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Tang J, Wu C, Zhong Z. Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs. Neurol Ther 2024; 13:749-761. [PMID: 38635141 PMCID: PMC11136917 DOI: 10.1007/s40120-024-00612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission. METHODS Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. RESULTS A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively). CONCLUSION Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.
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Affiliation(s)
- Jia Tang
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Changdong Wu
- Xinjiang Emergency Center, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tian-Chi Road, Tianshan District, Urumqi, 830001, Xinjiang, China.
| | - Zhenguang Zhong
- Department of Bioengineering, Imperial College London, London, UK
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Huang D, Zhu Y, Shen J, Song C. Identification of Potential Neddylation-related Key Genes in Ischemic Stroke based on Machine Learning Methods. Mol Neurobiol 2024; 61:2530-2541. [PMID: 37910287 DOI: 10.1007/s12035-023-03738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
Ischemic stroke (IS) is a complex neurological disease that can lead to severe disability or even death. Understanding the molecular mechanisms involved in the occurrence and progression of IS is of great significance for developing effective treatment strategies. In this context, the role of neddylation refers to the potential impact of neddylation on various cellular processes, which may contribute to the pathogenesis and outcome of IS. First, differential analysis was conducted on the GSE16561 dataset from the GEO database to identify 350 differentially expressed genes (DEGs) between the IS and Control groups. By intersecting the differential genes with neddylation-related genes, 11 neddylation-related DEGs were obtained. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses showed that the DEGs were mainly enriched in hematopoietic cell lineage and neutrophil degranulation, while the neddylation-related DEGs were mainly enriched in apoptosis and post-translational protein modification. Further Lasso-Cox and random forest analyses were performed on the 11 neddylation-related DEGs, identifying key genes SRPK1, BIRC2, and KLHL3. Additionally, validation of the key genes was carried out using the GSE58294 dataset and clinical patients. Finally, the correlation between the key genes and ferroptosis and cuproptosis was analyzed, and a ceRNA network was constructed. Our study helps to elucidate the complex role of neddylation in the mechanism of ischemic stroke, providing potential opportunities for the development of therapeutic interventions.
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Affiliation(s)
- Dian Huang
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Yan Zhu
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Junfei Shen
- Cardiac Color Doppler Ultrasound Room, Wuxi No.2 People's Hospital, Wuxi, 214000, China.
| | - Chenglin Song
- Nutritional Department, The Second People's Hospital of Lianyungang, Lianyungang, 222000, China.
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Li J, Huang H, Yan Y, Fu Y, Li M, Ju W, Cai Y, Liu Q, Chen H. Efficacy observation, complications and nursing of enteral nutrition suspension in patients with acute ischemic stroke. Int J Neurosci 2024:1-8. [PMID: 38512133 DOI: 10.1080/00207454.2024.2334368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study focuses on exploring the efficacy observation, complications and nursing aspects of using enteral nutrition suspension in patients with acute ischemic stroke. METHODS This study retrospectively analyzed clinical data from 188 patients with acute ischemic stroke treated in the Neurology Department of our hospital from October 2022 to September 2023. Patients who received intermittent enteral nutrition and nursing interventions were included in the control group (n=96), while patients who received continuous enteral nutrition and nursing interventions were included in the treatment group (n=92). Relevant indicators data changes before and after treatment were recorded for each patient, along with the occurrence of complications in both groups, and statistical analysis was conducted. RESULTS The treatment group had fewer days in the ICU and total hospitalization days compared to the control group, with p < .05. Patients in the treatment group had higher levels of serum albumin and serum prealbumin than those in the control group, with p < .05. The occurrence of abdominal pain, diarrhea, constipation, bloating and acid reflux in the treatment group was lower than in the control group, with p < .05. There was no significant difference in the occurrence of adverse outcomes at discharge, death at discharge, cerebral hemorrhage, lung infection and gastrointestinal bleeding between the two groups (p > .05). CONCLUSION The application of enteral nutrition suspension in patients with acute ischemic stroke effectively provides the necessary nutrients, maintains nutritional balance, promotes tissue repair and recovery and reduces the length of hospital stay.
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Affiliation(s)
- Jie Li
- Intensive Care Unit, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Huiying Huang
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Ying Yan
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Yanli Fu
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Manfang Li
- Nursing Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Wenhui Ju
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Yang Cai
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Qian Liu
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Hongbo Chen
- Neurology Department, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
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Wang SS, Xu H, Ge AQ, Yang KL, He Q, Ge JW. Bombyx batryticatus extract activates coagulation factor Ⅻ to promote angiogenesis in rats with cerebral ischemia/reperfusion injury. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117081. [PMID: 37633622 DOI: 10.1016/j.jep.2023.117081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Bombyx batryticatus is traditionally used to treat patients with stroke, but its mechanism remains unclear. AIM OF THE STUDY To explore the interventional effect of Bombyx batryticatus extract as an activator of FⅫ on angiogenesis of rats with cerebral ischemia/reperfusion injury. MATERIALS AND METHODS Firstly, the mechanism of Bombyx batryticatus interfering with IS was predicted by systematic pharmacology method, and then it was further verified by animal experiments. The effects of Bombyx batryticatus extract on plasma coagulation were detected, and the activation of coagulation factor Ⅻ (FⅫ) and its downstream substrate kallikrein kinase (KK) was detected in vitro. The brain morphology and expressions of FXII, KK, vascular endothelial growth factors (VEGF), CD31, Brdu/von Willebrand Factor (vWF) were detected. The morphological changes, cell proliferation and VEGF expression of brain microvascular endothelial cells were detected by oxygen glucose deprivation model. The pharmacodynamic substances of Bombyx batryticatus extract were identified by Liquid Chromatography - Mass Spectrometry (LC-MS). RESULTS The results of systematic pharmacology found that the treatment of IS by Bombyx batryticatus may be related to blood coagulation and other processes. In vitro, Bombyx batryticatus extract prolonged the activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) (P < 0.05), activated FⅫ and promoted the production of downstream substrate KK, with dose-dependent (P < 0.05). Bombyx batryticatus extract improved the neuronal damage of rats, activated FXII and increased the production of KK and the expressions of VEGF, CD31, Brdu/vWF (P < 0.05). Bombyx batryticatus extract also increased the proliferation of brain microvascular endothelial cells and expression of VEGF in rats (P < 0.05). A total of 809 metabolites in Bombyx batryticatus extract were identified by LC-MS. CONCLUSION Bombyx batryticatus extract may ameliorate the injury of nerve function in rats with cerebral ischemia/reperfusion injury.
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Affiliation(s)
- Shan-Shan Wang
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Hao Xu
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - An-Qi Ge
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Kai-Lin Yang
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qi He
- People's Hospital of Ningxiang City, Ningxiang, China
| | - Jin-Wen Ge
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China; Hunan Academy of Chinese Medicine, Changsha, Hunan, China.
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Hua Y, Yan C, Zhou C, Zheng Q, Li D, Tu P. Risk prediction models for intracranial hemorrhage in acute ischemic stroke patients receiving intravenous alteplase treatment: a systematic review. Front Neurol 2024; 14:1224658. [PMID: 38249727 PMCID: PMC10799340 DOI: 10.3389/fneur.2023.1224658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives To identify and compare published models that use related factors to predict the risk of intracranial hemorrhage (ICH) in acute ischemic stroke patients receiving intravenous alteplase treatment. Methods Risk prediction models for ICH in acute ischemic stroke patients receiving intravenous alteplase treatment were collected from PubMed, Embase, Web of Science, and the Cochrane Library up to April 7, 2023. A meta-analysis was performed using Stata 13.0, and the included models were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results A total of 656 references were screened, resulting in 13 studies being included. Among these, one was a prospective cohort study. Ten studies used internal validation; five studies used external validation, with two of them using both. The area under the receiver operating characteristic (ROC) curve for subjects reported in the models ranged from 0.68 to 0.985. Common predictors in the prediction models include National Institutes of Health Stroke Scale (NIHSS) (OR = 1.17, 95% CI 1.09-1.25, p < 0.0001), glucose (OR = 1.54, 95% CI 1.09-2.17, p < 0.05), and advanced age (OR = 1.50, 95% CI 1.15-1.94, p < 0.05), and the meta-analysis shows that these are independent risk factors. After PROBAST evaluation, all studies were assessed as having a high risk of bias but a low risk of applicability concerns. Conclusion This study systematically reviews available evidence on risk prediction models for ICH in acute ischemic stroke patients receiving intravenous alteplase treatment. Few models have been externally validated, while the majority demonstrate significant discriminative power.
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Affiliation(s)
- Yaqi Hua
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- School of Nursing, Nanchang University, Nanchang, China
| | - Chengkun Yan
- School of Nursing, Nanchang University, Nanchang, China
| | - Cheng Zhou
- School of Nursing, Nanchang University, Nanchang, China
| | - Qingyu Zheng
- Department of Post Anesthesia Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongying Li
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Tu
- Department of Post Anesthesia Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Guan Y, Liu T, Xu F, Xie S, Gu W, Bie Y. Integration of 16S rRNA gene sequencing and LC/MS-based metabolomic analysis of early biomarkers of acute ischaemic stroke in Tibetan miniature pigs. J Microbiol Methods 2023; 215:106846. [PMID: 37863204 DOI: 10.1016/j.mimet.2023.106846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
Acute ischaemic stroke (AIS) is a complex, systemic, pathological, and physiological process. Systemic inflammatory responses and disorders of the gut microbiome contribute to increased mortality and disability following AIS. We conducted 16S high-throughput sequencing and ultra-performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry-based non-targeted metabolomic analyses of the plasma from a Tibetan miniature pig middle cerebral artery occlusion (MCAO) model. A significant decrease in the abundance of Firmicutes and a significant increase in the abundance of Actinobacteria were observed after the onset of AIS. Among the plasma metabolites, the levels of phospholipids and amino acids were considerably altered. Loading values and differential metabolite-bacterial group association analyses of the metabolome and microbiome indicated a correlation between the microbiome and metabolome of Tibetan miniature pigs after MCAO. Furthermore, significant changes were observed in the ABC transporter pathway and purine metabolism in the gut microbiome-plasma metabolome during the early stage of AIS. Kyoto Encyclopaedia of Genes and Genomes enrichment analysis showed that arginine, proline, and cyanoamino acid metabolism was upregulated while ABC transporter metabolism pathway and carbohydrate digestion and absorption were substantially downregulated. The results of this study suggest that AIS affects the gut microbiota and plasma metabolites in Tibetan miniature pigs and that faecal microbiota transplantation could be a potential therapeutic approach for AIS.
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Affiliation(s)
- Yajin Guan
- Guangdong Provincial Key Laboratory of Large Animal models for Biomedicine, South China Institute of Large Animal Models for Biomedicine, Wuyi University, Jiangmen 519110, China; Guangdong Mingzhu Biotechnology Co., Ltd., Foshan 510168, China
| | - Tianping Liu
- Guangdong Provincial Key Laboratory of Large Animal models for Biomedicine, South China Institute of Large Animal Models for Biomedicine, Wuyi University, Jiangmen 519110, China; Guangdong Mingzhu Biotechnology Co., Ltd., Foshan 510168, China
| | - Fei Xu
- Guangdong Mingzhu Biotechnology Co., Ltd., Foshan 510168, China
| | - Shuilin Xie
- Guangdong Mingzhu Biotechnology Co., Ltd., Foshan 510168, China.
| | - Weiwang Gu
- Guangdong Provincial Key Laboratory of Large Animal models for Biomedicine, South China Institute of Large Animal Models for Biomedicine, Wuyi University, Jiangmen 519110, China; Institute of Comparative Medicine & Laboratory Animal Management Center, Southern Medical University, Guangzhou 510000, China.
| | - Yanan Bie
- School of Life Sciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou 510000, China.
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Adenova G, Kausova G, Tazhiyeva A. Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan. Heliyon 2023; 9:e18435. [PMID: 37593645 PMCID: PMC10427984 DOI: 10.1016/j.heliyon.2023.e18435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background According to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing "Stroke Schools" to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems. Aim To study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018-2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the "Electronic Register of Discharged Patients" (IS ERDB) and the annual collection "Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015-2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code "Acute Impaired Cerebral Circulation" (I60-I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the "Electronic Register of Dispensary Patients" of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection "Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations". Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.
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Affiliation(s)
| | - Galina Kausova
- Kazakhstan Medical University “KSPH”, Almaty, Kazakhstan
| | - Aigul Tazhiyeva
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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Zubair AS, Sheth KN. Hemorrhagic Conversion of Acute Ischemic Stroke. Neurotherapeutics 2023; 20:705-711. [PMID: 37085684 PMCID: PMC10275827 DOI: 10.1007/s13311-023-01377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
Stroke is a leading cause of morbidity and mortality worldwide; a serious complication of ischemic stroke is hemorrhagic transformation. Current treatment of acute ischemic stroke includes endovascular thrombectomy and thrombolytic therapy. Both of these treatment options are linked with increased risks of hemorrhagic conversion. The diagnosis and timely management of patients with hemorrhagic conversion is critically important to patient outcomes. This review aims to discuss hemorrhagic conversion of acute ischemic stroke including discussion of the pathophysiology, review of risk factors, imaging considerations, and treatment of patients with hemorrhagic conversion.
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Affiliation(s)
- Adeel S Zubair
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT, USA
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Xue L, Deng J, Zhu L, Shen F, Wei J, Wang L, Chen Q, Wang L. Effects of predictive nursing intervention on cognitive impairment and neurological function in ischemic stroke patients. Brain Behav 2023; 13:e2890. [PMID: 36738135 PMCID: PMC10013941 DOI: 10.1002/brb3.2890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/20/2022] [Accepted: 12/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ischemic stroke is a clinical emergency caused by insufficient intracranial blood supply, which eventually leads to brain tissue necrosis and neurological impairment. Predictive nursing intervention has achieved impressive success in the nursing of multiple surgeries. However, the role of predictive nursing intervention in the care of patients with ischemic stroke remains unclear. METHODS This study was a randomized controlled trial. Based on the inclusion and exclusion criteria, 126 patients were randomly assigned into two groups, namely the control group and the predictive nursing intervention group. Both groups were treated with thrombolytic therapy with alteplase. The patients in the control group were given routine nursing intervention and the predictive nursing intervention group received additional predictive care. Neurologic functions and cognitive impairment were evaluated by National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), Montreal cognitive assessment (MoCA), and mini-mental state examination (MMSE) scales, respectively. Door-to-Needle Times, venous thromboembolism (VTE)-related parameters, and complications were recorded. RESULTS Predictive nursing intervention significantly shortened the Door-to-Needle Times and enhanced the peak/average femoral venous blood flow and femoral venous diameter. In addition, predictive nursing intervention improved the NIHSS, FMA, MMSE, and MoCA scores and remarkably reduced the recurrence of ischemic stroke, deep vein thrombosis and gingival bleeding. CONCLUSION Predictive nursing intervention is beneficial to improve the effects of thrombolytic therapy in patients with ischemic stroke, which improves the neurological, cognitive and motor functions of patients, and reduces the occurrence of complications, suggesting an important clinical application value.
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Affiliation(s)
- Lianyu Xue
- Department of Nursing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Jiangshan Deng
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Lingyan Zhu
- Department of Nursing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Feifei Shen
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Jiewei Wei
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Lihui Wang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Qinqin Chen
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
| | - Lan Wang
- Department of Gastroenterology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui District, Shanghai, China
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Zubair AS, Sheth KN. IV tenecteplase: A non-inferior alternative to alteplase? MED 2022; 3:519-520. [PMID: 35963230 DOI: 10.1016/j.medj.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The standard medical therapy for intravenous thrombolysis in patients with stroke presenting within 3 h is alteplase, a tissue plasminogen activator. Menon and colleagues assessed the non-inferiority, efficacy, and safety of tenecteplase, a modified version of alteplase, in patients with acute ischemic stroke presenting within 4.5 h of onset.
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Affiliation(s)
- Adeel S Zubair
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA; Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, CT, USA
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Yang Y, Chang Q, Chen J, Zou X, Xue Q, Song A. Application of Integrated Emergency Care Model Based on Failure Modes and Effects Analysis in Patients With Ischemic Stroke. Front Surg 2022; 9:874577. [PMID: 35449548 PMCID: PMC9018110 DOI: 10.3389/fsurg.2022.874577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the application value of an integrated emergency care model based on failure modes and effects analysis (FMEA) in patients with acute ischemic stroke (AIS). Methods According to the convenience sampling method, 100 patients with AIS who visited the emergency department in our hospital from October 2018 to March 2019 were randomly selected as the control group and received routine emergency care mode intervention. Another 100 AIS patients who visited the emergency department from April to October 2019 were selected as the intervention group and received the integrated emergency care model based on FMEA. The total time spent from admission to completion of each emergency procedure [total time spent from admission to emergency physician reception (T0−1), total time spent from admission to stroke team reception (T0−2), total time spent from admission to imaging report out (T0−3), total time spent from admission to laboratory report out (T0−4), and total time spent from admission to intravenous thrombolysis (T0−5)] was recorded for both groups. The clinical outcome indicators (vascular recanalization rate, symptomatic intracerebral hemorrhage incidence, mortality rate) were observed for both groups. The National Institutes of Health Stroke Scale (NIHSS) score and Barthel score were evaluated for both groups after the intervention. The treatment satisfaction rate of the patients was investigated for both groups. Results The total time of T0−1, T0−2, T0−3, T0−4, T0−5 in the intervention group (0.55 ± 0.15, 1.23 ± 0.30, 21.24 ± 3.01, 33.30 ± 5.28, 44.19 ± 7.02) min was shorter than that of the control group (1.22 ± 0.28, 4.01 ± 1.06, 34.12 ± 4.44, 72.48 ± 8.27, 80.31 ± 9.22) min (P < 0.05). The vascular recanalization rate in the intervention group (23.00%) was higher than that in the control group (12.00%) (P < 0.05). There was no statistical significance in the symptomatic intracerebral hemorrhage incidence and mortality rate in the two groups (P > 0.05). After intervention, the NIHSS score of the intervention group (2.95 ± 0.91) was lower than that of the control group (6.10 ± 2.02), and the Barthel score (77.58 ± 7.33) was higher than that of the control group (53.34 ± 5.12) (P < 0.05). The treatment satisfaction rate in the intervention group (95.00%) was higher than that of the control group (86.00%) (P < 0.05). Conclusion Through FMEA, the failure mode that affects the emergency time of AIS patients is effectively analyzed and the targeted optimization process is proposed, which are important to enhance the efficiency and success rate of resuscitation of medical and nursing staff and improve the prognosis and life ability of patients.
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Affiliation(s)
- Yuying Yang
- Stroke Center Office, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Qing Chang
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Jing Chen
- Imaging Department, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Xiangkun Zou
- Information Section, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Qian Xue
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Aixia Song
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
- *Correspondence: Aixia Song
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