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Objective:To investigate the correlation between 24 h blood pressure variability and early neurological improvement (ENI) in patients with large vessel occlusion (LVO) after endovascular thrombectomy (ET).Methods:Patients with LVO received ET in the Emergency Department, the Affiliated Hospital of Nantong University from January 2012 to February 2018 were enrolled retrospectively. During the first 24 h after ET, the blood pressure was recorded every 2 h, and blood pressure variability was evaluated by standard deviation (SD) and successive variation (SV). At 24 h after ET, the National Institutes of Health Stroke Scale (NIHSS) score was evaluated again. The re-evaluation of 0 point or a decrease of ≥4 from the baseline score was defined as ENI. Multivariate logistic regression analysis was used to evaluate the relationship between blood pressure variability and ENI. Results:A total of 74 patients with LVO received ET were enrolled, of which 39 (52.7%) had ENI. Univariate analysis showed that the proportion of patients with good recanalization in the ENI group after procedure were significantly higher than that in the non-ENI group ( P<0.05), while the average systolic blood pressure, average diastolic blood pressure, systolic blood pressure variability (SBPV) -SD and SBPV-SV within 24 h after ET and baseline total cholesterol level were significantly lower than those in the non-ENI group (all P<0.05). Multivariate logistic regression analysis showed that higher SBPV-SV was an independent risk factor for non-ENI (odds ratio 1.223, 95% confidence interval 1.038-1.440; P=0.016). Conclusion:Higher SBPV-SV after ET is associated with poor early neurological improvement in patients with LVO, and it is expected to be a potential target for blood pressure management in patients after ET.
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Acute ischemic stroke is characterized by high morbidity, high disability and high mortality. The effectiveness and safety of endovascular therapy in the treatment of acute ischemic stroke have been recognized, but there are few studies on perioperative blood pressure control, and the best blood pressure control management strategy has not yet reached a consensus. This article reviews the blood pressure management during the perioperative period of endovascular treatment.
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Objective To explore the effect of carotid atherosclerotic plaque ( CAP) on severity and recurrence of patients with cerebral infarction ( CI ) .Methods The prospective cohort study was utilized in this research. Existence and type of CAP were detected by Doppler ultrasound, and patients were divided into plaque group and without plaque group.The patients was evaluated by NIHSS on admission and 7 d, 14 d after admission, and patients were followed up for 1 year.The condition of CI recurrence was be observed.Results According to the Doppler ultrasound, patients were divided into plaque group ( 173 cases, 70.3%) and without plaque group ( 73 cases, 29.7%) .Compared with without plaque group, age, NIHSS score and incidences of hypertension, diabetes, hyperlipidemia, hyperfibrinogenemia were significantly increased (P<0.05 -0.01).In the patients who were conducted follow-up, cerebral infarction recurrence was in 39 cases (24.84%) in plaque group, recurrence time was 10.12 month.The recurrence time was 11.82 month in patient with non-vulnerable plaque, it was 10.62 month in patient with mixed plaque, and it was 9.13 month in patient with vulnerable plaque.Cerebral infarct recurrence was in 7 cases (10.45%) in without plaque group, recurrence time was 11.56 month.The recurrence rate in plaque group was significant increased than that in without plaque, however, the recurrence time for without plaque group was longer than that for plaque group ( all P<0.05 ) .The recurrence rate and recurrence time in patient with vulnerable plaque was significantly earlier than that in patient with non-vulnerable plaque (P=0.034).Conclusion The CAP in patients with acute CI can exacerbate the disease, and increase recurrence rate.It is especially in patients with vulnerable plaque.
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Objective To explore changes of expression of pro-and anti-inflammatory cytokines in the hippocam-pus of Aβ1-42-induced Alzheimer’s disease (AD) rat model. Methods Twenty-four SD rats were divided into control group, PBS group (PBS was injected into CA1 area of hippocampus) and AD model group (Aβ1-42 was injected into CA1 area of hip-pocampus). The escape latency was evaluated by Morris water maze in three groups. Nissl staining was used to detect the le-sions of hippocampal CA1 neurons. Levels of amyloid precursor protein (APP) and protein phosphatase 2A (PP2A) in hippo-campus were measured by Western blot analysis. Real-time PCR was employed to examine the expressions of pro-inflamma-tory cytokines, including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and the mRNA expressions of anti-inflammatory cytokines, including IL-4, IL-10 and transforming growth factor-β(TGF-β). Re-sults Rats subjected to Aβ1-42 injection in bilateral hippocampus led to a ability reduction of learning and memory, a loss of neurons in hippocampus and an increase in the expression of APP, and a decrease in PP2A expression in the hippocampus. In AD hippocampus, The mRNA expressions of the pro-inflammatory mediator, IL-1β, TNF-αand IFN-γ, were significant-ly up-regulated, but the expressions of the anti-inflammatory cytokines, IL-4, IL-10 and TGF-β, were markedly down-reg-ulated in AD group compared with those of control and PBS groups. Conclusion The pro-inflammatory/anti-inflammatory imbalance induced neuro-inflammation in AD rats, which was involved in pathogenesis of AD.
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Homocystine (Hcy) is an important intermediate product of amino acid metabolism.It is dual-regulated by both gene and environmental factors.The key enzyme of metabolic reaction is dependent on vitamin B class.The studies of in vitro experiment and animal models have demonstrated that Hcy may aggravate atherosclerosis by reducing the nitric oxide activity,enhancing intracellular oxidative stress,and promoting thrombosis,etc.Epidemiological studies have also demonstrated that hyperhomocystinemia (HHcy) is an independent risk factor for atherosclerosis.However,large randomized controlled trials have failed to confirm the close correlation between HHcy and ischemic stroke.By supplementing vitamin B class to decrease the Hcy level is still controversial in the primary and secondary prevention.The therapeutic dose of vitamin B class may be unable to obtain additional benefits in patients with ischemic stroke.
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The occurrence of cerebral vasospasm (CVS) following aneurysmal subarachnoid hemorrhage is a multi-factor participatory process.Its pathogenic mechanism is complex.The clinical presentation and imaging findings are not consistent.Theoretically,by the measures of blocking calcium channels,inhibiting Rho kinase,removing oxygen free radicals and antagonizing endothelin receptors and other measures can prevent and treat CVS,but the actual clinical effects of various drugs are not satisfactory,especially in the aspects of improving clinical outcomes.The clinical application of the 3H therapy has been limited because of having many potential complications,and the intra-arterial interventional treatment is limited by the technology,equipment,indications,and other factors.Therefore,the prevention and treatment of CVS is still facing many challenges.
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Objective To investigate the long-term outcome of intra-arterial thrombolysis in patients with acute ischemic stroke and its influencing factors.Methods Patients with acute ischemic stroke received intra-arterial thrombolysis were included in the study.The neurological outcome at day 90 was assessed using the modified Rankin Scale (mRS).They were divided into the good outcome group (mRS scores,0 to 2) and the poor outcome group (mRS scores,3 to 6)according to the evaluation results; the degree of recanalization after thrombolysis was assessed by the grading criteria of the Thrombolysis in Myocardial Infarction (TIMI) trial; the incidence of intracerebral hemorrhage within 7 days after thrombolytic therapy and the mortality at 3months were recorded.Univariate analysis and multivariate logistic regression analysis were used to screen the influencing factors of long-term outcome of arterial thrombolysis.Results A total of 42 patients were included,of them,19 (45.2％) with good outcome and 23 (54.8％) with poor outcome after intra-arterial thrombolysis; 27 patients (64.5％ ) with good recanalization (TIMI grade,2 to 3); 13 patients (31.0％) occurred intracranial hemorrhage within 7 days,and 8 of them (19.0％ ) had symptomatic intracranial hemorrhage; 11 (26.2％ ) died within 90 days.Univariate analysis showed that the baseline blood glucose levels (P=0.019),the baseline National Institutes of Health Stroke Scale (NIHSS) scores (P =0.014),symptomatic intracranial hemorrhage (P =0.005),and the degree of recanalization (P =0.002) could influence the longterm outcome of patients with intra-arterial thrombolysis.Multivariate logistic regression analysis indicated that the lower level of basdine glucose and good recanalization were the independent predictive factors of the good long-term outcome after intra-arterial thrombolysis in patients with acute ischemic stroke.Conclusion After the exclusion of contraindications,the intra-arterial thrombolysis was safe and effective for patients with acute ischemic stroke.The lower blood glucose levels on admission and the good recanalization after thrombolysis were associated with the good long-term outcome of intm-arterial thrombolysis.
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The incidence,morbidity and mortality of stroke are very high.The evaluation of ischemic penumbra has very important significance for guiding clinical treatment and assessing prognosis.Currently,ischemic penumbra can be evaluated using imaging technologies,such as MRI,CT,positron emission tomography,and single photon emission computed tomography.
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Objective To enhance recognition of the clinical and radiological features of nonaneurysmal subarachnoid hemorrhage (SAH) and its prognosis, and to provide guidance for the diagnosis and treatment in clinical practice. Methods Patients with spontaneous SAH, whose initial 3-dimensional digital subtraction angiography (DSA) were negative, received a second DSA after 2 to 3 weeks.Nonaneurysmal was diagnosed as SAH when both DSA were negative. All subjects were divided into 2 subgroups, perimesencephalic nonaneurysmal subarachnoid hemorrhage ( PNSAH ) group and nonperimesencephalic nonaneurysmal subarachnoid hemorrhage ( n-PNSAH ) group. Results Among 49 patients with nonaneurysmal SAH, 24 patients were PNSAH and 25 patients were n-PNSAH. Two patients died and 47 patients recovered and discharged with an average follow-up of 26 months. Conclusion The clinical course and prognosis of patients with PNSAH were good, better than that of patients with n-PNSAH.
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Objective To observe the patients with subcortical cerebral infarction in the acute period, disabled in the motor function, and explore the extent of impact of several predictive factors to the recovery of motor function, including diffusion tensor imaging (DTF) displaying the involving extent of pyramidal tract, in order to find the most reliable and closely predictors. Methods 82 patients with acute cerebral infarction and disability (mRS score ≥ 3 points) were followed up on the 90 d after the symptom onset, respectively. Combining the baseline clinical characteristics, the laboratory and imaging auxiliary examination and treatment methods, choosing gender, age, hypertension, diabetes, hypercholesterolemia,atrial fibrillation or angina history, smoking history, alcohol history, the initial disability level,homocysteine, C-reactive protein, treatment modalities, the volume of infarction and the involving extent of pyramidal tract as observed indicators. According to mRS result, the outcome of the patients were divided into disabled groups ( mRS 3-5) and non-disabled group ( mRS 0-2). Results Using chi-square test to make univariate analysis, results showed that age (χ2 = 47.492, P ＜ 0. 01 ), diabetes ( χ2 = 5. 126, P =0. 024), hypercholesterolemia(χ2 =6. 242 ,P = 0. 012), the initial degree of disability (χ2 =45. 359, P ＜0. 01 ) and the involving extent of pyramidal tract (χ2 = 51. 467, P ＜ 0. 01 ) could effect patients gaining recovering. Using multivariate Logistic regression analysis to make a multivariate regression analysis, results suggest that age ( OR = 0. 068, P = 0. 042), the involving extent of pyramidal tract ( OR = 0. 026, P = 0. 002 )are independent predictors of recovery of motor function in patients, diabetes mellitus, hypercholesterolemia,initial disability level have no significant correlation. Conclusion The involving extent of pyramidal tract reflected by DTT is the best predictor of recovery in patients with subcortical cerebral infarction in the acute period.
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Secondary brain injury is closely associated with brain edema, inflammation response and other injury factors after intracerebral hemorrhage, such as the complement system activation, excitatory amino acid toxicity, the release of vasoactive substances and free radical damage. The main mode of neuronal death during secondary brain injury after intracerebral hemorrhage are necrosis and apoptosis.
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We report the treatment process of a patient with acute vertebral artery occlusion complicated by top of the basilar artery syndrome after arterial thrombolysis.The top branches of vertebral artery and basilar artery were patent after the mechanical and drug thrombolysis again. The prognosis of the patient was good. The modified Rankin scale score was 1. It suggested that in addition to the arterial local thrombolysis was effective to the lesions themselves, it also had good efficacy for the newly developed embolic complications during the process of thrombolysis.
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The morbidity and mortality of intracerebral hemorrhage (ICH) are very high. Brain injury involves in several mechanisms after ICH, including the direct tissue destruction by the mechanical force on brain tissue surrounding the hernatoma in the process of hematoma formation, the release of clot-derived factors (thrombin, hemoglobin degradation products), inflammatory response and complement cascade reaction, etc. This article reviews the above mechanisms
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Strokc is one of the most feared perioperative complications.This article systematically reviews the incidence, mechanisms, risk factors stratification,and relief of perioperative stroke.Aiming at the risk factors and pathogeneses,it is hopeful to improve from the aspect of operative methods.techniques,and medication,and thus to decrease the risks of perioperative stroke and improve prognosis.
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Objective To study the relationship between carotid atherosclerotic plaque and white blood cell(WBC),levels of plasma lipid,fibrinogen(Fib) in the patients with cerebral infarction(CI).Methods 38 patients with CI were examined on carotid arteries using magnetic resonance imagine(MRI) to discover the atherosclerotic plaques and ascertain their stability.WBC,the levels of plasma lipids [including total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein(LDL),lipoprotein(a)] and Fib were detected in CI patients and 31 healthy subjects(normal control group,all subjects were examined carotid arteries with color dopper ultrasonography and no plaques were found)].Results 26 patients with CI(68.4 %) showed carotid plaques and 12 patients with CI(31.6%)did not.Of these,the patients with unstable versus stable plaque were 20(52.6%) versus 6(15.8%) respectively.The levels of plasma Fib in the CI group(including CI without plaque,CI with stable plaque and CI with unstable plaque) were significantly higher than that in the normal control group(all P
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Objective To investigate the effect and safety of Batroxobin (DF-521) combined with Aspirin (ASA) in the treatment of acute cerebral infarction. Methods 102 patients with acute cerebral infarction were enrolled in the study and all the patients were divided into three groups: ASA group (n=23), Batroxobin group (n=35) and ASA combined with Batroxobin group (n=44). Platelet count, blood viscosity, platelet aggregation test (PAgT), fibrinogen, coagulation studies (PT, APTT, INR), TXB2, imaging, National Institutes of Health Stroke Scale (NIHSS) and Modified Barthel Index (MBI) were measured or assessed before and after treatment, respectively. Hemorrhage rate (including brain and other organs) as one of complication was also investigated.Results After treatments, ASA combined with Batroxobin group showed the strongest inhibition of platelet aggregation among the three groups (all P0.05). A follow up of 3 months showed that the scores of NIHSS and MBI in ASA combined with Batroxobin group were better than those in the other two groups (all P
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Objective To study the effects of lead exposure on expression of nerve growth factor(NGF)gene in the rat hippocampus,and explore the molecular toxicological mechanism of the learning and damage induced by lead exposure. Methods Using the reverse transcription-polymerase chain reaction(RT-PCR)and in situ hybridization,NGF mRNA levels in the hippocampus of normal and lead exposure rats were investigated. Results NGF mRNA presented in the normal hippocampus of rats.NGF mRNA levels in the hippocampus were significantly decreased by lead exposure.There was a negative correlativity between the expression of nerve growth factor mRNA in the hippocampus and the time of lead exposure.Conclusion Lead can downregulate the expression of nerve growth factor gene in the rat hippocampus.