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Objective:To investigate the predictive value of YKL-40 at admission on stroke-associated pneumonia (SAP) and poor outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to Taixing People’s Hospital from February 2020 to March 2021 were enrolled prospectively. The poor outcome was defined as 3-6 points on the modified Rankin Scale at 90 d after onset. Multivariate logistic regression analysis was used to determine the independent predictors of SAP and poor outcome, and the predictive value of serum YKL-40 on SAP and poor outcome was evaluated by receiver operating characteristic (ROC) curve. Results:A total of 377 patients with AIS were enrolled. The median serum YKL-40 was 127.16 μg/L. One hundred and four patients (27.6%) had SAP, and 126 (33.4%) had poor outcomes at 90 d after onset. Multivariate logistic regression analysis showed that after adjusting for confounding factors, YKL-40 was the independent predictors of SAP (odds ratio [ OR] 1.005, 95% confidence interval [ CI] 1.003-1.008; P=0.001) and poor outcome at 90 d ( OR 1.009, 95% CI 1.006-1.011; P=0.001). The ROC curve analysis showed that the area under the curve of YKL-40 for predicting SAP was 0.769 (95% CI 0.713-0.824; P<0.001), the best cutoff value was 168.70 μg/L, and the sensitivity and specificity were 71.2% and 75.1% respectively; the area under the curve of YKL-40 for predicting poor outcome at 90 d was 0.787 (95% CI 0.735-0.840; P<0.001), the best cutoff value was 195.56 μg/L, and the sensitivity and specificity were 68.3% and 84.1% respectively. Conclusion:Higher serum YKL-40 at admission has a good predictive value for SAP and poor outcome at 90 d in patients with AIS.
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Hypertension plays a unique role in the pathogenesis and outcomes of acute ischemic stroke. Therefore, blood pressure management, especially blood pressure regulation in acute stage, is of great significance for the treatment of acute ischemic stroke. However, there is no unified antihypertensive scheme for acute stroke. This article reviews the related research progress of blood pressure management in acute ischemic stroke.
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Objective:To investigate the safety of the use of the intermediate catheter in the endovascular treatment (EVT) of patients with acute anterior circulation large vessel occlusive stroke and its impact on the outcomes.Methods:From May 2015 to September 2018, patients with anterior circulation large vessel occlusive stroke received EVT in Nanjing First Hospital, Nanjing Medical University were enrolled retrospectively. According to whether intermediate catheter was used during the procedure, they were divided into intermediate catheter group and non-intermediate catheter group. The demographics, clinical data and procedure related information were collected. The outcome evaluation indicators included secondary embolization, symptomatic intracranial hemorrhage, clinical outcome and death at 90 d after onset. A good outcome was defined as the modified Rankin Scale score of 0-2. Multivariate logistic regression analysis was used to determine the independent predictor of clinical outcome. Results:A total of 195 patients with anterior circulation large artery occlusive stroke received EVT were enrolled, including 161 in the intermediate catheter group and 34 in the non-intermediate catheter group. There were no significant differences in demographics and clinical characteristics between the intermediate catheter group and the non-intermediate catheter group. In terms of procedure related information, the number of mechanical thrombectomy passes in the intermediate catheter group was significantly decreased (2 [1-3] times vs. 2.5 [1.75-4] times; Z=2.218, P=0.017), the recanalization rate of one-pass thrombectomy was significantly higher (38.5% vs. 20.6%; χ2=3.943, P=0.047), and the rate of thrombus escape and secondary embolism was significantly lower (19.3% vs. 35.3%; χ2=4.202, P=0.041). In terms of clinical outcome, there were no significant differences in the incidence of symptomatic intracranial hemorrhage, mortality and good outcome at 90 d between the intermediate catheter group and the non-intermediate catheter group. Multivariate logistic regression analysis showed that the use of intermediate catheter was an independent predictor of good outcome at 90 d (odds ratio 0.430, 95% confidence interval 0.196-0.947; P=0.036). Conclusion:In EVT of patients with acute anterior circulation large vessel occlusive stroke, the use of intermediate catheter can reduce the number of mechanical thrombectomy passes, improve recanalization rate of one-pass thrombectomy, reduce the rate of thrombus escape and second embolization, and then improve the outcome of patients.
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Intracranial atherosclerotic lesions are a common cause of ischemic stroke. Hemodynamics plays an important role in the formation and development of atherosclerosis and the risk assessment of clinical ischemic stroke events. As an evaluation method of cerebral hemodynamics, computational fluid dynamics can intuitively obtain hemodynamic parameters and provide valuable information for clinical diagnosis and treatment. This article reviews the application progress of computational fluid dynamics in evaluating peripheral hemodynamics of intracranial atherosclerotic lesions.
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The brain-gut axis is an important pathway for the interaction between the central nervous system and the gastrointestinal tract. Ischemic stroke can promote the imbalance and displacement of intestinal flora, and the intestinal flora and its metabolites in turn can affect the occurrence, development and outcome of ischemic stroke. This article reviews the related literature on ischemic stroke and intestinal flora, in order to review the relationship between the two and related mechanisms, and to prospect the stroke treatment of targeting intestinal flora.
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Objective:To investigate the predictive value of serum hypersensitive C-reactive protein (hs-CRP) for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) who received intravenous thrombolysis.Methods:From May 2015 to April 2017, the clinical data of the patients with AIS treated with intravenous thrombolysis in Nanjing First Hospital were collected retrospectively. Multivariate logistic regression analysis was used to determine the independent risk factors for SAP in patients with AIS after intravenous thrombolysis. Receiver operating characteristic (ROC) curve and nomogram-based methods were used to analyze the predictive value of hs-CRP for SAP. Results:A total of 243 patients with AIS who received intravenous thrombolysis were included, and 63 (34.6%) of them had SAP. There were significant differences in age ( P=0.006), leukocyte count ( P=0.044), fasting blood glucose level ( P=0.003), serum hs-CRP level ( P=0.001), hs-CRP classification ( P=0.001) and dysphagia rate ( P=0.035) between the SAP group and non-SAP group. Multivariate logistic regression analysis showed that after adjusting for the confounding factors, taking the first quartile of serum hs-CRP level as a reference, the third quantile (odds ratio [ OR] 18.790, 95% confidence interval [ CI] 4.771-74.007; P=0.001) and the fourth quantile ( OR 54.054, 95% CI 12.248-324.088; P=0.001) of hs-CRP were the independent predictors of SAP. The area under the ROC curve of the baseline serum hs-CRP level for predicting SAP was 0.805 (95% CI 0.742-0.868; P<0.001). When the optimal cut-off value of hs-CRP was 5.54 mg/L, the sensitivity and specificity of predicting SAP were 76.11% and 76.19%, respectively. The analysis of nomogram also showed that hs-CRP was an independent predictor of SAP (consistency index 0.862, 95% CI 0.738-0.986; P<0.001). Conclusions:The increased serum hs-CRP was an independent predictor of SAP in patients with AIS receiving intravenous thrombolysis, and had a higher predictive value.
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Objective@#To investigate the effect of the time from onset to recanalization on the outcomes after endovascular treatment (EVT) in patients with acute stroke due to posterior circulation large vessel occlusion.@*Methods@#From May 2015 to May 2019, patients with acute ischemic stroke due to posterior circulation large vessel occlusion receiving EVT in the Department of Neurology, Nanjing First Hospital, Nanjing Medical University were enrolled retrospectively. According to the modified Rankin Scale (mRS) score at 90 d after procedure, they were divided into good outcome group (≤2) and poor outcome group (>2). Demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent correlation between the time from onset to recanalization and the outcomes.@*Results@#A total of 64 patients with acute ischemic stroke due to posterior circulation large vessel occlusion treated by EVT were enrolled in this study. There were 50 males (78.0%) and 14 females (22.0%). The age was 67.52±10.30 years. The National Institutes of Health Stroke Scale (NIHSS) score was 22.04±4.17, and the time from onset to recanalization was 370.53±78.59 min. Thirty-one patients (48.0%) were in the good outcome group and 33 (52.0%) were in the poor outcome group. There were significant differences in baseline NIHSS score, systolic blood pressure, time from onset to revascularization, and the proportions of patients with tandem lesion and symptomatic intracranial hemorrhage between the two groups (all P<0.05). Multivariate logistic regression analysis showed that the longer time from onset to recanalization (odds ratio [OR] 1.317, 95% confidence interval [CI] 1.001-3.034; P=0.041) and symptomatic intracranial hemorrhage (OR 4.207, 95% CI 1.931-10.761; P=0.004) were the independent predictors of poor outcomes, while the lower baseline NIHSS score (OR 0.302, 95% CI 0.056-0.743; P=0.047) was the independent protective factor of poor outcomes.@*Conclusions@#The longer time from onset to recanalization is an independent risk factor for poor outcomes after EVT in patients with acute ischemic stroke caused by posterior circulation large vessel occlusion.
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Objective@#To compare the effects of modified Thrombolysis in Cerebral Infarction score (mTICI) 2b and mTICI 3 reperfusion on lesions′ changes and prognosis in patients who underwent endovascular therapy within six hours after onset.@*Methods@#A retrospective analysis was conducted on 94 patients with acute large intracranial artery occlusion of the anterior circulation who achieved reperfusion sucesssfully by endovascular therapy within 6 hours after onset in the Department of Neurology, Nanjing First Hospital from October 2016 to March 2019. The effects of mTICI 2b and mTICI 3 reperfusion on lesions′ changes and prognosis of patients were compared. The primary endpoint was the modified Rankin Scale (mRS) score at 90 days; the secondary endpoints were the early neurological deficit score, the mortality at 90 days, the volume of infarction at 24 hours, the changes in infarct volume for 24 hours and the rate of symptomatic intracerebral hemorrhage (sICH) , reocclusion and hemorrhagic transformation.@*Results@#In all patients, 35 cases received mTICI 2b reperfusion and 59 cases received mTICI 3 reperfusion. Compared with mTICI 2b group (10.00 (3.00, 16.00)), the early neurological deficit score at seven days of mTICI 3 group (6.00 (1.00,11.50)) was lower (Z=-2.004, P=0.045) . However, there were no statistically significant differences in mRS score at 90 days, early neurological deficit score at 24 hours and 3 days, mortality at 90 days, volume of infarction at 24 hours, the changes in infarct volume for 24 hours, and the rate of sICH, reocclusion, and hemorrhagic transformation between the two groups.@*Conclusion@#For patients with large intracranial artery occlusion of the anterior circulation within six hours after onset, achieving mTICI 3 reperfusion after endovascular therapy can improve the early neurological function more effectively, but the effects on 90-day functional outcome are similar to that of mTICI 2b reperfusion.
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Objective To investigate the correlations of serum uric acid with outcomes and symptomatic intracranial hemorrhage (sICH) after intravascular mechanical thrombectomy bridged with intravenous thrombolysis in patients with ischemic stroke.Methods From January 2015 to January 2019,patients with acute ischemic stroke admitted to Nanjing First Hospital,Nanjing Medical University and underwent intravascular mechanical thrombectomy bridged with intravenous thrombolysis were analyzed retrospectively.Demographic characteristics,vascular risk factors,laboratory findings,National Institutes of Health Stroke Scale (NIHSS) scores,onset to treatment time,and whether sICH occurred were recorded.The modified Rankin Scale was used to evaluate the outcomes at 90 d after onset,and 0 to 2 was defined as good outcome.Multivariate logistic regression models were used to determine the independent factors for outcomes and sICK Results A total of 144 patients were included,54 (37.5％) had a good outcome,90 (62.5％) had a poor outcome (including 28 deaths),and 29 (20.1％) had sICH.Serum uric acid was significantly higher in the good outcome group than in the poor outcome group (P ＜0.05).Serum uric acid was significantly higher in the non-sICH group than in the sICH group (P＜ 0.05).Multivariate logistic regression analysis show ed that higher serum uric acid w ere the independent protective factors of good outcome (odds ratio 0.82,95％ confidence interval 0.66-0.93;P ＜0.001) and sICH (odds ratio 0.97,95％ confidence interval 0.93-0.99;P=0.004).Conclusion High serum uric acid level is independently associated with good outcome after intravascular mechanical thrombectomy bridged with intravenous thrombolysis in patients with acute ischemic stroke.
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Objective@#To investigate the correlations of serum uric acid with outcomes and symptomatic intracranial hemorrhage (sICH) after intravascular mechanical thrombectomy bridged with intravenous thrombolysis in patients with ischemic stroke.@*Methods@#From January 2015 to January 2019, patients with acute ischemic stroke admitted to Nanjing First Hospital, Nanjing Medical University and underwent intravascular mechanical thrombectomy bridged with intravenous thrombolysis were analyzed retrospectively. Demographic characteristics, vascular risk factors, laboratory findings, National Institutes of Health Stroke Scale (NIHSS) scores, onset to treatment time, and whether sICH occurred were recorded. The modified Rankin Scale was used to evaluate the outcomes at 90 d after onset, and 0 to 2 was defined as good outcome. Multivariate logistic regression models were used to determine the independent factors for outcomes and sICH.@*Results@#A total of 144 patients were included, 54 (37.5%) had a good outcome, 90 (62.5%) had a poor outcome (including 28 deaths), and 29 (20.1%) had sICH. Serum uric acid was significantly higher in the good outcome group than in the poor outcome group (P<0.05). Serum uric acid was significantly higher in the non-sICH group than in the sICH group (P<0.05). Multivariate logistic regression analysis showed that higher serum uric acid were the independent protective factors of good outcome (odds ratio 0.82, 95% confidence interval 0.66-0.93; P<0.001) and sICH (odds ratio 0.97, 95% confidence interval 0.93-0.99; P=0.004).@*Conclusion@#High serum uric acid level is independently associated with good outcome after intravascular mechanical thrombectomybridged with intravenous thrombolysis in patients with acute ischemic stroke.
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Objective To investigate the effect and safety of intravenous thrombolytic therapy in the endovascular treatment of acute anterior circulation vascular occlusive stroke.Methods The clinical data of 226 patients with acute anterior circulation vascular occlusive stroke who underwent endovascular treatment in Nanjing First Hospital,Nanjing Medical University from May 2015 to May 2018 were retrospectively collected.According to whether or not intravenous thrombolysis was performed,the patients were classified into simple thrombectomy group (n=112) and bridging treatment group (n=114).The modified Thrombolysis in Cerebral Infarction Score (mTICI) was used to evaluate the vascular opening effect,and the blood vessel recanalization time,mTICI,the symptomatic intracranial hemorrhage rate,and the modified Rankin Scale (mRS) score at 90 days after surgery were evaluated.Results There were no statistically significant differences in gender,age,past history and National Institute of Health Stroke Scale score between the two groups (P＞0.05).There was no statistically significant difference in door-to-recanalization time between the two groups (P＞0.05).Excluding the patients with post-wake stroke and unexplained onset time,the simple thrombectomy group (n=63) and the bridging treatment group (n=1 11) showed statistically significant differences in onset-to-door time ((235.04± 182.64) min vs (102.48±60.51) min,t=7.01,P＜0.01)and onset-to-recanalization time ((405.31 ± 148.89) min vs (337.31 ± 117.65) min,t=3.32,P=0.01).The difference in number of thrombectomy between the simple thrombolysis group (2.55± 1.52) and the bridging treatment group (2.11± 1.48) was statistically significant (t=2.246,P=0.026).The total reperfusion (mTICI 2b/3) rate was 89.8％ (203/226),88.4％ (99/112) in the simple thrombectomy group and 91.2％ (104/114) in the bridging treatment group,with no statistically significant difference between the two groups (P＞0.05).The differences in symptomatic intracranial hemorrhage rate (8.93％ (10/112) vs 11.4％ (13/114)),mortality rate (12.5％ (12/112) vs 16.7％ (19/114)) and 90-day good functional outcome (mRS score 0-2;54.5％ (61/112) vs 55.8％ (63/114)) between the two groups were not statistically significant (P＞0.05).Conclusions In patients with acute anterior circulation vascular occlusive stroke undergoing endovascular treatment,intravenous thrombolysis can reduce the number of thrombectomy,not increase the door-to-recanalization time,the risk of symptomatic intracranial hemorrhage and mortality,and has similar good functional outcome as the simple thrombeetomy group.Therefore,intravenous thrombolysis is safe and effective for endovascular treatment of acute anterior circulation large vessel occlusive stroke.
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Objective To investigate the predictive value of serum lipoprotein (a) (Lp [a]) levels for short-term functional outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.Methods Elderly patients with acute ischemic stroke and type 2 diabetes mellitus admitted to Nanjing First Hospital from June 2016 to December 2016 were enrolled retrospectively.The modified Rankin scale was used to assess the outcomes at 90 d after onset;0-2 was defined as good outcome and ＞2 were defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for poor outcomes,and the receiver operator characteristic (ROC) curve analysis was used to evaluate the predictive value of serum Lp(a) levels for poor outcomes.Results A total of 231 patients were enrolled,with an average age of 69.7 years and males accounting for 65.4％.The median serum Lp(a) was 166 mg/L (interquartile range 78-331 mg/L).At 90 d after onset,140 patients (60.6％) had good outcomes and 91 (39.4％) had poor outcomes.After adjustment for other confounding variables,multivariate logistic regression analysis showed that elevated serum Lp(a) (referenced to the lowest quartile,the 3rd quartile:odds ratio[OR]2.899,95％ confidence interval[CI] 1.154-7.285,P =0.024;the 4th quartile:OR 3.334,95％ CI 1.329-8.361,P =0.010),the baseline National Institute of Health Stroke Scale score (OR 1.224,95％ CI 1.143-1.310;P＜ 0.001),and complicated with coronary heart disease (OR 2.504,95％ CI 1.196-5.243;P =0.015) were the independent risk factors for poor outcomes.ROC curve analysis showed that the area under the curve of serum Lp(a) level in predicting the poor outcome was 0.775 (95％ CI 0.696-0.854;P=0.04).The optimal cut-off value was 119 mg/L,the sensitivity was 71.15％,the specificity was 75.90％,the positive predictive value was 38.52％,and the negative predictive value was 61.48％.Conclusion Serum Lp(a) level has certain predictive value for the short-term poor outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.
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Objective To compare the safety and efficacy of directly thrombectomy and bridging therapy in patients with acute large vessel occlusion stroke within 4.5 h of onset.Methods From April 2014 to September 2017, patients with acute large vessel occlusion stroke treated with emergency mechanical thrombectomy in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were collected. The patients who were eligible for intravenous thrombolysis and whose onset time was ≤4.5 h were selected. The propensity score matching analysis and McNemar test were used to compare the safety and efficacy of direct mechanical thrombectomy and bridging therapy. Results A total of 41 patients with acute large vessel occlusion stroke were enrolled.The final propensity score matching was 12 pairs.In the direct thrombectomy group, the time from door to femoral artery sheath placement was significantly reduced (P=0.03), but there was no significant difference in the good functional outcome rate, mortality rate, and incidence of symptomatic intracranial hemorrhage between the two groups of patients at 90 d(P>0.05).Conclusion It is safe and effective to start direct mechanical thrombectomy within 4.5 h of onset in patients with acute large vessel occlusion stroke and can significantly shorten the time of vascular recanalization.
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Objective To investigate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke (CES) due to atrial fibrillation.Methods Patients with CES admitted to Nanjing First Hospital from January 2015 to September 2017 were enrolled retrospectively.They were divided into the thrombectomy group and the intravenous thrombolysis alone group.The baseline data,the National Institutes of Health Stroke Scale (NIHSS) score at 24 h after treatment,rates of good outcome (defined as the modified Rankin Scale score 0-2) at 90 d after onset,hemorrhagic transformation and death between the two groups were compared.Multivariate logistic regression analysis was used to determine the independent factors for the outcomes in patients with CES.Results A total of 117 patients with CES were enrolket,inchding 65 (55.6％) in the thrombectomy group and 52 (44.4％) in the intravenous thrombolysis alone group.Sixty-two patients (53.0％) had good outcome and 55 (47.0％) had poor outcome.The proportion of patients whose NIHSS score decreased ＞ 4 within 24 h after treatment (58.4％ vs.26.9％;x2 =6.254,P =0.007),rates of good recanalization (78.5％ vs.57.7％;x2 =5.850,P =0.016),and good outcome at 90 d (63.1％vs.40.4％;x2 =5.972,P=0.015) in the thrombectomy group were significantly higher than those in the intravenous thrombolysis alone group,while there were no significant differences in the incidences of hemorrhagic transformation,symptomatic intracerebral hemorrhage and gastrointestinal bleeding,as well as mortality at 90 d.Multivariate logistic regression analysis showed that good recanalization (odds ratio [OR] 0.371,95％ confidence interval [CI]0.157-0.876;P =0.024) and thrombectomy (OR 0.398,95％ CI 0.179-0.883;P =0.024) were the independent factors for good outcome,while diabetes (OR 6.572,95％ CI 1.684-25.641;P =0.007) was the independent factor for poor outcome.Conclusion The efficacy of mechanical thrombectomy for patients with CES due to atrial fibrillation is superior to intravenous thrombolysis alone,and it dose not increase the mortality and complications.Good recanalization and mechanical thrombectomy are the independent factors for good outcome,while diabetes is an independent factor for poor outcome in patients with CES due to atrial fibrillation.
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Objective To compare the effects of intensive blood pressure (BP) lowering and guideline-recommended standard BP lowering on the early reperfusion and prognosis after intravenous thrombolysis in patients with acute ischemic stroke. Methods This is a randomised controlled trial consisting of 118 consecutive patients who came from Department of Neurology, Nanjing First Hospital from July 2012 to April 2016, accepting intravenous recombinant tissue plasminogen activator thrombolysis with the systolic blood pressure (SBP) being 150-185 mmHg(1 mmHg=0.133 kPa). The patients with ischemic stroke were diagnosed by multi-mode MRI and confirmed to have ischemic penumbra. The SBP of patients randomly assigned to intensive BP lowering group and guideline BP lowering group was maintained in 140-150 mmHg or below 180 mmHg respectively for 72 h and all patients needed to reexamine multi-mode MRI at 24 h. The primary endpoints were the neurologic function at early stage, modified Rankin Scale (mRS) score and the mortality at 90 d;the secondary endpoints were the volume of infarction and hypoperfusion area, the rate of reperfusion, hemorrhagic transformation (HT) and syptomatic intracerebral hemorrhage (sICH). Results Forty-nine cases in intensive BP lowering group and 56 cases in guideline BP lowering group acquired the available images. The volume of infarction was increased both in these two groups, and there was no statistically significant difference in the increased values ((13.21±9.51) cm3 vs (12.95±9.68) cm3). There were no statistically significant differences in the volume of hypoperfusion, reperfusion rate, neurologic function at early stage, the mRS scores and mortality at 90 d, the incidence of sICH except the rate of HT (9.4%, 5/53 vs 23.1%, 15/65, χ2=3.860, P=0.049) between the two groups.Conclusion Early intensive BP-lowering treatment has no adverse effects on the transformation of ischemic penumbra and prognosis after intravenous thrombolysis in patients with acute ischemic stroke and may decrease the the rate of HT in some degree.
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Objective To investigate the predictive values of Kwon's score,Chumbler's score,Age,Atrial Fibrillation,Dysphagia,Sex,Stroke Severity (A2DS2) score,the Preventive ANtibacterial THERapy in Acute Ischemic Stroke (PANTHERIS) score,Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS),and prestroke Independence,Sex,Age,NIHSS (ISAN) score for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled retrospectively.They were grouped according to whether to be complicated with SAP or not.The demography and baseline characteristics were compared between the SAP group and the non-SAP group.Multivariate logistic regression analysis was used to identify the independent risk factors for SAP.Receiver operating characteristic (ROC) curves were used to compare the predictive values of the 6 kinds of scores for SAP.Results A total of 1 427 patients with acute ischemic stroke were enrolled.Three hundred ninety-five patients (27.7％) complicated with SAP within 7 d after onset.There were significant differences in age,gender,past history (pneumonia,atrial fibrillation,smoking),laboratory tests (white blood cell count ＞11 × 109/L,baseline blood glucose ≥ 11.1 mmol/L),Oxfordshire Community Stroke Project (OCSP) classification,falling at the time of onset,dysphagia,mechanical ventilation and the modifiel Rankin Scale (mRS) score before onset,baseline Glasgow Coma Scale (GCS) score,baseline National Institutes of Health Stroke Scale (NIHSS) score and 6 scores between the SAP group and the non-SAP group (all P ＜ 0.05).Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.034,95％ confidence interval [CI] 1.019-1.049;P=0.001),white cell count ＞ 11 × 109/L (OR 4.386,95％CI 2.763-6.905;P=0.001),baseline blood glucose ≥ 11.1 mmol/L (OR 1.933,95 ％ CI 1.305-2.864;P =0.001),dysphagia (OR 7.839,95％ CI 4.892-12.563;P =0.001),baseline NIHSS (OR 1.120,95％ CI 1.077-1.165;P =0.001),and baseline GCS score (OR 1.132,95％ CI 1.019-1.257;P =0.021) were the independent risk factors for SAP.The areas under the ROC curves of SAP predicted by the Chumbler's,AIS-APS,A2DS2,ISAN,Kwon's and PANTHERIS scores were 0.830 (95％ CI 0.805-0.855),0.827 (95％ CI 0.802-0.852),0.818 (95％ CI 0.792-0.845),0.788 (95％ CI 0.762-0.814),0.774 (95％CI 0.774-0.803),and 0.727 (95％ CI 0.695-0.758),respectively.There were no significant differences in the area under ROC curves of Chumbler's,A2DS2 and AIS-APS scores between the pairwise comparisons.There were significant differences in the area under ROC curves of the Chumbler's,A2DS2,AIS-APS and ISAN scores between the pairwise comparisons (AIS-APS compared with ISAN:P =0.001;the rests P ＜ 0.001).Conclusions The accuracies of predicting SAP with the Chumbler's,AIS-APS and A2DS2 scores are superior to the ISAN,Known's and PANTHERIS scores,and have higher clinical application value.
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Objectives To investigate the effects of different degrees of carotid artery stenosis on cognitive function and neuronal apoptosis of hippocampal CA1 region in rats and to analyze the possible mechanisms of cognitive impairment. Methods According to the random number table,50 male Wistar rats were allocated into a sham operation group,a unilateral mild stenosis group,a unilateral moderate stenosis group,a unilateral severe stenosis group,a bilateral mild stenosis group,a bilateral moderate stenosis group, a bilateral severe stenosis group,and a sham operation group. Aneedle-controlled suture method was used to induce a carotid stenosis model with different degrees of stenosis in rats. Water maze was to localize navigation and spatial search test was used to evaluate the cognitive function with different degrees of carotid artery stenosis in rats. Immunohistochemical method was used to observe the numbers of positive cells of P75 neurotrophin receptor (p75NTR),Bax,Bcl-2,neurotrophic factor-3 (NT-3 ),nerve growth factor (NGF)in hippocampal CA1 region under the light microscope. The conditions of neuronal apoptosis were observed. Results In 50 rats,6 died,1 rat in poor health failed to complete the Morris water maze test. The degree of bilateral carotid artery stenosis in 1 rat failed to meet 30%-60% at the same time,they were all removed. The remaining 42 rats were 6 in each group. (1)Compared with the sham operation group,the mean escape latency was prolonged (39 ± 6 s,32 ± 5 s,69 ± 7 s,respectively vs. 23 ± 4 s;all P < 0. 01),and the percentage of swimming distance in the platform quadrant was decreased (35 ± 4%,44 ± 4%,22 ± 5%,respectively vs. 53 ± 7%;all P < 0. 01),and the cognitive function was decreased with the degree of stenosis in the unilateral severe stenosis group,bilateral moderate stenosis group,and bilateral severe stenosis group. Compared with the unilateral severe stenosis group,the mean escape latency was prolonged and the percentage of swimming distance in the platform quadrant was decreased in the bilateral severe stenosis group (P < 0. 01). (2)Compared with the numbers of positive cells of Bax,p75NTR and Bcl-2 (8. 8 ± 3. 1,4. 2 ± 2. 3,and 5. 8 ± 1. 8,respectively)in the sham operation group,the numbers of positive cells of Bax,p75NTR,and Bcl-2 were increased (25. 5 ± 3. 5,11. 0 ± 2. 2,12. 3 ± 2. 7;15. 8 ± 3. 7,8. 9 ± 2. 2, 10. 5 ± 2. 9;and 47. 9 ± 6. 3,24. 7 ± 3. 0,12. 8 ± 2. 5,respectively)in the unilateral severe stenosis group, bilateral moderate stenosis group,and bilateral severe stenosis group (all P < 0. 01). The numbers of Bax and p75NTR positive cells were increased with the degree of stenosis. When the stenosis was severe,the numbers of Bax and p75NTR positive cells were increased in the bilateral severe stenosis group compared with those of the unilateral severe stenosis group (P < 0. 01). The numbers of NGF and NT-3 positive cells in each stenosis group had an increased trend compared with sham operation group,but there were no significant differences (F =1. 034,and 1. 358;P = 0. 420 and 0. 259 respectively). Conclusions Carotid stenosis can cause cognitive disorder in rats,and it is correlated with the degree of carotid stenosis. Ischemia caused neuronal apoptosis in hippocampal CA1 region may be one of the mechanisms of cognitive impairment after carotid artery stenosis in rats.
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Objective To investigate the risk factors of cerebral microbleeds (CMBs) in patients with acute isch?emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar?tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni?versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age (61.620±11.479 vs. 70.620±11.185), serum uric acid (UA) level (278.920±69.512 vs. 353.460±111.206), serum creatinine (Cr) level (71.360±19.797 vs. 90.450±44.989), serum ho?mocysteine (Hcy) level (12.587±2.664 vs. 21.715±10.437) between the two groups (P<0.05). There were significant differ?ences in constituent ratio of Fazekas' s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups (P<0.05). The results of multivariate analysis showed that age (OR=0.963, 95%CI:0.905~1.025, P<0.05) and serum Hcy level (OR=1.487, 95%CI:1.219~1.813, P<0.05) were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde?pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.
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Objective To assess the relationship between diffusion-weighted imaging-perfusionweighted imaging (DWI-PWI) mismatch and the prognosis of patients with acute anterior circulation ischemic stroke receiving intravenous thrombolysis.Methods Patients with acute anterior circulation ischemic stroke who finished multimode MRI (T1 WI,T2 WI,DWI,PWI) within 4.5 hours after disease onset were recruited in this study.They were divided into DWI-PWI mismatched and matched groups.All patients received intravenous thrombolysis using recombinant tissue type plasminogen activator (rt-PA).Head CT was performed 24 hours later to exclude cerebral hemorrhage,and the patients were followed up for 3 months.The improvement of neurological function,the rate of death and symptomatic intracranial hemorrhage (sICH) were recorded.Results A total of 63 patients were recruited in this study,of which 41 patients presented DWI-PWI mismatch while 22 patients presented DWI-PWI match.Three months later,the rate of the improvement of neurological function in the DWI-PWI mismatched group was significantly higher than that in the DWI-PWI matched group (70.7％ vs 40.9％,x2 =5.32,P =0.021).Of note,no significant difference in the rate of death and sICH was found between DWI-PWI mismatched and matched groups (9.8％ vs 13.6％,x2 =0.22,P =0.640).Conclusions Compared with DWI-PWI matched group,the DWI-PWI mismatched group has better prognosis after receiving intravenous tbrombolysis.The results provide more direct evidence supporting the application of intravenous thrombolysis under the guidance of multimode MRI in acute anterior circulation ischemic stroke.
ABSTRACT
Objective To investigate the effects of intensive antihypertensive treatment and guidelinerecommended standard blood pressure control on early reperfusion and outcomes after intravenous recombinant tissue plasminogen activator (rtPA) thrombolysis in patients with acute ischemic stroke.Methods A total of 50 patients with acute ischemic stroke (systolic blood pressure,150-185 mmHg;1 mmHg=0.133 kPa) and received intravenous rtPA therapy were enrolled prospectively.They were randomly divided into either a intensive antihypertensive treatment group or a guideline antihypertensive treatment group.In the the intensive antihypertensive treatment group,systolic blood pressure was decreased to 140-150 mmHg in 60 min for at least 72 h.In the guideline antihypertensive treatment group,systolic blood pressure was decreased to the target value ＜ 180 mmHg according to the guideline recommendation.Multi-mode MRI was completed at 24 h before and after thrombolysis.The primary endpoints were the modified Rankin Scale (mRS) score at day 90 and the mortality at day 90;the secondary endpoints were the early reperfusion rate in ischemic brain tissue,recanalization rate,and incidence of symptomatic intracranial hemorrhage.Results There was no significant difference in demographics and baseline data between the 2 groups.Within 24,48,and 72 h after thrombolysis the mean systolic blood pressure in the intensive antihypertensive treatment group was significantly lower than those in the guideline antihypertensive treatment group,while there was no significant difference in diastolic blood pressure.There were no significant differences in favorable outcome rate at day 90 (mRS score 0-2:68％ vs.64％;x2 =0-089,P=0.765),mortality (4％ vs.12％;x2 =1.087,P=0.297),incidence of symptomatic intracranial hemorrhage (4％ vs.8％;x2 =0.355,P =0.552),reperfusion rate after thrombolysis (76％ vs.68％;x2 =0.397,P =0.529),and recanalization rate (56％ vs.52％;x2 =0.081,P =0.777) between the intensive antihypertensive treatment group and the guideline antihypertensive treatment group.Conclusions Early intensive antihypertensive treatment in patients with acute ischemic stroke received intravenous rtPA thrombolysis does not have adverse effect on reperfusion rate,and does not increase the risk of death or disability either.