Objective:To explore the efficacy of bridging therapy (BT) and direct endovascular therapy (DEVT) in patients with acute ischemic stroke induced by large vessel occlusion (LVO-AIS) within 4.5 h of onset.Methods:The clinical data of 154 patients with LVO-AIS within 4.5 h of onset, admitted to our hospital from January 2017 to July 2019, were retrospectively collected. Among them, 88 patients were hospitalized within 3 h of onset (54 accepted BT and 34 accepted DEVT); 66 patients were hospitalized within 3-4.5 h of onset (39 accepted BT and 27 accepted DEVT). The differences in clinical data and treatment efficacy between patients from the BT group and DEVT group that were hospitalized within 3 h of onset and within 3-4.5 h of onset, respectively, were compared. Multivariate Logistic regression was used to analyze the independent protective factors for favorable outcome 90 d after treatment in patients within 3.0-4.5 h of onset and within 3 h of onset, respectively.Results:(1) In patients within 3 h of onset: as compared with the DEVT group, the BT group had significantly higher improvement rate of neurological function at 24 h after treatment (41.2% vs. 70.4%) and higher percentage of patients enjoying favorable outcome 90 d after treatment (44.1% vs. 66.7%, P<0.05); multivariate Logistic regression analysis showed that BT was an independent protective factor for favorable outcome 90 d after treatment in patients within 3 h of onset ( OR=4.644, 95%CI: 1.238-12.805, P=0.041). (2) In patients within 3-4.5 h of onset: as compared with the BT group, the DEVT group had significantly higher proportion of patients having time from onset to groin puncture≤4 h, and significantly higher proportion of patients with favorable outcome 90 d after treatment ( P<0.05); multivariate Logistic regression analysis showed that the time from onset to groin puncture≤4 h was an independent protective factor for favorable outcome 90 d after treatment in patients within 3-4.5 h of onset ( OR=5.724, 95%CI: 1.192-11.676, P=0.024). Conclusion:For LVO-AIS patients, BT is the first choice in patients hospitalized in the early time window; and BT should be performed within 4 h of onset to the greatest extent for patients hospitalized in the late time window; if time from onset to groin puncture is not within 4 h, DEVT should be the first choice.

Atherosclerosis is a chronic systemic inflammatory disease caused by the interaction of environment and genetic factors. Epigenetic modification is a bridge between environmental factors and genetic factors. DNA methylation is an important regulatory mode of epigenetic modification, which can regulate gene expression at the pre-transcriptional level. Studies have shown that DNA methylation plays an important role in the occurrence and development process of atherosclerosis. Therefore, atherosclerosis-related DNA demethylation, especially carotid atherosclerosis-related DNA demethylation, can be achieved by natural or synthetic DNA demethylases, thereby achieving the purpose of preventing or treating atherosclerotic cerebrovascular disease. This article reviews DNA methylation and its relationship with atherosclerosis and DNA demethylation therapy.

Objective To investigate the changes of the levels of sonic hedgehog (SHH) and vascular endothelial growth factor (VEGF) in serum and its relationship with collateral circulation in patients with symptomatic middle cerebral artery stenosis. Methods From January 2015 to January 2018, a total of 268 patients with acute ischemic stroke confirmed as unilateral middle cerebral artery M1 segment (MCA-M1) severe stenosis or occlusion by digital subtract angiography (DSA) were enrolled. The baseline clinical data were collected. According to the establishment of collateral circulation shown by DSA, they were divided into good collateral circulation group (152 patients) and poor collateral circulation group (116 patients). The levels of SHH and VEGF in serum were detected by enzyme linked immunosorbent assay (ELISA), the expression characteristics of SHH and VEGF in serum and the relative factors influencing the establishment of collateral circulation were analyzed. Results The levels of serum SHH and VEGF in good collateral circulation group were significantly higher than those in poor collateral circulation group (P < 0.01). Pearson correlation analysis showed that there was a positive correlation between SHH and VEGF (r=0.758, P < 0.01). Multivariate Logistic regression analysis showed that the levels of serum SHH ( OR=0.310, 95% CI 0.117-0.819, P=0.018) and VEGF ( OR=0.361, 95% CI 0.147-0.887, P=0.026) were independent protective factors for the establishment of collateral circulation. Diabetes ( OR=3.094, 95% CI 1.321-7.245, P=0.009) was independent risk factor for the establishment of collateral circulation. Conclusions The levels of serum SHH and VEGF are closely related to the formation of collateral circulation and they are independent protective factors. SHH may be involved in the establishment of cerebral collateral circulation by regulating the expression of VEGF and diabetes is not conducive to the formation of collateral circulation.

Objective To explore the effect of Linggui Zhugan decoction on the level of serum inflammatory factors , blood lipid and oxidation with coronary heart disease (CHD).Methods 123 cases of patients diagnosed as CHD and met criterions were collected from May 2013 to February 2015 in cardiovascular department of our hospital.They were divided into two groups according to different treatment modalities, observation group and control group.General information of the two groups were comparable, The patients of two groups reveived conventional treatments such as taking aspirin enteric-coated tablets, rosuvastatin, nitrate.The patients of observation group received Linggui Zhugan Decoction on the basis of conventional treatments.The serum levels of TC, TG, LDL-C, HDL-C, TNF-α, IL-6, IL-1β, SOD, MDA were recorded before and after treatment.Results The serum levels of TC, TG, LDL-C of observation groups were lower than those of control group after treatment (P<0.05).And the serum levels of HDL-C of observation groups were higher than those of control group after treatment (P<0.05).There was significant improvement in the serum levels of TNF-α, IL-6, IL-1β, MDA and SOD of two groups after treatment than those before treatment (P<0.05).The serum levels of TNF-α, IL-6, IL-1β, MDA of observation group were lower than those of control group after treatment ( P<0.05 ) , while the SOD serum levels of observation group were higher than those of control group after treatment (P<0.05).Conclusion Linggui Zhugan decoction could significantly improve the levels of blood lipids and decrease the levels of inflammation and oxidative stress in patients of CHD with significant effect.

Objective To evaluate and explore the Patients with acute cerebral infarction P-selectin and C-reactive protein (CRP) clinical significance.Methods According to the degree of neurological deficit scores were divided into light group (38 cases),medium group (35 cases) and severe group (25 cases),30healthy subjects were selected as the control group,measured at different time levels of P-selectin and CRP.Results Light group,medium group,severe group admitted 24 h P-selectin levels were higher,the difference was statistically significant (P ＜ 0.05).Light group,medium group,severe group admission decreased after 3 d P-selectin levels were highest; mild group admitted 24 h,7 d P-selectin levels and medium-sized group and severe group differences were statistically significant (P ＜ 0.05).Light group,medium group,severe group admission 3 d P-selectin levels were statistically significant differences (P ＜ 0.05) among the three groups.Light group,medium group admitted 14 d P-selectin levels and heavy group differences were statistically significant (P ＜ 0.05).Light group,medium group,severe group admitted 24 h CRP levels were higher,the difference was statistically significant (P ＜ 0.05).Light group,medium group,severe group admitted 24 h,3 d,7 d,14 d CRP levels decreased,comparing the differences among the three groups were statistically significant (P ＜ 0.05) at the same time point.Linear correlation analysis showed that P-selectin hormone levels and CRP levels were positively correlated (r =0.493,P ＜ 0.05).Conclusions Serum P-selectin and C reactive protein may be involved in the pathological process of ACI.The changes of serum P-selectin and C reactive protein levels were contributed to judge severity of pathological changes,focus range and prognosis assessment.It is an important biochemical observational indicator,and it's worthy recommending in clinic.

Objective To investigate the risk factors of mild renal impairment in cerebral infarction patients.Methods One hundred and fifty patients with cerebral infarction were enrolled from June 2012 to June 2013,and all patients received cranial magnetic resonance imaging at the first week.The clinical data of patients were recorded in detail,24 h microalbuminuria (mALB) was detected,renal function was assessed.According to mALB,the patients were divided into normal renal function group (105 cases) and mild renal dysfunction group (45 cases).Clinical risk factors between 2 groups were compared,and multivariate regression analysis was done.Results Age in mild renal dysfunction group was greater than that in normal renal function group [(67.04 ±9.37) years vs.(63.01 ± 11.18) years],the incidence of hypertension and multiple lacunar infarction were higher than those in normal renal function group[57.8％ (26/45) vs.33.3％ (35/105),57.8％ (26/45) vs.22.9％ (24/105)],leukoaraiosis grade was higher than that in normal renal function group,there were significant differences (P ＜ 0.05 or ＜ 0.01).Logistic regression analysis found that hypertension (OR =1.04 1,P =0.045) and leukoaraiosis (OR =2.048,P =0.000) were independent risk factors for cerebral infarction patients with mild renal impairment.Conclusions The incidence of mild renal impairment is higher in cerebral infarction patients,and is closely related to hypertension and leukoariosis.Early detection of 24 h mALB in cerebral infarction patients has important clinical significance.

Objective To explore the influence of the cognitive function and related dangerous factors in patients lacunar infarction(LI) after carotid artery stenting (CAS).Methods Neuropsychological tests (MoCA and MMSE)were conducted in 43 patients with LI before CAS,1 month,6 months,1 year and 2 years after CAS and the scores were compared with those of 41 healthy cases.Results Compared with control group,in therapy group,MMSE scores before CAS,1 month and 6 months after CAS,MoCA scores before CAS(19.39 ±2.17) and 1 month after CAS(19.51 ± 1.99) and the scores of Cube Copying before CAS,Alternating Trail Making Test,attention and delayed recall before CAS,1 month after CAS and Clock Drawing before CAS,1 month and 6 months after CAS all lowered obviously.There were statistical differences(P＜ 0.05 or P ＜ 0.01).Compared with before CAS,in therapy group,MMSE scores and MoCA scores 6 months,1 year and 2 years after CAS,the scores of Alternating Trail Making Test 2 years after CAS,Cube Copying and Clock Drawing 1 year and 2 years after CAS and attention and delayed recall 6 months,1 year and 2 years after CAS all increased obviously.There were statistical differences (P ＜ 0.05 or P ＜ 0.01).In the follow-up of 2 years,the result of Logistic Regression Analysis showed that MoCA scores has correlation with age(OR =50.751,95％ CI 1.407 ～ 19.464; P =0.006),high blood pressure(0R=8.012,95％ CI1.212 ～27.550; P=0.042)and low levels of education(OR=11.586,95％ CI1.164～ 16.903 ; P =0.029) and no correlation with diabetes and CAS.Conclusion Cognitive impairment in patients with LI is improved 2 years after CAS,and visuospatial function,attention and delayed recall are significantly improved.But CAS is not independent protective factors for cognitive functions,and old age,low education levels and high blood pressure are independent risk factors for cognitive impairment in patients with LI.

ObjectiveTo explore the characteristics of the cognitive changes in patients with lacunar infarction(LI) after carotid artery stenting(CAS).MethodsNeuropsychological tests were conducted in 43 patients with LI and carotid stenosis before and 1 month,6 months,12 months after CAS and the scores were compared with those of 41 healthy cases.ResultsCompared with control group,MMSE scores ( 26.33 ± 1.94),memory and executive function in therapy group lowered obviously.There was statistical difference (P＜ 0.05 or P＜ 0.01 ).Compared with before CAS,MMSE scores of 1 month (27.17±2.15),6 months (27.17 ±2.15),12 months (28.15±1.98) after CAS,memory and executive function in therapy group were all better obviously.There was statistical difference (P＜0.05 or P＜0.01).ConclusionIn acute stage of patients with LI (with in 1 week),most cognitive impairment was severe. Most cognition disorders was improved to normal level 12 months after CAS.The mechanism may be associated with the improvement of chronic cerebral insufficiency.

Objective To explore the changes and the clinical relevance of plasma p-selectin (PS) and vascular endothelial cell function in patients with carotid stenosis (CS) before and after carotid artery stenting (CAS). Methods The plasma levels of PS, yon willebrand (vWF) and endothelin-1 (ET-1) before CAS and 1hour,6 hours,24 hours,2 months after CAS in 67 patients with carotid stenosis and 54 cases of TIA with negative result from cerebral angiography were measured. The patients of the therapy group were further divided into group A and group B according to complexity of CAS. The plasma levels of PS and vWF were determined by enzyme linked immunosorbent assay,and the level of ET-1 was measured by radioimmunoassay. Results The plasma levels of PS,vWF and ET-1 all increased in the patients group after CAS. In the therapy group,the level of PS reached peak value (29.23 ± 6.98) ng/ml 1 hour after CAS, and the levels of vWF and ET-1 reached peak value (119.63 ±16.75) %, (79.71 ± 9.78) ng/L 6 hour after CAS. In therapy group, there was significant difference in the levels of PS and ET-1 between each time points after CAS and before CAS (P＜0.05,P ＜0.01 respectively). There was significant difference in the level of vWF between 1 hour, 6 hours, 24 hours after CAS and before CAS (P ＜ 0.05 orP ＜ 0.01). There was significant difference in tihe levels of PS 1 hour after CAS and ET-1 at 6 hours after CAS (P ＜0.05) ,and in the level of vWF at 1 hour,6 hours after CAS between control group and therapy group (P ＜0.01).There was significant difference in the level of vWF at every time point after CAS (P ＜ 0.05 or P ＜ 0.01), and in the level of ET-1 at 1 hour,6 hours,24 hours between A group and B group(P ＜0.05 or P ＜0.01). Conclusions PS, vWF and ET-1 were activated to some extent and related to pathological changes degree and complexity of CAS. Monitoring these biological indexes after CAS maybe of great value in predicting risk, evaluating clinical therapy and judging prognosis.