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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. [ABSTRACT FROM AUTHOR]

This investigation aimed to elucidate the application impact of prehospital-hospital integrated emergency nursing in individuals with acute cerebral infarction (ACI). Data of 230 ACI patients admitted to our hospital from May 2021 to July 2022 were retrospectively analyzed and divided into A and B groups (AG and BG) according to different nursing methods. The inter-group comparison of the treatment time (time for physician arrival, time for completion of examination, time between admission and thrombolytic therapy, length of stay in emergency) was compared. The success rate of thrombolysis, the inter-group comparison levels of coagulation function indexes [D-dimer (D-D) and fibrinogen (Fbg)], the national Institutes of Health Stroke Scale (NIHSS) score, the Barthel score, family members' self-rating anxiety scale (SAS) score, family members' self-rating depression scale (SDS) score, family satisfaction and adverse reactions were compared between the two groups. The treatment time were reduced in the BG than in the AG (all P < 0.05). The BG had a higher success rate of thrombolysis than the AG (P < 0.05). After the therapy, the D-D level in BG group was higher than that in AG group, and Fbg was lower than that in AG group (both P < 0.05). After nursing, BG's NIHSS score was increased compared with the AG; MBI was reduced (P < 0.05); the SAS and SDS scores of the family members were also reduced (both P < 0.05). The total family satisfaction of the BG (100.00%) was greater than the AG (89.00%) (P < 0.05). The application of prehospital-hospital integrated emergency nursing in ACI patients works effectively. [ABSTRACT FROM AUTHOR]

Objective Develop a clinical decision support system (CDSS) for the diagnosis coding of acute cerebral infarction, and evaluate whether it can play a positive role on improving the accuracy of disease coding in specific clinical application environment. Methods Based on the Chinese ischemic stroke sub-classification, a CDSS for international classification of diseases (ICD)-10 clinical modification was developed by establishing a knowledge base for diagnosis, etiology, pathogenesis, responsible vessels, and ICD-11. The primary diagnosis coding of patients with acute cerebral infarction (I63), who were hospitalized at Beijing Tiantan Hospital, Capital Medical University before applying the CDSS (January to June 2017), was retrospectively included as the control group. Conversely, the primary diagnosis coding of patients with acute cerebral infarction admitted after the application of the CDSS (January to June 2023) was included as the intervention group. This study compared the diagnosis coding between the two groups to reflect the biaxial classification of acute cerebral infarction etiology and responsible vessels, thereby evaluating the effect of the CDSS on coding accuracy. Results This study developed the diagnosis coding CDSS for acute cerebral infarction, which was integrated into the electronic medical record system and was applied by clinicians of their own choice. A total of 1847 hospitalized patients with acute cerebral infarction were included in the validation process, including 849 in the control group and 998 in the intervention group. The rate of biaxial classification of etiology and responsible vessels in I63 diagnosis coding in the intervention group was higher than that in the control group (93.99% vs. 9.42%, P<0.001). Conclusions The CDSS for acute cerebral infarction diagnosis coding is a new coding model that integrates clinical practice with ICD-10 classification rules, which is more accurate than traditional coding methods. At the same time, CDSS provides a coding self-learning tool for clinicians, and it also provides help in obtaining quality control data for disease diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Mechanical thrombectomy (MT) is standard of care for acute cerebral infarction (ACI) due to large vessel occlusions. However, its clinical efficacy in patients with ACI due to distal medium vessel occlusions (DMVOs) remains unclear. This study evaluates the efficacy and safety of MT in patients with ACI due to DMVOs. Methods: Totally, 306 patients with ACI at a very early stage were assigned into DMVOs‐MT, M1‐MT, and DMVOs‐intravenous thrombolysis (IVT) groups. These groups were compared regarding baseline data, recanalization rate, location of vessel occlusions, number of thrombectomy, first‐pass recanalization, mRS scores, NIHSS scores, 90‐day mRS scores, incidence of adverse events, and mortality. Risk factors for poor prognosis of patients with DMVOs following MT were analyzed. Results: DMVOs‐MT and M1‐MT groups showed comparable first‐pass recanalization rates, recanalization rates, and NIHSS score reduction ratios, with marked differences in location of vessel occlusions. Versus DMVOs‐IVT, DMVOs‐MT had increased differences between pre‐ and post‐treatment NIHSS scores and between pre‐treatment NIHSS scores and NIHSS scores at discharge and elevated NIHSS reduction ratios. The poor prognosis rate of DMVOs‐MT group was insignificantly different from that of M1‐MT group but lower than that of DMVOs‐IVT group. Adverse events and mortality incidences were comparable among the three groups. Diabetes, first‐pass recanalization, and pre‐treatment NIHSS scores were independent risk factors for poor prognosis in DMVO patients after MT. Conclusion: MT is as effective and safe in patients with DMVOs as in patients with M1 occlusions. In patients with DMVOs, MT has higher efficacy and safety than IVT. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the effect of resveratrol on neuronal damage in rats with acute cerebral infarction (ACI) by regulating the high-mobility group protein B1 (HMGB1) /Toll-like receptor 4 (TLR4) / nuclear factor-κB (NF-κB) signaling pathway. Methods Rats were randomly separated into blank group, infarction group, resveratrol group, HMGB1 activator (recombinant rat HMGB1 protein, rRHMGB1) group, and resveratrol+ rRHMGB1 group, with 18 rats in each group. Except for the blank group, rats in all other groups were used to construct ACI models using the method of middle cerebral artery occlusion. Drug treatment began at 1 hour after successful modeling, once a day, for 7 days. Changes in neurological impairment score and cerebral infarction volume coefficient were detected. ELISA was applied to detect levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6 in infarction region of brain tissue. Nissl staining was applied to detect the number of surviving neurons in infarction region of brain tissues. TUNEL staining was applied to detect neuronal apoptosis in infarction region of brain tissue. Western Blot was applied to detect Bcl2 associated X protein (Bax), TLR4, Cleaved Caspase-3, HMGB1, and p-NF-κB p65 protein in brain tissue. Results Compared with the blank group, the neurological damage score, cerebral infarction volume coefficient, levels of TNF- α, IL-1β, IL-6 in the infarction region of brain tissue, neuronal apoptosis rate, Bax, TLR4, Cleaved Caspase-3, HMGB1, p-NF- κB p65 protein increased in the infarction group, while the number of surviving neurons in the infarction region of brain tissue decreased (P＜0.05). Compared with the infarction group, the neurological damage score, cerebral infarction volume coefficient, levels of TNF-α, IL-1β, IL-6 in the infarction region of brain tissue, neuronal apoptosis rate, and protein expression of Bax, TLR4, Cleaved Caspase-3, HMGB1, p-NF- κB p65 decreased in resveratrol group and resveratrol+rRHMGB1 group, the number of surviving neurons in the infarction region of brain tissue increased (P＜0.05). Change of the corresponding indicators in the rRHMGB1 group was opposite to that in the resveratrol group (P＜0.05). Compared with the resveratrol group, the neurological damage score, cerebral infarction volume coefficient, levels of TNF-α, IL-1β, IL-6 in the infarction region of brain tissue, neuronal apoptosis rate, the protein expression of Bax, TLR4, Cleaved Caspase-3, HMGB1, p-NF-κB p65 increased in the resveratrol+rRHMGB1 group, the number of surviving neurons in the infarction region of brain tissue decreased (P＜0.05). Conclusion The mechanism by which resveratrol improves neuronal damage in ACI rats may be related to the inhibition of the HMGB1/TLR4/NF-κB signaling pathway. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to explore the clinical application of diterpene ginkgolides meglumine combined with edaravone dextracanthol and butylphthalide injection in treating acute cerebral infarction with beyond thrombolytic time window. Methods: The clinical data of 120 patients with acute cerebral infarction with beyond thrombolytic time window admitted to the Department of Neurology in Affiliated Hospital of Jiangnan University were retrospectively analyzed, and the patients were divided into control group and study group. The control group (60 cases) was treated with edaravone dextracanthol and butylphthalide injection, and the study group (60 cases) was added with diterpene ginkgolides meglumine. The hemorheology indexes, the peripheral blood inflammatory factors, neurological function (NIHSS score), daily living ability (MBI score). Results: After 10 days of treatment, the hematocrit, plasma viscosity and whole blood high shear viscosity decreased in both groups, and the decrease in the study group was greater than that in the control group (P<0.05). The levels of IL-6, CRP and NSE in both groups were also the same as above. The scores of NIHSS decreased in both groups after treatment. The rate of good prognosis was the same between the two groups 10 days after treatment (P>0.05), but the rate of good prognosis in the study group was higher than that in the control group at the 30th day after treatment (P<0.05). Conclusion: Diterpene ginkgolides meglumine combined with edaravone dextracanthol and butylphthalide injection has a good effect in the treatment of acute cerebral infarction with beyond thrombolytic time window, and has fewer adverse reactions. [ABSTRACT FROM AUTHOR]

Objective: To study Analysis of the expression of serum Low density lipoprotein (LDL), homocysteine (Hey) and lipid in acute cerebral infarction and their relationship with the severity and prognosis. Methods: 85 patients with acute cerebral infarction treated in our hospital from January 2021 to January 2023 were selected as the study object and set as the case group, and 80 healthy patients in our hospital during the same period were selected as the control group. The changes of serum LDL, Hey, total cholesterol (TC), triglyceride (TG) and high density lipoprotein cholesterol (HDL-L) were analyzed and the correlation with the severity and prognosis of the disease was analyzed. Results: Serum levels of LDL, Hcy, TC and TG in case group were significantly higher than those in control group, while HDL-L level was significantly lower than that in control group, with significant differences (P<0.05); Serum LDL, Hсу, TC and TG levels in mild patients were significantly lower than those in moderate and severe patients, and HDL-L levels were significantly higher than those in moderate and severe patients, serum LDL, Hey, TC and TG levels in moderate patients were significantly lower than those in severe patients, and HDL-L levels were significantly higher than those in severe patients (P<0.05). Serum levels of LDL, Hey, TC and TG in good prognosis group were significantly lower than those in poor prognosis group, and HDL-L level was significantly higher than that in poor prognosis group, the difference was significant (p<0.05). The severity of the disease and the prognosis were taken as dependent variables, and serum LDL, Hcy and blood lipid were taken as independent variables, respectively. The correlation analysis results showed that serum LDL, Hcy, TC and TG levels were positively correlated with the severity of the disease and the prognosis, while HDL-L levels were negatively correlated with the severity of the disease and the prognosis (P<0.05). Conclusion: There is a close relationship between the expression of serum LDL, Hey and lipid in patients with acute cerebral infarction and the severity and prognosis of the disease, which can promote the progression of the disease. This study also provides a new idea for the treatment of acute cerebral infarction with targeted drugs, and has high clinical application value. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effects of probucol combined with atorvastatin calcium in the treatment of acute cerebral infarction (ACI), with the aim of providing a therapeutic reference for ACI. Methods Data of ACI patients hospitalized within 24 h of symptom onset at Chongqing Emergency Medical Center from January 2018 to September 2023 were retrospectively collected. Patients included in the study met specific criteria, which included receiving lipid-regulating therapy with atorvastatin calcium (20 mg, qn) monotherapy or combined with probucol (0.5 mg, bid) for a treatment duration exceeding 3 months. Patients were divided into the combined treatment group and the control group according to whether probucol was combined or not. The study compared differences in neurological function (measured by the NIHSS), neurological outcome (measured by the mRS), life ability [measured by the Barthel index], and lipid levels (including TC, TG, HDL-C and LDL-C) between the two groups. Results A total of 102 patients were enrolled in the study, including 56 in the combined treatment group and 46 in the control group. There was no statistically significant difference in baseline data between the two groups. The NIHSS scores and lipid levels in both groups at 14 days posttreatment, as well as the lipid levels after 3 months of treatment, showed significant improvement compared to baseline controls (P<0.001). After 14 days of treatment, the NIHSS score (P=0.031), TC (P=0.005) and LDL-C (P=0.044) levels of the combined treatment group were lower than those of the control group, while the Barthel index score (P=0.004) was higher than that of the control group. The difference was statistically significant. After 3 months of treatment, the mRS score (P<0.001), TC (P<0.001), TG (P=0.002) and LDL-C (P<0.001) levels of the combined treatment group were lower than those of the control group, while the Barthel index score (P<0.001) was higher than that of the control group. The difference was statistically significant. The recurrence rate of cerebral infarction during the 3 months follow-up period was 0 in the combined treatment group and 2.17% in the control group. The difference was not statistically significant (P= 0.268). Conclusions The combination of probucol and atorvastatin calcium in treating patients in the acute phase of ACI demonstrated superior clinical efficacy compared to atorvastatin calcium alone. This combination effectively reduced lipid levels and improved neurological function and ability to live. [ABSTRACT FROM AUTHOR]

Objective: To analyze the psychological status of patients with acute cerebral infarction (ACI), and to evaluate the effect of positive psychological intervention on the treatment and prognosis of ACI. Methods: This was retrospective study. Eighty patients with ACI admitted to Institute of Psychology, Chinese Academy of Sciences from January 2021 to September 2022 were included and randomly divided into observation group (n=40) and control group(n=40). Patients in the control group received conventional treatment and routine care, while those in the observation group received positive psychological intervention based on the control group. Adverse psychological scores, treatment and prognosis, and quality of life as well as nursing satisfaction etc. were analyzed and compared between the two groups. Results: Both groups showed a significant decrease in SDS and SAS scores at three months after the intervention compared with the pre-intervention period, with a statistically significant difference(P<0.05). After the intervention, the NIHSS score of both groups decreased, with a statistically significant difference(P<0.05). The FMAS and MBI scores increased in both groups compared with those before the intervention, with a statistically significant difference(P<0.05). The SS-QOL scores of both groups were significantly improved compared with before the intervention, with a statistically significant difference(P<0.05). The hospital satisfaction rate in the observation group was significantly higher than that in the control group, with a statistically significant difference (t=12.325, P=0.000). Conclusion: Positive psychological intervention offers a variety of benefits in the treatment of patients with ACI, such as may alleviate anxiety and depression, reduce neurological deficits, improving quality of life and motor function, and ameliorate the prognosis of patients. [ABSTRACT FROM AUTHOR]

Wensheng Zhang,1,2,&ast; Weifang Xing,1,&ast; Jiyun Feng,3,&ast; Yangchun Wen,1 Xiaojing Zhong,1 Li Ling,2,4 Jinzhao He1,5 1Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Heyuan, People’s Republic of China; 2Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, People’s Republic of China; 3Department of Neurology, Lianzhou People’s Hospital, Lianzhou, People’s Republic of China; 4The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China; 5Heyuan Key Laboratory of Molecular Diagnosis & Disease Prevention and Treatment, Doctors Station of Guangdong Province, Heyuan People’s Hospital, Heyuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinzhao He, Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital, No. 733 Wenxiang Road, Yuancheng District, Heyuan City, Guangdong Province, 517000, People’s Republic of China, Email hejinzhao2019@163.com Li Ling, Department of Neurology, Shenzhen Hospital, Southern Medical University, The Third School of Clinical Medicine, Southern Medical University, 1333 Xinhu Road, Bao’an District, Shenzhen, Guangdong Province, 518101, People’s Republic of China, Email linglirabbit@163.comBackground: Cerebral hernia is a serious complication after thrombectomy in patients with acute ischemic stroke (AIS). This study aims to explore the predictive value of emergency preoperative plasma D-dimer levels in cerebral herniation after successful thrombectomy.Methods: Between January 2019 and December 2023, patients with AIS who received a successful thrombectomy in our single comprehensive stroke center were retrospectively enrolled. We conducted a statistical analysis on the data using SPSS 26.0. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of D-dimer level for cerebral herniation.Results: Among 278 enrolled patients, 20 cases (7.19%) experienced cerebral herniation. In patients with cerebral hernia, the score of the National Institutes of Health Stroke Scale was higher (16.5 vs 12.0, P < 0.001), the Alberta Stroke Plan early CT score was lower (6.5 vs 8.0, P < 0.001), the score of collateral circulation was lower (2.0 vs 3.0, P < 0.001), the proportion of eTICI blood flow grading of 3 of the occluded vessel was less (35% vs 75.19%), the proportion of pathogenesis of large atherosclerosis was less (5.00% vs 46.51%, P < 0.001), and the level of plasma D-dimer was higher (2.61 vs 0.82). After adjusting for potential confounders, the level of D-dimer (adjusted OR = 1.131, 95% CI 1.022– 1.250, P = 0.017) was significantly correlated with cerebral hernia. Based on the ROC curve, the sensitivity and specificity of D-dimer in predicting cerebral herniation were 75.0% and 73.3%, respectively, and the area under the curve was 0.766.Conclusion: Although our study had certain limitations, we found that elevated emergency preoperative plasma D-dimer level is an independent predictive factor for the cerebral herniation after successful thrombectomy in patients with AIS, which is of great clinical significance.Keywords: plasma D-dimer, acute cerebral infarction, thrombectomy, cerebral herniation

Abstract Objectives The aim of this study was to develop machine learning-based models for predicting acute cerebral infarction (ACI) in patients. Methods We extracted the data of ACI patients and non-ACI patients (as control) from two hospitals. The Lasso algorithm was employed to select the most crucial features associated with ACI. Five machine learning algorithms-based models were trained, which was performed with 10-fold cross-validation. Then, the area under the receiver operating characteristic curve (AUC), accuracy, and F1-score were calculated in the training models. Accordingly, the training models with excellent performance was selected as the final predictive model. The relative importance of variables was analyzed and ranked. Results A total of 150 patients were diagnosed with ACI (50.00%), with a higher proportion of males (70.67% vs. 44.00%) compared to the non-ACI patients. The logistic regression model exhibited a good performance in predicting ACI in the training set, as evidenced by its highest AUC, accuracy, sensitivity, and F1-score. Furthermore, feature importance analysis showed that blood glucose, gender, smoking history, serum homocysteine, folic acid, and C-reactive protein were the top six crucial variables of the logistic regression. Conclusions In our work, the ACI risk prediction model developed by the logistic regression exhibited excellent performance. This could contribute to the identification of risk variables for ACI patients and enables clinicians timely and effective interventions.

Hemichorea-hemiballismus caused by cerebrovascular disease has been reported in many literatures, but it is rare in clinic. It is necessary to enhance the vigilance of clinicians. Based on the intravenous thrombolytic therapy, a comprehensive nursing plan including vital signs monitoring, safe protection, and prevention of fall and disease recurrence should be carried out to improve the curative effect and prognosis of such patients. (脑血管病致偏侧舞蹈症临床少见, 若诊治不当可能延误治疗, 加重病情。急性脑梗死并发偏侧舞蹈除静脉溶栓治疗外, 还应密切观察患者生命体征, 做好安全防护, 防止跌倒、疾病复发等不良事件。)

Acute cerebral infarction (ACI) is a lethal disease whose early diagnosis is critical for treatment. microRNA (miR)-19a targets CC chemokine ligand 20 (CCL20) in myocardial infarction. We investigated the expression patterns of serum miR-19a and CCL20 of ACI patients and assessed their clinical values. Serum samples of 50 healthy subjects and110 ACI patients were collected. Serum levels of miR-19a, CCL20 mRNA, and biochemical indexes were assessed. miR-19a downstream target gene and the binding relationship between miR-19a and CCL20 were predicted and verified. miR-19a and CCL20 mRNA were subjected to correlation and diagnostic efficiency analysis. miR-19a was poorly expressed in the serum of ACI patients, especially in patients with unstable plaque and large infarction. tumor necrosis factor-α, low-density lipoprotein, and platelet/lymphocyte ratio negatively correlated with serum miR-19a level and positively correlated with CCL20. Dual-luciferase assay revealed that miR-19a could negatively regulate CCL20 expression. CCL20 was highly expressed in the serum of ACI patients. The area under receiver-operating characteristic curve of miR-19a combined with CCL20 was 0.9741 (98.00% specificity, 90.91% sensitivity), higher than their single diagnosis. Collectively, miR-19a had high diagnostic value for ACI and could target to restrain CCL20. The combination of miR-19a and CCL20 improved diagnostic value for ACI.

Objective: To investigate the application value of dual-source CT cerebral perfusion imaging combined with serum ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) and lipoprotein-associated phospholipase A2(Lp-PLA2) in the diagnosis and poor prognosis prediction of patients with acute cerebral infarction (ACI). Methods: 151 ACI patients admitted to Hulunbuir People's Hospital from February 2021 to March 2023 were selected as ACI group and 109 healthy volunteers as control group. According to the National Institutes of Health Stroke Scale (NIHSS), ACI patients were divided into mild group (52 cases), moderate group (53 cases), severe group (46 cases); and according to the Modified Rankin Score Scale (mRS), ACI patients were divided into poor prognosis group (37 cases) and good prognosis group (114 cases). All subjects were underwent dual-source CT cerebral perfusion imaging to obtain relevant parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP), and serum UCH-L1 and Lp-PLA2 levels were detected. The value of dual-source CT cerebral perfusion imaging parameters combine with serum UCH-L1 and Lp-PLA2 in the diagnosis of ACI and predicted the prognosis of ACI patients were analyzed by receiver operating characteristic (ROC) curve. Results: CBF and CBV in ACI group were lower than those in control group(P<0.05), MTT and TTP in ACI group were longer than those in control group (P < 0.05) serum UCH-L1 and Lp-PLA2 levels in ACI group were higher than those in con- trol group (P < 0.05) CBF and CBV in severe group were lower than those in moderate group and mild group(P<0.05), MTT and TTP in severe group were longer than those in moderate group and mild group(P<0.05), and serum UCH-L1 and Lp-PLA2 levels in severe group were higher than those in moderate group and mild group (P < 0.05) CBF and CBV in moderate group were lower than those in mild group (P < 0.05) MTT and TTP in moderate group were longer than those in mild group(P<0.05), and serum UCH-L1 and Lp-PLA2 levels in moderate group were higher than those in mild group (P < 0.05) . CBF and CBV in poor prognosis group were lower than those in good prognosis group (P < 0.05) MTT and TTP in poor prognosis group were longer than those in good prognosis group (P < 0.05) and serum UCH-L1 and Lp-PLA2 levels in poor prognosis group were higher than those in good prognosis group (P < 0.05) ROC curve analysis showed that: the area under the curve of combine dual-source CT cerebral perfusion imaging parameters and serum UCH-L1 and Lp-PLA2 in the diagnosis of ACI and the prediction of poor prognosis of ACI were 0.898 and 0.892, respectively, which were higher than those of single index diagnosis and prediction. Conclusion: In ACI patients, dual-source CT cerebral perfusion imaging parameters CBF and CBV decrease, MTT and TTP prolonged, serum UCH-L1 and Lp-PLA2 levels increase, which are relate to the aggravation of ACI nerve defect and poor prognosis. The combination of dual-source CT cerebral perfusion imaging parameters and serum UCH-L1 and Lp-pLA2 has high value in the diagnosis and prognosis analysis of ACI. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the clinical features of Trousseau syndrome (TS)-related cerebral infarction and determine predictors of early neurological deterioration (END). Methods: A retrospective study was conducted on patients with TS-related cerebral infarction admitted to the Zhongshan Hospital Affiliated with Xiamen University, from December 2015 to December 2023. Patients were categorized into groups with and without END. The laboratory findings and imaging data were compared, and receiver operating characteristic (ROC) curves were constructed to determine the best predictors of END. Results: The study included 30 patients with TS-related cerebral infarction, comprising 17 males and 13 females with an average age of 70.93 ± 8.7 years. Five patients experienced END. Lung cancer was the most common primary malignancy (n=13, 43.33%), with most patients (n=22, 73.33%) having stage IV disease with extensive metastasis. The primary neurological symptom was hemiplegia (n=17, 56.67%). The mean NIHSS score at admission was 9.33 ± 5.83. Imaging revealed varying stages of cerebral infarction in 10 patients (38.46%). Within three months, 25 patients (83.33%) died, 8 of whom (32%) succumbed to tumor-related complications. The incidence of END in TS-related cerebral infarction patients was 16.67% (5/30). Patients in the END group had significantly greater D-dimer levels and lower fibrinogen (Fib) levels upon admission (P < 0.001, P = 0.042). Comparisons of ROC curves revealed that D-dimer (AUC 0.916, optimal cutoff 17.86, sensitivity 1.000, specificity 0.840) and Fib (AUC 0.788, optimal cutoff 2.54, sensitivity 1.000, specificity 0.740) significantly predicted END (P = 0.004, P = 0.045). The combined use of these markers improved the AUC to 0.952, with a sensitivity of 1.00 and specificity of 0.920, surpassing those of the individual markers (P = 0.002). Conclusion: TS-related cerebral infarction most commonly occurs in patients with advanced-stage lung cancer with widespread metastasis and is associated with poor long-term prognosis. Elevated D-dimer and decreased fibrinogen levels are significant predictors of END in patients with TS-related cerebral infarction. [ABSTRACT FROM AUTHOR]

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 (PNIHSS < .001, PADL < .001, PHcy = .001). Multiple logistic regression analysis showed that high Hcy levels, NIHSS scores, and ADL scores were independent risk factors for PSD (PHcy =.038, PNIHSS =.002, PADL < .001). The receiver operating characteristic (ROC) curve showed that areas under curve (AUC) = 0.894, standard errora = 0.025, progressive significanceb <.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. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the efficacy of beraprost sodium combined with agatroban in the treatment of patients with acute cerebral infarction (ACI) and its effects on cognitive function and serum inflammatory factors. METHODS: From Dec. 2022 to Nov. 2023, a total of 126 patients with ACI admitted into the hospital were extracted to be divided into the combined treatment group and agatroban group via the random number table method, with 63 cases in each group. The agatroban group was treated with routine symptomatic therapy and agatroban, while the combined treatment group received beraprost sodium on the basis of agatroban group. The clinical efficacy and adverse drug reactions of two groups were recorded, and the cognitive function, levels of inflammatory factors, oxidative stress indicators, and cerebral hemodynamic indicators were compared between two groups. RESULTS: The total clinical effective rate of the combined treatment group was 88. 89%(56/63), significantly higher than 74. 60% (47/63) in the agatroban group, with statistically significant difference (P < 0. 05). After treatment, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) scores in both groups increased, and the scores MoCA and MMSE in the combined treatment group were significantly higher than those in the agatroban group, with statistically significant difference ( P < 0. 05). After treatment, the levels of tumor necrosis factor-ɑ ( TNF-ɑ), interleukin-1β (IL-1β), interleukin-6 (IL-6), and C-reactive protein (CRP) in both groups decreased, and the levels of TNF-ɑ, IL-1β, IL-6 and CRP in the combined treatment group were significantly lower than those in the agatroban group, with statistically significant difference (P <0. 05). After treatment, the levels of malondialdehyde (MDA) in both groups decreased, while the levels of superoxide dismutase (SOD), total antioxidant capacity (T-AOC) and glutathione peroxidase (GSH-Px) increased significantly, the MDA level in the combined treatment group was significantly lower than that in the agatroban group, while the levels of SOD, T-AOC, and GSH-Px were significantly higher than those in the agatroban group, with statistically significant differences (P < 0. 05). After treatment, the mean velocity of blood flow (Vmean) and mean blood flow (Qmean) of two groups increased significantly, while the vascular resistance (Rv) and characteristic impedance of cerebrovascular net (Zcv) decreased significantly; compared with agatroban group, Vmean and Qmean increased more significantly, Rv and Zcv decreased more significantly in the combined treatment group, with statistically significant differences (P < 0. 05). There was no statistically significant difference in the total incidence of adverse drug reactions between two groups (P>0. 05). CONCLUSIONS: Ceraprost sodium combined with agatroban in the treatment of patients with acute cerebral infarction can effectively improve the efficiency, reduce inflammatory and oxidative stress reactions, improve cognitive function and cerebral hemodynamic indicators, with higher medication safety. [ABSTRACT FROM AUTHOR]

Acute cerebral infarction poses a significant health risk and effective treatment is crucial. This randomized controlled trial assessed the impact of combining Butylphthalide and Atorvastatin on neurological function, quality of life and vascular endothelial function in 124 individuals with acute cerebral infarction. Participants were randomized into control and experimental groups, with the latter receiving the combination therapy. Objective assessments using NIHSS, SS-QOL, MBI and MoCA scales, along with biochemical markers, demonstrated improved outcomes in the experimental group. This study provides evidence for the clinical benefits of the drug combination in managing acute cerebral infarction. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop machine learning-based models for predicting acute cerebral infarction (ACI) in patients. Methods: We extracted the data of ACI patients and non-ACI patients (as control) from two hospitals. The Lasso algorithm was employed to select the most crucial features associated with ACI. Five machine learning algorithms-based models were trained, which was performed with 10-fold cross-validation. Then, the area under the receiver operating characteristic curve (AUC), accuracy, and F1-score were calculated in the training models. Accordingly, the training models with excellent performance was selected as the final predictive model. The relative importance of variables was analyzed and ranked. Results: A total of 150 patients were diagnosed with ACI (50.00%), with a higher proportion of males (70.67% vs. 44.00%) compared to the non-ACI patients. The logistic regression model exhibited a good performance in predicting ACI in the training set, as evidenced by its highest AUC, accuracy, sensitivity, and F1-score. Furthermore, feature importance analysis showed that blood glucose, gender, smoking history, serum homocysteine, folic acid, and C-reactive protein were the top six crucial variables of the logistic regression. Conclusions: In our work, the ACI risk prediction model developed by the logistic regression exhibited excellent performance. This could contribute to the identification of risk variables for ACI patients and enables clinicians timely and effective interventions. [ABSTRACT FROM AUTHOR]

• ENI predicts the success of IVT and correlates with vascular recanalization. • Decreased NAR levels increase the likelihood of post-IVT ENI in ACI patients. • NAR outperformed NLR in predicting ENI with higher AUC values. • NAR has the potential to be a novel and better biological indicator of ENI. Elevated neutrophil counts and decreased albumin levels have been linked to an unfavorable prognosis in acute cerebral infarction (ACI). The objective of this study is to explore the correlation between the neutrophil-to-albumin ratio (NAR) and the early neurological improvement (ENI) of ACI patients following intravenous thrombolysis (IVT). ACI patients who underwent IVT between June 2019 and June 2023 were enrolled. The severity of ACI was assessed using the National Institutes of Health Stroke Scale (NIHSS). ENI was defined as a reduction in NIHSS score of ≥ 4 or complete resolution of neurological deficit within 24 h after IVT. Propensity score match (PSM) and logistic regression analysis were used to explore the correlation between these variables and the early neurological outcomes of patients. A total of 545 ACI patients were included, with 253 (46.4 %) experiencing ENI. Among the 193 pairs of patients after PSM, there was a significant association between NAR and ENI (OR, 0.89; 95 % CI, 0.85–0.94; p < 0.001). The restricted cubic splines analysis revealed a significant nonlinear correlation between NAR and ENI (p for nonlinear = 0.0004; p for overall = 0.0002). The optimal cutoff for predicting ENI was determined as a NAR level of 10.20, with sensitivity and specificity values of 73.6 % and 60.9 %. NAR levels are associated with ENI in ACI patients after IVT. The decreased levels of NAR indicate an increased likelihood of post-thrombolysis ENI in ACI patients. [ABSTRACT FROM AUTHOR]

Compared with acute cerebral infarction alone, the nutritional status of patients with acute cerebral infarction and dysphagia is significantly worse, which not only negatively impacts clinical treatment, but also contributes to the poor prognosis of patients. In traditional clinical treatment, more focus is placed on improving the neurological function of patients with acute cerebral infarction combined with dysphagia, often neglecting their nutritional status, leading to unsatisfactory prognosis. In this study, we explored the influence of enhanced recovery after surgery care on the neurological function and nutritional status of patients with acute cerebral infarction combined with dysphagia after thrombolytic therapy. It was found that the use of enhanced recovery after surgery care improved neurological function and nutritional status and reduced blood pressure and stress responses, while promoting the recovery of patients' muscle strength. Therefore, enhanced recovery after surgery care has high application value in the future clinical treatment of acute cerebral infarction combined with dysphagia. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of mechanical thrombectomy using Solitaire stent combined with dual antiplatelet therapy (DAPT) on limb function and vascular reocclusion in patients with acute cerebral infarction. Methods A total of 134 patients with acute cerebral infarction who received treatment in our hospital from February 2020 to August 2023 were selected as samples. According to whether the patients regularly took aspirin and clopidogrel every day one week before surgery, they were divided into observation group (taking the medications) and control group (without taking medications), with 67 cases in each. The control group was given mechanical thrombectomy, and the observation group was treated with DAPT combined with mechanical thrombectomy. Outcomes measured included revascularization one week after treatment, and neurological and limb function assessment using NIHSS and FMA scale at baseline, 1 day, 1 week, and 1 month after treatment. Brain hemodynamics (CVR, Qmean, and Vmean) and thrombosis markers (TXB2, CD62P, and 6-keto-PGF1α) were evaluated pre-treatment and one month after treatment. Vascular reocclusion three months after treatment and its correlation with hemodynamics and thrombosis factors were analyzed. Results After treatment, higher revascularization rate, FMA score, Qmean, Vmean, and 6-keto-PGF1α level, and lower NIHSS score, CVR, TXB2, and CD62P level were found in the observation group (P < 0.05) . The incidence of vascular reocclusion was also lower in the observation group. Logistic analysis indicated that brain hemodynamic indicators and the level of thrombosis-related factors influenced vascular reocclusion occurrence (P < 0.05) . Conclusion Mechanical thrombectomy using Solitaire stent combined with DAPT helps the recovery of limb function in patients with acute cerebral infarction and reduces the risk of vascular reocclusion. [ABSTRACT FROM AUTHOR]

Objective To observe the ameliorating effect of intragastric administration of Klotho protein on cerebral ischemia-reperfusion injury (CIRI) in rats with acute cerebral infarction (ACI) and to explore its mechanism. Methods Fifty SD male rats were divided into the sham operation group, model group, low-dose Klotho group, medium-dose Klotho group and high-dose Klotho group, with 10 rats in each group. CIRI models after ACI were established in the model group, low-dose Klotho group, medium-dose Klotho group and high-dose Klotho group. In the sham operation group, only carotid artery vessel separation and wound suture were performed, and carotid artery clamping was not performed. After being fed for 24 h, the rats in the low-dose, medium-dose and high-dose Klotho groups were treated with 25，50 and 100 mg/kg Klotho protein, respectively, and the rats in the model group and sham operation group were treated with equal volume of normal saline. All rats in the five groups were treated once a day, for 14 days. Longa scoring method and balance beam scoring method were used to evaluate the neurological scores of rats in each group. Cerebral tissues of rats in each group were taken after decapitation. Hematoxylin staining method was used to measure the apoptosis rate of cerebral cortex neurons of rats, and receptor-interacting protein kinase 1（RIP1) and RIP3 proteins in cerebral cortex tissues of rats were detected by Western blotting. The inflammatory mediators interleukin (IL) -1β, tumor necrosis factor (TNF) -α and IL-6 were detected by enzyme-linked immunoassay, MDA was detected by TBA, SOD was detected by enzyme-linked immunoassay, and GSH-Px was detected by ultraviolet colorimetry. Results The the neurological score and cerebral cortical neuron apoptosis rate of rats in the sham operation group were lower than those in the other groups (all P<0. 05), and those in the model group were higher than those in the other groups (all P<0. 05), and those in the high-dose Klotho group were higher than those in the low-dose Klotho group and medium-dose Klotho group (all P<0. 05), and those in the mediumdose Klotho group were higher than those in the low-dose Klotho group (all P<0. 05) . The relative expression levels of RIP1 and RIP3 proteins and the expression levels of IL-1β, TNF-α, IL-6 and MDA in the cerebral cortex of rats in the sham operation group were lower than those in the other groups, while the expression levels of SOD and GSH-Px were higher than those in the other groups (all P<0. 05) . The relative expression levels of RIP1 and RIP3 proteins and the expression levels of IL-1β, TNF-α, IL-6 and MDA in cerebral cortex of rats in the model group were higher than those in the other groups, while the expression levels of SOD and GSH-Px were lower than those in the other groups (all P<0. 05) . The relative expression levels of RIP1 and RIP3 proteins and the expression levels of IL-1β, TNF-α, IL-6 and MDA in the cerebral cortex of rats in the high-dose Klotho group were lower than those in the low-dose Klotho group and medium-dose Klotho group, while the expression levels of SOD and GSH-Px were higher than those of the low-dose and medium-dose Klotho groups (all P<0. 05) . The relative expression levels of RIP1 and RIP3 protein and the expression levels of IL-1β, TNF-α, IL-6 and MDA in cerebral cortex of rats in the medium-dose Klotho group were lower than those in the low-dose Klotho group, while the expression levels of SOD and GSH-Px were higher than those in the low-dose Klotho group (all P< 0. 05) . Conclusion Gastric administration of 100 mg/kg Klotho protein can alleviate CIRI in ACI rats, and its mechanism may be related to inhibiting the expression of RIP1 and RIP3 proteins in cerebral cortex and inhibiting the inflammatory response and oxidative stress response at the site of brain injury. [ABSTRACT FROM AUTHOR]

Introduction: The present study was to investigate the clinical role of miR-330-3p in acute cerebral infarction (ACI), including its diagnostic and prognostic potential. Preliminary exploration of its target genes was archived by bioinformatics analysis. Methods: miR-330-3p in plasma of the patients with ACI and controls were quantified by real-time quantitative PCR. The 1-month prognosis of the ACI patients was evaluated by the Glasgow Outcome Scale (GOS). The correlation between the plasma levels of miR-330-3p and the GOS scores was tested by Pearson correlation analysis. The receiver operating characteristic (ROC) curves were established based on the expression level of miR-330-3p in different groups. The miR-330-3p-targeting genes were analyzed using Venn diagram, protein-protein interaction network, and Gene Ontology enrichment analysis. Results: miR-330-3p was significantly increased in the plasma of ACI patients compared with that in healthy controls, and ROC curve revealed its diagnostic value for ACI. miR-330-3p was significantly increased in the plasma of patients with poor 1-month prognosis compared with those with good 1-month prognosis. miR-330-3p expression was negatively correlated with GOS score, suggesting its potential to predict the 1-month prognosis for ACI. One-year survival analysis revealed surviving patients had lower levels of miR-330-3p than the deceased. miR-330-3p was proven to predict the death of patients with ACI. The miR-330-3p-targeting genes were associated with synapse-related Gene Ontology terms. Conclusion: miR-330-3p was upregulated in the plasma of patients with ACI, making it a promising diagnostic and prognostic marker for patients with ACI. miR-330-3p could facilitate synaptic plasticity following cerebral infarction. [ABSTRACT FROM AUTHOR]

BackgroundSalvia miltiorrhiza and ligustrazine injection (SML) is a type of traditional Chinese medicine injection, which has been considered a promising adjunctive therapy treatment for acute cerebral infarction (ACI). Although there have been positive reports on the treatment of SML, there is still controversy over its exact efficacy and safety in ACI patients. In this study, a systematic review was conducted on randomized controlled trials (RCTs) of SML for the treatment of ACI to evaluate its clinical efficacy and safety.MethodFrom the establishment of the database until May 2023, all randomized controlled trials related to SML and ACI were collected from the Cochrane Library, Web of Science, Embase, Medline, PubMed, CSJD, Wanfang database, CBM and CNKI. This systematic review and meta-analysis were strictly conducted in accordance with the PRISMA statement. The reported outcomes including overall response (ORR), National Institutes of Health Stroke Scale (NIHSS), hemorrheology indexes, activity of daily living (ADL) and adverse events were in detail investigated.ResultsAn analysis was conducted on the relevant data of 3869 ACI patients from 38 trials. The results indicated that the combination of conventional treatment and SML can significantly improve the ORR of patients (RR = 1.23, 95% CI = 1.20–1.27, P < 0.00001), neurological status (NIHSS, MD = −4.35, 95% CI = −5.15–3.54, P < 0.00001) and ADL (Barthel Index score, MD = 10.27, 95% CI = 7.75–12.79, P < 0.00001) compared with regular treatment alone. After the combined therapy, the hemorheology of ACI patients also significantly improved (P < 0.05). There is no significant difference in the frequency of adverse events between the two groups (RR = 1.49, 95% CI = 0.91–2.46, P = 0.11).ConclusionThe evidence from the meta-analysis suggested that the combination of conventional therapy and SML is safer and more effective than conventional therapy alone in treating ACI. However, due to the limitations of this analysis, such as regional bias and publication bias, the above conclusions need to be further verified by prospective, high-quality and multicenter clinical trials.

ABSTRACT Background Mechanical thrombectomy (MT) is standard of care for acute cerebral infarction (ACI) due to large vessel occlusions. However, its clinical efficacy in patients with ACI due to distal medium vessel occlusions (DMVOs) remains unclear. This study evaluates the efficacy and safety of MT in patients with ACI due to DMVOs. Methods Totally, 306 patients with ACI at a very early stage were assigned into DMVOs‐MT, M1‐MT, and DMVOs‐intravenous thrombolysis (IVT) groups. These groups were compared regarding baseline data, recanalization rate, location of vessel occlusions, number of thrombectomy, first‐pass recanalization, mRS scores, NIHSS scores, 90‐day mRS scores, incidence of adverse events, and mortality. Risk factors for poor prognosis of patients with DMVOs following MT were analyzed. Results DMVOs‐MT and M1‐MT groups showed comparable first‐pass recanalization rates, recanalization rates, and NIHSS score reduction ratios, with marked differences in location of vessel occlusions. Versus DMVOs‐IVT, DMVOs‐MT had increased differences between pre‐ and post‐treatment NIHSS scores and between pre‐treatment NIHSS scores and NIHSS scores at discharge and elevated NIHSS reduction ratios. The poor prognosis rate of DMVOs‐MT group was insignificantly different from that of M1‐MT group but lower than that of DMVOs‐IVT group. Adverse events and mortality incidences were comparable among the three groups. Diabetes, first‐pass recanalization, and pre‐treatment NIHSS scores were independent risk factors for poor prognosis in DMVO patients after MT. Conclusion MT is as effective and safe in patients with DMVOs as in patients with M1 occlusions. In patients with DMVOs, MT has higher efficacy and safety than IVT.

Cases of carbon monoxide (CO) poisoning complicated with massive cerebral infarction are rare. A chinese female patient with carotid atherosclerotic plaque was found unconscious during bathing. The patient was diagnosed as carbon monoxide poisoning complicated with massive acute cerebral infarction by carbon monoxide hemoglobin (COHb) detection and imaging examination. The patient regained consciousness after treatment with hyperbaric oxygen, antiplatelet, and atorvastatin. This case suggests that patients with carotid atherosclerotic plaque may be more susceptible to develop acute cerebral infarction when CO poisoning occurs.

摘要： 急性脑梗死是常见的缺血性脑血管病，与血小板活性密切相关。血小板活性在急性脑梗死发病、进展、治疗及预后等环节均存在重要影响。平均血小板体积（mean platelet volume，MPV）和血小板分布宽度（platelet distribution width，PDW）是反映血小板活性的两个重要指标，体积大的血小板因能分泌更多的促血栓因子、表达更多的P-选择素和血小板糖蛋白Ⅱb/Ⅲa受体而被认为拥有更高的活性；活化的血小板因伸出大小不一的伪足而使得PDW增大，因此高MPV值和高PDW值都是血小板活化的标志。本文对血小板活化对急性脑梗死的发生、发展及预后等方面的影响进行综述，以期为后续研究血小板活性和急性脑梗死的关系提供参考。 Abstract: Acute cerebral infarction is a common ischemic cerebrovascular disease and is closely related to platelet activity. Platelet activity has significant impact on occurrence, development, treatment and prognosis of acute cerebral infarction. Mean platelet volume (MPV)and platelet distribution width (PDW) are two important indicators that reflect platelet activity. Platelets with larger volume are considered to have higher activity for they can secrete more thrombosis factors and express more P-selections and platelet glycoprotein Ⅱb/Ⅲa receptors. Activated platelets increase PDW by protruding pseudopodia of varying sizes. Thus, both high MPV and PDW are the indications of platelet activation. This paper reviewed the effects of platelet activation on the occurrence, development and prognosis of acute cerebral infarction, in order to provide references for the subsequent study of the relationship between platelet activity and acute cerebral infarction.

Abstract Cerebral infarction is a common neurological disease with high rates of morbidity, mortality, and recurrence, posing a great threat to human life and health. Cerebral infarction is the second leading cause of death in the world and the leading cause of long-term disability in humans. The results of the third national retrospective sampling survey on causes of death in 2008 showed that cerebral infarction has become the leading cause of death in China and its mortality rate is 4–5 times that of European and American countries. Therefore, this article proposed a study on the predictive value of Cmmi-MHR combined with thromboelastography parameters that was performed for acute cerebral infarction. This paper mainly proposed a high frame rate imaging technology and analyzed its algorithm. In this article, in the experimental part, an in-depth analysis of the predictive value of the Monocyte-to-high-density lipoprotein cholesterol ratio (MHR) combined with thromboelastography parameters was performed for acute cerebral infarction. The final experimental results showed that HDL (OR = 1.695%, P-trend = 0.049) had a probability of death within 90 days of hospitalization (OR = 0.81, 95% CI = 1.06–3.11, P-trend = 0.523). There were no significant differences in mortality rate after 90 days. Regardless of adjusting for confounders such as age, gender, and NIHSS score, there was no significant difference in the risk of MHR or monocyte count within 90 days of hospitalization. The conclusion indicates that the combination of Cmmi-MHR and thromboelastography parameters provides a new perspective and method for the diagnosis and treatment of cerebral infarction, and provides important support for personalized treatment and management of cerebral infarction.

BACKGROUND: The modified Rankin Scale (mRS) assessment of global disability is the most common primary endpoint in acute stroke trials but lacks granularity (7 broad levels) and is ordinal (scale levels unknown distances apart), which constrains study power. Disability scales that are linear and continuous may better discriminate outcomes, but computerized administration in stroke patients is challenging. We, therefore, undertook to develop a staged use of an ordinal followed by a linear scale practical to use in multicenter trials. METHODS: Consecutive patients undergoing 3-month final visits in the NIH FAST-MAG phase 3 trial were assessed with the mRS followed by 15 mRS level-specific yes-no items of the Academic Medical Center Linear Disability Score (ALDS), a linear disability scale derived using item response theory. RESULTS: Among 55 patients, aged 71.2 (SD ± 14.2), 67% were men and the entry NIHSS was 10.7 (SD ± 9.5). At 90 days, the median mRS score was 3 (IQR, 1-4), and the median ALDS score was 78.8 (IQR, 3.3-100). ALDS scores correlated strongly with 90 days outcome measures, including the Barthel Index (r = 0.92), NIHSS (r = 0.87), and mRS (r = 0.94). ALDS scores also correlated modestly with entry NIHSS (r = 0.38). At 90 days, the ALDS showed greater scale granularity than the mRS, with fewer patients with identical values, 1.9 (SD ± 3.2) vs. 8.0 (SD ± 3.6), p < 0.001. When treatment effect magnitudes were small to moderate, projected trial sample size requirements were 2-12-fold lower when the ALDS rather than the mRS was used as the primary trial endpoint. CONCLUSION: Among patients enrolled in an acute neuroprotective stroke trial, the ALDS showed strong convergent validity and superior discrimination characteristics compared with the modified Rankin Scale and increased projected trial power to detect clinically meaningful treatment benefits.

To investigate the predictive value of amplitude integrated electroencephalogram (aEEG) score combine with oxidized low-density lipoprotein/high-density lipoprotein (ox-LDL/HDL) ratio, high-sensitivity C-reactive protein/albumin (hs-CRP/Alb) ratio and fibrinogen/albumin ratio (FAR) on the prognosis of patients with acute cerebral infarction (ACI). 242 ACI patients admitted to our hospital from January 2021 to December 2022 were selected, all patients underwent aEEG examination to obtain aEEG score, and serum ox-LDL/HDL ratio, hs-CRP/Alb ratio and FAR were detected. The modified Rankin scale (mRS) was used to evaluate the prognosis of patients 3 months after discharge. The clinical data of ACI patients were collected, and the influencing factors of poor prognosis of ACI patients were analyzed by multivariate Logistic regression. The efficacy of aEEG score, serum ox-LDL/HDL ratio, hs-CRP/Alb ratio and FAR in predicting the prognosis of ACI patients were analyzed by receiver operating characteristic (ROC) curve. The aEEG score, serum ox-LDL/HDL ratio, hs-CRP/Alb ratio and FAR in poor prognosis group were higher than those in good prognosis group(P<0.05). Multiple cerebral infarction lesions, high NHISS score, high aEEG score, high ox-LDL/HDL ratio, high hs-CRP/Alb ratio and high FAR were risk factors for poor prognosis in ACI patients (P<0.05). The area under the curve of aEEG score, serum ox-LDL/HDL ratio, hs-CRP/Alb ratio and FAR in predicting the prognosis of ACI patients were 0.793, 0.759, 0.777 and 0.821 respectively. The area under the curve of combined prediction was 0.915, which was higher than that of single index prediction. The aEEG score, ox-LDL/HDL ratio, hs-CRP/Alb ratio and FAR are increase in patients with poor prognosis of ACI. The combined application of the above indicators has a high value in predicting the poor prognosis of ACI patients. [ABSTRACT FROM AUTHOR]

Objective: This study was to investigate the influence factors of different doses of agatroban combined with butylphthalein on the effect and prognosis of patients with acute cerebral infarction. Methods: A total of 90 cases of emergency acute cerebral infarction admitted to our hospital from June 2019 to August 2022 were studied, and they were divided into a high-dose group (receiving high-dose agattriban combined with butylphthalide) and a low-dose group (receiving low-dose agattriban combined with butylphthalide) with 45 cases in each group by random number table method. The clinical efficacy and prognosis of the two groups after 7 days of treatment were compared, and the neurological function [Chinese Stroke Scale (CSS) score and neurological function (NIHSS) score] of the two groups were analyzed before treatment and after 7 days of treatment. Patients were divided into good prognosis group and poor prognosis group according to different prognosis. Single/multifactor Logisitic regression was used to analyze the prognostic factors of acute cerebral infarction. Results: (1) The clinical efficacy of the two groups was included in the study and the difference between the groups was compared. The results showed that the total effective rate of the high-dose group was higher than that of the low-dose group (P<0.05). (2) The neurological function of the two groups was evaluated by CSS score and NIHSS score, and the difference between the two groups was compared. The results showed that before treatment, CSS score and NIHSS score were compared between the two groups (P>0.05). After 7 days of treatment, the CSS score and NIHSS score in the high-dose group were higher than those in the low-dose group (P<0.05). (3) The prognosis of the two groups was included in the study using mRS Score assessment and the difference between the groups was compared. The results showed that the good prognosis of the high-dose group was 2.22% (1/45) higher than that of the low-dose group, 15.56% (7/45) (P<0.05). (4) Age of patients with good prognosis, pre-treatment CSS score and pre-treatment NIHSS score were different from the poor prognosis group (P<0.05). (5) With the prognosis of acute cerebral infarction as the dependent variable and the indicators with differences in the single factor as the independent variable, the factors affecting the prognosis of acute cerebral infarction were CSS score before treatment and NIHSS score before treatment by multifactor Logisitic regression analysis. Conclusion: High-dose agatroban combined with butylphthalide can effectively treat patients with acute cerebral infarction, and the prognostic factors of acute cerebral infarction are CSS score before treatment and NIHSS score before treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of Suhexiang Pill on regulating the cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signaling pathway on neuroinflammation and neuronal apoptosis in rats with acute cerebral infarction. Methods: SD rats were divided into model group, sham surgery group, low-dose Suhexiang pill group (2.5 mL/kg), medium dose Suhexiang pill group (5 mL/kg), high-dose Suhexiang pill group (10 mL/kg), nimodipine group (2 mg/kg), SQ22536 (cAMP inhibitor) group (2.13 mg/kg), and high-dose Suhexiang pill+SQ22536 group (10 mL/kg+2.13 mg/kg), with 24 rats in each group. Except for the sham operated group where only the arteries were isolated, all other groups of rats were required to construct acute cerebral infarction models. After successful modeling, medication treatment was performed once a day for 2 weeks. Zea Longa scoring method was used to detect neural function; Dry wet weight method was used to detect the water content of rat brain tissue; Measure the volume of cerebral infarction with 2,3,5-triph-enyltetrazole chloride (TTC) staining; Enzyme-linked immunosorbent assay (ELISA) was used to detect tumor necrosis factor-a (TNF-α), Interleukin(IL)-6, IL-1B, CAMP level in rat brain tissue; Hematoxylin eosin (HE) staining was used to detect pathological changes in rat neurons; TUNEL staining was used to detect neuronal apoptosis; Western blot was used to detect the expression of cleaved aspartate specific cysteine protease-3 (Cleaved Caspase-3), Bcl-2 related X protein (Bax), and p-PKA protein in rat brain tissue. Results: Compared with the sham surgery group, neurological function score, neuronal apoptosis rate, TNF-a, IL-1 β, IL-6 levels, cerebral infarction volume, Bax, Cleaved Caspase-3 protein expression, and brain tissue water content increased in model group, the expression of cAMP and p-PKA proteins was reduced (P<0.05), and the pathological damage to the CAl region of the hippocampus in brain tissue was severe. Compared with the model group, the low-dose Suhexiang pill group, medium dose Suhexiang pill group, high-dose Suhexiang pill group, nimodipine group of rat neurological function score, TNF-α, IL-1β, IL-6 level, brain tissue water content, neuronal apoptosis rate, cerebral infarction volume, Bax, Cleaved Caspase-3 protein expression decreased, CAMP and p-PKA protein expression increased (P<0.05), alleviation of pathological damage in hippocampal CA1 region of brain tissue, the trend of changes in corresponding indicators in the SQ22536 group was opposite to the above (P<0.05); SQ22536 weakened the inhibitory effect of high-dose Suhexiang Pill on neuroinflammation and neuronal apoptosis in rats with acute cerebral infarction. Conclusion: Suhexiang Pill may inhibit neuroinflammation and neuronal apoptosis in rats with acute cerebral infarction by activating the cAMP/PKA pathway. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the clinical effect of alteplase combined with early enteral nutrition preparation on patients with acute cerebral infarction. METHODS: A total of 98 patients with acute cerebral infarction admitted into Hai’an People’s Hospital Affiliated to Nantong University from Jan. 2021 to Jun. 2023 were selected to be divided into observation group and control group via random number table method, with 49 cases in each group. The control group was given early routine self-made nasal feeding liquid diet after alteplase thrombolytic therapy, while the observation group received early nasal feeding enteral nutrition preparation after alteplase thrombolytic therapy. The clinical efficacy, nutritional status indicators [ prealbumin ( PA), albumin ( ALB) and total protein ( TP )], neurological function [National Institutes of Health Stroke Scale (NIHSS)], neuro-impairment markers levels [serum neuron-specific enolase ( NSE), S100 calcium binding protein β ( S100β) and brain-derived neurotrophic factor (BDNF )], Glasgow outcome scores ( GOS ), intracranial hemorrhage rate and hospitalization indicators were compared between two groups. RESULTS: After treatment, the total effective rate of the observation group was significantly higher than that of control group [83. 7% (41 / 49) vs. 65. 3% (32 / 49)], with statistically significant difference (χ² = 4. 353, P<0. 05). After treatment, the PA level (t = 12. 593, P<0. 001), ALB level (t = 4. 583, P< 0. 001), TP level (t = 4. 497, P<0. 001), BDNF level (t = 4. 619, P<0. 01) and GOS score (t = 4. 342, P<0. 001) of the observation group were higher than those of the control group, the NIHSS score (t = 5. 371, P<0. 001), NSE level (t = 4. 342, P<0. 001) and S100β (t = 6. 015, P<0. 001) of the observation group were lower than those of the control group, the ICU stay (t = 4. 358, P<0. 001) and hospital stay (t = 6. 509, P<0. 001) of the observation group were shorter than those of control group, all of the above differences were statistically significant. One patient in the control group developed asymptomatic cerebral hemorrhage, while no patient in the observation group developed asymptomatic intracerebral hemorrhage, no symptomatic intracranial hemorrhage occurred in both groups; the difference in intracranial hemorrhage rates between two groups was not statistically significant ( P > 0. 05 ). CONCLUSIONS: Alteplase combined with early enteral nutrition preparation has significant efficacy in reducing nerve injury in patients with acute cerebral infarction, which also helps to promote the improvement of patients’ nutritional status and prognostic quality, with good clinical application value. [ABSTRACT FROM AUTHOR]

Objective: To investigate risk factors affecting short-term functional prognosis after discharge in patients with acute cerebral infarction and explore the correlation between relevant factors and National Institutes of Health Stroke Scale (NIHSS) scores. Methods: A retrospective analysis of 4,048 patients with acute cerebral infarction hospitalised between January 2014 and November 2018 in Department of Neurology, Renqiu Kangji Xintu Hospital, Hebei were conducted. The enrolled patients, including 2,506 men and 1,542 women, were divided into mild (n=3,696), moderate (n=278) and severe groups (n=74) based on NIHSS score. Baseline data (gender, history of hypertension, diabetes, hyperlipidaemia, drinking, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein (a), urea nitrogen, creatinine) were compared among the three groups, and the relationship between relevant factors and NIHSS scores was studied. Results: Through single factor regression analysis, it was found that age, history of stroke, atrial fibrillation, coronary heart disease, antiplatelet medication usage, systolic blood pressure and uric acid were risk factors for the moderate group. Multivariate logistic regression analysis showed that, after adjusting for confounding factors, age, history of stroke and systolic blood pressure (P<0.01) were independent risk factors for the moderate group. Age (OR=1.089;, history of stroke, atrial fibrillation, diastolic blood pressure, fasting plasma glucose and uric acid (P<0.05) were independent risk factors for the severe group. Conclusion: Age, history of stroke, atrial fibrillation, systolic and diastolic blood pressure, fasting plasma glucose and uric acid levels are independent risk factors affecting the short-term post-discharge functional prognosis of patients with acute cerebral infarction and are related to the NIHSS scores of these patients after discharge. [ABSTRACT FROM AUTHOR]

Aim To investigate the levels of krüppel-like factor 2 (KLF2) and endothelial nitric oxide synthase 3 (NOS3) in the serum of patients with acute cerebral infarction (ACI) of large-artery atherosclerosis (LAA) type, and to analyze their value in the diagnosis and disease assessment of LAA type ACI. Methods A total of 150 patients with LAA type ACI were divided into mild group (n = 36), moderate group (n = 48), and severe group (n = 66) based on their condition. Additionally, a control group ( n = 150) was selected from health exminers during the same period. The levels of serum KLF2 and NOS3 in each group were compared; receiver operator characteristic(ROC) curve was applied to analyze the diagnostic value of serum KLF2 and NOS3 levels for LAA type ACI and the predictive value for the occurrence of severe LAA type ACI, respectively. Results The serum KLF2 and NOS3 levels were significantly lower in LAA type ACI group than those in control group (P<0. 05). The serum KLF2 and NOS3 levels in the mild, moderate and severe groups were significantly decreased in turn(P<0. 05). The area under the curve (AUC) of the combined diagnosis of serum KLF2 and NOS3 for LAA type ACI was 0. 858, with a sensitivity of 73. 33% and a specificity of 86. 00%, which was superior to the individual diagnosis of KLF2 and NOS3 (Zcombined detection-KLF2 = 3. 796, Zcombined detection-NOS3 = 4. 689, all P< 0. 001). The AUC of combined prediction of serum KLF2 and NOS3 for the occurrence of severe LAA type ACI was 0. 878, with a sensitivity of 77. 27% and a specificity of 90. 48%, which was superior to the independent prediction of KLF2 and NOS3 (Zcombined detection-KLF2 = 2. 401, P= 0. 016; Zcombined detection-NOS3 = 3. 070, P = 0. 002). Conclusions The serum levels of KLF2 and NOS3 in patients with LAA type ACI were significantly reduced and negatively correlated with the severity of the disease. The combination of the two has high evaluation efficacy in the diagnosis and disease prediction of LAA type ACI. [ABSTRACT FROM AUTHOR]

This retrospective case-control study examined factors associated with in-hospital acute myocardial infarction (AMI) in patients hospitalized for acute cerebral infarction (ACI). In-patients with AMI following ACI (n = 33) and age- and sex-matched controls who had ACI without AMI (n = 66) were recruited in a 1:2 ratio, and their data were assessed. The results showed that the group of patients experiencing AMI after ACI exhibited a significantly higher prevalence of ischemic heart disease (p = 0.036) and heart failure (p < 0.001), had elevated fibrinogen levels (p = 0.029), presented with higher National Institutes of Health Stroke Scale (NIHSS) scores at admission (p < 0.001) and a lower proportion of them underwent thrombolytic therapy (p = 0.004) compared to the ACI-only group. The mortality rate was substantially higher in the AMI after ACI group than in the ACI-only group (18.2% vs. 1.5%, p = 0.008). Multivariable logistic regression analysis identified that higher NIHSS scores at admission (odds ratio, OR = 1.21, 95% confidence interval, CI = 1.16–1.39, p = 0.004), elevated high-sensitivity Creactive protein (hs-CRP) levels (OR = 1.07, 95% CI = 1.001–1.14, p = 0.047) and the administration of thrombolytic therapy (OR = 0.02, 95% CI = 0.001–0.48, p = 0.015) were independently associated with AMI following ACI. In conclusion, NIHSS scores at admission, hs-CRP levels and thrombolytic therapy were found to be independent factors associated with in-hospital AMI following ACI. [ABSTRACT FROM AUTHOR]

Cerebral infarction is a common neurological disease with high rates of morbidity, mortality, and recurrence, posing a great threat to human life and health. Cerebral infarction is the second leading cause of death in the world and the leading cause of long-term disability in humans. The results of the third national retrospective sampling survey on causes of death in 2008 showed that cerebral infarction has become the leading cause of death in China and its mortality rate is 4–5 times that of European and American countries. Therefore, this article proposed a study on the predictive value of Cmmi-MHR combined with thromboelastography parameters that was performed for acute cerebral infarction. This paper mainly proposed a high frame rate imaging technology and analyzed its algorithm. In this article, in the experimental part, an in-depth analysis of the predictive value of the Monocyte-to-high-density lipoprotein cholesterol ratio (MHR) combined with thromboelastography parameters was performed for acute cerebral infarction. The final experimental results showed that HDL (OR = 1.695%, P-trend = 0.049) had a probability of death within 90 days of hospitalization (OR = 0.81, 95% CI = 1.06–3.11, P-trend = 0.523). There were no significant differences in mortality rate after 90 days. Regardless of adjusting for confounders such as age, gender, and NIHSS score, there was no significant difference in the risk of MHR or monocyte count within 90 days of hospitalization. The conclusion indicates that the combination of Cmmi-MHR and thromboelastography parameters provides a new perspective and method for the diagnosis and treatment of cerebral infarction, and provides important support for personalized treatment and management of cerebral infarction. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the influence of a step-by-step inpatient rehabilitation program (SIRP) on the self-care capability and quality of life of patients who have undergone intravascular stent implantation to treat large vessel occlusion during acute cerebral infarction (ACI). Methods: This study included a cohort of 90 patients with ACI who received intravascular stent implantations at a tertiary hospital in the Third Affiliated Hospital of Anhui Medical University from January 2020 to February 2024. The patients were followed up for at least 3 months. Cohort grouping was based on the type of nursing care each patient received. The observation group participated in SIRP along with receiving routine nursing care, whereas the control group received only routine nursing care. Key outcome measures included the Barthel index, the National Institute of Health Stroke Scale (NIHSS) score, the incidence of complications, length of hospital stay, and 36-item short-form survey (SF-36) scores. These parameters were compared between the two groups. Results: At the time of admission, there were no significant differences in demographic data, NIHSS score, Barthel index, or SF-36 scores between the observation and control groups (all p > 0.05). However, at 3 months postoperatively, the observation group showed significant improvements, with higher average scores in the Barthel index (62.49 ± 7.32 vs. 53.16 ± 4.37, p < 0.001) and SF-36 scores (502.33 ± 14.28 vs. 417.64 ± 9.65, p < 0.001). Additionally, this group had significantly lower NIHSS scores (3.38 ± 1.19 vs. 10.24 ± 2.10, p < 0.001), fewer complications (3 vs. 15, p = 0.002), and shorter hospital stays (12.40 ± 1.68 vs. 15.56 ± 1.87, p < 0.001). Conclusion: Implementing SIRP notably enhanced self-care capabilities and overall quality of life, while also reducing complication rates and the length of hospital stays for patients with ACI who underwent intravascular stent implantation. This underscores the potential benefits of incorporating structured rehabilitation programs in the treatment and recovery processes of such patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically evaluate the efficacy and safety of edaravon dexborneo combined with butylphthalide and sodium chloride in the treatment of acute cerebral infarction. METHODS: PubMed, CBM, CNKI, Wanfang Data and VIP were retrieved to collect randomized controlled trial (RCT) of clinical efficacy and safety of edaravon dexborneo combined with butylphthalide and sodium chloride ( observation group ) compared with butylphthalein and sodium chloride alone ( control group) in the treatment of acute cerebral infarction, the retrieval time was from database establishment to Sept. 2023. After data extraction and quality evaluation, Meta-analysis was carried out by RevMan 5. 3 statistical software. RESULTS: A total of 9 RCT including 995 patients were enrolled. Meta-analysis results showed that the total effective rate (RR= 1. 21,95%CI = 1. 14-1. 29,P<0. 000 01), cure rate (RR= 1. 41,95%CI = 1. 08-1. 83,P = 0. 01) and markedly effective rate (RR = 1. 35,95%CI = 1. 14-1. 61,P = 0. 000 5) in the observation group were higher than those in the control group, the National Institute of Health Stroke Scale score (MD= -3. 08,95%CI = -4. 23--1. 92,P<0. 000 01) and inefficiency rate (RR = 0. 31,95% CI = 0. 21-0. 46,P<0. 000 01) were significantly lower than those in the control group, with statistically significant differences. There were no significant differences in the modified Rankin scale score (MD = - 0. 47,95% CI = - 0. 97-0. 03,P = 0. 06) and the incidence of adverse drug reactions (RR = 0. 74,95%CI = 0. 49-1. 12,P = 0. 15) between two groups. CONCLUSIONS: The clinical efficacy of edaravon dexborneo combined with butylphthalein and sodium chloride in the treatment of acute cerebral infarction is better than that of butylphthalein and sodium chloride alone, and the safety is comparable. [ABSTRACT FROM AUTHOR]

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AbstractObjectiveMethodsResultsConclusionTo evaluate the effects of argatroban on the levels of Hcy, hs-CRP and FIB in patients with acute cerebral infarction (ACI).A retrospective analysis was performed on 382 patients with ACI who were hospitalized in the Department of Neurology of our hospital from January 2017 to December 2019. Among them, 158 patients received conventional treatment as the control group and 224 patients received combined treatment with argatroban as the study group. NHISS score, mRS score, Hcy, hs-CRP, FIB level, quality of life, adverse reactions were compared between the two groups after treatment. The levels of Hcy and hs-CRP in patients with different mRS scores were compared.A superior clinical efficacy of the study group was observed than the control group (p < 0.05). The study group witnessed a remarkably lower NHISS score, Hcy, hs-CRP and FIB level as compare to the control group (p < 0.05). The ADL and FMA scores in the study group were higher than those in the control group (p < 0.05). The levels of Hcy and hs-CRP in mRS 0–2 patients were lower than those in mRS 3–6 patients (p < 0.05).Argatroban in ACI patients can significantly enhance the clinical efficacy and improve the quality of life. It is closely related to the reduction of Hcy and hs-CRP levels, but the mechanism needs to be further studied. [ABSTRACT FROM AUTHOR]

Purpose: To explore the relationship between obstructive sleep apnea (OSA) and hypoperfusion during ultra-early acute cerebral infarction. Patients and methods: Data were retrospectively collected from patients admitted to our hospital with acute cerebral infarction between January 2020 and January 2022, who underwent comprehensive whole-brain computed tomography perfusion imaging and angiography examinations within 6 h of onset. The F-stroke software automatically assessed and obtained relevant data (Tmax). The patients underwent an initial screening for sleep apnea. Based on their Apnea-Hypopnea Index (AHI), patients were categorized into an AHI ≤15 (n = 22) or AHI >15 (n = 25) group. The pairwise difference of the time-to-maximum of the residue function (Tmax) > 6 s volume was compared, and the correlation between AHI, mean pulse oxygen saturation (SpO2), oxygen desaturation index (ODI), percentage of time with oxygen saturation < 90% (T90%), and the Tmax >6 s volume was analyzed. Results: The Tmax >6 s volume in the AHI > 15 group was significantly larger than that in the AHI ≤ 15 group [109 (62–157) vs. 59 (21–106) mL, p = 0.013]. Spearman’s correlation analysis revealed Tmax >6 s volume was significantly correlated with AHI, mean SpO2, ODI, and T90% in the AHI > 15 group, however, no significant correlations were observed in the AHI ≤ 15 group. Controlling for the site of occlusion and Multiphase CT angiography (mCTA) score, AHI (β = 0.919, p < 0.001), mean SpO2 (β = −0.460, p = 0.031), ODI (β = 0.467, p = 0.032), and T90% (β =0.478, p = 0.026) remained associated with early hypoperfusion in the AHI > 15 group. Conclusion: In patients with acute cerebral infarction and AHI > 15, AHI, mean SpO2, ODI and T90% were associated with early hypoperfusion. However, no such relationship exists among patients with AHI ≤ 15. [ABSTRACT FROM AUTHOR]

Obejective: To observe the clinical effect of Xijiao Dihuang Decoction combined with conventional therapy in the treatment of acute cerebral infarction (ACI) with blood stasis heat syndrome and its impact on blood lipid levels in patients. Methods: A prospective study was conducted on 100 ACI patients with blood stasis heat syndrome admitted to the Department of Neurology at the our hospital from January 2021 to December 2022. They were divided into a control group and an observation group using a random number table method, with 50 patients in each group. Patients in the control group were given routine internal medicine treatment, and on this basis, patients in the observation group were given additional treatment with Xijiao Dihuang Decoction. Both groups were treated continuously for 14 days. Compare the clinical efficacy, modified Rankin Scale (mRS) score after treatment, and the National Institutes of Health Stroke Scale (NIHSS) score, blood stasis heat syndrome score, serum lipoprotein associated phospholipase A2 (Lp-PLA2), homocysteine (Hcy) score before and after treatment between two groups of patients D-dimer (DD), fibrinogen (FIB), and blood lipids [total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) ] levels. Results: (1) The NIHSS score, stasis heat syndrome score, and mRS score of the two groups of patients at the end of treatment were reduced, while the observation group had a more significant decrease (P<0.05). (2) The total effective rate of treatment in the observation group was higher than that in the control group (98.00% vs. 92.00%, P<0.05). (3) At the end of treatment, the serum levels of Lp-PLA2, Hcy, DD, and FIB in the observation group patients and the serum levels of Lp-PLA2, Hcy, and FIB in the control group patients were reduced (P<0.05). There was no difference in DD levels before and after treatment in the control group patients (P>0.05). At the end of treatment, the serum levels of Lp-PLA2, Hcy, DD, and FIB in the observation group were lower than those in the control group (P<0.05). (4) At the end of treatment, the levels of serum TC, TG, and LDL-C in the observation group and the control group were lower than before treatment (P<0.05). There was no difference in other indicators between the two groups before and after treatment (P>0.05). The levels of serum TC, TG, and LDL-C at the end of treatment in the observation group were lower than those in the control group (P<0.05), and there was no difference in serum HDL-C between the two groups at the end of treatment (P>0.05). Conclusion: Xijiao Dihuang Decoction can significantly improve the clinical efficacy of ACI patients with blood stasis and heat syndrome, alleviate neurological deficits and signs of blood stasis and heat, and improve living ability. This may be related to the further improvement of lipid metabolism and abnormal blood coagulation in patients with Xijiao Dihuang Decoction and the reduction of vascular endothelial damage. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to investigate the accuracy and clinical significance of an artificial intelligence (AI)-based automated Alberta Stroke Program Early Computed Tomography (ASPECT) scoring software of head CT for the indication of intravenous recombinant tissue plasminogen activator (rt-PA) therapy. METHODS: This study included two populations of acute ischemic stroke: one comprised patients who had undergone head CT within 48 h of presentation (Population #1, n = 448), while the other included patients within 4.5 h from onset (Population #2, n = 132). The primary endpoint was the concordance rate of ASPECTS of the neurologists and AI software against the benchmark score. The secondary endpoints were to validate the accuracy of the neurologist and AI software in assessing the ability to rule out extensive infarction (ASPECTS of 0-5) in population #2. RESULTS: The reading accuracy of AI software was comparable to that of the board-certified vascular neurologists. The detection rate of cardiogenic cerebral embolism was better than that of atherothrombotic cerebral infarction. By excluding extensive infarction, AI-software showed a higher specificity and equivalent sensitivity compared to those of experts. CONCLUSIONS: The AI software for ASPECTS showed convincing agreement with expert evaluation and would be supportive in determining the indications of intravenous rt-PA therapy.

Yi-Jun Feng,1,&ast; Bing-Quan Wang,1,&ast; Lu-Lu Cao,2 Li-Ying Dong,3 Chu-Yi Zhang,1 Dong-Jian Hu,1 Zhen Zhou,3 Jin-Xiu Cao4 1Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People’s Republic of China; 2Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China; 3Department of Encephalopathy and Acupuncture, Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, People’s Republic of China; 4Department of Geriatrics, Shanghai Eighth People’s Hospital, Shanghai, 200235, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhen Zhou, Department of Encephalopathy and Acupuncture, Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 69 of Zengchan Road, Hebei District, Tianjin, 300250, People’s Republic of China, Tel +86-2260637106, Email zhouzhenzzzen@126.com Jin-Xiu Cao, Department of Geriatrics, Shanghai Eighth People’s Hospital, No. 8 Caobao Road, Xuhui District, Shanghai, 200235, People’s Republic of China, Tel +86-13502089031, Email caojinxui8f6@126.comObjective: This study was to investigate the mechanism of action and clinical efficacy of fire-needle therapy in improving neurological function in patients with acute cerebral infarction (identified as a wind-phlegm-blood stasis syndrome in traditional Chinese medicine).Methods: We included patients diagnosed with acute cerebral infarction (wind-phlegm-blood stasis syndrome) admitted to the Encephalopathy and Acupuncture Center of the Second Affiliated Hospital of Tianjin University of Chinese Medicine. We randomly allocated them into the treatment and control groups, with 45 cases in each group. Acupuncture treatments that focused on regulating the mind and dredging the collaterals were used in the control group, while the treatment group additionally received fire-needle therapy. Our indicators included the National Institutes of Health Stroke Scale (NIHSS) scores, the Fugl-Meyer Assessment (FMA) scale, peripheral blood tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), hypersensitivity C-reactive protein (hs-CRP), and intestinal metabolites short-chain fatty acids (SCFAs). We measured these indicators before treatment and 14 days after treatment.Results: The post-treatment NIHSS scores of the two groups were significantly reduced (P < 0.05), and the treatment group showed a more significant decline in the score when compared to the control group (P < 0.05). The treatment group showing significant improvement in the domains of reflex activity, mobility, cooperative movement, and finger movement (P < 0.05). Both groups showed a significant decrease in the IL-17 and hs-CRP levels (P < 0.05), with the treatment group demonstrating a significant declining trend when compared to the control group (P < 0.05). The levels of acetic acid, propionic acid, butyric acid, and valeric acid all increased significantly in the two groups (P < 0.05), with acetic acid and butyric acid increasing significantly in the treatment group when compared to the control group (P < 0.05). Clinical efficacy rate: 78.6% of patients in the treatment group had an excellent rate, whereas it was 30.0% in the control group, and the difference was statistically significant (P < 0.001).Conclusion: Fire-needle therapy was effective in upregulating the SCFA content in patients with acute cerebral infarction (wind-phlegm-blood stasis syndrome), inhibiting the level of the inflammatory response, and improving the recovery of neurological functions.Clinical registration number: Registration website link: https://www.chictr.org.cn. Registration date: 2022/9/27. Registration number: ChiCTR2200064122.Keywords: acute cerebral infarction, fire-needle therapy, short-chain fatty acids, wind-phlegm-blood stasis syndrome

BACKGROUND: Acute cerebral infarction (ACI) is one of the most common ischemic cerebrovascular diseases in neurology, with high morbidity, mortality, and disability. Early thrombolytic treatment of ACI has significant efficacy, but intraprocedural complications of hypoxemia can significantly reduce the efficacy. This study aims to analyze the risk factors for intraprocedural hypoxemia in patients with ACI, so as to take effective measures in advance to reduce the likelihood of adverse patient outcomes. METHODS: We retrospectively analyzed a total of 238 patients with ACI treated with vascular interventions from May 2017 to May 2022. To assess and collate the patients' characteristics, factors associated with the development of intraprocedural hypoxemia. The independent risk factors for the development of intraprocedural hypoxemia were analyzed by binary logistic regression. RESULTS: A total of 238 patients were included in this study. Of these, intraprocedural hypoxemia occurred in 89 (37.4%). The results showed that old age (odds ratio [OR] = 2.666, P = 0.009), obesity (OR = 3.029, P = 0.003), smoking history (OR = 2.655, P = 0.010), preoperative oxygen saturation (SpO2) (OR = 0.001, P = 0.042), preoperative C-reactive protein (OR = 1.216, P = 0.002), and time from puncture to vascular recanalization (OR = 1.135, P = 0.000) were independent risk factors for intraprocedural hypoxemia in patients. The prognosis of the patients was assessed according to the modified Rankin scale, and the prognosis of the nonhypoxemia group was significantly better than that of the hypoxemia group. Regression analysis showed that intraprocedural hypoxemia (OR = 0.360, P = 0.001), postoperative lower extremity vein thrombosis (OR = 0.187, P = 0.018), hydrocephalus (OR = 0.069, P = 0.015), intracranial hemorrhage (OR = 0.116, P = 0.002), and reocclusion (OR = 0.217, P = 0.036) were independent risk factors for poor prognosis. CONCLUSIONS: Currently, intravascular hypoxemia in patients with ACI has a serious impact on prognosis. Clinical work should attach great importance to the clinical characteristics of patients, identify relevant risk factors, and aggressively take personalized therapeutic actions to improve patients' prognosis.

Objective: To explore the relationship between the levels of serum uric acid (UA), cystatin C (CysC) and lipoprotein-associated phospholipase A2 (Lp-PLA2) and prognosis of patients with acute cerebral infarction complicated with leukoaraiosis. Methods: 113 patients with acute cerebral infarction complicated with leukoaraiosis admitted to the 960 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from March 2020 to December 2022 were selected, the levels of serum UA, CysC and Lp-PLA2 were detected. Followed up for 1 month, the patients were divided into good prognosis group (0 ~ 2 scores, 75 cases) and poor prognosis group (3 scores and above, 38 cases) according to the modified Rankin Scale (mRS) score. Multivariate Logistic regression was used to analyze the risk factors of poor prognosis in patients with acute cerebral infarction complicated with leukoaraiosis, and receiver operating characteristic curve (ROC) was used to analyze the value of serum UA, CysC and Lp-PLA2 in predicting poor prognosis in patients with acute cerebral infarction complicated with leukoaraiosis. Results: The levels of serum UA, CysC, and Lp-PLA2 in the poor prognosis group were higher than those in the good prognosis group (P<0.05). Multivariate Logistic regression analysis showed that severe white matter lesions, high NIHSS score at admission, and high levels of serum UA, CysC, and Lp-PLA2 were risk factors for poor prognosis in patients with acute cerebral infarction complicated with leukoaraiosis (P<0.05). The area under the curve (AUC) of combined serum UA, CysC, and Lp-PLA2 to predict the prognosis of patients with acute cerebral infarction complicated with leukoaraiosis was 0.916, which was higher than the individual prediction. Conclusion: The elevated levels of serum UA, CysC, and Lp-PLA2 in patients with acute cerebral infarction complicated with leukoaraiosis were associated with poor prognosis, the combination of serum UA, CysC, and Lp-PLA2 had a higher predictive value for poor prognosis in patients with acute cerebral infarction complicated with leukoaraiosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of hyperbaric oxygen therapy at different time windows on serum tight junction protein (ZO-1), caveolin-1 (Caveolin-1) and Toll-like receptor 4 (TLR4) /nuclear transcription factor-κB (NF-κB) signaling pathway in patients with acute cerebral infarction (ACI) . Methods: 158 ACI patients who were treated in The First Affiliated Hospital of Air Force Military Medical University from April 2020 to April 2023 were selected as the research objects, patients were divided into group A (accept routine treatment, hyperbaric oxygen therapy was given within 12 h～7 d after the onset of the disease) and group B (accept routine treatment, hyperbaric oxygen therapy was performed within 12 h onset) by random number table method, with 79 cases in each group.The changes of each scale score, cerebral blood perfusion, serum ZO-1, Caveolin-1 levels and TLR4/NF-κB signaling pathway related indicators were compared in two groups. Results: After treatment, the National Institutes of Health Stroke Scale (NIHSS) in group B was lower than that in group A, and the activity of daily living (ADL) score was higher than that in group A (P＜0.05) . After treatment, the cerebral vascular reserve capacity (CVR), bilateral cerebral artery peak flow velocity and bilateral cerebral artery peak average flow velocity in group B were higher than those in group A (P＜0.05) . After treatment, serum Caveolin-1 in group B was lower than that in group A, and serum ZO-1 was higher than that in group A (P＜0.05) . After treatment, TLR4 and NF-κB in group B were lower than those in group A (P＜0.05) . Conclusion: Hyperbaric oxygen therapy in ACI patients within 12 hours of onset can effectively promote the recovery of neurological function and regulate the levels of serum ZO-1 and Caveolin-1, which may be relate to the inhibition of TLR4/NF-κB signaling pathway activation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of naomaili granules combined with edaravone dextrorphan injection concentrate solution on neurological function, hemorheology and oxidative stress in patients with acute cerebral infarction (ACI) . Methods: 140 ACI patients admitted to Nanjing Central Hospital and Changzhou First People’s Hospital from July 2022 to July 2023 were selected, and patients were divided into control group (n=70, conventional treatment combined with edaravone dextrorphan injection concentrate solution treatment) and observation group (n=70, received naomaili granules treatment on the basis of control group) according to random number table method. The efficacy, neurological function, activities of daily living, hemorheology and oxidative stress were compared in two groups. Results: The total clinical effective rate in observation group was higher than that in control group (P＜0.05) . The National Institutes of Health Stroke Scale (NIHSS), plasma viscosity, whole blood low shear viscosity, whole blood high shear viscosity, packet cell volume and malondialdehyde (MDA) in observation group were lower than those in control group after treatment, and daily living ability scale score (Barthel index) score and superoxide dismutase (SOD) in observation group were higher than those in control group (P＜0.05) .Conclusion: The combination of naomaili granules and edaravone dextroborneol injection concentrate solution in the treatment of ACI patients, which is helpful to regulate hemorheology, improve neurological function, reduce oxidative stress and improve their activities of daily living. [ABSTRACT FROM AUTHOR]