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Objective To investigate the effect of mild hypothermia therapy on plasma tissue-type plasminogen activator (tPA)/plasminogen activator inhibitor-1 (PAI-1) in patients with massive cerebral infarction (MCI).Methods The patients with MCI were randomly divided into the conventional therapy group and the mild hypothermia therapy group.On the basis of conventional therapy,the latter received local mild hypothermia therapy for 48 hours immediately after admission.Enzyme-linked immunosorbent assay was used to detect plasma tPA and PAI-1 at admission and at 48 hours after mild hypothermia,respectively.The general information and the tPA and PAI-1 levels before and after treatment in both groups were compared.Results A total of 46 patients with MCI were included.There were 26 and 20 patients in the conventional therapy group and the mild hypothermia therapy group,respectively.There were no significant differences in the general information,the tPA and PAI-1 levels before and after treatment in both groups,and the levels of plasma tPA (80.98 ± 34.64 pg/mL vs.110.1 ± 32.7 pg/mL; t =3.462,P =0.013) and PAI-1 (145.40 ± 45.29 pg/mL vs.174.2 ± 38.0 pg/mL; t =4.854,P =0.034) at 48 hours of mild hypothermia therapy in the mild hypothermia therapy group were significantly lower than those in the conventional therapy group.Conclusions Mild hypothermia therapy may decrease the plasma tPA and PAI-1 levels in patients with MCI,and it may be associated with the neuroprotective effect of hypothermia therapy.
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Objective To investigate the correlation between cerebral microbleed (CMB) and hemorrhage transformation (HT) after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.Methods The patients with acute cerebral infarction treated with intra-arterial urokinase were enrolled.They were divided into either an HT group or a non-HT goup according to whether they had HT or not.Conventional MRI sequences,susceptibility-weighted imaging (SWI),and CT scan were performed before procedure.CT or MRI was reexamined within 48 hours after procedure.The patients' demographic data,vascular risk factors,and the SWI sequences showed the numbers of CMB were documented in detail and they were compared and analyzed.Results A total of 62 patients were included,22 in HT group and 40 in non-HT group.Univariate analysis showed that the proportions of hypertension (81.8％ vs.57.5％ ; x2 =3.125,P =0.048),diabetes (63.6％ vs.40.0％ ; x2 =4.019,P =0.042),smoking (72.7％ vs.37.5％ ; x2 =4.971,P =0.030),and presence of CMB (x2 =5.297,P =0.018) of patients in the HT group were significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that hypertension (odds ratio [OR]1.51,95％ confidence interval [CI]1.102-2.954; P =0.028),diabetes (OR 1.48,95％ CI 1.09-2.825; P =0.039),and CMB (OR 1.867,95％ CI 1.103-3.158; P =0.020) were the independent risk factors for HT after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.Conclusions CMB was one of the independent risk factors for occurring HT after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.
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The imbalance in the fibrinolytic system participates in the pathophysic-logical processes of ischemic stroke. Most researchers consider that the fibrinolytic activity decreases in patients with ischemic stroke, while others believe that it increases. Mild hypothermia is a therapeutic approach with great potential and plays the neuroprotective effect through a variety of mechanisms. Animal experiments have demonstrated that the treatment with mild hypothermia may increase the plasma fibrinolytic activity and decrease the expression of local plasminogen activator in ischemic area. Howere, the related clinical research studies are few, and most of them are limited in the safty and collaborative research of mild hypothermia combined with other treatment therapies.