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Huang J, Lu K, Xie D, Dong S, Zhu F, Lu B, Liu A. Correlation between plasma lipoprotein-associated phospholipase A2 levels and risk of ischaemic stroke recurrence by gender in the Chinese population. Neurol Res 2024; 46:679-689. [PMID: 38602308 DOI: 10.1080/01616412.2024.2340886] [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: 05/30/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To investigate the correlation between gender differences in plasma lipoprotein phospholipase A2 (Lp-PLA2) levels and the risk of recurrent stroke in patients with acute ischaemic stroke in China. METHODS We conducted a prospective follow-up study that included baselineLp-PLA2 levels and NIH Stroke Scale (NIHSS) scores in patients with ischaemic stroke upon admission. The diagnostic efficacy of the baseline Lp-PLA2 level for stroke recurrence was evaluated. And Kaplan‒Meier method was used to analyse the difference in the risk of recurrent stroke between these two groups among males and females. A paired t test was used to analyse the difference in Lp-PLA2 levels in male and female patients after follow-up. RESULTS Baseline plasma Lp-PLA2 was higher in men and women with recurrent stroke than in those without recurrent stroke. The correlation between baseline Lp-PLA2 and neurological impairment was higher in female than male stroke patients (R = 0.338 and 0.253, respectively). Although weakly correlated with neurological impairment, baseline Lp-PLA2 was more effective in predicting recurrent stroke (AUC = 0.705 in men, 0.788 in women). A Cox model was used to compare the risk of stroke between the high- and low-Lp-PLA2 groups (OR = 3.98 in men, 2.61 in women). According to the follow-up time of 6 months as the node, Lp-PLA2 will give different risk indicators. CONCLUSION Elevated plasma Lp-PLA2 is an independent risk factor for recurrent ischaemic stroke but is not strongly associated with the degree of cerebral damage. The predictive value of baseline Lp-PLA2 for stroke recurrence risk was higher in females than in males.
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Affiliation(s)
- Jie Huang
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
| | - Kunjie Lu
- Department of Clinical Laboratory, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Dongde Xie
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
| | - Shaowen Dong
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
| | - Fangge Zhu
- Beijing Institute of Brain Disorders, Capital Medical University, Bejing, China
| | - Bingxian Lu
- Beijing Institute of Brain Disorders, Capital Medical University, Bejing, China
| | - Anqi Liu
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, Guangdong, China
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Del Brutto OH, Mera RM, Rumbea DA, Recalde BY, Sedler MJ. The effect of previous strokes on the relationship between ankle-brachial index determinations and incident strokes: A population-based, longitudinal prospective study in older adults. Vascular 2024; 32:412-417. [PMID: 36303424 DOI: 10.1177/17085381221135890] [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] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Abnormal ankle-brachial index (ABI) determinations may be associated with an increased risk of incident strokes. However, the impact of previous strokes in this relationship is unknown. We estimated the role of previous strokes on the association between abnormal ABI determinations and incident stroke risk in community-dwelling older adults. METHODS Atahualpa residents aged ≥60 years received ABI determinations, cardiovascular risk factors assessment, and brain MRIs. ABIs were classified as abnormal if ≤0.9 or ≥1.4. Incident strokes were diagnosed by a certified neurologist with the aid of a post-event MRI. Poisson regression models were fitted to estimate stroke incidence rate ratio (IRR) according to categories of ABI. RESULTS Analysis included 389 participants (mean age: 68.2 ± 8.1 years). Eighty-six persons (22%) had abnormal ABI determinations. Incident strokes occurred in 38 (9.8%) individuals after a mean follow-up of 6.1 ± 1.9 years. Abnormal ABIs were associated with incident strokes in unadjusted analyses (p = 0.002) as well as in a Poisson regression model adjusted for demographics and clinical covariates (IRR: 2.57; 95% C.I.: 1.29-5.13), but not when the model was adjusted for neuroimaging covariates (IRR: 1.46; 95% C.I.: 0.67-3.20). Interaction models showed that having both abnormal ABI and non-lacunar strokes at baseline made the individual 9.7 times more likely to have an incident stroke (95% C.I.: 3.87-24.4). The risk was reduced to 2.2 (95% C.I.: 0.96-5.13) for those who only had an abnormal ABI. CONCLUSIONS An abnormal ABI is associated with a doubling the risk of incident strokes, but its importance is superseded by history of non-lacunar strokes.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc, South San Francisco, CA, USA
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
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Jin X, Wang S, Zhang C, Yang S, Lou L, Xu S, Cai C. Development and external validation of a nomogram for predicting postoperative pneumonia in aneurysmal subarachnoid hemorrhage. Front Neurol 2023; 14:1251570. [PMID: 37745673 PMCID: PMC10513064 DOI: 10.3389/fneur.2023.1251570] [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: 07/01/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
Background Postoperative pneumonia (POP) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH) associated with increased mortality rates, prolonged hospitalization, and high medical costs. It is currently understood that identifying pneumonia early and implementing aggressive treatment can significantly improve patients' outcomes. The primary objective of this study was to explore risk factors and develop a logistic regression model that assesses the risks of POP. Methods An internal cohort of 613 inpatients with aSAH who underwent surgery at the Neurosurgical Department of First Affiliated Hospital of Wenzhou Medical University was retrospectively analyzed to develop a nomogram for predicting POP. We assessed the discriminative power, accuracy, and clinical validity of the predictions by using the area under the receiver operating characteristic curve (AUC), the calibration curve, and decision curve analysis (DCA). The final model was validated using an external validation set of 97 samples from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Results Among patients in our internal cohort, 15.66% (n = 96/613) of patients had POP. The least absolute shrinkage and selection operator (LASSO) regression analysis identified the Glasgow Coma Scale (GCS), mechanical ventilation time (MVT), albumin, C-reactive protein (CRP), smoking, and delayed cerebral ischemia (DCI) as potential predictors of POP. We then used multivariable logistic regression analysis to evaluate the effects of these predictors and create a final model. Eighty percentage of patients in the internal cohort were randomly assigned to the training set for model development, while the remaining 20% of patients were allocated to the internal validation set. The AUC values for the training, internal, and external validation sets were 0.914, 0.856, and 0.851, and the corresponding Brier scores were 0.084, 0.098, and 0.143, respectively. Conclusion We found that GCS, MVT, albumin, CRP, smoking, and DCI are independent predictors for the development of POP in patients with aSAH. Overall, our nomogram represents a reliable and convenient approach to predict POP in the patient population.
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Affiliation(s)
- Xiao Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shijia Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengwei Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Song Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lejing Lou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuyao Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chang Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Dimaras T, Merkouris E, Tsiptsios D, Christidi F, Sousanidou A, Orgianelis I, Polatidou E, Kamenidis I, Karatzetzou S, Gkantzios A, Ntatsis C, Kokkotis C, Retsidou S, Aristidou M, Karageorgopoulou M, Psatha EA, Aggelousis N, Vadikolias K. Leukoaraiosis as a Promising Biomarker of Stroke Recurrence among Stroke Survivors: A Systematic Review. Neurol Int 2023; 15:994-1013. [PMID: 37606397 PMCID: PMC10443317 DOI: 10.3390/neurolint15030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023] Open
Abstract
Stroke is the leading cause of functional disability worldwide, with increasing prevalence in adults. Given the considerable negative impact on patients' quality of life and the financial burden on their families and society, it is essential to provide stroke survivors with a timely and reliable prognosis of stroke recurrence. Leukoaraiosis (LA) is a common neuroimaging feature of cerebral small-vessel disease. By researching the literature of two different databases (MEDLINE and Scopus), the present study aims to review all relevant studies from the last decade, dealing with the clinical utility of pre-existing LA as a prognostic factor for stroke recurrence in stroke survivors. Nineteen full-text articles published in English were identified and included in the present review, with data collected from a total of 34,546 stroke patients. A higher rate of extended LA was strongly associated with stroke recurrence in all stroke subtypes, even after adjustment for clinical risk factors. In particular, patients with ischemic stroke or transient ischemic attack with advanced LA had a significantly higher risk of future ischemic stroke, whereas patients with previous intracerebral hemorrhage and severe LA had a more than 2.5-fold increased risk of recurrent ischemic stroke and a more than 30-fold increased risk of hemorrhagic stroke. Finally, in patients receiving anticoagulant treatment for AF, the presence of LA was associated with an increased risk of recurrent ischemic stroke and intracranial hemorrhage. Because of this valuable predictive information, evaluating LA could significantly expand our knowledge of stroke patients and thereby improve overall stroke care.
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Affiliation(s)
- Theofanis Dimaras
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Ermis Merkouris
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Anastasia Sousanidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Ilias Orgianelis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Efthymia Polatidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Iordanis Kamenidis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Aimilios Gkantzios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Christos Ntatsis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Sofia Retsidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Maria Aristidou
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Maria Karageorgopoulou
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Evlampia A. Psatha
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.A.); (M.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (T.D.); (E.M.); (F.C.); (A.S.); (E.P.); (I.K.); (S.K.); (A.G.); (C.N.); (S.R.); (E.A.P.); (K.V.)
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Xiong Y, Wang S, Li Z, Fisher M, Wang L, Jiang Y, Huang X, Zhao X, Meng X, Wang Y. Thirteen-year trends in risk scores predictive values for subsequent stroke in patients with acute ischemic event. Brain Behav 2023; 13:e2962. [PMID: 36978218 PMCID: PMC10176011 DOI: 10.1002/brb3.2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION A high residual risk of subsequent stroke suggested that the predictive ability of Stroke Prognosis Instrument-II (SPI-II) and Essen Stroke Risk Score (ESRS) may have changed over the years. AIM To explore the predictive values of the SPI-II and ESRS for 1-year subsequent stroke risk in a pooled analysis of three consecutive national cohorts in China over 13 years. RESULTS In the China National Stroke Registries (CNSRs), 10.7% (5297/50,374) of the patients had a subsequent stroke within 1 year; area under the curve (AUC) of SPI-II and ESRS was .60 (95% confidence interval [CI]: .59-.61) and .58 (95% CI: .57-.59), respectively. For SPI-II, the AUC was .60 (95% CI: .59-.62) in CNSR-I, .60 (95% CI: .59-.62) in CNSR-II, and .58 (95% CI: .56-.59) in CNSR-III over the past 13 years. The declining trend was also found in ESRS scale (CNSR-I: .60 [95% CI: .59-.61]; CNSR-II: .60 [95% CI: .59-.62]; and CNSR-III: .56 [95% CI: .55-.58]). CONCLUSIONS The predictive power of the traditional risk scores SPI-II and ESRS was limited and gradually decreased over the past 13 years, thus the scales may not be useful for current clinical practice. Further derivation of risk scales with additional imaging features and biomarkers may be warranted.
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Affiliation(s)
- Yunyun Xiong
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
| | - Shang Wang
- Neurocardiology Center, Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Zixiao Li
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
- National Center for Healthcare Quality Management in Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Marc Fisher
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Liyuan Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yong Jiang
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xinying Huang
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xing‐Quan Zhao
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xia Meng
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yongjun Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
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Zhang X, Zhang S, Wang C, Liu R, Li A. High Neutrophil-to-Albumin Ratio Predicts Postoperative Pneumonia in Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2022; 13:840858. [PMID: 35463142 PMCID: PMC9021997 DOI: 10.3389/fneur.2022.840858] [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: 01/04/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimThere is still an absence of objective and easily accessible biomarkers despite the variety of risk factors associated with postoperative pneumonia (POP) in patients with aneurysmal subarachnoid hemorrhage (aSAH). In the present study, we have thus evaluated the relationship between the neutrophil-to-albumin ratio (NAR) and POP in patients with aSAH.MethodsSeveral consecutive patients (n = 395) who had undergone clipping or coiling of the aneurism were retrospectively assessed, of which we were able to analyze the existing population data and the related baseline variables. The patients were divided into POP and revealed not to occur. To identify independent predictors, we used the recipient operation feature (receiver operating characteristic, ROC) curve and a logic regression analysis.ResultsThis cohort was based on POP that occurred in 78 out of the 395 patients (19.7%), and these revealed a significantly higher NAR than those without (0.31 [0.25–0.39] vs. 0.23 [0.18–0.28]; p < 0.001). On the other hand, a multivariate logistic regression analysis showed that NAR (odds ratio = 1.907; 95% confidence interval, 1.232–2.953; p = 0.004) was independently associated with a POP after due adjustment for confounders. Moreover, the predictive performances of NAR for POP were also significant (area under the ROC curve [95% CI] 0.775 [0.717–0.832]; p < 0.001).ConclusionThe elevation of NAR at admission in patients with aSAH might help predict POP.
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Affiliation(s)
- Xin Zhang
- Lianyungang Clinical College, Nanjing Medical University, Lianyungang, China
| | - Sheng Zhang
- Qingpu Branch, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Congkai Wang
- Lianyungang Clinical College, Nanjing Medical University, Lianyungang, China
| | - Ran Liu
- The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Aimin Li
- Lianyungang Clinical College, Nanjing Medical University, Lianyungang, China
- *Correspondence: Aimin Li
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Zhao L, Cao S, Pei L, Fang H, Liu H, Wu J, Sun S, Gao Y, Song B, Xu Y. Validation of CSR model to predict stroke risk after transient ischemic attack. Sci Rep 2022; 12:604. [PMID: 35022460 PMCID: PMC8755815 DOI: 10.1038/s41598-021-04405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
It is essential to identify high risk transient ischemic attack (TIA) patients. The previous study reported that the CSR (comprehensive stroke recurrence) model, a neuroimaging model, had a high predictive ability of recurrent stroke. The aims of this study were to validate the predictive value of CSR model in TIA patients and compare the predictive ability with ABCD3-I score. Data were analyzed from the prospective hospital-based database of patients with TIA which defined by the World Health Organization time-based criteria. The predictive outcome was stroke occurrence at 90 days. The receiver-operating characteristic (ROC) curves were plotted and the C statistics were calculated as a measure of predictive ability. Among 1186 eligible patients, the mean age was 57.28 ± 12.17 years, and 474 (40.0%) patients had positive diffusion-weighted imaging (DWI). There were 118 (9.9%) patients who had stroke within 90 days. In 1186 TIA patients, The C statistic of CSR model (0.754; 95% confidence interval [CI] 0.729–0.778) was similar with that of ABCD3-I score (0.717; 95% CI 0.691–0.743; Z = 1.400; P = 0.1616). In 474 TIA patients with positive DWI, C statistic of CSR model (0.725; 95% CI 0.683–0.765) was statistically higher than that of ABCD3-I score (0.626; 95% CI 0.581–0.670; Z = 2.294; P = 0.0245). The CSR model had good predictive value for assessing stroke risk after TIA, and it had a higher predictive value than ABCD3-I score for assessing stroke risk for TIA patients with positive DWI.
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Affiliation(s)
- Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shuang Cao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hao Liu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shilei Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Xia GH, Zhang MS, Wu QH, Wang HD, Zhou HW, He Y, Yin J. Dysbiosis of Gut Microbiota Is an Independent Risk Factor of Stroke-Associated Pneumonia: A Chinese Pilot Study. Front Cell Infect Microbiol 2021; 11:715475. [PMID: 34414134 PMCID: PMC8369370 DOI: 10.3389/fcimb.2021.715475] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/20/2021] [Indexed: 01/21/2023] Open
Abstract
Background and Purpose Identifying risks of stroke-associated pneumonia (SAP) is important for clinical management. We aimed to evaluate the association between gut microbiome composition and SAP in patients with acute ischemic stroke (AIS). Methods A prospective observational study was conducted, and 188 AIS patients were enrolled as the training cohort. Fecal and serum samples were collected at admission. SAP was diagnosed by specialized physicians, and disease severity scores were recorded. Fecal samples were subjected to 16S rRNA V4 tag sequencing and analysed with QIIME and LEfSe. Associations between the most relevant taxa and SAP were analysed and validated with an independent cohort. Fecal short-chain fatty acid (SCFA), serum D-lactate (D-LA), intestinal fatty acid-binding protein (iFABP) and lipopolysaccharide binding protein (LBP) levels were measured. Results Overall, 52 patients (27.7%) had SAP in the training cohort. The gut microbiome differed between SAP and non-SAP patients; specifically, Roseburia depletion and opportunistic pathogen enrichment were noted in SAP patients, as confirmed in the validation cohort (n=144, 28 SAP [19.4%]). Based on multivariate analysis, Roseburia was identified as a protective factor against SAP in both cohorts (training, aOR 0.52; 95% CI, 0.30-0.90; validation, aOR 0.44; 95% CI, 0.23-0.85). The combination of these taxa into a microbial dysbiosis index (MDI) revealed that dysbiosis increased nearly 2 times risk of SAP (training, aOR 1.95; 95% CI, 1.19-3.20; validation, aOR 2.22; 95% CI, 1.15-4.26). Lower fecal SCFA levels and higher serum D-LA levels were observed in SAP patients. Furthermore, SAP was an independent risk factor of 30-day death and 90-day unfavorable outcome. Conclusion We demonstrate that a microbial community with depleted Roseburia and enriched opportunistic pathogens is associated with increased risk of SAP among AIS patients. Gut microbiota screening might be useful for identifying patients at high risk for SAP and provide clues for stroke treatment.
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Affiliation(s)
- Geng-Hong Xia
- Department of Neurology, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ming-Si Zhang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi-Heng Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui-Di Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong-Wei Zhou
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medicine University, Guangzhou, China
| | - Yan He
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medicine University, Guangzhou, China
| | - Jia Yin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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9
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Rastogi A, Weissert R, Bhaskar SMM. Emerging role of white matter lesions in cerebrovascular disease. Eur J Neurosci 2021; 54:5531-5559. [PMID: 34233379 DOI: 10.1111/ejn.15379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
White matter lesions have been implicated in the setting of stroke, dementia, intracerebral haemorrhage, several other cerebrovascular conditions, migraine, various neuroimmunological diseases like multiple sclerosis, disorders of metabolism, mitochondrial diseases and others. While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision-making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.
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Affiliation(s)
- Aarushi Rastogi
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert Weissert
- Department of Neurology, Regensburg University Hospital, University of Regensburg, Regensburg, Germany
| | - Sonu Menachem Maimonides Bhaskar
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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10
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Chen Y, Lian BQ, Peng L, Ding CY, Lin YX, Yu LH, Wang DL, Kang DZ. Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients. Chin Med J (Engl) 2020; 134:682-689. [PMID: 33394700 PMCID: PMC7989986 DOI: 10.1097/cm9.0000000000001304] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients. Methods: We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed. Results: POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011). Conclusions: Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.
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Affiliation(s)
- Yue Chen
- The Graduate School of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Bao-Qiang Lian
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Lei Peng
- Department of Neurosurgery, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang, Yichang, Hubei 443000, China
| | - Chen-Yu Ding
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Liang-Hong Yu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Deng-Liang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
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11
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Strambo D, Zachariadis A, Lambrou D, Schwarz G, Sirimarco G, Aarnio K, Putaala J, Ntaios G, Vemmos K, Michel P. A score to predict one-year risk of recurrence after acute ischemic stroke. Int J Stroke 2020; 16:602-612. [PMID: 32878590 DOI: 10.1177/1747493020932787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An acute ischemic stroke carries a substantial risk of further recurrences. We aimed at developing and validating a prognostic tool to predict one-year stroke recurrence after acute ischemic stroke. METHODS An integer score was derived by Cox regression analysis on a hospital-referred cohort of 3246 acute ischemic stroke patients from Switzerland, and tested for external validity in three similar independent cohorts from Athens (n = 2495), Milan (n = 1279), and Helsinki (n = 714) by means of calibration and discrimination. RESULTS In the derivation cohort, the recurrence rate was 7% (n = 228/3246). We developed a nine-point score comprising: previous stroke or transient ischemic attack (1-point), stroke mechanism (small vessel disease and unknown mechanism: 0-points; rare stroke mechanism: 3-points; other mechanisms: 1-point), pre-stroke antiplatelets (1-point), active malignancy (2-points), chronic cerebrovascular lesions on imaging (1-point) and absence of early ischemic changes on first imaging (1-point). In the derivation cohort, the one-year risk of re-stroke was 3.0% (95%CI 1.9-4.1) in 932 (29%) patients with a score 0-1, 7.2% (6.1-8.3) in 2038 (63%) with a score 2-4, and 19.2% (14.6-23.9) in 276 (8%) with a score ≥ 5. The score calibrated well in the Athens (recurrences = 208/2495), but not in the Helsinki (recurrences = 15/714) or Milan (recurrences = 65/1279) cohorts. The AUC was 0.67 in the derivation cohort, and 0.56, 0.70, and 0.63 in the Athens, Helsinki, and Milan cohorts, respectively. CONCLUSION We developed a score to predict one-year stroke recurrence risk in patients with acute ischemic stroke. Since the score was not completely validated when applied to external datasets where it displayed poor to fair calibration and discrimination, additional efforts are required to ameliorate our accuracy for predicting stroke recurrence, by better refining this prognostic tool or developing new ones. Clinical and radiological markers of established cerebrovascular disease and stroke etiology were better predictors than the usual demographic vascular risk factors.
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Affiliation(s)
- Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.,Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Dimitris Lambrou
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Ghil Schwarz
- Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Sirimarco
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Karolinaa Aarnio
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | | | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
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12
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Kauw F, Greving JP, Takx RAP, de Jong HWAM, Schonewille WJ, Vos JA, Wermer MJH, van Walderveen MAA, Kappelle LJ, Velthuis BK, Dankbaar JW. Prediction of long-term recurrent ischemic stroke: the added value of non-contrast CT, CT perfusion, and CT angiography. Neuroradiology 2020; 63:483-490. [PMID: 32857214 PMCID: PMC7966192 DOI: 10.1007/s00234-020-02526-5] [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: 06/17/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to evaluate whether the addition of brain CT imaging data to a model incorporating clinical risk factors improves prediction of ischemic stroke recurrence over 5 years of follow-up. Methods A total of 638 patients with ischemic stroke from three centers were selected from the Dutch acute stroke study (DUST). CT-derived candidate predictors included findings on non-contrast CT, CT perfusion, and CT angiography. Five-year follow-up data were extracted from medical records. We developed a multivariable Cox regression model containing clinical predictors and an extended model including CT-derived predictors by applying backward elimination. We calculated net reclassification improvement and integrated discrimination improvement indices. Discrimination was evaluated with the optimism-corrected c-statistic and calibration with a calibration plot. Results During 5 years of follow-up, 56 patients (9%) had a recurrence. The c-statistic of the clinical model, which contained male sex, history of hyperlipidemia, and history of stroke or transient ischemic attack, was 0.61. Compared with the clinical model, the extended model, which contained previous cerebral infarcts on non-contrast CT and Alberta Stroke Program Early CT score greater than 7 on mean transit time maps derived from CT perfusion, had higher discriminative performance (c-statistic 0.65, P = 0.01). Inclusion of these CT variables led to a significant improvement in reclassification measures, by using the net reclassification improvement and integrated discrimination improvement indices. Conclusion Data from CT imaging significantly improved the discriminatory performance and reclassification in predicting ischemic stroke recurrence beyond a model incorporating clinical risk factors only. Electronic supplementary material The online version of this article (10.1007/s00234-020-02526-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - Jan A Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - L Jaap Kappelle
- Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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13
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Nam KW, Kwon HM, Kim HL, Lee YS. Left ventricular ejection fraction is associated with small vessel disease in ischaemic stroke patients. Eur J Neurol 2019; 26:747-753. [PMID: 30565350 DOI: 10.1111/ene.13883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The purpose was to evaluate the association between the left ventricular ejection fraction (LVEF) and cerebral small vessel disease (cSVD) in ischaemic stroke patients. METHODS Consecutive first-ever ischaemic stroke patients between 2010 and 2013 were included. White matter hyperintensity (WMH) volumes were rated using both the Fazekas score and quantitative methods on fluid-attenuated inversion recovery images. As spectra of cSVD, lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVSs) were also evaluated. To assess the dose-response relationship between LVEF and cSVD, the burdens of each radiological marker and the total cSVD score were rated. RESULTS A total of 841 patients were included [median WMH volume 2.98 (1.22-10.50) ml; the frequencies of lacunes, CMBs and moderate to severe EPVSs were 38%, 31% and 35%, respectively]. In the multivariate analysis about predictors of WMH volumes, the LVEF (B = -0.052, P < 0.001) remained significant after adjusting for confounders. LVEF was also a predictor of lacunes [adjusted odds ratio (aOR) 0.978, P = 0.012], CMBs (aOR = 0.96, P < 0.001) and moderate to severe EPVSs (aOR = 0.94, P < 0.001) after adjusting for their confounders. The LVEF values were negatively correlated with the burdens of lacunes (P = 0.026), CMBs (P < 0.001) and EPVSs (P = 0.002). The total cSVD score also showed a negative association with LVEF in a dose-response manner (P < 0.001). CONCLUSIONS The burden of cSVD is negatively correlated with the LVEF in a dose-response manner. Our results suggest clues for further studies about determining the pathophysiology of cSVD.
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Affiliation(s)
- K-W Nam
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.,Seoul National University College of Medicine, Seoul, Korea
| | - H-M Kwon
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.,Seoul National University College of Medicine, Seoul, Korea
| | - H-L Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Y-S Lee
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.,Seoul National University College of Medicine, Seoul, Korea
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14
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Bian Y, Wang JC, Sun F, Sun ZY, Lin YJ, Liu Y, Zhao B, Liu L, Luo XG. Assessment of cerebrovascular reserve impairment using the breath-holding index in patients with leukoaraiosis. Neural Regen Res 2019; 14:1412-1418. [PMID: 30964067 PMCID: PMC6524493 DOI: 10.4103/1673-5374.251332] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43–93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People’s Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
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Affiliation(s)
- Ying Bian
- Department of Neurology, the First Affiliated Hospital of China Medical University; Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Jin-Chun Wang
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Feng Sun
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Zi-Yi Sun
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China
| | - Yu-Jiao Lin
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Yang Liu
- Department of Neurology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bin Zhao
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Li Liu
- Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China
| | - Xiao-Guang Luo
- Department of Neurology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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15
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Schapira AHV. Progress in neurology 2017-2018. Eur J Neurol 2018; 25:1389-1397. [DOI: 10.1111/ene.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. H. V. Schapira
- Department of Clinical and Movement Neurosciences; UCL Queen Square Institute of Neurology; London UK
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16
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Nam KW, Kim TJ, Lee JS, Kwon HM, Lee YS, Ko SB, Yoon BW. High Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Pneumonia. Stroke 2018; 49:1886-1892. [DOI: 10.1161/strokeaha.118.021228] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ki-Woong Nam
- From the Department of Neurology, Seoul National University College of Medicine, Korea (K.-W.N., T.J.K., H.-M.K., Y.-S.L., S.-B.K., B.-W.Y.)
- Seoul National University Hospital, Korea (K.-W.N., T.J.K., S.-B.K., B.-W.Y.)
| | - Tae Jung Kim
- From the Department of Neurology, Seoul National University College of Medicine, Korea (K.-W.N., T.J.K., H.-M.K., Y.-S.L., S.-B.K., B.-W.Y.)
- Seoul National University Hospital, Korea (K.-W.N., T.J.K., S.-B.K., B.-W.Y.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea (J.S.L.)
| | - Hyung-Min Kwon
- From the Department of Neurology, Seoul National University College of Medicine, Korea (K.-W.N., T.J.K., H.-M.K., Y.-S.L., S.-B.K., B.-W.Y.)
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea (H.-M.K., Y.-S.L.)
| | - Yong-Seok Lee
- From the Department of Neurology, Seoul National University College of Medicine, Korea (K.-W.N., T.J.K., H.-M.K., Y.-S.L., S.-B.K., B.-W.Y.)
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea (H.-M.K., Y.-S.L.)
| | - Sang-Bae Ko
- From the Department of Neurology, Seoul National University College of Medicine, Korea (K.-W.N., T.J.K., H.-M.K., Y.-S.L., S.-B.K., B.-W.Y.)
- Seoul National University Hospital, Korea (K.-W.N., T.J.K., S.-B.K., B.-W.Y.)
| | - Byung-Woo Yoon
- From the Department of Neurology, Seoul National University College of Medicine, Korea (K.-W.N., T.J.K., H.-M.K., Y.-S.L., S.-B.K., B.-W.Y.)
- Seoul National University Hospital, Korea (K.-W.N., T.J.K., S.-B.K., B.-W.Y.)
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17
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Kauw F, Takx RAP, de Jong HWAM, Velthuis BK, Kappelle LJ, Dankbaar JW. Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2018; 45:279-287. [PMID: 29936515 DOI: 10.1159/000490422] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/24/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. METHODS A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms "ischemic stroke," "predictors/determinants," and "recurrence." Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I2) were calculated using inverse variance random effects models. RESULTS Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1-3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1-0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2-1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5-2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1-5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0-4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2-1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5-3.2). CONCLUSIONS In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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18
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Protocol for Systematic Review of Controlled Trials of Korean and Chinese Herbal Treatments for Stroke. JOURNAL OF ACUPUNCTURE RESEARCH 2017. [DOI: 10.13045/jar.2017.02243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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