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Objective:To investigate the effects of intravascular hypothermia combined with early post-pyloric feeding on the neurological function and prognosis in patients with severe ischemic stroke, and to provide a theoretical basis for clinical decision-making on the optimal nutritional support strategy for patients with severe ischemic stroke during intravascular hypothermia treatment.Methods:This was a retrospective, non-randomized, controlled study. A total of 78 patients with first severe ischemic stroke who were admitted to the ICU of Neurology Department, Xuanwu Hospital, Capital Medical University from January 2018 to December 2021 were selected. General information and clinical data of the patients were collected and grouped according to intrvascular hypothermia combined with nutritional support. Patients were divided into early post-pyloric feeding group of 52 cases and early parenteral nutrition group of 26 cases. The neurological prognosis, disease prognosis, nutritional status and complications related to nutritional support of the two groups were retrospectively analyzed.Results:The Glasgow score at 30th day after intravascular hypothermia in the early postpyloric feeding group was (11.25 ± 4.92) points, which was higher than that in the early parenteral nutrition group (8.40 ± 5.53), and the difference was statistically significant ( t=-2.45, P<0.05). After treatment, the serum total protein and hemoglobin of early postpyloric feeding group were (59.56 ± 5.09) g/L and (131.06 ± 19.58) g/L, respectively, which were higher than those of early parenteral nutrition group (56.52 ± 7.94) g/L and (122.07 ± 17.72) g/L. The difference was statistically significant ( t=-2.03, -1.91, P<0.05). The clinical pulmonary infection score of the early postpyloric feeding group was (7.33 ± 0.96) points, which was lower than that of the early parenteral nutrition group (9.42 ± 2.11). The mechanical ventilation time and ICU stay time were (17.46 ± 10.47) days and (28.89 ± 12.59) days, respectively. Compared with the early parenteral nutrition group (25.77 ± 15.20) days and (37.07 ± 17.15) days, the differences were statistically significant ( t=3.28, 2.83, 2.52, all P<0.05). There were no significant differences in catheter-associated bloodstream infection and ICU hospitalization mortality between the two groups (both P>0.05). Conclusions:Intravascular hypothermia combined with early post-pyloric feeding can improve the nutritional status of patients with severe ischemic stroke, effectively control pulmonary infection, shorten mechanical ventilation and hospital stay, and promote neurological repair.
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Neurological diseases include a variety of neurodegenerative diseases and other brain damage diseases.The treatment schemes for neurological diseases are still in research.The existing clinical and basic studies have confirmed that traditional estrogen therapy has certain protective effect on the nervous system,while it increases the risk of breast or endometrial cancer.The emergence of the selective estrogen receptor modulators (SERMs) can avoid the above mentioned problems.The available studies have confirmed the protective effect of tamoxifen as a SERM on the nervous system.This paper reviews the role and functioning mechanisms of tamoxifen in the nervous system and cognitive function,aiming to provide guidance for the future application of tamoxifen in the treatment of neurological diseases and the improvement of cognitive function.
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Tamoxifen/therapeutic use , Selective Estrogen Receptor Modulators/therapeutic use , Cognition , Nervous SystemABSTRACT
Abstract Objective To evaluate the effects of exercise training on neurological recovery, Growth Transforming Factor-β1 (TGF-β1), Hypoxia Inducible Factor-1α (HIF-1α), and Nogo-NgR signaling pathways after spinal cord injury in rats. Methods Forty-eight male Sprague-Dawley rats were randomly divided into four groups: normal group, sham-operated group, model group, and training group. The rat spinal cord injury model was established using Allen's method, and the training group received exercise training on the 8th day postoperatively. The Basso, Beattie and Bresnahan (BBB) score, modified Tarlow score, and inclined plane test scores were compared in each group before injury and 1, 7, 14, 21 and 28 days after injury. Results The BBB score and modified Tarlow score of the model group and the training group were 0 at the first day after the injury, and gradually increased on the seventh day onwards (p < 0.05). The BBB score and modified Tarlow score of the training group were higher than those of the model group at the 14th, 21st and 28th day (p < 0.05). The angles of the inclined plate at multiple time points after injury were lower in the model group and the training group than in the normal group and the sham-operated group (p < 0.05); The angles of the inclined plate at the 14th, 21st and 28th day after injury were higher in the training group than in the model group (p < 0.05). Conclusion The mechanism of exercise training may be connected to the inhibition of the Nogo-NgR signaling pathway to promote neuronal growth.
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OBJECTIVE@#To investigate the neuroprotective effect of electroacupuncture (EA) at "Quchi" (LI 11) and "Zusanli" (ST 36) in the rats with cerebral ischemic reperfusion and the potential mechanism of microglia pyroptosis.@*METHODS@#Sixty SD rats were randomly divided into a sham-operation group, a model group and an EA group, with 20 rats in each group. The Zea Longa method was employed to establish the rat model of the middle cerebral artery occlusion and reperfusion (MACO/R) in the left brain. In the EA group, since the 2nd day of modeling, EA was given at "Quchi" (LI 11) and "Zusanli" (ST 36) of right side with disperse-dense wave, 4 Hz/20 Hz in frequency and 0.2 mA in current intensity, 30 min each time, once a day for lasting 7 consecutive days. The reduction rate of cerebral blood flow was measured with laser Doppler flowmetry during operation. The neurological function of rats was observed using Zea Longa neurobehavioral score. The cerebral infarction volume was detected by TTC staining method. The microglia positive expression in the ischemic side of the cortex was detected with the immunofluorescence method. Under transmission electron microscope, the ultrastructure of cell in the ischemic cortex was observed. The mRNA expression levels of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), cysteinyl aspartate specific proteinase-1 (Caspase-1) and gasdermin D (GSDMD) in the ischemic cortex were detected using real-time PCR.@*RESULTS@#Compared with the sham-operation group, in the model group, the reduction rate of cerebral blood flow was increased during operation (P<0.001); Zea Longa neurobehavional score and the percentage of cerebral infarction volume were increased (P<0.001), the numbers of M1-type microglia marked by CD68+ and M2-type microglia marked by TMEM119+ were elevated in the ischemic cortex (P<0.001), the mRNA expression of NLRP3, ASC, Caspase-1 and GSDMD was increased (P<0.001, P<0.01); the cytomembrane structure was destroyed, with more cell membrane pores formed in the ischemic cortex. Compared with the model group, after intervention, Zea Longa neurobehavioral score and the percentage of cerebral infarction volume were reduced (P<0.05), the number of M1-type microglia marked by CD68+ was reduced (P<0.05) and the number of M2-type microglia marked by TMEM119+ was increased (P<0.05); and the mRNA expression of NLRP3, ASC, Caspase-1 and GSDMD was decreased (P<0.01, P<0.05) in the EA group. Even though the cytomembrane structure was incomplete, there were less membrane pores presented in the ischemic cortex in the EA group after intervention.@*CONCLUSION@#The intervention with EA attenuates the neurological dysfunction and reduces the volume of cerebral infarction in the rats with cerebral ischemic reperfusion. The underlying mechanism is related to the inhibition of microglia pyroptosis through modulating NLRP3/Caspase-1/GSDMD axis.
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Animals , Rats , Rats, Sprague-Dawley , Caspase 1/genetics , NLR Family, Pyrin Domain-Containing 3 Protein/genetics , Electroacupuncture , Cerebral Infarction/therapy , RNA, MessengerABSTRACT
OBJECTIVE@#To compare the clinical efficacy on cervical spondylosis of nerve root type with qi stagnation and blood stasis treated with warming needle with different lengths of moxa stick.@*METHODS@#Six hundred patients with cervical spondylosis of nerve root type with qi stagnation and blood stasis were randomly divided into 4 groups: a 4 cm length group (150 cases, 5 cases dropped off, 2 cases suspended), a 3 cm length group (150 cases, 6 cases dropped off, 2 cases suspended), a 2 cm length group (150 cases, 6 cases dropped off), and a routine acupuncture group (150 cases, 6 cases dropped off). Warming needle with moxa stick in the length of 4 cm, 3 cm and 2 cm was delivered in the 4 cm length group, the 3 cm length group and the 2 cm length group, respectively. In the routine acupuncture group, simple acupuncture was applied. The acupoints selected in the above groups included Dazhui (GV 14) and bilateral Jiaji (EX-B 2) of C5 and C7, Fengchi (GB 20), Jianzhen (SI 9), Quchi (LI 11), Zhongzhu (TE 3), etc. In each group, the intervention was delivered once daily and 5 times a week. One course of intervention was composed of 2 weeks and 2 courses were required. The TCM syndrome score, the score of clinical assessment scale for cervical spondylosis (CASCS), the score of the brachial plexus traction test of the affected upper limb, F wave occurrence rate and conduction velocity of the ulnar nerve, the median nerve and the radial nerve of the affected upper limb were compared before and after treatment in the patients of each group. The levels of serum inflammatory factors, i.e. interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α) and hypersensitive C-reactive protein (hs-CRP), were measured before and after treatment in the patients of each group. The clinical cfficacy was evaluated in the 4 groups.@*RESULTS@#After treatment, the results of TCM syndrome evaluation, i.e. the scores of neck pain, activity limitation and upper limb numbness and pain, as well as the total scores; and the scores of brachial plexus traction test were reduced when compared with those before treatment in each group (P<0.01, P<0.05). The scores of subjective symptoms and adaptability, and the total scores of CASCS were elevated in comparison with those before treatment in each group (P<0.01, P<0.05). In the 4 cm length group, compared with the other 3 groups, the scores of neck pain and activity limitation for TCM syndrome evaluation, and its total score were lower (P<0.05, P<0.01); and the scores of subjective symptoms and adaptability, and the total score of CASCS were higher (P<0.05, P<0.01). The score of the brachial plexus traction test in the 4 cm length group was lower than that of the routine acupuncture group (P<0.05). After treatment, F wave occurrence rates and conduction velocity of median nerve and radial nerve were increased when compared with those before treatment in each group (P<0.05, P<0.01). F wave occurrence rate and conduction velocity of the radial nerve in the 4 cm length group were higher than those of the other 3 groups (P<0.05), and those of the median nerve were higher when compared with the routine acupuncture group (P<0.05). After treatment, the levels of serum IL-1β, IL-6 and TNF-α were all reduced when compared with those before treatment in each group (P<0.01, P<0.05); the level of serum IL-6 in the 4 cm length group was lower than those of the other 3 groups and serum level of TNF-α was lower compared with that in the routine acupuncture group (P<0.05). The total effective rate of the 4 cm length group was 78.3% (112/143), which was higher when compared with the 3 cm length group (67.6%, 96/142), the 2 cm length group (65.3%, 94/144) and the routine acupuncture group (53.5%, 77/144), respectively (P<0.05).@*CONCLUSION@#Warming needle with moxa stick of 4 cm in length effectively relieves the clinical symptoms of cervical spondylosis of nerve root type with qi stagnation and blood stasis, improves the nerve function of the upper limbs, and reduces the inflammatory responses caused by nerve compression. The clinical efficacy of this therapy with moxa stick of 4 cm in length is superior to the warming needle with moxa sticks of 3 cm and 2 cm, as well as the routine acupuncture.
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Humans , Interleukin-6 , Neck Pain , Qi , Tumor Necrosis Factor-alpha , Spondylosis/therapyABSTRACT
ObjectiveTo evaluate the efficacy of Geriatric Nutritional Risk Index (GNRI) on admission on predicting neurological outcomes for stroke patients at the convalescence stage (three months after stroke). MethodsA total of 277 inpatients with ischemic stroke in Wenzhou TCM Hospital of Zhejiang Chinese Medical University from November, 2022 to January, 2023 were divided into good outcome group (n = 195) and poor outcome group (n = 82) according to the score of modified Rankin Scale (mRS) three months after stroke. Their clinical data and GNRI were compared. ResultsCompared with the good outcome group, the poor outcome group showed a lower level of GNRI (t = -9.569, P < 0.001), more proportion of patients with high nutritional risk (χ2 = 68.861, P < 0.001). More cases with poor outcome were found with higher nutritional risk (Z = 65.406, P < 0.001). After covariate adjustment, higher level of GNRI was an independent protective factor for poor outcome three months after stroke (OR = 0.895, 95%CI 0.864 to 0.927, P < 0.05), and the OR increased with the nutritional risk grade of GNRI (P < 0.05). The area under the curve (AUC) of GNRI, score of NIHSS, and BMI were 0.812 (Z = 11.576, P < 0.001), 0.759 (Z = 8.328, P < 0.001), and 0.594 (Z = 2.716, P = 0.007), respectively; while the combination of GNRI and NIHSS was more effective (AUC = 0.875, Z = 17.389, P < 0.001). The sensitivities of GNRI, NIHSS and the combination of the two in predicting neurological function were 65.85%, 76.83% and 79.21%, respectively, and the specificities were 81.54%, 60.51% and 82.95%, respectively. ConclusionGNRI on admission is associated with neurological function three months after stroke. GNRI can be used alone or in combination with NIHSS score to predict neurological outcome in the rehabilitation period, which is a useful complement to traditional predictors.
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Objective To observe the protective effect of Shenmajing formula on brain tissue of mice with cerebral ischemic injury and explore the possible mechanism. Methods Thirty SPF-grade C57 BL/6 male mice were randomly divided into model control group, Shenmajing group and nimodipine group, and the animal models of cerebral ischemic injury in mice were prepared by electrocoagulation. The protein expression level in endothelial progenitor cells were detected by Western blot. Results Compared with the model control group, the infarct volume of mice in the Shenmajing group was significantly reduced, and the migration, adhesion and tubule formation ability of endothelial progenitor cells were significantly improved, and the expression level of BDNF protein in endothelial progenitor cells was significantly increased. Conclusion The protective effect of Shenmajing granules on brain tissue of mice with cerebral ischemic injury could be closely related to the regulation of BDNF expression in endothelial progenitor cells and improvement of endothelial progenitor cell function of bone marrow origin.
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Objective:To explore any effect of supplementing psychological intervention with repeated transcranial magnetic stimulation (rTMS) in the rehabilitation of depressed persons with Parkinson′s disease (dPD).Methods:A total of 120 dPD patients were randomly divided into a psychological intervention group, an rTMS treatment group and an observation group, each of 40. In addition to conventional anti-Parkinson′s treatment and anti-depressant treatment, the psychological intervention group received such treatment and the rTMS group received 10Hz rTMS applied over the left dorsolateral prefrontal cortex for 8 weeks. The observation group received both interventions. Before and after the treatment, depression, neurological functioning and life quality were evaluated in all of the subjects using the 24-item Hamilton Depression Scale, the Movement Disorder Society′s unified Parkinson′s disease rating scale and the SF-36 questionnaire.Results:After the intervention, significant improvement was observed in all of the quantitative evaluations as well as in the remission rate (40%) and the reaction rate (90%). On average, the observation group′s results were significantly better than those of the other two groups.Conclusion:Psychological intervention and rTMS a have synergistic effect in treating dPD patients and their combination is worthy of clinical promotion and application, as it can relieve their depression and improve their neurological functioning and life quality.
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Objective:To investigate the protective mechanism of sevoflurane inhalation anesthesia on neurological function in rats with cerebral infarction.Methods:Sixty SD rats were randomly and equally divided into the sham group, cerebral obstruction group, and sevoflurane post conditioning group (Sevo group). Rats in the cerebral obstruction group and Sevo group were underwent wire embolization to establish permanent focal cerebral ischemia rat model. Rats in the sham group were not treated with wire embolization. Rats in the Sevo group received sevoflurane at a volume fraction of 2.5% immediately after reperfusion and were maintained with oxygen for 30 min with 1 L/min oxygen flow. Rats in the sham and cerebral obstruction group received 30 min of continuous oxygen inhalation with 1 L/min oxygen flow. After 24 h, modified neurological deficit bisection (mNSS) was used to assess the neurological function of the rats in the three groups. After that, blood was taken and the rats were sacrificed, and their brain tissues were collected to determine the level of cerebral infarction volume, apoptosis rate, and the levels of serum inflammatory factors, including interleukin (IL)-6, IL-10, IL-1β and tumor necrosis factor-α (TNF-α), as well as malondialdehyde (MDA) levels, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in brain tissue. Toll like receptor 4 (TLR4) and nuclear transcription factor κB (NF-κB) p65 protein expression levels in rat brain tissues were determined by Western blot analysis.Results:In the Sevo group, the mNSS score, cerebral infarct volume ratio, apoptosis rate, IL-6 level, IL-1β level, TNF-α level, MDA level as well as the expression levels of TLR4 and NF-κB p65 in the brain tissues were higher than those of the sham group (all P<0.05) and lower than those of the cerebral obstruction group (all P<0.05). In the Sevo group, IL-10 level as well as SOD and GSH-Px activities were lower than those of the sham group (all P<0.05) and higher than those of the cerebral obstruction group (all P<0.05). Conclusions:Sevoflurane has a certain protective effect on the brain tissue and neurological function of rats with cerebral infarction. This protective effect may be achieved by inhibiting the inflammatory response mediated by the TLR4/NF-κB signal channel, reducing the release of inflammatory factors, reducing inflammation and oxidative stress, and inhibiting cell apoptosis.
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Objective:To observe the changes of regional saturation of cerebral oxygenation (rScO 2) and blood neuron specific enolase (NSE) in patients after cardiopulmonary resuscitation (CPR), and to explore its value in evaluating the prognosis of patients' neurological function. Methods:From January 2012 to December 2020, 97 patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA) treated in the intensive care unit (ICU) of the Second Affiliated Hospital of Soochow University were selected. According to the prognosis, the patients were divided into two groups: good neurological function group [Glasgow-Pittsburgh Cerebral Performance Categories (CPC) 1-2, 20 cases] and neurological dysfunction group (CPC classification 3-5, 77 cases). The clinical data of gender, age, the number of patients with defibrillable rhythm, time of ROSC, the number of CA patients outside the hospital, acute physiology and chronic health evaluationⅡ(APACHEⅡ), Glasgow coma scale (GCS), global non-response scale (FOUR), body temperature, mean arterial pressure (MAP), blood lactic acid (Lac) and GCS at discharge, as well as the length of ICU stay, rScO 2 and blood NSE were collected. The differences of rScO 2 and NSE between the two groups were compared; and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of rScO 2 and NSE alone or in combination in predicting the prognosis of patients with ROSC after CA. Results:The rScO 2 of good neurological function group was significantly higher than that of neurological dysfunction group at 1, 3, 6, 12, 24 and 48 hours (all P < 0.05). At 24 hours after admission, the rScO 2 on the left and right sides of good neurological function group was significantly higher than that in neurological dysfunction group [left: 0.65 (0.59, 0.76) vs. 0.55 (0.44, 0.67), right: 0.62 (0.61, 0.73) vs. 0.50 (0.30, 0.69), both P < 0.05], and NSE was significantly lower than that in the neurological dysfunction group [ng/L: 21.42 (15.38, 29.69) vs. 45.82 (24.05, 291.26), P < 0.05]. ROC curve analysis showed that both rScO 2 and NSE alone and combined detection had a certain value in predicting the prognosis of neurological function in patients with ROSC after CA, and the area under the ROC curve (AUC) detected by the combination was the largest, which was higher than the AUC predicted by rScO 2 or NSE (0.904 vs. 0.884, 0.792). When the cut-off value of combination was 0.83, the sensitivity and specificity were 75.7% and 100% respectively. Conclusion:Monitoring rScO 2 and NSE can predict the prognosis of neurological function after CPR, especially the combined evaluation of the two indexes, which can greatly improve the accuracy of diagnosis.
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BACKGROUND: There is an inflammatory response in the lesion tissue of ischemic cerebral infarction, and the expression of miR-150-5p is significantly decreased. Whether miR-150-5p inhibits the release of inflammatory factors and alleviates the injury of ischemic cerebral infarction tissue through the Toll-like receptor-5/nuclear factor-KB pathway remains unclear. OBJECTIVE: To investigate the role and preliminary mechanism of miR-150-5p in ischemic cerebral infarction in rats. METHODS: (1) The rat models of middle cerebral artery occlusion were constructed and the rat models were divided into five groups: Control, miR-150-5p agomir, agomir control, miR-150-5p antagomir and antagomir control groups. (2) The rats in the control group was given the intracerebroventricular injection of normal saline, and the rats in the latter four groups were given the intracerebroventricular injection of miR-150-5p agomir (miR-150-5p agonist), agomir negative control, miR150-5p antagomir (miR150-5p inhibitor) and antagomir negative control, respectively. (3) After 7 days, the brain was graded by modified neurological severity score, the cerebral infarct volume was measured by MRI, and the histopathological changes were observed by hematoxylin-eosin staining. The expression levels of miR-150-5p, interleukin-6, tumor necrosis factor-a, Toll-like receptor-5 and nuclear factor-KB p65 in brain tissues were detected by qRT-PCR, ELISA and western blot assay, respectively. The target relationship between miR150-5p and Toll-like receptor-5 was verified by luciferase assay by retrieving the bioinformatics website Targetscan to predict the binding sites of miR-150-5p and Toll-like receptor-5. RESULTS AND CONCLUSION: (1) Compared with the control group, the modified neurological severity score, and levels of interleukin-6, tumor necrosis factor-a, Toll-like receptor-5 and nuclear factor-KB p65 proteins were significantly decreased in the miR-150-5p agomir group (P 0.05). (3) TargerScan website prediction results and luciferase reporter gene analysis results showed that miR-150-5p and Toll-like receptor-5 had a targeted binding site. (4) These results imply that miR-150-5p can inhibit the inflammatory signaling pathway of Toll-like receptor-5/nuclear factor-KB p65 in brain injury caused by ischemia and reduce the inflammatory response, thereby alleviating the damage of nerve function and playing a protective role.
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Objective@#To investigate the effects of health management based on the theory of protection motivation on fatigue status, neurological function recovery and life ability of stroke patients, and evaluate its clinical effects.@*Methods@#A total of 120 stroke patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were selected as subjects. Randomized digital table method was used to divided them into observation group and control group, 60 cases in each group; the control group underwent routine nursing and follow-up of neurology, and the observation group was given health management based on protection motivation theory on the basis of the control group. The Fatigue Severity Scale (FSS) was used to assess the patient's fatigue, the European Stroke Scale (ESS) was used to evaluate the patient's neurological function, the modified Barthel index was used to assess the patient's viability. The fatigue, neurological recovery, and changes in living ability were compared between the two groups before and after the nursing intervention.@*Results@#The Scores of FSS, MBI and ESS of the observation group were 45.34±8.84, 54.3±4.69 and 45.24±4.18 before intervention and 32.48±5.80, 75.50±4.93, 63.12±3.32 after intervention. The Scores of FSS, MBI and ESS of the control group was 44.97±8.47, 53.47±4.20, 43.48±5.67 before intervention and 39.59±7.43, 63.81±3.25, 55.32±3.48 after intervention. The difference after intervention between the two groups was statistically significant (t values were 15.335, 12.562, 5.843, P<0.01). The difference in the observation group before and after intervention was statistically significant (t values were 9.422, 24.133, 25.945, P<0.01). The differences in the control group before and after intervention was statistically significant (t values were 3.699, 15.082, 13.786, P<0.01).@*Conclusions@#Health management based on the theory of protection motivation is more effective than routine nursing to improve the fatigue, neurological function and life ability of stroke patients.
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OBJECTIVE@#To evaluate the efficacy of electro-acupuncture (EA) or transcutaneous electrical acupoint stimulation (TEAS) on perioperative cerebral blood flow (CBF) and neurological function in ischemic stroke (IS) patients undergoing carotid artery stenting (CAS).@*METHODS@#In total, 124 consecutive IS patients were randomly allocated to the EA, TEAS, and sham groups (groups A, T, and S; 41, 42, and 41 cases, respectively) by software-derived random-number sequence. Groups A and T received EA and TEAS, respectively, at the Shuigou (GV 26) and Baihui (GV 20), Hegu (LI4) and Waiguan (TE 5) acupoints. Group S received sham EA. The stimulation was started from 30 min before surgery until the end of the operation. The primary outcome was the CBF at 30 min after surgery, which was measured by transcranial Doppler sonography. The secondary outcomes included hyperperfusion incidence and neurological function. National Institutes of Health Stroke Scale (NIHSS) and General Evaluation Scale (GES) scores were recorded at 1 week, 1 month, and 3 months postoperatively.@*RESULTS@#Mean CBF velocity at 30 min after surgery in groups A and T was much lower than that in Group S (P < 0.05); the incidence of hyperperfusion in Groups A and T was also lower than that in group S (P <0.05). Acupuncture was an independent factor associated with reduced incidence of hyperperfusion (OR=0.042; 95% CI: 0.002-0.785; =0.034). NIHSS and GES scores improved significantly at 1 week postoperatively in Groups A and T than in Group S (P < 0.05). Relative to Group S, groups A and T exhibited significantly lower incidences of moderate pain, as well as higher incidences of satisfaction with anesthesia, at 1 day postoperatively (P < 0.05).@*CONCLUSIONS@#EA or TEAS administered in combination with local anesthesia during CAS can inhibit transient increases in CBF, reduce the incidence of postoperative hyperperfusion, and improve neurological function. (Registration No. ChiCTR-IOR-15007447).
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OBJECTIVE@#To observe the impacts of electroacupuncture (EA) on neurological function, the pathological morphology in brain tissue, apoptosis level and the protein expressions of apoptosis-related cytochrome C (Cyt-C) and cysteine aspartic acid protease-9 (Caspase-9) in the rats with traumatic brain injury (TBI) and explore the potential mechanism of EA in treatment of TBI.@*METHODS@#A total of 70 clean-grade SD mice were randomized into a blank group (8 rats), a sham-operation group (8 rats), a model group (27 rats) and an EA group (27 rats). In terms of interventions of 3, 7 and 14 days, 3 subgroups were divided in the model group and the EA group successively, 9 rats in each subgroup. The modified Feeney free-fall percussion method was adopted to establish TBI models of rats. In the sham-operation group, only the skull was exposed and drilled and no free-fall percussion was exerted. One day after modeling, EA was given in the rats of EA group at "Shuigou" (GV 26), "Baihui" (GV 20) and "Neiguan" (PC 6) and "Zusanli" (ST 36) on the affected side, with intermittent wave, 2 Hz in frequency, once daily, 10 min each time, for 3, 7 and 14 days successively. Separately, on the day 3, 7 and 14 of intervention, the modified neurological severity scale (mNSS) was used to evaluate the degree of neurological function injury in the rats, HE staining and Nissl staining were to observe the pathological and morphological changes in brain tissue, TUNEL method was to observe the level of apoptosis in brain tissue and immunohistochemistry (IHC) method and Western blot were to determine the protein expressions of Cyt-C and Caspase-9 in brain tissue.@*RESULTS@#Compared with the sham-operation group, on the day 3, 7 and 14 of intervention, mNSS scores were increased obviously in the rats of the model group respectively (<0.01). Compared with the model group, on the day 3, 7 and 14 of intervention, mNSS scores were reduced in the rats of the EA group respectively (<0.05). On day 3 of intervention, in brain injury region of the rats in the model group and the EA group, gross tissue necrosis, nuclear fragmentation, consolidation and obvious vacuolar changes, reduced Nissl bodies and scattered arrangement were found. On day 7 and 14 of intervention, in the model group and the EA group, the new connective tissue filling and normal cells were visible and Nissl bodies increased. The overall repair and Nissl body quantity in the EA group were better than the model group. Compared with the sham-operation group, on day 3, 7 and 14 of intervention, the numbers of apoptotic cells were increased obviously in the model group (<0.01) and they were reduced in the EA group as compared with the model group (<0.05). Compared with the sham-operation group, on day 3, 7 and 14 of intervention, the protein expressions of Cyt-C and Caspase-9 in damaged brain tissue were all increased obviously in the model group (<0.01) and they were all reduced in the EA group as compared with the model group successively (<0.05).@*CONCLUSION@#Electroacupuncture remarkably improves the condition in the neurological function injury and reduces apoptosis degree in TBI model rats, which is likely related to the down-regulation of the protein expressions of Cyt-C and Caspase-9 in damaged brain tissue and further to bring the impacts on mitochondria mediated apoptosis process.
Subject(s)
Animals , Rats , Apoptosis , Brain Injuries, Traumatic , Therapeutics , Caspase 9 , Metabolism , Cytochromes c , Metabolism , Electroacupuncture , Random Allocation , Rats, Sprague-DawleyABSTRACT
Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion,intracranial pressure and nerve function after decompression with bone flap.Methods From October 2015 to October 2018,132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People's Hospital of Jinan were selected and divided into observation group (66 cases) and control group(66 cases) by double blind random method.The observation group received three-dimensional titanium mesh repair at 24 ～ 42 d after bone disc decompression surgery.The control group received three-dimensional titanium mesh repair at 90 ～ 150 d(3 ～ 5 months) after surgery.The changes of operation,cerebral perfusion,intracranial pressure and nerve function were compared between the two groups.Results The operative time,blood loss and free time of the flap in the observation group were (92.5 ± 12.4) min,(354.3 ± 17.5) mL and (13.2 ± 3.1) min,respectively,which were shorter or less than those in the control group [(142.8 ± 15.3) min,(518.3 ± 22.3) mL and (38.3 ± 4.3) min],the differences between the two groups were statistically significant (t=4.745,6.831,4.963,all P ＜ 0.05).After treatment,the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were (0.1 ±0.0) and(0.2 ± 0.1),respectively,which were lower than those in the control group [(0.2 ± 0.1),(0.3 ± 0.1)] (t =3.657,2.579,all P ＜0.05).There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P ＜0.05).The incidence of treatment complications in the observation group was 10.94％ (7/64),which was significantly lower than that in the control group [38.7％ (24/62)] (x2 =14.094,P ＜ 0.05).Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time,restore the intracranial pressure on the affected side,improve the abnormal cerebral perfusion,and reduce the neurological damage in patients with hypertensive cerebral hemorrhage.
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Objective::To explore the clinical efficacy of Tongqiao Huoxuetang plus acupuncture on post-stroke cognitive impairment (PSCI) and its effect on neurotransmitters and neurological function of patients. Method::Totally 122 PSCI patients admitted in our hospital from January 2017 to March 2019 were randomly divided into observation group and control group by simple random number table method, with 61 patients in each group. Both groups were given oral donepezil hydrochloride tablets. The control group was given acupuncture treatment, while the observation group was given Tongqiao Huoxuetang plus acupuncture in addition to therapy of control group. All patients were treated continuously for 4 weeks. The clinical efficacy was compared between two groups. Before and after treatment, the general cognitive function of two groups was tested by mini-mental state examination (MMSE), changes of their neurologic impairment and daily living ability were evaluated by National institutes of health stroke scale (NIHSS) and Barthel index (BI) respectively, and euzymelinked immunosorbent assay was adopted to test the levels of neurotransmitters [acetyl choline (ACh), dopamine (DA), noradrenaline (NE), 5-hydroxytryptamine (5-HT)] and neurologic impairment markers [neuronspecific enolase (NSE), visinin-like protein-1 (VILIP-1), myelin basic protein (MBP)]. And the occurrence of adverse reactions was recorded. Result::The overall effective rate of the observation group was 91.8% (56/61), which was much higher than 78.7% (48/61) of control group (P<0.05). After treatment, both groups saw much higher MMSE and BI scores but lower NIHHS scores than before treatment (P<0.05), and above indicators in observation group were improved more significantly than those in control group over the same period after treatment (P<0.05). The levels of serum ACh, DA, NE and 5-HT after treatment were obviously higher than those before treatment (P<0.05), and observation group had significantly higher ACh, DA, NE and 5-HT levels than control group over the same period (P<0.05). After treatment, both groups witnessed a great decrease in NSE, VILIP-1, MBP (P<0.05), while the observation group saw dramatically lower NSE, VILIP-1, MBP levels than control group over the same period after treatment (P<0.05). Neither of two groups saw serious adverse reactions. Conclusion::In treating PSCI, Tongqiao Huoxuetang plus acupuncture can significantly improve neurological function of the patients, which may be due to increase of neurotransmitters. Besides, Tongqiao Huoxuetang plus acupuncture is proved to be generally effective in promoting the recovery of patients' neurological function and enhancing their abilities in daily life, with a good tolerance among patients.
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OBJECTIVE: To explore the mechanism of electroacupuncture (EA) underlying improvement of cerebral infarction (CI) by investigating its influence on expression of cerebral Wnt7a, lymphoid enhancer factor-1 (LEF1), glycogen synthase kinase 3β(GSK-3β) and Dickkopf-1(DKK1) mRNA and proteins in CI rats. METHODS: A total of 280 male Wistar rats were randomly divided into blank control (n＝10), sham-operation, model and EA groups，and 90 rats of the last 3 groups were further divided into 1, 3, 6, 9, 12 and 24 h, and 3, 7 and 12 d subgroups with 10 rats in each subgroup. The CI model was established by occlusion of the middle cerebral artery (MCAO). The sham-operation group received the same surgical operation but without thread embolus insertion. EA (2 Hz/15 Hz, 2 mA) was applied to "Shuigou" (GV26) for 20 min, once a day for 1, 3, 7 and 12 d, respectively. The neurological deficit was evaluated by using Neurological Severity Scores (NSS). The expression levels of Wnt7a，LEF1, GSK-3β and DKK1 mRNAs and proteins in the right ischemic brain tissues were detected by Quantative real-time PCR and Western blot, respectively. RESULTS: After MCAO, the NSS score was significantly increased in the model and EA groups relevant to the blank control and sham-operation groups (P0.05). CONCLUSION: EA of GV26 can significantly improve the neurological deficit symptoms in MCAO rats, which may be associated with its effects in up-regulating the expression of Wnt7a and LEF1 mRNAs and proteins, and in down-regulating the expression of GSK-3β and DKK1 mRNAs and proteins.
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Objective: To investigate the effect of nerve growth factor (NGF) on the expression level of growth differentiation factor-15 (GDF-15) in the brain tissue of the rats with cerebral infarction, and to elucidate the mechanism of NGF in the rats with cerebral infarction. Methods: The middle cerebral artery occlusion (MCAO) models were established by the Longa' s method. A total of 54 SD rats were randomly divided into sham operation group, model group and NGF group, and there were 18 rats in each group. The rats in NGF group were given NGF (50 μg middot; kg-1) by intraperitoneal injection, and equal volume of normal saline was given to the rats in sham operation (the artery was isolated without ligation) group and model group. The neurological function scores of the rats in various groups were measured 1, 3 and 7 d after operation; HE staining was used to observe the pathomorphology of nerves in brain tissue and immunohistochemical staining was used to detect the number of GDF-15 positive cells; the expression levels of GDF-15 in brain tissue of the rats in various groups were detected by ELISA method. Results: The results of HE staining showed that the degrees nerve cell necrosis, interstitial edema and glial cell proliferation were relatively low in NGF group 7 d after operation. Compared with sham operation group, the neurological function scores, the number of GDF-15 positive cells, and the expression levels of GDF-15 in brain tissue of the rats in model group and NGF group were significantly increased (P<0. 05). Compared with model group, the neurological function scores of the rats in NGF group were significantly decreased 3 and 7 d after operation (P<0. 05), and the number of GDF-15 positive cells and the expression levels of GDF-15 in brain tissue of the rats in NGF group were significantly increased at different time points after operation (P<0. 05). Conclusion: NGF can protect the brain nerve by up-regulating the expression level of GDF-15 in brain tissue and improving the nerve function.
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Objective:To investigate the effect of electroacupuncture at Jiaji (EX-B2) points and Stomach Meridian Foot-Yang Ming points on the neurological function and the expression of local Synapsin I in rats after spinal cord injury, and to explore its molecular mechanism. Methods:A total of 60 Sprague-Dawley rats were established spinal cord injury model and they were randomly divided into normal control group, Jiaji group and Yang Ming group, with 20 rats in each group. On the third day after operation, Jiaji group and Yang Ming group were treated with electroacupuncture while the normal control group was not. Their neurological function was assessed with BBB every day. Four rats in each group were sacrificed at the end of the 1st, 2nd, 3rd, 4th and 5th week during the intervention period. HE staining was used to observe the morphology of spinal cord. Immumohistochemical staining was used to detect the expression of Synapsin I protein. Reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR) and Western blotting was used to detect the content of of Synapsin I mRNA and protein. Results:The BBB scores were higher in Jiaji group and Yang Ming group than in the normal control group at all the time points (P < 0.05), and were higher in Yang Ming group than in Jiaji group from one to three weeks (P < 0.05). The immunohistochemical scores of Synapsin I protein were higher in Jiaji group than in the normal control group in the first week (P < 0.05), and were higher in Yang Ming group than in the normal control group from one to four weeks (P < 0.05). The immunohistochemical scores of Synapsin I protein were higher in Yang Ming group than in Jiaji group from three to four weeks (P < 0.05). The expression of Synapsin I mRNA and protein first increased and then decreased in the normal control group; which was higher in Jiaji group than in the normal control group in the first week (P < 0.05) and was higher in Yang Ming group than in the normal control group from one to four weeks (P < 0.05). The Synapsin I mRNA expression in the third week and the Synapsin I protein expression from two to three weeks was higher in Yang Ming group than in Jiaji group (P < 0.05). Conclusion:Electroacupuncture at both Jiaji points and Stomach Meridian Foot-Yang Ming points promote the recovery of nerve function in rats with spinal cord injury. It may be related to the elevated level of Synapsin I in the damaged parts of the spinal cord.
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Objective To study the effect of different collateral circulation on the neurological function and clinical outcome in acute ischemic stroke patients with intravenous thrombolysis, and explore the relationship of the sub item of National Institute of Health stroke scale (NIHSS) with collateral circulation status. Methods From December 2016 to April 2019, 73 consecutive patients with severe stenosis and occlusion of middle cerebral artery (Ml segment) who underwent intravenous thrombolysis at the Department of Neurology, The First Affiliated Hospital of Xinxiang Medical College were retrospectively recruited. The target patients were selected according to CT angiography (CTA) - CT perfusion (CTP) and the collateral circulation status was evaluated before intravenous thrombolysis. The patients were divided into the good collateral circulation group and the poor collateral circulation group. Clinical data were collected and the NIHSS score was used to assess the neurological deficit. The modified Ranking scale (mRS) was used to assess the prognosis of 90 days after onset. The clinical data of the two groups were compared to investigate the relationship between collateral circulation status and NIHSS score sub-items at admission by univariate and multivariate Logistic regression analysis. Also, the relationship between collateral circulation before thrombolysis and clinical outcome after thrombolysis was studied (The primary outcome: mRS score 0 -1 at 90 d; the secondary outcomes: early neurological function significant improvement [NIHSS score 0-1 at 72 h after treatment, or 8 points lower than baseline NIHSS score] and mRS score 0-2 at 90 d after onset; the safety outcome: cerebral hemorrhagic transformation and death 90 days after onset). Results Among the 73 patients, 43 patients were in the good collateral circulation group and 30 patients were in the poor collateral circulation group. The NIHSS scores at admission and 72 hours after treatment in the good collateral circulation group were lower than those in the poor collateral circulation group(2.00 [1.00, 5.00] score vs. 7.00[3.75, 10. 00]score, 1. 00[0. 00, 3. 00]score vs. 5. 00[1. 75, 6. 25]score, respectively; all P <0. 01). Single factor Logistic regression analysis showed that, the scores of facial paralysis, upper limb movement, lower limb movement, dysarthria in the poor collateral circulation group were more than those in the good collateral circulation group(OR and 95%CI, 5.058[2. 249 -11. 372], 1.465[1. 024-2. 094], 1. 633[1. 069 -2. 495], 2. 669 [1. 072 -6. 647], all P < 0. 05). For the primary outcome, 67.4% (29/43) of patients with good collateral circulation and 40. 0% (12/30) of patients with poor collateral circulation had a mRS score of 0-1 (OR, 1.686, 95% CI 1. 068 -3. 105, P = 0. 020). For the secondary outcomes, early neurological improvement was achieved in 53. 5% (23/43) of patients with good collateral circulation and 20.0% (6/30) in patients with poor collateral circulation (OR, 2. 672, 95% CI 1. 241 -5. 765, P = 0.004); the mRS score 0-2 was obtained in 86.0% (37/43) of patients with good collateral circulation and 63. 3% (19/30) of patients with poor collateral circulation (OR, 1. 359, 95% CI 1. 009-1.830, P = 0.024). For the safety outcome, 2 patients in the good collateral circulation group and 7 patients in the poor collateral circulation group had hemorrhagic transformation (OR, 0. 199, 95% CI 0. 044 - 0. 894, P = 0.043); there was no significant difference in mortality risk between the two groups (OR, 0. 698, 95% CI 0. 104 -4. 682, P = 1. 000). Conclusions For acute ischemic stroke patients with middle cerebral artery severe stenosis and occlusion, good collateral circulation is associated with mild clinical symptoms. The increased scores of the facial paralysis, upper limb movement, lower limb movement, dysarthria in NIHSS score sub-item could reflect the poor collateral circulation. Good collateral circulation is conducive to early improvement of neurological function and favorable prognosis in patients with intravenous thrombolysis. It may reduce the risk of hemorrhagic transformation but not the risk of death.