The term "mild stroke",or "minor stroke" refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of...The term "mild stroke",or "minor stroke" refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of mild stroke. Patients with mild stroke are assumed to have a good prognosis in natural course,so they are routinely not given thrombolysis despite early emergency department arrival. Recent studies have revealed that,however,approximately one third of so-called mild stroke patients who are not treated with thrombolysis have significant disability whereas those treated are more likely to achieve a good recovery. Thus excluding all mild strokes from thrombolysis is probably not justified. Those mild stroke patients who are likely to experience early deterioration or end with disability are mostly characterized by imaging findings. Therefore,selected patients with these characteristics based on neuroimaging to be given thrombolysis might be more justified. Meanwhile,new definition should be developed to exclude those who are at a higher risk of poor outcome. Applying information from imaging may make it come true. Using neuroimaging information to define mild stroke and select patients with mild symptoms to thrombolysis may be a future direction.展开更多
Objective: to investigate the clinical safety and efficacy of intravenous thrombolysis with alteplase in the treatment of acute mild ischemic stroke. Methods: a total of 92 patients with acute mild ischemic stroke adm...Objective: to investigate the clinical safety and efficacy of intravenous thrombolysis with alteplase in the treatment of acute mild ischemic stroke. Methods: a total of 92 patients with acute mild ischemic stroke admitted from September in 2019 to March in 2020 were selected and divided into control group and observation group, with 46 cases in each group. The control group received conventional treatment, and the observation group received intravenous thrombolytic therapy with alteplase. The neurological function deficit, therapeutic effect and safety of the two groups were compared. Results: Before treatment, there was no statistical difference in NIHSS scores between 2 groups (P > 0.05). After treatment, the scores of both groups decreased, and the NIHSS scores of the observation group at different stages decreased more than that of the control group, with statistical significance (P < 0.05). The effective rate of observation group was significantly higher than control group. The complication rate of the observation group was lower than that of the control group. Conclusion: intravenous thrombolysis with alteplase is effective in treating acute mild ischemic stroke. It can be seen that the neurological function deficit has been significantly improved, with fewer complications. It is a treatment method with guaranteed safety and effectiveness, which is worthy of clinical promotion.展开更多
Objective: to analyze the effect of Compound Changpu Yizhi Decoction combined with Nimodipine in the treatment of mild cognitive dysfunction after stroke. Methods: a total of 70 patients with mild cognitive impairment...Objective: to analyze the effect of Compound Changpu Yizhi Decoction combined with Nimodipine in the treatment of mild cognitive dysfunction after stroke. Methods: a total of 70 patients with mild cognitive impairment after stroke were selected from our hospital from July 2018 to July 2019, and randomly divided into 2 groups with 35 patients in each group in the digital table. Patients in the control group were treated with Nimodipine, while patients in the observation group were additionally treated with Compound Changpu Yizhi Decoction. Results: the scores of Montreal Cognitive Assessment Scale (MOCA), Simple Mental Status Checklist (MMSE) and ADL of daily living ability in 2 groups before treatment were compared (P > 0.05), while the above three scores were increased in 2 groups after treatment, and the scores of observation group were significantly higher than control group (P < 0.05). The total effective rate of observation group was 85.71% (30/35) higher than that of control group (65.71%, 23/35), P < 0.05. Conclusion: Nimodipine combined with Compound Changpu Yizhi Decoction has a definite effect on the treatment of mild cognitive dysfunction after stroke, which is beneficial to improve the cognitive function of patients and promote the ability of daily living activities of patients. Therefore, it is worthy of promotion and application.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;">Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also co...<div style="text-align:justify;"> <span style="font-family:Verdana;">Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also cognitive. Approximately two-thirds of Ischemic Stroke patients, who represent the most common type of stroke are found to have mild deficits. Minor stroke, sometimes also referred to as “mild stroke”, is often defined in research studies as a National Institute of Health Stroke Scale (NIHSS) score of 5 or less, although, the cut point for NIHSS score or standardized criterion to define minor stroke has not been established. In the past, many studies have been focusing on the definition of the minor stroke to better stabilize the acute treatment guidelines, to predict the functional outcome, and also for early risk factors stratification. Different studies use different criteria or different cut-points of NIHSS scores to define minor stroke. Aside from indecision of acute management of minor stroke, many other questions have been raised regarding minor strokes, for example, the interaction of large vessel occlusion with minor stroke, the prevalence rate of depression, anxiety, cognitive dysfunction, chronic head after minor stroke, and so on. Finding a universal definition for minor stroke is the key to establish the guideline for management for this group of patients. However, the guidance of treatment of minor stroke is not the focus of this review. The review will focus on the deep comprehension of minor stroke characteristics, summarizing the new findings related to minor stroke, and highlight the essential points to consider for characterizing mild stroke symptoms for a new direction guide for future studies.</span> </div>展开更多
目的探讨基于药物基因组学的抗血小板药物个体化药学服务模式对轻型缺血性卒中患者神经功能、用药依从性、安全性及预后的影响。方法纳入2022年2月—2023年10月焦作市人民医院收治的轻型缺血性卒中患者86例为研究对象,根据是否行基因检...目的探讨基于药物基因组学的抗血小板药物个体化药学服务模式对轻型缺血性卒中患者神经功能、用药依从性、安全性及预后的影响。方法纳入2022年2月—2023年10月焦作市人民医院收治的轻型缺血性卒中患者86例为研究对象,根据是否行基因检测分为观察组(n=43)和对照组(n=43)。观察组以阿司匹林及氯吡格雷基因多态性检测结果为导向,制定和调整个体化用药及药学监护方案。对照组采用临床经验性治疗模式。收集观察组药物抵抗基因分布情况,比较两组神经功能、住院时间、用药依从性、药物不良反应、随访90天预后情况。结果观察组阿司匹林高应答及中间应答患者分别占比46.51%、53.49%,未发现低应答患者;氯吡格雷中间代谢型和慢代谢型共占比55.81%。18例正常代谢型与1例快代谢型患者均按照常规剂量给药;20例中间代谢型及4例慢代谢型患者均将氯吡格雷更换为替格瑞洛或西洛他唑。治疗后,观察组住院天数为(9.77±3.53)天,低于对照组住院天数为(11.23±2.61)d(P<0.05);观察组美国国立卫生研究院卒中量表(NIHSS)评分较治疗前降低更为明显(2.02±1.65 vs 1.02±1.22,P<0.001);观察组药物不良反应发生率6.98%,低于对照组27.91%(P<0.05),其中轻度出血发生率无明显差异(P=0.616);随访90日,观察组脑卒中改良Rankin量表(mRS)评分0~1比例及用药总依从率分别为72.09%、90.70%,明显高于对照组48.84%、72.09%,P<0.05。结论基于抗血小板药物基因组学的个体化药学服务模式,可提高卒中患者用药依从性,减少不良反应产生,改善神经功能及短期预后。展开更多
目的探讨静脉溶栓与双抗治疗急性轻型非致残性缺血性脑卒中的临床疗效及安全性。方法回顾性连续纳入2022年1月至2024年3月发病6 h内的急性轻型非致残性缺血性脑卒中患者138例[美国国立卫生研究院卒中量表(National Institutes of Health...目的探讨静脉溶栓与双抗治疗急性轻型非致残性缺血性脑卒中的临床疗效及安全性。方法回顾性连续纳入2022年1月至2024年3月发病6 h内的急性轻型非致残性缺血性脑卒中患者138例[美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤5]为研究对象,根据是否接受静脉溶栓分为静脉溶栓组(66例)和双抗组(72例),采用倾向性评分匹配法将两组患者按照1∶1进行匹配,匹配后静脉溶栓组(44例)和双抗组(44例)。收集患者的人口学资料、临床资料、临床预后指标及不良事件。主要结局定义为发病后90 d良好功能结局[改良Rankin量表(modified Rankin Scale,mRS)评分0~2分]、发病后90 d mRS评分。次要结局为发病后24 h、72 h、7 d NIHSS评分,早期神经功能恶化比例,发病90 d内颅内出血及系统性出血事件及发病90 d内死亡。结果①匹配前静脉溶栓组年龄、入院时mRS评分均低于双抗组,差异均有统计学意义(均P<0.05)。匹配后两组患者在年龄、性别、高血压病、糖尿病、冠状动脉粥样硬化性心脏病、房颤、高低密度脂蛋白胆固醇血症、高同型半胱氨酸血症、既往脑卒中病史、吸烟史、入院时NIHSS评分、入院时mRS评分、梗死部位、TOAST分型等资料的差异均无统计学意义(均P>0.05);②静脉溶栓组与双抗组患者发病后90 d良好功能结局患者比例和发病后90 d mRS评分差异无统计学意义[88.6%(39/44)vs 93.2%(41/44),P=0.458、P=0.308];③静脉溶栓组发病后24 h、72 h中位NIHSS评分明显低于双抗组,差异有统计学意义[1 vs 2.5、1 vs 2,P=0.018、0.043],其余有效性结局和安全性结局差异均无统计学意义。结论静脉溶栓治疗能够为急性轻型非致残性缺血性脑卒中患者带来显著的短期获益,有助于缩短恢复至良好神经功能结局的时间,且不增加出血风险和病死率。然而,在发病后90 d良好功能结局方面,其效果与双抗治疗相似,尽管如此,亟需开展更大样本、更高质量的临床研究来进一步验证。展开更多
Mild therapeutic hypothermia has been shown to mitigate cerebral ischemia, reduce cerebral edema, and improve the prognosis of patients with cerebral ischemia. Adipose-derived stem cell-based therapy can decrease neur...Mild therapeutic hypothermia has been shown to mitigate cerebral ischemia, reduce cerebral edema, and improve the prognosis of patients with cerebral ischemia. Adipose-derived stem cell-based therapy can decrease neuronal death and infiltration of inflammatory cells, exerting a neuroprotective effect. We hypothesized that the combination of mild therapeutic hypothermia and adipose-derived stem cells would be neuroprotective for treatment of stroke. A rat model of transient middle cerebral artery occlusion was established using the nylon monofilament method. Mild therapeutic hypothermia（33°C） was induced after 2 hours of ischemia. Adipose-derived stem cells were administered through the femoral vein during reperfusion. The severity of neurological dysfunction was measured by a modified Neurological Severity Score Scaling System. The area of the infarct lesion was determined by 2,3,5-triphenyltetrazolium chloride staining. Apoptotic neurons were detected by terminal deoxynucleotidyl transferase-mediated d UTP-biotin nick end labeling（TUNEL） staining. The regeneration of microvessels and changes in the glial scar were detected by immunofluorescence staining. The inflammatory responses after ischemic brain injury were evaluated by in situ staining using markers of inflammatory cells. The expression of inflammatory cytokines was measured by reverse transcription-polymerase chain reaction. Compared with mild therapeutic hypothermia or adipose-derived stem cell treatment alone, their combination substantially improved neurological deficits and decreased infarct size. They synergistically reduced the number of TUNEL-positive cells and glial fibrillary acidic protein expression, increased vascular endothelial growth factor levels, effectively reduced inflammatory cell infiltration and down-regulated the m RNA expression of the proinflammatory cytokines interleukin-1β, tumor necrosis factor-α and interleukin-6. Our findings indicate that combined treatment is a better approach for treating stroke compared with mild therapeutic hypothermia or adipose-derived stem cells alone.展开更多
文摘The term "mild stroke",or "minor stroke" refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of mild stroke. Patients with mild stroke are assumed to have a good prognosis in natural course,so they are routinely not given thrombolysis despite early emergency department arrival. Recent studies have revealed that,however,approximately one third of so-called mild stroke patients who are not treated with thrombolysis have significant disability whereas those treated are more likely to achieve a good recovery. Thus excluding all mild strokes from thrombolysis is probably not justified. Those mild stroke patients who are likely to experience early deterioration or end with disability are mostly characterized by imaging findings. Therefore,selected patients with these characteristics based on neuroimaging to be given thrombolysis might be more justified. Meanwhile,new definition should be developed to exclude those who are at a higher risk of poor outcome. Applying information from imaging may make it come true. Using neuroimaging information to define mild stroke and select patients with mild symptoms to thrombolysis may be a future direction.
文摘Objective: to investigate the clinical safety and efficacy of intravenous thrombolysis with alteplase in the treatment of acute mild ischemic stroke. Methods: a total of 92 patients with acute mild ischemic stroke admitted from September in 2019 to March in 2020 were selected and divided into control group and observation group, with 46 cases in each group. The control group received conventional treatment, and the observation group received intravenous thrombolytic therapy with alteplase. The neurological function deficit, therapeutic effect and safety of the two groups were compared. Results: Before treatment, there was no statistical difference in NIHSS scores between 2 groups (P > 0.05). After treatment, the scores of both groups decreased, and the NIHSS scores of the observation group at different stages decreased more than that of the control group, with statistical significance (P < 0.05). The effective rate of observation group was significantly higher than control group. The complication rate of the observation group was lower than that of the control group. Conclusion: intravenous thrombolysis with alteplase is effective in treating acute mild ischemic stroke. It can be seen that the neurological function deficit has been significantly improved, with fewer complications. It is a treatment method with guaranteed safety and effectiveness, which is worthy of clinical promotion.
文摘Objective: to analyze the effect of Compound Changpu Yizhi Decoction combined with Nimodipine in the treatment of mild cognitive dysfunction after stroke. Methods: a total of 70 patients with mild cognitive impairment after stroke were selected from our hospital from July 2018 to July 2019, and randomly divided into 2 groups with 35 patients in each group in the digital table. Patients in the control group were treated with Nimodipine, while patients in the observation group were additionally treated with Compound Changpu Yizhi Decoction. Results: the scores of Montreal Cognitive Assessment Scale (MOCA), Simple Mental Status Checklist (MMSE) and ADL of daily living ability in 2 groups before treatment were compared (P > 0.05), while the above three scores were increased in 2 groups after treatment, and the scores of observation group were significantly higher than control group (P < 0.05). The total effective rate of observation group was 85.71% (30/35) higher than that of control group (65.71%, 23/35), P < 0.05. Conclusion: Nimodipine combined with Compound Changpu Yizhi Decoction has a definite effect on the treatment of mild cognitive dysfunction after stroke, which is beneficial to improve the cognitive function of patients and promote the ability of daily living activities of patients. Therefore, it is worthy of promotion and application.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;">Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also cognitive. Approximately two-thirds of Ischemic Stroke patients, who represent the most common type of stroke are found to have mild deficits. Minor stroke, sometimes also referred to as “mild stroke”, is often defined in research studies as a National Institute of Health Stroke Scale (NIHSS) score of 5 or less, although, the cut point for NIHSS score or standardized criterion to define minor stroke has not been established. In the past, many studies have been focusing on the definition of the minor stroke to better stabilize the acute treatment guidelines, to predict the functional outcome, and also for early risk factors stratification. Different studies use different criteria or different cut-points of NIHSS scores to define minor stroke. Aside from indecision of acute management of minor stroke, many other questions have been raised regarding minor strokes, for example, the interaction of large vessel occlusion with minor stroke, the prevalence rate of depression, anxiety, cognitive dysfunction, chronic head after minor stroke, and so on. Finding a universal definition for minor stroke is the key to establish the guideline for management for this group of patients. However, the guidance of treatment of minor stroke is not the focus of this review. The review will focus on the deep comprehension of minor stroke characteristics, summarizing the new findings related to minor stroke, and highlight the essential points to consider for characterizing mild stroke symptoms for a new direction guide for future studies.</span> </div>
文摘目的探讨基于药物基因组学的抗血小板药物个体化药学服务模式对轻型缺血性卒中患者神经功能、用药依从性、安全性及预后的影响。方法纳入2022年2月—2023年10月焦作市人民医院收治的轻型缺血性卒中患者86例为研究对象,根据是否行基因检测分为观察组(n=43)和对照组(n=43)。观察组以阿司匹林及氯吡格雷基因多态性检测结果为导向,制定和调整个体化用药及药学监护方案。对照组采用临床经验性治疗模式。收集观察组药物抵抗基因分布情况,比较两组神经功能、住院时间、用药依从性、药物不良反应、随访90天预后情况。结果观察组阿司匹林高应答及中间应答患者分别占比46.51%、53.49%,未发现低应答患者;氯吡格雷中间代谢型和慢代谢型共占比55.81%。18例正常代谢型与1例快代谢型患者均按照常规剂量给药;20例中间代谢型及4例慢代谢型患者均将氯吡格雷更换为替格瑞洛或西洛他唑。治疗后,观察组住院天数为(9.77±3.53)天,低于对照组住院天数为(11.23±2.61)d(P<0.05);观察组美国国立卫生研究院卒中量表(NIHSS)评分较治疗前降低更为明显(2.02±1.65 vs 1.02±1.22,P<0.001);观察组药物不良反应发生率6.98%,低于对照组27.91%(P<0.05),其中轻度出血发生率无明显差异(P=0.616);随访90日,观察组脑卒中改良Rankin量表(mRS)评分0~1比例及用药总依从率分别为72.09%、90.70%,明显高于对照组48.84%、72.09%,P<0.05。结论基于抗血小板药物基因组学的个体化药学服务模式,可提高卒中患者用药依从性,减少不良反应产生,改善神经功能及短期预后。
文摘目的探讨静脉溶栓与双抗治疗急性轻型非致残性缺血性脑卒中的临床疗效及安全性。方法回顾性连续纳入2022年1月至2024年3月发病6 h内的急性轻型非致残性缺血性脑卒中患者138例[美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分≤5]为研究对象,根据是否接受静脉溶栓分为静脉溶栓组(66例)和双抗组(72例),采用倾向性评分匹配法将两组患者按照1∶1进行匹配,匹配后静脉溶栓组(44例)和双抗组(44例)。收集患者的人口学资料、临床资料、临床预后指标及不良事件。主要结局定义为发病后90 d良好功能结局[改良Rankin量表(modified Rankin Scale,mRS)评分0~2分]、发病后90 d mRS评分。次要结局为发病后24 h、72 h、7 d NIHSS评分,早期神经功能恶化比例,发病90 d内颅内出血及系统性出血事件及发病90 d内死亡。结果①匹配前静脉溶栓组年龄、入院时mRS评分均低于双抗组,差异均有统计学意义(均P<0.05)。匹配后两组患者在年龄、性别、高血压病、糖尿病、冠状动脉粥样硬化性心脏病、房颤、高低密度脂蛋白胆固醇血症、高同型半胱氨酸血症、既往脑卒中病史、吸烟史、入院时NIHSS评分、入院时mRS评分、梗死部位、TOAST分型等资料的差异均无统计学意义(均P>0.05);②静脉溶栓组与双抗组患者发病后90 d良好功能结局患者比例和发病后90 d mRS评分差异无统计学意义[88.6%(39/44)vs 93.2%(41/44),P=0.458、P=0.308];③静脉溶栓组发病后24 h、72 h中位NIHSS评分明显低于双抗组,差异有统计学意义[1 vs 2.5、1 vs 2,P=0.018、0.043],其余有效性结局和安全性结局差异均无统计学意义。结论静脉溶栓治疗能够为急性轻型非致残性缺血性脑卒中患者带来显著的短期获益,有助于缩短恢复至良好神经功能结局的时间,且不增加出血风险和病死率。然而,在发病后90 d良好功能结局方面,其效果与双抗治疗相似,尽管如此,亟需开展更大样本、更高质量的临床研究来进一步验证。
基金supported by the National Natural Science Foundation of China,No.81371301
文摘Mild therapeutic hypothermia has been shown to mitigate cerebral ischemia, reduce cerebral edema, and improve the prognosis of patients with cerebral ischemia. Adipose-derived stem cell-based therapy can decrease neuronal death and infiltration of inflammatory cells, exerting a neuroprotective effect. We hypothesized that the combination of mild therapeutic hypothermia and adipose-derived stem cells would be neuroprotective for treatment of stroke. A rat model of transient middle cerebral artery occlusion was established using the nylon monofilament method. Mild therapeutic hypothermia（33°C） was induced after 2 hours of ischemia. Adipose-derived stem cells were administered through the femoral vein during reperfusion. The severity of neurological dysfunction was measured by a modified Neurological Severity Score Scaling System. The area of the infarct lesion was determined by 2,3,5-triphenyltetrazolium chloride staining. Apoptotic neurons were detected by terminal deoxynucleotidyl transferase-mediated d UTP-biotin nick end labeling（TUNEL） staining. The regeneration of microvessels and changes in the glial scar were detected by immunofluorescence staining. The inflammatory responses after ischemic brain injury were evaluated by in situ staining using markers of inflammatory cells. The expression of inflammatory cytokines was measured by reverse transcription-polymerase chain reaction. Compared with mild therapeutic hypothermia or adipose-derived stem cell treatment alone, their combination substantially improved neurological deficits and decreased infarct size. They synergistically reduced the number of TUNEL-positive cells and glial fibrillary acidic protein expression, increased vascular endothelial growth factor levels, effectively reduced inflammatory cell infiltration and down-regulated the m RNA expression of the proinflammatory cytokines interleukin-1β, tumor necrosis factor-α and interleukin-6. Our findings indicate that combined treatment is a better approach for treating stroke compared with mild therapeutic hypothermia or adipose-derived stem cells alone.
