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Background: Ischemic Stroke is a common cause of morbidity and mortality. Various parameters, both clinical and laboratory have been studied as markers of Early Neurological Deterioration (END) out of which CRP has been the most important. This retrospective study of ours is an attempt to study its influence on END by minimizing other variables as much as possible.Methods: 50 patients were chosen retrospectively strictly according to laid down inclusion and exclusion criteria, their data recorded and analyzed with 17.0 SPSS software. Any p value <0.05 was taken as significant.Results: Significantly raised CRP values were found in elderly patients (p=0.0001) and in males (p=0.003). Higher incidences of ENDs were also found in elderly patients (p=0.326) and males (p=0.846) and patients with raised CRP levels (p=0.057).Conclusions: Higher Values of CRP are associated with increased frequency of ENDs. But in patients with multiple factors which can influence both CRP and END, CRP alone should not be thought of as the only culprit.
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Background: Stroke, a serious neurological disease is a major cause of death and disability throughout world. The pathophysiology of stroke involves inflammatory pathways, oxidative damage, apoptosis, angiogenesis and neuroprotection. High sensitivity C - reactive protein (hs-CRP) is associated with atherosclerosis and predict incident stroke in many patients. Objective of present study was to find out change in pattern of hs-CRP in acute ischemic stroke (AIS) patients during 3-months follow up and its prognostic significance.Methods: Single centre prospective cross-sectional time bound study. 256 were screened and 130 meet the inclusion and exclusion criteria, of which 100 gave informed consent and 80 patients completed the study at 3 months. Demographic, clinical parameters including NIHSS scoring, biochemical analysis was collected at enrolment, discharge and at end of the study.Results: hs-CRP levels in AIS increased significantly (within 24 hours of stroke) and continued to increase further at discharge, while decreased significantly during 3 months follow up. >7mg/dl hs-CRP at admission had 3.5 fold higher risk of mortality. Age >60 years, metabolic syndrome, hyperlipidemic, SBP >160mmHg and hs-CRP > 7 mg/dL increases relative risk in AIS stroke patients by 1.42, 1.09, 1.11, 1.577 and 3.23 fold respectively.Conclusions: hs-CRP increased significantly in AIS patients during 1st weeks of stroke with subsequent gradual decrease by the end of 3 months, the severity scoring system could determine prognosis on admission to ICU while hs-CRP is the main factor determining short as well as long term prognosis. We recommend serial measurements of hs-CRP for prognostication in AIS subjects.
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Objective To analyze the clinical characteristics and short-term prognostic factors in acute cerebral infarction patients who underwent recanalization. Methods This retrospective study enrolled 94 cases of acute cerebral ischemic patients in the First Affiliated Hospital of Nanjing Medical University between October 2014 and August 2016. Based on the clinical characteristics of the enrolled patients, a multivariate Logistic regression model was established to analyze the risk factors of unfavorable prognosis. Besides, patients were further divided into good collateral circulation group (1-2) and poor collateral circulation group (3-5) according to the Pial Collateral score, and the prognosis improvement rates between patients recanalized within 4 h and over 4 h were analyzed in each group. Chi-square test or Fisher's exact test was used to analyze statistical difference as indicated. Results By multivariate Logistic regression analysis, age older than 70 years old (OR=2.651, 95％CI: 1.013-6.937)and poor collateral circulation (OR=3.160, 95％CI: 1.113-8.977) were independent risk factors of short-term poor prognosis. In the poor collateral circulation subgroup, patients recanalized within 4 h exerted a relatively better prognosis than patients recanalized over 4 h (42.9％ vs.10.5％, P=0.047). However, the effect of recanalization duration on the prognosis in the good collateral circulation subgroups was not statistically significant (42.9％ vs. 10.5％, P=0.047), however, the effect of recanalization duration on prognosis in patients with good collateral circulation was not statistically significant (58.3％ vs. 37.8％, P=0.117). Conclusions For patients with acute cerebral infarction, age and collateral circulation status may influence the prognosis of recanalization therapy. The treatment time had a significant influence on the prognosis in patients with poor collateral, while it had minimal significance on patients with good collateral.
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<p><b>OBJECTIVE</b>To observe the difference of clinical efficacy between " needles therapy" and conventional acupuncture in patients with acute cerebral infarction (ACI) and its relationship with autophagy.</p><p><b>METHODS</b>Sixty patients with ACI were randomly divided into an observation group (30 cases and 2 dropping) and a control group (30 cases and 3 dropping). Conventional drugs were applied in the two groups. In the observation group, acupuncture was applied at Dazhui (GV 14), Fengchi (GB 20), Qiangjian (GV 18), Baihui (GV 20), Shenting (GV 24), Yintang (GV 29), Shuigou (GV 26), Quchi (LI 11, affected side), Hegu (LI 4, affected side), Zusanli (ST 36, affected side), and EA was connected at Baihui (GV 20) and Yintang (GV 29). After 30 min, the EA and non-governor vessel acupoints were removed, and the governor vessel points were continued for 20 min. Twirling was used twice every 5 min, 1 min a time. In the control group, acupuncture was applied at Baihui (GV 20), Yintang (GV 29), Quchi (LI 11, affected side), Waiguan (TE 5, affected side), Shousanli (LI 10, affected side), Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6, affected side), Taixi (KI 3, affected side), Taichong (LR 3, affected side). EA was connected at Zusanli (ST 36) and Hegu (LI 4). The treatment was given for 10 days, once every day with needle retained for 30 min. National Institute of Health stroke scale (NIHSS), mini-mental state examination (MMSE), modified Barthel index (MBI) scores were observed before and after treatment in the two groups. The clinical efficacy, the changes of contents of LC3-II and Beclin1 in peripheral serum were judged.</p><p><b>RESULTS</b>After treatment, NIHSS score was lower than that before treatment, and MMSE score and MBI score were higher than those before treatment (all <0.01), and the result in the observation group was better than that in the control group (all <0.05). Contents of LC3-Ⅱ and Beclin1 in peripheral serum were higher than those before treatment in the two groups (both <0.01), and the result in the observation group was better than that in the control group (both <0.05). The total effective rate in the observation group was 92.9% (26/28), which was better than 70.4% (19/27) in the control group (both <0.05).</p><p><b>CONCLUSION</b>" needles therapy" have better effect to relieve the clinical symptoms of patients with acute cerebral infarction than conventional acupuncture, which may be related to the increasing number of autophagic bodies and autophagy activity.</p>
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Humans , Acupuncture Points , Acupuncture Therapy , Autophagy , Cerebral Infarction , Therapeutics , Combined Modality Therapy , Needles , Treatment OutcomeABSTRACT
Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1,2014 and February 1,2016.Patients were divided into good collaterals group (n =31) and poor collaterals group (n =18) according to their distribution of leptomeningeal arteries with CTA.Thirty day mortality rate,the incidence of symptomatic intracranial hemorrhage,24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups.Corrected chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0％ vs.16.7％,P ＜ 0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups (P ＞ 0.05),however,30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2 ± 3.1 vs.9.6 ± 2.7,P ＜ O.05).Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis,good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis.However,good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.
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Objective:To observe the clinical efficacy of rt-PA in the treatment of patients with acute ischemic stroke ( CIS) and hyperdense middle cerebral artery sign ( HMCAS) . Methods:Totally 107 patients with CIS and HMCAS were randomly divided into the control group (n=54) and the treatment group (n=53). The control group was treated with urokinase, while the treatment group was treated with recombinant tissue type plasminogen activator ( rt-PA) . The treatment course was 14 days, and then the clinical effi-cacy and safety were evaluated. Results:Compared with that before the treatment, the score of national institute of health stroke scale ( NIHSS) in both groups was decreased after the treatment, and the decrease in the treatment group was more notable than that in the control group with statistically significant difference (P<0. 05). The clinical effective rate of the treatment group was 88. 68%, while that of the control group was 79. 63%, and there was statistically significant difference between the groups (P<0. 05). Compared with that before the treatment, BI index in both groups was increased after the treatment, and the increase in the treatment group was more significant than that in the control group with statistically significant difference (P<0. 05). Conclusion:rt-PA thrombolytic therapy in the patients with CIS and HMCAS has remarkable clinical efficacy, which can improve patients’ life quality and is worthy of promo-tion.
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Objective To investigate the risk factors of recurrent ischemic stroke, and evaluate the severity and short-term outcome. Methods From March, 2014 to March, 2015, 238 patients with recurrent ischemic stroke and 378 patients with initial ischemic stroke matched with gender and age were enrolled. The clinical data of two groups were compared and the non-conditional Logistic regression model was made to analysis the risk factors of recurrent ischemic stroke. The National Institute of Health Stroke Scale (NIHSS) score as ad-mission and discharge, and the neural function improvement rate of two groups were compared. Results The incidences of leukoarailsis (χ2=8.666), hypertension (χ2=8.189), smoking (χ2=6.973) and alcohol consumption (χ2=4.722) were higher in the recurrent group than in the pri-mary group (P<0.05). Logistic regression analysis showed that leukoarailsis (OR=1.690, 95%CI:1.198~2.384, P=0.003), hypertension (OR=1.715, 95%CI:1.135~2.592, P=0.010) and smoking (OR=1.896, 95%CI:1.233~2.915, P=0.004) were the independent risk factors of recur-rent ischemic stroke. The NIHSS scores as admission and discharge were significantly higher (t=-3.645, t=-4.675, P<0.001), and the neural function improvement rate was lower (t=2.643, P<0.01) in the recurrent group than in the primary group. Conclusion Hypertension, leuko-arailsis and smoking are independent risk factors for recurrent ischemic stroke. Recurrent ischemic stroke is more serious than initial isch-emic stroke, and the short-term neural function recovers more slowly.
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Objective To observe the clinical effect of Yangyin Tongluo Pills combined with acupuncture for the treatment of cerebral infarction sequela. Methods One hundred patients with cerebral infarction sequela were evenly randomized into treatment group and control group. The control group was given acupuncture therapy combined with oral use of clopidogrel, and the treatment group was given acupuncture therapy combined with oral use of Yangyin Tongluo Pills (mainly composed of Fructus Lycii, Flos Chrysanthemi, Radix Rehmanniae, Cortex Moutan, Radix Salviae Miltiorrhizae, Flos Carthami, Semen Persicae, Pheretima, Rhizoma Gastrodiae, Ramulus Uncariae cum Uncis, Spica Prunellae, Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae Chinensis, Radix Pseudostellariae) . One month constituted a treatment course, and the treatment covered 2 courses. After treatment, the therapeutic effect of the two groups was evaluated, and the changes of National Institute of Health Stroke Scale ( NIHSS) scores and Barthel Index Scale for activities of daily living ( ADL) , and hemorrheology indexes were observed before and after treatment. Results (1) After treatment for 2 courses, NIHSS scores were decreased, ADL scores were increased in the two groups (P0.05) . The treatment group had better effect on improving hemorrheology indexes than the control group (P<0.05) . (3) The total effective rate of the treatment group was 90.00% and that of the control group was 64.00%, the overall therapeutic effect of the treatment group being superior to that of the control group (P<0.05) . Conclusion Yangyin Tongluo Pills combined with acupuncture are effective for the treatment of cerebral infarction sequela, and the effect is superior to that of acupuncture combined with clopidogrel.
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@#Objective To investigate the relationship of serum levels of macrophage migration inhibitory factor (MIF), matrix metallo-proteinase-9 (MMP-9), hypersensitive C-reactive protein (hs-CRP) with the severity of acute cerebral infarction (ACI). Methods 101 pa-tients with ACI were envolved and divided into 3 groups according to the scores of National Institute of Health Stroke Scale (NIHSS):mild group (group A, n=38, NIHSS score<4), moderate group (group B, n=36, NIHSS score 4-15) and severe group (group C, n=27, NIHSS score>15). Meanwhile, 44 non-ACI inpatients with atherosclerosis were included as control group (group D). Their serum MIF and MMP-9 were detected with ELISA, and hs-CRP with immunoturbidimety. Results The levels of serum MIF, MMP-9 and hs-CRP ranged from more to less as groups C, B, A and D (P<0.05). There was positive correlation of MIF with MMP-9 (r=0.301, P<0.01) and hs-CRP (r=0.309, P<0.001). Conclusion Serum MIF, MMP-9 and hs-CRP levels increased with the severity in ACI patients, which may be prediction of athero-sclerotic plaque instability.
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Objective To investigate the relationship of the serum bilirubin level with acute ischemic stroke (AIS), and Chinese isch-emic stroke subclassification (CISS), stroke severity and short-term outcome of AIS patients. Methods 616 patients with AIS as well as 664 patients without stroke matched with gender and age were compared and analyzed with the non-conditional Logistic regression. The AIS pa-tients were divided based on the CISS, and their bilirubin levels were compared. The AIS patients were divided into high bilirubin group and normal bilirubin group, their scores of the National Institute of Health Stroke Scale (NIHSS) as admission and discharge, and neural func-tion improvement rate were compared. Results The levels of total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) were higher in the AIS group than in the control group (P0.05). The NIHSS score was higher in the high bilirubin group than in the normal bilirubin group as admission (P0.05), nor the rate of neural function improvement (P>0.05). Conclusion The serum bilirubin level elevated and correlated with the severity in the AIS patients, which might be the risk of pathogenesis and AIS. The bilirubin was not various with the CISS, and might be less involved in the short-term outcome of AIS.
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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 National Institute of Health Stroke Scale (NIHSS) and motor evoked potential (MEP) after stroke, measured by transcranial magnetic stimulation (TMS). METHOD: Forty six subjects with the middle cerebral artery ischaemic/hemorrhagic stroke were examined with NIHSS and TMS. According to the responsiveness of MEP in the affected muscles, subjects were divided into 2 groups: Group I consisted of 26 subjects responsive to TMS of the affected hemisphere and group II, 20 subjects unresponsive to TMS. NIHSS score was expressed as a sum of NIHSS total score, NIHSS arm and leg subscore. RESULTS: The resting motor threshold (rMT) and the amplitude of MEP in group I were 75.1% and 13.5 uV, respectively. Although NIHSS leg subscore was no statistical difference between two groups, NIHSS total score and NIHSS arm subscore in group I were statistically lower than those in group II. In group I, the rMT had a correlation with NIHSS total score and NIHSS arm subscore (r=0.39, r=0.49, p0.05). CONCLUSION: The NIHSS has relationship with cortical neurophysiological changes in the affected cerebral cortex in stroke. Therefore, it would be a useful tool to evaluate the status of motor function of hemiplegic stroke.
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Arm , Cerebral Cortex , Evoked Potentials, Motor , Leg , Middle Cerebral Artery , Muscles , Stroke , Transcranial Magnetic StimulationABSTRACT
Objective To evaluate the value of acute physiology and chronic health condition evaluation Ⅱ(APACHEⅡ) and National Institute of Health Stroke Scale(NIHSS) score in evaluating outcome of patients with acute cerebral infarction(ACI).Methods 399 patients with ACI were scored by APACHEⅡ and NIHSS in 3 d after onset.Prognosis judgement accorded to the patients survival or death during 28 d after onset.Area under of the receiver operator characteristic(ROC) curves was used to scale the ability of APACHEⅡ and NIHSS scoring systems evaluating severity and predicting outcomes of patients with ACI to find best cut-off points of the two scoring systems.Using discriminant analysis method to analysis the two scoring systems and estabished mathematical functional equation to calculate accuracy.Results For prognosis of patients with ACI,the areas under ROC curves were 0.835 and 0.822,and the best cut-off points were 12 and 10 respectively for APACHEⅡand NIHSS.The accuracy rates of APACHEⅡand NIHSS were 74.5% and 76.9%,respectively.The accuracy rate of APACHEⅡcombined NIHSS was 85.5%.Conclusions The APACHEⅡand NIHSS score systems have satisfactory discrimination for patients witn ACI,The predictive accuracy may improve if APACHEⅡ is combined with NIHSS.