The Alberta Stroke Program Early CT Score (ASPECTS) is a simple, reliable and systematic approach for evaluating early ischemic changes in middle cerebral artery territory in patients with ischemic stroke. It can be used to conduct rapid semi-quantitative evaluation of ischemic lesions and help to determine the thrombolytic effect and long-term prognosis. The development of multimodal CT and MRI techniques have enriched the application scope of ASPECTS and have improved the validity and reliability of disease judgment. The development of the posterior circulation Acute Stroke Prognosis Early CT Score has made the fast scores extend to posterior circulation stroke, which is beneficial for all the patients with ischemic stroke to conduct early imaging scores. This article reviews the principle of the ASPECTS system, composition, its application in multimodal CT and MRI, as well as the posterior circulation scores.

After the characteristics and necessity of medical informatics experimental course were analyzed, the application of three-stage case teaching in medical informatics experimental course was described, and its steps and methods were explained with the teaching contents of hospital system module used in experimental course as an example. This teaching method can strengthen the knowledge the students have learned.

Objective To observe the expression of glial fibrillary acidic protein ( GFAP), and the pathological and ultrastructnral changes of astrocytes in the CA1 subfield of the hippocampus following global cerebral ischemia and reperfusion, and to explore the neuroprotective mechanism of mild hypothermia. Methods Global cerebral ischemia was established in rats by a modified version of Pulsinelli's method. Ninety-six rats were divided into three groups including a sham-operated group, a normothermic ischemic reperfusion (IR) group and a hypothermic ischemic reperfusion (HIR) group. Each group had four subgroups which were sacrificed for 6, 12 or 24 hours, or 4 days after reperfusion (for each subgroup n = 8 ). Hematoxylin-eosin (HE) staining was used to observe morphological changes in neurons in the CA1 subfield of the hippocampus. TUNEL methods were used to detect apoptosis among those neurons. Immunohistochemical staining was used to detect the expression of GFAP in the CA1 subfield and the mechanism of astrocyte pathology. GFAP TUNEL double-labeled immunohistochemistry was used with both the shamoperated and experimental groups. Electron microscopy was also used to evaluate morphological changes in astrocytes 24 hours and 4 days after ischemia and reperfusion. Results Compared with the sham-operated group, expression of GFAP immunoreactive positive cells increased gradually in the CA1 subfield of the IR group rats. Compared with the IR group, expression of GFAP immunoreactive positive cells was significantly lower in the HIR group at all time points. Microscopic observation at the 4th day showed that some astrocytes in the CA1 subfield had died through oncosis. Conclusions Mild hypothermia can significantly decrease the expression of GFAP immunoreactive positive cells and the number of apoptotic neurons in the CA1 subfield of the hippocampus, minimize cell oedema and provide protection for neurons. Oncosis kills astrocytes following global cerebral ischemia and reperfusion.

Objective To explore the role of medial temporal lobe (MTL) structure in generating P 300.Methods Event-related potentials (ERPs) were performed in the patient following left lateral anterior temporal lobectomy and 17 health subjects. Two models of vision and auditus were involved in the study.Results The latency, amplitude and sideway distribution of auditory and visual P 300 were in the normal range gained from the healthy controls.Conclusion MTL structure may be not important in generating scalp P 300.

Objective To study the effect of mild hypothermia on aquaporin 4 (AQP4) expressions and cerebral edema after intracerebral hemorrhage and the mechanisms of mild hypothermia on hemorrhagic brain edema. Methods The model of intracerebral hemorrhage (ICH) was established by infusing collagenase into right globus pallidus of the rat. The temperature was regulated by ice cubes and daylight lamp, which was modulated to an appropriate distance to the animals. Immunohistochemistry staining was used to detect the cerebral AQP4 expressions. Dynamic change of brain edema was observed through wet-dry weighing method. Results The brain water content (BWC) of injured side and level of AQP4 expression in perihematom tissue in ICH rats were obviously higher than those of the sham group (all P

Objective To investigate the relationship between the serum apolipoprotein B (ApoB)/ ApoA-Ⅰ ratio and intracranial artery stenosis in young patients with ischemic stroke.Methods Patients with ischemic stroke aged from 18 to 45 were enrolled in the study.Brain CT angiography was used to evaluate the degree of intracranial artery stenosis,and the concentrations of serum total cholesterol,triglyceride,highdensity lipoprotein cholesterol,low-density lipoprotein cholesterol,ApoA-Ⅰ,and ApoB were detected.The ratio of ApoB/ApoA-Ⅰ was calculated.The Demographic and clinical characteristics of the intracranial artery stenosis group and the non-intracranial artery stenosis group were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for intracranial artery stenosis in young patients with ischemic stroke.Results A total of 161 young patients with ischemic stroke were enrolled,including 89 in the intracranial artery stenosis group and 72 in the non-intracranial artery stenosis group.The constituent ratios of diabetes mellitus (20.2％ vs.6.9％;x2 =4.641,P =0.032),smoking (47.5％ vs.15.2％;x2 =15.121,P=0.001),hyperlipidermia (56.1％ vs.48.6％;x2 =4.197,P=0.040),as well as the radios in serum high-density lipoprotein cholesterol (1.29 ± 0.30 mmol/L vs.1.65 ± 0.34 mmol/L;t =7.131,P=0.002),ApoA-Ⅰ (1.49 ± 0.65 g/L vs.1.63 ± 0.23 g/L;t =2.751,P =0.001),ApoB (1.49 ± 0.65 g/L vs.1.63±0.23 g/L;t=2.751,P=0.001),and ApoB/ApoA-Ⅰ ratio (1.49±0.65 vs.1.63± 0.23;t =2.751,P=0.001) had significant differences between the two groups.Multivariate logistic regression analysis showed that diabetes (odds ratio [OR] 3.052,95％ confidence interval [CI] 1.186-7.856;P =0.021),smoking (OR 2.997,95％ Cl 1.456-6.172;P =0.003),hyperlipidemia (OR 4.745,95％ CI 2.108-10.668;P =0.001),ApoB (OR 4.861,95％ CI 3.029-7.802;P=0.001),and ApoB/ ApoA-Ⅰ ratio (OR 5.684,95％ CI 2.215-14.584;P=0.002) were the independent risk factors for intracranial artery stenosis in young patients with ischemic stroke,while HDL-C (OR 0.561,95％ CI 0.354-0.888;P=0.014) and ApoA-Ⅰ (OR 0.065,95％ CI 0.010-0.409;P=0.004) were the independent protective factors.After adjustment for hypertension,diabetes,smoking,hyperlipidemia,HDL-C,ApoA-Ⅰ,and ApoB,ApoB/ApoA-Ⅰ ratio was still an independent risk factor for intracranial artery stenosis in young patients with ischemic stroke (each increase of 1 standard deviation,OR 4.255,95％ CI 2.348-7.711;P=0.001).Conclusion ApoB/ApoA-Ⅰ ratio is an independent risk factor for intracranial artery stenosis in young patients with ischemic stroke.

Objective To investigate the value of modified NIHSS and MRI-PC-ASPECTS for the long-term prognosis in posterior circulation ischemic stroke. Methods Seventy eight patients with posterior circulation ischemic stroke were divided into two groups depended on MRS: good outcome group and bad outcome group. General information of patients was collected and vascular risk factors, NIHSS, MRI-PC-ASPECTS of the two groups were compared. Results The scores of admission NIHSS and highest NIHSS of bad outcome group were higher than that of good outcome group. The scores of MRI-PC-ASPECTS, T admission NIHSS (42-admission NIHSS) and T highest NIHSS of bad outcome group were lower than that of good outcome group (P<0.05). The areas under the ROC curves of MRI-PC-ASPECTS+T highest NIHSS, MRI-PC-ASPECTS, T highest NIHSS and T admission NIHSS were 0.907, 0.821, 0.870, 0.744, respectively (P<0.05). Conclusion NIHSS and MRI-PC-ASPECTS can predict the functional prognosis in patients with posterior circulation ischemic stroke.

BACKGROUND: Mild hypothermia (28-35 ℃) is becoming one of the promising methods in treating acute ischemic stroke. Hypothermia can effectively lessen brain edema, which is one of its neuroprotective roles.OBJECTIVE: To investigate the effect of mild hypothermia on brain water content and aquaporin-4 (AQP4) expression level following global cerebral ischemia-reperfusion injury in rats, so as to study the neuroprotective mechanisms of mild hypothermia.DESIGN: A randomized controlled trial.SETTING: Neurobiological Laboratory of Xuzhou Medical College.MATERIALS: 110 healthy male SD rats with body mass 250-300 g, provided by the Animal Center of Xuzhou Medical College, No. SYNK (Jiangsu) 2002-0079, were selected and randomly divided into 3 groups by SPSS 11.0software: ①sham-operated group (n=10);②normothermiagroup (n=50); ③mild hypothermia group (33 ℃, n=50). Normothermia group and mild hypothermia group were subdivided into five reperfusion subgroups for 6 hours, 1, 2, 3 and 7 days, respectively with 10 rats in each subgroup,in which 5 rats were used for measurement of brain water content, and others for HE staining and immunohistochemistry staining.METHODS: The models of global cerebral ischemia were established in the normothermia group and mild hypothermia group by four-vessel occlusion (4-VO) method with ischemia for 15 minutes as Pulsinelli described.The rats in the sham-operated group were only underwent the electrocauterization of bilateral vertebral arteries and the isolation of common carotid arteries except for occlusion of common carotid arteries. Twenty-four hours later, the rats were decapitated to take out the brains. The brains of rats in the normothermia group and mild hypothermia group were taken out to make sections for HE staining and immunohistochemistry staining, and the dynamic change of pathology of the brain tissue and AQP4 expression level were observed after reperfusion for 6 hours, 1, 2, 3 and 7 days, respectively. The brain wet-to-dry weight measurement was used to measure the brain water content of the rats at each time point of each group.MAIN OUTCOME MEASURES: ①The pathologic changes of brain tissues of rats in the normothermia group and mild hypothermia group. ②The brain water content and the AQP4 expression level of all rats at each time point.RESULTS: ①After 6 hours of reperfusion, brain edema appeared in the normothermia group including amplification of periyascular spaces and intercellular spaces, rarefaction of brain tissues, etc, which got worst after 2 days of reperfusion; the phenomenon of brain edema of the rats in the mild hypothermia group at each time point was relatively lighter than the normothermia group. ②Brain water content of the normothermia group and mild hypothermia group was increased after 6 hours of reperfusion and reached peak at the 2nd day; Although decreased at the 7th day, it was still higher than the sham-operated group. The brain water content of the mild hypothermia group at each time point was less than the normothermia group (values after 6 hour and 7 day, P ＜ 0.01, the rest groups P ＜ 0.05).③AQP4 expression level of the normothermia group and mild hypothermia group was increased after 6 hours of reperfusion and reached peak at the 2nd day. Although decreased at the 7th day, it was still higher than the sham-operated group.The AQP4 expression level of the mild hypothermia group at each time point was lower than the normothermia group (P ＜ 0.01).CONCLUSION:The change tendency of AQP4 level is parallel to that of brain water content after ischemia reperfusion, which indicates that the upregulation of AQP4 expression is one of molecular mechanisms for the for mation of ischemicbrain edema. Mild hypothermia can release ischemic brain edema by inhibiting AQP4 expression, which is one of its mechanisms.

Objective:To investigate the correlation between white matter hyperintensities (WMHs) and stroke etiology classification in patients with acute isolated penetrating artery territory infarction.Methods:Patients with first-ever acute isolated penetrating artery territory infarction admitted to the Department of Neurology, the Affiliated Hospital of Xuzhou Medical University from January 2017 to May 2020 were enrolled retrospectively. According to the Chinese Ischemic Stroke Subclassification (CISS) system, they were divided into large artery atherosclerosis (LAA) and perforating artery disease (PAD). According to the distribution of infarcts, they were divided into lenticulostriate artery (LSA) territory infarction and paramedian pontine artery (PPA) territory infarction. The demographics, vascular risk factors, baseline clinical data, WMHs location, and Fazekas Scale scores were documented. Multivariate logistic regression analysis was used to identify the independent influencing factors of stroke etiology classification. Results:A total of 440 patients with acute isolated penetrating artery territory infarction were enrolled, including 120 (27.3%) in the LAA group, and 320 (72.7%) in the PAD group; 213 (48.4%) with LSA territory infarction, and 227 (51.6%) with PPA territory infarction. The proportion of patients with total Fazekas score 3-6 and periventricular WMHs (PWMHs) score 2-3 in the PAD group was significantly higher than those in the LAA group (all P<0.05). In patients with LSA territory infarction, the proportion of the patients with hypertension, WMHs total Fazekas score 3-6 and PWMHs score 2-3 in PAD subgroup was significantly higher than those in the LAA subgroup, while the proportion of the patients with hyperlipidemia was significantly lower than that in LAA subgroup (all P<0.05). In patients with PPA territory infarction, the levels of low-density lipoprotein cholesterol and homocysteine in the PAD subgroup were significantly lower than those in the LAA subgroup. Multivariate logistic regression analysis showed that PWMHs score 2-3 was an independent correlation factor of PAD (odds ratio [ OR] 2.220, 95% confidence interval [ CI] 1.085-4.541; P=0.029). In patients with LSA territory infarction, hyperlipidemia was independently correlated with LAA ( OR 0.432, 95% CI 0.192-0.972; P=0.042), and PWMHs score 2-3 was independently correlated with PAD ( OR 3.846, 95% CI 1.193-12.397; P=0.024). In patients with PPA territory infarction, higher low-density lipoprotein cholesterol ( OR 0.660, 95% CI 0.494-0.883; P=0.005), homocysteine ( OR 0.958, 95% CI 0.930-0.987; P=0.005) and C-reactive protein ( OR 0.987, 95% CI 0.977-0.997; P=0.008) were independently correlated with LAA. Conclusions:WMHs are common in patients with acute isolated perforating territory infarction caused by LAA and PAD, and more severe PWMHs suggest that PAD is more likely to be the cause of the acute isolated perforating territory infarction, especially in patients with LSA territory infarction.

Objective To investigate the treatment of octanol on matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) protein expression,cerebral water content,infarction volume after ischemia-reperfusion in rats.Methods 150 SD rats were randomly divided into sham operated group (n=24),MCAO group (n=24),DMSO solvent control group (n=24) and octanol treatment group (n=24).A model of middle cerebral artery occlusion was induced by suture method.TTC stain was used to detect the infarction volume,dry-wet weight method to determine the brain water content.The expression of MMP-9 and TIMP-1 protein was detected by immunofiuorescence and Western blot.Results At 24 h of reperfusion after ischemia for 2 h,the octanol treatment group compared with MCAO group brain infarction volume obviously decreased(P＜0.05),water content significantly reduced ((78.16± 1.47) ％ vs (80.88±0.73) ％,P＜0.05),the number of MMP-9 positive cells obviously decreased((10.67±2.16) vs (29.00±3.40),P＜0.05),the expression of MMP-9 protein significantly reduced ((0.14±0.01) vs (0.21±0.02),P＜0.05)and the number of TIMP-1 positive cells significantly increased ((27.83 ±2.13) vs (5.67± 1.03),P＜0.05),the expression of TIMP-1 protein obviously increased((0.42±0.01) vs (0.28± 0.01),P＜0.05).The difference between MCAO group and DMSO solvent control group was not statistically significant(P ＜0.05).Conclusion Octanol may reduce brain edema,brain infarction volume.Up-regulation the expression of MMP-9 and down-regulation the expression of TIMP-1 may be one of the underlying mechanisms of the octanol neuroprotection.