Background and purpose: The composite score for insulin resistance (IR), known as the Metabolic Score of Insulin Resistance (METS-IR), serves as an assessment tool for IR and has been previously linked to symptomatic intracranial hemorrhage and poor functional outcomes in patients with acute ischemic stroke (AIS). Despite these associations, the impact of METS-IR on early neurological deterioration (END) in patients with minor AIS who underwent intravenous administration of recombinant tissue-type plasminogen activator (IV-rtPA) remains inadequately established. This investigation explored the link between METS-IR and END in patients with minor AIS receiving IV-rtPA treatment. Methods: In this study, a cohort comprising 425 consecutive patients with National Institutes of Health Stroke Scale Score (NIHSS)<= 5 who underwent IV-rtPA treatment was included. The METSIR was computed using the formula ln METS-IR=ln (2 x FBG + TG) x BMI/ln (HDL). END was defined as a NIHSS >= 2 within 24 h post IV-rtPA administration, while poor functional outcome was defined as a modified Rankin Scale (mRS) of 2-6. Multivariate logistical regression was performed to investigate the association between METS-IR and both poor functional outcomes and END. Results: Among the 425 enrolled patients, 64 (15.1 %) patients experienced END, while 80 (18.8 %) had poor functional outcomes three months post-discharge. Upon adjusting for confounding factors, a higher METS-IR emerged as an independent predictor for both END and poor functional outcomes. Similarly, noteworthy findings were observed when METS-IR was defined as a categorical group. The restricted cubic spline (RCS) analysis indicated a linear relationship between METS-IR and END (P = 0.593 for non-linearity, P = 0.034 for overall). The incorporation of METS-IR into the conventional model resulted in a significant enhancement of predictive accuracy for both END and poor functional outcomes. Conclusion: METS-IR emerges as an independent predictor for END and poor functional outcome at three months post-discharge in patients with minor AIS subjected to IV-rtPA. Considering its

Background and purpose Multiple inflammatory biomarkers have been shown to predict symptomatic cerebral vasospasm (SCVS) and poor functional outcome in patients with aneurysmal subarachnoid hemorrhage. However, the impact of the low-grade inflammation (LGI) score, which can reflect the synergistic effects of five individual inflammatory biomarkers on SCVS and poor functional outcome on aneurysmal subarachnoid hemorrhage (aSAH), has not yet been well established. The aim of this study was to evaluate the impact of the LGI score on SCVS and poor functional outcome in aSAH patients. Methods The LGI score was calculated as the sum of 10 quantiles of each individual inflammatory biomarker. The association of the LGI score with the risk of SCVS and poor functional outcome was analyzed with multivariate logistical regression. Results A total of 270 eligible aSAH patients were included in this study: 74 (27.4%) had SCVS, and 79 (29.3%) had poor functional outcomes. After adjusting for confounders, a higher LGI score was revealed to independently predict SCVS (OR, 1.083; 95% CI, 1.011–1.161; P = 0.024) and poor functional outcome (OR, 1.132; 95% CI, 1.023–1.252; P = 0.016), and the second and third tertile group had higher risk of SCVS than lowest tertile group (OR, 2.826; 95% CI, 1.090–7.327; P = 0.033) (OR, 3.243; 95% CI, 1.258–8.358; P = 0.015). The receiver operating characteristic (ROC) curve uncovered the ability of the LGI score to distinguish patients with and without SCVS (area under the curve [AUC] = 0.746; 95% CI, 0.690–0.797; P < 0.001) and poor functional outcomes (area under the curve [AUC] = 0.799; 95% CI, 0.746–0.845; P < 0.001), the predictive value of LGI on SCVS and poor functional outcome is superior than PLT, NLR and WBC, but there was no statistical difference between LGI and CRP for predicting SCVS ( P = 0.567) and poor functional outcome ( P = 0.171). Conclusions A higher LGI which represents severe low grade inflammation status is associated with SCVS and poor functional outcome at 3 months after aSAH.

Objective To investigate the impact of human serum albumin (HSA) levels on symptomatic cerebral vasospasm (SCVS) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods We retrospectively reviewed the medical records. SCVS was defined as the development of a new neurological deterioration when the cause was considered to be ischemia attributable to vasospasm after other possible causes of worsening had been excluded. The aSAH patients were divided into two groups: those with SCVS (group 1) and those without SCVS (group 2). The HSA level data on the 1st, 2nd, and 3rd day after admission was collected. Multivariate logistical regression and receiver operating characteristic (ROC) analysis were performed to evaluate the ability of HSA level to predict the development of SCVS. Results A total of 270 patients were included in our study, of which 74 (27.4%) developed SCVS. The average and lowest HSA levels were lower in group 1 ( P < 0.001). In univariate logistic regression, white blood cell count, neutrophil count, and average and lowest HSA levels were associated with SCVS. After adjustment for age, CT Fisher grade, Hunt-Hess grade, and WFNS grade, both the average and lowest HSA levels remained independent predictors of SCVS ( P < 0.001). The CT Fisher grade was confirmed to be an independent predictor of SCVS across each model. ROC analysis revealed that the lowest HSA level was a better predictor for SCVS than average HSA level and CT Fisher grade. Conclusion Clinicians are encouraged to measure HSA levels for the first 3 days after admission to predict the occurrence of SCVS after aSAH.

Background and Purpose: Glycemic Gap (GG) as an index reflecting the acute fluctuation of glycemia, has been proved to be associated with poor functional outcomes in Acute Ischemic Stroke (AIS) patients. However, it predictive value on post-thrombolysis Early Neurological Outcomes (ENOs) are still controversial. This study aimed to use GG to evaluate the influence of pretreatment relative glucose changes on post-thrombolysis ENOs, and we further explored the predictive value of GG in different glycemic control status. Methods: Early Neurological Deterioration (END) was defined as a National Institutes of Health Stroke Scale Score (NIHSS) =4, Early Neurological Improvement (ENI) was defined as a =4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after intravenous recombinant tissue-type plasminogen activator (IV-rtPA). GG was calculated as Admission Blood Glucose level (ABG)- estimated average blood glucose level (eAG), eAG could be derived from HbAlc according to the equation eAG=28.7*HbAlc-46.7 Results: Increased GG was significantly associated with post-thrombolysis END and poor functional outcome at discharge (OR, 1.982; 95% CI, 1.213-3.238; P=0.006) (OR, 2.079; 95% CI, 1.305-3.312; P=0.002). Its predictive value on END was more pronounce in diabetic patients (OR, 2.434; 95% CI, 1.079-5.491; P=0.032), after dichotomizing glycemic control status, its significance was only maintained in diabetic patients with good previous glucose control (OR, 6.946; 95% CI, 1.217-39.636; P=0.029). Conclusion: An evaluated GG was associated with high risk of post-thrombolysis END and poor functional outcome at discharge in AIS patients, and the previous glucose control should be considered when predicting ENOs.

Background and Purpose It has been widely reported that stress hyperglycemia contributes to poor prognosis in patients experiencing acute ischemic stroke (AIS). However, its predictive value for early neurological deterioration (END) after intravenous administration of recombinant tissue-type plasminogen activator (IV-rtPA) in AIS patients is still unclear. The aim of this study was to evaluate the impact of stress hyperglycemia on the risk of END after IV-rtPA. Methods A total of 798 consecutive patients treated with IV-rtPA were included in this study. The stress hyperglycemia ratio (SHR) was calculated as fasting plasma glucose level at admission (mg/dl)/glycosylated hemoglobin (HbAlc) (%). END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) ≥ 4 points 24 h after IV-rtPA, and poor functional outcome at discharge was defined as a modified Rankin Scale (mRS) score of 3–6 at discharge. Patients with a prior history of diabetes or HbAlc ≥ 6.5% were considered to have diabetes mellitus. Patients were grouped according to SHR values. Multivariate logistical regression was used to evaluate the risk of END for patients within specific SHR categories. Results In total, 139 (17.4%) patients had END. After adjusting for confounders, the highest tertile group had higher risks of END and poor functional outcome at discharge than those of patients in the lowest tertile group ( OR , 1.95; 95% CI , 1.21–3.15; p = 0.006) ( OR , 1.85; 95% CI , 1.163–2.941; p = 0.009), and the predictive value of high SHR for END was also significant in patients with diabetes mellitus ( OR , 3.05; 95% CI , 1.29–7.21; p = 0.011). However, a significant association of high SHR and poor functional outcome was only found in patients without diabetes ( OR , 1.85; 95% CI , 1.002–3.399; p = 0.045). Conclusion A higher SHR predicted that patients with severe stress hyperglycemia had higher risks of END and poor functional outcome at discharge after IV-rtPA.

Abstract Background and purpose: Abnormal glucose metabolism status (AGM), including prediabetes and diabetes mellitus (DM) have been reported to be an important predictor of poor functional outcome in patients experiencing acute ischemic stroke (AIS). However, conclusions of recent studies are inconsistent about which AGM status increases the risk of post-thrombolysis early neurological deterioration (END). The purpose of this study was to evaluate the impact of AGM status on the risk of post-thrombolysis early neurological outcomes. We further investigated the influence of previous glucose control of diabetic patients on the post-thrombolysis early neurological outcomes evaluation. Methods: Prediabetes was identified as glycosylated hemoglobin (HbAlc) (%) level within the range of 5.7%-6.4%, and diabetes mellitus (DM) was diagnosed based on prior history of diabetes or an HbAlc≥6.5% and patients with HbAlc less than 5.7% were classified as normal glucose metabolism (NGM). Diabetic patients with good PGC had HbAlc <7%, diabetic patients with poor PGC had HbAlc≥7%. END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) ≥ 4, ENI was defined as a ≥4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after IV-rtPA. Results In total, 261 (32.7%) patients were diagnosed with prediabetes, 91 (11.4%) patients were DM had good PGC and 186 (23.3%) patients were DM had poor PGC. After adjusted for confounders, in model 1, DM with poor PGC associated with the increased risk of post-thrombolysis END and poor functional outcome at discharge (OR, 2.09; 95% CI, 1.220-3.579; P=0.007) (OR, 1.91; 95% CI, 1.165-3.133; P=0.010), both prediabetes and DM with poor PGC were less likely to experience post-thrombolysis ENI (OR, 0.58; 95% CI, 0.377-0.907; P=0.016) (OR, 0.43; 95% CI, 0.255-0.71; P=0.001); in model 2, further adjusted for admission hyperglycemia, the presence of diabetes and DM with poor PGC was still independently related to post-thrombolysis ENI (OR, 0.62; 95% CI, 0.400-0.969; P=0.036) (OR, 0.51; 95% CI, 0.282-0.923; P=0.026). Conclusion Prediabetes and DM with poor PGC might be two abnormal blood glucose metabolism states that affects post-thrombolysis early neurological outcome in AIS patients.

目的:调查分析医护在线医学教育现状,为医学继续教育模式探讨对策建议.方法:采用定性定量结合的问卷调查法随机对医护进行问卷调查.问卷主要由三部分14个问题组成,采用单选、多选及梯度评价等多种方式.结果:137名医护完成了有效调查问卷;疫情导致在线教育所占比例较传统线下教育明显增加(P<0.01);最常选用的直播软件平台主要是zoom(59.12％)、腾讯会议(15.33％)、skype(7.30％)等;在线上课程评价中,对教师质量和教学内容的满意度比较高,参与度表现的最差.结论:COVID-19的流行导致在线教育所占比例明显提升,弥补了线下教育的缺失,但在线教学存在不足.因此,在线医学继续教育需要进一步改进.

Background and purpose The predictive effect of blood cell ratio on ischemic event has been widely confirmed. Whether PWR and PNR can assess the risk of endovascular treatment (EVT) is largely unclear. This study aimed to investigate the prognostic value of PNR and PWR in acute ischemic stroke patients treated with EVT. Methods Poor functional outcome was defined as Modified Rankin Scale (mRS) of 3-6 at 3 months, Symptomatic intracranial hemorrhage (sICH) was diagnosed based on CT scan and classified according to the criterial of Heidelberg Bleeding Classification. Binary logistical regression was used to analyze the relationship of PWR, PNR with functional outcome and symptomatic intracranial hemorrhage (sICH). Results Patients with good prognosis had higher PNR and PWR value (29 vs. 24, P=0.002) (22 vs. 19, P=0.009), a lower rate of sICH (2.9% vs. 24.9%, P<0.001). In model 1, the lower PNR significantly associated with poor functional outcome (OR, 0.48; 95% CI 0.26-0.88; P=0.018), and sICH (OR, 0.42; 95% CI 0.19-0.91; P=0.028). The lower PWR only significantly associated with poor prognosis (OR, 0.97; 95% CI 0.94-1.00; P=0.038), and had a trend relation with sICH (OR, 0.98; 95% CI 0.94-1.02; P=0.328). In model 2 lower PNR still significantly associated with poor functional outcome (OR, 0.53; 95% CI 0.29-0.99; P=0.047), but showed a trend for predicting sICH (OR, 0.56; 95% CI 0.25-1.25; P=0.158). Conclusion Platelet to leukocyte ratio may be use to assess the risk of functional outcome and sICH in patients with acute anterior circulation occlusion stroke undergoing endovascular treatment in real world China.

目的 探讨脑小血管病患者认知障碍和动态血压之间的关系.方法 选取2017年5月至2018年8月安徽医科大学第四附属医院神经内科诊断明确的脑小血管病患者145例.依据临床症状、认知功能测评和诊断标准将所有受试者分为认知正常组、皮质下血管性轻度认知障碍组和皮质下血管性痴呆组.使用便携袖带式动态血压自动记录系统监测动态血压变化.比较三组患者的动态血压变化特征,以及认知障碍与动态血压变化的相关性.结果 认知正常组80例,皮质下血管性轻度认知障碍组42例,皮质下血管性痴呆组23例.认知正常组和皮质下血管性轻度认知障碍组在夜间最低舒张压方面差异有显著性(q=6.375,P=0.019).记忆力损害与动态血压有一定相关性,其中远记忆与日间最高舒张压(r=0.248,P=0.011)和日间平均舒张压(r=0.229,P=0.019)相关,近记忆与日间最高收缩压相关(r=0.309,P=0.001).结论 脑小血管病患者认知障碍与动态血压变化密切相关,夜间最低舒张压对早期认知功能损害有一定影响.日间舒张压与远记忆受损有关,日间收缩压与近记忆受损有关.

目的 比较视神经脊髓炎和其他疾病脑脊液及血清的氯化物比值,探讨视神经脊髓炎可能的病理机制.方法 回顾性分析75例至少进行过一次血清和脑脊液配对检查的患者,分为视神经脊髓炎(N M O)、控制组(非感染性疾病)、周围神经病、中枢神经系统感染组,重点对比氯的商数(CSF水平/血清水平,QCl),并同时对比白蛋白、葡萄糖的商数及其脑脊液细胞数等指标.结果 视神经脊髓炎患者QCl较对照组差异有统计学意义(P<0.01),与其他疾病比较差异有统计学意义(P<0.05),除QCl以外的其他指标与对照组差异无统计学意义(P>0.05).其他疾病的QCl与对照组差异无统计学意义(P>0.05).周围神经炎症组及中枢神经系统感染组QCl较对照组差异无统计学意义(P>0.05).中枢神经系统感染组脑脊液细胞数较对照组差异有统计学有意义(P<0.05),年龄、性别、QCl与NMO阳性有回归关系.NMO阳性与QCl有强烈的相关性,血及脑脊液的其他指标未显示出相关性.结论 氯失衡是视神经脊髓炎较为特异的表现,并可能反映了其病理机制.

Excessive oxidative stress induces significant injury and cytotoxicity to neuronal cells. The current study tested expression and the potential function of the circular RNA PRKCI (circPRKCI) in oxidative stress-injured neuronal cells. In cultured SH-SY5Y neuronal cells, hydrogen peroxide (H2O2) downregulated circPRKCI expression, causing accumulation of miR-545 and miR-589, but reduction of their target, the transcription factor E2F7. Importantly, ectopic overexpression of circPRKCI in SH-SY5Y cells significantly attenuated H2O2-induced cytotoxicity. Conversely, siRNA-mediated knockdown of circPRKCI induced SH-SY5Y cell death and apoptosis. Further studies demonstrated that H2O2-induced cytotoxicity in SH-SY5Y cells was inhibited by miR-545/589 inhibitors, but mimicked by miR-545/589 mimics. Importantly, CRISPR/Cas9-mediated knockout (KO) of E2F7 induced potent SH-SY5Y cell death and apoptosis. Furthermore, transfection of circPRKCI siRNA or miR-545/589 mimics were ineffective in E2F7 KO cells. In the primary human neurons, H2O2 stimulation similarly induced circPRKCI downregulation, miR-545/589 accumulation and E2F7 reduction. Moreover, H2O2-induced death and apoptosis in the primary neurons were significantly inhibited by circPRKCI overexpression or miR-545/589 inhibitors. Taken together, our results show that dysregulation of circPRKCI-miR-545/589-E2F7 axis mediated H2O2-induced neuronal cell injury. Targeting this novel cascade could be a fine strategy to protect neurons from oxidative stress.

Objective To study the relationship of serum uric acid (UA) and 25 hydroxyl (OH) vitamin D3 levels with Parkinson's disease (PD).Methods One hundred and six PD patients admitted to our hospital from August 2014 to August 2016 served as a PD group and 108 healthy persons undergoing physical examination served as a control group in this study.Their baseline data (including age,gender,serum UA and 25 OH vitamin D3 levels) were recorded and compared.Results The serum UA and 25 OH vitamin D3 levels were significantly lower in PD group than in control group (263.24±105.02 μmol/L vs 304.11±79.31 μmol/L,P=0.002;27.14±6.45 μg/L vs 36.96±11.62 μg/L,P=0.001).Logistic regression analysis showed that age and serum levels of UA and 25 OH vitamin D3 were closely related with PD (OR=1.024,95 ％ CI:1.001-1.081,P =0.028;OR=0.996,95％CI:0.992-1.000,P=0.001;OR=0.890,95％CI:0.852-0.929,P=0.000).Conclusion The serum UA and 25 OH vitamin D3 levels are significantly lower in PD patients,high UA and 25 OH vitamin D3 levels are thus a protective factor for PD.

患者女,64岁,因"突发不能言语5 h"于2012年4月18日入住南京医科大学附属淮安一院神经内科二病区。患者于当天睡醒后不能说话,但能听懂家人说话,肢体活动无异常,无意识改变及大小便障碍。患者有高血压病史5年。体检:血压145/100 mmHg(1 mmHg=0.133 kPa),呼吸18次/min,脉搏78次/min,体温36.8℃,意识清楚,反应灵敏,右利手(书写亦右手),左右定向正常,能理解他人言语及书面文字,能执行言语及书面指令,但不能用语言表达,只能

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation (AF) is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome (P < 0.001) and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were: heart failure (P = 0.045); high systolic pressure (P = 0.039); high blood glucose (P = 0.030); and a high National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001). Moreover, high systolic pressure at admission (P = 0.007), high blood glucose (P = 0.027), and a high NIHSS score (P < 0.001) were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score (P = 0.006) and warfarin taken within 48 h before stroke onset (P = 0.032) were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.

Objective To evaluate the effectiveness of simvastatin for patients with aneurysmal subaraehnoid hemorrhage.Methods Systematic literature retrieval was carried out to obtain randomized controlled trials of simvastatin in patients with aneurysrnal subarachnoid hemorrhage before October 2015.Methodological quality assessment and data collection were performed by two individual reviewers.A Meta-analysis was performed by RevMan 5.1 software.Results Five studies,a total of 951 patients,were included.Meta-analysis showed that simvastatin could not reduce cerebral vasospasm (RR=l.26,95％ confidence interval [95％CI]:0.9-1.75,P=0.170),delayed cerebral ischemia (RR=1.06,95％CI:0.88-1.26,P=0.000),poor outcome (RR=1.05,95％CI:0.90-1.23,P=0.540),or mortality (RR=0.95,95％CI:0.62-1.44,P=0.800).Conclusion Simvastatin could not prevent cerebral vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage,and could not improve the prognosis.

报道一例以发作性咽部异物感为表现且无明显ST–T改变的急性冠状动脉综合征, 患者发作期心电图无明显ST–T改变, 但冠状动脉造影显示2处重度狭窄病变, 经支架植入后患者症状缓解。

目的：分析闭锁综合征临床表现、影像学表现，以及治疗与转归，以提高对疾病认识，降低病死率。方法回顾性分析2007年1月-2013年5月我院诊治为闭锁综合征患者8例临床资料，其中男6例，女2例，中位年龄56．7岁。结果8例患者均表现为起病急，头晕、四肢无力、不能言语及不能吞咽。影像MR均示双侧桥脑基底部长T1、长T2异常信号；颅颈MRA示椎动脉颅内段、基底动脉明显变细或中断，双侧脑桥穿支消失。给予抗血小板聚集、稳定斑块、神经保护等治疗后好转7例，死亡1例。结论闭锁综合征是脑梗死中的严重类型，积极预防、治疗并发症是治疗本病关键，且加强护理及营养治疗可降低病死率，早期进行康复治疗，以提高生活质量。

Current treatments for ischemic stroke are limited, stem cell transplantation offers great potential as a therapeutic strategy. The present study was undertaken to determine whether human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) could improve brain injury after middle cerebral artery occlusion (MCAO) through modulating peripheral immunoinflammation. The study showed that neurological deficit was ameliorated and brain edema, infarct volume was significantly decreased from 72 h to 1 week post-MCAO with hUC-MSCs treatment via tail vein injection within 30 mins after stroke; hUC-MSCs attenuated the levels of inflammatory factors including IL-1, TNF-α, IL-23, IL-17 and IL-10 in peripheral blood serum and ischemia hemisphere after stroke; hUC-MSCs significantly decreased the level of Th17 cells at 24 h and increased the level of Tregs at 72 h post-MCAO in peripheral immune system; the level of TGF-β in blood serum was enhanced by hUC-MSCs. In conclusion, our findings suggested that hUC-MSCs had neuroprotection in MCAO mice by TGF-β modulating peripheral immune and hUC-MSCs may be as a potential therapy for ischemic stroke.