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By age 40 years, over 90% of adults with Down syndrome have Alzheimer's disease pathology and most progress to dementia. Despite having few systemic vascular risk factors, individuals with Down syndrome have elevated cerebrovascular disease markers that track with the clinical progression of Alzheimer's disease, suggesting a role of cerebrovascular disease that is hypothesized to be mediated by inflammatory factors. This study examined the pathways through which small vessel cerebrovascular disease contributes to Alzheimer's disease-related pathophysiology and neurodegeneration in adults with Down syndrome. One hundred eighty-five participants from the Alzheimer's Biomarkers Consortium-Down Syndrome [mean (SD) age = 45.2 (9.3) years] with available MRI and plasma biomarker data were included in this study. White matter hyperintensity (WMH) volumes were derived from T2-weighted fluid-attenuated inversion recovery MRI scans, and plasma biomarker concentrations of amyloid beta 42/40, phosphorylated tau 217, astrocytosis (glial fibrillary acidic protein) and neurodegeneration (neurofilament light chain) were measured with ultrasensitive immunoassays. We examined the bivariate relationships of WMH, amyloid beta 42/40, phosphorylated tau 217 and glial fibrillary acidic protein with age-residualized neurofilament light chain across Alzheimer's disease diagnostic groups. A series of mediation and path analyses examined statistical pathways linking WMH and Alzheimer's disease pathophysiology to promote neurodegeneration in the total sample and groups stratified by clinical diagnosis. There was a direct and indirect bidirectional effect through the glial fibrillary acidic protein of WMH on phosphorylated tau 217 concentration, which was associated with neurofilament light chain concentration in the entire sample. Amongst cognitively stable participants, WMH was directly and indirectly, through glial fibrillary acidic protein, associated with phosphorylated tau 217 concentration, and in those with mild cognitive impairment, there was a direct effect of WMH on phosphorylated tau 217 and neurofilament light chain concentrations. There were no associations of WMH with biomarker concentrations among those diagnosed with dementia. The findings from this cross-sectional study suggest that among individuals with Down syndrome, cerebrovascular disease promotes neurodegeneration by increasing astrocytosis and tau pathophysiology in the presymptomatic phases of Alzheimer's disease, but future studies will need to confirm these associations with longitudinal data. This work joins an emerging literature that implicates cerebrovascular disease and its interface with neuroinflammation as a core pathological feature of Alzheimer's disease in adults with Down syndrome.

动脉粥样硬化性脑血管病疾病负担沉重，严重危害我国人民健康，是亟待解决的疾病问题之一，但目前我国尚未对动脉粥样硬化性脑血管病统一术语。《中英文标准化动脉粥样硬化性脑血管病术语中国专家共识》参考国内国际临床指南、本领域国际权威共识等内容，基于动脉粥样硬化性脑血管病的诊断、治疗、分型、并发症等10个类别扩增中英文术语，将为动脉粥样硬化性脑血管病术语的制定提供标准化的建议和指导，以推动我国动脉粥样硬化性脑血管病信息形成统一共识，促进其与国际接轨。 Abstract: Atherosclerotic cerebrovascular disease is one of the problems that need to be solved urgently because of its heavy burden and serious harm to people’s health. However, the academic community in China hasn’t unified terminology for atherosclerotic cerebrovascular disease. The Chinese Expert Consensus on Standardized Bilingual Terminology for Atherosclerotic Cerebrovascular Disease draws upon domestic and international clinical guidelines, and international authoritative consensus statements in the field to expand bilingual terminology based on ten key categories such as the diagnosis, treatment, classification, and complications of atherosclerotic cerebrovascular disease. The development of this consensus will provide standardized recommendations and guidance for the formulation of atherosclerotic cerebrovascular disease terminology, thereby promoting the formation of a unified consensus on atherosclerotic cerebrovascular disease information in China and being geared to international standards.

Abstract Background Cognitive impairment is an increasingly recognized comorbidity of diabetes, yet the mechanisms underlying this association remain poorly understood. This knowledge gap has contributed to conflicting findings regarding the impact of diabetes on long-term cognitive outcomes in older adults. The presence of cerebrovascular disease (CeVD) may potentially modify this relationship. However, interactive effect between diabetes and subclinical MRI markers of CeVD on cognitive trajectories and incident dementia remains unexplored. Methods A total of 654 participants underwent brain MRI at baseline, from whom 614 with at least one follow-up were selected for longitudinal analysis. Cognitive tests were performed annually up to 5 years. CeVD markers of interest were lacunes, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), cortical microinfarcts (CMIs), intracranial stenosis (ICS), and cortical infarcts. Blood-based Alzheimer biomarkers, including p-tau181 and p-tau181/Aβ42 ratio, were used as indicators of Alzheimer pathology. Results At baseline, diabetes was associated with lower cognitive performance and higher burden of CeVD, but not p-tau181 or p-tau181/Aβ42 ratio. Longitudinally, we found an interactive effect of diabetes and WMHs, rather than an independent effect of diabetes, on cognitive decline and dementia risk. Subgroup analyses showed association of diabetes with cognitive outcomes was stronger in participants with high WMHs load but non-significant in those with low WMHs load. Moreover, these associations remained unchanged after adjusting for blood-based Alzheimer biomarkers. Conclusions The effect of diabetes on cognitive decline is contingent upon the presence of WMHs and independent of Alzheimer’s pathology. This finding raises the possibility of utilizing WMHs as an imaging biomarker to identify diabetic subgroup at greater risk of developing cognitive impairment. Furthermore, therapeutic interventions targeting WMHs may prevent cognitive deterioration in older adults with diabetes.

目的 在立德树人视域下，根据“价值塑造、能力培养、知识传授”三位一体学生培养目标和职业核心能力要求，编制以脑血管病情景模拟案例为载体的教学效果评价问卷，并评价其信效度。 方法 采用访谈、专家函询等方法构建脑血管病情景模拟案例教学效果评价问卷。在山东第二医科大学2021级护理专业学生中随机抽取50名进行问卷填写和意见收集，进一步完善问卷。另外随机抽取130名学生进行正式问卷填写，并对问卷进行条目分析、效度和信度评价。 结果 本研究形成了脑血管病情景模拟案例教学效果评价问卷，该问卷包括能力培养、价值引领、案例编制3个维度，共25个条目。130份正式调查问卷中有125份为合格问卷，信效度检验显示：探索性因子分析提取3个公因子，累计方差贡献率为65.68%。问卷整体的Cronbach’α系数为0.914，能力培养、价值引领和案例编制维度的Cronbach’α系数分别为0.917、0.941和0.937。问卷具有良好的可靠性、稳定性。各维度得分与总分的相关系数r值在0.607～0.799之间。 结论 本研究形成的问卷具有良好的信效度，可以作为情景模拟案例教学效果的评价工具。 Abstract: Objective To compile a questionnaire for evaluating the teaching effects of cerebrovascular disease scenario simulation cases in accordance with the training objectives and occupational core competence requirements of students in the trinity of “value shaping, ability training and knowledge imparting” from the perspective of morality education. Methods Interviews and expert consultations were used to construct the evaluation questionnaire for cerebrovascular disease scenario simulation case teaching. Fifty nursing students in grade 2021 at Shandong Second Medical University were randomly selected to fill in the questionnaire, and their opinions were collected to the questionnaire. In addition, 130 students were randomly selected to complete a formal questionnaire. Then the questionnaire items were analyzed, and the validity and reliability were evaluated. Results In this study, a questionnaire was developed to evaluate the teaching effects of cerebrovascular disease scenario simulation cases, which included 25 items across three dimensions: ability cultivation, value guidance, and case compilation. A total of 125 out of the 130 formal questionnaires were qualified. The reliability and validity tests showed that three common factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 65.68%. The Cronbach’α coefficient of the whole questionnaire was 0.914, and the Cronbach’α coefficients of the ability cultivation, value guidance and case compilation dimensions were respectively 0.917, 0.941 and 0.937, indicating good reliability and stability of the questionnaire. The correlation coefficient between each dimension score and the total score were 0.607-0.799. Conclusions The questionnaire developed in this study has good reliability and validity, and can be used as an evaluation tool for the teaching effects of scenario simulation cases.

目的 探索脑血管病患者主观性失眠与慢性期功能预后的关系。 方法 本研究是对多中心、大型前瞻性研究——中国卒中后抑郁发生及其结局的前瞻性队列研究（prospective cohort study on the incidence and outcome of patients with post-stroke depression in China，PRIOD）的事后分析。选取PRIOD中入组患者人数较多的15个中心，对入组的脑血管病患者进行发病5年后的电话随访。收集患者的一般资料、临床特点。根据《精神障碍诊断与统计手册》（第五版）中失眠的诊断标准编制调查问卷，收集失眠及相关睡眠问题，评估患者是否存在主观性失眠以及睡眠时间。采用mRS评估患者的功能预后。采用多因素logistic回归分析脑血管病患者主观性失眠与功能预后的关系。 结果 本研究共纳入698例患者，其中319例（45.70%）为主观性失眠患者，仅17.55%（56/319）服用助眠药物。logistic回归分析显示，主观性失眠与脑血管病患者功能预后存在显著关联：校正协变量后，与无失眠患者相比，主观性失眠患者功能残疾风险较高（OR 1.64，95%CI 1.11～2.42，P=0.013）；亚组分析显示，在基线为首次脑血管病发作患者中，与无失眠患者相比，主观性失眠患者功能残疾的风险较高（OR 1.74，95%CI 1.13～2.68，P=0.013）。 结论 主观性失眠是导致脑血管病慢性期功能残疾的危险因素。 Abstract: Objective To explore the relationship between subjective insomnia and functional prognosis in the chronic phase of patients with cerebrovascular disease. Methods This study is a post-hoc analysis of the multicenter, large-scale prospective study— prospective cohort study on the incidence and outcome of patients with post-stroke depression in China (PRIOD). Fifteen centers with a high number of patients enrolled in the PRIOD were selected, and the patients were followed up by telephone 5 years after the onset of cerebrovascular disease. General information and clinical characteristics were collected. According to the diagnostic criteria of insomnia in the Diagnostic & Statistical Manual of Mental Disorders (Fifth Edition), a questionnaire was compiled to collect data on insomnia and related sleep issues, and to assess the presence of subjective insomnia and sleep duration. The functional prognosis was evaluated by mRS. Multivariate logistic regression was used to analyze the relationship between subjective insomnia and functional prognosis in cerebrovascular disease patients. Results A total of 698 patients were included, of which 319 (45.70%) had subjective insomnia. Only 17.55%(56/319) were taking sleep aids. Logistic regression analysis revealed a significant association between subjective insomnia and functional prognosis in cerebrovascular disease patients: after adjusting for covariates, subjective insomnia patients had a higher risk of functional disability compared to those without insomnia (OR 1.64, 95%CI 1.11-2.42, P=0.013). Subgroup analysis showed that among patients experiencing their first cerebrovascular event at baseline, those with subjective insomnia had a higher risk of functional disability compared to those without insomnia (OR 1.74, 95%CI 1.13-2.68, P=0.013). Conclusions Subjective insomnia is a risk factor for functional disability in the chronic phase of patients with cerebrovascular disease.

Abstract Background Ischemic cardio-cerebrovascular disease is the leading cause of mortality worldwide. However, studies focusing on elderly and very elderly patients are scarce. Hence, our study aimed to characterize and investigate the long-term prognostic implications of ischemic cardio-cerebrovascular diseases in elderly Chinese patients. Methods This retrospective cohort study included 1026 patients aged ≥ 65 years who were categorized into the mono ischemic cardio-cerebrovascular disease (MICCD) (either coronary artery disease or ischemic stroke/transient ischemic attack) (n = 912) and the comorbidity of ischemic cardio-cerebrovascular disease (CICCD) (diagnosed with both coronary artery disease and ischemic stroke/transient ischemic attack at admission) (n = 114). The primary outcome was all-cause death. The mortality risk was evaluated using the Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score-based approaches. Results Of the 2494 consecutive elderly patients admitted to the hospital, 1026 (median age 83 years [interquartile range]: 76.5–86.4; 94.4% men) met the inclusion criteria. Patients with CICCD consisted mostly of very elderly (79.2% vs. 66.1%, P

Cerebrovascular disease includes some of the most common and devastating disorders: ischemic and hemorrhagic stroke. Stroke is the second leading cause of death worldwide, with 6.2 million dying from stroke in 2015, an increase of 830,000 since 2000. Stroke remains the most common disabling disease worldwide and in many forms is preventable. A stroke, or cerebrovascular accident, is defined as an abrupt onset of a neurologic deficit that is attributable to the focal vascular cause. Thus, the definition of stroke is clinical, and laboratory studies including brain imaging are used to support the diagnosis.

Background Accumulating evidence suggests that cardiac findings after stroke are an important, yet understudied, manifestation of brain–heart interactions. Our aim was to investigate and compare cardiac findings after different cerebrovascular events (acute ischemic stroke, transient ischemic attack, and hemorrhagic stroke). Methods and Results There were 7113 patients screened who were treated between December 2013 and December 2020 at the University Hospital Zurich for ischemic stroke, transient ischemic attack, and hemorrhagic stroke. Seven hundred twenty‐one patients without evidence of previous cardiac disease or presumed cardioembolic origin of their cerebrovascular disease and with at least 1 cardiac checkup were included. Clinical reports from the year following disease onset were screened for new cardiac findings, which were categorized as arrhythmia/electrocardiographic changes, myocardial alterations, valvular abnormalities, and coronary perfusion insufficiency. Differences in proportions of findings among groups were analyzed using the Pearson χ2 test or Fisher exact test. ECG changes were observed in 81.7% (n=474) of patients with ischemic stroke, 71.4% (n=70) of patients with transient ischemic attack, and 55.8% (n=24) of patients with hemorrhagic stroke (P

With rapid urbanization in Taiwan, the green space has become a key factor in modifiable cardiovascular disease (CVD) risks. We investigated the relationships between socioeconomic status (SES), green space, and cerebrovascular disease (CBD) at the township level in Taiwan, focusing on urban–rural disparities. Analyzing data from 358 townships (2011–2020), we examined SES indicators (e.g., low-income households, education levels, median tax payments), green space (Normalized Difference Vegetation Index—NDVI), and CBD mortality rates using the pooled ordinary least squares (OLS) and random-effect models (REM) in panel regression. Additionally, we explored the mediating role of the NDVI in the SES-CBD mortality association. CBD mortality decreased more in urban areas over the decade, with consistent NDVI patterns across regions. Rural areas experienced a decline in low-income households, contrasting with an increase in urban areas. SES variables, NDVI, and time significantly affected CBD mortality in rural areas but not urban ones. Notably, the NDVI had a stronger impact on CBD mortality in rural areas. Mediation analysis revealed the NDVI's indirect effects, especially in rural areas. Despite overall declines in CBD mortality in Taiwan, urban–rural disparities in SES and green space persist. Addressing these disparities is critical for understanding and developing interventions to mitigate health inequalities. [ABSTRACT FROM AUTHOR]

对于出血性脑血管病，目前临床上采用外科手术干预较多，但是患者在治疗后仍不可避免地出现不同程度的神经功能损伤。因此，寻求一种能够有效减轻患者继发性损伤的治疗手段至关重要。随着再生医学的发展，外泌体概念的引入为出血性脑血管病的诊疗提供了新的理念与方向。外泌体作为一种细胞外囊泡，能够携带细胞内物质，在细胞间发挥信息传递功能，更重要的是外泌体能自由穿过血脑屏障，在神经系统相关疾病中发挥调控作用。本综述主要介绍外泌体减轻出血性脑血管病后继发性损伤的4种病理生理机制——抑制炎症反应、减少细胞程序性死亡、保护血脑屏障以及减轻氧化应激损伤，并总结了其在临床诊断和治疗中的应用前景。 Abstract: At present, there are many surgical interventions in the clinical practice for hemorrhagic cerebrovascular diseases, but patients still have different degrees of neurological damage after treatment. Therefore, it is very important to find a way to reduce the secondary injury of patients effectively. With the development of regenerative medicine, the introduction of the concept of exosomes provided new ideas and directions for the diagnosis and treatment of hemorrhagic cerebrovascular diseases. As a kind of extracellular vesicle, exosomes can carry intracellular substances and play a role in information transmission among cells. More importantly, exosomes can freely cross the blood-brain barrier, thus playing a regulatory role in nervous system-related diseases. Therefore, this paper mainly reviewed four pathophysiological mechanisms of exosomes in alleviating secondary injury of hemorrhagic cerebrovascular diseases, including inhibiting inflammatory reaction, reducing programmed cell death, protecting the blood-brain barrier, and alleviating oxidative stress damage, and summarized their application prospects in clinical diagnosis and treatment.

Brain changes at the end-stage of fragile X-associated tremor/ataxia syndrome (FXTAS) are largely unknown due to mobility impairment. We conducted a postmortem MRI study of FXTAS to quantify cerebrovascular disease, brain atrophy and iron content, and examined their relationships using principal component analysis (PCA). Intracranial hemorrhage (ICH) was observed in 4/17 FXTAS cases, among which one was confirmed by histologic staining. Compared with seven control brains, FXTAS cases showed higher ratings of T2-hyperintensities (indicating cerebral small vessel disease) in the cerebellum, globus pallidus and frontoparietal white matter, and significant atrophy in the cerebellar white matter, red nucleus and dentate nucleus. PCA of FXTAS cases revealed negative associations of T2-hyperintensity ratings with anatomic volumes and iron content in the white matter, hippocampus and amygdala, that were independent from a highly correlated number of regions with ICH and iron content in subcortical nuclei. Post-hoc analysis confirmed PCA findings and further revealed increased iron content in the white matter, hippocampus and amygdala in FXTAS cases compared to controls, after adjusting for T2-hyperintensity ratings. These findings indicate that both ischemic and hemorrhagic brain damage may occur in FXTAS, with the former being marked by demyelination/iron depletion and atrophy, and the latter by ICH and iron accumulation in basal ganglia.

BackgroundInflammation plays a crucial role in cerebrovascular disease (CVD) progression. Neutrophil-to-lymphocyte ratio (NLR) is an important inflammatory marker, though its diagnostic role in CVD is still under investigation. This study evaluates the relationship between NLR and short-term all-cause mortality in patients with CVD admitted to the intensive care unit (ICU).MethodsWe conducted a retrospective study using data from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.2) database, including 4,327 adult ICU-admitted CVD patients. NLR values at admission were analyzed alongside various mortality variables. Multivariate Cox proportional hazards regression models and Kaplan–Meier (K-M) survival curves assessed the relationship between NLR and short-term all-cause mortality. Predictive power, sensitivity, specificity, and area under the curve (AUC) of NLR for short-term mortality were investigated using Receiver Operating Characteristic (ROC) analysis. Additionally, restricted cubic spline (RCS) curves and subgroup analyses were conducted.ResultsAmong the 4,327 patients, 3,600 survived (survival group) and 727 died (non-survival group) within 28 days of admission (mortality rate: 16.8%). A multivariate Cox regression analysis identified NLR as an independent predictor of 28-day all-cause mortality (hazard ratio: 1.013; 95% confidence interval: 1.0086–1.0188; p

The increasing incidence and mortality rates of cerebrovascular disease impose a heavy burden on both patients and society. Retinal imaging techniques, such as fundus photography, optical coherence tomography, and optical coherence tomography angiography, can be used for rapid, non-invasive evaluation of cerebral microcirculation and brain function since the retina and the central nervous system share similar embryonic origin characteristics and physiological features. This article aimed to review retinal imaging biomarkers related to cerebrovascular diseases and their applications in cerebrovascular diseases (stroke, cerebral small vessel disease [CSVD], and vascular cognitive impairment [VCI]), thus providing reference for early diagnosis and prevention of cerebrovascular diseases.

Accelerated by the adoption of remote monitoring during the COVID-19 pandemic, interest in using digitally captured behavioral data to predict patient outcomes has grown; however, it is unclear how feasible digital phenotyping studies may be in patients with recent ischemic stroke or transient ischemic attack. In this perspective, we present participant feedback and relevant smartphone data metrics suggesting that digital phenotyping of post-stroke depression is feasible. Additionally, we proffer thoughtful considerations for designing feasible real-world study protocols tracking cerebrovascular dysfunction with smartphone sensors. [ABSTRACT FROM AUTHOR]

Background There is a scarcity of data on the prevalence and clinical impact of cerebrovascular disease detected on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with severe aortic stenosis. Methods and Results Among patients with severe aortic stenosis undergoing AVR, the authors compared clinical outcomes between patients with and without cerebrovascular disease detected on preprocedural CT, which was defined as chronic brain infarction or hemorrhage. The primary outcome measure in this study was a composite of all‐cause death or stroke. Among 567 study patients, 200 patients (35.3%) had cerebrovascular disease on preprocedural CT. Among 200 patients with cerebrovascular disease on preprocedural CT, only 28.5% of patients had a clinical history of symptomatic stroke. The cumulative 3‐year incidence of death or stroke was higher in patients with cerebrovascular disease on preprocedural CT than in those without cerebrovascular disease on preprocedural CT (40.7% versus 24.1%, log‐rank P

Objective To investigate the correlation between bone metabolism indicators and cerebrovascular diseases in patients with diabetic nephropathy and their impact on survival rate. Methods A total of 996 elderly patients with type 2 diabetic nephropathy who visited the department of endocrinology,Xuanwu Hospital,Capital Medical University from January 2014 to December 2019 were selected as the study subjects and divided into the combined group(n=599) and the uncombined group(n=397) according to the presence or absence of cerebrovascular disease.General data,clinical data,laboratory data,bone metabolism data and follow-up data of the patients were collected.Logistic regression was used to analyze the association between bone metabolism indicators(bone mineral density,osteocalcin,bone alkaline phosphatase,vitamin D,parathyroid hormone,etc.) and cerebrovascular disease. Results Bone mineral density and vitamin D in the combined group were lower than those in the uncombined group;osteocalcin and bone alkaline phosphatase were higher than those in the uncombined group;serum calcium and phosphorus levels in the combined group were lower than those in the uncombined group,and the differences were statistically significant(P

Abstract Background/Objective Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic inequalities and urbanization levels in township-based CBD mortality in Taiwan. Methods Socioeconomic variables, including the percentages of low-income households, individuals with a university education and above, and tax payments, were measured at the township level from 2011 to 2020. Urbanization was also determined by the national survey and divided into seven levels. Age-standardized mortality rate (ASMR) of CBD was calculated using a Geographic Information System (GIS) in 358 townships. The effects of socioeconomic variables and urbanization levels on relative and absolute inequalities in township-based CBD mortality rates were examined. Results Significant differences in ASMR of CBD were observed across all socioeconomic status indicators over the years. Higher proportions of low-income households were associated with higher ASMR of CBD. Conversely, there were negative correlations between higher proportions of individuals with a university education and above and tax payments with ASMR of CBD. The regression analysis indicated significant impacts of relative and absolute socioeconomic inequalities on ASMR of CBD. Additionally, a moderation effect of socioeconomic variables and urbanization on CBD mortality rates was observed, with rural areas showing sensitivity to these factors. Conclusion Although ASMR of CBD showed significant decreases over time, socioeconomic inequalities in CBD mortality rates persist. Interventions targeting socioeconomic inequalities in health outcomes, especially in rural areas, are needed to address this issue.

Background The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate‐to‐vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). Methods and Results In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929–0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001–1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001–1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771–0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997–0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827–0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002–1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977–0.992]). No between‐group differences were significant at subgroup analysis. Conclusions Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.

Adults with Down syndrome have a genetic form of Alzheimer's disease (AD) and evidence of cerebrovascular disease across the AD continuum, despite few systemic vascular risk factors. The onset and progression of AD in Down syndrome is highly age-dependent, but it is unknown at what age cerebrovascular disease emerges and what factors influence its severity. In the Alzheimer's Biomarker Consortium-Down Syndrome study (ABC-DS; n = 242; age = 25-72), we estimated the age inflection point at which MRI-based white matter hyperintensities (WMH), enlarged perivascular spaces (PVS), microbleeds, and infarcts emerge in relation to demographic data, risk factors, amyloid and tau, and AD diagnosis. Enlarged PVS and infarcts appear to develop in the early 30s, while microbleeds, WMH, amyloid, and tau emerge in the mid to late 30s. Age-residualized WMH were higher in women, in individuals with dementia, and with lower body mass index. Participants with hypertension and APOE-ε4 had higher age-residualized PVS and microbleeds, respectively. Lifespan trajectories demonstrate a dramatic cerebrovascular profile in adults with Down syndrome that appears to evolve developmentally in parallel with AD pathophysiology approximately two decades prior to dementia symptoms.

The respiratory virus SARS-CoV-2, responsible for the multisystem illness known as COVID-19 that resulted in the pandemic of 2020, is increasingly recognized for its ability to cause cerebrovascular complications. This series of four cases observed during the height of the pandemic in a single institution is presented to illustrate the diverse pathophysiology of COVID-19 cerebrovascular manifestations and their corresponding clinical and radiologic manifestations.

目的 探讨多元化教学模式在提高缺血性脑血管病介入诊疗进修医师培训质量和效率方面的应用。 方法 选择2018年1月—2022年12月在南京大学医学院附属鼓楼医院神经内科接受脑血管介入培训的进修医师为研究对象，应用多元化教学模式，即将多种教学方法融合交叉的培训模式进行教学。采用问卷调查的形式对进修医师满意度及其在培训前后介入诊疗理论知识和实践操作能力进行评估。 结果 共纳入55名进修医师，年龄32～50岁，其中男性51名（92.73%）。89.09%的进修医师对多元化教学模式非常满意；分别有83.64%和85.45%的进修医师认为多元化教学模式激发了学习兴趣和自主学习能力。经过多元化教学模式培训后，能够独立完成颅外支架置入治疗的进修医师显著增加 (41.82% vs. 12.73%，P=0.002)。 结论 多元化教学模式是提高缺血性脑血管病介入进修医师培训质量和效率的有效手段。 Abstract: Objective To explore the application of multi-model teaching in improving the quality and efficiency of training in neurointerventional operation for ischemic cerebrovascular disease. Methods Subjects were selected as training doctors who received cerebrovascular interventional operation training in the Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from January 2018 to December 2022. All training doctors received multi-model training, that is, a combination of multiple teaching methods and cross-training mode for teaching. Questionnaire survey was used to evaluate the training doctors’ satisfaction of multi-model teaching and the changes in theoretical knowledge and practical ability of intervention diagnosis and treatment before and after training. Results A total of 55 training doctors were included, aged from 32 to 50 years, including 51 males (92.73%). Among them, 89.09% were satisfied with the multi-model teaching. Meanwhile, 83.64% and 85.45% of training doctors believe that multi-model teaching has stimulated their learning interest and improved self-learning abilities, respectively. After training, a significant increase in the number of training doctors who can independently complete extracranial stent implantation was achieved (41.82% vs. 12.73%, P=0.001). Conclusions The muti-model teaching is an effective method to improve the quality and efficiency of training in neurointerventional operation for ischemic cerebrovascular disease.

Abstract Aims/Introduction History of coronary artery disease (CAD), cerebrovascular disease (CeVD), type 2 diabetes and their combined effect on cardiovascular disease are essential for cardiovascular risk management. We investigated the association of prior CAD, prior CeVD, type 2 diabetes and their combination with the risk of cardiovascular disease. Materials and Methods This is a historical cohort study including 342,033 participants (aged 18–72 years) followed up for ≥5 years between 2008 and 2016. Participants were classified into eight groups (with or without prior CAD, prior CeVD and type 2 diabetes). Type 2 Diabetes was defined by fasting plasma glucose and glycated hemoglobin levels, and antidiabetic drug prescription. Prior and subsequent CAD and CeVD were identified according to claims using International Classification of Diseases 10th Revision codes, medical procedures and questionnaires. Cox regression models were used to evaluate the risk of cardiovascular events. Results The median follow‐up period was 6.4 years. The incidence of composite cardiovascular events of CAD and CeVD in the CAD−/CeVD−, CAD+/CeVD−, CAD−/CeVD+ and CAD+/CeVD+ groups were 1.92 and 6.94, 25.14 and 31.98 per 1,000 person‐years in non‐diabetes participants, and 8.66, 18.04, 39.98 and 60.72 in type 2 diabetes patients, respectively. Hazard ratios of cardiovascular events compared with CAD−/CeVD−/non‐diabetes were 1.66 (95% confidence interval 1.55–1.78) in CAD−/CeVD−/type 2 diabetes and 1.84 (1.56–2.18) in CAD+/CeVD−/non‐diabetes. CeVD+ was linked to a 4‐7‐fold increase in the risk of cardiovascular events regardless of CAD+ or type 2 diabetes. Conclusions Type 2 diabetes increased the risk of cardiovascular disease as high as a history of CAD, whereas prior CeVD alone increased the risk of future CeVD without additional effects by type 2 diabetes.

Background: Timely diagnosis and treatment of silent cerebrovascular disease (SCD) are critical for future cerebrovascular disease prevention, whereas asymptomatic specificity of SCD can lead to a lack of reasonable healthcare utilization. In China, access barriers to care for SCD patients is rarely studied. This study aimed to estimate the access barriers to care for SCD patients in rural China and explored associated factors. Methods: We constructed a demand-side questionnaire using the six-dimensional model of access barriers to care, and collected survey data in Guizhou province, China. Data from SCD patients were collected including demographics, health status, and self-perceived access barriers to care. Linear regression was used to estimate the association between access barriers to care and self-reported health status. Results: A total of 162 SCD patients were included in the analysis. The questionnaire’s measures are adoptable with reliability (Cronbach’s α = 0.86) and validity (KMO = 0.774, Bartlett’s test p-value

Purpose: To assess the incidence of various neuro-ophthalmological symptoms in patients with chronic cerebrovascular disease (CVD). Material and Methods: This study was conducted at the clinical departments of the Petro Mohyla Black Sea National University (Mykolaiv) in 2018-2022. Two hundred and sixteen patients with CVD were involved in the study. Mean patient age was 62.3 ± 1.2 years and most patients (133 or 60.2%) were males. A neuroophthalmological examination included visual acuity testing, intraocular pressure measurement, perimetry, type of vision and heterophoria assessment, evaluation of ocular motility, convergence, and strabismus in the cardinal positions of gaze, and ophthalmoscopy. In addition, patients had optical coherence tomography with Оptovue Avanti XR apparatus, if indicated. Results: Of 216 patients, 45 (20.8%) had cerebral small-vessel disease, 157 (72.7%), a prior history of transient ischemic attack (TIA), and 118 (46.1%), a prior history of acute cerebrovascular events (ACVE). All patients exhibited signs of hypertensive angiopathy. Of 216 patients, 22 (10.2%) had grade 3, and 6 (2.8%), grade 4 hypertensive angiopathy. There was evidence of posterior ischemic optic neuropathy in the presence of cerebral small-vessel disease in 27 patients (12.5%). Retinal microvascular changes were seen in 133 patients (61.6%). In addition, 10 patients (4.6%) exhibited isolated retinal hemorrhages, 16 (7.4%), hard exudates, and 1 (6.3%) cotton-wool exudates. Moderate retinal and optic disc edema was seen in 23 patients (10.6%). Isolated homonymous visual field defects were found in 13 patients (6.0%); all these patients had a prior history of ACVE. Conclusion: In patients with CVD, we found fundus changes which were mostly ischemic and more severe in the presence of cerebral small-vessel disease. There is a need for an integrated multispecialty/interdisciplinary approach to further research on the neuroophthalmological aspect of CVD.

Abstract Background Triglyceride glucose (TyG) is associated with stroke, atherosclerosis, and adverse clinical outcomes. However, its correlation with cerebrovascular disease (CVD) mortality remains unclear. This study aimed to investigate the relationship between TyG index and mortality in patients with CVD. Methods Patient data sourced from the Medical Information Mart for Intensive Care -IV database were categorized based on TyG quartiles. Kaplan–Meier survival analysis was used to estimate survival disparities among the TyG subgroups. Cox proportional risk modeling was used to examine the association between the TyG index and mortality. Generalized summation models were applied to fit the smoothed curves. log-likelihood ratio test were used to analyze the non-linear relationship. Results The study comprised 1,965 patients (50.18% were male). The 28-day and 90-day mortality rates were 20.10% and 24.48%, respectively. The TyG index exhibited a linear relationship with the 28-day mortality (Hazards ratio (HR), 1.16; 95% confidence interval (CI), 0.99–1.36) and the 90-day mortality (HR, 1.18; 95% CI, 1.02–1.37). In the TyG Q4 group, each 1 mg/dl increase was linked to a 35% rise in the risk of 28-day mortality and a 38% increase in the risk of 90-day mortality. Subgroup analyses highlighted a more substantial association between TyG index and 90-day mortality in the diabetic group. Conclusion Our findings underscore the positive association between TyG and the 28- and 90-day mortality rates in patients with CVD. This insight may prove pivotal for identifying at-risk populations and enhancing risk prediction in the clinical management of CVD.

Abstract Aims We aimed to explore the associations between urine albumin-to-creatinine ratio (uACR) and cardia-cerebrovascular disease (CVD) in Chinese population with type 2 diabetes(T2D). Methods We included 8975 participants with T2D but free of prevalent CVD (including myocardial infarction, ischemic and hemorrhagic stroke) at baseline from Kailuan study who were assessed with uACR between 2014 and 2016. The participants were divided into three groups based on their baseline uACR: normal (

Abstract: Directed acyclic graph (DAG) is a visualization tool to construct causal hypotheses in causal inference, which can be used to control confounding bias in observational studies by screening the minimal adjustment subsets that need to be adjusted through the backdoor criterion. However, existing studies lack standardization in drawing DAGs and the quality of DAGs used in the literature varies, which causes application dilemmas. The emergence of the ESC-DAGs method provides a standardized process for constructing DAGs. Based on the basic idea of systematic review, ESC-DAGs extensively searches relevant literature and divides the construction process into three phases: mapping, translation, and integration. Firstly, a saturated DAG is constructed based on each retrieved study. The directed edges are screened in the graph according to the Hill criterion and the potential outcome framework, and finally, all the retained directed edges are integrated into one DAG. The ESC-DAGs method makes full use of the literature information and the expertise of researchers. It provides a reasonable and feasible criterion for applying DAGs, which has important guiding significance. This article presents the content of the ESC-DAGs method and elucidates the specific process of constructing a DAG using an example from a clinical study on stroke.

Background Stroke is featured by high mortality and recurrent rate worldwide. Serum uric acid (SUA) is the product of purine metabolism that has been identified as a risk factor for cardiovascular disease. The serum uric acid/serum creatinine ratio (SUA/Scr) is a renal function-normalized SUA. The role of SUA/Scr in acute cerebrovascular disease remains controversial. Objective To identify the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease. Methods This was a prospective cohort study involving patients with the initial cerebrovascular event consecutively admitted in Tianjin Huanhu Hospital from September 2006 to September 2019. All patients were followed up in the outpatient clinic combined with telephone contact until September 2020. The primary outcome was all-cause mortality. The secondary outcomes were recurrent cerebrovascular events, recurrent cardiovascular events and other vascular events (e.g., arteriovenous thrombosis of lower extremities). Cox proportional hazard models were used to explore the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease. Results According to the quartiles of SUA/Scr levels, patients with acute cerebrovascular disease were divided into Q1 group (SUA/Scr≤3.16, n=3 520), Q2 group (3.164.92, n=3 243). At the end of the follow-up, 774 (5.8%) patients died, while 2 064 (15.5%) reported recurrences of cerebrovascular events. In Q1-Q4 groups, there were 302, 375, 408 and 337 male cases of recurrences of cerebrovascular events, and 99, 125, 169 and 249 female cases of recurrences of cerebrovascular events, respectively. There were 261, 314, 345 and 283 male cases of recurrences of cerebral infarction, and 90, 101, 142 and 205 female cases of recurrences of cerebral infarction in Q1-Q4 groups, respectively. There were 154, 191, 214 and 183 male cases of recurrences of large atherosclerotic cerebral infarction, and 58, 52, 45 and 31 female cases of recurrences of large atherosclerotic cerebral infarction in Q1-Q4 groups, respectively. All-cause mortality in men was 165, 128, 131 and 88 cases in Q1-Q4 groups, respectively, and 57, 63, 62 and 80 cases in women. The mortality of men due to cerebral infarction was 93, 72, 70, and 46 cases in Q1-Q4 groups, respectively, and 31, 33, 36, and 44 cases in women. The mortality of men due to large artery atherosclerotic cerebral infarction was 58, 52, 45, and 31 cases in Q1-Q4 groups, respectively, and 17, 18, 27 and 24 cases in women. After adjusting for multiple confounding factors, SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of acute cerebral infarction in men (HR=0.690, 95%CI=0.500-0.953, P=0.026). SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup (HR=0.740, 95%CI=0.578-0.947, P=0.017). SUA/Scr in Q4 compared with Q1 was an influencing factor for all-cause mortality (HR=0.575, 95%CI=0.368-0.901, P=0.003) and death from cerebral infarction in men (HR=0.610, 95%CI=0.353-0.814, P=0.011). SUA/Scr in Q3 (HR=0.656, 95%CI=0.476-0.904, P=0.010) and Q4 (HR=0.582, 95%CI=0.409-0.829, P=0.001) compared with Q1 was an influencing factor for male death after discharge. SUA/Scr in Q4 compared with Q1 was an influencing factor for death due to large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup (HR=0.580, 95%CI=0.386-0.873, P=0.007) . Conclusion Within a certain range, the increased SUA/Scr ratio in the acute stage of cerebrovascular disease has a certain protective effect on the recurrence and death of cerebrovascular events in male patients. Low SUA/Scr ratio is associated with the increased risk of death and recurrence of male patients with large artery atherosclerotic cerebral infarction, but not correlated with small artery occlusion cerebral infarction and cardiogenic stroke. SUA/Scr is not correlated with cerebrovascular event recurrence or death in female patients.

目的 通过对比网络远程招生与非网络远程招生方式下脑血管病方向统招硕士研究生的一般情况和成绩等信息，探讨网络远程招生方式对生源质量的影响。 方法 以首都医科大学附属北京天坛医院2017—2022年脑血管病方向的统招硕士研究生为研究对象，根据招生方式将其分为两组，2017—2019年招收的统招硕士研究生为非网络远程招生组，2020—2022年招收的为网络远程招生组。本研究主要通过历年的研究生复试名单来获取研究数据，收集的信息包括考生的性别、年龄、民族、毕业院校、是否是应届生等基本信息以及其初试成绩和复试成绩，并对两组考生的上述指标进行差异化分析。 结果 2017—2022年，首都医科大学附属北京天坛医院脑血管病方向的统招硕士研究生生源数量总体呈增长趋势。在所招收的统招硕士研究生中，女性88名（33.98%），比例低于男性，民族以汉族（246名，94.98%）为主，来源以应届毕业生（203名，78.38%）为主，网络远程招生组与非网络远程招生组相比，上述指标的差异均不具有统计学意义。网络远程招生组生源的平均年龄显著小于非网络远程招生组[（23.1±1.1）岁 vs.（23.5±1.3）岁，P=0.014]。网络远程招生组神经病学和外科学（神经外科）专业的统招硕士研究生复试成绩均显著高于非网络远程招生组[神经病学，（255.5±12.3）分 vs.（241.0±13.8）分，P

Background: This study aimed to investigate the relationship between driving skills and cognitive function in patients with cerebrovascular disease and provide driving rehabilitation strategies based on actual vehicle driving training. Methods: Participants included 25 patients with cerebrovascular disease who wished to resume driving. The Mini-Mental State Examination (MMSE), Frontal Assessment Battery, and Trail Making Test were administered to assess cognitive function. Driving rehabilitation consisted of two driving sessions and verbal instruction from the driving school instructor between the first and second driving sessions. All of these sessions took place on the same day. The evaluation of actual vehicle driving was based on quantified point reduction items. This evaluation method is the evaluation scale used in the skill test for obtaining a Japanese automobile license and is based on the Japanese National Police Agency. Results: MMSE scores were extracted as a factor influencing actual vehicle driving performance. Furthermore, the MMSE scores were entered into a stepwise multiple regression model, which revealed That MMSE scores were an important predictor of actual vehicle driving performance. Driving rehabilitation resulted in improved actual vehicle driving performance. Moreover, the number of participants who passed the test increased from two to 11 (p < 0.001). Conclusions: Driving rehabilitation was found to have some positive effects, such as an increase in the pass rate for actual vehicle driving. However, it is necessary to consider the possibility that this effect could be due to the repetition of two driving sessions conducted on the same day. [ABSTRACT FROM AUTHOR]

Texts in medical fields containing sensitive information pose challenges for AI research usability. However, there is increasing interest in generating synthetic text to make medical text data bigger for text-based medical AI research. Therefore, this paper suggests a text augmentation system for cerebrovascular diseases, using a synthetic text generation model based on DistilGPT2 and a classification model based on BioBERT. The synthetic text generation model generates synthetic text using randomly extracted reports (5000, 10,000, 15,000, and 20,000) from 73,671 reports. The classification model is fine-tuned with the entire report to annotate synthetic text and build a new dataset. Subsequently, we fine-tuned a classification model by incrementally increasing the amount of augmented data added to each original dataset. Experimental results show that fine-tuning by adding augmented data improves model performance by up to 20%. Furthermore, we found that generating a large amount of synthetic text is not necessarily required to achieve better performance, and the appropriate amount of data augmentation depends on the size of the original data. Therefore, our proposed method reduces the time and resources needed for dataset construction, automating the annotation task and generating meaningful synthetic text for medical AI research.