Predictors and predictive scales of malignant brain edema in patients with acute ischemic stroke / 国际脑血管病杂志

Malignant cerebral edema (MCE) can lead to deterioration of neurological function in patients with acute ischemic stroke, and significantly increase the mortality and disability rate. Therefore, early detection and intervention of MCE is crucial for saving patients' lives. This article reviews the predictors and preventive scales of MCE after acute ischemic stroke.

Predictive factors for futile recanalization of acute anterior circulation ischemic stroke after endovascular treatment / 国际脑血管病杂志

Although endovascular therapy improves the recanalization rate of acute large vessel occlusive ischemic stroke, about half of the patients still have poor functional outcome at 90 d, which is called " futile recanalization" . This article reviews and summarizes the predictive factors of futile recanalization after endovascular therapy in acute anterior circulation ischemic stroke, in order to provide help for clinical work and scientific research in the future.

Glibenclamide protects neurovascular units in rats with cerebral ischemia/reperfusion injury by regulating inflammatory signaling pathway HSP70/p-Akt/MMP-9/COX-2 / 中华神经医学杂志

Objective To investigate the protective effect of glibenclamide on neurovascular units (NVUs) and its possible mechanism in cerebral ischemia/reperfusion injury models.Methods One hundred and twenty healthy male SD rats were randomly divided into sham-operated group, model group, and glibenclamide (GBC) treatment group (n=40). Two h reperfusion models of acute focal middle cerebral artery occlusion were prepared by thread occlusion in rats of the latter two groups; rats in the model group were treated with 0.05％ DMSO saline solution two h after ischemia, and rats in the GBC treatment group were given intraperitoneal injection of 10μg/kg GBC with single dose. Immunofluorescence and Western blotting were used to detect the protein levels of sulfonylurea receptor 1 (SUR1) and transient receptor potential cation channel subfamily M member 4 (TRPM4) 8 h after reperfusion, and ELISA was used to detect the plasma level of matrix metalloproteinase 9 (MMP-9). At 24 h after reperfusion, Zea Longa scale was used to determine the neurological deficits; water content in the brain tissues was detected by dry and wet weight method, and blood-brain barrier (BBB) permeability was detected by Evans blue (EB) staining; Nissl staining was employed to detect the survival neurons; ionized calcium bindingadaptor molecule-1 (Iba-1) and cyclooxygenase-2 (COX-2) positive cells and IgG seepage quantity were detected by immumohistochemical staining to assess the neuro-vascular inflammation; the expressions of heat shock protein 70 (HSP70), phosphorylated protein kinase B (p-Akt), phosphorylated c-jun amino-terminal kinase (p-JNK), and phosphatidylinositol-3 kinase (PI3K) were detected by Western blotting.Results (1) At 8 h after reperfusion, the protein expressions of SUR1 and TRPM4 in the brain tissues of the model group were significantly increased as compared with those of the sham-operated group (P<0.05), and the two proteins were co-located; as compared with those in the model group, the protein expressions of SUR1 and TRPM4 in GBC treatment group was decreased, but the differences were not statistically significant (P>0.05). As compared with the sham-operated group, the model group had significantly higher MMP-9 level (P<0.05); as compared with the model group, the GBC treatment group had significantly lower MMP-9 level (P<0.05). (2) At 24 h after reperfusion, as compared with the sham-operated group, the model group had significantly increased Zea Longa scale scores, statistically increased brain water content, significantly increased EB permeability, significantly increased IgG seepage quantity, significantly smaller number of Nissl's staining-positive neurons, significantly larger number of Iba-1, COX-2 positive cells, and significantly decreased protein expressions of HSP70 and p-Akt (P<0.05); as compared with the model group, the GBC treatment group had significantly decreased Zea Longa scores, statistically decreased brain water content, significantly decreased EB permeability, significantly decreased IgG seepage quantity, significantly larger number of Nissl's staining-positive neurons, significantly smaller number of Iba-1, COX-2 positive cells, and significantly increased protein expressions of HSP70 and p-Akt (P<0.05).Conclusion SUR1-TRPM4 expression is increased after cerebral ischemia/reperfusion injury, and inhibition of SUR1-TRPM4 with GBC shows a protective role in NVUs after cerebral ischemia/reperfusion injury, possibly by regulating HSP70/p-Akt/MMP-9/COX-2 inflammatory signal pathway.

Research progress of gut microbiota and microbiota-targeted therapy in critical ill patients / 中华危重病急救医学

In physiological conditions, a diverse microbiota might enhance host defense. However, the gut microbiota of critically ill patients is characterized by lower diversity, lower abundances of key commensal genera, and overgrowth by one bacterial generation, a state known as dysbiosis. Increasing evidences indicate that microbiota-derived components can reach the systemic circulation from the gut and modulate immune homeostasis. Dysbiosis could have greater consequences for the critically ill patients and might contribute to poor outcome. In this review, we highlighted the crucial role of intestinal microbiota in systemic homeostasis in the critically ill patients and summarized emerging evidence in the field of microbiota-targeted therapies. This would provide new perspective for further establishing the causes and consequences of dysbiosis found in the critically ill patients as well as developing new strategies of intervention.

Developing turns-amplitude clouds for healthy Chinese: reference values and influence factors / 中华神经科杂志

Objective To establish the reference values and evaluate influence factors of turns-amplitude clouds for healthy Chinese.Methods We recruited 59 healthy subjects From July 2017 to December 2017 in Nanfang Hospital,Southern Medical University,including 34 males and 25 females,who were divided into young group (15-39 years old),middle-aged group (40-64 years old) and the elderly group (over 65 years),respectively.The number of turns (NT) and mean amplitude (MA) normative data of sternocleidomastoid muscle,deltoid muscle,biceps brachii muscle,extensor digitorum muscle,abductor digiti minimi muscle,quadriceps femoris muscle,tibialis anterior muscle,and gastrocnemius muscle were obtained by using concentric needle electrodes.A total of 20-30 records were collected from each muscle in different degree of contraction.A linear regression of lg(MA-100) versus lgNT was made and the slope,intercept,the 95％ confidence interval of intercept,the largest MA and largest NT were calculated for each muscle.The influence factors,such as gender,age,muscles,and dominant limbs on the shape of cloud were evaluated by using the Chow breakpoint test.Results Normal turns-amplitude clouds were obtained and presented in this article.Muscle and age were found to be the main influence factors affecting the shape of cloud,and gender may affect some clouds,while the dominant limbs had little influence on the shape of the cloud.Conclusion The reference values of turns-amplitude cloud based on muscle,gender and age are of practical significance in clinic.

C-reactive protein/albumin ratio predicting early death in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of C-reactive protein/albumin ratio (CAR) for 30 d survival status in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Neurological Intensive Care Unit (NICU),Nanfang Hospital,Southern Medical University were selected from 2013 to 2016.They were divided into a survival group and a death group according to the 30 d survival status.The clinical data of both groups were compared and analyzed.Multivariate logistic regression analysis was used to determine the independent risk factors for 30 d survival status.The predictive value of the variables was analyzed using the receiver operating characteristic (ROC) curve.Results A total of 236 patients were enrolled in the study,including 64 (27.12％) in the death group and 172 (72.88％) in the survival group.The baseline National Institutes of Health Stroke Scale score,procalcitonin,C-reactive protein,CAR,and onset to NICU time in patients of the survival group were significantly lower or shorter than those of the death group,and the serum albumin level of the survival group was higher than that of the death group (all P ＜0.05).Pearson's correlation analysis showed that C-reactive protein (r =0.647,P ＜ 0.001),CAR (r =0.632,P ＜ 0.001),and onset to NICU time (r =0.596,P ＜ 0.001) were closely associated with the 30 d survival status in patients with acute ischemic stroke.Multivariate logistic regression analysis showed that CAR was an independent risk factor for 30 d mortality in patients with acute ischemic stroke (odds ratio 1.895,95％ confidence interval 1.573-2.282;P ＜ 0.001).ROC curve analysis showed that the area under the curve of CAR was 0.873 (95％ confidence interval 0.815-0.931),the optimal cut-off value was 2.197,the sensitivity of predicting 30 d death risk was 82.8％,and the specificity was 87.8％.Conclusion CAR is an independent risk factor for 30 d death in patients with acute ischemic stroke and can be used for 30 d survival assessment in patients with acute ischemic stroke.

Research progress of iron metabolism in critical ill patients / 中华危重病急救医学

Iron is an essential nutrient element for human, but has potential toxicity. Under physiological conditions, the processes of iron absorption, transportation, cellular uptake and utilization, storage, release, excretion as well as regulation of iron metabolism maintain the iron homeostasis. However under pathological conditions, the iron metabolism changes and is associated with the pathological states. In order to realize the relationship between the critical illness status and the iron metabolism, we start with an analysis of the basic processes of iron metabolism in human and the toxicity of iron, followed by summary on the alteration of iron metabolism in the settings of pathological conditions, such as inflammation, infection and anemia, which often occur in critical illness. Then, we discuss the relationship between the prognosis and the parameters of iron metabolism. Moreover, we review the current researches on treatments related to iron metabolism, which involve the iron supplementation, iron chelation and agents regulating iron metabolism.

The efficacy of intra-carotid infusion with cold saline in rats with acute cerebral ischemia / 实用医学杂志

Objective To investigate the safety and therapeutic effect of intra-carotid infusion with cold sa line in rats with acute focal cerebral ischemia-reperfusion injury.Methods 60 rats were randomly divided into six groups:sham operated group,normal infusion group,stroke group,local hypothermic group,local normothermic group,and systemic infusion group.Brain infarct volume and cerebral water content were analyzed 48 h after ischemia.Neurological deficits were assessed using the mNSS 24 h and 48 h after infarction.Results In the local hypothermic group,brain temperature was reduced to 33 to 34 ℃ within 5 to 10 minutes,and this significantly low temperature maintained to nearly 60 minutes after infusion continued.Physiological variables were not significantly different among each time point (P ＞ 0.05).No significant morphological abnormality was found in brain sections stained with TTC and HE.Animals receiving local cold infusion significantly decreased infarct volume and brain water content compared to stroke group (P ＜ 0.05).Both 24 h and 48 h mNSS in local hypothermic group was significantly lower than those in other groups (P ＜ 0.05).Conclusions Intra-carotid infusion with cold saline can quickly and effectively reduce brain temperature and is a relatively safe cooling method.Local hypothermia significantly reduced brain infarct volume,decreased brain water content and improved neurological functional outcomes after brain ischemia.

Activated microglia transplantation improves the neural function following acute cerebral infarction in mice / 中国组织工程研究

BACKGROUND: Microglia play an important role in immune surveillance in their quiescent state, but the role of the activated microglia is under discussion. OBJECTIVE: To analyze the mechanism of activated microglia in acute cerebral infarction. METHODS: Totally 96 male Kunming mice were selected and randomly divided into four groups, including transplantation, placebo, blank control and sham operation groups. Permanent occlusion of the middle cerebral artery was performed using suture method in the mice of the transplantation, placebo and blank control groups, followed by injection of microglia suspension via subclavian vein, medium containing the same volume of microglia, and nothing, respectively, at 12 hours after modeling. In the meanwhile, the same amount of microglia suspension was injected into the mice of the sham operation group. The Zea-longa scale and brain-derived neurotrophic factor expression at 12, 24 and 72 hours after modeling, the volume of cerebral infarction and the number of nerve cells positive for microtubule-associated protein-2 at 72 hours after modeling were detected. RESULTS AND CONCLUSION: The Zea-longa scale score was 0 point in the sham operation group, which was significantly lower than that in the other three groups at each time point after modeling (P < 0.01). The Zea-longa scores in the transplantation group were significantly lower than those in the placebo and blank control groups at 24 and 72 hours after transplantation (P < 0.01). The positive expression rate of brain-derived neurotrophic factor in the transplantation group was significantly higher than that in the other three groups after transplantation (P < 0.01). The sham group showed no infarction, while the size of cerebral infarction in the transplantation group was significantly lower than that in the placebo and blank control groups (P < 0.01), and the microtubule-associated protein-2 positive rate was significantly higher than that in the placebo and blank control groups (P < 0.01). These results manifest that the activated microglia can improve the survival rate of nerve cells, promote the recovery of cerebral nerve function and reduce the size of cerebral infarction.

Human leukocyte antigen II typing of neuromyelitis optica / 中国基层医药

Neuromyelitis optica ( NMO) is an idiopathic autoimmune inflammatory disorder of the central nervous system ( CNS) that predominantly affects the optic nerves and spinal cord.It is especially common in Asia. An association between NMO and other autoimmune diseases has been frequently reported, which is different from multiple sclerosis( MS) ,this phenomenon may due to different genetic background between these two diseases.There are reports on different populations to make this clear,which showed human leukocyte antigen( HLA) class II distribu-tion was unique entity different between NMO and MS or healthy controls,this would be a great help to make clear the mechanism underlying NMO pathogenesis.

Effects of statin therapy on the outcome of acute ischemic stroke: a meta-analysis / 中华行为医学与脑科学杂志

Objective To analyze quantitatively the safety and efficacy of statin therapy in acute phrase for acute ischemic stroke with the method of meta-analysis.Methods We performed a systematic literature search including the Cochrane Library,MEDLINE and EMBASE for published trials about statin therapy and the outcomes of acute ischemic stroke.Then we performed a meta-analysis with included studies to investigate the association between statin therapy and clinical outcome and mortality.All of the data were pooled and meta-analyzed by Cochrane Collaboration RevMan 5.3 meta-analysis software.Statistical heterogeneity between studies was evaluated by the chi-square and I-square tests.Forest plots were used to summarize study data and Egger tests were used to assess publication bias.Results A total of 27 studies including 52 034 patients,comprising 19 212 statin users and 32 822 non-statin users met the inclusion criteria,4 studies were randomized controlled trials (RCTs),and 23 were observational trials (OTs).Both pre-or post-stroke statin use was associated with reduced mortality.Statin use is associated with favorable functional outcome at hospital discharge and on the ninetieth day regardless of initiation time for pre-stroke group and post-stroke group.The results from observational trials were consistent with randomized controlled trials.There was no evidence of publication bias for all comparisons by Egger tests.Conclusions Statin therapy before or after AIS is safe and effective.

Expression of cyclophilin A/CD147 in carotid atherosclerotic plaque and the intervention of atorvastatin / 中南大学学报(医学版)

OBJECTIVE@#To explore the expression of CyPA and CD147 in rabbit models of vulnerable carotid atherosclerotic plaque and the therapeutic effect of atorvastatin.
@*METHODS@#Twenty-four male New Zealand rabbits were randomly divided into 3 groups. Eight rabbits were served as a normal diet group (Group A), and the remaining 16 rabbits underwent balloon-induced endothelial injury in the right carotid artery and thereafter were fed on high-cholesterol diet (1% cholesterol) for 12 weeks, then they were divided into 2 groups: a AS group (Group B), an atorvastatin group [Group C, 2.5 mg/(kg.d)]. 4 weeks later, plaque disrupture was triggered by China Russell's viper venom and histamine. Serum levels of TC, TG, LDL-C and HDL-C were measured at different timepoint. The damaged carotid arteries were collected to undergo pathological examination. The macrophage, expression of CyPA and CD147 were detected by immuno-histochemical analysis, and the mRNA levels of CyPA and CD147 were examined by reverse transcription polymerase chain reaction (RT-PCR).
@*RESULTS@#Compared with the Group A, the serum levels of TC and LDL-c in the Group B and Group C were significantly increased (all P<0.01). Compared with the Group B, the serum levels of TC and LDL-c in the Group C were reduced significantly after atorvastatin intervention for 4 weeks (all P<0.01). The plaques disruption and thrombosis occurred in 4 out of the 6 rabbits in the Group B, while only 1 rabbit demonstrated plaques disruption and thrombosis in the Group C. Compared with the Group B, the levels of CyPA, CD147 and macrophage in carotid atherosclerotic plaque in the Group C were decreased significantly (all P<0.01).
@*CONCLUSION@#The up-regulation of CyPA and CD147 may be involved in pathogenesis of vulnerable carotid atherosclerotic plaque. Atorvastatin could stabilize the plaque through inhibiting the CyPA and CD147 expression.

Predictive value of serum procalcitonin for acute stroke patients with bacterial pneumonia:a retrospective case series study / 国际脑血管病杂志

Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin (PCT) level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level (the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission) were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group (66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup) and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale (GCS) score, and PCT level between the bacterial pneumonia group and the non-infection group (P < 0. 05 ). Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L (odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P < 0. 01), GCS score ≤8 (OR 11. 361, 95% CI 2. 175 - 59. 352; P < 0. 01), and PCT level ≥0. 050 ng/ml (OR 16. 715, CI 5. 075 - 55. 049; P < 0. 01) were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level (median; interquartile range) in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup (0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P < 0. 01 ). ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 (CI 0. 806 - 0. 924, P < 0. 01); PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 (CI 0. 672 - 0. 858; P < 0. 01). Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.

Association of ApoB, ApoA Ⅰ and ApoB/ApoA Ⅰ ratio with intracranial atherosclerotic stenosis in patients with ischemic stroke / 国际脑血管病杂志

Objective To investigate the relationship between apolipoprotein B (ApoB),apolipoprotein A Ⅰ (ApoA Ⅰ) and their ratios and intracranial cerebral atherosclerotic stenosis (ICAS) in patients with acute ischemic stroke.Methods The patients with large artery atherosclerotic stroke were enrolled retrospectively.The patients were divided into either an ICAS group or a non-ICAS group based on their vascular imaging data.The blood pressure,blood lipids,blood glucose,ApoB,ApoA Ⅰ,and ApoB/ApoA Ⅰ ratios and demographic data were collected.The differences of the above indicators were compared between the two groups.Results A total of 360 patients with large artery atherosclerotic stroke were enrolled.There were 177 patients in the ICAS group (49.2％) and 183 in the non-ICAS group (50.8％).There were significant differences in the constituent ratios of the patients with hypertension,diabetes and coronary heart disease,as well as the levels of low-density lipoprotein cholesterol,ApoB and ApoA Ⅰ and ApoB/ApoA Ⅰ ratios between the 2 groups (all P ＜0.05).Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 1.75,95％ confidence interval [CI] 1.04-2.93; P =0.035),diabetes mellitus (OR 2.09,95％ CI 1.31-3.32; P =0.002),coronary heart disease (OR 2.68,95％ CI 1.09-6.57; P =0.031),ApoB ≥ 0.84 g/L (0.84-1.00 g/L:OR 2.68,95％ CI 1.30-5.56; 1.00-1.16 g/L:OR 3.95,95％ CI 1.87-8.40; ＞ 1.00 g/L:OR 6.41,95％ CI 2.82-14.49) and ApoB/ApoA Ⅰ ratio ≥0.60 (0.60-0.73:OR 1.92,95％ CI 1.14-3.24; 0.74-0.91:OR 1.79,95％ CI 1.06-3.02; ＞0.91:OR 3.30,95％ CI 1.92-5.67) were the independent risk factors for ICAS,while ApoA Ⅰ ＞ 1.28 g/L was an independent protective factor for ICAS (OR 0.39,95％ CI 0.16-0.98; P=0.044).Conclusions The increased ApoB level and ApoB/ApoA Ⅰ ratio are the independent risk factors for ICAS,and the increased ApoA Ⅰ level is an independent protective factor for ICAS in patients with acute ischemic stroke.The ApoB/ApoA Ⅰ ratio can be used as a biomarker of ICAS in patients with ischemic stroke in Chinese population.

Exploration of PBL teaching method combined with systematic instructional design in neurology teaching / 中华医学教育探索杂志

Neurology is one of the most difficult subjects in clinical medical education.How to improve the teaching model of neurology is a crucial problem.The systematic instructional design and problem-based learning (PBL) emerge as mature teaching techniques,and having a broad application prospect.However,simple PBL teaching model has not achieved the desired results,because PBL teaching method pays excessive attention to the subjective initiative of students,but ignores the supervision and assessment mechanisms,such as assessment,feedback,adjustment,which are the major concerns of systematic instructional design.This research tries to combine systematic instructional design with PBL teaching model,and explore the position in neurology teaching.By determining the teaching target,analysis of PBL teaching,writing teaching plans,organization of PBL teaching,feedback to adjust teaching design method,the final summative evaluation is done and the teaching,was completed.After practice tips may bring progress on neurology teaching mode.

Identification of Duchenne muscular dystrophy carrier by detecting junction fragments between the breakpoints of introns / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the value of the junction fragments between the breakpoints of introns in identifying deletional Duchenne muscular dystrophy (DMD) carriers.</p><p><b>METHODS</b>A DMD family (including the index patient III2 and the suspected carrier II3) and a sporadic DMD case (including the patient II1 and his mother I2) were studied. The patient III2 of the DMD family was identified as having exons 31-43 deletion of the DMD gene, and the sporadic patient II1 had exons 45-54 deletion. A PCR-based genome-walking method was used to locate the breakpoints in the corresponding introns. The junction fragments of the patients and their female relatives waiting for a diagnosis were amplified by PCR with primers adjacent to the deletion junctions.</p><p><b>RESULTS</b>PCR amplification yielded identical positive results for the female suspected carrier II3 of and the index patient of the DMD family, and the former was thus diagnosed as a carrier of DMD. PCR amplification of the sporadic patient's mother I2 showed a negative result, but the patient II1 had a positive result, so that the patient's mother was excluded as being a carrier of DMD.</p><p><b>CONCLUSION</b>Routine PCR technique for detecting the junction fragments allows identification of carriers among female relatives of patients with deletional DMD.</p>

Inhibition of Cdk5/p25 by TFP5 protects dopaminergic neurons in MPTP-induced mouse model of Parkinson's disease / 中华行为医学与脑科学杂志

Objective To study the neuroprotective role of TFP5 in a MPTP-induced mouse model of Parkinson's disease (PD).Methods C57BL/6 mice were used as experimental animals.Briefly, 5 consecutive days of intraperitoneal injection of 25 mg/Kg 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was applied to induce mouse PD model.The mice were randomized into 5 groups including control group,model group, scrambled TFP5 peptide (Scb) group, TFP5 group and roscovitine group.On the 7th day after the first injection of MPTP,behavior tests were performed, and then western blot method was employed to detect the expression of p25 and phosphorylated MEF2D in substantia nigra.Tyrosine hydroxylase (TH) immunohistochemical staining was performed to observe the apoptosis of dopaminergic neurons in substantia nigra pars compacta (SNpc) 28 days after the first injection of MPTP.Results MPTP increased the expression of p25 (0.48±0.10 vs 0.26±0.02, P＜0.05) and phosphorylated MEF2D (0.81±0.10 vs 0.22±0.02, P＜0.05) in substantia nigra, but decreased the number of dopaminergic neurons in SNpc (348.67±24.40 vs 463.29± 19.61, P＜0.05),resulting in motor impairment in the model mice (P＜0.05).Intraperitoneal injection of 30mg/Kg of TFP5 for 3 days effectively reduced the excessive phosphorylation of MEF2D (0.25 ± 0.12 vs 0.81 ± 0.10, P＜ 0.05) in substantia nigra, rescued dopaminergic neuron reduction of SNpc (422.92±8.41 vs 348.67±24.40, P＜0.05), and improved the motor ability of the model mice (P ＜0.05).Roscovitine exerted almost same neuroprotective role as TFP5 ,while Scb had no protective effect.Conclusion TFP5 can rescue MPTP-induced damage of dopaminergic neurons in substantia nigra, and thus improve motor impairment of model mice,which may be mediated by the inhibition of Cdk5/p25 activity.

Changes of cerebrovascular reserve of obstructive sleep apnea hypopnea syndrome patients evaluated by transcranial cerebral Doppler and its relationship with stroke / 中华神经医学杂志

Objective To evaluate the changes ofcerebrovascular reserve (CVR) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by transcranial cerebral doppler (TCD) and to study its relation with stroke.Methods One hundred and twenty-six patients with OSAHS,admitted to our hospitals from July 2012 to January 2013 and diagnosed as having OSAHS,were chosen in our study;they were divided into mild OSAHS group (n=49),moderate OSAHS group (n=44) and severe OSAHS group (n=33) according to test results of polysomnography (PSG).Another 40 healthy controls were collected.The CVR of all subjects were evaluated by TCD merging with CO2 experiment and compared among different groups.All the subjects were accepted continued two-year follow-up and recorded the accidents of stroke.The morbidities of stroke were compared between different groups.Results As compared with those in the control group and mild OSAHS group,all of the contractile reserve,dilatation reserve and overall reserve descended in moderate OSAHS group and severe OSAHS group with statistically significant differences (P＜0.05).As compared with those in the moderate OSAHS group,all of the contractile reserve,dilatation reserve and overall reserve descended in severe OSAHS group,and the differences were statistically significant (P＜0.05).In the two years of follow-up,the incidence of stroke in the severe OSAHS group (12.12％) was significantly higher than that in the control group (0％),mild OSAHS group (0％) and moderate OSAHS group (4.55％,P＜0.05).Conclusion The heavier the condition of OSAHS,the more obviously descended the CVR;the stroke morbidity of severe OSAHS patients is increased significantly.

Analysis of prognosis factors for acute stroke patients / 中华神经医学杂志

Objective To analyze the risk factors associated with prognosis of stroke patients.Methods A total of 551 stroke patients from 5 third class A hospital in Guangzhou from May 2014 to August 2014,were recruited.The clinical data and prognosis 3 months after follow up of these patients were collected and Logistic regression analysis was used to analyze the influencing factors of stroke prognosis.Results Good prognosis was noted in 311 patients (56.4％) and bad one was noted in 240 patients (43.6％);age,education degree,watcher,temperature,NIHSS and Barthel index (BI) scores,hospital stays,stroke frequency,dysphagia,urinary incontinence,coronary heart disease,smoking history and total cholesterol levels between patients with good or bad prognosis were significantly different (P＜ 0.05).Logistic regression analysis showed that major factors for stroke prognosis included age,temperature,NIHSS and BI scores,hospital stays,stroke frequency and urinary incontinence.Conclusions Patients with age≥60 years,temperature＞37 ℃,high NIHSS scores,serious defects of activities of daily living,long hospital stays,recurrent stroke,post-stroke urinary incontinence trend to have poor prognosis,therefore,these patients should be targeted to plan intervention program to improve the life quality.

Thrombolytic treatment of cardiogenic cerebral embolism：comparison study between different thrombolytic methods / 介入放射学杂志

Objective To evaluate the effect and safety of intravenous (IV) thrombolysis, intra-arterial (IA) thrombolysis and mechanical adjuvant intra- arterial thrombolysis (IA + MA) in treating cardiogenic cerebral embolism. Methods A total of 66 patients with cardiogenic cerebral embolism were randomly divided into IV group (n = 25), IA group (n = 18), IA + MA group (n = 23). The artery recanalization rate, NIHSS score, GCS score, BI excellent rate, symptomatic intracranial hemorrhage rate and mortality after different thrombolytic therapies were determined. The results were compared between each other among the three groups. Results In all three groups both the post-treatment NIHSS score and GCS score were significantly improved when compared with pre-treatment ones (P < 0.05). In IA + MA group the artery recanalization rate was 78.3%(18/23) and the BI excellent rate was 40%(10/25), which were significantly higher than those in IV group (P < 0.05). The symptomatic intracranial hemorrhage rate in IA group was 5.6%(1/18), which was strikingly lower than that in IV group (32%, 8/25). Analysis of the causes showed that the artery recanalization rate in patients with valvular heart disease or cardiac myxoma was rather lower, but the intracranial hemorrhage rate and mortality in these patients were much higher. Conclusion Thrombolytic therapy can improve neurological deficit in cardiogenic cerebral embolism, and the therapeutic effect of mechanical adjuvant intra- arterial thrombolysis is definitely better.