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Objective To investigate the dynamic characteristic changes of gastrointestinal mucosa and its relationship with disease progression in rats with acute cerebral infarction. Methods Fifty-six male Wistar rats were selected as the study subjects, and they were divided into three groups: normal control, sham operation and cerebral infarction model groups by random number table method. The middle cerebral artery occlusion (MCAO) model was prepared by the modified Longa thread embolic method. The levels of gastrin (GAS) were monitored in each group after modeling for 24 hours, 4 days and 7 days; after the rats were killed, the sections of gastric antrum and small intestine were taken and stained with hematoxylin-eosin (HE) staining method, the histopathological changes of gastric and small intestinal mucosa were observed under light microscope, in the mean time the gastric and small intestinal mucosal pathological scores were also performed, and the differences of pathological scores among the three groups were compared. Results There were no statistical significant differences in GAS, gastrointestinal mucosa and small intestinal mucosal pathological scores between the normal control group and sham operation group at each time point (all P > 0.05); the GAS level in cerebral infarction model group was decreased gradually with time prolongation, reaching the lowest level 7 days after modeling, but the GAS level in cerebral infarction model group was significantly higher than that in normal group and shamoperation group (ng/L: 205.02±7.68 vs. 130.51±8.03, 145.29±7.68, both P < 0.05). The pathological scores of gastrointestinal mucosa and small intestinal mucosa in the cerebral infarction model group were increased first and then decreased with time prolongation, peaked on 4th day and decreased significantly on 7th day, the pathological scores of gastrointestinal mucosa and small intestinal mucosa in the cerebral infarction model group at each time point were significantly higher than those in the normal control group and sham-operated group (gastric mucosal pathological score: 82.50±2.95 vs. 21.38±1.57, 36.10±3.41; small intestinal mucosal pathological score: 62.00±2.78 vs. 18.25±1.39, 25.55±1.75, all P < 0.05). Under light microscopy, the normal control group showed complete normal morphological appearance, normal structure, orderly arrangement of villi and no infiltration of inflammatory cells; in shamoperation group, inflammatory cells infiltrated the lamina propria at each time point, and there were villi slightly uneven, enlarged stroma, congestion, edema occasionally seen and no obvious ulcer; in cerebral infarction model group, the various layers of gastrointestinal mucosal were not very clear, the glands were arranged irregularly and the capillaries dilated, and in part of tissues, congestion, hemorrhage, edema and inflammatory cell infiltration were seen obviously. Conclusion The injury of gastrointestinal mucosa in acute stage of cerebral infarction should be related to the stress stimulation and disease progress of cerebral infarction itself, not due to the abnormal secretion of GAS.
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Objective To investigate pathogenic bacteria distribution and its effect on the expression of apoptosis protein in patients with acute cerebral infarction (ACI) complicated with pulmonary infection. Methods A retrospective analysis was conducted. From January 2014 to October 2017, the clinical data of 178 patients suffered from ACI hospitalized in Department of Neuromedical Center of Affiliated Hospital of the Chinese People's Armed Police Force Logistics Academy were collected, including 86 cases with ACI complicated with pulmonary infection selected as the observation group, and 92 cases with ACI without pulmonary infection assigned in the control group. The identification and classification of pathogenic bacteria were carried out by using the French BioMieux microorganism fully automatic identification instrument; the contents of serum interleukins (IL-8, IL-17), soluble intercellular adhesion molecule-1 (sICAM-1) and B type lymphocyte tumor-2 related X protein (Bax), B lymphocyte tumor-2 protein (Bcl-2) in two groups were detected by enzyme-linked immunosorbent assay (ELISA). Pearson correlation analysis was used to observe the correlations between sICAM-1 and Bax, Bcl-2 protein expression. Results From the bacterial cultures of 86 patients with ACI complicated with pulmonary infection, 86 strains of pathogenic bacteria were isolated, including 41 strains of gram positive (G+) bacteria (47.67%), mainly Staphylococcus aureus (25.58%); 37 strains of gram negative (G-) bacteria (43.02%), mainly Acinetobacter baumannii (11.63%); 8 strains of fungi (9.30%). The serum levels of IL-8 (μg/L: 0.72±0.15 vs. 0.68±0.09), IL-17 (μg/L: 9.31±3.58 vs. 8.12±2.76), sICAM-1 (ng/L: 421.36±39.74 vs. 385.13±28.59) and Bax (μg/L: 4.52±0.47 vs. 3.86±0.34) in the observation group were significantly higher than those in the control group, while the level of Bcl-2 in the observation group was significantly lower than that in the control group (μg/L: 0.84±0.26 vs. 1.13±0.31), all the differences were statistically significant (all P ＜ 0.05). In the observation group, sICAM-1 was significantly positively correlated with Bax protein (r = 0.401, P ＜ 0.001), while sICAM-1 was significantly negatively correlated with Bcl-2 (r = -0.447, P ＜ 0.001). Conclusion The pathogenic bacteria of ACI patients complicated with pulmonary infection is mainly G+bacteria, the infection can induce elevation of serum pro-inflammatory factors and sICAM-1 levels in the patients, and the mechanisms may be related to the up-regulation of Bax protein expression and down-regulation of Bcl-2 protein expression.
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Objective To observe the effect of butylphthalide sequential therapy combined with injection of alteplase(injection with recombinant human collagenous tissue plasminogen activator) in the treatment of acute cerebral infarction (ACI).Methods 61 patients with ACI and within 4.5 hours of onset were selected,and they were divided into treatment group(butylphthalide combined with alteplase group,31 cases) and the control group (alteplase only group,30 cases) by random number table.The two groups were given glucose-lowering,statins for maintaining the blood pressure,as well as aspirin enteric tablets or clopidogrel for those without bleeding on the 24 hour review head CT in the acute phase.The treatment group was given alteplase for injection with sequential butylphthalide therapy (butylphthalide injection for 2 weeks followed by an oral administration of butylphthalide soft capsules for 3 months),and the control group was given only alteplase for injection.The National Institute of Health stroke scale (NIHSS) and Barthel index (BI) were used for evaluating the final clinical efficacy.Results The NIHSS scores of the treatment group compared with the control group at 24 hour,14 days and 3.5 months after the treatment had statistically significant differences (t =-0.102,-1.964,-2.444,P =0.037,0.018 and 0.012).The NIHSS scores of the treatment group had decreased 2％,27％ and 41％ compared with the control group at 24 hour,14 days and 3.5 months after the treatment,respectively.The BI score of the treatment group and control group at 3.5 months after treatment had statistically significant difference (t =-1.956,P =0.029).Conclusion The sequential butylphthalide therapy combined with injection of alteplase has good synergistic effect for the patients with onset of ACI less than 4.5 hours,and it is a safe and effective treatment method for ACI within 4.5 h and it is worthy of clinical promotion.
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Objective To assess the safety and efficacy of danhong injection combined with edaravone for acute cerebral infarction ( ACI) . Methods To search CBM、CNKI、VIP、WF、MEDLINE for randomized controlled trials ( RCTs) of related articles from inception to November 2014.After assessed the quality of studies included,RevMan5.2 software was used to analyze data. Results 23 studies,were included and 2 001 patients were involved.The results showed that the effective rate of danhong injection combined with edaravone for ACI was better than that of control group with statistical significance [ RR=1.23, 95%CI (1.17,1.29), P<0.000 01].Meta-analysis on the improvement of neurological deficit and activities of daily living also showed a better effectiveness of experimental group than control group with statistical significance [MD=-3.09,95%CI(-3.68,-2.50),P<0.000 01];[MD=15.15,95%CI(12.69,17.62), P<0.000 01].But the result showed no statistical significance in safety evaluation of two groups [RR=1.88,95%CI(0.76,4.63),P=0.17]. Conclusion Although the results support the conclusion that danhong injection with edaravone is safe and superior to either danhong injection or edaravone or conventional treatment, further large sample and high quality randomized controlled trials should be carried out.
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Objective To discuss the expression and significance of platelet ultrastructure and platelet acti-vating factor(PAF)relationship in patients with acute cerebral infarction.Methods 40 patients with cerebral infarc-tion were chosen onset in 6-24 hours as the observation group,while at the same time 20 cases of healthy adults were selected as the control group.The observation group was given 1-7d of aspirin enteric-coated metformin hydrochloride 300mg,qd,and 8-14d had worship of aspirin enteric-coated metformin hydrochloride 100mg,qd.And before and 1,7, 14 days after treatment,control group and observation group respectively preclude the use of transmission electron microscopy ultrastructure of platelets,before and 1,14 days after treatment automatic blood cell analyzer test was used to analyze the average platelet volume (MPV),platelet count (PLT),platelet volume distribution width (PDW)of the two groups.And 1,2,3,7,14 days after treatment,enzyme-linked immunosorbent determination of double clamp method was used to test the concentration of PAF.Results Before treatment,MPV,PDW and PAF in peripheral blood of the observation group were (9.22 ±1.30)fL,(17.89 ±1.23)%,(211.31 ±11.22)pg/mL,which were sig-nificantly higher than those of the control group (8.68 ±1.03)fL,(16.06 ±1.03)%,(155.49 ±8.70)pg/mL(t =2.082,2.563,14.401,all P <0.05),while PLT was (173.22 ±63.40)×109 /L,which was significantly lower than that in the control group (231.22 ±56.76)×109 /L(t =3.048,P <0.05).After treatment in patients with acute cer-ebral infarction,the MPV,PDW of peripheral blood were (8.43 ±1.28)fL,(16.66 ±1.11)%,which were signifi-cantly lower than before treatment (9.22 ±1.30)fL,(17.89 ±1.23)% (t =1.937,3.320,all P <0.05),while PLT (195.33 ±61.45)×109 /L was significantly higher than before treatment (173.22 ±63.40)×109 /L(t =1.915, P <0.05).PAF peaked in the treatment of 3 days,which was (240.12 ±13.78)pg/mL,and gradually declined after 7 days,which was (215.33 ±16.43)pg/mL,and that after 14 days was(170.27 ±11.40)pg/mL,compared with before treatment (211.31 ±11.22)pg/mL,the difference was statistically significant (t =16.24,P <0.05).Before treatment,platelet shape had irregular,increased pseudopodia,several visible platelet aggregation,and was blend together.And after 14 days treatment in the observation group,platelet ultrastructure greatly recovered.Conclusion Monitoring of MPV,PDW,PAF and PLT in peripheral blood of patients with acute cerebral infarction before and after treatment has important clinical value for disease diagnosis and treatment.
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Objective To explore the chronergy of fibrinolysin and its influence on fibrinogen ( FIB ) and thrombus precursor protein (TpP) in treatment of acute cerebral infarction (ACI). Methods The clinical trial adopted the randomized single-blind placebo-controlled design.Totally, 150 patients with ACI (onset time≤12 h) were chosen and randomly divided into experimental group A ( group A receiving treatment of fibrinolysin after 12 h onset of ACI ) , experimental group B ( group B receiving treatment of fibrinolysin after 24 h onset of ACI) and control group ( group C without fibrinolysin treatment) , 50 cases in each group.The patients in experimental group A and B received basic treatment for ACI and fibrinolysin treatment.Patients in group C were given the basic treatment for ACI and placebo.The level of FIB and TpP before and after 7 days treatment, NIHSS scores before and after 14 days treatment, BI scores before and after 90 days treatment, incidence rate of progressive cerebral infarction ( PCI ) , stroke recurrence and mortality rate of the three groups were analyzed to evaluate the clinical effect of fibrinolysin.Hepatic and renal function before and after 7 days treatment, incidence rates of haemorrhage and hypersensitiveness were analyzed to evaluate the security of fibrinolysin. Results The NIHSS score of patients in group A, B and C (4.0±1.6, 6.5±2.2 and 8.0±4.7) was declined significantly after treatment (P0.05).The FIB in group A, B and C after treatment was (2.74±0.75) g?L-1,(2.82±0.83) and (3.67±1.35) g?L-1, respectively.The level of FIB in the three groups did not decrease significantly after treatment (P>0.05).However, the level of FIB in group A and B declined significantly as compared with that in group C.The TpP in group A, B and C after treatment was (3.56±1.26) mg?L-1, (3.43±1.22) and (13.21±6.54) mg?L-1, respectively.The level of TpP in group A and group B decreased significantly after treatment (P<0.05). The level of TpP in group A and B declined even more significantly than that in group C.Fibrinolysin did neither obviously injure liver and kidney nor increase the risk of bleeding, and had low hypersensitiveness incidence rate. Conclusion Treatment with fibrinolysin within 24 h after onset of cerebra infarction benefits the patients. However, dosing after 12 h onset of ACI benefits more than dosing after 24 h.Fibrinolysin plays a role of anti-thrombosis primarily by lowering the TpP level, and its influence on fibrinogen is limited.
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Objective To obserVe influence of danhong injection on leVels of serum S100B Protein and neuron_sPecific enolase ( NSE) in Patients with acute cerebral infarction ( ACI) ,and to exPlore its clinical effect. Methods Eighty cases of ACI were randomly diVided into treatment grouP and control grouP with 40 cases in each grouP. Both grouPs were giVen routine treatment according to the clinical guideline. Treatment grouP receiVed danhong injection once a day for 14 days. LeVels of serum S100B Protein and NSE were detected 1,3,5 and 10 days after ACI. The Patients in the two grouPs were eValuated by NIHSS 1 and 21 day(s) after ACI. Results ComPared with control grouP,leVels of serum S100B Protein and NSE were significantly lower in treatment grouP than in control grouP 3 and 5 days after ACI (all P<0. 01). NIHSS scores were significantly decreased 21 days after ACI in both grouPs,and NIHSS scores were lower in treatment grouP than in control grouP (P<0. 05). Peak concentration of S100B Protein in treatment grouP and control grouP was PositiVely correlated with NIHSS scores ( r=0. 761 and r=0. 792,resPectiVely,both P<0. 01). Conclusion Danhong injection can decrease serum S100B and NSE leVels,and imProVe the neurological function in ACI Patients.
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@#Objective To investigate the levels of CD62P expression on patients with acute thrombotic cerebral infarction （ATCI） or acute cardiogenic cerebral embolism (ACCE). Methods The levels of CD62P expression were detected with flow cytometry (FCM) in the blood of 35 patients with ATCI, 30 patients with ACCE, and 33 healthy controls. Results Comparing with the controls, the levels of CD62P expression on patients did not increase both in the ATCI group and the ACCE group. (F=1.12, F=1.59；P>0.05). Furthermore, there wasn't significant difference in the expressions of CD62P between the ATCI group and the ACCE group. Conclusion The expressions of CD62P do not increase on the patients with ATCI and ACCE, although it is one of the markers of platelets activation.
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Objective To study the influence of dl-3n-butyphthalide on serum C-reactive protein(CRP)level in patients with acute cerebral infarction.Methods A total of 68 patients with acute cerebral infarction were chosen and divided into two groups randomly.Both the groups were treated with normal method and the treatment group was given dl-3n-butyphthalide 200 mg,tid.Serum CRP levels in the two groups were measured by immunoturbidimetry within 24 h after final diagnosis and at two weeks after treatment.Results Serum CRP levels all increased in the patients.After treatment for two weeks the level decreased obviously in treatment group.The difference was significant compared with control group.Conclusion The dl-3n-butyphthalide can markedly decrease the serum CRP level in acute cerebral infarction patients and has important significance for the pathogenetic condition change and prognosis of cerebral infarction.
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Objective To observe the efficacy and safety of Shuxuetong injection with edaravone in treatment of acute cerebral infarction.Methods 70 patients of acute cerebral infarction were ramdonly divided into two groups:treatment group was done with Shuxuetong injection and edaravone,and the control group was treated by xiangdan.Two groups were treated with routine therapy.ESS and ADL content change in two groups were assessed at different point before treatment and two weeks after treatment.Results The scores of ESS of two groups increased after treatment(P
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Objective To study the method and therapeutic results of intra-arterial interventional treatment (selective intra-arterial fibrinolysis) in acute cerebral infarction(ACl).Methods A total of 106 patients with ACI are divided into two groups:selective intra-arterial fibrinolytic therapy group(SIAF),intra-venously thrombolysis group(IVF);SIAF is selective entered into the obliterative artery with improved Seldinger's technich,pumped urokinase(UK) in a dose of 500 000 i.u.in NS.60ml within 40 minutes;arteriography is done all the time to know if the obliterative artery is unobstruct- ed,if it remains obstructe,then pumps 300 000 i.u.of UK,as long as it unobstructed,the treatment is finished at once; IVF is injected 1000 000 i.u.of UK in NS.150 mL by intravenous drip within 40 minutes,others like SIAF.Results The artery is disobliteration after thrombolysis,48 patients in SIAF,30 patients in IVF,P
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@# ObjectiveTo investigate the characteristics of the ambulatory blood pressure of acute cerebral infarction patients in the first 24 hours from onset and to study the relationship between their neurological deficit and characteristics of blood pressure.MethodsBlood pressure in 31 acute cerebral infarction patients (within 24 h) was measured serially during the first 24 hours in hospital with ambulatory blood pressure monitoring. Their neurological deficit was assessed with the National Institutes of Health stroke scale (NIHSS) on the first and the fifth day. Results83.87% nocturnal blood pressures decreased less than 10%. In multiple linear regression analysis, 24 h diastolic blood pressure (DBP) becomes the only and the most important factor to NIHSS on the first day. The patients with improved NIHSS on the fifth day showed lower nocturnal DBP and mean arterial pressure (MAP) than those of patients with unimproved NIHSS.ConclusionNot only the level but also the circadian of ambulatory blood pressure in acute cerebral infarction patients is significantly abnormal, especially for the reduction of nocturnal blood pressure decrease. On the first day, the neuroulogical deficit and blood pressure influence each other. The patients with higher nDBP and nMAP on the first day may be associated with poor early neurological function outcomes.