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.

Effect of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction

BACKGROUND The aging of the population has become increasingly obvious in recent years,and the incidence of cerebral infarction has shown an increasing trend annually,with high death and disability rates.AIM To analyze the effects of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction.METHODS Between January 2020 and December 2023,we treated 98 cases of elderly acute insula,patients with cerebral infarction in the cerebral infarction acute phase(3-4 weeks)and for the course of 6 months in Montreal Cognitive Assessment Scale(MoCA)for screening of cognition.Notably,58 and 40 patients were placed in the cognitive impairment group and without-cognitive impairment group,respec-tively.In patients with cerebral infarction,magnetic resonance imaging was used to screen and clearly analyze the MoCA scores of two groups of patients with different infarctions,the relationship between the parts of the infarction volume,and analysis of acute insula cognitive disorder in elderly patients with cerebral RESULTS The number of patients with cognitive impairment in the basal ganglia and thalamus was significantly higher than that without cognitive impairment(P<0.05).The total infarct volume in the cognitive impairment group was higher than that in the non-cognitive impairment group,and the difference was statistically significant(P<0.05).The infarct volumes at different sites in the cognitive impairment group was higher than in the non-cognitive impairment group(P<0.05).In the cognitive impairment group,the infarct volumes in the basal ganglia,thalamus,and mixed lesions were negatively correlated with the total MoCA score,with correlation coefficients of-0.67,-0.73,and-0.77,respectively.CONCLUSION In elderly patients with acute insular infarction,infarction in the basal ganglia,thalamus,and mixed lesions were more likely to lead to cognitive dysfunction than in other areas,and patients with large infarct volumes were more likely to develop cognitive dysfunction.The infarct volume in the basal ganglia,thalamus,and mixed lesions was significantly negatively correlated with the MoCA score.

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.

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.

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.

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.

Relationship between glutathione and malonaldehyde levels in erythrocytes and the deformation index of erythrocyte in patients at various periods following acute cerebral infarction

BACKGROUND： Glutathione, as an in vivo free radical scavenger, plays an important role in the anti-oxidation defense mechanism in patients with acute cerebral infarction. OBJECTIVE： To observe the relationship between the levels of glutathione （GSH） and malonaldehyde （MDA）, the metabolite of lipid peroxidation, in erythrocyte and deformation index of erythrocyte in patients at various periods following acute cerebral infarction. DESIGN： Controlled observation.SETTING： Qilu Hospital of Shandong University and Institute of Cerebrovascular Disease of Qingdao Medical College. PARTICIPANTS： We chose 98 inpatients with acute cerebral infarction from Department of Neurology, Qilu Hospital of Shandong University from January to December 2000 , serving as cerebral infarction group, including 50 male and 48 female, with mean age of （62±7）years. There were 23 cases found on the 1^st day after onset; 25 cases on the 3^rd day after onset; 25 cases on the 7^th day after onset; 25 cases on the 14th days after onset, and they were all confirmed by craniocerebral CT or MRI. Another 30 homeochronous inpatients with neurosis, cervical syndrome, lumbar intervertebral disc herniation and motor neuron disease were chosen as control group, including 20 male and 10 female, with mean age of （52±8）years . There was no significant difference in age and gender distribution between two groups （P 〉 0.05）. Patients in the two groups were informed of detected index.METHODS：①Ulnar venous blood was chosen from the patients who were fasted on the 1^st, 3^rd,7^th and 14^th days after onset. Deformation index of erythrocyte was measured with BL88-CKX laser diffraction erythrocyte deformeter and photographing was performed. GSH level in erythrocyte was measured with DTNB assay introduced by Beu-tler. MDA level in erythrocyte was measured with modified thiobarbituric acid colorimetric method.②At each sample collecting , according to the criteria accepted by the Fourth National Conference of Cerebrovascular Disease, intergrant of neurologic impairment 〈 15 points was regarded as mild （n=46）, 15 to 30 points as moderate （n=40）and, 〉 30 points as severe （n=12）. ③ t test was used to compare data between two groups , and linear correlation analysis was used in relationship analysis among indexes. MAIN OUTCOME MEASURES ：① Comparison of erythrocyte GSH and MDA levels and deformation index of erythrocyte at various periods between patients with acute cerebral infarction and controls. ②Correlation of erythrocyte GSH level with erythrocyte MDA level and with deformation index of erythrocyte in patients with cerebral infarction . ③ Relationship between erythrocyte GSH level and severity of disease in patients with acute cerebral infarction. RESULTS： Totally 98 patients with acute cerebral infarction and 30 controls all entered the stage of result analysis. ① Erythrocyte GSH level and deformation index of erythrocyte were lower on the 1^st, 3^rd, 7^th and 14^th days after onset in cerebral infarction group than in control group （P 〈 0.05-0.01）, and erythrocyte MDA level was significantly higher in cerebral infarction group than in control group （P 〈 0.05-0.01）. The three indexes changed most significantly on day 3 after onset in patients, and began to recover or decrease on day 7 after onset and inclined to be normal on day 14 after onset. ② Erythrocyte GSH level was significantly negatively correlated with erythrocyte MDA level in patients with acute cerebral infarction on the 1^st, 3^rd, 7^th and 14^th days after onset （r=-0.534, -0.713, -0.645, -0.656, respectively, P 〈 0.05-0.01 ） ,and significantly positively correlated with erythrocyte deformation index （t-=0.502, 0.560, 0.455, 0.504, respectively, P 〈 0.05）. ③Erythrocyte GSH level was significantly lower in moderate or severe patients with acute cerebral infarction than in mild patients[（0.215±0.088）,（0.192±0.102）, （0.281±0.090） g/L, P〈 0.05]. CONCLUSION：①Erythrocyte GSH and MDA levels and deformation index of erythrocyte change significantly on the 3^rd day following acute cerebral infarction. Index detection results gradually tended to be normal on from the 7^th day to 14^th days day after onset. ② Change of erythrocyte GSH level can reflect the severity of disease of patients with acute cerebral infarction.③Decrease of erythrocyte GSH level in patients with acute cerebral infarction is one of reasons that result in the decrease of deformation ability of erythrocyte.

EFFECT OF ACUPUNCTURE ON PLASMA STRESS HORMONE LEVELS OF HYPOTHALAMUS-PITUITARY-ADRENAL AXIS IN TYPE II DIABETES WITH CONCURRENT ACUTE CEREBRAL INFARCTION PATIENTS

Objective: To observe the effect of acupuncture on the contents of stress hormones of the hypothalamus pituitary adrenal axis (HPA) in treatment of type II diabetes with concurrent acute cerebral infarction patients. Methods: 60 cases of inpatients were randomly and evenly divided into treatment group (conventional medication plus acupuncture) and control (conventional mediation) group. Plasma corticotropin releasing hormone (CRH), adrenocorticotropin hormone (ACTH) and corticosteroid (CS) contents before and after treatment were measured using radioimmunoassay (RIA) and compared with those of healthy subject group (n=30). Results: Plasma CRH, ACTH and CS levels in patients of both treatment group and control group at admission were significant higher than those of normal subject group (P<0.05). After treatment for 15～30 days, results showed that plasma CRH, ACTH and CS levels in both treatment and control groups lowered significantly in comparison with those of pre treatment (P<0.05 or 0.01); while those of treatment group were even more lower (being closer to the normal values) than those of control group (P<0.05 or 0.01). Conclusion: Acupuncture therapy can reduce the stress state of HPA in type II diabetes with concurrent acute cerebral infarction patients, i.e. regulate the neuroendocrine immunological net, which may be one of the mechanisms for acupuncture treatment of cerebral stroke.

Electrocardiogram changes in acute cerebral infarction patients

BACKGROUND： Comparison of different stroke locations had been focused in past researches in electrocardiogram （ECG） changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history. OBJ ECTIVE： To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people. DESIGN： Contrast observation SETTING： Shanghai Ninth People＇s Hospital PARTICIPANTS ： A total of 57 patients with cerebral infarction ware selected from the Neurological Department of Ninth People＇s Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4^th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9 in frontal lobe and 14 in other parts. According to their infarction size （plus size in every different scan）, they were divided into three different groups： large-size group （n = 10） with size larger than 3.5 cm^3, medium-size group （n = 13） with size between 1.5-3.5 cm^3, and small-size group （n = 34） with size smaller than 1.5 cm^3. Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40- 82 years. All these cases knew and agreed of the examination. METHODS ： Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups. MAIN OUTCOME MEASURES： The ECG changes and differences in two hemispheres, in different infarction lo- cations and sizes. RESULTS： All 57 patients and 50 healthy subjects ware involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with opposite T wave of infarction group compared with control group （P 〉 0.05）. PR and QTc [（0.167±0.010）, （0.383±0.029） s] in infarction group were longer than those in control group [（0.159±0.008）, （0.361±0.022） s, t = 1.982, 2.363, P 〈 0.05, 0.01]. ST changes cases were 77% （44/57）, which was more than those in control group [46% （23/50）, x^2= 11.072, P 〈 0.01]. ② Comparison of infarction in two hemispheres. HR, PR interval, QRS time, cases with opposite T wave and ST changes showed no differences （P 〉 0.05）, and QTc interval in right hemisphere infarction was longer than left one [（0.391±0.054）, （0.380±0.034） s, t=1.673, P 〈 0.05]. ③ ECG changes in different infarction locations. HR, PR interval, QTc interval, QRS time, cases with opposite T wave and ST changes showed no statistically significantly differences （P〉 0.05）. ④ ECG changes in different infarction sizes. HR, PR interval, QRS time showed no differences （P〉 0.05）. QTc interval in large size group was longer than the others [（0.399±0.044）, （0.388±0.073）t （0.378±0.124） s, F= 3.19, P 〈 0.05]. Cases with opposite T wave and ST changes in large size group were 80% （8/10）, 100% （10/10）, which were higher than those in medium size group [46% （6/13）, 69% （9/13）] and small size group [44% （15/34）, 35% （12/34）, x^2 = 8.495, 10.538, P 〈 0.05, 0.01]. CONCLUSION ： ① PR interval and QTc interval prolonged in cerebral infarction patients. Furthermore, QTc interval was more obvious in large size infarction group and right hemisphere infarction group. ② Infarction location did not affect the changes of ECG.

Effect of ultraviolet blood irradiation and oxygenation on nerve function and function of the red blood cell membrane pump in patients with acute cerebral infarction

BACKGROUND： Ultraviolet blood irradiation and oxygenation （UBIO） has obtained better clinical effect in treating acute cerebral infarction, but the mechanism underlying this effect remains unclear. OBJECTIVE： To observe the effect of UBIO on the nerve function and activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase activities on the red blood cell （RBC） membrane of patients with acute cerebral infarction. DESIGN： A randomized and controlled study.SETTING： Department of Neurology, Xiangfan Central Hospital.PARTICIPANTS： From January 2000 to December 2001, excluding those above 70 years old, 58 cases of 700 patients with acute cerebral infarction admitted in the Department of Neurology, Xiangfan Central Hospital, were recruited and divided into two groups according to the random number table： UBIO treated group （n=28）, including 17 males and 11 females, aged 40-68 years; and control group （n=30）, including 20 males and 10 females, aged 44-69 years. All the patients agreed to participate in the therapeutic program and detected items. The general informations were comparable without obvious differences between the two groups （P 〉 0.05）.METHODS： ① The patients in both groups received routine treatments, besides, those in the UBIO treated group were given UBIO treatment by using the XL-200 type therapeutic apparatus produced in Shijiazhuang, whose ultraviolet wave was set at 253.7 nm with the energy density of 0.568 J/m^2 per second, UBIO treatment started from the second day after admission, once every other day, with a single course consisting of 5-7 treatments. ② In the UBIO treated group, the venous blood was sampled before and after the first, third and the completion of the treatment course respectively, the venous blood was taken at each corresponding time point in the control group. After centrifugation of the blood at 10 000 rounds per minute, the RBC membrane was separated and then the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase were detected by means of phosphorus determination.③ The nerve function was scored before and after treatment in both groups with European stroke scale, which included 13 items, the total score was 0-100 points, the higher the score, the better the nerve function. MAIN OUTCOME MEASURES ：①Score of European stroke scale before and after treatment in both groups.② Comparison of the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase on RBC membrane between the two groups before treatment and after the first, third and the completion of the treatment. RESULTS： All the 58 patients with cerebral infarction were involved in the analysis of results.① The score of European stroke scale had no obvious difference between the two groups [（49.31±11.48）, （50.58±12.63）, P 〉 0.05], and it was obviously higher in the UBIO treated group than in the control group after treatment [84.66±13.75）, （77.05±11.17）, P 〈 0.05].②The activity of K^＋-Na^＋-ATPase on RBC membrane in the UBIO treated group was significantly increased after the first and third treatment as compared with before treatment [（31.56±19.25）, （27.64±15.83）, （17.67±13.83）, P 〈 0.01], it was still higher after the completion of the treatment than before treatment without obvious difference [（20.86±14.53）, P 〉 0.05]. After the first and third treatment, it was obviously higher in the UBIO treated group than in the control group [19.31±11.88）, （17.44±10.42）, P 〈 0.01]. ③ In the UBIO treated group, Ca2^＋-Mg2^＋-ATPase activity on RBC membrane significantly increased after the first treatment and remained higher than the pre-treatment level throughout the treatment [（27.49±14.72）, （17.41±4.82）, P 〈 0.01]. The activity of Ca2^＋-Mg2^＋-ATPase on RBC membrane was markedly higher in the UBIO treated group than in the control group after after the first, third and the completion of treatment respectively [（24.83±12.88）, （17.70±5.69）; （28.08±13.44）, （16.32±5.29）; （17.42±6.04）, P〈 0.05-0.01]. CONCLUSION： The effect of UBIO treatment against acute cerebral infarction may be mediated by the increased K^＋-Na^＋ ATPase and Ca2^＋-Mg2^＋-ATPase activities on RBC membrane, which enhances the RBC transformation ability so as to lower RBC aggregation and correct high blood viscosity.

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

BACKGROUND:Three-dimensional diffusion tensor tract(DTT)is the newest imaging to describe the structure of white matter fiber in three-dimensions,it has great significance in dividing the concrete anatomic site of gray and white matter lesions,displaying the correlation with fibrous band and judging clinical prognosis,which is incomparable by other imagings.OBJECTIVE:To observe the conditions of corticospinal tract(CST)in acute cerebral ischemic stroke patients,and analyze the relationship between motor function and the severity of CST injury.DESIGN:A case-control observation.SETTING:Department of Medical Imaging,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS:Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005.They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent,and were conformed by CT or MRI.There were 9 males and 6 females,aging 16-87 years old,the median age was 51.7 years,and all were right handed.Fifteen right-handed normal subjects,who were matched by age and sex with the patients in the cerebral infarction group,were selected from the relatives of patients and physicians of the Imaging Department as the control group.All the subjects were informed and agreed with the study.METHODS:The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging(DTI)with GE 1.5 T nuclear magnetic resonance system,fiber tracking with the software of dTV-Ⅱ.Fractional anisotropy(FA)maps and three-dimensional tractography of bilateral CST of all patients were created.Displacement,continuity and destroy of fibrous bands were observed.At the same time,muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard.The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis.MAIN OUTCOME MEASURES:①FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction;②CST manifestations in the patients with cerebral infarction and the control group.RESULTS:All the 30 testees were involved in the analysis of results.①The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones(t=4.570,P<0.001).②In the control group,bilateral CST were reconstructed,they originated from precentral gyrus,went downwards to internal capsule,and extended to pontine and medulla oblongata,each fiber had good uniformity in continuous form.In the patients with cerebral infarction,the forms of contralateral CST were consistent with those in the control group with good continuity.Due to the involvement by the infarcted site to different extents,the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form.The CST involvements were divided into three grades:integrated CST for grade 1(n=2);integrated CST but compressed or displaced for grade 2(n=5);interrupted CST for grade 3(n=8).③The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand(r=0.888,P<0.05).CONCLUSION:①CST is injured to different extents in patients with acute cerebral infarction,and the severity of injury is associated with muscle strength.It is indicated that it can be used to judge the prognosis of rehabilitative treatment.②DTT can directly display the status of pyramidal tract more three-dimensionally.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Comparison of the level of thrombus precursor protein in blood plasma between patients with acute cerebral infarction and healthy persons at different time

BACKGROUND： Thrombus precursor protein （TpP） is the index of thrombus activity level, and it is also early referencing index in detecting thrombus diseases. OBJECTIVE： To dynamically observe the changes of TpP level in blood plasma of patients with acute cerebral infarction at different time after onset, and to compare the differences of plasma TpP level between patients with acute cerebral infarction and healthy persons who received health examination. DESIGN： Controlled observation SETTING： Department of Neurology, Affiliated Hospital of Xuzhou Medical College PARTICIPANTS： Totally 58 patients with acute cerebral infarction who received the treatment in the Department of Neurology, Affiliated Hospital of Xuzhou Medical College between September 2004 and March 2005 were recruited in this study. They all met the diagnostic criteria revised by the 4^th National Conference of Cerebrovascular Disorders in 1995 and were diagnosed by clinical and skull CT and （or） MRI examinations. The patients included 33 male and 25 female aged from 36 to 87 years. Time to onset 〈 6 hours, 6 to 11 hours, 12 to 23 hours, 24 to 48 hours and 〉 48 hours were found in 10,11,14,10 and 13 patients respectively. Another 51 persons who homeochronously received the health body examination in our hospital were recruited, including 34 male and 17 female, aged 38 to 85 years, serving as control group. Patients with cardio-cerebrovascualr diseases or liver and kidney diseases were excluded. All the involved subjects were informed of the detected items. METHODS： About 4 mL venous blood was respectively taken from patients admitted to the hospital within 6 hours, 6 toll hours, 12 to 23 hours, 24 to 48 hours and more then 48 hours after onset, and healthy persons when receiving health examination. The level of TpP in blood plasma was measured with enzymelinked immunosorbent assay. MAIN OUTCOME MEASURES： ① Comparison of the level of plasma TpP between patients and controls;② Comparison of the level of plasma TpP of patients with acute cerebral infarction at different time after onset. RESULTS： Totally 58 patients with acute cerebral infarction and 51 persons who received health examination participated in the result analysis. ①Comparison of plasma TpP level between patients and controls： The plasma TpP level of patients with acute cerebral infarction was significantly higher than that of control group [（16.12±3.28）vs （5.38±1.36） mg/L, t= 20.993, P〈 0.01 ]. ② Comparison of plasma TpP level of patients with acute cerebral infarction at different time after onset： The level of plasma TpP was （12.06±3.06） mg/L within 6 hours, （15.11±3.42） mg/L at 6 to 11 hours, （20.63±4.05） mg/L at 12 to 23 hours, （16.15±3.50） mg/L at 24 to 48 hours and （11.88±3.11） mg/L at more than 48 hours after onset. It increased from the 6^th hour, reached the peak at the 12^th to 23^rd hours, maintained at very high level at the 48= hour and then gradually decreased and recovered to the level within 6 hours after onset. The level of plasma TpP of patients with acute cerebral infarction was signiticantly higher at the 12^th to 23^rd hours after onset and the 24^th to 48^th hours after onset than within 6 hours after onset （t = 13.385, P 〈 0.05）. CONCLUSION： ①The level of plasma TpP of patients with acute cerebral infarction is significantly higher than that of persons who received health examination.② Plasma TpP levels of patients with acute cerebral infarction change in wave manner at the different time after onset.

Changes of biochemical indexes in patients with acute cerebral infarction after treatment with simvastatin

BACKGROUND: At present, it is believed that the important causes of cerebral infarction are the disorders of lipid metabolism and endothelial function, and the outcomes of clinical treatment can be improved by regulating serum lipids and antiinflammation, etc. OBJECTIVE: To observe the effect of simvastatin, inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, on the levels of serum lipids, serum enzymic indexes and inflammatory metabolic indexes in patients with cerebral infarction. DESIGN: A comparative observation. SETTING: Department of Geriatrics, Longquanshan Hospital of Liuzhou City. PARTICIPANTS: Forty-eight patients with acute cerebral infarction were selected from the Department of Geriatrics of Longquanshan Hospital of Liuzhou from March 2004 to February 2006, including 24 males and 24 females, the mean age was (54±12) years, average disease course was (10.0±4.5) days. They were all accorded with the diagnostic standard for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1999, and cerebral hemorrhage was excluded by cranial CT scanning. The 48 patients were randomly divided into control group (n =24) and treatment group (n =24). Informed consents were obtained from all the participants. METHODS: ① All the patients were treated according to the symptoms, besides those in the treatment group were given simvastatin (Harbin Pharm. Group Sanjing Pharmaceutical Shareholding, Co.,Ltd., No. H20010454; Batch number: 20040218; 5 mg/tablet). The initial dosage was 10 mg per day for 4 weeks, and then increased to 30 mg per day for another 4 weeks. ② Before treatment and within 1 week after treatment, the total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), creatine kinase and C reactive protein in serum were determined with Beckman-cx7 automatic biochemical analytical apparatus in both groups. ③ The differences of intergroup and intragroup data were compared with the independent-samples t test and paired samples t test. MAIN OUTCOME MEASURES: Changes of total cholesterol, triglyceride, HDL-C, LDL-C, AST, creatine kinase and C reactive protein before and treatment in both groups. RESULTS: All the 48 patients with cerebral infarction were involved in the analysis of results. ① Changes of serum lipids: The levels of serum lipids were close between the two groups before treatment (P > 0.05). After treatment, the HDL-C level in the treatment group was obviously higher than that in the control group and that before treatment [(1.34±0.12), (0.92±0.33), (0.93±0.21) mmol/L, t =7.922, 11.699, P < 0.01], and the levels of total cholesterol, triglyceride and LDL-C were obviously lower than those in the control group and those before treatment (t =2.780-7.591, P < 0.01). ② Changes of serum enzymic indexes and C reactive protein in serum: The levels of enzymes and C reactive protein in serum had no obvious differences between the two groups before treatment (P > 0.05). The levels of AST, creatine kinase and C reactive protein in serum after treatment were obviously lower than those before treatment in both groups (t =7.259-17.996, P < 0.01). The levels of levels of creatine kinase and C reactive protein in serum after treatment in the treatment group were obviously lower than those in the control group [(3.061±0.522) μkat/L, (4.6±3.1) mg/L; (4.348±0.580) μkat/L, (12.3±4.8) mg/L, t =7.910, 6.463, P < 0.01]. CONCLUSION: Compared with common treatment according to symptoms, the additional administration of simvastatin is better for improving the serum lipids, serum enzymic indexes of patients with cerebral infarction at acute period, and benefit for repairing their inflammatory damages.

Effect of long-term low dose of aspirin on severity of disease following onset of acute cerebral infarction

BACKGROUND： Aspirin can decrease the incidence risk of high-risk crowdgroup of cerebral infarction, but there are still controversy if it might decrease the degree of disease in degree of patients with acute cerebral infarction. OBJECTIVE： To observe the effect of lower dose of aspirin during taking for a long time on disease degree of disease following onset of acute cerebral infarction. DESIGN： Grouping according to the admission time and 1：1 paired observation.SETTING ： Department of Neurology, Qilu Hospital of Shandong University.PARTICIPANTS ： The participants in present study were 321 patients with acute cerebral infarction who received treatments in the Department of Neurology, Qilu Hospital of Shandong University from January 1999 to June 2000. There were 190 male and 131 female ,with mean （65±11 ）years of age. Inclusive criteria： ① A focal neurological disturbance occurred suddenly and had lasted for more than 24 hours, patients were admitted within 3 days after onset of disease; ② A computed tomography of the brain was performed and excluded hemorrhage in all patients; ③ The patients were proved internal carotid occlusions by clinical features and image findings; ④ The functions of limbs were normal （before the first stroke） or almost normal （before the second stroke）. Exclusive criteria：①The patients who had have cardiogenic cerebral embolism; ②The patients who had taken warfarin orally and other platelet agglutination drugs. METHODS ：①All the patients were divided into 2 groups according to whether they had taken aspirin before： aspirin-treated group （n=110） and blank control group （n=211）. there were 70 male and 40 female in aspirin-treated group, with average（65±10） years of age.All patients had taken 50-100 mg/d aspirin for 6 months to 10 years before onset. There were 120 male and 91 female in blank control group, with average （65±13） years of age. Patients received a clinical scoring within 3 days and similar therapeutic measures （such as anti-platelet agglutination, improving cerebral circulation and metabolism-promoting reagent）. Two groups of patients had the same basic conditions except for taking aspirin or not before. ②The matched pairs were made between 50 cases selected from aspirin-treated group and 50 cases from non-aspirin-treated groups according to age, gender, and other stroke risk factors. ③ Evaluation： Degree of disease after onset was evaluated by means of Acute Cerebral Infarction Clinical Neurologic Impairment Degree Scoring Standard of Carotid Artery System. MAIN OUTCOME MEASURES： Acute Cerebral Infarction Clinical Neurologic Impairment Degree Scoring Standard of Carotid Artery System. RESULTS ： All 321 patients entered the stage of analysis with no loss in the midway. ① The symptom following onset of acute cerebral infarction was evaluated with clinical neurologic impairment scoring criteria, there were no significant differences between aspirin group and blank control group [（17.39±9.90） vs （16.22 ± 9.98） （t=1.025, P〉 0.05）]. ② No significant differences were found in 1：1 matched pairs of 100 cases from aspirin group and blank control group （t=1.74, P 〉 0.05）. CONCLUSION ： Taking a lower dose of aspirin during long time may not decrease the degree of disease following onset of acute cerebral infarction.

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.

Magnetic resonance diffusion tensor imaging following major ozonated autohemotherapy for treatment of acute cerebral infarction

Major ozonated autohemotherapy has been shown to promote recovery of upper limb motor function in patients with acute cerebral infarction, but whether naajor ozonated autohelnotherapy affects remote in）ury remains poorly understood. Here, we assumed that major ozonated autohemotherapy contributes to recovery of clinical function, possibly by reducing remote injury after acute cerebral infarction. Sixty acute cerebral infarction patients aged 30-80 years were equally and randomly allocated to ozone treatment and control groups. Patients in the ozone treatment group received medical treatment and major ozonated autohemotherapy （47 mg/L, 100 mL ozone） for 10 ± 2 days. Patients in the control group received medical treatment only. National Institutes of Health Stroke Scale score, modified Rankin scale score, and reduced degree of fractional anisotropy values of brain magnetic resonance diffusion tensor imaging were remarkably decreased, brain function improved, clinical efficiency significantly increased, and no obvious adverse reactions detected in the ozone treatment group compared with the control group. These findings suggest that major ozonated autohemotherapy promotes recovery of neurological function in acute cerebral infarction patients by reducing re,note injury, and additionally, exhibits high safety.

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.