Relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine fetal distress

BACKGROUND By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries,doctors can more accurately identify fetal intrauterine distress,as well as assess its severity,so that timely interventions can be implemented to safeguard the health and safety of the fetus.AIM To identify the relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine distress.METHODS Clinical data of pregnant women admitted between January 2021 and January 2023 were collected and divided into the observation and control groups(n=50 each),according to the presence or absence of intrauterine distress.The ultrasound hemodynamic parameters of the uterine artery(UtA),fetal middle cerebral artery(MCA),and umbilical artery(UmA)were compared with neonatal outcomes and occurrence of intrauterine distress in the two groups.RESULTS Comparison of ultrasonic hemodynamic parameters,resistance index(RI),pulsatility index(PI),and systolic maximal blood flow velocity of UmA compared to diastolic blood flow velocity(S/D),revealed higher values of fetal MCA,PI,and S/D of UmA in pregnant women with UtA compared to controls(P<0.05),while there was no difference between the two groups in terms of RI(P<0.05)The incidence of a neonatal Apgar score of 8-10 points was lower in the observation group(66.7%)than in the control group(90.0%),and neonatal weight(2675.5±27.6 g)was lower than in the control group(3117.5±31.2 g).Further,cesarean section rate was higher in the observation group(70.0%)than in the control group(11.7%),and preterm labor rate was higher in the observation group(40.0%)than in the control group(10.0%).The incidence of fetal distress,neonatal growth restriction and neonatal asphyxia were also higher in the observation group(all P<0.05).CONCLUSION Fetal MCA,UmA,and maternal UtA hemodynamic abnormalities all develop in pregnant women with intrauterine distress during late pregnancy,which suggests that clinical attention should be paid to them,and monitoring should be strengthened to provide guidance for clinical intervention.

Investigation multi-target synergistic mechanism of Choerospondias axillaris in the treat of cerebral ischemia based on systems pharmacology and experimental verification

Background:Choerospondias axillaris(CA)is a traditional Mongolian medicine that has been proven to have a good therapeutic effect on cerebrovascular disease.Cerebral Ischemia(CI)is a severe and life-threatening cerebrovascular disease.However,the specific mechanism of action of CA in the treatment of CI is still unclear.Methods:In this study,the related targets and pathways of CA in the treatment of CI were first predicted by system pharmacology and then verified by relevant experiments.Results:The results showed that 12 active ingredients and 208 targets were selected.Further validation through protein-protein interaction(PPI)network analysis and active ingredients-target-pathway(A-T-P)network analysis has confirmed the pivotal roles of the main bioactive constituents,including quercetin,kaempferol,naringin,β-sitosterol,and gallic acid.These components exert their anti-ischemic effects by modulating key targets such as IL6,TNF,MAPK3,and CASP3,thereby regulating the PI3K-Akt,HIF-1,and MAPK signaling pathways,which are integral to processes like inflammation,apoptosis,and oxidative stress.More importantly,through experimental verification,this study confirmed our prediction that CAE significantly reduced neurological function scores,infarct volume,and the percentage of apoptosis neurons.Conclusion:This indicates that CA acts on CI through multi-target synergistic mechanism,and this study provides theoretical basis for the clinical application of CA.

Therapeutic effects of different durations of acupuncture on rats with middle cerebral artery occlusion

Acupuncture is regarded as an effective therapy for cerebral ischemia. Different acupuncture ma- nipulations and durations may result in different therapeutic effects. In the present study, the Neig uan （PC6） acupoint of rats with occluded middle cerebral arteries was needled at a fixed frequency （3 Hz） with different durations, i.e., 5, 60 and 180 seconds under a twisting-rotating acupuncture method. Results showed that different durations of acupuncture had different therapeutic effects, with 60 seconds yielding a better therapeutic effect than the other two groups. This duration of treatment demonstrated rapid cerebral blood flow, encouraging recovery of neurological function, and small cerebral infarct volume. Experimental findings indicated that under 3 Hz frequency, the treatment of needling Neiguan for 60 seconds is effective for ischemic stroke.

Modified constraint-induced movement therapy alters synaptic plasticity of rat contralateral hippocampus following middle cerebral artery occlusion

Modified constraint-induced movement therapy is an effective treatment for neurological and motor impairments in patients with stroke by increasing the use of their affected limb and limiting the contralateral limb.However,the molecular mechanism underlying its efficacy remains unclear.In this study,a middle cerebral artery occlusion(MCAO)rat model was produced by the suture method.Rats received modified constraint-induced movement therapy 1 hour a day for 14 consecutive days,starting from the 7^th day after middle cerebral artery occlusion.Day 1 of treatment lasted for 10 minutes at 2r/min,day 2 for 20 minutes at 2 r/min,and from day 3 onward for 20 minutes at 4 r/min.CatWalk gait analysis,adhesive removal test,and Y-maze test were used to investigate motor function,sensory function as well as cognitive function in rodent animals from the 1st day before MCAO to the 21^st day after MCAO.On the 21^st day after MCAO,the neurotransmitter receptor-related genes from both contralateral and ipsilateral hippocampi were tested by micro-array and then verified by western blot assay.The glutamate related receptor was shown by transmission electron microscopy and the glutamate content was determined by high-performance liquid chromatography.The results of behavior tests showed that modified constraint-induced movement therapy promoted motor and sensory functional recovery in the middle cerebral artery-occluded rats,but had no effect on cognitive function.The modified constraint-induced movement therapy upregulated the expression of glutamate ionotropic receptor AMPA type subunit 3(Gria3)in the hippocampus and downregulated the expression of the beta3-adrenergic receptor gene Adrb3 and arginine vasopressin receptor 1 A,Avprla in the middle cerebral artery-occluded rats.In the ipsilateral hippocampus,only Adra2 a was downregulated,and there was no significant change in Gria3.Transmission electron microscopy revealed a denser distribution the more distribution of postsynaptic glutamate receptor 2/3,which is an a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor,within 240 nm of the postsynaptic density in the contralateral cornu ammonis 3 region.The size and distribution of the synaptic vesicles within 100 nm of the presynaptic active zone were unchanged.Western blot analysis showed that modified constraint-induced movement therapy also increased the expression of glutamate receptor 2/3 and brain-derived neurotrophic factor in the hippocampus of rats with middle cerebral artery occlusion,but had no effect on Synapsin I levels.Besides,we also found modified constraint-induced movement therapy effectively reduced glutamate content in the contralateral hippocampus.This study demonstrated that modified constraint-induced movement therapy is an effective rehabilitation therapy in middle cerebral artery-occluded rats,and suggests that these positive effects occur via the upregulation of the postsynaptic membrane a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor expression.This study was approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.201802173 S)on March 3,2018.

Effect of Fujian tablet on the expression of Nogo-A mRNA in the cervical spinal cord of middle cerebral artery occlusion model rats

Inhibiting the expression of Nogo-A in cervical spinal cord by use of interaction of antigen and antibody can help the remodeling of corticospinal projection of focal cerebral ischemia model rats to facilitate neurological recovery, which provides a new possible mechanism for drugs to promote neurological recovery. However, the effects of drugs on the expression of Nogo-A in cervical spinal cord are still unclear. OBJECTIVE： To observe the effect of Fujian tablet on the expression of Nogo-A mRNA in cervical spinal cords of middle cerebral artery occlusion （MCAO） rats, and to investigate the possible regulatory effect of Fujian tablet on the regenerated microenvironment of spinal conduction bundle. DESIGN： A randomized and controlled trial taking Wistar rats as experimental animals. SETTING： Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine. MATERIALS： This experiment was carried out in the laboratory of Shandong Academy of Medical Science between June 2005 and July 2006. A total of 40 healthy male Wistar rats, aged 12 weeks, weighing 250 - 300 g, were provided by the Experimental Animal Center of Shandong University. Fujian tablets （main components： Heshouwu, Yinyanghuo, etc） were provided by office of Pharmaceutics of Shandong University of traditional Chinese medicine. Nogo-A detection kit was provided by Wuhan Boster Biotechnology Co.,Ltd., and batch number was 040309009. This experiment was approved by Local Animal Ethics Committee. METHODS： Forty male rats were randomly divided into 4 groups, with 10 in each： normal group, sham-operation group, model group and administration group. Rats in the administration group and model group were subjected to MCAO. Rats in the sham-operation group underwent the same craniotomy, and their middle cerebral arteries （MCA） were not occluded. Rats in the normal group were untouched. Rats in administration group were intragastrically administrated with the solution of Fujian tablet at a dose of 9 g/kg and others were given equal dosage of normal saline two days later. The treatments were done once a day and the course totaled 2 weeks. MAIN OUTCOME MEASURES： The expression of Nogo-A mRNA in slices of cervical spinal cords. RESULTS： Forty rats were involved in the final analysis. The expression of Nogo-A mRNA in the cervical spinal cord of rats in the administration group and model group was significantly decreased as compared with that in the normal group （P 〈 0.01 and P 〈 0.05, respectively）. The expression of Nogo-A mRNA in the administration group was also significantly weaker than that in the model group （P 〈 0.05 ） . CONCLUSION： Fujian tablet can inhibit the expression of Nogo-A mRNA in cervical spinal cords of MCAO rats, which facilitates regeneration and remodeling of cervical spinal cords.

Apparent diffusion coefficient evaluation for secondary changes in the cerebellum of rats after middle cerebral artery occlusion

Supratentorial cerebral infarction can cause functional inhibition of remote regions such as the cerebellum, which may be relevant to diaschisis. This phenomenon is often analyzed using positron emission tomography and single photon emission CT. However, these methods are expensive and radioactive. Thus, the present study quantified the changes of infarction core and remote regions after unilateral middle cerebral artery occlusion using apparent diffusion coefficient values. Diffu- sion-weighted imaging showed that the area of infarction core gradually increased to involve the cerebral cortex with increasing infarction time. Diffusion weighted imaging signals were initially in- creased and then stabilized by 24 hours. With increasing infarction time, the apparent diffusion co- efficient value in the infarction core and remote bilateral cerebellum both gradually decreased, and then slightly increased 3-24 hours after infarction. Apparent diffusion coefficient values at remote regions （cerebellum） varied along with the change of supratentorial infarction core, suggesting that the phenomenon of diaschisis existed at the remote regions. Thus, apparent diffusion coefficient values and diffusion weighted imaging can be used to detect early diaschisis.

Establishment of a rhesus monkey model of middle cerebral artery ischemia and reperfusion using a microcatheter embolization method

Nonhuman primates are closest to humans in terms of lineage, and middle cerebral artery ischemia/reperfusion responses of nonhuman primates are most similar to ischemic stroke in humans. Therefore, nonhuman primates could be utilized to simulate the process of ischemic stroke in the human. Few studies, however, have reported the use of endovascular technology to establish a rhesus monkey stroke model. In the present study, seven adult, male, rhesus monkeys were selected and, following anesthesia, a microcatheter was inserted into one side of the middle cerebral artery via the femoral artery to block blood flow, thereby resulting in middle cerebral artery occlusion. After 2 hours, the microcatheter was withdrawn to restore the middle cerebral artery blood flow and to establish ischemia/reperfusion. Results from angiography and magnetic resonance angiography confirmed occlusion and reopening of the middle cerebral artery. Magnetic resonance imaging revealed the existence of ischemic brain lesions, and neurological examination showed sustained functional deficits following surgery. The rhesus monkey middle cerebral artery ischemia/reperfusion models established by microcatheter embolization had the advantage of non-craniotomy invasion and reproducibility. The scope and degree of ischemic damage using this model was controllable. Therefore, this nonhuman primate model is an ideal model for cerebral ischemia and reperfusion.

Intraoperative hemodynamic parameters of middle cerebral artery and other artery aneurysms utilizing transcranial Doppler ultrasonography

BACKGROUND： Hemodynamic changes accompany the initiation, development and rupture of middle cerebral artery （MCA） aneurysms. The complexity of the intraaneurysmal hemodynamic factors has not been completely clarified by the indirect measures and methods used in previous studies. OBJECTIVE： To evaluate correlations of intraoperative hemodynamic factors to initiation and rupture of MCA aneurysms. DESIGN, TIME AND SETTING： A case-control study was performed at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China between March and October 2008. PARTICIPANTS： A total of 12 consecutive patients diagnosed with MCA aneurysms （MCA aneurysms group） and five patients without middle cerebral artery aneurysms （with aneurysms located at other arteries, control group） were enrolled at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China. METHODS： The proximal and distal arteries of MCA aneurysms were exposed visibly in the MCA aneurysm group. The M1 segment of MCA without the aneurysm and the aneurysm on other arteries were also exposed visibly in the control group. Hemodynamic indices were then measured using an intraoperative 16 MHz probe installed in a Multi-Dop TCD8X4 device. MAIN OUTCOME MEASURES： Mean （time-averaged velocity） difference, maximum mean, pulsatility index difference, maximum pulsatility index, resistance index difference, maximum resistance index; correlation of development and rupture of MCA aneurysms to intraoperative hemodynamic factors of the parent artery. RESULTS： A total of 12 patients underwent microsurgery for treatment to occlude 15 MCA aneurysms. Of the 15 MCA aneurysms, 12 were located at the bifurcation, two at the M1 segment and one at the M3 segment; eight of the aneurysms were unruptured and seven were ruptured. The whole indices with combination mean difference, maximum mean, and maximum pulsatility index of the aneurysms were important factors influencing the rupture of MCA aneurysms （t = 2.92, P = 0.03, constant）. A higher velocity intraaneurismal flow at the bifurcation was identified （t = 3.48, P = 0.01, constant）. After the aneurysm was completely occluded, global high-velocity flow could not be detected in the parent arteries （t = 2.57, P=0.03, constant）. CONCLUSION： When short-term high-velocity blood flow is present, aneurysms can be easily initiated and ruptured at the bifurcation of MCA.

Fetal umbilical vein transplantation for the repair of middle cerebral artery injury

It is necessary to investigate the longitudinal tensile mechanical characteristics of the middle cere- bral artery and the fetal umbilical vein prior to applying fetal umbilical vein transplantation for repair of injured middle cerebral artery. Fifteen fresh fetal umbilical vein specimens and 15 normal human fresh cadaver middle cerebral artery specimens were collected for longitudinal tensile testing at the speed of 0.5 mm/min and at normal human temperature. The results showed that under 16.0 kPa physiological stress, the strain value of fetal umbilical vein specimens was larger, while the maximal stress and elastic modulus values were less than those of middle cerebral artery specimens. Our findings indicate that fetal umbilical vein has good elastic properties and the stress-strain curve of the fetal umbilical vein is similar to that of the middle cerebral artery. Fetal umbilical vein transplan- tation can, therefore, potentially repair the injured middle cerebral artery.

Occlusion of the middle cerebral artery Guidance by screen imaging using an EDA-H portable medium-soft electronic endoscope

The present study aimed to verify the practicability of performing screen-based surgical operations under the guidance of a real-time viewing and recording system （RTVRS） using a portable medium-soft electronic endoscope （pmsEE）. The middle cerebral artery in rats was occluded under screen-imaging guidance using a pmsEE RTVRS to reproduce an animal model of human cerebral infarction. The screen imaging of the pmsEE RTVRS was clear, life-like, stereoscopic and synchronous with the actual operation. Screen-imaging guidance led to an accurate, smooth, minimally invasive and comparatively easy surgical procedure. The surgical success rate, time of model establishment, neurological function scores, and infarct volume were similar to those using an operating microscope. These results indicate that the self-designed pmsEE RTVRS could be utilized for portable endoscopic screen-based surgical operations.

Superficial Temporal Artery to Middle Cerebral Artery Bypass and Endovascular Parent Artery Occlusion in the Treatment of Giant Intracranial Aneurysms

The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow diverters. The study was a retrospective review of giant intracranial aneurysms treated by superficial temporal artery to middle cerebral artery bypass combined with endovascular occlusion of the parent artery. From 1990 to 2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to selective treatment were managed in that way. Twenty-one medical records had enough data to allow objective evaluation. Sixteen female and five male patients bearing 21 giant aneurysms were involved. Their mean age was 46 years. The aneurysm was revealed by mass effect in 13 cases and subarachnoid hemorrhage in one case. On admission 19 patients presented with unruptured aneurysms and two have sustained a subarachnoid hemorrhage. The balloon occlusion test before the bypass operation was not tolerated in 18 patients. The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period was 30 months. After completion of the treatment, 16 (84%) patients had no symptom. Aneurysm recanalization or rupture was not observed after the parent artery occlusion. With the combination of superficial temporal artery to middle cerebral artery bypass + endovascular parent artery occlusion, 90% of giant intracranial aneurysms untreatable selectively were permanently excluded with a good outcome in 95%.

Electroacupuncture at the Renzhong (DU 26) and Neiguan (PC 6) acupoints repairs the DNA of nervous tissue supplied by the middle cerebral artery in rats

This study compares the changes of DNA repair in brain tissue dominated by the middle cerebral artery after electroacupuncture at the acupoints of Renzhong （DU 26）, Neiguan （PC 6）, Quchi （LI 11） and Zusanli （ST 36） in rats. In the apurinic/apyrimidinic endonuclease DNA basic group reparative excision experiments, the apurinic/apyrimidinic endonuclease activity of brain tissue increased slightly after electroacupuncture in rats. In the DNA polymerase β （Pol β）experiments, the Pol β ac-tivity of brain tissue increased after electroacupuncture, especially at DU 26 and PC 6. In the DNA ligase experiments, the expression of DNA ligase 1 in brain tissue increased significantly after electroacupuncture. These findings demonstrate increased activity of apurinic/apyrimidinic en-donuclease, Pol β and DNA ligase 1 after electroacupuncture at DU 26 and PC 6. Also, DNA repair in brain tissue supplied by the middle cerebral artery is promoted after electroacupuncture at DU 26 and PC 6, which are more effective than the LI 11 and ST 36 acupoints .

An experimental study of the biomechanics of the middle cerebral artery in acute cerebral infarction

Local cerebrovascular paralysis was found in most cases of cerebral infaction. The extent and severity of vascular paralysis and its effect on contraction-relaxation function of vessels were dependent on the developmental rapidity and duration of vascular

Unruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery Treated by Coil Embolization: A Case Report

Aneurysm at the origin of a duplication of the middle cerebral artery (DMCA) is very rare, and only 29 treated cases have been reported. All of the cases were treated by direct surgery except a ruptured case treated by intentional partial coil embolization. We report the first unruptured case treated by coil embolization and review the previously published cases. Coil embolization can be alternative treatment for an unruptured aneurysm at the origin of the DMCA. Stable framing to spare the origin of it and prevention of thromboembolic complications are keys for safe treatment.

Analysis of the hemodynamics changes of ipsilateral extracranial carotid artery with middle cerebral artery stenosis or occlusion patients

Objective: By observing the relation between middle cerebral artery stenosis or occlusion patients with ipsilateral extracranial carotid artery hemodynamics changes, to identify the value of hemodynamic change of extracranial carotid artery in predicting the middle cerebral artery stenosis, in order to improve the detection rate and accuracy. Methods: Eighty-three patients with unilateral severe middle cerebral artery stenosis or occlusion who confirmed by MRA were enrolled in the study, in all case were detected by TCD. The relationship of hemodynamic between extracranial carotid arteries and intracranial carotid arteries were analyzed. Results:The patients with severe middle cerebral artery stenosis or occlusion tend to have lower velocity and higher pulsitility index (PI). The PI(iCA), Vm(iCA) has a certain significance. The PI difference of carotid artery, end diastolic velocity of internal carotial artery (Vd (iCA) ) can evaluate stenosis of MCA more sensitive. The PI difference of common carotid artery=0.13, PI difference of internal carotid artery=0.15, Vd (iCA) =13.8 cm/s, Yonden index were 0.709, 0.710, 0.601.Sensitivity were 80.49%, 78.05%, 80.49%.Specificity were 90.48%, 92.86%, 78.57%;Positive predictive value were 89.20%, 91.42%, 78.57%.Negative predictive value were 82.60%, 81.25%, 80.48%. Conclusion: The patients tend to have lower velocity and higher PI. The PI difference of carotid artery, Vd(iCA), PI(iCA), Vm (iCA) severe middle cerebral artery stenosis or occlusion can be evaluated and provide a basis for the early diagnosis.

Expression of insulin-like growth factor-1 mRNA and protein level of corpora striata in ischemic side at the early stage of middle cerebral artery ischemia/reperfusion in rhesus monkeys

BACKGROUND： Insulin-like growth factor-I（IGF-1）, as one of the important members of growth factor family, participants in the regulation of many physiological functions and behaviors, having very strong neuroprotective effect. However, the expression of IGF-1 following cerebral ischemia/reperfusion is still disputed. OBJECTIVE： To observe the expression of IGF-1 and protein of corpora striata in ischemic side at the early stage of middle cerebral artery ischemia/reperfusion in rhesus monkey. DESIGN ： A completely randomized grouping design, controlled animal experiment SETTING ： Institute of Cerebrovascular Disease, Affiliated Hospital of Medical College of Qingdao University MATERIALS： ① Totally 17 rhesus monkeys , of either gender, aged 4 to 5 years, were enrolled . Seven rhesus monkeys observed with gene chip were randomly divided into 2 groups： sham operation group （n=3） and ischemia/reperfusion group 〈n=4〉. Ten rhesus monkeys observed with in situ hybridization and immunohistochemistry method were randomly divided into 2 groups： sham operation group 〈n=3 〉and ischemia/reperfusion group （n=7）. Rhesus monkeys observed under microscope were divided into 2 groups： sham operation group （n=6） and ischamia/reperfusion group （n=-11）.②Materials used in the experiment： cresyl violet （Sigma Company, America）; immunohistochemical reagent kit （ Huamei Bio-engineering Company）; In situ hybridization reagent kit （Boshide Bio-engineering Co.Ltd, Wuhan）; 12 800 dots chip （Boxing Company, Shanghai）. METHODS ： This experiment was carried out at the Institute of Cerebrovascular Disease, Affiliated Hospital of Medical College of Qingdao University from January 2001 to December 2003.① The onset area of middle cerebral artery was blocked for 2 hours, middle cerebral artery ischemia/reperfusion models were created.② After ischemia/reperfusion for 24 hours, cerebral tissue sections of rhesus monkeys were prepared and stained with cresyl violet. Image analysis was performed with 5001W image analysis software. Morphological change of corpora striata of operative side was observed in the rhesus monkeys between two groups. Total RNA was extracted from cerebral tissue. ③ Detection of gene chip： Cy3-duTP and Cy5-duTP were used to respectively perform reverse transcription labeling. The sample was reversely transcribed into cDNA, then hybridized with cDNA of cerebral tissue. Genes with the separate absolute value of cy3 and cy5〉800, cY3/cy5 〉 2（high expression） or 〈 0.5 （low expression） were found out. Those were genes with differential expression. ④ The expressions of IGF-1 mRNA and protein level of corpora striata in ischemic side of rhe- sus monkeys were detected between sham operation group and ischemia/reperfusion group at 9 and 24 hours after ischemia/reperfusion with in situ hybridization method and immunohistochemical method. Brown granules were IGF-1 protein positive cells. ⑤ Analysis of variance was used in the difference comparison of measurement data among groups. MAIN OUTCOME MEASURES ： ① Change of morphological structure of corpora striata at ischemic side in rhesus monkeys. ② Change of cerebral gene expression profiles at ischemia/reperfusion in rhesus monkeys between two groups.③ Expression of IGF-1 mRNA and protein level of corpora striata at ischemia/reperfu- sion in rhesus monkeys between two groups. RESULTS ： ① Pathological change ： Obvious pathological change of cerebral infarction appeared in the ischemia and reperfusion group, while there was no such pathological change in the sham operation group.② Change of gene expression profile ： There were 4480 genes with difference expression in the ischemia/reperfusion group and sham-operation group, in which, 260 genes had high expression and their absolute value was over 800, and 63 genes had low expression, cy3/cy5 of IGF-1 was 0.379, being relative low ex- pression. ③ IGF-1 mRNA and protein positive cell counts in corpora striata at cerebral ischemic side[IGF-1 mRNA： 〈9.72±1.18）,（9.11 ±0.76）,（14.77±0.60） counts/field：lGF-1 protein： （15.11 ±1.83）,（15.39±0.78）, （34.62±0.97）counts/field, P 〈 0.05-0.01]. CONCLUSION： IGF-1 mRNA and protein are lowly expressed in middle cerebral artery of rhesus monkeys at ischemia/reperfusion.

Fetal middle cerebral artery blood flow characteristics of gestational hypertension combined with fetal distress in uterus as well as their correlation with hypoxia

Objective:To study the fetal middle cerebral artery blood flow characteristics of gestational hypertension combined with fetal distress in uterus as well as their correlation with hypoxia. Methods: Puerperae with hypertensive disorders in pregnancy and fetal distress in uterus, puerperae with hypertensive disorders in pregnancy alone and healthy puerperae who gave birth in our hospital between January 2013 and January 2016 were included in group A, group B and group C of the study respectively. At 34-36 weeks of pregnancy, color Doppler ultrasonography was conducted to determine fetal middle cerebral artery blood flow parameters;after childbirth, umbilical arterial blood was collected to determine blood gas analysis parameters, and the placenta tissue was collected to determine oxidative stress and mitochondria damage indexes.Results:Fetal middle cerebral artery S/D, PI and RI of group A were significantly higher than those of group B and group C while umbilical artery pH value and PaO2 as well as HCO3- and BE content were significantly lower than those of group B and group C;fetal middle cerebral artery S/D, PI and RI as well as umbilical artery pH value, PaO2, HCO3- and BE content of group B were not significantly different from those of group C;Nrf2, ARE, NQO1, VitC, SVCT1, SVCT2, ATP, PGC-1α, PGC-1β, NRF1 and NRF2 content in placenta tissue of group A were significantly lower than those of group B and group C while ROS content was significantly higher than those of group B and group C;Nrf2, ARE, NQO1, VitC, SVCT1, SVCT2, ATP, PGC-1α, PGC-1β, NRF1 and NRF2 content in placenta tissue of group B were significantly lower than those of group C while ROS content was significantly higher than that of group C. Fetal middle cerebral artery S/D, PI and RI were negatively correlated with umbilical artery pH value, PaO2, HCO3- and BE content as well as Nrf2, ARE, NQO1, VitC, SVCT1, SVCT2, ATP, PGC-1α, PGC-1β, NRF1 and NRF2 content, and were positively correlated with ROS content.Conclusions:Gestational hypertension combined with fetal distress in uterus can lead to increased fetal middle cerebral artery blood flow resistance and decreased blood perfusion, and the changes of middle cerebral artery blood flow characteristics can assess the degree of hypoxia and oxidative stress damage.

Drug-coated balloon angioplasty for the treatment of intracranial arterial stenosis in a young stroke patient:A case report

BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonly associated with intracranial arterial narrowing,it is frequently of a non-atherosclerotic nature in younger patients.CASE SUMMARY Here,we present the case of a young stroke patient with narrowing of the middle cerebral artery(MCA),characterized as non-atherosclerotic lesions,who experienced an ischemic stroke despite receiving standard drug therapy.The patient underwent digital subtraction angiography(DSA)to assess the entire network of blood vessels in the brain,revealing significant narrowing(approximately 80%)in the M1 segment of the right MCA.Subsequently,the patient underwent Drug-Coated Balloon Angioplasty to treat the stenosis in the right MCA's M1 segment.Follow-up DSA confirmed the resolution of stenosis in this segment.Although the remaining branches showed satisfactory blood flow,the vessel wall exhibited irregularities.A review of DSA conducted six months later showed no evident stenosis in the right MCA,with a smooth vessel wall.CONCLUSION The use of drug-coated balloon angioplasty demonstrated favorable outcomes in repairing and reshaping the blood vessel wall in young patients.Therefore,it may be considered a promising treatment option for similar cases.

Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores

Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.

Motor outcomes of patients with a complete middle cerebral artery territory infarct

Detailed knowledge of motor outcomes enables to establish proper goals and rehabilitation strate-gies for stroke patients. Several previous studies have reported functional or motor outcomes in patients with a middle cerebral artery territory infarct. However, little is known about motor outcome in patients with a complete middle cerebral artery territory infarct. In this study, we investigated the motor outcomes in 23 patients with a complete middle cerebral artery territory infarct. All of these patients received comprehensive rehabilitative management, including movement therapy and neuromuscular electrical stimulation of the affected finger extensors and ankle dorsiflexors, for more than 3 months. Motor outcomes were measured at 6 months after stroke onset using the Medical Research Council, Motricity Index, the modified Brunnstrom Classification, and Functional Ambula-tion Category scores. The motor function of the lower extremities was found to be better than that of the upper extremities. After receiving rehabilitation treatments for 3–6 months, about 70% of these patients were able to walk independently （Functional Ambulation Category scores 3）, but no pa-tient achieved functional hand recovery.