Table of Content

20 June 2020, Volume 15 Issue 06

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Establish Clinical Research Big Data, Promote Precise Medicine on Stroke

JIANG Yong, MENG Xia,WANG Yong-Jun

2020, 15(06):  573-576.  DOI: 10.3969/j.issn.1673-5765.2020.06.001

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Application of Blockchain in Healthcare Quality Assessment of Ischemic Stroke

LI Zi-Xiao, LIU Xiang-Yu,ZHU Hao-Gang, WANG Meng, YANG Xin, WANG Chun-Juan, JIANG Yong, LIN Lin, WANG Tao, ZHAO Xing-Quan,WANG Yong-Jun

2020, 15(06):  578-586.  DOI: 10.3969/j.issn.1673-5765.2020.06.002

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Objective To evaluate the application of blockchain in medical quality assessment of ischemic stroke in a polycentric collaborative environment with the sensitive data restricted. Methods To establish the isolation belt between the sensitive domain and the public domain, using data gateway and security sandbox technology. The idea of "destroy after using" is used to prevent data leakage. The smart contract is applied to control data and algorithm. All traces are recorded on the blockchain. Results The record performance of the blockchain system was 9000 transactions per second. The retrieval time of medical information features was less than 10 ms. Medical quality control and in-depth statistical analysis capabilities were provided by the system in polycentric collaborative environment and validated in three hospitals. Conclusions An effective medical quality control evaluation system can be established in polycentric collaborative environment with blockchain, smart contract, security sandbox, digest generation and other technologies. With the application of knowledge extraction, tracing and crossdomain delivery, the improvement of healthcare quality will be accelerated.

Comparison of Prediction Models for In-hospital Stroke Recurrence in Patients with Ischemic Stroke Based on Logistic Regression and XGBoost Methods

GU Hong-Qiu, WANG Chun-Juan, LI Zi-Xiao, WANG Yi-Long,WANG Yong-Jun, JIANG Yong

2020, 15(06):  587-594.  DOI: 10.3969/j.issn.1673-5765.2020.06.003

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Objective To compare prediction models for in-hospital stroke recurrence in patients with ischemic stroke based on logistic regression and XGBoost methods. Methods Data of ischemic stroke inpatients discharged according to medical advice from China National Stroke Registry Ⅱ (CNSR Ⅱ) database were retrospectively analyzed. Logistic regression and XGBoost methods were used to develop a model for predicting in-hospital stroke recurrence. Candidate predictors included demographic characteristics, stroke severity, medical history, medication history, and clinical measure indicators. The performance measures of the predictive models included the area under the receiver operating characteristic curve (AUC), calibration intercept, calibration slope and Brier score. All statistical analysis was performed using R (version 3.6.2). Results A total of 17 227 eligible patients were included in this analysis. The mean age was 64.72±11.84 years, and 6317 (36.7%) cases were females. A total of 14 482 (84.1%) patients had a mRS score of 0 or 1 point before symptoms onset, and the NIHSS score at admission was 4 (2-6). A total of 444 (2.6%) patients had recurrent stroke during hospitalization. The three leading strong predictors were mRS score, atrial fibrillation and stroke history in logistic regression model, and mRS score, atrial fibrillation and total cholesterol in XGBoost model. No significant difference was found in AUC between logistic regression model and XGBoost model (0.63, 95%CI 0.58-0.68 vs 0.64, 95%CI 0.59-0.68, P =0.9229). The calibration intercept, calibration slope and Brier score in logistic regression model were -0.81, 0.76 and 0.03, respectively; and were -1.37, 1.20 and 0.38 in XGBoost model. Logistic regression model had better calibration than XGBoost model. Conclusions No significant difference was found in discrimination between logistic-based prediction model and XGBoost-based prediction model for in-hospital stroke recurrence constructed using data of CNSR II, while logistic-based prediction model had better calibration.

Machine Learning-based Model for Prediction of 90-day Death after Ischemic Stroke

CHEN Si-Ding, LIU Huan,HUANG Xin-Ying, LI HAO-Lin, GU Hong-Qiu, JIANG Yong

2020, 15(06):  595-599.  DOI: 10.3969/j.issn.1673-5765.2020.06.004

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Objective To explore the application value of a machine learning-based model using XGBoost algorithm in predicting 90-day death after ischemic stroke. Methods Ischemic stroke patients from China National Stroke Registry (CNSR) database were selected as subjects, all of them were randomly divided into a training set and test set at a ratio of 7:3. The training set was used to build the prediction model, and the test set was used to evaluate the performance of the model. XGBoost and logistic regression were used to construct the 90-day death prediction model of ischemic stroke. The prediction value of the two models were evaluated by the area under the ROC curve (AUC). Results A total of 10 645 patients were included, with an average age of 65.18±12.23 years old and 4045 females (38.0%). The NIHSS score at admission was 4 (2-9) points. There were 447 deaths (4.48%) at 3 months. The AUC of XGBoost and logistic regression model was 0.8539 and 0.8278, respectively (P =0.0835); the sensitivity was 0.7413 and 0.7133, respectively, and the specificity was 0.8286 and 0.8040, respectively. Conclusions The prediction model of 90-day death after ischemic stroke based on XGBoost machine learning algorithm had a good prediction value.

Advances in Clinical Research Data Management and Sharing

LI Hao-Lin, JIANG Yong

2020, 15(06):  600-605.  DOI: 10.3969/j.issn.1673-5765.2020.06.005

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The development of precision medicine requires a standardized data management system and efficient data sharing scheme. Based on current international norms, China's clinical data management standards emphasized centralized supervision on research qualification. In the early 21st century, western countries established integrated stroke databases to promote data sharing, and China in 2008 announced principles to encourage data sharing. China National Clinical Research Center of Neurological Diseases, by establishing clinical research public data standards and integrating specialized disease data resource catalogs, built a cerebrovascular disease big data management and sharing platform which conformed to FAIR principle--findable, accessible, interoperable and reusable, to improve clinical research data quality and promote scientific data sharing.

Application of Blockchain in Stroke Electronic Medical Record Sharing

QIN Qiu-Li, CAO Hui, LI Ming-Yan,JIANG Yong

2020, 15(06):  606-610.  DOI: 10.3969/j.issn.1673-5765.2020.06.006

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Blockchain technology has the characteristics of high security and decentralization in data sharing, and it is an effective method to solve the difficulty of sharing electronic medical records of stroke. This article mainly introduced an application scheme to ensure the safe and efficient sharing of stroke electronic medical records--a secp256k1 curve encryption using an elliptic curve digital signature algorithm at the data layer based on the blockchain and an improved BFT-RAFT consensus mechanism used at the consensus layer, and utilizing the advantages of data verification--the self-check ability of a single node and quasi real-time data check between multiple nodes, to provide certain reference for assisting stroke diagnosis, treatment and clinical data sharing.

Progress of Machine Learning-based Prediction Model for Complications and Prognosis in Acute Ischemic Stroke

QIN Wei, JIANG Yong, LIU Bao-Hua

2020, 15(06):  611-615.  DOI: 10.3969/j.issn.1673-5765.2020.06.007

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With the development of medical big data and the rapid increasing of computer analyzing capabilities, research on machine learning-based prediction models in stroke has gradually become hotspots in interdisciplinary research. Compared with traditional scales, machine learning-based models have great advantages such as fast, accurate and repeatable, which have been applied in the diagnosis and prognosis assessment in stroke, to help clinicians accurately judge the patient's condition. This article reviewed the progress of machine learning-based prediction models for complications and prognosis in acute ischemic stroke, and discussed the existing problems, such as the limited number of studies, small sample size, and the lack of external verification, etc.

Design and Application of Cerebrovascular Diseases Big Data Scientific Research Platform Based on Electronic Medical Records

2020, 15(06):  616-619.  DOI: 10.3969/j.issn.1673-5765.2020.06.008

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On the basis of information construction, cerebrovascular disease big data platform was established based on electronic medical records (EMR) in Beijing Tian Tan hospital, Capital Medical University. The platform aims to construct the data application mode covering multiple data utilization scenarios such as clinical and scientific research integration service, intelligent disease prediction, scientific knowledge base, clinical decision support and real world research and etc., and realize the coordination development of clinical and scientific research, through the integration and sharing of multisource and heterogeneous data inside and outside the hospital; meanwhile, provide data and technical support for multi-center clinical studies, and improve the overall treatment ability of refractory cerebrovascular diseases and critically ill emergency patients in the region.

Incidence, Risk Factors and In-hospital Outcomes of Symptomatic Seizures after Subarachnoid Hemorrhage:Analysis from China Stroke Center Alliance Registry Database

GU Hong-Qiu, Yang Xin, WANG Chun-Juan,LI Zi-Xiao, WANG Yi-Long, WANG Yong-Jun, JIANG Yong

2020, 15(06):  620-625.  DOI: 10.3969/j.issn.1673-5765.2020.06.009

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Objective To investigate the incidence and risk factors of symptomatic seizures after subarachnoid hemorrhage (SAH), and the relationship between secondary seizures and in-hospital outcomes. Methods The in-hospital SAH patients from the China Stoke Center Alliance (CSCA) registry database from August 1, 2015, to July 31, 2019 were enrolled in the retrospective analysis. According to the presence of symptomatic seizures or not after SAH during hospitalization, all the subjects were divided into SAH with seizure group and SAH without seizure group. Differences in demographics, score of Glasgow comma scale (GCS) at admission, vascular risk factors, surgery, and the class and region of hospitals were compared. A multivariate logistic regression model was used to identify risk factors of seizures after SAH and evaluate the association of in-hospital death,ischemic stroke, intracerebral hemorrhage (ICH) and pneumonia with symptomatic seizures after SAH. Results A total of 11 210 SAH patients were enrolled in this study, with the average age of 60.0±12.9 years and 6623 (59.1%) females, and the median GCS score was 15 points. A total of 228 (2.0%) cases had symptomatic seizures after SAH. Age (OR 0.92, 95%CI 0.87-0.97), prior stroke/ TIA (OR 1.61, 95%CI 1.20-2.17), carotid stenosis (OR 3.17, 95%CI 1.27-10.85), atrial fibrillation (OR 2.64, 95%CI 1.12-6.24), dyslipidemia (OR 1.79, 95%CI 1.03-3.13), and external ventricular drainage (OR 2.30, 95%CI 1.31-4.02) were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH may be associated with a higher risk of in-hospital death (OR 1.71, 95%CI 0.96-3.05), ischemic stroke (OR 4.21, 95%CI 2.70-6.56), ICH (OR 3.87, 95%CI 2.81- 5.33) and pneumonia (OR 2.96, 95%CI 2.26-3.86). Conclusions Symptomatic seizures is a common neurological complication in SAH patients. Younger age, prior stroke/TIA, carotid stenosis, atrial fibrillation, dyslipidemia and external ventricular drainages were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH increased the risk of in-hospital death, cerebral infarction, ICH pneumonia.

Risk Factors and Outcomes of Pneumonia in Patients with Subarachnoid Hemorrhage

2020, 15(06):  626-630.  DOI: 10.3969/j.issn.1673-5765.2020.06.010

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Objective To analyze the influencing factors and in-hospital outcomes of pneumonia in patients with subarachnoid hemorrhage (SAH). Methods The data of SAH patients from Beijing Tian Tan Hospital, Capital Medical University from May, 2015 to November, 2018 were retrospectively analyzed. Based on the presence of inhospital pneumonia or not, all the patients were divided into pneumonia group and non-pneumonia group. The differences of clinical characteristics between the two groups were compared. The univariate and multivariate logistic regression were used to analyze the risk factors for pneumonia and the in-hospital outcome of patients with pneumonia. Results A total of 457 patients were included, with an average age of 54.3±11.2 years and 219 males (47.9%). Pneumonia occurred in 76 cases (16.6%). Multivariate analysis showed that male (OR 2.31, 95%CI 1.17-4.58, P =0.016), dysphagia (OR 6.06, 95%CI 1.09-33.70, P =0.039) and Barthel index of 0-20 points (OR 15.58, 95%CI 4.17-58.23, P <0.001) were independent risk factors for pneumonia, and pneumonia was not associated with in-hospital mortality, the length of hospitalization and the total expense of hospitalization. Conclusions Male, dysphagia and Barthel index of 0-20 points were independent risk factors for pneumonia in SAH patients. The occurrence of pneumonia did not increase the risk of in-hospital death, the length of hospitalization and the total expense of hospitalization.

Clinical Analysis of 11 Cases of Anterior Inferior Cerebellar Artery Aneurysms

CHEN Xin, WANG Hao,JIANG Peng-Jun, JIAO Yu-Ming, CAO Yong, LI You-Xiang, WANG Shuo

2020, 15(06):  631-636.  DOI: 10.3969/j.issn.1673-5765.2020.06.011

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Objective To summarize the clinical characteristics of 11 cases of anterior inferior cerebellar artery (AICA) aneurysms and compare the efficacy of two treatment approaches of neurosurgical clipping and endovascular coiling. Methods Clinical data of patients with AICA aneurysms admitted to Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University from 2012 January to 2019 December were retrospectively analyzed. The clinical data included the baseline information, clinical presentation, aneurysm feature, treatment way and clinical outcome. Results A total of 11 cases were included, including 5 cases with neurosurgical treatment and 6 cases with endovascular treatment. The surgical success rate of neurosurgery group was 100%, with no recurrent aneurysms during the follow-up period, and partial aphasia and operation-ipsilateral facioplegia occurred in 2 cases (40%) after operation. Of 6 cases with endovascular treatment, there were 5 cases of successful endovascular coiling and 1 failure case, 1 of 5 successful cases died from re-ruptured aneurysm at 1 month after discharge, and dysmnesia occurred in 1 case after operation. Conclusions Both neurosurgical clipping and endovascular coiling are feasible and effective treatment approaches for patients with AICA aneurysms.

Application Value of 0.25 mg Low-dose Nitroglycerin-stimulated Head-up Tilt Test for the Diagnosis of Vasovagal Syncope

LIU Jie-Xin, DU Song, WANG Yue, JIN Ze-Ning, HUANG Ze-Ming, SONG Ke, FAN Zhi-Qi, CHEN Zhang-Huang, WU Bin

2020, 15(06):  637-643.  DOI: 10.3969/j.issn.1673-5765.2020.06.012

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Objective To evaluate the feasibility of 0.25 mg low-dose nitroglycerin-stimulated head-up tilt testing (HUTT) for the diagnosis of vasovagal syncope (VVS) . Methods Patients with suspected VVS were selected in this study for a HUTT provoked by 0.25 mg low-dose sublingual nitroglycerin. Noninvasive beat to beat blood pressure was monitored continuously, then the positive rate and the time from tilt to presyncope were compared with that in previous studies. Results A total of 343 patients were included, of whom 241 patients (70.3%) were elicited a positive result by the low-dose nitroglycerin-stimulated HUTT. Of the positive HUTT patients, 83 (34.4%) were mixed syncope, 2 (0.8%) were cardioinhibitory syncope and 156 (64.7%) were vasodepressor syncope. No significant differences in the drug provoked positive rate and overall positive rate were found between this study and previous international studies, while the overall positive rate in this study was higher than that in previous domestic studies (70.3% vs 64%, P =0.016). The time from tilt to presyncope in this study was shorter, compared to that in the study using 0.3 mg sublingual nitroglycerin (5.0±2.2 min vs 7±8 min, P =0.001), while had no statistical difference with that in the study using 0.4 mg sublingual nitroglycerin (spray) (P >0.99).

Conclusions Due to an acceptable positive result, the drug stimulated HUTT by 0.25 mg low-dose nitroglycerin are feasible in the clinical practice.

Correlation between Serum Alkaline Phosphatase and Recurrent Stroke in Patients with Mild Cerebral Infarction

LU Qing-Li, LIU Zhong-Zhong, LIN Xue-Mei, CAO Huan, WANG Jing, LIU Pei, WANG Fang, SHI Ya-Ling, WANG Qing, LIU Guo-Zheng, WU Song-Di

2020, 15(06):  644-649.  DOI: 10.3969/j.issn.1673-5765.2020.06.013

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Objective To investigate the correlation between serum alkaline phosphatase (ALP) and recurrent stroke in patients with mild cerebral infarction. Methods Patients with mild cerebral infarction who were admitted to four tertiary-grade A class hospitals from Xi'an stroke database between January 2015 and December 2015 were included in this analysis. Based on the quartile of serum ALP levels detected within 24 hours after admission, all the patients were divided into four groups. The endpoints were recurrent stroke (including ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage) within 1 year. Multivariate logistic regression analysis and curve fitting were used to evaluate the correlation between serum ALP level and 1-year stroke recurrence in patients with mild cerebral infarction. Results A total of 895 patients were included, with an average age of 63.52±12.31 years and 572 males (63.9%). The median NIHSS score at admission was 2 points, and recurrent stroke occurred in 26 patients (2.9%) during 1 year. Multivariate logistic regression analysis showed that the 1-year risk of stroke recurrence in patients with mild cerebral infarction increased by 2% per 1 U/L increase in serum ALP (OR 1.02, 95%CI 1.01-1.04, P =0.030), and the 1-year risk of stroke recurrence increased by 19% per 10 U/L increase (OR 1.19, 95%CI 1.01-1.41, P =0.030). There were no statistical difference in the 1-year stroke recurrence risk between the high level group (Q2, Q3 and Q4 groups) and the lowest level group (Q1 group), and as well as in the increase trend of stroke recurrence risk among the four groups. Conclusions Serum ALP may be an influencing factor for 1-year stroke recurrence in patients with mild cerebral infarction.

Impact of Leukoaraiosis on Symptomatic Intracranial Hemorrhage and Functional Outcome after Intravenous Thrombolysis in Elderly Patients with Acute Cerebral Infarction

LIU Xiao-Wei, HU Wen-Li

2020, 15(06):  650-654.  DOI: 10.3969/j.issn.1673-5765.2020.06.014

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Objective To investigate the impact of leukoaraiosis (LA) on symptomatic intracranial hemorrhage (sICH) within 24 hours after intravenous thrombolysis and 3-month functional outcome in elderly patients with acute ischemic stroke. Methods The elderly patients who received intravenous thrombolysis in Beijing Huairou Hospital from January 1, 2016 to December 31, 2018 were selected. Based on the head CT evaluation at admission. LA was graded using modifed Van Swieten scale. Multivariate logistic regression model was used to analyze the relationship between LA and sICH at 24 hours after thrombolysis and 3-month poor prognosis (mRS>2). Results A total of 125 patients were enrolled, with an average age of 73.2±8.4 years and 84 males (67.2%), of whom 82 patients (65.6%) had LA. The percentage of sICH in LA group and non-LA group was 12.2% (n =10) and 4.7% (n =2), P =0.298; and the percentage of poor prognosis was 70.7% (n =58) and 34.9% (n =15), P <0.001. Multivariate logistic regression analysis showed that LA was not correlated with sICH (OR 0.320, 95%CI 0.056-1.846, P =0.203), but associated with 3-month poor prognosis (OR 4.392, 95%CI 1.514-12.744, P =0.006). Conclusions LA was not associated with sICH within 24 hours after intravenous thrombolysis, but with poor prognosis at 3 months in elderly patients with acute cerebral infarction.

Correlation between Total Cerebral Small Vessel Diseases Burden and Long-term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolysis

YANG Miao-Juan, ZENG Si-Lin, XU Qian-Hui, FANG Jun-Lin,WANG Ying, GUO Yi

2020, 15(06):  655-661.  DOI: 10.3969/j.issn.1673-5765.2020.06.015

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Objective To explore the relationship between the total cerebral small vessel diseases (CSVD) burden and 1-year outcome after intravenous thrombolysis in patients with acute ischemic stroke. Methods This prospective study consecutively enrolled patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) and underwent MRI between January 2017 and December 2018. The total burden score of CSVD was calculated according to MRI results. 1-year outcome after stroke was evaluated using the modified Rankin scale (mRS). Multivariate logistic regression analysis was used to identify the relationship between the total burden score of CSVD and 1-year poor prognosis. ROC curve analysis was used to determine the area under the curve (AUC) and optimal cut-off value of the total CSVD score for predicting 1-year poor outcome. Results A total of 135 patients were included, with an average age of 61.56±12.64 years old. There were 17 cases (12.59%) with a total CSVD score of 0, 44 cases (32.59%) with a score of 1, 38 cases (28.15%) with a score of 2, 30 cases (22.22%) with a score of 3, and 6 cases (4.44%) with a score of 4. Multivariate analysis showed that NIHSS at admission (OR 1.615, 95%CI 1.209-2.157, P =0.001) and total CSVD score (OR 1.570, 95%CI 1.095-4.094, P =0.026) were independent risk factors for 1-year outcome. The AUC and optimal cut-off value of total CVSD score and NIHSS score at admission for predicting 1-year poor outcome were 0.735 (95%CI 0.641-0.828) and 2.5, 0.773 (95%CI 0.684-0.862) and 6.5, respectively. Conclusions The total CSVD burden score and NIHSS score at admission were independent influencing factors for 1-year outcome after intravenous thrombolysis in acute ischemic stroke.

Effects of Nutrition Regimen on Energy Metabolism in Acute Severe Ischemic Stroke Patients Based on Different Energy Estimation Method

ZHAO Su-Ping, LIU Li, DU Juan, CAI Yi-Ling, YUAN Jun, LI Zi-Ru

2020, 15(06):  662-667.  DOI: 10.3969/j.issn.1673-5765.2020.06.016

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Objective To compare the differences of nutrition regimens developed by different energy assessment methods in the treatment of acute severe ischemic stroke. Methods This prospective study enrolled consecutive patients with acute severe ischemic stroke admitted to Neurological Intensive Care Unit of the People's Hospital of Inner Mongolia Autonomous Region from July 2016 to January 2018. According to the random number method, all patients were divided into three groups: experience group, formula group and indirect energy measurement group. All the patients in the three groups were given nutritional support according to the daily resting energy expenditure requirement, which were measured by empirical energy estimation method, Harris-Benedict correction formula and indirect energy measurement method, respectively. The upper arm muscle circumference and waist circumference, lymphocyte count, serum pre-albumin, albumin and hemoglobin level were measured before nutrition support and at day 7, 14 after nutrition support. Results A total of 90 patients were included in the final analysis, with an average age of 71±8 years and 51 (56.67%) males, and 30 cases in each group. Difference in all the nutrition indicators among the three groups were not all statistically significant before nutrition support; there were statistical differences in lymphocyte count at day 7 after nutrition support and upper arm muscle circumference, serum prealbumin and albumin level at day 14 after nutrition support among the three groups; further pairwise comparison results as follows: lymphocyte counts at day 7 and serum albumin level at day 14 after nutrition support in indirect energy measurement group were highest, and that in formula group were higher than experience group, and the differences were all statistically significant. Conclusions Indirect energy measurement can more accurately assess the energy requirements for patients with acute severe ischemic stroke, and the nutrition regimen made by which can better improve the nutritional status of the patients.

Incidence of Aspirin Resistance and Correlation with Long-term Outcome in Patients with Cerebral Small Vessel Disease

LI Fang-Fei, LIU Dong-Tao, ZHOU Li-Chun

2020, 15(06):  668-672.  DOI: 10.3969/j.issn.1673-5765.2020.06.017

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Objective To explore the incidence of aspirin resistance (AR), and the relationship between AR and 2-year outcome in patients with cerebral small vessel disease (CSVD). Methods This prospective study enrolled consecutive patients diagnosed with CSVD in Department of Neurology from August 2015 to June 2017. The patients were divided into aspirin resistance (AR) group and non-aspirin resistance (non-AR) group according to the platelet inhibition rate measured by thromboelastography. Baseline data included demographic information, laboratory tests and imaging results. The outcomes were evaluated by recording new-onset vascular events and imaging re-examination within 2-year follow-up. Multivariate logistic regression analysis was used to determine the correlation between AR and outcome. Results A total of 94 CSVD patients were included, with the mean age of 66.20±7.37 years (range: 49-84 years), and 55 males (58.5%). The total incidence of AR was 23.4% (22/94). AR was associated with the risk of new-onset lacunar infarction (OR 4.70, 95%CI 1.56-24.13, P =0.041) and white matter lesions progression (OR 4.07, 95%CI 1.28-11.57, P =0.038), and not associated with the risk of new-onset vascular events and mortality within 2 years. Conclusions The incidence of AR in CSVD in-hospital patients was about one fifth. AR may be associated with the risk of new-onset lacunar infarction and white matter lesions progression.

Secondary Prevention Medications Adherence and Related Factors among Stroke Survivors in Rural Area of Nanhe County, Heibei Province

ZHOU Yun, YIN Li-Shi, GONG En-Ying, GU Wan-Bing, WANG Pei-Gang,ZHAO Rui, WANG Yi-Long, YAN Li-Jing

2020, 15(06):  673-680.  DOI: 10.3969/j.issn.1673-5765.2020.06.018

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Objective To assess the adherence to secondary prevention medications (antiplatelet drugs, statins, and antihypertensive drugs) among individuals with a history of stroke in rural China, and analyze the related factors of medications adherence. Methods The baseline survey data were analyzed from multi-center cluster-randomized controlled trial “Nanhe County Practical and Innovation Stroke Prevention Project”. This survey conducted in July 2017 was a cross-sectional survey enrolled eligible stroke patients from 50 villages of 5 townships, Nanhe County. The self-report questionnaire survey and physical examination were conducted in all patients. The main information of the questionnaire included socio - demographic information, medical history, social support, and medication compliance, etc. Medication adherence was measured by the Morisky Green Levine scale. Multivariate logistic regression was conducted to analyze the related factors of the persistence of antiplatelet drugs, statins, and antihypertensive drugs. Results A total of 1299 stroke patients were included in this analysis, with a mean age of 65.7±8.2 years old and 746 (57.4%) males. Participants who were actually taking antiplatelet drugs, statins and antihypertensive drugs accounted for 72.0%, 28.4%, and 91.1% of the estimated population who should take the corresponding drugs according to the disease diagnosis. Among those who were taking medicines, 63.0%, 63.5%, and 62.6% had good adherence to antiplatelet drugs, statins and antihypertensive drugs. Multivariate analysis showed that less self-perceived care needs was associated with better adherence to antiplatelet drugs (OR 0.58, 95%CI 0.45-0.75, P <0.001); stroke recurrence was associated with worse adherence to statins (OR 2.09, 95%CI 1.17-3.71, P =0.013), and no-smoking was associated with better adherence to statins (OR 0.43, 95%CI 0.19-0.97, P =0.043); elder age (OR 0.97, 95%CI 0.95-0.99, P =0.004), taking more than one kind of medicine (OR 0.54, 95%CI 0.39-0.75, P <0.001), less self-perceived care need (OR 0.58, 95%CI 0.40-0.84, P =0.004), and no-smoking (OR 0.63, 95%CI 0.41-0.84, P =0.046) were associated with better adherence to antihypertensive drugs. Conclusions There were relatively low rate of rational use of secondary prevention drugs and poor compliance of treatment among stroke patients in Nanhe County, Hebei Province. Age, smoking, stroke recurrence, taking more than one kind of medicine, less self-perceived care needs were associated with secondary prevention medications adherence.

Chinese Consensus on Standardized Nutrition Management in Patients with Stroke

Experts Committee of Standardized Nutrition Management in Patients with Stroke

2020, 15(06):  681-689.  DOI: 10.3969/j.issn.1673-5765.2020.06.019

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Experts Committee of Standardized Nutrition Management in Patients with Stroke

A Case of CADASIL

ZHAO Qian-Qian, WANG Ya-Jun, SUN Jia-Dong, CHEN Jiao, LI Xue-Mei

2020, 15(06):  690-693.  DOI: 10.3969/j.issn.1673-5765.2020.06.020

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