Objective To assess the clinical efficacy and safety of Xingnaojing for treating cerebral infarction. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to April 2005), EMBASE (1984 to April 2005), Cochrane Controlled Trials Register (Issue 2, 2005), CBMdisc (1978 to April 2005). We handsearched the related published and unpublished data and their references. All trials about Xingnaojing injection for cerebral infarction were included. Data were extracted and evaluated by two reviewers independently with designed extraction from RevMan 4.2.7 software was used for data analysis. Results Thirteen RCTs involving 1203 patients were include .The results of meta-analysis were listed as the following:①Mortality:Compared with danshen ,2 studies showed that Xingnaojing decreased mortality statistically (RR 0.31 and 95% CI 0.14 to 0.70).Compared with cerebrolysin ,1 study showed Xingnaojing didn’t decrease the mortality (RR 0.92 ,95%CI 0.14 to 6.27);②Total effective rate: Compared with Danshen ,4 studies showed that Xingnaojing were more effective (RR 0.92,95% CI 1.12 to 1.42 ); ③ Cure rate: Compared with each control , Xingnaojing had the same cure rate ;④ Adverse effect: The number of adverse drug reaction was small and the symptoms were moderate;⑤Neurologic impairment score:Compared with Danshen ,3 studies showed that Xingnaojing had better improvement (WMD 3.78 ,95%CI 2.30 to 5.26).Conclusions xingnaojing may decrease the mortality and increase the total effective rate of cerebral infarction .More high quality trials are required.
Periodontal disease is a common chronic infectious disease targeting the connective tissue supporting the dentition. In recent years, the research on periodontal disease and cerebral infarction has been increasing. However, the causal relationship between periodontal disease and cerebral infarction remains unclear. Periodontal disease may be associated with atherosclerosis, which is one of the major causes of cerebral infarction. Regular dental care can reduce the risk of cardiovascular disease. Therefore, investigating the above association and its underlying mechanisms is of great clinical significance, which may help clinicians to make appropriate treatment and prevention measures. In this paper, the research progress and possible mechanism of the relationship between periodontal disease and cerebral infarction were reviewed.
Objective To assess the response rate, improvement in neurological function and safety of cinepazide maleate injection for patients with cerebral infarction. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials (Issue 1, 2010), PubMed (1948 to March 2010), EMbase (1966 to March 2010) and Chinese Bio-Medicine Database (1978 to March 2010). We also hand searched relevant literatures and obtained unpublished trials from pharmaceutical companies. The Cochrane Collaboration’s software RevMan5.0 was used for meta-analysis. Results Fifteen randomized controlled trials involving 1 456 patients were included. The results of meta-analyses indicated that: 1) Neurological deficits: We identified 11 trials involved 978 patients. Cinepazide maleate injection group compared with the control groups (placebo, Xuesaitong, Dansen and Nimodipine) could significantly improve the neurological deficits. The difference was statistically significant with WMD= – 4.64, 95%CI – 6.43 to – 2.85, WMD= – 2.39, 95%CI – 4.37 to – 0.42, WMD= – 3.67, 95%CI – 5.26 to – 2.07 and WMD= – 6.14, 95%CI – 8.39 to – 3.89, respectively. 2) Response rate: A total of 14 trials involved 1 349 patients were identified. Compared with control groups (placebo, Xuesaitong, Dansen and Nimodipine), cinepazide maleate injection group were more efficient, the difference was statistically significant with RR=1.33, 95%CI 1.16 to 1.54; RR=1.24, 95%CI 1.04 to 1.50; RR=1.33, 95%CI 1.23 to 1.43 and RR=1.29, 95%CI 1.12 to 1.49, respectively. 3) Adverse events: No serious adverse events were observed. But the difference of adverse events reports of headache and skin itching in cinepazide maleate injection group was statistically significant compared with the control groups. Conclusion Current evidence shows that cinepazide maleate injection can reduce neurological deficits in patients with acute cerebral infarction, improve the clinical treatment efficacy without serious adverse events. Due to limited quality of included studies, high-quality, large sample randomized controlled trials are required.
Objective To assess the clinical efficacy and safety of Shuxuetong in the treatment of cerebral infarction. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1996 to Feb. 2006), EMBASE (1984 to Dec. 2005), Cochrane Controlled Trials Register (Issue 4, 2005), Chinese Cochrane Centre Database, CBMdisc (1978 to Dec. 2005). We handsearched the related published and unpublished data and their references. All trials about Shuxuetong injection for cerebral infarction were included. Data were extracted and evaluated by two reviewers independently with designed extraction form. RevMan 4.2.8 software was used for data analysis. Results Eleven RCTs involving 1 122 patients were included. The results of meta-analysis were listed as follows: ① Total effective rate: Compared with Danshen, three studies showed that Shuxuetong were more effective with OR 4.01, 95%CI 2.00 to 8.04; ② Adverse effect: The number of adverse drug reaction was small and the symptoms were moderate; ③ Neurologic impairment score: Compared with safflower, one study showed that Shuxuetong had better improvement with WMD -2.60, 95%CI -3.23 to -1.97. Conclusions Shuxuetong may increase the total effective rate of cerebral infarction. More high quality trials are required.
A large amount of research evidence has shown a correlation between cerebral infarction and malignant tumors, and malignant-tumor-related embolic stroke is the main type of malignant-tumor-related cerebral infarction. Hypercoagulation is considered to be the main mechanism. However, due to the complexity of the pathogenesis, the optimal diagnosis, treatment, and prevention strategies remain unclear. This review summarizes the published literature on the concepts, mechanisms, clinical manifestations, laboratory and imaging examinations, treatment and prevention of malignant-tumor-related embolic cerebral infarction, to clearly understand this disease and provide ideas for early recognition, reasonable diagnosis and treatment, improvement of prognosis, and further research of this disease.
Objective To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion ① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.
Objective To summarize cl inical experience of carotid endarterectomy (CEA) in treating severe carotid stenosis. Methods Between October 1998 and January 2010, 215 patients with carotid stenosis were treated with CEA. There were 140 males and 75 females with an average age of 66 years (range, 51-88 years). Transient ischemic attack (TIA) occurred in127 cases, and 31 cases had history of cerebral infarction. All cases were diagnosed definitely by selective angiography and/or CT angiography, and stenosis degree was more than 80%; contralateral carotid artery was also involved in 45 cases. Ninty-six cases were found to have coronary artery stenosis by coronary angiography. CEA and coronary artery bypass grafting were performed simultaneously in 25 cases. Peripheral arterial disease was found in 43 cases and treated at the same time. Results A total of 155 patients were followed up 6-72 months. The cl inical symptom significantly alleviated in 148 cases postoperatively. Two cases had compl ication of cerebral hemorrhage within 1 week postoperatively; one died and the other was resumed after the conservative treatment. One case had hypoglossal nerve injury. Four cases had injuring marginal mandibular branch of the facial nerve, and no special treatment was given. Restenosis was found in 25 patients, and the stenosis degree was less than 25%; moreover, the patients had no TIA. One case died of heart attack at 3 years of follow-up period. Conclusion CEA is an effective and safe method for treating severe carotid stenosis.
ObjectiveTo explore the clinical effect of comprehensive nursing on cerebral infarction patients with high blood glucose. MethodsEighty cerebral infarction patients with high blood glucose treated between March 2012 and February 2013 were divided into observation group and control group with 40 patients in each. Patients in the control group received routine nursing care, while those in the observation group were given comprehensive nursing care. Then, we compared the two groups of patients in terms of their blood glucose control level, the recovery of neurological function and life quality. ResultsThe fasting glucose, 2-hour postprandial blood glucose, National Institude of Health stroke scale (NIHSS), and modified Edinburgh Scandinavican scoring scale (MESSS) scores of the two groups were not statistically different at the time of hospital admission (P>0.05). However, fasting blood sugar, 2-hour postprandial blood glucose, NIHSS, and MESSS scores in the observation group were significantly lower than those in the control group before discharge (P<0.05). Life quality score of self-care, mental health, and social function before discharge in the observation group were significantly higher than those in the control group (P<0.05). ConclusionComprehensive nursing is helpful to control blood glucose in an ideal level range for cerebral infarction patients with hyperglycemia, which can also promote the recovery of neurological function and improve the life quality of patients.
Objective To systematically review the relationship between helicobacter pyloric (HP) infection and ischemia stroke. Methods We searched MEDLINE, BIOSIS, VIP, and China Full Text Journal databases to identify the studies that studied the relationship between HP infection and ischemia stroke. All the studies were strictly screened according to the inclusion criteria, and meta-analyses were performed for the included studies using RevMan 4.2 software.Results Eleven case-control studies involving 1 530 patients with ischemia stroke and 1 451 health controls were included. The results of meta-analyses showed that there was a significant difference in the infection ratio of HP between the patients with ischemia stroke and health controls (OR=1.77, 95%CI 1.38 to 2.28, Plt;0.0001), but this difference was not been found after adjusting some related risk factors (1.22, 95%CI 0.93 to 1.59, P=0.15). The results of subgroup meta-analyses showed these differences were only found in the LAA (large-artery atherosclerosis) subgroup (OR=3.65, 95%CI 2.58 to 5.17) and the SAA (small-artery atherosclerosis) subgroup (OR=1.74, 95%CI 1.30 to 2.34), but was not found in the CE (cardiogenic cerebral embolism) subgroup (OR=1.08, 95%CI 0.58 to 2.02). Conclusion HP infection is associated with ischemia stroke, but the relationships between HP infection and the subtypes of ischemia stroke are different. The association between HP and LAA is ber than that between HP and the other subtypes. More evidence is needed to prove whether Helicobacter pyloric infection is an independent risk factor of ischemia stroke.
ObjectiveTo observe the changes in visual field defect before and after treatment in patients with acute solitary occipital lobe cerebral infarction.MethodsFrom January 2017 to May 2019, 59 patients with hemianopsia who were diagnosed as acute occipital lobe cerebral infarction in Henan Provincial People's Hospital were selected. There were 35 males (59.3%) and 24 females (40.7%); aged from 50 to 72 years, with an average age of 62.86 ± 6.10 years. There were 23 patients of right occipital cerebral infarction and 36 patients of left occipital cerebral infarction. Lesions involved 41 patients in the striated area, 8 patients involved the occipital pole, and 23 patients involved visual radiation. All patients underwent standard medical treatment. All patients underwent visual field examination before treatment, and modified rankin scale (mRS) was used to evaluate the level of visual disability after cerebral infarction. At 1, 3, and 6 months after treatment, 54 patients underwent at least one visual field examination in outpatient or inpatient follow-up visits, and 5 patients were lost to follow-up; 49 patients received repeated mRS scores. The visual field defect and mRS score of patients before and after treatment were compared and analyzed. The improvement of visual field defect in the horizontal direction exceeding 10°or the vertical direction exceeding 15°was defined as improvement, otherwise it was defined as no improvement. According to the type of visual field defect, the patients were divided into two groups: complete homonymous hemianopia and incomplete homonymous hemianopia. The cumulative visual field improvement rate of the two groups of patients was calculated. An mRS score of 0 to 2 was defined as a good prognosis, and ＞2 was defined as a poor prognosis.ResultsBefore treatment, of the 59 patients, 47 were complete homonymous hemianopsia and 12 were incomplete. Of the 47 patients with complete homonymous hemianopia, 26 patients had hemianopia on the right side of both eyes, 21 patients had hemianopia on the left side of both eyes; 32 patients with macular avoidance (72.3%). Among the 12 patients of incomplete homonymous hemianopia, 10 patients of quadrant blindness included 6 patients of upper quadrant and 4 patients of lower quadrant; 2 patients of partial isotropic hemianopia on one side. Of the 54 patients reviewed after treatment, the visual field improved at the last follow-up of 25 patients (46.3%), and there was no improvement in 29 patients (53.7%). The cumulative visual field improvement rate of 47 patients with complete hemianopia hemianopia before treatment was 37.2% (16/43). The cumulative visual field improvement rate of 11 patients with incomplete isotropic hemianopia before treatment was 81.8% (9/11). There was a statistically significant difference in cumulative visual field improvement between the two groups of patients (χ2 = 7.011, P＜0.05). Before treatment, 59 patients had mRS scores of 1 to 2 points in 15 patients (25.4%), and 44 patients with 2 points or more (74.6%). Of the 49 patients reviewed after treatment, 28 (57.1%) had a good prognosis and 21 (42.9%) had a poor prognosis.ConclusionsThe visual field defect of patients with homonymous hemianopsia after acute occipital infarction may be improved after treatment. The improvement mostly occurs within 1 m after treatment, and patients with incomplete homonymous hemianopsia have more significant improvements than those with complete homonymous hemianopsia.