简介：摘要Stroke is the most important cause of death and disability in China, and most strokes (~80-90%) are preventable. Recent advances in a number of measures to reduce stroke are discussed in this narrative review, including smoking cessation, a Mediterranean pattern of eating, salt restriction, B vitamins to lower homocysteine, antiplatelet therapy, anticoagulants and the management of patent foramen ovale and carotid stenosis. Lowering of homocysteine with B vitamins does prevent stroke, but patients with variants of MTHFR require higher doses of folic acid, and because of harm from cyanocobalamin among persons with renal impairment, we should use methylcobalamin or oxocobalamin instead. Aspirin resistance appears to be due to enteric coating, and ＞ 50% of Chinese have a reduced response to clopidogrel because of variants of CYP2C19, required to convert the prodrug to its active form. Direct acting oral anticoagulants (DOACs) have revolutionized anticoagulation; important differences among the DOACs are discussed. Percutaneous closure of patent foramen ovale (PFO) does reduce the risk of stroke, but in most patients with stroke and PFO the PFO is incidental; it is important to identify the subgroup in whom paradoxical embolism was the probable cause of the stroke. Some patients with PFO would be better treated with anticoagulants because of the risk of pulmonary embolism. Carotid stenting carries a higher risk in older patients, and most patients with asymptomatic carotid stenosis would be better treated with intensive medical therapy than with either stenting or endarterectomy; the few who could benefit can be identified.

简介：Themajortherapyforischemicstrokeisthrombolytictreatment,butsevereconsequencesoccurwhenthismethodisusedtotreathemorrhagicstroke.Currently,computedtomographyandmagneticresonanceimagingareusedtodifferentiatebetweentwotypesofstroke,butthesetwomethodsarein-effectiveforpre-hospitalcare.

简介：Strokeisaleadingcauseoflong-termdisability.Moststrokepatientsregaintheirfunctionpartiallyorfullyduringthefirst3–6monthsdependingonlocationandsizeofthelesion.Duringthisfunctionalrecoveryphase,corticalreorganizationorplasticityoccurs,andphysiologicalresponsivenessorneuronalexcitabilityisalteredintheipsilesionalandcontralesionalareas.However,howtodrivesuccessfulplasticchangesorsuccessfulstrokerecoveryarenotfullyelucidatedyet.

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简介：Accordingtothe"InternationalStandardofChineseHeadAcupoints"207patientssufferingfromstrokeweretreatedbyneedlingalongtheanteriorandposteriorobliguelinesofvertex-temporal,andtheline1andline2lateraltovertex.Themarkedlyeffectiverateaccountedfor73.43%ofthetotal,andtheoveralleffectiveraterepresented89.86%.Afterthetreatmentsomesymptomsashemiplegia,lingualdysfunction,facialandtongueparalysiswereobviouslyimproved(P<0.01).ThetherapeuticeffectofheadacupuncturewasobviouslybetterthanthatofWesternmedicine(P<0.01).Comparisonoftherapeuticeffectsmadeamongneedlingalongdifferentlinesandbetweenthoseappliedontheintactandaffectedsidesofthebodyshowedthattheywerealleffectiveinimprovingthesymptoms,buttherewasnosignificantdifference(P<0.05)

简介：Onehundredandseventeenacutecerebralinfarctionpatientswererandomlydivid-edintotwogroups:Scalpacupuncturegroup(GroupA)andpuremedicationgroup(GroupB).Thefunctionofthenervoussystem,brainelectricalactivitymappingandsomatosensoryevokedpotentialswereobservedbeforeandafterthetreatment.Itwasfoundthattheindexesinthetwogroupschangedsignificantly(P<0.05).ThecurativeeffectsinGroupAwerebetterthanthatinGroupB(P<0.001).Thecurativeeffectsofscalpacupunctureonacutecerebralinfarctionwereobjectivelyconfirmedbymeansofelectrophysiologicalstudies.

简介：BACKGROUND:Strokepresentsasatransientorchronicbraindysfunctionandisassociatedwithhighmorbidityandhighmortality.Thedoctorsandscientistswouldliketoarguehowtoenhancethevalidityoftherehabilitationtreatmentandhowtofurtherimprovetheleveloftreatmentonstroke.OBJECTIVE:TheaimofthisstudywastoquantitativelyanalyzethecurrentworldwideprogressinresearchonstrokerehabilitationtreatmentbasedonWebofSciencedatabaseandClinicalTrial.govinthepast10years.METHODS:WeconductedaquantitativeanalysisofclinicaltrialarticlesregardingstrokerehabilitationpublishedinEnglishfrom2003to2013andindexedintheNationalInstitutesofHealthClinicalTrialsregistryandWebofSciencedatabases.DataweredownloadedonMarch15,2013.RESULTS:(1)From2003to2013,2654clinicaltrialsinvestigatingstrokewereindexedinClinicalTrials.gov.Therewereonly58clinicaltrialsregisteredin2003,andtherewasamarkedincreasefrom2005.Atotalof605clinicaltrialsontherehabilitationofstrokewereconductedinthepast10years.(2)TheanalysisshowedthatmostofthetrialsinthefieldwereregisteredbyNorthAmericaninstitutions.WithrespecttotheAsiancountries,ChinaandTaiwanareaofChinaalsopublishedareasonableproportionofthetrials,butcomparativelyspeaking,thenumberoftrialsisreallyrare.Mostoftheinterventionsweredrugs,followedbythedevices,andbehavioralinterventionswererankedthird.(3)Inthepast10years,therewere4052studiesonstrokeindexedbyWebofSciencedatabase.CONCLUSION:Fromperspectiveofresearchprogress,wefoundthatthenumberofclinicaltrialsandpapersonstrokerehabilitationhasincreasedsignificantlyinthepast10years,betweenthemaremarkablepositivecorrelationexists.

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简介：AccordingtothemethodofpuncturingthetwelveJing(well)acupointstotreathemiplegiafollowYinbai(SP1),Dadun(LR1),Shangyang(LI1)andGuanchong(TE1),combiningwithselectedacupointsaccordingtothepresentingsyndromes,totreat114casesofhemiplegiafollowingastroke,thetotaleffectiveratewas91.1%.

简介：目的：观察头针、体针结合治疗中风后共济失调的临床疗效。方法：选择符合诊断标准的中风后共济失调患者124例，采用头针、体针结合治疗，观察治疗前后脑血管血液流速变化及总体治疗效果。结果：根据Berg平衡量表评定结果，总有效率93．5％。治疗前后日常生活活动能力（ActivitiesofDailyLiving，ADL）指数比较，总有效率91．1％。治疗前后椎基底动脉血液流速比较差异具有统计学意义（P〈0．05）。结论：针刺治疗中风共济失调疗效明显。

简介：血管内治疗是急性缺血性卒中治疗的有效方法,但是受到时间窗的限制。在缺血的情况下神经组织迅速死亡,因此缩短治疗时间是卒中治疗的主要目标。在2015年以前,静脉溶栓是治疗急性缺血性卒中唯一有效的手段。

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简介：Strokeisthemostcommoncomplicationofatrialfibrillation(AF).GuidelinesrecommendanticoagulanttreatmentinpatientswithCHA2DS2VAScscoresof>2.RegistrydatasuggeststhatalmosthalfofpatientswhoshouldbeontherapeuticanticoagulationforstrokepreventioninAF(SPAF)arenot.Warfarinandmorerecentlydevelopedagents,the"novelanticoagulants"(NOACs)reducetheriskofembolicstrokes.Inaddition,theNOACsalsoreduceintracranialhemorrhage(ICH)byover50%comparedtowarfarin.Anticoagulationandbridgingstrategiesinvolvingcardioversion,catheterablation,andinvasive/surgicalproceduresarereviewed.ThedevelopmentofreversalagentsforNOACsandtheintroductionofleftatrialappendageoccludingdeviceswillevolvetheuseofnewerstrategiesforpreventingstrokeinhighriskAFpatients.

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简介：AbstractBackground:Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h.Methods:We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0-1) at 90 days, the functional independence (defined as mRS scores 0-2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5-9.0 h or >9.0 h).Results:Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12-1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08-1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35-20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97-3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.

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简介：摘要ObjectiveTo determine the mechanisms on cognitive improvement with repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex(L-DLPFC) in subacute stroke patients.MethodsTwenty-eight first-ever stroke patients with cognitive impairment were recruited. All subjects were randomly assigned to real or sham stimulation group and completed 10 sessions of rTMS for 2 weeks. 10 Hz of navigation rTMS were applied (5 s stimulation and 25 s resting, total 1500 pulses) on the L-DLPFC at 80% of resting motor threshold (rMT). At the time of baseline, 1 month and 3 months after stroke onset, all subjects received the Korean-mini mental state examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MOCA), Upper Fugl-Meyer Assessment (U-FMA), Korean-Modified Bathel Index (K-MBI), European Quality of life 5 Dimension (EQ-5D), Korean-Geriatric Depression Scale (K-GDS). In addition, the continuous performance test (CPT), vascular cognitive impairment harmonization standards (VCIHS), motor evoked potentials (MEP), event-related potentials (ERPs), resting state functional magnetic resonance imaging (RS fMRI) and diffusion tensor imaging (DTI) were completed at baseline and 3 months after stroke onset.ResultsAfter the intervention period, the real stimulation group improved significantly in the K-MMSE, K-MOCA, K-MBI and K-GDS compared with sham stimulation group. And these effects lasted after three months in MOCA. There was no significant time × group effect among the U-FMA, EQ-5D, and CPT. Among the VCIHS parameters, Z-scores of executive and memory function showed higher delta value between baseline and 3months timepoints in rTMS group. The MEP showed higher TIME × GROUP interaction in the intracortical inhibition value on right hand. It suggests that there is beneficial effect on premotor cortical excitability of rTMS. The change of P300 amplitude on F3 and C3 was more increased in real stimulation group significantly only in the auditry Oddball paradigm. The RS fMRI analysis results showed more increased functional connectivity of Cingulate Gyrus, Supramarginal Gyrus, Cerebelum Crus2, Precentral gyrus, Middle temporal gyrus and Inferial temporal gyrus after stimulation compared with the sham group. Brain activation in the cingulum showed a tendency that after 3 months, fractional anisotropy (FA) and fiber number (FN) in real group were larger than sham group, however there was no significant effect. The relationship between the change of K-MOCA and fractional anisotropy of the cingulum was found positive correlation in all subjects.ConclusionsThese results suggest that high frequency rTMS on the L-DLPFC improves cognitive function and functional network activity in subacute stroke. The rTMS seems to be a recommendable treatment in stroke patients with cognitive impairment.

简介：AbstractBackground:Stroke is a principal cause of mortality and disability globally. Numerous studies have contributed to the knowledge base regarding self-management interventions among chronic disease patients, but there are few such studies for patients with stroke. Therefore, it is necessary to analyze self-management interventions among stroke patients. This scoping review aimed to systematically identify and describe randomized controlled trials (RCTs) of self-management interventions for adults with stroke.Methods:A review team carried out a scoping review on stroke and self-management interventions based on the methodology of Arksey and O'Malley, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, Web of Science, CINAHL Plus Full Text, Medline Plus Full Text, and Cochrane Central Register of Controlled Trials were searched from inception to July 2020.Results:Fifty-four RCTs were included. The most popular study design is comparing a self-management intervention to usual care or waitlist control condition. Physical activity is the most common intervention topic, and interventions were mainly delivered face to face. The majority of interventions were located in inpatient and multiple settings. Interventions were conducted by various providers, with nurses the most common provider group. Symptom management was the most frequently reported outcome domain that improved.Conclusions:Self-management interventions benefit the symptom management of stroke patients a lot. The reasonable time for intervention is at least 6-12 months. Multifarious intervention topics, delivery formats, and providers are adopted mostly to meet the multiple needs of this population. Physical activity was the most popular topic currently. Studies comparing the effect of different types of self-management interventions are required in the future.

简介：摘要BACKGROUNDPaired associative stimulation (PAS) combining repeated pairing of lectrical stimulation of a peripheral nerve with transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) can induce neuroplastic adaptations in the human brain and enhance motor learning in neurologically-intact individuals. However, the extent to which PAS is an effective technique for inducing associative plasticity and improving motor function in individuals post-stroke is unclear.OBJECTIVEThe objective of this pilot study was to investigate the effects of a single session of PAS to modulate corticomotor excitability and motor skill performance in individuals post-stroke.METHODSSeven individuals with chronic stroke completed two separate visits separated by at least one week. We assessed general corticomotor excitability, intracortical network activity and behavioral outcomes prior to and at three time points following PAS and compared these outcomes to those following a sham PAS condition (PASSHAM)．RESULTSFollowing PAS, we found increased general corticomotor excitability but no significant difference in behavioral measures between PAS conditions. There was a relationship between PAS-induced corticomotor excitability increase and enhanced motor skill performance across post-PAS testing time points.CONCLUSIONThese results provide preliminary evidence for the potential of PAS to increase corticomotor excitability that could favorably impact motor skill performance in chronic individuals post-stroke and are an important first step for future studies investigating the clinical application and behavioral relevance of PAS interventions in post stroke patient populations.