Shuxuetong for Prevention of recurrence in Acute Cerebrovascular events with Embolism (SPACE) trial: rationale and design

Knowledge, attitudes, and practices of patients with hyperlipidemia towards stroke: a cross-sectional study

OBJECTIVE

With the rising incidence and mortality rates of stroke, understanding the knowledge, attitudes, and practices (KAP) of patients with hyperlipidemia towards stroke is crucial for improving their health management and preventing stroke. This study aimed to investigate the KAP of patients with hyperlipidemia towards stroke.

METHODS

A cross-sectional study was conducted at the First Hospital of Hebei Medical University between November 2, 2023, and December 31, 2023. Demographic information and KAP scores of the participants were collected via questionnaire administration.

RESULTS

In this study, a total of 385 patients diagnosed with hyperlipidemia were included. Among them, 211 (54.8%) were male, and 214 (55.6%) had been dealing with hyperlipidemia for less than one year. Multivariate analyses showed that age greater than or equal to 55 years (OR = 4.016, 95% CI: [2.128,7.579], p < .001) and attitude score greater than or equal to 21 (OR = 5.673, 95% CI: [3.432,9.376], p < .001) were independently associated with proactive practice. Mediation analysis showed that knowledge directly affected the attitude (β = 0.637, p = .010) and attitude directly affected the practice (β = 0.721, p = .010). Meanwhile, the direct effect of knowledge on practice was not significant (β = -0.059, p = .438), however, knowledge was found to indirectly affected practice through attitude (β = 0.459, p = .010).

CONCLUSION

Our study reveals that patients with hyperlipidemia exhibit a concerning gap in their understanding of stroke, despite holding positive attitudes and displaying suboptimal preventive practices.

Impacts of the Zero-Markup Drug Policy on Hospitalization Expenses of Patients with Stroke in Western China: An Interrupted Time Series Analysis

Background

In 2016, an innovative medical pricing reform called zero-markup drug policy (ZMDP) was implemented in selected pilot cities in China, which focuses on curbing the unreasonable growth of medical expenses. This study aimed to evaluate the impacts of ZMDP on medical expenditure of stroke in western China.

Methods

The quantitative data of inpatients diagnosed with stroke was extracted from the medical insurance system in 7 tertiary public hospitals. An interrupted time series (ITS) was used to analyze the instantaneous level and long-term trend changes of hospitalization expenses per visit from January 2015 to November 2018.

Results

A total of 22,407 stroke inpatients were extracted. The total hospitalization expense per visit had the highest proportion of 20,000 CNY and above (33.66%). After the ZMDP, the median total hospitalization expense and western medicine expense per visit decreased by 631.74 CNY and 966.35 CNY, respectively (P <0.001). Before the policy, the total hospitalization expense, traditional Chinese medicine (TCM) expense, examination expense, treatment expense, laboratory expense and surgical expense per visit showed upward trends (P<0.05), while the anesthesia expense per visit showed a downward trend (P<0.001). When the policy was implemented, the anesthesia expense per visit instantaneously increased by 91.70% (P<0.001). After the policy, the total hospitalization expense, western medicine expense, TCM expense, treatment expense and surgical expense per visit changed from upward trends to downward trends (P<0.05). The anesthesia expense per visit changed from a downward trend to an upward trend (P<0.001), and the examination expense per visit maintained an upward trend (P=0.005).

Conclusion

The economic burden of stroke inpatients decreased significantly with the implementation of the ZMDP, especially for the drug expenses. The medical service expenses increased significantly, reflecting the improvement in the value of medical staff's technical labor. However, the unexpected increase in the examination expenses was likely to be associated with the unreasonable medical compensation mechanism.

Targeted photothrombotic subcortical small vessel occlusion using in vivo real-time fiber bundle endomicroscopy in mice

The development of an accurate subcortical small vessel occlusion model for pathophysiological studies of subcortical ischemic stroke is still insignificant. In this study, in vivo real-time fiber bundle endomicroscopy (FBEµ) was applied to develop subcortical photothrombotic small vessel occlusion model in mice with minimal invasiveness. Our FBFµ system made it possible to precisely target specific blood vessels in deep brain and simultaneously observe the clot formation and blood flow blockage inside the target blood vessel during photochemical reactions. A fiber bundle probe was directly inserted into the anterior pretectal nucleus of the thalamus in brain of live mice to induce a targeted occlusion in small vessels. Then, targeted photothrombosis was performed using a patterned laser, observing the process through the dual-color fluorescence imaging. On day one post occlusion, infarct lesions are measured using TTC staining and post hoc histology. The results show that FBEµ applied to targeted photothrombosis can successfully generate a subcortical small vessel occlusion model for lacunar stroke.

A New Therapeutic Trend: Natural Medicine for Ameliorating Ischemic Stroke via PI3K/Akt Signaling Pathway

Ischemic stroke (IS) is an acute cerebrovascular disease caused by sudden arterial occlusion, which is characterized by a high morbidity, mortality, and disability rate. It is one of the most important causes of nervous system morbidity and mortality in the world. In recent years, the search for new medicine for the treatment of IS has become an attractive research focus. Due to the extremely limited time window of traditional medicine treatment, some side effects may occur, and accompanied by the occurrence of adverse reactions, the frequency of exploration with natural medicine is significantly increased. Phosphatidylinositol-3-kinase/Protein kinase B (PI3K/Akt) signaling pathway is a classical pathway for cell metabolism, growth, apoptosis, and other physiological activities. There is considerable research on medicine that treats various diseases through this pathway. This review focuses on how natural medicines (including herbs and insects) regulate important pathophysiological processes such as inflammation, oxidative stress, apoptosis, and autophagy through the PI3K/Akt signaling pathway, and the role it plays in improving IS. We found that many kinds of herbal medicine and insect medicine can alleviate the damage caused by IS through the PI3K/Akt signaling pathway. Moreover, the prescription after their combination can also achieve certain results. Therefore, this review provides a new candidate category for medicine development in the treatment of IS.

The Differences of Metabolites in Different Parts of the Brain Induced by Shuxuetong Injection against Cerebral Ischemia-Reperfusion and Its Corresponding Mechanism

Ischemic stroke is often associated with a large disease burden. The existence of ischemia-reperfusion injury brings great challenges to the treatment of ischemic stroke. The purpose of this study was to explore the differences of metabolites in different parts of the brain induced by Shuxuetong injection against cerebral ischemia-reperfusion and to extend the corresponding mechanism. The rats were modeled by transient middle cerebral artery occlusion (t-MCAO) operation, and the success of modeling was determined by neurological function score and TTC staining. UPLC-Q/TOF-MS metabolomics technique and multivariate statistical analysis were used to analyze the changes and differences of metabolites in the cortex and hippocampus of cerebral ischemia-reperfusion rats. Compared with the model group, the neurological function score and cerebral infarction volume of the Shuxuetong treatment group were significantly different. There were differences and changes in the metabolic distribution of the cortex and hippocampus in each group, the distribution within the group was relatively concentrated. The separation trend between the groups was obvious, and the distribution of the Shuxuetong treatment group was similar to that of the sham operation group. We identified 13 metabolites that were differentially expressed in the cortex, including glutamine, dihydroorotic acid, and glyceric acid. We also found five differentially expressed metabolites in the hippocampus, including glutamic acid and fumaric acid. The common metabolic pathways of Shuxuetong on the cortex and hippocampus were D-glutamine and D-glutamate metabolism and nitrogen metabolism, which showed inhibition of cortical glutamine and promotion of hippocampal glutamic acid. Specific pathways of Shuxuetong enriched in the cortex included glyoxylate and dicarboxylate metabolism and pyrimidine metabolism, which showed inhibition of glyceric acid and dihydroorotic acid. Specific pathways of Shuxuetong enriched in the hippocampus include arginine biosynthesis and citrate cycle (TCA cycle), which promotes fumaric acid. Shuxuetong injection can restore and adjust the metabolic disorder of the cortex and hippocampus in cerebral ischemia-reperfusion rats. The expression of Shuxuetong in different parts of the brain is different and correlated.

Shuxuetong injection and its peptides enhance angiogenesis after hindlimb ischemia by activating the MYPT1/LIMK1/Cofilin pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Shuxuetong (SXT) injection is formulated by leech and earthworm, has been widely used in the treatment of thrombotic cardiovascular and cerebrovascular diseases with remarkable clinical efficacy.

AIM OF THE STUDY

The purpose of this study is to investigate the protective mechanism of SXT injection on the mice model of hindlimb ischemia, and to evaluate the angiogenic effects of SXT injection and its main active substances.

MATERIALS AND METHODS

Hindlimb ischemia was induced by left femoral artery ligation. After operation, the mice were injected with saline, 10 mg/kg/d cilostazol, 37.5 mg/kg/d SXT injection, 75 mg/kg/d SXT injection and 150 mg/kg/d SXT injection via tail vein for 4 weeks. Ischemia severity was assessed using laser Doppler perfusion imaging system. Tissue recovery and capillary density were evaluated by histological and immunofluorescent staining. Vascular endothelial growth factor-A (VEGF-A) and platelet-derived growth factor (PDGF-BB) expression were measured by reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) analyses. Human umbilical vein endothelial cells (HUVECs) proliferation was measured using a BrdU kit and the viability of HUVECs was performed by MTT assay. Migration of HUVECs was performed by the wound healing method and a modified transwell assay. Capillary tube formation by HUVECs was examined by using Matrigel assay. Western blotting was used to detect the expressions of p-Cofilin, p-MYPT1, and p-LIMK1.

RESULTS

SXT injection treatment significantly restored the blood flow and reduced tissue injury in mouse gastrocnemius muscle. SXT injection treatment increased capillary density and promoted angiogenesis in hindlimb ischemia. Moreover, SXT injection enhanced the expression of VEGF-A and PDGF-BB at both mRNA and protein levels in ischemic tissue of mice. SXT injection and its main active peptides dramatically increased the migration and capillary tube formation of HUVECs. SXT injection and its peptides enhanced protein expressions of the phosphorylation of MYPT1, Cofilin, and LIMK1. DSYVGDEAQSKR, YNELRVAPEEHP, and IQFLPEGSPVTM may act as the active components of SXT injection.

CONCLUSION

SXT injection promoted angiogenesis and improved function recovery in hindlimb ischemia mice by regulation of VEGF-A/PDGF-BB. Moreover, SXT injection and its active peptides induced cell migration and tube formation in HUVECs through activating the MYPT1/LIMK1/Cofilin pathway. This study provided experimental basis for SXT injection in the treatment of ischemic diseases and revealed the effective substance of SXT injection in regulating angiogenesis, providing better evidence for the clinical application of SXT injection.

Prediction Model of Ischemic Stroke Recurrence Using PSO-LSTM in Mobile Medical Monitoring System

Aiming at the problems of low prediction accuracy and low sensitivity of traditional ischemic stroke recurrence prediction methods, which limits its application range, by introducing an adaptive particle swarm optimization (PSO) algorithm into the Long and Short-Term Memory (LSTM) model, a prediction model of ischemic stroke recurrence using deep learning in mobile medical monitoring system is proposed. First, based on the clustering idea, the particles are divided into local optimal particles and ordinary particles according to the characteristic information and distribution of different particles. By updating the particles with different strategies, the diversity of the population is improved and the problem of local optimal solution is eliminated. Then, by introducing the adaptive PSO algorithm into the LSTM, the PSO-LSTM prediction model is constructed. The optimal super parameters of the model are determined quickly and accurately, and the model is trained combined with the patient's clinical data. Finally, by using SMOTE method to process the original data, the imbalance of positive and negative sample data is eliminated. Under the same conditions, the proposed PSO-LSTM prediction model is compared with two traditional LSTM models. The results show that the prediction accuracy of PSO-LSTM model is 92.0%, which is better than two comparison models. The effective prediction of ischemic stroke recurrence is realized.