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BACKGROUND AND PURPOSE: There is increasing recognition of the importance of stroke in females to both clinical and public health. The natural course of stroke is worse in females than in males, but the evidence regarding sex disparities in the responses to thrombolysis in stroke patents is still controversial. We compared outcomes after thrombolysis treatment between females and males. METHODS: Clinical trials reported in the Embase, PubMed, and Cochrane Library electronic databases up to March 13, 2017 were included in this analysis. Two reviewers independently extracted the data and conducted quality assessments. Statistical tests were performed to check for heterogeneity and publication bias. Sensitivity analysis was also performed to evaluate the stability of the conclusions. RESULTS: Sixteen reports involving 60,159 patients were available for analysis. The female patients were a 0.89-fold [95% confidence interval (CI)=0.87–0.90, p < 0.001], 0.89-fold (95% CI=0.87–0.91, p < 0.001), and 1.24-fold (95% CI=1.11–1.36, p < 0.001) more likely to obtain good, excellent, and poor functional outcomes, respectively, with no significant difference in the complications of symptomatic intracranial hemorrhage among the sexes [risk ratios (RR)=0.99, 95% CI=0.92–1.07, p=0.81] after thrombolysis treatment. In addition, the prevalence of a good functional outcome did not differ significantly between females and males in the intra-arterial thrombolysis (IAT) group (RR=1.05, 95% CI=0.85–1.29, p=0.67) in a subgroup analysis. CONCLUSIONS: This study has demonstrated that females often exhibit a worse outcome than males after intravenous thrombolysis (IVT), whereas no relevant sex differences were found in outcome or recanalization after IAT, with safety regarding hemorrhage complications from thrombolysis being the same for the sexes. However, IVT should not be withheld from female stroke patients solely based on their sex before the findings are confirmed in further large-scale research.
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Feminino , Humanos , Masculino , Hemorragia , Hemorragias Intracranianas , Características da População , Prevalência , Saúde Pública , Viés de Publicação , Caracteres Sexuais , Acidente Vascular CerebralRESUMO
Objective To explore the various risk factors of the Stanford type B aortic dissection(ADA) patients in perioperation period .Methods Data of 100 Stanford type B ADA patients was collected from June 2009 to June 2012 in our hospital ,and their clinical characteristics and risk factors were analyzed .Results The clinical features of patients with ADA were related to many fac‐tors .Logistic regression analysis showed that the death risk of female was 4 .5 times larger than the male .Diastolic pressure was an independent protective factor of prognosis ,and 1 mm Hg increase in diastolic pressure resulted in 6% mortality decrease . Conclusion The clinical features of patients with ADA is related to many factors ,among which the gender is an independent one;level of diastolic blood pressure is independent protective factor of prognosis .
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Objective To explore the prognostic factors influencing the short-term outcome in patients with acute cerebral in-farction through the prospective study for guiding clinical treatment .Methods 92 patients with acute cerebral infarction were in-cluded in the study ,whose neurological functions were assessed via National Institute of Health Stroke Scale (NIHSS) and compu-ted tomography or magnetic resonance imaging performed within 24 h of symptom onset .All of the patients were administered with same medication regimen for acute cerebral infarction .The NIHSS and the modified Rankin Scale were used to assess the extent of disability at 15 d after admission .Multivariable logistic regression was used to analyze the associations between different factors and the two 2 prognostic factors respectively .Results When the difference of two NIHSS scores was treated as the dependent variable , the infarction volume was associated with the difference in multivariable regression ,the OR of the two groups with larger Infarction volume OR=2 .352 and OR=5 .161 ;When the Rankin Scale scores were treated as the dependent variable ,the outcome in rehabili-tation group was better than those in no rehabilitation group (OR=0 .207) .Patients with the greater baseline NIHSS scores had the worse prognosis ,the OR of the two groups with larger score OR=1 .257 and OR=1 .032 .The age ,gender ,admission time as well as infarction area were not significantly associated with clinical prognosis .Conclusion The baseline NIHSS scores and infarct vol-ume were independent prognostic factors for the short-term outcome in patients with acute cerebral infarction ,who should obtain re-habilitation treatment to improve prognosis .
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Objective To investigate the effects of Shuxuetong Injection (SXT ) on expressions of cell apoptosis and TLR4 a-round ischemic area after focal cerebral infarction in rats and to discuss its neuroprotective mechanism on ischemia-induced brain in-jury .Methods The SD rats were subjected to establish the model of middle cerebral artery occlusion (MCAO)by nylon monofila-ment suture ,then were randomly divided into the sham-operated group ,the model group and the SXT treatment group ;the cell ap-optosis and the expressions of TLR4 mRNA and protein around ischemic area at 12 ,24 ,48 ,72 h after cerebral ischemia were detec-ted respectively by TUNEL test mediated with DNA ,RT-PCR and immunohistochemistry .Results In the model group ,the number of TUNEL positive cells ,the expressions of TLR4 mRNA and protein were gradually increased at 12 h ,reached the peak at 24 h , then decreased and were still higher than those in the sham-operated group(P<0 .01);in the SXT treatment group ,these expres-sions after 24 h were lower than those in the model group (P<0 .05)and declined as the treatment time increase(P<0 .05) .Conclu-sion In subacute stage of cerebral ischemia injury ,apoptosis is related with the expression of TLR4 ,SXT may inhibit apoptosis , down-regulate the expression of TLR4 around ischemic area ,this may be one of the mechanisms of neuroprotection .
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Objective To analyze the effect of individualized care on prevention of postoperative urinary retention of malignancy patients undergoing hysterectomy and pelvic lymph node dissection.Methods 74 cases of patients with malignancies undergoing total hysterectomy and pelvic lymph node dissection in our hospital from June 2009 to December 2011 were chosen as the research object.They were divided into the control group and the observation group with 37 cases in each group.The control group was given traditional routine care,while the observation group was given individualized nursing assessment and intervention.The grasping level of knowledge about prevention of urinary retention,the cooperation degree with nursing,incidence of urinary retention,the residual urine volume and satisfaction degree of patients were analyzed and compared between two groups.Results The grasping level of knowledge about prevention of urinary retention,the cooperation degree with nursing,incidence of urinary retention,the residual urine volume and satisfaction degree of patients in the observation group were better than those of the control group,there were significant differences.Conclusions The effect of individualized care to prevent postoperative urinary retention of malignancies patients after hysterectomy and pelvic lymph node dissection is better.It plays an active role in improving mastering of knowledge about prevention of urinary retention and cooperative degree with nursing.
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Objective To observe the effects of dual antiplatelet therapy at different time after cervical artery stenting and to investigate the reasonable time for dual antiplatelet therapy. Methods Sixty-six patients with symptomatic cervical artery artery stenosis ＞50% or asymptomatic stenosis ＞70% performed stenting under local anesthesia. They were randomly allocated into dual antiplatelet therapy (aspirin + clopidogrel) for 1 month and for 3-month groups after procedure, and then they began to take aspirin for a long time. The complications, vascular events, and the incidence of restenosis were observed respectively. Results There were no vascular events and death in both groups from 6 to 36 months after procedure. There was no significant difference in the incidence of complication and restenosis (9% vs. 6%, P = 0. 642). Conclusions There was no significant difference in the efficacy of aspirin + clopidogrel treatment after cervical artery stenting between 1 month and 3 months. One month dual antiplatelet therapy may be appropriate, but large-scale randomized controlled trials are needed to confirm it.
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Objective To observe the effects of the expressions of matrix metalloproteinase-9(MMP-9),intracerebral hemorrhage volumae and blood-brain barrier permeability after embolic cerebral ischemia and thrombolysis with urokinase(UK)and to investigate the relationship between MMP-9 and blood-brain barrier permeability and intracerebral hemorrhage after thrombolysis. Methods A rat model of middle cerebral artery occlusion was established by intracarotid injection of autologous blood clots.UK was given intravenously at 6 hours after ischemia. After 24 hours. the expressions of MMP-9 in brain tissue, blood-brain barrier permeability, cerebral infarct volume, and intracerebral hemorrhage volume were detected by the immunohistochemical method, Evans blue extravasation method, TTC staining method, and spectrophotometric method,respectively. Results The expressions of MMP-9 in a cerebral ischemic group were significantly higher than those in a sham-operation group(P＜0.01),and in the UK group they were significantly higher than those in the cerebral ischemic group (P＜0.01).The Evens blue content in the cerebral ischemic group was 5774.00±1659.70 ng/g, which was significantly higher than 643.33±151.34 ng/g in the sham-operation group (P＜0.01),and in the UK group was 6283.83±1099.28 ng/g, there was a tendency higher than in the cerebral ischemic group. The intracerebral hemorrhage volumes in the UK and cerebral ischemic groups were 3.16±8.84μl(median±quartile)and 0.00±1.48μl, respectively, and the inciderices of intracerebral hemorrhage were 25.00%%and 4.17%.respectively.Conclusions UK thrombolysis may upregulate the expressions of MMP-9.and its expressions are associated with the increased blood-brain barrier permeability and intracerebral hemorrhage after thrombolysis.
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The article introduced experience of class teaching of neurology from attending a lecture and preparing lessons,actively making use of multimedia teaching,applying combina-tionly many kinds of teaching methods and thoroughly stimulating learning interest.It is key point for improving teaching quality that the teacher strengthen their mixed ability.