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ObjectiveTo re-evaluate the systematic reviews/Meta-analyses （SRs/MAs） of tonic traditional Chinese medicine （TCM） injections against cerebral ischemic stroke （CIS） and provide evidence support for clinical practice and decision-making. MethodTCM injections of different varieties were obtained after searching the three major drug catalogues. Seven Chinese and English databases were searched from database inception to March 13，2022，for the relevant SRs/MAs. The methodological quality，risk of bias，reporting quality，and quality of evidence were assessed by Assessment of Multiple Systematic Reviews-2 （AMSTAR-2），the Risk of Bias in Systematic Review （ROBIS），the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 （PRISMA 2020），and the Grading of Recommendations Assessment，Development，and Evaluation （GRADE）. In addition，the literature overlap matrix was established to calculate the corrected covered area （CCA） and evaluate the rate of overlaps of the original literature. ResultFive types of TCM injections and 18 SRs/MAs were included. AMSTAR 2 evaluation showed that the methodological quality of 18 SRs/MAs was extremely low，and 14 SRs/MAs had a high risk of bias assessed by ROBIS. The quality evaluation results reported by the PRISMA 2020 showed that the scores of the studies included ranged from 19.5 to 28.5，with 10 being of medium quality and eight of low quality. The evaluation with the GRADE system demonstrated that one outcome was moderate-quality evidence，15 outcomes were low-quality evidence，and 41 outcomes were very low-quality evidence. The CCA of the included SRs/MAs was 0.263，indicating a low rate of overlaps of the original literature. ConclusionTonic TCM injections are effective and safe in the treatment of CIS，but this conclusion should be treated with caution because of the low quality of methodology，reports，and evidence in published SRs/MAs. It is recommended to improve the study design，obtain clinical evidence of higher quality，and conduct systematic evaluations in strict accordance with procedures to standardize the reporting of research results.
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OBJECTIVE To investigate the mecha-nism of endoplasmic reticulum stress in cerebral isch-emic stroke from a theoretical perspective based on net-work pharmacology.METHODS GeneCards and OMIM databases were used to screen out the related targets of cerebral ischemic stroke and endoplasmic reticulum stress.And Venny2.1.0 was used to draw Venn's diagram to get the intersecting genes between cerebral ischemic stroke and endoplasmic reticulum stress.String data-base was used to get the protein-protein interaction(PPI)diagram and cytoscape was used for visualization analy-sis.The key genes were screened out by cytohubba plug-in,and enrichment analysis was performed.RESULTS Network pharmacology showed that there were 3744 cerebral ischemic stroke-related targets and 8675 endo-plasmic reticulum stress-related targets.After screening,41 common targets were got.There were 37 nodes,390 edges in the PPI network,namely,there were 37 interact-ing proteins and 390 interacting relationships.The key genes identified by cytohubba plug-in were IL-6,ALB,INS,TNF,AKT1,CASP3,MAPK3,TP53,SIRT1 and VEGF.The biological process involves reaction to oxida-tive stress,the regulation of neuron death,and negative regulation of cell differentiation,etc.;cellular components were related to the membrane raft,smooth endoplasmic reticulum,endoplasmic reticulum lumen and other com-ponents;molecular function aspects were related to sig-naling receptor activator activity,chaperone binding and protease binding.Enrichment analysis of pathway revealed that the intersecting targets were involved in PI3K/Akt pathway and protein processing in endoplasmic reticulum,etc.CONCLUSION The endoplasmic reticu-lum stress in cerebral ischemic stroke is related to the bi-ological processes of reaction to oxidative stress,the reg-ulation of neuron death,and negative regulation of cell differentiation,the mechanism may be related to neuroin-flammation and apoptosis.
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Danshen-Chuanxiongqin Injection (DCI) is a commonly used traditional Chinese medicine for the treatment of cerebral ischemic stroke in China. However, its underlying mechanisms remain completely understood. The current study was designed to explore the protective mechanisms of DCI against cerebral ischemic stroke through integrating whole-transcriptome sequencing coupled with network pharmacology analysis. First, using a mouse model of cerebral ischemic stroke by transient middle cerebral artery occlusion (tMCAO), we found that DCI (4.10 mL·kg
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Humans , Brain Ischemia/genetics , Drugs, Chinese Herbal , Infarction, Middle Cerebral Artery/genetics , Ischemic Stroke , Myeloid Differentiation Factor 88/genetics , NF-kappa B/metabolism , Stroke/genetics , Toll-Like Receptor 2 , Toll-Like Receptor 4/metabolismABSTRACT
OBJECTIVE@#To evaluate the therapeutic effect of the combined treatment with balance acupuncture therapy and exercise re-learning rehabilitation therapy and the impact on serum cAMP and cGMP in the patients with hemiplegia of cerebral ischemic stroke.@*METHODS@#A total of 90 patients of hemiplegia of cerebral ischemic stroke were randomized into an observation group and a control group, 45 cases in each one. All of the patients in the two groups received health education, diet guidance, routine symptomatic treatment as well as exercise re-learning rehabilitation therapy. Additionally, in the observation group, balance acupuncture therapy was applied, in which, the acupoints on the aspect of the human body, on the governor vessel and bladder meridian were adopted in the morning and those on the aspect of the human body, on the conception vessel and kidney meridian were stimulated in the afternoon. In the control group, the regular acupuncture was given. In the two groups, both acupuncture and rehabilitation therapies were given 5 days a week, 2 week-treatment as one course and totally 2 courses were required. Separately, before and after treatment, the score of Fugl-Meyer assessment (FMA) and the score of Chinese stroke scale (CSS) were recorded, the levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) detected in serum and the clinical therapeutic effect were evaluated in the two groups.@*RESULTS@#After treatment, FMA score was increased in the patients of either of the groups as compared with that before treatment (<0.01) and CSS score decreased as compared with that before treatment (<0.01). After treatment, FMA score in the observation group was higher than that in the control group (<0.01) and CSS score was lower than the control group (<0.01). After treatment, the level of serum cAMP of the patients in either of the groups was increased as compared with that before treatment (<0.01) and that of cGMP decreased as compared with that before treatment (<0.01). After treatment, the level of cAMP in the observation group was higher than that in the control group (<0.01) and that of cGMP was lower than the control group (<0.01). The total effective rate was 93.3% (42/45) in the observation group, better than 73.3% (33/45) in the control group (<0.01).@*CONCLUSION@#The balance acupuncture therapy combined with exercise re-learning rehabilitation effectively improves the motor function of the affected limb, relieves injury and regulate the levels of serum cAMP and cGMP in the patients with hemiplegia of ischemic stroke.
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Humans , Acupuncture Points , Acupuncture Therapy , Brain Ischemia , Therapeutics , Cyclic AMP , Blood , Cyclic GMP , Blood , Hemiplegia , Therapeutics , Stroke , Therapeutics , Stroke Rehabilitation , Treatment OutcomeABSTRACT
Objective:This study intends to study the regulatory effect and mechanism of the effective components of Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos on inflammatory factors related to cerebral ischemia-reperfusion injury in rats through multiple levels of neuropathology， molecular neurobiology and functional behavior. Method:The 32 male rats were randomly divided into four groups： sham group， model group， Danhong components compatibility group（720 mg·kg-1）， nimodipine （0.5 mg·kg-1）groups，each group of eight male rats.Cerebral ischemia was established by middle cerebral artery occlusion （MCAO） approach. The treatment was performed immediately and at 6 hour after MCAO.Hematoxylin-eosin （HE）staining was used to check the changes of brain histopathology， immunohistochemistry and Real time polymerase chain reaction （Real-time PCR） were used to check the expression of IL-1β and Nrf2 in brain tissue，Western blot was used to detect the protein expression of Nrf2 in brain tissue. The aim is to investigate the treatment mechanism of Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos components in a rat model of cerebral ischemic-reperfusion injury. Result:HE staining results showed， compared with sham group， the surviving neurons amount in the model group was significantly reduced（P<0.01），compared with the MCAO group，the number of surviving neurons in the brain tissue of Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos component compatibility group and nimodipine group was significantly increased（P<0.05，P<0.01）.The results of immunohistochemistry and Real-time PCR showed that，compared with normal group，IL-1β and Nrf2 expression in model group were significantly increased （P<0.01），compared with MCAO group， the expression of IL-1β and Nrf2 in Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos component compatibility group and the nimodipine group was significantly decreased （P<0.05，P<0.01）. Western blot results showed that， compared with sham group， Nrf2 positive expression in model group was much more increased （P<0.01）， compared with MCAO group， the expression of Nrf2 in Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos component compatibility group and the nimodipine group was significantly decreased （P<0.01）. Conclusion:The combination of effective components of Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos can significantly down-regulate the expression of IL-1β and Nrf2 proteins.The mechanism is to activate the protein expression of inflammatory pathways， reduce the apoptosis of nerve cells， and finally inhibit the inflammatory response in the process of ischemic stroke injury.
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Objective: To evaluate the effect of two-photon in vivo imaging on detecting the blood brain barrier (BBB) injury in the ultra-early stage of cerebral ischemic stroke. Methods: Twelve clean grade C57BL/6 healthy male mice aged 8-12 weeks were randomly divided into Sham group and middle cerebral artery occlusion (MCAO) group,which were sham operated or middle cerebral artery occluded,respectively. After 60 min of ischemia,MCAO mice were treated with reperfusion for 30-60 min after the suture being removed. The vessels and the neutrophils of mice in the two groups were labeled intravenously with Alexa-Fluora-488 conjugated dextran and rhodamine 6G,respectively. The integrity of BBB was detected by intravenous injection of tetramethylrhodamine-5-maleimide (TMR). Before and after the stroke,the real-time changes of the fluorescence intensity of the inside and outside cerebral vessels of mice in the MCAO group were observed by two-photon fluorescence microscopy. Results: The fluorescence intensity of TMR in the external cerebrovascular of mice in the MACO group was significantly increased within 30-60 min after stroke (P=0.000),suggesting there existed tracer leakage. Compared with the Sham group,the movement of neutrophils in the blood vessels of mice in the MACO group was significantly slowed down (P=0.000). Conclusion: Two-photon in vivo imaging can be used to detect the BBB injury in the ultra-early stage of cerebral ischemic stroke,which provides a certain reference value for clinical application.
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Objective To study the mechanism of Puerariae Radix in the treatment of ischemic stroke by using molecular docking technology. Methods The small molecules of Puerariae Radix based on molecular docking technology docked with 21 key targets protein of cerebral ischemic stroke, and multi-component protein target network was established by Cytoscape 3.1.1 software. Results Through virtual screening of molecular docking technology, 28 active small molecules of Puerariae Radix were chosen, 12 of which were novel small molecules, and it identified that 11 of those compounds had strong interactions with no less than 10 targets. Conclusion The molecular docking can be used to find the active components of Puerariae Radix in treatment of cerebral ischemic stroke, which provide a new reference of studying on the multiple ingredients and targets of Chinese materia medica compounds.
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Objective To explore the effects and the underlying mechanisms by which paired associative stimulation ( PAS) of tibial nerve electrostimulation and M1 cortex transcranial magnetic stimulation ( TMS) in pro-moting the recovery of forelimb dysfunction in rats with cerebral ischemic stroke. Methods Resting motor thresholds of left extensor carpi radialis muscle ( ECR) were determined 5 min before and 5 min, 30 min, 60 min after PAS,respectively, in 8 male Sprague-Dawley ( SD) rats. Then 48 male SD rats were divided into a sham group ( n=16) subject to sham surgery, an experimental group (n=32) which was further divided into a MCAO group (n=16) and a PAS group (n=16) after cerebral ischemic stroke model was established successfully by occluding the right middle cerebral artery. 24 hours after surgery, PAS consisting of left tibial nerve stimulation and right M1 cortex area TMS was applied to PAS group once daily for 7 consecutive days. The corner tests and grip strength tests were per-formed before and after 7 days of PAS treatment in each group. The RMTs of left ECR were determined, metabolites of the left area tissue of cervical spinal cord were measured by nuclear magnetic resonance spectrum, and expressions of Bcl-2 and Bax of left and right area tissue of cervical spinal cord enlargement were detected by Western Blot tech-nique after 7 days of intervention. Results The average RMTs of left ECR at 5 min, 30 min, 60 min after PAS were significantly lower than those at 5 min before PAS ( P<0.05) . All rats in experimental group showed significant higher turning scores and lower grip strength when compared with sham group (P<0.001 or P<0.01). After PAS interven-tion, PAS group demonstrated lower turning scores, higher grip strength and lower RMT of left ECR as compared with MCAO group ( P<0.05 or P<0.01) . The expression of GABA of left cervical enlargment was significantly decreased in MCAO group when compared with the sham group ( P<0.05) , and there was no significant difference between MCAO group and PAS group. Meanwhile, other metabolites showed no significant difference among the three groups. The av-erage expression level of Bcl-2 and Bax proteins in both sides of cervical spinal cord enlargment showed no significant difference among three groups either. Conclusions Tibial nerve-M1 cortex area PAS may increase the excitability of motor cortical representation of forelimbs in rats, by which PAS promotes the recovery of forelimb dysfunction in rats with cerebral ischemic stroke.
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Objective To investigate the efficacy and safety of surgical treatment for internal carotid artery atheromatous pseudo-occlusion (APO).Methods Clinical data of patients with carotid artery stenosis treated by carotid endarterectomy from Dec.,2011 to Jun.,2016 in Zhongshan Hospital Affiliated to Fudan University were analyzed retrospectively.Carotid endarterectomy were performed in 32 patients with pseudo-occlusion of the internal carotid artery (APO group).And 124 patients with traditional severe stenosis (70％-99％) served as control group.Perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosisrate and mortality in follow-up were compared between the two groups.Results Perioperative major complications:one patient (3.1 ％) developed myocardial infarction in the APO group,no ischemic stroke,cerebral hemorrhage and death cases;2 (1.4％) ischemic stroke cases,6 (4.2％) myocardial infarction cases and 1 (0.7％)death case was found in control group.Perioperative minor complications:1 (3.1％) incision bleeding case,2 (6.3％) pulmonary infection cases,2 (6.3％) cerebral hyperperfusion syndrome cases were found in APO group;3 (2.1％) incision bleeding cases,2 (1.4％) incision infection cases,4 (2.8％)pulmonary infection cases,2 (1.4％) cranial nerve injury cases,2 (1.4％) cerebral hyperperfusion syndrome cases were found in control group.Patients were followed up for 6-60 months,with mean follow-up period of (35.3 ± 17.5) months.During follow-up,1 (3.1％) ipsilateral ischemic stroke recurrence case,4 (12.5％) restenosis cases,and 3 (9.4％) death cases were found in the APO group.And 8 (5.6％) ipsilateral ischemic stroke recurrence cases,9 (6.3％) restenosis cases,8 (5.6％)death cases were found in control group.There were no significant differences in perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosis rate and mortality between the two groups.Conclusions Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery is safe and effective.Perioperative and follow-up results are satisfactory.
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Objective To explore the therapeutic effect and prognosis of enhanced external counterpulsation (EECP)on acute cerebral ischemic stroke,to provide clinical evidence for the treatment of patients with acute cerebral ischemic stroke.Methods Total171 patients with acute cerebral ischemic stroke were enrolled and measured the NIHSS and mRS,before EECP,after36 hours EECP,and 3-month after attack.Then contrast the difference of these indicators.Result Compare with the control group,after EECP treatment and after 3-month attack,the scores of NIHSS were statistically significant,(after EECP:44.1％ vs 31.5％;after 3-month attack:55.6％ vs 40.5％),(P＜ 0.05).Compare with the control group,after 3-month attack,the score of mRS in EECP group was declined statistically significant,and the rate of favourable prognosis rise obviously (P＜0.05).Conclusion EECP can effectively improve neurological function and promote health and improve prognosis in the patients with acute cerebral ischemic stroke.
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Objective:To provide reference for clinical monitoring and treatment of patients with gastric ulcer caused by antiplate-let therapy. Methods: Clinical pharmacists participated in the pharmaceutical care of antiplatelet therapy for a patient with acute stroke, and provided pharmaceutical recommendations in respects of antiplatelet therapy, antihypertensive therapy and nursing care by means of medication reconciliation and medication education. Results: The stomach bleeding in the patient was controlled, and the blood pressure was controlled within the target value. Conclusion: Clinical pharmacist can ensure the medication safety and improve the medication compliance through monitoring drug use, which can further improve clinical effectiveness.
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This study aims to analyze the effect of berberine on serum inflammatory factors and carotid atherosclerotic plaques in ppatients with acute cerebral ischemic stroke(AIS). In the study, 120 patients with AIS were randomly divided into berberine group(n=60) and general group (n=60). The 60 cases in the general group were provided with general therapy according to the latest guidelines of diagnosis and treatment of AIS. The berberine group received berberine 300 mg(tid) in addition to the therapy of the general group. The levels of serum inflammatory factors, the nerve function defect grades and the indexes of carotid atherosclerosis plaques [including the total plaque area(TPA), intima-media thickness(IMT) and the number of unstable carotid atherosclerotic plaques] were measured and compared. The results indicated that the levels of serum inflammatory factors, the NIHSS(national institute of health stroke scales) cores and the indexes of carotid atherosclerosis plaques were not significantly different between the berberine groups of general group, with positive correlation between serum inflammatory factors and NIHSS scores(P<0.05). The levels of serum inflammatory factors and NIHSS scores of the berberine groups on 14 d were significantly lower than those on 1 d(P<0.05). The levels of serum inflammatory factors and NIHSS scores of the berberine group on 14 d were significantly lower than those of the general group(P<0.05). The TPA and the number of unstable carotid atherosclerotic plaques of the berberine groups on 90 d were significantly lower than those of general group, with significant differences(P<0.05). The IMT showed a downward trend, but with significant difference.The mRS(modified rankin scale) scores of the berberine group on 90 d were significantly lower, with a higher rate of short-term favorable prognosis (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups. This study showed that berberine in addition to the general therapy can significantly lower the levels of serum MIF and IL-6, reduce the degree of carotid atherosclerosis to some extent and improve neurological impairment and the prognosis of patients with AIS.
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Objectives To explore the effects of enhanced external counterpulsation(EECP)on the serum level of C-reactive protein and endothelin-1 in patients with cerebral ischemic stroke,to provide clinical evidence for the treat?ment and secondary prevention of patients with cerebral ischemic stroke. Methods Total 187 patients with ischemic stroke were enrolled measure the serum level of C-reactive protein and endothelin-1, before EECP, after36 hours EECP, and one-month after EECP. Then contrast the difference of these indicators. Result After treatment, the serum levels of C-reactive protein and endothelin-1 in EECP group were obviously decrease and the difference was statistically signifi?cant(hs-CRP 60.1%vs. ET-1 40.9%,P0.05). Conclusion EECP can obvi?ously reduce the serum levels of C-reactive protein and endothelin-1 in the patients with ischemic stroke, which indi?cates that EECP can slow atherosclerotic process.
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During the previous years, with the emerging of nanotechnology, the enormous capabilities of nanoparticles have drawn great attention from researchers in terms of their potentials in various aspects of pharmacology. Cerium oxide nanoparticles (nanoceria), considered as one of the most widely used nanomaterials, due to its tempting catalytic antioxidant properties, show a promising potential in diverse disorders, such as cerebral ischemic stroke (CIS), cancer, neurodegenerative and inflammatory diseases. Overwhelming generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) during cerebral ischemia and reperfusion periods is known to aggravate brain damage via sophisticated cellular and molecular mechanisms, and therefore exploration of the antioxidant capacities of nanoceria becomes a new approach in reducing cerebral ischemic injury. Furthermore, utilizing nanoceria as a drug carrier might display the propensity to overcome limitations or inefficacy of other conceivable neuroprotectants and exhibit synergistic effects. In this review, we emphasize on the principle features of nanoceria and current researches concerning nanoceria as a potential therapeutic agent or carrier in improving the prognosis of CIS.
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Humans , Antioxidants , Therapeutic Uses , Brain Ischemia , Drug Therapy , Cerium , Chemistry , Therapeutic Uses , Nanoparticles , Chemistry , Therapeutic Uses , Neuroprotective Agents , Therapeutic Uses , Oxidative Stress , Reactive Nitrogen Species , Metabolism , Reactive Oxygen Species , Stroke , Drug Therapy , PathologyABSTRACT
Objective:To observe the clinical efficacy of rt-PA in the treatment of patients with acute ischemic stroke ( CIS) and hyperdense middle cerebral artery sign ( HMCAS) . Methods:Totally 107 patients with CIS and HMCAS were randomly divided into the control group (n=54) and the treatment group (n=53). The control group was treated with urokinase, while the treatment group was treated with recombinant tissue type plasminogen activator ( rt-PA) . The treatment course was 14 days, and then the clinical effi-cacy and safety were evaluated. Results:Compared with that before the treatment, the score of national institute of health stroke scale ( NIHSS) in both groups was decreased after the treatment, and the decrease in the treatment group was more notable than that in the control group with statistically significant difference (P<0. 05). The clinical effective rate of the treatment group was 88. 68%, while that of the control group was 79. 63%, and there was statistically significant difference between the groups (P<0. 05). Compared with that before the treatment, BI index in both groups was increased after the treatment, and the increase in the treatment group was more significant than that in the control group with statistically significant difference (P<0. 05). Conclusion:rt-PA thrombolytic therapy in the patients with CIS and HMCAS has remarkable clinical efficacy, which can improve patients’ life quality and is worthy of promo-tion.
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This systematic review was aimed to evaluation the effectiveness and safety of supplementingqi and activating blood circulation prescriptions in the treatment of cerebral ischemic stroke. Dtabases both at home and abroad were electronically searched for randomized controlled trials (RCTs) on supplementingqi and activating blood circulation prescriptions in the treatment of cerebral ischemic stroke. And meta-analyses were performed using RevMan 5.0 software. The results showed that 27 studies were included, which contained 2 908 cases. There were 1 490 cases in the treatment group, and 1 418 cases in the control group. The results of meta-analyses indicated that supplementingqi and activating blood circulation prescriptions combined with routine treatment of modern medicine had significant differences in the effective rate for cerebral ischemic stroke compared with the single using of routine treatment of modern medicine with significant difference (OR = 5.39, 95%CI (4.03, 7.22),P < 0.000 01). The treatment of supplementingqi and activating blood circulation prescriptions combined with routine treatment of modern medicine had better treatment effect on neurological function defects for cerebral ischemic stroke compared with the single using of routine treatment of modern medicine with significant difference (WMD = -2.99, 95%CI (-3.26, -2.72),P < 0.000 01). In addition, the treatment of supplementingqi and activating blood circulation prescriptions combined with routine treatment of modern medicine had better treatment effect on improving the activity of daily living (WMD = 9.65, 95%CI (8.36, 10.93),P < 0.000 01). Adverse reaction and event was mild in 2 included research reports. It was concluded that the treatment of supplementingqi and activating blood circulation prescription or it combined with routine treatment in modern medicine was quite effective in the treatment of cerebral ischemic stroke by the existed limited evidences. It can also improve the nerve dysfunction and the ability of daily living. Due to the limited quantity of the included studies and the evidence with limited strength, further high-quality RCTs were needed to verify the forementioned conclusion.
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Objectives To examine the effects of enhanced external counterpulsation on arterial elasticity in stroke patients to provide clinical evidence for secondary prevention of patients with cerebral ischemic stroke. Methods Total 192 patients with ischemic stroke were enrolled and then divided into the EECP (n=107) and control (n=85) group. Auto-matic measurement synchronous atherosclerosis detector was use to measure brachial-ankle pulse wave velocity (BaP-WV) and cardio-ankle vascular index (CAVI). The difference of BaPWV and CAVI were evaluated before, at 36 hours and one month after EECP. Results The BaPWV and CAVI significantly decreased at 36 hours and 1 month after treat-ment in EECP groups compared to either pre-therapy or control groups (all P<0.05). Conclusions EECP can signifi-cantly reduce the BaPWV and CAVI and improve the arterial elasticity in patients with cerebral ischemic stroke. Thus, arterial elasticity may be an important index to evaluate the effects of EECP on cerebral ischemic stroke.
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Objective To investigate the influnce factors of new diagnosed abnormal glucose metabolism in patients with acute cerebral ischemic stroke .Methods One hundres and twenty stroke patients without history of diabetes were divide into large artery atherosclerotic stroke (LAA), small arterial occlusive stroke(SAO), cardiac embolic stroke(CES), undeterminined etiology stroke (UND) subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classfication.The patients were tested oral glucose tolerance test (OGTT) one week later after stroke. The impaired glucose regulation ( IGR ) and diabetes patients called the abnormal glucose metabolism group ,compare related indicators and make multivariate Logistic regression analysis .Results There were 68 patients(56.7%) with normal metabolism, 52 patients (43.3%) with abnormal glucose metabolism.Among them, 38 cases were IGR (31.7%), 14 cases were diabetes (11.7%).The rate of abnormality of impaired glucose metabolism in LAA subgroup(63.8%) was significantly higher than the other subgroups (27.3%-31.4%)(all P<0.05).There was no statistically significant difference between the other subgroups .Compared with normal glucose metabolism group, age, the rate of hyperlipidemian and family history of diabetes were significant higher in abnormal glucose metabolism group (P<0.05 -0.01).Multivariate logistic regression analysis showed that hyperlipidemia ( OR=1.671,95%CI:1.208 -2.311,P=0.012), family history of diabetes (OR =1.421,95%CI:1.114 -1.813,P=0.042) and LAA(OR=2.825,95%CI:1.706-4.674,P=0.023) were independent risk factors of new diagnosed abnormal glucose metabolism in ischemic stroke .Conclusion There is a high prevalence of new diagnosed abnormal glucose metabolism in ischemic stroke .Hyperlipidemia , family history of diabetes and LAA are independent risk factors of it .
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OBJECTIVES: According to current knowledge, apolipoprotein B/A1 (apoB/A1) ratio is like to be risk factor in coronary artery disease. There is evidence form case-control studies that apoB/A1 ratio may be a superior to LDL and HDL cholesterol in discriminating coronary artery disease case subject from control subject. However, relationship between apoB/A1 ratio and cerebral ischemic stroke is undefined. The main object of this study is to determine whether the risk of cerebral ischemic stroke is related to levels of apoB/A1. METHODS: The study group included 643 patients (Men, 372; Women, 271) who diagnosed cerebral ischemic stroke between January 2008 to December 2010. The control groups were composed of 378 patients (Men, 139; Women, 239) who diagnosed other neurological disease. The correlation between lipid profiles and odds ratio of 10 preliminary risk factors (total cholesterol, triglyceride, LDL, HDL, apoA1, apoB, apoB/A1 ratio, non HDL, total cholesterol/HDL ratio, LDL/HDL ratio) for stroke were analyzed. RESULTS: ApoB/A1 ratio was significantly increased in case patients compared with control subjects. Multivariate logistic regression analysis identified decrease of apoB/A1 ratio (odds ratio [OR], 1.583; 95% confidence intercal [CI], 1.105~2.269) as significantly associated with stroke. Individual apoA1 (OR, 1.303; 95% CI, 0.967~1.755) and apoB (OR, 1.397; 95% CI, 0.773~2.523) were also not significantly associated with cerebral ischemic stroke. CONCLUSION: Increase of apoB/A1 ratio is associated with an increase risk of cerebral ischemic stroke. Use of apoB/A1 ratio is efficient as conventional lipids, for the identification of subjects at increased risk of stroke. So apoB/A1 ratio to standard lipid profile testing could improve the evaluation of risk factors of cerebral ischemic stroke.
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Female , Humans , Apolipoproteins , Apolipoproteins B , Case-Control Studies , Cholesterol , Cholesterol, HDL , Coronary Artery Disease , Logistic Models , Odds Ratio , Risk Factors , StrokeABSTRACT
Objective To evaluate the safety and efficacy of intra-arterial thrombolysis in patients with acute cerebral ischemic stroke.Methods Twenty-one patients with acute internal carotid circulation infraction(internal carotid 3,MCA 12,ACA 5,lenticulostriate in 1) were treated with intra-arterial thrombolysis of recombinant tissue plasminogen activator(rt-PA) which was performed within 2-6 hours of symptom onset.Recanalization was observed during the operation.Intracerebral hemorrhage(ICH) was monitored immediately and 24 h after the treatment by CT or MRI scanning.Chinese stroke scale was used to evaluate the recovery of neurological functions pre-operatively and 30 d after the treatment.Results All the 21 patients were 100% success in receiving intra-arterial thrombolysis technique and revealed 16 having the degree of recanalization of 2 to 3 grade as regards to TMI,16 patients' degree of recanalization reached 2 to 3 grade according to TMI;5 patients showed 1 to 2 grade.Symptomatic ICH was observed in 3 patients,with two dead.Arterial dissection was found in one patient.Thirty days after the operation,17 patients' cerebral function reduced over 50 percent;2 less than 50 percent;and 2 died.The patients achieved 2 to 3 grade of recanalization were obviously getting better than those achieving 0 to 1 grade.Conclusions It is adapt to have intra-arterial thrombolysis with six hours from onset;but still have the danger of severe ICH.The treatment should be started as early as possible.