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Objective To explore pathogenesis and influencing factors of poor outcome in patients with wake-up stroke.Methods In this prospective study,patients with acute ischemic stroke who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Xuzhou Medical University from October 2016 to December 2017 were continuously collected.All patients were divided into wake-up stroke group and non-wake-up stroke group according to the onset time.The clinical data of demographics,vascular risk factors,imaging examination,laboratory examination of the two groups were collected to identify the pathogenesis of wake-up stroke.Followed up to six months of onset,the patients were divided into poor outcome (modified Rankin Scale (mRS) score ＞2) and good outcome (mRS score 0-2) subgroups according to mRS score.Multivariate Logistic regression analysis was used to determine the influencing factors of poor outcome in patients with wake-up stroke.Results A total of 178 patients with acute ischemic stroke were enrolled in the study,including 42 patients (23.60％) in the wake-up stroke group and 136 patients (76.40％) in the non-wake-up stroke group.Followed up to six months of onset,11 patients lost,and 167 patients were followed up finally.There were 40 patients (23.95％) in the wake-up stroke group,including 17 patients (42.50％) with poor outcome and 23 patients (57.50％) with good outcome.There were 127 patients (45.64％) in the non-wake-up stroke group,including 32 patients (25.20％) with poor outcome and 95 patients (74.80％) with good outcome.The difference of poor outcome between the two groups was statistically significant (x2=4.393,P=0.036).Comparison of the demographic and baseline data of the wake-up stroke group and the non-wake-up stroke group showed that the differences between variables such as atrial fibrillation and double-dose hypertension were statistically significant.Univariate analysis showed that there were statistically significant differences in vascular risk factors,Trial of Org 10172 in Acute Stroke Treatment etiology,stroke severity,number of stroke lesions,treatment patterns,and number of cerebral microbleeds between the poor and good outcome subgroups.Multivariate Logistic regression analysis showed that the moderate to severe stroke (odds ratio (OR)=3.838,95％ confidence interval (Co 2.162-5.890,P=0.018),the number of lesions in cerebral microbleeds (OR=2.113,95％CI 1.291-2.868,P=0.049) were independent risk factors for poor outcome of wake-up stroke.Intravenous thrombolysis (OR=0.427,95％CI 0.242-0.615,P=0.036) was an independent protective factor for poor outcome of wake-up stroke.Conclusions The onset of wake-up stroke is closely related to atrial fibrillation and reverse scoop hypertension with higher incidence of poor outcome.Early adequate imaging screening and stroke severity assessment have important reference to guide clinical treatment and predict outcome.
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Objective To investigate the correlation between post-stroke depression(PSD) and cerebral microbleeds(CMBs)in elderly patients with ischemic stroke.Methods In the prospective study,220 elderly patients with ischemic stroke were enrolled and followed up to one month after onset.Finally a total of 214 elderly patients performed a follow-up.According to DSM-Ⅳ Diagnostic and Statistical Manual of Mental Disorders,patients were divided into the PSD group and non-PSD group.The degree of depression was evaluated by17-item Hamilton Depression Scale(HAMD-17)score,and patients were divided into mild depression,moderate depression and severe depression group.The loci number,distribution and location of CMBs lesions were assessed by SWI.Patients were divided into brain lobe type,deep lobe type and mixed type according to the CMBs lesion location.The influence of CMBs or not,loci number and location of CMBs lesions on PSD were compared.Results A total of 214 elderly patients with ischemic stroke were enrolled,in whom 84(84/214,39.3％)had PSD with 29(34.5％)males and 55(65.5％)females.According to the HAMD scale,there were 51 patients (60.7 ％) with mild depression,25 (29.8 ％) with moderate depression,and 8 (9.5 ％) with severe depression.The prevalence rate of CMBs was 62.5 ％ (32/51) in mild depression group,71.0 ％ (22/25) in moderate depression group,81.8 ％ (6/8)in severe depression group and 45.4 ％ (49/108)in non PSD group(all P=0.008).The number of CMBs lesions were(4.5±1.2)in mild depression group,(7.8± 2.0)in moderate depression group,(12.6±2.7)in severe depression group and(1.8±0.5)in non-PSD group,with the statistically significant differences between groups (F =2.79,P =0.041).The proportions of CMBs lesions location(brain lobe type,deep lobe type and mixed type)were 40.6 ％ (13/32),34.4％(11/32) and 25.0％ (8/32) in mild depression group,36.4％(8/22),40.9％(9/22) and 22.7％(5/22) in moderate depression group,33.3％ (2/6),50.0％ (3/6) and 16.7％ (1/6) in severe depression group,40.8％ (20/49),12.2％ (6/49) and 46.9％ (23/49) in non-PSD group,respectively (Fisher exact test,P =0.043).The proportions of CMBs lesions distribution(left side,right side and double side)were 37.5％(12/32),43.8％(14/32) and 18.8％(6/32) in mild depression group,36.4％ (8/22),40.9％ (9/22) and 22.7％ (5/22) in moderate depression group,50.0％ (3/6),33.3％ (2/6)and 16.7％(1/6) in severe depression group,36.7％(18/49),40.8％(20/49) and 22.5％(11/49) in non-PSD group,and the difference was not statistically significant (Fisher exact test,P =0.998).Conclusions The prevalence rate of CMBs,number of CMBs lesions and deep lobe type of CMBs are closely related to the degree of post-stroke depression in the elderly.The distribution of CMBs lesions has no relevance with the degree of post stroke depression in the elderly.Elderly patients with ischemic stroke at high risk of post-stroke depression can be identified by evaluating CMBs for early intervention,which is worthy of promotion in clinical work.
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Objective To investigate the prevalence and severity of cerebral microbleeds (CMBs) in patients with different stroke classifications of cerebral infarction.Methods From October 2016 to December 2017,the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed.Results A total of 254 patients with cerebral infarction were enrolled ,there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis ( 54.29%), small -artery occlusion (64.15%), cardioembolism (40.43%), stroke of other determined etiology ( 33.33%), stroke of undetermined etiology(38.46%),and the difference was statistically significant (χ2 ＝12.206,P＝0.016).The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts ( 43.75%), partial anterior circulation infarcts ( 51.19%), posterior circulation infarcts ( 49.18%), lacunar infarcts ( 67.53%), and the difference was statistically significant(χ2 ＝8.944,P＝0.030).The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis [mild(55.26%),moderate(26.32%),severe(15.79%)],small-artery occlusion[mild(25.00%),moderate (33.82%), severe (41.18%)], cardioembolism [ mild (57.89%), moderate (26.32%),severe(15.79%)),stroke of other determined etiology [ mild(50.00%),moderate (33.33%),severe (16.67%)],stroke of undetermined etiology [ mild(60.00%),moderate (20.00%),severe (20.00%)],and the difference was statistically significant (Fisher exact test,P＝0.025).The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts [mild(57.14%),moderate(28.57%),severe(14.29%)], partial anterior circulation infarcts [ mild (52.50%), moderate (32.50%), severe (15.00%)], posterior circulation infarcts[mild( 50.00%), moderate (33.33%), severe (16.67%)], lacunar infarcts [ mild (25.00%), moderate (32.69%),severe (42.31%)], and the difference was statistically significant ( Fisher exact test, P ＝0.023 ). Conclusion The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small -artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs (number of lesions≥10).We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies.
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Objective@#To investigate the prevalence and severity of cerebral microbleeds(CMBs) in patients with different stroke classifications of cerebral infarction.@*Methods@#From October 2016 to December 2017, the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed.@*Results@#A total of 254 patients with cerebral infarction were enrolled, there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis(54.29%), small-artery occlusion(64.15%), cardioembolism(40.43%), stroke of other determined etiology(33.33%), stroke of undetermined etiology(38.46%), and the difference was statistically significant(χ2=12.206, P=0.016). The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts(43.75%), partial anterior circulation infarcts(51.19%), posterior circulation infarcts(49.18%), lacunar infarcts(67.53%), and the difference was statistically significant(χ2=8.944, P=0.030). The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis[mild(55.26%), moderate(26.32%), severe(15.79%)], small-artery occlusion[mild(25.00%), moderate(33.82%), severe(41.18%)], cardioembolism[mild(57.89%), moderate(26.32%), severe(15.79%)), stroke of other determined etiology[mild(50.00%), moderate(33.33%), severe(16.67%)], stroke of undetermined etiology[mild(60.00%), moderate(20.00%), severe(20.00%)], and the difference was statistically significant(Fisher exact test, P=0.025). The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts[mild(57.14%), moderate(28.57%), severe(14.29%)], partial anterior circulation infarcts[mild(52.50%), moderate(32.50%), severe(15.00%)], posterior circulation infarcts[mild(50.00%), moderate(33.33%), severe(16.67%)], lacunar infarcts[mild(25.00%), moderate(32.69%), severe(42.31%)], and the difference was statistically significant(Fisher exact test, P=0.023).@*Conclusion@#The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small-artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs(number of lesions≥10). We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies.
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Objective To investigate the correlation between cerebral microbleeds (CMBs) and early neurological deterioration (END) in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enrolled prospectively. The clinical data, imaging data, and laboratory data were collected. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 within 7 d compared with the baseline. Susceptibility-weighted imaging was used to detecte CMBs. Multivariate logistic regression analysis was used to identify the independent correlation between CMBs and END. Results A total of 246 patients with acute acute ischemic stroke were enrolled. The incidence of END was 38. 21％ (94/246), 72. 34％ (68/94) occurred within 72 h and 21. 28％ (20/94) occurred from 72 h to 7 d. The detection rate of CMBs in the END group was 72. 34％ (68/94) and that of CMBs in the non-END group was 43. 42％ (66/152). There was significant difference between the two groups (χ2 = 19. 587, P < 0. 001). Multivariate logistic regression analysis showed that previous stroke or transient ischemic attack (odds ratio [ OR ] 1. 883, 95％ confidence interval [ CI ] 1. 284- 2. 277; P = 0. 033 ), large artery atherosclerosis (OR 4. 119, 95％ CI 2. 564-5. 771; P = 0. 003), baseline NIHSS score (OR 1. 682, 95％ CI 1. 320-1. 876; P = 0. 042), severe stroke (OR 4. 228, 95％ CI 2. 634-5. 917; P = 0. 003), onset to admission time (OR 2. 070, 95％ CI 1. 454-2. 582; P = 0. 029), and number of CMB ≥10 (OR 2. 728, 95％ CI 1. 834- 3. 217; P = 0. 016) were the independent risk factors for END. Conclusions END is common in patients with acute ischemic stroke, most of them occurred within 72 h. It is closely associated with the number of CMB, but it is not associated with the location of CMB lesions.
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Objective To investigate the screening of elderly patients with post?stroke depression (PSD) and to analyze risk factors. Methods In this prospective study, 220 elderly patients with ischemic stroke were enrolled. At one month after onset, 214 aged patients completed follow?up. According to the DSM?IV diagnosis standard, the patients were divided into PSD and non?PSD groups. Seventeen items of the Hamilton Depression Scale (HAMD) was used to evaluate the degree of depression, and the patients were divided into mild, moderate, and severe depression groups. The demographic and baseline clinical characteristics were compared. Multivariate logistic regression analysis was used to identify the risk factors of PSD in individuals. Results (1) Of the 214 aged patients with ischemic stroke who completed follow?up, 84 had PSD including 29 (34.52%) men and 55 (65.48%) women. The detection rate of PSD was 39.25%. According to the HAMD, 51 (60.72%) aged patients were diagnosed with mild depression, 25 (29.76%) with moderate depression, and 8 (9.52%) with serious depression. (2) Multivariate logistic regression analysis showed that advanced age (>75 years old), female sex, joblessness, being divorced or widowed, having cerebral microbleeds, experiencing social and family environment tension, having low cultural exposure, having moderate and severe neurologic deficits, and having a left?side lesion were the independent risk factors of PSD in elderly patients. Conclusion PSD is common in elderly patients. Evaluation of these risk factors can help identify aged patients at high risk for PSD to allow early intervention, which is worth promoting in clinical work.
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Objective@#To analysis the alterations of CaM and its downstream factors in the brains of scrapie infected mice.@*Methods@#Using the methods of Western blot and immunohistochemistry assay to detect the levels and distributions of CaM, as well as the expressing alterations of the downstream substrates of CaM in the brains of mice infected with scrapie.@*Results@#Compared with the normal controls, the levels of CaM are significantly increased in the brains of scrapie-infected mice and particularly distributing in the regions of cortex, thamalus and cerebellum. Remarkable high levels of CaMKII, p-CaMKII and p-CaMKIV are observed in the brain homogenates of scrapie-infected mice. The regulatory protein of cAMP response element binding protein (CREB) and p-CERB are also increased, while the levels of BDNF which is regulated by p-CREB are obeviously downregulated.@*Conclusions@#The synthesis of BDNF may be influenced by the prion replication in neuron and further attenuates its neuronal protective features.
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Objective To investigate the microbiology,risk factors,and impact on outcomes of stroke-associated pneumonia (SAP) in young patients with acute ischemic stroke.Methods Young patients with acute ischemic stroke were enrolled prospectively.Their microbiological data and risk factors for SAP were identified.The outcomes at 90 d after onset were evaluated with the modified Rankin Scale (mRS) scores,and mRS ＞ 2 was defined as poor outcome.The demography and baseline clinical characteristics were compared.Multivariate logistic regression analysis was used to identify the effect of SAP on the outcomes.Results A total of 418 young patients with ischemic stroke were enrolled,including 108 (25.84％) in the SAP group and 310 (74.16％) in the non-SAP group;16 were lost to follow-up,146 (36.32％) were in the poor outcome group and 256 (63.68％) were in the good outcome group.The results of pathogen test showed that the positive rate was 52.78％ and 19.30％ was mixed infection.The main pathogens were community-acquired pathogens (such as Staphylococcus aureus,Streptococcus pneumoniae and Klebsiella pneumoniae),followed by multidrug-resistant nosocomial pathogens (such as Pseudomonas aeruginosa,Acinetobacter Baumanii,and methicillin-resistant Staphylococcus aureus).Multivariate logistic regression analysis showed that smoking (odds ratio [OR] 4.328,95％ confidence interval [CI]2.847-6.442;P =0.014),chronic obstructive pulmonary disease (OR 3.927,95％ CI 2.419-5.253;P=0.017),dysphagia (OR 6.782,95％ CI 4.378-9.553;P=0.003),tracheal intubation or mechanical ventilation (OR 7.632,95％ CI 5.394-12.376;P=0.001),procalcitonin (OR 2.980,95％ CI 2.234-4.118;P =0.027),antibiotics (OR 6.321,95％ CI 4.362-8.376;P =0.007) were the independent risk factors for SAP,and age ＜ 35 years old was an independent protective factor of SAP (OR 0.582,95％ CI 0.329-0.719;P =0.028);history of previous stroke or transient ischemic attack (OR 3.854,95％ CI 2.645-5.023;P=0.014),tracheal intubation and mechanical ventilation (OR 3.501,95％ CI 2.329-4.614;P =0.016),large artery atherosclerosis (OR 5.274,95％ CI 3.342-7.246;P =0.006),baseline National Institutes of Health Stroke Scale score (OR 2.248,95％ CI 1.482-2.821;P=0.031),onset to admission time (OR 1.245,95％ CI 1.184-1.698;P=0.048),SAP (OR 3.347,95％ CI 2.275-4.338;P =0.018) were the independent risk factors for poor outcomes,and age ＜35 years old (OR 0.340,95％ CI 0.147-0.420;P =0.042) and thrombolytic therapy (OR 0.582,95％ CI 0.329-0.719;P =0.028) were the independent protective factors of good outcomes.Conclusion SAP was more common in young patients with acute ischemic stroke,and had its own characteristics in microbiological data and risk factors.SAP was closely associated with poor outcomes.
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ObjectiveTo investigate the effect of vitamin D supplementation on the outcome of acute ischemic stroke in young patients with vitamin D deficiency.MethodsThe prospective controlled study was used to select the consecutive young patients with acute ischemic stroke.Vitamin D deficiency was defined as 25-hydroxyvitamin D (25(OH)D) ≤50 nmol/L.The Patients with vitamin D deficiency were randomly divided into an intervention group and a routine treatment group according to the random number table method.Routine treatment group didn't receive the drug intervention for vitamin D deficiency, and the intervention group received daily oral alfacalcidol 0.5 μg.After 1 year of treatment, the 25(OH)D levels were examined again;the adverse reactions during the drug treatment were monitored;the modified Rankin Scale (mRS) was used to evaluate the functional outcome and 0-2 was defined as good outcome.ResultsThere are 94 patients (53.41%) with vitamin D deficiency among 176 young patients with acute ischemic stroke.They were randomly divided into either an intervention group or a routine treatment group (n=47 in each group).At the end of the follow-up, the good outcome rate (82.98% vs.63.83%;χ2=4.414, P=0.036) and serum 25(OH)D level (85.83±10.53 nmol/L vs.39.10±11.18 nmol/L;t=20.860, P<0.001) in the intervention group were significantly higher than those in the routine treatment group.During the follow-up period, there was no loss to follow-up or death events in both groups.Only 2 cases of nausea and 1 case of dizziness were observed, and the incidence of adverse reaction was 6.38% in the intervention group.ConclusionsVitamin D supplement can increase the vitamin D levels and improve functional outcome in young patients with acute ischemic stroke and vitamin D deficiency.
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Seventy two iscbemic stroke patients aged 18-45 years with nonvalvular atrial fibrillation treated in the Second Affiliated Hospital of Xuzhou Medical College from April 2014 to August 2016 were assigned to warfarin group (n =36) and dabigatran group (n =36).In warfarin group the oral warfarin started from small dose and maintained international normalized ratio (INR) as 2.0 to 3.0.In dabigatran group 110 mg dabigatran etexilate was given b.i.d.All patients were followed up for one year after treatment.Medication was discontinued in 10 cases (28％) of warfarin group and 2 cases (6％) of dabigatran group one year after treatment (P =0.02).There were 8 (22％) cases of thromboembolic events in warfarin group and 1 (3％) case in dabigatran group (P =0.03).In warfarin group 233 INR values were recorded with an average of 2.32,and the percentage of time in therapeutic range (TTR) was 75％ (174/ 233).There were 2 deaths in warfarin group and no death in dabiga group.There were 19 (53％) cases of adverse reactions in warfarin group,including 9 cases of bleeding (6 mild bleeding and 3 serious bleeding),5 cases of nausea and vomiting,2 cases constipation or diarrhea,3 cases of headache and dizziness.There were 6 (17％) cases of adverse reactions in dabigatran group,including 2 cases of mild bleeding,2 cases of nausea and vomiting,2 cases of constipation or diarrhea.There was significant difference in the incidence of adverse reactions between the two groups(x2 =13.3,P ＜ 0.01).The results indicate that the efficacy and safety of dabigatran is superior to that of warfarin for young ischemic stroke patients with nonvalvular atrial fibrillation.
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Objective To investigate the predictive factors of outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis. Methods Consecutive young patients with mild acute ischemic stroke ( age 18- 45 years ) treated with intravenous thrombolysis were enrol ed retrospectively. According to the modified Rankin Scale (mRS) score at day 90 after onset, they were divided into either a poor outcome group ( mRS ≥2 ) or a good outcome group ( mRS 0- 1 ). The demographic and baseline clinical characteristics were compared. Multivariate logistic regression analysis was used to identify the independent predictive factors of poor outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis. Results A total of 57 young patients with acute mild ischemic stroke treated with intravenous thrombolysis were enrol ed, including 41 patients (71. 93%) had good outcome and 16 (28. 07%) had poor outcome. There were significant differences in the proportion of the patients with previous stroke or transient ischemic attack (TIA) (25. 00% vs. 4. 88%; P=0. 046), smoking (56. 25% vs. 19. 51%; P=0. 010 ), atrial fibril ation (31. 25% vs. 7. 32%; P=0. 032 ), diabetes (62. 50% vs. 21. 95%;χ2 =8. 515, P=0. 004), large artery atherosclerotic stroke (68. 75% vs. 21. 95%;χ2 =11. 067, P=0. 001 ), and receiving antiplatelet therapy before symptom onset (6. 25% vs. 34. 15%;P=0. 044) and the age (Z=2. 396, P=0. 020) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that the age (odds ratio [OR] 2. 64, 95% confidence interval [CI] 1. 28-5. 36;P=0. 038), history of previous stroke or TIA (OR 2. 25, 95% CI 1. 22-4. 31;P=0. 042), atrial fibril ation (OR 5. 12, 95% CI 1. 58-19. 23; P=0. 032), and large artery atherosclerotic stroke (OR 5. 89, 95% CI 1. 78-19. 92; P=0. 002) were the independent risk factors for poor outcome after mild acute ischemic stroke thrombolytic therapy. Conclusions Age, history of stroke or TIA, atrial fibril ation, and large artery atherosclerotic stroke were the predictive factors of poor outcome at day 90 in young patients with mild acute ischemic stroke treated with intravenous thrombolysis.
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Objective To analyze the efficacy of epley maneuver associated with vertigo calming for treating posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in young.Methods Two hundred and fifty-eight cases(age was 18-50 years old) with PC-BPPV were randomly divided into maneuver group(86 cases),betahistine group(86 cases) and vertigo calming group(86 cases).The maneuver group was treated by epley maneuver associated with placebo,2 pills per time,3 times daily for one month and follow up one month.The betahistine group and vertigo calming group were treated by epley maneuver with betahistine(12 mg/ time,Tid) or vertigo calming(2 piles/time,Tid),the same dose,period of treatment and follow-up as maneuver group.Results After one time treatment,199 cases were cured in 258 patients,including 68 cases in maneuver group,66 cases in betahistine group,65 cases in vertigo calming group,and the difference between groups was not statistically significant(x2 =0.308,P＞0.05).After treatments and followed up for one month,72 cases were cured,3 cases were effective,11 cases were invalid in maneuver group;74 cases were cured,3 cases were effective,9 cases were invalid in betahistine group;81 cases were cured,4 cases were effective,1 cases were invalid in vertigo calming group.Efficient of betahistine group,maneuver group and vertigo calming group were 89.5％,87.2％ and 98.8％,and the difference between maneuver group and betahistine group was not statistically significant(x2=58.65,P＞0.05),the difference of vertigo calming group between with other groups was statistically significant(P＜0.05).Conclusion The effects of vertigo calming in addition to Epley maneuver is significantly better than both Epley maneuver and Epley maneuver combined with betahistine in young PC-BPPV,while the effects of Epley maneuver combined with betahistine isn't better than Epley maneuver.