Association of Plaque Features with Infarct Patterns in Patients with Acutely Symptomatic Middle Cerebral Artery Atherosclerotic Disease.

BACKGROUND AND PURPOSE: Understanding the stroke mechanism of middle cerebral artery (MCA) atherosclerosis is important for stroke triage and future trial design. The aim of this study was to characterize intrinsic MCA plaque and acute cerebral infarct in vivo by using high-resolution black-blood (BB) and diffusion-weighted magnetic resonance (MR) imaging and to investigate the relationship between plaque features and infarct patterns. METHODS: A single-center retrospective study was conducted at a tertiary referral center between March 2017 and August 2019. Patients consecutively admitted for acute ischemic stroke with MCA stenosis underwent diffusion-weighted and BB MR imaging. Plaque features and infarct patterns were assessed. The association between plaque features and infarct patterns (binary variable: single/multiple) was evaluated using a multivariate logistic regression model. RESULTS: Of 49 patients with MCA atherosclerotic stenosis, diffusion-weighted MR imaging showed that 28 patients (57%) had multiple acute cerebral infarcts and 21 patients had single acute cerebral infarcts. In contrast to single infarct, multiple infarcts were associated with greater plaque burden (81.9±7.24 versus 71.3±13.7; P=0.012). A multivariate logistic regression model adjusted for 7 potential confounders confirmed a statistically significant positive association between plaque burden and multiple acute infarcts (adjusted R2 =0.432, P< 0.001). The rate of plaque surface irregularity was significantly greater in patients with multiple infarcts than those with single infarct (71% versus 43%, P=0.044). For single acute penetrating artery infarct, patients with infarct size > 2cm had greater plaque burden compared with patients with infarct size < 2cm (75.3±13.4 versus 63.4±10.9; P = 0.016). CONCLUSIONS: Increased plaque burden, plaque surface irregularity in patients with MCA stenosis is associated with its likelihood to have caused an artery-to-artery embolism that produces multiple cerebral infarcts, especially along the border zone region, and increased plaque burden may promote subcortical single infarct size by occluding penetrating arteries. Our results provide important insight into stroke mechanism of MCA atherosclerosis.

Susceptibility Vessel Sign in Isolated Brainstem Infarction with Large Artery Occlusion.

BACKGROUND/AIMS: It is crucial to detect the composition of the thrombus in isolated brainstem infarction with large artery occlusion. The aim of this study was to explore the susceptibility vessel sign (SVS) whose composition is mainly deoxidized red cells in patients with isolated brainstem infarction and posterior circulation large artery occlusion. METHODS: This was a single-center retrospective study. All patients with posterior circulation large artery occlusion from January 2003 to September 2013 were included. We identified 213 patients who had posterior circulation large artery occlusion, and 81 patients met the imaging eligibility criteria. Among the 81 patients, 21 had isolated brainstem infarction. RESULTS: Among the 21 patients, 7 (33%) had SVS and 2 (10%) had pseudo-SVS (calcified vessels without thrombosis). In the 7 patients with SVS, we found atrial fibrillation in 2 patients, dissection in 3 patients and large artery atherosclerotic disease (LAAD) in 2 patients. There were SVS in 100% (2/2) of patients with atrial fibrillation, 50% (3/6) of patients with dissection, and 20% (2/10) of patients with LAAD. CONCLUSIONS: SVS reflects pathology of deoxidized red cells composition in patients with isolated brainstem infarction. This finding may be useful to explore the different stroke mechanisms and therapy strategies.

Ethnobotanical study on herbal tea drinks in Guangxi, China.

BACKGROUND: Herbal tea drinks, different from classical Camellia beverages, are a wide variety of herbal drinks consumed for therapeutic purposes or health promotion. Herbal tea is widely consumed in Guangxi. However, the documentation on the plants for herbal tea and their related health benefits is still limited. METHODS: An ethnobotanical survey was conducted in 52 villages and 21 traditional markets in Guangxi from 2016 to 2021. Semi-structured interviews, key informant interviews, and structured questionnaires were applied to obtain ethnobotanical information of herbal tea, in which 463 informants had participated. Relative frequency of citation (RFC) and cultural food significance index (CFSI) were used to evaluate the most culturally significant herbal tea plants, and informant consensus factor (ICF) was applied to assess the agreement among informants. RESULTS: This study recorded 155 herbal tea species belonging to 49 families. The most commonly used parts included leaf (27.61%), whole plant (22.09%), branch and leaf (19.02%), and flower (13.50%). The most frequent preparation method of herbal tea was decoction. Herbal tea was very popular in Guangxi, attributing to its therapeutic value, special odor, and good taste. There are 41 health benefits classified into eight categories. Among them, clearing heat was the most medicinal effects. Local people had high consistency in tonic, removing cold and cough, improving blood circulation, and clearing heat away. Based on CFSI values of each species, the most culturally significant herbal tea species were Siraitia grosvenorii (Swingle) C. Jeffrey ex A. M. Lu & Zhi Y. Zhang, Plantago asiatica L., Gynostemma pentaphyllum (Thunb.) Makino, Zingiber officinale Roscoe, Pholidota chinensis Lindl., and Morus alba L. CONCLUSION: Herbal tea is a valuable heritage that carries the local people's traditional knowledge, like health care and religious belief. The recorded herbal tea species in this study possess tremendous potential for local economic development in the future. Further research on efficacy evaluation and product development of herbal tea species is necessary.

Impact of the COVID-19 pandemic on acute stroke care: An analysis of the 24-month data from a comprehensive stroke center in Shanghai, China.

INTRODUCTION: Whether the coronavirus disease-2019 (COVID-19) pandemic is associated with a long-term negative impact on acute stroke care remains uncertain. This study aims to compare the timing of key aspects of stroke codes between patients before and after the COVID-19 pandemic. METHODS: This retrospective cohort study was conducted at an academic hospital in Shanghai, China and included all adult patients with acute ischemic stroke hospitalized via the emergency department (ED) stroke pathway during the 24 months since the COVID-19 outbreak (COVID-19: January 1, 2020-December 31, 2021). The comparison cohort included patients with ED stroke pathway visits and hospitalizations during the same period (pre-COVID-19: January 1, 2018-December 31, 2019). We compared critical time points of prehospital and intrahospital acute stroke care between patients during the COVID-19 era and patients during the pre-COVID-19 era using t test, χ2 , and Mann-Whitney U test where appropriate. RESULTS: A total of 1194 acute ischemic stroke cases were enrolled, including 606 patients in COVID-19 and 588 patients in pre-COVID-19. During the COVID-19 pandemic, the median onset-to-hospital time was about 108 min longer compared with the same period of pre-COVID-19 (300 vs 192 min, p = 0.01). Accordingly, the median onset-to-needle time was 169 min in COVID-19 and 113 min in pre-COVID-19 (p = 0.0001), and the proportion of patients with onset-to-hospital time within 4.5 h was lower (292/606 [48.2%] vs 328/558 [58.8%], p = 0.0003) during the pandemic period. Furthermore, the median door-to-inpatient admission and door-to-inpatient rehabilitation times increased from 28 to 37 h and from 3 to 4 days (p = 0.014 and 0.0001). CONCLUSIONS: During the 24 months of COVID-19, a prolongation of stroke onset to hospital arrival and to intravenous rt-PA administration times were noted. Meanwhile, acute stroke patients needed to stay in the ED for a longer time before hospitalization. Educational system support and process optimization should be pursued in order to acquire timely delivery of stroke care during the pandemic.

Association of Plaque Morphology With Stroke Mechanism in Patients With Symptomatic Posterior Circulation ICAD.

OBJECTIVE: Although the main mechanisms of stroke in patients with intracranial atherosclerotic disease (ICAD) - perforating artery occlusion (PAO) and artery-to-artery embolism (AAE) - have been identified and described, relatively little is known about the morphology of the symptomatic plaques and how they differ between these two mechanisms. METHODS: We prospectively recruited patients with acute ischemic stroke in the posterior circulation that was attributable to ICAD. 51 eligible patients were enrolled and underwent magnetic resonance imaging before being assigned to the PAO or AAE group according to probable stroke mechanism. Plaque morphological properties including plaque length, lumen area, outer wall area, plaque burden, plaque surface irregularity, vessel wall remodeling, and plaque enhancement, were assessed using high-resolution magnetic resonance imaging (HRMRI). Plaque morphological parameters of both PAO and AAE groups were compared using non-parametric tests. A binary logistic regression model was used to identify independent predictors while a receiver operating characteristic curve tested the sensitivity and specificity of the model. RESULTS: Among patients who met the imaging eligibility criteria, 38 (74.5%) had PAO and 13 (25.5%) had AAE. Plaque length was shorter (6.39 [interquartile range (IQR), 5.18-7.71] mm vs 10.90 [IQR, 8.18-11.85] mm, p<0.01) in PAO patients. Plaque burden was lower in PAO group (78.00 [IQR, 71.94-86.35] % vs 86.37 [IQR, 82.24-93.04] %, p=0.04). The proportion of patients with plaque surface irregularity was higher in AAE patients than in PAO patients (19/38, 50.00% vs 12/13, 92.30%, p=0.008). Plaque length was significantly associated with the PAO mechanism (adjusted OR 0.57, 95% CI, 0.41-0.79). CONCLUSION: Intracranial atherosclerotic plaque morphology differs between patients with PAO and those with AAE. Plaque with shorter length, lower plaque burden and regular surface is more likely to cause perforating artery occlusion.

Ethnoveterinary Survey Conducted in Baiku Yao Communities in Southwest China.

Baiku Yao is a branch of the Yao ethnic group mainly living in Guangxi and Guizhou provinces of China. They are recognized by UNESCO as an ethnic group with an intact ethnic culture. The Baiku Yao people have extensive ethnoveterinary knowledge, which they used to prevent and control various animal diseases. During the African swine fever outbreak, the livestock of the Baiku Yao community remained unaffected. We investigated ethnoveterinary knowledge among local Baiku Yao villagers. A total of 39 ethnoveterinary plant species are utilized for the treatment of various diseases. Five species, namely, Stephania kwangsiensis, Aristolochia kwangsiensis, Clerodendrum bungei, Paederia foetida, and Tetradium ruticarpum, had the highest relative frequency values. Strobilanthes cusia, Tetradium ruticarpum, and Stephania kwangsiensis are highly valued locally for treating animal plagues. The existing traditional ethnoveterinary knowledge needs to be conserved and validated scientifically.

Effect of fluoxetine on HIF-1α- Netrin/VEGF cascade, angiogenesis and neuroprotection in a rat model of transient middle cerebral artery occlusion.

Fluoxetine is one of the most promising drugs for improving clinical outcome in patients with ischemic stroke. This in vivo study investigated the hypothesis that fluoxetine may affect HIF-1α-Netrin/VEGF cascade, angiogenesis and neuroprotection using a rat model of transient middle cerebral artery occlusion (tMCAO). The rats were given fluoxetine or saline after tMCAO for 4 weeks. Then, protein expression of HIF-1α-Netrin/VEGF cascade was examined at 1, 2, 4 weeks after tMCAO. In vivo synchrotron radiation were performed to observe microangiography of ischemic brain after 4 weeks of tMCAO. The infarct size and neurobehavioral test were carried out 1 to 4 weeks after tMCAO. Results revealed that HIF-1α expression was upregulated in fluoxetine-treated group. Similarly, fluoxetine increased protein expression of Netrin and its receptor DCC, VEGF and its receptor VEGFR. Synchrotron radiation angiography revealed more branches in fluoxetine-treated rats. We found no difference of infarct volume between fluoxetine and saline treated rats after 1 week of tMCAO, and ischemia-induced brain atrophy volume in fluoxetine-treated group was attenuated after 4 weeks of tMCAO. Neurological deficits were improved in fluoxetine-treated rats at 3 and 4 weeks after tMCAO. Our results indicated that fluoxetine could upregulate protein expression of HIF-1α-Netrin/VEGF cascade, promote angiogenesis, and improve long-term functional recovery after ischemic stroke.

Intracranial Posterior Circulation Large Artery Thrombi Visualized Using Susceptibility-Weighted MRI.

PURPOSE: To identify thrombi in patients with posterior circulation large artery occlusion using susceptibility-weighted magnetic resonance imaging (MRI). METHODS: All patients hospitalized with intracranial posterior circulation occlusion from January 2003 to September 2013 were included. MRI and computed tomography angiography were reviewed to determine the presence of arterial occlusion and identify thrombi. Eighty-one patients were analyzed to investigate susceptibility vessel sign (SVS) that was identified as blooming artifact (BA) on T2*-weighted gradient echo imaging. RESULTS: We identified 21 of 63 (33.3%) patients with BA in symptomatic patients, and 1 of 18 (5.6%) in the asymptomatic group with significant difference (P = .019). BAs were found in 6 of 10 (60.0%) patients with cardioembolism, 5 of 13 (38.5%) with dissection, 9 of 34 (26.5%) with large artery atherosclerotic disease, and 1 of 6 (16.7%) with undetermined cause. CONCLUSION: Identifying SVS may be useful in exploring the fresh thrombi and the mechanism of posterior circulation stroke.