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Zhang L, Tang X, Wang C, Ding D, Zhu J, Zhou Y, Diao S, Kong Y, Cai X, Li C, Yao Y, Fang Q. Predictive Model of Dysphagia and Brain Lesion-Symptom Mapping in Acute Ischemic Stroke. Front Aging Neurosci 2021; 13:753364. [PMID: 34744695 PMCID: PMC8564389 DOI: 10.3389/fnagi.2021.753364] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: Early recognition and management of post-stroke dysphagia (PSD) based on MRI may reduce the incidence of complications. Combining clinical symptoms with applications of MRI, we aimed to identify the risk factors of PSD, develop a prediction scale with high accuracy and map key dysphagia brain areas. Methods: A total of 275 acute ischemic stroke patients were enrolled in this study, and 113 (41.1%) patients were diagnosed with PSD. All patients underwent the water-swallowing test (WST) and volume-viscosity swallow test (V-VST) within first 24 h following admission to assess swallowing. Vascular factors were evaluated and MRI brain scans were obtained within 3 days after symptom onset for each participant admitted to the hospital. T-test, chi-squared test and Fisher’s exact test were used to investigate the associations of various patient characteristics with dysphagia, and multivariable logistic regression models were used to construct a prediction scale. Scale accuracy was assessed using receiver operating characteristic (ROC) analysis. We extracted white matter hyperintensities for each patient as potential brain lesions. Voxel-based lesion-symptom mapping (VLSM) was used to identify key brain areas for dysphagia. Results: Risk factors related with PSD were older age, history of atrial fibrillation, higher fasting blood glucose, NIH stroke scale, TOAST classification, progressive stroke, middle cerebral artery lesion and anterior cerebral artery lesion. Three variables with most significant associations, including NIH stroke scale, TOAST classification and progressive stroke, combined with age and gender, were used to construct a dysphagia prediction scale with high accuracy (AUC = 0.86). VLSM identified left inferior parietal gyrus as a key brain region for PSD. Conclusion: Risk factors of PSD were identified and a predictive model of dysphagia was constructed intelligently and automatically. The left inferior parietal gyrus was identified as a key brain area for dysphagia, which provides a new symptom-based treatment target for early rehabilitation in the future.
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Affiliation(s)
- Lulu Zhang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Tang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Can Wang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongxue Ding
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juehua Zhu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Zhou
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shanshan Diao
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Kong
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiuying Cai
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cuiping Li
- Shanghai Zhiyu Software Technology Co., Ltd., Shanghai, China
| | - Ye Yao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Qi Fang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
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Hu R, Wang X, Liu Z, Hou J, Liu Y, Tu J, Jia M, Liu Y, Zhou H. Stigma, depression, and post-traumatic growth among Chinese stroke survivors: A longitudinal study examining patterns and correlations. Top Stroke Rehabil 2020; 29:16-29. [PMID: 33371827 DOI: 10.1080/10749357.2020.1864965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: With the development of positive psychology, several studies show that positive and negative emotions are not always opposing. Understanding how positive and negative emotions correlate and the factors contributing to resilience in stroke survivors requires further research.Objectives: To identify the patterns and correlations of stigma, depression, and posttraumatic growth (PTG) among stroke survivors.Methods: Stroke-related stigma, depression, PTG, and neurological status were evaluated at 1-month and 3 months post-stroke using the Stroke Stigma Scale (SSS), Patient Health Questionnaire-9 (PHQ-9), Chinese version of the Posttraumatic Growth Inventory (C-PTGI), modified Rankin Scale (mRS), and Social Support Rating Scale (SSRS). The paired t-test, nonparametric test, and Spearman's correlation test were used to analyze differences and relationships between results at the two time points.Results: At 3 months compared to 1-month post-stroke, we found significant reductions in mRS and stigma scores, and an increase in PTGI scores, while the PHQ-9 scores reduced non-significantly. SSS, PHQ-9, and mRS scores were positively correlated with each other at time1 (all P < .01), and all showed no significant relationships with PTGI scores (all P > .05). Social support scores were negatively correlated with stigma (P < .01), PHQ-9 (P < .01), and PTGI scores (P > .05) at 3 months.Conclusions: Stroke-related stigma is strongly associated with depression while neither of them has significant relationships with PTG during the early stage of survivors' rehabilitation in our study. Neurological impairment is a risk factor for negative emotions and increasing individualized support may reduce stigma, depression, and promote PTG in the long term.
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Affiliation(s)
- Ruidan Hu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoyan Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhihong Liu
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, Guangdong, China
| | - Jiakun Hou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yangyang Liu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Jinyi Tu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Miao Jia
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yue Liu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongzhen Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Liu S, Han S, Dai Q, Li S, Li J. BICAO-induced ischaemia caused depressive-like behaviours and caspase-8/-9-dependent brain regional neural cell apoptosis in mice. Stroke Vasc Neurol 2017; 3:1-8. [PMID: 29600001 PMCID: PMC5870644 DOI: 10.1136/svn-2017-000109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/04/2022] Open
Abstract
Introduction Cerebral ischaemia-induced depression is among the most frequent neuropsychiatric consequences and adversely impact the prognosis and recovery of patients. Although several brain regions have been implied in the development of ischaemia-induced depression, the brain region-specific neural cell apoptosis pathways have not been clarified yet. Methods In this study, bilateral internal carotid artery occlusion (BICAO) mouse model was established to induce cerebral ischaemia. Sucrose preference, tail suspension and forced swim tests were conducted on mice at 7, 21 and 30 days after BICAO treatment. In addition, brain regional ischaemic neuron loss was investigated by using immunofluorescent staining of neuronal nuclei (NeuN) and caspase-8/-9-dependent cell apoptosis was also examined by western blot analysis. Results BICAO-induced cerebral ischaemia resulted in decreased sucrose preference and increased immobility times, which were representative depressive-like behaviours of mice until 30 days after BICAO treatment compared with Sham-operated mice. This outcome was associated with significant neuron loss by using immunofluorescent staining and increased cleavage levels of pro-caspase-3/-8/-9, but not pro-caspase-12, by western blot analysis in hypothalamus, midbrain, prefrontal cortex and hippocampus of mice. Conclusions This study showed that BICAO-induced ischaemia caused depressive-like behaviours and caspase-8/-9-dependent neural cell apoptosis in several brain regions, including hypothalamus and midbrain of mice.
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Affiliation(s)
- Shuiqiao Liu
- Department of Neurobiology and Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Song Han
- Department of Neurobiology and Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Qingqing Dai
- Department of Neurobiology and Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Shujuan Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Junfa Li
- Department of Neurobiology and Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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