Objective To assess the effects and safety of Tongxinluo (TXL) Capsule for patients with acute ischemic stroke. Methods PubMed (1966 to 2011.12.23), EMbase (1966 to 2011.12.23), Ovid CENTRAL (2011.10), CBM (1978 to 2011.12.23), VIP (1989 to 2011.12.23), CNKI (1980 to 2011.12.23), CDFD (1999 to 2011.12.23), and CDFD (1999 to 2011.12.23) were electronically searched for randomized controlled trials (RCTs) on TXL Capsule for patients with acute ischemic stroke. Meanwhile, relevant data were retrieved by hand search and data from pharmaceutical factories were collected. Two reviewers independently screened literature, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirty nine RCTs (non-placebo-controlled trials) involving 3 906 patients were included. The quality of the included studies was generally low. The follow-up time started from the end of treatment (minimum: 7 days) to 6 months. The result of meta-analysis (16 trials, 1 445 patients) showed that the TXL group was better than the control group in improving neurological function (SMD= −1.09, 95%CI −1.68 to −0.49). The result of meta-analysis (21 trials, 2 500 patients) showed that, the effectiveness rate (91.3%) of the TXL group was significantly higher than that of the control group (RR=1.22, 95%CI 1.14 to 1.30). Eight trials reported adverse reactions such as nausea and gastric discomfort. Four trials reported that 5 patients in the control group died during the treatment. No studies reported the data of mortality, dependency rate during 3-month follow up, or quality of life. Conclusion Current studies show that, TXL Capsule improves neurological impairment of patients with acute ischemic stroke which has less adverse reactions. Further studies are still needed to verify the effects of TXL on long-term mortality and disability. It is necessary to conduct more high quality RCTs especially with placebo-controlled trials to confirm the efficacy of Tongxinluo for acute ischemic stroke.
Objective To assess the efficacy and safety of human urinary kallidinogenase injection (HUK) in treating patients with acute ischemic stroke. Methods Through adopting Cochrane systematic review methods, the relevant materials were retrieved by electronically and manually searching databases and claimed from pharmaceutical factories, so as to collect the randomized controlled trials (RCTs) about HUK for the patients with acute ischemic stroke, which were searched by the end of October 2010. The quality of each trial was assessed by two reviewers independently, and meta-analysis was conducted by using RevMan 5.0.2 software. Results Twenty-four trials involving 2 433 patients were included, of which 2 were multi-center placebo controlled trials, and the other 22 were all non-placebo trials. Only 2 trials (459 cases) reported the death or dependence at the end of 3-month follow-up. In those trials, HUK reduced death or dependency comparing to the control group (RR=0.69, 95%CI 0.55 to 0.86). Twenty trials (2 117 patients) reported the proportion of patients with marked neurological improvement after finishing the 7 to 21 days treatment. Meta-analysis showed the HUK group had more neurological improvement than the control group, with significant differences (RR=1.56, 95%CI 1.44 to 1.70). Fifteen trials reported adverse events, of which the transient hypotension was commonly seen (1.5%-5.1%). Non-fatal intracerebral hemorrhage was detected in 7 patients in 3 trials, but the difference between the HUK group (6 patients, 1.2%) and the control group (1 patient, 0.4%) was not significant (RR=1.82, 95%CI 0.34 to 9.61). Deaths occurred in both HUK group (2 patients, 0.4%) and the control group (1 patient, 1.1%) in 2 trials, without significant differences (RR=0.6, 95%CI 0.09 to 3.92). No trial assessed quality of life. Conclusion Available evidence suggests that HUK injection reduces neurological impairment after acute ischemic stroke and improves long-term outcomes, though a few patients suffer from transient hypotension. Further high-quality, large-scale RCTs are needed to confirm these results.
Objectives To assess the efficacy and safety of dl-3-butylphthalide for patients with acute ischemic stroke. Methods We collected randomized controlled trials, which compared dl-3-butylphthalide agents with placebo or open control in patients with acute ischaemic stroke, by searching the electronic bibliographic databases, scanning references listed in articles and handsearching journals. Meta-analysis was conducted based on the methods recommended by the Cochrane Collaboration. Results Twenty-one trials involving 2 123 patients were included, of which 2 were placebo-controlled and 19 were open-label controlled. Meta-analysis of 10 trials (n=958), in which neurological deficits were assessed by CSS, suggested that there were significant differences favoring butylphthalide in the mean change of neurological deficits’ score during the treatment period [MD=2.30, 95%CI (1.57, 3.03)]. Meta-analysis of 6 trials (n=590), in which neurological deficits were assessed by NIHSS, also favored butylphthalide [MD=2.06, 95%CI (0.65, 3.46)]. Adverse events (AEs) were reported in 13 trials. Gastrointestinal discomfort (1.7%~8%) and abnormal liver function including abnormal ALT (1.4%~17.5%) and abnormal AST (1.9%~8.82%) were the two most common AEs. However, no severe adverse events (SAEs) were reported. Numbers of dead and dependent patients at the end of followup (at least three months) were not reported in the 21 included trials. Quality of life was not assessed in any of the trials. Conclusion Dl-3-butylphthalide can improve the neurological function after acute ischemic stroke and appears to be safe. However, further study is needed to confirm its effects for lowering rates of death and dependency.
Objective To evaluate the reporting quality of randomized controlled trials (RCTs) on acupuncture for acute ischemic stroke. Methods Six databases including The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4, 2005), MEDLINE (1966 to December 2005), EMbase (1984 to December 2005), China National Knowledge Infrastructure (CNKI, 1994 to December 2005), China Biomedicine Database disc (CBMdisc, 1980 to December 2005), VIP (a full text issues database of China, 1989 to December 2005) were searched systematically. Handsearch for further references was conducted. Language was limited to Chinese and English. We identified 74 RCTs that used acupuncture as an intervention and assessed the quality of these reports against the Consolidated Standards for Reporting of Trials (CONSORT) statement and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA).Results In regard to the items in the CONSORT statement, 54 (73%) RCTs described baseline demographic and clinical characteristics in each group. Twenty-six (35%) mentioned the method of generating the random sequence, with 4 (5%) using a computer allocation. Only 6 (8%) RCTs had adequate allocation concealment, with 5 RCTs using sealed opaque envelopes and 1 RCT using centralized computer allocation. Only 8 (11%) RCTs used blinding, including 5 described as double-blind. Four (5%) RCTs reported the sample size calculation and 5 (7%) RCTs reported that an intention-to-treat (ITT) analysis. In regard to the items in STRICTA , only 4 (5%) RCTs reported the numbers of needles inserted. In 35 (47%) RCTs the needle type was reported, but only 26 (35%) mentioned the depths of insertion. Only 1 (1%) RCT mentioned the length of clinical experience and 6 (8%) RCTs reported the background of the acupuncture practitioners, but none stated the duration of their training.Conclusion The reporting quality of RCTs of acupuncture for acute ischemic stroke was low. The CONSORT statement and STRICTA should be used to standardize the reporting of RCTs of acupuncture.
Objective To investigate the risk factors, clinical features and outcomes of patients with large hemispheric infarction (LHI), and explore the association between TOAST classification and LHI. Methods We prospectively registered consecutive cases of acute ischemic stroke at the neurological wards of West China Hospital, Sichuan University from January 1st 2010 to February 29th 2012. We collected the demographic data, risk factors, and other related data, assessed the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores at admission, and followed-up the Modified Rankin Scale (mRS) scores at the third month from the onset. In different TOAST classifications, univariate analysis and multivariate analysis were used to find predictors for the occurrence and prognosis of LHI. Results Of the enrolled 1 729 patients with acute ischemic stroke, 317 (18.3%) had LHI. The multivariate analysis showed that male, hypertension and onset to admission time were the independent predictive factors for the large-artery atherosclerosis type LHI (P<0.05); atrial fibrillation and valvulopathy were the independent predictive factors for cardioembolism type LHI (P<0.05). Meanwhile, age, hypertension, onset to admission time, and NIHSS and GCS scores at admission were the independent predictive factors for death/disability (mRS>3) within three months (P<0.05). Conclusions Hypertension, gender, onset to admission time, atrial fibrillation, and valvulopathy are independently associated with the occurrence of LHI. Young patients with lower GCS, higher NIHSS scores and no hypertension are more likely to have a better prognosis after LHI.
ObjectivesTo systematically review the efficacy and safety of nalmefene hydrochloride for acute cerebral infarction.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on nalmefene hydrochloride for acute cerebral infarction from inception to February 21st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 RCTs involving 1 038 patients were included. The results of meta-analyses showed that, compared to the routine treatment group, the nalmefene hydrochloride group was significantly associated with an increased reduction in total effective rate (RR=1.14, 95%CI 1.04 to 1.23, P=0.003), GCS (MD=1.30, 95%CI 0.66 to 1.94, P<0.0001), patient satisfaction (RR=1.26, 95%CI 1.03 to 1.55, P=0.03), cerebral blood flow (MD=5.00, 95%CI 3.81 to 6.19, P<0.05), and cerebral blood volume (MD=0.28, 95%CI 0.23 to 0.32, P<0.05). It was also significantly associated with an reduction of NIHSS, CSS, level of inflammatory factors after treatment in 14 days, level of MMP-9 and mean transit time of contrast medium (P<0.05). However, no significant association was observed between two groups in level of inflammatory factors after treatment in 20 days. For safety outcomes, no significant association was found between two groups in mortality, dizziness, and nausea and vomiting.ConclusionsThe current evidence indicates that the nalmefene hydrochloride can be used to treat acute cerebral infarction based on routine treatment of acute cerebral infarction, and the safety is relatively good. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectiveTo explore the relevance of an increase in neutrophil count and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.MethodsA retrospective study was conducted on the patients who received thrombolysis treatment of alteplase within 4.5 hours after onset between January 2017 and November 2018. Based on the existence of END, the patients were divided into the END group and the non-END group. Univariate and multivariate logistic regression, and receiver operating characteristic curves were used to analyze the relevances between END and the indexes such as neutrophil count, lymphocyte count, and neutrophil to lymphocyte ratio (NLR) after thrombolysis. Paired sample t test and Wilcoxon signed-rank test were used to compare the changes of neutrophil and lymphocyte before and after thrombolysis.ResultsA total of 187 patients were included, including 48 in the END group and 139 in the non-END group. Before thrombolysis, the differences of total protein (t=2.130, P=0.035) and albumin (t=2.777, P=0.007) between the two groups were statistically significant, but the differences in other clinical indexes between the two groups were not statistically significant (P>0.05). After thrombolysis, white blood cell count, neutrophil count, NLR, fibrinase degradation product, baseline and change of National Institute of Health Stroke Scale score, proportion of cardiogenic embolism, degree of responsible vascular stenosis and anterior circulation cortical infarction site were all higher in the END group than those in the non-END group (P<0.05). The total protein, albumin, lymphocyte count and prealbumin in the END group were lower than those in the non-END group (P<0.05). Neutrophil in the END group increased significantly (Z=−2.314, P=0.021) after thrombolysis. Neutrophil count [odds ratio=1.288, 95% confidence interval (1.069, 1.552)] was one of the independent influencing factors of venous thrombolysis END, and the specificity was the highest (the sensitivity was 62.5%, and the specificity was 71.9%).ConclusionsAfter thrombolysis, elevated neutrophil count has some relevance to END. Dynamic monitoring on neutrophil count after intravenous thrombolysis treatment can predict the occurrence of END.
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=−0.55, 95%CI −0.72 to −0.38, P<0.001) and reduce fibrinogen after treatment (SMD=−0.93, 95%CI −1.41 to −0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Early endovascular interventional therapy can effectively improve the prognosis of patients with acute ischemic stroke. Dual-source CT dual-energy scanning, as a new CT imaging technology developed rapidly in recent years, with its unique technical characteristics and advantages, shows potential and application prospects in early endovascular interventional therapy of acute ischemic stroke. This article discusses the value of dual-source CT dual-energy scanning in the early screening and evaluation, the identification of postoperative iodine contrast agent extravasation and secondary cerebral hemorrhage, and the prediction of prognosis of patients with early endovascular interventional treatment of acute ischemic stroke. The purpose is to provide a theoretical basis for better application of dual-source CT dual-energy scanning in early endovascular interventional treatment of acute ischemic stroke.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.