ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=−0.55, 95%CI −0.72 to −0.38, P<0.001) and reduce fibrinogen after treatment (SMD=−0.93, 95%CI −1.41 to −0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo analyze the patterns of recurrent strokes among patients with initial ischemic stroke and investigate the possible predictors of recurrent ischemic stroke. MethodPatients with recurrent strokes after initial ischemic strokes hospitalized in our hospital between January 2008 and December 2012 were included in the study, and the data of general demographic information, life history, past medical history and laboratory test results were all retrospectively analyzed. The patterns of recurrent strokes in patients with initial ischemic stroke were analyzed, and multivariate logistic regression analysis was used to investigate the independent risk factors for recurrent ischemic stroke. ResultsA total of 237 patients were included in this study, including 198 patients with recurrent ischemic stroke and 39 patients with recurrent hemorrhagic stroke. Among patients with recurrent ischemic stroke, there were 137 patients with anterior circulation stroke, 52 with posterior circulation stroke and 9 with multiple infarction. Multivariate logistic regression analysis showed that older age at initial stroke onset[OR=1.968, 95%CI (1.533, 2.152), P=0.009], frequent mood swings[OR=1.345, 95%CI (1.121, 1.783), P=0.011], hyperlipidemia[OR=1.436, 95%CI (1.216, 1.732), P=0.018] and atrial fibrillation[OR=3.417, 95%CI (2.927, 4.897), P=0.005] were independent risk factors for recurrent ischemic stroke. ConclusionsIschemic stroke is the most common pattern of recurrent strokes; and aging, frequent mood swings, hyperlipidemia and atrial fibrillation are possible predictors of recurrent ischemic stroke after the initial ischemic stroke.
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.
In recent years, the incidence rate of ischemic stroke in people living with HIV/AIDS (PLWHA) is increasing, attracting wide attention from scholars at home and abroad. In addition to traditional risk factors of stroke, the secondary ischemic stroke in PLWHA is also affected by HIV infection. This study reviews the incidence rate and risk factors of secondary ischemic stroke in PLWHA, in order to provide a theoretical basis for preventing and reducing the incidence of ischemic stroke in PLWHA.
ObjectiveThe purpose of this study was to investigate clinical aspects as risk factors for seizure recurrence in patients with post-stroke epilepsy. MethodsDuring January 2010 to April 2016, patients admitted into Department of Neurology, West China Hospital were retrospectively selected. Inpatients diagnosed as epilepsy following stoke and attending our follow-up were participated in this study. Logistic regression model was used to analyze the risk factors of seizure recurrence. ResultsWe included 105 patients with diagnosis of post-stroke epilepsy, among them, 59.0% were male and the median age was 72 years. Median time from stroke onset to seizure attack was 180 days. Approximately 80% patients received antiepileptic drugs(AEDs). During 720 days follow-up period, 70% patients reported without seizure attack. Risk factors significantly associated with seizure recurrence were younger age [OR=3.03, 95 % CI(1.19, 7.76), P=0.02], poor modified Rankin Scale score [OR=3.01, 95 % CI(1.1, 8.18), P=0.03] and using more than two kinds of AEDs [OR=3.85, 95 % CI(1.3, 11.18), P=0.01]. ConclusionsIn the clinical course of post-stroke epilepsy, clinicians should realize the management for primary disease to alleviate stroke sequel and select rational AEDs to reduce seizure recurrence.
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.
Hemorrhagic transformation is one of the most serious complications after endovascular treatment in patients with acute ischemic stroke, which is closely related to neurological deterioration and poor functional prognosis. Therefore, early detection and treatment of hemorrhagic transformation are of great significance for improving patient prognosis. Brain CT, CT angiography, CT perfusion imaging, MRI, diffusion weighted imaging, and susceptibility weighted imaging are relatively commonly used imaging methods in clinical practice. Reasonable use of imaging methods can reduce the risk of hemorrhagic transformation and improve patient prognosis. This article reviews common imaging evaluation techniques for hemorrhagic transformation in clinical practice in order to provide ideas for clinical diagnosis and treatment.
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.