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ObjectiveTo observe and compare the electrocardiogram index， myocardial morphology， and connexin 43 （Cx43） expression of two rat models of acute cerebral infarction （ACI） due to stasis combined with toxin complicated with cerebral-cardiac syndrome （CCS）， and to provide experimental evidence for the research on the occurrence mechanism of cardiac diseases induced by ACI and the clinical diagnosis and treatment of CCS. MethodSixty SPF-grade male SD rats were randomized into six groups （n=10）： normal ， syndrome of stasis combined with toxin induced by carrageenin combined with dry yeast （CA/Y）， multi-infarct induced by micro-embolism （ME）， middle cerebral artery occlusion （MCAO）， CA/Y+ME， and CA/Y+MCAO groups. The model of syndrome of stasis combined with toxin was established by intraperitoneal injection with carrageenan （CA） at 10 mg·kg-1 on the first day and subcutaneous injection with dry yeast （Y） suspension （2 mg·kg-1） on the second day of modeling. Twenty-four hours after the modeling of ACI， the electrocardiograms （ECGs） of rats in each group were collected and the number/percentage （%） of abnormal ECG was calculated. The infarct area of the brain was evaluated by 2，3，5-triphenyltetrazolium chloride （TTC） staining， and myocardial injury was assessed by hematoxylin-eosin （HE） staining. Immumohistochemical staining and Western blot were employed to determine the expression of Cx43 in the myocardium. ResultA certain number of rats in each model group presented abnormal ECG. Compared with the normal group and CA/Y group， CA/Y+MCAO group had the highest rate of abnormal ECG （P<0.01）. Compared with the normal， CA/Y， ME， and CA/Y+ME groups， the CA/Y+ME and CA/Y+MCAO groups showed decreased amplitudes of P-wave and T-wave， shortened P-R interval， and extended Q-T interval， which were particularly obvious in the CA/Y+MCAO group （P<0.05， P<0.01） and in accordance with the cerebral infarction area and pathological changes. The expression of Cx43 was up-regulated in both CA/Y+ME and CA/Y+MCAO groups， especially in the CA/Y+MCAO group （P<0.01）. ConclusionThe two rat models of ACI due to stasis combined with toxin complicated with CCS can be used to study the mechanism of heart diseases caused by cerebrovascular diseases and the therapeutic effects of Chinese medicines with the functions of resolving stasis and detoxifying. Moreover， the CA/Y+MCAO method has higher abnormal electrocardiogram rate， severer myocardial pathological injury， and higher expression of Cx43 protein. The models can be chosen according to specific experimental purpose.
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BACKGROUND:Oxidative injury is considered to be one of the important factors of cerebral ischemia-reperfusion injury.Superoxide dismutase 2(SOD2)is a key mitochondrial antioxidant molecule,and fenofibrate can regulate the expression of SOD2 by activating peroxisome proliferator-activated receptor α. OBJECTIVE:To explore whether the mechanism of fenofibrate in the treatment of cerebral ischemia-reperfusion injury depends on the expression of SOD2. METHODS:The TALENs system was used to construct SOD2 transgenic mice.The transgenic mice were genotyped by PCR and DNA sequencing techniques.The expression of SOD2 protein in transgenic mice was detected by western blot assay.Wild-type and SOD2 transgenic mice were randomly divided into four groups:wild-type control group(n=6),wild-type fenofibrate group(n=6),SOD2 transgenic control group(n=5)and SOD2 transgenic fenofibrate group(n=5).A mouse model of middle cerebral artery occlusion was prepared using the suture-occlusion method.After 90 minutes of ischemia,the thread was removed to reperfuse cerebral blood flow for 30 minutes.A cerebral blood flow monitor was used to monitor local cerebral blood flow.Brain tissue slices were taken for 2,3,5-triphenyltetrazolium chloride staining to analyze the situation of cerebral infarction in each group. RESULTS AND CONCLUSION:After PCR and DNA sequencing analysis,nine SOD2+/+ transgenic mice were successfully constructed.After cerebral ischemia-reperfusion,the wild-type fenofibrate group showed partial recovery of cerebral blood flow and significantly reduced cerebral infarction volume compared with the wild-type control group(P<0.001).There was no significant difference in cerebral blood flow and cerebral infarction volume between the SOD2 transgenic fenofibrate group and the SOD2 transgenic control group.The SOD2 transgenic control was superior to the wild-type control group in terms of improving cerebral blood flow and cerebral infarction(P<0.001).There were also no significant differences in cerebral blood flow and cerebral infarction volume between the wild-type fenofibrate group and the SOD2 transgenic control group and between the wild-type fenofibrate group and the SOD2 transgenic fenofibrate group.To conclude,the expression of SOD2 is one of the mechanisms of fenofibrate in the treatment of cerebral ischemia-reperfusion injury.
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Objective To explore the possible mechanism of Naoshuantong capsule in the treatment of cerebral infarction by network pharmacology and molecular docking technology.Methods The main active ingredients and targets of Naoshuantong Capsule were screened based on the TCMSP database.At the same time,the targets related to cerebral infarction were collected through GeneCards,OMIM,PharmGKB,TTD and DrugBank databases,and the intersection targets of drugs and diseases were obtained using InteractiVenn platform.Cytoscape software was used to construct the"active ingredient-disease target"network model.STRING database and Cytoscape software were used to construct protein interaction network diagrams,and core targets were screened according to the degree.GO functional analysis and KEGG pathway enrichment analysis were performed on inter-secting targets using R language.Finally,AutoDock Vina and Symol were used to molecularly dock the active components in the"active ingredient-disease target"network with protein targets.Results 23 active ingredients and 264 related potential targets of Naoshuantong Capsule were collected;2,043 targets related to cerebral infarction were also collected;149 common targets were obtained by the intersection of the two.It mainly acts on JUN,TNF,IL6,NFKBIA and so on,which mainly involve TNF signa-ling pathway,IL-17 signaling pathway,NF-kappa B signaling pathway and apoptosis pathway to play a role in the treatment of cerebral infarction.Molecular docking results showed that the active components of drugs in the network bind well to target pro-teins.Conclusion This study preliminarily revealed the potential multi-component,multi-target and multi-pathway mecha-nism of Naoshuantong Capsule for cerebral infarction by network pharmacology,molecular docking and bioinformatics analysis.
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Objective:To explore the risk factors, clinical features and prognosis of traumatic cerebral infarction in patients with craniocerebral trauma.Methods:The clinical data and follow-up data of 48 patients with craniocerebral trauma and traumatic cerebral infarction (observation group) and 132 patients with craniocerebral trauma without traumatic cerebral infarction (control group) admitted to the Sanya Central Hospital from January 2021 to January 2023 were retrospectively reviewed. Statistically significant risk factors were screened out by univariate analysis and Logistic regression analysis.Results:The results of univariate analysis showed that there were no significant differences in age, sex, skull fracture, traumatic subarachnoid hemorrhage and multiple injuries between the two groups ( P>0.05). There were statistical differences in midline displacement, herniation, diffuse brain swelling, decompression of the deboned flap, hemorrhagic shock, and admission Rotterdam CT score >3( P<0.05). The results of multivariate Logistic regression analysis showed that cerebral herniation, diffuse brain swelling and hemorrhagic shock were risk factors for traumatic cerebral infarction ( P<0.05). The higher the Rotterdam CT score, the higher the incidence of traumatic cerebral infarction. In the observation group, 11 cases had good prognosis and 37 cases had poor prognosis, with an average Glasgow Prognostic Scale (GOS) of (2.45 ± 1.22) points. In the control group, 74 cases had good prognosis and 48 cases had poor prognosis, with an average GOS of (3.69 ± 1.10) points. The difference in prognosis between the two groups was statistically significant ( P<0.05). Conclusions:Cerebral herniation, diffuse cerebral swelling and hemorrhagic shock are risk factors for traumatic cerebral infarction in patients with craniocerebral trauma, and the prognosis of patients complicated by traumatic cerebral infarction is worse.
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Objective To investigate the common symptoms and associated disease characteristics of hyperhomocysteinemia in cere-bral infarction patients and the correlation analysis of influencing factors.Methods A total of 151 participants with blood homocysteine≥15μmol/L and 86 participants with blood homocysteine＜15μmol/L were identified as the hyperhomocysteinemia with cerebral infarction group(H group)and the normal cerebral infarction group(N group),respectively.The symptoms and influence factors in the two groups were compared.Results Among cerebral infarction patients,patients in H group were older(P=0.049),more male(P=0.002),had a history of smoking(P=0.025),diabetes(P=0.008),hyperlipidemia(P=0.034),folate deficiency(P=0.002)and associated cognitive impairment(P=0.009)and language barrier(P=0.043).Binary Logistic regression analysis showed that age(P=0.023),diabetes(P=0.018),folate deficiency(P=0.026),and cognitive impairment(P=0.019)were independent related factors of in-creased blood homocysteine level.Conclusion Cerebral infarction patients with hyperhomocysteinemia are elderly,and most of them have diabetes,folate deficiency,and cognitive impairment.
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Objective To evaluate the effectiveness and safety of edaravone combined with oxiracetam in the treatment of acute cere-bral infarction.Methods PubMed,Embase,Cochrane Library,CNKI,Wanfang Data and other databases were comprehensively searched from database inception until October 27,2022,to collect randomized controlled trials of edaravone combined with oxiracetam in the treatment of acute cerebral infarction(ACI).RevMan5.4software was used to analyze the collected data.Results A total of9studies involving 887 patients were included.Meta-analysis results showed that the overall effective rate and Barthel index in the observation group were significantly higher than those in the control group(OR=4.66,95％CI:2.74-7.93,P＜0.001;MD=14.57,95％CI:8.58-20.56,P＜0.001),the NIHSS scores in the observation group were significantly lower than that in the control group(MD=-5.28,95％CI:-6.42--4.13,P＜0.001).There was no significant difference in adverse effect rate between the two groups(RR=1.11,95％CI:0.63-1.95,P=0.72).Conclusion The combination of edaravone and oxiracetam in the treatment of ACI can significantly reduce NIHSS scores,and improve Barthel index and overall effective rate.The efficacy is better than edaravone alone,and a more comprehensive evaluation of safety is needed in the future.
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Objective Cardio-cerebral infarction(CCI)is a severe clinical syndrome in which acute myocardial infarction(AMI)and acute ischemic stroke(AIS)occurs simultaneously(synchronous CCI,SCCI)or successively(metachronous CCI,MCCI).The study aims to explore its clinical profile,management and outcomes.Methods This is a single-center retrospective study of inpatients with CCI who presented to Xuanwu hospital from January 2014 to December 2021.The study collected and analyzed demographic informa-tion,clinical profile,management and outcomes(all-cause death,MACE events,mRS scores,bleeding events).Results Totally 137 patients with CCI were enrolled in the study,including 28 SCCI and 109 MCCI.Hypertension,smoking and diabetes were prominent risk factors for CCI.The heart function decreased significantly,including 42.9％suffered Killip Ⅲ-Ⅳ and 40.0％suffered decreased left ventricular ejection fraction.Large artery atherosclerosis was the most predominant etiology of AIS.The average NIHSS score was 11.24± 10.50.The rate of emergency reperfusion therapy was low(29.2％).Compared to the group that did not received emergence reperfusion therapy,the patients received emergency reperfusion therapy had a lower in-hospital mortality(P=0.042).All-cause mortality oc-curred in up to 27.0％,including 11.7％cardiovascular death.Heart failure(43.8％)was the most frequent MACE events.34.3％pa-tients had good neurological function(mRS 0-2)at discharge.27 patients(19.7％)experiencing major bleeding events,including 19 patients(13.9％)had the hemorrhagic transformation of AIS.Conclusion The CCI therapy still faces challenges,such as low reperfu-sion rate,differentiated antithrombotic options,and poor clinical prognosis.Large clinical research is need for promote the optimization of CCI treatment.
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Objective:To investigate the impact of intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control on incidence of acute cerebral infarction after carotid endarterectomy.Methods:A retrospective study was peformed; 305 patients with atherosclerotic stenosis of the carotid artery admitted to and accepted carotid endarterectomy in Department of Vascular Neurosurgery, Dong'e County People's Hospital from January 2020 to September 2023 were selected. Intraoperative multimodal neurophysiological monitoring combined with traditional empirical modalities for blood pressure control was applied to 153 patients admitted to our hospital from January 2020 to December 2021 (control group), and intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control (based on monitored sensory or motor wave amplitude changes) was applied to 152 patients admitted to our hospital from January 2022 to September 2023 (experimental group). Difference in postoperative acute cerebral infarction incidence between the 2 groups was compared.Results:The experimental group had significantly lower postoperative acute cerebral infarction incidence compared with the control group (4.6% vs. 13.0%, P<0.05). The experimental group had significantly lower postoperative asymptomatic acute cerebral infarction incidence compared with the control group (3.3% vs. 9.8%, P<0.05), while no significant difference was noted in postoperative symptomatic acute cerebral infarction incidence between the 2 groups ( P>0.05). Conclusion:Intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control can reduce the postoperative acute cerebral infarction incidence in patients accepted carotid endarterectomy, especacailly postoperative asymptomatic acute cerebral infarction incidence, thereby enhancing surgical safety.
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Objective:To investigate the value of multiparameter MRI in predicting secondary acute cerebral infarction in patients with transient ischemic attack (TIA).Methods:A total of 358 patients with TIA admitted to Department of Neurology, Affiliated Hospital of Chengde Medical College from April 2020 to May 2022 were selected. They were divided into cerebral infarction group ( n=114) and non-cerebral infarction group ( n=244) according to whether they had secondary acute cerebral infarction within 3 months of follow up. Differences in multiparameter MRI (number of unstable plaques, reference vessel area/plaque area, internal carotid artery stenosis rate, intracranial arterial stenosis rate, ratio of unstable plaques, lumen area of the most stenotic responsible vessel, and wall area of the most stenotic responsible vessel) at the consultation time were collected and compared between the 2 groups; correlations of multiparameter MRI with secondary acute cerebral infarction was evaluated by partial regression analysis; value of multiparameter MRI in predicting secondary acute cerebral infarction in TIA patients was evaluated by receiver operating characteristic (ROC) curve. Results:Reference vessel area/plaque area, intracranial arterial stenosis rate, ratio of unstable plaques and wall area of the most stenotic responsible vessel in the infarction group were significantly higher/larger than those in the non-cerebral infarction group, and lumen area of the most stenotic responsible vessel in the infarction group was significantly smaller than that in the non-cerebral infarction group ( P<0.05). After adjusting for age and gender, reference vessel area/plaque area, intracranial arterial stenosis rate, ratio of unstable plaques and wall area of the most stenotic responsible vessel were positively correlated with secondary acute cerebral infarction, while lumen area of the most stenotic responsible vessel was negatively correlated with secondary acute cerebral infarction ( P<0.05); AUC of the combination of above parameters was 0.900, which was significantly greater than that of reference vessel area/plaque area (0.724), intracranial arterial stenosis rate (0.751), unstable plaque occurrence rate (0.812), lumen area of the most stenotic vessel (0.771), and wall area of the most stenotic vessel (0.763), respectively ( P<0.05). Conclusion:Multiparameter MRI analyzing reference vessel area/plaque area, intracranial arterial stenosis rate, ratio of unstable plaques, lumen area of the most stenotic responsible vessel, and wall area of the most stenotic responsible vessel can effectively predict secondary acute cerebral infarction in TIA patients.
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Distal medium arterial occlusive cerebral infarction has high incidence and high disability and mortality rates. At present, 1/2-2/3 patients cannot benefit from intravenous thrombolysis alone; no high-level recommendations for arterial thrombolysis or mechanical thrombectomy are noted either. However, with the development of interventional materials and technologies, mechanical thrombectomy may be an effective treatment for selected distal medium arterial occlusive cerebral infarction patients. This article reviews the recent research progress of mechanical thrombectomy in distal medium occlusive cerebral infarction in order to guide its treatment.
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Objective To explore the material basis and mechanism of the Chinese medicine Shenmajingfu granules in the treatment of cerebral infarction. Methods The potential active ingredients and targets of Shenmajingfu granules were retrieved through TCMSP, ETCM database and TCM Database. The related target genes of cerebral infarction were searched from OMIM database. The common targets of Shenmajingfu granules and cerebral infarction were obtained by the intersection method. Cytoscape was used to construct active components of Shenmajingfu granules-targets network. Protein-protein interaction network was constructed by STRING software. DAVID database was used for GO and KEGG enrichment analysis. Results The 183 potential active ingredients of Shenmajingfu granules were screened out. 1785 potential targets were screened in the TCMSP database, including 30 targets related to cerebral infarction. These target genes were mainly involved in the inflammatory response and apoptosis process, involving the TNF signaling pathway, HIF-1 signaling pathway and NF-κB signaling pathway. Conclusion The therapeutic effect of Shenmajingfu granules on cerebral infarction may be related to the regulation of inflammatory response, improvement of impaired neurological function and protection of cerebral ischemia-reperfusion injury.
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ObjectiveTo investigate the changes in cerebral blood perfusion in patients with acute cerebral infarction after taking Tongnaoyin， a traditional Chinese medicine， based on head and neck computed tomography （CT） angiography （CTA） combined with brain CT perfusion imaging （CTP）. MethodA total of 240 patients with cerebral infarction of phlegm and blood stasis syndrome treated in Jiangsu Province Hospital of Traditional Chinese Medicine from March 2018 to September 2023 were randomly divided into a control group （99 cases） and a Tongnaoyin group （141 cases）. Based on the guidelines， the control group was treated with conventional treatment such as anti-aggregation， anticoagulation， lipid-lowering and plaque stabilization， brain protection， and supportive treatment. The Tongnaoyin group was treated with Tongnaoyin of 200 mL in warm conditions in the morning and evening on the basis of the control group. Both groups underwent CTA combined with CTP within 24 hours after admission， and they were reexamined by CTA and CTP in the sixth month after admission. The degree of intracranial artery stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trial （NASCET） method. The relative cerebral blood volume （rCBV）， relative cerebral blood flow （rCBF）， mean transit time （MTT）， and time to peak （TTP） of the lesion area before and after treatment were compared. The adverse outcomes of the two groups within six months after discharge were compared. ResultCompared with the group before treatment， the degree of vascular stenosis in the Tongnaoyin group was significantly reduced， and the difference was statistically significant （Z=105.369，P<0.05）. Compared with the control group after treatment， the improvement rate of vascular stenosis in the Tongnaoyin group was higher （χ2=84.179，P<0.01）， and the curative effect was better.After treatment， the rCBV and rCBF of patients in the Tongnaoyin group were significantly increased， and the difference was statistically significant （P<0.01）. MTT and TTP showed a trend of shortening， but the difference was not statistically significant. There was no statistically significant difference in rCBV， rCBF， MTT， and TTP in the control group. Compared with those in the control group after treatment， the rCBV and rCBF in the Tongnaoyin group were significantly increased， while MTT and TTP were significantly reduced （P<0.01）. After six months of discharge， the risk of poor prognosis in the Tongnaoyin group was significantly reduced compared with the control group （P<0.05）. ConclusionTongnaoyin has a good effect on improving cerebral blood perfusion in patients with acute cerebral infarction. It can be used as an effective supplement for the conventional treatment of ischemic stroke to improve clinical efficacy.
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Acute cerebral infarction(ACI)has the characteristics of onset nasty and high mortality,and thus the rapid determination of the occurrence and development of ACI plays a key role in the diagnosis,treatment and prognosis of ACI patients.It has shown that the serum level of human haptoglobin(Hp)is related to ACI.In this study,surface enhanced Raman scattering(SERS)combined with immune recognition was applied to establish a quantitative analysis method for serum Hp.Firstly,the SERS substrate of silver nanoparticles was prepared on silicon wafer,and 4-mercaptobenzoic Acid(MBA)was used as a Raman probe by forming Ag—S bond and connecting it on the surface of nanoparticles.The carboxyl group of MBA was linked to amino group of self-made high-affinity antibody through forming CO—NH structure thus forming a SERS self-assembled chip of Hp(Ag/MBA/anti-Hp).Hp in serum could be specifically captured by antibodies on SERS substrate,which caused the shift of SERS characteristic peak of MBA.The results showed that there was a good linear relationship between the logarithm of Hp concentration and the SERS characteristic peak shift of MBA.The detection range was 1-1000 ng/mL(R2=0.988).The Hp concentrations in serum of 90 ACI patients were determined by this method,and the results were consistent with those of ELISA method,which proved the practicability and accuracy of this method.This method was highly specific,simple and convenient,which could realize the specific recognition and quantitative analysis of serum Hp,so as to be an effective means for clinical detection of serum Hp,thus providing a reference for the treatment and prognosis of ACI.
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Objective To explore the distribution of CYP2C19,MTHFR,SLCO1B1,and APOE gene poly-morphisms in patients with acute cerebral infarction,so as to provide theoretical basis for individualized drug treatment.Methods A total of 400 patients with acute cerebral infarction admitted to the hospital from 2020 to 2022 were selected as the research subjects,and the polymorphisms of CYP2C19,MTHFR,SLCO1B1 and APOE genes were tested by PCR fluorescene probe method,and the polymorphism distribution of those genes was analyzed.Results In patients with acute cerebral infarction,44.25％of CYP2C19 gene phenotype were EM type,and 9.75％of CYP2C19 gene phenotype were PM type.The proportion of mutations at the C677T locus of the MTHFR gene(CT type+TT type)was 78.50％,CC type accounted for 21.50％.78.75％of the SLCO1B1 genotypes were type Ⅰ wild type,and 1.50％SLCO1B1 gene phenotypes were type Ⅲ homozygous mutant type.The E2 and E3 types accounted for 84.25％of the APOE gene phenotype,while the E4 type ac-counted for 15.75％.Conclusion The distribution of CYP2C19,MTHFR,SLCO1B1 and APOE gene poly-morphisms in 400 acute cerebral infarction patients is analyzed,providing data support for guiding individual-ized medication in the population of acute cerebral infarction patients and of great significance for achieving safe medication.
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Objective To investigate the correlation and predictive effect of serum CD4+/CD8+T lympho-cyte ratio combined with magnetic resonance angiography(MRA)on recurrence of cerebral infarction.Meth-ods A total of 153 patients with acute cerebral infarction admitted to the Zhenjiang First People's Hospital from January 2021 to February 2022 were selected.CD4+/CD8+T lymphocyte ratio of patients was deter-mined,vascular stenosis score and collateral circulation filling score were evaluated by MRA.The patients were followed up for 1 year,including 34 patients with recurrent cerebral infarction as recurrent cerebral in-farction group,107 patients without recurrent cerebral infarction as the non-recurrent cerebral infarction group,12 patients were excluded due to other causes of loss of follow-up,and the receiver operating character-istic(ROC)curve for using the indicators to predict the recurrent cerebral infarction was drawn.Results The CD4+/CD8+T lymphocyte ratio in recurrent cerebral infarction group was significantly higher than that in non-recurrent cerebral infarction group(P<0.05).Vascular stenosis score and collateral circulation filling score in recurrent cerebral infarction group were lower than those in non-recurrent cerebral infarction group(P<0.05).The recurrence of cerebral infarction was correlated with CD4+/CD8+T lymphocyte ratio,vascu-lar stenosis score and collateral circulation filling score(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of CD4+/CD8+T lymphocyte ratio,vascular stenosis score,and collateral circulation filling score to predict recurrent cerebral infarction was 0.975,0.889,and 0.935,respectively,and the AUC of recurrent cerebral infarction was 0.994 when combined with the three factors.The AUC of cerebral infarction recurrence was significantly higher than that of each index alone.Conclusion Serum CD4+/CD8+T lympho-cyte ratio combined with MRA vascular stenosis score and collateral circulation filling score have high efficacy in the diagnosis of recurrent cerebral infarction,which have predictive value for recurrent cerebral infarction.
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Objective To explore the value of combined detection of lipoprotein-associated phospholipase A2(Lp-PLA2),neuron specific enolase(NSE)and S-100 calcium binding protein β(S-100β)in the diagnosis and prognosis evaluation of acute cerebral infarction(ACI)in patients with carbon monoxide poisoning(CMP).Methods A total of 102 patients with CMP complicated with ACI admitted to the hospital from Jan-uary 2020 to November 2021 were selected as the study group,meanwhile,102 patients with simple CMP were enrolled as the control group.Patients in the study group were followed up for 6 months after discharge,ac-cording to the follow-up results,they were grouped into good prognosis group(60 cases)and poor prognosis group(42 cases).The serum levels of Lp-PLA2,NSE and S-100β were detected by enzyme-linked immunosor-bent assay(ELISA).The receiver operating characteristic(ROC)curve was applied to analyze the value of the combination of serum Lp-PLA2,NSE and S-100β in the early diagnosis and prognosis evaluation of patients with CMP and ACI.Results Compared with the control group,the levels of Lp-PLA2,NSE and S-100β in the study group were obviously higher(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of the combined detection of serum Lp-PLA2、NSE、S-100β for the diagnosis of CMP complicat-ed with ACI was greater than the AUC of single detection of each indicator(P<0.001).Compared with the good prognosis group,the levels of Lp-PLA2,NSE and S-100β in the poor prognosis group were obviously higher(P<0.05).The results of ROC curve analysis showed that the AUC of the combined detection of ser-um Lp-PLA2、NSE、S-100β for the prognosis of patients with CMP complicated with ACI was greater than the AUC of single detection of each indicator(P<0.05).Conclusion The expression of Lp-PLA2,NSE and S-100β in serum of patients with CMP complicated with ACI is high,and the combined detection of the three has certain value in the diagnosis and prognosis evaluation for patients with CMP complicated with ACI.
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Objective To explore the changes of serum angiopoietin-like protein 4(ANGPTL4)and NOD-like receptor protein 3(NLRP3)levels after traumatic brain injury(TBI)and their diagnostic value for sec-ondary massive cerebral infarction.Methods A total of 100 TBI patients admitted to the hospital from Au-gust 2019 to August 2021 were enrolled as the TBI group,meantime,100 healthy people in the hospital were enrolled as the control group.The serum levels of ANGPTL4 and NLRP3 were detected by enzyme-linked im-munosorbent assay(ELISA).The clinical characteristics of TBI patients with and without secondary massive cerebral infarction were compared.Receiver operating characteristic(ROC)curve was applied to analyze the serum levels of ANGPTL4 and NLRP3 on their diagnostic value for TBI patients with secondary massive cere-bral infarction.Multivariate Logistic regression analysis was applied to analyze the factors affecting the occur-rence of secondary massive cerebral infarction in TBI patients.Results The serum ANGPTL4 level in TBI group was lower than that in the control group,and the serum NLRP3 level was higher than that in the con-trol group(P<0.05).There were obvious differences in proportion of brain hernia,proportion of subarach-noid hemorrhage,serum levels of ANGPTL4 and NLRP3 between patients with secondary massive cerebral infarction and patients without secondary massive cerebral infarction(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum ANGPTL4 and NLRP3 in diagnosing secondary massive cere-bral infarction in TBI patients was 0.792 and 0.812 respectively,with sensitivity of 77.80%and 83.30%re-spectively,and specificity of 86.60%and 64.60%respectively.The sensitivity,the specificity and AUC of the combined detection were 83.30%,82.90%and 0.867 respectively.Multivariate Logistic regression analysis showed that serum NLRP3 level was a risk factor for TBI patients with secondary massive cerebral infarction(P<0.05).After treatment,it was found that serum ANGPTL4 level increased and NLRP3 level decreased in TBI patients(P<0.05).Conclusion The serum level of ANGPTL4 in TBI patients decreases,while the level of NLRP3 increases,and the level of ANGPTL4 in the serum of patients with secondary massive cerebral in-farction decreases and the level of NLRP3 increases,both of them are of great significance in the diagnosis of secondary massive cerebral infarction in TBI patients.
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Objective To investigate the relationship between serum levels of thrombospondin-1(TSP-1)and thioredoxin 1(Trx1)and cognitive impairment after cerebral infarction.Methods A total of 155 patients with cerebral infarction(study group)admitted to a hospital from June 2021 to December 2022 were selected as the study objects,and were divided into normal cognitive function group(97 cases)and cognitive impair-ment group(58 cases)according to the scores of the montreal cognitive assessment scale(MoCA)after the pa-tients'condition stabilized.Another 150 healthy subjects in the same period were selected as the control group.Serum TSP-1 and Trx1 levels were detected by enzyme-linked immunosorbent assay(ELISA).Spearman analysis was used to analyze the correlation between serum TSP-1 and Trx1 levels and national in-stitutes of health stroke scale(NIHSS)score and MoCA score in patients with cerebral infarction.The predic-tive value of serum TSP-1 and Trx1 levels in cognitive impairment after cerebral infarction was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of serum TSP-1 and Trx1 in the study group were significantly higher,and the differences were statistically significant(P＜0.05).Compared with the normal cognitive function group,the levels of serum TSP-1 and Trx1 in the cognitive impairment group were significantly higher,and the difference was statistically significant(P＜0.05).Compared with the normal cognitive function group,the NIHSS score of the cognitive impairment group was significantly higher,and the MoCA score was significantly lower,with statistical significance(P＜0.05).Spearman correlation analysis showed that serum TSP-1 and Trx1 levels were positively correlated with NIHSS score(P＜0.05),and negatively correlated with MoCA score(P＜0.05)in patients with cerebral infarction.ROC curve analysis showed that the area under the curve(AUC)of serum TSP-1 to predict cogni-tive impairment after cerebral infarction was 0.834,and the sensitivity and specificity were 72.41％and 86.60％,respectively.Serum Trx1 level alone predicted the AUC of cognitive impairment after cerebral infarc-tion was 0.851,and its sensitivity and specificity were 70.69％and 85.57％,respectively.The AUC of the combined prediction of cognitive impairment after cerebral infarction was 0.926,which was significantly greater than that of serum TSP-1 alone(Z=3.050,P=0.002)and Trx1 alone(Z=2.846,P=0.004).Conclusion Serum TSP-1 and Trx1 levels are elevated in patients with cerebral infarction,and their levels have certain predictive value for cognitive impairment after cerebral infarction.
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Objective To investigate the relationship between the levels of serum CXC chemokine ligand 1(CXCL1)and phosphatase and tensin homology deleted on chromosome ten(PTEN)mRNA in patients with acute cerebral infarction and the severity and prognosis of the disease.Methods A total of 102 patients with acute cerebral infarction admitted to the hospital from March 2022 to March 2023 were enrolled in the study as the experimental group,and 85 healthy people who underwent physical examination in the hospital during the same period were enrolled as the control group.Serum samples of fasting venous blood were collected from people enrolled in the study.The serum CXCL1 level was detected by using enzyme-linked immunosorbent as-say.Real-time fluorescence quantitative PCR(qPCR)was used to detect the relative expression level of serum PTEN mRNA(hereinafter referred to as the level).According to the National Institutes of Health Stroke Scale(NIHSS)score,the patients in the experimental group were divided into three groups with different de-grees of neurological impairment(severe group,moderate group and mild group),and the serum CXCL1 and PTEN mRNA levels of the three groups were compared.According to the cerebral infarction volume evaluated by computed tomography(CT)or magnetic resonance imaging(MRI),the patients in the experimental group were divided into small infarction group,medium infarction group and large infarction group,and the serum CXCL1 and PTEN mRNA levels of the three groups were compared.According to the modified Rankin scale(mRS),the patients in the experimental group were divided into the good prognosis group and the poor prog-nosis group,and the serum CXCL1 and PTEN mRNA levels were compared between the two groups.Pearson correlation was used to analyze the correlation between serum CXCL1 and PTEN mRNA levels in patients with acute cerebral infarction.Multivariate Logistic regression analysis was used to analyze the factors affect-ing the prognosis of patients with acute cerebral infarction.Results The proportion of patients with a history of diabetes and hypertension and serum CXCL1 and PTEN mRNA levels in the experimental group were high-er than those in the control group,and the differences were statistically significant(P＜0.05).With the in-crease of the degree of neurological impairment,the serum CXCL1 level and PTEN mRNA level increased,and there were significant differences among the severe group,moderate group,and mild group(P＜0.05).With the increase of infarction size,the serum levels of CXCL1 and PTEN mRNA increased,and there were signifi-cant differences among small infarction group,medium infarction group,and large infarction group(P＜0.05).Compared with the good prognosis group,the poor prognosis group had significantly higher proportions of patients with a history of diabetes,a history of hypertension,and serum CXCL1 and PTEN mRNA levels(P＜0.05).There was a positive correlation between serum CXCL1 level and PTEN mRNA level in patients with acute cerebral infarction(r=0.479,P＜0.001).The levels of serum CXCL1 and PTEN mRNA,history of diabetes and hypertension were all influencing factors for the prognosis of patients with acute cerebral in-farction(P＜0.05).Conclusion The levels of serum CXCL1 and PTEN mRNA in patients with acute cere-bral infarction increase,which can be used to evaluate the disease severity and prognosis of patients.
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Objective:To investigate the association of white matter hyperintensities (WMHs) with long-term stroke recurrence in patients with recent subcortical small infarcts (RSSIs).Methods:Consecutive patients admitted to the Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University between January 2019 and August 2022 and met the clinical and imaging manifestations of RSSIs were collected. The demographic characteristics, baseline clinical data, and MRI features were collected. Using stroke recurrence as the endpoint event, the recurrence time was recorded, and Cox regression model was used to analyze relevant factors affecting stroke recurrence in patients with RSSIs.Results:A total of 202 patients were enrolled, including 138 males (68.3%), aged 67.9±10.5 years. Seventy-seven patients (38.1%) were mild WMHs, 64 (31.7%) were moderate WMHs, and 61 (30.2%) were severe WMHs. There were statistically significant differences in age, history of stroke, hypertension, hyperlipidemia, total cholesterol, infarct thickness, and infarct distribution among different WMHs severity groups (all P<0.05). The median follow-up time was 40.5 months (interquartile range, 27.7-49.0 months), and a total of 55 patients (27.2%) had stroke recurrence (ischemic stroke 54, occipital hemorrhage 1). Recurrence rates of stroke in the mild, moderate, and severe WMHs groups were 18.2%, 31.3%, and 34.4%, respectively. Cox regression analysis showed that WMHs were an independent risk factor for stroke recurrence (compared to the mild group, the risk ratio of the severe group was 2.225, 95% confidence interval was 1.116-4.436; P=0.023). Conclusion:The risk of long-term stroke recurrence in patients with RSSI is associated with the severity of WMHs.