Search

目的 明确我国接诊卒中患者的医疗机构卒中医疗资源配置情况及水平。 方法 2012年对当时的中国卒中研究网络成员单位（China Stroke Research Network，CSRN）的554家 单位进行了关于卒中医疗资源分布的调查。对每家单位发放调查问卷以获取该单位医疗资源分布情 况，包括人力资源情况、设备资源情况、空间资源情况和组织管理情况。调查问卷的内容设置参考欧 洲卒中医疗资源调查（European stroke facilities survey）对高级卒中中心（comprehensive stroke center， CSC）、初级卒中中心（primary stroke center，PSC）和卒中接诊最小机构（any hospital ward，AHW）的定 义标准。 结果 在发放调查问卷的所有医疗机构中，有521家（94.0%）反馈了合格的调查问卷。按照欧洲卒中 医疗资源调查标准，在反馈的医疗机构中有20家（3.8%）达到CSC标准，有179家（34.4%）达到PSC标准， 有64家（12.3%）达到AHW标准，而有258家（49.5%）未达到上述任何一级可收治卒中医疗机构的标准。 上述分别达到CSC、PSC、AHW和未符合标准的各级医疗机构中，在前一年收治卒中患者的数量分别为 70 052例（8.8%）、334 834例（42.2%）、88 364例（11.1%）和299 806例（37.8%）。在未达到标准的机 构中，有11家（4.3%）机构无法提供24 h头颅计算机断层扫描检查，209家（81.0%）机构既不能提供卒 中诊疗成型方案，也无法提供卒中患者接诊的标准化临床路径。 结论 在被调查的接诊急性卒中患者的医疗机构中，只有不足2/5的单位可提供较为理想的卒中诊 疗资源。我国仅有一半的急性卒中患者在CSC和PSC就诊。 Abstract: Objective To investigate the allocation of stroke medical facilities and the level of medical service in hospitals admitting stroke patients in China. Methods A survey of stroke medical facilities in all 554 hospitals from China Stroke Research Network (CSRN) was conducted in 2012. These hospitals were from 31 provinces or municipalities, covering nearly the entire mainland China. The relevant information was obtained by questionnaires, including hardware and software resources and medical service management and etc. The criteria and definitions for comprehensive stroke center (CSC), primary stroke center (PSC), and any hospital ward (AHW) of minimum unit admitting stroke patients in questionnaires were used referring to the relevant criteria and definitions of the European stroke facilities survey. Results Of all the hospitals, 521 (94.0%) completed the questionnaires. Of the 521 hospitals, 20 (3.8%) met CSC criterion, 179 (34.4%) met PSC criterion, 64 (12.3%) met AHW criterion, and 258 (49.5%) didn’t reach any of the above criteria. Hospitals meeting the criteria for CSC, PSC, AHW and none of all the criteria had admitted 70 052 (8.8%), 334 834 (42.2%), 88 364 (11.1%), and 299 806 (37.8%) patients in the last year before the survey, respectively. Of the 258 hospitals at the lowest level of medical service, 11 (4.3%) could not provide 24-hour cerebral computed tomography scanning service, 209 (81.0%) could provide neither the complete stroke diagnosis and treatment scheme nor standard clinical pathway for acute stroke patients. Conclusions Only less than 2/5 of investigated hospitals admitting acute stroke patients had optimal medical facilities for stroke. Only half of acute stroke patients received treatment in CSC and PSC in this survey.

目的 探讨基于病历会商制度的动脉瘤性蛛网膜下腔出血（aneurysmal s ubarachnoid h emorrhages， aSAH）医疗服务效率改进模式对脑血管病医师的继续教育作用及其成效分析。 方法 首都医科大学附属北京天坛医院自2013年7月开始对脑血管病医师进行基于病历会商制度的 aSAH治疗效率持续改进模式教育，评价2013年1月-6月与2017年7月-12月两个时间段脑血管病医师对 aSAH患者发病72 h内介入栓塞或外科夹闭术治疗率变化及患者到院距接受治疗平均时间的差异。 结果 通过基于病历会商制度的aSAH医疗服务效率改进模式的继续教育制度，脑血管病医师对 aSAH患者的治疗效率有显著改善[患者发病72h治疗率：83.6% vs 55.3%，P＜0.001；患者到院距接受 治疗的平均时间：（45.0±31.3）h vs（78.6±51.8）h，P＜0.001]。 结论 基于病历会商制度的aSAH医疗服务效率改进模式是一种持续高效的脑血管病医师继续教育方式。 Abstract: Objective To explore the continuous education effect of aneurysmal subarachnoid hemorrhage (aSAH) medical service improvement model based on case-consultation system for cerebrovascular physicians. Methods The education model of aSAH treatment efficiency improvement based on the caseconsultation system for cerebrovascular physicians was applied in Beijing Tiantan Hospital, Capital Medical University since July 2013. The treatment rates improvement of interventional embolization/surgical clipping and the mean time from door to treatment were compared between two stages of Jan. 2013-June.2013 and July 2017- Dec. 2017 in patients with aSAH within 72 hours after onset. Results The treatment efficiency for aSAH patients was significantly improved by the continuous education based on the case-consultation system [The treatment rate within 72 hours was 83.6% vs 55.3%, P

数字健康广义上是指发展和利用数字技术提高健康的知识和实践领域，包括智能设备、数字消费者、物联网等相关的健康服务等。近年来，数字健康技术在脑血管病领域发展迅速，在脑血管病的一级预防、二级预防及急性期和康复阶段的诊疗中均有应用。相关研究结果提示，开发良好的数字健康产品可预测脑血管病的发生风险，助力脑血管病急性期远程医疗，提高患者二级预防的依从性，辅助患者出院后的功能康复训练。数字健康可使更多临床数据得到即时共享，让患者得到更及时的救治，同时也在一定程度上降低医疗成本。本文讨论数字健康在脑血管病领域的应用现状，展望其未来的发展趋势。 Abstract: Digital health broadly refers to the development and use of digital technology to improve health knowledge and practice areas, including smart devices, digital consumers, the internet of things and other related health services. In recent years, digital health has developed rapidly in the field of cerebrovascular diseases. It has been applied in primary prevention and secondary prevention, as well as in the diagnosis and treatment of cerebrovascular diseases in the acute phase and rehabilitation. The related studies show that well-developed digital health products can predict the risk of cerebrovascular disease, help patients in the acute phase through telemedicine, enhance the compliance of patients with secondary prevention, and assist rehabilitation training after discharge. Digital health allows more clinical data to be shared instantly, patients to be treated more timely, and can reduce medical costs to some extent. This paper discussed the application of digital health in cerebrovascular disease and its possible development trend in the future.

心脑血管疾病是全球主要的致死和致残病因之一。尽管医疗技术不断进步，心脑血管疾病的诊治仍存在许多亟待解决的问题，人工智能与机器学习的出现为应对这些问题提供了新途径。美国心脏学会2024年发布的科学声明从影像分析、心电图判读、床旁监护、可穿戴设备、基因组学及电子健康记录等方面介绍了人工智能与机器学习在临床中的应用及面临的挑战。本文对该指南进行介绍，并分析人工智能与机器学习在脑血管病领域中应用的优势，为我国未来在这一领域的研究提供参考。 Abstract: Cardiovascular and cerebrovascular diseases are among the leading causes of death and disability worldwide. Despite continuous advancements in medical technology, the diagnosis and treatment of these diseases still face many unresolved challenges. The emergence of artificial intelligence and machine learning provides new approaches to addressing these issues. The American Heart Association’s 2024 scientific statement highlights the applications and challenges of artificial intelligence and machine learning in clinical scenarios, including imaging analysis, electrocardiogram interpretation, bedside monitoring, wearable devices, genomics, and electronic health records. This paper aims to introduce these aspects and analyze the advantages of artificial intelligence and machine learning in the field of cerebrovascular diseases, providing a reference for the future development of artificial intelligence and machine learning in this area in China.

近年来，虽然国内外学者对卒中及共患疾病的关注逐步提高，但由于多病共存的特殊性和异质性，针对此类患者的诊治仍存在诸多不足和挑战。卒中及共患疾病的诊疗能力很大程度上反映了医疗机构的神经系统专科技术水平和多学科协同救治能力。构建多学科协同诊疗模式是卒中救治和质量管理体系建设的重要内容之一。医疗机构应运用先进的质量管理工具，优化要素配置和运行机制，建立高效的多学科协同诊疗模式，从而实现卒中及共患疾病整体诊治水平的提升。 Abstract: In recent years, although scholars at home and abroad have gradually paid more attention to stroke and its comorbid conditions, there are still many shortcomings and challenges in the diagnosis and treatment of such patients due to the particularity and heterogeneity of the coexistence of multiple diseases. The ability to diagnose and treat stroke and its comorbid conditions reflects the technical level of the neurological system and the ability of multidisciplinary collaborative treatment in medical institutions. Establishing a multidisciplinary collaborative diagnosis and treatment model is one of the important content of stroke care and quality control system construction. Medical institutions should use advanced quality management tools, optimize resource allocation and operation mechanisms, and establish an efficient multidisciplinary collaborative diagnosis and treatment model, to improve the overall diagnosis and treatment level of stroke and its comorbid conditions.

目的 开发基于机器学习算法的缺血性卒中患者院内复发风险的预测模型，并进行外部验证，为相关研究提供借鉴。 方法 开发队列为中国卒中联盟（China Stroke Center Alliance，CSCA）研究队列，将此队列中的缺血性卒中患者按照8∶2随机划分为训练集和内部验证集。验证队列为第3次中国国家卒中登记（the third China national stroke registry，CNSR-Ⅲ）研究队列。基于指南、文献回顾，确定备选预测因子，然后采用拉索（least absolute shrinkage and selection operator，LASSO）回归进行筛选。基于logistic回归模型以及机器学习算法[随机森林模型、极端梯度提升（extreme gradient boosting，XGBoost）、轻量级梯度提升机器学习（light gradient boosting machine，LightGBM）模型]开发缺血性卒中患者院内复发风险预测模型。评价模型区分度（C统计量）和校准度（Brier得分）两方面的指标。 结果 CSCA研究队列共纳入1 587 779例缺血性卒中患者，其中院内复发99 085例（6.2%）。CNSR-Ⅲ研究队列共纳入14 146例缺血性卒中患者，其中院内复发623例（4.4%）。LASSO回归选择出年龄、性别、卒中病史、高血压、糖尿病、脂质代谢紊乱、心房颤动、心力衰竭、冠心病、周围血管病、LDL-C、空腹血糖、血清肌酐以及院内抗栓治疗作为缺血性卒中院内复发的预测因子。内部验证中，各模型的区分度均在0.75左右，XGBoost模型的区分度（AUC 0.765，95%CI 0.759～0.770）略高于其他模型，各模型的Brier分数均在0.05左右。外部验证中，所有模型的预测效能均较低（AUC＜0.60），各模型的Brier分数均＜0.08。 结论 在预测因子数量和维度有限的情况下，logistic回归模型和机器学习算法预测缺血性卒中院内复发风险的效能均较低。未来需从预测因子和算法模型上做更多探索。 Abstract: Objective Develop a predictive model for in-hospital recurrence risk of ischemic stroke patients based on machine learning algorithms and externally validate it to provide insights for related research. Methods The development cohort was the China Stroke Center Alliance (CSCA) research cohort, and ischemic stroke patients in this cohort were randomly divided into training and internal validation sets in an 8∶2 ratio. The validation cohort was the Third China National Stroke Registry (CNSR-Ⅲ) research cohort. A list of candidate predictive factors was determined based on guidelines, literature, and data, followed by selection using least absolute shrinkage and selection operator (LASSO) regression. A predictive model for the in-hospital recurrence risk of ischemic stroke patients was developed using logistic regression and machine learning algorithms[random forest model, eXtreme gradient boosting (XGBoost) model, light gradient boosting machine (LightGBM) model]. Model evaluation primarily focused on discrimination (C-statistic) and calibration (Brier score). Results The CSCA research cohort included 1 587 779 cases of ischemic stroke patients, with 99 085 cases of in-hospital recurrence (6.2%). The CNSR-Ⅲ research cohort included 14 146 cases of ischemic stroke patients, with 623 cases of in-hospital recurrence (4.4%). LASSO feature selection revealed that age, gender, stroke history, hypertension, diabetes, lipid metabolism disorders, atrial fibrillation, heart failure, coronary artery heart disease, peripheral vascular disease, LDL-C, fasting blood glucose, serum creatinine and in-hospital anticoagulation therapy were important predictive factors for predicting in-hospital recurrence of ischemic stroke patients. In internal validation, the discrimination of each model was around 0.75, with XGBoost model slightly outperforming other models (AUC 0.765, 95%CI 0.759-0.770), and the Brier scores for all models were around 0.05. In external validation, the predictive performance of all models was relatively low (AUC

目的 评估我国2016—2022年发病6 h内急性缺血性卒中患者静脉溶栓的变化趋势，并比较rt-PA与尿激酶静脉溶栓的院内临床结局差异。 方法 纳入中国卒中中心联盟（Chinese Stroke Center Alliance，CSCA）2016年1月—2022年12月登记的发病6 h内到院的急性缺血性卒中患者555 991例，计算各年份rt-PA静脉溶栓和尿激酶静脉溶栓的比例变化。采用多因素logistic回归法，以rt-PA溶栓为对照，分析尿激酶溶栓对院内脑梗死出血转化、院内死亡及出院时良好神经功能结局（mRS评分0～1分）的影响。 结果 分别有113 521例和30 950例患者进行了rt-PA和尿激酶静脉溶栓，溶栓率分别为20.42%和5.57%。从2016年至2022年，rt-PA静脉溶栓率从11.26%逐年递增至30.19%，而尿激酶静脉溶栓率则始终波动在较低水平。多因素logistic回归分析显示，与rt-PA静脉溶栓相比，尿激酶静脉溶栓患者发生脑梗死后出血转化（OR 0.740，95%CI 0.662～0.827，P＜0.01）和院内死亡的风险较低（OR 0.820，95%CI 0.764～0.881，P＜0.01），但两组患者出院时良好功能结局率无显著差异（OR 0.989，95%CI 0.951～1.028，P=0.57）。 结论 2016—2022年期间，我国发病6 h内到院的急性缺血性卒中患者rt-PA静脉溶栓率呈逐年增长趋势；尿激酶溶栓后发生脑梗死出血转化风险及院内死亡风险可能低于rt-PA静脉溶栓。 Abstract: Objective To investigate the temporal trend of intravenous thrombolysis in patients with acute ischemic stroke (AIS) who arrived within 6 hours after onset from 2016 to 2022 in China, and compare the risks of in-hospital outcomes between rt-PA and urokinase thrombolysis. Methods A total of 555 991 AIS patients who arrived within 6 hours after onset were enrolled in the Chinese Stroke Center Alliance (CSCA) from January 2016 to December 2022. The rates of rt-PA and urokinase intravenous thrombolysis in AIS patients within 6 hours after onset were calculated respectively of each year. Multivariate logistic regression was used to analyze the risks of hemorrhagic transformation, in-hospital death and good functional outcome at discharge (mRS score 0-1) of urokinase thrombolysis group compared with rt-PA group. Results 113 521 and 30 950 patients were treated with rt-PA and urokinase intravenous thrombolytic therapy respectively. The thrombolysis rates of rt-PA and urokinase were 20.42% and 5.57% respectively. From 2016 to 2022, the rt-PA intravenous thrombolysis rate increased from 11.26% to 30.19%, while the urokinase thrombolysis rate fluctuated at a low level. Multivariate logistic regression analysis showed that compared with rt-PA intravenous thrombolytic therapy, patients with urokinase intravenous thrombolytic therapy had a lower risk of hemorrhagic transformation (OR 0.740, 95%CI 0.662-0.827, P

目的 调查中国缺血性卒中（ischemic stroke，IS）患者出血转化（hemorrhagic transformation，HT）的危险因素。 方法 本研究数据来源于中国卒中中心联盟（China Stoke Center Alliance，CSCA）多中心登记数据库2015年8月1日—2019年7月31日连续入组的IS患者。按照是否发生HT，研究对象被划分为HT组和无HT组。收集组间的人口学特征、不良生活行为、既往疾病史、院内治疗、既往和院内用药以及疾病严重程度的差异。对上述指标进行多因素Poisson回归，以分析HT的危险因素。 结果 本研究纳入828 652例IS患者，男性518 063例（62.5%），年龄中位数67岁，入院NIHSS评分的中位数为3分。多因素分析发现，年龄（RR 1.01，95%CI 1.00～1.01）、卒中严重程度（RR 1.06，95%CI 1.05～1.06）、心房颤动（RR 2.56，95%CI 2.35～2.78）、心肌梗死（RR 1.33，95%CI 1.11～1.60）、周围血管病（RR 1.26，95%CI 1.06～1.51）、院内溶栓（RR 2.21，95%CI 2.05～2.37）、取栓治疗（RR 2.02，95%CI 1.79～2.28）、既往使用抗凝药物（RR 0.79，95%CI 0.70～0.90）、既往使用抗血小板药物（RR 0.87，95%CI 0.81～0.93）、院内抗凝治疗（RR 0.57，95%CI 0.51～0.65）和院内抗血小板治疗（RR 0.22，95%CI 0.20～0.23）是HT的独立影响因素（均P

临床预测模型在大数据与精准医学时代对精准风险分层、个性化诊疗和管理愈发重要。现有的缺血性卒中复发风险预测模型在开发队列人群、预测因子、预测结局、开发方法以及预测性能上存在较大差异。此外，开发方法上的缺陷、报告内容上的不完整以及外部验证和模型影响研究的缺失，使其临床应用效果受限。因此，后续的临床预测模型研究，一方面，应重视现有模型的验证和评价；另一方面，在开发新预测模型时，在预测因子的选取、模型的选用和拟合、展示方式及结果报告上，应遵循相应的方法学规范，以提高预测性能。 Abstract: In the era of big data and precision medicine, clinical prediction models are increasingly important in precise risk stratification, personalized diagnosis, and management. However, existing ischemic stroke recurrence risk prediction models vary significantly in terms of the population used for development, predictive factors, predicted outcomes, development methods, and predictive performance. Additionally, limitations in development methods, reporting, external validation, and model impact research have limited their clinical applicability. Therefore, future research on clinical prediction models should prioritize the validation and evaluation of existing models, while also adhering to methodological standards when developing new prediction models. This includes selecting predictive factors, model fitting, presentation methods, and reporting results, with the aim of enhancing predictive performance.

阶梯整群随机试验（stepped wedge cluster randomized trial，SW-CRT）是一种新型的研究设计，通常用于评价整群的服务或政策干预效果。该设计不需要单独设立对照，在设计初始阶段，所有整群均不暴露于干预，随后每一个观察期随机一组整群接受干预，进入干预组，直到所有整群均接受干预。本文从SW-CRT的基本原理、类别、研究设计、样本量计算、统计学方法和报告规范等方面进行介绍，为开展SW-CRT研究提供参考。 Abstract: The stepped wedge cluster randomized trial (SW-CRT) is a kind of new cluster randomized controlled trial design, mostly applied in the field of service delivery and policy evaluation. No control groups are specifically established in SW-CRTs. At the initial time of SW-CRT, no cluster is exposed to the intervention; whereafter, one random cluster will receive the intervention at regular observation intervals until all the clusters cross to the intervention groups. In this review, we summarized the rationale, types, study design, sample size calculation, statistical methods and the reporting standards of the SW-CRT, to provide reference for carrying out SW-CRTs in the future.

目的 探索阿司匹林和氯吡格雷联合应用对小鼠大脑中动脉远端缺血再灌注模型恢复期晚期糖基化终末产物受体（receptor for advanced glycation end products，RAGE）及可溶性晚期糖基化终末产物受体（soluble receptor for advanced glycation end products，sRAGE）表达的影响及其机制。 方法 60只C57BL/6J雄性小鼠随机分为假手术组、溶剂组、阿司匹林和氯吡格雷联合组（双抗组），每组20只。通过压迫大脑中动脉远端制作脑缺血再灌注模型（缺血60 min再灌注），再灌注即刻灌胃，溶剂组给予饮用水100 μL，双抗组给予阿司匹林（剂量12 mg/kg，每只实际用量0.3 mg）与氯吡格雷（剂量12 mg/kg，每只实际用量0.3 mg）混悬液100 μL，每日1次，连续21 d。缺血1、3、5、7、9、11、14、21 d对小鼠进行神经功能评价。缺血21 d取材，酶联免疫吸附法检测小鼠血清sRAGE表达水平；免疫印记检测脑组织RAGE表达水平；实时荧光定量PCR检测CD16、CD32、CD11b、诱导型一氧化氮合成酶（inducible nitric-oxide synthase，iNOS）、CD206、精氨酸酶1（arginase1，Arg1）、转化生长因子β（transforming growth factor β，TGF-β）、几丁质酶样蛋白（chitinase-like 3，Chil3/Ym1/2）等炎症因子及RAGE的mRNA表达情况；免疫荧光染色标记RAGE、神经元特异核蛋白（neuronal nuclei，NeuN）、胶质纤维酸性蛋白（glial fibrillary acidic protein，GFAP），观察RAGE与神经元和星形胶质细胞共定位情况。 结果 双抗组小鼠3 d时胡须碰触评分和神经功能总分、9 d时神经功能总分优于溶剂组，差异有统计学意义（P=0.0067、0.0140、0.0406）。缺血再灌注21 d时，双抗组小鼠血清sRAGE表达水平高于溶剂组（1.099±0.541 ng/mL vs. 0.319±0.341 ng/mL，P=0.0120）；脑组织iNOS（1.250±0.318 vs. 1.843±0.301，P=0.0164）及RAGE（2.105±0.300 vs. 2.732±0.249，P=0.0071）的mRNA相对表达较溶剂组下降。在小鼠脑梗死周边区RAGE与神经元具有共定位，与星形胶质细胞无共定位；双抗组RAGE+NeuN+细胞数量少于溶剂组（328.798±35.183个/平方毫米 vs. 814.437±165.758个/平方毫米，P=0.0012）。 结论 阿司匹林和氯吡格雷联合应用可能通过下调RAGE、上调sRAGE的表达水平，减轻炎症反应，从而发挥脑保护作用。 Abstract: Objective To explore the effects and mechanisms of aspirin combined with clopidogrel (ASA+CPG) on the expression of receptor for advanced glycation end products (RAGE) and soluble receptor for advanced glycation end products (sRAGE) in the convalescent stage of distal middle cerebral artery occlusion-reperfusion model in mice. Methods 60 male C57BL/6J mice were randomly divided into sham operation group, vehicle group and ASA+CPG group, 20 mice per group. A model of transient cerebral ischemia was performed by occluding the distal middle cerebral artery (ischemia for 60 minutes, then restore to reperfusion). 100 μL suspension of aspirin (12 mg/kg, 0.3 mg per mouse), clopidogrel (12 mg/kg, 0.3 mg per mouse) and water were administered by gavage at the onset of reperfusion, once a day for 21 days. The neurological function of mice was evaluated on day 1, 3, 5, 7, 9, 11, 14 and 21 after ischemia. Samples were harvested 21 days after ischemia. The serum sRAGE expression level was detected by enzyme-linked immunosorbent assay (ELISA). Immunoblotting was used to evaluate RAGE expression in brain tissues. Real-time quantitative PCR was applied to detect the mRNA expression levels of CD16, CD32, CD11b, inducible nitric oxide synthase (iNOS), CD206, arginase 1 (Arg1), transforming growth factor β (TGF-β), chitinase-like 3 (Chil3/Ym1/2) and RAGE. RAGE, neuronal nuclei (NeuN) and glial fibrillary acidic protein (GFAP) were labelled by immunofluence to observe the colocalization of RAGE with neurons and astrocytes. Results The vibrissae touch score at day 3, neurological function total score at day 3 and day 9 in ASA+CPG group were better than those in vehicle group (P=0.0067, 0.0140, 0.0406). At 21 days after ischemia, the level of serum sRAGE in ASA+CPG group was higher than that in vehicle group (1.099±0.541 ng/mL vs. 0.319±0.341 ng/mL, P=0.0120). The mRNA expression levels of iNOS (1.250±0.318 vs. 1.843±0.301, P=0.0164) and RAGE (2.105±0.300 vs. 2.732±0.249, P=0.0071) in ASA+CPG group decreased compared with vehicle group. RAGE colocalized with neurons but not with astrocytes in peri-infarct area of ischemic mice. The number of RAGE+NeuN+ cells in ASA+CPG group was less than that in vehicle group (328.798±35.183 vs. 814.437±165.758 per square millimeter, P=0.0012). Conclusions Combined treatment with aspirin and clopidogrel plays cerebral ischemia protective effect by down-regulate RAGE and up-regulate sRAGE expression to alleviate inflammatory response.

我国正面临着全球最大的卒中挑战。全球疾病负担（global b urden o f d isease，GBD）研究结果显示，2019年我国新发卒中394万例，卒中患者达到2876万例，卒中死亡人数为219万例。此外，卒中也是我国伤残调整生命年（disability-adjusted life years，DALYs）的首位原因，2019年卒中所致DALYs达到4590万。近期的几项大型流行病学调查对与卒中有关的既往疾病数据进行了更新。2018年我国18～69岁成人的超重和肥胖率分别为34.4%和16.8%；18岁及以上无高血压病史的成人中50.9%处于高血压前期，成人高血压的加权患病率为27.5%。根据美国糖尿病学会诊断标准，2017年我国18岁及以上成人中，总糖尿病和糖尿病前期的加权患病率分别为12.8%和35.2%；45岁以上成人的心房颤动加权患病率为1.8%，患者人数相当于790万人。医院质量监测系统（hospital quality monitoring system，HQMS）中1672家三级公立医院的数据显示，2019年收治卒中病例3 411 168例，其中缺血性卒中（ischemic stroke，IS）2 818 875例（82.6%），脑出血（intracebral hemorrhage，ICH）485 474例（14.2%），蛛网膜下腔出血（subarachnoid hemorrhage，SAH）106 819例（3.1%）。中位年龄为66岁，59.6%为男性。在I S、I CH和SAH中儿童卒中（年龄

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Arctic Passage connects the most strategic and economically developed regions in the world, and its opening is of great strategic significance. The geodetic region of Arctic Pas‐ sage can be considered from three dimensions: Arctic region, in-flight buffer, and route extension area. Based on the geodetic influence region of the Arctic Passage, this paper summarizes the globalization and grouping characteristics of the geopolitical pattern of the Arctic Passage. Based on the combination of distance and shipping income, this paper explores the combination of political actors based on countries, and puts forward the stereoscopic circle layer structure of the geopolitical pattern of the Arctic Passage: A five-tier structure inside out with different interests and positions centered on the Arctic Ocean. On the basis of the analysis of the shipping interests, propositions and policy systems of each circle structure, the relationship between the internal and external cooperation and competition among the circles is discussed. The analysis shows how to balance the inner-most Arctic Passage Coastal States' claims of "Internal hydration" and the institutionalized jurisdiction with the freedom of navigation in other circles will be the focus of future games, the competition and cooperation among and within the circles will gradually change with the change of resources and interests and the promotion of the process. [ABSTRACT FROM AUTHOR]

Copyright of Journal of South China Normal University (Natural Science Edition) / Huanan Shifan Daxue Xuebao (Ziran Kexue Ban) is the property of Journal of South China Normal University (Natural Science Edition) Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Coal Science & Technology (0253-2336) is the property of Coal Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: The rotation is unpredictable tooth movement in clear aligner treatment. Tooth shape can affect the efficiency of tooth de-rotation, but there is no relevant biomechanical study. OBJECTIVE: To investigate aligner activation influencing on biomechanics of clear aligner orthodontic therapy of rotated mandibular teeth with different shapes. METHODS: A three-dimensional finite element model of mandibular dentition-periodontium-alveolar bone-appliance with highly simulated crown shape was established based on cone-beam computed tomography and intraoral optical scanning data of an adult who had rotated lower central incisor and second premolar. The initial displacement, movement trend and von Mises stress distribution of periodontium of target teeth and adjacent teeth were analyzed when the loading of three different aligner activation of 1.0°, 1.5° and 2.0° was applied to rotated the left lower central incisor (group A) and second premolar (group B). RESULTS AND CONCLUSION: (1) The displacement and periodontium stress of target teeth were significantly higher in the group A than those in the group B under different rotation loads. Increasing the aligner activation could improve the efficiency of tooth de-rotation to a certain degree, but the risk of periodontal tissue injury was also increased. It was suggested that aligner activation should not exceed 1.5° for the lower incisor and 2.0° for the lower premolars. (2) In group A, the displacement of meso-adjacent tooth was 65%-105% as much as target tooth. For incisor de-rotation, we should pay attention to the adverse effect on adjacent teeth. (3) During the rotation movement, mesial tipping and slightly intrusive movement of target teeth were observed, and adjacent teeth showed the trend of tipping movement, which required additional measures to strengthen the grip on three-dimensional movement of teeth. [ABSTRACT FROM AUTHOR]

Copyright of Xinjiang Agricultural Sciences is the property of Xinjiang Agricultural Sciences Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Central China Normal University is the property of Huazhong Normal University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Southwest China Journal of Agricultural Sciences is the property of Editorial Department of Southwest China Journal of Agricultural Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Xi'an Jiaotong University (Medical Sciences) is the property of Xian Jiaotong University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Xi'an Jiaotong University (Medical Sciences) is the property of Xian Jiaotong University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Art Panorama is the property of Art Panorama Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Art Panorama is the property of Art Panorama Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的 调查蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者继发症状性癫痫的发生率、相关危险因素及其与院内结局的关系。 方法 本研究数据来源于中国卒中联盟（China Stoke Center Alliance，CSCA）登记数据库2015年8月1日-2019年7月31日入组的SAH患者。症状性癫痫限定为住院期间发作。依据是否出现继发症状性癫痫，将研究对象分为SAH继发癫痫组和无继发癫痫组，比较组间的人口学特征、入院GCS评分、血管危险因素、手术以及医院级别和地区的差异。采用多因素Logistic回归，分析SAH继发癫痫的危险因素，以及SAH继发癫痫与院内死亡、缺血性卒中、脑出血及肺炎的相关性。 结果 本研究纳入11 210例SAH患者，女性6623例（59.1%），平均年龄60.0±12.9岁，入院GCS评分的中位数为15分。总计228例（2.0%）继发症状性癫痫。年龄（OR 0.92，95%CI 0.87～0.97）、既往卒中/TIA（OR 1.61，95%CI 1.20～2.17）、颈动脉狭窄（OR 3.17，95%CI 1.27～10.85）、心房颤动（OR 2.64，95%CI 1.12～6.24）、脂代谢紊乱（OR 1.79，95%CI 1.03～3.13）和脑室外分流术（OR 2.30，95%CI 1.31～4.02）是SAH继发症状性癫痫的独立影响因素。SAH继发症状性癫痫可能与更高的院内死亡（OR 1.71，95%CI 0.96～3.05）、缺血性卒中（OR 4.21，95%CI 2.70～6.56）、脑出血（OR 3.87，95%CI 2.81～5.33）及肺炎（OR 2.96，95%CI 2.26～3.86）事件风险相关。 结论 症状性癫痫是SAH患者较为常见的神经系统并发症，低龄、既往卒中/TIA、颈动脉狭窄、心房颤动、脂代谢紊乱以及脑室外分流术是SAH继发症状性癫痫的独立危险因素。SAH继发症状性癫痫增加院内死亡、缺血性卒中、脑出血以及肺炎的风险。 【Abstract】 Objective To investigate the incidence and risk factors of symptomatic seizures after subarachnoid hemorrhage (SAH), and the relationship between secondary seizures and in-hospital outcomes. Methods The in-hospital SAH patients from the China Stoke Center Alliance (CSCA) registry database from August 1, 2015, to July 31, 2019 were enrolled in the retrospective analysis. According to the presence of symptomatic seizures or not after SAH during hospitalization, all the subjects were divided into SAH with seizure group and SAH without seizure group. Differences in demographics, score of Glasgow comma scale (GCS) at admission, vascular risk factors, surgery, and the class and region of hospitals were compared. A multivariate logistic regression model was used to identify risk factors of seizures after SAH and evaluate the association of in-hospital death, ischemic stroke, intracerebral hemorrhage (ICH) and pneumonia with symptomatic seizures after SAH. Results A total of 11 210 SAH patients were enrolled in this study, with the average age of 60.0±12.9 years and 6623 (59.1%) females, and the median GCS score was 15 points. A total of 228 (2.0%) cases had symptomatic seizures after SAH. Age (OR 0.92, 95%CI 0.87-0.97), prior stroke/TIA (OR 1.61, 95%CI 1.20-2.17), carotid stenosis (OR 3.17, 95%CI 1.27-10.85), atrial fibrillation (OR 2.64, 95%CI 1.12-6.24), dyslipidemia (OR 1.79, 95%CI 1.03-3.13), and external ventricular drainage (OR 2.30, 95%CI 1.31-4.02) were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH may be associated with a higher risk of in-hospital death (OR1.71, 95%CI 0.96-3.05), ischemic stroke (OR 4.21, 95%CI 2.70-6.56), ICH (OR 3.87, 95%CI 2.81-5.33) and pneumonia (OR 2.96, 95%CI 2.26-3.86). Conclusions Symptomatic seizures is a common neurological complication in SAH patients. Younger age, prior stroke/TIA, carotid stenosis, atrial fibrillation, dyslipidemia and external ventricular drainages were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH increased the risk of in-hospital death, cerebral infarction, ICH pneumonia.