Objective To explore the impact of gender difference in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. Methods A prospective registration, observational, and retrospective analysis study was carried out. Patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College and the Department of Neurology of Nanjing First Hospital between June 2015 and June 2019 were collected. Patients were divided into two groups based on gender. The detailed demographic, laboratory examination, imaging examination and clinical data were collected. Then, the data were analyzed using univariate and multivariate logistic regression analyses. Results A total of 298 patients were included. Among them, there were 185 males and 113 females. The differences in age, smoking, atrial fibrillation, using antiplatelet drugs before stroke, TOAST classification, and involved cerebrovascular sites between the two groups were statistically significant (P<0.05), and there was no statistically significant difference in other baseline data between the two groups (P>0.05). The results of univariate logistic regression analysis showed that the rate of 90-day favourable outcome of female patients was lower than that of male patients [odds ratio (OR)=0.462, 95% confidence interval (CI) (0.275, 0.775), P=0.030]. The results of multivariate logistic regression analysis showed that, after adjusting for confounding factors, there was no independent correlation between gender and the 90-day favourable outcome of patients with acute cerebral infarction who underwent mechanical thrombectomy [OR=1.511, 95% CI (0.745, 3.066), P=0.253]. Conclusion The gender has no significant effect on the 90-day favourable outcome of acute cerebral infarction patients treated with mechanical thrombectomy.
Objective To observe the short-term effect and safety of hyperbaric oxygen combined with edaravone and ozagrel sodium in treating progressive cerebral infarction. Methods A total of 65 in-patients with acute progressive cerebral infarction were randomly divided into two groups: 33 in-patients in the trial group were treated by hyperbaric oxygen combined with edaravone and ozagrel sodium, while the other 32 in-patients in the control group were treated by edaravone and ozagrel sodium. The course of treatment was 14 days. The following indications were assessed before and after the treatment respectively: the national institutes of health stroke scale (NIHSS), activities of daily living (ADL), and clinical effects. Results This study showed that the scores of both ADL and NIHSS in the trial group were higher than those in the control group, with significant differences (Plt;0.05). The clinical effective rate of the trial group was 90.91% which was obviously higher than the control group with a significant difference (P=0.028). There were no obvious adverse reactions in both groups. Conclusion Hyperbaric oxygen combined with both edaravone and ozagrel sodium is notable in short-term effect and safe, thus it is worth being popularized in clinical treatment.
Objective To assess the effect of naloxone in treating the disease of acute cerebral infarction. Methods Sixty patients of acute cerebral infarction were randomly divided into two groups. One group received routine therapy and the other routine therapy plus naloxone. Neuroprotective effect of naloxone were measured by using NIH stroke scale and Bathel-Index. Adverse effect of the drug was also observed. Results There were 27 patients (90%) improved with clinical manifestations in experiment group, and 20 patients (67%) improved in control group. There is a significant difference between the two groups (Plt;0.05).There is no adverse reactions of naxloxone observed. Conclusion Naloxone might protect the nervous cells and restore the function of the nervous system in patients with acute cerebral infraction.
Cerebral small vessel disease is a common neurological disease, including acute and non-acute categories. With the development of neuroimaging, cerebral small vessel disease has attracted substantial attention in recent years. However, the categories and concepts of cerebral small vessel disease and the related imaging markers usually confuse people. The purpose of this study was to discuss the relationships among acute and non-acute cerebral small vessel disease and the imaging markers, so as to improve the understanding of cerebral small vessel disease, and to shed light on clinical practice and research.
Acute cerebral infarction is characterized by high incidence rate, high recurrence rate, high disability rate and multiple complications. Early evaluation and treatment of acute cerebral infarction is particularly important to improve the survival rate and prognosis of patients. As an easily available clinical laboratory indicator, blood routine test can reflect the pathological changes in the body to a certain extent. In recent years, many studies have shown that the indicators such as red cell volume distribution width, mean platelet volume, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in blood routine examination have important values in the onset, severity and prognosis of acute cerebral infarction. This article reviews the correlations of the above parameters and ratio parameters with acute cerebral infarction, in order to provide some reference and basis for clinical diagnosis, treatment and prognosis evaluation of acute cerebral infarction.
Objective To evaluate the clinical efficacy and safety of imported and domestic oxiracetam injection in the treatment of acute cerebral infarction. Methods Between March 2013 and July 2014, a multicenter randomized blind controlled clinical study was conducted to learn the clinical efficacy and safety of imported oxiracetam injection (produced by Korea Pharmaceutical Corporation) and domestic oxiracetam injection (named as Oulantong, produced by Harbin Medisan Pharmaceutical Co., Ltd) in the treatment of acute cerebral infarction. West China Hospital of Sichuan University was in charge of the study, and the participants included the People’s Hospital of Guangxi Zhuang Autonomous Region, Affiliated Hospital of Guilin Medical University, Department of Neurology of Jilin Provincial People’s Hospital, the Second Affiliated Hospital of Kunming Medical University, the First Hospital of Lanzhou University, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, the First Affiliated Hospital of Soochow University, the First Affiliated Hospital of Tianjin University of TCM, Chongqing Three Gorges Central Hospital, and the Second Affiliated Hospital of Soochow University. A total of 240 patients with acute cerebral infarction were randomly divided into trial group (basic treatment plus imported oxiracetam injection) and control group (basic treatment plus domestic oxiracetam) with 120 patients in each. Follow-up was conducted 1 week, 2 weeks and 12 weeks after treatment. Finally, 200 patients consistent with the study criteria were included, including 101 in the trial group and 99 in the control group. National Institute of Health Stroke Scale (NHISS), Modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate patients’ neurologic impairment, disability degree, life quality and treatment effective rate. Safety indexes included adverse events and life vital signs. Results NHISS scores of the trial group and the control group were respectively (7.46±1.99) and (7.20±2.47) points before the treatment, (5.81±2.30) and (5.54±2.58) points one week after the treatment, (3.93±2.40) and (3.79±2.39) points two weeks after the treatment, (1.85±1.63) and (2.08±2.01) points 12 weeks after the treatment. There was no significant difference between the two groups at all time points (P>0.05). BI and mRS grading were not significantly different between the two groups at all time points after the treatment (P>0.05). NHISS score, mRS grading and BI at each time point after the treatment were significantly different from those before the treatment (P<0.05). No significant differences were found between the two groups in the treatment effective rate at each time point (P>0.05). Fifty patients (41.66%) in the trial group had 111 adverse events (92.50%), and 61 (50.83%) in the control group had 145 adverse events (120.83%). There was no significant difference between the two groups (P>0.05). Moreover, most of the adverse reactions were at a mild degree. Life vital signs two weeks after the treatment were not significantly different between the two groups, either (P>0.05). Conclusion Imported oxiracetam injection is of similar efficacy and safety with domestic Oulantong injection in the treatment of acute cerebral infarction.
Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.
摘要:目的:观察阿托伐他丁对脑梗死大鼠脑保护的作用以及对脑源性神经营养因子(braindeprived neurotrophic factor,BDNF)的影响。方法: 线栓法制备SD大鼠大脑中动脉梗死(middle cerebral artery occlusion,MCAO)再灌注模型。将大鼠随机分为:假手术组;MCAO组的2 h、24 h、3 d、5 d组;阿托伐他丁组的2 h、24 h、3 d、5 d组。MCAO组和阿托伐他丁组的各时程组再分别分为脑梗死体积亚组、免疫组化亚组,每亚组及假手术组各6只大鼠。在不同时间点观察阿托伐他丁组和MCAO组大鼠神经行为评分、脑梗死体积,用免疫组化法检测BDNF阳性细胞数。结果: 神经行为评分和脑梗死体积在阿托伐他丁组和MCAO组的2 h组之间无显著性差异(Pgt;0.05),在阿托伐他丁24 h、3 d、5 d组均显著低于对应时程的MCAO组(Plt;0.05);各组缺血半暗带BDNF阳性细胞数均增高,但阿托伐他丁组的阳性细胞数显著高于对应时程的MCAO组(Plt;0.05)。结论:阿托伐他丁能提高大鼠局灶脑缺血半暗带BDNF的表达水平,促进神经元的修复。Abstract: Objective: To observe the effect of atorvastatin in cerebral protection and braindeprived neurotrophic factor(BDNF) in rats. Methods: Ischemic reperfusion model of rats as established by an intraluminal filament and recirculation at different time point respectively. One hundred and two healthy SD rats were randomly assigned into three groups for different preconditioning, including the sham surgery group (SS, n=6), the sham and middle cerebralartery occlusion (MCAO) group (MCAO, n=48), and the atorvastatin and MCAO group (atorvastatin +MCAO, n=48). The latter two groups were further divided into two subgroups on different time points of tests. Each subgroup hase six rats. In the atorvastatin +MCAO group, intragastric administration of atorvastatin was given for five days, then the MCAO followed. In the MCAO group, the MCAO was given directly. The neurophysical marks and the volume of the cerebral infarction in atorvastatin group and MCAO group were determined at different time point. The expression of BDNF was valued by immunohistochemitry respectively. Results: At 2 h, there were no differences in the neurophysical marks and volume of the cerebral infarction between atorvastatin group and MCAO group (Pgt;0.05). At 24 h,3 d,5 d, the neurophysical marks and volume of the cerebral infarction of atorvastatin group were lower than that of MCAO group in the corresponding time (Plt;0.05). Around the necrotic areas,BDNF positive neurons were increased in both groups, but they were higher in atorvastatin group than in MCAO group in the corresponding time (Plt;0.05). Conclusion: Atorvastatin could increase the expression level of BDNF and promote the ischemic neuron to revive.
Massive and severe cerebral infarction can lead to a high mortality and disability rate, and it is the bottleneck of preventing and treating cerebrovascular disease. Once the malignant brain edema of massive cerebral infarction or the critical status of severe cerebral infarction occurs, the treatment effect is very poor. Therefore, we should not only focus on the treatment of critical cerebral infarction, but also prevent its occurrence. It is clinically important to prevent the occurrence of this critical condition in advance and to prevent the occurrence of massive cerebral infarction and severe cerebral infarction. This article points out that some patients with massive or severe cerebral infarction can be prevented from becoming critically ill. The definition, key risk factors and corresponding prevention and treatment strategies of critical cerebral infarction have also been proposed. Critical cerebral infarction can be divided into two categories with or without malignant brain edema, and the risk factors and prediction and prevention strategies by categories andphases can be studied separately.
ObjectiveTo explore the clinical features and prognosis of ischemic cerebral infarction in young population,and to provide a reference for clinical prevention of cerebral infarction in young population. MethodsA total of 547 patients with ischemic cerebral infarction diagnosed between January 2008 and June 2013 were included,and the difference in clinical data and outcomes between young and old patients were retrospectively compared. ResultsThe 547 patients included 233 young and 314 old patients,and there were more male patients in young group.As compared to the old group,the proportion of hypertension was significantly lower in young group (51.9%,64.3%;P=0.004);while smoking (51.9%,5.7%;P=0.000) and alcoholism (53.2%,28.3%;P=0.000) were significantly higher in young group.Moreover,there were more patients with vascular malformations in young group than that in old group (7.3%,3.2%;P=0.028).And there were also more patients in young group received thrombolytic therapy and antiplatelet therapy (98.3%,86.9;P=0.000),and the prognosis of young patients was significantly better than that of old patients. ConclusionThe prognosis of young patients with ischemic stroke prognosis is relatively good,and changing bad habits would be an effective measure to prevent and reduce the occurrence of ischemic cerebral infarction in young population.