Objective　To investigate the morphological changes of Cys C intervention on cerebral cortex AQP4,MMP-2 and BBB ultrastructure after cerebral ischemia reperfusion injury (CIRI) in rats and to explore its underlying mechanisms.Methods　One hundred male SD rats were randomly divided into sham group,IR group，Cys C low,medium and high concentration group.The rat middle cerebral artery embolism model was established by the modified Longa occlusion method.The water content of brain tissue was measured by dry and wet weight method,the content of EB in brain tissue was detected,and the degree of permeability change of the BBB was evaluated by focal ischemia for 2 h with middle cerebral artery occlusion and 24 h reperfusion.TEM was used to observe the ultrastructure changes of BBB.The opening of microvessels was observed under SEM;Western blot was used to detect AQP4 expression in cerebral cortex tissue.MMP-2 was detected expression by immune histochemistry.Results　Compared with IR group,the degree of BBB injury in Cys C low、medium groups was significantly reduced,and the number of capillaries opening increased.The expression of AQP4 protein was decreased,and the OD value of MMP-2 expression was also significantly decreased.In Cys C high group,the BBB was severely damaged.AQP4 protein expression was significantly increased,and the OD value of MMP-2 expression was also significantly increased.Conclusions　The application of Cys C intervention can reduce the damage of the BBB.It is mechanism may be relation to the decrease of AQP4 protein expression and the decrease of OD value of MMP-2 expression.

Objective　To explore the relationship between serum cystatin C (Cys-C),uric acid (UA)，CD4+T cells and CD8+T cells with intracranial artery stenosis and cerebral infarction and analyze their influencing factors.Methods 　The clinical data of 124 patients with cerebral infarction who were hospitalized in our hospital from June 2020 to September 2021 were collected.All patients were given Brain MRA or /and CTA and routine biochemical examinations.According to the degree of proximal stenosis of intracranial large vessels，patients were divided into no stenosis group (36cases),mild stenosis group (43 cases),and moderate to severe stenosis group (45 cases).The clinical data of the three groups of patients and the differences in serum Cys-C,UA,and T cell subsets were compared.The factors affecting intracranial artery stenosis in cerebral infarction were analyzed by multivariate Logistic regression.The ROC curve was used to evaluate the value of serum CysC,UA and T cell subsets in patients with the cerebral infarction intracranial artery stenosis narrow.Results　The serum levels of Cys-C,UA,CD4+T cells were lower in no stenosis group than those in mild stenosis group and those in medium-severe stenosis group,and positively correlated with cerebral infarction intracranial artery stenosis.The serum levels of CD8+T cells were higher in no stenosis group than those in mild stenosis group and those in medium-severe stenosis group,and were negatively correlated with cerebral infarction intracranial artery stenosis.Conclusion　The increase of serum Cys- C,UA,CD4+ T cells and the decrease of CD8+T cells are risk factors for intracranial artery stenosis in cerebral infarction.As the degree of intracranial artery stenosis worsens,Cys-C,UA,CD4+T cells increase,and CD8+T cells decrease.

Objective　It is important to distinguish between motor and sensory fascicles of the peripheral nerves for nerve alignment in surgery.No biomarkers currently are available for identification of motor or sensory fascicles.The objective of this study is to search the specific proteins between sensory and motor fascicles of peripheral nerves and provide biomarkers for the identification of functional fascicles of peripheral nerves.Methods　The normal state of motor branch and saphenous nerve of femoral nerve in Wistar rats,and at 8 hours and 8 days after Sunderland V injury were respectively sampled.Five mm long samples were taken from the distal side of the broken end,and a total of 18 groups of proteins were isolated from 6 samples.After purification and quantification,differential gel electrophoresis (DIGE) was used to label the proteins,gel image was scanned,and image analysis software (DeCyder) was used to compare and identify the differentially expressed proteins in each group.Protein spots with more than 1.5 times of difference in expression were selected to prepare glue-cutting,enzyme-cutting and spot target.PMF chromatogram was analyzed and identified by MALDI-TOF-PRO mass spectrometer,and the results of proteomics were analyzed and compared by RT-PCR.Chi-square tests and t-tests were performed for comparison between motor or sensory nerve groups.Results　The data identified 6 proteins that were differentially expressed between motor and sensory fascicles (>1.5-fold,P<0.05),including Annexin V,neurofilament light polypepticle,TEC kinase,serine protease inhibitor A3N,Peroxiredoxin-2,and TPM1.The proteomic results were consistent with the mRNA expression levels of these genes as determined by quantitative reverse transcription polymerase chain reaction.Conclusion　There were significant differences in proteomic expression between the peripheral sensory and motor fascicles,and Annexin V can be used as a high-difference marker protein to distinguish the peripheral sensory from motor fascicles.

Objective　To investigate the expression level of serum microrna-493 (mir-493) in patients with acute cerebral infarction (ACI) and its relationship with the prognosis after thrombolysis.Methods　Seventy patients with ACI in our hospital from October 2019 to March 2021 were selected as the study group,and 70 patients with healthy physical examination during the same period were selected as the control group.The serum miR-493 levels of the study group before treatment,3 d,7 d after treatment were detected.Results　The serum miR-493 levels in the study group were higher than that before treatment at 3 days after treatment,however,the serum miR-493 levels in the study group were lower in each time period (P<0.05).Serum miR-493 levels before treatment and neurological deficits in ACI patients Degree,serum VEGF,Ang-2,CRP,and IL-6 levels were negatively correlated (P<0.05).Serum miR-493 levels before treatment,3 d,and 7 d after treatment in the study group with good prognosis were higher than those with poor prognosis patients (P<0.05).The area under the curve (AUC) of serum miR-493 predicting poor prognosis of ACI patients with thrombolytic therapy before treatment,3 d and 7 d after treatment were 0.748,0.851,0.879,respectively,and 7 d after treatment serum miR-493 predicted the largest AUC,and the best prediction sensitivity and specificity were 73.68% and 88.24%,respectively.Conclusion　The expression levels of serum miR-493 in patients with acute cerebral infarction are significantly reduced,and related to the prognosis of patients after thrombolysis,and has certain value in assisting clinical prediction of the prognosis of patients.

Objective　To explore the difference of Neutrophil to lymphocyte ratio (NLR) among multiple sclerosis (MS),neuromyelitis optica spectrum disorders (NMOSD),and healthy people,and analyze the clinical value in differentiating MS and NMOSD.Method　Clinical data and laboratory results from patients admitted to Shengjing hospital who were diagnosed with MS or NMOSD,and calculate NLR were retrospectively analyzed.Fifty healthy people matched with sex and age were selected as controls.Result　There were significant differences of neutrophils,lymphocyte,monocyte and NLR among MS,NMOSD and healthy people.The area under curve of ROC in differentiating MS and NMOSD was 0.796 (P<0.001,95%CI 0.685~0.907).Conclusion　The NLR of patients with MS was higher than healthy control,but lower than NMOSD.And NLR was a helpful marker to differentiate MS and NMOSD.

Objective　To investigate the prognostic value of independent risk factors for ischemic stroke (IS) and acute physiological and chronic health status scoring system Ⅳ (APACHE Ⅳ) in predicting the severity of IS.Methods　We used individual patient data (n=200859) from a national multicenter cohort study (eICU database) to identify patients with primary diagnosis of IS (n=1934) for statistical analysis.The primary outcome was hospital mortality (HM).To evaluate the relationship between APACHE Ⅳscore and hospital mortality,binary logistic regression was used to analyze the independent predictors of HM of IS patients,and receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of APACHE Ⅳscore for the severity of ischemic stroke.Results　APACHE Ⅳscore of survival group and death group was statistically significant.(P<0.05).Binary logistic regression analysis showed that APACHE Ⅳscore was an independent risk factor for severity of IS.APACHE Ⅳscore predicted the severity of IS with an area under ROC curve of 0.770［95%CI (0.736，0.804)］.The best truncation value was 56.5,the sensitivity was 71.8%,and the specificity was 72.8%.Conclusion　APACHE Ⅳscore has certain predictive value for the severity of ischemic stroke.

Objective　To investigate the relationship between cerebral microbleeds and cerebral artery stenosis in patients with large atherosclerotic cerebral infarction.Methods　We retrospectively enrolled 512 patients with large atherosclerotic cerebral infarction who were the first time admitted to the Department of Neurology of our hospital from October 2018 to June 2021.According to the results from the craniocerebral magnetic sensitive weighted imaging,patients were divided into non-CMBs group and CMBs group.The purpose of this study was to investigate the risk factors and incidence rate of CMBs，the relationship between cerebral microbleeds and cerebral artery stenosis in patients with large atherosclerotic cerebral infarction.Results　The incidence rate of CMBs was 39.3% in this study.Factors including age,hypertension,hyperhomocysteinemia,history of antiplatelet drug use,WMH,intracranial and extracranial artery stenosis coexisted independently with CMBs.The degree of CMBs is positively correlated with cerebral artery stenosis.Conclusion　Age,hypertension,high-profile cysteinemia,anti-platelet drug application history,WMH and intracranial artery or both of extracranial vessels stenosis are independent risk factors of CMBs.The degree of CMBs is positively correlated with cerebral artery stenosis.Triacylglycerol may be a protective factor for CMBs.

Objective　To study the value of mean platelet volume/platelet ratio (MPV/PLT) in evaluating the severity and prognosis of acute cerebral infarction (ACI).Methods　One hundred and twenty-eight patients with ACI treated in our hospital from January 2019 to December 2020 were divided into mild group with NIHSS score (n=72) and moderate as well as severe group with NIHSS score>5 (n=56).The differences of clinical data between the two groups were compared.The prognosis was evaluated according to the modified Rankin Scale (mRS) at 3 months after discharge.mRS 0~3 was good prognosis and mRS 3~6 was poor prognosis.Results　The levels of MPV and MPV/PLT of ACI patients in moderate and severe group were higher than those of mild group (P<0.05).The levels of MPV and MPV/PLT of ACI patients with poor prognosis were higher than those in patients with good prognosis (P<0.05).By ROC curve analysis,MPV level and MPV/PLT level had evaluation value for the severity and prognosis of ACI patients.The sensitivity and specificity of MPV/PLT evaluation were better than MPV.Conclusion　MPV/PLT is valuable in evaluating the severity and prognosis of ACI patients.

Objective　To investigate the etiology,clinical manifestations and neuroimaging features of the lesions of the middle cerebellar foot caused by different diseases.Methods　The general clinical data of 9 patients with bilateral middle cerebellar peduncle lesions admitted to our hospital from May 2016 to October 2021 were retrospectively analyzed,and the clinical manifestations and imaging characteristics of different diseases were analyzed.Results　Abnormal lesions were seen in 9 patients with middle cerebellar feet,including case 1:Speech slurred,left limb weakness for 3 months,dizziness,walking instability for 10 days previous pontine infarction,diagnosed as Walle’s degeneration.Case 2:Dizziness and unstable walking for 1 year after pontine hemorrhage,diagnosed as pontine hemorrhage and Waller’s degeneration of the bridge arm.Case 3:Presented with dizziness and walking instability for 2 years and was diagnosed with mu-ltiple system atrophy.Case 4:Memory loss for 2 months,aggravation for 10 days,previous rheumatoid arthritis,diagnosed as lupus encephalopathy.Case 5:Seizures of limbs,loss of consciousness for 3 days,chronic renal insufficiency in the past,diagnosed as renal encephalopathy.Case 6:Left lower limb weakness for 4 months,dizziness,seppch impairment for 2 days,diagnosed as neuromyelitis optic specturum disease.Case 7:Dizziness,walking instability for 15 days,HIV positive,diagnosed as HIV encephalopathy.Case 8:Clumsy handholding for 4 years,involuntary shaking for 2 days,diagnosis of Wilsonl’s disease.Case 9:Dizziness,unstable walking for 3 months,previous history of Hodgkin’s lymphoma,diagnosed as Hodgkin’s lymphoma with central nervous system damage.Conclusion　The etiology of the lesions of middle cerebellar foot is complex,attentions are needed in order to reduce clinical misdiagnosis and missed diagnosis.

Objective　To investigate the efficacy and safety of edaravone dexcamphenol in the treatment of acute cerebral infarction.Methods　Patients with acute cerebral infarction were randomly divided into observation group (edaravone dexborneol+conventional treatment) and control group (conventional treatment) for 14 days.Neurological function was assessed by the National Institutes of Health Stroke Scale (NIHSS) at admission and the modified Rankin Scale (mRS) at 14 days after treatment,respectively.C-reactive protein (CRP) level was detected simultaneously.Furthermore,the occurrence of adverse drug reactions during treatment was observed.Results　NIHSS score,mRS score and CRP levels in experimental group were significantly lower than those in control group (all P<0.05).No adverse drug reactions in the two groups were observed during treatment.Conclusion　Edaravone dexborneol has a significant clinical effect in the treatment of acute cerebral infarction,and the safety of this treatment is relatively high.