Background: We aim to elucidate the contribution of early dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) to poor clinical outcomes in acute ischemic stroke patients after endovascular treatment (EVT). Methods: Acute ischemic stroke patients who underwent EVT were consecutively recruited from January 2019 to July 2022. Blood cell counts were sampled at admission and at following 24 hours after EVT. Clinical outcome measures included 3-month functional dependence (modified Rankin scale of 3-6), symptomatic intracranial hemorrhage, and mortality at 7 days and 30 days. Multinomial logistic regressions were used to evaluate the association of changes in the NLR with unfavorable outcomes. Results: A total of 590 patients were included in the final analysis. The multinomial logistic model indicated that the increasing changes in the NLR after EVT was an independent factor for poor outcomes; the adjusted odds ratio was 1.06 (95% confidence interval [CI] 1.03-1.10; P < 0.001) at poor 3-month functional outcomes, 1.07 (95% CI 1.04-1.10; P < 0.001) at symptomatic intracranial hemorrhage, 1.08 (95% CI 1.05-1.12; P < 0.001) at mortality at 7 days, and 1.04 (95% CI 1.02-1.07; P = 0.001) at mortality at 30 days. Areas under the curve of changes in NLR to discriminate adverse outcomes were 0.725, 0.687, 0.664, and 0.659, respectively. The optimal cutoff values were 5.77 (56.6% sensitivity, 81.0% specificity), 6.92 (60.0% sensitivity, 77.0% specificity), 8.64 (51.0% sensitivity, 82.0% specificity), and 8.64 (48.7% sensitivity, 83.0% specificity), respectively. Conclusions: The NLR in acute ischemic stroke patients increased remarkably independent of successful reperfusion. Elevated changes in the NLR might predict malignant hemorrhagic transformation, adverse functional outcomes, and short-term mortality.

OBJECTIVE: We aim to assess the incidence and impact outcomes in acute ischemic stroke (AIS) patients after METHODS: AIS patients who underwent EVT were consecutively recruited from January 2019 to July 2022. The primary outcome was a poor 3-month functional outcome, defined as a modified Rankin Scale score (mRS) of 3-6. hemorrhage and mortality at 7 and 30 days. RESULTS: A total of 306 (50.1%) patients experienced at least one of the MCs. The most common MC was pneumonia (42.6%). Multivariate analysis revealed that the setting of MCs was an independent predictor of a poor 3-month functional outcome (adjusted odds ratio [aOR] 4.40, 95% confidence interval [CI] 3.01-6.42; P < 0.001). In the subgroup analysis, this trend was significant, especially in the patients aged 60-75 years (aOR 5.87, 95% CI 3.45-9.97; P< 0.001) or with baseline NIHSS (<= 16) (aOR 5.05, 95% CI 2.84 9.01; P < 0.001). For individuals, cardiac events (aOR 8.56, 95% CI 4.05-18.09; P< 0.001), pneumonia (aOR 5.08, 95% CI 3.42-7.55; P < 0.001), and gastrointestinal bleeding (GIB) (aOR 6.12, 95% CI 3.40-11.01; P< 0.001) were independently associated with the poor 3 -month outcome. The setting of MCs was independently associated with symptomatic intracerebral hemorrhage (aOR 2.11, 95% CI 1.22-3.64; P = 0.007) and mortality at 30 days (aOR 2.11, 95% CI 1.22-3.64; P = 0.007) after adjustment, but not with mortality at 7 days. CONCLUSIONS: MCs in AIS patients after EVT have a high incidence, despite successful reperfusion, adversely affecting clinical outcomes and increasing short-term mortality.

Studies have indicated that reduced serum ALT levels are commonly linked to aging and are known to predict poor outcomes in many clinical conditions as potential frailty indicators. There are close connections between the brain and peripheral organs, particularly the liver. In patients with acute ischemic stroke (AIS), the interactive effects may change ALT levels, which in turn influence stroke outcomes. Whether ALT has potential neuroprotective effects or is an indicator of frailty in AIS patients remains unknown. This retrospective analysis examined 572 AIS patients in Beijing Luhe Hospital between August 2020 and June 2021. Patient demographics and laboratory results were assembled. The National Institutes of Health Stroke Scale (NIHSS) was used to analyze stroke severity. Modified Rankin Score (mRS) determined stroke outcome 3 months after AIS, with mRS <= 2 indicating a favorable outcome. Based on serum ALT measurements, patients were classified into three tertiles (T1-T3). Binary logistic regression analysis evaluated the correlation between ALT tertiles and AIS outcomes. Of the patients, 66 exhibited unfavorable outcomes. The median ALT level in this group was 13 (IQR: 11-18.25), which was lower than in the favorable outcomes cohort (16; IQR: 11-22). A decline in ALT corresponded with a higher incidence of poor outcomes at 3 months (T1, 15.5%; T2, 11.4%; T3, 7.0%; p = 0.03). The lowest ALT tertile (T1) was independently linked to an adverse 3-month outcome (OR 2.5095 %CI 1.24-5.07, p = 0.038) compared to the highest tertile. ALT levels demonstrated no correlation with age (T1, 62.59 +/- 12.64; T2, 64.01 +/- 11.47; T3, 65.12 +/- 11.27; p > 0.05). Regardless of age, lower serum ALT levels are independently associated with poorer outcomes in AIS patients. This finding suggests the potential pivotal part of the liver in AIS outcomes, highlighting the need to consider both neurological and liver functions post-stroke.

Objective To explore the application effect of the"organ system-based,disease-centric"multidisciplinary integrated teaching model in the teaching of cerebrovascular diseases for five-year clinical medicine undergraduate students. Methods Two classes of five-year clinical medicine undergraduate students of grade 2019 studying in Beijing Luhe Hospital,Capital Medical University from March to May 2023 were selected as the research objects.They were randomly divided into the experimental and control groups according to different teaching models.Both groups studied the chapter on cerebrovascular diseases.The control group was taught using the traditional teaching model,while the experimental group was taught using the"organ system-based,disease-centric"multidisciplinary integrated teaching model.The assessment indicators of teaching effect included students'test scores,students'evaluation of the classroom teaching quality,and the evaluation on the improvement of their ability.The teaching effect was evaluated after the completion of the teaching period. Results The theoretical assessment scores[(43.90±2.36)scores vs.(41.83±3.36)scores,P=0.008],practical assessment scores[(43.67±2.16)scores vs.(41.70±3.01)scores,P=0.005],and overall scores[(87.57±3.30)scores vs.(83.53±5.43)scores,P=0.001]of the experimental group were all higher than those of the control group.Additionally,the evaluation scores of the experimental group on the classroom teaching quality(including quality requirements and overall scores)and various dimensions of the improvement of their ability(such as classroom participation,cultivation of learning interest,expansion of clinical thinking,improvement of self-learning ability,and improvement of communication and teamwork skills)were higher than those of the control group.The differences were statistically significant(all P＜0.05). Conclusions The application of the"organ system-based,disease-centric"multidisciplinary integrated teaching model in the teaching of cerebrovascular diseases for five-year clinical medicine undergraduate students can improve their theoretical knowledge and clinical practice skills.

Objective This study assesses whether stress-induced hyperglycemia is a predictor of poor outcome at 3 months for patients with acute ischemic stroke (AIS) treated by endovascular treatment (EVT) and impacted by their previous blood glucose status. Methods This retrospective study collected data from 576 patients with AIS due to large vessel occlusion (LVO) treated by EVT from March 2019 to June 2022. The sample was composed of 230 and 346 patients with and without diabetes mellitus (DM), respectively, based on their premorbid diabetic status. Prognosis was assessed with modified Rankin Scale (mRS) at 3-month after AIS. Poor prognosis was defined as mRS>2. Stress-induced hyperglycemia was assessed by fasting glucose-to-glycated hemoglobin ratio (GAR). Each group was stratified into four groups by quartiles of GAR (Q1–Q4). Binary logistic regression analysis was used to identify relationship between different GAR quartiles and clinical outcome after EVT. Results In DM group, a poor prognosis was seen in 122 (53%) patients and GAR level was 1.27 ± 0.44. These variables were higher than non-DM group and the differences were statistically significant ( p < 0.05, respectively). Patients with severe stress-induced hyperglycemia demonstrated greater incidence of 3-month poor prognosis (DM: Q1, 39.7%; Q2, 45.6%; Q3, 58.6%; Q4, 68.4%; p = 0.009. Non-DM: Q1, 31%; Q2, 32.6%; Q3, 42.5%; Q4, 64%; p < 0.001). However, the highest quartile of GAR was independently associated with poor prognosis at 3 months (OR 3.39, 95% CI 1.66–6.96, p = 0.001), compared to the lowest quartile in non-DM patients after logistic regression. This association was not observed from DM patients. Conclusion The outcome of patients with acute LVO stroke treated with EVT appears to be influenced by premorbid diabetes status. However, the poor prognosis at 3-month in patients with DM is not independently correlated with stress-induced hyperglycemia. This could be due to the long-term damage of persistent hyperglycemia and diabetic patients’ adaptive response to stress following acute ischemic damage to the brain.

Abstract Background We aimed to investigate the risk factors of early neurological deterioration (END) after intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and the relationship between END and poor 3-month functional outcomes. Methods Patients who accepted intravenous recombinant rt-PA were enrolled continuously. END was defined as an increase in National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours after intravenous thrombolysis. The modified Rankin Scale (mRS) score was recorded to evaluate the functional outcome of stroke, and the poor 3-month prognosis was defined as an mRS score ≥ of 3. Univariate and multivariate analyses were used to analyze the risk factors of END. The relation between END and 3-month functional outcome was analyzed by multivariate logistic regression analysis. Results A total of 1107 patients (mean age, 63.42 ± 11.33 years; 673 males) were included in the final analysis, and 81(7.32%) patients had END. In multivariate analysis, the serum glucose level was significantly associated with END; the odds ratio was 1.10 (95% CI 1.03 to 1.18, p = 0.004). The multivariate logistic analysis showed END has a notable association with the poor 3-month functional recovery even after adjusting for confounding factors; the adjusted OR was 8.25 (95% CI 3.77 to 18.03, p < 0.0001). Conclusions The initial serum glucose level might be an independent risk factor of END, and END might predict a poor 3-month prognosis.

Abstract Background Intraplaque hemorrhage (IPH) is a hallmark of carotid plaque vulnerability. We aim to investigate the association between IPH and recurrent ipsilateral ischemic stroke. Methods Patients with a recent stroke or transient ischemic attack (TIA) were prospectively recruited and underwent an ultrasonographic examination and carotid HR VWMRI on the side consistent with symptoms. Carotid plaque was defined as carotid intima-media-thickness (IMT) by ultrasound≥1.5 mm. IPH was determined that the ratio of the plaque signal intensity relative to that of adjacent muscle was > 1.5. All enrolled patients were clinically followed until an ipsilateral ischemic stroke, TIA, carotid endarterectomy (CEA)/carotid artery stenting (CAS), or death within 12 months. Univariate analysis was used to analyze the correlation between clinical characteristics and IPH. Kaplan-Meier survival analysis and a log-rank test were used to compare recurrence-free survival time between the IPH and non-IPH groups. Cox regression models evaluated IPH as the predictor of ipsilateral stroke recurrence. Results A total of 171 patients (mean age, 60.13 ± 10.04 years; 118 males) were included in the final analysis. Thirty-two patients (18.7%) showed carotid IPH. During the follow-up, patients with carotid IPH suffered 60.9% (14 of 23) of recurrent ipsilateral strokes and 60.0% (3 of 5) TIA. Multivariate Cox regression analysis proved IPH as a strong predictor of ipsilateral stroke; the adjusted hazard ratio (HR) was 6.64 (95% confidence interval [CI], 2.84–15.54, P < 0.001). Meanwhile, Cox regression analysis also proved that IPH could predict recurrent ischemic events; the adjusted HR was 8.08 (95% CI, 3.65–17.91, P < 0.001). Conclusions Carotid intraplaque hemorrhage is strongly associated with recurrent ischemic events and could predict recurrent ipsilateral stroke.

目的 探索情景式案例分析教学法(case-based learning,CBL)联合标准化病人在神经内科住院医师医患沟通技能教学培训中的运用效果.方法 选取2020年9-12月在首都医科大学附属北京潞河医院神经内科轮转的住院医师为研究对象,随机分为实验组(20名)及对照组(20名).实验组采用情景式CBL并应用标准化病人进行医患沟通能力教学,对照组采用以授课为导向的教学法进行医患沟通能力教学,教学时长共4课时,每周1次,每次2课时.教学结束后,应用SEGUE量表对两组学生进行医患沟通能力评价并记录得分情况,对两组得分进行统计学分析.结果 实验组SEGUE量表总分(18.52±3.68分vs?11.38±2.52分)及各维度得分均高于对照组,差异具有统计学意义(均P<0.01).结论 情景式CBL联合标准化病人可用于住院医师医患沟通技能的教学,而且教学效果佳.

Background and Purpose: Carotid plaque hemorrhage (IPH) is a critical plaque vulnerable feature. We aim to elucidate the association between symptomatic extracranial carotid atherosclerotic IPH and poor 3-month functional outcome after acute ischemic stroke by high-resolution vessel wall MRI (HRVMRI). Methods: We prospectively studied consecutive patients with a recent stroke or transient ischemic attack (TIA) of carotid atherosclerotic origin. All patients underwent a High-Resolution (HR) VWMRI scan of ipsilateral extracranial carotid within 1 week after admission. The patients recruited were interviewed by telephone after 3 months after stroke onset. The primary outcome was a 3-month functional prognosis of stroke, expressed as a modified Rankin Scale (mRS) score. A poor prognosis was defined as a 3-month modified Rankin Scale (mRS) score ≥ of 3. Univariate analysis was used to analyze the correlation between risk factors and IPH. The relation between IPH and 3-month functional outcome was analyzed by Logistic regression analysis. Results: A total of 156 patients (mean age, 61.18 ± 10.12 years; 108 males) were included in the final analysis. There were significant differences in the age, gender, smoking history, national institutes of health stroke scale (NIHSS) on admission, and diastolic blood pressure (DBP) on admission between the IPH group and the non-IPH group (all p < 0.05). During the follow-up, 32 patients (20.5%) had a poor functional outcome. According to the prognosis analysis of poor functional recovery, there was a significant difference between the two groups [36.7 vs. 16.7%; unadjusted odds ratio (OR), 2.32, 95% confidence interval (CI), 1.12–4.81, p = 0.024). Even after adjusting for confounding factors [such as age, gender, smoking history, National Institutes of Health Stroke Scale (NIHSS) on admission, DBP on admission, stenosis rate of carotid artery (CA), calcification, loose matrix, lipo-rich necrotic core (LRNC), and statins accepted at 3 months], IPH was still a strong predictor of poor 3-month outcome, and the adjusted OR was 3.66 (95% CI 1.68–7.94, p = 0.001). Conclusions: Extracranial carotid IPH is significantly associated with poor 3-month outcome after acute ischemic stroke and can predict the poor 3-month functional prognosis.

In the present study, the aim was to investigate the function of microRNA‑323 (miR‑323) in cerebral infarction and its underlying mechanism. A rat model of cerebral infarction was established and hippocampal tissues were analyzed. In addition, to further understand the role of miR‑323, PC12 cells were transfected with miR‑323 mimics or inhibitors and subjected to hypoxia to model cerebral infarction. Reverse transcription‑quantitative polymerase chain reaction was used to measure the expression of miR‑323. A luciferase reporter assay was conducted to analyze miR‑323 target sites the partial sequence of the 3'‑untranslated region of SMAD3 mRNA in vitro. Western blot analysis was also used to analyze transforming growth factor‑β1 (TGF‑β1) and SMAD3 protein expression levels. It was observed that miR‑323 expression was significantly upregulated in rats with cerebral infarction compared with rats in the sham‑control group. In addition, overexpression of miR‑323 induced nerve cell toxicity and reduced nerve cell growth in an in vitro model of cerebral infarction, whereas downregulation of miR‑323 caused the opposite effects on nerve cell toxicity and growth in this model. In addition, overexpression of miR‑323 directly targeted and suppressed SMAD3 expression in the in vitro model of cerebral infarction, while inhibition of miR‑323 induced SMAD3 expression. The use of a SMAD3 inhibitor suppressed the effect of anti‑miR‑323 on nerve cell toxicity in the in vitro model of cerebral infarction. Collectively, these findings suggested that miR‑323 suppresses nerve cell apoptosis in cerebral infarction via the TGF‑β1/SMAD3 signaling pathway.

Objective To explore the values of intravenous thrombolytic therapy in patients with acute ischemic stroke and the factors of the clinical prognosis.Methods One hundred and twenty patients with acute ischemic stroke in our hospital treated from September 2013 to February 2016 were selected and randomly divided into two groups:control group (n=60)treated with routine treatment,and treatment group(n=60)treated with intravenous injection of recombinant human tissue plasminogen fibrinolytic enzyme activator (rt-PA).The short-term and the long-term efficacy were observed.The risk factors were investigated by multivariate logistic re-gression analysis.Results After 30 days of treatment,the total short-term clinical effective rate after treatment was significantly higher in treatment group than that in control group(85.0% vs 68.3%,P<0.05).After 90 days of treatment,the long-term prognosis effective rate was significantly higher in treatment group than that in control group (75.0% vs 56.7%,P<0.05).The incidences of symptomatic cerebral hemorrhage and non symptomatic cerebral hemorrhage were 0.0%,3.3% in treatment group,and 6.7%,13.3% in control group,which was lower in treatment group than that in control group (P<0.05).Logistic regression analysis showed that age,National Institutes of Health Stroke Scale(NIHSS)score,diabetes mellitus,onset to treatment time were the prognostic risk fac-tors of intravenous thrombolysis in patients with acute ischemic stroke(P<0.05).Conclusion Acute ischemic stroke patients by in-travenous thrombolysis with rt-PA has good short-term and long-term efficacy.The age,admission NIHSS score,diabetes,onset to treatment time are the risk factors that affect the prognosis of thrombolytic therapy.

目的 探讨老年高血压病人口服降压药物对自由基代谢的影响与临床意义.方法 选择2014年2月-2016年9月在我院诊治的老年高血压病人160例作为研究对象,根据服药情况分为两组,入院前6个月未口服降压药的40例病人为对照组,口服降压药的120例病人为观察组.收集两组病人一般资料,检测血浆丙二醛(MDA)、脂质过氧化物(LPO)、超氧化物歧化酶(SOD),并进行相关性与危险因素分析.结果 观察组与对照组性别、年龄、体重指数、病程、腰围、总胆固醇(TC)、空腹血糖、三酰甘油(TG)比较差异无统计学意义(P＞0.05).观察组血浆SOD、MDA与LPO均明显高于对照组(P＜0.05).直线相关分析显示:观察组LPO、MDA、SOD水平与体重指数、收缩压、舒张压、空腹血糖呈正相关(P＜0.05).二元Logistic回归模型分析显示:观察组病人的收缩压、舒张压、空腹血糖为影响LPO的危险因素(P＜0.05);舒张压、空腹血糖为影响MDA的危险因素(P＜0.05);体重指数、空腹血糖为影响SOD的危险因素(P＜0.05).结论 老年高血压病人口服降压药不影响机体糖脂代谢,可有效地清除自由基,增强自由基代谢作用,临床上应根据病人自身情况合理选择降压药物.

Objective To investigate and evaluate the intravenous thrombolytic therapeutic recanalization of acute ischemic stroke patients with different large vessel occlusion in the anterior circulation, and the association between thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades and the outcome of ischemic stroke patients. Methods Patients diagnosed as acute ischemic stroke with a proximal vessel occlusion in the anterior circulation were selected as subjects. Those who were able to receive intravenous thrombolysis were given alteplase intravenous thrombolysis therapy. Thrombolysis in brain ischemia (TIBI) flow grades of large vessels before and 24 h after thrombolysis were assessed by transcranial Doppler (TCD). National Institutes of Health Stroke Scale (NIHSS) was used to record the neurologic impairment of patients. The modified Rankin Scale (mRS) was used at 3 months follow-up to analyze the recanalization before and after thrombolysis of proximal vessel occlusion in the Anterior Circulation and 3-months prognosis. Results A total of 46 patients were included. There were 19 cases of internal carotid artery (ICA) occlusion and 27 cases of middle cerebral artery (MCA) occlusion. The 24 h TCD monitored TIBI before and after thrombolysis showed that the rates of recanalization of ICA occlusion group and MCA occlusion group were 5.26% and 55.56%, respectively. For the functional independence outcome at 90 days, MCA occlusion group was significantly better than ICA occlusion group. For excellent recovery outcome at 90 days, MCA occlusion group was also significantly better than ICA occlusion group. For mortality, MCA group was significantly lower than ICA group. There were no significant differences between MCA group and ICA group in the symptomatic intracranial hemorrhage. Conclusion The intravenous thrombolytic therapeutic recanalization of the acute ischemic stroke patients with large vessel occlusion in the anterior circulation was effective, in particular to patients with MCA occlusion. The changes of TIBI grade system blood flow grades before and after thrombolysis could reflect the status of recanalization, which is helpful in judging the clinical prognosis of patients.

Objective To investigate the correlation factors for the prognosis in patients with posterior circulation infarction after intravenous thrombolysis with alteplase. <br> Methods The patients with posterior circulation infarction at 0-4.5 h after onset were selected and divided into alteplase intravenous thrombolysis group and non-intravenous thrombolysis group. General demographic data and basic information were recorded and evaluated with National Institutes of Health Stroke Scale (NIHSS) score. The time from onset to thrombolysis and NIHSS score at 24 h after thrombolysis were also recorded. The outcome indexes included 90-day functional outcomes (by modiifed Rankin Scale, mRS), symptomatic intracranial hemorrhage (SICH) and mortality. Logistic regression analysis was used to evaluate the indexes in predicting the 3-month outcome of patients. <br> Results A total of 116 patients with acute posterior circulation infarction were included. Among which, 84 (72.4%) were in intravenous thrombolysis group and 32 were in non-thrombolysis group. There were 53 cases (63.1%) in good prognosis group and 31 cases (36.9%) in poor prognosis group.Whereby, there were 6 cases of hemorrhage transformation (7.1%), and 3 cases of symptomatic intracranial hemorrhage (3.5%). In non-intravenous thrombolysis group, there were 12 cases of good prognosis at month 3 (37.5%) and 20 cases of poor prognosis (62.5%). Whereby, there were 5 cases of hemorrhage transformation (15.6%), 3 cases of symptomatic intracranial hemorrhage (9.3%) and 3 cases of deaths (9.3%). Logistic regression analysis showed that the age, thrombolysis time and the NIHSS score, hypertension were the associated with the poor prognosis of posterior circulation infarction patients after intravenous thrombolysis at 90 d (P<0.05). Compared with non-intravenous thrombolysis group, patients in intravenous thrombolysis group had a signiifcant improvement of favorable outcome and lower mortality, however, there was no signiifcant difference in morbidity of SICH between the two groups. <br> Conclusion Early intravenous thrombolysis has certain significant influence on improving the short-term prognosis in patients with posterior circulation infarction.

Objective To explore the effect of case-based learning (CBL) combined classical learning methods on training of 5-years-clinical interns in cerebrovascular disease. Methods There were 60 cases of 5-years-clinical interns whom were randomized into CBL combined classical methods group and classical methods group with the ratio of 1:1 during September 2015 and September 2016 in Beijing Luhe Hospital of the Capital Medical University. CBL combined classical methods and classical methods were applied separately in teaching of patients with acute cerebrovascular diseases. The effects of these teaching methods were evaluated by questionnaire survey, basic theoretical knowledge examination, practice examination including physical examination and case analysis among these students. Results There were no signiifcant difference in basic theory knowledge examination. The result of physical examination and case analysis of CBL combined classical teaching method were much higher than that of the control group [(89.10±2.99)vs (86.60±3.41),P=0.015]. Compared with the classical teaching method, CBL combined classical methods could signiifcantly improve interns’ abilities in initiative learning ability, analytical skill, problem solving, expression and&nbsp;communication, expansion of professional knowledge and team cooperation. Conclusion CBL combined classical methods can signiifcantly improve the ability of interns in mastering the knowledge of cerebrovascular disease.

In the present study, the expression of microRNA (miR)-132 and the mechanism by which it modifies angiogenesis in patients with ischemic cerebrovascular disease (ICD) was investigated. RNA isolation and reverse transcription-quantitative polymerase chain reaction were used to measure miR-132 expression in patients with ICD. Inflammatory factors were measured using ELISA kits and western blotting measured B-cell lymphoma-2 (Bcl-2)-associated X/Bcl-2 ratio (Bax/Bcl-2 ratio), nuclear factor (NF)-kappa B p65, matrix metalloproteinase-9 (MMP-9), vascular cell adhesion molecule-1 (VCAM-1) and protein expression of inducible nitric oxide synthase (iNOS), and vascular endothelial growth factor (VEGF) protein expression. miR-132 expression in patients with ICD was lower compared with healthy volunteers. PC12 cells were used to create an oxygen glucose deprivation (OGD) model. miR-132 overexpression in an in vitro model was able to reduce tumor necrosis factor-a, interleukin (IL)-1 beta, IL-6, IL-8, cyclooxygenase-2, caspase-3 and caspase-9 levels, suppress Bax/Bcl-2 ratio, NF-kappa B p65, MMP-9, VCAM-1, iNOS, VEGF protein expression. The results suggested that miR-132 may modify angiogenesis in patients with ICD by suppressing the NF-kappa B pathway and promoting the VEGF pathway, and may develop into a therapy for ICD in future research.

Objective:To investigate the effects of intravenous thrombolysis in patients with acute ischemic stroke in different time windows.Methods:Used the prospective method,98 acute ischemic stroke patients with atrial fibrillation were treated from 2014 August to May 2016 in our hospital for diagnosis and treatment were selected that included before stroke diagnosed atrial dithering were the chronic atrial fibrillation group (n=50),and after admission diagnosis of atrial fibrillation were the new atrial fibrillation group (n=48);Two groups were given recombinant tissue type plasminogen activator (rt-PA)thrombolytic therapy,recorded the outcome in the two groups.Results:There were no significant differences in gender,age,time window,disease,blood glucose and triglyceride levels compared between the two groups (P＞0.05).The efficiency in the chronic atrial fibrillation group and the new atrial fibrillation groupwere 94.0％ and 95.8％ that compared between the two groups were not significant difference (P＞0.05).The mRS scores in the chronic atrial fibrillation group and new atrial fibrillation group after treatment were 6.22± 1.83 points and 6.29± 1.45 points,were significantly lower than the treatment of 924± 1.31 points and 9.19± 1.52 points (P＜0.05) that compared between the groups were not significant difference (P＞0.05).The symptomatic intracerebral hemorrhage and non symptomatic cerebral hemorrhage rates in the chronic atrial fibrillation group were 4.0％ and 2.0％ respectively that were significantly lower than 14.6％ and 12.5％ in the new atrial fibrillation group(P＜0.05).Conclusion:Within 4.5 hours of onset intravenous thrombolysis for acute ischemic stroke is safe and effective,and the new atrial fibrillation does not affect neurologic outcome after intravenous thrombolysis,but will increase the rates of symptomatic cerebral hemorrhage and non symptomatic cerebral hemorrhage that need strengthen the prevention and management.

(上接第10期第842页) 7 评估吞咽困难 作为卒中患者初始评估的一部分,在卒中患者开始经口摄入药物、液体或食物前,应使用简单、有效及可行的床边检查工具筛查有吞咽困难的患者(B级证据)(表6).

Some cardiovascular manifestations could be found in acute stroke patiens, which is called cerebrocardiac syndrome(CCS).We could also observe some abnormalities in Electrocardiography(ECG) and creatine kinase-MB elevation. However, such abnormalities will be gradually recovering with the improvement of stroke.

美国心脏协会(AHA)的宗旨是:建立更健康的生活方式,远离心血管疾病及卒中。此一系列文章分2部分,本文是其中的第1部分,对医疗人员在实践中应用循证医学的工作进行了概述。AHA支持并促进循证医学的应用,此方面的工作范围广泛,主要包括以下几方面:(1)鼎力支持科学研究,资助年轻的医疗专业人员及研究人员;(2)传播科学信息;(3)发布基于证据的指南及声明;(4)建立及推动运行指标/措施的应用;(5)开发临床决策支持及质量改善工具;(6)开展针对性的活动。以上均有助于改善患者医疗保健。本文也论述了新技术的需求,AHA缩短医疗工作差距的策略。此系列文章的第2篇将很快会发表,将对AHA的工作进行检验,检测其是否能够保证享受医疗保健的患者更加关注自己的健康及医疗问题。