Serum levels of ANGPTL4 and NLRP3 in patients with severe traumatic brain injury and their diagnostic value for secondary massive cerebral infarction / 国际检验医学杂志

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.

Analysis of risk factors of massive cerebral infarction after craniocerebral injury in children with acute subdural hematoma / 中国神经精神疾病杂志

Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.

Efficacy of emergency endovascular treatment in acute anterior circulation massive cerebral infarction and its influencing factors / 中华神经医学杂志

Objective:To investigate the safety and efficacy of endovascular treatment in acute anterior circulation massive cerebral infarction and its prognostic factors.Methods:A retrospective analysis was performed on clinical data of 34 patients with acute anterior circulatory massive cerebral infarction who received intravascular treatment in our hospital from February 2018 to December 2019. The perioperative hemorrhage rate and mortality rate were analyzed in these patients. Modified Rankin scale (mRS) scores were taken as the evaluation standard in the prognoses of these patients during the 90 d of follow up, and the influencing factors affecting the prognoses of patients with massive cerebral infarction were analyzed.Results:The operation was successful in 30 patients (88.2%); the operation time was (97.41±54.58) min, and the number of thrombolysis was (1.91±0.75) times. Distal embolization occurred in 4 patients (11.8%); there were 3 patients with non-symptomatic hemorrhage (8.8%) and 3 patients with symptomatic hemorrhage (8.8%). Cerebral hernia occurred in 7 patients (20.6%); there were 5 deaths (14.4%). During the 90 d of follow up, 13 patients (38.2%) had good prognosis, and 21 (61.8%) had poor prognosis; there were statistically significant differences in NIHSS scores at admission, infarction locations in diffusion weighted imaging, vascular occlusion locations in DSA, pecentages of patients accepted preoperative intravenous thrombolysis and patients with cerebral hernia between the two groups ( P<0.05). NIHSS scores at admission ( OR=0.817, 95% CI: 0.682-0.980, P=0.029), thrombus load scale scores ( OR=5.981, 95%CI: 1.827-19.575, P=0.003), vascular occlusion locations in DSA ( OR=0.031, 95% CI: 0.003-0.311, P=0.003) and pecentage of patients accepted preoperative intravenous thrombolysis ( OR=0.092, 95% CI: 0.010-0.838, P=0.034) were independent factors influencing the prognoses of emergency intravascular treatment. Conclusions:Endovascular recanalization can achieve a relatively good prognosis in patients with massive cerebral infarction. Patients with low NIHSS scores, high thrombotic load scale scores, and middle cerebral artery occlusion, and patients accepted direct intravascular treatment have relatively good prognosis.

Effect of continuous intracranial pressure monitoring combined with step-by-step therapy in elderly patients with acute massive cerebral infarction / 中风与神经疾病杂志

@#Objective　To elucidate the clinical effect of continuous intraventricular intracranial pressure monitoring combined with step-by-step treatment for elderly patients with acute massive cerebral infarction.Methods　Forty-six elderly patients with acute massive cerebral infarction were selected from November 2015 to October 2019.Patients according to the research requirements were randomly divided into two groups:ICP group(n=23) and control group (n=23),ICP group was given stepwise management guided by intraventricular ICP monitoring,control group was given routine drug treatment after admission,according to patients’ consciousness and the changes in pupil signs and head CT results adjusted the treatment plan.FIM scores were observed after 3 months and complications (including abnormal coagulation function,bedsore and pneumonia).Results　FIM scores of ICP group was (90.81±6.08),and FIM scores of control group was (76.56±7.82),the difference was statistically significant (P<0.05).The proportion of complications of ICP group was 17.4% (4/23),and that of control group was 78.3% (18/23),the difference was statistically significant (P<0.05).Conclusion　For elderly patients with acute massive cerebral infarction,intraventricular ICP monitoring with stepwise management is beneficial.Choosing appropriate treatment plan,reduced the occurrence of complications and improved the brain function of patients.

Clinical Profile and Risk Factors of Massive Middle Cerebral Artery Infarction in a Tertiary Care Centre in Central Tamilnadu

Introduction: Large territory middle cerebral artery strokesare devastating events that result in high rates of disabilityand death. Nearly half of all stroke survivors never regainfunctional independence. Current research aimed to study theclinical profile and risk factors of massive middle cerebralartery (MCA) infarction and to study the relation of alcoholismand its pattern to massive MCA stroke.Material and methods: Patients admitted with massive MCAinfarct with an early ischemic change on CT affecting at least>50% of the MCA territory within 48 hours of symptom onsetwere included in the study. Stroke mimics and those withhistory of previous stroke were excluded. Study design was across sectional, observational study.Results: A total of 60 cases were analyzed. Mean age was55.4. 35% subjects had NIHSS >20.Diabetes was present in18. Total of 60% were alcoholics, and 83% of males werealcoholics.31 subjects were heavy drinkers. Binge drinkingwas present in 30%.Mean duration of alcohol was 9.5 years.Average intake per day was 120 ml. Mean ASPECT scorein the subjects was 3. 25 patients had a MRS 4 at discharge.Craniotomy done in 6 cases. Total death were 17(29%).Aspiration pneumonia was the common cause of death (5).Conclusion: NIHSS 20 or more was associated with adverseoutcome (P value <0.05).60% were alcoholics. Binge intake in30%(associated with adverse outcome P value <0.05). MeanAspect score was 3 (3 or less associated with adverse outcomeP value <0.05).

Clinical Observation of Sofren Injection Combined with Vinpocetine Injection in the Treatment of Acute Massive Cerebral Infarction / 中国药房

OBJECTIVE:To investigate clinical efficacy of Sofren injection combined with Vinpocetine injection in the treatment of acute massive cerebral infarction,and its effects on hemorheological indexes and serum NOS.METHODS:A total of 60 patients with acute massive cerebral infarction in our hospital during Jan.2014-Jun.2016 were selected as research objects and divided into trial group and control group according to random number table,with 30 cases in each group.Control group was given Citicoline injection 0.5 g,ivgtt,qd.Trial group was additionally given Vinpocetine injection 20 mg added into 0.9％ Sodium chloride injection 250 mL,ivgtt,qd;1 h later washing tube,they were given Sofren injection 10 mL added into 0.9％ Sodium chloride injection 250 mL,ivgtt,for consecutive 14 d.Clinical efficacies and safety of 2 groups were observed,and hemorheological indexes and NOS levels were observed before and after treatment.RESULTS:The total response rate (83.33％)of trial group was significantly higher than that (50.00％) of control group,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in hemorheological indexes or serum NOS levels between 2 groups (P＞0.05).After treatment,hemorheological indexes of 2 groups were decreased significantly,and the trial group was significantly lower than the control group.The level of serum NOS in 2 groups were increased significantly,and the trial group was significantly higher than the control group,with statistical significance (P＜0.05).No obvious ADR was found in 2 groups.CONCLUSIONS:Sofren injection combined with Vinpocetine injection show significant therapeutic efficacy for acute massive cerebral infarction,can reduce blood viscosity and increase blood perfusion with good safety.

Clinical Observation of Shuxuetong Combined with Butylphthalide in the Treatment of Acute Massive Cere-bral Infarction in Elderly Patients / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of shuxuetong combined with butylphthalide in the treat-ment of elderly acute massive cerebral infarction. METHODS:76 elderly patients with acute massive cerebral infarction selected were randomly divided into observation group and control group,with 38 cases in each group. Control group was treated with bu-tylphthalide,100 ml,bid;observation group was additionally given shuxuetong 6 ml added into 55 Glucose injection 200 ml, ivgtt,qd,on the basis of control group. The NIHSS,coagulation index,hematocrit,platelet aggregation rate and clinical efficacy were observed in 2 groups before and after treatment. RESULTS:After 14 d treatment,NIHSS of observation group [(3.57±0.25) points] was significantly lower than that of control group [(5.98±1.13)points],with statistical significance(P0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Shuxuetong combined with butylphthalide is effective in the treatment of elderly acute massive cerebral infarction,and help restore neurological function with good safety.

Clinical application of susceptibility-weighted imaging in the early diagnosis of massive cerebral infarction with hemorrhage and analysis of collateral circulation / 中国综合临床

Objective To evaluate the clinical application of susceptibility-weighted imaging(SWI) in the early diagnosis of massive cerebral infarction with hemorrhage and analysis of collateral circulation.Methods Fifty patients with massive cerebral infarction underwent MRI (T1WI,T2WI,DWI,MRA and SWI) scan in acute stage and decubation respectively in Hanrison International Peace Hospital from January 2012 to January 2014.Analysis T1WI,T2WI,DWI,MRA and SWI differences in the delection of cerebral infarction with hemorrhage and analysis of Collateral circulation.Record the magnetic resonance angiography hemorrhagic transformation and display the ischemic area of collateral circulation in the detection of cerebral infarction remodeling differences.Results (1)SWI detected out 18 cases of cerebral infarction with hemorrhage (36％),including 14 cases of hemorrhagic infarction(HI) type(28％),4 cases of parenchymal hemorrhage(PH) type 8％).MRI detected 11 cases of cerebral infarction with hemorrhage (22％),including 7 cases of HI type 14％),4 cases of PH type (8％).SWI detected 106 focuses,the detection rate was 100％,MRI detected only 26,and the detection rate was 32.51％,and the missing mainly for micro hemorrhage.There was statistical significance between the groups(x2 =21.045,P＜0.05).(2) SWI can display the condition of micrangium in the area of cerebral infarction clearly.The number of micrangium decreased or disappeared in acute stage,but the micrangium increased in decubation.The ratio of capillary vessels increased to 66％.MRA detected 82％ of criminal vessel in patients with cerebral infarction.Conclusion SWI is more sensitive than conventional MR in the early diagnosis of massive cerebral infarction with hemorrhage.MRA combined with SWI could not only detect the criminal vessel of cerebral infarction area,but also monitor the reconstruction of collateral circulation in the infarction region,and there will be extremely valuable to the treatment massive cerebral infarction and evaluation of prognosis.

Application of cluster management in patients with massive cerebral in-farction / 中国现代医生

Objective To study the application of cluster management in patients with massive cerebral infarction. Methods 200 cases of massive cerebral infarction patients in our hospital were randomly divided into two groups, 100 cases in the experimental group, reduced lip breathing, effective cough, regular turning knock back, inhalation,bronchoscopy were applied; 100 cases in the control group, conventional measures of respiratory care were applied. 3 days, 7 days, 14 days expectoration ability, 7 days, 14 days atelectasis, pulmonary infection,the cases of respiratory failure of patients were observed. Results The independent expectoration capacity in the experimental group was better than the control group, atelectasis, pulmonary infection and respiratory failure of patients in the experimental group were significantly less than the control group. Conclusion Cluster management can improve patients'autonomy massive cerebral infarction expectoration capacity,reduce atelectasis,pulmonary infection,respiratory failure.

Treating massive cerebral infarction by butyl phthalide:a research on clinical application / 中国生化药物杂志

Objective To explore the effect of butylphthalide on the prognosis of massive cerebral infarction patients.Methods We studied 92 massive cerebral infarction patients hospitalized in the Neurology department of harrison international peace hospital from February 2011 to December 2013 as the researchers.According to the treatment of patients,patients were randomly divided into control group (n=46)and treatment group(n=46),control group was given edaravone.Treatment group was given butylphthalide capsule and edaravone.Two groups were all given 2 weeks treatment continuously.Improvement of symptoms is evaluated by the National Institute of Health stroke scale (NIHSS).The effect of butylphthalide on collateral circulation in ischemic infarction area was evaluated by the standards of collateral vessels grading of susceptibility-weighted imaging(SWI)imaging sequence. Results The symptoms and signs of two groups were improved in a certain extent,but the improvement of patients in treatment group was significantly greater than control group,the difference was statistically significant (P<0.05 ).Degree of NIHSS of treatment group was lower than control group,the difference was also statistically significant (P<0.05).The SWI collateral vessels grading of the two groups were all improved,and the cases of treatment group was higher than control group,the difference was statistically significant (P <0.05 ).The two groups have no obvious adverse reaction.Conclusion Butylphthalide have good effect on massive cerebral infarction.It can effectively improve the nerve function defect,and promote the reconstruction of collateral circulation in ischemic infarction area.

Standard hemicraniectomy combined temporal muscle resection in the treatment of cerebral infarction in a large area / 重庆医学

Objective To investigate the standard hemicraniectomy and temporal muscleresection therapeutic in the treatment effect of massive cerebral infarction patients .Methods Looking back at my hospital from February 2006 to October 2012 massive cerebral infarction patients ,30 cases were divided into two groups ,namely simple drug treatment(group A) ,the standard hemicrani-ectomy combined temporal muscleresection treatment (group B) .Followed up two groups of patients and deaths neurological deficit situation after treatment ,compared two groups of patients in hospital mortality and one month after treatment ,neurological impair-ment score .Results After treatment ,the patient midline reply ,mortality ,cure rates three aspects ,group B than the group A .Con-clusion Standard hemicraniectomy combined temporal muscle resection in the treatment can reduce the mortality rate of patients w ith active .

Analysis of Clinical Features of Massive Cerebral Infarction with Different Concious States / 中国康复理论与实践

@#ObjectiveTo explore the difference on clinical features of massive cerebral infarction with different concious states.MethodsPatients diagnosed as massive cerebral infarction of middle cerebral vascular or internal carotid artery were divided into group without conscious disorder and group with conscious disorder according to concious state. Their gender, age, past disease history, conscious state, location of ischemic area, blood pressure, heart rate, temperature, complications, white blood cell, blood glucose, lipemia, and electrolyte were recorded.ResultsThere are more hyperlipemia and diabetes, more complications and fast heart rate in the group with conscious disorder.ConclusionAbnormity of blood glucose and lipemia for a long time may affect the concious state of massive cerebral infarction patients.

Relationship between blood glucose concentration and early prognosis in patients with massive cerebral infarction / 中国基层医药

Objective To investigate the value of blood glucose concentration in estimating risk stratification and early prognosis in patients with massive cerebral infarction.Methods 136 patients were divided into three groups according to the level of the blood glucose concentrations:group A with irritable hyperglycemia,group B with diabetes' hyperglycemia and group C with normal blood glucose.The early prognosis and the degree of neurologic impairment were observed and compared with three groups.Results The degree of neurologic impairment in group A was significantly higher than that in group C.The patients in group A had higher adverse prognosis than those in group C (P＜0.05).No significance was occurred between group A and group B about the early prognosis and the degree of neurologic impairment(P＞0.05).Conclusion The blood glucose level for the patients suffered from acute massive cerebral infarction is helpful to the diagnosis of disease situation,evaluation for prognosis and instruction for treatment.

Effects of Partial Body Weight Supported Stand Training on Depression and Balance Function after Massive Cerebral Infarction in Early Stage / 中国康复理论与实践

@#Objective To investigate the effects of early partial body weight supported stand training on depression and balance function after massive cerebral infarction.Methods 40 patients with depression after massive cerebral infarction were divided into 2 groups,training group(n=20) and control group(n=20).All patients were treated with routine medication and rehabilitation.The patients of the training group also received partial body weight supported stand training in addition.They were assessed with the Hamilton depression scale(HAMD) and the Berg balance scale(BBS) before and after the treatment.Results After 8 weeks of treatment,the scores of HAMD and BBS of the training group had improved significantly more than those in the control group(P<0.05).Conclusion Early partial body weight supported stand training on the patients with depression after massive cerebral infarction may obviously improve balance function and reduce the degree of depression.

Curative effects observatin of Edaravone on the patients with acute massive cerebral infarction / 临床神经病学杂志

Objective To observe the curative effects of treatment with Edaravone for acute massive cerebral infarction.Methods 48 patients with acute massive cerebral infarction were randomized into the treatment with Edaravone group(Edaravone group,24 patients) and the conventional treatment control group(control group,24 patients).Two groups patients were admitted conventional treatment for cerebral infarction.Edaravone group patients were admitted with Edaravone 30 mg into 100 ml saline infusion introvenously,twice a day,linked 20 ～ 25 d.Respectively before and after the treatment,neurologic function dificit score(NDS),plasma fibrinogen(Fib) content,coagulation blood function,activity of superoxide dismutase(SOD) were examined.The clinical efficacy was compared between the two groups.Results NDS of tow groups after treatment were significantly lower than those of before treatment,activity of SOD were significantly increased than those before treatment(all P0.05).Significant efficiency ratio of the Edaravone group(87.5%) was significantly higher than that of the control group(45.8%)(P

Observation of curative effect of whole-body mild hypothermia therapy on massive cerebral infarction / 临床神经病学杂志

Objective To observe the curative effect of whole-body mild hypothermia therapy on massive cerebral infarction(MCI).Methods 68 MCI patients were divided randomly into the mild hypothermia group(35 cases) and control group(33 cases).At the basic of routine treatment in the two guoups,the mild hypothermia group received whole-body mild hypothermia therapy,including the cooling blanket cave all the body for decrease temperature,Chlorpromazine(50 mg) plus Promethazine(50 mg),Vecuroniumbromide(200～400 mg),0.9% sodium chloride to 50 ml;and Midazolam(50 mg) plus 0.9 % sodium chloride to 50 ml intravenous infusion slowly by trace-pump and continued 6～11 d.The rectal temperature was maintained between 32～33℃.The curative effect was evaluated according to American National Institute of Health Stroke Scale(NIHSS) scores and Barthel index(BI) pre and post-treatment.The mortality and incidence of epilepsy in the two groups were statistical.Results Compared to pre-treatment,the scores of NIHSS were significantly reduced and BI were apparently increased in the both groups post-treatment(all P