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Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease:a narrative review of the assessment methods and clinical implications

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Stroke & Vascular Neurology 2023年第6期8卷 521-530,I0085,I0086页

作者： Yuying Liu Shuang Li Xuan Tian thomas w leung Liping Liu David S Liebeskind Xinyi Leng Department of Medicine and Therapeutics The Chinese University of Hong KongHong Kong SARPeople's Republic of China Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingPeople's Republic of China Department of Neurology Neurovascular Imaging Research CoreUniversity of California Los AngelesLos AngelesCaliforniaUSA

Intracranial atherosclerotic disease(ICAD)is a common cause of ischaemic stroke and transient ischaemic attack(TIA)with a high recurrence rate.It is often referred to as intracranial atherosclerotic stenosis(ICAS),when the plaque has caused significant narrowing of the vessel lumen.The lesion is usually considered‘symptomatic ICAD/ICAS’(sICAD/sICAS)when it has caused an ischaemic stroke or TIA.The severity of luminal stenosis has long been established as a prognostic factor for stroke relapse in sICAS.Yet,accumulating studies have also reported the important roles of plaque vulnerability,cerebral haemodynamics,collateral circulation,cerebral autoregulation and other factors in altering the stroke risks across patients with sICAS.In this review article,we focus on cerebral haemodynamics in sICAS.we reviewed imaging modalities/methods in assessing cerebral haemodynamics,the haemodynamic metrics provided by these methods and application of these methods in research and clinical practice.More importantly,we reviewed the significance of these haemodynamic features in governing the risk of stroke recurrence in sICAS.we also discussed other clinical implications of these haemodynamic features in sICAS,such as the associations with collateral recruitment and evolution of the lesion under medical treatment,and indications for more individualised blood pressure management for secondary stroke prevention.we then put forward some knowledge gaps and future directions on these topics.

关键词： clinical intracranial cerebral

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Genome sequencing reveals the role of rare genomic variants in Chinese patients with symptomatic intracranial atherosclerotic disease

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Stroke & Vascular Neurology 2022年第3期7卷 182-189页

作者： Mengmeng Shi Xinyi Leng Ying Li Zihan Chen Ye Cao Tiffany Chung Bonaventure YM Ip Vincent HL Ip Yannie OY Soo Florence SY Fan Sze Ho Ma Karen Ma Anne Y Y Chan Lisa wC Au Howan leung Alexander Y Lau Vincent CT Mok Kwong wai Choy Zirui Dong thomas w leung Department of Obstetrics and Gynaecology The Chinese University of Hong KongHong KongChina Key Laboratory for Regenerative Medicine Ministry of Education(Shenzhen Base)Shenzhen Research InstituteThe Chinese University of Hong KongShenzhenChina Hong Kong Hub of Paediatric Excellence The Chinese University of Hong KongHong KongChina Department of Medicine and Therapeutics The Chinese University of Hong KongPrince of Wales HospitalHong KongChina Department of Paediatrics The Chinese University of Hong KongHong KongChina The Chinese University of Hong Kong-Baylor College of Medicine Joint Center For Medical Genetics The Chinese University of Hong KongHong KongChina

Objectives The predisposition of intracranial atherosclerotic disease(ICAD)to East Asians over Caucasians infers a genetic basis which,however,remains largely unknown.Higher prevalence of vascular risk factors(VRFs)in Chinese over Caucasian patients who had a stroke,and shared risk factors of ICAD with other stroke subtypes indicate genes related to VRFs and/or other stroke subtypes may also contribute to ICAD.Methods Unrelated symptomatic patients with ICAD were recruited for genome sequencing(GS,60-fold).Rare and potentially deleterious single-nucleotide variants(SNVs)and small insertions/deletions(InDels)were detected in genome-wide and correlated to genes related to VRFs and/or other stroke subtypes.Rare aneuploidies,copy number variants(CNVs)and chromosomal structural rearrangements were also investigated.Lastly,candidate genes were used for pathway and gene ontology enrichment analysis.Results Among 92 patients(mean age at stroke onset 61.0±9.3 years),GS identified likely ICAD-associated rare genomic variants in 54.3%(50/92)of patients.Forty-eight patients(52.2%,48/92)had 59 rare SNVs/InDels reported or predicted to be deleterious in genes related to VRFs and/or other stroke subtypes.None of the 59 rare variants were identified in local subjects without ICAD(n=126).31 SNVs/InDels were related to conventional VRFs,and 28 were discovered in genes related to other stroke subtypes.Our study also showed that rare CNVs(n=7)and structural rearrangement(a balanced translocation)were potentially related to ICAD in 8.7%(8/92)of patients.Lastly,candidate genes were significantly enriched in pathways related to lipoprotein metabolism and cellular lipid catabolic process.Conclusions Our GS study suggests a role of rare genomic variants with various variant types contributing to the development of ICAD in Chinese patients.

关键词： patients metabolism intracranial

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Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

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Stroke & Vascular Neurology 2023年第1期8卷 77-85页

作者： Xuan Tian Hui Fang Linfang Lan Hing Lung Ip Jill Abrigo Haipeng Liu Lina Zheng Florence S Y Fan Sze Ho Ma Bonaventure Ip Bo Song Yuming Xu Jingwei Li Bing Zhang Yun Xu Yannie O Y Soo Vincent Mok Ka Sing wong thomas w leung Xinyi Leng Department of Medicine and Therapeutics The Chinese UniversityHong KongChina Department of Neurology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Neurology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina Department of Imaging and Interventional The Chinese UniversityHong KongChina Research Centre of Intelligent Healthcare Faculty of Health and Life ScienceCoventry UniversityCoventryUK Department of Neurology Nanjing University Medical School Affiliated Nanjing Drum Tower HospitalNanjingJiangsuChina Department of Radiology Nanjing University Medical School Affiliated Nanjing Drum Tower HospitalNanjingJiangsuChina

Background and purpose Symptomatic intracranial atherosclerotic stenosis(sICAS)is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment.Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics(CFD)models were associated with the risk of stroke recurrence.we aimed to develop and compare stroke risk prediction nomograms in sICAS,based on vascular risk factors and these metrics.Methods Patients with 50%-99%sICAS confirmed in CT angiography(CTA)were enrolled.Conventional vascular risk factors were collected.Severity of luminal stenosis in sICAS was dichotomised as moderate(50%-69%)and severe(70%-99%).Translesional pressure ratio(PR)and wall shear stress ratio(wSSR)were quantified via CTA-based CFD modelling;the haemodynamic status of sICAS was classified as normal(normal PR&wSSR),intermediate(otherwise)and abnormal(abnormal PR&wSSR).All patients received guideline-recommended medical treatment.we developed and compared performance of nomograms composed of these variables and independent predictors identified in multivariate logistic regression,in predicting the primary outcome,recurrent ischaemic stroke in the same territory(SIT)within 1 year.Results Among 245 sICAS patients,20(8.2%)had SIT.The D2H2A nomogram,incorporating diabetes,dyslipidaemia,haemodynamic status of sICAS,hypertension and age≥50 years,showed good calibration(P for Hosmer-Lemeshow test=0.560)and discrimination(C-statistic 0.73,95%CI 0.60 to 0.85).It also had better performance in risk reclassification and provided larger net benefits in decision curve analysis,compared with nomograms composed of conventional vascular risk factors only,and plus the severity of luminal stenosis in sICAS.Sensitivity analysis in patients with anterior-circulation sICAS showed similar results.Conclusions The D2H2A nomogram,incorporating conventional vascular risk factors and the haemodynamic significance of sICAS as assessed in CFD models,could be a useful tool

关键词： intracranial otherwise stratification

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Is artificial intelligence the final answer to missed polyps in colonoscopy?

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world Journal of Gastroenterology 2020年第35期26卷 5248-5255页

作者： thomas K L Lui wai K leung Department of Medicine Queen Mary HospitalUniversity of Hong KongHong KongChina

Lesions missed by colonoscopy are one of the main reasons for post-colonoscopy colorectal cancer,which is usually associated with a worse prognosis.Because the adenoma miss rate could be as high as 26%,it has been noted that endoscopists with higher adenoma detection rates are usually associated with lower adenoma miss rates.Artificial intelligence(AI),particularly the deep learning model,is a promising innovation in colonoscopy.Recent studies have shown that AI is not only accurate in colorectal polyp detection but can also reduce the miss rate.Nevertheless,the application of AI in real-time detection has been hindered by heterogeneity of the AI models and study design as well as a lack of long-term outcomes.Herein,we discussed the principle of various AI models and systematically reviewed the current data on the use of AI on colorectal polyp detection and miss rates.The limitations and future prospects of AI on colorectal polyp detection are also discussed.

关键词： Artificial intelligence Adenoma Colonoscopy Colorectal cancer Polyps

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不同压力和不同扩张直径球囊对血管壁的影响

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中国卒中杂志 2006年第1期1卷 23-26页

作者：李伟姜卫剑王拥军杜彬孙异临 thomas w.leung 首都医科大学附属北京天坛医院神经内科北京市100050 首都医科大学附属北京天坛医院急诊介入科北京市100050 北京神经外科研究所电镜室

目的应用不同直径和压力的球囊扩张血管后,观察其管壁结构的变化。方法应用扩张球囊给予不同压力和不同扩张直径对游离猪的中小动脉血管进行持续扩张,随后进行肉眼、光镜及透射电镜检查。结果在6个大气压扩张作用下,血管内膜部分脱失,... 详细信息

目的应用不同直径和压力的球囊扩张血管后,观察其管壁结构的变化。方法应用扩张球囊给予不同压力和不同扩张直径对游离猪的中小动脉血管进行持续扩张,随后进行肉眼、光镜及透射电镜检查。结果在6个大气压扩张作用下,血管内膜部分脱失,中膜平滑肌层部分撕脱,内皮细胞与内弹力板层分离。在7个大气压球囊作用下,血管径增加10%,血管内膜不完整,中膜肌层可见撕裂,内弹力板断裂。在8个大气压球囊作用下,血管径增加15%,血管内膜不完整,中膜肌层可见撕裂。在9个大气压球囊扩张下,血管径增加15%,血管内膜层损伤更完全。在直径为2倍的球囊扩张作用下,血管内膜部分脱失,内皮细胞部分细胞器脱出。在直径为3倍的球囊扩张作用下,血管管径增宽1倍,血管内膜不完整,中膜肌层撕裂,内弹力板断裂。在直径为4倍的球囊扩张下,血管壁破裂,血管变形,血管内膜基本消失,中膜肌层普遍断裂并累及外膜肌层。结论血管壁损伤随球囊给予血管的压力及直径的增加而增加,压力作用和成倍扩张血管对血管壁的损坏具有相辅相成的关系,并且压力的作用大于血管径扩张的作用。

关键词：气囊扩张术小动脉中动脉猪

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Spontaneous basilar artery dissection

Spontaneous basilar artery dissection

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2007年浙江省神经病学学术年会

作者：韩钊 thomas w.leung wynnie Lam Yannie Soo Ka Sing wong 温州医学院附属第一医院神经科

Dissection of the basilar artery is rare.we report a 51-year-old man who developed acute pontine infarction associated with dissection of the distal basilar artery.There was no trauma or unaccustomed movement of the h...

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The effects of Spirulina on anemia and immune function in senior citizens

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Cellular & Molecular Immunology 2011年第3期8卷 248-254页

作者： Carlo Selmi Patrick SC leung Laura Fischer Bruce German Chen-Yen Yang thomas P Kenny Gerry R Cysewski M Eric Gershwin Division of Rheumatology Allergy and Clinical ImmunologyUniversity of California at DavisDavisCAUSA Department of Medicine IRCCS Istituto Clinico HumanitasRozzanoMilanItaly Department of Food Science and Technology University of California at DavisDavisCAUSA Cyanotech Kailua-KonaHIUSA

Anemia and immunological dysfunction(i.***.immunosenescence)are commonly found in older subjects and nutritional approaches are sought to counteract these phenomena.Spirulina is a filamentous and multicellular bule-green alga capable of reducing inflammation and also manifesting antioxidant effects.we hypothesized that Spirulina may ameliorate anemia and immunosenescence in senior citizens with a history of anemia.we enrolled 40 volunteers of both sexes with an age of 50 years or older who had no history of major chronic diseases.Participants took a Spirulina supplementation for 12 weeks and were administered comprehensive dietary questionnaires to determine their nutritional regimen during the study.Complete cell count(CCC)and indoleamine 2,3-dioxygenase(IDO)enzyme activity,as a sign of immune function,were determined at baseline and weeks 6 and 12 of supplementation.Thirty study participants completed the entire study and the data obtained were analyzed.Over the 12-week study period,there was a steady increase in average values of mean corpuscular hemoglobin in subjects of both sexes.In addition,mean corpuscular volume and mean corpuscular hemoglobin concentration also increased in male participants.Older women appeared to benefit more rapidly from Spirulina supplements.Similarly,the majority of subjects manifested increased IDO activity and white blood cell count at 6 and 12 weeks of Spirulina supplementation.Spirulina may ameliorate anemia and immunosenescence in older subjects.we encourage large human studies to determine whether this safe supplement could prove beneficial in randomized clinical trials.

关键词： functional food immunosenescence red blood cell IDO

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Effects of Ving Tsun sticking-hand training on upper-limb sensorimotor performance in community-dwelling middle-aged and older adults: A randomized controlled trial

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International Journal of Nursing Sciences 2020年第1期7卷 29-34页

作者： Joanne w.Y.Chung Shirley S.M.Fong Yang Gao Timothy T.T.Yam Yvonne T.C.Chak Joyce C.Y.leung thomas K.S.wong Department of Health and Physical Education Education University of Hong KongHong KongChina School of Nursing and Healthcare Hong Kong Nang Yan College of Higher EducationHong KongChina Hong Kong Martial Arts Institute Hong KongChina School of Public Health University of Hong KongHong KongChina Department of Sport and Physical Education Hong Kong Baptist UniversityHong KongChina Hong Kong Christian Service Hong KongChina School of Nursing and Health Studies Open University of Hong KongHong KongChina Department of Social work and Social Administration University of Hong KongHong KongChina

Objective:To evaluate the effects of Ving Tsun(VT)sticking-hand training on upper-limb joint position sense and muscular performance in community-dwelling middle-aged and older adults.Methods:Thirty-three adults were randomly allocated to either a VT group or a control group.The VT group received VT sticking-hand training twice per week for 3 months.Measurements were taken before and after the intervention period.The primary outcome was elbow-joint repositioning error,which was measured by an elbow-joint passive positioning and active repositioning test using a universal goniometer.Secondary outcomes were upper-limb muscles'peak force and time taken to reach peak force as measured by a hand-held dynamometer.Results:No significant time,group or time-by-group interaction effects were found for elbow-joint repositioning error or upper-limb muscle peak force outcomes.Shoulder flexor time to peak force decreased by 33.8%from pre-test to post-test in the VT group(P=0.007).Shoulder abductor,internal and external rotator,and elbow extensor times to peak force decreased by 30.0%-35.9%in the VT%roup(Pw-joint position sense or the maximum strength of upper-limb muscles in middle-aged and older adults.However,VT can improve shoulder flexor muscles'time to reach peak force in these populations.VT had no obvious effect on the time required to reach peak force in other shoulder muscles and elbow extensors.

关键词： Aged Exercise movement techniques Joint position sense Middle aged Muscle strength Upper extremities

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A randomized controlled trial of topical tea tree preparation for MRSA colonized wounds

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International Journal of Nursing Sciences 2014年第1期1卷 7-14页

作者： Rainbow L.P.Lee Polly H.M.leung thomas K.S.wong School of Nursing The Hong Kong Polytechnic UniversityHong Kong Department of Health Technology and Informatics The Hong Kong Polytechnic UniversityHong Kong Faculty of Health and Social Sciences The Hong Kong Polytechnic UniversityHong Kong

Background:The prevalence of MRSA(Methicillin-resistant Staphylococcus aureus)colonized wounds in home care residents is expected to grow continuously as a result of the substantial proportion of older people requiring institutionalized care due to chronic disease and declining functional status,which contribute to more frequent skin breakdown and wound formation.Tea tree oil has been claimed to have anti-bacterial,analgesic and anti-inflammatory effects that have been suggested in many in-vitro studies to have good efficacy against MRSA.The aims of this study were to evaluate the effectiveness of 10%topical tea tree preparation to eradicateMRSA and to ascertain its influence on wound healing forMRSA-colonized wounds.Methods:It was a randomized controlled trial,single-blind study.Those with stage II or above MRSA-colonized wounds and who had given their informed consent formed the sample.The determined sample sizewasbasedonthe effect size of our previouspilot study,whichwas 0.46.Five outcome measurements were taken for the MRSA bacterial count and wound healing condition at baseline and at 1-week intervals during the 4-week dressing intervention period.Results:Thirty-two participants were recruited from two non-government nursing homes,16 in the control group and 16 in the tea tree oil group.The control group residents received routine saline gauze dressing,while the tea tree oil group residents received the 10%topical tea tree preparation dressing.In the tea tree oil group,all chronic wounds that had previously been delayed in healing were healed within 28 days without adverse reaction.MRSA was also completely eradicated in 14(87.5%)out of 16 wounds in the group receiving the 10%topical tea tree preparation.

关键词： MRSA Topical tea tree preparation wounds

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Relationship between obesity and cardiovascular risk factors in elderly Chinese subjects

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Chinese Medical Journal 2002年第6期115卷 897-899,155页

作者： G Neil thomas 赵海潞马艳青 wilson YS leung Juliana CN CHAN Brian TOMLINSON Julian AJH CRITCHLEY 梁润成陈重娥汤宁信郭志良香港中文大学医学院内科药物与治疗系临床药理学部

OBJECTIVE: To investigate the relative effects of degree and distribution of body fat with several cardiovascular disease (CVD) risk factors in elderly Chinese subjects. METHODS: One hundred and thirty-five elderly Chinese individuals (age range, 60-65 y) without any history of significant renal, hepatic or cardiac disease were recruited. Seated blood pressure, anthropometric and fasting plasma biochemical parameters were measured. Student's t-test was used to compare the differences in biochemical and anthropometric markers between cohorts. RESULTS: Males were heavier (64.6 +/- 8.6, 57.2 +/- 8.2kg, P

关键词： Adult Aged Body Mass Index Cardiovascular Diseases Female Humans Male Middle Aged Obesity Research Support, Non-U.S. Gov't Risk Factors

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