Seasonal Variation in Ischemic Stroke Incidence and Association with Climate: A Six‐Year Population‐Based Study

Questions about the seasonality of stroke remain controversial. Using a nationwide population‐based dataset, this study presents a time series analysis of seasonal patterns in ischemic stroke occurrence, along with their association with climate in Taiwan. Using data from the Taiwan National Health Insurance Research Database, a total of 168,977 visits to emergency departments between 1998 and 2003 for ischemic stroke were identified for patients ranging between 20 and 84 yrs of age. Monthly stroke incidences were calculated for 72 months, by sex and stroke subtype, and for the age groups 20–54, 55–64, 65–74, and ≥75 yrs per 100,000 of the population. We performed auto‐regressive integrated moving average (ARIMA) analysis to investigate the presence of seasonality and any association with climate for acute ischemic stroke events. We found no significant seasonal variation in the incidence of ischemic stroke for any age or sex groups. Furthermore, after adjusting for seasonality, month, and trend, the ARIMA regression model revealed only associations between ischemic stroke incidence and atmospheric pressure. We conclude that seasonality of ischemic stroke does not exist in Taiwan. Ischemic stroke incidence is, however, significantly related to atmospheric pressure.     

乌司他丁对卒中相关性肺炎的疗效及血清炎症因子的影响

目的:研究乌司他丁治疗重症卒中相关性肺炎的疗效及其对患者血清炎症因子的影响。方法:选择2015年1月～2017年6月我院神经内科收治的重症卒中相关性肺炎患者96例,将其随机分为三组。对照组采用机械通气、抗感染、化痰、营养支持和补液等常规治疗,观察组A(低剂量组)在常规治疗基础上给予0.3万U/Kg体重静脉注射Q8h,观察组B(高剂量组)在常规治疗基础上给予给予1.2万U/kg体重静脉注射Q8h,两组均从入院时开始,连续注射7天。分别比较各组的住院时间、咳嗽减轻时间、体温复常时间、啰音消失时间,治疗前后血清白介素-6、肿瘤坏死因子-α以及高迁移率族蛋白-B1(HMGB1)水平的变化。结果:观察组A和B的有效率分别为91.67%和95.84%,均明显高于对照组的70.83%(P0.05);观察组A和B的住院时间、咳嗽减轻时间、体温复常时间、啰音消失时间均明显短于对照组(P0.05),且观察组B以上指标均明显短于观察组A(P0.05)。治疗后,所有患者的血清白介素-6、肿瘤坏死因子-α以及HMGB1水平均较治疗前明显降低(P0.05),且观察组以上指标明显低于对照组(P0.05),且观察组B以上指标均明显低于观察组A(P0.05)。结论:乌司他丁可加快改善卒中相关性肺炎患者的临床症状,可能与降低患者血清炎症因子IL-6、TNF-a和HMGB-1水平有关。     

G5G2.5 core‐shell tecto‐dendrimer specifically targets reactive glia in brain ischemia

Secondary neuronal death is a serious stroke complication. This process is facilitated by the conversion of glial cells to the reactive pro‐inflammatory phenotype that induces neurodegeneration. Therefore, regulation of glial activation is a compelling strategy to reduce brain damage after stroke. However, drugs have difficulties to access the CNS , and to specifically target glial cells. In the present work, we explored the use core‐shell polyamidoamine tecto‐dendrimer (G5G2.5 PAMAM ) and studied its ability to target distinct populations of stroke‐activated glial cells. We found that G5G2.5 tecto‐dendrimer is actively engulfed by primary glial cells in a time‐ and dose‐dependent manner showing high cellular selectivity and lysosomal localization. In addition, oxygen‐glucose deprivation or lipopolysaccharides exposure in vitro and brain ischemia in vivo increase glial G5G2.5 uptake; not being incorporated by neurons or other cell types. We conclude that G5G2.5 tecto‐dendrimer is a highly suitable carrier for targeted drug delivery to reactive glial cells in vitro and in vivo after brain ischemia.

     

Long non-coding RNA RMST silencing protects against middle cerebral artery occlusion (MCAO)-induced ischemic stroke

Long non-coding RNAs (lncRNAs) have emerged as major regulators in neurological diseases, and clarifying their roles in cerebral ischemic injury may provide novel targets for treating ischemic stroke. In this study, we mainly studied the role of lncRNA-RMST in middle cerebral artery occlusion (MCAO)-induced mouse brain injury. We showed that RMST expression level was significantly up-regulated in oxygen-glucose deprivation (OGD)-treated primary hippocampal neuron, MCAO-induced injured brain, and the plasma of patients with ischemic stroke. RMST silencing protected against MCAO-induced ischemic brain injury in vivo and OGD-induced primary hippocampal neuron injury in vitro. Intracerebroventricular injection of RMST shRNA significantly decreased brain RMST expression, reduced brain infarct size, and improved neurological function. Collectively, this study provides evidence that lncRNA is involved in the pathogenesis of ischemic brain injury, and suggests a promising approach of RMST inhibition in treating ischemic stroke.     

Dynamic Remodeling of Pericytes In Vivo Maintains Capillary Coverage in the Adult Mouse Brain

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降低胸膜腔内压促进冠脉血流的研究

临床上用调控呼吸的训练方法可使冠心病患者的症状明显减轻,心功能增强,这可能是主要通过过低胸膜腔内压,促进了冠脉血流,改善了心肌缺血来实现的,本实验为验证此设想的真实性,对８只狗从胸膜腔反复抽气推气,造成胸内压的较大变化,以模拟深吸气动作所致的胸内压变化。     

Circadian variation in clinical features and outcome of intracerebral hemorrhage: The INTERACT studies

Previous studies consistently reported a diurnal variation in the occurrence of intracerebral hemorrhage (ICH), with a morning peak. However, limited knowledge exists on the circadian pattern of ICH severity and outcome. This study aimed to determine possible associations between ICH onset time and admission severity and 90-day outcomes using the combined data set of the pilot and main-phase Intensive blood pressure (BP) reduction in an acute cerebral hemorrhage trial (INTERACT). The ICH onset time was categorized into three groups (1: 00:00–07:59; 2: 08:00–15:59; and 3: 16:00–23:59). We found an association between onset time and low Glasgow Coma Scale score: aOR (time 1: 1.72, 95% CI 1.12–2.66; time 3: 1.95, 95% CI 1.31–2.89, p = 0.003; in comparison to time 2). There was no association between onset time and volume of ICH (adjusted p = 0.354) or 90-day outcomes of death or major disability, and death and major disability separately (all adjusted p > 0.4). The results showed that more severe cases of ICH patients, defined by a reduced level of consciousness, had late afternoon to early morning stroke onset, but this was unrelated to baseline hematoma volume or location. There was no circadian influence on ICH clinical outcome.