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Low serum albumin levels predict poor outcome in patients with acute ischaemic stroke or transient ischaemic attack

Stroke & Vascular Neurology 2021年第3期6卷 458-466页

作者： Hongyu Zhou anxin wang Xia Meng Jinxi Lin Yong Jiang Jing Jing Yingting Zuo Yilong wang Xingquan Zhao Hao Li Yongjun wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Tiantan Neuroimaging Center of Excellence Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina

Background To examine the relationship of serum albumin with poor functional outcome and mortality in patients with acute ischaemic stroke(AIS)or transient ischaemic attack(TIA),and perform a meta-analysis to summarise the *** We analysed data from the Third China National Stroke Registry(CNSR-Ⅲ).Patients were divided into four groups based on serum albumin levels at *** outcomes included poor functional outcome(modified Rankin Scale(mRS)score of 3 to 6)and mortality at 3 months and 1 *** logistic regression models and Cox regression models were used to evaluate the association,*** used a fixed-effect model to calculate the risk ratio for poor functional outcome and a random-effect model for mortality in the *** A total of 13618 patients were *** the 3-month follow-up period,compared with 40 to 44.9 g/L group,patients in<35 g/L group had an increased risk of poor functional outcome and mortality(adjusted OR 1.37(95%CI 1.12 to 1.67);adjusted HR 2.13(95%CI 1.41 to 3.23)).The relationship in per 10 g/L decreased serum albumin with prognosis was consistently inversed(adjusted OR 1.17(95%CI 1.01 to 1.35);adjusted HR 1.86(95%CI 1.30 to 2.64)).Also,low serum albumin levels were independently correlated with clinical outcomes at 1 *** the meta-analysis,the OR for poor functional outcome pooled 3 studies per 1 g/L decrease was 1.03(95%CI 1.02 to 1.05),and the HR for mortality pooled 5 studies was 1.07(95%CI 1.03 to 1.11).Conclusions Low serum albumin levels predict poor functional outcome and mortality in patients with AIS or TIA.

关键词： patients mortality acute

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Cumulative burden of lipid profiles predict future incidence of ischaemic stroke and residual risk

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Stroke & Vascular Neurology 2021年第4期6卷 581-588,I0049-I0054页

作者： Liye Dai Jie Xu Yijun Zhang anxin wang Zimo Chen Jinglin Mo Hao Li Xia Meng Shouling Wu Yongjun wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Department of Cardiology Kailuan HospitalNorth China University of Science and TechnologyTangshanChina

Objectives Incident ischaemic stroke(IS)risk may increase not only with lipids concentration but also with longer duration of *** study aimed to investigate the impact of cumulative burden of lipid profiles on risk of incident *** A total of 43836 participants were enrolled who participated in four surveys during *** cumulative lipid burden was calculated as number of years(2006-2013)multiplied by the levels of low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),non-HDL C and triglyceride(TG),*** primary outcome was defined as the incident IS during *** During 4.67 years(±0.70 years)follow-up on average,we identified 1023(2.33%)incident *** with respective reference groups,the HRs(95%CIs)of the upper tertile in cumulative TG burden,cumulative LDL-C burden,cumulative TC burden and cumulative non-HDL C burden were 1.26 mmol/L(1.02-1.55 mmol/L),1.47 mmol/L(1.25-1.73 mmol/L),1.33 mmol/L(1.12-1.57 mmol/L)and 1.51 mmol/L(1.28-1.80 mmol/L)for incidence of IS,***,this association was not significant in cumulative HDL-C burden and IS(HR:1.09;95%CI:0.79 to 1.52),after adjustment for confounding *** 16600 participants with low cumulative LDL-C burden,HRs(95%CI)for TC,TG,non-HDL C and HDL-C with IS were 1.63 mmol/L(1.03-2.57 mmol/L),1.65 mmol/L(1.19-2.31 mmol/L),1.57 mmol/L(1.06-2.32 mmol/L)and 0.98 mmol/L(0.56-1.72 mmol/L),*** We observed the correlation between cumulative burden of lipid profiles,except for cumulative burden of HDL-C,with the risk of incident *** burden of TC,TG and non-HDL C may still predict IS in patients with low cumulative LDL-C *** registration number ChiCTR-TNRC 11001489.

关键词： cholesterol burden founding

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积极血管成形术在颅内动脉粥样硬化性急性大血管闭塞治疗中的应用价值——ANGEL-ACT亚组分析

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中华神经外科杂志 2024年第7期40卷 680-685页

作者：殷悦陈翰林邓一鸣王安心张怡君贾白雪罗岗马宁莫大鹏高峰缪中荣首都医科大学附属北京天坛医院神经介入中心北京100070 首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心北京100070 首都医科大学北京市神经外科研究所北京100070

目的分析积极的血管成形术在颅内动脉粥样硬化性大血管闭塞性卒中(LVOS)治疗中的作用。方法从急性缺血性卒中血管内治疗关键技术及急救流程改进研究(ANGEL-ACT)数据库中纳入颅内动脉粥样硬化性LVOS患者475例,根据治疗方案分为积极血管... 详细信息

目的分析积极的血管成形术在颅内动脉粥样硬化性大血管闭塞性卒中(LVOS)治疗中的作用。方法从急性缺血性卒中血管内治疗关键技术及急救流程改进研究(ANGEL-ACT)数据库中纳入颅内动脉粥样硬化性LVOS患者475例,根据治疗方案分为积极血管成形术组[定义为在1次机械取栓(MT)后行血管成形术,或仅行血管成形术](194例)与消极血管成形术组(定义为只接受MT,或在≥2次MT后行血管成形术)(281例)。比较两组的有效性和安全性。有效性主要终点为术后即刻改良脑梗死溶栓(mTICI,≥2b级为再通成功)分级、术后90 d改良Rankin量表评分(mRS);安全终点为术后24 h内症状性颅内出血和术后90 d的病死率。采用二元logistic回归分析拟合模型,分别分析消极血管成形术组与积极血管成形术组发生上述终点事件的比值比(OR值)。以P<0.05为差异有统计学意义。结果475例患者中,积极血管成形术组与消极血管成形术组术后24 h内症状性颅内出血率分别为3.1%(6/194)、5.0%(14/281),P=0.329;术后即刻mTICI分级≥2b级的比率分别为96.9%(188/194)、91.8%(258/281),P=0.023。术后90 d,mRS 0~1分的比率分别为55.7%(108/194)、38.8%(109/281),P<0.001;病死率分别为10.8%(21/194)、18.9%(53/281),P=0.018。对年龄、性别、术前美国国立卫生研究院卒中量表评分、心房颤动、原发性高血压、串联病变因素校正后,二元logistic回归分析显示,消极血管成形术组与积极血管成形术组术后即刻mTICI分级2b~3级的OR值为0.33(95%CI:0.13~0.85,P=0.022),术后90 d病死率的OR值为1.82(95%CI:1.00~3.31,P=0.051),mRS 0~1分的OR值为0.55(95%CI:0.37~0.82,P=0.004)。结论颅内动脉粥样硬化性急性LVOS患者早期积极行血管成形术可降低患者术后90 d的病死率,提高患者的神经功能恢复及脑灌注的恢复,有效性及安全性均更佳。

关键词：卒中动脉闭塞性疾病颅内动脉硬化急性血管成形术治疗结果

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Nutrition in Alzheimer's disease:a review of an underappreciated pathophysiological mechanism

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Science China(Life Sciences) 2023年第10期66卷 2257-2279页

作者： Jiwei Jiang Hanping Shi Shirui Jiang anxin wang Xinying Zou Yanli wang Wenyi Li Yuan Zhang Mengfan Sun Qiwei Ren Jun Xu Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China China National Clinical Research Center for Neurological Diseases Beijing 100070China Department of Gastrointestinal Surgery Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Clinical Nutrition Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition Beijing 100038China

Alzheimer's disease(AD)is the leading cause of dementia in older individuals and is an escalating challenge to global public *** therapy of AD is one of the well-funded areas;however,little progress has been made due to the complex *** evidence has demonstrated that modifying risk factors and lifestyle may prevent or delay the incidence of AD by 40%,which suggests that the management should pivot from single pharmacotherapy toward a multipronged approach because AD is a complex and multifaceted ***,the gut-microbiota-brain axis has gained tremendous traction in the pathogenesis of AD through bidirectional communication with multiple neural,immune,and metabolic pathways,providing new insights into novel therapeutic *** nutrition is an important and profound environmental factor that influences the composition and function of the *** Nutrition for Dementia Prevention Working Group recently found that dietary nutrition can affect cognition in AD-related dementia directly or indirectly through complex interactions of behavioral,genetic,systemic,and brain ***,considering the multiple etiologies of AD,nutrition represents a multidimensional factor that has a profound effect on AD onset and ***,mechanistically,the effect of nutrition on AD is uncertain;therefore,optimal strategies or the timing of nutritional intervention to prevent or treat AD has not been ***,this review summarizes the current state of knowledge concerning nutritional disorders,AD patient and caregiver burden,and the roles of nutrition in the pathophysiology of *** aim to emphasize knowledge gaps to provide direction for future research and to establish optimal nutrition-based intervention strategies for AD.

关键词： Alzheimer's disease nutrition diet pathogenesis metabolism brain-gut axis

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Different contribution of SBP and DBP variability to vascular events in patients with stroke

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Stroke & Vascular Neurology 2020年第2期5卷 110-115页

作者： Liye Dai Aichun Cheng Xiwa Hao Jie Xu Yingting Zuo anxin wang Xia Meng Hao Li Yilong wang Xingquan Zhao Yongjun wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Department of Neurology Inner Mongolia Baotou City Central HospitalBaotouChina

Background High blood pressure variability(BPV)is a novel risk factor for cardiovascular ***,the heterogeneity of systolic blood pressure variability(SBPV)and diastolic blood pressure variability(DBPV)for different vascular events remains *** study aims to investigate whether SBPV or DBPV has different contribution to vascular events in patients with acute ischaemic stroke(IS)or transient ischaemic attack(TIA).Methods Data from the BOSS(blood pressure and clinical outcome in TIA or IS)study were examined for vascular events at 3-month and 1-year *** was defined as the SD and coefficient of variation(CV)of day-to day measurements within 3 months after IS/*** events include cardiovascular events(myocardial infarction,unstable angina,cardiac death and congestive heart failure)and cerebrovascular events(ischaemic or haemorrhagic stroke).Logistic regression model was used to test the associations between BPV and vascular *** Of 2325 patients with IS or TIA,103(4.43%)experienced a recurrent stroke and 64(2.75%)had cardiovascular events within 3 ***-to day SBPV was only associated with stroke recurrence(BPVSD:OR,1.72,95%CI 1.09 to 2.71;BPVCV:1.86,95%CI 1.19 to 2.92),but not cardiovascular events(BPVSD:1.67,95%CI 0.94 to 2.94;BPVCV:1.51,95%CI 0.86 to 2.64).However,DBPV seems to be related to both stroke(BPVSD:1.60,95%CI 1.02 to 2.49;BPVCV:1.53,95%CI 0.99 to 2.37)and cardiovascular events(BPVSD:2.48,95%CI 1.37 to 4.48;BPVCV:1.92,95%CI 1.09 to 3.36).Similar results were found at 1 *** For patients with IS/TIA,stroke recurrence was associated with both SBPV and DBPV;however,cardiovascular events seem to be only related to DBPV.

关键词： patients cardiovascular unstable

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Detailed phenotype of RNF213 p.R4810K variant identified by the Chinese patients with acute ischaemic stroke or transient ischaemic attack

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Stroke & Vascular Neurology 2023年第6期8卷 503-510页

作者： Hongyu Zhou Jing Jing Yuehua Pu Wei Li Xia Meng anxin wang Yingting Zuo Zhe Xu Qin Xu Yue Suo Hao Li Yongjun wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Tiantan Neuroimaging Center of Excellence Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Monogenic Disease Diagnosis Center for Neurological Disorders and Precision Medicine Research Center for Neurological Disorders Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina Center of excellence for Omics Research(CORe) Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical SciencesBeijingChina

Background and purpose The ring finger protein 213 gene(RNF213)p.R4810K variant increased the risk of acute ischaemic stroke(AIS)attributable to intracranial arterial stenosis(ICAS)in the Japanese and Korean *** this study,we aimed to examine the prevalence of the RNF213 p.R4810K variant in Chinese patients with AIS or transient ischaemic attack and identify the phenotype of the *** We analysed data from the Third China National Stroke *** included participants were divided into two groups by carrier status of the p.R4810K *** aetiological classification was conducted according to the Trial of Org 10172 in Acute Stroke Treatment(TOAST)*** presence of ICAS and extracranial arterial stenosis(ECAS)was defined as 50%-99%stenosis or occlusion of any intracranial and extracranial *** regression models and Cox regression models were used to evaluate the association of the p.R4810K variant with TOAST classification,stenosis phenotypes and clinical *** A total of 10381 patients were enrolled,among which 56(0.5%)had the heterozygote GA genotype for *** variant carriers were younger(p=0.01),and more likely to suffer from peripheral vascular disease(p=0.04).The p.R4810K variant was associated with large-artery atherosclerosis(LAA)(adjusted OR=1.94,95%CI 1.13 to 3.33),anterior circulation stenosis(adjusted OR=2.12,95%CI 1.23 to 3.65)and ECAS(adjusted OR=2.29,95%CI 1.16 to 4.51).Nevertheless,the p.R4810K variant was not associated with recurrence,poor functional outcome and mortality at 3 months and 1 *** The RNF213 p.R4810K variant was associated with LAA,anterior circulation stenosis and ECAS in Chinese *** the low carrying rate and only 1-year follow-up information,caution should be taken to interpret our findings in no statistically significant association between the p.R4810K variant and stroke prognosis in Chinese patients.

关键词： patients transient younger

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体重指数对不同严重程度卒中患者短期预后的影响

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中国卒中杂志 2024年第7期19卷 809-814页

作者：于丹丹秦海强王安心张晓丽左颖婷张亚清杨波魏娜张婧首都医科大学附属北京天坛医院神经重症医学科北京100070 首都医科大学附属北京天坛医院神经病学中心国家神经系统疾病临床医学研究中心北京脑重大疾病研究院脑卒中研究所脑血管病转化医学北京市重点实验室首都医科大学宣武医院神经内科

目的探讨BMI对不同严重程度卒中患者3个月临床结局的影响。方法本研究是前瞻性多中心队列研究,观察发病7 d内首次卒中住院患者的BMI与3个月卒中结局的关系。根据入院时NIHSS评分,将患者分为轻度卒中(NIHSS评分<11分)组和中重度卒中(NIHS... 详细信息

目的探讨BMI对不同严重程度卒中患者3个月临床结局的影响。方法本研究是前瞻性多中心队列研究,观察发病7 d内首次卒中住院患者的BMI与3个月卒中结局的关系。根据入院时NIHSS评分,将患者分为轻度卒中(NIHSS评分<11分)组和中重度卒中(NIHSS评分≥11分)组。收集患者入院时的一般资料以及高血压、糖尿病等血管危险因素情况。记录入院时BMI、是否存在吞咽障碍及在院期间肺炎等资料,其中BMI按照四分位数分为4层。发病后3个月对患者进行随访,采集mRS评分,以mRS评分0~2分为预后良好,3~6分为预后不良。比较轻度卒中组和中重度卒中组BMI及其他基线指标的差异并探索不同水平BMI对不同严重程度卒中患者预后的影响。结果共纳入733例患者,其中男性474例(64.7%),女性259例(35.3%)。缺血性卒中552例(75.3%),出血性卒中181例(24.7%)。轻度卒中组526例,中重度卒中组207例。在校正混杂因素后,不同水平BMI对整体患者及轻度卒中患者3个月结局均无显著影响;在中重度卒中患者中,与BMI最低四分位水平患者相比,最高四分位水平患者3个月预后良好的比例降低(OR 0.376,95%CI 0.142~0.992,P=0.048)。结论不同BMI水平对不同严重程度卒中患者短期预后的影响不同,其中,在中重度卒中患者人群中,高BMI水平可能导致预后不良。

关键词：卒中体重指数预后超重

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Gastrointestinal bleeding during acute ischaemic stroke hospitalisation increases the risk of stroke recurrence

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Stroke & Vascular Neurology 2020年第2期5卷 116-120页

作者： Wanliang Du Xingquan Zhao Yilong wang Yuesong Pan Gaifen Liu anxin wang Ruijun Ji Liping Liu Hongqiu Gu Kehui Dong Penglian wang Yongjun wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeiingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina

Objective Gastrointestinal(GI)bleeding in patients who had a stroke is strongly associated with a higher risk of death and loss of ***,it is unknown whether GI bleeding increases risk for recurrence of *** this study,we assess the potential relationship between GI bleeding and stroke recurrence in patients within 12 months of an acute ischaemic stroke(AIS),using the China National Stroke Registry(CNSR).Methods This study included 22216 patients who had an ischaemic stroke included in the CNSR from 2007 to *** analysed baseline patient characteristics,GI bleeding and outcomes of patients who had an AIS,specifically stroke recurrence at 3,6 and 12 *** used multivariable logistic regression to evaluate a possible association between GI bleeding and stroke *** Of the 12415 patients included in our study,12.3%,15.5%and 17.7%had a stroke recurrence at 3,6 and 12 months,*** bleeding was an independent stroke recurrence risk factor in patients after ischaemic stroke at 3 months(adjusted OR 1.481,95%CI 1.118 to 1.962),6 months(adjusted OR 1.448,95%CI 1.106 to 1.896)and 12 months(adjusted OR 1.350;95%CI 1.034 to 1.763).Conclusion GI bleeding was associated with the increased risk of stroke recurrence after an AIS.

关键词： bleeding Gastrointestinal acute

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Clinical Observation of Neoadjuvant Chemotherapy in High-Risk Stage II Colorectal Cancer: A Report of 24 Cases

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Journal of Cancer Therapy 2017年第13期8卷 1169-1178页

作者： anxin wang Jinjun Li Medical College Wuhan University of Science and Technology Wuhan China

Background: Neoadjuvant chemotherapy is the systemic chemotherapy before the start of local chemotherapy or radiotherapy. At present, neoadjuvant chemotherapy in the high-risk phase II (AJCC TNM stage II period, including T3N0M0 and T4N0M0) treatment of colon cancer reported less. The authors discussed the efficacy and safety of neoadjuvant chemotherapy in 24 patients with high-risk stage II colorectal cancer. Method: Forty-eight patients with stage II colorectal cancer were randomly divided into experimental group and control group, the postoperative complications, the side effects of chemotherapy drugs and the effect of chemotherapy drugs on the tumor were observed. The quality of life, survival time and tumor recurrence or metastasis was compared between the two groups. Result: 1) The incidence of complications in the neoadjuvant chemotherapy group was 20.8%, the incidence of adjuvant chemotherapy was 25%, and the overall complication rate was 22.9%. P values were greater than 0.05. 2) Through the comparison of the two groups of toxic and side effects, after SPASS software analysis, obtained P > 0.05, the two groups were not statistically significant. 3) After 3 - 4 courses of preoperative chemotherapy, CR (complete remission) and PD (disease progression) patients were 0 cases, PR (partial remission) was 11 (45.8%), NC/SD (no change) was 13 (54.2%). 4) Through the comparison of the quality of life of the two groups of patients, from the function, symptoms and the overall situation to statistics, P value 0.05, This comparison makes sense. 5) The 1-year survival rate was 100% (24/24) in the control group, with a 3-year survival rate of 92% (22/24) and a 5-year survival rate of 75% (9/12). All survival rates in the experimental group were 100% (24/24). 6) There were no recurrence or metastasis cases in the neoadjuvant chemotherapy group, and 2 cases of recurrence and 1 case of metastasis in the adjuvant chemotherapy group were compared with the recurrence or metasta

关键词： Neoadjuvant Chemotherapy Adjuvant Chemotherapy Colon Cancer Efficacy Risk Factors

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Clopidogrel with aspirin in High- risk patients with Acute Non- disabling Cerebrovascular Events II (CHANCE-2): rationale and design of a multicentre randomised trial

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Stroke & Vascular Neurology 2021年第2期6卷 280-285页

作者： Yongjun wang Claiborne Johnston Philip M Bath Xia Meng Jing Jing Xuewei Xie anxin wang Yuesong Pan Anding Xu Qiang Dong Yilong wang Xingquan Zhao Zixiao Li Hao Li Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina The University of Texas at Austin Dell Medical School AustinTexasUSA Stroke Trials Unit Division of Clinical NeuroscienceUniversity of NottinghamNottinghamUK Department of Neurology The First Affiliated HospitalJinan University GuangzhouGuangzhouGuangdongChina Department of Neurology Huashan HospitalState Key Laboratory of Medical NeurobiologyFudan UniversityShanghaiChina

Background In patients with a minor ischaemic stroke or transient ischaemic attack(TIA),separate trials have shown that dual antiplatelet therapy with clopidogrel plus aspirin(clopidogrel-aspirin)or ticagrelor plus aspirin(ticagrelor-aspirin)are more effective than aspirin alone in stroke secondary ***,these two sets of combination have not been directly *** clopidogrel was less effective in stroke patients who were CYP2C19 loss-of function(LOF)allele carriers,whether ticagrelor-aspirin is clinically superior to clopidogrel-aspirin in this subgroup of patients with stroke is *** To describe the rationale and design considerations of the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events(CHANCE-2)*** CHANCE-2 is a randomised,double-blind,double-dummy,placebo-controlled,multicentre trial that compares two dual antiplatelet strategies for minor stroke or TIA patients who are CYP2C19 LOF allele carriers:ticagrelor(180 mg loading dose on day 1 followed by 90 mg twice daily on days 2-90)or clopidogrel(300 mg loading dose on day 1 followed by 75 mg daily on days 2-90),plus open-label aspirin with a dose of 75-300 mg on day 1 followed by 75 mg daily on day *** will be followed for 1 *** outcomes The primary efficacy outcome is any stroke(ischaemic or haemorrhagic)within 3 months and the primary safety outcome is any severe or moderate bleeding event within 3 *** The CHANCE-2 trial will evaluate whether ticagrelor-aspirin is superior to clopidogrel-aspirin for minor stroke or TIA patients who are CYP2C19 LOF allele carriers.

关键词： CYP2C19 aspirin patients

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