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Wang L, Zhu X, Li H, Jia B, Xie W, Zhang Y, Wang L, Liu L, Li M. Association between blood urea nitrogen to creatinine ratio and 3-month outcome in patients with acute ischaemic stroke: a retrospective cohort study from a large healthcare system. BMJ Open 2024; 14:e085912. [PMID: 39038861 PMCID: PMC11407194 DOI: 10.1136/bmjopen-2024-085912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES The blood urea nitrogen to creatinine (BUN/Cr) ratio is associated with early neurological deterioration in acute ischaemic stroke (AIS). However, the predictive value of the BUN/Cr ratio for the AIS prognosis remains unclear. Therefore, we evaluated the correlation between the BUN/Cr ratio and the 3-month outcome in patients with AIS, further testing their dose-response relationship. DESIGN This retrospective cohort study enrolled patients with AIS who were admitted between 1 January 2013 and 31 May 2022. Poor clinical outcome was defined as 3-month Modified Rankin Scale (mRS) >2. Cox proportional HR was used to evaluate the correlation between the BUN/Cr ratio and 3-month outcome. Restricted cubic spline and robust locally weighted regression analyses were conducted to determine the dose-response relationship between the BUN/Cr ratio and the 3-month outcome. RESULTS A total of 4952 eligible patients were included in the study. The patients were divided into three groups according to the tertiles of BUN/Cr ratio (T1, <0.071; T2, 0.071-0.093; and T3, >0.093). After logistic regression adjustment for demographic and clinical characteristics, the BUN/Cr ratio was found to be independently associated with the 3-month outcome in patients with AIS. The restricted cubic spline and locally regression smoothing scatterplot graph showed a strong dose-response relationship between the BUN/Cr ratio and the 3-month outcome in patients with AIS. CONCLUSION A dose-response relationship was observed between the BUN/Cr ratio and the 3-month outcome in patients with AIS, suggesting that the BUN/Cr ratio could serve as a reliable predictor for the AIS prognosis.
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Affiliation(s)
- Liumin Wang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinmei Zhu
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hui Li
- Taikang Community Su Garden, Nanjing, China
| | - Boluo Jia
- Nanjing Qixia District Xigang Community Health Service Center, Nanjing, China
| | - Wen Xie
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yanli Zhang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lina Wang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ling Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Mingquan Li
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Ning Y, Guo J, Pan D, Wu S, Song L, Wang C, Guo J, Gao X, Zhang J, Guo L, Gu Y. The Effects of Carotid Revascularization on 1-Year Cognitive Performance in Patients With Carotid Artery Stenosis. J Endovasc Ther 2024:15266028241252007. [PMID: 38733298 DOI: 10.1177/15266028241252007] [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: 05/13/2024]
Abstract
PURPOSE The impact of carotid revascularization on cognitive function for patients with severe carotid artery stenosis remains uncertain. This study is aimed to investigate the 1-year neurocognitive outcomes of patients who accept carotid revascularization and identify the risk factors associated with postoperative cognitive decline. METHODS From April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Logistic regression analysis was built to identify potential risk factors for postoperative long-term cognitive decline. RESULTS A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score, attention, language fluency, and delayed recall score were significantly improved compared with the baseline scores (p<0.05). At 12 months, there was also a significant improvement in cube copying compared with baseline (p=0.034). Logistic regression analysis showed that the advancing age, left side, and symptomatic carotid artery stenosis were independent risk factors for cognitive deterioration at 12 months after surgery. CONCLUSIONS Overall, carotid revascularization has a beneficial effect on cognition function in patients with severe carotid artery stenosis, while advancing age, left side, and symptomatic carotid artery stenosis were significantly related to a decreased cognitive score after carotid revascularization. CLINICAL IMPACT This study focused on the changes in cognitive function within 1 year after carotid revascularization in patients with severe carotid stenosis. Of course, carotid revascularization can improve the cognition function in these patients. On the other hand, we found the advancing age, left side and symptomatic carotid artery stenosis were significantly associated with decreased cognitive scores at 1 year after carotid revascularization, which suggests that clinicians may need to be aware of patients with these characteristics.
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Affiliation(s)
- Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lipo Song
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Intensive Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Xixiang Gao
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
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Ning Y, Dardik A, Song L, Guo J, Wang C, Gu Y, Guo L, Ji X, Guo J, Zhang J. Carotid revascularization improves cognitive function in patients with asymptomatic carotid artery stenosis. Ann Vasc Surg 2022; 85:49-56. [PMID: 35568326 DOI: 10.1016/j.avsg.2022.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate cognitive changes after carotid revascularization in elderly patients with asymptomatic carotid artery stenosis. We also compared cognitive outcomes of carotid endarterectomy with stenting in asymptomatic patients. METHODS From April 2019 to December 2019, patients with ≥70% asymptomatic carotid stenosis who were treated with CEA or CAS were recruited for this study. The Montreal cognitive assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and postoperatively at 3, 6, and 12 months. The incidence of ipsilateral ischemic cerebrovascular events and restenosis were analyzed within 12 months. RESULTS In 50 patients treated with CEA or CAS, baseline cognitive function was not different between CEA and CAS groups (P > 0.05). There was no difference in the incidence of ipsilateral ischemic cerebrovascular events and restenosis within the first 12 months between the two groups. There was a significant improvement in the total MoCA score, scores of attention, and delayed recall at 3, 6 and 12 months after revascularization compared with scores at baseline (all p<0.001). At 12 months, scores of cube copying and clock drawing were significantly improved (P=0.014, P=0.020). The clock drawing score was improved at 12 months after CAS compared with CEA (P=0.040). CONCLUSIONS Carotid revascularization has a beneficial effect on cognition in asymptomatic patients within 12 months of the procedure. Compared with CEA, CAS show improved test scores of executive functioning by 1 year.
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Affiliation(s)
- Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT, USA
| | - Lipo Song
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China.
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Ultimo S, Zauli G, Martelli AM, Vitale M, McCubrey JA, Capitani S, Neri LM. Cardiovascular disease-related miRNAs expression: potential role as biomarkers and effects of training exercise. Oncotarget 2018; 9:17238-17254. [PMID: 29682219 PMCID: PMC5908320 DOI: 10.18632/oncotarget.24428] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/20/2018] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are one of the most important causes of mortality worldwide, therefore the need of effective preventive strategies is imperative. Aging is associated with significant changes in both cardiovascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to CVDs morbidity and mortality. microRNAs (miRNAs) modulate gene expression at post-transcriptional level and increasing evidence has shown that miRNAs are involved in cardiovascular physiology and in the pathogenesis of CVDs. Physical activity is recommended by the medical community and the cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neuroendocrine systems, as well as beneficial modifications within the myocardium itself. In this review we describe the role of miRNAs and their dysregulation in several types of CVDs. We provide an overview of miRNAs in CVDs and of the effects of physical activity on miRNA regulation involved in both cardiovascular pathologies and age-related cardiovascular changes and diseases. Circulating miRNAs in response to acute and chronic sport exercise appear to be modulated following training exercise, and may furthermore serve as potential biomarkers for CVDs and different age-related CVDs.
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Affiliation(s)
- Simona Ultimo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Zauli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alberto M Martelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Vitale
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,CoreLab, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Silvano Capitani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Luca M Neri
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature. Case Rep Neurol Med 2017; 2017:2431041. [PMID: 29441210 PMCID: PMC5758945 DOI: 10.1155/2017/2431041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/04/2017] [Indexed: 12/03/2022] Open
Abstract
Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient's recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients.
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Zhang LH, Wen ZM. Management and Short-Term Follow-Up Study of Transient Ischaemic Attack Patients in a University Teaching Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to describe the management of patients admitted to a university teaching hospital in China who were diagnosed of having transient ischaemic attack (TIA) and to determine the outcome within a 7-day and 90-day period. Methods A retrospective, hospital-based study included consecutive patients having TIA from July 2009 to February 2013 was performed. Demographic data, risk factors, symptoms, clinical management, ABCD2 scores were analysed. The main outcome variable was the occurrence of TIA and ischaemic stroke during the 7 and 90 days follow up periods. Results A total of 157 patients were evaluated. After excluding 3 patients (1.9%) because they were lost to follow-up, 154 patients were included in the study. All patients underwent a cranial computed tomogram (CT) to exclude intracranial haemorrhage. If the cranial CT scan result was negative for bleeding or other diagnoses, further comprehensive tests would be initiated following a standardised clinical assessment protocol at the time of hospitalisation. Totally 148 (96%) patients received antiplatelet therapy and 6 (4%) patients received anticoagulation therapy. Eight (5.2%) patients received stenting therapy. Only 3 (1.9%) and 6 (3.8%) TIA patients developed subsequent TIA within 7 days and 90 days respectively. Twelve (7.8%) TIA patients developed ischaemic stroke within 7 days and 19 (12.3%) within 90 days. All the 6 patients who had recurrence of TIA within 90 days proceeded to develop ischaemic stroke. The ABCD2 scores of patients experienced subsequent TIA and ischaemic stroke (4.94±1.39, n=19) were significantly higher than those of patients without recurrence (3.91±1.37, n=135; p<0.05). None of the patients who received stenting therapy developed subsequent TIA or ischaemic stroke during the follow up period. Conclusions Our findings suggest that in-patient evaluation and management of TIA may be a safe and effective strategy. Rapid diagnosis and implementation of treatments for TIA patients are crucial to reduce stroke risk. (Hong Kong j.emerg.med. 2014;21:92-97)
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Hung CS, Lin MS, Chen YH, Huang CC, Li HY, Kao HL. Prognostic Factors for Neurologic Outcome in Patients with Carotid Artery Stenting. ACTA CARDIOLOGICA SINICA 2016; 32:205-14. [PMID: 27122951 PMCID: PMC4816919 DOI: 10.6515/acs20150119h] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/19/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) is a valid treatment for patients with carotid artery stenosis. The long-term outcome and prognostic factors in Asian population after CAS are not clear. This study aimed to identify the prognostic factors among Asian patients who have undergone CAS. METHODS We retrospectively analyzed 246 patients with CAS. Annual carotid duplex ultrasound was used to identify restenosis. Peri-procedural complications, restenosis, neurologic outcomes, and mortality were recorded. Cox regression analyses were used to identify prognostic factors. RESULTS The mean follow-up time was 49.2 months. Procedural success was achieved in 237 patients (98.3%), and protection devices were used in 208 patients (84.5%). Within 30 days of CAS, 13 (4.3% per procedure) peri-procedural complications occurred. During the follow-up period, 24 (9.7%) patients developed restenosis, and 37 (15.0%) developed ischemic strokes. In a multiple logistic regression analysis, head and neck radiotherapy [hazard ratio (HR) = 9.9, 95% confidence interval (CI), 3.38-29.1, p < .001], stent diameter (HR = 0.72, 95% CI, 0.58-0.89, p = .003), and predilatation (HR = 3.08 95% CI, 1.21-7.81, p = .018) were independent predictors for restenosis. In Cox regression analysis, hypercholesterolemia (HR = 0.25, 95% CI, 0.07-0.94, p = .04), head and neck radiotherapy (HR = 6.2, 95% CI, 1.8-21.3, p = .004), and restenosis (HR = 3.6, 95% CI, 1.1-11.18, p = .04) were predictors for recurrent ipsilateral ischemic stroke. CONCLUSIONS CAS provides reliable long-term results in Asian patients with carotid stenosis. Restenosis is associated with an increased rate of recurrent stroke and should be monitored carefully following CAS. KEY WORDS Carotid artery disease • Prognosis • Cerebrovascular disease.
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Affiliation(s)
- Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Xia ZY, Sun QJ, Yang H, Zhang MX, Ban R, Xu GL, Wu YP, Wang LX, Du YF. Effect of Carotid Artery Stenting on Cognitive Function in Patients with Internal Carotid Artery Stenosis and Cerebral Lacunar Infarction: A 3-Year Follow-Up Study in China. PLoS One 2015; 10:e0129917. [PMID: 26067432 PMCID: PMC4466228 DOI: 10.1371/journal.pone.0129917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/14/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Carotid artery stenting (CAS) is an important therapeutic strategy for patients with carotid artery stenosis. However, the potential influence of CAS on cognitive function in patients with carotid artery stenosis and cerebral lacunar infarction has not been determined. This study investigated changes in cognitive function associated with CAS and the factors related to these changes. METHODS This prospective cohort study comprised 579 Chinese patients with cerebral lacunar infarction and carotid artery stenosis for whom CAS was indicated, and a matched control group of 552 healthy individuals. Cognitive function before CAS and at scheduled intervals from 6 months to 3 years was assessed with instruments that included the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale. Potential factors that might affect cognitive function were analyzed via logistic regression. RESULTS The MMSE and MoCA scores of the patients before CAS were significantly lower than that of the control subjects. These scores were significantly higher 6 months after CAS and sustained or increased throughout the 3-year follow-up. Also significantly improved after CAS from baseline were scores for an alternating trail test, cube copying, clock-drawing, attention, and delayed recall in an auditory-verbal learning test. Logistic regression analyses showed that age greater than 65 y, little education, diabetes, and hypertension were independent risk factors for deteriorated MoCA scores 3 years after CAS. CONCLUSION CAS was associated with significantly improved cognitive function in cerebral lacunar infarction patients with severe stenosis.
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Affiliation(s)
- Zhang Yong Xia
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, PR China
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Qin Jian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, PR China
| | - Hua Yang
- Department of Neurology, the Third People’s Hospital of Liaocheng, Liaocheng, Shandong, 252000, PR China
| | - Ming Xia Zhang
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Ru Ban
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Ge Lin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, 210002, PR China
| | - Ya Ping Wu
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Le Xin Wang
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Yi Feng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, PR China
- * E-mail:
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Xiong Y, Zhou Z, Lin H, Lin M, Liu J, Niu G, Wang W, Jia Y, Leung TW, Liu D, Liu W, Fan X, Yin Q, Zhu W, Ma M, Zhang R, Xu G, Liu X. The safety and long-term outcomes of angioplasty and stenting in symptomatic intracranial atherosclerotic stenosis. Int J Cardiol 2014; 179:23-4. [PMID: 25464398 DOI: 10.1016/j.ijcard.2014.10.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Yunyun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Anhui Province, China
| | - Hang Lin
- Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian Province, China
| | - Min Lin
- Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian Province, China
| | - Jianlin Liu
- Center of Cerebrovascular Diseases, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710061, China
| | - Guozhong Niu
- Department of Neurology, The First People's Hospital of Hangzhou, Hangzhou, Zhejiang Province, China
| | - Wei Wang
- Department of Neurology, Yangzhou No.1 People's Hospital, Yangzhou, Jiangsu Province, China
| | - Yi Jia
- Department of Neurology, Xi'an Gaoxin Hospital, Shanxi Province, China
| | - Thomas W Leung
- Deparment of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Dezhi Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Wenhua Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Xiaobing Fan
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Qin Yin
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Minmin Ma
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Renliang Zhang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
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Lanzola G, Parimbelli E, Micieli G, Cavallini A, Quaglini S. Data quality and completeness in a web stroke registry as the basis for data and process mining. JOURNAL OF HEALTHCARE ENGINEERING 2014; 5:163-84. [PMID: 24918182 DOI: 10.1260/2040-2295.5.2.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Electronic health records often show missing values and errors jeopardizing their effective exploitation. We illustrate the re-engineering process needed to improve the data quality of a web-based, multicentric stroke registry by proposing a knowledge-based data entry support able to help users to homogeneously interpret data items, and to prevent and detect treacherous errors. The re-engineering also improves stroke units coordination and networking, through ancillary tools for monitoring patient enrollments, calculating stroke care indicators, analyzing compliance with clinical practice guidelines, and entering stroke units profiles. Finally we report on some statistics, such as calculation of indicators for assessing the quality of stroke care, data mining for knowledge discovery, and process mining for comparing different processes of care delivery. The most important results of the re-engineering are an improved user experience with data entry, and a definitely better data quality that guarantees the reliability of data analyses.
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Affiliation(s)
- Giordano Lanzola
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
| | - Enea Parimbelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
| | | | | | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
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11
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Angioplasty and stenting in middle cerebral artery: Results from multicenter China interventional stroke registry. Int J Cardiol 2014; 174:189-90. [DOI: 10.1016/j.ijcard.2014.03.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/29/2014] [Indexed: 12/23/2022]
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12
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Turan TN, Cotsonis G, Lynn MJ, Wooley RH, Swanson S, Williams JE, Stern BJ, Derdeyn CP, Fiorella D, Chimowitz MI. Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists. Cerebrovasc Dis 2014; 37:203-11. [PMID: 24557055 PMCID: PMC3991561 DOI: 10.1159/000358120] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS). METHODS Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n=525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n=598) and post-SAMMPRIS (n=2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test. RESULTS Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID=44%, post-WASID=85%, post-SAMMPRIS=94%) and posterior circulation (pre-WASID=36%, post-WASID=74%, post-SAMMPRIS=83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%). CONCLUSIONS The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.
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Affiliation(s)
- Tanya N Turan
- Medical University of South Carolina, Charleston, S.C., USA
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Abstract
Ischemic stroke predominates in all types of stroke and none neuroprotective agents success in the clinical trial. MicroRNAs are small endogenous noncoding RNA molecules that act as negative or positive regulators of gene expressions by binding completely or partially to complementary target sequences in the mRNAs. The genes which could be modulated by microRNAs play a role in the etiology and pathophysiology ischemic stroke. Therefore, microRNAs may have function on ischemic stroke. A lot of previous studies have investigated the roles of microRNAs in the ischemic stroke. This mini review would highlight the recent progress of microRNAs on the ischemic stroke. Accumulating evidence demonstrated that microRNAs contributed to the etiology of ischemic stroke and modulated the pathophysiological process such as brain edema, local inflammation, and apoptosis in the brain tissues after stroke. And we also discussed the potential application of microRNAs in ischemic stroke such as a biomarker of stroke and drug target. In conclusion, microRNAs play an important role in stroke etiology, pathophysiology, diagnosis, and therapy for ischemic stroke. It needs further research to investigate the biological function in ischemic stroke before it enters the clinical practice.
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Huang Z, Yin Q, Sun W, Zhu W, Li Y, Liu W, Xiao L, Duan Z, Cai Q, Liu D, Ma M, Liu X. Microbleeds in ischemic stroke are associated with lower serum adiponectin and higher soluble E-selectin levels. J Neurol Sci 2013; 334:83-7. [PMID: 23988228 DOI: 10.1016/j.jns.2013.07.2513] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are the important indicators of cerebral small vessel disease. However, it is still unclear whether endothelial dysfunction is involved in CMBs. In this study, we performed a prospective study to investigate the correlation between sE-selectin (soluble E-selectin) or adiponectin and the prevalence of CMBs. METHODS We recruited 133 consecutive patients with first-ever ischemic stroke for this study. Finally, 126 patients were analyzed. The number and presence of CMBs were detected and evaluated on susceptibility-weighted magnetic resonance imaging within two weeks after symptom onset. We assessed the serum levels of adiponectin and sE-selectin for patients. RESULTS CMBs were detected in 63 subjects (50%) within 126 patients and more prevalent in mixed brain regions (55.6%). In binary logistic regression analysis, each 1SD-increase in adiponectin level was significantly conversely associated with the prevalence of CMBs after adjusting for age, sex and cardiovascular risk factors (OR = 0.55; 95% CI: 0.36-0.84); but sE-selectin was significantly positively associated with the prevalence of CMBs (OR = 1.09; 95% CI: 1.02-1.15). Furthermore, partial correlation analyses showed that sE-selectin remained significantly associated with and correlated conversely to adiponectin (r = -0.452, p = 0.001). CONCLUSIONS Endothelial injury may play a role in the pathogenesis of CMBs, and serum levels of adiponectin and sE-selectin were closely related to CMBs. Adiponectin might be protective for the prevalence of CMBs.
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Affiliation(s)
- Zhixin Huang
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 21002, China; Department of Neurology, First Teaching Hospital of Fujian Medical University, Putian 351100, China
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