ObjectiveTo investigate the effect of vitamin D supplementation on the outcome of acute ischemic stroke in young patients with vitamin D deficiency.MethodsThe prospective controlled study was used to select the consecutive young patients with acute ischemic stroke.Vitamin D deficiency was defined as 25-hydroxyvitamin D (25(OH)D) ≤50 nmol/L.The Patients with vitamin D deficiency were randomly divided into an intervention group and a routine treatment group according to the random number table method.Routine treatment group didn't receive the drug intervention for vitamin D deficiency, and the intervention group received daily oral alfacalcidol 0.5 μg.After 1 year of treatment, the 25(OH)D levels were examined again;the adverse reactions during the drug treatment were monitored;the modified Rankin Scale (mRS) was used to evaluate the functional outcome and 0-2 was defined as good outcome.ResultsThere are 94 patients (53.41%) with vitamin D deficiency among 176 young patients with acute ischemic stroke.They were randomly divided into either an intervention group or a routine treatment group (n=47 in each group).At the end of the follow-up, the good outcome rate (82.98% vs.63.83%;χ2=4.414, P=0.036) and serum 25(OH)D level (85.83±10.53 nmol/L vs.39.10±11.18 nmol/L;t=20.860, P<0.001) in the intervention group were significantly higher than those in the routine treatment group.During the follow-up period, there was no loss to follow-up or death events in both groups.Only 2 cases of nausea and 1 case of dizziness were observed, and the incidence of adverse reaction was 6.38% in the intervention group.ConclusionsVitamin D supplement can increase the vitamin D levels and improve functional outcome in young patients with acute ischemic stroke and vitamin D deficiency.

Objective To explore the influencing factors on short -term efficacy of intravenous thrombolysis with rt -PA.Methods The clinical data of the 95 acute ischemic stroke(AIS)patients who received thrombolytic therapy were analyze.Multivariate logistic regression analysis was used to determine the possible influencing factors. Results Fifty -six(58.95%)patients had favourable outcomes after thrombolytic therapy for 24 hours.Multivariate logistic regression analysis indicated that diabetes(OR =3.933,95% CI 1.199 ~12.897)and TOAST classification (OR =1.448,95% CI 1.032 ~2.032 )were the independent predictors of short -term outcome.Conclusion Diabetes and TOAST classification are the major influencing factors of short -term efficacy after intravenous thrombolysis with rt -PA.It should pay attention screening patients for intravenous thrombolysis therapy and predicting the efficacy of thrombolysis.

Objective: To investigate the prevalence and severity of cerebral microbleeds(CMBs) in patients with different stroke classifications of cerebral infarction. Methods: From October 2016 to December 2017, the clinical data of patients with acute cerebral infarction in the Second Affiliated Hospital of Xuzhou Medical University were collected through the prospective study.The SWI technique was used to screen the CMBs.According to the TOAST and OCSP classifications, the prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction were analyzed. Results: A total of 254 patients with cerebral infarction were enrolled, there were 136 patients(53.54%) in CMBs group and 118 patients(46.46%) in no CMBs group.The prevalence of CMBs in patients with different TOAST classifications was large artery atherosclerosis(54.29%), small-artery occlusion(64.15%), cardioembolism(40.43%), stroke of other determined etiology(33.33%), stroke of undetermined etiology(38.46%), and the difference was statistically significant(χ²=12.206, P=0.016). The prevalence of CMBs in patients with different OCSP classifications was total anterior circulation infarcts(43.75%), partial anterior circulation infarcts(51.19%), posterior circulation infarcts(49.18%), lacunar infarcts(67.53%), and the difference was statistically significant(χ²=8.944, P=0.030). The severity of CMBs in patients with different TOAST classifications was large artery atherosclerosis[mild(55.26%), moderate(26.32%), severe(15.79%)], small-artery occlusion[mild(25.00%), moderate(33.82%), severe(41.18%)], cardioembolism[mild(57.89%), moderate(26.32%), severe(15.79%)), stroke of other determined etiology[mild(50.00%), moderate(33.33%), severe(16.67%)], stroke of undetermined etiology[mild(60.00%), moderate(20.00%), severe(20.00%)], and the difference was statistically significant(Fisher exact test, P=0.025). The severity of CMBs in patients with different OCSP classifications was total anterior circulation infarcts[mild(57.14%), moderate(28.57%), severe(14.29%)], partial anterior circulation infarcts[mild(52.50%), moderate(32.50%), severe(15.00%)], posterior circulation infarcts[mild(50.00%), moderate(33.33%), severe(16.67%)], lacunar infarcts[mild(25.00%), moderate(32.69%), severe(42.31%)], and the difference was statistically significant(Fisher exact test, P=0.023). Conclusion The prevalence and severity of CMBs in patients with different stroke classifications of cerebral infarction are variable.The prevalence of CMBs in small-artery occlusion and lacunar infarcts are the highest and give first place to severe CMBs(number of lesions≥10). We should pay attention to these two stroke classifications by early recognition and taking targeted clinical strategies.

Objective To explore the influencing factors of poor outcome in acute ischemic stroke patients with cerebral microbleeds (CMBs). Methods In prospective study, patients with acute ischemic stroke, admitted to our hospital from October 2016 to December 2017, were divided into CMBs group and non CMBs group. The clinical data of demographics, vascular risk factors, imaging examination, laboratory examination and treatment were collected. Follow up was performed till 6 months of onset, the patients were divided into poor outcome group (modified Rankin scale [mRS] scores>2) and good outcome group (mRS scores 0-2). Univariate analysis and multivariate Logistic regression analysis were used to determine the factors of poor outcome in acute ischemic stroke patients with CMBs. Results (1) A total of 274 patients with acute ischemic stroke were enrolled in the study, including 148 patients (54.01％) of CMBs group and 126 patients (45.99％) of non CMBs group. At the 6 months of follow up, 241 patients finished follow up, and there were 131 patients (54.36％) from CMBs group, 62 patients (47.33％) with poor outcome and 69 patients (52.67％) with good outcome;there were 110 patients (45.64％) from non CMBs group, 38 patients (34.55％) with poor outcome and 72 patients (65.45％) with good outcome; the difference of poor outcome rate in the two groups was statistically significant (P<0.05). (2) Univariate analysis showed that the differences of age distribution, percentage of having history of previous stroke or transient ischemic attack, stroke onset time, TOAST etiology type, stroke severity, number of stroke lesions, treatment methods, hemorrhagic transformation, number of CMBs lesions for grading in CMBs patients from poor and good outcome subgroups had statistical significance (P<0.05). Multivariable Logistic regression analysis showed that large atherosclerotic (odds ratio [OR]=2.239, 95％ confidence interval [CI]: 1.432-2.947, P=0.044), moderate and severe stroke (OR=3.887, 95％CI: 2.403-4.643, P=0.021), severe CMBs (OR=4.491, 95％CI:2.879-6.802, P=0.017), hemorrhagic transformation (OR=2.411, 95％CI: 1.347-3.232, P=0.040) were independent risk factors for poor outcome, and intravenous thrombolysis (OR=0.676, 95％ CI:0.324-0.865, P=0.039) was independent protective factor for good outcome. Conclusions CMBs is prevalent and poor outcome is more common in acute ischemic stroke patients with CMBs. Early evaluating the number of CMBs lesions has important reference value in predicting the occurrence of poor outcome in patients with acute ischemic stroke.

Objective To investigate the influencing factors and outcomes of patients with acute ischemic stroke having negative results in diffusion weighted imaging (DWI).Methods In prospective study, the patients with acute ischemic stroke, admitted to our hospital from October 2016 to January 2018, were selected as research subjects. The demographic and baseline characteristics, imaging data and laboratory examination data were collected. According to the signals of first DWI, the patients were divided into positive DWI group and negative DWI group. The influencing factors of negative results in DWI were clearly defined by univariate and multivariate Logistic regression analyses. The patients from negative DWI group were rechecked for DWI one week after first DWI. All patients were followed up for 90 d, and the outcomes were evaluated by modified Rankin scale (mRS).Results A total of 312 patients with acute ischemic stroke were enrolled finally. The negative rate of DWI was 12.82％ (40/312). Multivariate Logistic regression analysis showed that mild stroke (odds ratio [OR]= 2.533, 95％ confidence interval[CI]: 1.436-3.984,P=0.038), lacunar infarction (OR=4.668, 95％CI: 2.203-6.543,P=0. 005), arteriole occlusion (OR=4.236, 95％CI: 2.448-6.348,P=0.009), brainstem lesion (OR=1.629, 95％CI: 1.035-2.693,P=0.049) and time of onset within hyper-acute period (OR=4.074, 95％CI: 2.683-6.576, P=0.013) were influencing factors for negative results in DWI. The negative rate of DWI in the negative DWI group was reduced to 7.05％ (22/312) one week after first DWI. Totally, 302 patients finished the 90 d of follow up; 40 patients were into the negative DWI group, with poor outcome rate of 27.50％ (11/40); 262 patients were into the positive DWI group, with poor outcome rate of 30.15％ (79/262); the difference of poor outcome rates between the two groups was not statistically significant (P>0.05).Conclusion s The negative results in DWI in patients with acute ischemic stroke are closely related to severity of stroke, TOAST etiological types, locations of the lesions, sizes of the lesions and time of onset. Review of DWI can reduce negative rate of DWI. The outcomes of patients with acute ischemic stroke having negative results in DWI are not better than those with positive results in DWI. The patients with acute ischemic stroke having negative results in DWI and having onset within hyper-acute period should not be excluded from intravenous thrombolytic treatment.

Objective To explore pathogenesis and influencing factors of poor outcome in patients with wake-up stroke.Methods In this prospective study,patients with acute ischemic stroke who were hospitalized in the Department of Neurology of the Second Affiliated Hospital of Xuzhou Medical University from October 2016 to December 2017 were continuously collected.All patients were divided into wake-up stroke group and non-wake-up stroke group according to the onset time.The clinical data of demographics,vascular risk factors,imaging examination,laboratory examination of the two groups were collected to identify the pathogenesis of wake-up stroke.Followed up to six months of onset,the patients were divided into poor outcome (modified Rankin Scale (mRS) score ＞2) and good outcome (mRS score 0-2) subgroups according to mRS score.Multivariate Logistic regression analysis was used to determine the influencing factors of poor outcome in patients with wake-up stroke.Results A total of 178 patients with acute ischemic stroke were enrolled in the study,including 42 patients (23.60％) in the wake-up stroke group and 136 patients (76.40％) in the non-wake-up stroke group.Followed up to six months of onset,11 patients lost,and 167 patients were followed up finally.There were 40 patients (23.95％) in the wake-up stroke group,including 17 patients (42.50％) with poor outcome and 23 patients (57.50％) with good outcome.There were 127 patients (45.64％) in the non-wake-up stroke group,including 32 patients (25.20％) with poor outcome and 95 patients (74.80％) with good outcome.The difference of poor outcome between the two groups was statistically significant (x2=4.393,P=0.036).Comparison of the demographic and baseline data of the wake-up stroke group and the non-wake-up stroke group showed that the differences between variables such as atrial fibrillation and double-dose hypertension were statistically significant.Univariate analysis showed that there were statistically significant differences in vascular risk factors,Trial of Org 10172 in Acute Stroke Treatment etiology,stroke severity,number of stroke lesions,treatment patterns,and number of cerebral microbleeds between the poor and good outcome subgroups.Multivariate Logistic regression analysis showed that the moderate to severe stroke (odds ratio (OR)=3.838,95％ confidence interval (Co 2.162-5.890,P=0.018),the number of lesions in cerebral microbleeds (OR=2.113,95％CI 1.291-2.868,P=0.049) were independent risk factors for poor outcome of wake-up stroke.Intravenous thrombolysis (OR=0.427,95％CI 0.242-0.615,P=0.036) was an independent protective factor for poor outcome of wake-up stroke.Conclusions The onset of wake-up stroke is closely related to atrial fibrillation and reverse scoop hypertension with higher incidence of poor outcome.Early adequate imaging screening and stroke severity assessment have important reference to guide clinical treatment and predict outcome.

Objective To investigate the effect of hyperoside on proliferation and killing activity of NK cells against pancreatic cancer PANC1 cells in vitro,and explore its potential mechanism.Methods Peripheral blood mononuclear cells of healthy donors were isolated,NK cells were induced with medium contained with IL-2 and different concentrations of hyperoside (0.3,1.6,8,40 and 200 μg/ml) for 12 days.Cell viability was observed by trypan blue staining.Phenotype and perforin,granzyme B expression of NK cells were detected by flow cytometry.Killing activity of NK cells against PANC1 cells were analyzed with lactate dehydrogenase (LDH) releasing method.Results The proportion of NK cells in control group and experimental group treated with different concentration of hyperoside both reached about 80％,respectively.The proliferation of CDs-CD56 + NK cells treated by hyperoside at 0.3,1.6 and 8 μg/ml was (93.76 ±8.77),(106.67 ± 12.35) and (118.50 ± 11.51) times,respectively,which were significantly higher than (73.70 ± 9.43) times of the control group.The expressions of perforin in NK cells treated with hyperoside at 1.6,8 and 40 μg/ml were significantly higher than those of the control group [(82.34 ± 2.90) ％,(89.15 ±3.54) ％,(81.78 ± 2.81)％ vs (72.93 ± 2.06)％].The expressions of granzyme B in NK cells treated with hyperoside at 1.6 and 8 μg/ml were significantly higher than those of the control group [(87.30 ± 1.70) ％,(92.16 ±3.05)％ vs (82.35 ±2.73)％].The killing activity of NK cells against PANC1 cells treated by hyperoside at 1.6 and 8 μg/ml was significantly higher than those of the control group [(63.18 ± 3.77)％,(65.34 ± 4.97) ％ vs (52.16 ± 5.48) ％].The differences were statistically significant (all P ＜ 0.05).Conclusions Hyperoside could promote the proliferation of NK cells at certain concentrations and maybe enhance the killing effect against pancreatic cancer PANC1 cells through up-regulating the expression of perforin and granzyme B in NK cells.

Objective To investigate the correlation between post-stroke depression(PSD) and cerebral microbleeds(CMBs)in elderly patients with ischemic stroke.Methods In the prospective study,220 elderly patients with ischemic stroke were enrolled and followed up to one month after onset.Finally a total of 214 elderly patients performed a follow-up.According to DSM-Ⅳ Diagnostic and Statistical Manual of Mental Disorders,patients were divided into the PSD group and non-PSD group.The degree of depression was evaluated by17-item Hamilton Depression Scale(HAMD-17)score,and patients were divided into mild depression,moderate depression and severe depression group.The loci number,distribution and location of CMBs lesions were assessed by SWI.Patients were divided into brain lobe type,deep lobe type and mixed type according to the CMBs lesion location.The influence of CMBs or not,loci number and location of CMBs lesions on PSD were compared.Results A total of 214 elderly patients with ischemic stroke were enrolled,in whom 84(84/214,39.3％)had PSD with 29(34.5％)males and 55(65.5％)females.According to the HAMD scale,there were 51 patients (60.7 ％) with mild depression,25 (29.8 ％) with moderate depression,and 8 (9.5 ％) with severe depression.The prevalence rate of CMBs was 62.5 ％ (32/51) in mild depression group,71.0 ％ (22/25) in moderate depression group,81.8 ％ (6/8)in severe depression group and 45.4 ％ (49/108)in non PSD group(all P=0.008).The number of CMBs lesions were(4.5±1.2)in mild depression group,(7.8± 2.0)in moderate depression group,(12.6±2.7)in severe depression group and(1.8±0.5)in non-PSD group,with the statistically significant differences between groups (F =2.79,P =0.041).The proportions of CMBs lesions location(brain lobe type,deep lobe type and mixed type)were 40.6 ％ (13/32),34.4％(11/32) and 25.0％ (8/32) in mild depression group,36.4％(8/22),40.9％(9/22) and 22.7％(5/22) in moderate depression group,33.3％ (2/6),50.0％ (3/6) and 16.7％ (1/6) in severe depression group,40.8％ (20/49),12.2％ (6/49) and 46.9％ (23/49) in non-PSD group,respectively (Fisher exact test,P =0.043).The proportions of CMBs lesions distribution(left side,right side and double side)were 37.5％(12/32),43.8％(14/32) and 18.8％(6/32) in mild depression group,36.4％ (8/22),40.9％ (9/22) and 22.7％ (5/22) in moderate depression group,50.0％ (3/6),33.3％ (2/6)and 16.7％(1/6) in severe depression group,36.7％(18/49),40.8％(20/49) and 22.5％(11/49) in non-PSD group,and the difference was not statistically significant (Fisher exact test,P =0.998).Conclusions The prevalence rate of CMBs,number of CMBs lesions and deep lobe type of CMBs are closely related to the degree of post-stroke depression in the elderly.The distribution of CMBs lesions has no relevance with the degree of post stroke depression in the elderly.Elderly patients with ischemic stroke at high risk of post-stroke depression can be identified by evaluating CMBs for early intervention,which is worthy of promotion in clinical work.

Objective To investigate the microbiology,risk factors,and impact on outcomes of stroke-associated pneumonia (SAP) in young patients with acute ischemic stroke.Methods Young patients with acute ischemic stroke were enrolled prospectively.Their microbiological data and risk factors for SAP were identified.The outcomes at 90 d after onset were evaluated with the modified Rankin Scale (mRS) scores,and mRS ＞ 2 was defined as poor outcome.The demography and baseline clinical characteristics were compared.Multivariate logistic regression analysis was used to identify the effect of SAP on the outcomes.Results A total of 418 young patients with ischemic stroke were enrolled,including 108 (25.84％) in the SAP group and 310 (74.16％) in the non-SAP group;16 were lost to follow-up,146 (36.32％) were in the poor outcome group and 256 (63.68％) were in the good outcome group.The results of pathogen test showed that the positive rate was 52.78％ and 19.30％ was mixed infection.The main pathogens were community-acquired pathogens (such as Staphylococcus aureus,Streptococcus pneumoniae and Klebsiella pneumoniae),followed by multidrug-resistant nosocomial pathogens (such as Pseudomonas aeruginosa,Acinetobacter Baumanii,and methicillin-resistant Staphylococcus aureus).Multivariate logistic regression analysis showed that smoking (odds ratio [OR] 4.328,95％ confidence interval [CI]2.847-6.442;P =0.014),chronic obstructive pulmonary disease (OR 3.927,95％ CI 2.419-5.253;P=0.017),dysphagia (OR 6.782,95％ CI 4.378-9.553;P=0.003),tracheal intubation or mechanical ventilation (OR 7.632,95％ CI 5.394-12.376;P=0.001),procalcitonin (OR 2.980,95％ CI 2.234-4.118;P =0.027),antibiotics (OR 6.321,95％ CI 4.362-8.376;P =0.007) were the independent risk factors for SAP,and age ＜ 35 years old was an independent protective factor of SAP (OR 0.582,95％ CI 0.329-0.719;P =0.028);history of previous stroke or transient ischemic attack (OR 3.854,95％ CI 2.645-5.023;P=0.014),tracheal intubation and mechanical ventilation (OR 3.501,95％ CI 2.329-4.614;P =0.016),large artery atherosclerosis (OR 5.274,95％ CI 3.342-7.246;P =0.006),baseline National Institutes of Health Stroke Scale score (OR 2.248,95％ CI 1.482-2.821;P=0.031),onset to admission time (OR 1.245,95％ CI 1.184-1.698;P=0.048),SAP (OR 3.347,95％ CI 2.275-4.338;P =0.018) were the independent risk factors for poor outcomes,and age ＜35 years old (OR 0.340,95％ CI 0.147-0.420;P =0.042) and thrombolytic therapy (OR 0.582,95％ CI 0.329-0.719;P =0.028) were the independent protective factors of good outcomes.Conclusion SAP was more common in young patients with acute ischemic stroke,and had its own characteristics in microbiological data and risk factors.SAP was closely associated with poor outcomes.

Objective To investigate the correlation between cerebral microbleeds (CMBs) and early neurological deterioration (END) in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enrolled prospectively. The clinical data, imaging data, and laboratory data were collected. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score increased ≥2 within 7 d compared with the baseline. Susceptibility-weighted imaging was used to detecte CMBs. Multivariate logistic regression analysis was used to identify the independent correlation between CMBs and END. Results A total of 246 patients with acute acute ischemic stroke were enrolled. The incidence of END was 38. 21％ (94/246), 72. 34％ (68/94) occurred within 72 h and 21. 28％ (20/94) occurred from 72 h to 7 d. The detection rate of CMBs in the END group was 72. 34％ (68/94) and that of CMBs in the non-END group was 43. 42％ (66/152). There was significant difference between the two groups (χ2 = 19. 587, P < 0. 001). Multivariate logistic regression analysis showed that previous stroke or transient ischemic attack (odds ratio [ OR ] 1. 883, 95％ confidence interval [ CI ] 1. 284- 2. 277; P = 0. 033 ), large artery atherosclerosis (OR 4. 119, 95％ CI 2. 564-5. 771; P = 0. 003), baseline NIHSS score (OR 1. 682, 95％ CI 1. 320-1. 876; P = 0. 042), severe stroke (OR 4. 228, 95％ CI 2. 634-5. 917; P = 0. 003), onset to admission time (OR 2. 070, 95％ CI 1. 454-2. 582; P = 0. 029), and number of CMB ≥10 (OR 2. 728, 95％ CI 1. 834- 3. 217; P = 0. 016) were the independent risk factors for END. Conclusions END is common in patients with acute ischemic stroke, most of them occurred within 72 h. It is closely associated with the number of CMB, but it is not associated with the location of CMB lesions.