Objective:To investigate the protection of acupuncture on damaged myelin sheath from the poinr of view of neurological functional recovery and morphological changes of the myelin sheath.Methods:Eighty-nine adult male Sprague-Dawley rats were randomly allocated to normal (n=5),sham-operation (n=21),model (n=21),early acupuncture (n=21) and late acupancture (n=21) groups.A model of middle cerebral artery occlusion was induced by the intraluminal filament method.Acupuncture was performed at different time points after ischemia.Neurological function and morphological changes of the myelin sheath of ischemic focus were observed by using the methods of neurological deficit scores and Pal-Weigert's myelin staining.Results:Neurological deficit scores at 2.5 hours after the procedure in the model group increased significantly (P＜0.05).qhe scores decreased somewhat as the time elapsed.The internal capsule had obvious demyelination and recovered slowly.Neurological deficit scores in rats at each time point decreased faster in the acupuncture group compared with the model group,and they decreased significantly at day 3 (P＜0.05);the extent of demyelination was significantly alleviated.Neurological deficit scores decreased faster in the early acupuncture group compared with the late acupuncture group (P＜0.05);and demyelination in the early acupuncture group seemed milder at day one.Conclusions:Early acupuncture is beneficial to remyelination and neurological functional recovery after cerebral ischemia.

Objective To study the changes of AT-III and PAI-1 in the blood of patients with sudden sensorineural hearing loss(SSHL) and investigate the relationship between their levels and the disease.Methods The levels of AT-III and PAI-1 in the blood of 44 patients with SSHL and 30 healthy volunteers were detected using chromogentic substrate method.Results The changes of AT-III and PAI-1 in the blood of patients with SSHL were correlated with the process of the disease.There was significant difference between the levels of AT-III and PAI-1 in the blood of patients within 3 days and that of patients beyond 1 week(P

Objective: To investigate the impact of stroke unit (SU) on the compliance of secondary prevention in patients with stroke at 12 months after stroke. Methods: Research subjects were stroke patients who were treated in SU (n = 500) and in general ward (GW) (n =445) using a design of retrospective study. The patients in the SU group were followed up by hospital, telephone and home interviews for 12 months, and the patients in the GW group were followed up by telephone interview for 12 months. The main outcome measures were the rate of using antithrombotics, the rate of smoking cessation, and the rates of awareness of early stroke symptom and stroke risk factors of patients. Results: he rate of using antithrombotics was 92.76% in the SU group, and it was significantly higher than 51.49% in the GW group (P ＜0.01); the rate of smoking cessation, and the rates of awareness of early stroke symptom and stroke risk factors of patients were 82.33%, 91.04%, and 94.03% respectively in the SU group, and they were significantly higher than 54.75%, 6.53%, and 70.37% in the GW group(P all ＜ 0.01 ). Conclusions: SU attaches importance to the secondary stroke prevention and emphasizes standardized treatment, and the compliance of the secondary stroke prevention in patient with stroke is improved significantly.

Objective To evaluate the value of magnetic resonance black-blood thrombus imaging (BTI) of the stage of disease in intracranial venous and sinus thrombosis(CVT).Methods From June 2015 to October 2016,37 patients with CVT diagnosed with routine imaging examinations in Beijing Xuanwu Hospital,Capital Medical University were enrolled prospectively,and they also underwent BTI examination.The patients were randomly divided into either a acute group (≤14 d,n=23) or a chronic group (>15 d,n=14) according to the time from the onset of symptoms to BTI.Signal to noise ratio(SNR) and contrast to noise ratio(CNR) difference between acute and chronic CVT groups were compared.The magnetic resonance venography (MRV) examination was used as a reference to calculate the accuracy of BTI on per-segment level.Results (1) The SNR and CNR of thrombosis in the acute group and chronic group were 206±97 and 94±41,201±96 and 86±40,respectively.There was significant difference between two groups (t=4.9 and 5.0 respectively;all P<0.01).(2) In 37 patients with CVT,the thrombi in 159 cerebral veins and venous sinus segments were detected with MRV.BTI identified the thrombi accurately in 152 vascular segments,and the thrombi in 352 vascular segments were eliminated.The diagnostic sensitivity and specificity were 95.6% (152/159) and 98.0% (352/359) respectively.Conclusion Achieving direct angiography of cerebral venous thrombosis,BTI technique can accurately differentiate acute or chronic thrombus.It has higher accuracy.

Objectives To analyze the links of the in-hospital delay by investigating the status of in-hospital delay in patients with acute ischemic stroke in a tertiary hospital in Beijing and to shorten the in-hospital delay by intervention. Methods From August 2016 to July 2017,98 patients with ischemic stroke treated by endovascular therapy and met the inclusion criteria in the Xuanwu Hospital, Capital Medical University were collected prospectively. According to before and after intervention,the patients were divided into before intervention (from August 2016 to January 2017,n=44) and after intervention (from February to July 2017,n=54). The questionnaire was designed by the authors. The survey included the basic information of patients,clinical features,and key time point of hospital treatment process. The delay links were analyzed through the value flow diagram,and the targeted interventions were given to shorten the time of in-hospital delay. Results (1) The main links of the presence of in-hospital delay are physician evaluation,disease notification, signing of the informed consent, and preoperative preparation. ( 2 ) The intervention effect was significant. The median total nosocomial process time before and after intervention were 138. 0 (118. 5,188. 8) min and 93. 5 (80. 0,114. 0) min respectively. There was significant difference(Z=5. 929,P<0. 01). Compared with before intervention,the time of examination,imaging examination, preoperative preparation and femoral artery puncture were shorter ( 16. 5 [ 10. 0, 27. 2 ] min vs. 35. 0 [18. 2,51. 8] min;10. 0 [9. 0,11. 0] min vs. 12. 5 [10. 0,23. 8] min;48. 0 [30. 0,67. 5] min vs. 60. 5 [45. 5,90. 8] min;15. 0 [12. 0,18. 2] min vs. 21. 0 [13. 0,33. 0] min,Z=4. 150,3. 685,2. 801,and 2. 852,respectively;all P<0. 05). Conclusions The nosocomial process of endovascular treatment in patients with ischemic stroke is seriously delayed. Through continuous improvement of the nosocomial process,setting up a parallel treatment modality,strengthening the stroke team training,and improving the docking measures of the information system platform can significantly shorten the in-hospital time.

Objective To investigate the predictive effect of hypersensitive C-reactive protein(Hs-CRP)and neutrophil and lymphocyte ratio(NLR)on the prognosis in young patients with ischemic stroke. Methods From October 2016 to October 2017,110 consecutive young patients(18-45 years old)with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. According to the modified Rankin scale(mRS)scores,they were divided into either a good prognosis group(mRS≤2;n=90)or a poor prognosis group(mRS>2;n=20).The patients completed the related examinations within 24 h after admission,including blood routine and Hs-CRP.The NLR value was calculated according to the count of neutrophils and lymphocyte in blood routine.The age,gender,underlying diseases(hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia),histories of smoking and drinking,National Institutes of Health stroke scale(NIHSS)scores of both groups of patients were documented.The poor prognosis after discharge at 90 d was used as the dependent variable,the independent variables of P<0.05 in univariate analysis were further performed with multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of the independent risk factors. The Youden index was calculated and the optimal cut-off value was determined. Results (1)Compared with the good prognosis group,the poor prognosis group had higher NIHSS score,NLR and Hs-CRP at admission.The differences between the 2 groups were statistically significant(9.0[4.5,13.0]vs.2.5[2.0,4.0],2.97[2.31,4.20]vs.2.13[1.76,2.70],4.65 [2.70,9.52]mg/L vs.2.06[0.87,4.54]mg/L;all P<0.05).There were no significant differences in other baseline data and clinical characteristics between the two groups(all P>0.05).(2)The results of the multivariate logistic regression analysis indicated that the high level of Hs-CRP(OR,1.086,95%CI 1.009-1.169)and higher NIHSS score(OR,1.487,95%CI 1.229-1.797)at admission were the independent risk factors for poor prognosis(all P < 0. 05),and there was no significant relation between NLR and prognosis(P>0.05).(3)The area under the ROC curve of the Hs-CRP levels at admission was 0.722(95%CI 0.591-0.853,P=0.002).When the predictive value of Hs-CRP level at admission was 3.365 mg/L,the maximum Youden index was 0.367,its corresponding sensitivity was 70.0%and specificity was 66.7%. Conclusions The higher Hs-CRP level and NIHSS score at admission may independently predict the poor prognosis of young patients with ischemic stroke at 90 d after discharge to a certain extent.It is not appropriate to use Hs-CRP≥3.365 mg/L alone for poor prognosis screening,but NLR may not be associated with the prognosis at admission.

Objective:To explore the protective role and possible mechanism of neural stem cells combined with edaravone in cortical neurons after oxygen-glucose deprivation/reperfusion (OGD-R).Methods:(1) Neural stem cells from brain tissues of SD fetal rats aged 14-16 d were cultured in vitro, and identified with Nestin, glial fibrillary acidic protein (GFAP), and microtubule-associated protein 2 (MAP2) immunofluorescent staining. Expressions of neuron-specific nuclear protein (NeuN) and β-Tubulin were detected by immunofluorescent staining in primary cortical neurons from SD rats born within 24 h. (2) Primary cortical neurons were divided into normal group (normal culture), OGD-R model group (re-oxygenated culture for 24 h after hypoxia for 1.5 h), OGD-R+neural stem cells group (re-oxygenated co-culture with cortical neurons and neural stem cells for 24 h after hypoxia for 1.5 h), OGD-R+edaravone group (re-oxygenated culture for 24 h after hypoxia for 1.5 h; 100 μmol/L edaravone before hypoxia), OGD-R+neural stem cells+edaravone group (re-oxygenated co-culture with cortical neurons and neural stem cells for 24 h after hypoxia for 1.5 h; 100 μmol/L edaravone before hypoxia); 24 h after each treatment, neuron proliferation in each group was detected by cell counting Kit 8 (CCK8), apoptosis rate was detected by flow cytometry, contents of interleukin-1β (IL-1β), and tumor necrosis factor α (TNF-α) in neuronal supernatant were detected by enzyme-linked immunosorbent assay (ELISA), and real-time quantitative fluorescent polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the mRNA and protein expressions of Notch1, Hes1 and Hes5, respectively. Results:(1) Immunofluorescent staining results showed that neural stem cells were positive for Nestin, GFAP and MAP2, and cortical neurons were positive for NeuN and β-Tubulin; all of them were successfully identified. (2) Compared with normal group, OGD-R model group, OGD-R+neural stem cell group and OGD-R+edaravone group had decreased neuron viability, increased apoptosis, increased supernatant IL-1β and TNF-α contents, and increased Notch1 mRNA and protein expressions, with significant differences ( P<0.05). Compared with OGD-R model group, OGD-R+neural stem cells+edaravone group had increased neuron viability, decreased apoptosis, decreased supernatant IL-1β and TNF-α contents, and decreased mRNA and protein expressions of Hes1 and Hes5, with significant differences ( P<0.05). Compared with the OGD-R model group, OGD-R+edaravone group and OGD-R+neural stem cell+edaravone group had significantly decreased Notch1 mRNA and protein expressions ( P<0.05). Conclusion:Combination of edaravone and neural stem cell therapy can reverse the neuronal damage caused by OGD-R, whose mechanism may be by inhibiting the expressions of inflammatory factors and key signaling molecules in Notch signaling pathway, such as Notch1, Hes1, and Hes5.

Objective:To investigate the diagnostic value of ultrasonic measurement of optic nerve sheath diameter (ONSD) and optical disk elevation (ODE) for intracranial hypertension in patients with cerebral venous sinus thrombosis(CVST).Methods:A total of 50 patients with CVST who underwent lumbar puncture and ONSD examination in the Department of Neurology and Emergency Department of Xuanwu Hospital, Capital Medical University from January 2021 to December 2021 were retrospectively enrolled. After lumbar puncture, the patient′s initial intracranial pressure was recorded. Normal ICP was defined as ICP between 80 and 200 mmH 2O, and increased ICP was defined as ICP>200 mmH 2O. Fifty patients with CVST were divided into normal ICP group (14 cases) and increased ICP group (36 cases). The differences of baseline data, ONSD and ODE between the two groups were compared, and the receiver operating characteristic (ROC) curve was generated. The area under the curve (AUC) and the diagnostic cut-off value of ONSD were analyzed. Spearman correlation analysis was used to analyze the correlation between ONSD, ODE, CVST involvement range scores and intracranial pressure. Results:①There were no significant differences in gender, age and body mass index between the normal ICP group and the increased ICP group (all P>0.05). ②The ONSD and ODE in the increased ICP group were higher than those in the normal ICP group, and the differences were statistically significant [(4.83±0.33)mm vs (4.21±0.21)mm, (0.67±0.44)mm vs (0.24±0.29)mm, all P<0.001]. Spearman correlation analysis showed that ONSD and ODE were positively correlated with intracranial pressure ( rs=0.74, 0.51, all P<0.001). ③The extent of CVST involvement in the intracranial hypertension group was higher than that in the normal intracranial pressure group, and the difference was statistically significant [5.0(3.0, 7.5) vs 2.5(2.0, 5.0), P=0.015]. Spearman correlation analysis showed that CVST involvement score was positively correlated with intracranial pressure ( rs=0.43, P<0.001). ④In the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis, the AUC of ONSD was 0.935, the best diagnostic threshold of ONSD was 4.5 mm, the sensitivity was 0.81, and the specificity was 0.93. Conclusions:ONSD and ODE measured by ultrasound are reliable imaging methods to identify intracranial hypertension in patients with CVST.