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Taweephol T, Saksit P, Hiransuthikul A, Vorasayan P, Akarathanawat W, Chutinet A. Incidence of recurrent ischemic stroke and its associated factors in a tertiary care center in Thailand: a retrospective cohort study. BMC Neurol 2024; 24:152. [PMID: 38704525 PMCID: PMC11069183 DOI: 10.1186/s12883-024-03640-0] [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: 10/08/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Ischemic stroke (IS) is one of the leading causes of death among non-communicable diseases in Thailand. Patients who have survived an IS are at an increased risk of developing recurrent IS, which can result in worse outcomes and post-stroke complications. OBJECTIVES The study aimed to investigate the incidence of recurrent IS among patients with first-ever IS during a one-year follow-up period and to determine its associated risk factors. METHODS Adult patients (aged ≥ 18 years) who were hospitalized at the Stroke Center, King Chulalongkorn Memorial Hospital (KCMH) in Bangkok, Thailand, due to first-ever IS between January and December 2019 and had at least one follow-up visit during the one-year follow-up period were included in this retrospective cohort study. IS diagnosis was confirmed by neurologists and imaging. The log-rank test was used to determine the event-free survival probabilities of recurrent IS in each risk factor. RESULTS Of 418 patients hospitalized due to first-ever IS in 2019, 366 (87.6%) were included in the analysis. During a total of 327.2 person-years of follow-up, 25 (6.8%) patients developed recurrent IS, accounting for an incidence rate of 7.7 per 100 person-year (95% confidence interval [CI] 5.2-11.3). The median (interquartile range) time of recurrence was 35 (16-73) days. None of the 47 patients with atrial fibrillation developed recurrent IS. The highest incidence rate of recurrent IS occurred within 1 month after the first episode (34 per 100 person-years) compared to other follow-up periods. Patients with small vessel occlusion and large-artery atherosclerosis (LAA) constituted the majority of patients in the recurrent IS episode (48% and 40%, respectively), with LAA exhibiting a higher recurrence rate (13.5%). Additionally, smoking status was found to be associated with an increased risk of recurrence. CONCLUSION The incidence rate of the recurrence was moderate in our tertiary care setting, with a decreasing trend over time after the first episode. The various subtypes of IS and smoking status can lead to differences in event-free survival probabilities.
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Affiliation(s)
- Thanapoom Taweephol
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Pitsinee Saksit
- Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Akarin Hiransuthikul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Pongpat Vorasayan
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Wasan Akarathanawat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
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Liu X, Wang Y, Ding L, Hu R, Zhang Y, Zhang W, Pei L, Cao Y, Fang H, Liu K, Sun S, Wu J, Buonanno FS, Ning M, Xu Y, Song B. Atrial Cardiomyopathy Predicts the Functional Outcome and Mortality in Stroke Patients. J Atheroscler Thromb 2024:64756. [PMID: 38644203 DOI: 10.5551/jat.64756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
AIM Atrial cardiomyopathy (ACM) is characterized by atrial dysfunction. This study aims to assess the prognostic significance of ACM in patients with noncardioembolic stroke (NCS). METHODS Patients with NCS within seven days of onset were prospectively enrolled between January 2019 and December 2020. ACM was defined as either an N-terminal pro-brain natriuretic peptide (NT-pro BNP) >250 pg/ml or a P-terminal force in precordial lead V1 (PTFV1) ≥ 5000µV·ms. A poor functional outcome was determined as a score of 3-6 on the modified Rankin Scale (mRS) within a 2-year follow-up period. Logistic regression and Cox regression analyses were employed to examine the relationship between ACM and the long-term prognosis of patients with NCS. RESULTS A total of 1,346 patients were enrolled, of whom 299 (22.2%) patients were diagnosed with ACM. A total of 207(15.4%) patients experienced a poor functional outcome, and 58 (4.3%) patients died. A multivariate logistic regression analysis indicated that ACM was significantly associated with a poor functional outcome in NCS patients [adjusted odds ratio (aOR): 2.01; 95% confidence interval (CI): 1.42-2.87; p<0.001]. Additionally, a multivariate Cox regression analysis showed that an NT-pro BNP >250 pg/ml was significantly associated with an increased risk of all-cause mortality [adjusted hazard ratio (aHR), 2.51; 95% CI: 1.42-4.43; p=0.001]. CONCLUSIONS ACM may serve as a novel predictor of a poor long-term functional outcome in patients with NCS. Elevated NT-pro BNP levels (>250 pg/ml) were found to be associated with a higher risk of all-cause mortality. These findings warrant further validation in multicenter studies.
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Affiliation(s)
- Xinjing Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Yuying Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Lan Ding
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Ruiyao Hu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Yige Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Wan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Yuan Cao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Kai Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Shilei Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Ferdinando S Buonanno
- Department of Cardio-Neurology Division, Massachusetts General Hospital, Harvard Medical School
| | - Mingming Ning
- Department of Cardio-Neurology Division, Massachusetts General Hospital, Harvard Medical School
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University
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Yang D, Niu C, Li P, Du X, Zhao M, Jing W. Study of the neutrophil percentage-to-albumin ratio as a biomarker for predicting recurrence of first-episode ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107485. [PMID: 37966092 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107485] [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: 04/24/2023] [Revised: 10/19/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Neutrophils and albumin are associated with recurrence in patients with acute ischemic stroke. The purpose of this study was to evaluate the association between the neutrophil percentage-to-albumin ratio (NPAR) and recurrence in patients with first-episode acute ischemic stroke to identify a more predictive biomarker for ischemic stroke recurrence. METHODS In this study, the clinical data of patients with first-episode acute ischemic stroke admitted to the Department of Neurology of Shanxi Bethune Hospital from June 2021 to June 2022 were retrospectively collected, and a total of 829 patients who met the inclusion and exclusion criteria were followed up for 3 months. We evaluated the recurrence of patients within 3 months after acute ischemic stroke. Univariable and multivariable analyses were performed to determine the relationship between the NPAR and recurrence within 3 months in patients with AIS. Finally, ROC curves were used to compare the predicted values of albumin, neutrophil percentage, the neutrophil-to-lymphocyte ratio, and the NPAR. RESULTS A total of 829 first-episode acute ischemic stroke patients were included. The median NPAR was 1.60 (IQR 1.44-1.79). The percentage of patients with a 3-month recurrence was 6.0 % (50/829). The multivariate analysis showed that the NPAR was independently associated with the risk of recurrence within 3 months in acute ischemic stroke (OR 9.71, 95 % CI: 3.05-31.62, P < 0.001). The optimal cutoff value of the NPAR for predicting recurrence of acute ischemic stroke within 3 months was 1.78, with a sensitivity of 0.80 and a specificity of 0.75. Compared with the NLR, albumin and neutrophil percentage, the NPAR showed the greatest area under the curve (AUC) [0.78 (0.73, 0.83)]. The AUC test showed that the difference in the NPAR and neutrophil-to-lymphocyte ratio (P = 0.019), NPAR and albumin (P = 0.013), and NPAR and neutrophil percentage (P = 0.007) were statistically significant, while the difference between the other two were not statistically significant (P > 0.05). CONCLUSION 1. The recurrence rate within 3 months among patients with a first episode of acute ischemic stroke was 6.0 %.2. The NPAR was independently associated with recurrence within 3 months among patients with a first episode of acute ischemic stroke. Moreover, the NPAR may be a more effective biomarker for predicting recurrence in acute ischemic stroke patients than the albumin level, neutrophil percentage, and neutrophil-to-lymphocyte ratio.
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Affiliation(s)
- Debo Yang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Cailang Niu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Penghong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Xueqing Du
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Mina Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Wei Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China.
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Cheng Y, Wang Q, Niu G, Luo C. Correlation of Atherosclerotic Dyslipidemia with Long-Term Stroke Recurrence in Patients Undergoing Intravenous Thrombolysis for Acute Ischemic Stroke. Int J Gen Med 2023; 16:1621-1629. [PMID: 37159580 PMCID: PMC10163887 DOI: 10.2147/ijgm.s407971] [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: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
Abstract
Background Atherosclerotic dyslipidemia (AD) is associated with an increased risk of cardiovascular diseases and stroke events, but the effect of AD among acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis is unclear. This study aimed to investigate the relationship between AD and long-term stroke recurrence in AIS patients undergoing intravenous thrombolysis. Methods This prospective cohort study included 499 AIS patients treated with intravenous thrombolysis. Stroke subtype was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, patients' clinical characteristics, and results from multiple diagnostic tests. The primary endpoint event was ischemic stroke recurrence; the time to first AIS recurrence was estimated using Kaplan‒Meier analysis and compared using the two-sided Log rank test. Cox univariate and multivariate regression analyses were used to assess the association between AD and long-term stroke recurrence. Results Of the 499 patients with AIS treated with rt-PA intravenous thrombolysis, 80 (16.0%) had AD, and 60 (12.0%) had a stroke recurrence event. Kaplan‒Meier analysis showed that the stroke recurrence rate was significantly higher in patients with AD than in those without AD (p = 0.035, log rank test) and in the large-artery disease (LAD) subtype (p = 0.006, log rank test). Multivariate Cox regression analysis showed that AD (HR = 2.363, 95% CI: 1.294-4.314, P = 0.005) and atrial fibrillation (HR = 2.325, 95% CI: 1.007-5.366, P = 0.048) were associated with an increased risk of long-term stroke recurrence in AIS patients who underwent intravenous thrombolysis. Furthermore, AD was associated with an increased risk of stroke recurrence in patients undergoing intravenous thrombolysis in the LAD subtype (HR = 3.122, 95% CI: 1.304-7.437, P = 0.011). Conclusion We found that AD increases the risk of long-term stroke recurrence in AIS patients undergoing intravenous thrombolysis. This association may be stronger in the LAD subtype.
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Affiliation(s)
- Yuan Cheng
- Medical School, Fuyang Normal University, Fuyang, Anhui, People’s Republic of China
| | - Qingqing Wang
- Department of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, People’s Republic of China
| | - Guihong Niu
- Medical School, Fuyang Normal University, Fuyang, Anhui, People’s Republic of China
- Correspondence: Guihong Niu, Medical School, Fuyang Normal University, Fuyang, Anhui, 236300, People’s Republic of China, Email
| | - Chun Luo
- Department of Pediatric Surgery, Fuyang Women and Children’s Hospital, Fuyang, People’s Republic of China
- Chun Luo, Department of Pediatric Surgery, Fuyang Women and Children’s Hospital, Fuyang, Anhui, 236300, People’s Republic of China, Email
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Liu P, Hao J, Zhang Y, Wang L, Liu C, Wang J, Feng J, Zhang Y, Hou H, Zhang L. Acute Ischemic Stroke Comorbid with Type 2 Diabetes: Long-Term Prognosis Determinants in a 36-Month Prospective Study for Personalized Medicine. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2022; 26:451-460. [PMID: 35917518 DOI: 10.1089/omi.2022.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ischemic stroke (IS) is often comorbid with type 2 diabetes mellitus (T2DM) wherein the determinants of long-term outcomes, beyond the acute stroke phase, are not adequately known. This study identified the determinants of long-term outcomes for diabetic IS patients through a prospective nested case-control study in 624 patients treated with conservative measures (38.60% females, mean age: 63.85 years). After 36-month follow-up, 117 (18.8%) patients with poor outcome were enrolled in the case group. The poor outcome was defined with a modified Rankin Scale (mRS) score ≥3. Meanwhile, 374 (59.9%) patients with good outcome, defined as (mRS score <3), were included in the control group. Patients who died (n = 32) or lost to follow-up (n = 101) were excluded in analysis. Poor prognostic outcome was positively associated with (1) the pulse rate at admission, (2) diastolic blood pressure (DBP), and (3) fasting blood glucose (FBG) during follow-up, whereas physical activity and lipid-lowering treatment during follow-up were negatively associated. Importantly, a forecasting model with these indicators distinguished the patients with good versus poor outcomes with 70.1% sensitivity and 73.5% specificity. Health care professionals and laboratory medicine scholars may want to monitor an increase in DBP and FBG during follow-up, as well as physical activity and lipid-lowering treatment, in relationship to the prognosis of IS with comorbid T2DM after conservative therapies. The proposed predictive model for personalized/precision medicine requires field testing in independent studies, and might help risk stratification with theranostic tests for patients with acute IS who also have a diagnosis of T2DM.
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Affiliation(s)
- Pengcheng Liu
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Jiheng Hao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Yichun Zhang
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Lu Wang
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Chao Liu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Jingjun Feng
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Yanbo Zhang
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Haifeng Hou
- Department of Epidemiology, School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
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Kim JY, Lee KJ, Kang J, Kim BJ, Han MK, Kang K, Park JM, Park TH, Park HK, Cho YJ, Hong KS, Lee KB, Jang MS, Lee JS, Lee J, Bae HJ. Fasting and Non-Fasting Triglycerides in Patients With Acute Ischemic Stroke. J Korean Med Sci 2022; 37:e100. [PMID: 35380025 PMCID: PMC8980366 DOI: 10.3346/jkms.2022.37.e100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinical implications of elevated fasting triglycerides (FTGs) and non-fasting triglycerides (NFTGs) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients. METHODS Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24 hours of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year. RESULTS This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all P < 0.05). Patients with higher quartiles of NFTG were more likely to be male, younger, ever-smokers, diabetic, and have family histories of premature coronary heart disease and stroke (all P < 0.05). Similar tendencies were observed for FTG. The composite outcome was not associated with FTG or NFTG quartiles. CONCLUSION The fasting and non-fasting hypertriglyceridemia were prevalent in AIS patients and showed similar clinical characteristics and outcomes. High FTG and NFTG levels were not associated with occurrence of subsequent clinical events up to one year.
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Affiliation(s)
- Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Myung Suk Jang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Onset and Recurrence Characteristics of Chinese Patients with Noncardiogenic Ischemic Stroke in Chinese Medicine Hospital. Chin J Integr Med 2022; 28:492-500. [PMID: 35258782 DOI: 10.1007/s11655-022-3306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To delineate the onset and recurrence characteristics of noncardiogenic ischemic stroke patients in China. METHODS A prospective, multicenter and registry study was carried out in 2,558 patients at 7 representative clinical sub-centers during November 3, 2016 to February 17, 2019. A questionnaire was used to collect information of patients regarding CM syndromes and constitutions and associated risk factors. Additionally, stroke recurrence was defined as a primary outcome indicator. RESULTS A total of 327 (12.78 %) patients endured recurrence events, 1,681 (65.72%) were men, and the average age was 63.33 ± 9.45 years. Totally 1,741 (68.06%) patients suffered first-ever ischemic stroke, 1,772 (69.27%) patients reported to have hypertension, and 1,640 (64.11%) of them reported dyslipidemia, 1,595 (62.35%) patients exhibited small-artery occlusion by The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Specifically, 1,271 (49.69%) patients were considered as qi-deficient constitution, and 1,227 (47.97%) patients were determined as stagnant blood constitution. There were 1,303 (50.94%) patients diagnosed as blood stasis syndrome, 1,280 (50.04%) patients exhibited phlegm and dampness syndrome and 1,012 (39.56%) patients demonstrated qi deficiency syndrome. And 1,033 (40.38%) patients declared intracranial artery stenosis, and 478 (18.69%) patients reported carotid artery stenosis. The plaque in 1,508 (41.36%) patients were of mixed. Particularly, 41.09% of them demonstrated abnormal levels of glycated hemoglobin levels. CONCLUSIONS Recurrence in minor and small-artery stroke cannot be ignored. Hypertension, dyslipidemia, abnormal HbA1c, intracranial artery stenosis and carotid plaque were more common in stroke patients. Particularly, phlegm-dampness and blood stasis syndromes, as well as qi deficiency and blood stasis constitutions, were still the main manifestations of stroke. (Trial registration at ClinicalTrials.gov No. NCT03174535).
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Liu H, Liu K, Pei L, Li S, Zhao J, Zhang K, Zong C, Zhao L, Fang H, Wu J, Sun S, Song B, Xu Y, Gao Y. Atherogenic Index of Plasma Predicts Outcomes in Acute Ischemic Stroke. Front Neurol 2021; 12:741754. [PMID: 34707558 PMCID: PMC8542679 DOI: 10.3389/fneur.2021.741754] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Aim: The atherogenic index of plasma (AIP) was significantly related to adverse outcomes in patients with cardiovascular disease. Our aim was to investigate the association between AIP and adverse outcomes in acute ischemic stroke. Methods: Patients with acute ischemic stroke (AIS) admitted between 2015 and 2018 were prospectively enrolled in this study. Functional outcomes were evaluated by the modified Rankin Scale (mRS). Poor outcomes were defined as mRS 3–6. The relationship of AIP with the risk of outcomes was analyzed by multivariate logistic regression models. Results: A total of 1,463 patients with AIS within 24 h of symptom onset were enrolled. The poor outcome group had a significantly higher level of AIP [0.09 (−0.10 to 0.27) vs. 0.04 (−0.09 to 0.18), p < 0.001] compared with the good outcome group. Multivariable logistic regression analysis showed that higher AIP was associated with poor outcomes in all the stroke patients (OR 1.84, 95% CI, 1.23–2.53, p = 0.007), which was more evident in patients with large-artery atherosclerosis subtype (OR 1.90, 95% CI, 1.53–2.62, p = 0.002), but not in the other subtypes. Receiver operating curve (ROC) analysis revealed that the best predictive cutoff value of AIP was 0.112, with a sensitivity of 70.8% and a specificity of 59.2%, and the area under the ROC curves for AIP was 0.685. Conclusion: AIP may be an important and independent predictor of the outcome of dysfunction in patients with AIS, especially the stroke subtype of large-artery atherosclerosis.
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Affiliation(s)
- Hongbing Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shen Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiawei Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ce Zong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shilei Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Hidayat R, Asmaniar F, Priambodo A, Mesiano T, Kurniawan M, Rasyid A, Harris S. Endovascular treatment of an unruptured ophthalmic artery aneurysm with a flow diverter: a case report. MEDICAL JOURNAL OF INDONESIA 2021. [DOI: 10.13181/mji.cr.204899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
An unruptured aneurysm is often asymptomatic or present without neurological deficits, causing severe morbidity. However, the potential of this defect to rupture requires proper management. Herein, we report a case of an unruptured saccular aneurysm of the ophthalmic artery with initial clinical seizures. The patient was treated by flow diversion which redirects the blood flow that normally leads to the protrusion of the aneurysm back to the main vessel. Flow diversion is chosen because it is less risky and has a faster recovery time than other treatment options, but it is more expensive than others. Although this technology is not new, there is no report on its implementation in Indonesia. The patient was prescribed antiplatelet treatment for at least 6 months post-treatment, then she showed no sign of seizure or new focal neurological deficits 4 months post-treatment. The patients were expected to undergo digital subtraction angiography evaluation 6 months after flow diversion treatment, but it has not been performed due to the coronavirus disease 2019 pandemic.
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Yuan C, Chen S, Ruan Y, Liu Y, Cheng H, Zeng Y, Chen Y, Cheng Q, Huang G, He W, He J. The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke. Clin Interv Aging 2021; 16:431-442. [PMID: 33727806 PMCID: PMC7955757 DOI: 10.2147/cia.s280808] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. Stress hyperglycemia is frequent in patients with acute illness such as stroke. We aimed to explore the association between stress hyperglycemia and HT in AIS patients. Methods A total of 287 consecutive participants with HT and 285 age- and sex-matched stroke patients without HT were enrolled in this study. Baseline glucose and glycated hemoglobin (HbA1c) levels were collected to measure stress hyperglycemia. The stress hyperglycemia ratio (SHR) was calculated by dividing the fasting plasma glucose at admission with HbA1c. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction type (HI) 1 or 2 or parenchymal hematoma type (PH) 1 or 2. Results Univariate analysis showed that SHR is significantly higher among patients with HT than those without HT. Compared to the patients in the lower three quartiles of SHR, the incidence of HT was significantly higher among patients with the highest quartile of SHR in total population, diabetic and non-diabetic population. We also observed that patients with the highest SHR quartile were associated with an increased risk of hemorrhagic transformation after adjusted for potential covariates (68.4% versus 39.1%; adjusted odds ratio, 2.320; 95% confidence interval, 1.207-4.459; P=0.012). Conclusion The stress hyperglycemia ratio, representing the state of stress hyperglycemia, was significantly associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.
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Affiliation(s)
- Chengxiang Yuan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Siyan Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yiting Ruan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Haoran Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yaying Zeng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yunbin Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Qianqian Cheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Weilei He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
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11
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Tian M, Li Y, Wang X, Tian X, Pei LL, Wang X, Zhang L, Sun W, Wu J, Sun S, Ning M, Buonanno F, Xu Y, Song B. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Associated With Poor Outcome of Acute Ischemic Stroke. Front Neurol 2021; 11:610318. [PMID: 33510706 PMCID: PMC7835486 DOI: 10.3389/fneur.2020.610318] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background: The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) is considered a novel score to reflect systemic inflammation and nutritional status. This study aimed to investigate the association between HALP score and poor outcome in patients with acute ischemic stroke (AIS). Methods: Consecutive AIS patients within 24 h after onset were prospectively enrolled. Poor outcome was a combination of a new stroke event (ischemic and hemorrhagic) and all-cause death within 90 days and 1 year. The association between HALP score and poor outcome was analyzed using Cox proportional hazards. Results: A total of 1,337 patients were included. Overall, 60 (4.5%) and 118 (8.8%) patients experienced poor outcome within 90 days and 1 year, respectively. Patients in the highest tertile of HALP score had a lower risk of poor outcome within 90 days and 1 year (hazard ratio: 0.25 and 0.42; 95% confidence intervals: 0.11-0.57 and 0.25-0.69, P for trend <0.01 for all) compared with those in the lowest tertile after adjusting relevant confounding factors. Adding HALP score to the conventional risk factors improved prediction of poor outcome in patients with AIS within 90 days and 1 year (net reclassification index, 48.38 and 28.95%; integrated discrimination improvement, 1.51 and 1.51%; P < 0.05 for all). Conclusions: Increased HALP score was associated with a decreased risk of recurrent stroke and death within 90 days and 1 year after stroke onset, suggesting that HALP score may serve as a powerful indicator for AIS.
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Affiliation(s)
- Mengke Tian
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Youfeng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Xiao Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Xuan Tian
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Lu-Lu Pei
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Xin Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Luyang Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Wenxian Sun
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Jun Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Shilei Sun
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Mingming Ning
- Massachusetts General Hospital and Harvard Medical School, Clinical Proteomics Research Center and Cardio-Neurology, Boston, MA, United States
| | - Ferdinando Buonanno
- Massachusetts General Hospital and Harvard Medical School, Clinical Proteomics Research Center and Cardio-Neurology, Boston, MA, United States
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
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12
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Zheng X, Zhong C, Zhu Z, Zhang K, Peng H, Xu T, Bu X, Che B, Xu T, Wang A, Chen J, Zhang Y, He J. Association between serum matrix metalloproteinase-9 and poor prognosis in acute ischemic stroke patients: The role of dyslipidemia. Nutr Metab Cardiovasc Dis 2021; 31:209-215. [PMID: 33342644 DOI: 10.1016/j.numecd.2020.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Whether the prognostic value of matrix metalloproteinase-9 (MMP-9) is modified by patients' dyslipidemia status is unknown. The aim of present study was to evaluate the prognostic effect of MMP-9 among ischemic stroke patients stratified by dyslipidemia status. METHODS AND RESULTS MMP-9 levels were measured for 2977 acute ischemic stroke patients from 26 participating hospitals across China, and data of clinical outcomes within one year after ischemic stroke was collected. The primary outcome was a composite outcome of major disability and death at one year after stroke onset, and secondary outcomes were major disability, death, vascular events and recurrent stroke. The association between MMP-9 and primary outcome was appreciably modified by dyslipidemia status (Pinteraction = 0.048). After multivariate adjustment, increased MMP-9 level was associated with increased risk of primary outcome at one year after ischemic stroke in the patients with dyslipidemia (odds ratio, 1.34; 95% confidence interval, 1.06-1.79), but not in those without dyslipidemia (odds ratio, 1.23; 95% confidence interval, 0.90-1.68). Increased MMP-9 was also significantly associated with major disability, death and vascular events in the patients with dyslipidemia but not in those without dyslipidemia (P for interaction < 0.05 for all). CONCLUSION Increased MMP-9 was associated with poor prognosis within one-year after stroke only in patients with dyslipidemia, suggesting that the prognostic value of MMP-9 be modified by dyslipidemia status of ischemic stroke patients. Further prospective study from other populations and randomized clinical trials are needed to verify our findings and clarify the potential mechanisms.
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Affiliation(s)
- Xiaowei Zheng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Kaixin Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Tian Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Bizhong Che
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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13
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Tian X, Guo Y, Wang X, Pei L, Wang X, Wu J, Sun S, Li Y, Ning M, Buonanno FS, Xu Y, Song B. Serum soluble ST2 is a potential long-term prognostic biomarker for transient ischaemic attack and ischaemic stroke. Eur J Neurol 2020; 27:2202-2208. [PMID: 32593220 DOI: 10.1111/ene.14419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Soluble ST2 (sST2) is a promising biomarker in inflammation, atherosclerosis and cardiovascular diseases. We investigated the association between serum sST2 and poor outcome in patients with transient ischaemic attack (TIA)/ischaemic stroke. METHODS Patients within 24 h after onset and with measured serum sST2 were prospectively enrolled in this study. Poor outcome was a combination of a new stroke event (ischaemic or haemorrhagic) and all-cause death within 90 days and 1 year. The associations of serum sST2 with poor outcome were analysed by Cox proportional hazards. RESULTS Among the 430 patients included, the median (interquartile range) sST2 was 17.72 (9.31-28.84) ng/mL. A total of 19 (4.4%) and 38 (8.8%) patients experienced poor outcome within 90 days and 1 year, respectively. Compared with the lowest sST2 tertile, hazard ratios (HRs) [95% confidence intervals (CI)] for the highest tertile were 5.14 (1.43-18.51) for poor outcome within 90 days and 3.00 (1.29-6.97) at 1 year after multivariate adjustments. Adding sST2 to a prediction model significantly improved risk stratification of poor outcome in TIA/ischaemic stroke, as observed by the continuous net reclassification improvement of 60.98% (95% CI, 15.37-106.6%, P = 0.009) and integrated discrimination improvement of 2.63% (95% CI, 0.08-5.18%, P = 0.043) at 90 days and the continuous net reclassification improvement of 41.68% (95% CI, 8.74-74.61%, P = 0.013) at 1 year. CONCLUSIONS Increased serum sST2 levels in TIA/ischaemic stroke were associated with increased risks of poor outcome within 90 days and 1 year, suggesting that serum sST2 may be a potential long-term prognostic biomarker for TIA/ischaemic stroke.
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Affiliation(s)
- X Tian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Y Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - X Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - L Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - X Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - J Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - S Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Y Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - M Ning
- Clinical Proteomics Research Centre and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F S Buonanno
- Clinical Proteomics Research Centre and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Y Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - B Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
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14
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Chen XW, Nazri Shafei M, Abdul Aziz Z, Nazifah Sidek N, Imran Musa K. Modelling the prognostic effect of glucose and lipid profiles on stroke recurrence in Malaysia: an event-history analysis. PeerJ 2020; 8:e8378. [PMID: 32095319 PMCID: PMC7025698 DOI: 10.7717/peerj.8378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/09/2019] [Indexed: 02/05/2023] Open
Abstract
Background Diabetes and dyslipidemia are significantly associated with stroke recurrence, yet the evidence for this relationship is conflicting. Consequently, the parameters in the glucose and lipid profiles may inform us regarding their relationship with stroke recurrence, thus enhancing the physicians' clinical decision-making. Aim This study sought to investigate whether glucose and lipid profiles could prognosticate stroke recurrence in Malaysia. Methods We conducted a retrospective hospital-based study where we analyzed the first-ever stroke cases regarding about which the Malaysia National Stroke Registry was informed between 2009 and 2017, that fulfilled this study's criteria, and that were followed for stroke recurrence. Using the Cox proportional hazard regression analysis, we estimated the adjusted hazard ratios (HRs), which reflected the prognostic effect of the primary variables (i.e., glucose and lipid profiles on the first-stroke admission) on stroke recurrence. Results Among the 8,576 first-ever stroke patients, 394 (4.6%) experienced a subsequent first stroke recurrence event. The prognostic effect measured by univariable Cox regression showed that, when unadjusted, ten variables have prognostic value with regards to stroke recurrence. A multivariable regression analysis revealed that glucose was not a significant prognostic factor (adjusted HR 1.28; 95% CI [1.00-1.65]), while triglyceride level was the only parameter in the lipid profile found to have an independent prognostication concerning stroke recurrence (adjusted HR: 1.28 to 1.36). Conclusions Triglyceride could independently prognosticate stroke recurrence, which suggests the role of physicians in intervening hypertriglyceridemia. In line with previous recommendations, we call for further investigations in first-ever stroke patients with impaired glucose and lipid profiles and suggest a need for interventions in these patients.
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Affiliation(s)
- Xin Wee Chen
- Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Mohd Nazri Shafei
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Zariah Abdul Aziz
- General Medicine Department, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | | | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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15
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Liu H, Liu K, Pei L, Gao Y, Zhao L, Sun S, Wu J, Li Y, Fang H, Song B, Xu Y. Monocyte-to-High-Density Lipoprotein Ratio Predicts the Outcome of Acute Ischemic Stroke. J Atheroscler Thromb 2020; 27:959-968. [PMID: 31941849 PMCID: PMC7508725 DOI: 10.5551/jat.51151] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Monocyte-to-high-density lipoprotein ratio (MHR) recently emerged as an inflammatory marker and has been reported to be a novel prognostic indicator of cardiovascular diseases. However, the relationship between MHR and prognosis of acute ischemic stroke (AIS) remains unclear. Methods: Consecutive AIS patients were prospectively identified from January 2015 to December 2017. Functional outcome was evaluated by the modified Rankin Scale (mRS). Poor outcome was defined as of mRS 3–6. Multivariate logistic regression analysis was conducted to evaluate the relationship between MHR and poor outcome. Results: A total of 1090 AIS patients within 24 hours of the onset of symptoms were recruited. MHR was higher in poor outcome group compared to that in good outcome group [0.53 (0.37–0.69) vs. 0.48 (0.33–0.60), P = 0.007]. Multivariate logistic regression analysis indicated that higher MHR level was independently associated with the poor outcome at 3 months (OR 2.58, 95% CI, 1.21–5.51, P = 0.015), especially the stroke subtype of large artery atherosclerosis (OR 2.52, 95% CI, 1.03–6.19, P = 0.034). Receiver operating curve (ROC) analysis showed that the area under the ROC curves for MHR was 0.67 and the best predictive cutoff value of MHR was 0.51, with a sensitivity of 62.3% and a specificity of 66.5%. Conclusions: MHR may be a significant and independent predictor of poor functional outcome in patients with AIS.
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Affiliation(s)
- Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Kai Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Lulu Pei
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Lu Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Shilei Sun
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Jun Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Hui Fang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University
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16
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Sarecka-Hujar B, Kopyta I. Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults. Brain Sci 2020; 10:E24. [PMID: 31906461 PMCID: PMC7016965 DOI: 10.3390/brainsci10010024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022] Open
Abstract
Arterial ischemic stroke (AIS) experienced at a young age is undoubtedly a serious medical problem. AIS very rarely occurs at a developmental age, whereas in young adults, it occurs with a higher frequency. The etiologic mechanisms of AIS occurring in childhood and adulthood differ. However, for both age populations, neurological consequences of AIS, including post-stroke seizures, motor disability, and recurrence of the disease, are connected to many years of care, rehabilitation, and treatment. Recurrent stroke was observed to increase the risk of patients' mortality. One of the confirmed risk factors for recurrent stroke in children is the presence of vasculopathies, especially Moyamoya disease and syndrome, and focal cerebral arteriopathy of childhood (FCA). FCA causes a 5-fold increase in the risk of recurrent stroke in comparison with idiopathic AIS. In turn, young adults with recurrent stroke were found to more often suffer from hypertension, diabetes mellitus, or peripheral artery disease than young patients with first-ever stroke. Some reports also indicate relationships between specific genetic polymorphisms and AIS recurrence in both age groups. The aim of the present literature review was to discuss available data regarding the risk factors for recurrent AIS in children and young adults.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
| | - Ilona Kopyta
- Department of Paediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
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17
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Chen KN, He L, Zhong LM, Ran YQ, Liu Y. Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China. Front Neurol 2020; 11:483570. [PMID: 33329292 PMCID: PMC7717969 DOI: 10.3389/fneur.2020.483570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The benefit of blood cholesterol reduction for secondary prevention of ischemic stroke remains undetermined in Chinese patients. The purpose of this meta-analysis was to determine whether lipid-lowering agents including statins, fibrates, nicotinic acid, and ezetimibe reduced the risk of recurrent stroke in ischemic stroke patients in China and whether such findings could inform treatment decisions for blood lipid-lowering treatment in China. Methods: The English electronic databases PubMed, EMBASE, Cochrane Library and Chinese databases CNKI, Sino-Med, Wan Fang, and VIP were searched for studies published between January 1990 and April 2020. This meta-analysis included published data from trials that randomly assigned patients to groups treated with either blood lipid-lowering regimens or placebo. Effect comparisons were made using fixed effects model in meta-analysis and linear and spline regression were performed to identify the relative risk of stroke recurrence. The primary outcome was the reduction of total ischemic stroke events, and relative risk values were obtained using a risk prediction equation developed from the control groups of the included trials. Results: Five studies including 4,999 individuals with available data met the inclusion criteria. Relative to the control groups, the pooled estimated odds ratio (OR) for recurrent stroke among those who received lipid-lowering therapy was 0.79 (95% confidence interval [CI]: 0.63-1.00). A 50% or greater reduction in low-density lipoprotein cholesterol (LDL-C) significantly reduced the risk of ischemic stroke recurrence (OR: 0.15 [95% CI: 0.11-0.20]). The overall beneficial effect of statin therapy was confirmed to prevent ischemic stroke with an OR of 0.51 (95% CI: 0.36-0.72). Conclusions: Effective lipid-lowering therapy could decrease the blood LDL-C level, which had a protective effect against stroke recurrence. These results support the use of predicted baseline cerebrovascular disease risk equations to inform decisions regarding blood lipid-lowering treatment in ischemic stroke patients in China.
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Affiliation(s)
- Kang-Ning Chen
- Department of Neurology, The First Hospital Affiliated to Army Medical University (Southwest Hospital), Chongqing, China
- *Correspondence: Kang-Ning Chen
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lian-Mei Zhong
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu-Qin Ran
- Medical Affairs, MSD (China) Holding Co., Ltd., Shanghai, China
| | - Yan Liu
- Medical Affairs, MSD (China) Holding Co., Ltd., Shanghai, China
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18
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Transplantation of fecal microbiota rich in short chain fatty acids and butyric acid treat cerebral ischemic stroke by regulating gut microbiota. Pharmacol Res 2019; 148:104403. [PMID: 31425750 DOI: 10.1016/j.phrs.2019.104403] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/07/2019] [Accepted: 08/15/2019] [Indexed: 01/07/2023]
Abstract
The gut microbiota and its short chain fatty acid (SCFA) metabolites have been established to play an important protective role against neurodegenerative diseases. Our previous study demonstrated that cerebral ischemic stroke triggers dysfunctional gut microbiota and increased intestinal permeability. In this study, we aimed to clarify the mechanism by which gut microbiota and SCFAs can treat cerebral ischemic stroke in rat middle cerebral artery occlusion models and use the information to develop new therapies. Our results show that oral administration of non-absorbable antibiotics reduced neurological impairment and the cerebral infarct volume, relieved cerebral edemas, and decreased blood lipid levels by altering the gut microbiota. We also found that ischemic stroke decreased intestinal levels of SCFAs. And that transplanting fecal microbiota rich in these metabolites was an effective means of treating the condition. Compared with other SCFAs, butyric acid showed the highest negative correlation with ischemic stroke. Supplementation with butyric acid treated models of ischemic stroke effectively by remodeling the gut microbiota, enriching the beneficial Lactobacillus, and repairing the leaky gut. In conclusion, interfering with the gut microbiota by transplanting fecal bacteria rich in SCFAs and supplementing with butyric acid were found to be effective treatments for cerebral ischemic stroke.
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Polivka J, Polivka J, Pesta M, Rohan V, Celedova L, Mahajani S, Topolcan O, Golubnitschaja O. Risks associated with the stroke predisposition at young age: facts and hypotheses in light of individualized predictive and preventive approach. EPMA J 2019; 10:81-99. [PMID: 30984317 DOI: 10.1007/s13167-019-00162-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 12/25/2022]
Abstract
Stroke is one of the most devastating pathologies of the early twenty-first century demonstrating 1-month case-fatality rates ranging from 13 to 35% worldwide. Though the majority of cases do occur in individuals at an advanced age, a persistently increasing portion of the patient cohorts is affected early in life. Current studies provide alarming statistics for the incidence of "young" strokes including adolescents. Young stroke is a multifactorial disease involving genetic predisposition but also a number of modifiable factors, the synergic combination of which potentiates the risks. The article analyzes the prevalence and impacts of "traditional" risk factors such as sedentary lifestyle, smoking, abnormal alcohol consumption, drug abuse, overweight, hypertension, abnormal sleep patterns, and usage of hormonal contraceptives, among others. Further, less explored risks such as primary vascular dysregulation and associated symptoms characteristic for Flammer syndrome (FS) are considered, and the relevance of the FS phenotype for the stroke predisposition at young age is hypothesized. Considering the high prevalence of known genetic and modifiable risk factors in the overall predisposition to the young stroke, the risk mitigating measures are recommended including innovative screening programs by application of specialized questionnaires and biomarker panels as well as educational programs adapted to the target audiences such as children, adolescents, and young adults.
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Affiliation(s)
- Jiri Polivka
- 1Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 2Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Jiri Polivka
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Martin Pesta
- 2Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 4Department of Biology, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Vladimir Rohan
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Libuse Celedova
- 5Department of Social and Assessment Medicine, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | | | - Ondrej Topolcan
- 7Department of Immunochemistry, University Hospital Pilsen, Pilsen, Czech Republic
| | - Olga Golubnitschaja
- 8Radiological Clinic, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- 9Breast Cancer Research Centre, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- 10Centre for Integrated Oncology, Cologne-Bonn, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Abstract
Age- and sex-related differences of lipid profiles were not well understood among ischemic stroke patients in China. Our study aimed to investigate the relationship between lipid abnormalities and ischemic stroke in China. A retrospective analysis was performed involving 2074 patients with ischemic stroke who admitted to Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University between January 1, 2014 and March 1, 2017. Our study indicated that there were significant differences in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-high density lipoprotein cholesterol (non-HDL), and Apolipoprotein A (ApoA) between male and female patients. Meanwhile, different lipid levels including TC, TG, and ApoA were observed for patients of various age groups. The nonelderly patients tended to have higher lipid levels than elderly patients. Isolated low HDL (namely, normal LDL + low HDL + normal TG) was the most common lipid abnormalities in patients. In conclusion, there was age- and sex-related difference in lipid profiles among patients with ischemic stroke. Age, sex as well as some other factors should be carefully considered for lipid management in patients with ischemic stroke in China.
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Affiliation(s)
- Pingsen Zhao
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital)
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders
| | - Sudong Liu
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital)
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders
| | - Zhixiong Zhong
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Center for Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Jing Liu
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital)
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders
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Gaynor E, Brewer L, Mellon L, Hall P, Horgan F, Shelley E, Dolan E, Hickey A, Bennett K, Williams DJ. Interarm blood pressure difference in a post-stroke population. ACTA ACUST UNITED AC 2017; 11:565-572.e5. [DOI: 10.1016/j.jash.2017.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/02/2017] [Accepted: 06/20/2017] [Indexed: 02/01/2023]
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Yuan MZ, Li F, Fang Q, Wang W, Peng JJ, Qin DY, Wang XF, Liu GW. Research on the cause of death for severe stroke patients. J Clin Nurs 2017; 27:450-460. [PMID: 28677276 DOI: 10.1111/jocn.13954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the characteristics of mortality among severe stroke patients, analyse their causes of death and provide evidence for improving the survival rate of stroke patients. BACKGROUND Stroke is an important fatal and disabling disease that poses a large burden on its patients, and its high death rates have caused substantial concern to the World Health Organization. DESIGN A retrospective case-control study. METHODS A total of 188 patients who died of stroke in the neurological intensive care unit of the First Affiliated Hospital of Chongqing Medical University from January 2012-December 2015 were selected as cases. Additionally, 188 stroke survivors from the same neurological intensive care unit were randomly selected as paired cases. The clinical characteristics of the severe stroke patient deaths were analysed, and a univariate analysis was conducted to determine potential mortality risk factors. A logistic regression analysis was then conducted to determine the independent risk factors of mortality. RESULTS We investigated a total of 231 cases of death in neurological intensive care unit patients, 188 of whom died of stroke. Therefore, the death rate from stroke accounted for 81.3% of the total population, with ischaemic, haemorrhagic and mixed strokes accounting for 47.19%, 26.84% and 7.36% of the patients, respectively. The leading cause of death was central nervous system-related causes (central respiratory and circulatory failure, brain herniation), followed by multisystemic causes. The independent risk factors of death among the neurological intensive care unit patients were as follows: brain herniation (OR = 18.15), multiple organ failure (OR = 13.12), dyslipidemia (OR = 4.64), community-acquired lung infection (OR = 4.15), use of mechanical ventilation (OR = 3.37), hypoproteinemia (OR = 2.29), history of hypertension (OR = 2.03) and hospital-acquired pneumonia (OR = 1.75). CONCLUSIONS The most common cause of death in stroke patients was damage to the central nervous system. Independent risk factors were brain herniation, multiple organ failure, dyslipidemia, community-acquired lung infection, the use of mechanical ventilation, hypoproteinemia, a history of hypertension and hospital-acquired pneumonia. Clinicians should be aware of the presence and possible effects of these conditions. Early prevention, monitoring and intervention to modify controllable risk factors will improve patient prognosis. RELEVANCE TO CLINICAL PRACTICE Clinicians should be aware of the multiple independent risk factors of death and implement timely treatment measures to reduce the incidence of death in severe stroke patients.
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Affiliation(s)
- Mei-Zhen Yuan
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qin Fang
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wei Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jing-Jing Peng
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - De-Yu Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xue-Feng Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guang-Wei Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Villa RF, Ferrari F, Moretti A. Effects of Neuroprotectants Before and After Stroke: Statins and Anti-hypertensives. SPRINGER SERIES IN TRANSLATIONAL STROKE RESEARCH 2017. [DOI: 10.1007/978-3-319-45345-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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