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Objective To evaluate the cognitive impairment in elderly patients with minor ischemic stroke and to analyze risk factors for stroke recurrence.Methods This was a retrospective case-control study.Ninety-five elderly patients with acute ischemic stroke hospitalized in the neurology department of Second People's Hospital of Liaocheng were enrolled from January 2016 to January 2017.Based on the National Institutes of Health Stroke Scale(NIHSS),all cases were divided into the minor stroke group(NIHSS score≤3,n=62)and the medium-severe stroke group(NI HSS score＞ 3,n =33).After 12-month follow-up,the NIHSS,modified Rankin scale(mRS)and Montreal cognitive assessment (MoCA)were used to evaluate the study subjects.Results Of the 95 patients,there were 62 males(65.3％)and 33 females(34.7％),with age of(68.3 ± 6.7) years.No significant differences were found in baseline characteristics of age,male ratio,subtypes and history between two groups(all P＞0.05).But,the treatment rate of intravenous thrombolysis was lower in minor stroke group than in medium-severe stroke group [6.5 ％ (4 cases) vs.42.4 ％ (14 cases) (P ＜ 0.01)].The scores of NIHSS[(1.0±0.5)vs.(3.2± 1.1),P＜0.01],mRS[(1.6±0.7)vs.(2.4± 1.1),P＜0.01] were lower in the minor stroke group than in the medium-severe group.After a mean follow-up of(12.6± 1.9)months,the rate of cognitive impairment was comparable between the two groups(P ＞0.05),while the rate of post stroke depression had a significant difference between two groups(P＜0.05).Furthermore,there was lower rate of mortality and stroke recurrence in the minor stroke group than in the medium-severe group(0.0％ or 0/62 vs.30.3％ or 10/33,and 21.0％ or 13/62 vs.42.4％ or 14/33,P＜0.05).Cox proportional hazard model showed that baseline NIHSS score,diabetes and stroke history were the risk factors for stroke recurrence in patients with minor stroke(P＜0.05).Conclusions The treatment rate of intravenous thrombolysis with rt-PA,mortality rate and stroke recurrence rate are lower in patients with minor stroke than in patients with medium-severe stroke,while the incidence of post stroke cognitive impairment is high.High score of baseline NIHSS,diabetes and stroke history are risk factors for stroke recurrence in elderly patients with minor stroke.
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Objective@#To evaluate the cognitive impairment in elderly patients with minor ischemic stroke and to analyze risk factors for stroke recurrence.@*Methods@#This was a retrospective case-control study.Ninety-five elderly patients with acute ischemic stroke hospitalized in the neurology department of Second People's Hospital of Liaocheng were enrolled from January 2016 to January 2017.Based on the National Institutes of Health Stroke Scale(NIHSS), all cases were divided into the minor stroke group(NIHSS score≤3, n=62)and the medium-severe stroke group(NIHSS score>3, n=33). After 12-month follow-up, the NIHSS, modified Rankin scale(mRS)and Montreal cognitive assessment(MoCA)were used to evaluate the study subjects.@*Results@#Of the 95 patients, there were 62 males(65.3%)and 33 females(34.7%), with age of(68.3±6.7)years.No significant differences were found in baseline characteristics of age, male ratio, subtypes and history between two groups(all P>0.05). But, the treatment rate of intravenous thrombolysis was lower in minor stroke group than in medium-severe stroke group[6.5%(4 cases)vs.42.4%(14 cases)(P<0.01)]. The scores of NIHSS[(1.0±0.5)vs.(3.2±1.1), P<0.01], mRS[(1.6±0.7)vs.(2.4±1.1), P<0.01]were lower in the minor stroke group than in the medium-severe group.After a mean follow-up of(12.6±1.9)months, the rate of cognitive impairment was comparable between the two groups(P>0.05), while the rate of post stroke depression had a significant difference between two groups(P<0.05). Furthermore, there was lower rate of mortality and stroke recurrence in the minor stroke group than in the medium-severe group(0.0% or 0/62 vs.30.3% or 10/33, and 21.0% or 13/62 vs.42.4% or 14/33, P<0.05). Cox proportional hazard model showed that baseline NIHSS score, diabetes and stroke history were the risk factors for stroke recurrence in patients with minor stroke(P<0.05).@*Conclusions@#The treatment rate of intravenous thrombolysis with rt-PA, mortality rate and stroke recurrence rate are lower in patients with minor stroke than in patients with medium-severe stroke, while the incidence of post stroke cognitive impairment is high.High score of baseline NIHSS, diabetes and stroke history are risk factors for stroke recurrence in elderly patients with minor stroke.
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Electroacupuncture preconditioning can alleviate the nerve defect after cerebral ischemia injury, induce cerebral ischemic tolerance and exert the certain protective effect on brain, which may be involved in regulating endocannabinoid system, inhibiting exitotoxicity, inhibiting oxidative stress, inhibiting endoplasmic reticulum stress, inhibiting inflammatory response, protecting blood-brain barrier, inhibiting apoptosis and regulating autophagy, etc.
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Objective To investigate clinical characteristics and medium-term prognosis of the advanced elderly patients with mild ischemic stroke,and to evaluate the risk factors for poor clinical outcome.Methods The 574 elderly patients with mild acute ischemic stroke admitted in neurology department of our hospital were retrospectively studied from January 2016 to December 2017.All cases were divided into the advanced elderly group(n=276,≥80 years old)and elderly patient group(n=298,60-79 years old).Clinical characteristics were analyzed.After 12-month follow-up,the mid-term prognosis and risk factors for poor clinical outcome(mRS≥ 3)were analyzed in the two groups.Results Compared with the elderly patients,the advanced elderly patients were more often complicated with history of atrial fibrillation,diabetes and stroke(P ＜0.05).The scores of National Institute of Health stroke scale(NIHSS)and Modified Rankin Scale(mRS)were higher in the advanced elderly patients than in the elderly patients(1.37± 1.03 vs.0.94 ±0.43,2.79± 1.27 vs.1.92 ± 0.66,P＜0.001).The proportion of patients receiving anticoagulation treatment were lower in the advanced elderly patients than in the elderly patients,with no significant difference(P ＞0.05).After an average follow-up of(11.3 ± 1.5) months,the proportions of poor clinical outcome and mortality were higher in the advanced elderly patients than in the elderly patients(63.4％ or 175/276 vs.48.0％ or 143/298,25.7％ or 71/276 vs.16.1％ or 48/298,P＜0.05).Cox proportional hazard model analysis showed that age,baseline NIHSS score and mRS score,diabetes and stroke history were the risk factors for poor clinical outcome in elderly patients with mild ischemic stroke(all P＜0.05).Conclusions The advanced elderly patients with mild ischemic stroke have a severe clinical condition,higher rates of atrial fibrillation,diabetes and stroke history,and poor mid-term prognosis.Age,baseline scores of NIHSS and mRS,diabetes and stroke history are the risk factors for poor clinical outcome in elderly patients with mild ischemic stroke.
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Objective To explore the levels of serum alkaline phosphatase ( ALP) as well as its impact on the cognitive impairment in patients with subcortical ischemic vascular disease ( SIVD).Methods One hundred and fifty-eight SIVD patients were divided into two subgroups which included 86 patients with mild cognitive impairment ( SVMCI ) and 72 patients with vascular dementia ( SVaD ) according to the severity of cognitive impairment.Sixty-seven old people with normal cognitive function were selected as control qruop.Multiple lacunar infarction ( LI) or leukoaraiosis ( LA) was detected according to their MRI scan appearances and graded LA according to the severity.Serum ALP was measured by an enzymatic method as well as the Mini-Mental State Examination ( MMSE) and the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C) were used in assessments.Serum ALP was divided into 3 groups and the occurrence rate of LI , LA and cognitive impairment were compared with each other.The levels of ALP were compared in different cognitive impairment and Logistic regression was used to explore the relation between ALP and cognitive impairment.Results Both SVaD and SVMCI groups (17.00 (13.00, 20.00), 59.50 (49.00, 68.75);25.00 (25.00, 26.00), 82.50 (76.75, 89.00)) showed significantly lower scores in MMSE and CAMCOG-C than control group (28.00 (28.00, 29.00), 93.00 (89.00, 96.00); Z=187.337, P=0.000; Z=150.480, P=0.000).A positive relationship between the elevated ALP level and the severity of cognitive impairment was found after adjusting for sex , age and other confunding factors ((68.60 ±15.52), (78.76 ±13.39), (86.75 ±18.85) U/L, F=22.587, P=0.000).The occurrence rate of LI, LA and SVaD among the three groups were significantly different (χ2 =8.008, P=0.018;χ2 =17.998, P=0.000;χ2 =12.255, P=0.002).The ALP level was negatively correlated with MMSE and CAMCOG-C scores ( r=-0.350, P=0.000; r=-0.286, P=0.000 ).Logistic regression analysis revealed the relation between ALP and cognitive impairment was positive when we controlled all the vascular risk factors.However , the relation had gone when futher adjusting for the grade of LA.Conclusions The level of ALP is significantly higher in SIVD patients and positively relates with cognitive impairment especially in those whose grade of LA is severe.
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Objective To investigate the protective effects of ursolic acid (UA) on global cerebral ischemic-reperfusion injury in rats.MethodsThe experimental rats were divided into the sham operation group, the model group, the UA low, medium and high dose groups, 20 in each group. Except the rats in the sham operation group, the rats in other groups were dealed by four arteries occlusion to made global cerebral ischemia-reperfusion model. The rats in the UA low, medium, high dose groups were given UA as 40, 80, 120 mg/kg immediately after the occlusion line was inserted; the rats in the sham operation group and the model group were given equal-volume saline. And 6 hours later, the recovery time of righting reflex and electrical activity of brain were recorded, water content of the brain were evaluated, and the activity of LDH, MDA, SOD, CAT in brain tissue were determined; the inflammatory cytokines content of TNF-α, IL-1β, IL-6 were determined by ELISA. Results Compared with the model group, the recovery time of righting reflex (20.6 ± 7.2 min, 18.2 ± 6.9 min vs. 27.3 ± 8.8 min) and electrical activity of brain (16.2 ± 5.8 min, 14.9 ± 5.6 min vs.24.1 ± 7.2 min) of the UA medium and high dose groups were shortened (P<0.05 orP<0.01); the water content were significantly decreased (79.0% ± 0.7%, 78.6% ± 0.5%vs. 80.7% ± 0.9%;P<0.05 orP<0.01); the activity of SOD (158.5 ± 8.4 U/mg, 165.4 ± 9.0 U/mgvs. 143.0 ± 7.1 U/mg), CAT (3.3 ± 1.4 U/mg, 3.9 ± 1.5 U/mgvs. 2.4 ± 0.9 U/mg) in brain tissue of the UA medium and the high dose groups were significantly improved; the content of LDH (16.0 ± 2.6 mmol/g, 18.4 ± 2.8 mmol/gvs. 12.4 ± 1.9 mmol/g) were significantly increased; the content of MDA (18.6 ± 2.8μmol/g, 17.2 ± 2.4μmol/gvs. 24.9 ± 3.4μmol/g), TNF-α (45.8 ± 6.3 nmol/L, 40.1 ± 5.6 nmol/Lvs. 56.3 ± 7.2 nmol/L), IL-6 (187.2 ± 18.5 nmol/L, 136.8 ± 15.7 nmol/Lvs. 238.4 ± 22.9 nmol/L) were significantly decreased, and the content of IL-1β in UA 120 mg/kg treated group was significantly decreased (713.6 ± 56.3 nmol/L vs. 915.7 ± 70.5 nmol/L;P<0.05 orP<0.01).Conclusion UA can effectively promote righting reflex and EEG recovery, reduce brain water content, which perhaps related with its pharmacological effects of enhanceing the activity of antioxidant enzymes, lower oxidative stress, and inhibit inflammation.
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High mobility group protein box 1 (HMGB1) is a typical nonhistone chromosomal protein. It has many celular functions in nucleus. Studies in recent years have showed that HMGB1 can be released to the outside of cels to exert a wide range of cytological effects. Ischemic stroke is one of the diseases with the highest morbidity and disability. More and more evidence has shown that HMGB1 plays a variety of important roles in the occurrence and development process of ischemic stroke. This article reviews the roles of HMGB1 in ischemic stroke.
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Efeitos do nitrosil rutênio na lesão cerebral induzida por isquemia e reperfusão em ratos. MARCIO WILKER SOARES CAMPELO. Pós-Graduação Stricto Sensu do Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará (Grau de Mestre em Cirurgia). Novembro, 2009. Orientador: Prof. Dr. Paulo Roberto Leitão de Vasconcelos. Introdução e objetivo: Doadores de NO podem diminuir a lesão neuronal durante a isquemia e reperfusão cerebral (I/R) por aumento do fluxo sanguíneo cerebral. O objetivo deste estudo é avaliar se um novo complexo de nitrosilo complexo de rutênio (Rut-bpy) capaz liberar NO direto na musculatura lisa vascular apresenta algum efeito durante I/R. Método: Foram utilizados 96 ratos machos, da linhagem Wistar, com peso médio de 290.27 g, distribuídos em 2 fases com 8 grupos cada: Fase de isquemia 4 grupos sham (SF, Rut-bpy,L-NAME e L-NAME+Rut-bpy) e 4 grupos isquemia (SF, Rut-bpy,L-NAME e L-NAME+Rut-bpy); da mesma forma foi dividido a fase de reperfusão ( 4 grupos sham e 4 grupos isquemia/reperfusão) com as mesmas drogas teste da fase de isquemia. Foi utilizado um modelo de isquemia cerebral global incompleta, com oclusão da artéria carótida comum bilateral e administração do SF, Rut-bpy e L-NAME via intraperitoneal. No final do experimento os animais foram decapitados e o cérebro fatiado para ser avaliado à área de lesão por histoquímica. Durante todo o experimento a PAM dos animais foi monitorizada...
Effects of nitrosyl ruthenium in injury brain induced by ischemia and reperfusion of rats.MARCIO WILKER SOARES CAMPELO. Stricto SensuPost-graduation. Department of Surgery, Medicine School, Federal University of Ceará (Degree of Master of Surgery). November, 2009. Advisor: Prof. Dr. Paulo Roberto Leitão de Vasconcelos. Background and purpose - Nitric oxide (NO) donors are known to reduce neuronal damage during brain ischemia and reperfusion by increasing the blood flow. Rut-bpy is a novel nitrosyl-ruthenium complex releasing NO directly into the vascular smooth musculature. The objective of the study was to evaluate the effect of Rut-bpy on a rat model of brain ischemia and reperfusion. Methods - Ninety-six male Wistar rats weighing approximately 290g were randomly assigned to 16 groups. Four groups and their respective sham groups were submitted to ischemia (Stage 1), while four groups and their respective sham groups were submitted to ischemia + reperfusion (Stage 2). At each stage of the experiment the groups were treated pairwise with saline solution (SS), Rut-bpy, L-NAME and L-NAME+Rut-bpy, respectively. The study was based on an incomplete global brain ischemia model with occlusion of the common bilateral carotid arteries and intraperitoneal administration of the study drugs. Following the experiment the animals were decapitated and the brain was sectioned for histochemical evaluation of the area of damage. The mean arterial blood pressure (MABP) was monitored throughout the experiment...
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Humans , Brain Ischemia , Oxidative Stress , Nitric Oxide , Ruthenium CompoundsABSTRACT
Objective To observe the efficacy and safety of rosuvastatin in the treatment of hyperlipidemia and carotid atherosclerotic plaque in young ischemic stroke patients.Methods In prospective study,264 young ischemic stroke patients with hyperlipidemia and carotid atherosclerotic plaque were randomly divided into low dose group,middle dose group,high dose group,88 cases in each group.All patients were given rosuvastatin immediately after dinner,in doses of 5mg,10mg,20mg,respectively,for eight months.Then,the changes of hyperlipidemia and carotid atherosclerotic plaque in the three groups were surveyed,and its safety by the observation of clinical symptoms and monitoring of adverse reactions after eight months were assessed.Results Before treatment,the blood fat and carotid atherosclerosis plaque index in the three groups had no statistically significant differences (all P >0.05). After treatment,the total cholesterol,triglycerides,low -density lipoprotein cholesterol of the high dose group were (1.67 ±0.68)mmol/L,(3.23 ±0.53)mmol/L,(1.83 ±0.62)mmol/L,which of the middle dose group were (1.93 ±0.74)mmol/L,(3.73 ±0.23)mmol/L,(2.24 ±0.73)mmol/L,which of the low dose group were (2.16 ± 0.77)mmol/L,(4.06 ±0.93)mmol/L,(2.93 ±0.35)mmol/L.These indicators were decreased than before treat-ment [(2.79 ±0.72)mmol/L,(5.40 ±0.67)mmol/L,(3.64 ±1.03)mmol/L,(2.75 ±0.81)mmol/L,(5.59 ± 0.95)mmol/L,(3.43 ±0.92)mmol/L and (2.83 ±0.53)mmol/L,(5.84 ±0.79)mmol/L,(3.83 ±0.88)mmol/L].The decrease of the high dose group was higher than the middle and low dose group,the difference was statistically significant(F =6.61,P 0.05),and no serious adverse reaction was found.Conclusion The high dose rosuvastatin treatment can reverse the nature of plaque, decrease the thickness of the plaques and lower blood lipid of young ischemic stroke with hyperlipidemia and carotid atherosclerotic plaque,which is better than middle and low dose,and has better security.There is no serious adverse reaction.It is worth for clinical promotion.
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Objective To investigate the effects of gastrodin on neural function and the expression of myelin basic protein (MBP) and neurofilament high molecular weight (NFH) in the striatum during cerebral ischemiareperfusion in mice.Methods 36 Kunming mice were randomly divided into sham group,MCAO group and gastrodin (GAS) group.The middle cerebral artery occlusion(MCAO) was established by artery embolization.The mice in sham group were received fake surgery and saline,and the mice in MCAO and GAS group were exposed to MCAO,and received saline and GAS (100 mg/(kg · d)) injection,respectively,immediately after the operation for 7 days.On the 8th day of operation,the neurological severity scores of the mice were observed and the volume ratio of the cerebral infarction was estimated by triphenyl tetrazolium chloride (TTC) staining.Immunohistochemistry was used to detect the MBP and NF-H in the striatum.Results (1) The mice in MCAO group showed significant neurologic deficient in comparison with sham group,and the neurological severity scores of gastrodin group(3.13±0.64) were significantly higher than that(1.38±0.52) of MCAO group (P＜0.05).(2) Results of TTC staining showed that the infarction volume was obviously larger in the injured cerebral tissue in MCAO group in comparison with sham group,and the volume ratio of the cerebral infarction significantly decreased after the intervention with GAS (P＜0.05).(3) The integral optical density of MBP(272968.14±1215.23) and NF-H(12 142.73±47.16) in MCAO group decreased as compared to that((43 855.23±2434.16),(275 321.00±926.15)) in sham group and GAS group((321 531.2±2376.14),(106 135.73±598.15)) (P＜0.05).Conclusion GAS can improve neural function of mice after middle cerebral artery occlusion,and it may play an important role in protecting myelin and nerve fibers of striatum.
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Brain ischemic tolerance refers to endogenous brain protective mechanism during severe ischemic injury of the body. Ischemia preconditioning is an effective mean to induce brain ischemic tolerance. However, the invasive and ethical limitation made the application of ischemic preconditioning difficult in the clinical practice. Studies found that extracellular signal regulated kinase (ERK) signaling pathway played an important role in the formation of brain ischemic tolerance. Meanwhile, brain ischemic tolerance induced by traditional Chinese medicine (TCM) had its unique advantages. This article reviewed effects of ERK signaling pathway in the inducing of brain ischemic tolerance and TCM intervention in recent years.
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Neural stem cells (NSCs) have been suggested as a groundbreaking solution for stroke patients because they have the potential for self-renewal and differentiation into neurons. The differentiation of NSCs into neurons is integral for increasing the therapeutic efficiency of NSCs during inflammation. Apoptosis signal-regulating kinase 1 (ASK1) is preferentially activated by oxidative stress and inflammation, which is the fundamental pathology of brain damage in stroke. ASK1 may be involved in the early inflammation response after stroke and may be related to the differentiation of NSCs because of the relationship between ASK1 and the p38 mitogen-activated protein kinase pathway. Therefore, we investigated whether ASK1 is linked to the differentiation of NSCs under the context of inflammation. On the basis of the results of a microarray analysis, we performed the following experiments: western blot analysis to confirm ASK1, DCX, MAP2, phospho-p38 expression; fluorescence-activated cell sorting assay to estimate cell death; and immunocytochemistry to visualize and confirm the differentiation of cells in brain tissue. Neurosphere size and cell survival were highly maintained in ASK1-suppressed, lipopolysaccharide (LPS)-treated brains compared with only LPS-treated brains. The number of positive cells for MAP2, a neuronal marker, was lower in the ASK1-suppressed group than in the control group. According to our microarray data, phospho-p38 expression was inversely linked to ASK1 suppression, and our immunohistochemistry data showed that slight upregulation of ASK1 by LPS promoted the differentiation of endogenous, neuronal stem cells into neurons, but highly increased ASK1 levels after cerebral ischemic damage led to high levels of cell death. We conclude that ASK1 is regulated in response to the early inflammation phase and regulates the differentiation of NSCs after inflammatory-inducing events, such as ischemic stroke.
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Animals , Male , Mice , Cell Death , Infarction, Middle Cerebral Artery/metabolism , Lipopolysaccharides/pharmacology , MAP Kinase Kinase Kinase 5/genetics , Mice, Inbred C57BL , Microtubule-Associated Proteins/genetics , Neural Stem Cells/cytology , Neurogenesis , Neuropeptides/genetics , p38 Mitogen-Activated Protein Kinases/geneticsABSTRACT
Objective To analyze the stroke subtypes and influencing factors in four largest economic regions of China.Methods We analyzed the investigation data of QUEST(Quality Evaluation of Stroke Care and Treatment)study conducted in 2006 which included 62 hospitals in a national scale.According to the concept of four economic regions designed by the Development Research Center of the State Council,we performed the univariate and multivariate analysis for the stroke subtypes and its related risk factors in the different economic regions.Results There were 3362(73.5％)ischemic stroke patients and 1214(26.5％)hemorrhagic stroke patients among the total 4576 first-ever stroke patients.Comparison of stroke subtypes in the four different economic regions was statistically significant(P ＜ 0.001),with a percentage of 80.8％ ischemic stroke patients in the northeastern region,78.9％ in the eastern region,68.3％ in the central region and 67.0％ in the western region.The comparisons of risk factors such as history of hypertension,diabetes,hyperlipidaemia,coronary artery event,atrial fibrillation,and overweight in the four different economic regions were also statistically significant(P ＜0.05).Conclusions The subtypes of first-ever stroke vary in the four largest economic regions with a highest proportion of ischemic stroke in the northeastern region and relatively high proportion of hemorrhagic stroke in the central and western economic regions.There are also discrepancies of stroke risk factors in the different economic regions.
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Objective To explore the relationship of GFAP, NDKA and PARK7 serum concentrations of patients with IS, and their diagnose and prognosis value in IS. MethodsThe serum concentrations of GFAP, NDKA and PARK7 were detected in 37 IS patients, 28 ICH patients and and 30 healthy persons by ELISA. These indexes of patients were detected in 12 hours, 3 d and 14th day after onset of ischemic stroke. Their neurological injury status were also evaluated by MESSS at corresponding time points, and their activities of daily living were evaluated by BI at 14 d discharge from hospitaL At the same time, the diagnostic efficiency was analysed for IS using the three biomarkers and the combined detection. ResultsIn IS group, the serum concentrations of GFAP in 12 hours, 3rd and 14th day after onset were (5. 49 ±2. 25 )μg,/L, (5. 17 ± 2. 29) μg/L and (5. 96 ± 2.39 ) μg/L, respectively. The serum concentrations of NDKA were 9. 15(6.28 -12.79) μg/L, 9. 13(6.31 - 12.23) μg/L, 9.31(6.40 - 11.83) μg/L respectively,and the serum concentrations of PARK7 were (32. 71 ±6. 34 ) μg/L, (31.23 ±6. 04) μg/L, (32. 79 ±6. 94) μg/L respectively. The serum levels of GFAP, NDKA and PARK were respectively (4. 62 ± 1. 56)μg/L, 4. 24(3. 30 -5. 61 ) μg/L, ( 14. 25 +2. 65) μg/L in healthy control group. The levels in IS groups were remarkably increased compared with the healthy control group except the level of GFAP in the 3rd day (t = 1. 129, P＞0. 05). The levels in other time points were significantly different between patients group and healthy control. t value of GFAP were respectively 2. 642, 1. 870,P＜0. 05; Z value of NDKA were 6. 173, 6.100, 6.278,P ＜0. 01; t value of PARK7 were 14.964, 15.367,16.060, P ＜0. 01. The specificity and sensitivity of the individual detection for diagnosis of IS was 46. 7％ (14/30) and 81.1％( 30/37 ) for GFAP, 90. 0％ ( 27/30 ) and 78.4％ ( 29/37 ) for NDKA, 96. 7％ (29/30) and 97.3％ ( 36/37 )for PARK7. The specificity and sensitivity for combined detection of 3 biomarkers was 96. 7％ (29/30) and 100％ (37/37). The combined detection achieved better specificity and sensitivity. Moreover, the risk of IS with higher level GFAP was 1. 3 times that of the controls ( OR = 1. 300, P = 0. 044 ). The risk of higher NDKA was 1.7 times higher( OR = 1. 668, P = 0. 036 ). The risk of higher PARK7 was 1.8 times higher (OR = 1. 809, P =0. 005 ). The serum levels of GFAP were significantly different between IS and ICH in 12 h(t= 4.097, P=0.000). The serum concentrations of GFAP, NDKA and PARK7 were positively correlated with MESSS score at different time points. In IS, r value were 0. 534, 0. 482, 0. 357 , P ＜ 0. 05at less than 12 h; r value were 0.433, 0.487, 0. 299,P value were 0. 007, 0. 002, 0.073 at 3 d;r value were 0. 394, 0. 200, 0. 084,P value were 0.016, 0. 236, 0.620 at 14 d. And the serum levels of GFAP,NDKA and PARK7 were negatively correlated with BI score at 14th day, r value were -0. 430, -0. 321,-0.076,P value were 0.044,0.050,0.657. Conclusions The concentrations of GFAP, NDKA and PARK7 in serum are closely related with IS. The increased seruro levels of these indexes are risk factors in IS. The detection of these indexes could be helpful for the early diagnosis, timely treatment and prognosis assessment for IS.
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Objective To explore the polymorphisms of serotonin transporter gene-linked promoter region (5-HTTLPR) and cognitive function in patients with subcortical ischemic depression (SID). Methods A battery of neuropsychological tests including Hamilton Depression Scale (HAMD), Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate depression and cognitive function for all enrolled subjects. And the distribution frequency of 5-HTTLPR-promoter region polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism in 60 SID patients and 60 health controls. Results There were significant differences in 5-HTTLPR genotypes and alleles between SID group and control group (χ2=7.833, χ2=6.290, both P＜0.05).The SID group showed higher genotype SS than did the control group (58.3% vs. 23.3%) and higher allele S (68.3% vs. 52.5%) but lower genotype LL (16.7% vs. 23.3%) and allele L (31.7% vs. 47.5%). SID group had lower MoCA score than did the control group [(23.63±1.59) scores vs. (27.25±1.59) scores, t=12.44, P＜0.01]. Conclusions The polymorphism of 5-HTTLPR gene may play an important role as a nosogenesis of SID. The frequency of SS genotype may be associated with SID especially in females, having more cognitive impairment. The genotype LL and allele L may be a protective factor for depression symptoms of SID.
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Objective To analyze the angiography procedure,distribution of cerebral vascular lesions and complications of cerebral angiography in patients 75 years or older with cerebrovascular diseases.Methods A total of 83 consecutive patients 75 years or older (range 75-89 years) diagnosed as cerebral vascular diseases underwent cerebral angiography with a coverage of all arteries supplying blood to the whole brain including bilateral subclavian arteries between June 2003 and June 2009.The angiogram showed 61 patients (73.5%) with ischemic cerebralvascular diseases,22patients (26.5%) with hemorrhagic cerebralvascular diseases.Results The 78 (94.0%)angiographies were performed using transfemoral access.Composite curve catheters such as Simmons curve were selected in 11 (13.3%) angiographies.In patients with ischemic cerebralvascular diseases,159 stenotic lesions were detected,among which 107 (67.3%) lesions located at the anterior circulation and 52 (32.7%) lesions located at the posterior circulation;97 (61.0%) lesions were extracranial and 62 (39.0%) lesions were intracranial.The 9 unruptured aneurysms were incidentally detected in 8 patients.In patients with hemorrhagic cerebralvascular diseases,19 aneurysms were detected in 16 (72.6 % ) patients.Complications occurred in 5 (6.0 % ) patients:transient neurological complications occurred in 2 (2.4%) patients,hematoma at the puncture site occurred in 2 (2.4%)patients and uroschesis occurred in 1 (1.2%) patients.Conclusions As a kind of diagnostic technology,cerebral angiography is safe in patients 75 years or older with cerebral vascular diseases.The incidence of complications especially permanent neurological complications is low.
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Objective To study a possible correlation between the duration of reproductive period ( from puberty to menopause) and the prognosis of ischemic stroke. Methods Female in-patients with acute ischemic stroke confirmed by CT/MRI in the Neurology Department of the First Affiliated Hospital of Zhengzhou University from 09/03/2006 to 08/30/2008 were enrolled in this study. The probable risk factors of prognosis were analyzed and recovery was assessed by modified Rankin score (MRS) at 6 months followup. Multivariate Logistic regression was used for statistic analysis. Results 371 female patients were enrolled. The average age was (66. 2 ± 10. 0) years; average menopause age was (48. 5 ± 3.9 ) years and average duration of reproductive period was (33.3 ± 4. 3) years. There is a negative correlation between the duration and MRS (OR =0. 285, 95% CI: 0. 095-0. 850, P =0.024). There is no correlation between menopause age and prognosis of stroke. Conclusions Duration of reproductive period is a predictor for prognosis of ischemic stroke. Patients with longer reproductive period have better prognosis.
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AIM: To explore the role of NO/ inducible nitric oxide synthase (iNOS) in the metabotromi glutamate receptor 2/3C (mGluR2/3) mediated-brain ischemic tolerance induced by cerebral ischemic preconditioning (CIP), and to observe the influences of α-methyl- (4-tetrazolyl- phenyl) glycine (MTPG), an antagonist of mGluR2/3, on the expression of iNOS during the induction of brain ischemic tolerance. METHODS: Thirty-six Sprague-Dawley rats were subjected to four vessel occluding global brain ischemic model. Thionin staining and immunohistochemistry were used for neuropathological evaluation and assay of iNOS expression in the hippocampal CA1 subregion of the rats. RESULTS: In the sham group, weak expression of iNOS was detected. The expression of iNOS in the CIP and CIP+ischemic insult groups were increased significantly compared with that in the sham group. Administration of MTPG via lateral cerebral ventricle 20 min before CIP blocked the up-regulation of iNOS induced by CIP, but had no influence on the pyramidal neuron survival. However, in the MTPG+CIP+ischemic insult group, the expression of iNOS was extremely intensive compared to that in CIP and MTPG+CIP groups. Importantly, this up-regulation was accompanied with obvious delayed neuronal death. CONCLUSION: NO/iNOS pathway plays an important role in the process of mGluR2/3 mediated-brain ischemic tolerance induced by CIP.
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objective To describe the clinical features of patients with posterior circulation ischemic stroke.Methods 216 patients with posterior circulation ischemic stroke admitted in our department during 2004-2006 were analyzed retrospectively.All patients were undertaken MRI on admission and responsble lesions were identified at the posterior circulation territories.The patients'clinical symptoms and signs were evaluated and the relationships between lesion locations and clinical characteristics were analyzed.Results The common symptoms of posterior circulation ischemic stroke were unilateral limb Weakness(81.9%),speech difficulty(46.3%),dizziness(33.8%),and unilateral limb numbness (31.O%).The common signs of posterior circulation ischemic stroke were unilateral limb weakness (81.9%),central facial or lingual palsy(61.1%),dysarthria(46.3%),unilateral limb sensory loss (31.0%),and ataxia(30.1%).The incidence of crossed paralysis was low(2.8%).Isolated vertigo was rare (1.4%).Predominant clinical features such as bulbar paralysis,unconsciousness,visual disorder and amnesia can help to localize the lesions.Typical brainstem syndromes had topographic meanings.Conclusions The clinical features of patients with posterior circulation ischemic stroke were complex.Predominant symptoms can help to diagnose the posterior circulation ischemic stroke.
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Objective To observe changes of serum concentrations of interleukin-18(IL-18) and intercellular adhesion molecule-1(ICAM-1) in neonates with hypoxic-ischemic encephalopathy(HIE) and to explore the correlation of the 2 indices and its effect on patients′condition.Methods Thirty newborn infants met the criteria for HIE.There were 16 cases in mild HIE group,14 cases in moderate and severe HIE group.Twenty normal newborn infants were used as control group.The serum concentrations of IL-18 and ICAM-1 of HIE group and control group were detected using ELISA on the third day and 7th day.Results 1.The IL-18 levels of the mild,moderate and severe HIE and control groups measured within 3 days of life were (120.1?12.7),(175.1?15.4),(100.3?12.5) ng/L,respectively.The concentrations of IL-18 in HIE groups were higher than that of control group(Pa