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Shen CL, Xia NG, Wang H, Zhang WL. Association of Stress Hyperglycemia Ratio With Acute Ischemic Stroke Outcomes Post-thrombolysis. Front Neurol 2022; 12:785428. [PMID: 35095730 PMCID: PMC8793935 DOI: 10.3389/fneur.2021.785428] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Purpose: The association between stress hyperglycemia and clinical outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) is uncertain. We sought to analyze the association between the stress hyperglycemia ratio (SHR) using different definitions and clinical outcomes in acute patients with ischemic stroke undergoing IVT. Methods: A total of 341 patients with ischemic stroke receiving IVT were prospectively enrolled in this study. The SHR was evaluated using different equations: SHR1, fasting glucose (mmol/L)/glycated hemoglobin (HbA1c) (%); SHR2, fasting glucose (mmol/L)/[(1.59 × HbA1c)−2.59]; SHR3, admission blood glucose (mmol/L)/[(1.59 × HbA1c)−2.59]. A poor functional outcome was defined as a modified Rankin scale score of 3–6 at 3 months. Multivariate logistic regression analysis was used to identify the relationship between different SHRs and clinical outcomes after IVT. Results: A total of 127 (37.2%) patients presented with poor functional outcomes at 3 months. The predictive value of SHR1 for poor functional outcomes was better than that of SHR2 and SHR3 in receiver operating characteristic analyses. On multivariate analysis, SHR1 [odds ratio (OR) 14.639, 95% CI, 4.075–52.589; P = 0.000] and SHR2 (OR, 19.700; 95% CI; 4.475–86.722; P = 0.000) were independently associated with an increased risk of poor functional outcome but not SHR3. Conclusions: Our study confirmed that the SHR, as measured by SHR1 and SHR2, is independently associated with worse clinical outcomes in patients with ischemic stroke after intravenous thrombolysis. Furthermore, SHR1 has a better predictive performance for outcomes than other SHR definitions.
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Affiliation(s)
- Chuan-Li Shen
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nian-Ge Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wan-Li Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Chen YY, Ye ZS, Xia NG, Xu Y. TMAO as a Novel Predictor of Major Adverse Vascular Events and Recurrence in Patients with Large Artery Atherosclerotic Ischemic Stroke. Clin Appl Thromb Hemost 2022; 28:10760296221090503. [PMID: 35345908 PMCID: PMC8969508 DOI: 10.1177/10760296221090503] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives To explore the association of plasma trimethylamine N-oxide (TMAO) concentration with large artery atherosclerotic (LAA) ischemic stroke and its role in predicting neurological outcome and major vascular event recurrence. Materials and Methods We performed a case-control study that included patients with first-ever LAA stroke as cases (n = 291) and asymptomatic patients as controls (n = 235). Clinical data and venous blood samples were collected within 72 hours after stroke. All subjects were followed for 3 months. TMAO level was detected by liquid chromatography mass spectrometry (LC-MS). Logistic and Cox proportional hazard regression were performed to evaluate plasma TMAO concentration as a predictor of LAA stroke and major vascular event recurrence, respectively. Kaplan–Meier survival analysis was performed to compare major vascular event recurrence between patients with high and low TMAO concentration. Results After adjusting for traditional stroke risk factors, the plasma TMAO level was significantly higher in the LAA stroke group than the control group (OR = 1.031, 95% CI 1.024-1.037, P < .001). At a cutoff level of 106.9 pg/ml, TMAO had a sensitivity of 63.23% and specificity of 80.00% in discriminating the LAA stroke subjects from the controls in Receiver operator characteristic (ROC) analysis. Kaplan–Meier survival analysis demonstrated TMAO plasma concentration was significantly relevant with recurrent vascular events (Log Rank, P = .006). Moreover, this association was still existed after adjusting for traditional risks (adjusted HR, 3.128; 95% CI, 1.018-9.610) in Cox regression model. But TMAO plasma levels were not relevant with functional disability after 3 months of the LAA stroke. Conclusion Elevated plasma TMAO concentration was independently associated with LAA ischemic stroke. The risk of major vascular event recurrence increased by 2.128 times in the LAA stroke subjects with plasma TMAO level higher than 126.83 pg/mL. Plasma TMAO concentration might be a potential biomarker of major vascular event recurrence.
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Affiliation(s)
- Yan-Yan Chen
- Department of Neurology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Zu-Sen Ye
- Department of Neurology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nian-Ge Xia
- Department of Neurology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
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Xia NG, Lin JH, Ding SQ, Dong FR, Shen JZ, Du YR, Wang XS, Chen YY, Zhu ZG, Zheng RY, Xu HQ. Reliability and validity of the Chinese version of the Patient Health Questionnaire 9 (C-PHQ-9) in patients with epilepsy. Epilepsy Behav 2019; 95:65-69. [PMID: 31026785 DOI: 10.1016/j.yebeh.2019.03.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical reliability and validity of the Chinese version of the Patient Health Questionnaire 9 (C-PHQ-9) in patients with epilepsy. METHODS A total of 213 consecutive adult patients with epilepsy were evaluated. Receiver operating characteristic (ROC) analysis was performed using C-PHQ-9 and Chinese version of Patient Health Questionnaire 2 (C-PHQ-2) as predictors and the Mini International Neuropsychiatric Interview Plus Version 5.0.0 as the gold standard. RESULTS The C-PHQ-9 was easily understood and quickly finished by the patients. According to the gold standard, the prevalence of current major depressive disorder in this population was 16.4%. Cronbach's α coefficient for the C-PHQ-9 was 0.860. The ROC analysis showed an area under the curve (AUC) of 0.888 (95% confidence interval [CI] = 0.838-0.927). At a cutoff score of >6, the C-PHQ-9 had a sensitivity of 82.86%, a specificity of 84.27%, a positive predictive value of 50.9%, and a negative predictive value of 96.2%. The C-PHQ-2 at a cutoff score of >1 resulted in the greatest balance of sensitivity and specificity (77.14% and 75.28%, respectively). CONCLUSION Our findings support a high reliability and validity for the C-PHQ-9 as a screening tool for the detection of current major depression in Chinese patients with epilepsy.
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Affiliation(s)
- Nian-Ge Xia
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jia-He Lin
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Si-Qi Ding
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Fei-Rong Dong
- Department of Psychiatry, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jing-Zan Shen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yan-Ru Du
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xin-Shi Wang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yan-Yan Chen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhen-Guo Zhu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Rong-Yuan Zheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Hui-Qin Xu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
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Du YR, Lin JH, Mei PN, Wang L, Wang Y, Shen JZ, Ding SQ, Ye MQ, Wang XS, Xia NG, Zheng RY, Chen H, Hou ST, Xu HQ. Analysis of risk factors for antiepileptic drug-induced adverse psychotropic effects in Chinese outpatients with epilepsy. J Clin Neurosci 2019; 63:37-42. [PMID: 30827884 DOI: 10.1016/j.jocn.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/10/2019] [Accepted: 02/20/2019] [Indexed: 11/19/2022]
Abstract
Antiepileptic drugs (AEDs) have adverse psychotropic effects (APEs). To explore the risk factors for AED-induced APEs, we compared Chinese outpatients with epilepsy with and without AED-induced APEs. We reviewed the medical data of outpatients with epilepsy enrolled in the Epilepsy Long-term Follow Up Registry Study (ELFURS) between January 1, 2003 and December 31, 2015. Data on demographics, comorbidities, variables related to epilepsy, AED use, and APEs were collected. APEs were determined by experienced epileptologists based on the definition of "adverse drug reaction (ADR)" proposed by the World Health Organization (WHO) in 1972, and the causality relationship between APEs and suspected medications was assessed based on the WHO-UMC scale. APEs included effects on memory, sleep, behavior, mood, psychotic symptoms, and others in this study. We divided the study population into patients with and without AED-induced APEs and then compared the differences between the two groups using univariate and multivariate methods. A total of 3074 eligible patients were included in this study (1001 patients with AED-induced APEs and 2073 patients without AED-induced APEs). Of all APEs, the effects on memory and sleep were most pronounced. The results show that the female sex (odds ratio [OR] 1.242, 95% confidence interval [CI] 1.055-1.463), psychotic disorder comorbidities (OR 1.815, 95% CI 1.159-2.841), polytherapy with AEDs (OR 1.400, 95% CI 1.061-1.847), and the duration of epilepsy (OR 1.010, 95% CI 1.000-1.020) are significant nondrug risk factors for AED-induced APEs. Recognizing risk factors for APEs may help determine optimal treatment strategies for epilepsy.
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Affiliation(s)
- Yan-Ru Du
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia-He Lin
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pei-Na Mei
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li Wang
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Wang
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Jing-Zan Shen
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Si-Qi Ding
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meng-Qian Ye
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin-Shi Wang
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nian-Ge Xia
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rong-Yuan Zheng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Chen
- Department of Psychiatry, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng-Tao Hou
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui-Qin Xu
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Cheng JH, Zhang Z, Ye Q, Ye ZS, Xia NG. Characteristics of the ischemic stroke patients whose seizures occur at stroke presentation at a single institution in Eastern China. J Neurol Sci 2018; 387:46-50. [PMID: 29571870 DOI: 10.1016/j.jns.2018.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE We compared clinical characteristics and outcomes of the early-onset seizure post-stroke patients who had seizures occurring at stroke presentation (SSP) with other patients without SSP at a single institution in Eastern China. METHODS We reviewed 20,947 ischemic stroke patients in our hospital electronic medical records system from January 2007 to December 2016. Among them, there were 91 (0.43%) patients with early-onset seizure post-stroke. Among these 91 patients, there were 35 (0.16%) SSP patients and another 56 (0.27%) were designated as non SSP patients because they also had early-onset seizure post-stroke, but without SSP. We compared the clinical presentations of the SSP patients with those of the non SSP patients including baseline stroke risk factors, and 10-year Kaplan-Meier death risk after their first stroke. RESULTS In the SSP patients, 25.7% of them presented with posterior circulation infarction, whereas only 12.5% of the non SSP patients had this condition (P<0.05). In contrast, 17.1% of the SSP patients were being treated with antiepileptic drugs at discharge whereas 37.5% of the non SSP patients received such treatment (P<0.05). The percentage of SSP patients with temporal lobe lesions was less than in non SSP patients (P<0.05). However, brain stem and thalamus lesions were more frequently seen in SSP patients than non in SSP patients (P<0.05). The risk factors for ischemic stroke including a history of hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation were the same in these two groups (P>0.05). In the SSP patients group, the 10-year risk of death was 36.9% after the initial seizure incident, and in the non SSP patients group, the 10-year death risk was 40.1%, but this difference between the two groups was not significant (P>0.05). CONCLUSIONS Ischemic stroke patients with SSP had some unique signs that included a higher incidence of posterior circulation infarction than non SSP patients.
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Affiliation(s)
- Jian-Hua Cheng
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| | - Zheng Zhang
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qiang Ye
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zu-Sen Ye
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Nian-Ge Xia
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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Xia NG, Chen YY, Li J, Chen X, Ye ZS, Chen SY, Zhu ZG. Eight-and-a-half syndrome caused by a pontine haemorrhage: a case report and review of the literature. Int J Neurosci 2017; 128:746-750. [PMID: 29243534 DOI: 10.1080/00207454.2017.1418344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Eight-and-a-half syndrome is caused by a lesion in the dorsal tegmentum of the caudal pons involving parapontine reticular formation and median longitudinal fasciculus, as well as the nucleus and/or the fasciculus of the facial nerve. It is characterized by one-and-a-half syndrome and an ipsilateral cranial nerve VII palsy. Also, many variants of eight-and-a-half syndrome have been described, including nine syndrome, thirteen-and-a-half syndrome and fifteen-and-a-half syndrome. METHODS We describe a case of a 49-year-old man who presented with eight-and-a-half syndrome combined with contralateral hemiparesis. We reviewed the literature describing the related spectrum of eight-and-a-half syndrome associated with various etiologies. RESULTS Brain computed tomography scan revealed a hyperdensity located in the left paramedian aspect of the dorsal pons. T2-weighted magnetic resonance imaging at the 11-month follow-up showed hyperintensity and enlargement of the inferior olivary nuclei, which were compatible with a diagnosis of hypertrophic olivary degeneration. In light of our observations and cases reported in the literature, we categorize the spectrum of eight-and-a-half syndrome into three types, namely classic eight-and-a-half syndrome, eight-and-a-half syndrome variants and eight-and-a-half plus syndrome. Besides, the clinical feature and outcome of the three types are discussed in this article. CONCLUSIONS Recognition of the spectrum of eight-and-a-half syndrome allows precise anatomic localization of the lesion to pontine tegmentum region.
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Affiliation(s)
- Nian-Ge Xia
- a Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou City , China
| | - Yan-Yan Chen
- a Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou City , China
| | - Jia Li
- a Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou City , China
| | - Xi Chen
- b School of Sports Science , Wenzhou Medical University , Wenzhou , China
| | - Zu-Sen Ye
- a Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou City , China
| | - Si-Yan Chen
- a Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou City , China
| | - Zhen-Guo Zhu
- a Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou City , China
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