Maternal dietary deficiencies in folic acid or choline worsen stroke outcomes in adult male and female mouse offspring

Maternal one-carbon metabolism plays an important role in early life programming.There is a well-established connection between the fetal environment and the health status of the offspring.Howeve r,there is a knowledge gap on how maternal nutrition impacts stro ke outcomes in offspring.The aim of our study was to investigate the role of maternal dietary deficiencies in folic acid or choline on stroke outcomes in 3-month-old offspring.Adult female mice were fed a folic acid-deficient diet,choline-deficient diet,or control diet 4 weeks before pregnancy.They we re continued on diets during pregnancy and la ctation.Male and female offspring were weaned onto a control diet and at 2 months of age were subjected to ischemic stroke within the sensorimotor cortex via photothrombotic damage.Mothers maintained on either a folic acid-deficient diet or choline-deficient diet had reduced levels of S-adenosylm ethionine in the liver and S-adenosylhomocysteine in the plasma.After ischemic stro ke,motor function was impaired in 3-month-old offspring from mothers receiving either a folic acid-deficient diet or choline-deficient diet compared to the animals receiving a control diet.In brain tissue,there was no difference in ischemic damage volume.When protein levels were assessed in ischemic brain tissue,there were lower levels of active caspase-3 and hypoxia-inducible factor 1α in males compared to females and betaine levels were reduced in offspring from the mothers receiving a choline-deficient diet.Our results demonstrate that a deficient maternal diet at critical time points in neurodevelopment results in worse stro ke outcomes.This study emphasizes the importance of maternal diet and the impact it can have on offspring health.

Outcome assessment of stroke convalescence using multiple scales based on different dimensions

BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ’) of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.

Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator

Background Thrombolysis with recombinant tissue plasminogen activator （rt-PA） has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA. Methods One hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale （mRS） score, good outcome group： mRS score of 0-1; poor outcome group： mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression. Results Of the 101 patients studied, patients in good outcome group （n=55） were significantly younger than patients in poor outcome group （n=46, （62.82±14.25） vs. （68.81±9.85） years, P=0.029）. Good outcome group had fewer patients with diabetic history （9.09% vs. 28.26%, P=0.012）, fewer patients with leukoaraiosis （7.27% vs. 28.26%, P=-0.005） and presented with lower blood glucose level （（5.72±1.76） vs. （6.72±1.32） mmol/L, P=0.012）, lower systolic blood pressure level （（135.45±19.36） vs. （148.78±19.39） mmHg, P=0.003）, lower baseline NIHSS score （12.02±5.26 vs. 15.78±4.98, P=0.002） and shorter onset-to-treatment time （OTT） （（2.38±1.21） vs. （2.57±1.03） hours, P=0.044） than poor outcome group. Logistic regression analysis showed that absence of diabetic history （odds ratio （OR） 0.968 （95% CI 0.941-0.996））, absence of leukoaraiosis （OR 0.835 （95% C/0.712-0.980））, lower baseline NIHSS score （OR 0.885 （95% Cl 0.793- 0.989））, lower pre-thrombolysis systolic blood pressure （OR 0.962 （95% CI 0.929-0.997））, and lower blood glucose level （OR 0.699 （95% Cl 0.491-0.994）） before thrombolysis were significantly associated with better outcome. Conclusion Patients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolvsis have a better outcome.

Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation（AF）is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome（P ／ 0.001） and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were：heart failure（P = 0.045）; high systolic pressure（P = 0.039）; high blood glucose（P = 0.030）; and a high National Institutes of Health Stroke Scale（NIHSS） score（P ／ 0.001）. Moreover, high systolic pressure at admission（P = 0.007）, high blood glucose（P = 0.027）, and a high NIHSS score（P ／ 0.001） were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score（P = 0.006） and warfarin taken within 48 h before stroke onset（P = 0.032） were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.

Assessment of the early effectiveness of a stroke unit in comparison to the general ward

Background Stroke unit is the most effective treatment method to benefit stroke patients. Our study is to evaluate the early effectiveness of a hospital stroke unit (SU). Methods Three hundred and ninety-two patients who had suffered from acute strokes and who were admitted to our hospital between December 2001 and January 2003 were recruited for this controlled study. All patients were sent at random to either the SU or the general ward (GW) for treatment. The following indices were measured by: Barthel Index (BI),National Institute of Health Stroke Scale (NIHSS),Oxford Handicap Scale (OHS). Results The mean change in BI score between the day of admission and the day of discharge was 20.00±24.36 for the SU group and 10.63±23.59 for the GW group. A difference that is statistically significant ( P =0.000). The mean change in NIHSS score was -2.01±6.61 for the SU group and 0.55±7.44 for the GW group. A difference that is also statistically significant ( P =0.000). Finally,the mean change in OHS score was -0.74±1.04 for the SU group and -0.28±0.98 for the GW group,also a statistically significant difference ( P =0.000). Among SU patients,patient satisfaction was higher ( P =0.000),the rehabilitation success rate was higher ( P =0.000),and there were fewer complications ( P =0.000).Conclusion Compared to GW patients,stroke patients treated in a special SU were able to return to normal daily activities earlier,with better social abilities,and have reduced neurological defects,without increasing the overall economic burden.