Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis.@*METHODS@#Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month.@*RESULTS@#Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all 0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (=0.856, 95%:0.664-1.103, >0.05).@*CONCLUSIONS@#EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.

Advanced treatment time improves outcomes of patients with ischemic stroke undergoing reperfusion therapy / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of treatment time on the outcome of patients with ischemic stroke undergoing reperfusion therapy.@*METHODS@#The clinical data of 3229 ischemic stroke patients who received intravenous thrombolysis with or without arterial thrombolysis from 71 hospitals in Zhejiang province from June 2017 to September 2018 were retrospectively reviewed. The good outcome was defined as modified Rankin Scale (mRS) ≤ 2. Binary logistic regression analysis was used to investigate the association of door to needle time (DNT), or door to reperfusion time (DRT) with the outcomes in patients treated by intravenous thrombolysis or bridging arterial thrombolysis, respectively.@*RESULTS@#Binary logistic regression showed that DNT (=0.994, 95%:0.991-0.997, <0.01) or DRT (=0.989, 95%:0.983-0.995, <0.01) were independently associated with good outcomes, respectively. Every hour decreases in DNT resulted in a 4.7%increased probability of functional independence (mRS 0-2) in patients treated by intravenous thrombolysis; Every hour decreases in DRT was associated with a 11.4%increased probability of functional independence in patients treated by intravenous thrombolysis with arterial thrombolysis.@*CONCLUSIONS@#Good outcomes are associated with lower DNT in ischemic stroke patients treated by intravenous thrombolysis or lower DRT in patients treated by intravenous thrombolysis bridging arterial thrombolysis.

Association of atrial fibrillation with hemorrhagic transformation after intravenous thrombolysis in patients with ischemic stroke / 浙江大学学报·医学版

OBJECTIVE@#To investigate the association of atrial fibrillation (AF) with hemorrhagic transformation (HT) in patients with ischemic stroke treated by intravenous thrombolysis.@*METHODS@#Clinical data of 3272 patients treated by intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and December 2018 were retrospectively reviewed. Intracranial HT was defined as intracranial hemorrhage suggested by imaging examination 24 hours after intravenous thrombolysis. Patients were dichotomized into HT group (=533) and non-HT group (=2739). The association of AF and HT was analyzed by univariate analysis and binary logistic regression.@*RESULTS@#Compared with the non-HT group, the HT group were older, had longer onset to needle time (ONT), higher baseline National Institute of Health Stroke Scale (NIHSS) score, higher baseline glucose level, and higher AF rate (<0.05 or <0.01). Binary logistic regression analysis revealed that AF was independently associated with HT (=2.527, 95%:2.030-3.146, <0.01).@*CONCLUSIONS@#AF is independently associated with the occurrence of HT in ischemic stroke patients treated with intravenous thrombolysis.

Analysis of intravenous thrombolysis time and prognosis in patients with in-hospital stroke / 浙江大学学报·医学版

OBJECTIVE@#To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis.@*METHODS@#Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (=101) and out-of-hospital stroke (=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis.@*RESULTS@#Patients with in-hospital stroke had longer DIT[53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, <0.01], longer IDT[47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, <0.01], and longer DNT[99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, <0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT[59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, <0.01], longer DNT[110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, <0.05], but shorter INT[36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, <0.05], compared with patients in primary stroke center. Age (=0.934, 95% 0.882-0.989, <0.05) and baseline National Institute of Health Stroke Scale score (=0.912, 95% 0.855-0.973, <0.01) were independent risk factors for prognosis of in-hospital stroke patients.@*CONCLUSIONS@#In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.

Effect of different working time on the prognosis of ischemic stroke patients undergoing intravenous thrombolysis / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of working time on the prognosis of patients with ischemic stroke undergoing intravenous thrombolysis.@*METHODS@#Clinical data of 3050 patients with ischemic stroke received intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and September 2018 were retrospective analyzed. Whole day of Saturday and Sunday were defined as weekend; whole day of Monday to Friday were defined as weekdays; Monday to Friday 8:00-17:00 were defined as daytime of weekdays; Monday to Friday 17:01-07:59 on next day were defined as nights of weekdays; unconventional working time were defined as weekend and nights of weekdays. Good outcome was defined as mRS 0-2 at 3 months. Univariate analyses of baseline and prognostic variables in group of weekend and weekdays, nights of weekdays and daytime of weekdays, unconventional working time and daytime of weekdays were performed. Binary logistic regression was used to investigate whether weekend, nights of weekdays and unconventional working time were independent predicting factors of outcome after intravenous thrombolysis, respectively.@*RESULTS@#There was no difference in 7-day mortality, 3-month mortality and good outcome at 3-month between weekend group and weekdays group, nights of weekdays group and daytime of weekdays group, unconventional working time group and daytime of weekdays group (all >0.05). Binary logistic regression results showed that weekends, nights of weekdays and unconventional working time were not independent predicting factors for outcome after intravenous thrombolysis (all >0.05).@*CONCLUSIONS@#The working time has not affected the outcomes of patients with ischemic stroke undergoing intravenous thrombolysis in studied hospitals of Zhejiang province.

The clinical effect of butylphthalide in the treatment of acute cerebral infarction / 中国基层医药

Objective To investigate the clinical value of butylphthalide in patients with acute cerebral infarction.Methods 120 patients with acute cerebral infarction were randomly divided into study group and control group according to the method of random number table,60 cases in each group.The study group used butylphthalide on the basis of routine treatment,while the control group only received routine treatment.Main outcome measures included the National Institutes of Health Stroke Scale (NIHSS)table,activities of daily living Barthel index,blood viscosity,clinical curative effect and health related quality of life (HRQL)score.Results There was no significant difference in NIHSS score,Barthel score,blood viscosity and HRQL between the two groups on admission (P >0.05 ).When compared with the control group after 3 months,NIHSS score of the study group decreased significantly [(948 ±3.84)points vs.(14.38 ±3.29)points,t=5.395,P=0.000],Barthel score increased significantly[(84.44 ± 10.59)points vs.(75.89 ±8.39)points,t=3.854,P=0.015];blood viscosity decreased significantly[(5.09 ± 0.64)mPa.s vs.(648 ±0.71 )mPa.s,t =7.493,P=0.000];HRQL scores increased significantly [(80.47 ± 1 5.39)pointsvs.(69.58 ±14.39)points,t=4.395,P=0.002];clinical curative effect in the study group was significantly higher than control group (χ2 =6.122,P=0.013).Conclusion Butylphthalide is helpful to improve the prognosis and quality of life in patients with acute cerebral infarction.

Study on the relationship between SNP of CD14 gene and allergic rhinitis in Xinjiang Uygurs and Hans / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This study aimed to investigate the relationship between CD14 gene rs2569192(C/G), rs3138078 (--1359G/T) and allergic rhinitis (AR) in Xinjiang Uygur and Han populations as well as to determine characteristics of polymorphisms.@*METHOD@#A total of 300 AR and 300 healthy controls subjects were included. The frequencies of genotypes and alleles were detected as well as the levels of tIgE in different genotypes were compared.@*RESULT@#(1) The distribution of genotypes or alleles of CD14 gene rs2569192 (C/G), rs3138078 (--1359G/T) had no differences between the Xinjiang Uygurs and Hans (P > 0.05). The highest frequency of alleles was C, G. (2) The frequencies of genotypes and alleles were not different between the AR and control group in Uygur and Han (P > 0.05). The frequencies of genotypes and alleles of rs2569192 were different between the Uygur AR and Han AR group (P < 0.05). (3) The distribution of genotype frequencies and allele of rs 2569192 in the Xinjiang Uygur and Han population were quite different from Chinese Beijing Han populations, Japanese, European and African (P < 0.05). (4) The serum total IgE level in AR group was higher than that in healthy control group (P < 0.05).@*CONCLUSION@#(1) rs2569192 (C/G), rs3138078 (--1359G/T) polymorphisms were not different between the Chinese Xinjiang Uygur and Han population. The major allele were both C and G. rs2569192 of CD14 in Xinjiang populations was different from that in the other populations. (2) No relationship between rs2569192, rs3138078 and AR was found. (3) The serum total IgE level in AR group was higher than that in healthy control group. No relationship between CD14 two SNP and serum total IgE level was found.