Effect of in-hospital medical complications on case fatality post-acute ischemic stroke： data from the China National Stroke Registry

Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke. Methods From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke. Results There were 39741 patients screened, 14526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% （1826） had in-hospital medical complications. The most common complication was pneumonia （1373; 11.9% of patients）, followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period （adjusted OR=6.946; 95% CI 5.181 to 9.314）, at 3 months （adjusted OR=3.843; 95% C/3.221 to 4.584）, 6 months （adjusted OR=3.492; 95% CI 2.970 to 4.106）, and 12 months （adjusted OR= 3.511; 95% CI 3.021 to 4.080）. Having multiple complications strongly increased the death risk of patients. Conclusion Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.

Acupuncture plus Chinese Medicinal Fumigation and Washing for Edema of the Stroke-affected Limb

Objective: To evaluate the therapeutic efficacy of acupuncture plus Chinese medicinal fumigation and washing in treating edema of the affected limb in post-stroke hemiplegia. Methods: Two hundred patients with edema of the stroke-affected limb from our hospital were randomized into two groups according to their visiting sequence. In the observation group, 100 subjects were intervened by acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics, while the other 100 subjects in the control group were only given diuretics. The therapeutic efficacy was evaluated after successive 2-week treatments. Results: The total effective rate was 90.0% in the observation group, significantly higher than 66.0% in the control group, indicating that there was a significant difference in comparing the overall therapeutic effect(P<0.01). Conclusion: Acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics is effective in treating edema of the affected limb in post-stroke hemiplegia.

Clinical Observation of Acupuncture plus Patent Chinese Medicine for Post-stroke Constipation

Objective: To observe the clinical efficacy of acupuncture plus patent Chinese medicine in treating post-stroke constipation. Methods: Sixty eligible patients with post-stroke constipation were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by acupuncture plus Ma Zi Ren pill, while the control group was by Ma Zi Ren pill alone. The symptoms of constipation were observed before and after intervention. Results: After 2-week treatment, the constipation condition was improved in both groups, and the improvement in the treatment group was statistically more significant than that in the control group(P<0.05); respectively two weeks and a month after the intervention, the treatment group was superior to the control group in comparing the constipation score(P<0.05). However, acupuncture didn't show marked effect in improving defecation speed, initial defecation time, and spontaneous discharge frequency. The treatment group had a significantly higher short-term markedly-effective rate compared with the control group(P<0.05); the long-term therapeutic efficacy of the treatment group was significantly higher than that of the control group(P<0.05). The adverse events happened in the treatment group were significantly less than those in the control group(P<0.05). Conclusion: Acupuncture at specific acupoints plus patent Chinese medicine can produce a content therapeutic efficacy.

Reinforcing and Reducing Manipulation by Breathing on Yin and Yang Meridian Points for Motor Function of Knee Joints in Patients with Ischemic Stroke

Objective: To observe the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for motor function of knee joints in patients with ischemic stroke. Methods: A total of 60 ischemic stroke cases were randomly allocated into an observation group and a control group, 30 in each group. Other than basic and conventional rehabilitation therapies, cases in the observation group were treated with reinforcing and reducing manipulation on yin and yang meridians points for a period of 8 weeks; whereas cases in the control group only received the same basic and conventional rehabilitation therapy as that in the observation group. Then the knee joint energy, support moment and shaking moment were compared between the two groups before treatment, and after 4-week and 8-week treatment respectively. Results: Before treatment, there were no between-group significant differences in knee joint energy, support moment and shaking moment(all P>0.05). After treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved(P<0.05). After 8 weeks of treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved than that of 4-week treatment(P < 0.05). In addition, there were between-group statistical significances in comparing knee joint energy, support moment and shaking moment after 4 and 8 weeks of treatment(P<0.05). Conclusion: Reinforcing and reducing manipulation by breathing on yin and yang meridian points can increase the knee joint support and shaking force and moment in stroke patients and improve their walking ability.