In recent years, the incidence rate of ischemic stroke in people living with HIV/AIDS (PLWHA) is increasing, attracting wide attention from scholars at home and abroad. In addition to traditional risk factors of stroke, the secondary ischemic stroke in PLWHA is also affected by HIV infection. This study reviews the incidence rate and risk factors of secondary ischemic stroke in PLWHA, in order to provide a theoretical basis for preventing and reducing the incidence of ischemic stroke in PLWHA.
Hemorrhagic transformation is one of the most serious complications after endovascular treatment in patients with acute ischemic stroke, which is closely related to neurological deterioration and poor functional prognosis. Therefore, early detection and treatment of hemorrhagic transformation are of great significance for improving patient prognosis. Brain CT, CT angiography, CT perfusion imaging, MRI, diffusion weighted imaging, and susceptibility weighted imaging are relatively commonly used imaging methods in clinical practice. Reasonable use of imaging methods can reduce the risk of hemorrhagic transformation and improve patient prognosis. This article reviews common imaging evaluation techniques for hemorrhagic transformation in clinical practice in order to provide ideas for clinical diagnosis and treatment.
ObjectiveTo observe and compare the efficacy and safety of intravenous thrombolysis with alteplase or urokinase in the first-ever acute ischemic stroke patients arriving at the hospital 3.5-4.5 h after onset.MethodsClinical data of patients with acute ischemic stroke treated in Shihezi People’s Hospital between January 2019 and October 2020 were prospectively collected. The National Insititutes of Health Stroke Scale (NIHSS) score on the 7th day and the 90th day, the modified Rankin Scale (mRS) score and the Blessed Behavior Scale (BBS) score on the 90th day, and symptomatic bleeding within 36 h after thrombolysis were analyzed and compared between the patients receiving alteplase threatment (the alteplase group) and the ones receiving urokinase treatment (the urokinase group).ResultsTotally 96 patients were treated with intravenous thrombolysis. Among them, 58 patients received alteplase threatment and 38 received urokinase treatment. The difference in NIHSS, mRS, or BBS scores between the two groups before treatment was not statistically significant (P>0.05). On the 90th day after treatment, the NIHSS, mRS, and BBS scores of the alteplase group were 3.59±3.73, 2.26±1.26, and 15.33±8.28, respectively, and those of the urokinase group were 5.95±4.88, 3.00±0.87, and 20.37±11.80, respectively; the differences between the two groups were all statistically significant (P<0.05). There was no significant difference in the rate of symptomatic intracerebral hemorrhage between the two groups within 36 h after treatment (P>0.05). Multiple linear regression analyses showed that the treatment method was related to the NIHSS score on the 7th day, the NIHSS score on the 90th day, the mRS score on the 90th day, and the BBS score on the 90th day (P<0.05), the history of heart disease was related to the mRS score on the 90th day (P<0.05), and the income was related to the BBS score on the 90th day (P<0.05).ConclusionFor the hyperactue ischemic stroke, the overall effect of alteplase treatment may be better than that of urokinase treatment.
Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.
ObjectiveTo systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. MethodsLiterature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04). ConclusionFor patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
As a risk factor for vascular diseases and inflammatory diseases, fibrinogen has received more and more attention. Hyperfibrinogenemia is associated with the occurrence, development, and poor outcome of artery-venous ischemic stroke (acute ischemic stroke, transient ischemic attack and cerebral venous thrombosis). Therefore, fibrinogen may be a potential therapeutic target for the prevention and management of artery-venous ischemic stroke. However, there has been controversy regarding the defibrinogen therapy in artery-venous ischemic stroke. Therefore, this paper introduces the efficacy and safety of defibrinogen therapy alone, combined with antiplatelet or combined with anticoagulant in prevention and management of artery-venous ischemic stroke in detail, in order to re-understand the role of defibrinogen therapy in the prevention and management of artery-venous ischemic stroke.
Objective To analyze the methodological quality of clinical trails on butylphthalide for cerebral ischemic stroke. Methods We collected all of the published clinical studies on butylphthalide for cerebral ischemic stroke in the world, and evaluated the methodological quality of the included studies according to clinical epidemiologic standard. The search time was from the establishment of each database to December, 2009. Results A total of 62 studies involving 5 762 patients were included. In all included studies, there were 56 randomized controlled trials (RCTs). A total of 8 studies described the method of random assignments. There were 4 multi-center randomized double-blind placebo-control trials. A total of 55 reported diagnosis criteria, 40 reported included criteria, 28 reported excluded criteria; 36 reported the curative efficacy at the end of the treatment, 51 assessed the neurological deficit score of patients before and after the treatment, 27 evaluated the ADL scores; 32 studies reported the side effects; 6 trials did not conduct intention-to-treat analysis even though some people withdrew the treatment because of the side effects or poor tolerance, etc. Conclusion Except for several high quality RCTs, current quality of some clinical trials on butylphthalide for ischemic stroke should be improved. We recommend that researchers should use internationally accepted consolidate standards of reporting trials (CONSORT) in future studies.
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=−0.55, 95%CI −0.72 to −0.38, P<0.001) and reduce fibrinogen after treatment (SMD=−0.93, 95%CI −1.41 to −0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.