Influence of health literacy of rural junior middle school students on knowledge, attitudes and practices of COVID-19 protection in Jiangxi Province / 中国学校卫生

Objective@#To understand the influence of junior middle school students health literacy on knowledge, belief and behavior of COVID-19 in rural areas of Jiangxi Province, and to enhance junior middle school students ability to deal with public health emergencies.@*Methods@#Stratified cluster random sampling was used to investigate the health literacy, knowledge level and behavior of COVID-19 protection of 4 311 grade 7 to grade 8 students in rural areas of Jiangxi Province; Chi square test and Logistic regression analysis were used to analyze the correlation between junior high school students health literacy and COVID-19 protection knowledge, belief and behavior.@*Results@#The rate of health literacy of junior middle school students in rural areas was 18.21 %( n =785), the reported rate of intermediate level was high ( n =2 454, 56.92%), and the reported rate of junior high school students at a low level of health literacy was 24.87%( n =1 072). The rate of junior middle school students in rural areas with good COVID-19 protection knowledge was 63.49%, the rate of positive protection attitude was 74.25%, and the rate of good protection behavior was 85.36%; Rate of COVID-19 protection knowledge ( OR=4.85, 95%CI =3.80-6.18) and positive rate of protection attitude of high level health literacy ( OR=44.07, 95%CI =24.57-79.05), protective behavior possession rate ( OR=25.99, 95%CI = 19.67-34.35) were higher than those with low level of health literacy( P <0.01).@*Conclusion@#Health literacy is associated with COVID-19 protection knowledge, belief and behavior in rural junior high school students of Jiangxi Province, the findings provide direction for junior middle school students to improve their ability to deal with public health emergencies.

Safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis in patients with vertebral artery stenosis / 国际脑血管病杂志

Objective To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.Methods From January 2013 to September 2017,patients undergoing vertebral artery stenting in the Department of Neurology,Jinling Hospital were enrolled prospectively.They were divided into agatraban group and heparin group by random number table method.The argatroban group received argatroban anticoagulation during the procedure,and was continuously used for 5 d after procedure;while the heparin group underwent heparin anticoagulation during the procedure,and used saline as placebo after procedure.Clinical follow-up was performed at 1,3,and 6 months after procedure.Digital subtraction angiography,CT angiography,or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels.The primary endpoints included intraoperative safety,in-stent restenosis after procedure,and any clinical events that occurred during the follow-up period,including stroke,cardiovascular events,and death.Major safety events included bleeding from various organs,allergic reactions,liver dysfunction,and embolism events.Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.Results A total of 105 patients were enrolled in the analysis,including 53 in the argatroban group and 52 in the heparin group.During the periprocedural period,no hemorrhagic events,allergic reactions,liver dysfunction or embolism events occurred in both groups.There were no significant differences in preoperative vertebral artery stenosis degree,postoperative residual stenosis degree,and stenosis degree at 6 months after procedure between the two groups,but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56％ ±26.41％ vs.4.25％ ± 15.76％;P =0.031).There was no significant difference in the incidence of stroke recurrence (P =1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.Conclusions It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting.Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.

Safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis in patients with vertebral artery stenosis / 国际脑血管病杂志

Objective@#To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.@*Methods@#From January 2013 to September 2017, patients undergoing vertebral artery stenting in the Department of Neurology, Jinling Hospital were enrolled prospectively. They were divided into agatraban group and heparin group by random number table method. The argatroban group received argatroban anticoagulation during the procedure, and was continuously used for 5 d after procedure; while the heparin group underwent heparin anticoagulation during the procedure, and used saline as placebo after procedure. Clinical follow-up was performed at 1, 3, and 6 months after procedure. Digital subtraction angiography, CT angiography, or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels. The primary endpoints included intraoperative safety, in-stent restenosis after procedure, and any clinical events that occurred during the follow-up period, including stroke, cardiovascular events, and death. Major safety events included bleeding from various organs, allergic reactions, liver dysfunction, and embolism events. Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.@*Results@#A total of 105 patients were enrolled in the analysis, including 53 in the argatroban group and 52 in the heparin group. During the periprocedural period, no hemorrhagic events, allergic reactions, liver dysfunction or embolism events occurred in both groups. There were no significant differences in preoperative vertebral artery stenosis degree, postoperative residual stenosis degree, and stenosis degree at 6 months after procedure between the two groups, but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56%±26.41% vs. 4.25%±15.76%; P=0.031). There was no significant difference in the incidence of stroke recurrence (P=1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.@*Conclusions@#It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting. Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.

Correlation between subclinical hypothyroidism and early neurological deterioration in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the relationship between subclinical hypothyroidism (SCH) and early neurological deterioration (END) in patients with acute ischemic stroke.Methods The consecutive inpatients with first-ever acute ischemic stroke were enrolled.SCH was defined as thyroid stimulating hormone ＞ 5.0 mU/L and thyroid function was normal.END was defined as an increase of ≥ 1 point in motor power or an increase of ≥ 2 points in the total National Institute of Health Stroke Scale (NIHSS) score within 7 days.Univariate analysis was used to compare the differences in baseline data between END group and non-END group,multivariable logistic regression analysis was used to determine the independent correlation between SCH and END in acute ischemic stroke.Results A total of 198 patients were enrolled,48(24.2％) with END.The age (67.1± 8.5 yearsvs.63.9± 9.0 years;t=2.169,P=0.031),homocysteine level (15.1 ± 5.6 μmol/L vs.13.2 ± 4.5 μmol/L;t =2.353,P =0.020),high-sensitive C-reactive protein (median and interquartile range,5.5 [1.7-8.7] g/L vs.2.9[1.0-5.0] g/L;Z =2.765,P =0.006),baseline NIHSS score (4.0[6.0-8.0] vs.4.0[2.0-6.0];Z=2.681,P=0.007),and the proportion of patients with diabetes mellitus (29.2％ vs.16.0％;x2 =4.065,P =0.044)) in the END group were significantly higher than those in the non-END group,and the proportion of patients with SCH (10.4％ vs.28.7％;x2 =4.086,P=0.043) was significantly lower than that of the non-END group.Multivariate logistic regression analysis indicated that SCH was an independent protective factor for END in acute ischemic stroke after adjusted for age,sex and other potential confounders (odd ratio 0.221;95％ confidence interval 0.055-0.801;P =0.022).Conclusions The END risk is lower in acute ischemic patients with SCH.

Early adverse outcomes in young patients with ischemic stroke:an analysis of the related factors / 中国脑血管病杂志

Objective To investigate the related factors of early adverse outcomes in young patients with ischemic stroke.Methods From January 2006 to June 2016,685 young patients (18-45 years old) with acute ischemic stroke admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.They were diagnosed as the first onset with head CT or MRI.According to the modified Rankin scale (mRS) at 90 d,the patients were divided into a favorable outcome (mRS 0-2) group (n=554) and a poor outcome (mRS 3-6) group (n=131).The collection of clinical data were completed on the day of admission,including the risk factors for cerebrovascular disease (oral contraceptives,etc),the National Institutes of Health stroke scale (NIHSS) score on admission,the mean systolic blood pressure (>140 mmHg was analyzed) and laboratory examination.The stroke subtypes were classified with the trial of org 10172 in acute stroke treatment (TOAST) classification criteria.Univariate analysis was used to analyze the difference of clinical data between groups,and multivariate logistic regression analysis was used to analyze the risk factors for early poor outcomes.Results Compared with the favorable outcome group,the patients with the ratio of mean systolic pressure >140 mmHg in the first 3 d after hospitalization (37.4% [49/131] vs.21.7% [120/554],χ2=14.131),NIHSS score on admission (10.0 [7.0,14.0] vs.1.5 [0,3.0],Z=-15.300),white blood cell count (7.5 [6.0,9.0] ×109/L vs.6.8 [5.7,8.2] ×109/L,Z=-3.157),fasting glucose (4.9 [4.6,6.0] mmol/L vs.4.8 [4.4,5.3] mmol/L,Z=-2.726),higher fibrinogen level (2.8 [2.3,3.4] g/L vs.2.6 [2.3,3.2] g/L,Z=-2.018,blood uric acid level (291[220,346] mmol/L vs.315 [261,374] mmol/L,Z=-3.443),and plasma albumin level (43.1[40.0,45.9] g/L vs.44.8 [42.4,47.4] g/L,Z=-4.708) were decreased in the poor outcome group.There were significant differences between the two groups (all P0.05).Multivariate logistic regression analysis showed that the higher NIHSS score on admission (OR,1.474,95%CI 1.378-1.576,P140 mmHg at the first 3 d after admission (OR,2.134,95%CI 1.210-3.764,P=0.009) and the cardioembolism(OR,4.902,95%CI 1.073-22.222,P=0.040) were the risk factors for early poor outcome,and the elevated plasma albumin level (OR,0.902,95%CI 0.850-0.956,P=0.001) was a protective factor of early favorable outcome.Conclusion The higher NIHSS score at admission,the cardioembolism and the increased mean systolic blood pressure in the first 3 d after admission may result in early poor outcome in young patients with ischemic stroke,while the elevated plasma albumin level is beneficial to the early outcome.

Correlation between subclinical hypothyroidism and degree of cerebral atherosclerosis in patients with large artery atherosclerotic stroke / 国际脑血管病杂志

Objective To investigate the correlation between subclinical hypothyroidism (SCH) and cerebral atherosclerosis burden in patients with large artery atherosclerotic stroke.Methods Consecutive inpatients with acute large artery atherosclerotic stroke were enrolled.SCH was defined as TSH 4.50-10.0 mU/L and serum thyroxine level was normal.Cerebral atherosclerosis burden score was used to evaluate the severity of cerebral atherosclerosis.The total score of 1 or 2 was defined as mild atherosclerosis,and >2 was defined as severe atherosclerosis.Univariate analysis and multivariate logistic regression analysis was used to evaluate the correlation between SCH and severe cerebral atherosclerosis.ResultsA total of 263 patients with large artery atherosclerotic stroke were enrolled,including SCH 62 (23.6%),mild atherosclerosis 119 (45.2%),and severe atherosclerosis 144 (54.8%).The age (63.6±10.9 years vs.60.5±11.4 years;t=2.274,P=0.024),homocysteine (17.10±6.20 μmol/L vs.15.63±5.17 μmol/L;t=2.058,P=0.041),National Institutes of Health Stroke Scale (NIHSS) score (8.0 [5.0-10.0]vs.6.0 [5.0-9.0];Z=2.059,P=0.039),as well as the proportions of patients with hypertension (72.9%vs.58.8%;χ2=5.812,P=0.016),smoking (38.2%vs.26.1%;χ2=4.366,P=0.037),and SCH (30.6%vs.15.1%;χ2=8.610,P=0.003) in the severe cerebral atherosclerosis group were significantly higher than those in the mild cerebral atherosclerosis group.Multivariate logistic regression analysis indicated that SCH was an independent risk factor for severe atherosclerosis in patients with large atherosclerotic stroke (odd ratio 3.345;95%confidence interval 1.692-6.612;P=0.001) after adjusting for age,sex,hypertension,smoking,homocysteine,and NIHSS score.ConclusionSCH is an independent risk factor for severe cerebral atherosclerosis in patients with large atherosclerotic stroke.

C-reactive protein level correlates with early neurological deterioration in basal ganglia hemorrhage / 医学研究生学报

Objective Clinical studies show that the level of C-reactive protein ( CRP ) markedly increases in the acute phase of cerebral hemorrhage .However , the correlation of the CRP level with early neurological deterioration ( END) in patients with basal ganglia hemorrhage remains unclear .This study investigated the correlation between CRP and END in basal ganglia hemorrhage . Methods This study included 142 cases of basal ganglia hemorrhage diagnosed by cranial CT between Jan 2010 and Dec 2012 .END was defined as any decrease in Canadian Stroke Scale ( CSS) score≥1 point in the first 48 hours after stroke onset .We compared the baseline data between the END and non-END patients and evaluated the correlation between CRP and END by logistic regression analy -sis. Results END was found in 31 (21.8%) of the 142 patients.Univariate analysis of the END versus non-END cases showed that hyperglycemia (29.03 vs 11.71%, P=0.018), neutrophil count ([11.8 ±1.2] vs [7.8 ±7.7] ×109/L, P=0.019), CRP (P=0.001), hematoma expansion (54.83 vs 19.81%, P=0.001), hematoma volume ([23.6 ±21.9] vs [14.8 ±12.7] mL, P=0.005), and intraventricular hemorrhage (68.75 vs 28.83%, P<0.001) were significantly associated with END .Logistic regression a-nalysis indicated that the CRP level (OR=1.072, 95%CI:1.034-1.112, P=0.001), intraventricular hemorrhage (OR=4.162, 95%CI: 1.498 -11.564, P =0.006), and hematoma expansion (OR=5.297, 95%CI:1.906-14.723, P=0.001) were correlated with END in the patients during their hospital stay .ROC analysis man-ifested the predictive value of the CRP level for END in basal ganglia hemorrhage (OR=0.812, 95%CI: 0.732 -0.891, P <0.001). Conclusion The elevated level of CRP is significantly correlated with END in patients with basal ganglia hemorrhage and therefore can be re-garded as a predictive factor for this condition .

Stenting for atheros clerotic subclavian artery stenosis/occlusion A retrospective case series analysis and follow-up results / 国际脑血管病杂志

Objective To investigate the efficacy of endovascular stenting complicating other craniocervical artery stenosis (OCAS) in patients with atherosclerotic subclavian artery stenosis/occlusion (SASO).Methods The clinical data of receiving endovascular stenting therapy in patients with atherosclerotic SASO were analyzed retrospectively,including demographic characteristics,vascular risk factors,complicating OCAS,as well as stenting for SASO and follow-up results.Results A total of 65 patients with SASO were included in the study,47 of them were males and 18 were females (mean age of 64 ± 9 years).Forty-six patients (70.8％ ) complicated OCAS.The overall technical success rate was 95.4％,in which the patients with stenosis (n =58) were 98.1％ and those with complete occlusion (n =7) were 71.4％.The complications occurred in 4 patients.There were no intervention-related serious stroke and death.Mean follow-up was 24 ± 19 months,6 patients with restenosis and 10 with clinically relevant events were found.They mainly occurred in patients with OCAS.The first angioplasty patency rates were 94.5％,81.8％ and 81.8％,respectively at 12 and 24 months after procedure and at the end of follow-up.The survival rates of no clinically relevant events were 92.9％,74.6％ and 68.3％,respectively.Conclusions Endovascular stenting can safely and effectively treat the SASO patients complicating OCAS.Its overall clinical outcome may be affected to some extent by OCAS.

Vascular imaging findings in 43 patients with cerebral infarction due to spontaneous cerebral artery dissection / 国际脑血管病杂志

Objective To investigate the imaging characteristics of spontaneous cerebral artery dissection (CAD) causing cerebral infarction by analyzing the vascular imaging findings.Methods The neuroimaging and clinical data in patients with cerebral infarction due to spontaneous CAD were reviewed. The characteristic findings at different sites of CAD in all vascular imaging examinations were analyzed and summarized. Results A total of 43 patients (28 men, 15women; mean age, 45.1 + 12.3 years) with CAD were included in the study. Twenty-three patients with extracranial internal carotid artery dissection (ICAD), 5 with intracranial anterior circulation dissection, 7 with extracranial vertebral artery dissection (VAD), 6 with intracranial VAD, and 2 with basilar artery dissection (BAD). In patients with extracranial ICAD, occlusion (usually beginning about 1-2 cm above the bifurcation and tapering to a complete occlusion with a flame-like or mouse-tail appearance) was the common imaging findings, luminal stenosis (irregular, elongated, and tapered stenosis) and/or dissecting aneurysms were observed in partial patients, intimal flaps and double-lumen sign were found in a few patients, and vessel tortuosity of ipsilateral or bilateral ICA were observed in 6 patients. Characteristic signs of occlusion or stenosis of extracranial ICAD were observed in computed tomography angiography (CTA) or magnetic resonance angiography (MRA) in partial patients, and magnetic resonance imaging (MRI) could reveal the bright hyperintense crescent-shaped zone that represents the intramural hematoma, and resource imaging of CTA could reveal intimal flaps and double-lumen sign at the level of dissection. Occlusion (V1, V4 segment and V3 segment extending to V4 segment) was the common vascular imaging features in patients with VAD, V1 segment occlusion had a typical appearance: cut-off like or taped occlusion. MRA could reveal VA occlusion, and MRI could show the bright hyperintense of intramural hematoma at the level of VA occlusion. Concomitant dissecting aneurysms and stenosis of intracranial VA were found in 2 patients. Intracranial dissections of anterior circulation were verified mainly by digital subtraction angioraphy (DSA),if dissecting aneurysms or intimal flaps were observed, and intimal flaps were revealed by resource imaging of MRA in a patient. In patients with BAD, dissecting aneurysm was found in a patient, concomitant local stenosis in MRA and bright hyperintense of intramural hematoma on MRI were observed in another patients. Vascular imaging follow-up was performed in 7 patients, complete recanalization was found in a patient with extracranial ICA occlusion due to CAD, stenosis disappeared and dissecting aneurysm almost healed in a patient with extracranial ICAD, dissection lesions had no change in 2 patients with extracranial ICAD, dissecting aneurysm further expanded in a patient with extracranial ICAD, degree of stenosis reduced in a patient with intracranial ICAD, dissecting aneurysm healed after stenting in a patient with intracranial VAD. Conclusions Diagnosis of CAD mainly depends on vascular evaluations, and vascular imaging features of CAD, such as flame-like or taped occlusion, dissecting aneurysms,intimal flaps, irregular or/and elongated stenosis, MRI signals of intramural hematoma, doublelumen sign and so on, were the points for diagnosis of CAD. DSA was an important method for diagnosis of CAD, and MRA + MRA, or CTA and resource imaging were very valuable for diagnosis of CAD. CAD should be followed by methods of vascular imaging because the results of follow-up were very important for adjusting the treatment strategies in patients with CAD.

Characteristic analysis of severe stenosis and occlusion of extracranial internal carotid artery caused the distribution patterns of cerebral infarction lesion / 国际脑血管病杂志

Objective To analyze the severe extracranial internal carotid artery (EICA)stenosis and occlusion caused the distribution patterns of cerebral infarction lesion and then to investigate the differences of stenosis and occlusion caused mechanisms of cerebral infarction in order to provide the basis for individual prevention and treatment strategies. Methods The clinical and imaging data of 61 patients with atherosclerotic severe EICA stenosis (70-99%) or occlusion caused acute cerebral infarction were analyzed retrospectively. They were divided into stenosis group (n =31) and occlusion group (n =30) according to the degree of stenosis. The distribution pattems of infarct lesion of both groups were compared. They were divided into good (n =31) and poor (n = 26) collateral flow compensation groups according to the middle cerebral artery (MCA) and magnetic resonance angiography (MRA) on the lesion sides of EICA.The distribution patterns of the infarct lesion in both groups were compared. Results The proportion of the patients with hypertension in the poor collateral flow compensation group was significantly higher than that in the good collateral flow compensation group (22/26 vs.18/31, P = 0. 042). The proportion of the patients with multiple cerebral infarction in the occlusion group was significantly higher than thai in the stenosis group (15/30 vs. 24/31, P =0. 026),and the proportion of the patients with single cerebral infarction was significantly lower than that in the stenosis group (15/30 vs. 7/31, P =0. 026). The proportion of the patients with large cortical infarction was significantly higher than that in the stenosis group (7/30 vs. 1/31, P=0. 026). Among the patients with single cerebral infarction, the proportion of the patients with border-zone infarct (BZI) in the occlusion group was significantly higher than that in thestenosis group (8/15 vs. 5/24, P = 0. 036), and the proportion of the patients with cortical infarct (CI) was significantly lower than that in the stenosis group (15/24 vs. 4/15, P =0. 048).The proportion of the patients with BZI in the poor collateral flow compensation group was significantly higher than that in the good collateral flow compensation group (8/15vs. 4/22, P =0. 036), and the proportion of the patients with CI was significantly lower than that in the good collateral flow compensation group (4/15 vs. 14/22, P =0. 045). The proportions of the patients with large perforating artery infarct (11/30 vs. 3/31, P=0. 016) and BZI (20/30 vs. 10/31, P =0. 010) in the occlusion group were significantly higher than those in the stenosis group, and among the patients with BZI, the proportion of the infarction involving only the patients with internal border zone was significantly higher than that in the stenosis group (15/30 vs. 6/31, P =0. 016). The proportion of the patients with BZI in the poor collateral flow compensation group was significantly higher than that in the good collateral flow compensation group (19/26 vs.9/31, P =0. 001), and among the patients with BZI, the proportion of the infarction involving only the patients with internal border zone was significantly higher than that in the good collateral flow compensation group (14/26 vs. 6/31, P =0. 011). The proportion of the patients with incomplete anterior circle of Willis in the poor collateral flow compensation group was significantly higher than that in the good collateral flow compensation group (19/26 vs. 8/31,P =0. 001).Conclusions The lesion distribution patterns of cerebral infarction caused by severe EICA stenosis and occlusion are different, and it suggests that the cerebral infarction mechanisms caused by both are different. In patients with severe EICA occlusive disease, MRA showed that the developing signal change at the lesion sides of MCA may be a potential surrogate index for identifying the state of collateral circulation, but it needs to use the research means of quantitative determination of blood perfusion to verify.

Application of resole in carotid atherosclerotic plaque / 国际脑血管病杂志

Carotid atherosclerosis is a major cause of ischemie stroke. Understanding the compositions of carotid plaque arid preventing plaque rupture are of importance to reduce the risk of ischemic stroke. Magnetic resornance imaging (MRI) is noninvasive, highly reproducible, does not involve exposure to ionizing radiation. It is one of the most potential imaging tools for carotid atherosclerotic plaques. This article reviews the application of MRI in the imaging of carotid atherosclerotic plaques.

Gelatinase and Vascular Smooth Muscle Cell Migration in the Process of Intimal Hyperplasia / 国际脑血管病杂志

Intimal hyperplasia is an early presentation in the development of atherosclerosis.Vascular smooth muscle cell migration and proliferation have a very important position in this process.GelatiBase,an extracellular protcolytic enzyme,is playing important roles in various physiopalhological processes.This article reviews the relationship between gelatimse and vascular smooth muscle cell migration in the process of intimal hyperplasia.