Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.
Objective To systematically evaluate the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. Methods Databases including PubMed, EMbase, BIOSIS and CNKI were electronically searched from establishment dates of databases to June 2012 to retrieve animal experiments on the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke. The relevant studies were identified according to the predefined inclusion and exclusion criteria, the data were extracted, and the quality was evaluated. Then meta-analysis was performed using RevMan 5.1 software. Results Eight studies were included. The results of meta-analysis showed that no significant difference was found between the alcohol intervention group and the control group (MD=?6.98%, 95%CI ?20.38% to 6.43%, P=0.31). However, compared with the control group, low dose of acute alcohol intervention (less than 2 g/kg) improved the prognosis of ischemic stroke with a significant difference (MD=?22.83%, 95%CI ?38.77% to ?6.89%, P=0.005), and highly-concentrated of chronic alcohol intervention worsened the cerebral ischemic damage of rats and mice with a significant difference (MD=24.06%, 95%CI 10.54% to 37.58%, P=0.000 5). Conclusion Low dose of acute alcohol intervention (less than 2 g/kg) could improve the prognosis of rats and mice with ischemic stroke which has the potential neuro-protective effects. However, highly-concentrated chronic alcohol intervention could worsen the cerebral ischemic damage. Due to the limitations of the included studies such as publication bias, the influence of alcohol intervention on the outcome of rats and mice with ischemic stroke could be overestimated.
ObjectiveTo investigate the relationship between the level of homocysteine (HCY) and the overall burden of cerebral small vessel disease (CSVD) in patients with ischemic stroke.MethodsA total of 322 patients with first-ever ischemic stroke admitted to the People’s Hospital of Deyang City between January 2016 and December 2017 were enrolled. The patients’ demographic information, clinical information, and serum HCY concentration were collected after admission. The presence or absence of a CSVD was assessed by MRI and the overall burden score for the CSVD was determined. Multivariate logistic regression analysis was used to assess whether serum HCY level was associated with the overall burden of CSVD.ResultsThe median level of HCY was 13.2 μmol/L (inter-quartile range: 4.3 to 22.6 μmol/L). Univariate analysis showed that the difference of HCY levels among patients with different total CSVD scores was statistically significant (F=6.874, P=0.001); Spearman correlation analyses showed that the HCY level grouped by quartiles was correlated to the number of lacunar infarctions (rs=0.267, P=0.001), Fazekas score of white matter lesions (rs=0.122, P=0.042), and enlarged perivascular space (EPV) score (rs=0.319, P=0.001), but was not correlated to cerebral microhemorrhage (rs=?0.010, P=0.869). After multivariate regression analysis to adjust the effects of other factors, compared with the patients with HCY levels in the lowest quartile group, the patients with HCY levels in the highest quartile group were more likely to develop lacunar infarction [odds ratio (OR)=1.892, 95% confidence interval (CI) (1.012, 2.987)], white matter lesions [OR=1.548, 95%CI (1.018, 1.654)], severe EPV [OR=6.347, 95%CI (3.592, 13.978)], and the increase in the CSVD score [OR=2.981, 95%CI (1.974, 5.398)].ConclusionIn patients with ischemic stroke, elevated HCY levels may be associated with the overall burden of the CSVD.
Objective To analyze the methodological quality of clinical trails on butylphthalide for cerebral ischemic stroke. Methods We collected all of the published clinical studies on butylphthalide for cerebral ischemic stroke in the world, and evaluated the methodological quality of the included studies according to clinical epidemiologic standard. The search time was from the establishment of each database to December, 2009. Results A total of 62 studies involving 5 762 patients were included. In all included studies, there were 56 randomized controlled trials (RCTs). A total of 8 studies described the method of random assignments. There were 4 multi-center randomized double-blind placebo-control trials. A total of 55 reported diagnosis criteria, 40 reported included criteria, 28 reported excluded criteria; 36 reported the curative efficacy at the end of the treatment, 51 assessed the neurological deficit score of patients before and after the treatment, 27 evaluated the ADL scores; 32 studies reported the side effects; 6 trials did not conduct intention-to-treat analysis even though some people withdrew the treatment because of the side effects or poor tolerance, etc. Conclusion Except for several high quality RCTs, current quality of some clinical trials on butylphthalide for ischemic stroke should be improved. We recommend that researchers should use internationally accepted consolidate standards of reporting trials (CONSORT) in future studies.
ObjectiveTo systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. MethodsLiterature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04). ConclusionFor patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
Objective To investigate whether there is an off-hours effect on the endovascular treatment (EVT) process for patients with acute ischemic stroke (AIS) after emergency admission to the hospital. Methods We retrospectively analyzed AIS patients who were admitted to the West China Hospital of Sichuan University on the stroke green channel between September 2019 and August 2023 and planned to perform emergency EVT. The patients were divided into working-hour and off-hour groups according to their admission time. The clinical information, door-to-puncture time (DPT), door-to-head/neck imaging time (DIT) and door-to-blood test time (DBT) of the two groups patients were compared, and subgroup analysis was conducted according to whether they arrived at the hospital at night, before and after the guideline update, and whether they were in the coronavirus disease 2019 epidemic period. Results A total of 586 AIS patients with large vessel occlusion were included, including 220 patients admitted during working hours and 336 patients admitted during off-working hours. There was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Subgroup analysis showed that in patients admitted during off-working hours, there was no statistically significant difference in the basic information and EVT process time between patients arrived at the hospital at night and patients did not arrive at the hospital at night (P>0.05). Before and after the guideline updated, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). No matter whether it is in the coronavirus disease 2019 epidemic period, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Conclusions There is no off-hours effect on the EVT process time after AIS patients arrive at the hospital. In the future, more stroke centers of different levels are needed to further explore the impact of off-hours effect on emergency diagnosis and treatment of AIS patients.
Objective To evaluate the ability of the triglyceride-glucose (TyG) index and the brain symmetry index (BSI) to predict stroke recurrence in patients with acute ischemic stroke (AIS). Methods This retrospective study enrolled 366 AIS patients admitted to the Fourth Affiliated Hospital of Nanjing Medical University between January 2021 and August 2022. Before discharge, resting electroencephalography was recorded to obtain the eyes-open BSI (BSIo) and eyes-closed BSI (BSIc); the TyG index was calculated concurrently. Stroke recurrence was assessed at 3, 6, 12 and 18 months. Logistic regression and receiver-operating characteristic analyses were used to determine the predictive performance of baseline TyG index, BSIo and BSIc. Results Sixty-two patients (16.9%) experienced stroke recurrence within 18 months. Baseline TyG index, BSIo and BSIc were significantly higher in the recurrence group than those in the non-recurrence group (P<0.05). Multivariable logistic regression identified TyG index [odds ratio (OR)=2.273, 95% confidence interval (CI) (1.441, 3.585)] and BSIo [OR=27.305, 95%CI (1.155, 645.737)] as independent predictors of recurrence (P<0.05). TyG index and BSIo provided the highest predictive accuracy for recurrence within 3 months (area under the curve=0.777 and 0.795, respectively); their discriminative ability declined over longer follow-up periods. BSIo correlated positively with the National Institutes of Health Stroke Scale and modified Rankin Scale scores (P<0.001), and was elevated in patients with atrial fibrillation, heart failure or small-artery occlusion (P<0.05), while lowered in patients with diabetes (P<0.05). Conclusion Elevated TyG index and BSIo are closely associated with stroke recurrence after AIS and may serve as useful adjuncts for early risk stratification and individualized secondary prevention.
ObjectiveTo observe and compare the efficacy and safety of intravenous thrombolysis with alteplase or urokinase in the first-ever acute ischemic stroke patients arriving at the hospital 3.5-4.5 h after onset.MethodsClinical data of patients with acute ischemic stroke treated in Shihezi People’s Hospital between January 2019 and October 2020 were prospectively collected. The National Insititutes of Health Stroke Scale (NIHSS) score on the 7th day and the 90th day, the modified Rankin Scale (mRS) score and the Blessed Behavior Scale (BBS) score on the 90th day, and symptomatic bleeding within 36 h after thrombolysis were analyzed and compared between the patients receiving alteplase threatment (the alteplase group) and the ones receiving urokinase treatment (the urokinase group).ResultsTotally 96 patients were treated with intravenous thrombolysis. Among them, 58 patients received alteplase threatment and 38 received urokinase treatment. The difference in NIHSS, mRS, or BBS scores between the two groups before treatment was not statistically significant (P>0.05). On the 90th day after treatment, the NIHSS, mRS, and BBS scores of the alteplase group were 3.59±3.73, 2.26±1.26, and 15.33±8.28, respectively, and those of the urokinase group were 5.95±4.88, 3.00±0.87, and 20.37±11.80, respectively; the differences between the two groups were all statistically significant (P<0.05). There was no significant difference in the rate of symptomatic intracerebral hemorrhage between the two groups within 36 h after treatment (P>0.05). Multiple linear regression analyses showed that the treatment method was related to the NIHSS score on the 7th day, the NIHSS score on the 90th day, the mRS score on the 90th day, and the BBS score on the 90th day (P<0.05), the history of heart disease was related to the mRS score on the 90th day (P<0.05), and the income was related to the BBS score on the 90th day (P<0.05).ConclusionFor the hyperactue ischemic stroke, the overall effect of alteplase treatment may be better than that of urokinase treatment.