Background: The atherosclerotic process can cause compensatory enlargement of artery diameter. However, the association between common carotid artery (CCA) diameter and stroke remains unclear. Methods: This cross-sectional study included 5668 participants >= 40 years of age residing in rural northeast China, in whom the inter-adventitial diameter of CCA was measured. The association between CCA diameter and stroke prevalence was explored using multivariate logistic regression and concentration-response relationship in females and males, respectively. Results: CCA diameter (mm) was greater in stroke than in non-stroke populations in both males (7.73 versus [vs.] 7.49; P < 0.05) and females (7.69 vs. 7.13; P < 0.001). Among males, when dividing CCA diameters into quartiles, the second quartile (6.86-7.5 mm) had a 1.64 times higher risk for stroke than the bottom quartile (< 6.85 mm) (P < 0.05) in the adjusted model. In females, the top quartile (> 7.95 mm) had a 2.08 (1.07-4.04) times higher risk than the bottom quartile (< 6.50 mm) (P < 0.01) (overall trend 1.19 [1.00-1.43]). Moreover, dose-response relationship confirmed correlations between CCA diameter and stroke in females (P < 0.05). The net reclassification index (NRI) and integrated discrimination index (IDI) confirmed the incremental value of CCA diameter in predicting probability of stroke in females (NRI 0.353 [95% confidence interval (CI) 0.198-0.497], P < 0.001; IDI 0.004 [95% CI 0.001-0.006], P < 0.01) and males (NRI 0.201 [95% CI 0.158-0.241], P < 0.001; IDI 0.005 [95% CI 0.001-0.009], P < 0.01). Conclusions: This study highlighted the incremental value of CCA diameter in optimizing risk classification and stroke prevention in a Chinese population.

Objective: Carotid atherosclerosis is a known marker of increased cardiovascular risk. We aimed to assess the current epidemiology of carotid atherosclerosis, carotid plaque and related risk factors in rural northeast China. Methods: The population-based, cross-sectional study was conducted in 5,838 adults aged ≥40 years residing in rural northeast China in 2017–2018. A multi-stage cluster sampling method was used to select the representative sample. Carotid atherosclerosis was defined as carotid intima-media thickness (CIMT) ≥1.0 mm or presence of plaque. Results: The mean CIMT was 0.72 ± 0.13 mm and increased with age in this population. Among 2,457 individuals with carotid atherosclerosis, 2,333 were diagnosed with carotid plaque, and 210 individuals were moderate or severe carotid stenosis. Crude prevalence of carotid atherosclerosis and plaque were 42.1 and 40.0%, significantly higher in men than in women ( p < 0.001). The age-standardized prevalence of carotid atherosclerosis and carotid plaque were 33.1 and 31.5%, respectively. Advancing age, men, hypertension, diabetes, current smoking, ever-smoking and lack of exercise were risk factors for carotid atherosclerosis. Hypertension (69.1%), dyslipidemia (26.0%) and diabetes (16.1%) were highly prevalent in participants with carotid atherosclerosis. However, the control rates of those comorbidities were frustratingly low (4.7, 8.2, and 14.2%, respectively). Conclusions: The high prevalence of carotid atherosclerosis, carotid plaque, carotid stenosis and uncontrolled risk factors indicated the high burden of cardiovascular disease in rural northeast China, particularly in men. Strategies of prevention and management of atherosclerosis and related risk factors were urgently needed in rural northeast China.

Objective: This paper aims to examine the effect and advantages of Acetyl Gastrodin on residual dizziness after benign paroxysmal positional vertigo (BPPV) reduction. Methods: The method includes selecting the subjects of the study diagnosed as the first BPPV and treated by manual or instrumental resetting whose vertigo or positional nystagmus disappeared completely after one day when receiving treatment, but there are residual symptoms from the encephalopathy clinic in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from August 2017 to June 2018. The patients were randomly divided into 3 groups with 36 cases in each group. The treatment group of Acetyl Gastrodin (produced by Kunming Pharmaceutical Group Co., Ltd., 50mg/tablet) recieved 100mg each time, 3 times a day, orally; The treatment group of Merislon (produced by Eisai, betahistine mesylate, 6mg/tablet) recieved 12nzg each time, 3 times a day, orally; and both groups were treated for 10 days as a course of treatment. The treatment group of Placebo: Vitamin B1 tablets, recieved 20mg, 3 times a day, orally. Observing the dizziness disability score, vertigo recurrence rate, RD duration and activity balance confidence scale occured in 3 groups every one week, two weeks, one month and three months. Results: There are no statistically significant differences in gender, age, and vascular risk factors among the three groups. There is no significant difference in the physical, functional, and DHI body between the treatment group of Placebo before and after the treatment; The DHI body and functional rating in the treatment group of Acetyl Gastrodin are statistically different, DHI emotional scores are statistically different (P<0.05); There is a statistically significant difference in DHI function scores in the treatment group of Merislon before and after treatment (P<0.05), there is no statistical difference in DHI body scores and mood scores. Compared with the treatment group of Placebo, there is a statistically significant difference in the improvement of vertigo grading between the treatment group of Acetyl Gastrodin and the treatment group of Merislon (P<0.05). Compared to the treatment group of Acetyl Gastrodin, the treatment group of Merislon has a statistically significant difference in the DHI functional score reduction rate (P<0.05). While compared to the treatment group of Merislon, the treatment group of Acetyl Gastrodin has a statistically significant difference in the DHI emotional score reduction rate (P<0.05). There is no significant difference in the reduction rate between DHI body score and vertigo classification between the two groups (P<0.05). There is no significant difference in the DHI score and the ABC scale score between the 3 groups of patients at one week and two weeks. There is a statistically significant difference in the DHI score and the ABC scale score between one month and three months. There is no statistical difference in the duration of RD duration at one week, and there are significant differences at two weeks, one month and three months. There are no significant clinical adverse reactions that are observed in the three groups after treatment. Conclusion: Acetyl Gastrodin can improve DHI emotional scores more prominently, and there is no significant adverse reactions.

Intracranial arterial dolichoectasia (IADE), also known as dilatative arteriopathy of the brain vessels, refers to an increase in the length and diameter of at least one intracranial artery, and accounts for approximately 12% of all patients with stroke. However, the association of IADE with stroke is usually unclear. Cerebral small vessel disease (CSVD) is characterized by pathological changes in the small vessels. Clinically, patients with CSVD can be asymptomatic or present with stroke or cognitive decline. In the past 20 years, a series of studies have strongly promoted an understanding of the association between IADE and CSVD from clinical and pathological perspectives. It has been proposed that IADE and CSVD may be attributed to abnormal vascular remodeling driven by an abnormal matrix metalloproteinase/tissue inhibitor of metalloproteinase pathway. Also, IADErelated hemodynamic changes may result in initiation or progression of CSVD. Additionally, genetic factors are implicated in the pathogenesis of IADE and CSVD. Patients with Fabry's disease and late-onset Pompe's disease are prone to developing concomitant IADE and CSVD, and patients with collagen IV alpha 1 or 2 gene (COL4A1/COL4A2) and forkhead box C1 (FOXC1) variants present with IADE and CSVD. Race, strain, familial status, and vascular risk factors may be involved in the pathogenesis of IADE and CSVD. As well, experiments in mice have pointed to genetic strain as a predisposing factor for IADE and CSVD. However, there have been few direct genetic studies aimed towards determining the association between IADE and CSVD. In the future, more clinical and basic research studies are needed to elucidate the causal relationship between IADE and CSVD and the related molecular and genetic mechanisms.

Background and Purpose:Although vertebrobasilar ectasia (VBE) is diagnosed with increasing frequency, it is not clear whether this is because of altered hemodynamics caused by the effects of matrix metalloproteinases (MMPs) and/or vertebral artery dominance (VAD). Therefore, we investigate the relationship between plasma levels of MMPs and VBE in patients with vertigo or dizziness who also have vascular risk factors, in order to determine whether high levels of MMPs in VBE are independent of VAD. Methods:We prospectively studied 285 patients with vertigo or dizziness and at least one vascular risk factor. Plasma levels of MMPs, tissue inhibitor of metalloproteinases (TIMPs) and cathepsin L were measured. Subjects were classified as VBE-negative or VBE-positive, who were further classified based on the presence of VAD with magnetic resonance angiography. Acute ischemic stroke was screened by diffusion-weighted imaging, generally after bedside evaluation and the drawing of blood samples. Receiver operating characteristic (ROC) curves were applied to evaluate the utility of these potential biomarkers in predicting risk for ischemic stroke. Results:The prevalence of VBE in patients with vertigo or dizziness was 16.5%. Of the 82 patients with ischemic stroke, 14 strokes involved the cortex or subcortex. MMP-9 levels were significantly higher in the VBE-positive group than in the VBE-negative group (P= 0.022). There was a significant difference in the risk of posterior circulation ischemic stroke between the VBE-positive group and the VBE-negative group (P= 0.002). Levels of MMP-2 and cathepsin L tended to be higher in the VBE-negative group (P= 0.054,P= 0.060, respectively). Compared with the non-VAD subgroup, levels of MMP-2,-3,-9, TIMP-1,-2, and cathepsin L were similar in the VAD subgroup. ROC analysis showed that MMP-9 predicted risk for ischemic stroke (AUC = 0.582, 95%CI, 0.510-0.654,P= 0.030). Conclusions:MMP-9 was associated with VBE and independent of VAD. High levels of MMP-9 may predict risk for ischemic stroke in patients with vertigo or dizziness who also have vascular risk factors.