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Zhou Y, Luo Y, Liang H, Wei Z, Ye X, Zhong P, Wu D. Predictors of early neurological deterioration in patients with acute ischemic stroke. Front Neurol 2024; 15:1433010. [PMID: 39233686 PMCID: PMC11371773 DOI: 10.3389/fneur.2024.1433010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024] Open
Abstract
Background The present study aimed to develop a reliable and straightforward Nomogram by integrating various parameters to accurately predict the likelihood of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods Acute ischemic stroke patients from Shaoxing People's Hospital, Shanghai Yangpu District Shidong Hospital, and Shanghai Fifth People's Hospital were recruited based on specific inclusion and exclusion criteria. The primary outcome was END. Using the LASSO logistic model, a predictive Nomogram was generated. The performance of the Nomogram was evaluated using the ROC curve, the Hosmer-Lemeshow test, and a calibration plot. Additionally, the decision curve analysis was conducted to assess the effectiveness of the Nomogram. Results It was found that the Nomogram generated in the present study showed strong discriminatory performance in both the training and the internal validation cohorts when their ROC-AUC values were 0.715 (95% CI 0.648-0.782) and 0.725 (95% CI 0.631-0.820), respectively. Similar results were observed in two external validation cohorts when their ROC-AUC values were 0.685 (95% CI 0.541-0.829) and 0.673 (95% CI 0.545-0.800), respectively. In addition, CAD, SBP, neutrophils, TBil, and LDL were found to be positively correlated with the occurrence of END post-stroke, while lymphocytes and UA were negatively correlated. Conclusion Our study developed a novel Nomogram that includes CAD, SBP, neutrophils, lymphocytes, TBil, UA, and LDL and it demonstrated strong discriminatory performance in identifying AIS patients who are likely to develop END.
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Affiliation(s)
- Yang Zhou
- Emergency Department, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Yufan Luo
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Huazheng Liang
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou, Jiangsu Province, China
- Southeast University-Monash University Joint Graduate School, Suzhou, Jiangsu Province, China
- Monash University-Southeast University Joint Research Institute, Suzhou, Jiangsu Province, China
| | - Zhenyu Wei
- Department of Neurology, Shanghai Yangpu District Shidong Hospital, Shanghai, China
| | - Xiaofei Ye
- Department of Military Health Statistics, School of Health Service, People's Liberation Army, Naval Medical University, Shanghai, China
| | - Ping Zhong
- Department of Neurology, Shanghai Yangpu District Shidong Hospital, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
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Zhou Q, Xu Z, Duan Y, Tang H, Zhang H, Liu H. MTHFR C677T, hyperhomocysteinemia, and their interactions with traditional risk factors in early neurological deterioration in Chinese patients with ischemic stroke. Heliyon 2024; 10:e31003. [PMID: 38784530 PMCID: PMC11112322 DOI: 10.1016/j.heliyon.2024.e31003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aimed to investigate the relationship between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and early neurological deterioration (END) in patients with acute ischemic stroke (AIS) and any possible interactions between specific MTHFR alleles and traditional risk factors among a Han Chinese cohort. Methods 434 AIS patients were consecutively recruited between January 2017 and June 2019, including 129 END and 305 non-END cases. A candidate gene association study design was used to analyze the association between MTHFR gene polymorphism and END risk. The polymerase chain reaction-restriction fragment length polymorphism (RFLP) method was employed to genotype the MTHFR C677T polymorphism. The interactional analyses were performed using the multifactor dimensionality reduction test. Results Hyperglycemia (odds ratio [OR]: 2.410, 95 % confidence interval [CI]: 1.436-4.046, p = 0.001), neurological function impairment (NIHSS score >5) (OR: 2.158, 95%CI: 1.337-3.484, p = 0.002) on admission, and hyperhomocysteinemia (HHcy) (OR: 2.570, 95%CI: 1.229-5.376, p = 0.012) were independently associated with END. The TT genotype (OR: 1.710, 95%CI: 1.021-2.863, p = 0.043) and T allele (OR: 1.710, 95%CI: 1.021-2.863, p = 0.043) of this C677T polymorphism were associated with susceptibility to END, and the TT genotype was more common in the subjects with HHcy (OR: 2.525, 95%CI: 1.111-5.739, P = 0.023). In addition, we also found interactions for END risk between the C677T polymorphism and traditional risk factors for END, including: hyperglycemia on admission, drinking, and moderate to severe neurological deficits (OR 1.237, 95 % CI 0.227-6.734), although the results were not statistically significant (p = 0.806). Conclusions Our results show a possible association between MTHFR C677T polymorphism and gene-environment interactions with END susceptibility in a Han Chinese cohort.
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Affiliation(s)
- Qiang Zhou
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Zhiyao Xu
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Yuanyuan Duan
- Department of Neurology, the People's Hospital of Mianyang, Mianyang, Sichuan 621000, PR China
| | - Hui Tang
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Haitao Zhang
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
| | - Hua Liu
- Department of Neurology, the Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, PR China
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Misirlioglu NF, Uzun N, Ozen GD, Çalik M, Altinbilek E, Sutasir N, Baykara Sayili S, Uzun H. The Relationship between Neutrophil-Lymphocyte Ratios with Nutritional Status, Risk of Nutritional Indices, Prognostic Nutritional Indices and Morbidity in Patients with Ischemic Stroke. Nutrients 2024; 16:1225. [PMID: 38674915 PMCID: PMC11054104 DOI: 10.3390/nu16081225] [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: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: In recent years, whole blood parameters and derivatives have been used as prognostic criteria in the course of various diseases. The aim of this study was to evaluate the relationship between parameters such as the neutrophil-lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), the prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, nutritional risk index (NRI) and immunonutrition status and disease activity in patients with ischemic stroke of the small-vessel, large-vessel and other etiologies. Methods: We retrospectively evaluated the records of 1454 consecutive ischemic stroke patients hospitalized in the emergency department of Gaziosmanpasa Education and Research Hospital from 2019 to 2023. Results: Of the 1350 patients with ischemic stroke included in the study, 58.8% had small-vessel disease, 29.3% had large-vessel disease and 11.9% had other etiologies. There was a significant difference between the three etiology groups for PNI and CONUT. The mean of PNI was 47.30 ± 8.06 in the other etiology group, 37.25 ± 7.23 in the small-vessel group, and 34.78 ± 8.16 in the large-vessel disease group. The mean of CONUT was 5.49 ± 1.20 in the small-vessel group, 5.12 ± 1.46 in the large-vessel group and 4.22 ± 1.11 in the other etiology group. In addition, CONUT and PNI were also found to be independent risk factors for mortality. A negative significant correlation was observed between PNI and NLR (r: -0.692), SII (r: -0.591), and CONUT (r: -0.511). Significant correlations were observed between CONUT and NLR (r: 0.402), SII (r: 0.312). Conclusions: PNI, CONUT and NRI were found as more accurate prognostic indicators of nutritional status in patients with ischemic stroke. NLR and SII may be important predictive markers in the course and prognosis of stroke.
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Affiliation(s)
- Naile Fevziye Misirlioglu
- Department of Biochemistry, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey;
| | - Nedim Uzun
- Department of Emergency, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (N.U.); (M.Ç.)
| | - Gulenay Defne Ozen
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada;
| | - Mustafa Çalik
- Department of Emergency, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (N.U.); (M.Ç.)
| | - Ertugrul Altinbilek
- Department of Emergency, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (E.A.); (N.S.)
| | - Necmettin Sutasir
- Department of Emergency, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (E.A.); (N.S.)
| | - Sena Baykara Sayili
- Emergency Department, Istanbul Training and Research Hospital, Istanbul 34075, Turkey;
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul 34403, Turkey
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Cui Y, Chen Y, Nguyen TN, Chen H. Duration of Remote Ischemic Conditioning and Outcome in Acute Ischemic Stroke. J Am Heart Assoc 2024; 13:e033609. [PMID: 38533936 PMCID: PMC11179777 DOI: 10.1161/jaha.123.033609] [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: 11/17/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Remote ischemic conditioning has been found to be effective in improving functional outcomes in acute ischemic stroke. We conducted a post hoc analysis of the RICAMIS (Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) trial to determine whether long-term remote ischemic conditioning duration after stroke onset is associated with better clinical outcomes in ischemic stroke. METHODS AND RESULTS Patients from the full analysis set were included in this secondary analysis. The primary outcome was the proportion of patients with an excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. Among the 1776 patients, there were 55 patients in the 1 to 7 days remote ischemic conditioning group, 345 in the 8 to 10 days group, 412 in the 11 to 13 days group, 51 in the 14 to 16 days group, and 913 in the control group. Compared with the control group, a significantly higher proportion of excellent functional outcomes at 90 days was found in the 11 to 13 days remote ischemic conditioning group (adjusted absolute difference, 9.1% [95% CI, 3.7%-14.5%]; P =0.001), which was attenuated in the other groups (adjusted absolute difference in the 8-10 days group, 2.0% [95% CI, -4.0% to 8.0%]; P=0.51; adjusted absolute difference in the 14-16 days group, 7.4% [95% CI, -5.8% to 20.5%]; P=0.27), but compared to the control group, there was lower proportion of excellent functional outcomes in the 1 to 7 days group (adjusted absolute difference, -14.4% [95% CI, -27.8% to 0.0%]; P=0.05). CONCLUSIONS Among patients with acute moderate ischemic stroke, a higher likelihood of excellent clinical outcome was found in patients with longer duration of remote ischemic conditioning.
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Affiliation(s)
- Yu Cui
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Yi‐Ning Chen
- Department of OncologyThe First Affiliated Hospital of China Medical UniversityShenyangChina
| | - Thanh N. Nguyen
- Department of NeurologyRadiology, Boston Medical CenterBostonMAUSA
| | - Hui‐Sheng Chen
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
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Sharma A, Pandit AK, Mishra B, Srivastava MVP, Srivastava AK, Vishnu VY, Singh RK. Early neurological deterioration in acute ischemic stroke. Ir J Med Sci 2024; 193:949-955. [PMID: 37561387 DOI: 10.1007/s11845-023-03485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS Early neurological deterioration (END) in acute ischemic stroke (AIS), patients is defined as clinical worsening or recurrence during first 72 h after onset of AIS. We have conducted this study to determine the association between END and functional outcome at 3 months of onset of AIS along with associated risk factors of END in AIS cases. METHODOLOGY This study was conducted after approval of Institute Ethics Committee. Two hundred three consecutive patients were admitted from September 2020 to January 2022 at a tertiary care hospital. One hundred ninety patients were included in the study; patients were divided into two groups: (1) early neurological deterioration (END) and (2) non-early neurological deterioration (non-END). Patients were followed-up either telephonically or in person at approximately 3 months using modified Rankin Scale 0-6. All the clinically significant prognostic markers and p < 0.10 variables were considered significant in univariate analysis; P < 0.05 were considered statistically significant for the multivariate analysis. RESULTS Out of 190 cases included in the cohort 34/190 (17.8%) cases showed END with mean age (56.56 (± 16.6)) and males (20/34 (58.8%)). END was independently associated with high blood glucose at admission (OR = 1.015; P = 0.002; 95%CI = 1.005-1.024) and low serum albumin (OR = 0.208; P = 0.002; 95%CI = 0.077-0.562). Patients with END showed poor functional outcome (mRS > 2) at end of 3 months (32 (94.1%); P < 0.001) and death was also statistically significant (22 (64.7%); P < 0.001) as compared to AIS cases having non-END. CONCLUSION Our study showed END may be associated with poor functional outcome in AIS patients. Higher blood glucose at admission and low serum albumin may be statistically significant causing END. Future prospective cohort with larger sample size may confirm the findings.
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Affiliation(s)
- Archana Sharma
- Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishor Pandit
- Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Biswamohan Mishra
- Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Achal Kumar Srivastava
- Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Zou K, Wei C, Huang Q, Xu Z, Mao X, Zhang H, Zeng C, Zhang L, Lin J, Yi Y, Zhang J. Glycated serum protein is independently associated with progressive infarction in patients with acute ischemic stroke. J Int Med Res 2024; 52:3000605241245299. [PMID: 38613248 PMCID: PMC11016233 DOI: 10.1177/03000605241245299] [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: 12/08/2023] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE This study investigated the relationship between glycated serum protein (GSP) and progressive infarction (PI). METHODS From April 2017 to December 2020, we recruited 477 patients within 48 hours after the onset of acute ischemic stroke into this case-control study. Demographic characteristics, clinical information, and laboratory and neuroimaging data were recorded after admission. RESULTS PI occurred in 144 (30.8%) patients. Patients with PI had higher initial National Institute of Health Stroke Scale (NIHSS) scores, higher discharge NIHSS scores, higher modified Rankin scale scores at 3 months after onset, higher GSP levels, lower prothrombin times, and lower creatinine levels than patients without PI. The likelihood of PI increased with increases in the GSP quartile. Multiple regression analysis revealed that high GSP levels (>2.14 mmol/L) were independently associated with PI. Subgroup analyses identified high GSP levels as an independent predictor of PI in patients with large artery atherosclerosis (third quartile: odds ratio [OR] = 3.793; 95% confidence interval [CI] = 1.555-9.250; fourth quartile: OR = 2.675; 95% CI = 1.056-6.776) and anterior circulation small vessel occlusion (fourth quartile: OR = 13.859; 95% CI = 2.024-94.885). CONCLUSIONS GSP might be an independent predictor for PI in certain patients with acute ischemic stroke.
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Affiliation(s)
| | | | - Qin Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zubing Xu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaocheng Mao
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hudie Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chenying Zeng
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lanjiao Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Lin
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Jinchong Zhang
- Jinchong Zhang, First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Road, Nanchang, Jiangxi 330000, China.
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Jin X, Li X, Zhang H, Yao X, Gu Y, Pei S, Hu L. The effect of argatroban on early neurological deterioration and outcomes in minor ischemic stroke: preliminary findings. Front Neurol 2024; 15:1363358. [PMID: 38523614 PMCID: PMC10957773 DOI: 10.3389/fneur.2024.1363358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background Minor ischemic stroke (MIS) is associated with early neurological deterioration (END) and poor prognosis. Here, we investigated whether argatroban administration can mitigate MIS-associated END and improve functional outcomes by monitoring activated partial thrombin time (APTT). Methods Data were collected for patients with MIS admitted to our hospital from January 2019 to December 2022. Patients were divided into a dual antiplatelet therapy (DAPT) group (aspirin + clopidogrel) and an argatroban group (aspirin + argatroban). Those in the latter group who achieved a target APTT of 1.5-3-fold that of baseline and <100 s at 2 h after argatroban infusion were included in the argatroban subgroup. The primary outcome was the END rate of the DAPT group versus that of the argatroban group or the argatroban subgroup. Secondary outcomes included the proportion of patients with modified Rankin Scale (mRS) 0-2 at 7 and 90 days. In addition, baseline date were compared between patients with and without END in the argatroban group. Results 363 patients were included in the DAPT group and 270 in the argatroban group. There were no significant differences in any above outcome between them. 207 pairs were included in the DAPT group and the argatroban subgroup after 1:1 propensity score matching (PSM). Significant differences were observed in the proportion of END (OR, 2.337; 95% CI, 1.200-4.550, p = 0.011) and mRS 0-2 at 7 days (OR, 0.624; 95% CI, 0.415-0.939, p = 0.023), but not in mRS 0-2 at 90 days or the hemorrhagic events between the two groups. In the argatroban group, univariate analysis showed that the rate of diabetes (OR, 2.316; 95% CI, 1.107-4.482, p = 0.023), initial random blood glucose (OR, 1.235; 95% CI, 1.070-1.425, p = 0.004), drinking history (OR, 0.445; 95% CI, 0.210-0.940, p = 0.031) or those reaching the target APTT (OR, 0.418; 95% CI, 0.184-0.949, p = 0.033) was significantly different among patients with and without END. However, there were no statistical differences in these parameters between them following multivariate analysis. Conclusion In patients with MIS, argatroban administration and reaching the target APTT can reduce the incidence of END and improve short-term functional prognosis.
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Affiliation(s)
- Xuehong Jin
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Xia Li
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Hong Zhang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Xiaohan Yao
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Yongquan Gu
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Shaofang Pei
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Lan Hu
- Department of Neurology, Suzhou Ninth People’s Hospital, Soochow University, Suzhou, China
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Lin J, Ruan S, Sun W, Dong L, Li S, Huang Q, Mao X, Zhang J, Zou K, Zhang H, Huang P, Fang P, Li X, Fan Y, Hong D. A novel score to predict progression in anterior circulation single subcortical infarction patients. Ann Clin Transl Neurol 2024; 11:791-799. [PMID: 38303588 DOI: 10.1002/acn3.52003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Progressive infarction (PI) has a negative effect on functional prognosis. Our study aimed to develop and validate a risk score for predicting PI in patients with anterior circulation single subcortical infarction (ACSSI). METHODS Between January 2020 and October 2022, we retrospectively enrolled 638 eligible patients with ACSSI. Two-thirds of the eligible patients were randomly allocated to the training cohort (n = 425). Another resampling sample was formed through the bootstrap method and was used as the validation group (n = 425). Multivariate logistic regression analysis was used to identify the independent factors associated with PI. Each factor was then point assigned based on β-coefficient and a risk scoring system was developed. This scoring system was internally validated through 1000-bootstrap resamplings. The C-statistic and Hosmer-Lemeshow test were used to assess model discrimination and calibration. RESULTS PI occurred in 121 patients, accounting for 19.0% of the total patients. A 7-point NTS score system based on the initial NIHSS score, triglyceride-glucose index, and the number of infarct slices on axial diffusion-weighted imaging was developed. The NTS score showed good discrimination and calibration in the training cohort (C-statistic = 0.686; p value of Hosmer-Lemeshow test = 0.797) and validation cohort (C-statistic = 0.681; p value of Hosmer-Lemeshow test = 0.451). The three risk levels for predicting PI in the training and validation cohorts based on NTS score were as follows: low (0-2, 9.6% vs. 9.3%), intermediate (3-5, 28.2% vs. 26.7%), and high risk (6-7, 60.2% vs. 57.4%). INTERPRETATION The NTS score is a valid and convenient risk score for predicting PI in ACSSI patients.
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Affiliation(s)
- Jing Lin
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Shiying Ruan
- Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Weipeng Sun
- Department of Occupational Health and Toxicology, School of Public Health, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Liangbin Dong
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Shumeng Li
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Qin Huang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Xiaocheng Mao
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Jinchong Zhang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Keji Zou
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Hudie Zhang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Pengcheng Huang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Pu Fang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Xiaobing Li
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
| | - Yuhua Fan
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330000, China
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Cui Y, Wang XH, Shang ZY, Wang L, Chen HS. Baseline neurologic deficit and efficacy of remote ischemic conditioning after acute ischemic stroke: A post hoc analysis of RICAMIS. Neurotherapeutics 2024; 21:e00294. [PMID: 38241163 PMCID: PMC10903087 DOI: 10.1016/j.neurot.2023.10.004] [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: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 01/21/2024] Open
Abstract
RICAMIS (ClinicalTrials.gov Identifier: NCT03740971) trial has demonstrated efficacy of remote ischemic conditioning (RIC) in acute ischemic stroke, but whether baseline NIHSS score can affect outcomes in stroke remains unclear. We conducted a post hoc analysis of RICAMIS to investigate the issue. Patients included in RICAMIS were divided into three groups based on baseline NIHSS score. The primary outcome was excellent functional outcome at 90 days, defined as mRS score of 0-1. Compared with patients receiving usual care, we investigated association of RIC effect with outcomes in each group and interaction between RIC effect and stroke severity. Among 1776 patients, 1255 were assigned into NIHSS score 6-8 group, 402 into NIHSS score 9-12 group, and 119 into NIHSS score 13-16 group. A higher proportion of primary outcome was found associated with RIC in NIHSS score 9-12 group (adjusted risk difference [RD], 14.6 %; 95 % CI, 5.0 %-24.2 %; P = 0.003), but no significant association was found in NIHSS score 6-8 group (adjusted RD, 2.3 %; 95 % CI, -2.5 %-7.2 %; P = 0.34), or in NIHSS score 13-16 group (adjusted RD, 9.7 %; 95 % CI, -7.5 %-26.9 %; P = 0.27). There was a significant interaction between RIC effect and stroke severity when analysis was performed between NIHSS score 6-8 and 9-12 groups (P = 0.04), but not between NIHSS score 9-12 and 13-16 groups (P = 0.57). Current study firstly reported patients with NIHSS score 9-12 may get more benefit from RIC after stroke with respect to excellent functional outcome at 90 days.
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Affiliation(s)
- Yu Cui
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zi-Yang Shang
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Lu Wang
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China.
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10
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Rafay A, Abdul Fatir C, Hiba HT, Jamil M, Talha Awan M. Hyperhomocysteinemia Presenting as Stroke in a Young Individual: A Case Report. Cureus 2024; 16:e52381. [PMID: 38361671 PMCID: PMC10867708 DOI: 10.7759/cureus.52381] [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: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
This case report details the sudden onset of an ischemic stroke in a man in his late 20s, attributed to elevated homocysteine levels. Despite his young age, the patient exhibited increased homocysteine levels, a recognized stroke risk factor. This report underscores the critical importance of recognizing hyperhomocysteinemia as a potential underlying cause of strokes, even in younger age groups. Following ischemic stroke-directed treatment along with the addition of folic acid, vitamin B6, vitamin B12, and methylcobalamin, the patient's condition improved, leading to discharge with normalized homocysteine levels. Highlighting the significance of identifying this risk factor is particularly essential in regions like Pakistan, where a notably high prevalence of hyperhomocysteinemia has been reported. This case serves as a poignant reminder of the need for comprehensive stroke evaluations, urging medical practitioners to consider homocysteine as a potential contributing factor, even when dealing with young and healthy patients.
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Affiliation(s)
- Abdul Rafay
- Internal Medicine, Ameer-ud-din Medical College/Lahore General Hospital, Lahore, PAK
- Trauma and Orthopaedics, Our Lady's Hospital, Navan, IRL
| | | | | | - Manahil Jamil
- Psychology, Rawalpindi Medical University, Rawalpindi, PAK
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Cui Y, Yuan ZM, Liu QY, Wang YJ, Chen HS. Remote Ischemic Conditioning and Outcomes in Acute Ischemic Stroke With Versus Without Large Artery Atherosclerosis. Stroke 2023; 54:3165-3168. [PMID: 37850359 DOI: 10.1161/strokeaha.123.045040] [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: 08/13/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND RICAMIS trial (The Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke) has demonstrated efficacy of remote ischemic conditioning (RIC) in acute ischemic stroke. We conducted a post hoc analysis of RICAMIS to investigate whether large artery atherosclerosis (LAA) subtype contributed to the outcomes. METHODS This is a post hoc analysis of the RICAMIS trial. Patients randomized to RIC group and Control group in full analysis set of RICAMIS were classified into LAA and non-LAA subtypes. The primary outcome was excellent functional outcome at 90 days, defined as modified Rankin Scale score of 0 to 1. Compared with patients receiving usual care, we investigated the association of RIC effect with outcomes in stroke subtypes and the interaction between RIC effect and stroke subtypes. The primary analysis was adjusted analysis. RESULTS Among 1773 patients, 516 were assigned to LAA subtype (229 in the RIC group and 287 in the control group) and 1257 to non-LAA subtype (633 in the RIC group and 624 in the control group). Median age was 65 years, and 34.2% were women. A higher proportion of primary outcome was found to be associated with RIC treatment in LAA subtype (adjusted risk difference, 11.4% [95% CI, 3.6%-19.2%]; P=0.004), but not in non-LAA subtype (adjusted risk difference, 4.1% [95% CI, -1.1% to 9.3%]; P=0.12). There was no significant interaction between RIC effect and stroke subtypes (P=0.12). CONCLUSIONS Patients with LAA subtype may benefit from RIC after stroke with respect to excellent functional outcome at 90 days. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03740971.
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Affiliation(s)
- Yu Cui
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China (Y.C., Q.-Y.L., Y.-J.W., H.-S.C.)
| | - Zhi-Mei Yuan
- Department of Neurology, Tonghua Vascular Disease Hospital (Dongchang District People's Hospital), Tonghua, China (Z.-M.Y.)
| | - Quan-Ying Liu
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China (Y.C., Q.-Y.L., Y.-J.W., H.-S.C.)
| | - Ying-Jia Wang
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China (Y.C., Q.-Y.L., Y.-J.W., H.-S.C.)
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China (Y.C., Q.-Y.L., Y.-J.W., H.-S.C.)
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12
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Xu C, Cai L, Yi T, Yi X, Hu Y. Neutrophil-to-lymphocyte ratio is associated with stroke progression and functional outcome in patients with ischemic stroke. Brain Behav 2023; 13:e3261. [PMID: 37743586 PMCID: PMC10636384 DOI: 10.1002/brb3.3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE The objective of the present research was to examine the correlation between the neutrophil-to-lymphocyte ratio (NLR) and stroke progression (SP) as well as the functional outcome following an ischemic stroke (IS). METHODS The current study was conducted as prospective observational research. A cohort of 341 participants diagnosed with IS was included in the study from March 2019 to August 2021. This study's primary measure of interest was the occurrence of SP within the initial week following hospital admission. The secondary outcome was functional status 3 months after IS as measured by a modified Rankin scale score. The association between NLR with SP, and poor functional outcomes was examined using multivariate logistic regression. The predictive value of NLR for SP and poor functional outcomes was evaluated using the receiver operating characteristic (ROC) curve. RESULTS Among the 341 enrolled patients, 56 (16.4%) had SP, and 285 (83.6%) had no SP. The results of the multivariate logistic regression analysis demonstrated that the existence of diabetes mellitus and the NLR were independently associated with SP and poor functional outcomes. The area under the ROC curve of NLR in predicting poor functional outcome was 0.6117 (95% confidence interval, .5341-.6893, p = .0032), and the optimal cut-off point was 4.2139. The sensitivity and specificity of NLR in predicting poor functional outcomes were 52.7% and 72.0%, respectively. CONCLUSION Patients with acute IS exhibited a very high incidence of SP. NLR may be a valuable prognostic indicator in clinical practice because it was independently associated with SP and a poor functional outcome.
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Affiliation(s)
- Chongxi Xu
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduSichuanChina
| | - Linrui Cai
- National Drug Clinical‐Trial institution of West China Second HospitalSichuan UniversityChengduChina
- NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo CorrelationChengduChina
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan University, Ministry of EducationChengduChina
| | - Tong Yi
- Department of Neurology, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xingyang Yi
- Department of NeurologyPeople's Hospital of Deyang CityDeyangSichuanChina
| | - Yu Hu
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduSichuanChina
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13
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Cui Y, Chen YN, Nguyen TN, Chen HS. Time from Onset to Remote Ischemic Conditioning and Clinical Outcome After Acute Moderate Ischemic Stroke. Ann Neurol 2023; 94:561-571. [PMID: 37253659 DOI: 10.1002/ana.26715] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/06/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We conducted a post hoc exploratory analysis of Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) to determine whether early remote ischemic conditioning (RIC) initiation after stroke onset was associated with clinical outcome in patients with acute moderate ischemic stroke. METHODS In RICAMIS, patients receiving RIC treatment in the intention-to-treat analysis were divided into 2 groups based on onset-to-treatment time (OTT): early RIC group (OTT ≤ 24 hours) and late RIC group (OTT 24-48 hours). Patients receiving usual care without RIC treatment from intention-to-treat analysis were assigned as the control group. The primary outcome was excellent functional outcome at 90 days. RESULTS Among 1,776 patients from intention-to-treat analysis, 387 were in the early RIC group, 476 in the late RIC group, and 913 in the control group. In the post hoc exploratory analysis, a higher proportion of excellent functional outcome was found in the early RIC versus control group (adjusted absolute difference = 8.1%, 95% confidence interval [CI] = 2.5%-13.8%, p = 0.005), but no difference in outcomes was detected in the late RIC versus control group (adjusted absolute difference = 3.3%, 95% CI = -2.1% to 8.6%, p = 0.23), or in the early RIC versus late RIC group (adjusted absolute difference = 5.0%, 95% CI = -1.3% to 11.2%, p = 0.12). Similar results were found in the per-protocol analysis. INTERPRETATION Among patients with acute moderate ischemic stroke who are not candidates for intravenous thrombolysis or endovascular therapy, early RIC initiation within 24 hours of onset may be associated with higher likelihood of excellent clinical outcome. ANN NEUROL 2023;94:561-571.
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Affiliation(s)
- Yu Cui
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi-Ning Chen
- Department of Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Thanh N Nguyen
- Departments of Neurology and Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
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14
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Wang D, Yan D, Yan M, Li R, Jiang H, Wang J, Yang H. Leukoaraiosis severity is related to increased risk of early neurological deterioration in acute ischemic stroke: a retrospective observational study. Acta Neurol Belg 2023:10.1007/s13760-023-02249-3. [PMID: 37014516 DOI: 10.1007/s13760-023-02249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The relationship between leukoaraiosis and early neurological deterioration in acute cerebral infarction patients remains controversial. We tried to determine whether an association existed between leukoaraiosis and early neurological deterioration in patients with acute ischemic stroke. MATERIALS AND METHODS We retrospectively enrolled acute cerebral infarction patients admitted to our our department within 4.5-72.0 h of symptom onset between January 2016 and March 2022. On the basis of the van Swieten scale, leukoaraiosis was evaluated as supratentorial white matter hypoattenuation on admission head CT and graded as 0 (absent), 1 (mild), 2 (moderate) and 3-4 (severe). Early neurological deterioration was defined as an increase in the National Institute of Health Stroke Scale score by > = 2 points in the total score, or > = 1 point in motor power within the first seven days after admission. RESULTS Among 736 patients, 522 (70.9%) patients had leukoaraiosis, and of these, 332 (63.6%) had mild leukoaraiosis, 41 (7.9%) had moderate leukoaraiosis, and 149 (28.5%) had severe leukoaraiosis. 118 (16.0%) patients experienced early neurological deterioration: 20 of the 214 (9.5%) patients without leukoaraiosis and 98 of the 522 (18.8%) patients with leukoaraiosis. In multiple regression analysis, we found van Swieten scale predicted early neurological deterioration independently (OR = 1.570; 95% CI: 1.226-2.012). CONCLUSIONS Leukoaraiosis is common in acute cerebral infarction patients and leukoaraiosis severity is related to increased risk of early neurological deterioration in the patients.
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Affiliation(s)
- Dan Wang
- Department of Neurology, Hubei NO. 3 People's Hospital of Jianghan University, 26 Zhongshan Road, Qiaokou District, Wuhan, China
| | - Dan Yan
- Department of Neurology, Hubei NO. 3 People's Hospital of Jianghan University, 26 Zhongshan Road, Qiaokou District, Wuhan, China
| | - Mingmin Yan
- Department of Neurology, Hubei NO. 3 People's Hospital of Jianghan University, 26 Zhongshan Road, Qiaokou District, Wuhan, China
| | - Ruifang Li
- Department of Neurology, Hubei NO. 3 People's Hospital of Jianghan University, 26 Zhongshan Road, Qiaokou District, Wuhan, China
| | - Haiwei Jiang
- Department of Neurology, Hubei NO. 3 People's Hospital of Jianghan University, 26 Zhongshan Road, Qiaokou District, Wuhan, China
| | - Juan Wang
- Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Yang
- Department of Neurology, Hubei NO. 3 People's Hospital of Jianghan University, 26 Zhongshan Road, Qiaokou District, Wuhan, China.
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15
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Yang T, Hu Y, Pan X, Lou S, Zou J, Deng Q, Zhang Q, Zhou J, Zhu J. Interpretable Machine Learning Model Predicting Early Neurological Deterioration in Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Retrospective Study. Brain Sci 2023; 13:brainsci13040557. [PMID: 37190522 DOI: 10.3390/brainsci13040557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Early neurologic deterioration (END) is a common and feared complication for acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). This study aimed to develop an interpretable machine learning (ML) model for individualized prediction to predict END in AIS patients treated with MT. The retrospective cohort of AIS patients who underwent MT was from two hospitals. ML methods applied include logistic regression (LR), random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost). The area under the receiver operating characteristic curve (AUC) was the main evaluation metric used. We also used Shapley Additive Explanation (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) to interpret the result of the prediction model. A total of 985 patients were enrolled in this study, and the development of END was noted in 157 patients (15.9%). Among the used models, XGBoost had the highest prediction power (AUC = 0.826, 95% CI 0.781–0.871). The Delong test and calibration curve indicated that XGBoost significantly surpassed those of the other models in prediction. In addition, the AUC in the validating set was 0.846, which showed a good performance of the XGBoost. The SHAP method revealed that blood glucose was the most important predictor variable. The constructed interpretable ML model can be used to predict the risk probability of END after MT in AIS patients. It may help clinical decision making in the perioperative period of AIS patients treated with MT.
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16
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Jin D, Yang J, Zhu H, Wu Y, Liu H, Wang Q, Zhang X, Dong Y, Luo B, Shan Y, Zhang L, Wang P, Du J. Risk factors for early neurologic deterioration in single small subcortical infarction without carrier artery stenosis: predictors at the early stage. BMC Neurol 2023; 23:83. [PMID: 36849878 PMCID: PMC9969648 DOI: 10.1186/s12883-023-03128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVES This study aimed to assess the epidemiological features and explore the potential risk factors for early neurological deterioration (END) in patients with acute single small subcortical infarction (SSSI) who underwent antiplatelet therapy without carotid artery stenosis. MATERIALS & METHODS Patients with SSSI, as confirmed by cranial magnetic resonance imaging (MRI), who were hospitalized within 48 h after the onset of symptoms were enrolled. END was mainly defined as increment in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points or any new neurological deficit. Poor functional outcome was defined as modified Rankin Scale (mRS) score of > 2 points at 3-month after the onset. The association of END with multiple indicators was assessed at the early stage of admission using multivariate logistic regression analysis, and adjusted odds ratios (aORs) were calculated. RESULTS A total of 280 patients were enrolled from June 2020 to May 2021, of whom, END occurred in 44 (15.7%) patients (median age, 64 years; 70.5% male), while END occurred during sleep in 28 (63.6%) patients. History of hypertension (aOR: 4.82, p = 0.001), infarction in internal capsule (aOR: 3.35, p = 0.001), and elevated level of low-density lipoprotein cholesterol (LDL-C; aOR: 0.036, p = 0.0016) were significantly associated with the risk of END. Patients with END (aOR: 5.74, p = 0.002), history of diabetes (aOR: 2.61, p = 0.020), and higher NIHSS scores at discharge (per 1-score increase, aOR: 1.29, p = 0.026) were associated with the poor functional outcome at 3-month after the onset. CONCLUSION Patients with a history of hypertension, infarction in internal capsule or a higher level of LDL-C were found to be at a higher risk of END.
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Affiliation(s)
- Di Jin
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Jing Yang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Hui Zhu
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Yuexia Wu
- grid.256883.20000 0004 1760 8442Graduate School of the First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Haichao Liu
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Qi Wang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Xiaoyun Zhang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Yanhua Dong
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Bin Luo
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Yong Shan
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Lvming Zhang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Peifu Wang
- grid.464204.00000 0004 1757 5847Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049 People’s Republic of China
| | - Jichen Du
- Department of Neurology, Aerospace Center Hospital, Yuquan Road 15, Haidian District, Beijing, 100049, People's Republic of China.
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An Overview of the Risks of Contemporary Energy Drink Consumption and Their Active Ingredients on Cardiovascular Events. CURRENT CARDIOVASCULAR RISK REPORTS 2023. [DOI: 10.1007/s12170-023-00716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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18
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Wang K, Gu L, Liu W, Xu C, Yin C, Liu H, Rong L, Li W, Wei X. The predictors of death within 1 year in acute ischemic stroke patients based on machine learning. Front Neurol 2023; 14:1092534. [PMID: 36908612 PMCID: PMC9998042 DOI: 10.3389/fneur.2023.1092534] [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: 11/20/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Objective To explore the predictors of death in acute ischemic stroke (AIS) patients within 1 year based on machine learning (ML) algorithms. Methods This study retrospectively analyzed the clinical data of patients hospitalized and diagnosed with AIS in the Second Affiliated Hospital of Xuzhou Medical University between August 2017 and July 2019. The patients were randomly divided into training and validation sets at a ratio of 7:3, and the clinical characteristic variables of the patients were screened using univariate and multivariate logistics regression. Six ML algorithms, including logistic regression (LR), gradient boosting machine (GBM), extreme gradient boosting (XGB), random forest (RF), decision tree (DT), and naive Bayes classifier (NBC), were applied to develop models to predict death in AIS patients within 1 year. During training, a 10-fold cross-validation approach was used to validate the training set internally, and the models were interpreted using important ranking and the SHapley Additive exPlanations (SHAP) principle. The validation set was used to externally validate the models. Ultimately, the highest-performing model was selected to build a web-based calculator. Results Multivariate logistic regression analysis revealed that C-reactive protein (CRP), homocysteine (HCY) levels, stroke severity (SS), and the number of stroke lesions (NOS) were independent risk factors for death within 1 year in patients with AIS. The area under the curve value of the XGB model was 0.846, which was the highest among the six ML algorithms. Therefore, we built an ML network calculator (https://mlmedicine-de-stroke-de-stroke-m5pijk.streamlitapp.com/) based on XGB to predict death in AIS patients within 1 year. Conclusions The network calculator based on the XGB model developed in this study can help clinicians make more personalized and rational clinical decisions.
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Affiliation(s)
- Kai Wang
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Longyuan Gu
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chan Xu
- Department of Dermatology, Xianyang Central Hospital, Xianyang, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
| | - Haiyan Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liangqun Rong
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenle Li
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Xiu'e Wei
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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19
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Hu S, Ren L, Wang Y, Lei Z, Cai J, Pan S. The association between serum orexin A and short-term neurological improvement in patients with mild to moderate acute ischemic stroke. Brain Behav 2023; 13:e2845. [PMID: 36573700 PMCID: PMC9847589 DOI: 10.1002/brb3.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/20/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The serum orexin A level was significantly lower among patients with acute ischemic stroke (AIS) and negatively related to the volume of the infarction, but the relationship between serum orexin A and prognosis of AIS was still unclear. We aimed to clarify the association between serum orexin A and the short-term neurological improvement in patients with mild to moderate AIS. METHODS We consecutively enrolled patients with first ever mild to moderate AIS admitted to hospital within 48 h from symptom onset in this prospective observational study. The serum orexin A concentrations were determined on the second morning since the admission. The short-term neurological improvement was defined as more than 1 point decrease in the National Institute of Health Stroke Scale score within 7 days after admission. RESULTS We detected increased serum orexin A level in mild to moderate AIS patients with early onset of stroke-related insomnia (33.44 vs 18.66 pg/ml, p = .004) as well as in patients with short-term neurological improvement compared to those without improvement (31.78 vs 16.24 pg/ml, p = .038). The serum orexin A level was positively associated with the short-term neurological improvement after adjusting for sleep condition and other related variables. CONCLUSION Serum orexin A might be a useful biomarker for the assessment of early prognosis in patients with mild to moderate AIS.
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Affiliation(s)
- Shiyu Hu
- Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Lijie Ren
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Yang Wang
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Zhihao Lei
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Jingjing Cai
- Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Suyue Pan
- Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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20
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Lymphocyte-to-Monocyte Ratio Is Independently Associated with Progressive Infarction in Patients with Acute Ischemic Stroke. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2290524. [PMID: 36605104 PMCID: PMC9810397 DOI: 10.1155/2022/2290524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022]
Abstract
Methods From April 2017 to December 2020, we retrospectively recruited 477 patients with acute ischemic stroke (within 48 hours after onset). Progressive infarction was defined as an increase of ≥1 point in motor power or ≥2 points on the total National Institutes of Health Stroke Scale (NIHSS) within 7 days after admission and extension of the original infarction were further confirmed by diffusion-weighted imaging. Demographic characteristics, clinical information, and neuroimaging characteristics were evaluated after admission. All blood draws and initial imaging were completed within 24 hours of admission. Results PI occurred in 147 (30.8%) patients. Univariate analysis comparing the two groups revealed that hypertension, initial NIHSS score, discharge NIHSS score, modified Rankin scale score at 90 days, monocyte level, creatinine level, fasting glucose level, LMR, monocyte-to-high-density lipoprotein ratio (MHR), and lesion location were significantly different (P < 0.05). Multivariate logistic regression analysis showed that the odds ratio of PI increased as the quartile of LMR increased, with the lowest quartile as the reference value. Subgroup analyses showed that a high LMR was an independent predictor of PI only in large artery atherosclerosis (LAA) patients. The receiver operating characteristic (ROC) curve was drawn to estimate the predictive value of LMR for PI. For all cases, the area under the curve was 0.583 (95% CI 0.526-0.641), and the best predictive cutoff value was 3.506, with a sensitivity of 53.1% and a specificity of 63.9%. In patients with LAA, the area under the curve was 0.585 (95% CI 0.505-0.665), and the best predictive cutoff value was 3.944, with a sensitivity of 48.7% and a specificity of 72.8%. Conclusions LMR was an independent predictor for progressive infarction in patients with acute ischemic stroke, especially in LAA cerebral infarction patients.
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Du Y, Li Y, Duan Z, Ma C, Wang H, Liu R, Li S, Lian Y. The efficacy and safety of intravenous tirofiban in the treatment of acute ischemic stroke patients with early neurological deterioration. J Clin Pharm Ther 2022; 47:2350-2359. [PMID: 36461632 DOI: 10.1111/jcpt.13816] [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: 06/10/2022] [Revised: 08/13/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Many patients with acute ischemic stroke (AIS) develop early neurological deterioration (END), leading to disabilities or death. Thus, this study aimed to investigate the efficacy and safety of intravenous tirofiban in treating patients with AIS and END who missed the thrombolysis time window. METHODS A total of 123 AIS-END patients participated in the study between January 2021 and December 2021. Patients were randomized into the tirofiban group (n = 63) and the control group (n = 60) based on whether a tirofiban injection was administered. The National Institute of Health Stroke Scale (NIHSS) was used to assess neurological function at the 48th hour and on the 7th day after intervention, and the modified Rankin Scale (mRS) was used to assess neurological recovery 90 days after AIS. Adverse reactions during the intervention were recorded for safety analysis. RESULTS AND DISCUSSION The 7th day NIHSS and 90th day post-AIS mRS scores of the tirofiban group were significantly lower than those of the control group (p < 0.05), while the 90th day good prognosis (mRS ≤ 2) rate of the tirofiban group was significantly higher (84.13% vs. 65.00%, p < 0.05). Logistic regression demonstrated a protective effect of tirofiban for good prognosis in AIS patients with END (OR = 4.675, 95% CI [1.012-21.605], p < 0.05). No cases of intracranial haemorrhage transformation or death were observed during the treatment in either group. WHAT IS NEW AND CONCLUSION Tirofiban injection exhibited a high safety profile and significantly improved the prognosis of AIS-END patients who missed the intravenous thrombolysis time window.
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Affiliation(s)
- Yanjiao Du
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Yan Li
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Zhihui Duan
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Congmin Ma
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Hao Wang
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Ruihua Liu
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Shao Li
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Yu Q, Mao X, Fu Z, Luo S, Huang Q, Chen Q, Li S, Zhang J, Qiu Y, Wu Y, Fang P, Hong D, Lin J. Fasting blood glucose as a predictor of progressive infarction in men with acute ischemic stroke. J Int Med Res 2022; 50:3000605221132416. [PMID: 36271599 PMCID: PMC9597044 DOI: 10.1177/03000605221132416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Blood glucose is related to early neurological deterioration in acute
ischemic stroke, but multiple mechanisms are involved in early neurological
deterioration, such as progressive infarction. This study aimed to determine
whether fasting blood glucose (FBG) is an independent predictor of
progressive infarction. Methods From April 2017 to December 2020, we retrospectively enrolled 477 patients
with acute ischemic stroke within 48 hours of onset. Demographic
characteristics, clinical information, neuroimaging characteristics, and
laboratory data were collected after admission. Results We found that 147 (30.8%) patients had progressive infarction. Multiple
regression analysis showed that high FBG concentrations (>7.66 mmol/L)
were independently associated with progressive infarction. Sex subgroup
analysis showed that high FBG concentrations were an independent predictor
of progressive infarction in male patients (odds ratio, 2.559; 95%
confidence interval, 1.279–5.121). In a receiver operating characteristic
curve analysis, FBG concentrations were a predictor of progressive
infarction in all cases, especially in male patients. The cutoff value of
FBG in all patients and men was 7.155 mmol/L. Conclusions FBG is an independent predictor of progressive infarction in patients with
acute ischemic stroke within 48 hours of onset, especially in men. Patients
with FBG concentrations ≥7.155 mmol/L are more likely to develop progressive
infarction.
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Affiliation(s)
- Qiulong Yu
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Xiaocheng Mao
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Zhihui Fu
- Department of General Medicine, First Affiliated Hospital of
Nanchang University, Nanchang, Jiangxi, China
| | - Si Luo
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Qin Huang
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Qianxi Chen
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Shumeng Li
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Jinchong Zhang
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Yuexin Qiu
- Jiangxi Province Key Laboratory of Preventive Medicine, School
of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yuhang Wu
- Jiangxi Province Key Laboratory of Preventive Medicine, School
of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Pu Fang
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Daojun Hong
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China
| | - Jing Lin
- Department of Neurology, First Affiliated Hospital of Nanchang
University, Nanchang 330000, Jiangxi, China, Jing Lin, Department of Neurology, First
Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Road, Dong’hu
District, Nanchang 330000, China.
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Fang L, Wang Y, Zhang H, Jiang L, Jin X, Gu Y, Wu M, Pei S, Cao Y. The neutrophil-to-lymphocyte ratio is an important indicator correlated to early neurological deterioration in single subcortical infarct patients with diabetes. Front Neurol 2022; 13:940691. [PMID: 36341126 PMCID: PMC9632421 DOI: 10.3389/fneur.2022.940691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background and purpose This study aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and early neurological deterioration (END) among cases suffering from single subcortical infarction (SSI) and diabetes. Methods We collected the data of patients with SSI admitted to our hospital between January 2019 and December 2020 retrospectively. A score of ≥2 elevations in overall National Institutes of Health Stroke Scale (NIHSS) score or ≥1 increase in motor NIHSS score in 5-day post-admission was considered END. Furthermore, logistic regression was used to analyze the relationship between NLR and END among SSI cases. Results Altogether, we enrolled 235 consecutive SSI cases, of which 53 (22.5%) were diagnosed with END, while 93 (39.5%) were diabetic. In patients with diabetes, the value of NLR increased markedly among the patients with END (median, 3.59; IQR, 2.18–4.84) compared to patients without END (median, 2.64; IQR, 1.89–3.18; P = 0.032). Meanwhile, in patients without diabetes, NLR was not significantly associated with END. In the multivariate analysis, NLR values were positively related to END (adjusted odds ratio (OR), 1.768; 95% CI, 1.166–2.682, P = 0.007) upon adjusting age, SSI type, lesion diameter, initial NIHSS, fasting blood glucose (FBG), 2-h postprandial blood glucose (2hPBG), and estimated glomerular filtration rate (eGFR). The subgroup analysis showed that the relationship between NLR and END was more pronounced in the branch atheromatous disease (BAD) (adjusted OR, 1.819; 95% CI, 1.049–3.153, P = 0.033) and anterior SSI subgroups (adjusted OR, 2.102; 95% CI, 1.095–4.037, P = 0.026). Conclusion NLR value was significantly related to END among SSI patients with diabetes and was recognized as an independent factor in predicting the risk of END.
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Affiliation(s)
- Lijun Fang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Yali Wang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Hong Zhang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Lingling Jiang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Xuehong Jin
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Yongquan Gu
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Minya Wu
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Shaofang Pei
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
- *Correspondence: Shaofang Pei
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Yongjun Cao
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Homocysteine is associated with higher risks of ischemic stroke: A systematic review and meta-analysis. PLoS One 2022; 17:e0276087. [PMID: 36227950 PMCID: PMC9560514 DOI: 10.1371/journal.pone.0276087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High levels of homocysteine (Hct) have been associated with great risks of ischemic stroke. However, some controversy still exists. We performed a systematic review and meta-analysis to compare the levels of Hct between patients with ischemic stroke and controls. METHODS We performed a systematic literature search for articles reporting Hct levels of patients with occurrence of ischemic stroke. We employed a random-effects inverse-variance weighted meta-analytical approach in order to pool standardized mean differences, with estimation of τ2 through the DerSimonian-Laird method. RESULTS The initial search yielded 1361 studies. After careful analysis of abstracts and full texts, the meta-analysis included data from 38 studies, which involved almost 16 000 stroke events. However, only 13 studies reported means and standard deviations for cases and controls, and therefore were used in the meta-analysis. Those studies presented data from 5002 patients with stroke and 4945 controls. Standardized mean difference was 1.67 (95% CI 1.00-2.25, P < 0.01), indicating that Hct levels were significantly larger in patients with ischemic stroke compared to controls. Between-study heterogeneity was very large (I2 = 99%), particularly because three studies showed significantly large mean differences. CONCLUSION This meta-analysis shows that patients with ischemic stroke have higher levels of Hct compared to controls. Whether this is a modifiable risk factor remains to be assessed through larger prospective cohorts.
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Lin J, Mao X, Liao Y, Luo S, Huang Q, Song Z, Li S, Li C, Qiu Y, Wu Y, Zhu M, Li X, Yu Q, Hong D. A lesion extending three or more slices as a predictor of progressive infarction in anterior circulation small subcortical infarction. Front Neurol 2022; 13:926187. [PMID: 36277920 PMCID: PMC9579366 DOI: 10.3389/fneur.2022.926187] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Progressive infarction (PI) is common in small subcortical infarction and may lead to a poor outcome. The purpose of our study is to identify neuroimaging predictors for PI. From April 2017 to December 2020, we enrolled 86 patients with an anterior circulation subcortical infarction within 48 h after onset. Progressive infarction was defined by an increase of ≥ one point in motor power or ≥ two points in the total National Institute of Health Stroke Scale score within 7 days after admission and further confirmed by diffusion-weighted imaging (DWI). To identify predictors, demographic characteristics, clinical information, laboratory date, and neuroimaging characteristics were evaluated. The infarct size and infarct slice number were measured by DWI. We found that thirty-one patients (36%) had PI. In a univariate analysis, the patients with PI had higher levels of triglyceride, lower levels of blood urea nitrogen and prothrombin time, and a higher frequency of infarct slice number ≥ three compared to the patients without PI. After logistic regression stepwise adjustment for all considered relevant confounders, infarct slice number ≥ three slices proved to be independently associated with PI (OR = 4.781, 95% CI 1.677–13.627; OR = 4.867, 95% CI 1.6–14.864; OR = 3.584, 95% CI 1.034–12.420). Our study showed that a lesion extending ≥ three slices on DWI is an independent predictor for progressive infarction in patients with anterior circulation small subcortical infarction.
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Affiliation(s)
- Jing Lin
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaocheng Mao
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunfang Liao
- Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Si Luo
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qin Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ziwei Song
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shumeng Li
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chengjin Li
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuexin Qiu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Yuhang Wu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Min Zhu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaobing Li
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiulong Yu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Qiulong Yu
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Daojun Hong
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Li SWA, Lin YP, Hsieh SP, Chang ST. Binary effects of intravascular laser irradiation of blood on motor recovery and homocysteine reduction in a case with ischemic hemiparesis: portrayed with brain perfusion images. BMC Neurol 2022; 22:370. [PMID: 36162998 PMCID: PMC9513988 DOI: 10.1186/s12883-022-02896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Stroke is a burdensome cerebral eventthat affects many aspects of daily activities such as motion, speech, memory, vision, and cognition. Intravascular laser irradiation of blood (ILIB) is a novel therapy, going beyond conventional rehabilitation modalities, that is effective in stroke recovery. Homocysteine is an important risk factor associated with stroke. However, there are few studies that examine the relationship between ILIB treatment and the level of homocysteine. In recent years, researchers use the single-photon emission computed tomography (SPECT) scan of the brain to evaluate stroke patients and patients with a neurologicdeficit. The present report investigates the clinical effect of ILIB treatment on the level of serum homocysteine, the perfusion change of impaired brain region via SPECT, and the patient’s neurologic appearance. Casepresentation We focus on a case of a 62-year-old man with subacute stroke accompanied with left hemiparesis and hyperhomocysteinemia, who showed dramatic improvement in muscle power, a decreasing level of homocysteine, and increased blood flow of the right cerebral after three-courseILIB treatment. Conclusion We found that ILIB is effective in lowering serum levels of homocysteine and facilitating cerebral circulation for the patient with subacute stroke.
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Affiliation(s)
- Sheng-Wen A Li
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Po Lin
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Shih-Po Hsieh
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, 813414, Taiwan. .,Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital School of Medicine, National Defense Medical Center, Neihu District, No. 161, Section 6, Minquan East Road, Taipei, 114201, Taiwan.
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Amini H, Hewadmal H, Rasuli SF, Shahriar CS, Fattah A, Kavanoor Sridhar H, Khan M, Bhat S, Talpur AS, Qadar LT. Role of Serum Homocysteine and Outcome in Patients With Traumatic Brain Injury. Cureus 2022; 14:e28968. [PMID: 36237797 PMCID: PMC9548089 DOI: 10.7759/cureus.28968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background There have been indications of a correlation between serum homocysteine (Hcy) levels and poor patient outcomes in traumatic brain injury (TBI). Thus, we aimed to explore the role of serum Hcy in influencing the outcome post TBI. Methods A case-control study was conducted at Liaquat University of Medical and Health Sciences (LUMHS) between January 15, 2022 and July 1, 2022. All patients between the ages of 18 and 75 years who presented with TBI, irrespective of severity, were included in the study. All patients with neurological disorders and infections, including but not limited to cerebral tuberculosis, Alzheimer's disease, epilepsy, brain cancer, Parkinson's, and stroke, were excluded from the study. For comparison, healthy controls with similar demographics were enrolled in the study. All patients and controls underwent biochemical evaluation of serum Hcy and neurological assessment at presentation. In addition, all sociodemographic and clinical parameters, including the Glasgow Outcome Score (GOS), were collected in a predefined pro forma. Results A total of 175 patients were included who had experienced TBIs, along with an equal number of healthy controls. The most common etiology was road traffic accidents in 82 (46.9%) patients. The mean Glasgow Coma Score (GCS) at presentation was 5.78 ± 1.72. The mean Hcy levels were 31.4 ± 7.97 µmol/L in TBI patients and 11.12 ± 5.87 µmol/L in the control healthy patients (p=0.001). It was found that the severity of hyperhomocysteinemia (HHcy) was significantly related to the worst outcome possible, i.e., death (p=0.001). Conclusion The study concluded that patients who had suffered from a TBI had significantly higher serum Hcy levels. Furthermore, the study highlighted that the patients with the worst outcomes had more severe hyperhomocysteinemia (HHcy) than those with better outcomes. Moreover, patients with low GOS scores were more likely to have HHcy.
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Ji X, Tian L, Yao S, Han F, Niu S, Qu C. A Systematic Review of Body Fluids Biomarkers Associated With Early Neurological Deterioration Following Acute Ischemic Stroke. Front Aging Neurosci 2022; 14:918473. [PMID: 35711907 PMCID: PMC9196239 DOI: 10.3389/fnagi.2022.918473] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
Biomarkers are objectively measured biological properties of normal and pathological processes. Early neurological deterioration (END) refers to the deterioration of neurological function in a short time after the onset of acute ischemic stroke (AIS) and is associated with adverse outcomes. Although multiple biomarkers have been found to predict END, there are currently no suitable biomarkers to be applied in routine stroke care. According to the Preferred Reporting Items for Systematic Review standards, we present a systematic review, concentrating on body fluids biomarkers that have shown potential to be transferred into clinical practice. We also describe newly reported body fluids biomarkers that can supply different insights into the mechanism of END. In our review, 40 scientific papers were included. Depending on the various mechanisms, sources or physicochemical characteristics of body fluids biomarkers, we classified related biomarkers as inflammation, protease, coagulation, metabolism, oxidative stress, and excitatory neurotoxicity. The body fluids biomarkers whose related articles are limited or mechanisms are unknown are categorized as other biomarkers. The inflammation-related biomarkers, such as neutrophil-to-lymphocyte ratio and hypersensitive C-reactive protein, play a crucial role among the mentioned biomarkers. Considering the vast heterogeneity of stroke progression, using a single body fluids biomarker may not accurately predict the risk of stroke progression, and it is necessary to combine multiple biomarkers (panels, scores, or indices) to improve their capacity to estimate END.
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Affiliation(s)
- Xiaotan Ji
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Neurology, Jining No. 1 People’s Hospital, Jining, China
| | - Long Tian
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shumei Yao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Fengyue Han
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Shenna Niu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chuanqiang Qu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Chuanqiang Qu,
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Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Plasma Total Homocysteine Level Is Related to Unfavorable Outcomes in Ischemic Stroke With Atrial Fibrillation. J Am Heart Assoc 2022; 11:e022138. [PMID: 35470699 PMCID: PMC9238578 DOI: 10.1161/jaha.121.022138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Unlike patients with stroke caused by other mechanisms, the effect of elevated plasma total homocysteine (tHcy) on the prognosis of patients with both ischemic stroke and atrial fibrillation (AF) is unknown. This study aimed to evaluate the association between tHcy level and the functional outcome of patients with AF‐related stroke. Methods and Results We included consecutive patients with AF‐related stroke between 2013 and 2015 from the registry of a real‐world prospective cohort from 11 large centers in South Korea. A 3‐month modified Rankin Scale score ≥3 was considered an unfavorable outcome. Since tHcy is strongly affected by renal function, we performed a subgroup analysis according to the presence of renal dysfunction. A total of 910 patients with AF‐related stroke were evaluated (mean age, 73 years; male sex, 56.0%). The mean tHcy level was 11.98±8.81 μmol/L. In multivariable analysis, the tHcy level (adjusted odds ratio, 1.04; 95% CI, 1.01–1.07, per 1 μmol/L) remained significantly associated with unfavorable outcomes. In the subgroup analysis based on renal function, tHcy values above the cutoff point (≥14.60 μmol/L) showed a close association with the unfavorable outcome only in the normal renal function group (adjusted odds ratio, 3.10; 95% CI, 1.60–6.01). In patients with renal dysfunction, tHcy was not significantly associated with the prognosis of AF‐related stroke. Conclusions A higher plasma tHcy level was associated with unfavorable outcomes in patients with AF‐related stroke. This positive association may vary according to renal function but needs to be verified in further studies.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology Seoul Metropolitan Government-Seoul National University Boramae Medical Center Seoul South Korea
| | - Chi Kyung Kim
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Sungwook Yu
- Department of Neurology Korea University Anam HospitalKorea University College of Medicine Seoul South Korea
| | - Kyungmi Oh
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Jin-Man Jung
- Department of Neurology Korea University Ansan HospitalKorea University College of Medicine Ansan South Korea
| | - Tae-Jin Song
- Department of Neurology Ewha Womans UniversitySchool of Medicine Seoul South Korea
| | - Yong-Jae Kim
- Department of Neurology The Catholic University of Korea Seoul South Korea
| | - Bum Joon Kim
- Department of Neurology Asan Medical Center Seoul South Korea
| | - Sung Hyuk Heo
- Department of Neurology Kyung Hee University College of Medicine Seoul South Korea
| | - Kwang-Yeol Park
- Department of Neurology Chung-Ang University College of MedicineChung-Ang University Hospital Seoul South Korea
| | - Jeong-Min Kim
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Jong-Ho Park
- Department of Neurology Myongji HospitalHanyang University College of medicine Seoul South Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju South Korea
| | - Man-Seok Park
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Kang-Ho Choi
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Yang Ha Hwang
- Department of Neurology Kyungpook National University Hospital Dae-gu South Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea.,Departement of Digital Health SHAISTSungkyunkwan University Seoul South Korea
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30
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Wang M, Liang X, Zhang Q, Luo S, Liu H, Wang X, Sai N, Zhang X. Homocysteine can aggravate depressive like behaviors in a middle cerebral artery occlusion/reperfusion rat model: a possible role for NMDARs-mediated synaptic alterations. Nutr Neurosci 2022; 26:483-495. [PMID: 35416761 DOI: 10.1080/1028415x.2022.2060642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Post-stroke depression (PSD), the most frequent psychiatric complication following stroke, could have a negative impact on the recuperation of stroke patients. Hyperhomocysteinemia (HHCY) has been reported to be a modifiable risk factor of stroke. OBJECTIVE The study tries to explore the effect of HHCY on PSD and the role of N-methyl-d-aspartate receptors (NMDARs)-mediated synaptic alterations. METHODS Forty-five adult male Sprague-Dawley rats were randomly allocated into five groups: sham operation group, middle cerebral artery occlusion group (MCAO), HCY-treated MCAO group HCY and MK-801 co-treated MCAO group and MK-801-treated MCAO group. 1.6 mg/kg/d D, L-HCY was administered by tail vein injection for 28 d prior to SHAM or MCAO operationand up to 14 d after surgery. The MK-801 (3 mg/kg) was administered by intraperitoneal injection 15 min prior to MCAO operation. RESULTS HCY treatment aggravated depressive-like disorders of post-stroke rats by the open field test and sucrose preference test. Further, HCY significantly decreased central monoamines levels in the MCAO rats by HPLC. The transmission electron microscopy results showed that the number of synapses and the area of postsynaptic density decreased in the hippocampus of the HCY-treated MCAO rats. Additionally, HCY augmented ischemia-induced up-regulation of NMDARs, decreased the levels of synaptic structure-related marker PSD-95and the synaptic transmission-associated synaptic proteins (VGLUT1, SNAP-25 and Complexin Ι/ΙΙ). These effects of HCY were partly reversed by the NMDA antagonist MK-801. CONCLUSIONS The current study suggested that NMDARs-mediated synaptic plasticity may be involved in the adverse effect of HCY on PSD.
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Affiliation(s)
- Mengying Wang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xiaoshan Liang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Qiang Zhang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Suhui Luo
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Huan Liu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xuan Wang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Na Sai
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xumei Zhang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, People's Republic of China
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Baranovicova E, Hnilicova P, Kalenska D, Kaplan P, Kovalska M, Tatarkova Z, Tomascova A, Lehotsky J. Metabolic Changes Induced by Cerebral Ischemia, the Effect of Ischemic Preconditioning, and Hyperhomocysteinemia. Biomolecules 2022; 12:554. [PMID: 35454143 PMCID: PMC9032340 DOI: 10.3390/biom12040554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022] Open
Abstract
1H Nuclear Magnetic Resonance (NMR) metabolomics is one of the fundamental tools in the fast-developing metabolomics field. It identifies and quantifies the most abundant metabolites, alterations of which can describe energy metabolism, activated immune response, protein synthesis and catabolism, neurotransmission, and many other factors. This paper summarizes our results of the 1H NMR metabolomics approach to characterize the distribution of relevant metabolites and their alterations induced by cerebral ischemic injury or its combination with hyperhomocysteinemia in the affected tissue and blood plasma in rodents. A decrease in the neurotransmitter pool in the brain tissue likely follows the disordered feasibility of post-ischemic neurotransmission. This decline is balanced by the increased tissue glutamine level with the detected impact on neuronal health. The ischemic injury was also manifested in the metabolomic alterations in blood plasma with the decreased levels of glycolytic intermediates, as well as a post-ischemically induced ketosis-like state with increased plasma ketone bodies. As the 3-hydroxybutyrate can act as a likely neuroprotectant, its post-ischemic increase can suggest its supporting role in balancing ischemic metabolic dysregulation. Furthermore, the 1H NMR approach revealed post-ischemically increased 3-hydroxybutyrate in the remote organs, such as the liver and heart, as well as decreased myocardial glutamate. Ischemic preconditioning, as a proposed protective strategy, was manifested in a lower extent of metabolomic changes and/or their faster recovery in a longitudinal study. The paper also summarizes the pre- and post-ischemic metabolomic changes in the rat hyperhomocysteinemic models. Animals are challenged with hyperglycemia and ketosis-like state. A decrease in several amino acids in plasma follows the onset and progression of hippocampal neuropathology when combined with ischemic injury. The 1H NMR metabolomics approach also offers a high potential for metabolites in discriminatory analysis in the search for potential biomarkers of ischemic injury. Based on our results and the literature data, this paper presents valuable findings applicable in clinical studies and suggests the precaution of a high protein diet, especially foods which are high in Met content and low in B vitamins, in the possible risk of human cerebrovascular neuropathology.
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Affiliation(s)
- Eva Baranovicova
- Biomedical Center BioMed, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia; (E.B.); (P.H.); (A.T.)
| | - Petra Hnilicova
- Biomedical Center BioMed, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia; (E.B.); (P.H.); (A.T.)
| | - Dagmar Kalenska
- Department of Anatomy, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia;
| | - Peter Kaplan
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia; (P.K.); (Z.T.)
| | - Maria Kovalska
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia;
| | - Zuzana Tatarkova
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia; (P.K.); (Z.T.)
| | - Anna Tomascova
- Biomedical Center BioMed, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia; (E.B.); (P.H.); (A.T.)
| | - Jan Lehotsky
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia; (P.K.); (Z.T.)
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Liu Y, Zhao J, Li F, Sun H, Sun Y, Sun H, Yang F, Zhao Y, Liang Z, Tang Y. Predictive value of hemoglobin level on early neurological outcomes in acute ischemic stroke. Neurol Res 2022; 44:684-691. [PMID: 35130819 DOI: 10.1080/01616412.2022.2035621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have examined the association between hemoglobin (Hb) levels and early neurological changes following acute ischemic stroke (AIS). The present research investigated whether higher or lower Hb level on admission was associated with early neurological deterioration (END) in AIS patients. Furthermore, we evaluated the predictive effect of Hb concentration on stable or improving outcome. METHODS In this prospective cohort study, a total of 1330 patients admitted within 24 hours after AIS onset were finally involved in the analysis. We classified participants into four groups according to baseline Hb levels: ≤120, 121-140, 141-160, and >160 g/L. The risk of END was accessed by means of logistic regression analysis, and tendency of improvement and stability by multinomial logit analysis. We further evaluated the pattern and magnitude of association of Hb as a continuous variable and END by multivariate logistic regression analysis of restricted cubic spline. RESULTS Compared with the reference group, hemoglobin >160 g/L was associated with END (OR, 95%CI; 2.149, 1.314-3.512) and severe END (OR, 95% CI as 2.317, 1.351-3.976 and 2.810,1.589-4.968, respectively). Comparatively, higher Hb level also independently predicted improving (OR, 95% CI; 0.322, 0.170-0.609) and stable (OR, 95% CI; 0.371, 0.205-0.673) outcome. Similar results were found when restricted to anterior circulation ischemic stroke after adjustment of variables including large vessel disease. CONCLUSIONS We concluded that patients with higher baseline Hb level are at significantly higher risk for END, and less likely to reach stable or improving status at the early stage of stroke.
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Affiliation(s)
- Yue Liu
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingbo Zhao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Fang Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hongwei Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yanyan Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hongwei Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Fan Yang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Zhao
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Zijun Liang
- Department of Health Insurance Management, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Ying Tang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Polopalli S, Yetukuri AR, Danduga RCSR, Kola PK. A prognostic study on the effect of post-traumatic stress disorder on cerebral ischaemia reperfusion-induced stroke. World J Biol Psychiatry 2022; 23:136-150. [PMID: 34165039 DOI: 10.1080/15622975.2021.1935318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Previous studies have been established that persons who experienced a stroke are soon likely to develop several anxiety disorders. In which one of the major anxiety disorders is Post-traumatic Stress Disorder (PTSD). Yet, the likelihood of PTSD in conjunction with cerebral stroke has not been well described. Hence, we evaluated the impact of PTSD on cerebral stroke in rodents subjected to single prolonged stress (SPS) and bilateral common carotid artery occlusion (BCCAo), respectively. METHODS The relation between PTSD and cerebral stroke is evaluated by performing behavioural, biochemical, histopathological, and brain lesion area measurement studies. RESULTS Interestingly, SPS + BCCAo induction increased behavioural abnormalities like cognitive impairment and anxiety-like behaviour compared to SPS and BCCAo groups alone. Motor impairment was also observed in SPS + BCCAo rats compared to SPS rats, whereas no change with BCCAo rats. Furthermore, increased brain tissue MDA, acetylcholinesterase, and decreased SOD, catalase, and GSH were observed in SPS + BCCAo subjected rats compared to SPS and BCCAo rats alone. Additionally, SPS + BCCAo induction considerably increased the plasma corticosterone levels and caused severe neurotransmitter alterations. The SPS + BCCAo exposure significantly increased the brain lesion area in comparison with BCCAo rats. Moreover, severe histopathological alterations were observed in the hippocampus (CA1) of SPS + BCCAo rats compared to SPS and BCCAo rats alone. CONCLUSIONS In conclusion, our study results suggested that SPS-induced PTSD may aggravate the BCCAo induced cerebral ischaemia-reperfusion injury.
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Affiliation(s)
- Subramanyam Polopalli
- Department of Pharmacology, Vishnu Institute of Pharmaceutical Education and Research, Narsapur, Medak, India.,Department of Pharmacology, University College of Pharmaceutical Sciences, Acharya Nagarjuna University, Nagarjuna Nagar, India
| | - Amulya Rani Yetukuri
- Department of Pharmacology, University College of Pharmaceutical Sciences, Acharya Nagarjuna University, Nagarjuna Nagar, India
| | | | - Phani Kumar Kola
- Department of Pharmacology, University College of Pharmaceutical Sciences, Acharya Nagarjuna University, Nagarjuna Nagar, India
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Lauretta MP, Melotti RM, Sangermano C, George AM, Badenes R, Bilotta F. Homocysteine Plasmatic Concentration in Brain-Injured Neurocritical Care Patients: Systematic Review of Clinical Evidence. J Clin Med 2022; 11:jcm11020394. [PMID: 35054087 PMCID: PMC8780007 DOI: 10.3390/jcm11020394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Hyperhomocysteinemia (HHcy) is considered as an independent risk factor for several diseases, such as cardiovascular, neurological and autoimmune conditions. Atherothrombotic events, as a result of endothelial dysfunction and increased inflammation, are the main mechanisms involved in vascular damage. This review article reports clinical evidence on the relationship between the concentration of plasmatic homocysteine (Hcy) and acute brain injury (ABI) in neurocritical care patients. Materials and methods: a systematic search of articles in the PubMed and EMBASE databases was conducted, of which only complete studies, published in English in peer-reviewed journals, were included. Results: A total of 33 articles, which can be divided into the following 3 subchapters, are present: homocysteine and acute ischemic stroke (AIS); homocysteine and traumatic brain injury (TBI); homocysteine and intracranial hemorrhage (ICH)/subarachnoid hemorrhage (SAH). This confirms that HHcy is an independent risk factor for ABI and a marker of poor prognosis in the case of stroke, ICH, SAH and TBI. Conclusions: Several studies elucidate that Hcy levels influence the patient’s prognosis in ABI and, in some cases, the risk of recurrence. Hcy appears as biochemical marker that can be used by neuro-intensivists as an indicator for risk stratification. Moreover, a nutraceutical approach, including folic acid, the vitamins B6 and B12, reduces the risk of thrombosis, cardiovascular and neurological dysfunction in patients with severe HHcy that were admitted for neurocritical care.
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Affiliation(s)
- Maria Paola Lauretta
- Department of Anaesthesia and Pain Management, IRCCS Policlinico S. Orsola-Malpighi of Bologna, University of Bologna, 40138 Bologna, Italy;
| | - Rita Maria Melotti
- Department of Anaesthesia and Pain Management, IRCCS Policlinico S. Orsola-Malpighi of Bologna, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy;
| | - Corinne Sangermano
- Department of Anaesthesia, Intensive Care and Pain Management, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.S.); (A.M.G.); (F.B.)
| | - Anneliya Maria George
- Department of Anaesthesia, Intensive Care and Pain Management, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.S.); (A.M.G.); (F.B.)
| | - Rafael Badenes
- Department of Anesthesiology and Surgical Trauma Intensive Care, Hospital Clínic Universitar de Valencia, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Federico Bilotta
- Department of Anaesthesia, Intensive Care and Pain Management, Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (C.S.); (A.M.G.); (F.B.)
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35
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Bao Y, Zhang Y, Du C, Ji Y, Dai Y, Jiang W. Malnutrition and the Risk of Early Neurological Deterioration in Elderly Patients with Acute Ischemic Stroke. Neuropsychiatr Dis Treat 2022; 18:1779-1787. [PMID: 36035075 PMCID: PMC9401099 DOI: 10.2147/ndt.s366851] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the relationship between malnutrition and early neurological deterioration (END) in elderly patients with acute ischemic stroke in China. METHODS We used the registry data in the Third Affiliated Hospital of Nantong University and Nanjing Brain Hospital from June 2019 to January 2021. Malnutrition risk was evaluated by controlling nutritional status score (CONUT), geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) score, respectively. END was defined as an increment of at least two points in the total NIHSS score within three days after admission. We evaluated the relationship between malnutrition and END with multivariable logistic regression models and reclassification indexes. RESULTS A total of 732 elderly patients with first-ever acute ischemic stroke were included in the study. 243 patients developed END. 5.7%, 21.4%, 4.6% patients were classified as moderate to severe malnutrition by CONUT, GNRI and PNI, respectively. Malnutrition was associated with the risk of END for CONUT (odds ratio [OR], 1.210; 95% confidence interval [CI] 1.092-1.341; P < 0.001), for GNRI (OR, 0.943; 95% CI, 0.919-0.967; P < 0.001), and for PNI (OR, 0.936; 95% CI, 0.908-0.965; P < 0.001) in multivariable logistic regression models using the back-ward selection method. The discriminative ability was 0.763 (95% CI, 0.727-0.798) for CONUT, 0.769 (95% CI, 0.733-0.805) for GNRI and 0.769 (95% CI, 0.733-0.805) for PNI after adjusting for confounders. Besides, adding malnutrition indexes into models made the prediction of END more accurate. CONCLUSION Malnutrition was associated with END in elderly Chinese patients with acute ischemic stroke.
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Affiliation(s)
- Yuanfei Bao
- Department of Neurology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, People's Republic of China
| | - Yao Zhang
- Department of Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210002, People's Republic of China
| | - Chaopin Du
- Department of Neurology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, People's Republic of China
| | - Yan Ji
- Department of Neurology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, People's Republic of China
| | - Yiwei Dai
- Department of Neurology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, People's Republic of China
| | - Wei Jiang
- Department of Neurology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, 214000, People's Republic of China
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Haber G, Loffeld M, Braumiller M, Lorenzl S. Left hemispheric cortical watershed infarcts triggered by carotid sinus self-massage. BMJ Case Rep 2021; 14:e244926. [PMID: 34920996 PMCID: PMC8685934 DOI: 10.1136/bcr-2021-244926] [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] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
A 69-year-old man was presented to our emergency department with acute onset of hemianopsia, aphasia and dizziness. He reported that while he was sitting in front of his computer at home, he had performed a bilateral self-massage of his carotid arteries when suddenly the symptoms occurred. A neurological examination revealed a hemianopsia with a visual field loss on the right side. In addition, a mild aphasic syndrome with agraphia and a word-finding disorder (National Institutes of Health Stroke Scale (NIHSS): 3 points) was diagnosed. The initial brain CT scan with CT angiography showed neither an intracerebral haemorrhage nor a cerebral infarction. Also, no occlusion or any signs of artery dissection or a flow relevant stenosis of the brain supplying arteries were found. After excluding other contraindications, an intravenous thrombolysis with weight-adapted alteplase was performed. The symptoms of the patient significantly improved in the short-term follow-up. Three days after admission no neurological deficits remained. The MRI of the brain revealed multifocal, small, left hemispherical strokes in the middle cerebral artery territory. In general, watershed infarcts after carotid sinus self-massage follow a rare ischaemic stroke mechanism. This case emphasises the importance of a detailed anamnestic evaluation to determine the aetiological classification of ischaemic stroke as well as educating patients' (poststroke) behaviour.
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Affiliation(s)
- Georg Haber
- Neurology, Krankenhaus Agatharied GmbH, Hausham, Bavaria, Germany
| | - Miriam Loffeld
- Neurology, Krankenhaus Agatharied GmbH, Hausham, Bavaria, Germany
| | | | - Stefan Lorenzl
- Neurology, Krankenhaus Agatharied GmbH, Hausham, Bavaria, Germany
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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Li S, Li G, Luo X, Huang Y, Wen L, Li J. Endothelial Dysfunction and Hyperhomocysteinemia-Linked Cerebral Small Vessel Disease: Underlying Mechanisms and Treatment Timing. Front Neurol 2021; 12:736309. [PMID: 34899561 PMCID: PMC8651556 DOI: 10.3389/fneur.2021.736309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/01/2021] [Indexed: 02/05/2023] Open
Abstract
Cerebral small vessel disease (cSVD)—a common cause of stroke and vascular dementia—is a group of clinical syndromes that affects the brain's small vessels, including arterioles, capillaries, and venules. Its pathogenesis is not fully understood, and effective treatments are limited. Increasing evidence indicates that an elevated total serum homocysteine level is directly and indirectly associated with cSVD, and endothelial dysfunction plays an active role in this association. Hyperhomocysteinemia affects endothelial function through oxidative stress, inflammatory pathways, and epigenetic alterations at an early stage, even before the onset of small vessel injuries and the disease. Therefore, hyperhomocysteinemia is potentially an important therapeutic target for cSVD. However, decreasing the homocysteine level is not sufficiently effective, possibly due to delayed treatment, which underlying reason remains unclear. In this review, we examined endothelial dysfunction to understand the close relationship between hyperhomocysteinemia and cSVD and identify the optimal timing for the therapy.
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Affiliation(s)
- Shuang Li
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guangjian Li
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xia Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Huang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lan Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglun Li
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke. Sci Rep 2021; 11:20610. [PMID: 34663874 PMCID: PMC8523653 DOI: 10.1038/s41598-021-99920-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to develop a novel prediction model for early neurological deterioration (END) based on an interpretable machine learning (ML) algorithm for atrial fibrillation (AF)-related stroke and to evaluate the prediction accuracy and feature importance of ML models. Data from multicenter prospective stroke registries in South Korea were collected. After stepwise data preprocessing, we utilized logistic regression, support vector machine, extreme gradient boosting, light gradient boosting machine (LightGBM), and multilayer perceptron models. We used the Shapley additive explanation (SHAP) method to evaluate feature importance. Of the 3,213 stroke patients, the 2,363 who had arrived at the hospital within 24 h of symptom onset and had available information regarding END were included. Of these, 318 (13.5%) had END. The LightGBM model showed the highest area under the receiver operating characteristic curve (0.772; 95% confidence interval, 0.715–0.829). The feature importance analysis revealed that fasting glucose level and the National Institute of Health Stroke Scale score were the most influential factors. Among ML algorithms, the LightGBM model was particularly useful for predicting END, as it revealed new and diverse predictors. Additionally, the effects of the features on the predictive power of the model were individualized using the SHAP method.
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Wang J, Han M, Kuang J, Tu J, Starcevich K, Gao P, Peng C, Yin S, Chen J, Zhang X, Jia W, Wu Y, Yi Y. Personalized antiplatelet therapy based on clopidogrel/aspirin resistance tests in acute ischemic stroke and transient ischemic attack: Study protocol of a multi-center, single-blinded and randomized controlled trial. Contemp Clin Trials 2021; 108:106507. [PMID: 34274496 DOI: 10.1016/j.cct.2021.106507] [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: 03/05/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clopidogrel and aspirin are key intervention for acute ischemic stroke (AIS) and transient ischemic attack (TIA). However, with increased clinical application, many patients have shown clopidogrel resistance (CR) and/or aspirin resistance (AR) that affect antiplatelet therapy on AIS/TIA. At present, there is no research reported on personalized antiplatelet therapy guidelines for patients with CR and/or AR. Our study aims to assess the effect of personalized antiplatelet therapy based on CYP2C19 genotype and urine 11-dhTxB2 tests in patients with AIS or TIA. METHODS This is a multi-center randomized controlled trial. Eligible patients with AIS/TIA from 14 comprehensive hospitals in Jiangxi province will be recruited after obtaining informed consent. Participants will be randomly divided into the intervention group and the control group at a ratio of 1:1. personalized antiplatelet therapy based on the CYP2C19 genotype/urine11-dhTxB2 tests will be given to the intervention group. Demographics, disease history, laboratory investigations, therapys, physiological tests, imaging reports and other clinical features will be collected. Clinical outcomes including stroke recurrence, Modified Rankin Scale (mRS) score, bleeding events and all-cause mortality will be assessed at the 1st, 3rd, 6th, and 12th-month post-discharge. DISCUSSION Our study will conduct free antiplatelet resistance tests and personalized antiplatelet therapy for AIS/TIA patients with CR/AR, ultimately evaluating personalized therapy effectiveness through one-year follow-up. The research results will help to assess the impact of personalized antiplatelet therapy on the prognosis of stroke, thus providing reference for precise clinical treatment.
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Affiliation(s)
- Jiajing Wang
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Mengqi Han
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Jie Kuang
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China.
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China
| | - Katherine Starcevich
- School of Community Health Sciences, University of Nevada, Reno, 89557 Nevada, USA
| | - Peter Gao
- School of Community Health Sciences, University of Nevada, Reno, 89557 Nevada, USA
| | - Chen Peng
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Shujuan Yin
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Jibiao Chen
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Xiaolin Zhang
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Weijie Jia
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Yifan Wu
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461BaYi Road, Nanchang 330006, PR China
| | - Yingping Yi
- Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang 330006, PR China.
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Bi X, Liu X, Cheng J. Monocyte to High-Density Lipoprotein Ratio Is Associated With Early Neurological Deterioration in Acute Isolated Pontine Infarction. Front Neurol 2021; 12:678884. [PMID: 34262524 PMCID: PMC8273253 DOI: 10.3389/fneur.2021.678884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The monocyte to high-density lipoprotein ratio (MHR) has been considered to be a novel inflammatory marker of atherosclerotic cardiovascular disease. However, its role in the acute phase of acute isolated pontine infarctions remains elusive. We explored whether an association existed between elevated MHR levels and early neurological deterioration (END) in patients with isolated pontine infarction. Methods: Data from 212 patients with acute isolated pontine infarction were retrospectively analyzed. We examined the MHR in quartiles of increasing levels to evaluate for possible threshold effects. END was defined as an elevation in the total National Institutes of Health Stroke Scale (NIHSS) score ≥2 or an increase in NIHSS score ≥1 in motor power within the first week after symptom onset. Patients were divided into an END group and a non-END group. The association of MHR on END following pontine infarction was examined by logistic regression models after adjusting for age, NIHSS at admission, basilar artery stenosis, history of hypertension or hyperlipidemia or stroke, infarct size, fasting blood glucose, and paramedian pontine infarction. Results: The mean MHR was 0.44 ± 0.22. A total of 58 (27.36%) patients were diagnosed with END. END occurred within the first 48 h after hospitalization in 38 patients (65.52%). After adjusting for confounding and risk factors, the multivariate logistic regression analysis showed NIHSS at admission [odds ratio (OR), 1.228; 95% confidence interval (CI), 1.036–1.456], basilar artery stenosis (OR, 2.843; 95% CI, 1.205–6.727), and fasting blood glucose (OR, 1.296; 95% CI, 1.004–1.672) were independently associated with END. The odds ratio of END increased as the quartile level of MHR increased, with the lowest quartile used as the reference value. Compared to the first quartile of MHR, the third and fourth quartiles were associated with 4.847-fold (95% CI, 1.532–15.336) and 5.824-fold (95% CI, 1.845–18.385) higher odds of END in multivariate analysis. Conclusions: Elevated MHR levels may be valuable as a biomarker of END in patients with isolated pontine infarction. The elevated MHR was independently associated with END in isolated pontine infarction.
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Affiliation(s)
- Xinwei Bi
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqian Liu
- Department of Pharmacy, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiaqi Cheng
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Bennett C, Green J, Ciancio M, Goral J, Pitstick L, Pytynia M, Meyer A, Kwatra N, Jadavji NM. Dietary folic acid deficiency impacts hippocampal morphology and cortical acetylcholine metabolism in adult male and female mice. Nutr Neurosci 2021; 25:2057-2065. [PMID: 34042561 DOI: 10.1080/1028415x.2021.1932242] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE One-carbon (1C) metabolism is a metabolic network that integrates nutritional signals with biosynthesis, redox homeostasis, and epigenetics. There are sex differences in hepatic 1C metabolism, however, it is unclear whether sex differences in 1C impact the brain. The aim of this study was to investigate if sex modulates the effects of dietary folic acid deficiency, the main component of 1C, in brain tissue using a mouse model. METHODS Male and female C57Bl/6J mice were placed on a folic acid deficient (FD) or control diet (CD) at six weeks until six months of aged. After which brain tissue and serum were collected for analysis. In brain tissue, hippocampal volume, morphology, and apoptosis as well as cortical acetylcholine metabolism were measured. RESULTS Male and female FD mice had reduced serum levels of folate. Both males and females maintained on a FD showed a decrease in the thickness of the hippocampal CA1-CA3 region. Interestingly, there was a sex difference in the levels of active caspase-3 within the CA3 region of the hippocampus. In cortical tissue, there were increased levels of neuronal ChAT and reduced levels of AChE in FD females and male mice. CONCLUSIONS The results indicated that FD impacts hippocampal morphology and cortical neuronal acetylcholine metabolism. The data from our study indicate that there was only one sex difference and that was in hippocampal apoptosis. Our study provides little evidence that sex modulates the effects of dietary folate deficiency on hippocampal morphology and cortical neuronal acetylcholine metabolism.
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Affiliation(s)
- Calli Bennett
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, AZ, USA.,College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Jacalyn Green
- Biochemistry and Molecular Genetics, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Mae Ciancio
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Joanna Goral
- Department of Anatomy, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Lenore Pitstick
- Biochemistry and Molecular Genetics, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Matthew Pytynia
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Alice Meyer
- Department of Anatomy, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Neha Kwatra
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, AZ, USA.,College of Dental Medicine, Midwestern University, Glendale, AZ, USA
| | - Nafisa M Jadavji
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, Glendale, AZ, USA.,College of Veterinary Medicine, Midwestern University, Glendale, AZ, USA.,Department of Neuroscience, Carleton University, Ottawa, Canada
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Akimoto T, Hara M, Morita A, Uehara S, Nakajima H. Relationship between Nutritional Scales and Prognosis in Elderly Patients after Acute Ischemic Stroke: Comparison of Controlling Nutritional Status Score and Geriatric Nutritional Risk Index. ANNALS OF NUTRITION AND METABOLISM 2021; 77:116-123. [PMID: 34010837 DOI: 10.1159/000515212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Undernutrition is common in patients after acute ischemic stroke (AIS) and predicts poor clinical outcomes. We assessed the relationship between undernutrition and prognosis after AIS. METHODS We retrospectively assessed consecutively hospitalized AIS patients aged ≥65 years. A poor prognosis for patients after AIS was defined as a modified Rankin Scale (mRS) score of ≥3 at discharge. Nutritional status was evaluated based on the degree and risk of undernutrition as determined by the Controlling Nutritional Status (UND-CONUT) and Geriatric Nutritional Risk Index (UNR-GNRI) scores. RESULTS Among 218 patients (male, 62.8%; median age, 77 years), 81 had a poor prognosis. A significant correlation was found between UND-CONUT and UNR-GNRI scores (p < 0.001, r = 0.433). Patients with a poor prognosis showed significant undernutrition based on UND-CONUT (p = 0.003) but not on UNR-GNRI (p = 0.218). Patients with undernutrition based on UND-CONUT showed poor outcomes: higher mRS scores at discharge, higher percentages of mRS scores of ≥2 and ≥3, and more complications associated with pneumonia. No significant differences were seen between cases with and without undernutrition risk based on UNR-GNRI. CONCLUSION UND-CONUT appeared to be more useful than UNR-GNRI for predicting the prognosis of elderly patients with AIS at discharge.
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Affiliation(s)
- Takayoshi Akimoto
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Akihiko Morita
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Deng W, McMullin D, Inglessis-Azuaje I, Locascio JJ, Palacios IF, Buonanno FS, Lo EH, Ning M. Effect of Patent Foramen Ovale Closure After Stroke on Circulatory Biomarkers. Neurology 2021; 97:e203-e214. [PMID: 33986139 DOI: 10.1212/wnl.0000000000012188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To determine the influence of patent foramen ovale (PFO) closure on circulatory biomarkers. METHODS Consecutive patients with PFO-related stroke were prospectively enrolled and followed with serial sampling of cardiac atrial and venous blood pre- and post-PFO closure over time. Candidate biomarkers were identified by mass spectrometry in a discovery cohort first, and lead candidates were validated in an independent cohort. RESULTS Patients with PFO-related stroke (n = 254) were recruited and followed up to 4 years (median 2.01; interquartile range 0.77-2.54). Metabolite profiling in the discovery cohort (n = 12) identified homocysteine as the most significantly decreased factor in intracardiac plasma after PFO closure (false discovery rate 0.001). This was confirmed in a validation cohort (n = 181), where intracardiac total homocysteine (tHcy) was immediately reduced in patients with complete closure, but not in those with residual shunting, suggesting association of PFO shunting with tHcy elevation (β 0.115; 95% confidence interval [CI] 0.047-0.183; p = 0.001). tHcy reduction was more dramatic in left atrium than right (p < 0.001), suggesting clearance through pulmonary circulation. Long-term effect of PFO closure was also monitored and compared to medical treatment alone (n = 61). Complete PFO closure resulted in long-term tHcy reduction in peripheral blood, whereas medical therapy alone showed no effect (β -0.208; 95% CI -0.375∼-0.058; p = 0.007). Residual shunting was again independently associated with persistently elevated tHcy (β 0.184; 95% CI 0.051-0.316; p = 0.007). CONCLUSIONS PFO shunting may contribute to circulatory tHcy elevation, which is renormalized by PFO closure. PFO is not just a door for clots, but may itself enhance clot formation and injure neurovasculature by clot-independent mechanisms. Biomarkers such as tHcy can potentially serve as cost-effective measures of residual shunting and neurovascular risk for PFO stroke.
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Affiliation(s)
- Wenjun Deng
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - David McMullin
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ignacio Inglessis-Azuaje
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joseph J Locascio
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Igor F Palacios
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ferdinando S Buonanno
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eng H Lo
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - MingMing Ning
- From the Clinical Proteomics Research Center (W.D., D.M., F.S.B., E.H.L., M.M.N.), Cardio-Neurology Division (W.D., I.I.-A., J.J.L., I.F.P., F.S.B., E.H.L., M.M.N.), and Neuroprotection Research Laboratory (E.H.L., M.M.N.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Wang J, Kuang J, Yi Y, Peng C, Ge Y, Yin S, Zhang X, Chen J. Does CYP2C19 polymorphisms affect neurological deterioration in stroke/TIA patients?: A systematic review and meta-analysis of prospective cohort studies. Medicine (Baltimore) 2021; 100:e25150. [PMID: 33725999 PMCID: PMC7982215 DOI: 10.1097/md.0000000000025150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/13/2020] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The association between cytochrome P450 2C19 (CYP2C19) polymorphisms and neurological deterioration in stroke or transient ischemic attack (TIA) patients is not completely understood. Hence, we performed a systematic review and meta-analysis of prospective cohort studies to quantify this association. METHODS PubMed, Cochrane Library, Excerpta Medica Database, China National Knowledge Infrastructure and WanFang databases were searched for studies published up to April 2019. Prospective cohort studies that reported an association between CYP2C19 polymorphisms and neurological deterioration in stroke/TIA patients were included. Data on risk ratio (RR) and 95% confidence intervals (CI) were extracted and pooled by the authors. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. RESULTS Twelve eligible studies were included. Twelve studies reported CYP2C19∗2, ∗3 loss-of-function alleles and 5 studies reported CYP2C19∗17 gain-of-function allele. Compared to non-carriers, carriers of CYP2C19∗2, ∗3 loss-of-function alleles had a significantly higher risk of neurological deterioration (RR, 1.63; 95%CI, 1.32-2.02). Conversely, carriers of CYP2C19∗17 gain-of-function allele had a significantly lower risk of neurological deterioration (RR, 0.520; 95%CI, 0.393-0.689) compared to non-carriers. CONCLUSIONS This meta-analysis demonstrated that the carriers of CYP2C19∗2, ∗3 loss-of-function alleles have an increased risk of neurological deterioration compared to non-carriers in stroke or TIA patients. Additionally, CYP2C19∗17 gain-of-function allele can reduce the risk of neurological deterioration.
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Affiliation(s)
- Jiajing Wang
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Jie Kuang
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Yingping Yi
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Chen Peng
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Yanqiu Ge
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Shujuan Yin
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Xiaolin Zhang
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
| | - Jibiao Chen
- Department of Information, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University
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Zhong ZL, Liu J. Association between Hyperhomocysteinemia and Hypertensive Retinopathy in a Chinese Han Population. Curr Eye Res 2021; 46:1539-1543. [PMID: 33660574 DOI: 10.1080/02713683.2021.1894581] [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] [Indexed: 10/22/2022]
Abstract
Purpose/aim: In some diseases, hyperhomocysteinemia (HHcy) has been recognized as a risk factor. However, information on the correlation between HHcy and hypertensive retinopathy (HR) in the Chinese population is unclear. We, therefore, aimed to investigate this association.Materials and Methods: A total of 382 patients were collected and 126 individuals were excluded in this study. Finally, 128 patients with HR and 128 control subjects were enrolled sequentially. The association between HHcy and the occurrence of HR was determined by multivariate logistic regression analysis, including interaction and stratified analyses.Results: HHcy, cardiovascular disease, fasting blood glucose, creatinine, triglyceride, diabetes, smoking habits, drinking habits were significantly associated with HR (P < .05) in the univariate logistic regression analysis. Each increase of 1 μmol/L of homocysteine concentration was significantly correlated with a 9% increased risk of HR (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.07-1.55, P < .05). Hierarchical analysis identified history of diabetes (OR = 7.38, P > .05), age ≥60 years (OR = 3.08, P > .05), male sex (OR = 1.04, P > .05), history of cardiovascular disease (OR = 7.88, P > .05), smoking habit (OR = 1.08, P > .05), and drinking habit (OR = 78.31, P > .05), as factors associated with HR, but not as independent risk factors for HR. Interaction analysis demonstrated no interaction between HHcy and HR.Conclusions: Within the Chinese Han population, HHcy is an independent risk factor for HR.
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Affiliation(s)
- Ze-Long Zhong
- Department of Vitreoretinopathy, Tianjin Eye Hospital, Tianjin, China.,Department of Vitreoretinopathy, Nankai University Affiliated Eye Hospital, Tianjin, China.,Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jie Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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Gong P, Liu Y, Gong Y, Chen G, Zhang X, Wang S, Zhou F, Duan R, Chen W, Huang T, Wang M, Deng Q, Shi H, Zhou J, Jiang T, Zhang Y. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflammation 2021; 18:51. [PMID: 33610168 PMCID: PMC7896410 DOI: 10.1186/s12974-021-02090-6] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background and purpose To investigate the association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 within 24 h after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥ 4 or complete recovery within 24 h. Multinomial logistic regression analysis was performed to explore the relationship of NLR, PLR, and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI. Results Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with END and 398 (37.5%) were diagnosed with ENI. Multinomial logistic model indicated that NLR (odds ratio [OR], 1.385; 95% confidence interval [CI] 1.238–1.551, P = 0.001), PLR (OR, 1.013; 95% CI 1.009–1.016, P = 0.001), and LMR (OR, 0.680; 95% CI 0.560–0.825, P = 0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.713; 95% CI 0.643–0.791, P = 0.001) served as an independent factor for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR, and LMR to discriminate END were 0.763, 0.703, and 0.551, respectively. AUC of NLR, PLR, and LMR to discriminate ENI were 0.695, 0.530, and 0.547, respectively. Conclusions NLR, PLR, and LMR were associated with post-thrombolysis END. NLR and PLR may predict post-thrombolysis END. NLR was related to post-thrombolysis ENI. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02090-6.
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Affiliation(s)
- Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Yachi Gong
- Department of Gerontology, Nantong Third People's Hospital, Nantong University, Nantong, 226006, Jiangsu, China
| | - Gang Chen
- Department of Neurology, Haimen Hospital Affiliated to Nantong University, Nantong, 226000, Jiangsu, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210000, Jiangsu, China
| | - Siyu Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Feng Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Rui Duan
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210000, Jiangsu, China
| | - Wenxiu Chen
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Ting Huang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Hongchao Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China.
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China.
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, Jiangsu, China.
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Huang S, Cai J, Tian Y. The Prognostic Value of Homocysteine in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis. Front Syst Neurosci 2021; 14:600582. [PMID: 33643003 PMCID: PMC7907516 DOI: 10.3389/fnsys.2020.600582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background: This comprehensive meta-analysis aimed to assess whether an increased homocysteine (Hcy) level is an independent predictor of unfavorable outcomes in acute ischemic stroke (AIS) patients. Methods: A comprehensive literature search was conducted up to August 1, 2020 to collect studies reporting Hcy levels in AIS patients. We analyzed all the data using Review Manager 5.3 software. Results: Seventeen studies with 15,636 AIS patients were selected for evaluation. A higher Hcy level was associated with a poorer survival outcome (OR 1.43, 95% CI: 1.25–1.63). Compared with the AIS group, Hcy levels were significantly lower in the healthy control patients, with an SMD of 5.11 and 95% CI (1.87–8.35). Analysis of the different subgroups of AIS demonstrated significant associations between high Hcy levels and survival outcomes only in Caucasian and Asian patients. Moreover, whereas high Hcy levels were closely associated with gender, B12 deficiency, smoking, and patients who received tissue plasminogen activator treatment, no significant difference was found between increased Hcy levels and age, drinking, hypertension, diabetes mellitus, and hyperlipidemia. In addition, the cut-off value (20.0 μmol/L) might be an optimum cut-off index for AIS patients in clinical practice. Conclusion: This meta-analysis reveals that the Hcy level may serve as an independent predictor for unfavorable survival outcomes in AIS patients, particularly in Caucasian and Asian AIS patients. Further studies can be conducted to clarify this relationship.
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Affiliation(s)
- Shengming Huang
- Department of Neurology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, China
| | - Jirui Cai
- Department of Cardiology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, China
| | - Yuejun Tian
- Department of Neurology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College, Luohe, China.,Institute of Urology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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Bernstein JE, Browne JD, Savla P, Wiginton J, Patchana T, Miulli DE, Wacker MR, Duong J. Inflammatory Markers in Severity of Intracerebral Hemorrhage II: A Follow Up Study. Cureus 2021; 13:e12605. [PMID: 33585095 PMCID: PMC7872478 DOI: 10.7759/cureus.12605] [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] [Indexed: 12/02/2022] Open
Abstract
Introduction Spontaneous intracerebral hemorrhage (ICH) results in significant morbidity and mortality. The pathogenesis of brain injury after ICH is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue. Various inflammatory and non-inflammatory biomarkers have been studied as predictors and potential therapeutic targets for intracerebral hemorrhage. Our prior study showed an association with low vascular endothelial growth factor (VEGF) levels and increased mortality. This current study looks to expand on our prior results and will look at the relationship between tumor necrosis factor alpha (TNFα), C-reactive protein (CRP), VEGF, Homocysteine (Hcy), and CRP to albumin ratio (CAR) in predicting outcomes and severity in spontaneous intracerebral hemorrhage. Methods We conducted a retrospective chart review of patients with spontaneous intracerebral hemorrhage with TNFα, CRP, VEGF, Hcy levels drawn on admission. Albumin and CRP levels on admission were used to calculate CAR. Ninety-nine patients were included in the study. Primary outcomes included death, early neurologic decline (END), and hemorrhage size. Secondary outcomes included late neurologic decline (LND), Glasgow Coma Scale (GCS) on admission, GCS on discharge, ICH score, change in hemorrhage size, need for surgical intervention, and length of ICU stay. Results A total of 99 patients were included in this study, with 42% requiring surgical intervention and an overall mortality of 16%. Basal ganglia hemorrhage was seen in 41% of patients. Hcy and CAR were significantly correlated with ICH size in basal ganglia patients (r-=0.36, p=0.03; r=0.43, p=0.03, respectively). CAR was significantly correlated with ICH score (r=0.33, p=0.007874). Admission VEGF levels less than 45 pg/ml had 8.4-fold increase in mortality (odds ratio [OR] 8.4545, p=0.0488). Patients with TNFα levels greater than 1.40 pg/ml had a 4.1-fold increase in mortality (OR 4.1, p=0.04) Conclusion Our study demonstrated that low levels (<45 pg/ml) of VEGF were associated with an 8.4-fold increase in mortality, supporting the neuroprotective effect of this protein. Elevated Hcy and CAR levels were associated with an increase in hemorrhage size in patients with basal ganglia hemorrhages. TNFα levels greater than 1.40 pg/ml were associated with a 4.1-fold increase in mortality, and this together with CAR being correlated with increased hemorrhage size and ICH score further demonstrate the inflammatory consequences after intracerebral hemorrhage. Future studies directed at lowering CRP, TNFα, and Hcy and/or increasing VEGF in intracerebral hemorrhage patients are needed and may be beneficial.
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Affiliation(s)
- Jacob E Bernstein
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Jonathan D Browne
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | | | - Jason Duong
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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Xie X, Xiao J, Wang Y, Pan L, Ma J, Deng L, Yang J, Ren L. Predictive Model of Early Neurological Deterioration in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2021; 30:105459. [PMID: 33387889 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to develop a predictive model of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). METHODS The present retrospective cohort study considered patients with AIS who were admitted to a tertiary hospital in Shenzhen, China between January 2014 and December 2018. An increase of 2 points or more on the National Institute of Health Stroke Scale (NIHSS) within 7 days indicated END. We selected baseline clinical, laboratory, and neuroimaging variables to construct predictive models through multivariate logistic regression. The receiver operating characteristic curve and calibration plots were calculated. RESULTS A total of 391 patients with AIS were enrolled in the study. END was observed in 64 (16.4%) cases. A prediction model developed from the initial NIHSS score, middle cerebral artery stenosis, and carotid stenosis of≥ 50% showed good discriminative ability: area under the receiver operating characteristic curve, 0.870 (95%CI, 0.813-0.911); threshold, -1.570; specificity, 84.40%; sensitivity, 75.00%; positive predictive value, 48.48%; and a negative predictive value, 94.52%. CONCLUSION Our predictive model developed from the initial NIHSS score, middle cerebral artery stenosis, and carotid stenosis of ≥ 50% could identify patients with AIS who were at risk of developing END. The model requires validation by larger studies performed at other institutions.
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Affiliation(s)
- Xiaohua Xie
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 518035 Shenzhen, China.
| | - Jingyi Xiao
- School of Nursing, Guangzhou Medical University, Guangzhou 510030, China.
| | - Yunyun Wang
- Department of Nursing, Children's Hospital of Anhui Medical University, Heifei, 230000, China.
| | - Lu Pan
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 518035 Shenzhen, China.
| | - Jiahui Ma
- Clinical College of The Second Shenzhen Hospital, Anhui Medical University, Shenzhen, 518035, China.
| | - Liping Deng
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 518035 Shenzhen, China.
| | - Jie Yang
- Clinical College of The Second Shenzhen Hospital, Anhui Medical University, Shenzhen, 518035, China.
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen, Guangdong 518035, China.
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Wang Y, Wang Y, Du L, Liu P, Fei Z. Risk Factors, Recurrence and Short-Term Outcomes for Progressive Cerebral Infarction: A Retrospective Study. Neurol India 2021; 69:1675-1681. [DOI: 10.4103/0028-3886.333493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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