Objective To investigate the medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents and its influence on the prognosis of individuals at high risk of stroke. Methods A total of 16892 residents aged 40 years or above in eight communities in Sichuan participated in a face-to-face study from May to September 2015. A database of a high-risk population of stroke in Sichuan province was established, and data were collected via using a standardized structured questionnaire by experienced investigators, including the treatment status and medication compliance of participants with hypertension, diabetes, or dyslipidemia during the follow-up period. Multiple logistic regression analyses were performed to explore the influencing factors of medication adherence and its influence on the prognosis of individuals at high risk of stroke. Results A total of 2893 participants at high risk of stroke were enrolled. The treatment rates of hypertension, diabetes, and dyslipidemia were 50.1%, 49.2%, and 5.1%, respectively, when the high-risk individuals were identified. At the end of follow-up (with a median follow-up period of 4.8 years), the treatment rates of hypertension, diabetes, and dyslipidemia were 24.8%, 25.0%, and 7.9%, respectively. Medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents were 27.8%, 25.5%, and 18.1%, respectively. Multiple logistic regression analyses showed that the education level of high school or above [odds ratio (OR)=2.134, 95% confidence interval (CI) (1.098, 4.147), P=0.025], medical insurance for urban residents [OR=1.556, 95%CI (1.086, 2.230), P=0.016] and urban employees [OR=2.325, 95%CI (1.362, 3.967), P=0.002], having fewer children [OR=0.819, 95%CI (0.719, 0.933), P=0.003], and family history of stroke [OR=1.559, 95%CI (1.066, 2.282), P=0.022] were associated with greater adherence to antihypertensives; medical insurance for urban employees was associated with greater adherence to antidiabetics [OR=2.494, 95%CI (1.173, 5.300), P=0.018]. After adjusting for confounding factors, failure to regular use of antihypertensives [OR=2.617, 95%CI (1.414, 4.842), P=0.002], antidiabetics [OR=3.909, 95%CI (2.394, 6.380), P<0.001], and lipid-lowering agents [OR=4.828, 95%CI (2.581, 9.033), P<0.001] in patients with hypertension, diabetes, and dyslipidemia, respectively were associated with increased risk of ischemic stroke during the follow-up period. Regular use of lipid-lowering agents in patients with dyslipidemia was associated with an increased risk of intracerebral hemorrhage during the follow-up [OR=4.371, 95%CI (1.156, 16.530), P=0.030]. Conclusions The prevalences of hypertension, diabetes, and dyslipidemia are high in high-risk individuals of stroke in Sichuan province. However, the treatment rates are unsatisfactory, and the medication adherence is poor. The medication adherence is affected by a variety of demographic and socioeconomic factors. Regular treatments of hypertension, diabetes, and dyslipidemia reduce the risk of ischemic stroke in individuals at high risk of stroke, but regular use of lipid-lowering agents in patients with dyslipidemia is associated with an increased risk of intracerebral hemorrhage during the follow-up.
In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.
ObjectiveTo systematically evaluate the association between MTHFR gene C677T polymorphism and susceptibility to young and middle-aged adult ischemic stroke among Chinese population. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data were systemically searched to collect case-control studies published from Jan 1990 to Dec 2013. RevMan 5.2 was used to quantitatively analyzed the qualified and included studies, the pooled odds ratio (ORs) with 95% confidence interval (CI) were calculated; Stata 12.0 software were used for sensitivity and publication bias analysis. ResultsA total of 10 studies were included, which involved 787 cases and 766 controls. The results of meta-analysis showed that, in overall young and middle-aged adult group (aged less than 60), individuals that carried T allele risked more with ischemic stroke than those carried C allele (OR=1.42, 95%CI 1.07 to 1.89, P=0.02); more susceptibility to ischemic stroke was found among people of TT genotype compared with those of CC genotype (OR=2.11, 95%CI 1.58 to 2.81, P=0.00), as well as those of TT+TC genotype compared with CC genotype (OR=1.97, 95%CI 1.55 to 2.51, P=0.00), and those of TT genotype compared with TC+CC genotype (OR=1.42, 95%CI 1.13 to 1.77, P=0.00). Increased risk was also observed in TT+TC genotype compared with CC genotype in young adult subgroup (aged less than 45) (OR=1.66, 95%CI 1.19 to 2.32, P=0.00). ConclusionMTHFR gene C677T polymorphism is significantly associated with susceptibility to young and middle-aged adult ischemic stroke among Chinese population, and more risk may exist in middle-aged adult population.
Objective To assess the effect of different thrombolytic agents, and different regimens in acute ischaemic stroke. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed. RCTs were identified from the Cochrane Stroke Group trials register, Embase (1980 to 1997), handsearching Japanese and Chinese journals, and personal contact with pharmaceutical companies. We included randomised and quasi-randomised trials in patients with confirmed acute ischaemic stroke comparing different doses of a thrombolytic agent, or different thrombolytic agent, or the same agent given by different routes. Results Eight trials involving 1 334 patients were included. Concealment of allocation was generally adequate. All the trials were conducted in Japan. Different doses (of tissue plasminogen activator or urokinase) were compared in six trials. Different agents (tissue plasminogen activator versus urokinase,or tissue-cultured urokinase versus conventional urokinase) were compared in three trials. Few data were available for functional outcomes. A higher dose of thrombolytic therapy was associated with a five-fold increase in fatal intracranial haernorrhages (odds ratio 5.02, 95% confidence interval 1.56 to 16.18). There was a non-significant trend towards more early deaths or clinically significant intracranial haemorrhages in higher dose group. No difference in late deaths or extra-cranial haemorrhages was shown between low and higher doses. However, very few of these events occurred. No difference was shown between the different thrombolytic agents tested. Conclusions There is not enough evidence to conclude whether lower doses of thrombolytic agents might be safer or more effective than higher doses in acute ischaemic stroke. It is not possible to conclude whether one agent might be better than another, or which route of administration might be best.
Stroke is a common and frequently-occurring disease, which seriously endangers human health. Rehabilitation treatment can effectively reduce the disability rate of stroke and improve the quality of life. The tertiary rehabilitation treatment system for stroke can effectively improve the motor function of stroke patients and improve the quality of life. This paper focuses on the choices and methods of physical therapy and occupational therapy at all levels of the hospitals and in different periods of the disease. It also aims to summarize the tertiary rehabilitation strategy for motor dysfunction in stroke patients, to provide references for all levels of hospitals and communities, achieve standardization and unification of rehabilitation treatment, as well as the rehabilitation efficacy of homogeneity.
Objective To explore the correlation between interleukin-6 (IL-6) 174G/C polymorphism and ischemic stroke risks. Methods Systematic searches of electronic databases as CBM, CNKI, PubMed, MEDLINE and EMbase were performed. Meta-analysis was conducted by using RevMan 5.1.2 and Stata 11.0 software. The pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) were performed. Publication bias was tested by funnel plot, Egger’s regression test and Begg’s test. Sensitivity analysis was made by repeating the fixed effects model or random effects model Meta-analysis with each of the studies individually removed. Results A total of 11 publications with 12 studies were identified. The results of meta-analyses showed no significant difference was found in the correlation between IL-6 174G/C polymorphism and ischemic stroke risks (for G/C vs. G/G: OR=0.98, 95%CI 0.78 to 1.24; for C/C vs. G/G: OR=0.75, 95%CI 0.38 to 1.50; for dominant inheritance model: OR=0.93, 95%CI 0.68 to 1.28; for recessive inheritance model: OR=0.80, 95%CI 0.45 to 1.42). In the subgroup analyses on ethnicity, no significant correlation was found. But in the subgroup analyses on source of control population, the hospital-based subgroup showed IL-6 174G/C polymorphism was the protective factor of ischemic stroke (for G/C vs. G/G: OR=0.56, 95%CI 0.40 to 0.79; for C/C vs. G/G: OR=0.17, 95%CI 0.11 to 0.27; for dominant inheritance model: OR=0.40, 95%CI 0.29 to 0.55; for recessive inheritance model: OR=0.24, 95%CI 0.16 to 0.37). Conclusion Meta-analysis bly suggests that the correlation between IL-6 174 G/C polymorphism and ischemic stroke is not significantly different.
This article investigates the role of AMP-activated protein kinase (AMPK) and its downstream signaling targets in mediating cellular processes such as autophagy, apoptosis, and inflammation, offering insights into how acupuncture may treat common central nervous system (CNS) diseases, including ischemic stroke, spinal cord injury, Parkinson disease, and Alzheimer disease. AMPK and its downstream effectors are pivotal in the signaling pathways that underlie the pathophysiology of CNS diseases. These pathways are implicated in a variety of cellular responses that contribute to the progression of neurological disorders. During CNS injury, AMPK can be activated through phosphorylation, triggering the regulation of downstream molecules and exerting protective effects on neuronal function. Acupuncture has been shown to promote neuroprotection and enhance recovery in CNS diseases through multiple mechanisms, one of which involves the activation of AMPK-related signaling pathways. Nevertheless, numerous unresolved challenges remain in this research field.