Venous thromboembolism,including deep vein thrombosis and pulmonary embolism,is one of the common complications after stroke,and it also significantly increases the mortality in patients with stroke.Because of limb paralysis,prolonged bed rest,and specific hypercoagulable state,the patients with stroke become the high risk population of thrombosis.The preventive measures manly including physical and drug prevention.Clinical studies have confirmed that anticoagulation therapy for the prevention of venous thromboembolism is effective in patients with ischemic stroke.However,for patients with spontaneous intracerebral hemorrhage,whether anticoagulant drugs can be used and how to use them have not yet reached consensus,mainly on account of the risks of rebleeding or hematora enlargement.This article reviews the related literatures in recent years and summarizes the advances in research on the prevention and treatment of venous thrombosis in patients with intracerebral hemorrhage.

Objective To study the role of early intravenous nutrition given aggressively combined with early minimal feeding on very low birth weight infants (VLBWI),and to evaluate the clinical value of intestinal barrier protein and MicroRNA.Methods All of 62 cases of VLBWI admitted in NICU,the Maternal and Child Health Hospital of Nantong Affiliated to Nantong University from January 2006 to June 2014 were recruited.Sixty-two VLBWI were randomly divided into group A and group B.Thirty infants in group A were exposed to conventional intravenous nutrition.Thirty-two infants in group B were treated with early intravenous nutrition aggressively combined with early minimal feeding.The time of birth weight recovery,days with intravenous nutrition,hospital stay and complications were recorded.The liver and kidney functions,electrolytes,blood gas analysis were monitored.Enzyme-linked immunosorbent method was used to detect intestinal fatty acid binding protein (Ⅰ-FABP),an intestinal barrier protein in plasma.Infection related MicroRNA155 was detected with fluorescent quantitative polymerase chain reaction (RT-PCR).Results Group B was superior to group A in weight loss after birth [(13.70 ± 3.10) ％ vs (5.46 ± 2.64) ％,P ＜ 0.05],shorter recovery time of body weight [(12.20 ± 3.38) d vs (6.82 ± 3.20) d,P ＜ 0.05],fewer days with intravenous nutrition [(29.62 ± 4.16) d vs (20.80 ± 3.20) d,P ＜ 0.05] and shorter hospital stays [(44.60 ± 6.32) d vs (28.91 ± 4.36) d,P ＜ 0.05].Compared with group A,the infants in group B had less complications,including hyperbilirubinemia (31.2％ vs 56.7％),extrauterine growth retardation (34.3％ vs 73.3％),cholestasis (6.2％ vs 23.3％),feeding intolerance (15.6％ vs 53.3％) and necrotizing enterocolitis (0 vs 16.7％) (all P ＜ 0.05).Although Ⅰ-FABP had a higher plasma concentration in group A than that of group B [(9.083 ± 1.059) μg/L vs (7.563 ± 0.739) μg/L],the difference was not significant (t =1.190,P =0.076 4).However,the plasma levels of Ⅰ-FABP in infants with necrotizing enterocolitis were significantly higher than those of group B [(19.500 ± 3.510) μg/L vs (7.563 ±0.739) μg/L,t =5.231,P =0.035 0].The expression of MicroRNA155 in group A was markedly higher than that of group B (2-△△ct were 0.81 ± 0.12 and 0.24 ± 0.08,respectively,P ＜ 0.05).Conclusions Giving aggressive intravenous nutrition early combined with early minimal feeding was safety and effective to VLBWI,which was of benefit to their growth and development,reducing complications and shorting hospital stays.The detection of intestinal barrier protein Ⅰ-FABP and MicroRNA155 is useful for monitoring feeding complications of VLBWI.

Left atrial myxoma is one of the rare causes of cerebral infarction.As the left atrial myxoma complicated artery embolization is more common in cerebral vessels,the first clinical manifestation of about 1/3 patients with left atrial myxoma was cerebral infarction.This article reports a 24-year young female without common vascular risk factors,including hypertension,diabetes,and hyperlipidemia.Multiple cerebral infarctions are the first symptom in patients with left atrial myxoma,and they are analyzed in combination with literature.

Cerebral venous and sinus thrombosis (CVST) is a special type of cerebrovascular disease characterized by cerebral venous return disturbance with increased intracranial pressure due to variety of causes. CVST accounts for 0. 5% ~ 1% in al the cerebrovascular diseases. The early diagnosis and treatment of CVST have a significant impact on the prognosis of the patients. This article reviews the advances in the treatment of CVST.

Objective To investigate the effect of cocaine-amphetamine-regulated transcript peptide (CART) on the content of 4-hydroxy-2-noneral (HNE) and infarct volume after cerebral ischemia/reperfusion in mice.Methods A total of 96 healthy male mice were randomly divided into four groups:ischemia/reperfusion (n =27),CART (n =27),normal saline control (n =27) and sham operation (n =15) groups.A middle cerebral artery occlusion (MCAO) model was induced.Two hours after MCAO,CART 55-102 and equivalent normal saline were injected respectively via the tail veins of mice in the CART group and the normal saline control group,and then they were injected every other 24 hour.The neurological scores,infarct volume and the HNE content of lipid metabolism of oxidative stress were performed and detected respectively at 12,24,48 and 72hours after reperfusion.Results CART could significantly improve the neurological deficit scores (all P ＜0.05) and reduce infarct volume (all P＜0.05) at different time points after ischemia/reperfusion.The content of HNE was upregulated (all P＜0.05) at different points after referfusion.CART could significantly down-regulate the increased HNE levd in brain after ischemia (all P＜0.05).Conclusions CART may protect ischemic brain injury in mice by inhibiting lipid peroxidation.

Objective To assess the safety of early subcutaneous injection of a low-dose low molecular weight heparin (LMWH) nadroparin for prevention of deep vein thrombosis (DVT) in patients with spontaneous intracerebral hemorrhage (sICH).Methods The patients with sICH who early using nadroparin or lower limb intermittent pneumatic compression (IPC) for prevention of DVT were enrolled.A nadroparin group continuously injected nadroparin 0.4 ml/d subcutaneously for 10 days at day 4 after admission and an IPC group used lower limb IPC.Head CT was reexamined and hematoma volume changes were evaluated at day 3,5,and 14 after admission.The hemorrhagic events during the course of treatment were documented,and the lower limb DVT was examined by color Doppler sonography.Results A total of 94 patients with acute sICH (n =41 in the nadroparin group,n =53 in the IPC group) who early use of nadroparin or IPC for prevention of DVT were enrolled.Fourteen patients had lower limb DVT,5 (12.2％) of them were in the nadroparin group and 9 (17.0％) of them were in the IPC group.However,there was no significant difference in the incidence of DVT between the two groups (x2 =0.418; P =0.518).During the treatment,no patient experienced increased intracranial hematoma and rebleeding.Conclusion Early subcutaneous injection of low-dose nadroparin for the prevention of DVT in patients with sICH is safe.

Objective To investigate the effect of cocaine and amphetamine-regulated transcript (CART ) peptides on cortical synaptic plasticity in ischemia-reperfusion (I/R ) injury mice. Methods A total of 288 healthy male specific pathogen free(SPF)grade Kunming mice aged 0 to 12 weeks were selected. They were divided into four groups:I/R group (n =81 ),I/R +CART group (n =81),sham operation group (n=63),and sham operation+CART group (n=63)according to the random number table method. A model of middle cerebral artery occlusion (MCAO)for 2 h and reperfusion was induced. Before reperfusion,the mice of the I/R+CART group were injected CART via tail vein (0. 5μg, 200μl)and the those of the sham operation+CART group were injected equal CART;repeated administration once every 24 hours. 2,3,5-Triphenyl tetrazolium chloride assay was used to detect cerebral infarction volume of the I/R group and the I/R+CART group at different time points (24 h,72 h,and day 7 )after achieving reperfusion. The transmission electron microscope was used to observe the ultrastructural changes of synapses at different time points,and the synaptic morphological parameters were analyzed quantitatively. Western blot was used to observe the expression level of postsynaptic density 95 (PSD-95)proteins in the surrounding area of cortical infarct at 72 h after reperfusion. Results (1 )Compared with the sham operation group,the number of synapses was significantly decreased in the cortical slices in the I/R group (3. 37 ± 0. 38μm2 vs. 7. 04 ± 0. 55μm2 ,2. 89 ± 0. 22μm2 vs. 6. 89 ± 0. 04μm2 ,3. 25 ± 0. 18μm2 vs. 6. 78 ± 0. 42μm2;all P<0. 05). The density of PSD was significantly decreased (24. 4 ± 2. 8 nm vs. 47. 3 ± 6. 1 nm,23. 8 ± 3. 7 nm vs. 46. 5 ± 7. 5 nm,24. 6 ± 2. 2 nm vs. 48. 1 ± 5. 1 nm;all P <0. 05). The width of synaptic cleft was increased (25. 2 ± 2. 1 nm vs. 21. 5 ± 1. 6 nm,25. 2 ± 1. 4 nm vs. 21. 3 ± 1. 0 nm,23. 7 ± 2. 6 nm vs. 21. 6 ± 1. 6 nm;all P<0. 05). The expression level of PSD-95 protein was decreased at 72 h after reperfusion (P<0. 05). (2)Compared with the I/R group,the infarction volume of the I/R+CART group was significantly reduced at 24 h,72 h,and day 7 after reperfusion (29. 0 ± 1. 9% vs. 36. 3 ± 1. 4%,38. 1 ± 1. 4% vs. 47. 6 ± 2. 7%,and 36. 0 ± 2. 8% vs. 42. 5 ± 2. 0%,respectively;all P<0. 05). The number of synapses was significantly increased (4. 32 ± 0. 35 μm2 )and the expression level of PSD-95 protein was increased at 72 h after reperfusion (P<0. 05). The PSD density (33. 8 ± 3. 4,34. 2 ± 4. 6,38. 2 ± 4. 0 nm)was thickened at 24 h,72 h,and day 7 after reperfusion (all P <0. 05),and there were no significant differences in the width of synaptic cleft at each time point(allP>0.05).Conclusion CART can reduce cerebral infarct volume of I/R in mice and improve synaptic plasticity of cortical neurons in mice after ischemic injury.

Objective:To investigate the predictive value of matrix metalloproteinase-9 (MMP-9) and neutrophil to lymphocyte ratio (NLR) in delayed perihematomal edema (dPHE) after spontaneous intracerebral hemorrhage (sICH).Methods:Patients with sICH admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School within 24 h of onset from January 2018 to June 2020 were enrolled retrospectively. Serum MMP-9 levels and peripheral blood cell counts were detected, and NLR were calculated within 24 h of onset. dPHE was defined as an increase of 3 ml in absolute edema volume at 10-21 d after onset of sICH compared with that at 5-9 d. The demographic and baseline clinical and imaging data of the dPHE group and the non-dPHE group were compared. Multivariate logistic regression analysis was used to identify the independent predictors of dPHE. The receiver operating characteristic (ROC) curve was used to evaluate the predictive values of MMP-9 and NLR for dPHE. Results:A total of 195 patients with sICH (61.88±10.60 years old) were enrolled in the study. One hundred and forty-eight patients were males (75.9%). There were 53 patients (27.2%) in the dPHE group and 142 (72.8%) in the non-dPHE group. Univariate analysis showed that age, baseline hematoma volume, baseline National Institutes of Health Stroke Scale score, fasting blood glucose, high-sensitivity C-reactive protein, MMP-9, neutrophil count, NLR and the proportion of irregular hematoma in the dPHE group were significantly higher than those in the non-dPHE group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors, higher MMP-9 (odds ratio [ OR] 4.291, 95% confidence interval [ CI] 2.041-6.590; P=0.007) and higher NLR ( OR 2.530, 95% CI 1.157-4.022; P=0.011) were all the independent predictors of dPHE. ROC curve analysis showed that the area under the curve of MMP-9 for predicting dPHE was 0.819 (95% CI 0.756-0.884; P<0.001), the optimal cut-off value was 164.0 μg/L, and the sensitivity and specificity were 86.79% and 66.90% respectively. The area under the curve of NLR for predicting dPHE was 0.788 (95% CI 0.719-0.856; P<0.001), the optimal cut-off value was 5.683, and the corresponding sensitivity and specificity were 77.36% and 71.13% respectively. Conclusions:sICH patients with higher baseline MMP-9 and NLR are more likely to develop dPHE. Early detection of MMP-9 and NLR in peripheral blood after admission can predict dPHE.

ObjectiveToinvestigatetheriskfactorsofepilepticseizuresanditseffectonclinical outcome in patients w ith cerebral venous sinus thrombosis (CVST). Methods The patients w ith CVST w ere enrol ed retrospectively. The risk factors, clinical manifestations, and imaging data w ere col ected. The data of an epileptic seizure group and a non-epileptic seizure group w ere compared. Results A total of 69 patients with CVST were enroled, including 32 (46.38%) secondary epileptic seizures. In the aspect of clinical manifestations, more patients show ed hemiplegia in the epileptic seizure group (37.50%vs.15.63%; χ2 =5.240, P=0.020). Imaging examination show ed that more patients in the epileptic seizure group presented w ith bleeding ( 29.41%vs. 10.81%; χ2 = 3.818, P= 0.047 ), more lesion involving frontal lobe (31.25%vs.10.81%; χ2 =5.008, P=0.023), and temporal lobe (43.75%vs.8.11%; χ2 =7.318, P=0.005), and the thrombosis sites w ere more common in the superior sagittal sinuses (65.63%vs.40.54%;χ2 =4.264, P=0.036). Multivariate logistic regression analysis show ed that focal neurological deficits (odds ratio 5.167, 95% confidence interval 1.993-15.764; P=0.004) and superior sagittal sinus thrombosis (odds ratio 0.126, 95% confidence interval 0.042-0.370; P=0.039) w ere the independent risk factors for patients w ith secondary epileptic seizures. There w ere no significant differences in hospital mortality (6.25%vs.2.7%; χ2 =0.512, P=0.469 ) and 90 day 90-day ful recovery rate ( defined as Barthel Index >60) (81.25%vs.86.47%; χ2 =0.346, P=0.793) betw een the epileptic seizure group and the non-epileptic seizure group. Conclusions Focal neurologic deficits and superior sagittal sinus thrombosis are the independent risk factors for secondary epileptic seizures, how ever, secondary epileptic seizures is not associ-ated w ith in-hospital mortality risk and 90-day clinical outcomes in patients w ith CVST.

Objective Toinvestigatetheclinicalsignificanceofplasmamatrixmetalloproteinase9 (MMP-9)intheformationofdelayedcerebraledemaafterintracerebralhemorrhage.Methods The clinical data of 107 patients with spontaneous intracerebral hemorrhage treated with conservative medical treatment were analyzed retrospectively. According to the clinical features and imaging changes,they were divided into either a delayed cerebral edema group (case group n=39)or a non-delayed cerebral edema group (control group n =68 ). The plasma MMP-9 level was detected with enzyme-linked immunosorbent assay within 24 h after onset. The patients performed head CT scan again at day 7 and 14 after admission. The changes of hematoma and edema volume were detected. All the possible factors associated with the formation of delayed cerebral edema were firstly analyzed by the univariate analysis. Univariate analysis showed that the variables with significant differences were enrolled into multiple logistic regression analysis. Results TheplasmaMMP-9levelofthedelayedbrainedemagroupwassignificantlyhigherthanthatof the control group,they were 189 ± 51 and 118 ± 27 mg/L respectively (P<0. 01). The result of univariate analysis showed that age,history of smoking,blood glucose level,baseline hematoma volume,and National Institute of Health stroke scale (NIHSS )score on admission might be associated with the formation of delayed cerebral edema after intracerebral hemorrhage. Logistic regression analysis showed that MMP-9 level (OR,9. 745,95%CI 6. 754-15. 466,P<0. 01),baseline hematoma volume (OR,2. 411,95%CI 1. 190-2. 728,P =0. 018),blood glucose level on admission (OR,1. 327,95%CI 1. 133 -1. 850,P =0.004),and NIHSS score (OR,1. 867,95%CI 1. 272-2. 364,P=0. 020)were the independent risk factorsfortheformationofdelayedcerebraledemaafterintracerebralhemorrhage.Conclusion Theamount of bleeding,NIHSS score,and hyperglycemia are the risk factors for the formation of delayed cerebral edema in patients with spontaneous intracerebral hemorrhage,while high MMP-9 level on admission indicated that the risk of the formation of delayed cerebral edema is high.