[Application of vestibular function examination in the analysis of damaged site in patients with acute vestibular neuritis].

Objective:To analyze the site of vestibular nerve damaged in patients with acute vestibular neuritis. Methods:Fifty-seven patients with acute vestibular neuritis were recruited, and each patient underwent caloric irrigation test, video head impulse test（vHIT） and vestibular evoked myogenic potentials（VEMPs）. The results were further analyzed. Results:Analysis of abnormal rates of different vestibular function tests: the abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and posterior semicircular canal vHIT were 92.98%, 92.98%, 92.98%, and 52.63%, respectively. The abnormal rate of cervical vestibular evoked myogenic potentials（cVEMP） and ocular vestibular evoked myogenic potentials（oVEMP） were 52.63% and 89.47%. The abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP were significantly higher than posterior semicircular canal vHIT and cVEMP（P<0.01）. Combination analysis of different vestibular function tests: there are twenty-six patients（45.61%, superior and inferior vestibular nerve） with abnormal caloric irrigation test, video head impulse test, and VEMPs. There are twenty-five patients（43.86%, superior vestibular nerve） with abnormal caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP. There are 4 patients（7.02%, inferior vestibular nerve） with abnormal posterior semicircular canal vHIT and cVEMP. There are two patients（3.51%, ampullary vestibular nerve） with abnormal caloric irrigation test, horizontal semicircular canal vHIT, and anterior semicircular canal vHIT. The rate of superior and inferior vestibular neuritis and superior vestibular neuritis were significantly higher than inferior vestibular neuritis and ampullary vestibular neuritis（P<0.01）. Conclusion:Acute vestibular neuritis subtypes can be divided into four categories: superior and inferior vestibular neuritis, superior vestibular neuritis, inferior vestibular neuritis, and ampullary vestibular neuritis. Video head impulse test can accurately assess the site of vestibular nerve damage in patients with acute vestibular neuritis. In addition, vHIT combined with VEMPs can provide objective evidence for the diagnosis of ampullary vestibular neuritis.

Assessment of residual dizziness after successful canalith repositioning maneuvre in benign paroxysmal positional vertigo patients: a questionnaire-based study.

OBJECTIVE: The purpose of this study was to assess residual dizziness (RD) after successful canalith repositioning maneuvre (CRM) treatment in patients with benign paroxysmal positional vertigo (BPPV) using Dizziness Handicap Inventory (DHI) questionnaire and Visual Analog Scale (VAS). METHODS: One hundred sixty BPPV patients after successful CRM treatment were recruited. All patients were divided into the residual dizziness (RD) group and without RD group. The DHI questionnaire and VAS before CRM and follow-up were asked to complete. For analysis of the improvement in symptom, we defined ∆DHI and ∆VAS as the difference between the baseline score and the follow-up score. RESULTS: High incidence of RD was observed in the older patients (p < 0.001). The incidence of hypertension in the RD group was also significantly higher than that of the without RD group (p = 0.022). The ∆DHI-P, ∆DHI-E, ∆DHI-F, ∆DHI-T, and ∆VAS scores in the without RD group were significantly higher than that of the RD group (p < 0.001). When the cutoff point of the ∆DHI total scores was 17, the sensitivity was 64.86% and the specificity was 73.26% for diagnosing RD. When the cutoff point of the ∆VAS scores was 2.5, the sensitivity was 77.03% and the specificity was 81.40% for diagnosing RD. CONCLUSIONS: RD is prone to occur in the older patients and ∆VAS exhibits higher sensitivity and specificity in assessing RD.

Risk Factors of Residual Dizziness After Successful Treatment for Benign Paroxysmal Positional Vertigo in Middle-Aged and Older Adults.

Objective: The purpose of this study was to analyze risk factors of residual dizziness (RD) after successful treatment for benign paroxysmal positional vertigo (BPPV) in middle-aged and older adults. Methods: 181 patients with BPPV, after successful canalith repositioning maneuver (CRM) treatment, were recruited. All patients were divided into the middle-aged group (aged 45-59 years, n = 101) and the older group (over 60 years, n = 80). The clinical characteristics were recorded, including age, gender, numbers of maneuvers, involved canal, affected side, RD, comorbidities, dizziness handicap inventory score, and generalized anxiety disorder's 7-item scale score. Results: The incidence of RD in the older group was significantly higher than that of the middle-aged group (p = 0.033). Multivariate logistic regression analysis shows that age (odds ratio = 1.042, p = 0.006), moderate to severe dizziness (odds ratio = 2.017, p = 0.034), and moderate to severe anxiety (odds ratio = 2.228, p = 0.017) were independently associated with RD in middle-aged and older adults. Conclusion: Older adults exhibited higher incidence of RD after successful treatment for BPPV. Age, moderate to severe dizziness, and moderate to severe anxiety were independent risk factors of RD in middle-aged and older adults.

The Association Between Precuneus Function and Residual Dizziness in Patients With Benign Paroxysmal Positional Vertigo.

Objectives: The purpose of this study was to apply the amplitude of the low-frequency fluctuation (ALFF) method to investigate the spontaneous brain activity alterations in patients with residual dizziness (RD) after successful canalith repositioning manoeuvre for benign paroxysmal positional vertigo (BPPV). Methods: All BPPV patients underwent visual vertigo analog scale (VVAS) evaluations and functional magnetic resonance imaging (fMRI). The ALFF method was used to assess the spontaneous brain activity. Screening of brain regions with significant changes in ALFF values was based on analysis of the whole brain. We further analyze the relationship between ALFF values of the altered regions and VVAS scores in BPPV patients with RD. Results: Fifteen BPPV patients with RD and fifteen without RD were recruited in this study. In contrast to without RD, RD patients exhibited increased scores in VVAS tests (p < 0.001) and RD patients also showed significant ALFF decrease in the bilateral precuneus (left: 251 voxels; x = -10, y = -69, z = 51; peak t-value = -3.25; right: 170 voxels; x = 4, y = -59, z = 42; peak t-value = -3.43). Correlation analysis revealed that the mean ALFF z-values in the left precuneus displayed significant negative correlations with the VVAS scores(r = -0.44, p = 0.01). Conclusions: This study shows that RD is associated with left precuneus function as revealed by fMRI. It might provide useful information for explaining neural mechanisms in BPPV patients with RD.

[Review of persistent postural-perceptual dizziness and experience of diagnosis and treatment].

The concept and diagnostic standard of persistent postural-perceptual dizziness（PPPD） improve the ability of clinical workers to recognize these diseases to some extent. However, the diagnosis of PPPD mainly depends on the identification of postural symptoms and the elimination of structural vestibular diseases, so the subjectivity is relatively strong. Moreover, the lack of objective criteria and a slight carelessness will lead to generalized diagnosis or omission diagnosis and misdiagnosis. At present, there is a lack of domestic large sample epidemiological investigation and other related studies, therefore it is a problem for diagnosing generalization of persistent posture perception dizziness and needed to be alert and corrected. Only those items meeting the criteria of the diagnostic standards can be carried out for diagnosis. The treatment needs to ensure sufficient dose and full therapy course. Generally, the medication should not be less than half a year.

Effect of Stimulus Frequency on Air-Conducted Vestibular Evoked Myogenic Potentials.

OBJECTIVE: The aim of this study is to explore the effect of stimulus frequency on air-conducted cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP) in healthy subjects. METHODS: The study included 45 healthy subjects who underwent the VEMP tests. Different stimulus frequencies (250-1500 Hz) were used for air-conducted cVEMP and oVEMP. RESULTS: In cVEMP, P1 and N1 latencies were significantly affected by different frequencies (P < .01). The amplitude at 500 Hz was significantly larger than those at other frequencies (P < .01).There was no significant main effect of frequency on asymmetry ratio (AR) (P > .05). In oVEMP, there was a tendency for the N1 and P1 latencies to decrease from 250 Hz to 1500 Hz (P < .01). The amplitudes at 500 Hz and 1000 Hz were significantly larger than the amplitudes at 250 Hz and 1500 Hz (P < .01).There was no significant main effect of frequency on AR (P > .05). CONCLUSION: The optimal stimulus frequency of the cVEMP is 500 Hz and for the oVEMP is 500Hz or 1000Hz. Due to the absence of impact of stimulus frequency, AR is the best parameter of VEMP for clinical use.

Vestibular and oculomotor function in patients with vestibular migraine.

AIM: The purpose of this study was to assess the vestibular and oculomotor function in patients with vestibular migraine (VM). And we also investigate the relationship between testing results and effectiveness of preventive medications in VM. MATERIAL AND METHOD: 41 patients with VM were recruited in this study and examined with cervical and ocular vestibular evoked myogenic potential(cVEMP, oVEMP), video head impulse test(vHIT), caloric test and videonystagmography. All patients were treated with preventive medications. We calculated symptomatic improvement and record episodes frequency in patients with VM. Six months later, the effectiveness of preventive medications were evaluated and the relationship between vestibular testing and effectiveness of preventive medications were analyzed further. RESULTS: In vestibular function testing, 73% of patients with VM showed abnormal results. Abnormal cVEMP, oVEMP, vHIT, and caloric test were found in 20%, 44%, 32% and 56% respectively. The abnormal rate of oVEMP was significantly higher than that of cVEMP(p < 0.05). And the proportion of abnormal caloric test was obviously higher than that of vHIT (p < 0.05). In oculomotor function testing, 42% of the patients with VM showed pathological results which was significantly lower than that of vestibular function testing(p < 0.05). After 6 months follow-up, the proportion of prophylactic medication effectiveness was significantly higher in normal vestibular function testing group compared with the abnormal group (p < 0.05). CONCLUSION: Abnormal vestibular and oculomotor functions are commonly observed in patients with VM. And these patients with abnormal vestibular function possess a weak effectiveness of preventive medications.

Self-Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo: A Preliminary Study.

Objectives: The purpose of this study is to investigate a modified Epley maneuver for self-treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV). Methods: The study recruited 155 patients with PC-BPPV. All patients were randomized into the Epley maneuver group (n = 77) and modified Epley maneuver group (n = 78). We analyzed the resolution rate (1 day and 1 week), residual symptoms after the maneuver, and adverse effects. Results: It was found that the modified Epley maneuver group had a higher resolution rate than that of the Epley maneuver group in the treatment of PC-BPPV after 1 day of the initial maneuver (p < 0.05). However, there was no difference in resolution rate between the Epley maneuver group and the modified Epley maneuver group in resolution rate after 1 week of the initial maneuver (p > 0.05). The modified Epley maneuver group had fewer residual symptoms than that of the Epley maneuver group 1 week after treatment of PC-BPPV (p < 0.05). Significant improvements were also observed in average DHI scores in patients who underwent the modified Epley maneuver compared to the Epley maneuver (p < 0.05). There was no significant difference in adverse effects between the two groups (p > 0.05). Conclusions: The modified Epley maneuver has a satisfactory therapeutic efficacy with less residual symptoms and could be recommended as a self-treatment for patients with PC-BPPV.

Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis.

OBJECTIVE: This meta-analysis aims to systematically measure the immediate efficacy of the Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: A extensive search electronic databases, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials studying with treatment of HC-BPPV employ by the Gufoni maneuver. RESULTS: Five randomized clinical trials were included in the current meta-analysis with a total of 714 HC-BPPV patients. The meta-analysis revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (risk ratio = 2.68, 95% CI, 1.54-4.65, p < 0.01). No difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (risk ratio = 1.18, 95% CI, 0.99-1.41, p = 0.06). And Gufoni maneuver had a similar otolith switch rate with other maneuvers (risk ratio = 2.13, 95% CI, 0.56-8.07, p = 0.27). CONCLUSION: Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate.

Recovery Pattern of High-Frequency Acceleration Vestibulo-Ocular Reflex in Unilateral Vestibular Neuritis: A Preliminary Study.

Objective: To explore the recovery pattern of the high-frequency acceleration vestibulo-ocular reflex (VOR) function in unilateral vestibular neuritis (UVN). Methods: Forty-seven consecutive patients with UVN were recruited within 10 days of symptom onset for this study. The high-frequency acceleration horizontal VOR function was assessed using the video head impulse test (vHIT). Patients returned for follow-up evaluation at ~6 months after the onset of symptoms. According to the dizziness handicap inventory questionnaire (DHI), the patients were classified into the normal to mild dizziness group (DHI score ≤30) and moderate to severe dizziness group (DHI score >30) at the follow-up. All the obtained horizontal vHIT gains and corrective saccades parameters were analyzed. Results: vHIT results showed a significantly horizontal VOR gain recovery in UVN patients at the follow-up on the lesion side (p < 0.01). A significantly reduction in the occurrence of corrective saccades (overt and covert) and velocity of corrective saccades (overt and covert) were observed at the follow-up (p < 0.05). At the follow-up, the normal to mild dizziness group (DHI score ≤30) had a significantly higher normal rate of VOR gain, the mean vHIT gains and occurrence of isolated covert saccades (P < 0.05). Furthermore, the occurrence of mixed saccades and the mean velocity of covert saccades were significantly lower in normal to mild dizziness group (P < 0.05). Conclusion: Apart from the recovery of the VOR gain, recovery pattern of corrective saccades can play a key role in vestibular compensate.

Effects of Hand Positions During Video Head-Impulse Test (vHIT) in Patients With Unilateral Vestibular Neuritis.

Background: The aim of this study is to identify the effects of hand positions (head and jaw) on the video head-impulse test (vHIT). Methods: Eighty-six healthy volunteers and sixty-seven patients with unilateral vestibular neuritis (UVN) were recruited for this study. Different hand positions (head and jaw) were used in the vHIT of horizontal semicircular canals in healthy volunteers and UVN patients. All the obtained horizontal vHIT gains were analyzed. Results: It was observed that when horizontal vHIT was performed with the head hand position, the number of head impulses that produced overhigh vestibulo-ocular reflex (VOR) gains was more than that with the jaw hand position (p < 0.01), irrespective of whether the test was performed in healthy volunteers or UVN patients. The gains obtained were lower when the jaw hand position was used than that obtained when the head hand position was used (p < 0.05). However, no significant difference existed in the mean head velocity between the two hand positions (p > 0.05). Using the head hand position has greater a chance to elicit in UVN patients normal horizontal vHIT gains with refixation saccades than using the jaw hand position (p = 0.04). Conclusion: The jaw hand position can increase the accuracy of vHIT in determining the lesion side.

Study of inflammatory factors' effect on the endothelial barrier using piezoelectric biosensor.

This paper used piezoelectric sensor to study the dysfunction of endothelial cell monolayer barrier caused by inflammatory factors. The biocompatible conductive polymer membrane of pPy[pGlu]-pLys was prepared on the surface of the ITO work electrode to improve the interface between the endothelial cell and the electrode. Both the impedance analysis data and the stable plateau stage of sensor's frequency shift indicated that endothelial cells formed a good monolayer barrier on this polymer surface. The response frequency shifts of lipopolysaccharide (LPS)- and histamine-induced endothelial barrier dysfunction were different, which distinguished their different stimulation mechanism. It provided a valuable analysis method for detecting the endothelial barrier function affected by inflammatory factor, and could further promote the application of piezoelectric sensor in cell biology and toxicology research.

On-Line Monitoring the Growth of E. coli or HeLa Cells Using an Annular Microelectrode Piezoelectric Biosensor.

Biological information is obtained from the interaction between the series detection electrode and the organism or the physical field of biological cultures in the non-mass responsive piezoelectric biosensor. Therefore, electric parameter of the electrode will affect the biosensor signal. The electric field distribution of the microelectrode used in this study was simulated using the COMSOL Multiphysics analytical tool. This process showed that the electric field spatial distribution is affected by the width of the electrode finger or the space between the electrodes. In addition, the characteristic response of the piezoelectric sensor constructed serially with an annular microelectrode was tested and applied for the continuous detection of Escherichia coli culture or HeLa cell culture. Results indicated that the piezoelectric biosensor with an annular microelectrode meets the requirements for the real-time detection of E. coli or HeLa cells in culture. Moreover, this kind of piezoelectric biosensor is more sensitive than the sensor with an interdigital microelectrode. Thus, the piezoelectric biosensor acts as an effective analysis tool for acquiring online cell or microbial culture information.

Pulse shaping techniques for a high-g shock tester based on collision principle.

Pulse shaping techniques are discussed in this paper for the practicability of a developed high-g shock tester. The tester is based on collision principle where there is a one-level velocity amplifier. A theoretical and experimental study of pulse shaping techniques is presented. A model was built and theoretical formulae were deduced for the shock peak acceleration and its duration. Then theoretical analysis and some experiments were conducted. The test results verify the validity of theoretical model and show that the shock tester can generate the expected high-g shock pulses by integrated usage of different impact velocities and pulse shapers made from different materials. This is important in practical applications where the items under test can be shown to excite specific resonances at predetermined acceleration levels using the shock tester.

Treatment of Rivaroxaban versus Aspirin for Non-disabling Cerebrovascular Events (TRACE): study protocol for a randomized controlled trial.

BACKGROUND: Transient ischemic attack (TIA) or minor ischemic stroke represents the largest group of cerebrovascular disease, and those patients have a high risk of early recurrent stroke. Over decades, anticoagulation therapy has been used prudently in them for likely increasing the risk of intra-/extra-cranial hemorrhagic complications. However, recently rivaroxaban, a new oral anticoagulant, is proved to be as effective as traditional anticoagulants, while carrying significantly less risk of intracranial hemorrhage. Therefore, we assumed that patients may benefit from rivaroxaban if treated soon after TIA or minor stroke, and designed this adequately powered randomized study, TRACE. METHODS AND DESIGN: The Treatment of Rivaroxaban versus Aspirin in Non-disabling Cerebrovascular Events (TRACE) study is a randomized, double-blind clinical trial with a target enrollment of 4400 patients. A 14-days regimen of rivaroxaban 10 mg daily or a 14-days regimen of aspirin 100 mg daily will be administrated to randomized participants with acute TIA or minor stroke, defined as National Institute of Health Stroke Scale scores ≤ 3. The primary efficacy end point is percentage of patients with any stroke (ischemic or hemorrhage) at 14 days. Study visits will be performed at the day of randomization, day 14 and day 90. DISCUSSION: Even though the new oral anticoagulants seem to be both safe and effective, few clinical trials have been carried out to test their effect on non-disabling cerebrovascular events. Treatment with rivaroxaban may prevent more cerebrovascular events with an acceptable risk profile after TIA or minor stroke, compared with aspirin, thus helping to improve the outcome of the disease. TRIAL REGISTRATION: No. NCT01923818.

[Research on pericellular matrix properties for chondrcytes].

Pericellular matrix (PCM) is a narrow tissue region surrounding chondrocytes, which "chondron" with its enclosed cells. A number of studies suggested that PCM is rich in proteoglycans, collagen and fibronectin, and plays an important role in regulating microenvironment of chondrocytes. Direct measures of PCM properties through micropipette aspiration technique showed that PCM was different from mechanical property of chondrocytes and nature extracellular matrix. However, the function of PCM is not clear, and need further study.

The China Stroke Secondary Prevention Trial (CSSPT) protocol: a double-blinded, randomized, controlled trial of combined folic acid and B vitamins for secondary prevention of stroke.

RATIONALE: Epidemiological studies suggest that elevated homocysteine is linked to stroke and heart disease. However, the results of lowering homocysteine levels in reducing the risk of stroke recurrence are controversial. AIMS: The study aims to evaluate whether homocysteine-lowering therapy with folic acid and vitamins B6 and B12 reduces recurrent stroke events and other combined incidence of recurrent vascular events and vascular death in ischemic stroke patients of low folate regions. DESIGN: This is a multicenter, randomized, double-blinded, placebo-controlled trial. Patients (n = 8000, α = 0.05, ß = 0.10) within one-month of ischemic stroke (large-artery atherosclerosis or small-vessel occlusion) or hypertensive intracerebral haemorrhage with plasma homocysteine level ≥ 15 µmol/l will be enrolled. Eligible patients will be randomized by a web-based, random allocation system to receive multivitamins (folic acid 0.8 mg, vitamin B6 10 mg, and vitamin B12 500 µg) or matching placebo daily with a median follow-up of three-years. STUDY OUTCOMES: Patients will be evaluated at six monthly intervals. The primary outcome event is the composite event 'stroke, myocardial infarction, or death from any vascular cause', whichever occurs first. Secondary outcome measures include nonvascular death, transient ischemic attack, depression, dementia, unstable angina, revascularization procedures of the coronary, and cerebral and peripheral circulations. DISCUSSION: This is the first multicenter randomized trial of secondary prevention for ischemic stroke in a Chinese population with a higher homocysteine level but without folate food fortification.

Initial 3-weeks' Apixaban Versus Dual-antiplatelet Therapy (Clopidogrel and Aspirin) followed by Clopidogrel alone in high-risk patients with Acute Non-Disabling Cerebrovascular Events (ADANCE): study protocol for a randomized controlled trial.

BACKGROUND: Nondisabling cerebrovascular events represent the largest group of cerebrovascular disease with a high risk of recurrent stroke. A recent trial demonstrated that dual-antiplatelet therapy (clopidogrel and aspirin), compared with aspirin monotherapy, reduced the risk of recurrent stroke and was not associated with increased risk of hemorrhagic events. Apixaban, a new oral anticoagulant, has been proven to be as safe and effective as traditional anticoagulants while carrying significantly less risk of intracranial hemorrhage. Patients with transient ischemic attack (TIA)/minor stroke might benefit from apixaban treatment; therefore, an adequately powered randomized study is needed. METHODS AND RESULTS: The ADANCE [Apixaban Versus Dual-antiplatelet Therapy (Clopidogrel and Aspirin) in Acute Non-disabling Cerebrovascular Events] study is a randomized, double-blind clinical trial with a target enrollment of 5,500 patients. A 21-day regimen of apixaban or of clopidogrel with aspirin followed by clopidogrel on days 22 through 90 will be administered to randomized participants with acute TIA or minor ischemic stroke. The primary efficacy endpoint is the percentage of patients with any new stroke (ischemic or hemorrhage), including fatal stroke, at day 21. Study visits will be performed on the day of randomization, and at days 7, 22, and 90. DISCUSSION: The novel oral anticoagulant apixaban has been widely used with fewer adverse effects than traditional anticoagulants. We designed the ADANCE trial to observe the effects of apixaban on recurrent stroke after TIA or minor stroke. The results should better guide the selection of anticoagulant or dual-antiplatelet therapy for patients with acute TIA or minor ischemic stroke.

Ginsenoside Rd attenuates tau protein phosphorylation via the PI3K/AKT/GSK-3ß pathway after transient forebrain ischemia.

Phosphorylated tau was found to be regulated after cerebral ischemia and linked to high risk for the development of post-stroke dementia. Our previous study showed that ginsenoside Rd (Rd), one of the main active ingredients in Panax ginseng, decreased tau phosphorylation in Alzheimer model. As an extending study, here we investigated whether Rd could reduce tau phosphorylation and sequential cognition impairment after ischemic stroke. Sprague-Dawley rats were subjected to focal cerebral ischemia. The tau phosphorylation of rat brains were analyzed following ischemia by Western blot and animal cognitive functions were examined by Morris water maze and Novel object recognition task. Ischemic insults increased the levels of phosphorylated tau protein at Ser199/202 and PHF-1 sites and caused animal memory deficits. Rd treatment attenuated ischemia-induced enhancement of tau phosphorylation and ameliorated behavior impairment. Furthermore, we revealed that Rd inhibited the activity of Glycogen synthase kinase-3ß (GSK-3ß), the most important kinase involving tau phosphorylation, but enhanced the activity of protein kinase B (PKB/AKT), a key kinase suppressing GSK-3ß activity. Moreover, we found that LY294002, an antagonist for phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway, abolished the inhibitory effect of Rd on GSK-3ß activity and tau phosphorylation. Taken together, our findings provide the first evidence that Rd may reduce cerebral ischemia-induced tau phosphorylation via the PI3K/AKT/GSK-3ß pathway.