Efficacy and Safety of Endovascular Treatment for Acute Large-Vessel Ischemic Stroke Beyond 6 h After Symptom Onset: A Meta-Analysis

Background: There is considerable evidence on the benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) within 6 h after symptom onset. However, uncertainties remain regarding EVT efficacy beyond 6 h after symptom onset. We undertook a meta-analysis to assess the efficacy and safety of EVT in patients with AIS >6 h after symptom onset.

Methods: We searched PubMed, EMBASE, and Chinese Biomedical through July 2019. We included studies involving early (≤6 h) vs. delayed (>6 h) EVT in selected patients with AIS, based on radiological evaluation criteria. Functional independence, successful recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) rates were assessed.

Results: Eight articles, with 3,265 patients who had undergone early EVT and 1,078 patients who had received delayed EVT, were included in the meta-analysis. Patients treated with early EVT showed a similar proportion of functional independence at 90 days [odds ratio (OR) = 1.14, 95% confidence interval (CI) = 0.926–1.397, P = 0.219; I² = 36.2%, P = 0.128] as those treated with delayed EVT. Delayed EVT was also associated with no significant difference in mortality (OR = 1.015, 95% CI = 0.852–1.209; P = 0.871; I² = 0.0%, P = 0.527), successful recanalization (OR = 1.255, 95% CI = 0.923–1.705; P = 0.147; I² = 60.5%, P = 0.009), and sICH (OR = 0.976, 95% CI = 0.737–1.293; P = 0.871; I² = 0.0%, P = 0.742) rates compared with early EVT.

Conclusions: Among selected patients with AIS, delayed EVT showed comparable outcomes in functional independence, recanalization, mortality, and sICH rates compared with early EVT.

Murine inhibitory protein-kappa B alpha negatively regulates kappa B-dependent transcription in lipopolysaccharide-stimulated RAW 264.7 macrophages

The potential role of the inhibitory protein (I)-kappa B alpha gene in control of LPS-dependent transcription has been investigated in the murine macrophage cell line RAW 264.7. LPS-induced transcription in macrophages is believed to involve activation of members of the Rel homology family of transcription factors, and may be negatively regulated by cytoplasmic inhibitor proteins collectively termed I-kappa Bs. To evaluate the role of I-kappa Bs in LPS-stimulated macrophages, murine I-kappa B alpha (ml-kappa B alpha) has been expressed as a glutathione-S-transferase (GST) fusion protein and examined for its ability to control kappa B binding activities in nuclear extracts from LPS-treated RAW 264.7 macrophages. ml-kappa B alpha-GST inhibited LPS-induced kappa B binding activity from RAW 264.7 cells in a phosphorylation-dependent fashion, but did not affect IFN-alpha-induced IFN stimulus response element binding. Recombinant I-kappa B alpha inhibited kappa B motif binding by nuclear factor-kappa B1, RelA, and c-Rel as indicated by studies using UV radiation-induced covalent cross-linking to a bromodeoxyuridine-substituted kappa B oligonucleotide. Transfection of macrophages with an expression vector encoding ml-kappa B alpha inhibited LPS-stimulated transcription driven by a 243-bp promoter sequence obtained from the 5' flanking region of the murine IP-10 gene. This promoter sequence contains two kappa B motifs that have been shown to be critical to LPS-dependent reporter gene transcription. The kappa B sites seem to be the specific target of I-kappa B alpha function, as reporter gene transcription driven by these motifs in the context of a heterologous thymidine-kinase promoter (TK) also was inhibited by co-transfection with ml-kappa B alpha. These observations indicate that ml-kappa B alpha is capable of controlling kappa B-dependent transcription in LPS-stimulated murine macrophages.

Murine inhibitory protein-kappa B alpha negatively regulates kappa B-dependent transcription in lipopolysaccharide-stimulated RAW 264.7 macrophages

The potential role of the inhibitory protein (I)-kappa B alpha gene in control of LPS-dependent transcription has been investigated in the murine macrophage cell line RAW 264.7. LPS-induced transcription in macrophages is believed to involve activation of members of the Rel homology family of transcription factors, and may be negatively regulated by cytoplasmic inhibitor proteins collectively termed I-kappa Bs. To evaluate the role of I-kappa Bs in LPS-stimulated macrophages, murine I-kappa B alpha (ml-kappa B alpha) has been expressed as a glutathione-S-transferase (GST) fusion protein and examined for its ability to control kappa B binding activities in nuclear extracts from LPS-treated RAW 264.7 macrophages. ml-kappa B alpha-GST inhibited LPS-induced kappa B binding activity from RAW 264.7 cells in a phosphorylation-dependent fashion, but did not affect IFN-alpha-induced IFN stimulus response element binding. Recombinant I-kappa B alpha inhibited kappa B motif binding by nuclear factor-kappa B1, RelA, and c-Rel as indicated by studies using UV radiation-induced covalent cross-linking to a bromodeoxyuridine-substituted kappa B oligonucleotide. Transfection of macrophages with an expression vector encoding ml-kappa B alpha inhibited LPS-stimulated transcription driven by a 243-bp promoter sequence obtained from the 5' flanking region of the murine IP-10 gene. This promoter sequence contains two kappa B motifs that have been shown to be critical to LPS-dependent reporter gene transcription. The kappa B sites seem to be the specific target of I-kappa B alpha function, as reporter gene transcription driven by these motifs in the context of a heterologous thymidine-kinase promoter (TK) also was inhibited by co-transfection with ml-kappa B alpha. These observations indicate that ml-kappa B alpha is capable of controlling kappa B-dependent transcription in LPS-stimulated murine macrophages.