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1.
Ethiop. j. health sci. (Online) ; 32(2): 229-234, 2022.
Article in English | AIM, AIM | ID: biblio-1366924

ABSTRACT

BACKGROUND: Acute ischemic stroke has been reported to occur in a significantly higher number of COVID-19 patients as compared to healthy controls with variable proposed pathophysiologic mechanisms. To our knowledge, sufficient data regarding this subject is lacking in Ethiopia and the African continent at large. In this case series, we report the clinical characteristics and management of 5 cases with COVID-19 infection and acute ischemic stroke to shed light on the diagnostic and therapeutic challenges in resource-limited setups. METHODS: This is a case series including data collected from the medical records of 5 participants with confirmed RT-PCR positive COVID-19 infection and radiologically confirmed acute ischemic stroke, admitted at Eka Kotebe General Hospital Intensive Care Unit (ICU) in Addis Ababa, Ethiopia from June 10, 2020, to November 04, 2020. RESULTS: Cryptogenic stroke was documented in 4/5 participants included in this series with the most common vascular risk factors identified for stroke being hypertension and diabetes mellitus. The median time from onset of COVID-19 symptoms to the identification of stroke was 07 days. Two fifth of the participants in this series died during their ICU admission with the immediate cause of deaths reported to be related to the severe COVID-19 infection but not stroke. CONCLUSION: Cryptogenic stroke was documented in 4/5 patients in this series despite the presence of vascular risk factors for other stroke subtypes. The overall prevalence, subtypes, and outcomes of stroke in COVID-19 patients in Ethiopia and the African continent as a whole needs additional research to elucidate the local burden of the disease and define the predominant pathophysiologic mechanisms for stroke in COVID-19 in the region


Subject(s)
Humans , Male , Female , Clinical Diagnosis , Ischemic Stroke , COVID-19 , Disease Management
2.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 151-154, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352979

ABSTRACT

El caso expuesto a continuación demuestra que, a pesar del diagnóstico precoz de la endocarditis infecciosa, el buen pronóstico del paciente se da cuando el tratamiento es oportuno. Por lo tanto, es de suma importancia tener presente cuales son las posibles complicaciones para tratarlas a tiempo. Paciente de sexo masculino, de 72 años de edad, consultó por fiebre de ocho días de evolución. Al examen físico se constató soplo diastólico en foco aórtico. Retornaron hemocultivos positivos para streptococcus gallolyticus, se inició tratamiento con antibióticos según antibiograma; en la segunda semana de tratamiento presentó deterioro del sensorio, primero estuvo confuso y luego somnoliento. Se realizó una tomografía de cráneo simple en primera instancia y luego resonancia magnética encefálica donde se observaron lesiones compatibles con posibles complicaciones de la endocarditis infecciosa como el émbolo séptico. Se continuó con el mismo esquema de antibióticos por seis semanas con mejoría del sensorio. El germen aislado en el caso clínico se relaciona en un porcentaje no infrecuente en pacientes con patologías gastrointestinales, el dato positivo que se obtuvo dentro de sus hábitos fisiológicos era la constipación crónica como dato importante ya que se relaciona frecuentemente con pólipos intestinales o neoplasias que se descartaba con estudios complementarios. Además, que los patógenos frecuentemente implicados en complicaciones neurológicas fueron por S. aureus y Streptococcus gallolyticus, coincidiendo el último con el germen aislado en este caso clínico, además que presentaba dos de las muchas complicaciones como ictus isquémico y émbolos sépticos en un mismo paciente


The case presented below goes beyond the early diagnosis of infective endocarditis and the association of the patient's prognosis with timely treatment; It is also important to keep in mind about possible complications despite adequate clinical management. A male patient consulted for a fever of eight days of evolution, the positive finding on physical examination was the auscultation of a diastolic murmur in the aortic focus. Positive blood cultures returned for streptococcus gallolyticus, antibiotic treatment had been started according to the antibiogram, and in the second week of treatment there was deterioration of the sensorium. A simple skull tomography had been performed in the first instance and then brain magnetic resonance imaging showing lesions compatible with possible complications of infective endocarditis. The same antibiotic scheme was continued for six weeks with improvement of the sensorium. The isolated germ in the clinical case is related in a not infrequent percentage in patients with gastrointestinal pathologies, the positive data that was obtained within their physiological habits was chronic constipation as important data since it is frequently related to intestinal polyps or neoplasms that are ruled out with complementary studies. In addition, the pathogens frequently involved in neurological complications were S. aureus and Streptococcus gallolyticus, the latter coinciding with the isolated germ in this clinical case, in addition to presenting two of the many complications such as ischemic stroke and septic embolism in the same patient


Subject(s)
Embolism , Endocarditis , Ischemic Stroke
3.
Notas enferm. (Córdoba) ; 21(38): 34-42, nov. 2021.
Article in Spanish | LILACS, BDENF, BINACIS, UNISALUD | ID: biblio-1348586

ABSTRACT

Si bien el uso rtPA está indicado para diversas patologías como el tratamiento trombolítico en los infartos agudos de miocardio, el tromboembolismo pulmonar agudo con inestabilidad hemodinamica y el tratamiento trombolítico del accidente cerebrovascular isquémico agudo conforme a la disposición DI­2018-495-APN-ANMAT#MSYDS el uso del mismo en Argentina y conforme a consenso (consenso sobre accidente cerebrovascular isquémico agudo). La administración oportuna del rtPA, a pacientes apropiadamente seleccionados constituye el principal tratamiento de forma temprana en el ACV (1-8). Por lo que el rol que cumple enfermería es fundamental en la valoración de riesgos previa a la administración, preparación, administración del fármaco y valoración continua post administración del mismo[AU]


Although the use of rtPA is indicated for various pathologies such as thrombolytic treatment in acute myocardial infarctions, acute pulmonary thromboembolism with hemodynamic instability, and thrombolytic treatment of acute ischemic stroke according to the DI-2018-495-APN-ANMAT provision. #MSYDS the use of thesame in Argentina and accordingtoconsensus (consensus on accident cerebrovascular ischemico acute). Timely administration of rtPAto appropriately selected patients constitutes the main treat mentearly in stroke (1,8). Therefore, the role play edby nursingis fundamental in the risk ass essment prior to the administration, preparation, administration of the drug, and continuous post-administration assessment[AU]


Embora o uso de rtPA seja indicado para várias patologias, como tratamento trombolítico em infartos agudos do miocárdio, tromboembolismo pulmonar agudo com instabilidade hemodinâmica e tratamento trombolítico de acidente vascular cerebral isquêmico agudo de acordo com a disposição DI- 2018-495-APN-ANMAT. #MSYDS a uso do mesmona Argentina e de acordocom o consenso (consensus on accident cerebrovascular ischemico agute). A administração oportuna de rtPA a pacientes adequadamente selecionados constitui o principal tratamento no início do AVC (1,8). Por tanto, o papel da enfermagem é fundamental na avaliação do risco antes da administração, preparo, administração do medicamento e avaliação pós-administração contínua[AU]


Subject(s)
Humans , Plasminogen , Plasminogen/administration & dosage , Stroke , Ischemic Stroke , Myocardial Infarction , Nursing Care , Pulmonary Embolism , Hemodynamics
4.
Article in Portuguese | LILACS | ID: biblio-1353484

ABSTRACT

RESUMO: Introdução: A dissecção da artéria carótida (DAC) tem como uma das principais repercussões o Acidente Vascular Cerebral isquêmico (AVCi) em indivíduos jovens previamente saudáveis. É comum que nas DAC traumáticas, como em acidentes automobilísticos, o paciente seja submetido à investigação mais complexa com exames de imagem. Estes permitem um diagnóstico precoce e, portanto, um tratamento, reduzindo as chances de sequelas. Todavia, cau-sas não traumáticas com desfecho de DAC já foram relatadas, como as causas odontológicas. Objetivo: Contribuir para valorização diagnóstica da DAC não traumática e profilaxia de AVC subsequente. Métodos: Relatamos um caso de dissecção não aneurismática das artérias carótidas internas (ACI) pós-procedimento odontológico com desfecho de AVC bilateral em paciente de 52 anos. Resultados: Devido à forte associação de DAC a fatores traumáticos, em um primeiro contato com a paciente não foram levantadas suspeitas da ocorrência de DAC nem de AVC (ausência de déficit focal). Porém, tardiamente, foi identificada oclusão da ACI à esquerda e estenose na ACI direita, resultando em dois AVCs e incapacidade funcional severa na alta. Conclusão: O diagnóstico da DAC é um desafio, em especial por tratar-se de uma lesão de etiologia multifatorial. No entanto, seu reconhecimento precoce afetará diretamente o desfecho do paciente. Portanto, na presença de eventuais sintomas de alerta, faz-se necessário um meticuloso ques-tionamento sobre as últimas atividades do indivíduo. Este estudo alerta para a adoção de condutas profiláticas na ocorrência de fatores causais como hiperextensão cervical prolongada ou movimentos súbitos da cervical. (AU)


ABSTRACT: Introduction: Carotid artery dissection (CAD) has the ischemic stroke as one of the main repercussions in pre-viously healthy young individuals. It is common that in traumatic CAD, as in automobile accidents, the patient is subjected to a more complex investigation with imaging exams. These, allow an early diagnosis and, therefore, a treatment, reducing the chances of sequelae. However, non-traumatic causes with CAD outcomes have already been reported, such as dental causes. Objective: To contribute to the diagnostic valuation of non-traumatic CAD and subsequent stroke prophylaxis. Methods: We report a case of non-aneurysmatic dissection of the internal carotid arteries (ICA) after a dental procedure with evolution to bilateral stroke outcome in a 52-year-old patient. Results: Due to the strong association of CAD with traumatic factors, in a first contact with the patient there was no suspicion of CAD or stroke (absence of focal deficit). However, late, ICA occlusion on the left and stenosis on the right ICA were identified, resulting in two strokes and severe functional disability at discharge. Conclusion:The diagnosis of CAD is a challenge, especially since it is a multifactorial lesion. However, its early recognition will directly affect the patient's outcome. Therefore, in the presence of any warning symptoms, meticulous questioning about the individual's latest activities is necessary. This study alerts to the adoption of prophylactic conducts in the occurrence of causal factors such as prolonged cervical hyperextension or sudden movements of the cervical. (AU)


Subject(s)
Humans , Female , Middle Aged , Carotid Artery, Internal, Dissection , Stroke , Dental Implantation , Ischemic Stroke
5.
Medicina UPB ; 40(2): 22-32, 13 oct. 2021. tab, Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1342177

ABSTRACT

Objetivo: mejorar la independencia funcional de los pacientes con enfermedad vascular cerebral (EVC) es uno de los objetivos que se plantean los equipos de rehabilitación física y cognitiva. Uno de los modelos que podría dar respuesta a este objetivo es el entrenamiento cognitivo de la memoria de trabajo (MT). Aunque esta estrategia se viene estudiando desde hace 20 años, aún es necesario realizar un estudio de revisión sistemática que permita conocer con claridad los efectos del entrenamiento cognitivo computarizado de la MT en el funcionamiento de la vida diaria en pacientes con EVC isquémica. Metodología: para ello, se creó una ecuación de búsqueda para aplicar en la base de datos Web of Science (WoS), en el rango temporal desde enero de 2010 a enero de 2019. Posteriormente, se realiza un análisis bibliométrico con el objetivo de identificar los autores y revistas más importantes sobre el tema de investigación. Finalmente, el reporte cronológico identifica la evolución y avances del impacto de los entrenamientos de la memoria de trabajo en la EVC. Resultados: se encontraron tres enfoques relacionados con: efectos de un programa de realidad virtual en las actividades de la vida diaria, efectos del entrenamiento de la MT en la plasticidad cerebral y efectos del entrenamiento cognitivo de la MT en las actividades de la vida diaria. Conclusión: se ha propuesto el desempeño cognitivo como uno de los componentes más importantes del funcionamiento en la vida diaria, particularmente la MT como mediador entre los programas de entrenamiento cognitivo y las habilidades funcionales. Los entrenamientos cognitivos reducen el deterioro cognitivo y el riesgo de demencia. Sin embargo, los beneficios de un entrenamiento cognitivo se limitan a dominios muy similares a los entrenados (transferencia cercana, más que lejana).


Objective: improving functional independence of patients with cerebrovascular disease has become one of the main goals for physical and cognitive rehabilitation teams. A well-known framework that addresses this issue is Working Memory Training. Although this model has been studied for more than twenty years, a systematic review on the effects of Working Memory Training after ischemic stroke and its impact on everyday functioning is still needed. Methodology: thus, a search equation has been proposed on Web of Science database from January 2010 to January 2019. Then, a bibliometric analysis presents the most important authors and journals in the research topic. Finally, a chronological report shows advanced research lines and effects of Working Memory Training in patients with cerebrovascular disease. Results:these findings showed 3 approaches related to the following: effects of virtual reality-based programs on everyday functioning, effects of Working Memory Training on brain plasticity, and effects of Working Memory Training on everyday life. Conclusion: cognitive performance has been proposed to be one of the most important components of functioning in daily life. Working Memory has been shown to strongly mediate between cognitive training and functional abilities. Cognitive training is asso-ciated with less cognitive decline and reduced risk of dementia. However, the benefits from cognitive training may be limited to highly similar domains (close transfer rather than far transfer).


Introdução: melhorar a independência funcional do paciente com doença cerebrovas-cular (DCV) é um dos objetivos traçados pelas equipes de reabilitação física e cognitiva. Um dos modelos que poderia responder a esse objetivo é o treinamento cognitivo da memória de trabalho (MT).Objetivo: embora essa estratégia seja estudada há 20 anos, ainda é necessário realizar um estudo de revisão sistemática que nos permita conhecer claramente os efeitos do treinamento cognitivo computadorizado da MT no funcionamento da vida diária em pacientes com DCV isquêmica.Metodologia: para isso, foi criada uma equação de busca a ser aplicada na base de dados Web of Science (WoS), no período de janeiro de 2010 a janeiro de 2019. Pos-teriormente, é realizada uma análise bibliométrica a fim de identificar os autores mais importantes e periódicos sobre o tema de pesquisa. Por fim, o relatório cronológico identifica a evolução e a evolução do impacto do treino da memória de trabalho no CVS.Resultados: foram encontradas três abordagens relacionadas a: efeitos de um programa de realidade virtual nas atividades da vida diária, efeitos do treinamento da MT na plas-ticidade cerebral e efeitos do treinamento cognitivo da MT nas atividades da vida diária.Conclusão: o desempenho cognitivo tem sido proposto como um dos componentes mais importantes do funcionamento na vida diária, particularmente a MT como media-dor entre programas de treinamento cognitivo e habilidades funcionais. O treinamento cognitivo reduz o declínio cognitivo e o risco de demência. No entanto, os benefícios do treinamento cognitivo são limitados a domínios muito semelhantes aos treinados (transferência próxima, em vez de distante).


Subject(s)
Humans , Cerebrovascular Disorders , Activities of Daily Living , Cognitive Dysfunction , Virtual Reality , Ischemic Stroke , Functional Status , Neuronal Plasticity
6.
Rev. bras. neurol ; 57(3): 5-10, jul.-set. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1342495

ABSTRACT

INTRODUÇÃO: À medida que a população envelhece e a expectativa de vida aumenta, a incidência global e a prevalência de AVC isquêmico tendem a aumentar significativamente. Nesse contexto, surge a necessidade de avaliar novos marcadores preditores de mortalidade, como a contagem absoluta de monócitos, relação linfócitos sobre monócitos, relação neutrófilos sobre linfócitos e níveis de proteína C reativa ultrassensível, que além de serem de fácil acesso e baixo custo, sugerem indicar desfecho no paciente com AVC agudo. OBJETIVOS: o objetivo deste estudo foi avaliar a associação dos marcadores inflamatórios com a mortalidade de pacientes com AVC isquêmico. MÉTODOS: trata-se de um estudo retrospectivo observacional a partir de prontuários eletrônicos e exames laboratoriais de pacientes com AVC isquêmico em uma unidade hospitalar de Cascavel/PR. Uma análise estatística descritiva foi conduzida para determinar o perfil dos pacientes segundo o desfecho e aplicado um modelo de regressão logística para verificar as variáveis associadas a mortalidade. Foram considerados significativos apenas os dados com p-valor <0,05. RESULTADOS: Dos 65 pacientes que foram admitidos no estudo, 50 receberam alta hospitalar e 15 foram a óbito no hospital. Entre os marcadores inflamatórios, a relação de neutrófilos sobre linfócitos (OR 1,55; p-valor <0,01) mostrou-se significativamente associada a maior chance de óbito. Os pacientes que faleceram apresentaram níveis superiores de PCR ultrassensível, maior contagem absoluta de monócitos, relação linfócitos sobre monócitos diminuída, e relação neutrófilos sobre linfócitos elevada. CONCLUSÃO: a relação de neutrófilos sobre linfócitos elevada pode estar significativamente associada ao desfecho desfavorável após um AVC isquêmico


IINTRODUCTION: As the population ages and life expectancy increases, the global incidence and prevalence of ischemic stroke tends to rise significantly. In this context, the need arises to evaluate new predictive markers of mortality, such as absolute monocyte count, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) levels which, besides being easily accessible and affordable, manage to predict the outcome in patients with acute stroke. OBJECTIVES: the aim of this study was to evaluate the association between inflammatory markers and the mortality in ischemic stroke patients. METHODS: this is a retrospective observational study based on the analysis of electronic medical records and laboratory tests of in-patients who suffered an ischemic stroke in Cascavel/PR. A descriptive statistical analysis was conducted to determine patients´ profile according to the outcome and a logistic regression model was applied in order to verify the variables associated with mortality. Only data with a p-value <0,05 was considered. RESULTS: Out of the 65 patients who suffered an ischemic stroke included in the study, 50 were discharged and 15 died in hospital. Among the inflammatory markers, the neutrophil-tolymphocyte ratio (OR 1.55; p-value <0,01) was associated with a greater chance of death. Patients who died presented with higher levels of ultra-sensitive CRP, higher absolute monocyte count, lower lymphocyte-to-monocyte ratio and higher neutrophil-to- lymphocyte ratio. CONCLUSION: the elevated neutrophil-to-lymphocyte ratio may be significantly associated with negative outcomes following an ischemic stroke


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ischemic Stroke/mortality , Ischemic Stroke/epidemiology , Inflammation/blood , Blood Cell Count , Comorbidity , Prevalence , Retrospective Studies , Risk Factors
7.
Rev. bras. neurol ; 57(1): 13-16, jan.-mar. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1177695

ABSTRACT

FUNDAMENTO: O Acidente Vascular Cerebral é uma das principais causas de morte no Brasil. O conhecimento sobre a etiologia do AVC é fundamental para uma adequada abordagem dessa doença. OBJETIVO: Avaliar se existe relação entre o subtipo de AVC isquêmico com o prognóstico dele e os fatores de risco. MÉTODOS: Foram avaliados 86 casos de AVC isquêmico no Ambulatório de Neurologia do Hospital Universitário da cidade de Canoas-RS, no período de outubro de 2018 a novembro de 2019. Foi analisada a relação do prognóstico (mRankinS) com fatores de risco de AVC e TOAST. RESULTADOS: Avaliando 86 pacientes com 60.5 (±10.1) anos (40 homens), identificamos que oclusão de pequenos vasos apresentou melhor prognóstico (p: 0.031) e cardioembolia um pior prognóstico de acordo com mRankinS (p< 0.001). Diabetes mellitus também apresentou um pior prognóstico (p: 0.021). CONCLUSÃO: Pacientes com AVC isquêmico secundário a oclusão de pequenos vasos apresentam melhor prognóstico de acordo com mRs. Mecanismos cardioembólicos e a presença de DM estão associados com o pior prognóstico neurológico


BACKGROUND: Stroke is one of the main causes of death in Brazil. Knowledge about the etiology of stroke is essential for an adequate approach to this disease. OBJECTIVE: To assess whether there is a relationship between the ischemic stroke subtype and its prognosis and risk factors. METHODS: 86 cases of ischemic stroke were evaluated at the Neurology Outpatient Clinic of the University Hospital in the city of Canoas-RS, from October 2018 to November 2019. The relationship between prognosis (mRankinS) and stroke risk factors and TOAST. RESULTS: Evaluating 86 patients aged 60.5 (±10.1) years (40 men), we identified that small vessel occlusion had a better prognosis (p: 0.031) and cardioembolism a worse prognosis according to mRankinS (p <0.001). Diabetes mellitus also had a worse prognosis (p: 0.021). CONCLUSION: Patients with secondary ischemic stroke small vessel occlusion have a better prognosis according to mRs. Cardioembolic mechanisms and the presence of DM are associated with a worse neurological prognosis


Subject(s)
Humans , Male , Female , Middle Aged , Ischemic Stroke/diagnosis , Ischemic Stroke/physiopathology , Prognosis , Risk Factors , Diabetes Mellitus , Ischemic Stroke/therapy , Hypertension
8.
Rev. Assoc. Med. Bras. (1992) ; 67(1): 71-76, Jan. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287788

ABSTRACT

SUMMARY OBJECTIVE: Myocardial speckle-tracking echocardiography can detect subtle abnormalities in the left atrial function. In this study, we aimed to investigate the relationship between left atrial myocardium and tissue function n assessed by two-dimensional speckle-tracking echocardiography and the National Institutes of Health Stroke Scale score in patients with acute ischemic stroke. METHOD: The study was composed of 80 patients (45 men, 35 women, mean age: 67±15 years) with acute ischemic stroke. The patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale score (group 1, National Institutes of Health Stroke Scale score < 16; group 2, National Institutes of Health Stroke Scale score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac functions were evaluated using two-dimensional speckle-tracking echocardiography within 48 hours from admission to the neurology care unit. RESULTS: There were no significant differences between the patients' clinical parameters. Left ventricular ejection fraction was significantly higher in group 1 than in group 2 (59.2±5.6 to 51.4±6.3, p=0.024). Left atrial longitudinal strain was significantly higher in group 1 than in group 2 (34.48±9.73 to 26.27±7.41, p=0.019). There were no significant differences between other echocardiographic parameters. CONCLUSION: Our results suggest that left atrial longitudinal strain is associated with stroke severity during admission in patients with acute ischemic stroke. Left atrial longitudinal strain is an indicator of left atrial myocardial function.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Stroke/diagnostic imaging , Ischemic Stroke , Stroke Volume , Atrial Function, Left , Ventricular Function, Left , Middle Aged
9.
Article in English | WPRIM | ID: wpr-922760

ABSTRACT

Danshen-Chuanxiongqin Injection (DCI) is a commonly used traditional Chinese medicine for the treatment of cerebral ischemic stroke in China. However, its underlying mechanisms remain completely understood. The current study was designed to explore the protective mechanisms of DCI against cerebral ischemic stroke through integrating whole-transcriptome sequencing coupled with network pharmacology analysis. First, using a mouse model of cerebral ischemic stroke by transient middle cerebral artery occlusion (tMCAO), we found that DCI (4.10 mL·kg


Subject(s)
Brain Ischemia/genetics , Drugs, Chinese Herbal , Humans , Infarction, Middle Cerebral Artery/genetics , Ischemic Stroke , Myeloid Differentiation Factor 88/genetics , NF-kappa B/metabolism , Stroke/genetics , Toll-Like Receptor 2 , Toll-Like Receptor 4/metabolism
10.
Article in English | WPRIM | ID: wpr-922107

ABSTRACT

OBJECTIVE@#To evaluate the efficacy and safety of Yangyin Yiqi Huoxue Granule (, YYHG) in the treatment of ischemic stroke (IS) patients with qi-yin deficiency and blood stasis syndrome (QYDBSS), and to explore its effective dosage.@*METHODS@#The total of 288 patients were randomly assigned to the YYHG high-dose, YYHG low-dose, positive control (administered Xiaoshuantong Granule, XSTG, ), or placebo control (administered inert granule) groups (72 cases per group) by software-drived competitive block randomization. The trial was conducted for a 28-day period, with a 180-day follow-up period. The primary outcome was the comprehensive curative evaluation, and secondary outcomes were the National Institute of Health Stroke Scale (NIHSS) score, Barthel activities of daily living (ADL) index score, the quality of life index (QLI) score, and the Chinese medicine syndrome (CMS) score. All analyses were done on an intention-to-treat basis. The clinical safety was also assessed.@*RESULTS@#The total of 288 participants were recruited between June 1, 2008 and September 30, 2009, and 287 patients received intervention; the treatment groups were well balanced at baseline. The comprehensive cure rates of YYHG high-dose, low-dose, positive and placebo control groups were 63.38%, 31.94%, 36.11% and 6.14%, respectively; there was a statistical difference between the two groups (P<0.01), while the high-dose YYHG treatment group was significantly higher than the other 3 groups (P<0.01). The improvement of NIHSS, ADL, QLI and CMS scores of the YYHG high-dose and low-dose groups was significantly better than that of the positive control group and the placebo control group (P<0.05). In terms of improving the classification of the NIHSS scale and the assessment of the ADL scale, the YYHG high-dose group was significantly better than the other three groups (P<0.05), and the YYHG low-dose group was better than the placebo control group (P<0.01). At the same time, except for the QLI score, the high-dose group was better than the low-dose group (P<0.05). In terms of safety, adverse reactions after YYHG treatment were generally mild (3.78%), and no serious adverse reactions have been reported.@*CONCLUSION@#YYHG is safe and effective in the treatment of IS patients with QYDBSS.


Subject(s)
Activities of Daily Living , Brain Ischemia/drug therapy , Humans , Ischemic Stroke , Qi , Quality of Life , Stroke/drug therapy , Yin Deficiency
11.
Article in Chinese | WPRIM | ID: wpr-921720

ABSTRACT

The present study aimed to systematically evaluate the efficacy and safety of Ginkgo biloba extract 50(GBE50) in the treatment of ischemic stroke. The databases including CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library were searched for randomized controlled trial(RCT) of GBE50 for the treatment of ischemic stroke reported between database inception and May 2020. The methodological quality of the included RCTs was evaluated via the Cochrane risk of bias tool. The RevMan 5.4 was used for Meta-analysis. Sixteen RCTs were included, involving 1 615 patients with acute ischemic stroke. Most of the included RCTs reported the methods of random sequence generation, but only two performed the concealment of random sequence. All RCTs failed in blinding. Two RCTs reported the information of cases lost to follow-up and drop-outs. Since the number was small, the baselines of groups remained balanced. All RCTs reported key outcomes of ischemic stroke, which made selective reporting bias in a low risk. Meta-analysis results revealed that GBE50 combined with routine therapies could effectively lower the score of the National Institutes of Health stroke scale(NIHSS) and restore cognitive function and daily activity in ischemic stroke patients. Compared with routine therapies, the combination is advantageous in treating patients with ischemic stroke. However, high-quality multicenter RCTs with large sample sizes are still required for verification.


Subject(s)
Brain Ischemia/drug therapy , Ginkgo biloba , Humans , Ischemic Stroke , Multicenter Studies as Topic , Plant Extracts , Stroke/drug therapy
12.
Article in Chinese | WPRIM | ID: wpr-921695

ABSTRACT

With the widespread application of next-generation sequencing(NGS), especially 16 S rRNA and shotgun sequencing, researchers are no longer troubled with massive data on the gut microbiota, and the correlation between the gut microbiota and the brain(central nervous system) has been gradually revealed. Research on the microbiota-gut-brain axis(MGBA) based on the gut microbiota have provided insights into the exploration of the pathogenesis and risk factors of ischemic stroke(IS), a cerebrovascular disease with high disability and mortality rates, and also facilitate the selection of therapeutic targets of this class of drugs. This study reviewed the application of NGS in the study of gut microbiota and the research progress of MGBA in recent years and systematically collated the research papers on the correlation between IS and gut microbiota. Furthermore, from the bi-directional regulation of MGBA, this study also discussed the high-risk factors of IS under the dysregulation of gut microbiota and the pathophysiological changes of gut microbiota after the occurrence of IS and summarized the related targets to provide a reliable reference for the therapeutic research of IS from the gut microbiota.


Subject(s)
Brain , Gastrointestinal Microbiome , Humans , Ischemic Stroke , Stroke/genetics
13.
Acta Physiologica Sinica ; (6): 963-972, 2021.
Article in Chinese | WPRIM | ID: wpr-921301

ABSTRACT

Stroke is the second most common cause of death after cancer worldwide and a major cause of acquired disability in adults. Overwhelming majority of strokes are caused by cerebral ischemia and are classified as ischemic stroke. Microglia are the resident immune cells and play dual roles in response to ischemia injury in the central nervous system (CNS). On the one hand, microglia may contribute to tissue function recovery process by promoting inflammation resolution, cellular debris clearance, nerve regeneration and synapse remodeling. On the other hand, excessive activation of microglia aggravates nerve damage after ischemic injury. Here, we briefly describe the mechanism of microglia activation after stroke, and comprehensively review the dual role of microglia in neurodegeneration and regeneration after stroke. In-depth exploration of the cytotoxic and protective mechanisms of microglia will provide new targets and new strategies for stroke treatment.


Subject(s)
Brain Ischemia , Humans , Inflammation , Ischemic Stroke , Microglia , Stroke
14.
Chinese Medical Journal ; (24): 2666-2674, 2021.
Article in English | WPRIM | ID: wpr-921171

ABSTRACT

BACKGROUND@#Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h.@*METHODS@#We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0-1) at 90 days, the functional independence (defined as mRS scores 0-2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5-9.0 h or >9.0 h).@*RESULTS@#Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12-1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08-1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35-20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97-3.34).@*CONCLUSIONS@#Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.


Subject(s)
Administration, Intravenous , Aged , Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Humans , Ischemic Stroke , Stroke/drug therapy , Thrombolytic Therapy , Treatment Outcome
15.
Chinese Acupuncture & Moxibustion ; (12): 1084-1088, 2021.
Article in Chinese | WPRIM | ID: wpr-921014

ABSTRACT

OBJECTIVE@#To observe the efficacy difference between conventional needling depth and deep needling for dyspepsia after ischemic stroke.@*METHODS@#A total of 120 patients with dyspepsia after ischemic stroke were randomized into an observation group (60 cases, 4 cases dropped off) and a control group (60 cases, 3 cases dropped off). Basic treatment was given in the both groups. In the observation group, deep needling was applied at Zhongwan (CV 12), Tianshu (ST 25) and Liangmen (ST 21) for 60-70 mm, after even reinforcing-reducing manipulation of lifting-thrusting technique, the needles were withdrew to 35-50 mm. In the control group, the same acupoints as the observation group were selected and punctured for 25 mm. The needles were retained for 30 min, once a day, 6 times a week for 2 weeks in the both groups. The dyspepsia TCM symptom score was observed before treatment, 1 day and 1, 2 weeks into treatment, and the clinical efficacy was evaluated 2 weeks into treatment in the both groups.@*RESULTS@#The effective rate was 92.9% (52/56) in the observation group, which was superior to 78.9% (45/57) in the control group (@*CONCLUSION@#Conventional needling depth and deep needling can both improve the clinical symptoms in patients with dyspepsia after ischemic stroke, and deep needling has faster and better efficacy.


Subject(s)
Acupuncture Therapy , Brain Ischemia , Dyspepsia/therapy , Humans , Ischemic Stroke , Stroke/therapy
16.
Article in Chinese | WPRIM | ID: wpr-888240

ABSTRACT

Clinically, non-contrastive computed tomography (NCCT) is used to quickly diagnose the type and area of ​​stroke, and the Alberta stroke program early computer tomography score (ASPECTS) is used to guide the next treatment. However, in the early stage of acute ischemic stroke (AIS), it's difficult to distinguish the mild cerebral infarction on NCCT with the naked eye, and there is no obvious boundary between brain regions, which makes clinical ASPECTS difficult to conduct. The method based on machine learning and deep learning can help physicians quickly and accurately identify cerebral infarction areas, segment brain areas, and operate ASPECTS quantitative scoring, which is of great significance for improving the inconsistency in clinical ASPECTS. This article describes current challenges in the field of AIS ASPECTS, and then summarizes the application of computer-aided technology in ASPECTS from two aspects including machine learning and deep learning. Finally, this article summarizes and prospects the research direction of AIS-assisted assessment, and proposes that the computer-aided system based on multi-modal images is of great value to improve the comprehensiveness and accuracy of AIS assessment, which has the potential to open up a new research field for AIS-assisted assessment.


Subject(s)
Alberta , Brain Ischemia/diagnostic imaging , Humans , Ischemic Stroke , Stroke/diagnostic imaging , Tomography, X-Ray Computed
17.
Article in Chinese | WPRIM | ID: wpr-888040

ABSTRACT

To explore the potential effective components and mechanism of Zhishe Tongluo Capsules in the treatment of ischemic stroke via network pharmacology, molecular docking and cellular experiment. The chemical constituents of Zhishe Tongluo Capsules were found by TCMSP, BATMAN-TCM and literatures. The constituents-target network was predicted by BATMAN-TCM database. Key words such as cerebral stroke, ischemic stroke and cerebral ischemic stroke were used to search ischemic stroke related targets, and then Venny Map was constructed based on the targets of traditional Chinese medicine and the targets of ischemic stroke. The overlapping targets were imported into STRING database to establish the interaction network. Furthermore, the core targets were screened out by Cytoscape software. Go and KEGG enrichment analysis were performed through DVIAD database. The results showed a total of 193 potential chemical constituents, 985 drug targets and 6 035 disease targets. There were 631 potential targets, 44 core targets and 55 potential active components for treating ischemic stroke through Venny mapping. GO enrichment analysis mainly involved response to hypoxia and positive regulation of ERK1/ERK2. KEGG pathway enrichment analysis mainly involved cholinergic synapse, cAMP signaling pathway, and calcium signaling pathway. Molecular docking data revealed that TP53, EGFR, IL6, INS, TNF and SRC had a good capability to bind with their corresponding active components. To ensure the protective effect Zhishe Tongluo Capsules on the inflammation reaction, an in vitro model of lipopolysaccharide(LPS)-induced RAW264.7 cells was built. The contents of IL-1α, IL-1β, IL-6 and TNF-α in the supernatant were significantly decreased by enzyme linked immunosorbent assay(ELISA). The findings suggested that Zhishe Tongluo Capsules could prevent the injury of ischemic stroke by inhibiting the inflammation.


Subject(s)
Brain Ischemia/drug therapy , Capsules , Drugs, Chinese Herbal , Humans , Ischemic Stroke , Medicine, Chinese Traditional , Molecular Docking Simulation , Stroke/drug therapy
18.
Article in Chinese | WPRIM | ID: wpr-888035

ABSTRACT

There have been many clinical trials, systematic reviews/Meta-analysis proving that Xingnaojing Injection has a good clinical efficacy in treatment of cerebral ischaemic stroke, but with fewer comprehensive descriptions. In this study, an overview of systematic reviews/Meta-analysis of Xingnaojing Injection in treating cerebral ischaemic stroke was performed to provide current situation of evidences and basis for clinical practice. CNKI, Wanfang, VIP, CBM, EMbase, PubMed, Cochrane Library, Web of Science were retrieved through computers. A total of 6 literatures were included in this study. By AMSTAR-2 checklist and GRADE, the quality of included systematic reviews and the efficacy of Xingnaojing Injection were evaluated. The results of AMSTAR-2 checklist showed an extremely low quality for all of the 6 systematic reviews. According to the results of GRADE evaluation, among 55 outcomes, there were 2 outcomes with a medium quality, 4 outcomes with a low quality and 49 outcomes with an extremely low quality. The 6 systematic reviews reached a consistent conclusion that Xingnaojing Injection was effective in the treatment of cerebral ischaemic stroke. This therapy could improve the total efficacy, neurological deficit scores, hemodynamic and hemodynamic parameters. However, the methodolo-gical quality of all literatures was extremely low. The evidence levels of outcomes were between extremely low to medium. The effectiveness of Xingnaojing Injection in the treatment of cerebral ischaemic stroke still needs to be further verified by more high-quality studies. In the future, relevant clinical studies and systematic reviews/Meta-analysis shall be carried out in a strict accordance with relevant regulations.


Subject(s)
Brain Ischemia/drug therapy , Drugs, Chinese Herbal , Humans , Ischemic Stroke , Stroke/drug therapy , Systematic Reviews as Topic
19.
Article in Chinese | WPRIM | ID: wpr-888033

ABSTRACT

To analyze the use of outcome indicators of randomized controlled trial(RCT) of acupuncture in the treatment of acute ischemic stroke in recent three years, so as to provide a basis for building a study on the core outcome indicators for the treatment of acute ischemic stroke with acupuncture. The RCTs of acupuncture treatment for acute ischemic stroke in recent three years were collec-ted through computer retrieval of eight Chinese and English databases and two clinical trial registries at home and abroad. Literature was screened out, and data was extracted. Risk of assessment bias tool Cochrane 6.1 was used for bias risk assessment, outcome indicators were summarized and analyzed. A total of 47 RCTs were included, and 3 studies were trials registration scheme. Outcome indicators were divided into 6 categories according to functional attributes, namely physical symptoms/signs, physical and chemical examination, quality of life, traditional Chinese medicine symptoms/syndromes, safety events and long-term prognosis. The study found that in addition to the common problems in previous studies covered by the status quo of outcome indicators selection of RCT of acupuncture in the treatment of acute ischemic stroke, there were also the other problems as follows: emphasis on macroscopic efficacy indicators but neglect of acupuncture specific indicators, lack of characteristic indicators and economic indicators of traditional Chinese medicine therapy, and unification of indicators measurement tool and measurement time point. In the future, the outcome indicators set for the treatment of acute ischemic stroke with acupuncture shall be established, and the core outcome indicators set shall be in line with the characteristics of traditional Chinese medicine treatment.


Subject(s)
Acupuncture Therapy , Brain Ischemia/therapy , Humans , Ischemic Stroke , Quality of Life , Randomized Controlled Trials as Topic , Stroke/therapy , Treatment Outcome
20.
Article in Chinese | WPRIM | ID: wpr-879095

ABSTRACT

The aim of this paper was to explore the key genes and pathogenesis of ischemic stroke(IS) by bioinformatics, and predict the potential traditional Chinese medicines for IS. Based on the gene-chip raw data set of GSE22255 from National Center of Biotechnology Information(NCBI), the article enrolled in 20 patients with ischemic stroke and 20 sex-and age-matched controls, and differentially expressed genes(DEGs) were screened based on R language software. The DAVID tool and R language software were used to perform gene ontology(GO) biological process enrichment analysis and Kyoto encyclopedia of genes and gnomes(KEGG) pathway enrichment analysis. The DEGs were imported into STRING to construct a protein-protein interaction network, and the Molecular Complexity Module(MCODE) plug-in of Cytoscape software was used to visualize and analyze the key functional modules. Moreover, the core genes and the medical ontology information retrieval platform(Coremine Medical) were mapped to each other to screen the traditional Chinese medicines and construct drug-active ingredient-target network. Compared with healthy controls, 14 DEGs were obtained, of which 12 genes were up-regulated and 2 genes were down-regulated. DEGs were mainly involved in immune response, inflammatory process, signal transduction, and cell proliferation regulation. The interleukin-17(IL-17), nuclear factor kappaB(NF-κB), tumor necrosis factor(TNF), nucleotide binding oligomerization domain(NOD)-like receptor and other signaling pathways were involved in KEGG pathway enrichment analysis. The key modules of the DEGs-encoding protein interaction network mainly focused on 7 genes of TNF, JUN, recombinant immediate early response 3(IER3), recombinant early growth response protein 1(EGR1), prostaglandin-endoperoxide synthase 2(PTGS2), C-X-C motif chemokine ligand 8(CXCL8) and C-X-C motif chemokine ligand 2(CXCL2), which were involved in biological processes widely such as neuroinflammation and immunity. TNF and JUN were the key nodes in this module, which might become potential biological markers for diagnosis and prognosis evaluation of IS. The potential traditional Chinese medicines for the treatment of IS includes Salviae Miltiorrhizae Radix et Rhizoma, Croci Stigma, Scutellariae Radix, and Cannabis Fructus. The occurrence of stroke was the result of multiple factors. Dysregulation of genes and pathways related to immune regulation and inflammation may be the key link for the development of IS. This study provided research direction and theoretical basis for further exploring the mechanism of action of traditional Chinese medicine in the treatment of IS and searching for potential drug targets.


Subject(s)
Brain Ischemia , China , Computational Biology , Gene Expression Profiling , Humans , Ischemic Stroke , Medicine, Chinese Traditional , Stroke/genetics
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