ObjectiveTo investigate the relationship between the level of homocysteine (HCY) and the overall burden of cerebral small vessel disease (CSVD) in patients with ischemic stroke.MethodsA total of 322 patients with first-ever ischemic stroke admitted to the People’s Hospital of Deyang City between January 2016 and December 2017 were enrolled. The patients’ demographic information, clinical information, and serum HCY concentration were collected after admission. The presence or absence of a CSVD was assessed by MRI and the overall burden score for the CSVD was determined. Multivariate logistic regression analysis was used to assess whether serum HCY level was associated with the overall burden of CSVD.ResultsThe median level of HCY was 13.2 μmol/L (inter-quartile range: 4.3 to 22.6 μmol/L). Univariate analysis showed that the difference of HCY levels among patients with different total CSVD scores was statistically significant (F=6.874, P=0.001); Spearman correlation analyses showed that the HCY level grouped by quartiles was correlated to the number of lacunar infarctions (rs=0.267, P=0.001), Fazekas score of white matter lesions (rs=0.122, P=0.042), and enlarged perivascular space (EPV) score (rs=0.319, P=0.001), but was not correlated to cerebral microhemorrhage (rs=−0.010, P=0.869). After multivariate regression analysis to adjust the effects of other factors, compared with the patients with HCY levels in the lowest quartile group, the patients with HCY levels in the highest quartile group were more likely to develop lacunar infarction [odds ratio (OR)=1.892, 95% confidence interval (CI) (1.012, 2.987)], white matter lesions [OR=1.548, 95%CI (1.018, 1.654)], severe EPV [OR=6.347, 95%CI (3.592, 13.978)], and the increase in the CSVD score [OR=2.981, 95%CI (1.974, 5.398)].ConclusionIn patients with ischemic stroke, elevated HCY levels may be associated with the overall burden of the CSVD.
Objective To investigate the predictive factors of clinical progression and short-term prognosis of cerebral infarction caused by large artery atherosclerosis (LAA). MethodsPatients with acute LAA cerebral infarction who were hospitalized in the Department of Neurology, Lianyungang Hospital of Traditional Chinese Medicine between January 2016 and May 2019 were included. On admission, the patients’ medical history was collected. The degree of neurological deficit was assessed, blood pressure, blood glucose, blood lipids, plasma homocysteine, lipoprotein-associated phospholipase A2 (Lp-PLA2) were measured, and intracranial and extracranial blood vessels related test results were collected. Within 72 hours of onset, the Scandinavian Stroke Scale (SSS) was used to determine whether the patients’ condition progressed. The modified Rankin scale was used to evaluate the short-term prognosis at 30 days of onset. The related factors of clinical progression and short-term prognosis of LAA cerebral infarction were analyzed. Results Finally, 100 patients were included. According to the SSS assessment results within 72 hours of onset, 27 cases were divided into the progression group and 73 cases in the non-progression group. There was no significant difference in gender and age between the two groups (P>0.05). According to the evaluation results of the modified Rankin scale at 30 days of onset, they were divided into 31 cases in the poor prognosis group and 69 cases in the good prognosis group. There was no significant difference in gender and age between the two groups (P>0.05). Logistic regression analysis showed that plasma Lp-PLA2 [odds ratio (OR)=1.013, 95% confidence interval (CI) (1.007, 1.018), P<0.001], SSS score [OR=0.910, 95%CI (0.842, 0.985), P=0.019], and history of hypertension [OR=5.527, 95%CI (1.241, 24.613), P=0.025] were the predictors of disease progression within 72 hours. SSS score [OR=0.849, 95%CI (0.744, 0.930), P<0.001], carotid artery stenosis [OR=9.536, 95%CI (1.395, 65.169), P=0.021] and progressive stroke [OR=8.873, 95%CI (1.937, 40.640), P=0.005] were the predictors of short-term prognosis of LAA cerebral infarction. Conclusions History of hypertension and high levels of plasma Lp-PLA2 are predictors of early progression of cerebral infarction. Carotid artery stenosis and progressive stroke are predictors of adverse outcomes in the acute phase of cerebral infarction. Neurological scores on admission was a predictor for short-term adverse outcomes in the early and acute phases.
ObjectiveTo observe the morphological characteristics of retinal vessels in patients with ischemic stroke, and to preliminary analyze the correlation between retinal vascular morphological parameters and ischemic stroke. MethodsA retrospective study. From May 2015 to May 2017, 73 patients with ischemic stroke (ischemic stroke group) confirmed by examination at the Beijing Friendship Hospital, Capital Medical University were included in this study. In addition, 146 patients were included in the control group. A total of 146 patients with acute stroke who were excluded by head CT and/or magnetic resonance imaging were selected as the control group. Fundus images of patients were collected by nonmydriatic fundus camera. Retinal vascular parameters were measured by artificial intelligence fundus image analysis system, included retinal artery and vein caliber as well as vascular curvature, branching angle, fractal dimension, and density. The morphological characteristics of retinal vessels were compared between the control and ischemic stroke groups, and correlation between the retinal vascular parameters and ischemic stroke was analyzed using binary logistic regression. ResultsCompared with the control group, the ischemic stroke group had thinner retinal artery caliber, smaller retinal vascular fractal dimension, and lower retinal vascular density; moreover, these differences were statistically significant (t=3.232, 3.502, 3.280; P＜0.05). Vascular fractal dimension [odds ratio (OR)=0.291, 95% confidence interval (CI) 0.160-0.528] and retinal artery caliber (OR=0.924, 95%CI 0.870-0.981) were strongly correlated with ischemic stroke (P＜0.01). ConclusionCompared with the control group, the retinal artery caliber, fractal dimension and retinal vascular density in ischemic stroke group are smaller; decreased retinal artery caliber and fractal dimension are correlated with ischemic stroke.
Ischemic stroke (IS) is one of the important diseases threatening human health. The occurrence and development of IS can trigger a series of complex pathophysiological changes, including damage to the blood-brain barrier, ion imbalance, oxidative stress, mitochondrial damage, which ultimately lead to the apoptosis and necrosis of nerve cells in the ischemic area. Impaired blood-brain barrier is a key factor for cerebral edema, hemorrhagic transformation and poor prognosis in patients with IS, and neuroinflammatory response plays an important role in the damage and repair of the blood-brain barrier. This article mainly focuses on the neuroinflammatory response mediated by glial cells, pro-inflammatory cytokines and matrix metalloproteinases and the related mechanisms of IS blood-brain barrier damage and repair, in order to provide new directions for the treatment of IS.
Objective To explore the efficacy of endovascular therapy in elderly patients with acute ischemic stroke. Methods The acute ischemic stroke patients who received endovascular therapy between January 2020 and January 2023 were retrospectively enrolled. According to age, patients were divided into the elderly group (≥ 80 years old) and other age groups (<80 years old). The baseline data, green channel data, nerve function deficit, recanalization and complication information were collected, and the patients were followed up. Modified Rankin Scale (mRS) was used to evaluate patients prognosis at 3 months after onset. Score less than or equal to 2 points was defined as good prognosis and over 2 points was defined as poor prognosis. Results A total of 138 patients were included, and 7 patients were lost to follow-up. Finally, 131 patients were included. Among them, there were 50 cases in the elderly group and 81 cases in the other age group. There were statistically significant differences in age, hypertension, atrial fibrillation, and vascular recanalization between the elderly group and the other age group (P<0.05). There was no statistically significant difference in the other baseline data, complications, 3-month prognosis, or mortality between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that the National Institute of Health Stroke Scale score at admission [odds ratio (OR)=1.150, 95% confidence interval (CI) (1.033, 1.281), P=0.011], pulmonary infection [OR=2.933, 95%CI (1.109, 7.758), P=0.030], and hypoproteinemia [OR=3.716, 95%CI (1.226, 11.264), P=0.020] affected the mRS score at 3 months after onset. Conclusions Among the patients with acute ischemic stroke undergoing endovascular therapy, there is no difference in the occurrence of complications or short-term prognosis between elderly patients and other age patients. However, the attention should still be paid to reducing the occurrence of complications in patients, strengthening their nutritional support, and thereby improving their prognosis.
Objective To evaluate the associations of 16 variants in clopidogrel-relevant genes with early neurological deterioration (END) in acute ischemic stroke (AIS) patients receiving clopidogrel treatment. Methods AIS patients admitted to the Department of Neurology of three hospitals between June 2014 and January 2015 were included. The 16 variants in clopidogrel-relevant genes were examined using mass spectrometry. Gene-gene interactions were analyzed by generalized multifactor dimensionality reduction (GMDR) methods. The primary outcome was END within the 10 days of admission. Results A total of 375 patients with AIS were included. Among the 375 patients, 95 (25.33%) patients developed END within the first 10 days of admission. Among the 16 variants, only CYP2C19*2 rs4244285 AG+AA was associated with END using single-locus analytical approach (P<0.001). GMDR analysis revealed that there was a synergistic effect of gene-gene interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPⅢa rs2317676 on risk for END (P=0.019). Cox regression analysis showed that the high-risk interactive genotype was independent predictor for END [hazard ratio=2.184, 95% confidence interval (1.472, 3.238), P=0.004]. Conclusions END is very common in patients with AIS. Interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPⅢa rs2317676 may confer a higher risk for END. It may be very important to modify clopidogrel therapy for the patients carrying the high-risk interactive genotype.
ObjectiveTo systematically review the efficacy and safety of bone mesenchymal stem cells (BMSCs) transplantation for ischemic stroke. MethodsWe electronically searched PubMed, The Cochrane Library (Issue 12, 2014), EMbase, CBM, CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of BMSCs transplantation for ischemic stroke. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 6 RCTs involving 332 patients were included. The results of meta-analysis showed that, the BMSCs transplantation group was superior to the routine treatment group with significant differences in the neurologic deficits score (NIHSS score)(MD=-2.09, 95%CI -2.88 to -1.29, P<0.000 01), motor function (Fugl-Meyer rating scale) (MD=15.25, 95%CI 13.51 to 16.99, P<0.000 01) and daily life ability (Barthel index) (MD=20.04, 95%CI 9.91 to 30.17, P=0.000 1) after 3 months treatment. Two trials reported the adverse events including fever and headache, but the patients relieved in a brief period. ConclusionCurrent evidence shows that BMSCs transplantation can improve the neurological deficits, motor function and daily life ability after ischemic stroke with less adverse effect. No serious adverse events are observed. However, more high quality studies are needed to confirm its effects for lowering rates of death and dependency of BMSC.
Objective The core indicator pool of ischemic stroke (IS) was constructed to provide a basis for the establishment of the core outcome set (COS), so as to improve the consistency of clinical research and evaluation results of traditional Chinese medicine (TCM) treatment for IS. Methods In this study, the mixed methods research (MMR) convergent parallel design was used to carry out qualitative research and quantitative research at the same time, and the two research results were integrated to reach a conclusion. Quantitative research comprehensively collected the multi-source efficacy evaluation indicators of TCM treatment of IS, and carried out descriptive statistical analysis based on frequency theory. Semi-structured interviews were used in the qualitative research, relevant interest groups were selected to understand the evaluation indicators of the IS efficacy of TCM treatment that they were concerned about, and NVivo software was used for in-depth analysis, coding, classification, and extraction of the efficacy indicators. Based on the principle of pillar integration, quantitative and qualitative research results were integrated to construct an element pool of evaluation indicators for the treatment of IS with traditional Chinese medicine. Results A total of 437 standard papers, 71 registered trial protocols, 100 real-world medical data cases and several guideline consensus policy documents were included in the quantitative study, and a total of 314 indicators in the acute phase of IS, 154 indicators in the recovery phase, and 104 indicators in the sequelae phase were extracted. In the qualitative research part, a total of 32 indicators in the acute stage of IS, 34 indicators in the recovery stage and 35 indicators in the sequelae stage were extracted through interviews. Through group discussion and the principle of pillar integration, an element pool of IS indicators was formed, including 279 IS indicators in the acute stage, 142 indicators in the recovery stage and 91 indicators in the sequelae stage. Conclusion Based on the MMR convergent parallel design, the element pool of the characteristic indicators of the therapeutic effect of IS in TCM is constructed to meet the needs, which provides the preliminary work basis for the construction of the core outcome set of IS in the next stage.
Objective To systematically evaluate the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. Methods Databases including PubMed, EMbase, BIOSIS and CNKI were electronically searched from establishment dates of databases to June 2012 to retrieve animal experiments on the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. The relevant studies were identified according to the predefined inclusion and exclusion criteria, the data were extracted, and the quality was evaluated. Then meta-analysis was performed using RevMan 5.1 software. Results Eight studies were included. The results of meta-analysis showed that no significant difference was found between the alcohol intervention group and the control group (MD=−6.98%, 95%CI −20.38% to 6.43%, P=0.31). However, compared with the control group, low dose of acute alcohol intervention (less than 2 g/kg) improved the prognosis of ischemic stroke with a significant difference (MD=−22.83%, 95%CI −38.77% to −6.89%, P=0.005), and highly-concentrated of chronic alcohol intervention worsened the cerebral ischemic damage of rats and mice with a significant difference (MD=24.06%, 95%CI 10.54% to 37.58%, P=0.000 5). Conclusion Low dose of acute alcohol intervention (less than 2 g/kg) could improve the prognosis of rats and mice with ischemic stroke which has the potential neuro-protective effects. However, highly-concentrated chronic alcohol intervention could worsen the cerebral ischemic damage. Due to the limitations of the included studies such as publication bias, the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke could be overestimated.
ObjectivesTo systematically review the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) on the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages from inception to August, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 13 studies involving 2 995 patients were included. The results of meta-analysis showed that compared with the control group, patients aged 80 and above had no statistically significant difference in reperfusion success rates (OR=0.90, 95%CI 0.71 to 1.14, P=0.378), and incidence of symptomatic intracranial hemorrhage (OR=1.30, 95%CI 0.86 to 1.94, P=0.212), however, with higher incidence of arbitrary intracranial bleeding events (OR=1.61, 95%CI 1.28 to 2.04, P<0.001), 3-month mortality (OR=2.14, 95%CI 1.73 to 2.64, P<0.001) and lower good functional prognosis rate at 3 months (OR=0.46, 95%CI 0.30 to 0.71, P<0.001).ConclusionsCurrent evidence suggests that people aged 80 and above can obtain effective perfusion through mechanical thrombectomy, however, the incidence of postoperative adverse outcome events is higher and the prognosis is relatively poor. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.