Edaravone for Acute Ischemic Stroke: A Systematic Review and Meta-analysis.

PURPOSE: The management of acute stroke is challenging. The aim of this meta-analysis was to determine the efficacy and tolerability of edaravone, with or without thrombolytic therapy, in the treatment of patients with acute ischemic stroke. METHODS: The PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) and cohort studies. Mean differences (MD), risk ratios (RR), 95% confidence interval (CI), and heterogeneity were calculated. FINDINGS: Totals of nine RCTs and four cohort studies were included, for a total of 2102 patients. In patients with acute ischemic stroke, edaravone monotherapy was associated with significantly improved Barthel Index of functioning in activities for daily living (MD, 23.95; 95% CI, 18.48 to 29.41; P < 0.001) and neurologic deficit, (as measured using the National Institutes of Health Stroke Scale score) (MD = -3.49; 95% CI, -5.76 to 1.22; P = 0.003), on short-term follow-up. However, edaravone was not associated with an improved rate of death or disability (RR = 0.75; 95% CI, 0.45 to 1.23; P = 0.25) on long-term follow-up.When plus to thrombolytic therapy, edaravone was associated with significant improvements in recanalization rate (RR = 1.71; 95% CI, 1.05 to 2.77; P = 0.03) and neurologic deficit (MD = 3.97; 95% CI, 5.14 to 2.79; P < 0.001), without an increase in the prevalence of bleeding events (RR = 1.11; 95% CI, 0.76 to 1.62; P = 0.59). However, edaravone did not have a significant effect on death or disability (RR = 0.85; 95% CI, 0.69 to 1.04; P = 0.12). IMPLICATIONS: Based on the findings from the present meta-analysis, edaravone was an effective and well-tolerated neuroprotective agent in these patients with ischemic stroke. With the use of edaravone, activities of daily living and neurologic deficits, along with recanalization rates, were improved on short-term follow-up, but the long-term effects still need confirmation in larger-scale clinical trials.

[Effect of navel acupuncture on bladder emptying function in patients with urinary retention after stroke].

OBJECTIVE: To observe the effect of navel acupuncture on bladder emptying function in patients with urinary retention after stroke based on the conventional treatment. METHODS: A total of 106 patients with urinary retention after stroke were randomly divided into an observation group (53 cases, 3 cases dropped off) and a control group (53 cases, 3 cases dropped off). Patients in the control group were treated with drugs, catheterization and bladder function rehabilitation training. On the basis of the treatment in the control group, the observation group was treated with navel acupuncture, 30 min each time, once every other day, for 4 weeks. The bladder residual urine volume, spontaneous urination volume and catheterization times before and after treatment were compared between the two groups, and the clinical efficacy was evaluated. RESULTS: After treatment, in the two groups, the bladder residual urine volume and catheterization times were lower than those before treatment (P<0.01), and the spontaneous urination volume was higher than that before treatment (P<0.01); the bladder residual urine volume and catheterization times in the observation group were less than those in the control group (P<0.05, P<0.01), and the spontaneous urination volume was higher than that in the control group (P<0.01). The effective rate of the observation group was 90.0 % (45/50), which was higher than 72.0 % (36/50) in the control group (P<0.05). CONCLUSION: On the basis of conventional treatment, navel acupuncture can effectively improve the bladder emptying function of patients with urinary retention after stroke.

What drives progressive motor deficits in patients with acute pontine infarction?

Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be responsible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.

Microsurgical anatomy of lumbosacral nerve rootlets for highly selective rhizotomy in chronic spinal cord injury.

It is known that selective sacral roots rhizotomy is effective for relieving the neurogenic bladder associated with spinal cord injury. The goal of this study is to review the surgical anatomy of the lumbosacral nerve rootlets and to provide some morphological bases for highly selective sacral roots rhizotomy. Spinal cord dissections were performed on five cadavers under surgical microscope. At each spinal cord segment, we recorded the number, diameter and length of the rootlets, subbundles and bundles from the L1 to S2 spinal segments, and the length of the dorsal/ventral root entry zone. Peripheral nervous system myelin was examined by immunohistochemistry. We found: (1) the ventral or the dorsal root of the lumbosacral segment of the spinal cord was divided into one to three nerve bundles and each bundle was subdivided into one to three subbundles. Each subbundle further gave out two to three rootlets connected with the spinal cord; (2) there were no significant differences in the number of rootlets within the L1 to S2 segments, but the size of rootlets and the length of nerve roots varied (P < 0.05); and (3) the more myelinated fibers a rootlet contained, the larger transection area it had. The area of peripheral nervous system myelin positive cells and the total area of rootlets were correlated (P < 0.001). Thus, during highly selective sacral roots rhizotomy, the ventral and dorsal roots can be divided into several bundles of rootlets, and we could initially distinct the rootlets by their diameters.

[Effects of highly selective dorsal rootlets rhizotomy on bladder function and penis erection in SD rats].

OBJECTIVE: To study the highly selective dorsal rhizotomy influence on bladder and penis erection function of SD rats. METHODS: Forty mature male SD rats of clean grades, with weight range of 300-350 g were selected. Ten rats were chosen to do electrophysiology study on dorsal rootlets of L6 and S1 segment. Changes in intravesical pressure (IVP) and intracavernous pressure (ICP) were investigated to define main segments which conducted to bladder and corpus cavernosum. Thirty rats were divided into two groups (A and B) on average at random. In group A, we made highly selective dorsal rhizotomy on the fascicle of conduction bladder detrusor muscle. In group B, we made highly selective dorsal rhizotomy on the fascicle of conduction corpus cavernosum. Changes of IVP and ICP after rhizotomy were investigated and recorded. RESULTS: The changes of IVP during electrostimulation were of no significant variation between L6 and S1 (P=0.972). With the changes of ICP during electrostimulation, S1 segment was of more significant variation than L6 segment, ΔICP of S1 was (13.05±8.41) cmH2O (1 cmH2O=0.098 kPa), while ΔICP of L6 was (6.88±2.76) cmH2O (P<0.01). There was no reasonable variation in IVP and ICP on the left and right dorsal rootlets of S1 segment (P was 0.623 and 0.828 respectively). In group A, there was significant variation in IVP, ΔIVP of before rhizotomy was (14.37±4.89) cmH2O, while after rhizotomy was (3.25±1.29) cmH2O (P<0.001) while no obvious variation in ICP (P=0.153) after highly selective rhizotomy on S1 dorsal rootlets. In group B, there was significant variation in ICP, ΔICP of before rhizotomy was (11.97±4.41) cmH2O, while after rhizotomy was (2.68±1.01) cmH2O (P<0.001), but no obvious variation in IVP (P=0.162) after highly selective rhizotomy on S1 dorsal rootlets. CONCLUSION: SD rats' different rootlets of S1 dorsal rootlets can be distinguished by microanatomy and electrostimulation. The IVP and ICP had distinct changes after highly selective dorsal rhizotomy. It could provide an experimental support to treat spastic bladder after spinal cord injury and retain at maximum reflexible erection function in the clinic.