Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the em...Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.展开更多
BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been ca...BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited. AIM To explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction. METHODS A total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTS The intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy)(P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC]< 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively. CONCLUSION WSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.展开更多
BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,espec...BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,especially cerebral venous sinus thrombosis,and may lead to stroke.Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications.We present the case of a 24-year-old pregnant woman with a transient ischemic attack(TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine(at 37 2/7 wk).CASE SUMMARY TIA occurred 13 d following the coronavirus disease vaccination.At 39 1/7 wk of pregnancy,the patient presented with sudden onset of right eye blurred vision with headache,dizziness with nausea,right-hand weakness,anomia,and alexia.The symptoms lasted 3 h;TIA was diagnosed.Blood test results revealed elevated D-dimer,cholesterol,and triglyceride levels.Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke.At pregnancy 37 6/7 wk,she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor.Body mass index on admission was 19.8 kg/m~2.Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities.The next day,a mature female baby weighing 2895 g and measuring 50 cm was delivered.Apgar scores were 8 and 9 in the first and fifth minutes.D-dimer levels decreased on postoperative day 4.After discharge,the autoimmune panel was within normal limits,including antinuclear and antiphospholipid antibodies.CONCLUSION TIA might be developed after the mRNA vaccines in pregnant women.展开更多
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most c...Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.展开更多
Background:A rapid elevation of post-ischemic circulating hepatocyte growth factor(HGF)levels has been reported in acute vascular disease including stroke.However,the impact of transient ischemic attack(TIA)on circula...Background:A rapid elevation of post-ischemic circulating hepatocyte growth factor(HGF)levels has been reported in acute vascular disease including stroke.However,the impact of transient ischemic attack(TIA)on circulating HGF has never been studied.Methods:Patients with an onset of either stroke or TIA within the past 30 days were enrolled.Based on the ischemic event,the patients were divided into a stroke group and a TIA group.Blood samples were collected at enrollment and at follow-up visits at one,three,and six months until a recurrent cerebral ischemic event.Plasma levels of HGF were measured using an enzyme-linked immunosorbent assay and logarithmically transformed to eliminate skewness.Results:Thirty-six patients were enrolled in the study,with 20 in the stroke group and 16 in the TIA group.The dynamic HGF levels post-ischemia showed distinct patterns between the two groups.A significant decrease of HGF levels was observed in the stroke group,from 2.62±0.18 ng/mL within 30 days after stroke to 2.41±0.22 ng/mL beyond 30 days(P=0.026);however,no significant change was found in the TIA group(2.22±0.17 ng/mL vs.2.19±0.16 ng/mL,P=0.990).A multivariate regression analysis showed a last event of stroke and a comorbidity of systemic atherosclerotic disease(SAD)were independently associated with higher levels of HGF.Subgroup analyses showed HGF levels decreased from 2.64±0.22 ng/mL within 30 days after stroke to 2.36±0.18 ng/mL beyond 30 days in patients without SAD(P=0.008),but not in patients with SAD(P=0.700).Conclusion:Our data indicate that in patients without SAD,circulating HGF is a potential biomarker to distinguish between stroke and TIA.展开更多
Background：Acute minor ischemic stroke （AMIS） or transient ischemic attack （TIA） is a common cerebrovascular event with a considerable high recurrence.Prior research demonstrated the effectiveness of regular long...Background：Acute minor ischemic stroke （AMIS） or transient ischemic attack （TIA） is a common cerebrovascular event with a considerable high recurrence.Prior research demonstrated the effectiveness of regular long-term remote ischemic conditioning （RIC） in secondary stroke prevention in patients with intracranial stenosis.We hypothesized that RIC can serve as an effective adjunctive therapy to pharmacotherapy in preventing ischemic events in patients with AMIS/TIA.This study aimed to investigate the feasibility,safety,and preliminary efficacy of daily RIC in inhibiting cerebrovascular/cardiovascular events after AMIS/TIA.Methods：This is a single-arm,open-label,multicenter Phase IIa futility study with a sample size of 165.Patients with AMIS/TIA receive RIC as an additional therapy to secondary stroke prevention regimen.RIC consists of five cycles of 5-min inflation （200 mmHg） and 5-min deflation of cuffs on bilateral upper limbs twice a day for 90 days.The antiplatelet strategy is based on individual physician＇s best practice：aspirin alone,clopidogrel alone,or combination of aspirin and clopidogrel.We will assess the recurrence rate of ischemic stroke/TIA within 3 months as the primary outcomes.Conclusions：The data gathered from the study will be used to determine whether a further large-scale,multicenter randomized controlled Phase Ⅱ trial is warranted in patients with AMIS/TIA.Trial Registration：ClinicalTrials.gov,NCT03004820;https：//www.clinicaltrials.gov/ct2/show/NCT03004820.展开更多
目的:观察通过关键医疗质量指标(key performance indicator,KPI)监控对提高缺血性脑血管病患者医疗质量的作用。方法:参照卫生部脑梗死单病种质控要求和美国"跟着指南走"(get with the guideline,GWTG)卒中项目制定缺血性脑...目的:观察通过关键医疗质量指标(key performance indicator,KPI)监控对提高缺血性脑血管病患者医疗质量的作用。方法:参照卫生部脑梗死单病种质控要求和美国"跟着指南走"(get with the guideline,GWTG)卒中项目制定缺血性脑血管病的KPI,从2010年3月开始对本中心所有急性缺血性卒中和短暂性脑缺血发作的住院患者进行监控。以本中心2006年1月至2007年12月间卒中资料库的数据作为历史对照,并将缺血性卒中的KPI与美国及台湾GWTG卒中项目的研究数据进行横向比较。结果:共纳入患者565名。与2006年1月至2007年12月数据对比,实施KPI监控后缺血性卒中患者发病2 h内到院溶栓率从28.6%提高到50.0%(P=0.009),发病后3.5 h内到院患者的溶栓率从31.6%提高到36.2%(P=0.703);在深静脉血栓预防、出院时降脂治疗及建议、戒烟建议、吞咽困难筛查、卒中健康教育、康复评价及干预方面有明显改善(各P<0.01)。缺血性卒中整体指标与美国GWTG卒中项目2009年数据部分指标相比仍有一定差距,与台湾数据相比有明显优势。短暂脑缺血发作(transientischemic attack,TIA)患者在出院时降脂治疗及建议、戒烟建议两方面有明显改进(P<0.05),其余各指标也有一定程度的改善。结论:通过实施KPI的监控可以明显提高缺血性脑血管病的医疗质量,但依然存在较大的改进空间。展开更多
文摘Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.
基金Supported by Shanghai Health and Family Planning Commission,No.201440051Shanghai Pudong New Area Health and Family Planning Commission,No.PW2016A-19
文摘BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited. AIM To explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction. METHODS A total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTS The intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy)(P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC]< 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively. CONCLUSION WSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.
文摘BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,especially cerebral venous sinus thrombosis,and may lead to stroke.Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications.We present the case of a 24-year-old pregnant woman with a transient ischemic attack(TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine(at 37 2/7 wk).CASE SUMMARY TIA occurred 13 d following the coronavirus disease vaccination.At 39 1/7 wk of pregnancy,the patient presented with sudden onset of right eye blurred vision with headache,dizziness with nausea,right-hand weakness,anomia,and alexia.The symptoms lasted 3 h;TIA was diagnosed.Blood test results revealed elevated D-dimer,cholesterol,and triglyceride levels.Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke.At pregnancy 37 6/7 wk,she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor.Body mass index on admission was 19.8 kg/m~2.Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities.The next day,a mature female baby weighing 2895 g and measuring 50 cm was delivered.Apgar scores were 8 and 9 in the first and fifth minutes.D-dimer levels decreased on postoperative day 4.After discharge,the autoimmune panel was within normal limits,including antinuclear and antiphospholipid antibodies.CONCLUSION TIA might be developed after the mRNA vaccines in pregnant women.
文摘Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
基金supported by the grant from the Science and Technology Department of Zhejiang Province(2015C34007).
文摘Background:A rapid elevation of post-ischemic circulating hepatocyte growth factor(HGF)levels has been reported in acute vascular disease including stroke.However,the impact of transient ischemic attack(TIA)on circulating HGF has never been studied.Methods:Patients with an onset of either stroke or TIA within the past 30 days were enrolled.Based on the ischemic event,the patients were divided into a stroke group and a TIA group.Blood samples were collected at enrollment and at follow-up visits at one,three,and six months until a recurrent cerebral ischemic event.Plasma levels of HGF were measured using an enzyme-linked immunosorbent assay and logarithmically transformed to eliminate skewness.Results:Thirty-six patients were enrolled in the study,with 20 in the stroke group and 16 in the TIA group.The dynamic HGF levels post-ischemia showed distinct patterns between the two groups.A significant decrease of HGF levels was observed in the stroke group,from 2.62±0.18 ng/mL within 30 days after stroke to 2.41±0.22 ng/mL beyond 30 days(P=0.026);however,no significant change was found in the TIA group(2.22±0.17 ng/mL vs.2.19±0.16 ng/mL,P=0.990).A multivariate regression analysis showed a last event of stroke and a comorbidity of systemic atherosclerotic disease(SAD)were independently associated with higher levels of HGF.Subgroup analyses showed HGF levels decreased from 2.64±0.22 ng/mL within 30 days after stroke to 2.36±0.18 ng/mL beyond 30 days in patients without SAD(P=0.008),but not in patients with SAD(P=0.700).Conclusion:Our data indicate that in patients without SAD,circulating HGF is a potential biomarker to distinguish between stroke and TIA.
基金PICNIC-One study is supported by the grants from the National Natural Science Foundation of China （No. 81325007 and No. 81620108011）, the Capital Health Research and Special Development （No. 2016-4-1032）, the American Stroke Association （No. 14SDG 1829003）, and the National Institute of Health （No. P20GM 109040）.
文摘Background：Acute minor ischemic stroke （AMIS） or transient ischemic attack （TIA） is a common cerebrovascular event with a considerable high recurrence.Prior research demonstrated the effectiveness of regular long-term remote ischemic conditioning （RIC） in secondary stroke prevention in patients with intracranial stenosis.We hypothesized that RIC can serve as an effective adjunctive therapy to pharmacotherapy in preventing ischemic events in patients with AMIS/TIA.This study aimed to investigate the feasibility,safety,and preliminary efficacy of daily RIC in inhibiting cerebrovascular/cardiovascular events after AMIS/TIA.Methods：This is a single-arm,open-label,multicenter Phase IIa futility study with a sample size of 165.Patients with AMIS/TIA receive RIC as an additional therapy to secondary stroke prevention regimen.RIC consists of five cycles of 5-min inflation （200 mmHg） and 5-min deflation of cuffs on bilateral upper limbs twice a day for 90 days.The antiplatelet strategy is based on individual physician＇s best practice：aspirin alone,clopidogrel alone,or combination of aspirin and clopidogrel.We will assess the recurrence rate of ischemic stroke/TIA within 3 months as the primary outcomes.Conclusions：The data gathered from the study will be used to determine whether a further large-scale,multicenter randomized controlled Phase Ⅱ trial is warranted in patients with AMIS/TIA.Trial Registration：ClinicalTrials.gov,NCT03004820;https：//www.clinicaltrials.gov/ct2/show/NCT03004820.
文摘目的:观察通过关键医疗质量指标(key performance indicator,KPI)监控对提高缺血性脑血管病患者医疗质量的作用。方法:参照卫生部脑梗死单病种质控要求和美国"跟着指南走"(get with the guideline,GWTG)卒中项目制定缺血性脑血管病的KPI,从2010年3月开始对本中心所有急性缺血性卒中和短暂性脑缺血发作的住院患者进行监控。以本中心2006年1月至2007年12月间卒中资料库的数据作为历史对照,并将缺血性卒中的KPI与美国及台湾GWTG卒中项目的研究数据进行横向比较。结果:共纳入患者565名。与2006年1月至2007年12月数据对比,实施KPI监控后缺血性卒中患者发病2 h内到院溶栓率从28.6%提高到50.0%(P=0.009),发病后3.5 h内到院患者的溶栓率从31.6%提高到36.2%(P=0.703);在深静脉血栓预防、出院时降脂治疗及建议、戒烟建议、吞咽困难筛查、卒中健康教育、康复评价及干预方面有明显改善(各P<0.01)。缺血性卒中整体指标与美国GWTG卒中项目2009年数据部分指标相比仍有一定差距,与台湾数据相比有明显优势。短暂脑缺血发作(transientischemic attack,TIA)患者在出院时降脂治疗及建议、戒烟建议两方面有明显改进(P<0.05),其余各指标也有一定程度的改善。结论:通过实施KPI的监控可以明显提高缺血性脑血管病的医疗质量,但依然存在较大的改进空间。
