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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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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 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: 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 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 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.
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Objective To investigate the clinical effect of Xueshuantong Injection combined with Sodium Monosialotetrahexosylganglioside Injection on cerebral infarction.Methods Selected 100 cases of patients with cerebral infarction who were treated in Occupational Disease Hospital of Xinjiang Uygur Autonomous Region from January 2013 to December 2015,divided into two groups randomly.The observation group was treated with Xueshuantong Injection combined with Sodium Monosialotetrahexosylganglioside Injection,control group was treated with Xueshuantong Injection.The therapeutic effect,IL-6,C reactive protein level,NIHSS score,Barthel index and hemorheology were compared.Results The effective rate of observation group was 92.00％,significantly higher than the control group 70.00％,the difference was statistically significant (P ＜ 0.05).The level of serum IL-6 and C reactive protein were significantly decreased (P ＜ 0.05),and the observation group decreased more obviously,the difference was statistically significant (P ＜ 0.05).After treatment,NIHSS score of two groups decreased significantly,and Barthel index increased significantly (P ＜ 0.05),and the study group was significantly better than the control group,the difference was statistically significant (P ＜ 0.05).After treatment,platelet aggregation and blood viscosity were decreased significantly (P ＜ 0.05),and the observation group decreased more obviously,the difference was statistically significant (P ＜ 0.05).Conclusion Xueshuantong Injection combined with Sodium Monosialotetrahexosylganglioside Injection has significant therapeutic effect,can significantly improve the level of inflammatory factors,neural function,ability of daily life and blood rheology in patients with cerebral infarction.
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Objective To study the therapeutical effects of compound Danshen injection combined with edaravone in treatment of acute cerebral infarction.Methods 130 cases of ACI were randomly divided into two groups, control group(65 case) and observation group(65 cases), control group were administered with edaravone injection, while observation group were administered with compound Danshen injection and edaravone injection, NIHSS score and Barthel index score were used for effects evaluation, meanwhile, serous levels of copeptin, NT-proBNP and Hcy were measured by ELISA assay.Results Observation group had a better effect on ACI care, compared with control group (P<0.01), and serum levels of copeptin,NT-proBNP and Hcy significantly improved both in the two groups ( P <0.01 ) , while, observation group had a better effects ( P <0.01 ) . Conclusion Combination therapy of compound Danshen injection and edaravone has a fabulous effect on ACI care.
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Objective To observe the curative effect and safety of recombinant tissue plasminogen acti-vator (rt-PA) in acute ischemic stroke (AIS) patients in more than 15 points of NIHSS scores and less than 4.5 h in onset time. Methods One hundred and twenty-seven cases with AIS in more than 15 points of NIHSS scores and less than 4.5 h in onset time were included into the study. According to the patients′ option to accept the intravenous thrombolytic therapy , 68 patients received intravenous thrombolysis with alteplase as the treat-ment group, 59 patients did not receive intravenous thrombolytic therapy as the control group. The incidence of intracerebral hemorrhage and mortality were observed in the two groups after thrombolytic therapy. Their nerve function defect was scored according to the NIHSS scores before and after treatment at day 7 and day 30. Their living ability was assessed by mRS in modified Rankin chart after the treatment at the day 90. Results The NIHSS scores were significant lower in the 2 groups after therapy (P 0.05). Conclusion Intravenous rt-PA thrombolytic therapy is effective and safe for AIS whose NIHSS scores are more than 15 points and onset time are less than 4.5 h.
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Objective To analyse the effect of dual-antiplatelet drugs on S100β,IL-1β, adiponectin(ADPN)and NIHSS score in patients with acute cerebral infarction.Methods 58 patients diagnosed with acute cerebral infarction in first hospital of Qinhuangdao.All patients were collected and randomly divided into experimental group and control group according to random number table , 29 cases in each group.Both group were given the treatrnent of improvng the cerebral vascular circulation, protect brain cells, control blood pressure, blood glucose, oxygen when necessary.On the basis of conventional treatment, control group was treated with aspirin 200 mg, one time per day,orally.And experimental group was treated with clopidogrel 75 mg/d on the basis of control group,one time per day,orally.After treatment, the serum levels of S100β, IL-1β, ADPN and NIHSS score were detected in all patients.ResuIts After treatment, compared with control group,the serum S100βprotein level was significantly lower in the experimental group (P<0.05); the serum IL-1βlevel in experimental group was significantly lower (P<0.05);ADPN level in experimental group was significantly higher (P<0.05); NIHSS score of patients in experimental group was significantly lower (P<0.05).ConcIusions Dual antiplatelet drugs can reduce serum S100βprotein,IL-1βin serum of patients with acute cerebral infarction, increase the level of serum adiponectin, decrease NIHSS score, can effectively improre neurological function in patients with acute cerebral infarction.
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Objectives: Recent studies in acute ischemic stroke (AIS) have brought to light newer risk factors like serum levels of high sensitivity-C-Reactive Protein (hs-CRP), procalcitonin, homocysteine and albumin. Aim of our study is to objectively determine the short term prognostic value of serum albumin levels in AIS by correlating its levels with the clinical outcome. Methods: A cross-sectional study was carried out in Shri Sayajirao General Hospital, Vadodara over a period of 2 years where-in 108 cases of AIS were screened and 50 patients who met the inclusion criteria were studied. Patients presenting within 72 hours of onset and aged≥ 40 years were included in this study. Apart from routine investigations, serum albumin levels were done in all the patients. Results and Interpretation: Patients with a lower NIHSS score on admission had higher levels of serum albumin, and those with a higher National Institute of Health Stroke Scale (NIHSS) score had a lower level of albumin [P value <0.001]. Similarly, patients with a higher score on Barthel index after 1 week of admission had a higher serum albumin level, while those with lower score had lower albumin levels [P value <0.001]. Thus serum albumin level has a direct correlation with short term prognosis.
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Intravenous thrombolysis in acute ischemic stroke has been conventionally avoided in the elderly (>80years of age) with fear of higher incidence of complications like symptomatic intracranial hemorrhage (SICH) and possible loss of efficacy of thrombolysis in view of lack of evidence with most previous trials excluding this group of patients. There has been recent evidence suggesting benefit of IV thrombolysis in the elderly (>80 years) especially when treated within 3 hours of stroke onset. We report a successful thrombolysis in a 90 years old lady which to our knowledge is the first successful thrombolysis reported from India.
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Objective To analyze the blood pressure,heart rate,the US national institutes of health stroke scale(NIHSS) score,Glasgow coma scale(GCS) score for cerebral infarction patients with cerebral hemorrhage after recombinant human tissue-type plasminogen activator (rt-PA) therapy.Methods From April 2011 to April 2013,48 cases with cerebral infarction after intravenous rt-PA thrombolysis were collected.These cases were divided into two groups:the first group (32 cases):without cerebral hemorrhage after thrombolysis; the second group (16 cases):with cerebral hemorrhage after thrombolysis.The systolic blood pressure,diastolic blood pressure,heart rote,NIHSS score and GCS score were compared between the two groups before and after thrombolysis.Results After thrombolysis,the systolic and diastolic blood pressure were significantly increased in cerebral hemorrhage cases compared with before thrombolysis and patients without cerebral hemorrhage.After thrombolysis,the NIHSS score was significantly reduced in the cases without cerebral hemorrhage compared with that before thrombolysis,while the NIHSS score was significantly higher in the cases with cerebral hemorrhage compared with that before thrombolysis.After thrombolysis,the heart rate and GCS score showed no significant difference between the patients with and without cerebral hemorrhage.Conclusions The rising of systolic blood pressure,diastolic blood pressure and NIHSS score helps us determine the early cerebral hemorrhage after thrombolysis in cerebral infarction patients.
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Objective To observe the dynamic changes in plasma levels of neuropeptide Y (NPY) in patients with acute cerebral infarction (ACI) and the serum nitric oxide synthase (NOS) in order to find out the relationship between each other as well as their clinical significance. Method A prospective and control study was done in 30 patients with ACI including 21 male and 9 female with average age of (58.07 ± 12. 1S) years admitted from May 2008 to March 2009. These patients hit the diagnostic criteria for cerebral infarction (CI) set by the Chinese Society for Neruoscience and the Chinese Association of Neurosurgery in 1996 for their first attack of CI was treated within 48 hours. Patients with acute myocardial infarction, peripheral vascular disease, infection, tumor,or severe organic functional impairment, etc within six months were excluded. Another 27 healthy subjects asking for routine physical examination including 15 male and 12 female with average age of (55.00± 11.03) years were included as control group at the same period. The two groups were comparable. The blood samples of fasted subjects of control group and CI patients 48 hours after and within 10 days after attack were taken to examine the level of NPY by using radioimmunoassay and the level of serum NOS by using chemical colorimetry. The size of responsible focus of CI was calculated, and the degree of neurological deficits were estimated with Stroke Scales set by the American National Institutes Of Health (NIHSS). The chi-square test was used for constituent ratios within samples, while t -test was applied to analysis of differences between two groups, and linear was used for bivariate simple correlation analysis. Results (1) There was no significant difference in NPY between two groups. (2) The level of constructional NOS (cNOS) within 48 hours after attack in CI group was significantly lower than that in control group, and it was significantly and negatively correlated with the size of infarction and the NIHSS scores at the same period, whereas it significantly and positively correlated with difference in NIHSS scores, while it increased more significantly 10 days after attack than it did within 48 hours after attack. (3) The level of inducible NOS (iNOS) within 48 hours after attack in CI group was significantly higher than that in control group, and it was significantly and positively correlated with the size of infarctionand NIHSS scores at the same period, and it significantly and negatively crrelated with the difference in NIHSS scores, while it decreased more significantly 10 days after attack than it did within 48 hours after attack. (4) The level of NPY was not correlated with both cNOS and iNOS in CI group. The difference in levels of NPY was negatively and significantly correlated with the difference in levels of cNOS. Conclusions There was no significant change in plasma NPY level in ACI patients, and it was not correlated significantly with the disease itself. The serum cNOS was negatively correlated with the disease itself significantly within 48 hours after attack. The iNOS level was positively correlated with the disease itself significantly, and it reflected the severity of CI within 48 hours after attack. The changes of NPY level in plasma were significantly and negatively correlated with the changes of cNOS level in serum within 48 hours and 10 days after attack.