Evaluación de la hemodinamia cerebral mediante ecografía Doppler transcraneal en pacientes con preeclampsia/eclampsia / Evaluation of cerebral hemodynamics by transcranial Doppler ultrasound in patients with preeclampsia/eclampsia / Avaliação da hemodinâmica cerebral por ultrassonografia Doppler transcraniana em pacientes com pré-eclâmpsia/eclâmpsia

Resumen: Introducción: preeclampsia, la complicación más común del embarazo, ocasiona más de 76,000 muertes maternas al año, principalmente por complicaciones neurológicas. La alteración en la vasorregulación cerebral es clave en la patogénesis de dichas complicaciones. La ecografía Doppler transcraneal (EDT) evalúa el flujo de las principales arterias cerebrales, pero se desconocen los cambios que presentan las pacientes con preeclampsia/eclampsia. Objetivo: descripción de los cambios en el flujo sanguíneo cerebral evaluados mediante EDT en pacientes con preeclampsia/eclampsia. Material y métodos: se realizó EDT a las pacientes con diagnóstico de preeclampsia y/o eclampsia atendidas de forma consecutiva en la Unidad de Cuidados Intensivos del Hospital Civil de Guadalajara, del 01 de marzo de 2019 al 01 de marzo de 2021 y grupo control de embarazadas sanas; describimos el patrón de flujo de las arterias cerebrales anterior, media, posterior y arteria basilar. Resultados: Ochenta pacientes, 50 con preeclampsia/eclampsia y 30 embarazadas sanas, edad 23 ± 6.7, 50% primigestas, 34.8 ± 4.3 semanas de gestación. La presión de perfusión cerebral de las arterias cerebrales media derecha > 74 mmHg (sensibilidad 0.88, especificidad 0.86, ABC 0.92) y anterior derecha > 69 mmHg (sensibilidad 0.89, especificidad 0.93, ABC 0.92) tuvieron la mayor asociación con preeclampsia/eclampsia. El índice de flujo sanguíneo de las arterias cerebrales posteriores tuvo asociación significativa con eclampsia (p = 0.02), ABC: 0.695 (p = 0.009), punto de corte ≥ 34.6 cm/s (sensibilidad 1.0, especificidad 0.43, OR 26). Conclusiones: un incremento generalizado de la presión de perfusión es el hallazgo más común en preeclampsia/eclampsia. Aumento en el índice de flujo sanguíneo en las arterias cerebrales posteriores se asocia a complicaciones neurológicas graves en pacientes con preeclampsia.

Abstract: Introduction: preeclampsia, the most common complication of pregnancy, leads to > 76,000 maternal deaths annually, mainly due to neurological complications. An alteration in cerebral vasoregulation is key in the pathogenesis of these complications. Transcranial Doppler Ultrasound (TCD) evaluates the flow of the main cerebral arteries and could help to predict the development of preeclampsia/eclampsia and its complications. Objective: to determine the most frequent cerebral blood flow changes in preeclampsia/eclampsia. Material and methods: we prospectively analyzed by TCD patients with preeclampsia/eclampsia on admission to the ICU. Results: Eighty patients, 50 with preeclampsia/eclampsia and 30 healthy pregnant women, age 23 ± 6.7, 50% primigravida, 34.8 ± 4.3 weeks gestation. Cerebral perfusion pressure of right middle cerebral arteries > 74 mmHg (sensitivity 0.88, specificity 0.86, AUC 0.92) and right anterior cerebral arteries > 69 mmHg (sensitivity 0.89, specificity 0.93, AUC 0.92), had the highest association with preeclampsia/eclampsia. Posterior cerebral artery blood flow index had significant association with eclampsia (p = 0.02), AUC 0.695 (p = 0.009), with a cut-off ≥ 34.6 cm/s (sensitivity 1.0, specificity 0.43, OR 26). Conclusions: a generalized increase in perfusion pressure is the most common finding in preeclampsia/eclampsia. Hyper flow in the posterior cerebral arteries may predict severe neurological complications.

Resumo: Introdução: a pré-eclâmpsia, complicação mais comum da gravidez, causa mais de 76,000 mortes maternas anualmente, principalmente devido a complicações neurológicas. A vasorregulação cerebral alterada é fundamental na patogênese dessas complicações. A ultrassonografia Doppler transcraniana (DTC) avalia o fluxo das principais artérias cerebrais, as alterações que os pacientes com pré-eclâmpsia/eclâmpsia apresentam são desconhecidas. Objetivo: descrição das alterações do fluxo sanguíneo cerebral avaliados por DTC em pacientes com pré-eclâmpsia/eclâmpsia. Material e métodos: DTC foi realizado em pacientes com diagnóstico de pré-eclâmpsia e/ou eclâmpsia tratados consecutivamente na unidade de terapia intensiva do Hospital Civil de Guadalajara, de 1o de março de 2019 a 1o de março de 2021 e um grupo controle de gestantes saudáveis; descrevemos o padrão de fluxo das artérias cerebrais anterior, média, posterior e da artéria basilar. Resultados: 80 pacientes, 50 com pré-eclâmpsia/eclâmpsia e 30 gestantes saudáveis, idade 23 ± 6.7, 50% primíparas, 34.8 ± 4.3 semanas de gestação. A pressão de perfusão cerebral das artérias cerebrais médias direitas > 74 mmHg (sensibilidade 0.88, especificidade 0.86, AUC 0.92) e anterior direita > 69 mmHg (sensibilidade 0.89, especificidade 0.93, AUC 0.92), teve a maior associação com pré-eclâmpsia/eclâmpsia. O índice de fluxo sanguíneo das artérias cerebrais posteriores, teve associação significativa com eclâmpsia (p = 0.02), AUC: 0.695 (p = 0.009), ponto de corte ≥ 34.6 cm/s (sensibilidade 1.0, especificidade 0.43, OR 26). Conclusões: Um aumento generalizado da pressão de perfusão é o achado mais comum na pré-eclâmpsia/eclâmpsia. O aumento da taxa de fluxo sanguíneo nas artérias cerebrais posteriores está associado a complicações neurológicas graves em pacientes com pré-eclâmpsia.

Ultrasonographic evaluation of cerebrovascular reactivity in flight crew after simulated acute altitude hypoxia / 中华超声影像学杂志

Objective:To monitor the cerebral vascular blood flow parameters in the early stage of simulated acute exposure to high altitude hypoxia by transcranial color Doppler (TCCD), and to evaluate the change trend of cerebral hemodynamics and cerebrovascular reactivity.Methods:Sixty-four healthy volunteers were selected to observe the changes of peak systolic flow velocity(Vs), end diastolic flow velocity(Vd), mean flow velocity(Vm), resistance index (RI) and pulsatility index (PI) of middle cerebral artery (MCA) 30 minutes after they quickly entered the simulated altitude of 4 500 meters. Combined with breath holding test, breath holding index (BHI) was used to evaluate cerebrovascular reactivity (CVR), and subjects were divided into ≤30 years old group and >30 years old group, and the changes of CVR after hypoxia of the two groups were compared.Results:In the early stage of hypoxic environment, compared with baseline, SpO 2 decreased, heart rate increased, and blood flow velocity of middle cerebral artery(Vs, Vd, Vm) increased significantly, BHI showed a decreasing trend (all P<0.01). After hypoxia, the BHI rate of change in >30 years old was lower than that of the subjects ≤30 years old ( P<0.05). After breath holding, cerebral blood flow velocity increased significantly, PI and RI decreased significantly (all P<0.01). Conclusions:Cerebral blood flow is very sensitive to hypoxia. The application of TCCD technology can evaluate the trend of cerebral blood flow dynamics and cerebrovascular reserve capacity in real time and accurately, which is helpful to provide objective basis and research basis for the prevention and treatment of high altitude hypoxia.

Effect of acupuncture on pain and cerebral hemodynamics in patients with migraine: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the therapeutic effect between acupuncture combined with medication and simple medication on migraine and cerebral hemodynamics.@*METHODS@#A total of 120 patients with migraine were randomized into an acupuncture plus medication group (60 cases, 3 cases dropped off) and a medication group (60 cases, 6 cases dropped off). In the medication group, flunarizine hydrochloride capsule was given orally before sleep, 10 mg a day. On the basis of the treatment in the medication group, acupuncture was applied at Sizhukong (TE 23), Shuaigu (GB 8), Taiyang (EX-HN 5), Fengchi (GB 20) and etc. in the acupuncture plus medication group, 30 min each time, once a day. Treatment for 4 weeks was required in both groups. Before and after treatment, the visual analogue scale (VAS) score, indexes of cerebral hemodynamic [blood flow velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA)] and total TCM syndrome score were observed, and the clinical therapeutic effect and the incidence of the adverse events were evaluated in both groups.@*RESULTS@#Compared before treatment, the VAS scores, the blood flow velocity of ACA, MCA, PCA, VA, BA and the total TCM syndrome scores were decreased in both groups (@*CONCLUSION@#Acupuncture combined with flunarizine hydrochloride capsule can effectively relieve the pain in patients with migraine, reduce the cerebral blood flow velocity, the efficacy is superior to simple flunarizine hydrochloride capsule.

Protection of Addition and Subtraction Therapy of Ditantang Combined with Taohong Siwutang to Brain Nerve of Patients with Cerebral Infarction and （Syndrome of Phlegm and Blood Stasis Blocking Collaterals） During Early Recovery / 中国实验方剂学杂志

Objective:To discuss clinical effect of addition and subtraction therapy of Ditantang combined with Taohong Siwutang to cerebral infarction and syndrome of phlegm and blood stasis blocking collaterals during early recovery， and to study protection to brain nerve. Method:One hundred and fifty-two patients were randomly divided into control group （76 cases） and observation group （76 cases） by random number table， 71 patients in control group completed the therapy （5 patients were falling off， missing visit or eliminated）， and 70 patients in observation group completed the therapy. Both groups' patients got comprehensive rehabilitation measures. Patients in control group got Zhongfeng Huichun pills， 1.5 g/time， 3 times/day. Patients in observation group got addition and subtraction therapy of Ditantang combined with Taohong Siwutang in the morning and at night， 1 dose/day. The treatment was continued for 12 weeks. Before and after treatment， scores of degree of neurological deficit， Barthel （BI） index， Fugl-Meyer scale （FMA）， modified Rankin scale （MRS） and syndrome of phlegm and blood stasis blocking collaterals were graded. And levels of malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， superoxide dismutase （SOD）， advanced oxidation protein products （AOPP）， vascular endothelial growth factor （VEGF）， brain-derived neurotrophic factor （BDNF） and neuron specific enolase （NSE）. And cerebral hemodynamics were detected， and peak flow velocity （VS）， vascular resistance index （RI）， pulsatility index （PI） and cerebrovascular reserve function （CVR） were recorded. Safety was evaluated. Result:After the 6th week and 12th week of treatment， scores of degree of neurological deficit， BI， FMA， MRS， syndrome of phlegm and blood stasis blocking collaterals， AOPP， MDA， NSE， RI and PI were lower than those in control group （P<0.01）， levels of SOD， GSH-Px， BDNF， VEGF， Vs and CVR were higher than those in control group （P<0.01）. The clinical effect was better than which in control group （Z=2.109， P<0.05）. Besides， there was no adverse reaction caused by Ditantang combined with Taohong Siwutang. Conclusion:Ditantang combined with Taohong Siwutang can ameliarate the hemodynamics， reduce the lipid peroxidation damage， regulate the neurovascular repair factor， so it can promote the repair of nerve tissue and function， clinically reduce the degree of nerve function defect， improve the ability of daily life and exercise when it used to cerebral infarction and syndrome of phlegm and blood stasis blocking collaterals during early recovery， and it is good for clinical effect and safe using.

Correlation analysis between pulse pressure index, body mass index, and cerebral hemodynamics in 12 375 individuals undergoing physical examination in Urumqi / 中华健康管理学杂志

Objective@#This study aimed to explore and analyze the correlation between pulse pressure index (PPI), body mass index (BMI), and cerebral hemodynamics and evaluate their significance in early screening for stroke.@*Methods@#The subjects were selected from those who had completed the cerebral blood flow function test in the First Affiliated Hospital of Xinjiang Medical University from January to December 2018. First, basic information and disease history of the respondents were obtained through on-site questionnaire survey. Height, weight, and blood pressure were measured, and BMI, pulse pressure, PPI, and mean arterial pressure were calculated. Meanwhile, cerebral hemodynamic monitoring was completed. Individuals with cerebral hemodynamic indexes ≥75 were classified as normal cerebrovascular function group and those with cerebral hemodynamic indexes <75 as abnormal group. This study divided the PPI into three subgroups: high, medium, and low. According to the Chinese Adult Overweight and Obesity Prevention and Control Guidelines, the BMI was divided into too low, normal, overweight, and obese. The correlations of PPI and BMI with cerebral hemodynamics in different groups were calculated and compared.@*Results@#A total of 12 375 subjects, aged (52.6±7.3) years, were included in the study, consisting of 7 275 men (58.79%) and 5 100 women (41.21%). There were 9 900 patients (80.00%) in the normal group and 2 475 patients (20.00%) in the abnormal group. The abnormal rate of cerebral hemodynamics was higher in the Han nationality； those with a history of hypertension, diabetes, and hyperlipidemia. Moreover, those with abnormal cerebral hemodynamic indicators had a higher BMI, systolic pressure, diastolic pressure, pulse pressure and PPI, mean arterial pressure was higher than the normal group (all P<0.001). In different PPI groups, the average blood flow, average velocity, maximum velocity, minimum velocity, and critical pressure level of the left and right sides showed a downward trend with the increase in PPI. Peripheral resistance, pulse wave velocity, characteristic impedance, dynamic resistance, and difference between diastolic and critical pressure all showed an upward trend with the increase in PPI. In different BMI groups, the average blood flow in the obese group on the left side was lower than that in the underweight, normal, and super recombination groups. The average blood flow in the obese group on the right side was lower than that in the normal and super recombination groups and higher than that in the subhypoxia group. The mean, maximum, and minimum velocities of the left and right sides decreased with the increase in BMI. The differences in peripheral resistance, pulse wave velocity, characteristic impedance, dynamic resistance, critical pressure level, diastolic blood pressure, and critical pressure showed an increasing trend with the increase in BMI, and the differences of the above indicators were statistically significant (all P <0.001).The results of unconditional multivariate logistic regression analysis showed that Han nationality, history of hypertension, history of diabetes, PPI, and BMI were the main risk factors for abnormal cerebral hemodynamics. The higher the PPI and BMI, the higher the risk of abnormal cerebral blood flow.@*Conclusion@#The higher the PPI and BMI, the higher the possibility of abnormal cerebral hemodynamic indexes. Extremely high PPI and BMI should be paid greater attention.

Effect of acupuncture combined with repetitive transcranial magnetic stimulation on motor function and cerebral hemodynamics in children with spastic cerebral palsy with spleen-kidney deficiency / 针刺研究

OBJECTIVE: To investigate the clinical effect of acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of children with spastic cerebral palsy with spleen-kidney deficiency, as well as its effect in improving cerebral hemodynamics. METHODS: A total of 220 children with spastic cerebral palsy were divided into observation group and control group using a random number table, with 110 children in each group. The children in the control group were given rehabilitation training and repetitive transcranial magnetic stimulation, and those in the observation group were given acupuncture in addition to the treatment in the control group. Acupuncture was performed at Zusanli (ST36), Xuanzhong (GB39), Sanyinjiao (SP6), Pishu (BL20), Shenshu (BL23), Qihai (CV6), Quchi (LI11), Neiguan (PC6), Hegu (LI4) and Tianshu (ST25) once every other day, three times a week for 3 consecutive months. The two groups were compared in terms of Gross Motor Function Measure (GMFM), Fine Motor Function Measure (FMFM), comprehensive function score for children with cerebral palsy, clinical outcome, and related cerebral hemodynamic parameters (mean blood flow velocity [Vm], systolic peak velocity [Vs], and resistance index [RI] of the cerebral artery). RESULTS: After treatment, both groups had significant increases in the scores of GMFM, FMFM and comprehensive function (cognitive function, speech function, motor ability, self-care, and social adaptability,P<0.01), and the observation group had significantly better improvements in the scores of GMFM (domains A, B and C), FMFM (domains B, C, D and E), and comprehensive function than those of the control group (P<0.01). The therapeutic effect of the observation group (93/110, 84.55%)was superior to that of the control group (80/110, 72.73%, P<0.05). The observation group had significantly higher Vs and Vm and a significantly lower RI than the control group (P<0.01). CONCLUSION: In the treatment of children with spasmodic cerebral palsy with spleen-kidney deficiency, acupuncture combined with repeated transcranial magnetic stimulation can significantly improve their motor function, comprehensive function, and clinical outcome, which may be associated with the regulation of cerebral hemodynamics.

Advance in Relationship between Cerebral Hemodynamics and Clinical Manifestations after Cranioplasty (review) / 中国康复理论与实践

Cranioplasty is one of the common operations in neurosurgery at present. It can not only restore the integrity of the cranial cavity and meet the aesthetic requirements, but also relieve the clinical symptoms of headache, dizziness, fatigue, mood swings and so on. Cranioplasty can improve cerebral hemodynamics to promote the recovery of neurological function. The researches on relationship between cerebral hemodynamics and clinical symptoms were reported in recent years. However, the results were not consistent. Cranioplasty is recommended as early as permit.

Analysis of stroke risk factors and cerebrovascular hemodynamic indexes of Han nationality and major ethnic minorities in a tertiary hospital in southwest Yunnan / 中国脑血管病杂志

Objective To analyze the differences between the exposure levels of major stroke risk factors and cerebral vascular hemodynamic indexes (CVHIs) in Han nationality and major ethnic minorities in Pu'er People Hospital in southwest Yunnan. Methods In this cross-sectional study,26 640 patients admitted to Pu'er People Hospital for stroke risk assessment were recruited from July 2016 to September 2018. Major risk factors of stroke and CVHIs were investigated and detected. The subjects were divided into six ethnic groups,including Han, Yi, Hani, Dai, Lahu and Wa. The differences of the exposure rate of major stroke risk factors,CVHIs and cerebrovascular function scores among these ethnic groups were compared and analyzed. Results There were significant differences (all P < 0. 01) in the risk factors for stroke. Dai ethnic group had the highest prevalence of hypertension (34. 7% [194/559]) and Wa ethnic group the lowest (26. 3% [94/358]). Han ethnic group had the highest dyslipidemia rate of 7. 9% [1892/23887], and Dai ethnic group was 4. 3% [24/559] . The prevalence rate of diabetes among Lahu ethnic group was highest at 10. 1% [34/335] and Hani ethnic group lowest at 3.3% [30/907]. Among different ethnic groups, the minimum velocity, mean velocity, peripheral resistance, and cerebrovascular function scores were statistically significant (all P <0.05). The proportion of cerebrovascular function scores less than 75 points (stroke high-risk individual) in Han, Y i, Hani, Dai, Lahu, Wa ethnic group was respectively 36.7% [8 759/23 887],32.7% [194/594],34. 1% [309/907], 38. 3% [214/559], 31. 9% [107/335] and 32. 4% [116/358] (P < 0. 05) . Conclusions There were significant differences in the exposure levels of major stroke risk factors and CVHIs among ethnic groups in Pu'er People Hospital in southwest Yunnan. Han and Lahu ethnic groups had higher exposure level of risk factors. Cerebral vascular function damage was more serious in Han and Dai ethnic groups.

Effects of Memantine Hydrochloride on Cognitive Function, Cerebral Hemodynamics and Oxidative Stress Level in Patients with Vascular Dementia / 中国药房

OBJECTIVE: To investigate the effects of memantine hydrochloride on cognitive function, cerebral hemodynamics and oxidative stress level in patients with vascular dementia (VD). METHODS: A total of 70 VD patients in the Third Affiliated Hospital of Xinxiang Medical College from Feb. 2013 to Feb. 2015 were divided into control group (36 cases) and observation group (34 cases) aoccording to random number table. Observation group was given Memantine hydrochloride tablets orally with initial dose of 5 mg/d, qd, increasing by 5 mg/week gradually, maintaining at 20 mg/d, qd, at 4th week. Control group was given Piracetam tablets 0. 8 g orally, tid. A treatment course of 2 groups lasted for 4 weeks, and both were treated for 6 courses. Clinical efficacies as well as MoCA scores, ADL scores, systolic peak velocity (Vmax),diastolic peak velocity (Vmin),pulsatility index (PI), resistance index (RI) and breath holding index (BHI) of middle cerebral artery, the levels of MDA, SOD and Hcy were observed in 2 groups. The occurrence of ADR was recorded. RESULTS: Four, two patients withdrew from the study in control and observation group, respectively, and 32 patients in each group completed the study. The total response rate of observation group was 87. 50％, which was significantly higher than 65. 63％ of control group, with statistical significance (P＜0. 05). Before treatment, there was no statistical significance in above indexes between 2 groups (P＞0. 05). After treatment, MoCA, ADL scores and SOD levels of 2 groups were increased significantly, while MDA and Hcy levels were decreased significantly; Vmax and BHI of observation group were increased significantly, and above indexes of observation group was significantly better than those of control group, with statistical significance (P＜0. 05). There was no statistical significance in Vmin, PI or RI between 2 groups before and after treatment, and Vmax or BHI of control group before and after treatment (P＞0. 05). ADRs of 2 groups were mild, and there was no statistical significance in the incidence of ADR between 2 groups (P＞0. 05). CONCLUSIONS: Memantine hydrochloride in the treatment of VD patients can improve the cerebral hemodynamics, reduce oxidative stress and improve cognitive function with good safety.

Effects of combined antiplatelet treatment on cerebral hemodynamics and platelet parameters in progressive stroke patients / 医学研究生学报

Objective The double antiplatelet therapy with aspirin and clopidogrel is widely used in the progressive stroke patients.However, this therapeutic regimen is still lack of guideline confirmation .In this study, we aimed to observe the effects of cere-bral hemodynamics and platelet parameters of combined antiplatelet treatment with aspirin and clopidogrel on progressive stroke patients . Methods This retrospective study enrolled 82 patients with progres-sive stroke within 24 hours in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from January 2014 to January 2016.All the patients were divided into two groups ( single antiplatelet group and combined antiplatelet group ) according to the antiplatelet therapy .Forty patients were included in the single antiplatelet group oral-ly took aspirin 0.1g once a day while in the combined antiplatelet group forty-two patients were included to take clopidogrel 75 mg once a day besides aspirin for 21 days and then kept aspirin only .All the patients were observed for 3 months.On the 1st and 7th day of ad-mission and 3 months after admission , the patients were examined for the terms of the grades of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI), as well as the platelet parameters including plaletet count (PLT), thrombocytocrit (PCT), mean platelet volume ( MPV) and platelet distribution width ( PDW) .The thrombelastogram was done to test the plate inhibition rate . Meanwhile , the transcranial doppler examination was done to realize the cerebral hemodynamics . Results After 7 days'and 3 months'treatment, the grades of NIHSS of combined antiplatelet group were significantly decreased versus single antiplatelet group , while BI of the combined antiplatelet group was significantly increased ( P<0.05 ) .The inhibition rate induced through adenosine diphosphate pathway was higher in the combined antiplatelet group versus the single antiplatelet group (P=0.003) on the 7th day.PLT ( P=0.006) level in the combined antiplatelet group was higher than that in the single antiplatelet group , while MPV ( P=0.023) and PDW (P=0.017) were actually lower in the combined antiplatelet group than the single antiplatelet group after 7 days'treatment.After 3 months, PDW in the combined antiplatelet group was still lower than the single antiplatelet group (P=0.041).On the 7th day, Vs (P=0.046), Vm (P=0.039) in bilateral middle cerebral artery in the combined antiplatelet group were lower than the single anti -platelet group.After 3 months, the Vs (P=0.030), PI (P=0.041) in the combined antiplatelet group was further improved versus the single antiplatelet group . Conclusion The improved effects of combined antiplatelet treatment with aspirin and clopidogrel on the clinical symptoms, cerebral hemodynamics and platelet parameters were better than single antiplatelet treatment with aspirin .

Clinical observation of Sweet Dream Oral Liquid curing deficiency of spleen and kidney style MCI / 中草药

Objective To observe the clinical effect of Sweet Dream Oral Liquid on the mild cognitive impairment (MCI) patients of spleen and kidney deficiency. Methods A total of 102 patients with MCI were randomly divided into two groups, the treatment group with 53 patients and the control group with 49 patients. Both groups were given Citicoline Sodium Tablets for 8 weeks. The treatment group was given Sweet Dream Oral Liquid extra. Mini-mental state examination (MMSE), Transcranial Doppler (TCD) and Traditional Chinese Medicine Syndrome Score (TCMSS) were performed before and after the treatment. Compliance and adverse reactions for both groups were observed during the treatment. Results MMSE improved after the treatment for both groups; Especially, MMSE of the treatment group improved more obviously (P < 0.01); The difference between the two groups was significant (P < 0.05); For treatment group, the average blood flow velocity (Vm) of the cerebral arteries was increased significantly after the treatment(P < 0.01); Compared with the control group, the difference was obvious (P < 0.05); The total effective rate of the treatment group on spleen and kidney deficiency syndrome was 96.23%. It was 18.37% for the control group. Difference between the two groups was significant (P < 0.01). After the treatment, TCMSS of the treatment group was significantly reduced (P < 0.01); It was a significant difference comparing with the control group (P < 0.01). During the treatment, both groups had a good compliance, no adverse reactions and no shedding patients. Conclusion Sweet Dream Oral Liquid can improve the cognitive function and living quality of the patients with deficiency of spleen and kidney style MCI by reducing TCMSS, improving cerebral hemodynamics and rising MMSE score.

Therapeutic effect of Butylphthalide Injection in elderly patients with acute cerebral infarction and its influence in cerebral hemodynamics and cerebral vascular reserve / 吉林大学学报(医学版)

Objective:To probe the therapeutic effects of Butylphthalide Injection in the elderly patients with acute cerebral infarction (ACI) and its influence in cerebral hemodynamics and cerebral vascular reserve (CVR),and to clarify the pharmacological action mechanism of butylphthalide in treatment of ACI.Methods:A total of 100 cases of elderly patients with ACI were selected as the subjects and divided into observation group and control group according to the serial number on admission.Fifty cases were included in each group.The patients in control group were treated with the conventional treatment, while the patients in observation group were treated with Butylphthalide Injection on the basis of the conventional treatment.The National Institute of Health Stroke Scale (NIHSS) score, the brain hemodynamics indexes of the peak velocity (Vp), the mean velocity (Vm) and the differences of the velocity (DVp, DVm) as well as pulsatility index (PI), CVR of bilateral middle cerebral artery (MCA)of the patients in two groups were observed and compared.The therapeutic effects of the patients in two groups were evaluated and compared.Results:The NIHSS score of the patients in observation group after treatment was significantly lower than that in control group (t=15.420, P<0.05).The therapeutic effects and the clinical efficiency of the patients in observation group were significantly better than those in control group (U=2.225, χ2=5.005, P<0.05).The Vp and Vm of the patients in observation group after treatment were significantly higher than those in control group(t=10.819,t=7.259, P<0.05)and the DVp and DVm were significantly lower than those in control group (t=16.438,t=19.055, P<0.05).The CVR of the patients in observation group after treatment was significantly higher than that in control group(t=6.884, P<0.05)and the PI was significantly lower than that in control group (t=4.979, P<0.05).Conclusion:Butylphthalide Injection can effectively correct the abnormality of brain hemodynamics in the ACI patients, enhance the ability of body in maintaining the stability of cerebral vascular perfusion, improve the neurological symptoms in the patients with ACI, and improve the therapeutic effects.

Effects of combined antiplatelet treatment on cerebral hemodynamics and platelet parameters in progressive stroke patients / 医学研究生学报

Objective The double antiplatelet therapy with aspirin and clopidogrel is widely used in the progressive stroke patients.However, this therapeutic regimen is still lack of guideline confirmation .In this study, we aimed to observe the effects of cere-bral hemodynamics and platelet parameters of combined antiplatelet treatment with aspirin and clopidogrel on progressive stroke patients . Methods This retrospective study enrolled 82 patients with progres-sive stroke within 24 hours in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from January 2014 to January 2016.All the patients were divided into two groups ( single antiplatelet group and combined antiplatelet group ) according to the antiplatelet therapy .Forty patients were included in the single antiplatelet group oral-ly took aspirin 0.1g once a day while in the combined antiplatelet group forty-two patients were included to take clopidogrel 75 mg once a day besides aspirin for 21 days and then kept aspirin only .All the patients were observed for 3 months.On the 1st and 7th day of ad-mission and 3 months after admission , the patients were examined for the terms of the grades of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI), as well as the platelet parameters including plaletet count (PLT), thrombocytocrit (PCT), mean platelet volume ( MPV) and platelet distribution width ( PDW) .The thrombelastogram was done to test the plate inhibition rate . Meanwhile , the transcranial doppler examination was done to realize the cerebral hemodynamics . Results After 7 days'and 3 months'treatment, the grades of NIHSS of combined antiplatelet group were significantly decreased versus single antiplatelet group , while BI of the combined antiplatelet group was significantly increased ( P<0.05 ) .The inhibition rate induced through adenosine diphosphate pathway was higher in the combined antiplatelet group versus the single antiplatelet group (P=0.003) on the 7th day.PLT ( P=0.006) level in the combined antiplatelet group was higher than that in the single antiplatelet group , while MPV ( P=0.023) and PDW (P=0.017) were actually lower in the combined antiplatelet group than the single antiplatelet group after 7 days'treatment.After 3 months, PDW in the combined antiplatelet group was still lower than the single antiplatelet group (P=0.041).On the 7th day, Vs (P=0.046), Vm (P=0.039) in bilateral middle cerebral artery in the combined antiplatelet group were lower than the single anti -platelet group.After 3 months, the Vs (P=0.030), PI (P=0.041) in the combined antiplatelet group was further improved versus the single antiplatelet group . Conclusion The improved effects of combined antiplatelet treatment with aspirin and clopidogrel on the clinical symptoms, cerebral hemodynamics and platelet parameters were better than single antiplatelet treatment with aspirin .

Application of MR perfusion imaging in evaluation of hemodynamic of patients with moyamoya disease / 吉林大学学报(医学版)

Objective:To evaluate the hemodynamic situation of the patients with moyamoya disease using MR perfusion imaging,and to explore the relationship between compensatory collateral circulation and perfusion. Methods:Seventy-two hospitalized patients with moyamoya disease were selected as typical moyamoya disease group,including 37 males and 35 females,aged 10 - 62 years old,all patients underwent cerebral angiography (DSA)and MR perfusion imaging.And 20 patients with out neurological history were used as control group.With mean transit time (MTT)image as a standard,the abnormal perfusion ranges were classified as region of interest (ROI),and the corresponding perfusion parameter values,including cerebral blood flow (CBF),cerebral blood volume (CBV),MTT and time to peak (TTP)were recorded,respectively.The cerebellum was used as a reference in this study,the perfusion parameters were standardized,and the relative ratios of the perfusion parameters (rMTT,rTTP,rCBF,rCBV)were obtained.Results:Compared with control group,the rMTT and rTTP of the patients in typical moyamoya disease group were prolonged and the rCBF was reduced (P 0.05).②Compared with the contralateral side,the rMTT and rTTP of the suffered side were prolonged,and the rCBF and rCBV were reduced (P 0.05).There were no significant differences in all parameters between hemorrhagic moyamoya disease group and ischemia group (P > 0.05 ). Conclusion:MR perfusion imaging can accurately evaluate the hemodynamic condition of moyamoya disease;MTT and TTP hve higher sensitivities than CBF and CBV.MR perfusion imaging can evaluate the compensation of collateral circulation of moyamoya disease and provide the objective basis for the clinician to select the proper surgical timing and the best operation methods.

Study on detection value of noninvasive cerebral hemodynamics and serum nerve function indexes in patients with craniocerebral injury / 国际检验医学杂志

Objective To study and investigate the detection value of noninvasive cerebral hemodynamics and serum nerve func‐tion indexes in the patients with craniocerebral injury .Methods Totally 64 patients with craniocerebral injury in our hospital from September 2013 to May 2015 were selected as the observation group ,meanwhile 64 healthy persons with the same age were selected as the control group .Then the noninvasive cerebral hemodynamics and serum nerve function indexes were compared between the two groups ,furthermore the detection results in the observation group were compared among the patients with different severity de‐grees and intracranial pressures .Results The middle cerebral artery blood flow indexes of the observation group were all higher than those of the control group ,the serum nerve function indexes were also higher than those of the control group ,and the middle cerebral artery blood flow indexes and serum nerve function indexes of the observation group had obvious differences among the pa‐tients with different severity degrees and intracranial pressures too (P< 0 .05) ,showing statistical significance .Conclusion The noninvasive cerebral hemodynamics and serum nerve function indexes have highe detection value in the patients with craniocerebral injury ,and have active clinical role for the understand of disease severity degree and intracranial pressure situation .

External Counterpulsation Reduces Beat-to-Beat Blood Pressure Variability When Augmenting Blood Pressure and Cerebral Blood Flow in Ischemic Stroke

BACKGROUND AND PURPOSE: External counterpulsation (ECP) is a noninvasive method used to enhance cerebral perfusion by elevating the blood pressure in ischemic stroke. However, the response of the beat-to-beat blood pressure variability (BPV) in ischemic stroke patients during ECP remains unknown. METHODS: We enrolled recent ischemic stroke patients and healthy controls. Changes in the blood flow velocities in bilateral middle cerebral arteries and the continuous beat-to-beat blood pressure before, during, and after ECP were monitored. Power spectral analysis revealed that the BPV included oscillations at very low frequency (VLF; <0.04 Hz), low frequency (LF; 0.04-0.15 Hz), and high frequency (HF; 0.15-0.40 Hz), and the total power spectral density (TP; <0.40 Hz) and LF/HF ratio were calculated. RESULTS: We found that ECP significantly increased the systolic and diastolic blood pressures in both stroke patients and controls. ECP decreased markedly the systolic and diastolic BPVs at VLF and LF and the TP, and the diastolic BPV at HF when compared with baseline. The decreases in diastolic and systolic BPV reached 37.56% and 23.20%, respectively, at VLF, 21.15% and 12.19% at LF, 8.76% and 16.59% at HF, and 31.92% and 23.62% for the total TP in stroke patients, which did not differ from those in healthy controls. The change in flow velocity on the contralateral side was positively correlated with the total TP systolic BPV change induced by ECP (r=0.312, p=0.035). CONCLUSIONS: ECP reduces the beat-to-beat BPV when increasing the blood pressure and cerebral blood flow velocity in ischemic stroke patients. ECP might be able to improve the clinical outcome by decreasing the beat-to-beat BPV in stroke patients, and this should be explored further in future studies.

CT study of dependability in cerebral hemodynamic changes of carotid artery stenosis and the degree of carotid stenosis / 实用放射学杂志

Objective To investigate cerebral hemodynamic changes in patients with unilateral stenosis of carotid artery by using CTP and CTA,and to analyze the dependability of the degree of artery stenosis and cerebral hemodynamic changes.Methods Fifty patients with unilateral stenosis of carotid artery underwent toshiba aquilion one CTP and CTA.The patients were divided into mod-erate stenosis group,severe stenosis group and occlusion group according to the NASCET criteria.The rCBF,rCBV,rMTT and rTTP were measured ,and compared between stenosis and contralateral hemispheres ,and the dependability were analyzed between the de-gree of unilateral carotid artery stenosis and relative perfusion parameters by using ranking-test.Results (1)There were 20 cases of unilateral carotid artery occlusion,13 severe stenosis,1 7 moderate stenosis.(2 )No statistical significance on rCBF and rCBV was found among the three stenotic groups (P>0.05).There were statistical significances on rMTT and rTTP among the three stenotic groups(P<0.05).(3)There were statistically no correlations between the values of rCBV,rCBF and the degree of artery stenosis.There were statistically positive correlations between the values of rMTT,rTTP and the degree of artery stenosis with the pearson correlations 0.512 and 0.708. Conclusion rMTT and rTTP are more sensitive parameters for evaluation of cerebral hemodynamics and dependability of carotid ar-tery stenosis on the CTP and CTA.These have an important value to guide the clinical treatment.

Effect of hyperbaric oxygen on patients with severe traumatic brain injury and on intracranial hemodynamics / 军事医学

Objective To investigate the effect of hyperbaric oxygen on cerebral hemodynamics and intracranial pressure(ICP)in patients with severe traumatic brain injury (SBI).Methods A retrospective analysis was conduccted .82 cases of SBI patients treated in our hospital from January 2013 to January 2014 were randomly and evenly divided into two groups.Control group received conventional treatment while observation group was treated with continuous hyperbaric oxygen therapy.Intracranial hemodynamic parameters before and after treatment were determined and compared between the two groups.Results Peak systolic velocity ( Vs) and mean flow velocity ( Vm) of the middle cerebral artery ( MCA) were faster in hyperbaric oxygen group than in control group (P<0.05); the pulsatility index was lower than in control group (P<0.05);intracranial pressure (ICP) values (11.20 ±3.39)mmHg were significantly lower in observation group after hyperbaric oxygen therapy than in control group (15.24 ±3.13)mmHg.The difference was statistically significant (P<0.05), and the total effective rate was 85.37% vs 68.29% in control group(P<0.05).Conclusion Early hyperbaric oxygen therapy can significantly enhance SBI patients immune function and the ability to fight against infections in critically ill patients, therefore improving patients outcomes and overall quality of life .

Cerebral hemodynamics: concepts of clinical importance / Hemodinâmica encefálica: conceitos de importância clínica

Cerebral hemodynamics and metabolism are frequently impaired in a wide range of neurological diseases, including traumatic brain injury and stroke, with several pathophysiological mechanisms of injury. The resultant uncoupling of cerebral blood flow and metabolism can trigger secondary brain lesions, particularly in early phases, consequently worsening the patient's outcome. Cerebral blood flow regulation is influenced by blood gas content, blood viscosity, body temperature, cardiac output, altitude, cerebrovascular autoregulation, and neurovascular coupling, mediated by chemical agents such as nitric oxide (NO), carbon monoxide (CO), eicosanoid products, oxygen-derived free radicals, endothelins, K+, H+, and adenosine. A better understanding of these factors is valuable for the management of neurocritical care patients. The assessment of both cerebral hemodynamics and metabolism in the acute phase of neurocritical care conditions may contribute to a more effective planning of therapeutic strategies for reducing secondary brain lesions. In this review, the authors have discussed concepts of cerebral hemodynamics, considering aspects of clinical importance.

Alterações hemodinâmicas e metabólicas do encéfalo ocorrem frequentemente em diversas doenças neurológicas, principalmente em condições de traumatismo cranioencefálico e acidente vascular encefálico, com vários mecanismos patofisiológicos lesionais. O desacoplamento resultante do fluxo sanguíneo e do metabolismo encefálico pode resultar em lesões encefálicas secundárias, principalmente nas primeiras fases, e, consequentemente, no agravamento do desfecho neurológico dos pacientes. Diversos fatores influenciam o fluxo sanguíneo encefálico, entre eles, a concentração sanguínea de gases, viscosidade sanguínea, temperatura corpórea, débito cardíaco, altitude, autorregulação cerebrovascular e acoplamento neurovascular, que é mediado por óxido nítrico (ON), monóxido de carbono (CO), eicosanoides, radicais livres derivados do oxigênio, endotelinas, potássio, íons hidrogênio e adenosinas. Melhor compreensão destes fatores é fundamental para o manejo clínico dos pacientes neurológicos críticos. A avaliação hemodinâmica e metabólica do encéfalo nas lesões encefálicas agudas pode contribuir para o planejamento de estratégias de redução das lesões encefálicas secundárias. Nesta revisão, os autores discutiram princípios da hemodinâmica encefálica, considerando os aspectos de importância clínica.

Effects of Compound Anisodine Acupoint Injection on Cerebral Hemodynamics in Ischemic Stroke Patients:A Transcranial Color Doppler Study / 中国康复理论与实践

@#Objective To observe the cerebral hemodynamics in ischemic stroke patients after compound anisodine acupoint injection.Methods 40 stroke patients were measured with transcranial color Doppler before and 4 h,24 h after compound anisodine acupoint injection.Results After injection,the velocity of the cerebral artery showed some increase,the end diastolic velocity of the ophthalmic artery increased and the pulsitility index decreased(P<0.05).Conclusion The compound anisodine acupoint injection may improve the flow velocity of ophthalmic artery and cerebral artery.