Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra

BACKGROUND

The L2 nerve root is considered part of the lumbar plexus that innervates the iliopsoas (IP) and quadricep muscles (Qd). Total en bloc spondylectomy (TES) at the L2 vertebra requires bilateral nerve root transection to facilitate surgical dissection and vertebral body removal. Information regarding neurological function recovery of the IP and Qd in patients with muscle weakness before TES is lacking. We aimed to report the neurological recovery of IP and Qd after TES involving the L2 vertebra in preoperative lower extremity weakness in spinal tumor patients.

METHODS

We prospectively recorded all L2-involved spinal tumor patients undergoing TES between January 2018 and November 2020. As a primary outcome, we recorded the Manual Muscle Testing (MMT) grade of the IP and Qd preoperatively, immediately postoperatively, and at follow-up. Secondary outcomes included the Frankel neurological status, sensation impairment, and the Eastern Cooperative Oncology Group score.

RESULTS

From 8 TES-involving L2 patients, 6 (4 males) met the inclusion criteria. One patient had first-grade deterioration of the Qd MMT immediately postoperatively. All patients could ambulate independently 6 months after surgery. Five patients required follow-up for more than 1 year and could walk without any gait aids. All patients had persistent anterior groin and bilateral thigh numbness until the final follow-up.

CONCLUSION

Neurological recovery of the IP and Qd muscles as measured by MMT can occur within 6 months of bilateral L2 nerve root transection. Bilateral L2 nerve root sacrifice can have acceptable neurological outcomes and recovery, even in patients with preoperative IP and Qd weakness.

LEVEL OF EVIDENCE

4.

Curcumin suppress inflammatory response in traumatic brain injury via p38/MAPK signaling pathway

Traumatic brain injury (TBI) is a common disease worldwide with a high mortality and disability rate and is closely related to the inflammatory response. However, the molecular mechanisms during the pathophysiological responses are not completely understood. This study was conducted to investigate the protective effect of curcumin on TBI and the molecular mechanisms of the p38/MAPK signal pathway. We found that curcumin remarkably ameliorated secondary brain injury after TBI, including effects on the neurological severity score and inflammation. After injection of curcumin, the neurological function score of mice decreased significantly. Curcumin exhibited antiinflammatory pharmacological effects, as reflected by inhibition of inflammatory factors (e.g., interleukin [IL]-1β, IL-6, and tumor necrosis factor [TNF]-α). Additionally, curcumin notably reduced the expression of p-p38 according to western blotting and immunohistochemical analyses. In conclusion, curcumin remarkably alleviated posttraumatic inflammation and thus shows potential for treating inflammation associated with TBI.

Inhibition of Long non-coding RNA zinc finger antisense 1 improves functional recovery and angiogenesis after focal cerebral ischemia via microRNA-144-5p/fibroblast growth factor 7 axis

Long non-coding RNA zinc finger antisense 1 (ZFAS1) has been probed in cerebral ischemia, while the regulatory mechanism of ZFAS1 in focal cerebral ischemia (FCI) via binding to microRNA (miR)-144-5p remains rarely explored. This study aims to decipher the function of ZFAS1 on FCI via sponging miR-144-5p to modulate fibroblast growth factor 7 (FGF7). The focal cerebral ischemia rat model was established by occlusion of the middle cerebral artery (MCAO) Lentivirus vectors altering ZFAS1, miR-144-5p or FGF7 expression were injected into rats before MCAO. Then, ZFAS1, miR-144-5p, and FGF7 levels were detected, the inflammatory factor level, oxidative stress level, angiogenesis, neurological function injury and neuronal apoptosis were assessed. The binding relations among ZFAS1, miR-144-5p and FGF7 were validated. ZFAS1 and FGF7 expression was elevated, while miR-144-5p expression was reduced in FCI rats. Decreased ZFAS1 or FGF7 or enriched miR-144-5p repressed the inflammatory response, oxidative stress, neuronal apoptosis, while it improved angiogenesis, and neurological function recovery; while up-regulated ZFAS1 exerted opposite effects. The augmented miR-144-5p or silenced FGF7 reversed the effects of enriched ZFAS1. ZFAS1 sponged miR-144-5p that targeted FGF7. Inhibition of lncRNA ZFAS1 improves functional recovery and angiogenesis after FCI via miR-144-5p/FGF7 axis. This study provides novel therapeutic targets for FCI treatment.

The mechanisms through which auricular vagus nerve stimulation protects against cerebral ischemia/reperfusion injury

Previous studies have shown that vagus nerve stimulation can improve patients' locomotor function. The stimulation of the auricular vagus nerve, which is the only superficial branch of the vagus nerve, may have similar effects to vagus nerve stimulation. However, the precise mechanisms remain poorly understood. In this study, rat models of cerebral ischemia/reperfusion injury were established by modified Longa ligation. Twenty-four hours later, 7-day auricular vagus nerve stimulation was performed. The results showed that auricular vagus nerve stimulation promoted the secretion of acetylcholine, inhibited the secretion of interleukin-1β, interleukin-6, and tumor necrosis factor-α, and reduced connexin 43 phosphorylation in the ischemic penumbra and motor cortex, promoting locomotor function recovery in rats with cerebral ischemia/reperfusion injury. These findings suggested that auricular vagus nerve stimulation promotes the recovery of locomotor function in rats with cerebral ischemia/reperfusion injury by altering the secretion of acetylcholine and inflammatory factors and the phosphorylation of connexin 43. This study was approved by the Animal Use and Management Committee of Shanghai University of Traditional Chinese Medicine on November 8, 2019 (approval No. PZSHUTCM191108014).

Eucalyptol ameliorates early brain injury after subarachnoid haemorrhage via antioxidant and anti-inflammatory effects in a rat model

CONTEXT

As the terpenoid oxide extracted from Eucalyptus L. Herit (Myrtaceae), eucalyptol (EUC) has anti-inflammatory and antioxidant effects.

OBJECTIVE

To evaluate the neuroprotective role of EUC in subarachnoid haemorrhage (SAH).

MATERIALS AND METHODS

Sprague-Dawley rats were divided into 4 groups: sham group, SAH group, SAH + vehicle group, and SAH + EUC group. SAH was induced by endovascular perforation. In SAH + EUC group, 100 mg/kg EUC was administrated intraperitoneally at 1 h before SAH and 30 min after SAH, respectively. Neurological deficits were examined by modified Neurological Severity Scores (mNSS). The brain edoema was evaluated by wet-dry method. Neuronal apoptosis was detected by Nissl staining. The expression of Bcl-2, cleaved caspase-3, phospho-NF-κB p65, ionised calcium-binding adapter molecule-1 (Iba-1), nuclear factor erythroid-2 (Nrf-2), and haem oxygenase 1 (HO-1) were measured by Western blot. Expression of pro-inflammatory cytokines was detected by qRT-PCR. Oxidative stress markers were also measured.

RESULTS

EUC markedly relieved brain edoema (from 81.22% to 78.33%) and neurological deficits [from 16.28 to 9.28 (24 h); from 12.50 to 7.58 (48 h)]. EUC reduced neuronal apoptosis, microglial activation, and oxidative stress. EUC increased the expression of HO-1 (1.15-fold), Nrf2 (1.34-fold) and Bcl-2 (1.17-fold) in the rats' brain tissue, and down-regulated the expressions of cleaved caspase-3 (41.09%), phospho-NF-κB p65 (14.38%) and pro-inflammatory cytokines [TNF-α (34.33%), IL-1β (50.40%) and IL-6 (59.13%)].

DISCUSSION AND CONCLUSION

For the first time, this study confirms that EUC has neuroprotective effects against early brain injury after experimental SAH in rats.

The Structure and Function of the Glycocalyx and Its Connection With Blood-Brain Barrier

The vascular endothelial glycocalyx is a dense, bush-like structure that is synthesized and secreted by endothelial cells and evenly distributed on the surface of vascular endothelial cells. The blood-brain barrier (BBB) is mainly composed of pericytes endothelial cells, glycocalyx, basement membranes, and astrocytes. The glycocalyx in the BBB plays an indispensable role in many important physiological functions, including vascular permeability, inflammation, blood coagulation, and the synthesis of nitric oxide. Damage to the fragile glycocalyx can lead to increased permeability of the BBB, tissue edema, glial cell activation, up-regulation of inflammatory chemokines expression, and ultimately brain tissue damage, leading to increased mortality. This article reviews the important role that glycocalyx plays in the physiological function of the BBB. The review may provide some basis for the research direction of neurological diseases and a theoretical basis for the diagnosis and treatment of neurological diseases.

Effect of programmed nursing combined with cognitive behavioral intervention on clinical nursing effect and neurological function of patients with intracerebral hemorrhage

OBJECTIVE

To investigate the effect of programmed nursing combined with cognitive behavioral intervention on clinical efficacy and neurological function of patients with intracerebral hemorrhage (ICH).

METHODS

In this retrospective study, 96 patients with ICH admitted to our hospital were enrolled and divided into a programmed group and a joint group, with 48 cases in each group. Patients in the programmed group were treated with programmed nursing while those in the joint group were given cognitive behavior intervention based on programmed nursing, for 28 days. The Fugl-Meyer (FM) Assessment Scale was used to evaluate the motor function of patients, the Barthel index to analyze the activities of daily living (ADL), and the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Outcome Scale (GOS) to assess the neurological function. The quality of life of patients was evaluated by the World Health Organization quality of life Brief Version (WHOQOL-BREF), and the nursing satisfaction of patients or their families was investigated by the self-made satisfaction scale. The incidence of adverse reactions during treatment was recorded and compared.

RESULTS

FM Assessment Scale and Barthel index did not differ significantly between the two groups before nursing (t_Fugl-Meyer =0.059, t_Barthel =0.033, both P>0.05); after nursing, the two scores increased in both groups, with higher scores in the joint group (t_Fugl-Meyer =3.331, t_Barthel =2.735, both P<0.05). Before nursing, there was no difference in NIHSS and GOS scores between the two groups (t_NIHSS =0.257, t_GOS =0.553, both P>0.05); after nursing, however, the NIHSS score decreased and the GOS score increased in both groups, with statistically significant differences between the two groups (t_NIHSS =5.158, t_GOS =5.303, both P<0.05). The total effective rate in the joint group was significantly higher than that in the programmed group (91.67% vs. 77.08%; χ²=4.511, P=0.034). No significant difference was observed in the World Health Organization Quality of Life Scale Brief Version (WHOQOL BREF) score between the two groups (t=0.049, P=0.960) before nursing; after nursing, the score increased significantly in both groups, with a significant difference between the two groups (t=15.970, P<0.001). The satisfaction was 95.83% in the joint group, which was higher than that of 83.33% in the programmed group (χ²=3.913, P=0.048). The joint group also had fewer adverse reactions than the programmed group (χ²=7.401, P=0.007).

CONCLUSION

Programmed nursing combined with cognitive behavioral intervention can improve the clinical efficacy of patients with ICH, improve limb motor ability, and reduce neurological deficits, with high safety.

Effect of butylphthalide on serum CRP, PARK7, NT-3 and neurological function in patients with acute cerebral infarction

OBJECTIVE

The effects of butylphthalide on serum C-reactive protein (CRP), Parkinson disease protein 7 (PARK7), and neurotrophin-3 (NT-3) levels, and neurological function in patients with acute cerebral infarction (ACI) were explored in order to provide a reference for clinical treatment of the disease.

METHODS

One hundred and twenty patients with ACI treated in our hospital from September 2016 to June 2018 were selected and randomized into the control group and the study group, with 60 cases in each group. Patients in the control group were treated with conventional therapy, while those in the study group were treated with butylphthalide. Clinical efficacy, serum levels of CRP, PARK7, and NT-3, as well as the scores of National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), and Barthel Index (BI) before and 2 months after treatment were analyzed and compared between the two groups.

RESULTS

The study group had a significantly higher effective rate (93.33%) than the control group (73.33%; P<0.05). Before treatment, differences in serum CRP, PARK7, NT-3, IL-6, IL-8, and IL-10 levels between the study group and the control group were barely notable (P>0.05). After treatment, the study group observed lower serum levels of CRP, PARK7, IL-6, IL-8, and a higher levels of IL-10, NT-3 in comparison with those of the control group (P<0.05). Before treatment, NIHSS, FMA, and BI scores between the two groups did not show significant differences (P>0.05). After treatment, the study group yielded a remarkably lower NIHSS score and higher FMA and BI scores than the control group (P<0.05).

CONCLUSION

Butylphthalide is effective in the treatment of ACI. It can effectively facilitate the recovery of neurological and motor functions of patients, enhance their quality of life and improve serum CRP, PARK7, and NT-3 levels, which is worthy of clinical promotion.

Human Umbilical Cord-Derived Mesenchymal Stem Cell Therapy Effectively Protected the Brain Architecture and Neurological Function in Rat After Acute Traumatic Brain Injury

Intracranial hemorrhage from stroke and head trauma elicits a cascade of inflammatory and immune reactions detrimental to neurological integrity and function at cellular and molecular levels. This study tested the hypothesis that human umbilical cord–derived mesenchymal stem cell (HUCDMSC) therapy effectively protected the brain integrity and neurological function in rat after acute traumatic brain injury (TBI). Adult male Sprague-Dawley rats (n = 30) were equally divided into group 1 (sham-operated control), group 2 (TBI), and group 3 [TBI + HUCDMSC (1.2 × 10⁶ cells/intravenous injection at 3 h after TBI)] and euthanized by day 28 after TBI procedure. The results of corner test and inclined plane test showed the neurological function was significantly progressively improved from days 3, 7, 14, and 28 in groups 1 and 3 than in group 2, and group 1 than in group 3 (all P < 0.001). By day 28, brain magnetic resonance imaging brain ischemic volume was significantly increased in group 2 than in group 3 (P < 0.001). The protein expressions of apoptosis [mitochondrial-bax positive cells (Bax)/cleaved-caspase3/cleaved-poly(adenosine diphosphate (ADP)-ribose) polymerase], fibrosis (Smad3 positive cells (Smad3)/transforming growth factor-β), oxidative stress (NADPH Oxidase 1 (NOX-1)/NADPH Oxidase 2 (NOX-2)/oxidized-protein/cytochrome b-245 alpha chain (p22phox)), and brain-edema/deoxyribonucleic acid (DNA)–damaged biomarkers (Aquaporin-4/gamma H2A histone family member X ( (γ-H2AX)) displayed an identical pattern to neurological function among the three groups (all P < 0.0001), whereas the protein expressions of angiogenesis biomarkers (vascular endothelial growth factor/stromal cell–derived factor-1α/C-X-C chemokine receptor type 4 (CXCR4)) significantly increased from groups 1 to 3 (all P < 0.0001). The cellular expressions of inflammatory biomarkers (cluster of differentiation 14 (+) cells (CD14+)/glial fibrillary acidic protein positive cells (GFAP+)/ a member of a new family of EGF-TM7 molecules positive cells (F4/80+)) and DNA-damaged parameter (γ-H2AX) exhibited an identical pattern, whereas cellular expressions of neural integrity (hexaribonucleotide Binding Protein-3 positive cells (NeuN+)/nestin+/doublecortin+) exhibited an opposite pattern of neurological function among the three groups (all P < 0.0001). Xenogeneic HUCDMSC therapy was safe and it significantly preserved neurological function and brain architecture in rat after TBI.

Effect and prognosis of emergency nursing path in patients with acute stroke

OBJECTIVE

To evaluate the effect and prognosis of the emergency nursing path in patients with acute stroke.

METHODS

In this prospective study, 108 patients with acute stroke were randomly divided into an observation group (n=54, implementing the emergency nursing path) and a control group (n=54, implementing emergency routine care). We compared the rescue time-related indicators, neurological function, cognitive function and prognosis of the two groups.

RESULTS

The time from admission to diagnosis and the time from diagnosis to specialist treatment in the observation group were shorter than those in the control group (all P<0.05). After two weeks of intervention, the score of National Institute of Health Stroke Scale in the two groups of patients were lower than before the intervention, and the observation group was even lower (all P<0.05). After one month of discharge, the score of Activity of Daily Living Scale decreased while the scores of Montreal Cognitive Assessment, Mini-mental State Examination and Glasgow Outcome Scale increased in both groups, with more significant changes in the observation group (all P<0.05). The disability rate in the observation group was lower than that in the control group (P<0.05).

CONCLUSION

The implementation of emergency nursing could significantly shorten the time from admission to specialist treatment for patients with acute stroke. It could also promote the recovery of neurological and cognitive functions, which was conducive to the prognosis of patients.

Analysis of the application of "psycho-cardiology" model in nursing care of acute stroke patients with depression

OBJECTIVE

To evaluate the effect of "psycho-cardiology" model in nursing care of acute stroke patients with depression.

METHODS

Seventy-eight acute stroke patients with depression were selected for this prospective study, and they were divided into two groups according to the random number table method. The control group (n=39) were given usual care, and the study group (n=39) were given nursing intervention of "psycho-cardiology" model in addition to usual care. The changes of mental state (Hamilton Depression Scale, HAMD; Hamilton Anxiety Scale, HAMA), the neurological function (National Institute of Health Stroke scale, NIHSS), and the cognitive function (Mini-Mental State Examination, MMSE), the prognostic indicator (Fugl-Meyer Assessment, FMA; Barthel Index, BI) were compared between the two groups before and after the intervention. The incidence of complications and nursing satisfaction were also compared between the two groups.

RESULTS

After nursing, the scores of HAMA and HAMD in the study group were significantly lower than those in the control group (P<0.05). The NIHSS score of the study group was significantly lower than that of the control group (P<0.05). The score of MMSE in the study group was significantly higher than that of the control group (P<0.05). The scores of FMA and BI in the study group were significantly higher than those of the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). The nursing satisfaction of the study group was significantly higher than that of the control group (P<0.05).

CONCLUSION

Nursing intervention of "psycho-cardiology" model for acute stroke patients with depression can effectively alleviate the mental stress of patients, improve neurological function and cognitive function, reduce the occurrence of complications, improve prognosis and nursing satisfaction.

Effect of holistic rehabilitation nursing on postoperative neurological function recovery and limb function improvement in patients with intraintracerebral hemorrhage

OBJECTIVE

The aim of this study was to explore the effect of holistic rehabilitation nursing on postoperative neurological functional recovery and limb function improvement in patients with intraintracerebral hemorrhage (ICH).

METHODS

One hundred and twelve patients with ICH treated in our hospital were divided into the observation group (n=56) for holistic rehabilitation nursing and the control group (n=56) for routine nursing by a random number table. The neurological function [the National Institutes of Health Stroke Scale (NIHSS)], limb function (Fugl Meyer Assessment, FMA), psychological state (Hamilton Anxiety/Depression Scale, HAMA/HAMD), activities of daily living (ADL score) and nursing satisfaction were compared between the two groups.

RESULTS

After two weeks of intervention, NIHSS, HAMA, HAMD and ADL scores all decreased in the two groups, and were even lower in the observation group (all P<0.05); the scores of FMA and Simple Test for Evaluating hand Function (STEF) increased, and the scores were higher in the observation group as compared to the control group (both P<0.05). The nursing satisfaction of patients in the observation group was higher than that in the control group (P<0.05).

CONCLUSION

Holistic rehabilitation nursing intervention is more conducive to the recovery of postoperative neurological function and limb function improvement in patients with ICH, and meanwhile, it can alleviate the adverse psychological mood of patients and significantly improve their activities of daily living after operation.

Efficacy of intravascular mechanical thrombectomy combined with thrombolysis and anticoagulant therapy in the treatment of cerebral venous sinus thrombosis and its effect on neurological function and coagulation indices

OBJECTIVE

To evaluate the efficacy of Solitaire AB stent mechanical thrombectomy combined with thrombolysis and anticoagulant therapy (AT) in the treatment of cerebral venous sinus thrombosis (CVST) and its effect on neurological function and coagulation indices.

METHODS

Eighty-two patients with CVST were randomly divided into two groups according to the random number table method. The control group (n=41) were treated with arteriovenous thrombolysis combined with AT, and the observation group were treated with intravascular mechanical thrombectomy plus thrombolysis combined with AT. The effect of the treatment was evaluated 7 days after treatment, and a 6-month follow-up was conductedz after the course of treatment. The clinical efficacy, neurological function (National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS)), coagulation function, complications and prognosis were compared between the two groups.

RESULTS

The continuous improvement rate of clinical symptoms 7 days after treatment in the observation group (87.80%) was higher than that in the control group (58.54%) (P<0.01); The neurological function scores of both groups after treatment were lower than those before treatment (all P<0.001); The scores of NIHSS and mRS in the observation group were lower than those in the control group 7 days after treatment (all P<0.001). The coagulation indices of fibrinogen (FIB), prothrombin time (PT) and activated partial thromboplastin time (APTT) of 7 days after treatment in the observation group were shorter than those in the control group (all P<0.001), and the D-Dimer (D-D) level in the observation group was higher than that in the control group (P<0.001). The incidences of intracranial hemorrhage, infection, headache, quadriplegia, dizziness and drowsiness in the observation group were lower than those in the control group (all P<0.05). The recanalization rate of venous sinus in the observation group was higher than that in the control group 6 months after treatment (P<0.01).

CONCLUSION

Intravascular mechanical thrombectomy plus thrombolysis combined with AT for patients with CVST is effective, which can effectively improve the coagulation function and promote the recovery of neurological function, with fewer complications and a good prognosis.

Impact of enhanced recovery nursing combined with limb training on knee joint function and neurological function after total knee arthroplasty in patients with knee osteoarthritis

OBJECTIVE

To investigate the impact of enhanced recovery after surgery (ERAS) nursing combined with limb training on knee joint function and neurological function after total knee arthroplasty in patients with knee osteoarthritis (KOA).

METHODS

Eighty-six patients with KOA after TKA were randomly divided into two groups, group A and group B, with 43 patients in each group. Group A was given ERAS nursing, and group B was given limb rehabilitation training combined with ERAS nursing. The changes in knee joint function and neurological function were observed.

RESULTS

There was no significant difference in the time to get out of bed for the first time, first bowel movement time after the surgery, hospital stay and hospital costs between the two groups (P>0.05). There was no significant difference in VAS scores between the two groups before the operation and 1 d after the operation (P>0.05). Three days and seven days after the operation, the VAS scores in the two groups both decreased, and the VAS scores of group B were higher than those of group A (P<0.05). There was no significant difference in the excellent rate of Judet scores and Lysholm scores between the two groups (P>0.05), but the two indicators in the two groups all increased at three and six months after the operation, and the two indicators in group B were higher than those of group A (P<0.05). There was no significant difference in NIHSS scores between the two groups before the operation (P>0.05). Fifteen and thirty days after the operation, the NIHSS scores of the two groups both decreased, and the NIHSS scores of group B were lower than those of group A (P<0.05). After the nursing care, the scores of health knowledge level, self-care concept, self-care responsibility and self-care skills in group B were higher than those in group A (P<0.05). The incidence of complications in group B during nursing was lower than group A (P<0.05).

CONCLUSION

The enhanced recovery after surgery nursing combined with limb training has a better effect on KOA patients after TKA. It can significantly improve knee joint function, limb motor ability and neurological function, increase patients' cognition of disease and reduce the incidence of complications, compared with simple enhanced recovery after surgery nursing.

Stingless Bee Honey Reduces Anxiety and Improves Memory of the Metabolic Disease-induced Rats

BACKGROUND

Scientific studies support the evidence of the involvement of Metabolic Syndrome (MetS) in the progression of neurodegenerative diseases through oxidative stress. Consumption of antioxidant compounds was found to be beneficial for brain-health as it reduced the brain oxidative stress level and improved cognitive performance in animals. Stingless bee honey or locally known as Kelulut Honey (KH) has high phenolic content and is widely used as a food supplement.

OBJECTIVES

In this study, we aimed to investigate the effects of KH on the brain of MetS-induced rats.

METHODS

Forty male Wistar rats were divided into 5 groups; 8 weeks (C8) and 16 weeks control groups (C16), groups that received High-Carbohydrate High Fructose (HCHF) diet for 8 weeks (MS8) and 16 weeks (MS16), and a group that received HCHF for 16 weeks with KH supplemented for the last 35 days (KH).

RESULTS

Serum fasting blood glucose decreased in the KH group compared to the MS16 group. HDL levels were significantly decreased in MetS groups compared to control groups. Open field experiments showed that KH group exhibits less anxious behavior compared to the MetS group. Probe trial of Morris water maze demonstrated significant memory retention of KH group compared to the MS16 group. Nissl staining showed a significant decrease in the pyramidal hippocampal cells in the MS16 compared to the KH group.

CONCLUSION

KH has the ability to normalise blood glucose and reduce serum triglyceride and LDL levels in MetS rats, while behavior studies complement its effect on anxiety and memory. This shows a promising role of KH in attenuating neurodegenerative diseases through the antioxidant activity of its polyphenolic content.

Effect of Hyperbaric Oxygen Therapy on Polarization Phenotype of Rat Microglia After Traumatic Brain Injury

Background: The neurological defect caused by secondary damage following traumatic brain injury (TBI) is considered critical for the management of TBI. Microglia (MG) are a resident brain macrophage that could differentiate into M1 type or M2 type in response to injury and repair. It is known that the MG transition from M1 phenotype to anti-inflammatory M2 phenotype might reduce secondary injury of TBI. So, a TBI animal model was established and we compared biomarkers of M1 and M2MG between the controls and experimental animals receiving hyperbaric oxygen therapy (HBOT). This study aimed to explore whether HBOT was an effective method to improve neural functional recovery via promoting the polarization of MG into M2 after TBI.

Methods: The rats were randomly divided into four groups: SH (Sham-operated), SH + HBO (hyperbaric oxygen), TBI, and TBI + HBO. Each group included 42 rats, and each of these were divided into the following groups: 1, 6, 12, 24, 72 h, 7, and 14 days. The expression of M1 biomarker inducible nitric oxide synthase (iNOS), M2 biomarker arginase 1 (Arg1), associated cytokine tumor necrosis factor-α (TNF-α), and transforming growth factor-β1 (TGF-β1) was evaluated after the observation time.

Results: TBI significantly increased the expression levels of M1 marker iNOS and M2 markers Arg1 at different time points. The increased expression of iNOS was suppressed, while the expression level of Arg1 was enhanced by HBOT. Moreover, HBOT suppressed the pro-inflammatory TNF-α secreted by M1, and promoting the anti-inflammatory TGF-1β.

Conclusions: In the present study, HBOT showed the effects on shift of M1 toward M2 phenotype with increased expression of M2 biomarkers and decreased expression of M1 biomarkers in the early stage after TBI.

The Association Between Heart Rate Variability and 90-Day Prognosis in Patients With Transient Ischemic Attack and Minor Stroke

Background: Low heart rate variability (HRV) is known to be associated with increased all-cause, cardiovascular, and cerebrovascular mortality but its association with clinical outcomes in patients with transient ischemic attack (TIA) or minor stroke is unclear.

Methods: We selected TIA and minor stroke patients from a prospective registration study. From each continuous electrocardiograph (ECG) record, each QRS complex was detected and normal-to-normal (N-N) intervals were determined. The standard deviation of all N-N intervals (SDNN) and the square root of the mean squared differences of successive N-N intervals (RMSSD) were calculated. Logistic regression analysis and Cox regression analysis were performed to assess the outcomes of patients at 90 days, and the odds and risk ratios (OR/HR) of each index quartile were compared.

Results: Compared with SDNN patients in the lowest quartile, neurological disability was significantly reduced in other quartile groups at 90 days, with significant differences [OR of group Q2 was 0.659; 95% confidence interval (CI), 0.482–0.900; p = 0.0088; OR of group Q3 was 0.662; 95% CI, 0.478–0.916; p = 0.0127; OR of group Q4 was 0.441; 95% CI, 0.305–0.639; p <0.0001]. Compared with the lowest quartile, the recurrence rate of TIA or minor stroke in patients of the two higher quartiles (Q3 and Q4) of SDNN was significantly reduced at 90 days (HR of Q3 group was 0.732; 95% CI, 0.539–0.995; p = 0.0461; HR of Q4 group was 0.528; 95% CI, 0.374–0.745; p = 0.0003).

Conclusions: Based on our findings, autonomic dysfunction is an adverse indicator for neurological function prognosis and stroke recurrence 90 days after TIA or minor stroke.

Effects of an evidence-based nursing intervention on neurological function and serum inflammatory cytokines in patients with acute cerebral infarction: A randomized controlled trial

BACKGROUND

Acute cerebral infarction is a clinically common and critical disease which seriously endangers the life and safety of elderly patients. Evidence-based nursing is an effective way of nursing and has great significance in improving the neurological function and quality of life of patients. In China, evidence-based nursing has been highlighted and highly developed in recent decades.

OBJECTIVES

This research aimed to investigate the effect of evidence-based nursing on the recovery of neurological function and serum inflammatory cytokines in patients with acute cerebral infarction.

METHODS

A total of 116 patients with acute cerebral infarction were randomly divided into two groups: the control group patients (n = 58) received conventional nursing, while the intervention group patients (n = 58) received evidence-based nursing intervention. National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA) and activities of daily living (ADL) scores, as well as serum TNF-α and IL-6 levels were evaluated and compared between the two groups.

RESULTS

NIHSS scores in the intervention group were significantly lower than the control group. FMA and ADL scores in the intervention group were significantly higher than the control group. TNF-α and IL-6 levels in the serum of the intervention group were significantly lower than the control group.

CONCLUSIONS

In conclusion, evidence-based nursing has a positive effect on the treatment of patients with acute cerebral infarction, which decreases the level of serum inflammatory cytokines and contributes to the recovery of neurological function, motor function and activities of daily living.

Effect of acupuncture on sleep quality and neurological function in stroke patients with sleep apnea syndrome

OBJECTIVE

To investigate the effect of acupuncture on sleep quality and neurological function in stroke patients with sleep apnea syndrome (SAS).

METHODS

In this prospective study, a total of 88 stroke patients with SAS were randomized into two groups: observation group (44 cases; patients received the western medicine treatment combined with acupuncture) and control group (44 cases; patients were given western medicine treatment only). All patients in both groups were treated for three weeks. The clinical efficacy, sleep quality, apnea-hypopnea index (AHI), cognitive function, neuron-specific enolase (NSE) and S100 calcium binding protein β (S100β) levels before and after treatment were compared between patients in the two groups.

RESULTS

Compared with those before treatment, the sleep latency, sleep duration, sleep efficiency and minimal oxygen saturation (SaO_2min) increased, while the longest apnea time and AHI decreased in both groups after treatment. More significant changes were found in the observation group (all P<0.05). After treatment, the overall effective rate in the observation group was higher than that in the control group (P<0.05); serum levels of NSE and S100β in both groups were lower than those before treatment, and the levels of the observation group were lower than those of the control group (all P<0.05); Montreal Cognitive Assessment (MoCA) scores in both groups were higher than those before treatment, and scores of the observation group were higher than those of the control group (all P<0.05).

CONCLUSION

Western medicine treatment combined with acupuncture can significantly relieve the clinical symptoms of stroke patients with SAS and improve sleep quality and neurological function. Therefore, it is worthy of clinical application.

The influences of behavioral and psychological interventions on the neurological function and MMSE scores in Parkinson's disease patients

OBJECTIVE

To analyze the effects of behavioral and psychological interventions on the neurological function in Parkinson's disease (PD) patients.

METHODS

A total of 103 patients with PD admitted to our hospital were randomly divided into the observation group (OG, n=52) or the control group (CNG, n=51). The CNG was treated with routine nursing, while the OG was treated with behavioral and psychological interventions.

RESULTS

At 1, 2, and 3 months after the nursing, the National Institutes of Health Stroke Scale (NIHSS) scores, the unified PD disease rating scale III (UPDRS-III) scores, and the Pittsburgh Sleep Quality Index (PSQI) scores in both groups were lower than they were before the nursing, the NIHSS, UPDRS-III, and PSQI scores in the OG were lower than they were in the CNG, the General Self-efficacy Scale (GSES) and Mini-Mental State Examination (MMSE) scores and the Barthel scores in both groups were higher than they were before the nursing, and the GSES, MMSE, and Barthel scores in the OG were higher than they were in the CNG (P < 0.05).

CONCLUSION

Behavioral and psychological interventions can improve PD patients' impaired neurological function, self-efficacy, cognitive function, motor dysfunction, sleep quality, and quality of life.

Effect of PDCA-based nursing intervention on activities of daily living, neurological function and self-management in acute cerebral stroke

OBJECTIVE

This study explored and analyzed the effects of PDCA-based nursing intervention on the activities of daily living, neurological function and self-management of patients with acute cerebral stroke.

METHODS

A total of 137 patients with acute cerebral stroke who were hospitalized from March 2018 to March 2020 were enrolled and divided into the observation-group (n = 70) and the control-group (n = 67). The control-group was given routine care, while those subjects in the observation group were provided with nursing intervention under the optimization of PDCA cycling. The activities of daily living (ADL), NIHSS score, self-management ability and life quality were compared between these two groups.

RESULTS

ADL scores of the two groups after intervention were much higher than those without intervention (P<0.05), and the observation-group had apparently higher scores than the control-group (P<0.05). After intervention, the NIHSS scores of the two groups were much lower than before intervention (P<0.05), and the score of the observation-group was remarkably lower than the control-group (P<0.05). After intervention, the scores of each dimension of self-management behavior in both groups increased substantially compared to prior-intervention, and the score was higher in observation-group than in control-group (P<0.05). In addition, the two groups had increased scores in each dimension of life quality in post-intervention (P<0.05), and the observation-group had evidently higher scores than the control-group (P<0.05).

CONCLUSION

PDCA-based nursing intervention can substantially enhance the daily living ability, neurological function, and self-management ability of patients, thus contributing to improve the clinical prognosis of patients and as such is worth popularizing.

Surgical clipping and endovascular embolization for senile patients with posterior communicating artery aneurysms complicated with oculomotor nerve palsy

OBJECTIVE

To explore the clinical effect of the surgical clipping and endovascular embolization for senile patients with posterior communicating artery aneurysms (PComA) complicated with oculomotor nerve palsy (ONP) and their neurological recovery.

METHODS

A total of 96 senile patients with PComA complicated with ONP admitted to our hospital from May 2018 to May 2019 were selected and assigned into the experimental group and the control group according to the randomization method, with 48 cases in each group. The patients in the control group underwent surgical clipping, whereas the patients in the experimental group received the endovascular embolization. Subsequently, their surgical therapeutic effect, postoperative blood chemistry parameters, the incidence of complications, the recovery of neurological function and prognosis were analyzed and compared.

RESULTS

The operation duration, bleeding volume, respiratory recovery time and the time to extubation were significantly in favor of the experimental group when compared with the control group (P < 0.001); Senile patients in the experimental group had markedly lower levels of blood chemistry parameters than the control group (P < 0.001); The neurological recovery in the experimental group was found to be remarkably better than that in the control group (P < 0.05); The experimental group showed a distinct decrease in the incidence of complications compared to the control group (P < 0.05); A significant difference in good prognosis was observed between the control group and the experimental group (P < 0.05).

CONCLUSION

Endovascular embolization is more effective in the treatment of senile PComA with ONP. It is superior to the traditional surgical clipping, and has a lower incidence of complications, thereby contributing to the better recovery of neurological function and prognosis.

Umbilical cord-derived MSC and hyperbaric oxygen therapy effectively protected the brain in rat after acute intracerebral haemorrhage

This study tested the hypothesis that combined therapy with human umbilical cord‐derived mesenchymal stem cells (HUCDMSCs) and hyperbaric oxygen (HBO) was superior to either one on preserving neurological function and reducing brain haemorrhagic volume (BHV) in rat after acute intracerebral haemorrhage (ICH) induced by intracranial injection of collagenase. Adult male SD rats (n = 30) were equally divided into group 1 (sham‐operated control), group 2 (ICH), group 3 (ICH +HUCDMSCs/1.2 × 10⁶ cells/intravenous injection at 3h and days 1 and 2 after ICH), group 4 (ICH +HBO/at 3 hours and days 1 and 2 after ICH) and group 5 (ICH +HUCDMSCs‐HBO), and killed by day 28 after ICH. By day 1, the neurological function was significantly impaired in groups 2‐5 than in group 1 (P < .001), but it did not differ among groups 2 to 5. By days 7, 14 and 28, the integrity of neurological function was highest in group 1, lowest in group 2 and significantly progressively improved from groups 3 to 5 (all P < .001). By day 28, the BHV was lowest in group 1, highest in group 2 and significantly lower in group 5 than in groups 3/4 (all P < .0001). The protein expressions of inflammation (HMGB1/TLR‐2/TLR‐4/MyD88/TRAF6/p‐NF‐κB/IFN‐γ/IL‐1ß/TNF‐α), oxidative stress/autophagy (NOX‐1/NOX‐2/oxidized protein/ratio of LC3B‐II/LC3B‐I) and apoptosis (cleaved‐capspase3/PARP), and cellular expressions of inflammation (CD14+, F4/80+) in brain tissues exhibited an identical pattern, whereas cellular levels of angiogenesis (CD31+/vWF+/small‐vessel number) and number of neurons (NeuN+) exhibited an opposite pattern of BHV among the groups (all P < .0001). These results indicate that combined HUCDMSC‐HBO therapy offered better outcomes after rat ICH.

Successful treatment of continuous ossification of the posterior longitudinal ligament in the lumbar spine using percutaneous transforaminal endoscopic spinal decompression: a case report

Ossification of the posterior longitudinal ligament (OPLL) of the lumbar spine is rare relative to that of the cervical spine but is often associated with more severe symptoms. Continuous lumbar OPLL is extremely rare. We herein describe a 48-year-old Chinese woman with lumbar spinal stenosis caused by continuous OPLL. She presented with a 5-year history of lower back pain and intermittent claudication. We performed percutaneous transforaminal endoscopic decompression by the posterolateral approach to achieve adequate decompression of the spinal canal up to the lower 1/3 level (0.9 cm) of the L1 vertebral body and down to the upper 1/2 level (1.3 cm) of the L2 vertebral body. After surgery, the patient's neurological function substantially improved, and her visual analog scale scores for the lower back and both lower extremities and her Oswestry disability index were significantly lower than those in the preoperative period. During the 12-month clinical follow-up period, the patient's neurological function was fully restored, and she regained her ability to walk normally. No surgery-related complications were observed. This case report describes a novel surgical approach that may be an effective treatment alternative for continuous lumbar OPLL.

TMAO Aggregates Neurological Damage Following Ischemic Stroke by Promoting Reactive Astrocytosis and Glial Scar Formation via the Smurf2/ALK5 Axis

Ischemic stroke has been reported to cause significant changes to memory, thinking, and behavior. Intriguingly, recently reported studies have indicated the association of Trimethylamine N-oxide (TMAO) with the acute phase of ischemic stroke. However, the comprehensive underlying mechanism remained unknown. The objective of the present study was to investigate the association between TMAO and recovery of neurological function after ischemic stroke. For this purpose, a middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established and treated with TMAO or/and sh-ALK5, followed by the neurological function evaluation. Behaviors of rats were observed through staircase and cylinder tests. Moreover, the expression of Smurf2 and ALK5 was detected by immunohistochemistry while expression of GFAP, Neurocan, and Phosphacan in brain tissues was determined by immunofluorescence. Thereafter, gain- and loss-of-function assays in astrocytes, the proliferation, viability, and migration were evaluated by the EdU, CCK-8, and Transwell assays. Besides, Smurf2 mRNA expression was determined by the RT-qPCR, whereas, Smurf2, ALK5, GFAP, Neurocan, and Phosphacan expression was evaluated by the Western blotting. Finally, the interaction of Smurf2 with ALK5 and ALK5 ubiquitination was assessed by the co-immunoprecipitation. Notably, our results showed that TMAO promoted the proliferation of reactive astrocyte and formation of glial scar in MCAO/R rats. However, this effect was abolished by the Smurf2 overexpression or ALK5 silencing. We further found that TMAO upregulated the ALK5 expression by inhibiting the ubiquitination role of Smurf2. Overexpression of ALK5 reversed the inhibitory effect of Smurf2 on astrocyte proliferation, migration, and viability. Collectively, our work identifies the evolutionarily TMAO/Smurf2/ALK5 signaling as a major genetic factor in the control of reactive astrocyte proliferation and glial scar formation in ischemic stroke, thus laying a theoretical foundation for the identification of ischemic stroke.