Objective To investigate the value of total cerebral small vessel disease （CSVD） score combined with three-dimensional arterial spin labeling （3D-ASL） in predicting the prognosis of patients with acute ischemic stroke （AIS） after 90 days of intravenous thrombolysis. Methods A total of 189 AIS patients who were consecutively admitted to Department of Neurology， Changshu Hospital Affiliated to Nantong University， from January 2021 to June 2023 and underwent intravenous thrombolysis with alteplase were enrolled， and multimodal brain MRI was performed to assess total CSVD load and cerebral blood flow in the area of responsibility. A multivariate logistic regression analysis was used to identify the independent influencing factors for poor 90-day prognosis in AIS patients undergoing intravenous thrombolysis. The receiver operating characteristic （ROC） curve was used to investigate the value of total CSVD score and 3D-ASL used alone or in combination in predicting the prognosis of AIS. Results The multivariate regression analysis showed that diabetes （OR=3.601，95%CI 1.448‒8.954，P=0.006）， total CSVD score ≥3 points （OR=4.077， 95%CI 1.785‒9.313，P=0.001）， and baseline NIHSS score （for every 1-point increase：OR=1.167， 95%CI 1.061‒1.283， P=0.001） were independent risk factors for poor prognosis in AIS patients on day 90 after intravenous thrombolysis，while ASL hyperperfusion was an independent protective factor against poor prognosis （OR=0.16， 95%CI 0.050‒0.356，P=0.014）.The ROC curve analysis showed that the predictive model based on CSVD score and ASL perfusion had a C-value of 0.844 （95%CI 0.786‒0.902， P<0.05） and thus had the best predictive efficacy. Conclusion Total CSVD score combined with 3D-ASL can more comprehensively reflect the whole brain circulation network and has a better effect than each indicator alone in predicting the 90-day prognosis of AIS patients undergoing intravenous thrombolysis.

Objective To explore the relationship between glycemic instability index(GLI),peripheral blood CD4+/CD8+,neutrophil-to-lymphocyte ratio(NLR),red blood cell distribution width(RDW),neutrophil gelatinase-associated lipocalin(NGAL),and the occurrence,condition and prognosis of stroke-associated pneumonia(SAP).Methods According to the occurrence of SAP within 7 d after onset,550 patients with acute cerebral infarction were divided into the study group(129 cases with SAP)and the control group(421 cases without SAP).GLI,peripheral blood CD4+/CD8+,NLR,RDW and NGAL levels were measured.The differences in the above indicators were compared between the study group and the control group,as well as SAP patients with different conditions and prognoses.The relationship between above indicators and the occurrence,condition and prognosis of SAP was discussed.The prognostic values of each indicator and combination of indicators were analyzed.Results GLI,NLR,RDW and NGAL levels were higher in the study group,the medium to high risk group and the poor prognosis group than those in the control group,the low-risk group and the good prognosis group.CD4+/CD8+was lower than that in the corresponding group(P＜0.05).Multivariate Logistic regression analysis showed that higher GLI and NLR were independent risk factors for acute cerebral infarction complicated with SAP,and higher GLI,NLR,RDW and NGAL were independent risk factors for the medium to high risk conditions in SAP patients,while higher levels of CD4+/CD8+were protective factor for high-risk diseases in patients with concurrent SAP and SAP(P＜0.05).Higher GLI,NLR and RDW were independent risk factors for poor prognosis in patients with SAP(P＜0.05).ROC curves indicated that the AUC of the combination of GLI,NLR and RDW for evaluating poor prognosis in patients with SAP was better than that of GLI or RDW.Conclusion Changes in GLI,CD4+/CD8+and NLR are influencing factors for the occurrence of SAP.GLI,CD4+/CD8+,NLR,RDW and NGAL are influencing factors for the severity of SAP patients.GLI,NLR and RDW are associated with poor prognosis in SAP patients,and all three have certain predictive effective in predicting the prognosis of SAP patients,and NLR has the highest predictive efficacy.

Aim To study the preventive and therapeutic effects of Buyang Huanwu Decoction(BYHWD)on denervated tibial muscle atrophy of rats.Methods After 60 Sprague-Dawley rats were subjected to Common Peroneal nerve crush model of 5 mm injury, they were randomly divided into 6 groups for daily intragastric administration of drugs:BYHWD high-dose, medium-dose, low-dose groups, mecobalamin group(positive control), model group, sham operation group.The drug administration lasted for 18 days.18 days after operation, slice, masson staining and analysis morphology were performed. The wet weight ratio and section area of tibial muscle were also measured.Results Tibial muscle section area of sham operation group was large, morphous was regular, while that of model group significantly diminished, structure was chaotic, and connective tissue hyperplasia was more obvious;Tibial muscle section area of BYHWD group and mecobalamin group was fairly diminished, morphous was fairly regular, and connective tissue hyperplasia was not obvious.Compared with model group, the section area of BYHWD group all increased significantly(P <0.01)in a dose-dependent manner.Compared with mecobalamin group, the cross section area of BYHWD high-dose group was significantly larger(P <0.05).Compared with model group, the wet weight ratio of BYHWD high-dose and medium-dose group all increased significantly(P <0.01 or P <0.05)in a dose-dependent manner.Conclusion BYHWD has a significant effect of prevention and therapy on denervated tibial muscle atrophy of rats.