Research progress of acute reperfusion therapies for acute ischemic stroke in extended time window / 中华神经科杂志

The reperfusion therapies for acute ischemic stroke (AIS) patients in the past have set strict limits on time window. However, with the imaging assessment algorithms for "tissue window" becoming more mature, the time window for reperfusion therapies has been continuously extended. Nowadays the time window of intravenous thrombolysis has been extended to 9 hours after onset of stroke and is expected to be further broadened to 24 hours. At the same time, clinical studies of mechanical thrombectomy for posterior circulation large vessel occlusion (LVO), LVO with large ischemic cores and distal and medium vessel occlusion are all in hot progress. This article summarized diverse imaging assessment algorithms for "tissue window" and the latest advances of clinical research related to different fibrinolytic drugs for intravenous thrombolysis, mechanical thrombectomy for various vascular occlusion and bridging therapy of AIS in the extended time window. The objective of this review was to provide some references for the clinical diagnosis and therapy of stroke beyond time window.

Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window

OBJECTIVES: To investigate the safety and efficacy of combined tirofiban-ozagrel therapy for treating progressive stroke patients out of thrombolytic therapy time window. METHODS: This prospective, double-blind, randomized controlled study included 337 patients who had experienced an acute ischemic stroke between November 2017 and December 2018. All patients were randomized into three groups: 1) the tirofiban/ozagrel group (n=113), 2) the tirofiban group (n=110), and 3) the ozagrel group (n=114). The platelet aggregation (PAG), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) levels in the patients from these groups were evaluated before starting treatment and then, at 24h, 7 days, and 14 days after treatment. The National Institutes of Health Stroke Scale (NIHSS) scores were evaluated before treatment and then, 24h, 1 week, 2 weeks, and 4 weeks after treatment. The Barthel Index (BI) score was used to measure safety, and the modified Rankin scale (mRS) was used to evaluate disability following 3 months of treatment. The risk factors affecting clinical outcomes were analyzed using logistic multivariate regression. RESULTS: The mean NIHSS score for all the patients was 13.17±3.13 before treatment, and no significant difference between the basic clinical parameters of the three patient groups was found. Following treatment, both PAG and FIB were significantly reduced compared with the baseline (p<0.05). The levels of PAG and FIB in the tirofiban/ozagrel group were significantly lower than those in the tirofiban and ozagrel groups at 24h and 7 days after treatment (p<0.05). The NIHSS score decreased significantly in all treatment groups (p<0.05). The tirofiban/ozagrel NIHSS scores were significantly lower than that of the tirofiban and ozagrel groups at 24h, 1 week, and 2 weeks post initiation (p<0.05 for all). There were no significant differences in the BI and mRS scores or the intracranial hemorrhage rates; further, age, sex, Trial of ORG 10172 in acute stroke treatment (TOAST) type, baseline NIHSS and 24-h NIHSS scores, baseline thrombus-related factors, and treatment methods were shown to not be independent risk factors for clinical outcomes. CONCLUSION: The combination of tirofiban and ozagrel, as well as monotherapy with either tirofiban or ozagrel, transiently improves the neural function of patients and reduces platelet aggregation and fibrinogen formation in the first 4 weeks following a stroke event; additionally, none of these treatments increased the risk for hemorrhage in these progressive stroke patients over a 3-month period.

Anti-hematoma expansion time window and establishment of early emergency green channel for intracerebral hemorrhage / 中华神经科杂志

Intracerebral hemorrhage is one of the main causes of death and disability in adults, as a common emergency in neurology department. Hematoma expansion is related to early neurological deterioration and poor outcome in patients with intracerebral hemorrhage. Existing studies have not found effective treatment methods in reducing hematoma expansion. The effective time window of intervention should be paid attention to, and anti-expansion treatments, such as antihypertensive, hemostasis therapy and others, should be performed within the effective time window. The establishment of early emergency green channel for intracerebral hemorrhage is of great significance, to shorten the visiting time of patients with intracerebral hemorrhage and implement effective interventions for anti-hematoma within the anti-hematoma expansion treatment time window.

The efficacy of systemic hypothermia therapy initiated at different times on neonatal hypoxic-ischemic encephalopathy / 中国新生儿科杂志

Objective:To study the clinical efficacy, safety and prognosis of systemic hypothermia therapy on neonatal hypoxic-ischemic encephalopathy (HIE)initiated at different times after birth.Method:From January 2013 to August 2018, term neonates (within 12 hours after birth) diagnosed with neonatal moderate to severe HIE and received systemic treatment in the neonatal intensive care unit of our hospital were retrospectively included. According to the starting time of hypothermia therapy, the neonates were assigned into three groups: within 6 h after birth (TH1 group), 6~12 h (TH2 group) and conventional treatment group (control group). Their clinical data during perinatal period, hospitalization period and follow-up at 6-month were reviewed. Their clinical and neurodevelopmental outcomes were compared using SPSS 25.0 statistical software.Result:A total of 147 neonates with moderate to severe HIE were enrolled. 111 received 72-hour hypothermia therapy, including 79 in the TH1 group, 32 in the TH2 group and 36 in the control group. The neurobehavioral test scores at 10-day of life in the TH1 group were significantly higher than the control group ( P<0.05). No significant differences existed among the TH2 group, the TH1 group and the control group ( P>0.05). The brain magnetic resonance imaging (MRI) showed injuries in the TH1 group and the TH2 group were significantly milder than the control group ( P<0.05). No significant differences of brain injuries existed between TH1 group and TH2 group ( P>0.05). 100 patients completed Bailey Infant Intelligence Development Scale at 6-month follow-up. 21 had abnormal scores. No statistically significant differences existed in the psychomotor development index (PDI) scores among the three groups ( P>0.05). TH1 and TH2 groups had significantly fewer cases with mental development index (MDI) <70 points than the control group ( P<0.05). No statistically significant differences existed of MDI scores between the TH1 group and the TH2 group ( P>0.05). No statistically significant differences existed of PDI scores among the 3 groups ( P>0.05). At 6-month, the mortality rate of the control group (32.1%, 9/28) was significantly higher than the TH1 group (6.6%, 4/61) ( P<0.05). No significant differences existed of mortality rate at 6-month among the TH2 group, the TH1 group and the control group ( P>0.05). Conclusion:Systemic hypothermia therapy for neonatal HIE is safe. Starting systemic hypothermia therapy at 6~12-hour after birth may also be effective in reducing mortality rate and improving neurodevelopmental outcome.

Intravenous transplantation of olfactory ensheathing cells at different time points for repairing spinal cord injury / 中国组织工程研究

BACKGROUND: Olfactory ensheathing cells promote axonal regeneration, provide nutritional support for the injured host cells and regulate inflammation reaction, which possess potential for spinal cord injury repair. OBJECTIVE: To explore the optimal time window for intravenous transplantation of olfactory ensheathing cells in the treatment of spinal cord injury. METHODS: Thirty male SPF level rats were used to establish the rat models of spinal cord injury by spinal cord hemisection. Rat models were then randomly divided into five groups: 1-, 3-, 7-and 10-day olfactory ensheathing cell transplantation and PBS groups. Olfactory ensheathing cells were labeled with fluorescent quantum dots. PBS was injected into the rats in the PBS group after spinal cord injury. The injured spinal cord was removed at 1 day after injection. A small animal imager was used to measure the fluorescence transferred to the lesion at different time points. The number of cells transferred to the lesion was measured based on the intensity of fluorescence. The Anti-p75 NGF Receptor antibody was used for immunohistochemistry detection of the injured spinal cord. The study was approved by the Ethics Committee of Animal Laboratory of Ningxia Medical University, No. 2017-073. RESULTS AND CONCLUSION: Fluorescent quantum dots could label olfactory ensheathing cells. Results of fluorescence assay and immunohistochemistry indicated that transplanted olfactory ensheathing cells were transferred to the lesion at 1, 3, 7 and 10 days. Most cells were transferred to the lesion at 7 days. Therefore, these results indicate that olfactory ensheathing cells transplanted at different time points after spinal cord injury can be transferred to the lesion, with a number peak at 7 days that is the best time window for cell transplantation.

Effect of acupuncture on neurological function, cerebral infarction volume, thrombolysis time window and cerebral cell apoptosis signaling pathway in cerebral infarction rats / 针刺研究

OBJECTIVE: To observe the effect of acupuncture (Acupunct) on cerebral infarction volume and expression of poly ADP ribose polymerase 1 (PARP1), apoptosis-inducing factor (AIF) and endonuclease G (Endo-G) in the cerebral cortex tissue at different time-points after cerebral ischemia (CI) in acute cerebral infarction rats, so as to explore its underlying mechanisms in prolonging time window of thrombolysis. METHODS: Forty-eight SD rats were randomly divided into sham operation, model, intravenous thrombolysis (IVT)-4.5 h, IVT-6 h, IVT-9 h, Acupunct＋IVT-4.5 h, Acupunct ＋IVT-6 h, Acupunct＋IVT-9 h groups (n＝6 in each group). The CI model was established by using modified autologous thromboembolism via the right common carotid artery. Two hours after modeling, rats of the Acupunct groups received Acupunct stimulation of "Shuigou" (GV26) and bilateral "Neiguan" (PC6) for 30 min. Thrombolysis was conducted by injection of recombinant human tissue-type plasminogen activator (rt-PA, 10 mg/kg) via caudal vein. The neurological deficit was assessed with reference to Bederson's methods. 2，3，5-triphenyltetrazolium chloride (TTC) staining was used to assess the cerebral infarction volume, and the expression of cerebral PARP1, AIF and Endo-G proteins detected by Western blot. RESULTS: Compared with the sham operation group, the neurological score and percentage of cerebral infarction volume, expression levels of PARP1, AIF and Endo-G proteins were significantly increased in the model group (P0.05). The levels of neurological score, percentage of cerebral infarction volume, and AIF expression were significantly lower in both the Acupunct＋IVT 4.5 h and Acupunct＋IVT-6 h groups than in the simple IVT-4.5 h and simple IVT-6 h groups, respectively (P<0.05), and the expression levels of PARP1 and Endo-G proteins were obviously lower in the Acupunct＋IVT-4.5 h group than in the IVT-4.5 h group (P<0.05). Endo-G proteins were obviously lower in the Acupunct＋IVT-9 h group than in the IVT-9 h group (P<0.05). CONCLUSION: Acupuncture may improve neurological function, reduce cerebral infarction volume and prolong the time window of thrombolysis in CI rats, which may be associated with its effect in suppressing AIF/PARP1/ Endo-G signaling.

Reversibility of ischemic core defined by CT perfusion imaging in acute stroke patients receiving thrombolysis within different time windows / 中华神经科杂志

Objective@#To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors.@*Methods@#The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People′s Hospital from May 2016 to December 2018 were retrospectively reviewed. All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis. The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)<30%) was quantitatively assessed based on CT perfusion images using MIStar software, and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis. The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml. Then the clinical and imaging features of the patients between reversible group and irreversible group were compared, and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis.@*Results@#Finally, 97 patients were enrolled in the present study, of which 64 (66%) patients achieved successful recanalization, 51 (53%) patients with reversible baseline ischemic core. For patients with recanalization, the incidence of reversibility was 76% (26/34), 71% (17/24), 2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) <3.0 h, 3.0-4.5 h, 4.6-6.0 h, and >6.0 h, respectively. In the non-recanalization group, six patients were also showed with ischemic core reversibility, including 4 (4/12) in the ONT<3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group. It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805, P<0.001) by Spearman correlation analysis. Finally, binary Logistic regression analysis revealed that the history of hypertension, ONT and recanalization were independent predictors of reversible changes of baseline ischemic core.@*Conclusions@#The ischemic core defined by CT perfusion imaging (rCBF<30%) was considerably inaccurate for patients with ONT<6.0 h. If recanalization could be achieved within this time window, most of the patients would manifest with ischemic core reversibility, the predictors of which also included hypertension history and ONT.

Reversibility of ischemic core defined by CT perfusion imaging in acute stroke patients receiving thrombolysis within different time windows / 中华神经科杂志

Objective To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors.Methods The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People's Hospital from May 2016 to December 2018 were retrospectively reviewed.All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis.The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)＜30％) was quantitatively assessed based on CT perfusion images using MIStar software,and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis.The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml.Then the clinical and imaging features of the patients between reversible group and irreversible group were compared,and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis.Results Finally,97 patients were enrolled in the present study,of which 64 (66％) patients achieved successful recanalization,51 (53％) patients with reversible baseline ischemic core.For patients with recanalization,the incidence of reversibility was 76％ (26/34),71％ (17/24),2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) ＜3.0 h,3.0-4.5 h,4.6-6.0 h,and ＞6.0 h,respectively.In the non-recanalization group,six patients were also showed with ischemic core reversibility,including 4 (4/12) in the ONT＜3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group.It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805,P＜0.001) by Spearman correlation analysis.Finally,binary Logistic regression analysis revealed that the history of hypertension,ONT and recanalization were independent predictors of reversible changes of baseline ischemic core.Conclusions The ischemic core defined by CT perfusion imaging (rCBF＜30％) was considerably inaccurate for patients with ONT＜6.0 h.If recanalization could be achieved within this time window,most of the patients would manifest with ischemic core reversibility,the predictors of which also included hypertension history and ONT.

mTORC1 signaling specifically promotes proliferation of hair follicle stem cells during the telogen-to-anagen transition / 中华皮肤科杂志

Objective@#To identify the time window during which the mammalian target of rapamycin complex 1 (mTORC1) signaling pathway plays a key role in telogen-to-anagen transition of hair follicles, and to explore whether the pathway specifically promotes the proliferation of hair follicle stem cells (HFSCs) .@*Methods@#Totally, 36 newborn ICR mice were randomly and equally divided into 3 groups: RAPA-P19 group intraperitoneally injected with 5 mg·kg-1·d-1 sirolimus on days 19-24 after birth, RAPA-P21 group intraperitoneally injected with 5 mg·kg-1·d-1 sirolimus on days 21-24 after birth, and control group intraperitoneally injected with the same volume of solvent on days 19-24 after birth. Four mice were sacrificed in each group on days 22, 23 and 24 separately. Skin tissues were resected from the back, and hematoxylin-eosin staining of the skin tissues were performed followed by observation of hair follicle morphology to evaluate whether murine hair follicles progressed into the anagen phase on day 24. Immunofluorescence costaining was conducted to determine the expression and localization of mTORC1 downstream molecular marker pS6 and cell proliferation marker Ki67 on days 22 and 23.@*Results@#On day 24, hematoxylin-eosin staining showed anagen hair follicles in the control group and RAPA-P21 group, but telogen hair follicles in the RAPA-P19 group. On days 22 and 23, immunofluorescence costaining revealed positive staining for both pS6 and Ki67 in HFSCs in the control group, negative staining for both pS6 and Ki67 in the RAPA-P19 group, negative staining for pS6 and positive staining for Ki67 in the RAPA-P21 group. On day 23, epidermal cells and sebaceous gland cells in the upper hair follicle bulge were stained positively for Ki67 in all the 3 groups.@*Conclusion@#mTORC1 signaling specifically promotes the proliferation of HFSCs during telogen-to-anagen transition, but not affects proliferation of other cells in hair follicles.

Clinical efficacy of enclovascular thrombectomy in patients with ischemic stroke beyond the time window / 中国脑血管病杂志

Objective To investigate the clinical efficacy of endovascular thrombectomy in patients with acute anterior circulation stroke with large vessel occlusion beyond the time window. Methods From January 2014 to September 2018,182 patients with acute anterior circulation stroke with large vessel occlusion and treated with endovascular thrombectomy in the Department of Neurology of Liuzhou People's Hospital were retrospectively included. Preoperative CT angiography or MR angiography confirmed the presence of internal carotid artery or middle cerebral artery occlusion. According to the symptom onset to puncture (OTP) time, patients were divided into the within time windov group(0TP

Progress of adjuvant treatment with tissue plasminogen activator beyond time window in ischemic stroke / 解剖学报

Tissue plasminogen activator (tPA) thrombolysis remains the gold standard for the treatment of ischemic stroke. However, the time window of tPA treatment and the fatal side effects caused by application beyond the time window limit clinical application of tPA. In order to address the limitations, combined use of tPA with other drug or non-drug interventional approaches has been proposed and some combination therapies have been experimentally validated to decrease the complications beyond the time window, especially hemorrhagic transformation (HT). The mechanisms by which the combined drugs act include protecting the blood-brain barrier, enhancing angiogenesis, protecting cerebral blood vessels, etc. Non-drug interventions include stem cell transplantation and gas therapy with multiple biological effects. The combination of tPA and the above treatments intends to alleviate the side effects of delayed tPA treatment and the neurological deficits and behavioral impairment induced by stroke. Therefore, adjuvant therapy is an innovative form of treatment which addresses the limiting factors of tPA therapy and may prolong the time window of ischemic stroke.

Certain issues related to time window for neurorestoratology following spinal cord injury / 中华创伤杂志

Spinal cord injury has long been a major problem difficult to resolve in medicine, which brings heavy burdens to individuals, families and the society. Microenvironment imbalance after spinal cord injury is the main cause for poor nerve restoration. Besides, microenvironment imbalance after spinal cord injury has spatiotemporal specificity. It is necessary to accurately regulate the changes of microenvironment in different periods and clarify the therapeutic time window of different interventions to improve the therapeutic effect and reduce the related complications. However, the therapeutic time window of spinal cord injury is vague and general at present. This article mainly focused on the latest research progress in the time window of drug use, surgical operation, cell transplantation and rehabilitation for spinal cord injury, so as to provide references for clinical therapy strategies.

Mechanical Thrombectomy in Strokes with Large-Vessel Occlusion Beyond 6 Hours: A Pooled Analysis of Randomized Trials

BACKGROUND AND PURPOSE: Mechanical thrombectomy with or without intravenous thrombolysis is indicated in the acute treatment of ischemic strokes caused by an emergent large-vessel occlusion (ELVO) within 6 hours from symptom onset. However, a significant proportion of patients are referred to comprehensive stroke centers beyond this therapeutic time window. This study performed a pooled analysis of data from trials in which mechanical thrombectomy was performed beyond 6 hours from symptom onset. METHODS: We searched for randomized controlled trials that compared mechanical thrombectomy with the best medical treatment beyond 6 hours for ischemic strokes due to ELVO and reported on between 1990 and April 2018. The intervention group comprised patients treated with mechanical thrombectomy. Statistical analysis was conducted while pooling data and analyzing fixed- or random-effects models as appropriate. RESULTS: Four trials involving 518 stroke patients met the eligibility criteria. There were 267 strokes treated with mechanical thrombectomy, with a median time of 10.8 hours between when the patient was last known to be well to randomization. We observed a significant difference between groups concerning the rate of functional independence at 90 days from stroke, with an absolute difference of 27.5% (odds ratio=3.33, 95% CI=1.81–6.12, p < 0.001) and good recanalization (odds ratio=13.17, 95% CI=4.17–41.60, p < 0.001) favoring the intervention group. CONCLUSIONS: This meta-analysis confirms the efficacy of mechanical thrombectomy in selected ischemic stroke patients beyond 6 hours from symptom onset. The selection is mainly based on the limited core infarct detected by emergent assessment using neuroimaging techniques.

Phased Expression of Gene and Protein of NogoA and NgR in Rats with Spinal Cord Injury and Time Window of Electroacupuncture / 中国康复理论与实践

Objective To investigate the phased expression of gene and protein of NogoA and its receptor (NgR) that affects axon growth of spinal cord injury (SCI), and to explore the time window effect of electroacupuncture on SCI rats. Methods A total of 144 female Sprague-Dawley rats were randomly assigned to sham operation group (group A, n=48) and model group (n=96). In the model group, Allen's method was used to establish SCI rats model, and they were further subdivided into model control group (group B, n=48) and electroacupuncture group (group C, n=48). Group C received electroacupuncture on Dazhui (GV14), Yaoyangguan (GV3), bilateral Ciliao (BL32) and Zu-sanli (ST36) with loose-tight wave, for 20 minutes every day, one day, seven days and 14 days after modeling. The rats at every interventional therapy time were randomly subdivided into two subgroups, which accepted sev-en or 14 days of treatment. Groups A and B were killed and the injured spinal cord tissue was extracted one day, three days, seven days, 14 days and 28 days after modeling, group C at the corresponding time. The hind limb motor function was assessed with BBB score before all of rats were killed. Four samples at every time in each group were randomly selected to detect the expression of mRNA and protein of NogoA and NgR at different stage of SCI using reverse transcription real-time quantitative polymerase chain reaction (RT-qPCR) and Western blotting. Results The BBB score began to increase 14 days after modeling, and significantly increased until 28 days after model-ing (P<0.05), compared with one day, three days and seven days after modeling in group B. The BBB score in-creased in group C than in group B at all the time points (P<0.05), except 14 days after electroacupuncture one day after modeling. The BBB score was higher as electroacupuncture intervening seven days and 14 days after modeling than that at one day after modeling in group C, and no significant difference was found between seven days and 14 days of treatment at either electroacupuncture time point (P>0.05). The expression of gene and pro-tein of NogoA and NgR in group B was in the increasing tendency after SCI, and was at the peak until 21 days af-ter modeling, and was higher in group B than in group A at each time point (P<0.01). The expression of gene and protein of NogoA decreased at all the time points in group C than in group B (P<0.05), except seven days of elec-troacupuncture intervening one day after modeling in the expression of NogoA mRNA (P>0.05). The expression of gene and protein of NogoA and NgR was lower as electroacupuncture intervening 14 days after modeling than one day after modeling in group C (P<0.05). There was no significant difference in the expression of gene and protein of NogoA and NgR between electroacupuncture intervening 14 days and seven days after modeling, and seven days and one day after modeling (P>0.05); as well as between seven days and 14 days of treatment at each time point (P>0.05). Conclusion Elerctroacupuncture could improve the hind limb motor function, which may associate with the inhibition of the expression of gene and protein of NogoA and NgR in injured spinal cord of rats after SCI. Elerctroacu-puncture is effective in the treatment of SCI at the early time, however, it is much better in the recovery stage.

Mesenchymal stem cells in the treatment of stroke:analysis of latest research / 军事医学

Stroke is a neurological disease which is difficult to conquer clinically .Cell transplantation based on mesenchymal stem cells(MSCs) provides hope for the healthy recovery of stroke patients , but our study of MSCs for stroke therapy is not thorough enough and still faces some problems .The aim of this paper is to summarize the problems with MSCs in the treatment of stroke from the perspectives of tissue source , preparation process, time window, transplantation pathway , pretreatment , combined medication and tracer method , in order to provide guidance for scientific research and clinical application.

Research Progress of Acute Ischemic Stroke Treated with Thrombolytic / 现代生物医学进展

Stroke is a common neurological diseases with high morbidity,high mortality and high morbidity characteristics,which brings great suffer and economic burden to the patients and families,and has become an important research topic in contemporary medical profession.Treatment directly affects the prognosis of patients with cerebral infarction,and thus it is very important to find the most effective treatments and methods.Currently,thrombolytic therapy in acute cerebral infarction have carried out a large number of experimental studies,and achieved good results.This paper reviewed the thrombolytic therapy in acute cerebral infarctionincluding the time window,methods and drugs of thrombolysis,and the influencing factors of outcomes were also summarized and discussed.

Effects of delayed mild hypothermia based on different time windows on the expressions of Bcl-2, Bax and Caspase-3 after traumatic brain injury in rats / 天津医药

Objective To explore the effects of delayed mild hypothermia (MHT) in different time windows on the expressions of Bcl-2, Bax and Caspase-3 in brain tissue of model rats with traumatic brain injury (TBI). Methods Thirty-six clean adult male SD rats were randomly divided into NT group (normal temperature), MHT 15 min group, MHT 2 h group and MHT 4 h group. TBI rat model was established by electronical controlled cortical injury device. The rats in the NT group were treated with normothermia (37℃) and the rats in the three hypothermia groups were implemented with low temperature (33.0±1.0)℃at 15 min, 2 h and 4 h for 6 h respectively after establishment of TBI model. The modified neurological senerity scores (mNSS), morphological changes in hippocampal CA1 areas, immunohistochemical staining and Western blot assay for Bcl-2, Bax and Caspase-3 were compared 3 days after TBI between the four groups. Results The neurological behavioral deficits were found in each group. Compared with the NT group, the mNSS were decreased in the three hypothermia groups (P<0.01). The results of HE staining showed that the structure of neurons was regular and arranged neatly, and the number of neurons decreased with alleviated nuclear fragmentation and dissolution in hypothermia groups. Compared with the NT group, the expression of Bcl-2 was upregulated, and the expressions of Bax and Caspase-3 were downregulated in three hypothermia groups (P<0.05). The above experimental results were superior in MHT15 min group to MHT 2 h group, and the therapeutic effect in MHT 2 h group was similar to MHT 4 h group. Conclusion The proper delayed mild hypothermia treatment could inhibit neuronal apoptosis and alleviate brain damage.

Prognosis Effect of Shengmai Injection to the rt-PA Thrombolysis on Broadened Therapeutic Window Pa-tients of Mild-to-moderate Cerebral Infarction / 中国药房

OBJECTIVE:To explore the prognosis effect of Shengmai injection to the rt-PA thrombolysis on broadened thera-peutic window patients of mild-to-moderate cerebral infarction under the guidance of computer tomography(CT). METHODS:168 patients with mild-to-moderate cerebral infarction were randomly divided into control group (84 cases) and observation group (84 cases). Control group received rt-PA(0.9 mg/kg),and 10% of the total rt-PA was mixed and injected into patients within 1 min, the rest 90% adding into 250 ml 0.9% Sodium chloride injection (no less than 1 h),CT was performed after 24 h thrombolytic therapy,and the patients with no intracerebral hemorrhage in re-examination received 300 mg/d aspirin for 10 d,then 100 mg/d for 90 d,and appropriate statins,calcium antagonists,β-blockers and nitrates;observation group additionally received 40 ml Sheng-mai injection,adding into 250 ml 5% Glucose injection,intravenous infusion,once a day,for 28 d. National Institutes of Health Stroke Scale (NIHSS) score,Rankin score,daily living-Barthel Index (Barthel) score,rate of symptomatic intracranial hemor-rhage,rate of secondary hemorrhage,hospitalization time,3-month postoperative mortality and incidence of adverse reactions in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the NIHSS score,Rankin score and Barthel score(P>0.05). The NIHSS score in 2 groups after 6 h,24 h and 7 d were significantly lower than before,and observa-tion group was lower than control group after 24 h and 7 d;Rankin score after 3 months was significantly lower than before,and observation group was lower than control group;Barthel score after 3 months was significantly higher than before,and observation group was higher than control group,The differences were statistically significant (P<0.05). The hospitalization time in observa-tion group was significantly shorter than in control group,and 3-month postoperative mortality was significantly lower than control group,the differences were statistically significant(P<0.05). There were no obvious adverse reactions during treatment. CONCLU-SIONS:Based on conventional treatment,Shengmai injection has improvement in the rt-PA intravenous thrombolysis on broadened therapeutic window patients of mild-to-moderate cerebral infarction under the guidance of CT,it can reduce NIHSS score and Rankin score,increase Barthel score,shorten hospitalization time and reduce the 3-month postoperative mortality,with good safety.

Effects of thrombolytic information in different time windows upon thrombolytic decision making in patients with cerebral infarction / 中华行为医学与脑科学杂志

Objective To discuss the influence of framing information and time window information upon risk decision making about thrombolysis therapy in patients with cerebral infarction or their relatives in the scenarios of thrombolytic therapy for acute cerebral infarction.Methods Inpatients and outpatients with cerebral infarction or their relatives(n=327) were randomly divided into positive framing group(n=187) and negative framing group(n=140).Every participant underwent risky messages about thrombolytic treatment in three different time windows:0-90 minutes,91-180 minutes and 181-270 minutes.Results In any thrombolytic time window condition,there was no significant difference in thrombolytic tendency of participants between the positive framing group and the negative framing group (0-90 min:x2=1.24,P＞ 0.05;91-180 minutes:x2 =0.35,P＞0.05;181-270 minutes:x2 =0.07,P＞ 0.05).In a negative framework conditions,compared with the participants receiving thrombolytic information in 181-270 minutes time window,subjects receiving thrombolytic information in 0-90 minutes window were more tolerant of thrombolytic treatment (69.3 ％ vs 51.5 ％,P＜ 0.0125).Conclusion There are mutual effects of time window and framing information upon participants' preferences for thrombolysis.Different thrombolytic information are presented according to their corresponding time windows.

Therapeutic effect of arterial thrombolysis for acute cerebral infarction：analysis of related factors / 介入放射学杂志

Objective To investigate the relationship between the residual forward blood flow and the therapeutic outcome in patients with acute cerebral infarction after arterial thrombolysis treatment. Methods During the period from January 2009 to December 2013 at authors’ hospital, a total of 40 patients with acute anterior circle cerebral infarction were treated with arterial thrombolysis. The clinical data were retrospectively analyzed. The patients were divided into group A (n=23) when residual forward blood flow and/or collateral circulation were presented, and group B (n=17) if no residual forward blood flow and/or collateral circulation were detected. The NIHSS scores and hemorrhagic transformation state were determined 14 days after the thrombolysis treatment, and the results were compared between the two groups. Results In group A, 21 cases (91.3%) showed complete or partial re- canalization of the infracted vessels, and asymptomatic hemorrhagic transformation was seen in one case. The pre-treatment NIHSS score was 12.69 ± 3.88 and the post-treatment NIHSS score was 6.05 ± 3.25. In group B, complete or partial re-canalization of the infracted vessels was seen in 15 cases (88.2%), asymptomatic hemorrhagic transformation was found in one case and symptomatic hemorrhagic transformation occurred in one case, who died of massive cerebral hemorrhage seven hours after the thrombolysis treatment. The pre-treatment NIHSS score was 13.51 ± 4.19 and the post-treatment NIHSS score was 8.68 ± 5.16. The differences between the two groups were statistically significant (P < 0.05). The obvious effect rate in group A and group B was 68.1% and 43.8% respectively, and the effective rate in group A and group B was 86.3% and 56.3% respectively, indicating that the clinical outcome of group A was much better than that of group B. Conclusion The therapeutic effect of arterial thrombolysis for acute cerebral infarction patients is not only closely related to the time window but also to the residual forward blood flow. The more the residual forward blood flow there is, the better the therapeutic result with less risk of hemorrhagic transformation will be.