OBJECTIVE:To investigate whether fluid-attenuated inversion recovery vascular hyperintensity/diffusion-weighted imaging (FVH/DWI) mismatch is associated with post-procedural recanalization in patients with acute anterior-circulation large-vessel occlusion (LVO) treated with mechanical thrombectomy. METHODS:This retrospective cohort study enrolled 120 consecutive patients with acute anterior-circulation LVO who underwent mechanical thrombectomy at our hospital from March 2021 to June 2024. Clinical characteristics, imaging variables, and treatment-workflow data were collected. Based on angiographic reperfusion, patients were divided into a good recanalization group (modified Thrombolysis in Cerebral Infarction [mTICI] grade 2b-3; n = 82) and a poor recanalization group (mTICI grade 0-2a; n = 38). According to 90-day functional outcome assessed by the modified Rankin Scale (mRS), patients were further classified as having a favorable outcome (mRS 0-2; n = 74) or an unfavorable outcome (mRS 3-6; n = 46). Between-group differences were examined, and multivariable logistic regression was used to identify independent predictors of poor recanalization and unfavorable outcome. RESULTS:The mean age in the good recanalization group was 66.81±9.10 years, which was significantly lower than that in the poor recanalization group (P < 0.05). FVH/DWI mismatch was more common in the good recanalization group (76.83%) than in the poor recanalization group (P < 0.05). Compared with patients with favorable outcomes, those with unfavorable outcomes were older (76.61±7.98 years), had higher admission National Institutes of Health Stroke Scale (NIHSS) scores (17.20±3.12), and exhibited a higher rate of poor recanalization (52.17%) (all P < 0.05), while the FVH/DWI mismatch rate was lower (28.26%, P < 0.05). Multivariable analysis showed that age (per 1-year increase: OR=1.089, 95%CI 1.032-1.149) and FVH/DWI mismatch (OR=0.523, 95%CI 0.312-0.876) were independent factors associated with poor recanalization (both P < 0.05). Age (per 1-year increase: OR=1.102, 95%CI 1.045-1.162), admission NIHSS score (per 1-point increase: OR=1.212, 95%CI 1.089-1.348), successful recanalization (OR=0.467, 95%CI 0.267-0.817), and FVH/DWI mismatch (OR=0.432, 95%CI 0.245-0.761) were independently associated with an unfavorable 90-day outcome (all P < 0.05). CONCLUSION:FVH/DWI mismatch is independently associated with both angiographic recanalization after mechanical thrombectomy and 90-day neurological outcomes in acute anterior-circulation LVO, and may serve as an imaging biomarker for predicting reperfusion success and clinical prognosis.

Objective:To investigate the effect of simvastatin on serum NSE,TNF-α levels and recurrence in patients with chronic subdural hematoma after drilling and drainage.Method:A total of 60 patients with chronic subdural hematoma admitted to the hospital from January to December 2022 were selected as the research objects.They were divided into control group(n=30)and observation group(n=30)by random number table method.The control group was given drilling and drainage,and the observation group was treated with simvastatin on the basis of the control group.The residual hematoma volume,neurological function[National Institutes of Health Stroke Scale(NIHSS)score,serum neuron-specific enolase(NSE)],inflammatory factor levels[serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]and postoperative hematoma recurrence were compared between the two groups.Results:The amount of residual hematoma in the two groups after 1 week,1 month and 2 months of treatment was less than that before treatment,and that in the observation group was less than that in the control group(P<0.05).The NIHSS score and serum NSE of the two groups were lower than those before treatment,and the observation group was lower than the control group(P<0.05).The serum levels of TNF-α and IL-6 in the two groups were lower than those before treatment,and those in the observation group were lower than the control group(P<0.05).The recurrence rate of hematoma in the observation group was lower than that in the control group(P<0.05).Conclusion:The application of simvastatin after drilling and drainage can improve the levels of serum NSE and TNF-α in patients with chronic subdural hematoma and reduce the risk of postoperative hematoma recurrence.

Abstract Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections. One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed. A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%). Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.

Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections. One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed. A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%). Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.

目的 探讨颈动脉支架成形术(CAS)治疗颈动脉狭窄的临床疗效及术后诱发症状性脑梗死的危险因素.方法 选取笔者所在医院2013年1月—2018年12月收治的272例颈动脉狭窄患者为研究对象进行回顾性分析,所有患者均行颈动脉支架成形术治疗,比较患者手术前后颈动脉狭窄程度及mRS评分,术后随访6个月,依据患者是否发生症状性脑梗死分为脑梗死组和正常组,采用多因素Logistic回归分析颈动脉狭窄患者颈动脉支架成形术后诱发症状性脑梗死的危险因素.结果 所有颈动脉狭窄患者术后颈动脉狭窄程度和mRS评分较术前显著下降(P<0.05);脑梗死组和正常组在年龄、脑梗死病史、合并冠心病及心功能不全、术中操作不当方面比较具有显著差异(P<0.05),脑梗死组的年龄大于正常组(P<0.05),脑梗死病史、合并冠心病及心功能不全、术中操作不当、有抗血小板药物抵抗占比明显高于正常组(P<0.05);多因素Logistic回归分析结果显示,年龄、脑梗死病史、术中操作不当、有抗血小板药物抵抗及心功能不全等均是颈动脉狭窄患者颈动脉支架成形术后诱发症状性脑梗死的危险因素.结论 颈动脉狭窄采用颈动脉支架成形术治疗疗效肯定,对于术后诱发症状性脑梗死的危险因素,临床应予以重视并积极防范.

目的 探讨促红细胞生成素(EPO)对慢性脑缺血大鼠脑组织凋亡与促凋亡蛋白表达水平的影响.方法 采用双侧颈总动脉永久性结扎法建立慢性脑缺血大鼠模型,随机分为对照组、假手术组、模型组、EPO组.比较各组大鼠的神经功能评分,Morris水迷宫观察大鼠记忆能力,比较各组大鼠脑组织中超氧化物歧化酶(SOD)活性、丙二醛(MDA)、过氧化氢酶(CAT)活性以及谷胱甘肽(GSH)水平,苏木精-伊红(HE)染色法观察脑组织细胞形态,末端脱氧核苷酸转移酶介导的dUTP缺口末端标记测定(TUNEL)检测脑组织细胞凋亡率,蛋白免疫印迹法(Western-blot)检测脑组织中凋亡相关蛋白表达水平.结果 与假手术组相比,模型组大鼠神经功能评分、细胞凋亡率、Caspase-3、Bax、Omi/HtrA2蛋白水平均升高(P<0.05),逃避潜伏期延长(P<0.05),穿越平台次数减少(P<0.05),SOD、CAT、GSH及Bcl-2蛋白水平降低(P<0.05),MDA含量升高(P<0.05);与模型组相比,EPO组神经功能评分、细胞凋亡率、MDA含量及Caspase-3、Bax、Omi/HtrA2蛋白水平降低(P<0.05),逃避潜伏期缩短(P<0.05),穿越平台次数增加(P<0.05),SOD、CAT、GSH活性及Bcl-2蛋白水平升高(P<0.05).结论 EPO对慢性脑缺血大鼠的脑组织损伤有保护作用,可能与其能够增强抗氧化能力、抑制脑组织细胞凋亡有关.

目的 探讨丹红注射液在老年短暂性脑缺血治疗中的应用效果.方法 选择郑州大学附属洛阳中心医院接诊的144例老年短暂性脑缺血患者,随机分为对照组和观察组,每组各72例.对照组进行常规治疗,观察组在对照组基础上加用丹红注射液静脉滴注治疗.评估两组临床疗效,并观察治疗前后两组脑血流动力学、神经功能指标的变化情况及其不良反应发生情况.结果 治疗后,观察组治疗总有效率、最小血流速度(Minimum Blood flow velocity,Vmin)和最大血流速度(Maximum Bloodflow velocity,Vmax)均高于对照组,差异无统计学意义血流阻力指数(Resistance Index,RI)低于对照组(P＜0.05);观察组S100B、MBP和NSE水平均低于对照组(P＜0.05).治疗期间,两组腹痛、局部皮疹、食欲不振、恶心和出血等不良反应总发生率对比,(P＞0.05).结论 丹红注射液治疗老年短暂性脑缺血疗效显著,安全性高,值得临床推广.

1 病例介绍 患者,男性,63岁,退休工人.主因"头晕3 d,加重伴呼吸心跳骤停20 min"于2017年3月8日中午12时入郑州大学附属洛阳中心医院急诊重症监护室(emergency intensive care unit,EICU).患者3 d前无明显诱因出现头晕,呈阵发性,无双眼黑蒙、视物旋转、视物不清及视物成双,无恶心、呕吐及肢体活动障碍,自测右上臂血压150/100 mm Hg,自服硝苯地平缓释片降压,剂量与时长不详.后患者头晕逐渐加重,至郑州大学附属洛阳中心医院心内科门诊.在门诊就诊过程中,患者突发言语不清伴昏迷、呕吐,转至急诊抢救室抢救过程中患者突然出现呼吸心跳骤停,紧急予以心肺复苏及气管插管、呼吸机辅助呼吸、静脉推注肾上腺素,20 min后患者自主心跳恢复,自主呼吸仍未恢复,给予转入EICU继续抢救治疗.在心率稳定、血压稳定及车载呼吸机辅助呼吸情况下,急查头胸部电子计算机断层扫描(computed tomography,CT)排除脑出血,考虑后循环急性梗死,于EICU继续治疗.发病以来,无四肢抽搐及大小便障碍.

目的 分析老年脑梗死合并高同型半胱氨酸(Hcy)血症应用叶酸治疗的临床疗效.方法 将我院收治的110例老年脑梗死合并高Hcy血症病例随机分为观察组(常规治疗+叶酸,n=55)与对照组(常规治疗,n=55),观察两组治疗前后血浆Hcy水平、MMSE评分、超敏CRP水平,随访一年统计两组不良预后情况.结果 两组治疗后Hcy水平较治疗前呈下降趋势,且观察组各时间段下降幅度大于对照组(P＜0.05);两组治疗48周后MMSE得分分别为(27.12±6.25)分和(23.01±5.11)分,差异具有统计学意义(P＜0.05),均较治疗前显著上升(P＜0.05);治疗48周后两组超敏CRP水平分别为(4.13±1.02) mg/L和(4.21±1.04) mg/L,差异无统计学意义(P＞0.05),均较治疗前显著下降(P＜0.05);随访一年,两组不良预后事件(死亡、脑梗死复发、脑出血、心肌梗死)发生率无显著性差异(P＞0.05).结论 叶酸治疗可有效降低老年脑梗死患者血浆Hcy水平,改善神经功能,但对超敏CRP水平与远期预后无显著影响,这可能与叶酸不能改善血中炎性指标水平相关.

目的:探究中西医结合治疗动脉硬化性脑梗死临床效果.方法:选取2016年7月至2017年7月郑州大学附属洛阳中心医院收治的动脉硬化性脑梗死患者100例进行研究,随机分为两组各50例,对照组接受常规西医治疗,观察组加用中医治疗,比较两组治疗效果.结果:观察组治疗有效率为86.0％,对照组为52.0％,差异具有统计学意义(P＜0.05).治疗后,观察组神经功能缺损评分量表(NIHSS)评分(9.7±2.1)显著低于对照组,日常生活能力评分(79.9±2.7)分、肢体功能评分(79.8±2.4)分显著高于对照组,差异具有统计学意义(P＜0.05).结论;中西医结合治疗动脉硬化性脑梗死效果显著.

目的:探讨兴奋性氨基酸谷氨酸与脑梗死出血转化关系的研究.方法:连续收集2011年7月至2016年8月郑州大学附属洛阳中心医院神经内科住院的脑梗死患者66例为病例组,根据头颅计算机断层扫描(CT)检查有无出血转化分为出血性转化(HT)组和非出血转化(non-HT)组;收集本院健康体检中心体检的健康人33例为对照组.均用高效液相色谱法检测患者血清谷氨酸水平.结果患者HT组血清谷氨酸水平(133.10±16.58)μmol·L-1明显高于non-HT组(110.15±19.73)μmol·L-1和对照组(91.08±8.76)μmol·L-1,差异具有统计学意义(P＜0.05).发病不同时间点,3d内、3～8d、8d及以后HT组血清谷氨酸水平均高于同时间点non-HT组,差异具有统计学意义(P＜0.05).HT组血清谷氨酸水平3d内即明显升高,8d后明显降低,差异有统计学意义(P＜0.05);出血转化组不同亚型出血性梗死(HI)组和脑血肿形成(PH)组血清谷氨酸水平差异无统计学意义(P＞0.05);血清谷氨酸水平预测出血转化的界值是125.02μmol·L-1,当谷氨酸≥125.02 μmol·L-1时,脑梗死出血转化的灵敏度为81.3％,特异度为76.1％,阳性预测值46.67％,阴性预测值96.36％.结论通过检测血清谷氨酸水平对脑梗死出血转化进行早期预测、预防,指导临床治疗、改善预后有重要意义.

To investigate the value of MoCA and auditory P300 as a cognitive assessment tool in chinese idiopathic inflammatory-demyelinating diseases (IIDDs), eighty three consecutive patients with IIDDs and thirteen sex- and age-matched healthy controls were recruited in the study. MMSE, MoCA and auditory P300 potential were administrated to each participant. The percentage of cognitive impairment in IIDDs patients was 24.1% by using MMSE, while the percentage was 81.9% by using MoCA. The majority of IIDDs participants had MMSE scores in the normal range. In contrast, few IIDDs participants scored in the normal range on the MoCA. Age, EDSS and depression correlated negatively with the total score of MoCA and MMSE. Years of education correlated positively with MoCA and MMSE. ADEM patients scored lower on all MoCA subtests. Prolonged latency P300 which negatively correlated with MoCA and reduced P300 amplitude which positively correlated with MoCA were detected in IIDDs patients. Thus MoCA is superior to the MMSE as a cognitive impairment scan tool and P300 is useful for detecting cogntive deficiency in chinese IIDDs.

目的 探讨超早期重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗80岁以上脑梗死患者疗效与安全性.方法回顾性分析我院2015年5月至2017年5月期间收治的38例接受超早期(<3小时)溶栓治疗的80岁以上急性脑梗死(ACI)患者(rt-PA组)和同期38例不接受溶栓治疗的80岁以上ACI患者(常规组)的临床资料,rt-PA组给予奥扎格雷钠针+超早期rt-PA方案治疗,常规组给予奥扎格雷钠针治疗,观察两组疗效及安全性.结果 两组患者治疗后24小时、7天及14天的NIHSS评分均显著高于治疗前(P<0.05);rt-PA组治疗后不同时间点的NIHSS评分改善效果均优于常规组(P<0.05);rt-PA组和常规组的临床总有效率分别为(71.05%和47.37%,P <0.05),不良反应发生率分别为(13.16%和5.26%,P<0.05),两组均无死亡例数发生.结论 超早期rt-PA静脉溶栓治疗80岁以上的ACI患者,可促进患者的缺损神经功能的恢复,临床治疗安全、有效,临床值得推荐.

1病例资料 患者 女,54岁,以"进行性四肢麻木无力、饮水呛咳3 d"为主诉于2016-08-15入我院神经内科.患者3 d前腹泻后出现全身酸痛,随之四肢麻木,远端为重,伴四肢无力,饮水呛咳、吞咽困难、颈部发硬、气短,至县医院住院治疗,查头颅CT未见明显异常,以"吉兰-巴雷综合征"为诊断,予以营养神经等对症治疗,患者自觉症状进行性加重,遂来我院.行磁共振示双侧延髓内侧急性梗死.既往高血压史8 a,冠心病史5 a,正规治疗.体格检查:T 36.2 ℃,P 82次/min,R 19次/min,Bp 154/96 mmHg,心肺腹无异常.神经系统检查:神志清楚,言语流利,双瞳孔等大等圆,直径约3.0 mm,对光反射灵敏,眼球运动自如,无震颤,余脑神经检查无异常,四肢肌力Ⅳ级,四肢肌张力正常,四肢腱反射(+++),病理征阳性,四肢深感觉减退,浅感觉正常,双侧指鼻试验正常,颈强直.

The pathophysiologic significance of the CD16+ monocyte subset has been demonstrated by its expansion in various autoimmune disorders. To date, the characteristics and roles of monocyte subpopulations in patients with neuromyelitis optica (NMO) have been poorly defined. We measured the percentages of the monocyte subsets in the peripheral blood, the levels of IL-1β and TNF-α mRNA in monocyte subsets and the concentrations of IL-1β and TNF-α in plasma and CSF from NMO patients. Our results showed that nonclassical monocytes were up-regulated in NMO patients and significantly elevated IL-1β and TNF-α expression was detected in it. In addition the increased nonclassical monocytes could be selectively suppressed by GC in patients with NMO.

Objective To observe the effects of interferon p-1b(IFNp-1b) on the quality of life(QOL) in patients with relapsing-remitting multiple sclerosis(MS) and to determine the influential factors for QOL.Methods Thirteen MS patients treated with IFNβ-1b were included in the study.The scores on Multiple Sclerosis Quality of Life-54(MSQOL-54),Expanded Disability Status Scale(EDSS),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD) were determined at baseline and 1,3,6,9,and 12 months after treatment.Results The MS patients treated with IFNp-1b showed no significant changes in QOL and EDSS,HAMA,and HAMD scores at 1,3,6,9,and 12 months after treatment(P 0.05 for all).Before treatment,patients' physical health,sexual function,and satisfaction with sexual life were negatively correlated with EDSS score(P0.05 for all);role limitation due to emotional problems and bodily pain were positively correlated with the course of disease(P 0.05 for both);physical health,emotional status,social function,sexual function,and satisfaction with sexual life were negatively correlated with HAMA score(P0.05 for all);cognitive function and stress were negatively correlated with HAMD score(P 0.05 for both).Role limitation due to physical problems,energy,health perception,overall QOL,and change in health showed no correlations with the course of disease and EDSS,HAMA and HAMD scores(P 0.05 for all),and no correlation was found between age and QOL(P 0.05).Conclusions IFN-β1b therapy may not have significant impact on QOL in MS patients in short time.QOL is correlated with EDSS score and anxiety and depressive symptoms.