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Objective:To investigate the predictive value of baseline peripheral blood neutrophil to lymphocyte ratio (NLR), National Institutes of Health Stroke Scale (NIHSS) score combined with collateral circulation Tan score for the outcome of intravenous thrombolysis in patients with acute anterior circulation large vessel occlusive stroke.Methods:Patients with acute anterior circulation large vessel occlusive stroke received alteplase intravenous thrombolysis in the Departmet of Neurology, the Second Affiliated Hospital of Anhui Medical University from January 2019 to May 2021 were enrolled retrospectively. The modified Rankin Scale score was used to evaluate the outcomes at 90 d after thrombolysis. 0-2 was defined as good outcome and 3-6 were defined as poor outcome. The demographics, clinical data and imaging data between the good outcome group and the poor outcome group were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome of thrombolysis, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR, NIHSS score, Tan score and their combination on the outcome of intravenous thrombolysis. Results:A total of 118 patients with acute anterior circulation large vessel occlusive stroke were enrolled during the study. Their age was 67.73±11.91 years, and there were 71 males (60.2%). Fifty-eight patients (49.2%) were in the good outcome group and 60 (50.8%) were in the poor outcome group. Univariate analysis showed that there were significant differences in NLR, collateral circulation Tan score and baseline NIHSS score between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that NLR (odds ratio [ OR] 1.299, 95% confidence interval [ CI] 1.005-1.679; P=0.046), baseline NIHSS score ( OR 1.150, 95% CI 1.037-1.275; P=0.008), collateral circulation Tan score ( OR 0.298, 95% CI 0.160-0.556; P<0.001) were independently associated with the outcomes. ROC curve analysis showed that the areas under the curve of NLR, baseline NIHSS score, Tan score and their combination for predicting poor outcome were 0.640, 0.752, 0.823 and 0.870, respectively. Conclusions:Peripheral blood NLR before thrombolysis, baseline NIHSS score and collateral circulation Tan score could predict the outcomes after intravenous thrombolysis in patients with acute anterior circulation large vessel occlusive stroke, and the combination of the three had a higher predictive value.
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Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.
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@#To explore the correlation between leptomeningeal collateral circulation and efficacy and outcome of intravenous thrombolysis in patients with acute cerebral infarction of middle cerebral artery. Methods The clinical and imaging data of 136 patients with acute cerebral infarction of middle cerebral artery who received intravenous thrombolysis in the Second Affiliated Hospital of Anhui Medical University from January 2019 to December 2020 were retrospective analyzed. They were divided into poor collateral group（0～1 points，n=58） and good collateral group（2～3 points，n=78）. The differences in baseline clinical data，NIHSS score before and after thrombolysis，90 d MRS score after thrombolysis，early neurological deterioration（END），and the incidence of hemorrhage after thrombolysis were analyzed between the two groups. Factors influencing the prognosis of thrombolysis were analyzed by multivariate logistic regression. Receiver operating characteristic（ROC） curve was used to evaluate the prognostic value of collateral circulation score. Results Compared with the group with good collateral，the mean age and prevalence of atrial fibrillation were significantly increased in the poor collateral group，while the rate of thrombolysis and the incidence of good prognosis were significantly decreased （P< 0.01），and there was no significant difference in the incidence of hemorrhage after thrombolysis between the two groups （P> 0.05）. Multivariate logistic regression analysis showed that good collateral circulation was an independent influencing factor for good prognosis of thrombolysis （OR=5.503，95%CI 1.828～16.570，P=0.002）. The area under the ROC curve predicted by collateral circulation score was 0.801（95%CI 0.724～0.865，P< 0.001）. Conclusion Good leptomeningeal collateral circulation can significantly improve the efficacy of thrombolysis in patients with acute cerebral infarction of middle cerebral artery，and improve the prognosis of thrombolysis. The collateral circulation score has a good predictive value for the prognosis of thrombolysis.
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Objective:To explore the correlations of levels of blood urea nitrogen, creatinine and proteinuria with Parkinson's disease (PD).Methods:Using one case-control study method, 100 patients with PD, admitted to our hospital from January 2018 to January 2020, were selected as PD group, and 100 subjects accepted physical examination during the same period were selected as control group. The differences in general clinical data and levels of blood biochemical indicators and urine protein between the two groups were compared. Multivariate Logistic regression analysis was used to determine the influencing factors for PD. Receiver operating characteristic (ROC) curve was used to analyze the predictive values of blood urea nitrogen and creatinine in PD. Spearman correlation test was used to analyze the correlations of levels of serum urea nitrogen and creatinine with disease progression in PD patients.Results:The levels of cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B in the PD group were significantly lower than those in the control group ( P<0.05). Multivariate Logistic regression analysis showed that elevated blood urea nitrogen, creatinine, and urine protein levels were risk factors for PD, and elevated LDL-C level was protective factor for PD. The area under the curve (AUC) of urea nitrogen in predicting PD was 0.710 ( 95%CI: 0.638-0.783, P=0.000), with excellent diagnostic value of 4.55 μmol/L. The AUC of creatinine in predicting PD was 0.657 ( 95%CI: 0.577-0.737, P=0.000), with excellent diagnostic value of 4.95 μmol/L. The blood urea nitrogen and creatinine levels were positively correlated with the course of PD, Hoehn-Yahr staging and UPDRS exercise scores in PD patients ( r=0.509, r=0.506, r=0.630; r=0.347, r=0.325, r=0.349; P=0.000). Conclusion:Increased blood urea nitrogen, creatinine and proteinuria levels may be independent risk factors for PD in the elderly; blood urea nitrogen and creatinine levels are related to the course and severity of PD, which can be regarded as biomarkers for onset and progression of PD.
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Objective:To investigate the correlation of fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) and clinical outcome in patients with middle cerebral artery M1 occlusive stroke.Methods:Patients with acute middle cerebral artery M1 occlusive stroke admitted to the Department of Neurology, the Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2019 were enrolled retrospectively. The demographic and clinical data were collected. Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) and FVH score were performed with MRI images. The modified Rankin Scale (MRS) was used to evaluate the clinical outcome at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between FVH and the outcome. Results:A total of 65 patients with acute middle cerebral artery M1 occlusive stroke were enrolled, including 37 males (56.9%). Their age was 64.35±12.13 years. Twenty-nine patients (44.6%) had a good outcome, and 36 (55.4%) had a poor outcome. There were significant differences in triglyceride ( P=0.037), antihypertensive drug treatment ( P=0.037), baseline National Institutes of Health Stroke Scale (NIHSS) score ( P<0.001), DWI-ASPECTS ( P=0.017) and FVH score ( P<0.001) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that FVH score (odds ratio 6.477, 95% confidence interval 1.570-26.716; P=0.010) and NIHSS score (odds ratio 1.869, 95% confidence interval 1.326-2.635; P<0.001) were significantly independently correlated with the poor outcome. However, there was no significant independent correlation between DWI-ASPECTS and the outcome (odds ratio 0.451, 95% confidence interval 0.068-2.988; P=0.410). Conclusions:FVH score is an independent risk factor for poor outcome in patients with acute middle cerebral artery M1 occlusive stroke.
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Objective To investigate the relationship between total cerebral small vessel disease (CSVD) burden and intracranial hemorrhage transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods One hundred and fifty-four patients who suffered from ischemic stroke within 4.5 hours of onset and received recombinant tissue plasminogen activator thrombolytic therapy in the emergency green channel of the First Affiliated Hospital of Soochow University from August 2016 to January 2018 were enrolled.HT examined by computed tomography scan within 24 hours after thrombolysis was included.The magnetic resonance imaging examination was performed within 48 hours.The patients were divided into two groups:HT group and control group according to the presence or absence of HT.Periventricular white-matter hyperintensities (WMH) with Fazekas score of 3 or deep WMH with Fasekas score of 2 or 3 was recorded as 1 point,MRI of cerebral microbleeds (CMBs) or lacunar infarction (LI) was recorded as 1 point respectively,and peripheral vascular space (PVS) in basal ganglia graded 2-4 (≥11)was counted 1 point.Single-factor analysis was used to compare total CSVD burden score,baseline data and clinical data between the two groups.Multivariate Logistic regression analysis was performed to explore the relationship between total CSVD burden score and HT.Results The age of the 154 patients was 66.00(59.00,74.25) years,males accounted for 66.9％ (103/154),onset to treatment time (OTT) was 174.50 (131.50,200.00) minutes and the NIHSS score before thrombolytic therapy was 6.00 (3.00,10.25).There were 43 cases (27.9％) with moderate to severe WMH,35 cases (22.7％) with CMBs,52 cases (33.8％) with PVS graded 2-4,and 96 cases (62.3％) with LI.There were 21 enrolled patients (13.6％) who suffered from HT.Symptomatic intracranial hemorrhage occurred in nine cases (5.8％).In the multivariate Logistic regression model,the results demonstrated that baseline diastolic pressure (OR=1.072,95％CI 1.027-1.118,P=0.001)and atrial fibrillation (OR=28.564,95％CI 6.217-131.241,P=0.000) were independently associated with HT.After using the mild CSVD burden score as a reference,moderate CSVD burden (OR=0.810,95％ CI 0.154-4.257,P=0.804) was not associated with HT after thrombolysis,and severe CSVD burden (OR=8.429,95％ CI 1.643-43.227,P=0.011) was independently associated with HT.Conclusions The severity of total CSVD burden in patients with AIS was closely related to HT after thrombolysis.Severe CSVD was an independent risk factor for HT after thrombolysis.
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The development of neuroimaging has led to a high diagnostic rate of cerebral small vessel disease (CSVD).The hemorrhage transformation (HT) and clinical prognosis after intravenous thrombolysis in acute ischemic stroke (AIS) with CSVD have become hot topics in recent years.Relevant studies have shown that different subtypes of CSVD may have different influences in HT and clinical prognoses in AIS.In clinic,each subtype of CSVD may not exist alone in one patient,therefore,some scholars put forward the concept of total burden of CSVD to further quantitatively assess the severity of CSVD in the whole brain and their effects on HT and clinical prognosis after intravenous thrombolysis of AIS.This article reviews the researches on HT and clinical prognosis after intravenous thrombolysis in AIS with CSVD.
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@# Objective To explore the expression of signal-transducing adaptor protein 2 (STAP2) and importin 5 (Ipo5), and the effect of them on skeletal muscle protein turnover. Methods Twelve male Sprague-Dawley rats were divided into control group (n=6) and model group (n=6). The model group established skeletal muscle hypertrophy induced by blood flow restriction. The soleus muscle cells in both groups were cultured in vitro, and those in the model group infected with shRNA lentivirus to make the expression of STAP2 and Ipo5 silencing, over-expression and gene function salvage finally. The expression of STAP2, Ipo5 and myostatin were determined with Western blotting in soleus muscle in both groups.Results The expression of STAP2 increased (t=-11.786, P<0.001), while the expression of Ipo5 and myostatin decreased (t>14.039, P<0.001) in the model groups compared with those in the control group. Under the control group and the model group, and target genes silencing group, overexpressing group and rescuing group, the expression of myostatin increased with STAP2 decrease and Ipo5 increase.Conclusion The expression of STAP2 increasing and Ipo5 decreasing would promote the protein synthesis.
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@#Post-stroke aphasia is a common and disabling disease. The factors affecting the recovery of language function in aphasic patients include the location and size of injury, type of aphasia, and severity of stroke, etc. The individual factors include gender, age, handedness, educational level, and others. The mechanisms of recovery of language function include blood flow reperfusion, recovery of neural function linkage, disconnection of resuscitation structure and reorganization of language network functions. The right hemisphere may hinder the recovery of aphasia, and non-verbal-specific brain networks may relate to the occurrence of aphasia. For the treatment, in addition to classical speech-language therapy, non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, are more and more used clinically; Other treatments include drugs, acupuncture and traditional Chinese medicine.
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Objective To establish the quality standard for Xiaozhong Tablets (Radix Angelicae Sinensis, Pheretima, etc.). Methods TLC was performed to Radix Angelicae Sinensis, Pheretima, Ursolic acid. The content of Aconitine was identified by TLC. HPLC was used to determine Strychnine content. Results The characteristic for identification by TLC was distinct and hightly specific. The quantification method of Strychnine had the linear range of 0.52～1.56 ?g (r =0.9998). The average recovery was 99.9% (RSD=1.77%, n =5). Conclusion The methods of identification and quantification were accurate, realizable and reproducible. It can be used effectively for the quality control of Xiaozhong Tablets.