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Li F, Wei C, Huo S, Liu X, Du J. Predictors of deep-vein thrombosis for acute stroke at admission to a rehabilitation unit: A retrospective study. Front Neurol 2023; 14:1137485. [PMID: 37064195 PMCID: PMC10102505 DOI: 10.3389/fneur.2023.1137485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundDeep-vein thrombosis (DVT) is a common complication of acute stroke (AS). Only limited studies have discussed DVT in patients with AS at admission to a rehabilitation unit. The purpose of this study is to identify the predictors of DVT in AS patients admitted to a rehabilitation unit in China.MethodsWe retrospectively reviewed the medical records of all patients with AS admitted within 14 days of stroke onset between July 2019 and June 2022 at the Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, China. Ultrasonography was used to diagnose DVT in all patients within 3 days after rehabilitation admission. Univariate and binary logistic regression analyses were performed to determine the risk factors for DVT.ResultsOverall, 234 cases were identified and the incidence rate of DVT among AS patients was 13.2% (31/234). The univariate analysis showed that age, drinking, lower limb muscle strength, Brunnstrom Assessment (BRS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Barthel Index (BI) scale, serum albumin (Alb), and D-dimer were statistically significant factors. Age (OR = 1.037, 95% CI = 1.000–1.075, p < 0.05), BBS (OR = 0.952, 95% CI = 0.913–0.993, p < 0.05), and D-dimer (OR = 1.446, 95% CI = 1.130–1.849, p < 0.05) were demonstrated as independent risk factors for DVT.ConclusionOlder age, lower BBS, and higher D-dimer levels at rehabilitation admission were independent risk factors for DVT. Therefore, ultrasonography should be performed for those patients with these three significant factors before implementing rehabilitation therapy.
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Affiliation(s)
- Fang Li
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Changkun Wei
- School of Mathematics and Statistics, Beijing Jiaotong University, Beijing, China
| | - Su Huo
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuzhen Liu
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jubao Du
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Wei B, Zhou H, Liu G, Zheng Y, Zhang Y, Hao C, Wang Y, Kang H, Lu X, Yuan Y, Meng Q. Risk factors for venous thromboembolism in patients with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2023; 46:181-193. [PMID: 33890837 PMCID: PMC9987783 DOI: 10.1080/10790268.2021.1913561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Patients with spinal cord injury (SCI) are at high risk for venous thromboembolism (VTE). The risk factors for VTE in patients with SCI are complex. OBJECTIVE This meta-analysis was conducted to clarify the risk factors for VTE in patients with SCI. METHODS The Cochrane Library, PubMed, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang Med Data Database, and VIP Database were searched to identify studies reporting on risk factors for VTE in patients with SCI. RESULTS The meta-analysis included 25 studies. Findings showed that risk of VTE in patients with SCI was significantly associated with middle- and old-age (OR = 2.08, 95%CI, 1.47, 2.95), male sex (OR = 1.41, 95%CI, 1.26, 1.59), complete paralysis (OR = 3.69, 95%CI, 2.60, 5.24), personal/family history of venous thrombosis (OR = 1.95, 95%CI, 1.35, 2.81), history of smoking (OR = 2.67, 95%CI, 1.79, 3.98), lack of compression therapy (OR = 2.44, 95%CI, 1.59, 3.73), presence of lower limb/pelvic fracture (OR = 3.47, 95%CI, 1.79, 6.75), paraplegia (OR = 1.81, 95%CI, 1.49, 2.19), and diabetes (OR = 4.24, 95%CI, 2.75, 6.52). CONCLUSION The meta-analysis identified 9 risk factors for VTE in patients with SCI. Healthcare providers should be aware of the risk factors for VTE when rehabilitating patients with SCI.
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Affiliation(s)
- Bo Wei
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Hongjun Zhou
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Genlin Liu
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zheng
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zhang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Chunxia Hao
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yiji Wang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Haiqiong Kang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Xiaolei Lu
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yuan Yuan
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Qianru Meng
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
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Wang CM, Guo XF, Liu LM, Huang Y, Meng L, Song LP, Wu YF, Ning YC, Reilly KH, Wang HB. Prevention of Deep Vein Thrombosis by Panax Notoginseng Saponins Combined with Low-Molecular-Weight Heparin in Surgical Patients. Chin J Integr Med 2022; 28:771-778. [PMID: 35829956 DOI: 10.1007/s11655-022-2894-3] [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: 10/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of deep vein thrombosis (DVT) prevention among real-world surgical inpatients who received panax notoginseng saponins (PNS) combined with low-molecular-weight heparin (LMWH). METHODS A prospective cohort study was conducted among surgical patients between January 2016 and November 2018 in Xuanwu Hospital, Capital Medical University, Beijing, China. Participants received LMWH alone or PNS combined with LMWH for preventing DVT. The primary outcome was incidence of lower extremity DVT, which was screened once a week. Participants in the LMWH group were given LMWH (enoxaparin) via hypodermic injection, 4000-8000 AxalU once daily. Participants in the exposure group received PNS (Xuesaitong oral tablets, 100 mg, 3 times daily) combined with LMWH given the same as LMWH group. RESULTS Of the 325 patients screened for the study, 281 participants were included in the final analysis. The cohort was divided into PNS + LMWH group and LMWH group with 134 and 147 participants, respectively. There was a significant difference of DVT incidence between two groups (P=0.01), with 21 (15.7%) incident DVT in the PNS + LMWH group, and 41 (27.9%) incident DVT in the LMWH group. Compared with participants without DVT, the participants diagnosed with DVT were older and had higher D-dimer level. The multivariate logistic regression model showed a significant lower risk of incident DVT among participants in the PNS + LMWH group compared with the LMWH group (odds ratio 0.46, 95% confidence interval, 0.25-0.86). There were no significant differences in thromboelaslography values (including R, K, Angle, and MA) and differences in severe bleeding between two groups. No symptomatic pulmonary embolism occurred during the study. CONCLUSION Combined application of PNS and LMWH can effectively reduce the incidence of DVT among surgical inpatients compared with LMWH monotherapy, without increased risk of bleeding.
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Affiliation(s)
- Chun-Mei Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiang-Feng Guo
- Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Li-Min Liu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ying Huang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Liang Meng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Li-Po Song
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ying-Feng Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ya-Chan Ning
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Kathleen H Reilly
- Centers for Disease Control and Prevention, New York City, NY, 12237, USA
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, 100191, China.
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Huang Y, Guo C, Song K, Li C, Ding N. Association of clinical and laboratory variables with in-hospital incidence of deep vein thrombosis in patients after acute ischemic stroke: A retrospective study. Medicine (Baltimore) 2021; 100:e24601. [PMID: 33578563 PMCID: PMC7886450 DOI: 10.1097/md.0000000000024601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Deep vein thrombosis (DVT) is a serious complication in patients with acute ischemic stroke (AIS). Early prediction of DVT could enable physicians to perform a proper prevention strategy. We analyzed the association of clinical and laboratory variables with DVT to evaluate the risk of DVT in patients after AIS.AIS patients admitted to the Changsha Central Hospital between January 2017 and December 2019 with length of stay in hospital ≥7 days were included. Clinical and laboratory variables for DVT at baseline were collected, and the diagnosis of DVT was confirmed by ultrasonography. Independent factors were developed by Multivariate logistic regression analysis.A total of 101 patients were included in the study. The in-hospital incidence of DVT after AIS was 19.8%(20/101). The average level of D-dimer when DVT detected was significant increased around 4-fold than that on admission (P < .001). Pulmonary infection (odds ratio [OR] = 5.4, 95%CI:1.10-26.65, P = .037)) and increased muscle tone (OR = 0.11, 95%CI:0.02-0.58, P = .010) as independent relevant factors for DVT were confirmed.Pulmonary infection as a risk factor and increased muscle tone as a protective factor for DVT were identified in patients after AIS. The level of D-dimer which increased around 4-fold compared to the initial level could be an indicator for DVT occurrence.
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Bernardi M, Fedullo AL, Di Giacinto B, Squeo MR, Aiello P, Dante D, Romano S, Magaudda L, Peluso I, Palmery M, Spataro A. Cardiovascular Risk Factors and Haematological Indexes of Inflammation in Paralympic Athletes with Different Motor Impairments. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:6798140. [PMID: 31827693 PMCID: PMC6885819 DOI: 10.1155/2019/6798140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022]
Abstract
Haematological indexes of both inflammation and platelet activation have been suggested as predictive markers of cardiovascular disease (CVD), which has high prevalence in Paralympic athletes (PA). Different mechanisms could play a role in increasing CVD risk in PA with spinal cord injury (PA-SCI), lower limb amputation (PA-LLA), or upper limb impairment (PA-ULI). We compared, in 4 groups of PA competing in power, intermittent (mixed metabolism), and endurance sports, Framingham Risk Score (FRS), metabolic syndrome criteria (MetS-C), inflammation (INFLA) Score, 5 haematological indexes of platelet activation (mean platelet volume (MPV), platelet distribution width (PDW), and the ratios between MPV and platelet (MPVPR), between MPV and lymphocyte (MPVLR), and between PDW and lymphocyte (PDWLR)) and the endogenous antioxidants uric acid (UA) and bilirubin (BR). A retrospective chart review of PA from preparticipation examinations' records (London 2012 and Sochi 2014 Paralympics) was performed. We included 25 PA-SCI (13 with high and 12 with low lesion, PA-SCI-H and PA-SCI-L), 15 PA-LLA, and 10 PA-ULI. FRS and INFLA Score did not differ among groups, but PA-SCI-H had lower HDL, compared to PA-SCI-L and PA-ULI. PA-LLA had more MetS diagnostic criteria with significant higher glucose levels than other groups. PA-SCI-H had significantly lower lymphocytes' count compared to PA-LLA and higher MPV, PDW, MPVPR, MPVLR, and PDWLR. SCI-H had lower BR, haemoglobin, haematocrit, proteins, and creatinine. No interaction was found between the 3 kinds of sitting sports and the 2 groups of health conditions (PA-SCI and PA-LLA). In conclusion, PA-LLA had a higher cardiometabolic risk, whereas PA-SCI-H had a higher platelet-derived cardiovascular risk. Further larger studies are needed to investigate the relationship between indexes of inflammation/oxidation and dietary habit, body composition, and physical fitness/performance in PA with motor impairments.
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Affiliation(s)
- Marco Bernardi
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
- Comitato Italiano Paralimpico, Rome, Italy
| | | | | | | | - Paola Aiello
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Donatella Dante
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Ludovico Magaudda
- Sport Medicine Unit AOU “G. Martino”, BIOMORF Department University of Messina, Italy
| | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Italy
| | - Antonio Spataro
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy
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Rong Y, Liu W, Lv C, Wang J, Luo Y, Jiang D, Li L, Zhou Z, Zhou W, Li Q, Yin G, Yu L, Fan J, Cai W. Neural stem cell small extracellular vesicle-based delivery of 14-3-3t reduces apoptosis and neuroinflammation following traumatic spinal cord injury by enhancing autophagy by targeting Beclin-1. Aging (Albany NY) 2019; 11:7723-7745. [PMID: 31563124 PMCID: PMC6782003 DOI: 10.18632/aging.102283] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/05/2019] [Indexed: 12/11/2022]
Abstract
Neural stem cell-derived small extracellular vesicles (NSC-sEVs) play an important role in the repair of tissue damage. Our previous in vitro and in vivo studies found that preconditioning with NSC-sEVs promoted the recovery of functional behaviors following spinal cord injury by activating autophagy. However, the underlying mechanisms for such observations remain unclear. In this study, we further explored the mechanisms by which NSC-sEVs repair spinal cord injury via autophagy. We found that NSC-sEVs contain 14-3-3t protein, of which the overexpression or knockdown enhanced and decreased autophagy, respectively. In addition, 14-3-3t overexpression enhanced the anti-apoptotic and anti-inflammatory effects of NSC-sEVs, further promoting functional behavior recovery following spinal cord injury. The overexpression of 14-3-3t was used to further validate the in vivo results through a series of in vitro experiments. Conversely, knockdown of 14-3-3t attenuated the anti-apoptotic and anti-inflammatory effects of NSC-sEVs. Further studies also confirmed that NSC-sEVs increased Beclin-1 expression, with which 14-3-3t interacted and promoted its localization to autophagosome precursors. In this study, we found that NSC-sEVs deliver 14-3-3t, which interacts with Beclin-1 to activate autophagy. Our results indicate that 14-3-3t acts via a newly-discovered mechanism for the activation of autophagy by NSC-sEVs.
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Affiliation(s)
- Yuluo Rong
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Wei Liu
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Chengtang Lv
- Department of Orthopaedics, Yancheng Third People's Hospital, Yancheng 224000, Jiangsu, China
| | - Jiaxing Wang
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Yongjun Luo
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Dongdong Jiang
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Linwei Li
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Zheng Zhou
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Wei Zhou
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Qingqing Li
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Guoyong Yin
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Lipeng Yu
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Jin Fan
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Weihua Cai
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
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