ObjectiveTo review the recent research progress of different types of stem cells in the treatment of ischemic stroke.MethodsBy searching the PubMed database, a systematic review had been carried out for the results of applying different types of stem cells in the treatment of ischemic stroke between 2000 and 2020.ResultsStem cells can be transplanted via intracranial, intravascular, cerebrospinal fluid, and intranasal route in the treatment of ischemic stroke. Paracrine and cell replacement are the two major mechanisms of the therapy. The researches have mainly focused on utilization of neural stem cells, embryonic stem cells, and mesenchymal stem cells. Each has its own advantages and disadvantages in terms of capability of migration, survival rate, and safety. Certain stem cell therapies have completed phase one clinical trial.ConclusionStem cells transplantation is feasible and has a great potential for the treatment of ischemic stroke, albeit that certain obstacles, including the selection of stem cells, transplantation strategy, migration ability, survival rate, still wait to be solved.
Objective To evaluate the predictive effect of three machine learning methods, namely support vector machine (SVM), K-nearest neighbor (KNN) and decision tree, on the daily number of new patients with ischemic stroke in Chengdu. Methods The numbers of daily new ischemic stroke patients from January 1st, 2019 to March 28th, 2021 were extracted from the Third People’s Hospital of Chengdu. The weather and meteorological data and air quality data of Chengdu came from China Weather Network in the same period. Correlation analyses, multinominal logistic regression, and principal component analysis were used to explore the influencing factors for the level of daily number of new ischemic stroke patients in this hospital. Then, using R 4.1.2 software, the data were randomly divided in a ratio of 7∶3 (70% into train set and 30% into validation set), and were respectively used to train and certify the three machine learning methods, SVM, KNN and decision tree, and logistic regression model was used as the benchmark model. F1 score, the area under the receiver operating characteristic curve (AUC) and accuracy of each model were calculated. The data dividing, training and validation were repeated for three times, and the average F1 scores, AUCs and accuracies of the three times were used to compare the prediction effects of the four models. Results According to the accuracies from high to low, the prediction effects of the four models were ranked as SVM (88.9%), logistic regression model (87.5%), decision tree (85.9%), and KNN (85.1%); according to the F1 scores, the models were ranked as SVM (66.9%), KNN (62.7%), decision tree (59.1%), and logistic regression model (57.7%); according to the AUCs, the order from high to low was SVM (88.5%), logistic regression model (87.7%), KNN (84.7%), and decision tree (71.5%). Conclusion The prediction result of SVM is better than the traditional logistic regression model and the other two machine learning models.
Objective To understand the quality of life of patients with acute mild to moderate ischemic stroke one year after stroke, analyze the factors affecting their quality of life, and provide a scientific basis for improving their health-related quality of life. Methods This study included patients who were diagnosed with acute mild to moderate ischemic stroke between March 2019 and March 2021 in four hospitals in Nanchang. Sociodemographic information and relevant clinical data were collected during hospitalization. The EQ-5D-5L questionnaire was administered to assess health-related quality of life one year after discharge. The Mann-Whitney U test (for two groups) and Kruskal-Wallis one-way ANOVA (for multiple groups) were used to analyze differences in utility scores among various factors. A Tobit regression model was built to investigate the factors influencing quality of life one-year post-stroke. Results A total of 1 181 patients participated in the study, including 791 males (66.98%) and 390 females (33.02%), with an average age of 63.7±10.9 years. Health-related quality of life data collected one year after the stroke revealed that 22.69% of patients experienced pain/discomfort, 17.27% suffered anxiety/depression, 15.66% had mobility issues, 10.33% had difficulties with daily activities, and 8.64% had trouble with self-care. Tobit regression results showed that age (β=−0.263, 95%CI −0.327 to −0.198), gender (β=−0.134, 95%CI −0.189 to −0.080), previous hypertension (β=−0.068, 95%CI −0.120 to −0.016), previous dyslipidemia (β=−0.068, 95%CI −0.126 to −0.011), admission NIHSS score (β=−0.158, 95%CI −0.198 to −0.118), and discharge mRS score (β=−0.193, 95%CI −0.250 to −0.136) were negatively associated with health utility values. Current employment status (β=0.141, 95%CI 0.102 to 0.181) and admission GCS score (β=0.209, 95%CI 0.142 to 0.276) were positively correlated with health utility values. Conclusion One year after an acute mild to moderate ischemic stroke, patients commonly face pain/discomfort and anxiety/depression. Factors affecting overall quality of life include age, sex, current employment status, previous hypertension, previous dyslipidemia, admission NIHSS score, admission GCS score, and discharge mRS score. Clinically, developing scientifically sound and reasonable rehabilitation plans post-discharge is crucial for improving long-term quality of life.
ObjectiveTo systematically review the efficacy and safety of Salvia miltiorrhiza injection in the treatment of acute ischemic stroke (AIS). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, VIP, WanFang Data, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of Salvia miltiorrhiza injection in treatment of AIS from inception to February 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software and RevMan 5.3 software. ResultsA total of 160 RCTs were included. The measures included 7 Chinese medicine injections and 8 treatment measures, covering Danhong injection combined with conventional treatment (DH+CT), Danshen injection combined with conventional treatment (DS+CT), Danshen ligustrazine injection combined with conventional treatment (DSCXQ+CT), Danshen polyphenolic acid for injection combined with conventional treatment (DSDFS+CT), compound Danshen injection combined with conventional treatment (FFDS+CT), Danshen polyphenolate for injection combined with conventional treatment (SI+CT), and Sodium Tanshinone ⅡA Sulfonate injection combined with conventional treatment (STS+CT) and conventional treatment (CT). Results of network meta-analysis showed that for the total effective rate, the rank of cumulative probability was: DSDFS+CT (93.0%) > DH+CT (80.5%) > STS+CT (66.7%) > DSCXQ+CT (66.4%) > SI+CT (50.0%)> DS+CT (26.7%)> FFDS+CT (16.7%)> CT (0.1%). In terms of NIHSS, the rank of cumulative probability was: STS+CT (95.5%) >DH+CT (80.9%)> DSCXQ+CT (70.1%) > SI+CT (64.7%) > DSDFS+CT (42.0%) > FFDS+CT (24.4%) > DS+CT (20.1%) > CT (2.4%). In the aspect of Barthel index, the rank of cumulative probability was: DH+CT (76.2%) > DSCXQ+CT (74.3%) > STS+CT (64.1%) > DSDFS+CT (62.2%) > FFDS+CT (51.8%) > SI+CT (46.0 %) > DS+CT (21.7%)> CT (3.8%). ConclusionCurrent evidence shows that, for patients with AIS, DSDFS has an improved effect on the total effective rate, while STS and DH show advantages in NIHSS score and Barthel index. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective The primary objective was to determine whether Danshen agents can improve functional outcome without causing undue harm in patients with acute ischaemic stroke. Secondary objectives were to assess the effect of Danshen agents on impairment and on the quality of life. Methods Searches were performed in the Cochrane Stroke Group Specialized Trial Register, Trials Register of the Cochrane Complementary Medicine Field, Chinese Stroke Trials Register and data from the pharmaceutical company. In addition, we searched the electronic bibliographic databases: Cochrane Controlled Trials Register (CENTRAL/CCTR) Issue 1, 2002, MEDLINE (1996 to 2002), EMBASE (1980 to 2002), China Biological Medicine Database (1978 to 2002). We handsearched ten Chinese journals potentially related to our question. Two reviewers selected studies, assessed quality of studies, extracted data independently. The primary outcomes of death or dependency at the end of long term follow-up(at least three months) and adverse events were assessed. Secondary outcome measures included: measures of neurological deficit at the end of treatment, death from all causes within the first two weeks of treatment and during the whole follow-up period and quality of life. Results Eight potentially eligible trials were identified, of which three trials (304 patients) were included. Two trials were excluded and three trials were waiting for assessment. Number of death and dependency at the end of long term follow-up (at least three months) were not reported in the three included trials. Only one trial reported the adverse events. Three trials measured neurological deficit at the end of treatment. Danshen agents were associated with a significant improvement in neurological deficit (RR 1.07, 95%CI 1.01 to 1.14). There was no death and during the whole treatment period and there was no assessment on quality of life. Conlusions There were too few patients and outcome events to draw reliable conclusions from the present data. The methodological quality of all included studies was poor. Further high quality randomised controlled trials should be performed.
Objective To investigate the correlation between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and the presence of atherosclerotic stenosis in both intracranial and extracranial arteries among patients who have experienced cerebral infarction. Methods Patients with cerebral infarction admitted to the Department of Neurology of Sichuan Provincial People’s Hospital between January 2021 and June 2024 were retrospective selected. According to the digital subtraction angiography (DSA) performance, patients were divided into cerebral atherosclerotic stenosis group and no cerebral atherosclerotic stenosis group. According to the location of atherosclerotic stenosis, patients were divided into extracranial atherosclerotic stenosis group, intracranial atherosclerotic stenosis group, intracranial and extracranial atherosclerotic stenosis group. According to the severity of atherosclerotic stenosis, patients were divided into mild group, moderate group and severe group. Clinical data and laboratory indicators were collected. Multifactorial regression was used to analyze the risk factors, Spearman correlation analysis was used to evaluate the relationship between UHR and the degree of stenosis, and the predictive value of UHR for intracranial and extracranial atherosclerotic stenosis was analyzed by the receiver operating characteristic curve. Results A total of 388 patients were included. Among them, 291 cases in cerebral atherosclerotic stenosis group and 97 cases in no cerebral atherosclerotic stenosis group; 85 cases in the intracranial atherosclerotic stenosis group, 123 cases in the extracranial atherosclerotic stenosis group, and 83 cases in the intracranial and extracranial atherosclerotic stenosis group; There were 104 cases in the mild group, 81 cases in the moderate group, and 106 cases in the severe group. The results of multiple logistic regression analysis showed that age, hypertension, UHR and uric acid were independent influencing factors associated with atherosclerotic stenosis of intracranial and extracranial arteries. Furthermore, the uric acid and UHR were also risk factors for the degree of stenosis (P<0.05). Spearman correlation analysis results showed that UHR was positively correlated with the degree of stenosis (r=0.516, P < 0.001). Receiver operating characteristic curve showed that the predictive value of UHR (area under the curve was 0.724) was superior to that of uric acid (area under the curve was 0.638) or HDL-C (area under the curve was 0.709). It also showed good predictive value for stenosis in different locations of intracranial and extracranial arteries. Conclusion UHR is an independent risk factor for intracranial and extracranial atherosclerotic stenosis with notabla predictive value
Endovascular treatment for acute ischemic stroke has become the main therapy for large vessel occlusion. In addition to stent thrombectomy, in recent years, the application of aspiration thrombectomy is becoming more and more common. The physical principles of aspiration and stent thrombectomy extraction are different. The thrombus is captured by the negative pressure generated by suction through the contact between the reperfusion catheter and the thrombus, thus achieving cerebrovascular recanalization. Currently, more and more researches support the application of aspiration thrombectomy. What are the advantages and disadvantages of the aspiration thrombectomy compared with the stent thrombectomy and how to apply the aspiration technology reasonably are the hot issues concerned by everyone. This paper reviews the application and research progress of aspirating thrombectomy in order to provide reference for clinical treatment decisions.
Ischemic stroke (IS) is one of the important diseases threatening human health. The occurrence and development of IS can trigger a series of complex pathophysiological changes, including damage to the blood-brain barrier, ion imbalance, oxidative stress, mitochondrial damage, which ultimately lead to the apoptosis and necrosis of nerve cells in the ischemic area. Impaired blood-brain barrier is a key factor for cerebral edema, hemorrhagic transformation and poor prognosis in patients with IS, and neuroinflammatory response plays an important role in the damage and repair of the blood-brain barrier. This article mainly focuses on the neuroinflammatory response mediated by glial cells, pro-inflammatory cytokines and matrix metalloproteinases and the related mechanisms of IS blood-brain barrier damage and repair, in order to provide new directions for the treatment of IS.