Objective To investigate the efficacy and safety of tirofiban in the treatment of branch atheromatous disease(BAD)in elderly patients.Methods A retrospective analysis was conducted on 215 elderly BAD patients admitted to our department from June 2021 to June 2023.According to their treatment,they were divided into tirofiban group 1(55 cases)and control group 1(160 ca-ses).Using propensity score matching in a ratio of 1∶1 algorithm for adjustment,the differences in baseline features between the two groups were eliminated,and there were finally 53 cases in the tirofiban group 2 and 53 cases in the control group 2 after matching.The NIHSS scores before treatment and at 24 h and 7 d after treatment were collected.All of them were followed up for 90 d,and modified Rankin scale(mRS)was applied to evaluate the prognosis.Results The tirofiban group 1 had significantly lower NIHSS score at 24 h and 7 d after treatment and shorter length of hospital stay than the control group 1(P＜0.05,P＜0.01),so were in the tirofiban group 2 than the control group[3(1,4)vs 3(2,6),1(0,3)vs 1(1,4),8(6,10)d vs 9(8,11)d,P＜0.05].The proportion of mRS score ≤1 was obviously larger in the tirofiban group 1 than the control group 1(P＜0.01).The tirofiban group 2 obtained notably larger proportions of mRS score≤1 and≤2(71.7％vs 43.4％,P=0.003;79.2％vs 60.4％,P=0.034),and smaller proportion of mRS≥4(5.7％vs 20.8％,P=0.045)when compared with the control group 2.Logistic regression analysis indicated that in the patients without diabetes and those non-smoking,tirofiban was associated with increased good outcomes(OR=0.266,95％CI:0.090-0.788,P=0.017;OR=0.341,95％CI:0.107-0.931,P=0.046).Conclusion Tirofiban may effectively improve the clinical outcomes in the elderly BAD patients.But further randomized controlled trials are needed for verification.

Cardiac arrest is characterized by the sudden cessation of cardiac activity,accompanied by the abrupt loss of respiration and consciousness,leading to ischemia-hypoxia in vital organs and subsequently resulting in irreversible damage.Even among patients who achieve return of spontaneous circulation(ROSC),only approximately 1%attain favorable neurological functional outcomes.The primary driver of this poor prognosis is cerebral ischemia reperfusion injury(CIRI)following cardiopulmonary resuscitation(CPR).Pharmacological intervention has become a key strategy to improve neurological recovery in these patients.Currently,a wide range of agents targeting CIRI are diverse,with diverse mechanisms of action.Commonly used clinical drugs and their mechanisms include:①Anti-inflammatory agents:Minocycline mitigates inflammation by modulating microglial polarization,while aspirin improves cerebral microcirculation via anti-platelet aggregation;②Antioxidative stress agents:Mitoquinone mesylate(MitoQ)selectively targets,mitochondria to scavenge reactive oxygen species(ROS),while Edaravone dexborneol rapidly inhibits oxidative damage through broad-spectrum free radical scavenging;③Mitochondrial dysfunction-targeted agents:Methylene blue restores energy metabolism by stabilizing mitochondrial membrane potential and inhibiting mitochondrial permeability transition pore(MPTP)opening;④Multi-targeted traditional Chinese medicine(TCM)therapy:Angong Niuhuang Wan and Danshen Chuanxiongqin alleviate brain injury by inhibiting inflammasomes,suppressing astrocyte activation,and modulating relevant signaling pathways,demonstrating the synergistic advantage of a"multi-component-multi-target"mechanism.This review systematically summarizes the mechanisms of action and research progress of these agents,aiming to provide a theoretical basis for clinical drug selection in post-CA management.

Objective:To evaluate the effect of disulfiram on sepsis-associated encephalopathy (SAE) and the relationship with NOD-like receptor family pyrin domain-containing 3 (NLRP3)/caspase-1 signaling pathway in rats.Methods:Forty-five SPF healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 200-220 g, were divided into 3 groups ( n=15 each) using a random number table method: sham operation group, SAE group, and SAE+ disulfiram group (SAE+ DSF group). The SAE model was established by by using cecal ligation and puncture in anesthetized rats. SAE+ DSF group received an intraperitoneal injection of 50 mg/kg disulfiram 4 h before the cecal ligation and puncture. The survival status of rats was recorded within 72 h after surgery. Their neurobehavioral scores were assessed and recorded on days 1-3 after surgery. On the 3rd day after surgery, novel object recognition test (cognitive index) and open field test (activity distance and time in the central area) were conducted sequentially. Following the behavioral testing, the rats were anesthetized, and their hippocampi were dissected and isolated to observe the pathological changes in the hippocampal region (using HE staining) and to determine the expression of NLRP3 and caspase-1 (by Western blot) and the expression of interleukin-1beta (IL-1β), IL-18 and tumor necrosis factor-alpha (TNF-α) mRNA (by fluorescent quantitative polymerase chain reaction). Results:Compared with Sham group, the 72-h survival rate and postoperative neurobehavioral scores were significantly decreased, the activity distance and time in the central area of the open field were shortened, and the cognitive index was decreased, the expression of NLRP3, caspase-1 and IL-1β, IL-18 and TNF-α mRNA was up-regulated ( P<0.05), and the pathological damage was marked in the hippocampus in SAE group ( P<0.05). Compared with SAE group, postoperative neurobehavioral scores were significantly increased, the activity distance and time in the central area of the open field were prolonged, the cognitive index was increased, and the expression of NLRP3 and caspase-1 and IL-1β, IL-18 and TNF-α mRNA was down-regulated ( P<0.05), no significant change was found in the 72-h survival rate ( P>0.05), and the pathological damage to the hippocampus was significantly alleviated in SAE+ DSF group. Conclusions:Disulfiram can alleviate SAE in rats, and the mechanism may be related to the inhibition of the NLRP3/caspase-1 signaling pathway.

Cardiac arrest leads to abrupt cessation of cardiac ejection and effective systemic circulation,placing patients in a life-threatening state.Despite advancements in cardiopulmonary resuscitation(CPR)techniques significantly improving the rate of return of spontaneous circulation,overall hospital discharge rates remain low,primarily due to severe hypoxic-ischemic encephalopathy following CPR,which is the leading cause of mortality or prolonged coma.Accurately predicting neurological prognosis post-CPR is critical for optimizing therapeutic strategies and improving long-term outcomes.This review systematically explores diverse methods for predicting neurological prognosis after CPR,encompassing traditional neurological examinations,cerebral performance category scales,hemodynamic monitoring,and advanced approaches such as neuroimaging,serum biomarkers,neuroelectrophysiological assessments,inflammatory indicators,brain-computer interface technology,and multimodal detection.These methods collectively reflect the severity of brain injury and potential for functional recovery.Neurological examinations and cerebral performance category scales provide rapid initial assessments of functional status;neuroimaging visually delineates the extent of structural brain damage;serum biomarkers and inflammatory indicators evaluate metabolic and immune responses to injury;neuroelectrophysiological monitoring captures real-time neuronal activity.Furthermore,emerging brain computer interface technology and multimodal approaches integrate multiple modalities,offering novel possibilities for precise assessment and dynamic monitoring.By synthesizing reliable prognostic tools,this review facilitates early and accurate evaluation of brain injury severity and recovery potential,guiding timely clinical interventions and providing evidence-based references for post-CPR.

Objective To investigate the effects of different timing of initiation of rivaroxaban anti-coagulation therapy on the efficacy and bleeding risk of atrial fibrillation patients after stroke.Methods A total of 336 patients with atrial fibrillation and stroke admitted in our hospital be-tween January 2021 and December 2023 were consecutively enrolled,and randomly divided into an experimental group(165 cases)and a control group(171 cases).The experimental group received rivaroxaban treatment within 48 h of symptom onset,whereas the control group initiated oral ri-varoxaban treatment on the 3rd,6th,and 12th day post-stroke onset,respectively,depending on stroke severity(mild,moderate,and severe).Their baseline clinical data were collected,and all of them were followed up till 90 d after stroke.The incidences of recurrent ischemic stroke,symp-tomatic intracranial hemorrhage and extracranial hemorrhage,mortality,and proportion of pa-tients with mRS score≤ 2 and distribution of the score were observed and analyzed in the two groups.Results During a 90-day follow-up period,the patients with moderate stroke from the ex-perimental group of patients exhibited a significantly lower rate of recurrent ischemic stroke than those in the control group(5.4％vs 15.9％,P=0.037).However,for patients with mild and se-vere stroke,no obvious difference was observed in the primary endpoint of recurrent ischemic stroke between the experimental and control groups(3.0％vs 3.2％,12.5％vs 14.8％,P＞0.05).Though no statistical differences were observed,lower rates of symptomatic intracranial hemor-rhage(1.5％vs 3.2％,5.4％vs 9.8％),reduced incidence of extracranial hemorrhage(9.0％vs 14.5％,12.2％vs 15.9％),and lower mRS score[1(0,2)vs 1(1,2),3(1,4)vs 3(2,4)]were seen in the patients with mild and moderate stroke from the experimental group when compared with the control group(P＞0.05).Similarly,there were no statistically differences for the severe stroke patients between the experimental and control groups(P＞0.05)in the incidence of extracranial hemorrhage(20.8％vs 22.2％),rate of symptomatic intracranial hemorrhage(20.8％vs 7.4％),mortality(8.3％vs 3.7％),and mRS score[4(3,4)vs 3(3,4)].Two patients from the experimen-tal group died,with one case due to secondary pulmonary infection and the other due to brainstem hemorrhage.In the control group,only one death occurred due to brainstem hemorrhage.Conclu-sion For atrial fibrillation patients,anticoagulation with rivaroxaban within 48 h after stroke has no significant increase in the risk of bleeding,reduces the proportion of recurrent ischemic stroke in patients with moderate stroke,and may improve the prognosis of patients.

Objective:To evaluate the effect of disulfiram on sepsis-associated encephalopathy (SAE) and the relationship with NOD-like receptor family pyrin domain-containing 3 (NLRP3)/caspase-1 signaling pathway in rats.Methods:Forty-five SPF healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 200-220 g, were divided into 3 groups ( n=15 each) using a random number table method: sham operation group, SAE group, and SAE+ disulfiram group (SAE+ DSF group). The SAE model was established by by using cecal ligation and puncture in anesthetized rats. SAE+ DSF group received an intraperitoneal injection of 50 mg/kg disulfiram 4 h before the cecal ligation and puncture. The survival status of rats was recorded within 72 h after surgery. Their neurobehavioral scores were assessed and recorded on days 1-3 after surgery. On the 3rd day after surgery, novel object recognition test (cognitive index) and open field test (activity distance and time in the central area) were conducted sequentially. Following the behavioral testing, the rats were anesthetized, and their hippocampi were dissected and isolated to observe the pathological changes in the hippocampal region (using HE staining) and to determine the expression of NLRP3 and caspase-1 (by Western blot) and the expression of interleukin-1beta (IL-1β), IL-18 and tumor necrosis factor-alpha (TNF-α) mRNA (by fluorescent quantitative polymerase chain reaction). Results:Compared with Sham group, the 72-h survival rate and postoperative neurobehavioral scores were significantly decreased, the activity distance and time in the central area of the open field were shortened, and the cognitive index was decreased, the expression of NLRP3, caspase-1 and IL-1β, IL-18 and TNF-α mRNA was up-regulated ( P<0.05), and the pathological damage was marked in the hippocampus in SAE group ( P<0.05). Compared with SAE group, postoperative neurobehavioral scores were significantly increased, the activity distance and time in the central area of the open field were prolonged, the cognitive index was increased, and the expression of NLRP3 and caspase-1 and IL-1β, IL-18 and TNF-α mRNA was down-regulated ( P<0.05), no significant change was found in the 72-h survival rate ( P>0.05), and the pathological damage to the hippocampus was significantly alleviated in SAE+ DSF group. Conclusions:Disulfiram can alleviate SAE in rats, and the mechanism may be related to the inhibition of the NLRP3/caspase-1 signaling pathway.

Objective To investigate the clinical efficacy and safety of intravenous thrombolysis with tenecteplase in the treatment of CWS.Methods A prospective study was conducted on 136 CWS patients consecutively admitted in Department of Neurology of Zhengzhou People's Hospital from March 2019 to March 2024.They were randomly divided into a tenecteplase group(67 cases)and a control group(69 cases).NIHSS was used to evaluate the recovery of neurological function after treatment.mRS was employed to assess long-term prognosis.Results Significantly larger proportion of white matter lesions and higher baseline SBP level were observed in the tenecteplase group than the control group(P＜0.05).The tenecteplase group obtained obviously greater ratio of overall recovery than the control group,with notably lower NIHSS score,incidence of new CWS attacks and proportion of new acute cerebral infarction at 24 and 72 h and 7 d after treat-ment(P＜0.05,P＜0.01).Moreover,the proportion of mRS score of 0-2 was notably greater,while that of the score of 3-6 was lower in the tenecteplase group than the Control group(P＜0.05).Intravenous thrombolysis with tenecteplase was an influencing factors for 90-day mRS score of 0-2 and of 3-6 in the CWS patients(OR=0.264,95％CI:0.089-0.813;OR=4.144,95％CI:1.184-14.506,P＜0.05).Conclusion Intravenous thrombolysis with tenecteplase for CWS significantly improves the proportion of patients with good prognosis.

Objective To investigate the clinical efficacy and safety of intravenous thrombolysis with tenecteplase in the treatment of CWS.Methods A prospective study was conducted on 136 CWS patients consecutively admitted in Department of Neurology of Zhengzhou People's Hospital from March 2019 to March 2024.They were randomly divided into a tenecteplase group(67 cases)and a control group(69 cases).NIHSS was used to evaluate the recovery of neurological function after treatment.mRS was employed to assess long-term prognosis.Results Significantly larger proportion of white matter lesions and higher baseline SBP level were observed in the tenecteplase group than the control group(P＜0.05).The tenecteplase group obtained obviously greater ratio of overall recovery than the control group,with notably lower NIHSS score,incidence of new CWS attacks and proportion of new acute cerebral infarction at 24 and 72 h and 7 d after treat-ment(P＜0.05,P＜0.01).Moreover,the proportion of mRS score of 0-2 was notably greater,while that of the score of 3-6 was lower in the tenecteplase group than the Control group(P＜0.05).Intravenous thrombolysis with tenecteplase was an influencing factors for 90-day mRS score of 0-2 and of 3-6 in the CWS patients(OR=0.264,95％CI:0.089-0.813;OR=4.144,95％CI:1.184-14.506,P＜0.05).Conclusion Intravenous thrombolysis with tenecteplase for CWS significantly improves the proportion of patients with good prognosis.

Objective To investigate the efficacy and safety of tirofiban in the treatment of branch atheromatous disease(BAD)in elderly patients.Methods A retrospective analysis was conducted on 215 elderly BAD patients admitted to our department from June 2021 to June 2023.According to their treatment,they were divided into tirofiban group 1(55 cases)and control group 1(160 ca-ses).Using propensity score matching in a ratio of 1∶1 algorithm for adjustment,the differences in baseline features between the two groups were eliminated,and there were finally 53 cases in the tirofiban group 2 and 53 cases in the control group 2 after matching.The NIHSS scores before treatment and at 24 h and 7 d after treatment were collected.All of them were followed up for 90 d,and modified Rankin scale(mRS)was applied to evaluate the prognosis.Results The tirofiban group 1 had significantly lower NIHSS score at 24 h and 7 d after treatment and shorter length of hospital stay than the control group 1(P＜0.05,P＜0.01),so were in the tirofiban group 2 than the control group[3(1,4)vs 3(2,6),1(0,3)vs 1(1,4),8(6,10)d vs 9(8,11)d,P＜0.05].The proportion of mRS score ≤1 was obviously larger in the tirofiban group 1 than the control group 1(P＜0.01).The tirofiban group 2 obtained notably larger proportions of mRS score≤1 and≤2(71.7％vs 43.4％,P=0.003;79.2％vs 60.4％,P=0.034),and smaller proportion of mRS≥4(5.7％vs 20.8％,P=0.045)when compared with the control group 2.Logistic regression analysis indicated that in the patients without diabetes and those non-smoking,tirofiban was associated with increased good outcomes(OR=0.266,95％CI:0.090-0.788,P=0.017;OR=0.341,95％CI:0.107-0.931,P=0.046).Conclusion Tirofiban may effectively improve the clinical outcomes in the elderly BAD patients.But further randomized controlled trials are needed for verification.

Cardiac arrest leads to abrupt cessation of cardiac ejection and effective systemic circulation,placing patients in a life-threatening state.Despite advancements in cardiopulmonary resuscitation(CPR)techniques significantly improving the rate of return of spontaneous circulation,overall hospital discharge rates remain low,primarily due to severe hypoxic-ischemic encephalopathy following CPR,which is the leading cause of mortality or prolonged coma.Accurately predicting neurological prognosis post-CPR is critical for optimizing therapeutic strategies and improving long-term outcomes.This review systematically explores diverse methods for predicting neurological prognosis after CPR,encompassing traditional neurological examinations,cerebral performance category scales,hemodynamic monitoring,and advanced approaches such as neuroimaging,serum biomarkers,neuroelectrophysiological assessments,inflammatory indicators,brain-computer interface technology,and multimodal detection.These methods collectively reflect the severity of brain injury and potential for functional recovery.Neurological examinations and cerebral performance category scales provide rapid initial assessments of functional status;neuroimaging visually delineates the extent of structural brain damage;serum biomarkers and inflammatory indicators evaluate metabolic and immune responses to injury;neuroelectrophysiological monitoring captures real-time neuronal activity.Furthermore,emerging brain computer interface technology and multimodal approaches integrate multiple modalities,offering novel possibilities for precise assessment and dynamic monitoring.By synthesizing reliable prognostic tools,this review facilitates early and accurate evaluation of brain injury severity and recovery potential,guiding timely clinical interventions and providing evidence-based references for post-CPR.