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Objective To investigate the effect of prehospital transport mode on delay care in patients withacutestroke.Methods From March 2016 to August 2016,a total of 255 consecutive patients with acute stroke who met the inclusion criteria in Xuanwu Hospital,Capital Medical University were analyzed prospectively. Seven patients were excluded because of incomplete data. A total of 248 valid cases were enrolled. They were divided into either an ambulance transport group (n=88)or a non-ambulance transport group (n=160)according to whether they were transported by ambulance or not. The differences of the baseline data,prehospital status,onset-to-door time,door-to-examination time,door-to-CT scan time,door-to-intravenous thrombolysis time of the 2 groups were compared,and the related factors of ambulance use were analyzed in patients with acute stroke. Results (1)The ambulance utilization rate of 248 patients was 35. 5%. The age,the coronary heart disease rate,National Institutes of Health Stroke Scale (NIHSS)score of the patients in the ambulance transport group were higher than those of the non-ambulance transport group. There were significant differences between the two groups (65 ± 11 vs. 61 ± 11 years,15. 9%[14/88]vs. 5. 6%[9/160],9 [3,17]vs. 2 [1,5];all P <0. 05). The stroke rate of the patients in the ambulance transport group was lower than that of the non-ambulance transport group(23. 9%[21/88]vs. 37. 5%[60/160],P<0. 05). (2)There were significant differences in self-identified acute disease and self-health care consciousness between the ambulance transport group and the non-ambulance transport group (all P<0. 01). (3)Compared with the non-ambulance transport group,the onset-to-door time,door-to-examination time,door-to-CT scan time,door-to-intravenous thrombolysis time were shorter in patients of the ambulance transport group (102[64,150]min vs. 136[86,230]min,3[1,8]min vs. 7[4,11]min, 15[18,23]min vs. 16[22,27]min,and 41 ± 9 min vs. 50 ± 10 min;all P <0. 05). (4)The result of Logistic regression analysis showed that the acute stroke patients with advanced age (OR,1. 04,95%CI 1. 01-1. 08,P =0. 01),higher NIHSS score (OR,1. 13,95%CI 1. 08-1. 19,P <0. 01),they or the insiders thought that the disease was emergent (OR,17. 08,95%CI 5. 78-50. 41,P<0. 01),they would seek medical advice in time when they felt sick (OR,38. 13,95%CI 10. 13-143. 61,P<0. 01),and they would take medicine by themselves when they felt sick (OR,6. 82,95%CI 2. 33-19. 99,P<0. 01)were more likely to be transported to hospital by ambulance.Conclusion Using ambulance can reduce the treatment de-lay for patients with acute stroke. The patients with self-health care consciousness are more likely to choose am-bulance transport. The importance of using ambulance should be strengthened for patients with stroke.
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Objective To analyze the influencing factors of having clinical meaningful recanalization (CMR)after revascularization therapy in acute phase of ischemic stroke. Methods A total of 267 consecutive patients with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital, Capital Medical University and received intravenous thrombolysis or endovascular intervention in acute stage from March 2011 and March 2015 were enrolled retrospectively. CMR was used as a primary endpoint event. They were divided into either a CMR group (n = 92)or a non-CMR group (n = 175)according to whether they had CMR. The baseline data of the patients in both groups were compared by using the Rank sum test and Pearson Chi-Square test. A multivariate logistic regression model was established to analyze the independent influencing factor of CMR. Results The median (interquartile range)age of 267 patents was 60 (51 -69)years,and 69 of them were females (25. 8%);the median (interquartile range)time from onset to treatment was 250 (195 -305)min,and the median (interquartile range)NIHSS score was 10 (6 -15). The baseline NIHSS score,body mass index,blood glucose level,and proportion of diabetes of the CMR group were significantly lower than those of the non-CMR group (all P≤0. 05). The results of multivariate logistic regression analysis showed that the baseline NIHSS (OR,0. 93,95% CI 0. 88 -0. 98;P = 0. 01),intravenous thrombolysis (with respect to endovascular intervention)(OR,0. 35, 95% CI 0. 17 -0. 73;P = 0. 01),and baseline blood glucose (OR,0. 87;95% CI 0. 77 -0. 98;P =0. 02)were the independent negative predictors of CMR. Conclusion The baseline NIHSS,intravenous thrombolysis (with respect to endovascular intervention),and high blood glucose are the negative influencing factors for achieving CMR in the acute phase of ischemic stroke,suggesting blood sugar intervention and endovascular intervention in acute phase may contribute to the improvement of clinical prognosis.
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objective To investigate the recurrence of stroke,clinical prognosis and vascular changes in patients with ischemic stroke due to middle cerebral artery stenosis. Methods The ischemic stroke patients with symptomatic middle cerebral artery stenosis were enrolled continuously and followed up prospectively for six months. The recurrence of ipsilateral stroke,clinical prognosis and dynamic changes of vessels were analyzed. Results Eighty patients were included,and 20.0% of the patients(16 cases)presented with recurrence of ipsilateral ischemic stroke and 56 cases (70.0%)with a good outcome(modified Rankin scale[mRS]≤1)during the 6 months follow-up;38.6% patients (27 cases) presented with significant vascular changes with progression in 12 cases (17.1%)and regression in 15 cases (21.4%). Conclusion The patients with simple symptomatic middle cerebral artery stenosis have an high rate recurrence of ipsilateral stroke but have good prognosis;Lesioned artery of the majority of patients in the short period after stroke was stable,but vascular stenosis in some patients could appear progression or remission.
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Objective To investigate the distribution of five indicators of hepatitis B(HBV-M)and its relationship with liver function parameters and HBV-DNA load in patients with chronic HBV infection in different stages.Methods The serum samples were collected from 456 patients infected with HBV.The HBV-M,liver functional parameters and HBV-DNA level were quantita-tively detected.According to the stages of disease,the patients were divided into 3 groups including chronic hepatitis B group(inclu-ding mild subgroup,moderate subgroup and severe subgroup),liver cirrhosis group(including compensatory subgroup,decompen-sated subgroup)and hepatocellular carcinoma goup.Results The ratio of HBsAg,HBeAg,HBcAb positive pattern(135 pattern) and HBsAg,HBeAb,HBcAb positive pattern(145 pattern)in the three groups were statistically different(P <0.05).In each chron-ic hepatitis B subgroup,both ALT and AST levels of 135 pattern were significantly higher than the other two patterns(P <0.05). In each liver cirrhosis subgroup and hepatocellular carcinoma group,there were statistically significant differences in ALB and TBIL levels between the three patterns(P <0.05 ).In each group,the HBV-DNA level of 135 positive pattern were significantly higher than the other two patterns(P <0.05).Conclusion With the advancement of chronic hepatitis B,there is a downtrend in the ratio of 135 pattern and increasing trend in the ratio of 145 pattern.If the stage of hepatitis B is discriminated,ALT,AST,ALB TBIL and HBV-DNA level were closely related to HBV-M pattern.
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Objective To compare the safety and efficacy of intravenous thrombolysis for patients with acute cerebral infarction in a second-grand class-A hospital and a third-grand class-A hospital. Methods Twenty-one consecutive patients with cerebral infarction treated with alteplase for intravenous thrombolysis were enrolled in a second-grand class-A hospital (Fengtai Hospital,Beijing)prospectively from January 2012 to December 2013 as the study group,and 65 patients in a third-grand class-A teaching hospital (Xuanwu Hospital,Capital Medical University,Beijing)admitted at the same period for intravenous thrombolysis were used as a control group. The differences of efficacy and safety of intravenous thrombolysis in patients of both groups were compared. The primary outcome measures were Barthel Index (BI)at day14 after onset and the modified Rankin Scale (mRS)scores at discharge. The main safety indicator was the incidence of serious adverse events (SAEs)after thrombolysis (symptomatic intracranial hemorrhage and death). Results (1 )In the primary outcome measures,the proportions of mRS≤2 at discharge in the study group and the control group were 71. 4%(n=15)and 58. 5%(n=38)respectively. At day 14 after thrombolysis,the proportions of BI ≥60 were 61. 9%(n=13)and 64. 6%(n=42)respectively. There were no significant differences between the two groups (P>0. 05). (2)The incidences of the primary serious adverse events were 4. 8%(n=1)and 6. 2%(n=4). There was no significant difference (P>0. 05). Other secondary outcome measures,such as the early reperfusion rate,recanalization rate,and the proportion of neurological improvement at day 14 after thrombolysis and the overall incidence of cerebral hemorrhage had no significant differences. The case referral proportion (9. 5%,n=2)of the study group had a trend of lowering than the control group (27. 7%,n=18)P=0. 09. (3)The out-hospital time delay, in-hospital time delay,and overall time delay of the study group were less than those of the control group, and the mean time was 75 ± 33 vs. 102 ± 50 min,and 72 ± 41 vs. 111 ± 38 min,147 ± 41 vs. 212 ± 47 min. There were significant differences (P<0. 01). Conclusion The second-grand hospital selected by our study can relatively safely and effectively perform intravenous thrombolysis for acute cerebral infarction with alteplase. Moreover,the intravenous thrombolysis of the second-grand hospitals may reduce the case referral ratio and visiting time.
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Objective To explore the influence of integrated Chinese and western medicine therapy on anxiety,sugar metabolism and subjective well-being for type 2 diabetes Patients associated with anxiety.Methods Use glycated hemoglobin (HbAlc),trait anxiety inventory(TAI),and Memorial University of Newfoundland Scale of Happiness (MUNSH) to evaluate the condition of 60 patients with type 2 diabetes associated with anxiety.The patients participated in the study were randomly divided into Western medicine therapy group(control group)and integrated traditional Chinese and Western medicine therapy group (experimental group),with 30 cases in each group.The control group was treated with paroxetine while the experimental group was treated with paroxetine plus Jiawei-Xiaoyaowan.6 weeks after treatment,we tested the HbAlc level.TAI score and MUNSH score of those patients.Results After 6 weeks,the TAI score of patients in both experimental group and control group have obviously decreased (before treatment:54.07±6.41 and 56.33 ±6.01,respectively; after treatment:38.89±6.70 and 45.29±6.55,respectively) and the difference was statistically significant (P＜0.05).And the TAI score of the two groups after treatment was significantly different (P＜0.05).For both experimental and control groups,the HbA1e level were not obviously changed before and after the study with P＞0.05 (before treatment:8.14±2.69 and 8.07±2.11,respectively; after treatment:8.21±2.07 and 7.92± 1.90,respectively).Comparison between groups also showed no significant difference.MUNSH score have obviously increased in experimental group (before treatment:40.49±5.22; after treatment:44.53 ± 6.28,P＜0.05).The result of comparison between the two groups after treatment shows that MUNSH score of patients in the experimental group were obviously improved compared with patients in the control group (57.56 ±6.39),and the difference was statistically significant (P＜0.05).Conclusion The integrated traditional Chinese and western medicine therapy can obviously release anxiety and enhance subjective well-being in patients with cerebral infarction associated with anxiety.
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@#ObjectiveTo evaluate the value of National Institute of Health Stroke Scale (NIHSS) combined with CT angiography(CTA) to predict the clinical outcome of acute ischemic stroke patients at ultra-early stage.Methods70 patients with acute ischemic stroke underwent brain CTA within 6 hours from symptom onset and were divided into two groups according to NNIHSS score, and clinical outcome was compared between two groups.ResultsThere were 38 patients with arterial occlusion on CTA and 32 patients with normal CTA. The percentage of occlusion on CTA for patients presenting with more severe neurological deficits was higher than those patients with slight to moderate deficits. The patients with occlusion on CTA and presenting with more severe deficits had a poor clinical outcome (P<0.01). 78% of patients with normal angiograms had good outcome, only 44.7% patients with arterial occlusion had a good clinical outcome(P<0.05). Both CTA evidence of vessel occlusion and admission NIHSS score correlated with clinical outcome measured by discharge NIHSS score(r=0.25, P=0.04 and r=0.73, P=0.000 respectively). The sensitivity and specificity for predicting clinical outcome by using the NIHSS score alone was 56.65% and 85.29%, and positive predictive value (PPV+) was 80.00%. There was a sensitivity of 63.89%, a specificity of 73.53%, a PPV+ of 71.88% if CTA showed vessel obstruction. If NIHSS scores combined with CTA to predict clinical outcome, the result showed a sensitivity of 70.11%, a specificity of 91.18%, a PPV+ of 88.00%.ConclusionThose patients with vessel occlusion on CTA appear to have a worse clinical outcome. NIHSS combining with CTA may increase specificity for judging prognosis and guide treatment.
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@#ObjectiveTo evaluate the value of National Institute of Health Stroke Scale (NIHSS) combined with CT angiography(CTA) to predict the clinical outcome of acute ischemic stroke patients at ultra-early stage.Methods70 patients with acute ischemic stroke underwent brain CTA within 6 hours from symptom onset and were divided into two groups according to NNIHSS score, and clinical outcome was compared between two groups.ResultsThere were 38 patients with arterial occlusion on CTA and 32 patients with normal CTA. The percentage of occlusion on CTA for patients presenting with more severe neurological deficits was higher than those patients with slight to moderate deficits. The patients with occlusion on CTA and presenting with more severe deficits had a poor clinical outcome (P<0.01). 78% of patients with normal angiograms had good outcome, only 44.7% patients with arterial occlusion had a good clinical outcome(P<0.05). Both CTA evidence of vessel occlusion and admission NIHSS score correlated with clinical outcome measured by discharge NIHSS score(r=0.25, P=0.04 and r=0.73, P=0.000 respectively). The sensitivity and specificity for predicting clinical outcome by using the NIHSS score alone was 56.65% and 85.29%, and positive predictive value (PPV+) was 80.00%. There was a sensitivity of 63.89%, a specificity of 73.53%, a PPV+ of 71.88% if CTA showed vessel obstruction. If NIHSS scores combined with CTA to predict clinical outcome, the result showed a sensitivity of 70.11%, a specificity of 91.18%, a PPV+ of 88.00%.ConclusionThose patients with vessel occlusion on CTA appear to have a worse clinical outcome. NIHSS combining with CTA may increase specificity for judging prognosis and guide treatment.
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Objective To investigate the relationship between polymorphisms of apolipoprotein E (apoE) and hepatitis C virus (HCV) infection.Methods The multiplex amplification refractory mutation system polymerase chain reaction (multi-ARMS PCR) technique was used to analyze apoE genotype of 186 patients with HCV infection and 108 healthy controls. Serum lipid level was also determined. The results were processed by statistical analysis.Results The serum levels of triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol ( LDL-C) and apolipoproteinB (apoB) in patients group were significantly lower than those in healthy control group (P
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Objective To explore the value of craniocerebral CT angiography(CTA) to evaluate the prognosis in patients with acute cerebral infarction(ACI).Methods Craniocerebral CTA were performed in 70 patients with ACI at ≤6 h after onset.National Institutes of Health Stroke Scale(NIHSS) score and modeled Rank Scale(mRS) score were investigated at admission,discharge.Results There were 38 patients with visible occlusion on CTA and 32 patients with normal CTA.The patients with vessel occlusion on CTA had significantly worse discharge scores of NIHSS(P0.05).But for patients with vessel occlusion,the ratio of good prognosis in patients received thrombolytic treatment was higher than that of excluded thrombolysis(58.8% vs 31.8%;P