Central nervous system (CNS)-related diseases have a high mortality rate, are a serious threat to physical and mental health, and have always been an important area of research. Gastrodin, the main active metabolite of Gastrodia elata Blume, used in Chinese medicine and food, has a wide range of pharmacological effects, mostly related to CNS disorders. This review aims to systematically summarize and discuss the effects and underlying mechanisms of gastrodin in the treatment of CNS diseases, and to assess its potential for further development as a lead drug in both biomedicine and traditional Chinese medicine. Studies on the pharmacological effects of gastrodin on the CNS indicate that it may exert anti-neurodegenerative, cerebrovascular protective, and ameliorative effects on diabetic encephalopathy, perioperative neurocognitive dysfunction, epilepsy, Tourette\'s syndrome, depression and anxiety, and sleep disorders through various mechanisms. To date, 110 gastrodin products have been approved for clinical use, but further multicenter clinical case-control studies are relatively scarce. Preclinical studies have confirmed that gastrodin can be used to treat CNS-related disorders. However, important concerns need to be addressed in the context of likely non-specific, assay interfering effects when gastrodin is studied using in vitro and in silico approaches, calling for a systematic assessment of the evidence to date. High-quality clinical trials should have priority to evaluate the therapeutic safety and clinical efficacy of gastrodin. Further experimental research using appropriate in vivo models is also needed, focusing on neurodegenerative diseases, cerebral ischemic and hypoxic diseases, brain damage caused by methamphetamine or heavy metals, and epilepsy.

OBJECTIVE: To study the efficacy and safety of the use of the drug Picamilon with various therapy regimens in patients with stage I of chronic cerebral ischemia (CCI).
METHODS: Material and methods. An open randomized comparative clinical trial included 44 patients with stage CCI aged 46 to 67 years (average age 55.6±6.76 years). Patients were randomized into two groups, patients of group 1 (n=23) received Picamilon orally in tablets of 50 mg 3 times/day for 60 days; group 2 (n=21) received Picamilon first parenterally at 100 mg i/m for 10 days, then in tablets of 50 mg 3 times/day for 50 days. The total duration of therapy was 60 days. The study included 4 visits (before treatment, 10 days later, 60 days later, 1.5 months after completion of treatment). The dynamics of cognitive status were assessed according to the Montreal Cognitive Function Assessment Scale (MoCA), vegetative disorders on the A.M. Wayne scale, neurological disorders on the A.I. Fedin scale, and sleep quality on the Ya.I. Levin scale. The study of the state of cerebral blood flow (dopplerography of intracranial vessels) and endothelial function (assessment of the level of methylation.
RESULTS: During treatment, in the total sample of patients, there was a positive trend in the results of the MoCA scale, increasing in the delayed period (24.9/26.5/28.3 points, p=0.022 and p<0.001); improvement in sleep quality in 50% of patients by visit 3 and in 84% by visit 4, in the 2nd group the effect occurred in 28% of patients, in the 1st - in 11%, by the end of the study the effect was comparable (p=0.508). Improvement according to Fedin A.I. scale noted in 77% of patients, values decreased from 11.9±8.3 to 6±6.1 points (p<0.0001) and to 2.77±4.43 points by visit 4 (p<0.0001). Normalization of autonomic functions was observed in 29% of patients (p=0.024) without intergroup differences. Picamilon therapy showed high efficacy in terms of clinical outcomes (up to 89%), good tolerability (98% of patients) and a favorable safety profile (less than 8.6% of AEs). The use of Picamilon was accompanied by an increase in the linear velocity of blood flow, a decrease in the thickness of the intima-media complex and the resistance index; a decrease in elevated ADMA concentrations and ADMA/MMA and (ADMA+SDMA)/MMA ratios.
CONCLUSIONS: The use of Picamilon is effective in patients with stage I CCI, contributes to a significant regression of neurological deficits, cognitive impairment, improved sleep quality and autonomic function; improves vascular endothelial function, reduces the risk of atherosclerosis and cardiovascular complications in patients. The optimal duration of therapy with Picamilon in stage I of chronic cerebral ischemia is 2 months.
UNASSIGNED: Изучение эффективности и безопасности применения препарата Пикамилон с различными режимами терапии у пациентов с хронической ишемией головного мозга (ХИМ) I стадии.
UNASSIGNED: В открытое рандомизированное сравнительное клиническое исследование включены 44 пациента в возрасте от 46 до 67 лет (средний возраст 55,6±6,76 года) с ХИМ I стадии. Пациенты были рандомизированы в две группы, больные 1-й группы (n=23) получали перорально Пикамилон в таблетках по 50 мг 3 раза/сут в течение 60 дней; 2-й группы (n=21) — получали Пикамилон сначала парентерально по 100 мг в/м в течение 10 дней, затем в таблетках по 50 мг 3 раза/сут 50 дней. Общая продолжительность терапии составила 60 дней. Исследование включало 4 визита: до лечения, через 10 дней, через 60 дней, через 1,5 мес после завершения лечения. Исследование проводилось с использованием Монреальской шкалы оценки когнитивных функций (MoCA), шкалы вегетативных нарушений А.М. Вейна, шкалы неврологических нарушений А.И. Федина, шкалы качества сна Я.И. Левина. Оценивались состояния церебрального кровотока (допплерография интракраниальных сосудов) и функции эндотелия (оценка уровня метилированных форм аргинина — АДМА, ММА, СДМА). Регистрировались нежелательные явления (НЯ) на фоне терапии и переносимость лечения.
UNASSIGNED: На фоне лечения в общей выборке пациентов наблюдалась положительная динамика результатов шкалы MoCA, нарастающая в отсроченном периоде (24,9/26,5/28,3 балла, p=0,022 и p<0,001); улучшение качества сна у 50% пациентов к визиту 3 и у 84% к визиту 4, во 2-й группе эффект имел место у 28% пациентов, в 1-й — у 11%, к концу исследования эффект был сопоставим (p=0,508). Улучшение по шкале А.И. Федина отмечено у 77% пациентов, значения снижались с 11,9±8,3 до 6±6,1 балла на визите 3 (p<0,0001) и до 2,77±4,43 баллов к визиту 4 (p<0,0001). Нормализация вегетативных функций наблюдалась у 29% пациентов (p=0,024) без межгрупповой разницы. Терапия Пикамилоном показала высокую эффективность по оценке клинических исходов (до 89%), хорошую переносимость (98% пациентов) и благоприятный профиль безопасности (менее 8,6% НЯ). Применение Пикамилона сопровождалось повышением линейной скорости кровотока, уменьшением толщины комплекса интима-медиа и индекса резистентности; уменьшением повышенной концентрации АДМА и соотношений АДМА/ММА и (ADMA+SDMA)/MMA.
UNASSIGNED: Применение Пикамилона эффективно у пациентов с ХИМ I стадии, способствует значительному регрессу неврологического дефицита, когнитивных нарушений, улучшению качества сна и вегетативной функции; улучшает функцию эндотелия сосудов, снижает риск атеросклероза и сердечно-сосудистых осложнений у пациентов. Оптимальная продолжительность терапии Пикамилоном при ХИМ I стадии — 2 мес.

Stroke is one of the main causes of permanent disability and death and the risk increases with age. Primary and secondary prevention therefore have a high priority. The treatment of risk factors, such as high blood pressure, diabetes mellitus and hyperlipidemia is just as important as anticoagulation in atrial fibrillation, in addition to optimization of lifestyle and diet. Platelet function inhibitors play a role in the prophylaxis of recurrence, carotid surgery and stenting are used in selected patients. There is little study evidence for old people, individualized treatment planning takes functional status and comorbidities into account.
UNASSIGNED: Der Schlaganfall ist eine der Hauptursachen für bleibende Behinderung und Tod; das Risiko steigt mit dem Alter. Der Primär- und Sekundärprävention kommt eine hohe Priorität zu. Die Behandlung von Risikofaktoren wie Bluthochdruck, Diabetes mellitus und Hyperlipidämie ist neben der Optimierung von Lebensstil und Ernährung ebenso bedeutend wie die Antikoagulation bei Vorhofflimmern. In der Rezidivprophylaxe spielen Thrombozytenfunktionshemmer eine Rolle, Karotisoperation oder Stenting kommen bei ausgewählten Individuen zum Einsatz. Für alte Menschen gibt es nur geringe Studienevidenz; eine individualisierte Therapieplanung berücksichtigt funktionellen Status und Komorbiditäten.

BACKGROUND: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible.
OBJECTIVE: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB.
METHODS: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia.
RESULTS: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (β=-0.65, 95% CI -1.15 to -0.15; P=.01) and simple motor (β=-0.86, 95% CI -1.43 to -0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model.
CONCLUSIONS: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral.

Cerebrovascular diseases, especially stroke, are critical and heterogenous clinical conditions associated with high mortality and chronic disability. Genome-wide association studies reveal substantial stroke heritability, though specific genetic variants account for a minor fraction of stroke risk, suggesting an essential role for the epigenome. Epigenome-wide association studies and candidate gene approaches show that DNA methylation patterns significantly influence stroke susceptibility. Additionally, chromatin remodelers and non-coding RNA regulate gene expression in response to ischemic conditions. In this updated review, we summarized the progress of knowledge on epigenetics in the field of ischemic stroke underlying opportunities and challenges.
Cerebrovascular diseases include different clinical conditions, with stroke being the most serious. Stroke is the second leading cause of death and the primary cause of long-term disability globally. It is a multifactorial condition resulting from the interaction among environmental, genetic and epigenetic factors. In the last decades, several authors have explored the role of epigenetics in stroke.Epigenetics involves changes in how our genes work without altering the actual DNA. Fundamental epigenetic mechanisms include DNA methylation, histone modifications, chromatin remodeling and RNA-based mechanisms. Among these, DNA methylation, consisting of adding a methyl group to DNA, is the most studied mechanism in stroke. This summary reviews studies on how these epigenetic mechanisms play a role in stroke by examining human research. Understanding these mechanisms helps in finding better ways to treat or prevent stroke.

UNASSIGNED: Unawareness of the risk factors is one of the most important issues that need to be settled for stroke prevention. We aimed to evaluate the awareness of risk factors for cerebrovascular diseases (CVDs) among acute ischemic stroke patients and to investigate the characteristics of patients who were unaware of their risk factors in Shenzhen, China.
UNASSIGNED: Registered data on awareness of CVD risk factors of patients with confirmed acute ischemic stroke (AIS) from June 2020 to December 2022 were analyzed in May 2023. The data were extracted from the database of Shenzhen Quality Control Center for Management of Cerebrovascular Diseases.
UNASSIGNED: Totally, there were 5147 AIS patients with complete data eligible for this study. AIS patients\' awareness regarding existing hypertension, diabetes, dyslipidemia, and atrial fibrillation (AF) was 76.1%, 76.2%, 24.2%, and 53.4%, respectively. Patients who were lack of awareness of the CVD risk factors were more likely to be males, individuals with younger ages, and those without medical insurance or a CVD history.
UNASSIGNED: The overall awareness of the CVD risk factors was suboptimal among AIS patients in Shenzhen, especially for the existing dyslipidemia. The health education of AIS should be further improved in males as well as individuals without medical insurance or any CVD histories. Age was an independent factor associated with the lack of awareness of the CVD risk factors. The stroke screening program should be extended to younger people.

Chemokine like factor 1 (CKLF1) is a novel atypical chemokine, playing a crucial role in cardiovascular and cerebrovascular diseases (CCVDs) demonstrated by a growing body of works. In cardiovascular diseases including atherosclerosis and myocardial infarction, meanwhile in cerebrovascular diseases such as ischemic stroke and hemorrhagic stroke, the expression levels of CKLF1 change markedly, which triggers downstream signaling pathways by binding with its functional receptors, and then exerts multiple effects to participate in the occurrence and development of these CCVDs. The functional roles of CKLF1 are dynamic and CKLF1 may act as a double-edged sword. The CCVDs-promoting role is related to recruiting inflammatory cells, enhancing the proliferation of vascular smooth muscle cells and endothelial cells, while the CCVDs-suppressing role may correlate with migration of nerve cells and promotion of hematopoietic stem cell proliferation which contributes to disease recovery. Based on this, the paper intends to review expression shifts, potential roles, and molecular mechanisms of CKLF1 in CCVDs, and the current status of CKLF1 targeted therapeutic strategies is also included. We hope this review may provide a valuable reference for using CKLF1 as a diagnostic and prognostic biomarker for CCVDs or developing novel treatments.

Pyruvate kinase M2 (PKM2), a key enzyme involved in glycolysis,plays an important role in regulating cell metabolism and growth under different physiological conditions. PKM2 has been intensively investigated in multiple cancer diseases. Recent years, many studies have found its pivotal role in cerebrovascular diseases (CeVDs), the disturbances in intracranial blood circulation. CeVDs has been confirmed to be closely associated with oxidative stress (OS), mitochondrial dynamics, systemic inflammation, and local neuroinflammation in the brain. It has further been revealed that PKM2 exerts various biological functions in the regulation of energy supply, OS, inflammatory responses, and mitochondrial dysfunction. The roles of PKM2 are closely related to its different isoforms, expression levels in subcellular localization, and post-translational modifications. Therefore, summarizing the roles of PKM2 in CeVDs will help further understanding the molecular mechanisms of CeVDs. In this review, we illustrate the characteristics of PKM2, the regulated PKM2 expression, and the biological roles of PKM2 in CeVDs.

BACKGROUND: The method for compressing hemorrhagic sites after transradial access has been a topic of interest, yet definitive guidelines remain elusive. This study aims to address this gap by optimizing the mechanical compression hemostasis protocol after transradial access.
METHODS: This retrospective analysis included 300 patients from the Department of Cerebrovascular Diseases, Shanghai Fourth People\'s Hospital affiliated to Tongji University, who underwent transradial access for cerebrovascular angiography. Following the procedure, patients received radial artery compression hemostasis using a balloon compressor. They were divided into group A (n=100, continuous deflation) and group B (n=200, intermittent deflation) according to different hemostasis methods. The incidence of bleeding at the puncture site and complications were compared between the two groups.
RESULTS: The rate of bleeding at the puncture site was significantly lower in group B (20 out of 200 patients) compared to group A (20 out of 100 patients) (P=0.032). Similarly, the incidence of puncture site complications, such as edema, congestion, and wound infection was lower in group B (5 out of 200 patients) compared to group A (10 out of 100 patients) (P=0.006).
CONCLUSIONS: Four hours of compression with intermittent deflation (group B) emerged as the optimal compression method after transradial access, demonstrating fewer complications at the patient\'s puncture site.

Every year, millions of people around the world are disabled by stroke, it is well recognized that complications aftera stroke extend hospital stays and pressure ulcers, a stroke consequence, which can be prevented by educating the caregiver. The primary focus of this research is not only to investigate the prevalence of pressure ulcers (PU) among stroke patients, but this study also introduced a variety of factors which influence the formation of PU, such as restricted mobility, gender, duration of stroke, hypertension, diabetes, hygiene, type of mattress, malnutrition, awareness, etc. In addition, this research provides a comparative and statistical analysis, a cause of the catastrophic disabilities influenced by a variety of factors. Moreover, the proposed research also provides a room for the pertinent treatment of stroke patient to curtail the formation of pressure ulcer. In this research, a total of 120 stroke patients were initially included to monitor the frequency of pressure ulcers at incipient stage. Out of the total patients, the number of patients with ischemic stroke were 78.5 % while 8.3 % were of haemorrhagic type. In the results, the demographic characteristics and the factors which influence the formation of PU of the patients were examined with their cross-sectional impact on each other through comparative and statistical analysis. It was discovered that among all the stroke patients, 8.3 % were found with a PUs and the most frequent localization was sacrum and no new PU was observed for the participants under the observation.