factors, using head-neck HR-MRI, to seek the potential predictive factors for MCA atherosclerosis.
Methods  The patients at age 60 or less than 60 years old without traditional vascular risk factors from Peking Union Medical College Hospital between January 2018 and February 2019 and Guangdong Provincial People’s Hospital between August 2019 and January 2020 were included in this retrospective study, and a total of 150 artery units of ipsilateral anterior circulation of all the patients were analyzed. According to having MCA atherosclerotic plaque or not, artery units were categorized into two groups: MCA atherosclerosis (+) vs. MCA atherosclerosis (-). Carotid bifurcation angle, carotid artery lumen-area ratio and configuration of extracranial and intracranial internal carotid artery (ICA) were compared between two groups. Logistic regression analysis was used to evaluate the independent risk factors of MCA atherosclerosis. ROC curve was drawn to analyze the predictive value of carotid artery geometry for MCA atherosclerosis.
Results  Compared with MCA atherosclerosis (-) group (n=113), MCA atherosclerosis (+) group (n=37) had a larger carotid bifurcation angle [41.2° (28.8°-56.5°) vs. 32.6° (24.7°-46.2°), P=0.026], larger outflow/inflow lumen-area ratio, less smooth type, more tortuous and kinked type of extracranial ICA, and less obtuse angle, more right angle and acute angle shape of intracranial ICA, all without statistical differences. Multivariate logistic regression analysis showed that carotid bifurcation angle was independently associated with MCA atherosclerosis (per 10° increase, OR 1.232, 95%CI 1.007-1.507, P=0.042), and also in backward stepwise logistic regression analysis (per 10° increase, OR 1.276, 95%CI 1.050-1.550, P=0.014). The area under the ROC curve of carotid bifurcation angle for MCA atherosclerosis was 0.622 (95%CI 0.515-0.730), the cutoff value was 37.0°, the sensitivity was 57.5%, and the specificity was 64.9%.
Conclusions  For people at age 60 or less than 60 years old without traditional vascular risk factors, carotid bifurcation angle is independently associated with MCA atherosclerosis, which may be a potential imaging marker for intracranial atherosclerosis.




Association of Artery Occlusion and Recurrent Ischemic Stroke Related with Cerebral Artery Dissection

ZHANG Yige, ZHANG Wan, ZHANG Luyang, WANG Xin, DING Lan, WANG Yuying, PEI Lulu, FANG Hui, XU Yuming, SONG Bo

2022, 17(09):  932-936.  DOI: 10.3969/j.issn.1673-5765.2022.09.004

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Objective  To investigate the relationship between culprit cerebral artery occlusion and cerebral artery dissection (CAD)-related stroke recurrence.
Methods  The patients with first CAD-related ischemic stroke who were admitted in the First Affiliated Hospital of Zhengzhou University from January 2018 to February 2022 were prospectively included in this study. CTA, MRA, HR-MRI, DSA and other imaging methods were used to evaluate the imaging characteristics of culprit cerebral artery occlusion and long-segment dissection; and the long-term imaging follow-up was performed to evaluate stroke recurrence. COX regression analysis was used to evaluate the risk factors of stroke recurrence, and Kaplan-Meier survival curve was constructed to evaluate the relationship between cerebral artery occlusion and CAD-related stroke recurrence.
Results  A total of 107 cases were included in the analysis, with stroke recurrence in 10 patients (9.7%). Cox regression analysis showed that culprit artery occlusion (HR 6.150, 95%CI 1.227-30.810, P=0.027) and hemorrhagic transformation (HR 12.605, 95%CI 2.373-66.949, P=0.003) were independent risk factors of CAD-related stroke recurrence. The Kaplan-Meier survival curve showed that there was statistical difference in stroke recurrence between artery occlusion and non-occlusion groups (Log-rank P=0.001).
Conclusions  Artery occlusion is a risk factor of CAD-related stroke recurrence.




The Types and Risk Factors of Stroke in Young Patients with Moyamoya Disease

FU Heguan, SHEN Xuxuan, XU Jiali, ZHANG Houdi, LI Bin, ZOU Zhengxing, FENG Jie, DUAN Lian, HAN Cong

2022, 17(09):  937-943.  DOI: 10.3969/j.issn.1673-5765.2022.09.005

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Objective  To explore the stroke types and clinical characteristics of in young patients with moyamoya disease, and to analyze the risk factors of stroke in young patients with moyamoya disease (MMD).
Methods  The clinical and imaging data of MMD with stroke patient (age 18 to 45 years old) between January 2020 and December 2021 who were admitted to the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. The MMD patients with stroke were divided into hemorrhagic stroke and ischemic stroke groups, imaging and clinical features of patients with different stroke types were compared. The MMD patients without stroke during the same period were selected as the control group, and multivariate logistic regression analysis was used to analyze the risk factors of hemorrhagic stroke and ischemic stroke in young MMD patients.
Results  A total of 108 patients with stroke were enrolled, including 22 cases (20.4%) of hemorrhagic stroke and 86 cases (79.6%) of ischemic stroke. A total of 104 subjects in control group were included. In hemorrhagic stroke group, there were 12 cases (54.5%) intraventricular hemorrhage, 7 cases (31.8%)of parenchymal hemorrhage, 3 cases (13.6%) of subarachnoid hemorrhage. In ischemic stroke group, there were 21 cases (24.4%) of larger artery infarction type, 36 cases (41.9%) of hemodynamic infarction type, and 29 cases (33.7%) of perforating artery infarction type. There were statistical differences in gender and the percentage of aneurysms between hemorrhage stroke group and ischemic stroke group. Multivariate logistic regression analysis showed that aneurysm was a risk factor for hemorrhagic stroke in young MMD patients (OR 10.569, 95%CI 1.524-73.274, P=0.017); age increasing (OR 1.058, 95%CI 1.004-1.115, P=0.034), Suzuki stage (OR 1.363, 95%CI 1.037-1.793, P=0.027) and diabetes mellitus (OR 4.005, 95%CI 1.766-9.080, P=0.001) were independent risk factors for ischemic stroke in young MMD patients.
Conclusions  The main type of stroke in young MMD patients is ischemic stroke. For MMD patients with stoke, hemodynamic infarction type was the main type of ischemic stroke, and ventricular hemorrhage was the main type of hemorrhagic stroke. Age, Suzuki stage, diabetes mellitus and intracranial aneurysm were independent risk factors for stroke in young MMD patients.




Vitamin B₁₂ Deficiency Associated Unilateral Involuntary Movement in A Young Adult with Intracranial Artery Stenosis: A Case Report

SI Qianqian, LI Mingli, LIU Qing, XU Weihai

2022, 17(09):  944-949.  DOI: 10.3969/j.issn.1673-5765.2022.09.006

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The Application Value of Indirect Method of Peri-lesion Polar-halo Sign on SWI Phase Image in Differentiating Simple Calcification from Hemorrhage: A Retrospective Study

SU Lu, GAO Peiyi

2022, 17(09):  950-956.  DOI: 10.3969/j.issn.1673-5765.2022.09.007

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Objective  To compare the diagnostic value of traditional method of signal intensity of foci and indirect signs (reversed halo sign and bipolar sign) on SWI phase image in differentiating simple calcification from hemorrhage.
Methods  The included simple calcification and simple hemorrhage were confirmed by follow-up CT scan. All the lesions were evaluated by traditional method and indirect polar-halo method. The evaluation standard of traditional method as follows: low and high intensity sign representing hemorrhage and calcification, respectively. The evaluation standard of indirect method as follows: low signal intensity bipolar sign or high signal intensity reversed halo sign representing hemorrhage, and high signal intensity bipolar sign or low signal intensity reversed halo sign representing calcification. The Kappa value was calculated to evaluate the consistency of lesion signal intensity and peri-lesion polar-halo sign results between the two observers. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated to evaluate the diagnosis value of SWI direct and indirect characteristics in differentiating simple calcification and hemorrhage.
Results  A total of 224 lesions (36 patients) were included, with 101 simple calcifications (28 patients) and 123 simple hemorrhagic lesions (8 cases). The consistency coefficient of the two observers on traditional method and indirect polar-halo method was 0.768 and 0.876, respectively. The PPV, NPV, sensitivity and specificity of traditional method in identifying calcification were 66.7%, 70.2%, 61.4% and 74.8%, respectively. The PPV, NPV, sensitivity and specificity of polar-halo method in identifying calcification were 99.0%, 97.6%, 97.0% and 99.2%, respectively.
Conclusions  The indirect polar-halo sign on SWI phase image has a higher diagnostic accuracy, which may be a more reliable way to differentiate simple hemorrhage from simple calcification.




Meta-analysis of the Association of Menopausal Hormone Therapy with Stroke

CAO Yuting, FAN Wenjuan, WANG Chunxue, CHEN Ying

2022, 17(09):  957-965.  DOI: 10.3969/j.issn.1673-5765.2022.09.008

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Objective  To evaluate the association between menopausal hormone therapy and stroke.
Methods  The PubMed, Embase and Cochrane Library were retrieved for randomized controlled trials (RCTs) and observational studies on menopause hormone therapy for postmenopausal women published from inception to January 5, 2022. The treatment in RCTs must be oral hormone therapy, and the follow-up time should be over 6 months. The outcome was the incidence of stroke in the subjects of the included studies. The association between menopausal hormone therapy and stroke was analyzed.
Results  The meta-analysis of RCTs included 7 studies including 35 776 healthy women, and stroke occurred in 566 women (1.58%). Of 18 337 healthy women who received menopausal hormone therapy, stroke occurred in 332 women (1.81%). In the control group, stroke occurred in 234 (1.34%) among 17 439 healthy women. The incidence of stroke in healthy women who received menopausal hormone therapy was 1.40 times higher than that in those who did not receive menopausal hormone therapy (RR 1.40, 95%CI 1.19-1.65). The meta-analysis of observational studies on menopausal hormone therapy showed that 1425 (0.84%) stroke occurred in 167 770 women from 3 studies. Stroke occurred in 513 (0.84%) of 61 117 women receiving menopausal hormone therapy and 912 (0.86%) of 106 653 women in the control group, and there was no statistical difference in the incidence of stroke between the menopausal hormone treatment group and the control group (RR 0.96, 95%CI 0.86-1.07).
Conclusions  There may be no significant association between menopausal hormone therapy and stroke.




The Relationship between Nutritional Status and Postoperative Complications in Patients Undergoing Microsurgical Clipping of Intracranial Aneurysms Based on Peri-operative Enhanced Recovery

WANG Li, LI Zhenshui, WU Jun, XU Yingxia, HAO Chunman

2022, 17(09):  966-971.  DOI: 10.3969/j.issn.1673-5765.2022.09.009

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Objective  To investigate the effect of nutritional status on postoperative complications in patients who received microsurgical clipping of intracranial aneurysm and perioperative standard enhanced recovery.
Methods  This study prospectively enrolled consecutive patients who received microsurgical clipping of intracranial aneurysms and perioperative standard enhanced recovery at Beijing Tiantan Hospital from January 2018 to March 2019. The following data were collected including demographic information, aneurysm characteristics (location, diameter, rupture or not), medical history (hypertension, diabetes), perioperative nutritional parameters (nutritional risk, anthropometric measurements, laboratory test results, nutritional support, etc.), postoperative complications including pneumonia, intracranial infection, deep vein thrombosis of lower extremity and stroke (ischemic stroke and intracranial hemorrhage), etc. The patients were divided into complication group and non-complication group according to having at least one complication or not from the end of operation to discharge. The above indexes were compared between the two groups. Multivariate logistic regression analysis were used to evaluate the effects of perioperative nutritional indexes on the complications after microsurgical clipping of intracranial aneurysms.
Results  A total of 97 patients with intracranial aneurysm were recruited and underwent microsurgical clipping. Postoperative complications occurred in 33 patients (34.02%). The proportion of preoperative aneurysm rupture (12.1% vs. 0, P=0.009), hypertension (72.7% vs. 50.0%, P=0.005) and diabetes (9.0% vs. 3.1%, P=0.032) in complication group were higher than those in non-complication group, and nutritional parameters such as the preoperative BMI (26.37±6.58 kg/m2 vs. 24.61±3.32 kg/m2, P=0.015), triceps skin fold thickness (TSF) (24.92±8.57 mm vs. 18.61±8.09 mm, P=0.001), and calf circumference (37.60±3.067 cm vs. 36.06±3.44 cm, P=0.039) in complication group were higher than those in non-complication group, and the hemoglobin level (136.06±13.93 g/L vs. 143.27±12.08 g/L, P=0.010) was lower than that in non-complication group. The proportion of postoperative nutritional intervention (84.8% vs. 40.6%, P=0.030), oral nutrition supplements (33.3% vs. 26.5%, P<0.001), enteral nutrition (12.1% vs. 0, P<0.001), and parenteral nutrition (39.3% vs. 14.0%, P<0.001) in complication group were higher than those in non-complication group, and the duration of parenteral nutrition was longer than that in non-complication group [5.0 (3.0-11.5) day vs. 1.0 (1.0-3.5) day, P=0.009]. Multivariate logistic analysis showed that high preoperative TSF (OR 1.230, 95%CI 1.056-1.363, P=0.008) may be a risk factor for postoperative complications in patients with intracranial aneurysm, while high albumin level at the day after the operation (OR 0.734, 95%CI 0.561-0.961, P=0.025) may be a protective factor for postoperative complications.
Conclusions  In patients who underwent microsurgical clipping of intracranial aneurysms, the increased subcutaneous fat may mean an increased risk of postoperative complications, and the high serum albumin level at the day after the operation may mean a lower risk of postoperative complications.




Effect of Xinxuening Capsule on Short-term Functional Outcome in Patients with Ischemic Stroke and High Homocysteine Level

LYU Wei, WANG Anxin, TIAN Xue, ZHANG Xiaoli, XU Yuyuan, MENG Xia

2022, 17(09):  972-976.  DOI: 10.3969/j.issn.1673-5765.2022.09.010

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Objective  To investigate the effect of xinxuening capsule on short-term functional outcome among patients with ischemic stroke and high homocysteine level (>15 μmol/L).
Methods  This study included the patients who were treated with drugs and followed up for 3 months from the “Efficacy and safety of xinxuening capsule in the treatment of patients with ischemic stroke and high homocysteine level: a randomized, double-blind, controlled clinical trial (from October 30, 2018 to December 27, 2019)”. The patients were divided into 3 groups according to the taking medications: xinxuening group (xinxuening capsule 0.4 g/capsule, 2 capsules/time, 3 times/d, folic acid tablet analog agent 2 tablets/time, 1 time/d), folic acid group (xinxuening capsule analog agent 2 capsules/time, 3 times/d, folic acid tablet 0.4 mg/tablet, 2 tablets/time, 1 time/d), and placebo group (xinxuening capsule analog agent 2 capsules/time, 3 times/day, folic acid tablet analog agent 2 tablets/time, 1 time/d). The patients taken the medications continuously for 3 months. The chi-squared trend test was used to evaluate the 90-day functional outcome (mRS) of the three groups.
Results  A total of 238 patients were included in this study, with a mean age of 64.49±12.48 years. Among them, there were 79 patients in xinxuening group, 86 patients in folic acid group, and 73 patients in placebo group. The proportion of patients with a mRS of 0-1 at 90 days was 91.14% (72/79) in xinxuening group, 80.23% (69/86) in folic acid group, and 80.82% (59/73) in placebo group. There was no significant trend in mRS between folic acid group and placebo group (P=0.89), while a decreased trend was observed in xinxuening group compared to placebo group (P=0.04), and also a decreased trend in xinxuening group compared to folic acid group (P=0.03).
Conclusions  Xinxuening capsule could improve 90-day functional outcome among patients with ischemic stroke and high homocysteine level.




Early Clinical Pathway Intervention to Improve the Key Performance Indicators of Medical Care for Ischemic Stroke

ZHANG Xinmiao, PAN Yuesong, XIANG Xianglong, WANG Yongjun, MENG Xia

2022, 17(09):  977-984.  DOI: 10.3969/j.issn.1673-5765.2022.09.011

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Objective  To evaluate the improvement effect of early and late clinical pathway quality interventions on key performance indicators of medical service quality for ischemic stroke.
Methods  This prospective randomized control register study included consecutive ischemic stroke patients from 202 national hospitals from April 2016 to June 2017. The enrolled hospitals were matched according to the principle of geographical location, hospital level, teaching hospital, and were divided into early clinical pathway medical quality intervention group (as “early intervention group”) and “late intervention group”. The study time was divided into 5 phases, with every 3 months as one phase. The early intervention group started intervention from phase 1, and the late intervention group started from phase 3. Baseline characteristics and key performance indicators of medical service quality for ischemic stroke in the two groups were compared to assess the impact of early and late clinical pathway quality intervention on medical quality.
Results  There were 91 hospitals in the early intervention group and 111 hospitals in the late intervention group. A total of 15 167 patients were enrolled. In the 10 key performance indicators of medical service quality for ischemic stroke, the rate of antithrombotic therapy at discharge was higher in the early intervention group than that in the late intervention group in the first stage (95.6% vs. 92.7%, P=0.01). In the second stage, the rate of antithrombotic therapy (94.9% vs. 92.4%, P=0.01) and antihypertensives therapy (68.3% vs. 63.7%, P=0.02) in patients with hypertension were higher in the early intervention group. In the third stage, the rate of antithrombotic therapy (94.2% vs. 90.8%, P=0.01) and statin therapy (92.7% vs. 87.6%, P=0.01) at discharge were higher in the early intervention group. In the fourth stage, the early intervention group had higher rates of DVT prophylaxis (54.7% vs. 41.6%, P=0.01), antithrombotic therapy (94.7% vs. 91.1%, P=0.01) and statin therapy (93.6% vs. 88.5%, P=0.01) at discharge than the late intervention group. In the fifth stage, the early intervention group had a higher rate of rt-PA intravenous thrombolysis than the late intervention group (40.5% vs. 29.5%, P=0.04).
Conclusions  Early clinical pathway medical quality intervention is helpful to improve the key performance indicators of medical service quality for ischemic stroke in China.




Association of White Matter Hyperintensities with Clinical Outcome in Patients with Isolated Middle Cerebral Artery Severe Stenosis or Occlusion

DOU Pengyu, BAN Mengke, GUI Yongkun, BAO Wanli, ZHANG Ping

2022, 17(09):  985-990.  DOI: 10.3969/j.issn.1673-5765.2022.09.012

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Objective  To explore the relationship between cerebral white matter hyperintensities (WMH) and clinical outcome in patients with isolated middle cerebral artery (MCA) severe stenosis or occlusion.
Methods  This study prospectively enrolled the consecutive acute ischemic stroke patients with severe stenosis or occlusion of isolated MCA M1 segment who were admitted to the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical College within 72 hours of onset. Clinical data of the patients were collected. NIHSS score was used to assess the severity of stroke on admission, and Fazekas score was used to assess the severity of WMH. The primary outcomes were functional outcome (mRS score) at 90 days and 1 year, with a mRS score of 0-2 as good outcome and >2 as poor outcome. The secondary outcomes were stroke progression with 3 days of onset, stroke recurrence within 90 days and 1 year. Multivariate logistic regression analysis was used to identify independent risk factors for 90-day and 1-year clinical outcome.
Results  A total of 117 patients were included, with an average age of 60.61±9.92 years and 74 males (63.2%). At 90-day follow-up, 60 patients had a good prognosis and 57 patients had a poor prognosis. Multivariate logistic regression analysis showed that the total Fazekas score (OR 1.612, 95%CI 1.245-2.087, P<0.001), baseline NIHSS (OR 1.215, 95%CI 1.025-1.440, P=0.025), poor collateral circulation (OR 3.111, 95%CI 1.188-8.142, P=0.021) were associated with 90-day poor prognosis. At 1-year follow-up, 86 patients had a good prognosis, 31 patients had a poor prognosis. Multivariate logistic regression analysis showed that the total Fazekas score (OR 1.495, 95%CI 1.083-2.065, P=0.014), baseline NIHSS (OR 1.725, 95%CI 1.359-2.193, P<0.001), poor collateral circulation (OR 4.217, 95%CI 1.218-14.598, P=0.023) were associated with 1-year poor prognosis. Univariate logistic regression analysis showed that WMH had no correlation with stroke progression and recurrence.
Conclusions  WMH is closely related to clinical outcomes of patients with severe MCA stenosis and occlusion. Poor collateral circulation and high baseline NIHSS score were independent risk factors for clinical outcome of patients with severe MCA stenosis or occlusion.




Neuroprotective Effect and Mechanism of Salidroside in Cerebral Ischemia-reperfusion Injury in Mouse Model

WEN Shaohong, LIU Kuan, ZHAO Shunying, DONG Wen, CHEN Qingfang, CHEN Wentao, YE Weizhen, JIANG Mingyu, LIU Xiangrong

2022, 17(09):  991-1001.  DOI: 10.3969/j.issn.1673-5765.2022.09.013

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Objective  To explore the neuroprotective effect and mechanism of salidroside (SAL) on cerebral ischemia-reperfusion injury through animal models and in vitro cell culture.
Methods  A total of 36 male C57BL/6J mice were randomly divided into sham operation group (12 mice), vehicle group (12 mice) and SAL group (12 mice). The mice models of right middle cerebral artery occlusion were made by thread embolization method and were given reperfusion after 1 hour ischemia. At the onset of reperfusion, 150 μL SAL (10 mg/kg, 0.22 mg per mouse) was given to mice immediately by tail vein injection, the same volume of phosphate buffered saline was injected in vehicle group, while nothing was given in sham operation group. The neurological deficits of mice were evaluated 24 hours after ischemia. Cerebral infarction was calculated by neuronal nuclei (NeuN) staining. The autophagy marker microtubule associated protein 1 light chain 3 beta (LC3B) was co-stained with NeuN and glial fibrillary acidic protein (GFAP) to observe the colocalization of LC3B with neurons and astrocytes around infarction in vehicle group, so as to identify the main site of autophagy activity 24 hours after ischemia. Autophagy markers Beclin-1 and autophagy related protein 3 (Atg3) were co-stained with NeuN, respectively, thus to further observe the changes of autophagy level in neurons around infarction. The number of Beclin-1+/NeuN+ and Atg3+/NeuN+ cells per square millimeter was counted. Primary rat neurons were cultured for 10 days and subjected to oxygen glucose deprivation (OGD), and the cells were divided into six groups: normal control (control, CON) group, OGD 1 hour and reoxygenation 1 hour (OGD 1 h) group, OGD 1 hour and reoxygenation 4 hours (OGD 4 h) group, SAL group, OGD 1 hour and reoxygenation 1 hour with SAL (OGD+SAL 1 h) group, OGD 1 hour and reoxygenation 4 hours with SAL (OGD+SAL 4 h) group. CON group and SAL group were not subjected to OGD. The dosage of SAL was 50 μmol/L. The relative expression levels of LC3B, Beclin-1, Atg3, autophagy related protein 5 (Atg5) and Atg7 in each group were detected by immunoblotting. LC3B and NeuN in CON and OGD 4 h groups were co-stained to observe the expression changes of LC3B after OGD. The number of LC3B+/NeuN+ cells per square millimeter was counted.
Results  At 24 hours after ischemia, the neurological deficit scores (5.8±1.4 vs. 7.1±1.4, P=0.0332) and cerebral infarction rate (28.7%±9.7% vs. 39.9%±9.4%, P=0.0038) of mice in SAL group were lower than that in vehicle group. LC3B colocalized with neurons around infarct, but not with astrocytes in vehicle group. The number of Beclin-1+/NeuN+ (312.4±45.6 vs. 471.2±50.3 per square millimeter, P=0.0121) and Atg3+/NeuN+ (322.5±26.5 vs. 491.3±42.1 per square millimeter, P=0.0013) cells in SAL group were less than that in vehicle group. Immunoblotting of primary neurons showed that LC3B relative expression in OGD 1 h group (1.096±0.004 vs. 1.000±0.000, P=0.0174) and OGD 4 h group (1.213±0.019 vs. 1.000±0.000, P<0.0001) was higher than that in CON group. The relative expression of LC3B, Beclin-1 and Atg3 in OGD+SAL 4 h group were significantly lower than that in OGD 4 h group (0.833±0.029 vs. 1.213±0.019, P<0.0001; 0.579±0.081 vs. 1.152±0.144, P<0.0001; 0.726±0.182 vs. 1.091±0.177, P=0.0211). The relative expression of LC3B and Beclin-1 in OGD+SAL 4 h group were significantly lower than that in OGD+SAL 1 h group (0.833±0.029 vs. 1.046±0.063, P<0.0001; 0.579±0.081 vs. 0.921±0.090, P=0.0030). The number of LC3B+/NeuN+ cells in CON group was less than that in OGD 4 h group (51.9±18.7 vs. 584.2±34.5 per square millimeter, P=0.0002).
Conclusions  Salidroside may play a neuroprotective role in acute cerebral ischemia-reperfusion injury by inhibiting neuron autophagy.




Glioblastoma Presenting with Status Epilepticus and Cerebral Hemorrhage: A Case Report and Literature Review

FAN Linlin, TIAN Fei

2022, 17(09):  1002-1006.  DOI: 10.3969/j.issn.1673-5765.2022.09.014

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Neuromyelitis Optica Spectrum Disorders Presenting with Medulla Area Postrema Syndrome and Acute Brain Stem Syndrome: A Case Report

JIAN Xiaoli, DENG Xiao, BAI Xue

2022, 17(09):  1007-1010.  DOI: 10.3969/j.issn.1673-5765.2022.09.015

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The Clinical Application of Arterial Spin-labeled Perfusion MRI in Ischemic Stroke

LI Li, ZHOU Yijun, MENG Zhihua

2022, 17(09):  1011-1016.  DOI: 10.3969/j.issn.1673-5765.2022.09.016

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Advances in Imaging Evaluation of Post-stroke Aphasia

XU Luyao, CHEN Xiaodi, LIANG Zhigang

2022, 17(09):  1017-1021.  DOI: 10.3969/j.issn.1673-5765.2022.09.017

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Post-stroke aphasia is one of the important neurological deficits caused by cerebrovascular diseases, which severely affects patients' cognition and communication, even brings heavy spirit and economic burden to patients themselves, their families and the society. In recent years, with the development of functional imaging, especially functional magnetic resonance imaging has been used by many researchers to study the pathogenesis and recovery mechanism of post-stroke aphasia. This article summarized the advances in imaging research of post-stroke aphasia, in order to provide reference for exploring the pathogenesis, disease progression and recovery mechanism, and forecast the future direction of research.

Advances in the Relationship between IL-6 and Atherosclerotic Ischemic Stroke

GONG Yutian, LI Jiejie

2022, 17(09):  1022-1026.  DOI: 10.3969/j.issn.1673-5765.2022.09.018

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Ischemic stroke is a complex syndrome, and atherosclerosis is one of the main causes. Interleukin 6 (IL-6) is an important inflammatory factor involved in atherosclerosis. The epidemiological and molecular biological evidence indicated that IL-6 can promote the formation and growth of atherosclerosis plaque and influence the occurrence, development and prognosis of ischemic stroke. Recent clinical studies further suggested IL-6 may be a potential therapeutic target of ischemic stroke. This review aimed to elaborate the role of IL-6 in the occurrence and prognosis of ischemic stroke from the perspectives of molecular mechanism, epidemiology and clinical research.

Application of Virtual Reality Technology in Neuroanatomy Teaching

LIU Yuan, REN Lijie, WANG Yang, ZHANG Nenghua, ZHENG Yan, WU Xiaohong, HU Yi

2022, 17(09):  1027-1030.  DOI: 10.3969/j.issn.1673-5765.2022.09.019

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Objective  To explore the role of virtual reality (VR) technology in neuroanatomy teaching.
Methods  The junior medical students in clinical medicine major were selected as the subjects. The experiment was conducted in a phased randomized controlled trial. The teaching contents of the two stages were different, but the other experimental designs were all the same. Students in the experiment group were taught using VR technology, while students in the control group were taught using traditional methods such as video and models. In the first stage, there were 26 students in experiment group, 30 students in control group; in the second stage, 20 students in experiment group and 22 students in control group. The two groups were compared and analyzed through the after-class performance and questionnaires.
Results  In the first stage, the average after-school score was 7.00±1.17 points in experiment group, higher than 6.13±1.70 points in control group; in the second stage, the average score was 8.10±0.97 points in experimental group, higher than 7.14±1.78 points in control group, the above differences had statistical significance (P<0.05). The questionnaires showed that VR teaching made students become more interesting in learning and improved the effective interactions during the teaching course, compared to the control group (P<0.05).
Conclusions  Using VR technology in neuroanatomy teaching can improve students' academic performance and increase interest in learning.




Optimization Strategy for Acute Ischemic Stroke Fast Track during the COVID-19 Epidemic: Shanghai Experience during the Epidemic of Omicron Variant

XU Jiawen, DONG Yi, WANG Zigao, GAO Chao, NI Wei, JIANG Xiaofei, CAO Wenjie, CHENG Xin, GU Yuxiang, DONG Qiang

2022, 17(09):  1031-1036.  DOI: 10.3969/j.issn.1673-5765.2022.09.020

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With the spreading of Omicron variant of a novel coronavirus (SARS-CoV-2), the workflow of acute ischemic stroke emergency care faced great challenges. The increased transmissibility and the latent manifestations of the Omicron variant, made stroke emergency care more complex in Shanghai. The previous acute stroke in-hospital fast track had several limitations under the epidemic of Omicron variant. Combining the guidelines with clinical practice during the epidemic in Shanghai, this article summaried the optimized acute stroke emergency workflow, including SARS-CoV-2 antigen test, emergency area management and protective measure of medical staff, to provide reference for acute stroke emergency care.