Objectives To assess the efficacy and safety of dl-3-butylphthalide for patients with acute ischemic stroke. Methods We collected randomized controlled trials, which compared dl-3-butylphthalide agents with placebo or open control in patients with acute ischaemic stroke, by searching the electronic bibliographic databases, scanning references listed in articles and handsearching journals. Meta-analysis was conducted based on the methods recommended by the Cochrane Collaboration. Results Twenty-one trials involving 2 123 patients were included, of which 2 were placebo-controlled and 19 were open-label controlled. Meta-analysis of 10 trials (n=958), in which neurological deficits were assessed by CSS, suggested that there were significant differences favoring butylphthalide in the mean change of neurological deficits’ score during the treatment period [MD=2.30, 95%CI (1.57, 3.03)]. Meta-analysis of 6 trials (n=590), in which neurological deficits were assessed by NIHSS, also favored butylphthalide [MD=2.06, 95%CI (0.65, 3.46)]. Adverse events (AEs) were reported in 13 trials. Gastrointestinal discomfort (1.7%~8%) and abnormal liver function including abnormal ALT (1.4%~17.5%) and abnormal AST (1.9%~8.82%) were the two most common AEs. However, no severe adverse events (SAEs) were reported. Numbers of dead and dependent patients at the end of followup (at least three months) were not reported in the 21 included trials. Quality of life was not assessed in any of the trials. Conclusion Dl-3-butylphthalide can improve the neurological function after acute ischemic stroke and appears to be safe. However, further study is needed to confirm its effects for lowering rates of death and dependency.
Cryptogenic stroke (CS) accounts for 25% of ischemic stroke. The etiology of undetermined stroke is unclear leading to untargeted secondary prevention, high recurrence rate, so the clinical burden of cryptogenic stroke is substantial. Cardiac magnetic resonance (CMR) imaging can identify more occult cardiac embolism that cannot be identified by standard cardiac assessment based on its excellent spatial resolution and contrast, three-dimensional imaging capacity and ability to depict soft tissues, to accelerate the initiation of optimal secondary prevention and improve the prognosis of patients. This review summarizes the application of CMR in the field of CS in recent years. Based on the latest evidence of diagnosis and management strategies, this paper proposes a cardiac diagnostic examination plan for CS patients, thereby improving the secondary prevention strategy of CS patients and improving their quality of life.
Objective To evaluate the predictive effect of three machine learning methods, namely support vector machine (SVM), K-nearest neighbor (KNN) and decision tree, on the daily number of new patients with ischemic stroke in Chengdu. Methods The numbers of daily new ischemic stroke patients from January 1st, 2019 to March 28th, 2021 were extracted from the Third People’s Hospital of Chengdu. The weather and meteorological data and air quality data of Chengdu came from China Weather Network in the same period. Correlation analyses, multinominal logistic regression, and principal component analysis were used to explore the influencing factors for the level of daily number of new ischemic stroke patients in this hospital. Then, using R 4.1.2 software, the data were randomly divided in a ratio of 7∶3 (70% into train set and 30% into validation set), and were respectively used to train and certify the three machine learning methods, SVM, KNN and decision tree, and logistic regression model was used as the benchmark model. F1 score, the area under the receiver operating characteristic curve (AUC) and accuracy of each model were calculated. The data dividing, training and validation were repeated for three times, and the average F1 scores, AUCs and accuracies of the three times were used to compare the prediction effects of the four models. Results According to the accuracies from high to low, the prediction effects of the four models were ranked as SVM (88.9%), logistic regression model (87.5%), decision tree (85.9%), and KNN (85.1%); according to the F1 scores, the models were ranked as SVM (66.9%), KNN (62.7%), decision tree (59.1%), and logistic regression model (57.7%); according to the AUCs, the order from high to low was SVM (88.5%), logistic regression model (87.7%), KNN (84.7%), and decision tree (71.5%). Conclusion The prediction result of SVM is better than the traditional logistic regression model and the other two machine learning models.
Objective To evaluate the risk factors for cognitive impairment and their interactions in acute ischemic stroke (IS) patients. Methods IS patients admitted to the Department of Neurology, the People’s Hospital of Mianyang between January 2019 and January 2022 were selected. Patients were divided into a cognitive impairment group and a cognitive normal group. The demographic characteristics and clinical data of the subjects were collected, and the traditional risk factors for cognitive impairment were determined by univariate and multivariate logistic regression analysis. The multifactor dimensionality reduction test was used to detect the possible interactions between risk factors. Results A total of 255 patients were included. Among them, 88 cases (34.5%) in the cognitive impairment group and 167 cases (65.5%) in the cognitive normal group. The results of factor logistic regression analysis showed that after adjusting for covariates, big and medium infarction volume, severe IS, moderate to severe carotid artery stenosis as well as high hypersensitive C-reactive protein (hs-CRP) were associated with post-IS cognitive impairment (P<0.05). The cognitive impairment increased by 22.632 times [odds ratio=22.632, 95% confidence interval (5.980, 85.652), P<0.001] in patients with big and medium infarction volume, severe IS and high hs-CRP. Conclusions The cognitive impairment is common in acute IS. Patients with big and medium infarction volume, non-mild stroke, carotid artery stenosis, high hs-CRP, and non-right sided infarction are prone to cognitive impairment, and there are complex interactions among these risk factors.
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.
Objective To discuss the feasibility of treating the brain ischemic stroke by the co-transplantation of the neural stem cells(NSCs) and the endothelial progenitor cells(EPCs). Methods The original biomedical articles concerned with the treatment of the brain ischemic therapy by the use of the NSCs and the EPCs were extensively reviewed as well as retrieved and analyzed. Results The review revealed that the NSCs and the EPCs could migrate to the injured area due to brain ischemic stroke, the environment of the local microcirculation could induce the neurogenesis and the vasculogenesis to repair the injury, and the neurogenesis and vasculogenesis could promote each other. Conclusion The co-transplantation of the NSCs and the EPCscan represent a new promising strategy formore effectively solving the two difficult problems of the neural cell loss andthe vascular obstruction caused by the brain ischemic stroke.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.
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 explore the awareness of thrombolytic therapy for acute ischemic stroke in inpatients with a history of stroke and with a high risk of stroke. Methods From January to August 2012, using self-designed questionnaire, trained neurologists conducted the face to face investigation in 500 inpatients with a high risk of stroke, including those with a history of stroke in Department of Neurology in the Second Affiliated Hospital of Chongqing Medical University. Results A total of 467 valid questionnaires were recovered. Only 16.1% (75/467) patients were aware of thrombolytic therapy for acute stroke, of whom 50.7% (38/75) knew the time window of thrombolytic therapy. Awareness of thrombolytic therapy was higher in patients aged 56-70 years, with a higher level of education and income, and in those who knew at least 3 stroke warning signs and those with a history of stroke. While awareness of the time window of thrombolytic therapy was higher in those unmarried or widowed and with a history of stroke. Multiple logistic regression analysis showed that awareness of thrombolytic therapy was independently associated with age, education level, knowledge of stroke warning signs and a history of stroke; awareness of the time window was associated with marital status and a history of stroke (P<0.05). Conclusions Inpatients with a history of stroke and with a high risk of stroke in the Department of Neurology have poor awareness of thrombolytic therapy for acute ischemic stroke. It is necessary to improve the level of patients’ knowledge about thrombolytic therapy for acute stroke by health education.
Objective To analyze the efficacy of music therapy on the rehabilitation of post-stroke cognitive impairment (PSCI) and to provide a reference for rehabilitation intervention methods for PSCI. Methods Patients hospitalized in Beijing Bo’Ai Hospital, China Rehabilitation Research Center and diagnosed with PSCI between December 2020 and July 2022 were prospectively selected. According to the random number table method, patients were divided into a music therapy group and a control group. Both groups were given conventional neurology medication, nursing care, and conventional rehabilitation. The music therapy group received additional music therapy training, and both groups received treatment for one month. The Montreal Cognitive Assessment (MoCA), National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment Scale (FMA), and modified Barthel Index (MBI) were used before and after treatment to assess patients’ cognitive function, degree of neurological deficits, motor function and activities of daily live. Results A total of 48 patients were included, with 24 patients in both groups. There was no statistically significant difference in gender, age, education level, stroke type, lesion location, comorbidities, history of myocardial infarction or peripheral vascular disease, and smoking status between the two groups of patients (P>0.05). Before and after treatment, most patients in the two groups did not score in terms of language and delayed recall scores, and the difference were not statistically significant (P>0.05). There was no statistically significant difference in MoCA scores, visual space and executive function, naming, attention, calculation, abstract thinking, and orientation scores between the two groups of patients before treatment (P>0.05). After treatment, the MoCA score, visual space and executive function, naming, attention, calculation, abstract thinking, and orientation scores of the music therapy group improved compared to before treatment (P<0.05), while the MoCA score, visual space and executive function, naming, attention, and orientation scores of the control group improved compared to before treatment (P<0.05). After treatment, the improvement in MoCA scores [5.0 (3.0, 6.0) vs. 2.5 (1.0, 4.0)], attention [1.0 (0.0, 1.0) vs. 0.0 (0.0, 1.0)], and abstract thinking scores [0.0 (0.0, 1.0) vs. 0.0 (0.0, 0.0)] in the music therapy group were better than that in the control group (P<0.05). There was no statistically significant difference in NIHSS, FMA, and MBI scores between the two groups of patients before treatment (P>0.05), and both groups improved after treatment compared to before treatment (P<0.05). After treatment, there was no statistically significant difference in the improvement of NIHSS, FMA, and MBI scores between the two groups of patients (P>0.05). Conclusions Compared with conventional rehabilitation therapy, training combined with music therapy is more beneficial for improving cognitive function in PSCI patients, especially in the cognitive domains of attention and abstract thinking. However, significant advantages have not been found in improving the degree of neurological impairment, limb motor function, and daily living activities.