RESUMEN
Objective:To investigate the underlying neuroimaging mechanism of migraine without aura (MwoA) by using methods of voxel-based morphometry (VBM) and resting-state functional connectivity (FC).Methods:Twenty-five MwoA patients admitted to Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from September 2020 to June 2023 were recruited as MwoA group, and 22 volunteers were recruited as healthy control (HC) group. Demographic, clinical characteristics, scores of Hamilton Anxiety Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and Montreal Cognitive Assessment (MoCA) of all subjects were collected; MwoA patients also received Migraine Disability Assessment Questionnaire, Headache Impact Test-6 and headache Visual Analogue Scale assessments. All subjects underwent high-resolution 3D-T 1 and resting-state functional magnetic resonance imaging scanning. The SPM12 software was used to compare the difference in gray matter volume (GMV) between the 2 groups by VBM method. The GRETNA software was adopted to calculate the whole brain FC with anatomical automatic labeling 90 as the regions of interest, and the difference in FC between the 2 groups was statistically analyzed by two-sample t-test. Pearson partial correlation was used to analyze the correlation between brain GMV and FC changes and clinical features and scale scores of MwoA patients. Results:There existed no statistically significant difference between the 2 groups in age, gender, education, scores of HAMA, HAMD and MoCA (all P>0.05). Migraine Disability Assessment Questionnaire, Headache Impact Test-6 and headache Visua Analogue Scale scores of MwoA patients were (8.86±4.55), (50.27±6.35) and (6.68±1.73). Compared with the HC group, GMV was significantly decreased in the right superior frontal gyrus (SFG), right cingulate gyrus (CG) and left thalamus in the MwoA group ( P<0.05, false discovery rate corrected). In addition, the MwoA group showed decreased FC between left thalamus and right cuneus, left lingual gyrus (LG) and bilateral precuneus; decreased FC between right thalamus and right cuneus, right LG and right precuneus; decreased FC between right cuneus and left precuneus and right SFG; decreased FC between left LG and bilateral precuneus, decreased FC between right LG and right precuneus and left SFG; decreased FC between left precuneus and bilateral SFG, and between right precuneus and right SFG (edge P<0.001, component P<0.05, network-based statistics correction, interation=2 000). In MwoA patients, the FC (z-value) between left thalamus and right cuneus was negatively correlated with the duration of disease ( r=-0.530, P=0.011). Conclusions:MwoA patients showed decreased GMV in right SFG, CG and left thalamus. In MwoA patients, FC between thalamus and visual network (VN) and default mode network (DMN) was significantly decreased, and FC among VN, DMN and executive control network was significantly decreased. These changes in brain structure and function may be an adaptive change in the central sensitivity and responsiveness to pain stimuli, and may be an important neuroimaging mechanism of MwoA.
RESUMEN
Stroke has become the leading cause of disability and death in China. At present, intravenous thrombolysis is one of the most effective treatment for acute ischemic stroke, but not all patients can benefit from intravenous thrombolysis. In recent years, the exploration of predictive models for the outcomes after intravenous thrombolysis in patients with acute ischemic stroke has attracted increasing attention. This article systematically reviews the scoring models for predicting the functional outcome, death and symptomatic intracranial hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke, with the aim of screening the scoring system suitable for clinical application and providing reference for the clinical diagnosis, evaluation and treatment of acute ischemic stroke.
RESUMEN
Objective To investigate the prevalence and severity of cerebral microbleeds (CMBs) in patients with different stroke classifications of cerebral infarction.Methods From October 2016 to December 2017,the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed.Results A total of 254 patients with cerebral infarction were enrolled ,there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis ( 54.29%), small -artery occlusion (64.15%), cardioembolism (40.43%), stroke of other determined etiology ( 33.33%), stroke of undetermined etiology(38.46%),and the difference was statistically significant (χ2 ＝12.206,P＝0.016).The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts ( 43.75%), partial anterior circulation infarcts ( 51.19%), posterior circulation infarcts ( 49.18%), lacunar infarcts ( 67.53%), and the difference was statistically significant(χ2 ＝8.944,P＝0.030).The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis [mild(55.26%),moderate(26.32%),severe(15.79%)],small-artery occlusion[mild(25.00%),moderate (33.82%), severe (41.18%)], cardioembolism [ mild (57.89%), moderate (26.32%),severe(15.79%)),stroke of other determined etiology [ mild(50.00%),moderate (33.33%),severe (16.67%)],stroke of undetermined etiology [ mild(60.00%),moderate (20.00%),severe (20.00%)],and the difference was statistically significant (Fisher exact test,P＝0.025).The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts [mild(57.14%),moderate(28.57%),severe(14.29%)], partial anterior circulation infarcts [ mild (52.50%), moderate (32.50%), severe (15.00%)], posterior circulation infarcts[mild( 50.00%), moderate (33.33%), severe (16.67%)], lacunar infarcts [ mild (25.00%), moderate (32.69%),severe (42.31%)], and the difference was statistically significant ( Fisher exact test, P ＝0.023 ). Conclusion The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small -artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs (number of lesions≥10).We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies.
RESUMEN
Objective@#To investigate the prevalence and severity of cerebral microbleeds(CMBs) in patients with different stroke classifications of cerebral infarction.@*Methods@#From October 2016 to December 2017, the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed.@*Results@#A total of 254 patients with cerebral infarction were enrolled, there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis(54.29%), small-artery occlusion(64.15%), cardioembolism(40.43%), stroke of other determined etiology(33.33%), stroke of undetermined etiology(38.46%), and the difference was statistically significant(χ2=12.206, P=0.016). The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts(43.75%), partial anterior circulation infarcts(51.19%), posterior circulation infarcts(49.18%), lacunar infarcts(67.53%), and the difference was statistically significant(χ2=8.944, P=0.030). The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis[mild(55.26%), moderate(26.32%), severe(15.79%)], small-artery occlusion[mild(25.00%), moderate(33.82%), severe(41.18%)], cardioembolism[mild(57.89%), moderate(26.32%), severe(15.79%)), stroke of other determined etiology[mild(50.00%), moderate(33.33%), severe(16.67%)], stroke of undetermined etiology[mild(60.00%), moderate(20.00%), severe(20.00%)], and the difference was statistically significant(Fisher exact test, P=0.025). The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts[mild(57.14%), moderate(28.57%), severe(14.29%)], partial anterior circulation infarcts[mild(52.50%), moderate(32.50%), severe(15.00%)], posterior circulation infarcts[mild(50.00%), moderate(33.33%), severe(16.67%)], lacunar infarcts[mild(25.00%), moderate(32.69%), severe(42.31%)], and the difference was statistically significant(Fisher exact test, P=0.023).@*Conclusion@#The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small-artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs(number of lesions≥10). We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies.
RESUMEN
Objective To investigate the influencing factors and outcomes of patients with acute ischemic stroke having negative results in diffusion weighted imaging (DWI).Methods In prospective study, the patients with acute ischemic stroke, admitted to our hospital from October 2016 to January 2018, were selected as research subjects. The demographic and baseline characteristics, imaging data and laboratory examination data were collected. According to the signals of first DWI, the patients were divided into positive DWI group and negative DWI group. The influencing factors of negative results in DWI were clearly defined by univariate and multivariate Logistic regression analyses. The patients from negative DWI group were rechecked for DWI one week after first DWI. All patients were followed up for 90 d, and the outcomes were evaluated by modified Rankin scale (mRS).Results A total of 312 patients with acute ischemic stroke were enrolled finally. The negative rate of DWI was 12.82％ (40/312). Multivariate Logistic regression analysis showed that mild stroke (odds ratio [OR]= 2.533, 95％ confidence interval[CI]: 1.436-3.984,P=0.038), lacunar infarction (OR=4.668, 95％CI: 2.203-6.543,P=0. 005), arteriole occlusion (OR=4.236, 95％CI: 2.448-6.348,P=0.009), brainstem lesion (OR=1.629, 95％CI: 1.035-2.693,P=0.049) and time of onset within hyper-acute period (OR=4.074, 95％CI: 2.683-6.576, P=0.013) were influencing factors for negative results in DWI. The negative rate of DWI in the negative DWI group was reduced to 7.05％ (22/312) one week after first DWI. Totally, 302 patients finished the 90 d of follow up; 40 patients were into the negative DWI group, with poor outcome rate of 27.50％ (11/40); 262 patients were into the positive DWI group, with poor outcome rate of 30.15％ (79/262); the difference of poor outcome rates between the two groups was not statistically significant (P>0.05).Conclusion s The negative results in DWI in patients with acute ischemic stroke are closely related to severity of stroke, TOAST etiological types, locations of the lesions, sizes of the lesions and time of onset. Review of DWI can reduce negative rate of DWI. The outcomes of patients with acute ischemic stroke having negative results in DWI are not better than those with positive results in DWI. The patients with acute ischemic stroke having negative results in DWI and having onset within hyper-acute period should not be excluded from intravenous thrombolytic treatment.
RESUMEN
Objective To explore pathogenesis and influencing factors of poor outcome in patients with wake-up stroke.Methods In this prospective study,patients with acute ischemic stroke who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Xuzhou Medical University from October 2016 to December 2017 were continuously collected.All patients were divided into wake-up stroke group and non-wake-up stroke group according to the onset time.The clinical data of demographics,vascular risk factors,imaging examination,laboratory examination of the two groups were collected to identify the pathogenesis of wake-up stroke.Followed up to six months of onset,the patients were divided into poor outcome (modified Rankin Scale (mRS) score ＞2) and good outcome (mRS score 0-2) subgroups according to mRS score.Multivariate Logistic regression analysis was used to determine the influencing factors of poor outcome in patients with wake-up stroke.Results A total of 178 patients with acute ischemic stroke were enrolled in the study,including 42 patients (23.60％) in the wake-up stroke group and 136 patients (76.40％) in the non-wake-up stroke group.Followed up to six months of onset,11 patients lost,and 167 patients were followed up finally.There were 40 patients (23.95％) in the wake-up stroke group,including 17 patients (42.50％) with poor outcome and 23 patients (57.50％) with good outcome.There were 127 patients (45.64％) in the non-wake-up stroke group,including 32 patients (25.20％) with poor outcome and 95 patients (74.80％) with good outcome.The difference of poor outcome between the two groups was statistically significant (x2=4.393,P=0.036).Comparison of the demographic and baseline data of the wake-up stroke group and the non-wake-up stroke group showed that the differences between variables such as atrial fibrillation and double-dose hypertension were statistically significant.Univariate analysis showed that there were statistically significant differences in vascular risk factors,Trial of Org 10172 in Acute Stroke Treatment etiology,stroke severity,number of stroke lesions,treatment patterns,and number of cerebral microbleeds between the poor and good outcome subgroups.Multivariate Logistic regression analysis showed that the moderate to severe stroke (odds ratio (OR)=3.838,95％ confidence interval (Co 2.162-5.890,P=0.018),the number of lesions in cerebral microbleeds (OR=2.113,95％CI 1.291-2.868,P=0.049) were independent risk factors for poor outcome of wake-up stroke.Intravenous thrombolysis (OR=0.427,95％CI 0.242-0.615,P=0.036) was an independent protective factor for poor outcome of wake-up stroke.Conclusions The onset of wake-up stroke is closely related to atrial fibrillation and reverse scoop hypertension with higher incidence of poor outcome.Early adequate imaging screening and stroke severity assessment have important reference to guide clinical treatment and predict outcome.
RESUMEN
Objective To investigate the correlation between post-stroke depression(PSD) and cerebral microbleeds(CMBs)in elderly patients with ischemic stroke.Methods In the prospective study,220 elderly patients with ischemic stroke were enrolled and followed up to one month after onset.Finally a total of 214 elderly patients performed a follow-up.According to DSM-Ⅳ Diagnostic and Statistical Manual of Mental Disorders,patients were divided into the PSD group and non-PSD group.The degree of depression was evaluated by17-item Hamilton Depression Scale(HAMD-17)score,and patients were divided into mild depression,moderate depression and severe depression group.The loci number,distribution and location of CMBs lesions were assessed by SWI.Patients were divided into brain lobe type,deep lobe type and mixed type according to the CMBs lesion location.The influence of CMBs or not,loci number and location of CMBs lesions on PSD were compared.Results A total of 214 elderly patients with ischemic stroke were enrolled,in whom 84(84/214,39.3％)had PSD with 29(34.5％)males and 55(65.5％)females.According to the HAMD scale,there were 51 patients (60.7 ％) with mild depression,25 (29.8 ％) with moderate depression,and 8 (9.5 ％) with severe depression.The prevalence rate of CMBs was 62.5 ％ (32/51) in mild depression group,71.0 ％ (22/25) in moderate depression group,81.8 ％ (6/8)in severe depression group and 45.4 ％ (49/108)in non PSD group(all P=0.008).The number of CMBs lesions were(4.5±1.2)in mild depression group,(7.8± 2.0)in moderate depression group,(12.6±2.7)in severe depression group and(1.8±0.5)in non-PSD group,with the statistically significant differences between groups (F =2.79,P =0.041).The proportions of CMBs lesions location(brain lobe type,deep lobe type and mixed type)were 40.6 ％ (13/32),34.4％(11/32) and 25.0％ (8/32) in mild depression group,36.4％(8/22),40.9％(9/22) and 22.7％(5/22) in moderate depression group,33.3％ (2/6),50.0％ (3/6) and 16.7％ (1/6) in severe depression group,40.8％ (20/49),12.2％ (6/49) and 46.9％ (23/49) in non-PSD group,respectively (Fisher exact test,P =0.043).The proportions of CMBs lesions distribution(left side,right side and double side)were 37.5％(12/32),43.8％(14/32) and 18.8％(6/32) in mild depression group,36.4％ (8/22),40.9％ (9/22) and 22.7％ (5/22) in moderate depression group,50.0％ (3/6),33.3％ (2/6)and 16.7％(1/6) in severe depression group,36.7％(18/49),40.8％(20/49) and 22.5％(11/49) in non-PSD group,and the difference was not statistically significant (Fisher exact test,P =0.998).Conclusions The prevalence rate of CMBs,number of CMBs lesions and deep lobe type of CMBs are closely related to the degree of post-stroke depression in the elderly.The distribution of CMBs lesions has no relevance with the degree of post stroke depression in the elderly.Elderly patients with ischemic stroke at high risk of post-stroke depression can be identified by evaluating CMBs for early intervention,which is worthy of promotion in clinical work.
RESUMEN
Objective To investigate the predictors of early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke and its impact on short-term outcomes. Methods From January 2017 to April 2019, patients with acute ischemic stroke treated with intravenous thrombolysis in the Second Affiliated Hospital of Xuzhou Medical University were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission increased by ≥2 compared with the baseline. The short-term outcomes were evaluated by the modified Rankin Scale at discharge. 0-2 was defined as good outcomes and 3-6 was defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent predictors of END and their correlation with short-term outcomes. Results A total of 199 patients with acute ischemic stroke received intravenous thrombolysis were enrolled. The median age was 68 years (interquartile range: 62- 76 years), 69 were women (34. 7％), and the baseline median NIHSS score was 6 (interquartile range: 3- 12). END occurred in 35 patients (17. 6％). Symptom progression occurred mainly 2 days after admission (31 patients, 88. 6％). Most of the causes of END were ischemic progression or recurrence (28 patients, 80. 0％). The univariate analysis showed that fasting blood glucose and symptomatic intracranial hemorrhage were associated with END (all P < 0. 05). However, multivariate logistic regression analysis did not find independent predictors of END. Excluding 12 patients with missing short-term outcome data, a total of 187 patients were included in the short-term outcome analysis. Among them, 110 patients had good outcomes and 77 had poor outcomes. Univariate analysis showed that ischemic heart disease, atrial fibrillation, mild stroke, etiological classification, baseline NIHSS score, absolute lymphocyte count, fasting blood sugar, neutrophil/lymphocyte ratio, whether to receive interventional therapy, and END were correlated with short-term outcomes (all P < 0. 05 ). Multivariate logistic regression analysis indicated that high baseline NIHSS score (odds ratio 1. 350, 95％ confidence interval 1. 182-1. 541; P < 0. 001) and END (odds ratio 32. 540, 95％ confidence interval 6. 149- 172. 21; P < 0. 001 ) were the independent risk factors for short-term poor outcomes. Conclusions END still occurs in some patients after intravenous thrombolysis for acute ischemic stroke, and END is an independent risk factor for short-term poor outcomes.
RESUMEN
Objective To investigate the screening of elderly patients with post?stroke depression (PSD) and to analyze risk factors. Methods In this prospective study, 220 elderly patients with ischemic stroke were enrolled. At one month after onset, 214 aged patients completed follow?up. According to the DSM?IV diagnosis standard, the patients were divided into PSD and non?PSD groups. Seventeen items of the Hamilton Depression Scale (HAMD) was used to evaluate the degree of depression, and the patients were divided into mild, moderate, and severe depression groups. The demographic and baseline clinical characteristics were compared. Multivariate logistic regression analysis was used to identify the risk factors of PSD in individuals. Results (1) Of the 214 aged patients with ischemic stroke who completed follow?up, 84 had PSD including 29 (34.52%) men and 55 (65.48%) women. The detection rate of PSD was 39.25%. According to the HAMD, 51 (60.72%) aged patients were diagnosed with mild depression, 25 (29.76%) with moderate depression, and 8 (9.52%) with serious depression. (2) Multivariate logistic regression analysis showed that advanced age (>75 years old), female sex, joblessness, being divorced or widowed, having cerebral microbleeds, experiencing social and family environment tension, having low cultural exposure, having moderate and severe neurologic deficits, and having a left?side lesion were the independent risk factors of PSD in elderly patients. Conclusion PSD is common in elderly patients. Evaluation of these risk factors can help identify aged patients at high risk for PSD to allow early intervention, which is worth promoting in clinical work.
RESUMEN
Objective To explore the influencing factors of poor outcome in acute ischemic stroke patients with cerebral microbleeds (CMBs). Methods In prospective study, patients with acute ischemic stroke, admitted to our hospital from October 2016 to December 2017, were divided into CMBs group and non CMBs group. The clinical data of demographics, vascular risk factors, imaging examination, laboratory examination and treatment were collected. Follow up was performed till 6 months of onset, the patients were divided into poor outcome group (modified Rankin scale [mRS] scores>2) and good outcome group (mRS scores 0-2). Univariate analysis and multivariate Logistic regression analysis were used to determine the factors of poor outcome in acute ischemic stroke patients with CMBs. Results (1) A total of 274 patients with acute ischemic stroke were enrolled in the study, including 148 patients (54.01％) of CMBs group and 126 patients (45.99％) of non CMBs group. At the 6 months of follow up, 241 patients finished follow up, and there were 131 patients (54.36％) from CMBs group, 62 patients (47.33％) with poor outcome and 69 patients (52.67％) with good outcome;there were 110 patients (45.64％) from non CMBs group, 38 patients (34.55％) with poor outcome and 72 patients (65.45％) with good outcome; the difference of poor outcome rate in the two groups was statistically significant (P<0.05). (2) Univariate analysis showed that the differences of age distribution, percentage of having history of previous stroke or transient ischemic attack, stroke onset time, TOAST etiology type, stroke severity, number of stroke lesions, treatment methods, hemorrhagic transformation, number of CMBs lesions for grading in CMBs patients from poor and good outcome subgroups had statistical significance (P<0.05). Multivariable Logistic regression analysis showed that large atherosclerotic (odds ratio [OR]=2.239, 95％ confidence interval [CI]: 1.432-2.947, P=0.044), moderate and severe stroke (OR=3.887, 95％CI: 2.403-4.643, P=0.021), severe CMBs (OR=4.491, 95％CI:2.879-6.802, P=0.017), hemorrhagic transformation (OR=2.411, 95％CI: 1.347-3.232, P=0.040) were independent risk factors for poor outcome, and intravenous thrombolysis (OR=0.676, 95％ CI:0.324-0.865, P=0.039) was independent protective factor for good outcome. Conclusions CMBs is prevalent and poor outcome is more common in acute ischemic stroke patients with CMBs. Early evaluating the number of CMBs lesions has important reference value in predicting the occurrence of poor outcome in patients with acute ischemic stroke.
RESUMEN
Objective To investigate the correlation between cerebral microbleeds (CMBs) and early neurological deterioration (END) in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enrolled prospectively. The clinical data, imaging data, and laboratory data were collected. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 within 7 d compared with the baseline. Susceptibility-weighted imaging was used to detecte CMBs. Multivariate logistic regression analysis was used to identify the independent correlation between CMBs and END. Results A total of 246 patients with acute acute ischemic stroke were enrolled. The incidence of END was 38. 21％ (94/246), 72. 34％ (68/94) occurred within 72 h and 21. 28％ (20/94) occurred from 72 h to 7 d. The detection rate of CMBs in the END group was 72. 34％ (68/94) and that of CMBs in the non-END group was 43. 42％ (66/152). There was significant difference between the two groups (χ2 = 19. 587, P < 0. 001). Multivariate logistic regression analysis showed that previous stroke or transient ischemic attack (odds ratio [ OR ] 1. 883, 95％ confidence interval [ CI ] 1. 284- 2. 277; P = 0. 033 ), large artery atherosclerosis (OR 4. 119, 95％ CI 2. 564-5. 771; P = 0. 003), baseline NIHSS score (OR 1. 682, 95％ CI 1. 320-1. 876; P = 0. 042), severe stroke (OR 4. 228, 95％ CI 2. 634-5. 917; P = 0. 003), onset to admission time (OR 2. 070, 95％ CI 1. 454-2. 582; P = 0. 029), and number of CMB ≥10 (OR 2. 728, 95％ CI 1. 834- 3. 217; P = 0. 016) were the independent risk factors for END. Conclusions END is common in patients with acute ischemic stroke, most of them occurred within 72 h. It is closely associated with the number of CMB, but it is not associated with the location of CMB lesions.
RESUMEN
Objective To explore the teaching feasibility and practicability on team-based learning (TBL) and lecture-based learning (LBL) combined with PDCA circle teaching in clinical teaching of neurol-ogy, and evaluate its teaching effect. Method 100 cases clinical medical professional training students were chosen, divided into experiment group and control group, with 50 cases in each group. Control group used TBL and LBL teaching while experiment group used combined with PDCA circle teaching on the basis of control group. After the teaching, the teaching effects difference between two groups was evaluated and compared. Result The theoretical examination scores in experiment group (85.95 ±7.63) was higher than that in control group (77.31±5.38), and the difference was statistically significant (t=2.126, P=0.034). The practical operation scores in experiment group (82.37±5.15) was higher than that in control group (76.62± 4.35), and the difference was statistically significant (t=2.173, P=0.029). In anonymous satisfaction survey, the average coutent degree with teaching in experiment group is higher than control ( 92% vs . 82%) . Conclusion TBL and LBL combined with PDCA circle teaching improves the students' basic theory, prac-tical operation and doctor-patient communication ability, whose satisfaction has also significantly increased, which is worth popularizing in the clinical practice teaching of neurology.
RESUMEN
Objective To evaluate the nutritional risk screening for younger patients with stroke and to explore risk factors of malnutrition. Methods Younger patients with stroke were enrolled in a prospective way. The patients were evaluated by nutritional risk screening 2002 (NRS 2002) at their admission for nutritional risk screening, and were divided into nutritional risk group and no nutritional risk group according to the evaluation results. Prealbumin less than 200 mg/L was defined as malnutrition. Demographic and baseline clinical characteristics of the patients were analyzed with multivariate logistic regression analysis to determine independent risk factors for malnutrition at the admission and the 14th day. Results (1) A total of 152 young stroke patients were enrolled, including 51 in nutritional risk group, 101 in no nutritional risk group, the rate of nutritional risk was 33.6%(51/152). (2) The rate of malnutrition at admission was 13.8%(21/152), the rate of malnutrition in nutritional risk group was 25.5%(13/51), and 7.9%(8/101)in no nutritional risk group on admission. While the rate of malnutrition was 32.2%(49/152), including the rate of malnutrition in nutritional risk group was 60.78%(31/51)and 17.8%(18/101)in no nutritional risk group was at the 14th day of admission. (3) Multivariate Logistic regression analysis showed that advanced age (from 36 to 45 years), sex, diabetes, hyperthyroidism were independent risk factors for malnutrition in younger patients with stroke. Recent history of surgery and smoking, stroke-associated pneumonia, post-stroke depression, swallowing disorder, sleep disorder, moderate and severe neurologic deficits were also risk factors for malnutrition. Conclusion The incidence of malnutrition in youngerpatients with stroke were higher, and earlier nutritional risk screening and nutritional support in these patients were urgent.
RESUMEN
Seventy two iscbemic stroke patients aged 18-45 years with nonvalvular atrial fibrillation treated in the Second Affiliated Hospital of Xuzhou Medical College from April 2014 to August 2016 were assigned to warfarin group (n =36) and dabigatran group (n =36).In warfarin group the oral warfarin started from small dose and maintained international normalized ratio (INR) as 2.0 to 3.0.In dabigatran group 110 mg dabigatran etexilate was given b.i.d.All patients were followed up for one year after treatment.Medication was discontinued in 10 cases (28％) of warfarin group and 2 cases (6％) of dabigatran group one year after treatment (P =0.02).There were 8 (22％) cases of thromboembolic events in warfarin group and 1 (3％) case in dabigatran group (P =0.03).In warfarin group 233 INR values were recorded with an average of 2.32,and the percentage of time in therapeutic range (TTR) was 75％ (174/ 233).There were 2 deaths in warfarin group and no death in dabiga group.There were 19 (53％) cases of adverse reactions in warfarin group,including 9 cases of bleeding (6 mild bleeding and 3 serious bleeding),5 cases of nausea and vomiting,2 cases constipation or diarrhea,3 cases of headache and dizziness.There were 6 (17％) cases of adverse reactions in dabigatran group,including 2 cases of mild bleeding,2 cases of nausea and vomiting,2 cases of constipation or diarrhea.There was significant difference in the incidence of adverse reactions between the two groups(x2 =13.3,P ＜ 0.01).The results indicate that the efficacy and safety of dabigatran is superior to that of warfarin for young ischemic stroke patients with nonvalvular atrial fibrillation.
RESUMEN
Objective To investigate the microbiology,risk factors,and impact on outcomes of stroke-associated pneumonia (SAP) in young patients with acute ischemic stroke.Methods Young patients with acute ischemic stroke were enrolled prospectively.Their microbiological data and risk factors for SAP were identified.The outcomes at 90 d after onset were evaluated with the modified Rankin Scale (mRS) scores,and mRS ＞ 2 was defined as poor outcome.The demography and baseline clinical characteristics were compared.Multivariate logistic regression analysis was used to identify the effect of SAP on the outcomes.Results A total of 418 young patients with ischemic stroke were enrolled,including 108 (25.84％) in the SAP group and 310 (74.16％) in the non-SAP group;16 were lost to follow-up,146 (36.32％) were in the poor outcome group and 256 (63.68％) were in the good outcome group.The results of pathogen test showed that the positive rate was 52.78％ and 19.30％ was mixed infection.The main pathogens were community-acquired pathogens (such as Staphylococcus aureus,Streptococcus pneumoniae and Klebsiella pneumoniae),followed by multidrug-resistant nosocomial pathogens (such as Pseudomonas aeruginosa,Acinetobacter Baumanii,and methicillin-resistant Staphylococcus aureus).Multivariate logistic regression analysis showed that smoking (odds ratio [OR] 4.328,95％ confidence interval [CI]2.847-6.442;P =0.014),chronic obstructive pulmonary disease (OR 3.927,95％ CI 2.419-5.253;P=0.017),dysphagia (OR 6.782,95％ CI 4.378-9.553;P=0.003),tracheal intubation or mechanical ventilation (OR 7.632,95％ CI 5.394-12.376;P=0.001),procalcitonin (OR 2.980,95％ CI 2.234-4.118;P =0.027),antibiotics (OR 6.321,95％ CI 4.362-8.376;P =0.007) were the independent risk factors for SAP,and age ＜ 35 years old was an independent protective factor of SAP (OR 0.582,95％ CI 0.329-0.719;P =0.028);history of previous stroke or transient ischemic attack (OR 3.854,95％ CI 2.645-5.023;P=0.014),tracheal intubation and mechanical ventilation (OR 3.501,95％ CI 2.329-4.614;P =0.016),large artery atherosclerosis (OR 5.274,95％ CI 3.342-7.246;P =0.006),baseline National Institutes of Health Stroke Scale score (OR 2.248,95％ CI 1.482-2.821;P=0.031),onset to admission time (OR 1.245,95％ CI 1.184-1.698;P=0.048),SAP (OR 3.347,95％ CI 2.275-4.338;P =0.018) were the independent risk factors for poor outcomes,and age ＜35 years old (OR 0.340,95％ CI 0.147-0.420;P =0.042) and thrombolytic therapy (OR 0.582,95％ CI 0.329-0.719;P =0.028) were the independent protective factors of good outcomes.Conclusion SAP was more common in young patients with acute ischemic stroke,and had its own characteristics in microbiological data and risk factors.SAP was closely associated with poor outcomes.
RESUMEN
ObjectiveTo investigate the effect of vitamin D supplementation on the outcome of acute ischemic stroke in young patients with vitamin D deficiency.MethodsThe prospective controlled study was used to select the consecutive young patients with acute ischemic stroke.Vitamin D deficiency was defined as 25-hydroxyvitamin D (25(OH)D) ≤50 nmol/L.The Patients with vitamin D deficiency were randomly divided into an intervention group and a routine treatment group according to the random number table method.Routine treatment group didn't receive the drug intervention for vitamin D deficiency, and the intervention group received daily oral alfacalcidol 0.5 μg.After 1 year of treatment, the 25(OH)D levels were examined again;the adverse reactions during the drug treatment were monitored;the modified Rankin Scale (mRS) was used to evaluate the functional outcome and 0-2 was defined as good outcome.ResultsThere are 94 patients (53.41%) with vitamin D deficiency among 176 young patients with acute ischemic stroke.They were randomly divided into either an intervention group or a routine treatment group (n=47 in each group).At the end of the follow-up, the good outcome rate (82.98% vs.63.83%;χ2=4.414, P=0.036) and serum 25(OH)D level (85.83±10.53 nmol/L vs.39.10±11.18 nmol/L;t=20.860, P<0.001) in the intervention group were significantly higher than those in the routine treatment group.During the follow-up period, there was no loss to follow-up or death events in both groups.Only 2 cases of nausea and 1 case of dizziness were observed, and the incidence of adverse reaction was 6.38% in the intervention group.ConclusionsVitamin D supplement can increase the vitamin D levels and improve functional outcome in young patients with acute ischemic stroke and vitamin D deficiency.
RESUMEN
Objective To observe the efficacy and safety of rosuvastatin in the treatment of hyperlipidemia and carotid atherosclerotic plaque in young ischemic stroke patients.Methods In prospective study,264 young ischemic stroke patients with hyperlipidemia and carotid atherosclerotic plaque were randomly divided into low dose group,middle dose group,high dose group,88 cases in each group.All patients were given rosuvastatin immediately after dinner,in doses of 5mg,10mg,20mg,respectively,for eight months.Then,the changes of hyperlipidemia and carotid atherosclerotic plaque in the three groups were surveyed,and its safety by the observation of clinical symptoms and monitoring of adverse reactions after eight months were assessed.Results Before treatment,the blood fat and carotid atherosclerosis plaque index in the three groups had no statistically significant differences (all P >0.05). After treatment,the total cholesterol,triglycerides,low -density lipoprotein cholesterol of the high dose group were (1.67 ±0.68)mmol/L,(3.23 ±0.53)mmol/L,(1.83 ±0.62)mmol/L,which of the middle dose group were (1.93 ±0.74)mmol/L,(3.73 ±0.23)mmol/L,(2.24 ±0.73)mmol/L,which of the low dose group were (2.16 ± 0.77)mmol/L,(4.06 ±0.93)mmol/L,(2.93 ±0.35)mmol/L.These indicators were decreased than before treat-ment [(2.79 ±0.72)mmol/L,(5.40 ±0.67)mmol/L,(3.64 ±1.03)mmol/L,(2.75 ±0.81)mmol/L,(5.59 ± 0.95)mmol/L,(3.43 ±0.92)mmol/L and (2.83 ±0.53)mmol/L,(5.84 ±0.79)mmol/L,(3.83 ±0.88)mmol/L].The decrease of the high dose group was higher than the middle and low dose group,the difference was statistically significant(F =6.61,P 0.05),and no serious adverse reaction was found.Conclusion The high dose rosuvastatin treatment can reverse the nature of plaque, decrease the thickness of the plaques and lower blood lipid of young ischemic stroke with hyperlipidemia and carotid atherosclerotic plaque,which is better than middle and low dose,and has better security.There is no serious adverse reaction.It is worth for clinical promotion.
RESUMEN
Objective To assess the factors associated with occurrence of stroke in Xuzhou region on the basis of stroke registry database using data mining methods Relief F algorithm.Methods Five hundred and forty-six patients with acute cerebral infarction from June 2013 to June 2014 in Stroke Registry database and 546 healthy people at the same period in the region were chosen;their clinical data were collected and retrospectively analyzed.And the related data were collected,arranged and put into epidata database.Firstly,the data were normalized and converted to the number between 1 and 10.Relief F algorithm was used to analyze the weight of past histories and hematology index between healthy control group and stroke group.Matlab software was used to program and calculate,and the main program runs for 20 times.And then,the obtained results for each weighted average were summarized.Finally,the weight of past medical history and blood parameters in healthy control group and stroke group were obtained.Results Relief F algorithm was applied for data analysis:as compared with healthy controls,stoke group had higher weight of infarction (0.0353125) and history of drinking (0.01175),while not higher weight of history of hypertension,diabetes mellitus or transient ischemic attack;as compared with healthy controls,stoke group had higher weight of uric acid nitrogen level (0.0072),blood uric acid level (0.0071),cholesterol level (0.0067) and homocysteine level (0.0064),followed by high-density lipoprotein (0.0062),low density lipoprotein (0.0041) and triglyceride (0.0039).Conclusion Application of Relief F algorithm can excavate the closely related potential risk factors for stroke in stroke registration database.
RESUMEN
Objective To explore the influencing factors on short -term efficacy of intravenous thrombolysis with rt -PA.Methods The clinical data of the 95 acute ischemic stroke(AIS)patients who received thrombolytic therapy were analyze.Multivariate logistic regression analysis was used to determine the possible influencing factors. Results Fifty -six(58.95%)patients had favourable outcomes after thrombolytic therapy for 24 hours.Multivariate logistic regression analysis indicated that diabetes(OR =3.933,95% CI 1.199 ~12.897)and TOAST classification (OR =1.448,95% CI 1.032 ~2.032 )were the independent predictors of short -term outcome.Conclusion Diabetes and TOAST classification are the major influencing factors of short -term efficacy after intravenous thrombolysis with rt -PA.It should pay attention screening patients for intravenous thrombolysis therapy and predicting the efficacy of thrombolysis.
RESUMEN
Objective To analyze the efficacy of epley maneuver associated with vertigo calming for treating posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in young.Methods Two hundred and fifty-eight cases(age was 18-50 years old) with PC-BPPV were randomly divided into maneuver group(86 cases),betahistine group(86 cases) and vertigo calming group(86 cases).The maneuver group was treated by epley maneuver associated with placebo,2 pills per time,3 times daily for one month and follow up one month.The betahistine group and vertigo calming group were treated by epley maneuver with betahistine(12 mg/ time,Tid) or vertigo calming(2 piles/time,Tid),the same dose,period of treatment and follow-up as maneuver group.Results After one time treatment,199 cases were cured in 258 patients,including 68 cases in maneuver group,66 cases in betahistine group,65 cases in vertigo calming group,and the difference between groups was not statistically significant(x2 =0.308,P＞0.05).After treatments and followed up for one month,72 cases were cured,3 cases were effective,11 cases were invalid in maneuver group;74 cases were cured,3 cases were effective,9 cases were invalid in betahistine group;81 cases were cured,4 cases were effective,1 cases were invalid in vertigo calming group.Efficient of betahistine group,maneuver group and vertigo calming group were 89.5％,87.2％ and 98.8％,and the difference between maneuver group and betahistine group was not statistically significant(x2=58.65,P＞0.05),the difference of vertigo calming group between with other groups was statistically significant(P＜0.05).Conclusion The effects of vertigo calming in addition to Epley maneuver is significantly better than both Epley maneuver and Epley maneuver combined with betahistine in young PC-BPPV,while the effects of Epley maneuver combined with betahistine isn't better than Epley maneuver.