Objective To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion ① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.
Objective To systematically review the relationship between helicobacter pyloric (HP) infection and ischemia stroke. Methods We searched MEDLINE, BIOSIS, VIP, and China Full Text Journal databases to identify the studies that studied the relationship between HP infection and ischemia stroke. All the studies were strictly screened according to the inclusion criteria, and meta-analyses were performed for the included studies using RevMan 4.2 software.Results Eleven case-control studies involving 1 530 patients with ischemia stroke and 1 451 health controls were included. The results of meta-analyses showed that there was a significant difference in the infection ratio of HP between the patients with ischemia stroke and health controls (OR=1.77, 95%CI 1.38 to 2.28, Plt;0.0001), but this difference was not been found after adjusting some related risk factors (1.22, 95%CI 0.93 to 1.59, P=0.15). The results of subgroup meta-analyses showed these differences were only found in the LAA (large-artery atherosclerosis) subgroup (OR=3.65, 95%CI 2.58 to 5.17) and the SAA (small-artery atherosclerosis) subgroup (OR=1.74, 95%CI 1.30 to 2.34), but was not found in the CE (cardiogenic cerebral embolism) subgroup (OR=1.08, 95%CI 0.58 to 2.02). Conclusion HP infection is associated with ischemia stroke, but the relationships between HP infection and the subtypes of ischemia stroke are different. The association between HP and LAA is ber than that between HP and the other subtypes. More evidence is needed to prove whether Helicobacter pyloric infection is an independent risk factor of ischemia stroke.
Objective To assess the efficacy and safety of fructose-1,6 diphosphate (FDP) in the treatment of cerebral infarction. Methods We searched MEDLINE, EMbase, Cochrane CENTRAL Register of Controlled Trials, CBM and CNKI in 2006. Randomized controlled trials(RCTs) or quasi-randomized controlled trials involving FDP for cerebral infarction were collected. We assessed the quality of the studies and conducted meta-analyse with The Cochrane Collaboration’s RevMan 4.2. Results Ten RCTs were included, 9 of which were of low quality and only one was graded as high quality. None of the trials reported the number of patients who had died or were dependent at the end of long term follow-up. After 7 to 30 days of treatment, improvement of neurological deficiency was associated with FDP compared with placebo or control [OR 2.45, 95%CI (1.91,3.15)]. There was no statistical difference in the death rate between the FDP and control groups at the end of the treatment [RD –0.01, 95%CI (–0.03,0.01)]. One study found that FDP had a similar safety profile [OR 1.24, 95%CI (0.32,4.75)] to the control group. None of the trials compared the costs in the treatment groups. Conclusions The quality of the published clinical trials on FDP in the treatment of cerebral infarction is poor. FDP may improve short-term neurological deficits, but seems unlikely to decrease mortality. Moreover, we found no evidence to support the long-term efficacy of FDP on mortality, dependency and neurological deficit. Large-scale and high quality clinical trials with sufficient follow-ups are needed to evaluate the role of FDP in the treatment of cerebral infarction.
Objective To determine the effectiveness of statins in reducing C-reactive protein in patients with cerebral infarction and the potency of C-reactive protein as an indicator for preventing cerebrovascular events. Methods We searched PubMed, EMbase, Central Register of Controlled Trials, CBMdisc and CNKI from the date of establishment through August 2008. Bibliographies of the retrieved articles were also checked. Data was extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used to carry out meta-analysis. Results Twenty-three randomized trials involving 1946 patients were included. The results of meta-analyses showed the following: statins reduced C-reactive protein compared to the control group (WMD= –5.79, 95%CI –7.32 to –4.26); statins were associated with a reduction of carotid intima-media thickness (IMT) (WMD= –0.21, 95%CI –0.25 to –0.17); atorvastatin greatly reduced C-reactive protein than the simvastatin control group (WMD= –1.78, 95%CI –3.92 to 0.36); statins were associated with a slight improvement in neurological deficit (OR= 2.22, 95%CI 0.94 to 5.21). Conclusion The evidence currently available shows that statins can reduce C-reactive protein and carotid IMT in the patients with cerebral infarction compared to the control group. However, it is not clear whether statins reducing C-reactive protein is correlated to the improvement of neurological deficit and prognosis. Similar trials in future should focus on the relationship between the change of C-reactive protein and clinical outcomes.
Objective To assess the clinical efficacy and safety of Shuxuetong in the treatment of cerebral infarction. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1996 to Feb. 2006), EMBASE (1984 to Dec. 2005), Cochrane Controlled Trials Register (Issue 4, 2005), Chinese Cochrane Centre Database, CBMdisc (1978 to Dec. 2005). We handsearched the related published and unpublished data and their references. All trials about Shuxuetong injection for cerebral infarction were included. Data were extracted and evaluated by two reviewers independently with designed extraction form. RevMan 4.2.8 software was used for data analysis. Results Eleven RCTs involving 1 122 patients were included. The results of meta-analysis were listed as follows: ① Total effective rate: Compared with Danshen, three studies showed that Shuxuetong were more effective with OR 4.01, 95%CI 2.00 to 8.04; ② Adverse effect: The number of adverse drug reaction was small and the symptoms were moderate; ③ Neurologic impairment score: Compared with safflower, one study showed that Shuxuetong had better improvement with WMD -2.60, 95%CI -3.23 to -1.97. Conclusions Shuxuetong may increase the total effective rate of cerebral infarction. More high quality trials are required.
ObjectiveTo explore the feasibility and effectiveness of community-based rehabilitation for patients with cerebral infarction.
MethodThe cerebral infarction patients (n=285) registered before March 2011 and newly involved in the research between March 2011 and September 2012 were randomly divided into rehabilitation group (n=142) and control group (n=143). The doctors in community hospitals were trained by specialist physicians in Neurology Department and Rehabilitation Department from second-grade hospitals. Community physicians were responsible for the patients' rehabilitation for one year.
ResultsNo differences between the rehabilitation group and the control group in the time of enrollment situation (P>0.05). After six months of intervention, there were significant differences between the two groups of patients in neurological function, daily activity ability, anxiety and depression scale scores (P<0.05), and the difference was more significant after 12 months (P<0.01). The results of Kubota drinking experiment were significantly different between the two groups after six months of intervention (P<0.05).
ConclusionsCommunity-based rehabilitation treatment can significantly reduce the degree of physical and mental disability. The cooperation between second-grade hospitals and community hospitals is an effective way to realize three-stage neurological rehabilitation, which can better improve patients' quality of life and is helpful for them return to the society.
ObjectiveTo analyze the clinical characteristics, risk factors, treatment and prognosis of epilepsy secondary to cerebral infarction.MethodsThe clinical data of 109 patients with epilepsy secondary to cerebral infarction admitted to the Affiliated Central Hospital of Shandong First Medical University from October 2018 to February 2021 were retrospectively analyzed, including the location of cerebral infarction, seizure type, seizure time and antiepileptic treatment.Results3 426 patients with cerebral infarction were treated in the same period, and the incidence of epilepsy secondary to cerebral infarction was 3.18%. Among 109 patients with epilepsy secondary to cerebral infarction, 71 were male and 38 were female, the average age was (67.42 ± 28.58) years. Time of seizure after cerebral infarction: 67 cases (61.47%) were early onset epilepsy and 42 cases (42.47%) were late onset epilepsy. The infarct site: 63.30% (69 /109) in cortex, 11.93% (13/109) in subcortical area, and 24.77% (27/109) in lacunar infarction secondary epilepsy. 5 cases died, the fatality rate was 1.59%, of which 4 patients died of early onset epilepsy, status epilepticus, and 1 patient died of late onset epilepsy due to acute cerebral infarction.ConclusionsIn patients with epilepsy secondary to cerebral infarction, the cortex is the most common site of infarction; focal seizures are more than comprehensive seizures; status epilepticus often indicates poor prognosis, so timely antiepileptic treatment should be given to improve the prognosis.
Objective To assess the response rate, improvement in neurological function and safety of cinepazide maleate injection for patients with cerebral infarction. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials (Issue 1, 2010), PubMed (1948 to March 2010), EMbase (1966 to March 2010) and Chinese Bio-Medicine Database (1978 to March 2010). We also hand searched relevant literatures and obtained unpublished trials from pharmaceutical companies. The Cochrane Collaboration’s software RevMan5.0 was used for meta-analysis. Results Fifteen randomized controlled trials involving 1 456 patients were included. The results of meta-analyses indicated that: 1) Neurological deficits: We identified 11 trials involved 978 patients. Cinepazide maleate injection group compared with the control groups (placebo, Xuesaitong, Dansen and Nimodipine) could significantly improve the neurological deficits. The difference was statistically significant with WMD= – 4.64, 95%CI – 6.43 to – 2.85, WMD= – 2.39, 95%CI – 4.37 to – 0.42, WMD= – 3.67, 95%CI – 5.26 to – 2.07 and WMD= – 6.14, 95%CI – 8.39 to – 3.89, respectively. 2) Response rate: A total of 14 trials involved 1 349 patients were identified. Compared with control groups (placebo, Xuesaitong, Dansen and Nimodipine), cinepazide maleate injection group were more efficient, the difference was statistically significant with RR=1.33, 95%CI 1.16 to 1.54; RR=1.24, 95%CI 1.04 to 1.50; RR=1.33, 95%CI 1.23 to 1.43 and RR=1.29, 95%CI 1.12 to 1.49, respectively. 3) Adverse events: No serious adverse events were observed. But the difference of adverse events reports of headache and skin itching in cinepazide maleate injection group was statistically significant compared with the control groups. Conclusion Current evidence shows that cinepazide maleate injection can reduce neurological deficits in patients with acute cerebral infarction, improve the clinical treatment efficacy without serious adverse events. Due to limited quality of included studies, high-quality, large sample randomized controlled trials are required.
Objective To assess the clinical application of lysophosphatidic acid (LPA) as the early warning index for cerebral ischemic stroke (CIS). Methods Trials were collected through electronic searches of PubMed, The Cochrane Library, CBM, CNKI, Wanfang, and VIP (from the date of database establishment to June 2009). We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of the included studies, performed descriptive analysis and meta-analysis with The Cochrane Collaboration’s RevMan 4.2 software. Results A total of 22 studies were included. The results of meta-analyses showed that, there was a significant difference about LPA level in cerebral infarction (CI) group vs. healthy control group (WMD=2.00, 95%CI 1.85 to 2.15), and in transient ischemia attach (TIA) group vs. healthy control group (WMD=2.48, 95%CI 2.18 to 2.78); and a difference was noted about 24 hours LPA level in CI group vs. healthy control group (WMD=2.40, 95%CI 1.81 to 2.99). Conclusions According to the included studies, the contents of LPA is higher in CIS than that in healthy control group. It would be helpful to measure LPA in the TIA period for intervention. However, more high quality trials are expected for further study, in order to prove the value of LPA as early warning index because of the heterogeneity and poor quality of the current included studies.
Objective To assess the clinical efficacy and safety of Xingnaojing for treating cerebral infarction. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to April 2005), EMBASE (1984 to April 2005), Cochrane Controlled Trials Register (Issue 2, 2005), CBMdisc (1978 to April 2005). We handsearched the related published and unpublished data and their references. All trials about Xingnaojing injection for cerebral infarction were included. Data were extracted and evaluated by two reviewers independently with designed extraction from RevMan 4.2.7 software was used for data analysis. Results Thirteen RCTs involving 1203 patients were include .The results of meta-analysis were listed as the following:①Mortality:Compared with danshen ,2 studies showed that Xingnaojing decreased mortality statistically (RR 0.31 and 95% CI 0.14 to 0.70).Compared with cerebrolysin ,1 study showed Xingnaojing didn’t decrease the mortality (RR 0.92 ,95%CI 0.14 to 6.27);②Total effective rate: Compared with Danshen ,4 studies showed that Xingnaojing were more effective (RR 0.92,95% CI 1.12 to 1.42 ); ③ Cure rate: Compared with each control , Xingnaojing had the same cure rate ;④ Adverse effect: The number of adverse drug reaction was small and the symptoms were moderate;⑤Neurologic impairment score:Compared with Danshen ,3 studies showed that Xingnaojing had better improvement (WMD 3.78 ,95%CI 2.30 to 5.26).Conclusions xingnaojing may decrease the mortality and increase the total effective rate of cerebral infarction .More high quality trials are required.
