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 investigate the current situation of clinical studies on puerarin for ischemic stroke and the reliability of these evidence. Methods By electronic searching and handsearching, we collected all the published clinical study reports on puerarin for ischemic stroke and assessed all the included reports according to clinical epidemiologic standard. Results 35 RCTs, 22 non-randomized controlled trials and 17 case serials studies were included and analysed. Conclusions Current quality of clinical studies of puerarin for ischemic stroke is not good enough to provide reliable evidence.
Severe/massive ischaemic stroke is difficult to treat and has poor prognosis. There are limited studies for specific treatment of these conditions and no consensus on their definitions. This proposal suggests definitions and a flowchart for the diagnosis and treatment of these conditions. We focus on predicting and preventing malignant oedema at an early stage, monitoring the level of consciousness and vital signs, and the prevention and management of complications (eg. pulmonary infections). We particularly provide suggestions for the treatment with intravenous thrombolysis, endovascular treatment, antiplatelet and anticoagulation. More studies are warranted to support individualised management of infarct swelling, intracranial hypertension and early rehabilitation for severe/massive ischaemic stroke.
ObjectivesTo evaluate the quality of methodology and evidence of the exiting systematic reviews (SRs) of acupuncture therapy for post-stroke spastic paralysis.MethodsCNKI, CBM, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect SRs of acupuncture therapy for post-stroke spastic paralysis from inception to December 16th, 2018. Two reviewers independently screened literature, extracted data, and evaluated the quality of methodology and evidence by AMSTAR 2 scale and GRADE system.ResultsA total of 7 SRs were included. The results showed that acupuncture therapy had obvious advantages in treating post-stroke spastic paralysis without obvious adverse reactions. The results of AMSTAR 2 scale showed that the failure of key items 2 and 7 resulted in extremely low methodological quality. The results of GRADE system showed that 46.15% of which were low-level evidence quality, 42.31% were medium, 11.54% were extremely low, and no evidence quality were high.ConclusionsCurrent evidence shows that acupuncture and moxibustion therapy is effective in treating spastic paralysis after stroke, however, the quality of the SRs is low. The studies are required to be standardized and combined with the characteristics of TCM to obtain high quality evidence in the future.
Objective To investigate the application effect of ndividualized dietary care based on a multidisciplinary collaboration model on glycemic control, neurological recovery, dietary self-management, and satisfaction in stroke patients with abnormal blood glucose. Methods Patients with stroke and abnormal blood glucose admitted to the Department of Neurology, Shangjin Hospital, West China Hospital, Sichuan University between March and October 2024 were enrolled. Using SPSS 26.0 software, a random allocation sequence was generated to divide participants into an observation group and a control group. The control group received comprehensive nursing interventions, while the observation group received additional multidisciplinary collaboration model based individualized dietary care. Both groups were intervened until discharge. Glycemic indicators [glycated albumin (GA), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG)], neurological recovery, dietary adherence, and patient satisfaction were compared pre-intervention and post-intervention (at discharge). Results A total of 112 patients were included, with 56 patients in each group. At the post-intervention stage, GA, FBG and 2hPG in the observation group were lower than those in the control group (P<0.05), and the scores of the Dietary Compliance Scale for Type 2 Diabetes were higher than those in the control group (P<0.05). Except for admission (3.27±0.86 vs. 3.25±0.90, P＞0.05), the modified Rankin Scale scores of the observation group were lower than those of the control group at discharge (3.14±0.86 vs. 3.17±0.86), 30-days follow-up (2.93±0.76 vs. 3.02±0.84), and 90-days follow-up (1.05±0.80 vs.1.43±1.01) (P<0.05). The comparison results within the group showed that, there were significant differences in GA, FBG, 2hPG, modified Rankin Scale scores and Dietary Compliance Scale for Type 2 Diabetes between admission and discharge (P<0.05). The satisfaction rate of the observation group was higher than that of the control group (97.78% vs. 86.76%; χ2=3.877, P=0.049). Conclusion Multidisciplinary collaboration model based individualized dietary care improves short-term glycemic control, promotes long-term neurological recovery, enhances dietary adherence, and increases patient satisfaction in stroke patients with abnormal blood glucose, demonstrating clinical value for widespread application.
Objective To investigate the correlation between stress hyperglycemia ratio (SHR) and acute ischemic stroke (AIS) 1-year prognosis, to provide more clinical basis to improve the prognosis of AIS patients and to target and control the influencing factors. MethodsThe patients with AIS diagnosed for the first time and received treatment at the Shijiazhuang Fifth Hospital between May 2019 and January 2022 were retrospectively and continuously included. According to the Modified Rankin Scale score 1-year after the onset of the disease, the patients were divided into a good prognosis group and a poor prognosis group. Also the patients were divided into 2 groups based on the median of SHR. The correlation between SHR and stress blood glucose was analyzed, and the factors affecting the prognosis of AIS patients were identified. The predictive value of SHR and stress blood glucose on the prognosis of AIS patients was compared using receiver operating characteristic. Results A total of 206 patients were included. Among them, there were 125 cases (60.7%) in the good prognosis group and 81 cases (39.3%) in the poor prognosis group. The median SHR (lower quartile, upper quartile) is 1.20 (1.08, 1.33). There were statistically significant differences between the two groups in the scores of the National Institutes of Health Stroke Scale, diabetes history, hypertension history, low-density lipoprotein cholesterol, stress blood glucose, age, SHR and SHR classification (P<0.05). There was no statistically significant difference in the other indicators compared between the two groups (P＞0.05). Stress blood glucose was positively correlated with SHR (7.95±1.78 vs. 1.21±0.19; r=0.294, P<0.001). Multivariate logistic analysis showed that stress blood glucose and SHR were independent factors influencing the 1-year prognosis of AIS patients (P<0.05), and the interaction between SHR and diabetes was not significant (P>0.05) After adjusting for confounding factors, the area under the receiver operating characteristic curve of SHR for the prognosis of AIS patients was higher than that of stress blood glucose [0.682 (0.614, 0.745) vs .0.585 (0.515, 0.653); Z=2.042, P=0.041]. Conclusions SHR and stress blood glucose are independent risk factors for 1-year prognosis in AIS patients. However, SHR has a better predictive value for 1-year prognosis in AIS patients than stress blood glucose. Whether the patient has diabetes or not, the impact of SHR on the prognosis of AIS patients is consistent.
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 The primary objective was to determine whether Danshen agents can improve functional outcome without causing undue harm in patients with acute ischaemic stroke. Secondary objectives were to assess the effect of Danshen agents on impairment and on the quality of life. Methods Searches were performed in the Cochrane Stroke Group Specialized Trial Register, Trials Register of the Cochrane Complementary Medicine Field, Chinese Stroke Trials Register and data from the pharmaceutical company. In addition, we searched the electronic bibliographic databases: Cochrane Controlled Trials Register (CENTRAL/CCTR) Issue 1, 2002, MEDLINE (1996 to 2002), EMBASE (1980 to 2002), China Biological Medicine Database (1978 to 2002). We handsearched ten Chinese journals potentially related to our question. Two reviewers selected studies, assessed quality of studies, extracted data independently. The primary outcomes of death or dependency at the end of long term follow-up(at least three months) and adverse events were assessed. Secondary outcome measures included: measures of neurological deficit at the end of treatment, death from all causes within the first two weeks of treatment and during the whole follow-up period and quality of life. Results Eight potentially eligible trials were identified, of which three trials (304 patients) were included. Two trials were excluded and three trials were waiting for assessment. Number of death and dependency at the end of long term follow-up (at least three months) were not reported in the three included trials. Only one trial reported the adverse events. Three trials measured neurological deficit at the end of treatment. Danshen agents were associated with a significant improvement in neurological deficit (RR 1.07, 95%CI 1.01 to 1.14). There was no death and during the whole treatment period and there was no assessment on quality of life. Conlusions There were too few patients and outcome events to draw reliable conclusions from the present data. The methodological quality of all included studies was poor. Further high quality randomised controlled trials should be performed.
Objective Depression is a common consequence after stroke and has become a significant issue in clinical practice and research. The aim of this study was to explore associated factors of post-stroke depression among first-ever stroke patients in Hong Kong. Methods A longitudinal study was conducted to collect data in face-to-face interviews and by physical assessment at two time points: T1, within 48 hours of admission to a rehabilitation hospital; and T2, 6 months after the first interview. T2 interviews and assessments were conducted in the participant’s current place of residence. Participants were first-ever stroke patients in Hong Kong. Post-stroke depression was measured using the Center of Epidemiological Study-Depression (CES-D) Scale. Backward linear regression analysis was performed to examine factors associated with level of post-stroke depression at T2. Results Our findings showed that 69% of participants exhibited clinically relevant levels of depressive symptoms at T1 and 48% at T2. Regression analysis revealed complex relationships between the level of depressive symptoms, demographic characteristics and variations in perceived levels of social support. Five variables were found to explain 55% of the variance in depressive symptoms at T2. The variables with significant standardized regression coefficients (β) were: companionship (P=0.001), informational support (P=0.025), baseline level of depressive symptoms (Plt;0.001), ADL dependence level (Plt;0.001) and being a homemaker before the stroke (P=0.039). Conclusions We have followed a group of stroke patients over a 6-month period. Our findings suggest that when screening for post-stroke depression, health professionals must take into consideration of the clinical, socio-personal characteristics that might increase a stroke patient’s vulnerability to develop depression after stroke.
Objective?To evaluate Mental Imagery on rehabilitation of functions in patients with stroke. Methods?Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMbase, PEDro (www.pedro.org.au), OpenSIGLE, National Technical Information Service (NTIS), CNKI, VIP, Wanfang Data, and CBM were searched for the Randomized controlled trials (RCTs) of Mental Imagery on rehabilitation of functions in patients with stroke from the date of establishment of the databases to October 2010. The bibliographies of the included studies were searched, too. Three independent researchers evaluated the included studies using GRADE. The extracted data were analyzed by RevMan 5.0.25 and GRAEDprofiler 3.2.2. Results?A total 16 trials were discovered. Meta-analyses showed that at the end of 4th, 6th, and 8th, compared with conventional rehabilitation, the mental practice increased the score measured by FMA (WMD=7.81, 95%CI 1.96 to 13.65; WMD=13.89, 95%CI 4.53 to 23.25; and WMD=9.45, 95%CI 3.67 to 15.23, respectively) and ARAT (WMD=5.70, 95%CI 3.17 to 8.22, P=0.30). The 4 outcomes were all of low quality in the GRADE system. Conclusion?The current evidence shows mental practice could improve the upper limb function in patients after stroke, and the side effects of mental practice are not found in meta-analyses. Compared with other rehabilitative therapies, it is simper, of lower input costs, and of low operating costs. The clinicians should recommend it. Due to the limitations of the included studies, more large-sample, high-quality RCTs are required.