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Abstract Background To investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients. Methods A retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI). Results A total of 1267 patients were enrolled. Lower nocturnal blood pressure (BP) decreases were observed in ACI patients than in controls (3.3% vs 8.2%, P

Cattle encephalon glycoside and ignotin (CEGI) injection is a compound preparation formed by a combination of muscle extract from healthy 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).

ObjectiveTo detect the microstructural changes in patients with cognitive impairment after acute cerebral infarction using diffusion kurtosis imaging (DKI).Materials and MethodsA total of 70 patients with acute cerebral infarction were divided into two groups: 35 patients with cognitive impairment (VCI group), and 35 patients without cognitive impairment (N-VCI group), according to mini-mental state examination (MMSE) score. Healthy individuals (n = 36) were selected as the normal control (NORM) group. DKI parameters from 28 different brain regions of interest (ROIs) were selected, measured, and compared.ResultsVCI group patients had significantly higher mean diffusion (MD) and significantly lower mean kurtosis (MK) values in most ROIs than those in the N-VCI and NORM groups. DKI parameters in some ROIs correlated significantly with MMSE score. The splenium of corpus callosum MD was most correlated with MMSE score, the correlation coefficient was −0.652, and this parameter had good ability to distinguish patients with VCI from healthy controls; at the optimal cut-off MD value (0.9915), sensitivity was 91.4%, specificity 100%, and the area under the curve value 0.964.ConclusionsPathological changes in some brain regions may underlie cognitive impairment after acute cerebral infarction, especially the splenium of corpus callosum. These preliminary results suggest that, in patients with VCI, DKI may be useful for assessing microstructural tissue damage.

BackgroundThe relationship between baseline fasting blood glucose (FBG) levels and 1-year stroke recurrence in non-diabetic patients with acute cerebral infarction (ACI) is unclear. We aimed to clarify this relationship in non-diabetic patients with ACI.MethodsBaseline FBG levels and related information of the patients were collected at admission and the events of stroke recurrence were followed up 1, 3, 6, and 12 months after the patients were discharged. Baseline FBG levels were analyzed as continuous variables and quartiles (Q1–Q4). Multivariate Cox regression models and a two-piecewise linear regression model were used to investigate the relationship and determine the threshold effect between baseline FBG levels and 1-year stroke recurrence in non-diabetic patients with ACI.ResultsOverall, 1,634 non-diabetic patients with ACI were enrolled. After adjusting for potential confounding factors, the hazard is 2.24-fold higher in Q4 than those in Q2, being considered the reference in non-diabetic patients with ACI [hazard ratio (HR) = 2.24, 95%CI: 1.08–4.65, P = 0.031]. Plotting hazard ratios over baseline FBG levels suggested a J-shaped relationship for 1-year stroke recurrence. Further analysis revealed that the nadir value of baseline FBG levels is 4.6 mmol/L. The relationship was more significant in patients with atrial fibrillation than in those without (P for interaction = 0.009).ConclusionLower and higher baseline FBG levels may lead to an increased risk of 1-year stroke recurrence in non-diabetic patients with ACI as shown by a J-shaped curve with a nadir value of 4.6 mmol/L.

Abstract Soluble lectin‐like oxidized low‐density lipoprotein receptor‐1 (sLOX‐1) and lipoprotein‐associated phospholipase A2 (Lp‐PLA2) plays an important role in acute cerebral infarction (ACI), whereas its clinical value in predicting the prognosis is unclear. Thus, this study aimed to explore this issue. A total of 127 ACI patients were included in this prospective observational study. The concentrations of sLOX‐1 and Lp‐PLA2 in serum were measured and their relationship with a poor prognosis 90 days after the onset of ACI was analyzed. We found that patients with poor prognosis had higher mean serum levels of sLOX‐1 and Lp‐PLA2. The level of sLOX‐1 and Lp‐PLA2 could predict the functional outcome of ACI. At the optimal cut off value of sLOX‐1 level (1257.92 ng/ml), the sensitivity and specificity for the poor functional outcome were 0.69 and 0.753, respectively, and the area under ROC curve (AUC) was 0.727. Similarly, the optimal value for Lp‐PLA2 level was 160.9 ng/ml, at which the sensitivity and specificity were 0.643 and 0.835, respectively; and the AUC was 0.758. When the two biomarkers were used in combination, the AUC was 0.855, and the sensitivity and specificity were 0.643 and 0.976, respectively, indicating a significant improvement of the diagnostic specificity. The level of sLOX‐1 or Lp‐PLA2 could thus serve as useful biomarkers to predict the functional outcome of ACI. Combined use of both indicators is better than the use of either single indicator, and provides the highest specificity in predicting poor prognosis.

There are neither predictive tests nor preventive strategies/treatments for acute promyelocytic leukemia (APL)-associated bleeding/thrombosis incidence. We encountered the case of a woman in her 70s who was admitted due to sudden-onset right hemiparesis. The patient was diagnosed with acute cerebral infarction as the initial manifestation of APL. Intravenous recombinant human soluble thrombomodulin was initiated on admission, followed by oral all-trans retinoic acid two days later. However, the patient's condition deteriorated due to APL-associated diphasic cerebral infarction with left internal carotid artery occlusion, and she died 10 days after admission. Thus, the degree of main artery stenosis should be evaluated before treatment in patients with APL who have coagulopathy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethical Review Board of Nihonkai General Hospital issued approval 006-1-6. The patient’s daughter provided written informed consent for the publication of this report after the patient’s death. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Suzuki et al.)

Objectives Guidelines in several countries recommend against driving soon after a stroke; however, some patients resume driving within one month after onset. This study aimed to examine the relationship between neurological and social background factors at intensive care unit (ICU) admission and resumption of motor vehicle driving within 30 days of the first acute stroke/cerebral hemorrhage. Materials and methods Data were extracted from medical records of a single center linked to the National Cerebral and Cardiovascular Center Administration Office for Stroke Data Bank in Japan. The data included age, sex, Japan Coma Scale (JCS), National Institutes of Health Stroke Scale (NIHSS), employment status, family situation, and outcomes of driving resumption in patients with a valid driving license transported to the ICU within 24 hours of stroke onset. Time-to-event analysis was used to explore the associations between these factors and driving resumption, with data censored 30 days from onset. Results In total, 239 patients had complete medical records, of whom 66 resumed driving. A multivariate Cox proportional hazards analysis showed that fewer patients aged ≥65 years resumed driving than those aged <65 years (hazard ratio 0.46; 95% confidence interval: 0.25-0.84; p=0.009). Patients with NIHSS scores ≥5 and JCS scores ≥1 were also less likely to resume driving compared with those with scores <5 (0.22; 0.08-0.56; p=0.008) and 0 (0.13; 0.04-0.37; p<0.001), respectively. Conclusions Age, NIHSS score, and JCS score at ICU admission are independently associated with the likelihood of resuming driving within 30 days of stroke onset. These findings may aid with the provision of support and education to facilitate the efficient resumption of driving after an acute event., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Review Committee of Suiseikai Kajikawa Hospital issued approval 202303. This retrospective study was approved on August 14, 2023. The study employed an opt-out approach, which was deemed ethically appropriate by the IRB given the retrospective nature of the data collection and minimal risk to participants. Notices were provided (https://www.suiseikai.jp/other/%E8%87%A8%E5%BA%8A%E7%A0%94%E7%A9%B6.html) to inform participants of their right to opt-out. All data were anonymized, ensuring the protection of participants' privacy. This study was conducted in accordance with the Declaration of Helsinki and other relevant international ethical guidelines. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Morimatsu et al.)

Objective: Acute cerebral infarction (ACI) has a high mortality and disability, which brings a heavy burden to the medical and health system. This study aims to discover the clinical prevalence of post-stroke depression (PSD) in patients with ACI, explore the predictive factors leading to this complication, and provide more evidence for better identification of PSD in clinic., Methods: From April 2021 to April 2023, this retrospective study selected 166 ACI patients as the research subjects, collected clinical symptoms and laboratory indicators at baseline, and observed the prevalence of PSD using the Hamilton depression scale 17 and the diagnostic and statistical manual of mental disorders. Multiple logistic regression analysis was adopted to explore the predictive factors of PSD in patients with ACI., Results: The total incidence of PSD was 35.54% in 166 patients with ACI. The score of National Institute of Health Stroke Scale (NIHSS), the score of daily life ability scale (ADL), and homocysteine (Hcy) level in the PSD group were higher than non-PSD group ( P NIHSS < .001, P ADL < .001, P Hcy  = .001). Multiple logistic regression analysis showed that high Hcy levels, NIHSS scores, and ADL scores were independent risk factors for PSD ( P Hcy  =.038, P NIHSS  =.002, P ADL <.001). The receiver operating characteristic (ROC) curve showed that areas under curve (AUC) = 0.894, standard error a  = 0.025, progressive significance b <.001, 95% CI = 0.845-0.943, cut-off value = 0.520, sensitivity = 91.60%, specificity = 74.60%, and Hosmer-Lemeshow goodness-of-fit test P  = .246, suggesting that ROC curve has a certain clinical predictive efficacy., Conclusion: The prevalence of early PSD in patients with ACI is relatively high. Homocysteine levels, NIHSS scores and ADL scores may be independent risk factors for PSD, and targeted clinical intervention should be implemented for the above factors., Competing Interests: Declaration of Interests: The authors have no conflicts of interest to declare., (2024 authors.)

Background: Most acute cerebral infarctions (ACI) may develop vascular dementia (VD), which involves almost all types of cognitive impairment. Unfortunately, there is currently no effective treatment for VD. Most patients exhibit mild cognitive impairment (MCI) before the development of VD. N-butyl-phthalide (NBP) is used to treat ACI and improve cognitive function. The oxygen and glucose deprivation (OGD) model of neurons is an in vitro model of ischemia, hypoxia, and cognitive dysfunction., Methods: We conducted clinical studies and in vitro experiments to investigate the clinical efficacy and mechanism of action of NBP for treating ACI-induced MCI. Patients with ACI-induced MCI were randomly divided into control (Ctrl) and NBP groups. We assessed various indicators, such as clinical efficacy, montreal cognitive assessment scale (MOCA), activities of daily living (ADL), and cerebral infarct size in both groups before and after treatment. We observed the morphology of neurons and detected the survival rate, action potentials (APs), expression of high mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), and the interaction between TLR4 and HMGB1., Results: The MOCA and ADL scores increased significantly after treatment in the NBP group. A OGD model of neurons was established, and the neurons were divided into Ctrl and NBP groups. We observed that the survival rate and APs amplitude of the neurons were significantly increased in the NBP group, whereas TNF-α expression was decreased. Furthermore, the interaction between TLR4 and HMGB1 decreased in the NBP group., Conclusion: NBP plays a neuroprotective role by inhibiting the TLR4/HMGB1 pathway and ameliorating ACI-induced MCI., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Published by IMR Press.)

Renal anemia is generally caused by a decrease in the production of erythropoietin in kidney due to renal dysfunction, and this may be associated with the increase in mortality and cardiovascular events in addition to subjective symptoms such as fatigue and wobbliness. We report a case of an 87-year-old man with type 2 diabetes, hypertension, and dyslipidemia who had received roxadustat (a hypoxia-inducible factor (HIF) prolyl hydroxylase (PH) inhibitor) for renal anemia due to diabetic nephropathy and in whom roxadustat was switched to daprodustat (another HIF-PH inhibitor) due to the onset of central hypothyroidism. About three weeks after this change, the patient developed acute asymptomatic cerebral infarction with an elevation of hemoglobin (Hb). It is unclear if the change to daprodustat was involved in the onset of cerebral infarction. However, this case suggests that particular caution should be paid to unexpected acute elevation of Hb after a change from one HIF-PH inhibitor to another, especially in a patient at high risk for cardiovascular events., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Takebayashi et al.)

BACKGROUND: Acute cerebral infarction indicates hypoxic-ischemic necrosis in brain tissue, which has become the first cause of death in China. Hypoxiainducible factor-1α plays a dual role on the occurrence and development of cerebral infarction. Therefore, it is particularly important to use its inhibitor at immediate time in clinical therapy. OBJECTIVE: To investigate the effects of hypoxia-inducible factor-1α on the regulation of brain injury/protection in rats with acute cerebral infarction. METHODS: Male Sprague-Dawley rats were randomized into three groups: sham operation group (sham), MACO-24 h group, and MACO-72 h group. A middle cerebral artery occlusion (MCAO) model was prepared by thread embolization in the latter two groups. TTC, Nissl staining, immunohistochemical staining and western blot were used to detect infarct volume and microglia morphology in rat brain tissue, the expression levels of hypoxia-inducible factor 1α, caspase 3, interleukin-1β and p-NF-κBp65 were detected, and the secretion levels of interleukin-6 and tumor necrosis factor-α in rat peripheral blood. The study protocol was approved by the Animal Ethics Committee of the First Affiliated Hospital of Jiamusi University (approval No. JMSU-210). RESULTS AND CONCLUSION: Compared with the sham group, the cerebral infarction area in the MCAO groups was significantly increased, and the brain nerve cells were seriously damaged, arranged disorderly and reduced significantly in number. However, there was no significant difference between the MCAO-24 h group and the MCAO-72 h group. Compared with the sham group, the expression levels of hypoxia-inducible factor 1α, caspase3, p-NF-κBp65, and interleukin- 1β in the brain tissue of the MCAO groups were significantly increased (P < 0.05, P < 0.01). The secretion levels of interleukin-6 and tumor necrosis factor-α was significantly increased (P < 0.01) in the peripheral blood. However, compared with the MCAO-24 h group, the expression of caspase 3 in the MCAO-72 h group was significantly decreased, while the secretion of interleukin-6 and tumor necrosis factor-α increased. To conclude, hypoxia-inducible factor 1α participates in the brain injury/protection process after acute cerebral infarction, and the time target is determined as 24-72 hours after MCAO. The determination of the time target can provide a sufficient theoretical basis and therapeutic strategy for determining the optimal use time of clinical hypoxia-inducible factor-1α inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the effect of Xuesaitong injection combined with edaravone injection on hemorheology indexes in patients with acute cerebral infarction. Methods: Search CNKI, WanFang, VIP, SinoMed, PubMed, Cochrane Library and other databases, collect randomized controlled trials (RCTs) of Xuesaitong combined with edaravone in the treatment of acute cerebral infarction from the establishment of the database to November 2020, using RevMan 5.3 software Perform Meta analysis. Results: 10 RCTs were included, with a total of 834 patients, 417 in the experimental group and 417 in the control group. The results of Meta analysis showed that the experimental group was better than the control group in improving the whole plasma viscosity (MD=-0.73, 95%CI[ -0.83, -0.63], P<0.00001); in terms of improving the thrombosis coefficient, the test group is better than the control group (MD=-0.19, 95%CI[-0.22,-0.15], P<0.00001); In terms of platelet aggregation rate, the test group was better than the control group (MD=-0.21, 95%CI[-0.25,- 0.17], P<0.00001). GRADE systematically evaluates whole plasma viscosity, thrombosis coefficient, and platelet aggregation rate, showing that the level of evidence is low or very low, and the strength of the recommendation is weak. Conclusion: Xuesaitong injection combined with edaravone injection has relatively satisfactory results in improving hemorheology indexes in patients with acute cerebral infarction, and there is no obvious safety problem. However, due to the small number of included studies and the total sample size, and the limitation of the quality of the included original studies, the results of this study need to be designed with strict, high-quality, large-sample, multi-center, and more internationally recognized clinical outcome indicators and efficacy experiments to verify, in order to obtain stronger evidence-based medicine. [ABSTRACT FROM AUTHOR]

Background: Ligustrazine injection has been widely used as adjunctive therapy in the treatment of acute cerebral infarction (ACI) during the past decades in China, but its clinical efficacy is not yet well confirmed. This study aims to evaluate the efficacy of ligustrazine injection as adjunctive therapy for ACI. Methods: Databases including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), PubMed, Medline, Google Scholar, Chinese Biomedical Literature Database, Cochrane Library, Embase, Sino-Med, Wanfang Database, and Chinese Science Citation Database were systematically searched for the published randomized controlled trials (RCTs) on ligustrazine injection in the treatment of ACI until November 2020. Meta-analysis was performed on the primary outcome measure (i.e., clinical effective rate) and the secondary outcome measure [i.e., neurological deficit score (NDS), fibrinogen, low shear blood viscosity (LBV), and high shear blood viscosity (HBV)]. The quality of the included RCTs was assessed according to the M scoring system (the refined Jadad scale). Sensitivity analysis and subgroup analysis were conducted according to the methodological quality, years of publication, and sample size. Results: Nineteen RCTs, containing 2022 patients, were included in this study. Meta-analysis indicated that ligustrazine injection combined with Western medicine could achieve a better effect in the treatment of ACI than using Western medicine alone in terms of clinical effective rate (RR = 1.24; 95% CI, 1.19–1.29), NDS (MD = −3.88; 95%CI, −4.51 to −3.61), fibrinogen (MD = −0.59; 95% CI, −0.76 to −0.42), LBV (MD = −2.11; 95% CI, −3.16 to −1.06), and HBV (MD = −0.88; 95% CI, −1.20 to −0.55). Conclusions: This research indicated that ligustrazine injection as adjunctive therapy seemed to be more effective than using western medicine alone in treating ACI. However, more evidence is required to confirm the efficacy of ligustrazine injection due to the low methodological quality of the included RCTs. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the clinical effect of mild hypothermia combined with intravenous thrombolysis in the treatment of acute cerebral infarction. Methods: Eighty-eight patients with acute cerebral infarction in Binzhou People's Hospital between May 2018 and August 2019 were randomly selected and divided into a control group and an observation group according to the random number table method, with 44 patients in each group. The control group was given intravenous thrombolysis; the observation group was treated with mild hypothermia (30-350C) in addition to intravenous thrombolytic thrombolysis. The clinical efficacy, incidence of complications, oxidative stress indexes, inflammatory factor level, neurological function, and mental state of the two groups before and after treatment were compared. Results: The clinical efficacy of the observation group was significantly better than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the levels of oxidative stress indexes and inflammatory factors between the two groups before treatment (P<0.05). After treatment, the levels of oxidative stress indexes and inflammatory factors of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the neurological function and mental state between the two groups before treatment (P<0.05). After treatment, the neurological function and mental state of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the incidence of complications and mortality between the two groups (P>0.05). Conclusion: Thrombolytic therapy combined with mild hypothermia has a good efficacy in the treatment of acute cerebral infarction. The therapy can improve the neurological function of patients with acute cerebral infarction by significantly improving the oxidative stress index and relieving the inflammatory reaction. Its efficacy is better than single thrombolytic therapy. [ABSTRACT FROM AUTHOR]

To explore the effect of care transitions intervention (CTI) on the sense of benefit-finding of caregivers for patients with acute cerebral infarction (ACI). Ninety caregivers for patients with ACI were divided into two groups according to the random number table method (n = 45 in each group). The control group was given regular health guidance, and the intervention group was given care transitions intervention on the basis of the guidance used in the control group. The changes in the sense of benefit-finding and quality of life between the two groups were compared before and after the intervention. There was no statistically significant difference in caregivers between the two groups in gender, age, educational level, occupational status, gender and age of the patients, activities of daily living (ADL) scores before discharge, and the relationships between the caregiver and the patient. Before CTI, there was no statistically significant difference in the caregivers' sense of benefit-finding (including sense of benefit, family relationship, personal growth, social relationship and healthy behavior) and quality of life (including benefit-finding of care, stress of care, choice of care, support to care and money issue) between the two groups. While after CTI, the scores of each dimension of the caregivers' sense of benefit-finding and quality of life in the intervention group were significantly higher than those in the control group (p < 0.05). The CTI can help improve the sense of benefit-finding and quality of life of caregivers for patients with ACI. [ABSTRACT FROM AUTHOR]

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Background: To evaluate the prognosis of acute cerebral infarction at 1-year follow-up in different circulation infarctions.Methods: Clinical data of 858 consecutive patients with acute cerebral infarction were collected. Of the 858 cases, 21 (2.45%) were lost to follow-up and 837 completed follow-up and thus were enrolled in this study. At 1-year follow-up, death or moderate-to-severe dysfunction (modified Rankin Scale (mRS) ≥ 3 points) was regarded as the poor prognostic endpoint. Univariate analysis and multivariate logistic stepwise regression analysis were performed to assess the prognosis. The prediction probability of indicators was obtained for the multivariate model, and the receiver operating characteristic curve was delineated to calculate the area under the curve (AUC) to predict the fitness of the model.Results: The older the age, the greater the probability of a poor prognosis. Patients with previous diabetes and cerebral infarction had a poor prognosis. The higher the National Institutes of Health Stroke Scale and mRS scores and the lower the Barthel index at admission, the worse the prognosis of the patients. The longer the hospital stay, the worse the prognosis of the patients. The prognosis of different circulation infarctions was different. The AUC of the multivariate model was AUC = 0.893, and the 95% confidence interval was 0.870-0.913, indicating a good fit. The prognosis of anterior circulation infarction (ACI) was worse than that of posterior circulation infarction (PCI) (P < 0.05). The prognosis of patients with ACI and PCI was not significantly different from that of patients with ACI or PCI alone (P > 0.05).Conclusions: Diabetes, the Barthel index at admission and previous cerebral infarction are poor prognostic factors of acute cerebral infarction. The prognosis of ACI is worse than that of PCI. Different factors affect the prognosis of different circulatory system infarctions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of edaravone combined with different doses of atorvastatin on blood lipid, inflammatory factors and cerebral blood flow in patients with acute cerebral infarction (ACI). Methods: A total of 81 patients with ACI in our hospital from March 2018 to January 2020 were selected, and they were randomly divided into low-dose group (edaravone combined with 10 mg/d atorvastatin), medium-dose group (edaravone combined with 20 mg/d atorvastatin) and high-dose group (edaravone combined with 40 mg/d atorvastatin), with 27 cases in each group. The curative effect, blood lipid, inflammatory factors, cerebral blood flow indexes, related scale score and adverse reactions of the three groups were compared. 14 d after treatment, the total effective rate of high-dose group and medium-dose group was higher than that of low-dose group, and the high-dose group was higher than that of medium dose group (P<0.05). Results: 14 d after treatment, the scores of National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) scores and total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive protein (hs-CRP), interleukin-8 (IL-8), tumor necrosis factor-α(TNF-α) of high-dose group and medium-dose group were lower than those of low-dose group, and the high-dose group was lower than the medium-dose group (P<0.05). 14 d after treatment, the high-density lipoprotein cholesterol(HDL-C) of high-dose group and medium-dose group was higher than that of low-dose group, and high-dose group was higher than the medium-dose group (P<0.05). 14 d after treatment, the mean blood flow velocity of the three groups was increased compared with that before treatment, peripheral resistance was lower than that before treatment (P<0.05), but there were no significant differences in the mean blood flow velocity and peripheral resistance among the three groups (P>0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion: 40 mg/d Atorvastatin combined with edaravone in the treatment of ACI patients can more effectively control the disease progression, improve the body's blood lipid and inflammatory factors, which is more safe and reliable, but the changes of cerebral blood flow may not be related to the dose of atorvastatin. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically evaluate the clinical efficacy and safety of ganglioside combined with edaravone in the treatment of acute cerebral infarction. METHODS: CNKI, WanfangData, VIP database, PubMed and Cochrane Reviews were retrieved to collect the randomized controlled trials of ganglioside combined with edaravone in the treatment of acute cerebral infarction(the study group was given ganglioside combined with edaravone, while the control group received edaravone). The retrieval time was from the establishment of the database to Apr. 2021, the language of the literature was Chinese and English. According to inclusion and exclusion criteria, literature were screened, extracted, scored with newcastle-Ottawa scale, and meta-analysis was performed with RevMan 5. 3 and Stata 15. 0 software. RESULTS: Totally 11 literature were collected, including 1 011 patients(505 patients in the study group and 506 patients in the control group). Adverse drug reactions were mentioned in 7 literature. Meta-analysis results showed that the total effective rate in the study group was significantly higher than that in the control group (OR =3. 53,95%CI = 2. 26-5. 52,Z = 5. 52,P<0. 000 01), and the reduction degree of national institutes of health stroke scale(NHISS) score in the study group was significantly better than that in the control group(MD = -6. 21, 95%CI = - 6. 63-- 5. 80, Z = 29. 25, P < 0. 000 01), the differences were statistically significant. There was no significant difference in the incidence of adverse drug reactions between two groups(OR =1. 04,95%CI =0. 55-1. 94, Z =0. 11,P =0. 91). CONCLUSIONS: Based on existing evidence, ganglioside combined with edaravone is effective in the treatment of acute cerebral infarction. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of Naoxintong capsule combined with alteplase in the treatment of acute cerebral infarction (ACI), and to observe the effects of this treatment on coagulation function, hemorheology and cognitive function. Methods: 137 patients with ACI who were admitted to our hospital from June 2016 to December 2020 were selected. According to the random number table method, the patients were divided into control group and observation group, 68 cases in the control group were treated with alteplase, 69 cases in the observation group were treated with Naoxintong capsule combined with alteplase, both groups were treated for 10 d. The clinical total effective rate of the two groups at 10 d after treatment was compared. The changes of coagulation function, hemorheology and cognitive function of the two groups before treatment and 10d after treatment were observed. The liver and kidney function, blood routine and adverse drug reactions of the two groups were recorded. Results: There was significant difference in the total effective rate between the two groups (P<0.05). Compared with before treatment, the activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) in two groups at 10 d after treatment were all prolonged, D-dimer (D-D), whole blood low shear viscosity, whole blood high shear viscosity, plasma viscosity and hematocrit all decreased (P<0.05), compared with the control group, the improvement of above indexes in the observation group was more significant (P<0.05). 10 d after treatment, the National Institutes of Health Stroke Scale (NIHSS) scores were decreased in two groups compared with those before treatment, the scores of daily living ability scale (ADL) were all increased (P<0.05), compared with the control group, the improvement of above scores in the observation group was more significant (P<0.05). There was no abnormality in blood routine, liver and kidney function in the two groups, and no serious adverse reactions occurred. Compared with before treatment, all dimensions of quick cognitive screening scale for elderly (QCST-E) scores in two groups were increased at 10 d after treatment (P<0.05), and compared with the control group, the improvement in the observation group was more significant (P<0.05). Conclusion: On the basis of alteplase treatment combined with Naoxintong capsule in the treatment of ACI, it can improve the patients' neurological function, improve the patients' activities of daily living, and promote the improvement of coagulation function, hemorheology and cognitive function. [ABSTRACT FROM AUTHOR]

Background: Ligustrazine injection has been widely used as adjunctive therapy in the treatment of acute cerebral infarction (ACI) during the past decades in China, but its clinical efficacy is not yet well confirmed. This study aims to evaluate the efficacy of ligustrazine injection as adjunctive therapy for ACI.Methods: Databases including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), PubMed, Medline, Google Scholar, Chinese Biomedical Literature Database, Cochrane Library, Embase, Sino-Med, Wanfang Database, and Chinese Science Citation Database were systematically searched for the published randomized controlled trials (RCTs) on ligustrazine injection in the treatment of ACI until November 2020. Meta-analysis was performed on the primary outcome measure (i.e., clinical effective rate) and the secondary outcome measure [i.e., neurological deficit score (NDS), fibrinogen, low shear blood viscosity (LBV), and high shear blood viscosity (HBV)]. The quality of the included RCTs was assessed according to the M scoring system (the refined Jadad scale). Sensitivity analysis and subgroup analysis were conducted according to the methodological quality, years of publication, and sample size.Results: Nineteen RCTs, containing 2022 patients, were included in this study. Meta-analysis indicated that ligustrazine injection combined with Western medicine could achieve a better effect in the treatment of ACI than using Western medicine alone in terms of clinical effective rate (RR = 1.24; 95% CI, 1.19–1.29), NDS (MD = −3.88; 95%CI, −4.51 to −3.61), fibrinogen (MD = −0.59; 95% CI, −0.76 to −0.42), LBV (MD = −2.11; 95% CI, −3.16 to −1.06), and HBV (MD = −0.88; 95% CI, −1.20 to −0.55).Conclusions: This research indicated that ligustrazine injection as adjunctive therapy seemed to be more effective than using western medicine alone in treating ACI. However, more evidence is required to confirm the efficacy of ligustrazine injection due to the low methodological quality of the included RCTs.

This research was developed to investigate the effect of artificial intelligence neural network-based magnetic resonance imaging (MRI) image segmentation on the neurological function of patients with acute cerebral infarction treated with butylphthalide combined with edaravone. Eighty patients with acute cerebral infarction were selected as the research subjects, and the MRI images of patients with acute cerebral infarction were segmented by convolutional neural networks (CNN) upgraded algorithm model. MRI images of patients before and after treatment of butylphthalide combined with edaravone were compared to comprehensively evaluate the efficacy of this treatment. The results showed that compared with the traditional CNN algorithm, the running time of the CNN upgraded algorithm adopted in this study was significantly shorter, and the Loss value was lower than that of the traditional CNN model. Upgraded CNN model can realize accurate segmentation of cerebral infarction lesions in MRI images of patients. In addition, the degree of cerebral infarction and the degree of arterial stenosis were significantly improved after treatment with butylphthalide and edaravone. Compared with that before treatment, the number of patients with severe cerebral infarction or even vascular stenosis decreased significantly (P < 0.05), and gradually changed to mild vascular stenosis, and the neurological dysfunction of patients was also significantly improved. In short, MRI image segmentation based on artificial intelligence neural network can well-evaluate the efficacy and neurological impairment of butylphthalide combined with edaravone in the treatment of acute cerebral infarction, and it was worthy of promotion in clinical evaluation of the treatment effect of acute cerebral infarction. [ABSTRACT FROM AUTHOR]

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Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Mirror therapy (MT) has proven to be beneficial for treating patients suffering from motor aphasia after stroke. However, the impacts of MT on neuroplasticity remain unexplored. OBJECTIVE: In this paper we conducted a randomized controlled trial to evaluate the treatment using the MT on motor aphasia following acute cerebral infarction. METHODS: We randomly assigned 30 patients into test and control groups, with test group patients treated with MT, whereas control group patients were treated with sham MT. At 24 hours prior to and after the intervention, we obtained functional magnetic resonance imaging (fMRI) data from study subjects. At baseline, after treatment and 12-week follow-up, we additionally evaluated patients with the Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the aphasia quotient (AQ) in the western aphasia test. RESULTS: After 2 weeks of treatment, the test group demonstrated significant improvements in AQ values, naming, repetition, spontaneous speech, and mRS scores compared to the control group (P < 0.05). Furthermore, in the follow-up time point (12 weeks), we found that the test group exhibited significantly better NIHSS scores and AQ evaluation indicators than the control group (P < 0.05). Specifically, the fMRI study shows that functional connectivity significantly improved in test group patients mainly among frontal, temporal, and parietal lobes of the left hemisphere with each other than controls group. Meanwhile, we found significantly enhanced functional connectivity with the hippocampus (P < 0.01). CONCLUSIONS: Our results indicate that the MT can expedite the recovery of language function during the early phases of stroke recovery. These findings may elucidate the underlying mechanism of MT and the application of this therapy as an adjunct rehabilitation technique in language recovery. [ABSTRACT FROM AUTHOR]

Objective: To study Effect of tirofiban combined with butylphthalide on serum Heme oxygenase-1（HO-1), nitric oxide（NO), angiogenin-1（ANG-1), vascular endothelial growth factor（VEGF） in patients with acute cerebral infarction beyond time window.Methods: 141 patients with acute cerebral infarction beyond the time window treated in our hospital from January 2018 to January 2020 were selected and divided into combination group（n=71） and single drug group（n=70） by random number table method. The mono-drug group was given butylphthalide treatment, and the combination group was given tirofiban treatment on the basis of mono-drug group.Clinical efficacy, HO-1, NO, VEGF, ANG-1, the National Institutes of Health Stroke Scale（NIHSS), Barthel index（Barthel), thrombin time（TT), prothrombin time（PT), fibrinogen（FIB） levels and the incidence of drug complications were compared between the two groups. Results: After treatment, the total effective rate of the two groups was significantly different（P<0.05）; before treatment, there was no significant difference in serum HO-1, no, VEGF, Ang-1 between the combined group and the single drug group; after treatment, the serum HO-1, no, VEGF in the combined group and the single drug group decreased with time, and the combined group was lower than the single drug group, and Ang-1 increased with time, and the combined group was higher than the single drug group, the difference was significant Before treatment, there was no significant difference in NIHSS and Barthel between the combined group and the single drug group; after treatment, NIHSS in the combined group and the single drug group decreased with the passage of time, and Barthel in the combined group increased with the passage of time, and the combined group was higher than the single drug group, the difference was significant（P<0.05). Conclusion: The effect of tirofiban combined with butylphthalide in patients with acute cerebral infarction over time window is significant, which may be related to the effective improvement of serum HO-1, no, VEGF, Ang-1 levels, and does not increase adverse reactions. [ABSTRACT FROM AUTHOR]

Objective: To detect the serum procalcitonin (PCT) level and determine its relationship with the infarct volume in young patients with acute cerebral infarction. Methods: According to the infarct volume, young patients with acute cerebral infarction were divided into large group, intermediate group, and small group. The severity of clinical symptoms was determined according to the National Institute of Health Stroke Scale (NIHSS) score. Healthy young people were selected as the control group. Serum PCT levels were measured. The relationship among PCT, volume, and NIHSS score was analyzed. Results: PCT in observation group was significantly higher than that in control group (t = 6.879, P = 0.011), and PCT in severe group was significantly higher than in mild group (t = 6.978, P = 0.016). PCT in large cerebral infarction group was higher than that in intermediate and small-size infarct group (P = 0.0036 and P < 0.0001, respectively), and PCT in intermediate cerebral infarction group was higher than that in small-size infarct group (P = 0.0024). In observation group, the PCT level was positively correlated with both NIHSS (r = 0.793, P = 0.022) and infarction volume (r = 0.649, P = 0.007). Conclusion: The level of PCT in young patients with acute cerebral infarction may be related to the inflammatory reaction of the cerebral artery and positively related to the volume of cerebral infarction and NIHSS score. To some extent, PCT concentration can predict the disease severity of acute cerebral infarction. [ABSTRACT FROM AUTHOR]

Objective To summarize the factors affecting progosis of actue cerebral infarction patients receiving endovascular therapy (EVT) . Methods A total of 115 patients with acute cerebral infarction who received EVT were divided into good prognosis group (modified Rankin scale scole of 0-2 points) and poor prognosis group modified Rankin scale scole of 3-6 based on the prognosis of patients 3 months after operation. General data such as gender, age, complications (hypertension, diabetes or glucose tolerance disorder, atrial fibrillation, coronary heart disease), and responsible blood vessels of the patients in two groups were collected and compared. Treatment methods (stent thrombectomy, arterial thrombolysis, suction thrombosis, bridging therapy, balloon dilation or stent implantation, local use of tirofiban), time from onset to femoral artery puncture (OPT), EVT operation time, times of thrombectomy, vascular recanalization rate, incidence of hemorrhagic transformation, preoperative NIHSS score, NIHSS score 24 h after EVT, NIHSS score change (ΔNIHSS), neutrophil-lymphocyte count ratio (NLRT0) 0-6 h after onset, NLR (NLRT1) 6-24 h after onset and NLR change and other EVT-related indicators of the patients in two groups were collected and compared. Postoperative complications such as pneumonia, severe cerebral edema, hydrocephalus, stress ulcer, hyperthyroidism crisis, urinary tract infection, cardiac and respiratory arrest, secondary epilepsy. Treatment and outcome data of invasive mechanical ventilation, decompression of bone flap-removal, hematoma puncture and drainage and nosocomial of the patients in two groups were collected and compared. Results The proportion of women, age, EVT operation time, times of thrombectomy, preoperative NIHSS score, 24 h postoperative NIHSS score, ΔNIHSS score, NLRT1, pneumonia, invasive mechanical ventilation and severe brain edema in the poor prognosis group were compared with those in the good prognosis group (all P < 0. 05) . Age, invasive mechanical ventilation, severe cerebral edema, and NIHSS score 24 h after EVT were prognostic factors in patients with acute cerebral infarction receiving EVT. Conclusion Older age, invasive mechanical ventilation, severe postoperative cerebral edema, and high NIHSS score 24 h after EVT are risk factors for prognosis of patients with acute cerebral infarction receiving EVT. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the clinical effect of alteplase combined with butylphthalide in treating patients with acute anterior circulation cerebral infarction. Methods: Retrospective study methods were used. Eighty patient cases with acute anterior circulation cerebral infarction treated in Baoding First Central Hospital, China from January 2018 to December 2020 were randomly and averagely divided into two groups. Patients in the two groups were given symptomatic treatment. Patients in the experimental group were treated with alteplase combined with butylphthalide for thrombolytic therapy, whereas patients in the control group were treated with urokinase thrombolytic therapy. The NIHSS score, effective rates and neurological function recovery were analysed one day, seven days and 30 days after treatment were analyzed, respectively. So as the incidence of adverse reactions within seven days after drug adminutesistration. Results: The NIHSS scores of the two groups were significantly lower than those before treatment on one day, seven days and 30 days after treatment (experimental group, p=0.00; control group, p=0.02). The experimental group was more significantly lower than the control group (p=0.00). The effective rate of the experimental group was significantly higher than that of the control group (p=0.03), and the recovery rate after treatment was significantly higher than that of the control group (p=0.04). Within one week after treatment, the complication rate was 15% in the experimental group and 20% in the control group but was not significantly different (p=0.56). Conclusion: Alteplase combined with butylphthalide is effective and safe in the treatment of acute anterior circulation cerebral infarction without obvious complications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of high-dose atorvastatin combined with alteplase on serum inflammatory factors and neurological function in patients with acute cerebral infarction. METHODS: Totally 196 patients with acute cerebral infarction admitted into Wuming Hospital of Guangxi Medical University from Mar. 2017 to Mar. 2021 were extracted to be divided into the observation group and the control group via the random number table. Ninety-eight patients in the observation group were treated with high-dose atorvastatin combined with alteplase, and 98 patients in the control group received high-dose atorvastatin combined with urokinase. Clinical efficacy, national institutes of health stroke scale ( NIHSS) score, activity of daily living ( ADL) score, total cholesterol (TC), low density, lipoprotein cholesterol ( LDL-C), triglyceride ( TG) and high-density lipoprotein cholesterol ( HDL-C) levels, serum tumor necrosis factor-a ( TNF -a ), high sensitivity C-reactive protein ( hs-CRP ) and matrix metalloproteinase-9 ( MMP-9) levels before and after treatment in two groups were observed. RESULTS: The total effective rate of the observation group was 95. 92% ( 94/ 98), and the total effective rate of the control group was 91. 84% ( 90/98), with no statistically significant difference between two groups ( P> 0. 05). After 42 d of treatment, the NIHSS scores of two groups were significantly lower than those before treatment, and the observation group was significantly lower; the ADL score was significantly higher than those before treatment, and the observation group was significantly higher, the differences were statistically significant ( P<0. 05). After 42 d of treatment, the levels of TC, TG and LDL-C of two groups were significantly lower than those of the same group before treatment, and the levels of HDL-C were significantly higher than those of the same group before treatment, and the differences were statistically significant ( P 0. 05) . After 42 d of treatment, the levels of TNF-cx, hs-CRP and MMP-9 in two groups were significantly lower than those before treatment, and the reduction in the observation group was significantly greater than that in the control group, the differences were statistically significant ( P < 0. 05). CONCLUSIONS: Compared with high-dose atorvastatin combined with urokinase, high-dose atorvastatin combined with alteplase has advantages in improving neurological damage, restoring the ability of daily life and reducing the inflammation in patients with acute cerebral infarction. [ABSTRACT FROM AUTHOR]

This study aimed to explore the correlation between the serum level of indole-3-propionic acid (IPA) and the progression and prognosis of acute cerebral infarction (ACI). This study enrolled 197 patients with ACI, and 53 participants from a community-based stroke screening program during the same period were included as the control group. The patients with ACI were divided into quartiles of serum IPA. A logistic regression model was used for comparison. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of the IPA. Compared with the healthy control group, the ACI group had lower serum IPA (P < 0.05). The serum IPA was an independent factor for acute ischemic stroke (OR=0.992, 95% CI: 0.984-0.999, P =0.035). The serum IPA was lower in patients with progressive stroke or poor prognosis than in patients with stable stroke or good prognosis (P < 0.05). Patients with ACI with low serum IPA are prone to progression and poor prognosis. The best cutoff value for predicting progression was 193.62 pg/mL (sensitivity, 67.5%; specificity 83.7%), and that for poor prognosis was 193.77 pg/mL (sensitivity, 71.1%; specificity, 72.5%). The serum level of IPA was an independent predictor of ACI and had certain clinical value for predicting stroke progression and prognosis in patients with ACI. [ABSTRACT FROM AUTHOR]

Objective To analyze the correlation between thrombus composition and the prognosis of patients with acute cerebral infarction after mechanical thrombectomy. Methods This retrospective analysis was conducted among 48 patients with the diagnosis of acute ischemic stroke, who were eligible for mechanical thrombectomy as assessed by the first aid group and successfully underwent the surgery between June, 2015 and February, 2019. The clinical data were collected from the patients including TOAST(trail of org 10172 in acute stroke treatment) classification, thrombus position, number of stents placed, recanalization time, thrombolysis in cerebral infarction (TICI) grading and the use of recombinant tissue plasminogen activator (rt-PA) for intravenous thrombolysis. The patients were followed up and the modified Rankin scale (mRS) score at 3 months after the surgery was recorded. The composition of the retrieved thrombus was examined using HE staining, and the correlation between thrombus composition and the patients' outcomes was analyzed. Results Of the 48 patients included, 24 were diagnosed to have cardioembolic stroke, 16 had large artery atherosclerotic stroke, and 8 had stroke with unknown etiology. A significant difference was found in fibrin and platelet contents between the cardiogenic thrombi and atherosclerotic thrombi. Fibrin-rich thrombi were found in 35 patients, and erythrocyte-rich thrombi were found in 13 patients; the percentage of favorable mRS scores at the end of the third month after the surgery was significantly lower in the former patients than in the latter patients (26% vs 62%, P < 0.05). During mechanical thrombectomy, the recanalization time was significantly shorter in patients receiving intravenous thrombolysis with rt-PA than in those without the use of rt-PA (90±47.6 vs 131.6 ± 57.5 min, P < 0.05). Conclusion In patients with acute ischemic stroke undergoing mechanical thrombectomy, high fibrin and platelet contents in the thrombus are associated with a poor prognosis, and intravenous thrombolysis with rt-PA is associated with a shortened recanalization time during mechanical thrombectomy.

Abstract Background This study aims to investigate the pathogen distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection. Methods From August 2015 to December 2017, 172 pathogenic bacterial strains from patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection in our hospital were identified, and the drug sensitivity was analyzed. Results Among these 172 strains of pathogenic bacteria, gram negative bacteria was the main cause of pulmonary infection in hospitalized patients with acute cerebral infarction, accounting for 75.6% of all pathogens. Furthermore, 80% of diabetic patients with cerebral infarction had lung infection induced by gram negative bacteria, which was significantly higher than that in non-diabetic patients (72.2%). Moreover, the drug resistance rate in the diabetic group (68.3%) was significantly higher than that in the non-diabetic group (54.3%). Gram positive bacteria accounted for 19.1% of all pathogenic bacteria. The infection rate of gram-positive bacteria in diabetic patients with cerebral infarction was 14.7%, which was lower than that in the non-diabetic group (22.6%). The drug-resistance rate was higher in the diabetic group (45.5%) than in the non-diabetic group (28.2%). Furthermore, the fungal infection rate in patients with lung infection in these two groups was 5.3 and 5.2%, respectively, and fungi presented with high sensitivity to commonly used antifungal agents. Conclusion In patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection, the majority of pathogens are multidrug-resistant gram negative bacilli. Pathogen culture should be conducted as soon as possible before using antibiotics, and antimicrobial agents should be reasonably used according to drug sensitivity test results.

Objective To explore the risk factors of pulmonary infection in patients with acute cerebral infarction. Methods We retrospectively reviewed the clinical data of 417 patients admitted for acute cerebral infarction in our hospital between April and December, 2017. We compared the data between the patients with and without pulmonary infection, and analyzed the risk factors for pulmonary infection following acute cerebral infarction using multiple logistic regression analysis. Results There were significant differences in age, gender, length of hospital stay, smoking, history of previous lung disease, coronary heart disease, hyperlipidemia, dysphagia, consciousness disturbance at admission, complete bed rest, invasive operation, National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (MRS) score at admission between the pulmonary infection group(n=92) and the non-pulmonary infection group(n=325) (P < 0.05). Multiple logistic regression analysis suggested that NIHSS score>14 at admission, age>65 years, invasive operation, and complete bed rest were risk factors for pulmonary infection in patients with acute cerebral infarction(OR=5.410, 2.714, 21.823, 3.013, 95%CI:1.835~15.953, 1.257~5.587, 10.265~46.393, 1.365~6.651, all P < 0.05). Conclusion NIHSS score at admission, age, invasive operation and complete bed rest may be regarded as reference indexes in the prevention and treatment of pulmonary infection after acute cerebral infarction.

Abstract 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 1st, 2015, and December 31st, 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 (mRS). An mRS score of 0–2 points indicated excellent prognosis, and an mRS 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

ObjectiveThis study compared the clinical efficacy and safety of argatroban and alteplase in the treatment of acute cerebral infarction.MethodsThis study retrospectively analyzed 131 patients admitted for acute cerebral infarction within 48 h of onset from 1 December 2018 to 1 May 2021. The patients were divided according to treatment (i.e., the argatroban and alteplase groups). The National Institutes of Health Stroke Scale (NIHSS) scores (before treatment, at 24 h, and at 3, 7, and 14 days), 14-day response rate, 3-month modified Rankin Scale score (mRS), activities of daily living (ADL) score, prognosis, and adverse events during treatment were compared.ResultsSixty-two and 69 patients were enrolled in the alteplase and argatroban groups, respectively, and both had comparable baseline data. The NIHSS scores of the alteplase group decreased significantly before and after treatment (24 h and at 3, 7, and 14 days), whereas those of the alteplase group decreased most rapidly after 24 h of administration. The argatroban group showed no significant changes in NIHSS score in the first 7 days after treatment until day 14, at which it significantly decreased. Statistically significant differences between the two groups were observed in four points (P vs. 65.2%; χ2 = 131; P = 0.001). The 3-month mRS, ADL and pre-treatment comparisons were statistically significant in the two groups (P P > 0.05). Furthermore, the outcomes at 3 months after treatment in both groups did not vary significantly (alteplase vs. argatroban: 48/62 vs. 51/69; χ2 = 0.217; P = 0.641). Adverse events during treatment included gingival bleeding (two patients), positive fecal occult blood (two patients), and minor intracranial blood ooze (one patient) in the alteplase group, whereas no adverse events (e.g., bleeding and shock) were noted in the argatroban group.ConclusionThe short-term efficacy of argatroban in improving neurological function in patients with acute cerebral infarction was significantly lower than that of alteplase. However, the long-term efficacy at 3 months of treatment was comparably significant to that of alteplase with fewer adverse events.

Background: This study was to examine the patients with acute cerebral infarction (ACI) treated at a single center over 9 years and who underwent Unruptured intracranial aneurysm (UIA) screening by three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), and to explore the factors associated with outcomes.Methods: The outcome was the modified Rankin scale (mRS) score at 90 days after stroke onset. The outcome was classified into a good outcome (mRS score of 0–2 points) and poor outcome (mRS score of 3–6 points).Results: UIAs were found in 260 (6.5%) of 4,033 patients with ACI; 2,543 (63.1%) had a good outcome, and 1,490 (36.9%) had a poor outcome. There was no difference in outcomes between the two groups (P = 0.785). The multivariable analysis showed that age (OR = 1.009, 95%CI: 1.003–1.014, P = 0.003), diabetes (OR = 1.179, 95%CI: 1.035–1.342, P = 0.013), ischemic stroke history (OR = 1.451, 95%CI: 1.256–1.677, P < 0.001), and baseline NIHSS score (OR = 1.034, 95%CI: 1.018–1.050, P < 0.001) were independently associated with the 90-day outcomes in patients with ACI. The presence of incidental UIA was not associated with outcomes after ACI.Conclusions: Age, diabetes, ischemic stroke history, and baseline NIHSS score were independently associated with the early outcomes of patients with ACI.

aimed to explore the correlation between white matter hyperintensity (WMH) and post-stroke depression (PSD) at 3 months, and to further investigate sex differences in the pathogenesis of PSD. Methods: A total of 238 consecutive patients with acute cerebral infarction were recruited. PSD was assessed at 2 weeks and at 3 months after stroke onset. All stroke cases were divided into four subgroups according to the diagnosis of depression at two time nodes: continuous depression; depression remission; late-onset PSD; and continuous non-depression. The Fazekas and Scheltens visual rating scales were adopted to assess WMH. Results: Logistic regression revealed that the presence of periventricular white matter hyperintensity (PVWMH) at baseline in male patients was an independent risk factor for PSD at 3 months. Further subgroup analysis revealed that PVWMH was associated with late-onset PSD in males, but not with continuous depression 3 months after stroke. Male acute stroke patients with PVWMH at baseline were more likely to develop PSD at 3 months, especially late-onset PSD. Conclusion: Our data suggest that sex differences may influence the pathogenesis of PSD. [ABSTRACT FROM AUTHOR]

Acute cerebral infarction (ACI) possesses high mortality. Exosomes present in serum have potential application value in ACI diagnosis. This study investigated the mechanism of serum exosomes in ACI. Serum exosomes isolated from ACI patients and normal people were identified and then injected into the established middle cerebral artery occlusion (MCAO) rat model to evaluate cerebral injury and inflammation. Exosomal microRNA (miR)-27-3p expression was detected and interfered to analyze rat cerebral inflammation. The binding relationship between miR-27-3p and PPARγ was predicted and verified. The lipopolysaccharide (LPS)-treated microglia model was established and intervened with miR-27-3p to detect PPARγ, Iba-1, and inflammation-related factor expressions. After overexpressing PPARγ, rat cerebral inflammation was evaluated. The clinical significance of serum exosomal miR-27-3p in ACI was evaluated. Serum exosomes from ACI patients caused exacerbated MCAO rat cerebral injury and poor behavior recovery, as well as promoted cerebral inflammation. Serum exosomal miR-27-3p deepened rat brain inflammation. miR-27-3p targeted PPARγ to promote microglia activation and inflammation-related factor expressions in MCAO rats, and overexpressing PPARγ attenuated MCAO rat cerebral inflammation. Serum exosomal miR-27-3p promised to be a biomarker for ACI. We proved that serum exosomes from ACI patients aggravated ACI patient cerebral inflammation via the miR-27-3p/PPARγ axis. [ABSTRACT FROM AUTHOR]

Background and Objectives: It is important to evaluate the swallowing function of patients with acute cerebral infarction. The effects of nutritional intervention after an early assessment by a flexible endoscopic evaluation of swallowing (FEES) were evaluated.Methods and Study Design: This retrospective study included 274 patients who were hospitalized for acute cerebral infarction and underwent a FEES between 2016 and 2018. The effects of early nutritional intervention after an assessment by a FEES within 48 h from admission were evaluated. The patients were divided into a shorter hospital stay group (<30 days) and a longer group (≥30 days). A multivariate analysis was performed to identify the predictive factors for a shorter hospital stay.Results: The overall patient characteristics were as follows: 166 men; median age, 81 years old; and median body mass index (BMI), 21.1 kg/m2. No significant differences in the age, sex, or BMI were found between the shorter and longer hospital stay groups. A FEES within 48 h of admission (odds ratio [OR], 2.040; 95% confidence interval [CI], 1.120-3.700; p=0.019), FILS level ≥6 at admission (OR, 2.300; 95% CI, 1.190-4.440; p=0.013), and an administered energy dose of ≥18.5 kcal/kg on hospital day 3 (OR, 2.360; 95% CI, 1.180-4.690; p=0.015) were independently associated with a hospital stay <30 days.Conclusions: Patients with acute cerebral infarction are more likely to have a shorter hospital stay (<30 days) if they undergo a FEES early after admission and receive optimal nutritional intervention. [ABSTRACT FROM AUTHOR]

Background: Aortic dissection is one of the causes of stroke. Because cerebral infarction with aortic dissection is a contraindication to intravenous recombinant tissue plasminogen activator (rt-PA) therapy, exclusion of aortic dissection is necessary prior to its administration. However, imaging takes time to provide a diagnosis, possibly causing delays in surgical treatment.Case Presentation: A 65-year-old Japanese female patient was transported to the hospital for a suspected stroke, with back pain and left upper and lower extremity palsy which occurred while eating. Upon arrival at the hospital, the left lower limb paralysis had improved, but the left upper limb paralysis remained. Right back pain had also developed. A plain head computed tomography (CT) scan performed 110 minutes after onset showed no acute bleeding or infarction. Subsequent CT perfusion (CTP) showed acute perfusion disturbance in the right hemisphere without infarction, known as ischemic penumbra. The four-dimensional maximum-intensity projection image reconstructed from CTP showed a delayed enhancement at the right internal carotid and right middle cerebral arteries compared to the contralateral side, suggesting a proximal vascular lesion. Contrast helical CT from the neck to abdomen revealed an acute aortic dissection of Stanford type A with false lumen patency. The dissection extended to the proximal right common carotid artery. The patient underwent an emergency total arch replacement and open stent graft. After recovering well, the patient was ambulatory upon discharge from the hospital. The combination of plain head CT, CTP, and helical CT scan from the neck to abdomen enabled us to evaluate for stroke and aortic dissection within a short amount of time, allowing for early therapeutic intervention.Conclusions: When acute stroke is suspected due to neurological deficits, plain head CT is the first choice for imaging diagnosis. The addition of cervical CT angiography can reliably exclude stroke due to aortic dissection. CTP can identify ischemic penumbra, which cannot be diagnosed by plain head CT or diffusion-weighted magnetic resonance imaging. These combined stroke CT protocols helped us avoid missing an aortic dissection. [ABSTRACT FROM AUTHOR]

Objective: To explore the correlation between serum advanced glycosylation end products (AGEs) and soluble phase glycosylation end product receptors (sRAGE) and hemorrhagic transformation after acute cerebral infarction. Methods: A total of 131 patients with acute cerebral infarction diagnosed and treated in our hospital from January 2017 to December 2019 were included in the study. They were divided into HT group and NHT group according to whether hemorrhagic transformation occurred. The AGEs, sRAGE and other related laboratory indicators, using multi-factor Logistic regression model to analyze the factors affecting hemorrhagic transformation of acute cerebral infarction, and Pearson correlation model to analyze the correlation between serum AGEs and sRAGE. Results: The proportion of patients with HT group combined with diabetes history, atrial fibrillation history, cerebral embolism ratio, infarct size, the proportion of anticoagulant therapy and serum levels of IL-1β, TNF-α, and AGEs were significantly higher than those of NHT group (all P＜0.05). There were no significant differences in age, gender and other general data of the two groups of patients and laboratory indicators such as PLT and TC (both P>0.05); multivariate logistic regression analysis showed large infarct size, high IL-1β, TNF-α and AGEs Level is a protective factor for hemorrhagic conversion after acute cerebral infarction (OR=0.625, 0.832, 0.874, 0.708; all P<0.05), while no anticoagulation therapy and high sRAGE are hemorrhagic conversion after acute cerebral infarction Risk factors (OR=10.901, 1.004; all P<0.05); correlation analysis showed that serum sRAGE levels were significantly negatively correlated with AGEs, IL-1β and TNF-α levels (ρ=-0.852, -0.828, -0.826; Both P<0.05). Conclusion: Serum AGEs is a risk factor for hemorrhagic conversion in patients with acute cerebral infarction, and sRAGE is a protective factor. sRAGE may inhibit the combination of RAGE and AGEs, thereby reducing the release of inflammatory mediators, vascular damage, and the risk of HT. [ABSTRACT FROM AUTHOR]

Objective: To observe the curative effect of acute cerebral infarction (ACI) combined with Ginkgo biloba extract injection on the basis of thrombolytic therapy, and to analyze the effect of the treatment on inflammatory factors and hemorheology. Methods: 60 patients with ACI who were admitted to our hospital from June 2019 to October 2020 were selected, they were divided into control group (n=30, intravenous thrombolytic therapy with alteplase) and observation group (n=30, intravenous thrombolytic therapy with Ginkgo biloba extract injection combined with alteplase) according to the parity order of admission. The course of treatment was 7 d. The curative effects of the two groups were compared 7 d after treatment, hemorheology, national Institutes of health Stroke Scale (NIHSS), inflammatory factors and activities of daily living scale (ADL) scores before and 7d after treatment were compared between the two groups, the incidence of adverse reactions in the two groups were observed. Results: The total effective rate of the observation group was higher than that of the control group (P<0.05). 7 d after treatment, NIHSS score of observation group was lower than that of control group, ADL score of observation group was higher than that of control group (P<0.05). 7 d after treatment, the levels of high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) in the observation group were lower than those in the control group (P<0.05). 7 d after treatment, the hematocrit, platelet distribution width and fibrinogen in the observation group were lower than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Ginkgo biloba extract injection combined with alteplase intravenous thrombolytic therapy in patients with ACI has clear curative effect, can improve hemorheology, reduce nerve function damage, reduce the level of inflammatory factors, improve the self-care ability of patients with good safety. [ABSTRACT FROM AUTHOR]

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Background: This study was to examine the patients with acute cerebral infarction (ACI) treated at a single center over 9 years and who underwent Unruptured intracranial aneurysm (UIA) screening by three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), and to explore the factors associated with outcomes. Methods: The outcome was the modified Rankin scale (mRS) score at 90 days after stroke onset. The outcome was classified into a good outcome (mRS score of 0–2 points) and poor outcome (mRS score of 3–6 points). Results: UIAs were found in 260 (6.5%) of 4,033 patients with ACI; 2,543 (63.1%) had a good outcome, and 1,490 (36.9%) had a poor outcome. There was no difference in outcomes between the two groups (P = 0.785). The multivariable analysis showed that age (OR = 1.009, 95%CI: 1.003–1.014, P = 0.003), diabetes (OR = 1.179, 95%CI: 1.035–1.342, P = 0.013), ischemic stroke history (OR = 1.451, 95%CI: 1.256–1.677, P < 0.001), and baseline NIHSS score (OR = 1.034, 95%CI: 1.018–1.050, P < 0.001) were independently associated with the 90-day outcomes in patients with ACI. The presence of incidental UIA was not associated with outcomes after ACI. Conclusions: Age, diabetes, ischemic stroke history, and baseline NIHSS score were independently associated with the early outcomes of patients with ACI. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of Xingxiong sodium chloride injection combined with edaravone on neurological function, cerebral blood perfusion and oxidative stress in patients with acute cerebral infarction (ACI). Methods: 120 patients with ACI who were admitted to our hospital from January 2018 to July 2019 were randomly divided into two groups, all of which were given conventional neurology treatment. The control group (60 cases) received edaravone intravenous infusion for 2 weeks on the basis of conventional treatment, and the observation group (60 cases) received Xingxiong sodium chloride injection for 2 weeks on the basis of the control group. The clinical efficacy and safety of the two groups were observed, and the differences in neurological functions, cognitive functions, handicapped degree, cerebral blood perfusion, and oxidative stress levels before and after treatment were compared. Results: The total effective rate in the observation group were higher than that in the control group (P<0.05). After treatment, National Institute of Health stoke scale (NIHSS), Modified RANKIN scale (MRS) scores, mean transit time (MTT), time to peak (TTP), serum malondialdehyde (MDA) and advanced oxidation protein products (AOPP) in the observation group were lower than those in the control group (P<0.05), and Mini-Mental State Examination (MMSE) score, cerebral blood flow(CBF), cerebral blood volume (CBV), serum uperoxide distamuse (SOD), glutathione peroxidase (GSH-Px) and total anti-oxidation capacity (T-AOC) were higher than those in the control group (P<0.05). There was no statistically significant difference in adverse reaction rates between the two groups (P>0.05). Conclusions: Xingxiong sodium chloride injection combined with edaravone can effectively improve the neurological function of patients with ACI, it can increase cerebral blood perfusion in ischemic areas, improve the oxidative stress, and it can improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Abnormal expression of miR‐409‐3p has been found in several neurodevelopmental disorders, but whether it is dysregulated in the patients with acute cerebral infarction (ACI) has not been evaluated. The current study mainly focused on the clinical significance and the underlying mechanism of plasma miR‐409‐3p in the progression of ACI. The level of plasma miR‐409‐3p was determined in ACI patients (n = 80) and healthy controls (n = 30). Pearson correlation assay was performed to evaluate the association and cardiovascular risk factors. A receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of plasma miR‐409‐3p levels in patients with ACI. Dual luciferase reporter assay and western blot were performed to determine the possible target gene of miR‐409‐3p. Our data showed that the expression of plasma miR‐409‐3p in the ACI group was higher than that in the healthy controls. Furthermore, Pearson correlation analysis indicated a positive correlation between plasma miR‐409‐3p and the NIHSS score. ROC analysis indicated that plasma miR‐409‐3p could differentiate plasma miR‐409‐3p in ACI patients from healthy controls. Then, we explored the possible target genes of miR‐409‐3p. Interestingly, C1q and TNF‐related 3 (CTRP3), a novel adipose tissue‐derived secreted factor, was found to be a target gene of miR‐409‐3p. We found that knockdown of CTRP3 significantly induced PC12 cell apoptosis, even in PC12 cells transfected with miR‐409‐3p inhibitor. These data suggested that miR‐409‐3p induced PC12 cell apoptosis by targeting CTRP3. Altogether, elevated plasma miR‐409‐3p is correlated with disease severity and may be efficient for the early diagnosis of ACI. [ABSTRACT FROM AUTHOR]

Objective To investigate the changes of serum ubiquitin C-terminal hydrolase-L1（UCH-L1）and Fibulin- 5 in patients with acute cerebral infarction（ACI）and clinical significance. Methods Totally 138 ACI patients（ACI group）and 100 outpatients（control group）were detected. The clinical outcome 90 days after onset of ACI was assessed by modified Rankin scale（mRS). Serum UCH-L1 and Fibulin-5 levels were detected by double-antibody sandwich chemiluminescence assay. Pearson correlation analyzed the relation between UCH-L1，Fibulin-5 and infarct size，National Institutes of Health Stroke Scale（NIHSS）score，Mini-Mental State Examination（MMSE), and mRS score. Univariate and multivariate Logistic regression were used to analyze the relationship between UCH-L1，Fibulin-5 and adverse clinical outcomes in ACI patients. Receiver operating characteristic（ROC）curve was used to analyze the value of UCH-L1 and Fibulin- 5 in predicting adverse clinical outcomes in ACI patients. Results The levels of serum UCH-L1 and Fibulin-5 in the ACI group were higher than those in the control group（both P<0. 05). The levels of serum UCH-L1 and Fibulin-5 increased with the increase of infarct area and the severity of neurological deficit degree（both P<0. 05). The level of serum UCH-L1 in the group with abnormal cognitive function was higher than that in the normal group（P<0. 05). The levels of UCH-L1 and Fibulin-5 in the group with poor clinical outcome were higher than those in the group with good clinical outcome（ both P<0. 05). The results of correlation analysis showed that the levels of serum UCH-L1 and Fibulin-5 were positively correlated with infarct area，NIHSS score and mRs score（r=0. 513，0. 416，0. 591；0. 526，0. 492，0. 601；both P <0. 05), and serum UCH-L1 was negatively correlated with MMSE score（r=-0. 506，P<0. 05). Multivariate Logistic regression analysis showed that infarct area，NHISS score，UCH-L1，Fibulin-5 levels were all independently related to the poor clinical outcome of ACI（all P<0. 05). ROC analysis showed that the area under the curve（AUC）of UCH-L1，Fibulin- 5，and combined UCH-L1 + Fibulin-5 in predicting poor clinical outcome of ACI was 0. 860，0. 741，and 0. 947，respectively. Conclusions The levels of serum UCH-L1 and Fibulin-5 increase in patients with ACI，and they are related to the infarct area，neurological deficit degree and clinical outcome. The level of UCH-L1 is related to the cognitive impairment. UCH-L1 and Fibulin-5 can be used as predictive indicators of poor clinical outcomes in patients with ACI. [ABSTRACT FROM AUTHOR]

Background: Acute cerebral infarction is a clinically common and critical disease which seriously endangers the life and safety of elderly patients. Evidence-based nursing is an effective way of nursing and has great significance in improving the neurological function and quality of life of patients. In China, evidence-based nursing has been highlighted and highly developed in recent decades. Objectives: This research aimed to investigate the effect of evidence-based nursing on the recovery of neurological function and serum inflammatory cytokines in patients with acute cerebral infarction. Methods: A total of 116 patients with acute cerebral infarction were randomly divided into two groups: the control group patients (n = 58) received conventional nursing, while the intervention group patients (n = 58) received evidence-based nursing intervention. National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA) and activities of daily living (ADL) scores, as well as serum TNF-α and IL-6 levels were evaluated and compared between the two groups. Results: NIHSS scores in the intervention group were significantly lower than the control group. FMA and ADL scores in the intervention group were significantly higher than the control group. TNF-α and IL-6 levels in the serum of the intervention group were significantly lower than the control group. Conclusions: In conclusion, evidence-based nursing has a positive effect on the treatment of patients with acute cerebral infarction, which decreases the level of serum inflammatory cytokines and contributes to the recovery of neurological function, motor function and activities of daily living. [ABSTRACT FROM AUTHOR]