Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific t...Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p 6.5) (OR, 1.57;95%CI, 0.81 - 3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based cohort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.展开更多
Objective:To design and implement a specialized nurse decision support system in the Department of Neurology and explore its effectiveness in preventing stroke-associated pneumonia(SAP).Methods:A decision support modu...Objective:To design and implement a specialized nurse decision support system in the Department of Neurology and explore its effectiveness in preventing stroke-associated pneumonia(SAP).Methods:A decision support module for specialized nurses was developed based on SAP-graded prevention strategies.A total of 664 neurology inpatients admitted to The First People’s Hospital of Xuzhou between July 2023 and September 2023 were selected as the conventional group,receiving standard nursing care.Another 704 neurology inpatients admitted between October 2023 and December 2023 were selected as the experimental group,receiving SAP-graded prevention strategies under the specialized nurse decision support system.The incidence of SAP in the two groups was compared.The occurrence of SAP was recorded using the Acute Ischemic Stroke-Associated Pneumonia Risk(A2DS2)scoring system.Swallowing function was evaluated using the Water Swallow Test(WST),and quality of life was assessed using the Swallowing Quality of Life(SWAL-QOL)scale.Results:The incidence of SAP in the experimental group was significantly lower than in the conventional group(P<0.05).After nursing interventions,the WST scores in the experimental group were lower,while the SWAL-QOL scores were higher compared to the conventional group(P<0.05).Conclusion:The design and implementation of a specialized nurse decision support system in the Department of Neurology significantly reduced the incidence of SAP in neurology inpatients,improved swallowing function,and enhanced quality of life.This approach shows promise for widespread application.展开更多
Splenic sympathetic activity critically modulates peripheral immunity after ischemic stroke,thus intervention in spleen sympathetic activity represents a promising therapeutic strategy for stroke.However,the mechanism...Splenic sympathetic activity critically modulates peripheral immunity after ischemic stroke,thus intervention in spleen sympathetic activity represents a promising therapeutic strategy for stroke.However,the mechanisms underlying spleen-brain-immune axis communication remain poorly understood.Here,we utilized a surgical denervation protocol to perform splenic sympathetic denervation(SDN),which significantly attenuated brain injury following stroke.Through single-cell RNA sequencing,we identified a novel GZMK^(+)CD8^(+)CD27^(+)CCR7^(+)T-cell subset in patients with acute ischemic stroke(AIS),which we designated stroke-associated T(Tsa)cells.The expansion of Tsa cells was positively correlated with the severity of clinical symptoms and was driven by the splenic sympathetic nervous system.Stroke-induced sympathetic activation triggers the release of splenic norepinephrine(NE),which preferentially signals through ADRB2 on Tsa cells to promote their mobilization.Additionally,ischemic injury induces endothelial cell-specific expression of CCL19,which chemoattracts Tsa cells into the brain parenchyma via their cognate CCR7 receptor,exacerbating neuroinflammatory injury and neurological deficits in a transient middle cerebral artery occlusion(tMCAO)mouse model.We developed a CCR7-targeting peptide to disrupt this chemotactic axis and reduce T-cell infiltration,thereby mitigating brain injury.Our findings highlight SDN as a promising therapeutic strategy to attenuate ischemia‒reperfusion injury and suggest its potential as an adjunctive therapy for reperfusion treatment in AIS patients.展开更多
文摘Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p 6.5) (OR, 1.57;95%CI, 0.81 - 3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based cohort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.
文摘Objective:To design and implement a specialized nurse decision support system in the Department of Neurology and explore its effectiveness in preventing stroke-associated pneumonia(SAP).Methods:A decision support module for specialized nurses was developed based on SAP-graded prevention strategies.A total of 664 neurology inpatients admitted to The First People’s Hospital of Xuzhou between July 2023 and September 2023 were selected as the conventional group,receiving standard nursing care.Another 704 neurology inpatients admitted between October 2023 and December 2023 were selected as the experimental group,receiving SAP-graded prevention strategies under the specialized nurse decision support system.The incidence of SAP in the two groups was compared.The occurrence of SAP was recorded using the Acute Ischemic Stroke-Associated Pneumonia Risk(A2DS2)scoring system.Swallowing function was evaluated using the Water Swallow Test(WST),and quality of life was assessed using the Swallowing Quality of Life(SWAL-QOL)scale.Results:The incidence of SAP in the experimental group was significantly lower than in the conventional group(P<0.05).After nursing interventions,the WST scores in the experimental group were lower,while the SWAL-QOL scores were higher compared to the conventional group(P<0.05).Conclusion:The design and implementation of a specialized nurse decision support system in the Department of Neurology significantly reduced the incidence of SAP in neurology inpatients,improved swallowing function,and enhanced quality of life.This approach shows promise for widespread application.
基金supported by grants from the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0526600/2024ZD0526601/2024ZD0526603)the National Natural Science Foundation of Distinguished Young Scholars(82025033)+5 种基金the National Natural Science Foundation of China(82230115,82273914,82473903 and 81903591)the Science and Technology innovation 2030-Major Project of the Ministry of Science and Technology of China(2021ZD0202904)the Natural Science Foundation Outstanding Youth Fund of Jiangsu Province(BK20240175)the Qinglan Project of Jiangsu Province,the Nanjing U35 Strong Foundation Program,the Fundamental Research Funds for the Central Universities grant(2242024RCB0026 and 2242025RCB0028)the Jiangsu Provincial Key Laboratory of Critical Care Medicine(JSKLCCM-2022-02-008)the National Key Research and Development Program of China(2017YFA0104303).
文摘Splenic sympathetic activity critically modulates peripheral immunity after ischemic stroke,thus intervention in spleen sympathetic activity represents a promising therapeutic strategy for stroke.However,the mechanisms underlying spleen-brain-immune axis communication remain poorly understood.Here,we utilized a surgical denervation protocol to perform splenic sympathetic denervation(SDN),which significantly attenuated brain injury following stroke.Through single-cell RNA sequencing,we identified a novel GZMK^(+)CD8^(+)CD27^(+)CCR7^(+)T-cell subset in patients with acute ischemic stroke(AIS),which we designated stroke-associated T(Tsa)cells.The expansion of Tsa cells was positively correlated with the severity of clinical symptoms and was driven by the splenic sympathetic nervous system.Stroke-induced sympathetic activation triggers the release of splenic norepinephrine(NE),which preferentially signals through ADRB2 on Tsa cells to promote their mobilization.Additionally,ischemic injury induces endothelial cell-specific expression of CCL19,which chemoattracts Tsa cells into the brain parenchyma via their cognate CCR7 receptor,exacerbating neuroinflammatory injury and neurological deficits in a transient middle cerebral artery occlusion(tMCAO)mouse model.We developed a CCR7-targeting peptide to disrupt this chemotactic axis and reduce T-cell infiltration,thereby mitigating brain injury.Our findings highlight SDN as a promising therapeutic strategy to attenuate ischemia‒reperfusion injury and suggest its potential as an adjunctive therapy for reperfusion treatment in AIS patients.
