Mediating effects of disease perception on disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke / 中国实用护理杂志

Objective:To explore the mediating effects of disease perception on disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke, to provide a theoretical basis for improving patient health behavior.Methods:By cross-sectional survey methods, from June 2021 to June 2022, a total of 123 thrombolysis therapy in patients with acute ischemic stroke were investigated by general information, Mishel Uncertainty in Illness Scale, Health Behavior Scale for Stroke Patients and Revised Illness Perception Questionnaire by convenience sampling method. The mediating effect of disease perception between disease uncertainty and health behavior was verified by structural equation model.Results:The scores of disease uncertainty, health behaviors and disease perception were (52.21 ± 7.67), (63.77 ± 9.40), (127.70 ± 26.19) points in patients with acute ischemic stroke. Health behaviors and each dimension including exercise, medication, instruction, nutrition, responsibility, tobacco and alcohol were negatively correlation between disease uncertainty ( r values were -0.762 to -0.411, all P<0.01), and positively correlation between disease perception ( r values were 0.689 to 0.912, all P<0.01). Disease uncertainty was a significantly negative predictor for health behaviors ( β= -0.71, P<0.01); disease perception was also a significantly negative predictor for disease perception ( β = -0.85, P<0.01). Disease uncertainty had a significantly indirect effect on the health behaviors for thrombolysis therapy in patients with acute ischemic stroke through disease perception, which showed the mediating effect of health behaviors accounts for 15.2% of total effect. Conclusions:Disease perception play a mediating role in the relationship between disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke.

Eficacia de tenecteplase comparada con alteplase para tratamiento de ictus isquémico agudo. Una revisión narrativa

Introducción: La trombólisis intravenosa con Alteplase (ALT) se recomienda como tratamiento estándar siendo el único agente trombolítico aprobado por la FDA, en infarto cerebral. La Tenecteplase (TNK), un activador tisular del plasminógeno modificado, surge como agente antitrombótico alternativo. Esta revisión narrativa evalúa la evidencia actual y aborda los problemas prácticos sobre la eficacia y seguridad de tenecteplase en comparación con alteplase. Metodología: Se realizó una búsqueda sistemática y analítica de la literatura, y se proporcionó una síntesis cualitativa de metaanálisis y ensayos clínicos concluidos, que compararon la efectividad y seguridad de la tenecteplase con alteplase en el AIS, utilizando artículos indexados en MEDLINE, Cochrane Library y Scopus. Resultados: Los ensayos clínicos aleatorizados en su mayoría coinciden al encontrar que TNK es al menos tan o más efectiva que la ALT para mejoría neurológica después del AIS; mientras los metaanálisis coinciden en que los pacientes que recibieron TNK presentaron una mayor recanalización exitosa, pero difieren en cuanto a los hallazgos de mejoría neurológica temprana, resultado funcional a los 90 días y mortalidad a los 90 días. Conclusión: La tenecteplase es al menos tan eficaz como la Alteplase con respecto a la mejoría neurológica después del tratamiento del accidente cerebrovascular isquémico agudo.

Introduction: Intravenous thrombolysis with alteplase (ALT) is recommended as standard treatment, being the only thrombolytic agent approved by the FDA. Tenecteplase (TNK), a modified tissue plasminogen activator, is emerging as an alternative antithrombotic agent. This narrative review assesses the current evidence and addresses practical issues regarding the efficacy and safety of tenecteplase compared to alteplase. Methodology: A systematic and analytical search of the literature was performed, providing a qualitative synthesis of meta-analyses and completed clinical trials comparing the effectiveness and safety of tenecteplase with alteplase in AIS, using articles indexed in MEDLINE, the Cochrane Library, and Scopus. Results: Randomized clinical trials mostly agree in finding TNK to be at least as or more effective than ALT for neurological improvement after AIS; while the meta-analyses agree that patients who received TNK had more successful recanalization, they differ in terms of the findings of early neurological improvement, functional outcome at 90 days, and mortality at 90 days. Conclusion: Tenecteplase is at least as effective as alteplase with regard to neurological improvement after treatment of acute ischemic stroke.

Nuevos paradigmas: 12 años de trombólisis sistémica. Unidad ACV, Hospital de Clínicas / New paradigms: 12 years of systemic thrombolysis. Stroke Unit, Clinicas Hospital / Novos paradigmas: 12 anos de trombólise sistêmica. Unidade AVC, Hospital de Clínicas

Introducción: el ACV constituye un problema de salud y la trombólisis sistémica una estrategia de reperfusión con alto nivel de evidencia para su tratamiento. Los reportes nacionales sobre su utilización son escasos. Objetivos: comunicar y analizar los resultados de esta terapia en el Hospital de Clínicas. Establecer predictores de buena evolución, hemorragia intracraneana y mortalidad. Métodos: estudio observacional analítico de los pacientes trombolizados en el Hospital de Clínicas (2010-2021). Resultados: se realizó trombólisis sistémica a 268 pacientes. La mediana del NIHSS al ingreso fue 12 puntos. Un 42% fueron infartos totales de la circulación anterior. La cardioembolia constituyó la etiopatogenia más frecuente. El 59,3% de los pacientes fueron externalizados con independencia funcional y 55,2% con déficit neurológico mínimo. Las tasas de hemorragia intracraneana sintomática y mortalidad fueron 7,1% y 18,7% respectivamente. El 57% de los pacientes se trataron con tiempo puerta aguja ≤60 minutos. El porcentaje de trombólisis en el total de ACV fue 18,9%. La edad, NIHSS al ingreso e internación en unidad de ACV se comportaron como variables importantes para predecir buena evolución, hemorragia intracraneana y muerte. Discusión y conclusiones: se comunicó la mayor casuística nacional sobre el tema. Los parámetros de efectividad y seguridad del tratamiento fueron comparables a los reportados internacionalmente. Se destacaron los buenos tiempos puerta aguja y tasa trombólisis sobre ACV totales como indicadores satisfactorios de calidad asistencial. La internación en unidad de ACV se comportó como un factor predictor de independencia funcional y protector frente a mortalidad hospitalaria.

Introduction: Strokes are a health problem and systemic thrombolysis constitutes a reperfusion strategy backed up by significant evidence on its positive therapeutic impact. National reports on its use are scarce. Objectives: To report and analyze results obtained with this therapeutic approach at the Clinicas Hospital. To establish predictive factors for a good evolution, intracranial hemorrhage and mortality. Method: Observational, analytical study of thrombolysed patients at Clinicas Hospital (2010-2021). Results: Systemic thrombolysis was performed in 268 patients. Average NIHSS score was 12 points when admitted to hospital.42 % of cases were total anterior circulation infarct (TACI). Cardioembolic ischaemmic stroke was the most frequent etiopahogenesis. 59.3% of patients were discharged with functional independence and 55.2% had minimal neurologic deficit. Symptomatic intracranial hemorrhage and mortality rates were 7.1% and 18.7% respectively. 57% of patients were assisted within ≤60 minutes they showed up at the ER. Thrombolysis percentage in total number of strokes was 18.9%. Age, NIHSS score upon arrival to hospital and admission to the stroke unit were significant variables to predict a good evolution, intracranial hemorrhage and death. Discussion and conclusions: The large number of cases in the country was reported. Effectiveness and safety parameters for this treatment were comparable to those reported internationally. The good door-to-needle time and thrombolysis rate versus total number of strokes stood out as satisfactory indicators of healthcare quality. Admission to the stroke unit behaved as a predictive factor of functional independence and it protected patients from hospital mortality.

Introdução: o AVC é um problema de saúde sendo a trombólise sistêmica uma estratégia de reperfusão com alto nível de evidência para seu tratamento. Os dados nacionais sobre seu uso são escassos. Objetivos: comunicar e analisar os resultados desta terapia no Hospital de Clínicas. Estabelecer preditores de boa evolução, hemorragia intracraniana e mortalidade. Métodos: estudo observacional analítico de pacientes trombolisados no Hospital de Clínicas (2010-2021). Resultados: a trombólise sistêmica foi realizada em 268 pacientes. A mediana do índice NIHSS na admissão foi de 12 pontos. 42% eram infartos totais da circulação anterior. A cardioembolia foi a etiopatogenia mais frequente. 59,3% dos pacientes tiveram alta da unidade com independência funcional e 55,2% com déficit neurológico mínimo. As taxas de hemorragia intracraniana sintomática e mortalidade foram de 7,1% e 18,7%, respectivamente. 57% dos pacientes foram tratados com tempo porta-agulha ≤60 minutos. A porcentagem de trombólise no AVC total foi de 18,9%. Idade, NIHSS na admissão e internação na unidade de AVC se comportaram como variáveis importantes para prever boa evolução, hemorragia intracraniana e óbito. Discussão e conclusões: este trabajo inclui a maior casuística nacional sobre o tema. Os parâmetros de eficácia e segurança do tratamento foram comparáveis aos descritos na bibliografia internacional. Foram destacados como indicadores satisfatórios da qualidade do atendimento os bons tempos porta-agulha e taxa de trombólise em relação ao AVC total. A internação em unidade de AVC comportou-se como preditor de independência funcional e protetor contra a mortalidade hospitalar.

Serum uric acid and short term prognosis of acute ischemic stroke in patients received intravenous thrombolysis / 中华内分泌代谢杂志

Objective:To investigate the relationship between serum uric acid (SUA) and 3-month outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis.Methods:A total of 386 patients with acute ischemic stroke received intravenous thrombolysis therapy from 1 January 2017 to 31 December 2019 in the Affiliated Hospital of Lianyungang, Xuzhou Medical University were enrolled prospectively. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. The functional outcome was evaluated by the modified Rankin Scale at discharge or 3 months after onset. Pearson′s correlation was used to assess the relationship between SUA and NIHSS scores at baseline and discharge. Propensity score matching was used to balance confounding factors. Multivariate logistic regression model was used to identify the correlation between SUA and prognostic outcome after thrombolysis.Results:A total of 386 eligible patients were included. Two hundred and thirty patients (59.6%) had good outcomes in the follow-up after 3 months. The levels of SUA are negatively associated with the NIHSS score at discharge ( r=-0.171, P=0.003). A positive correlation was observed between the levels of SUA and the difference of NIHSS at baseline and discharge ( r=0.118, P=0.032). Patients were divided into three groups according to the quartile of SUA. Multivariate logistic regression analysis showed that high SUA levels were independently associated with good outcome three months after stroke ( OR=0.421, 95% CI 0.327-0.541, P<0.001). Conclusion:In patients with acute ischemic stroke, elevated SUA levels can predict better recovery and short-term outcomes in patients undergoing intravenous thrombolysis.

Construction of an evaluation index system for nursing quality of ischemic stroke intravenous thrombolysis based on three-dimensional quality / 中国实用护理杂志

Objective:To establish a scientific and practical evaluation index system of nursing quality of intravenous thrombolysis for ischemic stroke based on three-dimensional quality model, so as to scientifically evaluate the nursing quality in thrombolytic period.Methods:Based on the three-dimensional quality structure model, read the literature related to intravenous thrombolysis in ischemic stroke patients, and used semi-structured interview to construct the framework of nursing quality evaluation index system for patients with ischemic stroke during thrombolytic period. Delphi method was used for expert consultation, and the results were analyzed.Results:The positive coefficient of the two rounds of expert consultation was 100%, and the degree of authority in the first round was 0.881, and that in the second round was 0.879. The coefficient of variation of 10 second level indexes and 51 third level indexes were all smaller than 0.15.The second round of coordination coefficients were 0.504 for the first-level index, 0.509 for the second-level index, and 0.541 for the third-level index. The chi-square test was all P<0.001.The weight values of structural quality, process quality and result quality indicators were 0.189, 0.601, 0.210, respectively. The evaluation index system of nursing quality of intravenous thrombolysis for ischemic stroke was constructed, including 3 first level items (structure quality index, process quality index, result quality index), 10 second level items and 51 third level items. Conclusions:Consulting experts are highly motivated, authoritative, and coordinated. It also provides managers with standard and practical tools for evaluating the quality of intravenous thrombolytic care for ischemic stroke.

Eficacia y seguridad del tenecteplase en el tratamiento del ACV isquémico agudo / Safety and efficacy of tenecteplase in acute ischemia stroke a narrative review

RESUMEN El alteplase es el único fibrinolítico actualmente autorizado en Colombia para el tratamiento del ACV isquémico agudo. El tenecteplase constituye una nueva alternativa de tratamiento en esta enfermedad al ofrecer mejor perfil farmacológico, mayor eficacia con mejores desenlaces mayores, porcentajes de recanalización, y con seguridad similar a la del alteplase. La posibilidad de desabastecimiento temporal de alteplase con disponibilidad de tenecteplase en Colombia abre la posibilidad de su uso en ACV isquémico agudo.

SUMMARY Alteplase is the only one fibrinolytic currently authorized in Colombia for the treatment of acute ischemic stroke. Tenecteplase constitutes a new treatment alternative in this disease by offering a better pharmacological profile, greater efficacy with better outcomes: like higher recanalization percentages and with similar safety profile. The possibility of a temporary shortage of alteplase with availability of tenecteplase in Colombia opens the possibility of its use in acute ischemic stroke.

COVID-19 with acute cerebral infarction: one case report / 中华神经科杂志

COVID-19 is caused by the 2019 novel coronavirus, which is characterized by hidden onset, long incubation period, and high contagion. The study found that the COVID-19 not only attacks the respiratory system, but also affects other systems such as the heart, kidney, and digestive tract, and could be combined with multiple system diseases such as acute cerebrovascular disease. If doctors, especially non-infective or respiratory doctors, do not pay great attention to the patient when they are receiving patients, and take good care of them, they may easily cause their own infection. This article summarizes the case of a concealed onset COVID-19 patient with cerebral infarction, which caused a medical staff infection after intravenous thrombolytic therapy, explores its clinical characteristics, treatment process and analyzes its prevention and control links to help the epidemic situation. In the prevention and control, the first-time doctor should pay attention to identification, reduce missed diagnosis, and scientific investigation to reduce occupational infection.

Study on the prognosis of intravenous thrombolysis in patients with ischemic stroke by thyroid-related hormones and antibodies / 上海交通大学学报（医学版）

Objective : To explore the association between thyroid-related hormones and antibodies and the prognosis of ischemic stroke pa-tients treated with intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA). Methods ¡¤ A total of 213 consecutive pa-tients with ischemic stroke who underwent rt-PA intravenous thrombolysis in the Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, were retrospectively included from May 2012 to August 2018. Thyroid-related hormones and antibodies were tested on admission, and assessment of intracranial hemorrhage (ICH) was conducted 24 hours after thrombolysis. Func-tional outcomes were assessed by modified Rankin Scale (mRS) after 3 months of follow-up. The relationship between thyroid-related hormones and antibodies and the prognosis (including functional outcome and ICH) was analyzed by logistic regression analysis. Results ¡¤ In univariate regression analysis, free triiodothyronine (fT3), total triiodothyronine, (tT3) and total thyroxine (tT4) levels were associated with poor functional prognosis (P=0.000, P=0.028, P=0.000) and fT3, and free thyroxine (fT4) levels were associated with ICH (P=0.008, P=0.014). However, after adjustment for other variables, low fT3 levels were independently associated with poor prognosis (OR=0.35, 95%CI 0.138-0.890, P=0.027), and both fT3 and fT4 levels had nothing to do with ICH. In addition, fT3 was negatively correlated with stroke severity (r=-0.291, P=0.000). Con-clusion ¡¤ Low fT3 levels are associated with stroke severity and functional outcome.

The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage

Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effect of these therapies. Among 1,694 AIS patients, 805 patients were treated with intravenous thrombolysis, including patients with (n=793) or without (n=12) a history of cerebral hemorrhage, and the rate of incidence of SICH significantly differed between them (8.3 vs 4.3%, P=0.039). No significant difference was found in 90-d mRS measurements (41.7 vs 43.6%, P=0.530) and 90-d mortality rates (8.3 vs 6.5%, P=0.946). A total of 76 AIS patients with a history of cerebral hemorrhage received tPA thrombolytic therapy (n=12) or conventional therapy (n=64), and a significant difference was noted in the 90-d mRS scores between the two groups (41.7 vs 23.4%, P=0.029), while no significant difference was found in SICH measurements (8.3 vs 4.6%, P=0.610) and 90-d mortality rates (8.3 vs 9.4%, P=0.227). A history of cerebral hemorrhage is not an absolute contraindication for thrombolytic therapy; tPA intravenous thrombolysis does not increase SICH measurements and mortality rates in patients with a history of cerebral hemorrhage, and they may benefit from thrombolytic therapy.

Clinical prognosis analysis of collateral circulation and vascular recanalization in patients with acute ischemic stroke based on multiphase CTA / 中华急诊医学杂志

Objective@#To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion.@*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 from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test.@*Results@#The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P<0.05). The incidence of NIHSS score improved by ≥50% and the incidence of 90-day mRS 0-2 was significantly higher in the good collateral group after 24 h of thrombolysis (77.4% vs 27.8%, P<0.05; 80.6% vs 27.8%, P=0.00); The incidence of symptomatic cerebral hemorrhage was significantly lower in the good collateral group than in the poor group (9.7% vs 50.0%, P<0.05). There was no significant difference in mortality between the two groups after 30 days of thrombolysis (P>0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%).@*Conclusion@#For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate.

Recent advances in the relationship between cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke / 中华神经科杂志

Cerebral small vessel disease refers to a series of clinical, imaging and pathological syndromes caused by various diseases affecting small arteries, arterioles, capillaries, venules, and venules in the brain, thereby causing ischemia or hemorrhage in brain tissue. At present, intravenous thrombolytic therapy is the first choice for the treatment of acute ischemic stroke, however a large number of studies have shown that the presence of cerebral small vessel disease before acute ischemic stroke increases the risk of intravenous thrombolysis. In this article, the recent research progresses about the relationship between cerebral small vessel disease and hemorrhagic transformation after venous thrombolysis in acute ischemic stroke are reviewed, aiming to provide a new reference for clinical intravenous thrombolytic therapy.

Effect of modified Buyang Huanwu Decoction on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with super early cerebral infarction / 中国中药杂志

To study the effect of modified Buyang Huanwu Decoction on the hemorrhagic transformation after intravenous thrombolysis of recombinant tissue type plasminogen activator(rt-PA) in patients with super early(onset time<4. 5 h) cerebral infarction. From March 2016 to July 2018,at the brain disease zone of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,212 cases of super early cerebral infarction were selected and divided into two group according to the randomized complete blocks designs: control group(106 cases) and traditional Chinese medicine group(106 cases). The control group was treated with rt-PA intravenous thrombolysis,while the traditional Chinese medicine group was treated with modified Buyang Huanwu Decoction in addition to the therapy of the control group. Both groups were treated for 14 days. Neurological deficit score,serum matrix metalloproteinase-9(MMP-9),neuron specific enolase(NSE),vascular endothelial growth factor(VEGF) and plasma cellular fibronectin(c-FN) levels,the incidence of hemorrhagic transformation,clinical efficacy and adverse drug reactions before and after treatment were compared between the two groups. According to the findings,at the 14 thday after treatment,the rank sum test of the grade data showed that the clinical efficacy of the traditional Chinese medicine group was better than that of the control group(Z =-2. 033,P = 0. 042); on the basis of χ2 test,the total efficiency of the traditional Chinese medicine group was higher than that of the control group(χ2= 4. 895,P =0. 027); the hemorrhagic transformation rate of the traditional Chinese medicine group was lower than that of the control group within14 days of treatment(χ2= 3. 962,P = 0. 047). MMP-9 levels in the traditional Chinese medicine group were lower than those in the control group at the 3 rd,5 th,7 th,10 th,14 thd after treatment(t =-2. 474,-3. 022,-5. 163,-6. 998,-9. 821; P = 0. 014,0. 003,0,0,0). The improvement of c-FN,NSE,VEGF and NIHSS scores in the traditional Chinese medicine group was superior to that of the control group after 14 days of treatment(t =-2. 343,-3. 187,-2. 129,-3. 105; P = 0. 020,0. 002,0. 034,0. 002). No obvious adverse reactions of modified Buyang Huanwu Decoction were observed during 14 days of treatment. Modified Buyang Huanwu Decoction could reduce the expressions of MMP-9,c-FN,NSE and VEGF after rt-PA intravenous thrombolysis in patients with super early cerebral infarction,and decrease the hemorrhagic transformation rate after thrombolysis,with high safety.

A study on application value of susceptibility weighted imaging combined with platelet distribution width in intravenous thrombolysis for treatment of patients with acute cerebral infarction / 中国中西医结合急救杂志

Objective To investigate the application value of susceptibility weighted imaging (SWI) combined with platelet distribution width (PDW) in intravenous thrombolysis for treatment of patients with acute cerebral infarction (ACI). Methods One hundred and ten patients with ACI treated by intravenous thrombolysis admitted to the Department of Radiology of the Second Affiliated Hospital of Medical College of Zhejiang University from February 2017 to June 2018 were enrolled as the subjects. Before treatment, all patients were detected by routine magnetic resonance imaging (MRI), SWI scanning and PDW detection. The patients were divided into hemorrhage group (77 cases) and non-hemorrhage group (33 cases) according to the presence or absence of hemorrhage shown in SWI, and according to the amount of bleeding, the hemorrhage group patients were subdivided into light (24 cases), medium (32 cases) and severe (21 cases) three groups. After intravenous thrombolysis, the patients were scanned by SWI to show whether bleeding being present or not, the cerebral microbleeding (CMBs) after 24 hours treatment in two groups, and after treatment of 14 days, modified Rankin score (MRS), PDW and hemorrhagic transformation (HT) situation in the two groups were evaluated and compared, the differences in hemorrhagic infarction 1 (HI1), hemorrhagic infarction 2 (HI2), parenchymal hemorrhage 1 (PH1) and parenchymal hemorrhage 2 (PH2) in different bleeding volume groups were compared. Results Before treatment, 129 lesions detected by SWI were significantly greater than 14 lesions detected by T1 weighted imaging, 22 lesions detected by T2 weighted imaging and 86 lesions detected by diffusion weighted imaging. After treatment for 24 hours, the number of CMBs (number: 10 vs. 0), after treatment for 14 days, the incidence of HT [36.36% (28/77) vs. 12.12% (4/33)], MRS (1.78±0.39 vs. 1.51±0.42) and PDW [(12.34±5.29)% vs. (6.79±3.27)%] in the hemorrhagic group were higher than those in non-hemorrhagic group (all P < 0.05). After treatment of 14 days, the incidences of HT [71.43% (15/21) vs. 20.83% (5/24), 25.00% (8/32)], PDW [(14.52±4.11)% vs. (10.78±3.67)%, (11.34±3.89)%] in severe group were higher than those in light group and moderate groups (all P < 0.05), and the rate of good prognosis was significantly lower than those in mild and moderate groups [42.86% (9/21) vs. 70.83% (17/24), 71.88% (23/32), P < 0.05]. The incidence of HT in severe group was also significantly higher than those in the non-hemorrhage group [71.43% (15/21) vs. 11.76% (4/34), P < 0.05]. Conclusion SWI combined with PDW can guide the intravenous thrombolysis very well for patients with ACI, and has relatively high clinical value.

Mild hypothermia combined with intravenous thrombolytic therapy can improve cognitive functioning and stress response after cerebral infarction / 中华物理医学与康复杂志

Objective To explore the effect of combining mild hypothermia with intravenous thrombolytic therapy on the cognitive functioning and stress response of persons with acute cerebral infarction.Methods A total of 126 patients with acute cerebral infarction were randomly divided into a control group,a study group 1 and a study group 2,each of 42.All three groups were given intravenous thrombolytic therapy,while study group 1 also received 12 hours of mild hypothermia,and study group 2 received 24 hours.Before the treatment and 1,7,14,30 and 90 days later the National Institutes of Health stroke scale (NIHSS) was used to evaluate the subjects' nerve functions.Intracranial pressure,oxidative stress,and inflammatory cytokine levels were also measured before the treatment and 2,3 and 7 days afterward.Results The average NIHSS scores of both study groups were significantly lower than that of the control group at each time point after the treatment.Study group 2 showed significantly greater improvement than study group 1.The total effectiveness rate was 76.2％ in study group 1 and 85.7％ in study group 2,both significantly better than in the control group but without significant difference between the study groups.Both study groups' average intracranial pressures were significantly lower than the control group's average after the treatment.Moreover,3 and 7 days after the treatment,the average intracranial pressure of study group 2 was significantly lower than study group 1's average.After 1,3 and 7 days,significant differences in superoxide dismutase and malondialdehyde levels were observed between the study groups and the control group.Three days after the treatment,the average TNF-α,IL-1β and IL-6 levels of the study groups were significantly lower than the control group's average,and those of study group 2 were significantly lower than those of study group 1.The total incidence of adverse reactions was not significantly different among the 3 groups.Conclusion For patients with acute cerebral infarction,thrombolytic therapy combined with mild hypothermia for 24 hours has a definite curative effect.It can improve intracranial pressure,reduce oxidation and inflammation and improve neurological function.The patients recover well.The combined therapy is safe and worthy of clinical application.

Research progress in hemorrhagic transformation after intravenous thrombolysis / 中华神经科杂志

Stroke has increasingly become one of the three major diseases threatening human beings,among which acute ischemic stroke is the most common.Intravenous thrombolysis has become the first choice for acute ischemic stroke,but a large number of studies have shown that intravenous thrombolysis increases the risk of hemorrhagic transformation.The latest advances in clinical types,incidence,mechanism and risk factors of hemorrhagic transformation after thrombolysis with recombinant human tissue plasminogen activator are reviewed in this article,and the possible predictors of hemorrhagic transformation are discussed,aiming to provide new reference for clinical thrombolytic therapy.

Relationship between total cerebral small vessel disease burden and hemorrhagic transformation of acute ischemic stroke patients after intravenous thrombolysis / 中华神经科杂志

Objective To investigate the relationship between total cerebral small vessel disease (CSVD) burden and intracranial hemorrhage transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods One hundred and fifty-four patients who suffered from ischemic stroke within 4.5 hours of onset and received recombinant tissue plasminogen activator thrombolytic therapy in the emergency green channel of the First Affiliated Hospital of Soochow University from August 2016 to January 2018 were enrolled.HT examined by computed tomography scan within 24 hours after thrombolysis was included.The magnetic resonance imaging examination was performed within 48 hours.The patients were divided into two groups:HT group and control group according to the presence or absence of HT.Periventricular white-matter hyperintensities (WMH) with Fazekas score of 3 or deep WMH with Fasekas score of 2 or 3 was recorded as 1 point,MRI of cerebral microbleeds (CMBs) or lacunar infarction (LI) was recorded as 1 point respectively,and peripheral vascular space (PVS) in basal ganglia graded 2-4 (≥11)was counted 1 point.Single-factor analysis was used to compare total CSVD burden score,baseline data and clinical data between the two groups.Multivariate Logistic regression analysis was performed to explore the relationship between total CSVD burden score and HT.Results The age of the 154 patients was 66.00(59.00,74.25) years,males accounted for 66.9％ (103/154),onset to treatment time (OTT) was 174.50 (131.50,200.00) minutes and the NIHSS score before thrombolytic therapy was 6.00 (3.00,10.25).There were 43 cases (27.9％) with moderate to severe WMH,35 cases (22.7％) with CMBs,52 cases (33.8％) with PVS graded 2-4,and 96 cases (62.3％) with LI.There were 21 enrolled patients (13.6％) who suffered from HT.Symptomatic intracranial hemorrhage occurred in nine cases (5.8％).In the multivariate Logistic regression model,the results demonstrated that baseline diastolic pressure (OR=1.072,95％CI 1.027-1.118,P=0.001)and atrial fibrillation (OR=28.564,95％CI 6.217-131.241,P=0.000) were independently associated with HT.After using the mild CSVD burden score as a reference,moderate CSVD burden (OR=0.810,95％ CI 0.154-4.257,P=0.804) was not associated with HT after thrombolysis,and severe CSVD burden (OR=8.429,95％ CI 1.643-43.227,P=0.011) was independently associated with HT.Conclusions The severity of total CSVD burden in patients with AIS was closely related to HT after thrombolysis.Severe CSVD was an independent risk factor for HT after thrombolysis.

Effect of rt-PA thrombolysis combined with antiplatelet therapy on recurrent cardiovascular and cerebrovascular events in patients with mild acute ischemic stroke / 中国基层医药

Objective To explore the effect of recombinant human tissue plasminogen activator(rt-PA) intravenous thrombolytic therapy combined with antiplatelet therapy on the recurrence of cardio cerebral vascular adverse events in patients with mild acute ischemic stroke (AIS).Methods From December 2015 to December 2017,74 patients with mild AIS treated in Shaoxing Central Hospital were selected in the research.According to the random number table method,the patients were divided into two groups,with 37 cases in each group.The control group received rt-PA intravenous thrombolysis,and the combined group was treated with antiplatelet therapy on the basis of the control group.The serum creatinine(SCr),alanine transaminase(ALT) and platelet count(PLT) were compared before and after treatment in the two groups,and the scores of the Barthel index scale and the modified Rankin scale were compared between the two groups.The incidence of cardiovascular adverse events in 3 months of the two groups was also recorded.Results There were no statistically significant differences in liver and kidney function indicators between the two groups before and after treatment (t =0.30,0.27,0.20,0.77,0.03,0.64,all P ＞ 0.05).Before treatment,the Barthel index scale scores in the combined group and control group[(74.97 ±4.74)points,(61.95 ± 4.24) points] were significantly increased,and the increasing degree in the combined group was more significant than that in the control group(t =12.45,P ＜ 0.05).The modified Rankin scale scores in the combined group and control group[(1.16 ± 0.37) points,(2.05 ± 0.45) points] were significantly decreased compared with those before treatment,and the reduction degree of the combined group was more significant than that in the control group(t =9.29,P ＜ 0.05).The total incidence rate of bleeding events,cardiovascular events,cerebrovascular events and death events in the combined group(5.41％) was significantly lower than that of the control group(27.03％) (x2 =4.87,P ＜ 0.05).Conclusion rt-PA intravenous thrombolytic therapy combined with antiplatelet therapy can effectively improve the nerve function and daily activity of patients with mild AIS.It can also effectively reduce the incidence of cardiovascular and cerebrovascular adverse events,and thus help to improve the prognosis and improve the quality of life.Therefore,it has good clinical application value.

Collateral circulation and Toll-like receptor 4 levels in patients with acute cerebral infarction after intravenous thrombolysis / 南方医科大学学报

OBJECTIVE@#To investigate the relationship between Toll-like receptor 4 (TLR4) and collateral circulation in patients with acute cerebral infarction (AIS) after thrombolytic therapy.@*METHODS@#This retrospective, observational cohort study was conducted among 65 patients with AIS receiving thrombolytic therapy, who were divided according to findings by computed tomographic angiography (CTA) into good collateral circulation (group A, = 34) and poor collateral circulation (group B, = 31). Serum samples were collected from all the patients and the levels of TLR4 were measured with ELISA.@*RESULTS@#The patients in group A had significantly better outcomes than those in group B. The NIHSS scores at 24 h and 30 days after thrombolytic therapy, mRS scores at 90 days and serum TLR4 levels were significantly lower in group A than in group B ( < 0.05); the percentages of patients with symptomatic intracerebral hemorrhage were comparable between the two groups. The serum levels of TLR4 were negatively correlated with the rMLC score ( < 0.05). Multivariate logistic regression analysis showed that a high level of TLR4 was associated with a poor collateral circulation after thrombolysis.@*CONCLUSIONS@#Good collateral circulation can increase the benefit of intravenous thrombolysis in patients with ACI, and the level of TLR4 is a predictive factor for the compensation of collateral circulation following ACI.

Recent advances in the relationship between cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke / 中华神经科杂志

Cerebral small vessel disease refers to a series of clinical, imaging and pathological syndromes caused by various diseases affecting small arteries, arterioles, capillaries, venules, and venules in the brain, thereby causing ischemia or hemorrhage in brain tissue. At present, intravenous thrombolytic therapy is the first choice for the treatment of acute ischemic stroke, however a large number of studies have shown that the presence of cerebral small vessel disease before acute ischemic stroke increases the risk of intravenous thrombolysis. In this article, the recent research progresses about the relationship between cerebral small vessel disease and hemorrhagic transformation after venous thrombolysis in acute ischemic stroke are reviewed, aiming to provide a new reference for clinical intravenous thrombolytic therapy.

Efficacy of different vascular recanalization methods for acute ischemic stroke / 中华全科医师杂志

Objective To assess the efficacy of different vascular recanalization methods for acute ischemic stroke (AIS). Methods The clinical data of AIS patients receiving vascular recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively analyzed. Among 141 AIS patients, 64 received intravenous thrombolysis (IVT group), 57 received endovascular treatment (EVT group) and 20 received intravenous thrombolysis and endovascular treatment (IVT+EVT group). The efficacy and safety of therapy were compared among three groups. Results There were no significant differences in the risk factors of cerebrovascular diseases among 3 groups (P>0.05). The National Institute of Health Stroke Scale(NIHSS) scores [M(Q1,Q3)] of patients in the IVT group, EVT group and IVT+EVT group were 9.5 (6.0, 15.0), 15.0 (9.0,19.0) and 14.0(8.3,17.0), respectively (Z=7.19, P<0.05). The time from onset to treatment in the three groups was 205.0 (156.3, 254.3) min, 260.0 (170.0, 401.5) min, and 137.5 (90.3, 137.5) min, respectively (Z=22.83, P<0.01). The proportion of large arteries occlusion was lower in IVT group (32.8％, 21/64), compared with EVT group (86.0％, 49/57) and IVT+EVT group (95.0％, 19/20) (χ2=46.77, P<0.01). The proportion of symptomatic intracranial hemorrhage in IVT group was lower than EVT and IVT+EVT group [1.6％ (1/64) vs. 15.8％ (9/57) and 10.0％ (2/20), χ2=8.36, P<0.05]. The favorable outcome rates in IVT, EVT and IVT+EVT groups at the 90 d (mRS score≤2) were 57.8％ (37/64), 45.6％ (26/57) and 40.0％(8/20), respectively (χ2=2.79, P=0.24). The fatality rates in three groups were 10.9％ (7/64), 19.3％ (11/57) and 5.0％ (1/20), respectively (χ2=2.84, P=0.21). Conclusions Intravenous thrombolysis, endovascular therapy and bridging therapy have similar effects on the prognosis of AIS. Mild severity of AIS patients are more likely to benefit from intravenous thrombolysis. AIS patients with severe disease are usually combined with large artery occlusion, and more suitable for endovascular treatment and bridging treatment.