Objective To explore the change of gait of middle-aged and elderly people with mild cognitive impairment in the community,the correlation between gait and cognitive domain,and the role of gait in early recognition of cognitive decline. Methods 140 people over 40 years old in Tongxing Village,Yancheng City,Jiangsu Province were enrolled.The subjects were divided into normal cognitive group (n=64) and mild cognitive impairment group(n=76)through the Montreal Cognitive Assessment and the Minimum Mental State Examination,and gait tests were conducted at the same time.The data were collected and statistically analyzed to explore the difference of gait indicators between the two groups,the relationship between gait indicators and cognitive domains,and the ability of gait indicators to recognize mild cognitive impairment. Results The gait of the mild cognitive impairment group was worse than that of the normal cognitive group in terms of space (stride length,step height,step width) and time (step speed,stride speed,swing speed).Partial correlation analysis showed that step width was negatively correlated with delayed recall;Step size,step width and delayed recall,step height and naming were positively correlated.The logistic regression model constructed by step speed,stride length,stride speed,swing speed,step height and step width can reliably identify the existence of MCI (AUC=0.761,95%CI 0.683-0.840,P<0.05). Conclusion In the middle-aged and elderly community,the spatial and temporal performance of gait of patients with mild cognitive impairment is worse than that of the normal cognitive population.There is a close relationship between spatial indicators and delayed recall and naming.The temporal and spatial characteristics of gait have the potential to identify cognitive decline at an early stage.
Mild cognitive impairment

To study the clinical effects of beprost sodium tablets combined with Epley manual reduction in treatment of benign paroxysmal positional vertigo（BPPV）. Methods A total of 338 patients with posterior semicircular canal BPPV who were treated in the neurogy clinic of our hospital from January 2019 to December 2020 were enrolled in the study，who were randomly divided into the observation group，who were treated in Epley manual reduction combined with oral beprost sodium tablets，118 cases；control group 1，who were treated with only Epley manual reduction，114 cases and control group 2，who were treated with Epley manual reduction combined with oral betahistine mesilate tablets，106 cases. The clinical efficacy，vestibular symptom index（VSI），dizziness handicap inventory（DHI） and relapse rate were observed and compared between the three groups. Results The total effective rate in the observation group was 91.53%，which was significantly higher than that（73.68） in control group1 and（86.79%） in control group2，the difference was statistically significant（P<0.05）. One week and one month After manual reduction，the vestibular symptom index（VSI） scores and the dizziness handicap inventory（DHI） scores in three group were significantly lower than pretreatment，moreover，the decrease degree in the observation group was more significant than the other two control groups，the difference was statistically significant（P<0.05）. Within 3 months after treatment，the relapse rate in the observation group（18.64%）was lower than that in control group1（34.21%） and in control group2（27.36%），the difference was statistically significant（P<0.05）. Conclusion The clinical effects of beprost sodium tablets combined with Epley manual reduction in treatment of posterior semicircular canal BPPV are superior to those by simple Epley manual reduction and by Epley manual reduction combined with betahistine mesilate.

To analyze the correlation between trace element levels and carotid atherosclerosis（CAS），explore the risk factors of CAS. Methods People who underwent physical examination，and performed carotid artery ultrasonography，trace element detection and inflammatory factors detection were collected from January 2020 to February 2022 in the Physical Examination Center of the First Hospital of Jilin University. 325 cases were selected in strict accordance with the inclusion and exclusion criteria，the subjects were classified into two groups according to carotid intima-media thickness（IMT）. There were 146 cases in the normal carotid artery group and 179 cases in the carotid atherosclerosis group. Chi-square test，t test and rank sum test were used to compare the differences in basic information，serum trace element levels，C-reactive protein（CRP） and blood biochemistry between the two groups；Spearman correlation analysis was used to explore the correlation between carotid IMT and trace elements，CRP and inflammatory factors；multivariate Logistic regression was used to analyze the risk factors of CAS；all tests were performed on two sides，and the difference was statistically significant at P<0.05.Results （1）The age，waist circumference，carotid IMT，systolic blood pressure，prevalence rate of diabetes，the ratio of smoking，drinking and male in the carotid atherosclerosis group were higher than those in the normal carotid artery group，and the difference was statistically significant（P<0.05）. （2）There were statistical differences（P<0.05） in the contents of CRP，iron，zinc，LDL-C，FBG and UA between the normal carotid artery group and the carotid atherosclerosis group. The contents of CRP，iron，LDL-C，FBG and UA in the carotid atherosclerosis group were higher than those in the normal carotid group，and the zinc content in the carotid atherosclerosis group was lower than that in the normal carotid artery group. （3）Carotid IMT was positively correlated with age，waist circumference，systolic blood pressure，diastolic blood pressure，iron，CRP，triglycerides，LDL-C，fasting blood glucose，uric acid，while negatively correlated with zincand ratio of zinc and copper. （4）Multivariate Logistic regression analysis of carotid atherosclerosis，the results showed that age，gender，the ratio of smoking，the ratio of drinking，CRP，zinc，LDL-C，and fasting blood glucose were risk factors for carotid atherosclerosis，and zinc was a protective factor for carotid atherosclerosis. Conclusion Trace element iron is positively correlated with carotid IMT，and the higher its level is，the higher the risk of CAS；the trace element zinc is negatively correlated with carotid IMT，and the higher its level is，the lower the risk of CAS is；zinc is a protective factor for CAS.

Objective　This study aims to explore the correlation between white blood cell count (WBC),absolute neutrophil count (ANC),relative neutrophil count (RNC) and neurological impairment,poor prognosis at discharge and 90 days after onset.Methods　This study was a retrospective study,including patients aged 18 to 45 years old with first ischemic stroke within 72 hours.NIHSS score at discharge,mRS score at discharge and 90 days were used as outcome.Multivariate logistic regression was used to analyze the relationship between WBC quartile,ANC,RNC and neurological deficit (NIHSS score>4) and poor prognosis (mRS score 2~5).Results　WBC>7.82×10 9/L was independently associated with moderate and severe neurological deficit at discharge and poor prognosis at 90 days.The ANC was only associated with poor prognosis at 90 days,independently.The RNC was an independent risk factor for moderate and severe neurological impairment at discharge,poor prognosis at discharge and 90 days.Conclusion　WBC>7.82×10-9/L is an independent risk factor for moderate and severe neurological impairment at discharge and poor prognosis at 90 days in young patients with stroke.The increase of RNC,which is independently related to moderate and severe neurological impairment and poor prognosis,is more indicative than ANC for poor prognosis in young patients with stroke.

Objective　To evaluate the efficacy and safety of intravenous thrombolysis in acute mild ischemic stroke patients (National Institution of Health Stroke Scale≤5),moreover,to verify the effectiveness of multi-modality assessment in screening high-risk patients.Methods　We retrospectively included 227 patients identified with acute mild neurological deficits treated with or without intravenous thrombolysis.Odds ratios (OR) with their confidence intervals (CI) for different outcomes between groups were assessed by using multivariable binary logistic regression analyses.And the heterogeneity of treatment effect magnitude for excellent outcome［modified Rankin scale (mRS) 0~1 was estimated in different subgroups stratified by optimal cut-off value from receiver operating characteristic curve.Results　In multivariate analysis,intravenous thrombolysis could both achieve higher rate of excellent outcome(OR=3.302，95%CI1.488~7.326，P=0.003) and 7 day significant improvement (OR=2.566，95%CI1.287~5.118，P=0.007).However,there was no significant difference in the risk of early neurological deterioration,intracranial hemorrhage transformation or the 90 day stroke recurrence(P>0.05).It is indicated from the subgroup analysis that,compared with non-thrombolytic group,the classification of large artery atherosclerosis(OR=9.448，95%CI1.129~79.035，P=0.038) and baseline ABCD-2 score of 5 or more(OR=2.664，95%CI1.150~6.168，P=0.022) might benefit more from intravenous thrombolysis.Conclusion　For acute mild ischemic stroke patients,we reassured the safety and especially the efficacy of intravenous thrombolysis at 7 days and 90 days.Patients with ABCD-2 score of 5 or more and classification of large artery atherosclerosis might benefit more from intravenous thrombolytic therapy.

Objective　To analyze the role of mitochondrial autophagy and NLRP3 mediated inflammatory response in stroke rehabilitation.Methods　Male SD rats were randomly divided into 6 groups:sham operation group (sham),sham+rapamycin (rapa) group,6 hours after reperfusion (i/r 6 h),i/r 6 h+Rapa group,24 hours after reperfusion (i/r 24 h) and i/r 24 h+Rapa group.A transient middle cerebral artery occlusion model was established to stimulate ischemia/reperfusion (i/r) injury in rats.The expression of caspase-1 positive cells in different types of neurons in ischemic core cortex was analyzed.The expression of NLRP3 and mitochondrial membrane potential were measured in BV2 cells under hypoxia glucose deprivation/reoxygenation (ogd/r).Results　At 6 h after i/r injury,cleaved caspase-1 was mainly expressed in microglia (88.4±1.1)% and neurons (63.4±2.2)% at 24 h.After ogd/r,the transformation from lc3-Ⅰ to lc3-Ⅱ in BV2 cells decreased with time.BV2 cells showed a percentage of low membrane potential 24 hours after exposure to ogd/r.Compared with ogd/r group,Rapa could rescue mitochondrial damage (P<0.05),and Rapa could inhibit NLRP3,cleaved caspase-1 and cleaved IL-1 in BV2 cells induced by ogd/r β.The expression level was up-regulated (P<0.05).In the i/r+rapa group,the expression of cleaved caspase-1 in microglia ［(12.7±1.8)% vs (70.0±2.0)%］ and neurons ［(11.9±1.9)% vs (70.8±1.7)%］ was significantly lower than that in the i/r group at 6 or 24 hours after brain i/r injury (P<0.001).Conclusion　Down regulation of mitochondrial autophagy is essential for the activation of NLRP3 inflammasomes in microglia,and an autophagy inducer can effectively alleviate the NLRP3 inflammasome response in microglia,and neurons after OGD/R and cerebral I/R injury.

Objective　To analyze the effects and mechanism of cichoric acid (CA) on neuronal apoptosis and inflammatory response in ischemic stroke rats.Methods　The ischemic stroke rat model was prepared by the modified suture method.The rats were grouped into sham operation group,model group,CA group (10 mg/kg),and CA+p38 MAPK activator (Anisomycin) group (10 mg/kg CA+2 mg/kg Anisomycin).Each group received corresponding intervention for 2 weeks,the Zea Longa score were performed and volume percentage of cerebral infarction were detected on rats,Nissl staining was used to detect neuronal damage in rat hippocampal tissue.TUNEL method was used to detect neuronal apoptosis in rat hippocampal tissue,the levels of tumor necrosis factor-α (TNF-α),interleukin (IL)-1β and IL-6 in rat hippocampal tissue were detected by enzyme-linked immunosorbent assay,the expression of phosphorylated p38 MAPK (p-p38 MAPK),p38 mitogen activated protein kinase (p38 MAPK),phosphorylated NF-κB p65 (p-NF-κB p65),nuclear factor-κB p65 (NF-κB p65),nucleotide binding oligomerization domain like receptor protein 3 (NLRP3) protein in rat hippocampal tissue was detected by Western blot.Results　Compared with the sham operation group,the morphology of neurons in the model group was irregular,the staining was shallow,the number of Nissl bodies decreased significantly,and the Zea Longa score,the volume percentage of cerebral infarction,the rate of neuronal apoptosis and the TNF-α,IL-1β,IL-6,p-p38 MAPK/p38 MAPK,p-NF-κB p65/NF-κB p65,NLRP3 protein expression leves in hippocampal tissue increased significantly (P<0.05);compared with the model group,the morphology of neurons in CA group was significantly improved,the morphology was plump,the staining was uniform,the Nissl body was dense,and the Zea Longa score,the volume percentage of cerebral infarction,the rate of neuronal apoptosis and the TNF-α,IL-1β,IL-6,p-p38 MAPK/p38 MAPK,p-NF-κB p65/NF-κB p65,NLRP3 protein expression leves in hippocampal tissue decreased significantly (P<0.05);Anisomycin can reverse the above-mentioned improvement effect of CA on ischemic stroke rats.Conclusion　CA can inhibit the inflammatory response,reduce neuronal apoptosis,and alleviate the brain injury of rats caused by ischemic stroke by inhibiting the p38 MAPK/NF-κB/NLRP3 signaling pathway.

Objective　To investigate the current status of personal control in patients with ischemic stroke（IS） and to analyze its influencing factors.Methods　The convenience sampling method was used to select 180 IS patients who met the inclusion criteria as the research objects.It conducts a questionnaire survey.Results　IS patients had PMS score (17.96±1.96),GSES score (18.47±2.09),and AODS total score (74.21±4.22).Multiple linear regression analysis showed that the level of education,the number of dysfunctions,the NIHSS score,and the general Efficacy and disability acceptance were the influencing factors of personal control (P<0.05).Conclusion　The level of personal control of IS patients is low,and there are many influencing factors.Medical staff should guide patients to establish confidence in the face of the disease and improve disease cognition,so as to promote the level of personal control.

Objective　To study the value of amplitude integrated electroencephalogram (aEEG) combined with the Scandinavian Stroke Scale (SSS) in evaluating the prognosis of acute infarction.Methods　One hundred and twenty-four patients with acute cerebral infarction admitted to our hospital from February 2019 to July 2021 were selected as the research objects.After admission,the amplitude integrated EEG and SSS scores were measured.After 28 days,the prognosis of the patients was assessed by the activity of daily living scale (Barthel Index).According to the scores,the patients were divided into the good prognosis group (Barthel index score>45) and the poor prognosis group (Barthel index score≤45).Logistic regression analysis was used to analyze the risk factors of poor prognosis.Draw the receiver operating characteristic (ROC) curve,and analyze the predictive value of AEEG and SSS scores for poor prognosis.Results　The AEEG upper and lower boundaries,SSS score and GCS score in the poor prognosis group were lower than those in the good prognosis group (P<0.05),the proportion of brain hernia formation and multiple organ failure,and the levels of hs CRP and D-D in the poor prognosis group were higher than those in the good prognosis group (P<0.05).Logistic regression analysis showed that AEEG upper and lower bounds,brain hernia formation,multiple organ failure,SSS score at admission and GCS score at admission were all risk factors for poor prognosis (P<0.05).ROC curve analysis showed that the sensitivity,accuracy and AUC of aEEG upper and lower boundaries combined with SSS score in predicting poor prognosis of patients with acute cerebral infarction at admission were 92.35%,89.57% and 0.829 respectively.Conclusion　aEEG and SSS scores are independent risk factors for poor prognosis in patients with acute cerebral infarction,and the combination of the two has a high predictive value for the prognosis of acute cerebral infarction.

Objective　To investigated the predictive value of cerebral artery stenosis combine with serum Tau protein,β-amyloid (Aβ) and cone-like protein-1 (VILIP-1) detection in elderly patients with mild cognitive impairment (MCI).Methods　A total of 80 elderly MCI patients (MCI group) who were treated in our hospital from July 2020 to December 2021 were selected,80 Alzheimer’s disease (AD) patients (AD group) and 80 healthy people (Healthy group),the serum Tau protein,Aβ and VILIP-1 levels were compared among the three groups,and the differences in the MMSE score,MOCA score,ADL score,and cerebral artery stenosis between the MCI group and the AD group were also analyzed.Results　Serum Tau protein in MCI group was higher than healthy group (P＜0.05).A was lower than healthy group (P＜0.05),VILIP-1 was higher than healthy group (P＜0.05),but lower than AD group (P＜0.05).The MMSE score and MOCA score in the MCI group were higher than AD group (P<0.05).The level of VILIP-1 in MCI group and AD group was negatively correlated with MMSE score and MOCA score (P<0.05).The rate of posterior cerebral artery stenosis in the MCI group was lower AD group (P<0.05).The area under the ROC curve of the posterior cerebral artery stenosis rate combine with VILIP-1 level in predicting MCI was 0.852,which was higher than posterior cerebral artery stenosis rate and VILIP-1 alone (P<0.05).Conclusion　Posterior cerebral artery stenosis rate combine with VILIP-1 level has good application value in predicting MCI in the elderly.