Abstract:Aim To investigate the levels of krüppel-like factor 2 (KLF2) and endothelial nitric oxide synthase 3 (NOS3) in the serum of patients with acute cerebral infarction (ACI) of large-artery atherosclerosis (LAA) type, and to analyze their value in the diagnosis and disease assessment of LAA type ACI. Methods A total of 150 patients with LAA type ACI were divided into mild group (n＝36), moderate group (n＝48), and severe group (n＝66) based on their condition. Additionally, a control group (n＝150) was selected from health exminers during the same period. The levels of serum KLF2 and NOS3 in each group were compared; receiver operator characteristic(ROC) curve was applied to analyze the diagnostic value of serum KLF2 and NOS3 levels for LAA type ACI and the predictive value for the occurrence of severe LAA type ACI, respectively. Results The serum KLF2 and NOS3 levels were significantly lower in LAA type ACI group than those in control group (P＜0.05). The serum KLF2 and NOS3 levels in the mild, moderate and severe groups were significantly decreased in turn(P＜0.05). The area under the curve (AUC) of the combined diagnosis of serum KLF2 and NOS3 for LAA type ACI was 0.858, with a sensitivity of 73.33% and a specificity of 86.00%, which was superior to the individual diagnosis of KLF2 and NOS3 (Zcombined detection-KLF2＝3.796, Zcombined detection-NOS3＝4.689, all P＜0.001). The AUC of combined prediction of serum KLF2 and NOS3 for the occurrence of severe LAA type ACI was 0.878, with a sensitivity of 77.27% and a specificity of 90.48%, which was superior to the independent prediction of KLF2 and NOS3 (Zcombined detection-KLF2＝2.401, P＝0.016; Zcombined detection-NOS3＝3.070, P＝0.002). Conclusions The serum levels of KLF2 and NOS3 in patients with LAA type ACI were significantly reduced and negatively correlated with the severity of the disease. The combination of the two has high evaluation efficacy in the diagnosis and disease prediction of LAA type ACI.

Abstract:Aim To study the construction of carotid vulnerable plaque risk model and its relationship with cognitive impairment and prognosis in patients with acute cerebral infarction (ACI). Methods 180 patients with carotid vulnerable plaques in Lianyungang First Peoples Hospital from July 2018 to July 2020 were selected as observation group, and another 180 patients with unstable plaques who underwent physical examination were selected as control group. The unstable plaque integral ratio, the maximum length of plaques, the maximum thickness of plaques, ulcer plaques, area stenosis, peak flow velocity at stenosis and resistance index were compared to study the construction of carotid vulnerable plaque risk model and its relationship with cognitive impairment and prognosis in patients with ACI. Results There were significant differences between the two groups in unstable plaque integral ratio, maximum plaque length, maximum plaque thickness, ulcer plaque, area stenosis, peak flow velocity at stenosis and resistance index (P＜0.05). Multivariate analysis showed that high unstable plaque integral ratio, maximum plaque length, maximum plaque thickness, ulcer plaque, peak flow velocity at area stenosis and resistance index were the risk factors for carotid vulnerable plaque. The incidence of cognitive impairment (χ2＝11.432, P＝0.001) and poor prognosis (χ2＝14.362, P＝0.000) in the observation group was significantly higher than those in the control group. Correlation analysis showed that carotid vulnerable plaques in ACI patients were significantly correlated with cognitive impairment and prognosis. Conclusions Carotid vulnerable plaque is significantly correlated with cognitive impairment and prognosis in patients with ACI. High unstable plaque integral ratio, maximum plaque length, maximum plaque thickness, ulcer plaque, area stenosis, peak flow velocity at stenosis and resistance index are all risk factors for carotid vulnerable plaque, it is suggested that clinical intervention should be carried out in time for such patients.

Abstract:Aim To investigate the effects of argatroban combined with edaravone on the recovery of neurological function and serum homocysteine (Hcy), CXC chemokine ligand 16 (CXCL16), and transforming growth factor-β1 (TGF-β1) in patients with posterior circulation acute cerebral infarction. Methods A total of 123 patients with acute cerebral infarction of the posterior circulation who were admitted to our hospital from January 2017 to March 2019 were selected as the research objects. According to the random number table, they were divided into combined treatment group, argatroban group, and edaravone group, with 41 cases in each group. On the basis of routine symptomatic treatment such as oxygen inhalation, infection prevention, anticoagulation, and plaque stabilization, the argatroban group was given argatroban, the edaravone group was given edaravone, and the combined treatment group was given argatroban and edaravone. After 14 days of treatment, comparing the therapeutic effect, hemodynamic index of the posterior circulation (post-cerebral artery, vertebral artery, basilar artery systolic peak blood flow velocity (Vs), resistance index (RI)), serum brain injury markers (neuron-specific enolase (NSE), polyamine oxidase (PAO), S-100β protein), serum inflammatory factors (Hcy, CXCL16, TGF-β1) levels, nerve function (NIHSS scores), daily living ability (ADL scores) before and after 14 days of treatment and adverse reactions of the three groups. Results The total effective rate of the combined treatment group was higher than that of argatroban group and the edaravone group. After 14 days of treatment, the NIHSS scores and ADL scores were better in combined treatment group than those of the argatroban group and edaravone group (P＜0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P＞0.05). After 14 days of treatment, the Vs of the posterior cerebral artery, vertebral artery, and basilar artery of the three groups increased, and it was higher in combined treatment group than that in argatroban group and edaravone group, and the RI decreased, and it was lower in combined treatment group than that in argatroban group and edaravone group. After 14 days of treatment, serum NSE, PAO, and S-100β levels in the three groups decreased, and the combined treatment group decreased the most (P＜0.05). After 14 days of treatment, the levels of serum Hcy, CXCL16 and TGF-β1 in three groups decreased, they were lower in combined treatment group than those in argatroban group and edaravone group (P＜0.05).Conclusion Agatroban combined with edaravone is effective in the treatment of posterior circulation acute cerebral infarction, which can effectively improve the state of cerebral blood flow, suppress nerve damage, at the same time ease the bodys inflammation, improve the patients nerve function and daily life ability, and ensure the safety of treatment.

Abstract:Aim To investigate the correlation between miR-25 expression in peripheral blood and apoptotic molecules contents, and 90 d prognosis of patients with acute cerebral infarction. Methods 162 patients with acute cerebral infarction were selected as the acute cerebral infarction group and 150 healthy people as the normal control group. Peripheral blood levels of miR-25 and apoptotic molecules cysteinyl aspartate specific proteinase-3(Caspase-3), B-cell lymphoma-2(bcl-2) were determined in acute cerebral infarction group and normal control group. According to the score of modified Rankin scale (mRS), prognosis of 90 d follow-up was divided into:good prognosis(mRS score≤2 points) and poor prognosis(mRS score ＞2 points). The clinical data of acute cerebral infarction patients with different prognosis were compared and further Logistic regression analysis was performed. ROC curve was used to evaluate the predictive value of miR-25 expression level in peripheral blood of acute cerebral infarction patients for adverse prognosis at 90 days. Results Expression levels of miR-25 and bcl-2 in peripheral blood of acute cerebral infarction group were lower than those in normal control group, levels of Caspase-3 were higher than those in normal control group(P＜0.05). Correlation analysis found that the expression level of miR-25 in peripheral blood of acute cerebral infarction patients was positively correlated with the expression level of bcl-2, negatively correlated with expression level of Caspase-3 (P＜0.05). Patients with acute cerebral infarction were followed up for 90 days, including 119 patients with good prognosis, 43 patients with poor prognosis. The differences in age, onset treatment time and NIHSS score on the day of admission in acute cerebral infarction patients with different prognosis were statistically significant(P＜0.05), while the differences in other clinical data were not statistically significant(P＞0.05). Logistic regression analysis found that:older age, higher NIHSS score on the day of admission, low expression level of miR-25 in peripheral blood were independent risk factors for poor prognosis in patients with acute cerebral infarction on 90 day(P＜0.05). ROC curve found that, cut-off value of miR-25 expression level in peripheral blood predicting the poor prognosis of patients with acute cerebral infarction on the 90 d was 0.635, AUC was 0.699(95%CI 0.609~0.789). The corresponding sensitivity and specificity were 72.09% and 65.55%, respectively.Conclusions Expression level of miR-25 in peripheral blood of patients with acute cerebral infarction decreases, which may be involved in the expression regulation of apoptotic molecules. Low level of miR-25 is a risk factor for poor prognosis and has certain early prediction value.

Abstract:Aim To evaluate the diagnostic value of gemstone CT iodine-water based images for acute cerebral infarction after interventional therapy. Methods 31 patients with acute cerebral infarction were found to have abnormal intracranial high density on the immediate gemstone CT scan QC images after the interventional therapy. Iodine-water based images were used to reconstruct and analyze the images. Simultaneously, the iodine based value and water based value of high density were measured, and the images were compared with the results of 24 h ordinary CT review. Results By using iodine-water based images, 17 cases were diagnosed as iodine contrast agent exudation, 14 cases were diagnosed as cerebral hemorrhage transformation, which were identical with the results of 24 h ordinary CT reexamination (Kappa=1,P＜0.01). The immediate postoperative iodine based value:iodine contrast agent exudation(32.09±5.36) g/L, cerebral hemorrhage transformation(6.86±2.26) g/L, there was statistical significant difference (t=53.291, P＜0.01). The immediate postoperative water based value:the iodine contrast agent exudation(1 027.93±8.29) g/L, the cerebral hemorrhage transformation(1 069.68±7.18) g/L, there was statistical significant difference (t =－8.897, P＜0.01). Conclusion Gemstone CT iodine-water based images can accurately diagnose intracranial iodine contrast agent exudation and cerebral hemorrhage transformation after interventional therapy for acute cerebral infarction, which is worthy of clinical promotion.

Abstract:Aim To investigate the effects of butylphthalide combined with edaravone on carotid intima-media thickness (IMT) and neurological function in elderly patients with acute cerebral infarction. Methods From January 2014 to March 6,2 elderly patients with acute cerebral infarction in the Department of Neurology in our hospital were randomly divided into edaravone treatment group and butylphthalide combined edaravone treatment group (combined treatment group), 46 cases in each group. Edaravone treatment group was treated with edaravone, and combined treatment group was treated with edaravone and butylphthalide for 90 days. The therapeutic effects of the two groups were observed, carotid IMT and plaque area were evaluated, and neurological function was evaluated by NIHSS score, modified Rankin scale (mRS) score and Barthel index. At the same time, the occurrence of adverse reactions in the two groups was observed. Results The total effective rate of combined treatment group was significantly higher than that of edaravone treatment group (P＜0.05). After treatment, carotid IMT and plaque area in the two groups were significantly lower than those before treatment (P＜0.05), and significantly lower in the combined treatment group than those in the edaravone treatment group (P＜0.05), the NIHSS score and mRS score in the combined treatment group were lower than those in the edaravone treatment group (P＜0.05), and the Barthel index was significantly higher than that in the edaravone treatment group (P＜0.05), there was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05). Conclusion Butylphthalide combined with edaravone can significantly reduce carotid IMT in elderly patients with acute cerebral infarction and improve their nerve function, the clinical effect is remarkable and the safety is high.

Abstract:The most ideal treatment for acute cerebral infarction is the recanalization of occlusive vessels as soon as possible. Intravenous thrombolytic therapy is an effective treatment for acute cerebral infarction. Bridging therapy improves the recanalization rate of occlusive vessels, but there are still some patients with residual vascular stenosis. Platelets are known to play an important role in the occurence and development of acute cerebral infarction. One of the key factors for reocclusion of blood vessels after thrombolytic / bridging treatment is the prohibition of antiplatelet aggregation within 24 hours after thrombolytic therapy. Platelet aggregation and activation make a part of the patients with residual artery stenosis reoccluded. Inorder to explore the feasibility and safety of using antiplatelet drugs within 24 hours after intravenous thrombolysis/bridging treatment and improving the prognosis of patients, this paper reviewed the mechanism of platelet activation and the platelet activation status after intravenous thrombolysis/bridging therapy in acute cerebral infarction and the related research of antiplatelet combined with intravenous thrombolysis/bridging therapy.

Abstract:Aim To investigate the expression levels of serum microRNA-124 (miR-124) and microRNA-182 (miR-182) in acute cerebral infarction (ACI) and the value in the combined diagnosis and prognosis of ACI. Methods 120 patients with ACI were enrolled as the observation group, and 80 healthy subjects were used as healthy controls.According to the brain infarct volume, patients of the observation group were divided into small infarction group(＜5 cm3), middle infarction group (≥5 cm3 and ≤10 cm3) and large infarction group (＞10 cm3). The relative expression levels of serum miR-124 and miR-182 were measured in all enrolled patients, and the value of combined diagnosis was analyzed by receiver operating characteristic curve (ROC curve). ACI patients were followed up for one year, and the prognosis of the combined positive and negative groups was analyzed. Results The relative expressions of serum miR-124 and miR-182 in ACI patients were (2.63±0.59) and (2.69±0.69), respectively, which were significantly higher than those in the control group((1.08±0.32) and (1.07±0.46))(P<0.05). The relative expression of miR-124 in the middle and large infarction group was significantly lower than that in the small infarction group (P<0.05). The relative expression of miR-182 in the middle and large infarction group was significantly higher than that in the small infarction group (P<0.05). Pearson correlation analysis showed that the relative expression of miR-124 was negatively correlated with brain infarct volume (r=－0.613, P<0.01), and the relative expression of miR-182 was positively correlated with brain infarct volume (r=0.761, P<0.01). When miR-124 was cut off by 1.34, the sensitivity of diagnosis of ACI was 73.33%, the specificity was 90.00%, the area under the curve was 0.775 (95%CI 0.715～0.834, P=0.030); when miR-182 was cut off by 1.45, the sensitivity of diagnosis of ACI was 66.67%, the specificity was 87.50%, the area under the curve was 0.675 (95%CI 0.602～0.749, P=0.038); the sensitivity of combined diagnosis was 88.33%, the specificity was 86.25%, and the area under the curve was 0.811 (95%CI 0.756～0.866, P=0.028). The area under the combined detection ROC was significantly higher than that of the single test (P<0.05). The follow-up prognosis found that the patients with positive diagnosis had significantly higher mortality at 8 months and 12 months after treatment than those with negative diagnosis (P<0.05). Conclusion miR-124 and miR-182 are highly expressed in the serum of patients with ACI. The combination of the two is of great value in the diagnosis and prognosis evaluation of ACI.

Abstract:Aim To study the clinical value of serum pentraxin 3 (PTX3) and caveolin-1 (Cav-1) in evaluating the prognosis of thrombolytic therapy for patients with acute cerebral infarction (ACI). Methods Data of 90 ACI patients admitted to our hospital from March 2015 to September 2018 were retrospectively analyzed. All patients were treated with urokinase intravenous thrombolysis. The patients were divided into good prognosis group (n＝33) and poor prognosis group (n＝57) according to the modified Rankin scale score 90 days after treatment. Univariate analysis was used for baseline data of two groups. Non-conditional Logistic multivariate regression analysis was used to analyze the univariate factors with statistical significance in two groups. Risk factors for poor prognosis in ACI thrombolytic therapy were explored and predictive model was established. Results Serum PTX3 and Cav-1 levels in poor prognosis group were significantly higher than those in good prognosis group (t＝4.369, P＝0.000; t＝20.252, P＝0.000). Logistic regression analysis showed that interval time (OR 1.8,5%CI 0.343-5.446), blood sugar (OR 1.7,5%CI 0.917-1.724), urokinase dose (OR 1.6,5%CI 0.530-2.351), PTX3 (OR 2.9,5%CI 0.689-10.262), Cav-1 (OR 3.6,5%CI 0.644-14.879) were risk factors for poor prognosis of ACI thrombolytic therapy. ROC curve analysis showed that the cut-off value of PTX3 diagnosis was 2.38 g/L, sensitivity was 84.21%, specificity was 75.76%, area under curve (AUC) of ROC was 0.839 (95%CI 0.741-0.937); the cut-off value of Cav-1 diagnosis was 21.70 g/L, sensitivity was 75.44%, specificity was 69.70%, AUC was 0.842 (95%CI 0.744-0.940); the sensitivity, specificity and AUC of the combined detection were 91.23%, 72.73% and 0.947 (95%CI 0.896-0.999). Conclusions Interval time, blood sugar, urokinase dose, PTX3 and Cav-1 are risk factors for poor prognosis of ACI thrombolytic therapy. Detection of serum PTX3 and Cav-1 alone or in combination can be used to predict the degree of poor prognosis.

Abstract:Aim To explore the relationship between the expression of serum aquaporin 1 (AQP1), aquaporin 4 (AQP4), vascular endothelial growth factor (VEGF) and the severity of cerebral edema in patients with acute cerebral infarction. Methods 78 patients with acute cerebral infarction were selected as the observation group and 80 healthy people were selected as the control group, enzyme-linked immunosorbent assay was used to detect the levels of serum AQP1, AQP4 and VEGF, the severity of brain edema was judged by measuring the electrical impedance disturbance coefficient with non-invasive dynamic monitor. According to the electrical impedance disturbance coefficient, the observation group was divided into severe group (>9.5) and mild group (7.5