Search

Background: The epidemiology of stroke is evolving in China as the population undergoes demographic, lifestyle, and economic transitions. An updated review is pertinent to providing feedback on current, and in planning future, prevention and management strategies. Aims: To identify high-quality epidemiological studies for quantifying the prevalence, incidence, mortality, and case fatality for stroke in China. Methods: A search was undertaken across a range of bibliographic databases on 30 November 2021 without time limitation. Assessments were made of the risk of bias of the included studies. The outcomes were synthesized using a random-effects model. Subgroup analysis and meta-regression models were used to define the source of heterogeneity. Results: Of 9407 identified records, 26 population-based studies were included. Due to significant heterogeneity across the studies, the original range for crude rates of indices was wide. The pooled annual prevalence was 1329.5/100,000 (95% confidence interval (CI) 713.6–2131.9, p 2 = 100%, p 2 = 97%, p Conclusion: Despite improved public health policies and healthcare delivery, the burden of stroke remains high in China. Further coordinated efforts are required in prevention and community care to offset the likelihood of further expansion in the absolute number of stroke cases in this large population.

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.

Objective To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes. Design Randomised controlled parallel group trial. Setting Three Scottish stroke services. Subjects Stroke survivors with fatigue three months to two years post-stroke onset. Interventions Seven telephone calls (fortnightly then a ‘booster session’ at 16 weeks) of a manualised intervention, plus information about fatigue, versus information only. Main measures Feasibility of trial methods, and collected outcome measures (fatigue, mood, anxiety, social participation, quality of life, return to work) just before randomisation, at the end of treatment (four months after randomisation) and at six months after randomisation. Results Between October 2018 and January 2020, we invited 886 stroke survivors to participate in postal screening: 188/886 (21%) returned questionnaires and consented, of whom 76/188 (40%) were eligible and returned baseline forms; 64/76 (84%) returned six month follow-up questionnaires. Of the 39 allocated the intervention, 23 (59%) attended at least four sessions. At six months, there were no significant differences between the groups (adjusted mean differences in Fatigue Assessment Scale −0.619 (95% CI −4.9631, 3.694; p = 0.768), the Generalised Anxiety Disorder 7 −0.178 (95% CI −3.823, 3.467, p = 0.92), and the Patient Health Questionnaire −0.247 (95% CI −2.935, 2.442, p = 0.851). There were no between-group differences in quality of life, social participation or return to work. Conclusion Patients can be recruited to a trial of this design. These data will inform the design of further trials in post-stroke fatigue.

BACKGROUND Postinterventional cerebral hyperdensities are common on non-contrast-enhanced computed tomography (CT) after endovascular thrombectomy in patients with acute ischemic stroke, which may reflect blood-brain barrier damage. The disruption of the blood-brain barrier may lead to malignant brain edema. The relationship between the extent of postinterventional cerebral hyperdensities and malignant brain edema is unclear. METHODS Patients with middle cerebral artery territory infarction and successful recanalization were consecutively enrolled. Postinterventional non-contrast-enhanced CT was performed to evaluate postinterventional cerebral hyperdensities within 24 h after endovascular thrombectomy. On the basis of the areas of the Alberta Stroke Program Early CT Score, we devised the Hyperdensity on CT Score to evaluate the extent of postinterventional cerebral hyperdensities. The primary outcome was malignant brain edema, defined as the development of clinical signs of herniation (including a decrease in consciousness and/or anisocoria), accompanied by imaging evidence of brain swelling. The component of postinterventional cerebral hyperdensities was divided into contrast staining and hemorrhage on the basis of persistency. RESULTS Three hundred sixty patients were included (50.6% male, mean age 67.9 years), of whom 247 (68.6%) developed postinterventional cerebral hyperdensities and 66 (18.3%) developed malignant brain edema. After adjustment for confounders, including the component of postinterventional cerebral hyperdensities, the extent of postinterventional cerebral hyperdensities assessed by the Hyperdensity on CT Score was significantly associated with malignant brain edema (odds ratio 1.46, 95% confidence interval 1.20-1.77, p

Background Amantadine hydrochloride is one of the most frequently prescribed drugs for patients with severe traumatic brain injury in restoring consciousness and accelerating the pace of functional recovery. However, there is a paucity of studies on the effectiveness of amantadine in patients with severe stroke especially large hemisphere infarction (LHI). The present study aimed to investigate whether amantadine treatment is associated with better clinical outcomes in conservatively treated LHI patients. Methods We retrospectively collected conservatively treated LHI patients according to inclusion/exclusion criteria. The patients were divided into two groups based on the treatment regimen, whether they did receive amantadine hydrochloride in addition to standard therapy (ST) or not. The primary outcomes were in-hospital death, 3-month mortality, and unfavorable outcome (defined as modified Rankin Scale score of 4 to 6). All outcomes were compared between the two groups before and after propensity score matching (PSM). Multivariate logistic regression was performed to identify the association between early amantadine hydrochloride treatment and clinical outcomes in LHI patients. Results Thirty-one LHI patients treated with amantadine combined with ST and 127 patients treated with ST were enrolled. Amantadine group had a shorter prehospital delay (median: 2 vs. 10 h), a higher baseline NIHSS score (21.71 ± 4.76 vs. 17.49 ± 5.84), and a higher rate of dominant hemisphere involvement (67.74% vs. 45.67%). After PSM, amantadine treatment significantly reduced the risk of in-hospital death (7.41% vs. 31.11%, p=0.019) and 3-month mortality (25.93% vs. 55.56%, p=0.008). Amantadine treatment yielded a significant decrease in death in-hospital (before PSM: OR 0.143, 95% CI 0.034 to 0.605; after PSM: OR 0.113, 95% CI 0.020 to 0.635) and 3-month mortality (before PSM: OR 0.214, 95% CI 0.077 to 0.598; after PSM: OR 0.176, 95% CI 0.053 to 0.586) in unmatched and matched multivariate analyses. Conclusion The results of our study provide initial evidence that early amantadine treatment was associated with a decrease in death in conservatively treated LHI patients. Considering the limitations of observational study, randomized controlled trials with a large sample size may help provide a clearer picture of the utility of amantadine in LHI patients.

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Stroke is a major cause of adult disability. Selective serotonin reuptake inhibitors (SSRIs) have been used for many years to manage depression and other mood disorders after stroke. Small studies suggested that SSRIs might also promote motor recovery by direct effects on the brain. In this Cochrane review, we aimed to determine the effects of SSRIs in improving outcomes in people

We report the development of novel cannabinergic probes that can stabilize the cannabinoid receptors (CBRs) through tight binding interactions. Ligand design involves the introduction of select groups at a judiciously chosen position within the classical hexahydrocannabinol template (monofunctionalized probes). Such groups include the electrophilic isothiocyanato, the photoactivatable azido, and the polar cyano moieties. These groups can also be combined to produce bifunctionalized probes potentially capable of interacting at two distinct sites within the CBR-binding domains. These novel compounds display remarkably high binding affinities for CBRs and are exceptionally potent agonists. A key ligand (27a, AM11245) exhibits exceptionally high potency in both in vitro and in vivo assays and was designated as "megagonist," a property attributed to its tight binding profile. By acting both centrally and peripherally, 27a distinguishes itself from our previously reported "megagonist" AM841, whose functions are restricted to the periphery.

Lacunar stroke (LS) accounts for about one-quarter of all acute ischemic strokes, represents an important marker of cerebral small vessel disease (CSVD), and has prognostic significance in terms of recurrent vascular events and vascular cognitive impairment. Our understanding of the etiology and pathogenesis of LS is largely based on the meticulous postmortem work of C. Miller Fisher in the late 1960s, with scarce subsequent pathological analysis of the “lacunar hypothesis” and no reliable approaches for direct in vivo imaging of the small intracranial vessels. The recent development of high-resolution MRI, which allows both large-vessel wall and perforating arteries to be imaged in one setting, provides the opportunity to advance understandings of the clinical mechanisms, imaging characteristics, and pathogenesis of LS. Given accumulating evidence of endothelial dysfunction and blood-brain-barrier disruption as early features of CSVD-related LS, advanced imaging may allow various underlying pathogenetic mechanisms to be defined and for better targeting of therapeutic approaches in LS. In this review, progress in understanding the pathogenesis of LS is outlined, covering pathology, pathophysiology, and imaging characteristics, with a focus toward future directions in the complex entity of LS.

Impaired consciousness (IC) at stroke onset in large hemispheric infarctions (LHI) patients is common in clinical practice. However, little is known about the incidence and risk factors of IC at stroke onset in LHI. Besides, stroke-related complications and clinical outcomes in relation to the development of IC has not been systematically examined. Data of 256 consecutive patients with LHI were collected. IC at stroke onset was retrospectively collected from the initial emergency department and/or admission records. Of the 256 LHI patients enrolled, 93 (36.3%) had IC at stroke onset. LHI patients with IC at stroke onset were older (median age 66 vs. 61, p = 0.041), had shorter prehospital delay (24 vs. 26 h, p p p p p = 0.019). The IC group had higher rates of in-hospital death (23.66% vs. 11.66%, p = 0.012), 3-month mortality (49.46% vs. 24.87%, p = 0.002), and 3-month unfavorable outcome (64.51% vs. 49.07%, p = 0.017). However, after adjusting for age, baseline NIHSS score and other confounders, IC at stroke onset was not an independent predictor of in-hospital death (adjusted OR 0.56, 95% CI 0.22 to 1.47), 3-month mortality (adjusted OR 0.54, 95% CI 0.25 to 1.14) and 3-month unfavorable outcome (adjusted OR 0.64, 95% CI 0.31 to 1.33) in LHI patients (all p > 0.05). Our results suggested that IC occur in 1 out of every 3 LHI patients at stroke onset and was associated with initial stroke severity and atrial fibrillation. LHI patients with IC at stroke onset more frequently had stroke-related complications, 3-month mortality and unfavorable outcome, whereas IC was not an independent predictor of poor outcomes.

Regeneration and reuse of draw solute (DS) is a key challenge in the application of forward osmosis (FO) technologies. Herein, EDTA-Na

Background We aimed to explore the association of serum level of the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) and its related inflammatory biomarkers (hypoxia inducible factor-1α, cathepsin B, caspase-1 and matrix metalloproteinase-9) with malignant brain edema (MBE) in patients with acute ischemic stroke. Methods We prospectively enrolled patients with acute ischemic stroke admitted Results 200 patients (69.3 ± 14.3 years; male 55 %) were included for analysis, of whom 26 patients developed MBE (median time from stroke onset to MBE 32.5 h). Compared with patients without MBE, those with MBE had higher level of serum concentration of NLRP3 (median time from onset to blood collection 3 h, 1.85 ng/ml vs. 1.11 ng/ml, P = 0.026). NLRP3 level was positively correlated with NIHSS on admission (Spearman ρ = 0.18, P = 0.01) and the association between NLRP3 and MBE was attenuated (OR 1.47, 95 % CI 0.88–2.46, P = 0.138) after adjusting for age and NIHSS. There was no significant difference in other biomarkers between MBE and non-MBE groups. Conclusions There was a trend of association between a higher level of serum concentration of NLRP3 and an increased risk of MBE after ischemic stroke, possibly confounded by the severity of stroke, which is worth further validation in large cohort studies.

Accurate prediction of malignant brain edema (MBE) after stroke is paramount to facilitate close monitoring and timely surgical intervention. The Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score was useful to predict potentially lethal malignant edema in Western populations. We aimed to validate and modify it to achieve a better predictive value for MBE in Chinese patients. Of ischemic stroke patients consecutively admitted in the Department of Neurology, West China Hospital between January 2010 and December 2017, we included patients with anterior circulation stroke, early signs of brain edema on computed tomography within 24 h of onset, and admission National Institutes of Health Stroke Scale (NIHSS) score ≥ 8. MBE was defined as the development of signs of herniation (including decrease in consciousness and/or anisocoria), accompanied by midline shift ≥ 5 mm on follow-up imaging. The EDEMA score consisted of five parameters: glucose, stroke history, reperfusion therapy, midline shift, and cistern effacement. We created a modified score by adding admission NIHSS score to the original EDEMA score. The discrimination of the score was assessed by the area under the receiver operating characteristics curve (AUC). Calibration was assessed by Hosmer–Lemeshow test and calibration plot. We compared the discrimination of the original and modified score by AUC, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Clinical usefulness of the two scores was compared by plotting net benefits at different threshold probabilities in the decision curve analysis. Of the 478 eligible patients (mean age 67.3 years; median NIHSS score 16), 93 (19%) developed MBE. The EDEMA score showed moderate discrimination (AUC 0.72, 95% confidence interval [CI] 0.67–0.76) and good calibration (Hosmer–Lemeshow test, P = 0.77). The modified score showed an improved discriminative ability (AUC 0.80, 95% CI 0.76–0.84, P

Osmotic microbial fuel cell (OsMFC) is an emerging biotechnology that integrates forward osmosis (FO) membrane into microbial fuel cells. Selection of an appropriate draw solute (DS) could affect both water extraction and electricity generation. Herein, we have investigated a promising DS - EDTA-Na2, a widely used chelating agent. The OsMFC with the EDTA DS achieved 779.6 ± 18.5C (electricity production) and 1.22 ± 0.02 LMH (water flux), both of which were comparable to that with the NaCl DS at the same conductivity. However, the EDTA DS resulted in a significantly lower reverse solute flux (RSF) of 0.36 ± 0.08 gMH and a lower catholyte pH that could ensure healthy operation of the tested FO membrane. The OsMFC with the EDTA DS exhibited a positive forward flux for Na+ ions, likely related to the effect of EDTA-Na complexion. Due to the lumping effects of EDTA dissociation equilibrium and membrane surface chemistry, a higher catholyte pH led to a higher water flux and reduced RSF, but lower electricity production. The cyclic voltammetry tests revealed that the reverse-fluxed EDTA species might have chelated FeII/III redox coupled to facilitate electron transfer on the anode surface, but the EDTA DS in the cathode could interfere with the cathodic reaction through assisting in metal wires oxidation. In the reuse test, >90% of EDTA DS could be recovered and then successfully reused in the subsequent OsMFC operation. The results of this study would encourage further exploration of using EDTA-based compounds as a draw solute for OsMFC applications.

With over 2 million new cases annually, stroke is associated with the highest disability-adjusted life-years lost of any disease in China. The burden is expected to increase further as a result of population ageing, an ongoing high prevalence of risk factors (eg, hypertension), and inadequate management. Despite improved access to overall health services, the availability of specialist stroke care is variable across the country, and especially uneven in rural areas. In-hospital outcomes have improved because of a greater availability of reperfusion therapies and supportive care, but adherence to secondary prevention strategies and long-term care are inadequate. Thrombolysis and stroke units are accepted as standards of care across the world, including in China, but bleeding-risk concerns and organisational challenges hamper widespread adoption of this care in China. Despite little supporting evidence, Chinese herbal products and neuroprotective drugs are widely used, and the increased availability of neuroimaging techniques also results in overdiagnosis and overtreatment of so-called silent stroke. Future efforts should focus on providing more balanced availability of specialised stroke services across the country, enhancing evidence-based practice, and encouraging greater translational research to improve outcome of patients with stroke.

In-situ electron microscopy mechanical testing is a promising deformation observation technology that has been extensively applied to explore the deformation and fracture behaviour of MGs. In this paper, we adopt it in conjunction with digital image correlation technique to investigate the impact of free volume on shear band multiplication and bending plasticity in MGs. The strain evolutions of the notched Zr-, Ce- and Mg-based MGs are studied respectively. The results indicate that the strain-concentration striations before yielding contain amounts of free volume can improve the shear band multiplication, and are beneficial to the subsequent bending plasticity. Such conclusions successively verify a novel integrated method to explore the in-situ strain field evolution process near the notch of MGs, which is advantage for understanding the deformation and fracture behaviour of MGs in a complex stress state.

Melting is a common solidification treatment that concentrates and encapsulates heavy metals into a glass matrix for waste containing heavy metals (Chae et al., 2016). To control the risk of heavy metal leaching into the glass product, a reduction in the amount of heavy metal was achieved in a pilot-scale furnace by co-melting electroplating sludge (EPS) and municipal solid waste incineration fly ash (MSWI FA). Through the melting process, the chloride from MSWI FA led to heavy metals volatilization in the form of chlorine salts. The fly ash additionally increased heavy metals volatilization by 4%–91%. The highest volatilization ratios of Zn, Pb, Cu, Cd, Cr and Ni were 33%, 96%, 33%, 79%, 81% and 31%, respectively. The concentrations of Pb and Zn in the secondary fly ash were close to the Pb and Zn concentrations in lead-zinc ore that are required in smelting industry. Moreover, glass sand was produced after the melting treatment. With an increase in the fly ash mixing ratio, the leaching concentration of Zn and Cu decreased to 3.8 mg/L and 2.1 mg/L. The leaching concentrations of other heavy metals stayed below 1 mg/L in all cases. When the ratio of MSWI FA reached 10%, the glass sand contained the least amount of impurities and a large amount of phosphate and silicate, which were probably responsible for the stability of the heavy metals. Therefore, our results provided a promising approach to the stability of the waste by the recovery of heavy metals in the co-treatment of heavy metal-bearing wastes.

Whether matrix metalloproteinase 9 (MMP-9) concentrations in plasma predict risk of spontaneous haemorrhagic transformation (sHT) in acute ischaemic stroke is unclear. From 1 March 2003 to 27 February 2006, patients with acute ischaemic stroke admitted to West China Hospital within 24 h of onset and healthy controls were enrolled and blood samples obtained. Plasma MMP-9 concentrations were determined using enzyme-linked immunosorbent assay, and sHT was diagnosed based on brain computed tomography or magnetic resonance performed 3-14 d after stroke onset. MMP-9 concentrations were compared for sHT patients, non-sHT patients and healthy controls. The threshold concentration for predicting sHT was determined using receiver operating characteristic analysis and the association between MMP-9 concentration and sHT was tested. One hundred and sixty-eight stroke patients and 40 healthy controls were included. Spontaneous HT occurred in 17.3% (29/168) of stroke patients and median plasma MMP-9 concentration in the sHT subgroup [244.3 ng/mL; interquartile range (IQR), 190.6-431.4] was significantly higher than in the non-sHT subgroup (110.0 ng/mL; IQR, 54.4-172.2) as well as in healthy controls (63.3 ng/mL; IQR 37.9-84.9) (both P 0.001). We identified 181.7 ng/mL as the threshold MMP-9 concentration, for which the positive predictive value was 48% and the negative predictive value was 96%. After controlling for potential confounding factors, MMP-9 concentration181.7 ng/mL was an independent predictor of sHT (odds ratio 18.8, 95% confidence interval 6.0-58.5, P 0.001). Plasma MMP-9 concentration181.7 ng/mL within 24 h after stroke onset independently predicts sHT in patients with ischaemic stroke.

Background: Individual values and beliefs vary according to cultural and social factors. To better understand clinical decision-making and inform future research, we undertook a survey of preferences in treatment goals for managing patients with acute ischemic stroke among medical professionals in China. Methods: We designed a web-based survey through literature search, face-to-face interviews, pilot questionnaire development, and focus group meetings. Key outcomes explored were death, disability, quality of life, neurological impairments, cognitive dysfunction, and hemorrhagic transformation. Participants were asked to rate the importance of each outcome on a 5-point Likert scale to allow calculation of a weighted score of importance: higher scores indicating greater importance. Results: During promotion among 2700 delegates at several major neurology conferences in 2018, 1189 participants (mean age 40 years, 53% female) completed the survey of whom 96% were clinicians, mainly from tertiary care hospitals located in 30 Provinces of China. For established therapies with bleeding risk (e.g. thrombolysis and thrombectomy), death was the most important outcome (weighted score 4.60), followed by disability (4.45), quality of life (4.45), neurological impairments (4.34), cognitive dysfunction (4.03), and hemorrhagic transformation (3.99). For other acute therapies without bleeding risk, quality of life ranked first (4.08), followed by disability (4.03), neurological impairment (3.92), death (3.79), cognitive dysfunction (3.78), and hemorrhagic transformation (3.51). Given a therapy with insufficient evidence of benefit, 845 (71%) participants thought it would be worth trying for potential to improve neurological recovery or quality of life. Conclusions: From the perspective of Chinese medical staff, death is the most important outcome measure for patients with acute ischemic stroke. When reduction of death or disability were less likely to be achievable, the improvement in quality of life is an acceptable outcome measure. In contrast to the previously perceived high fear of bleeding in practice, hemorrhagic transformation was the least concerned even for therapies with a potential bleeding risk.

Objective Amantadine hydrochloride is one of the most frequently prescribed drugs for patients with severe traumatic brain injury in restoring consciousness and accelerating the pace of functional recovery. However, there is a paucity of studies on the effectiveness of amantadine in patients with severe stroke especially large hemisphere infarction (LHI). The present study aimed to investigate whether amantadine treatment is associated with better clinical outcomes in conservatively treated LHI patients. Methods We retrospectively collected conservatively treated LHI patients according to inclusion/exclusion criteria. The patients were divided into two groups based on the treatment regimen, whether they did receive amantadine hydrochloride in addition to standard therapy (ST) or not. The primary outcomes were in-hospital death, 3-month mortality and unfavorable outcome (defined as modified Rankin Scale score of 4 to 6). All outcomes were compared between the two groups before and after propensity score matching (PSM). Multivariate logistic regression was performed to identify the association between early amantadine hydrochloride treatment and clinical outcomes in LHI patients. Results 31 LHI patients treated with amantadine combined with ST and 127 patients treated with ST were enrolled. Amantadine group had a shorter prehospital delay(median: 2 vs. 10 hours), higher baseline NIHSS score (21.71 ± 4.76 vs. 17.49 ± 5.84) and higher rate of dominant hemisphere involvement (67.74% vs. 45.67%). After PSM, amantadine treatment significantly reduced the risk of in-hospital death (7.41% vs. 31.11%, p๦0.019) and 3-month mortality (25.93% vs. 55.56%, p๦0.008). Amantadine treatment yielded a significant decrease in death in-hospital (before PSM: OR 0.143, 95% CI 0.034 to 0.605; after PSM: OR 0.113, 95% CI 0.020 to 0.635) and 3-month mortality (before PSM: OR 0.214, 95% CI 0.077 to 0.598; after PSM: OR 0.176, 95% CI 0.053 to 0.586) in unmatched and matched multivariable analysis. Conclusion The results of our study provide initial evidence that early amantadine treatment was associated with a decrease in death in conservatively treated LHI patients. Considering the limitations of observational study, randomized controlled trials with large sample size may help provide a clearer picture of the utility of amantadine in LHI patients.