Characteristics and risk factors of cerebrovascular accidents after percutaneous coronary interventions in patients with history of stroke

Background Percutaneous coronary intervention （PCI） is a well-established method for managing coronary diseases. However, the increasing use of PCI has led to an increased incidence of acute cerebrovascular accidents （CVA） related to PCI. In this study, we investigated the characteristics and risk factors of CVA after PCI in patients with known stroke history. Methods Between January 1, 2005 and March 1, 2009, 621 patients with a history of stroke underwent a total of 665 PCI procedures and were included in this retrospective study. Demographic and clinical characteristics, previous medications, procedures, neurologic deficits, location of lesion and in-hospital clinical outcomes of patients who developed a CVA after the cardiac catheterization laboratory visit and before discharge were reviewed. Results Acute CVA was diagnosed in 53 （8.5%） patients during the operation or the perioperative period. Seventeen patients suffered from transient ischemic attack, thirty-four patients suffered from cerebral infarction and two patients suffered from cerebral hemorrhage. The risk factors for CVA after PCI in stroke patients were： admission with an acute coronary syndrome, use of an intra-aortic balloon pump, urgent or emergency procedures, diabetes mellitus, and poor left ventricular systolic function, arterial fibrillation, previous myocardial infarction, dyslipidemia, tobacco use, and no/irregular use of anti-platelet medications. Conclusions The incidence of CVA during and after PCI in patients with history of stroke is much higher than that in patients without history of stroke. Patients with atrial fibrillation, previous myocardial infarction, diabetes mellitus, dyslipidemia, tobacco use, and no or irregular use of anti-platelet medications were at higher risk for recurrent stroke. This study showed a strong association between acute coronary svndromes and in-hospital stroke after PCI.

Stroke (Cerebrovascular Accident): Epidemiological, Clinical and Evolving Aspects in the Internal Medicine Department of the Public Health Establishment 1 (EPS1) of Tivaouane

Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.

Information-motivation-behavioral guided nursing for stroke patients with pulmonary dysfunction:A randomized controlled trial

BACKGROUND Patients with stroke frequently experience pulmonary dysfunction.AIM To explore the effects of information-motivation-behavioral(IMB)skills modelbased nursing care on pulmonary function,blood gas indices,complication rates,and quality of life(QoL)in stroke patients with pulmonary dysfunction.METHODS We conducted a controlled study involving 120 stroke patients with pulmonary dysfunction.The control group received routine care,whereas the intervention group received IMB-model-based nursing care.Various parameters including pulmonary function,blood gas indices,complication rates,and QoL were assessed before and after the intervention.RESULTS Baseline data of the control and intervention groups were comparable.Post-intervention,the IMB model-based care group showed significant improvements in pulmonary function indicators,forced expiratory volume in 1 sec,forced vital capacity,and peak expiratory flow compared with the control group.Blood gas indices,such as arterial oxygen pressure and arterial oxygen saturation,increased significantly,and arterial carbon dioxide partial.pressure decreased significantly in the IMB model-based care group compared with the control group.The intervention group also had a lower complication rate(6.67%vs 23.33%)and higher QoL scores across all domains than the control group.CONCLUSION IMB model-based nursing care significantly enhanced pulmonary function,improved blood gas indices,reduced complication rates,and improved the QoL of stroke patients with pulmonary dysfunction.Further research is needed to validate these results and to assess the long-term efficacy and broader applicability of the model.

Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors

The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.

Acupuncture combined with Buyang Huanwu decoction in the treatment of sequelae of cerebrovascular accident:a systematic review and meta-analysis

Background:Cerebrovascular accident has high morbidity,high disability,and high mortality,possibly causing several serious sequelae and bringing a heavy burden to the patient,the family,and the society.Buyang Huanwu decoction,a classic ancient prescription of traditional Chinese medicine,and acupuncture are often used in combination to treat the sequelae of cerebrovascular accident.In the present study,we systematically evaluated the clinical efficacy and safety of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident.Methods:Relevant randomized controlled trials of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident were comprehensively retrieved from electronic databases from inception to May 8,2020,including PubMed,Embase,The Cochrane Library,China National Knowledge Infrastructure,WanFang Data,and China Science and Technology Journal Database.The main outcomes of clinical efficacy,degree of nerve function impairment,daily self-care capacity,Fugl-Meyer locomotor function score,life quality score,and occurrence of adverse reactions were subjected to meta-analysis.Results:The 28 randomized controlled trials included 2,341 patients with the sequelae of cerebrovascular accident.Systematic review and meta-analysis indicated that compared with acupuncture alone,its combined treatment with Buyang Huanwu decoction significantly increased clinical efficacy(RR=1.19,95%CI(1.14,1.23),P<0.001),improved nerve function impairment(WMD=−4.89,95%CI(−8.25,−1.53),P=0.004),promoted daily self-care capacity(WMD=15.87,95%CI(11.22,20.51),P<0.001),strengthened Fugl-Meyer locomotor function(WMD=20.89,95%CI(13.79,27.98),P<0.001),enhanced physical functioning(WMD=16.99,95%CI(6.01,27.96),P<0.001)and mental health(WMD=16.91,95%CI(9.14,24.69),P<0.001)in terms of life quality score(SF-36 scale)of patients with sequelae of cerebrovascular accident,with few adverse reactions.Conclusion:Compared with acupuncture alone,its combination with Buyang Huanwu decoction had better comprehensive effects on sequelae of cerebrovascular accident without obvious adverse reactions.

Effects of aquatic exercise on depression and anxiety in ischemic stroke subjects

Background: Stroke ranks third and is the leading cause of permanent disability in western countries. Furthermore there are no treatments for the psychosocial effects of this pathology. Purpose: Analyse the effect of an aquatic exercise program in depression and trace and state anxiety in subjects who suffered an ischemic stroke. Methods: Two groups were analyzed: experimental group (EG) n = 15, 50.3 ± 9.1 years;control group (CG) n = 13, 52.5 ± 7.7 years. EG underwent a 12-week aquatic exercise program. Both groups were evaluated in pre and post- treatment using Beck Depression Inventory (BDI) and Trace State Anxiety Inventory (IDATE). Wilcoxon signed-rank and Mann-Whitney tests were used to compare moments and groups, respec- tively. Results: The BDI scores of aquatic activities were: pre-treatment, 17.4 ± 7.7 and 16.9 ± 8.6 for the EG and CG, respectively;post-treat- ment, 13.2 + 7.1 and 16.4 + 7.9 for the EG and CG, respectively. The IDATE scores for anxiety trace in strength training were: pre-treatment, 43.2 + 12.5 and 42.9 + 12.2 for the EG and CG, respec- tively;post-treatment, 39.7 + 7.1 and 42.6 + 12.1 for the EG and CG, respectively. The IDATE scores for anxiety state in strength training were: pre-treatment, 46.9 + 7.6 and 47.4 + 8.1 for the EG and CG, respectively;post-treatment, 44.4 + 7.9 and 47.5 + 8.0 for the EG and CG, respectively. Significant differences were found in pre and post-treatment values in the EG and between groups in the depression and trace and state anxiety levels in post-treatment (p Conclusions: Aquatic physical activity contributes to an improvement of the levels of depression and anxiety in people who suffered a stroke.

Stroke prevention awareness and treatment knowledge among patients' relatives

BACKGROUND： Recent research indicates that if a stroke can be effectively treated within three hours, prognosis is improved. Therefore, it is necessary to properly educate stroke patients＇ relatives about prevention and treatment. OBJECTIVE： To survey and analyze the present awareness of stroke prevention and treatment knowledge among patients＇ relatives. DESIGN： Cross-sectional study. SETTING： Beijing Hospital and Medical College of Shandong University and Harrison International Peace Hospital, the Affiliated Hospital of Hebei Medical University. PARTICIPANTS： From May 2005 to November 2006, a ＂stroke awareness＂ questionnaire survey was performed in four hospitals, including Harrison International Peace Hospital in Hengshui City （third class, first grade）, Fucheng County People＇s Hospital （second class, first grade）, Zaoqiang County Jiahui Countryside Hospital （first class, first grade） and Hengshui City Electricity Industry Bureau Infirmary. The participants provided confirmed consent. METHODS： The ＂stroke awareness＂ questionnaire included 10 questions： 1 -8 were related to the understanding of stroke, 9 and 10 were related to behavior and attitude towards medical treatment. Demographic information was also collected on each participant, including age, education level, and occupation. Each positive answer accounted for one point. A score of 8 or higher was categorized as ＂good stroke awareness＂. MAIN OUTCOME MEASURES： Scores of stroke awareness. RESULTS： A total of 4 000 ＂stroke awareness＂ questionnaires were printed and distributed. 3 597 copies were completed and 3 468 were included in the study. （1） Relative factors of stroke awareness： The survey demonstrated that the participant＇s age, educational level, occupation, grade of hospital, and the relationship with the patient had a significant effect on their stroke awareness （P 〈 0.05-0.01）. （2） Stroke knowledge： With regard to stroke awareness, 72% subjects did not know the signs indicating the onset of transient ischemic attack; 86%, 72%, and 51% did not know that diabetes, cardiopathy, or smoking and drinking were risk factors for cerebral thrombosis, respectively. With regard to awareness of cerebral thrombosis symptoms almost 60% did not know the symptoms of vertebrobasilar ischemia, such as dizziness, vomiting, and impaired eyesight. With respect to cerebral thrombosis treatment, 27% reported that when a stroke occurs, they would like to see the doctor subsequent to discussion with their families, or they would even wait a few days. They did not regard their condition as an ＂emergency＂. CONCLUSION： Relatives have little knowledge about stroke, but there are significant differences in levels of awareness with respect to occupation and educational levels.

Family function and health behaviours of stroke survivors

Purpose:To investigate health behaviours and family function in stroke survivors,and evaluate the relationships among them.Methods:Patients who were diagnosed with stroke before and went back to neurology clinic between August 2011 and February 2012 in a tertiary hospital in Guangzhou,China were recruited for this study.Patients that were discharged and living at home for at least two months were asked to complete Family Assessment Device(FAD)and Health Promoting Lifestyle Profile,version II(HPLP-II)questionnaires.Individual items were scored between 1 and 4 points,and survey scores were compared and analysed using Pearson's correlations.Results:The mean overall FAD family function score was 2.18±0.25 points,with lower scores observed for problem solving and role function factors,and higher scores for communication,affection involvement,and behaviour control.The mean overall HPLP-II health behaviour score was 2.27±0.36 points,with the highest score for the nutrition factor,and the lowest score for the exercise factor.The total score of family function negatively correlated with health behaviours(r?0.535,p<0.01).Conclusions:Family function and health behaviours in stroke survivors are related,and need further improvement.Healthcare workers should pay close attention to patients'family function and health behaviours and find the reasons which may be influence their level.

Retrospective investigation of hospitalized patients with atrial fibrillation in China's Mainland

Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current status of treatment in patients with AF in China's Mainland Methods Retrospective analysis of hospital records were taken from patients with primary diagnosis of AF, discharged from January 1999 to December 2001 A total of 9297 cases (mean age 65 5 years) with AF were enrolled from 40 hospitals in major parts of China Results The percentage of hospital admissions with AF was gradually increased comparing to those of total cardiovascular admission during three years, with the average of 7 9% The cases distribution progressively rose with age The causes and associated conditions of AF: advanced age 58 1%, hypertension 40 3%, coronary heart disease 34 8%, heart failure 33 1%, rheumatic valvular disease 23 9%, idiopathic AF 7 4%, cardiomyopathy 5 4%, diabetes 4 1% The most common coexistence among these variables was advanced age with hypertension Permanent AF almost accounted for half of these cases (49 5%), paroxysmal and persistent AF were 33 7% and 16 7%, respectively Paroxysmal AF was mainly treated with rhythm control (56 4%) However, 82 8% of patients with chronic AF had therapeutic strategy of rate control In patients with persistent AF, the cardioversion had been attempted in cases more than 50%, with only 31 1% of these patients who could maintain stabilized sinus rhythm The prevalence of stroke in this group was 17 5% In nonvalvular AF patients the risk factors that significantly associated with stroke included advanced age, history of hypertension, coronary heart disease and type of AF Sixty four point five percent of these patients received antithrombotic therapy with dominated use of antiplatelet agents The long term prevention with anticoagulants only accounted for 6 6% In this investigation patients with antiplatelets as well as patients with anticoagulants showed significant lower stroke rate in comparison with those managed neither However, the difference between antiplatelets and anticoagulants in terms of stroke rate was not significant Conclusions Most epidemiological factors of AF from this group showed highly in accordance with those from the reports from other countries, such as age distribution, causes and associated conditions, type of AF, dominantly with approach of rate control Both antiplatelet and anticoagulant treatments significantly reduced stroke rate But there was no significant difference between these two kinds of treatments in reducing stroke rate

Aortic arch and intra-/extracranial cerebral arterial atherosclerosis in patients suffering acute ischemic strokes

OBJECTIVE: To determine the distribution of aortic arch and intra/extracranial cerebral arterial atherosclerosis in Chinese patients who had suffered acute ischemic strokes. METHODS: Eighty-nine patients with acute ischemic strokes were included in this study. Transesophageal echocardiography (TEE) was used to evaluate potential sources of embolisms in the aortic arch and in the heart; duplex ultrasound was used for the carotid artery; and intracranial Doppler (TCD) imaging was used for the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and basilar artery (BA). An atherosclerotic lesion in the aortic arch was defined as normal (0); mild plaque (1); moderate plaque (2); and protruding plaque or mobile plaque (3). A lesion in the carotid artery was considered a plaque if the maximal carotid plaque thickness was 1.2 mm. TCD results were deemed abnormal if flow velocity was either greater or lower than normal, and, in the case of the MCA, if an asymmetry index above 21% was measured. RESULTS: Of the 89 patients, 52 (58.43%) patients showed evidence of aortic arch atherosclerosis (AAA), including 11 (12.36%) patients graded mild, 18 (20.22%) patients graded moderate, and 23 (25.84%) patients graded severe. Of the 23 patients with severe AAA, AAA was determined to be an important potential embolic source in 14 patients. Forty-nine (50.56%) patients had carotid arterial plaques (CAPs). The incidence of carotid plaques was higher among patients with AAA than among patients without AAA (71.15% vs 21.62%, OR = 3.291, 95% CI = 1.740 - 6.225, P