Guang-Sheng Wang

Metabolic Syndrome Is a Strong Risk Factor for Minor Ischemic Stroke and Subsequent Vascular Events

Background Minor ischemic stroke (MIS) represents a major global public health problem worldwide due to high incidence. The aim of this study was to investigate whether metabolic syndrome (MetS) is a strong risk for MIS and subsequent vascular events (SVE). Methods A retrospective cohort study was performed examining symptomatic MIS in a Chinese neurologic outpatient population aged over 25 years without history of stroke. MetS was defined using the International Diabetes Federation criteria. MIS was diagnosed by magnetic resonance imaging-diffusion weighted images or fluid-attenuated inversion recovery. Results Of 1361 outpatients, a total of 753 (55.3%) patients were diagnosed with MIS; of them, 80% had a score of 0 using the MIS had a 0 score on the National Institutes of Health Stroke Scale. Among these, 303 (40.2%) individuals with MIS were diagnosed with MetS. Diagnosed of MIS with MetS significantly correlated with abdominal obesity (30.7% v.s 18.0%), hypertension (91.1% v.s 81.6%), increased blood glucose (6.9±2.4 v.s 5.0±0.4), dyslipidemia (78.2% v.s 48.2%), and SVE (50.5% v.s 11.3%) when compared with the controls group. On adjusted analysis, the risk of SVE was also significantly associated with three additional MetS criterion (RR,9.0; 95% CI, 5.677–14.46). Using Cox proportional analysis, risk of SVE in patient with MIS was significantly associated with MetS (RR, 3.3; 95% CI, 1.799–6.210), older age (RR, 1.0; 95% CI, 1.001–1.048), and high blood glucose (RR,1.1; 95%CI, 1.007–1.187). Conclusions The MetS is a strong risk factor for MIS, and patients presenting with MIS and MetS are at a high risk of SVE. Further studies are required to determine the improvement of Mets prevention in the reduction of MIS and SVE.

Reference intervals for total bilirubin, ALT, AST and creatinine in healthy Chinese elderly.

Background The aim of this study was to establish the reference intervals (RIs) of total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate transaminase (AST), and creatinine (CREA) for apparently healthy elderly (Han ethnicity) in Shuyang, China. Material/Methods A total of 54 912 blood specimens from elderly residents age 65–104 years were collected by standard procedures in Shuyang county of Jiangsu province. TBIL, ALT, AST, and CREA for each participant were determined by automatic biochemical analyzer. Distribution and differences of TBIL, ALT, AST, and CREA were analyzed and compared between the elderly of the same age of different sexes and different ages of the same sex. RIs of TBIL, ALT, AST, and CREA were compared with the current RIs. The RIs and 95% confidence intervals were calculated using nonparametric method (2.5th–97.5th percentiles) according to the guideline of the Clinical and Laboratory Standards Institute. Results RIs established for the healthy elderly include: TBIL 7.8~30.6 μmol/L for males and 7.3~26.1 μmol/L for females; ALT 8.7~47.3 U/L for males and 8.4~45.2 U/L for females; AST 15.7~46.9 U/L for males and 15.1~46.2 U/L for females; and CREA 45.1~100.9 μmol/L for males and 38.7~85.0 μmol/L for females. Reference intervals of TBIL, ALT, AST, and CREA for male elderly were higher than those of females, and values of CREA increased with increasing age. Conclusions We have established a panel of locally relevant RIs. It is necessary to establish scientific and reasonable RIs of TBIL, ALT, AST, and CREA for the healthy elderly in our region, which will provide a reference for clinicians and inspection officers.

Hemorrhagic Pure Sensory Strokes in the Thalamus and Striatocapsular Area: Causes, Clinical Features and Long-Term Outcome

Background: Although there have been sporadic reports of patients with hemorrhagic pure sensory strokes (HPSS) in the thalamus and striatocapsular areas, the causes, clinical featuring and long-term outcome have not been adequately investigated. Methods: We recruited 7 consecutive patients without hemiparetic stroke who had HPSS in the thalamic and striatocapsular areas. A CT scan was performed to verify brain imaging patterns, and their causes, clinical featuring and long-term outcome were observed. Results: We studied 7 patients who had HPSS in the thalamic and striatocapsular areas as seen in CT scans. The 7 patients had hypertension, and small hemorrhages were found in the thalamus of 2 patients and in the posterior quarter of the posterior limb of the internal capsule in 4 patients; only 1 patient had a microhemorrhage in the thalamus. The volume of the hemorrhages ranged from 0.3 to 6.3 ml, with a mean of 2.3 ± 1.9 ml. Three patients showed a decreased sense of spinothalamic modality, and position and vibration senses were spared. Four patients showed a sensory deficit of both spinothalamic and medial lemniscal type. The outcomes were excellent and without post-stroke pain in all patients. Conclusion: HPSS in the thalamus and striatocapsular area are usually small hemorrhages or microhemorrhages from rupturing of the microvessels or the branches of small vessels. HPSS only have an impact on the adjacent sensory nucleus or pathway, and have a good outcome without post-stroke pain.

Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis. Results Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P < 0.01). There was a significant difference in body temperature, heart rate, respiratory rate, white blood cell (WBC), systolic blood pressure (SBP), diastolic blood pressure (DBP), systemic inflammatory response syndrome (SIRS), acute respiratory failure, septic shock, hypernatremia, and sequential organ failure assessment (SOFA) score between the SE and non-SE group (P < 0.05). On a repeat head imaging, vasogenic edema (P = 0.023) and subcortical white matter lesions (P = 0.011) were significantly higher in patients with SE than those without SE, while hematoma growth (P = 0.000), infarction progress (P = 0.003), and recurrent subarachnoid hemorrhage (SAH) (P = 0.011) were significantly lower in patients with SE than those without SE. Patients with SE had higher adjusted rates of fever ≥ 39 °C (odds ratio (OR): 2.753; 95% confidence interval (CI): 1.116 - 6.794; P = 0.028) and SIRS ≥ 3 items (OR: 6.459; 95% CI: 2.050 - 20.351; P = 0.001). The 30-day mortality in stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003). Conclusion High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.

Long-term outcome in patients with subarachnoid hemorrhage with negative CT scan.

Despite improvements in diagnostic imaging, the initial interpretation of third-generation head CT scans to detect subarachnoid hemorrhage (SAH) has not reached 100% sensitivity [1,2]. The proportion of patients with SAH and a negative CT scan was 3.3% within 0 to 3 days of onset and 3.0% within 4 to 14 days of onset [3]. Another study showed that the proportion of patients with SAH and a negative CT may be close to 7% within 3 days [4].This indicates that SAH with a negative CT scan is not rare. Recurrent hemorrhage remains a serious consequence of aneurysmal SAH, with a fatality rate of approximately 70%, but it may be the most preventable cause of poor outcomes [5]. However, the recently published guidelines by the American Heart Association do not clear and definie the long-term outcome for patients who have SAH with a negative CT scan [5].This study addresses the longterm outcomes of SAH with a negative CT scan. A prospective study of outcomes of consecutive patients with SAH with a negative CT scan from January 1995 to September 2009 was commenced at a university teaching hospital in China. Twenty-eight patients included in the study did not have SAH visible on head CT, and the diagnosis of SAH was based on the results of a lumbar puncture (LP) with the xanthrochromia of the cerebrospinal fluid. Patients with spontaneous aneurysmal and nonaneurysmal SAH were included. Individuals with SAH caused by trauma, traumatic taps, arteriovenous malformation or other secondary causes were excluded. A cerebral angiography was performed within 3–5 days after admission in some patients. We divided these patients into two groups based on whether they agree or rejected angiography: an angiography group and a nonangiography group. Nine of 17 patients of the angiograpphy group showed an aneurysmal pattern of hemorrhage. In addition to eight patients for surgery therapy, the other one patient was not to receive surgery therapy. Those patients who were surviving 30 days after onset of the initial SAH were followed continuously. Rehemorrhage after the initial SAH was defined as a sudden headache with or without coma, and the new bleed was confirmed by head CT or LP. Follow-up was begun on October 10, 2009. Patients or their surrogates were interviewed either by telephone or in person. Subarachnoid hemorrhage and data regarding any rehemorrhages include the date, postmortem reports, and imaging data. Global outcome and functional status were assessed with the modified Rankin Scale (mRS = 0–6; 0 = no symptoms or disability; 6 = dead). Data for the survival and rehemorrhage analyses were extracted in April 2010. Data for the overall death and rehemorrhage analyses were compiled for the initial hospitalization after the primary SAH and from the date of the first SAH until the end September of 2009. A P value <0.05 was considered to be statistically significant. Twenty-eight patients who underwent an initial SAH with a negative CT were enrolled during their first hospitalization. One (fatal rehemorrhage) of 11 patients in the nonangiography group died during the first hospitalization. Therefore, the 27 remaining patients were enrolled and contacted for further follow-up. Table 1 shows the baseline characteristics of the patients in this study. As of April 2010, there were 15 survivors in the angiography group (including the eight patients for surgery therapy) and five survivors (except one lost to follow-up and four died) in nonangiography group. The rate of complete loss of follow-up was

Risk factors for nosocomial nontraumatic coma: sepsis and respiratory failure.

Background Coma’s are a major cause of clinical deterioration or death. Identification of risks that predispose to coma are important in managing patients; however, the risk factors for nosocomial nontraumatic coma (NNC) are not well known. Our aim was to investigate the risk factors in patients with NNC. Methods A retrospective case–control design was used to compare patients with NNC and a control group of patients without coma in a population-based cohort of 263 participants from the neurological intensive care unit in Shuyang County People’s Hospital of Northern China. Coma was diagnosed by a Glasgow Coma Scale score ≤8. Adjusted odds ratios for patients with NNC were derived from multivariate logistic regression analyses. Results A total of 96 subjects had NNC. The prevalence of NNC was 36.5% among the subjects. Among these, 82% had acute cerebrovascular etiology. Most of the NNC usually occurred at day 3 after admission to the neurological intensive care unit. Patients with NNC had higher hospital mortality rates (67.7% vs 3%, P<0.0001) and were more likely to have a central herniation (47.9% vs 0%, P<0.001) or uncal herniation (11.5% vs 0%, P<0.001) than those without NNC. Multiple logistic regression showed that systemic inflammatory response syndrome-positive sepsis (odds ratio =4, 95% confidence interval =1.875−8.567, P<0.001) and acute respiratory failure (odds ratio =3.275, 95% confidence interval =1.014−10.573, P<0.05) were the factors independently associated with a higher risk of NNC. Conclusion Systemic inflammatory response syndrome-positive sepsis and acute respiratory failure are independently associated with an increased risk of NNC. This information may be important for patients with NNC.

Transient and persistent symptoms in patients with lacunar infarction: results from a prospective cohort study

Background The transient symptoms with lacunar infarction (TSI) and persistent symptoms with lacunar infarction (PSI) are the most common forms of symptomatic lacunar infarction (LI). The aim of this study was to compare the differences in TSI and PSI of symptomatic LI. Methods A prospective cohort study was conducted in the neurologic outpatients of the tertiary teaching hospital in Northern China between February 2011 and February 2012. The TSI and PSI in participants aged 35 years or over were assessed. Patients were followed up and their outcomes were compared. Results Of the 453 symptomatic outpatients, 251 patients with LI were diagnosed by magnetic resonance imaging. Approximately 77.3% (194/251) of the patients with LI at this time had TSI. and the remaining 23.7% had PSI. After the adjusted odds ratios, only middle age (risk ratio [RR], 1.1; 95% confidence interval [CI], 1.157–1.189), lower National Institutes of Health Stroke Scale score (RR, 20.6; 95% CI, 6.705–13.31), smaller lacunae on brain images (RR, 2.9; 95% CI, 1.960–4.245), and LI frequently in the anterior circulation territory (RR, 0.2; 95% CI, 0.079–0.721) were independently associated with TSI. During a mean follow-up of 6 months, survival rate was significantly higher among patients with TSI than among those with PSI (log rank, 6.9; P=0.010); estimated unadjusted incidence of vascular subsequent events (30.9% vs 54.4%, P=0.001) was significantly lower in TSI than in PSI. Conclusion The TSI has a higher prevalence and is associated with a lower risk of vascular subsequent events and death than PSI. The implications of these findings for TSI and PSI may require different interventions.