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1.
Circ Cardiovasc Qual Outcomes ; 12(12): e005610, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31830825

RESUMO

BACKGROUND: Little is known about long-term trends in outcomes of patients with ischemic stroke in China. We aimed to assess longitudinal trends in these outcomes over the past 15 years in China and explore possible factors behind the trends. METHODS AND RESULTS: Patients with ischemic stroke admitted to the Department of Neurology at West China Hospital were prospectively and consecutively enrolled in a central registry since 2002, and the present study analyzed data from those admitted to hospital within 7 days of stroke during the period 2002 to 2016. Patients were binned into three 5-year intervals for temporal analysis. Death, disability, and death/disability at 3 and 12 months after stroke were compared among the time intervals across the entire sample and in subsets stratified by age (<65 or ≥65 years). To explore the possible factors related to the trends in outcomes, interaction between the factors and time on outcomes was entered separately into the multivariable logistic regression model. Of 6462 patients with ischemic stroke in the final analysis, 3837 (59.4%) were men, and mean age was 64.2 years (SD, 13.7). Mean age at stroke onset and National Institutes of Health Stroke Scale score at admission decreased significantly during the 15-year period (P<0.001). Between 2002 to 2006 and 2012 to 2016, cumulative incidences declined significantly for death at 3 months (from 9.6% to 6.4%), disability at 3 months (from 36.8% to 28.7%), and death/disability at 3 months (from 42.9% to 33.3%), as well as for death at 12 months (from 15.9% to 10.7%), disability at 12 months (from 23.2% to 17.6%), and death/disability at 12 months (from 35.4% to 26.4%; all P<0.001). The decreases in disability and death/disability at 3 and 12 months between 2002 to 2006 and 2012 to 2016 remained significant after adjusting for confounders, and the results were similar for the entire cohort and for subgroups of patients <65 or ≥65 years. Only interactions of National Institutes of Health Stroke Scale score on admission and time period (2012-2016) were found to significantly correlate with disability and death/disability at 3 and 12 months (all P≤0.03). CONCLUSIONS: Our study from a large medical center in southwest China suggests that since 2002, risks of disability and death/disability at 3 and 12 months after ischemic stroke have declined. This appears to be due, at least in part, to a significant decline in National Institutes of Health Stroke Scale score on admission, which may reflect greater public awareness of stroke detection, willingness to seek medical attention, and ease of access to healthcare infrastructure. The factors behind this apparent improvement require further study.

2.
Front Neurol ; 10: 945, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31555200

RESUMO

Studies suggest that microRNAs that regulate expression of matrix metalloproteinase (MMP)-9 may be involved in hemorrhagic transformation (HT) after cardioembolic stroke, so we examined whether such microRNAs could predict HT in acute cardioembolic stroke patients. Blood samples were prospectively collected from patients who later experienced HT (n = 29) or did not (n = 29), and the samples were assayed for eight microRNAs identified as related to MMP-9 based on three microRNA databases. Expression levels of these microRNAs were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) in 28 of the 58 patients, 14 of whom suffered HT and 14 of whom did not. Four differentially expressed miRNAs were identified: hsa-miR-21-5p, hsa-miR-206, hsa-miR-491-5p, and hsa-miR-3123. Subsequent qRT-PCR analysis of these four miRNAs across all 58 patients showed that levels of miR-21-5p, miR-206, and miR-3123 were significantly higher in patients with HT than in those without HT, while expression of miR-491-5p was similar between the two groups. The area under the receiver operating characteristic curve for predicting HT was 0.677 (95% CI 0.535-0.818) for miR-21-5p, 0.687 (95% CI 0.543-0.830) for miR-206, and 0.661 (95% CI 0.512-0.810) for miR-3123. Our results suggest that these three microRNAs may be prognostic markers for HT after cardioembolic stroke, which should be verified by future studies with large samples.

3.
World Neurosurg ; 129: e669-e676, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181362

RESUMO

BACKGROUND: Results are conflicting as to whether sex has an impact on the outcome of intracerebral hemorrhage (ICH), especially when etiologies differ. In this study, we investigated whether sex differences exist in patients with vascular abnormality-related ICH. METHODS: Patients (age ≥18 years) diagnosed with ICH within 7 days of symptom onset were admitted consecutively between January 2012 and February 2014 from 50 hospitals across mainland China. Vascular abnormality related to ICH included aneurysm, arteriovenous malformation, moyamoya disease, and cavernous malformation. The outcomes were death and death/disability at 3 months. Disability was defined as modified Rankin Scale score >2. Multivariable logistic regression was used to estimate the association between sex and outcome. RESULTS: Women accounted for 41.9% (170) of the 406 patients, and they tended to be older than the men (women: 43.5 ± 19.3 years; men: 40.0 ± 17.7 years; P = 0.056). The proportions of ICH-related vascular abnormalities were as follows: aneurysm, 32% (130/406); arteriovenous malformation, 50.3% (204/406); moyamoya disease, 11.3% (46/406); and cavernous malformation, 6.4% (26/406). After we adjusted for age, National Institute of Health Stroke Scale, Glasgow Coma Scale score, location of hemorrhage, and surgery, female sex remained an independent predictor of death/disability at 3 months (odd ratio 2.49, 95% confidence interval 1.31-4.75), but not for death alone (odd ratio 1.45, 95% confidence interval 0.58-3.61). CONCLUSIONS: In our study, female sex was an independent risk factor for poor outcomes in patients with vascular abnormality-related ICH. The factors contributing to this sex difference should be investigated in the future.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Hemorragia Cerebral/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fatores Sexuais , Adulto Jovem
4.
World Neurosurg ; 126: e534-e544, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30831290

RESUMO

BACKGROUND: White matter injury (WMI) has been observed after experimental intracerebral hemorrhage (ICH). The supporting clinical data have been sparse. We assessed the presence, extent, and progression of WMI in patients with ICH. METHODS: We performed a retrospective review of data from 65 consecutive patients with spontaneous supratentorial ICH who had undergone baseline brain magnetic resonance imaging (MRI) within 7 days of ICH onset and repeat MRI afterward. We used the Fazekas scale (FZKS) to grade the severity of WMI. The clinical and imaging characteristics of the patients with and without WMI progression (WMIP) were compared using uni- and multivariate logistic regression analyses. RESULTS: We observed WMIP in 23 patients (35.4%). WMIP was noted in both hemispheres but more commonly ipsilateral to the ICH (33% vs. 21%). The mean total FZKS score had increased from 3 (interquartile range [IQR], 1-4) at baseline to 4 (IQR, 2-5) on repeat MRI (P < 0.0001). Patients with lobar ICH had a greater median FZKS score than those with deep ICH (median, 3; IQR, 2-4; vs. 1.5, IQR, 1-3.25; P = 0.027). The baseline parenchymal ICH volume (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.018-1.119; P = 0.007) and ventricular volume on baseline MRI (OR, 1.073; 95% CI, 1.019-1.130; P = 0.007) were predictors of WMIP after adjustment. Multivariate analyses showed an independent association between WMIP and unfavorable 3-month outcomes (OR, 5.196; 95% CI, 1.059-25.483; P = 0.042). CONCLUSIONS: WMI will progress over time in patients with ICH, and WMIP has been associated with worse outcomes. This novel finding could represent a potential therapeutic target. Future prospective larger studies are needed to confirm our findings.


Assuntos
Hemorragia Cerebral/patologia , Substância Branca/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
World Neurosurg ; 127: e49-e57, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30802552

RESUMO

BACKGROUND: The use of mechanical thrombectomy for the treatment of acute ischemic stroke (AIS) is rapidly increasing. However, there are limited data on the comparative effects of the various devices approved by the U.S. Food and Drug Administration for the treatment of AIS. We aimed to perform a network meta-analysis to assess the relative efficacy and safety of 4 thrombectomy devices. METHODS: We searched PubMed, the Cochrane Library Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) and parallel group observational studies that assessed thrombectomy devices in patients with AIS. Primary efficacy outcomes included functional independence (90-day modified Rankin Scale score) and recanalization rate (thrombolysis in cerebral infarction score). Safety outcomes included incidence of symptomatic intracranial hemorrhages and 90-day mortality. RESULTS: Five RCTs and 5 observational studies, including 1659 participants, were included. According to GRADE (Grading of Recommendations, Assessment, Development and Evaluations), most of the studies are of moderate quality of evidence. Compared with Penumbra, Solitaire and Trevo were associated with higher rates of functional independence (3.75 [1.44-7.66] and 4.68 [1.42-11.50], respectively). For revascularization, Solitaire and Trevo had higher rates of successful recanalization than Merci (2.99 [1.15-6.53] and 3.34 [1.20-8.01], respectively). In terms of safety outcomes (symptomatic intracerebral hemorrhage and mortality), there was no significant difference between any comparators. CONCLUSIONS: We concluded that stent retriever devices were superior to non-stent retriever devices in functional outcomes and recanalization without significant increases in death or symptomatic hemorrhage. We found no evidence for a differential therapy effect by stent type. Further high-quality RCTs assessing efficacy difference between these 2 stent retrievers are justified.


Assuntos
Isquemia Encefálica/cirurgia , Trombólise Mecânica/instrumentação , Doença Aguda , Hemorragia Cerebral/epidemiologia , Aprovação de Equipamentos , Desenho de Equipamento , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Stents , Análise de Sobrevida , Estados Unidos , United States Food and Drug Administration
6.
J Clin Neurosci ; 58: 108-112, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30287248

RESUMO

Whether matrix metalloproteinase 9 (MMP-9) concentrations in plasma predict risk of spontaneous haemorrhagic transformation (sHT) in acute ischaemic stroke is unclear. From 1 March 2003 to 27 February 2006, patients with acute ischaemic stroke admitted to West China Hospital within 24 h of onset and healthy controls were enrolled and blood samples obtained. Plasma MMP-9 concentrations were determined using enzyme-linked immunosorbent assay, and sHT was diagnosed based on brain computed tomography or magnetic resonance performed 3-14 d after stroke onset. MMP-9 concentrations were compared for sHT patients, non-sHT patients and healthy controls. The threshold concentration for predicting sHT was determined using receiver operating characteristic analysis and the association between MMP-9 concentration and sHT was tested. One hundred and sixty-eight stroke patients and 40 healthy controls were included. Spontaneous HT occurred in 17.3% (29/168) of stroke patients and median plasma MMP-9 concentration in the sHT subgroup [244.3 ng/mL; interquartile range (IQR), 190.6-431.4] was significantly higher than in the non-sHT subgroup (110.0 ng/mL; IQR, 54.4-172.2) as well as in healthy controls (63.3 ng/mL; IQR 37.9-84.9) (both P < 0.001). We identified 181.7 ng/mL as the threshold MMP-9 concentration, for which the positive predictive value was 48% and the negative predictive value was 96%. After controlling for potential confounding factors, MMP-9 concentration >181.7 ng/mL was an independent predictor of sHT (odds ratio 18.8, 95% confidence interval 6.0-58.5, P < 0.001). Plasma MMP-9 concentration >181.7 ng/mL within 24 h after stroke onset independently predicts sHT in patients with ischaemic stroke.


Assuntos
Biomarcadores/sangue , Hemorragia Cerebral/sangue , Metaloproteinase 9 da Matriz/sangue , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Isquemia Encefálica/sangue , Isquemia Encefálica/complicações , Hemorragia Cerebral/etiologia , China , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Curva ROC , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico
7.
Oncotarget ; 9(34): 23718-23728, 2018 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-29805769

RESUMO

Background: Post-stroke depression (PSD) occurs in approximately one third of stroke survivors, leading to great disability and mortality. As there is no consensus on the optimal pharmacological treatment for PSD, we aimed to evaluate the relative efficacy and tolerability of the available pharmacological interventions. Materials and Methods: We did a network meta-analysis to incorporate evidence from relevant trials providing direct and indirect comparisons. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Embase and the reference lists of relevant articles up to March, 2017 for randomized controlled trials (RCTs), for different pharmacotherapies of PSD. For efficacy analysis, the primary outcome was the mean change in Hamilton Depression Scale (HAMD) score between baseline and endpoint. For tolerability analysis, the outcome was presented by the discontinuation for any reason. This study is registered with PROSPERO, number CRD42016049049. Results: From a total of 869 citations, 15 RCTs with 876 participants were included. 13 drugs were considered. For efficacy, paroxetine ranked the best for HAMD reduction, followed by imipramine, reboxetine, nortriptyline, citalopram and fluoxetine at the end of treatment. However, duloxetine ranked the best at 4-week and 8-week duration for HAMD reduction. For tolerability, paroxetine ranked the best but there is no significant result between any comparisons. Conclusions: Paroxetine is probably the best option to consider for patients with PSD. To get a quicker relief of depression, duloxetine might be useful for its rapid onset of antidepressant action. The tolerability was comparable among all the antidepressants. But more high-quality RCTs are needed.

8.
J Stroke Cerebrovasc Dis ; 27(9): 2381-2387, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29778315

RESUMO

BACKGROUND: There is a widespread belief that Asians are more susceptible to hemorrhagic transformation (HT) after receiving recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke (AIS). However, this has not been examined in clinical practice. This study aims to compare the incidence of symptomatic hemorrhagic transformation (SHT) among thrombolysis-treated AIS patients in China and in the United States. METHODS: We compared 212 consecutive patients receiving thrombolysis within 4.5 hours of onset ± endovascular therapy from an American (n = 86) and a Chinese Stroke Center (n = 126). SHT was defined using various definitions based on the National Institute for Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator (NINDS rt-PA) trials, European-Australian Cooperative Acute Stroke Study 2 (ECASS2), and a modified version of Safe Implementation of Thrombolysis in Stroke-Monitoring Study (mSITS-MOST) study criteria. We used Firth logistic regression to adjust for confounding variables and to identify potential predictors. RESULTS: American patients were older, and had higher prevalence of diabetes, hypertension, cardiac disease, and prestroke use of antithrombotics. They also had higher baseline serum glucose, shorter onset-to-treatment time, and fewer endovascular treatments. The rates of SHT were higher in the American cohort compared to the Chinese cohort: 18.6% versus 14.3% based on NINDS definition of SHT; 15.1% versus 12.7% based on ECASS2; and 11.6% versus 7.2% based on mSITS-MOST. However, none of these differences were significant (unadjusted and adjusted P values > .05). Fatal HT was comparable in Americans versus Chinese (8.1% versus 8.7%). Serum glucose emerged as an independent predictor of SHT (P = .024). CONCLUSIONS: In our cohorts, the rate of SHT after thrombolysis is equivalent between Chinese and North American stroke patients.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Glicemia/metabolismo , Boston/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , Isquemia Encefálica/mortalidade , China/epidemiologia , Comorbidade , Diabetes Mellitus/sangue , Diabetes Mellitus/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Fibrinolíticos/administração & dosagem , Mortalidade Hospitalar , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/etnologia , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prevalência , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/mortalidade , Terapia Trombolítica/mortalidade , Fatores de Tempo , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
9.
Front Neurol ; 9: 1184, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30687227

RESUMO

Background and purpose: Cerebral microbleeds (CMBs) could contribute to an increased risk of intracerebral hemorrhage in patients with antithrombotic therapy (antiplatelets or anticoagulants). Antithrombotic agents are commonly prescribed to the patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) for preventing ischemic stroke. However, the impact of antithrombotic therapy on CMBs remained controversial. We aimed to explore the association between the prevalence of CMBs and prior antithrombotic therapy in ischemic stroke patients with AF and/or RHD. Materials and Methods: Ischemic stroke patients with AF and/or RHD within 7 days of onset from two hospitals were enrolled. Clinical information, prior use of antiplatelets or anticoagulation, presence and location of CMBs on susceptibility weighted imaging were recorded. We investigated the association of antithrombotic use with the presence or location of CMBs using multivariable logistic regression. Results: A total of 160 patients (68 males; median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep or infratentorial CMBs. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3 vs. 11.4%, P = 0.001), but not found in anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175-8.045, P = 0.022) and especially strictly lobar CMBs (OR 2.635, 95% CI 1.050-6.612, P = 0.039) in multivariate analysis. Conclusions: The present study suggests that CMBs are common in ischemic stroke patients with AF and/or RHD and prior antiplatelet use may relate to the presence of CMBs predominantly in the strictly lobar region. Whether anticoagulants could cause CMBs need to be determined in future longitudinal studies.

10.
Sci Rep ; 7(1): 16466, 2017 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-29184194

RESUMO

Post-stroke depression (PSD) is an important complication of stroke, leading to increased disability and mortality. Given that there is no consensus on which treatment is optimal for PSD, we aimed to evaluate the relative efficacies of available pharmacological and non-pharmacological interventions. We conducted a network meta-analysis to incorporate evidence from relevant trials and provide direct and indirect comparisons. We searched PubMed, Cochrane Library Central Register of Controlled Trials, and Embase until November 1, 2016 for randomized controlled trials involving different pharmacological and non-pharmacological PSD treatment interventions. The primary outcome was reduction in the Hamilton depression scale (HAMD) score. This study is registered with PROSPERO (number, CRD42016049049). Of a total of 1,152 studies, 23 randomized trials comprising 1,542 participants were included. Nine PSD treatment interventions were considered. Noradrenaline reuptake inhibitor (NRI) was associated with the highest reduction in the HAMD score, followed by tricyclic antidepressant (TCA), psychotherapy plus antidepressant, and selective serotonin reuptake inhibitor (SSRI). This study indicated that NRIs, SSRIs, and TCAs are associated with a considerable higher HAMD score reduction compared with the control treatment. rTMS is a beneficial therapeutic approach for managing PSD to obtain good response to treatments compared with the control treatment.


Assuntos
Depressão/epidemiologia , Depressão/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Antidepressivos Tricíclicos/uso terapêutico , Teorema de Bayes , Terapia Combinada , Depressão/diagnóstico , Depressão/terapia , Gerenciamento Clínico , Humanos , Razão de Chances , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Magnética Transcraniana , Resultado do Tratamento
11.
World Neurosurg ; 107: 1016-1024.e1, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28778779

RESUMO

BACKGROUND: The safety and efficacy of intraventricular fibrinolysis (IVF) in patients with intraventricular hemorrhage (IVH) are unclear. We aimed to determine these issues and to evaluate whether there are differences between recombinant tissue-plasminogen activator (rt-PA) and urokinase according to subgroup analyses. METHODS: A meta-analysis was undertaken of randomized controlled trials in patients with IVH that compared the administration of rt-PA or urokinase through extraventricular drainage (EVD) with normal saline through EVD or EVD placement alone. RESULTS: Six randomized controlled trials involving 607 patients with IVH were included; 2 trials investigated urokinase and 4 rt-PA. IVF reduced death from any cause at the end of follow-up (risk ratio [RR] 0.63, 95% confidence interval [CI] 0.47-0.83), which was driven mostly by rt-PA (RR 0.65, 95% CI 0.48-0.86). Urokinase did not reduce mortality (RR 0.30, 95% CI 0.06-1.53). However, rt-PA did not reduce the proportion of survivors with poor functional outcome (RR 1.36, 95% CI 1.04-1.77), or the composite endpoint of death and poor functional outcome (RR 0.96, 95% CI 0.83-1.11). IVF neither reduced the need for shunt placement (RR 1.06, 95% CI 0.75-1.49) nor increased ventriculitis (RR 0.57, 95% CI 0.35-0.93) and rebleeding (RR 1.65, 95% CI 0.79-3.45). CONCLUSIONS: Although the use of IVF in patients with IVH appears generally safe, its benefit is limited to a reduction in mortality at the expense of an increased number of survivors with moderately-severe to severe disability. Subgroup analyses do not suggest an advantage of IVF with urokinase over rt-PA.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Terapia Trombolítica/métodos , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Humanos , Injeções Intraventriculares , Ativador de Plasminogênio Tecidual/administração & dosagem
12.
Brain Behav ; 7(6): e00697, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28638706

RESUMO

OBJECTIVES: To explore the association, if any, between the relationship between cardiac troponin and cerebral herniation after intracerebral hemorrhage (ICH). METHODS: Six hundred and eighty-seven consecutive ICH patients admitted to West China Hospital from May 1, 2014 to September 1, 2015 were retrospectively reviewed. Data on demographics, etiology, laboratory examinations at admission including serum cardiac troponin, computed tomography (CT) scans at admission and follow-up, and clinical outcomes were obtained. Using multiple logistic regression to identify the relationship of troponin and herniation. The association between troponin and hematoma volume was assessed using bivariate correlation and linear regression. RESULTS: Among 188 (27.4%) patients who underwent the test of serum cardiac troponin at admission, 16 (8.5%) demonstrated cerebral herniation. The median time from symptom onset to CT at admission and follow-up was 4 and 30.25 hr, respectively. In multivariate analysis, elevated troponin was independently associated with cerebral herniation (adjusted odds ratio [OR] 5.19; 95% confidence interval [CI], 1.08-24.93). And those with elevated troponin had larger hematoma volume at follow-up in bivariate correlation (correlation coefficient, .375, p = .003) and linear regression (ß, .370, 95% CI, 0.062-0.320, p = .005), higher National Institutes of Health Stroke Scale score (adjusted OR 2.06; 95% CI, 1.06-4.01, p = .033) and lower Glasgow Coma Scale score (adjusted OR 2.34; 95% CI, 1.17-4.68, p = .016) than those without. CONCLUSIONS: Elevated cardiac troponin was associated with an almost five-fold increased risk of cerebral herniation, but not in-hospital mortality. The possibility of cerebral herniation should be considered when ICH patients with large hematoma volume and elevated troponin.


Assuntos
Hemorragia Cerebral , Encefalocele , Troponina/sangue , Idoso , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , China/epidemiologia , Encefalocele/diagnóstico , Encefalocele/etiologia , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
Aging Dis ; 8(2): 131-135, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28400980

RESUMO

Cerebral microbleeds (CMBs), which indicate hemorrhage-prone disease, may associate with hemostatic abnormalities, but the association between CMBs and coagulation function is uncertain. We aimed to examine this possible association. The following coagulation function indicators were evaluated in 85 consecutive ischemic stroke patients diagnosed with atrial fibrillation and/or rheumatic heart disease: prothrombintime (PT), activated partial thromboplastin time (APTT), and levels of D-dimer and fibrinogen. Indicators were assessed within 24 h after admission. CMBs were identified based on published criteria by two experienced stroke neurologists working independently. PT, APPT, and levels of D-dimer and fibrinogen were compared between patients with and without CMBs using univariate and multivariate analysis. CMBs were detected in 48 patients (56.5%), and fibrinogen levels in these patients were independently and significantly higher than in patients without CMBs after adjustment (OR 2.16, 95% CI 1.20-3.90, P=0.01), whereas the two types of patients did not differ significantly in PT, APPT, or D-dimer levels. The presence of CMBs in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease is associated with elevated levels of fibrinogen. Larger prospective studies are needed to verify this association and explore the mechanisms involved.

14.
Curr Neurovasc Res ; 14(2): 104-109, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28294063

RESUMO

BACKGROUND AND PURPOSE: Cerebral microbleeds (CMBs) are known to be potential risk factors for intracerebral hemorrhage (ICH), but there is controversy on the relationship between CMBs and hemorrhagic transformation (HT) after ischemic stroke. Besides, the question regarding whether the relationship between CMBs and HT can be affected by antithrombotic drugs in acute stage of ischemic stroke has not yet reached a consensus. METHODS: 174 acute ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) were prospectively and consecutively enrolled in the study, of which 160 patients (mean 68.09 ±12.59 years) were finally included in the final analysis (West China Hospital, Sichuan University, n=125; People's Hospital of Deyang City, n=35).We assessed the presence, location and number of CMBs by using susceptibility-weighted imaging (SWI) within 7 days after admission, and the incidence of hemorrhagic transformation was evaluated by magnetic resonance imaging(MRI) during hospitalization. The univariate and multivariate analyses were used to analyze the relationship between CMBs and HT. RESULTS: CMBs were detected in 90 patients (56.3%). HT was found in 62 (38.8%) patients, among which 43 were hemorrhagic infarction (HI) and 19 were parenchymal haemorrhage (PH). The presence of CMBs was not significantly different among different HT subtypes (no HT, HI and PH; 59.2%, 51.2%, versus 52.6%, P=0.64). There was no relationship between the number/location of CMBs and hemorrhagic transformation subtypes (P=0.38). In the 2 subgroups of patients treated with anticoagulants and antiplatelets after admission, the incidence of HT was not significantly different between patients with and without CMBs (anticoagulants, 13.3% versus 18.2%, P=0.71; antiplatelets, 29.2% versus 40.3%, P= 0.21). CONCLUSION: The present study suggests that CMBs do not predict the presence of hemorrhagic transformation in acute ischemic stroke patients with AF and/or RHD. The results were not affected by anticoagulant or antiplatelet agents used in acute stage of ischemic stroke.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/complicações , Hemorragia Cerebral/etiologia , Cardiopatia Reumática/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Distribuição de Qui-Quadrado , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Cardiopatia Reumática/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto Jovem
15.
Medicine (Baltimore) ; 96(7): e6100, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28207523

RESUMO

INTRODUCTION: Poststroke depression (PSD) constitutes an important complication of stroke, leading to great disability as well as increased mortality. Since which treatment for PSD should be preferred are still matters of controversy, we are aiming to compare and rank these pharmacological and nonpharmacological interventions. METHODS AND ANALYSIS: We will employ a network meta-analysis to incorporate both direct and indirect evidence from relevant trials. We will search PubMed, the Cochrane Library Central Register of Controlled Trials, Embase, and the reference lists of relevant articles for randomized controlled trials (RCT) of different PSD treatment strategies. The characteristics of each RCT will be summarized, including the study characteristics, the participant characteristics, the outcome measurements, and adverse events. The risk of bias will be assessed by means of the Cochrane Collaboration's risk of bias tool. The primary outcome was change in Hamilton Depression Scale (HAMD) score. Secondary outcomes involve patient response rate (defined as at least a 50% score reduction on HAMD), and remission rate (defined as no longer meeting baseline criteria for depression). Moreover, we will assess the acceptability of treatments according to treatment discontinuation. We will perform pairwise meta-analyses by random effects model and network meta-analysis by Bayesian random effects model. CONCLUSION: Formal ethical approval is not required as primary data will not be collected. Our results will help to reduce the uncertainty about the effectiveness and safety of PSD management, which will encourage further research for other therapeutic options. The review will be disseminated in peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42016049049.


Assuntos
Teorema de Bayes , Depressão/etiologia , Depressão/terapia , Projetos de Pesquisa , Acidente Vascular Cerebral/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Terapias Complementares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meta-Análise em Rede , Escalas de Graduação Psiquiátrica , Psicoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Apoio Social , Estimulação Magnética Transcraniana/métodos , Adulto Jovem
16.
Oncotarget ; 8(28): 46532-46539, 2017 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-28147329

RESUMO

This study aimed to help clarify the possible relationships of thyroid function with intracranial arterial stenosis or carotid atheromatous plaques in ischemic stroke patients with euthyroidism. We retrospectively reviewed the medical records of a consecutive series of ischemic stroke patients prospectively entered into the Chengdu Stroke Registry between February 2010 and March2012. We performed univariate and multivariate analysis to assess possible relationships of thyroid function with intracranial artery stenosis or carotid atheromatous plaques. Of the 172 patients analyzed (42 women; 61.7 ± 14.0 years old), 62 (32.0%) had carotid atheromatous plaques, and 81 (47.1%) had intracranial artery stenosis. Free thyroxine levels were lower in patients with carotid atheromatous plaques than in patients without plaques (15.80±2.09 vs. 16.92±2.69, P = 0.005).After adjusting for age, gender, hyperlipidemia, and previous smoking, free thyroxine levels were independently associated with carotid atheromatous plaques (OR 0.73, 95% CI 0.54-0.99, P = 0.04). In contrast, thyroid function indicators showed no associations with intracranial arterial stenosis. In conclusion, low free thyroxine levels were independently associated with carotid atheromatous plaques in ischemic stroke patients with euthyroidism, but thyroid function indicators were not associated with intracranial artery stenosis.


Assuntos
Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/patologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/patologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Glândula Tireoide/metabolismo , Biomarcadores , Feminino , Humanos , Masculino , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Testes de Função Tireóidea
17.
J Stroke Cerebrovasc Dis ; 26(3): 636-643, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28041901

RESUMO

BACKGROUND: The prognostic significance of intraventricular hemorrhage (IVH) in patients with vascular structural abnormality-related intracerebral hemorrhage (VSARICH) is poorly understood. METHOD: We prospectively included consecutive patients diagnosed with VSARICH. Imaging of initial brain computed tomography (CT) scans within 48 hours of symptom onset was analyzed. The presence and severity of IVH were recorded. Severity of IVH was measured using the modified Graeb (mGraeb) score. Baseline characteristics and 3-month outcomes were compared between the IVH and non-IVH groups. Multivariate logistic regression was used to examine the independent association between IVH and 3-month outcomes. RESULTS: A total of 132 VSARICH patients were included for analysis, and 71 (53.8%) of them had IVH on initial CT imaging. IVH patients had a median mGraeb score of 15 (6-21), and compared to non-IVH patients, they had shorter delay to first CT scan and higher stroke severity on admission (all P ≤ .005). At 3 months, IVH patients had higher death rates (30.3% versus 7.0%; P = .001) and poor outcome rates (48.5% versus 21.1%; P = .002) than non-IVH patients. After multivariate analysis, IVH severity was associated with 3-month death (Model 1 OR 1.112, 95% CI [1.027-1.204], P = .009; Model 2 OR 1.110, 95% CI [1.027-1.200], P = .009) and poor outcome (Model 2 OR 1.053, 95% CI [1.001-1.108], P = .047), although no independent association between IVH presence and outcomes was observed. CONCLUSION: IVH severity measured by mGraeb score independently predicts death and poor functional outcome in patients with VSARICH.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Ventrículos Cerebrais/patologia , Adulto , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Modelos Logísticos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estatísticas não Paramétricas , Tomógrafos Computadorizados , Adulto Jovem
18.
Int J Neurosci ; 127(7): 586-591, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27451828

RESUMO

BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is the deadliest, most disable and least treatable form of acute cerebral accident. Prognostic risk factors of ICH are not yet fully identified. This study investigated the possible clinical factors leading to poor outcomes in patients with ICH, which can be used to guide clinical treatment and predict prognosis. METHODS: We prospectively enrolled patients with ICH who were admitted within 7 d of stroke onset from January 2012 to April 2014. The prognostic factors of patients with ICH were analyzed in univariate analyses and logistic regression analyses. RESULTS: A total of 908 consecutive patients with ICH (mean age, 57.87 ± 13.92 years) were finally included, of which 616 patients (67.8%) were male. 59.5%, 54.5% and 52.2% patients with ICH had poor outcomes (death/disability) at 3, 6 and 12 months, respectively. Stroke severity and stroke-related complications during hospitalization were independently associated with poor outcomes both at 3 and 12 months. In addition, hyperglycemia, hematocrit and blood urea nitrogen on admission were independently associated with poor outcomes at three months. CONCLUSION: This study found that severity of ICH and stroke-related complications were independent predictors of poor outcomes at three months and one year after ICH. Thereby, it highlights the importance of understanding the role of clinical features in ICH prognostic evaluation.


Assuntos
Hemorragia Cerebral/diagnóstico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Adulto , Idoso , Hemorragia Cerebral/complicações , Hemorragia Cerebral/epidemiologia , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
19.
World Neurosurg ; 98: 258-265, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27838433

RESUMO

BACKGROUND AND OBJECTIVE: In China, stroke has risen to the first commonest cause of death. Currently published data on stroke come mainly from university hospitals and less from community hospitals, especially lacking information on stroke focusing on the differences between university hospitals and nonuniversity hospitals. Therefore we aimed to investigate the patterns and differences of acute stroke between university hospitals and nonuniversity hospitals in China. METHODS: The survey was conducted in 281 hospitals in China: 62 in the west, 85 in the middle, and 134 in the eastern regions. The participating hospitals were sorted into university hospitals (n = 93) and nonuniversity hospitals (n = 118). We prospectively registered patients with acute stroke within 7 days of symptom onset between 1 April and 20 May 2006. The diagnosis of stroke was defined by World Health Organization criteria, and the pathologic types of stroke were determined by clinical and computed tomography/magnetic resonance imaging findings. The demographic data, pathologic types of stroke, and outcomes (death or disability) at discharge (or 30 days if not discharged) were collected. Disability was defined as modified Rankin Scale (mRs) score >2. Basic characteristics, pathologic types of stroke, and functional outcomes were compared between university hospitals and nonuniversity hospitals. RESULTS: We enrolled 5273 patients (3135 males; mean age, 65 ± 12 years), of which ischemic stroke accounted for 70.8% (3733), intracranial hemorrhage for 25.7% (1357), and subarachnoid hemorrhage for 3.5% (183). Most of the patients (3555, or 67.4%) were from nonuniversity hospitals, and 1718 patients (32.6%) came from university hospitals. There were no significant differences between university hospitals and nonuniversity hospitals in terms of age, sex, pathologic types of stroke, and history of stroke (all P > 0.05), except the less stroke severity (mRS) on admission (3.1 ± 1.4 vs. 3.2 ± 1.3; P = 0.005) in patients from nonuniversity hospitals. After adjustment for age, sex, and mRS on admission, only patients with intracranial hemorrhage from nonuniversity hospitals had significantly lower proportions of disability (40.8% vs. 47.1%; P = 0.005) and death/disability (49.9% vs. 57.1%; P = 0.008) at discharge than those from university hospitals. CONCLUSION: This survey comparing stroke patients treated in university and nonuniversity hospitals in China showed that both cohorts were largely comparable including most demographic features, such as age and gender, history of stroke, and stroke subtypes. It may be concluded that patient cohorts treated on stroke units in university and nonuniversity hospitals are similar and stroke units in both types of institutions are also comparable in terms of workload and most patient outcomes.


Assuntos
Hospitais Universitários/tendências , Tempo de Internação/tendências , Sistema de Registros , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Idoso , China/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Hospitais/normas , Hospitais/tendências , Hospitais Universitários/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros/normas , Acidente Vascular Cerebral/mortalidade
20.
J Neurol Sci ; 369: 15-18, 2016 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-27653858

RESUMO

BACKGROUND AND OBJECTIVE: Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with coronary disease and small-vessel ischemic stroke through their associations with atherosclerosis. Considering the relationship between atherosclerosis and cerebral microbleeds (CMBs), the purpose of this study was to examine associations between serum hs-cTnT levels and risk of CMBs in acute ischemic stroke patients. METHODS: This prospective study involved consecutively recruited acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease treated at a large tertiary care hospital in southwestern China. Clinico-demographic data were collected and analyzed by logistic regression to identify the relationship between serum hs-cTnT levels and CMB occurrence and location. RESULTS: In the final analysis, of 66 patients (27 males; mean age, 68.7years), 39 (59.1%) had CMBs. Hs-cTnT levels were not associated with risk of strictly lobar CMBs. However, after adjusting age, sex, current alcohol consumption, total cholesterol, hypertension, diabetes mellitus, prior antithrombotic therapy and NIHSS on admission, patients in the higher tertile were more likely to have CMBs and deep or infratentorial CMBs (P<0.05) compared with the lower hs-cTnT tertile. CONCLUSION: Hs-cTnT may be an independent predictor for the occurrence of CMBs, particularly of deep or infratentorial CMBs. This finding justifies further research into how hs-cTnT levels may contribute to CMBs and potentially other subclinical small-vessel diseases.


Assuntos
Fibrilação Atrial/sangue , Cardiopatia Reumática/sangue , Acidente Vascular Cerebral/sangue , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Isquemia Encefálica/complicações , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cardiopatia Reumática/complicações , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia
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