Table of Content

20 May 2023, Volume 18 Issue 05

Previous Issue    Next Issue

Exploration of Argatroban Combined with Alteplase in the Treatment of Acute Ischemic Stroke: High-level Clinical Evidence from China

FAN Dongsheng

2023, 18(05):  495-496.  DOI: 10.3969/j.issn.1673-5765.2023.05.001

Asbtract ( )   PDF (1587KB) ( )  

References | Related Articles | Metrics

Stroke-related Sleep Disorder

ZHANG Ya'nan, WANG Zan

2023, 18(05):  497-501.  DOI: 10.3969/j.issn.1673-5765.2023.05.002

Asbtract ( )   PDF (1810KB) ( )  

References | Related Articles | Metrics

Stroke-related Sleep Disorder

WANG Zan

2023, 18(05):  502-502. 

Asbtract ( )   PDF (1727KB) ( )  

Related Articles | Metrics

Spatial Statistical Analysis based on Fiber Tracerto Study the Changes of Brain Microstructure in Patients with Cerebral Small Vessel Disease Combined with Obstructive Sleep Apnea

ZENG Huixing, LI Jinbiao, WANG Meng, OUYANG Fubing, YU Lei, YI Ming, GUO Jiayu, NI Ruichen, CUI Liqian, FAN Yuhua

2023, 18(05):  503-513.  DOI: 10.3969/j.issn.1673-5765.2023.05.003

Asbtract ( )   PDF (3737KB) ( )  

References | Related Articles | Metrics

Objective  To investigate the characteristics of brain microstructural changes in patients of cerebral small vessel disease (CSVD) combined with obstructive sleep apnea (OSA) by tract-based spatial statistics (TBSS) based on diffusion tensor imaging (DTI). 
Methods   The study included patients with CSVD who were hospitalized in the Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University from September 2018 to June 2020. Data on demographic information, clinical characteristics, scores of cognitive function assessment scale and sleep quality scale, CSVD routine imaging, DTI, polysomnography (PSG) parameters were collected. According to the apnea hypopnea index (AHI), they were divided into OSA group (AHI≥5) and non-OSA group (AHI<5). The different regions in cerebral white matter between two groups as well as their fractional anisotropy (FA) and mean diffusivity (MD) values were calculated by TBSS. The correlation between MD and PSG parameters, cognitive function scores, CSVD imaging markers, and CSVD burdens were also analyzed. 
Results  A total of 39 CSVD patients were included, of which 7 were excluded due to the lack of MRI data/parameter inconsistency/poor image quality, therefore 32 were eventually included. OSA group included 21 patients with an average age of (64.14±11.57) years old and 18 males (85.7%) while 11 patients without OSA was (67.64±8.95) years old, including 6 males (54.5%). TBSS showed that MD value of OSA group was increased in the bilateral anterior thalamic radiation, bilateral corticospinal tract, bilateral cingulate gyrus, bilateral hippocampus, forceps major and forceps minor, bilateral inferior fronto-occipital fasciculus, bilateral inferior/superior longitudinal fasciculus and bilateral uncinate fasciculus compared with non-OSA group (P<0.001). Bivariate correlation analysis showed that MD increase in OSA group was positively correlated with white matter hyperintensity (WMH) (r=0.646, P<0.05) and Fazekas grade 2 to 3 (r=0.458, P<0.05), and negatively correlated with Montreal cognitive assessment (MoCA) (r=-0.374, P<0.05). There was no significant correlation with mini-mental state examination (MMSE), Alzheimer's disease assessment scale (ADAS-cog), sleep quality assessment scale, AHI, PSG parameters, other CSVD imaging markers and CSVD burdens (P>0.05). 
Conclusions  CSVD patients with OSA have more extensive white matter fiber damage, and extensive brain microstructure damage is closely related to high white matter signal and cognitive dysfunction.



Study of Biomarkers of Stroke with Obstructive Sleep Apnea Syndrome

HUANG Zhencan, ZHANG Ya’nan, SUN Qingqing, WU Xiaodan, WANG Zan

2023, 18(05):  514-519.  DOI: 10.3969/j.issn.1673－5765.2023.05.004

Asbtract ( )   PDF (1910KB) ( )  

References | Related Articles | Metrics

Obstructive sleep apnea syndrome (OSAS) is one of the most common chronic disorders, with an independent risk factor for stroke, poor recovery after stroke, and recurrent stroke. 60%-70% of patients with stroke have sleep apnea in the acute stage, of which OSAS is the most common. The current diagnostic criteria for OSAS is polysomnography, but the operation process is cumbersome, requires a large number of medical staff, and the examination is expensive, which delays the diagnosis and treatment of OSAS. Some out-of-hospital screening devices for OSAS have been developed, but their accuracy needs to be improved. Therefore, it is of great significance to find a simple, fast and effective diagnostic method and regularly screen potential OSAS. At present, biomarkers of OSAS may become an ideal method for screening OSAS and provide a reference for predicting stroke prognosis. This paper reviews the research progress of biomarkers of OSAS in the pathogenesis and physiology of stroke, hoping to help clinicians improve the diagnosis, treatment, disease prevention and prognosis of patients with stroke with OSAS.



Research Advances on Mechanisms of Increased Stroke Risk by Circadian Rhythm Disruption

JIA Hui, WANG Di, SUO Rui, WEI Xinya, ZHU Yulan

2023, 18(05):  520-526.  DOI: 10.3969/j.issn.1673－5765.2023.05.005

Asbtract ( )   PDF (1913KB) ( )  

References | Related Articles | Metrics

The causes of circadian rhythm disorders mainly including internal factors: internal circadian rhythm sleep-wake disorders, as well as external factors: social jet lag, shift work, artificial light during night, travel across time zones, stay up late, irregular diet, etc. Internal/external factors can lead to central and peripheral circadian clock disorder. Circadian clock genes regulate the expression of almost the entire genome. Circadian clock disorder leads to glucose-insulin metabolic disorder, hypertension, dyslipidemia, immune activation, obesity, premature aging, which are risk factors of stroke. The relationship between the circadian rhythm disturbance in addition to its caused above-mentioned risk factors and the risk of stroke is attracting increasing attention in recent years. This article reviews the research progress on the mechanism of circadian rhythm disturbance increasing the risk of stroke. 

Research Progress of Insomnia after Stroke

YANG Hangmei, HAN Meirong, JIANG Xuelong, HE Zhongming, HAN Fang

2023, 18(05):  527-533.  DOI: 10.3969/j.issn.1673－5765.2023.05.006

Asbtract ( )   PDF (2229KB) ( )  

References | Related Articles | Metrics

Post stroke insomnia (PSI) is a group of clinical syndromes that first appear after a stroke and meet the diagnostic criteria for insomnia. Similar to common clinical insomnia, the main manifestations are abnormal sleep depth and average sleep time less than 6 hours per night. Meta-analysis showed that 32.5%, 34.8% and 37.1% of patients in acute, subacute and convalescent stages of stroke met the diagnostic criteria for insomnia disorders, respectively. PSI not only increases the risk of stroke death and recurrence, but also has adverse effects on stroke rehabilitation and prognosis. This paper reviews the incidence, pathogenesis, and treatment of insomnia after stroke, in order to provide information for clinical practice and provide targeted intervention and treatment measures for insomnia after stroke. 

Application of Problem-based Learning Combined with Virtual Reality Technology in Clinical Teaching of Post-stroke Sleep Disorder

GUO Zhenni, ZHANG Han, FU Yuli, WANG Zan, YANG Yi, DENG Fang

2023, 18(05):  534-537.  DOI: 10.3969/j.issn.1673-5765.2023.05.007

Asbtract ( )   PDF (2639KB) ( )  

References | Related Articles | Metrics

Objective  To explore the effect of problem-based learning (PBL) combined with virtual reality (VR) into neurology clinical teaching on post-stroke sleep disorder. 
Methods  A total of 70 postgraduates who underwent training in the Department of Neurology of the First Hospital of Jilin University from September 2022 to January 2023 were included and randomly divided into the experimental group and the control group, 35 in each group. The control group adopted PBL teaching method, and the experimental group adopted PBL combined with VR teaching method. The teaching content was about the anatomical basis of post-stroke sleep disorder. After the course, two groups were assessed with test papers and questionnaires, and the assessment results were compared. 
Results  Students in the experimental group had higher scores in basic theory (46.03±1.76 vs. 43.69±1.91), case analysis (42.11±2.19 vs. 39.57±2.56) and total score (88.14±2.55 vs. 83.26±3.55)than the control group, and the difference was statistically significant (P<0.001); students in the experimental group had higher evaluations on the role of this course in stimulating motivation (2.63±0.49 vs. 2.11±0.47), improving learning efficiency (2.57±0.50 vs. 1.97±0.57), improving self-learning ability (2.54±0.51 vs. 2.00±0.42) and cultivating clinical thinking (2.51±0.51 vs. 1.94±0.42) than the control group, and the difference was statistically significant (P<0.001).
Conclusions  Application of PBL combined with VR in neurology clinical teaching improves effectiveness of teaching on clinical education of post-stroke sleep disorder.



Relationship between Total Cholesterol Burden and Newly Developed Peripheral Artery Disease

ZHANG Lei, WU Jianwei, KANG Kaijiang, ZHAO Xingquan

2023, 18(05):  538-546.  DOI: 10.3969/j.issn.1673-5765.2023.05.008

Asbtract ( )   PDF (2046KB) ( )  

References | Related Articles | Metrics

Objective  To investigate the relationship between TC burden and newly developed peripheral artery disease (PAD) . 
Methods  In the asymptomatic polyvascular abnormalities community (APAC) study, the participants (were followed-up every 2 years from 2006 to 2012. The TC was measured at each follow-up. TC burden was calculated as the weighted sum of the difference between measured value and cutoff value. Ankle-brachial index (ABI) measurements were completed at the third and fourth follow-up, and unilateral or bilateral lower extremity ABI<0.90 indicates that PAD exists. Participants were divided into four groups according to the TC burden quartile, and the relationship between TC burden and PAD was evaluated by logistic regression. 
Results  Of the 2939 participants, 159 (5.4%) had newly developed PAD. In univariate analysis, increased TC burden was not significantly associated with new PAD compared to the lowest quartile group (Q1) (OR 1.109, 95%CI 0.961-1.280, P=0.157) . After adjusting for confounding factors, there was still no significant correlation between TC burden and new PAD (OR 1.062, 95%CI 0.916-1.232, P=0.346) . Among the four groups, participants in the second quartile (Q2) had the lowest incidence of new PAD. Compared with Q2, participants in Q1 and the highest quartile (Q4) group as a whole had an increased risk of new PAD (Q4 group was not statistically significant after excluding participants aged 65 years or older) , while participants in the third quartile (Q3) were not statistically significant.
Conclusions  There is no significant linear correlation between TC burden and newly developed PAD, but long-term high or low TC level may increase the risk of newly developed PAD.



Study on Predictive Model of Cerebral Hemorrhage during Hospitalization in Patients with Acute Ischemic Stroke Treated with rt-PA Intravenous Thrombolysis

CHEN Hui, CHEN Siding, ZHU Zhikai, YU Weiran, JIANG Yong, WANG Yongjun

2023, 18(05):  547-555.  DOI: 10.3969/j.issn.1673-5765.2023.05.009

Asbtract ( )   PDF (3197KB) ( )  

References | Related Articles | Metrics

Objective  To predict the incidence of cerebral hemorrhage in patients with acute ischemic stroke (AIS) or TIA undergoing intravenous thrombolytic therapy with rt-PA based on machine learning algorithm, and explore the risk factors affecting the incidence of cerebral hemorrhage after rt-PA thrombolytic therapy.  
Methods  A total of 74 654 patients who were initially diagnosed as AIS or TIA and received rt-PA intravenous thrombolytic therapy were enrolled in the Chinese Stroke Center Alliance (CSCA) from January 2016 to December 2020, with an average age of (65.55±12.14) years. Among them, 48 493 were male patients, accounting for 64.96%, and 2038 were cerebral hemorrhage patients during hospitalization, accounting for 2.73%. The data is divided into training sets and test sets by year, that is, the registered patients in 2016—2019 are divided into training sets, and the registered patients in 2020 are divided into test sets. The positive and negative samples of the training set data are 77∶100 balanced using the prototype selection down-sampling technology, and the logistic regression, extreme gradient boosting (XGBoost), random forest, gradient boosting decision tree (GBDT) and categorical boosting (CatBoost) are five models to predict the outcome of intracerebral hemorrhage, and use AUC, sensitivity, specificity, Brier score and other indicators to evaluate and compare the prediction effect of the model, and use SHAP chart to analyze the interpretability of the features screened by the machine learning model. 
Results  The AUC values of XGBoost, GBDT, CatBoost, logistic regression and random forest were 0.770 (95%CI 0.745-0.774), 0.766 (95%CI 0.753-0.786), 0.765 (95%CI 0.752-0.766), 0.758 (95%CI 0.747-0.761) and 0.757 (95%CI 0.739-0.759) respectively, the sensitivity was 0.624 (95%CI 0.574-0.672), 0.606 (95%CI 0.555-0.655), 0.570 (95%CI 0.519-0.620), 0.557 (95%CI 0.506-0.607) and 0.585 (95%CI 0.534-0.635) respectively, the specificity was 0.780 (95%CI 0.773-0.786), 0.785 (95%CI 0.778-0.791), 0.790 (95%CI 0.783-0.796), 0.805 (95%CI 0.799-0.811) and 0.769 (95%CI 0.762-0.776) respectively, and the Brier score was 0.157, 0.154, 0.156, 0.160 and 0.161 respectively. Through the SHAP diagram, we found that the characteristics of high NIHSS score, old age, high fasting blood glucose level, history of atrial fibrillation, low platelet count, long time window between onset and thrombolytic therapy, low BMI, and high NIHSS score at the time of visit were risk factors affecting the incidence of cerebral hemorrhage during the hospitalization of rt-PA thrombolytic therapy.  
Conclusions  The prediction model based on machine learning can predict the occurrence of intracerebral hemorrhage in AIS patients undergoing rt-PA thrombolytic therapy during hospitalization. This study has certain exploration value for the application of machine learning technology in the field of intracerebral hemorrhage prediction in the future.



Study on the Relationship between Hypersensitive C-reactive Protein, Asymptomatic Carotid Artery Stenosis and Cognitive Impairment in Chinese Community Adults

SHEN Yuan, WANG Jing, WANG Anxin, ZHAO Xingquan

2023, 18(05):  556-563.  DOI: 10.3969/j.issn.1673-5765.2023.05.010

Asbtract ( )   PDF (2022KB) ( )  

References | Related Articles | Metrics

Objective  To explore the relationship between hs-CRP, asymptomatic carotid stenosis (ACS) and cognitive impairment based on a Chinese community study.
Methods  This study is based on a cross-sectional analysis of the follow-up data of asymptomatic polyvascular abnormalities community (APAC) study in 2012. The Chinese MMSE was used as the cognitive screening scale, and less than 24 is considered cognitive impairment. After adjusting for confounding factors such as sex, age, BMI, education, smoking, alcohol consumption, physical activity, history of hypertension, hyperlipidemia, diabetes, and stroke, the logistic regression model was used to analyze the correlation between hs-CRP, ACS and cognitive impairment. 
Results  A total of 3925 subjects (including 1688 women, accounting for 43.01%) were included in the study. Logistic regression analysis showed that hs-CRP≥3 mg/L had no significant difference in the effect with or without ACS on cognitive impairment without adjusting for relevant factors (without ACS: OR 0.67, 95%CI 0.30-1.45; with ACS: OR 0.86, 95%CI 0.58-1.28). After adjusting for confounding factors, hs-CRP≥3 mg/L also had no significant difference in the effect with or without ACS on cognitive impairment (without ACS: OR 0.65, 95%CI 0.24-1.75; with ACS: OR 0.97, 95%CI 0.59-1.60). 
Conclusions  The levels of hs-CRP has no significant impact on cognitive impairment in patients with or without ACS. Therefore, regardless of whether patients have ACS or not, hs-CRP may not be significantly associated with early cognitive decline.

Risk Factors of Secondary Cerebral Infarction after Trepanation and Drainage in Patients with Hypertensive Intracerebral Hemorrhage

WANG Bei, TAN Bo, ZHANG Yue, LIU Yongdong, YANG Jiaqiang, ZOU Xueli, JIAO Yang, SUN Haijing

2023, 18(05):  564-571.  DOI: 10.3969/j.issn.1673-5765.2023.05.011

Asbtract ( )   PDF (2245KB) ( )  

References | Related Articles | Metrics

Objective  To investigate the risk factors of secondary cerebral infarction after trepanation and drainage in patients with hypertensive cerebral hemorrhage (HICH).  
Methods  Clinical data of HICH patients who underwent trepanation and drainage in the Neurosurgery Department of Nanjing Tongren Hospital from January 2017 to January 2020 were included for retrospective analysis. According to the results of head CT examination 1-7 d after surgery, they were divided into two groups: secondary cerebral infarction group (24 cases) and non-secondary cerebral infarction group (186 cases). The independent risk factors for secondary cerebral infarction in HICH patients were screened by univariate analysis and multivariate logistic regression analysis, and the risk prediction model of secondary cerebral infarction was constructed. The differentiation, accuracy and validity of the model were evaluated by receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve. 
Results  A total of 210 HICH patients were included in this study, including 24 patients with postoperative secondary cerebral infarction, with an incidence of 11.43%. Univariate analysis showed that hypertension history, systolic blood pressure, diastolic blood pressure, proportion of diabetic patients, hematoma quantity, distribution range of cerebral edema, brain tissue displacement, hs-CRP and uric acid (UA) levels in patients with secondary cerebral infarction group were higher than those without secondary cerebral infarction group, and the proportion of patients taking vasodilators was lower than that without secondary cerebral infarction group. The difference was statistically significant. Multivariate analysis showed that long history of hypertension (OR 1.642, 95%CI 1.175-1.892, P<0.001), high systolic blood pressure (OR 1.349, 95%CI 1.048-2.071, P=0.013), high diastolic blood pressure (OR 1.299, 95%CI 1.091-1.715, P=0.016), history of diabetes (OR 2.074, 95%CI 1.192-2.891, P=0.027), large volume of hematoma (OR 1.457, 95%CI 1.183-1.894, P=0.001), large distribution range of cerebral edema (OR 1.516, 95%CI 1.029-2.183, P=0.005) and high level of brain tissue displacement (OR 1.439, 95%CI 1.167-2.446, P=0.008) were independent risk factors for secondary cerebral infarction after drilling and drainage surgery in HICH patients after trepanation and drainage surgery, while vasodilators was the protective factor (OR 0.774, 95%CI 0.415-0.975, P=0.011). The above factors were used to construct a alignment diagram model to assess the risk of secondary cerebral infarction. The evaluation results of the model show that Consistency Index (C-Index) is 0.852 (95%CI 0.773-0.920), with good differentiation and high calibration, which has strong practicability. 
Conclusions  HICH patients with long history of hypertension, high systolic blood pressure, high diastolic blood pressure, history of diabetes, large volume of hematoma, large distribution range of cerebral edema and high level of brain tissue displacement are at an increased risk of secondary cerebral infarction after trepanation and drainage surgery, and vasodilators can reduce the risk.



Effect Analysis of a New Model of Posture Management after Lumbar Puncture in Subarachnoid Hemorrhage Patients

HE Xin, ZHAO Donghong, YAN Ying, FAN Yanzhu

2023, 18(05):  572-576.  DOI: 10.3969/j.issn.1673-5765.2023.05.012

Asbtract ( )   PDF (2031KB) ( )  

References | Related Articles | Metrics

Objective  To explore the effect of the new model of posture management in subarachnoid hemorrhage patients after lumbar puncture (LP) .  
Methods  Subarachnoid hemorrhage patients (modified Fisher classification 0-Ⅱgrades) who were hospitalized in the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from February to December 2021 and underwent lumbar puncture under local anesthesia were selected as the research objects. The patients were randomly divided into the intervention group and the control group by the random control table method. The control group used routine nursing, and the intervention group used the new model of posture management for nursing intervention. The immediate (4 h) and short-term (24 h) incidence of headache, low back pain, severity of pain, and satisfaction of patients 24 h after the intervention were compared between the two groups.
Results  There was no significant difference in the incidence of post lumbar puncture headache at  4 hours (41.2% vs. 37.5%, P=0.627) and 24 hours (25.0% vs. 22.5%, P=0.710) respectively, between the experimental group and the control group nor was there any significant difference in the severity of headache (P=0.533, P=0.685); the incidence of low back pain at 4 hours (50.0% vs. 27.5%, P=0.003) and 24 hours (37.5% vs. 22.5%, P=0.038) after LP in the control group was significantly higher than that in the intervention group, and there was statistical significance between the control group and the intervention group on the severity of low back pain 4 hours and 24 hours after LP (P=0.005, P=0.033). The total score of nursing satisfaction 24 hours after LP was 78.19 ± 3.17in the control group and 88.41 ± 2.80 in the intervention group, which was significantly higher than that in the control group (P=0.003). The two groups showed statistical differences in aspects of respect level, nursing techniques, comfort level, health education, communication, and patient family participation.
Conclusions  The new mode of posture management is applicable for patients with mild subarachnoid hemorrhage requiring lumbar puncture. By shortening the bedtime of patients after lumbar puncture, this mode can significantly reduce the incidence and severity of low back pain in a short period of time after surgery without increasing the incidence of postoperative headache, and improve patient satisfaction, which is worthy of clinical promotion and application.


Risk Factors of Lower Extremity Deep Vein Thrombosis in Patients with Acute Intracerebral Hemorrhage

ZHENG Xin, GUO Junping, ZHANG Runhua, JI Ruijun

2023, 18(05):  577-582.  DOI: 10.3969/j.issn.1673-5765.2023.05.013

Asbtract ( )   PDF (2111KB) ( )  

References | Related Articles | Metrics

Objective  To analyze the incidence, occurrence time and risk factors of deep vein thrombosis (DVT)  in patients with acute intracerebral hemorrhage (ICH) during hospitalization. 
Methods  Patients with ICH from the In-hospital medical Complications after Acute Stroke Study of Beijing Tiantan Hospital, Capital Medical University were selected. The patients were divided into two groups according to whether DVT of lower limbs occurred during hospitalization (DVT group) and no DVT group (non-DVT group). The clinical characteristics of the two groups were compared, and the risk factors of DVT in patients with ICH were analyzed by multivariate logistic regression. 
Results  A total of 314 patients with ICH were included in this study. Among them, 18 patients (5.7%) developed DVT during hospitalization, and the time from onset of ICH to diagnosis of DVT was 7.5 (4.0-9.0) days. The results of multivariate analysis showed that female (OR 3.43, 95%CI 1.04-11.37, P=0.0436), history of coronary heart disease (OR 6.89, 95%CI 1.90-25.04, P=0.0034) , high NIHSS score at admission (OR 1.18, 95%CI 1.06-1.23, P=0.0004) and long hospital stay after onset (OR 1.07, 95%CI 1.01-1.13, P=0.0273) were independent risk factors for DVT in patients with ICH.
Conclusions  The DVT time of patients with acute intracerebral hemorrhage is about 1 week after stroke, and the patients who were more prone to lower extremity DVT were female, had a history of coronary heart disease, were seriously ill at admission, and had a long hospital stay. 



A Case of Recurrent Cerebral Infarction due to Mucor Sinusitis Invading Vertebrobasilar Artery

CHEN Lulu, WANG Jingye

2023, 18(05):  583-586.  DOI: 10.3969/j.issn.1673-5765.2023.05.014

Asbtract ( )   PDF (3375KB) ( )  

References | Related Articles | Metrics



A Case of Ultrasound Diagnosis and Treatment of Cerebral Infarction Secondary to Thrombosis on Vulnerable Plaque Surface due to Carotid Web

NING Zihong, WANG Jing, LI Zixiao, JING Jing, NING Bin, DONG Kehui, GONG Xiping

2023, 18(05):  587-593.  DOI: 10.3969/j.issn.1673-5765.2023.05.015

Asbtract ( )   PDF (8484KB) ( )  

References | Related Articles | Metrics



Research Progress of Current Status for Pre-hospital Delay and Improvement Measures for Acute Ischemic Stroke

LIAO Yuqi, CAO Liming, REN Lijie

2023, 18(05):  594-600.  DOI: 10.3969/j.issn.1673-5765.2023.05.016

Asbtract ( )   PDF (1689KB) ( )  

References | Related Articles | Metrics

he incidence of acute ischemic stroke in China is high, the situation of pre-hospital delay is severe, and the burden of treatment is heavy. However, the relevant influencing factors and measures that can be taken are not clear or contradictory reports exist, which is not conducive for the government departments' decision-making. This review found that people with low education, living alone or alone during a stroke attack, the COVID-19 epidemic and being located in the countryside were more likely to cause pre-hospital delay. Patients with a history of hypertension, transient ischemic attacks, and ischemic stroke, or patients had dysarthria, decreased muscle strength, anterior circulation stroke, and ambulance transfer had fewer pre-hospital delays. Effective and feasible measures to shorten pre-hospital delay include strengthening propaganda and education on stroke, implementing mobile stroke units and raising the level of informatization. These findings provide a reference for further reducing pre-hospital delay, improving the efficiency of first aid, and assisting government decision-making.



Sleep Disorder and Non-drug Therapy in Patients with Vascular Cognitive Impairment

ZHANG Xinyi, CHEN Chuxin, DONG Jianyu, ZHANG Ning, WANG Chunxue

2023, 18(05):  601-609.  DOI: 10.3969/j.issn.1673-5765.2023.05.017

Asbtract ( )   PDF (1718KB) ( )  

References | Related Articles | Metrics

Patients of vascular cognitive impairment often suffered from all kinds of sleep problems, which further reduced their quality of life, improved risk of cerebrovascular events and increased their caregiver’s burden. Effective treatment of sleep disorders can not only improve the quality of life of patients, but also have positive effects on the cognitive and functional rehabilitation of patients. In this article, we reviewed the common sleep problems in patients of vascular cognitive impairment, elaborated on the present research results of non-pharmacological treatments to these problems, and discussed the future research fields and application prospects of non-pharmacological therapy for sleep disturbance of vascular cognitive impairment patients.

Study on Discharge Summary Quality Analysis of Stroke Patients and Its’ Association with Standardized Training for Resident Doctors

SONG Xiaowei, HOU Duoduo, ZHAO Lei, WU Jian

2023, 18(05):  610-615.  DOI: 10.3969/j.issn.1673-5765.2023.05.018

Asbtract ( )   PDF (2268KB) ( )  

References | Related Articles | Metrics

Objective  To investigate the current situation of discharge summary of stroke patients, as well as the relationship between standardized training of resident doctors and discharge summary, to clarify the existing problems, and to provide reliable data for formulating targeted improvement measures in the next step.
Methods  This study examined the discharge summary of the medical records of stroke patients discharged during the continuous 2 months from a regional advanced stroke center. The criteria for case quality scales (including 7 items about integrity and quality of important elements of writing content, 10 points in total) and stroke medical record quality scores (including stroke type, etiology classification, diagnosis and treatment process and medication, complication description, neurological function evaluation at discharge, prognosis evaluation, further diagnosis and examination suggestions, discharge medication guidance, discharge blood pressure and lipid control objectives and treatment follow-up suggestions, 1 points for each item, 11 points in total) were used to evaluate the cases we collected by two stroke neurologists independently. To understand the current situation, summarize the existing problems, and compare the differences between residents who were before and after neurology first-stage training. 
Results  A total of 105 cases were included into analysis, which were written by 6 residents at different levels.  The overall score for standard medical record writing quality ranged from 6-10, and the average score was 9±1. Most of them were above 8 points (83.8%, 88/105) . One case got the lowest score of 6 points. 50.5% (53/105) of them have some defect on suggestions after discharge, as well as follow up time. The overall score for stroke medical history quality score ranged from 4-10, and the average score was 7±1. 76.2% (80/105) were 7 points and above. Of the items included, treatment goals for blood pressure and lipid ranking last, only 6.7% (7/105) and 1.0% (1/105) reached the standard, individually. The scores of standard medical record writing quality of senior residents who had received first-stage training in neurology and those of junior residents who had not received training were (9±1) points (P=0.753) , and there was  no significant difference in the scores of each sub-item (P > 0.05) . The quality scores of stroke patients medical records in both groups were (7±1) points (P=0.335) . However, in terms of the stroke patients medical records quality score for further diagnostic, the writing quality of the senior residents was slightly higher than junior residents (95.6% vs. 78.4%, P=0.016) . 
Conclusions  The general stroke case discharge summary is acceptable, but need further improvement in content, especially for the treatment goals in cardiovascular risk factors, as well as in further follow up. In terms of residency training, the importance of writing stroke medical records should be highlighted in the residency training in the future.