Cerebral microbleed is a cerebral small vessel disease.The detection rate is 4.5％ to 84.9％in different populations.Vascular cognitive impairment is the general name of various cerebrovascular diseases and their risk factors caused varying degrees of cognitive impairments.Studies have shown that cerebral microbleed is closely associated with vascular cognitive impairment.This article reviews the relationship between cerebral microbleed and vascular cognitive impairment in different populations,different degrees and different locations.

β2-Microglobulin is a small molecule protein, consisting of a polypeptide chain.Previous studies have confirmed that serum β2-microglobulin is a biomarker that reflects early renal function injury, and renal function injury is closely correlated with ischemic stroke.Studies in recent years have shown that the level of serum β2-microglobulin increases significantly in patients with ischemic stroke.Thus, it can be used as a biomarker for the risk of ischemic stroke.

Objective To investigate whether the decision-making ability was impaired under the condition of clear risk probability in patients with cerebral miceobleeds (CMBs).Methods The Game of Dice Test (GDT) with the clear risk probability was used to conduct the risk decision ability study in 45 patients with CMBs and 45 without CMBs.Results GDT showed that patients in the CMBs group was more like to choose the risky option compared with the non-CMB group (9.64 ± 3.22 vs.6.51 ± 4.48;t =3.809,P ＜0.001).Among the 4 options,the most frequent choice in the CMBs group was the option of the highest risk,i.e.2 numbers (6.91 ±3.02 vs.4.71 ±2.95;t =3.494,P =0.001);and the most frequent choice in the non-CMBs was 3 numbers (4.87 ±2.17 vs.7.71 ±2.71;t =-5.496,P＜0.001).The GDT was divided into 3 stages.The number of security options selected by patients in the CMBs group was significantly less than that by patients in the non-CMBs group in all stages (stage 1:-0.27 ± 3.00 vs.0.93 ±3.09;t =-1.867,P =0.065;stage 2:-0.62 ± 2.55 vs.2.27 ± 2.65;t =-5.268,P ＜ 0.001;stage 3:-0.53 ± 2.57 vs.2.89 ± 3.12;t =-5.677,P＜ 0.001),and with the increase of the number of tests,selecting security options increased gradually in the non-CMB group (F =4.780,P =0.010),while the CMBs group was not (F =0.209,P =0.812).Conclusions The patients with CMBs have significant impairment in decision making ability under the condition of specific risk probability.

OBJECTIVE To investigate the optimal surgical approach and compatible material for large nasal septal perforation.METHODS Operations were underwent via labiogingival groove approach under endoscope.Double layer of flaps were perichondrium of nasal septal cartilage,base of nasal cavity and inferior nasal meatus on the left and acellular dermal matrix (ADM) on the right and the two flaps were adhered with ear-cerebral glue (EC).RESULTS All of 36 cases were successfully repaired and no reperforation occurred after following-up for 3 months to 2 years.CONCLUSION Large mucosal flaps with wide pedicel and abundant blood supply and ADM of good biocompatibility provide a higher survival rate of the flaps.This method has the advantages of wide field of vision,less damage of the donated area and short time of operation.It is an optimal and practical method for repair of the large nasal septal perforation.

Objective To investigate the correlation between cognitive function and cerebral microbleeds (CMBs) in patients with acute cerebral infarction.Methods The clinical and imaging findings in patients with acute stroke were analyzed retrospective.CMBs were counted according to the findings of MRI.The general conditions,CMB site and leukoaraiosis severity of the patients were recorded in detail.The cognitive function of the patients was assessed with the Montreal cognitive assessment scale (MoCA) the next day in the hospital.MoCA assessment follow-up was conducted at 3,6 and 9 months.The changes in cognitive function of the patients with acute cerebral infarction and its relationship with CBMs were analyzed.Results A total of 82 patients with ischemic stroke were enrolled in the study,33 of them had CBMs and 49 had no CBMs.The systolic blood pressure (155.03 ± 19.68 mm Hg vs.142.20 ± 21.22 mm Hg;t =2.762,P =0.007) and the National Institutes of Health Stroke Scale (NIHSS) score (6.21 ±4.57 vs.4.00 ±3.98; t =2.322,P =0.023) in the CBM group were significantly higher than those in the non-CBM group.Multivariate logistic regression analysis showed that the systolic blood pressure level (odds ratio [OR] 1.032,95％ confidence interval [CI] 1.008-1.057; P=0.009) and the NIHSS score (OR 1.163,95％ CI 1.013-1.311;P=0.014) were the independent predictors of CBMs in patients with acute cerebral infarction.CMBs were closely associated with MoCA scores,and the longer follow-up time,the correlation would stronger.The executive function (rs =0.318,P =0.004),visual space function (rs =0.403,P =0.000) and calculation function (rs =0.362,P=0.001) in patients with CMBs were significantly impaired.The more serious of CMBs,the lower of the scores in above 3 cognitive domains,and the damage would be more serious.Conclusions CMBs are closely associated with cognitive function impairment in patients with acute cerebral infarction.The more serious of CMBs,the more serious of cognitive function impairment will be,and with the extension of time,cognitive function impairment in patients with CMBs will aggravate.

Objective:To investigate the correlation between mean platelet volume (MPV) and clinical outcome in patients with acute ischemic stroke (AIS) after intravenous thrombolysis.Methods:Consecutive patients with AIS treated with standard dose alteplase intravenous thrombolysis in the Department of Neurology, the Second People's Hospital of Hefei from July 1, 2019 to August 30, 2020 were enrolled retrospectively. The clinical, laboratory, and imaging data of the patients were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after onset, and a score of >2 was defined as a poor outcome. Multivariate logistic regression model was used to analyze the independent correlation between MPV and clinical outcome. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of MPV for clinical outcome. Results:A total of 104 patients with AIS who received intravenous thrombolytic therapy were included, including 40 males (38.5%), 64 females (61.5%), and their age was 68.7±12.5 years. The baseline median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range, 4-11), and the time from onset to intravenous thrombolysis was (128.5±55.9) min. Seventy-five patients (72.1%) had a good outcome, 29 (27.9%) had a poor outcome, and there was no death. The baseline NIHSS score, C-reactive protein, MPV, MPV/platelet count ratio and the proportion of patients with anterior circulation infarction in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that MPV (odds ratio [ OR] 1.868, 95% confidence interval [ CI] 1.277-2.732; P=0.001) and baseline NIHSS score ( OR 1.199, 95% CI 1.083-1.328; P<0.001) were the independent risk factors for poor outcome. ROC curve analysis showed that the area under the curve for predicting poor outcome was 0.714 (95% CI 0.606-0.821; P=0.001). The optimal cut-off value was 11.25 fl, the predictive sensitivity and specificity were 65.5% and 70.5%, respectively. Conclusions:There was a significant independent correlation between MPV and the clinical outcome in patients with AIS after intravenous thrombolysis. A higher baseline MPV had a certain predictive value for poor outcome.

0.05].Sao and Eao was significantly different between CHD group and the control group,but Aao has not significant different.③Sao positively correlated with ascending aortic distensibility coefficient(D)(r=0.73,P=0.03),and negatively correlated with aortic stiffness(?)(r=-0.68,P=0.03).Conclusion:Elastic properties of the aorta can directly be assessed by measuring the movements in the upper wall of the aorta with DTI.Reduced aortic S-velocity is significantly correlated with Ascending aortic distensibility coefficient(D) and stiffness index beta(?),which are important factors in assessing the changes of the aortic distensibility.

In recent years, the concept of " microbiome-gut-brain axis" has been proposed to reveal the wide connection between gut microbiome and nervous system diseases. As a common and frequently occurring disease of nervous system, the occurrence and outcome of ischemic stroke are closely related to gut microbiome. This article reviews the relationship between gut microbiome and risk factors of ischemic stroke and immune inflammation after stroke.

Objective:To investigate the correlation between neutrophil to lymphocyte ratio (NLR) and 30-day clinical outcomes in patients with spontaneous cerebral hemorrhage and whether adding NLR to ICH score improve the accuracy of predicting poor outcomes.Methods:Patients with spontaneous intracerebral hemorrhage admitted to the Department of Neurology, the Second People's Hospital of Hefei from March 2018 to April 2019 were enrolled retrospectively. The demographic and baseline clinical and imaging data were documented. The absolute neutrophil counts and absolute lymphocyte counts within 24 h of onset were obtained and NLR was calculated. At 30 d after the onset of cerebral hemorrhage, the modified Rankin Scale was used to evaluate the outcomes. Good outcome was defined as ≤2, and poor outcome was defined as >2. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of baseline NLR, ICH score and NLR+ ICH score for poor outcomes in patients with spontaneous cerebral hemorrhage. Results:A total of 159 patients with spontaneous cerebral hemorrhage were enrolled, including 106 males (66.67%), age 62.29±15.10 years. Neutrophil count was (7.30±3.95)×10 9/L, lymphocyte count was (1.41±0.67)×10 9/L, and NLR was 6.94±7.66. Baseline hematoma volume was 17.93±25.87 ml, median ICH score 0 (interquartile range 0-1). The outcomes of 60 patients (37.7%) were poor at 30 d. Univariate analysis showed that coronary heart disease, systolic blood pressure, diastolic blood pressure, high-sensitivity C-reactive protein, fasting blood glucose, white blood cell count, neutrophil count, NLR, hematoma broken into the ventricle, hematoma volume, NIHSS and ICH scores in the poor outcome group were significantly higher than those of the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that NLR was an independent predictor of poor outcomes at 30 d after the onset of spontaneous cerebral hemorrhage (odds ratio 1.135, 95% confidence interval 1.092-2.321; P=0.038). The ROC curve analysis showed that the best cut-off value of NLR was 6.679, and the sensitivity and specificity of predicting poor outcomes were 51.67% and 76.77% respectively; the best cut-off value of ICH score was 1.0, and the sensitivity and specificity of predicting poor outcomes were 69.71% and 89.80% respectively; the sensitivity and specificity of the combined application of NLR + ICH score to predict poor outcomes were 74.58% and 82.65% respectively. Conclusions:NLR was independently associated with poor outcomes at 30 d after the onset of spontaneous cerebral hemorrhage. Adding it to the ICH score could improve the accuracy of predicting poor outcome.

Objective:To investigate the efficacy and safety of intravenous thrombolysis based on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch in patients with wake-up stroke (WUS).Methods:Patients with acute ischemic stroke received alteplase intravenous thrombolysis in the Stroke Center, the Second People's Hospital of Hefei from July 2019 to June 2021 were enrolled retrospectively. According to the time of finding the symptoms, they were divided into WUS group and non-WUS group. The demographic and baseline clinical data were documented and compared between the two groups. The efficacy endpoint was the clinical outcome assessed by the modified Rankin Scale (MRS) score at 90 d after onset. 0-2 was defined as a good outcome, and >2 were defined as a poor outcome. The primary safety endpoint was symptomatic intracranial hemorrhage (sICH); the secondary safety endpoint was death within 90 d after onset. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcome. Results:A total of 256 patients with acute ischemic stroke were enrolled, including 155 males (60.5%), aged 63.0±8.53 years. The median time from symptom onset to intravenous thrombolysis was 130.5 min, and the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Forty-eight patients (18.7%) were WUS and 208 (81.3%) were non-WUS; 186 (72.7%) had a good outcome and 70 (27.3%) had a poor outcome. There were no significant differences in 90 d good outcome rate (79.2% vs. 71.2%; χ2=1.260, P=0.262), sICH incidence (4.2% vs. 5.3%; χ2=0.102, P=0.750) and 90 d mortality (2.1% vs. 3.4%; χ2=0.000, P=1.000) between the WUS group and the non-WUS group. The baseline NIHSS score, the time from symptom onset to intravenous thrombolysis and the proportion of patients with cardiogenic embolism in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio 1.670, 95% confidence interval 1.453-1.919; P<0.001) and the time from symptom onset to intravenous thrombolysis (odds ratio 1.007, 95% confidence interval 1.000-1.015; P=0.043) were the independent risk factors for the poor outcome. Conclusion:The efficacy and safety of intravenous thrombolysis in DWI-FLAIR-mismatched wake-up stroke patients are comparable to those of acute ischemic stroke within the time window.