Background: Stroke is a worldwide health problem, the world’s second-leading cause of death and third-leading cause of disability. Currently, the majority of stroke patients are ischemic stroke patients. It is necess...Background: Stroke is a worldwide health problem, the world’s second-leading cause of death and third-leading cause of disability. Currently, the majority of stroke patients are ischemic stroke patients. It is necessary to evaluate risk factors to prevent ischemic stroke. Data and Methods: The risk factors for stroke in the previous fiscal year were analyzed. They were divided into nonmodifiable and modifiable factors. The probit and ordered probit models were used in the study, with 59341 and 50542 observations used in the estimation of the models, respectively. Results: Among the nonmodifiable factors, age, gender and cerebrovascular disease history are important risk factors. The history of cerebrovascular diseases is considered to be an especially important factor. Among the modifiable factors, taking antihypertensive drugs and recent large weight change are negative risk factors;however, sleeping well significantly reduces the probability of ischemic stroke. Conclusion: It is very important to ensure that medical personnel know a patient’s history of cerebrovascular diseases for proper treatments. Ischemic stroke might be considered an important side effect of antihypertensive drugs. Limitations: The dataset was observatory. There are various types of antihypertension drugs, and their effects are not analyzed.展开更多
BACKGROUND： Acute stroke unit （stroke care unit） is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medi...BACKGROUND： Acute stroke unit （stroke care unit） is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital （secondary hospital）, where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE： To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility. DESIGN： Non-randomized concurrent controlled observation SETTING： Department of Neurology, Beijing Longfu Hospital PARTICIPANTS： Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale （SSS） 〉 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives： （1）treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;（2） control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS： A same basic treatment was conducted in the patients of the two groups. （1） Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet： randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. （2） The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians. MAIN OUTCOME MEASURES： The following assessments were conducted on admission and 7 and 28 days after admission： （1） Severity of stroke and motor function： scored as 0 to 45 points by SSS, the higher points, the severer damage. （2）Activities of daily living： Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. （3）Mental status： evaluated by Hopkin＇s symptom scale with a 5-point scoring. The symptom was scored with low to high points. （4）Cognitive function： Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS： （1） Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. （2）The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days：（9.73±6.43） points vs. （12.63± 7.87） points, t =2.28, P〈 0.05;28 days：（7.88±4.81） points vs. （9.84±7.03）points, t =2.04, P〈 0.05]. Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days：（54.28±8.38） points vs. （39.76±7.31） points, t =2.206, P 〈 0.05; 28 days： （89.72±7.94） points vs. （67.34±8.63） points, t =2.812, P 〈 0.01]. （4） Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups （P 〉 0.05）. （5） Totally 160 patients in the two groups accomplished the Hopkin＇s test, among them, 94 （58.7%） had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION： （1） Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. （2） More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. （3） The cognitive function of stroke reconvalescents is not related to age.展开更多
Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we p...Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui（GV20） and Taiyang（EX-HN5）. We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave（Hmax/Mmax）, muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of ＂Deficiency and Excess＂. The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was 〉 0 or 〈 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.展开更多
目的探讨基于生命八要素(LE8)的心血管健康评分对急性缺血性脑卒中(AIS)患者90 d功能预后的影响,探究相关实验室指标在其中的中介作用。方法采用多中心前瞻性队列研究设计,纳入发病72 h内的急性缺血性脑卒中患者。收集患者临床资料,依...目的探讨基于生命八要素(LE8)的心血管健康评分对急性缺血性脑卒中(AIS)患者90 d功能预后的影响,探究相关实验室指标在其中的中介作用。方法采用多中心前瞻性队列研究设计,纳入发病72 h内的急性缺血性脑卒中患者。收集患者临床资料,依据美国心脏协会定义的LE8标准计算心血管健康评分。通过电话随访及评估患者发病后90 d的功能预后。及改良Rankin量表(mRS)评分。应用多重线性回归分析LE8总评分及各单项评分与90 d mRS评分的关系。采用Lasso回归筛选与90 d mRS评分相关的实验室指标,并通过Bootstrap法进行中介效应分析,探究筛选出的指标在LE8评分与卒中预后关系中的中介作用。结果共纳入599例患者,校正混杂因素后,LE8总评分与90 d mRS评分呈负相关(β=-0.05,95%CI:-0.06,-0.041,P<0.001);LE8各单项评分:运动、饮食质量、尼古丁暴露、睡眠、体质量指数、胆固醇、血压均与90 d mRS评分呈负相关(P<0.05)。影响90 d mRS的检验指标中,纤维蛋白原(FIB)水平(β=0.215;95%CI:0.068,0.361;P=0.0041)与90 d mRS评分呈正相关,MCHC(β=-0.012;95%CI:-0.022,-0.002;P=0.0229)及HRR(β=-0.007;95%CI:-0.013,0.00;P=0.042)与90 d mRS评分呈负相关。中介效应分析显示,FIB在LE8评分与90 d mRS评分的关系中起显著中介作用,间接效应为-0.0019(95%CI:-0.00381,0.00,P=0.006),中介效应比例为3.778%(95%CI:0.00869,0.08)。结论基于LE8评分的心血管健康评分与AIS患者90 d功能预后呈负相关,提示维持良好的心血管健康水平对改善卒中预后至关重要。血凝及炎症相关指标FIB及红细胞参数MCHC、HRR与预后不良相关,其中FIB在LE8评分影响卒中预后的过程中发挥部分中介作用,为卒中二级预防提供依据。展开更多
目的探讨阿替普酶静脉溶栓治疗在急性缺血性脑卒中患者中的应用效果,评价其应用疗效及安全性。方法选取本院2023年3月—2024年9月收治的76例急性缺血性脑卒中患者作为研究对象,应用随机数字表法,分为观察组(阿替普酶静脉溶栓治疗)和对照...目的探讨阿替普酶静脉溶栓治疗在急性缺血性脑卒中患者中的应用效果,评价其应用疗效及安全性。方法选取本院2023年3月—2024年9月收治的76例急性缺血性脑卒中患者作为研究对象,应用随机数字表法,分为观察组(阿替普酶静脉溶栓治疗)和对照组(尿激酶静脉溶栓治疗),每组38例,对比两组患者的治疗效果。结果观察病情康复效果,观察组的优良率(97.37%)更高(P<0.05)。观察病情再发情况,观察组的再发率(15.79%)更低(P<0.05)。观察神经功能恢复情况,观察组治疗后24 h NIHSS评分[(11.51±1.43)分]、治疗后7 d NIHSS评分[(27.74±1.16)分]更低(P<0.05)。观察认知功能恢复情况,观察组治疗后24 h MMSE评分[(26.92±1.82)分]、治疗后7 d MMSE评分[(27.74±1.16)分]更高(P<0.05)。对比凝血功能指标,观察组治疗7d后的PT[(12.61±1.21)s]、APTT[(29.90±1.50)s]更高(P<0.05),Fib[(2.64±0.27)g/L]更低(P<0.05)。对比脑血流动力学指标,观察组治疗后7d的脑动脉血流峰值[(71.33±4.94)cm/s]、脑动脉平均流速[(35.54±2.86)cm/s]更高(P<0.05)。观察不良反应发生情况,观察组的发生率(2.63%)更低(P<0.05)。对比氧化应激指标,观察组治疗7 d后的MDA[(6.54±1.48)μmol/L]更低,SOD[(7.28±0.61)U/mL]更高(P<0.05)。对比炎性因子指标,观察组治疗7d后的各项指标更低(P<0.05)。结论在急性缺血性脑卒中的临床治疗中,阿替普酶静脉溶栓治疗方法有着良好的应用疗效,同时可以有效保障治疗的安全性。展开更多
文摘Background: Stroke is a worldwide health problem, the world’s second-leading cause of death and third-leading cause of disability. Currently, the majority of stroke patients are ischemic stroke patients. It is necessary to evaluate risk factors to prevent ischemic stroke. Data and Methods: The risk factors for stroke in the previous fiscal year were analyzed. They were divided into nonmodifiable and modifiable factors. The probit and ordered probit models were used in the study, with 59341 and 50542 observations used in the estimation of the models, respectively. Results: Among the nonmodifiable factors, age, gender and cerebrovascular disease history are important risk factors. The history of cerebrovascular diseases is considered to be an especially important factor. Among the modifiable factors, taking antihypertensive drugs and recent large weight change are negative risk factors;however, sleeping well significantly reduces the probability of ischemic stroke. Conclusion: It is very important to ensure that medical personnel know a patient’s history of cerebrovascular diseases for proper treatments. Ischemic stroke might be considered an important side effect of antihypertensive drugs. Limitations: The dataset was observatory. There are various types of antihypertension drugs, and their effects are not analyzed.
文摘BACKGROUND： Acute stroke unit （stroke care unit） is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital （secondary hospital）, where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE： To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility. DESIGN： Non-randomized concurrent controlled observation SETTING： Department of Neurology, Beijing Longfu Hospital PARTICIPANTS： Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale （SSS） 〉 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives： （1）treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;（2） control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS： A same basic treatment was conducted in the patients of the two groups. （1） Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet： randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. （2） The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians. MAIN OUTCOME MEASURES： The following assessments were conducted on admission and 7 and 28 days after admission： （1） Severity of stroke and motor function： scored as 0 to 45 points by SSS, the higher points, the severer damage. （2）Activities of daily living： Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. （3）Mental status： evaluated by Hopkin＇s symptom scale with a 5-point scoring. The symptom was scored with low to high points. （4）Cognitive function： Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS： （1） Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. （2）The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days：（9.73±6.43） points vs. （12.63± 7.87） points, t =2.28, P〈 0.05;28 days：（7.88±4.81） points vs. （9.84±7.03）points, t =2.04, P〈 0.05]. Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days：（54.28±8.38） points vs. （39.76±7.31） points, t =2.206, P 〈 0.05; 28 days： （89.72±7.94） points vs. （67.34±8.63） points, t =2.812, P 〈 0.01]. （4） Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups （P 〉 0.05）. （5） Totally 160 patients in the two groups accomplished the Hopkin＇s test, among them, 94 （58.7%） had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION： （1） Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. （2） More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. （3） The cognitive function of stroke reconvalescents is not related to age.
基金supported by a grant from the Supporting Program of the"Eleventh Five-year Plan"for Science&Technology Research of China,Ministry of Science and Technology of China,No.2006BAI12B02a grant from the Scientific Research Fund for Talent Introduction in the Gansu University of Chinese Medicine of China,No.2012-11
文摘Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui（GV20） and Taiyang（EX-HN5）. We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave（Hmax/Mmax）, muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of ＂Deficiency and Excess＂. The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was 〉 0 or 〈 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.
文摘目的探讨基于生命八要素(LE8)的心血管健康评分对急性缺血性脑卒中(AIS)患者90 d功能预后的影响,探究相关实验室指标在其中的中介作用。方法采用多中心前瞻性队列研究设计,纳入发病72 h内的急性缺血性脑卒中患者。收集患者临床资料,依据美国心脏协会定义的LE8标准计算心血管健康评分。通过电话随访及评估患者发病后90 d的功能预后。及改良Rankin量表(mRS)评分。应用多重线性回归分析LE8总评分及各单项评分与90 d mRS评分的关系。采用Lasso回归筛选与90 d mRS评分相关的实验室指标,并通过Bootstrap法进行中介效应分析,探究筛选出的指标在LE8评分与卒中预后关系中的中介作用。结果共纳入599例患者,校正混杂因素后,LE8总评分与90 d mRS评分呈负相关(β=-0.05,95%CI:-0.06,-0.041,P<0.001);LE8各单项评分:运动、饮食质量、尼古丁暴露、睡眠、体质量指数、胆固醇、血压均与90 d mRS评分呈负相关(P<0.05)。影响90 d mRS的检验指标中,纤维蛋白原(FIB)水平(β=0.215;95%CI:0.068,0.361;P=0.0041)与90 d mRS评分呈正相关,MCHC(β=-0.012;95%CI:-0.022,-0.002;P=0.0229)及HRR(β=-0.007;95%CI:-0.013,0.00;P=0.042)与90 d mRS评分呈负相关。中介效应分析显示,FIB在LE8评分与90 d mRS评分的关系中起显著中介作用,间接效应为-0.0019(95%CI:-0.00381,0.00,P=0.006),中介效应比例为3.778%(95%CI:0.00869,0.08)。结论基于LE8评分的心血管健康评分与AIS患者90 d功能预后呈负相关,提示维持良好的心血管健康水平对改善卒中预后至关重要。血凝及炎症相关指标FIB及红细胞参数MCHC、HRR与预后不良相关,其中FIB在LE8评分影响卒中预后的过程中发挥部分中介作用,为卒中二级预防提供依据。
文摘目的探讨阿替普酶静脉溶栓治疗在急性缺血性脑卒中患者中的应用效果,评价其应用疗效及安全性。方法选取本院2023年3月—2024年9月收治的76例急性缺血性脑卒中患者作为研究对象,应用随机数字表法,分为观察组(阿替普酶静脉溶栓治疗)和对照组(尿激酶静脉溶栓治疗),每组38例,对比两组患者的治疗效果。结果观察病情康复效果,观察组的优良率(97.37%)更高(P<0.05)。观察病情再发情况,观察组的再发率(15.79%)更低(P<0.05)。观察神经功能恢复情况,观察组治疗后24 h NIHSS评分[(11.51±1.43)分]、治疗后7 d NIHSS评分[(27.74±1.16)分]更低(P<0.05)。观察认知功能恢复情况,观察组治疗后24 h MMSE评分[(26.92±1.82)分]、治疗后7 d MMSE评分[(27.74±1.16)分]更高(P<0.05)。对比凝血功能指标,观察组治疗7d后的PT[(12.61±1.21)s]、APTT[(29.90±1.50)s]更高(P<0.05),Fib[(2.64±0.27)g/L]更低(P<0.05)。对比脑血流动力学指标,观察组治疗后7d的脑动脉血流峰值[(71.33±4.94)cm/s]、脑动脉平均流速[(35.54±2.86)cm/s]更高(P<0.05)。观察不良反应发生情况,观察组的发生率(2.63%)更低(P<0.05)。对比氧化应激指标,观察组治疗7 d后的MDA[(6.54±1.48)μmol/L]更低,SOD[(7.28±0.61)U/mL]更高(P<0.05)。对比炎性因子指标,观察组治疗7d后的各项指标更低(P<0.05)。结论在急性缺血性脑卒中的临床治疗中,阿替普酶静脉溶栓治疗方法有着良好的应用疗效,同时可以有效保障治疗的安全性。
