The TRACE-3 trial established the efficacy of intravenous tenecteplase for patients with acute ischemic stroke and large vessel occlusion in the late time window. It remains unclear whether intravenous tenecteplase confers clinical benefits specifically in the subpopulation of patients who did not achieve successful large vessel recanalization. This is a post-hoc analysis of the TRACE-3 trial, a multicenter randomized controlled trial comparing tenecteplase with standard medical therapy in patients with large vessel occlusion between 4.5 and 24 h of symptom onset. The analysis included participants who had failed recanalization (defined as an Arterial Occlusive Lesion [AOL] score of 0) on follow-up angiography at 24 h. Primary outcome of current study was functional independence (modified Rankin Scale [mRS] score 0–2) at 90 days. We assessed effect modification by baseline characteristics, including stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and collateral circulation status. Among 288 patients with failed recanalization (123 in the tenecteplase group and 165 in the control group), tenecteplase was associated with a significantly higher rate of functional independence at 90 days compared with standard medical therapy (42.3

Importance Trials have not demonstrated superiority of alteplase or tenecteplase vs standard care in patients with mild stroke and have raised safety concerns. Prourokinase is an alternative fibrinolytic that may have a favorable safety profile, and the benefit-risk profile of prourokinase in mild stroke is unknown. Objective To investigate the efficacy and safety of prourokinase in mild ischemic stroke within 4.5 hours of symptom onset. Design, Setting, and Participants This was a multicenter, prospective, open-label, blinded–end point randomized clinical trial conducted from November 2022 through December 2023 with 3 months of follow-up. The trial was conducted at 89 hospitals in China. Patients with a baseline National Institutes of Health Stroke Scale score of 5 or less (scores range from 0-42, with higher scores indicating more severe neurological deficit) within 4.5 hours from the time the patient was last known to be well. Patients with intention to proceed to endovascular treatment were excluded. Interventions Eligible patients were randomly assigned in a 1:1 ratio to receive prourokinase, 35 mg (15-mg bolus + 20-mg infusion over 30 minutes) or standard care, including antiplatelet or anticoagulant therapy, at the discretion of local investigators. Main Outcomes and Measures The primary outcome was modified Rankin Scale score of 0 or 1 (range, 0-6, with higher scores indicating greater disability) at day 90. Safety outcomes were symptomatic intracranial hemorrhage and death. Results Of 3836 patients who underwent screening, 1446 (37.7%) were enrolled in the trial. Median (IQR) age was 65.9 (57.7-72.7) years, and 948 were male (65.5%). A total of 723 patients were assigned to prourokinase and 723 to standard care. The primary outcome occurred in 639 patients (88.5%) in the prourokinase group and 658 (91.0%) in the standard care group (relative risk, 0.97; 95% CI, 0.94-1.01; 2-sided P = .12). Symptomatic intracranial hemorrhage was 0.7% (5 of 723 patients) with prourokinase and 0% with standard care, and mortality at 90 days was 2.3% and 1.4%, respectively. Conclusions and Relevance Results of this randomized clinical trial demonstrate that prourokinase was not superior to standard care to improve the functional outcomes for patients with mild ischemic stroke within 4.5 hours after symptom onset but had a similar safety profile. Trial Registration ClinicalTrials.gov Identifier: NCT05507645

Background: More than half of the patients who underwent endovascular treatment for reperfusion had a poor prognosis. Our study aimed to investigate the factors associated with futile reperfusion following endovascular treatment in patients with acute ischemic stroke. Methods: This study conducted a postoperative analysis at Guangdong Province Second People's Hospital, focusing on patients with anterior circulation large-vessel occlusion who underwent endovascular treatment or a combination of intravenous thrombolysis from June 2019 to October 2023. Futile recanalization was determined based on a modified Rankin score of 3-6 at 90 days post-treatment. The researchers utilized multifactorial logistic regression to identify factors linked to futile recanalization following reperfusion in patients. Results: A total of 120 patients were enrolled, amongst which 52 patients (43.3%) had FR. After adjusting for confounders, the discharge NIHSS score, as a continuous variable, was associated with futile recanalization (per 1 score: aOR: 7.30,95%CI: 2.176-24.491, P=0.001), indicating an increased risk, hemorrhagic transformation was also associated with higher futile recanalization risk(aOR:8.556,95%CI: 11.038-70.549, P=0.046). Conclusion: In patients with large anterior circulation stroke, our findings suggest that the discharge INHSS score and hemorrhagic transformation are risk factors for FR.

Background Tenecteplase is an effective thrombolytic agent for eligible patients with stroke who are treated within 4.5 hours after the onset of stroke. However, data regarding the effectiveness of tenecteplase beyond 4.5 hours are limited.Methods In a trial conducted in China, we randomly assigned patients with large-vessel occlusion of the middle cerebral artery or internal carotid artery who had salvageable brain tissue as identified on perfusion imaging and who did not have access to endovascular thrombectomy to receive tenecteplase (at a dose of 0.25 mg per kilogram of body weight; maximum dose, 25 mg) or standard medical treatment within 4.5 to 24 hours after the time that the patient was last known to be well (including after stroke on awakening and unwitnessed stroke). The primary outcome was the absence of disability, which was defined as a score of 0 or 1 on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability), at day 90. The key safety outcomes were symptomatic intracranial hemorrhage and death.Results A total of 516 patients were enrolled; 264 were randomly assigned to receive tenecteplase and 252 to receive standard medical treatment. Less than 2% of the patients (4 in the tenecteplase group and 5 in the standard-treatment group) underwent rescue endovascular thrombectomy. Treatment with tenecteplase resulted in a higher percentage of patients with a modified Rankin scale score of 0 or 1 at 90 days than standard medical treatment (33.0% vs. 24.2%; relative rate, 1.37; 95% confidence interval, 1.04 to 1.81; P=0.03). Mortality at 90 days was 13.3% with tenecteplase and 13.1% with standard medical treatment, and the incidence of symptomatic intracranial hemorrhage within 36 hours after treatment was 3.0% and 0.8%, respectively.Conclusions In this trial involving Chinese patients with ischemic stroke due to large-vessel occlusion, most of whom did not undergo endovascular thrombectomy, treatment with tenecteplase administered within 4.5 to 24 hours after stroke onset resulted in less disability and similar survival as compared with standard medical treatment, and the incidence of symptomatic intracranial hemorrhage appeared to be higher. (Funded by the National Natural Science Foundation of China and others; TRACE-III ClinicalTrials.gov number, NCT05141305.) In patients with large-vessel ischemic stroke and no access to thrombectomy, tenecteplase given within 4.5 to 24 hours resulted in less disability at 90 days than standard care but also a higher risk of intracranial hemorrhage.

Elsberg综合征是一种累及腰骶脊髓神经根并引起急性尿便障碍的综合征.主要临床表现为尿潴留、严重便秘、大便失禁、阳痿和感觉障碍,部分患者伴有发热、头痛等感染前驱症状.现报道广东省第二人民医院收治的1例51岁女性患者,在影像学及脑脊液等检查结果阴性情况下,临床高度可疑Elsberg综合征.入院后予以地塞米松抗炎治疗后效果欠佳,经验性予以抗病毒、营养神经等治疗后,患者会阴及双下肢麻木明显减轻,预后良好.

BackgroundVascular disease is the second most common cause of dementia. The prevalence of vascular dementia (VaD) has increased over the past decade. However, there are no licensed treatments for this disease. Carotid atherosclerosis (CAS) is highly prevalent and is the main cause of ischemic stroke and VaD. We studied co-expressed genes to understand the relationships between CAS and VaD and further reveal the potential biomarkers and therapeutic targets of CAS and VaD.MethodsCAS and VaD differentially expressed genes (DEGs) were identified through bioinformatic analysis Gene Expression Omnibus (GEO) datasets GSE43292 and GSE122063, respectively. Furthermore, a variety of target prediction methods and network analysis approaches were used to assess the protein–protein interaction (PPI) networks, the Gene Ontology (GO) terms, and the pathway enrichment for DEGs, and the top 7 hub genes, coupled with corresponding predicted miRNAs involved in CAS and VaD, were assessed as well.ResultA total of 60 upregulated DEGs and 159 downregulated DEGs were identified, of which the top 7 hub genes with a high degree of connectivity were selected. Overexpression of these hub genes was associated with CAS and VaD. Finally, the top 7 hub genes were coupled with corresponding predicted miRNAs. hsa-miR-567 and hsa-miR-4652-5p may be significantly associated with CAS and VaD.

目的 分析帕金森病伴抑郁(DPD)患者肠道菌群的变化,并分析其代谢功能.方法 选择2021年6月至2022年10月广东省第二人民医院神经内科收治的DPD患者48例(DPD组),帕金森病不伴抑郁(NDPD)患者47例(NDPD组),选入帕金森病(PD)患者的健康配偶43名作为对照组.采集研究对象粪便样本,提取样本中的细菌DNA进行16SrDNA测序,比较三组间肠道菌群结构差异,分析DPD组差异菌属.应用PICRUSt2软件对肠道菌群测序结果进行代谢功能分析.结果 与对照组相比,DPD组和NDPD组的菌群α多样性显著增高(P<0.05).β多样性分析结果显示,DPD组和NDPD组肠道菌群构成差异有统计学意义(P<0.05).相较于对照组和NDPD组,DPD组放线菌门(Actinobacteria)、互养菌门(Synergistetes)丰度增加,与对照组比较差异有统计学意义(P<0.05),但与NDPD组比较差异无统计学意义(P>0.05).线性判别分析(LDA)结果显示,另枝菌属(Alistipes)、Anaerotruncus属、Dielma属、霍尔德曼氏菌属(Holdemania)、芽胞杆菌属(Cloa-cibacillus)、柯林斯氏菌属(Collinsella)是DPD患者的特征性肠道菌群.PICRUSt2代谢功能分析发现,光合生物中的碳固定和抗坏血酸抵抗是DPD患者肠道菌群的主要代谢途径.结论 DPD患者肠道菌群与NDPD患者及健康者相比存在显著差异,DPD患者特征性肠道菌群可能通过蛋白酰化、抗坏血酸抵抗途径参与疾病的发病过程.

The present study describes the case of patient with contrast-induced encephalopathy following cerebrovascular angiography, and presents the clinical and imaging features, as well as the treatment and prognosis of this patient. Following digital subtraction angiography, cortical blindness and cognitive dysfunction were the main complaints of the patient. The emergency craniocerebral CT scan revealed hyperdense areas in the bilateral cerebellum, thalamus, sulcus and cistern, and a review of the CT scan 24 h following the procedure revealed that the hyperintense lesions were reduced or resolved in these areas. The patient obtained a good prognosis following treatment anti-inflammatory and intracranial pressure reduction treatment. On the whole, the present study demonstrates that cognitive dysfunction may be a clinical manifestation of contrast-induced encephalopathy. Thus, the earlier diagnosis and earlier treatment are crucial for the prognosis of patients.

HepatologyEarly View CORRESPONDENCE Letter to the editor: Selection of appropriate statistical methods for prediction model Zhixin Huang, Corresponding Author Zhixin Huang hzxd6@163.com orcid.org/0000-0003-0705-1970 Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China Faculty of Medical Science, Jinan University, Guangzhou, China Correspondence Zhixin Huang and Xintong Liu, Department of Neurology, Guangdong Second Provincial General Hospital, 466 Middle Xingang Road, Guangzhou 510317, Guangdong, China. Email: hzxd6@163.com and liuxt@gd2h.org.cnSearch for more papers by this authorDong Yang, Dong Yang Guangzhou AID Cloud Technology, Guangzhou, ChinaSearch for more papers by this authorYan Huang, Yan Huang Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, ChinaSearch for more papers by this authorGuang Xu, Guang Xu Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, ChinaSearch for more papers by this authorXintong Liu, Corresponding Author Xintong Liu liuxt@gd2h.org.cn Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China Correspondence Zhixin Huang and Xintong Liu, Department of Neurology, Guangdong Second Provincial General Hospital, 466 Middle Xingang Road, Guangzhou 510317, Guangdong, China. Email: hzxd6@163.com and liuxt@gd2h.org.cnSearch for more papers by this author Zhixin Huang, Corresponding Author Zhixin Huang hzxd6@163.com orcid.org/0000-0003-0705-1970 Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China Faculty of Medical Science, Jinan University, Guangzhou, China Correspondence Zhixin Huang and Xintong Liu, Department of Neurology, Guangdong Second Provincial General Hospital, 466 Middle Xingang Road, Guangzhou 510317, Guangdong, China. Email: hzxd6@163.com and liuxt@gd2h.org.cnSearch for more papers by this authorDong Yang, Dong Yang Guangzhou AID Cloud Technology, Guangzhou, ChinaSearch for more papers by this authorYan Huang, Yan Huang Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, ChinaSearch for more papers by this authorGuang Xu, Guang Xu Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, ChinaSearch for more papers by this authorXintong Liu, Corresponding Author Xintong Liu liuxt@gd2h.org.cn Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China Correspondence Zhixin Huang and Xintong Liu, Department of Neurology, Guangdong Second Provincial General Hospital, 466 Middle Xingang Road, Guangzhou 510317, Guangdong, China. Email: hzxd6@163.com and liuxt@gd2h.org.cnSearch for more papers by this author First published: 28 January 2022 https://doi.org/10.1002/hep.32371 Zhixin Huang and Xintong Liu contributed equally to the manuscript. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Background: The evidence between diurnal temperature range (DTR) and stroke remains controversial and sparse. We aimed to assess the relationship between DTR and emergency ambulance dispatches (EADs) due to stroke, and to explore whether there were effect modifications to the relationship. Methods: A Quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the relationship between DTR and EADs for stroke between January 1st 2011 and June 30th 2018 in Guangzhou, China. We estimated the effects of the low DTR and high DTR (defined as DTR below and above 10 center dot C respectively) on EADs. The effects of minimum, maximum, 5th, 25th, 50th, 75th, and 95th percentiles of DTR compared with the DTR of 10 center dot C were also analyzed. Results: A total of 20,275 EADs for stroke were included for analyses, among which 17,556 EADs were used in the model further adjusted for age and sex. A quasi-U-shaped relationship between DTR and EADs over lag0-2 days was observed. For the low DTR, per 1 center dot C decrease in DTR was significantly associated with an increase of 2.64% (RR = 1.03, 95% CI: 1.01-1.04) for EADs, while per 1 center dot C increase for the high DTR was non-significantly related with an increased risk of EADs (RR = 1.01, 95% CI: 0.90-1.13). Significant effects of the 5th and 25th percentiles of DTR on EADs were found when compared with the DTR of 10 center dot C. No significant effect modifications by age, sex or season were found to the association between DTR and EADs. Conclusions: We found a quasi-U-shaped relationship between DTR and EADs due to stroke in this study, while age, sex or season did not significantly modify the association between DTR and EADs. More high-quality evidence is needed to further explore and validate the relationship between DTR and stroke.

Evidence for the association between vitamin D and risk of recurrent stroke remains sparse and limited. We aimed to assess the relationship between serum circulating 25-hydroxyvitamin D (25(OH)D) level and risk of recurrent stroke in patients with a stroke history, and to identify the optimal 25(OH)D level in relation to lowest recurrent stroke risk. Data from the nationwide prospective United Kingdom Biobank were used for analyses. Primary outcome was time to first stroke recurrence requiring a hospital visit during follow-up. We used Cox proportional hazards regression model with restricted cubic splines to explore 25(OH)D level in relation to recurrent stroke. The dose-response relationship between 25(OH)D and recurrent stroke risk was also estimated, taking the level of 10 nmol/L as reference. A total of 6824 participants (mean age: 60.6 years, 40.8% females) with a baseline stroke were included for analyses. There were 388 (5.7%) recurrent stroke events documented during a mean follow-up of 7.6 years. Using Cox proportional hazards regression model with restricted cubic splines, a quasi J-shaped relationship between 25(OH)D and risk of recurrent stroke was found, where the lowest recurrent stroke risk lay at the 25(OH)D level of approximate 60 nmol/L. When compared with 10 nmol/L, a 25(OH)D level of 60 nmol/L was related with a 48% reduction in the recurrent stroke risk (hazard ratio = 0.52, 95% confidence interval: 0.33–0.83). Based on data from a large-scale prospective cohort, we found a quasi J-shaped relationship between 25(OH)D and risk of recurrent stroke in patients with a stroke history. Given a lack of exploring the cause–effect relationship in this observational study, more high-quality evidence is needed to further clarify the vitamin D status in relation to recurrent stroke risk.

Objectives Epidemiological research has indicated that hyperuricemia may impair cognitive ability; however, the underlying mechanisms remain unclear. The present study thus investigated the possible mechanism underlying hyperuricemia-related cognitive impairment. Methods Using hyperuricemic rats and high uric acid (UA) intracerebroventricularly treated mice, the current study elucidated whether and how high UA impaired cognitive ability and hippocampal mitochondrial bioenergetic function. Results Hyperuricemia induced UA uptake by hippocampal mitochondria, which impaired cognitive ability and disrupted the bioenergetic function of hippocampal mitochondria, indicated by reduced ATP production and decreased cytochrome c oxidase (COX) activity. Mechanistically, excess UA might trigger intramitochondrial NF-κB inhibitor α (IκBα)/nuclear factor-κB (NF-κB) pathway to downregulate the subunit III of COX (COXIII). Conclusion The results provided new insights into the mechanism underlying hyperuricemia-related cognitive decline.

BACKGROUND:The role of continuous intravenous administration of tirofiban in endovascular therapy is still unclear. This meta-analysis aims to evaluate the 90-day functional prognosis in acute ischemic stroke patients (AIS) treated by endovascular treatment and intravenous administration of tirofiban. METHODS:We searched PubMed, Embase, and CENTRAL databases with the subject terms "tirofiban", "brain ischemia", and some related free words. Inclusion criteria were: (1) cohort study or randomized control trials; (2) AIS patients who received endovascular therapy; (3) the intervention or exposure was intravenous tirofiban monotherapy or combined with intra-arterial tirofiban; (4) containing data on modified Rankin Scale at 90 days and including at least one of the following indicators: mortality, symptomatic intracranial hemorrhage (sICH), intracranial hemorrhage (ICH), and recanalization. A summary odds ratio was calculated. RESULTS:Twelve eligible studies, consisting of 3268 AIS participants, were identified. There was a significant trend of favorable outcomes (measured by mRS at three months) in the tirofiban group (ORs = 1.36; 95% CI = 1.09-1.70). In addition, compared with the non-tirofiban group, intravenous tirofiban was significantly associated with decreased risk of 90-day mortality (ORs = 0.73; 95% CI:0.59-0.89) and increased recanalization rate (ORs = 1.50; 95% CI:1.08-2.09) but no significant difference in rates of sICH (ORs = 0.93; 95% CI = 0.70-1.24) or ICH (ORs = 0.84; 95% CI = 0.62-1.15). CONCLUSIONS:Intravenous tirofiban appears to be safe and effective when used following intra-arterial tirofiban or as monotherapy in AIS patients treated by endovascular therapy, which can improve the 90-day functional outcome, decrease the 90-day mortality and increase the possibility of early recanalization without increasing rates of sICH and ICH.

Purpose:To systematically review available evidence of indirect comparisons from RCTs and direct comparisons from observational studies regarding the comparative effectiveness and safety of DOACs in patients with AF. Methods: Electronic databases including EMBASE, MEDLINE, and PUBMED were searched up to June 5th, 2020. Primary endpoints included effectiveness (stroke or systemic embolism [SE]) and safety (major bleeding) outcomes. Bucher methods and random-effects models were conducted for indirect and direct comparisons among DOACs, respectively. Ranking probability analyses and the number needed to treat for net effect (NNTnet) were applied. Results: A total of 36 studies, involving 7 RCTs (n = 60,292 patients) and 29 observational studies (n = 1,164,821 patients), were included for analyses. Regarding the risk of stroke/SE, no significant differences were found from indirect comparisons of RCTs among the DOACs. For major bleeding, apixaban tended to be safer than rivaroxaban and dabigatran based on both direct and indirect comparisons (all p < 0.05; evidence quality: very low to moderate). Ranking probability analysis showed that apixaban had a high probability of being the best treatment in decreased risk of stroke/SE and major bleeding (80.30% and 91.30%, respectively). Likewise, apixaban was found to have the highest net clinical benefit (0.02, 95% CI: 0.014–0.029) and smallest NNTnet (48, 95% CI: 35–74). Conclusions: Apixaban appeared to have a favorable effectiveness-safety profile compared with the other DOACs in AF for stroke prevention, based on evidence from both direct and indirect comparisons. However, additional high-quality evidence is needed to support firm recommendations on clinical decision-making.

神经重症监护室(NICU)是救治神经系统危急重症患者的重要监护单元,然而NICU的建设和管理尚无统一规范化指南,各地NICU建设和管理差异较大.如何在有条件的高级别医院建设高效有序的现代化NICU单元,仍是各大医院神经专科建设要研究的课题.广东省第二人民医院于2016年对NICU进行了改建,在改建过程中将目前能开展的信息化、智能化技术,充分应用到重症患者的诊断、治疗、护理等各个环节,以达到节约人力、提高效率、增强服务质量之目的.此经验可供其他在建NICU单位参考.

目的 探讨大动脉粥样硬化型脑梗死不同CISS机制、危险因素与替罗非班治疗后病情进展的关系,探讨不同发病机制及危险因素对替罗非班疗效的影响.方法 收集192例接受替罗非班治疗的急性缺血性脑梗死患者作为研究对象,根据患者治疗后7d内病情是否进展分为对照组(133例)和进展组(59例).对比两组患者的美国国立卫生研究院卒中量表(NIHSS)、ESSEN卒中风险量表(ESRS)和出院时改良Rankin量表(mRS)评分,对两组患者发病机制分型及危险因素进行多因素Logistic回归分析.结果 进展组治疗24h、7d的NIHSS评分、入院时ESRS评分、出院时mRS评分均高于对照组,两组差异有统计学意义(P<0.05);多因素Logistic回归分析显示糖尿病、高血压、后循环梗死及CISS分型中的混合机制是替罗非班治疗后脑梗死病情进展的独立危险因素(OR=2.319,95％CI:1.180～4.561,P=0.015;OR=2.714,95％CI:1.260～5.964,P=0.011;OR=0.498,95％CI:0.254～0.975,P=0.042;OR=2.847,95％CI:1.049～7.723,P=0.040).结论 脑梗死病情进展患者入院时ESRS评分、治疗24h、7d的NIHSS评分、出院时mRS评分明显升高,CISS分型中的混合机制及糖尿病、高血压、后循环梗死是替罗非班治疗后脑梗死病情进展的独立危险因素.

目的 评价良肢位摆放对瘫痪肢体功能恢复的作用及影响因素.方法 选择2018年10月-2019年10月我科住院的肢体瘫痪患者,采用随机数表法分为对照组41例和实验组40例.对照组按常规摆放,实验组从入院当天开始用良肢位摆放对瘫痪肢体进行护理,记录入院当天、1周及出院时的肌力积分值,比较各组入院1周、2周及出院时肌力积分差值变化.结果 实验组入院治疗后1周、2周时肌力积分差值均高于对照组,但差异无统计学意义(P>0.05);实验组出院时肌力积分差值高于对照组(P<0.05);实验组女性、>75岁及住院天数>15 d以上的患者肌力积分差值高于对照组(P<0.05);多因素Logistic回归分析显示,实验组住院天数和年龄是肌力积分差值的影响因素(P<0.05).结论 良肢位摆放护理可提高肢体瘫痪患者肌力恢复能力,但临床应用时要考虑疗程、年龄的影响因素.

Mitochondrial transplantation emerges as a novel therapeutic solution for ischemia/reperfusion injury (IRI) in various tissues. Platelets have recently been used in mitochondrial transplantation as readily-available donors of small-size platelet mitochondria (plt-mito). Interestingly, FUN14 Domain Containing 2 (FUNDC2), a protein highly-expressed in the outer membrane (OMM) of plt-mito, has been identified to maintain platelet survival under hypoxic condition. The current study determined whether and how FUNDC2 contributed to the therapeutic effect of plt-mito transplantation for hypoxia/reoxygenation (HR) injury. The results showed that incorporation of human plt-mito into SH-SY5Y cells rescued HR-induced mitochondrial malfunction and mitochondrial apoptotic pathway. Mechanistically, plt-mito transplantation led to an increased expression of FUNDC2 in the recipient cells. This protein induced mitochondrial translocation of phosphatidylinositol-3,4,5-trisphosphate (PIP3) via its N-term, resulting in the stimulation of the protein kinase B (Akt)/forkhead box O3a (FOXO3a) pathway, which inhibited HR-induced mitochondrial accumulation of a mitochondrial target of FOXO3a, Bim, also known as a pro-apoptotic protein. Therefore, the FUNDC2/PIP3/Akt/FOXO3a axis may facilitate the incorporated plt-mito to restore mitochondrial function and cell viability of the recipient cells, and platelets may serve as readily-available sources of donor mitochondria that afford therapeutic benefits against IRI.

PURPOSE:The aim of this study was to compare regional homogeneity (ReHo) changes in Parkinson's disease mild cognitive impairment (PD-MCI) patients with respect to normal controls (NC) and those with cognitively normal PD (PD-CN). Further, the study investigated the relationship between ReHo changes in PD patients and neuropsychological variation.PATIENTS AND METHODS:Thirty PD-MCI, 19 PD-CN, and 21 NC subjects were enrolled. Resting state functional magnetic resonance imaging data of all subjects were collected, and regional brain activity was measured for ReHo. Analysis of covariance for ReHo was determined between the PD-MCI, PD-CN, and NC groups. Spearman rank correlations were assessed using the ReHo maps and data from the neuropsychological tests.RESULTS:In comparison with NC, PD-CN patients showed significantly higher ReHo values in the right middle frontal gyrus (MFG) and lower ReHo values in the left supramarginal gyrus, bilateral inferior parietal lobule (IPL), and the right postcentral gyrus (PCG). In comparison with PD-CN patients, PD-MCI patients displayed significantly higher ReHo values in the right PCG, left middle occipital gyrus (MOG) and IPL. No significant correlation between ReHo indices and the neuropsychological scales was observed.CONCLUSION:Our finding revealed that decreases in ReHo in the default mode network (DMN) may appear before PD-related cognitive impairment. In order to preserve executive attention capacity, ReHo in the right MFG in PD patients lacking cognition impairment increased for compensation. PD-MCI showed increased ReHo in the left MOG, which might have been caused by visual and visual-spatial dysfunction, and increased ReHo in the left IPL, which might reflect network disturbance and induce cognition deficits.

目的 探讨阿托伐他汀治疗进展性缺血性脑卒中(PIS)后心力衰竭的临床效果.方法 60例PIS后心力衰竭患者,按随机数字表法分为观察组与对照组,各30例.所有患者均采取常规稳压及控制血糖治疗,在此基础上对照组患者使用阿司匹林+氯吡格雷治疗,观察组在对照组基础上加用阿托伐他汀治疗.比较两组治疗效果;治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力评定量表(ADL)评分;不良反应发生率及复发率.结果 观察组治疗总有效率96.67％明显高于对照组的80.00％,差异有统计学意义(P<0.05).治疗前,两组NIHSS、ADL评分比较差异无统计学意义(P>0.05);治疗后,观察组的NIHSS评分、ADL评分分别为(13.36±2.18)、(75.54±7.19)分;对照组的NIHSS评分、ADL评分分别为(18.65±2.56)、(70.21±7.04)分.治疗后,两组NIHSS评分、ADL评分均优于治疗前,且观察组NIHSS评分、ADL评分均优于对照组,差异有统计学意义(P<0.05).观察组不良反应发生率为10.00％,对照组不良反应发生率为13.33％,比较差异无统计学意义(P>0.05).观察组复发率0低于对照组的13.33％,差异有统计学意义(P<0.05).结论 针对PIS后心力衰竭患者采取阿托伐他汀、阿司匹林与氯吡格雷的联合治疗方式,可取得满意的疗效,改善患者神经功能及提高患者日常生活能力,因此值得在临床中大力推广使用.