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Introdução: a terapia trombolítica é a principal medida salvadora adotada em vítimas de acidente vascular cerebral isquêmico (AVCI), adequada para a maioria delas. Entretanto, alguns pacientes não apresentam evolução clínica, piorando o prognóstico, o que constitui uma lacuna científica essencial. Objetivo: analisar os determinantes da não melhora clínica em pacientes com AVC em uso de trombolíticos rt-PA.Método: estudo observacional retrospectivo caso-controle, realizado de 2014 a 2017 por meio de busca ativa de prontuários de pacientes com AVC submetidos à terapia trombolítica em um hospital de referência no Ceará. A falência clínica foi caracterizada como ausência de redução no National Institutes of Health Stroke Scale-Score (NIHSS).Resultados: um total de 139 pacientes incluídos no estudo em uma única unidade de AVC. A média de idade foi de 66,14 anos (variando de 34 a 95). O seguimento de 24 horas foi completado em 100% dos pacientes. Resultado favorável 24 horas pós-trombólise foi observado em 113 pacientes (81,29%), e não houve melhora clínica em 26 (18,7%). A transformação hemorrágica pós-trombólise foi um forte preditor de não melhora (p=0,004), e diabetes foi o principal fator de risco modificável encontrado (p=0,040).Conclusão: diabetes e transformação hemorrágica após trombólise foram identificados como fatores de risco para não melhora clínica em pacientes com AVC agudo submetidos à terapia trombolítica.
Introduction: thrombolytic therapy is the primary saving measure adopted in ischemic cerebrovascular accident (ICVA) victims, adequate for most of them. However, some patients do not show clinical progress, worsening the prognosis, which constitutes an essential scientific gap.Objective: to analyze the determinants of clinical non-improvement in stroke patients who used rt-PA thrombolytic agentes.Methods: retrospective observational case-control study, carried out from 2014 to 2017 through an active search of medical records of CVA patients undergoing thrombolytic therapy in a reference hospital in Ceará. Clinical failure was characterized as no reduction in the National Institutes of Health Stroke Scale-Score (NIHSS).Results: a total of 139 patients enrolled in the study in a single CVA unit. The mean age was 66.14 years (range 34 to 95). The 24-hour follow-up was completed in 100% of patients. A favorable result 24 hours post-thrombolysis was observed in 113 patients (81.29%), and there was no clinical improvement in 26 (18.7%). Post-thrombolysis hemorrhagic transformation was a strong predictor of no improvement (p=0.004), and diabetes was the main modifiable risk factor found (p=0.040).Conclusion: diabetes and hemorrhagic transformation after thrombolysis were identified as risk factors for clinical non-improvement in patients with acute stroke undergoing thrombolytic therapy.
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Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.
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Background : Stroke is a common, potentially devastating disease with potential high morbidity and mortality. EEG (Electro-encephalogram), functional representation of electrical activity of brain, changes are closely tied to CBF (Cerebral Blood Flow). Thus EEG is useful to establish the location of Ischaemic CVA (Cerebro-vascular accident). It can also prognosticate Ischaemic stroke. Aims & Objectives : (1) To assess the grade and severity of clinical manifestations in acute ischaemic stroke patients by clinical scoring following admission. (2) To obtain EEG findings of ischaemic stroke patients following admission and after 1 month. (3) To assess the morbidity of ischaemic stroke patients by Modified Rankin Scale after 1 month. (4) To correlate EEG changes according to the clinical outcome and according to the site of involvement of ischaemic stroke. Materials and Methods : 90 Patients were selected during the study period as per the inclusion and exclusion criteria. Clinical scoring was done by NIHSS (National Institute of Health Scoring System). CT (Computed Tomography) scan of brain and MRI (Magnetic Resonance Imaging) Brain with DWI (Diffusion Weighted Image) extension was done. EEG findings on admission of morbidity was done by Modified Rankin Score on follow up after 1 month was noted. EEG findings after 1 month was noted on follow up. Assessment Clinical correlation was compared with EEG changes. All the data were collected and analysed by statistical software SPSS version 20. Results : The mean MRS (Modified Rankin Score) after 1 month for abnormal EEG on admission was 4.50 in comparison to score of 3.36 in case of normal EEG. The p value of this association was 0.003 and was considered significant. Conclusions : Normal EEG and focal slowing of EEG was mostly noted in MCA (Middle Cerebral Artery) and PCA (Posterior Cerebral Artery) infarcts involving the cortical region. Those with normal EEG findings had good clinical outcome in comparison to those with abnormal findings in EEG
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Objective:To investigate the changes and clinical significance of plasma S100A1 protein, nuclear factor-κB p65 (NF-κB p65) and interleukin-6 (IL-6) levels in patients with acute ischemic cerebrovascular diseases.Methods:A total of 141 patients with acute ischemic cerebral infarction (AICI; AICI group) and 20 patients with transient ischemic attack (TIA; TIA group) who received treatment in Northern Jiangsu People's Hospital from April to November 2020 were included in this study. According to the volume of cerebral infarct, the AICI group was subdivided into small-volume cerebral infarct (SCI group, n = 78), moderate-volume cerebral infarct (MCI group, n = 32) and large-volume cerebral infract (LCI group, n = 31) groups. An additional 31 healthy controls who concurrently received physical examination were included as controls (HC group). S100A1, NF-κB p65, and IL-6 levels were compared between AICI, TIA and HC groups and between SCI, MCI and LCI groups. S100A1, NF-κB p65, and IL-6 levels were correlated with the National Institutes of Health Stroke Scale score and the volume of cerebral infarct. The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic value of S100A1, NF-κB p65, and IL-6 levels for AICI. Results:S100A1, NF-κB p65, and IL-6 levels in the AICI group were (230.96 ± 39.37) ng/L, (3.99 ± 0.65) mg/L, (13.32 ± 1.57) ng/L, respectively, which were significantly higher than (185.85 ± 43.24) ng/L, (3.58 ± 0.74) mg/L, (11.61 ± 1.67) ng/L in the TIA group ( t = 4.95, 2.39, 4.14, all P < 0.05) and (181.47 ± 27.39) ng/L, (3.51 ± 0.99) mg/L, (11.42 ± 2.34) ng/L in the HC group ( t = 6.54, 3.32, 5.55, all P < 0.05). There were no significant differences in S100A1, NF-κB p65, and IL-6 levels between TIA and HC groups (all P > 0.05). S100A1, NF-κB p65, and IL-6 levels in the LCI group were (254.25 ± 37.07) ng/L, (4.41 ± 0.45) mg/L, and (14.00 ± 1.40) ng/L, respectively, which were significantly higher than (225.42 ± 30.92) ng/L, (3.85 ± 0.64) mg/L, (12.77 ± 1.31) ng/L in the MCI group ( t = 3.04, 3.60, 3.20, all P < 0.05) and (223.98 ± 40.21) ng/L, (3.88 ± 0.66) mg/L, (13.27 ± 1.65) ng/L in the SCI group ( t = 3.79, 4.01, 2.25, all P < 0.05). There were no significant differences in S100A1, NF-κB p65, and IL-6 levels between MCI and SCI groups (all P > 0.05). S100A1 and NF-κB p65 levels in patients with AICI were positively correlated with the volume of cerebral infarct ( r = 0.24, 0.27, both P < 0.05). S100A1 and IL-6 levels in patients with AICI were positively correlated with the National Institutes of Health Stroke Scale score ( r = 0.24, 0.28, both P < 0.05). The areas under the curves plotting S100A1, NF-κB p65, and IL-6 levels against AICI diagnosis were 0.818, 0.667 and 0.754, respectively. The optimal cutoff values were 181.03, 3.50 and 10.79, respectively. The corresponding sensitivities were 95.0%, 76.6% and 97.2%, respectively, and the specificities were 37.3%, 45.1% and 49.0%, respectively. Conclusion:Increased S100A1, NF-κB p65, and IL-6 levels in patients with AICI are closely related to the severity of AICI.
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Objective:investigate the effect of serum uric acid (SUA) on long-term cerebrovascular mortality and recurrent stroke in patients with acute cerebral infarction.Methods:A total of 132 patients from the same center were enrolled in this study. The patients were divided into three groups according to the quartile level of SUA: group 1 (SUA < 442 μmol/L, n= 69) , group 2 (SUA 442-620 μmol/L, n=35) and group 3 (SUA > 620 μmol/L, n= 28). SUA, blood urea nitrogen, serum creatinine, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglyceride and hypersensitive c-reactive protein (hs-CRP) were measured in the three groups, the National Institutes of Health Stroke Scale (NIHSS) score was determined on the day of admission, and the patients were followed up until December 31, 2020. The differences of recurrent stroke and cerebrovascular mortality in the three groups were analyzed. Results:Sixty-nine patients were selected in group 1, 35 in group 2 and 28 in group 3. Patients in group 2 and group 3 were younger, and had higher hs-CRP levels, higher SUA levels, and higher rates of recurrent stroke and cerebrovascular mortality, and the differences were statistically significant (all P<0.05). Cerebrovascular mortality (log-rank χ2 =13.19, P=0.001) and recurrent stroke (log-rank χ2 =10.30, P=0.006) were significantly increased in group 3. The risk of recurrent stroke in group 3 was 3.55 times higher than that in group 1. Conclusions:The risks of long-term cerebrovascular mortality and recurrent stroke were significantly increased in patients of acute cerebral infarction with elevated serum uric acid.
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Objective:To investigate blood glucose variability, National Institutes of Health Stroke Scale (NIHSS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and prognosis in patients with acute and severe cerebrovascular disease, providing a reference for clinical treatment of this disease.Methods:The clinical data of 76 patients with acute and severe cerebrovascular disease who received treatment in Xixi Hospital of Hangzhou between January 2014 and December 2019 were retrospectively analyzed. These patients were divided into a survival group ( n = 51) and a death group ( n = 25) according to the prognosis 28 days after admission. Baseline data, baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were compared between the survival and death groups. The effects of these parameters on the prognosis of acute and severe cerebrovascular disease were analyzed. Results:There were no significant differences in gender, age, history of diabetes, type of disease, and length of hospital stay between the two groups ( χ2 = 1.674, t = 1.048, χ2 = 3.833, 0.263, t = 0.832, all P > 0.05). The proportion of patients with a history of hypertension in the death group was significantly higher than that in the survival group [15.69% (8/51) vs. 52.00% (13/25), χ2 = 11.063, P < 0.05]. There was no significant difference in mean blood glucose between the two groups ( t = 0.118, P > 0.05). The baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions and blood glucose variability rate in the death group were (24.41 ± 4.14) points, (25.00 ± 6.97) points, (2.72 ± 0.91) mmol/L, (6.27 ± 2.01) mmol/L, (34.83 ± 5.61) %,which were significantly higher than those in the survival group [(17.22 ± 3.63) points, (19.21 ± 5.36) points, (1.69 ± 0.70) mmol/L, (3.72 ± 1.68) mmol/L, (19.54 ± 3.22) %, t = 7.744, 3.999, 5.448, 5.823, 15.095, all P < 0.05]. The proportion of patients with blood glucose variability rate < 20% in the death group was significantly lower than that in the survival group [16.00% (4/25) vs. 74.51% (38/51), χ2= 23.230, P < 0.05]. The proportion of patients with blood glucose variability rate > 30% in the death group was significantly higher than that in the survival group [60.00% (15/25) vs. 13.73% (7/51), χ2 = 17.466, P < 0.05). Logistic regression analysis revealed that baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were the independent risk factors of death of cerebrovascular disease patients (all P < 0.05). Conclusion:In patients with acute and severe cerebrovascular disease, an obvious blood glucose fluctuation, high baseline NIHSS score, and high APACHE II score help to assess the prognosis of acute and severe cerebrovascular disease and determine the risk of death.
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@#Introduction: Stroke is a common cause of mortality and morbidity and has an increasing prevalence across the world.1 Bilirubin is now being considered an antioxidant which increases in response to diseases associated with increased oxidative stress. Hence the present observational study was undertaken to assess the bilirubin levels with the outcome of acute ischemic stroke. Methods: This observational study was conducted from January 2018 to December 2018 on 64 ischemic stroke patients admitted at KLE’S Dr. Prabhakar kore hospital at Belagavi, Karnataka. All adult patients above 18 years of age presenting with cerebrovascular accident and proved as ischemic stroke on CT scan or MRI scan were included. The patients were empirically divided into different Groups based on the bilirubin level. They were then analysed with their NIHSS scores for assessing stroke severity. Results: A total of 64 patients were included in the final analysis. The mean total bilirubin level in the patients was 0.68±0.34 mg/dl ( mean±SD). 34.3% (22) of ischemic stroke patients in the study had serum total bilirubin levels 0.7 mg/dl or more. Mean NIHSS Score for Group 1(Low) total bilirubin group was 9.37 and for Group 2(High) bilirubin group was 10.9, which was statistically not significant. This indicates that there was no significant correlation between total bilirubin and severity of symptoms at the time of admission.There was no statistically significant correlation between NIHSS and direct bilirubin levels Conclusion: The current study has documented no association between the bilirubin levels and stroke severity and prognosis.
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INTRODUCTION@#Stroke patients with underlying chronic kidney disease (CKD) and those on haemodialysis have complex rehabilitation needs, and their survival and functional outcomes are limited. This study aimed to review post-stroke survival and functional outcomes following rehabilitation in patients with CKD and those on haemodialysis.@*METHODS@#We conducted a retrospective analysis of consecutive stroke patients with underlying CKD (Stages G3b, G4 and G5; n = 30) and those on dialysis at the time of stroke (n = 7), who underwent in-patient rehabilitation between June 2008 and May 2017. The mean duration of follow-up was 56 months. Demographic details, associated comorbidities and laboratory parameters were reviewed. Baseline and follow-up scores of the National Institute of Health Stroke Scale (NIHSS) and Functional Independence Measure (FIM), and dates of death of the patients were analysed.@*RESULTS@#Of the 37 consecutive stroke patients (mean age 64.7 years), 34 had ischaemic stroke and three had haemorrhagic transformation. Significant improvements in NIHSS and FIM scores were observed from the time of admission to after discharge. Older age, longer duration of hospital stay, lower estimated glomerular filtration rate and low haemoglobin levels were all significantly related to mortality.@*CONCLUSION@#Despite significant functional and neurological improvements following rehabilitation, stroke patients with underlying CKD had higher average duration of hospital stay, more recurrent hospitalisations and poorer survival outcomes than those without underlying CKD. This could be attributed to the complications associated with CKD rather than stroke. Multidisciplinary community rehabilitation may be an alternative to reduce recurrent hospitalisations and morbidity in this group of patients.
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Background: Normal cerebral membrane integration is important to maintain the cellular calcium homeostasis. Recent studies have suggested that elevated serum calcium levels at presentation correlates well with the infarct size and severity of stroke.Methods: A total of 73 patients with acute ischemic stroke satisfying inclusion and exclusion criteria were included in the study from November 1st 2017 to April 30th 2019 at a tertiary care centre in Kolar, Karnataka. Serum calcium (total, ionized and albumin corrected calcium) levels were measured at the time of presentation and compared with the infarct size and severity of stroke using NIHSS score (National Institute of Health Stroke Scale).Results: The levels of total calcium, albumin-corrected calcium, and ionized calcium were 9.13±0.89 mg/dL (range: 8.24-10.02), 9.56±0.82 mg/dL (range: 8.74-10.38), and 4.79±0.47 mg/dL (range: 4.3-5.2), respectively. Mean stroke size as measured on the CT scan was 47.38±17.7 cm (range: 21-88). Analysis revealed significant negative correlation between calcium levels (total, corrected, and ionized) and infarct size and severity of stroke.Conclusions: In this study, it was found that there was a statistically significant negative correlation between total, ionized and corrected calcium with the infarct size in patients with ischemic stroke and also the total calcium at presentation and severity of stroke calculated using NIHSS score.
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Objective: To compare the baseline characteristics and treatment outcomes of mechanical thrombectomy in patients with intracranial arterial occlusion caused by embolic stroke of undetermined source and cardiogenic stroke. Methods: Retrospective analysis was made on ESUS and CS patients in registration databases who received thrombectomy in two stroke centers, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine and Lishui Central Hospital, Zhejiang University from November 2012 to April 2019. T-test and Mann-Whitney U test were used to compare the measurement data, χ2 test and Fisher's exact test were used to compare the counting data, and the independent prognostic risk factors were analyzed by Logistic regression. Results: In all, 117 participants were eventually enrolled, including 30 (25.6%) with ESUS and 87 (74.4%) with CS. Compared with the CS group, the ESUS group was significantly younger (mean ages, 64 years vs 75 years, P=0.003) with lower median baseline NIHSS scores (12 vs. 15, P=0.020), lower median NIHSS scores at 24 h (10 vs 12, P=0.033) and lower median MRS scores at 90 days (2 vs 4, P=0.015). The rates of successful recanalization were similar. Logistic regression analysis showed hypertension (OR=0.264, 95%CI 0.099-0.704, P=0.008) and baseline NIHSS scores (OR=0.758, 95%CI 0.673-0.853, P=0.000) were independent risk factors affecting prognoses. Conclusion: Compared with CS, ESUS patients are relatively younger and have milder neurological dysfunction at onset and better prognoses; however, both groups have high mortality rates. The successful recanalization rates for mechanical thrombectomy are similar. The baseline NIHSS score and hypertension are independent prognostic risk factors.
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Background: Cerebrovascular accidents (CVA) are leading cause of death worldwide, after coronary artery disease and cancer. The main objectives of study were 1) to study the clinical profile of cerebral infarction in relation to the glycemic status at admission 2) to study the infarct size on CT in relation to glycemic status 3). To observe the clinical recovery during the first 10 days in the hospital, using the National Institute of Health Stroke scale (NIHSS). Methods: Total 60 samples were included in this study. This prospective study was conducted in Chalmeda institute of medical sciences, Karimnagar, over a period of one year between December 2016 and December 2018. During the study period, all patients presenting with acute cerebral infarction and fulfilling the inclusion criterion were included in the study. Results: Maximum number of patients of cerebral infarction belonged to age groups 51-60 years and 61-70 years. There were no large sized infarcts in the euglycemic group. The stress hyperglycemia group have higher baseline NIHSS score compared to diabetes group (*p=0.277). Conclusion: This study shows that in patients with no history of diabetes who have an ischemic stroke, with elevated glucose levels (stress hyperglycemia) are associated with increased risk of poor functional recovery compared with lower glucose levels.
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Background: Stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Acute ischemic stroke is the fourth leading cause of death and most common cause of long-term disability worldwide. Hyponatremia is the commonest electrolyte disturbance encountered in the neurological intensive care units. This study investigated to evaluate hyponatremia in acute ischemic stroke patients as a reliable prognostic marker on admission to ICU.Methods: A total of 150 patients admitted to M S Ramaiah Hospitals during the period of October 2014 to September 2016 who fulfilled the inclusion criteria were considered in the study. All patients were evaluated by neurologist/ physician and the diagnosis of Acute ischemic stroke was made by Clinical examination and confirmed by Computed Tomography (CT) and/ Magnetic resonance imaging (MRI) brain. Hyponatremia was defined as serum sodium level <135 mmol/L and recorded on admission. Outcome was assessed by National Institute of Health Stroke Scale (NIHSS) score at admission, day 5 and at discharge, duration of ICU stay, duration of hospital stay and in-patient mortality.Results: Among the 150 patients admitted with acute ischemic stroke, mean age was 60 years, 68% were males and 36% patients had hyponatremia. Baseline characteristics were similar between groups except for gender distribution (p=0.037). Hyponatremic patients had higher NIHSS score on admission, on day 5 and at discharge (p=<0.001). Hyponatremic patients had a longer duration of ICU stay (p=<0.001) and in hospital stay (p=<0.001). Hyponatremia was associated with higher mortality in hospital (p=0.026).Conclusions: Study demonstrates that hyponatremia at admission in acute ischemic stroke patients is associated with acute mortality, worse NIHSS score at admission and at discharge, and longer duration of ICU and hospital stay.
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Objective To observe the effect of heated humidified high flow nasal cannula oxygen therapy (HFNC) on patients with post-stroke systemic inflammatory response syndrome (SIRS). Methods Totally 78 patients with post-stroke SIRS were selected in the department of neurology of Wuxi People's Hospital and were randomly divided into HFNC group (n=40) and conventional therapy group (n = 38). The neurological impairment score (NIHSS) , APACHE-Ⅱ, clinical pulmonary infection score (CPIS) , C-reactive protein (CRP) of the 2 groups were recorded before and after the treatment. At the same time, modified Rankin score (mRS) of the two groups were also recorded. Results There was no significant difference in terms of morality and the number of patients with mechanical ventilation in the 2 groups. The 7-day APACHE Ⅱ, 7-day CPIS, 7-day SIRS cure rate, 14-day NIHSS and mRS of 3 months in HFNC group were higher than those in the conventional therapy group (P < 0.05).There was no significant difference in 7-day CRP, 14-day CRP and 14-day CPIS between HFNC group and conventional oxygen therapy group (P> 0.05). Conclusions HFNC can improve lung infection of patients with SIRS thus improve the recovery rate of SIRS. At the same time, it can improve the recovery of the neurological deficit and prognosis in acute stroke.
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Objective To investigate the changes of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) and omentin-1 in patients with H-type hypertension complicated with acute ischemic stroke, and to analyze the correlation of sLOX-1 and omentin-1 levels with the severity and prognosis of the disease.Methods Totally 136 patients with H-type hypertension complicated with acute ischemic stroke from February2017 to May 2018 were selected as observation group, and 136 non-acute ischemic stroke patients with H-type hypertension in the same period as the control group. The patients of observation group were divided into mild, moderate and severe sub-groups according to NIHSS score, and they were also divided into good prognosis group and poor prognosis group based on modified RANKIN scale (mRS) score. The serum sLOX-1 and omentin-1 levels were detected, and the correlation of sLOX-1 and omentin-1 levels with severity and prognosis of disease was analyzed. Results The serum sLOX-1 level of the observation group was higher, but the serum omentin-1 level lower than that of control group (P < 0.05). With the severity of the disease, the serum sLOX-1 level increased, but the serum omentin-1 level decreased (P < 0.05). The serum sLOX-1 level of good prognosis group was significantly lower, whereas the serum omentin-1 level significantly higher than that of poor prognosis group (P < 0.05). sLOX-1 was positively correlated with NIHSS score and mRS score, while omentin-1 was negatively correlated with NIHSS score and mRS score (P < 0.05). Conclusions The levels of serum sLOX-1 and omentin-1 are closely related to the severity and prognosis of patients with H-type hypertension complicated with acute ischemic stroke, which could be used as markers for evaluating the severity and prognosis of the patients.
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Objective To investigate the expression and clinical significance of plasma miR-124 in acute ischemic stroke (AIS). Methods Forty patients with AIS were collected and 40 volunteers without history of AIS were set as control. Infarction volume was detected by MRI; plasma miR-124 expression level was measured by RTPCR technique and neural function was evaluated by NIHSS scores. Results Compared with that in the control group, plasma miR-124 level in AIS group was significantly reduced (P < 0.05). Plasma miR-124 level in AIS patients with infarction volume greater than 3 cm3 was significantly lower than that of AIS patients with infarction volume less than 3 cm3 (P < 0.05). Correlation analysis showed a negative correlation between miR-124 and infarction volume (r =-0.473, P < 0.05). Plasma miR-124 level in AIS with NIHSS score higher than 5 was significantly lower than that of AIS patients with NIHSS lower than 5 (P< 0.05). NIHSS score negatively correlated with the miR-124 level of AIS patients (r =-0.567, P < 0.05). Conclusion The plasma miR-124 is significantly reduced in patients with AIS, and negatively correlated with the cerebral infarction volume and NIHSS score.
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Objective To investigate the indicators of thrombolytic therapy in patients with acute ischemic stroke,find out the early warning value,and provide guidance for decision-making of emergency doctors.Methods Patients with acute ischemic stroke who were treated with thrombolytic therapy from January,2010 to August,2017 in our hospital were enrolled in this study.According to the modified Rankin scale,patients were divided into the good prognosis group and poor prognosis group.Logistic regression model was used to evaluate the relative dependent risk factors.Results Totally 210 patients were enrolled in the good prognosis group and 152 patients in the poor prognosis group.Multivariate logistic regression analysis showed that NIHSS score on admission,blood glucose,systolic blood pressure before thrombolytic therapy,homocysteine,onset-to-needle time and previous history of diabetes mellitus were independent risk factor for poor prognosis (P＜0.05).Conclusions Risk factors as NIHSS score on admission,blood glucose,systolic blood pressure before thrombolytic therapy,homocysteine,onsetto-needle time and previous history of diabetes mellitus are early warning indicators of poor prognosis in patients with acute ischemic stroke treated with thrombolytic therapy.
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OBJECTIVE: To outline the association between the National Institutes of Health Stroke Scale (NIHSS) in the acute stage and the Functional Independence Measure (FIM) of motor items several months later. METHODS: Seventy-nine infarct cases with middle-cerebral-artery region transferred to long-term rehabilitation facilities were analyzed. Patients were allocated to either the model-development group or the confirmatory group at a 2:1 ratio. Independent variables were based on the NIHSS during the acute care and on demographic factors such as age and modified Rankin Scale (mRS) before onset. Multivariate logistic analyses were performed to predict the independence of each FIM motor item. These models were evaluated in the confirmatory group. RESULTS: Multivariate logistic analyses in the model-development group (n=53) indicated that at least one NIHSS item was statistically significantly associated with the functional independence of a single FIM motor item. Of the NIHSS items, the affected lower extremity item was the most widely associated with 11 of the FIM motor items, except for eating and shower transfer. The affected upper extremity function was the second widely involved factor associated with 7 of the FIM motor items including eating, grooming, bathing, toileting, bed transfer, toilet transfer, and shower transfer. Age and mRS were also statistically significant contributing factors. The obtained predictive models were assessed in the confirmatory group (n=26); these were successful except for the stairs climb item. CONCLUSION: In combination with age and pre-stroke status, the NIHSS items (especially the affected extremity items) may be useful for the prediction of long-term outcome in terms of activities in daily living.
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Animals , Humans , Baths , Demography , Eating , Extremities , Grooming , Infarction, Middle Cerebral Artery , Lower Extremity , Middle Cerebral Artery , Rehabilitation , Stroke , Upper ExtremityABSTRACT
@#Background & Objectives: The National Institute of Health Stroke Scale (NIHSS) provides a valid and quick assessment of stroke severity in hyperacute stroke management. Stroke patients who are eligible for reperfusion therapy require prompt assessment. There is no validated Bahasa Malaysia (BM) version of the NIHSS that allows easier assessment by BM-speaking health professionals. This study aimed to translate and validate a BM version of the NIHSS. Methods: The English NIHSS was translated to BM, then back translated to ensure linguistic accuracy. We also adapted the language assessment of the NIHSS to be more culturally appropriate. Training and certification videos were downloaded from the NIH website and dubbed into BM. We determined intra-class correlation and unweighted kappa as the best measure of reliability. Median scores were used in the analysis for language items. Results: One hundred and one raters participated in the test-retest reliability study. Agreement between the original NIHSS and our translated version of the BM-NIHSS was good (ICC = 0.738, 95% CI: 0.611 to 0.823). Fair to moderate agreement was found on item-by-item analysis (unweighted κ=0.20-0.50) despite high observed agreement. Fifty patients participated in the language assessment arm. Scores were better in BM for reading, naming objects and repetition (Mdn = 100, p < 0.001). There was no difference in the median scores for the description component. Conclusions: The BM-NIHSS is a valid translation of the NIHSS, and may be used in clinical practice by BM-speaking healthcare professionals.
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Objective To discuss the impacts of stroke center construction upon therapeutic indexes for di-agnosing and treating patients with acute ischemic stroke. Methods Patients were divided into a control group (180 patients)and a formal group(245 patients)based on the time of stroke center construction.Patients in both groups were recorded time points in the course of diagnosis and treatment,and compared in number of cases with intravenous thrombolysis,number of cases receiving intravascular interventional therapies,DTN(door-to-needle) time,number of deaths,National Institutes of Health Stroke Scale(NIHSS)scores upon grouping,NIHSS scores after four weeks,NIHSS scores after 3 months,days of hospital stay and hospital charges.Results After the con-struction of the stroke center,time spent in different links were decreased.The number of cases with pure intrave-nous thrombolysis and DTN time(shorter than 60 min)were increased,and the difference were statistically signifi-cant(P<0.01).The number of cases who only received intravascular interventional therapies is increased,mean-while,DTN time was decreased,NIHSS scores after 4 weeks was increased and NIHSS scores after 3 months were also increased(P < 0.05)in these cases. No statistically significant differences existed in number of cases who were treated by bridging with intravenous thrombolysis in combination with intravascular interventional therapies and death cases(P=0.153,P=0.247).There were no statistically significant differences in days of hospital stay and hospital charges(P=0.152,P=0.406).Conclusions After the stroke center construction,it is helpful for significantly improving medical institutions′diagnosis and treatment of stroke,reducing time of such diagnosis and treatment in different links,shortening DTN time,increasing thrombolysis rate,improving patients′prognosis and bringing more benefits to patients with acute ischemic stroke by optimizing procedures for diagnosing and treating stroke.
ABSTRACT
Objective To observe the effect ofXing Nao Kai Qiao (awakening brain and opening orifice) needling method on the cognitive and motor function of patients in acute stage of cerebral infarction.Method Sixty-four patients in acute stage of cerebra infarction were recruited and randomized into a trial group and a control group, 32 cases in each group. The control group was intervened by Edaravone 30 mg plus Fibrinogenase injection 200 U mixed in 500 mL 0.9% NaCl via intravenous drip, once a day. The trial group was byXing Nao Kai Qiao needling method in addition to the intervention given to the control group, once a day, 5 times a week. The two groups were both given 2-week successive treatment. At the end of the intervention, clinical efficacy, cognitive function, motor function, nervous function, serum C-reactive protein and NO levels, and adverse reactions of the two groups were compared.Result After the treatment, the Chinese Stroke Scale (CSS) score dropped significantly, Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score, Barthel Index (BI) score and motor function score of both upper and lower limbs increased significantly in both groups (P<0.05); the total effective rate of the trial group was significantly higher than that of the control group (P<0.05); the CSS score was lower, and LOTCA score, BI score, and motor function scores of both upper and lower limbs were higher in the trial group compared with those in the control group, and the differences were statistically significant (P<0.05); on the 1st, 3rd, 7th and 14th day after the intervention, the serum CRP and NO levels were significantly lower in the trial group compared with those in the control group (P<0.05). There was no significant difference in comparing the adverse reaction incidence between the two groups (P>0.05).Conclusion Xing Nao Kai Qiao needling method can produce a significant efficacy in treating patients in acute stage of cerebral infarction, and it can improve the cognitive, motor and nervous functions with high security.