The Effect of Different Hyperbaric Oxygen Treatment Time Windows on Neurological Function and Prognosis in Acute Cerebral Infarction

Objective:To observe the effects of different hyperbaric oxygen treatment time windows on the prognosis and neurological function of acute cerebral infarction.Method:160 patients with acute cerebral infarction admitted to Xiangyang Central Hospital in Hubei Province were randomly divided into four groups,each with 40 cases,using a random number table method.According to the 2017 guidelines for the treatment of cerebral infarction,the control group received routine treatment for acute cerebral infarction;On the basis of the control group,patients in Group A received hyperbaric oxygen therapy within 48 hours of onset;Group B patients receive hyperbaric oxygen therapy within 3-6 days of onset;Group C patients receive hyperbaric oxygen therapy within 7-12 days of onset.Observe the efficacy,recurrence,and neurological function recovery of four groups of patients after treatment.Result:There was no statistically significant difference in the National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI)scores among the four groups before treatment(P>0.05).There were statistically significant differences in NIHSS and BI scores between 14 and 30 days after treatment and before treatment(F=16.352,27.261,11.899,28.326,P<0.05).At 14 and 30 days after treatment,the NIHSS score in Group A decreased compared to the control group,Group B,and Group C,while the BI score increased compared to the control group,Group B,and Group C,with statistical significance(P<0.05).There was no statistically significant difference in NIHSS and BI scores between Group C and the control group after treatment(P>0.05).After 30 days of treatment,the total effective rate of Group A was higher than that of the control group and Group C,and the difference was statistically significant(X2=6.135,P<0.05).The one-year recurrence rate of Group A and Group B is lower than that of Group C and the control group,and the difference is statistically significant(X2=8.331,P<0.05).There was no statistically significant difference in adverse reactions among the four groups(P>0.05).Conclusion:Patients with acute cerebral infarction who receive hyperbaric oxygen therapy within 48 hours can improve neurological function and reduce the recurrence rate.The efficacy of receiving hyperbaric oxygen therapy within 7-12 days of onset is equivalent to that of not receiving hyperbaric oxygen therapy.

A Case of Acute Upper Gastrointestinal Bleeding in Liver Cirrhosis Complicated by Acute Cerebral Infarction and Acute Myelitis

Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.

Analysis of mental health status and related factors in patients with acute cerebral infarction

BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has serious effects on patients’physical status,life and economy,often causing anxiety,depression and other psychological problems,these problems can lead to the aggravation of physical symptoms;thus,it is very important to understand the factors affecting the mental health of these patients.AIM To understand the elements that affect the mental health of patients who have suffered an ACI.METHODS A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals(Quanzhou First Hospital,Fuqing City Hospital Affiliated to Fujian Medical University,and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China)in Fujian Province from January 2022 to December 2022 using the convenience sampling method.ACI inpatients who met the inclusion criteria were selected.Informed consent was obtained from the patients before the investigation,and a face-to-face questionnaire survey was conducted using a unified scale.The questionnaire included a general situation questionnaire,Zung’s self-rating depression scale and Zung’s self-rating anxiety scale.All questionnaires were checked by two researchers and then the data were input and sorted using Excel software.The general situation of patients with ACI was analyzed by descriptive statistics,the influence of variables on mental health by the independent sample t test and variance analysis,and the influencing factors on psychological distress were analyzed by multiple stepwise regression.RESULTS The average age of the 220 patients with ACI was 68.64±10.74 years,including 142 males and 78 females.Most of the patients were between 60 and 74 years old,the majority had high school or technical secondary school education,most lived with their spouse,and most lived in cities.The majority of patients had a personal income of 3001 to 5000 RMB yuan per month.The new rural cooperative medical insurance system had the largest number of participants.Most stroke patients were cared for by their spouses and of these patients,52.3%had previously smoked.Univariate analysis showed that gender,age,residence,course of disease,number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI.Age,living conditions,monthly income,course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI.The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients’anxiety scores,and the course of disease was also the most important factor influencing patients’depression scores.CONCLUSION Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders.These groups require more attention and counseling.

Value of Tongue Color Combined with Sublingual Microcirculation in Predicting the Severity of Mild to Moderate Acute Cerebral Infarction

Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients with ACI were admitted to the Department of Neurology of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine.According to the NHISS score on the 5th day of admission,the patients were divided into mild group(35 cases)and moderate group(55 cases).The changes of tongue color and arterial lactate on the 5th day of admission were observed and monitored.Side-stream dark field imaging(SDF)was used to determine the total vascular density(TVD),perfused vascular density(PVD),perfused vascular ratio(PPV)and microvascular flow index(MFI).The multivariate logistic regression analysis was used to screen the risk factors for the severity of ACI,and the receiver operating characteristic curve(ROC)to evaluate their values in predicting ACI severity.Results:There was no significant difference in lactate between the two groups(P>0.05),and the frequency of red tongue in the mild group was higher,and the frequency of red tongue in the moderate group was significantly higher in the dark tongue group(P<0.05).The multivariate logistic regression analysis showed that PVD and PPV were independent risk factors for the severity of mild to moderate ACI(P<0.05).The ROC curve analysis showed that an area under the curve of 0.832 was achieved by the combination of PVD and PPV,which was larger than that of a single factor.Conclusion:Tongue color combined with sublingual microcirculation can be combined to predict the severity of mild to moderate ACI.

CLINICAL REPORT ON IMPROVEMENT OF MOBILITY OF AFFECTED SHOULDER JOINT CAUSED BY ACUTE CEREBRAL INFARCTION TREAT-ED WITH ACUPUNCTURE AND MASSAGE

Objective To observe the effects of acupuncture and massage to improve the mobility of affected shoulder joint caused by acute cerebral infarction. Methods 120 cases of acute cerebral infarction were randomized into two groups, named treatment group with acupuncture and massage and control group with western medicine. Acupoint selection of treatment group with acupuncture and massage： Yōngquán （涌泉 KI1）, Láogōng （劳宫 PC8）, Hòuxī （后溪SI3）, Gōngsūn （公孙 SP4）, Fēngchī （风池 GB20）, Jiānyú （肩髃 LI15）, Qūchí （曲池 LI11）, Hégǔ （合谷 LI4）, Huántiào （环跳 GB30）, Zúsānlǐ （足三里 ST36）, Tàichōng （太冲 LR3）, Anterior Oblique Line of Vertex-Temporal and Posterior Oblique Line of Vertex-Temporal. Massage techniques： roll for relax, hold and press, flick and fiddle, and shake. Control group with western medicine was treated with mannitol ＋ low molecular weight dextran ＋ CDP-choline. Results Compared with control group, treatment group could apparently improve the mobility of shoulder joint and lower the injury percentage （P〈0. 01） ; and the therapeutic effect of treatment group is better than that of control group （P〈0. 05） for treating acute cerebral infarction. Conclusion The therapy of acupuncture combined with massage could improve the function of the affected shoulder joint caused by acute cerebral infarction, and enhance therapeutic effect.

Influences of blood lipids on the occurrence and prognosis of hemorrhagic transformation after acute cerebral infarction: a case-control study of 732 patients

Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator(r TPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis.Conclusions: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.

Efficacy of cattle encephalon glycoside and ignotin in patients with acute cerebral infarction: a randomized, double-blind, parallel-group, placebo-controlled study

Cattle encephalon glycoside and ignotin(CEGI)injection is a compound preparation formed by a combination of muscle extract from hea lthy rabbits and brain gangliosides from cattle,and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries.However,there is still a need for high-level clinical evidence from large samples to support the use of CEGI.We therefore carried out a prospective,multicenter,randomized,double-blind,parallel-group,placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016.The patients were randomized at a 3:1 ratio into CEGI(n=239;155 male,84 female;61.2±9.2 years old)and placebo(n=80;46 male,34 female;63.2±8.28 years old)groups.All patients were given standard care once daily for 14 days,including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium,both taken orally,and intravenous infusion of 250–500 mL 0.9%sodium chloride containing 40 mg sodium tanshinone IIA sulfonate.Based on conventional treatment,patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water,respectively,in an intravenous drip of 250 mL 0.9%sodium chloride(2 mL/min)once daily for 14 days.According to baseline National Institutes of Health Stroke Scale scores,patients in the two groups were divided into mild and moderate subgroups.Based on the modified Rankin Scale results,the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group,and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment.In the CEGI group,neurological deficits were decreased on days 14 and 90 after treatment,as measured by the National Institutes of Health Stroke Scale and the Barthel Index.Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients.No drug-related adverse events occurred in the CEGI or placebo groups.In conclusion,CEGI may be a safe and effective treatment for acute cerebral infarction patients,especially for moderate stroke patients.This study was approved by the Ethical Committee of Peking University Third Hospital,China(approval No.2013-068-2)on May 20,2013,and registered in the Chinese Clinical Trial Registry(registration No.ChiCTR1800017937).

Hypoxic preconditioning stimulates angiogenesis in ischemic penumbra after acute cerebral infarction

Previous studies have demonstrated the protective effect of hypoxic preconditioning on acute cerebral infarction, but the mechanisms underlying this protection remain unclear. To investigate the protective mechanisms of hypoxic preconditioning in relation to its effects on angiogenesis, we in- duced a photochemical model of cerebral infarction in an inbred line of mice （BALB/c）. Mice were then exposed to hypoxic preconditioning 30 minutes prior to model establishment. Results showed significantly increased vascular endothelial growth factor and CD31 expression in the ischemic penumbra at 24 and 72 hours post infarction, mainly in neurons and vascular endothelial cells. Hypoxic preconditioning increased vascular endothelial growth factor and CD31 expression in the ischemic penumbra and the expression of vascular endothelial growth factor was positively related to that of CD31. Moreover, hypoxic preconditioning reduced the infarct volume and improved neu- rological function in mice. These findings indicate that the protective role of hypoxic preconditioning in acute cerebral infarction may possibly be due to an increase in expression of vascular endothelial growth factor and CD31 in the ischemic penumbra, which promoted angiogenesis.

Effect of Xuesaitong Soft Capsule (血塞通软胶囊) on Hemorrheology and in Auxiliarily Treating Patients with Acute Cerebral Infarction

Objective: To observe the therapeutic effect of Xuesaitong soft capsule(血塞通软胶囊, XST)and its effect on platelet counts, coagulation factor 1 (CF1) as well as hemorrheologic indexes in treating patients with acute cerebral infarction (ACI). Methods: Two hundred and four patients with ACI were assigned into two groups, the control group (n=96) and the treated group (n=108). They were all treated with conventional Western medicines, including mannitol, troxerutin, citicoline, piracetam and aspirin, while to the treated group, XST was given additionally through oral intake, twice a day, 2 capsules each time for 8 successive weeks. The clinical efficacy was evaluated according to the nerve function deficits scoring and the changes of platelet count. CF1 and hemorrheological indexes were measured before and after treatment.Results: The total effective rate was 87.0% in the treated group, and 87.5% in the control group, respectively, showing insignificant difference between them. But the markedly effective rate in the treated group ( 66.7%) was significantly higher than that in the control group (27.1%, P<0.01). The count of platelet was not changed significantly in both groups after treatment, while CF1 in them evidently lowered at the end of the 4th and 8th weeks of treatment, but showed insignificant difference between the two groups. The hematocrit, whole blood viscosity and plasma viscosity in both groups were all improved significantly after treatment, but also showed insignificant difference in comparison of the two groups. Conclusion: XST has good efficacy in auxiliary treatment of patients with ACI, though its mechanism remains to be further explored.

Efficacy of Solitaire AB stent-release angioplasty in acute middle cerebral artery atherosclerosis obliterative cerebral infarction

BACKGROUND In both national and international studies,the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good,and the disability rate was significantly reduced.However,there are currently only a few reports on the differences in endovascular treatment for different etiological classifications,especially in the anterior cranial circulation,aorta atherosclerotic stenosis,and acute thrombosis.AIM To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.METHODS Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019.The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis[modified thrombolysis in cerebral infarction(mTICI)]at the 2b/3 level or above,the stent was then unfolded and released.RESULTS All 25 patients underwent successful surgery,with an average recanalization time of 23 min.One patient died of cerebral hemorrhage and cerebral herniation after the operation.The National Institutes of Health Stroke Scale(NIHSS)scores immediately after surgery(7.5±5.6),at 24 h(5.5±5.6)and at 1 wk(3.6±6.7)compared with the preoperative NIHSS score(15.9±4.4),were significantly different(P<0.01).One case of restenosis was observed 3 mo after surgery(the stenosis rate was 50%without clinical symptoms),the modified Rankin scale scores were 0 points in 14 cases(56%),1 point in 4 cases(16%),2 points in 2 cases(8%),3 points in 3 cases(12%),4 points in 1 case(4%),and 6 points in 1 case(4%).CONCLUSION In acute middle cerebral artery atherosclerosis obliterative cerebral infarction,when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher,stent release may be a safe and effective treatment method;however,long-term observation and a larger sample size are required to verify these findings.

Effect of the Principle of Activating Blood Circulation to Break Stasis on GMP-140 and D_2 Dimer in Patients with Acute Cerebral Infarction

Objective: To explore the clinical efficacy of the principle of activating blood circulation to break stasis (ABCBS) and its influence on platelet membranous protein particle (GMP-140) and D 2 dimer (D-dimer) before and after treatment. Methods: Eighty-eight patients with blood stasis syndrome (BSS) of acute cerebral infarction (ACI) were randomly divided into two groups, both of which were treated with conventional treatment, i.e. with western medicine (WM), with Salvia injection added through intravenously dripping.One of the two groups was used as the control and the other group as the treated group who had ABCBS herbs orally taken in addition. The duration of treatment course for both groups was 3 weeks. Results: There were changes in both groups over clinical symptoms, nerve function deficit scoring and GMP-140, D-dimer, but the treated group showed significantly better than that of the control group, ( P <0.05). Conclusion: ABCBS principle could serve as an important auxiliary treating method for BSS of ACI, as it can effectively alter the blood of ACI patients which was viscous, condense, coagulant and aggregating.

Effects of acupuncture therapy on plasma neuropeptide Y levels and resuscitation in patients with very early stage acute cerebral infarction A randomized controlled study

BACKGROUND： It is known that acupuncture therapy can decrease plasma neuropeptide Y （NPY） levels in patients with cerebral infarction, but different types of acupuncture therapy used in various stages of cerebral infarction have not been evaluated. OBJECTIVE： To explore the effect of acupuncture therapy on resuscitation （Xingnao Kaiqiao） and plasma NPY levels in patients with very early stage acute cerebral infarction. DESIGN, TIME AND SETTING： This case-controlled study was performed at the Affiliated Hospital of the Medical College of the Chinese People＇s Armed Police Force between September 2004 and October 2005. PARTICIPANTS： Sixty patients with acute cerebral infarction of ≤ 6 hours were used in this study. Patients were randomly divided into an acupuncture therapy group （n = 30） and a routine treatment group （n = 30）. Another 30 healthy subjects were used as the control group. METHODS： The acupuncture therapy of Xingnao Kaiqiao used in the acupuncture therapy group was based on routine western medical treatment and was performed at bilateral Neiguan （PCG） using the twirling, reinforcing-reducing method, Renzhong （DU26） using heavy bird-pecking needling, Sanyinjiao （SPG） using reinforcing and reducing by lifting and thrusting the needle, Jiquan （HT1）, Weizhong （BL40） and Chize （LU5） using reinforcing and reducing by lifting and thrusting the needle. The acupuncture lasted for 14 days. Patients in the routine treatment group underwent routine medical treatment and no intervention was given to subjects in the control group. MAIN OUTCOME MEASURES： A 4 mL venous blood sample was obtained at different time points, i.e., immediately after hospitalization, the next morning, 7 and 14 days after treatment, to measure plasma NPY levels pre- and post-treatment using the radio-immunity method. RESULTS： The plasma NPY levels were significantly higher in both the routine treatment group and the acupuncture therapy group than in the control group pre- and post-treatment （P 〈 0.01）. In particular, the plasma NPY levels in both the acupuncture therapy group and the routine treatment group were increased 7 days post-treatment but decreased from 7-14 days post-treatment. In addition, the plasma NPY levels were significantly lower in the acupuncture therapy group than in the routine treatment group on day 7 and 14 post-treatment （P 〈 0.01）. CONCLUSION： Acupuncture therapy of Xingnao Kaiqiao can decrease plasma NPY levels in patients with very early stage acute cerebral infarction. In addition, the therapeutic effect of acupuncture with a prolonged therapy time is superior to routine treatment.

Resuscitating acupuncture therapy for glucose metabolism in acute cerebral infarction of basal ganglia

BACKGROUND： Acupuncture can improve motor function in patients with cerebral infarction, and activate brain glucose metabolism in relevant brain areas. However, the association between encephalic region activation and acupuncture, as well as the clinical significance of activation remain unclear. OBJECTIVE： Through the use of positron emission tomography-computed tomography （PET-CT）, acute cerebral infarction patients were analyzed for global cerebral metabolism, cerebral infarction focus, peripheral edema, and pyramidal tract pathway changes, which were directly related to clinical symptoms. The influence of resuscitating acupuncture on cerebral glucose metabolism was analyzed in patients with acute cerebral infarction in basal ganglia. DESIGN, TIME AND SETTNG： Randomized, controlled, clinical trials were performed from March 2007 to October 2008 at the PET-CT Center of the General Hospital of Tianjin Medical University, China. PARTICIPANTS： Twelve patients with acute basal ganglia infarction were recruited from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin Chinese Medicine Hospital, and Affiliated Hospital of Medical College of Chinese People＇s Armed Police Force. METHODS： The cerebral infarcted patients were randomly assigned to acupuncture and control groups. In addition to routine treatment, the acupuncture group was treated by acupuncture at the main acupoints for resuscitation [Neiguan （PC 6）, Renzhong （DU 26）, and Sanyinjiao （SP 6）], while the control group received routine treatment. MAIN OUTCOME MEASURES： Before and after treatment, patients with acute cerebral infarction were evaluated for global brain, cerebral infarction focus, and surrounding edema and glucose metabolism in encephalic region of pyramidal tract conduction by 18-labeled fluorodeoxyglucose for PET-CT imaging. RESULTS： The resuscitating acupuncture therapy can significantly activate the metabolism of global brain, infarction center and surrounding edema in patients with cerebral infarction in basal ganglia, also has effects on the activation of glucose metabolism in the encephalic regions of pyramidal tract pathway （P 〈 0.05）. CONCLUSION： Resuscitating acupuncture was superior to routine treatment for significantly activating glucose metabolism in patients with acute cerebral basal ganglia infarction.

Acute recurrent cerebral infarction caused by moyamoya disease complicated with adenomyosis:A case report

BACKGROUND Moyamoya disease is essentially an ischemic cerebrovascular disease.Here,we describe a case of acute recurrent cerebral infarction caused by moyamoya disease with concurrent adenomyosis which,to our knowledge,is the first in the literature.A literature review is also presented.CASE SUMMARY A 38-year-old female presented to the Research and Treatment Center of Moyamoya Disease in our hospital with"left limb weakness"as the main symptom.She was diagnosed with acute cerebral infarction and moyamoya disease through magnetic resonance imaging and digital subtraction angiography.Prior to this,she had experienced a prolonged menstrual period of one-month duration.This was investigated and adenomyosis was diagnosed.After passing the acute cerebral infarction phase,the patient underwent surgery for adenomyosis followed by combined cerebral revascularization.During the postoperative follow-up,improvements of the perfusion imaging stage and modified Rankin Scale were observed.A review of the literature showed only 16 reported cases of gynecological diseases complicated with stroke.The clinical characteristics,pathogenesis,therapeutic effects,and long-term prognosis of these cases have been studied and discussed.CONCLUSION In patients with moyamoya disease,early management of gynecological-related bleeding disorders is essential to prevent the complications of cerebral events.

Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator(rt-PA) on the onset of acute cerebral infarction(ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale(NIHSS) scores were statistically decreased in both groups(P>0.05) at 24 hours and 7 days after ACI.There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups(P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rtPA within 4.5 hours after the onset of this disease.Therefore,intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe.

Bioinformatics Study of Plasma Differentially Expressed Proteins in H-Type Hypertension with or without Acute Cerebral Infarction

Objective: To investigate the bioinformatics of differentially expressed proteins in plasma in patients with acute cerebral infarction associated with H-type hypertension. Methods: Gene chip public database (gene expression omnibus, GEO) GDS4521 chip data, in the chip in 30 cases of H patients with acute cerebral infarction with high blood pressure and age, gender, matching the 20 H hypertension patients as the research object, collects the mononuclear cells (PBMCs) is used to detect the gene chip, using the GO (gene Ontology, GO), protein function analysis tools such as KEGG, screening and analysis of enrichment of differentially expressed genes function and related signaling pathway. Results: 31 genes in PBMCs were significantly changed in h-type hypertension and H-type hypertension with acute cerebral infarction, 32 of which were increased and 2 of which were decreased. GO analysis showed that in terms of biological processes, the genes related to inflammatory response and neutrophil chemotaxis were the most. In terms of molecular function, chemokine activity-related genes are the most. KEGG signaling pathway analysis showed that the most differentially expressed genes were located in the TNF signaling pathway. Conclusion: H-type hypertension with acute cerebral infarction has a variety of functional proteins and signaling pathways changes, suggesting that inflammatory response in H-type hypertension with acute cerebral infarction recovery period may still play a role in the prognosis and reactivation of the disease.

Research of expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction before and after the intervention of rosuvastatin

Objective: To study the expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction before and after the intervention of rosuvastatin and its correlation with toll-like receptor 2 (TLR2) and TLR4 signaling pathways. Methods:A total of 65 patients with acute cerebral infarction treated in our hospital from December 2015 to August 2016 were selected for prospective study. They were treated with lipid-lowering rosuvastatin, and peripheral blood samples were collected at 8th week before and after treatment, respectively. Serum was separated and expression quantity of miR-146a and miR-146b and contents of TNF-α, interleukin (IL)-1β, IL-6 and IL-17 were determined. Peripheral blood mononuclear cells were isolated and fluorescence intensities of TLR2, TLR4, myeloid differentiation primary response gene 88 (MyD88), interleukin-1 receptor-associated kinase 1 (IRAK-1) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) were measured. Results:At 8th week of intervention of rosuvastatin, expression quantity of serum miR-146a [(0.762 ± 0.092)vs. (0.346 ± 0.053)] and miR-146b [(0.714 ± 0.088)vs. (0.317 ± 0.047)] in patients with acute cerebral infarction was significantly higher than those before the intervention. Fluorescence intensities of peripheral blood mononuclear cells such as TLR2 [(10.34 ± 1.27)vs. (16.94 ± 1.94)], TLR4 [(11.37 ± 1.54)vs. (24.35 ± 3.26)], IRAK [(9.34 ± 0.92)vs. (15.32 ± 1.82)], MyD88 [(4.42 ± 0.56) vs. (9.41 ± 1.03)] and NF-kB [(6.65 ± 0.78) vs. (13.49 ± 1.76)] and contents of inflammatory factors such as TNF-α [(64.26 ± 8.29) μg/L vs. (106.39 ± 13.84) μg/L], IL-1β [(37.91 ± 5.24) μg/Lvs. (64.23 ± 8.33) μg/L], IL-6 [(34.28 ± 4.85) ng/Lvs. (82.46 ± 11.97) ng/L] and IL-17 [(56.75 ± 7.49) ng/Lvs. (98.31 ± 11.36) ng/L] of serum were all significantly lower than those before the intervention. Expression quantity of serum miR-146a and miR-146b had a negative correlation with fluorescence intensities of TLR2, TLR4, IRAK, MyD88 and NF-kB. Fluorescence intensities of TLR2 and TLR4 in peripheral blood mononuclear cells had a positive correlation with contents of TNF-α, IL-1β, IL-6 and IL-17 in serum. Conclusions: Treatment with rosuvastatin can up-regulate the expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction and further inhibit the secretion of IRAK, MyD88, NF-kB, TNF-α, IL-1β, IL-6 and IL-17 mediated by TLR2 and TLR4.

Clinical Studies on Treatment of Acute Cerebral Infarction with Xueshuantong(血栓通)Injection

Objective: To observe the effect of Xueshuantong injection (XST,血栓通注射液) with its ingredient as Notoginseng saponin, on acute cerebral infarction (ACI) and on blood coagulation and fibri-nolysis, so as to comprehensively analyse the mechanism of XST. Methods: Fifty ACI patients were randomly divided into 2 groups, and XST group (30 patients) was treated with XST, and the control group (20 patients) given low molecular dextrose, as well as low molecular heparin calcium. The course of treatment for both groups was 15 days. The changes of effective rate, score of neurologic impairment, tissue-type plasminogen activator (tPA), inhibitor of plasminogen activator (PAI), D-D dimmer, antithrombin-III (AT-III), and fibrinogen (Fbg) were all observed. Results: The total effective rate of XST group was 73.33%, that of the control group 65. 00%. After the therapy, plasma level of tPA, ratio of tPA/PAI, and AT-III content were increased obviously, while the plasma level of PAI and D-D dimmer were decreased significantly (all P<0.01) . But there was only insignificant difference between the 2 groups (P> 0.05).Conclusion: XST injection could be effective to ACI, the mechanism of which is probably related to improving the balance between plasminogen activator and its inhibitory factor, increasing the activity of fi-brinolysin, inactivating thrombin, inhibiting platelet aggregation induced by thrombin, and decreasing blood coagulation.

Changes of auditory evoked magnetic fields in patients after acute cerebral infarction using magnetoencephalography

Auditory evoked magnetic fields were recorded from 15 patients with acute cerebral infarction and 11 healthy volunteers using magnetoencephalography.The auditory stimuli of 2 kHz pure tone were binaurally presented with an interstimulus interval of 1 second.The intensity of stimuli was 90 dB and the stimulus duration was 8 ms.The results showed that the M100 was the prominent response, peaking approximately 100 ms after stimulus onset in all subjects.It originated from the area close to Heschl’s gyrus.In the patient group,the peak latency of M100 responses was significantly prolonged,and the mean strength of equivalent current dipole was significantly smaller in the affected hemisphere.The three-dimensional inter-hemispheric difference of the M100 positions was increased in the patient group.Our experimental findings suggested that impairment of cerebral function in patients with acute ischemic stroke can be detected using magnetoencephalography with the higher spatial resolution and temporal resolution.Magnetoencephalography could provide objective and sensitive indices to estimate auditory cortex function in patients with acute cerebral infarction.

Significance of neuroglobin in serum of acute atherosclerotic cerebral infarction patients

This study sought to examine neuroglobin （NGB） in the serum of acute cerebral infarction patients with double-antibody sandwich enzyme-linked immunosorbent assay to identify all risk factors, calculate infarct size, assess neurological impairment, and analyze the relation between NGB and each of these factors. The double-antibody sandwich assay indicated that levels of NGB in serum were unaltered within 6 hours following acute cerebral infarction compared with normal levels. NGB levels then underwent a distinct change, peaking at 24 hours then returning to normal levels in 72 hours. The results suggest that the level of NGB might be related to infarct size and low-density lipoprotein at 24 hours after acute cerebral infarction. There were no significant differences in neurological impairment scores and infarct size at different periods following infarction. The findings indicated that the level of NGB in serum of acute cerebral infarction patients was correlated with infarct time.