Acute Cerebral Infarction Patients Research Articles

Plasma Klotho concentrations predict functional outcome at three months after acute ischemic stroke patients

Background: The Klotho protects the cardiovascular system by protecting against cell apoptosis, inhibiting the production of reactive oxygen species, and modulating inflammation. We aimed to investigate relationship of plasma Klotho concentrations with functional outcome at 3 months after acute cerebral infarction.Methods: We prospectively enrolled 262 first-ever acute cerebral infarction patients from whom a blood sample was acquired within 24 h of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. Functional outcome on admission and three months was evaluated.Results: Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean ± standard deviation of plasma Klotho concentrations was 312.7 ± 153.3 pg/mL. As opposed to patients with good outcome, plasma Klotho levels were lower in the poor outcome group (207.8 ± 96.2 vs. 342.5 ± 153.5 pg/mL, p = .001). In multivariate analysis, increased plasma Klotho concentrations were independently associated with good functional outcome (Odds ratio: 2.42, 95% confidence interval: 1.45–4.04, p < .001).Conclusions: Increased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke. We attribute these associations to the pleiotropic effects of Klotho in stroke and vascular diseases.Key messageIncreased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke.

Risk factors and prognosis of acute cerebral infarction patients complicated with pulmonary infection

Objective To explore the risk factors and prognosis of pulmonary infection in patients with acute cerebral infarction. Methods From May 2015 to October 2017, the clinical data of 236 patients with acute cerebral infarction in the First People's Hospital of Jinzhong were studied.The patients were divided into infection group (36 cases) and uninfected group (200 cases) according to whether or not the infection occurs.The clinical data and prognosis were compared between the two groups for half a year. Results The age, disturbance of consciousness, difficulty swallowing, invasive operation, large area cerebral infarction between the infected group and uninfected group had statistically significant differences (t=11.093, χ2=83.388, 69.925, 43.274, 151.345, all P<0.05). Logistic regression analysis showed that the results of age, consciousness disorder, dysphagia, invasive operation and massive cerebral infarction all had statistically significant differences(all P<0.05). In the infected group, the length of hospitalization[(23.24±5.61)d] and the cost of hospitalization[(15 239.24±3 522.60) CNY]were significantly higher than those in the uninfected group[(15.65±2.35)d, (9687.24±2215.78) CNY](t=13.671, 12.486, all P<0.05). After treatment for 6 months, the neural function defect scale of the infection group[(24.26±2.12)points] was significantly higher than that of the uninfected group[(16.24±2.23)points], and the daily life activities ability score of the infection group[(70.12±2.81)points] was significantly lower than that of the uninfected group[(79.24±3.25) points], the differences were statistically significant between the two groups(t=20.009, 15.800, all P<0.05). Conclusion There are many risk factors of pulmonary infection in patients with acute cerebral infarction, such as advanced age, invasive operation, disturbance of consciousness, dysphagia, large area cerebral infarction and so on.The prognosis of patients with acute cerebral infarction complicated with pulmonary infection is poor. Key words: Brain infarction; Respiratory tract infections; Risk factors; Activity of daily living; Length of stay; Cost of hospitalization

Dynamic changes in miR-124 levels in patients with acute cerebral infarction

Objective: To investigate the changes in serum miR-124 levels in patients with acute cerebral infarction (ACI) and elucidate the underlying mechanism by a dynamic monitor.Methods: Fifty-four patients with ACI and 51 healthy controls were included in our study. Baseline characteristics and blood samples were collected for further analysis. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the serum miR-124 levels. The dual-luciferase reporter assay was used to evaluate the effect of miR-124 on iASPP, a protein that inhibits apoptosis stimulating proteins in the p53 family.Results: Compared with normal controls, the miR-124 levels in the ACI group rapidly decreased at phase 1 (within 24 h after ischemia) (p < 0.001) and then gradually increased at phase 2 (48 ∼ 72 h after ischemia) (p < 0.001) and phase 3 (the 7th day after ischemia) (p < 0.001). The dual-luciferase reporter assay showed that miR-124 down-regulates iASPP expression in 293T cells.Conclusion: The miR-124 levels are down-regulated in ACI patients. The dynamic changes of miR-124 might provide a possible method for the detection of ischemic stroke.HighlightsThe difference in miR-124 expression levels between ACI patients and normal controls.Dynamic changes of miR-124 expression levels in ACI patients.The down-regulation of miR-124 upon iASPP expression.

Abstract TP242: Internal Carotid Artery Angle and the Risk of Floating Mural Thrombosis in Acute Cerebral Infarction Patients

Background and Purpose: Floating mural thrombosis in an internal carotid artery (ICA) is a rare and uncommon pathology with a high risk of embolism. Carotid anatomy and geometry may play a role in the pathogenesis of internal carotid artery stenosis. However, their effects to the formation of thrombus are unknown. Therefore, we sought to find whether the ICA angle affected the formation of thrombus or not. Method: We retrospectively analyzed 603 consecutive patients with a diagnosis of acute cerebral stroke from April 2015 to June 2017. We conducted brain MRI/MRA scans and carotid ultrasonography to assess the atherosclerotic change and the prevalence of mural thrombosis. We found four patients (0.6%) with a mobile mural thrombus in the ICA without a significant stenosis. As a control group, we also chose 24 patients who had atherothrombotic infarctions with 50% or less ICA stenosis. We measured the ICA angle which is the angle of deviation of the ICA from a vertical line drawn through the center of the common carotid artery. We investigated the degree of ICA angle as well as traditional vascular risk factors and coagulation factors. Results: The mural thrombosis group was younger than the control group (60.5±14.7 vs. 76.5±8.7 years, p&lt;0.01). The ICA angle was significantly wider in patients with floating mural thrombosis (56.0°:IQR 33.3 to 69.6° vs. 24.5°:IQR 19.9 to 34.6°, p=0.009). There were no significant differences in coagulation factors, vascular risk factors, and comorbidities between the mural thrombosis group and the control group. Conclusion: Our study implies that wide ICA angle is an important factor for the formation of the floating mural thrombosis as well as developing carotid artery atherosclerosis.

Cystatin C as an index of acute cerebral infraction recurrence: one-year follow-up study

Background and purpose: Cystatin C is associated with acute cerebral infarction (ACI). However, the correlation of serum cystatin C level with recurrence of ACI and different subtypes of ACI had not been fully clarified. The aim of this study was to detect the relationship between serum cystatin C level and recurrent ACI in one-year follow-up and different subtypes of ACI.Methods: A total of 532 consecutive patients with ACI and 339 healthy controls were included. All ACI patients were followed up for one year, the clinical and biochemical characteristics of ACI and ACI recurrent patients were documented and analyzed.Results: A total of 477 (89.7%) patients completed one-year follow-up study, 64 (13.4%) patients suffered ACI recurrence. The results showed serum cystatin C was 1.04 ± 0.19 mg/L and 1.14 ± 0.49 mg/L in control and ACI, respectively (p< .001). The significant risk factors for ACI recurrence were presence of hypertension (p = .009, OR =3.32), diabetes (p =.03, OR =1.87), coronary heart disease (p = .01, OR =2.46), and cystatin C (p = .003, OR =2.87). The risk of ACI recurrence increased with serum cystatin C level. Additionally, cystatin C level was associated with different subtypes of ACI; large-artery atherosclerosis (LAA) subtype had the highest level of cystatin C in ACI and recurrent ACI group.Conclusions: Serum cystatin C level is an independent prediction biomarker for ACI recurrence. LAA subtype of ACI and ACI recurrence was more closely related to elevated cystatin C level.

Expression and Clinical Significance of Serum miR-497 in Patients with Acute Cerebral Infarction.

There are no effective serum biomarkers for early diagnosis and prognosis prediction of acute cerebral infarction (ACI). This study is to explore the roles of miR-497 in the prognosis of patients with ACI and the correlation between miR-497 and some cytokines. MiR-497 expression in 90 serum samples from ACI patients compared to 60 normal control samples subjects was determined by real-time PCR. The serum levels of IL-6, IL-22, IFN-γ, and TNF-α were detected using ELISA kits. Moreover, the GOS was used to evaluate the prognosis of ACI patients on the 30th day after onset. In addition, the diagnostic and prognostic value of miR-497 for ACI was systemically assessed. Serum miR-497 expression was significantly increased in ACI patients (p < 0.05) compared with the healthy control subjects. Additionally, the serum levels of IL-6, IL-22, IFN-γ, and TNF-α were remarkably up-regulated in ACI patients (p < 0.05, p < 0.01 or p < 0.001). Evaluated via the prognostic indicator GOS, the levels of serum miR-497, IL-6, IL-22, IFN-γ, and TNF-α were negatively correlated with GOS score, while miR-497 expression was positively correlated with IL-6, IL-22, IFN-γ, and TNF-α. The level of miR-497 may be used as a biological marker for prognosis of ACI patients. In addition, miR-497 in the serum has the potential to be a prognostic and diagnostic marker of ACI and a therapeutic target.

DCA can improve the ACI-induced neurological impairment through negative regulation of Nrf2 signaling pathway.

To investigate the effect of tauroursodeoxycholic acid (TUDCA) on neurological impairment induced by acute cerebral infarction (ACI) and its relevant mechanism of action. A total of 60 male Sprague-Dawley (SD) rats were randomly divided into Sham group (n = 20), ACI group (n = 20), and TUDCA group (n = 20). The rat model of ACI in middle cerebral artery was established. TUDCA was intravenously injected into rats in the TUDCA group, while an equal amount of sodium bicarbonate solution was intravenously injected into the other two groups. The blood was drawn after modeling to detect the content of serum glutamate (Glu), triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). The degree of cerebral infarction in each experimental group was observed under an optical microscope, and the infarct area was measured and compared. The content of serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and high-sensitivity C-reactive protein (hs-CRP) was detected via enzyme-linked immunosorbent assay (ELISA); mRNA and protein expressions of them were detected using reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, respectively, followed by statistical analysis. Moreover, the expression levels of serum malondialdehyde (MDA), oxidized-LDL (ox-LDL), superoxide dismutase (SOD), and glutathione peroxidase (GPX) were detected, followed by statistical analysis. The protein expressions of nuclear factor (erythroid-derived 2)-like 2 (Nrf2), very low-density lipoprotein receptor (VLDLR), nuclear factor-κB (NF-κB), B-cell lymphoma 2-associated X protein (Bax), and caspase-3 were detected via Western blotting, and the gray value was determined, followed by statistical analysis. TUDCA could improve the symptoms of neurological impairment in ACI patients, decrease the National Institute of Health Stroke Scale (NIHSS) score but increase the activity of daily living (ADL) score of patients, and significantly reduce the content of serum TG, TC, and LDL-C, showing statistically significant differences (p < 0.05). TUDCA significantly decreased the serum Glu content in ACI rats, reduced the cerebral infarction area and lowered the serum TG, TC, and LDL-C content, displaying statistically significant differences (p < 0 .05). Besides, TUDCA inhibited mRNA and protein expressions of TNF-α, IL-8, and hs-CRP, and alleviated the inflammatory response. TUDCA inhibited MDA and ox-LDL expressions, but increased SOD and GPX expressions, and relieved oxidative stress injury. In addition, TUDCA could negatively regulate Nrf2 signaling pathway, and down-regulated VLDLR and NF-κB protein expressions and expressions of apoptotic proteins (Bax and caspase-3). TUDCA can alleviate the ACI-induced neurological impairment in rats through mitigating lipid peroxidation and inflammatory response and reducing apoptosis, whose relevant mechanism may be that TUDCA negatively regulates Nrf2 signaling pathway.

Diagnostic Values of Neutrophil and Neutrophil to Lymphocyte Ratio in Distinguishing between Acute Cerebral Infarction and Vertigo

Vertigo and acute cerebral infarction (ACI) patients show similar symptoms such as dizziness and imbalance. This study was to investigate the diagnostic values of neutrophil counts and neutrophil to lymphocyte ratio (NLR) in distinguishing patients with ACI from those with vertigo. This retrospective study was performed and data were gathered from medical records of patients with vertigo symptoms from the Department of Emergency and Neurology Clinics who were admitted to the Fourth Affiliated Hospital Zhejiang University School of Medicine between August 2017 and January 2019. Of the 173 patients with vertigo symptoms, 111 non-ACI vertigo patients (vertigo group) and 62 cases diagnosed with ACI (ACI group) were enrolled in this study. The neutrophil counts, lymphocyte counts, platelet counts, NLR, and PLT to lymphocyte ratio (PLR) within 24 hours after admission were compared between the two groups. Student's t-test of independent samples was adopted for the comparison of the mean between two groups. The neutrophil counts and NLR were evaluated by comparing the areas under the receiver operating characteristic curve (AUC) in distinguishing patients with ACI from those with vertigo. Comparison of AUC was performed using the Z-test. The neutrophil counts and NLR were significantly increased in the ACI group compared with the vertigo group (all p < 0.05), while there were no significant statistical differences of the lymphocyte counts, platelet counts, and PLR (all p > 0.05); moreover, AUC in distinguishing patients with ACI from those with vertigo was 0.647 (95% confidence interval (CI), 0.570 to 0.718) for neutrophil counts and 0.639 (95% CI, 0.562 to 0.710) for NLR, but there was no significant statistical difference (p > 0.05); finally, the cutoff values were 3.1 x 109/L in distinguishing patients with ACI from those with vertigo (specificity 41.44% and sensitivity 83.87%) for neutrophil counts and 2 (specificity 55.86% and sensitivity 67.74%) for NLR. As easy-to-obtain inflammatory biomarkers, both neutrophil counts and NLR could demonstrate diagnostic values in distinguishing between ACI and vertigo.

Peripheral Blood Platelet to Lymphocyte Ratio as Potential Diagnostic and Prognostic Markers of Acute Cerebral Infarction and its Clinical Significance.

The aim of the present study is to explore the diagnostic and prognostic value of peripheral blood platelet-to-lymphocyte ratio (PLR) in acute cerebral infarction (ACI). We enrolled 121 patients with ACI and 35 healthy volunteers in the present study. The lymphocyte and platelet counts and the platelet-to-lymphocyte ratios of the candidates were calculated, and a receiver-operating characteristic (ROC) curve was drawn to examine whether PLR was a sensitive biomarker for distinguishing ACI patients from the healthy volunteers; moreover, the Glasgow outcome scale (GOS) results of the patients were recorded to evaluate the short-term prognosis of the patients, and the relationship between PLR and GOS were investigated. We observed that the platelet counts were decreased in patients with ACI compared to the healthy volunteers, but no significant differences were observed (p > 0.05). On the other hand, lymphocyte counts were significantly decreased in patients with ACI, and PLR was significantly increased in patients with ACI compared with the healthy controls (p < 0.001). Moreover, the area under the curve (AUC) of platelet counts, lymphocyte counts, and PLR were 0.5365 (95% confidence interval (CI), 0.4373 to 0.6357), 0.7526 (95% CI, 0.6630 to 0.8421), and 0.8320 (95% CI, 0.7586 to 0.9054), respectively, suggesting that PLR was a sensitive biomarker for distinguishing ACI patients from the healthy controls. Finally, the PLR of the patients were negatively correlated with the GOS score of the patients. We reported that PLR was significantly increased in the peripheral blood of patients with ACI, sug-gesting that PLR might be a potential early diagnostic and prognostic marker for ACI.

The role of high high-sensitivity C-reactive protein levels at admission on poor prognosis after acute ischemic stroke

Objective: Plasma high hypersensitive C-reactive protein (hs-CRP) levels are associated with risk and prognosis of vascular diseases. The clinical implications of markedly elevated hs-CRP levels are more discovered in the onset and development of stroke. The aim of this study is to determine the association of plasma hs-CRP levels on the prognosis in patients with acute ischemic stroke.Methods: Retrospective analysis of a single-center database of consecutive cases for acute cerebral infarction (ACI) from January 1 2012 to December 30 2016 was performed. Significant predictors of the dependent variable variance were identified by standard linear, univariate and multivariate, or binary logistic regression modeling. Multivariate regression analysis was introduced to investigate the relationship between plasma hs-CRP levels at admission and change in National Institutes of Health Stroke Scale (NIHSS) score at discharge.Results: The percentages of hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, body mass index (BMI) and chronic kidney disease were raised with the increase of hs-CRP plasma concentration at admission among all patients (p < 0.05). ACI patients with large-artery atherosclerosis had an increasing percentage with the increase of hs-CRP mean value (p < 0.05). The initial NIHSS scores, the acute infection rate and age advance also increased with the increase of hs-CRP plasma concentration at admission (p < 0.05). The ratio of neurological improvement increased with the decrease of plasma hs-CRP concentration (p < 0.05). The neurological deterioration and poor prognosis increased with the increase of plasma hs-CRP concentration (p < 0.05).Conclusion: High plasma hs-CRP levels are associated with worse outcomes in the ACI patients. Monitoring plasma hs-CRP levels and cutting down the elevated plasma hs-CRP levels will be beneficial in screening and treatment decisions for the prognosis of acute ischemic stroke.

Multivariate analysis of short-term prognostic factors in recanalization therapy for acute cerebral ischemia

Objective To analyze the clinical characteristics and short-term prognostic factors in acute cerebral infarction patients who underwent recanalization. Methods This retrospective study enrolled 94 cases of acute cerebral ischemic patients in the First Affiliated Hospital of Nanjing Medical University between October 2014 and August 2016. Based on the clinical characteristics of the enrolled patients, a multivariate Logistic regression model was established to analyze the risk factors of unfavorable prognosis. Besides, patients were further divided into good collateral circulation group (1-2) and poor collateral circulation group (3-5) according to the Pial Collateral score, and the prognosis improvement rates between patients recanalized within 4 h and over 4 h were analyzed in each group. Chi-square test or Fisher’s exact test was used to analyze statistical difference as indicated. Results By multivariate Logistic regression analysis, age older than 70 years old (OR=2.651, 95%CI: 1.013-6.937) and poor collateral circulation (OR=3.160, 95%CI: 1.113-8.977) were independent risk factors of short-term poor prognosis. In the poor collateral circulation subgroup, patients recanalized within 4 h exerted a relatively better prognosis than patients recanalized over 4 h (42.9% vs.10.5%, P=0.047). However, the effect of recanalization duration on the prognosis in the good collateral circulation subgroups was not statistically significant (42.9% vs. 10.5%, P=0.047), however, the effect of recanalization duration on prognosis in patients with good collateral circulation was not statistically significant (58.3% vs. 37.8%, P=0.117). Conclusions For patients with acute cerebral infarction, age and collateral circulation status may influence the prognosis of recanalization therapy. The treatment time had a significant influence on the prognosis in patients with poor collateral, while it had minimal significance on patients with good collateral. Key words: Retrospective research; Cerebral infarction; Vascular recanalization; Prognosis; Influencing factor; Logistic regression model; National Institute of Health Stroke Scale; Collateral circulation

Prediction of hemorrhagic transformation in patients with mild atrial fibrillation-associated stroke treated with early anticoagulation: post hoc analysis of the Triple AXEL Trial

ObjectivesTo investigate the predictors of hemorrhagic transformation (HT) in patients with mild atrial fibrillation-related stroke who were treated with early anticoagulation. We conducted a post-hoc subgroup analysis from Acute Cerebral Infarction Patients with Non-valvular Atrial Fibrillation (Triple AXEL) study. Patients and methodsThe Triple AXEL study was a randomized, multicenter, open-label, blinded end-point evaluation, comparative phase 2 trial. To identify the relationship between the type of HT and risk factors. We analyzed various factors using data from the Triple AXEL study, such as sex, history of hypertension, diabetes, microbleeds, concomitant antiplatelet use, initial infarction volume, initial infarction location, and new intracranial hemorrhage on follow-up gradient recalled echo or susceptibility-weighted imaging. ResultsWe analyzed various factors by dividing patients into a new HT group and a no HT group. No correlation was found between HT and risk factors that were significantly associated with HT, including age, sex, history of hypertension, diabetes, microbleeds, concomitant antiplatelet use, and initial infarction volume. When the initial infarction was classified into anterior circulation infarction (ACI) and posterior circulation infarction (PCI), the occurrence of new HT was significantly more associated with PCI than with ACI (57.6% vs 24.0%, P = 0.001). Multivariate logistic regression analysis was performed using HT as a response variable. Only the location of initial infarction according to the vascular territory contributed to the increased risk of HT (OR2.3, 95%CI1.33–3.91, P = 0.003). ConclusionPCI is a very important independent risk factor for HT in patients with mild AF-related stroke treated with early anticoagulation.

Autologous Endothelial Progenitor Cells Transplantation for Acute Ischemic Stroke: A 4-Year Follow-Up Study.

Transplantation of endothelial progenitor cells (EPCs) is a proven safe and effective method for treatment of cerebral ischemia in animal experiments. However, safety and efficacy need to be determined in clinical trials. We performed a two‐center, randomized, placebo‐controlled phase I/IIa trial with blinded outcome assessment on 18 patients with acute cerebral infarct within the middle cerebral artery territory, and followed for up to 4 years. Autologous ex vivo expanded EPCs were injected intravenously in the EPC group, and patients who received saline or autologous bone marrow stromal cells served as control groups. Mortality of any cause, adverse events, and new‐onset comorbidities were monitored. Changes in neurological deficits were assessed at different time points. We found no toxicity events or infusional or allergic reactions in any treated group. Three patients in the placebo group died during the 4‐year follow‐up. We found that the EPC group had fewer serious adverse events compared with the placebo‐controlled group, although there were no statistical differences in mortality among the three groups. Furthermore, there was no significant difference in neurological or functional improvement observed among the three groups, except for the Scandinavia Stroke Scale score at 3 months between the EPC group and placebo‐controlled group. Autologous transplantation of EPCs appears to improve long‐term safety in acute cerebral infarct patients, supporting the feasibility of this novel method for treatment of ischemic stroke (ClinicalTrials.gov: NCT01468064). Stem Cells Translational Medicine 2019;8:14–21

Correlation between antiplatelet therapy in secondary prevention of acute cerebral infarction and cerebral microbleeds: A susceptibility-weighted imaging (SWI) study.

To investigate the clinical significance of antiplatelet aggregation therapy for patients diagnosed with acute cerebral infarction (ACI) complicated with the cerebral microbleeds (CMBs). Thirty patients with ACI and 36 patients with intracerebral hemorrhage (ICH) were included in this research. Two groups, studied by susceptibility-weighted imaging (SWI), were compared in terms of the number, location, and severity of CMBs. Then, 30 cases of ACI patients were divided into CMBs sub-group and non-CMBs sub-group. Univariate analysis between these two sub-groups was performed to determine the risk factors regarding the incidence of CMBs. For ACI patients, the number of CMBs before and after applying anti-platelet treatment were compared to examine the impacts of anti-platelet treatment on hemorrhagic transformation. CMBs were found to be more prevalent and severe in ICH patients than in ACI patients. CMBs in patients with ICH were more severe than in patients with ischemic stroke (IS), which indicates that CMBs closely relate to ICH. Hypertension and leukoaraiosis were found to have significant effects on the incidence of CMBs. After anti-platelet treatment, patients with CMBs (≥5) increased the number of CMB, whereas there was no obvious effect on patients with the CMBs less than 5 or no CMBs. The number of CMBs increased significantly among ACI patients with 5 or more CMBs before the anti-platelet treatment. CMBs are more frequently found in patients with hemorrhagic stroke than in patients with ischemic stroke, and more severe than the latter, which suggests that the clinical impact of higher association between the increase of the number of the CMBs and the hemorrhagic stroke.

Values of serum LDL and PCT levels in evaluating the condition and prognosis of acute cerebral infarction.

Values of low density lipoprotein (LDL) and procalcitonin (PCT) levels in evaluating the condition and prognosis of patients with acute cerebral infarction (ACI) were investigated. According to the volume of cerebral infarction, 150 patients with ACI (observation group) were divided into the mild infarction group (n=50), moderate infarction group (n=50), and severe infarction group (n=50). Besides, another 50 healthy subjects were enrolled during the same period as the control group. The levels of serum LDL and PCT on admission and at the 1st, 3rd, 7th and 10th day after treatment were detected, which were compared with those in the control group. Ten days after treatment, patients were divided into two groups, the effective group and non-effective group, based on the clinical efficacy. The differences in LDL and PCT levels were compared between the two groups. After 1 month, the clinical efficacy was evaluated again, and the correlations of LDL and PCT levels with prognosis were analyzed. The levels of serum LDL and PCT in the observation group 1 day after admission were higher than those in the control group (P<0.05), which reached the peak at the 3rd day and continuously declined after the 7th day. The LDL and PCT levels had statistically significant differences between the effective group and non-effective group (P<0.05). Pearson's correlation analysis showed that the serum LDL and PCT levels in acute phase were negatively correlated with the National Institutes of Health Stroke Scale (NIHSS) score after 1 month of treatment (P<0.05). The dynamic monitoring of serum LDL and PCT levels in ACI patients can help evaluate the condition and prognosis of patients.

Plasma D-dimer level for prediction of functional outcome in ischemic stroke

Elevated D-dimer level has positive correlations with infarction volume and stroke severity on admission. Previous studies have demonstrated that D-dimer levels predict a progressing stroke, which is associated with poor short-term outcome in acute ischemic stroke. Conflicting data about the relationship between D-dimer level and functional outcomes were reported. We aimed to investigate the relations between serum D-dimer levels on admission and functional outcome of subacute stage in ischemic stroke patients. We retrospectively reviewed the medical records of 68 first-ever acute cerebral infarction patients (35 men, 33 women; age 67.2 ± 13.8 years). Plasma D-dimer level was measured on admission within 24 hours after stroke onset. The patients were classified into elevated group (plasma D-dimer > 0.55 mg/L FEU, 31 patients) and control group (≤ 0.55 mg/L FEU, 37 patients) based on the level of plasma D-dimer. National Institutes of Health Stroke Scale (NIHSS) was checked within a week after stroke onset. Modified Barthel Index (MBI) and PULSES profile were assessed on admission and at 3 months after stroke onset. (1) Plasma D-dimer level on admission was 0.32 ± 0.11 mg/L in control group and 2.59 ± 3.61 mg/L in elevated group. (2) NIHSS was 6.32 ± 3.80 in control group and 9.30 ± 6.63 in elevated group. There was no significant difference in NIHSS between both groups ( P = 0.073). (3) ΔMBI was 23.39 ± 16.28 in control group, 12.00 ± 13.05 in experimental group. There was significant difference in ΔMBI between both groups ( P = 0.004). There was a significant correlation between the level of plasma D-dimer on admission and ΔMBI ( r = −0.304, P = 0.012). (4) ΔPULSES was 2.00 ± 2.42 in control group and 1.03 ± 1.83 in elevated group. There was no significant difference in ΔPULSES between both groups ( P = 0.059). Plasma D-dimer level measured on admission would be helpful for predicting the functional outcome at subacute stage in ischemic stroke patients.

Effects of edaravone, the free radical scavenger, on outcomes in acute cerebral infarction patients treated with ultra-early thrombolysis of recombinant tissue plasminogen activator

ObjectivesEdaravone, a free radical scavenger, alleviates blood-brain barrier disruption in conjunction with suppression of the inflammatory reaction in acute cerebral infarction. Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established therapy for acute cerebral infarction patients. The purpose of this study was to assess the effects of edaravone on outcomes in acute cerebral infarction patients treated with ultra-early thrombolysis of iv-rt-PA. Patients and MethodsWe conducted a retrospective cohort study using the database of Ningbo First Hospital. We identified patients who were admitted with a primary diagnosis of acute cerebral infarction and treated with intravenous rtPA(iv-rtPA) within 3 h of symptom onset from March 1st in 2014 to October 31st in 2016.Thenceforth,the patients were divided into 2 groups by treatment with(edaravone group) or without edaravone(non-edaravone group). Glasgow Coma Scale (GCS) scores and mRS score at admission were used. Clinical background, risk factors for acute cerebral infarction hemorrhagic transformation, 7-day mortality, recanalization rate, bleeding complications and blood rheology indexes were collected. We also collected the following factors: National Institutes of Health Stroke Scale scores, barthel index. Results136 patients treated without edaravone during hospitalization were selected in non-edaravone group while edaravone group included 132 patients treated with edaravone during hospitalization. The patient baseline distributions were well balanced between non-edaravone group and edaravone group. The rate of hemorrhagic transformation in non-edaravone group was higher than that in edaravone group (P ＜ 0.05). The NIHSS scores 7 days and 14 days after symptom onset were higher in non-edaravone group than in edaravone group (both P ＜ 0.05). Edaravone group showed a higher recanalization rate and a lower bleeding complications rate at discharge than the non-edaravone group (both P ＜ 0.05). The differences of all the blood rheology indexes between the two groups were statistically significant (all P ＜ 0.05). ConclusionsEdaravone may improve outcomes of acute cerebral infarction patients treated with ultra-early thrombolysis of iv-rt-PA.

Abstract TP147: Factors Influencing Home Discharge Preference of Inpatients With Acute Cerebral Infarction: A Retrospective Cohort Study

Background and Purpose: Many previous studies explained clinical predictors of discharge planning for inpatients with acute cerebral infarction, while the factors that influence inpatients and their family’s preference for discharge destination are not often investigated. The purpose of this study was to clarify the relationship between home discharge preference of inpatients with acute cerebral infarction and socio-demographic factors or clinical characteristics. Methods: We surveyed the electronic medical records of 2,495 (mean age 73.5+ years, 62% were male) acute cerebral infarction patients who were admitted to a stroke center in Japan between January 1, 2011 and December 31, 2015. The main outcome variable was the home discharge preference within 5 days after hospitalization. The explanatory variables were socio-demographic and clinical factors. Multiple logistic regression analysis with backward variable selection was performed to investigate relationships between home discharge preference and these factors. Results: In all, 1,056 (42%) patients showed their preference for discharge to their homes. Multiple logistic regression analysis identified relationships between discharge preference to home and five variables. Patients exhibiting the following characteristics tend to show the preference for discharge to their home: higher age, paresis, cancer, cohabitating, and higher functional independence measure motor (FIM-M) score on admission (13-91 points). The odds ratio of these factors for home discharge preference were 1.02 per a year (95% confidence interval[95%CI] 1.00-1.03), 3.68 (vs. without paresis, 95%CI 1.83-7.38), 2.35 (vs without cancer, 95%CI 1.11-4.94), 3.04 (vs. living alone, 95%CI 2.03-4.56), 1.06 (vs lower FIM-M score, 95% 1.05-1.07), respectively. The model showed an area under the curve equal to 0.83 (95%CI 0.80-0.86). Conclusion: Patients’ preference for home discharge is influenced largely by physical impairments and support availability. Additionally, patients with comorbidity such as cancer tend to choose facility care rather than home care. These results showed that development of a family support system for elder patients in multimorbid situations facilitated their decision for home discharge.

Distensibility coefficient of the common carotid artery in acute cerebral infarct by M-mode ultrasound: A cross-sectional study

Introduction: Distensibility coefficient (DC) is abnormal in most cases of acute cerebral infarct patients. Intima-media thickness (IMT) is measured by B (brightness)-mode and distensibility by M (motion)-mode ultrasound. DC is not routinely measured in clinical practice even though it is the earliest functional change to occur in common carotid arteries. IMT represents structural change and DC represents functional changes that occur in common carotid.Aim: DC is a valid independent indicator for risk assessment of acute cerebral infarcts. The present study is aimed at knowing the association of abnormal DC with acute cerebral infarct patients.Materials and Methods: Cross sectional study was undertaken over a period of 9 months with 210 cases of acute cerebral infarct. Distensibility of common carotid artery was measured by M-mode ultrasound. Cramer's V value ranged from 0.0 to 1.0 and P < 0.05 was considered statistically significant.Results: DC was reduced in 62.8% of the total 210 cases of acute cerebral infarct. Maximum cases (38%) were in the age groups of 61–70 years. Cramer's V value ranged from <15 to <24 × 10−3 kPa (P < 0.001). There was a good association between reduced DC and acute cerebral infarct in the present study.Conclusion: DC is a valid independent risk factor for acute cerebral infarct. DC represents functional vessel wall property and decreases with age. M-mode-derived measurements for DC are valid, and abnormal DC value is associated well with acute cerebral infarct.

Clinical value of detection of homocysteine and high sensitive C reactive protein in diagnosis of patients with acute cerebral infarction

Objective To explore the application value of combined detection of homocysteine (Hcy) and high sensitive C reactive protein (hs-CRP) in diagnosis of patients with acute cerebral infarction (ACI). Methods 15 cases with ACI were selected as the study group.According to Hamilton Depression Scale (HAMD), the patients were divided into depression group (n=5) and non-depression group (n=10), another 15 healthy persons were selected as control group.The fasting venous blood was extracted in the early morning, the levels of Hcy and hs-CRP were detected by enzyme linked immunosorbent assay and turbidimetry, and the results were analyzed. Results The serum levels of Hcy and hs-CRP in the study group were (16.70±2.65)μmol/L, (10.16±1.08)mg/L, respectively, which were significantly higher than those in the control group, the differences were statistically significant (t=8.55, 9.31, all P<0.05). The serum levels of Hcy and hs-CRP in the moderate group were (16.28±2.09)μmol/L, (10.23±1.32)mg/L, respectively, which were significantly higher than those in the mild group, the differences were statistically significant (t=6.75, 8.56, all P<0.05). The serum levels of Hcy and hs-CRP in the severe group were (20.54±2.54)μmol/L, (15.10±1.49)mg/L, respectively, which were significantly higher than those in the mild group and moderate group, the differences were statistically significant (t=6.64, 7.88, t=6.69, 6.44, all P<0.05). The serum Hcy, hs-CRP levels in patients with middle cerebral infarction group were (15.78±1.56)μmol/L, (10.54±1.67)mg/L, respectively, which were significantly higher than those in the small infarction group, the differences were statistically significant (t= 6.36, 7.83, all P<0.05). The serum Hcy, hs-CRP levels in the patients with large infarction group were (21.77±2.05)μmol/L, (16.76±1.79)mg/L, respectively, which were significantly increased compared with the small infarction group and the middle infarction group, the differences were statistically significant(t=6.70, 7.55, t=6.46, 6.65, all P<0.05). The serum levels of Hcy and hs-CRP in ACI patients with depression were (19.98±2.69)μmol/L and (14.06±1.93)mg/L, respectively, which were significantly higher than those in the non-depression group (t=6.87, 7.50, all P<0.05). Conclusion Detection of Hcy and hs-CRP has high application value in the early prevention and diagnosis of patients with ACI, it is worthy of promoting. Key words: Homocysteine; C reactive protein; Acute cerebral infarction; Prevention; diagnosis