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.

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).

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.

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.

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.

Time-effect relationship of acupuncture on histopathology, ultrastructure, and neuroethology in the acute phase of cerebral hemorrhage

Many clinical studies have addressed the treatment of acute cerebral hemorrhage using acupuncture. However, few studies have examined the relationship between time of acupuncture and curative effect on cerebral hemorrhage. By observing the effect of acupuncture on changes in histopathology, ultrastructure, and neuroethology in a cerebral hemorrhage model of rats, we have directly examined the time-effect relationship of acupuncture. The rat model of cerebral hemorrhage was produced by slowly injecting autologous blood to the right caudate nucleus. The experimental groups were: 3-, 9-, 24-, and 48-hour model groups; and 3-, 9-, 24-, and 48-hour acupuncture groups. The sham-operation group was used for comparison. Acupuncture was performed at the Neiguan(PC6) and Renzhong(DU26) acupoints, twice a day, 6 hours apart, for 5 consecutive days. Brain tissue changes were observed by light microscopy and transmission electron microscopy. Neuroethology was assessed using Bederson and Longa scores. Our results show that compared with the sham-operation and model groups, Bederson and Longa scores were lower in each acupuncture group, with visibly improved histopathology and brain tissue ultrastructure. Further, the results were better in the 3-and 9-hour acupuncture groups than the 24-and 48-hour acupuncture groups. Our findings show that acupuncture treatment can relieve pathological and ultrastructural deterioration and neurological impairment caused by the acute phase of cerebral hemorrhage, and may protect brain tissue during this period. In addition, earlier acupuncture intervention following cerebral hemorrhage(by 3 or 9 hours) is associated with a better treatment outcome.

Effects of butyphthalide + rt-PA intravenous thrombolysis on the DWI characteristics, coagulation function and neurological function in patients with acute cerebral infarction

Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.

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.

Effects of Xingnaojing Injection on Cerebral Neurological Function and ET-1, hs-CRP and TNF-α Levels in Elderly Patients with Acute Cerebral Infarction

OBJECTIVE: To observe the effects of Xingnaojing Injection on the function of cranial nerves and the level of ET-1,hs-CRP and TNF-α in elderly patients with acute cerebral infarction. METHODS: A total of 86 elderly patients with acute cerebral infarction were randomly divided into observation group and control group. The 43 cases in the control group were treated by conventional Western medicine, and 43 cases in the observation group were treated by Xingnaojing injection on the basis of the treatment in control group. After 2 weeks' treatment in Xuancheng People's Hospital of Anhui Province, the neurological function(NIHSS score and MMSE score), daily living ability(BI Index score and ADL score),laboratory indicators(hs-CRP, ET-1, TNF-α) of the 2 groups before and after the treatment were observed and compared,the total clinical effectiveness of the 2 groups were compared. RESULTS: The total effective rate was 88.4% in the observation group, which was signi?cantly higher than that in the control group(62.8%)(P < 0.05). The NIHSS scores in the 2 groups were both signi?cantly increased after the treatment(P < 0.05) while the MMSE scores were signi?cantly decreased(P < 0.05) in the 2 groups, and the scores' improvement in the observation group was signi?cantly higher than that in the control group(P < 0.05). The BI score and ADL score were significantly increased in the 2 groups after the treatment(P < 0.05), and the improvements were obvious in the observation group. The levels of ET-1, hs-CRP and TNF-αin the 2 groups were signi?cantly decreased after the treatment(P < 0.05), and the indexes in the observation group were signi?cantly lower than that in the control group(P < 0.05). CONLUSIONS: Xingnaojing injection can reduce the levels of serum ET-1, hs-CRP and TNF-α, as well as the degree of neurological de?cit in the treatment of elderly patients with acute cerebral infarction. It is also helpful for the prognosis and outcomes of patients with cerebral infarction.

Effects of emergency hyperbaric oxygen therapy on nerve injury, angiogenesis and cerebral blood perfusion in patients with acute cerebral infarction

Objective:To explore the effects of emergency hyperbaric oxygen therapy on nerve injury, angiogenesis and cerebral blood perfusion in patients with acute cerebral infarction.Methods:A total of118 patients with acute cerebral infarction who were treated in the hospital between April 2015 and October 2017 were selected as study subjects and divided into hyperbaric oxygen group (n=59) and control group (n=59) by random number table method. Control group received conventional therapy, hyperbaric oxygen group received conventional therapy combined with hyperbaric oxygen therapy, and both groups were treated for 2 weeks. The differences in nerve injury, angiogenesis and cerebral blood perfusion were compared between the two groups before and after treatment.Results: Differences in nerve injury, angiogenesis and cerebral perfusion were not significant between the two groups immediately after diagnosis. After 2 weeks of treatment, serum nerve injury indexes IGF-1, Copeptin, PAO, AQP4 and H-FABP contents of hyperbaric oxygen group were lower than those of control group;serum angiogenesis indexes PEDF, Ang-1 and VEGF contents were higher than those of control group whereas ES content was lower than that of control group;stenotic-side cerebral blood perfusion parameters CBF and CBV levels were higher than those of control group whereas TTP level was lower than that of control group.Conclusion: Emergency hyperbaric oxygen therapy can effectively reduce nerve injury, promote cerebral angiogenesis and increase cerebral blood perfusion in patients with acute cerebral infarction.

Effects of adjuvant danhong injection therapy on nerve injury and platelet activation markers in patients with acute cerebral infarction

Objective:To investigate the effects of adjuvant danhong injection therapy on nerve injury and platelet activation markers in patients with acute cerebral infarction.Methods: A total of 102 patients with acute cerebral infarction who were treated in our hospital between January 2016 and September 2017 were reviewed and divided into the routine group (n=54) who received conventional therapy and the danhong injection group who received adjuvant danhong injection therapy. The differences in the contents of nerve injury indexes in serum and platelet activation markers in peripheral blood were compared between the two groups before treatment, after 3 d of treatment and after 7 d of treatment.Results: There was no statistically significant difference in the contents of nerve injury indexes in serum and platelet activation markers in peripheral blood between the two groups before treatment. After 3 d of treatment and after 7 d of treatment, copeptin, H-FABP and NSE contents in serum of danhong injection group were lower than those of routine group whereas BDNF and bFGF contents were higher than those of routine group;CD62p, CD42b, PAC-1 and PMA contents in peripheral blood were lower than those of routine group.Conclusion: Conventional therapy combined with adjuvant danhong injection therapy can effectively reduce the degree of nerve injury and inhibit the platelet activation in patients with acute cerebral infarction.

Research on the relationship between traditional Chinese medicine's syndrome and serum level of IGF-1 and IGFBP-3 in patients with acute cerebral infarction

Objective To study the relationship between traditional Chinese medicine (TCM) syndrome and serum level of IGF 1 and IGFBP 3 in patients with acute cerebral infarction (ACI).Methods 75 patients of ACI were divided into two groups by TCM`s syndrome differentiation: apolexy involving the channels (AIC) and apolexy involving the viscera (AIV).Serum level of IGF 1 and IGFBP 3 was detected by ELISA di antibody clipping technique (DACT) and was compared with that of 30 normal controls.Results Serum level of IGF 1 and IGFBP 3 in AIC group and AIV group were significantly different from control groups;and differences between AIC group and AIV group were statistically significant.Serum level of IGF 1 and IGFBP 3 in all syndromes of AIC group and AIV group were remarkably lower than control group.Among them,syndrome of Yin deficiency of liver and kidney and sthenia liver yang and syndrome of blood stasis due to Qi deficiency had lower serum level of IGF 1 and IGFBP 3 than syndrome of empty and obstruction of channel.So did collapse syndrome and syndrome of mental disorder due to phlegm fire to syndrome of wind fire evil lucid orifices and block Yin syndrome.Conclusion There are to some extent correlation with TCM’s Syndrome and serum level of IGF 1 and IGFBP 3 in patients with ACI. Serum level of IGF 1 and IGFBP 3 might be microcosmic referent markers of the damage of Qi and Yin by TCM`s syndrome differentiation.

Meta-analysis of the clinical efficacy and safety of Urinary Kallidinogenase in the treatment of acute cerebral infarction

Objective:To evaluate the clinical efficacy and safety of Urinary Kallidinogenase for Injection in the treatment of acute cerebral infarction.Methods:PubMed,The Cochrane Library,Embase,CNKI,VIP,Wan Fang and bibliographic database of Chinese medicine were searched by computer to collect randomized controlled trials of Urinary Kallidinogenase's treatment of acute cerebral infarction.The time limit was set up until September 2019.At the same time,the references and grey literature in the literature were manually screened.Two independent researchers were screened,evaluated and extracted according to inclusion and exclusion criteria.Meta-analysis was carried out by RevMan 5.3 software.Results:A total of 17 randomized controlled trials involving 2,066 patients,including 1,033 in the experimental group,and 1,033 in the control group.meta-analysis results showed that compared with the conventional treatment,Urinary Kallidinogenase had better effect in the treatment of acute cerebral infarction[OR=3.26,95%CI(2.56,4.16),P<0.00001];the national institule of Health Stroke Scale of the Urinary Kallidinogenase group was significantly better than that of the control group.Urinary Kallidinogenase group activity of daily living scale was better than the control group[OR=21.33,95%CI(6.64,36.01),P=0.004];a total of 7 articles reported adverse reactions,including 19 cases in the trial group and 21 cases in the control group,the main adverse reactions were blood pressure drop,other symptoms were chest tightness,facial redness,dizziness fever,nausea and vomiting,arrhythmia,and no other serious adverse reactions.It can recover itself.Conclusion:the available evidence shows that Urinary Kallidinogenase can effectively improve the symptoms of neurological deficits and improve the ability of daily living in patients with acute cerebral infarction,and is safe.However,the quality of the study is limited.

Effects of Intravenous Thrombolytic Therapy with Alteplase on Neurological Function,Coagulation Function and Serum Inflammatory Factors in Patients with Acute Cerebral Infarction

Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.

Differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction

Objective:To study the differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction as well as the specific molecular mechanism.Methods:Patients with acute cerebral infarction who were treated in our hospital between April 2013 and May 2016 were selected and randomly divided into two groups, thrombolysis group received intravenous alteplase thrombolysis and non-thrombolysis group received conventional treatment. After treatment, transcranial color Doppler ultrasound was used to assess intracranial blood flow, and serum was collected to detect blood coagulation function indexes, nerve injury indexes and inflammatory stress response indexes.Results:1 week and 2 weeks after treatment, middle cerebral artery Vs, Vd and Vm levels of thrombolysis group were significantly higher than those of non-thrombolysis group;2 weeks after treatment, serum FVIII, VWF, S100β, NSE, GFAP, MBP, UCH-L1, TNF-α, IL-1β, MDA, AOPP and 8-OHdG content of thrombolysis group were significantly lower than those of control group while PT, TT and APTT were significantly higher than those of control group.Conclusion: Intravenous alteplase thrombolysis can improve cerebral blood perfusion and alleviate nerve injury in patients with acute cerebral infarction, and inhibiting blood coagulation process as well as oxidizing and inflammatory reaction is the molecular mechanism for alteplase to achieve therapeutic action.