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Simultaneous assessment of plaque morphology, cerebral micro-embolic signal status and platelet biomarkers in patients with recently symptomatic and asymptomatic carotid stenosis 近期有症状和无症状颈动脉狭窄患者斑块形态、脑微栓塞信号状态和血小板生物标志物的同步评估
Pub Date : 2019-11-11 DOI: 10.1177/0271678X19884427
S. J. Murphy, S. T. Lim, J. Kinsella, S. Tierney, B. Egan, T. Feeley, Clare Dooley, James Kelly, S. Murphy, R. Walsh, R. Collins, T. Coughlan, D. O’Neill, J. Harbison, P. Madhavan, S. O'Neill, M. Colgan, J. Meaney, G. Hamilton, D. McCabe
The relationship between plaque morphology, cerebral micro-embolic signals (MES) and platelet biomarkers in carotid stenosis patients warrants investigation. We combined data from two prospective, observational studies to assess carotid plaque morphology and relationship with cerebral MES and platelet biomarkers in patients with recently symptomatic (≤4 weeks of transient ischaemic attack (TIA)/ischaemic stroke) versus asymptomatic carotid stenosis. Plaque morphology on ultrasound was graded with Grey-Scale Median (GSM) and Gray–Weale (GW) scoring. Bilateral transcranial Doppler ultrasound classified patients as ‘MES+ve’ or ‘MES-ve’. Full blood counts were analysed and flow cytometry quantified CD62P and CD63 expression, leucocyte-platelet complexes and reticulated platelets. Data from 42 recently symptomatic carotid stenosis patients were compared with those from 36 asymptomatic patients. There were no differences in median GSM scores between symptomatic and asymptomatic patients (25 vs. 30; P = 0.31) or between MES+ve vs. MES-ve symptomatic patients (36 vs. 25; P = 0.09). Symptomatic patients with GSM-echodense plaques (GSM ≥25) had higher platelet counts (228 vs. 191 × 109/L), neutrophil–platelet (3.3 vs. 2.7%), monocyte–platelet (6.3 vs. 4.55%) and lymphocyte–platelet complexes (2.91 vs. 2.53%) than ‘asymptomatic patients with GSM-echodense plaques’ (P ≤ 0.03). Recently, symptomatic carotid stenosis patients with ‘GSM-echodense plaques’ have enhanced platelet production/secretion/activation compared with their asymptomatic counterparts. Simultaneous assessment with neurovascular imaging and platelet biomarkers may aid risk-stratification in carotid stenosis.
颈动脉狭窄患者斑块形态、脑微栓塞信号(MES)和血小板生物标志物之间的关系值得研究。我们结合了两项前瞻性观察性研究的数据,以评估近期有症状(≤4周的短暂性缺血发作(TIA)/缺血性卒中)与无症状颈动脉狭窄患者的颈动脉斑块形态及其与大脑MES和血小板生物标志物的关系。超声对斑块形态进行灰度中位数(GSM)和灰度weale (GW)评分。双侧经颅多普勒超声将患者分为“MES+ve”或“MES-ve”。全血细胞计数分析和流式细胞术定量CD62P和CD63表达,白细胞-血小板复合物和网状血小板。我们比较了42例近期出现症状的颈动脉狭窄患者和36例无症状患者的数据。有症状和无症状患者的中位GSM评分无差异(25 vs 30;P = 0.31)或MES+ve与MES-ve症状患者之间的差异(36 vs 25;p = 0.09)。有症状的GSM-回声致密斑块(GSM≥25)患者血小板计数(228比191 × 109/L)、中性粒细胞-血小板计数(3.3比2.7%)、单核细胞-血小板计数(6.3比4.55%)和淋巴细胞-血小板复合物计数(2.91比2.53%)均高于无症状的GSM-回声致密斑块患者(P≤0.03)。最近,有症状的颈动脉狭窄患者与无症状的患者相比,伴有“gsm -回声致密斑块”的患者血小板生成/分泌/激活增强。同时评估神经血管成像和血小板生物标志物可能有助于颈动脉狭窄的风险分层。
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引用次数: 4
The JCBFM Symposium at BRAIN 2019 2019年BRAIN JCBFM研讨会
Pub Date : 2019-11-11 DOI: 10.1177/0271678X19887783
R. Dijkhuizen
A symposium dedicated to the readership of the Journal of Cerebral Blood Flow and Metabolism was organized by the Journal’s editorial team at the BRAIN 2019 meeting in Yokohama, Japan. The JCBFM Symposium offered excellent presentations by two top-cited authors and two Associate Editors, with topics ranging from basic science to clinical studies, followed by stimulating discussion with the audience. Hence, the JCBFM Symposium was a great example of committed participation of authors, editors and readers of the Journal, who all contribute to the advancement of translational neurovascular research.
《脑血流与代谢杂志》的编辑团队在日本横滨举行的2019年BRAIN会议上组织了一场专门为《脑血流与代谢杂志》读者举办的研讨会。JCBFM研讨会由两位被引用最多的作者和两位副编辑提供了精彩的演讲,主题从基础科学到临床研究,随后与听众进行了刺激的讨论。因此,JCBFM研讨会是期刊作者、编辑和读者共同参与的一个很好的例子,他们都为翻译神经血管研究的进步做出了贡献。
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引用次数: 0
HDAC4 and HDAC5 form a complex with DREAM that epigenetically down-regulates NCX3 gene and its pharmacological inhibition reduces neuronal stroke damage HDAC4和HDAC5与DREAM形成复合物,表观遗传下调NCX3基因,其药理抑制作用可减轻神经元卒中损伤
Pub Date : 2019-11-07 DOI: 10.1177/0271678X19884742
L. Formisano, G. Laudati, N. Guida, L. Mascolo, Angelo Serani, O. Cuomo, Maria Cantile, F. Boscia, P. Molinaro, S. Anzilotti, Vincenzo Pizzorusso, G. di Renzo, G. Pignataro, L. Annunziato
The histone deacetylases (HDACs)-dependent mechanisms regulating gene transcription of the Na+/Ca+ exchanger isoform 3 (ncx3) after stroke are still unknown. Overexpression or knocking-down of HDAC4/HDAC5 down-regulates or increases, respectively, NCX3 mRNA and protein. Likewise, MC1568 (class IIa HDACs inhibitor), but not MS-275 (class I HDACs inhibitor) increased NCX3 promoter activity, gene and protein expression. Furthermore, HDAC4 and HDAC5 physically interacted with the transcription factor downstream regulatory element antagonist modulator (DREAM). As MC1568, DREAM knocking-down prevented HDAC4 and HDAC5 recruitment to the ncx3 promoter. Importantly, DREAM, HDAC4, and HDAC5 recruitment to the ncx3 gene was increased in the temporoparietal cortex of rats subjected to transient middle cerebral artery occlusion (tMCAO), with a consequent histone-deacetylation of ncx3 promoter. Conversely, the tMCAO-induced NCX3 reduction was prevented by intracerebroventricular injection of siDREAM, siHDAC4, and siHDAC5. Notably, MC1568 prevented oxygen glucose deprivation plus reoxygenation and tMCAO-induced neuronal damage, whereas its neuroprotective effect was abolished by ncx3 knockdown. Collectively, we found that: (1) DREAM/HDAC4/HDAC5 complex epigenetically down-regulates ncx3 gene transcription after stroke, and (2) pharmacological inhibition of class IIa HDACs reduces stroke-induced neurodetrimental effects.
脑卒中后组蛋白去乙酰化酶(hdac)依赖性调节Na+/Ca+交换物异构体3 (ncx3)基因转录的机制尚不清楚。过表达或低表达HDAC4/HDAC5分别下调或上调NCX3 mRNA和蛋白。同样,MC1568 (IIa类hdac抑制剂),而MS-275 (I类hdac抑制剂)没有增加NCX3启动子活性、基因和蛋白的表达。此外,HDAC4和HDAC5与转录因子下游调控元件拮抗剂(DREAM)相互作用。如MC1568, DREAM敲除阻止HDAC4和HDAC5募集到新启动子。重要的是,在短暂性大脑中动脉闭塞(tMCAO)大鼠的颞顶叶皮层中,DREAM、HDAC4和HDAC5向ncx3基因募集增加,导致ncx3启动子组蛋白去乙酰化。相反,脑室内注射siDREAM、siHDAC4和siHDAC5可以阻止tmcao诱导的NCX3减少。值得注意的是,MC1568可以防止氧葡萄糖剥夺加再氧化和tmcao诱导的神经元损伤,而其神经保护作用被ncx3敲除而消除。综上所述,我们发现:(1)DREAM/HDAC4/HDAC5复合体在脑卒中后通过表观遗传下调ncx3基因转录;(2)IIa类hdac的药理抑制可减少脑卒中诱导的神经损伤。
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引用次数: 11
Opening the time window 打开时间窗口
Pub Date : 2019-10-14 DOI: 10.1177/0271678X19882782
K. van Leyen, Xiaoying Wang, M. Selim, E. Lo
Abstract The recently completed EXTEND trial tested the idea that tissue plasminogen activator thrombolysis can be safely extended up to 9 h after stroke onset if automated perfusion imaging indicates the presence of a salvageable penumbra. This important trial contributes to an ongoing paradigm shift for stroke therapy. Combined with the introduction of endovascular therapy, image-guided patient selection is expanding the toolbox of the stroke practitioner. At the same time, pushing the limits of reperfusion has raised important questions about mechanisms to pursue for combination therapy as well as potential approaches to mitigate side effects and optimize treatments for patients with various co-morbidities.
最近完成的EXTEND试验验证了组织纤溶酶原激活剂溶栓可以安全地延长至中风发作后9小时,如果自动灌注成像显示存在可抢救的半暗带。这项重要的试验有助于中风治疗的持续范式转变。结合血管内治疗的引入,图像引导的患者选择正在扩大中风医生的工具箱。同时,推动再灌注的极限提出了重要的问题,即寻求联合治疗的机制,以及减轻副作用和优化治疗各种合并症患者的潜在方法。
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引用次数: 9
Delayed recanalization in acute ischemic stroke patients: Late is better than never? 急性缺血性脑卒中患者延迟再通:晚做总比不做好?
Pub Date : 2019-10-08 DOI: 10.1177/0271678X19881449
Jinwei Pang, John H. Zhang, Yong Jiang
Successful recanalization of the occluded vessel as early as possible has been widely accepted as the key principle of acute ischemic stroke (AIS) treatment. Unfortunately, for many years, the vast majority of AIS patients were prevented from receiving effective recanalization therapy because of a narrow therapeutic window. Recently, a series of inspiring clinical trials have indicated that more patients may benefit from delayed recanalization during an expanded therapeutic window, even up to 24 h after symptom onset. However, could potentially salvageable brain tissue (penumbra) in patients who do not receive medication within 24 h still possible to be saved?
尽早成功的闭塞血管再通已被广泛认为是治疗急性缺血性脑卒中的关键原则。不幸的是,多年来,由于狭窄的治疗窗口,绝大多数AIS患者无法接受有效的再通治疗。最近,一系列鼓舞人心的临床试验表明,在扩大的治疗窗口期间,甚至在症状发作后24小时,更多的患者可能受益于延迟再通。然而,在24小时内未接受药物治疗的患者中,有可能挽救的脑组织(半暗带)仍然有可能被挽救吗?
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引用次数: 9
The effect of angiopoietin-1 upregulation on the outcome of acute ischaemic stroke in rodent models: A meta-analysis 血管生成素-1上调对啮齿动物急性缺血性卒中预后的影响:一项荟萃分析
Pub Date : 2019-10-04 DOI: 10.1177/0271678X19876876
J. Moxon, A. Trollope, Brittany Dewdney, Catherine de Hollander, Domenico R. Nastasi, J. Maguire, J. Golledge
Clinical studies report that low circulating angiopoietin-1 concentration at presentation predicts worse outcomes after ischaemic stroke. Upregulating angiopoietin-1 may therefore have therapeutic benefit for ischaemic stroke. This systematic review assessed whether upregulating angiopoietin-1 improved outcomes in rodent models of ischaemic stroke. Random-effects models quantified the effect of angiopoietin-1 upregulation on stroke severity in terms of the size of cerebral infarction and the extent of blood–brain barrier permeability. Eleven studies utilising rat and mouse models of ischaemic stroke fulfilled the inclusion criteria. Meta-analyses demonstrated that angiopoietin-1 upregulation significantly reduced cerebral infarction size (standardised mean difference: –3.02; 95% confidence intervals: –4.41, –1.63; p < 0.001; n = 171 animals) and improved blood–brain barrier integrity (standardized mean difference: –2.02; 95% confidence intervals: –3.27, –0.77; p = 0.002; n = 129 animals). Subgroup analyses demonstrated that angiopoietin-1 upregulation improved outcomes in models of transient, not permanent cerebral ischaemia. Six studies assessed the effect of angiopoietin-1 upregulation on neurological function; however, inter-study heterogeneity prevented meta-analysis. In conclusion, published rodent data suggest that angiopoietin-1 upregulation improves outcome following temporary cerebral ischaemia by reducing cerebral infarction size and improving blood–brain barrier integrity. Additional research is required to examine the effect of angiopoietin-1 upregulation on neurological function during stroke recovery and investigate the benefit and risks in patients.
临床研究报告,出现时低循环血管生成素-1浓度预示着缺血性卒中后更糟糕的预后。因此,上调血管生成素-1可能对缺血性中风有治疗作用。本系统综述评估了上调血管生成素-1是否能改善缺血性脑卒中啮齿动物模型的预后。随机效应模型量化了血管生成素-1上调对脑梗死大小和血脑屏障通透程度的影响。11项利用大鼠和小鼠缺血性卒中模型的研究符合纳入标准。荟萃分析显示,血管生成素-1上调可显著减少脑梗死面积(标准化平均差:-3.02;95%置信区间:-4.41,-1.63;p < 0.001;N = 171只动物)和改善血脑屏障完整性(标准化平均差:-2.02;95%置信区间:-3.27,-0.77;p = 0.002;N = 129只动物)。亚组分析表明,血管生成素-1上调可改善短暂性而非永久性脑缺血模型的预后。六项研究评估了血管生成素-1上调对神经功能的影响;然而,研究间的异质性阻碍了meta分析。总之,已发表的啮齿动物数据表明,血管生成素-1上调可通过减少脑梗死面积和改善血脑屏障完整性来改善暂时性脑缺血后的预后。需要进一步的研究来检验血管生成素-1上调对中风恢复期间神经功能的影响,并调查其对患者的益处和风险。
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引用次数: 11
Different preprocessing strategies lead to different conclusions: A [11C]DASB-PET reproducibility study 不同的预处理策略导致不同的结论:A [11C]DASB-PET重复性研究
Pub Date : 2019-10-01 DOI: 10.1177/0271678X19880450
M. Nørgaard, M. Ganz, C. Svarer, V. Frokjaer, D. Greve, S. Strother, G. Knudsen
Positron emission tomography (PET) neuroimaging provides unique possibilities to study biological processes in vivo under basal and interventional conditions. For quantification of PET data, researchers commonly apply different arrays of sequential data analytic methods (“preprocessing pipeline”), but it is often unknown how the choice of preprocessing affects the final outcome. Here, we use an available data set from a double-blind, randomized, placebo-controlled [11C]DASB-PET study as a case to evaluate how the choice of preprocessing affects the outcome of the study. We tested the impact of 384 commonly used preprocessing strategies on a previously reported positive association between the change from baseline in neocortical serotonin transporter binding determined with [11C]DASB-PET, and change in depressive symptoms, following a pharmacological sex hormone manipulation intervention in 30 women. The two preprocessing steps that were most critical for the outcome were motion correction and kinetic modeling of the dynamic PET data. We found that 36% of the applied preprocessing strategies replicated the originally reported finding (p < 0.05). For preprocessing strategies with motion correction, the replication percentage was 72%, whereas it was 0% for strategies without motion correction. In conclusion, the choice of preprocessing strategy can have a major impact on a study outcome.
正电子发射断层扫描(PET)神经成像为研究基础和介入性条件下的体内生物过程提供了独特的可能性。对于PET数据的量化,研究人员通常采用不同的顺序数据分析方法阵列(“预处理管道”),但通常不知道预处理的选择如何影响最终结果。在这里,我们使用来自双盲、随机、安慰剂对照[11C]DASB-PET研究的可用数据集作为案例来评估预处理的选择如何影响研究结果。我们测试了384种常用的预处理策略对先前报道的新皮质5 -羟色胺转运体结合变化与抑郁症状变化之间的正相关的影响,这些变化与[11C]DASB-PET测定的基线呈正相关,在30名女性中进行了药理学性激素操纵干预。对结果最关键的两个预处理步骤是动态PET数据的运动校正和动力学建模。我们发现36%的预处理策略重复了最初报道的发现(p < 0.05)。有运动校正的预处理策略复制率为72%,无运动校正的预处理策略复制率为0%。总之,预处理策略的选择会对研究结果产生重大影响。
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引用次数: 8
Robust RBM3 and β-klotho expression in developing neurons in the human brain RBM3和β-klotho在人脑发育神经元中的表达
Pub Date : 2019-09-29 DOI: 10.1177/0271678X19878889
Travis C. Jackson, Keri L Janesko-Feldman, S. Carlson, S. E. Kotermanski, P. Kochanek
RNA binding motif 3 (RBM3) is a powerful neuroprotectant that inhibits neurodegenerative cell death in vivo and is a promising therapeutic target in brain ischemia. RBM3 is increased by the hormone fibroblast growth factor 21 (FGF21) in an age- and temperature-dependent manner in rat cortical neurons. FGF21 receptor binding is controlled by the transmembrane protein β-klotho, which is mostly absent in the adult brain. We discovered that RBM3/β-klotho is unexpectedly high in the human infant vs. adult brain (hippocampus/prefrontal cortex). The use of tissue homogenates in that study precluded a comparison of RBM3/β-klotho expression among different CNS cell-types, thus, omitted key evidence (i.e. confirmation of neuronal expression) that would otherwise provide a critical link to support their possible direct neuroprotective effects in humans. This report addresses that knowledge gap. High-quality fixed human hippocampus, cortex, and hypothalamic tissues were acquired from the NIH Neurobiobank (<1 yr (premature born) infants, 1 yr, 4 yr, and 34 yr). Dual labeling of cell-type markers vs. RBM3/β-klotho revealed enriched staining of targets in neurons in the developing brain. Identifying that RBM3/β-klotho is abundant in neurons in the immature brain is fundamentally important to guide protocol design and conceptual frameworks germane to future testing of these neuroprotective pathways in humans.
RNA结合基序3 (RNA binding motif 3, RBM3)是一种有效的神经保护剂,在体内可抑制神经退行性细胞死亡,是脑缺血治疗中有前景的治疗靶点。成纤维细胞生长因子21 (FGF21)在大鼠皮质神经元中以年龄和温度依赖的方式增加RBM3。FGF21受体的结合由跨膜蛋白β-klotho控制,该蛋白在成人大脑中大多不存在。我们发现RBM3/β-klotho在婴儿大脑(海马/前额叶皮质)中出乎意料地高。在该研究中,使用组织匀浆排除了RBM3/β-klotho在不同中枢神经系统细胞类型之间表达的比较,因此,忽略了关键证据(即神经元表达的确认),否则将提供关键联系,以支持它们在人类中可能的直接神经保护作用。本报告解决了这一知识差距。高质量的固定人海马、皮质和下丘脑组织来自NIH神经生物银行(<1岁(早产)婴儿、1岁、4岁和34岁)。细胞类型标记物与RBM3/β-klotho的双重标记显示,发育中的大脑神经元中的靶标染色丰富。确定RBM3/β-klotho在未成熟大脑的神经元中丰富,对于指导方案设计和概念框架至关重要,这与未来在人类中测试这些神经保护通路有关。
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引用次数: 14
Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion 临床记忆患者的皮质微梗死与脑灌注减少有关
Pub Date : 2019-09-26 DOI: 10.1177/0271678X19877403
D. Ferro, H. Mutsaerts, S. Hilal, H. Kuijf, E. Petersen, J. Petr, Susanne J. van Veluw, N. Venketasubramanian, Tan Boon Yeow, G. Biessels, Christopher L H Chen
Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = −.20) and 22% higher spatial CoV (beta = .20) (both p < .05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia.
脑皮质微梗死(CMIs)是与认知障碍和痴呆相关的小的缺血性病变。cmi经常在皮质分水岭区观察到,这表明灌注不足有助于其发展。我们研究了CMIs的存在是否与脑灌注减少有关,是否与CMIs周围皮质的整体或特异性减少有关。181例临床记忆患者(平均年龄72±9岁,男性占51%),在3-T磁共振成像(MRI)上评估CMI的存在。采用伪连续动脉自旋标记参数脑血流(CBF)(以mL血/100 g组织/min为灌注单位)和空间变异系数(CoV)(反映动脉传递时间(ATT)),从前循环皮层灰质评估脑灌注。在基于体素的CBF分析中,CMIs患者的CBF低12% (β = - 0.20),空间CoV高22% (β = 0.20)(均p < 0.05),没有特定的区域模式。cmi周围2cm感兴趣区域的脑血流与对侧半球参考区域的脑血流没有差异。这些发现表明,记忆临床患者的CMIs主要与脑灌注的整体减少有关,从而为痴呆症血管性脑损伤的病因学提供了新的思路。
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引用次数: 26
Optimizing functional outcome endpoints for stroke recovery studies 优化脑卒中恢复研究的功能终点
Pub Date : 2019-09-14 DOI: 10.1177/0271678X19875212
M. Balkaya, Sunghee Cho
Novel therapeutic intervention that aims to enhance the endogenous recovery potential of the brain during the subacute phase of stroke has produced promising results. The paradigm shift in treatment approaches presents new challenges to preclinical and clinical researchers alike, especially in the functional endpoints domain. Shortcomings of the “neuroprotection” era of stroke research are yet to be fully addressed. Proportional recovery observed in clinics, and potentially in animal models, requires a thorough reevaluation of the methods used to assess recovery. To this end, this review aims to give a detailed evaluation of functional outcome measures used in clinics and preclinical studies. Impairments observed in clinics and animal models will be discussed from a functional testing perspective. Approaches needed to bridge the gap between clinical and preclinical research, along with potential means to measure the moving target recovery, will be discussed. Concepts such as true recovery of function and compensation and methods that are suitable for distinguishing the two are examined. Often-neglected outcomes of stroke, such as emotional disturbances, are discussed to draw attention to the need for further research in this area.
新的治疗干预,旨在提高大脑的内源性恢复潜力在亚急性期中风已经产生了可喜的结果。治疗方法的范式转变对临床前和临床研究人员都提出了新的挑战,特别是在功能终点领域。中风研究的“神经保护”时代的缺点尚未得到充分解决。在诊所和潜在的动物模型中观察到的比例恢复需要对用于评估恢复的方法进行彻底的重新评估。为此,本综述旨在给出临床和临床前研究中使用的功能结果测量的详细评估。在临床和动物模型中观察到的损伤将从功能测试的角度进行讨论。将讨论弥合临床和临床前研究之间差距所需的方法,以及测量移动目标恢复的潜在手段。研究了功能真正恢复和补偿等概念以及区分两者的方法。经常被忽视的结果中风,如情绪障碍,讨论提请注意,需要进一步研究在这一领域。
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引用次数: 18
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Journal of Cerebral Blood Flow & Metabolism
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