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Objective@#To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors.@*Methods@#The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People′s Hospital from May 2016 to December 2018 were retrospectively reviewed. All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis. The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)<30%) was quantitatively assessed based on CT perfusion images using MIStar software, and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis. The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml. Then the clinical and imaging features of the patients between reversible group and irreversible group were compared, and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis.@*Results@#Finally, 97 patients were enrolled in the present study, of which 64 (66%) patients achieved successful recanalization, 51 (53%) patients with reversible baseline ischemic core. For patients with recanalization, the incidence of reversibility was 76% (26/34), 71% (17/24), 2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) <3.0 h, 3.0-4.5 h, 4.6-6.0 h, and >6.0 h, respectively. In the non-recanalization group, six patients were also showed with ischemic core reversibility, including 4 (4/12) in the ONT<3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group. It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805, P<0.001) by Spearman correlation analysis. Finally, binary Logistic regression analysis revealed that the history of hypertension, ONT and recanalization were independent predictors of reversible changes of baseline ischemic core.@*Conclusions@#The ischemic core defined by CT perfusion imaging (rCBF<30%) was considerably inaccurate for patients with ONT<6.0 h. If recanalization could be achieved within this time window, most of the patients would manifest with ischemic core reversibility, the predictors of which also included hypertension history and ONT.
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Objective:To investigate the expression of myeloid-derived suppressor cells (MDSCs) and cytokines in peripheral blood of patients with ankylosing spondylitis (AS).Methods:From June 2018 to June 2019, 50 AS patients (AS group) and 50 healthy people (control group) in Lishui People's Hospital were selected in this study.The number of PMN-MDSC and monocyte MDSC(M-MDSC) and the expression of cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α, γ-IFN and IL-17) in the peripheral blood were detected by flow cytometry.The differences of MDSCs expression frequency in each group and its relationship with cytokine expression were analyzed.Results:The PMN-MDSC, M-MDSC and IL-6 in peripheral blood of the AS group were (0.22±0.08)%, (1.48±0.32)% and (20.74±5.14)ng/L, respectively, which were significantly higher than those of the control group[(0.06±0.02)%, (0.43±0.11)% and (2.52±0.53)ng/L], and the differences were statistically significant ( t=7.933, 6.310, 10.553, all P<0.05). Conclusion:IL-6 may be one of the reasons to promote the infiltration and recruitment of MDSCs, and the increase of MDSCs may be related to the occurrence and development of immune tolerance after ankylitis infection.
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Objective To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors.Methods The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People's Hospital from May 2016 to December 2018 were retrospectively reviewed.All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis.The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)＜30％) was quantitatively assessed based on CT perfusion images using MIStar software,and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis.The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml.Then the clinical and imaging features of the patients between reversible group and irreversible group were compared,and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis.Results Finally,97 patients were enrolled in the present study,of which 64 (66％) patients achieved successful recanalization,51 (53％) patients with reversible baseline ischemic core.For patients with recanalization,the incidence of reversibility was 76％ (26/34),71％ (17/24),2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) ＜3.0 h,3.0-4.5 h,4.6-6.0 h,and ＞6.0 h,respectively.In the non-recanalization group,six patients were also showed with ischemic core reversibility,including 4 (4/12) in the ONT＜3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group.It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805,P＜0.001) by Spearman correlation analysis.Finally,binary Logistic regression analysis revealed that the history of hypertension,ONT and recanalization were independent predictors of reversible changes of baseline ischemic core.Conclusions The ischemic core defined by CT perfusion imaging (rCBF＜30％) was considerably inaccurate for patients with ONT＜6.0 h.If recanalization could be achieved within this time window,most of the patients would manifest with ischemic core reversibility,the predictors of which also included hypertension history and ONT.
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Objective To investigate the effects of valproic acid ( VPA ) on SD rats with experimental autoimmune encephalomyelitis ( EAE) and its possible immunomodulatory mechanism .Meth-ods Fifty female Sprague-Dawley ( SD) rats were randomly divided into five groups by random digit table , including control group (n=10), EAE group(n=10), low dose VPA treated group (100 mg/kg, n=10), median dose VPA treated group (300 mg/kg, n=10) and high dose VPA treated group (600 mg/kg, n=10).The SD rat model of EAE was induced by immunizing with a guinea pigs′spinal cord homogenate (GPSCH).Normal saline and various doses of VPA were given to rats in according groups twice a day from day 0 to day 19 ( close to the peak stage of EAE ) .The severity of EAE was scored according to the signs and symptoms.Pathological changes were observed through Hematoxylin-Eosin staining, and then the degrees of inflammatory infiltration were evaluated .The numbers of activated neuroglia that expressed Iba-1 in cerebral and lumber cords were counted by immunohistochemistry .The expression of IFN-γ, IL-17 and IL-10 in cer-ebral and lumber cords were measured by ELISA .Results Compared with EAE group , rats in the low, me-dian and high dose VPA treated groups had lower incidence of EAE and prolonged latency , but only the me-dian dose treated group showed significant alleviation in clinical symptoms (P<0.05).Both the median and the high dose treated group showed decreased inflammatory cell infiltration in CNS (P<0.05).Immunohisto-chemistry results showed that the numbers of activated microglia were significantly inhibited in rats treated with median and high dose of VPA in comparison with those in EAE group (P<0.05).Results of ELISA demonstrated that the expression of IFN-γand IL-17 in both median and high dose VPA treated groups were significantly decreased compared with those in EAE group (P<0.05), but only the median dose treated group showed a remarkably increased expression of IL-10 (P<0.05).Conclusion VPA, especially medi-um dose of VPA ( 300 mg/kg ) , had neuroprotective effects on rats with EAE .The possible mechanism might be associated with the inhibited activation of microglia and the increased percentage of anti -inflammato-ry cytokines .