Objective:To systematically evaluate the efficacy of virtual reality (VR) technology in improving cognitive function and alleviating negative emotions among stroke patients.Methods:Randomized controlled trials (RCTs) investigating VR-based 1nterventions for cognitive and mental health outcomes in stroke patients were retrieved from China Knowledge Network, WANFANG, Wipro database, PubMed, Embase, Web of Science, and Cochrane Library databases (inception to June 21, 2024). After screening 5545 records, two researchers independently performed deduplication, study selection, data extraction, and risk-of-bias assessment. The VR group used VR technology combined with conventional therapy, while the control group only used the conventional therapy. A total of 12 outcome indicators were categorized into 9 domains. Meta-analyses were conducted using RevMan 5.4 and Stata 17.0.Results:A total of 29 RCTs were included, including 1516 patients, including 727 in the VR group and 789 in the control group. In the VR training group, the scores of overall cognitive function (SMD=0.69, 95%CI: 0.40-0.99), perceptual function (MD=2.19, 95%CI: 1.30~3.19), language function (MD=9.87, 95%CI: 7.47-12.26), memory function (MD=2.59, 95%CI: 2.00-3.18), depression [MD=-2.92, 95%CI: (-4.55)-(-1.29)] and anxiety [SMD=-0.61, 95%CI: (-1.17)-(-0.04)] of stroke patients were the difference was statistically significant (P<0.05); There was no significant difference in the scores of executive ability, attention and visuospatial ability between the two groups (P>0.05).Conclusions:VR training effectively improves global cognition, language function, and alleviates anxiety/depression in stroke patients, while its effects on executive function, attention, and visuospatial ability require further validation.
脑肿瘤是颅内常见的疾病，患病率逐年上升，因部分脑肿瘤症状不典型和影像学非特异性，导致诊断相对困难[1-3]。显微镜下开颅脑肿瘤切除术既可明确病理诊断，也可减少肿瘤负荷，但对于肿瘤位于脑功能区和基础疾病较复杂的患者，能否做到最大范围地安全切除肿瘤仍是神经外科医生面临的重大挑战[3-6]。随着立体定向、术中超声及神经导航等的应用，脑肿瘤穿刺活检得到了越来越多的认可，但利用3D打印导板技术辅助脑肿瘤穿刺活检却鲜有报道[7-12]。川北医学院附属大竹医院神经外科收治了1例脑功能区肿瘤、影像学不典型且无开颅手术意愿的患者，笔者利用增强CT与增强MRI进行图像融合，而后进行个体化脑肿瘤穿刺导板制作，并成功完成了脑肿瘤穿刺活检，现报道如下。
Objective:To explore the changes of blood pressure variability (BPV) and its relationship with prognosis in patients with acute cerebral infarction (ACI) and H-type hypertension.Methods:A total of 88 patients with ACI and H-type hypertension admitted to Neurology Department of Rugao People's Hospital were enrolled as H-type hypertension ACI group between March 2021 and March 2022, while 40 patients with ACI and simple hypertension during the same period were enrolled as simple hypertension ACI group. Both groups of patients underwent 24 h blood pressure monitoring, and the BPV parameters of the two groups were recorded and compared. According to scores of modified Rankin scale (mRS) after 3 months of treatment, patients in H-type hypertension ACI group were divided into good prognosis group and poor prognosis group, and the differences in scores of National Institutes of Health stroke scale (NIHSS) between the two groups were compared. The relationship between BPV and prognosis was analyzed.Results:The 24 h variation coefficient of systolic blood pressure (24 h SCV), variation coefficient of daytime mean systolic blood pressure (dSCV) and variation coefficient of nighttime mean systolic blood pressure (nSCV) in H-type hypertension ACI group were higher than those in simple hypertension ACI group (P<0.05). After 3 months of treatment, scores of NIHSS and mRS in H-type hypertension ACI group were higher than those in simple hypertension ACI group (P<0.05). There were 63 patients with good prognosis and 25 patients with poor prognosis in H-type hypertension ACI group. 24 h SCV, dSCV and nSCV in patients with good prognosis were lower than those with poor prognosis (P<0.05). After 3 months of treatment, NIHSS score in poor prognosis group was higher than that in good prognosis group (P<0.05). 24 h SCV, dSCV and nSCV were positively correlated with mRS score (r=0.247, 0.357, 0.471, 0.378, P<0.05); nSCV was positively correlated with NIHSS score (r=0.266, P<0.05).Conclusion:The variability of systolic blood pressure increases in patients with ACI and H-type hypertension, which has certain correlation with prognosis and can be applied to predict poor prognosis.
Post-stroke dyskinesia is a common complication of stroke, characterized by spasticity, muscle atrophy, decreased muscle strength, and balance and gait abnormalities. In recent years, it has been found that focal muscle vibration (FMV) is widely used for the recovery of impaired motor function in neurological disorders such as stroke and Parkinson's disease. It not only improves spasticity, slows down muscle atrophy and improves muscle strength, but also improves balance and improves gait abnormalities. This article reviews the definition of FMV, the mechanism of action to improve motor function after stroke, clinical application and adverse effects, with a view to providing a more effective treatment for the clinic and new ideas for scientific research.
Objective:To explore the value of CT perfusion (CTP) combined with angiography (CTA) in predicting neurological prognosis in patients with acute cerebral infarction (ACI) in the near future.Methods:Two hundred and thirty-two ACI patients admitted to Xuzhou First People's Hospital from December 2018 to April 2022 were selected as the study subjects, all of whom underwent CTP imaging and CTA examination within 24 h of admission, and the CTP parameters and Alberta stroke early CT score (ASPECTS) were recorded. They were divided into good/poor prognosis group according to the score results of modified Rankin scale (mRS) at 3 months after treatment. The general data, CTP imaging parameters and ASPECTS scores of the two groups were compared. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of CTP combined with CTA for neurological prognosis in ACI patients in the near future.Results:Two hundred and thirty-two patients with ACI were followed up for 3 months after treatment, 51 patients had poor prognosis of neurological function, and the total incidence was 21.98%. Compared with the good prognosis group, the poor prognosis group showed an increase in the National Institutes of Health stroke scale score, time to peak, and mean transit time (P<0.05), while ASPECTS score, cerebral blood volume, and cerebral blood flow decreased (P<0.05). The sensitivity and area under the curve of CTP imaging parameters in predicting the poor prognosis of neurological function in patients with ACI respectively were 74.51% and 0.820, which were higher than those predicted alone. The sensitivity and AUC of CTP combined with CTA in predicting the poor prognosis of neurological function in patients with ACI respectively were 90.20% and 0.919, which were higher than those predicted alone (P<0.05), and the specificity was not statistically significant compared with that predicted alone (P>0.05).Conclusion:Both CTP imaging and CTA can predict poor neurological prognosis in ACI patients in the near future, but the combined predictive value of the two is higher.
Objective:To observe the clinical efficacy of virtual scenario interaction technology combined with shoulder blade motor control training on upper limb motor function and daily living activities in hemiplegia.Methods:From May 2019 to October 2021, 105 patients with stroke hemiplegia admitted to the Department of Rehabilitation Medicine of Hefei Second People's Hospital were selected as the research subjects, and were divided into virtual group, scapula group and joint group by random number table method, with 35 cases in each group. All three groups of patients were given conventional rehabilitation training treatment, the virtual group was supplemented with virtual scenario interactive training, the scapula group was supplemented with scapula motion control intensive training, and the joint group was given virtual situational interaction technology combined with shoulder blade motion control intensive training. Before treatment and 4 weeks after treatment, Brunnstrom staged upper limb part, simplified Fugl-Meyer assessment upper extremity (FMA-UE), Wolf motor function test (WMFT), Hong Kong edition of functional test for the hemiplegic upper extremities (FTHUE-HK) were used to evaluate the patient's upper limb recovery, and the modified Barthel index (MBI) was used to evaluate the patient's daily living activities.Results:After 4 weeks of treatment, the FMA-UE score, WMFT score, MBI score, Brunnstrom stage upper limb part and FTHUE-HK grade of the three groups were all improved to a certain extent compared with the pre-treatment treatment of this group, and the outcomes of the joint group were better than those in the virtual group and the scapular group, and the differences were statistically significant (P<0.05).Conclusion:Virtual scenario interactive technology combined with scapular motor control intensive training can significantly improve upper limb motor function and daily living activities of patients with hemiplegia after stroke.
Objective:To study the relationship between the first CT signs after mechanical thrombectomy and prognosis of patients based on different neutrophil-lymphocyte ratios (NLR).Methods:The clinical data of 201 patients who underwent mechanical thrombectomy from January 2017 to December 2021 in the Neurology Department of The First People's Hospital of Zhangjiagang City were retrospectively analyzed. According to the first postoperative CT imaging, they were divided into high-density CT imaging group and non high-density CT imaging group; At the same time, they were divided into low NLR group and high NLR group according to preoperative NLR values, and then subgroup analysis was conducted based on whether there were high-density shadows on the first postoperative CT. The 90-day good prognosis rate, the incidence of symptomatic intracranial hemorrhage and the mortality rate within 90 d were compared among the subgroups.Results:There were 100 patients with high-density CT imaging after operation (high-density CT imaging group), and the remaining 101 patients were included in the non high-density CT imaging group. The rate of symptomatic intracranial hemorrhage in the non high-density CT imaging group was lower than that in high-density CT imaging group (OR=0.207, 95%CI: 0.082-0.521, P<0.001), but there was no statistically significant difference in 90-day good prognosis and mortality between the two groups (P>0.05). There were 137 patients in the low NLR group. There was no significant difference in the rate of 90-day good prognosis, mortality and symptomatic intracranial hemorrhage at 90 d between the subgroup without and with high-density CT imaging (P>0.05). There were 64 patients in the high NLR group. Compared with the subgroup with high-density CT imaging, the subgroup without high-density CT imaging had a higher 90-day good prognosis (OR=3.515, 95%CI: 1.051-11.748, P=0.041), and a lower 90-day mortality (OR=0.262, 95%CI: 0.071-0.977, P=0.046), symptomatic intracranial hemorrhage rate was low (OR=0.132, 95%CI: 0.026-0.679, P=0.015).Conclusion:After mechanical thrombectomy, CT with high-density imaging has a higher rate of symptomatic intracranial hemorrhage than without high-density imaging, but it has no significant effect on prognosis. In patients with high NLR, the first high-density CT imaging after thrombectomy affects the clinical prognosis; In patients with low NLR, the presence or absence of high-density has no significant effect on prognosis.
Cerebrovascular diseases are characterized by high disability and high mortality rates, seriously threatening human health. Natural medicine yerba mate tea has the characteristics of safety, multi-component, and multi-target action. It can cut off the pathway of cerebrovascular diseases and improve the function of the cerebrovascular system through various mechanisms of action such as hypoglycemia, hypolipidemia, antioxidation, regulation of inflammatory response, improvement of blood rheology, and improvement of vascular endothelial dysfunction, which can play a role in the prevention and treatment of cerebrovascular diseases. This paper reviews the above aspects to provide a reference for further research on the preventive and curative effects of yerba mate tea on cerebrovascular diseases and to expand the clinical application of yerba mate tea.
患者，男性，30岁，因"突发意识障碍4 d"入院。患者入院前4 d无明显诱因下突发头痛、头晕，随后出现意识障碍，呼叫反应差、不能言语，伴呕吐、抽搐，呕吐物为胃内容物，无咖啡样物，非喷射性呕吐，无发作性肢体抽搐、大小便失禁等症状。神经系统检查：脉率166次/min，38.6℃，血压145/78 mmHg（1 mmHg=0.133 kPa），无自主呼吸，气管插管，呼吸机辅助呼吸，双肺大量啰音，深昏迷，GCS评分3分，双侧瞳孔2.0 mm，光反射消失，病理征未引出。头颅CT提示"全脑室铸型血肿"（图1），患者第四脑室血肿量约20 mL，脑干受压并出现严重脑干功能障碍，第四脑室铸型血肿，继发暮上梗阻性脑积水，予双侧脑室穿刺外引流术。
Objective:To construct a predictive model of cerebral hemorrhage prognosis prognosis using multimodal medical data and machine learning, and to explore its predictive value.Methods:A total of 400 cerebral hemorrhage data was retrospective analyzed, included 98 cerebral hemorrhage patients in the Neurology Department of Peking Union Medical College Shenzhen Hospital, Huazhong University of Science and Technology from January to December 2020 and 302 cerebral hemorrhage patients from the National Multicenter Intracranial Hemorrhage Database established by Peking Union Medical College Hospital from January to December 2020 to build an imaging database of cerebral hemorrhage, extract the labels of imaging omics and clinical related factors, and build a model to predict patients' prognosis. Another 100 patients with intracerebral hemorrhage in the Neurology Department of Peking Union Medical College Shenzhen Hospital, Huazhong University of Science and Technology from January to December 2021 were selected for prospective verification of the model.Results:The incidence of poor prognosis in 400 patients was 19.00%. The results of univariate analysis and multivariate logistic regression analysis showed that GCS score, systolic blood pressure, diastolic blood pressure, blood glucose, hematoma volume, peripheral edema volume, fibrinogen were all the influencing factors of poor prognosis (P<0.05). The sensitivity, specificity, accuracy and area under curve (AUC) [95% confidence interval (95%CI)] of self coding image feature clinical data model for predicting prognosis in patients with cerebral hemorrhage were 100.00%, 99.38%, 99.50% and 0.994 (0.935-0.998) respectively, which were higher than those of self coding image feature model and traditional model (P<0.05), and those of the self coding image feature model were higher than those of traditional model (P<0.05). After verification, the sensitivity, specificity, accuracy and AUC (95%CI) of the self coded image feature clinical data model for predicting prognosis in patients with cerebral hemorrhage were 100.00%, 97.47%, 98.00% and 0.974 (0.922-0.996) respectively.Conclusion:The self coding image feature clinical data model based on multi-modal medical data and machine learning has high efficiency in predicting cerebral hemorrhage prognosis.
Some neurological diseases can cause the signal "bridge" between the brain and limbs to be broken, leaving serious dysfunction. Therefore, how to restore the function of this "bridge" has always been a hot-topic in the field of nervous system. Brain-computer interface (BCI) is based on the process of connecting the brain with machinery to realize the control of machinery by the brain. BCI technology has become a research hotspot in the fields of neuroscience and computer technology, which plays an important role in the field of nervous system, especially in the aspects of neural rehabilitation, prosthetics, robotics, disease diagnosis and treatment related to neuroscience. With the development of information technology, opportunities and challenges coexist in BCI technology. This article reviews the application of BCI in the field of neurological diseases.
Objective:To investigate the clinical efficacy and health economic evaluation of hematoma drainage for spontaneous intracerebral hemorrhage (SICH) with the assistance of neurosurgical navigation and positioning planning system (referred to as robot).Methods:The clinical data and economic data of 199 SICH patients who underwent surgical treatment from March 2019 to March 2022 were collected. All patients were divided into 4 groups according to surgical methods: the robotic surgery group consisted of 77 patients who underwent robot assisted stereotactic hematoma drainage surgery; 65 cases in the neuro-endoscopy groups underwent hematoma removal surgery under neuroendoscopy; 21 cases in the small bone window craniotomy group underwent microscopic hematoma removal with small bone window open; 36 cases in the rigid catheter group underwent CT image-guided free-hand rigid catheter technique. Clinical follow-up outcomes and medical cost from the immediate post-operative to one year period were compared and analyzed. Data from both the robotic surgery and neuro-endoscopy groups were sampled and matched using propensity scoring methods, and health economics were evaluated using modified Rankin scale (mRS) scores and quality adjusted life years (QALYs) indicators.Results:At the time of discharge, there were differences between the groups in terms of operation time, hematoma residual volume, total hospital costs, surgery-related costs, number of days in the ICU, and duration of ventilator use (P<0.05). In the robotic surgery group complication rate of rebleeding was 2.6%, intracranial infection was 1.3%, average hospital stay was 15.45 d, and average hospital cost was ￥46 077.90. There was difference in the proportion of mRS≤3 points between the 4 groups (P<0.05), in which the proportion of patients with mRS≤3 points at 3 months and 1 year after surgery in the robotic surgery group was 55.8% and 74.0%, respectively. Propensity score sampling was matched, resulting in 37 patients each in the balanced and comparable robotic surgery and neuro-endoscopy groups. One year after surgery, the robotic surgery group was able to save ￥36 862.14 per capita and gain 0.062 more QALYs.Conclusion:Based on our model of SICH calculations suggest that robotic-assisted stereotactic drainage has the health economic advantage of being less costly and more effective, further results await multicenter, prospective randomized controlled trials with expanded sample size.
Objective:To explore the effect of electroacupuncture (EA) with Quchi and Zusanli acupoints on the regulation of microRNA-34a (miR-34a) on the proliferation of reactive astrocytes in the ischemic peripheral area of rats with cerebral ischemia-reperfusion injury.Methods:A total of 40 male rats were randomly assigned into sham group, model group, EA group, EA+miR-34a inhibitor group and EA+dimethyl sulfoxide (DMSO) group, with 8 rats in each group. Preparation of a left focal middle cerebral artery ischemia-reperfusion injury (MCAO) rat model using the Koizumi method. EA was applied at ipsilateral Quchi and Zusanli after operation, 30 min once a day until animals were sacrificed. The neurological scores of rats in each group before and after the EA intervention were compared, the behavioral Rat Rota-Rod test was performed after 3 d of the EA intervention, and the co-location condition of glial fibrillary acidic protein (GFAP) and 5-bromodeoxyuridine (Brdu) was detected by immunofluorescence staining; Reverse transcription real-time quantitative PCR was used to detect the relative expression of miR-34a in the ischemic peripheral area.Results:After 3 d of EA intervention, the neurological deficit symptoms and residence time on Rota-Rod rotating rod of MCAO rats were significantly improved compared to the EA group, with a statistically significant difference (P<0.05). The expression of miR-34a in the model group was significantly higher than that in the Sham surgery group, the expression of miR-34a in the EA group and the EA+DMSO group was higher than that in the model group, with a statistically significant difference (P<0.05). The expression of GFAP+/Brdu+ positive cells in the ischemic pericortical area of rats in both the model group and the EA group increased, and the increase was more significant in the EA group compared to the model group, the expression of GFAP+/Brdu+ positive cells in the EA+miR-34a inhibitor group was lower than that of the EA group and the EA+DMSO group, and the differences were statistically significant (P<0.05).Conclusion:Electroacupuncture could promote the reactive astrocyte proliferation in ischemic peripheral areas by regulation of miR-34a expression.
The diagnosis of cerebral edema mainly relies on traditional monitoring techniques such as CT and MRI, but traditional techniques often do not have the ideal monitoring method of economy, real-time dynamic, and bedside monitoring. At present, there are an increasing number of new Brain edema monitoring devices that are popular at home and abroad. These new non-invasive monitoring technologies are used to monitor the situation of brain edema in patients with craniocerebral injury and the profile of intracranial pressure in high-risk populations with craniocerebral diseases. It may play a key role in assisting and guiding the decision-making of specialized medical behavior. Therefore, a reliable, inexpensive and widely applicable brain edema monitoring technology has become an urgent need for scientific researchers, clinical staff and patients. This article reviews the research status and prospect of noninvasive brain edema monitoring techniques.
脑脓肿是一类中枢神经系统的感染性疾病，多由化脓性细菌引起，具有致死的风险。根据感染途径的不同，可分为邻近组织的感染、血源性感染、颅脑外伤或颅脑术后感染和隐源性感染。隐源性脑脓肿是指隐源性感染引起的脑脓肿，具有起病隐匿的特点，无明显感染源，缺少发热、头痛或局灶性神经功能障碍等典型临床症状，早期的影像学表现与脑梗死或颅内肿瘤相似，容易误诊[1]。脑脓肿的主要治疗方式为单纯药物治疗和药物联合手术治疗，具体治疗方式的选择还需结合脓肿大小、数量、对手术的耐受性等多方面因素[2]。颅脑手术在外科领域对精准度的要求更高，ROSA机器人正是在这种背景下诞生的。ROSA是法国Medtech公司生产的一种无框架立体定向手术机器人，具有精准度高、手术安全性好、创伤小和低感染率等优点[3]。本文报道了1例由ROSA机器人辅助的立体定向抽吸术治疗的脑脓肿患者的诊疗过程，并结合ROSA机器人的治疗优势，以期为临床治疗提供参考。
Objective:To explore related factors affecting the results of decannulation in patients with acquired brain injury (ABI), and to evaluate the combined predictive value of independent factors for successful decannulation in patients with ABI.Methods:A retrospective study was conducted on clinical data of 145 ABI patients who underwent tracheotomy admitted to the Eighth People's Hospital of Hefei from January 2017 to October 2021. According to the success of decannulation, the group was divided into the decannulation group (n=100) and the undecannulation group (n=45). Independent factors influencing decannulation results were screened by univariate and multivariate Logistic regression analysis, and their combined predictive value was evaluated by receiver operating characteristic (ROC) curve analysis.Results:Univariate analysis showed that there were statistically significant differences between the two groups in consciousness level (GCS score), pulmonary infection control, swallowing function, cough reflex, voluntary cough, sputum aspiration times/8 h and tube blockage tolerance (tube blockage ≥48 h) (P<0.05). Multivariate Logistic regression analysis showed pulmonary infection (95%CI: 0.071-0.813, P=0.022), sputum aspiration times /8 h (95%CI: 0.045-0.451, P=0.001) and cough reflex (95%CI: 1.785-27.718, P=0.005) was an independent risk factor affecting extubation results, and the area under ROC curve of its combined prediction model was 0.924 (95%CI: 0.880-0.969), the optimal cut-off value was 0.646, the sensitivity was 84.4%, and the specificity was 90%.Conclusion:Pulmonary infection, sputum aspiration times/8 h and cough reflex have high predictive value for successful decannulation in ABI patients.
Objective:To explore the effects of transcranial direct current stimulation (tDCS) combined with electromyographic biofeedback on limb function, motor function and dynamic posture stability in elderly patients with hemiplegia after cerebral infarction.Methods:A total of 86 elderly patients with hemiplegia after cerebral infarction admitted to the Rehabilitation Medicine Department of the Cancer Hospital of Cangzhou People's Hospital from December 2021 to December 2022 were prospectively selected and divided into two groups with 43 cases in each group by random number table method. The control group received routine rehabilitation training, and the experimental group received tDCS combined with myoelectric biofeedback intervention on the basis of routine rehabilitation training. After 6 weeks of intervention, Fugl-Meyer motor function assessment (FMA), simple test for evaluating hand function (STEF), Berg balance scale (BBS), Barthel index (BI), National Institute of Health stroke scale (NIHSS), the clinical spasticity index (CSI) and the time "up and go" test (TUGT) were used to evaluate patients motor function, limb spasm degree, neurological impairment, quality of life, balance status, upper limb function, neurological function recovery, and anterior dynamic stability margin (MOSA), lateral dynamic stability margin (MOSL), and performance oriented mobility assessment-gait (POMA-G) scores were measured. Follow up for 3 months by telephone, the fall injuries between the two groups were compared.Results:After intervention, the total score of FMA, STEF, BBS, BI, and POMA-G in the test group were higher than those in the control group (P<0.05); the scores of NIHSS, CSI, TUGT, MOSA and MOSL in the test group were lower than those in the control group (P<0.05). After 3 months of follow-up, the fall injury rate of experimental group was lower than that of control group (P<0.05).Conclusion:In the course of intervention treatment for the elderly with hemiplegia after cerebral infarction, the application of tDCS combined with electromyographic biofeedback can improve the upper limb telekinesis and balance ability of patients, improve posture stability, relieve the degree of limb spasms, promote the rehabilitation of their neurological functions, improve the quality of life, and reduce the rate of fall injury, which is safe and reliable.
患者，女性，65岁，主因"发现颅内转移病灶2年"入院。患者3年前曾因肺癌行左肺叶癌灶切除术，手术后定期复查及规律放射治疗与化学治疗。2年前发现右额叶脑转移灶，当时大小约4 cm×3 cm，给予盐酸恩沙替尼靶向药物治疗，转移病灶缩小至1 cm左右。近1年来复查头颅MRI显示病灶持续增大，1周前增强MRI提示肿瘤最大直径约2 cm，位于额叶皮层下，伴周围水肿（图1），且恩沙替尼控制不理想。神经系统检查：神志清楚，对答切题，瞳孔等大，对光反射灵敏，左下肢肌力稍弱，约V-级，活动较对侧灵活度差，肌张力正常。
Objective:To investigate whether edaravone pretreatment can prolong the thrombolytic time window of acute ischemic stroke (AIS) rat model and its mechanism.Methods:Sixty-four healthy SD rats were randomly divided into sham operation group, AIS group, recombinant tissue plasminogen activator (rt-PA) treatment group and rt-PA+edaravone treatment group. The AIS model was constructed by autologous thrombosis. The neurological function of rats in each group was evaluated after AIS, and the volume of cerebral infarction was measured by TTC method; Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling was used to observe the changes of cell apoptosis in rats; The levels of ROS and superoxide dismutase (SOD) in brain were detected by enzyme-linked immunosorbent assay; The content of malondialdehyde (MDA) in brain was detected by thiobarbituric acid; The content of hemoglobin in brain was detected by colorimetry; The content of hemoglobin in brain was measured by hemoglobin assay; The protein expression level of ASC, TXNIP, Caspase-1, IL-18 and IL-1β related to ROS/TXNIP/NLRP3 pathway were detected by Western blot.Results:The Longa score of the rt-PA+edaravone treatment group was lower than that in the rt-PA treatment group after intravenous thrombolysis at 6 and 7 h, and the improvement of cerebral edema degree and cerebral infarction volume at different intervention time points were better than those in the rt-PA treatment group (P<0.05). The apoptosis rate was significantly lower than that in the AIS group and rt-PA treatment group, with a statistically significant difference (P<0.05). Compared with the rt-PA treatment group, the levels of ROS protein, MDA and hemoglobin of the rt-PA+edaravone treatment group after intravenous thrombolysis at 7 h were significantly reduced, and the SOD level after intravenous thrombolysis at 7 and 8 h were higher (P<0.05). The protein expression level of NLRP3, ASC, IL-18 and IL-1β of the rt-PA treatment group and rt-PA+edaravone treatment group after intravenous thrombolysis at 4.5 h were lower than those of AIS group, and the protein expression level of ASC, TXNIP, Caspase-1, IL-1 of rt-PA+edaravone treatment group after intravenous thrombolysis at 6 and 7 h were decreased (P<0.05). Compared with the rt-PA treatment group, the protein expression level of NLRP3 after intravenous thrombolysis at 6 h, the protein expression levels of ASC and TXNIP after intravenous thrombolysis at 7 h, and the protein expression level of IL-18 after intravenous thrombolysis at 7 and 8 h of the rt-PA+edaravone treatment group were decreased, with statistical significance (P<0.05).Conclusion:Edaravone pretreatment can appropriately prolong the thrombolytic time window of rt-PA treatment in AIS rats, and its mechanism may be related to the participation of ROS/TXNIP/NLRP3 pathway.
Objective:To explore the prognostic value of neutrophil to lymphocyte ratio (NLR), red blood cell distribution width (RDW) combined with amplitude integrated electroencephalogram (aEEG) score in neonatal hypoxic ischemic encephalopathy (HIE).Methods:A retrospective analysis was conducted on the clinical data of 76 HIE newborns admitted to the neonatal intensive care unit of Luzhou People's Hospital from October 2017 to October 2019 (HIE neonatal group), and 78 healthy newborns born in the same period were selected as the control group. The NLR, RDW and aEEG scores of the two groups of newborns were compared. The value of drawing receiver operating characteristic curve curves to analyze NLR, RDW levels, and aEEG scores in predicting the prognosis of HIE newborns.Results:Compared with the control group, the levels of NLR and RDW in HIE groups with different degrees of illness increased (P<0.05); The levels of NLR and RDW in the moderate and severe HIE groups were higher than those in the mild HEI group, while those in the severe HIE group were higher than those in the moderate HIE group (P<0.05). The aEEG abnormal score decreased sequentially with the severity of HIE (P<0.05). The NLR and RDW levels in the death group were higher than those in the survival group, and the aEEG score was lower than that in the survival group (P<0.05). The AUC of NLR, RDW, and aEEG in predicting the prognosis of HIE newborns is 0.889 (95%CI: 0.803-0.964), the optimal cutoff value is 0.784, the sensitivity is 84.54%, and the specificity is 90.43%, all of which are higher than the sensitivity and specificity of individual indicators.Conclusion:The combination of NLR and RDW levels with aEEG score is helpful in clinical evaluation of the prognosis of neonatal HIE, and is worthy of clinical promotion.
