Progresses of functional MRI for exploring mechanism of neurovascular coupling changes in diabetes mellitus type 2 / 中国医学影像技术

The cognitive impairment of diabetes mellitus type 2(T2DM)is closely related to neurovascular coupling(NVC)changes,but the exact mechanism remains unclear.Functional MRI(fMRI)technology were able to jointly analyze NVC changes of T2DM,providing new ideas for revealing the mechanism of cognitive dysfunction caused by T2DM.The progresses of fMRI for exploring NVC changes in T2DM were reviewed in this article.

Is there a correlation between dizziness and intracranial artery calcification?

SUMMARY OBJECTIVE: This study aimed to investigate the correlation between dizziness and intracranial artery calcification. METHODS: A total of 107 consecutive patients were recruited for this study. These patients were categorized into first (case) and second (control) groups. The first and second groups had complaints of dizziness and headache, respectively. All the patients had noncontrast cranial computed tomography images. Bilateral internal carotid arteries, bilateral vertebral arteries, and basilar arteries were evaluated for detecting burden of intracranial artery calcification. Finally, demographic characteristics, stroke risk factors, and burden of intracranial artery calcification of these two groups were compared. The Mann-Whitney U test, chi-square test, and Spearman's correlation were performed to analyze the study. RESULTS: It was found that the first and second groups included 39 and 68 patients, respectively. The mean age of the first group was significantly higher than that of the second group. The mean burden of intracranial artery calcification of the posterior circulation in the first and second groups were not statistically different from each other (p=0.555). The mean burden of intracranial artery calcification of the anterior circulation in the first group was found to be significantly higher than the second group (p=0.005). However, no significant difference was found between the two groups in terms of burden of intracranial artery calcification of anterior or posterior circulation, when the age variable was synchronized in both groups. CONCLUSION: Although this study found a limited correlation between dizziness and intracranial artery calcification, this situation was basically related to aging.

Hemodynamic parameters and cognitive impairment in middle-aged and elderly people in rural China: a community-based transcranial Doppler ultrasound study / 国际脑血管病杂志

Objective:To investigate the differences in transcranial Doppler (TCD) hemodynamic parameters and their correlation with cognitive impairment in middle-aged and elderly populations with different cognitive states in rural communities.Methods:From January to February 2022, participants were recruited from rural communities in Yandu District, Yancheng for cognitive assessment and TCD examination. TCD parameters were recorded, including mean flow velocity (MFV), peak systolic velocity (PSV), pulsatile index, and resistance index of bilateral anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vertebral artery and basilar artery. According to the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores, the participants were divided into a normal cognitive function group, a mild cognitive impairment (MCI) group, and a dementia group. Spearman correlation analysis was used to investigate the correlation between hemodynamic parameters and blood pressure. Multivariate logistic regression analysis was used to identify the independent influencing factors of MCI and dementia, and multiple linear regression analysis was used to identify the correlation between hemodynamic parameters and cognitive assessment scale scores. Results:A total of 270 participants were enrolled, including 82 in the normal cognitive function group, 100 in the MCI group, and 88 in the dementia group. The comparison between groups showed that advanced age, female and low education years might be the risk factors for dementia in rural areas. The proportion of smoking and drinking in the dementia group was lower than that in the normal cognitive function group and the MCI group. The right ACA MFV and PSV in the dementia group were significantly lower than those in the normal cognitive function group and the MCI group, while the left PCA PSV was significantly lower than that in the MCI group (all P<0.05). Multivariate logistic regression analysis showed that compared with the normal cognitive function group, the right ACA PSV (odds ratio [ OR] 0.964, 95% confidence interval [ CI] 0.935-0.993; P=0.016) was an independent related factor associated with dementia; compared with the MCI group, right ACA PSV ( OR 0.967, 95% CI 0.936-0.999; P=0.043) and left PCA PSV ( OR 0.953, 95% CI 0.911-0.998; P=0.039) were the independent related factors for dementia. Multiple linear regression analysis showed that the right ACA PSV ( β=0.431, P=0.036) and left PCA PSV ( β=0.133, P=0.021) were the independent related factors for MMSE score. Spearman correlation analysis showed that there was a significant correlation between blood pressure and several hemodynamic parameters (all P<0.05). Conclusion:The right ACA and left PCA PSV are significantly associated with dementia in rural middle-aged and elderly people, and are expected to serve as non-invasive early screening biomarkers for cognitive impairment in rural population.

Cerebral circulation time: evaluation methods and clinical significance in patients with acute ischemic stroke / 国际脑血管病杂志

Cerebral circulation time is defined as the difference between the time to peak of the cavernous sinus segment of the internal carotid artery and the Trolard vein, which is easily obtained in digital subtraction angiography and is closely associated with hemodynamics. Cerebral circulation time can be used to evaluate the outcome of acute ischemic stroke, especially in patients receiving endovascular treatment. This article reviews the evaluation methods of cerebral circulation time and its clinical significance in patients with acute ischemic stroke.

Associations of cerebral perfusion impairment with early neurological deterioration and poor outcome in patients with acute small subcortical infarction / 国际脑血管病杂志

Objective:To investigate associations of cerebral perfusion impairment with early neurological deterioration (END) and poor outcome in patients with acute small subcortical infarction (SSI).Methods:Patients with SSI in the perforator artery region admitted to the Department of Neurology, Zhengzhou People's Hospital between January 2020 and November 2022 were prospectively included. END was defined as an increase of ≥2 in the total score of the National Institutes of Health Stroke Scale (NIHSS) or an increase of ≥1 in the motor function score within 72 h after admission. Poor outcome was defined as the modified Rankin Scale score of 2 at 90 d after onset. Cerebral perfusion impairment was defined according to MRI perfusion-weighted imaging parameters. The demographic, baseline clinical and imaging data were collected. Multivariate logistic regression analysis was used to determine associations of cerebral perfusion impairment and END and poor outcome in patients with SSI. Results:A total of 100 patients with SSI were enrolled, including 56 males (56.0%), and aged 69.2±5.8 years. Among them, 19 patients (19.0%) developed END, 27 (27.0%) had poor outcome, and 51 (51.0%) had significant cerebral perfusion impairment. There were statistically significant differences in high sensitivity C-reactive protein, white matter hyperintensities (WMHs) in the basal ganglia, enlarged perivascular space (EPVS) in the basal ganglia, deep cerebral microbleeds (CMBs), and cerebral perfusion impairment between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that higher diastolic blood pressure (odds ratio [ OR] 1.070, 95% confidence interval [ CI] 1.003-1.141); P=0.040], deep WMHs ( OR 2.271, 95% CI 1.135-4.544; P=0.020), deep CMBs ( OR 5.047, 95% CI 1.240-20.549; P=0.024), and cerebral perfusion impairment ( OR 6.083, 95% CI 1.318-28.080; P=0.021) were independent risk factors for END in patients with SSI. There were statistically significant differences in hypersensitive C-reactive protein, NIHSS score at END, basal ganglia EPVS, END, and cerebral perfusion impairment between the poor outcome group and the good outcome group ( P<0.05). Multivariate logistic regression analysis showed that NIHSS score at END ( OR 1.485, 95% CI 1.034-2.133; P=0.032), basal ganglia EPVS ( OR 3.005, 95% CI 1.224-7.378; P=0.016), and cerebral perfusion impairment ( OR 9.234, 95% CI 1.994-42.765; P=0.004) were independent risk factors for the poor outcome at 90 d in patients with SSI, while anterior circulation infarction ( OR 0.066, 95% CI 0.013-0.334; P=0.001) was independently negatively correlated with the poor outcomes at 90 d after onset. Conclusion:Cerebral perfusion impairment is an independent risk factor for END and poor outcome at 90 d after onset in patients with SSI.

Influence of cerebral blood flow on volumetric loss related to Alzheimer's disease / Influência do fluxo sanguíneo cerebral na perda volumétrica relacionada à doença de Alzheimer

ABSTRACT: CBF measured with Arterial Spin Labeling (ASL) obtained by Magnetic Resonance Imaging (MRI) may become an important biomarker by showing changes in early stages of AD, such as in the prodromal stage of Mild Cognitive Impairment (MCI). Objective: Verify the correlation between atrophy and CBF in patients with MCI and mild phase ADD, to demonstrate whether changes in CBF can be considered as vascular biomarkers in the diagnosis of the DA continuum. Methods: 11 healthy volunteers, 16 MCI and 15 mild ADD were evaluated. Images of the brain were acquired, including CBF measured with Arterial Spin Labeling (ASL). Results: When comparing MCI with control, a reduction in normalized CBF was observed in left posterior cingulate (estimated difference -0.38; p=0.02), right posterior cingulate (estimated difference -0.45; p=0.02) and right precuneus (estimated difference -0.28; p <0.01); also increase in normalized CBF in right upper temporal pole (estimated difference 0.22; p=0.03). It was also observed that in MCI, the smaller the gray matter volume, the smaller the CBF in the left posterior cingulate; as well as the greater the cerebrospinal fluid volume, consequent to the encephalic volumetric reduction associated with atrophy, the greater the CBF in the right superior temporal pole. When comparing controls, MCI and mild AD, in relation to the other variables, no other correlations were observed between CBF and atrophy. Conclusion: In patients with MCI, the reduction of CBF in the left posterior cingulate correlated with gray matter atrophy, as well as the increase of CBF in the right upper temporal pole correlated with an increase in cerebrospinal fluid consequent to the encephalic volumetric reduction associated with atrophy, demonstrating the influence of CBF in AD related brain atrophy. These findings position CBF as a possible vascular biomarker for early-stage AD diagnoses.

RESUMO: A imagem por ressonância magnética (IRM) pode se tornar um importante biomarcador ao mostrar alterações nos estágios iniciais da doença de Alzheimer (DA). Objetivo: Sendo a atrofia cerebral um importante biomarcador de neurodegeneração na DA, o presente estudo foi realizado com o objetivo de verificar se há correlação entre atrofia e fluxo sanguíneo cerebral (FSC) em pacientes com diagnóstico de CCL e demência da doença de Alzheimer (DDA) leve, com o objetivo de revelar se as alterações no FSC podem ser consideradas possíveis biomarcadores vasculares no diagnóstico do continuum da DA. Métodos: Foram avaliados 11 voluntários saudáveis, 16 CCL e 15 DDA leve. Imagens do cérebro foram adquiridas em um equipamento de 3 T, incluindo imagens ponderadas em T1 de alta resolução para avaliação anatômica e Arterial Spin Labeling (ASL) para a quantificação de FSC. Resultados: Quando comparado CCL com controle, observou-se redução no FSC normalizado em cingulado posterior esquerdo (diferença estimada de -0,38; p=0,02), cingulado posterior direito (diferença estimada de -0,45; p=0,02) e precúneo direito (diferença estimada de -0,28; p <0,01); e aumento de FSC normalizado no polo temporal superior direito (diferença estimada de 0,22; p=0,03). No CCL, quanto menor o volume da substância cinzenta, menor o FSC no cingulado posterior esquerdo; quanto maior o volume de fluido cerebroespinhal, consequente à redução volumétrica encefálica, maior o FSC no polo temporal superior direito. Conclusão: Nos pacientes com diagnóstico de CCL, a redução de FSC no cingulado posterior esquerdo apresentou correlação com atrofia da substância cinzenta, assim como o aumento de FSC no polo temporal superior direito apresentou correlação com o aumento de fluido cerebroespinhal, demonstrando a provável influência do FSC na atrofia encefálica relacionada à DA.

Influence of the selective insufflation technique on cerebral blood flow in preterm infants / Influência da técnica de insuflação seletiva no fluxo sanguíneo cerebral de prematuros

Abstract Introduction The intervention of respiratory physio-therapy in neonatal units is in continuous development, having its own care characteristics related to the weight and gestational age of the newborn, respecting the immaturity of the organs and systems and the diseases of this patient. Through techniques, the objective is to optimize the respiratory function, assisting in the clearance of secretions, and the restoration of lung volumes. Objective To verify if the respiratory physiotherapy technique of selective insufflation alters the cerebral blood flow in premature infants under 34 weeks of gestational age. Methods This is an uncontrolled clinical trial, conducted in a Neonatal Intensive Care Unit of a level III hospital, between January 2019 and March 2020, with participation of premature newborns under 34 weeks of gestational age. All were submitted to transfontanellar Doppler ultrasonography to assess cerebral blood flow measurements, mainly the resistance index, before and after the application of the selective insufflation respiratory physiotherapy technique. Results Sixty-two newborns were included, with a mean gestational age of 29.3 ± 2.2 weeks and birth weight of 1,259 ± 388 grams. The resistance index did not change significantly (RI before: 0.55 ± 0.07; after: 0.54 ± 0.07; p = 0.06) before and after the intervention and no studied variables such as, gender, gestational age, weight, Apgar score or SNAPPE II score had an influence on cerebral blood flow measurements. Conclusion The selective insufflation technique did not alter cerebral blood flow in premature newborn infants under 34 weeks gestational age.

Resumo Introdução A intervenção da fisioterapia respiratória nas unidades neonatais está em contínuo desenvolvimento, tendo características próprias de atendimento relacio-nadas ao peso e à idade gestacional do recém-nascido, respeitando a imaturidade dos órgãos e sistemas e as doenças desse paciente. Objetivo Verificar se a técnica de fisioterapia respiratória de insuflação seletiva altera o fluxo sanguíneo cerebral de prematuros menores de 34 semanas de idade gestacional. Métodos Trata-se de um ensaio clínico não controlado, realizado em uma Unidade de Terapia Intensiva Neonatal de um hospital nível III, entre janeiro de 2019 e março de 2020, com a participação de recém-nascidos prematuros menores de 34 semanas de idade gestacional. Todos foram submetidos ao exame de ultrassonografia transfontanela com Doppler para avaliar as medidas de fluxo sanguíneo cerebral, principalmente o índice de resistência, antes e depois da aplicação da técnica de fisioterapia respiratória de insuflação seletiva. Resultados Sessenta e dois recém-nascidos foram incluídos, com média de idade gestacional de 29,3 ± 2,2 semanas e peso de nascimento de 1259 ± 388 gramas. O índice de resistência não se modificou de forma significativa antes e depois da intervenção (IR antes: 0,55 ± 0,07; depois: 0,54 ± 0,07; p = 0,06) e nenhuma variável estudada, como sexo, idade gestacional, peso, escore de Apgar ou escore SNAPPE II, teve influência nas medidas de fluxo sanguíneo cerebral. Conclusão A técnica de insuflação seletiva não alterou o fluxo sanguíneo cerebral de recém-nascidos prematuros menores de 34 semanas de idade gestacional.

Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review / Risco de acidente vascular cerebral perioperatório e monitoramento de autorregulação cerebral: uma revisão sistemática

Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98;p < 0.0001).

Resumo Antecedentes Acidente vascular cerebral (AVC) perioperatório, delírio e comprometimento cognitivo podem estar relacionados ao manejo e à variações no controle da pressão arterial, à hipoperfusão cerebral, e ao aumento do volume sanguíneo. A autorregulação cerebral (ARC) é um mecanismo para manter a perfusão cerebral por meio do controle do tônus vascular e das reações hemodinâmicas na circulação. Objetivo Este trabalho aborda sistematicamente a determinação da relação entre a falha da ARC e o AVC perioperatório, com uma avaliação da taxa de complicações neurológicas pós-cirúrgicas em estudos em que a ARC perioperatória foi monitorada. Métodos Esta revisão sistemática incluiu ensaios clínicos randomizados e estudos observacionais prospectivos. Todos os estudos ajustaram o risco relativo, a razão de risco ou os valores de intervalo de confiança de 95% (IC95%). Esses efeitos de estimativas foram testados usando modelos de efeitos aleatórios. A heterogeneidade entre os diferentes estudos foi avaliada por meio das estatísticas de Higgins e Thompson I2. Resultados As bases de dados eletrônicas Web of Science, PubMed e Embase foram pesquisadas para selecionar os artigos. Um total de 4.476 estudos publicados entre 1983 e 2019 foram analisados, mas apenas 5 se qualificavam para a extração de dados e foram incluídos na análise final. A coorte combinada do estudo foi composta por 941 pacientes. Todos os estudos forneceram informações sobre AVC perioperatório, o que equivaleu a 16% (158 de 941) da população geral de pacientes. Conclusão Esta meta-análise mostrou evidências do impacto do prejuízo da ARC no risco de AVC perioperatório. Na análise conjunta, as flutuações sanguíneas ou outros insultos cerebrais grandes o suficiente para comprometer a ARC foram associados ao resultado do AVC (razão de probabilidades [RP]: 2,26; IC95%: 1,54-2,98;p < 0,0001).

Development of a mouse model of stellate ganglion block and subsequent effects on cerebral cortical blood flow / 中华麻醉学杂志

Objective:To develop a model of stellate ganglion block (SGB) in mice and investigate the effect of SGB on cerebral cortical blood flow.Methods:Thirty clean-grade healthy male C57BL/6 mice, aged 8-9 weeks, weighing 23-27 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), left SGB group (group L), left normal saline group (group SL), right SGB group (group R) and right normal saline group (group SR). Group C received no intervention.SGB was performed with 0.25% ropivacaine 0.08 ml via percutaneous posterior approach in L and R groups, while the equal volume of normal saline 0.08 ml was given instead at the location of left and right stellate ganglion in SL and SR groups, respectively.The cerebral cortical blood flow was determined using laser speckle contrast imaging system before SGB (T 0) and at 10, 30, 60, 90 and 120 min after SGB (T 1-5). Results:Mice developed ptosis on the block side, indicating that the model of SGB was successfully developed in L and R groups.There was no significant difference in cerebral cortical blood flow at each time point among C, SL and SR groups ( P>0.05), and cerebral cortical blood flow on the block side decreased at T 1, began to increase at T 2, peaked at T 3, and decreased at T 5 which was still higher than that at T 0 in group L and group R ( P<0.01). Compared with C and SL groups, the left cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group L ( P<0.01). Compared with C and SR groups, the right cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group R ( P<0.01). There were no significant differences in cerebral cortical blood flow at each time point between group C and group SL and between group C and group RL ( P>0.05). Conclusions:The mouse model of SGB via percutaneous posterior approach is successfully developed.Unilateral SGB can affect cerebral cortical blood flow on the block side, which shows a transitory decrease followed by a sustained significant increase.

Effects of electroacupuncture pretreatment on motor function and cerebral blood flow in MCAO model rats / 针灸推拿医学（英文版）

Objective: To observe the effects of electroacupuncture (EA) pretreatment on motor function, cerebral blood flow, cerebral infarction volume, and vascular endothelial growth factor (VEGF) level in middle cerebral artery occlusion (MCAO) model rats. Methods: Twenty-four male Sprague-Dawley rats were randomly divided into a normal group, a model group, and an EA group, with eight rats in each group. The middle cerebral artery ischemia-reperfusion model was established by the suture-occluded method in the model group and the EA group, while not in the normal group. The EA group was pretreated with EA at bilateral Fengchi (GB20) before model preparation, once a day for 30 min each time for a total of 7 d. The changes in the CatWalk gait parameters, modified Bederson neurological deficit score, cerebral blood flow, cerebral infarction volume after ischemia, and VEGF level in the brain tissue of rats in each group were observed. Results: Compared with the normal group, the modified Bederson neurological deficit score in the model group and the EA group increased after modeling (P<0.05), and the CatWalk gait parameters (one-leg stance duration, gait cadence, and gait cycle) were all changed (P<0.05). Compared with the model group, the modified Bederson neurological deficit score in the EA group decreased (P<0.05), and the CatWalk gait parameters improved (P<0.05). Immediately after ischemia, the cerebral blood flow in the normal group was greater than that in the model group and the EA group (P<0.05); after reperfusion, the cerebral blood flow in the EA group was greater than that in the model group (P<0.05). Compared with the normal group, the cerebral infarction volume in the model group and the EA group increased (P<0.05). Compared with the model group, the cerebral infarction volume in the EA group decreased (P<0.05). The expression level of VEGF-positive cells in the rat brain tissue in the model group was higher than that in the normal group (P<0.05), and was higher in the EA group than in the model group (P<0.05). Conclusion: EA pretreatment improves the limb motor function in MCAO model rats, alleviates the symptoms of neurological deficits, promotes the recovery of cerebral blood flow, reduces the cerebral infarction area after MCAO modeling, and increases the VEGF expression in the brain tissue.

Intracranial compliance in type 2 diabetes mellitus and its relationship with the cardiovascular autonomic nervous control

The intracranial compliance in type 2 diabetes mellitus (T2DM) patients and the association with cardiovascular autonomic control have not been fully elucidated. The aim of this study was to assess intracranial compliance using the noninvasive intracranial pressure (niICP) and the monitoring of waveform peaks (P1, P2, and P3) and the relationship with cardiovascular autonomic control in T2DM patients. Thirty-two men aged 40-60 years without cardiovascular autonomic neuropathy (CAN) were studied: T2DMG (n=16) and control group CG (n=16). The niICP was evaluated by a noninvasive extracranial sensor placed on the scalp. Cardiovascular autonomic control was evaluated by indices of the baroreflex sensitivity (BRS), from temporal series of R-R intervals of electrocardiogram and systolic arterial pressure, during supine and orthostatic positions. The participants remained in the supine position for 15 min and then 15 min more in orthostatism. T2DMG presented a decrease of the P2/P1 ratio during the orthostatic position (P<0.001). There was a negative moderate correlation between the P2 peak with cardiovascular coupling (K2HP-SAPLF) in supine (r=-0.612, P=0.011) and orthostatic (r=-0.568, P=0.020) positions in T2DMG. We concluded that T2DM patients without CAN and cardiovascular complications presented intracranial compliance similar to healthy subjects. Despite preserved intracranial adjustments, T2DM patients had a response of greater magnitude in orthostatism. In addition, the decoupling between the heart period and blood pressure signal oscillations in low frequency appeared to be related to the worsening of intracranial compliance due to the increased P2 peak.

Transcranial Doppler ultrasound for assessment of dynamic cerebral autoregulation in patients with acute ischemic stroke / 国际脑血管病杂志

Transcranial Doppler (TCD) is a method for measuring cerebral artery blood flow velocity, which has the advantages of low cost, non-invasive, high temporal resolution. Dynamic cerebral autoregulation (dCA) is to study the instantaneous change of cerebral blood flow (CBF) at the moment of arterial blood pressure or intracranial pressure change, that is, the ability to recover CBF in the face of sudden change of perfusion pressure. After the onset of acute ischemic stroke (AIS), effective dCA can maintain the stability of cerebral hemodynamics and avoid excessive or insufficient perfusion at the injured site. Therefore, it is of great significance to evaluate dCA in patients with AIS. However, at present, there is no recognized optimal evaluation method for dCA. This article mainly summarizes the advantages of TCD in evaluating dCA compared with other methods and the application of TCD combined with transfer function analysis (TFA) in evaluating dCA in AIS.

Damage mechanism of neurovascular unit in cerebral small vessel disease / 国际脑血管病杂志

Cerebral small vessel disease (CSVD) is a common and slowly progressive cerebrovascular disease. Its pathological mechanism involves vascular endothelial dysfunction, blood-brain barrier destruction, neuronal apoptosis, glial cell activation, and inflammatory reaction. Neurovascular unit is the basic unit of brain structure and function, and its pathological changes are closely associated with many cerebrovascular diseases. At present, the damage mechanism of neurovascular unit in CSVD has been paid more and more attention. This article reviews the damage mechanism of neurovascular unit in CSVD.

Effects of acupuncture combined with Brunnstrom staging on upper-limb motor function, cerebral arterial blood flow velocity, and brain function remodeling after stroke / 针灸推拿医学（英文版）

Objective: To explore the effects of acupuncture combined with Brunnstrom staging on upper-limb motor function, cerebral arterial blood flow velocity, and brain function remodeling after stroke. Methods: A total of 77 patients after stroke were selected between January 2017 and December 2019 to perform a prospective study. All cases were divided into an observation group and a control group by the random number table method. Both groups were treated with conventional symptomatic treatment for stroke and functional exercise according to the Brunnstrom staging. The observation group was treated with additional acupuncture treatment based on the Brunnstrom staging therapy. The therapeutic efficacy was evaluated after six-week treatment. The traditional Chinese medicine (TCM) symptom scores of dizziness, headache, limb numbness, and language disorders before and after the treatment in the two groups were compared. According to the Fugl-Meyer motor function assessment (FMA), the upper-limb motor function before and after the treatment was compared. And the average systolic blood flow velocity of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) in the two groups before and after the treatment were compared. According to the modified Edinburgh-Scandinavia stroke scale (MESSS), the nerve function before and after the treatment was compared. Results: The total effective rate of the observation group was 94.9％, significantly higher than 79.0％ of the control group (P<0.05). After the treatment, the TCM symptom scores of dizziness, headache, limb numbness, and language disorders in both groups decreased, and the scores in the observation group were all significantly lower than those in the control group (P<0.05). The FMA score of upper limbs in both groups increased, and the score in the observation group was significantly higher than that in the control group (P<0.05). The average systolic blood flow velocities of the ACA, MCA and PCA in both groups increased, and were significantly higher in the observation group than in the control group (P<0.05). The MESSS score in both groups decreased, and the score in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Acupuncture combined with Brunnstrom staging is effective for patients after stroke. It can effectively improve the upper-limb motor function and cerebral artery blood flow velocity, promote brain function remodeling, and restore nerve function.

Effects of electroacupuncture on angiogenesis and cortical VEGF and BDNF expression inrats with focal cerebral ischemia / 针灸推拿医学（英文版）

Objective: To observe the effect of electroacupuncture (EA) of "concurrent treatment of the brain and heart" on angiogenesis and cortical vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF) in rats with focal cerebral ischemia, and to explore the mechanism of EA in cerebral ischemia treatment. Methods: A total of 108 Sprague-Dawley rats, 27 rats were randomly selected as the sham-operation group, and the rest rats received the right middle cerebral artery occlusion operation for model preparation firstly, and then were divided into a model group, a traditional acupoint group, and a concurrent treatment of the brain and heart group, with 27 rats in each group. In the sham-operation group, only the carotid artery was isolated. EA at Shuigou (CV26), Quchi (LI11), Hegu (LI4), and Zusanli (ST36) in the traditional acupoint group, and EA at Fengfu (GV16), Baihui (GV20), Xinshu (BL15), and Neiguan (PC6) in the concurrent treatment of the brain and heart group were performed 4 h after the operation, once a day, for 14 consecutive days. Rats in the sham-operation group and the model group were identically fixed without any treatment. Before and after treatment, the modified neurological severity score (mNSS), regional cerebral blood flow (rCBF), and CD34 positive expression by immunohistochemistry were measured. The positive protein expression levels of VEGF and BDNF were detected by immunofluorescence, and the mRNA expression levels of VEGF and BDNF were detected by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Results: Compared with the sham-operation group, the mNSS, rCBF, and ischemic side cortical micro-vessel density (MVD) decreased, and the protein and mRNA expression levels of VEGF and BDNF increased in the model group (P<0.01). Compared with the model group, the mNSS of the two EA groups decreased, and the mNSS of the concurrent treatment of the brain and heart group was lower than that of the traditional acupoint group on the 14th day (P<0.05). Compared with the model group, the rCBF in the two EA groups increased, and the rCBF reached the highest on the 14th day (P<0.05 or P<0.01), and the rCBF in the concurrent treatment of the brain and heart group was higher than that in the traditional acupoint group (P<0.05); the MVD of the two EA groups was higher than that of the model group, and the MVD of the concurrent treatment of the brain and heart group was higher than that of the traditional acupoint group on the 7th and 14th days (P<0.05 or P<0.01). Compared with the model group, the protein and mRNA expression levels of VEGF and BDNF in the two EA groups increased (P<0.01). The VEGF expression level was the highest on the 7th day in the concurrent treatment of the brain and heart group (P<0.05), and the BDNF expression level was higher on the 7th and 14th days than on the 3rd day (P<0.05). The mRNA expression levels of VEGF and BDNF in both EA groups reached the highest on the 7th day (P<0.05 or P<0.01). Conclusion: EA therapy can up-regulate the VEGF and BDNF expression levels and increase the rCBF in the cortex of rats with focal cerebral ischemia, which may be one mechanism of EA in the cerebral ischemia treatment. The therapeutic effect is accumulated with the effective time, and the concurrent treatment of the brain and heart group is superior to the traditional acupoint group in promoting angiogenesis.

Therapeutic efficacy of acupuncture plus Tuina for spastic cerebral palsy and discussion ofits mechanism / 针灸推拿医学（英文版）

Objective: To discuss the effects of acupuncture plus Tuina (Chinese therapeutic massage) in intervening the mental development, motor function, cerebral hemodynamics, and muscle tone in kids with spastic cerebral palsy (CP). Methods: A retrospective analysis was conducted on 87 kids with spastic CP. They were divided into a control group and an observation group based on their original treatment plan. Kids in the control group received symptomatic treatment, motor development therapy, and Tuina treatment. The observation group was additionally given acupuncture treatment. One month was taken as a treatment course. After six courses, the efficacy, change in muscle tone, mental development, gross motor function, fine motor function, and the systolic velocity (Vs), mean velocity (Vm), and pulsatility index (PI) of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were compared between the two groups. Results: After treatment, the muscle tone score dropped in both groups (P<0.05) and was significantly lower in the observation group than in the control group (P<0.05). The observation group achieved more significant efficacy than the control group (P<0.05). After the intervention, the mental development index (MDI), psychomotor development index (PDI), gross motor function measure (GMFM) score, and fine motor function measure (FMFM) score all increased in both groups (P<0.05) and were notably higher in the observation group than in the control group (P<0.05). After treatment, the Vs and Vm of the ACA, MCA, and PCA were markedly higher in the observation group than in the control group (P<0.05), and the observation group was significantly lower than the control group comparing the PI of the ACA, MCA, and PCA (P<0.05). Conclusion: Based on the symptomatic treatment and motor development therapy, Tuina and acupuncture treatment can effectively treat spastic CP children, manifesting as reducing muscle tone, boosting mental development, and improving motor function and cerebral hemodynamics.

Effects of controlled low central venous pressure on cerebral blood flow in patients undergoing open hepatectomy / 中华麻醉学杂志

Objective:To evaluate the effects of controlled low central venous pressure (CLCVP) on the cerebral blood flow in the patients undergoing open hepatectomy.Methods:Thirty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-60 yr, with body mass index of 18-30 kg/m 2, with Child-Pugh classification A and expected operation time of 2-4 h, undergoing elective open hepatectomy, were enrolled.After anesthesia induction, patients were placed at head-up tilt position, nitroglycerin 0.5-1.5 μg·kg -1·min -1 was infused, and furosamide 5-10 mg was intravenously injected when necessary to maintain CVP less than 5 cmH 2O during hepatectomy.After the end of hepatectomy, CLCVP was stopped, the infusion rate was increased to 10 ml·kg -1·h -1 with a crystalline gel ratio of 1∶2 to restore CVP to more than 5 cmH 2O.At 5 min after anesthesia induction (T 0), 5 min after head-up tilt (T 1), 5 and 15 min after CVP reaching the target (T 2, 3) and 5 min after the end of CLCVP (T 4), the blood flow of internal carotid artery was detected by ultrasound, and peak systolic velocity(IBVs), end diastolic velocity (IBVd)and vessel diameter of the internal carotid artery (ID)were measured by doppler ultrasound.Mean velocity [IBVm=(IBVs+ IBVd×2)÷3] and internal carotid artery blood flow [IBF=IBVm×π×(ID/2) 2×HR] were calculated.Heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO), stroke volume (SV), end-tidal pressure of carbon dioxide (P ETCO 2) and maximum airway pressure (P max) were recorded at each time point. Results:Compared with the baseline at T 0, MAP, CO, SV, IBVm and IBF were significantly decreased at T 2, 3 ( P<0.001), and no significant change was found in HR, P ETCO 2 and P max at T 1-4 ( P>0.05). The results of linear mixed-effects model analysis showed that the regression coefficients for CO, MAP, HR, and SV were 0.600 3, 0.022 88, 0.363 7, and 0.614 8, respectively ( P<0.05 or 0.01). Conclusions:CLCVP can decrease the cerebral blood flow in the patients, which is closely associated with decreased CO, MAP, HR and SV when used for open hepatectomy.

Effects of Breaking up Deskwork with Physical Activity Combined with Tea Consumption on Cerebrovascular Function, Mood, and Affect

Abstract Background: Prolonged sitting, typical of desk work, decreases cerebral blood flow (CBF), mood and affect. Conversely, short physical activity breaks from sitting may prevent these detrimental effects and provide cardiometabolic benefits. Objective: We evaluated the effect of interrupting prolonged sitting with short breaks of light physical activity combined with tea consumption on CBF, cerebral autoregulation (CA), mood, and affect in desk workers. Methods: Nineteen healthy desk workers (ten male, 27±10 years) performed desk work in a laboratory for six hours on two separate intervention days: tea breaks (TEA-BREAK: short walk combined with ingestion of one cup of tea every hour) and sedentary (SED: ingestion of one cup of water every hour, while seated). Before and after desk work, we assessed mean arterial pressure (MAP), middle cerebral artery blood velocity (MCAv) and CA. Questionnaires were used to assess mood (Bond & Lader, PANAS) and affect (Affect grid) before and after the intervention. Data are expressed as mean ± standard deviation. Two-way ANOVA with repeated measurements followed by Sidak post hoc test was used for data analysis. Paired Student's t-test was also used to compare changes (Δ) between trials. Statistical significance was at p<0.05. Results: Desk work increased MAP (4.6±4.6 Δ mmHg; P<0.05), and decreased MCAv (-5.2±7.0 Δ cm/s; P<0.05), with no difference between interventions in these parameters. TEA-BREAKS, but not SED, decreased gain (-0.08±0.12 Δ cm.s−1.mmHg.−1) and increased phase (5.26±8.84 Δ radians) at very low frequency (P<0.05), but not at low frequency. Small changes in positive affect were found after the six hours of desk work (-5.5±7.3 Δ scale; P<0.05), with no differences between interventions. Conclusion: Changes in MCAv and positive affect induced by prolonged desk work could not be prevented by TEA-BREAKS. However, TEA-BREAKS improved CA, suggesting a higher efficiency in maintaining MCAv in response to blood pressure fluctuations.