1.
Sex- related differences in the factors associated with outcomes among patients with strokes of undetermined source: a hospital-based follow-up study.
Yan, L, Huangfu, C, Yang, N, Li, R, Yang, X, Feng, Y, Xuan, L, Wang, Q, Meng, Y, Hou, X, et al
Postgraduate medicine. 2021;(4):428-435
Abstract
Objective: Sex-related differences are well established among stroke patients, including the incidence and prevalence of stroke being higher among men than among women. However, the sex-related factors for differences in the outcomes of strokes of undetermined source (SUSs) have not been well described, especially in the Chinese population. We assessed the sex-related differences in the factors associated with outcomes among patients with SUSs in China.Method: Between January 2011 and December 2018, we recruited 205 patients diagnosed with SUSs from Kailuan General Hospital (China). The clinical features, risk factors, and outcome data were collected for the patients at 3 and 12 months after their strokes.Results: There were higher frequencies of hyperlipidemia (27.8% vs. 26.4%), smoking (41.4% vs. 5.6%), and alcohol consumption (21.8% vs. 0%) for male patients than for female patients. However, women were more likely than men to have hypertension (63.9% vs. 46.6%), diabetes (27.8% vs. 20.3%), and atrial fibrillation (9.7% vs. 5.3%); they were also more likely to be obese (16.7% vs. 12.0%). There were no significant differences in outcome between the sexes. Among men, severe strokes were associated with higher case fatality and disability risks at 12 months after stroke onset; hyperlipidemia was a risk factor for recurrence within 3 months of the initial stroke. Among women, severe strokes also increased the risk of disability; in women, high total cholesterol (TC) and age were associated with poor outcomes.Conclusion: The factors associated with outcomes in SUS differed by sex. For male patients, more severe stroke and hyperlipidemia were associated with poor outcomes in SUS. Risk factors for poor outcomes in female patients were stroke severity, age, and TC level. These findings suggest that taking measures to manage blood lipid levels and severe stroke among patients with SUS is important for both male and female patients and is crucial for reducing the burden of stroke in China.
2.
The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia.
Meng, P, Zhang, S, Wang, Q, Wang, P, Han, C, Gao, J, Yue, S
Journal of back and musculoskeletal rehabilitation. 2018;(2):363-370
Abstract
OBJECTIVE To assess whether the clinical efficacy of a therapeutic protocol using surface neuromuscular electrical stimulation (sNMES) on patients with post-stroke dysphagia (PSD) is superior to that without sNMES, and whether swallowing functional outcome is different with regards to different electrode placement on patients' skin of neck. METHODS Thirty patients with PSD were randomly allocated into treatment group A (TGA), treatment group B (TGB) and control group according to a random number table. The three groups of patients all received traditional dysphagia therapy (TDT) and other general rehabilitation therapy such as physical therapy and occupational therapy as a basic treatment project. Besides this, sNMES treatment was applied on different sites of patients' neck skin in group A and B separately. All the patients received video-fluoroscopic swallowing study (VFSS) pre-treatment and 2 weeks post-treatment, during which the displacement of the hyolaryngeal complex towards the superior and anterior sides while swallowing semi-liquid diet were measured. Outcome of the VFSS was measured using dysphagia outcome and severity scale (DOSS). RESULTS Post-treatment evaluation was carried out using water swallow test (WST), repetitive saliva swallowing test (RSST) and dysphagia outcome and severity scale (DOSS) from the three study groups were all improved (P< 0.05). The results of post-treatment evaluation using WST from TGA and TGB were 2.40 ± 1.26 and 2.10 ± 0.99 respectively, using RSST from TGA and TGB were 5.30 ± 1.89 and 5.20 ± 1.69 respectively, using DOSS from TGA and TGB were 5.20 ± 1.40 and 5.10 ± 1.45 respectively. Compared to control group, the results of post-treatment evaluation using the three scales, there were significant improvement between TGA and TGB (P< 0.05), however, the inter-group differences of TGA and TGB indicated no statistically significant difference (P> 0.05). The post-treatment evaluation of the moving distance of hyoid bone towards anterior side in swallowing was significantly improved as compared to TGB (-8.40 ± 7.48, t=-3.552, P= 0.006), and was statistically significant as compared to the control group (P> 0.05). CONCLUSIONS Swallowing function in the patients with PSD was significantly improved using TDT combined with NMES. Stimulating electrodes placed at the suprahyoid region or on both suprahyoid and infrahyoid regions resulted in no difference of effect. However, NMES on suprahyoid region could further improve the moving distance of hyoid bone anteriorly.
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Is adjunctive treatment with medication of liver-soothing-oriented method beneficial for depression after cerebrovascular accident?: A PRISMA-compliant meta-analysis.
Zeng, LF, Liang, WX, Liu, JC, Chen, XY, Du, WY, Li, ZP, Wang, Q, Cao, Y, Wang, L, Meng, CR, et al
Medicine. 2016;(44):e5208
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Abstract
BACKGROUND Adjunctive treatment with medication of liver-soothing-oriented method (MLSM) is one of the most commonly used approaches for subjects with depression after cerebrovascular accident (DCVA) in China. The purpose of this meta-analysis was to evaluate the outcome of MLSM treatment in subjects with DCVA using relevant published literature. METHODS The PubMed, Cochrane Library, Embase, Chinese databases of China National Knowledge Infrastructure, WanFang, Sinomed, and VIP were used to collect all publications until March 2016. Randomized controlled trials comparing treatments with and without MLSM for subjects with DCVA were included. The quality of each publication was assessed based on the recent Handbook (5.1 version) for Cochrane Reviewers. Cochrane Collaboration's software RevMan 5.3 software was applied for data analysis. RESULTS Thirty studies, including 2599 cases, were identified and collected. Adjunctive treatment with MLSM noticeably enhanced total effective rates (odds ratio 3.76; 95% confidence interval [CI] 2.92-4.85, I = 0%, P = 0.96) in comparison to non-MLSM conventional pharmacotherapy. Compared to non-MLSM treatment, the changes of Hamilton Depression Scale in adjunctive treatment with MLSM, respectively, decreased and showed beneficial effects after 3 weeks (weighted mean difference [WMD] -4.83; 95% CI -6.82 to -2.83; I = 86%, P < 0.001), 4 weeks (WMD -4.20; 95% CI -5.06 to -3.33; I = 78%, P < 0.001), 6 weeks (WMD -3.36; 95% CI -4.05 to -2.68; I = 54%, P = 0.02), 8 weeks (WMD -4.83; 95% CI -5.62 to -4.04; I = 73%, P < 0.001), and 12 weeks (WMD -2.88; 95% CI -4.09 to -1.67; I = 58%, P = 0.09). As for changes in inflammatory cytokine levels, adjunctive treatment with MLSM was associated with a significant decrease in tumor necrosis factor-α, IL-6, and interleukin-1β levels in comparison to non-MLSM treatment. Moreover, there were positive effects on score changes for National Institute of Health Stroke Scale, activities of daily living, Hamilton Anxiety Scale, Modified Edinburgh Scandinavian Stroke Scale, and Self-Rating Anxiety Scale. No serious adverse events were reported. CONCLUSION MLSM appears to improve symptoms of depressive disorders, enhance immediate responses, and the quality of life in subjects with DCVA. The positive action of MLSM might be potentially connected with its immunoregulating effects. More prospective trials with strict design and larger sample sizes are warranted to clarify its effectiveness and safety.