Ischemic Stroke In China Research Articles

Efficacy and safety of the injection of the traditional Chinese medicine salviae miltiorrhizae and ligustrazine hydrochloride for the treatment of perioperative period of fracture: A meta-analysis of randomized controlled trials.

Background:The injection of the traditional Chinese patent medicine salviae miltiorrhizae and ligustrazine hydrochloride injection (SMLHI) has been widely used in treatment of various diseases such as angina pectoris or ischemic stroke in China. We aim to evaluate the efficacy and safety of SMLHI for the treatment of perioperative period of fracture.Methods:A systematic literature search was performed in seven medical databases from their inception until February 2019. 16 studies with randomized controlled trials, totaling 1589 patients, were included in this meta-analysis. The included studies were assessed by the cochrane risk of bias and analyzed by Review Manager 5.3 software.Results:The meta-analysis showed that SMLHI for the treatment of perioperative period of fracture was significantly better compared with the control group in terms of the total effective rate. The result showed that SMLHI could significantly reduce the risk of deep vein thrombosis and inflammatory cytokines. Furthermore, the result showed that SMLHI could significantly improve the coagulation function indexes such as prothrombin time, plasma fibrinogen and D-Dimer (P < .0001).Conclusions:This meta-analysis demonstrated that SMLHI may be more effective and safe for the treatment of perioperative period of fracture. However, further and higher quality randomized controlled trials are required to prove treatment outcome.

Application of capillary index score in predicting three-month functional outcome after endovascular treatment for acute ischemic stroke in China.

Preoperative neuroimaging assessment of collateral circulation is important for selecting acute ischemic stroke patients who are appropriate for endovascular treatment. We sought to validate the capillary index score system in an Asian population and compare its ability in predicting clinical outcomes with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system. We continuously enrolled acute ischemic stroke patients from two neurological centers from March 2014 to March 2017. Multivariate analyses were performed to assess the capillary index score system with 90-day clinical outcome (modified Rankin scale score). The scoring systems were compared for predicting good (modified Rankin scale 0-2) and excellent (modified Rankin scale 0-1) functional outcomes using area under the receiver operating characteristic curves. We identified 157 patients (median age, 65 years; 96 (61.1%) males), of whom 71 (45.2%) patients with 90-day good functional outcomes were selected. Capillary index score was independently associated with clinical outcome after endovascular treatment (OR 0.63; 95% CI 0.43-0.92; P = 0.016) with its predictive ability for good functional outcome (area under the receiver operating characteristic curve 0.755). For excellent functional outcome, the capillary index score system was not inferior to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system (area under the receiver operating characteristic curve 0.748 versus 0.793, P = 0.09). The capillary index score system is a potentially useful tool for predicting 90-day functional outcomes in acute ischemic stroke patients after endovascular treatment.

Cost-Effectiveness of a Multifaceted Quality Improvement Intervention for Acute Ischemic Stroke in China.

Background and Purpose- Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world's largest low- and middle-income country. Methods- A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings. Results- Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1× gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year. Conclusions- A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.

Risk Factors of Incident Total Stroke and Ischemic Stroke in China

Background: Stroke places a considerable burden on human beings. Managing risk factors is crucial to prevent stroke. However, few cohort studies have evaluated socioeconomic factors together with conventional factors affecting incident stroke, particularly ­in China. Methods: A 2014-2016 cohort of the China National Stroke Screening and Intervention Program was studied, comprised 437 318 adults aged 40 years or older without stroke at baseline from 31 provinces. Cox regression yielded adjusted hazard ratios for risk factors related to the incidence of first-ever stroke and ischemic stroke. Findings: There were 2 429 cases of first-ever stroke during a median follow-up period of 2·1 years, including 2 206 ischemic strokes and 237 hemorrhagic strokes. The multivariable Cox regression analysis indicated that age 50–59 years (vs. 40-49 years), primary school or no formal education (vs. middle school), having more than one child (vs. one child), and living in Northeast, Central, East, or North China (vs. Southwest China), fruit consumption ≤4 days/week (vs.≥5 days/week), vegetable-based diet (vs. balance portion of vegetables and meat), physical inactivity, smoking (former, current, and passive), heavy drinking, hypertension, diabetes, obesity, family history (stroke, coronary heart disease, and hypertension) were positively associated with the risk of total and ischemic stroke, whereas age 60-69 years (vs. 40-49 years), living with spouse or children (vs. living alone), and vegetable consumption 3-4 days/week (vs.≥5 days/week) were negatively associated with the risk of total and ischemic stroke. The population-attributable risk of hypertension for stroke was the highest among all modifiable risk factors, followed by physical inactivity and smoking. Interpretation: We identified socioeconomic factors that complement traditional risk factors associated with incident stroke and ischemic stroke, allowing targeting these factors to reduce stroke burden. Funding Statement: The National Natural Science Foundation of China (No. 71532014). Declaration of Interests: The authors stated: None. Ethics Approval Statement: The study was performed according to the Helsinki declaration and approved by the Ethics Committee of Xuanwu Hospital Institutional Review Board of Capital Medical University, located in Beijing, China. All participants were informed about the study and signed written informed consent.

Risk factors associated with recurrence within 90 days of ischemic stroke onset in chinese medicine hospital: A national cross-sectional study in China

Objective: The short- and long-term risk factors for stroke recurrence may be different. This study is aimed to determine the risk factors for recurrence within 90 days in patients with ischemic stroke in China. Method: This was cross-sectional registry-based study in Chinese medicine hospitals from eight provinces and ten cities in China between November 3, 2016 and May 28, 2018. Two thousand one hundred and twenty patients with ischemic stroke aged between 35 and 80 years. Stroke recurrence was defined as an outcome indicator. Computed tomography/magnetic resonance imaging was used as a diagnostic tool for stroke recurrence. Patients' age, sex, height, weight, body mass index (BMI), education level, medical history, family history, smoking, and drinking were recorded. Routine laboratory examinations were performed. Associated factors were investigated by calculating the odds ratio (OR) using logistic regression modeling. Results: In all, 2120 patients were included in the study, 712 (33.6%) of whom were women and 1408 (66.4%) were men, with a mean age of 62.84 ± 9.35 years. Eighty-two patients experienced stroke recurrence within 90 days, and the accumulative recurrence rates of stroke were 3.9% (95% confidence interval [CI], 3.0%–4.7%). The binary logistic analysis showed that previous history of one (OR = 8.113; 95% CI, 4.497–14.637), two (OR = 8.848; 95% CI, 4.025–9.449), or ≥3 ischemic strokes (OR = 24.599; 95% CI, 9.307–65.018), and BMI

D-dimer and diffusion-weighted imaging pattern as two diagnostic indicators for cancer-related stroke: A case-control study based on the STROBE guidelines.

The aim of this study was to evaluate the risk factors and elucidate the clinical characteristics of cancer-associated ischemic stroke to differentiate it from conventional ischemic stroke in China and East Asia. Between June 2012 and June 2016, a retrospective analysis was performed on 609 stroke patients with cancer. They were divided into 3 groups: cancer-stroke group (CSG, 203 cases), stroke group (SG, 203 cases), and cancer group (CG, 203 cases). The d-dimer levels and diffusion-weighted imaging lesion (DWI) pattern were compared to an age- and sex-matched control group. The most common cancer types were colorectal cancer (20.2%) and lung cancer (18.72%). The average d-dimer level in stroke patients and cancer patients were 0.34 and 1.50 mg/L, respectively. The descending levels of d-dimer from cancer types were lung cancer (2.06 mg/L), pancreas (1.74 mg/L), gastric (1.61 mg/L), among others. Univariate analysis of the CSG and the others shows there were significant differences in the prevalence of the levels of d-dimer and DWI pattern, hypertension, diabetes mellitus, and thrombus. CSG has a unique pathological characteristic including high plasma d-dimer levels and multiple vascular lesions. The results show that d-dimer and DWI can be used as diagnostic index in clinical practice.

Effects of the introduction of objective criteria for referral and discharge in physical therapy for ischemic stroke in China: a randomized controlled trial

Objective: To examine the effectiveness of a set of rules for referral and therapy input in a three-tiered physiotherapy program on activities of daily living (ADL), motor function, and quality of life of stroke survivors. Design: Randomized controlled study. Setting: Rehabilitation departments of 11 teaching hospitals. Subjects: A total of 285 participants with stroke. Outcome measures: Primary outcome was ADL independence measured with the Modified Barthel Index (MBI) at weeks 3, 6, 9, 13, and 17. Secondary outcomes were motor function and quality of life measured with Fugel-Meyer Assessment (FMA) and Stroke-Specific Quality-of-Life (SSQOL) scale. Intervention: Two complementary sets of rules governing rehabilitation delivery were introduced: a set of criteria that determined when someone ought to move from tier 1 onto tier 2, and from tier 2 onto tier 3, and a second set of rules that determined the amount and type of physiotherapy input given in each tier. Control group participants received conventional rehabilitation without any specified guidelines. Results: With a difference of 3.97 (95% confidence interval (CI): 1.59–6.36), MBI increased stronger in the study group than in controls between baseline and week 3 (P = 0.001). This difference could be sustained until study end-point. No significant differences were found for FMA. Differences in increase of SSQOL were higher in the intervention than control at week 9 (P < 0.05). Conclusion: Introduction of a set of rules for referral and therapy input at different stages of rehabilitation partially improved patients’ ADL and quality of life, but did not improve motor function.

Short-term effect of PM1 on hospital admission for ischemic stroke: A multi-city case-crossover study in China

This study aims to examine the association between short-term exposures to PM1, PM2.5 and PM10 (particulate matter with aerodynamic diameters ≤1 μm, ≤2.5 μm and ≤10 μm, respectively) and hospital admission for ischemic stroke in China. Daily counts of hospital admission for ischemic stroke were collected in 5 hospitals in China during November 2013 to October 2015. Daily concentrations of PM1, PM2.5 and PM10 were collected in 5 cities where the hospitals were located. A time-stratified case-crossover design was used to examine the hospital-specific PM-ischemic stroke association after controlling for potential confounders. Then the effect estimates were pooled using a random-effect meta-analysis. A total of 68,122 hospital admissions for ischemic stroke were identified from 5 hospitals during the study period. The pooled results showed that exposures to PM1, PM2.5 and PM10 were significantly associated with increased hospital admission for ischemic stroke on the current day and previous 1 day. The RRs (relative risk associated with per 10 μg/m3 increase in each pollutant) and 95%CIs (confidence intervals) for the cumulative effects of PM1, PM2.5 and PM10 on ischemic stroke during lag 0–1 days were 1.014 (1.005, 1.0023), 1.007 (1.000, 1.014) and 1.005 (1.001, 1.009), respectively. In total, 3.5%, 3.6% and 4.1% of hospital admissions for ischemic stroke could be attributable to PM1, PM2.5 and PM10, respectively. Exposures to ambient PM1, PM2.5 and PM10 pollution showed acute adverse effects on hospital admission for ischemic stroke. The health effects of PM1 should be considered by policy-makers.

Trends in Outcomes of Patients With Ischemic Stroke Treated Between 2002 and 2016: Insights From a Chinese Cohort.

Little is known about long-term trends in outcomes of patients with ischemic stroke in China. We aimed to assess longitudinal trends in these outcomes over the past 15 years in China and explore possible factors behind the trends. Patients with ischemic stroke admitted to the Department of Neurology at West China Hospital were prospectively and consecutively enrolled in a central registry since 2002, and the present study analyzed data from those admitted to hospital within 7 days of stroke during the period 2002 to 2016. Patients were binned into three 5-year intervals for temporal analysis. Death, disability, and death/disability at 3 and 12 months after stroke were compared among the time intervals across the entire sample and in subsets stratified by age (<65 or ≥65 years). To explore the possible factors related to the trends in outcomes, interaction between the factors and time on outcomes was entered separately into the multivariable logistic regression model. Of 6462 patients with ischemic stroke in the final analysis, 3837 (59.4%) were men, and mean age was 64.2 years (SD, 13.7). Mean age at stroke onset and National Institutes of Health Stroke Scale score at admission decreased significantly during the 15-year period (P<0.001). Between 2002 to 2006 and 2012 to 2016, cumulative incidences declined significantly for death at 3 months (from 9.6% to 6.4%), disability at 3 months (from 36.8% to 28.7%), and death/disability at 3 months (from 42.9% to 33.3%), as well as for death at 12 months (from 15.9% to 10.7%), disability at 12 months (from 23.2% to 17.6%), and death/disability at 12 months (from 35.4% to 26.4%; all P<0.001). The decreases in disability and death/disability at 3 and 12 months between 2002 to 2006 and 2012 to 2016 remained significant after adjusting for confounders, and the results were similar for the entire cohort and for subgroups of patients <65 or ≥65 years. Only interactions of National Institutes of Health Stroke Scale score on admission and time period (2012-2016) were found to significantly correlate with disability and death/disability at 3 and 12 months (all P≤0.03). Our study from a large medical center in southwest China suggests that since 2002, risks of disability and death/disability at 3 and 12 months after ischemic stroke have declined. This appears to be due, at least in part, to a significant decline in National Institutes of Health Stroke Scale score on admission, which may reflect greater public awareness of stroke detection, willingness to seek medical attention, and ease of access to healthcare infrastructure. The factors behind this apparent improvement require further study.

Prognosis and Associated Factors among Elderly Patients with Small Artery Occlusion

Small artery occlusion (SAO) is the one of the primary subtype of ischemic stroke in China. However, its outcomes among elderly patients are unclear. Consecutive patients with SAO were recruited at Jiamusi University First Hospital, China between January 2008 and December 2016. Stroke subtype, severity, and risk factors were collected; outcomes at 3, 12, and 36 months after stroke onset were assessed. A total of 1464 SAO patients were included in this study. Participants aged ≥75 years had higher dependency rates than Participants aged <75 years with SAO in all three follow-up periods, in addition to a higher recurrence rate at 12 months and a higher mortality rate 36 months after stroke. After adjusting for confounders, elevated triglyceride level was found to be a protective factor against mortality 36 months after stroke. Stroke severity, diabetes mellitus, artery stenosis, gender, obesity, and high-density lipoprotein cholesterol level were independently associated with the risk of dependency; elevated triglyceride level was an independent risk factor for recurrence at 3 months point after stroke onset. These findings suggest that it is vital to manage risk factors that may affect prognosis of stroke among elderly patients with SAO to improve patient prognosis and reduce the burden of stroke in China.

Research progress and inspiration on treatment of acute ischemic stroke in China and abroad

Acute ischemic stroke is the main type of stroke and its treatment highly relies on time. Thus how to conduct treatment effectively is the current research hotpot. This article summarizes the treatment methods, treatment modes and specialized nursing of acute ischemic stroke aiming to provide some references for the treatment of ischemic stroke in China. Key words: Review; Stroke; Acute ischemic stroke; Treatment

Safety and Efficacy of the C-117 Formula for Vulnerable Carotid Artery Plaques (Spchim): A Randomized Double-Blind Controlled Pilot Study.

Objective To investigate the safety and efficacy of the Herbal Medicine C-117 (C-117) formula in the treatment of carotid atherosclerotic vulnerable plaques. Methods This was a prospective, single-centre, randomized, double-blind study. A total of 120 eligible patients were randomly divided into two groups to receive the C-117 formula or placebo. As the basic treatment, both groups were treated according to the Guidelines for Secondary Prevention of Ischemic Stroke/Transient Ischemic Stroke in China using statins to regulate blood lipids, blood pressure lowering drugs, drugs for controlling blood sugar, and antiplatelet drugs according to the indications. The primary outcomes were the change in stability, the mean change of the plaque Crouse score, and the area and number of bilateral carotid artery plaques before and after 6 months of treatment. The secondary outcomes were the total number of cardiocerebrovascular events during the treatment and follow-up and the mean changes of lipid levels. Result After 180 days of treatment, the plaque Crouse score(95% CI, 0.39 (0.01-0.77), P=0.046) and plaque area (95% CI, 2.14 (-10.10-14.39), P=0.727) were lower in the C-117 formula group than that before treatment. The plaque Crouse score of the control group (95% CI, 0.17 (-0.24-0.57), P=0.417) was lower than that before treatment, while the plaque area (95% CI, -0.35 (-9.35-8.65), P=0.938) increased, but without statistical significance. There was no significant difference in the reduction of the intima-media thickness (IMT), plaque Crouse score, or plaque area between the two groups after treatment (P>0.05). Subgroup analysis of patients whose Lipitor medication time ≥ 20% of the 6-month treatment showed that the levels of total cholesterol, triglycerides, and low-density lipoprotein were lower in the two groups after treatment than before, and the low-density lipoprotein levels in the C-117 formula group significantly decreased (95% CI, 2.99 (-0.08-0.39), P=0.005), but there was no statistical difference between the two groups after treatment (P>0.05). No serious adverse events occurred in the two groups after 180 days of treatment. Conclusion The C-117 formula may be antiatherosclerotic by strengthening statins to reduce the low-density lipoprotein levels and reducing the carotid plaque Crouse scores. Clinical trials with large sample sizes, long-term interventions, and follow-up are needed to investigate the efficacy of the C-117 formula. Clinical Trials Registration This trial is registered with clinicaltrials.gov identifier: NCT03072225 (registered retrospectively on 1st March 2017).

Intravenous Thrombolysis Registry for Acute Ischemic Stroke in China

Intravenous Thrombolysis Registry for Acute Ischemic Stroke in China

Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke

Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been...

Correlation between the distribution of intracranial and extracranial aterial lesions and risk factors in Chinese patients with ischemic stroke: a multicenter registry study

Objective To investigate the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in Chinese patients with ischemic stroke. Methods In this multi-center study, 2 310 continuously inpatients with ischemic stroke diagnosed in 20 stroke screening and prevention project base hospitals from June 2015 to May 2016 were enrolled. Carotid ultrasonography and transcranial color-coded sonography or transcranial Doppler were performed in all patients to confirm the presence of cerebral artery stenosis or occlusion. According to the distribution of lesions, the subjects were divided into 2 groups: the simple intracranial artery stenosis group and the simple extracranial artery stenosis group. The difference of risk factors between the two groups was compared. Results Of the 2 310 patients with ischemic stroke, 1 516 (65.6%) had simple intracranial artery stenosis and 794 (34.4%) had simple extracranial artery stenosis. The incidence of anterior circulation artery stenosis was higher in the group of intracranial artery stenosis than that in the extracranial artery stenosis group (68.1% vs 48.7%, P<0.001). Posterior circulation artery stenosis and combined anterior with posterior circulation artery stenosis were more common in patients with extracranial artery stenosis group than those in intracranial artery stenosis group (36.4% vs 22.1%, 14.9% vs 9.8%; all P<0.001). Univariate analysis of risk factors for stroke showed that patients with intracranial arterial stenosis had a higher prevelence of hypertension, diabetes, obesity, and family history of stroke, and their systolic blood pressure, diastolic blood pressure, body mass index (BMI), fasting blood-glucose, glycosylated hemoglobin, triacylglycerol, total cholesterol, and low-density lipoprotein cholesterol were significantly higher than those in the extracranial arterial stenosis group (all P<0.05). The proportion of elderly (≥65 years old), male and smokers in the extracranial arterial stenosis group was significantly higher than that in the intracranial arterial stenosis group (all P<0.05). Multivariate logistic regression analysis showed that elderly (≥65 years old), male, and smoking history were independent risk factors for extracranial arterial stenosis (OR=2.012, 1.637, 1.325, respectively; all P<0.05). While hypertension, diabetes, less physical activity, and high BMI levels were independent risk factors for simple intracranial arterial disease (OR=1.301, 1.252, 1.248, 1.030, respectively; all P<0.05). Conclusions There are significant differences in the distribution characteristics and risk factors of intracranial and extracranial aterial lesions in patients with ischemic stroke in China. Key words: Ultrasonography; Ischemic stroke; Atherosclerosis; Distribution; Risk factor

Dl-3-n-butylphthalide for alleviation of neurological deficit after combined extracranial-intracranial revascularization for moyamoya disease: a propensity score-matched analysis.

Postoperative neurological deficits impair the overall outcome of revascularization surgery for patients with moyamoya disease (MMD). dl-3-n-butylphthalide (NBP) is approved for the treatment of ischemic stroke in China. This pilot study evaluated the effect of NBP on perioperative stroke and neurological deficits in patients with MMD. The authors studied cases in which patients underwent combined revascularization surgery for MMD at their institution, with or without NBP administration. The overall study group included 164 patients (213 surgically treated hemispheres), including 49 patients who received NBP (25 mg twice daily) for 7 postoperative days. The incidence of perioperative stroke and transient neurological deficit (TND) and the severity of neurological deficits were compared between 49 propensity score-matched case pairs with or without NBP treatment. Subgroup analyses by type of onset and preoperative neurological status were also performed to determine specific characteristics of patients who might benefit from NBP administration. In the overall cohort, baseline characteristics differed with respect to preoperative stroke and modified Rankin Scale (mRS) score between patients who received NBP and those who did not receive it. In the 49 propensity score-matched pairs, postoperative stroke was observed in 11 patients and TND occurred in 21 patients, with no significant difference in incidence between the 2 groups. However, the TND was less severe in the NBP-treated group (p = 0.01). At 1 month after surgery, the neurological outcome was more favorable (p = 0.001) and the disability-free recovery rate was higher in patients with NBP treatment (p < 0.001). The number of patients who experienced an improved neurological function, compared to preoperative function, as measured by mRS, was greater in the NBP group than in the no-NBP group (p < 0.001). Multivariable analysis revealed that NBP administration was associated with decreased severity of TND (OR 0.28, p = 0.02), improved neurological function (OR 65.29, p = 0.04), and lower postoperative mRS score (OR 0.06, p < 0.001). These beneficial effects of NBP remained significant in ischemic type MMD and patients with preoperative mRS scores of 2 or greater. Postoperative administration of NBP may alleviate perioperative neurological deficits after revascularization surgery for MMD, especially in patients with ischemic MMD and unfavorable preoperative status. The results of this study suggest that randomized controlled trials to assess the potential benefit of NBP in patients with MMD may be warranted.

Consecutive Slides on Axial View Is More Effective Than Transversal Diameter to Differentiate Mechanisms of Single Subcortical Infarctions in the Lenticulostriate Artery Territory.

Objective: Lipohyalinosis or atherosclerosis might be responsible for single subcortical infarctions (SSIs); however, ways of differentiating between the two clinically remain uncertain. We aimed to investigate whether consecutive slides on axial view or transversal diameter is more effective to differentiate mechanisms by comparing their relationships with white matter hyperintensities (WMHs).Methods: All the participants from the Standard Medical Management in Secondary Prevention of Ischemic stroke in China (SMART) cohort who had SSIs in the lenticulostriate artery territory were included and categorized according to consecutive slides on axial view (≥4 consecutive slices or not) and transversal diameter (≥15 mm or not). The associations between the severity of WMHs and the different categories were analyzed.Results: Among the 3,821 patients of the SMART study, 281 had diffusion-weighted image-proven SSIs in the lenticulostriate artery territory. When classified by consecutive slides on axial view, SSIs on ≥4 slices were significantly associated with the severity of the WMHs, both in deep WMH (DWMH) (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.11–0.97; p = 0.04) and periventricular hyperintensity (PVH) (OR, 0.37; 95% CI, 0.17–0.78; p = 0.01). No such association was found on the basis of the transversal diameter (p > 0.1).Conclusion: Consecutive slides on axial view (≥4 consecutive slices) might be more effective than transversal diameter to identify the atherosclerotic mechanisms of SSIs in the lenticulostriate artery territory.Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00664846

Ambient Coarse Particulate Matter and Hospital Admissions for Ischemic Stroke.

Background and Purpose- Evidence on the effects of coarse particulate matter (PM10-2.5) on ischemic stroke is limited and inconsistent. We evaluated the acute effects of PM10-2.5 exposure on hospital admissions for ischemic stroke in China. Methods- We conducted a national time-series analysis of associations between daily PM10-2.5 concentrations and daily hospital admissions for ischemic stroke in China between January 2014 and December 2016. Hospital admissions for ischemic stroke were identified from the database of Urban Employee Basic Medical Insurance, which contains data from 0.28 billion beneficiaries. We applied a city-specific Poisson regression to examine the associations of PM10-2.5 and daily ischemic stroke admissions. We combined the city-specific effect estimates with a random effects meta-analysis, and further evaluated the exposure-response relationship curve and potential effect modifiers. Results- We identified >2 million hospital admissions for ischemic stroke in 172 Chinese cities. A 10 μg/m3 increase in PM10-2.5 concentrations (lag day 0) was associated with a 0.91% (95% CI, 0.73-1.10) increase in hospital admissions for ischemic stroke. The association remained significant after adjusting for PM2.5 (percentage change, 0.96%; 95% CI, 0.75-1.18). The exposure-response relationship was approximately linear, with a moderate response at lower levels (<200 μg/m3) and a steeper response at higher levels. The association was stronger in cities with lower PM10-2.5 concentrations, higher temperatures, or higher relative humidity. Conclusions- This nationwide study provides robust evidence of the short-term association between exposure to PM10-2.5 and increased hospital admissions for ischemic stroke and supports the hypothesis that the association differs by city characteristics.

Features of Childhood Arterial Ischemic Stroke in China

Objective: The aim of this study was to identify the features and risk factors for arterial ischemic stroke (AIS) in children.Methods: We retrospectively analyzed the initial symptoms, clinical manifestations, risk factors, neuroradiological findings, and treatment data of 75 Chinese children aged between 1 month and 14 years (median 5.7 years) who were diagnosed with AIS in our hospital between 2013 and 2018.Results: Among these 75 cases of childhood AIS, 53 patients (70.67%) were male, and the male-to-female ratio was 2.41:1. A total of 55 cases (73.33%) had respiratory tract infection with fever. Seventy cases had lesions in the basal ganglia (46 left, 24 right). All patients were treated conservatively without thrombolytic therapy. Intravenous immunoglobulin treatment was given to children with fever and drowsiness.Conclusion: Infection was an important risk factor for children with AIS in China. Infection and thrombophilia risk factors were more likely to occur in isolation. The stroke lesions commonly occurred in the basal ganglia region.

Low-dose rt-PA may not decrease the incidence of symptomatic intracranial haemorrhage in patients with high risk of symptomatic intracranial haemorrhage

ABSTRACT Background: Recombinant tissue plasminogen activator (rt-PA) has been used as the standard treatment for acute ischemic stroke (AIS). The following study investigates whether low-dose rt-PA can decrease the incidence of symptomatic intracranial haemorrhage (sICH) in AIS patients with high-risk sICH compared to standard-dose rt-PA. Materials and Methods: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) studies were assessed to explore risk factors for sICH after intravenous thrombolysis. For high-risk sICH patients (age ≧70 years old, or with diabetes, or serum glucose on admission >9.0 mmol/L, or NIHSS on admission>20, or with cardioembolism), standard-dose rt-PA (0.85 to 0.95 mg/kg) and low- dose rt-PA (0.5 to 0.7 mg/kg) were compared. Primary outcome measure was the incidence of sICH, and the secondary outcome measures were 7-day mortality and 90-day functional independence outcome (modified Rankin scale, 0–2). Results: A total of 554 patients were enrolled (60 cases for low dose, and 494 cases for standard dose). Median rt-PA doses were 0.63 and 0.90 mg, respectively. After adjustment for the baseline variables, low-dose rt-PA did not decrease the incidence of sICH (per SITS-MOST criteria, 3.33% versus 2.23%, P = 0.3467) compared to low dose. The low-dose group revealed less functional independence outcomes (modified Rankin scale, 0–2) compared to standard-dose group (36.67% versus 52.43%; odds ratio = 0.49; p = 0.0204) at 90 days. Conclusions: Our study suggests that low-dose intravenous rt-PA for high-risk sICH stroke in Chinese patients may not decrease the incidence of sICH, and concomitant with a poor outcome compared to standard-dose rt-PA.Abbreviations: rt-PA: recombinant tissue plasminogen activator; AIS: acute ischemic stroke; sICH: symptomatic intracranial haemorrhage