Intravenous thrombolysis in combination with mild hypothermia therapy in the treatment of acute cerebral infarction

Effect of intravenous thrombolysis combined with endovascular treatment on vascular recanalization rate and peak systolic velocity in patients with acute cerebral infarction

Objectives

To investigate the efficacy of intravenous thrombolysis (IVT) combined with endovascular treatment (EVT) on vascular recanalization rate and peak systolic velocity (PSV) in patients with acute cerebral infarction (ACI).

Methods

A retrospective observational study was conducted from January 2019 to December 2021 in Chengdu First People's Hospital. The clinical data of 96 patients with ACI were reviewed and the patients were assigned to either the control group (IVT alone, n=54) or the observation group (IVT+EVT, n=42). The vascular recanalization rate, PSV, neurological function, modified Rankin Scale (mRS) score and major adverse cardiovascular events (MACE) were compared between groups.

Results

The vascular recanalization rate and PSV in the observation group were higher than the control group (P<0.05). The NIHSS scores of the observation group at 24 hour, one week and one month after treatment were significantly lower than those of the control group (P<0.05). The mRS scores of the observation group were significantly lower than the control group after treatment (P<0.05), while there was no difference in the incidence of MACE between groups (P>0.05).

Conclusions

IVT combined with EVT can improve the vascular recanalization rate and PSV in patients with ACI, which is worthy of promotion in clinical practice.

Chebulic Acid Prevents Hypoxia Insult via Nrf2/ARE Pathway in Ischemic Stroke

Excessive reactive oxygen species (ROS) production contributes to brain ischemia/reperfusion (I/R) injury through many mechanisms including inflammation, apoptosis, and cellular necrosis. Chebulic acid (CA) isolated from Terminalia chebula has been found to have various biological effects, such as antioxidants. In this study, we investigated the mechanism of the anti-hypoxic neuroprotective effect of CA in vitro and in vivo. The results showed that CA could protect against oxygen-glucose deprivation/reoxygenation (OGD/R) induced neurotoxicity in SH-SY5Y cells, as evidenced by the enhancement of cell viability and improvement of total superoxide dismutase (T-SOD) in SH-SY5Y cells. CA also attenuated OGD/R-induced elevations of malondialdehyde (MDA) and ROS in SH-SY5Y cells. Nuclear factor-E2-related factor 2 (Nrf2) is one of the key regulators of endogenous antioxidant defense. CA acted as antioxidants indirectly by upregulating antioxidant-responsive-element (ARE) and Nrf2 nuclear translocation to relieve OGD/R-induced oxidative damage. Furthermore, the results showed that CA treatment resulted in a significant decrease in ischemic infarct volume and improved performance in the motor ability of mice 24 h after stroke. This study provides a new niche targeting drug to oppose ischemic stroke and reveals the promising potential of CA for the control of ischemic stroke in humans.

Effectiveness of Combined Thrombolysis and Mild Hypothermia Therapy in Acute Cerebral Infarction: A Meta-Analysis

Objective

To evaluate the effectiveness and safety of thrombolytic therapy combined with mild hypothermia in patients with acute cerebral infarction (ACI), based on a meta-analysis of randomized controlled trials (RCTs).

Methods

PubMed, EMBASE, Cochrane Library, and Chinese National Knowledge Infrastructure Database of Controlled Trials were systematically screened for randomized controlled trials (RCTs) of thrombolytic therapy combined with mild hypothermia in treating ACI from inception to January 2021. Participation and outcomes among intervention enrollees are as follows: P, participants (patients in ACI); I, interventions (thrombolysis in combination with mild hypothermia therapy); C, controls (thrombolysis merely); O, outcomes (main outcomes are the change of NIHSS, glutathione peroxidase, superoxide dismutase, malondialdehyde, inflammatory factor interleukin-1β, tumor necrosis factor-α, and adverse reaction). Following data extraction and quality assessment, a meta-analysis was performed using RevMan 5.3 software.

Results

A total of 26 RCTs involving 2071 patients were included. Compared to thrombolysis alone, thrombolytic therapy combined with mild hypothermia leads to better therapeutic efficacy [RR = 1.23, 95% CI (1.16, 1.31)], NIHSS [MD = -2.02, 95% CI (-2.55, -1.49)], glutathione peroxidase [MD = 8.71, 95% CI (5.55, 11.87)], superoxide dismutase [MD = 16.52, 95% CI (12.31, 19.74)], malondialdehyde [MD = -1.86, 95% CI (-1.98, -1.75)], interleukin-1β [MD = -3.48, 95% CI (-4.88, -2.08)], tumor necrosis factor-α [MD = -0.46, 95% CI (-3.39, 2.48)], and adverse reaction [RR = 0.87, 95% CI (0.63, 1.20)].

Conclusions

Thrombolytic therapy combined with mild hypothermia demonstrates a beneficial role in reducing brain nerve function impairment and inflammatory reactions in ACI subjects analysed in this meta-analysis.

Dysregulation of Serum miR-138-5p and Its Clinical Significance in Patients with Acute Cerebral Infarction

INTRODUCTION

Acute cerebral infarction (ACI) occurs with the involvement of differential expression of microRNAs. The study detected the expression pattern of miR-138-5p in the serum of ACI cases and evaluated its clinical significance, in an attempt to provide some guidance for the treatment and daily nursing of patients with ACI clinically.

METHODS

Levels of miR-138-5p in the serum of ACI patients and healthy controls (HCs) were detected via qRT-PCR. Ninety days after treatment, the modified Rankin Scale (mRS) was used to evaluate the prognosis of ACI patients. Receiver operating characteristic (ROC) curve was drawn, and the area under the curve was calculated. The logistic regression analysis was performed to estimate the relationship between various indicators and the clinical outcome.

RESULTS

miR-138-5p showed a diminished trend in ACI cases compared with the control group. A significantly negative correlation was detected for serum miR-138-5p with the National Institutes of Health Stroke Scale score in all ACI cases (r = -0.704, p < 0.001). The ROC curve demonstrated the diagnostic potential of serum miR-138-5p to distinguish ACI from HCs. Lessened expression of miR-138-5p was detected in ACI patients with poor prognosis, which can predict the poor prognosis of ACI patients after treatment. Logistic regression analysis determined the independent influence relationship between miR-138-5p and poor prognosis.

CONCLUSION

Diminished miR-138-5p is identified to be a risk factor for the occurrence of ACI, and it is associated with the worse outcome of the patients.

Clinical observation of mild hypothermia combined with intravenous thrombolysis in treating patients with acute cerebral infarction

Objectives:

To investigate the clinical effect of mild hypothermia combined with intravenous thrombolysis in the treatment of acute cerebral infarction.

Methods:

Eighty-eight patients with acute cerebral infarction in Binzhou People’s Hospital between May 2018 and August 2019 were randomly selected and divided into a control group and an observation group according to the random number table method, with 44 patients in each group. The control group was given intravenous thrombolysis; the observation group was treated with mild hypothermia (30-35°C) in addition to intravenous thrombolytic thrombolysis. The clinical efficacy, incidence of complications, oxidative stress indexes, inflammatory factor level, neurological function, and mental state of the two groups before and after treatment were compared.

Results:

The clinical efficacy of the observation group was significantly better than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the levels of oxidative stress indexes and inflammatory factors between the two groups before treatment (P<0.05). After treatment, the levels of oxidative stress indexes and inflammatory factors of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the neurological function and mental state between the two groups before treatment (P<0.05). After treatment, the neurological function and mental state of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the incidence of complications and mortality between the two groups (P>0.05).

Conclusion:

Thrombolytic therapy combined with mild hypothermia has a good efficacy in the treatment of acute cerebral infarction. The therapy can improve the neurological function of patients with acute cerebral infarction by significantly improving the oxidative stress index and relieving the inflammatory reaction. Its efficacy is better than single thrombolytic therapy.

Mesenchymal Stem Cell-Induced Anti-Neuroinflammation Against Traumatic Brain Injury

Traumatic brain injury (TBI) is a pervasive and damaging form of acquired brain injury (ABI). Acute, subacute, and chronic cell death processes, as a result of TBI, contribute to the disease progression and exacerbate outcomes. Extended neuroinflammation can worsen secondary degradation of brain function and structure. Mesenchymal stem cell transplantation has surfaced as a viable approach as a TBI therapeutic due to its immunomodulatory and regenerative features. This article examines the role of inflammation and cell death in ABI as well as the effectiveness of bone marrow-derived mesenchymal stem/stromal cell (BM-MSC) transplants as a treatment for TBI. Furthermore, we analyze new studies featuring transplanted BM-MSCs as a neurorestorative and anti-inflammatory therapy for TBI patients. Although clinical trials support BM-MSC transplants as a viable TBI treatment due to their promising regenerative characteristics, further investigation is imperative to uncover innovative brain repair pathways associated with cell-based therapy as stand-alone or as combination treatments.

Comparative study on the efficacy and safety of alteplase and urokinase in the treatment of acute cerebral infarction

BACKGROUND

Acute cerebral infarction (ACI) is a common cerebrovascular disease in clinical practice.

OBJECTIVE

The present study aims to investigate the efficacy and safety of alteplase and urokinase in treating ACI.

METHODS

A total of 96 patients with ACI, who were treated with alteplase and urokinase, were selected as the main subjects. Among these patients, 45 patients with ultra-early acute cerebral infarction, who received intravenous thrombolysis with RT-PA (alteplase), were included in the treatment group, while 51 patients with acute cerebral infarction, who were treated with urokinase in the same time period, were included in the control group.

RESULTS

The National Institute of Health Stroke Scale (NIHSS) scores were significantly lower in the treatment group and control group (P< 0.05) at two hours, seven days and 14 days after thrombolysis, when compared to those before thrombolysis. The bleeding rate was significantly lower in the control group, when compared to the treatment group (P< 0.05).

CONCLUSION

The intravenous thrombolysis with urokinase or alteplase in the ultra-early stage of acute cerebral infarction can reduce the neurological injury symptoms and effectively improve the prognosis of patients with stroke. Urokinase is lower in risk of bleeding, but better in safety, when compared to alteplase.

The clinical efficacy of compound Danshen injection on acute cerebral infarction and on the changes in the CRP, D-dimer, and IL-6 levels

OBJECTIVE

To study the clinical curative effect of compound Danshen injection on acute cerebral infarction (ACI) patients and its impact on the CRP, D-dimer, and IL-6 levels.

METHODS

116 patients with ACI admitted to our hospital were randomly placed in an observation group (n=58) or a control group (n=58). The control group received rosuvastatin tablets (10 mg/time, qd) in addition to the standard treatment. The observation group received compound Danshen injection in addition to the standard treatment. The treatment continued for 21 days. The clinical treatment efficacy, the CRP, D-dimer, and IL-6 levels, the NIHSS scores (to evaluate the degree of neurological impairment), the Fugl-Meyer scores (to access patients' motor function), the ADL scores, the sleep quality (the PSQI and AIS scores), and the complication incidence rates were compared between the two groups.

RESULTS

After the treatment, the effective rate in the observation group (89.66%) was significantly higher than it was in the control group (74.14%) (P<0.05). After the treatment, the serum CRP, D-dimer, and IL-6 levels in the two groups were lower than they were before the treatment, and the levels were lower in the observation group than they were in the control group (all P<0.05). After the treatment, the NIHSS scores in the observation group were lower than they were in the control group, and the Fugl-Meyer and ADL scores were higher than they were in the control group (all P<0.05). Compared with the control group, the PSQI and AIS scores in the observation group were lower than they were in the control group after the treatment (P<0.05). The severe diarrhea, bedsore, urinary tract infection, liver and kidney function injury, skin allergic reactions and other total adverse reaction incidence rates in the observation group were lower than they were in the control group.

CONCLUSION

Rosuvastatin combined with compound Danshen injection is effective in ACI treatment. It is able to effectively improve the clinical symptoms, reduce the incidence of complications, improve the recovery of the IL-6, CRP, and D-dimer levels and enhance patients' sleep quality.

Ginkgo biloba Damo injection combined with troxerutin regulates the TLR4/NF-κB pathway and promotes the recovery of patients with acute cerebral infarction

OBJECTIVE

Analysis of the effect of Ginkgo biloba Damo injection combined with troxerutin on patients with acute cerebral infarction (ACI) by regulating the TLR4/NF-κB signaling pathway.

METHODS

150 patients with ACI were recruited for a prospective study. These patients were randomly divided into Ginkgo biloba Damo treatment group (n=75) and combined treatment group (Ginkgo biloba Damo + troxerutin, n=75) bilobabiloba. The patients in both groups were treated with conventional treatment. In addition, patients in the Ginkgo biloba Damo treatment group were treated with Ginkgo biloba Damo injection, and those in the combined treatment group were treated with Ginkgo biloba Damo injection combined with troxerutin. The National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) of the two groups were compared. The serum levels of GSH-Px, OX-LDL, CAT, TLR4, NF-κB p65, TNF-α, IL-1β and IL-6 were detected. The therapeutic effects of the two groups were compared.

RESULTS

After treatment, compared with the Ginkgo biloba Damo group, the combined treatment group had a lower NIHSS score and lower expression levels of OX-LDL, TLR4, NF-κB p65, TNF-α, IL-1β, and IL-6, but higher Barthel score and total effective rate as well as higher serum levels of GSH-Px and CAT (all P<0.05).

CONCLUSION

Ginkgo biloba Damo injection combined with troxerutin can improve the neurologic function and activities of daily life in patients with ACI, which can also regulate the TLR4/NF-κB signaling pathway and downstream inflammatory factors to reduce brain tissue inflammation and oxidative stress damage.

Effects of intravenous thrombolysis with alteplase combined with edaravone on cerebral hemodynamics and T lymphocyte level in patients with acute cerebral infarction

Our study aimed to investigate the effect of intravenous thrombolysis with alteplase and edaravone on cerebral hemodynamics and T lymphocyte level in patients harboring acute cerebral infarction.There involved a total of 118 patients with acute cerebral infarction from November 2017 to May 2019 in our hospital were randomly divided into 2 groups: the observation group (59 patients were treated with intravenous thrombolysis with alteplase combined with edaravone) and the control group (59 patients were treated with intravenous thrombolysis of alteplase). The clinical effect, neurological function, cerebral hemodynamic index, T lymphocyte level, oxygen free radical scavenging level and oxidative stress index of the 2 groups were observed and compared.Before the treatment, there were no significant differences in neurological function, cerebral hemodynamic indexes, T-lymphocyte level, oxygen free radical scavenging level and oxidative stress indexes between the 2 groups (P > .05). After the treatment, the neurological function, cerebral hemodynamic indexes, T-lymphocyte level, oxygen free radical scavenging level and oxidative stress indexes of the 2 groups were significantly improved. In addition, the observation group exerted greater beneficial effect in terms of the clinical effect, neurologic function, cerebral hemodynamic index, T lymphocyte level, oxygen free radical scavenging level and oxidative stress index than those of the control group (P < .05).The intravenous thrombolysis with alteplase and edaravone is effective in the treatment of acute cerebral infarction, which also provides better results in terms of improving the clinical efficacy and prognosis of patients and might be an alternative option for clinical practice.

Protective effect of hypothermia and vitamin E on spermatogenic function after reduction of testicular torsion in rats

This study was designed to investigate the protective effect of hypothermia and vitamin E on spermatogenic function after reduction of testicular torsion in rats. Ninety-six pure inbred male SD rats were divided into group A, B, C and D according to the principle of body weight and birth similarity, with 24 rats in each group. Four groups of rats were respectively twisted on the left testis to establish unilateral testicular torsion rats. Rats in groups A, B, C, D were respectively given normal saline, hypothermia therapy, vitamin E therapy, and hypothermia and vitamin E therapy. The superoxide dismutase (SOD) activity and malondialdehyde (MDA) content of the four groups were detected, and the correlation levels of inflammatory factors IL-1β, hs-CRP and related sex hormones luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (T) were detected by ELISA. Apoptosis of spermatogenic cells of testis in the four groups was detected by flow cytometry. SOD activity and MDA content in groups B, C and D were significantly higher than those in group A, MDA content was significantly lower than that in group A (P<0.05), SOD activity in group D was higher than that in groups B and C, while MDA content was lower than that in groups B and C (P<0.05). The levels of IL-1β and hs-CRP in group A were much higher than those in groups B, C and D (P<0.05). LH and FSH levels in group A were significantly higher than those in groups B, C and D (P<0.05), and in group D were significantly lower than those in groups B and C (P<0.05). Apoptosis rate of spermatogenic cells in group A was significantly higher than that in groups B, C and D (P<0.05). Hypothermia combined with vitamin E can reverse testicular injury in rats and reduce the apoptosis rate of spermatogenic cells.

Mesenchymal stem cell therapy alleviates the neuroinflammation associated with acquired brain injury

Ischemic stroke and traumatic brain injury (TBI) comprise two particularly prevalent and costly examples of acquired brain injury (ABI). Following stroke or TBI, primary cell death and secondary cell death closely model disease progression and worsen outcomes. Mounting evidence indicates that long‐term neuroinflammation extensively exacerbates the secondary deterioration of brain structure and function. Due to their immunomodulatory and regenerative properties, mesenchymal stem cell transplants have emerged as a promising approach to treating this facet of stroke and TBI pathology. In this review, we summarize the classification of cell death in ABI and discuss the prominent role of inflammation. We then consider the efficacy of bone marrow–derived mesenchymal stem/stromal cell (BM‐MSC) transplantation as a therapy for these injuries. Finally, we examine recent laboratory and clinical studies utilizing transplanted BM‐MSCs as antiinflammatory and neurorestorative treatments for stroke and TBI. Clinical trials of BM‐MSC transplants for stroke and TBI support their promising protective and regenerative properties. Future research is needed to allow for better comparison among trials and to elaborate on the emerging area of cell‐based combination treatments.

Hypothermic neuroprotection against acute ischemic stroke: The 2019 update

Acute ischemic stroke is a leading cause of death and disability worldwide. Therapeutic hypothermia has long been considered as one of the most robust neuroprotective strategies. Although the neuroprotective effects of hypothermia have only been confirmed in patients with global cerebral ischemia after cardiac arrest and in neonatal hypoxic ischemic encephalopathy, establishing standardized protocols and strictly controlling the key parameters may extend its application in other brain injuries, such as acute ischemic stroke. In this review, we discuss the potential neuroprotective effects of hypothermia, its drawbacks evidenced in previous studies, and its potential clinical application for acute ischemic stroke especially in the era of reperfusion. Based on the different conditions between bench and bedside settings, we demonstrate the importance of vascular recanalization for neuroprotection of hypothermia by analyzing numerous literatures regarding hypothermia in focal cerebral ischemia. Then, we make a thorough analysis of key parameters of hypothermia and introduce novel hypothermic therapies. We advocate in favor of the process of clinical translation of intra-arterial selective cooling infusion in the era of reperfusion and provide insights into the prospects of hypothermia in acute ischemic stroke.