Recent advance in multimodal magnetic resonance imaging of the hippocampus and its circuits in cognitive impairment / 中华神经医学杂志

The hippocampus and its circuits play crucial roles in human learning, memory, and emotional regulation. Whether it is vascular cognitive impairment (VCI) or Alzheimer's disease (AD), damage to the hippocampus is a prominent pathological feature. This review summarizes the recent advance in multimodal magnetic resonance imaging in anatomy, blood supply, structure and function of the hippocampus and the circuits related to VCI and AD in recent years, aiming to provide help in early recognizing and differentially diagnosing VCI and AD.

Biological clock rhythm disorder and hypertension / 国际脑血管病杂志

Biological clock proteins are involved in the regulation of many important physiological processes, including blood pressure. The deletion or mutation of core circadian clock genes may cause elevated blood pressure levels and disrupted blood pressure rhythms, exacerbating vascular function damage, and ultimately leading to the occurrence, development and poor outcome of ischemic stroke. This article reviews the molecular mechanism of biological clock rhythm, the relationship between biological clock gene and blood pressure regulation mechanism, the mechanism of circadian rhythm disorder in the occurrence and development of hypertension, and the relationship between blood pressure rhythm disorder and stroke.

Serum uric acid and short term prognosis of acute ischemic stroke in patients received intravenous thrombolysis / 中华内分泌代谢杂志

Objective:To investigate the relationship between serum uric acid (SUA) and 3-month outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis.Methods:A total of 386 patients with acute ischemic stroke received intravenous thrombolysis therapy from 1 January 2017 to 31 December 2019 in the Affiliated Hospital of Lianyungang, Xuzhou Medical University were enrolled prospectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. The functional outcome was evaluated by the modified Rankin Scale at discharge or 3 months after onset. Pearson′s correlation was used to assess the relationship between SUA and NIHSS scores at baseline and discharge. Propensity score matching was used to balance confounding factors. Multivariate logistic regression model was used to identify the correlation between SUA and prognostic outcome after thrombolysis.Results:A total of 386 eligible patients were included. Two hundred and thirty patients (59.6%) had good outcomes in the follow-up after 3 months. The levels of SUA are negatively associated with the NIHSS score at discharge ( r=-0.171, P=0.003). A positive correlation was observed between the levels of SUA and the difference of NIHSS at baseline and discharge ( r=0.118, P=0.032). Patients were divided into three groups according to the quartile of SUA. Multivariate logistic regression analysis showed that high SUA levels were independently associated with good outcome three months after stroke ( OR=0.421, 95% CI 0.327-0.541, P<0.001). Conclusion:In patients with acute ischemic stroke, elevated SUA levels can predict better recovery and short-term outcomes in patients undergoing intravenous thrombolysis.

Effect of psychological support during perithrombotic period on post-stroke depression in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the effect of psychological support during perithrombotic period on post-stroke depression (PSD) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 1, 2021 to July 31, 2021 were enrolled prospectively. The intervention group received one-to-one individual psychological support therapy in the perithrombolytic period on the basis of receiving standard intravenous thrombolytic therapy. At 30 d after onset, Hamilton Depression Scale was used to assess whether PSD occurred. Multivariate logistic regression analysis was used to evaluate the independent influencing factor of PSD. Results:A total of 126 patients with AIS were enrolled, and 86 of them were male (68.25%). Their age was 63.65±10.46 years; 65 were in the intervention group and 61 were in the control group. The incidence of PSD in the intervention group was significantly lower than that in the control group (20.00% vs. 36.07%; χ2=4.049, P=0.044). Multivariate logistic regression analysis showed that psychological intervention (odds ratio [ OR] 0.333, 95% confidence interval [ CI] 0.132-0.838; P=0.020] was an independent protective factor for PSD, while ischemic heart disease ( OR 4.510, 95% CI 1.181-17.217; P=0.028), alcohol consumption ( OR 3.421, 95% CI 1.317-8.888; P=0.012), anticoagulation therapy ( OR 3.145, 95% CI 1.155-8.567; P=0.025) and modified Rankin Scale score before thrombolysis ( OR 1.627, 95% CI 1.142-2.317; P=0.007) were the independent risk factors for PSD. Conclusion:Perithrombolytic psychological support may reduce the incidence of PSD.

Blood pressure rhythm and circadian clock protein expression after cerebral ischemia-reperfusion in spontaneously hypertensive rats / 国际脑血管病杂志

Objective:To investigate the changes of blood pressure and serum circadian clock protein levels after cerebral ischemia-reperfusion in spontaneously hypertensive rat (SHR) and their correlation.Methods:The middle cerebral artery occlusion method was used to prepare the SHR cerebral ischemia-reperfusion model at zero point of Zeitgeber Time (ZT), and the systolic blood pressure within 24 h was continuously monitored after the model was made. The tail vein blood of rats was taken every 3 h, and the changes in serum circadian clock proteins (CLOCK, BMAL1, PER1 and CRY1) levels were detected by enzyme-linked immunosorbent assay. Pearson correlation analysis was used to determine the relationship between blood pressure circadian rhythm pattern and circadian clock protein level fluctuation after cerebral ischemia-reperfusion.Results:In the sham operation group, there were various blood pressure patterns, including dipper (53%), non-dipper (27%), super dipper (13%), and reverse dipper (7%), and the main pattern was dipper. In contrast, the degree of blood pressure disorder in the model group was aggravated, and the non-dipper was the main type, with the proportion as high as 40%. The proportion of super dipper and reverse dipper increased to 27% and 13% respectively; proportion of dipper blood pressure decreased to 20%. The serum level of CLOCK in the model group was relatively stable, while the circadian rhythm of BMAL1, PER1 and CRY1 was significantly changed compared with the sham operation group. Pearson analysis showed that PER1 was negatively correlated with the dipper ( r=-0.565, P=0.002) and super dipper ( r=-0.531, P=0.001) blood pressure patterns, and positively correlated with the non-dipper blood pressure pattern ( r=0.620, P<0.001). Conclusion:The circadian rhythm pattern of blood pressure in SHR after cerebral ischemia-reperfusion was obviously disordered, which was closely associated with the regulation of Per1 gene.

Mechanism of period gene regulating renin-angiotensin-aldosterone system in rhythm of blood pressure / 国际脑血管病杂志

Rhythm of blood pressure refers to the circadian variation of blood pressure, which is regulated by clock genes. However, the rhythm disorder of blood pressure increases the risk of stroke. Taking the process of blood pressure regulation as a clue and focusing on the clock gene pathway, this article explores the possible mechanism of period gene regulating renin-angiotensin-aldosterone system in rhythm of blood pressure, so as to provide reference for the in-depth study of the relevant mechanism of rhythm disorder of blood pressure and search for a new target for the primary prevention of cerebrovascular diseases.

Correlation between total cholesterol/high-density lipoprotein cholesterol ratio and asymptomatic carotid atherosclerotic plaque stability / 国际脑血管病杂志

Objective:To investigate the correlation between total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio and unstable carotid plaque.Methods:From February 2021 to May 2021, adult patients with asymptomatic carotid atherosclerotic plaque admitted to the Department of Neurology, the First People's Hospital of Lianyungang were retrospectively enrolled. The demographic and related clinical data were collected. Carotid artery plaques were detected by ultrasound, and the subjects were divided into a stable plaque group and an unstable plaque group. Multivariate logistic regression analysis was used to assess the independent risk factors for unstable carotid plaques. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of TC/HDL-C ratio for unstable carotid plaques. Results:A total of 362 patients with asymptomatic carotid atherosclerotic plaque were enrolled, including 226 (62.43%) in the stable plaque group and 136 (37.57%) in the unstable plaque group. Multivariate logistic regression analysis showed that after adjusting for confounding factors, only TC/HDL-C ratio was the independent risk factor for unstable carotid plaque (taking the 1 st quintile array of TC/HDL-C ratio as a reference, the 4 th quintile array: odds ratio 3.13, 95% confidence interval 1.50-6.55, P=0.002; the 5 th quintile array: odds ratio 6.75, 95% confidence interval 3.21-14.22, P<0.001). ROC curve analysis showed that the area under the curve of TC/HDL-C ratio for predicting unstable carotid plaque was 0.691 (95% confidence interval 0.634-0.748; P<0.001), the optimal cut-off value was 4.38, and the sensitivity and specificity were 50.0% and 82.7%, respectively. Conclusion:TC/HDL-C ratio is an independent risk factor for unstable carotid plaques and has a certain predictive value for unstable carotid plaques.

Stress hyperglycemia predicts the outcomes in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the predictive value of stress hyperglycemia for the functional outcomes in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Affiliated Hospital of Lianyungang, Xuzhou Medical University from September 1, 2019 to December 31, 2020 were enrolled prospectively. The glucose to glycated hemoglobin ratio (GAR) was used to express stress hyperglycemia. The functional outcome was evaluated by the modified Rankin Scale at 3 month after discharge, 0-2 was defined as a good outcome and >2 as a poor outcome. Multivariate logistic regression analysis was used to determine the independent related factors of functional outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of GAR for poor functional outcome. Results:A total of 1 286 patients with AIS were included. Their median age was 67 years old, and 762 were males (59.3%). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 2. The median fasting blood glucose level was 5.48 mmol/L, the median glycosylated hemoglobin was 6.00%, and the median GAR was 0.92. Eight hundred and twelve patients (63.1%) had good outcomes and 474 (36.9%) had poor outcomes. The GAR in the good outcome group was significantly lower than that in the poor outcome group (0.86 vs. 1.03; P<0.001). All patients were divided into 4 groups (GAR1, GAR2, GAR3, and GAR4) according to the GAR quartile from low to high. Multivariate logistic regression analysis showed that after adjusting for relevant confounding factors, GAR4 (taking the GAR1 as a reference, odds ratio [ OR] 8.896, 95% confidence interval [ CI] 5.775-13.702; P<0.001), age ( OR 1.041, 95% CI 1.027-1.055; P<0.001) and baseline NIHSS score classification ( OR 25.898, 95% CI 14.221-47.163; P<0.001) were closely associated with the poor outcomes at 3 months. Further subgroup analysis showed that the higher level of GAR was significantly and independently correlated with the poor functional outcome, regardless of whether the patients had diabetes or not. The ROC curve analysis showed that the area under the curve of GAR predicting poor outcome at 3 months was 0.705 (95% CI 0.675-0.735; P<0.001), and the predictive value was significantly higher than that of glycosylated hemoglobin and fasting blood glucose. When the cut-off value of GAR was 0.97, the Yoden index was the largest, which was 0.370. The sensitivity and specificity of its predicting the poor outcome at 3 months were 61.6% and 75.4%. Conclusion:Whether or not diabetes is present, GAR is an independent predictor of the poor outcomes in patients with AIS.

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction / 中国医师进修杂志

Objective@#To assess the relationship between hemoglobin A1c (HbA1c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction.@*Methods@#From January 2014 to June 2016, in the Lianyungang Hospital Affiliated to Xuzhou Medical University, 426 patients with acute anterior circulation infarction were included. The blood sugar status before stroke was expressed by HbA1c. HbA1c and fasting blood glucose (FBG) were measured on the second day after admission. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission. The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge. CT or MRI/SWI examination was performed to determine whether there was HT. Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.@*Results@#Of the 426 patients enrolled, 93 (21.8%) appeared HT, 60 (14.1%) had hemorrhagic cerebral infarction (HI) and 33 (7.7%) had parenchymal hemorrhage (PH). Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT. When patients were grouped according to fasting blood glucose (FBG<7.8 mmol/L or ≥ 7.8 mmol/L), the predictive effect of HbA1c on HT was found in both groups. In multiple Logistic regression analysis, HbA1c was also a predictor of poor prognosis after stroke (OR=1.482, 95% CI 1.228 -1.788).@*Conclusions@#In patients with ischemic stroke, elevated HbA1c is independently associated with post-infarction HT, and this result doesn′t change even in patients with well-controlled blood glucose. HbA1c is also a predictor of poor prognosis after stroke. These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Nontraditional lipid indicators and ischemic stroke / 国际脑血管病杂志

Personalized management of ischemic stroke prevention and treatment remains a top priority in the field of neurology. The purpose of this article is to elucidate the role of nontraditional lipid profile and traditional lipids in the pathogenesis and recurrence of acute ischemic stroke in order to provide new indicators for stroke prevention, risk grading and high-risk population screening, and attempt to discuss the potential predictive value of nontraditional lipid indicators.

Blood pressure management in patients with acute ischemic stroke receiving intravenous thrombolysis / 国际脑血管病杂志

Blood pressure management is an important and complex part of the treatment of acute ischemic stroke. There is no consensus on blood pressure management options for patients with acute ischemic stroke receiving intravenous thrombolysis. Blood pressure levels and blood pressure variability before and after thrombolysis, and timing of blood pressure interventions have significant effects on hemorrhagic transformation, functional outcome, and recurrence risk in patients with acute ischemic stroke. This article reviews the necessity, safety, goals of blood pressure management before and after thrombolysis, and its impact on the outcomes in acute ischemic stroke.

Circadian clock and ischemic stroke / 国际脑血管病杂志

Almost all life on Earth has a 24 h circadian rhythm. The circadian clock that controls the circadian rhythm is an important regulator of physiology and disease. Disturbance of circadian rhythm can negatively affect physiological homeostasis at the molecular, cellular, organ system, and whole organism levels. The circadian clock rhythm disorders are considered to be involved inmany cardiocerebrovascular diseases, such as ischemic stroke and myocardial infarction. Ischemic stroke is one of the main causes of long-term disability and death worldwide. The incidence is higher in the daytime and lower at night, but the exact mechanism of this time distribution is unclear. This article discusses the role of the circadian clock in stroke pathophysiological mechanism and the specific molecular mechanism of clock gene regulation. It is expected that molecular time can be used or changed to open up new targets for stroke treatment.

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction / 中国医师进修杂志

Objective To assess the relationship between hemoglobin A1c (HbA1c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction.Methods From January 2014 to June 2016,in the Lianyungang Hospital Affiliated to Xuzhou Medical University,426 patients with acute anterior circulation infarction were included.The blood sugar status before stroke was expressed by HbA1c.HbA1c and fasting blood glucose (FBG) were measured on the second day after admission.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission.The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge.CT or MRI/SWI examination was performed to determine whether there was HT.Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.Results Of the 426 patients enrolled,93 (21.8％) appeared HT,60 (14.1％) had hemorrhagic cerebral infarction (HI) and 33 (7.7％) had parenchymal hemorrhage (PH).Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT.When patients were grouped according to fasting blood glucose (FBG ＜ 7.8 mmol/L or ≥ 7.8 mmol/L),the predictive effect of HbA1c on HT was found in both groups.In multiple Logistic regression analysis,HbA1c was also a predictor of poor prognosis after stroke (OR =1.482,95％ CI 1.228-1.788).Conclusions In patients with ischemic stroke,elevated HbA1c is independently associated with post-infarction HT,and this result doesn't change even in patients with well-controlled blood glucose.HbA1c is also a predictor of poor prognosis after stroke.These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Optimal blood pressure during peri-thrombolysis period of acute ischemic stroke / 中华神经医学杂志

Objective:To explore the influence of blood pressure during peri-thrombolysis period (from admission to 24 h after thrombolysis) in intracranial hemorrhage, improvement of neurological function, primary endpoint event (recurrence of symptomatic stroke) and secondary endpoint events (complex cardiovascular and cerebrovascular events, and all-cause death) in patients with acute ischemic stroke.Methods:A total of 422 patients with acute ischemic stroke who underwent intravenous thrombolysis with alteplase during hospitalization at National Center for Stroke in Lianyungang from January 2015 to March 2019 were followed up for 90 d. According to the quintile of mean systolic and diastolic blood pressures during peri-thrombolysis period, they were divided into group of blood pressure <130.00 mmHg (Q1), group of blood pressure of 130.00-140.49 mmHg (Q2), group of blood pressure of 140.50-147.99 mmHg (Q3), group of blood pressure of 148.00-158.00 mmHg (Q4), and group of blood pressure >158.00 mmHg (Q5), and group of blood pressure <71.30 mmHg (G1), group of blood pressure of 71.30-76.19 mmHg (G2), group of blood pressure of 76.20-81.89 mmHg (G3), group of blood pressure of 81.90-90.79 mmHg (G4), group of blood pressure >90.79 mmHg (G5). Univariate and multivariate Logistic regression analyse were used to evaluate the relations of blood pressure with postoperative intracranial hemorrhage and neurological function improvement. Kaplan-Meier curve, Log-rank test and multivariate Cox proportional risk model were used to evaluate the relations of blood pressure with primary endpoint event and secondary endpoint events.Results:(1) After adjusting for confounding factors, multivariate Logistic regression analysis showed that the risk of postoperative intracranial hemorrhage in patients from Q2 was significantly lower than that in patients from Q5 ( OR= 0.160, 95%CI: 0.031-0.827, P=0.029). (2) After adjusting for confounding factors, multivariate Logistic regression analysis showed that the probability of postoperative improvement of nerve function in patients from Q2 and Q3 was significantly higher than that in patients from Q5 ( OR=2.144, 95%CI: 1.043-4.407, P=0.038; OR=2.224, 95%CI: 1.105-4.479, P=0.025); the probability of postoperative improvement of nerve function in patients from G3 and G4 was significantly higher than that in patients from G5 ( OR= 2.153, 95%CI: 1.081-4.287, P=0.029; OR=2.182, 95%CI: 1.131-4.210, P=0.020). (3) After adjusting for confounding factors, multivariate Cox proportional risk model showed that the risk of primary endpoint event in patients from Q1 and Q2 was significantly lower than that in patients from Q5 ( HR=0.079, 95%CI: 0.010-0.613, P=0.015; HR=0.211, 95%CI: 0.062-0.724, P=0.013). (4) After adjusting for confounding factors, multivariate Cox proportional risk model showed that the risk of secondary endpoint events in patients from Q1, Q2, Q3 and Q4 was significantly lower than that in patients from Q5 ( HR=0.246, 95%CI: 0.100-0.607, P=0.002; HR=0.360, 95%CI: 0.177-0.732, P=0.005; HR=0.448, 95%CI: 0.246-0.817, P=0.009; HR=0.467, 95%CI: 0.252-0.867, P=0.016). Conclusion:The risks of postoperative intracranial hemorrhage, primary endpoint event and secondary endpoint events in patients with acute ischemic stroke decrease with the decrease of systolic blood pressure during peri-thrombolysis period; moderate blood pressures (systolic blood pressure: 130.00-147.99 mmHg; diastolic blood pressure:76.20-90.79 mmHg) are beneficial for improvement of neurological function.

Recent advance in relation between ischemic stroke and brain-gut axis / 中华神经医学杂志

Ischemic stroke patients are often accompanied by complications such as gastrointestinal bleeding, microbiological disorders, and constipation, while intestinal microbiological disorders can affect the progress and prognoses of ischemic stroke. Researchers have found two-way communication between the brain and the intestines, and they communicate with each other through various mechanisms, called gut-brain axis or brain-gut axis. However, researches on ischemic stroke and brain-gut axis are still in its infancy, and further understanding of the potential relation between ischemic stroke and brain-gut axis may be helpful in developing new methods for the treatments of ischemic stroke. This paper reviews the relation between ischemic stroke and brain-gut axis to open up new ideas for preventions and treatments of ischemic stroke.

Effects of systolic blood pressure and diastolic blood pressure on White matter lesions：a meta-analysis / 中风与神经疾病杂志

@#Objective　To systematically evaluate the effect of systolic and diastolic blood pressure on the progression of White matter lesions. Methods　The title term “white matter” “Leukoencephalopathy” “leukoaraiosis” “blood pressure” “hypertension” in PubMed and Cochrane Library were searched for 174 AND 101 articles respectively from 1981 to August 2019.Then two researchers independently screened AND evaluated the included literatures，AND meta-analysis was performed using RevMan 5.3 software. Results　Finally，a total of 11 closely related studys were included for research. The results of meta-analysis showed that the increase of systolic blood pressure and diastolic blood pressure could promote the progression of white matter lesions（Respectively OR=2.90，95%CI 2.86～2.95；OR=3.13，95%CI 3.03～3.23），especially in diastolic blood pressure. Conclusion　The increase of systolic blood pressure and diastolic blood pressure can promote the progress of white matter lesions，but it is more closely related to diastolic blood pressure. Therefore，more researchers are expected to pay attention to the change of diastolic blood pressure，and more importantly，to identify the range of blood pressure and control strategies that control diastolic blood pressure is beneficial to delay the progress of white matter lesions，especially for patients under 70 years old.

CTdiagnosisofinfantilehepatichemangioendothelioma / 实用放射学杂志

Objective ToexploretheCTcharacteristic manifestationsoftheinfantilehepatichemangioendothelioma (IHHE). Methods 10cases(5malesand5females)withIHHE (agerangefromonly1dayto8months,withthemeanageof53days)were collected.Theclinicalmanifestationsincludedabdominalmassesin5cases,vomitingin2andjaundicein1.Therewasababygirlwith congenitalcholedochalcyst.Allpatientsunderwenttheplainandcontrast-enhancedscans.Results CTshowedlocalandsingleintrahepatic massin6cases(including2casesinrighthepaticlobe,2casesinquadratelobeand2casesinleftlobe),2－3massesinliverin2,and diffusenodulesin2.PlainCTshowedallmasseswithlowdensityorlow-equalhybriddensity.Themarginswereclearin4cases,and unclearin6cases,withspottedcalcificationin2cases.TheenhancedCTshowedall10caseswithrosette-likemarginalenhancement, and6caseswithgradualwash-inindelayedphase.Threepatientsreceivedinterventionaltreatmentswithintrahepaticarterialembolization, andthenthediffuselesionsintwopatientssignificantlyreducedafter20monthsand33monthsrespectively,whilethesinglelesionin 1casealsosignificantlyshrankafter6monthsoftreatment.Conclusion CTisaneffectivemethodforthediagnosisofinfantilehepatic vascularendothelioma.Marginalring-enhancementisthecharacteristicmanifestationofIHHE,anditdoesnotinvadeadjacentliver parenchymaandbloodvessels,whichcanbedistinguishedfromotherliveroccupyinglessions.

Recent advance in low/high -density lipoprotein cholesterol concentration ratio and carotid unstable plaque / 中华神经医学杂志

Carotid unstable plaque is closely related to the occurrence and development of ischemic stroke. As a new predictor, low/high-density lipoprotein cholesterol concentration ratio can provide accurate monitoring indicator for stroke prevention and control, risk stratification and screening of high-risk population. It is of great clinical significance to explore its ideal level and regulation methods. This article reviews the vulnerability mechanism of carotid unstable plaques, the relationship between carotid unstable plaques and ischemic stroke, and the predictive value and ideal level of low/high-density lipoprotein cholesterol concentration ratio in order to pave the way for relevant research.

Low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio predicts asymptomatic carotid plaques and their stability in high-risk stroke population / 国际脑血管病杂志

Objective To investigate the relationship between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LHR) and asymptomatic carotid plaques and their stability in high-risk stroke population.Methods Between December 2012 and April 2015,a total of 39 944 permanent resident population ≥40 years were used as subjects of the survey from 11 rural communities in Haitou Town,Banzhuang Town and Tashan Town,Ganyu District,and 9 urban communities in Xinpu District and Haizhou District,Lianyungang City using epidemiological survey method of cluster sampling.Excluding those who took lipid-lowering drugs within 3 months and had a history of stroke or transient ischemic attack,6 592 people at high risk of stroke were finally screened out.Ultrasound was used to detect carotid plaques.The subjects were divided into plaque-free group and plaque group.The latter was further divided into stable plaque group and unstable plaque group.Multivariate logistic regression analysis was used to evaluate the independent risk factor for carotid plaques and their stability.The odds ratio (OR) and 95％ confidence interval (CI) were calculated.Receiver Operating Characteristic (ROC) curve was used to evaluate the prediction efficiency of LHR on carotid plaques.Results Multivariate logistic regression analysis showed that low-density lipoprotein cholesterol (LDL-C) was an independent risk factor for carotid plaques,while high-density lipoprotein cholesterol (HDL-C) was an independent protection factor of carotid plaques.Using the lowest quintile (Q1) of LHR as a reference,carotid plaque risk increased significantly with the increasing LHR (Q2:OR 1.448,95％ CI 1.082-1.937,P =0.013;Q3:OR 2.414,95％ CI 1.754-3.322,P＜0.001;Q4:OR 2.939,95％ CI 1.945-4.441,P＜0.001;Q5:OR 4.884,95％ CI 3.143-7.115,P＜0.001).ROC curve analysis showed that the area under the curve (AUC) of LHR predicting carotid plaques was 0.795 (95％ CI 0.792-0.807;P＜ 0.001),and the optimal cut-off value was 3.00 (sensitivity 68.37％,specificity 75.65％).LHR ≥3.92 (LHR in the Q4 and Q5 subgroups) was an independent risk factor for unstable carotid plaques (OR 2.915,95％ CI 2.104-4.040;P＜0.001).The AUC of the LHR predicting unstable carotid plaques was 0.658 (95％ CI 0.633-0.684;P＜0.001).Conclusions LHR was an independent predictor of carotid plaques in high-risk stroke patients.It had higher predictive value for carotid plaques,and its conversion threshold for promoting plaque formation was 3.00.When LHR was ≥3.92,there was a significant increase in the risk of unstable carotid plaques.

Recent advance in effect of endothelin multi-target intervention on improving low perfusion in acute ischemic stroke / 中华神经医学杂志

The high morbidity,high mortality and high disabling rate of ischemic stroke have caused a serious burden on health of patients and economy of their families and society.Timely and effective recovery of cerebral blood flow is the key to the treatment of acute ischemic stroke.Endothelin plays an important role in the pathophysiology of cerebral ischemic stroke.In this paper,the changes of endothelin and its receptor after cerebral ischemia,combined with the current research situation of the corresponding target in the signal pathways,are reviewed,and some new ideas for further study are proposed.