Currently,thrombolytic therapy is the most effective treatment for acute ischemic stroke.Intravenous recombinant tissue plasminogen activator administered within 3 hours of symptom onset is the only medication approved by U.S.Food and Drug Administration for the treatment of acute ischemic stroke.However,because the time window for intravenous thrombolytic therapy is very short,only a very few patients can reach the hospital for intravenous thrombolytic therapy within 3 hours of onset.Therefore,how to extend the time window of thrombolytic therapy for more patients to have accessed to it and benefit from it have been the concern of researchers.This article reviews about the recent advances in research on extending the time window of thrombolytic therapy.

The sex difference in stroke is increasingly receiving attention. The incidence and prevalence of stroke in males are higher than in females. There are greater differences both among the age groups and populations. The incidences of cerebral infarction and intracerebral hemorrhage in males are higher than females, while the incidence of subarachnoidal hemorrhage is even higher in females. Studies have shown that mortality of stroke in males is higher; however,because the females are older and have more serious symptoms at the onset of stroke, therefore their prognosis is poorer. Poststroke depression is common in females and their quality of life is lower. Stroke in females is mostly involved in cerebral cortex; their atypical symptoms are more common. Both males and females can benefit from thrombolytic and stroke unit therapies. Females with cardioembolic stroke may benefit more from anticoagulant therapy.

Objective To compare different ways to trace bone marrow mesenchymal stem cells (BMSCs) after being transplanted in cerebral ischemia-reperfusion injury. Methods Male SD rats of SPF grade were randomly divided into sham group, model group (ischemia-reperfusion,IR), BrdU tracing group, PKH26 tracing group and GFP tracing group. Fo?cal cerebral ischemia-reperfusion model was established by blocking middle cerebral artery. 24 hours after cerebral isch?emia-reperfusion injury, 10μL BMSCs that were labeled respectively by BrdU, PKH26, GFP were added respectively into BrdU, PKH26 and GFP tracing group while equal volum of normal saline was added into sham group and model group. Mod?el and transplanting cells efficacy was determined by neural behavioral score, TTC staining and brain water content;Neurons were counted using tar violet staining;The number of transplant cells in the transplanting site was assessed by fluorescence microscopy. Results Before transplanting, there was no significant difference among BrdU, PKH26 and GFP group in cell labeled efficacy. By contrast, neural behavioral score, brain infarct volume and brain tissue water content were significantly lower in all three tracing groups than that in model group 4 weeks after transplantation while neuron counts were markedly higher. There was no significant difference of above parameters among the three tracing groups. However, the number of traced transplanting cells in damaging area in GFP group is significantly higher than that in BrdU group and PKH26 group. Conclusion In cerebral ischemia-reperfusion injury, the tracing effect of GFP last longer, therefore it is significantly more effective than BrdU and PKH26.

Objective To investigated the effect of procyanidin (PC) on the expression of cysteine proteinase -3 (Caspase -3) in type 2 diabetes mellitus SD rats with focal cerebral ischemia. Methods Following the random principle, 40 healthy Sprague - Dawley (SD) rats were numbered sequentially and randomly divided to normal rats with focal cerebral ischemia group,type 2 diabetes mellitus SD rats with focal cerebral ischemia group,PC low/ middle/ high -dose groups,with 8 rats in each group. The type 2 diabetes mellitus - MCAO model was set up. The doses of PC for low,middle and high - dose groups were 50 mg/ kg,100 mg/ kg,200 mg/ kg. Immunohistochemistry method was used to measure the activity of Caspase - 3. Results Compared with that in the normal rats with focal cerebral ischemia group[(11. 42 ±2. 52)],the expression of Caspase -3 increased in the type 2 diabetes with ischemia group[(15. 00 ± 2. 38)](t = 2. 17,P < 0. 01). Compared with that in the type 2 diabetes with ischemia group,the expression of Caspase - 3 decreased in the PC groups[(9. 38 ± 2. 00),(7. 71 ± 1. 55),(6. 96 ± 1. 57)](t = 2. 86,3. 13,3. 36,all P < 0. 01),whereby the middle and high - dose groups showed more significant decrease (t = 1. 92,2. 03,all P <0. 01) and with no statistically significant difference between the two groups(t = 1. 13,P > 0. 05). Conclusion PC can decrease the expression of Caspase - 3 protein in type 2 diabetes mellitus SD rats with focal cerebral ischemia, finally may inhibit the apoptosis.

BACKGROUND: Various etiological mechanisms are involved in cerebral infarction. Both free radicals and lipid peroxidation participate in the atherosclerosis and damage of neural cells after cerebral ischemia. Compound danshen(Radix Salviae Miltiorrhizae) is a common prescribed Chinese herb, acting on activating blood circulation and removing stasis for cerebral infarction and coronary heart disease, but its mechanism has been unknown in many aspects.OBJECTIVE: To observe the effect of compound danshen on neural function defect and free radicals in patients with cerebral infarction so as to probe into its possible mechanisms.DESIGN: A randomized controlled trial.SETTING: Neurological Internal Department of a hospital affiliated to one university.PARTICIPANTS: Totally 538 inpatients were collected in Neurological Internal Department of First Hospital affiliated to Jinzhou Medical College from February to December 2002, their diagnosis compiled with "Diagnostic Keys on Every Type Cerebral Vascular Disorders" adopted on the 4th National Acadenic Meeting on Cerebral Vascular Disorders, and determined by cerebral CT scan. All of those were the first attack of atherosclerosis cerebral infarction in 72 hours. The patients with cardiac infarction, heart failure, auricular fibrillation, insufficiency of liver and kidney function,hemorrhage of digestive tract, vascular dementia and bulbar paralysis and the patients who could not be well cooperated were not included. A total of 68 patients compiled with the standards, of which, 38 patients were male and 30 patients female, aged varied from 52 to 78 years, at the average of (64. 62 ±5.80) years. The patients selected were randomized into study group and the control by lot-drawing nethod according to the hospitalized sequence and volunteer principle of the control.METHODS: The basic treatment was same in two groups. In study group,compound danshen injection was added together with physiological saline 250 mL for intra-venous drip, once daily, continuous 14 days made one course. In the control, thrombosis removing injection 15 mL was added together with physiological saline 250 mL for intra-venous drip, once daily,continuous 14 days made one course.Level of serum lipoperoxide(LPO) and activity of superoxide dismutase (SOD).RESULTS: Statistical differences presented in declined scores of severity of neural function defect after treatment in two groups compared with their own controls(in study group: 28.62 ±6.76 vs 13.84 ± 8.16; in the control:28.58±7.05 vs 21.52±8.24, t=8.134, t=3.796 respectively, P＜ 0. 001 ). The score in study group was declined more obviously compared with the control after treatment, indicating very significant difference ( t = 3. 861, P ＜ 0. 001 ). The effective rate of compound danshen injection was 88.24% in treatment of cerebral infarction, which significantly superior to that in the control(67.65% ) (x2 =4.19, P ＜ 0.05). Compound danshen remarkably reduced serum LPO level[ (8.69 ± 1.28) nmol/L vs (5.86 ± 1.42) nmol/L, t =8. 628, P ＜ 0. 001 ] and statistical differences presented compared with the result in the control after treatment[(5.86±1.42) nmol/L vs(8.56±0.95) nmol/L, t=9.125, P ＜0.001] . Simultaneously, SOD activity in serum was significantly increased, [ (26. 25±4. 64) mkat/g vs(30. 01 ± 3.87) mkat/g, t = 3. 629, P ＜ 0. 001] indicating statistical differences compared with the result in the control after treatment[ (30. 01 ±3.87) mkat/g vs(26.33 ±4. 14) mkat/g, t =3. 778,P ＜ 0.001].CONCLUSION: Compound danshen improves significantly neural function defect in patients with cerebral infarction, with definite therapeutic effects on the treatment. It can reduce serum LPO content and increase serum SOD activity in patients with cerebral infarction. It is predicted that removing free radicals and anti-lipid peroxidation damage is probably one of the important mechanisms of it, which provides a further theoretic evidence for the treatment of cerebral infarction clinically.

Heart failure and stroke are the important causes of death worldwide, and both are closely related. This article reviews the prevention and reperfusion therapy of ischemic stroke in patients with heart failure.

Objective To investigate the risk factors for death within 30 d after onset in patients with acute ischemic stroke.Methods Consecutive inpatients with acute ischemic stroke were prospectively enrolled.The onset to admission time,baseline clinical characteristics,past history,routine laboratory results,and neuroimaging data of the patients were collected.Taking death within 30 d after the onset as primary outcome,they were divided into a death group and a survival group.The multivariate logistic regression analysis was used to determine the independent risk factors for death.Results A total of 758 patients were enrolled in the study,including 47 (6.2％) deaths.The mortality rate increased gradually with age (P ＜ 0.01).Multivariatelogistic regression analysis showed that male (odds ratio [OR]4.291,95％ confidence interval [CI] 1.560-11.791;P =0.005),age ＞ 80 years (OR 2.440,95％ CI 1.216-4.859;P=0.011),atrial fibrillation (OR 2.394,95％ CI 1.032-5.545;P =0.042),onset to admission time ＞3 h (OR 2.110,95％ CI 1.024-4.350;P =0.043),body temperature ＞37.4 ℃ at admission (OR 2.334,95％ CI 1.122-4.860;P =0.023),oxygen saturation ≤94％ (OR 17.125,95％ CI 2.873-102.162;P =0.001),baseline National Institutes of Health Stroke Scale score ＞ 15 (OR 8.411,95％ CI 2.263-31.287;P =0.003),baseline Glasgow Coma Scale score ＜3 (OR 16.490,95％ CI 2.821-96.444;P =0.005),white blood cell count ＞ 10 × 109/L (OR 2.115,95％ CI 1.042-4.291;P=0.038),complicated with pulmonary infection (OR 8.154,95％ CI 1.818-36.611;P=0.006),and cerebrocardiac syndrome (OR 2.667,95％ CI 1.055-6.740;P =0.038) were the independent risk factors for death within 30 d.Conclusion Male,advanced age,onset to admission time ＞ 3 h,body temperature ＞ 37.4 ℃ at admission,hypoxia,elevated white blood cell cotmt,as well as complicated with pulmonary infection after stroke,and cerebrocardiac syndrome were the independent risk factors for death within 30 d in patients with acute ischemic stroke.

Objective To investigate Prehospital delay and its influencing factors in acute ischemic stroke in Fuxin area.Methods Consecutive patients with acute ischemic stroke admitted from March 1,2015 to July 1,2017 were enrolled prospectively.The patients were grouped by the cutoff value from onset to admission time ≤3 h.The demographic data,vascular risk factors,onset to admission time,and clinical data were recorded.Multivariate logistic regression analysis was used to identify the independent influencing factors of prehospital delay.Results A total of 758 patients were enrolled,including 123 (16.2％) from the onset to the admission time ≤3 h.Multivariatelogistic regression analysis showed that women (odds ratio,[OR] 14.782,95％ confidence interval [CI] 2.378-91.809;P=0.004),Mongolian (OR 6.218,95％ CI 1.642-23.520;P=0.008),low level of education (0-6 years:OR 5.047,95％ CI 1.306-19.519;P=0.023),place of residence (suburb or rural area:OR 4.024,95％ CI 1.080-14.987;P =0.038),low economic income (0-1500 yuan/month:OR 5.985,95％ CI 1.500-23.873;P =0.011),previous history of stroke/transient ischernic attack (OR 6.293,95％ CI 1.558-25.384;P=0.013),National Institutes of Health Stroke Scale score ≤8 (OR 12.352,95％ CI3.239-47.119;P＜0.001),limb weakness (OR 3.335,95％ CI 1.043-10.658;P=0.042) and dizziness (OR 7.031,95％ CI 1.814-14.027;P=0.005) as the initial symptom,transportation means (non-120 ambulances,private cars or taxis:OR 1.929,95％ CI 1.106-3.366;P =0.021),transferred from other hospital (OR 1.761,95％ CI 1.011-3.067;P=0.045),and first visit hospitals as health centers or primary hospitals (OR 1.811,95％ CI 1.034-3.173;P=0.037) were the independent factors of prehospital delay in patients with acute ischemic stroke.Conclusion Women,Mongolian,educational level,residence,economic income,history of stroke/transient ischemic attack,severity of illness,transportation initial,level of first visit hospital,and transfered from other hospital are the influencing factors for prehospital delay in patients with acute ischemic stroke in Fuxin area.

Objective To investigate the correlation between early serum β2-microglobulin (β2-MG) and cystatin-C (Cys-C) levels and post-stroke depression (PSD) in patients with acute cerebral infarction and their clinical significance. Methods Patients with acute cerebral infarction within 72 hours of the first onset were consecutively collected,and the diagnosis met the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018,all confirmed by head MRI DWI,with reference to the diagnostic criteria of PSD and the 24-item version of the Hamilton Depression Scale-24 (HAMD-24) scores were included in the patients. Scores≥8 were included in the study group (PSD group),and the PSD group was further divided into two subgroups,mild and moderate-severe,according to the HAMD score. Laboratory indicators such as serum β2-MG,Cys-C and biochemistry and clinical data were collected on admission. Results 64 of 174 patients with acute cerebral infarction were diagnosed with PSD,with an incidence of 37%. Compared with the control group,there were statistical differences in age,hypertension,high-density lipoprotein cholesterol (HDL-C),serum creatinine (Scr),β2-MG and Cys-C in the study group,and the results of multifactorial logistic regression analysis showed that age,β2-MG and Cys-C might be the most important factors. β2-MG and Cys-C may be independent risk factors for the occurrence of PSD;meanwhile,the levels of β2-MG and Cys-C were found to be positively correlated with the severity of PSD (P<0.01). The analysis of the role of serum β2-MG and Cys-C in the diagnosis of PSD by applying ROC curves showed that the AUC of β2-MG was 0.781,with a sensitivity of 0.672 and specificity of 0.909;the AUC of Cys-C was 0.785,with a sensitivity of 0.828 and specificity of 0.736;the AUC of the combined diagnosis was 0.815,with a sensitivity of 0.656 and specificity of 0.909.Conclusion Age,serum β2-MG and Cys-C may be independent risk factors for the occurrence of PSD,and serum β2-MG and Cys-C are associated with the severity of PSD;β2-MG and Cys-C may have some diagnostic value for the occurrence of PSD,and the combined diagnostic value of the two is higher.

OBJECTIVE：To st udy preventive effect and mec hanism of ginsenoside Rg 1 on focal cerebral ischemia-reperfusion injury（CIRI）model rats. METHODS ：Totally 78 SD rats were randomly divided into sham operation group ，model group ， butylphthalide control group （positive control ，10 mL/kg），ginsenoside Rg 1 low-dose，medium-dose and high-dose groups （10， 20，40 mg/kg），with 13 rats in each group. Administration groups were give relevant medicine intraperitoneally ，sham operation group and model group were given constant volume of normal saline intraperitoneally ，once a day ，for consecutive 7 d. After medication，except for the sham operation group ，focal CIRI model was induced by middle cerebral artery occlusion （MCAO） method in other groups. After modeling ，neurological deficit scoring was performed according to the modified neurological difict scoring standard ； TTC staining was used to detected the percentage of cerebral infarction of rats ；the cerebral water content was measured by dry/wet weight method ；serum contents of IL- 1β and IL-6 were detected by ELISA ；the protein expressions of p-p 38 MAPK and p-NF-κB p65 in cerebral tissue were determined by immunohistochemistry and Western blotting assay. RESULTS ： Compared with sham operation ，neurological deficits score ，percentage of cerebral infarction and cerebral water content ，serum contents of IL- 1β and IL-6，positive expression numbers of cells and protein expressions of p-p 38 MAPK and p-NF-κB p65 in cerebral tissue were increased significantly in model group （P＜0.05 or P＜0.01）. Compared with model group ，above index levels of administration groups were all decreased significantly （P＜0.05 or P＜0.01），and the effect of ginsenoside Rg 1 had a dose-dependent trend ；there was no significant difference of all above indexes between ginsenoside Rg 1 middle-dose，high-dose groups and butylphthalide control group （P＞0.05）. CONCLUSIONS ：Ginsenoside Rg 1 has a certain preventive effect on focal CIRI model rats ，the mechanism of which may be associated with down-regulating the protein expression of p-p 38 MAPK and p-NF-κB p65，inhibiting the release of inflammatory factors such as IL- 1β and IL-6.