Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.
Objective To assess the efficacy and safety of fructose-1,6 diphosphate (FDP) in the treatment of cerebral infarction. Methods We searched MEDLINE, EMbase, Cochrane CENTRAL Register of Controlled Trials, CBM and CNKI in 2006. Randomized controlled trials(RCTs) or quasi-randomized controlled trials involving FDP for cerebral infarction were collected. We assessed the quality of the studies and conducted meta-analyse with The Cochrane Collaboration’s RevMan 4.2. Results Ten RCTs were included, 9 of which were of low quality and only one was graded as high quality. None of the trials reported the number of patients who had died or were dependent at the end of long term follow-up. After 7 to 30 days of treatment, improvement of neurological deficiency was associated with FDP compared with placebo or control [OR 2.45, 95%CI (1.91,3.15)]. There was no statistical difference in the death rate between the FDP and control groups at the end of the treatment [RD –0.01, 95%CI (–0.03,0.01)]. One study found that FDP had a similar safety profile [OR 1.24, 95%CI (0.32,4.75)] to the control group. None of the trials compared the costs in the treatment groups. Conclusions The quality of the published clinical trials on FDP in the treatment of cerebral infarction is poor. FDP may improve short-term neurological deficits, but seems unlikely to decrease mortality. Moreover, we found no evidence to support the long-term efficacy of FDP on mortality, dependency and neurological deficit. Large-scale and high quality clinical trials with sufficient follow-ups are needed to evaluate the role of FDP in the treatment of cerebral infarction.
Objective To assess the effectiveness and safety of edaravone for acute cerebral infarction. Methods We searched The Cochrane Central Register of Controlled Trials （ Issue 2, 2005 ）, MEDLINE （ 1966 to Aug. 2005）, EMBASE （ till Aug. 2005 ）, the China Biological Medcine Database （ till Aug. 2005 ）, the Chinese Stroke Clinical Trials Database （ till August 2005 ） and the reference lists of related articles. Two reviewers independently selected studies, assessed quahty of studies and extracted data. The RevMan 4.2 software was used for statistical analysis. Results We identified 12 randomized controlled trials, of which 9 （ n = 948 ） were included. The level of methodology quality was B. Since the conventional therapy was different among some studies, the improvement of disability and long-term death rate and incidence of adverse reactions were not included by meta-analysis. Meta-analysis on the improvement of neurological deficit showed a better effectiveness of edaravone than control with statistical significance [ OR2.98, 95% CI （ 1.39,6.39 ） ]. Possible adverse reactions to edaravone included abnormal liver function and skin rash. Conclusions With relatively poor quality of most included trials and small sample size, insufficient evidence is obtained to support the conclusion that edaravone is safe or effective in the treatment of acute cerebral infarction. Further high quality and large sample randomized controlled trials should be carried out.
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.
Objective To assess the effect of naloxone in treating the disease of acute cerebral infarction. Methods Sixty patients of acute cerebral infarction were randomly divided into two groups. One group received routine therapy and the other routine therapy plus naloxone. Neuroprotective effect of naloxone were measured by using NIH stroke scale and Bathel-Index. Adverse effect of the drug was also observed. Results There were 27 patients (90%) improved with clinical manifestations in experiment group, and 20 patients (67%) improved in control group. There is a significant difference between the two groups (Plt;0.05).There is no adverse reactions of naxloxone observed. Conclusion Naloxone might protect the nervous cells and restore the function of the nervous system in patients with acute cerebral infraction.
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.
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 research on the effect of protoparaxaxotrid saporlirs (PTS), active component in Sanqi Tongshu Capsule, on the expressions of the serum level of IL-6 and VEGF of patients with the acute cerebral infarction at different time points. Method 86 patients were randomly divided into two groups: PTS group and Nimodipine group, healthy person as control group. ELISA was applied to measure the serum level of IL-6 and VEGF in during different phases (3 d, 7 d, 14 d and 28 d after the onset of cerebral infarction). Results The expressions of VEGF rose significantly in the all of ACI patients. The expressions of IL-6 rose significantly on third day, then began to decrease. The serum level of IL-6 declined significantly (Plt;0.05) and the serum level of VEGF rose in both of PTS group and Nimodipine group in contrast with control group (Plt;0.01). Conclusion PTS can promote the expressions of VEGF after the cerebral infarction at different time points, and decrease the expressions of IL-6 in the early period of ACI, decreased，which may be one of the molecular mechanisms of this PTS in treating acute cerebral infarction.