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Objective:To investigate the neuroimaging features of hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke received intravenous thrombolysis with a standard dose of alteplase in the Department of Neurology, Ninghe District Hospital from April 2018 to May 2022 and had HT within 24 h after treatment were retrospectively included. Demography, clinical data and neuroimaging findings of HT were recorded. The clinical data of symptomatic intracerebral hemorrhage (sICH) group and asymptomatic intracerebral hemorrhage (asICH) group, as well as HT in the infarct group and HT outside the infarct group were compared. Multivariate logistic regression analysis was used to determine independent risk factors for HT types. Results:A total of 63 patients with HT were enrolled (40 males and 23 females, aged 73.5±8.95 years). There were 42 patients with sICH (66.7%), 21 (33.3%) with asICH, 37 (58.7%) with HT in the infarct (ECASS classification: hemorrhagic infarction [HI]-1, 5 cases [7.9%]; HI-2, 6 cases [9.5%]; parenchymal hematoma [PH]-1, 11 cases [17.5%]; PH-2, 15 cases [23.8%]), 17 (27.0%) with HT outside the infarct, and 9 cases (14.3%) with HT both inside and outside the infarct. Heidelberg classification: 1a HI-1, 5 cases (7.9%); 1b HI-2, 6 cases (9.5%); 1c PH-1, 11 cases (17.5%); 2, 15 cases (23.8%); 3a, 14 cases (22.2%); 3b, 6 cases (9.5%); 3c, 4 cases (6.3%); and 3d, 2 cases (3.2%). Multivariate logistic regression analysis showed that lower baseline National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [ OR] 1.413, 95% confidence interval [ CI] 1.216-1.447; P=0.001), small vessel occlusion ( OR 1.378, 95% CI 1.134-1.429; P=0.002), minor stroke ( OR 1.447, 95% CI 1.120-1.467; P<0.001), and HT outside the infarct ( OR 1.335, 95% CI 1.131-1.363; P=0.007) were independently associated with sICH. Higher baseline NIHSS scores ( OR 1.737, 95% CI1.102-1.801; P<0.001), cardiogenic embolism ( OR 1.789, 95% CI 1.095-1.881; P<0.001), and severe stroke ( OR 1.648, 95% CI 1.110-1.672; P<0.001) were independently associated with HT in the infarct. Conclusions:The most common neuroimaging feature of HT after intravenous thrombolysis in patients with acute ischemic stroke is PH in the infarct, while HT outside the infarct and HT both inside and outside the infarct are rare. For patients with cardiogenic embolism with higher baseline NIHSS score, the HT after thrombolysis was mostly asICH, and its imaging features were mostly multiple punctuate hemorrhage in the infarct. In patients with small vessel occlusion with lower baseline NIHSS score, most of the HT after thrombolytic therapy is sICH, and their imaging features are mostly PH outside the infarct.
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Objective:To investigate the outcomes and its influencing factors of ischemic stroke patients with lung cancer.Methods:Patients with acute ischemic stroke complicated with lung cancer admitted to the Department of Neurology, Ninghe District Hospital of Tianjin from January 2017 to December 2020 were retrospectively enrolled. The demographic and baseline clinical data were collected. The main outcome measure was the clinical outcome evaluated by the modified Rankin Scale at 90 days after the onset of ischemic stroke. 0-2 was defined as a good outcome, and 3-6 was defined as a poor outcome. The secondary outcome measures were bleeding events within 90 d after the onset of ischemic stroke, including hemorrhagic transformation and hemoptysis.Results:A total of 37 patients were enrolled, including 25 males (68%) and 12 females (32%); age 72.6±8.0 years; 23 patients (62.2%) had a good outcome and 14 (37.8%) had a poor outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score and the proportions of patients with stage Ⅳ lung cancer, cerebral infarction due to other causes, moderate and severe stroke, anterior + posterior circulation cerebral infarction, bilateral cerebral infarction and multiple cerebral infarction in the poor outcome group were significantly higher than those in the good outcome group, while the proportion of patients with minor stroke, stage Ⅲ lung cancer and intravenous thrombolysis were significantly lower than those of patients with good outcomes (all P<0.05). Multivariate logistic regression analysis showed that the high baseline NIHSS score (odd ratio [ OR] 1.342, 95% confidence interval [ CI] 1.219-1.586; P=0.018], stage Ⅳ lung cancer ( OR 1.180, 95% CI 1.088-2.187; P=0.042), severe stroke ( OR 1.216, 95% CI 1.008-2.136; P=0.037) and multiple cerebral infarction ( OR 1.508, 95% CI 1.005-1.516; P<0.001) were independently associated with the poor outcomes, while intravenous thrombolytic therapy ( OR 0.572, 95% CI 0.262-0.802; P=0.001) was independently associated with the good outcomes. In addition, the incidence of hemorrhagic transformation and hemoptysis in intravenous thrombolytic patients was significantly higher than that in the non-intravenous thrombolytic patients (all P<0.05). Conclusions:Higher baseline NIHSS scores, multiple cerebral infarction and advanced lung cancer are associated with the poor outcomes in patients with lung cancer and ischemic stroke; intravenous thrombolytic therapy is associated with good outcomes, although it increased the risk of bleeding.
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Objective:To explore the clinical application of intermttent oro-esphageal (IOE) tube feeding in the treatment of dementia patients with dysphagia.Methods:Sixty dementia patients with dysphagia were randomly divided into an IOE group and an nasogastric tube feeding (NGT) group, each of 30. Both groups were given conventional treatment, but the group members were fed through IOE or NGT respectively. Both groups′ swallowing and nutritional condition were evaluated 24 hours after admission and 30 days after the end of the treatment. The incidence of complications within 30 days, the average hospital stay and hospitalization cost were compared between the 2 groups.Results:No significant differences were observed between the two groups in any of the measurements before the intervention. During the intervention, the number of malnourished subjects decreased and the average body mass index (BMI), albumin (ALB) level, hemoglobin (HB) level and FOIS score improved significantly in both groups. Significantly better improvements in the incidence of malnutrition and the FOIS scores was observed in the IOE group. By the 30th day the average effective swallowing rate in the IOE group (90%) was significantly higher than in the NGT group (70%).Conclusions:IOE can improve the nutrition and swallowing of dementia patients with dysphagia. It can reduce the incidence of complications, shorten hospital stays and reduce hospitalization cost.
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Objective To investigate the effect of intermittent oro-esophageal rube feeding (IOE) on dysphagia in acute stroke patients with bulbar or pseudobulbar palsy.Methods From May 2016 to December 2018,patients with acute stroke complicated with bulbar or pseudobulbar palsy admitted to the Department of Neurobgy,Ninghe District Hospital of Tianjin were enrolled retrospectively.They were divided into IOE group and nasogastric gavage tube (NGT) group.The baseline clinical data,swallowing function and nutritional indicators before and after treatment,and the incidence of aspiration pneumonia were collected and compared.Kubota's water swallow test was used to evaluate the swallowing function,and Grade ≥ 3 was defined as poor swallowing function after 30 days of treatment.Multivariate logistic regression analysis was used to determine the independent influencing factors of poor outcomes of swallowing function.Results A total of 92 patients were enrolled,58 were males (63％),and aged 64.3-± 11.2 years;the National Institutes of Health Stroke Scale (NIHSS) score 5.98 ±-2.29;76 patients (82.6％) had cerebral infarction,16 (17.4％) had cerebral hemorrhage;16 (17.4％) had bulbar palsy,and 76 (82.6％) had pseudobulbar palsy.There were 46 cases in each of the IOE group and the NGT group.The improvement of swallowing function and nutritional status at 30 d in the IOE group were significantly better than those in the NGT group (all P ＜0.01),while the incidence of aspiration pneumonia was significantly lower than that in the NGT group (19.6％ vs.39.1％;x2 =4.246,P =0.039).The dysphagia of 70 patients (76.1％) had good outcomes,and that of 22 (23.9％) had poor outcomes.Multivariate logistic regression analysis showed that the NIHSS score on admission (odds ratio [OR] 1.225,95％ confidence interval [CI] 1.221-1.445;P=0.030),bulbar palsy (OR 1.428,95％ CI 1.327-1.545;P＜0.001),and left lesions (OR 1.424,95％ CI 1.352-1.565;P＜0.001) were independently associated with the poor outcomes of swallowing function,while IOE (OR 0.351,95％ CI 0.075-0.643;P ＜0.001) was independently associated with the good outcomes of swallowing function.Conclusion IOE can improve the swallowing function of stroke patients with bulbar or pseudobulbar palsy,and reduce the incidence of aspiration pneumonia while providing good nutritional support.
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Objective To inves1tigate the needs and influencing factors of patients with cerebrovascular disease and their caregivers in rural areas.Methods An online questionnaire designed by World Stroke Organization for stroke patients and their caregivers was used,and modified appropriately according to China's national conditions.A questionnaire survey about general situation,and needs for psychological support,stroke-related knowledge,diagnosis and nursing,social support,and functional recovery in inpatients with cerebrovascular disease and their caregivers in rural areas was performed.Results A total of 514 patients with stroke and their caregivers (n =514) completed the questionnaires.93.0％ of the patients had the needs for mental support,followed by clinical diagnosis and nursing (84.8％),stroke knowledge (74.7％),social support and functional recovery (53.5％);95.1％ of the caregivers had the needs for mental support,followed by stroke knowledge (89.9％),clinical diagnosis and nursing (84.0％),social support,and functional recovery (66.3％).The degree of need for stroke knowledge,social support,and functional recovery in caregivers was higher than that in the patients (all P ＜ 0.05).Multiple linear regression analysis showed that age,gender,degree of education,the National Institutes of Health Stroke Scale score,and the time from the first stroke onset were the influencing factors of needs for patients with cerebrovascular disease and their caregiver.Conclusions Many needs have not been met in patients with cerebrovascular disease and their caregivers,especially the psychological demand.The regional and individual services should be provided according to the different demands in patients with cerebrovascular disease and their caregivers,enhance the awareness of the prevention and treatment of stroke,and continuously improve the construction of rural health service system.