RESUMO
Objective:To investigate the neuroprotective effect of long-term prophylactic use of buphthalein on mice with permanent distal middle cerebral artery occlusion and its relationship with the nuclear factor erysid 2 related factor 2 (Nrf2) pathway.Methods:Nrf2 + /+ wild-type and Nrf2 -/- knockout mice were randomly divided into control group (equal volume vegetable oil), low-dose butylphthalide group (20 mg/kg) and high-dose butylphthalide group (60 mg/kg), with 6 mice in each group. The drug was administered once a day by gavage for 1 month, and then a permanent middle cerebral artery occlusion model was induced by electrocoagulation. After the model was made, the drug was continued and the mice were sacrificed on the 10 th day. The modified Longa grading scale and the rotating rod test were used to evaluate neurological deficits on the 3 rd and 10 th day after the model was made. After the mice were sacrificed, the cerebral infarct volume was measured by triphenyltetrazolium chloride staining. The brain water content was measured by dry and wet weight method. The expression of Nrf2 pathway related factors, including Nrf2, heme oxygenase 1 (HO-1) and NAD(P)H quinone oxidoreductase 1 (NQO1) were measured by quantitative real-time PCR and Western blotting. Results:On the 10 th day after modeling, compared with the Nrf2 -/- control group, the neurological deficit was significantly milder, the volume of cerebral infarction and brain water content were significantly smaller, and the mRNA and protein levels of Nrf2, HO-1 and NQO1 were significantly higher in the Nrf2 + /+ control group, and the differences were statistically significant ( P<0.05). For Nrf2 + /+ mice, compared with the control group, the cerebral infarct volume was significantly reduced ( P<0.05), the brain water content was significantly reduced ( P<0.05), and the neurological function recovery was significantly better ( P<0.05), and the levels of Nrf2, HO-1, and NQO1 mRNA and protein were significantly higher in the high-dose butylphthalide group (all P<0.05). For Nrf2 -/- mice, there were no significant differences in neurological function, cerebral infarction group volume, brain water content, Nrf2, HO-1, NQO1 mRNA and protein levels among the groups. Conclusion:Long-term butylphthalide pretreatment can significantly improve the neurological function, reduce cerebral infarction volume, reduce brain water content, and increase Nrf2, HO-1, NQO1 mRNA and protein expression levels in mice with permanent distal middle cerebral artery occlusion, suggesting butylphthalide may play a neuroprotective effect by up-regulating the expression of Nrf2 gene and its downstream antioxidant stress factors HO-1 and NQO1.
RESUMO
Objective To determine collateral circulation in patients with acute ischemic stroke using capillary index score (CIS)in order to evaluate the prognosis of endovascular treatment. Methods From January 2013 to December 2015,46 consecutive patients with acute ischemic stroke treated with endovascular treatment at the Department of Neurology,Central Hospital of Baotou were enrolled retrospectively. Angiography was performed before endovascular treatment in order to complete CIS score. The patients were divided into a good prognosis group (n = 21)and a poor prognosis group (n = 25)according to the modified Rankin scale (mRS)scores. Univariate analysis was used to compare the baseline data and the clinical data of the two groups,including age,sex,history of diabetes,pretreatment systolic blood pressure,conducting intravenous thrombolysis or not,time from ictus to intravenous thrombolysis,National Institutes of Health Stroke Scale (NIHSS)score,Alberta stroke program early CT score (ASPECTS),vascular filling,time from onset to revascularization,and postoperative vascular recanalization (the modified Thrombolysis in Cerebral Infarction [mTICI]). Multivariate analysis was used to analyze the effect of CIS score on good prognosis. Results There were no significant differences in age,sex,history of diabetes,pretreatment systolic blood pressure,conducting intravenous thrombolysis or not,time from ictus to thrombolysis,and number of mechanical thrombectomy between the good prognosis group and the poor prognosis group (all P > 0. 05). There were significant differences in the NIHSS score (15 ± 3 vs. 19 ± 4),ASPECTS score (8 [7,10]vs. 6 [5,8]),filling well 85. 7% (18 / 21)vs. 44. 0% [11 / 25]),time from ictus to recanalization (363 ± 42 min vs. 398 ± 53 min),and postoperative vascular recanalization (mTICI≥Ⅱb)(100. 0% [21 / 21]vs. 68. 0%[17 / 25];all P < 0. 05). CIS (OR,8. 600,95% CI 2. 670 -33. 800)and mTICI grade (OR,5. 720, 95%CI 12. 170-22. 300)were significantly associated with the prognosis. Conclusion The CIS score can be used to evaluate brain perfusion. fCIS is closely associated with the good clinical prognosis. When screening the suitable patients for endovascular therapy,increasing the CIS score to evaluate the salvageable brain tissue is effective and feasible.
RESUMO
Objective To investigate the correlation between plasma cathepsin L (CatL) levels and establishment of cerebral collateral circulation in acute ischemic stroke patients with cerebral artery stenosis.Methods The patients with acute ischemic stroke with at least one cerebral large artery (including internal carotid artery,middle cerebral artery,vertebral artery,and basilar artery) stenosis ＞ 70％ diagnosed by whole cerebral angiography were enrolled.ASITN/SIR blood flow classification system was used to systematically evaluate the establishment of cerebral collateral circulation.Grade 0-2 was defined as poor collateral branch and 3-4 was defined as good collateral branch,Enzyme linked immunosorbent assay was used to detect the plasma CatL level.Results A total of 79 acute ischemic stroke patients with cerebral artery stenosis were enrolled,including 63 male and 16 female.Their mean age was 58.76 ± 12.24 years old.There were 51 patients (64.56％) in the poor collateral branch group and 28 (35.44％) in the good collateral branch group.There was no significant difference in plasma CatL levels between the good collateral circulation group and the poor collateral circulation group (7.09± 2.27 mg/L vs.8.79±3.53 mg/L;t =2.751,P =0.069).Multivariable logistic regression analysis showed that only the high National Institutes of Health Stroke Scale score was the independent risk factor for poor collateral circulation (odds ratio 0.935,95％ confidence interval 0.823-0.963;P=0.046),and there was no significant independent correlation between plasma CatL levels and collateral circulation (odds ratio 0.910,95％ confidence interval 0.766-1.081;P =0.285).Conclusion There was no significant correlation between plasma CatL levels and cerebral collateral development in acute ischemic stroke patients with cerebral artery stenosis.
RESUMO
Objective To investigate the effect of high frequency (10 Hz),low frequency (1 Hz) and theta burst stimulation (TBS) mode of repetitive transcranial magnetic stimulation (rTMS) on the recovery of motor function in hemiplegic patients following acute ischemic stroke.Methods Seventy-two patients with hemiplegia after acute ischemic stroke were randomly grouped with the random number table.They were treated with low frequency (n=18),high frequency (n=18),and TBS (n=18) rTMS or sham stimulation (control group,n=18),once a day,for 2 weeks.Fugl-Meyer Assessment (FMA) and National Institutes of Health Stroke Scale (NIHSS) were used to evaluate neurological function in all patients before rTMS treatment (on the day before the first treatment) and after treatment (on the day after the last treatment).Results After treatment,the FMA and NIHSS scores in the 4 groups were significantly improved compared with before treatment (all P<0.05).After rTMS treatment,the FMA and NIHSS scores were improved significantly in the high frequency group,low frequency group and TBS group compare with the control group (all P<0.05).There were no significant differences among all the treatment groups.Conclusion sHigh frequency,low frequency and TBS rTMS can improve the recovery of motor function in hemiplegic patients following acute ischemic stroke.There were no significant differences among all the treatment modes.
RESUMO
Objective To explore whether fluid-attenuated inversion recovery can be used to estimate the onset time of acute ischemic stroke (ALS) based on the analysis of signal strength through the fluid-attenuated inversion-recov?ery (FLAIR)and volume of interest (ROI) in ALS patients with known time of onset. Method Forty-seven AIS patients who met the inclusion criteria were recruited from Baotou Central Hospital, Department of Neurology from January 2011 to December 2012. The patients had stroke onset within 12 hours and completed MRI scan including diffusion-weighted imaging DWI, apparent diffusion and coefficient ADC FLAIR. Based on MRI findings, patients were divided into, three groups:0~180 min, 180~360 min and 360~720 min groups. Signal strength values of the DWI、FLAIR and ADC in ipsi?lateral and contralateral sides were measured. Result There was a significant difference in the FLAIR signal strength among these three groups.The FLAIR signal strength was significantly lower in 0~180 min and 180~360 min groups than in 360-720 min. FLAIR positive rate was 16.7%, 62.5%, and 70.6% in 0~180 min, 180~360 min and 360~729 min groups, respectively. Conclusion FLAIR positive rate gradually increases as the onset prolongs. Thus, lower FLAIR posi?tive rate indicates shorter onset time of AIS, which can be used to assist acute intravenous thrombolytic therapy.
RESUMO
Objective To explore the association of increased cerebrospinal fluid pressure with delayed encepha?lopathy after acute carbonmonoxide poisoning. Methods One hundred twenty cases of severe acute carbon monoxide poi?soning patients were included in the present study. All patients underwent lumbar puncture for measurement of cerebro?spinal fluid pressure (mmH2O) within seven days following acute carbon monoxide poisoning. Results Thirty-eight pa?tients of total 120 patients had a delayed encephalopathy and the incident rate of delayed encephalopathy was 31.67%. In?creased cerebrospinal fluid pressure was detected in 34 cases of delayed encephalopathy patients and the abnormal rate was 89.47%. Thirty-two of 38 patients with delayed encephalopathy demonstrated improvement to varying degrees af?ter treatment:6 cases had complete recovery, 26 regained or partially regained the ability to live independently, four died and two were in coma. Cerebrospinal fluid pressure was less than 150 mmH2O in six patients who achieved full recovery, while cerebrospinal fluid pressure was great than 200 mmH2O in six patients who died or were in coma. Cerebrospinal flu?id pressure was around 150~180 mmH2O in patients who regained or partially regained the ability to live independently. Conclusion Elevated cerebrospinal fluid pressure at the early phase of carbon monoxide poisoning may have a predictive value in diagnosis and prognosis of delayed encephalopathy.
RESUMO
Objective To understand the incidence and the severity of hypertension in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to analyze the impact of OSAHS on the circadian rhythm of blood pressure in patients with hypertension and to investigate the risk factors for the occurrence of hypertension from the aspects of nocturnal hypoxemia and sleep structure. Methods Polysomnography monitor was used for 7-hour sleep monitoring at night and 24-hour ambulatory blood pressure monitoring in 77 patients with OSAHS (severe, n = 33; moderate, n = 23; mild, n = 23). The sleep-related indicators and blood pressure at different times were analyzed, and they were compared to the patients with hypertension without OSAHS (n = 15) and normal controls (n = 15). Results (1) The body mass index (BMI) in the severe, moderate, and mild OSAHS groups was 29.1±2.8, 25.0±2.5, and 23.2±3.0 kg/m~2 respectively, and they were all significantly higher than 20.3±4.1 kg/m~2 in the control group (all P <0.05); sleep apnea-hypopnea index (AHI) was 56.2±14.7, 19.1± 4.4, and 11.2±4.3/h respectively, and they were significantly higher than 2.9±1.0/h in the control group (all P <0. 05); oxygen saturation index (ODI) was 62.5±20.4, 19.6±8.8, and 24.8±22.7/h respectively, and they were significantly higher than 2.7±2.0/h in the control group (all P <0.05); microarousal index (MI) was 47.5±20.9, 12.8±4.6, and 9.8±4.6/h respectively, arid they were significantly higher than 1.3±1.1/h in the control group (all P < 0.05); 24-hour mean systolic blood pressure was 133±14.5, 126±6.5, and 118± 9.9 mm Hg respectively, and the severe and moderate OSAHS groups were significantly higher than 117±9. 6 mm Hg (all P <0.05); 24-hour mean diastolic blood pressure was 92.8±9.6, 86.3±7.5, and 81.9±3.9 mm Hg respectively, and the severe and moderate OSAHS groups were significantly higher than 78.5±5.6 mm Hg in the control group (all P <0.05); and the lowest oxygen saturation was 65.5%±10.4%, 78.5%±5.1%, and 79.7%±9.6% respectively, and the severe and moderate OSAHS groups were significantly lower than 84.7% ±8.2% (P <0.05). (2) There was no significant difference in blood pressure before going to bed and waking up between the hypertension group and the control group. The blood pressure after waking up in the OSAHS combined with hypertension group was significantly higher than before going to bed (142.0±12.4/110.0±10.2 mm Hg vs. 127.4±9.8/84.2± 6.0 mm Hg, P <0.05). (3) ODI and MI in the OSAHS combined with hypertension group were 43.5±26.2/h and 31.6±21.2/h respectively, and they were significantly higher than 26.7± 13.2/h and 27.5±20.6/h in the non-hypertension OSAHS group (all P <0.05), and the non-rapid eye movement sleep period S3 +4 and the sleep efficiency of the former were 5.1%± 3.5% and 62.2±15.4% respectively, and they were all significantly lower than 8.8%± 5.2% and 69.92%±14.8% of the latter (P <0.05 and 0.01, respectively). (4) component ratio of non-dipper blood pressure curve was 56.1% in the OSAHS combined with hypertension group, and it was significantly higher than 13.1% in the control group and 16.7% in the simple hypertension group (all P <0.01 ). (5) Multivariate logistic regression analysis showed that ODI (OR = 1.29, 95% CI 1.57-1.07; P = 0.01 ), MI (OR = 0.925, 95% CI 0.874-0.980; P =0.008) and the time of period S3 +4 (OR = 1.087, 95% CI 1.034-1.142; P =0.001 ) were significantly correlated with hypertension alter adjusting for BMI, sex and age. Conclusions Systolic and diastolic blood pressures in the OSAHS group were significantly high-er than those in the normal control group, and the blood pressure increased with the aggravation of OSAHS. 1he circadian rhythm of blood pressure disappeared, and the blood pressure variabili-ty showed a non-dipper-shaped curve. The major risk factor for causing patients with OSAHS combined with hypertension was nocturnal hypoxemia and then severe sleep disorders and in-creased MI.