Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008，twentythree patients with ischemic stroke after mechanical heart valve replacement had been researched(ischemic stroke group). One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity(INR), INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of ischemic stroke were analyzed by logistic regression analysis. Results (1) Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month-3 years after discharged. All the patients’ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. (2) There was no statistical significance between two groups in gender, age and the dose of warfarin（Pgt;0.05）. (3) Nonconditional logistic regression analysis on influence factors showed that atrial fibrillation（P=0.000）, left atrial enlargement（P=0.002）, low anticoagulation intensity（P=0.012） and longtime INR review interval（P=0.047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions (1)The prognosis of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. (2)The influences of risk factors should be minimized in order to avoid ischemic stroke. (3) Early low intensity anticoagulation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
ObjectiveTo observe the morphological characteristics of retinal vessels in patients with ischemic stroke, and to preliminary analyze the correlation between retinal vascular morphological parameters and ischemic stroke. MethodsA retrospective study. From May 2015 to May 2017, 73 patients with ischemic stroke (ischemic stroke group) confirmed by examination at the Beijing Friendship Hospital, Capital Medical University were included in this study. In addition, 146 patients were included in the control group. A total of 146 patients with acute stroke who were excluded by head CT and/or magnetic resonance imaging were selected as the control group. Fundus images of patients were collected by nonmydriatic fundus camera. Retinal vascular parameters were measured by artificial intelligence fundus image analysis system, included retinal artery and vein caliber as well as vascular curvature, branching angle, fractal dimension, and density. The morphological characteristics of retinal vessels were compared between the control and ischemic stroke groups, and correlation between the retinal vascular parameters and ischemic stroke was analyzed using binary logistic regression. ResultsCompared with the control group, the ischemic stroke group had thinner retinal artery caliber, smaller retinal vascular fractal dimension, and lower retinal vascular density; moreover, these differences were statistically significant (t=3.232, 3.502, 3.280; P＜0.05). Vascular fractal dimension [odds ratio (OR)=0.291, 95% confidence interval (CI) 0.160-0.528] and retinal artery caliber (OR=0.924, 95%CI 0.870-0.981) were strongly correlated with ischemic stroke (P＜0.01). ConclusionCompared with the control group, the retinal artery caliber, fractal dimension and retinal vascular density in ischemic stroke group are smaller; decreased retinal artery caliber and fractal dimension are correlated with ischemic stroke.
Objective To systematically evaluate the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. Methods Databases including PubMed, EMbase, BIOSIS and CNKI were electronically searched from establishment dates of databases to June 2012 to retrieve animal experiments on the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. The relevant studies were identified according to the predefined inclusion and exclusion criteria, the data were extracted, and the quality was evaluated. Then meta-analysis was performed using RevMan 5.1 software. Results Eight studies were included. The results of meta-analysis showed that no significant difference was found between the alcohol intervention group and the control group (MD=−6.98%, 95%CI −20.38% to 6.43%, P=0.31). However, compared with the control group, low dose of acute alcohol intervention (less than 2 g/kg) improved the prognosis of ischemic stroke with a significant difference (MD=−22.83%, 95%CI −38.77% to −6.89%, P=0.005), and highly-concentrated of chronic alcohol intervention worsened the cerebral ischemic damage of rats and mice with a significant difference (MD=24.06%, 95%CI 10.54% to 37.58%, P=0.000 5). Conclusion Low dose of acute alcohol intervention (less than 2 g/kg) could improve the prognosis of rats and mice with ischemic stroke which has the potential neuro-protective effects. However, highly-concentrated chronic alcohol intervention could worsen the cerebral ischemic damage. Due to the limitations of the included studies such as publication bias, the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke could be overestimated.
Objective To systematically review the association between SG13S89 polymorphism inALOX5AP gene and ischemic stroke in Chinese population. Methods Web of Science, PubMed, CNKI, CBM, EMbase and WanFang Data databases were searched to collect studies about the association between SG13S89 polymorphism inALOX5AP gene and ischemic stroke from inception to October 2016. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies. The meta-analysis was performed by STATA 12.0. Results A total of 11 case-control studies were included. The results of meta-analysis showed that SG13S89 polymorphism inALOX5AP gene was associated with the risk of ischemic stroke in Chinese (Avs. G: OR=1.192, 95%CI 1.029 to 1.381,P=0.019; AA+AGvs. GG: OR=1.20, 95%CI 1.029 to 1.400,P=0.020; AGvs. GG: OR=1.195, 95%CI 1.022 to 1.397,P=0.025). Conclusion SG13S89 polymorphism inALOX5AP gene may be related to ischemic stroke for Chinese, A allele may be a risk factor.
Objectives To observe the distribution of enlarged perivascular spaces (EPVSs) in acute ischemic stroke, and determine the factors that influence basal ganglia and centrum semiovale EPVSs. Methods We prospectively registered consecutive patients with acute ischemic stroke at the neurological wards of Jianyang Municipal People’s Hospital and West China Hospital of Sichuan University from February 1st to November 1st, 2014. Patients with ischemic stroke within 14 days of symptom onset, having magnetic resonance image (MRI) scan were included. Basal ganglia and centrum semiovale EPVSs, white matter hyperintensity, cerebral atrophy and lacunar infraction were rated using validated scales by reading MRI. Clinical information was obtained using standardized forms. The distribution of EPVSs was observed and analyzed. The evalution of EPVSs was analyzed in relation to age, vascular risk factor, cerebral atrophy, white matter hyperintensity, lacunar infraction, etc, by using univariate and multivariate logistical regression to evaluate the influencing factors for basal ganglia and centrum semiovale EPVSs. Results A total of 170 patients with acute ischemic stroke within 14 days from onset were included; in whom, 97.6% had EPVSs in basal ganglia and all had EPVSs in centrum semiovale. The most common scores of basal ganglia EPVSs were 1 point and 2 points. The most common scores of centrum semiovale EPVSs were 2 and 3 points. In logistic regression, age [odds ratio (OR)=1.043, 95% confidence interval (CI) (1.015, 1.071), P=0.002], periventricular white matter hyperintensity [OR=4.203, 95%CI (1.525, 11.583), P=0.006] and hypertension [OR=3.965, 95%CI (1.927, 8.157), P<0.001] were independently associated with increased severity of basal ganglia EPVSs. Only periventricular white matter hyperintensity [OR=2.248, 95%CI (1.054, 4.795), P=0.036] was independently associated with increased severity of centrum semiovale EPVSs in logistic regression. Conclusions EPVSs are common in ischemic stroke. There is a lower prevalence of EPVS in the basal ganglia compared with the centrum semiovale. Compared with centrum semiovale EPVSs, basal ganglia EPVSs are more associated with hypertensive cerebral small vessel disease, which may be a marker for hypertensive cerebral small vessel disease.
ObjectivesTo investigate risk factors for unplanned readmission in ischemic stroke patients within 31 days by using random forest algorithm.MethodsThe record of readmission patients with ischemic stroke within 31 days from 24 hospitals in Beijing between between 2015 and 2016 were collected. Patients were divided into two groups according to the occurrence of readmission within 31 days or not. Chi-squared or Mann-Whitney U test was used to select variables into the random forest algorithm. The precision coefficient and the Gini coefficient were used to comprehensively assess the importance of all variables, and select the more important variables and use the margind effect to assess relative risk of different levels.ResultsA total of 3 473 patients were included, among them 960 (27.64%) were readmitted within 31 days after stroke hospitalization. Based on the result of random forest, the most important variables affecting the risk of unplanned readmission within 31 days included the length of hospital stay, age, medical expense payment, rank of hospital, and occupation. When hospitalization was within 1 month, 10-day-hospitalization-stay patients had the lowest risk of rehospitalization; the younger the patients was, the higher the risk of readmission was. For ranks of hospital, patients from tertiary hospital had higher risk than secondary hospital. Furthermore, patients whose medical expenses were paid by free medical service and whose occupations were managers or staffs had higher risk of readmission within 31 days.ConclusionsThe unplanned readmission risk within 31 days of discharged ischemic stroke patients was connected not only with disease, but also with personal social and economic factors. Thus, more attention should be paid to both the medical process and the personal and family factors of stroke patients.
Objective To evaluate the risk factors for cognitive impairment and their interactions in acute ischemic stroke (IS) patients. Methods IS patients admitted to the Department of Neurology, the People’s Hospital of Mianyang between January 2019 and January 2022 were selected. Patients were divided into a cognitive impairment group and a cognitive normal group. The demographic characteristics and clinical data of the subjects were collected, and the traditional risk factors for cognitive impairment were determined by univariate and multivariate logistic regression analysis. The multifactor dimensionality reduction test was used to detect the possible interactions between risk factors. Results A total of 255 patients were included. Among them, 88 cases (34.5%) in the cognitive impairment group and 167 cases (65.5%) in the cognitive normal group. The results of factor logistic regression analysis showed that after adjusting for covariates, big and medium infarction volume, severe IS, moderate to severe carotid artery stenosis as well as high hypersensitive C-reactive protein (hs-CRP) were associated with post-IS cognitive impairment (P<0.05). The cognitive impairment increased by 22.632 times [odds ratio=22.632, 95% confidence interval (5.980, 85.652), P<0.001] in patients with big and medium infarction volume, severe IS and high hs-CRP. Conclusions The cognitive impairment is common in acute IS. Patients with big and medium infarction volume, non-mild stroke, carotid artery stenosis, high hs-CRP, and non-right sided infarction are prone to cognitive impairment, and there are complex interactions among these risk factors.
Objective To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO). MethodsA single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients’ comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (＜6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke. ResultsAmong the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio (HR)=1.76, 95% confidence interval (CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke (HR=0.66, 95%CI 0.33-1.33, P=0.247). ConclusionsaCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.
Good collateral circulation can effectively improve the prognosis of patients with severe stenosis or occlusion of cerebral blood supply artery. Studies have shown that CT angiography (CTA) can non-invasively and intuitively evaluate the degree of stenosis and collateral blood flow in diseased vessels. Rapid and accurate CTA collateral circulation score is of great significance for clinical decision-making and judging the prognosis of ischemic stroke. At present, there are many scoring scales based on CTA collateral circulation. This article will review the existing 7 CTA collateral circulation scoring scales, the advantages and disadvantages of clinical application and related research progress in predicting prognosis, aiming to provide a reference for clinicians to choose the collateral circulation score scale and the best treatment plan according to different situations.
Objective To know more about the correlation between patent foramen ovale (PFO) and ischemic stroke among young and middle-aged people through analysis on various risk factors of ischemic stroke. Methods Eighty-three patients with cerebral infarction from 15 to 55 years old diagnosed for the first time in the Department of Neurology of Xianyang Hospital between January 2016 and January 2017 were selected as the study subjects. They were divided into two groups, PFO group (n=42) and non-PFO group (n=41). Seventy-eight heathy people from the Physical Examination Department of the same hospital were selected as controls. All patients and heathy subjects underwent transcranial Doppler (TCD) foaming experiments, and the occurrence and shunt volume of PFO were observed. General information and cerebrovascular disease risk factors of the patients were investigated. Results The age of subjects in PFO and non-PFO groups was not significantly different (P>0.05). Among the risk factors, there was no significant difference between the PFO and non-PFO groups in drinking history (P>0.05). The incidences of other ischemic stroke risk factors (hypertension, diabetes, smoking, hyperlipidemia, hyperhomocysteinemia, and carotid arteriosclerosis) in the PFO group were significantly lower than those in the non-PFO group (P<0.05). The rank sum test results showed that large and medium shunt rates of the cerebral infarction group were significantly higher than those of the control group (P<0.05). Conclusions PFO may be one of the cause of ischemic stroke in young and middle-aged people. Pathogenesis of ischemic stroke is likely to have a relationship with the severity of the shunt from right to left.