ObjectiveTo understand the status and risk factors of care ability among main caregivers of stroke patients.MethodsA total of 395 stroke patients and their main caregivers were enrolled in the Department of Neurology, West China Hospital, Sichuan University from August 2017 to February 2018. General data of the patients and their main caregivers were collected. The caring ability of the main caregivers was assessed by the family care test inventory. Connor- Davision Resilience Scale and Mishel Uncertainty in Illness Scale-Family Member Form were used to assess the psychological resilience and uncertainty illness of caregivers. Single factor analysis and multiple linear regression analysis were all used to explore the risk factors.ResultsThe care ability of the main caregivers of stroke patients was basically at a high level. Multivariate analysis showed that patients’ age [non-standardized partial regression coefficient (b)=?0.051, 95% confidence interval (CI) (?0.079, ?0.024), P<0.001], family income [b=?0.455, 95%CI (?0.770, ?0.141), P=0.005], and activities of daily living ability at admission [b=?0.017, 95%CI (?0.029, ?0.006), P=0.003], and caregivers’ sleeping status [b=0.636, 95%CI (0.340, 0.932), P<0.001], scores of resilience [b=?0.143, 95%CI (?0.202, ?0.083), P<0.001] and illness uncertainty [b=?0.127, 95%CI (?0.153, ?0.100), P<0.001] were influencing factors of caregivers’ care ability.ConclusionsThe main caregivers of stroke patients have good care ability. The older the patients are, the higher the family income is, and the better the ability of activities of daily living at admission is, the better the caregivers’ care ability they have. The better the caregivers’ sleep is, and the stronger the caregivers’ psychological resilience and uncertainty of disease are, the better the caring ability they have. It is suggested that we should pay more attention to the physical and mental status of caregivers, raise their awareness of stroke, teach them relevant knowledge and care skills, so as to lighten the physical and mental burden of caregivers, improve the prognosis of patients and finally improve the quality of life of patients and their caregivers.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.
Objective To systematically review the association between ALDH2 polymorphism and ischemic stroke. Methods Web of Science, PubMed, CNKI, CBM and WanFang data were searched to collect case-control studies about the association between ALDH2 polymorphism and ischemic stroke from the inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Stata 12.0 software. Results A total of seven case-control studies were included. The results of meta-analysis showed that the A allele and AA genotype in ALDH2 was associated with the risk of ischemic stroke (Avs. G: OR=1.430, 95%CI 1.006 to 2.033,P=0.046; AAvs. AG+GG: OR=1.734, 95%CI 1.267 to 2.373,P=0.001; AAvs. GG: OR=1.757, 95%CI 1.274 to 2.424,P=0.001). Conclusion ALDH2 gene polymorphism may related to ischemic stroke for Chinese and A allele of ALDH2 may be the risk factors.
Objective To systematically evaluate the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. Methods Databases including PubMed, EMbase, BIOSIS and CNKI were electronically searched from establishment dates of databases to June 2012 to retrieve animal experiments on the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. The relevant studies were identified according to the predefined inclusion and exclusion criteria, the data were extracted, and the quality was evaluated. Then meta-analysis was performed using RevMan 5.1 software. Results Eight studies were included. The results of meta-analysis showed that no significant difference was found between the alcohol intervention group and the control group (MD=?6.98%, 95%CI ?20.38% to 6.43%, P=0.31). However, compared with the control group, low dose of acute alcohol intervention (less than 2 g/kg) improved the prognosis of ischemic stroke with a significant difference (MD=?22.83%, 95%CI ?38.77% to ?6.89%, P=0.005), and highly-concentrated of chronic alcohol intervention worsened the cerebral ischemic damage of rats and mice with a significant difference (MD=24.06%, 95%CI 10.54% to 37.58%, P=0.000 5). Conclusion Low dose of acute alcohol intervention (less than 2 g/kg) could improve the prognosis of rats and mice with ischemic stroke which has the potential neuro-protective effects. However, highly-concentrated chronic alcohol intervention could worsen the cerebral ischemic damage. Due to the limitations of the included studies such as publication bias, the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke could be overestimated.
ObjectiveTo investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion?rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.
ObjectiveTo explore the correlation between -765G/C polymorphism of cyclooxygenase-2 (COX-2) gene and the risk of ischemic stroke (IS). MethodsPubMed, CBM, The Cochrane Library (Issue 3, 2015), CNKI, CBM, VIP and WanFang Data were searched from inception to March 2015 to collect case-control or nested case-control studies about -765G/C polymorphism of COX-2 gene and the risk of IS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.1 software and Stata 12.0 software. ResultsA total of 10 studies involving 2611 cases and 18589 controls were included. The results of meta-analysis showed that, there was no correlation between -765G/C polymorphism and the risk of IS (GC+CC vs. GG: OR=1.05, 95%CI 0.88 to 1.25, P=0.620; CC vs. GG+GC: OR=1.04, 95%CI 0.83 to 1.30, P=0.730; GC vs. GG: OR=1.04, 95%CI 0.87 to 1.25, P=0.630; CC vs. GG: OR=1.09, 95%CI 0.86 to 1.36, P=0.480; C vs. G: OR=1.03, 95%CI 0.89 to 1.20, P=0.700). Subgroup analysis results showed that, the COX-2 gene -765G/C polymorphism was a risk factor for IS in African-Americans (GC+CC vs. GG: OR=1.42, 95%CI 1.12 to 1.78, P=0.003; GC vs. GG: OR=1.39, 95%CI 1.09 to 1.78, P=0.008; CC vs. GG: OR=1.51, 95%CI 1.04 to 2.18, P=0.030; C vs. G: OR=1.27, 95%CI 1.08 to 1.51, P=0.004), but not in Asians and Caucasians. ConclusionCurrent evidence shows that -765G/C polymorphism of COX-2 gene may be a genetic risk factor for IS in African-Americans, but not in Asians and Caucasians. Due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
A realizaton project of electrical stimulator aimed at motor dysfunction of stroke is proposed in this paper. Based on neurophysiological biofeedback, this system, using an ARM9 S3C2440 as the core processor, integrates collection and display of surface electromyography (sEMG) signal, as well as neuromuscular electrical stimulation (NMES) into one system. By embedding Linux system, the project is able to use Qt/Embedded as a graphical interface design tool to accomplish the design of stroke rehabilitation apparatus. Experiments showed that this system worked well.
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=?0.55, 95%CI ?0.72 to ?0.38, P<0.001) and reduce fibrinogen after treatment (SMD=?0.93, 95%CI ?1.41 to ?0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.