CT Permeability Imaging Predicts Clinical Outcomes in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolytic Therapy

In this study, we determined whether a prediction of final infarct volume (FIV) and clinical outcomes in patients with an acute stroke is improved by using a contrast transfer coefficient (K ^trans) as a biomarker for blood–brain barrier (BBB) dysfunction. Here, consecutive patients admitted with signs and symptoms suggesting acute hemispheric stroke were included in this study. Ninety-eight participants with intra-arterial therapy were assessed (46 female). Definition of predicted FIV was performed using conventional perfusion CT (PCT-PIV) parameters alone and in combination with K ^trans (K ^trans-PIV). Multiple logistic regression analyses and linear regression modeling were conducted to determine independent predictors of the 90-day modified Rankin score (mRS) and FIV, respectively. We found that patients with favorable outcomes were younger and had lower National Institutes of Health Stroke Scale (NIHSS) score, smaller PCT-PIV, K ^trans-PIV, and smaller FIV (P?<?0.001). K ^trans-PIV showed good correlation with FIV (P?<?00.001, R ²?=?0.6997). In the regression analyses, K ^trans-PIV was the best predictor of clinical outcomes (P?=?0.009, odds ratio (OR)?=?1.960) and also the best predictor for FIV (F?=?75.590, P?<?0.0001). In conclusion, combining PCT and K ^trans maps derived from first-pass PCT can identify at-risk cerebral ischemic tissue more precisely than perfusion parameters alone. This provides improved accuracy in predicting FIV and clinical outcomes.     

护理干预对应用阿替普酶早期溶栓治疗急性脑梗塞患者的临床观察

目的:探讨采用阿替普酶(rt-PA)静脉溶栓治疗急性脑梗塞患者的护理措施,以期改善患者的预后并提高患者的生存质量.方法:对2011年1月-2012年5月我院收治的20例使用阿替普酶早期溶栓治疗的急性脑梗塞患者进行护理干预,使用NIHSS进行效果评价.将20例患者随机分为两组,普通组实施常规护理,对照组实施护理干预,比较两组的临床治疗效果.结果:使用阿替普酶溶栓的急性脑梗塞患者经护理干预后溶栓结束无明显不良反应,NIHSS评分自溶栓前逐渐降低,效果较好.两组患者临床治疗效果存在显著差异(P＜0.05).结论:使用阿替普酶对急性脑梗塞患者进行溶栓治疗效果较好,溶栓前后进行科学的护理干预,可以促进患者康复,保证患者的康复.     

Knowledge of Thrombolytic Therapy for Acute Ischemic Stroke among Community Residents in Western Urban China

Background and Purpose

Thrombolytic therapy rate for acute ischemic stroke remains low, and improving public awareness of thrombolytic therapy may be helpful to reduce delay and increase chances of thrombolytic therapy. Our purpose was to survey the level of knowledge about thrombolytic therapy for acute ischemic stroke among community residents in Yuzhong district, Chongqing, China.

Methods

In 2011, a population-based face-to-face interview survey was conducted in Yuzhong district, Chongqing. A total of 1500 potential participants aged ≥18 years old were selected using a multi-stage sampling method.

Results

A total of 1101 participants completed the survey. Only 23.3% (95% CI = 20.8 to 25.8) were aware of thrombolytic therapy for acute ischemic stroke, of whom 59.9% (95% CI = 53.9 to 65.9) knew the time window. Awareness of thrombolytic therapy was higher among young people, those with higher levels of education and household income, those with health insurance, and those who knew all 5 stroke warning signs, while awareness of the time window was higher among those aged 75 years or older. Multivariate logistic regression analysis showed that awareness of thrombolytic therapy was independently associated with age, education level, health insurance and knowledge of stroke warning signs (P<0.05).

Conclusions

In this population-based survey the community residents have poor awareness of thrombolytic therapy for acute ischemic stroke.     

多模式磁共振指导超时间窗急性缺血性卒中的静脉溶栓治疗研究

目的:评价多模式磁共振指导下超时间窗静脉应用重组组织型纤溶酶原激活剂rt PA治疗急性缺血性卒中的疗效及安全性。方法:将68例急性脑梗塞患者分为rt PA静脉溶栓组A组、强化抗栓治疗组B组,各组按药物干预时间再分为4.5小时亚组及4.5-6小时亚组。A组给予rt PA静脉溶栓治疗和常规治疗,B组给予首剂氯吡格雷300毫克+阿司匹林100毫克和常规治疗。治疗前行急诊头多模式磁共振检查,治疗24小时后复查头CT,分别于治疗前后不同时间点进行NIHSS评分和3个月MRS评分,记录不良事件的发生情况。结果:A组两个亚组治疗后各时间点NIHSS评分均明显低于B组,且A组4.5小时亚组治疗后NIHSS评分低于其4.5-6小时亚组,A组3个月预后良好患者比例显著高于B组,差异均有统计学意义(P0.05)。A组症状性颅内出血的发生率高于B组。结论:多模式头磁共振指导下超时间窗rt PA静脉溶栓治疗安全有效,远期疗效优于强化抗栓治疗,但颅内症状性出血风险略高于强化抗栓治疗。     

静脉溶栓时机对急性ST段抬高型心肌梗死患者溶栓效果及主要不良心脏事件发生率的影响

目的:探讨静脉溶栓时机对急性ST段抬高型心肌梗死患者溶栓效果及主要不良心脏事件发生率的影响。方法:将2016年1月至2017年12月我院接诊的314例急性ST段抬高型心肌梗死患者纳入本研究,按照溶栓治疗时间不同分为A组(发病至溶栓时间6 h)172例、B组(发病至溶栓时间为6～12 h)102例和C组(发病至溶栓时间12 h)40例,比较三组患者溶栓效果、溶栓后ST段回落情况以及住院期间主要不良心脏事件发生情况。结果:A组患者梗死冠脉溶通率、溶栓后ST段回落幅度高于B组和C组,且B组高于C组,差异均有统计学意义(P0.05)。A组患者治疗后ST段回落最大幅度所需时间、住院期间主要不良心脏事件总发生率低于B组和C组,且B组低于C组,差异均有统计学意义(P0.05)。结论:急性ST段抬高型心肌梗死患者发病后6 h内静脉溶栓治疗梗死冠脉溶通率更高、ST段回落效果更好,可降低住院期间主要不良心脏事件发生风险。     

Predictors of Outcome and Hemorrhage in Patients Undergoing Endovascular Therapy with Solitaire Stent for Acute Ischemic Stroke

Background

Endovascular mechanical thrombectomy is emerging as a promising therapeutic approach for acute ischemic stroke and show some advantages. However, the data of predicting clinical outcome after thrombectomy with Solitaire retriever were limited. We attempt to identify prognostic factors of clinical outcome in patients with acute ischemic stroke undergoing thrombectomy with Solitaire retriever.

Methods

We conducted a retrospective analysis of consecutive acute ischemic strokes cases treated between December 2010 and December2013 where the Solitaire stent retriever was used for acute ischemic stroke. We assessed the effect of selected demographic characteristics, clinical factors on poor outcome at 3 months (modified Rankin score 3–6), mortality at 3 months, and hemorrhage within 24 h (symptomatic and asymptomatic). Clinical, imaging and logistic variables were analyzed. A multivariate logistic regression analysis was used to identify variables influencing clinical outcome, based on discharge NIHSS score change and mRS at 3 months.

Results

Eighty nine consecutive patients with acute ischemic stroke underwent mechanical thrombectomy. Multivariate analysis revealed that admission NIHSS score, Serum glucose and endovascular procedure duration were independently associated with clinical outcome. Sex, NIHSS score at admission, diabetes and time of operation were associated with sICH in 1 day. NIHSS score ≥20 (OR 9.38; 95% CI 2.41–36.50), onset to reperfusion >5 hours (OR 5.23; 95% CI1.34,20.41) and symptomatic intracranial hemorrhage (OR 10.19; 95% CI1.80,57.83) were potential predictive factors of mortality at 3 months.

Conclusion

Multiple pre- and intra-procedural factors can be used to predict clinical outcome, symptomatic intracranial hemorrhage and mortality in acute ischemic stroke patients undergoing endovascular therapy. This knowledge is helpful for patients selection for endovascular mechanical thrombectomy.     

The Outcome of Patients with Mild Stroke Improves after Treatment with Systemic Thrombolysis

Introduction

In up to one third of patients with mild stroke suitable to receive systemic thrombolysis the treatment is not administered because the treating physicians estimate a good spontaneous recovery. However, it is not settled whether the fate of these patients is equivalent to those who are thrombolysed.

Methods

We analyzed 203 consecutive patients (134 men and 69 women, mean age 69±14 years) without premorbid disability and a NIHSS score ≤5 at admission [median 3 (IQR 2–4)]. Intravenous thrombolysis was administered within 4.5 hours from stroke onset (n = 119), or it was withheld (n = 84) whenever the treating physician predicted a spontaneous recovery. The baseline risk factors, clinical course, infarction volume, bleeding complications, and functional outcome at 3 months were analyzed and declared to a Web-based registry which was accessible to the local Health Authorities.

Results

Expectedly, not thrombolysed patients had the mildest strokes at admission [median 2 (IQR 1–3.75)]. At day 2 to 5, the infarct volume on DWI-MRI was similar in both groups. There were no symptomatic cerebral bleedings in the study. An ordinal regression model adjusted for baseline stroke severity showed that thrombolysis was associated with a greater proportion of patients who shifted down on the modified Rankin Scale score at 3 months (OR 2.66; 95% CI 1.49–4.74, p = 0.001).

Conclusions

Intravenous thrombolysis seems to be safe in patients with mild stroke and may be associated with improved outcome compared with untreated patients. These results support the evaluation of the efficacy of intravenous thrombolysis in mild stroke patients in randomized clinical trials.     

西洛他唑在急性脑梗死患者rt-PA溶栓治疗后的作用及对血清CD62p、CD63、PAF的作用分析

摘要 目的：探讨西洛他唑在急性脑梗死患者重组人组织型纤溶酶原激活物（rt-PA）溶栓治疗后的作用及对血清血小板溶酶体膜蛋白（CD63）、α颗粒膜糖蛋白（CD62p）、血小板活化因子（PAF）的作用分析。方法：选择2020年2月至2022年2月我院接诊的90例急性脑梗死患者,按照随机数表法分为观察组及对照组,各45例。两组均接受rt-PA溶栓治疗,对照组溶栓后使用阿司匹林治疗,观察组在对照组基础上,联合西洛他唑治疗,均连续治疗14 d。比较两组临床疗效、血清CD62p、CD63、PAF、全血粘度、血浆粘度和红细胞比容（HCT）及美国国立卫生院卒中量表（NIHSS）评分、巴氏量表（Barthel指数）评分的变化及出血事件发生率。结果：观察组患者的临床疗效总有效率为91.11%,高于对照组的73.33%,有统计学意义（P＜0.05）;观察组血清CD62p、CD63、PAF均比对照组低,有统计学意义（P＜0.05）;观察组全血粘度、血浆粘度、HCT均比对照组低,有统计学意义（P＜0.05）;观察组的NIHSS评分均低于对照组,Barthel指数高于对照组,有统计学意义（P＜0.05）;两组出血事件总发生率比较,无统计学意义（P＞0.05）。结论：西洛他唑在急性脑梗死患者rt-PA溶栓治疗后的作用明显,可有效降低血清CD62p、CD63、PAF的表达,改善血小板功能,安全性较好,值得临床推广。     

急性脑卒中患者腹泻并发症的临床分析

目的:探讨急性脑卒中患者并发腹泻的发生状况及危险因素,以降低脑卒中并发腹泻的发生率。方法:对264例急性脑卒中患者观察腹泻并发症的发生,分析一般临床资料,使用Logistic回归分析腹泻并发症的可能危险因素。结果:不同类型急性脑卒中并发腹泻发生率差异无统计学意义(P0.05),有无糖尿病的并发腹泻发生率差异有统计学意义(P0.05),抗生素使用的并发腹泻发生率差异有统计学意义(P0.05),腹泻并发症的发生与患者年龄、入院时GCS昏迷量表评分、营养状况、糖尿病史、抗生素使用有关(OR=4.36、8.78、4.48、6.26、5.64),腹泻组和非腹泻组病死率差异有统计学意义(P0.05)。结论:急性脑卒中的患者易发生腹泻,合理选择和使用抗生素,合理饮食,尽量减少医疗干预措施的影响,可减少腹泻并发症的发生。     

Risks and Benefits of Estrogen Therapy for a Male-to-Female Transsexual with a Prothrombin Gene Mutation

ObjectiveWe present the case of a male-to-female transsexual person in her 20s requesting hormone therapy in the setting of a history of a deep venous thrombosis and pulmonary embolus and carrying the prothrombin G20210A gene mutation.MethodsWe interviewed the patient and reviewed her medical records. We carefully weighed the risks and benefits of hormone therapy and took into account two important ethical principles: beneficence (to act in the patient’s best interest) and nonmaleficence (to avoid harm).ResultsOur patient presented to an outside facility with weight loss, generalized weakness, right lower extremity swelling, and chest pain. She was diagnosed with a pulmonary embolus and extensive deep venous thrombus by computed tomography (CT) scan and Doppler ultrasound, respectively. She was found to carry the pro-thrombin G20210A gene mutation. She was treated with anticoagulation therapy for 12 months, which was restarted prior to beginning therapy with transdermal estrogen.ConclusionWhile the exact risk of recurrent deep venous thrombosis and pulmonary embolus in our patient is unknown, we recommended that hormone therapy should only be given in conjunction with anticoagulation. We speculate that this strategy would allow the patient to experience the benefits to her overall well-being with hormone therapy while reducing the risks of venous thrombosis to acceptable levels. Prospective long-term follow-up of this patient is needed to verify the benefits and risk of the intervention chosen. (Endocr. Pract. 2013;19:e150-e153)     

Impact of Early Initiation of Antiretroviral Therapy in Patients with Acute HIV Infection in Vienna,Austria

BackgroundIt is unclear whether antiretroviral therapy (ART) should be initiated during acute HIV infection. Most recent data provides evidence of benefits of early ART.MethodsWe retrospectively compared the clinical and immunological course of individuals with acute HIV infection, who received ART within 3 months (group A) or not (group B) after diagnosis.ResultsAmong the 84 individuals with acute HIV infection, 57 (68%) received ART within 3 months (A) whereas 27 (32%) did not receive ART within 3 months (B), respectively. Clinical progression to CDC stadium B or C within 5 years after the diagnosis of HIV was less common in (A) when compared to (B) (P = 0.002). After twelve months, both the mean increase in CD4+ T cell count and the mean decrease in viral load was more pronounced in (A), when compared to (B) (225 vs. 87 cells/μl; P = 0.002 and -4.19 vs. -1.14 log10 copies/mL; P<0.001). Twenty-four months after diagnosis the mean increase from baseline of CD4+ T cells was still higher in group A compared to group B (251 vs. 67 cells/μl, P = 0.004).ConclusionsInitiation of ART during acute HIV infection is associated with a lower probability of clinical progression to more advanced CDC stages and significant immunological benefits.     

早期康复训练对冠心病介入治疗术后恢复的影响

目的：探讨经皮冠脉介入（PCI）治疗的急性心肌梗死（AMI）患者行早期康复训练后的疗效与安全性。方法：192例AMI患者经PCI治疗后随机分为康复组与对照组各96例,分别予早期心脏程序康复训练与传统康复治疗。比较2组患者的心脏结构、并发症及住院时间。结果：在住院期间及随访1年后,两组患者左室舒张末内径、左室收缩末内径、左室后壁厚度及左室射血分数无统计学差异（P〉0．05）;心律失常、心绞痛及死亡率等并发症均无显著性差异（P〉0．05）;而对照组院内感染发生率明显多于康复组（P〈0．05）。结论AMI患者PCI术后行早期心脏程序康复训练安全、有益,可明显减少院内感染的发病率,缩短住院时间。     

早期康复训练对冠心病介入治疗术后恢复的影响

目的:探讨经皮冠脉介入(PCI)治疗的急性心肌梗死(AMI)患者行早期康复训练后的疗效与安全性。方法:192例AMI患者经PCI治疗后随机分为康复组与对照组各96例,分别予早期心脏程序康复训练与传统康复治疗。比较2组患者的心脏结构、并发症及住院时间。结果:在住院期间及随访1年后,两组患者左室舒张末内径、左室收缩末内径、左室后壁厚度及左室射血分数无统计学差异(P>0.05);心律失常、心绞痛及死亡率等并发症均无显著性差异(P>0.05);而对照组院内感染发生率明显多于康复组(P<0.05)。结论:AMI患者PCI术后行早期心脏程序康复训练安全、有益,可明显减少院内感染的发病率,缩短住院时间。     

Plasma D-Dimer Levels Are Associated with Stroke Subtypes and Infarction Volume in Patients with Acute Ischemic Stroke

Background

It has been suggested that modestly elevated circulating D-dimer values may be associated with acute ischemic stroke (AIS). Thus, the purpose of this study was to investigate the association between plasma D -dimer level at admission and AIS in Chinese population.

Methods

In a prospective observational study, plasma D-dimer levels were measured using a particle-enhanced, immunoturbidimetric assay on admission in 240 Chinese patients with AIS. The National Institutes of Health Stroke Scale (NIHSS) score was assessed on admission blinded to D-dimer levels.

Results

Plasma median D-dimer levels were significantly (P = 0.000) higher in AIS patients as compared to healthy controls (0.88; interquartiler range [IQR], 0.28–2.11 mg/L and 0.31; IQR, 0.17–0.74 mg/L). D-dimer levels increased with increasing severity of stroke as defined by the NIHSS score(r = 0.179, p = 0.005) and infarct volume(r = 0.425, p = 0.000). Those positive trends still existed even after correcting for possible confounding factors (P = 0.012, 0.000; respectively). Based on the Receiver operating characteristic (ROC) curve, the optimal cut-off value of plasma D-dimer levels as an indicator for diagnosis of cardioembolic strokes was projected to be 0.91 mg/L, which yielded a sensitivity of 83.7% and a specificity of 81.5%, the area under the curve was 0.862(95% confidence interval [CI], 0.811–0.912).

Conclusion

We had shown that plasma D-dimer levels increased with increasing severity of stroke as defined by the NIHSS score and infarct volume. These associations were independent other possible variables. In addition, cardioembolic strokes can be distinguished from other stroke etiologies by measuring plasma D-dimer levels very early (0–48hours from stroke symptom onset).     

血清UA、Hcy、LDL-C联合监测对急性脑梗死患者阿替普酶静脉溶栓治疗后脑出血性转化的预测价值

摘要 目的：探讨血清尿酸（UA）、同型半胱氨酸（Hcy）和低密度脂蛋白胆固醇（LDL-C）联合监测对急性脑梗死（ACI）患者阿替普酶静脉溶栓治疗后脑出血性转化（HT）的预测价值。方法：选取2018年1月～2020年12月西南医科大学附属成都三六三医院收治的173例接受阿替普酶静脉溶栓治疗的ACI患者,根据静脉溶栓后是否发生HT分为HT组和非HT组。对比两组的临床资料和血清UA、Hcy、LDL-C水平,采用多因素Logistic回归分析ACI患者阿替普酶静脉溶栓治疗后发生HT的影响因素,采用受试者工作特征（ROC）曲线分析血清UA、Hcy、LDL-C联合监测对ACI患者阿替普酶静脉溶栓治疗后发生HT的预测价值。结果：173例患者中有47例发生HT,发生率为27.17％。与非HT组比较,HT组年龄更大,收缩压、舒张压、美国国立卫生研究院卒中量表（NIHSS）评分、溶栓前随机血糖以及Hcy水平更高,而LDL-C及UA水平更低（P＜0.05）。多因素Logistic回归分析结果显示：收缩压、NIHSS评分、溶栓前随机血糖以及Hcy水平为ACI患者阿替普酶静脉溶栓治疗后发生HT的危险因素,而UA、LDL-C水平为保护因素。ROC曲线分析结果显示：血清UA、Hcy、LDL-C单独与联合监测预测ACI患者阿替普酶静脉溶栓治疗后HT的曲线下面积（AUC）分别为0.764、0.794、0.674、0.888,联合监测时的AUC明显更高。结论：血清UA、LDL-C低水平和Hcy高水平是ACI患者阿替普酶静脉溶栓治疗后HT的影响因素,联合监测能提高对HT发生的预测价值。     

臭氧大自血疗法治疗急性缺血性脑梗死患者的临床疗效评估

目的:研究臭氧大自血疗法治疗急性缺血性脑梗死患者的临床疗效,为临床治疗提供依据。方法:选取2014年10月到2015年8月我院收治的急性缺血性脑梗死患者210例,按照随机数字表法将患者分为研究组和对照组,每组105例,两组均给予常规治疗,研究组在常规治疗的基础上给予臭氧大自血疗法,应用barthel指数评定日常生活活动能力,应用美国国立卫生研究院卒中量表(NIHSS)评价神经功能缺损,比较两组临床疗效,治疗前后甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HLD-C)和低密度脂蛋白(LDL-C),并比较两组不良反应。结果:研究组总有效率为87.6%(92/105)显著高于对照组的73.3%(77/105),比较差异具有统计学意义(P0.05);治疗后两组NIHSS评分显著降低,barthel评分显著升高,且研究组NIHSS评分显著低于对照组,barthel评分显著高于对照组,比较差异具有统计学意义(P0.05);治疗后两组TG、TC和LDL-C均显著降低,HDL-C显著升高,且研究组TG、TC和LDL-C低于对照组,HDL-C高于对照组,比较差异具有统计学意义(P0.05);两组不良反应比较无统计学意义(P0.05)。结论:臭氧大自血疗法治疗急性缺血性脑梗死疗效较好,能明显改善患者的神经功能和日常生活。     

Sensorimotor Plasticity after Music-Supported Therapy in Chronic Stroke Patients Revealed by Transcranial Magnetic Stimulation

Background

Several recently developed therapies targeting motor disabilities in stroke sufferers have shown to be more effective than standard neurorehabilitation approaches. In this context, several basic studies demonstrated that music training produces rapid neuroplastic changes in motor-related brain areas. Music-supported therapy has been recently developed as a new motor rehabilitation intervention.

Methods and Results

In order to explore the plasticity effects of music-supported therapy, this therapeutic intervention was applied to twenty chronic stroke patients. Before and after the music-supported therapy, transcranial magnetic stimulation was applied for the assessment of excitability changes in the motor cortex and a 3D movement analyzer was used for the assessment of motor performance parameters such as velocity, acceleration and smoothness in a set of diadochokinetic movement tasks. Our results suggest that the music-supported therapy produces changes in cortical plasticity leading the improvement of the subjects'' motor performance.

Conclusion

Our findings represent the first evidence of the neurophysiological changes induced by this therapy in chronic stroke patients, and their link with the amelioration of motor performance. Further studies are needed to confirm our observations.