Monitoring the Outcome of Leprosy Using Leprosy Neuropathy Scale: A Preliminary Study

The disability and progress of leprosy patients is monitored by the WHO disability grading system which has limited sensitivity in leprous neuropathy. This study aims to report the spectrum of leprosy patients at a tertiary care neurology service and compare WHO grading, modified Rankin Scale (mRS) and Leprosy Neuropathy Scale (LNS) in monitoring the treatment outcome. The patients with leprosy diagnosed as per WHO criteria were subjected to medical history and clinical examination. Their disability was graded as per WHO grading scale, modified Rankin scale (mRS) and LNS. These parameters were repeated and compared after six months of multiple drug therapy (MDT). Thirty-eight patients with leprosy, aged 40 (`5-80) years, 33 of whom were males have been evaluated. The duration of symptoms was 24 (91-120) months. Mononeuropathy was present in 14, mononeuropathy multiplex in 24, trophic ulcer in two, claw hand in 11, wrist drop in two, foot drop in four, facial palsy in one, Charcot’s joint in one and lepra reaction in seven patients. Their disability as per WHO grade 1 and 2 was in 19 patients each. After 6 months of MDT, WHO grade improved in two patients, mRS revealed improvement in seven and LNS in nine patients. LNS- a clinical scale, seems more effective and easier to use for monitoring the progress/ outcome of neuropathy in leprosy patients and may complement the WHO grading scale

The effect of smoking in the development of stroke in young patients 19 to 45 years old: A case-control study

Introduction@#The increasing incidence of stroke in young adults has been a growing concern, which is why research studies were generated to find out the risk factors contributing to the development of this disease. This study investigated the dose-dependent effect of smoking in the development of stroke in the young ages (19-45 years).@*Methods@#A case-control retrospective study was conducted using electronic and printed records of the patients admitted to Amang Rodriguez Memorial Medical Center last 2017-2018. There were 275 patients included in the study. The smoking status and pack-years cigarette smoking of the subjects were recorded and were correlated with the duration of hospitalization and the Modified Rankin Scale (MRS). Results were analyzed using student’s t-test, ANOVA, and Pearson’s Correlation.@*Result@#The prevalence of stroke was higher in men than in women. The ORs (95% CI) of stroke were significant in current cigarette smoking at 2.71 (CI: 1.6398 to 4.4943). Compared with non-smokers and those who smoked 1 to 9 pack years, the OR of stroke was significantly increased for those who smoked 10 to 19, and ≥ 20 cigarettes per day with OR of 14.0765 (4.10 to 48.35), and 31.5854 (1.82 to 548.97), respectively (p= 0.032 for linear trends). There was a weak positive linear correlation between pack years of cigarette smoking (1-9, 10-19, >20 pack years) and days of hospitalization (r= 0.28; p for trend = 0.0168). There was also a strong positive linear correlation between stroke outcome using the Modified Rankin Scale and pack years of cigarette smoking (r = 0.72; P for trend = 0.001). This study shows an increase in the odds of stroke in current cigarette smokers with a dose-dependent relationship in its outcome.@*Conclusion@#Smoking is a significant risk factor for stroke with a dose-dependent effect on its outcome. Furthermore, quitting smoking significantly decreases the risk of developing stroke.

Study of risk factors associated with prognosis in patients with aortic acute cerebral infarction / 中国综合临床

Objective:To explore the risk factors associated with a three-month prognosis in patients with aortic acute cerebral infarction.Methods:A prospective study was conducted on 191 patients with aorthropathic acute cerebral infarction included in the Department of Neurology from June 2018 to December 2019, and the patients were divided into good prognosis group (153 cases) and poor prognosis group (38 cases) according to the MRS score of the patient's 3-month prognosis, and the general data, past medical history and blood pressure variability evaluation index (BPV) between the two groups were correlated analysis. The t-test was used to compare the measurement data with normal distribution, the χ 2 test was used to compare the counting data, and the Logistic regression analysis was used to analyze the risk factors. Results:The proportion of patients with diabetes history in the poor prognosis group (20.3% (31/153)), admission NIHSS score ((3.03±2.01) points), standard deviation (SD) ((12.06±4.46) mmHg) and coefficient of variation (CV) ((8.61±3.08)%) of systolic blood pressure at 24 h were lower than those in the good prognosis group (47.4% (18/38), (5.61±3.84) points, (14.75±3.46) mmHg, (10.41±2.18)%), the differences were statistically significant (the statistical values were χ 2=11.73, t=4.01, t=3.46, t=3.38; P values were 0.001, <0.001, 0.001, and 0.001, respectively). Because 24 h systolic blood pressure SD and 24 h systolic blood pressure CV had obvious collinearity, they were respectively included in the Logistic regression model. Taking diabetes history, NIHSS score and 24 h systolic blood pressure SD into the variables, the multivariate Logistic regression results of adverse prognostic risk factors in patients with acute cerebral infarction showed that the history of diabetes mellitus ( OR=3.649, 95% CI: 1.545-8.648, P=0.003), NIHSS score ( OR=1.472, 95% CI: 1.247-1.725, P<0.001) and 24 h systolic blood pressure SD ( OR=1.201, 95% CI: 1.085-1.336, P<0.001). Taking diabetes history, NIHSS score and 24 h systolic blood pressure CV into consideration, multivariate Logistic regression results of adverse prognostic risk factors in patients with acute cerebral infarction showed that the history of diabetes mellitus ( OR=4.695, 95% CI: 1.873-11.766, P=0.001), admission NIHSS score ( OR=1.922, 95% CI: 1.513-2.441, P<0.001) and 24 h systolic blood pressure CV ( OR=1.220, 95% CI: 1.045-1.425, P=0.012). All are independent risk factors influencing the prognosis of patients. Conclusion:The effect of 24 h systolic blood pressure SD and 24 h systolic blood pressure CV on patient prognosis was more valuable in clinical prediction, and the prognosis value of controlling blood glucose levels in patients with diabetes was higher in patients with cerebral infarction.

Rehabilitación oportuna: un importante coadyuvante para el manejo del paciente crítico en unidades de terapia intensiva / Timely rehabilitation: an important adjuvant for management of the critical patient in intensive therapy units / Reabilitação oportuna: um coadjuvante importante para o tratamento de pacientes críticos em unidades de terapia intensiva

Resumen: Introducción: Las unidades de terapia intensiva (UTI) se centran principalmente en el soporte vital y el tratamiento de pacientes críticamente enfermos, pero hay muchos supervivientes con complicaciones, como trastornos musculares generalizados, discapacidad funcional y reducción de la calidad de vida tras el alta hospitalaria, como resultado de estancias prolongadas en estas unidades. En México, a pesar de los beneficios ya reportados, la terapia de rehabilitación en unidades de cuidados intensivos es una estrategia que se lleva a cabo con muy baja frecuencia. El objetivo de este estudio fue demostrar la eficacia de la rehabilitación temprana en una Unidad de Terapia Intensiva. Material y métodos: Estudio de cohorte, prospectivo, observacional con grupos paralelos, conformado por pacientes ingresados a la Unidad de Terapia Intensiva que recibieron durante su estancia terapia de rehabilitación y un grupo control, pareado por edad y sexo. La eficacia de la intervención fue determinada, por la mejoría identificada por medio de la escala modificada de Rankin, evaluada al ingreso y al egreso del paciente de Unidad de Terapia Intensiva. Resultados: Se estudió un total de 168 individuos, 94 conformaron la cohorte de intervención y 74 integraron el grupo control. El promedio de edad fue de 64 años y los grupos se equilibraron por género. Los datos obtenidos en este estudio demuestran que la intervención fisioterapéutica interviene en la recuperación del paciente dentro de la UTI, como un factor protector (RR 0.69 IC95% 0.61-0.81) y del mismo modo se aprecia que aquellos que no recibieron terapia de rehabilitación mostraron mayor deterioro en las condiciones de egreso que aquellos que fueron intervenidos, con diferencias hasta de dos puntos en la escala de Rankin (p < 0.001). Conclusiones: Aquí comprobamos que la rehabilitación es una excelente opción como tratamiento coadyuvante en el paciente ingresado en la Unidad de Terapia Intensiva. La decisión de utilizarla como un procedimiento de rutina, podría impactar de manera positiva en la calidad de vida del paciente recuperado de una condición que eventualmente mantuvo en riesgo su vida. Nosotros proponemos la integración de este tipo de manejo en guías de práctica clínica, normalizadas en todas las Unidades de Terapia Intensiva, dando la oportunidad de elevar las expectativas en los cuidados del paciente crítico, más allá del soporte vital.

Abstract: Introduction: Intensive care units focus primarily on life support and treatment of critically ill patients, but there are many survivors with complications, such as generalized muscle disorders, functional disability, and reduced quality of life after discharge from the hospital, as a result of extended stays in these units. In Mexico, despite the benefits already reported, physiotherapeutic intervention in intensive care units is a strategy that is carried out with very low frequency. The objective of this study was to demonstrate the efficacy of early rehabilitation in an intensive care unit. Material and methods: A prospective, observational cohort study with parallel groups, made up of patients admitted to the Intensive Care Unit who received rehabilitation therapy during their stay and a control group, matched by age and sex. The efficacy of the intervention was determined by the improvement identified by means of the modified Rankin scale, evaluated at admission and discharge of the ICU patient. Results: A total of 168 individuals were studied, 94 made up the intervention cohort and 74 made up the control group. The average age was 64 years and the groups were balanced by gender. The data obtained in this study demonstrate that the physiotherapeutic intervention intervenes in the recovery of the patient within the ICU, as a protective factor (RR 0.69 CI95% 0.61-0.81) and in the same way it is appreciated that those who did not receive therapy Rehabilitation patients showed greater deterioration in discharge conditions than those who underwent surgery, with differences of up to two points on the Rankin scale (p < 0.001). Conclusions: Here we verify that rehabilitation is an excellent option as adjuvant treatment in the patient admitted to the Intensive Care Unit. The decision to use it as a routine procedure could have a positive impact on the quality of life of the patient recovered from a condition that eventually kept his life at risk. We propose the integration of this type of management in clinical practice guidelines, standardized in all intensive care units, giving the opportunity to raise expectations in the care of the critical patient, beyond life support.

Resumo: Introdução: As unidades de terapia intensiva estão voltadas principalmente para suporte de vida e tratamento de pacientes críticos, mas há muitos sobreviventes com complicações, como distúrbios musculares generalizados, incapacidade funcional e redução da qualidade de vida após a alta hospitalar, como resultado de internações prolongadas em essas unidades. No México, apesar dos benefícios já relatados, a terapia de reabilitação em unidades de terapia intensiva é uma estratégia realizada com pouca frequência. O objetivo deste estudo foi demonstrar a eficácia da reabilitação precoce em unidade de terapia intensiva. Material e métodos: Estudo prospectivo, observacional, de corte com grupos paralelos, composto por pacientes internados na Unidade de Terapia Intensiva que receberam terapia de reabilitação durante a internação e um grupo controle, pareados por idade e sexo. A eficácia da intervenção foi determinada pela melhora identificada por meio da escala de Rankin modificada, avaliada na admissão e alta do paciente da UTI. Resultados: Foram estudados 168 indivíduos, sendo 94 da coorte intervenção e 74 do grupo controle. A média de idade foi de 64 anos e os grupos foram balanceados por gênero. Os dados obtidos neste estudo mostram que a intervenção fisioterapêutica intervém na recuperação do paciente dentro da UTI, como fator de proteção (RR 0.69 IC95% 0.61-0.81) e da mesma forma avalia-se que aqueles que não receberam terapia de reabilitação apresentaram maior deterioração das condições de alta do que aqueles que foram reabilitados, com diferenças de até 2 pontos na escala Rankin (p < 0.001). Conclusões: Aqui verificamos que a reabilitação é uma excelente opção como tratamento coadjuvante em pacientes internados em Unidade de Terapia Intensiva. A decisão de utilizá-lo como procedimento de rotina pode ter um impacto positivo na qualidade de vida do paciente recuperado de uma condição que acabou por colocar sua vida em risco. Propomos a integração deste tipo de gestão nas diretrizes da prática clínica, padronizadas em todas as unidades de terapia intensiva, dando a oportunidade de elevar as expectativas no cuidado ao paciente crítico, além do suporte de vida.

Independência funcional após acidente vascular cerebral (AVC) isquêmico em relação à fisiopatologia de acordo com TOAST / Functional independence after ischemic stroke in relation to pathophysiology according to TOAST

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

A follow-up study on the prognosis of pediatric arterial ischemic stroke / 中国小儿急救医学

Objective:To investigate the prognosis of pediatric arterial ischemic stroke(PAIS).Methods:We retrospectively analyzed the clinical data of patients aging from 1 month to 18 years old who were diagnosed with PAIS at the Emergency Department of Beijing Children′s Hospital from July 2015 to April 2020.We used the modified Rankin scale(MRS)to evaluate patients.We analyzed their recovery of neurological function, mortality rates, and the recurrence of PAIS, while statistically calculating the risk factors leading to disability and death caused by PAIS.Results:A total of 101 children with PAIS were involved.During the follow-up period, 32.7%(33/101)had no obvious neurological sequelae(MRS 0), and 24.8%(25/101)had mild symptoms that did not affect the patients′daily life(MRS 1). The proportion of mild disability(MRS 2)and moderate to severe disability(MRS 3-5)were 13.9%(14/101)and 9.9%(10/101), respectively.Notably, 18.8%(19/101)of the patients died during the follow-up period, and PAIS-related fatality rate was 7.9%.Of the 49 patients with MRS score of 1-5, 89.8%(44/49)had dyskinesia, 16.3%(8/49)had language disorder, 10.2%(5/49)had epilepsy, 10.2%(5/49)had intellectual impairment, and 4.1%(2/49)had memory impairment.Four children relapsed during the follow-up period.Infantile onset, cardiogenic stroke, consciousness disorder and multiple angiopathy may be the risk factors of severe disability and death of PAIS.Conclusion:PAIS has a certain probability of mortality and disability.Infantile onset, complicated with consciousness disorder, cardiogenic stroke and multiple angiopathy are risk factors for poor prognosis.

Effect of timing of acupuncture on limb dysfunction in patients with cerebral infarction: a multicenter prospective cohort pilot study / 中国针灸

OBJECTIVE@#To evaluate the clinical efficacy of acupuncture at different timings in acute stage for limb dysfunction in patients with cerebral infarction.@*METHODS@#A total of 101 patients with cerebral infarction limb dysfunction were divided into an early exposure group (@*RESULTS@#Compared before treatment, the mRS grade at 30 and 60 days after onset in the early exposure group was improved (@*CONCLUSION@#The timing of acupuncture is an independent factor affecting the disability status and limb motor dysfunction in patients with cerebral infarction, and the effect of early intervention may be better than late intervention.

Effect of Exercise Type on Vascular Stabilization Factor in Ischemic Stroke Patients.

Stroke is one of the leading causes of mortality and disability in the world. The angiogenesis strategy is a new therapeutic approach to exercise in these patients. The purpose of this study was to investigate the effect of continuous exercise on serum levels of vascular stabilizing factor and its consequences. MethodsIn this randomized clinical trial study, 30 patients with stroke who volunteered to participate in the study, aged 45 - 65 years, were selected by convenience sampling and non-random sampling method. Subjects were randomly selected. The patients were randomly divided into intervention group (4 weeks of continuous exercise in 40 - 60 minutes pedal with 60 - 65% VO2 peak intensity for 5 days per week and physiotherapy) and control group (physiotherapy only). Blood angiogenesis and motor function levels were measured at baseline and twenty-eight days after the last exercise session. Data was analyzed by using Stata software version 13 at the significance level of 0.05. ResultsIn this trial, thirty patients completed the study period, and were included in the analysis. The mean ages of patients in the control and intervention groups were 55.66 (S.D.: 6.69) and 61.46 (S.D.: 6.47) years, respectively. Serum levels of angiopoietin-1 increased after exercise at alpha level (P = 0.011). The reduction of the Modified Rankin Scale was obtained as a secondary consequence (P = 0.001). ConclusionsContinuous exercise training over four weeks can improve the prognosis of patients by altering the levels of angiogenesis-stabilizing factor in decreasing the symptoms of stroke.

Assessment of Capillary Blood Glucose Levels as a Prognostic Indicator in Acute Ischemic Stroke

Acute Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. The diagnosis of stroke is based on clinical examination, and brain imaging. Cerebral ischemia is caused by a reduction in blood flow lasting longer than several seconds with manifestation of neurologic symptoms due to infarction or death of brain tissue because neurons utilise only glucose and lack glycogen stores, so energy failure is rapid. Neurologic signs and symptoms lasting for >24 hours or brain infarction demonstrated on brain imaging is known as Acute Stroke.[1] Abnormal blood glucose at the time of acute stroke is associated with poor clinical outcomes, longer in-hospital stay and mortality. We wanted to evaluate the influence of abnormal capillary glucose levels on functional outcomes by grading the Acute Ischemic Stroke patient on modified Rankin scale.METHODSThis cross sectional study was conducted for a period of 6 months in the medicine and neurology wards, ICU in a tertiary care rural hospital in central India and included a total of 35 patients after obtaining institutional ethical committee clearance. The capillary blood glucose samples were taken using a standard glucometer. Capillary blood glucose was determined at the time of admission, each day within the first 72 hrs. Two values of blood glucose were considered; admission value and max. value within the 1st 72 hrs. Functional prognosis was assessed on Modified Rankin scale at the time of discharge or 1 month. The categorical variables were assessed using chi-square test and odd’s ratio and p-value were calculated and assessed. The association of altered capillary glucose levels with functional outcomes on modified Rankin scale were analysed. The data were entered in excel spreadsheet and all the statistical analysis was conducted using STATA version 14.2 software.RESULTSA significant correlation between the higher admission capillary blood glucose levels with the outcomes on modified Rankin scale after 1 month or after discharge was found (p-0.0032). Hyperglycaemia at the time of admission with poor prognosis on mRS (p-value 0.007) was also found.CONCLUSIONSThe results of the study reveal that the patients with admission hyperglycaemia have poor prognosis as compared to the normoglycemic patients. There is a significantly positive correlation between the altered capillary blood glucose levels at the onset of stroke and functional prognosis of the patients with stroke after treatment.

High sensitivity C-reactive protein level in cerebrovascular accident

Background: Stroke is the second leading cause of death worldwide according to WHO. High sensitivity C-Reactive Protein (hs-CRP) is an acute phase reactant which is being studied extensively to delineate its role in development of stroke as well as in prognostication. This study was done to assess correlation of hs-CRP with risk factors of stroke and its association with types of stroke and prognosis.Methods: A prospective case control study of 100 patients with acute stroke along with 100 controls was conducted with informed consent. At baseline, hs-CRP levels were measured and Modified Rankin Scale (MRS) was assessed. On day 90 the Modified Rankin Scale was assessed again. Patients were divided into groups based on hs-CRP levels and MRS and the results were analysed.Results: Prevalence of stroke was more in men than women (p=0.0002). Statistically significant difference was found between mean hs-CRP levels in men (4.722±0.8982 mg/L) and women (4.133±0.9446 mg/L) (p=0.005) and between cases and controls (p=0.0003). There was no significant association with type of stroke (p=0.456). Mean total cholesterol levels between cases and controls showed statistically significant difference (p=0.0005). High MRS was significantly associated with high hs-CRP levels (p=0.003). Higher hs-CRP on day 1 correlated with higher MRS on day 90.Conclusions: hs-CRP level is increased in stroke and shows significant association with severity of stroke and prognosis.

Related factors affecting postoperative pneumonia in patients with cavernous cerebrovascular malformation / 中华神经医学杂志

Objective To explore the related factors affecting postoperative pneumonia in patients with cavernous cerebrovascular malformation (CCM).MethodsClinical data of 151 CCM patients admitted to our hospital from January 2010 to January 2017 were retrospectively collected. Patients were divided into postoperative pneumonia group (n=11) and postoperative non-pneumonia group (n=140) according to the occurrence of postoperative pneumonia. Univariate Logistic regression analysis, multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve were used to screen the relevant factors influencing the occurrence of postoperative pneumonia in CCM patients and evaluate the predictive value of relevant factors in postoperative pneumonia.ResultsAs compared with patients from postoperative non-pneumonia group, patients from postoperative pneumonia group had significantly increased modified Rankin scale (mRS) scores and significantly higher percentage of CCM combined with hemorrhage, and significantly decreased Glasgow coma scale (GCS) scores (P<0.05). Multivariate Logistic regression analysis showed that preoperative GCS scores (OR=4.75, 95％CI: 1.14-19.80,P=0.032) and mRS scores (OR=15.61, 95％CI: 3.22-75.58,P=0.001) were independent factors influencing the occurrence of postoperative pneumonia. ROC curve showed that the sensitivity and specificity of mRS scores≥4 to predict postoperative pneumonia were 45.5％ and 95.7％, respectively, and the sensitivity and specificity of GCS scores≤13 to predict postoperative pneumonia were 54.5％ and 85.7％, respectively.ConclusionFor CCM patients with preoperative GCS scores≤13 or mRS scores≥4, more attention should be paid to perioperative lung management and occurrence of postoperative pneumonia should be vigilant.

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

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

Efficacy of mechanical thrombectomy with stent-retriever for anterior circulation distal vessel occlusion / 第二军医大学学报

Objective To explore the therapeutic effect of mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion. Methods Consecutive cases with anterior circulation distal vessel occlusion treated with mechanical thrombectomy in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) from Sep. 2013 to May 2018 were enrolled. According to whether undergoing intravenous thrombolysis, the patients were divided into bridging group and direct thrombectomy group. The primary outcome was the neurological functional prognosis at 90 d after operation measured with modified Rankin Scale (mRS, mRS score≤2 reflected good prognosis). The secondary outcomes were the rate of recanalization (modified thrombolysis in cerebral ischemia [mTICI] grade≥2b), the National Institutes of Health stroke scale (NIHSS) score at 24 h after operation, complications and mortality. Results Totally 36 patients aged (68.3±13.6) years (ranging from 26 to 88 years) were included. There were 27 cases with middle cerebral artery (MCA) M2 segment occlusion, 5 cases with anterior cerebral artery (ACA) A1/A2 segment occlusion and 4 cases with MCA M2 segment accompanied with ACA A2 segment occlusion. The rate of recanalization of the occluded distal vessels was 91.7% (33/36) after mechanical thrombectomy with stent-retriever. The rate of good prognosis at 90 d after operation was 52.8% (19/36). The most common complication was vasospasm (33.3%, 12/36), followed by hemorrhagic transformation (16.7%, 6/36). The incidence of symptomatic intracranial hemorrhage was 5.6% (2/36) and the mortality was 8.3% (3/36). There were 14 cases in the brigding group and 22 cases in the direct thrombectomy group. The preoperative NIHSS score of the bridging group was significantly higher than that of the direct thrombectomy group (Z=3.025, P=0.002). While there were no significant differences in the NIHSS score at 24 h after operation, times of thrombectomy, the rate of recanalization, the rate of good prognosis at 90 d after operation, the incidence of hemorrhagic transformation or mortality between the bridging group and the direct thrombetomy group (all P>0.05). Conclusion The mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion is likely safe and effective, and it is beneficial for vascular recanalization and good outcomes at 90 d.

Effect of Recombinant Human Growth Hormone Add on Therapy on Acute Stroke Outcome

Recombinant human growth hormone (rhGH) administration stimulate the secretion of the brain insulin-like growth factor-1 (IGF-1) concentration and IGF-1 is a pleiotropic neurotropic peptide to exert beneficial effect for the injured brain tissues. Citicoline (cytidine-59-diphosphocholine; CDP-choline) is well known to improve neurological outcome in acute stroke. This study aimed to evaluate whether rhGH can potentiate citicoline effect on functional recovery in acute stroke patient. Thirty patients were enrolled. Ten patients were treated with rhGH subcutaneous injection for 6 months on top of citicoline for 6 weeks (GH6 group), and 10 patients for 3 months (GH3 group) with 6 weeks of citicoline treatment as well, and final 10 patients only with citicoline (control group). Functional outcome was determined by Korean modified Barthel Index (K-MBI) and modified Rankin Scale (mRS) at baseline and 6 months after treatment. Seven and 4 patients withdrew from GH6 and GH3 group, respectively. Final 3 patients in GH6 group, 6 patients in GH3 group and 10 patients in control group were analyzed. The K-MBI, and mRS scores from all 3 groups increased in 6 months compared to baseline in intra-group comparison. In inter-group comparison, however, GH6 but not GH3 showed statistically significant improvement compared to control. Administration of rhGH for 6 months on top of 6-week citicoline treatment resulted in further improvement in K-MBI and mRS in acute stroke patients. Further studies in increasing injection dose or injection period is needed.

Predictive value of circulating endothelial progenitor cells in prognosis of acute ischemic stroke / 上海交通大学学报（医学版）

Objective·To study the change of circulating endothelial progenitor cells (cEPCs) in acute ischemic stroke (AIS) patients within one week after attack,and the correlation of cEPCs with the prognosis.Methods·Ninty-two patients with AIS (AIS group) and 20 patients with risk factors (Risk group) were recruited.The proportion of cEPCs (CD34TKDR+ cells) in peripheral blood mononuclear cells of AIS patients was measured by flow cytometry (FCM) on the first day of admission and the seventh day after attack.Functional recovery was assessed by modified Rankin Scale (mRS) on the 90th day after onset.The cEPCs percentages of AIS patients with different mRS were compared to analyze their correlation.Results·Compared with Risk group,cEPCs percentage of AIS group on the 1st day of admission was lower (P=0.016).In AIS group,compared with poor prognosis group (mRS＞2),eEPCs percentage of good prognosis group on the 7th day after onset (mRS ≤ 2) elevates (P=0.002).The result of multiple linear regression showed that cEPCs percentage on the 7th day after onset was positively correlated with mRS on the 90th day (t=4.608,P=0.011).Conclusion·The percentage of cEPCs in peripheral blood of AIS patients decreases significantly during the acute phase.The percentage on the 7th day after onset is correlated with prognosis of AIS patients.

The clinical effects and prognosis evaluation of enhanced external counterpulsation on acute cerebral ischemic stroke / 中国神经精神疾病杂志

Objective To explore the therapeutic effect and prognosis of enhanced external counterpulsation (EECP)on acute cerebral ischemic stroke,to provide clinical evidence for the treatment of patients with acute cerebral ischemic stroke.Methods Total171 patients with acute cerebral ischemic stroke were enrolled and measured the NIHSS and mRS,before EECP,after36 hours EECP,and 3-month after attack.Then contrast the difference of these indicators.Result Compare with the control group,after EECP treatment and after 3-month attack,the scores of NIHSS were statistically significant,(after EECP:44.1％ vs 31.5％;after 3-month attack:55.6％ vs 40.5％),(P＜ 0.05).Compare with the control group,after 3-month attack,the score of mRS in EECP group was declined statistically significant,and the rate of favourable prognosis rise obviously (P＜0.05).Conclusion EECP can effectively improve neurological function and promote health and improve prognosis in the patients with acute cerebral ischemic stroke.

Effects of statin therapy on the outcome of acute ischemic stroke: a meta-analysis / 中华行为医学与脑科学杂志

Objective To analyze quantitatively the safety and efficacy of statin therapy in acute phrase for acute ischemic stroke with the method of meta-analysis.Methods We performed a systematic literature search including the Cochrane Library,MEDLINE and EMBASE for published trials about statin therapy and the outcomes of acute ischemic stroke.Then we performed a meta-analysis with included studies to investigate the association between statin therapy and clinical outcome and mortality.All of the data were pooled and meta-analyzed by Cochrane Collaboration RevMan 5.3 meta-analysis software.Statistical heterogeneity between studies was evaluated by the chi-square and I-square tests.Forest plots were used to summarize study data and Egger tests were used to assess publication bias.Results A total of 27 studies including 52 034 patients,comprising 19 212 statin users and 32 822 non-statin users met the inclusion criteria,4 studies were randomized controlled trials (RCTs),and 23 were observational trials (OTs).Both pre-or post-stroke statin use was associated with reduced mortality.Statin use is associated with favorable functional outcome at hospital discharge and on the ninetieth day regardless of initiation time for pre-stroke group and post-stroke group.The results from observational trials were consistent with randomized controlled trials.There was no evidence of publication bias for all comparisons by Egger tests.Conclusions Statin therapy before or after AIS is safe and effective.

The Application of mRS in the Methods of Outcome Assessment in Chinese Stroke Trials / 中国神经精神疾病杂志

Objective To evaluate the current situation and problems of the application of modified Rankin scale (mRS) in the outcome assessment in Chinese stroke trials. Methods Randomised and quasi-randomised controlled tri?als on stroke therapy published before September 2013 in 3 Chinese databases were included. All clinical trials applied mRS as the method of outcome assessment. Subarachnoid hemorrhage and transient cerebral ischemia were excluded. Types of stroke, statistical methods used for data analysis, duration of follow up, blinding of outcome assessment, types of intervention and the significance of the results were evaluated. Results Two hundred and ninety-eight trials were includ?ed in this analysis. 71.14%was for ischemic stroke, 21.48%for hemorrhagic stroke, 7.38%for both ischemic and hemor?rhagic stroke and 91.28%was for acute stroke(onset time<14d). Regarding to statistical methods used for data analysis, 50.00%of the trials used t-test or variance analysis which treated the mRS score as continuous data, while 22.15%used rank sum test or Chi-square test which regarded the mRS score as ranked data or multiply variable data. Dichotomous data was applied in statistical analysis accounts for 25.50%of trials. 12.42%trials applied mRS with other scales as the methods of outcome assessment. Duration of follow up ranged from 10d to 2 years (median 90 d, interquartile range 30-90 d). Only 5.03%assessed outcome blindly. 60.07%of the trials were drug therapy, 7.72%was rehabilitation thera?py, 10.40%were surgical treatment, 14.43%were combined therapy, 2.35%were management mode, 0.67%were nurs?ing, and 4.36%other therapy. Results in 86.91%of the trials were favorable to the tested interventions. Conclusions In aspects of, there is large difference between domestic and foreign clinical stroke trials in methodology of mRS including duration of follow up, blinding of outcome assessment and statistical methods used for data analysis.

Malformaciones arteriovenosas. Revisión y análisis estadístico de 52 MAVs tratadas durante el período de 2000-2010. Tercera parte / Arteriovenous malformations. Review and statistical analysis of 52 MAVs treated during the period 2000-2010. Third part

INTRODUCCIÓN: describir nuestra experiencia en el tratamiento de las MAVs analizando: procedimientos endovasculares utilizados, resultados postoperatorios y complicaciones asociadas, estadificación según escalas de Barthel y Rankin modificadas. MATERIAL Y MÉTODOS: la población de estudio se constituyó por 52 pacientes con MAVs la cual fue analizada y estudiada mediante examen neurológico pre y postoperatorio, TC cerebral, RM cerebral y arteriografía de 4 vasos de cuello, la totalidad fue tratada mediante cirugía convencional en nuestro Servicio durante el período comprendido entre los años 2000 a 2010. RESULTADOS: recibieron tratamiento endovascular previo a la cirugía 16 MAVs (30,76 %). Todas fueron operadas. Doce pacientes mejoraron en el postoperatorio (23,07 %), 30 pacientes (57,69%) no sufrieron modificaciones y 10 de ellos (19,23%) empeoraron durante el postoperatorio. La mortalidad fue de 7 casos (13,46 %). CONCLUSIÓN: consideramos a los procedimientos endovasculares y la radiocirugía una herramienta de indudable valor terapéutico. Creemos que el subgrupo de MAVs grados III, IV y V representa una entidad singular que las distingue del resto, como una subtipo que requiere más aun de una compleja toma de decisiones. Tuvimos las mayores complicaciones postoperatorias en MAVs grados III y IV. Nuestra mortalidad postoperatoria coincide con la bibliografía consultada

INTRODUCTION: to describe our experience in treating AVMs based on the endovascular procedures used, postoperative results and associated complications, staging according to Barthel Index and modified Rankin Scale. PATIENTS AND METHOD: we present 52 patients with AVMs which were analysed and studied by Pre and Post-Surgery Neurological exam, brain CT, Brain IRM and four Neck vessels arteriography. All the patients were treated by conventional Surgery at our Department of Neurosurgery for the 2000­2010 period. RESULTS: Sixteen patients with AVMs (30.76%) underwent endovascular treatment prior to surgery. 100% were operated. 12 patients (23.07%) improved their clinical condition in the postoperative period, 30 patients (57.69%) showed no changes, and 10 of them (19.23%) experienced deterioration during the postoperative period. There were 7 mortal cases (13.46%). CONCLUSION: we believe that endovascular procedures and radiosurgery are tools of immense therapeutic value. We also consider that the subgroup of AVMs grade III, IV and V have unique features that distinguish them among the rest as a subtype, thus requiring extreme care when making decisions. Most postoperative complications occurred with AVMs grade III and IV. The mortal cases in the postoperative period coincided with those mentioned in the bibliography consulted

Prognostic Factors and Clinical Outcomes of Acute Intracerebral Hemorrhage in Patients with Chronic Kidney Disease

OBJECTIVE: We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis. METHODS: From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis. RESULTS: The mean GCS score on admission was 9.4+/-4.4 and the mean mRS was 4.3+/-1.8. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome. CONCLUSION: Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.