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Zhang W, Zhou Y, Xu L, Qiu C, Luo Z, Jiang Z, Tao X, Wu Y, Yao S, Huang H, Wang X, Yang Y, Lin R. Development and validation of radiology-clinical statistical and machine learning model for stroke-associated pneumonia after first intracerebral haemorrhage. BMC Pulm Med 2024; 24:357. [PMID: 39048959 PMCID: PMC11267827 DOI: 10.1186/s12890-024-03160-0] [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: 11/06/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Society is burdened with stroke-associated pneumonia (SAP) after intracerebral haemorrhage (ICH). Cerebral small vessel disease (CSVD) complicates clinical manifestations of stroke. In this study, we redefined the CSVD burden score and incorporated it into a novel radiological-clinical prediction model for SAP. MATERIALS AND METHODS A total of 1278 patients admitted to a tertiary hospital between 1 January 2010 and 31 December 2019 were included. The participants were divided into training and testing groups using fivefold cross-validation method. Four models, two traditional statistical models (logistic regression and ISAN) and two machine learning models (random forest and support vector machine), were established and evaluated. The outcomes and baseline characteristics were compared between the SAP and non-SAP groups. RESULTS Among the of 1278 patients, 281(22.0%) developed SAP after their first ICH. Multivariate analysis revealed that the logistic regression (LR) model was superior in predicting SAP in both the training and testing groups. Independent predictors of SAP after ICH included total CSVD burden score (OR, 1.29; 95% CI, 1.03-1.54), haematoma extension into ventricle (OR, 2.28; 95% CI, 1.87-3.31), haematoma with multilobar involvement (OR, 2.14; 95% CI, 1.44-3.18), transpharyngeal intubation operation (OR, 3.89; 95% CI, 2.7-5.62), admission NIHSS score ≥ 10 (OR, 2.06; 95% CI, 1.42-3.01), male sex (OR, 1.69; 95% CI, 1.16-2.52), and age ≥ 67 (OR, 2.24; 95% CI, 1.56-3.22). The patients in the SAP group had worse outcomes than those in the non-SAP group. CONCLUSION This study established a clinically combined imaging model for predicting stroke-associated pneumonia and demonstrated superior performance compared with the existing ISAN model. Given the poor outcomes observed in patients with SAP, the use of individualised predictive nomograms is vital in clinical practice.
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Affiliation(s)
- Wenru Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liuhui Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chaomin Qiu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhixian Luo
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Xinyi Tao
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingjie Wu
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shishi Yao
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hang Huang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Liu Y, Chen Y, Zhi Z, Wang P, Wang M, Li Q, Wang Y, Zhao L, Chen C. Association Between TCBI (Triglycerides, Total Cholesterol, and Body Weight Index) and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients. Clin Interv Aging 2024; 19:1091-1101. [PMID: 38911675 PMCID: PMC11192204 DOI: 10.2147/cia.s467577] [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] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Stroke-associated pneumonia (SAP) usually complicates stroke and is linked to adverse prognoses. Triglycerides, total cholesterol, and body weight index (TCBI) is a new and simple calculated nutrition index. This study seeks to investigate the association between TCBI and SAP incidence, along with its predictive value. Patients and Methods Nine hundred and sixty-two patients with acute ischemic stroke were divided into SAP group and Non-SAP group. The TCBI was divided into three layers: T1, TCBI < 948.33; T2, TCBI 948.33-1647.15; T3, TCBI > 1647.15. Binary Logistic regression analysis was used to determine the relationship between TCBI levels and the incidence of SAP. Furthermore, restricted cubic splines (RCS) analysis was utilized to evaluate the influence of TCBI on the risk of SAP. Results TCBI in the SAP group was markedly lower compared to that in the Non-SAP group (P < 0.001). The Logistic regression model revealed that, using T3 layer as the reference, T1 layer had the highest risk for SAP prevalence (OR = 2.962, 95% CI: 1.600-5.485, P = 0.001), with confounding factors being controlled. The RCS model found that TCBI had a linear relationship with SAP (P for nonlinear = 0.490, P for overall = 0.004). Moreover, incorporating TCBI into the A2DS2 (Age, atrial fibrillation, dysphagia, sex, and severity) model substantially enhanced the initial model's predictive accuracy. Conclusion Low TCBI was associated with a higher risk of SAP. In clinical practice, TCBI has shown predictive value for SAP, contributing to early intervention and treatment of SAP.
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Affiliation(s)
- Yufeng Liu
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Yan Chen
- Department of Neurological Medicine, Siyang Hospital of Traditional Chinese Medicine, Siyang, Jiangsu, 223700, People’s Republic of China
| | - Zhongwen Zhi
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Ping Wang
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Mengchao Wang
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Qian Li
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Yuqian Wang
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Liandong Zhao
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
| | - Chun Chen
- Department of Neurology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, Jiangsu, 223002, People’s Republic of China
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Wang S, Kang H, Wang Q, Wang D, Hu L, Kou J, Yang Z. Incidence and influencing factors of urinary incontinence in stroke patients: A meta-analysis. Neurourol Urodyn 2024; 43:680-693. [PMID: 38247371 DOI: 10.1002/nau.25398] [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: 08/28/2023] [Revised: 11/10/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The incidence of stroke in China ranks first in the world and is the leading cause of death and disability in adults. Urinary incontinence is an independent risk factor leading to poor prognosis of stroke. However, studies on the incidence of urinary incontinence in stroke patients and its influencing factors are different, fluctuate greatly, and there is no unified basis. OBJECTIVE To quantitatively analyze the incidence of urinary incontinence in stroke patients and its related influencing factors, and further make public health strategic decisions to reduce the occurrence of adverse outcomes. METHODS Computer searches were conducted in PubMed, Medline, Web of Science, Cochrane Library, Embase, CLNAHL Complete, China National Knowledge Infrastructure (CNKI), Chinese Biomedical database(CBM), Wan Fang Database, VIP Database, observational studies such as cohort studies, case-control studies or cross-sectional studies on the incidence or influencing factors of urinary incontinence in stroke patients from the establishment of the database to the publication in August 2023. Studies selection, quality evaluation and data extraction were conducted independently by two researchers according to the established search strategy. Stata 14.0 statistical software was used for meta-analysis. RESULTS A total of 21 manuscripts were included, with a cumulative sample size of 7327 cases, including 2887 patients with urinary incontinence. Meta-analysis results showed that the incidence of urinary incontinence in stroke patients was 38% [95% confidence interval (34%, 41%)], including married patients and lacunar infarction were the protective factors for urinary incontinence in stroke patients, while age, chaperone, low educational level, chronic cough, lesion sites (parietal lobe, frontal lobe, and temporal lobe), stroke type (cerebral hemorrhage, subarachnoid hemorrhage and cerebral hemorrhage complicated with subarachnoid hemorrhage), dysfunction (aphasia dyslexia, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, the higher the NIHSS score, the lower the Bachmann index (BI) score, OCSP classification (total anterior circulation infarction) and other 11 items were risk factors for urinary incontinence in stroke patients. CONCLUSION The incidence of urinary incontinence in stroke patients is 38%. Marriage and lacunar infarction are the protective factors of urinary incontinence. Age, carer, low educational level, chronic cough, lesion site (parietal, frontal and temporal lobes), stroke type (cerebral hemorrhage, subarachnoid hemorrhage, cerebral hemorrhage combined with subarachnoid hemorrhage), dysfunction (aphasia and dysarthria syndrome, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, and higher NIHSS score, Lower BI score and OCSP classification (total anterior circulation infarction) were risk factors for urinary incontinence in stroke patients.
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Affiliation(s)
- Shuyao Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hua Kang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qingyuan Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dan Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lizi Hu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiaojiao Kou
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zijiang Yang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Hua X, Liu M, Wu S. Definition, prediction, prevention and management of patients with severe ischemic stroke and large infarction. Chin Med J (Engl) 2023; 136:2912-2922. [PMID: 38030579 PMCID: PMC10752492 DOI: 10.1097/cm9.0000000000002885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Indexed: 12/01/2023] Open
Abstract
ABSTRACT Severe ischemic stroke carries a high rate of disability and death. The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct, defined as severe stroke and large infarction, respectively. Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention, which includes stroke with malignant brain edema, a leading cause of death during the acute phase, and stroke with severe complications of other vital systems. Early prediction of high-risk patients with critically severe stroke would inform early prevention and treatment to interrupt the malignant course to fatal status. Selected patients with severe stroke could benefit from intravenous thrombolysis and endovascular treatment in improving functional outcome. There is insufficient evidence to inform dual antiplatelet therapy and the timing of anticoagulation initiation after severe stroke. Decompressive hemicraniectomy (DHC) <48 h improves survival in patients aged <60 years with large hemispheric infarction. Studies are ongoing to provide evidence to inform more precise prediction of malignant brain edema, optimal indications for acute reperfusion therapies and neurosurgery, and the individualized management of complications and secondary prevention. We present an evidence-based review for severe ischemic stroke, with the aims of proposing operational definitions, emphasizing the importance of early prediction and prevention of the evolution to critically severe status, summarizing specialized treatment for severe stroke, and proposing directions for future research.
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Affiliation(s)
- Xing Hua
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Song X, Wang Y, Guo W, Liu M, Deng Y, Ye K, Liu M. Heart-Rate-to-Blood-Pressure Ratios Correlate with Malignant Brain Edema and One-Month Death in Large Hemispheric Infarction: A Cohort Study. Diagnostics (Basel) 2023; 13:2506. [PMID: 37568871 PMCID: PMC10416946 DOI: 10.3390/diagnostics13152506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Large hemispheric infarction (LHI) can lead to fatal complications such as malignant brain edema (MBE). We aimed to investigate the correlation between heart-rate-to-blood-pressure ratios and MBE or one-month death after LHI. METHODS We prospectively included LHI patients from a registered cohort. Hourly heart-rate-to-blood-pressure ratios were recorded as a variation of the traditional shock index (SI), SIs and SId (systolic and diastolic pressures, respectively), and calculated for mean and variability (standard deviation) in 24 h and two 12 h epochs (1-12 h and 13-24 h) after onset of symptoms. MBE was defined as neurological deterioration symptoms with imaging evidence of brain swelling. We employed a generalized estimating equation to compare the trend in longitudinal collected SIs and SId between patients with and without MBE. We used multivariate logistic regression to investigate the correlation between SIs, SId and outcomes. RESULTS Of the included 162 LHI patients, 28.4% (46/162) developed MBE and 25.3% (40/158) died within one month. SIs and SId increased over baseline in all patients, with a similar ascending profile during the first 12 h epoch and a more intensive increase in the MBE group during the second 12 h epoch (p < 0.05). During the overall 24 h, patients with greater SId variability had a significantly increased MBE risk after adjustment (OR 3.72, 95%CI 1.38-10.04). Additionally, during the second 12 h epoch (13-24 h after symptom onset), patients developing MBE had a significantly higher SId level (OR 1.18, 95%CI 1.00-1.39) and greater SId variability (OR 3.16, 95%CI 1.35-7.40). Higher SId and greater SId variability within 24 h independently correlated with one-month death (all p < 0.05). Within the second 12 h epoch, higher SIs, higher SId and greater SId variability independently correlated with one-month death (all p < 0.05). No significant correlation was observed in the first 12 h epoch. CONCLUSIONS Higher and more fluctuated heart-rate-to-blood-pressure ratios independently correlated with MBE development and one-month death in LHI patients, especially during the second 12 h (13-24 h) epoch after onset.
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Affiliation(s)
- Xindi Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
| | - Yanan Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
| | - Wen Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Meng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
| | - Yilun Deng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
- Department of Neurology, No. 3 People’s Hospital of Chengdu, Chengdu 610031, China
| | - Kaili Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (X.S.); (Y.W.); (W.G.); (M.L.); (Y.D.); (K.Y.)
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Yang G, Xu M, Chen W, Qiao X, Shi H, Hu Y. A brain CT-based approach for predicting and analyzing stroke-associated pneumonia from intracerebral hemorrhage. Front Neurol 2023; 14:1139048. [PMID: 37332986 PMCID: PMC10272424 DOI: 10.3389/fneur.2023.1139048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Stroke-associated pneumonia (SAP) is a common complication of stroke that can increase the mortality rate of patients and the burden on their families. In contrast to prior clinical scoring models that rely on baseline data, we propose constructing models based on brain CT scans due to their accessibility and clinical universality. Methods Our study aims to explore the mechanism behind the distribution and lesion areas of intracerebral hemorrhage (ICH) in relation to pneumonia, we utilized an MRI atlas that could present brain structures and a registration method in our program to extract features that may represent this relationship. We developed three machine learning models to predict the occurrence of SAP using these features. Ten-fold cross-validation was applied to evaluate the performance of models. Additionally, we constructed a probability map through statistical analysis that could display which brain regions are more frequently impacted by hematoma in patients with SAP based on four types of pneumonia. Results Our study included a cohort of 244 patients, and we extracted 35 features that captured the invasion of ICH to different brain regions for model development. We evaluated the performance of three machine learning models, namely, logistic regression, support vector machine, and random forest, in predicting SAP, and the AUCs for these models ranged from 0.77 to 0.82. The probability map revealed that the distribution of ICH varied between the left and right brain hemispheres in patients with moderate and severe SAP, and we identified several brain structures, including the left-choroid-plexus, right-choroid-plexus, right-hippocampus, and left-hippocampus, that were more closely related to SAP based on feature selection. Additionally, we observed that some statistical indicators of ICH volume, such as mean and maximum values, were proportional to the severity of SAP. Discussion Our findings suggest that our method is effective in classifying the development of pneumonia based on brain CT scans. Furthermore, we identified distinct characteristics, such as volume and distribution, of ICH in four different types of SAP.
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Affiliation(s)
- Guangtong Yang
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Min Xu
- Neurointensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Wei Chen
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xu Qiao
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Hongfeng Shi
- Neurointensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Yongmei Hu
- School of Control Science and Engineering, Shandong University, Jinan, China
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Escudero-Martínez I, Thorén M, Ringleb P, Nunes AP, Cappellari M, Rand VM, Sobolewski P, Egido J, Toni D, Chen SY, Tsao N, Ahmed N. Cerebral Edema in Patients with severe Hemispheric Syndrome: Incidence, Risk Factors, and Outcomes-Data from SITS-ISTR. J Stroke 2023; 25:101-110. [PMID: 36470246 PMCID: PMC9911855 DOI: 10.5853/jos.2022.01956] [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: 06/14/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia. METHODS Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003-2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0-2) and death at 90 days. RESULTS Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age <50 years (relative risk [RR], 1.56), signs of acute infarct (RR, 1.29), hyperdense artery sign (RR, 1.39), blood glucose >128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02). CONCLUSIONS In patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, University Hospital La FE, Valencia, Spain,Neurovascular Research Laboratory, Biomedicine Institute IBiS, Sevilla, Spain,Correspondence: IreneEscudero-Martínez Stroke Unit, Department of Neurology, University Hospital La Fe, Av. Fernando Abril 106, 46026, Valencia, Spain Tel: +34-96-124-4000 Fax: +34-96-124-6241 E-mail:
| | - Magnus Thorén
- Department of Neurology, Danderyd Hospital, Stockholm, Sweden,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ana Paiva Nunes
- Department of Neurology, Sao Jose Hospital, University Hospital Lisboa, Lisboa, Portugal
| | - Manuel Cappellari
- Department of Neuroscience, Integrate University Hospital, Verona, Italy
| | - Viiu-Marika Rand
- Department of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Piotr Sobolewski
- Department of Neurology and Stroke Unit in Sandomierz, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Jose Egido
- Stroke Unit, Department of Neurology, San Carlos Clinic Hospital, Madrid, Spain
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Zhai H, Liu Z, Wu S, Cao Z, Xu Y, Lv Y. Predictive value of magnetic resonance imaging-based texture analysis for hemorrhage transformation in large cerebral infarction. Front Neurosci 2022; 16:923708. [PMID: 35937879 PMCID: PMC9353395 DOI: 10.3389/fnins.2022.923708] [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: 04/19/2022] [Accepted: 06/30/2022] [Indexed: 01/31/2023] Open
Abstract
Massive cerebral infarction (MCI) is a devastating condition and associated with high rate of morbidity and mortality. Hemorrhagic transformation (HT) is a common complication after acute MCI, and often results in poor outcomes. Although several predictors of HT have been identified in acute ischemic stroke (AIS), the association between the predictors and HT remains controversial. Therefore, we aim to explore the value of texture analysis on magnetic resonance image (MRI) for predicting HT after acute MCI. This retrospective study included a total of 98 consecutive patients who were admitted for acute MCI between January 2019 and October 2020. Patients were divided into the HT group (n = 44) and non-HT group (n = 54) according to the follow-up computed tomography (CT) images. A total of 11 quantitative texture features derived from images of diffusion-weighted image (DWI) or T2-weighted-Fluid-Attenuated Inversion Recovery (T2/FLAIR) were extracted for each patient. Receiver operating characteristic (ROC) analysis were performed to determine the predictive performance of textural features, with HT as the outcome measurement. There was no significant difference in the baseline demographic and clinical characteristics between the two groups. The distribution of atrial fibrillation and National Institutes of Health Stroke Scale (NIHSS) were significantly higher in patients with HT than those without HT. Among the textural parameters extracted from DWI images, six parameters, f2 (contrast), f3 (correlation), f4 (sum of squares), f5 (inverse difference moment), f10 (difference variance), and f11 (difference entropy), differs significantly between the two groups (p < 0.05). Moreover, five of six parameters (f2, f3, f5, f10, and f11) have good predictive performances of HT with the area under the ROC curve (AUC) values of 0.795, 0.779, 0.791, 0.780, and 0.797, respectively. However, the texture features f2, f3, and f10 in T2/FLAIR images were the only three significant predictors of HT in patients with acute MCI, but with a relatively low AUC values of 0.652, 0.652, and 0.670, respectively. In summary, our preliminary results showed DWI-based texture analysis has a good predictive validity for HT in patients with acute MCI. Multiparametric MRI texture analysis model should be developed to improve the prediction performance of HT following acute MCI.
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Affiliation(s)
- Heng Zhai
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhijun Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziqin Cao
- Department of Chemistry, Emory University, Atlanta, GA, United States
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yan Xu,
| | - Yinzhang Lv
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Yinzhang Lv,
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Lim JX, Liu SJ, Cheong TM, Saffari SE, Han JX, Chen MW. Intracranial Pressure as an Objective Biomarker of Decompression Adequacy in Large Territory Infarction: A Multicenter Observational Study. Front Surg 2022; 9:823899. [PMID: 35769152 PMCID: PMC9235838 DOI: 10.3389/fsurg.2022.823899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
Background Decompressive craniectomy (DC) improves the survival and functional outcomes in patients with malignant cerebral infarction. Currently, there are no objective intraoperative markers that indicates adequate decompression. We hypothesise that closure intracranial pressure (ICP) correlates with postoperative outcomes. Methods This is a multicentre retrospective review of all 75 DCs performed for malignant cerebral infarction. The patients were divided into inadequate ICP (iICP) and good ICP (gICP) groups based on a suitable ICP threshold determined with tiered receiver operating characteristic and association analysis. Multivariable logistic regression was performed for various postoperative outcomes. Results An ICP threshold of 7 mmHg was determined, with 36 patients (48.0%) and 39 patients (52.0%) in the iICP and gICP group, respectively. After adjustment, postoperative osmotherapy usage was more likely in the iICP group (OR 6.32, p = 0.003), and when given, was given for a longer median duration (iICP, 4 days; gICP, 1 day, p = 0.003). There was no difference in complications amongst both groups. When an ICP threshold of 11 mmHg was applied, there was significant difference in the duration on ventilator (ICP ≥11 mmHg, 3–9 days, ICP <11 mmHg, 3–5 days, p = 0.023). Conclusion Surgical decompression works complementarily with postoperative medical therapy to manage progressive cerebral edema in malignant cerebral infarctions. This is a retrospective study which showed that closure ICP, a novel objective intraoperative biomarker, is able to guide the adequacy of DC in this condition. Various surgical manoeuvres can be performed to ensure that this surgical aim is accomplished.
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Affiliation(s)
- Jia Xu Lim
- National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, Singapore
- Correspondence: Jia Xu Lim
| | - Sherry Jiani Liu
- National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, Singapore
| | - Tien Meng Cheong
- National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Center for Qualitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Julian Xinguang Han
- National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, Singapore
| | - Min Wei Chen
- National Neuroscience Institute, Department of Neurosurgery, Singhealth, Singapore, Singapore
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10
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Yang Z, Li Z, He X, Yao Z, Xie X, Zhang S, Shen Y, Li S, Qiao S, Hui Z, Gao C, Chen J. The impact of heart rate circadian rhythm on in-hospital mortality in stroke and critically ill patients: insights from the eICU Collaborative Research Database. Heart Rhythm 2022; 19:1325-1333. [PMID: 35367661 DOI: 10.1016/j.hrthm.2022.03.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data showing the impact of dysregulated heart rate circadian rhythm in stroke and critically ill patients are scarce. OBJECTIVE The purpose of this study was to investigate whether the circadian rhythm of heart rate was an independent risk factor for in-hospital mortality in stroke and critically ill patients. METHODS Study patients from the recorded eICU Database were included in the current analyses. Three variables, Mesor, Amplitude, and Peak time were used to evaluate the heart rate circadian rhythm. The incremental value of circadian rhythm variables in addition to Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict in-hospital mortality was also explored. RESULTS A total of 6,201 Patients whose heart rate have cosinor rhythmicity. After adjustments, Mesor per 10 beats per min (bpm) increase was associated with a 1.18-fold (95%CI: 1.12, 1.25, P<0.001) and Amplitude per 5 bpm was associated with a 1.17-fold (95%CI: 1.07, 1.27, P<0.001) increase in the risk of in-hospital mortality, respectively. The risk of in-hospital mortality was highest in patients who had Peak time reached between 12:00-18:00 (OR: 1.35, 95%CI: 1.06, 1.72, P=0.015). Compared with APACHE IV score only (c-index=0.757), combining APACHE IV score and circadian rhythm variables of heart rate (c-index=0.766) was associated with increased discriminative ability (P=0.003). CONCLUSION Circadian rhythm of heart rate is an independent risk factor of the in-hospital mortality in stroke and critically ill patients. Including circadian rhythm variables regarding heart rate might increase the discriminative ability of the risk score to predict the prognosis of patients.
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Affiliation(s)
- Zhengning Yang
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Zhe Li
- Department of First Clinical Medicine, Affiliated Hospital of Shaanxi University of Chinese Medicine, 712000, Xian Yang, China
| | - Xu He
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Zhen Yao
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Xiaoxia Xie
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Sha Zhang
- Department of Basic Medicine, Shaanxi University of Chinese Medicine, 712000, Xian Yang, China
| | - Yan Shen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Shaowei Li
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Shuzhen Qiao
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Zhenliang Hui
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Chao Gao
- Department of Cardiology, Xijing hospital, Xi'an, China; Department of Cardiology, Radboud University, Nijmegen, The Netherlands.
| | - Jun Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China.
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11
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Li J, Zhang P, Liu Y, Chen W, Yi X, Wang C. Stroke Lateralization in Large Hemisphere Infarctions: Characteristics, Stroke-Related Complications, and Outcomes. Front Neurol 2021; 12:774247. [PMID: 34956055 PMCID: PMC8702425 DOI: 10.3389/fneur.2021.774247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives: To assess the hemispheric differences in characteristics, stroke-related complications, and outcomes of patients with large hemisphere infarctions (LHI). Methods: We enrolled consecutive patients admitted within 24 h after the diagnosis of LHI (defined as an ischemic stroke involving more than 50% of the territory of the middle cerebral artery in computed tomography and/or magnetic resonance imaging). Univariate and multivariate analysis were performed to explore the association between lateralization and stroke-related complications and clinical outcomes. Results: A total of 314 patients with LHI were enrolled, with 171 (54.5%) having right hemispheric involvement. Right-sided patients with LHI had lower baseline National Institutes of Health Stroke Scale (NIHSS) score (18 vs. 22, p < 0.001), higher frequency of atrial fibrillation (69.0 vs. 52.4%, p = 0.003), and higher proportion of cardio-embolism (73.1 vs. 56.6%, p = 0.013) than the left. Right-sided LHI had higher incidence rates of malignant brain edema (MBE) (48.5 vs. 30.8%, p = 0.001) and a composite of cardiovascular events (29.8 vs. 17.5%, p = 0.011) during hospitalization. The incidence rate of 1-month mortality (34.5 vs. 23.8%, p = 0.036) was higher in right-sided patients with LHI, but there were no hemispheric differences in the incidence rates of 3-month mortality and unfavorable outcome (both p > 0.05). Multivariate analyses suggested right hemisphere involvement was independently associated with increased risk of MBE (adjusted OR 2.37, 95% CI 1.26–4.43, p = 0.007) and composite of cardiovascular events (adjusted OR 2.04, 95% CI 1.12–3.72, p = 0.020). However, it was not independently associated with 1-month death, 3-month mortality, and 3-month unfavorable outcome (all p > 0.05). Conclusions: Right-sided patients with LHI had higher frequency of atrial fibrillation and cardio-embolism than the left-sided patients. Right hemisphere involvement was independently associated with increased risk of MBE and composite of cardiovascular events during hospitalization, whereas stroke lateralization was not an independent predictor of mortality and unfavorable outcome in patients with LHI.
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Affiliation(s)
- Jie Li
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Yingying Liu
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Wanli Chen
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang, Deyang, China
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12
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Li J, Zhang P, Liu Y, Wu S, Yi X, Zhang S, Wang C, Liu M. Early amantadine treatment reduces the risk of death in patients with large hemisphere infarctions:a Chinese hospital-based study. BMC Neurol 2021; 21:419. [PMID: 34711177 PMCID: PMC8554877 DOI: 10.1186/s12883-021-02444-w] [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: 06/14/2020] [Accepted: 10/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background Amantadine hydrochloride is one of the most frequently prescribed drugs for patients with severe traumatic brain injury in restoring consciousness and accelerating the pace of functional recovery. However, there is a paucity of studies on the effectiveness of amantadine in patients with severe stroke especially large hemisphere infarction (LHI). The present study aimed to investigate whether amantadine treatment is associated with better clinical outcomes in conservatively treated LHI patients. Methods We retrospectively collected conservatively treated LHI patients according to inclusion/exclusion criteria. The patients were divided into two groups based on the treatment regimen, whether they did receive amantadine hydrochloride in addition to standard therapy (ST) or not. The primary outcomes were in-hospital death, 3-month mortality, and unfavorable outcome (defined as modified Rankin Scale score of 4 to 6). All outcomes were compared between the two groups before and after propensity score matching (PSM). Multivariate logistic regression was performed to identify the association between early amantadine hydrochloride treatment and clinical outcomes in LHI patients. Results Thirty-one LHI patients treated with amantadine combined with ST and 127 patients treated with ST were enrolled. Amantadine group had a shorter prehospital delay (median: 2 vs. 10 h), a higher baseline NIHSS score (21.71 ± 4.76 vs. 17.49 ± 5.84), and a higher rate of dominant hemisphere involvement (67.74% vs. 45.67%). After PSM, amantadine treatment significantly reduced the risk of in-hospital death (7.41% vs. 31.11%, p=0.019) and 3-month mortality (25.93% vs. 55.56%, p=0.008). Amantadine treatment yielded a significant decrease in death in-hospital (before PSM: OR 0.143, 95% CI 0.034 to 0.605; after PSM: OR 0.113, 95% CI 0.020 to 0.635) and 3-month mortality (before PSM: OR 0.214, 95% CI 0.077 to 0.598; after PSM: OR 0.176, 95% CI 0.053 to 0.586) in unmatched and matched multivariate analyses. Conclusion The results of our study provide initial evidence that early amantadine treatment was associated with a decrease in death in conservatively treated LHI patients. Considering the limitations of observational study, randomized controlled trials with a large sample size may help provide a clearer picture of the utility of amantadine in LHI patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02444-w.
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Affiliation(s)
- Jie Li
- Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang, 618000, Sichuan Province, PR China.,Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan Province, 610041, PR China
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang, 618000, Sichuan Province, PR China
| | - Yingying Liu
- Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang, 618000, Sichuan Province, PR China
| | - Simiao Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan Province, 610041, PR China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang, 618000, Sichuan Province, PR China
| | - Shihong Zhang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan Province, 610041, PR China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang, 618000, Sichuan Province, PR China.
| | - Ming Liu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan Province, 610041, PR China.
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13
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Huang K, Zha M, Xiao L, Gao J, Du J, Wu M, Yang Q, Liu R, Liu X. Prognostic Value of Abnormal Liver Function Tests After Mechanical Thrombectomy for Acute Ischemic Stroke. Front Neurol 2021; 12:670387. [PMID: 34393970 PMCID: PMC8356900 DOI: 10.3389/fneur.2021.670387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the clinical significance of post-procedural abnormal liver function test (ALFT) on the functional outcomes at 90 days in acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). Methods: In this retrospective observational study, patients with AIS undergoing MT were enrolled from the Nanjing Stroke Registry Program and the multicenter Captor trial. A favorable outcome was defined as a modified Rankin Scale score 0–2 at 90 days. Predictive models were established by multivariable logistic regression. Improved predictive value of models was assessed by continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In addition, multivariable logistic regression and restricted cubic spline were used to analyze dose–response correlations between the severity of ALFT and prognosis. Results: Among 420 patients enrolled, 234 (55.7%) patients were diagnosed as post-procedural ALFT after MT. Patients with post-procedural ALFT had higher National Institute of Health Stroke Scale score on admission (median, 18 vs. 15, p < 0.001) and more pneumonia (65.4 vs. 38.2%, p < 0.001) than those without post-procedural ALFT. Post-procedural ALFT, rather than preprocedural ALFT, was independently associated with favorable outcome (adjusted odds ratio, 0.48; 95% CI 0.28–0.81; p = 0.006). The improvement of predictive model after adding post-procedural ALFT was significant [continuous NRI (value, 0.401; p < 0.001), IDI (value, 0.013; p < 0.001)]. However, the restricted cubic spline indicated no evidence of a dose–response relationship between the severity of post-procedural ALFT and prognosis. Conclusions: In AIS patients treated by MT, post-procedural ALFT was associated with more severe stroke and served as an independent predictor of worse prognosis at 90 days.
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Affiliation(s)
- Kangmo Huang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Juan Du
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Qingwen Yang
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
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14
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Moustafa H, Schoene D, Altarsha E, Rahmig J, Schneider H, Pallesen LP, Prakapenia A, Siepmann T, Barlinn J, Passauer J, Reichmann H, Puetz V, Barlinn K. Acute kidney injury in patients with malignant middle cerebral artery infarction undergoing hyperosmolar therapy with mannitol. J Crit Care 2021; 64:22-28. [PMID: 33770572 DOI: 10.1016/j.jcrc.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/28/2021] [Accepted: 02/19/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To assess the kidney safety profile of mannitol in patients with malignant middle cerebral artery (MCA) infarction. MATERIAL AND METHODS We studied consecutive patients with malignant MCA infarction (01/2008-01/2018). Malignant MCA infarction was defined according to DESTINY criteria. We compared clinical endpoints including acute kidney injury (AKI; according to Kidney Disease: Improving Global Outcomes [KDIGO]) and dialysis between patients with and without mannitol. Multivariable model was built to explore predictor variables of AKI and in-hospital death. RESULTS Overall, 219 patients with malignant MCA infarction were included. Mannitol was administered in 93/219 (42.5%) patients with an average dosage of 650 g (250-950 g). Patients treated with mannitol more frequently suffered from AKI (39.8% vs. 11.9%; p < 0.001) and required hemodialysis (7.5% vs. 0.8%; p = 0.01) than patients without mannitol. At discharge, more patients in the mannitol group had persistent AKI than control patients (23.7% vs. 6.4%, p < 0.001). In multivariable model, mannitol emerged as independent predictor of AKI (OR 5.02, 95%CI 2.36-10.69; p < 0.001). CONCLUSIONS Acute kidney injury appears to be a frequent complication of hyperosmolar therapy with mannitol in patients with malignant MCA infarction. Given the lack of evidence supporting effectiveness of mannitol in these patients, its routine use should be carefully considered.
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Affiliation(s)
- Haidar Moustafa
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniela Schoene
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Eyad Altarsha
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jan Rahmig
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany; Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexandra Prakapenia
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jens Passauer
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Xu M, Li B, Zhong D, Cheng Y, Wu Q, Zhang S, Zhang S, Wu B, Liu M. Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years. Front Aging Neurosci 2021; 13:628271. [PMID: 33679377 PMCID: PMC7933464 DOI: 10.3389/fnagi.2021.628271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH). Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome. Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB < 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038). Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.
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Affiliation(s)
- Mangmang Xu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Baojin Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Di Zhong
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Yajun Cheng
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Shuting Zhang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Shihong Zhang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
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16
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Zhang B, Zhao W, Wu C, Wu L, Hou C, Klomparens K, Ding Y, Li C, Chen J, Duan J, Zhang Y, Chang H, Ji X. SDL Index Predicts Stroke-Associated Pneumonia in Patients After Endovascular Therapy. Front Neurol 2021; 12:622272. [PMID: 33664704 PMCID: PMC7921145 DOI: 10.3389/fneur.2021.622272] [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: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aimed to develop and validate a novel index to predict SAP for AIS patients who underwent endovascular treatment. Methods: A study was conducted in an advanced comprehensive stroke center from January 2013 to December 2019 aiming to develop and validate a novel index to predict SAP for AIS patients who underwent endovascular treatment. This cohort consisted of a total of 407 consecutively registered AIS patients who underwent endovascular therapy, which was divided into derivation and validation cohorts. Multiple blood parameters as well as demographic features, vascular risk factors, and clinical features were carefully evaluated in the derivation cohort. The independent predictors were obtained using multivariable logistic regression. The scoring system was generated based on the β-coefficients of each independent risk factor. Results: Ultimately, a novel predictive model: the SDL index (stroke history, dysphagia, lymphocyte count < 1.00 × 103/μL) was developed. The SDL index showed good discrimination both in the derivation cohort (AUROC: 0.739, 95% confidence interval, 0.678–0.801) and the validation cohort (AUROC: 0.783, 95% confidence interval, 0.707–0.859). The SDL index was well-calibrated (Hosmer–Lemeshow test) in the derivation cohort (P = 0.389) and the validation cohort (P = 0.692). We therefore divided our population into low (SDL index = 0), medium (SDL index = 1), and high (SDL index ≥ 2) risk groups for SAP. The SDL index showed good discrimination when compared with two existing SAP prediction models. Conclusions: The SDL index is a novel feasible tool to predict SAP risk in acute ischemic stroke patients post endovascular treatment.
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Affiliation(s)
- Bowei Zhang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Longfei Wu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chengbei Hou
- Center for Evidence-Based Medicine, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kara Klomparens
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Chuanhui Li
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yunzhou Zhang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Hong Chang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
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Cheng HR, Chen YB, Zeng YY, Ruan YT, Yuan CX, Cheng QQ, Chen HJ, Luan XQ, Huang GQ, He JC. Hemostasis functions are associated with hemorrhagic transformation in non-atrial fibrillation patients: a case-control study. BMC Neurol 2021; 21:36. [PMID: 33499823 PMCID: PMC7836156 DOI: 10.1186/s12883-021-02065-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Hemorrhagic transformation (HT) is a serious neurological complication of acute ischemic stroke (AIS) after revascularization. The majority of AIS patients do not have atrial fibrillation (AF) which could also develop into HT. In this study, we aimed to explore whether hemostasis parameters are risk factors of HT in non-AF patients. Methods We consecutively enrolled 285 AIS patients with HT. Meanwhile, age- and sex-matched 285 AIS patients without HT were included. The diagnosis of HT was determined by brain CT or MRI during hospitalization. All patients were divided into two subgroups based on the presence of AF and explore the differences between the two subgroups. Blood samples were obtained within 24 h of admission, and all patients were evenly classified into three tertiles according to platelet counts (PLT) levels. Results In this study, we found the first PLT tertile (OR = 3.509, 95%CI = 1.268–9.711, P = 0.016) was independently associated with HT in non-AF patients, taking the third tertile as a reference. Meanwhile, we also found mean platelet volume (MPV) (OR = 0.605, 95%CI = 0.455–0.805, P = 0.001) and fibrinogen (FIB) (OR = 1.928, 95%CI = 1.346–2.760, P < 0.001) were significantly associated with HT in non-AF patients. But in AF patients, hemostasis parameters showed no significant difference. Meanwhile, we found the MPV (OR = 1.314, 95%CI = 1.032–1.675, P = 0.027) and FIB (OR = 1.298, 95%CI = 1.047–1.610, P = 0.018) were significantly associated with long-term outcomes in non-AF HT patients. Conclusions Low PLT, low MPV, and high FIB levels were independently associated with HT in non-AF patients. Additionally, MPV and FIB levels were significantly associated with unfavorable long-term outcomes in non-AF HT patients. Our study showed that hemostasis functions at admission may be beneficial for clinicians to recognize patients with a high risk of HT at an early stage and improve unfavorable long-term outcomes in non-AF patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02065-3.
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Affiliation(s)
- Hao-Ran Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yun-Bin Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Ya-Ying Zeng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yi-Ting Ruan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Cheng-Xiang Yuan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Qian-Qian Cheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Hui-Jun Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiao-Qian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Gui-Qian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Jin-Cai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Lipopolysaccharide-induced sepsis-like state compromises post-ischemic neurological recovery, brain tissue survival and remodeling via mechanisms involving microvascular thrombosis and brain T cell infiltration. Brain Behav Immun 2021; 91:627-638. [PMID: 33122024 DOI: 10.1016/j.bbi.2020.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/04/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023] Open
Abstract
Sepsis predisposes for poor stroke outcome. This association suggests that sepsis disturbs post-ischemic tissue survival and brain remodeling. To elucidate this link, we herein exposed mice to 30 min intraluminal middle cerebral artery occlusion (MCAO) and induced a sepsis-like state at 72 h post-ischemia by intraperitoneal delivery of Escherichia coli lipopolysaccharide (LPS; three doses of 0.1 or 1 mg/kg, separated by 6 h), a major component of the bacterium's outer membrane. Neurological recovery, ischemic injury, brain remodeling and immune responses were evaluated over up to 56 days post-sepsis (dps) by behavioral tests, immunohistochemistry and flow cytometry. Delivery of 1 mg/kg but not 0.1 mg/kg LPS reduced rectal temperature over 48 h by up to 3.4 ± 3.1 °C, increased general and focal neurological deficits in the Clark score over 72 h and increased motor-coordination deficits in the tight rope test over up to 21 days. Notably, 1 mg/kg, but not 0.1 mg/kg LPS increased intercellular adhesion molecule-1 abundance on ischemic microvessels, increased microvascular thrombosis and increased patrolling monocyte and T cell infiltrates in ischemic brain tissue at 3 dps. Infarct volume was increased by 1 mg/kg, but not 0.1 mg/kg LPS at 3 dps (that is, 6 days post-MCAO), as was brain atrophy at 28 and 56 dps. Microglial activation in ischemic brain tissue, evaluated by morphology analysis of Iba-1 immunostainings, was transiently increased by 0.1 and 1 mg/kg LPS at 3 dps. Our data provide evidence that neurological recovery and brain remodeling are profoundly compromised in the ischemic brain post-sepsis as a consequence of cerebral thromboinflammation.
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Li J, Zhang P, Wu S, Yuan R, Liu J, Tao W, Wang D, Liu M. Impaired consciousness at stroke onset in large hemisphere infarction: incidence, risk factors and outcome. Sci Rep 2020; 10:13170. [PMID: 32759986 PMCID: PMC7406648 DOI: 10.1038/s41598-020-70172-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/23/2020] [Indexed: 02/05/2023] Open
Abstract
Impaired consciousness (IC) at stroke onset in large hemispheric infarctions (LHI) patients is common in clinical practice. However, little is known about the incidence and risk factors of IC at stroke onset in LHI. Besides, stroke-related complications and clinical outcomes in relation to the development of IC has not been systematically examined. Data of 256 consecutive patients with LHI were collected. IC at stroke onset was retrospectively collected from the initial emergency department and/or admission records. Of the 256 LHI patients enrolled, 93 (36.3%) had IC at stroke onset. LHI patients with IC at stroke onset were older (median age 66 vs. 61, p = 0.041), had shorter prehospital delay (24 vs. 26 h, p < 0.001and higher baseline National Institutes of Health Stroke Scale (NIHSS) score (19 vs. 12, p < 0.001). Independent risk factors of IC at stroke onset were high NIHSS score (odds ratio, OR 1.17, 95% confidence interval [CI] 1.12 to 1.23) and atrial fibrillation (OR 1.93, 95% CI 1.07 to 3.47). Dyslipidemia appeared to protect against IC at stroke onset (adjusted OR 0.416, 95% CI 0.175 to 0.988). IC at stroke onset was associated with higher frequency of stroke-related complications (90.32% vs. 67.48%, p < 0.001), especially brain edema (45.16% vs. 23.31%, p < 0.001) and pneumonia (63.44% vs. 47.82%, p = 0.019). The IC group had higher rates of in-hospital death (23.66% vs. 11.66%, p = 0.012), 3-month mortality (49.46% vs. 24.87%, p = 0.002), and 3-month unfavorable outcome (64.51% vs. 49.07%, p = 0.017). However, after adjusting for age, baseline NIHSS score and other confounders, IC at stroke onset was not an independent predictor of in-hospital death (adjusted OR 0.56, 95% CI 0.22 to 1.47), 3-month mortality (adjusted OR 0.54, 95% CI 0.25 to 1.14) and 3-month unfavorable outcome (adjusted OR 0.64, 95% CI 0.31 to 1.33) in LHI patients (all p > 0.05). Our results suggested that IC occur in 1 out of every 3 LHI patients at stroke onset and was associated with initial stroke severity and atrial fibrillation. LHI patients with IC at stroke onset more frequently had stroke-related complications, 3-month mortality and unfavorable outcome, whereas IC was not an independent predictor of poor outcomes.
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Affiliation(s)
- Jie Li
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China. .,Department of Neurology, People's Hospital of Deyang City, No. 173, North Taishan Road, Deyang, 618000, Sichuan Province, People's Republic of China.
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang City, No. 173, North Taishan Road, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Simiao Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Ruozhen Yuan
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Junfeng Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Wendan Tao
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Deren Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China.
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