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Objective. This study seeks to explore the efficacy and prognosis of stereotactic aspiration for malignant middle cerebral artery infarction (mMCAI). Methods. A total of 50 mMCAI patients who were diagnosed and treated in our hospital from January 2018 to June 2020 were collected and then randomly divided into control group (decompressive craniectomy, n = 24) and study group (stereotactic aspiration, n = 26). After 1 and 6 months of treatment, the scores of the National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), Barthel Index, and modified Rankin Scale (mRS) were used to evaluate the therapeutic effect. Additionally, the mortality and survival rates after treatment were recorded to compare the prognostic effect between the two groups. Results. One month after treatment, the GCS scores and Barthel Index score increased in both the control and study groups and were significantly higher in the study group. The follow-up results at 1 and 6 months after treatment showed that in comparison with the control group, stereotactic aspiration led to a higher survival rate and lower mortality rate; the latter had superior NIHSS score and mRS score and better prognosis. Conclusion. In comparison with decompressive craniectomy, stereotactic aspiration shows outstanding clinical efficacy and more advantages in the treatment of mMCAI. Therefore, stereotactic aspiration is more worthy of clinical application.

Mesenchymal stem cells-derived exosome (MSCs-exo) is a potential method for cerebral infarction (CI) treatment. Here, western blot and qRT-PCR were carried out to measure the expression of proteins and genes, respectively. Modified neurological severity score and TTC staining were used to evaluate the brain injury of middle cerebral artery occlusion (MCAO) rats. Immunohistochemistry was performed to detect the expression of Iba-1, iNOS, and Arg-1 in tissues. Moreover, the rate of M1/M2 microglia was ensured by flow cytometry, and the concentration of pro-inflammatory factors in medium was measured using ELISA. Here, we found that miR-23a-3p is increased in human umbilical cord blood MSCs-exo. Bone marrow MSCs-exo (BMSCs-exo) could improve the injury in neuronal function and reduce the infarct size in vivo. However, the improvement of BMSCs-exo to CI was reversed by miR-23a-3p knockdown. The inhibition of BMSCs-exo to MCAO-induced microglia activation and M1 polarization and the upregulation of pro-inflammatory factors were limited by miR-23a-3p knockdown, which also confirmed in lipopolysaccharide-induced microglia. Overall, our data indicated that MSCs-exo improves CI via transferring miR-23a-3p, thus to induce the deactivation of microglia and M2 polarization. Our study revealed a new regulatory mechanism of CI.

Background Excessive reactive oxygen species (ROS) may attack biological macromolecules and induce oxidative stress. The inhibition by ascorbic acid (AsA) on oxidative damage has been reported in fruits, while the barrier effect of ceramide has also been proven. However, there are few reports about the effects of ceramide-AsA interactions to enhance storability and boost antioxidant systems in fruits during storage. This study was conducted to study the synergistic effects of AsA in combination with ceramide on the quality of postharvest strawberry (Fragaria anannasa cv. Tianbao). Results Treatment with 100 mg L-1 AsA plus 1.2 mmol L-1 ceramide significantly delayed the rot of strawberries, reduced the water loss and the contents of ROS, malonaldehyde (MDA), and proline, however, increased the contents of total flavonoids, total phenols, and anthocyanins compared with other treatments. Also, treatment with 100 mg L-1 AsA plus 1.2 mmol L-1 ceramide significantly increased the activities of peroxidase (POD) and superoxide dismutase (SOD) but inhibited the activity of polyphenol oxidase (PPO). Conclusion It is suggested that treatment with 100 mg L-1 AsA plus 1.2 mmol L-1 ceramide could significantly reduce the oxidative damage and maintain the storage quality of strawberries during storage by enhancing the antioxidant systems. © 2019 Society of Chemical Industry.

Background This study aimed to evaluate the efficacy and safety of stereotactic aspiration of necrotic brain tissue for treating malignant middle cerebral artery infarction (MMI) in patients older than 60 years of age. Case Description A total of 13 consecutive patients with MMI (mean age, 67 ± 6.62 years) were enrolled in the study. These patients were treated with stereotactic aspiration of necrotic brain tissue within 72 hours from stroke onset between January 2016 and June 2017. The surgical results and clinical outcomes were evaluated in response to stereotactic aspiration of necrotic brain tissue. The mean preoperative infarction volume in the patients was found to be 153.46 ± 9.39 mL according to the latest computed tomography scan. The 30-day mortality was 2 out of 13 patients (15.4%). Patients were followed-up for 6 months to evaluate the efficacy of stereotactic aspiration of necrotic brain tissue using the modified Rankin Scale (mRS). Among the 11 surviving surgical patients, 6 (54.5%) had an mRS score of 3 (defined as moderate disability), 4 (36.4%) had an mRS score of 4 (defined as moderate to severe disability), and 1 (9.1%) had an mRS score of 5 (defined as severe disability). The probability of 6-month unfavorable outcome, defined as an mRS score of 5 or 6 (death), was 3 out of 13 (23.1%). Conclusions Our results suggest the stereotactic aspiration of necrotic brain tissue is an effective and safe method in patients with MMI who are over 60 years of age.

Atherosclerotic subclavian artery stenosis (SAS) accompanied with other craniocervical artery stenosis (OCAS) is not uncommon in practice. We sought to investigate the safety and efficacy of endovascular stenting for SAS in patients with OCAS. Between January 2004 and February 2012, 71 consecutive atherosclerotic SAS patients who underwent primary stenting in our medical center were included. The enrolled patients were divided into combined-SAS group (n = 51) and solitary-SAS group (n = 20) depending on the presence or absence of OCAS. Data of demographics, procedure, and the followed-up were retrieved and analyzed. The technical success rate was 95.8 %; the clinical success rate was 90.1 %. There was no catheter-related major stroke or death. The immediate outcomes had no statistical difference between groups. During a mean of 27 ± 20 months (range 2–88 months) followed-up, 7(10.3 %) restenosis and 12(17.6 %) clinical events were identified. The primary patency rate was 95.3, 84.9 and 84.9 % at 12, 24 months, and final followed-up respectively, which had no statistical difference between groups (odds ratio (OR), 2.60; 95 % confidence interval (CI), 0.54–12.53; P = 0.232). The overall clinical event-free survival rate was 93.5, 86.2 and 54.6 %, respectively, where the result of combined-SAS group was inferior to that of the solitary-SAS group (OR, 3.34; 95 % CI, 1.02–11.00; P = 0.047). Endovascular stenting was safe and feasible for atherosclerotic SAS in patients with OCAS, although the combined OCAS may have a significant influence on the long-term outcome. Further studies are warrant to investigate the effects of revascularization for multiple craniocervical artery stenoses on the cerebral hemodynamics and long-term outcomes.

Gene therapy holds great potential for treating neurological disorders. However, delivering gene vectors to the brain has been either invasive or inefficacious in most studies to date. The aim of this study was to develop a safe and efficacious strategy for delivering gene vectors to the brain. A tetracycline-inducible replication-defective herpes simplex virus type-1 vector, QR9TO-LacZ, was administered to rats intranasally. QR9TO-LacZ could infect primary cortical neurons and express the reporter gene without detectable replication. QR9TO-LacZ was observed in the olfactory bulb, hippocampus, striatum, cortex, medulla, cerebellum, ventricles, and nasal septum after intranasal administration. Expression of the reporter gene could be controlled effectively by tetracycline. In vitro, introduction of QR9TO-LacZ did not change the structure of transfected neurons. In vivo, QR9TO-LacZ did not increase apoptosis in neurons and did not alter levels of interleukin 6 and tumor necrosis factor α in the brain after intranasal delivery. Our data suggest that intranasally applied QR9TO-LacZ has a wide distribution and expresses the reporter gene in the brain under the control of tetracycline with less cytotoxicity than intravenous or stereotactic delivery methods.

Background: To investigate the correlation between tortuosity of extracranial internal carotid artery (EICA) and intraprocedural complications in patients undergoing carotid artery stenting (CAS). Methods: The study included 244 EICA in 223 patients undergoing CAS. Tortuosity in EICA was measured by the tortuosity index (TI). Multivariate logistic regression was performed to assess the independent risk factors of vasospasm during CAS. Receiver operating characteristic curve was performed to identify the cut-off of TI to predict vasospasm. Results: During the 244 CAS, 71 EICA presented vasospasm and 114 CAS presented hypotension. High TI, long procedural duration and female are independent risk factors for vasospasm during CAS. TI of 118 was the optimal cut-off to predict vasospasm during CAS (sensitivity: 85.9%, specificity: 78.6%). Linear regression analysis demonstrated that TI is positively correlated with procedural duration (p < 0.001). There was no significant difference in TI between the hypotension and non-hypotension groups (p = 0.145). Conclusion: TI is an independent risk factor for vasospasm during CAS and a TI ≥118 has the high sensitivity and specificity to predict vasospasm. Our results indicate the value of assessing tortuosity of EICA prior to choosing or performing the procedure in patients with carotid stenosis or occlusion.

We aimed to investigate the association between plasma homocysteine and obstructive sleep apnoea (OSA) syndrome in patients with ischaemic stroke. A total of 102 patients with ischaemic stroke were classified into four OSA groups based on their apnoea-hypopnoea index (AHI): absent (AHI5/hour); mild (5-14/hour); moderate (15-30/hour); and severe (30/hour). The mean (± standard deviation) homocysteine levels in the four OSA groups were: absent, 8.98 ± 3.74 μmol/L; mild, 11.46 ± 3.31 μmol/L; moderate, 14.18 ± 4.36 μmol/L; and severe, 18.57 ± 4.56 μmol/L; and these differences were statistically significant (p0.001). The Pearson correlation analysis revealed a positive correlation between homocysteine levels and the severity of AHI (r = 0.482, p0.001). Multiple linear regression analysis showed that AHI and folate were independent predictors of homocysteine levels (R(2) = 0.539, p0.001, β for AHI = 0.259, β for folate = -0.400). In conclusion, the severity of OSA is significantly associated with elevated homocysteine levels in patients with ischaemic stroke, and this association is independent of other factors that cause elevation in homocysteine.

Background and Purpose: Recent studies reported that peripheral blood CD34+ cells and endothelial progenitor cells contributed to angiogenesis in patients with moyamoya disease (MMD), and stromal cell-derived factor-1α (SDF-1α) modulated angiogenesis by interacting with corresponding CXCR4 receptors. We investigated in this study whether SDF-1α/CXCR4 axis involved in neovascularization in patients with MMD. Methods: Eighteen patients with MMD and twelve healthy individuals were enrolled. Patients with MMD detected by cerebral angiography were retrieved from the Nanjing Stroke Registry Program. Peripheral whole blood cells were double stained with anti-CD34 and anti-CXCR4 (CD184). Numbers of CD34+ CXCR4+ cells were analyzed by flow cytometry. Plasma concentration of SDF-1α was determined by enzyme-linked immunosorbent assay. Results: In consecutive patients with MMD, the number of CD34+ CXCR4+ cells was greater than healthy individuals (54.1 ± 28.6/μl peripheral blood (PB) versus 24.6 ± 25.6/μl PB; P = 0.015). Plasma SDF-1α level was significantly higher in patients with MMD compared with healthy controls (1676.76 ± 198.65 pg/ml versus 1508.26 ± 137.27 pg/ml; P = 0.016). No significant correlation between number of CD34+ CXCR4+ cells and plasma SDF-1α level in the patients with MMD was observed (r = 0.185; P = 0.46). Conclusion: This study indicated that increased levels of circulating SDF-1α and CD34+ CXCR4+ cells in patients with MMD, which may play an important role in the vasculogenesis in MMD.

This study aimed to evaluate the efficacy and safety of stereotactic aspiration combined with subsequent thrombolysis in treating moderate thalamic hemorrhage (TH).A total of 105 patients with TH were nonrandomly assigned to the conservative treatment group (n = 60) or to the aspiration group (n = 45). Patients in the aspiration group were treated with stereotactic aspiration plus subsequent thrombolysis for removal for their hematomas.The 30-day mortality in the conservative group was significantly higher than that in the aspiration group (28.3% (17/60) vs. 11.2% (5/45), P = 0.032). The rank of the 30-day Glasgow outcome scale in the conservative group was significantly lower than that in the aspiration group (P = 0.041), and the mean 30-day National Institutes of Health Stroke Scale score of the survivors in the conservative group was significantly higher than that in the aspiration group (16.5 ± 4. 2 vs. 14.2 ± 3.9, P = 0.012). There were a greater reduction in TH volume in the aspiration group than in the conservative group from day 1 to day 3 (-0.24% and 39.28%, respectively, P0.0001) and from day 1 to day 7 (26.58% and 63.26%, respectively, P0.0001). The rank of 90-day Glasgow outcome scale was significantly lower in the conservative group than that in the aspiration group (P = 0.015). Eighteen of 60 patients (30.0%) had a favorable outcome in the conservative group, whereas 23 of 45 patients (51.1%) had a favorable outcome in the aspiration group, and this difference was significant (P = 0.028). The 90-day cumulative mortality rate in the conservative group was significantly higher than that in the aspiration group (33.3% (20/60)) vs. 15.6% (7/45), P = 0.039).Stereotactic aspiration plus subsequent thrombolysis is effective and safe for moderate TH.

Ginsenoside Rb1 has been demonstrated with neuroprotective effects, but the mechanisms remain unclear. This study aimed to probe the effects and mechanisms of ginsenoside Rb1 on activation of autophagy in glutamate-injured neurons. Ginsenoside Rb1 of exponential concentrations (1.2, 12, 120 microM) or autophagy inhibitor 3-methyladenine (5mM) was added to culture medium for cortical neurons after being treated with glutamate. Cell viability was measured by MTT assay. Autophagosomes formation was observed with transmission electron microscope. Autophagy marked protein LC3 was detected with immunofluorescence and visualized under laser confocal microscopy. Changes of autophagy related protein Beclin-1 were measured with Western blot. We found that ginsenoside Rb1 protected cortical neurons from glutamate-induced cell injury. Autophagy was activated after glutamate treatment, with both autophagosomes and punctate LC3 increased significantly compared with control. Beclin-1 was elevated in glutamate-treated cells. Formation of autophagosome and punctate LC3 was attenuated by ginsenoside Rb1. The level of Beclin-1 in ginsenoside Rb1 treated cells was simultaneously decreased compared with glutamate-treated cells. These results suggested that inhibition of autophagy could be responsible for neuroprotective effects of ginsenoside Rb1 in glutamate-induced injury. Down-regulation of Beclin-1 may play an important role in this process.