Cerebral Infraction Research Articles

Trillium tschonoskii rhizome saponin improves spatial learning and memory by enhancing neurovascular restorative in ischemic rats

BackgroundTrillium tschonoskii rhizome saponins (TSTT) has been significantly effective in treating traumatic injury, neurasthenia, cancer and inflammatory diseases as a folk medicine. However, the mechanism regarding to TSTT induced the neurovascular restorative after ischemia is without fully elucidated. PurposeThis research was constructed to study the value of TSTT in promoting endogenous repair of neurovascular and augmenting the ability of spatial study and memory retention in ischaemic rats. Study designThe improvement of TSTT on cerebral infraction and perfusion was observed by magnetic resonance imaging (MRI) experiments and the molecular mechanisms were further explored. MethodsFirst, rats were ligated the middle cerebral artery to construct a permanent ischaemia model, subsequently intragastric injection administrated with TSTT (120, 60, 30 mg kg-1) at 6 h after operation, then once a day during next 30 days. Morris water maze was applied to observe the neurobehavioral changes. Multimodal MRI sequences were performed to monitoring brain injuries as well as cerebral blood flow. Histopathological staining was employed to evaluate the morphological changes of neurons. Transmission electron microscopy (TEM) was employed to detect the neurons, vascular structure, and synapse. Immunofluorescent staining was utilized to evaluate the endogenous repair progress. The axonal growth-inhibitors and axonal guidance cues were analyzed using western blotting. ResultsContrast to the model group, TSTT declined the infarction and elevated the parenchymal volume. Notably, treated with TSTT significantly decreased the ADC (ipsilateral/contralateral). In histopathologic examination, TSTT prominently boosted amounts of cortical and striatal nerve cells and protected ultrastructure of neurovascular unit. According with results of nuclear magnetic imaging, TSTT enhanced endogenous repair progress. Especially, TSTT treatments obviously inhibited protein levels of NogoA/NgR/RhoA/ROCK2, accompanied by increased expression of Netrin/DCC and Slit2/Robo1. ConclusionTo sum up, our data illustrated that TSTT promoted cerebral reestablishment. The above result was in line with improving cerebral blood flow, elevated integrity of neurovascular structure, accelerating endogenous restoration and impairing the axonal growth inhibitors NogoA/NgR/RhoA/ROCK2 signaling, thereby improving poststroke learning and memory.

Understanding the mechanism of acupuncture in acute cerebral infraction through a proteomic analysis: protocol for a prospective randomized controlled trial.

Acute cerebral infarction (ACI), being the predominant form of stroke, presents challenges in terms of the limited effectiveness of various treatments in improving the neurological function. Although acupuncture shows promise in addressing ACI, the availability of high-quality evidence regarding its efficacy, safety, and underlying mechanism remains insufficient. In this study, we design a multicenter, prospective, single-blind, randomized controlled trial with the aim of evaluating the efficacy and safety of acupuncture for ACI, making an attempt to unveil the molecular mechanisms by proteomic. A total of 132 patients involving four hospitals will be randomized at a 1:1:1 ratio in the acupuncture group, control group, and sham acupuncture group. All the patients will receive basic treatment, and the patients in the acupuncture and sham acupuncture groups will also receive either acupuncture or sham acupuncture treatment, respectively, at six sessions each week for a 2 weeks period, followed by 3 months of follow-up. The primary outcome will be the change in the National Institute of Health Stroke Scale (NIHSS) scores after treatment. The secondary outcomes will include the Fugl-Meyer Assessment (FMA) scale scores and the Barthel Index (BI). Adverse events that occur during the trial will be documented. To discover differentially expressed proteins (DEPs) and their roles between the ACI subjects and healthy controls, we will also perform 4D-DIA quantitative proteomics analysis, and the DEPs will be confirmed by enzyme-linked immunosorbent assay (ELISA). This study was approved by the institutional review board of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (TYLL2023043). Written informed consent from patients is required. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2300079204). Trial results will be published in a peer-reviewed academic journal. The results of this study will determine the preliminary efficacy and safety of acupuncture in ACI patients and whether the mechanism of this form of non-pharmacologic stimulation is mediated by a novel therapeutic target for neurorehabilitation through our proteomic analysis. https://www.chictr.org.cn, identifier ChiCTR2300079204.

Protective effect and possible mechanisms of geniposide for ischemia-reperfusion injury: A systematic review with meta-analysis and network pharmacology of preclinical evidence

BackgroundGeniposide, as a pharmacologically bioactive component, is derived from a classic and common Chinese herb, Gardenia jasminoides Ellis. Geniposide has been shown to be effective for treating I/R injury in recent studies. Current effectively pharmaceutical treatments are scarce, and treatment based on geniposide may become a novel option. As far as we know, this research is the initial systematic evaluation of the protective effects of geniposide in I/R injury. Aim of the studyThis study is engrossed in evaluating the mechanism of action of geniposide in I/R injury through a preclinical systematic review with meta-analysis and network pharmacology. Materials and methodsWe built a systematic review which provided a view of effect and mechanism of geniposide for I/R injury. Based on seven databases, an open-ended search from their inception to August 31st, 2022, was conducted. Animal studies on the effects of geniposide in I/R injury were considered. The data was analyzed using Review Manager 5.3, and bias was assessed using the CAMARADES 10-item scale. 13 articles including 279 animals were selected finally. And network pharmacology was joined to elucidate the mechanism. ResultsAccording to the meta-analysis, in I/R injury, geniposide can attenuate cardiomyocytes viability and the size of MI, decrease the volume of cerebral infraction and neurological score, decrease serum ALT and AST activity, and downregulated serum Cr and BUN. The review found that geniposide protects against I/R injury by inhibiting apoptosis, oxidation, inflammation and improvement of autophagy and mitochondrial respiration, which is consistent with the results of the network pharmacology screening. ConclusionThis preclinical systematic review including meta-analysis and network pharmacology, which was the first one summarizing the relationship between geniposide and ischemia diseases, shows a novel therapy for I/R injury and appears an enticing implication of geniposide in I/R injury, and further research is looked forward. Given the restricted quantity of included researches and the unclear risk of bias of the studies, we should interpret the results with caution.

Safety of Mechanical Thrombectomy in Patients on Antiplatelet/Anticoagulation

Mechanical thrombectomy (MT) is performed in patients who are already on anticoagulation (AC)/antiplatelet therapy (AP). However, data are insufficient regarding MT's safety and efficacy profiles in these patients. Investigate the outcome of stroke patients already on anticoagulation/antiplatelet receiving MT. We included consecutive acute ischemic stroke patients treated with MT for 10years (2012-2022) in a comprehensive stroke center. Baseline variables, efficacy (recanalization [Thrombolysis in Cerebral Infraction]≥2b), good functional outcome (modified Ranking Scale ≤ 2 at 3months), and safety (symptomatic intracranial hemorrhage [sICH], mortality rates) were evaluated. Additionally, we conducted a subgroup analysis of patients with prior single-AP versus DAPT. Six hundred forty-six patients were included (54.5% women, median age 71years), 84 (13%) were on AC, 196 (30.3%) on AP, and 366 (56.7%) in the control group. The AC and AP groups were older and had more comorbidities. sICH occurred in 7.3% of cases. There was no significant difference in sICH incidence across the groups. The AC group had a lower rate of intravenous thrombolysis (15.9%; P < 0.001), a higher rate of sICH (11.9% vs. AP 7.7% and control 6%; P= 0.172), and higher mortality at discharge (17.9% vs. AP 8.7% and control 10.4%; P= 0.07). However, the groups had similar functional outcomes and mortality rates at 3months. Successful recanalization was achieved in 92.7% and was similar across groups. Multivariable logistic regression and the subgroup analysis (single-AP vs. dual AP) did not reveal statistically significant associations. MT in patients with prior anticoagulation and AP presenting with acute ischemic strokeis feasible, effective, and safe.

Analysis on application effect and prognostic factors of medical care combined with nursing in the elderly with T2DM and Cerebral Infarction based on targeted management mode

ABSTRACT To explore the analysis on application effect and prognostic factors of medical care combined with nursing in the elderly with type 2 diabetes mellitus (T2DM) and cerebral infraction (CI) based on targeted management mode. The clinical data of 180 elderly patients with T2DM and CI in our hospital from August 2017 to August 2019 were selected for retrospective analysis. Their cognitive function and daily living ability before and after intervention were evaluated, using the National Institutes of Health Stroke Scale (NIHSS) to evaluate their prognosis. They were divided into good prognosis group (n = 134) and poor prognosis group (n = 46) according to the score. Binary Logistic regression analysis was adopted to analyze the prognostic factors of such patients. After intervention, patients had visibly lower indexes of blood glucose fluctuation and lower average scores of ADL and MMSE (P < 0.001), with differences in body mass index, systolic pressure, diastolic pressure, fasting blood glucose and triglyceride in both groups (P < 0.001). Binary Logistic regression analysis showed that systolic pressure, diastolic pressure and triglyceride were risk factors affecting patients’ prognosis (P < 0.05). Medical care combined with nursing based on targeted management mode has a remarkable control effect on blood glucose, and has a positive effect on improving cognitive function and living ability of elderly patients with T2DM and CI. In addition, attention should be paid to monitoring systolic and diastolic blood pressures, and triglyceride in patients to improve the prognosis.

Oxidation‑reduction potential parameters worsen following intraarterial therapy in patients with reduced collateral circulation and middle cerebral artery occlusions.

Collateral circulation is important for cerebral perfusion in acute ischemic strokes. Monitoring the oxidation-reduction potential (ORP) may be useful to assess collateral status or treatment efficacy. The objectives of the present study were to determine if the ORP was associated with collateral circulation status in middle cerebral artery (MCA) occlusions and to identify patterns in the ORP and the collateral circulation status among patients treated with intraarterial therapy (IAT) over time. The present pilot study was nested within a prospective cohort study measuring the ORP of the peripheral venous plasma of stroke patients. The population included in the present study were patients with MCA (M1/M2) occlusions. Two ORP parameters were examined: Static ORP (sORP; mV), indicating oxidative stress, and capacity ORP (cORP; µC), indicating antioxidant reserves. Collateral status was retrospectively graded using Miteff's system as good (grade 1) or reduced (grade 2/3). Comparisons were made between collateral status groups (reduced vs. good collaterals) in all patients, within a subset including only patients who received IAT, and between thrombolysis in cerebral infraction scale score (TICI) groups (0-2a vs. 2b/3). The Fisher's exact test, Student's t-test and Wilcoxon tests were used (α<0.20). The 19 patients were categorized based on their collaterals: Good collaterals (53%) and reduced collaterals (47%). The baseline characteristics were similar with the exception that the patients with good collaterals had a lower international normalized ratio (P=0.12) and were more likely to have a stroke on the left side (P=0.18) or to have a mismatch (P=0.05). The admission sORP values were comparable (169.5 vs. 164.2 mV; P=0.65), as was admission cORP (P=0.73). When considering only the patients who received IAT (n=12), admission sORP (P=0.69) and cORP (P=0.90) were also statistically similar. On day 2, after IAT, both groups experienced a worsening in ORP measures; however, the patients with good collaterals had a significantly lower sORP (169.4 vs. 203.5 mV; P=0.02) and a higher cORP (0.2 vs. 0.1 µC; P=0.002) compared with the patients with reduced collaterals. Neither sORP nor cORP were significantly different between TICI score groups on admission or on day 2. Upon discharge, patients with a TICI of 2b-3 had a significantly better sORP (P=0.03) and cORP (P=0.12) compared with those with a TICI of 0-2a. In conclusion, upon patient admission, the ORP parameters were not significantly different between the collateral circulation status groups for MCA occlusions. The ORP parameters worsened after IAT regardless of the collateral circulation status; however, after IAT, on day 2, patients with good collaterals experienced less oxidative stress (sORP) and had higher antioxidant reserves (cORP) than patients with reduced collaterals.

Danshensu Enhances Cerebral Angiogenesis in Mice by Regulating the PI3K/Akt/Mtor/VEGF Signaling Axis.

Cerebral infraction seriously affects the life quality of patients. Danshensu has been reported to exhibit anti-inflammatory and vascular protective effects. However, the therapeutic function of Danshensu in cerebral vascular injury is still unclear. Middle cerebral artery occlusion (MCAO) was used to construct the cerebral infraction model. Wound healing and tube formation assays were used to evaluate angiogenesis in vitro. Western blot assay was used to evaluate the activation of the PI3K/Akt/mTOR signaling pathway. The laser Doppler scanner was used to measure the regional cerebral blood flow (rCBF) in the area around the infarction, and the adhesion removal test was used to measure the sensorimotor function. The Modified Neurological Severity Score was performed to evaluate the cognitive functions of mice. Danshensu promoted the proliferation of bEnd.3 cells and angiogenesis in vitro. Danshensu upregulated the expression of VEGF through PI3K/Akt/mTOR signaling pathway in bEnd.3 cells. Danshensu improved rCBF restoration and attenuated the behavioral deficits in mice post-MCAO/R. Danshensu enhances angiogenesis through the PI3K/Akt/mTOR/VEGF signaling pathway in a mouse model of cerebral ischemic injury.

Acute cerebral ischemic stroke as a presentation of polycythemia vera: a case report and a review of literature.

In the presenting study, we report a 60-year-old male patient who presented with a right-side weakness for 3 days. After laboratory and brain imaging, he was diagnosed with an acute cerebral infarct affecting the left basal ganglion secondary to PV. PV as the cause of ischemic stroke is a rare condition but can be encountered in clinical practice, and clinicians should be familiar with this combination.

Preliminary research of the classification of the brain acute stroke lesions by the Diffusion Kurtosis Imaging (DKI) and Diffusion Weighted Imaging (DWI) parameters.

Diffusion-weighted magnetic resonance imaging (DWI) is a mature scanning technique. With high sensitivity in detecting cerebral infractions, it has become an essential part of the clinical evaluation of acute stroke. However, with the update in medical ideals and treatment, clinicians are now focusing on distinguishing between reversible and irreversible brain tissue damage rather than detecting ischaemic lesions alone. We supposed that Diffusion Kurtosis Imaging (DKI) could classify heterogeneous DWI lesions, deepening the understanding of tissue injury. We systematically studied the different parameters of DKI in acute stroke patients in the literature. We collected 41 patients (26 male, 15 female), including different infarctions with acute cerebral infarction in different brain regions. Of all patients, 20 were single-infarction, while others were multi-infarctions. In this paper, we categorized acute cerebral infarction lesions into two types according to the parametric characteristics of both DKI and DWI. Type I means the DKI and DWI were matched, and Type II means the DKI and DWI were mismatched. Based on each parametric map, the region of interest (ROI) is outlined in each most severe lesion area (as large as possible in the center of the lesion). In the control group, ROIs of the same size are located in the corresponding regions of the contralateral hemisphere. In both Type I and Type II, all parameters conform to a normal distribution. An independent sample T-test was used to compare the differences between each group. In Type I, we found the FA, MD, Da, Dr, MK and Ka values were statistically different (P< 0.05), while in Type II, only the MK and Ka values were statistically different (P< 0.05). DKI, compared to DWI, can provide more imaging information about intracranial ischemic infarction, which can deepen the understanding of the mechanism of ischemic tissue damage. Our classification of the brain acute stroke lesions by DKI parameters and DWI may help us rediscover the real core of infraction.

THE CIRCADIAN PATTERN OF 24-HOUR AMBULATORY BLOOD PRESSURE AND HEART RATE IN THE CEREBRAL INFRACTION PATIENTS WITH HYPERTENSION AND HYPERTENSIVES PATIENTS

Aims: Evaluation of the circadian rhythm of 24-hour ambulatory blood pressure and pulse rate in the cerebral infraction patients with hypertension and hypertensives patients with purpose prognostic, prevention and treatment in two group.&#x0D; Objects and methods: This study included 140 cerebral infarction patients with hypertension, hospitalized for the first 7 days (mean age 65.5±10.4 years) and 143 primary hypertensive patients (mean age of 64.4±7.5 years). All had 24-h ambulatory recording, with measurement 30 every minutes in the daytime (6.00 am - 10.00 pm) and every 60 minutes at night (10.00 pm - 6.00 am). Results: Blood pressure in patients with cerebral infarction oscillated significantly more than in hypertensive patients; mean standard deviation of systolic blood pressure (25.8 mmHg) and diastolic blood pressure (15.8 mmHg) in patients with cerebral infarction respectively was significantly higher than those with hypertension (20 mmHg and 12.1 mmHg) with p &lt;0.01. The rate of non-dipping blood pressure at night, the overload of systolic and diastolic blood pressure, morning surge blood pressure in patients with cerebral infarction was significantly higher than that of hypertensive patients (92.1; 75.5; 60.2; 57.8 versus 64.3; 60.1; 49.1; 36.3 respectively; p &lt;0.01). Conclusion: It is necessary to monitor 24-hours ambulatory blood pressure in hypertensive patients and patients with cerebral infarction in the first week of admission to identify some phenomena such as nocturnal non-dipping blood pressure, the overload of blood pressure, especially morning surge blood pressure early to plan for prevention of target organ damage, particularly cerebral stroke in hypertensive patients.

CLINICAL PROFILE OF ISCHEMIC STROKE AND ITS OUTCOME IN RELATION TO GLYCEMIC STATUS ON PRESENTATION AT A TERTIARY CARE CENTRE: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Stroke, also known as a cerebrovascular accident, is common in patients and can be a major cause of morbidity and mortality. Stroke and hyperglycemia appear to be linked in two ways. Diabetics are known to have a greater stroke rate than non-diabetics. Even in non-diabetics, a mild degree of hyperglycemia early in a stroke has been reported to increase infarct size and lead to a bad prognosis. Aim: To study the clinical prole, infarct size on CT scan, and clinical outcome of cerebral infraction in relation to glycemic status at presentation. Material and Methodology: This prospective observational study was conducted in the medicine department of Jhalawar Medical College, Jhalawar, a tertiary care center in south-east Rajasthan, from January 2020 to June 2021. The study included all ischemic stroke patients. Data were analyzed in SPSS 21. Independent t-tests and Chi-square tests were applied. A p value of &lt; 0.05 was considered statistically signicant. Results: The current study revealed that out of 100 participants, 39 were euglycemic, 27 had stress hyperglycemia, and 34 had diabetes; a small, medium, or large infarct was present in 39, 27, and 34 patients, respectively. Diabetes patients had a statistically signicant high NIHSS score, blood sugar level, and deaths, followed by stress hyperglycemia, and euglycemic patients had the lowest. Conclusion: Hyperglycemia, including stress hyperglycemia and diabetes, was a common nding in patients with ischemic stroke, and NIHSS, blood sugar, and death were associated with hyperglycemia in ischemic stroke patients.

Abstract WP205: Principal Diagnosis And Independent Predictors For 30-day Readmissions In Cryptogenic Stroke

Background: Cryptogenic stroke is defined as cerebral infraction that can’t be attributed to large artery atherosclerosis, small artery disease, or cardio-embolism, despite a standard cardiovascular and serologic workup. Our objective was to identify rates and causes for readmissions of cryptogenic stroke. Methods: A retrospective analysis was conducted using National Readmission Database 2018 with ICD-10 codes. Readmission rate and principal diagnosis for 30-day readmission for cryptogenic stroke were primary outcomes. Secondary outcomes were in-hospital mortality, and independent predictors of readmission. Multivariate logistic regression analysis was used for assessment. Results: Within 30 days, 21,418 out of 206,627 patients were readmitted, giving a 30-day readmission rate of 10.4%. For the index admissions, 49.9% were females, and mean age was 70 years. The in-hospital mortality rate for index admissions was 2.4% while it was 4.9% for the readmissions. The ten most common principal diagnosis for 30-day readmissions were subsequent admission for cryptogenic stroke (10.5%), sepsis (7.1%), acute kidney injury (3.2%), transient ischemic attack (1.9%), urinary tract infection (1.8%), aspiration pneumonitis (1.7%), hypertensive heart and chronic kidney disease (HHD/CKD) with heart failure (1.6%), left carotid artery stenosis/occlusion (1.5%), non-specific cerebral infarction (1.3%), and HHD with heart failure (1.2%). The independent predictors for readmission were heart failure, ischemic heart disease, ventricular arrhythmia, infective endocarditis, peripheral artery disease, venous thromboembolism, pulmonary embolism, and diabetes mellitus. Conclusions: Readmission rate for cryptogenic stroke is 10.4% within 30 days and is associated with higher mortality and costs. Most common principal diagnosis for readmission are cryptogenic stroke, sepsis, acute kidney injury, transient ischemic attack, urinary tract infection, and aspiration pneumonitis. The independent predictors for readmission are heart failure, ischemic heart disease, ventricular arrhythmia, infective endocarditis, peripheral artery disease, venous thromboembolism, pulmonary embolism, and diabetes mellitus.

A cross-sectional study of early-onset epilepsy of intracerebral hemorrhage and construction of a risk prediction model

To study the early-onset epilepsy of intracerebral hemorrhage and build a prediction model to evaluate its prediction efficiency. A cross-sectional investigation was conducted to construct a specialized optimized prediction model. The prediction model was converted into a visual optimized scoring scale, so as to quantify the probability of secondary epilepsy after intracerebral hemorrhage. Based on the current prediction model of acute cerebral infraction and post-stroke seizure (AIS-PSS), the evaluation efficacy of optimized score for secondary epilepsy after hemorrhagic stroke was explored. (1) After sample size calculation and sufficient inclusion and exclusion, 159 patients with cerebral hemorrhage were continuously selected as the model group of this cross-sectional study. A total of 29 patients with early-onset epilepsy and 130 patients without secondary epilepsy were enrolled. The time span was from January 2021 to August 2021. In addition, 77 patients with acute cerebral hemorrhage from August 2021 to February 2022 were selected as the verification group, among which 12 patients had early-onset epilepsy and 65 patients had not any secondary epilepsy. (2) There were significant differences in demographic characteristics such as diabetes history, cerebral infarction history, smoking history, National Institutes of Health Stroke Scale (NIHSS) score, intracerebral hemorrhage hematoma volume, serum creatinine (SCr), neuron-specific enolase (NSE), S-100 protein and intracerebral hemorrhage site between the two model groups with different prognosis (all P < 0.05). (3) The above indexes were included in univariate and multivariate Poisson regression analysis, and the results showed that the duration of diabetes [relative risk (RR) = 1.229, 95% confidence interval (95%CI) was 1.065-1.896, P = 0.036], smoking history (RR = 1.419, 95%CI was 1.133-2.160, P = 0.030), history of cerebral infarction (RR = 1.634, 95%CI was 1.128-2.548, P = 0.041), hematoma volume of cerebral hemorrhage (RR = 1.222, 95%CI was 1.024-2.052, P = 0.041), NES content (RR = 1.146, 95%CI was 1.041-1.704, P = 0.032), were independent influencing factors to constitute the prediction model. The prediction model was converted into a visual optimized scoring scale in the form of a line diagram to obtain the prediction probability corresponding to the corresponding score. (4) Receiver operator characteristic curve (ROC curve) was used to test the evaluation efficiency of optimized score and AIS-PSS score for early-onset cerebral hemorrhage epilepsy. Relevant data of patients in the verification group were extracted according to the information of two scores, and the final score of each patient in the verification group was obtained. The score and prognosis were put into the ROC curve to evaluate the predictive ability of different prediction models. The results showed that the cut-off value of the optimized score and the AIS-PSS score were 144 points and 7 points, respectively, and the area under the ROC curve (AUC) and the Yoden index of the optimized score were slightly lower than the AIS-PSS score. However, compared with AIS-PSS score, there was no significant difference in the evaluation efficiency of optimized score for early-onset epilepsy (Z = 1.874, P > 0.05). This study constructed a specific early-onset epilepsy prediction model for patients with hemorrhagic stroke, and transformed it into an optimized score that is easy for clinical use, and its evaluation efficiency is reliable.

Comparison of the Appendicular Emptying Velocity of Left Atrium in patient with moderate versus severe chronic rheumatic mitral stenosis measured by pulsed wave Doppler in Transesophageal echocardiography

Background: Left atrial appendage (LAA) is considered the “most lethal human appendage” as it causes significant mortality and morbidity in chronic rheumatic mitral stenosis patients due to cardiogenic cerebral infract. Presence of LAA dysfunction has been shown to be a strong predictor of thrombus formation and the risk of embolic event, even if no clot is found at the time of initial examination. LAA emptying velocity are measured by trans esophageal echocardiography (TEE) represent as a surrogate marker for left atrial(LA) function .LAA emptying velocities (contraction velocity) &lt; 20cm/s are associated with risk of spontaneous echo contrast(SEC), LAA thrombus, and subsequent cardio embolic events. So early detection of low emptying velocity without SEC or LA thrombus can reduce mortality &amp; morbidity related to cardio embolic stroke and also helps in further management procedure like cardio version etc. So we will compare LAA emptying velocity moderate versus severechronic rheumatic mitral stenosis patients in our population for further attention.&#x0D; Objective: To assess emptying velocity of LAA in patient with moderate versus severe chronic rheumatic mitral stenosis, from a Bangladesh health service perspective.&#x0D; Method: This was a cross sectional study which was conducted in UCC, BSMMU during the period of from February 2019 to September 2019 in Echo lab .&#x0D; Study Procedure: We were enrolled 33 CRHD with MS (moderate to severe) patients who underwent TEE and met inclusion &amp; exclusion criteria. The purpose of the study was explained to each subject &amp; informed written consent was obtained. After getting consent relevant history, physical examination and preprocedural investigation was obtained in predesigned structured data collection sheet. TEE was done with Vivid E9® machine. Pulse wave Doppler was position at the tip of the LAA and then emptying velocity of LAA moderate and severe were compared.&#x0D; Outcome measure: Among 33 patients, 3 patients were excluded due to outlier and inadequate data.. In chronic rheumatic mitral stenosis in moderate versus severe cases average LAA emptying velocities were significantly higher moderate CRHD with MS compare to severe CRHD with MS,(26.57±4.91;31.12±5.04), P=0.018.&#x0D; Conclusion:Appendicular emptying velocity of LAA significantly lower in severe CRHD with MS compare to moderate CRHD with MS and it has temporal relation with MS severity. It can be used as a reliable, simple and sami-invasive tool to early predict severity and prevent complication in CRHD with MS as well as for prophylactic measured taken.&#x0D; University Heart Journal 2022; 18(2): 73-79

Protective effect of Xingnaojing injection on ferroptosis after cerebral ischemia injury in MCAO rats and SH-SY5Y cells

Xingnaojing（XNJ）injection is a traditional Chinese medicine injection with neuroprotective effect, which has been widely used in the treatment of stroke for many years. This study aimed to explore the potential mechanism of XNJ in cerebral ischemia mediated by ferroptosis using proteomics and in vivo and in vitro experiments. After the rat model of middle cerebral artery occlusion (MCAO) was successfully established, they were randomly divided into model, XNJ, and deferoxamine (DFO) group. Triphenyl tetrazolium chloride (TTC) staining, Hematoxylin and eosin (H&E), and Nissl staining were used to observe the infarct area, pathological changes and the degree of neuronal apoptosis of rat brain. Proteins extracted from rat brain tissues were analyzed by quantitative proteomics using tandem mass tags (TMT). Western blotting and immunohistochemical assessment were used to measure the expression of ferroptosis-related proteins. In vitro, the SH-SY5Y cells were subjected to hypoxia (37°C/5% CO2/1% O2) for 24h to observe the survival rate, and detect the reactive oxygen species (ROS) content and ferroptosis-related proteins. In TTC and H&E experiments, we found that XNJ drug treatment reduced the infarct volume and brain tissue damage in MCAO rats. Nissl staining also showed that compared with MCAO group rats, the Nissl bodies of brain tissue after XNJ drug intervention were clear with a 3.54-fold increased times, suggesting that XNJ improved cerebral infraction, and neurological deficits in MCAO rats. Proteomics identified 101 intersected differentially expressed proteins (DEPs). According to the bioinformatics analysis, these DEPs were closely related to ferroptosis. Further research indicated that MCAO-induced cerebral ischemia was alleviated by upregulating recombinant glutathione peroxidase 4 (GPX4), ferroportin (FPN) expression, Heme oxygenase-1 (HO-1) expression, and downregulating cyclooxygenase-2 (COX-2), transferring receptor (TFR) and divalent metal transporter-1 (DMT1) expression after XNJ treatment. In addition, in vitro experiment indicated that XNJ improved the survival rate of hypoxia-damaged SH-SY5Y cells. XNJ increased the level of GPX4 and inhibited the protein expression of COX-2 and TFR after cell hypoxia. Moreover, different concentrations of XNJ (0.25%, 0.5%, 1%) reduced the ROS content of hypoxic cells, suggesting that XNJ could inhibit hypoxia-induced cell damage by regulating the expression of ferroptosis-related proteins and decreasing the production of ROS. XNJ could promote the recovery of neurological function in MCAO rats and hypoxia SH-SY5Y cells by regulating ferroptosis.

Effect of Xingnao Kaiqiao acupuncture on safety of rt-PA intravenous thrombolysis in patients with cerebral infarction: a randomized controlled trial

To assess the effect of Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with cerebral infarction. A total number of 142 patients of cerebral infarction undergoing rt-PA intravenous thrombolysis were randomized into an acupuncture-medication group (71 cases) and a western medication group (71 cases, 1 case dropped off). In the western medication group, rt-PA intravenous thrombolysis was given. In the acupuncture-medication group, besides the intervention as the control group, Xingnao Kaiqiao acupuncture was provided at Shuigou (GV 26), Neiguan (PC 6), Sanyinjiao (SP 6), Jiquan (HT 1), etc. once daily. One treatment session contained 6 treatments and 1 session was required. Before and after treatment, the score of the National Institute of Health stroke scale (NIHSS), the levels of the relevant indexes of symptomatic intracerebral hemorrhage (sICH) (platelet [PLT], D-dimer and fibrinogen), the incidences of sICH and adverse effect were compared between groups. The efficacy was assessed in two groups. After treatment, NIHSS scores and the levels of D-dimer were reduced compared with those before treatment in both groups (P<0.05), and those in the acupuncture-medication group were lower than the western medication group (P<0.05). The level of fibrinogen in the acupuncture-medication group was increased in comparison with that before treatment (P<0.05), and also higher than the western medication group (P<0.05). The incidence of sICH was 0% (0/71) in the acupuncture-medication group, lower than 8.6% (6/70) in the western medication group (P<0.05). The effective rate was 97.2% (69/71) in the acupuncture-medication group, higher than 87.1% (61/70) in the western medication group (P<0.05). The incidence of adverse effect was 2.8% (2/71) in the acupuncture-medication group, lower than 12.9% (9/70) in the western medication group (P<0.05). Xingnao Kaiqiao acupuncture may improve the efficacy of rt-PA intravenous thrombolysis in the patients with cerebral infraction and decrease the incidences of sICH and adverse effect. The mechanism may be related to the regulation of fibrinogen and D-dimer levels.

Artificial Intelligence–Parallel Stroke Workflow Tool Improves Reperfusion Rates and Door‐In to Puncture Interval

Background The Viz.ai artificial intelligence (AI) software module Viz large‐vessel occlusion (LVO) utilizes AI‐powered LVO detection and triage technology to automatically identify suspected LVOs through computed tomographic angiogram imaging and alert on‐call stroke teams. We performed this analysis to determine whether the Viz LVO software can reduce the door‐in to puncture time interval within a comprehensive stroke center (CSC) for patients requiring endovascular treatment. Methods We conducted a retrospective chart review that compared the time interval between patient arrival in the emergency department (door‐in) to puncture for patients who presented consecutively with a stroke code to our CSC between November 2016 and May 2020. The implementation of the AI software (Viz LVO) at the CSC was in November 2018. Using a prospectively collected database at the CSC, demographics, and outcomes were examined. This study was based on evaluating real‐world practice. Results We analyzed 86 patients from the pre‐AI study phase (average age, 68.53±13.13 years, 40.7% female) and 102 patients from the post‐AI study phase (average age, 69.87±15.75 years, 43.1% women). Following the implementation of the software, the mean door‐in to puncture time interval within the CSC significantly improved by 86.7 minutes (206.6 versus 119.9 minutes; P &lt;0.001); significant improvements were also noted in the rate of reperfusion (modified Thrombolysis in Cerebral Infraction 2B‐3) for patients in the post‐AI population ( P =0.036). Conclusion The incorporation of the software was associated with a significant improvement in treatment time within the CSC, as well as significantly higher rates of adequate reperfusion. Prospective, multicenter, controlled studies with a larger cohort are warranted to expand on the ability of Viz LVO to improve treatment times and outcomes for patients with an LVO stroke.

An emergency nursing and monitoring procedure on cognitive impairment and neurological function recovery in patients with acute cerebral infarction.

The optimization and standardization of emergency nursing and monitoring procedures are of great significance for thrombolytic treatment of acute cerebral infarction. Studies on the emergency nursing and monitoring procedure on cognitive impairment and neurological function in patients with acute cerebral infarction are still limited. The study was a randomized controlled trial and 134 patients with acute cerebral infarction were recruited. They were randomly arranged into the control group (n = 67) receiving normal nursing procedure and the intervention group (n = 67) receiving emergency nursing and monitoring procedure after pre-intervention assessment. The cognitive impairment, neurological function and levels of inflammatory biomarkers and neuron-specific enolase of the participants were evaluated and analyzed. Emergency nursing and monitoring procedure improved Mini-mental State Examination and Montreal Cognitive Assessment scores of patients with cerebral infraction compared with the control group. It also improved the scores of National Institutes of Health Stroke Scale, activities of daily living scale, Fugl-Meyer scale in the participants. Emergency nursing and monitoring procedure led to significantly decreased neuron-specific enolase and inflammatory cytokines in the serum of the participants. Emergency nursing and monitoring procedure are beneficial for cognitive impairment and neurological function recovery in patients with acute cerebral infarction.

Pharmacological Effect of Panax notoginseng Saponins on Cerebral Ischemia in Animal Models.

Panax notoginseng saponins (PNS), bioactive compounds, are commonly used to treat ischemic heart and cerebral diseases in China and other Asian countries. Most previous studies of PNS have focused on the mechanisms underlying their treatment of ischemic cardiovascular diseases but not cerebral ischemic diseases. This study sought to explore the pharmacological mechanisms underlying the effectiveness of PNS in treating cerebral ischemic diseases. Different experimental cerebral ischemia models (including middle cerebral artery occlusion (MCAO) and the blockade of four arteries in rats, collagen-adrenaline-induced systemic intravascular thrombosis in mice, thrombosis of carotid artery-jugular vein blood flow in the bypass of rats, and hypoxia tolerance in mice) were used to investigate the mechanisms underlying the actions of PNS on cerebral ischemia. The results indicated that (1) PNS improved neurological function and reduced the cerebral ischemia infraction area in MCAO rats; (2) PNS improved motor coordination function in rats with complete cerebral ischemia (blockade of four arteries), decreased Ca2+ levels, and ameliorated energy metabolism in the brains of ischemia rats; (3) PNS reduced thrombosis in common carotid artery-jugular vein blood flow in the bypass of rats; (4) PNS provided significant promise in antistroke hemiplegia and hypoxia tolerance in mice. In conclusion, PNS showed antagonistic effects on ischemic stroke, and pharmacological mechanisms are likely to be associated with the reduction of cerebral pathological damage, thrombolysis, antihypoxia, and improvement in the intracellular Ca2+ overload and cerebral energy metabolism.

High thrombus platelet content is associated with a lower rate of first pass effect in stroke treated by endovascular therapy.

First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays. Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass. AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content. Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.