Establishment of a dynamic nomogram including thyroid function for predicting the prognosis of acute ischemic stroke with standardized treatment.

Purpose: Many patients with acute ischemic stroke (AIS) cannot undergo thrombolysis or thrombectomy because they have missed the time window or do not meet the treatment criteria. In addition, there is a lack of an available tool to predict the prognosis of patients with standardized treatment. This study aimed to develop a dynamic nomogram to predict the 3-month poor outcomes in patients with AIS. Methods: This was a retrospective multicenter study. We collected the clinical data of patients with AIS who underwent standardized treatment at the First People's Hospital of Lianyungang from 1 October 2019 to 31 December 2021 and at the Second People's Hospital of Lianyungang from 1 January 2022 to 17 July 2022. Baseline demographic, clinical, and laboratory information of patients were recorded. The outcome was the 3-month modified Rankin Scale (mRS) score. The least absolute shrinkage and selection operator regression were used to select the optimal predictive factors. Multiple logistic regression was performed to establish the nomogram. A decision curve analysis (DCA) was applied to assess the clinical benefit of the nomogram. The calibration and discrimination properties of the nomogram were validated by calibration plots and the concordance index. Results: A total of 823 eligible patients were enrolled. The final model included gender (male; OR 0.555; 95% CI, 0.378-0.813), systolic blood pressure (SBP; OR 1.006; 95% CI, 0.996-1.016), free triiodothyronine (FT3; OR 0.841; 95% CI, 0.629-1.124), National Institutes of Health stroke scale (NIHSS; OR 18.074; 95% CI, 12.264-27.054), Trial of Org 10172 in Acute Stroke Treatment (TOAST; cardioembolic (OR 0.736; 95% CI, 0.396-1.36); and other subtypes (OR 0.398; 95% CI, 0.257-0.609). The nomogram showed good calibration and discrimination (C-index, 0.858; 95% CI, 0.830-0.886). DCA confirmed the clinical usefulness of the model. The dynamic nomogram can be obtained at the website: predict model (90-day prognosis of AIS patients). Conclusion: We established a dynamic nomogram based on gender, SBP, FT3, NIHSS, and TOAST, which calculated the probability of 90-day poor prognosis in AIS patients with standardized treatment.

Thyroid hormone levels paradox in acute ischemic stroke.

Objective: Accumulating evidence has suggested that thyroid hormone levels affect the prognosis of acute ischemic stroke (AIS), but the results have been inconsistent. Methods: Basic data, neural scale scores, thyroid hormone levels, and other laboratory examination data of AIS patients were collected. The patients were divided into excellent and poor prognosis group at discharge and 90 days after discharge. Logistic regression models were applied to evaluate the relationship between thyroid hormone levels and prognosis. A subgroup analysis was performed based on stroke severity. Results: A number of 441 AIS patients were included in this study. Those in the poor prognosis group were older, with higher blood sugar levels, higher free thyroxine (FT4) levels, and severe stroke (all p < 0.05) at baseline. Free thyroxine (FT4) showed a predictive value (all p < 0.05) for prognosis in the model adjusted for age, gender, systolic pressure, and glucose level. However, after adjustment for types and severity of stroke, FT4 showed insignificant associations. In the severe subgroup at discharge, the change in FT4 was statistically significant (p = 0.015), odds ratio (95% confidence interval) = 1.394 (1.068-1.820) but not in the other subgroups. Conclusions: High-normal FT4 serum levels in patients with severe stroke receiving conservative medical treatment at admission may indicate a worse short-term prognosis.

Value of MRI T2 FLAIR Vascular Hyperintensities Combined with DWI ASPECTS in Predicting the Prognosis of Acute Cerebral Infarction with Endovascular Treatment.

OBJECTIVE: To explore the MRI T2 fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) combined with diffusion-weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) in predicting the prognosis of acute cerebral infarction (ACI) with endovascular treatment. METHODS: The patients with ACI in the anterior circulation who underwent endovascular treatment from June 2016 to December 2020 were divided into a good prognosis group and a poor prognosis group according to the modified Rankin Scale (mRS) score at 90 days after the operation. The differences in general clinical baseline data, CT-ASPECTS, FVH, and DWI-ASPECTS between the two groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive power of prediction models on prognosis. RESULTS: The results of the Binomial Logistic regression equation showed initial National Institute of Health stroke scale (NIHSS), Mori grade, DWI-ASPECTS, and FVH were independent risk factors for prognosis. The predictive power of the FVH + DWI-ASPECTS prediction model was highest, and the predictive power of DWI-ASPECTS was higher than that of CT-ASPECTS. CONCLUSION: DWI-ASPECTS is better than CT-ASPECTS in predicting the prognosis of ACI with endovascular treatment, and the combined prediction model of FVH and DWI-ASPECTS has higher prediction performance, which can be used as a preoperative evaluation method to predict the effect of endovascular treatment for ACI.

Effects of blood glucose and glycosylated hemoglobin levels on intravenous thrombolysis in patients with acute cerebral infarction and type 2 diabetes mellitus.

OBJECTIVE: To investigate the effect of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbAlc.) levels on thrombolytic therapy in patients with acute cerebral infarction and type 2 diabetes mellitus. METHODS: A total of 135 patients with acute cerebral infarction were selected for this study. They were divided into study group (n=70, with acute cerebral infarction & type 2 diabetes mellitus) and control group (n=65, with acute cerebral infarction but no type 2 diabetes mellitus). All patients underwent thrombolysis treatment with Alteplase for injection. The patients were evaluated by the national institutes of health stroke scale (NIHSS) score, the modified Rankin scale (MRS) score and the Barthel index score, such indicators in patients as FPG, HbAlc, triglyceride (TG), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) were determined, the fast blood sugar before thrombolysis and the treatment effect after 24h thrombolysis in the observation group were observed and meanwhile the mortality rate in patients after 5 months thrombolysis was analyzed. RESULTS: Compared with before thrombolysis, the indexes of the two groups were significantly improved after thrombolysis, and the improvements of FPG, HbAlc, TG and LDL-C in the control group were better than those in the study group (P<0.05). There was no significant difference between the two groups in the levels of TC and HDL-C after thrombolysis (P>0.05). The 24h MBG, SDBG and MAGE in the study group were higher than those in the control group (P<0.05). In the study group, when the blood glucose was less than 6.0mmol/L before thrombolysis, the lowest effective rate after 24h thrombolysis was 33.3%, and when the blood glucose was ranging from 7.0 to 9.0mmol/L, the highest effective rate after 24h thrombolysis was 73.9%, and with the gradual increase of blood glucose, the effective rate after 24h thrombolysis decreased gradually. Also the effective rate after 24h thrombolysis also decreased gradually with the increase of HbAlc value, it reached the highest value of 64.4% at HbAlc <6.0mmol/Lad the lowest value of 25% at HbAlc >7.0mmol/L. Compared with the control group, the MHSS score and MRS score were higher and the Barthel index after thrombolysis was lower in the study group with the difference being statistically significant (P<0.05). The five months mortality rate after thrombolytic therapy was 12.9% (9/70) in the study group and 10.8% (7/65) in the control group, with no significant difference between the two groups (P=0.316). The incidence of intracranial hemorrhage after thrombolytic therapy was higher in the study group than in the control group, but the difference was not statistically significant (P>0.05), however there was significant difference between the two groups in revascularization and prognosis (P<0.05). CONCLUSION: The level of HbAlc affected the curative efficacy, the higher the level, the poorer the efficacy and to control the blood glucose within a certain range before thrombolysis was beneficial to enhance the effect of static thrombolysis.

Epicatechin Gallate Protects HBMVECs from Ischemia/Reperfusion Injury through Ameliorating Apoptosis and Autophagy and Promoting Neovascularization.

Green tea is one of the most beverages with antioxidants and nutrients. As one of the major components of green tea, (-)-epicatechin gallate (ECG) was evaluated for its antioxidative properties in the present study. Cell proliferation assay, tube formation, cell migration, apoptosis, and autophagy were performed in human brain microvascular endothelial cells (HBMVECs) after oxygen-glucose deprivation/reoxygenation (OGD/R) to investigate potential anti-ischemia/reperfusion injury properties of ECG in vitro. Markers of oxidative stress as ROS, LDH, MDA, and SOD were further assayed in our study. Data indicated that ECG could affect neovascularization and promote cell proliferation, tube formation, and cell migration while inhibiting apoptosis and autophagy through affecting VEGF, Bcl-2, BAX, LC3B, caspase 3, mTOR, and Beclin-1 expression. All the data suggested that ECG may be protective for the brain against ischemia/reperfusion injury by promoting neovascularization, alleviating apoptosis and autophagy, and promoting cell proliferation in HBMVECs of OGD/R.