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.

Validación del instrumento de conocimiento sobre enfermedad vascular cerebralen el personal de enfermería (GGA/NICEVC-22) / Validation of the knowledge instrument on cerebrovascular disease in nursing staff (GGA/NICEVC-22) / Validação do instrumento de conhecimento sobre doença cerebrovascular na equipe de enfermagem (GGA/NICEVC-22)

Objetivo: validar un instrumento que evalué el nivel conocimiento del personal de enfermería en la atención al paciente con enfermedad vascular cerebral. Método: estudio longitudinal-proceso con 115 profesionales de enfermería pertenecientes en un hospital de segundo nivel, realizado el periodo de diciembre 2019 a mayo 2020. Muestro no probabilístico por conveniencia. La validación del instrumento se hizo en cinco momentos:1) creación del constructo, 2) validación por 15 jueces expertos, 3) Prueba piloto del instrumento, 4) consistencia interna por el Alpha de Cronbach y 5) validación por análisis factorial con componente rotados, además se aplicó estadística descriptiva. Resultados: el análisis factorial mostró la distribución de los 22 ítems distribuidos en cuatro factores con una varianza explicada de 53.30% y una consistencia interna de α=0.89. Conclusión:los resultados permiten concluir que el instrumento presenta una validez y confiabilidad aceptables, el cual permite evaluar el nivel de conocimiento sobre EVC en el personal de enfermería.

Objective:validar um instrumento que avalia o nível de conhecimento da equipe de enfermagem no cuidado ao paciente com doença cerebrovascular. Method:longitudinal-process study with 115 nursing professionals belonging to a second level hospital, carried out from December 2019 to May 2020. Non-probabilistic sampling for convenience. The validation of the instrument was done in five moments: 1) creation of the construct, 2) validation by 15 expert judges, 3) pilot test of the instrument, 4) internal consistency by Cronbach's Alpha and 5) validation by factorial analysis with rotated components, descriptive statistics were also applied. Results:the factorial analysis showed the distribution of the 22 items distributed in four factors with an explained variance of 53.30% and an internal consistency of α=0.89. Conclusion:the results allow us to conclude that the instrument has acceptable validity and reliability, which allows us to evaluate the level of knowledge about CVD in the nursing staff.

Objetivo:validar um instrumento que avalia o nível de conhecimento da equipe de enfermagem no cuidado ao paciente com doença cerebrovascular. Método:estudode processo longitudinal com 115 profissionais de enfermagem pertencentes a um hospital de segundo nível, realizado no período de dezembro de 2019 a maio de 2020. Amostragem não probabilística por conveniência. A validação do instrumento foi feita em cinco momentos: 1) criação do construto, 2) validação por 15 juízes especialistas, 3) teste piloto do instrumento, 4) consistência interna pelo Alfa de Cronbach e 5) validação por análise fatorial com rodízio componentes., também foi aplicada estatística descritiva. Resultados:a análise fatorial mostrou a distribuição dos 22 itens distribuídos em quatro fatores com variância explicada de 53,30% e consistência interna de α=0,89. Conclusão: os resultados permitem concluir que o instrumento possui validade e confiabilidade aceitáveis, o que permite avaliar o nível de conhecimento sobre DCV na equipe de enfermagem.

Comparison between carotid ultrasound and digital subtraction angiography in the diagnosis of carotid artery stenosis in patients with cerebral infarction / Comparación entre la ecografía carotídea y la angiografía por sustracción digital en el diagnostic de estenosis de la arteria carótida en pacientes con infarto cerebral

SUMMARY: This study aimed to compare the clinical value of carotid ultrasound and digital subtraction angiography (DSA) for carotid artery stenosis in patients with cerebral infarction. Sixty patients with cerebral infarction underwent carotid ultrasound and DSA. Carotid artery stenosis, degree of stenosis (mild, moderate, severe, and occlusion), and carotid artery plaques were recorded and compared. Carotid stenosis rate was 96.67 % (58/60) and 91.67 % (55/60) on DSA and carotid ultrasound, respectively, and the difference was not statistically significant. Mild, moderate, and severe carotid artery stenosis and occlusion were diagnosed in 35, 28, 20, and 17 arteries, respectively, with DSA, and in 39, 25, 10, and 9 arteries, respectively, with carotid ultrasound. There was a statistically significant difference in the degree of carotid stenosis between the two methods (p<0.05). The kappa value of carotid plaques detected by carotid ultrasound and DSA was 0.776, indicating good consistency. Both carotid ultrasound and DSA are effective for screening carotid artery stenosis and carotid atherosclerotic plaques. While carotid ultrasound is faster and more convenient, DSA can more accurately detect the degree of stenosis and presence of occlusion. Thus, our recommendation is a combination of carotid ultrasound and DSA in clinical settings to improve the convenience and accuracy of diagnosis.

Este estudio tuvo como objetivo comparar el valor clínico de la ecografía carotídea y la angiografía por sustracción digital (DSA) para la estenosis de la arteria carótida en pacientes con infarto cerebral. Sesenta pacientes con infarto cerebral fueron sometidos a ecografía carotídea y DSA. Se registraron y compararon la estenosis de la arteria carótida, el grado de estenosis (leve, moderada, grave y oclusión) y las placas de la arteria carótida. La tasa de estenosis carotídea fue del 96,67 % (58/60) y del 91,67 % (55/60) en DSA y ecografía carotídea, respectivamente, y la diferencia no fue estadísticamente significativa. Se diagnosticaron estenosis y oclusión de la arteria carótida leve, moderada y grave en 35, 28, 20 y 17 arterias, respectivamente, con DSA, y en 39, 25, 10 y 9 arterias, respectivamente, con ecografía carotídea. Hubo una diferencia estadísticamente significativa en el grado de estenosis carotídea entre los dos métodos (p<0,05). El valor kappa de las placas carotídeas detectadas por ecografía carotídea y DSA fue de 0,776, lo que indica una buena consistencia. Tanto la ecografía carotídea como la DSA son eficaces para detectar la estenosis de la arteria carótida y las placas ateroscleróticas carotídeas. Si bien la ecografía carotídea es más rápida y conveniente, la DSA puede detectar con mayor precisión el grado de estenosis y la presencia de oclusión. Por lo tanto, nuestra recomendación es una combinación de ecografía carotídea y DSA en entornos clínicos para mejorar la conveniencia y precisión del diagnóstico.

Actuación de enfermería en el infarto cerebral agudo / Nursing performance in acute cerebral stroke

La enfermedad vascular cerebral (EVC) es una patología caracterizada por un déficit neurológico súbito, secundario a oclusión o ruptura de un vaso sanguíneo cerebral; se divide en isquémica o infarto cerebral (IC) y hemorrágica. La EVC es reconocida como la primera causa de discapacidad y la quinta causa de muerte en México, registrándose cerca de 170 mil casos nuevos al año. Existe amplia evidencia que demuestra una reducción en los desenlaces negativos, como muerte y discapacidad, al realizar intervenciones rápidas, incluyendo la administración de trombolisis intravenosa con rt-PA (activador tisular de plasminógeno recombinante) y trombectomía mecánica. La coordinación multidisciplinaria del equipo de salud y los cuidados efectivos de enfermería, son vitales durante todas las etapas de atención de la EVC. Esta revisión da a conocer un panorama general del manejo del infarto cerebral e identificar las intervenciones indispensables del profesional de enfermería realiza durante las etapas prehospitalarias, pretrombolisis, durante trombolisis y postrombolisis.

Cerebralvascular disease (CVD) is a pathology characterized by a sudden neurological deficit secondary to occlusion or rupture of a cerebral blood vessel; it is divided into ischemic or cerebral infarction (CI) and hemorrhagic. CVD is recognized as the first cause of disability and the fifth cause of death in Mexico, with nearly 170,000 new cases registered each year. There is ample evidence that shows a reduction in negative outcomes, such as death and disability, with rapid interventions, including the administration of intravenous thrombolysis with rt-PA (recombinant tissue plasminogen activator) and mechanical thrombectomy. Multidisciplinary coordination of the health care team and effective nursing care are vital during all stages of CVD care. This review provides an overview of the management of cerebral infarction and identifies essential nursing interventions during the prehospital, prethrombolysis, during thrombolysis, and postthrombolysis stages.

Eficacia de la atorvastatina en el infarto cerebral aterotrombótico agudo / Effectiveness of atorvastatin in acute atherothrombotic cerebral infartation

Introducción: Las enfermedades Cerebrovasculares constituyen un importante problema de salud a escala global y en Cuba ocupan la tercera causa de muerte y la primera causa de discapacidad. Objetivo: Evaluar el uso de atorvastatina en el infarto cerebral aterotrombótico agudo. Métodos: Se realizó un estudio prospectivo longitudinal en los pacientes que acudieron al cuerpo de guardia del Hospital Clínico Quirúrgico Julio Trigo López diagnosticados como infarto cerebral aterotrombótico agudo. De forma aleatoria y con previo consentimiento informado se les suministró una dosis de 0, 20 mg o 40 mg de atorvastatina. Se les realizó tomografía axial computarizada de cráneo, la cual fue repetida al tercer día y a los 30 días. Se determinó el valor de proteína C reactiva en el cuerpo de guardia, y a los 30 días fueron evaluados clínicamente de acuerdo a la escala de National Institute of Health Stroke Scale en cuerpo de guardia, diariamente durante su ingreso y 30 días después. Resultados: El tamaño del área infartada disminuyó un 19,4 por ciento con 40 mg de atorvastatina al igual que el valor de proteína C reactiva que se redujo en 16 mg/L. La evaluación clínica según la escala de National Institute of Health Stroke Scale mostró una reducción en más de 8 puntos de acuerdo a la dosis de atorvastatina empleada. Conclusiones: Se demostró la eficacia de la atorvastatina por la disminución del área infartada, la reducción de los valores de proteína C reactiva y la evolución clínica favorable. Todos estos factores fueron directamente proporcional a la dosis de atorvastatina empleada(AU)

Introduction: Cererovascular diseases represent an important health problem worldwide and in Cuba they rank the third cause of death and the first cause of disability. Objective: To evaluate the use of astorvastin in acute atherotrombotic cerebral infactation. Methods: A longitudinal prospective study was carried out in patients who attended the emergency room of Julio Trigo López Surgical Clinical Hospital diagnosed with acute atherothrombotic cerebral infarction. Randomly and with prior informed consent, they were given a dose of 0, 20 mg or 40 mg of atorvastatin. Computerized axial tomography of the skull was performed, which was repeated on day 3 and day 30. The value of C-reactive protein in the emergency room was determined, and at day 30, they were clinically evaluated daily during admission and 30 days later, according to the scale of the National Institute of Health Stroke Scale in emergency room. Results: The size of the infarcted area decreased by 19.4 percent with 40 mg of atorvastatin, as well as the value of C-reactive protein, which decreased by 16 mg/L. The clinical evaluation according to the National Institute of Health Stroke Scale showed reduction of more than 8 points according to the dose of atorvastatin used. Conclusions: The efficacy of atorvastatin was demonstrated by the reduction of the infarcted area, the reduction of C-reactive protein values and the favorable clinical evolution. All of these factors were directly proportional to the dose of atorvastatin used(AU)

Correlation analysis of Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score in acute cerebral infarction with risk factors

SUMMARY OBJECTIVE: The aim of this study was to investigate the correlation between the Trial of Org 10172 in acute stroke treatment classification and the National Institutes of Health Stroke Scale score of acute cerebral infarction as well as acute cerebral infarction's risk factors. METHODS: The clinical data of 3,996 patients with acute cerebral infarction hospitalized in Hebei Renqiu Kangjixintu Hospital from January 2014 to November 2018 were analyzed retrospectively. According to Trial of Org 10172 in acute stroke treatment, they were divided into five groups: arteriosclerosis, cardio cerebral embolism, arterial occlusion, other causes, and unknown causes. Through questionnaire design, routine physical examination, and physical and chemical analysis of fasting venous blood samples, the risk factors were evaluated, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale classification was analyzed using multivariate logistic regression. In addition, the relationship between National Institutes of Health Stroke Scale score and risk factors in different groups was compared, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score was analyzed. RESULTS: Multivariate logistic regression analysis showed that diabetes, atrial fibrillation or stroke history, age, and education level were related to Trial of Org 10172 in acute stroke treatment classification. In the National Institutes of Health Stroke Scale comparison, the scores of the cardio cerebral embolism group were significantly higher than those of the other four groups, and patients with diabetes, atrial fibrillation, or stroke history had a high share, especially atrial fibrillation (33.06%). CONCLUSIONS: The nerve function defect is more serious after acute cerebral infarction with cardiogenic cerebral embolism, indicating a poor prognosis.

Effect of Electro-acupuncture on Vasomotor Symptoms in Rats with Acute Cerebral Infarction Based on Phosphatidylinositol System / 中国结合医学杂志

OBJECTIVE@#To investigate the effect of electro-acupuncture (EA) on vasomotor symptoms in rats with acute cerebral infarction, by observing the changes in the expression of factors related to the phosphatidylinositol (PI) system.@*METHODS@#Forty-two Wistar rats were randomly divided into 3 groups by a random number table: the control group (n=6), the model group (n=18) and the EA group (n=18). The EA group was given EA treatment at Shuigou (GV 26) instantly after modeling with middle cerebral artery occlusion (MCAO) method, while the model and control groups were not given any treatment. The degrees of neurological deficiency were evaluated using neurological severity scores (NSS) and the brain blood flow was evaluated by a laser scanning confocal microscope. Western blot analysis was conducted to detect the expression levels of G-protein subtype (Gq) and calmodulin (CaM). Competition for protein binding was conducted to detect the expression level of inositol triphosphate (IP3). Thin layer quantitative analysis was conducted to detect the expression level of diacylglycerol (DAG). The expression level of intracellular concentration of free calcium ion ([Ca@*RESULTS@#The NSS of the model group was significantly higher than the control group at 3 and 6 h after MCAO (P<0.01), while the EA group was significantly lower than the model group at 6 h (P<0.01). The cerebral blood flow in the model group was significantly lower than the control group at 1, 3 and 6 h after MCAO (P<0.01), while for the EA group it was remarkably higher than the model group at the same time points (P<0.01). The expressions of Gq, CaM, IP3, DAG and [Ca@*CONCLUSION@#EA treatment at GV 26 can effectively decrease the over-expression of related factors of PI system in rats with acute cerebral infarction, improve cerebral autonomy movement, and alleviate cerebral vascular spasm.

Echinacoside Alleviates Cognitive Impairment in Cerebral Ischemia Rats through α 7nAChR-Induced Autophagy / 中国结合医学杂志

OBJECTIVES@#To evaluate the effect of echinacoside (ECH) on cognitive dysfunction in post cerebral stroke model rats.@*METHODS@#The post stroke cognitive impairment rat model was created by occlusion of the transient middle cerebral artery (MCAO). The rats were randomly divided into 3 groups by a random number table: the sham group (sham operation), the MCAO group (received operation for focal cerebral ischemia), and the ECH group (received operation for focal cerebral ischemia and ECH 50 mg/kg per day), with 6 rats in each group. The infarct volume and spatial learning were evaluated by triphenyl tetrazolium chloride staining and Morris water maze. The expression of α7nAChR in the hippocampus was detected by immunohistochemistry. The contents of acetylcholine (ACh), malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), activities of choline acetyltransferase (ChAT), acetylcholinesterase (AChE), and catalase (CAT) were evaluated by enzyme linked immunosorbent assay. The neural apoptosis and autophagy were determined by TUNEL staining and LC3 staining, respectively.@*RESULTS@#ECH significantly lessened the brain infarct volume and ameliorated neurological deficit in infarct volume and water content (both P<0.01). Compared with MCAO rats, administration of ECH revealed shorter escape latency and long retention time at 7, 14 and 28 days (all P<0.01), increased the α7nAChR protein expression, ACh content, and ChAT activity, and decreased AChE activity in MCAO rats (all P<0.01). ECH significantly decreased MDA content and increased the GSH content, SOD, and CAT activities compared with MCAO rats (all P<0.05). ECH suppressed neuronal apoptosis by reducing TUNEL-positive cells and also enhanced autophagy in MCAO rats (all P<0.01).@*CONCLUSION@#ECH treatment helped improve cognitive impairment by attenuating neurological damage and enhancing autophagy in MCAO rats.

Comparative Analysis of Thromboelastogram and Coagulation Items in Mongolian Patients with Thrombosis / 中国实验血液学杂志

OBJECTIVE@#To investigate the age distribution of Mongolian patients with cerebral infarction caused by thrombosis and the correlation and consistency between thromboelastography (TEG) and four parameters of coagulation.@*METHODS@#The age distribution of 298 Mongolian patients with cerebral infarction treated in Affiliated Hospital of Inner Mongolia Minzu University from January 2020 to December 2021 and their TEG, four items of routin coagulation and platelet count were analyzed retrospectively. The correlation and consistency of above-mentioned two detection methods were statistically analyzed.@*RESULTS@#The onset age of 298 Mongolian patients with cerebral infarction was mainly 61-70 years old, accounting for 38.3%, followed by 51-60 years old, accounting for 26.8%. The R time detected by TEG was linearly correlated with PT and APTT（r=0.186，r=0.152）. K value, MA value and α-Angle measured by TEG was linearly correlated with Fib (r=-0.364，r=0.616，r=0.359), K value, MA value and α-Angle measured by TEG was linearly correlated with Plt (r=0.318，r=0.519，r=0.301). The R time detected by TEG was consistent with PT and APTT, and the Kappa values were 0.252 (P<0.001), 0.336 (P<0.001). K, MA, and α-Angle measured by TEG was consistent with Fib, the Kappa values were 0.265 (P<0.001), 0.289 (P<0.001) and 0.290 (P<0.001), respectively; K、MA and α-Angle measured by TEG was consistent with Plt, the Kappa values were 0.276 (P<0.001), 0.285 (P<0.001) and 0.302 (P<0.001), respectively.@*CONCLUSION@#The onset age of Mongolian patients with cerebral infarction caused by thrombosis is mainly 61-70 years old, followed by 51-60 years old. The onset age shows a younger trend. There is a significant correlation between TEG and coagulation, but the consistency is weak, therefore, the two methods can not be replaced each other.

Influence of ApoE gene polymorphisms on therapeutic effects of lipid-lowering statins among patients with ischemic cerebral infarction / 中华医学遗传学杂志

OBJECTIVE@#To assess the influence of apolipoprotein E (ApoE) gene polymorphisms on the therapeutic effect of lipid-lowering statins in patients with ischemic cerebral infarction.@*METHODS@#One hundred and six patients with ischemic cerebral infarction who orally took lipid-lowering statins for 3 months were enrolled. Changes in serum triacylglycerol (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) before and after the drug administration were analyzed. ApoE gene polymorphisms were detected by real-time fluorescent quantitative PCR, and genotypes of ApoE gene in patients with different effects were compared.@*RESULTS@#The detection rates for E2/E2, E2/E3, E3/E3, E2/E4 and E3/E4 genotypes were 0.94%, 11.32%, 63.21%, 1.89% and 22.64%, respectively. And the detection rates for E2, E3 and E4 alleles were 7.55%, 80.19% and 12.26%, respectively. Biochemical phenotypes included E2 type (13 cases, 12.26%), E3 type (69 cases, 65.09%) and E4 type (24 cases, 22.65%). Before administration, TG and TC of E2 type were the highest (P<0.05), but no significant difference was detected in HDL-C and LDL-C among the three phenotypes (P>0.05).Following the drug administration, TG, TC and LDL-C were decreased, while HDL-C was increased. HDL-C of E2 type was the highest, TC and LDL-C of E4 type were the highest (P<0.05). The E3/E3 ratio in low-efficiency group at admission was lower than that in the high-efficiency group, while the E3/E4 ratio was higher than that in the high-efficiency group (P<0.05). The proportion of E3 allele in low-efficiency group was lower than that in high-efficiency group, while the proportion of E4 allele was higher than that in high-efficiency group (P<0.05).@*CONCLUSION@#ApoE gene polymorphisms are closely correlated with the therapeutic effect of lipid-lowering statins in patients with ischemic cerebral infarction. The lipid-lowering effects are more significant in patients with E2 and E3 genotypes, but were poor in those with the E4 genotype. Personalized regimens should be applied.

Analysis of risk factors for readmission in elderly patients with hip fractures undergoing hip hemiarthroplasty / 中国骨伤

OBJECTIVE@#To explore the incidence and risk factors of readmission of elderly patients with hip fracture after hip hemiarthroplasty.@*METHODS@#A retrospective analysis of 237 elderly hip fracture patients who underwent hip hemiarthroplasty from February 2015 to October 2020 were performed. According to the readmission status of the patients at 3 months postoperatively, the patients were divided into readmission group (39 cases)and non-readmission group(198 cases). In readmission group, there were 7 males and 32 females with an average age of(84.59±4.34) years old, respectively, there were 34 males and 164 females with average age of (84.65±4.17) years old in non-readmission group. The general information, surgical status, hip Harris score and complications of patients in two groups were included in univariate analysis, and multivariate Logistic regression was used to analyze independent risk factors of patients' readmission.@*RESULTS@#The proportion of complications(cerebral infarction and coronary heart disease) in readmission group was significantly higher than that of non-readmission group (P<0.05), and intraoperative blood loss in readmission group was significantly higher than that of non-readmission group(P<0.05). Harris score of hip joint was significantly lower than that of non-readmission group(P<0.05). The proportion of infection, delirium, joint dislocation, anemia and venous thrombosis in readmission group were significantly higher than that of non-readmission group (all P<0.05). Multivariate Logistic regression analysis showed that the risk factors for readmission of elderly patients with hip fracture after hip hemiarthroplasty included cerebral infarction, infection, delirium, dislocation, anemia and venous thrombosis (all P<0.05).@*CONCLUSION@#The complications of the elderly patients who were readmission after hip hemiarthroplasty for hip fractures were significantly higher than those who were non-readmission. Cerebral infarction, infection, delirium, dislocation, anemia and venous thrombosis are risk factors that lead to patient readmission. Corresponding intervention measures can be taken clinically based on these risk factors to reduce the incidence of patient readmissions.

Clinical comprehensive evaluation of Ginkgolide Injection in treatment of cerebral infarction / 中国中药杂志

This clinical value-oriented comprehensive evaluation of drugs was carried out in accordance with Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021), with the qualitative and quantitative evaluation methods adopted. Based on the evidence-based medicine, epidemiology, clinical medicine, pharmacoeconomics, mathematical statistics, and health technology evaluation(HTA), the clinical value of Ginkgolide Injection was evaluated from the "6+1" dimension by giving weight to the criterion level and index level and calculating with multi-criteria decision analysis(MCDA) model and CSC v2.0. After entering the market, Ginkgolide Injection has been subjected to phase Ⅳ clinical trial, spontaneous reporting system(SRS)-based data monitoring, systematic review and Meta-analysis, acute toxicity and long-term toxicity assays, active monitoring, and RCTs, and the evidence of safety was sufficient. The results of active monitoring showed that the incidence of adverse reactions was 0.09%(rare), mainly manifested as flushing, dizziness, rash, nausea, and vomiting. According to the nested case-control study, the adverse reactions of this drug had nothing to do with the product batch, implying that the drug quality was controllable. The adverse reactions mainly resulted from the pharmacodynamic reactions. Because the drug was effective in resisting platelet aggregation, the resulting adverse reactions such as flushing, dizziness, headache, and phlebitis were caused by vasodilation. Skin rash and gastrointestinal symptoms were mainly attributed to the patients' sensitivity to drugs and their own allergic constitution. According to the sufficiency of evidence and the incidence of adverse reactions in the safety research, the safety of Ginkgolide Injection was grade A. The results of Meta-analysis showed that Ginkgolide Injection combined with conventional western medicine was superior to conventional western medicine in improving the clinical effective rate, neurological function score, and activity of daily living score of patients with cerebral infarction. The validity evidence was evaluated according to the PICO principle to be high. According to the GREAD evaluation principle, the quality of such evidence as clinical effective rate, National Institute of Health stroke scale(NIHSS), and Barthel Index(BI) was evaluated, and the results demonstrated that the evidence quality of clinical effective rate and activity of daily living score was medium. The effectiveness of Ginkgolide Injection was grade A. According to the economic report of Ginkgolide Injection, it had short-term and long-term pharmacoeconomic advantages in the treatment of ischemic stroke, and the economic evidence value was good. According to the CASP economic evaluation checklist, the overall quality evaluation results of the economic report are basically clear. To be specific, the economic evidence quality was high. Based on the comprehensive economic evidence quality and economic value, the economy of this drug was grade A. The innovation of this product was evaluated from three aspects: clinical innovation, enterprise service system innovation, and industrial innovation. Ginkgolide Injection could be used 24 h after intravenous thrombolysis for improving patients' neurological function without increasing bleeding, indicating its important clinical innovation. There were many innovations in ensuring drug supply, especially at the grass roots, drug safety, effectiveness, and reasonable price, which has provided reference for establishing enterprise philosophy, managing drug resources, developing process and technology, and determining enterprise management and marketing. Therefore, its innovation was grade A. The drug had no special medication plan in use, exhibiting good suitability for doctors, nurses, and patients. The suitability was grade B. Compared with similar drugs, its price was at a medium level, meaning good affordability, sufficient production capacity, and easy accessibility. Its accessibility was therefore grade B. This drug belonged to Chinese medicinal injection. The large-sample real-world research revealed rich human use experience, so it was grade C for the traditional Chinese medicine characteristic. According to the comprehensive evaluation, the clinical value of Ginkgolide Injection in the treatment of cerebral infarction fell into class A. It is suggested that it can be transformed into the relevant policy results of basic clinical medication management according to the procedure.

Post-coital internal carotid artery dissection associated with acute cerebral infarction in a Filipino female: A case report

@#Carotid arterial dissections may result from spontaneous or traumatic causes. Postcoital arterial dissections have been reported in both the vertebral and coronary arteries. We report a rare case of spontaneous dissection on the extracranial internal carotid artery in a Filipino female after sexual intercourse, leading to a fulminant middle cerebral artery (MCA) territory infarct. Although postcoital carotid artery dissection is a very rare cause of neck vessel dissections, its rapid progressive course can lead to massive cerebral infarction and prompt management must be initiated.

Fetal-type variant of the posterior cerebral artery and concurrent bilateral cerebral infarctions in a Korean male cadaver / Variante de tipo fetal de la arteria cerebral posterior e infartos cerebrales bilaterales concurrentes en un cadáver masculino coreano

SUMMARY: Fetal-type variant of the posterior cerebral artery is a relatively common variant of the cerebral arterial circle (circle of Willis), but concurrent cerebral pathologies have not been well reported. We describe a case of fetal-type variant of the posterior cerebral artery and concurrent bilateral cerebral infarctions in the territories of the middle cerebral artery in a 78-year-old Korean male cadaver. Fetal-type variant of the posterior cerebral artery was found the right cerebral arterial circle, arose from the internal carotid artery with larger diameter than the pre-communicating segment from the basilar artery. Histopathological examination revealed that left supramarginal gyrus and right infraparietal lobule showed characteristic cerebral infarctions with chronological changes, respectively. Knowledge on the variation in the posterior cerebral artery combined with clinical features including cerebral infarction plays a pivotal role to anatomists and clinicians.

RESUMEN: La variante de tipo fetal de la arteria cerebral posterior es una variante relativamente común del círculo arterial cerebral (polígono de Willis) de arterial cerebral, pero las patologías cerebrales concurrentes no han sido bien informadas. Describimos un caso de variante de tipo fetal de la arteria cerebral posterior e infartos cerebrales bilaterales concurrentes en los territorios de la arteria cerebral media en un cadáver masculino coreano de 78 años. La variante de tipo fetal de la arteria cerebral posterior se encontró en la parte de derecha del círculo arterial cerebral, surgido de la arteria carótida interna con mayor diámetro que el segmento precomunicante de la arteria basilar. El examen histopatológico reveló que el giro supramarginal izquierdo y el lóbulo infraparietal derecho mostraban infartos cerebrales característicos con cambios cronológicos, respectivamente. El conocimiento sobre la variación en la arteria cerebral posterior combinado con las características clínicas, incluido el infarto cerebral es fundamental para los anatomistas y los médicos.

Pituitary Apoplexy, Meningitis and Cerebral Infarction - A Perplexing Trifecta

Pituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together. We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.

Revascularizacion cerebral en el moyamoya del adulto / Cerebral revascularization in adult moyamoya

Introducción: el Moyamoya (MM) es una enfermedad crónica esteno-oclusiva de los vasos arteriales intracraneanos asociado al desarrollo secundario de arteriolas dilatadas en la base del cerebro. La historia natural de la enfermedad predispone a infartos y/o hemorragias cerebrales. El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo quirúrgico del MM del adulto. Material y método: se realizó una revisión retrospectiva de 11 pacientes adultos con diagnóstico de MM tratados entre mayo 2014 y mayo 2020. Se analizaron las historias clínicas, estudios diagnósticos, protocolos y videos operatorios. En el preoperatorio se utilizó la escala angiográfica de Suzuki y para la valoración clínica pre y postoperatoria la escala de Rankin modificada. Resultados: se operaron 11 pacientes (8 femeninos), 9 son portadores de EMM y 2 con SMM secundario a NF1 y enfermedad de Hashimoto. Se realizaron 16 procedimientos de revascularización en 11 pacientes (en 5 pacientes la revascularización cerebral fue bilateral), 12 fueron combinados (bpTS más EDMS) y en 4 sólo sinangiosis tipo EDAMS.El aumento del flujo sanguíneo cerebral se constató en todos los casos mediante ADC luego de los 6 meses de la cirugía. La permeabilidad del bpTS se comprobó en 10 de 12 bpTS (83.3 %) y la revascularización de la sinangiosis fue muy buena en todos los pacientes. El 82 % de los pacientes mejoraron un punto o más en la escala de Rankin y un paciente presentó un infarto frontal en TAC postoperatoria sin repercusión clínica. Conclusiones: la evolución natural de la enfermedad conduce al deterioro neurológico por ACV isquémico y/o hemorrágico. En nuestra experiencia, la mejor opción terapéutica en el adulto es la revascularización cerebral combinada porque disminuye la incidencia de ACV con resultados favorables y escasa morbilidad

Introduction: Moyamoya is a chronic steno-occlusive disease of the intracranial vessels associated to the secondary development of dilated arterioles at the base of the brain. The natural history of the disease predisposes to cerebral infarcts and/or hemorrhages. The objective of this paper is to show our experience and surgical management of adult moyamoya. Materials and Methods: retrospective review of 11 adult patients with moyamoya treated from May 2014 to May 2020 was performed. Clinical charts, neuroimaging studies, operative records and surgical videos were analyzed. The Suzuki scale was used as a preoperative score, and the modified Rankin scale was used for pre and postoperative clinical assessment. Results: Eleven patients (8 females) were operated at our Institution: 9 are MMD and 2 MMS secondary to NF1 and Hashimoto disease. We performed 16 cerebral revascularizations in 11 patients (in 5 patients thecerebral revascularization was bilateral), 12 were combined (STA-MCA bypass plus EDMS) and in only 4 EDAMS synangiosis was done.The increase in cerebral blood flow was verified in all cases by follow-up DSA at 6 months. The STA-MCA bypass permeability was verified in 10 of 12 cases (83.3%) and the revascularization by synangiosis was demonstrated in all patients. Clinical follow-up showed that 82 % of the patients improved one point or more on the modified Rankin scale and one patient presented a frontal infarction on postoperative CT without clinical worsening. Conclusions: The natural course of the disease leads to neurological deterioration due to ischemic and hemorrhagic stroke. According to our experience, the best therapeutic option in adults is combined cerebral revascularization because it decreases the incidence of stroke with good results and low morbidity

Memoria episódica posterior a cirugía de epilepsia del lóbulo temporal / Episodic memory after temporal lobe epilepsy surgery

RESUMEN INTRODUCCIÓN: La cirugía resectiva del lóbulo temporal anterior con amigdalo-hipocampectomía es un tratamiento efectivo para la epilepsia farmacorresistente del lóbulo temporal con esclerosis hipocampal. Sin embargo, este procedimiento conlleva riesgo de deterioro de la memoria episódica verbal y no verbal postoperatoria, dependiendo de la dominancia hemisférica para la memoria y el lenguaje. OBJETIVO: Explorar el desenlace de la memoria episódica posterior a la cirugía resectiva mediante lobectomía temporal anterior con amigdalo-hipocampectomía. MÉTODOS: Se analizó retrospectivamente la memoria episódica verbal y no verbal mediante pruebas neurop-sicológicas de 51 pacientes consecutivos sometidos a lobectomía temporal anterior con amigdalo-hipocampectomía del lado izquierdo y derecho. Todos los pacientes fueron sometidos a resonancia magnética cerebral preoperatoria, video-electroencefalografía y evaluaciones neuropsicológicas. A 12 pacientes (24 %) no se les realizó el test de Wada. RESULTADOS: Hubo disminución en la memoria episódica verbal postoperatoria con diferencias respecto a la preoperatoria, en la subprueba de textos II recuerdo de la escala de memoria de Wechsler III (p = 0,035). El resultado en la memoria episódica visual se mantuvo igual, no hubo diferencias en el grupo de lobectomía temporal estándar. CONCLUSIÓN: La lobectomía temporal anterior más amigdalo-hipocampectomía izquierda afecta levemente el desempeño de la memoria episódica postoperatoria, que clínicamente no es significativo en pacientes con epilepsia del lóbulo temporal mesial farmacorresistente.

SUMMARY INTRODUCTION: Resective surgery of the anterior temporal lobe with amygdalohippocampectomy is an effective treatment for drug-resistant epilepsy of the temporal lobe with hippocampal sclerosis. However, this procedure carries a risk of post-operative episodic verbal and nonverbal memory impairment depending on the hemispheric dominance for memory and language. OBJECTIVE: To explore the outcome of episodic memory after resective surgery by means of anterior temporal lobectomy with amygdalohippocampectomy. METHODS: Verbal and non-verbal episodic memory was retrospectively analyzed by neuropsychological tests of 51 consecutive patients undergoing anterior temporal lobectomy with amygadalohyppocampectomy on the left and right sides. All patients underwent preoperative brain MRI, video electroencephalography, and neuropsychological evaluations. 12 patients (24%) did not undergo the Wada test. RESULTS: There was a decrease in postoperative verbal episodic memory with differences compared to preoperative, in the text II subtest recall of the Wechsler III memory scale (p = 0.035). The result in visual episodic memory remained the same, there were no differences in the standard temporal lobectomy group. CONCLUSION: Anterior temporal lobectomy plus left amygadalohyppocampectomy slightly affects the performance of postoperative episodic memory, which is clinically not significant in patients with drug-resistant mesial temporal lobe epilepsy.

Pronóstico en pacientes con ataque cerebrovascular isquémico de circulación posterior / Functional outcome in posterior circulation acute ischemic stroke patients

RESUMEN INTRODUCCIÓN: El ochenta por ciento de los ataques cerebrovasculares son isquémicos, y uno de cada cinco afecta la circulación posterior. Su diagnóstico es difícil y los datos disponibles sobre el pronóstico y la mortalidad son discordantes. OBJETIVO: Evaluar el desenlace funcional a 180 días de los pacientes con ataque cerebrovascular (ACV) isquémico de circulación posterior (CP). MATERIALES Y MÉTODOS: Seguimiento prospectivo a pacientes con ACV de CP que ingresaron al Instituto Neurológico de Colombia entre septiembre del 2017 y septiembre del 2018. El desenlace clínico fue determinado mediante la escala Rankin modificada (mRS) al mes, a los seis meses y al año. RESULTADOS: Fueron incluidos 68 pacientes. La edad promedio fue 61 ±17 años y 60,3 % fueron hombres. El 85% tenía un mRS previo al ACV ≤ 1 y el 63 % un NIHSS basal ≤ 4. Nueve pacientes (13,2 %) recibieron terapia de reperfusión aguda (rtPA, TEV o ambas) y siete (10,3 %) adicionales arteriografía diferida. Dieciséis pacientes (23,5 %) presentaron una mejoría del NIHSS basal ≥ 4 puntos. Cuarenta y seis pacientes (74,2 %) presentaron un desenlace excelente mRS 0-1 a los seis meses y 87,1 % fueron categorizados mRS favorable (mRS 0-2). En el análisis ajustado, el NIHSS ≥ 4 fue un predictor de desenlace desfavorable a seis meses (RR 6,4; IC95 % 2,9-14,2). Seis pacientes (9,0 %) fallecieron, cuatro relacionados con el episodio actual o su recurencia. CONCLUSIONES: La mayoría de los pacientes con ACV de CP tienen desdenlaces favorables y una baja mor%talidad. La escala de NIHSS basal es un factor pronóstico independiente.

SUMMARY BACKGROUND: Ischemic strokes account for 80 % of all strokes, and one of every five compromises the posterior circulation. The diagnosis is difficult, and the data available about the outcome and mortality are discordant in the literature. OBJECTIVE: To investigate the clinicai outcome of patients at 180 days after posterior circulation ischemic stroke METHODS: Patients with diagnosis of posterior circulation stroke admitted to Instituto Neurológico de Colombia between September 2017 to 2018 were prospective included. The functional outcome by modified Rankin scale score (mRS) was determined at 1-month, 6-month, and 12-month after disease onset. RESULTS: 68 patients were included. The median age was 61 years ± 17 and 60.3 % were male. 85 % had a baseline mRS ≤ 1, and 63 % had a baseline National Institute Stroke Scale (NIHSS) ≤ 4. Nine patients were taken to acute recanalization therapies (rtPA, endovascular therapy or both) and seven more delayed arteriography. Sixteen patients (23.5 %) demonstrated an improvement of four or more points over the baseline NIHSS. Forty-six patients (74.2 %) had an excellent outcome 0-1 at six months and 87,1 % were categorized favorable mRS (mRS 0-2). In the adjusted analysis an NIHSS > 4 was a predictor of an unfavorable outcome at 6-month (RR 6.4; IC95 % 2.9-14.2). Six patients died (9 %); four of them in relation to the current event or an ischemic stroke recurrence. CONCLUSION: Most of the patients with posterior ischemic stroke have favorable outcomes and a low mortality. The baseline NIHSS is an independent prognostic risk factor.

Factores de riesgo para enfermedad cerebrovascular en el adulto mayor / Risk Factors for Cerebrovascular Disease in the Older Adult

Introducción: La vejez está subvalorada, poco se piensa en el bienestar físico y psicosocial del anciano. La enfermedad cerebrovascular tiene como factores de riesgo comorbilidades como la hipertensión arterial, la diabetes mellitus, la dislipidemia, cardiopatías o malos estilos de vida como el consumo de cigarrillo, la obesidad y la poca actividad física, todos estos comunes en esta etapa de la vida. Objetivo: Identificar los factores de riesgo que presentan los adultos mayores para sufrir enfermedad cerebrovascular de un centro gerontológico de la ciudad de Medellín. Métodos: Fue una investigación descriptiva, de tipo transversal; se indagaron 37 adultos mayores con historias clínicas y exámenes de laboratorio. Se midieron los niveles de hemoglobina glicosilada, colesterol total, colesterol de baja densidad, colesterol de alta densidad y triglicéridos. Resultados: Se evidenció que la población era en su mayoría de sexo masculino con 51,4 por ciento y el sexo femenino con 48,6 por ciento; con rango de edad entre 60 y 70 años el 51,4 por ciento. Los factores de riesgo más relevantes fueron el índice de masa corporal mayor o igual a 25 con (75,7 por ciento), hipertensión arterial y no realizar actividad física. Conclusiones: Se logró determinar los principales factores de riesgo que tienen estos adultos mayores para sufrir enfermedad cerebrovascular; con resultados algunos similares y otros diferentes a estudios a nivel mundial. Con actividades de promoción y prevención se pueden intervenir estilos de vida de la población(AU)

Introduction: Old age is undervalued; little is thought about the physical and psychosocial well-being of the elderly. Among the risk factors of cerebrovascular disease, there are comorbidities, such as high blood pressure, diabetes mellitus, dyslipidemia and cardiopathies, or poor lifestyles like cigarette smoking, obesity and little physical activity, all of which are common at this stage of life. Objective: To identify, in a gerontological center in Medellín City, the risk factors that older adults present for being affected by cerebrovascular disease. Methods: This was a descriptive and cross-sectional research carried out with 37 older adults with medical antecedents and laboratory tests. The levels of glycated hemoglobin, total cholesterol, low-density and high-density cholesterol, as well as triglycerides were measured. Results: It was evidenced that the population was mostly male (51.4 por ciento), while females accounted for 48.6 por ciento. Their age range was mostly between 60 and 70 years (51.4 por ciento). The most relevant risk factors were body mass index greater than or equal to 25 (75.7 por ciento), arterial hypertension and not doing any physical activity. Conclusions: It was possible to determine the main risk factors for these older adults being affected by cerebrovascular disease; in this respect, some results were similar to and others were different from studies worldwide. With promotion and prevention activities, lifestyles of the population can be intervened(AU)

Electroencefalograma cuantitativo en la predicción precoz de la isquemia cerebral tardía en hemorragia subaracnoidea aneurismática: reporte de un caso / Quantitative electroencephalogram for prediction of delayed ischemia in subarachnoid haemorrhage: report of one case

Subarachnoid hemorrhage (SAH) is a devastating disease, with a mortality rate of 35%. Among patients who survive the initial bleeding, the leading cause of morbidity and mortality is delayed cerebral ischemia (DCI). Electroencephalography (EEG) can detect cerebral ischemia in the early stages. We report a 66-year-old female patient who consulted for ictal headache and impaired consciousness. On admission, she was confused, dysarthric, and with meningeal signs. Brain angio-CT showed SAH FISHER IV and an aneurysm of the left posterior cerebral artery. After excluding the aneurysm (by coiling), the patient recovered the altered consciousness. Continuous EEG monitoring was initiated. On the sixth day of follow up, she had a transient headache and apathy. The brain MRI showed low cerebral blood flow in the left frontotemporal area, without ischemic lesions. On the seventh day, she presented expression aphasia and right facial-brachial paresis. Angiography confirmed severe vasospasm in M1 and M2 segments bilaterally. Pharmacological angioplasty with nimodipine was performed, with an excellent radiological response, although not clinical. A second MRI was carried out on the eighth day, which showed a left insular infarction and generalized vasospasm. A second therapeutic angiography was performed; the patient persisted with aphasia and left central facial paresis. The quantitative EEG analysis performed retrospectively showed a generalized reduction in the spectral edge frequency 95 (SEF95; meaning slowing in the EEG signal) at the fourth day of follow up, three days earlier than the clinical and imaging diagnosis of DCI was established.