The effect of butylphthalide injection on the cognitive function and the TLRs/NF-κB pathway in hypertensive intracerebral hemorrhage.

OBJECTIVE: This study explored and analyzed the effects of butylphthalide injection on the cognitive function and on the TLRs/NF-κB pathway in hypertensive intracerebral hemorrhage patients. METHODS: A total of 115 patients admitted to our hospital with hypertensive intracerebral hemorrhages were recruited as the study cohort and randomly placed in the observation group (n=60) or the control group (n=55). In addition to the routine treatment administered in both groups, the control group was additionally administered oral nimodipine tablets, and the observation group was administered intravenous butylphthalide injections. Both groups were treated continuously for 14 days. Subsequently, the changes in the clinical efficacy, the NIHSS scores, the extremity motor function, the Fugl-Meyer scores, the blood-brain barrier (BBB) and the peripheral blood mononuclear cells (PBMCs), the TLR2, TLR9, and the NF-κB mRNA levels in the two groups before and after the treatment were compared, and any adverse reactions were observed. RESULTS: The total effective rate in the observation group was significantly superior to the total effective rate in the control group (P<0.05). The post-treatment NIHSS scores in the two groups were dramatically lower (P<0.05), and the post-treatment scores in the observation group were significantly lower than they were in the control group (P<0.05). The post-treatment cerebral spinal fluid (CSF) albumin and BBB indexes in the two groups were decreased significantly compared to their pre-treatment levels (P<0.05), and the post-treatment indexes in the observation group were significantly lower than the post-treatment indexes in the control group (P<0.05). The post-treatment relative TLR2, TLR9, and NF-κB mRNA expressions in the two groups were apparently lower than their in pre-treatment levels (P<0.05), and the relative expressions in the observation group after the treatment were clearly lower than they were in the control group (P<0.05). CONCLUSION: Butylphthalide injection has a high clinical efficacy in treating hypertensive intracerebral hemorrhages. The drug can effectively improve patients' cognitive functions, extremity motor functions, and BBB indexes, and its mechanism may connect with the expressive suppression of the TLRs/NF-κB signaling pathway. The treatment is safe and effective, so it is worthy of clinical promotion.

Effects of butylphthalide injection on treatment of transient ischemic attack as shown by diffusion-weighted magnetic resonance imaging abnormality.

Background and Objective: Transient ischemic attack (TIA) is a serious condition that is often called a warning stroke. The risk of cerebral infarction in patients with TIA and positive DWI findings is greater than that in patients with TIA and normal DWI findings. Butylphthalide injection is a new type of brain protective drug. The study aimed to determine the efficacy and safety of butylphthalide injection for treating TIA as shown by DWI abnormality progressing to infarction.Methods: We studied 98 patients with positive DWI findings among 260 patients with TIA, and randomly divided into the experimental (treatment with butylphthalide injection) and control (treatment with aspirin) groups. The number of cerebral infarctions in the two groups was recorded on 7th, 14th, 30th and 90th day, and adverse reactions were observed. The number of cerebral infarctions was compared among the different ABCD2 scores of patients with TIA and positive DWI findings.Results: The incidence of cerebral infarction in the experimental group was significantly lower than that in the control group (p < .05). The incidence of cerebral infarction with an ABCD2 score less than 3 points was significantly lower than that with an ABCD2 score of more than 3 points (p < .05), with less adverse reactions.Conclusion: Butylphthalide injection is helpful and safe for preventing stroke following TIA, and treating TIA with positive DWI and progression to infarction.

Effect of butylphthalide injection to mitochondrial function of porcine cerebral neuron after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To investigate the mechanism of cerebral protection by treatment of butylphthalide (NBP) and its effect to mitochondria in a porcine model of cardiac arrest (CA) after cardiopulmonary resuscitation (CPR). Methods Healthy Wuzhishan pigs weighting (30±2) kg were divide into three groups randomly(random number): The sham group (n=6), the control group (n=12) and the NBP group (n=12). Operation was performed in the sham group. Cardiac arrest of ventricular fibrillation was induced by programed electrical stimulation in the control and NBP group. After CPR, asynchronous defibrillation of 150J was performed to achieve the restoration of spontaneous circulation. NBP was injected at the rate of 2.5 mg?kg-1 in the NBP group. Hemodynamics were recorded at baseline, 1 hr, 2 hr, 3 hr and 4 hr after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were calculated under light and electrical microscope respectively. Mitochondria were separated by differential centrifugation. Mitochondrial respiratory function was measured with oxygen consumption of R3 and R4, respiratory control rate (RCR), ADP/oxygen. Mitochondrial permeability transition pore (MPTP) open was tested by colorimetric. Results After CPR, the mean artery pressure, coronary perfusion pressure and cardiac output decreased significantly, whereas no significant differences were found between the control and NBPgroup (P>0.05). Significant cerebral injury was found after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were improved significantly by the NBP treatment (P<0.05). Compared with the sham group, oxygen consumption of R3 and R4, R3/R4 and ADP/O decreased significantly in the cerebral frontal cortex mitochondria of the control group (P<0.01), whereas they were increased in the NBP group (P<0.01). MPTP increased in the control group, which could be improved by the NBP treatment. Conclusions NBP can improve the neurologic outcome after CPR and decrease the apoptosis of neurons by improving the respiratory function of mitochondria and inhibiting the MPTPopening.

Effect of pretreatment with butylphthalide injection on prognosis of intravenous thrombolysis in ultra-early acute cerebral infarction / 中国中西医结合急救杂志

Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.

Effect of pretreatment with butylphthalide injection on prognosis of intravenous thrombolysis in ultra-early acute cerebral infarction / 中国中西医结合急救杂志

Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.

Therapeutic effect of Butylphthalide Injection in elderly patients with acute cerebral infarction and its influence in cerebral hemodynamics and cerebral vascular reserve / 吉林大学学报(医学版)

Objective:To probe the therapeutic effects of Butylphthalide Injection in the elderly patients with acute cerebral infarction (ACI) and its influence in cerebral hemodynamics and cerebral vascular reserve (CVR),and to clarify the pharmacological action mechanism of butylphthalide in treatment of ACI.Methods:A total of 100 cases of elderly patients with ACI were selected as the subjects and divided into observation group and control group according to the serial number on admission.Fifty cases were included in each group.The patients in control group were treated with the conventional treatment, while the patients in observation group were treated with Butylphthalide Injection on the basis of the conventional treatment.The National Institute of Health Stroke Scale (NIHSS) score, the brain hemodynamics indexes of the peak velocity (Vp), the mean velocity (Vm) and the differences of the velocity (DVp, DVm) as well as pulsatility index (PI), CVR of bilateral middle cerebral artery (MCA)of the patients in two groups were observed and compared.The therapeutic effects of the patients in two groups were evaluated and compared.Results:The NIHSS score of the patients in observation group after treatment was significantly lower than that in control group (t=15.420, P<0.05).The therapeutic effects and the clinical efficiency of the patients in observation group were significantly better than those in control group (U=2.225, χ2=5.005, P<0.05).The Vp and Vm of the patients in observation group after treatment were significantly higher than those in control group(t=10.819,t=7.259, P<0.05)and the DVp and DVm were significantly lower than those in control group (t=16.438,t=19.055, P<0.05).The CVR of the patients in observation group after treatment was significantly higher than that in control group(t=6.884, P<0.05)and the PI was significantly lower than that in control group (t=4.979, P<0.05).Conclusion:Butylphthalide Injection can effectively correct the abnormality of brain hemodynamics in the ACI patients, enhance the ability of body in maintaining the stability of cerebral vascular perfusion, improve the neurological symptoms in the patients with ACI, and improve the therapeutic effects.

Effect of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage / 中国生化药物杂志

To investigate influence of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage.Methods Ninety patients with cerebral vasospasm were admitted to The First Affiliated Hospital of Fujian Medical University, then the patients were divided into two groups: The control group (45 patients) was treated with nimodipine and triple-H therapy after surgery;in addition to nimodipine and triple-H therapy, butylphthalide injection was administered to the experimental group(45 patients).Transcranial doppler(TCD)was used for the evaluating cerebral artery blood flow velocity, and the serum neuron specific enolase(NSE), C-reactive protein(CRP) and fatty acid binding protein(FABP) levels in patients with cerebral vasospasm were measured. Results The experimental group improved significantly more than the control group, a significant decrease in cerebral blood flow velocity of the middle cerebral artery in the experimental group as measured by TCD (P<0.05).The serum levels of NSE, CRP and FABP in the patients in the experimental group decreased more significantly (P<0.05).And the incidence of cerebral infarction in experimental group was lower than that in control group (P<0.05).Conclusion The serum levels of NSE, CRP and FABP in the patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage could be significantly reduced by administration of butylphthalide injection, which also could improve cerebral blood supply.Therefore, administration of butylphthalide injection is an effective treatment for cerebral vasospasm.