Increased retinal venule diameter as a prognostic indicator for recurrent cerebrovascular events:a prospective observational study

Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Fibrinogen’s potential role in connecting cerebrovascular abnormalities with glymphatic dysfunction in Alzheimer’s disease

Alzheimer’s disease(AD)stands out as the primary manifestation of age-related dementia,portraying a chronic neurodegenerative disorder distinguished by the accumulation of fibrillar amyloid-β(Aβ)plaques and neurofibrillary tangles of hyperphosphorylated tau.However,from a clinical standpoint,AD presents itself as a complex condition with a spectrum of dysfunctions rather than a singular pathological mechanism.An often-overlooked aspect of the disease is the presence of extensive cerebrovascular abnormalities,given that the majority of AD patients experience altered cerebral blood flow,damaged vasculature,increased microinfarcts and microhemorrhages.Animal models of AD further support this observation,showing cerebrovascular dysfunction such as impaired cerebral blood flow and altered cerebrovascular reactivity(Tataryn et al.,2021;Gareau et al.,2023).

Characterization of cerebrovascular changes in Alzheimer's disease mice by photoacoustic imaging

The cerebral vasculature plays a significant role in the development of Alzheimer's disease(AD),however,the specific association between them remains unclear.In this paper,based on the benefits of photoacoustic imaging(PAI),including label-free,high-resolution,in vivo imaging of vessels,we investigated the structural changes of cerebral vascular in wild-type(WT)mice and AD mice at different ages,analyzed the characteristics of the vascular in different brain regions,and correlated vascular characteristics with cognitive behaviors.The results showed that vascular density and vascular branching index in the cortical and frontal regions of both WT and AD mice decreased with age.Meanwhile,vascular lacunarity increased with age,and the changes in vascular structure were more pronounced in AD mice.The trend of vascular dysfunction aligns with the worsening cognitive dysfunction as the disease progresses.Here,we utilized in vivo PAI to analyze the changes in vascular structure during the progression of AD,elucidating the spatial and temporal correlation with cognitive impairment,which will provide more intuitive data for the study of the correlation between cerebrovascular and the development of AD.

Stem cell transplantation in cerebrovascular accidents:A global bibliometric analysis(2000-2023)

BACKGROUND Cerebrovascular accident(CVA)is a major global contributor to death and disability.As part of its medical management,researchers have recognized the importance of promising neuroprotective strategies,where stem cell transplantation(SCT)is thought to confer advantages via trophic and neuroprotective effects.AIM To evaluate the current state of research on SCT in patients with CVA,assess key trends and highlight literature gaps.METHODS PubMed was screened for SCT in CVA-related articles in October 2023,for each country during the period between 2000 and 2023.Using the World Bank data,total population and gross domestic product were collected for comparison.VOSviewer_1.6.19 was used to create the VOS figure using the results of the same query.Graphs and tables were obtained using Microsoft Office Excel.RESULTS A total of 6923 studies were identified on SCT in CVA,making 0.03%of all published studies worldwide.Approximately,68%were conducted in high-income countries,with a significant focus on mesenchymal stem cells.The journal“Stroke”featured the largest share of these articles,with mesenchymal SCT having the highest rate of inclusion,followed by hematopoietic SCT.Over time,there has been a noticeable shift from in vitro studies,which assess stem cell proliferation and neurogenesis,to in vivo studies aimed at evaluating efficacy and safety.Additionally,the number of reviews increased along this approach.CONCLUSION This bibliometric analysis provides a comprehensive guide for physicians and researchers in the field through an objective overview of research activity,and highlights both current trends and gaps.Having a potential therapeutic role in CVA,more research is needed in the future to focus on different aspects of SCT,aiming to reach a better treatment strategy and improve life quality in patients.

A Medicinal and Edible Plant Crocus sativus L.and Its Therapeutic Effects on Cardiovascular and Cerebrovascular Diseases

This paper introduces the biological characteristics,medicinal value,chemical component,and pharmacological effects of Crocus sativus L.,and explores its therapeutic effects on cardiovascular and cerebrovascular diseases such as angina pectoris and coronary heart disease.

Progress and challenges of cerebrovascular endothelial cells research promoted by single-cell transcriptome sequencing technology

Single-cell transcriptome sequencing has been a rapidly developing and powerful biological tool in recent years,and it plays a vital role in describing tissue development,cell heterogeneity,stress response,etc.Cerebrovascular disease is one of the leading causes affecting human health in the world.Thus,it is important to understand the characteristics of cerebrovascular structure,function,and environmental response.Notably,single-cell transcriptome sequencing provides deeper insights into cerebrovascular research in health and disease states.This article will briefly introduce the basic structure and function of cerebrovascular endothelial cells(ECs),summarize the current research and new findings on cerebrovascular ECs at the single-cell transcriptome level,and discuss the challenges in this field.

Analysis of The Impact of Interventional Nursing on The Therapeutic Effect, Negative Emotions, and Quality of Life of Patients Undergoing Cardiovascular and Cerebrovascular Interventional Therapy

Objective: To explore the impact of interventional nursing on the therapeutic effect, negative emotions, and quality of life of patients undergoing cardiovascular and cerebrovascular interventional therapy. Methods: A total of 106 patients who underwent cardiovascular and cerebrovascular interventional treatment were collected and randomly divided into Group A (control) and Group B (observation), with 53 cases each. Group A received the routine nursing intervention and Group B received the interventional nursing intervention. The clinical efficacy, complications, negative emotions, quality of life, and nursing satisfaction of the two groups of patients were evaluated. Results: The total clinical effective rate of Group B (52/98.12%) was higher than that of Group A (45/84.91%) (χ^(2)= 4.371, P < 0.05). The total incidence of complications in Group B (2/3.78%) was lower than that of Group A (9/16.98%) (χ^(2)= 4.970, P < 0.05). The self-rating anxiety (SAS) score and self-rating depression (SDS) of Group B were lower than those of Group A (P < 0.001). The quality of life of Group B was significantly higher than that of Group A (P < 0.001). The nursing satisfaction of group B (51/96.22%) was higher than that of group A (43/81.13%) (χ^(2)= 6.014, P < 0.05). Conclusion: In the care of patients undergoing cardiovascular and cerebrovascular interventional therapy, interventional nursing intervention effectively improved the patient’s clinical efficacy, reduced the incidence of complications, reduced negative emotions, improved the quality of life, and increased nursing satisfaction.

Gamma-glutamyl transferase 5 overexpression in cerebrovascular endothelial cells improves brain pathology,cognition,and behavior in APP/PS1 mice

In patients with Alzheimer’s disease,gamma-glutamyl transferase 5(GGT5)expression has been observed to be downregulated in cerebrovascular endothelial cells.However,the functional role of GGT5 in the development of Alzheimer’s disease remains unclear.This study aimed to explore the effect of GGT5 on cognitive function and brain pathology in an APP/PS1 mouse model of Alzheimer’s disease,as well as the underlying mechanism.We observed a significant reduction in GGT5 expression in two in vitro models of Alzheimer’s disease(Aβ_(1-42)-treated hCMEC/D3 and bEnd.3 cells),as well as in the APP/PS1 mouse model.Additionally,injection of APP/PS1 mice with an adeno-associated virus encoding GGT5 enhanced hippocampal synaptic plasticity and mitigated cognitive deficits.Interestingly,increasing GGT5 expression in cerebrovascular endothelial cells reduced levels of both soluble and insoluble amyloid-βin the brains of APP/PS1 mice.This effect may be attributable to inhibition of the expression ofβ-site APP cleaving enzyme 1,which is mediated by nuclear factor-kappa B.Our findings demonstrate that GGT5 expression in cerebrovascular endothelial cells is inversely associated with Alzheimer’s disease pathogenesis,and that GGT5 upregulation mitigates cognitive deficits in APP/PS1 mice.These findings suggest that GGT5 expression in cerebrovascular endothelial cells is a potential therapeutic target and biomarker for Alzheimer’s disease.

Protective effects of catalpol on cardio-cerebrovascular diseases: A comprehensive review

Catalpol,an iridoid glucoside isolated from Rehmannia glutinosa,has gained attention due to its potential use in treating cardio-cerebrovascular diseases(CVDs).This extensive review delves into recent studies on catalpol's protective properties in relation to various CVDs,such as atherosclerosis,myocardial ischemia,infarction,cardiac hypertrophy,and heart failure.The review also explores the compound's anti-oxidant,anti-inflammatory,and anti-apoptotic characteristics,emphasizing the role of vital signaling pathways,including PGC-1a/TERT,PI3K/Akt,AMPK,Nrf2/HO-1,estrogen receptor(ER),Nox4/NF-kB,and GRP78/PERK.The article discusses emerging findings on catalpol's ability to alleviate diabetic cardiovascular complications,thrombosis,and other cardiovascular-related conditions.Although clinical studies specifically addressing catalpol's impact on CVDs are scarce,the compound's established safety and well-tolerated nature suggest that it could be a valuable treatment alternative for CVD patients.Further investigation into catalpol and related iridoid derivatives may unveil new opportunities for devising natural and efficacious CVD therapies.

Mg alloy cardio-/cerebrovascular scaffolds: Developments and prospects

Vascular scaffolds are one of the important application fields of biodegradable Mg alloys, and related research has been carried out for more than 20 years. In recent years, the application expansion of Mg alloy vascular scaffolds has brought new challenges to the research of related fields. This review focuses on the relevant advances in the field of Mg alloys for both cardio-/cerebrovascular scaffolds. The frequently investigated alloy series for vascular scaffolds were reviewed. The bottleneck of processing of Mg alloy minitubes was elucidated.The idea of functionalized surface modification was also pointed out in this review, and the authors put forward guidelines based on research experience in terms of scaffold structural design and degradation behavior evaluation. Finally, suggestions for further research directions of Mg alloy vascular scaffolds were provided.

Spontaneous Heparin-Induced Thrombocytopenia Presenting as Concomitant Bilateral Cerebrovascular Infarction and Acute Coronary Syndrome

Background:Spontaneous heparin-induced thrombocytopenia is a pro-thrombotic syndrome in which anti-heparin antibodies develop without heparin exposure.Case presentation:A 78-year-old man who underwent a successful lumbar laminectomy presented to the hospital 5 days after discharge for stroke-like symptoms and was found to have acute infarcts of the bilateral frontal lobes.The patient was found to be severely thrombocytopenic and was incidentally found to have an inferior wall myocardial infarction.Further investigation led to the diagnosis of bilateral lower extremity deep vein thromboses.His overall clinical presentation prompted a detailed hematologic workup that indicated positivity for heparin-induced thrombocy-topenia despite no previous exposure to heparin products.Conclusions:This case illustrates a patient with no prior lifetime heparin exposure who underwent laminectomy with subsequent development of acute infarcts of the bilateral frontal lobes,an inferior wall myocardial infarction,and bilateral lower extremity deep vein thromboses,with concern for sequelae of spontaneous heparin-induced thrombo-cytopenia.

Stroke (Cerebrovascular Accident): Epidemiological, Clinical and Evolving Aspects in the Internal Medicine Department of the Public Health Establishment 1 (EPS1) of Tivaouane

Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.

肉苁蓉的药理作用及其在中枢神经系统疾病中的研究进展

肉苁蓉(Cistanches)是列当科植物肉苁蓉的肉质茎,又名金笋、地精、大芸。肉苁蓉的提取物主要包括肉苁蓉总苷、苯乙醇苷类、环烯醚萜类、挥发性成分、木脂素类、多糖、生物碱等。肉苁蓉的传统中药作用有补肾壮阳、润肠通便、女子不孕、滋补强身等;现代药理作用包括抗氧化、抗凋亡、调控自噬、增强体力和抗疲劳、改善学习认知功能。相关研究表明肉苁蓉对中枢神经系统疾病具有良好的治疗效果。脑缺血再灌注损伤(Cerebral ischemia reperfusion injury,CIRI)发生常伴随着脑水肿、血脑屏障的破坏、神经炎症、神经元凋亡,肉苁蓉提取物肉苁蓉总苷可抑制神经细胞炎症及凋亡,减少脑梗死面积,对CIRI模型大鼠具有神经保护作用。肉苁蓉通过减少自由基堆积、抑制氧化应激和炎症反应,提高阿尔茨海默病(Alzheimer’s disease,AD)和血管性痴呆(Vascular dementia,Va D)模型大鼠的学习记忆能力。肉苁蓉可以改善帕金森病(Parkinson’s disease,PD)小鼠运动行为异常,发挥神经保护作用。肉苁蓉能够抑制肌萎缩侧索硬化症(Amyotrophic lateral sclerosis,ALS)兴奋性氨基酸的水平,减轻神经毒性作用,改变星形胶质细胞功能,提高神经细胞存活率。目前肉苁蓉对于中枢神经系统疾病的应用越来越广泛,就其药理作用及其在中枢神经系统疾病中的研究进展进行综述,以期为肉苁蓉的开发和利用提供新的思路。

脑血管疾病风险人群湿证相关特征的流行病学调查

【目的】探究广东地区脑血管疾病风险人群与中医湿证相关的流行病学特征。【方法】采用横断面研究的方法,调查330例广东常住居民脑血管疾病风险相关的临床资料,进行中医湿证诊断、量化评分及脑卒中风险评级,总结湿证分布规律并分析其影响因素。【结果】(1)诊断为湿证的研究对象共306例(占92.73%),风险组诊断为湿证人群的占比为93.82%(258/275),略高于健康组的87.27%(48/55),但差异无统计学意义(χ2=2.91,P=0.112),而风险组的湿证量化得分高于健康组,差异有统计学意义(Z=-2.24,P=0.025)。(2)在具有脑血管疾病危险因素的研究对象中,评价时间(χ2=26.11,P=0.001)、脑卒中风险等级(χ2=8.85,P=0.031)、脑卒中或短暂性脑缺血发作(TIA)病史(χ2=9.28,P=0.015)是脑血管病风险人群湿证等级的影响因素。【结论】湿证是广东地区人群常见的中医证候;具有脑血管疾病危险因素,尤其是脑卒中高风险人群、脑卒中或TIA病史患者,其湿证程度明显增高;未来在广东开展脑卒中预防工作应考虑湿证的评估与干预。

脑神经血管功能体系及其评估方法的展望

人脑具有极为精妙的神经血管功能体系以满足脑细胞对能量代谢刻不容缓的需求。然而,现有的仪器设备仅能探测单一的神经血管功能,导致碎片化认知,许多与神经血管疾病相关的科学问题悬而未决。本文旨在回顾在面对重大疾病时脑血流自动调节功能、脑血管反应性功能、神经血管耦联功能以及自主神经功能等神经血管功能所扮演的角色,并探讨多功能、多范式、高分辨率的人体多模态跨尺度神经血管功能测量系统的可行性,为深入研究脑血管病及神经退行性疾病等重大神经血管疾病的新理论和新机制提供科学工具。

多元化教学模式在缺血性脑血管病介入进修医师培训中的应用探索

目的 探讨多元化教学模式在提高缺血性脑血管病介入诊疗进修医师培训质量和效率方面的应用。方法 选择2018年1月-2022年12月在南京大学医学院附属鼓楼医院神经内科接受脑血管介入培训的进修医师为研究对象,应用多元化教学模式,即将多种教学方法融合交叉的培训模式进行教学。采用问卷调查的形式对进修医师满意度及其在培训前后介入诊疗理论知识和实践操作能力进行评估。结果 共纳入55名进修医师,年龄32~50岁,其中男性51名(92.73%)。89.09%的进修医师对多元化教学模式非常满意;分别有83.64%和85.45%的进修医师认为多元化教学模式激发了学习兴趣和自主学习能力。经过多元化教学模式培训后,能够独立完成颅外支架置入治疗的进修医师显著增加(41.82%vs. 12.73%,P=0.002)。结论 多元化教学模式是提高缺血性脑血管病介入进修医师培训质量和效率的有效手段。

经头颈部CTA联合三维重建技术用于脑血管疾病动脉狭窄的诊断价值

目的分析经头颈部CT血管造影(CTA)联合三维重建技术对脑血管疾病的特点及对脑血管疾病动脉狭窄的诊断作用。方法选择我院在2021年8月至2022年8月期间收治的脑血管疾病动脉狭窄患者118例进行观察,所有患者均进行经头颈部CTA检查,将获取的图像,完成最大密度投影和血管三维重建,将数字减影血管造影(DSA)检查结果作为“金标准”,分析经头颈部CTA联合三维重建的诊断特点,对脑血管疾病动脉狭窄患者的诊断价值。结果以DSA检查结果作为“金标准”,经头颈部CTA联合三维重建技术对脑血管动脉狭窄患者的灵敏度、特异度、准确率、阳性及阴性预测值更高,118例脑血管动脉狭窄患者显示982条血管,经头颈部CTA联合三维重建技术与DSA检查的符合率为86.97%(854/982),118例脑血管动脉狭窄患者显示颅内侧支动脉1422条,经头颈部CTA联合三维重建技术与DSA检查的符合率为97.54%(1387/1422)。结论针对脑血管疾病动脉狭窄患者,以经头颈部CTA联合三维重建技术进行检查,对患者血管病变的分布情况、动脉狭窄程度的检查效果较好,能够有效分辨患者侧支循环等级,为后续的治疗提供参考依据。

微信辅助的案例教学法在脑血管病临床实习带教中的应用效果

目的探讨微信辅助的案例教学法在脑血管病临床实习带教中的应用效果。方法选择2022年9月至12月于苏州大学附属第二医院神经内科实习的80名实习生作为研究对象,按照随机数字表法分为观察组和对照组,每组各40名。观察组采用微信辅助的案例教学法,对照组采用传统教学法。评估两组学生的考核成绩,综合素质和教学满意度。结果观察组的理论知识成绩、实践技能成绩和综合素质评分均高于对照组,差异有统计学意义(P<0.05)。同时,观察组教学满意度高于对照组,差异有统计学意义(P<0.05)。结论微信辅助的案例教学法在神经内科脑血管病临床实习带教中具有良好的应用效果,该方法值得在神经内科临床实习教学中推广应用。

脉血康胶囊(肠溶片)治疗心脑血管疾病临床应用专家共识

脉血康胶囊(肠溶片)治疗心脑血管疾病具有良好的临床疗效及安全性。在临床医生问卷调查和脉血康胶囊(肠溶片)研究文献系统回顾的基础上,采用国际临床医学专家共识研制方法,基于现有最佳证据,充分结合专家经验,遵循“循证为主,共识为辅,经验为鉴”的原则,国内26位中西医临床、药学、方法学等多学科专家共同研制该共识,旨在进一步提高临床医生对该药的认识,更好地指导其临床合理用药。共识采用国际公认的证据分级推荐标准即评估、发展和评价建议的分级(Grading of Recommendations Assessment,Development and Evaluation,GRADE分级),如果证据充分则形成“推荐意见”,采用GRADE网格计票规则;如果证据不充分,则形成“共识建议”,采用多数计票规则。共识对脉血康胶囊(肠溶片)用于心脑血管疾病的适应证、用法用量、疗程、禁忌证、合并用药进行了推荐或建议,并完善了安全性信息,为其临床的合理使用提供参考。