Quantitative analysis of effects of salvianic acid a combined with hydroxy safflower yellow a on rat endothelial cells after hypoxic injury using the combination index method

Abstract Cerebrovascular disease is the second most serious disease in the world. It has the features of high morbidity, high mortality and recurrence rate. Numerous research on the compatibility of Chinese medicine with effective ingredients of cerebral ischemia has been made during the past decades. The purpose of this study is to quantitatively analyze the combined pharmacological effect of effective ingredients in Danshen and Honghua (Dan Hong) on rat microvascular endothelial cells after gradually oxygen-glucose deprivation. The experimental concentration range for the compatibility of two effective ingredients were determined in the preliminary experiments by Cell Counting kit-8 (CCK-8) method. Drugs were added to rat brain microvascular endothelial cells at a non-toxic dose level. After that, the cells were cultured for 12 h, and placed in a hypoxic environment. Finally, the cell survival rate was used as a measure of drug effect. In order to determine synergism or antagonism, the combination index (CI)-isobologram method was performed to analyze the data from the experiments. Based on this theory, the potencies of each drug and the shapes of their does-effect curves are both taken into account. The results show that the synergism or the antagonism between two effective ingredients compatibility change with different proportion and dosage. Furthermore, it can be seen from the results of these experiments that when these drugs are used in combination, the dosage required to achieve the same therapeutic effects is greatly reduced compared with the case of single one. It is worth mentioning that our experiments also prove that the median-effect equation and the CI method can be applied in the field of traditional Chinese medicine.

The role of necroptosis in neurosurgical diseases

Programmed necrosis or necroptosis is an alternative form of cell death that is executed through a caspase-independent pathway. Necroptosis has been implicated in many pathological conditions. Genetic or pharmacological inhibition of necroptotic signaling has been shown to confer neuroprotection after traumatic and ischemic brain injury. Therefore, the necroptotic pathway represents a potential target for neurological diseases that are managed by neurosurgeons. In this review, we summarize recent advances in the understanding of necroptotic signaling pathways and explore the role of necroptotic cell death in craniocerebral trauma, brain tumors, and cerebrovascular diseases.

Factores de riesgos prevalentes en pacientes ingresados por enfermedad cerebrovascular / Prevailing risk factors in hospitalized patients with cerebrovascular disease

INTRODUCCIÓN: la enfermedad cerebrovascular en la actualidad es uno de los problemas de salud más importantes, no solo en Cuba, sino en los países desarrollados del mundo. Ocupa el segundo lugar como causa de discapacidad permanente en el adulto y muerte, solo es superada por las enfermedades cardiovasculares y el cáncer, lo que determina su relevancia médica, económica y social por el costo en la rehabilitación y los cuidados que requieren los pacientes con importantes daños neurológicos. OBJETIVO: caracterizar los factores de riesgos prevalecientes en los pacientes ingresados por enfermedad cerebrovascular. MÉTODOS: estudio descriptivo y longitudinal en una muestra de 144 pacientes ingresados por enfermedad cerebrovascular en el servicio de urgencias del Hospital Clinicoquirúrgico Docente "Dr. Octavio de la Concepción y de la Pedraja" entre enero y diciembre de 2012. Se aplicó una encuesta que exploró diferentes variables y los datos obtenidos se codificaron manualmente. RESULTADOS: el tipo de enfermedad cerebrovascular que prevaleció fue la hemorragia subaracnoidea, seguida por la hemorragia cerebral. Los factores de riesgo modificables que se identificaron con mayor frecuencia fueron la hipertensión arterial y la diabetes mellitus. Se constató insuficiente control de los factores de riesgo en la atención primaria de salud. CONCLUSIONES: los factores de riesgo mayormente asociados a la enfermedad cerebrovascular fueron la hipertensión arterial y la edad avanzada, seguidos por el tabaquismo y la diabetes mellitus, en correspondencia con un control deficiente de estas enfermedades.

INTRODUCTION: cerebrovascular diseases are presently one of the most important health problems not only in Cuba but in the developed countries as well. It holds the second place in the list of causes of permanent disability and of death in adults, just preceded by cancer and cardiovascular diseases, which determines its medical, economic and social relevance due to the cost of rehabilitation and of care that patients having significant neurological damage require. OBJECTIVE: to characterize the prevailing risk factors in hospitalized patients with cerebrovascular disease. METHODS: longitudinal and descriptive study of a sample of 144 patients with cerebrovascular disease, who were admitted to the emergency service of "Dr Octavio de la Concepcion y de la Pedraja" teaching, clinical and surgical hospital from January through December, 2012. A survey was conducted to explore different variables and the collected data were manually coded. RESULTS: the predominant type of cerebrovascular disease was subararachnoid hemorrhage followed by brain hemorrhage. The most frequently modifiable risk factors were blood hypertension and diabetes mellitus. It was observed that the control of risk factors was poor at the primary health care setting. CONCLUSIONS: the risk factors mainly associated to cerebrovascular disease were blood hypertension and advanced age, followed by tabaquismo and diabetes mellitus, in correspondence with a deficient control of these illnesses.

Enfermedades respiratorias del sueño y patología vascular cerebral / Respiratory-related sleep disorder and cerebral vascular disease

Las patologías respiratorias del sueño (PRS), especialmente las Apneas del tipo Obstructivo, tienen una alta prevalencia en pacientes con Accidente Cerebrovascular y en Enfermedades Cardiacas. Numerosos estudios publicados en la literatura hasta la fecha, sugieren y confirman que estas patologías respiratorias del sueño constituyen hoy en día un factor de riesgo independiente de morbilidad y mortalidad para eventos isquémicos cerebrales y cardiogénicos. Existen mecanismos fisiopatológicos como la hipoxemia, activación simpática, estados de hipercoagubilidad y daño de la pared endotelial que explican la relación existente entre patologías respiratorias del sueño y enfermedades cardiocerebrovasculares. Por otra parte, para aquellos pacientes que están cursando con un evento isquémico cerebral en fase aguda, las Apneas del Sueño se asocian a una alta mortalidad y a un peor pronóstico funcional. Identificar y tratar precozmente estas patologías respiratorias del sueño, puede constituirse en una estrategia terapéutica crucial para reducir la morbi-mortalidad asociada a los AccidentesVasculares Cerebrales y a las Enfermedades Cardiacas. El instaurar políticas de salud de prevención primaria será quizás la principal herramienta de trabajo que permitirá en un futuro cercano mantener un mejor control y reducir el alto riesgo de salud de los pacientes portadores de Apneas del Sueño.

Respiratory-related sleep disorders, especially type Obstructive Apnea have a high prevalence in patients with stroke and heart disease. Numerous studies published in the literature to date, confirm and suggest that these respiratory disorders of sleep are now an independent risk factor for morbidity and mortality and cardiogenic cerebral ischemic events. There are pathophysiological mechanisms such as hypoxemia, sympathetic activation, blood coagulation abnormalities and damage to the endothelial wall that explain the relationship between respiratory diseases of sleep and vascular diseases. On the other hand, for those patients who are attending an event with ischemic stroke in acute phase, the sleep apnea is associated with high mortality and a worse functional prognosis To identify and treat these diseases early respiratory sleep, can become a crucial therapeutic strategy to reduce morbidity and mortality associated with stroke and heart disease. The institute health policies for primary prevention is perhaps the main working tool that will in the near future to maintain better control and reduce the high risk of health of patients with sleep apnea.

Stent carotídeo: estado del arte / Carotid stenting: state of the art

El implante percutáneo del stent carotídeo es utilizado ampliamente en todo el mundo como una alternativa menos invasiva a la endarterectomía carotídea para la prevención del ataque cerebrovascular isquémico causada por una estemosis arterial carotídea extracraneana. La estenosis arterial carotídea que particularmente involucra el origen de la arteria carótidea interna, es un problema clínico frecuente. Esta estenosis de etiología invariablemente aterosclerótica, puede presentarse como un soplo carotídeo asintomático descubierto en el examen físico, o por ataques isquémicos transitorios relacionados con la embolización de trombos originados en el sitio de lesión, o menos comúnmente como un ataque isquémico cerebral. Recientes estudios observacionales y aleatorizados han demostrado que el riesgo de sufrir un accidente cerebrovascular o muerte relacionado con el implante de stent carotídeo es comparable a endarterectomía carotídea, cuando operadores entrenados realizan estas intervenciones en grupos de pacientes bien definidos.

Carotid artery stenting is now utilized worlwide as a less invasive alternative to carotid end arterectomy for the prevention of ischemic strokes caused by stenoses at the extracraneal bifurcation of carotid arteries. Carotid artery stenosis, particularly involving the origin of the internal carotid artery, is a frequently encountered clinical problem. Such stenoses, almost invariably atherosclerotic, can present as an asymptomatic bruit discovered on physical examination, asone or more transient ischemic attacks related to embolization from a stenotic lesion or less commonly, as an ischemic stroke. Recent observational and randomized studies have shown that the risk of procedure-related stroke and death is comparable with carotid endarterectomy when skilled operators perform these interventions in well-defined patient subsets.

Clinico-pathological discrepancies in a general university hospital in São Paulo, Brazil

INTRODUCTION: The autopsy rate has continuously diminished over the past few decades, reducing the quality of medical care and the accuracy of statistical health data. OBJECTIVE: To assess the accuracy of clinical diagnoses by comparing pre- and postmortem findings, and to identify potential risk factors for misdiagnoses. METHODS: Retrospective evaluations performed between June 2001 and June 2003 in a 2500-bed tertiary university hospital in São Paulo, Brazil, including 288 patients who died at that institution and had a postmortem examination. RESULTS: Clinical and autopsy records were reviewed and compared for categorization using the adapted Goldman criteria. The overall major and minor discrepancy rates were 16.3 percent and 28.1 percent, respectively. The most common missed diagnoses were pulmonary embolism, pneumonia, and myocardial infarction, and the most prevalent underlying diseases were infectious diseases, cerebro-cardiovascular conditions, and malignancies. Patients age 60 or older had an increased risk of diagnostic disagreement, as did female patients. The period of hospitalization, last admission unit at the hospital and underlying disease were not significantly related to the pre-mortem diagnostic accuracy. DISCUSSION: The discrepancy rate found in this study is similar to those reported globally. The factors influencing diagnostic accuracy as well as the most commonly missed diagnoses are also consistent with the literature. CONCLUSION: Autopsy remains a crucial tool for improving medical care, and effort must be focused on increasing its practice worldwide.

Experiencia con el tratamiento endovascular de los aneurismas del tope de la arteria basilar / Experience with the endovascular treatment of vasilar tip aneurysms

Objetivo. Describir los resultados inmediatos obtenidos en una serie de pacientes con aneurismas del tope de la arteria basilar tratados por vía endovascular en relación con el tamaño del cuello y saco del aneurisma, la presencia o no de ruptura aneurísmática y la gravedad clínica. Método. Se realizó un estudio descriptivo en una cohorte retrospectiva de 37 pacientes adultos de ambos sexos con aneurismas del tope de la arteria basilar tratados por vía endovascular (período 1993-2006). Los pacientes fueron clasificados con la escala de Hunt-Hess. Los aneurismas fueron clasificados según su tamaño y ancho del cuello. El grado de oclusión se clasificó en 4 categorías: A(100), B(>95), C(>90), D(<90). Resultados. En el 68 se logró una oclusión grado A y en el 1 se logró una oclusión grado B. La morbilidad fue del 7 en el subgrupo sin HSA y del 28 en el subgrupo con HSA. Se encontró una morbilidad del 9 en el grado HH 0; 12,5 en el grado HH 1-2; 58 en el grado HH 3 y 50 en el grado HH 4-5. La oclusión fue grado A en el 75 de los aneurismas con saco pequeño y cuello angosto y en el 55 de los aneurismas con saco grande y cuello ancho. La morbilidad global fue del 24 y la mortalidad global fue del 5,4. Conclusión. En base a los resultados descriptos la vía endovascular fue una buena alternativa para el tratamiento en agudo de los aneurismas rotos e incidentales del tope de la basilar, sobre todo cuando tenían un saco pequeño y cuello angosto y presentaban una menor gravedad clínica. Palabras clave: aneurisma cerebral, tope de basilar, tratamiento endovascular.

Objective. We describe the early results obtained in a series of cases with basilar tip aneurysms treated by endovascular surgery with detachable coils. The results are compared according to the size of the neck and the sac of the aneurysms, the history of aneurysms rupture and neurological state. Method: A retrospective descriptive study was made in a cohort of 37 adults patients of both sexes with basilar tip aneurysms treated by endovascular surgery (period 1993-2006). Hunt-Hess scale was usedfor patients classification. The aneurysms were classified according to their size and the wide of the neck. The occlusion grade was classified in 4 categories: A(100), B(>95), C(>90), D(<90). Results: Occlusion grade A was obtained un 68 of patients and occlusion grade B was obtained in 18 of patients. The morbidity was 7 in the non-SHA group and 28 in the SAH group. Morbidity was 9 in HH 0, 12,5 in grade HH 1-2, 58 in grade HH 3 and 50 in grade HH 4-5. Occlusion was grade A in 75 of the aneurysms with small sac and narrow neck and in 55 fo the aneurysms with a huge sac an broad neck. Global morbidity was 24 and global mortality was 5.4. Conclusion: According with our results, endovascular surgery was a good alternative for acute ruptured basilar tip aneurysms and incidental ones too, mainly when they had smaller sacs, narrower necks and a better neurological state. Key words: basilar tip aneurysm - cerebral aneurysm - endovascular treatment.

Pathophysiology of dementias and implications for therapy.

Dementia is characterized clinically by progressive cognitive decline, often with impairment of memory. The pathology of dementias is either focal as with infarcts in Vascular Dementia or diffuse as typified by Alzheimer's disease. In many cases of Alzheimer's disease there is a mixture of focal infarcts and diffuse changes. Diffuse pathology in dementias comprises mainly intracellular and extracellular protein deposits. Intracellular inclusions are of tau protein (Alzheimer's disease; and some frontotemporal dementias), alpha-synuclein (Dementia with Lewy bodies) and huntingtin (Huntington's disease). Soluble and insoluble peptides also accumulate in the extracellular spaces of brain parenchyma in dementias with diffuse pathology, mainly amyloid-beta (Abeta) in parenchymal plaques and in artery walls as cerebral amyloid angiopathy (Alzheimer's disease and Dementia with Lewy bodies). Insoluble prion protein (PrP) is deposited in brain parenchyma in Creutzfeldt-Jakob disease and other insoluble amyloid peptides accumulate in brain and vessel walls infamilial dementias. The pattern of extracellular deposits in brain and artery walls suggests that there is a failure of elimination of peptides, such as Abeta along perivascular interstitial fluid drainage pathways ("lymphatics") from the aged brain and in Alzheimer's disease. Such failure may be due to reduced pulsations as arteries stiffen with age and cerebrovascular disease. Immunization against Abeta removes insoluble deposits of Abeta from brain parenchyma and may allow improved clearance of soluble Abeta. Reducing cerebrovascular disease and facilitating elimination of Abeta along perivascular drainage routes may offer long-term preventative measuresfor both Vascular Dementia and for Alzheimer's disease.

The research progression of S100beta as a neurochemistry maker / 法医学杂志

S100beta is one kind of the calcium binding proteins. As growth factor of neuraxon, it is excreted by neuroglial cell, and distributing in nerve tissue extensively. Although S100beta has very important values neurophysiological, it also has neurotoxicity with excreting overmuch. Concentration of S100beta changes regularity in serum after the brain injury. In addition, it has a close relations with the degree of brain damage, which can be regarded as the neural new marker of biochemistry after brain damage. The advances of S100beta protein, in the research on neurophysiological values and its application for nerve tissue injury, disease were reviewed.

Efeitos das terapêutica com estrogênios eqüinos conjugados ou raloxifeno sobre a rigidez arterial em mulheres na pós-menopausa / Effects of therapies with conjugated equine estrogens or raloxifene on arterial stiffiness in post menopausal women

Sessenta e sete mulheres saudáveis, normotensas e com 1 a 10 anos de menopausa foram aleatoriamente divididas em três grupos constituídos por 24, 25 e 18 mulheres. Receberam placebo, 0,625 mg de estrogênios eqüinos conjugados ou 60 mg de raloxifeno, respectivamente, 1 comprimido por dia, por 4 meses consecutivos. Analisou-se a rigidez arterial, através da avaliação das velocidades de onda de pulso carótido-femoral e fêmoro-pediosa, e do índice de amplificação da pressão sistólica na artéria carótida por tonometria. Não se observou, ao final do quarto mês, qualquer alteração dos índices de rigidez arterial associada às intervenções farmacológicas. Estrogênios eqüinos conjugados e raloxifeno não parecem afetar a rigidez arterial de mulheres sadias e normotensas com menos de 10 anos de menopausa / Sixty-seven healthy and normotensive women with 1 to 10 years of menopause were randomly assigned to one of three groups, with 24, 25, and 18 participants. They were given placebo, conjugated equine estrogen, or raloxifene, respectively, 1 pill a day, for 4 consecutive months. Arterial stiffness was evaluated after 4 months of treatment by measurement of the carotid-femoral and femoral-dorsalis pedis pulse wave velocity, and the systolic pressure augmentation index at the carotid artery obtained by applanation tonometry. Neither one of the treatment regimens affected arterial stiffness. Conjugated equine estrogen and raloxifene do not seem to affect arterial stiffness of healthy normotensive women with less than 10 years of menopause...

Accidente cerebrovascular en pacientes menores de 35 años: Hospital Pérez de León de Petare / Cerebrovascular accident in patients younger than 35 years: Hospital Perez the Leon the Petare

En este estudio descriptivo-retrospectivo se revisaron las historias médicas de 436 pacientes que ingresaron con diagnóstico de accidente cerebrovascular al Hospital Pérez de León, desde enero de 1989 a diciembre de 1993. Encontramos que el 4.1 por ciento correspondieron a menores de 35 años, siendo el sexo masculino el más afectado y observamos la existencia de una relación directa entre la presencia de prolapso de válvula mitral asintomático y el desarrollo del accidente cerebrovascular. Las causas encontradas fueron accidente vascular embólico 38,9 por ciento, hemorragia subaracnoidea 27,8 por ciento, isquemia cerebral transitoria 22,3 por ciento, arteriosclerosis prematura 5,5 por ciento y vasculitis 5,5 por ciento. La evolución clínica fue satisfactoria en la mayoría de los casos y la mortalidad baja

Hallazgos angiotomográficos en pacientes con diagnóstico clínico de enfermedad vascular cerebral / Angiotomography in patients with cerebral vascular disease

Se describe, retrospectivamente los hallazgos angiotomográficos en 58 pacientes con diagnóstico de enfermedad vascular cerebral consistentes en isquemia cerebral transitoria, insuficiencia vértebrobasilar, ictus completo, alteraciones visuales y cefalea. Las ventajas de este procedimiento son su rapidez, alta sensibilidad para detectar placas de ateroma calcificadas y excelente demostración de la anatomía vascular intra y extracraneal. La aterosclerosis (31 por ciento) y los infartos lacunares (21 por ciento) fueron los hallazgos más comunes sobrre todo en pacientes mayores a los 50 años de edad. El 20 por ciento de los estudios no presentaron anormalidades, 8 por ciento correspondieron a aneurismas y el restante 20 por ciento correspondió a infartos crónicos, trombosis arterial, vasculitis, angiomas venosos, lesión selar y hemorragia subaracnoidea. Por último, considerando únicamente los estudios de cráneo (50 pacientes) los aneurismas saculares a nivel del polígono de Willis fueron el 12 por ciento

Study of different risk factor profiles in stroke patients in Alexandria

The study included 94 stroke cases. They were admitted at the Internal Medicine Department between October 1994 and March 1995. For each case studied, an attempt was made to obtain, from the same hospital, age and sex matched control patient. The aims of this work are to identify different stroke risk factors and to measure the strength of association of the different risk factors and stroke. Results of this work revealed that hypertension, diabetes mellitus, ischemic heart diseases, arrythmias possible symptoms of transient ischemic attacks and android type of fat distribution are major risk factors of stroke in Alexandria. This necessitates initiation and continuation of stroke control program in Alexandria

Estudio anatomopatológico de la sustancia blanca periventricular en condiciones normales y patológicas / Periventricular white matter study in normal and pathological conditions

La presencia de áreas hipodensas en sustancia blanca periventricular vistas con tomografía computada o como imágenes hipertensas en las ponderaciones en T2 de la resonancia nuclear magnética pueden corresponder a un hallazgo de etiopatogenia controvertida. Se efectuó un estudio neuropatológico incluyendo los tres tipos de pacientes que más comúnmente pueden presentar estos hallazgos en los estudios por imágenes: enfermos con demencia tipo Alzheimer, individuos con afección cerebrovascular crónica y pacientes con envejecimiento normal. Los resultados de la anatomía patológica permiten plantear diferentes mecanismos fisiopatológicos para esta afección de la sustancia blanca periventricular, proponiendo que en parte corresponden a un envejecimiento de la sustancia periventricular y a una concomitante disminución de la población neuronal cortical

Accidentes vasculares encefálicos no traumáticos: una emergencia no tan excepcional / Non traumatic vascular encephalic accidents: a not so unusual experience

Se analizaron 14 historias clínicas del Departamento de Energencia del Hospital "Pereira Rossell" en el período comprendido entre junio de 1988 a mayo de 1992 con diagnóstico de accidente vascular encefálico no traumático en los que se realizó TAC. El rango etario fue de 10 meses a 14 años. Constituyeron el 0,4 por ciento de las emergencias reales. Nueve fueron de naturaleza isquémica, cinco hemorrágica; la edad promedio fue significativamente mayor para los hemorrágicos. En la mitad de los casos no se llegó al diagnóstico al ingreso, sólo en 1/3 de los pacientes figuró como primer diagnóstico. Los síntomas de inicio más frecuentes fueron: plejía, trastornos de conciencia y convulsiones. La TAC en las primeras 48 horas fue patológica en 12/14. La etiología fue aclarada en 8/14. De la evolución inmediata se destaca que 4 hemorrágicos murieron y 8 isquémicos quedaron con secuelas

Free oxygen radical activity and some antioxidants in plasma of patients with cerebrovascular stroke

Neuronal cell loss in cerebral ischemia is partly due to oxidative damage caused by free oxygen radical [FOR] formation and subsequent lipid peroxidation, a process that can be halted by antioxidants. In this study, levels of malondialdehyde [MDA]. An end product of lipid peroxidation, as a marker of FOR activity, together with levels of three antioxidants namely vitamin C. vitamin E and the trace element selenium. Were measured in plasma of 30 patients with cerebrovascular stoke [CVS] grouped according to CT findings into patients with cerebral infarction and those with cerebral haemorrhage [15 patients each]. The study included also 15 healthy subjects as control. Results showed statistically significant decrease in both vitamin E [P 0.01] and selenium [P 0.01]. accompanied by significant increase in MDA [P 0.001] in plasma of all patients compared to control, with no significant difference between the two groups of patients except vitamin E levels which decreased signiticantly in patients with infarction compared to those with haemorrhage [P 0.05]. Significant negative correlations were noticed between MDA and each of vitamin E [P 0.423, P 0.05] and selenium [P 0.369, P 0.05] plasma levels. In conclusion. Patients with CVE have deranged antioxidant satus and increased FOR activity which almost occur whatever the cause of stoke. Further studies are recommended to clarify the significance of these changes and to elucidate whether antioxidant supplementation will alter the course of the disease beneficially

Estudio clínico de los accidentes cerebro-vasculares en 111 pacientes (Hospital General de Guatire-Guarenas 1986-1990) / Clinical study of the cerebrovascular diseases in 111 patients (Hospital General of Guatire-Guarena 1986-1990)

Se hizo una revisión retrospectiva de 111 casos de ACV en el período de 1986-1990, en el Hospital General de Guatire-Guarenas. Se revisaron los accidentes patológicos, factores de riesgo, características clínicas, estudios neuroradiólogos, tratamiento y evolución en todos los casos. Los resultados obtenidos revelaron la influencia de la edad, HTA, hábitos alcohólicos y tabaquicos como factores predisponentes, así como, la aparición de signos de focalización en la mayoría de los casos estudiados, el tratamiento de los pacientes incluyó múltiples drogas: Calciantagonistas, antiagregantes, anticonvulsivantes, antihipertensivos y otras de reciente aparición como la Nimodipina