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Han Y, Liu C, Yang X, Zhou J, Shi W, Gao H, Zhang H, Ran D, Shi L. Bibliometric analysis: Hot spots and frontiers in acupuncture treatment of cerebral infarction. Medicine (Baltimore) 2024; 103:e37800. [PMID: 38608052 PMCID: PMC11018181 DOI: 10.1097/md.0000000000037800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE CiteSpace6.1.R2 is used to analyze the research status of acupuncture in the treatment of cerebral infarction, and to find relevant hot spots and frontiers. METHODS The researchers searched the Web of Science Core Collection database. The search date is from the establishment of the database to August 31, 2023. The search terms and expressions are: ("Cerebral Infarction" OR "Ischemic stroke") AND ("Acupuncture" OR "fire needle"). The researchers used CiteSpace software to draw a knowledge map to explore the hot spots and frontiers of acupuncture in treating cerebral infarction. RESULTS We screened 414 articles in the Web of Science Core Collection database. China is the country with the largest number of publications, with a total of 343 papers published. China's institutions cooperate most closely, and cooperation between countries is less and more scattered. The author with the highest number of published articles is Chen L, with a total of 31 published articles. The research focus mainly revolves around the mechanism of acupuncture treatment of cerebral infarction and electroacupuncture treatment of cerebral infarction. Among them, acupuncture treatment of cerebral infarction is the most. CONCLUSION According to CiteSpace's analysis results, China is at the forefront of this research field, while other countries have less research in this field and little cooperation among countries. At present, the mainstream aspect of research is the mechanism of acupuncture treatment of cerebral infarction electroacupuncture and acupuncture points. Therefore, in future research, we should pay more attention to the treatment of cerebral infarction mechanism of acupuncture, problems with the type of acupuncture used, and acupuncture points.
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Affiliation(s)
- Yutong Han
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chang Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinming Yang
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jiaxiao Zhou
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weiping Shi
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Huasong Gao
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Huixue Zhang
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dawei Ran
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lei Shi
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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LI M, WANG Y, RAN D, YANG X, DENG S, SHI L, MENG Z. Effects of anterior sciatic nerve acupuncture on lower limb paralysis after cerebral infarction: study protocol for a randomized controlled trial. J TRADIT CHIN MED 2024; 44:205-211. [PMID: 38213256 PMCID: PMC10774733 DOI: 10.19852/j.cnki.jtcm.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/16/2022] [Indexed: 01/13/2024]
Abstract
Stroke is the main cause of disability in the middle and old age. Hemiplegia, especially lower limb paralysis, often leads to the loss of self-care ability and a series of secondary injuries. The main method to improve hemiplegic limb movement is exercise therapy, but there are still many patients with disabilities after rehabilitation treatment. As one of the non-pharmacological therapies for stroke, acupuncture has been recognized to improve motor function in patients. Here, we propose a new method, anterior sciatic nerve acupuncture, which can stimulate both the femoral nerve and the sciatic nerve. We designed this study to determine the effect of this method on lower limb motor function. Sixty participants recruited with hemiplegia after cerebral infarction will be randomly assigned to the test group or control group in a 1:1 ratio. The control group will receive Xingnao Kaiqiao acupuncture, and the test group will receive anterior sciatic nerve acupuncture on this basis. All participants will get acupuncture treatment once a day, 6 times a week for 2 weeks. The primary outcome is Fugl-Meyer Assessment of Lower Extremity and the secondary outcomes are Modified Ashworth Scale and Modified Barthel Index. Data will be collected before treatment, 1 week after treatment, and 2 weeks after treatment, and then statistical analysis will be performed. This study can preliminarily verify the effect of anterior sciatic nerve acupuncture on improving lower limb motor function in patients with cerebral infarction, which may provide an alternative approach for clinical treatment of hemiplegia.
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Affiliation(s)
- Menghan LI
- 1 Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China; Graduate department, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yu WANG
- 2 Department of Massage and Rehabilitation, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300250, China
| | - Dawei RAN
- 3 Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Xinming YANG
- 3 Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Shizhe DENG
- 3 Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Lei SHI
- 3 Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Zhihong MENG
- 3 Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
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Zhu ZL, Shen TY, Sun Z, Li H, Shan H, Cao LL, Zhang JB. Effects of zhongfeng cutong moxibustion on motor function and corticospinal tract in the patients with motor dysfunction during the recovery period of cerebral infarction. Zhongguo Zhen Jiu 2023; 43:1358-1362. [PMID: 38092532 DOI: 10.13703/j.0255-2930.20230623-k0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVES To observe the effects of zhongfeng cutong moxibustion (moxibustion therapy for unblocking and treating stroke) on the motor function and the structure of corticospinal tract (CST) in the patients with motor dysfunction during the recovery period of cerebral infarction, and to explore the central mechanism of this moxibustion therapy for improving the motor function. METHODS Fifty patients with motor dysfunction during the recovery period of cerebral infarction were randomly divided into an observation group (25 cases, 1 case dropped out) and a control group (25 cases, 1 case dropped out). The patients in both groups underwent the conventional basic treatment. In the control group, acupuncture was applied to Baihui (GV 20) and Shuigou (GV 26), as well as Chize (LU 5), Neiguan (PC 6), Weizhong (BL 40) and Sanyinjiao (SP 6) etc. on the affected side. Besides the intervention of the control group, in the observation group, zhongfeng cutong moxibustion therapy was combined at Baihui (GV 20), Shenque (CV 8) and bilateral Zusanli (ST 36). Both acupuncture and moxibustion therapies were delivered once daily, 5 times a week, for 2 weeks. The scores of Fugl-Meyer assessment scale (FMA) and National Institutes of Health stroke scale (NIHSS) were compared between the two groups before and after treatment. The diffusion tensor imaging technique was used to observe the fractional anisotropy (FA) of CST at the bilateral whole segment, the cerebral cortex, the posterior limb of the internal capsule and the cerebral peduncle before and after treatment in the two groups. RESULTS The scores of the upper and the lower limbs of FMA, as well as the total FMA score swere increased after treatment when compared with those before treatment in the two groups (P<0.05), the upper limb FMA score and the total FMA score in the observation group were higher than those in the control group (P<0.05), and NIHSS scores of the two groups were dropped compared with those before treatment (P<0.01). FA of CST at the bilateral sides of the posterior limb of the internal capsule and the whole segment on the focal side was improved in comparison with that before treatment in the observation group (P<0.05), and FA of CST at the healthy side of the whole segment was higher than that before treatment in the control group (P<0.05). CONCLUSIONS Zhongfeng cutong moxibustion improves motor function and reduces neurological deficits in the patients with motor dysfunction during the recovery period of cerebral infarction, which may be related to enhancing the remodeling of white matter fiber bundles in the corticospinal tract on the focal side of the whole segment and the bilateral posterior limb of the internal capsule.
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Affiliation(s)
| | - Tian-Yi Shen
- Department of Rehabilitation Medicine, Changshu Hospital Affiliated to Soochow University/Changshu First People's Hospital
| | - Zheng Sun
- Department of Acupuncture and Moxibustion
| | - Hao Li
- Department of Acupuncture and Moxibustion
| | - Hua Shan
- Department of Medical Imaging, Second Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Second Hospital of TCM, Nanjing 210017, China
| | - Lin-Li Cao
- Department of Medical Imaging, Second Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Second Hospital of TCM, Nanjing 210017, China
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Liu Y, Zhang Q, Yuan J, Chen X, Tao J, Chen B, Zhao W, Li G, Li Y, Liu D. [Acute cerebral infarction following extracorporeal membrane oxygenation treatment in patients with cardiogenic shock: 2 cases report and review of the literature]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2023; 35:1286-1290. [PMID: 38149391 DOI: 10.3760/cma.j.cn121430-20221011-00909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To explore the diagnosis and treatment of acute cerebral infarction following extracorporeal membrane oxygenation (ECMO) therapy in patients with cardiogenic shock to review the literature. METHODS The clinical data of two patients with cardiogenic shock treated with veno-arterial ECMO (VA-ECMO) complicated with acute cerebral infarction admitted to department of intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University were retrospectively analyzed and the treatment experience was shared. RESULTS Case 1 was a 46-year-old male patient who was admitted to the hospital on September 16, 2021, due to "repeated chest tightness, shortness of breath, syncope for 2+ years, and worsened for 15 days. Coronary artery angiography showed 3-vessel coronary artery disease lesions. On October 15, 2021, coronary artery bypass grafting (CABG), pericardial fenestration and drainage, thoracic closed drainage, femoral bypass, thoracotomy exploration, and sternal internal fixation were performed under support of extracorporeal circulation. After surgery, the heart rate was 180-200 bpm, the blood pressure could not be maintained, and the improvement was not obvious after active drug treatment. The right femoral artery and femoral vein were intubated, VA-ECMO support treatment was performed, and the patient was transferred to the ICU. Intra-aortic balloon pump (IABP) was treated on the day of transfer because the circulation could not be maintained. Due to acute cerebral infarction in the left hemisphere and right parieto-occipital lobe, subfalcine herniation, tentorial herniation, the patient ultimately died after withdrawing from ECMO. Case 2 was a 43-year-old male patient who was admitted to the hospital on June 29, 2021, with "fever for 8 days and vomiting for 4 days". Bedside ultrasound showed cardiac enlargement and diffuse wall motion reduction in the left and right ventricles. On June 30, 2021, the patient underwent catheterization through the right femoral artery and femoral vein, VA-ECMO support, and was transferred to ICU for treatment. Acute cerebral infarction on both sides of the cerebellum occurred, and after treatment, the patient was discharged with mild impairment of daily living ability. CONCLUSIONS Strengthen monitoring of anticoagulation; regular neurological examination of patients undergoing ECMO therapy; ECMO under light sedation or awake can be performed if the condition permitsif the condition permits, perform light sedation or awake ECMO, which helpful for the early detection of nervous system injury.
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Affiliation(s)
- Ying Liu
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Qian Zhang
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Jia Yuan
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Xianjun Chen
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Junling Tao
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Bowen Chen
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Wei Zhao
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Guangsu Li
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Yehong Li
- Department of Intensive Care Unit, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Di Liu
- Internet Development Research Institute of Beijing Normal University, Beijing 100875, China. Corresponding author: Liu Ying,
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Xu XM, Zhang H, Meng RL. Cranial midline shift is a predictor of the clinical prognosis of acute cerebral infarction patients undergoing emergency endovascular treatment. Sci Rep 2023; 13:21037. [PMID: 38030746 PMCID: PMC10687008 DOI: 10.1038/s41598-023-48401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/26/2023] [Indexed: 12/01/2023] Open
Abstract
Endovascular treatment is widely used in acute cerebral infarction (ACI), but patient prognosis varies greatly. We aimed to investigate the predictive value of midline shift (MLS) threshold for the clinical prognosis of patients with ACI who undergo emergency endovascular treatment. We prospectively enrolled patients with ACI who received endovascular treatment within 24 h of onset. Cranial images were collected within 24 h after endovascular treatment. We assessed MLS at the level of the midbrain, pineal calcification, septum pellucida, and falx cerebri and noted the maximum MLS (MLS[max]) among these locations. Functional outcomes were assessed at 90 days using the modified Rankin Scale. Receiver operating characteristic curves and optimal cutoff points were used to analyze the predictive value of MLS. We enrolled 82 patients, including 46 with poor outcomes. Although the MLS values at all levels were significantly different between the poor and favorable outcome groups (p < 0.01), the MLS(max) tended to be a better marker for 90-day poor outcome. To predict poor outcome, the optimal cutoff values for MLS(max) within 24 and 48 h after intervention were 0.45 and 2.35 mm, respectively. MLS(max) has predictive value for patient prognosis.
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Affiliation(s)
- Xiao-Min Xu
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
- Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, China.
| | - Hao Zhang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, China
| | - Ren-Liang Meng
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, Sichuan, China
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Liu LL, Liu PN, Li XA, Li YN. Ultra-early electroacupuncture rehabilitation for intravenous thrombolysis-induced cerebral infarction. Eur Rev Med Pharmacol Sci 2023; 27:10419-10426. [PMID: 37975365 DOI: 10.26355/eurrev_202311_34316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The purpose of this research was to investigate whether it is possible to perform ultra-early interventional electroacupuncture on individuals who had experienced intravenous thrombolysis prior to receiving therapy for acute cerebral infarction. PATIENTS AND METHODS Patients who have undergone intravenous thrombolysis between July 2019 and March 2021 were eligible for participation in this study. The participants were divided into two groups; one group received electroacupuncture therapy 24 hours after their condition became stable, while the other group received treatment 48 hours after their condition became stable. Both groups received the same therapy for their respective forms of rehabilitation. The Fugl-Meyer Motion Assessment Scale (FMA) was used to assess the patients' motor function before and after therapy, as well as two weeks and one month after treatment. The scores of the FMA were recorded before and after treatment. RESULTS After therapy, the FMI scores were higher in both groups (p<0.05), and the researchers found that the ultra-early electroacupuncture intervention was related to higher FMI ratings 2 weeks and 1 month after treatment (p<0.05). In neither of the two study groups was there any sign of a major adverse response or consequence (p>0.05). CONCLUSIONS This research offers evidence that ultra-early interventional electroacupuncture rehabilitation therapy may be an effective and safe method of treatment for individuals who have had a cerebral infarction after receiving intravenous thrombolysis. The results lend credence to the notion that this kind of therapy should be taken into consideration as an adjunctive model for rehabilitation in patients of this type.
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Affiliation(s)
- L-L Liu
- Department of Emergency, Binzhou People's Hospital, Binzhou, Shandong, China.
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Wang YY, Li RQ, Li JW, Mei JJ, Zhang LH, Zhang JY, Guo J. [Effects of Governor Vessel electroacupuncture on chloridion homeostasis in the cortex of rats with limb spasm after cerebral ischemia-reperfusion]. Zhen Ci Yan Jiu 2023; 48:860-9. [PMID: 37730256 DOI: 10.13702/j.1000-0607.20220553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To observe the effect of electroacupuncture (EA) stimulation of Governor Vessel on chloridion (Cl-) homeostasis and the expression of γ-aminobutyric acid (GABA) and Na+-K+-Cl- cotransporter 1 (NKCC1) in the cerebral cortex of cerebral ischemia-reperfusion injury (CIRI) model rats, so as to explore its mechanism underl-ying alleviating limb spasm after stroke. METHODS Forty-five male SD rats were randomly divided into normal, sham-operation, model, EA and baclofen groups, with 9 rats in each group. The CIRI model was established by occlusion of the middle cerebral artery and reperfusion. EA(100 Hz) was applied to "Dazhui" (GV14), "Jizhong"(GV6) and "Houhui" for 30 min. Rats of the baclofen group received gavage of baclofen solution (0.4 mg/kg, 1 mL/100 g), once daily for 7 consecutive days. Neurological deficit score was assessed according to Zea Longa's method. The muscular tone of quadriceps femoris of the limb was evaluated by modified Ashworth scale and electrophysiological recor-ding methods, separately. TTC staining was used to detect cerebral infarction volume, and the brain water content of rats in each group was determined by wet and dry weight method. The contents of Cl- and GABA in the cerebral cortex were detected by colorimetric method, and the expression levels of NKCC1 mRNA and protein in the cerebral cortex were detected by quantitative real-time PCR and Western blot, separately. RESULTS No significant differences were found between the normal and sham-operation groups in all the indexes. Compared with the normal and sham-operation groups, the neurological deficit score, modified Ashworth muscle tone score, brain water content, cerebral infarct volu-me percent, Cl- content and expression levels of NKCC1 mRNA and protein were all evidently increased (P<0.01), and muscle tone of electrophyiological electromyogram (EMG) signal and GABA content were strikingly decreased (P<0.01) in the model group. Compared with the model group, both EA and baclofen groups had an obvious increase in EMG signal displayed muscle tone, and GABA content (P<0.05, P<0.01), and a marked decrease in the neurological deficit score, modified Ashworth score, brain water content, cerebral infarct percent, Cl- content and expression levels of NKCC1 mRNA and protein (P<0.05, P<0.01). CONCLUSION EA stimulation of acupoints of the Governor Vessel can improve the degree of limb spasm and reduce the degree of cerebral edema and infarction in rats with stroke, which may be related to its functions in protecting Cl- homeostasis, up-regulating GABA concentration, and down-regulating the expression of NKCC1 protein and mRNA in the cerebral cortex.
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Affiliation(s)
- Yi-Ying Wang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Rui-Qing Li
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China; Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000
| | - Jing-Wen Li
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Jin-Jin Mei
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Li-Hong Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Jian-Yun Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Jian Guo
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou 450000, China; Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000
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Cai ZY, Zhang XC, Liu FR, Huang Z, Yang MN, Huang PY, Zhang ZH, Ni GX. [Effect of acupuncture on HIF-1α/NLRP3 inflammatory signaling pathway in the rats with cerebral ischemia-reperfusion injury]. Zhongguo Zhen Jiu 2023; 43:1056-61. [PMID: 37697882 DOI: 10.13703/j.0255-2930.20210912-k0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To observe the effects of Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture therapy on the expression of hypoxia-inducible factor 1α (HIF-1α) and Nod-like receptor protein 3 (NLRP3) in cerebral ischemia-reperfusion rats, and to explore the mechanism of acupuncture against cerebral ischemia-reperfusion injury. METHODS Seventy-two male SD rats were randomly divided into a sham-operation group, a model group, an acupuncture group and a non-point acupuncture group, with 18 rats in each one. Using modified Longa thread embolization method, the rat model of acute focal cerebral ischemia was prepared; and after 2 h ischemia, the reperfusion was performed to prepared the model of cerebral ischemia-reperfusion. Immediately after reperfusion, Xingnao Kaiqiao acupuncture method was applied to bilateral "Neiguan" (PC 6) and "Shuigou" (GV 26) in the acupuncture group, while in the non-point acupuncture group, acupuncture was delivered at non-points and all of the needles were retained for 30 min in these two groups. The samples were collected 24 h after reperfusion in the rats of each group. Zea-Longa neurological deficit score was used to evaluate the degree of cerebral neurological impairment, TTC staining was adopted to observe the volume percentage of cerebral infarction, HE staining was provided to observe the morphological changes of brain, and Western blot was applied for detecting the expression of HIF-1α and NLRP3 proteins in the cerebral cortex on the right side. RESULTS Compared with the sham-operation group, neurological deficit score and volume percentage of cerebral infarction were increased in the model group (P<0.01), and HIF-1α and NLRP3 protein expression was elevated (P<0.01). Compared with the model group, neurological deficit score and volume percentage of cerebral infarction were decreased (P<0.01), and HIF-1α and NLRP3 protein expression was lower (P<0.01) in the acupuncture group. There was no significant difference in above indexes in the non-point acupuncture group compared with the model group (P>0.05). Compared with the sham-operation group, the brain tissue of the rats in the model group and the non-point acupuncture group was loose and edema, and the nuclei were shriveled. The brain tissue morphology in the acupuncture group was similar to that of the sham-operation group. CONCLUSION Acupuncture can alleviate cerebral ischemia-reperfusion injury, and its mechanism may be related to the regulation of HIF-1α/NLRP3 signaling pathway to attenuate inflammatory response.
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Affiliation(s)
- Zheng-Yun Cai
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Xin-Chang Zhang
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Fu-Rong Liu
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Zheng Huang
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Meng-Ning Yang
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Pei-Yan Huang
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Zhi-Hui Zhang
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
| | - Guang-Xia Ni
- School of Acupuncture-Moxibustion and Tuina/School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province
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Li J, Tang S, Liu J, He W, Yan J, Huang Z, Li X. A Preliminary Discussion on the Safety of Mild Therapeutic Hypothermia in Target Vessels after Endovascular Intervention in Acute Large Vessel Occlusion Cerebral Infarction. J Vasc Res 2023; 60:227-233. [PMID: 37640011 PMCID: PMC10614551 DOI: 10.1159/000532030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/05/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION The aim of this study was to discuss the safety of rapid administration of 4°C hypothermic normal saline into the occluded vessels using an intra-arterial catheter to induce mild hypothermia following endovascular thrombectomy in patients with acute large vessel occlusion cerebral infarction. METHODS We selected 78 patients with acute large vessel occlusion cerebral infarction who underwent endovascular thrombectomy in the Department of Neurology of our hospital from January 2020 to July 2022 and achieved TICI 2b recanalization. RESULT Twenty-five patients were administered 500 mL of 4°C hypothermic normal saline in the occluded vessels at a rate of 25 mL/min to induce mild hypothermia. Twenty pairs of subjects conformed to strict matching and were finally included in the statistical analysis. The two groups of patients differed significantly in white blood cell count and percentage of neutrophils (p < 0.05); however, there were no significant differences in D-dimer, procalcitonin, and BNP levels. The two groups of patients did not differ significantly with respect to the incidence of the following indicators: upper gastrointestinal bleeding; pulmonary infection; venous thrombosis; vasospasms; seizures; and chills (p > 0.05). CONCLUSION Mild therapeutic hypothermia in target vessels plus endovascular thrombectomy was shown to be safe in patients with acute large vessel occlusion cerebral infarction.
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Affiliation(s)
- Jiang Li
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
| | - Shaonian Tang
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
| | - Juanli Liu
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
| | - Wenlin He
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
| | - Jinjin Yan
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
| | - Zhiyong Huang
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
| | - Xuesong Li
- Neuromedical Center, Huizhou Hospital Affiliated to Guangzhou Medical University, The Third People's Hospital of Huizhou, Huizhou, China
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Tian XH, Chen X, Jiang GF. Effects of comprehensive care measures based on the HAPA model on self-care, neurotransmitters and clinical outcomes in cerebral infarction patients. Eur Rev Med Pharmacol Sci 2023; 27:4462-4470. [PMID: 37259727 DOI: 10.26355/eurrev_202305_32452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Cerebral infarction is induced by cerebral artery occlusion, resulting in ischemia, hypoxia, necrosis of brain cells in the corresponding blood supply area, and then dysfunction. Health action process approach (HAPA) model emphasizes the proposal and practice of health behavior as a whole and uses self-monitoring and encouraging ultimately developed health behavior. The present study explores the effects of comprehensive nursing measures of HAPA model on neurotransmitters, self-care ability and clinical outcomes of cerebral infarction patients. PATIENTS AND METHODS One hundred and ten patients with cerebral infarction diagnosed and treated in our hospital from July 2020 to February 2022 were included as the subjects. The subjects were randomly grouped as the control (55 patients) and the study group (55 patients) and received conventional nursing measures and additional comprehensive nursing measures of HAPA model, respectively. The patients were tested for changes in self-care ability, nerve damage [myelin basic protein (MBP), S100B, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE)] and neurotransmitter indexes [acid-soluble protein (Asp), neuropeptide Y (NPY), substance P (SP), glutamate (Glu)], respectively. The patients were considered as the good prognosis group (47 cases) and poor prognosis group (63 cases) according to the prognosis after comprehensive care. The logistic regression model was used to analyze the risk factors affecting the poor prognosis of patients with cerebral infarction. RESULTS After nursing, China Stroke Scale (CSS) score, the Fugl Meyer Rating Scale (FMA) score and Barthel index were significantly higher in both groups than before nursing, and all indexes were significantly higher in the study group than in the control group (p< 0.05). The length of hospital stay was significantly shorter in the study group than in the control group (p< 0.05). Compared with before nursing, the health knowledge, self-care skills, self-responsibility and self-concept of two groups were strongly increased after nursing, and the study group had much higher indexes than the control group (p< 0.05). After nursing, the levels of MBP, S100B, GFAP, NSE, Asp, NPY, SP and Glu in both groups were largely decreased, and more significant decrease was found in the study group (p< 0.05). Age, body mass index (BMI), hypertension history, coronary heart disease history and National Institutes of Health Stroke Score (NIHSS) score after treatment were significantly different between the good and poor prognosis groups (p< 0.05). The prognosis of patients in the study group was 52.73%, which was significantly higher than 32.73% in the control group (p< 0.05). Age, hypertension history, and post-treatment NIHSS score were independent risk factors related to poor prognosis by logistic multiple regression analysis (p< 0.05). CONCLUSIONS Comprehensive care measures of HAPA model may be used with advantage to improve the self-care ability, reduce the degree of neurological damage, and improve neurological function in cerebral infarction patients. Age, hypertension history, and NIHSS score after treatment were all risk factors related to poor prognosis.
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Affiliation(s)
- X-H Tian
- Department of Neurology, The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China.
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Yang P, Davidson JO, Zhou KQ, Wilson R, Wassink G, Prasad JD, Bennet L, Gunn AJ, Dean JM. Therapeutic Hypothermia Attenuates Cortical Interneuron Loss after Cerebral Ischemia in Near-Term Fetal Sheep. Int J Mol Sci 2023; 24:ijms24043706. [PMID: 36835117 PMCID: PMC9962824 DOI: 10.3390/ijms24043706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Therapeutic hypothermia significantly improves outcomes after neonatal hypoxic-ischemic (HI) encephalopathy but is only partially protective. There is evidence that cortical inhibitory interneuron circuits are particularly vulnerable to HI and that loss of interneurons may be an important contributor to long-term neurological dysfunction in these infants. In the present study, we examined the hypothesis that the duration of hypothermia has differential effects on interneuron survival after HI. Near-term fetal sheep received sham ischemia or cerebral ischemia for 30 min, followed by cerebral hypothermia from 3 h after ischemia end and continued up to 48 h, 72 h, or 120 h recovery. Sheep were euthanized after 7 days for histology. Hypothermia up to 48 h recovery resulted in moderate neuroprotection of glutamate decarboxylase (GAD)+ and parvalbumin+ interneurons but did not improve survival of calbindin+ cells. Hypothermia up to 72 h recovery was associated with significantly increased survival of all three interneuron phenotypes compared with sham controls. By contrast, while hypothermia up to 120 h recovery did not further improve (or impair) GAD+ or parvalbumin+ neuronal survival compared with hypothermia up to 72 h, it was associated with decreased survival of calbindin+ interneurons. Finally, protection of parvalbumin+ and GAD+ interneurons, but not calbindin+ interneurons, with hypothermia was associated with improved recovery of electroencephalographic (EEG) power and frequency by day 7 after HI. The present study demonstrates differential effects of increasing the duration of hypothermia on interneuron survival after HI in near-term fetal sheep. These findings may contribute to the apparent preclinical and clinical lack of benefit of very prolonged hypothermia.
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Xie D, Zhao L, Liu H, Wang J, Lu P, Ye X, Yang S. Tubridge Flow Diverter for the Treatment of Unruptured Dissecting Cerebral Aneurysms. World Neurosurg 2023; 172:e343-e348. [PMID: 36639100 DOI: 10.1016/j.wneu.2023.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Tubridge flow diverter is a device widely used in China aimed at reconstructing parent artery and occluding complex aneurysm. The experience of the Tubridge in treating unruptured vertebrobasilar artery dissecting aneurysms is still limited. In this study, we aimed to evaluate the safety and efficacy of the Tubridge flow diverter for the treatment of vertebrobasilar artery dissecting aneurysms. METHODS We reviewed the clinical records of aneurysms treated with the Tubridge flow diverter between 2019 and 2021 in a national cerebrovascular disease center. Therapeutic process, occlusion rate, and clinical outcome were compared. RESULTS Twenty-three patients with 23 vertebrobasilar artery aneurysms were identified. The results showed that the mean length and mean maximal width were 15.14 and 9.14 mm, respectively, in the vertebrobasilar artery. Twenty-four Tubridge flow diverters were successfully implanted without unfold failure. A complete occlusion rate at the last angiographic follow-up was achieved in 78.26% of vertebrobasilar artery aneurysms. Fifteen branch arteries were covered, and only 1 branch artery disappeared at follow-up. Mild asymptomatic cerebral infarction occurred in 3 patients (13.04%); intracranial hemorrhage was not found in the patients. CONCLUSIONS Our preliminary experience suggests that the Tubridge flow diverter might be a safe and effective tool for dissecting cerebral aneurysms. Branch arteries were well protected and mild asymptomatic cerebral infarction occurred in some patients. Adequate evidence is required to clear the definite indications and complications in a multicenter randomized controlled trial with a long-term follow-up.
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Affiliation(s)
- Dajiang Xie
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Li Zhao
- Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hailong Liu
- Department of Neurosurgery, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Jiaxiong Wang
- Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province (The First People's Hospital of HongHe Prefecture), Mengzi, China
| | - Peng Lu
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Xin Ye
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Shuxu Yang
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China.
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Nguyen NB, Nguyen Thi HH, Thi HL, Nguyen ST, Nguyen TV. Results of acute cerebral infarction treatment with hyperbaric oxygen therapy, 2020-2022. Int Marit Health 2023; 74:265-271. [PMID: 38111247 DOI: 10.5603/imh.97720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Cerebral stroke is the third leading cause of death after cardiovascular disease, cancer and the leading cause of disability for patients. Hyperbaric oxygen is a non-drug treatment that has the potential to improve brain function for patients with ischaemic stroke. The objective of this study was to evaluate the results of treatment of acute cerebral infarction with hyperbaric oxygen therapy (HBOT). MATERIALS AND METHODS This was a case-control study. One hundred ninety-five patients diagnosed with cerebral infarction, with signs of onset within 24 hours, were treated at the Centre for Underwater Medicine and Hyperbaric Oxygen of Vietnam National Institute of Maritime Medicine during the period from January 2020 to December 2022. Study group included 100 patients with acute cerebral infarction treated with a combination of HBOT and medication and reference group included 95 patients treated by medication only (antiplatelets drugs, statins, control of associated risks factors) RESULTS: After 7 days of treatment with hyperbaric oxygen (HBO), symptoms such as headache, dizziness, nausea, sensory disturbances, and Glasgow score of the study group improved better than that of the reference group (p < 0.01). Movement recovery in the study group was better than the reference group: the percentage of patients with mild and moderate paralysis in the study group increased higher than that of the reference group (86.0% and 68.4%), the degree of complete paralysis of the study group decreased more than that of the reference group (14.0% and 31.6%). The degree of independence in daily activities in the study group was better than the reference group. In the study group, the percentage of patients with complete independence in daily life increased from 27.0% to 84.0%. In the reference group, the rate of patients who were independent in their daily activities increased from 37.9% to 51.6%. The average number of treatment days of the study group was 10.32 ± 2.41 days and it the reference group 14.51 ± 3.24 days. CONCLUSIONS Hyperbaric oxygen therapy is a non-drug treatment with many good effects in the treatment of cerebral infarction, especially acute cerebral infarction. HBOT reduces and improves functional symptoms, improves mobility, and reduces treatment time for patients.
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Affiliation(s)
- Nam Bao Nguyen
- Vietnam National Institute of Maritime Medicine (VINIMAM), Haiphong, Vietnam.
| | | | | | - Son Truong Nguyen
- Vietnam National Institute of Maritime Medicine (VINIMAM), Haiphong, Vietnam
| | - Tam Van Nguyen
- Faculty of Marine Medicine-Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
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Li J, Zhang M, He Y, Du YH, Zhang XZ, Georgi R, Kolberg B, Xu YL. Molecular Mechanism of Electroacupuncture Regulating Cerebral Arterial Contractile Protein in Rats with Cerebral Infarction Based on MLCK Pathway. Chin J Integr Med 2023; 29:61-68. [PMID: 35344120 DOI: 10.1007/s11655-022-3468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the effect of electroacupuncture (EA) intervention on the vasoconstriction of cerebral artery smooth muscle cells after cerebral infarction. METHODS Male Wistar rats were randomly divided into 3 groups by a random number table: the model group (n=24), the EA group (n=24), and the normal group (n=6). The model and the EA groups were divided into different time subgroups at 0.5, 1, 3, and 6 h after middle cerebral artery occlusion (MCAO), with 6 rats in each subgroup. MCAO model was established using intraluminal suture occlusion method. The EA group was given EA treatment at acupoint Shuigou (GV 26) instantly after MCAO for 20 min. The contents of cerebrovascular smooth muscle MLCK, the 3 subunits of myosin light chain phosphatase (MLCP) MYPT1, PP1c-δ and M20, as well as myosin-ATPase activity were detected using immunohistochemistry and Western blotting. RESULTS The overall expression level of the MYPT1 and PP1c-δ in the model group was significantly higher (P<0.01). After EA intervention, the 0.5 h group expression level was close to that of the normal group (P>0.05), and the other subgroups were still significantly higher than the normal group (P<0.01). After EA intervention, the expression level of each subgroup was significantly lower than the corresponding model group. There was a significant difference between the 0.5 and 1 h subgroups (P<0.01), while a difference was also observed between the 3 and 6 h subgroups (P<0.05). The dynamic change rule gradually increased with the prolongation of infarction time within 6 h after infarction. CONCLUSION EA intervention can inhibit contraction of cerebral vascular smooth muscle cells and regulate smooth muscle relaxation by regulating MLCK pathway.
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Affiliation(s)
- Jing Li
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Min Zhang
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Ying He
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Yuan-Hao Du
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China.
| | - Xue-Zhu Zhang
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Rainer Georgi
- Max Planck Institute for Medical Research, Heidelberg, 69120, Germany
| | | | - Yan-Long Xu
- Department of Acupuncture and Moxibustion, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730050, China
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Zhai Z, Guo Y. Combination of constraint-induced movement therapy with fasudil amplifies neurogenesis after focal cerebral ischemia/reperfusion in rats. Int J Neurosci 2022; 132:1254-1260. [PMID: 33527868 DOI: 10.1080/00207454.2021.1881088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Spontaneous axonal plasticity and functional restoration after stroke may be limited by Nogo-A, a myelin-associated inhibitor, via activation of the Rho/Rho-associated protein kinase (ROCK) pathway. Constraint-induced movement therapy (CIMT) is a rehabilitation technique based on neuroplasticity and neural recombination. We recently reported that CIMT promoted neurogenesis after cerebral ischemia/reperfusion in part by inhibiting the Nogo-A-RhoA-ROCK pathway. Here, we examine the hypothesis that CIMT combined with the ROCK inhibitor fasudil further amplifies neurogenesis during stroke recovery. METHODS Four groups of rats were randomized as follows: Cerebral ischemia-reperfusion (IR), Fasudil, CIMT and CIMT + Fasudil. Seven days after stroke, CIMT and/or intraperitoneal infusion of fasudil were initiated and continued for 3 weeks. The behavioral outcomes and immunohistochemical markers of neurogenesis were quantified. RESULTS Compared with other groups, the combination of CIMT with fasudil after IR significantly improved motor and memory function recovery. In addition, BrdU, BrdU/doublecortin and BrdU/GFAP all increased significantly in the brain tissue of the combined treatment group compared to the CIMT or Fasudil group. CONCLUSION These results suggest that the effects of CIMT on neurogenesis are amplified by fasudil during the recovery phase after stroke.
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Affiliation(s)
- Zhiyong Zhai
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yang Guo
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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Shao J, Li B, Yuan AH, Hu XQ, Guo J, Ren MX, Yang J. [ Huayu Tongluo moxibustion combined with intradermal needling in patients with mild to moderate depression after cerebral infarction]. Zhongguo Zhen Jiu 2022; 42:1211-1215. [PMID: 36397216 DOI: 10.13703/j.0255-2930.20220424-k0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To observe the effect of Huayu Tongluo (resolving stasis and promoting collateral circulation) moxibustion combined with intradermal needling on depressive symptoms, quality of life and cognitive impairment in patients with mild to moderate depression after cerebral infarction on the basis of western medicine treatment. METHODS Fifty patients with mild to moderate depression after cerebral infarction were randomly divided into an acupuncture combined with western medication group (group A, 25 cases) and a western medication group (group B, 25 cases). In the group B, paroxetine hydrochloride tablets were taken orally, 20 mg after breakfast, once a day, and the dose could be adjusted to the maximum 40 mg/d according to the patients' condition, for 4 weeks totally. On the basis of the treatment in the group B, the group A was treated with Huayu Tongluo moxibustion, namely aconite cake-separated moxibustion at Baihui (GV 20) and suspended moxibustion at Dazhui (GV 14) and Shenting (GV 24), combined with intradermal needling at Shenmen (HT 7), Jianshi (PC 5), Zusanli (ST 36), etc. Huayu Tongluo moxibustion was performed 6 times a week, and intradermal needling was performed 3 times a week,for 4 weeks totally. In the two groups, the scores of Hamilton depression scale (HAMD), stroke specific quality of life scale (SS-QOL) and mini mental state examination (MMSE) were observed before and after treatment, and the clinical efficacy and safety were compared. RESULTS After treatment, the HAMD score in the each group was decreased compared with that before treatment (P<0.05), and that in the group A was lower than the group B (P<0.05); after treatment, the SS-QOL score in the group A and MMSE score in the two groups were increased compared with those before treatment (P<0.05), and the SS-QOL score in the group A was higher than the group B (P<0.05). The total effective rate was 88.0% (22/25) in the group A, which was higher than 60.0% (15/25) in the group B (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (4.0% [1/25] vs 16.0%[4/25], P>0.05). CONCLUSION On the basis of the treatment of western medication paroxetine hydrochloride tablets, Huayu Tongluo moxibustion combined with intradermal needling therapy can effectively improve the depressive symptoms, quality of life and cognitive impairment of patients with mild to moderate depression after cerebral infarction.
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Affiliation(s)
- Jun Shao
- Second Department of Acupuncture-Moxibustion and Rehabilitation, First Affiliated Hospital of Anhui University of CM, Hefei 230031, China; Second Department of Acupuncture-Moxibustion and Rehabilitation, Anhui Hospital of Integrated Traditional Chinese and Western Medication, Hefei 230031
| | - Bo Li
- Second Department of Acupuncture-Moxibustion and Rehabilitation, Anhui Hospital of Integrated Traditional Chinese and Western Medication, Hefei 230031
| | - Ai-Hong Yuan
- Second Department of Acupuncture-Moxibustion and Rehabilitation, First Affiliated Hospital of Anhui University of CM, Hefei 230031, China; Second Department of Acupuncture-Moxibustion and Rehabilitation, Anhui Hospital of Integrated Traditional Chinese and Western Medication, Hefei 230031
| | - Xiu-Qiang Hu
- Second Department of Acupuncture-Moxibustion and Rehabilitation, Anhui Hospital of Integrated Traditional Chinese and Western Medication, Hefei 230031
| | - Jie Guo
- Second Department of Acupuncture-Moxibustion and Rehabilitation, Anhui Hospital of Integrated Traditional Chinese and Western Medication, Hefei 230031
| | - Ming-Xing Ren
- Second Department of Acupuncture-Moxibustion and Rehabilitation, Anhui Hospital of Integrated Traditional Chinese and Western Medication, Hefei 230031
| | - Jun Yang
- Second Department of Acupuncture-Moxibustion and Rehabilitation, First Affiliated Hospital of Anhui University of CM, Hefei 230031, China
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Kanou S, Nakahara S, Asaki M, Takeuchi M, Uchida K, Yamamori N, Tanaka Y, Yokoyama T, Nakaya S, Miki Y. Initial medical protocol efforts using both CT and MRI/MRA for acute cerebral infarction. Am J Emerg Med 2022; 61:199-204. [PMID: 36183627 DOI: 10.1016/j.ajem] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Earlier administration of intravenous recombinant tissue-type plasminogen activator (rtPA) and mechanical thrombectomy (MT) improves the neurological prognosis of patients with acute ischemic stroke (AIS). We introduced a new protocol that includes head and chest computed tomography (CT) and magnetic resonance imaging (MRI)/ magnetic resonance angiography (MRA) for all patients, which is quite different from previously evaluated protocols. This study aimed to examine whether this protocol could contribute to the prompt therapeutic intervention of AIS. METHODS This is a retrospective observational study analyzing patients with AIS who were transported to our hospital by ambulance between January 2015 and November 2021. An AIS initial treatment protocol was introduced in April 2020, under which, CT and MRI/MRA imaging were performed in all patients, and the indication for rtPA and MT were determined. The participants were divided into those who were treated before and after the protocol introduction (conventional treatment and protocol groups, respectively). The time from hospital arrival to the start of rtPA administration (door-to-needle time: DNT) and the time from hospital arrival to the start of endovascular treatment (door-to-puncture time: DPT) were compared between the groups. RESULT A total of 121 patients were analyzed, wherein 63 patients received rtPA (18 in the conventional treatment group and 45 in the protocol group) and 98 patients received MT (32 in the conventional treatment group and 66 in the protocol group). The median DNT was 97.0 (IQR 49.0-138.0) min vs. 56.5 (IQR 41.0-72.0) min (p < 0.001) for the conventional treatment and the protocol groups, respectively. The median DPT was 129.0 (IQR 62.0-196.0) min vs. 55.0 (IQR 40.5-69.5) min (p < 0.001), respectively. Moreover, DNT was achieved within 60 min in 5.6% vs. 69.9% (p < 0.001) and DPT within 90 min in 25.0% vs. 85.7% (p < 0.001), respectively. CONCLUSION The introduction of a protocol, including CT/MRI imaging, significantly shortened DNT and DPT.
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Affiliation(s)
- Seiya Kanou
- Department of Emergency Medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan.
| | - Shinji Nakahara
- Graduate School of Health Innovation, Kanagawa University of Human Services, 3-25-10, Tomomachi, Kawasaki-ku, Kanagawa 210-0821, Japan.
| | - Motohiro Asaki
- Department of Emergency Medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Masato Takeuchi
- Department of Emergency Medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Kana Uchida
- Department of Emergency Medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Nodoka Yamamori
- Department of Emergency Medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Yujiro Tanaka
- Department of Neurosurgery, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Tomoya Yokoyama
- Department of Neurosurgery, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Shohei Nakaya
- Department of Neurosurgery, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan
| | - Yasuo Miki
- Department of Emergency Medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka 426-8677, Japan.
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Lee SH, Kim SW, Kim JM, Son WC. In vivo evaluation of histopathologic findings of vascular damage after mechanical thrombectomy with the Tromba device in a canine model of cerebral infarction. PLoS One 2022; 17:e0276108. [PMID: 36240152 PMCID: PMC9565453 DOI: 10.1371/journal.pone.0276108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
A novel stent retriever device for in vivo mechanical thrombectomy for acute cerebral infarction has been developed. In this study, we compared the thrombus removal capacity, potential complications, and extent of vessel wall damage of this novel device with those of the Solitaire FR device by performing a histopathologic analysis using an autopsied canine model. Through this experimental evaluation, we aimed to assess the safety and efficacy of the newly developed thrombus removal device for cerebral infarction. Blood clots (autologous thrombus) were injected into 12 canines. Mechanical thrombectomy was performed in six canines using the newly developed Tromba thrombectomy device (experimental group) and in the other six canines using the Solitaire FR thrombectomy device (control group). Angiographic and histopathologic evaluations were performed 1 month after the blood vessels underwent mechanical thrombectomy. In the experimental group, the reperfusion patency was classified as "no narrowing" in five cases and "moderate narrowing (25%-50% stenosis)" in one case. In the control group, the reperfusion patency was classified as "no narrowing" in four cases, "moderate narrowing (25%-50% stenosis)" in one case, and "slight narrowing (less than 25% stenosis)" in one case. In the experimental group, intimal proliferation was observed in only two cases, endothelial loss was observed in two cases, and device-induced medial injury was observed in one case. In the control group, intimal proliferation was observed in two cases, endothelial loss was observed in one case, and thrombosis (fibrin/platelet) was observed in one case. The Tromba thrombectomy device showed no significant difference to the conventional Solitaire device in angiographic and histopathologic evaluations after thrombus removal. The stability and efficiency of the newly developed Tromba device are considered to be high and comparable to those of Solitaire.
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Affiliation(s)
- Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
- * E-mail:
| | - Sang Woo Kim
- Laboratory Animal Center, Osong Medical Innovation Foundation (K-BIO HEALTH), Cheonju, Republic of Korea
| | - Jong Min Kim
- Laboratory Animal Center, Osong Medical Innovation Foundation (K-BIO HEALTH), Cheonju, Republic of Korea
| | - Woo Chan Son
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Feng Y, Bai X, Li W, Cao W, Xu X, Yu F, Fu Z, Tian Q, Guo X, Wang T, Sha A, Chen Y, Gao P, Wang Y, Chen J, Ma Y, Chen F, Dmytriw AA, Regenhardt RW, Lu J, Ma Q, Yang B, Jiao L. Postoperative neutrophil-lymphocyte ratio predicts unfavorable outcome of acute ischemic stroke patients who achieve complete reperfusion after thrombectomy. Front Immunol 2022; 13:963111. [PMID: 36275640 PMCID: PMC9585914 DOI: 10.3389/fimmu.2022.963111] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Only approximately half of anterior circulation large vessel occlusion (LVO) patients receiving endovascular treatment (EVT) have a favorable outcome. The aim of this study was to explore the association of dynamic inflammatory markers (i.e., neutrophil to lymphocyte ratios, NLR, measured at different times after EVT) as well as other potential influencing factors with unfavorable outcome among acute ischemic stroke (AIS) patients who achieved complete reperfusion after EVT. Methods Patients treated with EVT for LVO between January 2019 to December 2021 were prospectively enrolled. Complete reperfusion was defined as modified thrombolysis in cerebral infarction (mTICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3-6 was defined as unfavorable outcome (i.e., futile reperfusion). A logistic regression analysis was performed with unfavorable outcome as a dependent variable. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were then used to determine the diagnostic values of NLR and other relevant factors. Results 170 patients with complete reperfusion (mTICI 3) were included in this study. Unfavorable outcome was observed in 70 (41.2%). Higher NLR within 24h (p=0.017) and at 3-7d (p=0.008) after EVT were an independent risk factors for unfavorable outcome at 3 months. In addition, older age, higher NIHSS scores, poor collaterals, and general anesthesia were independent predictors of unfavorable outcomes. When accounting for NLR, the diagnostic efficiency improved compared to conventional characteristics. Conclusion Our findings suggest that advanced age, increased stroke severity, poor collaterals, general anesthesia, and NLR are independent predictors for an unfavorable clinical outcome following complete reperfusion after EVT. Neuroinflammation may merit particular attention in future studies.
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Affiliation(s)
- Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Wei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China
| | - Wenbo Cao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Fan Yu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhaolin Fu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaofan Guo
- Department of Neurology, Loma Linda University Health, Loma Linda, CA, United States
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Arman Sha
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Fei Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Liu DN, Zhou J, Huang XR, Sun GH, Luo F, Tan JQ, Liao Y, Peng T, Feng WB. [Effect of electroacupuncture at "Shuigou" (GV26) and "Baihui" (GV20) on autophagy of hippo-campal neurons in rats with cerebral ischemia-reperfusion injury]. Zhen Ci Yan Jiu 2022; 47:491-496. [PMID: 35764515 DOI: 10.13702/j.1000-0607.20210561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the effect of electroacupuncture (EA) at "Shuigou"(GV6) and "Baihui"(GV20) on autophagy of hippocampal neurons in cerebral ischemia-reperfusion (I/R) injury rats. METHODS Forty-eight healthy male SD rats were randomly divided into sham operation, model and EA groups, with 16 rats in each group. The rat model of cerebral I/R injury was established by occlusion of the middle cerebral artery (MCAO). Rats of the EA group received EA at GV26 and GV20 for 20 min, once daily for 5 days. The neurological function of rats in each group was evaluated by Longa neurological function score. The cerebral infarction volume was measured by TTC staining. The levels of IL-6, IL-18 and TNF-α in cerebrospinal fluid were detected by ELISA. Real-time PCR and Western blot were respectively used to detect the expressions of autophagy-related proteins AMPK, Beclin-1, VPS34 and LC3B. RESULTS Compared with the sham operation group, neurological function scores of rats in the model group were significantly increased (P<0.01); the volume of cerebral infarction was significantly increased (P<0.01); the contents of IL-6, IL-18 and TNF-α in cerebrospinal fluid were increased (P<0.01, P<0.05); the mRNA expression levels of AMPK, Beclin-1, VPS34 and LC3B were significantly increased (P<0.01); the protein expressions of AMPK, Beclin-1, VPS34 and the ratio of LC3B-Ⅱ/LC3B-Ⅰ were increased (P<0.01, P<0.05). After intervention and in comparison with the model group, the neurological function scores were decreased (P<0.05); the cerebral infarct volume were decreased (P<0.05); the contents of IL-6, IL-18 and TNF-α in cerebrospinal fluid were decreased (P<0.05); the mRNA expressions of AMPK, Beclin-1, VPS34 and LC3B were significantly decreased (P<0.01); the protein expressions of AMPK, Beclin-1, VPS34 and the ratio of LC3B-Ⅱ/LC3B-Ⅰ were decreased (P<0.05, P<0.01). CONCLUSION EA can improve the neurological function and alleviate the degree of nerve injury in rats with cerebral I/R injury, which may be related to inhibiting the autophagy level of hippocampal neurons.
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Affiliation(s)
- Dan-Ni Liu
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Jun Zhou
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Xia-Rong Huang
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Guang-Hua Sun
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Fu Luo
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Jin-Qu Tan
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Yuan Liao
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Ting Peng
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
| | - Wei-Bin Feng
- Rehabilitation Medicine Center, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China; Rehabilitation Laboratory, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
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21
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Ng TP, Wong C, Leong ELE, Tan BY, Chan MYY, Yeo LL, Yeo TC, Wong RC, Leow AS, Ho JSY, Sia CH. Simultaneous cardio-cerebral infarction: a meta-analysis. QJM 2022; 115:374-380. [PMID: 34051098 DOI: 10.1093/qjmed/hcab158] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/INTRODUCTION Cardio-cerebral infarction (CCI), which involves the simultaneous occurrence of acute ischaemic stroke and acute myocardial infarction, has a reported incidence of 0.0009%. Treatment of CCI presents a dilemma to physicians as both conditions are time critical. Despite the need for standardized treatment protocols, published data are sparse. AIM We aimed to summarize the reported cardio-cerebral infarction cases in the literature. DESIGN Meta-analysis. METHODS Four databases, Pubmed, Embase, Scopus and Google Scholar were searched until 25 August 2020. A title and abstract sieve, full-text review and extraction of data were conducted independently by three authors. RESULTS A total of 44 cases of CCI were identified from 37 case reports and series; 15 patients (34.1%) were treated using percutaneous coronary intervention (PCI) with stent, 8 patients (18.2%) were treated with a PCI without stent, 10 patients (22.7%) were treated via a cerebral vessel thrombectomy and 8 patients (18.2%) were treated via a thrombectomy of a coronary vessel. For medications, 20 patients (45.5%) were treated with thrombolytics, 10 patients (22.7%) were treated with anticoagulants, 8 patients (18.2%) were treated with antiplatelets and 11 patients (25.0%) were treated with anticoagulants and antiplatelets. Of 44 patients, 10 patients died, and 9 of those were due to cardiac causes. Among the 44 patients, days to death was observed to be a median of 2.0 days (interquartile range (IQR): 1.5, 4.0). The modified Rankin Score was measured in nine patients, with a median score of 2.0 (IQR: 1.0, 2.5) being reported. DISCUSSION/CONCLUSION The condition of CCI has substantial morbidity and mortality, and further studies are needed to examine the optimal diagnostic and treatment strategies of these patients.
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Affiliation(s)
- T P Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - E L E Leong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10 , 119228, Singapore
| | - B Y Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road , NUHS Tower Block Level 10, 119228, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - M Y-Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - T-C Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road, 119074, Singapore
| | - R C Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, 5 Lower Kent Ridge Road , 119074, Singapore
| | - A S Leow
- Internal Medicine Residency, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - J S-Y Ho
- Academic Foundation Programme, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK
| | - C-H Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Department of Cardiology, National University Heart Centre, Singapore , 5 Lower Kent Ridge Road, 119074, Singapore
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Zhang D, Huang L, Zhang L, Gui X, Tao J, Zeng P, Ding M. Acupuncture-Moxibustion Combined with Rehabilitation Training Is Conducive to Improving the Curative Effect, Cognitive Function, and Daily Activities of Patients with Cerebral Infarction. Comput Math Methods Med 2022; 2022:4430345. [PMID: 35637845 PMCID: PMC9148241 DOI: 10.1155/2022/4430345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022]
Abstract
Objective To elucidate the effect of acupuncture-moxibustion combined with rehabilitation training (RHT) on the curative effect, cognitive function (CF), and activities of daily living (ADL) of patients with cerebral infarction (CI). Methods This study enrolled 150 patients with CI admitted to the Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University from June 2020 to July 2021. Among them, 80 patients who were treated with acupuncture-moxibustion combined with RHT were included in the research group, and 70 patients who received acupuncture-moxibustion alone were included in the control group. The efficacy, CF, and ADL were observed in both groups, and the influences of the two therapies on serum uric acid (UA), high-sensitivity C-reactive protein (hs-CRP), and cystatin C (Cys-C) were compared. Among the various indexes, the CF of patients was assessed by the Montreal Cognitive Assessment (MoCA), and the ADL was evaluated by the Barthel index. Results After treatment, the research group presented significantly better efficacy, CF, and ADL than the control group, with lower levels of serum UA, hs-CRP, and Cys-C than the control group and before treatment. Conclusion Acupuncture-moxibustion combined with RHT can inhibit serum UA, hs-CRP, and Cys-C levels of patients with CI while improving the curative effect, CF, and ADL, which is worthy of clinical promotion.
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Affiliation(s)
- Ding Zhang
- Department of Rehabilitation Medicine, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
| | - Liemi Huang
- Department of Rehabilitation Medicine, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
| | - Lun Zhang
- Department of Rehabilitation Medicine, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
| | - Xinghua Gui
- Department of Rehabilitation Medicine, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
| | - Jiping Tao
- Department of Rehabilitation Medicine, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
| | - Pengli Zeng
- Department of Rehabilitation Medicine, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
| | - Min Ding
- Department of Urology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, Wuhan, 430000 Hubei Province, China
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He X, Liu G, Zou C, Li R, Zhong J, Li H. Artificial Intelligence Algorithm-Based MRI in Evaluating the Treatment Effect of Acute Cerebral Infarction. Comput Math Methods Med 2022; 2022:7839922. [PMID: 35111236 PMCID: PMC8803452 DOI: 10.1155/2022/7839922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/11/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
The study is aimed at exploring the application of artificial intelligence algorithm-based magnetic resonance imaging (MRI) in the diagnosis of acute cerebral infarction, expected to provide a reference for diagnosis and effect evaluation of acute cerebral infarction. In this study, 80 patients diagnosed with suspected acute cerebral infarction per Diagnostic Criteria for Cerebral Infarction were selected as the research subjects. MRI images were reconstructed by deep dictionary learning to improve their recognition ability. At the same time, the same diagnostic operation was performed by Computed Tomography (CT) images to compare with MRI. The results of the interalgorithm comparison showed the image reconstruction effect of the deep dictionary learning model is significantly better than SAE reconstruction, single-layer dictionary reconstruction model, and KAVD reconstruction. After comparison, the results of MRI based on artificial intelligence algorithm and CT evaluation were statistically significant (P < 0.05). In the lesion image, the diameter of MRI lesions (3.81 ± 0.77 cm) based on artificial intelligence algorithm and the diameter of lesions in CT (3.66 ± 1.65 cm) also had significant statistical significance (P < 0.05). The results showed that MRI based on deep learning was more sensitive than CT imaging for diagnosis and evaluation of patients with acute cerebral infarction, with only 1 case misdiagnosed. The rate of disease detection and lesion image quality had a higher improvement. The results can provide effective support for the clinical application of MRI based on artificial intelligence algorithm in the diagnosis of acute cerebral infarction.
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Affiliation(s)
- Xiaojie He
- Department of Emergency, The First Affiliated Hospital of Jiamusi University, Jiamusi, 154002 Heilongjiang, China
| | - Guangxiang Liu
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Jiamusi, 154002 Heilongjiang, China
| | - Chunying Zou
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Jiamusi, 154002 Heilongjiang, China
| | - Rongrui Li
- Department of Orthopedics, The First Affiliated Hospital of Jiamusi University, Jiamusi, 154002 Heilongjiang, China
| | - Juan Zhong
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Jiamusi, 154002 Heilongjiang, China
| | - Hong Li
- Clinical Skills Center of the First Clinical College, Mudanjiang Medical University, Mudanjiang, 157011 Heilongjiang, China
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Hamblin MH, Murad R, Yin J, Vallim G, Lee JP. Modulation of gene expression on a transcriptome-wide level following human neural stem cell transplantation in aged mouse stroke brains. Exp Neurol 2022; 347:113913. [PMID: 34752785 PMCID: PMC8647207 DOI: 10.1016/j.expneurol.2021.113913] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Neural stem cell (NSC) transplantation offers great potential for treating ischemic stroke. Clinically, ischemia followed by reperfusion results in robust cerebrovascular injury that upregulates proinflammatory factors, disrupts neurovascular units, and causes brain cell death. NSCs possess multiple actions that can be exploited for reducing the severity of neurovascular injury. Our previous studies in young adult mice showed that human NSC transplantation during the subacute stage diminishes stroke pathophysiology and improves behavioral outcome. METHODS We employed a well-established and commonly used stroke model, middle cerebral artery occlusion with subsequent reperfusion (MCAO/R). Here, we assessed the outcomes of hNSC transplantation 48 h post-MCAO (24 h post-transplant) in aged mouse brains in response to stroke because aging is a crucial risk factor for cerebral ischemia. Next, we tested whether administration of the integrin α5β1 inhibitor, ATN-161, prior to hNSC transplantation further affects stoke outcome as compared with NSCs alone. RNA sequencing (RNA-seq) was used to assess the impact of hNSC transplantation on differentially expressed genes (DEGs) on a transcriptome-wide level. RESULTS Here, we report that hNSC-engrafted brains with or without ATN-161 showed significantly reduced infarct size, and attenuated the induction of proinflammatory factors and matrix metalloproteases. RNA-seq analysis revealed DEGs and molecular pathways by which hNSCs induce a beneficial post-stroke outcome in aged stroke brains. 811 genes were differentially expressed (651 downregulated and 160 upregulated) in hNSC-engrafted stroke brains. Functional pathway analysis identified enriched and depleted pathways in hNSC-engrafted aged mouse stroke brains. Depletion of pathways following hNSC-engraftment included signaling involving neuroinflammation, acute phase response, leukocyte extravasation, and phagosome formation. On the other hand, enrichment of pathways in hNSC-engrafted brains was associated with PPAR signaling, LXR/RXR activation, and inhibition of matrix metalloproteases. Hierarchical cluster analysis of DEGs in hNSC-engrafted brains indicate decreased expression of genes encoding TNF receptors, proinflammatory factors, apoptosis factors, adhesion and leukocyte extravasation, and Toll-like receptors. CONCLUSIONS Our study is the first to show global transcripts differentially expressed following hNSC transplantation in the subacute phase of stroke in aged mice. The outcome of our transcriptome study would be useful to develop new therapies ameliorating early-stage stroke injury.
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Affiliation(s)
- Milton H Hamblin
- Tulane University Health Sciences Center, Tulane University, New Orleans, LA 70112, USA.
| | - Rabi Murad
- Bioinformatics, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Jun Yin
- Bioinformatics, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037, USA
| | - Gustavo Vallim
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Jean-Pyo Lee
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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Zhang JC, Wu XG, Cao XL, Zhou LF. [Effect of electroacupuncture on expression of NF-κB and TNF-α in renal tissue of rats with acute cerebral infarction]. Zhen Ci Yan Jiu 2021; 46:1005-1010. [PMID: 34970876 DOI: 10.13702/j.1000-0607.200242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To observe the effect of electroacupuncture (EA) on motor function, serum Cystatin C (Cys C) content, and expressions of tumour necrosis factor-α (TNF-α) and nuclear factor-kappa B (NF-κB) in renal tissue of rats with acute cerebral infarction (ACI), so as to explore its underlying mechanisms in protecting renal tissue after ACI. METHODS Seventy-two male SD rats were randomly divided into three groups: sham operation, model and EA groups which were further randomly allocated to 1 d, 3 d, 7 d and 14 d subgroups (n=6 per subgroup). The ACI model was established by occlusion of the middle cerebral artery (MCAO). Rats of the EA group received EA of "Neiguan" (PC6) and "Zusanli" (ST36) for 30 min, once daily for 1, 3, 7 and 14 days, respectively. The motor function and content of Cys C were determined on the 1st, 3rd, 7th and 14th day after ACI. The expressions of TNF-α and NF-κB were detected by immunohistochemistry. RESULTS Compared with the sham operation group, the motor function scores and the content of Cys C increased significantly on the 1st, 3rd, 7th and 14th d (P<0.01), while the numbers of TNF-α and NF-κB positive cells of the model group increased significantly on the 3rd, 7th and 14th d (P<0.01). After EA treatment, the motor function scores and the content of Cys C on the 7th, and 14th d, and the numbers of TNF-α and NF-κB positive cells on the 3rd, 7th and 14th d obviously decreased (P<0.05). CONCLUSION EA at PC6 and ST36 can improve motor function and alleviate renal injury in ACI rats, possibly by regulating the expression of TNF-α, NF-κB in renal tissue and Cys C in serum.
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Affiliation(s)
- Jun-Chuan Zhang
- The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xin-Gui Wu
- The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xiang-Ling Cao
- The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Li-Fang Zhou
- The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Zhong Z, Xu P, Wen J, Li X, Zhang X. Enriched Environment Regulates Dendritic Cells to Alleviate Inflammation in Cerebral Infarction Lesions. Comput Math Methods Med 2021; 2021:1574109. [PMID: 34976103 PMCID: PMC8719993 DOI: 10.1155/2021/1574109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim was to investigate the role that enriched environment (EE) plays in the regulation of inflammation in cerebral infarction (CI) lesions and further explore the relationship between this regulation and dendritic cells (DCs). METHODS 72 Sprague-Dawley rats were randomly divided into sham operation group (CON group, n = 24) and CI model group (n = 48). On completion of the establishment of CI rat models by Longa's method, rats in the models group were further assigned to standard environment group (NC group, n = 24) and EE group (n = 24). HE staining was utilized for evaluation of neuronal injury in the lesions. The number of CD74- and integrin αE-positive cells was detected by immunofluorescence. The expression of the IL-1β, IL-6, and TNF-α in the brain tissue and serum of rats was measured by immunohistochemistry and ELISA, respectively. RESULTS In comparison with the CON group, the NC and EE groups showed significant increases in neuronal injury, CD74- and Integrin αE-positive cells, DC content, as well as IL-1β, IL-6, and TNF-α expression in brain tissue and serum. According to the further comparison between the NC group and EE group, the latter showed decreases in each indicator, and these decreases were in a time-dependent manner. CONCLUSION EE avoids the accumulation of DCs in the lesions and reduces the contents of IL-1β, IL-6, and TNF-α, consequently promoting the recovery of CI. And better recovery results can be obtained through increasing the time to stay in EE.
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Affiliation(s)
- Zhenzhen Zhong
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Ping Xu
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Jun Wen
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Xiangdong Li
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Xiaobo Zhang
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
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Wei J, Zhu X, Xia L, Zhao Y, Yang G, Han Q, Shen J. Intermittent pneumatic compression combined with rehabilitation training improves motor function deficits in patients with acute cerebral infarction. Acta Neurol Belg 2021; 121:1561-1566. [PMID: 32734564 DOI: 10.1007/s13760-020-01414-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
To investigate the effect of intermittent pneumatic compression (IPC) combined with rehabilitation training on patients with acute cerebral infarction and motor impairment, seventy-four patients with acute cerebral infarction and hemiplegia were randomly and equally divided into two groups, the control group and the IPC treatment group. The patients in the control group received conventional drug therapy and rehabilitation training, and the patients in the treatment group received the IPC treatment in addition to the treatment given in the control group. Motor function, the primary outcome, of the two groups was evaluated by Fugl-Meyer motor function scores. The Barthel index assessment scale was used to evaluate the ability to perform activities of daily living of the two groups, as a secondary outcome. All these indicators were collected and compared before treatment and at 7 days, 14 days, and 30 days after treatment. The incidence of adverse reactions associated with treatment was also recorded. At 7, 14, and 30 days after treatment, the Fugl-Meyer scores (27.16 ± 7.37, 33.41 ± 7.16 and 38.72 ± 7.65) and Barthel scores (47.16 ± 7.37, 52.41 ± 7.16, and 56.09 ± 8.32) of the treatment group were also significantly higher than those (23.65 ± 3.11, 26.13 ± 3.25, and 28.75 ± 5.92; 44.15 ± 3.11, 46.63 ± 3.25 and 47.75 ± 4.22) of the control group (all P < 0.05). With the extension of follow-up time, both scores were higher. There were no treatment-related adverse events in either of the two groups of patients during or after treatment. In conclusion, the IPC combined with rehabilitation training can effectively improve motor function deficits, the ability to perform activities of daily living, and quality of life for patients.
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Affiliation(s)
- Jiangshan Wei
- Department of Neurology, Hongze Huai'an District People's Hospital, No.1 Huanghe West Road, Huai'an, 223300, Jiangsu, People's Republic of China
| | - Xiangyu Zhu
- ICU, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, No.62 Huaihai South Road, Huai'an, 223002, Jiangsu, People's Republic of China
| | - Lei Xia
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China
| | - Ying Zhao
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, 223002, Jiangsu, China
| | - Guang Yang
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, 223002, Jiangsu, China
| | - Qiu Han
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, Jiangsu, China.
| | - Jun Shen
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, 223002, Jiangsu, China.
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Chang SQ, Zhang XC, Zhang A, Song YY, Jiang SY, Zhang ZH, Cai ZY, Liu FR, Ni GX. [Acupuncture intervention prolongates thrombolysis time window by regulating cerebral cortex angiogenesis-related genes and proteins in cerebral infarction rats]. Zhen Ci Yan Jiu 2021; 46:751-756. [PMID: 34558240 DOI: 10.13702/j.1000-0607.201121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To observe the effect of acupuncture on the expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and endostatin (Endostatin, ES) mRNAs and proteins (angiogenesis related factors) in the ischemic penumbra region in rats with cerebral infarction (CI), so as to explore its underlying mechanisms in prolonging the time window of thrombolysis therapy for CI. METHODS A total of 48 male SD rats were randomly divided into sham operation, model, medication (6 h thrombolysis) and acupuncture (Acupunct)+medication groups (n=12 in each group). The CI model was established using modified auto-thrombus method. Six hours after thrombolysis, recombinant human tissue plasminogen activator (rt-PA,10 mg/kg) was given to rats of the thrombolysis group through tail vein. Acupuncture was applied at "Shuigou"(CV26) and bilateral "Neiguan" (PC6) 2 h after successful modeling, and the needles were retained for 30 minutes. Cerebral blood flow (CBF) was monitored during modeling in each group, and the neurological deficit score (0-7 points) was given 2 h and 24 h after successful modeling according to Bederson's methods. The cerebral infarction volume was observed after triphenyltetrazole chloride (TTC) staining. The protein and mRNA expression levels of VEGF, bFGF and ES in the ischemic penumbra region of the right cerebral cortex were detected by Western blot and real-time PCR, separately. RESULTS The neurological deficit score at both 2 h and 24 h after modeling, percentage of cerebral infarction volume, and the expression levels of VEGF, bFGF and ES proteins and mRNAs in the model group were significantly higher than those of the sham operation group (P<0.01, P < 0.05). Compared with the model group, the neurological deficit score 24 h (not at 2 h) after modeling and percentage of cerebral infarction volume, and the expression levels of ES protein and mRNA in the Acupunct+medication group (not in the medication group) were notably lower (P<0.05, P<0.01), while the expression levels of VEGF and bFGF proteins and mRNAs in the Acupunct +medication group (not in the medication group) were considerably higher (P<0.01, P<0.05). No significant differences were found between medication and model groups in the CI percentage, VEGF, bFGF and ES proteins and mRNAs (P>0.05). The therapeutic effect of Acupunct +medication group was significantly superior to that of medication in lowering neurological deficit score, percentage of CI volume and expression of ES protein and mRNA and in up-regulating the expression of VEGF and bFGF proteins and mRNAs (P<0.05, P<0.01). CONCLUSION Acupuncture and timely intervention can prolong the time window of thrombolysis in CI rats, which may be related to its function in up-regulating the expression of VEGF and bFGF mRNAs and proteins and in down-regulating the expression of ES mRNA and protein in ischemic cerebral cortex.
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Affiliation(s)
- Si-Qi Chang
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xin-Chang Zhang
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Ao Zhang
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yang-Yang Song
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Si-Yuan Jiang
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Zhi-Hui Zhang
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Zheng-Yun Cai
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Fu-Rong Liu
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Guang-Xia Ni
- College of Acupuncture and Massage, Nanjing University of Chinese Medicine, Nanjing 210023, China
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Tao Z, Rao G, Wu S, Lin Y, Wang J, Chen Z. Rehabilitation Evaluation of Hemiplegic Patients with Anterior Circulation Cerebral Infarction Based on Cranial Magnetic Stimulation. J Healthc Eng 2021; 2021:7868419. [PMID: 34367539 PMCID: PMC8346300 DOI: 10.1155/2021/7868419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/13/2021] [Accepted: 07/21/2021] [Indexed: 01/20/2023]
Abstract
Cerebral infarction is a common cerebrovascular disease in clinical medicine. Cerebral infarction in the anterior circulation accounts for about 90% of cerebral infarction. Its treatment and rehabilitation has always been a research hotspot in the medical field. Functional retraining can enhance the afferent impulses received by receptors, make the plasticity development of cerebral cortex function, and improve the loss of function. Based on the patient's individual condition, exercise therapy carries out the corresponding comprehensive functional training plan, which also includes the training of patients' daily living ability, turning over, bridge exercise, trunk rotation, etc., in order to improve the motor function of patients. The other is psychotherapy, which can cause emotional fluctuations, depression, anxiety, and other negative emotions due to the occurrence of diseases. In the rehabilitation treatment, relevant personnel can conduct psychological counseling for patients through timely and effective communication, so as to better establish patients' confidence in rehabilitation and improve the effect of rehabilitation treatment. The third is acupuncture treatment. Acupuncture is a traditional rehabilitation treatment in China. The rehabilitation effect of stroke has been proved by a large number of clinical practice. Acupuncture at Hegu, Quchi, Zusanli, and Taichong points can dredge channels and improve blood circulation. This paper mainly studies and analyzes the effect of behavior rehabilitation of hemiplegic patients with cerebral anterior circulation infarction treated by cranial magnetic stimulation. The rehabilitation treatment status of hemiplegic patients with anterior circulation cerebral infarction in a hospital was selected, and 100 cases were studied. Among them, 50 cases were treated with conventional rehabilitation therapy, and the other 50 cases were treated with cranial magnetic stimulation. The motor function, activities of daily living, and language expression ability of the two groups were compared for statistical analysis. After transcranial magnetic stimulation treatment, the abilities of the study group were better than those of the control group, P < 0.05, with statistical significance. Based on the reliable experimental data, we can draw a conclusion that the treatment of cranial magnetic stimulation has a significant effect on the rehabilitation of hemiplegic patients with cerebral anterior circulation infarction, which is higher than the conventional treatment and rehabilitation methods, and can be popularized in clinical application.
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Affiliation(s)
- Zhengde Tao
- Rehabilitation Department, The First People's Hospital of Wenling, Wenling 317500, Zhejiang, China
| | - Gaofeng Rao
- Rehabilitation Department, The First People's Hospital of Wenling, Wenling 317500, Zhejiang, China
| | - Shasha Wu
- Rehabilitation Department, The First People's Hospital of Wenling, Wenling 317500, Zhejiang, China
| | - Yongqiang Lin
- Rehabilitation Department, The First People's Hospital of Wenling, Wenling 317500, Zhejiang, China
| | - Jinqiao Wang
- Rehabilitation Department, The First People's Hospital of Wenling, Wenling 317500, Zhejiang, China
| | - Zhirui Chen
- Rehabilitation Department, The First People's Hospital of Wenling, Wenling 317500, Zhejiang, China
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Yang FX, Gao JY, Liu G, Tan WB, Gu M, Su WS, Yao SY, Yan SJ, Liu LM, Xie YQ. [Effect of tiaoren tongdu acupuncture method on fractional anisotropy of diffusion densor imaging and upper extremity motor function after cerebral infarction]. Zhen Ci Yan Jiu 2021; 46:610-615. [PMID: 34369683 DOI: 10.13702/j.1000-0607.20210033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To observe the effect of tiaoren tongdu acupuncture method (for regulating the function of the Conception Vessel and promoting the circulation of the Governor Vessel) on fractional anisotropy (FA) and upper-extremity motor function after cerebral infarction by diffusion densor imaging (DTI) technology. METHODS The patients with cerebral infarction were divided into an acupuncture group and a control group according to the random number table method, 27 cases in each group. In the control group, the basic treatment with conventional medication was used. In the acupuncture group, on the basic treatment as the control group, the tiaoren tongdu acupuncture method was provided. Main acupoints included Baihui (GV20), Shuigou(GV26), Chengjiang(CV24), Guanyuan(CV4), Qihai (CV6), Zhongwan (CV12), Shenting(GV24) and Mingmen(GV4). Supplementary points included Jianyu(LI15), Chize(LU5), Houxi (SI3), Weizhong (BL40), Zusanli (ST36) and Taichong (LR3) on the affected side. The needles were retained for 30 min. Acupuncture was given once a day, at the interval of 1 days every week, consecutively for 4 weeks. The upper extremity Fugl-Meyer assessment (UE-FMA) was used to evaluate the motor function of upper extremity before and after treatment. DTI was adopted to observe the FA values of infarct focus, posterior limb of internal capsule (PLIC) and cerebral peduncle on the affected side, as well as FA values at the corresponding parts on the healthy side in the patients of two groups. The relative differences (rFA) were calculated. RESULTS Compared with their own pretreatment, the UE-FMA value was significantly higher after treatment in either of two groups separately (P<0.05 in the control group, P<0.01 in the acupuncture group). The difference of UE-FMA before and after treatment in the acupuncture group was larger than that in the control group (P<0.05). The FA and rFA values in infarct focus were higher than those before treatment in the two groups (P<0.05). The FA and rFA differences before and after treatment in the infarct focus and PLIC on the affected side were higher in the acupuncture group as compared with the control group (P<0.05). The UE-FMA difference was positively correlated with the rFA difference of each part in either group (P<0.05), and the correlation was the strongest in PLIC on the affected side in either group (P<0.01). CONCLUSION Tiaoren tongdu acupuncture significantly improves the upper limb movement function after cerebral infarction. The rFA value of PLIC combined with UE-FMA can be used to evaluate the therapeutic effect of acupuncture on the upper extremity movement after cerebral infarction.
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Affiliation(s)
- Fu-Xia Yang
- Acupuncture and Moxibustion Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Jin-Yun Gao
- Radiographic Imaging Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Gang Liu
- Neurology Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Wei-Bin Tan
- Neurology Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Mei Gu
- Neurology Department of Shenzhen People's Hospital, Shenzhen 518033, Guangdong Province
| | - Wen-Shan Su
- Acupuncture and Moxibustion Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Shu-Yang Yao
- Acupuncture and Moxibustion Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Si-Jin Yan
- Acupuncture and Moxibustion Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Li-Min Liu
- Acupuncture and Moxibustion Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
| | - Yao-Qin Xie
- Institute of Medical Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518033, Guangdong Province
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Wang Y, Xing J, Li Y, Zhang R. Effect and safety of acupuncture on cerebrovascular reserve in patients with acute cerebral infarction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26636. [PMID: 34260557 PMCID: PMC8284725 DOI: 10.1097/md.0000000000026636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND As far as we know, no evidence has been established to assess the effects of acupuncture for acute cerebral infarction patients. Therefore, this systematic review and meta-analysis will be conducted to assess the efficacy and safety of acupuncture on cerebrovascular reserve in patients with acute cerebral infarction. METHODS On June 20, 2021, the authors will perform a preliminary search in the PubMed, Embase, and Scopus databases using the following keywords: "acupuncture," "acute cerebral infarction." We will also examine the Clinical Trials Registry for other ongoing and unpublished studies. The inclusion criteria included (1) patients with acute cerebral infarction, (2) patients who received acupuncture, and (3) studies assessed cerebrovascular reserve, breath-holding index, Barthel index, and adverse events. All English language randomized controlled trials published within the last 20 years were eligible for inclusion. Primary outcome measures in our study are cerebrovascular reserve, and secondary outcome measures include the breath-holding index, Barthel index, and adverse events. All outcomes are pooled on a random-effect model. RESULTS The results of this research will be delivered in a peer-reviewed journal. OSF REGISTRATION NUMBER 10.17605/OSF.IO/7M4BK.
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Affiliation(s)
- Yuliang Wang
- Department of Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, China
| | - Jijie Xing
- Department of Acupuncture, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Heilongjiang, China
| | - Ying Li
- Department of Science and Education, Beijing Xiaotangshan Hospital, Beijing, China
| | - Rui Zhang
- Department of Rehabilitation, Hotan District People's Hospital, Xinjiang, China
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Quintero-Consuegra MD, Toscano JF, Babadjouni R, Nisson P, Kayyali MN, Chang D, Almallouhi E, Saver JL, Gonzalez NR. Encephaloduroarteriosynangiosis Averts Stroke in Atherosclerotic Patients With Border-Zone Infarct: Post Hoc Analysis From a Performance Criterion Phase II Trial. Neurosurgery 2021; 88:E312-E318. [PMID: 33469657 PMCID: PMC7956046 DOI: 10.1093/neuros/nyaa563] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/09/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is one of the leading causes of stroke worldwide. Patients with ICAD who initially present with ischemia in border-zone areas and undergo intensive medical management (IMM) have the highest recurrence rates (37% at 1 yr) because of association with hemodynamic failure and poor collaterals. OBJECTIVE To evaluate the effect of encephaloduroarteriosynagiosis (EDAS) on stroke recurrence in patients with ICAD and border-zone stroke (BDZS) at presentation. METHODS A phase II clinical trial of EDAS revascularization for symptomatic ICAD failing medical management (EDAS Revascularization for Symptomatic Intracranial Atherosclerosis Steno-occlusive [ERSIAS]) was recently concluded. We analyze the outcomes of the subgroup of patients with BDZS at presentation treated with EDAS vs the previously reported Stenting versus Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) IMM subgroup with BDZS at presentation. RESULTS Of 52 patients included in the ERSIAS trial, 35 presented with strokes at baseline, and 28 had a BDZ pattern, including 15 (54%) with exclusive BDZS and 13 (46%) with mixed patterns (BDZ plus other distribution). Three of the 28 (10.7%) had recurrent strokes up to a median follow-up of 24 months. The rate of recurrent stroke in ICAD patients with BDZS at presentation after EDAS was significantly lower than the rate reported in the SAMMPRIS IMM subgroup with BDZS at presentation (10.7% vs 37% P = .004, 95% CI = 0.037-0.27). CONCLUSION ICAD patients with BDZS at presentation have lower rates of recurrent stroke after EDAS surgery than those reported with medical management in the SAMMPRIS trial. These results support further investigation of EDAS in a randomized clinical trial.
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Affiliation(s)
| | - Juan F Toscano
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robin Babadjouni
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Peyton Nisson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mohammad N Kayyali
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel Chang
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey L Saver
- Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
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Tan YJ, Narasimhalu K, Chan Y, De Silva DA. Stroke Patients Without COVID-19 Symptoms: Is There a Need to Screen? Neurologist 2021; 26:73-74. [PMID: 33646994 PMCID: PMC8041490 DOI: 10.1097/nrl.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION COVID-19 patients who present with strokes but without typical COVID-19 symptoms have been described in small numbers. Despite the paucity of fever and respiratory symptoms, they remain capable of infecting others. The patient we discuss herein highlights the important issues of strokes as presenting events of COVID-19 infections, and how testing for COVID-19 in stroke patients, even when asymptomatic for COVID-19, can play an important role in infection control, clinical management and outcomes amidst this global pandemic. CASE REPORT A 45-year-old male resident of a dormitory presented to our unit with acute vertigo and left-sided dysmetria. NIHSS was 2. The initial magnetic resonance imaging demonstrated infarction of the left cerebellar hemisphere, middle cerebellar peduncle and hemipons. An extensive work-up for stroke etiologies was unremarkable. Despite having no fever, respiratory symptoms, anosmia or ageusia, he was isolated and screened for COVID-19 due to his epidemiologic risks, with multiple residents from his dormitory being recently diagnosed with COVID-19. Confirming our suspicion, his respiratory samples returned positive for COVID-19. His D-dimer levels returned normal. Thereafter, the patient underwent posterior decompression surgery due to worsening edema caused by the cerebellar infarct. He was started on antiplatelet therapy and recovered significantly a month from presentation with an modified Rankin Sore of 2. He remained without typical COVID-19 symptoms. CONCLUSION Our patient's case clearly supports the screening for COVID-19 in stroke patients who are without COVID-19 symptoms, appreciating the significant value it adds to infection control, clinical management, and outcomes amidst this global pandemic.
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Affiliation(s)
- You-Jiang Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital
| | - Kaavya Narasimhalu
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital
| | - Yvonne Chan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Deidre A. De Silva
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital
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Wang J, Ran C, Pan P, Wang Y, Zhao Y. Rehabilitation training combined acupuncture for limb hemiplegia caused by cerebral infarction: A protocol for a systematic review of randomized controlled trial. Medicine (Baltimore) 2021; 100:e23474. [PMID: 33429730 PMCID: PMC7793329 DOI: 10.1097/md.0000000000023474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Previous studies have reported that rehabilitation training combined acupuncture (RTA) can be used for the treatment of limb hemiplegia (LH) caused by cerebral infarction (CI). However, its effectiveness is still unclear. In this systematic review study, we aim to evaluate the effectiveness and safety of RTA for LH following CI. METHODS We will retrieve the databases of CENTRAL, EMBASE, MEDILINE, CINAHL, AMED, CBM, PUBMED, and CNKI from inception to June 1, 2020 with no language restrictions. The randomized controlled trials of RTA for evaluating effectiveness and safety in patients with LH following CI will be included. Cochrane risk of bias tool will be used to measure the methodological quality for all included studies. Two authors will independently select the studies, extract the data, and assess the methodological quality of included studies. A third author will be invited to discuss if any disagreements exist between 2 authors. We will perform heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we select random effect model or fixed effect model for meta-analysis of the included cohort studies. Cochrane risk of bias tool will be used to determine the methodological quality for included studies. RevMan 5.3 software (Cochrane Community, London, UK) will be utilized to perform statistical analysis. RESULTS This systematic review will assess the effectiveness and safety of RTA for LH caused by CI. The primary outcome includes limbs function, as measured by the Wolf Motor Function Test (WMFT) Assessment scale, or other associated scales. The secondary outcomes consist of muscle strength, muscle tone, quality of life, and any adverse events. CONCLUSION The findings of this study will summarize the current evidence of RTA for LH caused by CI, and may provide helpful evidence for the clinical treatment. DISSEMINATION AND ETHICS The findings of this study are expected to be published in peer-reviewed journals. It does not require ethical approval, because no individual data will be utilized in this study. SYSTEMATIC REVIEW REGISTRATION INPLASY202070114.
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Affiliation(s)
| | | | - Ping Pan
- Henan University of Chinese Medicine
| | | | - Yinglin Zhao
- The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, P.R. China
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Regenhardt RW, Etherton MR, Das AS, Schirmer MD, Hirsch JA, Stapleton CJ, Patel AB, Leslie-Mazwi TM, Rost NS. Infarct Growth despite Endovascular Thrombectomy Recanalization in Large Vessel Occlusive Stroke. J Neuroimaging 2021; 31:155-164. [PMID: 33119954 PMCID: PMC8365346 DOI: 10.1111/jon.12796] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Endovascular thrombectomy (EVT) has revolutionized large vessel occlusion stroke care. However, not all patients with good endovascular results achieve good outcomes. We sought to understand the clinical significance of magnetic resonance imaging defined infarct growth despite adequate reperfusion and identify associated clinical and radiographic variables. METHODS History, presentation, treatments, and outcomes for consecutive EVT patients at a referral center were collected. Adequate reperfusion was defined as thrombolysis in cerebral infarction (TICI) score 2b-3. Region-specific infarct volumes in white matter, cortex, and basal ganglia were determined on diffusion-weighted imaging. Infarct growth was defined as post-EVT minus pre-EVT volume. Good outcome was defined as 90-day modified Rankin Scale ≤2. RESULTS Forty-four patients with adequate reperfusion were identified with median age 72 years; 64% were women. Each region showed infarct growth: white matter (median pre-EVT 7 cubic centimeters [cc], post-EVT 16 cc), cortex (4 cc, 15 cc), basal ganglia (2 cc, 4 cc), total (20 cc, 39 cc). In multivariable regression, total infarct growth independently decreased the odds of good outcome (odds ratio = .946, 95% CI = .897, .998). Further multivariable analyses for determinants of infarct growth identified female sex was associated with less total growth (β = -.294, P = .042), TICI 3 was associated with less white matter growth (β = -.277, P = .048) and cortical growth (β = -.335, P = .017), and both female sex (β = -.332, P = .015) and coronary disease (β = -.337, P = .015) were associated with less cortical growth. CONCLUSIONS Infarct growth occurred despite adequate reperfusion, disproportionately in the cortex, and independently decreased the odds of good outcome. Infarct growth occurred while patients were hospitalized and may represent a therapeutic target. Potential determinants of region-specific infarct growth were identified that require confirmation in larger studies.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School
| | - Markus D Schirmer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School
| | | | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School
| | - Thabele M Leslie-Mazwi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School
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Xu YL, Xu XM, Yang ZF, Guo MJ, Jiang XJ. [Effects of electroacupuncture "Shuigou" on expression of soluble guanylate cyclase(sGC) and protein kinase G (PKG)in vascular smooth muscle of cerebral artery in rats with cerebral infarction]. Zhen Ci Yan Jiu 2020; 45:789-792. [PMID: 33788443 DOI: 10.13702/j.1000-0607.200076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To observe the effect of electroacupuncture (EA) on the expression of soluble guanylate cyclase (sGC), cyclic guanosine phosphate (cGMP) and protein kinase G (PKG) of cerebral vascular smooth muscle in cerebral infarction (CI) rats, so as to study its dynamic regulation mechanism. METHODS Male Wistar rats were randomly divided into normal control (n=10), sham operation (n=40), model (n=40), and EA (n=40) groups, and the latter three groups were further di-vided into 3, 6, 12 and 24 h subgroups (n=10 in each subgroup). The CI model was established by occlusion of the middle cerebral artery (MCAO). EA(15 Hz, 2 mA)was applied to "Shuigou" (GV26) for 20 min. The cGMP, sGC and PKG activity and expression levels in the vascular smooth muscle of cerebral artery were detected using ELISA and Western blot, respectively. RESULTS After modeling, the immunoactivity and activities of sGC at 3 h, PKG at 3 and 6 h and cGMP from 3 h to 24 h were ob-viously decreased in the model group relevant to the normal control and sham-operation groups (P<0.05, P<0.01). After the intervention, the expression levels and activities of sGC at 3 h, PKG at 3 and 6 h and cGMP at 3 and 6 h were apparently up-regulated in the EA group relevant to the model group (P<0.05). CONCLUSION EA intervention can significantly inhibit the down-regulation of sGC, PKG and cGMP expression of cerebral artery smooth muscle in MCAO model rats, which plays an important role in inhibiting cerebral artery smooth muscle spasm after ischemia, maintaining normal vascular function and state, and thus increasing blood perfusion around cerebral infarction area. However, acupuncture effect has a certain time-effectiveness.
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Affiliation(s)
- Yan-Long Xu
- Department of Acupuncture and Moxibustion, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China
| | - Xiu-Mei Xu
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China
| | - Zheng-Fei Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300193
| | - Mao-Juan Guo
- College of Integrated Chinese and Western Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193
| | - Xi-Juan Jiang
- College of Integrated Chinese and Western Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193
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Gui X, Wang L, Wu C, Wang H, Kong J. Prognosis of Subtypes of Acute Large Artery Atherosclerotic Cerebral Infarction by Evaluation of Established Collateral Circulation. J Stroke Cerebrovasc Dis 2020; 29:105232. [PMID: 33066931 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prognosis of acute ischemic stroke is related to collateral circulation, which is different with different pathogenesis. OBJECTIVE To explore the prognosis of acute large atherosclerotic (LAA) cerebral infarction with different pathogenesis by assessing the establishment of collateral circulation. METHODS 108 patients with acute LAA cerebral infarction in our hospital, who failed to thrombolytic or thrombectomy in the acute phase were selected and classified by Chinese ischemic stroke subclassification (CISS). They were evaluated by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). CT angiography (CTA) of head and neck were used to evaluate the collateral circulation for patients with large vessel stenosis or occlusion within one week of admission. The CTA collateral scores (CS) were recorded in a dichotomized fashion (ie, poor vs good). RESULTS Patients with good CS had significantly lower NIHSS score and good prognosis at 2 weeks and 3 months than patients with poor CS (P < 0.001). The arterial-to-arterial embolization mechanism was the highest in the ratio of good CS and good prognosis at 3 months (P < 0.001). Multivariate Logistic regression analysis showed that baseline NIHSS score (OR=1.407, 95%CI:1.153-1.717, P=0.001) was an independent factor affecting poor CS. The NIHSS score at baseline (OR=0.604, 95%CI:0.436-0.837, P=0.002) and good CS (OR=39.552, 95%CI:8.908-175.618, P=0.000) were important predictors of good prognosis at 3 months. CONCLUSION The prognosis and collateral circulation of acute LAA cerebral infarction with different pathogenesis was different. Baseline NIHSS score and collateral circulation had great impact on prognosis at 3 months.
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Affiliation(s)
- Xiaohong Gui
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
| | - Liping Wang
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China.
| | - Chenglong Wu
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
| | - Hua Wang
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
| | - Jianguo Kong
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
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Ong CS, Xiong J, Tan YJ. Cheiro-oral syndrome secondary to thalamic infarction: a clinical syndrome a physician should know. BMJ Case Rep 2020; 13:13/10/e236017. [PMID: 33122226 PMCID: PMC7597495 DOI: 10.1136/bcr-2020-236017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Liu R, Yu X, Zhang L, Zhang H, Gong Y, Wu K, Yan S, Song L. Computed tomography (CT) imaging evaluation of integrated traditional Chinese medicine cooperative therapy in treating acute cerebral infarction: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e19998. [PMID: 32358375 PMCID: PMC7440100 DOI: 10.1097/md.0000000000019998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Acute cerebral infarction is a clinically common cerebrovascular disease. Acute cerebral infarction is characterized by sudden onset, dangerous illness, high risk of death, and disability. Computed tomography perfusion imaging can detect abnormal brain tissue perfusion 30 minutes after the onset of cerebral ischemia, providing the earliest and most valuable information for clinical diagnosis and treatment. In recent years, the effect of traditional Chinese medicine on acute cerebral infarction has been remarkable. METHODS/DESIGN This study plan randomly divided eligible acute cerebral infarction patients into two groups. Patients in the control group will be treated with conventional Western medicine; patients in the intervention group will be treated with traditional Chinese medicine cooperative therapy on the basis of conventional Western medicine. The curative effects will be selected before treatment, 2 weeks after treatment, and 3 months follow-up. The changes in CT imaging evaluation, NIHSS score, and BI index of the two groups of patients will be observed. DISCUSSION We aim to provide higher evidence-based medical evidence for traditional Chinese medicine treatment of acute cerebral infarction. And clarify the application value of computed tomography perfusion imaging in the diagnosis and efficacy evaluation of acute cerebral infarction. TRIAL REGISTRATION ClinicalTrials.gov, ChiCTR2000030230, Registered on 03 March 2020.
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Affiliation(s)
- Ruijia Liu
- Graduate School of Beijing University of Chinese Medicine
- The First Department of Neurology
| | - Xudong Yu
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology
| | - Liping Zhang
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Hong Zhang
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yuanyuan Gong
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Kang Wu
- Graduate School of Beijing University of Chinese Medicine
- The First Department of Neurology
| | - Shuting Yan
- Graduate School of Beijing University of Chinese Medicine
- The First Department of Neurology
| | - Lianying Song
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
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Wang D, Bo Z, Lan T, Pan J, Cui D. Application of Magnetic Resonance Imaging Molecular Probe in the Study of Pluripotent Stem Cell-Derived Neural Stem Cells for the Treatment of Posttraumatic Paralysis of Cerebral Infarction. World Neurosurg 2020; 138:637-644. [PMID: 32001413 DOI: 10.1016/j.wneu.2020.01.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/20/2022]
Abstract
The feasibility and efficacy of magnetic resonance imaging molecular probe application and pluripotent stem cell-derived neural stem cell (NSC) transplantation for the treatment of hind limb paralysis in mice with cerebral infarction were studied. A model of middle cerebral artery infarction using adult mice was established to stimulate hind limb reactions. After the model was successfully established, the mice were first divided into an experimental group and a control group, with 25 mice in each group. Cultured neural cells were obtained from the cerebral cortex and hippocampus of a mouse 15 days pregnant to prepare pluripotent stem cells. Pluripotent stem cell-derived NSCs were identified by positive expression of Nestin. The experimental group was injected with 1 μL of NSC suspension through the tail vein, and the control group was injected with 1 μL of saline through the tail vein. The neurologic function of mice in each group was scored 1 day, 3 days, 7 days, 14 days, and 28 days after transplantation according to the Garcia 18 subscale. Finally, the differentiation, migration, and integration of pluripotent stem cell-derived NSCs after transplantation were observed using a magnetic resonance imaging molecular probe method. The results showed that the neurologic function scores of the ischemic transplantation group were significantly higher than those of the control group, and the results were significantly different (P < 0.05). Through research, it was found that after transplantation of pluripotent stem cell-derived NSCs, the transplanted cells migrated and differentiated around the body at 28 days and participated in angiogenesis, and the blood vessels in the infarcted area were obviously proliferated. The NSCs cultured in vitro were transplanted to the small infarction after cerebral infarction. In rats, it plays a positive role in the repair of nerve function in mice with cerebral infarction. NSCs cultured in vitro can survive, migrate, and differentiate in the brain tissue of mouse ischemic models and play a positive role in the repair of neurologic function in mice with cerebral infarction. Magnetic resonance imaging molecular probes have a good adjuvant effect on the use of pluripotent stem cell-derived NSCs to treat hind limb paralysis in mice with cerebral infarction.
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Affiliation(s)
- Dayan Wang
- Department of Neurology, Qianwei Hospital of Jilin Province, Changchun City, China
| | - Zhang Bo
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, China
| | - Tianye Lan
- Department of Encephalopathy, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Jianyu Pan
- Department of Encephalopathy, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Dayong Cui
- Department of Neurosurgery, Qianwei Hospital of Jilin Province, Changchun City, China.
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Iizuka T, Oki K, Hayashida K, Minami K, Izawa Y, Takahashi S, Shimizu H, Fukuda K, Nakahara J. Cerebral Infarction after Transcatheter Aortic Valve Implantation in Japan: Retrospective Analysis at a Single High-Volume Center. J Stroke Cerebrovasc Dis 2019; 28:104455. [PMID: 31680032 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Perioperative cerebral infarction is one of the concerning complications after transcatheter aortic valve implantation in patients with aortic stenosis. Several studies have reported on this complication; however, those included only Caucasians and analyzed a small number of cases. Here, we report on the characteristics and risk factors of symptomatic cerebral infarction after transcatheter aortic valve implantation in a single, high-volume center in Japan. METHODS We included 308 consecutive patients who underwent transcatheter aortic valve implantation in our facility between 2013 and 2016. We retrospectively analyzed the occurrence, characteristics, and prognoses of symptomatic cerebral infarction within 7 days after the procedure and statistically compared the risk factors between patients with or without cerebral infarction. RESULTS Five patients (1.6%) suffered from symptomatic cerebral infarction, which was usually recognized just after the procedure, with mild symptoms. Long-term prognoses tended to be good unless other factors influenced disability. Comorbidities, such as carotid artery stenosis and peripheral artery disease, were significantly higher in patients with cerebral infarction (P = .036 and .002, respectively); in addition, coronary artery disease and longer anesthesia duration (indicating challenging catheter procedures) tended to be associated with cerebral infarction (P = .080 and .069, respectively). CONCLUSIONS Symptomatic cerebral infarction occurred in 1.6% of patients after transcatheter aortic valve implantation in a single, high-volume center in Japan; the infarctions were of mild severity tending toward good long-term prognoses. We speculate arterial embolism from atherosclerotic large arteries, especially from the aortic arch, during catheter procedures might be the mechanistic basis of cerebral infarction.
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Affiliation(s)
- Takashi Iizuka
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Oki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology, Saiseikai Central Hospital, Tokyo, Japan.
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazushi Minami
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikane Izawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Takahashi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology and Stroke, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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Hu Y, Chen W, Wu L, Jiang L, Qin H, Tang N. Hypoxic preconditioning improves the survival and neural effects of transplanted mesenchymal stem cells via CXCL12/CXCR4 signalling in a rat model of cerebral infarction. Cell Biochem Funct 2019; 37:504-515. [PMID: 31368195 DOI: 10.1002/cbf.3423] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/17/2019] [Accepted: 06/18/2019] [Indexed: 11/11/2022]
Abstract
The treatment of neural deficiency after cerebral infarction is challenging, with limited therapeutic options. The transplantation of mesenchymal stem cells (MSCs) to the ischemic penumbra is a potential therapeutic approach. In the present study, a cerebral infarction model was generated by performing middle cerebral artery occlusion (MCAO) in SD rats. The expression of CXCR4 increased, and the number of MSCs migrating to the peri-infarct area was higher in rats transplanted with preconditioned MSCs than in rats transplanted with untreated MSCs. The rate of apoptosis, as evaluated by TUNEL staining and immunoblotting assays, was reduced in rats receiving preconditioned MSCs. A significant amelioration of neural regeneration and improved neurological function were observed in rats injected with preconditioned MSCs compared with those injected with untreated MSCs. However, the application of an siRNA targeting CXCL12 significantly inhibited the protective role of preconditioned MSCs against apoptosis and promoted the migration of MSCs to the ischemic area, leading to impaired neuronal regeneration and limited recovery of neuronal function. Hypoxic preconditioning of MSCs prior to transplantation suppressed apoptosis and increased their migration abilities, leading to the promotion of neuronal regeneration and improvement in neural function after transplantation. This preconditioning strategy may be considered as a potential approach for the modification of MSCs prior to cell transplantation therapy in patients with cerebral infarction. SIGNIFICANCE OF THE STUDY: We found that hypoxic preconditioning of MSCs improved their ability to promote neuronal regeneration and the recovery of neuronal function. Moreover, we showed that CXCR4 inhibited apoptosis, improved cell homing, and promoted neuronal differentiation, without influencing angiogenesis. Our study provides a relatively safe preconditioning method for potential use for cell transplantation therapy in ischemic cerebral infarction. The results presented here will facilitate the development of novel strategies and techniques to improve the tolerance and migration ability of transplanted cells for the treatment of cerebral infarction sequelae.
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Affiliation(s)
- Yueqiang Hu
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
- Key Laboratory of Guangxi Basic Chinese, Nanning, Guangxi, China
| | - Wei Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
- Key Laboratory of Guangxi Basic Chinese, Nanning, Guangxi, China
| | - Lin Wu
- Key Laboratory of Guangxi Basic Chinese, Nanning, Guangxi, China
- Scientific Laboratorial Centre Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Lingfei Jiang
- Graduate College of Guangxi University of traditional Chinese Medicine, Nanning, Guangxi, China
| | - Hongling Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Nong Tang
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
- Key Laboratory of Guangxi Basic Chinese, Nanning, Guangxi, China
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Hu H, Yan S, Zhou Y, Lou M. Time-dependent infarct volume affects the benefit of recanalization. Neuroimage Clin 2019; 24:102000. [PMID: 31494401 PMCID: PMC6734046 DOI: 10.1016/j.nicl.2019.102000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/29/2019] [Accepted: 08/31/2019] [Indexed: 01/01/2023]
Abstract
Objectives The benefit threshold of infarct volume from recanalization remains unclear. We assumed that the threshold decreased over time, and then investigated the benefit curve of infarct volume during different time periods. Methods We reviewed prospectively collected clinical and imaging data from acute ischemic stroke patients with internal carotid artery and M1 occlusion who underwent angiography before and 24 h after reperfusion therapy. Ordinal analyses of modified Rankin Scale scores were performed and curves were fitted. Results Of the included 445 patients, the median age was 71 years and 157 (35.3%) were women. The mean time from onset to treatment (OTT) was 248 ± 142 min. The median baseline infarct core volume was 49 (IQR 22–85) ml. Follow-up angiography revealed recanalization in 265 (59.6%) patients. The fitting curves showed that patients with an OTT ≤3 h would benefit from recanalization no matter how large the infarct volume was, whereas patients with an OTT between 3 and 4.5 h and with an infarct volume ≥ 125 ml, and those with an OTT ≥ 4.5 h and with an infarct volume ≥ 80 ml did not benefit from recanalization. Conclusions We established a time-dependent benefit threshold of infarct volume from recanalization, and thus suggested to estimate infarct core volume to select patients for reperfusion therapy in those with an OTT beyond 3 h. The benefit of recanalization within 3 h is independent of infarct volume. The benefit threshold of infarct volume decreases over time if beyond 3 h. Infarct volume is recommended to aid in patient selection for reperfusion therapy.
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Affiliation(s)
- Haitao Hu
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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Nakamura ZM, Nash RP, Laughon SL. The Course of Catatonia: A Case Report From Inpatient Consultation Through Two Years of Outpatient Care. Psychosomatics 2019; 61:171-176. [PMID: 31248614 DOI: 10.1016/j.psym.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC.
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Sarah L Laughon
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, NC
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Leys D, Dequatre-Ponchelle N, Ferrigno M, Henon H, Mounier-Vehier F, Moulin S, Casolla B, Tortuyaux R, Chochoi M, Moreau C, Girard-Buttaz I, Pruvo JP, Goldstein P, Cordonnier C. Access to mechanical thrombectomy for cerebral ischaemia: A population-based study in the North-of-France. Rev Neurol (Paris) 2019; 175:519-527. [PMID: 31208814 DOI: 10.1016/j.neurol.2018.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/18/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Hospitals admitting acute strokes should offer access to mechanical thrombectomy (MT), but local organisations are still based on facilities available before MT was proven effective. MT rates and outcomes at population levels are needed to adapt organisations. We evaluated rates of MT and outcomes in inhabitants from the North-of-France (NoF) area. METHOD We prospectively evaluated rates of MT and outcomes of patients at 3 months, good outcomes being defined as a modified Rankin scale (mRS) 0 to 2 or like the pre-stroke mRS. RESULTS During the study period (2016-2017), 666 patients underwent MT (454, 68.1% associated with intravenous thrombolysis [IVT]). Besides, 1595 other patients received IVT alone. The rate of MT was 81 (95% confidence interval [CI] 72-90) per million inhabitants-year, ranging from 36 to 108 between districts. The rate of IVT was 249 (95% CI 234-264) per million inhabitants-year, ranging from 155 to 268. After 3 months, 279 (41.9%) patients who underwent MT had good outcomes, and 167 (25.1%) had died. Patients living outside the district of Lille where the only MT centre is, were less likely to have good outcomes at 3 months, after adjustment on age, sex, baseline severity, and delay. CONCLUSION The rate of MT is one of the highest reported up to now, even in low-rate districts, but outcomes were significantly worse in patients living outside the district of Lille, and this is not only explained by the delay.
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Affiliation(s)
- D Leys
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance.
| | | | - M Ferrigno
- University of Lille, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - H Henon
- Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - F Mounier-Vehier
- Stroke unit, Lens hospital, neurology clinic, 59800 Lille, France
| | - S Moulin
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - B Casolla
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - R Tortuyaux
- Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
| | - M Chochoi
- Neurology clinic, CHU Lille, 59800 Lille, France
| | - C Moreau
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Neurology clinic, CHU Lille, 59800 Lille, France
| | - I Girard-Buttaz
- Stroke unit, Valenciennes hospital, neurology clinic, 59800 Lille, France
| | - J-P Pruvo
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Neuroradiology department, CHU Lille, 59800 Lille, France
| | - P Goldstein
- Emergency department, SAMU 59, CHU Lille, 59800 Lille, France
| | - C Cordonnier
- University of Lille, 59800 Lille, France; Inserm U1171, 59800 Lille, France; Stroke unit, neurology clinic, CHU Lille, 59800 Lille, FFrance
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46
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Chen Y, Huang W, Li Z, Duan Y, Liang Z, Zhou H, Tang C. The effect of acupuncture on the expression of inflammatory factors TNF-α, IL-6,IL-1 and CRP in cerebral infarction: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15408. [PMID: 31192907 PMCID: PMC6587630 DOI: 10.1097/md.0000000000015408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The mechanisms of acupuncture on the treatment of cerebral infarction remain unclear, the aim of the present study was to provides a protocol of systematic review and meta-analysis, with which we will collect clinical evidence to verify whether acupuncture will have an effect on reducing the levels of tumor necrosis factor α (TNF-α), C-reactive protein (CRP), interleukin-1 (IL-1), and interleukin (IL-6) after cerebral infarction based on evidence-based studies. METHODS Included studies will be retrieved according to inclusion and exclusion criteria from 5 English databases (the MEDLINE via PubMed, the Cochrane Library, Embase, the Web of Science, and Ovid database), and 4 Chinese databases (China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), Wan-fang Database, China National Knowledge Infrastructure (CNKI)) from October 1990 to October 2017. The inflammatory factor levels of TNF-α and IL-1,IL-6,CRP will be marked as major outcomes. We will use RevMan V.5.3 software to calculate the data synthesis and will conduct meta-analysis based on the collected data. RESULTS The inflammatory factor levels of TNF-α and IL-1,IL-6,CRP, mortality and adverse effects will be measured and comprehensively assessed to evaluate the adjunctive effect of XBP on CHF from this systematic review and meta-analysis with current clinical evidence. CONCLUSION The systematic review and meta-analysis will assess the effect of acupuncture on the expression of inflammatory factors TNF-α, IL-6, IL-1 and CRP in cerebral infarction with up-to-date clinical evidence. PROSPERO REGISTRATION NUMBER PROSPERO CRD42017078583.
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Affiliation(s)
- Yuru Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou
| | - Wei Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou
| | - Zunjiang Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou
| | - Yunbiao Duan
- Jiangmen City Hospital of Chinese Medicine, Jiangmen
| | - Zhaoxiong Liang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hong Zhou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou
| | - Chuyue Tang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou
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Li H, Chen Y, Gao H, Chang J, Su D, Lei S, Jiang D, Hu X, Tan M, Chen Z. Effect of an Integrated Payment System on the Direct Economic Burden and Readmission of Rural Cerebral Infarction Inpatients: Evidence from Anhui, China. Int J Environ Res Public Health 2019; 16:ijerph16091554. [PMID: 31058801 PMCID: PMC6539045 DOI: 10.3390/ijerph16091554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/21/2019] [Accepted: 04/30/2019] [Indexed: 01/14/2023]
Abstract
Rural China is piloting an integrated payment system, which prepays a budget to a medical alliance rather than a single hospital. This study aims to evaluate the effect of this reform on the direct economic burden and readmission rates of cerebral infarction inpatients. The settlement records of 78,494 cerebral infarction inpatients were obtained from the New Rural Cooperative Medical Scheme (NRCMS) database in Dingyuan and Funan Counties in the Anhui Province. The direct economic burden was estimated by total costs, out-of-pocket expenditures, the out-of-pocket ratio, and the compensation ratio of the NRCMS. Generalized additive models and multivariable linear/logistic regression were applied to measure the changes of the dependent variables along with the year. Within the county, the total costs positively correlated to the year (β = 313.10 in 2015; 163.06 in 2016). The out-of-pocket expenditures, out-of-pocket ratios, and the length-of-stay positively correlated to the year in 2015 (β = 105.10, 0.01, and 0.18 respectively), and negatively correlated to the year in 2016 (β = −58.40, −0.03, and −0.30, respectively). The odds ratios of the readmission rates were less than one within the county (0.70 in 2015; 0.53 in 2016). The integrated payment system in the Anhui Province has considerably reduced the direct economic burden for the rural cerebral infarction inpatients, and the readmission rate has decreased within the county. Inpatients’ health outcomes should be given further attention, and the long-term effect of this reform model awaits further evaluation.
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Affiliation(s)
- Haomiao Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Yingchun Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Hongxia Gao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Jingjing Chang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Dai Su
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Shihan Lei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Di Jiang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Xiaomei Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Min Tan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
| | - Zhifang Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China.
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Wang Q, Wei J, Shi Y. Platelet microvesicles promote the recovery of neurological function in mouse model of cerebral infarction by inducing angiogenesis. Biochem Biophys Res Commun 2019; 513:997-1004. [PMID: 31005253 DOI: 10.1016/j.bbrc.2019.04.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 12/17/2022]
Abstract
The aim of this study is to investigate the effect of PMVs on mice with ischemic cerebral infarction and its mechanism. Male C57BL/6 mice were selected, and the right focal cortical infarction model was established via cauterization under a microscope and randomly divided into sham operation (Sham) group, normal saline control (Saline) group and platelet microvesicles intervention (PMVs) group. At 1 h after modeling, 5 μL of PMVs (50 μg/mL) or normal saline was injected into the lateral ventricle. The neurological function of mice in each group was evaluated at 1, 3, 7, 14 and 28 d after modeling. After 28 d, the cerebral infarction area was detected via 2,3,5-triphenyltetrazolium chloride (TTC) staining. At 7 and 28 d after modeling, the blood vessel density, proliferation rate of new vessels and encapsulation rate of pericytes were detected via immunofluorescence staining. Moreover, the changes in cerebral cortical blood flow at the infarction side were detected before modeling and at 7 and 28 d after modeling, respectively. Finally, the expressions of proangiogenic factors vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and N-Cadherin were detected via Western blotting at 3, 7 and 28 d after modeling. PMVs could promote the improvement of neurological function and significantly reduce the cerebral infarction volume in mice with cerebral infarction. PMVs promoted proliferation of new vessels and increased blood vessel density at the infarction edge in mice with cerebral infarction. PMVs could increase the encapsulation rate of pericytes at the infarction edge and improve the permeability of blood-brain barrier in mice with cerebral infarction. PMVs could increase the cerebral cortical blood flow perfusion in mice with cerebral infarction. PMVs could increase proangiogenic factors in brain tissues in mice with cerebral infarction. PMVs could significantly improve the recovery of neurological function in mice with cerebral infarction, which is closely related to the ability of PMVs to promote angiogenesis at the infarction edge. The possible mechanism is that PMVs facilitate angiogenesis after cerebral infarction through promoting the expressions of VEGF, Ang-1 and N-Cadherin. More importantly, the new vessels promoted by PMVs have complete structure and perfect function, and can improve the cerebral blood flow perfusion at the infarction side.
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Affiliation(s)
- Qing Wang
- Department of Neurology, The First Hospital of Xi'an, Xi'an, China
| | - Jiachen Wei
- Department of Endocrinology, The First Hospital of Xi'an, Xi'an, China
| | - Yaling Shi
- Department of Neurology, The First Hospital of Xi'an, Xi'an, China.
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Behme D, Tsogkas I, Colla R, Gera RG, Schregel K, Hesse AC, Maier IL, Liman J, Liebeskind DS, Psychogios MN. Validation of the extended thrombolysis in cerebral infarction score in a real world cohort. PLoS One 2019; 14:e0210334. [PMID: 30629664 PMCID: PMC6328192 DOI: 10.1371/journal.pone.0210334] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022] Open
Abstract
Background A thrombolysis in cerebral infarction (TICI) score of 2b is defined as a good recanalization result although the reperfusion may only cover 50% of the affected territory. An additional mTICI2c category was introduced to further differentiate between mTICI scores. Despite the new mTICI2c category, mTICI2b still covers a range of 50–90% reperfusion which might be too imprecise to predict neurological improvement after therapy. Aim To compare the 7-point “expanded TICI” (eTICI) scale with the traditional mTICI in regard to predict functional independence at 90 days. Methods Retrospective review of 225 patients with large artery occlusion. Angiograms were graded by 2 readers according the 7-point eTICI score (0% = eTICI0; reduced clot = eTICI1; 1–49% = eTICI2a, 50–66% = eTICI2b50; 67–89% = eTICI2b67, 90–99% = eTICI2c and complete reperfusion = eTICI3) and the conventional mTICI score. The ability of e- and mTICI to predict favorable outcome at 90days was compared. Results Given the ROC analysis eTICI was the better predictor of favorable outcome (p-value 0.047). Additionally, eTICI scores 2b50, 2b67 and 2c (former mTICI2b) were significantly superior at predicting the probability of a favorable outcome at 90 days after endovascular therapy with a p-value of 0.033 (probabilities of 17% for mTICI2b50, 24% for mTICI2b67 and 54% for mTICI2c vs. 36% for mTICI2b). Conclusions The 7-point eTICI allows for a more accurate outcome prediction compared to the mTICI score because it refines the broad range of former mTICI2b results.
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Affiliation(s)
- Daniel Behme
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ioannis Tsogkas
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ruben Colla
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Roland G. Gera
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Katharina Schregel
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Amélie C. Hesse
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ilko L. Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Liman
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - David S. Liebeskind
- Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, UCLA, Los Angeles, CA, United States of America
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
- * E-mail:
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50
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Lin PC, Lee CW, Liu HM, Xiao FR. Acute Infarction in the Artery of Percheron Distribution during Cerebral Angiography: A Case Report and Literature Review. J Radiol Case Rep 2018; 12:1-9. [PMID: 30651912 DOI: 10.3941/jrcr.v12i7.3318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improvements in techniques, contrast agents, and catheter design have significantly decreased angiography-related neurological deficits and complications. This article reports a case involving an angiographic total obliteration arteriovenous malformation (AVM) in a patient with an acute infarction in the artery of Percheron (AOP) distribution following angiography. Furthermore, imaging of an AOP acute infarction in cerebral angiography is presented.
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Affiliation(s)
- Pao-Chun Lin
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, ROC
| | - Chung-Wei Lee
- Department of Neuroradiology, National Taiwan University Hospital, Taipei, ROC
| | - Hon-Man Liu
- Department of Neuroradiology, National Taiwan University Hospital, Taipei, ROC
| | - Fu-Ren Xiao
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, ROC
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