Stem cell transplantation in cerebrovascular accidents:A global bibliometric analysis(2000-2023)

BACKGROUND Cerebrovascular accident(CVA)is a major global contributor to death and disability.As part of its medical management,researchers have recognized the importance of promising neuroprotective strategies,where stem cell transplantation(SCT)is thought to confer advantages via trophic and neuroprotective effects.AIM To evaluate the current state of research on SCT in patients with CVA,assess key trends and highlight literature gaps.METHODS PubMed was screened for SCT in CVA-related articles in October 2023,for each country during the period between 2000 and 2023.Using the World Bank data,total population and gross domestic product were collected for comparison.VOSviewer_1.6.19 was used to create the VOS figure using the results of the same query.Graphs and tables were obtained using Microsoft Office Excel.RESULTS A total of 6923 studies were identified on SCT in CVA,making 0.03%of all published studies worldwide.Approximately,68%were conducted in high-income countries,with a significant focus on mesenchymal stem cells.The journal“Stroke”featured the largest share of these articles,with mesenchymal SCT having the highest rate of inclusion,followed by hematopoietic SCT.Over time,there has been a noticeable shift from in vitro studies,which assess stem cell proliferation and neurogenesis,to in vivo studies aimed at evaluating efficacy and safety.Additionally,the number of reviews increased along this approach.CONCLUSION This bibliometric analysis provides a comprehensive guide for physicians and researchers in the field through an objective overview of research activity,and highlights both current trends and gaps.Having a potential therapeutic role in CVA,more research is needed in the future to focus on different aspects of SCT,aiming to reach a better treatment strategy and improve life quality in patients.

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.

Machine learning applications in stroke medicine:advancements,challenges,and future prospectives

Stroke is a leading cause of disability and mortality worldwide,necessitating the development of advanced technologies to improve its diagnosis,treatment,and patient outcomes.In recent years,machine learning techniques have emerged as promising tools in stroke medicine,enabling efficient analysis of large-scale datasets and facilitating personalized and precision medicine approaches.This abstract provides a comprehensive overview of machine learning’s applications,challenges,and future directions in stroke medicine.Recently introduced machine learning algorithms have been extensively employed in all the fields of stroke medicine.Machine learning models have demonstrated remarkable accuracy in imaging analysis,diagnosing stroke subtypes,risk stratifications,guiding medical treatment,and predicting patient prognosis.Despite the tremendous potential of machine learning in stroke medicine,several challenges must be addressed.These include the need for standardized and interoperable data collection,robust model validation and generalization,and the ethical considerations surrounding privacy and bias.In addition,integrating machine learning models into clinical workflows and establishing regulatory frameworks are critical for ensuring their widespread adoption and impact in routine stroke care.Machine learning promises to revolutionize stroke medicine by enabling precise diagnosis,tailored treatment selection,and improved prognostication.Continued research and collaboration among clinicians,researchers,and technologists are essential for overcoming challenges and realizing the full potential of machine learning in stroke care,ultimately leading to enhanced patient outcomes and quality of life.This review aims to summarize all the current implications of machine learning in stroke diagnosis,treatment,and prognostic evaluation.At the same time,another purpose of this paper is to explore all the future perspectives these techniques can provide in combating this disabling disease.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Increased retinal venule diameter as a prognostic indicator for recurrent cerebrovascular events:a prospective observational study

Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.

Medical Direct Cost of Hospital Admission for Cerebrovascular Accident on Medical Recovery at the Sylvanus Olympio Teaching Hospital of Lomé

Objectives: Appreciate the Medical direct cost for cerebrovascular accident on medical recovery at the Sylvanus Olympio Teaching Hospital of Lomé. Patients and method: This was a prospective and cross study that took place from 01st October 2015 to 31st July 2016 in the medical recovery Unit of Sylvanus Olympio Teaching Hospital of Lomé. Results: Of the 91 stroke patients surveyed, the average age was 55.1 years;the sex-ratio (Men/women) was 1.3 and only 8.8% of patients had benefited from INAM (National Institute of Health Insurance) granting of benefits. The proportion of ICVA was 73.6% compared to 26.4% for the MCVA. The average overall cost of granting benefits of a CVA patient was 312,245 FCFA for an average stay of 18.6 days. This cost was 399.115 FCFA in MCVA for an average stay of 19.0 days against 281.130 FCFA in ICVA for an average stay of 16.1 days. Conclusion: CVAs on the one hand inflict losses of national productivity by its handicap, and a heavy economic burden for both patients and their families on the other hand, by its high cost of granting of benefits;Hence there is the need for assistance of all kinds by national and international health actors.

Transcranial Doppler Ultrasonography to Prevent Cerebrovascular Accident in Children with Sickle-Cell Disease

Sickle-cell disease (SCD) is the most common cause of ischemic stroke in children and it happens in about 11% of patients between the age of 2 and 20 years old. About 7% of the world population is affected by hemoglobin disorders, mostly sickle cell anemia. SCD has a high prevalence in the population of African offspring and it is a public health problem in Brazil that affects more than 30,000 million people. Prevention of primary stroke might be feasible with a way to identify children at greatest risk. Transcranial Doppler Ultrasonography (TCD) to SCD patients can be a valuable service that results in a significant decrease of first stroke rates. In this work, we present a review about TCD as an effective strategy to detect children with SCD who are at risk for stroke.

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.

RESEARCH ON SEQUELAE OF CEREBROVASCULAR ACCIDENT TREATED BY THREE DIFFERENT NEEDLING TECHNIQUES

One hundred and sixty cases of sequelae of cerebrovascular accident (CVA) wererandomly divided into three groups: The temporal point group (TG), 58 cases; the scalp acupuncturegroup(SG), 52 cases; the body acupuncture group(BG), 50 cases. It was shown that after 30 treat-ments the curative effects were significantly different (P【0. 01) among the three groups. The effectin TG was better than those in SG and BG. There was no difference in curative effects between SGand BG. It is indicated that all the three needling techniques can improve encephalic blood flow in pa-tients. It seems that the effects of the three needling techniques are as follows: TG】SG】BG.

Predictors of a Cerebrovascular Accident in a Population of Systemic Sclerosis Patients Followed at a Large Academic Center with a Dedicated Scleroderma Center

Aim: The aim of this study is to describe the clinical characteristics of patients with a diagnosis of systemic sclerosis who later suffer a stroke and to identify associations for this relationship. Background: Prior studies have showed an increased risk of cardiovascular disease among patients with chronic inflammatory disorders, with chronic inflammation leading to atherosclerosis believed to be the culprit. Systemic sclerosis (SSc) is a chronic inflammatory disease characterized by diffuse fibrosis of the skin and internal organs. Previous studies have suggested a possible link between systemic sclerosis and macrovascular complications such as stroke. Methods: This is a retrospective chart review of patients treated within the University of Pennsylvania Health System from October 2015 to April 2019 with a diagnosis of SSc. Using ICD10 codes, we identified a cohort of SSc patients who suffered a stroke. Information regarding demographics and stroke risk factors were gathered from the charts of patients with a diagnosis of both SSc plus stroke and compared to a control group of randomly selected patients with SSc who never suffered a stroke. Continuous variables were conveyed using a mean plus a standard deviation. A two-sample t-test was used to compare the two groups of patients. Qualitative variables were compared using a two-tailed Fisher’s exact test. Results: Based on a large cohort of SSc patients (n = 2080) followed between October 2015 and April 2019, we identified 36 SSc patients who developed a subsequent stroke (1.7% of cohort). When looking at risk factors for stroke in SSc patients, we identified hypertension and atrial fibrillation to be associated with the diagnosis of stroke in such patients. Specifically, 28 of the 36 patients with both SSc and stroke also had a diagnosis of hypertension while in the control group, only 17 of 36 patients had hypertension. Atrial fibrillation was seen in 9 of 36 patients with both SSc and CVA while it was seen in only 2 of 36 patients in the control group. Conclusions: This case control study demonstrated that the presence of hypertension and atrial fibrillation had a statistically significant association with the diagnosis of CVA in patients with SSc.

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.

Cardiovascular and Cerebrovascular Prognosis at 5 Years of Patients Who Presented with an Ischemic Stroke at Principal Hospital of Dakar

Aims: To determine the cardiovascular and cerebrovascular prognosis at 5 years of patients who underwent an ischemic stroke in Senegal. Methods: We performed a descriptive, retrospective and exhaustive study conducted at Principal Hospital of Dakar. We included all patients hospitalized at Principal Hospital of Dakar from 2013 to 2019 for an ischemic stroke confirmed by a cerebral CT-Scanner or by magnetic resonance imaging, and who survived the acute phase. Results: Overall, one hundred and seventy-one (171) patients were gathered. Ninety-six (96) male patients account for 56.14% and seventy-five (75) female patients account for 43.86%, with a sex ratio of 1.28. Patients’mean age was 66.33 ±13.99 years. Twenty-one (21) young patients (12.35%), aged less than 50 years, presented with an ischemic stroke. Myocardial infarction was found in a female patient (0.6%) 3 months after she experienced an ischemic stroke, nine (9) patients (5.29%) underwent a recurrence of the ischemic stroke with a mean recurrence period of 8 months and extremes ranging from 1 to 24 months. Five (5) patients (2.92%) developed dementia with a score less than 28. A 30 years old patient presented with epilepsy 12 months after the ischemic stroke accounting for 0.58%. We registered ninety (90) deaths that occurred in a mean period of 24 months ± 9.8 after they presented their ischemic stroke, standing for 52.63% amongst which thirty-five (35) accounting for 39% were female patients and fifty-five patients (55) representing 61% were male patients. Mortality-related factors included: advanced age, past medical history of heart surgery, known as dyslipidemia, physical inactivity, obesity and recurrent ischemic stroke. Conclusion: Long-term prognosis of ischemic stroke remains unclear in Senegal. Therefore, a strategy for primary prevention is highly crucial and it requires the control of risk factors in general and that of high blood pressure in particular.

Traumatic Brain Injury and Cerebral Vascular Accident: Application of Rasch Analysis to Examine Differences in Disability and Outcome in Post-Hospital Rehabilitation

The purpose of this study was to demonstrate an application of Rasch analysis to identify differences in disability profiles resulting from traumatic brain injury (TBI) and cerebral vascular accident (CVA) and to examine outcome differences between the two groups following post-hospital residential rehabilitation. Participant data were collected from 32 facilities in 16 states. From 2990 neurologically impaired individuals with consecutive admissions from 2011 through 2017, 874 met inclusion criteria: TBI (n = 687) or CVA (n = 187), 18 years or older, minimum length of stay of one month, and maximum chronicity of 1 year. Participants were evaluated at admission and discharge on the Mayo Portland Adaptability Inventory-Version 4 (MPAI-4). Rasch analysis was performed to establish item reliability, construct validity and item difficulty. A Repeated Measures Multivariate Analysis of Covariance (RM MANCOVA) determined group differences and improvement from admission and discharge. Rasch Analysis demonstrated satisfactory construct validity and internal consistency (Person reliability > 0.90, Item reliability > 0.98 for admission and discharge MPAI-4s). Both groups showed significant improvement on the MPAI-4 (p 0.0005). The TBI group was more impaired on the adjustment scale at both admission and discharge (p 0.001). Rasch analysis identified two distinct impairment patterns. CVA participants exhibited deficits characteristic of focal impairment while the TBI group presented with deficits reflective of diffuse impairment. Rehabilitation was shown to be beneficial in reducing disability following neurologic injury in both groups. Importantly, Rasch Analysis accurately produced unique disability profiles that differentiated the treatment groups. This unique statistical technique offers a promising prescriptive hierarchical model for guiding neurological rehabilitation treatment.

Impact of Strokes: The Burden of Care, Post-CVA Fatigue & Caregiver Role Strain

Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke victims experience motor, cognitive, emotional, and psycho-social deficits and their caregivers may not be prepared for these abrupt life altering effects. The impact for caregivers, factors impacting strokes, and solutions for care will be addressed in the paper. Evidence suggests that post fatigue stroke (PFS) may be triggered by a dysfunction of the stress system. Family caregivers with a low level of social engagement may be more likely to perceived stress, and increased risk for caregiver role strain.

脑血管疾病风险人群湿证相关特征的流行病学调查

【目的】探究广东地区脑血管疾病风险人群与中医湿证相关的流行病学特征。【方法】采用横断面研究的方法,调查330例广东常住居民脑血管疾病风险相关的临床资料,进行中医湿证诊断、量化评分及脑卒中风险评级,总结湿证分布规律并分析其影响因素。【结果】(1)诊断为湿证的研究对象共306例(占92.73%),风险组诊断为湿证人群的占比为93.82%(258/275),略高于健康组的87.27%(48/55),但差异无统计学意义(χ2=2.91,P=0.112),而风险组的湿证量化得分高于健康组,差异有统计学意义(Z=-2.24,P=0.025)。(2)在具有脑血管疾病危险因素的研究对象中,评价时间(χ2=26.11,P=0.001)、脑卒中风险等级(χ2=8.85,P=0.031)、脑卒中或短暂性脑缺血发作(TIA)病史(χ2=9.28,P=0.015)是脑血管病风险人群湿证等级的影响因素。【结论】湿证是广东地区人群常见的中医证候;具有脑血管疾病危险因素,尤其是脑卒中高风险人群、脑卒中或TIA病史患者,其湿证程度明显增高;未来在广东开展脑卒中预防工作应考虑湿证的评估与干预。

以问题为导向联合线上学习模式在缺血性脑血管病专业进修中的应用分析

目的探讨以问题为导向联合线上学习模式相比于非问题为导向的线下学习模式在缺血性脑血管病专业进修中的可行性及有效性。方法采取问卷调查法对2017年1月至2023年1月在首都医科大学宣武医院介入放射中心接受过系统培训的152名进修医师进行回访。根据进修时间以及学习模式的不同,将2017年1月至2020年1月进修方式为非问题为导向的线下学习模式的进修医师纳入非问题为导向组,将2020年2月至2023年1月进修方式为以问题为导向联合线上学习模式的进修医师纳入以问题为导向组。于培训结束时以及结束2个月后进行问卷调查。问卷内容包括:进修医师的性别、年龄,参与培训前已有的工作年限,参加进修培训的目的,培训时长,对培训的感受、建议和意见,培训结束后是否开展新手术(主要包括颅内外动脉支架置入术、颈动脉内膜切除术、杂交手术、动脉旁路移植术、急诊取栓术或其他)和培训结束后开展的新手术数量。结果(1)共发放问卷调查表152份,参与问卷调查并完成反馈者136名,其中4份问卷填写不全或填写错误,排除无效问卷后,剩余有效问卷调查表共132份,回收率和有效应答率分别为89.5%和97.1%。参与培训时,进修医师的年龄为25~44岁,平均(34±4)岁。医师的工作年限分布不等,>10年者占22.7%(30/132),>5~10年者占40.9%(54/132),0~5年者占36.4%(48/132)。不同工作年限者间是否开展新手术的比例差异有统计学意义(χ^(2)=2.501,P=0.012)。(2)参与以问题为导向和非问题为导向两种培训模式的人数分别为70人和62人。以问题为导向组中,希望通过培训学习新技术和提高手术能力的进修医师占88.6%(62/70),而在非问题为导向组中,该比例为87.1%(54/62),两组进修医师的进修培训目的差异无统计学意义(χ^(2)=0.067,P=0.796)。对培训体会进行分析显示,认为现有的培训形式合理和内容较为充实的进修医师占比为96.2%(127/132),以问题为导向组和非问题为导向组中比例分别为97.1%(68/70)和95.2%(59/62),两组差异无统计学意义(χ^(2)=0.354,P=0.552)。(3)经过培训后,以问题为导向组开展新手术的进修医师比例为80.0%(56/70),非问题为导向组的比例为66.1%(41/62),两组差异无统计学意义(χ^(2)=3.247,P=0.072)。在开展新手术的数量方面,以问题为导向组和非问题为导向组中,开展新手术数量≥30例的进修医师比例分别为70.0%(49/70)和46.8%(29/62),两组差异有统计学意义(χ^(2)=7.337,P=0.007)。(4)在非问题为导向组中,开展新手术例数≥30例的进修医师进修时长为3、6、12个月者分别占13.8%(4/29)、82.8%(24/29)、3.4%(1/29);在以问题为导向组中,开展新手术例数≥30例的进修医师进修时长为3、6、12个月者分别占4.1%(2/49)、57.1%(28/49)、38.8%(19/49),两组差异有统计学意义(χ^(2)=3.531,P<0.01)。结论以问题为导向联合线上学习模式有助于中青年神经外科医师的新手术开展以及增加开展的新手术数量,但需结合既往的工作年限和进修时长作为参考。

脑血管疾病风险人群湿证相关的肠道菌群特征及影响因素研究

【目的】研究脑血管疾病风险人群湿证相关肠道菌群的特征及其影响因素。【方法】基于2021年10月至2023年2月在广东开展的脑血管疾病风险人群湿证相关的流行病学调查,纳入60例研究对象(包括脑血管疾病风险组41例和健康对照组19例),进行湿证诊断与脑卒中风险评级,收集粪便样本,采用高通量16S rRNA测序技术及生物信息学方法分析菌群特征。【结果】(1)共53例诊断为湿证(88.33%),风险组与健康组间及低、中、高危3组间在湿证诊断量化得分的组间比较有统计学差异(P=0.016;P=0.041)。(2)湿证组与非湿证组的肠道菌群物种种类及丰度无显著性差异。(3)在已诊断为湿证的人群中,健康组与风险组的Alpha多样性无显著性差异,而Beta多样性分析有显著性差异;LEfSe分析发现梭杆菌和乳杆菌富集于风险组;相关性分析提示差异菌与糖尿病、血脂异常、肥胖3个危险因素以及颈动脉内-中膜厚度(IMT)相关。(4)在已诊断为湿证且有脑血管疾病危险因素的人群中,低、中、高危3组的Alpha多样性无显著性差异,而Beta多样性分析则提示有显著性差异;LEfSe分析发现,Acidaminococcaceae、Phascolarctobacterium、Butyricimonas明显富集于低危组,Veillonellaceae明显富集于中危组,Ruminococcus 2、Alloprevotella明显富集于高危组;相关性分析提示,差异菌与高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白细胞计数(WBC)、中性粒细胞计数(NEUT)相关。【结论】以湿证为主的广东地区人群,湿证程度与脑卒中风险有关,且呈现与亚临床动脉粥样硬化、炎性反应、脂质代谢相关的特征菌群。

鼻肠管及鼻胃管的营养干预护理对脑血管意外患者发生吸入性肺炎并发症及睡眠质量的影响

目的:探讨研究脑血管意外患者用鼻肠管营养干预效果。方法:选取2021年4月至2022年4月厦门大学附属第一医院神经内科收治的脑血管意外患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例。2组患者均予以常规护理,对照组给予常规鼻胃管营养干预,观察组给予鼻肠管营养干预。比较2组患者的吸入性肺炎发生率、睡眠质量评分及营养状况。结果:观察组吸入性肺炎发生率低于对照组,差异有统计学意义(P<0.05);观察组入睡潜伏期、PSQI评分低于对照组,实际睡眠时长高于对照组,差异有统计学意义(P<0.05);观察组血红蛋白(Hb)、血清白蛋白(Alb)、血清总蛋白(TP)均高于对照组,差异有统计学意义(P<0.05)。结论:鼻肠管营养干预护理可降低脑血管意外患者吸入性肺炎发生率,改善患者睡眠质量及营养状况,值得临床推广应用。

结构化认知康复治疗在新加坡脑卒中后认知功能障碍患者中的应用效果分析

目的目前关于脑卒中后认知功能障碍(post stroke cognitive impairment,PSCI)预后的研究较少,尤其是关于接受结构化认知康复治疗但预后无显著改善患者的脑血管病危险因素尚未有报道。本研究旨在探讨影响认知康复治疗应用效果的脑血管病危险因素,为临床实践提供依据。方法对149例缺血性脑卒中患者[年龄(63.60±9.66)岁,男性64.4%]进行为期8周的非药物结构化认知康复治疗,并收集纵向的预后数据。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)和痴呆生活质量量表(dementia-quality of life instrument,DemQOL)在基线、治疗结束时和治疗结束后6个月进行整体认知功能和生活质量评估。最后通过回归分析评估结构化认知康复治疗对卒中后认知功能障碍预后的影响。结果卒中发作次数更多的患者在接受结构化认知康复治疗结束时MoCA评分提高不明显(OR=2.17,95%CI:0.98~4.81,P=0.056)。与基线相比,脑白质高信号程度越严重的患者在接受结构化认知康复治疗结束时MoCA评分提高越不明显(OR=2.13,95%CI:1.04~4.38,P=0.039)。存在深部微出血的患者在接受认知康复治疗后6个月MoCA评分改善不明显(OR=19.93,95%CI:1.04~384,P=0.047)。结论卒中发作次数、脑白质高信号程度和深部微出血等脑血管病危险因素影响认知康复治疗的预后。然而,这些发现仍需进一步研究验证,且可指导未来临床试验的设计。

药物涂层球囊与普通球囊血管成形术治疗症状性颅内动脉粥样硬化性狭窄的安全性和预后对比研究

目的对比分析药物涂层球囊(drug-coated balloon,DCB)和普通球囊血管成形术治疗症状性颅内动脉粥样硬化性重度狭窄患者的安全性和预后。方法回顾性分析2020年3月-2022年4月在青岛大学附属医院进行治疗的症状性颅内动脉粥样硬化性重度狭窄患者,按照治疗方式的不同分为DCB组和普通球囊组。比较两组患者的一般临床资料、疗效和安全性终点,包括围手术期并发症、临床结局和影像随访结果。结果研究共纳入49例患者,其中DCB组30例,普通球囊组19例。两组的基线资料、围手术期并发症、术后6个月内再发卒中率、再狭窄率及死亡率差异均无统计学意义(P>0.05);6个月随访DCB组狭窄程度为14.50%(9.55%~23.42%),低于普通球囊组的30.00%(15.42%~37.61%),差异有统计学意义(P=0.027)。结论与普通球囊相比,DCB治疗症状性颅内动脉粥样硬化性重度狭窄是安全的,可以有效降低目标血管再狭窄的进展。