Acupuncture Treatment of Depressive Syndromes after Cerebral Vascular Accidents

Depressive syndrome is a common complication in cerebral vascular accidents (CVA), which accounts for 70% of the complications. A mild case of the syndrome is marked by grief, sleeping disturbance, weakened mental activities, worry, loss of interest, and irritability. A severe case may have worse symptoms and signs, except the above mentioned ones, such as anxiety, reduced appetite, hallucination, delusion, desperation, etc. The author has adopted acupuncture to treat depressive syndromes after CVA with good therapeutic result as reported in the following.

Treating Cerebral Vascular Diseasewith Rational Medication of IntegrativeChinese and Western Medicine

Cerebral vascular disease(CVD)also called thecerebral stroke or windstroke.There are twocommon types in clinic,that is,thrombotic CVDand hemorrhagic CVD.CVD has both a high incidence rate and a high mor-tality rate.It has become

Cerebral vascular disorder

209527 Transvenous embolization of cavernous sinus dural arteriovenous fistulaes/Liu Lian(刘恋, Beijing Neurosurg Inst,Cap Univ Med Sci,Beijing 100050)…∥Chin J Neurosurg. -2009,25(8). -695

Enlarged perivascular spaces and lacunar infarction Cerebral magnetic resonance evaluation

BACKGROUND： Previous studies have demonstrated that enlarged perivascular spaces （EPVS） are a result of microvascular disease. To date, there are few reports about the relationship between EPVS and lacunar infarction. OBJECTIVE： To investigate whether EPVS is associated with lacunar infarction on the basis of cerebral magnetic resonance （MR） examination, clinical symptoms and signs, and past medical history of patients. DESIGN, TIME AND SETTING： Case contrast analysis was performed at the Department of Neurology, Shanghai Ninth People＇s Hospital from January 2007 to January 2008. PARTICIPANTS： Sixty-eight patients with lacunar infarction were admitted to the Department of Neurology of Shanghai Ninth People＇s Hospital, including 37 cases with first-ever infarction, and 31 with infarction recurrence. In addition, 53 healthy people were selected as controls. METHODS： All participants underwent past medical history investigation, nervous system examination, and cranial MR. The subjects were assessed using the JMW rating scale to identify the EPVS grade. MAIN OUTCOME MEASURES： EPVS scores of patients and controls; risk factors for cerebral vascular disease in patients with first-ever or recurrence of lacunar infarction. RESULTS： The EPVS grade from lacunar infarction patients was significantly higher than of the control group （P 〈 0.05）. The EPVS grade in patients with recurring lacunar infarction was significantly higher than in patients with first-ever infarction （P 〈 0.05）. In addition, hypertension incidence in patients with recurring lacunar infarction was significantly higher than in patients with first-ever infarction （P 〈 0.05）. CONCLUSION： Results indicate that EPVS is related to the incidence of lacunar infarction. Earlier screening of EPVS, and the evaluation of EPVS severity, is of great importance to control the risk factors for cerebral vascular disease and to prevent lacunar infarction.

THROMBOLYTIC THERAPY FOR ACUTE CEREBRAL VASCULAR OCCLUSION

Superselective intra-arterial thrombolytic therapy with urokinase infusion was effective in 10 patients with acute cerebral vascular occlusion. PATIENTS AND METHODS In the 10 patients, 8 were men and 2 women. Their age ranged from 34 to 70 years.

Vascular endothelial growth factor induced angiogenesis following focal cerebral ischemia/reperfusion injury in rabbits

BACKGROUND： Therapeutic angiogenesis has opened up new pathway for the treatment of ischemic cerebrovascular disease in recent years. The exploration of the effect of vascular endothelial growth factor （VEGF） on inducing angiogenesis following ischemia/reperfusion injury can provide better help for the long-term treatment of cerebrovascular disease in clinic. OBJECTIVE： To observe the effect of VEGF on inducing angiogenesis following focal cerebral ischemia /reperfusion injury in rabbits through the angiogenesis of microvessels reflected by the expression of the factors of vascular pseudohemophilia. DESIGN： A randomized controlled animal tria SETTNG： Department of Medical Imaging, Second Hospital of Hebei Medical University MATERIALS： Sixty-five healthy male New Zealand rabbits of clean degree, weighing （2.6±0.2） kg, aged 4.5-5 months, were used. The polyclonal antibody against vascular pseudohemophilia （Beijing Zhongshan Company）, recombinant VEGF165 （Peprotech Company, USA）, biotinylated second antibody and ABC compound （Wuhan Boster Company） were applied. METHODS： The experiments were carried out in the Laboratory of Neuromolecular Imaging and Neuropathy, Second Hospital of Hebei Medical University from May to August in 2005. （1） The rabbits were randomly divided into three groups： sham-operated group （n=15）, control group （n=25） and VEGF-treated group （n=-25）. In the control group and VEGF-treated group, models were established by middle cerebral artery occlusion （MCAO） induced focal cerebral ischemia/reperfusion. In the VEGF-treated group, VEGF165 （2.5 mg/L） was stereotactically injected into the surrounding regions of the infarcted sites immediately after the 2-hour ischemia/reperfusion; Saline of the same dosage was injected in the control group. But the rabbits in the sham-operated group were only drilled but not administrated. （2） The experimental indexes were observed on the 3^rd 7^th, 14^th, 28^th and 70^th days of the experiment respectively, 3 rabbits in the sham-operated group and 5 in the control group and VEGF-treated group were observed at each time point. The brain tissues in the surrounding regions of the infarcted sites were collected. The positive expressions of the factors of vascular pseudohemophilia in vascular endothelial cells were analyzed with immunohistochemical method. The microvessels in unit statistical field were counted with the imaging analytical software. MAIN OUTCOME MEASURES： The changes of microvascular density in the brain tissue and the positive expressions of the factors of vascular pseudohemophilia in the surrounding regions of the infarcted sites were observed on the 3^rd 7^th, 14^th, 28^th and 70^th days of the experiment. RESULTS： All the 65 New Zealand rabbits were involved in the analysis of results without deletion. Changes of the number of microvessels at different time points in each group： There were no obvious changes at different time points in the sham-operated group. The numbers of microvessels at 7 and 14 days were obviously more in the control group than in the sham-operated group [（6.0±1.1）, （9.0±0.9） microvessels; （3.0±1.1）, （3.0±1.1） microvessels; P〈 0.05-0.01], and those at 3, 7, 14 and 28 days were obviously more in the VEGF-treated group than in the control group [（8.3±2.0）, （13.4±1.4）, （15.5±2.3）, （6.8± 1.0） microvessels; （3.4±0.6）, （6.0±1.1）, （9.0±0.9）, （3.2±0.8） microvessels; P 〈 0.01]. （2） Positive expressions of the factors of vascular pseudohemophilia in the surrounding regions of infarcted sites： There were no obvious changes at different time points in the sham-operated group. In the control group, the changing law of the expressions was the same as that for the number of microvessels that the expression began to mildly increase at 7 days, reached the peak value at 14 days, and began to reduce at 28 days. In the VEGF-treated group, the expression was obviously increased at 3 days, also reached the peak value at 14 days, and reduced to the normal level at 70 days, but the expressions were obviously stronger than those in the control group at the same time points. CONCLUSION： Angiogenesis can be obviously induced in rabbits after the focal cerebral ischemia/reperfusion injury is treated with VEGF for 18 days.

EFFECT OF ELECTROACUPUNCTURE ON CEREBRAL BLOOD FLOW, VIP AND ET IN RATS WITH VASCULAR DEMENTIA

Objective: To investigate the relationship between electroacupuncture (EA)-induced improvement of regional cerebral blood flow and the alternations of vasoactive intestinal peptide (VIP) and endothelin (ET) in rats with experimental vascular dementia (VD). Methods: 40 Wistar rats were evenly randomized into sham-operation, model, medication (Nimotone) and EA groups. Vascular dementia model was established by repeated cerebral ischemia-reperfusion which was induced by occlusion and reopen of the bilateral common carotid arteries. EA (2～200 Hz, 2～3 mA) was applied to "Baihui"(GV 20), "Dazhui"(GV 14) and "Zusanli"(ST 36) for 30 min, once daily and continuously for 15 days. The regional cerebral blood flow (rCBF) in parietal lobe and hippocampus was determined with method of hydrogen clearance; a step-down avoidance test was adopted to observe the rats’ behavior change; and plasma VIP and ET contents were assayed by radioimmunoassay. Results: In comparison with sham-operation group, the correct rate of step-down avoidance test, rCBF in parietal lobe and hippocampus and plasma VIP level in VD model group lowered significantly (P<0.01) and plasma ET increased considerably (P<0.01). However, compared with model group, the correct rate of step-down avoidance test, rCBF values and plasma VIP in EA group raised obviously while plasma ET declined significantly. No significant differences were found between EA and medication groups in the 4 indexes. Conclusion: EA can raise rCBF in the parietal lobe and hippocampus, elevate plasma VIP level and reduce plasma ET in rats with VD.

A Study on the Correlation Between Cerebral Small Vascular Disease and Constitution Types of Traditional Chinese Medicine

Objective:To study the correlation between cerebral small vascular disease and constitution types of Traditional Chinese Medicine(TCM).Methods:The severity of lacunar infarction and leukoaraiosis were graded in 230 patients with cerebral small vascular disease,and they were divided into TCM constitution types.The survey of TCM constitution types was carried out by using standardized TCM constitution scale,and order multivariate Logistic regression was used to analyze the correlation between TCM constitution types with severity of lacunar infarction and leukoaraiosis.Results:Yang-deficiency(阳虚)constitution,blood-stasis constitution and phlegm-dampness constitution were the most common TCM constitution types in patients with lacunar infarction,accounting for 33.7%,12.5%,11.5%respectively.Yang-deficiency constitution,blood-stasis constitution and Yin-deficiency(阴虚)constitution were the most common TCM constitution types in patients with leukoaraiosis,accounting for 28.8%,18.5%,13.7%respectively.There were significant differences in lacunar infarction of Yang-deficiency constitution and blood stasis constitution(P<0.05),and there were significant differences in leukoaraiosis of phlegmdampness constitution and blood-stasis constitution(P<0.05).Single factor analysis showed that the main risk factors of lacunar infarction were age,smoking,alcohol consumption,Yang-deficiency constitution and blood-stasis constitution,and the main risk factors of leukoaraiosis were age,smoking,hypertensive disease,phlegm-dampness constitution and blood-stasis constitution.The ordered multivariate Logistic regression analysis found that the severity of lacunar infarction was closely related to age,and the severity of leukoplosis was closely related to age,smoking and hypertension disease.Conclusion:TCM constitution types of lacunar infarction in patients with small cerebral vascular disease is mainly Yang-deficiency constitution and blood-stasis constitution,and the risk factors include age,smoking,alcohol consumption,Yang-deficiency constitution and blood-stasis constitution.Age is closely related with lacunar infarction.TCM constitution types with leukoaraiosis are mainly phlegm-dampness constitution and blood-stasis constitution,and the risk factors are age,smoking,hypertension disease,phlegm-dampness constitution and blood-stasis constitution.Age,smoking and hypertension disease are closely related with leukoaraiosis.

The potential mechanism and clinical application value of remote ischemic conditioning in stroke

Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.

Vitamin D deficiency and increased inflammatory factor intercellular cell adhesion molecule-1 indicate severe leukoaraiosis in northern China

Background and objective:Commonly plaguing in the frigid zone of the world,vitamin D deficiency,as indicated by low levels of 25-hydroxyvitamin D,exacerbated inflammatory responses and impaired endothelial function.Leukoaraiosis(LA)is a prevalent cause of cognitive dysfunction in the elderly and is potentially associated with inflammatory responses.This study aimed to investigate the impact of vitamin D on the severity of LA.Methods:Patients with LA were categorized based on 3.0 T brain MRI findings into mild(N=43),moderate(N=40),or severe groups(N=29)using the Fazekas scale(scoring 1-6).A control group consisting of 41 healthy individuals was included.Serum fibrinogen C,homocysteine,plasma 25-hydroxyvitamin D,and intercellular cell adhesion molecule-1(ICAM-1)levels were measured using ELISA.Results:All LA severity groups exhibited lower plasma 25-hydroxyvitamin D levels compared to the control group,with a more pronounced decrease observed as LA severity increased.Low plasma 25-hydroxyvitamin D was identified as an independent risk factor for LA(P<0.05)according to Multiple logistic regression analysis.Additionally,a negative association was observed between 25-hydroxyvitamin D and vascular inflammatory factor ICAM-1.Conclusions:Disease severity positively correlated with levels of the inflammatory marker ICAM-1,worsening as plasma 25-hydroxyvitamin D concentration decreased.Low 25-hydroxyvitamin D emerged as an independent risk factor for LA,potentially exacerbating the inflammatory response.These findings suggest 25-hydroxyvitamin D supplementation as a potential therapeutic approach for LA.

Effect of Electromagnetic Pulse Exposure on Brain Micro Vascular Permeability in Rats

Objective To observe the effect of electromagnetic pulse (EMP) exposure on cerebral micro vascular permeability in rats. Methods The whole-body of male Sprague-Dawley rats were exposed or sham exposed to 200 pulses or 400 pulses (1 Hz) of EMP at 200 kV/m. At 0.5, 1, 3, 6, and 12 h after EMP exposure, the permeability of cerebral micro vascular was detected by transmission electron microscopy and immunohistochemistry using lanthanum nitrate and endogenous albumin as vascular tracers, respectively. Results The lanthanum nitrate tracer was limited to the micro vascular lumen with no lanthanum nitrate or albumin tracer extravasation in control rat brain. After EMP exposure, the lanthanum nitrate ions reached the tight junction, basal lamina and pericapillary tissue. Similarly, the albumin immunopositive staining was identified in pericapillary tissue. The changes in brain micro vascular permeability were transient, the leakage of micro vascular vessels appeared at 1 h, and reached its peak at 3 h, and nearly recovered at 12 h, after EMP exposure. In addition, the leakage of micro vascular was more obvious after exposure of EMP at 400 pulses than after exposure of EMP at 200 pulses. Conclusion Exposure to 200 and 400 pulses (1 Hz) of EMP at 200 kV/m can increase cerebral micro vascular permeability in rats, which is recoverable.

Impact of Strokes: The Burden of Care, Post-CVA Fatigue & Caregiver Role Strain

Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke victims experience motor, cognitive, emotional, and psycho-social deficits and their caregivers may not be prepared for these abrupt life altering effects. The impact for caregivers, factors impacting strokes, and solutions for care will be addressed in the paper. Evidence suggests that post fatigue stroke (PFS) may be triggered by a dysfunction of the stress system. Family caregivers with a low level of social engagement may be more likely to perceived stress, and increased risk for caregiver role strain.

Distribution of ApoE Gene Polymorphism and Significance of Auxiliary Diagnosis and Treatment of Cerebrovascular Diseases(Intracerebral Hemorrhage and Cerebral Thrombosis) in the Longyan Area

Objective:To make statistics on the distribution of ApoE gene polymorphism in the Longyan area,provide data for the statistics of regional cerebrovascular diseases,explore the significance of ApoE gene polymorphism distribution for clinical guidance,diagnosis and treatment,and provide more suggestions for clinical diagnosis and treatment of cerebrovascular diseases.Methods:800 patients with cerebrovascular disease in the Longyan area from July 2018 to April 2021 were selected as the research object,and 800 normal healthy patients were selected as the control group.The data were further analyzed according to the collected patient information,and the patients were distinguished according to age and other basic information,the type of cerebrovascular disease,ApoE gene polymorphism and blood lipid test results.The distribution of ApoE gene polymorphism in the cerebrovascular disease population in the Longyan area was given to determine the correlation between the incidence of cerebrovascular disease and the distribution of ApoE gene polymorphism.Results:In the study group,E2/E3 genotyping was the most common 400(50.00%),and E4/E4 genotyping 6(0.75%)was the least common;In the control group,E2/E4 genotyping was the most common 480(60.00%),and E2/E3 genotyping accounted for the second 290(36.25%).In the study group,E3 allele was the most common 383(47.88%),E4 allele 121(15.12%);in the control group,E2 allele was the most common391(48.88%),and E3 allele 142(17.75%).Conclusion:According to the statistics of ApoE gene polymorphism distribution in the Longyan area and the analysis of the correlation of other cerebrovascular diseases,it is found that E2/E3 genotype may be related to cerebrovascular diseases,and E3 allele may be a susceptibility factor.Through the above analysis,the occurrence of diseases can be predicted and prevented.

MRI Features and Site-specific Factors of Ischemic Changes in White Matter： A Retrospective Study

Brain magnetic resonance imaging （MRI） of the elderly often reveals white matter changes （WMCs） with substantial variability across individuals. Our study was designed to explore MRI features and site-specific factors of ischemic WMCs. Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed. Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations. Analyses of variance （ANOVAs） were used to detect regionally specific differences in lesions. We found that lesion distribution differed significantly across five cerebral areas, with lesions being predominant in the frontal lobe and parieto-occipital area. To explore WMCs risk factors, after adjusting for gender, diabetes mellitus, and hypertension, only age （P〈0.01）, creatinine （P=0.01）, alkaline phosphatase （ALP） （P=0.01） and low-density lipoprotein cholesterol （LDL-C） （P=0.03） were found to be independently associated with severe WMCs. Age （P〈0.001） was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia （P=0.048） or infratentorial area （P=0.016）. In conclusion, MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area. The infratentorial area was least affected by WMCs. Typically, age-related WMCs were observed in the frontal lobes, while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.

Magnetic resonance imaging and cell-based neurorestorative therapy after brain injury

Restorative cell-based therapies for experimental brain injury, such as stroke and traumatic brain injury,substantially improve functional outcome. We discuss and review state of the art magnetic resonance imaging methodologies and their applications related to cell-based treatment after brain injury. We focus on the potential of magnetic resonance imaging technique and its associated challenges to obtain useful new information related to cell migration, distribution, and quantitation, as well as vascular and neuronal remodeling in response to cell-based therapy after brain injury. The noninvasive nature of imaging might more readily help with translation of cell-based therapy from the laboratory to the clinic.

Effect of Chinese Patent Medicine Naodesheng against Repeated Transient Global Cerebral Ischemia in Mice

Objective To investigate the therapeutic effect and possible mechanisms of Chinese ptent medicine Naodesheng（NDS） on repeated transient global cerebral ischemia（GCI） in mice. Methods The repeated transient GCI mice were induced by bilateral carotid arteries ligation, and were randomly divided into model group, Sham group without arteries ligation, NDS groups（1.25 and 2.5 g/kg） and positive control（vinpocetine 3.1 mg/kg, VP） group. After oral administration once daily for successive 7 d, the transient GCI was induced. The degree of neurological deficit, histological changes, and neurons loss in the hippocampus were evaluated. In order to investigate the possible mechanisms, the oxidative stress and inflammatory factor were measured after 24 h of GCI. Comparison among multiple groups was performed with one-way analysis of variance（ANOVA）. Results NDS could significantly alleviate the neurological function impairment, histological injury, and neurons loss, increase the superoxide dismutase（SOD） activity, decrease the content of malondialdehyde（MDA）, and reduce inflammatory factor in the ischemic brain tissue. Conclusion NDS could significantly reduce brain injury induced by global ischemia, and its mechanism is closely associated with anti-oxidation and anti-inflammation.

Comparison of Clinical Characteristics and Outcomes of MAFLD and NAFLD in Chinese Health Examination Populations

Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.