Objective To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion ① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.
ObjectiveTo explore the relationship between plasma homocysteine level and intracranial artery atherosclerosis in patients with cerebral infarction. MethodsA total of 120 patients with cerebral infarction diagnosed between January and December 2013 were selected.Plasma homocysteine level was analyzed and intracranial artery was detected by DSA. ResultsIntracranial artery atherosclerosis can be found in most of patients with cerebral infarction.Moreover,Plasma Hcy level of patients with large cerebral artery atherosclerosis was much higher than others (P<0.05).The much higher Plasma Hcy level,the severe intracranial artery atherosclerosis were found in internal carotid artery and cerebral middle artery (P<0.05). ConclusionIntracranial artery atherosclerosis is common in patients with cerebral infarction.Occurrence of intracranial artery atherosclerosis is positively correlated with plasma homocysteine level.Plasma homocysteine level may be a risk factor of intracranial artery atherosclerosis in patients with cerebral infarction.
Objective To assess the clinical efficacy and safety of Shuxuetong in the treatment of cerebral infarction. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1996 to Feb. 2006), EMBASE (1984 to Dec. 2005), Cochrane Controlled Trials Register (Issue 4, 2005), Chinese Cochrane Centre Database, CBMdisc (1978 to Dec. 2005). We handsearched the related published and unpublished data and their references. All trials about Shuxuetong injection for cerebral infarction were included. Data were extracted and evaluated by two reviewers independently with designed extraction form. RevMan 4.2.8 software was used for data analysis. Results Eleven RCTs involving 1 122 patients were included. The results of meta-analysis were listed as follows: ① Total effective rate: Compared with Danshen, three studies showed that Shuxuetong were more effective with OR 4.01, 95%CI 2.00 to 8.04; ② Adverse effect: The number of adverse drug reaction was small and the symptoms were moderate; ③ Neurologic impairment score: Compared with safflower, one study showed that Shuxuetong had better improvement with WMD -2.60, 95%CI -3.23 to -1.97. Conclusions Shuxuetong may increase the total effective rate of cerebral infarction. More high quality trials are required.
Objective To assess the effectiveness and safety of sodium ozagrel combined with edaravone for cerebral infarction. Methods Such databases as PubMed (1995 to 2010), EMCC (1995 to 2010), CBM (1995 to 2010), CNKI (1995 to 2010), and VIP (1989 to 2010) were searched to collect randomized controlled trials (RCTs) of odium ozagrel combined with edaravone for cerebral infarction. Then the retrieved studies were screened according to the predefined inclusion and exclusion criteria, the data were extracted, the quality of the included studies was evaluated, and meta-analyses were performed by using the Cochrane Collaboration’s RevMan 5.0 software. Results A total of 32 RCTs involving 3 059 cases were involved, among which 1 559 cases were in the treatment group and the other 1500 were in the control group. All studies with comparable baseline data reported the application of random methods without explaining the detailed methods, the blinding method and the allocation concealment. The results of meta-analyses indicated that sodium ozagrel combined with edaravone had significant differences in the effective rate for cerebral infarction compared with both single sodium ozagrel (OR=3.51, 95%CI 2.70 to 4.57) and routine treatment (OR=3.77, 95%CI 2.58 to 5.52), and it had significant differences in treating the defect of neurological function compared with both sodium ozagrel (WMD= –4.26, 95%CI –4.97 to –3.55) and routine treatment (WMD= –3.89, 95%CI –4.96 to –2.82). In addition, Sodium ozagrel combined with edaravone was superior to sodium ozagrel (WMD=13.57, 95%CI 9.84 to 17.30) in improving the ability of daily living. Conclusion This systematic review shows that sodium ozagrel combined with edaravone is quite effective in treating cerebral infarction, and it can improve the nerve dysfunction. This conclusion should be treated cautiously for the poor quality and higher possibility of bias in the included studies which may impact on the power of proof, so more double-blind RCTs with high quality are expected to provide high-quality evidence.
Objective To assess the clinical efficacy and safety of Xingnaojing for treating cerebral infarction. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to April 2005), EMBASE (1984 to April 2005), Cochrane Controlled Trials Register (Issue 2, 2005), CBMdisc (1978 to April 2005). We handsearched the related published and unpublished data and their references. All trials about Xingnaojing injection for cerebral infarction were included. Data were extracted and evaluated by two reviewers independently with designed extraction from RevMan 4.2.7 software was used for data analysis. Results Thirteen RCTs involving 1203 patients were include .The results of meta-analysis were listed as the following:①Mortality:Compared with danshen ,2 studies showed that Xingnaojing decreased mortality statistically (RR 0.31 and 95% CI 0.14 to 0.70).Compared with cerebrolysin ,1 study showed Xingnaojing didn’t decrease the mortality (RR 0.92 ,95%CI 0.14 to 6.27);②Total effective rate: Compared with Danshen ,4 studies showed that Xingnaojing were more effective (RR 0.92,95% CI 1.12 to 1.42 ); ③ Cure rate: Compared with each control , Xingnaojing had the same cure rate ;④ Adverse effect: The number of adverse drug reaction was small and the symptoms were moderate;⑤Neurologic impairment score:Compared with Danshen ,3 studies showed that Xingnaojing had better improvement (WMD 3.78 ,95%CI 2.30 to 5.26).Conclusions xingnaojing may decrease the mortality and increase the total effective rate of cerebral infarction .More high quality trials are required.
ObjectiveTo explore the concentration of the plasma homocysteine (Hcy) and the relationship with TOAST subtypes in patients with acute cerebral infarction. MethodsA total of 120 patients with acute cerebral infarction (ACI) treated from April 2012 to April 2013 were enrolled into the ACI group.They were classified with Korean TOAST classification as five subtypes:atherothrombosis (AT) type,small artery disease (SAD) type,cardioembolism (CE) type,stroke of other disease (SOD) type,and stroke of undetermined etiology (SUE) type.The plasma Hcy concentrations in each group and in 60 heathy people who were selected into the control group were measured.Furthermore,the relationship between plasma Hcy concentration and their subtypes were analyzed. ResultsThe plasma Hcy level in ACI group was significant higher than that in the control group (P<0.01).The levels of plasma Hcy were much higher in patients with AT,SAD,SOD,and CE than those in the control groups (P<0.01).In different subtypes,AT and SAD subtypes had higher homocysteine concentration than SUD and CE subtypes did.The concentration of Hcy in AT and SAD group had no significant difference. ConclusionACI is related to hyperhomocysteinemia.The plasma Hcy level varies with different TOAST subtypes of ACI,specially elevating in the subtypes of AT and SAD,which may indicate that hyperhomocysteinemia may increase stroke risk through proatherogenic effect and endothelial dysfunction.
ObjectiveTo explore the clinical effect of comprehensive nursing on cerebral infarction patients with high blood glucose. MethodsEighty cerebral infarction patients with high blood glucose treated between March 2012 and February 2013 were divided into observation group and control group with 40 patients in each. Patients in the control group received routine nursing care, while those in the observation group were given comprehensive nursing care. Then, we compared the two groups of patients in terms of their blood glucose control level, the recovery of neurological function and life quality. ResultsThe fasting glucose, 2-hour postprandial blood glucose, National Institude of Health stroke scale (NIHSS), and modified Edinburgh Scandinavican scoring scale (MESSS) scores of the two groups were not statistically different at the time of hospital admission (P>0.05). However, fasting blood sugar, 2-hour postprandial blood glucose, NIHSS, and MESSS scores in the observation group were significantly lower than those in the control group before discharge (P<0.05). Life quality score of self-care, mental health, and social function before discharge in the observation group were significantly higher than those in the control group (P<0.05). ConclusionComprehensive nursing is helpful to control blood glucose in an ideal level range for cerebral infarction patients with hyperglycemia, which can also promote the recovery of neurological function and improve the life quality of patients.
ObjectiveTo evaluate the usage status of drugs in the treatment of senile cerebral infarction in Xuanwu Hospital of Capital Medical University in 2011, and to provide references for rational usage of drugs for inpatients with senile cerebral infarction. MethodsMedical records of the elderly (≥60 years old) inpatients with cerebral infarction in Xuanwu Hospital in 2011 were collected. ATC codes were used to standardize names of drug and classifications. Patients' general information, number of patients' used drugs, Defined Daily Doses (DDDs), and Drug Utilization Index (DUI) were calculated by using Microsoft Excel 2007 to evaluate the rationality of drugs usage. ResultsA total of 430 patients were included. The average age was 70.61±7.29 years old. The average types of diseases were 5.39. The major combined disease was circulatory system disease, accounting for 42.45%. A total of 15 656 medication records were included, involving 243 kinds of drugs (including different administration routes). The average number of used drugs for each patient during the admission was 17.11. The top 5 drugs based on percentage of patients with drug use were Ginkgo Biloba Preparation (injection), clopidogrel (oral), prostaglandin E1 (injection), atorvastatin (oral) and cinepazide (injection). The top 5 drugs of DDDs were Ginkgo Biloba Preparation (injection), ipratropium bromide (inhalation), prostaglandin E1 (injection), folic acid (orla), and clopidogrel (oral). The top 5 drugs of DUI were vitamin B12 (injection), multi-vitamin (oral), nikethamide (injection), methylprednisolone (injection), and vitamin C (oral). ConclusionFor therapeutic drugs used among the elderly patients with cerebral infarction in Xuanwu Hospital of Capital Medical University, the choice, dosage and administration route of medication are rational. However, the drugs with higher DUI are not related with major diseases, which indicates that we should pay attention to the irrational drug use of clinical application, so as to ensure safety, effectiveness and economy of drug application.
Objective To investigate the relationship between systolic blood pressure (SBP) and etiological subtype in patients with cerebral infarction. Methods Retrospective analysis was made on the data of patients with cerebral infarction admitted to West China Hospital of Sichuan University between January 2015 and March 2018. Patients within 24 h of symptom were included. Etiological subtypes were classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Multinomial logistic regression was used to analyze the correlation between SBP at admission and etiological subtype. Results A total of 944 eligible cases were included, accounting for 37.3% (944/2528) of the total number of registered cases. The mean age was (65.35±14.17) years, and 57.5% (543/944) were male. The median time from onset to admission was 15 h, with 54.7% (516/944) of patients having elevated blood pressure. Among the patients, large artery atherosclerosis, small artery occlusion, cardiogenic embolism, other definite causes and undetermined causes accounted for 24.9% (235 cases), 21.2% (200 cases), 20.0% (189 cases), 1.8% (17 cases), and 32.1% (303 cases), respectively. Multinomial analysis showed that there was a significant negative correlation between SBP at admission and cardioembolic etiology [odds ratio (OR)=0.987, 95% confidence interval (CI) (0.977, 0.998)]; normal SBP at admission [<140 mm Hg (1 mm Hg=0.133 kPa)] was significantly positively correlated with cardioembolic etiology [OR=2.016, 95%CI (1.211, 3.357)]. Conclusion Normal SBP at admission with acute cerebral infarction predicts cardioembolic etiology, which will be helpful for clinicians to make individual decision based on the pathogenesis in the early stage.
Objective To assess the response rate, improvement in neurological function and safety of cinepazide maleate injection for patients with cerebral infarction. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials (Issue 1, 2010), PubMed (1948 to March 2010), EMbase (1966 to March 2010) and Chinese Bio-Medicine Database (1978 to March 2010). We also hand searched relevant literatures and obtained unpublished trials from pharmaceutical companies. The Cochrane Collaboration’s software RevMan5.0 was used for meta-analysis. Results Fifteen randomized controlled trials involving 1 456 patients were included. The results of meta-analyses indicated that: 1) Neurological deficits: We identified 11 trials involved 978 patients. Cinepazide maleate injection group compared with the control groups (placebo, Xuesaitong, Dansen and Nimodipine) could significantly improve the neurological deficits. The difference was statistically significant with WMD= – 4.64, 95%CI – 6.43 to – 2.85, WMD= – 2.39, 95%CI – 4.37 to – 0.42, WMD= – 3.67, 95%CI – 5.26 to – 2.07 and WMD= – 6.14, 95%CI – 8.39 to – 3.89, respectively. 2) Response rate: A total of 14 trials involved 1 349 patients were identified. Compared with control groups (placebo, Xuesaitong, Dansen and Nimodipine), cinepazide maleate injection group were more efficient, the difference was statistically significant with RR=1.33, 95%CI 1.16 to 1.54; RR=1.24, 95%CI 1.04 to 1.50; RR=1.33, 95%CI 1.23 to 1.43 and RR=1.29, 95%CI 1.12 to 1.49, respectively. 3) Adverse events: No serious adverse events were observed. But the difference of adverse events reports of headache and skin itching in cinepazide maleate injection group was statistically significant compared with the control groups. Conclusion Current evidence shows that cinepazide maleate injection can reduce neurological deficits in patients with acute cerebral infarction, improve the clinical treatment efficacy without serious adverse events. Due to limited quality of included studies, high-quality, large sample randomized controlled trials are required.