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Mechanical thrombectomy is the most effective method for the treatment of adult acute ischemic stroke caused by occlusion of large blood vessels. Compared with traditional therapy, the curative effect is greatly improved. The evidence-based medicine evidence of the treatment is sufficient, and the efficacy is safe and reliable. Since 2015, it has been recommended by the guidelines of various countries. In 2018, the time window of mechanical thrombectomy has been extended from six hours to 24 hours, which benefits more adult patients with acute ischemic stroke. However, due to the lack of high-quality clinical research, there is no corresponding guide recommendation in children, which greatly limits its clinical application. There are some cases of mechanical thrombectomy in children and a few retrospective studies show that it is safe and effective in children in the world, but there are also some challenges. The article reviewed the challenges and implementation plan of thrombectomy in children to provide reference for clinical practice.
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Objective To analyze the clinical efficacy of acupuncture and moxibustion in treating acute cerebral infarction.Methods A thorough literature search of randomized and controlled tests of acupuncture and moxibustion in treating the acute cerebral infarction was conducted.A meta-analysis was performed using version 5.3 of the ReviewManager software.Results Thirty-nine reports covering 3792 cases were found and analyzed.The neurologic impairment analysis found that in the experimental group mean difference (MD) was-1.86,with the 95％ credibility interval (CI) of between-2.06 and-1.66 showing significant differences compared with the control group.The average clinical effectiveness rate of the experimental groups was 3.95,with a 95％ CI of between-3.02 and 5.16,significantly higher than the control groups'.The experimental groups' markedly effective rate was 1.54,with a 95％ CI of 1.40 to 1.70,showing significant differences compared with the control groups.Conclusion Acupuncture and moxibustion are effective in treating acute cerebral infarction.They are worth popularizing in clinical practice.
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Objective To evaluate the curative effect of imipenem on stroke associated pneumonia(SAP).Methods Seventy-two inpatients with SAP in ICU of the Affiliated Hospital of Southwest Medical University from January 2014 to January 2016 were selected.The patients were given the stroke associated treatment and symptomatic treatment.On this basis imipenem 1.0 g+ 0.9％ normal saline 100 mL was injected,once per 8 h.The disease condition change during treatment process was observed.The laboratory test results and chest CT changes were compared between before and after 2-week treatment.And the correlation analysis of risk factors was performed.Results Twelve cases died during treatment,60 cases were survival.The body temperature was declined to normal at 2 weeks after using imipenem.The NIHSS score,white blood cell (WBC) count,neutrophil count and C-reactive protein level after treatment were decreased compared with before treatment,the blood gas analysis showed that the arterial partial pressure of oxygen and oxygenation index were elevated compared with before treatment.The chest CT showed that pulmonary inflammatory exudation lesions and hydrothorax were absorbed and improved compared with before treatment.Among 72 cases,55 cases were cured,5 cases were remarkably effective,12 cases were ineffective,the total effective rate was 83.3 ％.The risk factors correlation analysis indicated that swallowing dysfunction,consciousness disturbance and acute attack history of chronic obstructive pulmonary disease were negatively correlated with the curative effect.Conclusion Imipenem has satisfactory effect in treating SAP.
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Objective To explore the effects of vasoactive intestinal peptide (VIP)on the ratio of CD4+CD25+Treg/CD4+T cell and the expression of TGF-β1 in experimental autoimmune encephalomyelitis (EAE)rats. Methods We randomly divided 60 healthy female Wistar rats into normal control group,EAE control group,VIP low-dose group and VIP high-dose group.We used myelin basic protein (MBP)+ complete adjuvant (CFA)to establish EAE model. Since the day of model construction, the low- and high-dose VIP groups received intraperitoneal injection of 4 nmol/kg (0.2 mL)and 16 nmol/kg (0.8 mL)of VIP every other day,respectively;normal control group and EAE group received injection of saline of 0.8 mL for 10 days in a row.We recorded the peak of neurological dysfunction score (NDS)changes in the rats,observed the pathological changes and GFAP+astrocyte activation in the brain at the morbidity peak of rats with HE staining,and detected the ratio of CD4+CD25+Treg/CD4+T in the spleen with FACS and TGF-β1 cytokine level in brain tissue with ELISA.Results The peak nerve dysfunction score was decreased in each VIP dose group.In normal control group,there were decreased inflammatory cell infiltration and decreased number of active astrocytes in the brain tissue.The degree of infiltration of inflammatory cells and astrocyte activation in VIP control groups were significantly lower than those in EAE group.The CD4+CD25+Treg/CD4+T cell ratio of the spleen tissue in each dose VIP treated group rats was higher than that in EAE control group.The cytokine level of TGF-β1 in the brain tissue increased in each VIP dose group in the dose-dependent manner.Conclusion Through up-regulating the ratio of CD4+CD25+Treg/CD4+T cell in the spleen tissue,increasing TGF-β1 content in brain tissue,and inhibiting the infiltration of inflammatory cells and the astrocyte activation,VIP plays an important role in prevention and control of EAE.
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Objective To investigate the effect of doxycycline on the Th1/Th2 cell balance in experimental allergic encepha-lomyelitis(EAE)rats.Methods Forty female Wistar rats were randomly divided into the EAE control group,low,medium and high does DOX treatment groups,10 cases in each group.The onset situation in rats was observed.The IL-4 and IFN-γlevels secreted by peripheral blood mononuclear cells (PBMC)at the peak stage were detected.The levels of IL-1β,IL-10,TNF-αin brain tissue,and the albumin content in cerebrospinal fluid and serum were detected.The QA value was calculated.Results In each DOX group,the clinical symptoms of rats were alleviated compared with the EAE control group.In each DOX group,the PBMC secreting IFN-γlev-el and IFN-γ/IL-4 ratio in the onset peak stage were lower than those in the EAE control group,while the IL-4 level was higher than that in the EAE control group(P 0.05),but the difference between other DOX groups had statistical significance(P <0.01).The IL-1βand TNF-αlevels of brain tissue and QA value during onset peak stage in various doses DOX groups were decreased compared with the EAE control group,while the IL-10 level was increased compared with the EAE control group(P <0.05).With the DOX dose increasing,the levels of IL-1β,TNF-αand QA value in various doses DOX groups became lower,the IL-10 level became high-er,there was statistically significant difference among various doses DOX groups (P <0.05 ).Conclusion DOX can obviously alle-viate the clinical symptoms of EAE rats,its mechanism may be related with that DOX could decrease the level of Th1 cytokine and increase the level of Th2 cytokine,correct the Th1/Th2 cell balance,thus protect the blood brain barrier(BBB).
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Objective To discuss the effects of Paclitaxel(PTX) on levels of CD28 and CTLA-4,B lymphocyte stimulator(BAFF) in experimental autoimmune encephalomyelitis(EAE).Methods The 50 rats were divided into 5 groups by the random number table, 10 rats in each group,the doses of small group,Middle group, High group were 1 mg/kg,2 mg/kg,4 mg/kg by intraperitoneal injection for 10 consecutive days, the normal group and model group were injected 0.9% NS 2 mL,Using brain tissue score to estimate the neurological dysfunctions of rats.Using flow cytometry to detect the levels of CD28 and CTLA-4,using enzyme-linked immunosorbent (ELISA) to detect the levels of BAFF.Results The brain tissue score in PTX experimental groups were lower than model group,the comparative differences between groups were statistically significant(P < 0.01);The levels of CD28 in PTX groups were lower than EAE group,the comparative differences between groups were statistically significant(P < 0.01).The levels of CTLA-4 in PTX groups were higher than EAE group,the comparative differences between groups were statistically significant(P < 0.01);the content of BAFF in all PTX groups were lower than EAE control group.Conclusions PTX could decrease the brain tissue score,the mechanism may adjust the express of CD28、CTLA-4 in brain and the expression of BAFF.PTX may have preventive and therapeutic effects on EAE rats.
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Objective To evaluate the curative effect of imipenem on stroke associated pneumonia(SAP).Methods Seventy-two inpatients with SAP in ICU of the Affiliated Hospital of Southwest Medical University from January 2014 to January 2016 were selected.The patients were given the stroke associated treatment and symptomatic treatment.On this basis imipenem 1.0 g+ 0.9％ normal saline 100 mL was injected,once per 8 h.The disease condition change during treatment process was observed.The laboratory test results and chest CT changes were compared between before and after 2-week treatment.And the correlation analysis of risk factors was performed.Results Twelve cases died during treatment,60 cases were survival.The body temperature was declined to normal at 2 weeks after using imipenem.The NIHSS score,white blood cell (WBC) count,neutrophil count and C-reactive protein level after treatment were decreased compared with before treatment,the blood gas analysis showed that the arterial partial pressure of oxygen and oxygenation index were elevated compared with before treatment.The chest CT showed that pulmonary inflammatory exudation lesions and hydrothorax were absorbed and improved compared with before treatment.Among 72 cases,55 cases were cured,5 cases were remarkably effective,12 cases were ineffective,the total effective rate was 83.3 ％.The risk factors correlation analysis indicated that swallowing dysfunction,consciousness disturbance and acute attack history of chronic obstructive pulmonary disease were negatively correlated with the curative effect.Conclusion Imipenem has satisfactory effect in treating SAP.
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Objective To investigate the effects of minocycline on regional cerebral blood flow and the expression of endothe-lin-1(ET-1) in ischemic penumbra of rats after focal cerebral ischemia reperfusion injury .Methods Middle cerebral artery occlusion (MCAO) with nylon suture was used to be established as focal cerebral ischemia reperfusion mode (I/R) ,a total of 35 male Spra-geue-Dawley rats were randomly divided into 3 groups :sham-operated group(n= 10) ,model group(n= 15) and minocycline group (n= 15) .After 24 hours of I/R ,The neurobehavioral function of rats was evaluated by Longa′s test ,the regional cerebral blood flow in ischemic penumbra was assessed with laser-Doppler flowmetry .After 6 and 24 hours of I/R ,the expression of ET-1 in peri-in-farct region was measured by both immunohistochemistry and radioimmunoassay .Results Compared with sham-group ,the Longa′s test scales ,ET-1 protein expression increased and the rCBF decreased in ischemic penumbra in model group(P< 0 .05) .the Longa′s test scales ,ET-1 protein expression decreased and the rCBF decreased in ischemic penumbra in minocycline group when compared to the model group(P< 0 .05) .Conclusion Minocycline could promote neurological functional recovery of rats after MCAO ,which might be attributed to increase the cerebral blood flow and regulate the endothelin-1 expression in ischemic penumbra .
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OBJECTIVE:To study the protective effect of sivelestat sodium on experimental autoimmune encephalomyelitis (EAE) model rats. METHODS:60 Wistar rats were randomly divided into normal control group (normal saline),model group (normal saline),positive drug group [prednisone acetate tablets 5 mg/(kg·d)] and sivelestat sodium low-dose,middle-dose and high-dose groups [5,8,10 mg/(kg·d)] with 10 rats in each group. Except for normal control group,other groups were given guin-ea pig spinal cord homogenate as antigen to produce EAE model,and then given relevant medicine ip since the same day of model-ing,for consecutive 16 d. The neurologic function of mice was scored,and pathological changes of brain and spinal cord were ob-served;the content of IFN-γ,IL-4,CCL3,chemotactic factor CCL5 regulating and activating normal T cell expression and secre-tion were determined. RESULTS:Compared with normal control group,neurological function score and the content of IFN-γ, CCL5 and CCL3 increased,while IL-4 content decreased (P0.05). Above effect depended on drug dose. CONCLUSIONS:Sivelestat sodium can relieve myelinoclasis and inflammatory cell infiltration,and the mechanism may be related to the decrease of IFN-γ content, the increase of IL-4 content,and inhibition of CCL3 and CCL5 expression in peripheral blood.
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Objective To explore the effect of vasoactive intestinal peptide (VIP) on the content of IL-17A in the brain tissue of rat models of experimental autoimmune encephalomyelitis ( EAE) .Methods Sixty healthy female Wistar rats were randomly divided into normal control group, EAE control group, low-dose VIP group and high-dose VIP group. Ten healthy guinea pigs were used to prepare anti-IL-17A antibody.Myelin basic protein ( MBP) +complete adjuvant ( CFA) were used to establish the EAE model.Since the first day of modelling, the low-dose and high-dose VIP groups received intraperitoneal injection of VIP 4 nmol/kg (0.2 mL) and 16 nmol/kg (0.8 mL), respectively, every other day for 10 consecutive days.The normal control group and EAE group were injected with 0.8 mL saline instead of VIP.The incubation period, progression and the peak of neurological dysfunction scores ( NDS) of the rats were recorded.The levels of IL-17A in the brain tissue was determined by ELISA assay, and the GFAP+astrocyte activation in brain at morbidity peak in the rats was examined using anti-GFAP ( glial fibrillary acidic protein) antibodies.Results The incubation period were extended, the progression period was shortened and the peak neuological dysfunction score ( NDS) was decreased in the VIP-treated groups, in a dose-response relationship.The cytokine levels of IL-17A and the astrocyte activation degree in brain tissue were reduced in each VIP dose group, in a dose-response relationship.Conclusions VIP exerts therapeutic effect on experimental autoimmune encephalomyelitis through lowering the IL-17A content and inhibition of astrocyte activation in the brain tissue.
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Objective To explore the effect of vasoactive intestinal peptide ( VIP) on the prevention and treatment of experimental autoimmune encephalomyelitis(EAE) rats by regulating the levels of IFN-γand IL-17A in brain tissue. Methods Sixty healthy female Wistar rats were randomly divided into 4 groups:normal control group, EAE control group, VIP low-dose group and VIP high-dose group.Myelin basic protein ( MBP)+complete Freurd′s adjuvant ( CFA) was used to establish an EAE model.The low and high-dose VIP groups were intraperitoneally injected with VIP 4 nmol/kg(0.2 ml) and 16 nmol/kg (0.8 ml) respectively every other day,while normal control group and EAE group with 0.8 ml saline for ten consecutive days.The incubation period, progression and peak of neurological dysfunction score ( NDS) changes of rats were recorded.The pathological changes, the GFAP+astrocyte activation in the brain at the morbidity peak of rats and the cytokine levels of IFN-γand IL-17A in brain tissue were observed.Results The incubation period was extended, the progression and peak NDS were shortened in the two VIP groups.In normal control group, there was no inflammatory cell infiltration or active astrocytes in brain tissue.The degree of infiltration of inflammatory cells and the degree of astrocyte activation in the VIP control group were significantly lower than in the EAE group.The cytokine levels of IFN-γand IL-17A in brain tissue were reduced in VIP groups.Conclusion By lowering IFN-γand IL-17A content in brain tissue, the infiltration of inflammatory cells and astrocyte activation are inhibited.VIP plays an important role in prevention and control of EAE.
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Objective To investigate the etiological, clinical and neuroimaging features of symmetric corpus callosum lesions. Methods The clinical data of 27 patients with symmetric corpus callosum lesions were analyzed including the etiological, clinical and neuroimaging data retrospectively. Results In 27 patients, 16 patients suffered from chronic alcoholic encephalopathy, 5 patients suffered from viral encephalitis, 2 patients suffered from disturbance of water and electrolyte, 1 patient suffered from acute disseminated encephalomyelitis(ADEM), 2 patients suffered from brain trauma, and the etiology of 1 patient was unknown. Clinical manifestation: 8 patients had conscious disturbance, 5 patients had psychological and behavior disorder, 5 patients had epileptic seizure, 4 patients had ataxia, 3 patients had dysarthria and 2 patients had headache. There were abnormalities in CT scans and MRI. Manifestations in CT scans were symmetric low-density focus with clear boundary in corpus callosum. The performance in MRI was low-signals on T1WI but high signals on T2WI and DWI images, and there might be other intracranial lesions. In the follow-up period, foci disappeared in 15 patients, and foci persisted in 7 patients. Four patients lost in follow-up periods, and 1 patient was not followed up because of death. Conclusions The causes of symmetric corpus callosum lesions include chronic alcoholic encephalopathy, infections, disturbance of water and electrolyte and demyelination. And in some patients the cause is unknown up to now. The etiological treatment and symptomatic treatment are the common treating ways in clinic.
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Objective To analyze the clinical features and image characteristic of neuro-Behcet disease with epileptic seizure as the primary symptom. Methods The data of 4 patients with neuro-Behcet disease with epileptic seizure as the first symptom were collected and retrospectively analyzed. Results One patient had recurrent joint pain in the department of dermatology, and 1 patient had blurred vision in the department of ophthalmology. They were shifted to department of neurology because of epileptic seizure. Head CT of four patients were normal. There were abnormal signal in brainstem in 2 cases, and in the other 2 cases, there were symmetry abnormal signals in periventricle, centrum semiovale. The abnormal signal was low in T1 weighted image and high in T2 weighted image, flair, diffuse weighing imaging , but there were no abnormal signals in cortex in these 4 cases. In CSF examination, 3 patients′cell number was high, 1 patient′s cell number was normal, 2 patients′protein levels were high, and the other 2 patients′protein levels were normal. One patient had spike wave and sharp wave in video-EEG, and the other 3 patients were normal. Conclusions Epileptic seizure is rare in neuro-Behcet disease, and CT and MRI is frequently-used in diagnosing nervous system disease. There are no abnormal signals in cortex, but there are generalized tonic-clonic seizure, which may relate with the abnormal discharge of cortex.
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Objective To investigate immunological mechanism underlying leflunomide ( LEF ) against experimental allergic encephalomyelitis ( EAE) by studying the effects of LEF on peripheral blood CD28/CTLA-4 costimulatory molecules expression in guinea pig with EAE.Methods 50 adult female guinea pigs were randomly divided into normal control group,low dose group,EAE control group,middle dose group,and high dose group, 10 guinea pigs in each group respectively.Low, medium and high dose group were treated with LEF 10 mg/kg· D, 20 mg/kg· D and 40 mg/kg· D orally, 1 times/day, to the termination of the experiment.The expression of CD28, CTLA-4 were detected by flow cytometry, incidence was recorded at the same time.Results Compared with EAE control group,high dose and middle dose group incubation period were prolonged, progress period were shorten and neurological dysfunction score decreased(P<0.05).Compared with normal control group, the expression of CD28 of EAE control group increased and the decreased expression of CTLA-4 (P<0.05).High, middle dose treatment group compared with EAE control group CD28 down regulated expression (P<0.05), but the expression of CTLA-4 increased(P<0.05).Among the treatment groups, of CD28 molecules with high dose group decreased significantly(P<0.05), the expression of CTLA-4 molecules with high dose treatment groups upregulated significantly (P<0.05).Correlation analysis showed that the EAE control group, the treatment group the CD28/CTLA-4 ratio in peripheral blood and nerve dysfunction score is proportional ( r=0.85, P=0.002; r=0.77, P=0.000).Conclusion LEF can reduce EAE guinea pig neurological symptoms, the better and the higher dose effect.Its mechanism may be through down-regulation of CD28 molecules in peripheral blood, upregulation of the expression of CTLA-4 molecule.so as to reduce the inflammatory response, relieve the clinical symptoms.
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Objective To investigate the value of the Changsha version of the Montreal Cognitive Assessment Scale (MoCA) in the assessment of vascular cognitive impairment after cerebral infarction .Methods 112 cases of clinically diagnosed cerebral infarc-tion were selected and divided into the normal cognition (NC) group and vascular cognitive impairment(VCI) group .The Changsha version of MoCA and the mini-mental state examination(MMSE) were adopted to detect the cognitive function ,the correlation of two scales was analyzed and the cutoff values of the Changsha version of MoCA were preliminarily studied .Results The total scores of the Changsha version of MoCA and MMSE in the VCI group were 15 .12 ± 4 .60 and 20 .44 ± 3 .22 respectively ,which were lower than 22 .75 ± 1 .79 and 25 .21 ± 1 .74 in the NC group ,the difference had statistical significance (P< 0 .05);the total scores of the Changsha version of MoCA was positively correlated with the total scores of MMSE (r=0 .84 ,P<0 .01);the best cut-off value of the Changsha version of MoCA was 20/21 ,the sensitivity and specificity were 92% and 95% respectively .Conclusion The Changsha version of MoCA can screen VCI well and has a high screening value ,and its optimal cutoff value is 20/21 .
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Erythropoietin (EPO) is a hematopoietic growth factor that has a specific role on erythroid progenitor cells. Recent studies have suggested that EPO has the important neuroprotective effect on brain damage following stroke, and its major mechanisms include neurotrophy, anti-neuronal apoptosis, inhibition of secondary inflammatory response and excitatory amino acid toxicity, maintenance of vascular integrity and promoting angiogenesis, promoting neurogenesis, as well as anti-oxidative stress.
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OBJECTIVE: At present the function of Fas and Bcl-2 gene in the pathogenesis of myasthenia gravis has gained more attention and more studies have been extensively made inside and outside, to investigate the modulation of Fas and Bcl-2 gene expression is of extremely significance for exploring the pathogenesis and treatment of myasthenia gravis.DATA SOURCE: The related articles published in English from January 1990 to December 2004 were computer searched in Medline database using the terms of "Fas", "Bcl-2", "Myasthenia Gravis" and "gene".STUDY SELECTION: The data were identified preliminarily and literatures on the relationship between Fas and Bcl-2 gene and myasthenia gravis, as well as on Fas and Bcl-2 gene and genotherapy were remained for searching the full content.DATA EXTRACTION: A great deal of literatures about Fas and Bcl-2 gene were searched, 21 of which were studies on Fas and Bcl-2 gene and myasthenia gravis, and 32 on myasthenia gravis related genotherapy. A total of 20 representative articles were selected for analysis in this study.DATA SYNTHESIS: Eight out of 20 literatures were about the relationship between Fas gene and myasthenia gravis, 5 about the Bcl-2 gene and myasthenia gravis, 7 about the genotherapy in the treatment of myasthenia gravis and immune diseases.CONCLUSION: Abnormal Fas and Bcl-2 gene modulation and uncontrollable expression were closely associated with apoptosis defect of T lymphocyte and thymocytes, and even closely related to the pathogenesis of myasthenia gravis. To explore pathogenesis of myasthenia gravis at gene level by inducing cell apoptosis and depressing self-antibody production, would provide new means for the treatment of myasthenia gravis.
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Objective To explore the effect of tumor necrosis factor-alpha(TNF-?) on brain damage following experimental intracerebral hemorrhage(ICH) in rats.Methods We induced intracerebral hemorrhage models of rats with injecting autologous blood into the left caudate.The levels of TNF-? and water contents in perihematoma at different stages were examined by radioimmunoassay and wet-dry weight measurement,and neurobehavioral outcomes were assessed in the meanwhile.Results The levels of TNF-? at 12~96 h in ICH group were higher than those in control group(all(P
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Objective To understand the pathogenetic role and clinical significance of interleukin 6(IL－ 6 ),tumor necrosis factor(TNF) and soluble interleukin－ 2 receptor(sIL－ 2R) in patients with cerebral infarction(CI) .Methods The IL－ 6,TNF and sIL－ 2R levels were measured in 46 CI patients with ELISA. Results The serum IL－ 6,TNF and sIL－ 2R levels of CI group were much higher than those of controls group .The variation of IL－ 6,TNF and sIL－ 2R levels was closely related to the size of cerebral infarction. The serum IL－ 6,TNF and sIL－ 2R levels of recovery period were much lower than those of acute period in patients with CI .Conclusions The IL－ 6 ,TNF and sIL－ 2R take part in the pathologic process after CI .The measurement of IL－ 6, TNF and sIL－ 2R is useful in determining the size of cerebral infarction.
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Objective To investigate the pharmacodynamic action of Yunkang Capsule(YKC).Methods The animals were divided into YKC groups(at high-,moderate-and low-dosage respectively),diphenidol control group,model control group and blank control group.The action of YKC on vertigo and thrombosis,hemorrheologic indexes,piamatral microcirculation and free radicals of the animal models were observed.Results YKC could significantly prolong the latency of vertigo,reduce wet weight of thrombus,decrease blood viscosity,plasma viscosity and hematocrit,promote the dilation of piamatral micro-vessels,increase the amount of interweave microdot,increase plasma SOD activity and decline plasma MDA content of animal models.Conclusion YKC has actions of counteracting vertigo and thrombosis,improving hemorrheology and microcirculation,and clearing away free radicals.