51
|
Gao X, Xie H, Zhu S, Yu B, Xian Y, Ouyang Q, Ji Y, Yang X, Wen C, Wang P, Tong Y, Wang Q. The Combination of Human Urinary Kallidinogenase and Mild Hypothermia Protects Adult Rats Against Hypoxic-Ischemic Encephalopathy-Induced Injury by Promoting Angiogenesis and Regeneration. Front Aging Neurosci 2018; 10:196. [PMID: 30050428 PMCID: PMC6050362 DOI: 10.3389/fnagi.2018.00196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives: Human Urinary Kallidinogenase (HUK) is a tissue kallikrein that plays neuroprotective role in ischemic conditions via different mechanisms. Mild hypothermia (MH) is another robust neuroprotectant that reduces mortality but does not profoundly ameliorate the neurological outcome in hypoxic-ischemic encephalopathy (HIE) patients. However, whether the combination of HUK and MH can be used as a promising neuroprotective treatment in HIE is unknown. Methods: One-hundred and forty-four adult Wistar rats were randomly divided into five groups: Sham, HIE, HUK, MH and a combination of HUK and MH treatment. The HIE rat model was established by right carotid dissection followed by hypoxia aspiration. The survival curve was created within 7 days, and the neurological severity scores (NSS) were assessed at days 0, 1, 3, and 7. Nissl staining, Terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL), immunofluorescent staining and western blotting were used to evaluate neuronal survival, apoptosis and necrosis, tight-junction proteins Claudin-1 and Zonula occludens-1 (ZO-1), vascular endothelial growth factor (VEGF), doublecortex (DCX), bradykinin receptor B1 (BDKRB1), BDKRB2 and Ki67 staining. Results: The combined treatment rescued all HIE rats from death and had a best survival curve compared to HIE. The Combination also reduced the NSS scores after HIE at days 7, better than HUK or MH alone. The combination of HUK and MH reserved more cells in Nissl staining and inhibited neuronal apoptosis and necrosis as well as significantly attenuated HIE-induced decreases in claudin-1, ZO-1, cyclin D1 and BDKRB1/B2 in comparison to HUK or MH treatment alone. Moreover, the combined treatment increased the expression of VEGF and DCX as well as the number of Ki67-labeled cells. Conclusions: This study demonstrates that both HUK and MH are neuroprotective after HIE insult; however, the combined therapy with HUK and MH enhanced the efficiency and efficacy of either therapy alone in the treatment of HIE, at least partially by promoting angiogenesis and regeneration and rescuing tight-junction loss. The combination of HUK and MH seems to be a feasible and promising clinical strategy to alleviate cerebral injury following HIE insult. Highlights: -The combination of HUK and MH distinctly reduces neurological dysfunction in HIE rats.-HUK enhances the neuroprotective effects of MH in HIE.-MH attenuates tight-junction disruption, upregulates the BDKR B1/2, DCX and cyclin D1.-The combination of MH and HUK enhances the expressions of MH/HUK mediated-BDKR B1/2, DCX, cyclin D1 and Ki67 positive cells.
Collapse
Affiliation(s)
- Xiaoya Gao
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Haiting Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Xian
- Department of General Intensive Care Unit of Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Ouyang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yabin Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chunyan Wen
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Penghua Wang
- Department of Microbiology & Immunology, School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Yufeng Tong
- Structural Genomics Consortium, Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
52
|
Chu DK, Kim LHY, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, Szczeklik W, Schünemann HJ, Neary JD, Alhazzani W. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018; 391:1693-1705. [PMID: 29726345 DOI: 10.1016/s0140-6736(18)30479-3] [Citation(s) in RCA: 461] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Supplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practice is unclear. We systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults. METHODS In the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years). Studies limited to patients with chronic respiratory diseases or psychiatric disease, patients on extracorporeal life support, or patients treated with hyperbaric oxygen therapy or elective surgery were excluded. We screened studies and extracted summary estimates independently and in duplicate. We also extracted individual patient-level data from survival curves. The main outcomes were mortality (in-hospital, at 30 days, and at longest follow-up) and morbidity (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) assessed by random-effects meta-analyses. We assessed quality of evidence using the grading of recommendations assessment, development, and evaluation approach. This study is registered with PROSPERO, number CRD42017065697. FINDINGS 25 randomised controlled trials enrolled 16 037 patients with sepsis, critical illness, stroke, trauma, myocardial infarction, or cardiac arrest, and patients who had emergency surgery. Compared with a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO2] across trials, 96% [range 94-99%, IQR 96-98]) increased mortality in-hospital (relative risk [RR] 1·21, 95% CI 1·03-1·43, I2=0%, high quality), at 30 days (RR 1·14, 95% CI 1·01-1·29, I2=0%, high quality), and at longest follow-up (RR 1·10, 95% CI 1·00-1·20, I2=0%, high quality). Morbidity outcomes were similar between groups. Findings were robust to trial sequential, subgroup, and sensitivity analyses. INTERPRETATION In acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an SpO2 range of 94-96%. These results support the conservative administration of oxygen therapy. FUNDING None.
Collapse
Affiliation(s)
- Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lisa H-Y Kim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
| | - Nima Zamiri
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Roman Jaeschke
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Wojciech Szczeklik
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Holger J Schünemann
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - John D Neary
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
53
|
Malisch TW, Zaidat OO, Castonguay AC, Marden FA, Gupta R, Sun CHJ, Martin CO, Holloway WE, Mueller-Kronast N, English J, Linfante I, Dabus G, Bozorgchami H, Xavier A, Rai AT, Froehler M, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Janardhan V, Shaltoni H, Novakovic R, Yoo AJ, Abou-Chebl A, Chen PR, Britz GW, Kaushal R, Nanda A, Nogueira RG. Clinical and Angiographic Outcomes with the Combined Local Aspiration and Retriever in the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry. INTERVENTIONAL NEUROLOGY 2017; 7:26-35. [PMID: 29628942 DOI: 10.1159/000480353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. Summary Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC. Baseline demographics were comparable, except that ARTS patients are less likely to have hypertension or atrial fibrillation. The ARTS group had more ICA occlusions (41.4 vs. 22% in the BGC, p = 0.04 and 26% in CGC, p = 0.1) and less MCA/M1 occlusions (44.8 vs. 68% in BGC and 62% in CGC). Time from arterial puncture to reperfusion or end of procedure with ARTS was shorter than with CGC (54 vs. 91 min, p = 0.001) and was comparable to the BGC time (54 vs. 67, p = 0.11). Final degree of reperfusion was comparable among the groups (TICI [modified Thrombolysis in Cerebral Infarction] score 2b or higher was 72 vs. 70% for CGC vs. 78% for BGC). Procedural complications, mortality, and good clinical outcome at 90 days were similar between the groups. Key Messages The ARTS mechanical thrombectomy in acute ischemic stroke patients appears to yield better results as compared to the use of CGCs with no significant difference when compared to BGC. This early ARTS technique NASA registry data are limited by the earlier generation distal large bore catheters and small sample size. Future studies should focus on the comparison of ARTS and BGC techniques.
Collapse
Affiliation(s)
- Tim W Malisch
- Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Osama O Zaidat
- St Vincent Mercy Hospital, Toledo, Ohio, USA.,Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA
| | | | - Franklin A Marden
- Department of Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Rishi Gupta
- St Vincent Mercy Hospital, Toledo, Ohio, USA.,Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA
| | - Chung-Huan J Sun
- St Vincent Mercy Hospital, Toledo, Ohio, USA.,Neuroscience Center, Well Star Health System, Atlanta, Georgia, USA
| | | | | | | | - Joey English
- California Pacific Medical Center, San Francisco, California, USA
| | - Italo Linfante
- Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | - Guilherme Dabus
- Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | | | - Andrew Xavier
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ansaar T Rai
- Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Michael Froehler
- Department of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Thanh N Nguyen
- Department of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - M Asif Taqi
- Desert Regional Medical Center, Palm Springs, California, USA
| | | | | | - Hashem Shaltoni
- University of Texas Health Science Center, Houston, Texas, USA
| | - Robin Novakovic
- Department of Radiology, Neurology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Albert J Yoo
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Peng Roc Chen
- Department of Neurosurgery, University of Texas, Houston, Texas, USA
| | - Gavin W Britz
- Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA
| | | | | | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|