To investigate the clinical assessment of dual-enhanced antiplatelet therapy after cerebrovascular intervention to reduce the risk of cerebral infarction recurrence, and to provide a reference for the prevention and treatment of cerebral infarction recurrence risk. 202 patients with cerebral infarction who underwent cerebrovascular intervention in Tianjin Fifth Central Hospital from January 2018 to October 2022 were selected as study subjects. The patients were divided into a treatment group ( n=104) based on randomized controlled single-blind method with 61 males and 43 females with a mean age of (62.33±2.57) years old and a control group ( n=98) with 56 males and 42 females with a mean age of (62.49±2.36) years old. The control group was given aspirin mono-antiplatelet therapy, and the treatment group was given clopidogrel doublet augmented antiplatelet therapy on the basis of the control group, and both groups continued the treatment for 2 months. Platelet counts, coagulation indexes and inflammatory factors were compared between the two groups before and after treatment, and the America National Institutes of Health Stroke Scale (NIHSS) score was used to assess the neurological functions of the two groups before and after treatment, and the recurrence of cerebral infarction in the two groups was counted within 6 months after treatment. In addition, the patients in the treatment group were divided into the cerebral infarction recurrence group and the cerebral infarction non-recurrence group according to whether they had cerebral infarction recurrence within 6 months after treatment, and the clinical data of the patients in the treatment group were collected to analyze the influencing factors of the dual-enhancement antiplatelet therapy for the recurrence of cerebral infarction in patients with cerebral infarction after cerebral vascular intervention by multifactorial logistic regression. The results showed that after treatment, patients in the treatment group had an international normalized ratio (INR) of (1.76±0.38), a platelet activation rate of (39.52±4.79)%, a platelet aggregation rate of (48.54±5.21)%, a tumor necrosis factor-alpha (TNF-alpha) of (28.37±4.47)ng/L, an interleukin 6 (IL-6) of (24.77±3.52)ng/L, a high-sensitivity C-reactive protein (hs-CRP) of (7.39±1.53)mg/L and an NIHSS score of (6.11±1.39) were lower than those of the control group (2.32±0.41), (44.81±6.37)%, (51.39±5.58)%, (39.66±4.51) ng/L, (29.25±4.04) ng/L, (9.03±1.78) mg/L and (9.93±1.46) points (all P<0.05). At 6-month follow-up of all patients, cerebral infarction recurred in 16 (15.38%) patients in the treatment group and in 33 (33.67%) patients in the control group ( χ2=9.185, P<0.05). Kaplan-Meier results showed a statistically significant difference in the rate of recurrence without cerebral infarction in the treatment group compared with the control group(LogRank χ2=4.595, P<0.05). Logistic regression analysis showed that smoking history, cervical vascular plaque, post-treatment NIHSS score, post-treatment stenosis score, post-treatment INR, post-treatment hs-CRP and CYP2C19 gene polymorphism were independent influences on the recurrence of cerebral infarction in cerebral infarction patients with cerebral vascular interventions followed by doublet augmentation of antiplatelet therapy (all P<0.05). In conclusion, dual-enhanced antiplatelet therapy may be an effective measure to reduce the risk of cerebral infarction recurrence after cerebrovascular intervention in patients with cerebral infarction, but it is still influenced by more factors.

To investigate the clinical assessment of dual-enhanced antiplatelet therapy after cerebrovascular intervention to reduce the risk of cerebral infarction recurrence, and to provide a reference for the prevention and treatment of cerebral infarction recurrence risk. 202 patients with cerebral infarction who underwent cerebrovascular intervention in Tianjin Fifth Central Hospital from January 2018 to October 2022 were selected as study subjects. The patients were divided into a treatment group ( n=104) based on randomized controlled single-blind method with 61 males and 43 females with a mean age of (62.33±2.57) years old and a control group ( n=98) with 56 males and 42 females with a mean age of (62.49±2.36) years old. The control group was given aspirin mono-antiplatelet therapy, and the treatment group was given clopidogrel doublet augmented antiplatelet therapy on the basis of the control group, and both groups continued the treatment for 2 months. Platelet counts, coagulation indexes and inflammatory factors were compared between the two groups before and after treatment, and the America National Institutes of Health Stroke Scale (NIHSS) score was used to assess the neurological functions of the two groups before and after treatment, and the recurrence of cerebral infarction in the two groups was counted within 6 months after treatment. In addition, the patients in the treatment group were divided into the cerebral infarction recurrence group and the cerebral infarction non-recurrence group according to whether they had cerebral infarction recurrence within 6 months after treatment, and the clinical data of the patients in the treatment group were collected to analyze the influencing factors of the dual-enhancement antiplatelet therapy for the recurrence of cerebral infarction in patients with cerebral infarction after cerebral vascular intervention by multifactorial logistic regression. The results showed that after treatment, patients in the treatment group had an international normalized ratio (INR) of (1.76±0.38), a platelet activation rate of (39.52±4.79)%, a platelet aggregation rate of (48.54±5.21)%, a tumor necrosis factor-alpha (TNF-alpha) of (28.37±4.47)ng/L, an interleukin 6 (IL-6) of (24.77±3.52)ng/L, a high-sensitivity C-reactive protein (hs-CRP) of (7.39±1.53)mg/L and an NIHSS score of (6.11±1.39) were lower than those of the control group (2.32±0.41), (44.81±6.37)%, (51.39±5.58)%, (39.66±4.51) ng/L, (29.25±4.04) ng/L, (9.03±1.78) mg/L and (9.93±1.46) points (all P<0.05). At 6-month follow-up of all patients, cerebral infarction recurred in 16 (15.38%) patients in the treatment group and in 33 (33.67%) patients in the control group ( χ2=9.185, P<0.05). Kaplan-Meier results showed a statistically significant difference in the rate of recurrence without cerebral infarction in the treatment group compared with the control group(LogRank χ2=4.595, P<0.05). Logistic regression analysis showed that smoking history, cervical vascular plaque, post-treatment NIHSS score, post-treatment stenosis score, post-treatment INR, post-treatment hs-CRP and CYP2C19 gene polymorphism were independent influences on the recurrence of cerebral infarction in cerebral infarction patients with cerebral vascular interventions followed by doublet augmentation of antiplatelet therapy (all P<0.05). In conclusion, dual-enhanced antiplatelet therapy may be an effective measure to reduce the risk of cerebral infarction recurrence after cerebrovascular intervention in patients with cerebral infarction, but it is still influenced by more factors.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Background:Acute lung injury(ALI)is the most common organ dysfunction in severe acute pancreatitis(SAP).Somatostatin analogue octreotide is a common used drug in acute pancreatitis.Aims:To explore the protective mechanism of octreotide on lung injury in SAP mice.Methods:In the first part,the experimental mice were randomly assigned into four groups.SAP model was induced by caerulin and lipopolysaccharide,and the mice were sacrificed 24 hours,48 hours and 72 hours after establishment.HE staining was used to observe the pathological score of pancreas and lung.Serum amylase and lung tissue myeloperoxidase(MPO)activity were detected.Real-time quantitative PCR was used to detect mRNA expressions of pyroptosis-related molecules apoptosis-associated speck-like protein containing a CARD(ASC),caspase-1,Gasdermin D(GSDMD),interleukin(IL)-1β,IL-18 and inflammatory factors IL-6,tumor necrosis factor(TNF)-α,high mobility group protein B1(HMGB1)in lung tissue.Western blotting was used to detect protein expressions of NOD-like receptor thermal protein domain associated protein 3(NLRP3),caspase-1,GSDMD and IL-1β in lung tissue.In the second part,mice were randomly divided into control group,SAP group,and octreotide group.HE staining was used to observe the pathological score of pancreas and lung.Serum amylase and lung tissue MPO activity were detected.Real-time quantitative PCR was used to detect mRNA expressions of pyroptosis-related molecules caspase-1,ASC,IL-1β,IL-18 and inflammatory factors IL-6,TNF-α,HMGB1.Immunofluorescence was used to detect protein expressions of NLRP3,caspase-1,GSDMD,ASC,IL-1β in lung tissue.Results:In the first part,compared with control group,pathological score of pancreas and lung tissue,serum amylase and MPO activity were significantly increased in SAP group(all P<0.05),mRNA expressions of pyroptosis-related molecules caspase-1,ASC,GSDMD,IL-1β,IL-18 and inflammatory factors IL-6,TNF-α,HMGB1 were significantly increased(all P<0.05),protein expressions of NLRP3,caspase-1,GSDMD and IL-1β in lung tissue were significantly increased(all P<0.05),especially in 24 hours after establishment group.In the second part,compared with SAP group,pathological score of pancreas and lung tissue,serum amylase were significantly decreased in octreotide group(all P<0.05),mRNA expressions of pyroptosis-related molecules caspase-1,ASC,IL-1β,IL-18 and inflammatory factors IL-6,TNF-α,HMGB1 were significantly decreased in lung tissue in octreotide group(all P<0.05),protein expressions of NLRP3,caspase-1,GSDMD,ASC and IL-1β in lung tissue were significantly decreased(all P<0.05).Conclusions:Cell pyroptosis is involved in the occurrence and development of lung injury in SAP mice,and octreotide may attenuate lung injury in SAP mice by inhibiting pyroptosis.

OBJECTIVE To compare the safety of polysaccharide iron complex and ferrous sulfate in the treatment of anemia during pregnancy. METHODS Retrieved from Cochrane Library， PubMed， Embase， SinoMed， CNKI， VIP and Wanfang database， randomized controlled trials （RCTs） about polysaccharide iron complex （trial group） versus ferrous sulfate （control group） in the treatment of anemia during pregnancy were collected from the inception to May 20th， 2022. After literature screening， data extraction and quality evaluation， meta-analysis， sensitivity analysis and publication bias analysis were conducted with RevMan 5.3 software. RESULTS A total of 13 RCTs were included， with a total of 1 318 patients. Results of meta-analysis showed that the total incidence of adverse drug reactions （ADR） [RR＝0.11， 95%CI （0.06， 0.18）， P＜0 000 01]， gastrointestinal adverse reactions [RR＝0.08， 95%CI （0.05， 0.12）， P＜0.000 01]， anorexia and nausea [RR＝0.21， 95%CI （0.09， 0.54）， P＝ 0.001]， abdominal pain [RR＝0.18， 95%CI （0.04， 0.78）， P＝0.02]， diarrhea [RR＝0.18， 95%CI （0.04， 0.79）， P＝0.02]， vomiting [RR＝0.24， 95%CI （0.06， 0.89）， P＝0.03] and gingival melanosis [RR＝0.09， 95%CI （0.03， 0.28）， P＜0.000 1] in the trial group were all significantly lower than the control group. The results of sensitivity analysis showed that the conclusions obtained in this study were relatively robust. The results of publication bias analysis indicated that there was a high possibility of publication bias in this study. CONCLUSIONS The polysaccharide iron complex is safer than ferrous sulfate for treatment of anemia during pregnancy.

Objective:To compare the differences in N-acetylaspartate/creatine(NAA/Cr), N-acetylaspartate/choline(NAA/Cho)and choline/creatine(Cho/Cr)in different brain regions of patients with different motor subtypes of Parkinson's disease(PD)or essential tremor(ET)using proton magnetic resonance spectroscopy( 1H-MRS), and to provide an imaging basis for the diagnosis of different PD subtypes and their differential diagnosis from ET. Methods:92 PD outpatients and inpatients, ET patients and healthy individuals receiving check-ups at our hospital from June 2018 to May 2021were retrospectively enrolled and divided into four groups: tremor-dominant(TD)(n=45), postural instability and gait disorders(PIGD)(n=47), ET(n=44), and healthy controls(n=40). Participant clinical information was collected and bilateral basal ganglia and cerebellar cortex 1H-MRS examinations were performed for each group.Values of NAA/Cr, NAA/Cho and Cho/Cr of the basal ganglia and the cerebellar cortex were compared between the groups. Results:NAA/Cr and NAA/Cho values in the basal ganglia were 1.65±0.19 and 1.55±0.20 for the TD group and 1.48±0.11 and 1.46±0.17 for the PIGD group, respectively, lower than in the control group(NAA/Cr: 1.92±0.28; NAA/Cho: 2.08±0.34)and the ET group(NAA/Cr: 2.10±0.16; NAA/Cho: 2.23±0.23), with statistical significance( P<0.05), whereas Cho/Cr values for the former two groups(TD: 1.07±0.25; PIGD: 1.02±0.13)were higher than in the latter two groups(control: 0.92±0.27; ET: 0.91±0.21), with statistical significance( P<0.05). NAA/Cr values of the basal ganglia in the PIGD group were lower than in the TD group( P<0.05). NAA/Cr, NAA/Cho and Cho/Cr values of the basal ganglia in the ET group were not statistically different compared with those in the control group( P>0.05). In the cerebellar cortex, NAA/Cr(0.72±0.16)and NAA/Cho(0.78±0.14)in the ET group were lower than in the control group(0.92±0.20)and(1.12±0.17), the TD group(0.90±0.14); (1.10±0.13)and the PIGD group(0.89±0.25)and(1.08±0.17)( P<0.05). NAA/Cr, NAA/Cho and Cho/Cr values of the cerebellar cortex for the TD group, the PIGD group and the control group had no statistical difference( P>0.05). Conclusions:1H-MRS can detect brain metabolic changes with damage or loss of neurons in the basal ganglia of PD patients and the cerebellar cortex of ET patients, potentially providing an objective imaging basis for early diagnosis of PD, its subtyping and the differential diagnosis from ET.

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.

Objective:To investigate the indwelling time of nasointestinal tube and the safety of delayed use, and to analyze the main influencing factors.Methods:216 patients with indwelling nasointestinal tube were analyzed retrospectively by designing a survey from 2018 to 2020. Receiver operating characteristic curve (ROC) analysis method was used to analyze the threshold of pipe blocking time.Results:Among the 216 patients, the shortest indwelling time was 7 days and the longest was 120 days. The incidence rate of tube blockage, aspiration and accidental extubation was 6.02%(13/216), 2.78%(6/216) and 1.39%(3/216), respectively. Statistical analysis of 13 patients with tube occlusion showed that the incidence of tube occlusion was related to the indwelling time and the speed of pumping (χ 2=46.056, 36.564, P<0.05). In addition, the duration of nasointestinal tube use not only affected the incidence of tube occlusion, but also was related to the incidence of aspiration. With the prolongation of catheter insertion time, the rate of tube occlusion and the incidence of aspiration also increased significantly (χ 2=13.190, P<0.05). ROC curve was used to analyze the correlation between the indwelling time of the feeding tube and the occlusion. The area under the ROC curve was 0.933 (95% CI: 0.886-0.981, P<0.001), the Youden index was 0.829, and the cut-off value of the best indwelling time was 52.5 d. The sensitivity and specificity of the method for determining the occurrence of pipe blockage were 92.3% and 90.6%. Conclusions:It is safe and feasible to extend the indwelling time of nasointestinal tube appropriately, which can reduce the discomfort caused by frequent replacement of nasointestinal tube in patients with long-term enteral nutrition, and reduce the medical cost at the same time. However, when the indwelling time exceeds the threshold, the probability of tube blockage increases significantly, so we should maintain the catheter or replace it in time.

Objective: To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction, and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score. Methods: One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke(the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score, patients in the cerebral infarction group were divided into 3 subgroups: NIHSS score 0-4 group(n=32), NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28). The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups: (1)the traditional treatment group(n=44), taking routine drugs for cerebral infarction; (2)the special treatment group(n=42), taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups. Results: In patients with acute cerebral infarction, the time-domain parameters of normal-to-normal intervals(NNI), standard deviation of normal-to-normal intervals(SDNN), square root of the mean squared successive differences between normal-to-normaI RR intervals(RMSSD), percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50), frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P<0.05). While, pulse rate and frequency domain parameters of sympathetic vagus balance index(LF/HF)were significantly increased(P<0.05). The time-domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF, HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P<0.05). The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P<0.05), and the frequency domain parameters(LF/HF)were increased(P<0.05)in NIHSS score ≥15 group compared with in NIHSS score 5-15 group(P<0.05). Compared with pre-treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), the frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the incidence of cardiac complication(total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P<0.05). As compared with the traditional treatment group after treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the total incidence of cardiac complication were significantly reduced(18.4% or 7 cases vs.40.0% or 16 cases, P<0.05). Conclusions The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores, which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke, early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.