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Yan J, Huang L, Feng J, Yang X. The Recent Applications of PLGA-Based Nanostructures for Ischemic Stroke. Pharmaceutics 2023; 15:2322. [PMID: 37765291 PMCID: PMC10535132 DOI: 10.3390/pharmaceutics15092322] [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: 08/22/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
With the accelerated development of nanotechnology in recent years, nanomaterials have become increasingly prevalent in the medical field. The poly (lactic acid-glycolic acid) copolymer (PLGA) is one of the most commonly used biodegradable polymers. It is biocompatible and can be fabricated into various nanostructures, depending on requirements. Ischemic stroke is a common, disabling, and fatal illness that burdens society. There is a need for further improvement in the diagnosis and treatment of this disease. PLGA-based nanostructures can facilitate therapeutic compounds' passage through the physicochemical barrier. They further provide both sustained and controlled release of therapeutic compounds when loaded with drugs for the treatment of ischemic stroke. The clinical significance and potential of PLGA-based nanostructures can also be seen in their applications in cell transplantation and imaging diagnostics of ischemic stroke. This paper summarizes the synthesis and properties of PLGA and reviews in detail the recent applications of PLGA-based nanostructures for drug delivery, disease therapy, cell transplantation, and the imaging diagnosis of ischemic stroke.
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Affiliation(s)
- Jun Yan
- Department of Neurology, Fushun Central Hospital, Fushun 113000, China;
| | - Lei Huang
- Department of Cardiac Function, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xue Yang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Dong E, Sun X, Xu T, Zhang S, Wang T, Zhang L, Gao W. Measuring the inequalities in healthcare resource in facility and workforce: A longitudinal study in China. Front Public Health 2023; 11:1074417. [PMID: 37006575 PMCID: PMC10060654 DOI: 10.3389/fpubh.2023.1074417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveThe study aimed to measure time trends of inequalities of the geographical distribution of health facilities and workforce in Shanghai from 2010 to 2016 and used a spatial autocorrelation analysis method to precisely detect the priority areas for optimizing health resource reallocation in metropolises like Shanghai in developing countries.MethodsThe study used secondary data from the Shanghai Health Statistical Yearbook and the Shanghai Statistical Yearbook from 2011 to 2017. Five indicators on health resources, namely, health institutions, beds, technicians, doctors, and nurses, were employed to quantitatively measure the healthcare resource in Shanghai. The Theil index and the Gini coefficient were applied to assess the global inequalities in the geographic distribution of these resources in Shanghai. Global and local spatial autocorrelation was performed using global Moran's index and local Moran's index to illustrate the spatial changing patterns and identify the priority areas for two types of healthcare resource allocation.ResultsShanghai's healthcare resources showed decreasing trends of inequalities at large from 2010 to 2016. However, there still existed an unchanged over-concentration distribution in healthcare facilities and workforce density among districts in Shanghai, especially for doctors at the municipal level and facility allocation at the rural level. Through spatial autocorrelation analysis, it was found that there exhibited a significant spatial autocorrelation in the density distribution of all resources, and some identified priority areas were detected for resource re-allocation policy planning.ConclusionThe study identified the existence of inequality in some healthcare resource allocations in Shanghai from 2010 to 2016. Hence, more detailed area-specific healthcare resource planning and distribution policies are required to balance the health workforce distribution at the municipal level and institution distribution at the rural level, and particular geographical areas (low–low and low–high cluster areas) should be focused on and fully considered across all the policies and regional cooperation to ensure health equality for municipal cities like Shanghai in developing countries.
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Affiliation(s)
- Enhong Dong
- Department of Health Management, School of Nursing and Health Management, Shanghai University of Medicine and Health Science, Shanghai, China
- Health and Medical Communication Research Center, School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoting Sun
- College of Public Health and Family Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ting Xu
- Department of Health Management, School of Nursing and Health Management, Shanghai University of Medicine and Health Science, Shanghai, China
| | - Shixiang Zhang
- Emergency Medical Rescue Technology Research Institute, Shanghai University of Medicine and Health Science, Shanghai, China
- *Correspondence: Shixiang Zhang
| | - Tao Wang
- Department of Emergency Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Tao Wang
| | - Lufa Zhang
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
- Department of Public Economy and Social Policy, School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Lufa Zhang
| | - Weimin Gao
- Department of Pharmacy, School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, China
- Weimin Gao
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Kharel S, Nepal G, Joshi PR, Yadav JK, Shrestha TM. Safety and efficacy of low-cost alternative urokinase in acute ischemic stroke: A systematic review and meta-analysis. J Clin Neurosci 2022; 106:103-109. [PMID: 36274296 DOI: 10.1016/j.jocn.2022.09.015] [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: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Use of intravenous thrombolysis (IVT) for treatment of acute ischemic stroke (AIS) varies greatly between countries, ranging from 10% to 15% in high-income countries to less than 2% in low- and middle income countries (LMICs). This is because alteplase is expensive and has been cited as one of the most common barriers to IVT in LMICs. Urokinase (UK) is a thrombolytic agent which is almost 50 times cheaper with easier production and purification than alteplase. UK may become a cost-effective option for IVT in LMICs if it is found to be safe and effective. We conducted this study to assess the existing evidence on the safety and efficacy of UK vs alteplase for IVT in AIS. METHODS The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and meta-Analyses) guideline. Systematic literature search was done in PubMed, EMBASE, and Google Scholar for English literature published from 2010 to 2021. RESULTS A total of 4061 participants in the alteplase and 2062 participants in the UK group were included in the final statistical analysis. After IVT, a good functional outcome at last follow-up was found among 80.57 % of patients in the alteplase group compared to 73.79 % of patients in the UK group (OR: 1.11; 95 % CI: 0.95- 1.31; I2 = 0 %; P = 0.18). Symptomatic Intracerebral Hemorrhage (sICH) was found among 1.77 % of patients in the alteplase group compared to 2.83 % of patients in the UK group (OR: 0.84; 95 % CI: 0.56- 1.26; I2 = 0 %; P = 0.41). Similarly, mortality was found among 5.03 % of patients in the alteplase group compared to 5.42 % of patients in the UK group (OR: 0.87; 95 % CI: 0.66-1.14; I2 = 0 %; P = 0.30). CONCLUSION Our meta-analysis found that intravenous UK is not inferior to alteplase in terms of safety and efficacy and can be a viable alternative for IVT in AIS patients in LMICs.
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Affiliation(s)
- Sanjeev Kharel
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Gaurav Nepal
- Rani Primary Health Care Centre, Biratnagar, Nepal.
| | - Padam Raj Joshi
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Jayant Kumar Yadav
- Department of Neurology, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal.
| | - Tirtha Man Shrestha
- Department of General Practice, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Xue Y, Li S, Xiang Y, Wang Z, Wang F, Yu Y, Yan P, Liu X, Sun Q, Du Y, Li J. Predictors for symptomatic intracranial hemorrhage after intravenous thrombolysis with acute ischemic stroke within 6 h in northern China: a multicenter, retrospective study. BMC Neurol 2022; 22:6. [PMID: 34980004 PMCID: PMC8722135 DOI: 10.1186/s12883-021-02534-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/23/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE This study assessed the predictive factors for symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke (AIS) after receiving intravenous thrombolysis (IVT) within 6 h in northern China. METHODS We retrospectively analyzed ischemic stroke patients who were treated with IVT between November 2016 and December 2018 in 19 hospitals in Shandong Province, China. Potential predictors of sICH were investigated using univariate and multivariate analyses. RESULTS Of the 1293 enrolled patients (845 men, aged 62 ± 11 years), 33 (2.6%) developed sICH. The patients with sICH had increased coronary heart disease (36.4% vs. 13.7%, P = 0.001), more severe stroke (mean National Institutes of Health Stroke Scale [NIHSS] score on admission of 14 vs.7, P < 0.001), longer door-to-needle time [DNT] (66 min vs. 50 min, P < 0.001), higher blood glucose on admission, higher white blood cell counts (9000/mm3 vs. 7950/mm3, P = 0.004) and higher neutrophils ratios (73.4% vs. 67.2%, P = 0.006) et al. According to the results of multivariate analysis, the frequency of sICH was independently associated with the NIHSS score (OR = 3.38; 95%CI [1.50-7.63]; P = 0.003), DNT (OR = 4.52; 95%CI [1.69-12.12]; P = 0.003), and white blood cell count (OR = 3.59; 95%CI [1.50-8.61]; P = 0.004). When these three predictive factors were aggregated, compared with participants without any factors, the multi-adjusted odds ratios (95% confidence intervals) of sICH for persons concurrently having one, two or three of these factors were 2.28 (0.25-20.74), 15.37 (1.96-120.90) and 29.05 (3.13-270.11), respectively (P for linear trend < 0.001), compared with participants without any factors. CONCLUSION NIHSS scores higher than 10 on admission, a DNT > 50 min, and a white blood cell count ≥9000/mm3 were independent risk factors for sICH in Chinese patients within 6 h after IVT for AIS.
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Affiliation(s)
- Yuan Xue
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Yuanyuan Xiang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Ziran Wang
- Department of Emergency, Linyi People's Hospital Affiliated to Shandong University, Lin yi, Shandong, China
| | - Fengyun Wang
- Department of Neurology, Liaocheng Brain Hospital, Liaocheng, Shandong, China
| | - Yuanying Yu
- Department of Neurology, Haiyang People's Hospital, Haiyang, Shandong, China
| | - Peng Yan
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Xiaohui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China
| | - Jifeng Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China.
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Dose-Response Relationship and Threshold Drug Dosage Identification for a Novel Hybrid Mechanical-Thrombolytic System with an Ultra-Low Dose Patch. Cell Mol Bioeng 2021; 14:627-637. [PMID: 34900015 DOI: 10.1007/s12195-021-00683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction Ischemic stroke treatment has advanced in the last two decades and intravenous thrombolysis is now considered the standard of care for selected patients. Recanalization can also be achieved by mechanical endovascular treatment for patients with large vessel occlusions. Complicating treatment-related symptomatic intracerebral hemorrhage and prolonged needle-to-recanalization times have been identified as major determinants of poor three-month functional outcomes. A hybrid mechanical-thrombolytic system with a patch imbued with an ultra-low dose of thrombolytic agents loaded onto a stent-retriever has been developed. Methods In this study, the in situ dose-response relationship of the thrombolytic patch imbued with up to 1000 IU of urokinase plasminogen activator (uPA) was quantified using Raman spectroscopy. Results Thrombi of up to 400 μm thickness dissolved within 15 min when patches imbued with < 1% of the conventional thrombolysis therapy dosage were applied. The results demonstrated that low-dose thrombolytic patches can dissolve normal clots compressed in the blood vessel in a short time. 500 IU is the threshold uPA dosage in the thrombolytic patch that most effectively dissolves the clots. Conclusion This study suggests that a novel endovascular stent-retriever loaded with an ultra-low drug dose fibrinolytic patch may be a suitable treatment for patients who are ineligible for conventional thrombolytic therapy.
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Zeng J, Chen F, Chen Y, Peng M, Chen X, Yang Q, Wang R, Miao J. Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients: A single-center study of 391 cases. Medicine (Baltimore) 2021; 100:e27053. [PMID: 34664830 PMCID: PMC8448058 DOI: 10.1097/md.0000000000027053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients.Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed.Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group (P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06-7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10-0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06-0.45 P = .000) were protective factors of hemorrhagic complications.For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.
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Affiliation(s)
- Jianqi Zeng
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Feng Chen
- Department of Neurology, Zhaoqing Gaoyao People's Hospital, Guangdong Province, Zhaoqing, China
| | - Yiqian Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Muli Peng
- Department of Neurology, Zhaoqing Gaoyao People's Hospital, Guangdong Province, Zhaoqing, China
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Qingwei Yang
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Ru Wang
- Department of Neurology, Weinan Central Hospital, Weinan, China
| | - Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
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Zhang R, Wei H, Ren Y, Wu Y, Luo Y, Zhang L, Huo Y, Feng J, Monnier PP, Qin X. Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China. Front Neurol 2021; 12:685454. [PMID: 34322082 PMCID: PMC8311518 DOI: 10.3389/fneur.2021.685454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Intravenous thrombolysis with alteplase benefits eligible patients with acute ischemic stroke. However, in some countries such as China, alteplase may be too expensive for low-income patients, and also for regions with low economic development. Urokinase is much less expensive than alteplase. This study aimed to assess the outcomes and treatment complications of urokinase in acute ischemic stroke patients, which are poorly understood. Methods: This multicenter retrospective study included acute ischemic stroke patients who received intravenous urokinase or alteplase from January 2014 to January 2018 at 21 centers in China. Outcomes and treatment complications were analyzed by univariate and multivariate analyses. Results: Among the 618 patients included in this study, 489 were treated with urokinase and 129 were treated with alteplase. Functional independence, no/minimal disability, mortality, intracranial hemorrhage (ICH), and symptomatic ICH did not significantly differ between the urokinase and alteplase groups in the univariate and multivariate analyses. However, the patients who received alteplase had a lower odds ratio (OR) of extracranial bleeding in the univariate analysis and a lower adjusted OR (aOR) in the multivariate analysis than the patients who received urokinase (OR = 0.410 [95% CI, 0.172–0.977], p = 0.038; aOR = 0.350 [95% CI, 0.144–0.854], p = 0.021). Furthermore, in patients treated with urokinase, the patients who received high-dose urokinase had a higher OR of extracranial bleeding in the univariate analysis and a higher aOR of extracranial bleeding in the multivariate analysis than patients who received low-dose urokinase (OR = 3.046 [95% CI, 1.696–5.470], p < 0.001; aOR = 3.074 [95% CI, 1.627–5.807], p = 0.001). Moreover, patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase. Conclusions: Patients treated with urokinase had similar outcomes but a higher risk of extracranial bleeding compared to patients treated with alteplase. The risk of extracranial bleeding was higher in the patients treated with high-dose urokinase than in the patients treated with low-dose urokinase. Patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase. In countries such as China where some acute ischemic stroke patients cannot afford alteplase, urokinase may be a good alternative to alteplase for intravenous thrombolysis.
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Affiliation(s)
- Rongrong Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Wei
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Ren
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanping Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Biostatistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lei Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingchao Huo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinzhou Feng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Philippe P Monnier
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Ophthalmology and Vision Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zeng J, Wang F, Feng H, Chen F, Wang R, Chen Y, Chen X, Miao J. Influencing Factors of Recanalization after Intravenous Thrombolysis with Urokinase in Acute Cerebral Infarction Patients. Eur Neurol 2020; 83:162-166. [PMID: 32460290 DOI: 10.1159/000507288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) with urokinase is the standard reperfusion therapy for acute cerebral infarction (ACI) in China. Only about 30% patients who use urokinase for IVT can recanalize. Therefore, this study aimed to analyze the influencing factors of recanalization after IVT using urokinase in ACI patients. METHODS A total of 391 consecutive patients with a diagnosis of ACI from January 2013 to October 2019 were enrolled and divided into 2 groups: patients without recanalization and patients with recanalization. Related data were collected and analyzed. RESULTS Univariate analysis showed that there were significant differences in gender, atrial fibrillation, erythrocyte mean corpuscular volume, platelet large cell ratio (P-LCR), glucose (GLU), and severity of ICAS between patients without recanalization and patients with recanalization (p < 0.05). Multivariate logistic regression analysis indicated that P-LCR (odds ratio [OR] = 0.17, 95% confidence interval [CI] = 0.03-0.89, p = 0.04), GLU (OR = 0.28, 95% CI = 0.11-0.67, p = 0.004), and ICAS severity (OR = 0.48, 95% CI = 0.32-0.76, p = 0.001) were the influencing factors of recanalization. CONCLUSION For patients with higher levels of P-LCR, GLU, or ICAS severity, the recanalization rate might decrease after ACI.
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Affiliation(s)
- Jianqi Zeng
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Feng Wang
- College of Computer Engineering, Jimei University, Xiamen, China
| | - Haishan Feng
- Department of Emergency, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Feng Chen
- Department of Neurology, Gaoyao People's Hospital, Zhaoqing, China
| | - Ru Wang
- Department of Neurology, Weinan Central Hospital, Weinan, China
| | - Yiqian Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China,
| | - Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
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Zhu B, Fu Y, Liu J, He R, Zhang N, Mao Y. Detecting the priority areas for health workforce allocation with LISA functions: an empirical analysis for China. BMC Health Serv Res 2018; 18:957. [PMID: 30541543 PMCID: PMC6292090 DOI: 10.1186/s12913-018-3737-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/19/2018] [Indexed: 01/21/2023] Open
Abstract
Background Health workforce misdistribution leads to severe inequity and low-efficiency in health services in the developing countries. Targeting at China, this research aims to reveal, visualize and compare the geographical distribution patterns of different subtypes of urban and rural health workforce and identify the priority regions for health workforce planning and allocation policies designing. Methods The health workforce density (workforce-to-population ratio) is adopted to represent the accessibility to health workforce in each geographical unit. Besides a descriptive geography of health workforce as a whole, the local indicators of spatial association (LISA) are used to explore the spatial clusters of different subtypes of health workforce, which are visualized by geographical tools. Results Results reveal that regional disparities and spatial clusters exist in China’s health workforce distribution, with different types of workforce exhibiting relatively different spatial distribution characteristics. Besides, huge urban-rural disparities are found in the distribution of health workforce in China. Unexpectedly but intriguingly, most of the high-high and high-low cluster area of urban health workforce are concentrated in the western China (Xinjiang, Xizang etc.), indicating the relative abundant stock of urban health workforce in these units, while the low-low and low-high cluster area of different types of urban health workforce are mainly distributed in middle China. Regarding the rural health workforce, there is an obvious and similar low-low and low-high clustering pattern in western provinces (Sichuan, Yunnan) for the licensed doctors, pharmacists, technologists, which play a critical role in health services delivery. Conclusions Different types of health workforce displayed distinct spatial distribution patterns, while the misdistribution of rural health workforce imposed more challenges to the Chinese health sector due to its poorer stock and more disadvantaged positions of backward regions (i.e., low-low and low-high cluster area). Subtype-specific and region-oriented health workforce planning and allocation policies are suggested to be made, aiming at the urban and rural health workforce respectively, by prioritizing the identified low-low and low-high cluster areas. Electronic supplementary material The online version of this article (10.1186/s12913-018-3737-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bin Zhu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Public Policy, City University of Hong Kong, Hong Kong, 999077, China
| | - Yang Fu
- College of Management, Shenzhen University, Nanhai Ave 3688, Shenzhen, Guangdong, China
| | - Jinlin Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Rongxin He
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ning Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
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Qin Z, Ciucci F, Chon CH, Kwok JCK, Lam DCC. Model development and comparison of low hemorrhage-risk endoluminal patch thrombolytic treatment for ischemic stroke. Med Eng Phys 2018; 61:32-40. [PMID: 30177419 DOI: 10.1016/j.medengphy.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
Abstract
Clot dissolution drugs delivered into the systemic circulation can dissolve intracranial blood clots in 90 min with 20-50% hemorrhage rate. Immobilizing <5% of the intravenous dosage on an endoluminal patch can reduce the dissolution time to <20 min with negligible hemorrhage risk. The thrombus dissolution behavior in endoluminal patch thrombolytic treatment is modeled and compared with experimental results from a companion study. Analyses showed that the thrombus dissolution time decreases with increasing dosage, but the dissolution time reaches a dosage-independent minimum when uPA dosage on the patch is >800 IU. Model analyses showed that dissolution time in the plateau regime is controlled by diffusion. Further results showed that dissolution time could be reduced in this regime by reducing thrombus thickness. This suggests that a stented endoluminal thrombolytic >800 IU patch that compresses the thrombus to thin the clot thickness can help reduce dissolution time. This ultra-low transition dosage (i.e., 800 IU), compared to 0.6-2.4 million IU in conventional thrombolysis suggests that hemorrhage risk in endoluminal patch thrombolytic treatment is low. The low hemorrhagic-risk endoluminal patch can be considered for use in patients who are ineligible for conventional thrombolytic treatment because of high hemorrhagic treatment risk.
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Affiliation(s)
- Zhen Qin
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Francesco Ciucci
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Chi Hang Chon
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - John C K Kwok
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong; Department of Neurosurgery, Kwong Wah Hospital, Hong Kong
| | - David C C Lam
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong.
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Abstract
Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology - the use of technology to provide neurological care and education remotely - has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers - especially the digital divide - will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.
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12
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Pandian JD, William AG, Kate MP, Norrving B, Mensah GA, Davis S, Roth GA, Thrift AG, Kengne AP, Kissela BM, Yu C, Kim D, Rojas-Rueda D, Tirschwell DL, Abd-Allah F, Gankpé F, deVeber G, Hankey GJ, Jonas JB, Sheth KN, Dokova K, Mehndiratta MM, Geleijnse JM, Giroud M, Bejot Y, Sacco R, Sahathevan R, Hamadeh RR, Gillum R, Westerman R, Akinyemi RO, Barker-Collo S, Truelsen T, Caso V, Rajagopalan V, Venketasubramanian N, Vlassovi VV, Feigin VL. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review. Neuroepidemiology 2017; 49:45-61. [DOI: 10.1159/000479518] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/11/2017] [Indexed: 01/10/2023] Open
Abstract
Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
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Zhao G, Huang H, Yang F. The progress of telestroke in China. Stroke Vasc Neurol 2017; 2:168-171. [PMID: 28989806 PMCID: PMC5628380 DOI: 10.1136/svn-2017-000084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/14/2017] [Accepted: 04/26/2017] [Indexed: 01/17/2023] Open
Abstract
Stroke remains the leading cause of death in China. The disparity of distribution in specialists and hospitals affects access to timely stroke care. Telestroke, the use of telemedicine for stroke, may be the solution to access to stroke care. Telestroke can improve the rate of successful intravenous thrombolysis and shorten the time to treatment. Here we review the progress of telestroke in China.
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Affiliation(s)
- Gang Zhao
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Huan Huang
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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14
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Zhao G, Wei D. Mobile health: new technologies, new modes and new era. J Biomed Res 2016; 30:251-2. [PMID: 27231042 PMCID: PMC4946315 DOI: 10.7555/jbr.30.20160002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/08/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Gang Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi 710199, China.
| | - Dong Wei
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi 710199, China
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