Incidence and survival of lacunar infarction in a southern Chinese population: A 7-year prospective study

Cerebral autoregulation in patients with acute lacunar infarction: a reliable predictor of outcome

OBJECTIVE

To further investigate the association between dynamic cerebral autoregulation (dCA) and the outcomes in patients with acute lacunar infarction.

METHODS

Patients were prospectively and consecutively enrolled at The First Hospital of Jilin University between 2016 and 2023. dCA was monitored at 1-3 and 7-10 days after the stroke. The outcomes were evaluated using a 3-month modified Rankin Scale score. Binary and ordered logistic regression were employed to analyze the relationship between dCA parameters and outcomes. dCA-based nomogram models were also developed to assess the predictive value of dCA for these patients.

RESULTS

Overall, 332 patients were included in analysis. dCA showed no significant differences between bilateral cerebral hemispheres, as well as two measurement time points (all P > 0.05). Regression analyses showed that dCA at 1-3 and 7-10 days were independently associated with the outcomes of patients with acute lacunar infarction after adjusting for confounders (all P < 0.05). Incorporating dCA parameters into conventional risk factors enhanced the risk-predictive ability of a 3-month unfavorable outcome, significantly improving the area under the receiver operating characteristic curve from 0.798(95% confidence interval [CI], 0.748-0.848) to 0.829(95% CI, 0.783-0.875) (P = 0.046).

INTERPRETATION

dCA remained consistent in bilateral cerebral hemispheres within acute and subacute periods among patients with lacunar infarction. It was independently associated with 3-month outcomes and could be regarded as a reliable predictor for discriminating outcome.

The microstructural abnormalities of cingulum was related to patients with mild cognitive impairment: a diffusion kurtosis imaging study

OBJECTIVE

Our study aimed to investigate the correlations between microstructural changes of cingulum and patients with mild cognitive impairment (MCI) by diffusion kurtosis imaging (DKI) technique.

METHOD

A total of 104 patients with cerebral small vessel diseases (cSVD) were retrospectively enrolled in this study. According to Montreal Cognitive Assessment Scale (MoCA) scores, these patients were divided into MCI group (n = 59) and non-MCI group (n = 45). The general clinical data was collected and analyzed. The regions of interests (ROIs) were selected for investigation in cingulum. The values of DKI parameters were measured in each ROI and compared between the two groups, the correlations between DKI parameters and MoCA scores were examined.

RESULTS

Compared to non-MCI group, MCI patients had more severe white matter hyperintensities (WMHs) (P = 0.038) and lower MoCA scores (P < 0.01). MCI patients showed significantly decreased fractional anisotropy (FA), axial kurtosis (AK), mean kurtosis (MK), radial kurtosis (RK), and kurtosis fractional anisotropy (KFA) in the left cingulum in the cingulated cortex (CgC) region (all P < 0.0125). In the left CgC region, FA, AK, MK, RK, and KFA were positively correlated with MoCA scores (r = 0.348, 0.409, 0.310, 0.441, 0.422, all P < 0.001). Meanwhile, FA, AK, MK, RK, and KFA were also positively correlated with MoCA scores (r = 0.338, 0.352, 0.289, 0.380, 0.370, all P < 0.001) in the right CgC region.

CONCLUSION

DKI technique could be used to explore the microstructural changes of cingulum in MCI patients and DKI-derived parameters might be feasible to evaluate MCI patients.

Prevalence and distribution of lacunar stroke in China: a cross-sectional study using self-reported survey data

OBJECTIVES

To report the prevalence and distribution of lacunar stroke in different regions of China, as well as the demographical characteristics of symptomatic and asymptomatic lacunar stroke.

DESIGN

Cross-sectional study.

SETTING

Data were derived from NESS-China Study that was conducted in 157 sites covering all 31 provinces, including 64 urban and 93 rural areas in mainland China between 1 September 2013 and 31 December 2013. Lacunar stroke was defined as being previously diagnosed according to the participants' medical history. Patients were further divided into symptomatic or asymptomatic groups, depending on whether they were initially diagnosed with neurological symptoms.

PARTICIPANTS

458 833 participants aged ≥20 years were enrolled in this study.

RESULTS

A total of 7520 participants (1.63%) were diagnosed with lacunar stroke. The peak rate of diagnosis was between the ages of 70 and 79 years in both men and women. Geographically, the age-standardised and sex-standardised prevalence was highest in Northeast China (2495.3/100 000 persons) and lowest in Southeast China (599.7/100 000 persons), showing a geographical disparity. Over 90% of patients with lacunar stroke were diagnosed in secondary or tertiary hospitals. Patients with symptomatic lacunar stroke had significantly different demographic characteristics in age, sex and geographical regions compared with those who were asymptomatic.

CONCLUSIONS

In this study, the prevalence and distribution of lacunar stroke were reported at population level across China. Special attention and prevention should be given to the age, sex and geographical groups that are vulnerable to lacunar stroke.

Pooled incidence and case-fatality of acute stroke in Mainland China, Hong Kong, and Macao: A systematic review and meta-analysis

Background

Stroke incidence and case-fatality in Mainland China, Hong Kong, and Macao vary by geographic region and rates often differ across and within regions. This systematic review and meta-analysis (SR) estimated the pooled incidence and short-term case-fatality of acute first ever stroke in mainland China, Hong Kong, and Macao.

Methods

Longitudinal studies published in English or Chinese after 1990 were searched in PubMed/Medline, EMBASE, CINAHL, Web of Science, SinoMed and CQVIP. The incidence was expressed as Poisson means estimated as the number of events divided by time at risk. Random effect models calculated the pooled incidence and pooled case-fatality. Chi-squared trend tests evaluated change in the estimates over time. When possible, age standardised rates were calculated. Percent of variation across studies that was due to heterogeneity rather than chance was tested using the I2 statistic.The effect of covariates on heterogeneity was investigated using meta-regressions. Publication bias was tested using funnel plots and Egger’s tests.

Results

Overall, 72 studies were included. The pooled incidences of total stroke (TS), ischaemic stroke (IS) and haemorrhagic stroke (HS) were 468.9 (95% confidence interval (CI): 163.33–1346.11), 366.79 (95% CI: 129.66–1037.64) and 106.67 (95% CI: 55.96–203.33) per 100,000 person-years, respectively, varied according to the four economic regions (East Coast, Central China, Northeast and Western China) with the lowest rates detected in the East Coast. Increased trends over time in the incidence of TS and IS were observed (p<0.001 in both). One-month and three-to-twelve-month case-fatalities were 0.11 (95% CI: 0.04–0.18) and 0.15 (95% CI: 0.12–0.17), respectively for IS; and 0.36 (95% CI: 0.26–0.45) and 0.25 (95% CI: 0.18–0.32), respectively for HS. One-month case-fatality of IS and HS decreased over time for both (p<0.001). Three-to-twelve-month fatalities following IS increased over time (p<0.001). Publication bias was not found.

Conclusions

Regional differences in stroke incidence were observed with the highest rates detected in less developed regions. Although 1-month fatality following IS is decreasing, the increased trends in 3-12-month fatality may suggest an inappropriate long-term management following index hospital discharge.

Registration

Registration-URL: https://www.crd.york.ac.uk/prospero/; Reference code: CRD42020170724

Factors associated with prognosis after small-vessel occlusion among young and middle-aged patients: a hospital-based follow-up study

Objective: Small-vessel occlusions are the most common causes of mild strokes and, in China, account for approximately 27.3% of ischemic stroke cases. However, the factors associated with short- and long-term outcomes appear contradictory. Thus, we assessed the factors related to outcomes 3 years after small-vessel occlusion among patients aged 18 to 55 years.Methods: Between 2007 and 2014, we recruited patients who experienced small-vessel occlusion (according to Trial of Org 10,172 in Acute Stroke Treatment [TOAST] classification) aged 18 to 55 years and conducted a hospital-based follow-up study. The assessed outcomes were mortality, recurrence, and dependency within 3 years after the initial stroke. The outcome determinants were assessed using a multivariate logistic regression analysis.Results: A total of 276 patients (men, 76.09%) with small-vessel occlusions were enrolled in this study. In addition, 85.1% of the patients had strokes between the ages of 45 and 55 years. The risk of recurrence within 3 years was higher for patients who had moderate strokes than for those who had mild events (relative risk [RR], 3.09; 95% confidence interval [CI], 1.14-8.34; P < 0.05). Further, the risk of dependency within 3 years was 2.61 times higher in obese patients than in non-obese patients (RR, 2.61; 95% CI, 1.00-6.79; P < 0.05). The risks of recurrence and dependency within 3 years increased by 17% and 18%, respectively, for each 1-unit increase in fasting plasma glucose levels (RR, 1.17; 95% CI, 1.05-1.30 and RR, 1.18; 95% CI, 1.06-1.32, respectively; both P < 0.05).Conclusion: Our findings suggest that small-vessel occlusions cause the heaviest disease burden in patients aged 45 to 55 years. To reduce stroke recurrence, young and middle-aged patients with small-vessel occlusions should control their fasting plasma glucose levels and manage their weight.

Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction

BACKGROUND

Although increasing evidence has demonstrated that elevated homocysteine (Hcy) levels may be an important contributor for the development of cerebral infarction, rare studies focused on its diagnostic and early prognostic roles in acute lacunar infarction.

METHODS

A total of 197 patients with acute lacunar infarction and 192 to form the control group were prospectively recruited between January 2013 and February 2017. Early neurological deterioration was defined as an increase of ≥2 points in National Institutes of Health Stroke Scale or the decrease in Barthel index (BI) score at discharge.

RESULTS

Univariate and multivariate logistic regression analyses revealed that higher levels of fibrinogen and Hcy were independently clinical predictors associated with lacunar infarction. Receiver operating characteristic curves analysis demonstrated that the diagnosis value of Hcy was superior to fibrinogen, with the area under the curve of 0.881 and 0.688 respectively. Using the optimal cutoff value of 15.5 μmol/L of Hcy, a sensitivity of 65% and a specificity of 100% were achieved for predicting lacunar infarction. Hcy was only significantly related with BI reduction in the males (30.5 [15.5-65.5] vs. 18 [15-24], p = 0.034) in the univariate analysis but not in the females and the multivariate analysis.

CONCLUSIONS

Serum Hcy may be an independent diagnostic and not an early prognostic biomarker for patients with acute lacunar infarction.

Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke

INTRODUCTION

Stroke is the second leading cause of long-term disability and death worldwide. Diabetes and hyperglycemia may impact the outcome of stroke. We examined the impact of hyperglycemia and diabetes on in-hospital death among ischemic and hemorrhagic stroke patients.

MATERIAL AND METHODS

Data from 766 consecutive patients with ischemic (83.15%) and hemorrhagic stroke were analyzed. Patients were classified into four groups: ischemic and diabetic; ischemic and non-diabetic; hemorrhagic and diabetic; and hemorrhagic and non-diabetic. Serum glucose was measured on admission at the emergency department together with biochemical and clinical parameters.

RESULTS

Mean admission glucose in ischemic stroke patients with diabetes was higher than in non-diabetic ones (p < 0.001) and in hemorrhagic stroke patients with diabetes than in those without diabetes (p < 0.05). Mean admission glucose in all patients who died was significantly higher than in patients who survived. In multivariate analysis, the risk factors for outcome in patients with ischemic stroke and without diabetes were age, admission glucose level and estimated glomerular filtration rate (eGFR), while in diabetics they were female gender, admission glucose level, and eGFR; in patients with hemorrhagic stroke and without diabetes they were age and admission glucose levels. The cut-off value in predicting death in patients with ischemic stroke and without diabetes was above 113.5 mg/dl, while in diabetics it was above 210.5 mg/dl.

CONCLUSIONS

Hyperglycemia on admission is associated with worsened clinical outcome and increased risk of in-hospital death in ischemic and hemorrhagic stroke patients. Diabetes increased the risk of in-hospital death in hemorrhagic stroke patients, but not in ischemic ones.

The prevalence of lacunar infarct decreases with aging in the elderly: a case-controlled analysis

Background and purpose

Lacunar infarct (LI) is well known as a heterogeneous primary disorder of cerebral small vessel. Compelling results have demonstrated that age is a risk factor to the prevalence of LI. However, the relationship between age and the prevalence of LI remains obscure. It is essential to note the relationship between age and the prevalence of LI through more clinical data.

Methods

A total of 3,500 patients were included in the case-controlled study. All data were collected from the Examination Center of Magnetic Resonance Imaging, Lu’an People’s Hospital from January 2014 to December 2015. A primary discharge diagnosis of LI was done, and all subjects were evaluated as retrospective data. The relationship between the risk factors and the prevalence of diabetes and the relationship between age and the prevalence of diabetes was analyzed. A chi-square test was used to analyze the associations between different variables. A one-way analysis of variance was used to test the equality of three or more means at one time by using variances. Statistical significance was defined as a P-value of <0.05.

Results

The one-way analysis of variance demonstrated that the prevalence of LI increased with age before 60 years and decreased with age after 69 years. The same results were found in both the male and the female subjects. These results showed that the age-related risk factors (hypertension, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking) have no relationship with the prevalence of LI on the basis of age. There is a significant difference among the different age ranges (P=0.0006). Two-tailed P-value (unpaired t-test) showed the mean significant difference between 30–39 years and 40–49 years (P=0.009) and between 70–79 years and 80–100 years (P=0.0196). F-test (to compare variances) demonstrated that the variances of the different age ranges are significantly different between 30–39 years and 40–49 years (P=0.0002), between 40–49 years and 50–59 years (P=0.0424), and between 70–79 years and 80–100 years (P=0.0003).

Conclusion

The age-related risk factors (hypertension, diabetes, cerebral infarct, cardiovascular diseases, smoking, and drinking) have no relationship with the prevalence of LI on the basis of age. A decreasing prevalence of LI with aging occurs in the elderly, while the prevalence of LI increases with aging in the young and in adults. This investigation implicates that age is not a risk factor for LI in the elderly.

Psychometric properties of the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in patients with stroke

BACKGROUND

It has been reported that stroke has a higher incidence and mortality rate in the People's Republic of China compared to the global average. These conditions can be managed by proper medication use, but ensuring medication adherence is challenging.

OBJECTIVE

To translate the Self-Efficacy for Appropriate Medication Use Scale into Chinese and test its validity and reliability in patients with stroke.

METHODS

Instrument performances were measured from January 15, 2015 to April 28, 2015 on a convenience sample of 400 patients with stroke recruited at four neurology departments of the First Affiliated Hospital of Zhengzhou University. Questionnaires included the Chinese versions of the Self-Efficacy for Appropriate Medication Use Scale (C-SEAMS) and the General Self-Efficacy Scale (C-GSE). Construct validity, convergent validity, internal consistency, and test-retest reliability were measured.

RESULTS

Item analysis showed that item-to-total correlations were in the range of 0.362-0.672. Exploratory factor analysis revealed two factors (which accounted for 60.862% of total variance), with factor loading ranging from 0.534 to 0.756. Confirmatory factor analysis was performed to support the results, with an acceptable fit (χ (2)=73.716; df=64; P<0.01; goodness-of-fit index =0.902; adjusted goodness-of-fit index =0.897; comparative fit index =0.865; root-mean-square error of approximation =0.058). The convergent validity of the C-SEAMS correlated well with the validated measure of the C-GSE in measuring self-efficacy (r=0.531, P<0.01). Good internal consistency (Cronbach's alpha ranged from 0.826 to 0.915) and test-retest reliability (Pearson's correlation coefficient r=0.642, P<0.01) were found.

CONCLUSION

The C-SEAMS is a brief and psychometrically sound measure for evaluating self-efficacy for medication adherence in the Chinese population with stroke.