Cerebral Infarction Patients Research Articles

Effect of Rehabilitation in Combination with Hyperbaric Oxygen Treatment on the Secretion of Neurotrophic Factors and Oxidative Stress in Recovery Phase of Cerebral Infarction Patients

This research study was conducted to elucidate the effect of rehabilitation in combination with hyperbaric oxygen treatment on the secretion of neurotrophic factors and oxidative stress in recovery phase of cerebral infarction patients. A total of 120 cerebral infarction patients undergoing the treatment in recovery phase between June 2017 and May 2019 were randomized into the control group and the experiment group, with 60 patients in each group. In the control group, patients took the regular rehabilitation, while those in the experiment group performed the rehabilitation in combination with hyperbaric oxygen treatment. At admission (T0) and after 14 d of treatment (T1), we detected the differences of the level’s neurotrophic factors, neurotransmitters and indicators of oxidative stress by comparison. At T0, comparison of the neurotrophic factors, neurotransmitters and indicators of oxidative stress showed no significant differences between two groups. At T1, patients in the experiment group experienced sharp decreases in myelin basic protein and neuron specific enolase levels and increase in nerve growth factor as compared with their counterparts in the control group; in serum, the level of glutamic acid in the experiment group was lower than that in the control group, while γ-aminobutyric acid showed the totally opposite change; in terms of the indicators of oxidative stress, the levels of reactive oxygen species and lipid hydrogen peroxide were lowered in the experiment group, with increases in the levels of catalase and superoxide dismutase when comparing with the control group. For treatment of cerebral infarction patients in recovery phase, rehabilitation in combination with hyperbaric oxygen treatment can optimize the nerve function while inhibit the general oxidative stress responses.

MiR-124 Is Downregulated in Serum of Acute Cerebral Infarct Patients and Shows Diagnostic and Prognostic Value

Acute cerebral infarct (ACI) is a severe subtype of ischemic stroke. microRNAs (miRNAs) are implicated in the pathogenesis of ACI. This study investigated the expression pattern and clinical implication of miR-124 in ACI patients. Serum samples were collected from 108 healthy people and 108 ACI patients at 24 h, 48 h, and 72 h. Serum miR-124 expression was tested using qRT-PCR. The levels of interleukin (IL)-6, IL-8, and C-reactive protein (CRP) were detected using ELISA kits. The correlations between miR-124 expression and infarct classification, infarct size, risk factors, and inflammatory factors were analyzed. The diagnostic efficacy of miR-124 in ACI was analyzed by the ROC curve. ACI patients were assigned to the miR-124 high/low expression group and the incidence of poor prognosis was compared between the two groups. miR-124 expression was poorly expressed in the serum of ACI patients. The area under the ROC curve of miR-124 in the diagnosis of ACI was 0.9527, the specificity was 91.67%, and the sensitivity was 93.52%. miR-124 expression in ACI patients was not affected by infarct classification, infarct size, low-density lipoprotein level, and homocysteine level. miR-124 expression was negatively correlated with IL-6, IL-8, and CRP in ACI patients. Low expression of miR-124 was positively correlated with the poor prognosis of ACI. miR-124 was poorly expressed in the serum of ACI patients and served as a biomarker for the diagnosis and prognosis. This study shall confer a promising novel target for the diagnosis and treatment of ACI.

Factors Predicting Basic Mobility at Discharge with Acute Cerebral Infarction Patients

Factors Predicting Basic Mobility at Discharge with Acute Cerebral Infarction Patients

Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window

OBJECTIVES:To investigate the safety and efficacy of combined tirofiban-ozagrel therapy for treating progressive stroke patients out of thrombolytic therapy time window.METHODS:This prospective, double-blind, randomized controlled study included 337 patients who had experienced an acute ischemic stroke between November 2017 and December 2018. All patients were randomized into three groups: 1) the tirofiban/ozagrel group (n=113), 2) the tirofiban group (n=110), and 3) the ozagrel group (n=114). The platelet aggregation (PAG), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) levels in the patients from these groups were evaluated before starting treatment and then, at 24h, 7 days, and 14 days after treatment. The National Institutes of Health Stroke Scale (NIHSS) scores were evaluated before treatment and then, 24h, 1 week, 2 weeks, and 4 weeks after treatment. The Barthel Index (BI) score was used to measure safety, and the modified Rankin scale (mRS) was used to evaluate disability following 3 months of treatment. The risk factors affecting clinical outcomes were analyzed using logistic multivariate regression.RESULTS:The mean NIHSS score for all the patients was 13.17±3.13 before treatment, and no significant difference between the basic clinical parameters of the three patient groups was found. Following treatment, both PAG and FIB were significantly reduced compared with the baseline (p<0.05). The levels of PAG and FIB in the tirofiban/ozagrel group were significantly lower than those in the tirofiban and ozagrel groups at 24h and 7 days after treatment (p<0.05). The NIHSS score decreased significantly in all treatment groups (p<0.05). The tirofiban/ozagrel NIHSS scores were significantly lower than that of the tirofiban and ozagrel groups at 24h, 1 week, and 2 weeks post initiation (p<0.05 for all). There were no significant differences in the BI and mRS scores or the intracranial hemorrhage rates; further, age, sex, Trial of ORG 10172 in acute stroke treatment (TOAST) type, baseline NIHSS and 24-h NIHSS scores, baseline thrombus-related factors, and treatment methods were shown to not be independent risk factors for clinical outcomes.CONCLUSION:The combination of tirofiban and ozagrel, as well as monotherapy with either tirofiban or ozagrel, transiently improves the neural function of patients and reduces platelet aggregation and fibrinogen formation in the first 4 weeks following a stroke event; additionally, none of these treatments increased the risk for hemorrhage in these progressive stroke patients over a 3-month period.

Silent cerebral infarcts in patients with sickle cell disease: a systematic review and meta-analysis

Background and purposeSilent cerebral infarcts (SCIs) are the most common neurological complication in children and adults with sickle cell disease (SCD). In this systematic review, we provide an overview of studies that have detected SCIs in patients with SCD by cerebral magnetic resonance imaging (MRI). We focus on the frequency of SCIs, the risk factors involved in their development and their clinical consequences.MethodsThe databases of Embase, MEDLINE ALL via Ovid, Web of Science Core Collection, Cochrane Central Register of Trials via Wiley and Google Scholar were searched from inception to June 1, 2019.ResultsThe search yielded 651 results of which 69 studies met the eligibility criteria. The prevalence of SCIs in patients with SCD ranges from 5.6 to 80.6% with most studies reported in the 20 to 50% range. The pooled prevalence of SCIs in HbSS and HbSβ0 SCD patients is 29.5%. SCIs occur more often in patients with the HbSS and HbSβ0 genotype in comparison with other SCD genotypes, as SCIs are found in 9.2% of HbSC and HbSβ+ patients. Control subjects showed a mean pooled prevalence of SCIs of 9.8%. Data from included studies showed a statistically significant association between increasing mean age of the study population and mean SCI prevalence. Thirty-three studies examined the risk factors for SCIs. The majority of the risk factors show no clear association with prevalence, since more or less equal numbers of studies give evidence for and against the causal association.ConclusionsThis systematic review and meta-analysis shows SCIs are common in patients with SCD. No clear risk factors for their development were identified. Larger, prospective and controlled clinical, neuropsychological and neuroimaging studies are needed to understand how SCD and SCIs affect cognition.

Association of Anterior Cerebral Artery Variants and Cerebral Infarction in Patients with Balloon-Assisted Coil Embolization for Unruptured Internal Carotid Artery Aneurysms

Balloon-assisted coiling (BAC) is an endovascular treatment that may be associated with increased complications and thromboembolic events compared with other coiling techniques. We compared clinical outcomes of endovascular treatment (simple coiling, stent-assisted coiling, and BAC) in patients with unruptured intracranial aneurysms at the internal carotid artery and assessed risk factors that could cause cerebral infarction in patients who underwent BAC. We retrospectively reviewed the records of 528 patients with 544 aneurysms who underwent endovascular treatment for unruptured intracranial aneurysms between January 2013 and November 2019. Demographic features, clinical information, balloon inflation time, fetal posterior cerebral artery, anterior cerebral artery (ACA) variants, and angiographic results were analyzed to determine risk factors for cerebral infarction. There were no significant differences among the 3 groups in terms of general characteristics. In the BAC group, 14 of 39 patients showed a significantly higher incidence of cerebral infarction on diffusion magnetic resonance imaging compared with the stent-assisted coiling (37/238) and simple coiling (21/267) groups (P<0.001). There was no significant difference between the ACA variants (normal vs. hypoplasia or aplasia) and cerebral infarction in the simple coiling and stent-assisted coiling groups, but the proportion of aplasia or hypoplasia in the BAC group was significantly higher (P=0.001). There is a significant association between anatomic ACA variants and cerebral infarction occurrence after BAC. Identifying the variant of the anatomic ACA using digital subtraction angiography would help to predict cerebral infarction after BAC.

Feasibility of Recruiting and Assessing Health-Related Quality of Life and Physical Function in Older Chinese Adults with Cerebral Infarction

Objective: While it is known that exercise therapy can improve physical and emotional function in cerebral infarction (CI) patients, few studies have examined how well this would be accepted by older adults in China. Methods: In this study, the feasibility of recruiting and assessing health-related quality of life and physical function in older Chinese adults with cerebral infarction was assessed. Specific aims of the study were to evaluate the feasibility of recruiting older adults, with and without CI, from three different locations/settings in China; Compare the quality of life and physical function measures between CI and control subjects; Propose future larger randomized controlled studies of aerobic and resistance exercise training in both human and animal models after CI. Results: Overall, 66/275 (24.0%) surveys that were sent to older Chinese adults were returned and evaluated. Of those surveys returned, 18 (27%) met the study inclusion and exclusion criteria. Consequently, the results of this feasibility study indicate there is a recruitment yield (number of subject contacted/number of subjects who qualified for study) of 6.5%. These number varied at the different sites/settings, but the highest recruitment yield was seen in hospitalized patients. Despite small sample sizes, there were statistically significant differences in health-related quality of life and physical function between CI patients and control subjects. Conclusion: This feasibility study demonstrated that it is possible to successfully recruit CI patients for an exercise intervention study as well as to perform important assessments of health-related quality of life and physical function. Further randomized controlled trials, in humans and animal models, will be needed determine if aerobic and/or resistance exercise training can improve health and physical function in older CI patients. Additional studies will be needed to determine the specific mechanisms responsible for the benefits see with aerobic and resistance training.

Abstract 15499: The Increase of Proplatelets and Tpo in Circulation May be a New Pathological Mechanism of Thrombosis

Introduction: Platelets are produced from megakaryocytes, which mainly regulated by thrombopoietin (TPO) and 5-HT. We hypothesized that the secretion of inflammatory cytokines increased in patients with thrombosis under stress or inflammation, leading to increased TPO levels, which in turn increased production capacity of platelet, and increased the number of platelet intermediates proplatelets into the circulation. Therefore, the increase in the number of proplatelets in the circulation, and the increase in plasma TPO levels may be a new pathological mechanism of thrombosis. Methods: TPO was detected by ELISA. Proplatelets from patients were stained with CD41-FITC and further confirmed by a fluorescence microscope and flow cytometry. The in vitro proplatelets were tested by CD41-FITC staining under a fluorescence microscope and flow cytometry detection. Results: Our clinical data demonstrated that patients' plasma TPO levels were significantly higher with acute inflammation state compared with healthy subjects (181.1 ± 35.38 vs 96.1 ± 9.7 pg/ml, p&lt;0.001, n=65). The plasma TPO levels of cerebral infarction patients (186.2±12.5 pg/ml, n=20) were significantly higher than that of the control group (122.3±10.2 pg/ml, n=20). The number of platelets in patients with cerebral infarction (222.11±8.55 х10 9 /L, n=20) was slightly higher than that in the control group (206.55±8.83 х10 9 /L, n=20). More large platelets or proplatelets were found in the circulating blood of patients with cerebral infarction, which was significantly different from the control group (n=8, p&lt;0.05). In vitro study confirmed that in 200 megakaryocytes (MKs), more proplatelets were produced in the TPO group (100 ng/ml, 18±2.5%) and in the 5-HT group (100 nM, 15±3.2%), while the control group was only (7±3.2) % (n=5). The effects of TPO/ 5-HT were interfered with by its receptor blockers, confirming that their effects were mediated by its receptors. Both TPO and 5-HT affect the cytoskeleton by activating p-ERK1/2, reorganizing F-actin to generate proplatelets, and its role was blocked by PD98059. Conclusions: The studies showed that the increase of proplatelets in circulation and TPO levels in plasma may be a new pathological mechanism of cerebral infarction or thrombosis.

Serum anion gap at admission predicts all-cause mortality in critically ill patients with cerebral infarction: evidence from the MIMIC-III database

Background Recent studies reported that serum anion gap could be regarded as a prognostic biomarker for patients admitted to intensive care units. However, the association between AG and mortality in cerebral infarction patients remained largely unknown. Methods Relevant clinical data were collected from Medical Information Mart for Intensive Care III. Patients were divided into three groups according to tertiles of AG. Kaplan–Meier curve and Cox proportional hazards models were used to evaluate the association between AG levels and all-cause mortality. Subgroup analyses were performed to verify the predictive role of AG on mortality. Results Kaplan–Meier analysis showed that patients with higher AG had shorter survival time. Cox regression model indicated high AG as an independent risk factor of 30-day, 60-day and 180-day all-cause mortality (30-day: HR = 2.45, 95% CI = 1.21–4.97, 60-day: HR = 2.04, 95% CI = 1.07–3.89, and 180-day: HR = 1.85, 95% CI = 1.02–3.36). However, no significance was observed between AG and 365-day all-cause mortality (HR = 1.56, 95% CI = 0.87–2.78). Conclusions High AG was associated with increased risk of all-cause mortality, and AG could be an independent short-term prognostic factor for cerebral infarction.

MiR-5787 Attenuates Macrophages-Mediated Inflammation by Targeting TLR4/NF-κB in Ischemic Cerebral Infarction.

Accumulating studies have suggested the important role of microRNA (miRNA) in ischemic cerebral infarction. However, little is known of the modifying effect of miR-5787, a newly found miRNA, in ischemic cerebral infarction. We aim to elucidate the effect and underlying molecular mechanism of miR-5787 in the pathogenesis of ischemic cerebral infarction. MiR-5787 is demonstrated to be downregulated in peripheral blood mononuclear cells (PBMCs) samples of patients compared with controls, which is negatively associated with inflammatory cytokines of IL-6 and TNF-α in ischemic cerebral infarction. Besides, the expression of miR-5787 is also negatively related to TLR4, which is unregulated in PBMCs of ischemic cerebral infarction patients. Moreover, TLR4 is demonstrated to be a target of miR-5787 by bioinformatics' analysis and the luciferase reporter assay. In addition, miR-5787 can prevent from the proliferation and migration of macrophages, and attenuate LPS/TLR4-mediated inflammatory response via NF-κB in macrophages. MiR-5787 may be a promising biomarker for ischemic cerebral infarction.

Increased Circulating Proplatelets and Elevated Plasma TPO Levels: A Novel Pathological Mechanism of Cerebral Infarction

Background: Platelets are produced by megakaryocytes and are primarily regulated by thrombopoietin (TPO). In the conditions of inflammation or stress, increased 5-HT and other inflammatory cytokines may affect liver and bone marrow to increase TPO and platelet production (Yang et al., Stem Cells, 2007; 2014). Mature megakaryocytes are fragmented in pulmonary circulation to generate more platelet intermediate proplatelets, then entered the circulation. We hypothesized that in patients with cerebral infarction, the secretion of inflammatory cytokines increases under stress or inflammatory conditions, increasing circulating TPO levels, followed by an increase in platelet production, and an increase in the number of platelet intermediate proplatelets. At the same time, platelets also have varying degrees of activation. Therefore, the increase in the number of proplatelets in the circulation and the increase in TPO levels may be the new pathological mechanism of cerebral infarction. Methods: The plasma levels of TPO were detected by ELISA. The in vivo proplatelets from patients were stained with CD41-FITC, which was further confirmed under a fluorescence microscope and flow cytometry. The in vitro proplatelets were observed in a culture system by CD41-FITC staining under a fluorescence microscope and flow cytometry detection. Results: Our clinical data demonstrated that patients with acute inflammation states, plasma TPO levels were significantly higher compared with healthy subjects (181.1 ± 35.38 vs 96.1 ± 9.7 pg/ml, p&amp;lt;0.001, n=65), which may act as an acute response protein to protect the body. We also detected 20 patients with cerebral infarction and 20 normal controls and found that the plasma TPO levels of cerebral infarction patients (186.2±12.5 pg/ml) was significantly higher than that of the control group (122.3±10.2 pg/ml). The number of platelets in patients with cerebral infarction (222.11±8.55 ×109/L, n=20) was slightly higher than that in the control group (206.55±8.83 ×109/L, n=20). More importantly, we found more large platelets or proplatelets in the circulating blood of patients with cerebral infarction, which was significantly different from the control group (n=8). Furthermore, in vitro study confirmed that in 200 megakaryocytes (MKs), (18±2.5)% of MKs producing proplatelets in the TPO group (100 ng/ml), and in 5-HT group (100 nM), (15±3.2)% of MKs producing proplatelets, while the control group was only (7±3.2)% (n=5). At the same time, the effects of TPO and 5-HT were interfered by the corresponding receptor blockers, confirming that their effects were mediated by its receptors. The study further confirmed that both TPO and 5-HT affect the cytoskeleton by activating p-ERK1/2, reorganizing F-actin to generate proplatelets, and its role was blocked by PD98059. Conclusions: The study demonstrated that increased numbers of proplatelets in circulation and elevated plasma TPO levels may be novel pathological mechanisms of cerebral infarction Disclosures No relevant conflicts of interest to declare.

The usefulness of total thrombus-formation analysis system for predicting high bleeding risk in coronary artery disease patients taking anticoagulants who underwent percutaneous coronary intervention

Abstract Background Although anticoagulants are widely used for prevention of cerebral infarction in patients with atrial fibrillation (AF), venous thrombosis, and valvular disease, it is possible that anticoagulants increase bleeding events in daily medical practices. Recently, we reported that the total thrombus-formation analysis system (T-TAS) was useful for evaluating bleeding risk in coronary artery disease (CAD) patients. Aim We examined whether T-TAS was practical for predicting bleeding risk in CAD patients taking anticoagulants who underwent percutaneous coronary intervention (PCI). Methods This study was the retrospective analysis of the 500 consecutive CAD patients who underwent PCI. Blood samples obtained on the day of PCI were used in T-TAS to compute the thrombus formation area under the curve (AUC) (AR10-AUC30, AUC for AR chip). We divided the total number of study patients into two groups according to the presence of anticoagulants; 53 CAD patients with triple therapy (TT) and 447 CAD patients with dual antiplatelet therapy (DAPT). We compared clinical characteristics and prognosis between the two groups. The primary endpoint was 1-year bleeding events that were defined by ISTH bleeding criteria. We excluded the CAD patients who underwent emergency PCI, and who were treated for hemodialysis. Results All patients took aspirin and clopidogrel, or aspirin and prasugrel at baseline. Compared to the patients with DAPT, the patients with TT had atrial fibrillation and history of stroke. The AR10-AUC30 levels were significantly lower in the patients with TT than the patients with DAPT (median [interquartile range] 1402.6 [1095.1–1609.8] vs. 1679.8 [1526.4–1783.3], p&amp;lt;0.001). Thirty-five patients (7%) had bleeding events during follow-up [11 cases (20.8%) in the patients with TT, 24 cases (5.4%) in the patients with DAPT]. Kaplan-Meier curve analysis showed a worse 1-year bleeding event-free survival rate in the patients with TT compared with the patients with DAPT (p&amp;lt;0.001). Receiver operating characteristic analysis showed that AR10-AUC30 levels significantly predicted bleeding events (AUC 0.653, 95% CI 0.555–0.751; p=0.003) and the cut-off point was 1586.4 by Youden index in the present study. In multivariate Cox hazards analysis, low AR10-AUC30 level (≤1586.4) (hazard ratio 2.99; 95% CI 1.46–6.11; p=0.003) and taking warfarin (hazard ratio 3.02; 95% CI 1.24–7.34; p=0.015) were significant predictors for 1-year bleeding events. Conclusions The present findings suggested that the AR10-AUC30 level determined by T-TAS could be a useful marker for predicting high bleeding risk in CAD patients taking anticoagulants who underwent PCI. Funding Acknowledgement Type of funding source: None

Effects of Arteriovenous Thrombolysis Combined with Mechanical Thrombectomy on Efficacy and Neurological Function of Acute Cerebral Infarct Patients.

Objective To investigate the effects of arteriovenous thrombolysis combined with mechanical thrombectomy on clinical efficacy, neurological function, and the changes of nerve injury markers of acute cerebral infarct (ACI) patients. Methods A total of 143 cases with ACI admitted to our hospital from June 2017 to June 2019 were elected as research subjects. Among them, 69 cases of patients who received treatment of arteriovenous thrombolysis were considered as group A, and 74 cases of patients who received treatment of arteriovenous thrombolysis combined with mechanical thrombectomy were considered as group B. NIHSS score, clinical efficacy, vascular recanalization, adverse reactions, hemodynamics, neurological injury indexes, duration of coma, length of hospital stay, and prognosis of patients in the two groups were compared. Results After treatment, the NIHSS score of group A was higher than that of group B (P < 0.05), the clinical efficacy of group B was better than that of group A, and the incidence of adverse reactions was lower than that of group A (P < 0.05). There was no difference in vascular recanalization rate, duration of coma, and prognosis between the two groups (P > 0.05). Length of hospital stay, maximum peak velocity after treatment (Vs), and mean flow rate (Vm) of group A were lower than those of group B, while vascular resistance index (RI), pulsatility index (PI), serum glutamic acid (Glu), neuron-specific enolase (NES), and S100β protein detected by enzyme-linked immunosorbent assay (ELISA) of group A were higher than those of group B (P < 0.05). Conclusion Arteriovenous thrombolysis combined with mechanical thrombectomy has a significant effect on ACI, with high safety and quick effect. In addition, it has a stronger effect on improving and protecting the neurological function of patients, which is worth promoting in clinical practice.

LncRNA SNHG4 Attenuates Inflammatory Responses by Sponging miR-449c-5p and Up-Regulating STAT6 in Microglial During Cerebral Ischemia-Reperfusion Injury.

BackgroundInflammatory response mediated by microglia plays a key role in cerebral ischemia-reperfusion injury. This study intends to probe the role of lncRNA SNHG4 in regulating the inflammatory response of the microglia during cerebral ischemia reperfusion.Materials and MethodsBlood samples and cerebrospinal fluid samples were collected from acute cerebral infarction (ACI) patients and healthy controls. The middle cerebral artery occlusion (MCAO) models were constructed with rats. LPS induction and oxygen-glucose deprivation methods were respectively applied to simulate the activation of microglia in vitro. qRT-PCR was employed to determine the expressions of SNHG4, miR-449c-5p and related inflammatory factors in vivo and in vitro. The inflammatory responses of the microglia subject to the varied expressions of SNHG4 and miR-449c-5p were detected. Luciferase assays were conducted to verify the crosstalk involving SNHG4, miR-449c-5p and STAT6.ResultsCompared with the control group, the expression of SNHG4 derived from the samples of ACI patients and the microglia of MCAO group were remarkably down-regulated, but the expression of miR-449c-5p was dramatically up-regulated. Overexpression of SNHG4 and knock-down of miR-449c-5p could inhibit the expression of pro-inflammatory cytokine in the microglia and promote the expression of anti-inflammatory factors. Meanwhile, the phospho-STAT6 was up-regulated, whereas the knock-down of SNHG4 and over-expression of miR-449c-5p in microglia had the opposite effects. Luciferase assay confirmed that SNHG4 could target miR-449c-5p, while miR-449c-5p could target STAT6.ConclusionSNHG4 can regulate STAT6 and repress inflammation by adsorbing miR-449c-5p in microglia during cerebral ischemia-reperfusion injury.

Cognitive Function In Strategic And Non-Strategic Cerebral Infarction Locations, And White Matter Changes On Head MSCT Scan

Stroke is one of leading cause of mortality. Stroke increases 5-8 times the risk of cognitive impairment. The presence of strategic infarct locations and white matter changes were reported to be associated with cognitive impairment on ischemic stroke. This study aims to describe the characteristic of cognitive function of cerebral infarction patient in strategic and non-strategic locations; and white matter changes. This is descriptive study with retrospective design. Data of ischemic stroke patient at the Diagnostic Radiology Installation of Dr. Soetomo Surabaya during January - February 2020, were collected. Blennow scale was used to evaluate white matter changes, based on MSCT Scan. Degree of cognitive function assessed with MoCA-INA score. Total of 49 ischemic stroke patients, mostly in the age group of 51-60 and >60 years old (38,8%), male (59,2%), with strategic infarct locations (75,5%), and Blennow scale 2-3 (55,1%). Most of the subjects have decreased cognitive function (83.7%). Subjects who experienced cognitive dysfunction were mostly found in the age group 41 - 50 and >60 years old (34.7%). Cognitive impairment were mostly found in male patients (46.9%), with strategic infarct locations (69.4%), and with Blennow scale 2 – 3 (51%). Cognitive function in patient with strategic infarct locations, and white matter changes, mostly impaired.

Feasibility and Safety of Paclitaxel-Coated Balloon Angioplasty for the Treatment of Intracranial Symptomatic In-Stent Restenosis.

Objective: Symptomatic in-stent restenosis (sISR) is the major cause of medium- or long-term cerebral infarctions in patients who underwent percutaneous transluminal angioplasty and stenting for severe intracranial atherosclerotic stenosis. This study aims to evaluate the feasibility and safety of paclitaxel-coated balloon (PCB) angioplasty for the treatment of intracranial sISR.Methods: We report 11 cases of PCB angioplasty for intracranial sISR. Lesion locations and number were as follows: intracranial internal carotid artery (n = 4), M1 segment of middle cerebral artery (MCA) (n = 1), V4 segment of vertebral artery (n = 6). The technical success rate, periprocedural complications, and short-term outcome were retrospectively analyzed.Results: All procedures were successfully performed without periprocedural complication. Asymptomatic vessel dissection after PCB inflation occurred in one case. Postprocedural diffusion-weighted imaging (DWI) showed new asymptomatic ipsilateral infarction in one case. All 11 cases did not experience ipsilateral stroke or death within 30 days or ischemic stroke in the territory of the target artery between 31 and 90 days after procedure.Conclusion: This preliminary study indicates that PCB angioplasty is feasible and safe for the treatment of intracranial sISR. Further studies are needed to clarify its efficiency and long-term outcome.

Effects of Floium ginkgo extract and tertram ethypyrazine sodium chloride injection on expression of inflammatory cytokines and cerebral infarction

This experiment was carried out to observe and analyze the effect of floium ginkgo extract and tertram ethypyrazine sodium chloride injection in patients with cerebral infarction. A total of 200 patients diagnosed with cerebral infarction were enrolled in the study. They were randomly divided into a research group and control group, each containing 100 patients. The control group was given routine treatment measures while the research group was given floium ginkgo extract and tertram ethypyrazine sodium chloride injection on the basis of routine treatment. The therapeutic effects of the two groups were observed and compared. After implementing different treatment schemes, the levels of MMP-9, SOD, CBV and CBF in the research group were significantly higher than those in the control group, p&lt;0.05. The research group was lower in hs-CRP, MDA, MTT, TTP and TNF-α as compared with the control group, p&lt;0.05. In terms of the quality of life of the two groups after six months of treatment, the scores of various indicators in the research group were all significantly superior, p&lt;0.05. Conclusion: The treatment of cerebral infarction patients with floium ginkgo extract and tertram ethypyrazine sodium chloride injection can significantly improve the therapeutic effect, which is a relatively ideal treatment.

Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke

PurposeEarly infarcts are hard to diagnose on non-contrast head CT. Dual-energy CT (DECT) may potentially increase infarct differentiation. The optimal DECT settings for differentiation were identified and evaluated.MethodsOne hundred and twenty-five consecutive patients who presented with suspected acute ischemic stroke (AIS) and underwent non-contrast DECT and subsequent DWI were retrospectively identified. The DWI was used as reference standard. First, virtual monochromatic images (VMI) of 25 patients were reconstructed from 40 to 140 keV and scored by two readers for acute infarct. Sensitivity, specificity, positive, and negative predictive values for infarct detection were compared and a subset of VMI energies were selected. Next, for a separate larger cohort of 100 suspected AIS patients, conventional non-contrast CT (NCT) and selected VMI were scored by two readers for the presence and location of infarct. The same statistics for infarct detection were calculated. Infarct location match was compared per vascular territory. Subgroup analyses were dichotomized by time from last-seen-well to CT imaging.ResultsA total of 80–90 keV VMI were marginally more sensitive (36.3–37.3%) than NCT (32.4%; p > 0.680), with marginally higher specificity (92.2–94.4 vs 91.1%; p > 0.509) for infarct detection. Location match was superior for VMI compared with NCT (28.7–27.4 vs 19.5%; p < 0.010). Within 4.5 h from last-seen-well, 80 keV VMI more accurately detected infarct (58.0 vs 54.0%) and localized infarcts (27.1 vs 11.9%; p = 0.004) than NCT, whereas after 4.5 h, 90 keV VMI was more accurate (69.3 vs 66.3%).ConclusionNon-contrast 80–90 keV VMI best differentiates normal from infarcted brain parenchyma.

Venous cerebral infarction in patient with thrombophilia while taking hormonal drugs

A clinical case of venous cerebral infarction in a patient with congenital thrombophilia without thrombosis of cerebral venous sinuses is presented. Etiology, diagnosis and treatment of venous heart attacks are considered. Particular attention is paid to methods of diagnosis and therapy.

Association Between Ghrelin Gene Polymorphism and Cerebral Infarction.

BackgroundThe aim of this study was to explore the associations of ghrelin gene polymorphisms at rs26312, rs26802 and rs27647 with cerebral infarction.Material/MethodsA total of 200 cerebral infarction patients in our hospital were enrolled as the disease group, while 200 healthy people were enrolled as the control group. Peripheral venous blood was collected from both groups, and the ghrelin gene polymorphisms at rs26312, rs26802, and rs27647 in nucleated cells were detected through sequencing.ResultsThe genotype distribution at ghrelin gene loci rs26802 and rs27647 in the disease group was significantly different from that in the control group. The distribution of recessive model at ghrelin gene locus rs26802 in the disease group was different from that in the control group, in which the TG+GG frequency was evidently higher in the disease group. The AA genotype at ghrelin gene locus rs26312 was remarkably associated with the ghrelin gene expression level, and the expression level of ghrelin gene in the disease group was remarkably lower than that in the control group. The genotype at ghrelin gene locus rs26312 was associated with activated partial thromboplastin time (APTT), and APTT was significantly shorter in patients with GG genotype. The genotype at ghrelin gene locus rs26802 was associated with D-dimer, and the D-dimer level was significantly lower in patients with TG genotype. The genotype at ghrelin gene locus rs27647 was associated with prothrombin time (PT), and PT was obviously shorter in patients with TT genotype.ConclusionsThe ghrelin gene polymorphisms are remarkably associated with the occurrence of cerebral infarction.