Effect of renal insufficiency on the treatment of patients with ischemic stroke / 国际脑血管病杂志

Patients with chronic kidney dysfunction (CKD) have abnormal coagulation function and impaired drug metabolism, resulting in increased bleeding risk and decreased drug clearance. Therefore, while receiving treatment, the prognosis of ischemic stroke patients with CKD is different from that of ischemic stroke patients without CKD. For patients with CKD who need anticoagulant treatment, the use of new anticoagulants without renal metabolism can achieve the same anticoagulant effect as warfarin, and the risk of bleeding is lower. When using antiplatelet drugs, due to the increased risk of bleeding in ischemic stroke patients with CKD, the clinical benefits and bleeding risk should be carefully weighed. Although CKD is not an absolute contraindication of intravenous thrombolysis or endovascular treatment in patients with acute ischemic stroke, attention should be paid to the influence of CKD on the increased risk of death in patients with ischemic stroke after treatment.

Evaluation of characteristics of carotid plaques and immediate outcomes after carotid artery stenting in diabetic and non-diabetic patients by optical coherence tomography / 国际脑血管病杂志

Objective:To evaluate the characteristics of carotid plaque and the immediate outcomes after carotid artery stenting (CAS) in diabetic and non-diabetic patients by optical coherence tomography (OCT).Methods:Patients underwent CAS and OCT before and after operation in the Department of Neurology, Jinling Hospital from January 2014 to March 2019 were enrolled retrospectively. The clinical features, the characteristics of carotid plaque on OCT and the immediate outcomes after CAS were compared between diabetic group and non-diabetic group. The risk factors of stent malapposition were analyzed.Results:A total of 46 patients were enrolled. Their age was 64.02±8.32 years and 41 were males (89.1%). There were 20 patients (43.5%) in the diabetes group and 26 (56.5%) in the non-diabetes group. The proportions of atherosclerotic plaque with thin fibrous cap (40.0% vs. 7.7%; χ2=5.166, P=0.023), plaque rupture (55.0% vs. 23.1%; χ2=4.945, P=0.026) and macrophage infiltration (60.0% vs. 30.8%; χ2=3.930, P=0.047) in the diabetic group were significantly higher than those in the non-diabetic group. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.208, 95% confidence interval [ CI] 1.033-1.413; P=0.018), coronary heart disease ( OR 15.953, 95% CI 1.142-222.952; P=0.040), alcohol consumption ( OR 6.192, 95% CI 1.098-34.923; P=0.039) and lower systolic blood pressure ( OR 0.944, 95% CI 0.894-0.997; P=0.037) were independently associated with stent malaposition. Conclusion:Compared with the non-diabetic patients, carotid plaque in diabetic patients may be more unstable. Older age, coronary heart disease, alcohol consumption and lower systolic blood pressure were associated with stent malaposition after carotid stenting. OCT can reveal the characteristics of carotid plaque and the immediate outcomes after CAS, which can provide strong evidence for treatment decision.

The effect of butylphthalide injection combined with interventional therapy on patients with acute anterior circulation large vessel occlusive stroke / 中华神经科杂志

Objective To investigate the effect of butylphthalide and sodium chloride injection on patients who received endovascular treatment for acute anterior circulation large vessel occlusive stroke.Methods A total of 173 patients were identified from February 2015 to December 2017 in the Department of Neurology of Jingling Hospital in this retrospective observational study.Propensity score-matching analysis was performed to balance differences in baseline characteristics between patients who received butylphthalide injection (butylphthalide group) and those who did not (control group).The modified Rankin Scale scores at 90 days were compared between the butylphthalide and control groups.Results A total of 144 patients who received endovascular treatment for acute anterior circulation large vessel occlusive stroke were finally analyzed,54 cases in the butylphthalide group and 90 cases in the control group.The proportion of good functional outcome at 90 days in the butylphthalide group was higher than that in the control group (63.0％ (34/54) vs 44.4％ (40/90);x2=4.633,P=0.031).Thirty-six pairs were matched successfully by the propensity score matching,36 patients in the butylphthalide group and 36 in the control group.There was no statistically significant difference in the 90-day functional outcome between the two groups (66.7％ (24/36) vs 44.4％ (16/36);x2=3.600,P=0.058).One hundred and fifteen patients were recanalized,47 cases in the butylphthalide group and 68 cases in the control group,and after the propensity score matching,30 pairs were analyzed.The proportion of good functional outcome at 90 days in the butylphthalide group was higher than that in the control group (73.3％ (22/30) vs 46.7％ (14/30);x2=4.444,P=0.035).Conclusion After propensity score-matching,butylphthalide and sodium chloride injection could improve 90-day functional outcome in patients with acute anterior circulation large vessel occlusive stroke and obtained recanalization by endovascular treatment while could not before propensity score-matching.

Association between early functional outcome and serum thyroid hormone level in elderly acute ischemic stroke patients / 中华老年心脑血管病杂志

Objective To study the association between early functional outcome and serum thyroid hormone level in elderly acute ischemic stroke (AIS) patients.Methods Two hundred and twenty-four AIS patients admitted to our hospital from May to December 2016 were divided into good functional outcome group (n=166) and poor functional outcome group (n=58) according to their mRS score.The serum levels of FT3,FT4,TSH were measured.The patients were further divided into FT3≤4.05 pmol/L,FT3 4.06-4.46 pmol/L,and FT3＞4.46 pmol/L.The association between early functional outcome and serum levels of FT3,FT4,TSH in elderly AIS patients were analyzed by univariate and multivariate logistic analysis.Results The AIS was severer,the BMI and incidence of AF were higher,the number of WBC was greater,the serum FT3 and CRP levels were higher in poor functional outcome group than in good functional outcome group (P＜0.05,P＜0.01).The rate of poor functional outcome was significantly higher in FT3≤4.05 pmol/L than in FT3 4.06-4.46 pmol/L and FT3 ＞4.46 pmol/L (39.5％ vs 22.2％,39.5％ vs 15.8％,P=0.003).Univariate logistic regression analysis and multivariate logistic regression analysis showed that FT3 was an independent risk factor for early poor functional outcome in AIS patients.Concision The lower the serum FT3 level on admission is,the poorer the early functional outcome is in AIS patients.

Histopathology of the temporal artery in young ischemic stroke patients with elevated serum immunoglobu-lin E / 医学研究生学报

Objective Ischemic stroke with elevated serum immunoglobulin E ( IgE) in some young patients is regarded as cerebral vasculitis clinically though without sufficient pathological evidence .This study was to investigate the characteristics of vascular lesions in these patients by temporal artery biopsy . Methods We performed histopathologic examinations on the temporal arteries of 32 young ischemic stroke patients with unknown etiology , 16 with normal and the other 16 with elevated serum IgE .We observed inflammatory cells infiltration and mast cells by HE staining and toluidine blue stai-ning respectively and determined the expressions of matrix metalloproteinase -9 (MMP-9), monocyte chemotaxis protein -1 (MCP-1) and serum IgE by immunohistochemistry . Results Compared with the patients with normal IgE , those of the elevated IgE group showed a significantly higher rate of inflammatory cells infiltration (12.5%vs 62.5%, P0.05).Nor was any signifi-cant difference observed in the number of the mast cells between the normal and elevated IgE groups (2.8 ±1.5 vs 3.6 ±2.3, P>0.05). Conclusion The infiltration and necrosis of inflammatory cells and fibrin exudation in the temporal artery of the young pa-tient with elevated serum IgE are likely to be the manifestations of vasculitis , and MCP-1 may play a role in the pathogenesis of the disease.

Intranasal delivery of nerve growth factor attenuates neuroinflammation following traumatic brain injury in rats / 医学研究生学报

Objective Neuroinflammation following traumatic brain injury (TBI) may give rise to neurodisorder.This study aimed to investigate the effect of intranasal delivery of nerve growth factor ( NGF) on neuroinflammation following TBI and its action mechanism in rats. Methods Thirty-six male adult Sprague-Dawley rats were equally divided into a sham , a TBI, and a TBI+NGF group.The rats in the TBI +NGF group were treated with NGF intranasally at 12 and 24 hours after TBI.The levels of IL-1βand TNF-αin the injured cerebral cortex were detected by ELISA , the DNA-binding activity of NF-κB evaluated by EMSA , and the expres-sion of amyloid-β( Aβ42 ) determined by Western blot . Results NGF attenuated the inflammation following TBI .Compared with the TBI group, the level of IL-1βwas obviously decreased in the TBI +NGF group at 12 hours (70.65 ±3.10 vs 37.51 ±1.92) and 24 hours (68.85 ±8.10 vs 36.23 ±2.99, P<0.05), and so was that of TNF-α(47.12 ±7.38 vs 27.63 ±5.77 and 56.15 ±11.20 vs 29.94 ±8.62, P<0.05).The DNA-binding activity of NF-κB was reduced to 111.62 ±0.49 and 131.52 ±0.88, and the expression of Aβ42 to 0.23 ±0.008 and 0.52 ±0.004 at 12 and 24 hours respectively after treatment with NGF , both with statistically significant differences from the TBI group (P<0.05). Conclusion Intranasal administration of NGF attenuates TBI-induced neuroinflamma-tion in rats, which may be associated with its regulatory effect on the Aβ42/NF-κB signaling pathway .

Endovascular treatment modalities in patients with ischemic stroke / 国际脑血管病杂志

Ischemic cerebrovascular disease is one of the major reasons of mortality and disability in adult populations.Ultra-early recanalization is by far the most positive treatment.Relative to intravenous thrombolysis,various endovascular treatment modalities can extend therapeutic time window and increase the recanalization rate.Furthermore,interventional therapy can also improve the clinical outcomes of patients by increasing the perfusion of colhteral circulation.This article reviews various endovascular treatment modalities and their application validated in previous clinical studies in China.

Effect of nerve growth factor delivering intranasally on β-amyloid deposition after traumatic brain injury in rats / 中华神经科杂志

Objective To study the effect of intranasal nerve growth factor (NGF) on the expression of amyloid-β,peptide (Aβ) in the central nervous system in rats with traumatic brain injury (TBI).Methods Eighty rats were randomly divided into sham(n =26),control(n =27) and treatment group (n =27 ).They were subjected to the modified Feeney' s weight-drop model.The treatment group was treated with NGF administered by nasal route,and the control group was given phosphate-buffered saline (PBS).Beam walking and Morris water maze test were performed in the three groups.The concentration of Aβ40 and Aβ42 in the injured ipsilateral hippocampus was elevated by ELISA measurement.Immunohistochemistry was used to detect the amyloid precursor protein (APP) positive cells near the region of injury in the hippocampus in rats after TBI.Results NGF group traversed the beam significantly quicker (s) than control group ( 19.00 + 6.99 vs 27.33 ± 7.39 respectively,F2,15 =12.87,P =0.028 ).Morris water maze performance revealed that mean time of latency in the NGF group was significant shorter than vehicle group,and significant memory retention in NGF group as evidenced by a greater percentage of the 60 s allotted time spent in the target quadrant (45.82％ ± 11.15％ vs 33.99％ ± 3.46％,F2,15 =6.814,P=0.037),as well as the number crossing of the former site of the removed platform in NGF group was significant more than control group (8.60 ±2.73 vs 3.60 ±2.06,F2,15 =5.346,P =0.04).The Aβ42 level in control group was increased significantly higher than NGF group as indicated by ELISA measurements.While the Aβ40 level did not have similar shown.Immunohistochemical staining showed that APP level had significant differences among three groups ( F2,15 =8.672,P =0.003).The APP level in NGF group did not alter with control group.Conclusion Intranasal administration of NGF can regulate Aβ42 overproduction,improve the motor and cognitive function after brain injury in rats.

Advances in improving the efficiency of nasal delivery / 国际脑血管病杂志

At present,intranasal delivery has entered clinical trial stage.In recent years,how to imroving the efficiency of intranasal delivery has been extensively investigated.This article briefly reviews some factors that impact the targeting of intranasal delivery and the drug concentration in the central nervous system.

Influence of TNF-? gene polymorphisms on TNF-? production and disease / 医学研究生学报

Tumor necrosis factor ?(TNF ?) is a potent proinflammatory cytokine. In human, TNF ? gene is located within the highly polymorphic major histocompatibility complex(MHC) region on chromosome 6p21.3. TNF gene cluster contains many polymorphisms including microsatellites and single nucleotide polymorphisms(SNPs).Many of these polymorphisms were found to be in linkage disequilibrium with HLA class Ⅰand Ⅱ alleles. Some of the TNF ? gene polymorphisms were found to influence TNF ? production in vitro , for example the 308SNP. Many studies have shown that this SNP and others within the TNF ? gene associate with different inflammatory conditions. Whether this phenomenon is due to the direct influence if the SNP in question and/or due to linkage disequilibrium with other polymorphisms within the TNF ? gene or the HLA system is still controversial.

Pathological opening of blood-brain barrier in disease conditions / 医学研究生学报

Most compounds in blood are blocked from flowing into brain by blood-brain barrier(BBB) to keep central nerve system normal, but this barrier will be open in different diseases with different mechanisms. As these mechanisms are understood more and more clearly, it will do help to protect blood-brain barrier and treat diseases which are correlative to blood-brain barrier. At the same time, it may also be helpful to let drugs entering central nerve system through BBB.

Trigeminal nerve pathway to brain following intranasal administration of transforming growth factor beta 1 / 解放军医学杂志

Objective To study whether intranasally administered transforming growth factor beta1(TGF-?1)can reach central nervous system(CNS)through the trigeminal nerve pathway.Methods Nineteen healthy male SD rats were randomly assigned into control group(n=6)and administration(IN)0.5h group(n=3),1h group(n=4),2h group(n=3)and 6h group(n=3).Rats in IN groups were given 50?l(20?g)recombinant human TGF-?1(rhTGF-?1)intranasally and were sacrificed at 0.5,1,2 or 6h after IN following blood sample collection.The cerebellum,midbrain,pon,medulla and trigeminal nerve were separated quickly and the concentration of TGF-?1 was analyzed by ELISA.Results Compared with the control group(15.01?1.50pg/mg),TGF-?1 was significantly elevated in the trigeminal nerve in all the IN groups(P0.05).TGF-?1 concentrations in plasma and other caudal CNS regions,such as cerebellum,midbrain and cervical spinal cord,were not significantly changed compared with that in control group.Conclusion TGF-?1 is likely to be absorbed by the trigeminal nerve following intranasal administration,and is subsequently delivered to some brain regions through the trigeminal nerve pathway,which may provide a potential treatment strategy for trigeminal nerve and CNS disorders.