目的探讨美国国立卫生研究院卒中量表(NIHSS)评分<6分的合并大血管闭塞的急性缺血性卒中(AIS-LVO)患者行血管内治疗(EVT)的预后影响因素。方法回顾性选取2021年1月至2023年1月在浙江省台州医院接受EVT的42例NIHSS评分<6分的AIS-LV...目的探讨美国国立卫生研究院卒中量表(NIHSS)评分<6分的合并大血管闭塞的急性缺血性卒中(AIS-LVO)患者行血管内治疗(EVT)的预后影响因素。方法回顾性选取2021年1月至2023年1月在浙江省台州医院接受EVT的42例NIHSS评分<6分的AIS-LVO患者为研究对象。根据术后90 d改良Rankin量表(mRS)评分评估患者预后,比较预后良好组与预后不良组患者的临床资料,采用多因素logistic回归分析预后影响因素。结果所有患者均成功实现血管再通(100.0%),术中均未发生血栓逃逸、血管损伤、夹层、出血事件;术后发生24 h症状性颅内出血1例(2.4%),恶性脑水肿1例(2.4%)。随访90 d mRS评分显示预后良好33例,预后不良9例(未发生死亡病例)。预后良好组与预后不良组在年龄、术前舒张压、穿刺至再灌注时间等方面比较,差异均有统计学意义(均P<0.05)。穿刺至再灌注时间是影响NIHSS评分<6分的AIS-LVO患者行EVT预后的独立危险因素(OR=1.026,P=0.029)。结论NIHSS评分<6分的AIS-LVO患者行EVT可能是安全有效的,缩短穿刺至再灌注时间可能改善患者预后。展开更多
美国国立卫生院卒中量表(National Institute Health stroke scale,NIHSS)评分是临床上常用的脑卒中神经功能缺损评估量表,正确的NIHSS评分有助于更好地评估卒中严重程度和指导临床治疗决策,但现实中NIHSS评分临床使用中存在异质性。如...美国国立卫生院卒中量表(National Institute Health stroke scale,NIHSS)评分是临床上常用的脑卒中神经功能缺损评估量表,正确的NIHSS评分有助于更好地评估卒中严重程度和指导临床治疗决策,但现实中NIHSS评分临床使用中存在异质性。如何建立合格的培训模式、助力医务人员规范进行NIHSS评分具有重要意义。文章总结采取“线上+线下”“理论+实践”“案例+思政”“实时+延伸”的教学思路进行“线上+线下+思政+延伸”混合式教学模式的经验,探讨NIHSS评分教学方法,认为该混合式教学模式通过多渠道、多维度的培训模式,使得教学主导、学生主动相结合,并注重思政教育融入,且有助于提高教师教学效率,顺应了信息化时代的教育改革,符合未来教育课程发展的趋势,是NIHSS评分技能培训和改革的新思路和新方法。展开更多
Leukoaraiosis(LA)results from ischemic injury in small cerebral vessels,which may be attributable to decreased vascular density,reduced cerebrovascular angiogenesis,decreased cerebral blood flow,or microcirculatory dy...Leukoaraiosis(LA)results from ischemic injury in small cerebral vessels,which may be attributable to decreased vascular density,reduced cerebrovascular angiogenesis,decreased cerebral blood flow,or microcirculatory dysfunction in the brain.In this study,we enrolled 357 patients with mild intracerebral hemorrhage(ICH)from five hospitals in China and analyzed the relationships between LA and clinical symptom severity at admission,neurological function prognosis at 3 months,and 1-year stroke recurrence.Patients were divided into groups based on Fazekas scale scores:no LA(n=83),mild LA(n=64),moderate LA(n=98)and severe LA(n=112).More severe LA,larger hematoma volume,and higher blood glucose level at admission were associated with more severe neurological deficit.More severe LA,older age and larger hematoma volume were associated with worse neurological function prognosis at 3 months.In addition,moderate-to-severe LA,admission glucose and symptom-free cerebral infarction were associated with 1-year stroke recurrence.These findings suggest that LA severity may be a potential marker of individual ICH vulnerability,which can be characterized by poor tolerance to intracerebral attack or poor recovery ability after ICH.Evaluating LA severity in patients with mild ICH may help neurologists to optimize treatment protocols.This study was approved by the Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University(approval No.12)on March 10,2011.展开更多
BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size,and the level of clinical evidence is low.AIM To assess the safety and efficacy of Guhong injection for mild ischemic ...BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size,and the level of clinical evidence is low.AIM To assess the safety and efficacy of Guhong injection for mild ischemic stroke(IS).METHODS A total of 399 IS patients treated at six hospitals from August 2018 to August 2019 were retrospectively analyzed.The patients were given Guhong injection(experimental group)or Butylphthalide injection(control group).Changes in National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores were observed before treatment and at 1,2,and 3 wk after treatment in each group.The efficacy and safety of Guhong injection for IS were assessed.Other medications taken by the patients were confounding factors for efficacy assessment.These factors were controlled by propensity score matching,and the results were further analyzed based on the matching.RESULTS The marked response rates at three follow-up visits were 64.64%,74.7%,and 66.7%in the experimental group,and 48.26%,45.4%,and 22.2%in the control group.The marked response rates increased significantly in the experimental group compared with the control group(P<0.05).The overall response rate at the first visit(days 7±2)did not differ significantly between the two groups,but differed significantly at the second(days 14±2)and third visits(days 21±3)(P<0.05).The proportion of patients without any symptoms in the experimental group was significant different at the first visit(P<0.05),but not significantly different at the second visit.The two groups showed no significant difference in the baseline distribution of mRS scores.At the first and second visits,the change in mRS scores was-2 and-1 in the experimental and control groups,respectively,which were significantly different(P<0.05).After propensity score matching,the overall response rate and marked response rate were 97.29%and 100%in the experimental group(P>0.05)and 64.0%and 47.7%in the control group(P<0.05)at the first visit,respectively.The decreased NIHSS scores in the two groups were significant different(P<0.05).The overall response rate and marked response rate differed significantly between the two groups at the second visit(P<0.05).There was no significant difference in the incidence of adverse events between the two groups.No severe adverse events occurred in either group.CONCLUSION Guhong injection is safe and more effective than Butylphthalide injection for treatment of IS.展开更多
BACKGROUND Acute ischemic stroke(AIS)is one of the major causes of the continuous increasing rate of global mortality due to the lack of timely diagnosis,prognosis,and management.This study provides a primitive platfo...BACKGROUND Acute ischemic stroke(AIS)is one of the major causes of the continuous increasing rate of global mortality due to the lack of timely diagnosis,prognosis,and management.This study provides a primitive platform for non-invasive and cost-effective diagnosis and prognosis of patients with AIS using circulating cellfree mitochondrial DNA(cf-mtDNA)quantification and validation.AIM To evaluate the role of cf-mtDNA as s non-invasive,and affordable tool for realtime monitoring and prognosticating AIS patients at disease onset and during treatment.METHODS This study enrolled 88 participants including 44 patients with AIS and 44 healthy controls with almost similar mean age group at stroke onset,and at 24 h and 72 h of treatment.Peripheral blood samples were collected from each study participant and plasma was separated using centrifugation.The cf-mtDNA concentration was quantified using nanodrop reading and validated through real-time quantitative polymerase chain reaction(RT-qPCR)of NADH-ubiquinone oxidoreductase chain 1(ND1)relative transcript expression levels.RESULTS Comparative analysis of cf-mtDNA concentration in patients at disease onset showed significantly increased levels compared to control individuals for both nanodrop reading,as well as ND1 relative expression levels(P<0.0001).Intergroup analysis of cf-mtDNA concentration using nanodrop showed significantly reduced levels in patients at 72 h of treatment compared to onset(P<0.01).However,RT-qPCR analysis showed a significant reduction at 24 h and 72 h of treatment compared to the disease onset(P<0.001).The sensitivity and specificity were relatively higher for RT-qPCR than nanodrop-based cfmtDNA quantification.Correlation analysis of both cf-mtDNA concentration as well as ND1 relative expression with National Institute of Health Stroke Scale score at baseline showed a positive trend.CONCLUSION In summary,quantitative estimation of highly pure cf-mtDNA provides a simple,highly sensitive and specific,non-invasive,and affordable approach for real-time monitoring and prognosticating AIS patients at onset and during treatment.展开更多
Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location...Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.展开更多
目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未...目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。展开更多
文摘目的探讨美国国立卫生研究院卒中量表(NIHSS)评分<6分的合并大血管闭塞的急性缺血性卒中(AIS-LVO)患者行血管内治疗(EVT)的预后影响因素。方法回顾性选取2021年1月至2023年1月在浙江省台州医院接受EVT的42例NIHSS评分<6分的AIS-LVO患者为研究对象。根据术后90 d改良Rankin量表(mRS)评分评估患者预后,比较预后良好组与预后不良组患者的临床资料,采用多因素logistic回归分析预后影响因素。结果所有患者均成功实现血管再通(100.0%),术中均未发生血栓逃逸、血管损伤、夹层、出血事件;术后发生24 h症状性颅内出血1例(2.4%),恶性脑水肿1例(2.4%)。随访90 d mRS评分显示预后良好33例,预后不良9例(未发生死亡病例)。预后良好组与预后不良组在年龄、术前舒张压、穿刺至再灌注时间等方面比较,差异均有统计学意义(均P<0.05)。穿刺至再灌注时间是影响NIHSS评分<6分的AIS-LVO患者行EVT预后的独立危险因素(OR=1.026,P=0.029)。结论NIHSS评分<6分的AIS-LVO患者行EVT可能是安全有效的,缩短穿刺至再灌注时间可能改善患者预后。
文摘美国国立卫生院卒中量表(National Institute Health stroke scale,NIHSS)评分是临床上常用的脑卒中神经功能缺损评估量表,正确的NIHSS评分有助于更好地评估卒中严重程度和指导临床治疗决策,但现实中NIHSS评分临床使用中存在异质性。如何建立合格的培训模式、助力医务人员规范进行NIHSS评分具有重要意义。文章总结采取“线上+线下”“理论+实践”“案例+思政”“实时+延伸”的教学思路进行“线上+线下+思政+延伸”混合式教学模式的经验,探讨NIHSS评分教学方法,认为该混合式教学模式通过多渠道、多维度的培训模式,使得教学主导、学生主动相结合,并注重思政教育融入,且有助于提高教师教学效率,顺应了信息化时代的教育改革,符合未来教育课程发展的趋势,是NIHSS评分技能培训和改革的新思路和新方法。
基金supported by the National Natural Science Foundation of China,Nos.81771281(to FXS),81471177(to FXS)the Natural Science Foundation of Shanghai of China,No.20ZR1434200(to YF)。
文摘Leukoaraiosis(LA)results from ischemic injury in small cerebral vessels,which may be attributable to decreased vascular density,reduced cerebrovascular angiogenesis,decreased cerebral blood flow,or microcirculatory dysfunction in the brain.In this study,we enrolled 357 patients with mild intracerebral hemorrhage(ICH)from five hospitals in China and analyzed the relationships between LA and clinical symptom severity at admission,neurological function prognosis at 3 months,and 1-year stroke recurrence.Patients were divided into groups based on Fazekas scale scores:no LA(n=83),mild LA(n=64),moderate LA(n=98)and severe LA(n=112).More severe LA,larger hematoma volume,and higher blood glucose level at admission were associated with more severe neurological deficit.More severe LA,older age and larger hematoma volume were associated with worse neurological function prognosis at 3 months.In addition,moderate-to-severe LA,admission glucose and symptom-free cerebral infarction were associated with 1-year stroke recurrence.These findings suggest that LA severity may be a potential marker of individual ICH vulnerability,which can be characterized by poor tolerance to intracerebral attack or poor recovery ability after ICH.Evaluating LA severity in patients with mild ICH may help neurologists to optimize treatment protocols.This study was approved by the Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University(approval No.12)on March 10,2011.
文摘BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size,and the level of clinical evidence is low.AIM To assess the safety and efficacy of Guhong injection for mild ischemic stroke(IS).METHODS A total of 399 IS patients treated at six hospitals from August 2018 to August 2019 were retrospectively analyzed.The patients were given Guhong injection(experimental group)or Butylphthalide injection(control group).Changes in National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores were observed before treatment and at 1,2,and 3 wk after treatment in each group.The efficacy and safety of Guhong injection for IS were assessed.Other medications taken by the patients were confounding factors for efficacy assessment.These factors were controlled by propensity score matching,and the results were further analyzed based on the matching.RESULTS The marked response rates at three follow-up visits were 64.64%,74.7%,and 66.7%in the experimental group,and 48.26%,45.4%,and 22.2%in the control group.The marked response rates increased significantly in the experimental group compared with the control group(P<0.05).The overall response rate at the first visit(days 7±2)did not differ significantly between the two groups,but differed significantly at the second(days 14±2)and third visits(days 21±3)(P<0.05).The proportion of patients without any symptoms in the experimental group was significant different at the first visit(P<0.05),but not significantly different at the second visit.The two groups showed no significant difference in the baseline distribution of mRS scores.At the first and second visits,the change in mRS scores was-2 and-1 in the experimental and control groups,respectively,which were significantly different(P<0.05).After propensity score matching,the overall response rate and marked response rate were 97.29%and 100%in the experimental group(P>0.05)and 64.0%and 47.7%in the control group(P<0.05)at the first visit,respectively.The decreased NIHSS scores in the two groups were significant different(P<0.05).The overall response rate and marked response rate differed significantly between the two groups at the second visit(P<0.05).There was no significant difference in the incidence of adverse events between the two groups.No severe adverse events occurred in either group.CONCLUSION Guhong injection is safe and more effective than Butylphthalide injection for treatment of IS.
文摘BACKGROUND Acute ischemic stroke(AIS)is one of the major causes of the continuous increasing rate of global mortality due to the lack of timely diagnosis,prognosis,and management.This study provides a primitive platform for non-invasive and cost-effective diagnosis and prognosis of patients with AIS using circulating cellfree mitochondrial DNA(cf-mtDNA)quantification and validation.AIM To evaluate the role of cf-mtDNA as s non-invasive,and affordable tool for realtime monitoring and prognosticating AIS patients at disease onset and during treatment.METHODS This study enrolled 88 participants including 44 patients with AIS and 44 healthy controls with almost similar mean age group at stroke onset,and at 24 h and 72 h of treatment.Peripheral blood samples were collected from each study participant and plasma was separated using centrifugation.The cf-mtDNA concentration was quantified using nanodrop reading and validated through real-time quantitative polymerase chain reaction(RT-qPCR)of NADH-ubiquinone oxidoreductase chain 1(ND1)relative transcript expression levels.RESULTS Comparative analysis of cf-mtDNA concentration in patients at disease onset showed significantly increased levels compared to control individuals for both nanodrop reading,as well as ND1 relative expression levels(P<0.0001).Intergroup analysis of cf-mtDNA concentration using nanodrop showed significantly reduced levels in patients at 72 h of treatment compared to onset(P<0.01).However,RT-qPCR analysis showed a significant reduction at 24 h and 72 h of treatment compared to the disease onset(P<0.001).The sensitivity and specificity were relatively higher for RT-qPCR than nanodrop-based cfmtDNA quantification.Correlation analysis of both cf-mtDNA concentration as well as ND1 relative expression with National Institute of Health Stroke Scale score at baseline showed a positive trend.CONCLUSION In summary,quantitative estimation of highly pure cf-mtDNA provides a simple,highly sensitive and specific,non-invasive,and affordable approach for real-time monitoring and prognosticating AIS patients at onset and during treatment.
基金supported by the Science and Technical Committee of Shanghai Municipality of China,No.16QA1400900the Outstanding Youth Grant from Shanghai Municipal Commission of Health and Family Planning of China,No.XYQ2013107+1 种基金the China Postdoctoral Science Foundation,No.2016M592595the National Key Research and Development Program of China,No.2016YFA0203700
文摘Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.
文摘目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。
