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Objective:To investigate the long-term death of patients with ischemic stroke and its influencing factors.Methods:Based on the data of patients with ischemic stroke in the multi-center oral fibrinogen-lowering drug secondary prevention database, the follow-up patient information and the cause of death were registered through the epidemiological investigation method, and then compared with the baseline data of patients in the original database.Results:A total of 278 patients completed the follow-up, and 166 were in lumbrokinase group and 112 were in control group. There were 124 deaths (44.6%) within 10 years, of which 92 (74.2%) were vascular deaths. In the lumbrokinase group, 74 patients (44.6%) died of all causes and 55 (33.1%) died of vascular diseases; in the control group, 50 (44.6%) died of all causes and 37 (33.0%) died of vascular diseases. Cox proportional risk model analysis showed that lumbrokinase treatment had no significant effect on the 10-year survival rate of patients with ischemic stroke. The analysis of death influencing factors showed that the baseline international normalized ratio (INR) was significantly associated with the 10-year non-vascular death risk of patients (hazard ratio [ HR] 1.98, 95% confidence interval [ CI] 1.21-3.25; P=0.006). The greater the decrease of tissue plasminogen activator (tPA) within half a year, the lower the 10-year all-cause mortality risk ( HR 0.94, 95% CI 0.90-0.99; P=0.011); the greater the decrease in INR within one year , the lower the 10-year vascular death risk ( HR 0.41, 95% CI 0.17-0.96; P=0.040); the greater the decrease of D-dimer within one year , the higher the risk of the 10-year vascular death ( HR 1.37, 95% CI 1.02-1.83; P=0.034). The greater the decrease of INR in patients with ischemic stroke within one year, the higher the 10-year non-vascular death risk ( HR 2.15, 95% CI 1.29-3.59; P=0.004). Conclusions:The 10-year mortality rate of patients with ischemic stroke is higher, and about 3/4 are vascular deaths. The fibrinogen-lowering treatment in the acute stage has no significant effect on the 10-year all-cause mortality of patients with ischemic stroke. The greater the decrease of tPA in half a year, the lower the all-cause mortality; the greater the decrease of D-dimer level at baseline and within 1 year, the higher the 10-year vascular death; the greater the decrease of INR at baseline and within 1 year, the higher the 10-year non-vascular death risk.
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Objective:To investigate the correlation between peripheral blood renal function indexes and brain frailty imaging score in patients with mild ischemic stroke or transient ischemic attack (TIA).Methods:Patients with mild ischemic stroke or transient ischemic attack (TIA) admitted to the Department of Neurology, the Second Affiliated Hospital of Soochow University from March 2018 to August 2019 were enrolled retrospectively. General clinical data and peripheral blood renal function indexes, including urea, uric acid and estimated glomerular filtration rate (eGFR), were collected. eGFR <60 ml/(min·1.73 m 2) was used to reflect chronic kidney disease. According to the findings of MRI examination, the imaging score of cerebral frailty was performed. When there were white matter lesions, brain atrophy and lacunar infarction/lacuna, 1 point was given, and the total score was 3. Ordinal multi-class logistic regression analysis was used to evaluate the relationship between renal function indexes and brain frailty imaging score in patients with mild ischemic stroke or TIA. Binary logistic regression analysis was used to evaluate the relationship between renal function indexes and brain frailty imaging score >1. Results:A total of 204 patients with mild ischemic stroke or TIA were enrolled during the study. Their average age was 64.82 years old and 78 (38.2%) were females. There were 28 cases (13.73%), 70 cases (34.31%), 63 cases (30.88%) and 43 cases (21.08%) with brain frailty imaging scores of 0, 1, 2, and 3, respectively. One hundred and six patients (51.96%) were in the brain frailty imaging score >1 group and 98 (48.04%) were in the ≤1 group. Univariate analysis showed that there were significant differences in age, diabetes mellitus, eGFR, eGFR classification, homocysteine, intracranial vascular stenosis, stroke etiology classification and vascular distribution between the group with brain frailty imaging score >1 and those with brain frailty imaging score ≤1 (all P<0.05). Ordinal multi-class logistic regression analysis showed that urea (odds ratio [ OR] 0.67, 95% confidence interval [ CI] 0.51-0.89, P=0.005) and eGFR ( OR 0.98, 95% CI 0.96-0.99; P=0.004) were significantly and independently correlated with brain frailty imaging score. Binary logistic regression analysis showed that eGFR was significantly and independently correlated with brain frailty imaging score >1 ( OR 0.98, 95% CI 0.96-1.00; P=0.016). However, urea, uric acid and eGFR classification were not independently correlated with brain frailty imaging score or brain frailty imaging score >1. Conclusion:Blood urea and eGFR are correlated with the brain frailty imaging score in patients with mild ischemic stroke or TIA.
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Objective To study the relationship between climatic factors and cerebral hemorrhagic disease.Methods A total of 1125 cerebral hemorrhage patients were included in this study.The relationship between the onset time of cerebral hemorrhage and daily climatice factors (including temperature,humidity,atmospheric pressure,wind direction and rainfall volume) was analyzed and the onset time of cerebral hemorrhage in each patient was analyzed according to the X2 test for goodness of fit.Results The number of male cerebral hemorrhagy patients was greater than that of female cerebral hemorrhage patients.The mean age of femalc cerebral hemorrhage patients was older than that of male cerebral hemorrhage patients (P＜0.01).The incidence of cerebral hemorrhage accounted for 11％ in January in a greatest number of such patients,accounted for 5.0％ in September in a smallest number of such paticnts,and was the highest at h 4-8 AM and at h 16-20 FM in ≤45 years old cerebral hemorrhage patients.Univariate correlation analysis showed that cerebral hemorrhage was negatively related with daily mean temperature,daily mean maximal and minimal temperature (r=-0.157,r =-0.163,r=-0.156,P＜0.05),positively related with daily mean atmospheric pressure (r=0.157,P＜0.05).Multivariate linear stepwise analysis showed that cerebral hemorrhage was related with daily mean temperature,maximal and minimal temperature,and daily mean atmospheric pressure (P＜0.05,P＜0.01).Conclusion The incidence of cerebral hemorrhage differs in seasons and months,is higher in winter and lower in summer,and is thus related with temperature,atmospheric pressure and wind direction.
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Objective To investigate the impact of short-term exposure to atmospheric particulates (PM10/PM2.5) on stroke risk.Methods The literature databases were retrieved.A Meta-analysis of the literature on atmospheric particulate matters and stroke onset met the inclusion criteria was conducted.Results A total of 42 articles were included.Meta-analysis showed that the PM10 increase per 10 μg/m3,the short-term risk of stroke increased 0.6％ (odds ratio [OR] 1.006,95％ confidence interval [CI] 1.003-1.009);PM2.5 increase per 10 μg/m3,the short-term risk of stroke increased 1.3％ (OR 1.013,95％ CI 1.006-1.019).Subgroup analysis showed that the PM10 exposure was only associated with the increased risk of ischemic stroke (OR 1.025,95％ CI 1.010-1.041),and the PM2.5 exposure was only associated with the increased risk of hemorrhagic stroke (OR 1.031,95％ CI 1.010-1.052).Conclusions In the short term,the increased PM10 or PM2.5 concentration is associated with the increased risk of stroke.PM2.5 caused the risk of stroke onset is higher than that of PM10.
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Objective To investigate the impact of short-term exposure to atmospheric particulates (PM10/PM2.5) on stroke risk.Methods The literature databases were retrieved.A Meta-analysis of the literature on atmospheric particulate matters and stroke onset met the inclusion criteria was conducted.Results A total of 42 articles were included.Meta-analysis showed that the PM10 increase per 10 μg/m3,the short-term risk of stroke increased 0.6％ (odds ratio [OR] 1.006,95％ confidence interval [CI] 1.003-1.009);PM2.5 increase per 10 μg/m3,the short-term risk of stroke increased 1.3％ (OR 1.013,95％ CI 1.006-1.019).Subgroup analysis showed that the PM10 exposure was only associated with the increased risk of ischemic stroke (OR 1.025,95％ CI 1.010-1.041),and the PM2.5 exposure was only associated with the increased risk of hemorrhagic stroke (OR 1.031,95％ CI 1.010-1.052).Conclusions In the short term,the increased PM10 or PM2.5 concentration is associated with the increased risk of stroke.PM2.5 caused the risk of stroke onset is higher than that of PM10.
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Objective To analyze the cognitive changes and influencing factors in patients with lacunar cerebral infarction after carotid artery intervention therapy. Methods Sixty lacunar cerebral infarction combined with carotid stenosis patients treated with artery intervention therapy (intervention therapy group) and 68 lacunar cerebral infarction without carotid stenosis patients treated with drug therapy (drug therapy group) were selected. The neuropsychological test was completed at entry and 1, 6, 12 months after entry, and the results were compared with 60 healthy controls (control group). The cognitive changes were observed. The neuropsychological test included mini mental state examination (MMSE), Montreal cognitive assessment scale (MoCA) and cognitive field test. Results There were statistical differences in other scores except the Stroop test C section and Wechsler adult intelligence scale (WAIS-RC) picture arrangement subtest at entry in intervention therapy group and drug therapy group compared with control group (P0.05). In intervention therapy group, the MMSE scores, MoCA total score, Rey-Osterrieth complex figure test (ROCFT), auditory verb learning test (AVLT), and the WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function 12 months after entry were significantly better than those at entry, and there were statistical differences (P0.05);the MMSE score, MoCA total score, ROCFT, the immediate recall, long-time delayed recall and short delayed recall of AVLT, WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function and digit span backwards subtest of WAIS-RC 12 months after entry were significantly better than those at entry, and there were statistical differences (P0.05). In patients intervention therapy group, Logistic regression analysis showed that the MoCA score was related with age, hypertension and low education level (P0.05). Conclusions Cognitive impairment in patients with lacunar cerebral infarction and carotid stenosis is severe and extensive, but most cognition disorders can improve to normal level 12 months after artery intervention therapy.
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Magnetic resonance (MR) images can be used to detect lesions in the brains of patients with multiple sclerosis (MS). An automatic method is presented for segmentation of MS lesions using multispectral MR images in this paper. Firstly, a Pd-w image is subtracted from its corresponding T1-w images to get an image in which the cerebral spinal fluid (CSF) is enhanced. Secondly, based on kernel fuzzy c-means clustering (KFCM) algorithm, the enhanced image and the corresponding T2-w image are segmented respectively to extract the CSF region and the CSF-MS lesions combinatoin region. A raw MS lesions image is obtained by subtracting the CSF region from CSF-MS region. Thirdly, based on applying median filter and thresholding to the raw image, the MS lesions were detected finally. Results were tested on BrainWeb images and evaluated with Dice similarity coefficient (DSC), sensitivity (Sens), specificity (Spec) and accuracy (Acc). The testing results were satisfactory.
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Humans , Algorithms , Brain , Pathology , Image Enhancement , Magnetic Resonance Imaging , Multiple Sclerosis , Diagnosis , Sensitivity and SpecificityABSTRACT
ObjectiveToanalyzetheclinicalandimagingcharacteristicsinpatientswithcarotidsteal syndrome ( CSS ) and to investigate its compensatory pathw ays, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were colected. Their vascular lesions, colateral circulation, treatment, and prognosis w ere analyzed. Results A total of 11 patients w ith CSS (8 males and 3 females, mean age 66.7 ±5.1 years) were enroled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) ( n=9, 81.8%), posterior circulation infarction ( n=1, 9.1%), and anterior circulation TIA ( n=1, 9.1%). A total of 19 pathological arteries w ere found:12 (63.1%) w ith occlusion, 2 (10.5%) w ith subtotal occlusion, 4 (21.0%) w ith severe stenosis and 1 (5.2%) w ith artery dissection. Seven patients (63.6%) w ere bilateral internal carotid artery lesions, 3 (27.2%) w ere unilateral bilateral internal carotid artery lesions, and 1 (9.1%) w as bilateral common carotid artery occlusion. Eleven patients had primary col ateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary col ateral circulation and 1 (9.1%) had tertiary col ateral circulation. Al patients w ere treated w ith medication on the basis of the management of risk factors. Three patients w ere treated w ith stenting and tw o were treated with carotid endarterectomy. No stroke occurred in al patients during folow -up til September 2014. Conclusions The vascular lesions of patients w ith CSS often occur in the extracranial segment of internal carotid artery. Usual y the compensatory blood is through the circle of Wil is. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated w ith surgery or endovascular intervention.
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s and no restenosis was found in 3 patients according to cerebral angiography. Preliminary results show that PTAS in the management of the vertebrobasilar arterial stenosis is a safe and effective method.