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.
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.
Objective To explore the impact of gender difference in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. Methods A prospective registration, observational, and retrospective analysis study was carried out. Patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College and the Department of Neurology of Nanjing First Hospital between June 2015 and June 2019 were collected. Patients were divided into two groups based on gender. The detailed demographic, laboratory examination, imaging examination and clinical data were collected. Then, the data were analyzed using univariate and multivariate logistic regression analyses. Results A total of 298 patients were included. Among them, there were 185 males and 113 females. The differences in age, smoking, atrial fibrillation, using antiplatelet drugs before stroke, TOAST classification, and involved cerebrovascular sites between the two groups were statistically significant (P<0.05), and there was no statistically significant difference in other baseline data between the two groups (P>0.05). The results of univariate logistic regression analysis showed that the rate of 90-day favourable outcome of female patients was lower than that of male patients [odds ratio (OR)=0.462, 95% confidence interval (CI) (0.275, 0.775), P=0.030]. The results of multivariate logistic regression analysis showed that, after adjusting for confounding factors, there was no independent correlation between gender and the 90-day favourable outcome of patients with acute cerebral infarction who underwent mechanical thrombectomy [OR=1.511, 95% CI (0.745, 3.066), P=0.253]. Conclusion The gender has no significant effect on the 90-day favourable outcome of acute cerebral infarction patients treated with mechanical thrombectomy.
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.
ObjectiveTo observe the relationship between the serum level changes of high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-18, intercellular adhesion molecule-1(ICAM1), matrix metalloproteinase (MMP)-9 and lipoprotein-associated phospholipase A2(Lp-PLA2), and the multiple factors of acute cerebral infarction (ACI). MethodsWe chose 76 patients with ACI treated between July 2012 and June 2014 as our study subjects.On the second day (acute phase) and the 15th day (recovery phase) after onset, we checked the patients for their serum levels of hsCRP, IL-18, ICAM1, MMP-9 and Lp-PLA2.Then, multiple linear regression analysis was performed to observe the correlation of the serum level change degree of inflammatory factors with hypertension, diabetes, coronary heart disease, smoking history, carotid atherosclerotic plaque, lipid levels, infarct size and National Institute of Health Stroke Scale (NIHSS) score. ResultsThe changes of all the inflammatory factors in the acute phase and the recovery phase of cerebral infarction were not significantly related to smoking history, hypertension, coronary heart disease, low-density lipoprotein and NIHSS scores (P > 0.05).The changes of hsCRP and ICAM1 had significant correlation with cerebral infarct size, diabetes mellitus and carotid atherosclerotic plaque (P < 0.05), and the change level of Lp-PLA2 was related to diabetes mellitus, and carotid atherosclerotic plaque (P < 0.05).MMP-9 serum level change had correlation with only cerebral infarct size (P < 0.05). ConclusionsSerum level changes of inflammatory factors are related to various factors of cerebral infarction.The main factors that affecting the serum level changes are cerebral infarction area, diabetes mellitus and carotid atherosclerosis.
ObjectiveTo observe the dynamic changes of the concentrations of serum matrix metalloproteinase (MMP)-2 and MMP-9, and to discuss its clinical significance. MethodsFrom January to May 2014, 50 cases of clinically diagnosed cerebral infarction patients were included in the study as the cerebral infarction group, and we randomly selected 30 healthy volunteers at the same time in the same age group as the control group. The serum MMP-2 and MMP-9 of patients with acute cerebral infarction were detected in the onset of 24 hours, 7th day and 14th day respectively, which were compared with the control group accordingly. The patients with cerebral infarction were divided into small infarction group (1.5-3.0 cm), middle infarction group (3.1-5.0 cm) and large infarction group (>5.0 cm) according to the infraction volume. According to neurological functional deficit score they were divided into mild (0-15 points), moderate (16-30 points) and severe group (31-45 points). Changes of the level of MMP-9 and MMP-2 were compared in patients with different cerebral infarction volume and different impairment degree. ResultsFor the cerebral infarction group, the serum MMP-2 and MMP-9 levels were significantly higher in the onset of 24 hours, 7th day and 14th day[MMP-2:(2.36±0.76), (2.86±0.87), and (2.20±0.79) ng/mL; MMP-9:(238.8±99.6), (360.4±141.8), and (152.2±80.4) ng/mL] than the control group[MMP-2:(1.20±0.27) ng/mL; MMP-9:(124.8±28.2) ng/mL] (P<0.05). The larger the infarction volume was in the patients with acute ischemic stroke, the higher the levels of serum MMP-9 and MMP-2. The severer the neurologic impairment degree was in the patients with acute ischemic stroke, the higher the levels of serum MMP-9 and MMP-2 were. ConclusionFor patients with acute cerebral infarction, the levels of serum MMP-2 and MMP-9 are closely related to time of onset, infarct volume and neurological deficits, which can be used as an important basis to estimate the condition and assess the prognosis.
Stroke with hereditary cerebral small vessel diseases is a rare disease. Its clinical manifestations include early-onset ischemic lacunar or hemorrhagic stroke with high disability. Its typical imaging markers include lacunes, white matter hyperintensities, microbleeds, intracerebral hemorrhages located in deep or lobe of brain, crotical microinfarcts, and enlarged perivascular spaces. As the clinical and neuroimaging signs and symptoms of hereditary cerebral small vessel diseases often overlap with sporadic cerebral small vessel diseases, it is hard to diagnose. This article summarizes the clinical features, importance of obtaining valuable family history, genetic diagnosis, and management of stroke with hereditary cerebral small vessel disease to improve its accuracy diagnosis.
Objective To observe the short-term effect and safety of hyperbaric oxygen combined with edaravone and ozagrel sodium in treating progressive cerebral infarction. Methods A total of 65 in-patients with acute progressive cerebral infarction were randomly divided into two groups: 33 in-patients in the trial group were treated by hyperbaric oxygen combined with edaravone and ozagrel sodium, while the other 32 in-patients in the control group were treated by edaravone and ozagrel sodium. The course of treatment was 14 days. The following indications were assessed before and after the treatment respectively: the national institutes of health stroke scale (NIHSS), activities of daily living (ADL), and clinical effects. Results This study showed that the scores of both ADL and NIHSS in the trial group were higher than those in the control group, with significant differences (Plt;0.05). The clinical effective rate of the trial group was 90.91% which was obviously higher than the control group with a significant difference (P=0.028). There were no obvious adverse reactions in both groups. Conclusion Hyperbaric oxygen combined with both edaravone and ozagrel sodium is notable in short-term effect and safe, thus it is worth being popularized in clinical treatment.
Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.
Objective To assess the efficacy and safety of pueraria for acute cerebral infarction. Methods We searched MEDLINE, EMBASE, CBM, and the Chinese Stroke Clinical Trials Database. The search was conducted in Feb., 2006. Data were extracted and assessed by two reviewers independently. Revman 4.2 software was used for statistical analysis. Results Nineteen potentially eligible trials were identified, of which 14 (1 141 patients) were included. Only one trial reported the death or disability rate at the end of 6-month follow-up (the difference between the two groups was not significant). Meta-analysis of 11 trials invovling the improvement of neurological deficit indicated that pueraria was significantly more effective than the control group [OR 3.04, 95%CI 2.11, 4.39]. Conclusions Pueraria might improve the short-term neurological deficit of patients with acute cerebral infarction. But the methodological quality of all the included trials is poor, reliable conclusions can not be drawn from the present data. More high-quality randomized controlled trials are required.