BACKGROUND: Severe stroke has high rates of mortality and morbidity. This study aimed to investigate the clinical course, causes of worsening, and outcomes of severe ischemic stroke. METHODS: This prospective, multicenter cohort study enrolled adult patients admitted ≤30 days after ischemic stroke from nine hospitals in China between September 2017 and December 2019. Severe stroke was defined as a score of ≥15 on the National Institutes of Health Stroke Scale (NIHSS). Clinical worsening was defined as an increase of 4 in the NIHSS score from baseline. Unfavorable functional outcome was defined as a modified Rankin scale score ≥3 at 3 months and 1 year after stroke onset, respectively. We performed Logistic regression to explore baseline features and reperfusion therapies associated with clinical worsening and functional outcomes. RESULTS: Among 4201 patients enrolled, 854 patients (20.33%) had severe stroke on admission. Of 3347 patients without severe stroke on admission, 142 (4.24%) patients developed severe stroke in hospital. Of 854 patients with severe stroke on admission, 33.95% (290/854) experienced clinical worsening (median time from stroke onset: 43 h, Q1-Q3: 20-88 h), with brain edema (54.83% [159/290]) as the leading cause; 24.59% (210/854) of these patients died by 30 days, and 81.47% (677/831) and 78.44% (633/807) had unfavorable functional outcomes at 3 months and 1 year respectively. Reperfusion reduced the risk of worsening (adjusted odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.12-0.49, P  <0.01), 30-day death (adjusted OR: 0.22, 95% CI: 0.11-0.41, P  <0.01), and unfavorable functional outcomes at 3 months (adjusted OR: 0.24, 95% CI: 0.08-0.68, P <0.01) and 1 year (adjusted OR: 0.17, 95% CI: 0.06-0.50, P  <0.01). CONCLUSIONS: Approximately one-fifth of patients with ischemic stroke had severe neurological deficits on admission. Clinical worsening mainly occurred in the first 3 to 4 days after stroke onset, with brain edema as the leading cause of worsening. Reperfusion reduced the risk of clinical worsening and improved functional outcomes. REGISTRATION ClinicalTrials.gov , NCT03222024.
Humans ; Male ; Female ; Prospective Studies ; Ischemic Stroke/mortality* ; Aged ; Middle Aged ; Aged, 80 and over ; Stroke ; Brain Ischemia

OBJECTIVE To study the impr ovement effects of Dianxianqing granule on blood-brain barrier （BBB）injury in Alzheimer’s disease （AD）model mice by regulating NLR family pyrin domain containing 3（NLRP3）inflammasome signaling pathway. METHODS Totally 125 mice were randomly divided into sham operation group （n＝25）and modeling group （n＝100） by body weight. AD model was induced by intracerebroventricular injection of β-amyloid 25-35 in model group. Sham operation group was given normal saline with same method. The 100 model mice were randomly divided into model group ，Donepezil hydrochloride tablets group （positive control 1，1.3 mg/kg，i.g.），MCC950 group [positive control 2（selective NLRP 3 inhibitor），10 mg/kg，i.p.] and Dianxianqing granule group （12.48 g/kg by crude drug ，i.g.）by body weight ，with 25 mice in each group. Second day after modeling ，administration groups were given relevant medicine ，once a day ，for consecutive 21 d. Sham operation group and model group were given intragastric administration of water and intraperitoneal injection of normal saline. At last administration，the learning and memory ability was determined by Y maze test ，and blood-brain barrier permeability was measured by Evans blue leakage assay. The expressions of NLRP 3，anti-ionized calcium-binding adapter molecule 1（IBA-1），nuclear factor kappa B （NF-κB）p65，p53 upregulated modulator of apoptosis （PUMA），occludin（ocln），zonula occluden- 1（ZO-1）and claudin-5 （cldn5） in cerebral tissue were determined. RESULTS Compared with model group ， spontaneous alternate response rate ，protein expressions of ocln ，cldn5 lnzyxyqy2003@163.com and ZO- 1 in cerebral tissue were increased significantly in administration groups （P＜0.05 or P＜0.01）；Evans blue E-mail：jiadg2003@126.com content and protein expressions of NLRP 3，IBA-1，PUMA and NF-κB p65 in cerebral tissue were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS Dianxianqing granule can improve BBB injury of AD model m ice by inhibiting NLRP 3 inflammasome signaling pathway.

OBJECTIVE: To test the performance of CHADS-VASc score in predicting stroke recurrence in first-ever ischemic stroke survivors without atrial fibrillation (AF). METHODS: A total of 768 patients were included in this study, including 475 male (61.85%) and 293 female patients (38.15%) with a mean age of 61.52±12.59 years (17-90 years). The baseline information of the patients was collected by face-to-face questionnaire survey and electronic medical record review, and their follow-up information was collected by telephone follow-up once every 3 months. Chi-square test and Wilcoxon rank sum test were used to compare the baseline characteristics between the patients regularly followed up and those withdrawn from the study. The area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio and other indicators of CHADS-VASc score were determined, and C-index based on Cox proportional hazards model was used to evaluate the performance of CHADS- VASc score in predicting the risk of stroke recurrence in patients at different time points during the follow-up. RESULTS: The 1-year, 3-year, and 5-year recurrence rate of stroke was 10.59%, 20.45%, and 29.46% in these patients, respectively. The AUC value, Optimal Operating Point (OOP) and the corresponding positive likelihood ratios (LR+) for predicting stroke recurrence were 0.558 (95%: 0.492-0.624), 4.5, and 1.256 at 1 year; 0.574 (95%: 0.517-0.630), 4.5, and 1.397 at 3 years; and 0.604 (95%: 0.548-0.661), 4.5, and 1.655 at 5 years, respectively. Sensitivity analysis of congestive heart failure showed that the predictive effect of CHADS-VASc score was basically unchanged. CONCLUSIONS CHADS-VASc score can be used to predict the 3-year and 5-year risk of stroke recurrence in first-ever ischemic stroke survivors without AF. The score has a better prediction ability for long-term stroke recurrence, but the prediction value remains low, suggesting the need to further improve the score or establish a new score for predicting stroke recurrence.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation ; Brain Ischemia ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Risk Assessment ; Risk Factors ; Stroke ; Survivors ; Young Adult

Descending necrotizing mediastinitis that has an abdominal pain as a main clinical manifestation is seldom. Here one case is reported. At the beginning, the patient had pharyngalgia and his swallowing was not smooth. After that, abdominal pain became a main symptom. Pharyngalgia relieved . However CT showed mediastinal infection. Surgical drainage,antibiotics treatment and nutritional support were performed. The patient was cured.
Abdominal Pain ; etiology ; Deglutition ; Drainage ; Humans ; Infection ; Mediastinitis ; complications ; diagnosis ; therapy ; Necrosis

10.3969/j.issn.1000-3606.2013.06.004

Objective To evaluate the effect of contrast-enhanced transcranial Doppler (c-TCD) for detection of patent foramen ovale (PFO) comparing to transesophageal echocardiography (TEE). Methods 28 ischemic stroke patients with PFO detected with TEE were evaluated with TCD bubble study at rest and under Valsalva maneuver (VM). Results PFO was identified in 20 cases (71.43%) at rest by TCD bubble study. When VM was performed, PFO was detected in 24 cases (85.71%). There was no relevant in sensitivity of c-TCD with PFO size (P>0.05). Conclusion c-TCD is an excellent method for PFO identification with high sensibility while under VM. C-TCD can be used as a screening method for suspected PFO in patients with stroke test before TEE.

ObjectiveTo investigate the related factors of ischemic cerebrovascular diseases in patients with patent foramen ovale (PFO). Methods42 patients with PFO，aged ≤55 years old, with cerebral infarction or transient ischemic attack and treated with aspirin were involved. All patients were examined with transesophageal echocardiography. 6 cases relapsed and 36 cases did not. The size of PFO, serum fibrinogen level, and combination of atrial septal aneurysm (ASA) were compared. ResultsThey were followed up for (512.51±127.38) d. The serum fibrinogen level was (3.33±1.11) g/L in no relapse group, and was (4.40±1.49) g/L in relapse group （P=0.032）. There was not significant difference in the size of PFO (P=0.618) and combination ASA (P=0.554) between these groups. Logistic regression showed that patients with ischemic cerebrovascular diseases history involved in relapse (OR=46.913,95%CI:2.371～928.254), but the serum fibrinogen level did not （OR=2.656,95%CI:0.977～7.219）. ConclusionThe PFO patients with history of ischemic cerebrovascular diseases incline to relapse. It is not sure the influence of the serum fibrinogen level on it.