1
|
Yang P, Shi M, Jia Y, Zhong C, Peng H, Sun L, Guo D, Chen J, Wang A, Xu T, Zhu Z, Zhang Y, He J. Plasma Polyamines and Short-Term Adverse Outcomes Among Patients With Ischemic Stroke: A Prospective Cohort Study. J Am Heart Assoc 2024; 13:e035837. [PMID: 39082415 DOI: 10.1161/jaha.124.035837] [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] [Received: 04/01/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Polyamines have been reported to be associated with neurological function, but the associations between polyamines and the prognosis of ischemic stroke remain unclear. We aimed to prospectively investigate whether elevated plasma polyamine levels are associated with adverse outcomes in patients with ischemic stroke. METHODS AND RESULTS Plasma polyamine levels were measured at admission in 3570 patients with acute ischemic stroke, and clinical outcomes were assessed at 3 months after stroke onset. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale score≥3), and secondary outcomes included the individual outcomes of death and major disability. During a 3-month follow-up period, 877 participants (25.1%) experienced the primary outcome. Increased putrescines were associated with a decreased risk of the primary outcome (the highest versus the lowest tertile: odds ratio, 0.72 [95% CI, 0.58-0.91]; P=0.005) and major disability (odds ratio, 0.59 [95% CI, 0.47-0.74]; P<0.001). Conversely, increased spermidines were associated with an increased risk of death (hazard ratio, 1.86 [95% CI, 1.10-3.14]; P=0.020), and increased spermines were associated with an increased risk of the primary outcome (odds ratio, 1.36 [95% CI, 1.08-1.71]; P=0.009) and major disability (odds ratio, 1.27 [95% CI, 1.01-1.59]; P=0.041). CONCLUSIONS Among patients with ischemic stroke, high plasma putrescine levels were associated with a decreased risk of adverse outcomes, whereas high plasma spermidine and spermine levels were associated with an increased risk of adverse outcomes. Further studies are needed to investigate whether targeting these polyamines can improve the prognosis of patients with ischemic stroke. REGISTRATION https://clinicaltrials.gov. Identifier: NCT01840072.
Collapse
Affiliation(s)
- Pinni Yang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases Suzhou Medical College of Soochow University Suzhou China
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA USA
| | - Yiming Jia
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases Suzhou 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 Major Chronic Non-communicable Diseases Suzhou 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 Major Chronic Non-communicable Diseases Suzhou Medical College of Soochow University Suzhou China
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA USA
| | - Lulu Sun
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Daoxia Guo
- School of Nursing Suzhou 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
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases Suzhou 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 Major Chronic Non-communicable Diseases Suzhou 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 Major Chronic Non-communicable Diseases Suzhou Medical College of Soochow University Suzhou China
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA USA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases Suzhou 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
| |
Collapse
|
2
|
Tan Y, Sun X, Qin F, Cai Y. Factors affecting stroke pre-hospital delay behavioral intention among community residents: A path analysis. Appl Nurs Res 2024; 78:151820. [PMID: 39053993 DOI: 10.1016/j.apnr.2024.151820] [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: 10/05/2022] [Revised: 08/01/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Pre-hospital delay is the major cause of stroke treatment delay, and behavioral intention is considered to be the most direct predictor of behavior. Therefore, to effectively reduce stroke pre-hospital delay, it is essential to further understand the relationship between stroke pre-hospital delay intention (SPDBI) and its social-psychological influencing factors, namely personality traits, social support and coping style. AIM This study aims at examining the relationships among personality traits, coping style, social support, and SPDBI. METHODS A cross-sectional, self-administered questionnaire was distributed to 845 residents. The content of the questionnaire included demographic information, the knowledge of "Stroke 120", Ten-Item Personality Inventory-Chinese version, Simplified Coping Style Questionnaire, Perceived Social Support Scale and SPDBI Scale. Path analysis was used to investigate the relationship among SPDBI and its psychosocial influencing factors. RESULTS The final path model showed a good fit to the data (χ2/df = 2.981, RMSEA = 0.048, GFI = 0.936, CFI = 0.941). Extroversion (β = 0.106), positive coping (β = -0.110), negative coping (β = 0.150) and the knowledge of "Stroke 120" (β = -0.152) had only direct effects on SPDBI. While agreeableness (β = 0.113), openness (β = -0.121) and social support (β = -0.118) had direct effects on SPDBI, they also had indirect effects (β = -0.009; -0.022; -0.049) on SPDBI though positive coping. CONCLUSIONS Adequate social support and positive coping of health threat may reduce residents' SPDBI. Meanwhile, the interventions to reduce SPDBI should take personality differences into consideration.
Collapse
Affiliation(s)
- Yibing Tan
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xinglan Sun
- Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Fengyin Qin
- Xiangyang Central Hospital, Xiangyang, Hubei Province, China
| | - Yefeng Cai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| |
Collapse
|
3
|
Guo M, Yue C, Yang J, Hu J, Guo C, Peng Z, Xu R, Yang D, Kong W, Liu X, Huang J, Tian Y, Li F, Li CQ. Thrombectomy alone versus intravenous thrombolysis before thrombectomy for acute basilar artery occlusion. J Neurointerv Surg 2024; 16:794-800. [PMID: 37665653 DOI: 10.1136/jnis-2023-020361] [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: 03/23/2023] [Accepted: 07/05/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Endovascular treatment (EVT) is a well-established approach for acute ischemic stroke. Whether bridging intravenous thrombolysis (IVT) before EVT confers any benefits remains uncertain. The objective of the study was to compare the efficacy and safety of direct EVT with or without bridging IVT in patients with acute basilar artery occlusion (BAO). METHODS This multicenter cohort study enrolled 647 patients with acute BAO who underwent either bridging IVT before EVT or direct EVT from the BASILAR registry. The primary outcome was an independent functional outcome measured by the modified Rankin Scale (mRS) score of 0-2. Secondary outcomes included excellent functional outcome (mRS 0-1), favorable functional outcome (mRS 0-3), and mortality rate at 90 days, as well as symptomatic intracranial hemorrhage (sICH), and successful reperfusion between the two treatment groups. RESULTS Direct EVT and bridging IVT before EVT exhibited similar primary outcomes (27.3% vs 27.7%, respectively) and distributions of mRS scores at 90 days. Moreover, rates of sICH and 90-day mortality were not significantly different between the two groups (7.3% vs 6.0%, adjusted OR (aOR) 0.79, 95% CI 0.34 to 1.86, P=0.84 for sICH; 46.8% vs 43.7%, aOR 0.86, 95% CI 0.54 to 1.38, P=0.53 for mortality). CONCLUSIONS Among patients with acute BAO, functional outcomes were similar between those treated with bridging IVT before EVT and those treated with direct EVT, and there was no difference between the two groups in terms of sICH and mortality rates.
Collapse
Affiliation(s)
- Meng Guo
- Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Chengsong Yue
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Jie Yang
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Jinrong Hu
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Changwei Guo
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
- Department of Neurology, Guangyang Bay Laboratory, Chongqing, Chongqing, China
| | - Zhouzhou Peng
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Rui Xu
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Dahong Yang
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Weilin Kong
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Xiang Liu
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Jiacheng Huang
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Yan Tian
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Fengli Li
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| | - Chang-Qing Li
- Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China
- Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China
| |
Collapse
|
4
|
Abbas A, Hamad AA, El Din Moawad MH, Ewis DK, Youssef RA, Hamouda H, Hassan MA, Aladawi M, Elfil M, Meshref M, Al-Mufti F. Dual antiplatelet therapy versus intravenous tissue plasminogen activator with acute minor ischemic stroke: A systematic review and meta-analysis of safety and efficacy. J Stroke Cerebrovasc Dis 2024; 33:107704. [PMID: 38561167 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107704] [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: 11/15/2023] [Revised: 03/13/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES To compare the safety and efficacy of Dual Antiplatelet Therapy (DAPT) and Intravenous (IV) Tissue Plasminogen Activator (t-PA) in minor Acute Ischemic Stroke (AIS). MATERIALS AND METHODS Following Cochrane and PRISMA guidelines, we analyzed observational studies and clinical trials comparing DAPT and IV t-PA in patients with minor AIS. Databases included PubMed, Scopus, and Web of Science. Data extraction included study characteristics, patient demographics, and analyzed outcomes. RevMan 5.3 and OpenMetaAnalyst 2021 were used to analyze the data and assess heterogeneity, respectively. The risk of bias was determined using RoB 2.0 and the Newcastle-Ottawa scale. RESULTS This meta-analysis included five studies with 3,978 DAPT-treated patients and 2,224 IV t-PA-treated patients. We found no significant differences in achieving modified Rankin scale (mRS) scores of 0-1 (OR 1.11, 95 % CI: 0.79, 1.55, p = 0.56) and 0-2 (OR 0.90, 95 % CI: 0.61, 1.31, p = 0.57), as well as combined mRS scores (OR 1.05, 95 % CI: 0.82, 1.34, p = 0.72). Similarly, there were no significant disparities between the two treatment groups in NIHSS score change from baseline (MD 0.32, 95 % CI: -0.35, 0.98, p = 0.35) and in mortality rates (OR 0.87, 95 % CI: 0.26, 2.93, p = 0.83). Notably, in comparison to the IV t-PA group, the DAPT group exhibited a significantly lower incidence of bleeding (OR 0.31, 95 % CI: 0.14, 0.69, p = 0.004) and symptomatic intracranial hemorrhage (sICH) (OR 0.10, 95 % CI: 0.04, 0.26, p < 0.00001). CONCLUSIONS Our meta-analysis found no significant differences in efficacy between DAPT and IV t-PA. However, DAPT demonstrated a significantly lower risk of sICH and bleeding compared with IV t-PA.
Collapse
Affiliation(s)
- Abdallah Abbas
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy Clinical Department, Alexandria University, Alexandria, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | - Heba Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Malak A Hassan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA.
| |
Collapse
|
5
|
Li Y, Ou Q, Lu Y, Shen Z, Li J, Zhang Z, Tai L, Li G, Chen H, Zhang G, Zhang L, Sun X, Qiu J, Wei Y, Zhu S, Wang Z, Sun W, Huang Y. Geographic differences in pharmacotherapy patterns and outcomes of acute ischemic stroke in China. BMC Neurol 2024; 24:64. [PMID: 38360588 PMCID: PMC10868026 DOI: 10.1186/s12883-024-03564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Vast economic and healthcare status discrepancies exist among regions in China, contributing to different treatment patterns. This study was aimed to investigate the current status of pharmacotherapy for acute ischemic stroke (AIS) and outcomes in China and explore the geographic variation in stroke care. METHODS This study was a multicenter prospective registry study, which collected the data of patients with AIS from 80 hospitals in 46 cities in 2015-2017 across China. Poor functional outcome defined as a modified Rankin Scale score of 3-6 was assessed at 3 and 12 months. Multivariate logistic regression was used. RESULTS Among 9973 eligible patients, the number of receiving intravenous thrombolysis (IVT), antiplatelet agents, anticoagulants, statin and human urinary kallidinogenase was 429 (4.3%), 9363 (93.9%), 1063 (10.7%), 6828 (74.7%) and 5112 (51.2%), respectively. Multivariable analysis showed IVT use in northeastern was significantly more frequent than in eastern region (OR = 3.17, 95% CI, 2.53-3.99), while the antiplatelets agents use were less frequent (OR = 0.46, 95%CI: 0.38-0.57). The proportions of poor outcomes at 3 and 12 months were 20.7% and 15.8%, respectively. Multivariate analysis showed AIS patients from northeastern and central region had significantly lower risk of poor outcome at month 3 and 12 than those from eastern region (all P < 0.05). CONCLUSIONS There was a low IVT use and a high antiplatelet agent and statin use for AIS in China. The pharmacotherapy and prognosis of AIS had variation by geographic region. TRIAL REGISTRATION This study was registered with ClinicalTrials.gov (NCT02470624).
Collapse
Affiliation(s)
- Ying Li
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China
| | - Qianhua Ou
- Department of medical affairs, Techpool Bio-Pharma Co., LTD, Guangzhou, China
| | - Yuxuan Lu
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China
| | - Zhiyuan Shen
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China
| | - Jieyu Li
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China
| | - Zhuangzhuang Zhang
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China
| | - Liwen Tai
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guozhong Li
- Department of Neurology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huisheng Chen
- Department of Neurology, General Hospital of Shenyang Military Command, Shenyang, China
| | - Guiru Zhang
- Department of Neurology, Penglai People's Hospital, Penglai, China
| | - Lei Zhang
- Department of Neurology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xuwen Sun
- Department of Neurology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jinhua Qiu
- Department of Neurology, Huizhou First Hospital, Huizhou, China
| | - Yan Wei
- Department of Neurology, Harrison International Peace Hospital, Hengshui, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China
| | - Weiping Sun
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China.
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
- Beijing Key Laboratory of Neurovascular disease discovery, Beijing, China.
| |
Collapse
|
6
|
Jia W, Jiang Y, Ma R, Huang X, Gu H, Meng X, Li H, Zhao X, Wang Y, Wang Y, Li Z, Wang C. 10-year Temporal Trends of Intravenous Thrombolysis in Acute Ischemic Stroke: Analysis of the China National Stroke Registry I-Ⅲ. J Stroke Cerebrovasc Dis 2024; 33:107431. [PMID: 37951082 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107431] [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: 08/07/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVES To investigate the 10-year trend in healthcare quality of intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator in acute ischemic stroke (AIS) in China. MATERIALS AND METHODS We analyzed 42,188 AIS within 7 days of onset from the China National Stroke Registry (CNSR) Ⅰ-Ⅲ. Primary outcomes were temporal changes in the proportion of patients arriving at the hospital within 3.5 hours (and 2 hours) of onset and receiving IVT within 4.5 hours (and 3 hours), stratified by region and hospital tier. Secondary outcomes included temporal changes in door-to-needle time (DNT), DNT ≤60 min and favorable outcome defined as a 90-day modified Rankin Scale (mRS) of 0-1. RESULTS Among patients arriving at the hospital within 3.5 hours of onset, 13.5%, 7.1% and 33.4% patients received IVT within 4.5 hours in CNSR Ⅰ, Ⅱ and Ⅲ, respectively, including a higher proportion from eastern China (37.0%) and tertiary hospitals (36.5%). The median DNT was shorter in CNSR Ⅲ (60.0 min) than those in Ⅱ (95.0 min) and I (94.0 min). The proportion of patients with DNT ≤60 min was greater in Ⅲ (53.4%) than those in Ⅱ (26.7%) and Ⅰ (13.4%). The proportion of favorable outcomes was higher in CNSR Ⅲ (72.8%) than those in Ⅱ (49.6%) and Ⅰ (49.4%). Similar trends were observed for patients arriving at the hospital within 2 hours and receiving IVT within 3 hours of onset. CONCLUSIONS The healthcare quality of IVT has improved remarkably in the past decade, notably in eastern China and tertiary hospitals.
Collapse
Affiliation(s)
- Weili Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Ruihua Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xinying Huang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Advanced Innovation Center for Human Brain Protection, Capital Medical University; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Advanced Innovation Center for Human Brain Protection, Capital Medical University; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences; Chinese Institute for Brain Research, Beijing, China.
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
| |
Collapse
|
7
|
Tan E, Gao L, Tran HN, Cadilhac D, Bladin C, Moodie M. Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost-utility analysis for a middle income country. J Telemed Telecare 2024; 30:18-30. [PMID: 34292801 DOI: 10.1177/1357633x211032407] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost-utility analysis of telestroke, using China as a case study. METHODS We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost-utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results. RESULTS Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost-utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results. DISCUSSION Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China.
Collapse
Affiliation(s)
- Elise Tan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Huong Nq Tran
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Dominique Cadilhac
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Chris Bladin
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Public Health and Health Services Research, The Florey Institute Neuroscience and Mental Health, University of Melbourne, Australia
- Ambulance Victoria, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| |
Collapse
|
8
|
Jia B, Zhang L, Pan Y, Tong X, Zhang X, Mo D, Ma N, Luo G, Song L, Li X, Wang B, Nguyen TN, Gao F, Miao Z. Rescue angioplasty and/or stenting after mechanical thrombectomy: who can benefit? J Neurointerv Surg 2023:jnis-2023-020824. [PMID: 38050150 DOI: 10.1136/jnis-2023-020824] [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: 07/18/2023] [Accepted: 10/25/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Angioplasty and/or stenting is a rescue therapy for mechanical thrombectomy (MT) in acute intracranial large vessel occlusion. This study was undertaken to determine whether rescue angioplasty and/or stenting improves the outcome after MT and to investigate whether outcomes differ by subgroup of rescue indication. METHODS We performed propensity score matching (PSM) with data from a prospective multicenter registry of patients with acute large vessel occlusion receiving endovascular treatment. Patients were divided into the MT alone group and the MT with rescue therapy group. The primary outcome was functional independence (modified Rankin Scale score of 0-2) at 90 days. PSM was also performed in the failed MT (modified Thrombolysis In Cerebral Infarction (mTICI) 0-2a) and the residual severe stenosis (mTICI 2b-3) subgroups, respectively. RESULTS 326 patients of mean±SD age 62.7±12.0 years (90 women, 27.6%) were matched from 1274 patients. In the matched cohort, functional independence at 90 days was higher in the rescue therapy group than in the MT alone group (44.2% vs 29.5%; OR 1.90, 95% CI 1.18 to 3.06, P=0.008). In the failed MT subgroup with 66 matched pairs, more patients had functional independence in the rescue therapy group than in the MT alone group (39.0% vs 17.0%; OR 3.12, 95% CI 1.29 to 7.59, P=0.01). In the residual stenosis subgroup with 63 matched pairs, functional independence rates were similar in the rescue therapy and the MT alone groups (51.6% vs 55.7%; OR 0.85, 95% CI 0.42 to 1.72, P=0.65). CONCLUSION Rescue angioplasty and/or stenting could improve the clinical outcome in patients with acute large vessel occlusion with failed MT, while no benefit was seen in those with residual severe stenosis but substantial reperfusion.
Collapse
Affiliation(s)
- BaiXue Jia
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Longhui Zhang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuelei Zhang
- Stroke Center, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gang Luo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Li
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Feng Gao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
9
|
Monday O, Rawat A, Isaak AK, Manzoor A, Jaiswal G, Saeed L, Kumari A, Amin A. Comparing the Effectiveness of Intravenous Tissue Plasminogen Activator and Dual Antiplatelet Therapy in Patients With Minor Stroke: A Meta-Analysis. Cureus 2023; 15:e46436. [PMID: 37927654 PMCID: PMC10624328 DOI: 10.7759/cureus.46436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of this study was to compare the outcomes between dual antiplatelet therapy (DAPT) versus intravenous tissue plasminogen activator (IV t-PA) in patients with minor stroke. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two authors independently conducted online database searches using PubMed, Web of Science, and EMBASE to identify articles published in English language from inception to September 5, 2023. Outcomes assessed in this meta-analysis included all-cause mortality, stroke incidence, and functional outcomes (measured by modified ranking scale (mRS) scores of 0 to 1). A total of three studies fulfilled the eligibility criteria and included in the final analysis. Pooled analysis showed that the risk of all-cause mortality was not significantly different between the t-PA group and DAPT group (relative risk (RR): 1.14, 95% confidence interval (CI): 0.32-4.06). Compared with those treated with DAPT, there was no significant difference in t-PA in terms of the number of patients with a favorable functional outcome (defined as an mRS score of 0-1). The risk of stroke was not significantly different between the t-PA group and DAPT group (RR: 1.11, 95% CI: 0.68 to 1.82). The analysis, based on three studies, revealed no significant differences between t-PA and DAPT regarding all-cause mortality, stroke incidence, and functional outcomes.
Collapse
Affiliation(s)
- Obinna Monday
- Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Abraham K Isaak
- Telemetry, Sharp Memorial Hospital, San Diego, USA
- Internal Medicine, Orotta School of Medicine and Dentistry, Asmara, ERI
| | - Amima Manzoor
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Goldi Jaiswal
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Leena Saeed
- Internal Medicine, National Ribat University, Khartoum, SDN
| | - Ajanta Kumari
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Adil Amin
- Cardiology, Pakistan Navy Ship Shifa (PNS Shifa), Karachi, PAK
| |
Collapse
|
10
|
Liu QH, Tan JX, Hu CX, Zhang XP, Liu SY, Wan LH. Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma. Eur J Cardiovasc Nurs 2023; 22:586-593. [PMID: 36611018 DOI: 10.1093/eurjcn/zvad001] [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] [Received: 05/21/2022] [Revised: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
AIMS Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship. METHODS AND RESULTS A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay. CONCLUSION Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.
Collapse
Affiliation(s)
- Qun-Hong Liu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
| | - Ju-Xiang Tan
- Department of Neurology and Stroke Center, The Third Affiliated Hospital, Sun Yat-sen University, 2693 Kaichuang Avenue, Guangzhou 510700, China
| | - Cai-Xia Hu
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Xiao-Pei Zhang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Shu-Ying Liu
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
| |
Collapse
|
11
|
Liu F, Yang P, Wang Y, Shi M, Wang R, Xu Q, Peng Y, Chen J, Zhang J, Wang A, Xu T, Zhang Y, He J. HS-CRP Modifies the Prognostic Value of Platelet Count for Clinical Outcomes After Ischemic Stroke. J Am Heart Assoc 2023:e030007. [PMID: 37449575 PMCID: PMC10382093 DOI: 10.1161/jaha.123.030007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/24/2023] [Indexed: 07/18/2023]
Abstract
Background We examined whether the relationship between baseline platelet count and clinical outcomes is modulated by HS-CRP (high-sensitivity C-reactive protein) in patients with ischemic stroke. Methods and Results A total of 3267 patients with ischemic stroke were included in the analysis. The primary outcome was a combination of death and major disability at 1 year after ischemic stroke. Secondary outcomes included major disability, death, vascular events, composite outcome of vascular events or death, and an ordered 7-level categorical score of the modified Rankin Scale at 1 year. Multivariate logistic regression and Cox proportional hazards regression models were used to assess the association between the baseline platelet count and clinical outcomes stratified by HS-CRP levels when appropriate. There was an interaction effect of platelet count and HS-CRP on the adverse clinical outcomes after ischemic stroke (all Pinteraction<0.05). The elevated platelet count was significantly associated with the primary outcome (odds ratio [OR], 3.14 [95% CI, 1.77-5.58]), major disability (OR, 2.07 [95% CI, 1.15-3.71]), death (hazard ratio [HR], 2.75 [95% CI, 1.31-5.79]), and composite outcome of vascular events or death (HR, 2.57 [95% CI, 1.38-4.87]) among patients with high HS-CRP levels (all Ptrend<0.05). Conclusions The HS-CRP levels had a modifying effect on the association between platelet count and clinical outcomes in patients with ischemic stroke. Elevated platelet count was significantly associated with adverse clinical outcomes in patients with ischemic stroke with high HS-CRP levels, but not in those with low HS-CRP levels. These findings suggest that strategies for anti-inflammatory and antiplatelet therapy should be developed according to the results of both platelet and HS-CRP testing.
Collapse
Affiliation(s)
- Fanghua Liu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Pinni Yang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Yinan Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Ruirui Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Qingyun Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Yanbo Peng
- Department of Neurology Affiliated Hospital of North China University of Science and Technology Tangshan Hebei China
| | - Jing Chen
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
- Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Jintao Zhang
- Department of Neurology The 960th Hospital of People's Liberation Army Jinan Shandong China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou 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 Suzhou Medical College of Soochow University Suzhou China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China
| | - Jiang He
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
- Department of Medicine Tulane University School of Medicine New Orleans LA
| |
Collapse
|
12
|
Zhang P, Xu J, Cui Q, Lin G, Wang F, Ding X, You S, Sang N, Tan J, Xu W, Zhan C, Zhu Y, Zhang J. Multi-pathway neuroprotective effects of a novel salidroside derivative SHPL-49 against acute cerebral ischemic injury. Eur J Pharmacol 2023; 949:175716. [PMID: 37059375 DOI: 10.1016/j.ejphar.2023.175716] [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: 01/17/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
SHPL-49 ((2R,3S,4S,5R,6R)-2-(hydroxymethyl)-6-(4-(4-methoxyphenyl) butoxy) tetrahydro-2H-pyran-3,4,5-triol) is a novel glycoside derivative obtained from structural modification of salidroside, which is isolated from the medicinal plant Rhodiola rosea L. SHPL-49 was administered to rats with permanent middle cerebral artery occlusion (pMCAO) for 5 days, and it was found that SHPL-49 could alleviate the cerebral infarct volume and reduce the neurological deficit score. Moreover, the effective time window of SHPL-49 in the pMCAO model was from 0.5 to 8 h after embolization. In addition, the result of immunohistochemistry showed that SHPL-49 could increase the number of neurons in the brain tissue and reduce the occurrence of apoptosis. Morris water maze and Rota-rod experiments showed that SHPL-49 could improve neurological deficits, repair neurocognitive and motor dysfunction, and enhance learning and memory ability in the pMCAO model after 14 days of SHPL-49 treatment. Further in vitro experiments showed that SHPL-49 significantly reduced the calcium overload of PC-12 cells and the production of reactive oxygen species (ROS) induced by oxygen and glucose deprivation (OGD), and increased the levels of antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), decreased the production of malondialdehyde (MDA). Furthermore, SHPL-49 could reduce cell apoptosis by increasing protein expression ratio of anti-apoptotic factor Bcl-2 to pro-apoptotic factor Bax in vitro. SHPL-49 also regulated the expression of Bcl-2 and Bax in ischemic brain tissue, and even inhibited the caspase cascade of pro-apoptotic proteins Cleaved-caspase 9 and Cleaved-caspase 3. Taken together, SHPL-49 exhibited neuroprotective effects against cerebral ischemic injury through multiple pathways, such as alleviating calcium overload, reducing oxidative stress damage, and inhibiting apoptosis.
Collapse
Affiliation(s)
- Pei Zhang
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jiazhen Xu
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Qianfei Cui
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Guoqiang Lin
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Feiyun Wang
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xinyue Ding
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Suxin You
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Nina Sang
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Junchao Tan
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Wenwen Xu
- Shanghai Hutchison Pharmaceuticals Limited, Shanghai Engineering Research Center for Innovation of Solid Preparation of TCM, Shanghai, China
| | - Changsen Zhan
- Shanghai Hutchison Pharmaceuticals Limited, Shanghai Engineering Research Center for Innovation of Solid Preparation of TCM, Shanghai, China
| | - Yuying Zhu
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jiange Zhang
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine (IRI), Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| |
Collapse
|
13
|
Karedath J, Avanteeka FNU, Nouman Aslam M, Nadeem A, Yousaf RA, Shah S, Palleti SK, Khan A. Comparison of Effectiveness and Safety of Low-Dose Versus Standard-Dose Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke: A Meta-Analysis. Cureus 2023; 15:e35571. [PMID: 37007347 PMCID: PMC10062115 DOI: 10.7759/cureus.35571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
The aim of the present meta-analysis is to compare the efficacy and safety of low-dose and standard-dose recombinant tissue plasminogen activators (r-tPA) in patients with acute ischemic stroke. The present meta-analysis was conducted according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted a systematic search in PubMed, Embase, and the Cochrane Library to identify studies published between January 1, 2010, and January 31, 2023, using the following terms: "stroke," "alteplase," "doses," "efficacy," "tissue plasminogen activator," "r-tPA," and "safety." Primary efficacy outcomes included favorable outcomes (Modified Rankin Scale scores of 0-2), while secondary efficacy outcome was all-cause mortality at 90 days. Safety outcomes included asymptomatic intracerebral hemorrhage (ICH) and symptomatic ICH assessed using the National Institute of Neurological Disorders and Stroke (NINDS) study and the Safe Implementation of Thrombolysis in Stroke-Monitoring (SITS-MOST) study. We also compared parenchymal hematomas as safety outcome between the two groups defined by the authors themselves in their research. A total of 16 studies were included in the present meta-analysis. The meta-analysis did not report any significant difference between low-dose and standard-dose r-tPA in terms of mortality, symptomatic intracranial hemorrhage (SICH), asymptomatic ICH, and parenchymal hematomas. However, the favorable outcome was significantly greater in patients receiving a standard dose of r-tPA.
Collapse
|
14
|
Wang CJ, Gu HQ, Zhang XM, Jiang Y, Li H, Bettger JP, Meng X, Dong KH, Wangqin RQ, Yang X, Wang M, Liu C, Liu LP, Tang BS, Li GZ, Xu YM, He ZY, Yang Y, Yip W, Fonarow GC, Schwamm LH, Xian Y, Zhao XQ, Wang YL, Wang Y, Li Z. Temporal trends and rural-urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey. Stroke Vasc Neurol 2023; 8:34-50. [PMID: 35985768 PMCID: PMC9985802 DOI: 10.1136/svn-2022-001552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stroke is the leading cause of mortality in China, with limited evidence of in-hospital burden obtained from nationwide surveys. We aimed to monitor and track the temporal trends and rural-urban disparities in cerebrovascular risk factors, management and outcomes from 2005 to 2015. METHODS We used a two-stage random sampling survey to create a nationally representative sample of patients admitted for ischaemic stroke in 2005, 2010 and 2015. We sampled participating hospitals with an economic-geographical region-stratified random-sampling approach first and then obtained patients with a systematic sampling approach. We weighed our survey data to estimate the national-level results and assess changes from 2005 to 2015. RESULTS We analysed 28 277 ischaemic stroke admissions from 189 participating hospitals. From 2005 to 2015, the estimated national hospital admission rate for ischaemic stroke per 100 000 people increased (from 75.9 to 402.7, Ptrend<0.001), and the prevalence of risk factors, including hypertension, diabetes, dyslipidaemia and current smoking, increased. The composite score of diagnostic tests for stroke aetiology assessment (from 0.22 to 0.36, Ptrend<0.001) and secondary prevention treatments (from 0.46 to 0.70, Ptrend<0.001) were improved. A temporal decrease was found in discharge against medical advice (DAMA) (from 15.2% (95% CI 13.7% to 16.7%) to 8.6% (8.1% to 9.0%); adjusted Ptrend=0.046), and decreases in in-hospital mortality (0.7% in 2015 vs 1.8% in 2005; adjusted OR (aOR) 0.52; 95% CI 0.32 to 0.85) and the composite outcome of in-hospital mortality or DAMA (8.4% in 2015 vs 13.9% in 2005; aOR 0.65; 95% CI 0.47 to 0.89) were observed. Disparities between rural and urban hospitals narrowed; however, disparities persisted in in-hospital management (brain MRI: rural-urban difference from -14.4% to -11.2%; cerebrovascular assessment: from -20.3% to -16.7%; clopidogrel: from -2.1% to -10.3%; anticoagulant for atrial fibrillation: from -10.9% to -8.2%) and in-hospital outcomes (DAMA: from 2.7% to 5.0%; composite outcome of in-hospital mortality or DAMA: from 2.4% to 4.6%). CONCLUSIONS From 2005 to 2015, improvements in hospital admission and in-hospital management for ischaemic stroke in China were found. A temporal improvement in DAMA and improvements in in-hospital mortality and the composite outcome of in-hospital mortality or DAMA were observed. Disparities between rural and urban hospitals generally narrowed but persisted.
Collapse
Affiliation(s)
- Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Miao Zhang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke-Hui Dong
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China
| | - Run-Qi Wangqin
- Department of Neurology, Duke Univeristy Medical Center, Durham, North Carolina, USA
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meng Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bei-Sha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guo-Zhong Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Key Laboratory of Cerebrovascular Disease Prevention and Treatment, National Health Commission (Province and Ministry Co-constructed), Zhengzhou, Henan, China
| | - Zhi-Yi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ying Xian
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijng, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
| |
Collapse
|
15
|
Wang L, Zhang B, Yang X, Guo S, Waterhouse GI, Song G, Guan S, Liu A, Cheng L, Zhou S. Targeted alleviation of ischemic stroke reperfusion via atorvastatin-ferritin Gd-layered double hydroxide. Bioact Mater 2023; 20:126-136. [PMID: 35663341 PMCID: PMC9136047 DOI: 10.1016/j.bioactmat.2022.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/24/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022] Open
Abstract
In acute ischemic stroke therapy, potent neuroprotective agents are needed that prevent neural injuries caused by reactive oxygen species (ROS) during ischemic reperfusion. Herein, a novel 2D neuroprotective agent (AFGd-LDH) is reported, comprising Gd-containing layered double hydroxide nanosheets (Gd-LDH, as a drug nanocarrier/MRI contrast agent), atorvastatin (ATO, as a neuroprotective drug) and the ferritin heavy subunit (FTH, as a blood brain barrier transport agent). Experiments revealed AFGd-LDH to possess outstanding antioxidant activity, neuroprotective properties, blood‒brain barrier transit properties, and biocompatibility. In vitro studies demonstrated the ROS scavenging efficiency of AFGd‒LDH to be ∼90%, surpassing CeO2 (50%, a ROS scavenger) and edaravone (52%, a clinical neuroprotective drug). Ischemia‒reperfusion model studies in mice showed AFGd‒LDH could dramatically decrease apoptosis induced by reperfusion, reducing the infarct area by 67% and lowering the neurological deficit score from 3.2 to 0.9. AFGd-LDH also offered outstanding MRI performance, thus enabling simultaneous imaging and ischemia reperfusion therapy. The simple stepwise method was used to construct AFGd-LDH by the confinement of atorvastatin and the ferritin heavy subunit (FTH) with Gd-LDH. AFGd-LDH demonstrated outstanding antioxidant activity and ROS scavenging efficiency. AFGd-LDH offered neuroprotective properties to dramatically decrease apoptosis induced by reperfusion. AFGd-LDH presented blood‒brain barrier transit properties and outstanding MRI performance, thus enabling simultaneous imaging and ischemia reperfusion therapy.
Collapse
|
16
|
Yang J, Li F, Qiu Z, Wang Y, Luo J, Wu Y, Zeng G, Wan Y, Liu S, Yue C, Song J, Luo W, Liu C, Li L, Sun R, Huang J, Sang H, Zhao C, Yang Q, Zi W. Effect of endovascular treatment within 6 hours for acute basilar artery occlusion. J Neurosurg 2023; 138:205-214. [PMID: 35623368 DOI: 10.3171/2022.4.jns22355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/05/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) plus standard medical treatment (SMT) in patients with acute basilar artery occlusion (BAO) within 6 hours of the estimated occlusion time, based on a Chinese population. METHODS The authors selected patients from the Endovascular Treatment of Acute Basilar Artery Occlusion Study (BASILAR) registry, which was a nationwide prospective registry, within 6 hours after the estimated time of onset of a stroke in acute BAO. Patients were divided into the SMT-alone group or the EVT+SMT group according to treatment modalities. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score between 0 and 3 at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage. RESULTS The authors assessed 590 patients for eligibility. Of these patients, 127 received SMT alone and 463 were treated with EVT plus SMT. EVT was associated with a higher rate of a favorable functional outcome (adjusted OR 3.804, 95% CI 1.890-7.658; p < 0.001) and a lower proportion of deaths at 90 days (adjusted OR 0.364, 95% CI 0.223-0.594; p < 0.001). Lower age (adjusted OR 0.978, 95% CI 0.960-0.997; p = 0.022); lower baseline National Institutes of Health Stroke Scale score (adjusted OR 0.926, 95% CI 0.902-0.950; p < 0.001); higher baseline posterior circulation Alberta Stroke Program Early CT Score (adjusted OR 1.681, 95% CI 1.424-1.984; p < 0.001); absence of diabetes mellitus (adjusted OR 0.482, 95% CI 0.267-0.871; p = 0.016); and modified Thrombolysis in Cerebral Infarction scores 2b-3 (adjusted OR 5.117, 95% CI 2.304-11.367; p < 0.001) were independent factors for a favorable outcome in the EVT+SMT group. CONCLUSIONS Based on the study design, patients with acute BAO who received EVT within 6 hours were associated with improved favorable outcome and decreased deaths compared with patients who received SMT. Predictors of desirable outcome in patients undergoing EVT included lower age, lower baseline National Institutes of Health Stroke Scale score, higher baseline posterior circulation Alberta Stroke Program Early CT Score, absence of diabetes mellitus, and modified Thrombolysis in Cerebral Infarction scores 2b-3.
Collapse
Affiliation(s)
- Jie Yang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Fengli Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Zhongming Qiu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Yan Wang
- 2Department of Neurology, Chengdu Fifth People's Hospital, Chengdu
| | - Jun Luo
- 3Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang
| | - Youlin Wu
- 4Department of Neurology, Chongzhou People's Hospital, Chongzhou
| | - Guoyong Zeng
- 5Department of Neurology, Ganzhou People's Hospital, Ganzhou; and
| | - Yue Wan
- 6Department of Neurology, Yangluo District of Hubei Zhongshan Hospital, Wuhan, China
| | - Shuai Liu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Chengsong Yue
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Jiaxing Song
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Weidong Luo
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Chang Liu
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Linyu Li
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Ruidi Sun
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Jiacheng Huang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Hongfei Sang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Chenhao Zhao
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Qingwu Yang
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Wenjie Zi
- 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing
| |
Collapse
|
17
|
Li J, Wu Z, Peng C, Song L, Luo Y. Microwave-induced thermoacoustic imaging for the early detection of canine intracerebral hemorrhage. Front Physiol 2022; 13:1067948. [PMID: 36467679 PMCID: PMC9709279 DOI: 10.3389/fphys.2022.1067948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2023] Open
Abstract
Purpose: This study aimed to investigate the feasibility and validation of microwave-induced thermoacoustic imaging (TAI) for the early detection of canine intracerebral hemorrhage. Methods: A TAI system was used to record the thermoacoustic signal (TAS) of canine intracerebral hemorrhage in the study. First, the difference in TAS between deionized water, fresh ex vivo porcine blood and brain tissue was explored. Second, the canine hemorrhagic stroke model was established, and canine brain ultrasound examination and TAI examination were performed before modeling and at 0.5 h, 1 h, 2 h, 3 h, 4 h, 4.5 h, 5 h and 6 h after modeling. Finally, pathology and ultrasound were used as the reference diagnoses to verify the accuracy of the thermoacoustic imaging data. Results: The results showed that significant differences were observed in TASs among deionized water, fresh ex vivo porcine blood and brain tissue. The intensity of the thermoacoustic signal of blood was significantly higher than that of ex vivo porcine brain tissue and deionized water. The intracerebral hemorrhage model of five beagles was successfully established. Hematomas presented hyperintensity in TAI. Considering ultrasound and pathology as reference diagnoses, TAI can be used to visualize canine intracerebral hemorrhage at 0.5 h, 1 h, 2 h, 3 h, 4 h, 4.5 h, 5 h and 6 h after modeling. Conclusion: This is the first experimental study to explore the use of TAI in the detection of intracerebral hemorrhage in large live animals (canine). The results indicated that TAI could detect canine intracerebral hemorrhage in the early stage and has the potential to be a rapid and noninvasive method for the detection of intracerebral hemorrhage in humans.
Collapse
Affiliation(s)
- Jiawu Li
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Zhenru Wu
- Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, Chengdu, China
| | - Chihan Peng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Ling Song
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
18
|
Muacevic A, Adler JR. Knowledge and Attitude of Sudanese Emergency Registrars Towards the Use of Tissue Plasminogen Activator in the Management of Acute Ischemic Stroke. Cureus 2022; 14:e29908. [PMID: 36381832 PMCID: PMC9635934 DOI: 10.7759/cureus.29908] [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] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recent guidelines report that the administration of tissue plasminogen activator (tPA) within 4.5 hours enhances the clinical outcome of ischemic stroke. We assessed the knowledge and attitude of Sudanese emergency medicine registrars towards the use of tissue plasminogen activators in the management of acute ischemic stroke (AIS). METHODS This is a descriptive, cross-sectional, hospital-based study. The study was conducted in emergency departments at Khartoum State Hospitals in Sudan during the period from May to July 2021. The study sample was 150 emergency medicine registrars who fulfilled the inclusion criteria of the study. Data was collected by using a self-administered questionnaire as a Google form that was sent to the study participants by email. RESULTS Knowledge about tPA in the management of AIS at the emergency department was poor, average, and good in 54 (36%), 55 (36.7%), and 41 (27.3%) individuals, respectively. However, there was no significant difference in overall knowledge based on age; nevertheless, good and average knowledge levels were considerably higher among females, level 3 and level 4 of training, and years of experience 5-10 years (p-value = 0.05). The overall attitude of the participants was positive 62 (41.3%), neutral 45 (30%), and negative 43 (28.7%). The positive attitude regarding tPAs for patients with AIS was significantly associated with age 30-40 years, females, levels 3 and 4 of training, and experience 5-10 years (p-value < 0.05). CONCLUSION The overall knowledge and attitude of emergency medicine registrars were average to good, with a significant proportion of participants reporting low knowledge. The issues encountered by participants in the use of tPAs were the absence of a stroke team in hospitals, the absence of a protocol for the care pathway of AIS management in hospitals, and the absence of tPAs.
Collapse
|
19
|
Zhong W, Lin L, Gong X, Chen Z, Chen Y, Yan S, Zhou Y, Zhang X, Hu H, Tong L, Cheng C, Gu Q, Chen Y, Yu X, Huang Y, Yuan C, Lou M. Evaluation of a multicomponent intervention to shorten thrombolytic door-to-needle time in stroke patients in China (MISSION): A cluster-randomized controlled trial. PLoS Med 2022; 19:e1004034. [PMID: 35788767 PMCID: PMC9255731 DOI: 10.1371/journal.pmed.1004034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Rapid intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is crucial for improving outcomes. However, few randomized trials of interventions aimed at reducing in-hospital delay have been carried out in China. We aimed to evaluate the effect of a multicomponent intervention on thrombolytic door-to-needle time (DNT) of AIS patients via video teleconference based on the Behavior Change Wheel (BCW) method. METHODS AND FINDINGS This cluster-randomized trial, conducted between January 1, 2019 and December 31, 2019, randomly allocated 22 hospitals equally to PEITEM (Persuasion Environment reconstruction Incentivization Training Education Modeling) intervention or routine care plus stroke registry and subsequently enrolled 1,634 AIS patients receiving IVT within 4.5 hours upon stroke onset from participant hospitals. The PEITEM group received a 1-year PEITEM 6-component intervention based on the behavioral theory monthly via video teleconference. The primary outcome was the proportion of patients with a DNT of 60 minutes or less. A total of 987 patients participated in the PEITEM group (mean age, 69 years; female, 411 [41.6%]) and 647 patients in the control group (mean age, 70 years; female, 238 [36.8%]). Of all participants, the proportion of DNT ≤60 minutes in the PEITEM group was higher than in the control group (82.0% versus 73.3%; adjusted odds ratio, 1.77; 95% confidence interval (CI), 1.17 to 2.70; ICC, 0.04; P = 0.007). Among secondary outcomes, the average DNT was 43 minutes in the PEITEM group and 50 minutes in the control group (adjusted mean difference: -8.83; 95% CI, -14.03 to -3.64; ICC, 0.12; P = 0.001). Favorable functional outcome (score of 0 to 1 on the modified Rankin scale (mRS)) was achieved in 55.6% patients of the PEITEM group and 50.4% of the control group (adjusted odds ratio, 1.38; 95% CI, 1.00 to 1.90; ICC, 0.01; P = 0.049). Main study limitations include non-blinding of clinicians, and that specific interventions component responsible for the observed changes could not be determined. CONCLUSIONS The teleconference-delivered PEITEM intervention resulted in a moderate but clinically relevant shorter DNT and better functional outcome in AIS patients receiving IVT. TRIAL REGISTRATION Clinicaltrials.gov NCT03317639.
Collapse
Affiliation(s)
- Wansi Zhong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Longting Lin
- Imaging Laboratory Manger, Sydney Brain Center, University of New South Wales, Australia
| | - Xiaoxian Gong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yi Chen
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xuting Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haitao Hu
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lusha Tong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chaochan Cheng
- Department of Neurology, Yongkang First People’s Hospital, Yongkang, China
| | - Qun Gu
- Department of Neurology, Huzhou First People’s Hospital, Huzhou, China
| | - Yong Chen
- Department of Neurology, Li Huili Hospital of Ningbo Medical Center, Ningbo, China
| | - Xiaojin Yu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Yuhui Huang
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, China
- * E-mail: , (ML); (CY)
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- * E-mail: , (ML); (CY)
| | | |
Collapse
|
20
|
Luo Y, Li J, Huang L, Liu X, Zhang B, Lin J, Jiang A, Zhao J. Safety and efficacy of a new modified intravenous recombinant tissue plasminogen activator (rt-PA) regimen in Chinese patients with acute ischemic stroke: A descriptive retrospective cohort study with subgroup-analysis of different rt-PA dose. J Clin Neurosci 2022; 101:244-251. [DOI: 10.1016/j.jocn.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
|
21
|
Buus SMØ, Schmitz ML, Cordsen P, Johnsen SP, Andersen G, Simonsen CZ. Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke. Stroke 2022; 53:2307-2316. [PMID: 35579017 DOI: 10.1161/strokeaha.121.037687] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reperfusion therapies (thrombolysis and thrombectomy) are of paramount importance for the recovery after ischemic stroke. We aimed to investigate if socioeconomic status (SES) was associated with the chance of receiving reperfusion therapy for ischemic stroke in a country with tax-funded health care. METHODS This nationwide register-based cohort study included patients with ischemic stroke registered in the Danish Stroke Registry between 2015 and 2018. SES was determined by prestroke educational attainment, income level, and employment status. Data on SES was obtained from Statistics Denmark and linked on an individual level with data from the Danish Stroke Registry. Risk ratios (RR) for receiving reperfusion therapies were calculated using univariate and multivariable Poisson regression with robust variance. RESULTS A total of 37 187 ischemic stroke patients were included. Low SES, as defined by education, income and employment status, was associated with lower treatment rates. The socioeconomic gradient was most pronounced according to employment status, with intravenous thrombolysis rates of 23.7% versus 15.8%, and thrombectomy rates of 5.1% versus 2.8% for employed versus unemployed patients. When the analyses were restricted to patients with timely hospital arrival, and adjusted for age, sex and immigrant status, low SES according to income and employment remained unfavorable for the likelihood of receiving intravenous thrombolysis: adjusted RR, 0.90 (95% CI, 0.86-0.95) for low versus high income, and adjusted RR, 0.77 (95% CI, 0.71-0.84) for unemployed versus employed patients. Similarly, low SES according to income and employment status remained unfavorable for the likelihood of receiving thrombectomy: adjusted RR, 0.83 (95% CI, 0.72-0.95) for low versus high income and adjusted RR, 0.68 (95% CI, 0.53-0.88) for unemployed versus employed patients. CONCLUSIONS Socioeconomic inequalities in reperfusion treatment rates among ischemic stroke patients prevail, even in a country with tax-funded universal health care.
Collapse
Affiliation(s)
| | - Marie Louise Schmitz
- Department of Neurology, Aarhus University Hospital, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
| | - Pia Cordsen
- Danish Center for Clinical Health Services Research, Aalborg University, Denmark (P.C., S.P.J.)
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg University, Denmark (P.C., S.P.J.).,Department of Clinical Medicine, Aalborg University (S.P.J.)
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.).,Department of Clinical Medicine, Aarhus University (G.A., C.Z.S.)
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.).,Department of Clinical Medicine, Aarhus University (G.A., C.Z.S.)
| |
Collapse
|
22
|
Yang H, Huang X, Yang C, Zhu S, Chen X, Zhang M, Yu X, Wang HHX. Time Window for Acute Stroke Management: A Cross-Sectional Study Among Community Healthcare Practitioners in Primary Care. Int J Gen Med 2022; 15:4483-4493. [PMID: 35518516 PMCID: PMC9064173 DOI: 10.2147/ijgm.s361189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Time-to-treatment window is critical for managing acute ischaemic stroke. The community healthcare practitioners (CHPs) who deliver frontline care in the health system play an important role in stroke prevention and treatment. Methods A multi-stage sampling design was adopted in Guangdong province, China. A total of 997 CHPs who participated in the survey were divided into two groups (the awareness group vs the unawareness group) according to their knowledge on the time window for stroke management. Logistic regression analysis was performed to explore factors associated with the awareness of “time window”. Results Overall, less than half (49.1%) of CHPs were aware of the time window for stroke management. The proportion of CHPs who were able to recognise stroke symptoms were higher in the awareness group (42.7%) than that in the unawareness group (38.8%). Most CHPs (82.9%) in the awareness group had the knowledge about the effectiveness of intravenous thrombolysis in treating acute cerebral infarction, whereas this was perceived by only less than half (43.6%) of CHPs in the unawareness group. Factors associated with the knowledge of time window for stroke management included participation in cerebrovascular disease management training (adjusted odds ratio [aOR]=4.203, 95% CI: 1.707–10.348, p=0.002), awareness of the time frame for CT initiation (aOR=5.214, 95% CI: 1.803–15.078, p=0.002) and for urokinase thrombolysis administration (aOR=11.927, 95% CI: 4.393–32.382, p<0.001), accurate perceptions about the target for blood pressure lowering (aOR=4.181, 95% CI: 1.713–10.207, p=0.002) and blood glucose control (aOR=2.446, 95% CI: 1.019–5.869, p=0.045), and the familiarity with prehospital stroke management principles (aOR=3.593, 95% CI: 1.383–9.332, p=0.009). Conclusion The CHPs need to enhance their ability to address the acute ischaemic stroke onset promptly to provide effective treatment within the beneficial “time window”. This may help improve the stroke chain of survival with better multidisciplinary decision support systems that enable optimal stroke care delivery.
Collapse
Affiliation(s)
- Huajie Yang
- School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People's Republic of China
| | - Xiang Huang
- Department of Public Health, Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People's Republic of China
| | - Chunyu Yang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Xiaoyi Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Man Zhang
- Department of Public Health, Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People's Republic of China
| | - Xiao Yu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| |
Collapse
|
23
|
Lu W, Jia D, Qin Y. Decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction. BMC Neurol 2022; 22:167. [PMID: 35501820 PMCID: PMC9063210 DOI: 10.1186/s12883-022-02688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and prognosis of decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction, in order to provide basis for treatment selection. METHODS The clinical data of the patient with massive cerebral infarction treated in our hospital from January 2015 to December 2018 were analyzed retrospectively. According to the surgical methods, the patients were divided into control group (decompressive craniectomy) and study group (decompressive craniectomy + temporal pole resection). Intracranial pressure monitoring devices were placed in both groups. The NIHSS scores of the two groups before and 14 days after operation, the changes of intracranial pressure, length of hospital stay, length of NICU, mortality and modified Rankin scale before and after treatment were compared between the two groups. RESULTS The NIHSS score of the two groups after operation was lower than that before operation, and the NIHSS score of the study group was significantly lower than that of the control group (P < 0.05); The intracranial pressure in the study group was significantly lower than that in the control group (P < 0.05); One month after operation, the mortality of the study group (13.0%) was lower than that of the control group (27.8%). After one year of follow-up, the mortality of the study group (21.7%) was significantly lower than that of the control group (38.8%) (P < 0.05); The scores of mRS in the two groups were significantly improved compared with those before treatment (P < 0.05), and the scores of mRS in the study group were better than those in the control group (P < 0.05). CONCLUSION Decompressive craniectomy combined with temporal pole resection has a better effect in the treatment of patients with massive cerebral infarction. It has good decompression effect, the postoperative intracranial pressure is well controlled, and significantly reduced the mortality. So it has better clinical application value.
Collapse
Affiliation(s)
- Wenchao Lu
- Department of Neurosurgery, the Xi'an Daxing Hospital, No. 353 Laodong North Road, Xi'an, 710000, Shaanxi Province, China
| | - Dong Jia
- Department of Neurosurgery, the Xi'an Daxing Hospital, No. 353 Laodong North Road, Xi'an, 710000, Shaanxi Province, China
| | - Yanchang Qin
- Department of Neurosurgery, the Xi'an Daxing Hospital, No. 353 Laodong North Road, Xi'an, 710000, Shaanxi Province, China.
| |
Collapse
|
24
|
Ye Q, Zhai F, Chao B, Cao L, Xu Y, Zhang P, Han H, Wang L, Xu B, Chen W, Wen C, Wang S, Wang R, Zhang L, Jiao L, Liu S, Zhu YC, Wang LD. Rates of intravenous thrombolysis and endovascular therapy for acute ischaemic stroke in China between 2019 and 2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100406. [PMID: 35243459 PMCID: PMC8873940 DOI: 10.1016/j.lanwpc.2022.100406] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND In recent years, a series of initiatives have been launched to promote intravenous thrombolysis (IVT) and endovascular therapy (EVT) for acute ischaemic stroke (AIS) in China. We aimed to update the rates of IVT and EVT in China between 2019 and 2020 and to evaluate the current IVT and EVT according to hospital grades. METHODS Cross-sectional data on patients receiving IVT/EVT were derived from the Bigdata Observatory platform for Stroke of China (BOSC). The monthly number of discharged patients with a principal diagnosis of AIS was derived from the first pages of medical records of each hospital. The rates and information of IVT and EVT were analysed according to hospital grades. FINDINGS During this period, 938 tertiary hospitals and 786 secondary hospitals from 31 provinces continuously reported data to the BOSC. The overall IVT rate for AIS was 5·64%, and the EVT rate was 1·45%. The IVT rate in secondary hospitals was higher than that in tertiary hospitals (6·39% vs. 5·39%, P < 0·001), whereas the EVT rate in secondary hospitals was much lower than that in tertiary hospitals (0·29% vs. 1·84%, P < 0·001). Significant differences in demographic and clinical characteristics of patients receiving IVT/EVT were also shown between tertiary and secondary hospitals. INTERPRETATION The rates of IVT and EVT for AIS have greatly increased in China, but there is still a large gap compared with developed countries. Hospital inhomogeneity in IVT and EVT suggests the importance of developing a region-specific network for stroke treatment. FUNDING None.
Collapse
Affiliation(s)
- Qing Ye
- Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Feifei Zhai
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Baohua Chao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Lei Cao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Peilan Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Hongxing Han
- Department of Neurology, Linyi People's Hospital, Shandong, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Bing Xu
- Department of Neurology and Neuroscience, Shenyang First People's Hospital, Liaoning, China
| | - Wenhuo Chen
- Department of Neurointervention, Zhangzhou affiliated Hospital of Fujian Medical University, Fujian, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Shouchun Wang
- Department of Neurology, The First Hospital of Jilin University, Jilin, China
| | - Runqing Wang
- Department of Neurology, Zhengzhou Central Hospital, Zhengzhou, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Shandong, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Long-De Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
- School of Public Health, Peking University, Beijing, China
| |
Collapse
|
25
|
Bao H, Zhang S, Hao J, Zuo L, Xu X, Yang Y, Jiang H, Li G. Improving the Prehospital Identification and Acute Care of Acute Stroke Patients: A Quality Improvement Project. Emerg Med Int 2022; 2022:3456144. [PMID: 35186333 PMCID: PMC8850070 DOI: 10.1155/2022/3456144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are a large number of stroke patients in China, and there is currently a lack of prehospital acute stroke care training programs. AIM To develop a prehospital emergency medical service (PEMS) training program to improve the prehospital identification and acute care of acute stroke. METHODS Forty prehospital emergency doctors whose service stations are located within a 10 km radius from Shanghai Pudong New Area Medical Emergency Service Center took this course on November 13, 2014. A questionnaire was designed to evaluate the PEMS personnel's knowledge in stroke and acute stroke care and was conducted before and after training as an assessment of the effectiveness of training. The patient population in this study included a baseline cohort before training and a prospective cohort after training, each composed of patients who were sent to Shanghai East Hospital South Stoke Center within one year. The transit time, final diagnosis, administration of thrombolysis, and door-to-needle time (DNT) were collected and analyzed. RESULTS After the training, 100% of the PEMS personnel were competent to identify stroke cases using the Cincinnati prehospital stroke scale (CPSS). All participants realized that intravenous thrombolysis therapy in a time-sensitive manner is the most effective way to treat acute ischemic stroke. Although there was no difference in first-aid transit time before and after training, the stroke diagnosis rate improved by 6.5% after training (P=0.03). The thrombolysis rate increased to 29.6% from 24.3% but did not reach statistical significance. Compared to 84.0 minutes (standard deviation: 23.1 minutes) before the training, the average DNT after training was 53 minutes (standard deviation: 15.0 minutes), demonstrating a remarkable reduction (P < 0.01). CONCLUSION The training program effectively improved the PEMS personnel's knowledge in stroke and stroke acute care.
Collapse
Affiliation(s)
- Huan Bao
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Sumian Zhang
- Department of ICU, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Junjie Hao
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Lian Zuo
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Xiahong Xu
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yumei Yang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hua Jiang
- Department of Medical Education, Shanghai Pudong Medical Emergency Center, Shanghai 201206, China
| | - Gang Li
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| |
Collapse
|
26
|
Improving Thrombolysis for Acute Ischemic Stroke: The Implementation and Evaluation of a Theory-Based Resource Integration Project in China. Int J Integr Care 2022; 22:9. [PMID: 35221825 PMCID: PMC8833266 DOI: 10.5334/ijic.5616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Intravenous thrombolysis for acute ischemic stroke remains underused in the developing countries. In 2016, a theory-based resource integration project was initiated at a major stroke center in China. This report describes the implementation process and results of the quality improvement project. Description: Eighteen environment-tailored interventions were implemented, including stroke code activation, electronic wristband bundling, structured information sharing, etc. The project was implemented from July 2016 to June 2017. A total of 519 acute ischemic stroke patients were included. After the intervention, median DNT decreased from 62 min to 37 min (P < 0.001). The percentage of cases treated within 30, 45 or 60 minutes increased from 2.5%, 17.4% and 44.6% to 27.4%, 69.4% and 84.7% respectively (P < 0.001). The median length of inpatient stay decreased from 10 days to 8 days (P < 0.001). The proportion of patients with severe disability decreased from 25.5% to 15.8% post-intervention. Discussion: Adequate pre-intervention activities are important conditions for the smooth implementation of the complex service integration initiative. The new treatment pathway has undergone a process of destruction, remodeling and solidification before stable and effective operation. In order to realize the full effect of service integration, whole society efforts are also required. Conclusions: Introduction of the theory-based resource integration project was associated with increased thrombolysis administrations, shorter DNT, and no statistically significant change in adverse outcomes. The basic principles of this project might be applicable to various resource settings.
Collapse
|
27
|
Ding Y, Gao F, Ji Y, Zhai T, Tong X, Jia B, Wu J, Wu J, Zhang Y, Wei C, Wang W, Zhou J, Niu J, Miao Z, Liu Y. Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry. Front Neurol 2022; 12:771803. [PMID: 34992575 PMCID: PMC8724306 DOI: 10.3389/fneur.2021.771803] [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: 09/07/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background: There may be a delay in or a poor outcome of endovascular treatment (EVT) among acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) during off-hours. By using a prospective, nationwide registry, we compared the workflow intervals and radiological/clinical outcomes between patients with acute LVO treated with EVT presenting during off- and on-hours. Methods: We analyzed prospectively collected Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke (ANGEL-ACT) data. Patients presenting during off-hours were defined as those presenting to the emergency department from Monday to Friday between 17:30 and 08:00, on weekends (from 17:30 on Friday to 08:00 on Monday), and on national holidays. We used logistic regression models with adjustment for potential confounders to determine independent associations between the time of presentation and outcomes. Results: Among 1,788 patients, 1,079 (60.3%) presented during off-hours. The median onset-to-door time and onset-to-reperfusion time were significantly longer during off-hours than during on-hours (165 vs. 125 min, P = 0.002 and 410 vs. 392 min, P = 0.027). The rates of successful reperfusion and symptomatic intracranial hemorrhage were similar in both groups. The adjusted odds ratio (OR) for the 90-day modified Rankin Scale score was 0.892 [95% confidence interval (CI), 0.748–1.064]. The adjusted OR for the occurrence of functional independence was 0.892 (95% CI, 0.724–1.098), and the adjusted OR for mortality was 1.214 (95% CI, 0.919–1.603). Conclusions: Off-hours presentation in the nationwide real-world registry was associated with a delay in the visit and reperfusion time of EVT in patients with AIS. However, this delay was not associated with worse functional outcomes or higher mortality rates. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.
Collapse
Affiliation(s)
- Yunlong Ding
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Feng Gao
- Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Hospital Office, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Yong Ji
- Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Hospital Office, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Tingting Zhai
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Wu
- Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Hospital Office, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Department of Rehabilitation, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Jiaqi Wu
- Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Department of Rehabilitation, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Yanrong Zhang
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Can Wei
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Wenjuan Wang
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Jue Zhou
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Jiali Niu
- Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Department of Clinical Pharmacy, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Neurology, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China.,Stroke Center, JingJiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Taizhou, China
| |
Collapse
|
28
|
MRI radiomic features-based machine learning approach to classify ischemic stroke onset time. J Neurol 2022; 269:350-360. [PMID: 34218292 DOI: 10.1007/s00415-021-10638-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to investigate the ability of MRI radiomics features-based machine learning (ML) models to classify the time since stroke onset (TSS), which could aid in stroke assessment and treatment options. METHODS This study involved 84 patients with acute ischemic stroke due to anterior circulation artery occlusion (51 in the training cohort and 33 in the independent test cohort). Region of infarct segmentation was manually outlined by 3D-slicer software. Image processing including registration, normalization and radiomics features calculation were done in R (version 3.6.1). A total of 4312 radiomic features from each image sequence were captured and used in six ML models to estimate stroke onset time for binary classification (≤ 4.5 h). Receiver-operating characteristic curve (ROC) and other parameters were calculated to evaluate the performance of the models in both training and test cohorts. RESULTS Twelve radiomics and six clinic features were selected to construct the ML models for TSS classification. The deep learning model-based DWI/ADC radiomic features performed the best for binary TSS classification in the independent test cohort, with an AUC of 0.754, accuracy of 0.788, sensitivity of 0.952, specificity of 0.500, positive predictive value of 0.769, and negative predictive value of 0.857, respectively. Furthermore, adding clinical information did not improve the performance of the DWI/ADC-based deep learning model. The TSS prediction models can be visited at: http://123.57.65.199:3838/deeptss/ . CONCLUSIONS A unique deep learning model based on DWI/ADC radiomic features was constructed for TSS classification, which could aid in decision making for thrombolysis in patients with unknown stroke onset.
Collapse
|
29
|
Qin H, Turnbull I, Chen Y, Wright N, Liu L, Pei P, Tang W, Xiang S, Guo Y, Zhao X, Clarke R, Li L, Wang Y, Chen Z. Hospital management of major stroke types in Chinese adults: a population-based study of 20 000 hospitalised stroke cases. BMJ Open 2021; 11:e054265. [PMID: 34785558 PMCID: PMC8596044 DOI: 10.1136/bmjopen-2021-054265] [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: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare hospital treatments for major stroke types in Chinese adults by stroke pathological types, sex, age, calendar year, hospital tier, region and other factors. DESIGN Cross-sectional analysis of medical records retrieved from 20 229 stroke cases in the China Kadoorie Biobank. SETTING Ten diverse areas (five urban, five rural) in China. PARTICIPANTS First-incident stroke cases who were recruited during an 11-year follow-up of 0.5M participants in the China Kadoorie Biobank. METHODS Electronic copies of medical records of stroke cases were retrieved for clinical adjudication by local neurologists. Stroke cases were classified as ischaemic stroke (IS) (including lacunar infarction (LACI) and non-LACI (non-LACI)), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) and unspecified stroke types. RESULTS Among 20 299 first-ever stroke cases, 17 306 (85%) had IS, 7123 had non-LACI, 6690 had LACI, 3493 had silent LACI, 2623 (13%) had ICH and 370 (2%) had SAH. Among IS cases, antiplatelet treatment was used by 64% (65% non-LACI, 66% LACI, 56% silent LACI), lipid-lowering by 50% (52% non-LACI, 53% LACI, 43% silent LACI) and blood pressure-lowering by ~42% of all IS types, with positive trends in the use of these treatments by calendar year and hospital tier. Among ICH cases, 53% used blood pressure-lowering and 10% used lipid-lowering treatments, respectively. In contrast, traditional Chinese medicines (TCMs) were used by 59% of IS (50% non-LACI, 62% LACI, 74% silent LACI), 38% of ICH and 30% of SAH cases, with positive trends by calendar year and by hospital tier. CONCLUSIONS Among IS cases, use of antiplatelet and lipid-lowering medications increased in recent years, but use of TCM still exceeded use of blood pressure-lowering treatment. In contrast, blood pressure-lowering treatment was widely used for ICH, but only half of all ICH cases used blood pressure-lowering treatment.
Collapse
Affiliation(s)
- Haiqiang Qin
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Iain Turnbull
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Liping Liu
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Wei Tang
- Emergency Department, Pengzhou Traditional Chinese Medical Hospital, Sichuan, China
| | | | - Yu Guo
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| |
Collapse
|
30
|
Li X, Zhao Y, Jiang J, Cheng J, Zhu W, Wu Z, Jing J, Zhang Z, Wen W, Sachdev PS, Wang Y, Liu T, Li Z. White matter hyperintensities segmentation using an ensemble of neural networks. Hum Brain Mapp 2021; 43:929-939. [PMID: 34704337 PMCID: PMC8764480 DOI: 10.1002/hbm.25695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
White matter hyperintensities (WMHs) represent the most common neuroimaging marker of cerebral small vessel disease (CSVD). The volume and location of WMHs are important clinical measures. We present a pipeline using deep fully convolutional network and ensemble models, combining U‐Net, SE‐Net, and multi‐scale features, to automatically segment WMHs and estimate their volumes and locations. We evaluated our method in two datasets: a clinical routine dataset comprising 60 patients (selected from Chinese National Stroke Registry, CNSR) and a research dataset composed of 60 patients (selected from MICCAI WMH Challenge, MWC). The performance of our pipeline was compared with four freely available methods: LGA, LPA, UBO detector, and U‐Net, in terms of a variety of metrics. Additionally, to access the model generalization ability, another research dataset comprising 40 patients (from Older Australian Twins Study and Sydney Memory and Aging Study, OSM), was selected and tested. The pipeline achieved the best performance in both research dataset and the clinical routine dataset with DSC being significantly higher than other methods (p < .001), reaching .833 and .783, respectively. The results of model generalization ability showed that the model trained on the research dataset (DSC = 0.736) performed higher than that trained on the clinical dataset (DSC = 0.622). Our method outperformed widely used pipelines in WMHs segmentation. This system could generate both image and text outputs for whole brain, lobar and anatomical automatic labeling WMHs. Additionally, software and models of our method are made publicly available at https://www.nitrc.org/projects/what_v1.
Collapse
Affiliation(s)
- Xinxin Li
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,BioMind Technology AI Center, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijng, China
| | - Yu Zhao
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Jian Cheng
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicin, School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Wanlin Zhu
- Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijng, China
| | - Zhenzhou Wu
- BioMind Technology AI Center, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijng, China
| | - Jing Jing
- Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijng, China
| | - Zhe Zhang
- Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijng, China
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Sydney, New South Wales, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Sydney, New South Wales, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Yongjun Wang
- Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijng, China
| | - Tao Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicin, School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Zixiao Li
- Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijng, China.,Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
31
|
Miao M, Du J, Che B, Guo Y, Zhang J, Ju Z, Xu T, Zhong X, Zhang Y, Zhong C. Circulating choline pathway nutrients and depression after ischemic stroke. Eur J Neurol 2021; 29:459-468. [PMID: 34611955 DOI: 10.1111/ene.15133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Choline pathway nutrients, including choline and betaine, are reported to exert antidepressant effects. However, there is little population-based evidence on the relationships between circulating choline and betaine and poststroke depression (PSD). We aimed to prospectively explore the associations between plasma choline and betaine and depression after ischemic stroke. METHODS This study was based on the China Antihypertensive Trial in Acute Ischemic Stroke. A total of 612 participants with plasma choline and betaine concentrations were included in the analysis. The study outcome was depression 3 months after ischemic stroke. Logistic regression models were performed to estimate the relationships between plasma choline and betaine and the risk of PSD. Risk reclassification and calibration of models with choline or betaine were analyzed. RESULTS Patients with PSD had lower choline and betaine levels than those without PSD (p < 0.05). Compared with tertile 1, the multivariable-adjusted odds ratios (95% CIs) for tertile 3 of choline and betaine were 0.54 (0.35-0.83) and 0.59 (0.38-0.92), respectively. Per 1 SD increase in choline or betaine was associated with a 25% (95% CI 9%-37%) or an 19% (95% CI 3%-32%) decreased risk of PSD, respectively. Furthermore, the addition of choline or betaine to the established risk factors model improved the risk reclassification for PSD, as shown by an increase in the net reclassification index and integrated discrimination improvement (all p < 0.05). CONCLUSIONS Patients with elevated levels of choline and betaine had a lower risk of depression after acute ischemic stroke, suggesting the protective significance of choline pathway nutrients for PSD.
Collapse
Affiliation(s)
- Mengyuan Miao
- 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
| | - Jigang Du
- 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
| | - 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
| | - Yufei Guo
- 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
| | - Jintao Zhang
- Department of Neurology, The 88th Hospital of PLA, Shandong, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, 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
| | - Xiaoyan Zhong
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - 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
| | - 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
| |
Collapse
|
32
|
Chen Y, Li J, Dang C, Tan S, Ouyang F, Li J, Yu J, Zeng J, Fan Y. Impact of stroke center certification on rt-PA thrombolysis after acute ischemic stroke in South China from 2015 to 2020. Int J Stroke 2021; 17:559-565. [PMID: 34235984 DOI: 10.1177/17474930211031440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In China, stroke center certification was launched in 2015, but little is known about its impact on intravenous thrombolysis. This study aimed to evaluate the effects of stroke center certification on the use of intravenous thrombolysis during a five-year period in South China. METHODS We retrospectively collected data regarding the use of recombinant tissue plasminogen activator (rt-PA) in 21 cities of Guangdong from 2015 to 2020. The annual thrombolysis rate was defined as the number of patients who underwent intravenous rt-PA therapy divided by the number of those who had acute ischemic stroke within the same year. The density of stroke centers was calculated as the number of stroke centers divided by the corresponding residents. Spearman's correlation analysis was used to determine the correlations between the annual thrombolysis rates and the number/density of stroke centers. Paired t-test was used to compare differences in growth in annual thrombolysis rates before and after having stroke centers. RESULTS From 2015 to 2020, the annual rt-PA thrombolysis rates of Guangdong increased from 1.4% to 7.2%, which was accompanied by an increase in the number of stroke centers from 0 to 82 and density of stroke centers from 0.00 to 0.71 per million population. The average annual rt-PA use in stroke centers was higher than that in non-stroke centers from 2016 to 2020 (all P < 0.05). There was a positive correlation of annual thrombolysis rates with the number of stroke centers (r = 1.00, P = 0.0028) and with the density of stroke centers in the 21 cities from 2018 to 2020 (all P < 0.05). The growth in annual thrombolysis rates significantly accelerated at the city-level after having stroke centers (1.55%/y vs. 0.77%/y, P < 0.001). CONCLUSIONS Stroke center certification may partially drive the increased use of rt-PA thrombolysis. Stroke center certification should be continually promoted to facilitate access to intravenous thrombolysis for patients with acute ischemic stroke.
Collapse
Affiliation(s)
- Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Chao Dang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Shuangquan Tan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Fubing Ouyang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jianle Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| |
Collapse
|
33
|
Zhou T, Zhu L, Wang M, Li T, Li Y, Pei Q, Chen W, Zhao J, Wu H, Liu H, Li Z, He Y. Application of Mobile Stroke Unit in Prehospital Thrombolysis of Acute Stroke: Experience from China. Cerebrovasc Dis 2021; 50:520-525. [PMID: 34175842 DOI: 10.1159/000514370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Most patients cannot receive intravenous thrombolytic therapy in the early stage of stroke onset, and the application of mobile stroke unit (MSU) in prehospital intravenous thrombolytic therapy of acute stroke may change this situation. The first MSU in China was put into use in 2017. Herein, we aimed to explore the preliminary experience of MSU in prehospital thrombolysis of acute stroke. METHODS Patients who received prehospital intravenous thrombolytic therapy using MSU were classified to the MSU thrombolysis group, and the control group consisted of stroke patients admitted by regular ambulances, who were transferred to hospital for intravenous thrombolytic therapy. The feasibility, safety, and duration of procedures were compared. RESULTS There were 14 patients received prehospital intravenous thrombolysis on the MSU, and 24 patients underwent intravenous thrombolysis in the emergency center, who were transferred by the ordinary ambulance during the same period. The median call-to-needle time was 59.5 min in the MSU thrombolysis group, while it was 89 min in the control group; the difference between the 2 groups was statistically significant (p = 0.001). The median time from onset to thrombolysis was 70 and 102.5 min, respectively, in the 2 groups (p = 0.002). The percentages of good clinical outcome (modified Rankin Scale score ≤ 2) at 90-day follow-up were 79 and 67%, respectively (p = 0.488). The rate of symptomatic intracranial hemorrhage and mortality during the perioperative period did not differ significantly between 2 groups. CONCLUSION Despite the small sample size, our preliminary experience of the application of MSU in the prehospital thrombosis therapy seems to indicate a significant reduction in time from call to needle, the efficacy of MSU in the treatment of acute stroke needs further experiment and larger sample size to confirm.
Collapse
Affiliation(s)
- Tengfei Zhou
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China,
| | - Liangfu Zhu
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yucheng Li
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Quansun Pei
- Department of Neurology, Xingyang People's Hospital, Zhengzhou, China
| | - Weifeng Chen
- Department of Neurology, Xingyang People's Hospital, Zhengzhou, China
| | - Juntao Zhao
- Department of Neurology, Xingyang People's Hospital, Zhengzhou, China
| | - Hongkun Wu
- Department of Neurology, Xingyang People's Hospital, Zhengzhou, China
| | - Huan Liu
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhaoshuo Li
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yingkun He
- Department of Interventional Neuroradiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| |
Collapse
|
34
|
Gut Microbiota-Related Effects of Tanhuo Decoction in Acute Ischemic Stroke. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5596924. [PMID: 34136066 PMCID: PMC8175183 DOI: 10.1155/2021/5596924] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 01/06/2023]
Abstract
Acute ischemic stroke (AIS) is a major cause of acquired adult disability and death. Our previous studies proved the efficacy and effectiveness of Tanhuo decoction (THD) on AIS. However, the therapeutic mechanism remains unclear. We recruited 49 AIS patients and 30 healthy people to explore the effects of THD+basic treatment on the poststroke gut microbiota of AIS patients using 16S rRNA sequencing, in which 23 patients received basic treatment (control group) and 26 patients received THD+basic treatment (THD group). By comparing the data before and after treatments, we found the THD group acquired better outcome than the control group on both clinical outcome indices and the characteristics of gut microbiota. In addition to the mediation on short-chain fatty acid- (SCFA-) producing bacteria in two groups, treatment in the THD group significantly decreased the lipopolysaccharide- (LPS-) producing bacteria to reduce LPS biosynthesis. Besides, the complexity of the cooccurrence of gut microbiota and the competition among LPS-producing bacteria and opportunistic pathogenetic bacteria were enhanced in the THD group. Treatment in the THD group also exhibited the potential in decreasing genes on the biosynthesis of trimethylamine (TMA), the precursor of Trimethylamine N-oxide (TMAO), and increasing genes on the degradation of TMA, especially increasing trimethylamine-corrinoid protein Co-methyltransferase (mttB) which catabolizes TMA to methane. These results hinted that THD+basic treatment might exert its efficacy by mediating the gut microbiota and microbial metabolites, including LPS and TMAO that aggravate the sterile inflammation and platelet aggregation. Moreover, the well-fitting regression model results in predicting the clinical outcome with the alteration of gut microbiota proved gut microbiota as a potential indicator of AIS and provided evidence of the communication between the gut and brain of AIS patients.
Collapse
|
35
|
Wang Y, Liu Y, Liu R, Zhao J. Cluster-randomised controlled trial of Stroke 1-2-0 education programme to reduce stroke prehospital delay in China: a study protocol. BMJ Open 2021; 11:e048064. [PMID: 34035108 PMCID: PMC8154964 DOI: 10.1136/bmjopen-2020-048064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stroke is the leading cause of death and disability in China. The median time of stroke pre-hospital delay is more than 15 hours, mainly due to the lack of awareness on stroke symptoms and calling emergency services. We developed Stroke 1-2-0 recognition tool in China, by adapting Face, Arm, Speech and Time. Our preliminary findings suggested that Stroke 1-2-0 can improve public's knowledge of the stroke symptoms, but its impact on the prehospital delay is still unclear. Furthermore, these findings were mainly obtained from Shanghai, one of the largest metropolises in China. However, more than half of population in China lives in the rural area. Given the striking disparities in socioeconomic status and quality of stroke care across the nation, a multicentre trial is warranted. METHODS AND ANALYSIS Stroke 1-2-0 education programme will adopt a multicentre, cluster-randomised controlled design. We aimed to recruit 32 communities from 16 counties across China. Each county includes two communities having more than 100 000 residents. The two communities sampled in the same county will be randomly assigned to receive either Stroke 1-2-0 education programme or usual care. The primary objective of this study is to evaluate the impact of Stroke 1-2-0 public education programme in reducing stroke prehospital delay among adults residing in the community, compared with the usual care. The intervention will be implemented for 1 year. The primary outcomes are the symptom onset to hospital arrival time ('onset-to-door time', ODT) and 3-hour hospital arriving rate. We will use an intention-to-treat approach. A linear mixed model will be used to control for potential cluster effects. ETHICS AND DISSEMINATION This study is approved by the Shanghai Minhang District Central Hospital Institutional Review Board (Shanghai, China). The findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2000040782.
Collapse
Affiliation(s)
- Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| |
Collapse
|
36
|
Dordoe C, Chen K, Huang W, Chen J, Hu J, Wang X, Lin L. Roles of Fibroblast Growth Factors and Their Therapeutic Potential in Treatment of Ischemic Stroke. Front Pharmacol 2021; 12:671131. [PMID: 33967812 PMCID: PMC8102031 DOI: 10.3389/fphar.2021.671131] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke is the leading cause of death worldwide, and its treatment remains a challenge. Complex pathological processes are involved in stroke, which causes a reduction in the supply of oxygen and energy to the brain that triggers subsequent cascade events, such as oxidative stress, inflammatory responses and apoptosis, resulting in brain injury. Stroke is a devastating disease for which there are few treatments, but physical rehabilitation can help improve stroke recovery. Although there are very few treatments for stroke patients, the discovery of fibroblast growth factors (FGFs) in mammals has led to the finding that FGFs can effectively treat stroke in animal models. As presented in this review, FGFs play essential roles by functioning as homeostatic factors and controlling cells and hormones involved in metabolism. They could be used as effective therapeutic agents for stroke. In this review, we will discuss the pharmacological actions of FGFs on multiple targets, including their ability to directly promote neuron survival, enhance angiogenesis, protect against blood-brain barrier (BBB) disruption, and regulate microglial modulation, in the treatment of ischemic stroke and their theoretical mechanisms and actions, as well as the therapeutic potential and limitations of FGFs for the clinical treatment of stroke.
Collapse
Affiliation(s)
- Confidence Dordoe
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Keyang Chen
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China.,Department of Neurology, The Second Affiliated Hospital and Yuying Children' Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenting Huang
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jun Chen
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jian Hu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xue Wang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Li Lin
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China.,Research Units of Clinical Translation of Cell Growth Factors and Diseases Research, Chinese Academy of Medical Science, Beijing, China
| |
Collapse
|
37
|
Xue Y, Nie D, Wang LJ, Qiu HC, Ma L, Dong MX, Tu WJ, Zhao J. Microglial Polarization: Novel Therapeutic Strategy against Ischemic Stroke. Aging Dis 2021; 12:466-479. [PMID: 33815877 PMCID: PMC7990355 DOI: 10.14336/ad.2020.0701] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
Ischemic stroke, which is the second highest cause of death and the leading cause of disability, represents ~71% of all strokes globally. Some studies have found that the key elements of the pathobiology of stroke is immunity and inflammation. Microglia are the first line of defense in the nervous system. After stroke, the activated microglia become a double-edged sword, with distinct phenotypic changes to the deleterious M1 types and neuroprotective M2 types. Therefore, ways to promote microglial polarization toward M2 phenotype after stroke have become the focus of attention in recent years. In this review, we discuss the process of microglial polarization, summarize the alternation of signaling pathways and epigenetic regulation that control microglial polarization in ischemic stroke, aiming to find the potential mechanisms by which microglia can be transformed into the M2 polarized phenotype.
Collapse
Affiliation(s)
- Yimeng Xue
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,2Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Ding Nie
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin-Jian Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,2Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Han-Cheng Qiu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Long Ma
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming-Xin Dong
- 3Institute of Radiation Medicine, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - Wen-Jun Tu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,3Institute of Radiation Medicine, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - Jizong Zhao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,2Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China.,4China National Clinical Research Center for Neurological Diseases, Beijing, China.,5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,6Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| |
Collapse
|
38
|
Jia B, Ren Z, Mokin M, Burgin WS, Bauer CT, Fiehler J, Mo D, Ma N, Gao F, Huo X, Luo G, Wang A, Pan Y, Song L, Sun X, Zhang X, Gui L, Song C, Peng Y, Wu J, Zhao S, Zhao J, Zhou Z, Li Y, Jing P, Yang L, Liu Y, Zhao Q, Liu Y, Peng X, Gao Q, Guo Z, Chen W, Li W, Cheng X, Xu Y, Zhang Y, Zhang G, Lu Y, Lu X, Wang D, Wang Y, Li H, Ling L, Peng G, Zhang J, Zhang K, Li S, Qi Z, Xu H, Tong X, Ma G, Liu R, Guo X, Deng Y, Leng X, Leung TW, Liebeskind DS, Wang Y, Wang Y, Miao Z. Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry. Stroke 2021; 52:1203-1212. [PMID: 33596674 DOI: 10.1161/strokeaha.120.031869] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population. METHODS We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome. RESULTS Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56-73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55-72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P=0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213-2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065-2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325-3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085-3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098-2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222-13.385]). CONCLUSIONS Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.
Collapse
Affiliation(s)
- Baixue Jia
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Zeguang Ren
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - W Scott Burgin
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - Clayton T Bauer
- Department of Neurosurgery, University of South Florida (Z.R., M.M., W.S.B., C.T.B.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.)
| | - Dapeng Mo
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Ning Ma
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Feng Gao
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xiaochuan Huo
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Gang Luo
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases (A.W., Y. Pan), Beijing Tiantan Hospital, Capital Medical University
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases (A.W., Y. Pan), Beijing Tiantan Hospital, Capital Medical University
| | - Ligang Song
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xuan Sun
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xuelei Zhang
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Liqiang Gui
- Department of Interventional Neuroradiology, Langfang Changzheng Hospital, China (L.G.)
| | - Cunfeng Song
- Department of Interventional Neuroradiology, Liaocheng Third People's Hospital, China (C.S.)
| | - Ya Peng
- Department of Neurosurgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, China (Y. Peng)
| | - Jin Wu
- Department of Neurology, Second Affiliated Hospital of Nanjing Medical University, China (J.W.)
| | - Shijun Zhao
- Department of Interventional Radiology, Fengrun District People's Hospital of Tangshan City, China (S.Z.)
| | - Junfeng Zhao
- Department of Neurology, SiPing Central People's Hospital, China (J. Zhao)
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, China (Z.Z.)
| | - Yongli Li
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, China (Y. Li)
| | - Ping Jing
- Department of Neurology, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, China (P.J.)
| | - Lei Yang
- Department of Neurosurgery, The First Hospital of Shijiazhuang, China (L.Y.)
| | - Yajie Liu
- Department of Neurology, Shenzhen Hospital of Southern Medical University, China (Yajie Liu)
| | - Qingshi Zhao
- Department of Neurology, The People's Hospital of Longhua, China (Q.Z.)
| | - Yan Liu
- Department of Neurology, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, China (Yan Liu)
| | - Xiaoxiang Peng
- Department of Neurology, Hubei Third People's Hospital, China (X.P.)
| | - Qingchun Gao
- Department of Neurology, Institute of Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, China (Q.G.)
| | - Zaiyu Guo
- Department of Neurosurgery, Tianjin TEDA Hospital, China (Z.G.)
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.)
| | - Weirong Li
- Department of Neurology, Taiyuan Central Hospital, China (W.L.)
| | - Xiaojiang Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, China (X.C.)
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, China (Y.X.)
| | - Yongqiang Zhang
- Department of Neurosurgery, Wenling First People's Hospital, China (Y.Z.)
| | - Guilian Zhang
- Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, China (G.Z.)
| | - Yijiu Lu
- Department of Internal Neurology, The First People's Hospital of Yulin, China (Y. Lu)
| | - Xinyu Lu
- Department of Neurosurgery, Zhenjiang First People's Hospital, China (X. Lu)
| | - Dengxiang Wang
- Department of Neurology, Qitaihe Coal General Hospital, China (D.W.)
| | - Yan Wang
- Stroke Center, People's Hospital of Tangshan City, China (Yan Wang)
| | - Hao Li
- Department of Neurology, Affiliated Hospital Guilin Medical University, China (H.L.)
| | - Li Ling
- Department of Neurology, The Affiliated Hospital of Hebei University, China (L.L.)
| | - Guangge Peng
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Jingyu Zhang
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Kai Zhang
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Shuo Li
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Zhongqi Qi
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Haifeng Xu
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xu Tong
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Gaoting Ma
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Raynald Liu
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xu Guo
- Department of Neurointervetion, Beijing Anzhen Hospital, Capital Medical University, China (X.G.)
| | - Yiming Deng
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, China (X. Leng, T.W.L.)
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, China (X. Leng, T.W.L.)
| | | | - Yilong Wang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Tiantan Clinical Trial and Research Center for Stroke (Yilong Wang), Beijing Tiantan Hospital, Capital Medical University
- Beijing Tiantan Hospital, Capital Medical University, China (Yongjun Wang)
| | | | - Zhongrong Miao
- Interventional Neuroradiology Center (B.J., D.M., N.M., F.G., X.H., G.L., L.S., X.S., X.Z., G.P., J. Zhang, K.Z., S.L., Z.Q., H.X., X.T., G.M., R.L., Y.D., Z.M.), Beijing Tiantan Hospital, Capital Medical University
| | | |
Collapse
|
39
|
Tong X, Wang Y, Fiehler J, Bauer CT, Jia B, Zhang X, Huo X, Luo G, Wang A, Pan Y, Ma N, Gao F, Mo D, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Ma G, Wang Y, Ren Z, Miao Z. Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke: A Matched-Control Study. Stroke 2021; 52:1589-1600. [PMID: 33657849 DOI: 10.1161/strokeaha.120.031599] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Xu Tong
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yilong Wang
- Department of Neurology (Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases (A.W., Y.P., Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.)
| | - Clayton T Bauer
- Department of Neurosurgery, University of South Florida, Tampa (C.T.B., Z.R.)
| | - Baixue Jia
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xuelei Zhang
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Gang Luo
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases (A.W., Y.P., Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases (A.W., Y.P., Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China
| | - Ning Ma
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Feng Gao
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Ligang Song
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xuan Sun
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Lian Liu
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yiming Deng
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | | | | | | | | | - Zeguang Ren
- Department of Neurosurgery, University of South Florida, Tampa (C.T.B., Z.R.)
| | - Zhongrong Miao
- Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China
| | | |
Collapse
|
40
|
Berge E, Whiteley W, Audebert H, De Marchis GM, Fonseca AC, Padiglioni C, de la Ossa NP, Strbian D, Tsivgoulis G, Turc G. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J 2021; 6:I-LXII. [PMID: 33817340 DOI: 10.1177/2396987321989865] [Citation(s) in RCA: 482] [Impact Index Per Article: 160.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
Intravenous thrombolysis is the only approved systemic reperfusion treatment for patients with acute ischaemic stroke. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions with regard to intravenous thrombolysis for acute ischaemic stroke. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Expert consensus statements were provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high quality evidence to recommend intravenous thrombolysis with alteplase to improve functional outcome in patients with acute ischemic stroke within 4.5 h after symptom onset. We also found high quality evidence to recommend intravenous thrombolysis with alteplase in patients with acute ischaemic stroke on awakening from sleep, who were last seen well more than 4.5 h earlier, who have MRI DWI-FLAIR mismatch, and for whom mechanical thrombectomy is not planned. These guidelines provide further recommendations regarding patient subgroups, late time windows, imaging selection strategies, relative and absolute contraindications to alteplase, and tenecteplase. Intravenous thrombolysis remains a cornerstone of acute stroke management. Appropriate patient selection and timely treatment are crucial. Further randomized controlled clinical trials are needed to inform clinical decision-making with regard to tenecteplase and the use of intravenous thrombolysis before mechanical thrombectomy in patients with large vessel occlusion.
Collapse
Affiliation(s)
- Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Oslo, Norway
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Heinrich Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin & Center for Stroke Research Berlin, Berlin, Germany
| | - Gian Marco De Marchis
- University Hospital of Basel & University of Basel, Department for Neurology & Stroke Center, Basel, Switzerland
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Chiara Padiglioni
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hopital Sainte-Anne, Université de Paris, Paris, France.,INSERM U1266.,FHU NeuroVasc
| |
Collapse
|
41
|
Cheng CY, Chen SH, Chen HM, Li CJ, Liu TY, Tan TY. Impact of estimated-weight-base dose of alteplase in acute stroke treatment on clinical outcome. J Clin Neurosci 2021; 85:101-105. [PMID: 33581779 DOI: 10.1016/j.jocn.2020.12.024] [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: 08/09/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
Dosing of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke treatment is often based on estimated body weight (BW) worldwide in routine clinical practice due to infeasible of accurate BW measurement. The aim of our study is to explore the impact of estimated BW when dosing rt-PA in acute ischemic stroke treatment on clinical outcome. Between January 2013 to May 2018, 126 acute ischemic stroke patients received intravenous rt-PA treatment based on estimated BW dosage were recruited. All patients had actual BW measured in ward after treatment. Based on the dosage of rt-PA given, patients were categorized into three groups, standard dose (0.8-1.0 mg/kg), overdose (>1.0 mg/kg), and underdose (<0.8 mg/kg). Among all 126 patients, 101 (80.2%) patients were treated with standard dose, 12 (9.5%) patients with overdose, and 13 (10.3%) patients with underdose of rt-PA respectively. There was no significant difference between demographic characteristics, pre-morbid risk factors, National Institutes of Health Stroke Scale (NIHSS) score at 24 h, NIHSS score at discharge, modified Rankin scale (mRS) within 0 to 2 in discharge or in 3 months after the event within the three groups. There was also no significant difference in hemorrhagic transformation and symptomatic intracranial hemorrhage (SICH). In conclusion, calculation of the dose of rt-PA based upon the estimated BW to treat acute ischemic stroke patients had no negative impact on the clinical outcome in our study.
Collapse
Affiliation(s)
- Chi-Yung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Shih-Hsuan Chen
- Division of Cerebrovascular Disease, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Hsiu-Min Chen
- Division of Cerebrovascular Disease, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Chao-Jui Li
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Tzu-Yun Liu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Teng-Yeow Tan
- Division of Cerebrovascular Disease, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
| |
Collapse
|
42
|
Che B, Zhu Z, Bu X, Yin J, Han L, Xu T, Ju Z, Liu J, Zhang J, Chen J, He J, Zhang Y, Zhong C. Multiple biomarkers covering several pathways for the prediction of depression after ischemic stroke. J Affect Disord 2021; 280:442-449. [PMID: 33242715 DOI: 10.1016/j.jad.2020.10.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To assess the potential incremental utility of multiple biomarkers reflecting several pathological pathways for the risk prediction of depression after stroke. METHODS We used data from the China Antihypertensive Trial in Acute Ischemic Stroke, and a panel of 13 circulating biomarkers were measured. The study outcome was depression (24-item Hamilton Depression Rating Scale score≥8) at 3 months after ischemic stroke. Logistic regression models were performed to evaluate the risk of depression associated with multiple biomarkers. Discrimination and risk reclassification for depression were analyzed. RESULTS Among 631 included ischemic stroke patients, elevated growth differentiation factor-15, anticardiolipin antibodies, antiphosphatidylserine antibodies and matrix metalloproteinase-9 were individually associated with increased risks of depression after stroke. The multiple biomarker analysis showed a clear gradient in the risk of depression with increasing numbers of elevated biomarkers, and multivariate adjusted odds ratio (95% confidence interval) of patients with 4 elevated biomarkers was 6.52 (2.24-18.95) compared with those without elevation in any of 4 biomarkers. The simultaneous inclusion of all 4 biomarkers to the conventional model significantly improved discrimination (C statistic increased from 0.702 to 0.748, P=0.004) and risk reclassification (net reclassification improvement 45.0%; integrated discrimination improvement 6.2%; both P<0.001) for depression after stroke. LIMITATIONS We selected biomarkers that had previously been reported to be promising predictors of depression after stroke, while other novel biomarkers not tested might have additional predictive value. CONCLUSIONS Simultaneously adding multiple biomarkers from several pathophysiological pathways to traditional risk factors provided substantial incremental utility of the risk stratification for depression after stroke.
Collapse
Affiliation(s)
- 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, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, 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, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China; Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jieyun Yin
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR 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, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China
| | - Jiale Liu
- Department of Neurology, Jilin Central Hospital, Jilin, China
| | - Jintao Zhang
- Department of Neurology, the 88th Hospital of PLA, Taian, Shandong, 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
| | - 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
| | - 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, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, 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, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.
| |
Collapse
|
43
|
Ding R, Zhang H. Effects of Magnetic Nanoparticle Drug Delivery Systems on Thrombosis and Neuroprotection in Brain Stroke Model. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:859-867. [PMID: 33183417 DOI: 10.1166/jnn.2021.18654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nanomaterials refer to solid materials that are composed of ultrafine particles on the order of nanometers. Nanomaterials show broad application prospects in the fields of chemistry, metallurgy, electronics, aerospace, biology and medicine. The incidence of stroke in China ranks first in the world and the mortality rate is much higher than that in European and American countries. Drugs that are sensitive to the internal environment of the living body can be combined in the nuclear department to prevent them from reacting with the biological environment before reaching the target site, thereby reducing the efficacy or causing toxic side effects on other cells, tissues and organs. This project uses transgenic mice as experimental materials to establish an animal model of cerebral stroke. The light-embedded stroke model is used to simulate the pathological state of acute ischemic stroke. In vivo imaging and immunohistochemical techniques are used to analyze the administration of magnetic nanoparticles. Effects of the system on thrombolysis and neurological function protection in cerebral stroke models.
Collapse
Affiliation(s)
- Ruolan Ding
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan Province, China
| | - Hong Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan Province, China
| |
Collapse
|
44
|
Zheng S, Lyu TJ, Li Z, Gu H, Yang X, Wang C, Li H, Jiang Y, Shen H, Wang Y. GRP per capita and hospital characteristics associated with intravenous tissue plasminogen activator adherence rate: evidence from the Chinese Stroke Center Alliance. Stroke Vasc Neurol 2021; 6:337-343. [PMID: 33431514 PMCID: PMC8485228 DOI: 10.1136/svn-2020-000633] [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: 09/16/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Timely delivery of intravenous tissue plasminogen activator (IV-rt PA) is pivotal to eligible patients who had a stroke while achieving higher rates of IV-rt PA has been problematic. This paper focuses on investigating influential factors associated with the administration of IV-rt PA, primarily per capita gross regional product (GRP) and healthcare system factors. Methods The study included 980 hospitals in the Chinese Stroke Center Alliance where 158 003 patients who had an acute ischaemic stroke received IV-rt PA between August 2015 and August 2019. The adherence rate to IV-rt PA within 4.5 hours time window in each hospital was the primary outcome. Influential factors were grouped into two categories: macroeconomic status and hospital characteristics. The outcome was analysed using multivariable linear regression. Results GRP per capita (β=2.37, p<0.001), hospital stroke centre certification (β=3.77, p<0.001), number of neurologists (β=0.12, p<0.001), existence of emergency services for neurological treatment (β=7.43, p=0.014), presence of emergency department (β=10.03, p=0.019) and cooperating with emergency centre (β=4.65, p=0.029) were significantly positively associated with the adherence rate to IV-rt PA. Conclusions Higher GRP per capita, affluent neurological personnel, well-equipped emergency services for neurological treatment and routine cooperation with the emergency centre were important for enhancing the adherence rate to IV-rt PA among patients who had an acute ischaemic stroke in China.
Collapse
Affiliation(s)
- Suxi Zheng
- Innvotion and Information Management, HKU Business School, The University of Hong Kong, Hong Kong, China
| | - Tian Jie Lyu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunjuan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haipeng Shen
- Innvotion and Information Management, HKU Business School, The University of Hong Kong, Hong Kong, China .,Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
45
|
Lu Y, Qian S, Chen H, Yuan P, Zhang R, Wang A, Zhang J, Ju Z, Zhang Y, Xu T, Zhong C. Plasma soluble suppression of tumorigenicity 2 and depression after acute ischemic stroke. Eur J Neurol 2021; 28:868-876. [PMID: 33368822 DOI: 10.1111/ene.14699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Soluble suppression of tumorigenicity 2 (sST2) might be related to stroke and depression, but the association of sST2 with poststroke depression (PSD) is unclear. The study aimed to prospectively assess the association between plasma sST2 levels and PSD. METHODS A total of 635 acute ischemic stroke patients with sST2 measurements from the China Antihypertensive Trial in Acute Ischemic Stroke were included in this analysis. We used the 24-item Hamilton Rating Scale for Depression to assess depression at 3 months, and PSD was defined as a score of ≥8. Logistic regression analysis was performed to estimate the risk of PSD associated with sST2, and net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to assess the predictive value of sST2. RESULTS Two hundred fifty (39.4%) patients developed depression at 3 months after ischemic stroke. Patients with PSD had higher sST2 levels than patients without PSD (172.7 vs. 153.8 pg/ml; p = 0.003). After adjustment for age, sex, education, National Institutes of Health Stroke Scale score, and other covariates, the odds ratio for the highest quartile of sST2 compared with the lowest quartile was 1.84 (95% confidence interval, 1.10-3.08) for PSD. Adding sST2 to a conventional model notably improved risk prediction for PSD (category-free NRI = 19.34%, 95% confidence interval = 4.39%-34.28%, p = 0.017; IDI = 1.20%, 95% confidence interval = 0.25%-2.15%, p = 0.014). CONCLUSIONS Increased plasma sST2 levels in the acute phase of ischemic stroke were significantly associated with the increased risk of PSD, independently of conventional risk factors.
Collapse
Affiliation(s)
- Yaling Lu
- 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
| | - Sifan Qian
- 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
| | - Haichang Chen
- 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
| | - Pengcheng Yuan
- 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
| | - Rui 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
| | - 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
| | - Jintao Zhang
- Department of Neurology, 88th Hospital of PLA, Shandong, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, China
| | - 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
| | - 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
| | - 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
| |
Collapse
|
46
|
Zheng X, Zhu Z, Guo D, Zhong C, Xu T, Peng Y, Wang A, Peng H, Ju Z, Geng D, Zhang Y, He J. Prognostic value of plasma fibroblast growth factor 21 among patients with acute ischemic stroke. Eur J Neurol 2021; 28:844-851. [PMID: 33320402 DOI: 10.1111/ene.14683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the association between plasma fibroblast growth factor 21 (FGF-21) and clinical outcomes in patients with acute ischemic stroke. METHODS A total of 3412 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke with plasma FGF-21 measurements were included in this analysis. The primary outcome was a combination of death or major disability (modified Rankin Scale score ≥3) within 1 year after stroke. RESULTS During the 1-year of follow-up, 745 (21.83%) patients experienced the primary outcome; 550 had a major disability and 195 died. After multivariate adjustment, higher plasma FGF-21 was significantly associated with increased risk of the primary outcome (odds ratio = 1.52, 95% confidence interval = 1.11-1.29). Each 1-SD increase of log-transformed FGF-21 (0.67 pg/ml) was associated with 19%, 3%, and 33% increased risk of the primary outcome, major disability, and death, respectively. The addition of FGF-21 to the conventional risk factors significantly improved prediction of the primary outcome in ischemic stroke patients (net reclassification index = 10.8%, p = 0.011; integrated discrimination improvement = 0.3%, p = 0.038). CONCLUSIONS Higher plasma FGF-21 was associated with poor prognosis in acute ischemic stroke patients, suggesting that FGF-21 may be a prognostic marker for ischemic stroke.
Collapse
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, Jiangsu, 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, Jiangsu, China.,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Daoxia Guo
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Jiangsu, 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, Jiangsu, 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, Jiangsu, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Hebei, 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, Jiangsu, 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, Jiangsu, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao City, China
| | - Deqin Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - 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, Jiangsu, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
El-khatib MES, El Ahwal SA, Masoud M, El Mously S. Knowledge of the Egyptian emergency physicians about the use of rt-PA in acute ischemic stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The administration of recombinant tissue plasminogen activator (rt-PA) has increased the focus on acute ischemic stroke (AIS) as an emergency condition. The emergency physicians have to rapidly recognize the patients who are candidates for rt-PA and refer them to the specialized stroke team within the proper time window. The knowledge of the emergency physicians about the benefit and the drawbacks of this therapy is crucial and it affects their attitudes towards its use.
Objective
To apply a survey on the Egyptian emergency physicians aiming to investigate their knowledge about the use rt-PA therapy in AIS.
Methodology
A self-administered questionnaire was sent to the emergency physicians who are working in three Egyptian governorates.
Results
Out of 120 emergency physicians, the total knowledge of the study group was good with a score of 7 ± 1.8/11. Most of the participants mentioned the correct answers (over 50%) for all items except for one question regarding the blood glucose control before the use of rt-PA. Significant positive correlation was noted between the knowledge score and the age.
Conclusions
The surveyed emergency physicians had a good knowledge about the use of rt-PA in AIS, yet, this knowledge is mainly theoretical. Therefore, tutorials, clinical training, and active engagement in the stroke care team are warranted to improve their clinical practice.
Collapse
|
49
|
Ouyang M, Zhang Y, Wang X, Song L, Billot L, Robinson T, Lavados PM, Arima H, Hackett ML, Olavarría VV, Muñoz-Venturelli P, Middleton S, Watkins CL, Pontes-Neto OM, Lee TH, Brunser AM, Anderson CS. Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study. J Neurol Sci 2020; 419:117187. [DOI: 10.1016/j.jns.2020.117187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/22/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
|
50
|
Fan L, Han W, Zhang Y, Zhou M, Ye H, Chen W, Su Y. Risk factors for ineffective recanalization after endovascular treatment in acute ischemic stroke. Clin Neurol Neurosurg 2020; 200:106362. [PMID: 33243698 DOI: 10.1016/j.clineuro.2020.106362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the risk factors of early ineffective recanalization, defined as a modified Rankin scale (mRS) score of 4∼6 at two weeks after symptom onset, in acute ischemic stroke (AIS) patients receiving endovascular treatment (EVT). METHOD One hundred eighty-four AIS patients who received EVT in 01/2016-12/2018 were analyzed. The recanalization rate was 81.5 % (150/184). Patients were divided into effective (mRS 0-3) and ineffective (mRS 4-6) recanalization groups. The independent risk factors for ineffective recanalization were analyzed. RESULT The ineffective recanalization rate was 67.3 % (101/150 cases) at 14 days after symptom onset. Twenty-five patients (24.8 %) in the ineffective recanalization group had coronary heart disease, higher than that in the effective group (4 patients, 8.2 %, P = 0.016). Infratentorial pathology accounted for 34.7 % (35 cases) of the ineffective group and only 14.3 % (7 cases) of the control group (P = 0.011). Systolic blood pressure (SBP) was higher in the ineffective group than in the effective group (146 mmHg vs 140 mmHg, P = 0.038). General anesthesia was more common in the ineffective group than in the control group (49 cases, 48.5 %, vs 9 cases, 18.4 %; P = 0.000). Logistic regression showed that coronary heart disease (odds ratio (OR) = 3.399, 95 % confidence interval (CI) 1.013-11.401, P = 0.048), unconsciousness before EVT (OR = 4.292, 95 % CI 1.963-9.386, P = 0.000), SBP (OR = 1.016, 95 % CI 0.997-1.035, P = 0.090) and general anesthesia (OR = 3.378, 95 % CI 1.395-8.180, P = 0.007) were independent risk factors for ineffective recanalization. CONCLUSION Patients with coronary heart disease, unconsciousness before EVT, elevated SBP and general anesthesia need precise assessment to benefit from EVT.
Collapse
Affiliation(s)
- Linlin Fan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Han
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China; Department of Neurology, Affiliated Hospital of Jiang Su University, Zhejiang, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Meijun Zhou
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China; Department of Neurology, The Fourth Hospital of Changsha, Changsha, China
| | - Hong Ye
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| |
Collapse
|