Initial Result of Stroke Care at the Stroke Center in a New Hospital Opened by the Merger of Three Facilities with Different Management Bases: Effect of Stroke Center on Mechanical Thrombectomy.

Objective: The most important function required for the stroke center is prompt treatment for acute stroke. We report the initial results of stroke care under the new medical care system of stroke center in a new hospital that merges three hospitals with different management bases to verify the effect of stroke center on mechanical thrombectomy. Methods: We investigated changes in the number of inpatients and surgical treatments compared with the past 3 years (Stages I, II, and III) with stage IV one year after the new hospital was opened, and examined the effect of establishing a stroke center on mechanical thrombectomy for acute main cerebral artery occlusion. Results: From stage I to stage IV, the number of hospitalized patients increased from 396, 485, 482 to 630, respectively, and the proportion of patients with cerebrovascular disease increased from 57.6%, 55.7%, 60.4% to 68.3%, respectively. Total surgical treatment increased from 137, 195, 224 to 297, respectively, especially endovascular therapy increased markedly from 22, 36, 68 to 118, respectively. The main treatment contents of endovascular treatment in stage IV were ruptured cerebral aneurysm embolization 22 cases, unruptured cerebral aneurysm embolization 13 cases, carotid artery stenting 23 cases, other intracranial or extracranial artery angioplasty/stenting 9 cases, and mechanical thrombectomy 34 cases. In particular, mechanical thrombectomy was significantly increased to 34 in stage IV, compared to 4 in stage I, 4 in stage II, and 17 in stage III (degree of contribution [DC] 25.0%, contribution ratio [CR] 34.0%). Conclusion: With the establishment of the stroke center, the number of cases of acute cerebral infarction within the adaptation time who received mechanical thrombectomy remarkably increased. It is considered that the effect and validity of function aggregation by establishing stroke center are shown.

Effects of transient focal cerebral ischemia in mice deficient in puma.

Bcl-2 homology domain 3 (BH3)-only pro-apoptotic proteins may play an important role in upstream cell death signaling pathways underlying ischemic brain injury. Puma is a potent BH3-only protein that can be induced via p53, FoxO3a and endoplasmic reticulum stress pathways and is upregulated by global cerebral ischemia. To more completely define the contribution of Puma to ischemic brain injury we measured the expressional response of Puma to transient focal cerebral ischemia in mice and also compared infarct volumes in puma-deficient versus puma-expressing mice. Real-time quantitative PCR determined puma mRNA levels were significantly increased 8h after 90min middle cerebral artery (MCA) occlusion in the ipsilateral cortex, while expression remained unchanged contralaterally. Puma protein levels were also increased in the ischemic cortex over the same period. However, cortical and striatal infarct volumes were not significantly different between puma-deficient and puma-expressing mice at 24h, and no differences between genotypes were found for post-ischemic neurological deficit scores. These data demonstrate that focal cerebral ischemia is associated with puma induction but suggest that Puma does not contribute significantly to lesion development in the present model.

NMDA receptor-mediated excitotoxic neuronal apoptosis in vitro and in vivo occurs in an ER stress and PUMA independent manner.

Disruption of endoplasmic reticulum (ER) Ca2+ homeostasis and ER dysfunction have been suggested to contribute to excitotoxic and ischaemic neuronal injury. Previously, we have characterized the neural transcriptome following ER stress and identified the BH3-only protein, p53 up-regulated mediator of apoptosis (PUMA), as a central mediator of ER stress toxicity. In this study, we investigated the effects of excitotoxic injury on ER Ca2+ levels and induction of ER stress responses in models of glutamate- and NMDA-induced excitotoxic apoptosis. While exposure to the ER stressor tunicamycin induced an ER stress response in cerebellar granule neurons, transcriptional activation of targets of the ER stress response, including PUMA, were absent following glutamate-induced apoptosis. Confocal imaging revealed no long-term changes in the ER Ca2+ level in response to glutamate. Murine cortical neurons and organotypic hippocampal slice cultures from PUMA+/+ and PUMA-/- animals provided no evidence of ER stress and did not differ in their sensitivity to NMDA. Finally, NMDA-induced excitotoxic apoptosis in vivo was not associated with ER stress, nor did deficiency in PUMA alleviate the injury induced. Our data suggest that NMDA receptor-mediated excitotoxic apoptosis occurs in vitro and in vivo in an ER stress and PUMA independent manner.