BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,i...BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.展开更多
Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:3...Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.展开更多
Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW ...Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.展开更多
BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing ser...BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.展开更多
Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which po...Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.展开更多
BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasin...BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone.Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions.Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction,clinicians’knowledge is the key element in recognizing this phenomenon.展开更多
BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has ser...BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has serious effects on patients’physical status,life and economy,often causing anxiety,depression and other psychological problems,these problems can lead to the aggravation of physical symptoms;thus,it is very important to understand the factors affecting the mental health of these patients.AIM To understand the elements that affect the mental health of patients who have suffered an ACI.METHODS A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals(Quanzhou First Hospital,Fuqing City Hospital Affiliated to Fujian Medical University,and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China)in Fujian Province from January 2022 to December 2022 using the convenience sampling method.ACI inpatients who met the inclusion criteria were selected.Informed consent was obtained from the patients before the investigation,and a face-to-face questionnaire survey was conducted using a unified scale.The questionnaire included a general situation questionnaire,Zung’s self-rating depression scale and Zung’s self-rating anxiety scale.All questionnaires were checked by two researchers and then the data were input and sorted using Excel software.The general situation of patients with ACI was analyzed by descriptive statistics,the influence of variables on mental health by the independent sample t test and variance analysis,and the influencing factors on psychological distress were analyzed by multiple stepwise regression.RESULTS The average age of the 220 patients with ACI was 68.64±10.74 years,including 142 males and 78 females.Most of the patients were between 60 and 74 years old,the majority had high school or technical secondary school education,most lived with their spouse,and most lived in cities.The majority of patients had a personal income of 3001 to 5000 RMB yuan per month.The new rural cooperative medical insurance system had the largest number of participants.Most stroke patients were cared for by their spouses and of these patients,52.3%had previously smoked.Univariate analysis showed that gender,age,residence,course of disease,number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI.Age,living conditions,monthly income,course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI.The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients’anxiety scores,and the course of disease was also the most important factor influencing patients’depression scores.CONCLUSION Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders.These groups require more attention and counseling.展开更多
Objective:To analyze the efficacy and safety of Ginkgo biloba tincture combined with conventional medication in the treatment of cerebral infarction by systematic evaluation.Methods:Searched the randomized controlled ...Objective:To analyze the efficacy and safety of Ginkgo biloba tincture combined with conventional medication in the treatment of cerebral infarction by systematic evaluation.Methods:Searched the randomized controlled trials of Ginkgo biloba tincture in treating cerebral infarction.English literatures were searched from PubMed,EMbase,Cochrane Library and Web of Science,and Chinese literatures were searched from Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP)and Wanfang Medical Database.At the same time,we searched dissertations,conference papers,and found relevant unpublished research results reports.Literature quality was evaluated using a"bias risk assessment tool"and Meta-analysis using RevMan 5.4 software(from the Cochrane Collaboration).A total of 29 literatures were retrieved,and finally 4 literatures meeting the standards were included.There were 455 samples involved,including 244 cases in the experimental group and 211 cases in the control group.Results:①Effectiveness analysis:The total effective rate of Ginkgo biloba tincture combined with routine treatment was better than that of the control group[RR=1.26,95%CI(1.07,1.47),P=0.005].The hematocrit of Ginkgo biloba tincture combined with conventional treatment was significantly better than that of conventional treatment alone(P<0.05),The neurological deficits of Ginkgo biloba tincture combined with routine therapy was significantly improved(P<0.05).After Ginkgo biloba tincture combined with conventional therapy,the scores of mini-mental state examination(MMSE),activity daily living scale(ADL)and MOSSF-36 quality of life scale were significantly better than those of the control group(P<0.05).②Safety analysis:3 articles reported the safety of medication.There was no obvious change in blood routine,liver and kidney function results and no adverse reactions in the experimental group and the control group.Conclusion:The above results indicated that Ginkgo biloba tincture combined with conventional treatment can improve the total effective rate of patients with cerebral infarction,and it is safe and has no adverse reactions.However,the number of literatures included in this study is small,and the quality of controlled trials is not good.It is still necessary to adopt clinical controlled trials with reasonable design,outcome indicators in line with international social norms and large sample content to further improve the evidence level of clinical research.展开更多
Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension a...Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.展开更多
This study explored whether the transplantation of modified marrow stromal cells (MSCs) has angiogenic effects in a left middle cerebral artery occlusion infarction/reperfusion (MCAO I/R) rat model and preliminarily e...This study explored whether the transplantation of modified marrow stromal cells (MSCs) has angiogenic effects in a left middle cerebral artery occlusion infarction/reperfusion (MCAO I/R) rat model and preliminarily examined the mechanism of angiogenesis following cerebral infarction.MSCs were isolated by using a direct adherent method and cultured.Vascular endothelial growth factor (VEGF) was transfected into MSCs by employing the liposome transfection.The transfection efficiency was measured by the optical density method.The protein expression of VEGF gene before and after transfection was measured by Western blotting.SD rat model of transient occlusion of the left middle cerebral artery was established by using an approach of intra-luminal occlusion.Tetrazolium (TTC) and HE staining were performed to observe the cerebral infarction.ELISAs were used to measure the levels of VEGF in the rat cerebral tissues.The expression patterns of angiopoietin-2 (Ang-2) and CD34 in cells surrounding the area of infarction were immunohistochemistrically oserved.Ang-2 protein expression in the tissue surrounding the area of infarction was measured by Western blotting.VEGF expression in the MSCs increased after transfection at a rate of approximately 28%±3.4%.ELISA showed that the expression of VEGF in the cerebral tissue was significantly increased after induction of infarction,peaking on the 4th day and decreasing to the levels of the sham surgery group (normal) within 7 to 10 days.The VEGF level was significantly higher at each time point in the VEGF-MSC and MSC groups compared to the model group.Moreover,the VEGF level was higher in the VEGF-MSC group than in the MSC group and stayed relatively high until the 10th day.The immunohistochemical results showed that 10 days after the infarction,the number of Ang-2 and CD34-expressing cells in the area surrounding the infarction was significantly higher in the VEGF-MSC group and the MSC group compared to the model group.Moreover,the VEGF level was higher in the VEGF-MSC group than the MSC group.A similar trend in Ang-2 protein expression was revealed by Western blotting.In the MCAO rat model transfected with modified MSCs over-expressing VEGF,compared to the MSC transplantation group,the concentration of VEGF was significantly increased in the brain tissue after cerebral infarction.In addition,the level of Ang-2 was up-regulated,with angiogenesis promoted,the blood supply to the areas surrounding the cerebral infarction increased,and neurological function improved.We are led to speculate that the synergistic effects of VEGF and Ang-2 may be responsible for the angiogenesis following cerebral infarction.展开更多
Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 ...Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator(r TPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis.Conclusions: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.展开更多
Cattle encephalon glycoside and ignotin(CEGI)injection is a compound preparation formed by a combination of muscle extract from hea lthy rabbits and brain gangliosides from cattle,and it is generally used as a neuropr...Cattle encephalon glycoside and ignotin(CEGI)injection is a compound preparation formed by a combination of muscle extract from hea lthy rabbits and brain gangliosides from cattle,and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries.However,there is still a need for high-level clinical evidence from large samples to support the use of CEGI.We therefore carried out a prospective,multicenter,randomized,double-blind,parallel-group,placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016.The patients were randomized at a 3:1 ratio into CEGI(n=239;155 male,84 female;61.2±9.2 years old)and placebo(n=80;46 male,34 female;63.2±8.28 years old)groups.All patients were given standard care once daily for 14 days,including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium,both taken orally,and intravenous infusion of 250–500 mL 0.9%sodium chloride containing 40 mg sodium tanshinone IIA sulfonate.Based on conventional treatment,patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water,respectively,in an intravenous drip of 250 mL 0.9%sodium chloride(2 mL/min)once daily for 14 days.According to baseline National Institutes of Health Stroke Scale scores,patients in the two groups were divided into mild and moderate subgroups.Based on the modified Rankin Scale results,the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group,and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment.In the CEGI group,neurological deficits were decreased on days 14 and 90 after treatment,as measured by the National Institutes of Health Stroke Scale and the Barthel Index.Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients.No drug-related adverse events occurred in the CEGI or placebo groups.In conclusion,CEGI may be a safe and effective treatment for acute cerebral infarction patients,especially for moderate stroke patients.This study was approved by the Ethical Committee of Peking University Third Hospital,China(approval No.2013-068-2)on May 20,2013,and registered in the Chinese Clinical Trial Registry(registration No.ChiCTR1800017937).展开更多
This study examined the effect of electro-acupuncture (EA) combined with transcranial magnetic stimulation (TMS) therapy at different time windows on learning and memory ability of rats with cerebral infarction and th...This study examined the effect of electro-acupuncture (EA) combined with transcranial magnetic stimulation (TMS) therapy at different time windows on learning and memory ability of rats with cerebral infarction and the underlying mechanism.Two hundred SD rats were randomly divided into four groups:normal group,sham-operated group,model group and EA+TMS group,and each group was then divided into five sub-groups in terms of the different time to start treatment post operation:6,12,24,48 and 72 h.Cerebral infarction models were established in the model and the EA+TMS groups by left middle cerebral artery occlusion/reperfusion (MCAO/R).After treatment for 14 d,the Morris water maze test was applied to examine the spatial learning and memory abilities of rats.In infarcted area,the expression of caspase-3 was immunohistochemically detected,and real-time fluorescent quantitative PCR was used to measure the expression of Bcl-2 mRNA.The results showed that in EA+TMS group compared with model group at the same treatment time windows,the escape latency was substantially shortened,the expression of caspase-3 was considerably decreased and the expression level of Bcl-2 mRNA significantly increased (P<0.05).In the EA+TMS sub-groups,the escape latency was shortest,the expression level of caspase-3 lowest,and the expression level of Bcl-2 mRNA highest at the treatment time window of 24 h.It was concluded that EA combined with TMS can promote neurological function of rats with cerebral infarction by increasing the expression level of Bcl-2 mRNA and decreasing the expression of caspase-3.The best time window is 24 h after perfusion treatment to ischemia.展开更多
Objective:To explore the function and mechanism of microRNA-155 to regulate the angiogenesis after the cerebral infarction of rats through the angiotensin Ⅱ receptor 1(AT1R)/vascular endothelial growth factor(VEGF) s...Objective:To explore the function and mechanism of microRNA-155 to regulate the angiogenesis after the cerebral infarction of rats through the angiotensin Ⅱ receptor 1(AT1R)/vascular endothelial growth factor(VEGF) signaling pathway.Methods:Female SD rats were chosen for the construction of cerebral infarction model of rats using the modified right middle cerebral artery occlusion.The real-time PCR(RT-PCR) method was employed to detect the expression of microRNA-155 in each group at different time points after the cerebral infarction(1 h,I d,3 d and 7 d).SD rats were randomly divided into four groups(n=20 rats):sham operation group(Sham group),MACO group,MACO+microRNA-155 mimic group,and MACO+microRNA-155 inhibitor group.Sham group was given the free graft,while MACO+microRNA-155 mimic group and MACO+microRNA-155 inhibitor group were treated with microRNA-155 mimic and microRNA-155 inhibitor respectively.The Zea Longa5-point scale was used to score the neurologic impairment of rats in each group;2,3,5-triphenyl tetrazolium chloride staining to evaluate the volume of cerebral infarction of rats in each group;the immunohistochemistry to detect the expression of CD31;Western blot and RT-PCR to detect the expression of AT1 R and VEGF receptor 2(VEGFR2).Results:The expression of microRNA-155 was increased in the cerebral ischemia tissue after the cerebral infarction.It was significantly increased at 1 d of ischemia and maintained at the high level for a long time.Rats in the Sham group had no symptom of neurologic impairment while rats in the MACO group had the obvious neurologic impairment.After being treated with microRNA-155 inhibitor,the neural function of MACO rats had been improved,with the decreased area of cerebral infarction.But after being treated with microRNA-155 mimic,the neural function was further worsened,with the increased area of cerebral infarction.Results of immunohistoehemical assay indicated that microRNA-155 inhibitor could up-regulate the expression of CD31,while microRNA-155 mimic could down-regulate the expression of CD31.The RT-PCR found that,after being treated with microRNA-155 inhibitor,MACO rats had the increased expression of ATIR and VEGFR2 messenger RNA(mRNA);but after being treated with microRNA-155 mimic,the expression of ATIR and VEGFR2 mRNA was decreased.Results of Western blot showed that,after being treated with microRNA-155 inhibitor,MACO rats had the increased expression of ATIR and VEGFR2 mRNA;but after being treated with microRNA-155 mimic,the expression of ATIR and VEGFR2 mRNA was decreased.Conclusions:The inhibition of microRNA-155 can improve the neurologic impairment of rats with the cerebral infarction,reduce the volume of cerebral infarction and effectively promote the angiogenesis in the region of ischemia,which may be mediated through AT1R/VEGFR2 pathway.展开更多
Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the ex...Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex(M1). The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.展开更多
Many studies using diffusion tensor tractography(DTT) have demonstrated that injury of the spinothalamic tract(STT) is the pathogenetic mechanism of central post-stroke pain(CPSP) in intracerebral hemorrhage; however,...Many studies using diffusion tensor tractography(DTT) have demonstrated that injury of the spinothalamic tract(STT) is the pathogenetic mechanism of central post-stroke pain(CPSP) in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age-and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients(patients 1 and 2) and three patients(patients 3, 4, and 5), respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient(patient 2). Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.展开更多
Low frequency(≤ 1 Hz) repetitive transcranial magnetic stimulation(r TMS) can affect the excitability of the cerebral cortex and synaptic plasticity. Although this is a common method for clinical treatment of cerebra...Low frequency(≤ 1 Hz) repetitive transcranial magnetic stimulation(r TMS) can affect the excitability of the cerebral cortex and synaptic plasticity. Although this is a common method for clinical treatment of cerebral infarction, whether it promotes the recovery of motor function remains controversial. Twenty patients with cerebral infarction combined with hemiparalysis were equally and randomly divided into a low frequency r TMS group and a control group. The patients in the low frequency r TMS group were given 1-Hz r TMS to the contralateral primary motor cortex with a stimulus intensity of 90% motor threshold, 30 minutes/day. The patients in the control group were given sham stimulation. After 14 days of treatment, clinical function scores(National Institute of Health Stroke Scale, Barthel Index, and Fugl-Meyer Assessment) improved significantly in the low frequency r TMS group, and the effects were better than that in the control group. We conclude that low frequency(1 Hz) r TMS for 14 days can help improve motor function after cerebral infarction.展开更多
Corticospinal tract(CST), a major neural tract in the human brain for motor function, is involved mainly in the movement of the distal extremities(Jang and Lee, 2019). Recovery of an injured CST is essential for good ...Corticospinal tract(CST), a major neural tract in the human brain for motor function, is involved mainly in the movement of the distal extremities(Jang and Lee, 2019). Recovery of an injured CST is essential for good recovery of impaired motor function in stroke patients(Jang and Lee, 2019). Peri-infarct reorganization of an injured CST is an important mechanism underlying recovery of motor function in stroke patients(Jang, 2007). In this study, we reported on a patient with cerebral infarction who showed recovery of an injured CST by periinfarct reorganization using diffusion tensor tractography(DTT) and transcranial magnetic stimulation(TMS).展开更多
BACKGROUND Acute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction(PCCI).PCCI affects the structure...BACKGROUND Acute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction(PCCI).PCCI affects the structure of the posterior circulation brain,because posterior part of the brain,which has more complex anatomical structures and more prone to posterior circulation vascular variation.Therefore,improving the prognosis of PCCI patients is necessary.AIM To explore the effect of medical care linkage-continuous management mode(MCLMM)on endovascular interventional therapy(EIT)for PCCI.METHODS Sixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group,and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group.The incidence of postoperative complications,compliance and disease selfmanagement behavior after six months of intervention,modified Rankin scale(mRS)and Barthel index(BI)scores in the acute phase and after one year of intervention,and recurrence within one year were compared between the two groups.RESULTS The total incidence rate of postoperative complications in the observation group(7.69%)was lower than that in the control group(18.84%)(P<0.05).The scores for medical compliance behavior(regular medication,appropriate diet,and rehabilitation cooperation rates)and disease self-management behavior(self-will,disease knowledge,and self-care ability)in the observation group were higher than those in the control group(P<0.05).After one year of intervention,in the observation group,the mRS score was significantly lower,and the BI score was significantly higher than those in the control group(P<0.05).The recurrence rate within one year in the observation group(3.85%)was significantly lower than that in the control group(13.04%)(P<0.05).CONCLUSION MCLMM can reduce the incidence of complications after EIT for PCCI,improve patient compliance behavior and disease self-management ability,and promote the recovery of neurological function.展开更多
BACKGROUND In both national and international studies,the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good,and the disabi...BACKGROUND In both national and international studies,the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good,and the disability rate was significantly reduced.However,there are currently only a few reports on the differences in endovascular treatment for different etiological classifications,especially in the anterior cranial circulation,aorta atherosclerotic stenosis,and acute thrombosis.AIM To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.METHODS Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019.The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis[modified thrombolysis in cerebral infarction(mTICI)]at the 2b/3 level or above,the stent was then unfolded and released.RESULTS All 25 patients underwent successful surgery,with an average recanalization time of 23 min.One patient died of cerebral hemorrhage and cerebral herniation after the operation.The National Institutes of Health Stroke Scale(NIHSS)scores immediately after surgery(7.5±5.6),at 24 h(5.5±5.6)and at 1 wk(3.6±6.7)compared with the preoperative NIHSS score(15.9±4.4),were significantly different(P<0.01).One case of restenosis was observed 3 mo after surgery(the stenosis rate was 50%without clinical symptoms),the modified Rankin scale scores were 0 points in 14 cases(56%),1 point in 4 cases(16%),2 points in 2 cases(8%),3 points in 3 cases(12%),4 points in 1 case(4%),and 6 points in 1 case(4%).CONCLUSION In acute middle cerebral artery atherosclerosis obliterative cerebral infarction,when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher,stent release may be a safe and effective treatment method;however,long-term observation and a larger sample size are required to verify these findings.展开更多
文摘BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.
文摘Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.
基金Project of Science and Technology Plan of Tianjin City(Grant number 20ZYJDSY00020)。
文摘Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.
基金Supported by the Key Research and Development Programs of Shaanxi Province,No.2021SF-059。
文摘BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.
文摘Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.
文摘BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone.Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions.Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction,clinicians’knowledge is the key element in recognizing this phenomenon.
文摘BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has serious effects on patients’physical status,life and economy,often causing anxiety,depression and other psychological problems,these problems can lead to the aggravation of physical symptoms;thus,it is very important to understand the factors affecting the mental health of these patients.AIM To understand the elements that affect the mental health of patients who have suffered an ACI.METHODS A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals(Quanzhou First Hospital,Fuqing City Hospital Affiliated to Fujian Medical University,and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China)in Fujian Province from January 2022 to December 2022 using the convenience sampling method.ACI inpatients who met the inclusion criteria were selected.Informed consent was obtained from the patients before the investigation,and a face-to-face questionnaire survey was conducted using a unified scale.The questionnaire included a general situation questionnaire,Zung’s self-rating depression scale and Zung’s self-rating anxiety scale.All questionnaires were checked by two researchers and then the data were input and sorted using Excel software.The general situation of patients with ACI was analyzed by descriptive statistics,the influence of variables on mental health by the independent sample t test and variance analysis,and the influencing factors on psychological distress were analyzed by multiple stepwise regression.RESULTS The average age of the 220 patients with ACI was 68.64±10.74 years,including 142 males and 78 females.Most of the patients were between 60 and 74 years old,the majority had high school or technical secondary school education,most lived with their spouse,and most lived in cities.The majority of patients had a personal income of 3001 to 5000 RMB yuan per month.The new rural cooperative medical insurance system had the largest number of participants.Most stroke patients were cared for by their spouses and of these patients,52.3%had previously smoked.Univariate analysis showed that gender,age,residence,course of disease,number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI.Age,living conditions,monthly income,course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI.The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients’anxiety scores,and the course of disease was also the most important factor influencing patients’depression scores.CONCLUSION Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders.These groups require more attention and counseling.
基金The 2018 National Key R&D Program of the Ministry of Science and Technology"Research on the Modernization of Traditional Chinese Medicine"project"Evidence-based evaluation and demonstration study on the mechanism of effects of the treatment of major diseases after the marketing of ten large varieties of proprietary Chinese medicines and classic formulas"(2018YFC1707400)。
文摘Objective:To analyze the efficacy and safety of Ginkgo biloba tincture combined with conventional medication in the treatment of cerebral infarction by systematic evaluation.Methods:Searched the randomized controlled trials of Ginkgo biloba tincture in treating cerebral infarction.English literatures were searched from PubMed,EMbase,Cochrane Library and Web of Science,and Chinese literatures were searched from Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP)and Wanfang Medical Database.At the same time,we searched dissertations,conference papers,and found relevant unpublished research results reports.Literature quality was evaluated using a"bias risk assessment tool"and Meta-analysis using RevMan 5.4 software(from the Cochrane Collaboration).A total of 29 literatures were retrieved,and finally 4 literatures meeting the standards were included.There were 455 samples involved,including 244 cases in the experimental group and 211 cases in the control group.Results:①Effectiveness analysis:The total effective rate of Ginkgo biloba tincture combined with routine treatment was better than that of the control group[RR=1.26,95%CI(1.07,1.47),P=0.005].The hematocrit of Ginkgo biloba tincture combined with conventional treatment was significantly better than that of conventional treatment alone(P<0.05),The neurological deficits of Ginkgo biloba tincture combined with routine therapy was significantly improved(P<0.05).After Ginkgo biloba tincture combined with conventional therapy,the scores of mini-mental state examination(MMSE),activity daily living scale(ADL)and MOSSF-36 quality of life scale were significantly better than those of the control group(P<0.05).②Safety analysis:3 articles reported the safety of medication.There was no obvious change in blood routine,liver and kidney function results and no adverse reactions in the experimental group and the control group.Conclusion:The above results indicated that Ginkgo biloba tincture combined with conventional treatment can improve the total effective rate of patients with cerebral infarction,and it is safe and has no adverse reactions.However,the number of literatures included in this study is small,and the quality of controlled trials is not good.It is still necessary to adopt clinical controlled trials with reasonable design,outcome indicators in line with international social norms and large sample content to further improve the evidence level of clinical research.
基金supported by the National Natural Science Foundation of China,Nos.82274611 (to LZ),82104419 (to DM)Capital Science and Technology Leading Talent Training Project,No.Z1 91100006119017 (to LZ)+3 种基金Beijing Hospitals Authority Ascent Plan,No.DFL20190803 (to LZ)Cultivation Fund of Hospital Management Center in Beijing,No.PZ2022006 (to DM)R&D Program of Beijing Municipal Education Commission,No.KM202210025017 (to DM)Beijing Gold-Bridge Project,No.ZZ20145 (to DM)。
文摘Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.
基金supported by a grant from the open fund ofKey Laboratory of Molecular Imaging of Hubei Province(No.2008-72)
文摘This study explored whether the transplantation of modified marrow stromal cells (MSCs) has angiogenic effects in a left middle cerebral artery occlusion infarction/reperfusion (MCAO I/R) rat model and preliminarily examined the mechanism of angiogenesis following cerebral infarction.MSCs were isolated by using a direct adherent method and cultured.Vascular endothelial growth factor (VEGF) was transfected into MSCs by employing the liposome transfection.The transfection efficiency was measured by the optical density method.The protein expression of VEGF gene before and after transfection was measured by Western blotting.SD rat model of transient occlusion of the left middle cerebral artery was established by using an approach of intra-luminal occlusion.Tetrazolium (TTC) and HE staining were performed to observe the cerebral infarction.ELISAs were used to measure the levels of VEGF in the rat cerebral tissues.The expression patterns of angiopoietin-2 (Ang-2) and CD34 in cells surrounding the area of infarction were immunohistochemistrically oserved.Ang-2 protein expression in the tissue surrounding the area of infarction was measured by Western blotting.VEGF expression in the MSCs increased after transfection at a rate of approximately 28%±3.4%.ELISA showed that the expression of VEGF in the cerebral tissue was significantly increased after induction of infarction,peaking on the 4th day and decreasing to the levels of the sham surgery group (normal) within 7 to 10 days.The VEGF level was significantly higher at each time point in the VEGF-MSC and MSC groups compared to the model group.Moreover,the VEGF level was higher in the VEGF-MSC group than in the MSC group and stayed relatively high until the 10th day.The immunohistochemical results showed that 10 days after the infarction,the number of Ang-2 and CD34-expressing cells in the area surrounding the infarction was significantly higher in the VEGF-MSC group and the MSC group compared to the model group.Moreover,the VEGF level was higher in the VEGF-MSC group than the MSC group.A similar trend in Ang-2 protein expression was revealed by Western blotting.In the MCAO rat model transfected with modified MSCs over-expressing VEGF,compared to the MSC transplantation group,the concentration of VEGF was significantly increased in the brain tissue after cerebral infarction.In addition,the level of Ang-2 was up-regulated,with angiogenesis promoted,the blood supply to the areas surrounding the cerebral infarction increased,and neurological function improved.We are led to speculate that the synergistic effects of VEGF and Ang-2 may be responsible for the angiogenesis following cerebral infarction.
文摘Background: To study the influence of blood lipid levels on hemorrhagic transformation(HT) and prognosis after acute cerebral infarction(ACI).Methods: Patients with ACI within 72 h of symptoms onset between January 1 st, 2015, and December 31 st, 2016, were retrospectively analyzed. Patients were divided into group A(without HT) and group B(HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale(m RS). An m RS score of 0–2 points indicated excellent prognosis, and an m RS score of 3–6 points indicated poor prognosis.Results: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d(interquartile range, 1–7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8% and 79.8%, respectively, which were both significantly higher than those in group A(28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation(AF) in group B was significantly higher than that in group A(39.4% vs. 13.9%, P<0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol(TC) was a protective factor of HT(OR=0.359, 95% CI 0.136–0.944, P=0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B(21.2% and 76.7%, respectively) were both significantly higher than those in group A(8.0% and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size(OR=12.178, 95% CI 5.390–27.516, P<0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol(LDL-C) was a protective factor(OR=0.538, 95% CI 0.300–0.964, P=0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator(r TPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis.Conclusions: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.
文摘Cattle encephalon glycoside and ignotin(CEGI)injection is a compound preparation formed by a combination of muscle extract from hea lthy rabbits and brain gangliosides from cattle,and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries.However,there is still a need for high-level clinical evidence from large samples to support the use of CEGI.We therefore carried out a prospective,multicenter,randomized,double-blind,parallel-group,placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016.The patients were randomized at a 3:1 ratio into CEGI(n=239;155 male,84 female;61.2±9.2 years old)and placebo(n=80;46 male,34 female;63.2±8.28 years old)groups.All patients were given standard care once daily for 14 days,including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium,both taken orally,and intravenous infusion of 250–500 mL 0.9%sodium chloride containing 40 mg sodium tanshinone IIA sulfonate.Based on conventional treatment,patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water,respectively,in an intravenous drip of 250 mL 0.9%sodium chloride(2 mL/min)once daily for 14 days.According to baseline National Institutes of Health Stroke Scale scores,patients in the two groups were divided into mild and moderate subgroups.Based on the modified Rankin Scale results,the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group,and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment.In the CEGI group,neurological deficits were decreased on days 14 and 90 after treatment,as measured by the National Institutes of Health Stroke Scale and the Barthel Index.Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients.No drug-related adverse events occurred in the CEGI or placebo groups.In conclusion,CEGI may be a safe and effective treatment for acute cerebral infarction patients,especially for moderate stroke patients.This study was approved by the Ethical Committee of Peking University Third Hospital,China(approval No.2013-068-2)on May 20,2013,and registered in the Chinese Clinical Trial Registry(registration No.ChiCTR1800017937).
基金supported by a grant from the National Natural Science Foundation of China (No.30640010)
文摘This study examined the effect of electro-acupuncture (EA) combined with transcranial magnetic stimulation (TMS) therapy at different time windows on learning and memory ability of rats with cerebral infarction and the underlying mechanism.Two hundred SD rats were randomly divided into four groups:normal group,sham-operated group,model group and EA+TMS group,and each group was then divided into five sub-groups in terms of the different time to start treatment post operation:6,12,24,48 and 72 h.Cerebral infarction models were established in the model and the EA+TMS groups by left middle cerebral artery occlusion/reperfusion (MCAO/R).After treatment for 14 d,the Morris water maze test was applied to examine the spatial learning and memory abilities of rats.In infarcted area,the expression of caspase-3 was immunohistochemically detected,and real-time fluorescent quantitative PCR was used to measure the expression of Bcl-2 mRNA.The results showed that in EA+TMS group compared with model group at the same treatment time windows,the escape latency was substantially shortened,the expression of caspase-3 was considerably decreased and the expression level of Bcl-2 mRNA significantly increased (P<0.05).In the EA+TMS sub-groups,the escape latency was shortest,the expression level of caspase-3 lowest,and the expression level of Bcl-2 mRNA highest at the treatment time window of 24 h.It was concluded that EA combined with TMS can promote neurological function of rats with cerebral infarction by increasing the expression level of Bcl-2 mRNA and decreasing the expression of caspase-3.The best time window is 24 h after perfusion treatment to ischemia.
基金supported by Shandong Key Scientific and Technological Project Fund(No.2013YD 18021)
文摘Objective:To explore the function and mechanism of microRNA-155 to regulate the angiogenesis after the cerebral infarction of rats through the angiotensin Ⅱ receptor 1(AT1R)/vascular endothelial growth factor(VEGF) signaling pathway.Methods:Female SD rats were chosen for the construction of cerebral infarction model of rats using the modified right middle cerebral artery occlusion.The real-time PCR(RT-PCR) method was employed to detect the expression of microRNA-155 in each group at different time points after the cerebral infarction(1 h,I d,3 d and 7 d).SD rats were randomly divided into four groups(n=20 rats):sham operation group(Sham group),MACO group,MACO+microRNA-155 mimic group,and MACO+microRNA-155 inhibitor group.Sham group was given the free graft,while MACO+microRNA-155 mimic group and MACO+microRNA-155 inhibitor group were treated with microRNA-155 mimic and microRNA-155 inhibitor respectively.The Zea Longa5-point scale was used to score the neurologic impairment of rats in each group;2,3,5-triphenyl tetrazolium chloride staining to evaluate the volume of cerebral infarction of rats in each group;the immunohistochemistry to detect the expression of CD31;Western blot and RT-PCR to detect the expression of AT1 R and VEGF receptor 2(VEGFR2).Results:The expression of microRNA-155 was increased in the cerebral ischemia tissue after the cerebral infarction.It was significantly increased at 1 d of ischemia and maintained at the high level for a long time.Rats in the Sham group had no symptom of neurologic impairment while rats in the MACO group had the obvious neurologic impairment.After being treated with microRNA-155 inhibitor,the neural function of MACO rats had been improved,with the decreased area of cerebral infarction.But after being treated with microRNA-155 mimic,the neural function was further worsened,with the increased area of cerebral infarction.Results of immunohistoehemical assay indicated that microRNA-155 inhibitor could up-regulate the expression of CD31,while microRNA-155 mimic could down-regulate the expression of CD31.The RT-PCR found that,after being treated with microRNA-155 inhibitor,MACO rats had the increased expression of ATIR and VEGFR2 messenger RNA(mRNA);but after being treated with microRNA-155 mimic,the expression of ATIR and VEGFR2 mRNA was decreased.Results of Western blot showed that,after being treated with microRNA-155 inhibitor,MACO rats had the increased expression of ATIR and VEGFR2 mRNA;but after being treated with microRNA-155 mimic,the expression of ATIR and VEGFR2 mRNA was decreased.Conclusions:The inhibition of microRNA-155 can improve the neurologic impairment of rats with the cerebral infarction,reduce the volume of cerebral infarction and effectively promote the angiogenesis in the region of ischemia,which may be mediated through AT1R/VEGFR2 pathway.
基金several colleague therapists of the Rehabilitation Medicine Department of the Affiliated Hospital of Qingdao University of China for their support and selfless help
文摘Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex(M1). The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.
基金supported by the National Research Foundation(NRF)of Korea Grant funded by the Korean Government(MSIP),No.NRF-2015R1D1A1A01060314
文摘Many studies using diffusion tensor tractography(DTT) have demonstrated that injury of the spinothalamic tract(STT) is the pathogenetic mechanism of central post-stroke pain(CPSP) in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age-and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients(patients 1 and 2) and three patients(patients 3, 4, and 5), respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient(patient 2). Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.
基金supported by the National Natural Science Foundation of China,No.30540058,30770714the Natural Science Foundation of Beijing of China,No.7052030+2 种基金the Talents Foundation of Organization Department of the Beijing Municipal Committee in Chinathe Beijing Science Plan Project Fund of China,No.Z0005187040191-1the Research Foundation of Capital Medical Development of China,No.2007-2068
文摘Low frequency(≤ 1 Hz) repetitive transcranial magnetic stimulation(r TMS) can affect the excitability of the cerebral cortex and synaptic plasticity. Although this is a common method for clinical treatment of cerebral infarction, whether it promotes the recovery of motor function remains controversial. Twenty patients with cerebral infarction combined with hemiparalysis were equally and randomly divided into a low frequency r TMS group and a control group. The patients in the low frequency r TMS group were given 1-Hz r TMS to the contralateral primary motor cortex with a stimulus intensity of 90% motor threshold, 30 minutes/day. The patients in the control group were given sham stimulation. After 14 days of treatment, clinical function scores(National Institute of Health Stroke Scale, Barthel Index, and Fugl-Meyer Assessment) improved significantly in the low frequency r TMS group, and the effects were better than that in the control group. We conclude that low frequency(1 Hz) r TMS for 14 days can help improve motor function after cerebral infarction.
基金supported by the Medical Research Center Program(2015R1A5A2009124,to SHJ)through the National Research Foundation of Korea(NRF)funded by the Ministry of Science,ICT and Future Planning。
文摘Corticospinal tract(CST), a major neural tract in the human brain for motor function, is involved mainly in the movement of the distal extremities(Jang and Lee, 2019). Recovery of an injured CST is essential for good recovery of impaired motor function in stroke patients(Jang and Lee, 2019). Peri-infarct reorganization of an injured CST is an important mechanism underlying recovery of motor function in stroke patients(Jang, 2007). In this study, we reported on a patient with cerebral infarction who showed recovery of an injured CST by periinfarct reorganization using diffusion tensor tractography(DTT) and transcranial magnetic stimulation(TMS).
文摘BACKGROUND Acute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction(PCCI).PCCI affects the structure of the posterior circulation brain,because posterior part of the brain,which has more complex anatomical structures and more prone to posterior circulation vascular variation.Therefore,improving the prognosis of PCCI patients is necessary.AIM To explore the effect of medical care linkage-continuous management mode(MCLMM)on endovascular interventional therapy(EIT)for PCCI.METHODS Sixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group,and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group.The incidence of postoperative complications,compliance and disease selfmanagement behavior after six months of intervention,modified Rankin scale(mRS)and Barthel index(BI)scores in the acute phase and after one year of intervention,and recurrence within one year were compared between the two groups.RESULTS The total incidence rate of postoperative complications in the observation group(7.69%)was lower than that in the control group(18.84%)(P<0.05).The scores for medical compliance behavior(regular medication,appropriate diet,and rehabilitation cooperation rates)and disease self-management behavior(self-will,disease knowledge,and self-care ability)in the observation group were higher than those in the control group(P<0.05).After one year of intervention,in the observation group,the mRS score was significantly lower,and the BI score was significantly higher than those in the control group(P<0.05).The recurrence rate within one year in the observation group(3.85%)was significantly lower than that in the control group(13.04%)(P<0.05).CONCLUSION MCLMM can reduce the incidence of complications after EIT for PCCI,improve patient compliance behavior and disease self-management ability,and promote the recovery of neurological function.
文摘BACKGROUND In both national and international studies,the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good,and the disability rate was significantly reduced.However,there are currently only a few reports on the differences in endovascular treatment for different etiological classifications,especially in the anterior cranial circulation,aorta atherosclerotic stenosis,and acute thrombosis.AIM To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.METHODS Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019.The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis[modified thrombolysis in cerebral infarction(mTICI)]at the 2b/3 level or above,the stent was then unfolded and released.RESULTS All 25 patients underwent successful surgery,with an average recanalization time of 23 min.One patient died of cerebral hemorrhage and cerebral herniation after the operation.The National Institutes of Health Stroke Scale(NIHSS)scores immediately after surgery(7.5±5.6),at 24 h(5.5±5.6)and at 1 wk(3.6±6.7)compared with the preoperative NIHSS score(15.9±4.4),were significantly different(P<0.01).One case of restenosis was observed 3 mo after surgery(the stenosis rate was 50%without clinical symptoms),the modified Rankin scale scores were 0 points in 14 cases(56%),1 point in 4 cases(16%),2 points in 2 cases(8%),3 points in 3 cases(12%),4 points in 1 case(4%),and 6 points in 1 case(4%).CONCLUSION In acute middle cerebral artery atherosclerosis obliterative cerebral infarction,when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher,stent release may be a safe and effective treatment method;however,long-term observation and a larger sample size are required to verify these findings.
