[Objectives]To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on neurophysiological outcomes in patients with acute stroke.[Methods]A systematic literature search was conducted across PubMed...[Objectives]To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on neurophysiological outcomes in patients with acute stroke.[Methods]A systematic literature search was conducted across PubMed,EMBASE,Web of Science,the Cochrane Central Register of Controlled Trials(CENTRAL),and CINAHL databases up to March 1,2025.Randomized controlled trials(RCTs)and clinical controlled trials(CCTs)involving adult patients(≥18 years)with acute ischemic stroke(within 2 weeks of onset)who received rTMS intervention were included.Data on motor evoked potential(MEP)amplitude,resting motor threshold(RMT),and central motor conduction time(CMCT)were extracted.The quality of the studies was assessed using the Cochrane risk of bias tool.Statistical analyses were performed using Stata 18.0,with standardized mean differences(SMDs)and 95%confidence intervals(CIs)calculated.Heterogeneity was evaluated using the I^(2)statistic.[Results]Eight studies involving 932 identified records met the inclusion criteria.Meta-analysis revealed that rTMS significantly increased MEP amplitude(Hedges'g=0.77,95%CI:0.52-1.02,P<0.01)and reduced RMT(Hedges g=-1.13,95%CI:-1.63 to-0.62,P<0.01)in the lesioned hemisphere,indicating enhanced corticospinal excitability.No significant effects were observed on MEP amplitude or RMT in the unaffected hemisphere.Additionally,rTMS did not significantly alter CMCT in either hemisphere.Heterogeneity was low to moderate for most outcomes,and no significant publication bias was detected.[Conclusions]rTMS is a safe and effective intervention for improving corticospinal excitability and motor recovery in patients with acute stroke.Both high-frequency stimulation of the ipsilesional hemisphere and low-frequency stimulation of the contralesional hemisphere have demonstrated beneficial effects,supporting the interhemispheric inhibition model.Future large-scale,multi-center RCTs are needed to optimize rTMS parameters and establish standardized treatment protocols for acute stroke rehabilitation.展开更多
OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated T...OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated Traditional Chinese and Western Medicine.METHODS:Randomized controlled trials(RCTs)of China National Knowledge Infrastructure Database,Wanfang Database,Chinese BioMedical Literature Database,PubMed,Embase,and the Cochrane Library were searched from the establishment to March 2022.Two researchers screened the literature and extracted the data according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.RESULTS:A total of 28 RCTs were included,including 2745 patients in the acute stage of stroke(1375 in the experimental group and 1370 in the control group).Metaanalysis showed that compared with conventional treatment,combined treatment with ANP could improve the effective rate of acute stroke patients[relative risk(RR)=1.26,95%confidence interval(CI)(1.21,1.31)],Glasgow Coma Scale scores[mean difference(MD)=2.01,95%CI(1.04,2.98)],Mini-mental State Examination scores[MD=4.79,95%CI(2.22,7.37)],Activities of Daily Living scores[MD=15.70,95%CI(14.05,17.36)]and the Barthel index scores[MD=13.89,95%CI(12.12,15.65)],reduce National Institute of Health stroke scale scores[MD=-3.90,95%CI(-4.96,-2.84)]and serum brain natriuretic peptide[MD=-38.50,95%CI(-46.85,-30.15)].In terms of safety,the incidence of adverse reactions showed no statistical differences between the two groups[RR=0.71,95%CI(0.43,1.15),P=0.16],and no serious adverse reactions/events were observed,indicating a good safety.CONCLUSIONS:Existing clinical research evidence shows that ANP has good efficacy and safety in the treatment of acute stroke,which can provide a basis for the treatment of integrated Traditional Chinese and Western Medicine.However,the quality of included research methodology needs to be improved,and the above conclusions need to be verified by more highquality studies.展开更多
BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remai...BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.展开更多
[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous a...[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous and systematic electronic search was conducted across the Medline,PubMed,and Web of Science databases,encompassing literature up to July 1,2024.To ensure the reliability of the in-cluded studies,an assessment of their risk of bias was conducted using RevMan 5.4 software,in accordance with the rigorous standards out-lined in the Cochrane Handbook for Systematic Revieus.Subsequently,we employed either the random-effects model or the fixed-effects model,depending on the heterogeneity of the data,to estimate the standardized mean difference(SMD)in outcomes,utilizing Stata 18.0 software for statistical analysis.[Results]Our review encompassed a total of five studies,involving 252 patients with acute stroke.The pooled analysis of these studies revealed a statistically significant improvement in Fugl-Meyer Assessment of the Upper Extremity(FMA-UE)scores among pa-tients who received rTMS therapy(SMD=2.71,95%CI:0.85 to 4.56;P<0.0001),albeit with considerable heterogeneity(I^(2)=97.65%)across the trials.[Conclusions]The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke.These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population.展开更多
Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, und...Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.展开更多
This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electro...This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electronically searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, and China Biology Medicine disc. Two reviewers independently screened the articles and extracted the data based on the inclusion and exclusion criteria. The quality of included articles was evaluated by using Revman5.0, and meta-analysis was performed. The results showed that 1027 articles were obtained in initial retrieval, and finally 7 articles, involving a total of 4039 cases, were included for analysis. The meta-analysis showed that no significant differences were found in the long-term mortality（OR=0.91, 95% CI 0.07 to 1.09, P=0.30）, the rate of dependency（OR=1.02, 95% CI 0.87 to 1.24, P=0.85）, and the effective rate（OR=0.98, 95% CI 0.84 to 1.14, P=0.82） between citicoline group and control group. The overall rate of adverse events in citicoline group was not significantly different from that in control group（P=0.30）. The quality of included articles reached moderate-low level. In conclusion, citicolne cannot reduce long-term mortality and dependence rate in the treatment of acute stroke, and the effective rate of citivoline may be not better than that of controls but with reliable safety.展开更多
BACKGROUND： Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect （HS...BACKGROUND： Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect （HSN） dunng acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE： To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN ： Case analysis SETTING ： Department of Neurology, First Affiliated Hospital of Guangxi Medical University PARTICIPANTS： A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria： ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion cnteda： Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was （68±10） years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS： Disappearance and existence of HSN were analyzed with HSN evaluation criteria： body agnosia, left and nght agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method, Items mentioned below belonged to HSN disappearance： ① without body agnosia; ② without left and nght agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one＇s own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and nght agnosia and difficult maintenance of supine position were observed during acute period （within 1 week） and recovery period （at 2 weeks after onset）. Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training （sitting in bed and near bedside： heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage） and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean＋SD and compared with ttest; enumeration data were compared with Chi-square test and Mann-Whitney Utest. P 〈 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES： ① HSN disappearance; ②Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position;③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS： All 21 patients were involved in the final analysis. ① HSN disappearance： Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 （38%, 8/21） HSN disappearance, and 13 （62%, 13/21） HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases： Within 1 week, 19% （4/21） HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% （13/21）, but 43% （17/21） during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention： At acute phase, HSN disappearance through sitting training lasted for （2.5±1.3） days, and remaining HSN symptoms were relieved for （5.0±3.7） days. There was significant difference between them （ x^2= 3.96, P = 0.039）. The hospitalized time of patients with HSN disappearance and HSN remnant was （17.6±10.4）, （16.2±4.9） days, but there was no significant difference between them （x^2 = 1.41, P = 0.679）. Physiotherapy time of patients with HSN disappearance and HSN remnant was （11.1 ±7.5）, （11.4±4.1 ） days, but there was no significant difference between them （x^2 = 1.05, P = 0.894）. CONCLUSION： Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.展开更多
Objective: to study the effect of comprehensive rehabilitation nursing of traditional Chinese medicine on the nursing of patients with acute stroke. Methods: 92 patients with acute stroke from January 2021 to January ...Objective: to study the effect of comprehensive rehabilitation nursing of traditional Chinese medicine on the nursing of patients with acute stroke. Methods: 92 patients with acute stroke from January 2021 to January 2022 were divided into observation group and control group, with an average of 46 patients. According to TCM comprehensive nursing and routine nursing intervention, the effects were compared. Results: ① before nursing, there was no significant difference in FMA score and NHISS score between the two groups (P > 0.05). After nursing, the improvement of FMA score and NHISS score in the observation group was better than that in the control group, with statistical difference (P < 0.05);② the incidence of complications in the observation group (5 cases, accounting for 10.87%) was lower than that in the control group (13 cases, accounting for 28.26%), with statistical difference (P < 0.05);③ the satisfaction of the observation group (41 cases, accounting for 89.13%) was higher than that of the control group (33 cases, accounting for 71.74%), with statistical difference (P < 0.05). Conclusion: comprehensive rehabilitation nursing of traditional Chinese medicine can promote the rehabilitation of patients with acute stroke, reduce the complications of the body and improve the satisfaction, which is worthy of recommendation.展开更多
Objective: to use early rehabilitation treatment for the patients with acute stroke hemiplegia, to observe and analyze its impact on the upper and lower limb function recovery and daily life ability. Methods: in June ...Objective: to use early rehabilitation treatment for the patients with acute stroke hemiplegia, to observe and analyze its impact on the upper and lower limb function recovery and daily life ability. Methods: in June 2021-June 2022 for intercept research time interval, a total of 60 cases of acute stroke hemiplegia, random principle specification grouping, control group received 30 cases of routine treatment, observation group received 30 cases of early rehabilitation treatment, around the upper and lower limb function assessment score, daily life ability evaluation score, balance function, cognitive function scale evaluation score and complication rate data line to compare. Results: before the treatment work, the evaluation results, daily life ability, balance function, and cognitive function evaluation results showed no difference (P> 0.05), and the results were higher (P <0.05);for the complication rate, the observation group showed lower results (P <0.05). Conclusion: for acute stroke cases, early rehabilitation treatment, which can improve the function of upper and lower limbs, strengthen their living ability, balance function and cognitive function, and prevent complications in patients, which is worthy of clinical application.展开更多
Objective: to explore the effect of emergency nursing fast track on the treatment time and effect of acute stroke. Conclusion: emergency nursing fast track has a good effect in the treatment of acute cerebral infarcti...Objective: to explore the effect of emergency nursing fast track on the treatment time and effect of acute stroke. Conclusion: emergency nursing fast track has a good effect in the treatment of acute cerebral infarction, which can effectively shorten the time of receiving and treatment, reduce the disability rate of patients and improve the treatment and prognosis of patients. It has high application value and is worthy of active promotion in clinical treatment.展开更多
BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has ...BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.展开更多
Introduction Obtaining informed consent for research from patients in medical emergencies remains a challenge,particularly in acute stroke care as treatment must be administered quickly and patients often arrive in th...Introduction Obtaining informed consent for research from patients in medical emergencies remains a challenge,particularly in acute stroke care as treatment must be administered quickly and patients often arrive in the hospital in a state of incapacitation.Adaptations to standard consenting approaches-such as the use of surrogate consent or deferral of consent-have significant limitations.This feasibility study aims to test a new consenting approach in acute stroke care that we call advance consent.Advance consent has the potential to render emergency trial enrolment faster,fairer and more transparent,leading to more generalisable results.Methods and design We will conduct a five-part study at The Ottawa Hospital,a quaternary care stroke centre:(1)administering questionnaires in the Ottawa Hospital Stroke Prevention Clinic that will examine patients’perspectives on research participation and advance consent;(2)inviting participants to consent in advance to any or both currently enrolling acute stroke trials;(3)tracking patient enrolment into these trials over 1 year;(4)administering a follow up questionnaire to participants at 1 year and(5)administering a questionnaire to participating hospital staff in order to interrogate their experiences with advance consent.Outcomes include but are not limited to eligibility rate,recruitment rate,withdrawal rate and the proportion of patients whose advance consent results in trial enrolment.展开更多
Background Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium(ASPP)mainly used European and American national healthcare databases,lacking detailed patient-level data and pr...Background Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium(ASPP)mainly used European and American national healthcare databases,lacking detailed patient-level data and precise event timing.Aim(1)To identify the risk factors and prognostic factors for ASPP,(2)to assess the risk of recurrent stroke,particularly during subsequent pregnancies,and(3)to evaluate offspring prognosis.Design This study is a retrospective,observational,nationwide,multicenter research project planned to include 400 ASPP patients from 36 centers across 22 provinces in China,from 2015 to 2024.ASPP is defined as acute ischemic or hemorrhagic stroke during pregnancy or within 6 weeks postpartum,confirmed by neuroimaging.Two matched groups will be included for comparison:400 pregnant/puerperal participants without a stroke history and 400 nonpregnant/puerperal participants with a recent stroke,matched by age and/or stroke etiology.Methods All participants will be followed up through telephone interviews.The initial follow-up is scheduled to take place between December 2024 and February 2025.The follow-up phase will consist of three rounds,each lasting 3 months and conducted every 3 years.Primary outcomes include unfavorable functional outcomes(mRS>2 or EQ-5D index score<0.7)at follow-up for Aim 1,recurrent strokes(neuroimaging-confirmed)for Aim 2,and neonatal asphyxia(Apgar scoring)and future development(ASQ-3)of offspring for Aim 3.Discussion The ASPP study is the first nationwide multicenter study to systematically evaluate the risk factors,prognosis,and risk of recurrent stroke in ASPP patients,particularly during subsequent pregnancies.This research may offer new insights into the long-term impacts of pregnancy-related stroke.展开更多
Background Transdural collaterals,originating mainly from the extracalvarial superficial temporal artery and intracalvarial middle meningeal artery via the external carotid artery(ECA),have been observed after revascu...Background Transdural collaterals,originating mainly from the extracalvarial superficial temporal artery and intracalvarial middle meningeal artery via the external carotid artery(ECA),have been observed after revascularisation surgery.However,the origin of these collaterals in patients with stroke with perfusion insufficiency is not yet known.Therefore,we studied the revascularisation patterns and characteristics based on the origin of these collaterals.Methods We employed erythropoietin pretreatment and performed multiple burr holes under local anaesthesia to achieve transdural revascularisation in patients with acute stroke with perfusion insufficiency.After 6 months,we reassessed the transfemoral cerebral angiography to evaluate the revascularisation patterns.The collaterals were categorised into intracalvarial ECA-dominant(originating from the middle meningeal artery),extracalvarial ECA-dominant(originating from the superficial temporal or occipital artery)and balanced groups.We compared various imaging parameters among these groups.Results Overall,87 patients with 103 treated hemispheres were involved.Among them,57.3%were classified as intracalvarial ECA-dominant,20.4%as extracalvarial ECA-dominant and 22.3%as balanced.Most of the hemispheres with intracalvarial or extracalvarial collaterals(vs balanced collaterals)showed successful revascularisation(78/80(97.5%)vs 12/23(52.1%)),(p<0.001).In ultrasonographic haemodynamic changes according to revascularisation pattern,only the intracalvarial ECA-dominant revascularisation was significantly associated with specific changes in ECA blood flow,leading to the conversion to a low-resistance ECA Doppler sonography waveform.Conclusions Our findings suggest that intracalvarial ECA-dominant revascularisation plays a crucial role in the formation of transdural collaterals following combined therapy.These distinct changes in ECA haemodynamics can be non-invasively identified through bedside ultrasound studies.展开更多
Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic ...Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic stroke remain undetermined.With innovations in high-throughput gene sequencing analysis,many aberrantly expressed non-coding RNAs(ncRNAs)in the brain and peripheral blood after acute ischemic stroke have been found in clinical samples and experimental models.Differentially expressed ncRNAs in the post-stroke brain were demonstrated to play vital roles in pathological processes,leading to neuroprotection or deterioration,thus ncRNAs can serve as therapeutic targets in acute ischemic stroke.Moreover,distinctly expressed ncRNAs in the peripheral blood can be used as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.In particular,ncRNAs in peripheral immune cells were recently shown to be involved in the peripheral and brain immune response after acute ischemic stroke.In this review,we consolidate the latest progress of research into the roles of ncRNAs(microRNAs,long ncRNAs,and circular RNAs)in the pathological processes of acute ischemic stroke–induced brain damage,as well as the potential of these ncRNAs to act as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.Findings from this review will provide novel ideas for the clinical application of ncRNAs in acute ischemic stroke.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with ...BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.展开更多
Objective To explore the clinical characteristics and methods for syndrome differentiation prediction,as well as to construct a predictive model for Qi deficiency and blood stasis syndrome in patients with acute ische...Objective To explore the clinical characteristics and methods for syndrome differentiation prediction,as well as to construct a predictive model for Qi deficiency and blood stasis syndrome in patients with acute ischemic stroke(AIS).Methods This study employed a retrospective case-control design to analyze patients with AIS who received inpatient treatment at the Neurology Department of The First Hospital of Hunan University of Chinese Medicine from January 1,2013 to December 31,2022.AIS patients meeting the diagnostic criteria for Qi deficiency and blood stasis syndrome were stratified into case group,while those without Qi deficiency and blood stasis syndrome were stratified into control group.The demographic characteristics(age and gender),clinical parameters[time from onset to admission,National Institutes of Health Stroke Scale(NIHSS)score,and blood pressure],past medical history,traditional Chinese medicine(TCM)diagnostic characteristics(tongue and pulse),neurological symptoms and signs,imaging findings[magnetic resonance imaging-diffusion weighted imaging(MRI-DWI)],and biochemical indicators of the two groups were collected and compared.The indicators with statistical difference(P<0.05)in univariate analysis were included in multivariate logistic regression analysis to evaluate their predictive value for the diagnosis of Qi deficiency and blood stasis syndrome,and the predictive model was constructed by receiver operating characteristic(ROC)curve analysis.Results The study included 1035 AIS patients,with 404 cases in case group and 631 cases in control group.Compared with control group,patients in case group were significantly older,had extended onset-to-admission time,lower diastolic blood pressure,and lower NIHSS scores(P<0.05).Case group showed lower incidence of hypertension history(P<0.05).Regarding tongue and pulse characteristics,pale and dark tongue colors,white tongue coating,fine pulse,astringent pulse,and sinking pulse were more common in case group.Imaging examinations demonstrated higher proportions of centrum semiovale infarction,cerebral atrophy,and vertebral artery stenosis in case group(P<0.05).Among biochemical indicators,case group showed higher proportions of elevated fasting blood glucose and glycated hemoglobin(HbA1c),while lower proportions of elevated white blood cell count,reduced hemoglobin,and reduced high-density lipoprotein cholesterol(HDL-C)(P<0.05).Multivariate logistic regression analysis identified significant predictors for Qi deficiency and blood stasis syndrome including:fine pulse[odds ratio(OR)=4.38],astringent pulse(OR=3.67),superficial sensory abnormalities(OR=1.86),centrum semiovale infarction(OR=1.57),cerebral atrophy(OR=1.55),vertebral artery stenosis(OR=1.62),and elevated HbA1c(OR=3.52).The ROC curve analysis of the comprehensive prediction model yielded an area under the curve(AUC)of 0.878[95%confidence interval(CI)=0.855-0.900].Conclusion This study finds out that Qi deficiency and blood stasis syndrome represents one of the primary types of AIS.Fine pulse,astringent pulse,superficial sensory abnormalities,centrum semiovale infarction,cerebral atrophy,vertebral artery stenosis,elevated blood glucose,elevated HbA1c,pale and dark tongue colors,and white tongue coating are key objective diagnostic indicators for the syndrome differentiation of AIS with Qi deficiency and blood stasis syndrome.Based on these indicators,a syndrome differentiation prediction model has been developed,offering a more objective basis for clinical diagnosis,and help to rapidly identify this syndrome in clinical practice and reduce misdiagnosis and missed diagnosis.展开更多
This study evaluates the findings of Gu et al,who investigated the role of neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for predicting neuropsychiatric complications in acute ischemic stroke(AIS)pati...This study evaluates the findings of Gu et al,who investigated the role of neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for predicting neuropsychiatric complications in acute ischemic stroke(AIS)patients.The results revealed that elevated serum NGAL levels at admission are associated with a higher risk of cognitive impairment,anxiety,and depressive symptoms at discharge.The study analyzed 150 AIS patients(mean age 65.4 years,58%male)using the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale to assess neuropsychiatric outcomes.Multivariate analysis demonstrated that higher NGAL levels were independent predictors of cognitive impairment[odds ratio(OR)=1.42],anxiety(OR=1.28),and depression(OR=1.39).Notably,NGAL exhibited strong predictive power for cognitive impairment,with an area under the curve of 0.78.Despite these promising findings,NGAL’s clinical utility is limited by its non-specificity across various conditions.Nevertheless,NGAL levels could help identify AIS patients at risk for neuropsychiatric complications,enabling timely intervention and comprehensive neuropsychiatric evaluation.The study emphasizes the need for further research to validate NGAL’s predictive accuracy and specificity in diverse AIS populations and advocates for its integration with other diagnostic modalities to enhance clinical decision-making.展开更多
BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke pa...BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke patients in rural areas.However,it is uncertain if telemedicine-administered thrombolytics is as safe and effective as inperson evaluation by neurology specialists.AIM The authors conducted a meta-analysis evaluating stroke metrics,safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.METHODS PubMed,EMBASE,and Cochrane were searched for randomized clinical trials and observational cohort studies.The Mantel-Haenszel method or inverse variance,as applicable,were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio(RR)or standardized mean difference(SMD).Risk of bias was analyzed using the Newcastle-Ottawa Scale.Primary outcome examined was door-to-needle time(DTN).Secondary outcomes were symptomatic intracranial hemorrhage(sICH),mortality,and mRS≤2.RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis.Of those,34%(n=794)received thrombolytics via telemedicine.Telemedicine was associated with a significantly longer mean DTN compared to inperson evaluation[SMD:0.72 minutes;95%confidence interval(CI)0.22-1.22;P<0.01],a similar rate of sICH[3.9%vs 4.2%;Odds ratio(OR):0.75;95%CI 0.42-1.37;P=0.35],similar rate of mortality(13.2%vs 14.7%;OR:0.87;95%CI 0.47-1.63;P=0.67),and comparable rate of favorable short-term functional outcome(46.8%vs 50.7%;OR:0.79;95%CI 0.41-1.53;P=0.48).Risk of bias was low to moderate for each outcome.CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation.This difference in stroke metric does not affect safety or outcome.Further studies are needed to understand and address the underlying factors of the longer DTN time.展开更多
文摘[Objectives]To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on neurophysiological outcomes in patients with acute stroke.[Methods]A systematic literature search was conducted across PubMed,EMBASE,Web of Science,the Cochrane Central Register of Controlled Trials(CENTRAL),and CINAHL databases up to March 1,2025.Randomized controlled trials(RCTs)and clinical controlled trials(CCTs)involving adult patients(≥18 years)with acute ischemic stroke(within 2 weeks of onset)who received rTMS intervention were included.Data on motor evoked potential(MEP)amplitude,resting motor threshold(RMT),and central motor conduction time(CMCT)were extracted.The quality of the studies was assessed using the Cochrane risk of bias tool.Statistical analyses were performed using Stata 18.0,with standardized mean differences(SMDs)and 95%confidence intervals(CIs)calculated.Heterogeneity was evaluated using the I^(2)statistic.[Results]Eight studies involving 932 identified records met the inclusion criteria.Meta-analysis revealed that rTMS significantly increased MEP amplitude(Hedges'g=0.77,95%CI:0.52-1.02,P<0.01)and reduced RMT(Hedges g=-1.13,95%CI:-1.63 to-0.62,P<0.01)in the lesioned hemisphere,indicating enhanced corticospinal excitability.No significant effects were observed on MEP amplitude or RMT in the unaffected hemisphere.Additionally,rTMS did not significantly alter CMCT in either hemisphere.Heterogeneity was low to moderate for most outcomes,and no significant publication bias was detected.[Conclusions]rTMS is a safe and effective intervention for improving corticospinal excitability and motor recovery in patients with acute stroke.Both high-frequency stimulation of the ipsilesional hemisphere and low-frequency stimulation of the contralesional hemisphere have demonstrated beneficial effects,supporting the interhemispheric inhibition model.Future large-scale,multi-center RCTs are needed to optimize rTMS parameters and establish standardized treatment protocols for acute stroke rehabilitation.
基金Science and Technology Innovation Project of China Academy of Chinese Medical Sciences:Research on Key Technologies of Real-world Clinical Evaluation and Data Governance Analysis Based on Disease Research(No.CI2021A00702-2)Project of National Key Research and Development Program:Development of International Clinical Research Service Standard for Acupuncture and Moxibustion(No.2019YFC1712205)。
文摘OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated Traditional Chinese and Western Medicine.METHODS:Randomized controlled trials(RCTs)of China National Knowledge Infrastructure Database,Wanfang Database,Chinese BioMedical Literature Database,PubMed,Embase,and the Cochrane Library were searched from the establishment to March 2022.Two researchers screened the literature and extracted the data according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.RESULTS:A total of 28 RCTs were included,including 2745 patients in the acute stage of stroke(1375 in the experimental group and 1370 in the control group).Metaanalysis showed that compared with conventional treatment,combined treatment with ANP could improve the effective rate of acute stroke patients[relative risk(RR)=1.26,95%confidence interval(CI)(1.21,1.31)],Glasgow Coma Scale scores[mean difference(MD)=2.01,95%CI(1.04,2.98)],Mini-mental State Examination scores[MD=4.79,95%CI(2.22,7.37)],Activities of Daily Living scores[MD=15.70,95%CI(14.05,17.36)]and the Barthel index scores[MD=13.89,95%CI(12.12,15.65)],reduce National Institute of Health stroke scale scores[MD=-3.90,95%CI(-4.96,-2.84)]and serum brain natriuretic peptide[MD=-38.50,95%CI(-46.85,-30.15)].In terms of safety,the incidence of adverse reactions showed no statistical differences between the two groups[RR=0.71,95%CI(0.43,1.15),P=0.16],and no serious adverse reactions/events were observed,indicating a good safety.CONCLUSIONS:Existing clinical research evidence shows that ANP has good efficacy and safety in the treatment of acute stroke,which can provide a basis for the treatment of integrated Traditional Chinese and Western Medicine.However,the quality of included research methodology needs to be improved,and the above conclusions need to be verified by more highquality studies.
基金This study has been registered at the Clinical Research Registry at www.researchregistry.com.The registration identification number is(researchregistry9015).
文摘BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
文摘[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous and systematic electronic search was conducted across the Medline,PubMed,and Web of Science databases,encompassing literature up to July 1,2024.To ensure the reliability of the in-cluded studies,an assessment of their risk of bias was conducted using RevMan 5.4 software,in accordance with the rigorous standards out-lined in the Cochrane Handbook for Systematic Revieus.Subsequently,we employed either the random-effects model or the fixed-effects model,depending on the heterogeneity of the data,to estimate the standardized mean difference(SMD)in outcomes,utilizing Stata 18.0 software for statistical analysis.[Results]Our review encompassed a total of five studies,involving 252 patients with acute stroke.The pooled analysis of these studies revealed a statistically significant improvement in Fugl-Meyer Assessment of the Upper Extremity(FMA-UE)scores among pa-tients who received rTMS therapy(SMD=2.71,95%CI:0.85 to 4.56;P<0.0001),albeit with considerable heterogeneity(I^(2)=97.65%)across the trials.[Conclusions]The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke.These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population.
基金the Science and Technology Foundation of Shanghai Railway Bureau of China, No. B340406052
文摘Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.
文摘This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electronically searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, and China Biology Medicine disc. Two reviewers independently screened the articles and extracted the data based on the inclusion and exclusion criteria. The quality of included articles was evaluated by using Revman5.0, and meta-analysis was performed. The results showed that 1027 articles were obtained in initial retrieval, and finally 7 articles, involving a total of 4039 cases, were included for analysis. The meta-analysis showed that no significant differences were found in the long-term mortality（OR=0.91, 95% CI 0.07 to 1.09, P=0.30）, the rate of dependency（OR=1.02, 95% CI 0.87 to 1.24, P=0.85）, and the effective rate（OR=0.98, 95% CI 0.84 to 1.14, P=0.82） between citicoline group and control group. The overall rate of adverse events in citicoline group was not significantly different from that in control group（P=0.30）. The quality of included articles reached moderate-low level. In conclusion, citicolne cannot reduce long-term mortality and dependence rate in the treatment of acute stroke, and the effective rate of citivoline may be not better than that of controls but with reliable safety.
文摘BACKGROUND： Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect （HSN） dunng acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE： To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN ： Case analysis SETTING ： Department of Neurology, First Affiliated Hospital of Guangxi Medical University PARTICIPANTS： A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria： ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion cnteda： Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was （68±10） years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS： Disappearance and existence of HSN were analyzed with HSN evaluation criteria： body agnosia, left and nght agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method, Items mentioned below belonged to HSN disappearance： ① without body agnosia; ② without left and nght agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one＇s own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and nght agnosia and difficult maintenance of supine position were observed during acute period （within 1 week） and recovery period （at 2 weeks after onset）. Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training （sitting in bed and near bedside： heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage） and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean＋SD and compared with ttest; enumeration data were compared with Chi-square test and Mann-Whitney Utest. P 〈 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES： ① HSN disappearance; ②Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position;③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS： All 21 patients were involved in the final analysis. ① HSN disappearance： Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 （38%, 8/21） HSN disappearance, and 13 （62%, 13/21） HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases： Within 1 week, 19% （4/21） HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% （13/21）, but 43% （17/21） during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention： At acute phase, HSN disappearance through sitting training lasted for （2.5±1.3） days, and remaining HSN symptoms were relieved for （5.0±3.7） days. There was significant difference between them （ x^2= 3.96, P = 0.039）. The hospitalized time of patients with HSN disappearance and HSN remnant was （17.6±10.4）, （16.2±4.9） days, but there was no significant difference between them （x^2 = 1.41, P = 0.679）. Physiotherapy time of patients with HSN disappearance and HSN remnant was （11.1 ±7.5）, （11.4±4.1 ） days, but there was no significant difference between them （x^2 = 1.05, P = 0.894）. CONCLUSION： Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.
文摘Objective: to study the effect of comprehensive rehabilitation nursing of traditional Chinese medicine on the nursing of patients with acute stroke. Methods: 92 patients with acute stroke from January 2021 to January 2022 were divided into observation group and control group, with an average of 46 patients. According to TCM comprehensive nursing and routine nursing intervention, the effects were compared. Results: ① before nursing, there was no significant difference in FMA score and NHISS score between the two groups (P > 0.05). After nursing, the improvement of FMA score and NHISS score in the observation group was better than that in the control group, with statistical difference (P < 0.05);② the incidence of complications in the observation group (5 cases, accounting for 10.87%) was lower than that in the control group (13 cases, accounting for 28.26%), with statistical difference (P < 0.05);③ the satisfaction of the observation group (41 cases, accounting for 89.13%) was higher than that of the control group (33 cases, accounting for 71.74%), with statistical difference (P < 0.05). Conclusion: comprehensive rehabilitation nursing of traditional Chinese medicine can promote the rehabilitation of patients with acute stroke, reduce the complications of the body and improve the satisfaction, which is worthy of recommendation.
文摘Objective: to use early rehabilitation treatment for the patients with acute stroke hemiplegia, to observe and analyze its impact on the upper and lower limb function recovery and daily life ability. Methods: in June 2021-June 2022 for intercept research time interval, a total of 60 cases of acute stroke hemiplegia, random principle specification grouping, control group received 30 cases of routine treatment, observation group received 30 cases of early rehabilitation treatment, around the upper and lower limb function assessment score, daily life ability evaluation score, balance function, cognitive function scale evaluation score and complication rate data line to compare. Results: before the treatment work, the evaluation results, daily life ability, balance function, and cognitive function evaluation results showed no difference (P> 0.05), and the results were higher (P <0.05);for the complication rate, the observation group showed lower results (P <0.05). Conclusion: for acute stroke cases, early rehabilitation treatment, which can improve the function of upper and lower limbs, strengthen their living ability, balance function and cognitive function, and prevent complications in patients, which is worthy of clinical application.
文摘Objective: to explore the effect of emergency nursing fast track on the treatment time and effect of acute stroke. Conclusion: emergency nursing fast track has a good effect in the treatment of acute cerebral infarction, which can effectively shorten the time of receiving and treatment, reduce the disability rate of patients and improve the treatment and prognosis of patients. It has high application value and is worthy of active promotion in clinical treatment.
基金Supported by the Research Grant of the Chungbuk National University Hospital in 2020.
文摘BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.
基金supported by CIHR SPOR Grant 2021(Application number 453176 Competition code 202010PJK)the New Frontiers in Research Fund(NFRF)2021 Innovative Approaches to Research in the Pandemic Context(Application ID 00379).
文摘Introduction Obtaining informed consent for research from patients in medical emergencies remains a challenge,particularly in acute stroke care as treatment must be administered quickly and patients often arrive in the hospital in a state of incapacitation.Adaptations to standard consenting approaches-such as the use of surrogate consent or deferral of consent-have significant limitations.This feasibility study aims to test a new consenting approach in acute stroke care that we call advance consent.Advance consent has the potential to render emergency trial enrolment faster,fairer and more transparent,leading to more generalisable results.Methods and design We will conduct a five-part study at The Ottawa Hospital,a quaternary care stroke centre:(1)administering questionnaires in the Ottawa Hospital Stroke Prevention Clinic that will examine patients’perspectives on research participation and advance consent;(2)inviting participants to consent in advance to any or both currently enrolling acute stroke trials;(3)tracking patient enrolment into these trials over 1 year;(4)administering a follow up questionnaire to participants at 1 year and(5)administering a questionnaire to participating hospital staff in order to interrogate their experiences with advance consent.Outcomes include but are not limited to eligibility rate,recruitment rate,withdrawal rate and the proportion of patients whose advance consent results in trial enrolment.
基金supported by the China Postdoctoral Science Foundation(2024M762182).
文摘Background Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium(ASPP)mainly used European and American national healthcare databases,lacking detailed patient-level data and precise event timing.Aim(1)To identify the risk factors and prognostic factors for ASPP,(2)to assess the risk of recurrent stroke,particularly during subsequent pregnancies,and(3)to evaluate offspring prognosis.Design This study is a retrospective,observational,nationwide,multicenter research project planned to include 400 ASPP patients from 36 centers across 22 provinces in China,from 2015 to 2024.ASPP is defined as acute ischemic or hemorrhagic stroke during pregnancy or within 6 weeks postpartum,confirmed by neuroimaging.Two matched groups will be included for comparison:400 pregnant/puerperal participants without a stroke history and 400 nonpregnant/puerperal participants with a recent stroke,matched by age and/or stroke etiology.Methods All participants will be followed up through telephone interviews.The initial follow-up is scheduled to take place between December 2024 and February 2025.The follow-up phase will consist of three rounds,each lasting 3 months and conducted every 3 years.Primary outcomes include unfavorable functional outcomes(mRS>2 or EQ-5D index score<0.7)at follow-up for Aim 1,recurrent strokes(neuroimaging-confirmed)for Aim 2,and neonatal asphyxia(Apgar scoring)and future development(ASQ-3)of offspring for Aim 3.Discussion The ASPP study is the first nationwide multicenter study to systematically evaluate the risk factors,prognosis,and risk of recurrent stroke in ASPP patients,particularly during subsequent pregnancies.This research may offer new insights into the long-term impacts of pregnancy-related stroke.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&Welfare,Republic of Korea(HR21C1003 and HR22C1734).
文摘Background Transdural collaterals,originating mainly from the extracalvarial superficial temporal artery and intracalvarial middle meningeal artery via the external carotid artery(ECA),have been observed after revascularisation surgery.However,the origin of these collaterals in patients with stroke with perfusion insufficiency is not yet known.Therefore,we studied the revascularisation patterns and characteristics based on the origin of these collaterals.Methods We employed erythropoietin pretreatment and performed multiple burr holes under local anaesthesia to achieve transdural revascularisation in patients with acute stroke with perfusion insufficiency.After 6 months,we reassessed the transfemoral cerebral angiography to evaluate the revascularisation patterns.The collaterals were categorised into intracalvarial ECA-dominant(originating from the middle meningeal artery),extracalvarial ECA-dominant(originating from the superficial temporal or occipital artery)and balanced groups.We compared various imaging parameters among these groups.Results Overall,87 patients with 103 treated hemispheres were involved.Among them,57.3%were classified as intracalvarial ECA-dominant,20.4%as extracalvarial ECA-dominant and 22.3%as balanced.Most of the hemispheres with intracalvarial or extracalvarial collaterals(vs balanced collaterals)showed successful revascularisation(78/80(97.5%)vs 12/23(52.1%)),(p<0.001).In ultrasonographic haemodynamic changes according to revascularisation pattern,only the intracalvarial ECA-dominant revascularisation was significantly associated with specific changes in ECA blood flow,leading to the conversion to a low-resistance ECA Doppler sonography waveform.Conclusions Our findings suggest that intracalvarial ECA-dominant revascularisation plays a crucial role in the formation of transdural collaterals following combined therapy.These distinct changes in ECA haemodynamics can be non-invasively identified through bedside ultrasound studies.
基金supported by the National Natural Science Foundation of China,Nos.82301486(to SL)and 82071325(to FY)Medjaden Academy&Research Foundation for Young Scientists,No.MJR202310040(to SL)+2 种基金Nanjing Medical University Science and Technique Development,No.NMUB20220060(to SL)Medical Scientific Research Project of Jiangsu Commission of Health,No.ZDA2020019(to JZ)Health China Buchang Zhiyuan Public Welfare Project for Heart and Brain Health,No.HIGHER202102(to QD).
文摘Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic stroke remain undetermined.With innovations in high-throughput gene sequencing analysis,many aberrantly expressed non-coding RNAs(ncRNAs)in the brain and peripheral blood after acute ischemic stroke have been found in clinical samples and experimental models.Differentially expressed ncRNAs in the post-stroke brain were demonstrated to play vital roles in pathological processes,leading to neuroprotection or deterioration,thus ncRNAs can serve as therapeutic targets in acute ischemic stroke.Moreover,distinctly expressed ncRNAs in the peripheral blood can be used as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.In particular,ncRNAs in peripheral immune cells were recently shown to be involved in the peripheral and brain immune response after acute ischemic stroke.In this review,we consolidate the latest progress of research into the roles of ncRNAs(microRNAs,long ncRNAs,and circular RNAs)in the pathological processes of acute ischemic stroke–induced brain damage,as well as the potential of these ncRNAs to act as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.Findings from this review will provide novel ideas for the clinical application of ncRNAs in acute ischemic stroke.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
基金Supported by the Foundation of Jiangsu Provincial Commission of Health and Family Planning,No.QNRC2016353the Commission of Health and Family Planning Xuzhou,No.KC22206.
文摘BACKGROUND Stress hyperglycemia(SH)is a common phenomenon that is present in about 50%of patients with acute ischemic stroke(AIS).It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis(IVT).AIM To investigate the predictive value of glycemic indicators for early neurological outcomes(ENOs)in patients with AIS treated with IVT.METHODS We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology,Second Affiliated Hospital of Xuzhou Medical University,between January 2017 and June 2022.ENO included early neurological improvement(ENI)and early neurological deterioration(END),defined as a decrease or increase in the National Institutes of Health Stroke Scale(NIHSS)score between baseline and 24 hours after IVT.We analyzed the associations between glycemic indicators[including admission hyperglycemia(AH),fasting blood glucose(FBG),and SH ratio(SHR)]and ENO in all patients and in subgroups stratified by diabetes mellitus(DM).RESULTS A total of 819 patients with AIS treated with IVT were included.Among these,AH was observed in 329 patients(40.2%).Compared with patients without AH,those with AH were more likely to have a higher prevalence of DM(P<0.001)and hypertension(P=0.031)and presented with higher admission NIHSS scores(P<0.001).During the first 24 hours after IVT,END occurred in 208 patients(25.4%)and ENI occurred in 156 patients(19.0%).Multivariate mixed logistic regression analyses indicated that END was independently associated with AH[odds ratio(OR):1.744,95%confidence interval(CI):1.236-2.463;P=0.002].Subjects were classified into four groups representing quartiles.Compared with Q1,patients in the higher quartiles of SHR(Q2:OR:2.306,95%CI:1.342-3.960;P=0.002)(Q3:OR:2.284,95%CI:1.346-3.876;P=0.002)(Q4:OR:3.486,95%CI:2.088-5.820;P=0.001)and FBG(Q3:OR:1.746,95%CI:1.045-2.917;P=0.033)(Q4:OR:2.436,95%CI:1.476-4.022;P=0.001)had a significantly higher risk of END in the overall population.However,none of the glycemic indicators were found to be associated with ENI in patients with or without DM.CONCLUSION Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.
基金National Natural Science Foundation of China(U22A20377)Natural Science Foundation of Hunan Province of China(23C0168).
文摘Objective To explore the clinical characteristics and methods for syndrome differentiation prediction,as well as to construct a predictive model for Qi deficiency and blood stasis syndrome in patients with acute ischemic stroke(AIS).Methods This study employed a retrospective case-control design to analyze patients with AIS who received inpatient treatment at the Neurology Department of The First Hospital of Hunan University of Chinese Medicine from January 1,2013 to December 31,2022.AIS patients meeting the diagnostic criteria for Qi deficiency and blood stasis syndrome were stratified into case group,while those without Qi deficiency and blood stasis syndrome were stratified into control group.The demographic characteristics(age and gender),clinical parameters[time from onset to admission,National Institutes of Health Stroke Scale(NIHSS)score,and blood pressure],past medical history,traditional Chinese medicine(TCM)diagnostic characteristics(tongue and pulse),neurological symptoms and signs,imaging findings[magnetic resonance imaging-diffusion weighted imaging(MRI-DWI)],and biochemical indicators of the two groups were collected and compared.The indicators with statistical difference(P<0.05)in univariate analysis were included in multivariate logistic regression analysis to evaluate their predictive value for the diagnosis of Qi deficiency and blood stasis syndrome,and the predictive model was constructed by receiver operating characteristic(ROC)curve analysis.Results The study included 1035 AIS patients,with 404 cases in case group and 631 cases in control group.Compared with control group,patients in case group were significantly older,had extended onset-to-admission time,lower diastolic blood pressure,and lower NIHSS scores(P<0.05).Case group showed lower incidence of hypertension history(P<0.05).Regarding tongue and pulse characteristics,pale and dark tongue colors,white tongue coating,fine pulse,astringent pulse,and sinking pulse were more common in case group.Imaging examinations demonstrated higher proportions of centrum semiovale infarction,cerebral atrophy,and vertebral artery stenosis in case group(P<0.05).Among biochemical indicators,case group showed higher proportions of elevated fasting blood glucose and glycated hemoglobin(HbA1c),while lower proportions of elevated white blood cell count,reduced hemoglobin,and reduced high-density lipoprotein cholesterol(HDL-C)(P<0.05).Multivariate logistic regression analysis identified significant predictors for Qi deficiency and blood stasis syndrome including:fine pulse[odds ratio(OR)=4.38],astringent pulse(OR=3.67),superficial sensory abnormalities(OR=1.86),centrum semiovale infarction(OR=1.57),cerebral atrophy(OR=1.55),vertebral artery stenosis(OR=1.62),and elevated HbA1c(OR=3.52).The ROC curve analysis of the comprehensive prediction model yielded an area under the curve(AUC)of 0.878[95%confidence interval(CI)=0.855-0.900].Conclusion This study finds out that Qi deficiency and blood stasis syndrome represents one of the primary types of AIS.Fine pulse,astringent pulse,superficial sensory abnormalities,centrum semiovale infarction,cerebral atrophy,vertebral artery stenosis,elevated blood glucose,elevated HbA1c,pale and dark tongue colors,and white tongue coating are key objective diagnostic indicators for the syndrome differentiation of AIS with Qi deficiency and blood stasis syndrome.Based on these indicators,a syndrome differentiation prediction model has been developed,offering a more objective basis for clinical diagnosis,and help to rapidly identify this syndrome in clinical practice and reduce misdiagnosis and missed diagnosis.
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea Funded by the Ministry of Education,No.RS-2023-00237287Regional Innovation Strategy Through the National Research Foundation of Korea Funded by the Ministry of Education,No.2021RIS-003.
文摘This study evaluates the findings of Gu et al,who investigated the role of neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for predicting neuropsychiatric complications in acute ischemic stroke(AIS)patients.The results revealed that elevated serum NGAL levels at admission are associated with a higher risk of cognitive impairment,anxiety,and depressive symptoms at discharge.The study analyzed 150 AIS patients(mean age 65.4 years,58%male)using the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale to assess neuropsychiatric outcomes.Multivariate analysis demonstrated that higher NGAL levels were independent predictors of cognitive impairment[odds ratio(OR)=1.42],anxiety(OR=1.28),and depression(OR=1.39).Notably,NGAL exhibited strong predictive power for cognitive impairment,with an area under the curve of 0.78.Despite these promising findings,NGAL’s clinical utility is limited by its non-specificity across various conditions.Nevertheless,NGAL levels could help identify AIS patients at risk for neuropsychiatric complications,enabling timely intervention and comprehensive neuropsychiatric evaluation.The study emphasizes the need for further research to validate NGAL’s predictive accuracy and specificity in diverse AIS populations and advocates for its integration with other diagnostic modalities to enhance clinical decision-making.
文摘BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke patients in rural areas.However,it is uncertain if telemedicine-administered thrombolytics is as safe and effective as inperson evaluation by neurology specialists.AIM The authors conducted a meta-analysis evaluating stroke metrics,safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.METHODS PubMed,EMBASE,and Cochrane were searched for randomized clinical trials and observational cohort studies.The Mantel-Haenszel method or inverse variance,as applicable,were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio(RR)or standardized mean difference(SMD).Risk of bias was analyzed using the Newcastle-Ottawa Scale.Primary outcome examined was door-to-needle time(DTN).Secondary outcomes were symptomatic intracranial hemorrhage(sICH),mortality,and mRS≤2.RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis.Of those,34%(n=794)received thrombolytics via telemedicine.Telemedicine was associated with a significantly longer mean DTN compared to inperson evaluation[SMD:0.72 minutes;95%confidence interval(CI)0.22-1.22;P<0.01],a similar rate of sICH[3.9%vs 4.2%;Odds ratio(OR):0.75;95%CI 0.42-1.37;P=0.35],similar rate of mortality(13.2%vs 14.7%;OR:0.87;95%CI 0.47-1.63;P=0.67),and comparable rate of favorable short-term functional outcome(46.8%vs 50.7%;OR:0.79;95%CI 0.41-1.53;P=0.48).Risk of bias was low to moderate for each outcome.CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation.This difference in stroke metric does not affect safety or outcome.Further studies are needed to understand and address the underlying factors of the longer DTN time.
