Increased Blood Viscosity in Ischemic Stroke Patients with Small Artery Occlusion Measured by an Electromagnetic Spinning Sphere Viscometer

Whole Blood Viscosity and Cerebral Blood Flow in Acute Ischemic Stroke

Existing effective treatments for ischemic stroke restore blood supply to the ischemic region using thrombolysis or mechanical removal of clot. However, it is increasingly recognized that successful removal of occlusive thrombus from the large artery-recanalization, may not always be accompanied by successful restoration of blood flow to the downstream tissues-reperfusion. Ultimately, brain tissue survival depends on cerebral perfusion, and a functioning microcirculation. Because capillary diameter is often equal to or smaller than an erythrocyte, microcirculation is largely dependent on erythrocyte rheological (hemorheological) factors such as whole blood viscosity (WBV). Several studies in the past have demonstrated elevated WBV in stroke compared with healthy controls. Also, elevated WBV has shown to be an independent risk factor for stroke. Elevated WBV leads to endothelial dysfunction, decreases nitric oxide-dependent flow-mediated vasodilation, and promotes hemostatic alterations/thrombosis, all leading to microcirculation sludging. Compromised microcirculation further leads to decreased cerebral perfusion. Hence, modulating WBV through pharmacological agents might be beneficial to improve cerebral perfusion in stroke. This review discusses the effect of elevated WBV on endothelial function, hemostatic alterations, and thrombosis leading to reduced cerebral perfusion in stroke.

Diagnosis and treatment of dehydration after stroke: A synthesis of existing evidence

Dehydration after stroke is associated with poor health outcomes, increased mortality, and poses a significant economic burden to health services. Yet research suggests that monitoring and assessment of hydration status is not routinely undertaken. In this commentary, we critically appraise a systematic review which aimed to synthesise the existing evidence regarding diagnosis and treatment of dehydration after stroke. The review discusses common measures of dehydration, describes studies evaluating rehydration treatments, and highlights the link between dehydration and poorer health outcomes in both human and animal studies. The reviewers suggest, future research should focus on determining a single, validated, objective measure to clinically diagnose dehydration in stroke patients. Research designs should include clearly defined patient characteristics, type and severity of stroke, and type and time point of dehydration measurement, to enable comparison between studies. Management of hydration status is a crucial element of acute stroke care which should be routinely practiced.

Possible Effects of Acupuncture in Poststroke Aphasia

Neural plasticity promotes the reorganization of language networks and is an essential recovery mechanism for poststroke aphasia (PSA). Neuroplasticity may be a pivotal bridge to elucidate the potential recovery mechanisms of acupuncture for aphasia. Therefore, understanding the neuroplasticity mechanism of acupuncture in PSA is crucial. However, the underlying therapeutic mechanism of neuroplasticity in PSA after acupuncture needs to be explored. Excitotoxicity after brain injury affects the activity of neurotransmitters and disrupts the transmission of normal neuron information. Thus, a helpful strategy of acupuncture might be to improve PSA by affecting the availability of these neurotransmitters and glutamate receptors at synapses. In addition, the regulation of neuroplasticity by acupuncture may also be related to the regulation of astrocytes. Considering the guiding significance of acupuncture for clinical treatment, it is necessary to carry out further study about the influence of acupuncture on the recovery of aphasia after stroke. This study summarizes the current research on the neural mechanism of acupuncture in treating PSA. It seeks to elucidate the potential effect of acupuncture on the recovery of PSA from the perspective of synaptic plasticity and integrity of gray and white matter.

Association of cerebral infarction with vertebral arterial fenestration using non-Newtonian hemodynamic evaluation

PURPOSE

Cerebral artery fenestration is a rare vascular anomaly, but its existence has been increasingly documented. The association of cerebral infarction and fenestration is of great clinical interest, and the exact underlying mechanism remains unclear. This study aims to identify risk factors contributing to cerebral infarction by computational hemodynamics analysis.

METHODS

Eight patients with image findings of fenestration structure were recruited in this research, in which four suffered fenestration-related cerebral infarction (A series) while the other four (B series) were set as control matched by the fenestration size. Three-dimensional models were reconstructed from the MRA images and computational simulations with non-Newtonian flow model were performed to get interested hemodynamic characteristics.

RESULTS

The blood flow pattern was relatively separated along two channels of fenestration in series A compared with series B cases in Group 1-2, however, no significant difference was shown in Group 3-4. Quantitatively, planes were cut in the middle of fenestrations and the ratio of mass flow rate and area was calculated at systolic peak. Results showed that the side of the dominant blood supply was opposite between A and B series, and the dominant side was also opposite between small and large fenestrations. In infarction cases, the basilar top was distributed with larger areas of detrimental hemodynamic indicators and a larger concentrated high viscosity region.

CONCLUSION

The flow division condition throughout the fenestration structure has a key impact on further flow redistribution and flow pattern. The blood viscosity has the potential to be a useful tool in identifying the risk factors for cerebral infarction and more emphasis should be placed on the hemodynamic environment at superior cerebellar arteries.

Prediction of Blood Viscosity Based on Usual Hematological Parameters in a Clinically Healthy Population Living in a High-Altitude City

Huamaní, Charles, William Sarmiento, Golda Córdova-Heredia, Luz Cruz-Huanca, Paulina Damián-Saavedra, and Dario Antonio. Prediction of blood viscosity based on usual hematological parameters in a clinically healthy population living in a high-altitude city. High Alt Med Biol. 23:78-84, 2022. Background and Aims: Variations in blood viscosity are mainly determined by the hematocrit level, but in residents of high-altitude cities, the hemoglobin levels and blood viscosity values are often high. We aimed to determine the blood viscosity values in clinically healthy chronic hypoxia-acclimatized individuals and establish a predictive model based on the hematocrit level and other common hematological parameters. Methods: A prospective observational study was conducted in asymptomatic young adults living in Cusco (a city located at 3,399 m). Venous blood samples were collected to determine the hemoglobin, hematocrit, and albumin and serum protein levels and blood viscosity values. Results: Altogether, 253 volunteers were included, of whom 147 (58.1%) were women. The hematological values were mean values of hemoglobin, 16.32 ± 2.0 g/dl; hematocrit, 48.12% ± 5.24%; triglycerides, 130.68 ± 90.64 mg/dl; globulin, 3.07 ± 0.36 g/dl; and mean blood viscosity, 6.17 ± 0.94 centipoises. The prediction model with the highest explained variance (R² = 68.07%) and parsimony conservation comprised hematocrit, globulin, and triglycerides [blood viscosity = hematocrit × (0.176) + globulin × (0.595) + triglycerides × (1.77/1,000) - 4.13]. Conclusions: In a population living at high altitude, the blood viscosity level is extremely high and mainly determined by the hematocrit level. This population has chronic high blood viscosity levels, which can be predicted using other blood elements.

A New In Vitro Blood Hyperviscosity Model

We developed a model of blood hyperviscosity avoiding extreme impact on the blood. The model shows reproducibility in rat blood under common storage conditions (4±1°C; stabilization with citrate-phosphate-glucose additive solution). Storage of rat blood under these condition leads to impairment of its rheological properties, which manifested in an increase in blood viscosity in a wide range of shear rates (3-300 sec^-1). An increase in blood viscosity appeared the first day of storage and reached a maximum on the third day. During further 11-day storage, the blood viscosity did not change significantly. A hybrid macromolecular compound O-(3-(3,5-di-tert-butyl-4-hydroxyphenyl)propanoyl)-(1→6)-α-D-glucan improved the hemorheological properties during storage. The most pronounced effect was observed on the third day of storage and manifested in a decrease in blood viscosity in the range of shear rates of 50-300 sec^-1. Thus, storage of rat blood with citrate-phosphate-glucose additive solution for 3 days at 4±1°C reproduces the phenomenon of blood hyperviscosity; this model can be used to screen agents with hemorheological activity.

Whole blood viscosity is associated with baseline cerebral perfusion in acute ischemic stroke

Whole blood viscosity (WBV) is the intrinsic resistance to flow developed due to the frictional force between adjacent layers of flowing blood. Elevated WBV is an independent risk factor for stroke. Poor microcirculation due to elevated WBV can prevent adequate perfusion of the brain and might act as an important secondary factor for hypoperfusion in acute ischaemic stroke. In the present study, we examined the association of WBV with basal cerebral perfusion assessed by CT perfusion in acute ischaemic stroke. Confirmed acute ischemic stroke patients (n = 82) presenting in hours were recruited from the single centre. Patients underwent baseline multimodal CT (non-contrast CT, CT angiography and CT perfusion). Where clinically warranted, patients also underwent follow-up DWI. WBV was measured in duplicate within 2 h after sampling from 5-mL EDTA blood sample. WBV was significantly correlated with CT perfusion parameters such as perfusion lesion volume, ischemic core volume and mismatch ratio; DWI volume and baseline NIHSS. In a multivariate linear regression model, WBV significantly predicted acute perfusion lesion volume, core volume and mismatch ratio after adjusting for the effect of occlusion site and collateral status. Association of WBV with hypoperfusion (increased perfusion lesion volume, ischaemic core volume and mismatch ratio) suggest the role of erythrocyte rheology in cerebral haemodynamic of acute ischemic stroke. The present findings open new possibilities for therapeutic strategies targeting erythrocyte rheology to improve cerebral microcirculation in stroke.

Dynamic perfusion analysis in acute ischemic stroke: A comparative study of two different softwares

BACKGROUND

In clinical practice, decisions often must be made rapidly; therefore, automated software is useful for diagnostic support. Perfusion computed tomography and follow-up evaluation of perfusion data are valuable tools for selecting the optimal recanalization therapy in patients with acute ischemic stroke.

OBJECTIVE

This study aimed to compare commercially available software used to evaluate stroke patients prior to thrombectomy.

METHODS

The performance of Olea Sphere (OlS) software vs. CT Neuro Perfusion from Syngo (Sy), as well as the electronic Alberta Stroke Program Early Computed Tomography Score (e-ASPECTS) software vs. an experienced radiologist, were compared using descriptive statistics including significance analysis, Spearman's correlation, and the Bland-Altman agreement analysis. For this purpose, 43 data sets of patients with stroke symptoms related to the middle cerebral artery territory were retrospectively post-processed with both tools and analyzed.

RESULTS

The automatic e-ASPECTS showed high agreement with an expert rater assessment of the ASPECTS. Using OlS and Sy, we compared the parameters for the ischemic core (relative cerebral blood flow), Time to maximum (Tmax) for the penumbra, and the relative mismatch between these two values. Overall, both software tools achieved good agreement, and their respective values correlated well with each other. However, OlS predicted significantly smaller infarct core volumes compared with Sy.

CONCLUSIONS

Although the absolute values have a certain degree of variation, both software programs have good agreement with each other.

MicroRNA-125b inhibits the proliferation of vascular smooth muscle cells induced by platelet-derived growth factor BB

Excessive proliferation and migration of vascular smooth muscle cells (VSMCs) is the main cause of arteriosclerosis obliterans (ASO). The present study aimed to investigate the role of microRNA (miR)-125b on the proliferation and migration of VSMCs. Platelet-derived growth factor-BB (PDGF-BB; 20 ng/ml) was used to treat VSMCs to establish an in vitro model of ASO. VSMCs were transfected with miR-125b mimic to overexpress miR-125. Cell Counting kit-8 (CCK-8) and BrdU assays were performed to assess the proliferative ability of VSMCs, while Transwell and wound healing assays were performed to assess the migratory ability of VSMCs. Western blot and immunofluorescence analyses were performed to detect the expression levels of angio-associated migratory cell protein (AAMP) and serum response factor (SRF) in VSMCs following transfection with miR-125b mimic or inhibitor. The results demonstrated that miR-125b expression decreased following treatment with PDGF-BB, the effects of which were reversed following transfection with miR-125b mimic. According to the CCK-8 assay, the cell proliferative ability decreased by ~50% compared with the negative control (NC) group, and ~40% at day 4 based on the BrdU assay. The results of the Transwell and wound healing assays indicated that the migratory ability of VSMCs significantly decreased in the miR-125b mimic group compared with the NC group. Furthermore, western blot and immunofluorescence analyses demonstrated that AAMP and SRF expression levels decreased following transfection with miR-125b mimic compared with the NC group, the effects of which were reversed following transfection with miR-125 inhibitor. Taken together, the results of the present study suggested that miR-125b inhibits the proliferative and migratory abilities of VSMCs by regulating the expression levels of AAMP and SRF.

Association of blood viscosity with first-pass reperfusion in mechanical thrombectomy for acute ischemic stroke

BACKGROUND

Elevated blood viscosity has been reported as a risk factor for cerebrovascular disease.

OBJECTIVE

The relationship between blood viscosity and outcomes of mechanical thrombectomy (MT) for large artery occlusion (LAO) were investigated in the present study.

METHODS

A total of 238 patients were enrolled and systolic blood viscosity (SBV) and diastolic blood viscosity (DBV) were measured using the scanning capillary tube viscometer. Receiver operating characteristic (ROC) analysis was performed to specify the association of viscosity with the first-pass reperfusion (FPR). Multivariable and regression analyses were performed to evaluate the relationship of viscosity with FPR and various variables.

RESULTS

Based on ROC analysis, the best DBV cutoff value was 10.55 (cP). In multivariable analysis, high DBV was associated with FPR failure (odds ratio 2.82, 95% confidence interval 1.64-4.22; p = 0.001). Increased DVB could be associated with elevated SBV, hematocrit level, and blood urea nitrogen/creatinine ratio (p = <0.001, 0.004, and 0.002, respectively).

CONCLUSIONS

Elevated DBV was associated with FPR failure. Patients with high DBV had longer thrombus length and required more stent passages than patients with low DBV.

Clinical Outcomes and Medical Costs of Hydration Therapy with Hydroxyethyl Starch (130/0.4) or Acute Single Infarction

OBJECTIVES

To investigate the effects of hydration with or without Hydroxyethyl Starch (HES) 130/0.4 on neurological outcomes and medical costs during hospitalisation in patients with a single infarction (SI) in the posterior lenticulostriate artery (LSA) territory.

MATERIALS AND METHODS

In this retrospective, single-centre, non-blinded cohort study, SI in the posterior LSA was defined as an ischaemic lesion with a high-signal intensity area ≥20 mm. All patients received basic stroke care within 48 h of symptom onset between April 2015 and January 2019. Patients were divided into the following two groups by clinician's preference: 1) those administered HES 130/0.4 and 2) those receiving other infusion fluid. The relationships between hospital costs and hydration therapy type were examined.

RESULTS

Eighteen (31%) of 58 patients received HES 130/0.4. The HES group had a significantly lower total cost than the control group (3.6 vs. 6.4 million yen, p=0.006). Moreover, the HES group had a significantly shorter hospital stay duration (79.5 vs. 141.0 days) and lower National Institutes of Health Stroke Scale score on day 7. Multivariate analysis found that HES 130/0.4 administration was an independent factor associated with high costs.

CONCLUSIONS

Hydration therapy with HES 130/0.4 significantly decreased the total costs and hospitalisation duration of patients with SI in the posterior LSA territory.

The relationship between changes in deoxy Hb and body composition before and after cycling exercise during unilateral lower extremity occlusion

[Purpose] To clarify the relationship between changes in deoxygenated hemoglobin level due to cycling exercise and body composition in healthy participants with unilateral lower-limb obstruction. [Participants and Methods] The height, weight, body mass index, and body composition (skeletal muscle mass, body water content, and body fat percentage) of nine healthy males were measured along with the anaerobic threshold. The protocol consisted of 7 minutes of rest followed by 4 minutes of cycling exercise (anaerobic threshold level) with unilateral lower extremity occlusion. After exercise, ischemia was released, and the participants was allowed rest for 5 minutes. Deoxygenated hemoglobin levels before and after the exercise and the relationship between the level of variation and each index were examined. [Results] Body water content and skeletal muscle mass showed a significant negative correlation with changes in deoxygenated hemoglobin level; however, no correlation was found for the other indices. Body water content and skeletal muscle mass were found to be significantly positively correlated. they showed a significant positive correlation with deoxygenated hemoglobin levels. [Conclusion] Our study indicates that body water content and skeletal muscle mass play a significant role in the recovery of blood flow following exercise.

Unusual manifestation of heat stroke: Isolated trochlear nerve palsy

Heat stroke is a life-threatening disease characterized by hyperthermia and neurological dysfunction. The central nervous system is highly sensitive to hyperthermia, which causes neurological complications due to the involvement of the cerebellum, basal ganglia, anterior horn cells, and peripheral nerves. Several studies reported about clinical symptoms and brain image findings of heat stroke. Isolated cranial nerve dysfunction caused by lacunar infarction is an extremely rare condition in patient with heat stroke. We experienced a rare case of trochlear nerve palsy due to midbrain infarction caused by heat stroke.

A comparison of erythrocyte sedimentation rates of bloods anticoagulated with trisodium citrate and EDTA among TB presumptive patients at the University of Gondar comprehensive specialized hospital, northwest Ethiopia

OBJECTIVE

The purpose of this study was comparing the erythrocyte sedimentation rate (ESR) results of trisodium citrate (TSC) and ethylene diamine tetra-acetic acid (EDTA) anticoagulants. A comparative cross-sectional study was conducted at the University of Gondar specialized referral hospital, northwest Ethiopia. A total of 70 TB presumptive participants were recruited. From each of the 70 participants of the study, 3 and 1.6 ml of blood was collected in EDTA tubes and 0.4 ml of trisodium Citrate anticoagulant containing test tubes, respectively.

RESULTS

The mean ± SD values of ESR were 57.9 ± 41.45 mm/h in EDTA and 50.99 ± 43.5 mm/h in TSC anticoagulated blood. The mean difference of ESR values between EDTA and TSC blood (6.91 ± 13.66 mm/h) was statistically significant. The Mean ± SD of ESR values using EDTA and TSC in males were 59.57 ± 42.31 and 53.57 ± 44.61 mm/h while for females it was 54.71 ± 40.44 and 46.04 ± 41.82 mm/h, respectively. The study indicated that there was a significant difference between ESR values with EDTA and TSC anticoagulants.

Effect of warfarin versus aspirin on blood viscosity in cardioembolic stroke with atrial fibrillation: a prospective clinical trial

Background

Warfarin is evidence-based therapy for the prevention of cardioembolic stroke, but has not been studied for its effects on whole blood viscosity (WBV). This study investigated the effect of warfarin versus aspirin on WBV in patients presenting with non-valvular atrial fibrillation (NVAF) and acute cardioembolic stroke.

Methods

We enrolled patients with acute cerebral infarction, aged 56–90 years who had NVAF, CHADS₂ score ≥ 2, presenting with mild-to-moderate stroke (National Institute of Health Stroke Scale (NIHSS) score < 20 and modified Rankin Scale (2mRS) score < 4) in a single center. The patients were alternately assigned to warfarin or aspirin groups. Post-treatment WBV was assessed after international normalized ratio (INR) reached target range [2, 3] for patients in the warfarin group, and 5 days after baseline in the aspirin group.

Results

Total 67 patients were included, and 56 completed this study (33 warfarin and 23 aspirin). Compared to baseline values, warfarin reduced post-treatment BV at all shear rates. The BV reductions greater than 1 cP measured at shear rates of 300, 150, 5, and 1 s^− 1 were independently and significantly associated with warfarin treatment compared to aspirin after adjusting for age, sex, CHA₂DS₂-VASc scores, and baseline hematocrit.

Conclusions

Warfarin confers greater reductions in BV than aspirin in patients with acute cardioembolic stroke. BV could be a useful method to estimate thrombotic risk in patients receiving warfarin.

Trial registration

KCT0001291, Date of Registration: 2014-12-01

Is the Occlusion Site of the Lenticulostriate Artery Identified on Admission Related to Clinical Prognosis in Patients with Lacunar Stroke?

BACKGROUND

The mechanism of lacunar stroke (LS) is rather speculative due to the lack of neuropathological evidence in clinical practice. To explore the significance of the occlusion site of the lenticulostriate artery (LSA) to this mechanism, we investigated the characteristics and prognosis of patients with LS with proximal occlusions.

MATERIALS AND METHODS

We studied 202 patients with acute LS in the region of the LSA. The presumed occlusion site of the LSA was assessed on coronal, diffusion-weighted magnetic resonance images. Based on the distance from the basal surface of the hemisphere to the proximal site of the lacunar infarct, patients were divided into 3 groups: proximal, middle, and distal site occlusions, and their characteristics and outcomes were compared.

RESULTS

White blood cell counts, blood glucose, hemoglobin A1c, low-density lipoprotein cholesterol, triglyceride, and admission National Institutes of Health Stroke Scale score were statistically different among the 3 groups. In multivariate analysis, both high levels of white blood cells (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.01-1.33) and triglyceride (OR, 1.31; 95% CI, 1.09-1.61) were positively related to the proximal occlusion site. Proximal occlusion (OR, 3.98; 95% CI, 1.06-16.11) was related to poor outcome at discharge.

CONCLUSIONS

Proximal occlusion of the LSA was independently related to elevated triglyceride and white blood cell counts. Patients with LS with proximal LSA occlusion had severe neurological deficits both on admission and at discharge.

Primary 'dehydration' and acute stroke: a systematic research review

BACKGROUND AND PURPOSE

Hydration status at the time of stroke has been acknowledged as an important determinant in early stroke recovery. However, the diagnosis of dehydration, or more accurately, a volume-contracted state, at the time of stroke is challenging since there are currently no consensus diagnostic criteria. In this systematic review, we gather the available evidence about diagnosis and treatment of dehydration after stroke.

METHODS

Studies of hospitalized ischemic stroke patients that reported rates of dehydration from January 1997 to March 2017 were screened for inclusion via a systematic search of PubMed, CINAHL, Cochrane, and Scopus using keywords hydration, dehydration, hemodilution, viscosity, volume status, and thirst.

RESULTS

Twenty-five studies of 8699 acute stroke patients were included. Nineteen studies reported on the diagnostic approach to dehydration. Findings are synthesized into four main categories of available research including studies that specify: (1) biological mechanisms using animal models to investigate the relationship between dehydration and stroke; (2) measures of dehydration in the acute human stroke population; (3) rehydration therapies after stroke; and (4) outcomes after stroke in dehydrated patients.

CONCLUSIONS

We found considerable variation in terminology specific to hydration status, diagnostic approach to dehydration, and few prospective studies of treatment strategies with varying results. This review supports the need for consensus development of operational diagnostic criteria, standardization of language, and the opportunity for prospective study of rehydration strategies to impact outcome after stroke.

Serum lipoprotein and RBC rigidity index to predict cerebral infarction in patients with carotid artery stenosis

OBJECTIVE

This study aims to determine the risk factors and to predict the occurrence of cerebral infarction in patients with carotid artery stenosis.

METHODS

Two hundred and one subjects with carotid artery stenosis were retrospectively selected from Jinshan Branch of Shanghai Sixth People's Hospital, 115 cases of which with cerebral infarction and 86 without it. Clinical tests were performed including coagulation indices, fasting glucose, serum lipid, and blood rheology. Logistic regression analyses were used to identify the risk factors. Regression model was established, and receiver operating characteristic (ROC) curve was applied to analyze its diagnostic value.

RESULTS

Our data indicated that apolipoprotein AI (OR = 0.051, 95% CI: 0.009-0.295), lipoprotein (a) (OR = 1.003, 95% CI: 1.001-1.005), and RBC rigidity index (OR = 0.383, 95% CI: 0.209-0.702) were independent risk factors. Area under the curve (AUC) of the regression model = 0.78, with the sensitivity of 73.9% (95% CI: 64.9%-81.7%) and specificity of 69.2% (95% CI: 52.4%-83.0%). Prediction probability was determined while logistic regression score >0.748 defaulted as high-risk status. High-risk ratios were 80% in progressive cerebral infarction and 72% in nonprogressive cerebral infarction (P > .05), respectively, while significant differences were found when both compared with controls (P < .001).

CONCLUSIONS

We show herein that the regression model based on apolipoprotein AI, lipoprotein (a), and RBC IR is a promising tool to predict the occurrence of cerebral infarction in patients with carotid artery stenosis. However, identification of novel diagnostic markers for progressive cerebral infarction is still necessary.

Endometrial receptivity and conception outcome among women with light menstrual bleeding of unidentified etiology

OBJECTIVE

To investigate endometrial receptivity (ER), conception outcome, and other factors among women with light menstrual bleeding of unidentified etiology.

METHODS

A prospective study was undertaken at a center in China. Between January 1, 2011, and December 31, 2014, women meeting the inclusion criteria (aged 20-35 years, without any history of pregnancy, desire to conceive, follicle-stimulating hormone <10 IU on second or third day of cycle, and regular menstrual periods) were enrolled. Participants with a menstrual blood volume of 5-20 mL formed the study group; others were in the control group. ER measures were obtained by transvaginal Doppler ultrasonography. Serum estradiol and progesterone levels were measured and items of prethrombotic state were screened in mid-luteal phase. Participants were followed up for 1 year to establish conception outcome.

RESULTS

The ER (Salle) score was significantly lower in the study group (n=110) than in the control group (n=330; 9.41 ± 3.02 vs 15.67 ± 2.63, P<0.001). The natural rate of conception within 1 year was lower (60.0% [63/105] vs 72.1% [230/319], P=0.020), and the spontaneous abortion rate in early pregnancy was higher (34.4% [21/61] vs 18.1% [41/227], P=0.006) in the study group than in the control group.

CONCLUSION

Women with light menstrual bleeding of unidentified etiology had an increased prevalence of low ER and poor conception outcome.

Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke

BACKGROUND

Increased level of blood viscosity, which is one of the major factors that determine blood rheology, has been reported as a risk factor or predictor for cerebrovascular events. We investigated how blood viscosity is associated with acute stroke and chronic radiological manifestations of cerebral small vessel disease, and how blood viscosity changes after stroke.

METHODS

We prospectively enrolled consecutive patients with acute ischemic stroke. Whole blood viscosities at a low or high shear rate were measured using a scanning capillary tube viscometer, and were referred to as diastolic blood viscosity (DBV) and systolic blood viscosity (SBV), respectively. Correlations between blood viscosity and acute stroke etiology or chronic radiological manifestations of cerebral small vessel disease were investigated. The temporal profiles of blood viscosity at the onset of stroke and follow-up at 1 and 5 weeks were investigated.

RESULTS

Of the 127 patients admitted with acute ischemic stroke, 63 patients were included in the final analyses. DBV at the onset of stroke was significantly higher in small artery occlusion (SAO) stroke than in other stroke subtypes (p = 0.037). DBV showed a significant positive correlation with the number of chronic lacunes (r = 0.274, p = 0.030). The temporal profiles of DBV in SAO stroke showed a transient decrease due to the hydration therapy after 1 week and recurrent elevation at 5 week follow-up (p = 0.009).

CONCLUSIONS

Our study suggests that elevated DBV may play a role in the development of acute and chronic manifestations of cerebral small vessel disease. The recurring elevation of DBV in SAO stroke indicates that sufficient hydration and additional therapeutic interventions targeting blood viscosity may be needed in patients with SAO stroke.

Efficacy and safety of puerarin injection in curing acute ischemic stroke: A meta-analysis of randomized controlled trials

BACKGROUND

Previous studies indicated that the puerarin injection has been widely employed in China for the treatment of acute ischemic stroke. We aim to evaluate the efficacy and safety of the puerarin injection for the treatment of acute ischemic stroke.

METHODS

A systematic literature search was performed in PUBMED, EMBASE, SPRINGER LINK, Scopus, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Journals Database, Wanfang database and the China Biological Medicine database before November 2016, randomized controlled clinical trials (RCTs) of puerarin injection treating acute ischemic stroke were included. In addition, we searched reference lists of relevant retrieved articles. Two authors extracted data independently. The effective rate, the neurologic deficit score, the blood rheology indexes, and fibrinogen were assessed and analyzed by the Review Manager 5.3 software. The continuous variables were expressed as MD with 95% CI and dichotomous data used RR or ORs. Adverse reactions related to the puerarin injection were also examined.

RESULTS

Thirty-five RCTs with a total of 3224 participants were identified in the meta-analysis. The combined results of 32 trials indicated that the puerarin injection was better than control drugs at the clinical effective rate (RR 1.22, 95% CI 1.17 to 1.28, P < 0.001) and 16 studies showed the neurological deficit was significantly improved (MD -3.69, 95% CI -4.67 to -2.71, P < 0.001); the hemorheology index and fibrinogen were much lower with the puerarin injection when compared with western conventional medicines (WCM) or other control drugs (the whole blood viscosity: MD -0.89, 95% CI -1.37 to -0.41, P < 0.001; the HCT: MD -0.04, 95% CI -0.06 to -0.02, P < 0.001; the fibrinogen: MD -0.64, 95% CI -0.96 to -0.31, P < 0.001). Eleven trials reported that the adverse reactions related to the puerarin injection included facial flushing, dizziness, vomiting, nausea, and other mild gastrointestinal discomfort and allergic reaction. No serious adverse drug reactions were reported.

CONCLUSIONS

Puerarin injection may be more effective and relatively safe in clinic for treating acute ischemic stroke. However, the current evidence is insufficient due to the poor methodological quality and lack of adequate safety data. Further RCTs are required to examine its efficacy.