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Objective:To investigate effect of blood glucose on early neurological deterioration (END) and outcome after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS treated with intravenous thrombolysis in the Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from June 2020 to December 2021 were collected retrospectively. Demographic and baseline clinical data of the patients were collected. END was defined as an increase of ≥2 in reassessing the maximum score of the National Institutes of Health Stroke Scale within 72 h after admission compared with the baseline. Poor outcome was defined as the modified Rankin Scale score ≥3 at 3 months after onset. Multivariate logistic regression analysis was used to evaluate the independent correlation between various blood glucose indicators (including admission blood glucose [ABG], admission hyperglycemia [AH], fasting blood glucose [FBG] on the next day after admission, and stress hyperglycemia ratio [SHR]) and END and poor outcome after intravenous thrombolysis. Results:A total of 319 patients with AIS were enrolled, including 126 (39.5%) had AH, 67 (21.0%) had END, and 85 (26.6%) had poor outcomes at 3 months after onset. Multivariate logistic regression analysis showed that after adjusting for confounding factors, ABG (odds ratio [ OR] 1.188, 95% confidence interval [ CI] 1.105-1.278; P<0.001), AH ( OR 4.246, 95% CI 2.291-7.869; P<0.001), FBG ( OR 1.272, 95% CI 1.139-1.420; P<0.001), and SHR ( OR 2.559, 95% CI 1.192-5.664; P=0.016) were independently associated with END, while all blood glucose indicators were not independently associated with the poor outcomes at 3 months after onset. Conclusion:Higher blood glucose is independently associated with END after intravenous thrombolysis in patients with AIS, but not with the outcomes at 3 months after onset.
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Objective:To investigate the correlation between metabolic syndrome (MetS) and early neurological deterioration (END) in patients with acute minor ischemic stroke (MIS) and high-risk transient ischemic attack (TIA).Methods:Consecutive patients with acute MIS or high-risk TIA admitted to the Second Affiliated Hospital of Xuzhou Medical University between May 2018 and June 2020 were enrolled prospectively. MIS was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3, high-risk TIA was defined as ABCD 2 score ≥4, and END was defined as the highest score of NIHSS within 72 h after admission increased by ≥1 compared with the baseline. Multivariate logistic regression analysis was used to determine the correlation between MetS or its component and END. Results:A total of 145 patients with acute MIS or high-risk TIA were enrolled, including 66 males (45.5%), aged 68.28±9.71 years. Fifty-two patients (35.9%) met the diagnostic criteria of MetS, and 46 (31.7%) developed END. Univariate analysis showed that there were significant differences in age, sex, atrial fibrillation, elevated blood glucose, MetS, fasting blood glucose and C-reactive protein between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MetS (odds ratio 2.637, 95% confidence interval 1.127-6.169) and high blood glucose (odds ratio 2.672, 95% confidence interval 1.052-6.789) were the independent risk factors for END within 72 h of admission in patients with acute MIS or high-risk TIA. Conclusion:MetS is significantly associated with END in patients with acute MIS or high-risk TIA.
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Objective To investigate the predictors of early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke and its impact on short-term outcomes. Methods From January 2017 to April 2019, patients with acute ischemic stroke treated with intravenous thrombolysis in the Second Affiliated Hospital of Xuzhou Medical University were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission increased by ≥2 compared with the baseline. The short-term outcomes were evaluated by the modified Rankin Scale at discharge. 0-2 was defined as good outcomes and 3-6 was defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent predictors of END and their correlation with short-term outcomes. Results A total of 199 patients with acute ischemic stroke received intravenous thrombolysis were enrolled. The median age was 68 years (interquartile range: 62- 76 years), 69 were women (34. 7％), and the baseline median NIHSS score was 6 (interquartile range: 3- 12). END occurred in 35 patients (17. 6％). Symptom progression occurred mainly 2 days after admission (31 patients, 88. 6％). Most of the causes of END were ischemic progression or recurrence (28 patients, 80. 0％). The univariate analysis showed that fasting blood glucose and symptomatic intracranial hemorrhage were associated with END (all P < 0. 05). However, multivariate logistic regression analysis did not find independent predictors of END. Excluding 12 patients with missing short-term outcome data, a total of 187 patients were included in the short-term outcome analysis. Among them, 110 patients had good outcomes and 77 had poor outcomes. Univariate analysis showed that ischemic heart disease, atrial fibrillation, mild stroke, etiological classification, baseline NIHSS score, absolute lymphocyte count, fasting blood sugar, neutrophil/lymphocyte ratio, whether to receive interventional therapy, and END were correlated with short-term outcomes (all P < 0. 05 ). Multivariate logistic regression analysis indicated that high baseline NIHSS score (odds ratio 1. 350, 95％ confidence interval 1. 182-1. 541; P < 0. 001) and END (odds ratio 32. 540, 95％ confidence interval 6. 149- 172. 21; P < 0. 001 ) were the independent risk factors for short-term poor outcomes. Conclusions END still occurs in some patients after intravenous thrombolysis for acute ischemic stroke, and END is an independent risk factor for short-term poor outcomes.
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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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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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BACKGROUND:The angiogenesis may be related to the proliferation of neural stem ceils,but there is still no unified view.OBJECTIVE:To observe the influence of angiogenesis on neural stem cell proliferation in the subventricular zone of rats after focal cerebral ischemia/reperfusion.METHODS:Male Sprague-Dawley rats were randomly divided into normal group,sham group,vascular endothelial growth factor (VEGF)+cerebral ischemia/reperfusion group,normal saline (NS)+cerebral ischemia/reperfusion group.The injection was done via the lateral cerebral ventricle.Then,each group was subdivided into four groups (1,2,7,14 days after ischemia/reperfusion).Focal cerebral ischemia/reperfusion models were made by the thread method.After modeling,the corresponding intervention was given in each group.The expression changes of Nestin and vWF mRNA in the subventricular zone were detected in all groups by immunohistochemical staining and real-time PCR,respectively.RESULTS AND CONCLUSION:There was a certain increase in vWF and Nestin positive expression in the subventricular zone after cerebral ischemia/reperfusion.At 7 days after ischemia,the expression of vWF mRNA and Nestin reached the peak,indicating the proliferation of neural stem cells in the subventricular zone after cerebral ischemia/reperfusion is associated with the time of angiogenesis.In addition,the expression of vWF mRNA and Nestin was significantly higher in the VEGF+cerebral ischemia/reperfusion group than the other two groups,indicating angiogenesis could promote the proliferation of neural stem ceils in the subventricular zone of rats after cerebral ischemia/reperfusion.
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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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Objective To explore the influencing factors on short -term efficacy of intravenous thrombolysis with rt -PA.Methods The clinical data of the 95 acute ischemic stroke(AIS)patients who received thrombolytic therapy were analyze.Multivariate logistic regression analysis was used to determine the possible influencing factors. Results Fifty -six(58.95%)patients had favourable outcomes after thrombolytic therapy for 24 hours.Multivariate logistic regression analysis indicated that diabetes(OR =3.933,95% CI 1.199 ~12.897)and TOAST classification (OR =1.448,95% CI 1.032 ~2.032 )were the independent predictors of short -term outcome.Conclusion Diabetes and TOAST classification are the major influencing factors of short -term efficacy after intravenous thrombolysis with rt -PA.It should pay attention screening patients for intravenous thrombolysis therapy and predicting the efficacy of thrombolysis.
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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.