Cerebral small vessel disease is a common neurological disease, including acute and non-acute categories. With the development of neuroimaging, cerebral small vessel disease has attracted substantial attention in recent years. However, the categories and concepts of cerebral small vessel disease and the related imaging markers usually confuse people. The purpose of this study was to discuss the relationships among acute and non-acute cerebral small vessel disease and the imaging markers, so as to improve the understanding of cerebral small vessel disease, and to shed light on clinical practice and research.
ObjectiveTo observe the relationship between the serum level changes of high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-18, intercellular adhesion molecule-1(ICAM1), matrix metalloproteinase (MMP)-9 and lipoprotein-associated phospholipase A2(Lp-PLA2), and the multiple factors of acute cerebral infarction (ACI). MethodsWe chose 76 patients with ACI treated between July 2012 and June 2014 as our study subjects.On the second day (acute phase) and the 15th day (recovery phase) after onset, we checked the patients for their serum levels of hsCRP, IL-18, ICAM1, MMP-9 and Lp-PLA2.Then, multiple linear regression analysis was performed to observe the correlation of the serum level change degree of inflammatory factors with hypertension, diabetes, coronary heart disease, smoking history, carotid atherosclerotic plaque, lipid levels, infarct size and National Institute of Health Stroke Scale (NIHSS) score. ResultsThe changes of all the inflammatory factors in the acute phase and the recovery phase of cerebral infarction were not significantly related to smoking history, hypertension, coronary heart disease, low-density lipoprotein and NIHSS scores (P > 0.05).The changes of hsCRP and ICAM1 had significant correlation with cerebral infarct size, diabetes mellitus and carotid atherosclerotic plaque (P < 0.05), and the change level of Lp-PLA2 was related to diabetes mellitus, and carotid atherosclerotic plaque (P < 0.05).MMP-9 serum level change had correlation with only cerebral infarct size (P < 0.05). ConclusionsSerum level changes of inflammatory factors are related to various factors of cerebral infarction.The main factors that affecting the serum level changes are cerebral infarction area, diabetes mellitus and carotid atherosclerosis.
ObjectiveTo explore the association between prediabetes and early vascular cognitive impairment (VCI) in patients with acute cerebral infarction. MethodsNon-diabetes mellitus patients with first-ever acute cerebral infarction hospitalized in the Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology between January and April 2019 were retrospectively enrolled. The enrolled patients were divided into prediabetes group and normal blood glucose group according to the level of glycosylated hemoglobin, and the patients were divided into normal cognitive function group and cognitive impairment group according to the Montreal Cognitive Assessment score. The general information and clinical related data of the included patients were compared. Results A total of 129 patients were enrolled. Among them, 46 cases were in the prediabetes group and 83 cases were in the normal blood glucose group. There were 82 cases in the normal cognitive function group and 47 cases in the cognitive impairment group. Multivariate logistic regression analysis showed that compared with the normal blood glucose group, the prediabetes group was associated with early VCI in patients with acute cerebral infarction [odds ratio (OR)=4.172, 95% confidence interval (CI) (1.786, 9.754), P=0.001]; the higher the NationalInstitutes of Health Stroke Scale score at the first admission was, the higher the risk of early VCI was [OR=1.379, 95%CI (1.183, 1.650), P<0.001]. Conclusion In patients with first-ever acute cerebral infarction, prediabetes is associated with early VCI.
Objective To explore the association between procalcitonin (PCT) level and the development of malignant brain edema (MBE) after acute cerebral infarction. Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital, Sichuan University between January 1, 2017 and December 31, 2018 were retrospective collected. Patients were divided into MBE group and non-MBE group based on whether MBE had occurred. The basic information and neuroimaging data of two groups of patients were compared and analyzed. Results A total of 798 patients were included. Among them, there were 93 cases of MBE (11.65%) and 705 cases of non-MBE (88.35%). The median time of MBE occurrence (lower quartile, upper quartile) was 29 (24, 54) hours after onset. The difference in the National Institutes of Health Stroke Scale, large-scale middle cerebral artery infarction, dysarthria, low fever, consciousness status, chronic heart failure, TOAST typing, mechanical ventilation, gastric tube placement, PCT on the first and third day of admission between the two groups were statistically significant (P<0.05). There was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE. Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction. Patients with elevated PCT after cerebral infarction may require careful clinical management.
Objective To assess the efficacy and safety of pueraria for acute cerebral infarction. Methods We searched MEDLINE, EMBASE, CBM, and the Chinese Stroke Clinical Trials Database. The search was conducted in Feb., 2006. Data were extracted and assessed by two reviewers independently. Revman 4.2 software was used for statistical analysis. Results Nineteen potentially eligible trials were identified, of which 14 (1 141 patients) were included. Only one trial reported the death or disability rate at the end of 6-month follow-up (the difference between the two groups was not significant). Meta-analysis of 11 trials invovling the improvement of neurological deficit indicated that pueraria was significantly more effective than the control group [OR 3.04, 95%CI 2.11, 4.39]. Conclusions Pueraria might improve the short-term neurological deficit of patients with acute cerebral infarction. But the methodological quality of all the included trials is poor, reliable conclusions can not be drawn from the present data. More high-quality randomized controlled trials are required.
Acute cerebral infarction is characterized by high incidence rate, high recurrence rate, high disability rate and multiple complications. Early evaluation and treatment of acute cerebral infarction is particularly important to improve the survival rate and prognosis of patients. As an easily available clinical laboratory indicator, blood routine test can reflect the pathological changes in the body to a certain extent. In recent years, many studies have shown that the indicators such as red cell volume distribution width, mean platelet volume, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in blood routine examination have important values in the onset, severity and prognosis of acute cerebral infarction. This article reviews the correlations of the above parameters and ratio parameters with acute cerebral infarction, in order to provide some reference and basis for clinical diagnosis, treatment and prognosis evaluation of acute cerebral infarction.
摘要:目的:观察阿托伐他丁对脑梗死大鼠脑保护的作用以及对脑源性神经营养因子(braindeprived neurotrophic factor,BDNF)的影响。方法: 线栓法制备SD大鼠大脑中动脉梗死(middle cerebral artery occlusion,MCAO)再灌注模型。将大鼠随机分为:假手术组;MCAO组的2 h、24 h、3 d、5 d组;阿托伐他丁组的2 h、24 h、3 d、5 d组。MCAO组和阿托伐他丁组的各时程组再分别分为脑梗死体积亚组、免疫组化亚组,每亚组及假手术组各6只大鼠。在不同时间点观察阿托伐他丁组和MCAO组大鼠神经行为评分、脑梗死体积,用免疫组化法检测BDNF阳性细胞数。结果: 神经行为评分和脑梗死体积在阿托伐他丁组和MCAO组的2 h组之间无显著性差异(Pgt;0.05),在阿托伐他丁24 h、3 d、5 d组均显著低于对应时程的MCAO组(Plt;0.05);各组缺血半暗带BDNF阳性细胞数均增高,但阿托伐他丁组的阳性细胞数显著高于对应时程的MCAO组(Plt;0.05)。结论:阿托伐他丁能提高大鼠局灶脑缺血半暗带BDNF的表达水平,促进神经元的修复。Abstract: Objective: To observe the effect of atorvastatin in cerebral protection and braindeprived neurotrophic factor(BDNF) in rats. Methods: Ischemic reperfusion model of rats as established by an intraluminal filament and recirculation at different time point respectively. One hundred and two healthy SD rats were randomly assigned into three groups for different preconditioning, including the sham surgery group (SS, n=6), the sham and middle cerebralartery occlusion (MCAO) group (MCAO, n=48), and the atorvastatin and MCAO group (atorvastatin +MCAO, n=48). The latter two groups were further divided into two subgroups on different time points of tests. Each subgroup hase six rats. In the atorvastatin +MCAO group, intragastric administration of atorvastatin was given for five days, then the MCAO followed. In the MCAO group, the MCAO was given directly. The neurophysical marks and the volume of the cerebral infarction in atorvastatin group and MCAO group were determined at different time point. The expression of BDNF was valued by immunohistochemitry respectively. Results: At 2 h, there were no differences in the neurophysical marks and volume of the cerebral infarction between atorvastatin group and MCAO group (Pgt;0.05). At 24 h,3 d,5 d, the neurophysical marks and volume of the cerebral infarction of atorvastatin group were lower than that of MCAO group in the corresponding time (Plt;0.05). Around the necrotic areas,BDNF positive neurons were increased in both groups, but they were higher in atorvastatin group than in MCAO group in the corresponding time (Plt;0.05). Conclusion: Atorvastatin could increase the expression level of BDNF and promote the ischemic neuron to revive.
Massive and severe cerebral infarction can lead to a high mortality and disability rate, and it is the bottleneck of preventing and treating cerebrovascular disease. Once the malignant brain edema of massive cerebral infarction or the critical status of severe cerebral infarction occurs, the treatment effect is very poor. Therefore, we should not only focus on the treatment of critical cerebral infarction, but also prevent its occurrence. It is clinically important to prevent the occurrence of this critical condition in advance and to prevent the occurrence of massive cerebral infarction and severe cerebral infarction. This article points out that some patients with massive or severe cerebral infarction can be prevented from becoming critically ill. The definition, key risk factors and corresponding prevention and treatment strategies of critical cerebral infarction have also been proposed. Critical cerebral infarction can be divided into two categories with or without malignant brain edema, and the risk factors and prediction and prevention strategies by categories andphases can be studied separately.
Objective To evaluate the effectiveness and safety of edaravone combined with Xingnaojing injection in the treatment of adult acute cerebral infarction. Methods Databases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched from inception to March 2012 to identify the randomized controlled trials (RCTs) on edaravone combined with Xingnaojing injection for adult acute cerebral infarction. Two reviewers independently selected the literature, extracted the data and assessed the methodological quality of the included RCTs, and then meta-analysis was performed using RevMan 5.0 software. Results A total of 9 RCTs involving 1 098 patients were included. The results of meta-analyses showed: a) The edaravone combined with Xingnaojing injection group was superior to the Xingnaojing injection group with significant differences in the effective rate (OR=3.43, 95%CI 2.44 to 4.82, Plt;0.000 01), significantly-effective rate (OR=2.33, 95%CI 1.78 to 3.05, Plt;0.000 01), mortality (OR=0.38, 95%CI 0.15 to 0.95, P=0.04), ESS score after treatment (7 days after treatment: SMD=–0.48, 95%CI –0.80 to –0.17, P=0.003; 14 days after treatment: SMD=–0.89, 95%CI –1.17 to –0.62, Plt;0.000 01; 1 month after treatment: SMD=–0.89, 95%CI –1.20 to –0.59, Plt;0.000 01) and NDS score after treatment (7 days after treatment: MD=10.42, 95%CI 4.78 to 16.05, P=0.000 3; 14 days after treatment: MD=13.82, 95%CI 12.86 to 14.79, Plt;0.000 01; 21 days after treatment: MD=10.33, 95%CI 4.43 to 16.23, P=0.000 6); and b) The edaravone + Xingnaojing injection + conventional therapy group was superior to the conventional therapy group with significant differences in the effective rate (OR=3.03, 95%CI 1.36 to 6.73, P=0.006), significantly-effective rate (OR=2.86, 95%CI 1.50 to 5.44, P=0.001) and ESS score after treatment (7 days after treatment: MD=–6.26, 95%CI –8.49 to –4.03, Plt;0.000 01; 14 days after treatment: MD=–6.43, 95%CI –8.73 to –4.13, Plt;0.000 01). Conclusion Current evidence shows edaravone combined with Xingnaojing injection is obviously superior to either Xingnaojing injection or conventional therapy for adult acute cerebral infarction. But this conclusion still needs to be further proved by more high-quality and large-scale RCTs because of the low quality of the included studies.
ObjectivesTo systematically review the efficacy and safety of nalmefene hydrochloride for acute cerebral infarction.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on nalmefene hydrochloride for acute cerebral infarction from inception to February 21st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 RCTs involving 1 038 patients were included. The results of meta-analyses showed that, compared to the routine treatment group, the nalmefene hydrochloride group was significantly associated with an increased reduction in total effective rate (RR=1.14, 95%CI 1.04 to 1.23, P=0.003), GCS (MD=1.30, 95%CI 0.66 to 1.94, P<0.0001), patient satisfaction (RR=1.26, 95%CI 1.03 to 1.55, P=0.03), cerebral blood flow (MD=5.00, 95%CI 3.81 to 6.19, P<0.05), and cerebral blood volume (MD=0.28, 95%CI 0.23 to 0.32, P<0.05). It was also significantly associated with an reduction of NIHSS, CSS, level of inflammatory factors after treatment in 14 days, level of MMP-9 and mean transit time of contrast medium (P<0.05). However, no significant association was observed between two groups in level of inflammatory factors after treatment in 20 days. For safety outcomes, no significant association was found between two groups in mortality, dizziness, and nausea and vomiting.ConclusionsThe current evidence indicates that the nalmefene hydrochloride can be used to treat acute cerebral infarction based on routine treatment of acute cerebral infarction, and the safety is relatively good. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.