BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remai...BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.展开更多
Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, und...Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 (75%) of the patients exhibited cognitive impairment to varying degrees, and 25 (45%) of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 (20%) required intermittent supervision, and 20 (36%) required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.展开更多
This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electro...This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electronically searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, and China Biology Medicine disc. Two reviewers independently screened the articles and extracted the data based on the inclusion and exclusion criteria. The quality of included articles was evaluated by using Revman5.0, and meta-analysis was performed. The results showed that 1027 articles were obtained in initial retrieval, and finally 7 articles, involving a total of 4039 cases, were included for analysis. The meta-analysis showed that no significant differences were found in the long-term mortality(OR=0.91, 95% CI 0.07 to 1.09, P=0.30), the rate of dependency(OR=1.02, 95% CI 0.87 to 1.24, P=0.85), and the effective rate(OR=0.98, 95% CI 0.84 to 1.14, P=0.82) between citicoline group and control group. The overall rate of adverse events in citicoline group was not significantly different from that in control group(P=0.30). The quality of included articles reached moderate-low level. In conclusion, citicolne cannot reduce long-term mortality and dependence rate in the treatment of acute stroke, and the effective rate of citivoline may be not better than that of controls but with reliable safety.展开更多
BACKGROUND: Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect (HS...BACKGROUND: Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect (HSN) dunng acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE: To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN : Case analysis SETTING : Department of Neurology, First Affiliated Hospital of Guangxi Medical University PARTICIPANTS: A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria: ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion cnteda: Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was (68±10) years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS: Disappearance and existence of HSN were analyzed with HSN evaluation criteria: body agnosia, left and nght agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method, Items mentioned below belonged to HSN disappearance: ① without body agnosia; ② without left and nght agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one's own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and nght agnosia and difficult maintenance of supine position were observed during acute period (within 1 week) and recovery period (at 2 weeks after onset). Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training (sitting in bed and near bedside: heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage) and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean+SD and compared with ttest; enumeration data were compared with Chi-square test and Mann-Whitney Utest. P 〈 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES: ① HSN disappearance; ②Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position;③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS: All 21 patients were involved in the final analysis. ① HSN disappearance: Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 (38%, 8/21) HSN disappearance, and 13 (62%, 13/21) HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases: Within 1 week, 19% (4/21) HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% (13/21), but 43% (17/21) during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention: At acute phase, HSN disappearance through sitting training lasted for (2.5±1.3) days, and remaining HSN symptoms were relieved for (5.0±3.7) days. There was significant difference between them ( x^2= 3.96, P = 0.039). The hospitalized time of patients with HSN disappearance and HSN remnant was (17.6±10.4), (16.2±4.9) days, but there was no significant difference between them (x^2 = 1.41, P = 0.679). Physiotherapy time of patients with HSN disappearance and HSN remnant was (11.1 ±7.5), (11.4±4.1 ) days, but there was no significant difference between them (x^2 = 1.05, P = 0.894). CONCLUSION: Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.展开更多
BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has ...BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.展开更多
Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic ...Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic stroke remain undetermined.With innovations in high-throughput gene sequencing analysis,many aberrantly expressed non-coding RNAs(ncRNAs)in the brain and peripheral blood after acute ischemic stroke have been found in clinical samples and experimental models.Differentially expressed ncRNAs in the post-stroke brain were demonstrated to play vital roles in pathological processes,leading to neuroprotection or deterioration,thus ncRNAs can serve as therapeutic targets in acute ischemic stroke.Moreover,distinctly expressed ncRNAs in the peripheral blood can be used as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.In particular,ncRNAs in peripheral immune cells were recently shown to be involved in the peripheral and brain immune response after acute ischemic stroke.In this review,we consolidate the latest progress of research into the roles of ncRNAs(microRNAs,long ncRNAs,and circular RNAs)in the pathological processes of acute ischemic stroke–induced brain damage,as well as the potential of these ncRNAs to act as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.Findings from this review will provide novel ideas for the clinical application of ncRNAs in acute ischemic stroke.展开更多
OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated T...OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated Traditional Chinese and Western Medicine.METHODS:Randomized controlled trials(RCTs)of China National Knowledge Infrastructure Database,Wanfang Database,Chinese BioMedical Literature Database,PubMed,Embase,and the Cochrane Library were searched from the establishment to March 2022.Two researchers screened the literature and extracted the data according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.RESULTS:A total of 28 RCTs were included,including 2745 patients in the acute stage of stroke(1375 in the experimental group and 1370 in the control group).Metaanalysis showed that compared with conventional treatment,combined treatment with ANP could improve the effective rate of acute stroke patients[relative risk(RR)=1.26,95%confidence interval(CI)(1.21,1.31)],Glasgow Coma Scale scores[mean difference(MD)=2.01,95%CI(1.04,2.98)],Mini-mental State Examination scores[MD=4.79,95%CI(2.22,7.37)],Activities of Daily Living scores[MD=15.70,95%CI(14.05,17.36)]and the Barthel index scores[MD=13.89,95%CI(12.12,15.65)],reduce National Institute of Health stroke scale scores[MD=-3.90,95%CI(-4.96,-2.84)]and serum brain natriuretic peptide[MD=-38.50,95%CI(-46.85,-30.15)].In terms of safety,the incidence of adverse reactions showed no statistical differences between the two groups[RR=0.71,95%CI(0.43,1.15),P=0.16],and no serious adverse reactions/events were observed,indicating a good safety.CONCLUSIONS:Existing clinical research evidence shows that ANP has good efficacy and safety in the treatment of acute stroke,which can provide a basis for the treatment of integrated Traditional Chinese and Western Medicine.However,the quality of included research methodology needs to be improved,and the above conclusions need to be verified by more highquality studies.展开更多
BACKGROUND Stroke is the second and third leading cause of death and disability,respectively.To date,no definitive treatment can repair lost brain function.Recently,various preclinical studies have been reported on me...BACKGROUND Stroke is the second and third leading cause of death and disability,respectively.To date,no definitive treatment can repair lost brain function.Recently,various preclinical studies have been reported on mesenchymal stromal cells(MSCs)and their derivatives and their potential as alternative therapies for stroke.CASE SUMMARY A 45-year-old female suffered an acute stroke,which led to paralysis in the left upper and lower limbs.The amniotic membrane MSC-derived secretome(MSCsecretome)was intravenously transplanted once a week for 4 wk.MSC-secretomeregulated regulatory T cells were investigated for the beneficial effects.The clinical improvement of this patient was accompanied by an increased frequency of regulatory T cells after transplantation.CONCLUSION Intravenous administration of MSC-secretome can potentially treat patients who suffer from acute ischemic stroke.展开更多
Objective:To explore the characteristics of plasma metabolites,feces gut microbiota and the crosstalk between gut microbiota and host metabolism in patients with acute ischemic stroke and phlegm-heat pattern(AIS-PHP)....Objective:To explore the characteristics of plasma metabolites,feces gut microbiota and the crosstalk between gut microbiota and host metabolism in patients with acute ischemic stroke and phlegm-heat pattern(AIS-PHP).Methods:The metabolic and microbiome profiles of 20 AIS-PHP patients and 20 healthy controls(HCs)were analyzed using liquid chromatography-tandem mass spectrometry(LC-MS/MS)-based metabolomics and 16s rDNA sequencing,respectively.The covariation between LC-MS/MS-based metabolite data and 16s rDNA sequence data was presented.Results:Distinct alterations in the plasma metabolic phenotype of AIS-PHP patients were found,in which 16 metabolites differed significantly between the AIS-PHP patients and the HCs.These metabolites represented 17 different metabolic pathways,including amino acid metabolism,lipid metabolism,and nucleotide metabolism.Additionally,significant alterations of gut microbiota composition and taxon were revealed at the phylum level between the AIS-PHP patients and the HCs.In AIS-PHP,Bacteroidetes,Firmicutes,and Proteobacteria dominated.Moreover,some microbes that differed between the 2 groups manifested a sole association with certain metabolites,such as the connection between Bacteroides and inosine and between Lachnospiraceae_unclassified and hypoxanthine.Conclusion:The present study preliminarily investigated the metabolomic and gut microbiome characteristics of AIS-PHP patient indicators.The link between metabolic and microbial dysbiosis in AIS-PHP sheds new light on the function of gut microbiota and associated metabolomics in the pathogenesis of the disease.展开更多
BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,...BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,70%of patients with stroke have serious disability,which results in heavy burden to their families and the society.AIM To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke.METHODS A total of 68 patients with acute severe stroke admitted to Lanzhou Second People’s Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method.The control group was administered routine Western medicine treatment,such as dehydration,lowering intracranial pressure,anticoagulation,improving cerebral blood circulation and cerebral nerve protection according to the“Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China.”The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture.The two groups were compared.RESULTS The acute physiology and chronic health evaluation II,organ dysfunction syndrome score,National Institutes of Health Stroke Scale,and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment,and the complements C3 and C4,and immunoglobulins(Ig)M and G were significantly increased compared with those observed before treatment(P<0.05).After treatment,the scores of the observation group were lower than those of the control group,and the complement and Ig levels were higher than those of the control group(P<0.05).The levels of diamine oxidase(DAO),Dlactic acid(D-LA),and calcitonin gene-related peptide(CGRP)in the two groups were significantly higher than those before treatment,while the levels of lipopolysaccharide,ubiquitin carboxyl-terminal hydrolase 1(UCH-L1),tumor necrosis factor-α(TNF-α),interleukin(IL)-2,and IL-8 were significantly lower than those before treatment(P<0.05).After treatment,DAO,D-LA,and CGRP were higher in the observation group than in the control group,while lipopolysaccharide,UCH-L1,TNF-α,IL-2,and IL-8 were lower than in the control group(P<0.05).The hospitalization time of individuals in the observation group was shorter than that of the control group(P<0.05).CONCLUSION Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora,reduce inflammation,improve intestinal mucosal barrier function and immune function related indicators,and promote recovery.展开更多
Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web o...Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.展开更多
Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that...Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.展开更多
BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and...BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.展开更多
Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofib...Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.展开更多
Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospecti...Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.展开更多
Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with A...Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.展开更多
Ischemic stroke is an important disease leading to death and disability for all human beings, and the key to its treatment lies in the early opening of obstructed vessels and restoration of perfusion to the local infa...Ischemic stroke is an important disease leading to death and disability for all human beings, and the key to its treatment lies in the early opening of obstructed vessels and restoration of perfusion to the local infarcted area. Intravenous thrombolysis with tissue plasminogen activator (tPA) is one of the effective therapies to achieve revascularization, but it faces strict indications with a narrow therapeutic time window, and significantly increases the incidence of hemorrhagic transformation, HT, after reperfusion of the infarcted foci, which greatly reduces the incidence of patients with ischemic stroke. which significantly increases the incidence of hemorrhagic transformation (HT) after reperfusion of the infarcted focus, greatly reducing patient utilization and clinical benefit. Since the mechanism of HT has not been fully elucidated, and the related molecular mechanisms are complex and interactive, there is no specific and effective therapy to avoid the occurrence of HT. In this article, we focus on the research progress on the mechanism of HT after tPA intravenous thrombolysis in ischemic stroke patients from the aspects of vascular integrity disruption, oxidative stress, and neuroinflammatory response and the corresponding therapeutic strategies, in order to improve the safety and prognosis of tPA intravenous thrombolysis in the clinic.展开更多
Objective To assess the effect and safety of bloodletting puncture at hand twelve Jing-Well points(HTWPs)in acute stroke patients with conscious disturbance.Methods In this multi-center and randomized controlled trial...Objective To assess the effect and safety of bloodletting puncture at hand twelve Jing-Well points(HTWPs)in acute stroke patients with conscious disturbance.Methods In this multi-center and randomized controlled trial,360 patients suffered from ischemic or hemorrhagic stroke with conscious disturbance within 48 h from the onset of symptom were divided into bloodletting(180 cases)and control(180 cases)groups using a block randomization.Patients in both groups received routine Western medicine,and patients in the bloodletting group received additional bloodletting puncture at HTWPs on admission immediately before conventional treatment.The primary outcome measure was Glasgow Coma Scale(GCS)score and the secondary outcomes included blood pressure,respiratory rate and pulse rate.All variables were evaluated at baseline(before bloodletting),0(after bloodletting immediately),15,30,50 and 80 min post bloodletting.Results At 80 min post bloodletting,the proportion of patients with improved consciousness in the bloodletting group was greater than the control group(P<0.05).In the separate analysis of moderate consciousness disturbance subgroup,bloodletting therapy benefited ischemic patients,and improved the eye and language response of GCS score at 15,30,50,80 min post bloodletting(P<0.05 or P<0.01).No significant differences were observed regarding the secondary outcomes between two groups(P>0.05).Conclusion The bloodletting puncture at HTWPs was safe and could improve conscious levels of ischemic stroke patients,highlighting a first-aid intervention for acute stroke.展开更多
Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who v...Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.展开更多
Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Pro...Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale (NIHSS) 〉10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. Results The serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 (1.259, 7.214)/2.655 (1.298, 5.43), 3.157 (1.306, 7.631)/3.405 (1.621, 7.154), and 0.482 (0.245, 0.946)/0.51 (0.282, O.921), respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke (chi-square=8.235, P=0.411). Conclusion Serum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.展开更多
基金This study has been registered at the Clinical Research Registry at www.researchregistry.com.The registration identification number is(researchregistry9015).
文摘BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
基金the Science and Technology Foundation of Shanghai Railway Bureau of China, No. B340406052
文摘Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 (75%) of the patients exhibited cognitive impairment to varying degrees, and 25 (45%) of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 (20%) required intermittent supervision, and 20 (36%) required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.
文摘This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electronically searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, and China Biology Medicine disc. Two reviewers independently screened the articles and extracted the data based on the inclusion and exclusion criteria. The quality of included articles was evaluated by using Revman5.0, and meta-analysis was performed. The results showed that 1027 articles were obtained in initial retrieval, and finally 7 articles, involving a total of 4039 cases, were included for analysis. The meta-analysis showed that no significant differences were found in the long-term mortality(OR=0.91, 95% CI 0.07 to 1.09, P=0.30), the rate of dependency(OR=1.02, 95% CI 0.87 to 1.24, P=0.85), and the effective rate(OR=0.98, 95% CI 0.84 to 1.14, P=0.82) between citicoline group and control group. The overall rate of adverse events in citicoline group was not significantly different from that in control group(P=0.30). The quality of included articles reached moderate-low level. In conclusion, citicolne cannot reduce long-term mortality and dependence rate in the treatment of acute stroke, and the effective rate of citivoline may be not better than that of controls but with reliable safety.
文摘BACKGROUND: Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect (HSN) dunng acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE: To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN : Case analysis SETTING : Department of Neurology, First Affiliated Hospital of Guangxi Medical University PARTICIPANTS: A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria: ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion cnteda: Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was (68±10) years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS: Disappearance and existence of HSN were analyzed with HSN evaluation criteria: body agnosia, left and nght agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method, Items mentioned below belonged to HSN disappearance: ① without body agnosia; ② without left and nght agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one's own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and nght agnosia and difficult maintenance of supine position were observed during acute period (within 1 week) and recovery period (at 2 weeks after onset). Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training (sitting in bed and near bedside: heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage) and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean+SD and compared with ttest; enumeration data were compared with Chi-square test and Mann-Whitney Utest. P 〈 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES: ① HSN disappearance; ②Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position;③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS: All 21 patients were involved in the final analysis. ① HSN disappearance: Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 (38%, 8/21) HSN disappearance, and 13 (62%, 13/21) HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases: Within 1 week, 19% (4/21) HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% (13/21), but 43% (17/21) during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention: At acute phase, HSN disappearance through sitting training lasted for (2.5±1.3) days, and remaining HSN symptoms were relieved for (5.0±3.7) days. There was significant difference between them ( x^2= 3.96, P = 0.039). The hospitalized time of patients with HSN disappearance and HSN remnant was (17.6±10.4), (16.2±4.9) days, but there was no significant difference between them (x^2 = 1.41, P = 0.679). Physiotherapy time of patients with HSN disappearance and HSN remnant was (11.1 ±7.5), (11.4±4.1 ) days, but there was no significant difference between them (x^2 = 1.05, P = 0.894). CONCLUSION: Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.
基金Supported by the Research Grant of the Chungbuk National University Hospital in 2020.
文摘BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.
基金supported by the National Natural Science Foundation of China,Nos.82301486(to SL)and 82071325(to FY)Medjaden Academy&Research Foundation for Young Scientists,No.MJR202310040(to SL)+2 种基金Nanjing Medical University Science and Technique Development,No.NMUB20220060(to SL)Medical Scientific Research Project of Jiangsu Commission of Health,No.ZDA2020019(to JZ)Health China Buchang Zhiyuan Public Welfare Project for Heart and Brain Health,No.HIGHER202102(to QD).
文摘Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic stroke remain undetermined.With innovations in high-throughput gene sequencing analysis,many aberrantly expressed non-coding RNAs(ncRNAs)in the brain and peripheral blood after acute ischemic stroke have been found in clinical samples and experimental models.Differentially expressed ncRNAs in the post-stroke brain were demonstrated to play vital roles in pathological processes,leading to neuroprotection or deterioration,thus ncRNAs can serve as therapeutic targets in acute ischemic stroke.Moreover,distinctly expressed ncRNAs in the peripheral blood can be used as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.In particular,ncRNAs in peripheral immune cells were recently shown to be involved in the peripheral and brain immune response after acute ischemic stroke.In this review,we consolidate the latest progress of research into the roles of ncRNAs(microRNAs,long ncRNAs,and circular RNAs)in the pathological processes of acute ischemic stroke–induced brain damage,as well as the potential of these ncRNAs to act as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.Findings from this review will provide novel ideas for the clinical application of ncRNAs in acute ischemic stroke.
基金Science and Technology Innovation Project of China Academy of Chinese Medical Sciences:Research on Key Technologies of Real-world Clinical Evaluation and Data Governance Analysis Based on Disease Research(No.CI2021A00702-2)Project of National Key Research and Development Program:Development of International Clinical Research Service Standard for Acupuncture and Moxibustion(No.2019YFC1712205)。
文摘OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated Traditional Chinese and Western Medicine.METHODS:Randomized controlled trials(RCTs)of China National Knowledge Infrastructure Database,Wanfang Database,Chinese BioMedical Literature Database,PubMed,Embase,and the Cochrane Library were searched from the establishment to March 2022.Two researchers screened the literature and extracted the data according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.RESULTS:A total of 28 RCTs were included,including 2745 patients in the acute stage of stroke(1375 in the experimental group and 1370 in the control group).Metaanalysis showed that compared with conventional treatment,combined treatment with ANP could improve the effective rate of acute stroke patients[relative risk(RR)=1.26,95%confidence interval(CI)(1.21,1.31)],Glasgow Coma Scale scores[mean difference(MD)=2.01,95%CI(1.04,2.98)],Mini-mental State Examination scores[MD=4.79,95%CI(2.22,7.37)],Activities of Daily Living scores[MD=15.70,95%CI(14.05,17.36)]and the Barthel index scores[MD=13.89,95%CI(12.12,15.65)],reduce National Institute of Health stroke scale scores[MD=-3.90,95%CI(-4.96,-2.84)]and serum brain natriuretic peptide[MD=-38.50,95%CI(-46.85,-30.15)].In terms of safety,the incidence of adverse reactions showed no statistical differences between the two groups[RR=0.71,95%CI(0.43,1.15),P=0.16],and no serious adverse reactions/events were observed,indicating a good safety.CONCLUSIONS:Existing clinical research evidence shows that ANP has good efficacy and safety in the treatment of acute stroke,which can provide a basis for the treatment of integrated Traditional Chinese and Western Medicine.However,the quality of included research methodology needs to be improved,and the above conclusions need to be verified by more highquality studies.
基金Supported by the National Natural Science Foundation of China,No.81960252 and No.81860157Natural Science Foundation of Inner Mongolia,No.2021LHMS08019 and No.2021LHMS08023.
文摘BACKGROUND Stroke is the second and third leading cause of death and disability,respectively.To date,no definitive treatment can repair lost brain function.Recently,various preclinical studies have been reported on mesenchymal stromal cells(MSCs)and their derivatives and their potential as alternative therapies for stroke.CASE SUMMARY A 45-year-old female suffered an acute stroke,which led to paralysis in the left upper and lower limbs.The amniotic membrane MSC-derived secretome(MSCsecretome)was intravenously transplanted once a week for 4 wk.MSC-secretomeregulated regulatory T cells were investigated for the beneficial effects.The clinical improvement of this patient was accompanied by an increased frequency of regulatory T cells after transplantation.CONCLUSION Intravenous administration of MSC-secretome can potentially treat patients who suffer from acute ischemic stroke.
基金funded by Chang Jingling Professor Scholars Programthe Special funds for basic scientific research in Central Universities of China(2019-JYB-TD-003)+2 种基金the National Natural Science Foundation of China(81973790)Huang Xing Scholars Program Central University Basic Scientific Research Operating Expenses Special Project(2022-JYB-XJSJJ-093)funded in part by the Austrian Agency for International Cooperation in Education and Research(OEAD)and the Federal Minister of Education,Science,and Research under the Scientific and Technological Cooperation with China Project(CN 06/2020)。
文摘Objective:To explore the characteristics of plasma metabolites,feces gut microbiota and the crosstalk between gut microbiota and host metabolism in patients with acute ischemic stroke and phlegm-heat pattern(AIS-PHP).Methods:The metabolic and microbiome profiles of 20 AIS-PHP patients and 20 healthy controls(HCs)were analyzed using liquid chromatography-tandem mass spectrometry(LC-MS/MS)-based metabolomics and 16s rDNA sequencing,respectively.The covariation between LC-MS/MS-based metabolite data and 16s rDNA sequence data was presented.Results:Distinct alterations in the plasma metabolic phenotype of AIS-PHP patients were found,in which 16 metabolites differed significantly between the AIS-PHP patients and the HCs.These metabolites represented 17 different metabolic pathways,including amino acid metabolism,lipid metabolism,and nucleotide metabolism.Additionally,significant alterations of gut microbiota composition and taxon were revealed at the phylum level between the AIS-PHP patients and the HCs.In AIS-PHP,Bacteroidetes,Firmicutes,and Proteobacteria dominated.Moreover,some microbes that differed between the 2 groups manifested a sole association with certain metabolites,such as the connection between Bacteroides and inosine and between Lachnospiraceae_unclassified and hypoxanthine.Conclusion:The present study preliminarily investigated the metabolomic and gut microbiome characteristics of AIS-PHP patient indicators.The link between metabolic and microbial dysbiosis in AIS-PHP sheds new light on the function of gut microbiota and associated metabolomics in the pathogenesis of the disease.
基金Supported by Lanzhou Science and Technology Development Plan Project,No.2020-ZD-126。
文摘BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,70%of patients with stroke have serious disability,which results in heavy burden to their families and the society.AIM To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke.METHODS A total of 68 patients with acute severe stroke admitted to Lanzhou Second People’s Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method.The control group was administered routine Western medicine treatment,such as dehydration,lowering intracranial pressure,anticoagulation,improving cerebral blood circulation and cerebral nerve protection according to the“Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China.”The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture.The two groups were compared.RESULTS The acute physiology and chronic health evaluation II,organ dysfunction syndrome score,National Institutes of Health Stroke Scale,and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment,and the complements C3 and C4,and immunoglobulins(Ig)M and G were significantly increased compared with those observed before treatment(P<0.05).After treatment,the scores of the observation group were lower than those of the control group,and the complement and Ig levels were higher than those of the control group(P<0.05).The levels of diamine oxidase(DAO),Dlactic acid(D-LA),and calcitonin gene-related peptide(CGRP)in the two groups were significantly higher than those before treatment,while the levels of lipopolysaccharide,ubiquitin carboxyl-terminal hydrolase 1(UCH-L1),tumor necrosis factor-α(TNF-α),interleukin(IL)-2,and IL-8 were significantly lower than those before treatment(P<0.05).After treatment,DAO,D-LA,and CGRP were higher in the observation group than in the control group,while lipopolysaccharide,UCH-L1,TNF-α,IL-2,and IL-8 were lower than in the control group(P<0.05).The hospitalization time of individuals in the observation group was shorter than that of the control group(P<0.05).CONCLUSION Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora,reduce inflammation,improve intestinal mucosal barrier function and immune function related indicators,and promote recovery.
基金This study was supported by Hainan Provincial Key Research and Development Plan(ZDYF2021SHFZ092,ZDYF2022SHFZ109),Hainan Provincial Natural Science Foundation(822RC832)Hainan Provincial Clinical Medical Center(2021)Epilepsy Research Innovation Team of Hainan Medical College(2022)。
文摘Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.
基金High Level Talent Program of Hainan Natural Science Foundation(No.821RC680)。
文摘Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.
基金The Clinical Research Project of The First Affiliated Hospital of Shenzhen University,No.20223357030 and No.20223357021the“Double-First Class”Application Characteristic Discipline of Hunan Province(Pharmaceutical Science).
文摘BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.
基金supported by the Natural Science Foundation of Inner Mongolia(No.2021MS08169)the Medical and health Science and Technology Project of Inner Mongolia(No.202201571).
文摘Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.
基金supported by Health Science and Technology Project of Inner Mongolia Autonomous Region 2022(202201571).
文摘Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.
文摘Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.
文摘Ischemic stroke is an important disease leading to death and disability for all human beings, and the key to its treatment lies in the early opening of obstructed vessels and restoration of perfusion to the local infarcted area. Intravenous thrombolysis with tissue plasminogen activator (tPA) is one of the effective therapies to achieve revascularization, but it faces strict indications with a narrow therapeutic time window, and significantly increases the incidence of hemorrhagic transformation, HT, after reperfusion of the infarcted foci, which greatly reduces the incidence of patients with ischemic stroke. which significantly increases the incidence of hemorrhagic transformation (HT) after reperfusion of the infarcted focus, greatly reducing patient utilization and clinical benefit. Since the mechanism of HT has not been fully elucidated, and the related molecular mechanisms are complex and interactive, there is no specific and effective therapy to avoid the occurrence of HT. In this article, we focus on the research progress on the mechanism of HT after tPA intravenous thrombolysis in ischemic stroke patients from the aspects of vascular integrity disruption, oxidative stress, and neuroinflammatory response and the corresponding therapeutic strategies, in order to improve the safety and prognosis of tPA intravenous thrombolysis in the clinic.
基金Supported by the National Basic Research Program of China(No.2014CB543201)Clinic Study for Acupoints Dictionary of People’s Republic of China(No.03XDLZ14)。
文摘Objective To assess the effect and safety of bloodletting puncture at hand twelve Jing-Well points(HTWPs)in acute stroke patients with conscious disturbance.Methods In this multi-center and randomized controlled trial,360 patients suffered from ischemic or hemorrhagic stroke with conscious disturbance within 48 h from the onset of symptom were divided into bloodletting(180 cases)and control(180 cases)groups using a block randomization.Patients in both groups received routine Western medicine,and patients in the bloodletting group received additional bloodletting puncture at HTWPs on admission immediately before conventional treatment.The primary outcome measure was Glasgow Coma Scale(GCS)score and the secondary outcomes included blood pressure,respiratory rate and pulse rate.All variables were evaluated at baseline(before bloodletting),0(after bloodletting immediately),15,30,50 and 80 min post bloodletting.Results At 80 min post bloodletting,the proportion of patients with improved consciousness in the bloodletting group was greater than the control group(P<0.05).In the separate analysis of moderate consciousness disturbance subgroup,bloodletting therapy benefited ischemic patients,and improved the eye and language response of GCS score at 15,30,50,80 min post bloodletting(P<0.05 or P<0.01).No significant differences were observed regarding the secondary outcomes between two groups(P>0.05).Conclusion The bloodletting puncture at HTWPs was safe and could improve conscious levels of ischemic stroke patients,highlighting a first-aid intervention for acute stroke.
文摘Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.
基金supported by the National Natural Science Foundation of China(Grant No.81172761)a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale (NIHSS) 〉10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. Results The serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 (1.259, 7.214)/2.655 (1.298, 5.43), 3.157 (1.306, 7.631)/3.405 (1.621, 7.154), and 0.482 (0.245, 0.946)/0.51 (0.282, O.921), respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke (chi-square=8.235, P=0.411). Conclusion Serum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.