Xingjiang Xiong

Mechanical thrombectomy (MT) has made macrovessel reopening achievable in acute ischemic stroke, but angiographic success does not ensure effective tissue-level reperfusion or microvascular oxygen delivery. This narrative review examines endothelial glycocalyx dysfunction as a plausible blood-facing interface that may connect pre-existing cardiometabolic vulnerability with post-thrombectomy microvascular dysfunction. Targeted English-language literature from PubMed/MEDLINE, Web of Science, Embase, and Google Scholar through 30 April 2026 was synthesized, with emphasis on MT, impaired microvascular reperfusion (IMR), no-reflow, blood–brain barrier (BBB) and neurovascular-unit (NVU) biology, glycocalyx-related biomarkers, cardiometabolic risk, perfusion imaging, and microcirculatory rescue. The evidence base is heterogeneous and is explicitly separated into direct human MT/LVO evidence, indirect human biomarker or imaging evidence, experimental cerebral evidence, non-cerebral/cross-disease vascular evidence, and hypothesis-generating mechanistic inference. Ischemic priming, abrupt reperfusion, oxidative and inflammatory stress, complement activation, metabolic stress, distal embolization, device-endothelial trauma, and host vulnerability may converge on the luminal endothelial surface. Glycocalyx dysfunction may amplify leukocyte adhesion and capillary plugging, platelet adhesion and microthrombosis, impaired mechanosensing and nitric-oxide signaling, BBB destabilization, and heterogeneous capillary flow; however, direct causal proof in human MT is lacking. Circulating syndecan-1, heparan sulfate, and hyaluronan are therefore best interpreted as time- and compartment-dependent systemic signals rather than direct readouts of the cerebral glycocalyx. Post-EVT microcirculatory rescue trials show that downstream perfusion may remain therapeutically actionable, but they do not demonstrate glycocalyx repair as the operative mechanism. A practical translational strategy is to combine serial, compartment-annotated biomarkers with prespecified early perfusion/barrier imaging and tissue endpoints, while explicitly modeling cardiometabolic vulnerability and competing microvascular mechanisms. The glycocalyx framework should therefore be considered a testable network hypothesis rather than an established primary cause of post-thrombectomy no-reflow or futile recanalization.

Since Ephedra Herba (ephedra) and its major alkaloid ephedrine were prohibited as dietary supplements due to their adverse effects on the cardiovascular and central nervous system (CNS), most studies have focused on their amphetamine-like effects and neurotoxicity. However, ephedra also has a long history of use in the treatment of various CNS diseases (known as “Zhong Feng” syndrome) according to two thousand years of traditional Chinese medicine (TCM) records. Pharmacokinetic reports have also demonstrated that alkaloids of ephedra can quickly penetrate the blood–brain barrier (BBB) once absorbed into the blood and there are multiple alkaloids derived from ephedra which have been identified as natural sympathomimetic drugs. These drugs are capable of interfering with several types of neurotransmitter, and have an especially potent effect on monoamine neurotransmitters. The effects of ephedra on CNS therefore remain both contradictory and confusing. In this review, we summarized the available evidence of pharmacology and toxicology of ephedra and ephedrine on CNS, and aimed to clarify their effects. Given the unmet need for more efficient treatments of neurological disorders, ephedra is potentially valuable herbal medicine which may provide a promising avenue for development of treatments and encourage further drug research and development (R&D).

Background: Previous studies indicated that the Fibrosis-4 Index (FIB-4), an evaluation metric for liver fibrosis, is associated with adverse outcomes in coronary artery disease. However, the correlation between FIB-4 and myocardial infarction (MI) in Chinese patients with Type 2 Diabetes Mellitus (T2DM) has not been well-defined. Thus, this study aims to elucidate the association between FIB-4 and MI in Chinese T2DM patients.Methods: Cross-sectional data were collected from T2DM patients at two hospitals in China, designated as the discovery and validation centers. The exposure variable, FIB-4 index, was derived from patient age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count. This index was stratified into four distinct clusters via k-means clustering analysis. The primary outcome was defined as the incidence of co-occurring MI. Logistic and restricted cubic spline regression was conducted to assess the association between the FIB-4 index and MI in Chinese T2DM patients.Results: In the discovery phase, data were analyzed from 2,980 T2DM patients, including 1,114 females (37.38%), with 58 years average age (SD: 10.4). Among them, 190 were also MI patients. Based on the fully adjusted logistic regression analysis, the odds ratio (OR) for the second cluster was 1.00 (95% CI, 0.60-1.40); for the third cluster, it was 1.94 (95% CI, 1.32-2.57), and for the poorest controlled cluster it was 16.18 (95% CI, 14.97-17.39) in comparison to the best-controlled cluster of FIB-4. Restricted cubic spline regression revealed a linear relationship between the FIB-4 index and MI risk. Subgroup analysis demonstrated that this association was significant in elderly adults, females with high BMI, and those with comorbidities such as hypertension, coronary artery disease, and chronic heart failure. These findings yield consistent results in the validation set (n = 224).Conclusions: Among Chinese patients with T2DM, elevated FIB-4 levels have been independently associated with MI, particularly among females and individuals with concomitant hypertension. Consequently, the FIB-4 index is anticipated to serve as a promising tool for early detection and risk stratification in this population.

Background: Although the pathogenesis of essential hypertension is not clear, a large number of studies have shown that oxidative stress plays an important role in the occurrence and development of hypertension and target organ damage. Purpose: This paper systematically summarizes the relationship between oxidative stress and hypertension, and explores the potential mechanisms of Chinese herbal medicine (CHM) in the regulation of oxidative stress in hypertension, aiming to establish a scientific basis for the treatment of hypertension with CHM. Methods: To review the efficacy and mechanism by which CHM treat hypertension through targeting oxidative stress, data were searched from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure, the VIP Information Database, the Chinese Biomedical Literature Database, and the Wanfang Database from their inception up to January 2024. NPs were classified and summarized by their mechanisms of action. Results: In hypertension, the oxidative stress pathway of the body is abnormally activated, and the antioxidant system is inhibited, leading to the imbalance between the oxidative and antioxidative capacity. Meanwhile, excessive production of reactive oxygen species can lead to endothelial damage and vascular dysfunction, resulting in inflammation and immune response, thereby promoting the development of hypertension and damaging the heart, brain, kidneys, blood vessels, and other target organs. Numerous studies suggested that inhibiting oxidative stress may be the potential therapeutic target for hypertension. In recent years, the clinical advantages of traditional Chinese medicine (TCM) in the treatment of hypertension have gradually attracted attention. TCM, including active ingredients of CHM, single Chinese herb, TCM classic formula and traditional Chinese patent medicine, can not only reduce blood pressure, improve clinical symptoms, but also improve oxidative stress, thus extensively affect vascular endothelium, renin–angiotensin–aldosterone system, sympathetic nervous system, target organ damage, as well as insulin resistance, hyperlipidemia, hyperhomocysteinemia and other pathological mechanisms and hypertension related risk factors. Conclusions: CHM display a beneficial multi-target, multi-component, overall and comprehensive regulation characteristics, and have potential value for clinical application in the treatment of hypertension by regulating the level of oxidative stress.

Clinical evidence for and advances in translational research on the classic formulas of traditional Chinese medicine 2 Clinical evidence for the classic formulas of TCM Currently, rigorous "totality of evidence" of the classic formulas of TCM that includes chemical standardization, biological assays, experimental studies, and clinical trials is receiving