Ischemic stroke is a disease with high morbidity, disability and mortality. At present, there is no effective rehabilitation therapy for ischemic stroke. Neural stem cell (NSC) has great potential in the treatment of ischemic stroke. With the progress in stem cell preparation technology and the development of many animal experiments, the research of NSC has gradually moved from laboratory experiment to clinical application. In 2016, the first clinical trial of human-derived NSC in the treatment of ischemic stroke was published. This article elaborates the treatment mechanism, clinical cell preparation, preclinical research and clinical research of NSC in detail. By reviewing the current research of NSC in treating ischemic stroke, it can provide references for more clinical research of NSC in treating ischemic stroke in the future.
At present, there is no consensus on the criteria for diagnosis and classification of vascular cognitive impairment (VCI), and there is a lack of comparability among the published diagnostic criteria for VCI, which affects the efficiency of diagnosis, and then affects the estimation of prevalence, the development of related research and the treatment of VCI. For that reason, 122 participants (81% of them were academic researchers) from 27 countries participated in the online survey using Delphi method. They reviewed the relevant concepts of VCI to develop a new consensus among experts. If the agreement rate reached 67%, that was to say, the consensus was formed. In 2017, the Vascular Impairment of Cognition Classification Consensus Study (VICCCS) was released. VICCCS redefines the conceptual model of VCI, including the severity of VCI and the discrimination of subtypes, as well as new VCI-related standardized terms, in order to solve the differences in understanding of VCI. At the same time, VICCCS has proposed potential research topics in the future. The development and release of VICCCS provide diagnostic and classification criteria for VCI research, and lay a foundation for collaborative research with larger sample size in the future.
Due to the lack of systematic research data on acute stroke in the pregnant and postpartum population currently, the clinicians always treat those patients according to their own experience. This situation has led to non-standard treatment and could not effectively protect the health of mothers and infants. In 2018, the Heart and Stroke Foundation of Canada (HSFC) combined with Canadian Stroke Consortium (CSC) published 2018 Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during Pregnancy. This consensus statement was developed by interdisciplinary cooperation between stroke experts and maternal-fetal experts, covering initial emergency management, imaging diagnosis, acute stroke treatment, hemorrhagic stroke management, anesthesia management, management in the gestational (prenatal, intrapartum and postpartum) stroke population, and secondary prevention and post-stroke rehabilitation. The evidence was primarily derived from studies of non-pregnant stroke or synchronous pregnancy groups. Pregnancy has been the exclusion criteria for almost all acute stroke trials and the cases of pregnant stroke are relatively rare, the high-quality evidence from randomized controlled trials is insufficient. Accordingly, this consensus statement used the data as evidence obtained by case reports, case series reports, and population-based registration studies. The recommendations of this consensus statement reflected expert opinions based on professional and clinical experience.
Objective: White matter hyperintensity (WMH) is an important imaging feature of cerebral small vessel disease (CSVD). In this study, a data-driven method was used to conduct quantitative analysis of WMH, which was compared with the traditional semi-quantitative assessment, to explore the correlation between WMH and early cognitive impairment in post-stroke patients with CSVD.
Methods: From July 2015 to February 2018, 117 post-stroke patients with CSVD who met the selection criteria were recruited consecutively from the Stroke Clinic of Renji Hospital, Shanghai Jiao Tong University School of Medicine, comprising 72 individuals with mild cognitive impairment (MCI) and 45 with no cognitive impairment (NCI). There were no significant differences in baseline demographic sociology and vascular risk factors between the two groups (P > 0.05). Detailed neuropsychological assessments and multimodal magnetic resonance imaging (MRI) were performed in all patients. The WMH was semiquantitatively scored by Fazekas scale and the volume of WMH was quantitatively calculated. The cognitive function was compared between the two groups, and the correlation between WMH semi-quantitative Fazekas score and quantitative score of WMH volume and cognitive function was analyzed.
Results: There were significant differences in cognitive domains including attentionexecution, visual space, language and memory functions between MCI and NCI patients (P < 0.05), but there was no significant difference in WMH semi-quantitative Fazekas score (P = 0.090), while the quantitative score of WMH volume was significant different between MCI and NCI patients (P = 0.004). After adjusting for age, gender and years of education, there was no correlation between WMH semi-quantitative Fazekas score and cognitive functions (P > 0.05), but quantitative score of WMH volume was significantly correlated with cognitive function (P < 0.05). Deep WMH volume was significantly correlated with attentionexecution and visual space functions (P < 0.05), while the periventricular WMH volume was significantly correlated with cognitive functions (P < 0.05).
Conclusion: WMH is closely related to cognitive decline in post-stroke patients with CSVD. Quantitative score of WMH volume is more sensitive than WMH semi-quantitative Fazekas score in assessing early cognitive function changes in patients with CSVD, and the relationship of WMH location with cognitive fuction exhibits heterogeneity.
Objective: To explore the effect of pulmonary rehabilitation on early rehabilitation of patients with ischemic stroke.
Methods: Twenty patients with ischemic stroke who met the selection criteria from January 2016 to January 2017 were recruited and randomly divided into control group (n = 10) and pulmonary rehabilitation group (n = 10). The pulmonary rehabilitation was administered on the basis of routine rehabilitation treatment for 4 weeks in pulmonary rehabilitation group, and 4 weeks of routine rehabilitation treatment alone was administered in control group. The quality of life, depression, maximum inspiratory pressure (PImax), National Institute of Health Stroke Scale (NIHSS) score and the muscle strength extraction rate were compared between the two groups before and after intervention.
Results: After intervention, the scores of physiological function, physiological pain, vitality, social function and mental health in the pulmonary rehabilitation group were significantly higher than those in the control group (all P < 0.05), but there were no significant differences in the scores of physiological role, general health and emotional function (all P > 0.05). After intervention, the score of Hamilton Depression Scale in the pulmonary rehabilitation group was significantly lower than that in the control group (P < 0.05). After intervention, PImax in pulmonary rehabilitation group was significantly higher than that in control group (P < 0.05), but there was no significant difference in NIHSS score (P > 0.05). The muscle strength extraction rates of pulmonary rehabilitation group and control group after intervention were both significantly higher than those before intervention (both P < 0.05).
Conclusion: Pulmonary rehabilitation therapy combined with routine rehabilitation therapy can effectively improve the quality of life, depression and respiratory function of patients in the rehabilitation process of stroke.
Objective: To observe the effect of regular rehabilitation intervention on post-stroke patients in community.
Methods: From January 2017 to June 2018, 60 post-stroke patients who met the selection criteria were recruited and divided into regular rehabilitation intervention group (n = 30) and non-regular rehabilitation intervention group (n = 30) used by random number table. The regular rehabilitation intervention group received outpatient rehabilitation intervention once a week, and the patients were instructed by the rehabilitation therapist to choose appropriate sports items for family self-rehabilitation training; the non-regular rehabilitation intervention group received outpatient rehabilitation intervention once for family self-random rehabilitation training. Fugl-Meyer Assessment, modified Barthel Index and Life Satisfaction Index-A were used to evaluate the motor function, activities of daily
living and quality of life before intervention (0 week) and after 12 weeks of rehabilitation intervention (12 weeks) and 12 weeks of follow-up self-rehabilitation training (24 weeks).
Results: The motor function, activities of daily living and quality of life of the two groups after 12 weeks of rehabilitation intervention (12 weeks) and 12 weeks of follow-up selfrehabilitation training (24 weeks) were significantly better than those before intervention (0 week) (P < 0.05). After 12 weeks of rehabilitation intervention (12 weeks), the scores of Fugl-Meyer Assessment, modified Barthel Index and Life Satisfaction Index-A in the regular rehabilitation intervention group were 72.74+9.32, 75.98+8.71 and 12.93+1.75, respectively, and those in the non-regular rehabilitation intervention group were 61.89+8.56, 61.38+9.11, and 6.78+2.35, respectively. After 12 weeks of follow-up self-rehabilitation training (24 weeks), the scores of Fugl-Meyer Assessment, modified Barthel Index and Life Satisfaction Index-A of the regular rehabilitation intervention group were 81.59+8.54, 86.36+8.52 and 16.39+2.12, respectively, while those of the non-regular rehabilitation intervention group were 62.78+12.34, 63.13+13.37 and 8.54+4.51, respectively; the scores of the regular rehabilitation intervention group were significantly higher than those of the non-regular rehabilitation intervention group (P < 0.05).
Conclusion: Regular rehabilitation intervention can significantly improve the motor function, activities of daily living and quality of life of post-stroke patients in community, and shows good continuity effect, which is worthy of promotion and application in rehabilitation treatment of stroke in community.
Vascular dementia may be the one of the main causes of early-onset cognitive impairment. Subcortical vascular cognitive impairment (SVCI) is the main subgroup of vascular dementia, but there is still little attention on early-onset SVCI. This paper analyzes the epidemiology, risk factors, clinical and imaging characteristics, differential diagnosis and treatment of early-onset SVCI, aiming to improve the clinicians’ understanding of early-onset SVCI, and enhance their recognition of super-early symptoms of early-onset SVCI.
Atherosclerosis is a major risk factor for cardiovascular and cerebrovascular diseases. The mechanism of atherosclerosis is not clear in modern medicine. According to traditional Chinese medicine, atherosclerosis is closely related to pathological products such as turbid phlegm and static blood. Turbid phlegm and static blood are caused by dysfunction of viscera and organs and obstruction of transfusion of Qi, blood and body fluid. There is correlation and independence between turbid phlegm and static blood. Qi can move blood, and circulation of blood depends on Qi flow; the stagnation of Qi leads to blood stasis, while the smoothness of Qi causes the turbid phlegm to disappear; the insufficient Qi reasults in the formation of turbid phlegm. Therefore, turbid phlegm and static blood often stick to each other for disease. Modern medicine has different limitations in the prevention and treatment of atherosclerosis. Traditional Chinese medicine has the characteristics of omni-directional and multi-target action, which can affect the occurrence and development of atherosclerosis in all aspects, thus providing a more comprehensive way for the prevention and treatment of atherosclerosis.
Stroke is the second leading cause of death and the leading cause of disability in the world. At present, rehabilitation training after stroke mainly focuses on the recovery of motor function, but the weakening of respiratory muscle strength and accompanied by diaphragm and abdominal muscle dysfunction in stroke patients, which leads to respiratory muscle dysfunction, can affect the rehabilitation process of stroke patients. The improvement of respiratory muscle strength plays an important role in rehabilitation training of patients with stroke. This review demonstrates the effect of breathing training on the prognosis of patients with stroke and the intervention methods of breathing training and its observational indicators, aiming at discussing the application value of breathing training in patients with stroke and providing basis for its further clinical application.
