Plasma D-dimer level is associated with clinical outcomes in patients with atrial fibrillation related acute ischemic stroke after pneumonia.

BACKGROUND: Pneumonia is related to poor prognosis in acute ischemic stroke (AIS), and its risk might be higher in atrial fibrillation (AF) related AIS with elevated plasma D-dimer. The aim of our study was to investigate the prognostic value of D-dimer for predicting clinical outcome of AF-related AIS with pneumonia. METHOD: AF-related AIS patients with pneumonia were prospectively enrolled. Receiver operating characteristic (ROC) curve was used to determine the optimal D-dimer point for 3-month mortality and death/severe disability. The associations between the D-dimer and 3-month mortality and death/severe disability were assessed by multivariable logistic regression analysis. RESULTS: A total of 415 patients were enrolled in this study. ROC curve analysis showed that the optimal cut point of D-dimer for 3-month death/severe disability and mortality were D-dimer≥2.35 mg/l and D-dimer≥3.35 mg/l, respectively. Multivariable logistic regression analysis showed that D-dimer≥2.35 mg/l [adjusted odds ratio (aOR) 5.99, 95% confidence interval (CI): 3.04-11.83, P<0.001], higher NIHISS score (aOR:1.53, 95% CI: 1.38-1.69, P<0.001) and larger infarct volume (aOR 1.01, 95% CI: 1.01-1.02, P<0.001) were associated with increased risk of 3-month death/severe disability), and anticoagulant was associated with decreased risk of death/severe disability (aOR:0.21, 95% CI: 0.09-0.47, P<0.001). Higher NIHISS score (aOR:1.64, 95% CI: 1.38-1.94, P<0.001), older age (aOR 1.08, 95% CI: 1.02-1.14, P = 0.007), D-dimer≥3.35 mg/l (OR 8.49, 95% CI: 4.13-17.84,P<0.001), larger infarct volume (aOR 1.02, 95% CI: 1.00-1.03, P = 0.014), and higher CRUB-65 score (aOR 6.43, 95% CI: 3.10-13.34, P<0.001) were associated with increased risk of 3-month mortality. CONCLUSIONS: AF-related AIS patients with concurrent high D-dimer and pneumonia increased risk of 3-month mortality and death/severe disability, plasma D-dimer may have predictive value in outcome after AF-related AIS with pneumonia.

Prestroke Statins Improve Prognosis of Atrial Fibrillation-Associated Stroke through Increasing Suppressor of Cytokine Signaling-3 Levels.

BACKGROUND: Cerebral infarction associated with atrial fibrillation (AF) has relatively higher mortality and morbidity rates than other types of stroke. Statins are being commonly prescribed to patients with stoke. However, the use of statins in AF-related stroke, especially prestroke, has not been well studied. This study aimed to investigate whether the use of prestroke statins could improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS) and its mechanism. METHODS: This prospective study enrolled 453 AF-associated AIS patients from 4 medical centers and divided them into 2 groups based on the statin use before the stroke episode. All patients received comprehensive clinical examinations including 72-h Holter electrocardiogram monitoring and were followed up for 3 months. Plasma suppressor of cytokine signaling-3 (SOCS-3) and matrix metalloproteinase-9 (MMP-9) levels were measured by ELISA on admission and days 3 and 7 after enrollment. The endpoints were death, major disability (modified Rankin Scale score ≥3), and composite outcome (death/major disability) at 3 months after the AIS episode. RESULTS: Plasma SOCS-3 levels were significantly increased and MMP-9 levels decreased in patients in the prestroke statin group on hospital admission and days 3 and 7 after enrollment (p < 0.001). Furthermore, our data suggested that baseline plasma SOCS-3 levels were associated with increased risk of 3-month mortality (adjusted odds ratio [OR], 1.012; 95% confidence interval [CI], 1.006-1.018; p < 0.001) and major disability (adjusted OR, 1.013; 95% CI, 1.007-1.02; p < 0.001). Similarly, baseline plasma MMP-9 levels were also associated with increased risk of 3-month mortality (adjusted OR, 1.037; 95% CI, 1.022-1.053; p < 0.001) and major disability (adjusted OR, 1.038; 95% CI, 1.022-1.55; p < 0.001). CONCLUSION: Our data suggested that the prestroke use of statins improved the clinical outcomes in AIS patients with AF by upregulating the level of SOCS-3 and reducing the plasma MMP-9 level.

Percutaneous mastoid electrical stimulator improves Poststroke depression and cognitive function in patients with Ischaemic stroke: a prospective, randomized, double-blind, and sham-controlled study.

BACKGROUND: Poststroke depression can lead to functional dependence, cognitive impairment and reduced quality of life. The aim of this study was to evaluate the effects of a percutaneous mastoid electrical stimulator (PMES) plus antidepressants on poststroke depression and cognitive function. METHODS: This study was a prospective, randomized, double-blind, and sham-controlled study. A total of 258 clinically depressed ischaemic stroke patients within 14 days of index stroke were randomly assigned to the PMES plus antidepressant (PMES group, N = 125) and sham plus antidepressant (sham group, N = 133) groups. All patients underwent the Montreal Cognitive Assessment (MoCA) and Hamilton Rating Scale for Depression (HRSD) test at 2 weeks (baseline), and 6 months(M6) after ischaemic stroke. Primary outcomes were the percentage of patients showing a treatment response (≥50% reduction in HRSD score) and depression remission (HRSD score ≤ 9) at 6 months. The secondary outcome was the percentage of patients with a MoCA score < 26. RESULTS: The percentages of patients showing a treatment response and depression remission were significantly higher in the PMES group than in the sham group (57.60% vs 41.35%, P = 0.009; 44.00% vs 29.32%, P = 0.014 respectively). The mean value of the HRSD score change [M (month)6-baseline] was significantly higher in the PMES group than in the sham group at 6 months (- 11.93 ± 5.32 vs - 10.48 ± 6.10, P = 0.036, respectively). The percentage of patients with MoCA scores < 26 was lower in the PEMS group than in the sham group (12.0% vs 24.06%, P = 0.012,respectively), and the mean value of the MoCA score change (M6-baseline) was higher in the PMES group than in the sham group (3.50 ± 2.55 vs 2.72 ± 2.52, P = 0.005, respectively). CONCLUSION: These findings demonstrate that PMES adjunctive to antidepressant therapy is effective in reducing depression, achieving remission in the short term, and improving cognition. TRIAL REGISTRATION: This trial was retrospectively registered (registration number: ChiCTR1800016463) on 03 June 2018.

Electroacupuncture improves behavioral recovery and increases SCF/c-kit expression in a rat model of focal cerebral ischemia/reperfusion.

This study aims to investigate the mechanism of electroacupuncture (EA) in promoting behavioral recovery after focal cerebral ischemia/reperfusion. The SD rats received filament occlusion of the right middle cerebral artery for 2 h followed by reperfusion for 1, 3, 7, 14, and 21 days, respectively. Rats were randomly divided into sham group, model group and EA group. After 2 h of the reperfusion, EA was given at bilateral "Hegu" point (LI 4) in the EA group. Neurobehavioral evaluation, the expression of stem cell factor (SCF), its receptor c-kit and matrix metalloproteinase-9 (MMP-9) protein and mRNA in the cortical ischemic region were measured. EA treatment can improve behavioral recovery after ischemia/reperfusion. Compared with the sham group, the positive cells and mRNA expression of SCF, c-kit, MMP-9, the protein expression of SCF were increased significantly in the model and EA groups (P < 0.001). Compared with the model group, the positive cells, protein and mRNA expression of SCF were increased significantly in EA groups (P < 0.01). The positive cells and mRNA expression of c-kit were increased in EA groups beginning at 3 day and remained significantly high thereafter. The expression of MMP-9 positive cells and mRNA were deceased significantly in the 1 day subgroup in EA (P < 0.01), but increased significantly in the 3, 7 days subgroups (P < 0.01). We conclude that EA treatment up-regulates the positive cells and mRNA expression of SCF, c-kit and MMP-9 after cerebral ischemia/reperfusion. EA may promote neurobehavioral recovery by increasing the protein and mRNA expression of SCF, c-kit and MMP-9 after cerebral ischemia/reperfusion.

[Effects of electroacupuncture on endothelial progenitor cells in peripheral blood and bone marrow in local cerebral ischemia/reperfusion rats].

OBJECTIVE: To observe the influence of electroacupuncture (EA) of "Hegu" (LI 4) on blood stromal cell-derived factor 1alpha (SDF-1alpha), CXC chemokine receptor 4+ (CXCR 4+) positive cells and endothelial progenitor cells (EPCs) and bone marrow (BM) EPCs levels in local cerebral ischemia/reperfusion injury (CI/IR) rats, so as to study its mechanisms underlying improvement of cerebral ischemia. METHODS: A total of 54 SD rats were randomly divided into normal control, model, and EA groups. The latter two groups were further divided into 1 d, 2 d, 3 d and 7 d subgroups (4 time-points), respectively. CI/RI model was established by occlusion of the middle cerebral artery. EA (40 Hz/60 Hz, 1-2 mA) was applied to bilateral "Hegu" (LI 4) for 15 min, once daily, 1, 2, 3 and 7 days, respectively. Flow cytometer was used to detect the counts of EPCs and CXCR 4+ cells in the peripheral blood, and BM EPCs. Serum SDF-1alpha was detected by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with the normal control group, the percentages of blood EPCs and CXCR 4+ cells and BM EPCs, and serum SDF-1alpha content on the 1st day, and the percentage of blood CXCR 4+ cells on the 2nd day were increased significantly in the model group (P<0.01, P<0.05). In comparison with the model group, percentages of blood EPCs and CXCR 4+ cells on the 1st day of EA group were reduced significantly (P<0.01), but the percentage of blood EPCs on the 2nd day, those of blood CXCR 4+ cells on the 2nd day and 3rd day, serum SDF-1alpha content on the 2nd day, and the percentage of BM EPCs on the 2nd day in the EA group were all up-regulated significantly (P<0.05, P<0.01). No significant differences were found among the 3 groups in blood EPCs percentages on the 3rd day and 7th day, in blood SDF-1alpha content and BM EPCs percentage on the 7th day (P>0.05). CONCLUSION: Generally, 2 days' EA of LI 4 can up-regulate the percentages of blood and BM EPCs and blood CXCR 4+ cells as well as blood SDF-1alpha protein content in CI/RI rats, which may contribute to its effect in improving cerebral ischemia.