ObjectiveTo explore the association of elongase of very long chain fatty acids family member 6 (ELOVL6) gene with increased risk of large-artery atherosclerosis stroke (LAA) in Han Chinese population in Chengdu.MethodsHan Chinese populations in Chengdu, Sichuan were chosen for this study using the case-control design between January 2015 and December 2017. The genotypes and haplotypes of six single nucleotides polymorphisms (SNPs) of ELOVL6 gene (rs3813825, rs17041272, rs4141123, rs9997926, rs6824447, and rs12504538) were analyzed in different genetic models in entire samples, and gene-enviromental interaction analyses were also carried out to get an insight of the risk factors for LAA. At the same time, we also analyzed the gene expression profile in peripheral blood mononuclear cells between groups.ResultsA total of 240 LAA cases and 211 healthy controls were enrolled in this study. All the enrolled subjects presented CC genotype of rs9997926, while the other five SNPs (rs3813825, rs17041272, rs4141123, rs6824447, and rs12504538) were genotyped successfully in all the enrolled subjects. rs17041272 polymorphism and TGTTG haplotype were significantly associated with LAA risk in studied population [CC/(CG+GG): odds ratio (OR)=0.640, 95% confidence interval (CI) (0.423, 0.968), P=0.034; TGTTG: OR=1.776, 95%CI (1.069, 2.951), P=0.024], and the interaction among rs17041272, rs6824447 SNPs and dyslipidemia increased susceptibility to LAA [OR=2.737, 95%CI (1.715, 4.368), P<0.001]. The ELOVL6 gene expression level was higher in LAA subjects (t=−3.167, P=0.003).ConclusionsELOVL6 gene is associated with LAA risk in Han nationality of Chinese population in Chengdu, and the interaction of gene-environmental risk factors could be of great importance in pathophysiology of LAA.
Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008，twentythree patients with ischemic stroke after mechanical heart valve replacement had been researched(ischemic stroke group). One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity(INR), INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of ischemic stroke were analyzed by logistic regression analysis. Results (1) Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month-3 years after discharged. All the patients’ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. (2) There was no statistical significance between two groups in gender, age and the dose of warfarin（Pgt;0.05）. (3) Nonconditional logistic regression analysis on influence factors showed that atrial fibrillation（P=0.000）, left atrial enlargement（P=0.002）, low anticoagulation intensity（P=0.012） and longtime INR review interval（P=0.047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions (1)The prognosis of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. (2)The influences of risk factors should be minimized in order to avoid ischemic stroke. (3) Early low intensity anticoagulation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
As the “power center” of the cell and the center of metabolic signaling, mitochondria play an important role before, during, and after cerebral ischemia. After ischemic stroke, molecules such as mitoNEET, optic atrophy 1, and mitochondrial division inhibitor 1 can play a neuroprotective role by regulating the state of the mitochondria. Mitochondria are not only energy-supplying organelles, but their biogenesis and movement also play an important role in neuronal growth, differentiation, synapse formation and neural circuit formation after ischemic stroke. Rehabilitation at all stages can play a therapeutic role by modulating mitochondrial function.
ObjectiveTo systematically review the efficacy and safety of major ozonated autohemotherapy in the treatment of ischemic stroke.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang Data, VIP and CNKI were electronically searched to collect randomized controlled trials (RCTs) of the efficacy and safety of major ozonated autohemotherapy in the treatment of ischemic stroke from inception to July 1st, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 25 RCTs involving 3 681 patients were included. The results of meta-analysis showed that the major ozonated autohemotherapy combined with conventional therapy in the treatment of patients with ischemic stroke in terms of total effective rate (RR=1.20, 95%CI 1.15 to 1.25, P<0.001), national institutes of health stroke scale (MD=−3.15, 95%CI −4.72 to −1.59, P<0.001), total cholesterol (MD=−1.00, 95%CI −1.48 to −0.53, P<0.001), triglyceride (MD=−0.74, 95%CI −1.04 to −0.43, P<0.001), low-density lipoprotein cholesterol (MD=−0.65, 95%CI −1.22 to −0.09, P=0.02), and activity of daily living (MD=11.97, 95%CI 4.48 to 19.47, P=0.002) were superior to the conventional treatment group. There was no significant difference between the two groups in high-density lipoprotein cholesterol (MD=0.25, 95%CI −0.46 to 0.96, P=0.49) and the incidence of adverse effects (OR=3.15, 95%CI 0.93 to 10.63, P=0.06).ConclusionsThe major ozonated autohemotherapy can significantly improve the prognosis of patients with ischemic stroke while not affecting the adverse effects. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo observe the morphological characteristics of retinal vessels in patients with ischemic stroke, and to preliminary analyze the correlation between retinal vascular morphological parameters and ischemic stroke. MethodsA retrospective study. From May 2015 to May 2017, 73 patients with ischemic stroke (ischemic stroke group) confirmed by examination at the Beijing Friendship Hospital, Capital Medical University were included in this study. In addition, 146 patients were included in the control group. A total of 146 patients with acute stroke who were excluded by head CT and/or magnetic resonance imaging were selected as the control group. Fundus images of patients were collected by nonmydriatic fundus camera. Retinal vascular parameters were measured by artificial intelligence fundus image analysis system, included retinal artery and vein caliber as well as vascular curvature, branching angle, fractal dimension, and density. The morphological characteristics of retinal vessels were compared between the control and ischemic stroke groups, and correlation between the retinal vascular parameters and ischemic stroke was analyzed using binary logistic regression. ResultsCompared with the control group, the ischemic stroke group had thinner retinal artery caliber, smaller retinal vascular fractal dimension, and lower retinal vascular density; moreover, these differences were statistically significant (t=3.232, 3.502, 3.280; P＜0.05). Vascular fractal dimension [odds ratio (OR)=0.291, 95% confidence interval (CI) 0.160-0.528] and retinal artery caliber (OR=0.924, 95%CI 0.870-0.981) were strongly correlated with ischemic stroke (P＜0.01). ConclusionCompared with the control group, the retinal artery caliber, fractal dimension and retinal vascular density in ischemic stroke group are smaller; decreased retinal artery caliber and fractal dimension are correlated with ischemic stroke.
Objective To assess the efficacy and safety of fibfinogen-depleting agents (snake venom extracts) in the treatment of acute ischemic stroke. Method A systematic review of all the relevant randomized controlled trails (RCTs) was performed. RCTs were identified from the Cochrane Stroke Group’s Specialized Trials Register, additional electronic and handsearching, and personal contract with pharmaceutical companies. We included all completed and unconfounded truly or quasi-randomized trials in patients with ischemic stroke comparing fibrinogen depleting agents for analysis. Results Ten completed and one ongoing RCTs have been identified so far. Up to 1998, only three trials using ancrod (182 patients) met the inclusion criteria. Ancrod was associated with a significant reduction in early deaths (5.6% vs. 16%; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13 to 0.85; 2P=0.02) suggesting that treatment of 100 patients would avoid about 10 early deaths. The frequency of asymptomatic intracranial hemorrhage shown by computed tomography was similar between ancrod-treated and control groups (7.6% vs. 9.6%; OR 0.78; 95%CI 0.26 to 2.33; 2P=0.65). No major intracranial or extracranial hemorrhages or recurrent ischemic strokes occurred in the ancord-allocated patients. There were nonsignificant trends in favor of ancrod in death from any cause (OR 0.57; 95%CI 0.27 to 1.23; 2P=0.15) and death or disability (OR 0.52; 95%CI 0.26 to 1.03; 2P=0.06) at the end of trial follow-up. Up to 2000, other two trials published results. This review will be updated with new trial results soon, which will provide more data. Conclusions There were too few patients and outcome events to draw reliable conclusions from the present data. Although ancrod-like agents appeared promising, their routine use cannot be recommended at the moment. Future trials should test simpler fixed-dose regimens to allow better generalizability.
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.
Objective To evaluate the predictive effect of three machine learning methods, namely support vector machine (SVM), K-nearest neighbor (KNN) and decision tree, on the daily number of new patients with ischemic stroke in Chengdu. Methods The numbers of daily new ischemic stroke patients from January 1st, 2019 to March 28th, 2021 were extracted from the Third People’s Hospital of Chengdu. The weather and meteorological data and air quality data of Chengdu came from China Weather Network in the same period. Correlation analyses, multinominal logistic regression, and principal component analysis were used to explore the influencing factors for the level of daily number of new ischemic stroke patients in this hospital. Then, using R 4.1.2 software, the data were randomly divided in a ratio of 7∶3 (70% into train set and 30% into validation set), and were respectively used to train and certify the three machine learning methods, SVM, KNN and decision tree, and logistic regression model was used as the benchmark model. F1 score, the area under the receiver operating characteristic curve (AUC) and accuracy of each model were calculated. The data dividing, training and validation were repeated for three times, and the average F1 scores, AUCs and accuracies of the three times were used to compare the prediction effects of the four models. Results According to the accuracies from high to low, the prediction effects of the four models were ranked as SVM (88.9%), logistic regression model (87.5%), decision tree (85.9%), and KNN (85.1%); according to the F1 scores, the models were ranked as SVM (66.9%), KNN (62.7%), decision tree (59.1%), and logistic regression model (57.7%); according to the AUCs, the order from high to low was SVM (88.5%), logistic regression model (87.7%), KNN (84.7%), and decision tree (71.5%). Conclusion The prediction result of SVM is better than the traditional logistic regression model and the other two machine learning models.
ObjectiveTo construct the comprehensive evaluation indicator system of Chinese patent medicines for ischemic stroke, to determine the weight of indicators, and to provide references for the comprehensive evaluation of the efficacy, safety, and economy of Chinese patent medicines.MethodsTwo rounds of expert consultation by Delphi method were applied to establish the comprehensive evaluation indicator system of Chinese patent medicines for ischemic stroke, and the weight of each indicator was determined by the analytic hierarchy process method.ResultsQuestionnaire recovery rates of 2 rounds were 92.59% and 96.00%, the expert authority coefficient was greater than 0.7, and the coordination coefficients of experts in the total index were 0.224 and 0.370 (P<0.001). A three-level comprehensive evaluation indicator system for Chinese patent medicines for ischemic stroke was established and the three first-level indicators included efficacy, safety, and economy. And there were 15 second-level indicators, and 33 third-level indicators. Through the analytic hierarchy process method, the weights of each first-level indicator were 0.626 4, 0.301 2, and 0.072 4, respectively.ConclusionThe comprehensive evaluation indicator system contains efficacy, safety and economy, and provides a basis for a comprehensive evaluation of Chinese patent medicines for ischemic stroke. The indicator system is of great significance for the design of outcomes for clinical trials of ischemic stroke, the conduction of systematic reviews, and the development of clinical practice guidelines for ischemic stroke patients when selecting study outcomes.
Objective To analyze the methodological quality of clinical trails on butylphthalide for cerebral ischemic stroke. Methods We collected all of the published clinical studies on butylphthalide for cerebral ischemic stroke in the world, and evaluated the methodological quality of the included studies according to clinical epidemiologic standard. The search time was from the establishment of each database to December, 2009. Results A total of 62 studies involving 5 762 patients were included. In all included studies, there were 56 randomized controlled trials (RCTs). A total of 8 studies described the method of random assignments. There were 4 multi-center randomized double-blind placebo-control trials. A total of 55 reported diagnosis criteria, 40 reported included criteria, 28 reported excluded criteria; 36 reported the curative efficacy at the end of the treatment, 51 assessed the neurological deficit score of patients before and after the treatment, 27 evaluated the ADL scores; 32 studies reported the side effects; 6 trials did not conduct intention-to-treat analysis even though some people withdrew the treatment because of the side effects or poor tolerance, etc. Conclusion Except for several high quality RCTs, current quality of some clinical trials on butylphthalide for ischemic stroke should be improved. We recommend that researchers should use internationally accepted consolidate standards of reporting trials (CONSORT) in future studies.