Aspirin plus dipyridamole has the highest surface under the cumulative ranking curves (SUCRA) values in terms of mortality, intracranial hemorrhage, and adverse event rate among 7 drug therapies in the treatment of cerebral infarction

Comparative effectiveness and tolerability of targeted agents combined with chemotherapy in patients with HER2-positive gastroesophageal cancer: A network meta-analysis

Background

Gastric cancer (GC) or gastroesophageal junction (GEJ) cancer with HER2 overexpression is highly invasive, with a poor prognosis. With the development of new targeted agents, which agents have ideal therapeutic effects must be determined. This network meta-analysis analyzed the effectiveness and tolerability of targeted agents combined with chemotherapy in HER2-positive GC/GEJ cancer.

Methods

Public databases were searched from the date of inception to October 22, 2020. Randomized controlled trials (RCTs) on targeted agent-related regimens for HER2-positive advanced GC or GEJ cancer were included. Subgroup analyses based on publication language, first-line treatment, second/third-line treatment, and HER2 staining intensity were performed.

Results

In total, 13 articles were included. The trastuzumabderuxtecan (TraD) and pertuzumab plus trastuzumab and chemotherapy (PerTraChemo) regimens were considered to have high effectiveness but low tolerability. In the subgroup analysis, PerTraChemo still had high effectiveness with low tolerability as the first-line therapy. As the second- or third-line therapy, TraD and lapatinib plus chemotherapy (LapChemo) had high effectiveness and moderate tolerability. In terms of overall survival (OS) time, PerTraChemo had a relative advantage in the immunohistochemistry (IHC) 2+/in situ hybridization (ISH)+ population, whereas TraD, PerTraChemo, and trastuzumab plus chemotherapy (TraChemo) had a relative advantage in the IHC3+ population.

Conclusion

TraD had relative advantages as the second- or third-line therapy and in the IHC3 + population. PerTraChemo is a potential first-line therapy, but it requires further confirmation because the JACOB phase III clinical trial failed to confirm the superiority of PerTraChemo over TraChemo with regard to OS.

Protective multi‑target effects of DL‑3‑n‑butylphthalide combined with 3‑methyl‑1‑phenyl‑2‑pyrazolin‑5‑one in mice with ischemic stroke

DL-3-n-butylphthalide (NBP) and 3-methyl-1- phenyl-2-pyrazolin-5-one (edaravone) are acknowledged neuroprotective agents that protect against ischemic stroke. However, the underlying mechanisms of a combination therapy with NBP and edaravone have not yet been fully clarified. The aim of the present study was to explore whether the co-administration of NBP and edaravone had multi-target protective effects on the neurovascular unit (NVU) of mice affected by ischemic stroke. Male C57BL/6 mice were randomly divided into the following three groups: i) Sham operation control, ii) middle cerebral artery occlusion (MCAO) and reperfusion, iii) and MCAO/reperfusion with the co-administration of NBP (40 mg/kg) and edaravone (6 mg/kg) delivered via intraperitoneal injection at 0 and 4 h after reperfusion (NBP + edaravone). After ischemia and reperfusion, infarct volumes and neurological deficits were evaluated. The immunoreactivity of the NVU, comprising neurons, endothelial cells and astrocytes, was determined using immunofluorescence staining of neuronal nuclei (NeuN), platelet and endothelial cell adhesion molecule 1 (CD31) and glial fibrillary acidic protein (GFAP). Western blotting was used to detect the expression levels of apoptosis-related proteins. The infarct volume, neurological function scores and cell damage were increased in the MCAO group compared with the sham operation group. Furthermore, the MCAO mice had reduced NeuN and CD31 expression and increased GFAP expression compared with the sham group. By contrast, the NBP + edaravone group exhibited reduced cell damage and consequently lower infarct volume and neurological deficit scores compared with the MCAO group. The NBP + edaravone group exhibited increased NeuN and CD31 expression and decreased GFAP expression compared with the MCAO group. Furthermore, the expression levels of Bax and cleaved caspase-3 in the NBP + edaravone group were decreased significantly compared with the MCAO group, while the expression levels of Bcl-2 and mitochondrial cytochrome c were increased. In conclusion, the results of the present study demonstrated that NBP and edaravone effectively prevented ischemic stroke damage with multi-target protective effects. In addition, NBP + edaravone may be a promising combination therapy for ischemic stroke.

[Diabetic encephalopathy: current insights and potential therapeutic strategies]

OBJECTIVE

To study the effect of alpha-lipoic acid (ALA) on cognitive functions in patients with non-insulin dependent diabetes mellitus type 2 (DM-2) and thick fiber polyneuropathy.

MATERIAL AND METHODS

The MoCA test was used to assess cognitive functions, and vibrometry («Somedic» vibrometer) was used to assess the function of thick fibers. Patients in group 1 (n=37) received alpha lipoic acid (ALA) in a dose of 600 mg per day for 16 weeks, patients in group 2 (n=41) started taking ALA 8 weeks after the start of the study.

RESULTS

Comparison of both groups showed an increase in the indicators of the MoCA test in group 1 after 8 weeks (p=0.0025) with a further plateau and an improvement in vibration sensitivity after 16 weeks (p=0.023). The improvement in the MoCA test in group 2 also began after 8 weeks.

CONCLUSION

The authors recommend ALA in polyneuropathy as a drug that also has a positive effect on cognitive functions in DM-2 and dipyridamole for the treatment of patients with diabetic encephalopathy and cerebral small vessels disease and stroke.

The effect of rosuvastatin on cardiogenic cerebral infarction

OBJECTIVE

To investigate the effect of rosuvastatin on cardiogenic cerebral infarction and its related effects on patients' neurological function, lipid levels, inflammatory factor levels, and oxidative stress status.

METHODS

300 patients with cardiogenic cerebral infarction were recruited as the study cohort and randomly divided into an observation group and a control group. Routine treatment, including urinary kallikrein injections and bayaspirin tablets were given to the patients in the control group for one month. Rosuvastatin was given once a day in addition to the treatment the control group received to the patients in the observation group, also for one month. The two groups' treatment efficacies were compared. Also, the two groups' NIHSS and mRS scores, lipid and inflammatory factor levels, and their oxidative stress statuses were also compared.

RESULTS

The total effective rate in the observation group was significantly higher than it was in the control group (74.0% vs 84.7%, P=0.023). The NIHSS and mRS scores in the observation group were significantly lower than they were in the control group (all P<0.001). Compared with their levels after the treatment in the control group, the cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels in the observation group were significantly decreased and the high-density lipoprotein cholesterol (HDL-C) was significantly increased (all P<0.001). Moreover, after the treatment, the inflammatory factors, such as the tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) levels, and the oxidative stress status, such as the oxidatively modified low density lipoprotein (ox-LDL) levels, were significantly lower than they were in the control group, but the superoxide dimutase (SOD) levels were significantly higher.

CONCLUSIONS

Rosuvastatin remarkably improves the treatment efficacy and neurological function in cardiogenic cerebral infarction patients, and is associated with the improvement of the lipid levels, the inflammatory response, and the oxidative stress status.

Immunological effects of the intraparenchymal administration of allogeneic and autologous adipose-derived mesenchymal stem cells after the acute phase of middle cerebral artery occlusion in rats

BACKGROUND

Adipose-derived mesenchymal stem cell (ADMSC) therapy can promote recovery from cerebral ischemia; however, more information regarding appropriate sources of ADMSCs is required. This study was aimed at analyzing the immunogenicity of rat ADMSCs by comparing the immunological effects of intraparenchymal administration of allogeneic ADMSCs (allo-ADMSCs) and autologous ADMSCs (auto-ADMSCs) after the acute phase of middle cerebral artery occlusion (MCAO) in rats.

METHODS

Allo- or auto-ADMSCs from rats (1 × 10⁶ cells) were transplanted into Lewis rats 8 days post MCAO. The immunogenicity of ADMSCs was analyzed using coculture with T lymphocytes. The in vivo immune response induced by rat ADMSCs and the viability, migration, and differentiation of transplanted ADMSCs were detected using immunohistochemistry. Apoptosis within the populations of transplanted cells were detected using a TUNEL assay. Infarct volume was detected by 2,3,5-triphenyltetrazolium chloride staining. Post-treatment neurological function was evaluated using a modified neurological severity score and rotarod test. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

Compared with allo-ADMSCs, auto-ADMSCs showed lower immunogenicity and evoked weaker immunological responses. Allo-ADMSCs evoked significantly stronger protein expression of interleukin-2 and interferon-gamma, as well as the local accumulation of CD4+ T lymphocytes, CD8+ T lymphocytes, and microglial cells. This indicates that auto-ADMSCs may contribute to higher survival rates, longer survival time, wider migratory scope, and fewer apoptotic cells. In addition, a small number of transplanted auto-ADMSCs expressed astrocyte-like and neuron-like markers 28 days after transplantation. We did not observe surviving transplanted allo-ADMSCs at this time point. We also found that auto-ADMSCs induced a greater degree of functional recovery and a greater reduction in infarct volume than allo-ADMSCs 28 days after transplantation.

CONCLUSIONS

Auto-ADMSCs were more effective than allo-ADMSCs in promoting recovery and reducing the infarct volume of MCAO rats. This could be associated with better viability, migratory ability, and differentiation potential, as well as a lower rate of apoptosis. Confirmation of the superiority of auto-ADMSCs and clarification of the underlying mechanisms will provide a theoretical basis for the improved clinical treatment of cerebral infarction.