Stroke:Evolution of newer treatment modalities for acute ischemic stroke

Acute ischemic stroke is one of the leading causes of morbidity and mortality worldwide.Restoration of cerebral blood flow to affected ischemic areas has been the cornerstone of therapy for patients for eligible patients as early diagnosis and treatment have shown improved outcomes.However,there has been a paradigm shift in the management approach over the last decade,and with the emphasis currently directed toward including newer modalities such as neuroprotection,stem cell treatment,magnetic stimulation,anti-apoptotic drugs,delayed recanali-zation,and utilization of artificial intelligence for early diagnosis and suggesting algorithm-based management protocols.

Epigenetic regulation of the inflammatory response in stroke

Stroke is classified as ischemic or hemorrhagic,and there are few effective treatments for either type.Immunologic mechanisms play a critical role in secondary brain injury following a stroke,which manifests as cytokine release,blood–brain barrier disruption,neuronal cell death,and ultimately behavioral impairment.Suppressing the inflammatory response has been shown to mitigate this cascade of events in experimental stroke models.However,in clinical trials of anti-inflammatory agents,longterm immunosuppression has not demonstrated significant clinical benefits for patients.This may be attributable to the dichotomous roles of inflammation in both tissue injury and repair,as well as the complex pathophysiologic inflammatory processes in stroke.Inhibiting acute harmful inflammatory responses or inducing a phenotypic shift from a pro-inflammatory to an anti-inflammatory state at specific time points after a stroke are alternative and promising therapeutic strategies.Identifying agents that can modulate inflammation requires a detailed understanding of the inflammatory processes of stroke.Furthermore,epigenetic reprogramming plays a crucial role in modulating post-stroke inflammation and can potentially be exploited for stroke management.In this review,we summarize current findings on the epigenetic regulation of the inflammatory response in stroke,focusing on key signaling pathways including nuclear factor-kappa B,Janus kinase/signal transducer and activator of transcription,and mitogen-activated protein kinase as well as inflammasome activation.We also discuss promising molecular targets for stroke treatment.The evidence to date indicates that therapeutic targeting of the epigenetic regulation of inflammation can shift the balance from inflammation-induced tissue injury to repair following stroke,leading to improved post-stroke outcomes.

Expert consensus on the diagnosis and treatment of heat stroke in China

Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.

Interpretations and comments for expert consensus on the diagnosis and treatment of heat stroke in China

Heat stroke is the most severe type of heat illness,it is often accompanied by severe multiorgan damage and has a high fatality rate.In January 2020,based on new research evidence and the experiences of Chinese experts in heat stroke,the Expert Group of Heat Stroke Prevention and Treatment of the Chinese People’s Liberation Army(PLA)and the Professional Committee of Critical Care Medicine of the Chinese PLA jointly issued a new Expert Consensus on the Diagnosis and Treatment of Heat Stroke in China.This article aims to interpret and supplement the major updates to the new consensus.

Research progress in rehabilitation treatment of stroke patients A bibliometric analysis

BACKGROUND： Stroke presents as a transient or chronic brain dysfunction and is associated with high morbidity and high mortality. The doctors and scientists would like to argue how to enhance the validity of the rehabilitation treatment and how to further improve the level of treatment on stroke. OBJECTIVE： The aim of this study was to quantitatively analyze the current worldwide progress in research on stroke rehabilitation treatment based on Web of Science database and CiinicalTrial.gov in the past 10 years. METHODS： We conducted a quantitative analysis of clinical trial articles regarding stroke rehabilitation published in English from 2003 to 2013 and indexed in the National Institutes of Health Clinical Trials registry and Web of Science databases. Data were downloaded on March 15, 2013. RESULTS： （1） From 2003 to 2013, 2 654 clinical trials investigating stroke were indexed in ClinicalTrials.gov. There were only 58 clinical trials registered in 2003, and there was a marked increase from 2005. A total of 605 clinical trials on the rehabilitation of stroke were conducted in the past 10 years. （2） The analysis showed that most of the trials in the field were registered by North American institutions. With respect to the Asian countries, China and Taiwan Region of China also published a reasonable proportion of the trials, but comparatively speaking, the number of trials is really rare. Most of the interventions were drugs, followed by the devices, and behavioral interventions were ranked third. （3） In the past 10 years, there were 4 052 studies on stroke indexed by Web of Science database. CONCLUSION： From perspective of research progress, we found that the number of clinical trials and papers on stroke rehabilitation has increased significantly in the past 10 years, between them a remarkable positive correlation exists.

Vein transplantation using human umbilical cord blood stem cells in the treatment of stroke sequela

BACKGROUND: Transplanted mononuclear cell (MNC) of umbilical blood can survive in central nervous system (CNS) of host through blood brain barrier, differentiate into nerve cells, migrate to damaged site and integrate morphological structure and function with nerve cells of host so as to improve deficiencies of sensatory function, motor function and cognitive function and influence on stroke sequela. OBJECTIVE: To observe the vein transplantation of human umbilical cord blood stem cells (HUCBSC) for improving neurological function, limb function and activity of daily living of patients with stroke and evaluate the reliability. DESIGN: Self-controlled study. SETTING: Department of Neurosurgery, the Second People's Hospital of Zhengzhou City; Red-crossed Blood Center of Henan Province; Department of Neurosurgery, the Fist Affiliated Hospital of Zhengzhou University. PARTICIPANTS: A total of 10 patients with stroke sequela were selected from Department of Cerebral Surgery, the Second People's Hospital of Zhengzhou City from April to December 2005. There were 9 males and 1 female aged from 35 to 75 years with the mean age of 56 years. All of them were diagnosed with CT and MRI examination and coincidence with diagnostic criteria of stroke established by the Fourth National Academic Meeting for Cerebrovascular Disease. All patients provided informed consent. METHODS: 80-140 mL umbilical blood of term birth of newborn was selected hermetically and maintained in sterile plastic bag. And then, the blood was centrifugated at the speed of 1 500 r/min for 30 minutes at 22 ℃ in order to separate MNC, i.e., HUCBSC. In addition, after final diagnosis during hospitalization, stroke patients were perfused with HUCBSC through superficial vein of back of the hand. Each patient was averagely perfused with 6 portions of HUCBSC (cellular numbers ≥ 1×108/portion) and the interval between each portion was 1-7 days with the mean interval of 4 days. MAIN OUTCOME MEASURES: ① Neurological function of stroke patients was evaluated with neurological function deficiency (NFD) before treatment and at 3 months after treatment. The scale includes consciousness, level fix function, facial paralysis, language, muscle force of upper limbs, muscle force of lower limb and step function. The total scores ranged from 0 to 45; meanwhile, the lower the scores were, the better the neurological function was. ② Motor function of injured limbs was evaluated with Fugl-Meyer Assessment (FMA), including motor function of upper limbs, motor function of lower limbs, balance ability, sensory function and motion of joint. The total scores ranged from 0 to 226; meanwhile, the higher the scores were, the better the motor function of limbs was. ③ Activities of daily living (ADL) was evaluated with Barthel Index (BI), including having meals, taking a bath, dressing oneself, putting on clothes, walking in balance and stair activity. The total scores ranged from 0 to 100; meanwhile, the higher the scores were, the stronger the ADL was. RESULTS: A total of 10 patients were involved in the final analysis. After treatment, NFD of stroke patients was (10.9±5.09) points, which was lower than that before treatment [(25.4±6.09) points, t =8.213, P < 0.01]. In addition, after treatment, FMA and BI of stroke patients were (80.9±25.00) points and (81.1±15.93) points, respectively, which were higher than those before treatment [(31.9±21.85) points, (36.2±19.41) points, t =13.024, 13.670, P < 0.01]. Immuno-suppressive drugs were not used during the whole therapeutic procedure; moreover, immunological rejection and allergic reaction were not observed during the same period. CONCLUSION: Transplanting HUCBSC through superficial vein of back of the hand is regarded as a simple and safe method for the treatment of stroke sequela.

Advances in minimally invasive treatment of hemorrhagic and ischemic stroke

Cerebrovascular diseases,including ischemic and hemorrhagic strokes,affect more than 6 million US adults annually.Strokes cause high rates of morbidity and mortality due to the central nervous system’s sensitivity to disruptions in blood flow,and are refractory to traditional surgical interventions.A variety of minimally invasive surgical and endovascular approaches have recently been developed to improve patient outcomes following stroke.

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

Ferroptosis:a potential therapeutic target for stroke

Ferroptosis is a form of regulated cell death characterized by massive iron accumulation and iron-dependent lipid peroxidation,differing from apoptosis,necroptosis,and autophagy in several aspects.Ferroptosis is regarded as a critical mechanism of a series of pathophysiological reactions after stroke because of iron overload caused by hemoglobin degradation and iron metabolism imbalance.In this review,we discuss ferroptosis-related metabolisms,important molecules directly or indirectly targeting iron metabolism and lipid peroxidation,and transcriptional regulation of ferroptosis,revealing the role of ferroptosis in the progression of stroke.We present updated progress in the intervention of ferroptosis as therapeutic strategies for stroke in vivo and in vitro and summarize the effects of ferroptosis inhibitors on stroke.Our review facilitates further understanding of ferroptosis pathogenesis in stroke,proposes new targets for the treatment of stroke,and suggests that more efforts should be made to investigate the mechanism of ferroptosis in stroke.

China stroke surveillance report 2021

Since 2015,stroke has become the leading cause of death and disability in China,posing a significant threat to the health of its citizens as a major chronic non-communicable disease.According to the China Stroke High-risk Population Screening and Intervention Program,an estimated 17.8 million[95%confidence interval(CI)17.6–18.0million]adults in China had experienced a stroke in 2020,with 3.4 million(95%CI 3.3–3.5 million)experiencing their first-ever stroke and another 2.3 million(95%CI 2.2–2.4 million)dying as a result.Additionally,approximately 12.5%(95%CI 12.4%–12.5%)of stroke survivors were left disabled,as defined by a modified Rankin Scale score greater than 1,equating to 2.2 million(95%CI 2.1–2.2 million)stroke-related disabilities in 2020.As the population ages and the prevalence of risk factors like diabetes,hypertension,and hyperlipidemia continues to rise and remains poorly controlled,the burden of stroke in China is also increasing.A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%;the awareness,treatment,and control rates in hypertensive patients were:60.1%,42.5%,and 25.4%,respectively.A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%,suggesting there are 120 million adults with diabetes in China,and the awareness,treatment,and control rates in diabetic patients were:43.3%,49.0%,and 49.4%,respectively.The“Sixth National Health Service Statistical Survey Report in 2018”showed that the proportion of the obese population in China was 37.4%,an increase of 7.2 points from 2013.Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China(BOSC)showed that a total of 3,418,432 stroke cases[mean age±standard error(SE)was(65.700±0.006)years,and 59.1%were male]were admitted during 2020.Of those,over 80.0%(81.9%)were ischemic stroke(IS),14.9%were intracerebral hemorrhage(ICH)strokes,and 3.1%were subarachnoid hemorrhage(SAH)strokes.The mean±SE of hospitalization expenditures was Chinese Yuan(CNY)(16,975.6±16.3),ranging from(13,310.1±12.8)in IS to(81,369.8±260.7)in SAH,and out-of-pocket expenses were(5788.9±8.6),ranging from(4449.0±6.6)in IS to(30,778.2±156.8)in SAH.It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion,of which the patient pays approximately CNY 19.8 billion.In-hospital death/discharge against medical advice rate was 9.2%(95%CI 9.2%–9.2%),ranging from 6.4%(95%CI 6.4%–6.5%)for IS to 21.8%(95%CI 21.8%–21.9%)for ICH.From 2019 to 2020,the information about 188,648 patients with acute IS receiving intravenous thrombolytic therapy(IVT),49,845 patients receiving mechanical thrombectomy(MT),and 14,087 patients receiving bridging(IVT+MT)were collected through BOSC.The incidence of intracranial hemorrhage during treatment was 3.2%(95%CI 3.2%–3.3%),7.7%(95%CI 7.5%–8.0%),and 12.9%(95%CI 12.3%–13.4%),respectively.And in-hospital death/discharge against medical advice rate was 8.9%(95%CI 8.8%–9.0%),16.5%(95%CI 16.2%–16.9%),and 16.8%(95%CI 16.2%–17.4%),respectively.A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals(Level III)from 31 provinces in China through BOSC from January 2019to December 2020 and 136,282 stroke patients were included and finished 12-month follow-up.Of those,over 86.9%were IS,10.8%were ICH strokes,and 2.3%were SAH strokes.The disability rate[%(95%CI)]in survivors of stroke at 3-month and 12-month was 14.8%(95%CI 14.6%–15.0%)and 14.0%(95%CI 13.8%–14.2%),respectively.The mortality rate[%(95%CI)]of stroke at 3-month and 12-month was 4.2%(95%CI 4.1%–4.3%)and 8.5%(95%CI 8.4%–8.6%),respectively.The recurrence rate[%(95%CI)]of stroke at 3-month and 12-month was 3.6%(95%CI 3.5%–3.7%)and 5.6%(95%CI 5.4%–5.7%),respectively.The Healthy China 2030 Stroke Action Plan was launched as part of this review,and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.

Treatment of Sequelae of Wind Stroke by Acupuncture in Combination with Massage

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Possibilities of transcatheter treatment of patients after extensive ischemic stroke

The research investigates the efficacy of brain transcatheter laser revascularization in patients who have had extensive ischemic stroke. 1125 patients aged 29 - 81 (average age 75) with cerebral atherosclerosis were examined. The examination plan included: CT brain scan, magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA), laboratory tests, assessment of severity of dementia (CDR), cognitive impairment (MMSE) and activities of daily living (IB). 93 patients suffered extensive ischemic stroke of whom 7 (7.53%) had 10 - 15 IB points, 25 (26.88%)—20 - 30 IB points, 61 (65.59%)—35 - 45 IB points. 69 patients underwent transcatheter treatment (Test Group). 24 patients underwent conservative treatment (Control Group). High-energy laser systems were used for revascularization of major intracranial arteries;lowenergy laser systems were used for revascularization of distal intracranial branches. Test Group: 67 (97.10%) patients had good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization. 12 - 24 months later the following positive trend was observed: 14 (20.59%) patients demonstrated good clinical outcome (IB 90 - 100);26 (38.24%) patients had satisfactory clinical outcome (IB 75 - 85);28 (41.18%) patients showed relatively satisfactory clinical outcome (IB 60 - 70);relatively positive clinical outcome (IB < 60) was not obtained in any case. Control Group: 4 (16.67%) patients showed relatively satisfactory clinical outcome (IB 60 - 70), relatively positive clinical outcome (IB < 60) was achieved in 20 (83.33%) cases. Evaluating the data obtained, it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of extensive ischemic strokes. The effect is maintained for a long time;it causes regression of mental, intellectual and motor disorders, promotes regression of post-stroke dementia and significantly improves the quality of life, which makes it noticeably different from the conservative methods of treatment.

Sulindac for stroke treatment: neuroprotective mechanism and therapy

Sulindac, a widely used nonsteroidal anti-inflammatory drug （NSAID） is a prodrug that is reduced by methionine sulfoxide reductase to its active form as an inhibitor of cyclooxygenase 1 and 2. The drug has been shown to elicit tissue protection by processes that may include at least three functions： antioxidant, preconditioning and anti-inflammatory. Sulindac demonstrates neuroprotection that involves inhibition of mitochondrial calcium overload or a decrease in protein oxidation.

Treatment of Sequelae of Wind Stroke with Long Needle

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N-methyl-D-aspartate glutamate receptors (NMDARs) in stroke pathogenesis and treatments

N-methyl-D-aspartate glutamate receptors(NMDARs)play crucial roles in the pathogenesis of neuronal injuries following a stroke insult;therefore,a plethora of preclinical studies focus on better understanding functions of NMDARs and their associated signaling pathways.Over the past decades,NMDARs have been found to exert dual effects in neuronal deaths signaling and neuronal survival signaling during cerebral ischemia.Moreover,many complex intracellular signaling pathways downstream of NMDAR activation have been elucidated,which provide novel targets for developing much-needed neuro-protectants for patients with stroke.In this review,we will discuss the recent progress in understanding the underlying mechanisms of stroke related to NMDAR activation and the potential therapeutic strategies based on these discoveries.

Bidirectional Benign Regulation of Acupuncture in the Treatment of Stroke

Acupuncture is a traditional Chinese medicine therapy originated in China.In recent years,acupuncture is widely used in the field of neurological diseases,especially in the acute stage of stroke.Its mechanism of action is becoming clearer;one of the possible mechanisms is its bidirectional benign regulation.

Advances in the diagnosis and treatment of symptomatic intracranial atherosclerotic disease

Intracranial atherosclerotic disease(ICAD)manifests systemic atherosclerosis in the intra-cranial arterial bed.It is the most common risk factor for ischemic stroke in Chinese population,with symptomatic ICAD(sICAD)patients at higher stroke risk.Continuous cerebral hypoperfusion and hemodynamic decompensa-tion caused by arterial stenosis or occlusion are the main pathological mechanisms for stroke recurrence and cog-nitive impairment in sICAD patients.Despite receiving reinforced medical therapy,about 10%of sICAD patients still suffer stroke recurrence.Blood flow reconstruction techniques are not yet established as routine stroke pre-vention for sICAD due to complex perioperative com-plications.Limb remote ischemic conditioning(LRIC)can effectively reduce the incidence of ischemic stroke,and composite cerebrovascular diseases,and improve ce-rebral perfusion,brain metabolism,and cerebrovascular reserve(CVR)in sICAD patients,serving as a novel ther-apeutic strategy.However,the protective mechanisms of LRIC and the optimal treatment regimen for sICAD still require further exploration.Exploring imaging biomark-ers with high sensitivity and specificity for diagnosis is of great significance in evaluating and predicting stroke risk in sICAD patients.

脑卒中病人治疗负担现状及影响因素研究

目的:探讨脑卒中病人的治疗负担现状及影响因素。方法:采用便利抽样法,使用一般资料调查表、治疗负担量表、社会支持量表、全面健康素养量表对339例脑卒中病人进行问卷调查,运用Mann-Whitney U秩和检验/Kruskal-Wallis H秩和检验、Pearson相关分析、有序Logistic回归分析进行统计分析。结果:脑卒中病人治疗负担总分为(62.45±24.35)分,轻度治疗负担者132例,占38.9%;中度治疗负者163例,占48.1%;重度治疗负担者44例,占13.0%。有序Logistic回归分析显示,低龄[OR=3.387,95%CI(1.488,3.928)]、未婚[OR=9.412,95%CI(0.177,4.308)]、独居[OR=0.108,95%CI(−3.887,−0.560)]、社会支持[OR=0.934,95%CI(−0.107,−0.030)]、全面健康素养[OR=0.831,95%CI(−0.253,−0.117)]是脑卒中病人治疗负担的影响因素(P<0.05)。结论:脑卒中病人的治疗负担以中度治疗负担为主。应重点关注低龄、非独居、未婚、社会支持较低、全面健康素养较低的脑卒中病人。国家应加大医疗财政投入,加大脑卒中知识宣传,医护人员加强对病人进行针对性的健康教育,亲朋好友给予更多关心与支持,从而减轻脑卒中病人的治疗负担。

从肾脾论治缺血性脑卒中后功能障碍的中医机制探析及研究进展

缺血性脑卒中因其高发病率和病死率历来是临床防治重点,而抢救存活后的高致残率又严重影响患者生存质量。中医药在改善功能障碍、预防残疾方面具备天然优势,但现有缺血性脑卒中的中医康复尚缺乏精准理论指导,亟需深入研究。运动、认知、语言等功能恢复基于脑和脊髓中突触重塑,元神恢复、神机运转有赖先后天之精充盈髓海,借助中医髓理论,中西医学在卒中后功能恢复的治疗逻辑上达成共识。欲复髓海,肾脾所藏先后天之精首当其责,变生血、津液等精微物质,最终化髓充脑,以养元神。故而缺血性脑卒中患者的功能恢复宜重视调补肾脾,填精益髓,生液养髓,髓海得充,神机以复。当下临床治疗缺血性脑卒中多以益气活血、清热化瘀、养阴活血等法,少有人基于中医髓认知聚焦卒中后功能障碍的中医康复机制研究。因此,通过对中医典籍和历代名家医案的深入挖掘,基于肾脾全面地分析影响缺血性脑卒中急性期病情演进与恢复期功能恢复的多种因素,从病理指标与功能评价对从肾脾论治缺血性脑卒中方药的效果进行综合论述,系统呈现肾脾同补方药的研究进展,进而丰富缺血性脑卒中的中医治疗理论,并为探求缺血性脑卒中的康复治疗提供新思路。

中西医治疗脑卒中后肢体肌张力增高的临床研究进展

脑卒中是包含出血性和梗死性脑血管病等的临床综合症状,脑卒中后肢体肌张力升高是脑血管病患者最常见的并发症之一,常继发引起患者的身心损伤。目前临床中西医治疗脑卒中后肢体肌张力增高的方法多种多样,积极合理有效的治疗可大幅缓解患者症状,改善患者预后。本文就近几年中西医治疗脑卒中后肢体肌张力增高的研究进展进行综述。