Predictive model for early neurological deterioration in minor ischemic stroke without reperfusion therapy / 中风与神经疾病杂志

@#Objective　To explore independent risk factors for early neurological deterioration in first-ever minor ischemic stroke without reperfusion therapy,and to achieve individualized prediction by constructing a nomogram model.Methods　We enrolled first-ever minor ischemic stroke patients of non-reperfusion therapy from January 1,2017 to December 31,2019 in the Zhaoqing First People’s Hospital.The clinical and imaging data of the Neurological deterioration group(END group) and the non-END group were analyzed.The independent related factors were screened and the nomogram model was constructed.Results　A total of 384 cases were enrolled,including 66 cases (17.19%) in the END group and 318 cases (82.81%) in the non-END group.Logistic regression analysis showed that diabetes mellitus,TOAST typing,albumin levels,and cerebral atherosclerosis score (CAS) were independent influencing factors (P<0.05).The nomogram model is constructed and the ROC curve is generated,and the area under the curve is 0.859［95%CI(0.758,0.864)］.Model consistency can be hinted at by the calibration curve and the Hoster-Lemeshow test.Finally,the clinical decision curve indicates that the model has clinical application value.Conclusion　This study explores the nomogram model for END in first-ever minor ischemic stroke without reperfusion therapy,which has some clinical application value,is composed of four major factors:diabetes mellitus,TOAST typing,albumin level and CAS.

Long-chain non-coding RNA-p21 induces apoptosis of vascular smooth muscle cells in cerebral atherosclerosis / 西安交通大学学报(医学版)

Objective: To explore the mechanism of lncRNA-p21 regulating the apoptosis of cerebral smooth muscle cells (SMCs) involved in the occurrence and development of cerebral atherosclerosis. Methods: We selected 30 subjects receiving physical checkup and 30 patients with cerebrovascular atherosclerosis in our hospital. The content of lncRNA-p21 in serum was detected by Real-time fluorescence quantitative PCR. The rat model of cerebral atherosclerosis was established. The pathological changes of rat brain were observed by HE staining. The content of lncRNA-p21 in brain tissue was detected by RT-PCR; Western blot was used to detect the expressions of mTOR, anti-apoptotic protein Bcl-2 and pro-apoptotic protein Bax. Vascular smooth muscle cells (BVSMCs) were stimulated with ox-LDL to establish atherosclerosis model of vascular SMCs. lncRNA-p21 was overexpressed or inhibited. Apoptosis was detected by flow cytometry and TUNEL. The Caspase-3 activity assay kit was used to detect the expression of Caspase-3. Western Blot was used to detect the expressions of mTOR, anti-apoptotic protein Bcl-2 and pro-apoptotic protein Bax. Results: The expression of lncRNA-p21 was significantly decreased in patients with cerebral atherosclerosis and model group rats (P<0.05). HE staining showed that the decrease of lncRNA-p21 could contribute to the pathological changes of rat brain tissue accompanied by increased activity of Caspase-3, decreased expressions of Bcl-2 and mTOR protein and increased expression of Bax protein (P<0.05). Flow cytometry and TUNEL showed that overexpression of lncRNA-p21 could reduce the apoptosis of BVSMCs, inhibiting lncRNA-p21 could promote the apoptosis of BVSMCs (P<0.05). In VSMCs, lncRNA-p21 was overexpressed, Caspase-3 activity decreased, Bcl-2, mTOR protein expression increased, and Bax protein expression decreased (P<0.05). The expression of lncRNA-p21 was inhibited; Caspase-3 activity increased; Bcl-2 and mTOR protein expressions decreased; and Bax protein expression increased (P<0.05). Conclusion: lncRNA-p21 may regulate the apoptosis of cerebrovascular smooth muscle cells by regulating the expression of mTOR protein and participate in the pathological process of cerebral atherosclerosis.

Relationship between galectin-3 and the severity of cerebral artery atherosclerosis and the prognosis of patients with large artery atherosclerotic stroke / 中华神经科杂志

Objective To investigate the relationship between the plasma galectin-3 level and the severity of cerebral artery atherosclerosis as well as the prognosis of patients with large artery atherosclerosis (LAA) stroke.Methods According to the TOAST classification,105 patients with LAA stroke,50 patients with small artery occlusion (SAO) stroke,33 patients with asymptomatic cerebral artery stenosis,and 60 healthy controls were enrolled.The plasma galectin-3 level was measured using enzyme-linked immunosorbent assay.According to the number of cerebral arteries with atherosclerosis,the LAA group was divided into single-branch lesions group (n =30),double-branch lesions group (n =30) and multi-branch lesions group (n =45).Plasma galectin-3 levels were compared among the three subgroups,and the associations between galectin-3 and the severity of cerebral atherosclerosis were analyzed.The LAA group patients were followed up for three months,and the value of galectin-3 on predicting the prognosis of patients with LAA stroke was assessed using the receiver operating characteristic (ROC) curve and the modified Rankin scale (mRS) scores.Results The plasma galectin-3 level in LAA group ((13.64 ± 3.08) ng/ml) was significantly higher than in SAO group ((12.20 ± 2.88) ng/ml) and control group ((11.89 ± 2.93) ng/ml;t =2.790,3.617,P =0.006,0.000).Besides,the plasma galectin-3 level in asymptomatic stenosis group ((13.94 ± 2.89) ng/ml) was significantly higher than in SAO group and control group (t =2.695,3.238,P =0.009,0.002).However,the differences between asymptomatic stenosis group and LAA group,SAO group and control group were not statistically significant.In LAA group,the plasma galectin-3 level in multi-branch lesions group ((15.02 ±2.94) ng/ml) was significantly higher than in double-branch lesions group ((13.47 ± 2.88) ng,/ml) and single-branch lesions group ((11.73 ± 2.43) ng/ml;t =2.261,5.080,P =0.027,0.000).The plasma galectin-3 level in double-branch lesions group was significantly higher than in single-branch lesions group (t =2.532,P =0.014).The plasma galectin-3 level and the range of atherosclerosis and mRS scores were positively correlated (r =0.433,0.629;P =0.000,0.000).The area under the ROC curve of plasma galectin-3 level and prognosis was 0.812 (95％ CI O.726-0.897,P =0.000).Conclusions The plasma galectin-3 level was found associated with the severity of cerebral artery atherosclerosis,but not with acute onset of LAA and SAO stroke.Galectin-3 may be involved in the inflammatory pathogenesis and development of cerebral atherosclerosis,and may have the potential to become a plasma marker for evaluating the severity of cerebral artery atherosclerosis and judging the prognosis of patients with LAA stroke.

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis

BACKGROUND/OBJECTIVES: This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS: A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS: When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B₆, β-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B₆, B₁₂, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B₁₂ intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS: When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.

Association between intakes of minerals (potassium, magnesium, and calcium) and diet quality and risk of cerebral atherosclerosis in ischemic stroke patients / 한국영양학회지

PURPOSE: This study was conducted to evaluate the association between intakes of potassium, magnesium, and calcium and diet quality in ischemic stroke patients. METHODS: This study analyzed data from 285 subjects recruited from February 2011 to August 2014 in Seoul, Korea. Nutrition intakes were obtained from a semi-quantitative food frequency questionnaire composed of 111 food items. The subjects were divided into 4 groups by quartiles according to intakes of potassium, magnesium, and calcium. Index of Nutritional Quality (INQ), Mean Adequacy Ratio (MAR), and DQI-International (DQI-I) were analyzed for assessment of diet quality. RESULTS: We found a positive association of intakes of these three minerals with MAR and DQI-I after adjustment for age, sex, education level, smoking, atrial fibrillation, and total energy intake. However, total moderation of DQI-I score in the Q4 group was significantly lower than that of the Q1 group. The age, sex, education level, and smoking, atrial fibrillation, and total energy intake-adjusted odds ratios of extensive cerebral atherosclerosis were inversely associated with intake of magnesium (Ptrend = 0.0204). However, this association did not exist with intakes of potassium and calcium. CONCLUSION: Potassium, magnesium, and calcium rich and high quality diet could be associated with decreased risk of ischemic stroke, in part, via effect on extensive cerebral atherosclerosis.

Estudio de frecuencia de los factores de riesgo asociados al desarrollode enfermedad cerebrovascular isquémica no embólica en un hospitalde tercer nivel / Frecuency study of risk factors for cerebrovascular disease development in tertiary hospital in Colombia

Los factores epidemiológicos y las características clínicas de la Enfermedad Cerebrovascular(ECV) varían de acuerdo a factores ambientales, raciales, de género y socioculturales; por tal razón, el conocimientode dichos factores epidemiológicos de riesgo para ECV en nuestra población tiene gran importanciay aporta elementos claves en términos de salud pública.Objetivos. Determinar la frecuencia de los factores de riesgo para el desarrollo de ECV y su tiempo de evolución,así como el número de pacientes que reciben tratamiento para dichos factores de riesgo, la adherenciaal mismo y el seguimiento de recomendaciones de dieta y actividad física.Materiales y métodos. Se realizó un estudio observacional, tipo serie de casos, en pacientes mayores de 18años que consultaron por ECV isquémico en el periodo comprendido entre enero de 2009 hasta septiembrede 2013. Los pacientes se identificaron a través de los códigos CIE-10 contenidos en la base de datos de lainstitución para obtener los registros que incluyeran un diagnóstico principal o relacionado de EnfermedadCerebrovascular Isquémica.Resultados. El promedio de edad fue de 72.7 (SD 12.7) años. Hubo predominio del sexo masculino (50.4%).Conclusiones. La frecuencia de factores de riesgo para ECV parece haber aumentado respecto a publicacionesprevias, posiblemente por modificaciones no saludables en el estilo de vida de la población. El presente estudio brinda información respecto al tratamiento y adherencia farmacológica, ya que realizar un diagnóstico correctode factores de riesgo es muy importante; así mismo, es fundamental instaurar un tratamiento adecuado y, sobre todo, que los pacientes sean adherentes con la terapia para obtener los resultados esperados...

to environmental racial, gender and cultural factors, for this reason, knowledge of the epidemiology of CVDrisk factors in our population is very important and provides key elements in terms of public health.Objective. To determine the frequency of risk factors for the development of CVD and its development time,as well and the number of patients receiving treatment for these risk factors, their adherence to it, in terms offollowing recommendations of diet and physical activity.Materials and Methods. We performed an observational, case series, in patients over 18 years old whoconsulted for ischemic CVD in the period between January 2009 and September 2013. Patients were identifiedby ICD-10 codes in the database for those records or associated with a diagnosis of Ischemic CerebrovascularDisease. Thus, 220 patients met the inclusion criteria. For data collection, a questionnaire was designed to beapplied to each of the records. The information collected was entered in a database in Excel. Descriptive analysiswas performed using STATA statistical software version 12.0. Measures of central tendency and dispersionfor continuous variables and frequencies and proportions for nominal and ordinal variables were estimated...