ObjectiveTo explore the association between prediabetes and early vascular cognitive impairment (VCI) in patients with acute cerebral infarction. MethodsNon-diabetes mellitus patients with first-ever acute cerebral infarction hospitalized in the Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology between January and April 2019 were retrospectively enrolled. The enrolled patients were divided into prediabetes group and normal blood glucose group according to the level of glycosylated hemoglobin, and the patients were divided into normal cognitive function group and cognitive impairment group according to the Montreal Cognitive Assessment score. The general information and clinical related data of the included patients were compared. Results A total of 129 patients were enrolled. Among them, 46 cases were in the prediabetes group and 83 cases were in the normal blood glucose group. There were 82 cases in the normal cognitive function group and 47 cases in the cognitive impairment group. Multivariate logistic regression analysis showed that compared with the normal blood glucose group, the prediabetes group was associated with early VCI in patients with acute cerebral infarction [odds ratio (OR)=4.172, 95% confidence interval (CI) (1.786, 9.754), P=0.001]; the higher the NationalInstitutes of Health Stroke Scale score at the first admission was, the higher the risk of early VCI was [OR=1.379, 95%CI (1.183, 1.650), P<0.001]. Conclusion In patients with first-ever acute cerebral infarction, prediabetes is associated with early VCI.
Objective To compare the risk factors between multiple cerebral infarction (MCI) and single cerebral infarction (SCI). This would be beneficial for carrying out corresponding prevention and treatment. Methods We prospectively registered consecutive cases of ischemic stroke in the neurological wards and divided them into two groups: MCI group and SCI group according to their clinical and imaging data. Firstly, the single variable analyses of 24 factors that could be related to the onset of MCI were conducted, and then the multivariate non-condition stepwise logistic regression was performed. Results Significant differences were noted between MCI group and SCI group in terms of age, gender, hpertension, diabetes, heart valvular disease, smoking, cerebral infarction history and first systolic blood pressure after admission. The logistic regression analyses showed that factors of age (OR=1.014, 95%CI 1.003 to 1.026), hypertension (OR=1.566, 95%CI 1.185 to 2.068), smoking (OR=1.473, 95%CI 1.052 to 2.061), cerebral infarction history (OR=1.948, 95%CI 1.326 to 2.864) were independent risk factors for MCI. Conclusion Compared to SCI, age, hypertension, smoking and cerebral infarction history were independent risk factors for MCI patients.
Objective To assess the effectiveness and safety of edaravone for acute cerebral infarction. Methods We searched The Cochrane Central Register of Controlled Trials （ Issue 2, 2005 ）, MEDLINE （ 1966 to Aug. 2005）, EMBASE （ till Aug. 2005 ）, the China Biological Medcine Database （ till Aug. 2005 ）, the Chinese Stroke Clinical Trials Database （ till August 2005 ） and the reference lists of related articles. Two reviewers independently selected studies, assessed quahty of studies and extracted data. The RevMan 4.2 software was used for statistical analysis. Results We identified 12 randomized controlled trials, of which 9 （ n = 948 ） were included. The level of methodology quality was B. Since the conventional therapy was different among some studies, the improvement of disability and long-term death rate and incidence of adverse reactions were not included by meta-analysis. Meta-analysis on the improvement of neurological deficit showed a better effectiveness of edaravone than control with statistical significance [ OR2.98, 95% CI （ 1.39,6.39 ） ]. Possible adverse reactions to edaravone included abnormal liver function and skin rash. Conclusions With relatively poor quality of most included trials and small sample size, insufficient evidence is obtained to support the conclusion that edaravone is safe or effective in the treatment of acute cerebral infarction. Further high quality and large sample randomized controlled trials should be carried out.
ObjectiveTo compare the risk factors of angina pectoris and atherosclerotic thrombotic cerebral infarction, and to study the possible risk factors of angina pectoris complicated with atherosclerotic thrombotic cerebral infarction (XNHB abbr. in Chinese) and provide the basis for the prevention of XNHB.
MethodsClinical epidemiological cross-sectional survey methods were used. Information of angina pectoris patients, atherosclerotic thrombotic cerebral infarction patients and XNHB patients were collected. The statistical software SPSS 17.0 was used to analyze the single risk factors, and then logistic regression analysis was used to filter the independent risk factors of XNHB.
Results1 002 cases of angina pectoris, 963 cases of atherosclerotic thormbotic cerebral infaction and 982 cases of XNHB were included. There were significant differences among the three diseases in the following index:age (P=0.000 0), gender (P < 0.000 1), resting lifestyle (P=0.000 0), body mass index (BMI) (P=0.000 0), diabetes (P=0.001 9), hypertension (P < 0.000 1), diabetes complicated with hypertension (P < 0.000 1), smoking (P < 0.000 1), alcohol consumption (P < 0.000 1), and the combination of more than 3 risk factors (P=0.000 0). Age (OR=1.690, 95%CI 1.420 to 2.012), hypertension (OR=1.558, 95%CI 1.312 to 1.850), abnormal BMI (OR=1.356, 95%CI 1.158 to 1.587) and resting lifestyle (OR=1.319, 95%CI 1.107 to 1.572) were shown as the independent risk factors of XNHB filtering by logistic multiple regression analysis.
ConclusionThe elderly with hypertension, abnormal BMI or live a resting way of life are more likely to have XNHB, so positive control of risk factors should be needed.
ObjectiveTo explore the clinical features and prognosis of ischemic cerebral infarction in young population,and to provide a reference for clinical prevention of cerebral infarction in young population.
MethodsA total of 547 patients with ischemic cerebral infarction diagnosed between January 2008 and June 2013 were included,and the difference in clinical data and outcomes between young and old patients were retrospectively compared.
ResultsThe 547 patients included 233 young and 314 old patients,and there were more male patients in young group.As compared to the old group,the proportion of hypertension was significantly lower in young group (51.9%,64.3%;P=0.004);while smoking (51.9%,5.7%;P=0.000) and alcoholism (53.2%,28.3%;P=0.000) were significantly higher in young group.Moreover,there were more patients with vascular malformations in young group than that in old group (7.3%,3.2%;P=0.028).And there were also more patients in young group received thrombolytic therapy and antiplatelet therapy (98.3%,86.9;P=0.000),and the prognosis of young patients was significantly better than that of old patients.
ConclusionThe prognosis of young patients with ischemic stroke prognosis is relatively good,and changing bad habits would be an effective measure to prevent and reduce the occurrence of ischemic cerebral infarction in young population.
ObjectiveTo analyze the cases of cryptogenic cerebral infarction complicated with patent foramen ovale (PFO) treated by interventional occlusion, and evaluate the efficacy and safety of occlusion of PFO on preventing the recurrence of cerebral infarction.MethodsA total of 24 patients with cerebral infarction complicated with PFO who underwent interventional occlusion from January 2015 to August 2018 in Mianyang Central Hospital were retrospectively analyzed. The data of these patients was collected, including relevant medical history, clinical examinations, and treatment processes. Detailed examinations (electrocardiogram, right heart contrast echocardiography, transcranial Doppler ultrasound foaming test, cranial imaging, etc.) were performed and the clinical manifestations were evaluated when patients returned to the outpatient department. Combining with regular telephone calls and outpatient follow-up, the recurrence of cerebral infarction and postoperative complications were evaluated.ResultsAmong the 24 patients, there were 11 males and 13 females, who were aged from 16 to 72 (with an average age of 49); the National Institutes of Health Stroke Scale Score was ≤5 in 19 patients, and was >5 in 5. The preoperative MRI and other examinations of the 24 patients showed that there were 21 cases of unilateral cerebral infarctions and 3 cases of bilateral cerebral infarctions; 10 cases of single lesions and 14 cases of multiple lesions; 9 cases of cortical infarctions and 15 cases of subcortical infarctions; 11 cases of lacunar infarctions and 13 cases of non-lacunar infarctions. Anterior circulation was involved in 14 cases, posterior circulation was involved in 8 cases, and both anterior and posterior circulations were involved in 2 cases. All the 24 patients underwent interventional occlusion successfully. No complications occurred during hospitalization or 3, 6, and 12 months of follow-up visits. No cerebral infarctions reoccurred.ConclusionsInterventional occlusion of PFO is effective on preventing the recurrence of cerebral infarction. And the operation is safe with rare complications.
摘要:目的:觀察阿托伐他丁對腦梗死大鼠腦保護的作用以及對腦源性神經營養因子(braindeprived neurotrophic factor,BDNF)的影響。方法: 線栓法制備SD大鼠大腦中動脈梗死(middle cerebral artery occlusion,MCAO)再灌注模型。將大鼠隨機分為:假手術組;MCAO組的2 h、24 h、3 d、5 d組;阿托伐他丁組的2 h、24 h、3 d、5 d組。MCAO組和阿托伐他丁組的各時程組再分別分為腦梗死體積亞組、免疫組化亞組,每亞組及假手術組各6只大鼠。在不同時間點觀察阿托伐他丁組和MCAO組大鼠神經行為評分、腦梗死體積,用免疫組化法檢測BDNF陽性細胞數。結果: 神經行為評分和腦梗死體積在阿托伐他丁組和MCAO組的2 h組之間無顯著性差異(Pgt;0.05),在阿托伐他丁24 h、3 d、5 d組均顯著低于對應時程的MCAO組(Plt;0.05);各組缺血半暗帶BDNF陽性細胞數均增高,但阿托伐他丁組的陽性細胞數顯著高于對應時程的MCAO組(Plt;0.05)。結論:阿托伐他丁能提高大鼠局灶腦缺血半暗帶BDNF的表達水平,促進神經元的修復。Abstract: Objective: To observe the effect of atorvastatin in cerebral protection and braindeprived neurotrophic factor(BDNF) in rats. Methods: Ischemic reperfusion model of rats as established by an intraluminal filament and recirculation at different time point respectively. One hundred and two healthy SD rats were randomly assigned into three groups for different preconditioning, including the sham surgery group (SS, n=6), the sham and middle cerebralartery occlusion (MCAO) group (MCAO, n=48), and the atorvastatin and MCAO group (atorvastatin +MCAO, n=48). The latter two groups were further divided into two subgroups on different time points of tests. Each subgroup hase six rats. In the atorvastatin +MCAO group, intragastric administration of atorvastatin was given for five days, then the MCAO followed. In the MCAO group, the MCAO was given directly. The neurophysical marks and the volume of the cerebral infarction in atorvastatin group and MCAO group were determined at different time point. The expression of BDNF was valued by immunohistochemitry respectively. Results: At 2 h, there were no differences in the neurophysical marks and volume of the cerebral infarction between atorvastatin group and MCAO group (Pgt;0.05). At 24 h,3 d,5 d, the neurophysical marks and volume of the cerebral infarction of atorvastatin group were lower than that of MCAO group in the corresponding time (Plt;0.05). Around the necrotic areas,BDNF positive neurons were increased in both groups, but they were higher in atorvastatin group than in MCAO group in the corresponding time (Plt;0.05). Conclusion: Atorvastatin could increase the expression level of BDNF and promote the ischemic neuron to revive.
Objective To explore the association between procalcitonin (PCT) level and the development of malignant brain edema (MBE) after acute cerebral infarction. Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital, Sichuan University between January 1, 2017 and December 31, 2018 were retrospective collected. Patients were divided into MBE group and non-MBE group based on whether MBE had occurred. The basic information and neuroimaging data of two groups of patients were compared and analyzed. Results A total of 798 patients were included. Among them, there were 93 cases of MBE (11.65%) and 705 cases of non-MBE (88.35%). The median time of MBE occurrence (lower quartile, upper quartile) was 29 (24, 54) hours after onset. The difference in the National Institutes of Health Stroke Scale, large-scale middle cerebral artery infarction, dysarthria, low fever, consciousness status, chronic heart failure, TOAST typing, mechanical ventilation, gastric tube placement, PCT on the first and third day of admission between the two groups were statistically significant (P<0.05). There was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE. Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction. Patients with elevated PCT after cerebral infarction may require careful clinical management.
摘要:目的:觀察銀杏達莫聯合依達拉奉治療急性腦梗死的臨床療效。方法:將50例急性腦梗死患者隨機分為治療組與對照組各25例,均予常規治療,治療組加用依達拉奉注射液30 mg及銀杏達莫注射液20 mL靜滴。兩組均以14 d為一個療程,于治療前、治療結束比較兩組神經功能缺損評分情況。結果:治療組治療顯效率顯著高于對照組。結論:銀杏達莫聯合依達拉奉可有效治療急性腦梗死。Abstract: Objective: To observe the therapeutic effect of Edaravone combined with Gingko Bilobate on acute cerebral infarction. Methods: Fifty cases with acute cerebral infarction were devided into two groups randomly, 25 cases in each. Two groups received routine therapy for 14 days, while in therapeutic group 30 mg Edaravone and 20 mL Ginkgo Bilobate were intravenously drip infused additionally per day. The therapeutic effect was evaluated through scoring of nervous function defect before and after treatment. Results: The obvious effective rate of therapeutic group was superior to the one of the control group (Plt;0.05). Conclusion: Edaravone combined with Gingko Bilobate can treat the patients with acute cerebral infarction effectively.
Objective
To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction.
Methods
The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared.
Results
Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000).
Conclusion
For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
