Research progress in pharmacological effectsand mechanism of Fel Ursi against cardiovascular and cerebrovascular diseases / 中国中药杂志

Fel Ursi is a dried product obtained from the gallbladder of Ursidae animals, such as Selenarctos thibetanus or Ursus arctos, through gallbladder surgery for bile drainage. It is one of the rare animal medicinal materials in China and is known for its therapeutic effects, including clearing heat, removing toxins, extinguishing wind, relieving spasms, clearing the liver, and improving vision. Research has also found that Fel Ursi has pharmacological effects against cardiovascular and cerebrovascular diseases, such as anti-inflammatory, anti-apoptotic, and antioxidant stress properties. Recently, numerous studies have confirmed the close relationship between cardiovascular and cerebrovascular diseases and the gut microbiota as well as gut metabolites. Fel Ursi contains bile acid components that may have bidirectional regulatory effects on the gut microbiota and gut metabolites. This aspect could represent a potential therapeutic pathway for Fel Ursi in the treatment of cardiovascular and cerebrovascular diseases. This article comprehensively summarized relevant literature in China and abroad, reviewed the research progress on the pharmacological effects of Fel Ursi against cardiovascular and cerebrovascular diseases, and explored the impact of Fel Ursi on gut microbiota and gut metabolites, thereby aiming to provide references for further in-depth research and clinical application of Fel Ursi.

Expert consensus on clinical application of GBE50 Dispersible Tablets for ischemic cardiovascular and cerebrovascular diseases / 中国中药杂志

Ginkgo biloba Extract( GBE50) Dispersible Tablets is a new standardized prescription,which is widely used in the treatment of ischemic cardiovascular and cerebrovascular diseases. However,there are still many problems in its clinical application.Rational and safe use of GBE50 Dispersible Tablets is pivotal to the medication safety and clinical prognosis of patients. This consensus has been jointly formulated by clinical experts of traditional Chinese medicine and western medicine in cardiovascular and cerebrovascular diseases and followed the Manual for the Clinical Experts Consensus of Chinese Patent Medicine published by the China Association of Chinese Medicine. The present study identified clinical problems based on clinical investigation,searched the research papers according to PICO clinical problems,carried out evidence evaluation,classification,and recommendation by GRADE system,and reached the expert consensus with nominal group technique. The consensus combines evidence with expert experience. Sufficient evidence of clinical problems corresponds to " recommendations",while insufficient evidence to " suggestions". Safety issues of GBE50 Dispersible Tablets,such as indications,usage and dosage,and medication for special populations,are defined to improve clinical efficacy,promote rational medication,and reduce drug risks. This consensus needs to be revised based on emerging clinical issues and evidencebased updates in practical applications in the future.

Research progress on Chinese medicinal material-derived active polypeptides against ischemic cardiovascular and cerebrovascular diseases / 中国中药杂志

Ischemic cardiovascular and cerebrovascular diseases threatening human health and survival have high morbidity and mortality. The common cause of them is reduced blood supply caused by vascular stenosis, atherosclerosis, and infarction. However,the pathological processes of ischemic cardiovascular and cerebrovascular diseases are complex, involving oxidative stress, calcium overload, inflammation, apoptosis, autophagy and other mechanisms. Protein drugs such as recombinant tissue plasminogen activator(rt-PA) and urokinase have been proved with excellent therapeutic effects and huge economic and social benefits in the clinical treatment and interventional therapy. Among them, peptide drugs have shown unique advantages and potential prospects owing to their strong biological activity, high target specificity, biochemical diversity, and low toxicity. Chinese medicinal materials, characterized by multi-component and multi-target therapy, have also shown excellent clinical efficacy against ischemic cardiovascular and cerebrovascular diseases. However, the research and development of related peptides in Chinese medicinal materials is at the initial stage. Therefore, this paper reviewed the targets and action mechanisms of a variety of Chinese medicinal material-derived polypeptides with activities against ischemic cardiovascular and cerebrovascular diseases, aiming to provide support for the in-depth research as well as the clinical development and application of these polypeptides.

Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of life in mixed dementia: a 24-week, randomized, placebo-controlled exploratory trial (the REMIX study) / Efeitos da galantamina e da galantamina combinada à nimodipina sobre a velocidade de processamento cognitivo e qualidade de vida na demência mista: ensaio clínico exploratório, randomizado e controlado com placebo (estudo REMIX)

The effects of galantamine (GAL) on quality of life (QoL) and cognitive speed, as well its effects combined with nimodipine (NIM) in Alzheimer disease (AD) with cerebrovascular disease (mixed dementia), have not been explored. Method : Double-blind, placebo-controlled, multicenter Brazilian trial, studying the effects of GAL/NIM vs. GAL/placebo (PLA) in mild to moderate mixed dementia. Patients were randomized to receive GAL/NIM or GAL/PLA for 24 weeks. Primary efficacy measures were changes on a computerized neuropsychological battery (CNTB) and QoL Scale in Alzheimer's Disease (QoL-AD) from baseline to week 24. Results : Twenty-one patients received at least one drug dose (9 GAL/NIM and 12 GAL/PLA). Groups were matched for age, sex, education, cognitive and QoL scores at baseline. No significant differences were observed between groups on primary or secondary measures. QoL and cognitive performance showed significant improvement (p<0.05) from baseline when all GAL-treated patients were analyzed. Adverse events were predominantly mild to moderate. Conclusion : GAL treatment improved QoL in mixed dementia, in addition to its previously known cognitive benefits. The combination GAL/NIM was not advantageous. However, the small sample size precludes any definitive conclusions. Trial registered at ClinicalTrials.gov: NCT00814658 .

Os efeitos da galantamina (GAL) sobre qualidade de vida (QdV) e velocidade de processamento cognitivo, bem como da combinação com nimodipina (NIM) no tratamento da doença de Alzheimer (DA) com doença cerebrovascular (demência mista) ainda não foram investigados. Método : Estudo multicêntrico brasileiro, duplo-cego, controlado com placebo, avaliando os efeitos de GAL/NIM x GAL/placebo (PLA) na demência mista leve a moderada. Pacientes receberam tratamento com GAL/NIM ou GAL/PLA por 24 semanas. Medidas de eficácia primária foram as variações no desempenho em bateria de testes neuropsicológicos computadorizados e na escala QdV-DA ao final do estudo. Resultados : Vinte um pacientes receberam pelo menos uma dose da droga (9 GAL/NIM e 12 GAL/PLA). Os grupos foram emparelhados por idade, sexo, escolaridade, escores cognitivos e de QdV na linha de base. Não foram observadas diferenças significativas entre os dois grupos nas medidas de eficácia primária e secundária. Na avaliação de todos os pacientes que receberam GAL, houve melhora significativa (p<0,05) em QdV-DA e desempenho cognitivo. Os eventos adversos foram predominantemente leves a moderados. Conclusão : O tratamento com GAL proporcionou melhora da QdV na demência mista, além dos benefícios cognitivos previamente conhecidos. A combinação GAL/NIM não foi vantajosa. O reduzido tamanho amostral impede conclusões definitivas. .

Vascular parkinsonism: a case series of 17 patients / Parkinsonismo vascular: uma serie de casos de 17 pacientes

Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response. .

Objetivo Relatar os achados clínicos e de neuroimagem em parkinsonismo vascular (PV). Métodos Foram avaliados 17 pacientes com PV do ponto de vista motor, cognitivo e de neuroimagem através de testes e escalas padronizados. Resultados Dos 17 pacientes, 10 (58,5%) eram homens; a média de idade média foi 75,8±10,1 anos. Todos os pacientes eram hipertensos; a média de idade do início do parkinsonismo foi 72,2±10,0 anos. Achados clínicos mais frequentes: incontinência urinária (88,2%); parkinsonismo de membros inferiores com bloqueio de marcha e quedas (82,3%); sinais piramidais (76,4%). A média dos escores UPDRS e Hoehn-Yahr foram, respectivamente, 72,5±21,6 e 3,3±0,9 pontos. Dezesseis pacientes (94,1%) apresentaram bloqueio de marcha e disfunção executiva. Doze pacientes (70,5%) preencheram critérios para demência vascular provável. A dose média de levodopa foi 530,9 mg/dia e os pacientes tiveram uma baixa resposta à droga, tendo havido redução de apenas 6,9 pontos em média no escore UPDRS após o teste “practically-defined off”. Conclusão O perfil de PV encontrado neste estudo foi caracterizado por: envolvimento predominante de membros inferiores, com bloqueio de marcha e quedas; sinais piramidais; disfunção executiva; demência vascular concomitante e resposta pobre à levodopa. .

Cytochrome P450 2C19 Polymorphism is Associated with Reduced Clopidogrel Response in Cerebrovascular Disease

PURPOSE: Clopidogrel is a prodrug that requires transformation into an active metabolite by cytochrome P450 (CYP) in the liver in order to irreversibly inhibit the P2Y12 adenosine diphosphate platelet receptor. CYP2C19 polymorphism has been reported to correlate with reduced antiplatelet activity of clopidogrel in coronary artery disease. We assessed the association between CYP2C19 polymorphism and clopidogrel resistance in patients with cerebrovascular disease. MATERIALS AND METHODS: We retrospectively gathered data from patients who experienced cerebrovascular disease, received clopidogrel, and were tested for clopidogrel resistance and CYP2C19 polymorphism. Clopidogrel resistance was tested by the VerifyNow P2Y12 system, and the CYP2C19 polymorphism was tested by the Seeplex CYP2C19 ACE Genotyping system. Clopidogrel resistance was expressed in P2Y12 reaction units (PRU) and percent inhibition. High PRU and low percent inhibition suggests clopidogrel resistance. CYP2C19 polymorphisms were expressed as extensive, intermediate, and poor metabolizers. Clopidogrel resistance was assessed according to the subgroup of CYP2C19 polymorphism. RESULTS: A total of 166 patients were evaluated. The PRU values of extensive CYP2C19 metabolizers (195.0+/-84.9) were significantly lower than those of intermediate and poor metabolizers (237.9+/-88.0, 302.2+/-58.9). The percent inhibition of extensive metabolizers (44.6+/-21.8) was significantly higher than that of intermediate and poor metabolizers (30.5+/-21.5, 14.0+/-13.4). CONCLUSION: Intermediate and poor metabolizing CYP2C19 polymorphism is associated with reduced clopidogrel antiplatelet activity in patients with cerebrovascular disease. The clinical implications of this finding require further investigation.

Pharmacological treatment, lifestyle modification and awareness in coronary artery and cerebrovascular disease patients

Cardiovascular diseases [CVD] and cerebrovascular diseases [CeVD] are a large and growing problem in low- and middle-income populations. Secondary prevention which can reduce the risk of recurrent CVD includes changes in lifestyle, pharmacological interventions and revascularization procedures. The aim of the first phase of this project was to perform situation analysis and identify gaps in secondary prevention of major cardiovascular diseases. This study estimated the physicians' awareness and the patients' knowledge and behavior towards CVD and CeVD complications. It also assessed the efficacy of methods for decreasing recurrent events. A sample of consecutive patients was selected from the outpatient units of the health care facilities selected for the study. Stratified random sampling of primary and secondary private and public health care facilities in cities and villages was performed to select 449 eligible cases. We selected 257 men and 192 women. The inclusion criteria were as follows: Age above 21 years, established diagnosis of cardiovascular and/or cerebrovascular disease defined as any of the following alone or in combination with others: previous myocardial infarction, stable/unstable angina, percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft [CABG], stroke, transient ischemic attack [TIA] or carotid arterectomy. The patients were included if their first event had occurred more than a month, but no earlier than three years ago. The prevalence of high systolic and diastolic blood pressure was 40.1% and 26.9% respectively in MI patients, and 70.1% and 51.2% respectively in CeVD patients. In most of the patients fasting blood sugar and total cholesterol were within the normal range. Among MI patients, 93.9%, 68.5% and 48.2% were already taking aspirin, beta-blockers and statins respectively. Among CeVD patients, 79.9%, 61.1% and 23.2% were taking aspirin, beta-blockers and statins, respectively. Blood pressure had been managed in 94.9% and 93.7% of MI and CeVD patients, respectively. Among MI patients, 85.8% and 83.2% had correct behavior towards blood sugar and cholesterol control and 68% had adequate knowledge of the risk of recurrent events. Secondary prevention of vascular disease should be regarded as a key component of public health strategies to reduce the rising burden of CVD and CeVD in Iran

Terapia trombolítica en enfermedad cerebrovascular de tipo isquémica / Thrombolytic therapy in ischenic cerebrovascular disease

La enfermedad cerebrovascular (ECV) constituye el transtorno neurológico más frecuente como causa de la enfermedad invalidante y es la tercera causa de muerte en la población en general. Según su etiopatogenia se distinguen dos grandes formas de presentacion: El objetivo principal en la ECV de tipo isquémica es revertir la isquemia lo mas pronto posible para evitar el daño neurológico permanente. Con el uso de trombolíticos se puede revertir o limitar la extensión del infarto. Si se revisan los principales ensayos clínicos en la relación al uso de trombolíticos en ECV isquémica, con especial mención al activador del plasmonógeno tisular recombinante (r-TPA), con el que se ha logrado disminuir la mortalidad y las secuelas en el corto plazo(10 por ciento menos mortalidad y secuelas a los 3 meses) y largo plazo (30 porciento menos invalidez al año)

Hypertension and cerebrovascular disease.

Cerebrovascular disease (CVD) is the third leading cause of death in United States and hypertension is a leading cause of both stroke and heart disease. It may cause headache, acute hypertensive encephalopathy, dementia and various types of strokes e.g., thrombotic, haemorrhagic, lacunar infarcts and transient ischaemic attacks. It remains the singlemost important treatable risk factor for stroke in all age groups and modern antihypertensive therapy has its documented prevention of stroke. Hypertension in acute phase of ischaemic stroke should not be treated. Hypertension in acute stroke should be treated. In advanced centres with specialised stroke units, the favoured drugs are short acting vasodilators e.g., sodium nitroprusside and labetalol. Nifedipine is the most popular drug followed by captopril, both sublingually and orally.

Diagnóstico y evaluación terapéutica del debris en la aorta ascendente mediante ecocardiografía transesofágica / Transesophageal echocardiography in the detection and therapy of thrombus in ascending aorta

Se presenta un hombre de 70 años, con antecedentes de hipertensión arterial, que padece un accidente cerebrovascular isquémico al quinto día de la cirugía de un adenocarcinoma de colon. El ecocardiograma trastorácico fue normal, pero el transesofágico mostró un gran trombo móvil adherido a una placa ateromatosa (debris) en la aorta torácica ascendente. Se realizó tratamiento anticoagulante y, al octavo mes del mismo, el ecocardiograma transesofágico comprobó la disolución del trombo sin detectarse complicaciones. El caso destaca la importancia del ecocardiograma transesofágico para detectar la fuente embolígena aórtica, la eficacia de la terapéutica anticoagulante y la posibilidad de un síndrome paraneoplásico

Diagnóstico e conduta na fase aguda do acidente vascular cerebral / Diagnostic and management for acute phase of stroke

O acidente vascular cerebral (AVC) é uma das doenças mais comuns nos serviços de emergência. Na maioria das vezes, os primeiros socorros näo säo do neurologista, sendo importante que os médicos generalistas tenham conhecimento sobre os procedimentos adequados. Descrevem-se as principais condutas realizadas no Serviço de Emergência da Santa Casa de Säo Paulo. Até hoje, há dúvidas e controvérsias, porém, há outros pontos que já estäo consagrados. Para uma melhor compreensäo, alguns tópicos seräo apresentados resumidamente, como definiçäo, classificaçäo, fisiopatologia e diagnóstico.

Accidentes cerebrovasculares: recomendaciiones; manejo de fase aguda / Cerebrovascular accidents: recommendations; acute phase management

Deseamos aportar al médico no especializado en neurología, criterios y pautas objetivamente válidos, para el manejo de los accidentes cerebrovasculares en Fase aguda, basados en las recomendaciones obtenidas de las más amplias, confiables y recientes publicaciones y entidades. Nuestra finalidad es mejorar el pronóstico evolutivo de dichos pacientes como consecuencia de un manejo más adecuado y universal

Fibrinolisis intrarterial directa en el manejo terapéutico del accidente cerebrovascular agudo / Fibrinolysis in acute ischaemic stroke

El tratamiento de los pacientes con un accidente cerebrovascular agudo incluye, en casos seleccionados, el cateterismo y la infusión de agentes trombolíticos directamente en el coágulo de una arteria cerebral intracraneana. Se procede a la infusión de fibrinolíticos dentro del trombo hasta lograr la lisis y restablecer la perfusión. Esto se ha hecho en 27 pacientes incluyendo 45 territorios vasculares. Se logró mejoría clínica en 18 (66,7 por ciento) de los casos. Las complicaciones incluyeron 3 hemorragias intracraneanas sintomáticas (11,1 por ciento), un caso (3,7 por ciento) de perforación vascular, 8 (26,9 por ciento) pacientes sin mejoría y 9 (33,3 por ciento) muertes en el seguimiento alejado. La infusión local directa de trombolíticos puede mejorar la morbilidad global y la mortalidad relacionadas con enfermedad aguda tromboembólica en el sistema nervioso central

Fibrinolisis en el accidente cerebrovascular isquémico agudo / Fibrinolysis in acute ischaemic stroke

La terapéutica trombolítica podría significar un tratamiento eficaz del accidente cerebrovascular isquémico agudo. Sin embargo está todavía en etapa experimental. Se espera el resultado de estudios clínicos importantes para poder evaluar los riesgos potenciales inmediatos a su administración, así como también los beneficios a largo plazo

Fibrinolisis intraarterial en el tratamiento del accidente cerebrovascular isquémico agudo / Intra-arterial fibrinolysis in the treatment of acute ischemic stroke

El uso del tratamiento fibrinolítico intraarterial en el accidente cerebrovascular isquémico agudo representa un adelanto importante para el manejo más efectivo de una situación de emergencia que requiere la atención cercana de neurólogos y neurocirujanos. Las técnicas y dispositivos para la caracterización selectiva continúan desarrollándose y la experiencia en el uso de estos procedimientos avanza rápidamente. El futuro debe demostrar aún las posibilidades plenas del uso de esta metodología en el cuidado de los pacientes con accidente cerebrovascular isquémico

Gravidez, puerpério e doença vascular cerebral / Pregnancy, puerperium and cerebrovascular disease

Foram estudadas seis pacientes com doenças cerebrovasculares no período gravídico-puerperal. Uma apresentou hemorragia cerebral, três apresentaram infarto cerebral e duas trombose de seio venoso cerebral. A associaçao de fatores clínicos ao estado peculiar produzido pela gravidez parece ter resultado nas doenças apresentadas, com especial ênfase à doença de Chagas presente em todos os infartos cerebrais.