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Objective:To compare the prediction of Ischemic Stroke Predictive Risk Score (iScore), Preadmission Comorbidities, Level of Consciousness, Age, and Neurologic Deficit (PLAN), Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and Totaled Health Risks in Vascular Events (THRIVE) for short- and long-term death for patients with acute ischemic stroke (AIS). Methods:From August, 2015 to June, 2018, 323 AIS patients in emergency ward were included, and followed up 30 days, three months and a year after including. Receiver operating characteristic (ROC) curve was used to analyze the predictive effects of iScore, PLAN, ASTRAL and THRIVE. Results:The all-cause mortality 30 days, three months and a year after including was 12.4% (40/323), 17.3% (56/323) and 25.7% (83/323), respectively. The area under curve (AUC) from more to less arranged as iScore, PLAN, ASTRAL and THRIVES. There was significant difference of AUC between iScore and THRIVE (Z > 1.990, P < 0.05), but not among the others (Z < 1.943, P > 0.05). Conclusion:iScore, PLAN, ASTRAL and THRIVE may predict short- and long-term death of AIS patients in the emergency well, and iScore is the best. However, the procedure of iScore is complex, it is recommended to use PLAN and ASTRAL for emergency.
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Objective:To explore the change of serum 25-hydroxyvitamin D [25(OH)D] and prediction for outcome of acute ischemic stroke in emergency. Methods:From October, 2017 to September, 2019, 224 patients with acute ischemic stroke in emergency and 240 healthy controls were detected serum 25(OH)D within 24 hours after enrollment. The patients were assessed with National Institute of Health Stroke Scale (NIHSS) and Nutritional Risk Screening 2002 (NRS2002), and measured biochemics within 24 hours after admission. They were assessed with modified Rankin Scale (mRS) 180 days after stroke, and divided into favourable group (mRS ≤ 2, n = 106) and unfavourable group (mRS > 2, n = 118). The factors related with the outcome were analyzed with Logistic regression, and the prediction of 25(OH)D for the outcome were analyzed with receiver operator characteristic (ROC) curve. Results:Serum 25(OH)D was less in the patients than in the controls (Z = 4.296, P < 0.001), and less in the unfavourable group than in the favourable group (Z = 5.876, P < 0.001). Serum 25(OH)D (OR = 0.925, P < 0.05) was related with the outcome even controlling the impacts of age, sex, nutritional risk, infarct volume, scores of NIHSS, etc. The area under curve for serum 25(OH)D predicting outcome was 0.795 (P < 0.001). The cut-off point of prediction was 13.17 ng/ml, with the Yoden index of 0.548, which yielded a sensitivity of 0.746 and a specificity of 0.802. Conclusion:Serum 25-hydroxyvitamin D may predict the outcome 180 days after acute ischemic stroke, which may help for risk stratification in emergency.
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Obstructive sleep apnea (OSA) may increase the risk of stroke, and patients with stroke are also prone to suffer OSA. Advanced age, high body mass index, male, hypertension and diabetes are risk factors for stoke in OSA patients, and severe sleep apnea may also be associated with poor functional outcomes of stroke. Potential pathophysiological mechanisms may include endothelial dysfunction, abnormal neuromodulation, metabolic abnormalities, change of cerebral hemodynamic and hypercoagulability. Continuous positive airway pressure (CPAP) is the standard treatment for patients with moderate to severe OSA, but it has not been proved that CPAP can reduce the risk of cardiovascular events including stroke.
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Objective:To explore the characteristics of nosocomial infection in patients with spinal cord injury, and analyze the risk factors. Methods:From January, 2015 to June, 2017, 526 patients with spinal cord injury in our hospital were reviewed. The distribution of pathogens and the characteristics of drug resistance of strains were summarized, and the risk factors of nosocomial infection were analyzed. Results:There were 159 person-times with nosocomial infection, and most of the infections were found in urinary tract (60.4%) and lower in respiratory tract (28.9%). The main pathogenic germs were Escherichia coli (39.0%), Pseudomonas aeruginosa (15.7%), Klebsiella pneumoniae (11.3%) and Proteus mirabilis (9.4%). The main pathogens were resistant to second or third generation of cephalosporins and quinolones moderately or severely, but sensitive to compound preparations containing beta-lactamase inhibitors, carbapenems and aminoglycosides. The risk factors for the nosocomial infections in the spinal cord injury patients included the hospitalization time, severity of spinal cord injury, invasive operation history, nutritional risk and use of antibiotics (P < 0.05). Conclusion:Most of the nosocomial infections in patients with spinal cord injury are in urinary tract and respiratory tract. Gram-negative bacilli are the main pathogenic bacteria, which often show multiple drug resistance. It is necessary to take targeted interventions according to the risk factors of nosocomial infections in order to improve the quality of life of patients.
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@#ObjectiveTo investigate the effect of mechanical ventilation (MV) on myocardial infarction (MI).Methods43 MI patients of the treating group were treated with mechanical ventilation when PaO2<55 mmHg, SaO2<85%.26 MI patients of the control group were treated with same treatment except for inhaling O2 through nose or face mask.ResultsThe survival rate of the treating group was 34.9%, but that of the control group was 7.8%, there was a significant difference between two groups (P<0.01).ConclusionMechanical ventilation can raise the survival rate of MI patients and improve functions of failing heart.