Progressive Cerebral Infarction Research Articles

Prognostic impact of oral anticoagulation therapy and atrial fibrillation in patients with type B acute aortic dissection.

The prognostic impact of atrial fibrillation (AF) and oral anticoagulation (OAC) therapy in patients with type B acute aortic dissection (AAD) remains unclear. Therefore, we investigated the prognostic impact of AF and OAC therapy in patients with type B AAD. Consecutive patients diagnosed with AAD were included in this single-center, retrospective study. Patients with type B AAD were selected from the study population and divided into three groups: AF(+)/OAC(+), AF(+)/OAC(-), and AF(-)/OAC(-). The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, progressive aortic events, cerebral infarction, and organ malperfusion. In total, 139 patients diagnosed with type B AAD were analyzed. AF was observed in 27 patients (19%). Among them, 13 patients (9%) received OAC therapy for AF. MACCE occurred in 32 patients (23%) during the observation period: all-cause death in four patients, progressive aortic events in 24 patients, cerebral infarction events in two patients, and malperfusion events in two patients. The incidence of MACCE was higher in the AF(+)/OAC(+) group than in the AF(+)/OAC(-) group (hazard ratio[HR]: 3.875; 95% confidence interval [CI]: 1.153-17.496). In contrast, there was no significant difference in the incidence of MACCE between the AF(+)/OAC(-) and AF(-)/OAC(-) groups (HR: 1.001, 95% CI: 0.509-1.802). Among patients with type B AAD, the use of OAC for AF was associated with a higher risk of MACCE.

Effect of Clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction: A retrospective single-center analysis.

To explore the effect of clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction (APCI). We retrospectively analyzed the records of 190 patients with APCI admitted to Chengdu First People's Hospital from September 2020 to April 2023. The records were divided into an aspirin group (76 cases), a clopidogrel group (72 cases), and a clopidogrel plus aspirin group (42 cases) according to the treatment records. We compared the efficacy of the three treatment outcomes by analyzing the National Institutes of Health Stroke Scale (NIHSS) scores, and the levels of serum inflammatory factors (IL-8, TNF-α, and IL-1β), cone like protein-1 (VILIP-1), and caveolin-1 (Cav-1). The total efficacy of the combination group (97.62%) was significantly higher than those of the aspirin group (73.68%) or the clopidogrel group (79.17%) (p<0.05). After treatment, the NIHSS scores, inflammatory factor levels, serum VILIP-1 and Cav-1 levels were significantly lower than those before treatment in the three groups, but all the levels were significantly lower in the combination group (all p<0.05). Our results indicate that compared with aspirin alone or clopidogrel alone, the combination of aspirin and clopidogrel is more effective for the treatment of APCI. The combination regimen effectively lowers serum inflammatory factors (IL-8, TNF-α, and IL-1β), as well as the VILIP-1 and Cav-1 levels.

Clinical Evaluation of miR-155 and miR-21 Alone and in Combination for Diagnosis of Acute Progressive Cerebral Infarction

Clinical Evaluation of miR-155 and miR-21 Alone and in Combination for Diagnosis of Acute Progressive Cerebral Infarction

Single-center experience of endovascular treatment for patients with progressive posterior circulation cerebral infarction exceeding 24 h.

Evidence of endovascular treatment (ET) for patients with progressive infarction of the posterior circulation exceeding 24 h is lacking. To evaluate the efficacy and safety of ET for progressive posterior circulation cerebral infarction. This retrospective study evaluated the ET for 18 patients with posterior circulation infarction caused by vertebrobasilar artery occlusion from July 2017 to November 2018. The conditions of patients worsened despite receiving intravenous thrombolysis or combination therapy with clopidogrel and aspirin. The time from the onset of cerebral infarction to puncture was >24 h. The preoperative National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and related risk factors of patients at 3 months were analyzed postoperatively. The preoperative NIHSS score was 10.6 (IQR: 6.5), and the time from onset to puncture was 163.5 ± 144.7 h. Postoperative blood flow was modified thrombolysis in cerebral infarction (mTICI) grade 2b or above. During the follow-up period, 1 patient died of basilar artery re-occlusion and pulmonary infection, and 1 died of postoperative hyperperfusion hemorrhage, with a mortality rate of 11.1% (2/18). No recurrent ischemic events were observed in any of the 16 patients during the 3-month follow-up period. The mean mRS score was 1.3 (IQR: 2.3), and 75% patients (12/16) had an mRS score of 0-2. There were no significant differences in age, gender, clinical characteristics, and stroke subtype between patients with mRS scores ≤2 and >2. In patients with progressive posterior circulation cerebral infarction caused by vertebral basilar artery occlusion, ET is effective and safe even if the time from onset to puncture exceeds 24 h.

Analysis of Perioperative Nursing Intervention Effect of Cerebrovascular Intervention Patients Based on Intelligent Internet of Things.

The postoperative results of cerebrovascular surgery patients have been successfully used in medical practice using the Internet. The results obtained through data analysis were used in the study. So far, 120 patients who underwent cerebrovascular surgery from February 2018 to December 2018 have been enrolled. The selected class was divided into two groups: 60 psychiatric patients, a control group and an observation group. The former is medical treatment and the latter is postoperative treatment. Results: The results showed that the blood pressure of control group was lower than that of control group, and the incidence of adverse events was lower than that of control group (P < 0.05). Meanwhile, the average hospitalization rate of cerebrovascular disease patients in control group was lower than that in control group (P < 0.05). Conclusion: For patients with cerebrovascular disease, postoperative nursing can reduce the incidence of postoperative complications, reduce the risk of surgery, and improve the effect of surgery. Acute ischemic stroke refers to a kind of clinical syndrome caused by abnormal blood supply in the brain, resulting in ischemia, hypoxic brain tissue necrosis, and focal or comprehensive neurological deficiency. Among them, progressive cerebral infarction accounted for about 20~35%, and most occurred in the early stage of the disease (48~72)h.

Acute progressive large-area cerebral infarction caused by wasp sting: a case report

ABSTRACT Acute renal failure, multiple organ failure, and allergic reactions caused by wasp sting have been reported in many clinical reports, however, there are few reports on cerebral infarction due to wasp sting. We report a patient who developed acute progressive cerebral infarction after wasp stings, suffered from left-sided hemiplegia, clumsy speech, and left facial droop, only left the MRC grade 2 power and left conjugate gaze palsy after treatment. The MRA showed normal blood vessels. And the wasp sting was detected in head and right shoulder. We explored the mechanism by which the bee venom induced vasospasm and stimulated the superior cervical sympathetic ganglion leading to cerebral infarction. The treatment strategy is presented to provide experience for other clinicians.

The value of diffusion weighted imaging in predicting the clinical progression of perforator artery cerebral infarction

ObjectivesTo investigate the value of diffusion weighted imaging (DWI) in predicting the clinical progression of perforator artery cerebral infarction. MethodsThe magnetic resonance imaging (MRI) data of patients with perforator artery cerebral infarction hospitalized in our hospital from October 2015 to February 2022 were analyzed retrospectively. Then we compared the differences of apparent diffusion coefficient (ADC) value, maximal size, location of cerebral infarction, clinical data and treatment plan between the two groups. ResultsA total of 81 patients with perforating artery cerebral infarction were included, with 33 patients in the progressive cerebral infarction (PCI) group and 48 patients in the non-progressive cerebral infarction (NPCI) group. The ADC value in the progressive group was lower than that in the non-progressive group (P < 0.001), and ADC value was an independent factor influencing the clinical progression (OR = 0.974, 95 %CI = 0.960–0.989, P = 0.001); The average area of cerebral infarction in the progressive group was larger than that in the non-progressive group (P = 0.004). There was no difference between the two groups (P > 0.05) in terms of clinical data and treatment plan. ConclusionsThe ADC value and maximal size of infarction were correlated with the clinical Progression. ADC value was an independent factor influencing the clinical progression of perforating artery cerebral infarction, which could be used for the prediction of clinical progress and provide guidance for the development of individualized treatment.

Intractable Progressive Cerebral Infarction with Multiple Atypical Aneurysms in Systemic Lupus Erythematosus

We report a case of intractable progressive cerebral infarction with multiple fusiform aneurysms in a 34-year-old female patient with systemic lupus erythematosus (SLE), non-responsive to massive immunotherapy. The patient visited the emergency department with dysarthria and left-sided hemiparesis that occurred 2 days before. She was diagnosed with SLE involving the brain and received 12 cycles of cyclophosphamide 12 years prior. Brain diffusion-weighted imaging showed acute infarctions involving the pons and medulla. Additionally, multifocal microbleeding-like signals in various cisternal spaces were detected using susceptibility-weighted imaging. Digital subtraction angiography revealed multiple fusiform aneurysms. Despite antithrombotic treatment with trif lusal and immunotherapies, including corticosteroids, mycophenolate mofetil, and immunoglobulins, for cerebral vasculitis associated infarction, her neurologic deficits worsened with recurrent cerebral infarction. Further investigation for accurate diagnosis and treatment is required.

Refractory brainstem encephalitis mimicking progressive cerebral infarction: infliximab and methotrexate as a salvage immunotherapy

Refractory brainstem encephalitis mimicking progressive cerebral infarction: infliximab and methotrexate as a salvage immunotherapy

Skull base aneurysms: a retrospective review of fifteen cases focusing on the involvement of internal carotid artery

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.

Risk Factors, Recurrence and Short-Term Outcomes for Progressive Cerebral Infarction: A Retrospective Study.

Only a few studies have investigated the risk factors for the prognosis of progressive cerebral infarction (PCI) and the relationship between PCI and cerebral infarction (CI) recurrence. The objective of this study is to analyze the risk factors for PCI and PCI prognosis and evaluate the relationship between PCI and CI recurrence, mortality, short-term outcomes. The retrospective study included 221 CI patients. PCI and non-PCI patients were divided into the observation (91) and control (130) groups, respectively. Patients' clinical data, including diabetes history, laboratory blood indices, National Institutes of Health Stroke Scale (NIHSS) scores at admission, and presence of carotid and intracranial artery stenoses, were retrospectively analyzed. Instances of CI recurrence, adverse short-term outcomes, and death within 1 year postanalysis were recorded. Diabetes, homocysteine, NIHSS score at admission, fibrinogen, and intracranial artery stenosis were associated with PCI. Age, NIHSS score at admission, and pneumonia were associated with PCI prognosis. By 12-month follow-up, the mortality and adverse outcome rate in the observation group were significantly increased than those of the control group. There was no diference in CI recurrence rates between the groups. Adverse outcomes were associated with PCI, age, and homocysteine. PCI risk factors included diabetes, homocysteine, NIHSS score at admission, fibrinogen, and intracranial artery stenosis. The independent risk factors for PCI prognosis included age, high NIHSS score at admission, and pneumonia. PCI did not affect CI recurrence but may affect adverse short-term outcomes.

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.

Acute progressive stroke with middle cerebral artery occlusion caused by idiopathic hypereosinophilic syndrome: a case report

BackgroundIdiopathic hypereosinophilic syndrome (IHES) is associated with various organ system dysfunctions. Neurologic abnormalities have been previously noted in this syndrome. Cerebral infarction secondary to occlusion of large cerebral artery is rarely reported. Here we described a patient with IHES presented progressive multiple cerebral infarctions caused by bilateral middle cerebral artery occlusion.Case presentationA 55-year-old Chinese woman presented to our hospital with acute onset of right limbs weakness and slurred speech. Laboratory tests showed a significant eosinophilia of 5.29 × 109/L (normal, < 0.5), 49.9% of leukocytes. Brain magnetic resonance imaging (MRI) revealed multiple acute cerebral ischemic lesions. Magnetic resonance angiography (MRA) demonstrated stenosis in horizontal segment of right middle cerebral artery. A pretibial skin biopsy revealed eosinophilic infiltration around the capillaries in deep dermis and adipose tissue. The patient was given oral dual anti platelet agents and intravenous methylprednisolone. However, one week later, the patient presented significant neurological deterioration with right-sided hemiparesis and totally motor aphasia. Brain MRI and computed tomography perfusion (CTP) demonstrated new acute cerebral ischemia in left hemisphere. Digital subtraction angiography (DSA) revealed left middle cerebral artery completely occluded. The patient received a high-dose of intravenous methylprednisolone 500 mg per day and the eosinophil count quickly fell to normal within 2 days. She was transferred to a rehabilitation center and her neurological symptoms improved with modified Ranking Scale from 4 to 2.ConclusionsIHES is one of the rare causes of acute ischemic stroke with large cerebral artery occlusion. An early high-dose of corticosteroids therapy should be considered in cases of IHES patients. Our case study is benefit to clinical diagnosis and treatment of cerebral infarction with IHES.

Observation of the efficacy of Eureklin in the treatment of progressive cerebral infarction in young and middle-aged people outside the thrombolytic time window

Objective To observe the clinical efficacy of Eureklin in the treatment of progressive cerebral infarction in young and middle-aged people outside the thrombolytic time window (the onset time was more than 6h). Methods From March 2016 to March 2019, 120 young and middle-aged patients with progressive brain infarction who admitted to the neurology department of Chaonan Minsheng Hospital were selected and all patients were confirmed by cranial CT or MRI.They were divided into two groups by random drawing method.Clinical conventional therapy was applied in the control group (60 cases), and on the basis of conventional treatment, Eureklin intravenous drips was used in the treatment group (60 cases). Before and after treatment 14d, the national institutes of health stroke scale(NIHSS), daily living ability scale(ADL) were used to assessment of neurological impairment and Barthel index in patients.At the same time, the drug side effects and adverse reactions were observed. Results After treatment, the NIHSS score in the conventional treatment group[(3.4±0.3)points] was lower than that in the Eureklin group[(4.1±0.4)points], and the ADLscore in the conventional treatment group [(67.5±24.8)points]was higher than that in the Eureklin group[(57.8±26.7) points], the difference was statistically significant(t=0.014, 0.003, all P<0.05). The total effective rate of the treatment group[83.33%(50/60)] was higher than that of the control group[71.67%(43/60)], the difference was statistically significant(χ2=3.596, P<0.05). At the same time, no serious adverse reactions were found in the Eureklin treatment group. Conclusion For young and middle-aged patients with progressive cerebral infarction outside the thrombolytic time window, the application of Eureklin can improve the patients’ symptoms of neurological dysfunction, improve the ability of daily life, and without serious adverse events such as bleeding, which is worthy of clinical application. Key words: Infarction, middle cerebral artery; Thrombolytic therapy; Stroke; Activities of daily living; Middle aged; Eureklin

Analysis of the risk factors for poor prognosis of progressive cerebral infarction

Objective To analyze the risk factors affecting the poor prognosis of progressive cerebral infarction. Methods The clinical data of 326 patients with cerebral infarction admitted to Dermatology and Venereal Disease Prevention and Cure Hospital of Zaozhuang from January 2013 to March 2017 were retrospectively analyzed.The patients were divided into poor prognosis group(n=148) and good prognosis group(n=178) according to their prognosis during hospitalization.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors affecting prognosis. Results Statistical analysis showed that there were no statistically significant differences in sex composition, average age, diastolic blood pressure, LDL, anterior cerebral artery stenosis, posterior cerebral artery stenosis and vertebral basilar artery stenosis between the two groups (all P>0.05). The incidence rates of hypertension history (60.81% vs. 48.88%, χ2=1.683, P=0.031), diabetes history (41.89% vs. 30.90%, χ2=4.244, P=0.039), hyperlipidemia history (62.84% vs. 49.44%, χ2=5.875, P=0.015) in the poor prognosis group were higher than those in the good prognosis group.The systolic blood pressure in poor prognosis group was lower than that in the good prognosis group [(144±17)mmHg vs. (150±22)mmHg, t=2.928, P=0.004]. The body temperature[(38.10±0.22)℃ vs. (38.03±0.34)℃, t=2.240, P=0.026], FPG[(7.85±1.95)mmol/L vs. (6.91±1.77)mmol/L, t=4.558, P=0.000], TC[(5.21±1.66)mmol/L vs. (4.84±1.55)mmol/L, t=2.708, P=0.039], TG[(2.49±0.79 mmol/L vs. (2.30±0.54)mmol/L, t=2.483, P=0.014], HDL [(1.30±0.51)mmol/L vs. (1.17±0.44)mmol/L, t=2.470, P=0.014] and FIB[(4.37±1.67)g/L vs. (3.79±1.42)g/L, t=3.339, P=0.001], stenosis of internal carotid artery (31.08% vs. 20.79%, χ2=4.636, P=0.031), stenosis of middle cerebral artery(39.86% vs. 29.21%, χ2=4.083, P=0.043), and plaque of internal carotid artery (48.65% vs. 36.52%, χ2=4.882, P=0.027) in the poor prognosis group were higher than those in the good prognosis group.Multivariate regression analysis showed that history of hypertension, diabetes, hyperlipidemia, fever, decreased blood pressure, elevated TC, elevated TG, elevated HDL and elevated FIB were the risk factors for the prognosis of progressive cerebral infarction. Conclusion There are many risk factors affecting the poor prognosis of progressive cerebral infarction, and the physiological mechanism is complex.In clinical treatment, attention should be paid to patients' past diseases, prevention and treatment should be carried out according to different mechanisms. Key words: Infarction, middle cerebral artery; Prognosis; Risk factors; Factor analysis, statistical; Blood glucose; Cholesterol esters

Clinical observation of clopidogrel combined with aspirin in the treatment of progressive cerebral infarction

目的 探讨氯吡格雷联合阿司匹林治疗进展性脑梗死的临床疗效。 方法 选取2012年1月至2016年1月在黄石市第二医院神经内科住院治疗的进展性脑梗死患者106例为研究对象，采用随机数字表法分为对照组(55例)和观察组(51例)，两组在常规治疗基础上，对照组口服阿司匹林肠溶片100 mg，1次/d；观察组采用氯吡格雷片75 mg和肠溶阿司匹林片100 mg口服，1次/d，疗程14 d。评估两组患者神经功能缺损程度、神经功能障碍康复程度。 结果 治疗后14 d，观察组美国国立卫生研究院卒中量表(NIHSS)评分(8.25±2.76)分，优于对照组的(10.14±2.17)分(P＝0.021)；治疗后28 d，观察组日常生活活动能力量表Barthel指数(72.31±6.77)，优于对照组的(64.35±4.63)(P＝0.017)。 结论 氯吡格雷联合阿司匹林治疗进展性脑梗死的临床疗效优于单用阿司匹林。

Usefulness of intraoperative Indocyanine green video angiography to select the recipient artery for bypass surgery in arteriosclerotic occlusion of the middle cerebral artery: a technical case report

BackgroundIn superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass surgery, indocyanine green video angiography (ICG-VA) is usually used to verify bypass patency. Less-commonly reported is the ability to use this technique to evaluate candidate recipient vessels based on either collateral flow or identification of the distal branch of interest.Case presentationAn 82-year-old man presented with progressive cerebral infarction due to infarction of the M2 inferior trunk of the right middle cerebral artery. He underwent superficial temporal artery-middle cerebral artery bypass to prevent further ischemia 1 week after the initial stroke. In the surgery, M4 cortical arteries fed by the inferior trunk could not be identified as recipient arteries. Intraoperative ICG-VA showed delayed luminescence of some M4 arteries. Because the M4 arteries fed by the inferior trunk showed delayed retrograde flows from the anterior cerebral artery on preoperative digital subtraction angiography, the M4 arteries with delayed luminescence on ICG-VA were considered to be M4 arteries fed by the inferior trunk and selected as the recipient arteries.ConclusionsICG-VA shows differences in flow speed as delayed luminescence. This finding may be useful for detecting target vessels.

Changes of fibrinogen and homocysteine in patients with progressive cerebral infarction

Objective To investigate the changes of fibrinogen(Fib) and homocysteine(Hcy) in patients with progressive cerebral infarction, and their relationship with triglyceride(TG), cholesterol(TC), high-density lipoprotein(HDL-C) and low density lipoprotein(LDL-C). Methods A total of 246 patients with acute cerebral infarction with clear diagnosis and complete clinical data from department of Neurology in the People′s Hospital of Qinghai Province from June 2012 to June 2015 were selected and divided into progressive cerebral infarction group(progressive group, n=61) and non-progressive cerebral infarction group(non-progressive group, n=185) according to the deterioration of their condition.The changes of Fib and Hcy in patients with progressive cerebral infarction, and their relationship with TG, TC, HDL-C and LDL-C were analyzed. Results At the 2nd, 7th day after admission, the Fib and Hcy levels in the progressive group were (5.56±1.14)g/L, (5.11±1.35)g/L, (26.09±6.47)μmol/L, (23.32±5.78)μmol/L, respectively, which were significantly higher than those in the non-progressive group[(4.44±0.97)g/L, (4.09±0.58)g/L, (18.33±5.02)μmol/L, (16.97±6.31)μmol/L], the differences were statistically significant(t=7.478, 5.729, 9.710, 6.955, all P<0.05). Pearson's correlation analysis showed that Fib had significantly positive correlation with whole blood viscosity, whole blood reduced viscosity, plasma viscosity and hematocrit (r=0.613, 0.544, 0.507, 0.496, all P<0.05). Hcy had significantly positive correlation with carotid intima-media thickness, TG, TC and LDL-C (r=0.593, 0.601 0.527, 0.452, all P<0.05). Conclusion The levels of Fib and Hcy are closely related to progressive cerebral infarction.Fib and Hcy in patients with acute cerebral infarction can be used as detection index for progressive cerebral infarction. Key words: Brain infarction; Fibrinogen; Cysteine

Serum lipoprotein and RBC rigidity index to predict cerebral infarction in patients with carotid artery stenosis.

This study aims to determine the risk factors and to predict the occurrence of cerebral infarction in patients with carotid artery stenosis. Two hundred and one subjects with carotid artery stenosis were retrospectively selected from Jinshan Branch of Shanghai Sixth People's Hospital, 115 cases of which with cerebral infarction and 86 without it. Clinical tests were performed including coagulation indices, fasting glucose, serum lipid, and blood rheology. Logistic regression analyses were used to identify the risk factors. Regression model was established, and receiver operating characteristic (ROC) curve was applied to analyze its diagnostic value. Our data indicated that apolipoprotein AI (OR=0.051, 95% CI: 0.009-0.295), lipoprotein (a) (OR=1.003, 95% CI: 1.001-1.005), and RBC rigidity index (OR=0.383, 95% CI: 0.209-0.702) were independent risk factors. Area under the curve (AUC) of the regression model=0.78, with the sensitivity of 73.9% (95% CI: 64.9%-81.7%) and specificity of 69.2% (95% CI: 52.4%-83.0%). Prediction probability was determined while logistic regression score >0.748 defaulted as high-risk status. High-risk ratios were 80% in progressive cerebral infarction and 72% in nonprogressive cerebral infarction (P>.05), respectively, while significant differences were found when both compared with controls (P<.001). We show herein that the regression model based on apolipoprotein AI, lipoprotein (a), and RBC IR is a promising tool to predict the occurrence of cerebral infarction in patients with carotid artery stenosis. However, identification of novel diagnostic markers for progressive cerebral infarction is still necessary.

The efficacy and safety of Dl-3n-butylphthalide on progressive cerebral infarction: A randomized controlled STROBE study.

Progressive cerebral infarction (PCI) is associated with high rates of mortality and disability. Many studies have shown that Dl-3n-butylphthalide (NBP) is effective against acute ischemic stroke. The administration of NBP can result in an increased number of capillaries in the ischemic region, promote the establishment of collateral circulation, protect the mitochondria, and narrow the infarction area, among other effects. In the present study, we evaluated the efficacy and safety of NBP for the treatment of PCI.Between March 2008 and May 2012, we performed a randomized, double-blind placebo-controlled study including 304 inpatients with PCI. These patients were randomly assigned to the test (152 cases) and control groups (152 cases). The test group received 200 mg of NBP soft capsules orally, 15 minutes before each meal, 3 times daily. The control group received 200 mg of placebo soft capsules orally, 15 minutes before each meal, 3 times daily. Treatment was administered during 21 days. The National Institute of Health Stroke Scale (NIHSS) score was assessed before the treatment and on days 7, 14, 21, and 30 after treatment. The Barthel index (BI) was assessed on the same days and on day 90.In the test group, the NIHSS scores on days 7, 14, 21, and 30 were 14.75 ± 4.85, 11.62 ± 3.49, 8.87 ± 5.17, and 6.38 ± 4.93, respectively. In the control group, they were 16.08 ± 3.76, 13.28 ± 5.02, 11.05 ± 4.25, and 8.43 ± 5.41 (P < .05), respectively. The BI on days 7, 14, 21, 30, and 90 were 51.57 ± 15.11, 61.21 ± 16.39, 70.48 ± 18.21, 76.41 ± 19.02, and 81.10 ± 15.52 for the test group and 46.79 ± 18.42, 55.93 ± 19.12, 64.84 ± 17.67, 70.65 ± 18.54, and 76.54 ± 17.05 for the control group (P < .05), respectively. Adverse events were elevation of alanine aminotransferase and aspartate aminotransferase (P > .05).NBP was useful to improve the outcome of patients with PCI and decreased their disability for activities of daily living. NBP was an efficacious and safe treatment for PCI.