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Lin QQ, Chen HS, Yang Y, Zhang M, Wu SW, Li ML, Huang YN, Xu WH. Small vessel disease burden and prognosis of recent subcortical ischaemic stroke differ by parent artery atherosclerosis. Eur J Neurol 2024:e16422. [PMID: 39096086 DOI: 10.1111/ene.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND PURPOSE Parent artery atherosclerosis is an important aetiology of recent subcortical ischaemic stroke (RSIS). However, comparisons of RSIS with different degrees of parent artery atherosclerosis are lacking. METHODS Prospectively collected data from our multicentre cohort (all were tertiary centres) of the Stroke Imaging Package Study between 2015 and 2017 were retrospectively reviewed. The patients with RSIS defined as a single clinically relevant diffusion-weighted imaging positive lesion in the territory of lenticulostriate arteries were categorized into three subgroups: (1) normal middle cerebral artery (MCA) on magnetic resonance angiography and high-resolution magnetic resonance imaging (HR-MRI); (2) low-grade MCA atherosclerosis (normal or <50% stenosis on magnetic resonance angiography and with MCA plaques on HR-MRI); (3) steno-occlusive MCA atherosclerosis (stenosis ≥50% or occlusion). The primary outcome was 90-day functional dependence (modified Rankin Scale score >2). The clinical and imaging findings were compared between subgroups. RESULTS A total of 239 patients (median age 60.0 [52.0-67.0] years, 72% male) were enrolled, including 140 with normal MCA, 64 with low-grade MCA atherosclerosis and 35 with steno-occlusive MCA atherosclerosis. Patients with steno-occlusive MCA atherosclerosis had the largest infarct volume. Low-grade MCA atherosclerosis was independently associated with cerebral microbleeding, more severe perivascular spaces in basal ganglia and higher total cerebral small vessel disease burden. Low-grade MCA atherosclerosis was an independent determinant of 90-day functional dependence (odds ratio 3.897; 95% confidence interval 1.309-11.604). CONCLUSIONS Our study suggested RSIS with varying severity of parent artery atherosclerosis exhibits distinctive clinical and neuroimaging characteristics, with low-grade MCA atherosclerosis associating with higher cerebral small vessel disease burden and worse prognosis.
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Affiliation(s)
- Qian-Qian Lin
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurology, Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meng Zhang
- Department of Neurology, Army Medical Centre of PLA, Chongqing, China
| | - Shi-Wen Wu
- Department of Neurology, First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Ning Huang
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Wei-Hai Xu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chen Y, Zhang Y, Jiang L, Lu Y, Ding X, Jin W, Xiong C, Huang D. Investigation of vascular risk factor control and secondary prevention medication compliance in acute ischemic stroke. Front Neurol 2024; 15:1365860. [PMID: 38974682 PMCID: PMC11224152 DOI: 10.3389/fneur.2024.1365860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives This study aimed to investigate the management of vascular risk factors, with a specific focus on understanding the various factors affecting risk factor control through an in-depth analysis of clinical data and a longitudinal follow-up of patients who have experienced ischemic strokes. Methods A total of 1,572 participants were included in the analysis. We assessed thresholds for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin (HbA1c) levels to uncover the contextual conditions and factors affecting vascular risk factor control. Moreover, the study also scrutinized medication compliance at intervals of 3, 6, and 12 months post-onset. Logistic regression was used to adjust for confounding factors. Results At 3, 6, and 12 months, BP,LDL, hemoglobin control targets were achieved in 50.7, 51.8, and 50.6%; 51.5, 59.4, and 50.6%; 48.1, 44.0, and 48.4%,respectively. Notably, age was associated with the achievement of BP control (odds ratio [OR], 0.96; 95% confidence intervals [CI], 0.94-0.98; p < 0.0001). Ethnic minorities (OR, 4.23; 95% CI, 1.19-15.09; p = 0.02) and individuals with coronary heart disease (OR, 0.5; 95% CI, 0.3-1.0; p = 0.05) experienced decreased BP control ratios. A previous history of stroke (OR, 1.7; 95% CI, 1.0-2.8; p = 0.03) and unrestricted alcohol consumption (OR, 3.3; 95% CI, 1.0-11.1; p = 0.05) was significantly associated with the achievement of lipid control. Furthermore, lifestyle modifications were significantly correlated with the achievement of BP control (OR, 0.19; 95% CI, 0.12-0.30; p < 0.01), blood glucose control (OR, 0.03; 95% CI, 0.01-0.08; p < 0.01), and blood lipid control (OR, 0.26; 95% CI, 0.16-0.42; p < 0.01). The absence of regular physical activity was associated with lower rates of glycemic (OR, 0.14; 95% CI, 0.06-0.36; p < 0.01) and lipid controls (OR, 0.55; 95% CI, 0.33-0.90; p = 0.01). Over time, overall medication compliance declined. Conclusion Within the cohort of patients under medication, the compliance rate concerning vascular risk factors remains unsatisfactory. Attention should be paid to compliance with secondary prevention medications and enhance the control of vascular risk factors, as compliance emerges as the key to effective prevention.
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Affiliation(s)
- Yun Chen
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Yuan Zhang
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Lianyan Jiang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanbin Lu
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Xiaojie Ding
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Wei Jin
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Canxin Xiong
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
| | - Daping Huang
- Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, China
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Yuan W, Liu X, Yan Z, Wu B, Lu B, Chen B, Tian D, Du A, Li L, Liu C, Liu G, Gong T, Shi Z, Feng F, Liu C, Meng Y, Lin Q, Li M, Xu WH. Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study. Int J Stroke 2024; 19:569-576. [PMID: 38229443 DOI: 10.1177/17474930241228203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND High-resolution magnetic resonance vessel wall imaging (HRMR-VWI) is a promising technique for identifying intracranial vulnerable plaques beyond lumen narrowing. However, the association between HRMR-VWI characteristics and recurrent stroke remains uncertain. AIMS This study aimed to investigate the association between HRMR-VWI characteristics and recurrent ipsilateral stroke in patients with symptomatic intracranial atherosclerotic steno-occlusive disease (ICAS). METHODS This multicenter, observational study recruited first-ever acute ischemic stroke patients attributed to ICAS (>50% stenosis or occlusion) within 7 days after onset. Participants were assessed by multiparametric magnetic resonance imaging (MRI) including diffusion-weighted imaging, three-dimension time-of-flight magnetic resonance angiography, and three-dimensional T1-weighted HRMR-VWI. The patients were recommended to receive best medical therapy and were systematically followed up for 12 months. The association between HRMR-VWI characteristics and the time to recurrent ipsilateral stroke was investigated by univariable and multivariable analysis. RESULTS Two hundred and fifty-five consecutive patients were enrolled from 15 centers. The cumulative 12 month ipsilateral recurrence incidence was 4.1% (95% confidence interval (CI): 1.6-6.6%). Patients with recurrent ipsilateral stroke exhibited higher rates of intraplaque hemorrhage (IPH) (30.0% vs 6.5%) and eccentric plaque (90.0% vs 48.2%), and lower occurrence of occlusive thrombus (10.0% vs 23.7%). Plaque length (5.69 ± 2.21 mm vs 6.67 ± 4.16 mm), plaque burden (78.40 ± 7.37% vs 78.22 ± 8.32%), degree of stenosis (60.25 ± 18.95% vs 67.50% ± 22.09%) and remodeling index (1.07 ± 0.27 vs 1.03 ± 0.35) on HRMR-VWI did not differ between patients with and without recurrent ipsilateral stroke. In the multivariable Cox regression analysis, IPH (hazard ratio: 6.64, 95% CI: 1.23-35.8, p = 0.028) was significantly associated with recurrent ipsilateral stroke after adjustment.Conclusions:Our results suggest intraplaque hemorrhage (IPH) is significantly associated with recurrent ipsilateral stroke and has potential value in the selection of patients for aggressive treatment strategies. DATA ACCESS STATEMENT Data from this study are available and can be accessed upon request.
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Affiliation(s)
- Weizhuang Yuan
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyun Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongrui Yan
- Department of Neurology, Jining No. 1 People's Hospital, Jining, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Baoquan Lu
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Beilei Chen
- Department of Neurology, Subei People's Hospital of Jiangsu Province, Yangzhou, China
| | - Daishi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ailian Du
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Litao Li
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Changyun Liu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guangzhi Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Zhimin Shi
- Department of Neurology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caiyan Liu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Qianqian Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Mingli Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Hai Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Huang LX, Wu XB, Liu YA, Guo X, Liu CC, Cai WQ, Wang SW, Luo B. High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review. Heliyon 2024; 10:e27948. [PMID: 38571643 PMCID: PMC10987942 DOI: 10.1016/j.heliyon.2024.e27948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Ischemic stroke is a significant burden on human health worldwide. Carotid Atherosclerosis stenosis plays an important role in the comprehensive assessment and prevention of ischemic stroke patients. High-resolution vessel wall magnetic resonance imaging has emerged as a successful technique for assessing carotid atherosclerosis stenosis. This advanced imaging modality has shown promise in effectively displaying a wide range of characteristics associated with the condition, leading to a comprehensive evaluation. High-resolution vessel wall magnetic resonance imaging not only enables a comprehensive evaluation of the instability of carotid atherosclerosis stenosis plaques but also provides valuable information for understanding the pathogenesis and predicting the prognosis of ischemic stroke patients. The purpose of this article is to review the application of high-resolution magnetic resonance imaging in ischemic stroke and carotid atherosclerotic stenosis.
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Affiliation(s)
- Li-Xin Huang
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiao-Bing Wu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Ao Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xin Guo
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Chi-Chen Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wang-Qing Cai
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sheng-Wen Wang
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Wechsler PM, Pandya A, Parikh NS, Razzak JA, White H, Navi BB, Kamel H, Liberman AL. Cost-Effectiveness of Increased Use of Dual Antiplatelet Therapy After High-Risk Transient Ischemic Attack or Minor Stroke. J Am Heart Assoc 2024; 13:e032808. [PMID: 38533952 PMCID: PMC11179775 DOI: 10.1161/jaha.123.032808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Rates of dual antiplatelet therapy (DAPT) after high-risk transient ischemic attack or minor ischemic stroke (TIAMIS) are suboptimal. We performed a cost-effectiveness analysis to characterize the parameters of a quality improvement (QI) intervention designed to increase DAPT use after TIAMIS. METHODS AND RESULTS We constructed a decision tree model that compared current national rates of DAPT use after TIAMIS with rates after implementing a theoretical QI intervention designed to increase appropriate DAPT use. The base case assumed that a QI intervention increased the rate of DAPT use to 65% from 45%. Costs (payer and societal) and outcomes (stroke, myocardial infarction, major bleed, or death) were modeled using a lifetime horizon. An incremental cost-effectiveness ratio <$100 000 per quality-adjusted life year was considered cost-effective. Deterministic and probabilistic sensitivity analyses were performed. From the payer perspective, a QI intervention was associated with $9657 in lifetime cost savings and 0.18 more quality-adjusted life years compared with current national treatment rates. A QI intervention was cost-effective in 73% of probabilistic sensitivity analysis iterations. Results were similar from the societal perspective. The maximum acceptable, initial, 1-time payer cost of a QI intervention was $28 032 per patient. A QI intervention that increased DAPT use to at least 51% was cost-effective in the base case. CONCLUSIONS Increasing DAPT use after TIAMIS with a QI intervention is cost-effective over a wide range of costs and proportion of patients with TIAMIS treated with DAPT after implementation of a QI intervention. Our results support the development of future interventions focused on increasing DAPT use after TIAMIS.
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Affiliation(s)
- Paul M. Wechsler
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Ankur Pandya
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMA
| | - Neal S. Parikh
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Junaid A. Razzak
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNY
| | - Halina White
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Babak B. Navi
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Hooman Kamel
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
| | - Ava L. Liberman
- Department of Neurology, Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNY
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Wong AKC, Wang SL, So C, Lian J, Yan Y, Li H, Wu L, Pei H, Wang W, Wong FKY. Economic Evaluation of an Enhanced Post-Discharge Home-Based Care Program for Stroke Survivors. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:405-414. [PMID: 38309655 DOI: 10.1016/j.jval.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To examine the cost-effectiveness of an enhanced postdischarge home-based care program for stroke survivors compared with usual care. METHODS This was a trial-based economic evaluation study. One hundred and sixteen patients with ischemic stroke were recruited from neurology units in a Chinese hospital and randomized into intervention (n = 58) or usual care groups (n = 58). The intervention commenced with predischarge planning and transitioned to home follow-up postdischarge. Trained nurse case managers supported by an interdisciplinary team provided comprehensive assessment, individualized goal setting, and skill training to support home-based rehabilitation for intervention group participants. Standard care was provided to usual care group participants. Total cost and quality-adjusted life-years gained at 3-month (T1), 6-month (T2), and 12-month (T3) follow-ups were calculated. The incremental cost-effectiveness ratios between the groups were obtained. RESULTS The intervention group showed a significant increase in utility compared with the usual care group at T1 (P = .003), T2 (P = .007), and T3 (P < .001). The average total QALY gain from baseline for the intervention group was higher than for the usual care group at all time points. The likelihood of being cost-effective ranged from 61.9% to 67.2% from the provider perspective, and from 59.7% to 66.8% from the societal perspective. CONCLUSIONS The results showed that the intervention program was cost-effective with significantly higher quality-adjusted life-years for stroke survivors when compared with usual care. It provides economic evidence to support the development of home-based stroke rehabilitation program, especially in the low- and middle-income countries.
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Affiliation(s)
| | - Shao Ling Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ching So
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jinxiao Lian
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ying Yan
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Haiyan Li
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Lijie Wu
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Haixia Pei
- Rehabilitation Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Wei Wang
- Neurology Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
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Liu X, Lv X, Peng Y, Wang J, Lei J, Tang C, Luo S, Mai W, Cai Y, Fan Q, Liu C, Zhang L. Clopidogrel with indobufen or aspirin in minor ischemic stroke or high-risk transient ischemic attack: a randomized controlled clinical study. BMC Neurol 2024; 24:81. [PMID: 38429754 PMCID: PMC10905919 DOI: 10.1186/s12883-024-03585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Ischemic stroke and transient ischemic attack (TIA) are the most prevalent cerebrovascular diseases. The conventional antiplatelet drugs are associated with an inherent bleeding risk, while indobufen is a new antiplatelet drug and has the similar mechanism of antiplatelet aggregation as aspirin with more safety profile. However, there have been no studies evaluating the combination therapy of indobufen and clopidogrel for antiplatelet therapy in cerebrovascular diseases. OBJECTIVE The CARMIA study aims to investigate the effectiveness and safety of a new dual antiplatelet therapy consisting of indobufen and clopidogrel comparing with the conventional dual antiplatelet therapy consisting of aspirin and clopidogrel in patients with minor ischemic stroke or high-risk TIA. METHODS An open-label randomized controlled clinical trial was conducted at a clinical center. We randomly assigned patients who had experienced a minor stroke or transient ischemic attack (TIA) within 72 h of onset, or within 1 month if they had intracranial stenosis (IS), to receive either indobufen 100 mg twice daily or aspirin 100 mg once daily for 21 days. For patients with IS, the treatment duration was extended to 3 months. All patients received a loading dose of 300 mg clopidogrel orally on the first day, followed by 75 mg once daily from the second day to 1 year. We collected prospective data using paper-based case report forms, and followed up on enrolled patients was conducted to assess the incidence of recurrent ischemic stroke or TIA, mRS score, NIHSS (National Institutes of Health Stroke Scale) score, and any bleeding events occurring within 3 month after onset. RESULTS We enrolled 202 patients diagnosed with ischemic stroke or transient ischemic attack. After applying the criteria, 182 patients were eligible for data analysis. Endpoint events (recurrence of ischemic stroke/TIA, myocardial infarction, or death) were observed in 6 patients (6.5%) receiving aspirin and clopidogrel, including 4 (4.3%) with stroke recurrence, 1 (1.1%) with TIA recurrence, and 1 (1%) with death. In contrast, no endpoint events were reported in the indobufen and clopidogrel group (P = 0.029). The group of patients receiving indobufen and clopidogrel exhibited significantly lower modified Rankin Scale (mRS) score. (scores range from 0 to 6, with higher scores indicating more severe disability) compared to the aspirin and clopidogrel group (common odds ratio 3.629, 95% CI 1.874-7.036, P < 0.0001). Although the improvement rate of NIHSS score in the indobufen and clopidogrel group was higher than that in the aspirin and clopidogrel group, the difference was not statistically significant (P > 0.05). Bleeding events were observed in 8 patients (8.6%) receiving aspirin and clopidogrel, including 4 (4.3%) with skin bleeding, 2 (2.2%) with gingival bleeding, 1 (1.1%) with gastrointestinal bleeding, and 1 (1.1%) with urinary system bleeding. On the other hand, only 1 patient (1.1%) in the indobufen and clopidogrel group experienced skin bleeding (P = 0.035). CONCLUSION The combination of indobufen and clopidogrel has shown non-inferior and potentially superior effectiveness and safety compared to aspirin combined with clopidogrel in patients with minor ischemic stroke and high-risk TIA in the CARMIA study (registered under chictr.org.cn with registration number ChiCTR2100043087 in 01/02/2021).
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Affiliation(s)
- Xudong Liu
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Xuxian Lv
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Yanfang Peng
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Jianing Wang
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Junjie Lei
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Chaogang Tang
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Shijian Luo
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Weihua Mai
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Yiming Cai
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Qian Fan
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Chenhao Liu
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China
| | - Lei Zhang
- The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihua East Road, Zhuhai City, Guangdong Province, China.
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Zhang D, Jia N, Hu Z, Keqing Z, Chenxi S, Chunying S, Chen C, Chen W, Hu Y, Ruan Z. Bioinformatics identification of potential biomarkers and therapeutic targets for ischemic stroke and vascular dementia. Exp Gerontol 2024; 187:112374. [PMID: 38320734 DOI: 10.1016/j.exger.2024.112374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
Ischemic stroke and vascular dementia, as common cerebrovascular diseases, with the former causing irreversible neurological damage and the latter causing cognitive and memory impairment, are closely related and have long received widespread attention. Currently, the potential causative genes of these two diseases have yet to be investigated, and effective early diagnostic tools for the diseases have not yet emerged. In this study, we screened new potential biomarkers and analyzed new therapeutic targets for both diseases from the perspective of immune infiltration. Two gene expression profiles on ischemic stroke and vascular dementia were obtained from the NCBI GEO database, and key genes were identified by LASSO regression and SVM-RFE algorithms, and key genes were analyzed by GO and KEGG enrichment. The CIBERSORT algorithm was applied to the gene expression profile species of the two diseases to quantify the 24 subpopulations of immune cells. Moreover, logistic regression modeling analysis was applied to illustrate the stability of the key genes in the diagnosis. Finally, the key genes were validated using RT-PCR assay. A total of 105 intersecting DEGs genes were obtained in the 2 sets of GEO datasets, and bioinformatics functional analysis of the intersecting DEGs genes showed that GO was mainly involved in the purine ribonucleoside triphosphate metabolic process,respiratory chain complex,DNA-binding transcription factor binding and active transmembrane transporter activity. KEGG is mainly involved in the Oxidative phosphorylation, cAMP signaling pathway. The LASSO regression algorithm and SVM-RFE algorithm finally obtained three genes, GAS2L1, ARHGEF40 and PFKFB3, and the logistic regression prediction model determined that the three genes, GAS2L1 (AUC: 0.882), ARHGEF40 (AUC: 0.867) and PFKFB3 (AUC: 0.869), had good diagnostic performance. Meanwhile, the two disease core genes and immune infiltration were closely related, GAS2L1 and PFKFB3 had the highest positive correlation with macrophage M1 (p < 0.001) and the highest negative correlation with mast cell activation (p = 0.0017); ARHGEF40 had the highest positive correlation with macrophage M1 and B cells naive (p < 0.001), the highest negative correlation with B cell memory highest correlation (p = 0.0047). RT-PCR results showed that the relative mRNA expression levels of GAS2L1, ARHGEF40, and PFKFB3 were significantly elevated in the populations of both disease groups (p < 0.05). Immune infiltration-based models can be used to predict the diagnosis of patients with ischemic stroke and vascular dementia and provide a new perspective on the early diagnosis and treatment of both diseases.
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Affiliation(s)
- Ding Zhang
- Guangxi university of chinese medicine Nanning, China
| | - Ni Jia
- Shaanxi University of Traditional Chinese Medicine Xianyang, China
| | - Zhihan Hu
- Shanghai University of Traditional Chinese Medicine Shanghai, China
| | - Zhou Keqing
- Guangxi university of chinese medicine Nanning, China
| | - Song Chenxi
- Guangxi university of chinese medicine Nanning, China
| | - Sun Chunying
- Guangxi university of chinese medicine Nanning, China
| | - Canrong Chen
- Guangxi university of chinese medicine Nanning, China
| | - Wei Chen
- Guangxi university of chinese medicine First Affiliated Hospital Nanning, China
| | - Yueqiang Hu
- Guangxi university of chinese medicine First Affiliated Hospital Nanning, China.
| | - Ziyun Ruan
- Guangxi university of chinese medicine Nanning, China
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Fu Y, Tang R, Chen R, Wang A, Ren J, Zhu S, Feng X, Fan D. Efficacy and safety of Y-2 sublingual tablet for patients with acute ischaemic stroke: protocol of a phase III randomised double-blind placebo-controlled multicentre trial. Stroke Vasc Neurol 2024; 9:90-95. [PMID: 37308251 PMCID: PMC10956111 DOI: 10.1136/svn-2022-002014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/02/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Clinical studies have demonstrated that edaravone dexborneol can improve the functional outcomes in patients with acute ischaemic stroke (AIS). The present clinical trial aimed at testing the efficacy and safety of Y-2 sublingual tablet on 90-day functional outcome in patients with AIS. METHODS AND DESIGN This is a randomised, double-blind, placebo-controlled, multicentre, parallel-group trial of Y-2 sublingual tablet on patients with AIS.An estimated 914 patients at age of 18-80 years with AIS within 48 hours after symptom onset from 40 hospitals will be randomly assigned to receive Y-2 sublingual tablet or placebo for 14 days. Patients are at score 6-20 points on National Institutes of Health Stroke Scale (NIHSS) and had a modified Rankin Scale (mRS) ≤1 before this stroke, except mechanical thrombectomy and neuroprotective agents treatment. STUDY OUTCOMES The primary outcome is the proportion of patients with mRS ≤1 on day 90 after randomisation. Secondary efficacy outcomes include mRS score on day 90, the proportion of patients with mRS ≤2 on day 90; the change of NIHSS score from baseline to day 14 and the proportion of patients with NIHSS score ≤1 at the days 14, 30 and 90. DISCUSSION This trial will provide valuable evidence for the efficacy and safety of Y-2 sublingual table for improving 90 days the functional outcomes in patients with AIS. TRIAL REGISTRATION NUMBER NCT04950920.
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Affiliation(s)
- Yu Fu
- Deparment of Neurology, Peking University Third Hospital, Beijing, China
| | - Renhong Tang
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, Jiangsu, China
- Simcere Pharmaceutical Group Limited, Nanjing, Jiangsu, China
| | - Rong Chen
- Neurodawn Pharmaceutical Co., Ltd, Nanjing, Jiangsu, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinsheng Ren
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, Jiangsu, China
- Simcere Pharmaceutical Group Limited, Nanjing, Jiangsu, China
| | - Shunwei Zhu
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, Jiangsu, China
- Simcere Pharmaceutical Group Limited, Nanjing, Jiangsu, China
| | - Xiaofei Feng
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, Jiangsu, China
- Simcere Pharmaceutical Group Limited, Nanjing, Jiangsu, China
| | - Dongsheng Fan
- Deparment of Neurology, Peking University Third Hospital, Beijing, China
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10
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Fu Y, Wang A, Tang R, Li S, Tian X, Xia X, Ren J, Yang S, Chen R, Zhu S, Feng X, Yao J, Wei Y, Dong X, Ling Y, Yi F, Deng Q, Guo C, Sui Y, Han S, Wen G, Li C, Dong A, Sun X, Wang Z, Shi X, Liu B, Fan D. Sublingual Edaravone Dexborneol for the Treatment of Acute Ischemic Stroke: The TASTE-SL Randomized Clinical Trial. JAMA Neurol 2024; 81:2815107. [PMID: 38372981 PMCID: PMC10877503 DOI: 10.1001/jamaneurol.2023.5716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/11/2023] [Indexed: 02/20/2024]
Abstract
Importance Sublingual edaravone dexborneol, which can rapidly diffuse and be absorbed through the oral mucosa after sublingual exposure, is a multitarget brain cytoprotection composed of antioxidant and anti-inflammatory ingredients edaravone and dexborneol. Objective To investigate the efficacy and safety of sublingual edaravone dexborneol on 90-day functional outcome in patients with acute ischemic stroke (AIS). Design, Setting, and Participants This was a double-blind, placebo-controlled, multicenter, parallel-group, phase 3 randomized clinical trial conducted from June 28, 2021, to August 10, 2022, with 90-day follow-up. Participants were recruited from 33 centers in China. Patients randomly assigned to treatment groups were aged 18 to 80 years and had a National Institutes of Health Stroke Scale score between 6 and 20, a total motor deficit score of the upper and lower limbs of 2 or greater, a clinically diagnosed AIS symptom within 48 hours, and a modified Rankin Scale (mRS) score of 1 or less before stroke. Patients who did not meet the eligibility criteria or declined to participate were excluded. Intervention Patients were assigned, in a 1:1 ratio, to receive sublingual edaravone dexborneol (edaravone, 30 mg; dexborneol, 6 mg) or placebo (edaravone, 0 mg; dexborneol, 60 μg) twice daily for 14 days and were followed up until 90 days. Main Outcomes and Measures The primary efficacy outcome was the proportion of patients with mRS score of 1 or less on day 90 after randomization. Results Of 956 patients, 42 were excluded. A total of 914 patients (median [IQR] age, 64.0 [56.0-70.0] years; 608 male [66.5%]) were randomly allocated to the edaravone dexborneol group (450 [49.2%]) or placebo group (464 [50.8%]). The edaravone dexborneol group showed a significantly higher proportion of patients experiencing good functional outcomes on day 90 after randomization compared with the placebo group (290 [64.4%] vs 254 [54.7%]; risk difference, 9.70%; 95% CI, 3.37%-16.03%; odds ratio, 1.50; 95% CI, 1.15-1.95, P = .003). The rate of adverse events was similar between the 2 groups (89.8% [405 of 450] vs 90.1% [418 of 464]). Conclusion and Relevance Among patients with AIS within 48 hours, sublingual edaravone dexborneol could improve the proportion of those achieving a favorable functional outcome at 90 days compared with placebo. Trial Registration ClinicalTrials.gov Identifier: NCT04950920.
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Affiliation(s)
- Yu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Anxin Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Renhong Tang
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, China
| | - Shuya Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Tian
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xue Xia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinsheng Ren
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, China
- Simcere Pharmaceutical Group Limited, Nanjing, China
| | - Shibao Yang
- Neurodawn Pharmaceutical Co Ltd, Nanjing, China
| | - Rong Chen
- Neurodawn Pharmaceutical Co Ltd, Nanjing, China
| | - Shunwei Zhu
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, China
- Simcere Pharmaceutical Group Limited, Nanjing, China
| | - Xiaofei Feng
- State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, China
- Simcere Pharmaceutical Group Limited, Nanjing, China
| | | | - Yan Wei
- Harrision International Peace Hospital, Hengshui, China
| | | | - Yun Ling
- Nanshi Hospital of Nanyang, Nanyang, China
| | - Fei Yi
- Pingxiang People’s Hospital, Pingxiang, China
| | - Qian Deng
- The First Affiliated Hospital of Nanyang Medical College, Nanyang, China
| | - Cunju Guo
- Liaocheng People’s Hospital, Liaocheng, China
| | - Yi Sui
- The First People’s Hospital of Shenyang, Shenyang, China
| | - Shugen Han
- Mei He Kou Central Hospital, Jilin, China
| | | | | | | | - Xin Sun
- The First Hospital of Jilin University, Jilin, China
| | - Zhimin Wang
- Taizhou First People’s Hospital, Zhejiang, China
| | | | - Bo Liu
- The First Affiliated Hospital Baotou Medical College, Baotou, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
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11
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Yao Y, Liu F, Gu Z, Wang J, Xu L, Yu Y, Cai J, Ren R. Emerging diagnostic markers and therapeutic targets in post-stroke hemorrhagic transformation and brain edema. Front Mol Neurosci 2023; 16:1286351. [PMID: 38178909 PMCID: PMC10764516 DOI: 10.3389/fnmol.2023.1286351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
Stroke is a devastating condition that can lead to significant morbidity and mortality. The aftermath of a stroke, particularly hemorrhagic transformation (HT) and brain edema, can significantly impact the prognosis of patients. Early detection and effective management of these complications are crucial for improving outcomes in stroke patients. This review highlights the emerging diagnostic markers and therapeutic targets including claudin, occludin, zonula occluden, s100β, albumin, MMP-9, MMP-2, MMP-12, IL-1β, TNF-α, IL-6, IFN-γ, TGF-β, IL-10, IL-4, IL-13, MCP-1/CCL2, CXCL2, CXCL8, CXCL12, CCL5, CX3CL1, ICAM-1, VCAM-1, P-selectin, E-selectin, PECAM-1/CD31, JAMs, HMGB1, vWF, VEGF, ROS, NAC, and AQP4. The clinical significance and implications of these biomarkers were also discussed.
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Affiliation(s)
- Ying Yao
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Liu
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaowen Gu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lintao Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Yu
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Cai
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Reng Ren
- Department of Neuroscience Intensive Care Unit, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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12
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Han X, Li Y, Chen X, Pan D, Mo J, Qiu J, Li Y, Chen Y, Huang Y, Shen Q, Tang Y. Platelet-activating factor antagonist-based intensive antiplatelet strategy in acute ischemic stroke: A propensity score matched with network pharmacology analysis. CNS Neurosci Ther 2023; 29:4082-4092. [PMID: 37435773 PMCID: PMC10651968 DOI: 10.1111/cns.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Diterpene ginkgolides meglumine injection (DGMI) is a platelet-activating factor receptor (PAFR) antagonist that can be used to treat acute ischemic stroke (AIS). This study evaluated the efficacy and safety of an intensive antiplatelet strategy based on PAFR antagonists and explored the underlying mechanisms of PAFR antagonists in AIS treatment. METHODS This is a retrospective study applying propensity score methods to match AIS patients treated with DGMI to nontreated patients. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days. The safety outcome was bleeding risk. We used McNemar test to compare the efficacy outcome. Subsequently, the network pharmacology analysis was performed. RESULTS 161 AIS patients treated with DGMI in the study were matched with 161 untreated patients. Compared with untreated patients, DGMI-treated patients had a significantly higher rate of mRS ranking 0-2 at 90 days (82.0% vs. 75.8%, p < 0.001), without increased risk of bleeding. The gene enrichment analysis showed that the overlap genes of DGMI targeted and AIS-related enriched in thrombosis and inflammatory-related signaling pathways. CONCLUSIONS An intensive antiplatelet strategy of DGMI plus traditional antiplatelet agents is effective in treating AIS and may work by mediating post-stroke inflammation and thrombosis.
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Affiliation(s)
- Xiaoyan Han
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Youjia Li
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Xuemin Chen
- Guangdong Medical UniversityZhanjiangPeople's Republic of China
| | - Dong Pan
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Junning Mo
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Jiaming Qiu
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Yi Li
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yan Chen
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Yan Huang
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Qingyu Shen
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yamei Tang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of MedicineSun Yat‐Sen UniversityGuangzhouPeople's Republic of China
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13
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Han B, Raynald, Sun D, Tong X, Jia B, Wang A, Mo D, Gao F, Ma N, Nguyen TN, Miao Z. Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry. Front Neurol 2023; 14:1255043. [PMID: 37928147 PMCID: PMC10623312 DOI: 10.3389/fneur.2023.1255043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background The incidence of acute ischemic stroke caused by large vessel occlusion is relatively infrequent in the young adult population. We sought to evaluate their clinical outcomes after endovascular treatment (EVT) and stroke etiology compared with older patients. Methods We examined data from the ANGEL-ACT registry, a nationwide study in China focusing on EVT for acute ischemic stroke. We compared two age groups: <50 years old and ≥50 years old. Our analysis focused on outcome measures such as the 90-day modified Rankin Scale (mRS) score, mortality, and symptomatic intracranial hemorrhage (sICH). We adjusted for confounding variables. Results We included 1,691 patients, and 216 patients (13%) were <50 years old. Young patients had lower median National Institutes of Health Stroke Scale (NIHSS) scores (14 vs. 17, P < 0.001) and fewer cardiovascular comorbidities than older patients. Underlying intracranial atherosclerosis disease (ICAD) was higher in young patients (39.4 vs. 28.7%, P = 0.001). Clinical outcome was less favorable in older compared to younger patients (mRS shift: 0.76 [95% confidence interval (CI), 0.58-0.99]); functional independence [mRS score 0-2] 61% vs. 39% (adjusted odds ratio (OR), 0.7 [95% CI, 0.51-0.97]). Mortality and sICH did not differ between groups. Onset to puncture time (OTP) was longer in young patients (357 min vs. 294 min, P = 0.001). Conclusion An estimated 13% of patients who underwent endovascular thrombectomy for acute ischemic stroke were <50 years old. Symptomatic underlying ICAD was more prevalent in the younger patient population. Despite a prehospital delay, younger patients exhibited more favorable outcomes than their older counterparts.
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Affiliation(s)
- Bin Han
- Shanxi Key Laboratory of Brain Disease Control, Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston, MA, United States
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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14
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Saito T, Sakakibara F, Uchida K, Yoshimura S, Sakai N, Imamura H, Yamagami H, Morimoto T. Effect of edaravone on symptomatic intracranial hemorrhage in patients with acute large vessel occlusion on apixaban for non-valvular atrial fibrillation. J Neurol Sci 2023; 453:120806. [PMID: 37717280 DOI: 10.1016/j.jns.2023.120806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Edaravone administration was associated with lower incidence of symptomatic intracranial hemorrhage (sICH) in patients with acute large vessel occlusion (LVO). However, its protective effect on sICH in patients with LVO who receive direct oral anticoagulants for non-valvular atrial fibrillation (NVAF) is uncertain. OBJECTIVES To explore the effect of edaravone administration on the incidence of sICH in patients with acute LVO receiving apixaban for NVAF. METHODS A Japanese multicenter registry of apixaban on clinical outcome of the patients with LVO or stenosis (ALVO study) included patients who were admitted within 24 h after stroke onset and were received apixaban within 14 days of stroke onset. Patients were divided into two groups according to edaravone administration (Edaravone and No-Edaravone groups). The incidence of sICH within one year and infarct growth before apixaban administration were compared between these groups. RESULTS Of the 686 enrolled patients, 622 were included and edaravone was administered to 407 (65.4%). The incidences of sICH in Edaravone and No-Edaravone groups were 1.3% and 5.0%, respectively (p = 0.01). The inverse probability of treatment-weighting (IPTW) hazard ratio (HR) (95% confidence interval [CI]) of Edaravone group for sICH within one year was 0.36 (0.15-0.80) compared to No-Edaravone group. The incidences of infarct growth in Edaravone and No-Edaravone groups were 35.3% and 42.0%, respectively (p = 0.13). IPTW HR (95% CIs) for infarct growth was 0.76 (0.60-0.97). CONCLUSIONS Edaravone administration was associated with a lower incidence of sICH in patients with LVO and NVAF who administrated apixaban.
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Affiliation(s)
- Takuya Saito
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Fumihiro Sakakibara
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kazutaka Uchida
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
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15
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Zhang ZMY, Si QQ, Chen HS, Yang Y, Zhang M, Wu SW, Meng Y, Li ML, Lin QQ, Liebeskind DS, Huang YN, Xu WH. High-resolution magnetic resonance imaging of acute intracranial artery thrombus. Eur J Neurol 2023; 30:3172-3181. [PMID: 37452734 DOI: 10.1111/ene.15985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND PURPOSE The development of high-resolution magnetic resonance imaging (HR-MRI) has enabled submillimeter-level evaluation of intracranial artery plaque and luminal thrombus. We sought to investigate the value of HR-MRI in assessing the pathogenesis of acute intracranial artery thrombus. METHODS We examined the presence of intracranial thrombus on three-dimensional T1-weighted HR-MRI in acute ischemic stroke patients with intracranial artery occlusion on magnetic resonance angiography. We defined two thrombus-related HR-MRI features (peri-thrombus plaque and distal residual flow beyond the thrombus) and analyzed their association with potential embolic sources. RESULTS Luminal thrombus and a shrunken artery without luminal thrombus were detected in 162 (96.4%) and six (3.6%) of 168 patients with intracranial artery occlusion, respectively. Among 111 patients with culprit major artery thrombus, peri-thrombus plaques were observed in 46.8% and distal residual flow beyond the thrombus in 64.0%. Patients with peri-thrombus plaque had a higher prevalence of diabetes (44.2% vs. 25.4%; p = 0.037), a lower prevalence of potential sources of cardioembolism (0% vs. 16.9%; p = 0.002), and a nonsignificantly lower prevalence of potential embolic sources from extracranial arteries (9.6% vs. 20.3%; p = 0.186) than those without. Patients with distal residual flow beyond the thrombus had a lower prevalence of potential sources of cardioembolism (1.4% vs. 22.5%; p < 0.001) and smaller infarct volumes (5.0 [1.4-12.7] mL vs. 16.6 [2.4-94.6] mL; p = 0.012) than those without. CONCLUSIONS Our study showed that HR-MRI helps clarify the pathogenesis of acute intracranial artery thrombus. The presence of peri-thrombus plaque and distal residual flow beyond the thrombus favor the stroke mechanism of atherosclerosis rather than cardioembolism.
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Affiliation(s)
- Zong-Mu-Yu Zhang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian-Qian Si
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Yang
- Department of Neurology, the First Hospital of Jilin University, Changchun, China
| | - Meng Zhang
- Department of Neurology, Army Medical Center of PLA, Beijing, China
| | - Shi-Wen Wu
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Yao Meng
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian-Qian Lin
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - David S Liebeskind
- UCLA Department of Neurology, Neurovascular Imaging Research Core and UCLA Comprehensive Stroke Center, Los Angeles, California, USA
| | - Yi-Ning Huang
- Department of Neurology, Peking University First Hospital, Peking University, Beijing, China
| | - Wei-Hai Xu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Liu H, Shao T, Yang T, Li D, Wang H, Cheng Y, Zhang T, Zhang J. Comparison of Cilostazol versus Clopidogrel in Addition to Aspirin in Patients with Ischemic Stroke who Underwent Intracranial or Extracranial Artery Stent Implantation. J Atheroscler Thromb 2023; 30:1010-1021. [PMID: 36328566 PMCID: PMC10406684 DOI: 10.5551/jat.63632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/19/2022] [Indexed: 08/04/2023] Open
Abstract
AIMS The role of cilostazol after intracranial or extracranial artery stent implantation is still unclear. Therefore, we designed this trial to explore the efficacy and safety of cilostazol in this particular population. METHODS In this retrospective study, patients were divided into the cilostazol or clopidogrel group by the antiplatelet therapy received after artery stent implantation. The primary efficacy endpoint was ischemic stroke. Bleeding events and other antiplatelet drug-related adverse reactions (ADRs) were also recorded. Neurological function prognosis was evaluated by the modified Rankin Scale (mRS) after discharge. RESULTS A total of 156 patients were enrolled; 56 underwent intracranial artery stenting, 95 underwent extracranial artery stenting, and 5 underwent intracranial combined with extracranial artery stenting. Any stroke and bleeding events in the hospital of the two groups were comparable (P=0.38, P=0.34, respectively). The incidence of stroke recurrence tended to be lower in the cilostazol group, although not significant (cilostazol vs. clopidogrel, 1.35% vs. 4.88%, P=0.25). There was a significant difference of any bleeding events between the two groups (cilostazol vs. clopidogrel, 5.41% vs. 20.73%, P=0.02). During follow-up, we did not observe an apparent increase of ADRs in the cilostazol group (cilostazol vs. clopidogrel, palpitation 4.05% vs. 2.44%, P=0.58; gastrointestinal discomfort events 8.11% vs. 12.20%, P=0.80). There were no differences between the two groups of neurological function prognosis (P=0.29). CONCLUSIONS Cilostazol-based dual antiplatelet therapy could be recommended as an effective and safe therapy regimen among patients undergoing intracranial or extracranial artery stent implantation.
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Affiliation(s)
- Hui Liu
- China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tengfei Shao
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tao Yang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Di Li
- Department of Pharmacy, Wuhan No.1 Hospital, Wuhan, Hubei, China
| | - Huan Wang
- Department of Pharmacy, Wuhan Fourth Hospital,Wuhan,Hubei, China
| | - Yue Cheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tingzheng Zhang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jinping Zhang
- China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
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17
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Zhang K, Liu T, Fan H, Wang Y, Li Y, Li J, Li Y, Yu Y, Wang J, Xue L, Du W, Niu W, Yan Y, Gao X, Li G, Liu Q, Liu Y, Fan Y, Ren J, Li X, Wu X, Niu X. Dual Versus Mono Antiplatelet Therapy in Patients with Acute Mild-to-Moderate Stroke: A Multicentre Perspective Cohort Study. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07468-7. [PMID: 37310551 DOI: 10.1007/s10557-023-07468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the association between different antiplatelet therapy regimens and the functional outcomes and bleeding complications among mild-to-moderate ischaemic stroke patients based on real-world data. METHODS We used data from the SEACOAST trial (Safety and efficacy of aspirin-clopidogrel in acute noncardiogenic minor ischaemic stroke) to analyse the data of patients with mild-to-moderate stroke within 72 h after onset who were treated with aspirin or clopidogrel alone or a combination of clopidogrel and aspirin from September 2019 to November 2021. Propensity score matching (PSM) was used to balance the differences between groups. We performed an analysis to evaluate the association of different antiplatelet regimens and 90-day disability, which was defined as a modified Rankin Scale score ≥2, as well as disability ascribed to index or recurrent stroke by the local investigator. In terms of safety, we then compared the bleeding events between the two groups. RESULTS A total of 2822 mild-to-moderate ischaemic stroke patients were treated with either clopidogrel plus aspirin (n = 1726, 61.2%) or aspirin/clopidogrel (n = 1096, 38.8%). Of 1726 patients in the dual antiplatelet group, 1350 (78.5%) received less than or equal to 30 days of combined therapy. At 90 days, 433 (15.3%) patients were disabled. Patients who received combined therapy had a lower overall disability rate (13.7% versus 17.9%; OR 0.78 (0.6-1.01); P = 0.064). However, investigators found that index stroke was the reason for significantly fewer patients in the dual antiplatelet group having disability (8.4% versus 12%; OR, 0.72 (0.52-0.98); P = 0.038). There was no statistically significant difference in the incidence of moderate to severe bleeding complications between the dual and mono antiplatelet drug regimens (0.4% versus 0.2%; HR 1.5 (0.25, 8.98); P = 0.657). CONCLUSION Aspirin plus clopidogrel was associated with a reduction in the incidence of disability attributed to index stroke. There was no statistically significant difference in the incidence of moderate to severe bleeding complications between the two antiplatelet drug regimens. TRIAL REGISTRATION NUMBER ChiCTR1900025214.
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Affiliation(s)
- Kaili Zhang
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Liu
- Department of Neurology, The First Hospital of Shanxi Medical University, Xiaoyuan Niu; 85 Jiefang South Road, Taiyuan, Shanxi, China
| | - Haimei Fan
- Department of Neurology, The General Hospital of TISCO Affiliated to Shanxi Medical University, Taiyuan, China
| | - Yongle Wang
- Department of Neurology, The First Hospital of Shanxi Medical University, Xiaoyuan Niu; 85 Jiefang South Road, Taiyuan, Shanxi, China
| | - Yanan Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Xiaoyuan Niu; 85 Jiefang South Road, Taiyuan, Shanxi, China
| | - Juan Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Xiaoyuan Niu; 85 Jiefang South Road, Taiyuan, Shanxi, China
| | - Yali Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Xiaoyuan Niu; 85 Jiefang South Road, Taiyuan, Shanxi, China
| | - Yaqin Yu
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junhui Wang
- Department of Neurology, Yanhu Branch First Hospital of Shanxi Medical University, Yuncheng, China
| | - Lixi Xue
- Department of Neurology, Yanhu Branch First Hospital of Shanxi Medical University, Yuncheng, China
| | - Wenxian Du
- Department of Neurology, First People's Hospital of JIN ZHONG, Jinzhong, China
| | - Wenhua Niu
- Department of Neurology, First People's Hospital of JIN ZHONG, Jinzhong, China
| | - Yuping Yan
- Department of Neurology, Taiyuan Wanbailin District Medical Group Central Hospital, Taiyuan, China
| | - Xiaolei Gao
- Department of Neurology, Taiyuan Wanbailin District Medical Group Central Hospital, Taiyuan, China
| | - Gaimei Li
- Department of Neurology, China Railway 17th Bureau Group Company Central Hospital, Taiyuan, China
| | - Qingping Liu
- Department of Neurology, China Railway 17th Bureau Group Company Central Hospital, Taiyuan, China
| | - Yuting Liu
- Department of Neurology, Shanxi cardiovascular hospital, Taiyuan, China
| | - Yanhong Fan
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Jing Ren
- Department of Neurology, Shanxi cardiovascular hospital, Taiyuan, China
| | - Xinyi Li
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xuemei Wu
- Department of Neurology, The General Hospital of TISCO Affiliated to Shanxi Medical University, Taiyuan, China
| | - Xiaoyuan Niu
- Department of Neurology, The First Hospital of Shanxi Medical University, Xiaoyuan Niu; 85 Jiefang South Road, Taiyuan, Shanxi, China.
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18
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Chen G, Wang Z, Song W, Liao Y, Wang X, Chen C, Ming J, Cui J, Xu K. Effects of long-term regular oral aspirin combined with atorvastatin to prevent ischemic stroke on human gut microbiota. Eur J Pharmacol 2023; 951:175800. [PMID: 37201625 DOI: 10.1016/j.ejphar.2023.175800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Every year, there is a large number of people take aspirin and atorvastatin to prevent ischemic stroke, but the effect of these drugs on gut microbiota remains unknown. We aimed to examine the effects of long-term regular oral aspirin with atorvastatin to prevent ischemic stroke on human gut microbiota. METHODS A cross-sectional study of 20 participants with the drugs over one year and the other 20 gender- and age-matching participants without medication were recruited from the Affiliated Hospital of Guizhou Medical University. The medication habits and dietary information were obtained using a questionnaire. Fecal samples collected from all participants were subjected to 16S rRNA sequencing of the microbiome. The datasets were analyzed using bioinformatics approaches. RESULTS The Alpha diversity showed that compared with controls, medication participants had lower ACE and Chao1 index, while no difference in the Shannon index and Simpson index. The Beta diversity analysis revealed significant shifts in the taxonomic compositions of the two groups. Linear discriminant analysis effect size (LEfSe) analysis combined with receiver operating characteristic (ROC) curves revealed the marker bacteria associated with taking medication were g_Parabacteroides(AUC = 0.855), g_Bifidobacterium(AUC = 0.815), s_Bifidobacterium_longum_subsp(AUC = 0.8075), and with no taking medication was g_Prevotella_9(AUC = 0.76). CONCLUSIONS Our findings indicated that long-term regular oral aspirin and atorvastatin modulate the human gut microbiota. Taking these drugs may affect the preventive effect of ischemic stroke by changing the abundance of specific gut microbiota.
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Affiliation(s)
- Guangtang Chen
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Zili Wang
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wenxue Song
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Yidong Liao
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Xudong Wang
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Chen Chen
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Jiang Ming
- School of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Junshuan Cui
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Kaya Xu
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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19
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Yan Z, Li S, Wang Y, Guo Y, Zhang L. Protective effects of a novel glycogen phosphorylase inhibitor against cerebral ischemia-reperfusion injury in mice. Future Med Chem 2023; 15:587-597. [PMID: 37097106 DOI: 10.4155/fmc-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Aim: To evaluate the effects of a novel glycogen phosphorylase inhibitor (NGPI) on cerebral ischemia-reperfusion injury (CIRI). Methods: Cerebral ischemia was induced in mice using a modified bilateral common carotid artery ligation model. To assess the effects of NGPI against CIRI, mice which had been administered with different doses of NGPI (1.25, 2.5, 5 mg/kg/day) for 7 days before the injury were evaluated for infarct volume, the apoptosis level of brain tissue, integrity of brain tissue and oxidative stress level. Results: NGPI effectively improved the infarct area, apoptosis of neurons, integrity of brain tissue and oxidative stress level of mice with CIRI. Conclusion: NGPI could effectively improve CIRI and deserves further study.
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Affiliation(s)
- Zhiwei Yan
- Key Laboratory of Traditional Chinese Medicine Research & Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde, Hebei, 067000, China
| | - Shuai Li
- Key Laboratory of Traditional Chinese Medicine Research & Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde, Hebei, 067000, China
| | - Youde Wang
- Key Laboratory of Traditional Chinese Medicine Research & Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde, Hebei, 067000, China
| | - Yachun Guo
- Department of Pathogen Biology, Chengde Medical University, Chengde, Hebei, 067000, China
| | - Liying Zhang
- Key Laboratory of Traditional Chinese Medicine Research & Development of Hebei Province, Institute of Traditional Chinese Medicine, Chengde Medical University, Chengde, Hebei, 067000, China
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20
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Cui M, You T, Zhao Y, Liu R, Guan Y, Liu J, Liu X, Wang X, Dong Q. Ginkgo biloba extract EGb 761® improves cognition and overall condition after ischemic stroke: Results from a pilot randomized trial. Front Pharmacol 2023; 14:1147860. [PMID: 37063270 PMCID: PMC10090660 DOI: 10.3389/fphar.2023.1147860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Patients who experienced an ischemic stroke are at risk for cognitive impairment. Quantified Ginkgo biloba extract EGb 761® has been used to treat cognitive dysfunction, functional impairment and neuropsychiatric symptoms in mild cognitive impairment and dementia.Objectives: To assess the cognitive-related effects of EGb 761® treatment in patients after acute ischemic stroke, as well as the feasibility of patient selection and outcome measures.Methods: We conducted a randomized, multicentric, open-label trial at 7 centers in China. Patients scoring 20 or lower on the National Institutes of Health Stroke Scale were enrolled between 7 and 14 days after stroke onset and randomly assigned to receive 240 mg per day of EGb 761® or no additional therapy for 24 weeks in a 1:1 ratio. Both groups received standard treatments for the prevention of recurrent stroke during the trial. General cognitive function and a battery of cognitive tests for sub-domains were evaluated at 24 weeks. All patients were monitored for adverse events.Results: 201 patients ≥50 years old were included, with 100 assigned to the EGb 761® group and 101 to the reference group. The mean change from baseline on the global cognitive function as assessed by the Montreal Cognitive Assessment score was 2.92 in the EGb 761® group and 1.33 in the reference group (between-group difference: 1.59 points; 95% confidence interval [CI], 0.51 to 2.67; p < 0.005). For cognitive domains, EGb 761® showed greater effects on the Hopkins Verbal Learning Test Total Recall (EGb 761® change 1.40 vs. reference −0.49) and Form 1 of the Shape Trail Test (EGb 761® change −38.2 vs. reference −15.6). Potentially EGb 761®-related adverse events occurred in no more than 3% of patients.Conclusion: Over the 24-week period, EGb 761® treatment improved overall cognitive performance among patients with mild to moderate ischemic stroke. Our findings provide valuable recommendations for the design of future trials, including the criteria for patient selection.Clinical Trial Registration:www.isrctn.com, identifier ISRCTN11815543.
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Affiliation(s)
- Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongyao You
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yangtai Guan
- Department of Neurology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianren Liu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Ninth People’s Hospital, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tong Ji University Affiliated Tenth People’s Hospital, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Qiang Dong,
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21
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Mead GE, Sposato LA, Sampaio Silva G, Yperzeele L, Wu S, Kutlubaev M, Cheyne J, Wahab K, Urrutia VC, Sharma VK, Sylaja PN, Hill K, Steiner T, Liebeskind DS, Rabinstein AA. A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization. Int J Stroke 2023; 18:499-531. [PMID: 36725717 DOI: 10.1177/17474930231156753] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. AIMS To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). SUMMARY OF REVIEW Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. CONCLUSION The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.
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Affiliation(s)
- Gillian E Mead
- Usher Institute, University of Edinburgh and Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.,Heart & Brain Lab, Western University, London, ON, Canada.,Robarts Research Institute, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Laetitia Yperzeele
- Antwerp NeuroVascular Center and Stroke Unit, Antwerp University Hospital, Antwerp, Belgium.,Research Group on Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mansur Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa, Russia
| | - Joshua Cheyne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Neurology, University Medicine Cluster, National University Health System, Singapore
| | - P N Sylaja
- Neurology and Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Kelvin Hill
- Stroke Treatment, Stroke Foundation, Melbourne, VIC, Australia
| | - Thorsten Steiner
- Departments of Neurology, Klinikum Frankfurt Höchst and Heidelberg University Hospital, Frankfurt, Germany
| | - David S Liebeskind
- UCLA Department of Neurology, Neurovascular Imaging Research Core, UCLA Comprehensive Stroke Center, Los Angeles, CA, USA
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22
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Wang CJ, Gu HQ, Zhang XM, Jiang Y, Li H, Bettger JP, Meng X, Dong KH, Wangqin RQ, Yang X, Wang M, Liu C, Liu LP, Tang BS, Li GZ, Xu YM, He ZY, Yang Y, Yip W, Fonarow GC, Schwamm LH, Xian Y, Zhao XQ, Wang YL, Wang Y, Li Z. Temporal trends and rural-urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey. Stroke Vasc Neurol 2023; 8:34-50. [PMID: 35985768 PMCID: PMC9985802 DOI: 10.1136/svn-2022-001552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stroke is the leading cause of mortality in China, with limited evidence of in-hospital burden obtained from nationwide surveys. We aimed to monitor and track the temporal trends and rural-urban disparities in cerebrovascular risk factors, management and outcomes from 2005 to 2015. METHODS We used a two-stage random sampling survey to create a nationally representative sample of patients admitted for ischaemic stroke in 2005, 2010 and 2015. We sampled participating hospitals with an economic-geographical region-stratified random-sampling approach first and then obtained patients with a systematic sampling approach. We weighed our survey data to estimate the national-level results and assess changes from 2005 to 2015. RESULTS We analysed 28 277 ischaemic stroke admissions from 189 participating hospitals. From 2005 to 2015, the estimated national hospital admission rate for ischaemic stroke per 100 000 people increased (from 75.9 to 402.7, Ptrend<0.001), and the prevalence of risk factors, including hypertension, diabetes, dyslipidaemia and current smoking, increased. The composite score of diagnostic tests for stroke aetiology assessment (from 0.22 to 0.36, Ptrend<0.001) and secondary prevention treatments (from 0.46 to 0.70, Ptrend<0.001) were improved. A temporal decrease was found in discharge against medical advice (DAMA) (from 15.2% (95% CI 13.7% to 16.7%) to 8.6% (8.1% to 9.0%); adjusted Ptrend=0.046), and decreases in in-hospital mortality (0.7% in 2015 vs 1.8% in 2005; adjusted OR (aOR) 0.52; 95% CI 0.32 to 0.85) and the composite outcome of in-hospital mortality or DAMA (8.4% in 2015 vs 13.9% in 2005; aOR 0.65; 95% CI 0.47 to 0.89) were observed. Disparities between rural and urban hospitals narrowed; however, disparities persisted in in-hospital management (brain MRI: rural-urban difference from -14.4% to -11.2%; cerebrovascular assessment: from -20.3% to -16.7%; clopidogrel: from -2.1% to -10.3%; anticoagulant for atrial fibrillation: from -10.9% to -8.2%) and in-hospital outcomes (DAMA: from 2.7% to 5.0%; composite outcome of in-hospital mortality or DAMA: from 2.4% to 4.6%). CONCLUSIONS From 2005 to 2015, improvements in hospital admission and in-hospital management for ischaemic stroke in China were found. A temporal improvement in DAMA and improvements in in-hospital mortality and the composite outcome of in-hospital mortality or DAMA were observed. Disparities between rural and urban hospitals generally narrowed but persisted.
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Affiliation(s)
- Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Miao Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke-Hui Dong
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China
| | - Run-Qi Wangqin
- Department of Neurology, Duke Univeristy Medical Center, Durham, North Carolina, USA
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meng Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bei-Sha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo-Zhong Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Key Laboratory of Cerebrovascular Disease Prevention and Treatment, National Health Commission (Province and Ministry Co-constructed), Zhengzhou, Henan, China
| | - Zhi-Yi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ying Xian
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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Meng Y, Zhang Y, Chu X, Song Y, Zhao W, Zheng M, Zhang J, Han J. Plaque modification and stabilization after drug-coated balloon angioplasty for intracranial atherosclerotic lesions. Eur Radiol 2023; 33:1112-1120. [PMID: 36136108 DOI: 10.1007/s00330-022-09129-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES A drug-coated balloon (DCB) has potential applications in the treatment of intracranial atherosclerotic disease (ICAD). We aimed to evaluate changes of vessel wall features of ICAD lesions after DCB treatment by using vessel wall MRI (VWMRI). METHODS We retrospectively included patients with symptomatic ICAD who underwent DCB angioplasty alone. The incidences of stenosis of the lumen area, vessel wall thickening, hyperintense plaques, and prominent wall enhancement were compared between the baseline and follow-up VWMRI. RESULTS There were 29 ICAD lesions from 29 patients, of which 22 were stenosis and 7 were occlusion. The median interval between DCB treatment and follow-up VWMRI was 4.1 [3.3, 6.7] months. After DCB treatment, follow-up VWMRI showed a significant decrease in the stenosis degree of the lumen area (83% [71%, 96%] vs 15% [3%, 41%], p < 0.001). Thirty-eight percent (11/29) of the patients observed normal appearance of the target vessel wall on follow-up VWMRI. In the stenosis group, the prevalence of hyperintense plaques decreased from 66.7% (14/21) at baseline to 23.8% (5/21) at follow-up, and prominent wall enhancement decreased from 66.7% (14/21) at baseline to 19.0%(4/21) at follow-up. The incidence of hyperintense plaques (p = 0.028) and vessel wall thickening (p = 0.018) tended to decrease with follow-up time. Although not significant (p = 0.106), a similar trend was observed between the incidence of prominent wall enhancement and follow-up time. CONCLUSION Vascular healing with plaque modification and stabilization occurred following DCB treatment of ICAD lesions. KEY POINTS • A drug-coated balloon (DCB) has potential applications in the treatment of intracranial atherosclerotic disease (ICAD). • Vascular healing with plaque modification and stabilization occurred following DCB treatment of ICAD lesions.
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Affiliation(s)
- Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yuyan Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Xi Chu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yun Song
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Wei Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Meimei Zheng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Ju Han
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
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Luo H, Guo H, Zhou Y, Fang R, Zhang W, Mei Z. Neutrophil Extracellular Traps in Cerebral Ischemia/Reperfusion Injury: Friend and Foe. Curr Neuropharmacol 2023; 21:2079-2096. [PMID: 36892020 PMCID: PMC10556361 DOI: 10.2174/1570159x21666230308090351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 03/10/2023] Open
Abstract
Cerebral ischemic injury, one of the leading causes of morbidity and mortality worldwide, triggers various central nervous system (CNS) diseases, including acute ischemic stroke (AIS) and chronic ischemia-induced Alzheimer's disease (AD). Currently, targeted therapies are urgently needed to address neurological disorders caused by cerebral ischemia/reperfusion injury (CI/RI), and the emergence of neutrophil extracellular traps (NETs) may be able to relieve the pressure. Neutrophils are precursors to brain injury following ischemic stroke and exert complicated functions. NETs extracellularly release reticular complexes of neutrophils, i.e., double-stranded DNA (dsDNA), histones, and granulins. Paradoxically, NETs play a dual role, friend and foe, under different conditions, for example, physiological circumstances, infection, neurodegeneration, and ischemia/reperfusion. Increasing evidence indicates that NETs exert anti-inflammatory effects by degrading cytokines and chemokines through protease at a relatively stable and moderate level under physiological conditions, while excessive amounts of NETs release (NETosis) irritated by CI/RI exacerbate the inflammatory response and aggravate thrombosis, disrupt the blood-brain barrier (BBB), and initiates sequential neuron injury and tissue damage. This review provides a comprehensive overview of the machinery of NETs formation and the role of an abnormal cascade of NETs in CI/RI, as well as other ischemia-induced neurological diseases. Herein, we highlight the potential of NETs as a therapeutic target against ischemic stroke that may inspire translational research and innovative clinical approaches.
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Affiliation(s)
- Haoyue Luo
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese Medicine and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Hanjing Guo
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese Medicine and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Yue Zhou
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese Medicine and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Rui Fang
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese Medicine and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Wenli Zhang
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Zhigang Mei
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese Medicine and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
- Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang, Hubei, 443002, China
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Bai Y, He Z, Duan W, Gu H, Wu K, Yuan W, Liu W, Huang H, Li Y. Sodium formononetin-3'-sulphonate alleviates cerebral ischemia-reperfusion injury in rats via suppressing endoplasmic reticulum stress-mediated apoptosis. BMC Neurosci 2022; 23:74. [PMID: 36482320 PMCID: PMC9733209 DOI: 10.1186/s12868-022-00762-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sodium formononetin-3'-sulphonate (Sul-F) may alleviate I/R injury in vivo with uncertain mechanism. Endoplasmic reticulum (ER) stress-mediated apoptosis participates in the process of cerebral ischemia-reperfusion (I/R) injury. Our aim is to figure out the effect of Sul-F on cerebral I/R injury and to verify whether it works through suppressing ER stress-mediated apoptosis. RESULTS The cerebral lesions of middle cerebral artery occlusion (MCAO) model in SD rats were aggravated after 24 h of reperfusion, including impaired neurological function, increased infarct volume, intensified inflammatory response and poor cell morphology. After intervention, the edaravone (EDA, 3 mg/kg) group and Sul-F high-dose (Sul-F-H, 80 mg/kg) group significantly alleviated I/R injury via decreasing neurological score, infarct volume and the serum levels of inflammatory factors (TNF-α, IL-1β and IL-6), as well as alleviating pathological injury. Furthermore, the ER stress level and apoptosis rate were elevated in the ischemic penumbra of MCAO group, and were significantly blocked by EDA and Sul-F-H. In addition, EDA and Sul-F-H significantly down-regulated the ER stress related PERK/eIF2α/ATF4 and IRE1 signal pathways, which led to reduced cell apoptosis rate compared with the MCAO group. Furthermore, there was no difference between the EDA and Sul-F-H group in terms of therapeutic effect on cerebral I/R injury, indicating a therapeutic potential of Sul-F for ischemic stroke. CONCLUSIONS Sul-F-H can significantly protects against cerebral I/R injury through inhibiting ER stress-mediated apoptosis in the ischemic penumbra, which might be a novel therapeutic target for ischemic stroke.
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Affiliation(s)
- Yue Bai
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Zhiwei He
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Weisong Duan
- grid.452702.60000 0004 1804 3009Neurological Laboratory of Hebei Province, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - He Gu
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Kefeng Wu
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Wei Yuan
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Wenkang Liu
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Huaipeng Huang
- grid.256883.20000 0004 1760 8442Department of Internal Medicine, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Yanan Li
- grid.256883.20000 0004 1760 8442Department of Clinical Laboratory Diagnosis, Shijiazhuang Pingan Hospital, Hebei Medical University, Shijiazhuang, 050000 Hebei China
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Hu R, Liang J, Ding L, Zhang W, Liu X, Song B, Xu Y. Edaravone dexborneol provides neuroprotective benefits by suppressing NLRP3 inflammasome-induced microglial pyroptosis in experimental ischemic stroke. Int Immunopharmacol 2022; 113:109315. [DOI: 10.1016/j.intimp.2022.109315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/09/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
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Naoxintong Capsule for Secondary Prevention of Ischemic Stroke: A Multicenter, Randomized, and Placebo-Controlled Trial. Chin J Integr Med 2022; 28:1063-1071. [PMID: 36251140 DOI: 10.1007/s11655-022-3586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding. METHODS A total of 23 Chinese medical centers participated in this trial. Adult patients with a history of ischemic stroke were randomly assigned in a 1:1 ratio using a block design to receive either Naoxintong Capsule (1.2 g orally, twice a day) or placebo in addition to standard care. The primary endpoint was recurrence of ischemic stroke within 2 years. Secondary outcomes included myocardial infarction, death due to recurrent ischemic stroke, and all-cause mortality. The safety of drugs was monitored. Results were analyzed using the intention-to-treat principle. RESULTS A total of 2,200 patients were enrolled from March 2015 to March 2016, of whom 143 and 158 in the Naoxintong and placebo groups were lost to follow-up, respectively. Compared with the placebo group, the recurrence rate of ischemic stroke within 2 years was significantly lower in the Naoxintong group [6.5% vs. 9.5%, hazard ratio (HR): 0.665, 95% confidence interval (CI): 0.492-0.899, P=0.008]. The two groups showed no significant differences in the secondary outcomes and safety, including rates of severe hemorrhage, cerebral hemorrhage and subarachnoid hemorrhage (P>0.05). CONCLUSION The combination of Naoxintong Capsule with standard care reduced the 2-year stroke recurrence rate in patients with ischemic stroke without increasing the risk of severe hemorrhage in high-risk patients. (Trial registration No. NCT02334969).
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Effects of miRNA-Modified Exosomes Alleviate Cerebral Ischemic Reperfusion Injury in Preclinical Studies: A Meta-Analysis. World Neurosurg 2022; 168:278-286.e2. [DOI: 10.1016/j.wneu.2022.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
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Chronic remote ischaemic conditioning in patients with symptomatic intracranial atherosclerotic stenosis (the RICA trial): a multicentre, randomised, double-blind sham-controlled trial in China. Lancet Neurol 2022; 21:1089-1098. [DOI: 10.1016/s1474-4422(22)00335-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/10/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
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Edaravone Dexborneol Alleviates Cerebral Ischemic Injury via MKP-1-Mediated Inhibition of MAPKs and Activation of Nrf2. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4013707. [PMID: 36110124 PMCID: PMC9470337 DOI: 10.1155/2022/4013707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022]
Abstract
The edaravone and dexborneol concentrated solution for injection (edaravone-dexborneol) is a medication used clinically to treat neurological impairment induced by ischemic stroke. This study was aimed at investigating the preventive effects and the underlying mechanisms of edaravone-dexborneol on cerebral ischemic injury. A rat four-vessel occlusion (4-VO) model was established, and the neuronal injury and consequent neurological impairment of rats was investigated. Brain tissue malondialdehyde (MDA), myeloperoxidase (MPO), and nitric oxide (NO) levels were determined. The levels of proteins in mitogen-activated protein kinases (MAPKs), nuclear factor erythroid 2-related factor 2 (Nrf2), and nuclear factor-κB (NF-κB) signaling pathways were determined by western immunoblotting. The function of mitogen-activated protein kinase phosphatase 1 (MKP-1) was investigated using both western blot and immunofluorescence methods, and the effect of the MKP-1 inhibitor, (2E)-2-benzylidene-3-(cyclohexylamino)-3H-inden-1-one (BCI), was investigated. The results indicated that edaravone-dexborneol alleviated neurological deficiency symptoms and decreased apoptosis and neuron damage in the hippocampal CA1 area of the ischemic rats. Edaravone-dexborneol increased the MKP-1 level; decreased the phosphorylation of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 mitogen-activated protein kinase (p38 MAPK); inhibited NF-κB p65 activation; and boosted Nrf2 activation, all of which were partially reversed by the MKP-1 inhibitor, BCI. The above results indicated that the upregulation of MKP-1 contributed to the protective effects of edaravone-dexborneol against ischemic brain injury. Our findings support the hypothesis that edaravone-dexborneol can alleviate cerebral ischemic injury via the upregulation of MKP-1, which inhibits MAPKs and activates Nrf2.
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Liu T, Li Y, Niu X, Wang Y, Zhang K, Fan H, Ren J, Li J, Fang Y, Li X, Wu X. Factors affecting physician decision-making regarding antiplatelet therapy in minor ischemic stroke. Front Neurol 2022; 13:937417. [PMID: 36119700 PMCID: PMC9477012 DOI: 10.3389/fneur.2022.937417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To identify the most important factors affecting physician decision-making regarding antiplatelet therapy. Methods We retrospectively gathered data from minor ischemic stroke patients with NIHSS scores ≤ 5 within 72 h of onset from 2010 to 2018. The population was divided into four groups by initial antiplatelet therapy: aspirin monotherapy (AM), dual antiplatelet therapy with aspirin and a loading dose of clopidogrel (clopidogrel loading dose of 300 mg on the first day; DAPT-ALC), dual antiplatelet therapy with aspirin and no loading dose of clopidogrel (clopidogrel 75 mg daily, no loading dose; DAPT-AUC), and clopidogrel monotherapy (CM). Results In total, 1,377 patients were included in the analysis (excluding patients who accepted thrombolytic drugs, participated in other clinical trials, or had not used antiplatelet drugs). The mean ± S.D. age was 62.0 ± 12.7 years; 973 (70.7%) patients were male. The four groups were AM (n = 541, 39.3%), DAPT-ALC (n = 474, 34.4%), DAPT- AUC (n = 301, 21.9%), and CM (n = 61, 4.4%). Patients receiving antiplatelet monotherapy were older than those receiving dual antiplatelet therapy (63.7–65.7 vs. 59.6–61.4 years), and the median initial systolic blood pressure level was higher in the DAPT-ALC group than in the other groups (all P < 0.05). Patients under 75 years old with an admission SBP lower than 180 mmHg, a history of AM, coronary heart disease, no history of intracerebral hemorrhage, stroke onset occurring after guideline recommendations were updated (the year of 2015), onset-to-arrival time within 24 h, and initial NIHSS score ≤ 3 were more likely to take DAPT-ALC than AM. Compared with DAPT-ALC, DAPT-AUC was associated with an initial SBP level lower than 180 mmHg, a history of smoking, hypertension, no history of ICH, previous treatment with antihypertensives, and onset year after the recommendations were updated. Conclusions Many factors affect doctors' decisions regarding antiplatelet therapy, especially guidelines, age, admission SBP level, and hypertensive disease.
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Affiliation(s)
- Tingting Liu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Medical University, Taiyuan, China
| | - Yanan Li
- Shanxi Medical University, Taiyuan, China
| | - Xiaoyuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Xiaoyuan Niu
| | | | - Kaili Zhang
- The Bethune Hospital of Shanxi Province, Taiyuan, China
| | - Haimei Fan
- General Hospital of Tisco (Sixth Hospital of Shanxi Medical University), Shanxi, China
| | - Jing Ren
- Shanxi Medical University, Taiyuan, China
| | - Juan Li
- Shanxi Medical University, Taiyuan, China
| | - Yalan Fang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinyi Li
- The Bethune Hospital of Shanxi Province, Taiyuan, China
| | - Xuemei Wu
- General Hospital of Tisco (Sixth Hospital of Shanxi Medical University), Shanxi, China
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Zhang L, Li X, Lyu Q, Shi G. Imaging diagnosis and research progress of carotid plaque vulnerability. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:905-912. [PMID: 35801515 DOI: 10.1002/jcu.23266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/26/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Ischemic stroke (IS) exhibits a high disability rate, mortality, and recurrence rate, imposing a serious threat to human survival and health. Its occurrence is affected by various factors. Although the previous research has demonstrated that the occurrence of IS is mainly associated with lumen stenosis caused by carotid atherosclerotic plaque (AP), recent studies have revealed that many patients will still suffer from IS even with mild carotid artery lumen stenosis. Blood supply disturbance causes 10% of IS to the corresponding cerebral blood supply area caused by carotid vulnerable plaque. Thrombus blockage of distal branch vessels caused by rupture of vulnerable carotid plaque is the main cause of ischemic stroke. Therefore, how to accurately evaluate vulnerable plaque and intervene as soon as possible is a problem that needs to be solved in clinic. The vulnerability of plaque is determined by its internal components, including thin and incomplete fibrous cap, necrotic lipid core, intra-plaque hemorrhage, intra-plaque neovascularization, and ulcerative plaque formation. The development of imaging technology enables the routine detection of AP vulnerability. By analyzing the pathological changes, characteristics, and formation mechanism of carotid plaque vulnerability, this article aims to explore the modern imaging methods which can be used to identify plaque composition and plaque vulnerability to provide a reference basis for disease diagnosis and differential diagnosis.
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Affiliation(s)
- Lianlian Zhang
- Yancheng Clinical College of Xuzhou Medical University, The First peolie's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Xia Li
- Affiliated Hospital of Jiangsu medical vocational college, The Third People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Qi Lyu
- Taizhou People's Hospital, Taizhou, China
| | - Guofu Shi
- Affiliated Hospital of Jiangsu medical vocational college, The Third People's Hospital of Yancheng, Yancheng, Jiangsu, China
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Edaravone Dexborneol Downregulates Neutrophil Extracellular Trap Expression and Ameliorates Blood-Brain Barrier Permeability in Acute Ischemic Stroke. Mediators Inflamm 2022; 2022:3855698. [PMID: 36032782 PMCID: PMC9410976 DOI: 10.1155/2022/3855698] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Our previous work has shown that inflammatory processes play a detrimental role in the pathophysiology of acute ischemic stroke (AIS). Neutrophil extracellular traps (NETs) have been recognized as a key contributor to the proinflammatory response in AIS and could aggravate blood-brain barrier (BBB) damage. Recently, experimental and clinical researches showed that Edaravone Dexborneol (Eda.B), which is comprised of two active ingredients, Edaravone and (+)-Borneol, was effective in treatment of AIS. However, it is not clear whether the effects of Eda.B against AIS are related to NETs and BBB permeability. Methods Experiment 1 was to detect the effects of Eda.B in AIS patients. Serum samples of volunteers and AIS patients were collected before and 3 days after Edaravone Dexborneol treatment. Markers of NETs and occludin were detected by ELISA kit. Experiment 2 was to explore the effects of Eda.B on experimental stroke mice. Male C57BL/6 mice were subjected to distal middle cerebral artery occlusion (MCAO) and treated with vehicle, Eda.B, or DeoxyribonueleaseI (DNase I). After stroke, the neurobehavioral tests, infarct volume, and cerebral blood flow evaluation were determined. Leakage of Evans blue was to assess the integrity of BBB. Western blot, real-time quantitative polymerase chain reaction (RT-qPCR), and immunofluorescence were used to examine the expression of NETs and tight junction- (TJ-) associated proteins. Results Eda.B significantly improved neurological function and cerebral blood flow but reduced infarct volume after experimental stroke. Eda.B downregulated level of NETs in serum samples of AIS patients and tissue samples of MCAO mouse cortex. Eda.B and DNase I alleviated BBB permeability by upregulating TJ-associated proteins. Conclusion NETs are related to the early stage of AIS. Eda.B exerted neuroprotective effects and ameliorated BBB permeability after AIS.
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Xu J, Zhang X, Jin A, Pan Y, Li Z, Meng X, Wang Y. Trends and Risk Factors Associated With Stroke Recurrence in China, 2007-2018. JAMA Netw Open 2022; 5:e2216341. [PMID: 35704318 PMCID: PMC9201671 DOI: 10.1001/jamanetworkopen.2022.16341] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Recurrent stroke rates have decreased substantially in Western countries. However, data on changes in stroke recurrence and risk factor patterns in China are limited. OBJECTIVE To systematically assess stroke recurrence trends by evaluating temporal improvement in guideline-recommended secondary prevention treatment performance and changes in risk factor patterns over 10 years in China. DESIGN, SETTING, AND PARTICIPANTS This post hoc cohort study was conducted based on data from the China National Stroke Registries (CNSRs, comprising 3 phases, I-III, from 2007-2018). Participants were patients with ischemic stroke who were enrolled in CNSR I or III within 7 days of symptom onset. Data were analyzed from September through November 2021. EXPOSURES Vascular risk factors included current smoking, alcohol consumption, hypertension, diabetes, coronary artery disease, atrial fibrillation, and low-density lipoprotein cholesterol (LDL-C) levels. MAIN OUTCOMES AND MEASURES The cumulative incidence rates of stroke recurrence at 3, 6, and 12 months were calculated, and the performance of guideline-based secondary prevention treatments was investigated at each visit in CNSR I (2007-2008) and III (2015-2018). Logistic regression models were used to evaluate changes in risk factor patterns for stroke recurrence based on data from CNSR I and III. RESULTS A total of 10 952 patients with ischemic stroke from CNSR I (6740 [61.5%] men; median [IQR] age, 67 [57-75] years) and 10 348 patients with ischemic stroke from CNSR III (7128 [68.9%] men; median [IQR] age, 63 [54-70] years) were selected. Over 10 years, the adjusted cumulative incidence of recurrent stroke within 12 months decreased from 15.5% (95% CI, 14.8%-16.2%) to 12.5% (95% CI, 11.9%-13.1%) (P < .001). Factors associated with increased risk of stroke in CNSR I that were still associated after 10 years included age per 10 years (CNSR I: odds ratio [OR], 1.24; 95% CI, 1.18-1.31; CNSR III: OR, 1.08; 95% CI, 1.01-1.15), prior stroke (CNSR I: OR, 1.62; 95% CI, 1.45-1.82; CNSR III: OR, 1.66; 95% CI, 1.44-1.92), coronary heart disease (CNSR I: OR, 1.21; 95% CI, 1.04-1.40; CNSR III: OR, 1.23; 95% CI, 1.02-1.49), and LDL-C level per 10 mg/dL (0.259 mmol/L) (CNSR I: OR, 1.02; 95% CI, 1.01-1.04; CNSR III: OR, 1.02; 95% CI, 1.00-1.03), whereas atrial fibrillation (CNSR I: OR, 1.51; 95% CI, 1.26-1.81; CNSR III: OR, 0.95; 95% CI, 0.74-1.23) was no longer an independent risk factor in 2015 to 2018. CONCLUSIONS AND RELEVANCE This study found that stroke recurrence rate in China decreased significantly, but approximately 12.5% of patients still experienced stroke recurrence within 12 months. These findings suggest that more intensive control of traditional risk factors, including LDL-C levels, may be needed to further reduce stroke recurrence.
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Affiliation(s)
- Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xing Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Aoming Jin
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, 2019RU018, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
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Xu L, Gao Y, Hu M, Dong Y, Xu J, Zhang J, Lv P. Edaravone dexborneol protects cerebral ischemia reperfusion injury through activating Nrf2/HO-1 signaling pathway in mice. Fundam Clin Pharmacol 2022; 36:790-800. [PMID: 35470467 PMCID: PMC9545784 DOI: 10.1111/fcp.12782] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/26/2022] [Accepted: 04/21/2022] [Indexed: 12/16/2022]
Abstract
Stroke is the leading cause of disability and death. When blood flow is restored after prolonged ischemia and hypoxia, it leads to excessive production of reactive oxygen species (ROS), increased local inflammation, and apoptosis, which are the cause of most cerebral ischemia reperfusion injury (CIRI), leading to secondary brain tissue damage. Edaravone dexborneol is a novel neuroprotective agent consisting of edaravone and borneol. Studies have shown that it has synergistic antioxidant and anti‐inflammatory effects. However, whether Edaravone dexborneol stimulates the Nrf2/HO‐1 pathway to regulate NADPH oxidase 2 (NOX2) remains unclear. In this study, wild‐type (WT) mice and Nrf2 knockout (KO) mice were used to investigate the antioxidant, anti‐inflammatory, and anti‐apoptotic effects of Edaravone dexborneol on CIRI and its mechanism. The cognitive function of mice was evaluated with the Morris water maze (MWM), test and the cell structures of hippocampus were observed by hematoxylin and eosin (H&E) staining. Nrf2, HO‐1, and NOX2 proteins and apoptosis‐related proteins Bcl‐2, Bax, and Caspase 3 were detected by western blotting. Nrf2, HO‐1, NOX2, and inflammatory factors TNF‐α, IL‐1β, IL‐4, and IL‐10 were detected by real‐time polymerase chain reaction. The results showed that Edaravone dexborneol treatment improved learning and memory performance, neuronal damage, and enhanced antioxidant, inflammation, and apoptosis in CIRI mice. In addition, Edaravone dexborneol induced the activation Nrf2/HO‐1 signaling pathway activation while inhibiting NOX2 expression. Overall, these results indicate that Edaravone dexborneol ameliorates CIRI‐induced memory impairments by activating Nrf2/HO‐1 signaling pathway and inhibiting NOX2.
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Affiliation(s)
- Lili Xu
- Hebei North University, Zhangjiakou, China
| | - Yaran Gao
- Department of Neurology, Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Ming Hu
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Yanhong Dong
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Jing Xu
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Jiawei Zhang
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
| | - Peiyuan Lv
- Hebei North University, Zhangjiakou, China.,Department of Neurology, Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, China
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Wang Y, Pan Y, Li H, Amarenco P, Denison H, Evans SR, Himmelmann A, James S, Knutsson M, Ladenvall P, Molina CA, Johnston SC. Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack. Neurology 2022; 99:e46-e54. [PMID: 35437261 PMCID: PMC9259092 DOI: 10.1212/wnl.0000000000200355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the short-term time course benefit and risk of ticagrelor with aspirin in acute mild-moderate ischemic stroke or high-risk transient ischemic attack (TIA) in the THALES (The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death) trial. METHODS In an exploratory analysis of the THALES trial, we evaluated the cumulative incidence of irreversible efficacy and safety outcomes at different timepoints during the 30-day treatment period. The efficacy outcome was major ischemic events defined as a composite of ischemic stroke or non-hemorrhagic death. The safety outcome was major hemorrhage defined as a composite of intracranial hemorrhage and fatal bleedings. Net clinical impact was defined as the combination of these two endpoints. RESULTS This analysis included a total of 11,016 patients (5523 in the ticagrelor-aspirin group and 5493 in the aspirin group) with mean age of 65 years, and 39% were women. The reduction of major ischemic events by ticagrelor occurred in the first week (4.1% vs 5.3%; absolute risk reduction 1.15%, 95% CI 0.36% to 1.94%), and remained throughout the 30-day treatment period. An increase in major hemorrhage was seen during the first week and remained relatively constant in the following weeks (absolute risk increase, approximately 0.3%). Cumulative analysis showed that the net clinical impact favored ticagrelor-aspirin in the first week (absolute risk reduction 0.97%, 95% CI, 0.17% to 1.77%) and remained constant throughout the 30 days. DISCUSSION In patients with mild-moderate ischemic stroke or high-risk TIA, the treatment effect of ticagrelor-aspirin was present from the first week. The ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the treatment period, which may support the use of 30 days treatment with ticagrelor and aspirin in these patients. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with mild-moderate ischemic stroke or high-risk TIA, the ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the 30-day treatment period.
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Affiliation(s)
- Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Bichat-Claude Bernard Hospital, University of Paris, Paris, France
| | - Hans Denison
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Scott R Evans
- Biostatistics Center, George Washington University, Washington, DC, USA
| | - Anders Himmelmann
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mikael Knutsson
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Per Ladenvall
- Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
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Chen Y, Liu Y, Zhang J, Zhou K, Zhang X, Dai H, Yang B, Shang H. Efficacy and safety of lumbrokinase plus aspirin versus aspirin alone for acute ischemic stroke (LUCENT): study protocol for a multicenter randomized controlled trial. Trials 2022; 23:285. [PMID: 35410433 PMCID: PMC8996506 DOI: 10.1186/s13063-022-06200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Lumbrokinase has been widely used for patients with acute ischemic stroke (AIS) in China; however, because rigorously designed studies are lacking, safety and efficacy of lumbrokinase in the treatment of acute ischemic stroke remains largely unknown. In this multicenter, randomized, and controlled trial, we aim to compare lumbrokinase plus aspirin versus aspirin alone in patients with acute ischemic stroke. Methods A total of 220 eligible participants will be randomized to either the intervention or control group with a 1:1 ratio. These participants must be diagnosed with acute ischemic stroke for the first time, whose symptoms appear within 72 h. Their NIHSS score must be greater than 5 and less than 15, and their age must be between 35 and 85 years old. They must have not received intravenous thrombolysis, arterial thrombolysis, or intravascular intervention. Participants in the intervention group will be treated with lumbrokinase plus aspirin for the first 90 days. Participants in the control group will use placebo plus aspirin for the first 90 days. Then, all participants will be treated with aspirin only and followed up for another 90 days (180-day follow-up). The primary outcome is the modified Rankin Scale (mRS) score. The secondary outcomes are National Institutes of Health Stroke Scale (NIHSS) score, Activity of Daily Living (ADL) Scale score, coagulation function, and serum hypersensitive C-reactive protein. The exploratory outcomes are fasting lipid panel, recurrence rate, the occurrence of cardiovascular and cerebrovascular events, and the mortality rate. Safety evaluations include liver function and kidney function, serum fibrinogen, adverse events, serious adverse events, and bleeding events. Adherence of participants will also be assessed. Discussion This trial will investigate the efficacy and safety of lumbrokinase plus aspirin as compared to aspirin alone in the treatment of acute ischemic stroke. Trial registration Chinese Clinical Trial Registry, ChiCTR2000032952. Registered on May 16, 2020.
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38
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Zhang K, Fang Y, Fan H, Ren J, Liu C, Liu T, Wang Y, Li Y, Li J, Meng J, Qian L, Li X, Wu X, Niu X. A nomogram for predicting the in-hospital risk of recurrence among patients with minor non-cardiac stroke. Curr Med Res Opin 2022; 38:487-499. [PMID: 35119325 DOI: 10.1080/03007995.2022.2038488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with minor stroke suffer a substantial risk of further recurrences, especially in the first two weeks. We aimed to develop and validate a prognostic nomogram to predict in-hospital stroke recurrence among patients with acute minor stroke. METHODS A total of 1326 patients with minor non-cardiac stroke (NIHSS) ≤5) from three centers were divided into development cohort (1016 patients from two centers) and validation cohort (310 patients from another center). Recurrent stroke was defined as a new ischemic stroke. A logistic regression model was employed to develop the nomogram to predict in-hospital stroke recurrence in patients with minor stroke using demographic, medical and imaging information. We then validated the nomogram externally. The predictive discrimination and calibration of the nomogram were assessed in the development and validation cohorts by area under the curve (AUC) and calibration plots. RESULTS During a median length of stay of 12 days, stroke recurrence occurred in 34 patients (3.3%). Predictors of in-hospital recurrence included prior history of transient ischemic attack, baseline NIHSS score, multiple infarctions, and carotid stenosis. The clinical and imaging-based nomogram B demonstrated adequate calibration and discrimination (AUC = 0.777), which was validated among 273 patients in a separate validation cohort (AUC = 0.753). Our clinical-imaging based nomogram was determined to be superior to the clinical-based nomogram and the RRE90 score in terms of discrimination. CONCLUSION A prognostic nomogram that integrates clinical and imaging information to predict the in-hospital risk of stroke recurrence among patients after acute minor stroke was constructed and validated externally. The nomogram demonstrated adequate calibration and discrimination in both the development and validation cohort.
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Affiliation(s)
- Kaili Zhang
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalan Fang
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Haimei Fan
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Neurology of The General Hospital of TISCO Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jing Ren
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chang Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tingting Liu
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongle Wang
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanan Li
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Li
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jingwen Meng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Lixia Qian
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinyi Li
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Wu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyuan Niu
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
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Liu T, Wang Y, Niu X, Li Y, Zhang K, Fan H, Ren J, Li J, Ma L, Li X, Wu X. Evaluation of the association between admission systolic blood pressure and the choice of initial antiplatelet therapy for minor ischemic stroke in real-world. J Clin Hypertens (Greenwich) 2022; 24:465-474. [PMID: 35297147 PMCID: PMC8989760 DOI: 10.1111/jch.14466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/12/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
To evaluate whether admission systolic blood pressure (SBP) is associated with the choice of initial antiplatelet therapy for minor stroke. Eligible patients retrospectively gathered from 2010 to 2018. Finally, 1312 of 1494 patients were divided into three groups: aspirin monotherapy (AM, n = 538, 41.0%), dual antiplatelet therapy with aspirin and load-clopidogrel (clopidogrel loading dose of 300 mg on the first day, DAPT-ALC, n = 474, 35.6%), and dual antiplatelet therapy with aspirin and unload-clopidogrel (clopidogrel 75 mg daily with no loading dose, DAPT-AUC, n = 300, 22.9%). The mean ± SD age of final patients was 62.0 ± 12.7 years old; 903 (70.9%) participants were male. Patients in the DAPT-ALC group were more likely to be younger, to arrive earlier, and to have a lower proportion of intracerebral hemorrhage than those in the AM group. DAPT-AUC group patients were more like to have a history of acute myocardial infarction and less likely to have a history of ICH than the AM group (4.7% vs. 1.7% and .3% vs. 2.6%, p < .05). Overall, there was a likely "S-shaped" association between the selection of the DAPT-ALC or DAPT-AUC scheme and admission systolic blood pressure (P for nonlinearity = .012). Compared with the SBP < 140 mmHg group, the SBP ≥ 180 mmHg group was more likely to be given DAPT-AUC (OR = 2.92 [1.62-5.26], p < .001) than DAPT-ALC. Our findings support that admission SBP is associated with the choice of initial antiplatelet, especially when the SBP was greater than or equal to 180 mmHg.
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Affiliation(s)
- Tingting Liu
- Shanxi Medical University, Taiyuan City, China.,Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan City, Shanxi Province, China
| | - Yongle Wang
- Shanxi Medical University, Taiyuan City, China
| | - Xiaoyuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan City, Shanxi Province, China
| | - Yanan Li
- Shanxi Medical University, Taiyuan City, China
| | - Kaili Zhang
- Department of Neurology, The Bethune Hospital of Shanxi Province, Taiyuan, Shanxi Province, China
| | - Haimei Fan
- Department of Neurology, Taiyuan Iron and Steel Group, Taiyuan, Shanxi Province, China
| | - Jing Ren
- Shanxi Medical University, Taiyuan City, China
| | - Juan Li
- Shanxi Medical University, Taiyuan City, China
| | - Liansheng Ma
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan City, Shanxi Province, China
| | - Xinyi Li
- Department of Neurology, The Bethune Hospital of Shanxi Province, Taiyuan, Shanxi Province, China
| | - Xuemei Wu
- Department of Neurology, Taiyuan Iron and Steel Group, Taiyuan, Shanxi Province, China
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Kam Yuet Wong F, Wang SL, Ng SSM, Lee PH, Wong AKC, Li H, Wang W, Wu L, Zhang Y, Shi Y. Effects of a transitional home-based care program for stroke survivors in Harbin, China: a randomized controlled trial. Age Ageing 2022; 51:6530454. [PMID: 35180283 DOI: 10.1093/ageing/afac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND China has the biggest stroke burden in the world. Continued measures have been taken to enhance post-stroke rehabilitation management in the last two decades. The weak link is with home-based rehabilitation, with more attention and resources devoted to inpatient rehabilitation. OBJECTIVE to address the service gap, this study tested a home-based transitional care model for stroke survivors. METHODS a randomized controlled trial was conducted from February 2019 to May 2020 in Harbin, China, involving 116 patients with ischemic stroke. The intervention group participants (n = 58, 50%) received a 12-week home-based care program with components of transitional care measures and the national guidelines for facilitating patients to perform home-based exercises with continued monitoring and gradual progression. Control group participants received standard care including medication advice, rehabilitation exercise and one nurse-initiated follow-up call. Data were collected at baseline and after a 90-day (post-intervention) and a 180-day (post-intervention) follow-up. The primary outcome was quality of life (QOL), measured using the EuroQol-Five Dimension 5-Level scale (EQ-5D-5L). RESULTS both intervention and control groups showed improvement in EQ-5D-5L from baseline to post-intervention (0.66 versus 0.83, P < 0.001) and (0.66 versus 0.77, P < 0.001), respectively, and there was significant group-by-time interaction in EuroQol-Visual Analogue Scale from baseline to post-intervention at 90 days and follow-up at 180 days with the intervention group experiencing better improvement. Similarly, significant interaction effects were also found in the Stroke Impact Symptom scale, self-efficacy and modified Barthel Index. CONCLUSIONS home-based transitional care was effective in improving QOL, symptoms, self-efficacy and activities of daily living.
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Affiliation(s)
| | - Shao Ling Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Paul H Lee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Haiyan Li
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Wei Wang
- Neurology Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Lijie Wu
- Nursing Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Yi Zhang
- Psychology Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
| | - Yangyang Shi
- Neurology Department, The First Hospital of Harbin, Harbin, Heilongjiang, China
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Liu QH, Tan JX, Hu CX, Hu DL, Wan LH. A Decade-long Comparison of Prestroke Health Behaviors Among Hypertensive Stroke Patients in Mainland China. J Neurosci Nurs 2022; 54:42-47. [PMID: 34775393 DOI: 10.1097/jnn.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Patients with hypertension are at a high risk for stroke, but a healthy lifestyle can greatly reduce the risk of stroke. However, there has been no research on the change in prestroke health behaviors in Chinese patients with hypertensive stroke over a decade. OBJECTIVES: The aims of this study were to determine whether prestroke health behaviors of patients with hypertensive stroke changed over a decade and to explore the predictors of prestroke health behaviors over a decade. METHODS: This study used data from 2 cross-sectional studies conducted in the neurology departments of 3 hospitals in Guangzhou, China. In total, 110 hypertensive stroke patients were recruited in stage I (2008-2009), and 119 hypertensive stroke patients were recruited in stage II (2018-2019). Patients' stroke knowledge was measured by the Stroke Knowledge Questionnaire. Patients' prestroke health behavior was measured by the Health Behavior Scale for Stroke Patients. RESULTS: The total score of prestroke health behaviors significantly increased over the decade (P < .001), but the scores of the subcategories of low-fat diet, low-sugar diet, and blood pressure checkups decreased over the decade (P < .05). Stroke knowledge was a significant predictor of prestroke health behaviors in stage I (P < .05). Besides stroke knowledge, sex and age were significant predictors of prestroke health behaviors in stage II (P < .05). CONCLUSIONS: Prestroke health behaviors of hypertensive stroke patients significantly improved over the decade. Moreover, prestroke health behaviors were significantly influenced by stroke-related knowledge over the decade. Healthcare providers should focus in particular on assisting patients who are male, young, and middle-aged, and lack stroke-related knowledge to improve their prestroke health behaviors, especially in terms of adherence to a low-fat/low-sugar diet and regular blood pressure checks.
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Kamarova M, Baig S, Patel H, Monks K, Wasay M, Ali A, Redgrave J, Majid A, Bell SM. Antiplatelet Use in Ischemic Stroke. Ann Pharmacother 2022; 56:1159-1173. [PMID: 35094598 PMCID: PMC9393649 DOI: 10.1177/10600280211073009] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: A literature review of antiplatelet agents for primary and secondary stroke
prevention, including mechanism of action, cost, and reasons for lack of
benefit. Data sources: Articles were gathered from MEDLINE, Cochrane Reviews, and PubMed databases
(1980-2021). Abstracts from scientific meetings were considered. Search
terms included ischemic stroke, aspirin, clopidogrel, dipyridamole,
ticagrelor, cilostazol, prasugrel, glycoprotein IIb/IIIa inhibitors. Study selection and data extraction: English-language original and review articles were evaluated. Guidelines from
multiple countries were reviewed. Articles were evaluated independently by 2
authors. Data synthesis: An abundance of evidence supports aspirin and clopidogrel use for secondary
stroke prevention. In the acute phase (first 21 days postinitial stroke),
these medications have higher efficacy for preventing further stroke when
combined, but long-term combination therapy is associated with higher
hemorrhage rates. Antiplatelet treatment failure is influenced by poor
adherence and genetic polymorphisms. Antiplatelet agents such as cilostazol
may provide extra benefit over clopidogrel and aspirin, in certain racial
groups, but further research in more diverse ethnic populations is
needed. Relevance to patient care and clinical practice: This review presents the data available on the use of different antiplatelet
agents poststroke. Dual therapy, recurrence after initiation of secondary
preventative therapy, and areas for future research are discussed. Conclusions: Although good evidence exists for the use of certain antiplatelet agents
postischemic stroke, there are considerable opportunities for future
research to investigate personalized therapies. These include screening
patients for platelet polymorphisms that confer antiplatelet resistance and
for randomized trials including more racially diverse populations.
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Affiliation(s)
- Marharyta Kamarova
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
| | - Sheharyar Baig
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
- Sheffield Institute for Translational
Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Hamish Patel
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
| | - Kimberley Monks
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
| | - Mohammed Wasay
- Department of Neurology, The Aga Khan
University, Karachi, Pakistan
| | - Ali Ali
- Department of Medicine for the Elderly,
Royal Hallamshire Hospital, Sheffield, UK
| | - Jessica Redgrave
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
| | - Arshad Majid
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
- Sheffield Institute for Translational
Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
| | - Simon M. Bell
- Department of Clinical Neurology, Royal
Hallamshire Hospital, Sheffield, UK
- Sheffield Institute for Translational
Neuroscience (SITraN), The University of Sheffield, Sheffield, UK
- Simon M. Bell, NIHR Clinical Lecturer in
Neurology, Sheffield Institute for Translational Neuroscience (SITraN), The
University of Sheffield, 385a Glossop Road, Sheffield S10 2HQ, UK.
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Liberman AL, Lendaris AR, Cheng NT, Kaban NL, Rostanski SK, Esenwa C, Kummer BR, Labovitz DL, Prabhakaran S, Friedman BW. Treating High-Risk TIA and Minor Stroke Patients With Dual Antiplatelet Therapy: A National Survey of Emergency Medicine Physicians. Neurohospitalist 2022; 12:13-18. [PMID: 34950381 PMCID: PMC8689540 DOI: 10.1177/19418744211022190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Treatment with aspirin plus clopidogrel, dual antiplatelet therapy (DAPT), within 24 hours of high-risk transient ischemic attack (TIA) or minor stroke symptoms to eligible patients is recommended by national guidelines. Whether or not this treatment has been adopted by emergency medicine (EM) physicians is uncertain. METHODS We conducted an online survey of EM physicians in the United States. The survey consisted of 13 multiple choice questions regarding physician characteristics, practice settings, and usual approach to TIA and minor stroke treatment. We report participant characteristics and use chi-squared tests to compare between groups. RESULTS We included 162 participants in the final study analysis. 103 participants (64%) were in practice for >5 years and 96 (59%) were at nonacademic centers; all were EM board-certified or board-eligible. Only 9 (6%) participants reported that they would start DAPT for minor stroke and 8 (5%) reported that they would start DAPT after high-risk TIA. Aspirin alone was the selected treatment by 81 (50%) participants for minor stroke patients who presented within 24 hours of symptom onset and were not candidates for thrombolysis. For minor stroke, 69 (43%) participants indicated that they would defer medical management to consultants or another team. Similarly, 75 (46%) of participants chose aspirin alone to treat high-risk TIA; 74 (46%) reported they would defer medical management after TIA to consultants or another team. CONCLUSION In a survey of EM physicians, we found that the reported rate of DAPT treatment for eligible patients with high-risk TIA and minor stroke was low.
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Affiliation(s)
- Ava L. Liberman
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,Ava L. Liberman, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 4th Floor, Bronx, NY 10467, USA.
| | - Andrea R. Lendaris
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Natalie T. Cheng
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole L. Kaban
- Department of Medicine, Section of Emergency Medicine, Louisiana State University, New Orleans, LA, USA
| | - Sara K. Rostanski
- Department of Neurology, New York University School of Medicine, NY, USA
| | - Charles Esenwa
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin R. Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Daniel L. Labovitz
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Benjamin W. Friedman
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Liu S, Gao Z, Meng R, Song H, Tang T, Zhao Y, Chen R, Sheng Y, Fan Q, Jiang F, Zhang Q, Ding J, Huang X, Ma Q, Dong K, Xue S, Yu Z, Duan J, Chu C, Chen X, Huang X, Li S, Ovbiagele B, Zhao W, Ji X, Feng W. Preventing Ischemic Cerebrovascular Events in High-Risk Patients With Non-disabling Ischemic Cerebrovascular Events Using Remote Ischemic Conditioning: A Single-Arm Study. Front Neurol 2021; 12:748916. [PMID: 34975717 PMCID: PMC8716386 DOI: 10.3389/fneur.2021.748916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Secondary stroke prevention after a high-risk, non-disabling ischemic cerebrovascular event needs to be enhanced. The study was conducted to investigate whether remote ischemic conditioning (RIC) is effective in preventing recurrent ischemic events within 3 months. Methods: This was a four-center, single-arm, open-label Phase IIa futility trial (PICNIC-One Study). Adult patients (≥18 years of age) who had an acute minor ischemic stroke (AMIS) with a National Institutes of Health Stroke Scale score ≤ 3 or a transient ischemic attack (TIA) with moderate-to-high risk of stroke recurrence (ABCD score ≥ 4) within 14 days of symptom onset were recruited. Patients received RIC as adjunctive therapy to routine secondary stroke prevention regimen. RIC consisted of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuffs (45 min) on bilateral upper limbs twice a day for 90 days. Results: A total of 285 patients met the study criteria, of which 167 provided signed informed consent and were enrolled. Data from 162 were analyzed with five subjects excluded. Recurrent AIS/TIA occurred in 6/162 (3.7%) patients within 3 months, with no occurrence of hemorrhagic stroke. The top three adverse events were upper limb pain (44/162, 27.2%), petechia (26/162, 16.0%), and heart palpitation (5/162, 3.1%). About 68 (42.0%) subjects completed ≥ 50% of 45-min RIC sessions. Conclusions: RIC is a safe add-on procedure and it has a potential benefit in reducing recurrent cerebrovascular events in patients with high-risk, non-disabling ischemic cerebrovascular events as the risk of stroke/TIA events is lower than expected; however, its compliance needs to be improved. Our study provides critical preliminary data to plan a large sample size, randomized controlled clinical study to systematically investigate the safety and efficacy of RIC in this population.
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Affiliation(s)
- Shimeng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zongen Gao
- Department of Neurology, Shengli Oilfield Center Hospital, Dongying, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianping Tang
- Department of Neurology, Shengli Oilfield Center Hospital, Dongying, China
| | - Ya Zhao
- Department of Neurology, Taoyuan People's Hospital, Changde, China
| | - Rong Chen
- Department of Neurology, First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yanzhen Sheng
- Department of Neurology, Taoyuan People's Hospital, Changde, China
| | - Qianqian Fan
- Department of Neurology, First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Fang Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianping Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoqin Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sufang Xue
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhipeng Yu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Changbiao Chu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Chen
- Department of Neurology, Shengli Oilfield Center Hospital, Dongying, China
| | - Xingquan Huang
- Department of Neurology, Taoyuan People's Hospital, Changde, China
| | - Sijie Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bruce Ovbiagele
- Departmeng of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Wenle Zhao
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, China
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Laboratory of Brain Disorders, Beijing Institute of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
- Beijing University of Aeronautics & Astronautics-China Capital Medical University (BUAA-CCMU) Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China
- Xunming Ji
| | - Wuwei Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States
- *Correspondence: Wuwei Feng
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Hu J, Tan X, Wang D, Li Y, Liang H, Peng J, Li F, Zhou Q, Geng P, Wang S, Yu Y, Liu J. A stepwise-targeting strategy for the treatment of cerebral ischemic stroke. J Nanobiotechnology 2021; 19:371. [PMID: 34789285 PMCID: PMC8600695 DOI: 10.1186/s12951-021-01118-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
Background Effective amelioration of neuronal damages in the case of cerebral ischemic stroke (CIS) is essential for the protection of brain tissues and their functional recovery. However, most drugs can not penetrate the blood–brain barrier (BBB), resulting in the poor therapeutic outcomes. Results In this study, the derivatization and dual targeted delivery technologies were used to actively transport antioxidant melatonin (MLT) into the mitochondria of oxidative stress-damaged cells in brain tissues. A mitochondrial targeting molecule triphenylphosphine (TPP) was conjugated to melatonin (TPP-MLT) to increase the distribution of melatonin in intracellular mitochondria with the push of mitochondrial transmembrane potential. Then, TPP-MLT was encapsulated in dual targeted micelles mediated by TGN peptide (TGNYKALHPHNG) with high affinity for BBB and SHp peptide (CLEVSRKNG) for the glutamate receptor of oxidative stress-damaged neural cells.TGN/SHp/TPP-MLT micelles could effectively scavenge the overproduced ROS to protect neuronal cells from oxidative stress injury during CIS occurrence, as reflected by the improved infarct volume and neurological deficit in CIS model animals. Conclusions These promising results showed this stepwise-targeting drug-loaded micelles potentially represent a significant advancement in the precise treatment of CIS. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12951-021-01118-6.
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Affiliation(s)
- Jingbo Hu
- Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, 315211, China.
| | - Xueying Tan
- College of Pharmacy, Zhejiang Pharmaceutical College, Ningbo, 315100, China
| | - Dongwei Wang
- Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, 315211, China
| | - Yixuan Li
- Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, 315211, China
| | - Hongze Liang
- Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, 315211, China
| | - Jiejun Peng
- State Key Laboratory for Managing Biotic and Chemical Threats To the Quality and Safety of Agroproducts, Institute of Plant Virology, Ningbo University, Ningbo, 315211, Zhejiang, China.
| | - Fengyan Li
- College of Pharmacy, Zhejiang Pharmaceutical College, Ningbo, 315100, China
| | - Quan Zhou
- Department of Neurosurgery, The People's Hospital of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, China
| | - Peiwu Geng
- Department of Neurosurgery, The People's Hospital of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, China
| | - Shuanghu Wang
- Department of Neurosurgery, The People's Hospital of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, China
| | - Yue Yu
- Department of Pharmacy, Ningbo Women and Children's Hospital, Ningbo, 315012, China
| | - Jin Liu
- Department of Neurosurgery, The People's Hospital of Lishui, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, China.
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Peng Q, Bi R, Chen S, Chen J, Li Z, Li J, Jin H, Hu B. Predictive value of different bilirubin subtypes for clinical outcomes in patients with acute ischemic stroke receiving thrombolysis therapy. CNS Neurosci Ther 2021; 28:226-236. [PMID: 34779141 PMCID: PMC8739039 DOI: 10.1111/cns.13759] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/19/2022] Open
Abstract
Aims To explore the association of total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels with, as well as the incremental predictive value of different bilirubin subtypes for, poor outcomes in acute ischemic stroke patients after thrombolysis. Methods We analyzed 588 individuals out of 718 AIS participants, and all patients were followed up at 3 months after thrombolysis. The primary outcome was 3‐month death and major disability (modified Rankin Scale (mRS) score of 3–6). The secondary outcomes were 3‐month mortality (mRS score of 6), moderate‐severe cerebral edema, and symptomatic intracranial hemorrhage (sICH), respectively. Results Elevated DBIL pre‐thrombolysis was associated with an increased risk of primary outcome (OR 3.228; 95% CI 1.595–6.535; p for trend = 0.014) after fully adjustment. Elevated TBIL pre‐thrombolysis showed the similar results (OR 2.185; 95% CI 1.111–4.298; p for trend = 0.047), while IBIL pre‐thrombolysis was not significantly associated with primary outcome (OR 1.895; 95% CI 0.974–3.687; p for trend = 0.090). Multivariable‐adjusted spline regression model showed a positive linear dose‐response relationship between DBIL pre‐thrombolysis and risk of primary outcome (p for linearity = 0.004). Adding DBIL pre‐thrombolysis into conventional model had greater incremental predictive value for primary outcome, with net reclassification improvement (NRI) 95% CI = 0.275 (0.084–0.466) and integrated discrimination improvement (IDI) 95% CI = 0.011 (0.001–0.024). Increased DBIL post‐thrombolysis had an association with primary outcome (OR 2.416; 95%CI 1.184–4.930; p for trend = 0.039), and it also elevated the incremental predictive value for primary outcome, with NRI (95% CI) = 0.259 (0.066–0.453) and IDI (95% CI) = 0.025 (0.008–0.043). Conclusion Increased DBIL pre‐thrombolysis had a stronger association with, as well as greater incremental predictive value for, poor outcomes than TBIL and IBIL did in AIS patients after thrombolysis, which should be understood in the context of retrospective design. The effect of DBIL on targeted populations should be investigated in further researches.
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Affiliation(s)
- Qiwei Peng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiefang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhifang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianzhuang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Long-Term Effect of Left Atrial Appendage Occlusion in Treating Patients with Previous Ischemic Stroke on the Disease Recurrence. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6991002. [PMID: 34691240 PMCID: PMC8528575 DOI: 10.1155/2021/6991002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/23/2021] [Indexed: 12/14/2022]
Abstract
Methods A total of 120 patients with IS admitted to Tangdu Hospital from July 2016 to September 2017 were grouped into the control group (n = 60) and the observation group (n = 60). Patients in the control group were only treated with thrombolytics and anticoagulants while those in the observation group were treated with both drugs and LAAO. Transesophageal echocardiography (TEE) was performed to observe the occlusion of LAA in patients in the observation group after 45 d and 6 months, respectively. Clinical outcomes in two groups were compared from the following aspects: recurrence of IS, incidence of systemic embolism, and the 3-year recurrence-free survival (RFS). The 3-year IS recurrence of patients was compared by Fisher's exact test. Results No significant differences were observed at baseline levels (age, sex, etc.) between the observation group and control group (p > 0.05). During follow-up visit of 45 d and 6 months, all occluders met the efficacious occludsion criteria. The results of TEE at 45 d after LAAO showed that 50% of patients (30/60) in the observation group had complete occlusion of LAA. The results of TEE at 6 months after LAAO suggested that 58.3% of patients (35/60) had complete occlusion of LAA. IS recurrence in the observation group (3.33%, 2/60) was significantly lower than that in the control group (18.33%, 11/60), with the difference presenting statistical significance (p = 0.008). Incidence of systemic embolism in the observation group (1.67%, 1/60) was markedly lower than that in the control group (13.33%, 11/60) (p = 0.014). The average RFS in the observation group (31.97 months, 95% CI: 27.50~32.31 months) was notably longer than that in the control group (29.91 months, 95% CI: 29.85~32.92 months) (p < 0.05). The 3-year IS recurrence of patients between two groups compared by Fisher's exact test showed significant differences (1 year: p = 0.014, 2 year: p = 0.008, 3 year: p = 0.008). Conclusion Regarding patients with previous IS who had poor response to thrombolytics and anticoagulants, LAAO could effectively decrease recurrence of IS and incidence of systemic embolism and prolong RFS of patients. LAAO was, therefore, an alternative for patients with high IS recurrence risk.
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Lendaris AR, Lessen S, Cheng NT, Friedman BW, Esenwa C, Labovitz DL, Prabhakaran S, Lipton RB, Liberman AL. Under Treatment of High-Risk TIA Patients with Clopidogrel-Aspirin in the Emergency Setting. J Stroke Cerebrovasc Dis 2021; 30:106145. [PMID: 34649036 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Treating high-risk transient ischemic attack (TIA) with dual antiplatelet therapy (DAPT) reduces subsequent ischemic stroke risk yet current rates of clopidogrel-aspirin treatment are uncertain. MATERIALS AND METHODS We conducted a retrospective cohort study of consecutive TIA patients who presented to any of the four emergency departments (ED) of a single urban health system from 1/1/2018-3/1/2020. Medical record review was used to describe the cohort and assess clopidogrel-aspirin treatment. Patient eligibility for clopidogrel-aspirin was determined using relevant criteria from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial. Comparisons among eligible patients who received versus did not receive clopidogrel-aspirin were conducted using t-test, chi-squared, and Mann-Whitney as indicated. RESULTS We identified 248 TIA patients of whom 95 met eligibility criteria for clopidogrel-aspirin treatment. Among these 95 patients, mean age was 69.5 (SD: 12), 68.4% were women, and median ABCD2 score was 5 (IQR: 4-6). A total of 26/95 (27.4%) eligible patients received clopidogrel-aspirin within 24 hours of symptom onset. Appropriate clopidogrel-aspirin use was associated with having a stroke code called upon ED arrival (88.5% vs. 34.8%; P<0.001), being evaluated by a vascular neurologist (88.5% vs. 21.1%; P<0.001), and not presenting to the community ED site wherein only a single patient received clopidogrel-aspirin. CONCLUSIONS In a multisite, single health system study, nearly three-fourths of high-risk TIA patients eligible for clopidogrel-aspirin treatment did not receive it. Appropriate clopidogrel-aspirin use was highest among patients seen by vascular neurologists and lowest at the community ED, though under treatment was evident at all sites.
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Affiliation(s)
- Andrea R Lendaris
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Samantha Lessen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalie T Cheng
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Charles Esenwa
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Daniel L Labovitz
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago School of Medicine, Chicago, IL, United States
| | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
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Lu S, Luo X, Ni X, Li H, Meng M, Cai Y, Liu Y, Ren M, Sun Y, Chen Y. Reporting quality evaluation of the stroke clinical practice guidelines: a systematic review. Syst Rev 2021; 10:262. [PMID: 34593016 PMCID: PMC8485553 DOI: 10.1186/s13643-021-01805-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To analyze the effectiveness and quality of stroke clinical practice guidelines (CPGs) published in recent years in order to guide future guideline developers to develop better guidelines. PARTICIPANTS No patient involved METHOD: PubMed, China Biology Medicine (CBM), Wanfang, CNKI, and CPG-relevant websites were searched from January 2015 to December 2019 by two researchers independently. The RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was used to assess the reporting quality in terms of domains and items. Then, a subgroup analysis of the results was performed. PRIMARY AND SECONDARY OUTCOME MEASURES RIGHT checklist reporting rate RESULTS: A total of 66 CPGs were included. Twice as many CPGs were published internationally as were published in China. More than half were updated. Most CPGs are published in journals, developed by societies or associations, and were evidence-based grading. The average reporting rate for all included CPGs was 47.6%. Basic information got the highest (71.7% ± 19.7%) reporting rate, while review and quality assurance got the lowest (22.0% ± 24.6%). Then, a cluster analysis between countries, publishing channels, and institutions was performed. There were no statistically significant differences in the reporting quality on the CPGs between publishing countries (China vs. international), publishing channels (journals vs. websites), and institutions (associations vs. non-associations). CONCLUSIONS Current stroke CPGs reports are of low quality. We recommend that guideline developers improve the quality of reporting of key information and improve the management of conflicts of interest. We recommend that guideline developers consider the RIGHT checklist as an important tool for guideline development. TRIAL REGISTRATION https://doi.org/10.17605/OSF.IO/PBWUX .
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Affiliation(s)
- Shuya Lu
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 611731 People’s Republic of China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Xiaojia Ni
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 People’s Republic of China
| | - Haoxuan Li
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
| | - Miaomiao Meng
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
| | - Yefeng Cai
- Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical School of Chinese Medicine, Guangzhou, 510120 People’s Republic of China
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 People’s Republic of China
| | - Yunlan Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Mengjuan Ren
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Yanrui Sun
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000 People’s Republic of China
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Institute of Health Data Science, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000 People’s Republic of China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, 730000 People’s Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, 730000 Lanzhou, People’s Republic of China
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Feng L, Kong L, Dong X, Lai X, Zhang D, Ren B, Liu S, Xie X, Li C, Song Y, Du Y, Cao K, Zhang C, Gao Y. China Stroke Registry for Patients With Traditional Chinese Medicine (CASES-TCM): Rationale and Design of a Prospective, Multicenter, Observational Study. Front Pharmacol 2021; 12:743883. [PMID: 34531755 PMCID: PMC8438566 DOI: 10.3389/fphar.2021.743883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Given the complexity of stroke treatment and the current widespread use of traditional Chinese medicine (TCM) in the absence of robust, large, long-term effectiveness and safety studies, and the lack of nationwide epidemiology and clinical characteristics of patients with stroke receiving TCM treatment, the acquisition of data from longitudinal cohorts is essential. We intend to generate the major clinical characteristics of patients with stroke who receive TCM treatment and to investigate the effectiveness and safety of TCM in the Chinese population. Methods: The China Stroke Registry for Patients with Traditional Chinese Medicine (CASES-TCM) study is a prospective, multicenter, observational disease registry aiming to register 20,000 hospitalized patients. Eligible adult patients with clearly diagnosed acute ischemic stroke or intracerebral hemorrhage within 7 days of symptom onset will be consecutively registered from 126 participating sites across China. Baseline data will be recorded, and all patients will be regularly followed up at 3, 6, 12, and 24 months after stroke onset. Collected data will be entered into a web-based system with high-level data security. The primary outcomes include the distribution of scores on the modified Rankin Scale at the 3-months follow-up, and recurrent stroke events within the 12-months follow-up. Conclusion: To our knowledge, the CASES-TCM study is the first and largest nationwide registry to document comprehensive data on TCM treatment in patients with acute stroke. The findings of this study will be valuable to improve our knowledge about TCM treatment for patients with stroke and its subsequent outcomes in the actual clinical setting, consequently facilitating and standardizing the optimization of individualized interventions with TCM for stroke prevention and treatment in China. Study registration: This study was registered with Clinicaltrials.gov (URL: https://clinicaltrials.gov/, Unique identifier: NCT04921397).
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Affiliation(s)
- Luda Feng
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Lingbo Kong
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Xinglu Dong
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Xinxing Lai
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Dandan Zhang
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Beida Ren
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Shen Liu
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaolong Xie
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Chuanpeng Li
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Yuebo Song
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Yawei Du
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kegang Cao
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chi Zhang
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.,Chinese Medicine Key Research Room of Brain Disorders Syndrome and Treatment of the National Administration of Traditional Chinese Medicine, Beijing, China
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