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1.
J Biomed Nanotechnol ; 15(12): 2401-2412, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31748020

RESUMO

Ischemic strokes are caused by decreased blood flow into the brain, due to narrowed cerebral arteries. In the ischemic brain, high-mobility group box 1 (HMGB1) is released into extracellular spaces and induces inflammatory reactions. In this study, HMGB1 small interfering RNA (siRNA) was delivered into ischemic brains by intravenous administration using rabies virus glycoprotein (RVG) peptide-decorated exosomes. A fusion protein of RVG and Lamp2b was expressed in 293T cells. Since Lamp2b is an exosome membrane-integral protein, RVG-Lamp2b is integrated into the exosomes, producing RVG-decorated exosomes (RVG-Exo). HMGB1-siRNA was loaded into RVG-Exo and unmodified exosomes (Unmod-Exo) by electroporation. The exosomes were homogenous with a size of less than 50 nm and a negative surface charge. In vitro delivery assays showed that RVG-Exo showed higher efficiency to Neuro2A cells than Unmod-Exo. Also, HMGB1 levels were reduced more effectively by RVG-Exo/HMGB1-siRNA. In vivo delivery efficiency and therapeutic effects of RVG-Exo/HMGB1-siRNA were evaluated in a middle cerebral artery occlusion (MCAO) model. RVG-Exo/HMGB1-siRNA, Unmod-Exo/HMGB1-siRNA, and PEI25k/HMGB1-siRNA were administrated into the MCAO model intravenously through the tail vein. The results showed that HMGB1, tumor necrosis factor-α (TNF-α), and apoptosis levels in the brain were reduced in the RVG-Exo/HMGB1-siRNA group more efficiently than the other groups. In addition, the infarct size was decreased in the RVG-Exo/HMGB1 group more effectively than the other groups. These results suggest that RVG-Exo with HMGB1-siRNA may have potential as a therapeutic system for the treatment of ischemic strokes.


Assuntos
Isquemia Encefálica , Exossomos , Proteína HMGB1/genética , Acidente Vascular Cerebral , Encéfalo , Isquemia Encefálica/genética , Isquemia Encefálica/terapia , Humanos , RNA Interferente Pequeno , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/terapia
2.
Rev Lat Am Enfermagem ; 27: e3198, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618391

RESUMO

OBJECTIVE: to evaluate the clinical and nutritional evolution of elderly patients receiving home enteral nutritional therapy. METHOD: retrospective cohort observational study. Data collection was performed through the analysis of clinical and nutritional records. The demographic, nutritional and clinical variables were analyzed. The sample consisted of elderly patients using home enteral nutritional therapy via the probe or the stomach. For the statistical analysis, the Statistical Package for the Social Sciences program was used, adopting the level of significance of 5%. RESULTS: the sample was 218 participants, with a mean age of 76 ± 10.12 years, of which 54.1% were female. The main morbidity was the stroke sequelae. Malnutrition was the nutritional diagnosis and the overall subjective assessment, the main instrument of nutritional evaluation. The route of administration of the most prevalent diet was the nasoenteric/nasogastric tube, however, after one year of follow-up, gastrostomy became the main route. It was observed the predominance of general condition maintenance and the most prevalent clinical outcome was death. CONCLUSION: the majority of patients in home enteral nutrition therapy presented maintenance and / or improvement of clinical and nutritional status. Therefore, this therapy may contribute to a better clinical and nutritional evolution.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Estado Nutricional , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrostomia/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Desnutrição/terapia , Estudos Retrospectivos , Resultado do Tratamento
3.
Life Sci ; 236: 116889, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610199

RESUMO

Stroke is the major cause of adult disability and the second or third leading cause of death in developed countries. The treatment options for stroke (thrombolysis or thrombectomy) are restricted to a small subset of patients with acute ischemic stroke because of the limited time for an efficacious response and the strict criteria applied to minimize the risk of cerebral hemorrhage. Attempts to develop new treatments, such as neuroprotectants, for acute ischemic stroke have been costly and time-consuming and to date have yielded disappointing results. The repurposing approved drugs known to be relatively safe, such as statins and minocycline, may provide a less costly and more rapid alternative to new drug discovery in this clinical condition. Because adequate perfusion is thought to be vital for a neuroprotectant to be effective, endovascular thrombectomy (EVT) with advanced imaging modalities offers the possibility of documenting reperfusion in occluded large cerebral vessels. An examination of established medications that possess neuroprotective characters using in a large-vessel occlusive disorder with EVT may speed the identification of new and more broadly efficacious medications for the treatment of ischemic stroke. These approaches are highlighted in this review along with a critical assessment of drug repurposing combined with reperfusion therapy as a supplementary means for halting or mitigating stroke-induced brain damage.


Assuntos
Isquemia Encefálica/terapia , Hemorragia Cerebral/terapia , Reposicionamento de Medicamentos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Terapia Combinada , Humanos , Reperfusão , Resultado do Tratamento
4.
Fisioterapia (Madr., Ed. impr.) ; 41(5): 275-284, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183937

RESUMO

Introducción: La actividad física (AF) es fundamental para la salud. Las secuelas producidas tras un ictus y otras barreras pueden interferir en la realización de ejercicio físico (EF). Consecuentemente, podría variar la percepción de sus beneficios. El objetivo de este estudio fue determinar el nivel de AF en función de la capacidad de deambulación, y el grado de incapacidad que presentan los individuos con dichos caracteres, así como las barreras y los beneficios en la práctica de EF percibidos por estos. Material y métodos: Se realizó un estudio transversal de encuesta en una muestra de personas con secuelas crónicas tras ictus. Se elaboró una encuesta que contó con un diario de actividad, la escala SIS-16, el cuestionario IPAQ-E, y las escalas FAC y EBBS. Resultados: Participaron 74 personas (edad media de 59,19±15,4 años). El 51,4% mostraron una AF baja; particularmente las mujeres (56,7%), los mayores de 65 años (76,9%), los que vivían institucionalizados (100%) y los residentes en el ámbito rural (69,2%). Aquellos individuos con un bajo grado de incapacidad destacaron dentro de los niveles de AF moderada (Mdn=76) y alta (Mdn=87,5), mientras que las personas con un mayor grado de incapacidad despuntaron dentro del nivel de AF bajo (Mdn=51). Hubo diferencias significativas entre el grupo de marcha totalmente dependiente (Mdn=0) y el grupo de marcha independiente (Mdn=1110,500)U=108,500; p<0,001), siendo el primero de los grupos el que obtuvo un nivel bajo de AF. Las barreras más comunes fueron las relacionadas con la fatiga y el cansancio que provoca el EF. Los participantes reconocieron los beneficios del EF para el incremento de la fuerza y el tono muscular; la mejora de la flexibilidad; el funcionamiento del corazón y la condición física. No se encontraron diferencias significativas en cuanto a la percepción de barreras y beneficios. Conclusión: La mayoría de los participantes presenta una AF baja, predominando esta en aquellos con un mayor grado de incapacidad y con una marcha dependiente. Se reconocen los beneficios del EF para la mejora de su sistema cardiovascular, su fuerza muscular y su condición física. Justifican la falta de EF por la fatiga y el cansancio que provoca


Introduction: Physical activity (PA) is fundamental for health. The sequelae produced after a stroke and other barriers can interfere in the performance of physical exercise (PE). Consequently, the perception of its benefits may vary. The aim of this study was to determine the level of PA according to the ability to walk, and the degree of disability that individuals with these characteristics present, as well as the barriers and benefits to PE practice perceived by them. Material and methods: A cross-sectional survey study was conducted in a sample of people with chronic squeal after stroke. The survey included a daily activity diary, the SIS-16 scale, the IPAQ-E questionnaire, and the FAC and EBBS scales. Results: 74 people participated (mean age 59.19 ±15.4). Of these, 51.4% showed a low PA; particularly the women (56.7%), those over 65 years (76.9%), those who were institutionalized (100%), and residents in rural areas (69.2%). The individuals with a low degree of disability stood out within the levels of moderate PA (Mdn=76) and high PA (Mdn=87.5), while those with a higher degree of disability stood out within the level of low PA (Mdn=51). There were significant differences between the totally dependent walking group (Mdn=0) and the independent walking group (Mdn=1110.500) (U=108.500, p<.001), the first of the groups obtained a low level of PA. The most common barriers were those related to fatigue caused by PE. Participants recognized the benefits of PA for increasing strength and muscle tone; the improvement of flexibility; the functioning of the heart and physical condition. No significant differences were found regarding the perception of barriers and benefits. Conclusion: The majority of participants present a low PA, predominantly those with a higher degree of disability and with dependent walking. The benefits of PE are recognized for improving cardiovascular health, muscle strength and physical condition. They justify their lack of PE by the fatigue it causes


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Atividade Motora/fisiologia , Acidente Vascular Cerebral/epidemiologia , Comportamento Sedentário , Modalidades de Fisioterapia , Acidente Vascular Cerebral/terapia , Estudos Transversais , Inquéritos e Questionários
5.
Zhen Ci Yan Jiu ; 44(10): 762-5, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31657168

RESUMO

OBJECTIVE: To investigate short-term and long-term efficacy of PGLA thread-embedding therapy in the treatment of stage Ⅰ post-stroke shoulder-hand syndrome. METHODS: A total of 60 patients with stage Ⅰ post-stroke shoulder-hand syndrome were randomly divided into control group and treatment group, with 30 patients in each group. The patients in the control group were given acupuncture combined with rehabilitation training, and those in the treatment group were given PGLA thread-embedding therapy combined with rehabilitation training. Conventional acupuncture was performed once a day, and thread-embedding therapy was performed once every 5 days. Both groups were treated for 30 days. Clinical outcome, Visual Analogue Scale (VAS) score, hand edema score, and Fugl-Meyer Assessment (FMA) score were compared within and between groups immediately and at 1 month after treatment. RESULTS: The treatment group had a significantly higher overall response rate than the control group immediately and at 1 month after treatment (93.33%/86.67% vs 73.33%/56.67%, P<0.05). Both groups had significant reductions in VAS score and hand edema score and a significant increase in FMA score immediately and at 1 month after treatment (P<0.05), and the treatment group had significantly greater improvements than the control group (P<0.05). CONCLUSION: PGLA thread-embedding therapy has a better clinical effect than conventional acupuncture in the treatment of stage Ⅰ post-stroke shoulder-hand syndrome.


Assuntos
Terapia por Acupuntura , Distrofia Simpática Reflexa , Acidente Vascular Cerebral , Peptídeos Catiônicos Antimicrobianos , Humanos , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
6.
Zhen Ci Yan Jiu ; 44(10): 777-80, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31657171

RESUMO

Astrocytes are the most abundant cells in the central nervous system, which has been demonstrated to be one of the targets for the treatment of ischemic stroke. Many studies have confirmed that acupuncture can effectively regulate astrocyte activity in ischemic stroke through these approaches: repairing astrocyte morphology structure, regu-lating energy metabolism, inhibiting excitotoxicity, inhibiting inflammation response and promoting nerve regeneration. In this paper, the authors summarized the relationship between astrocyte and ischemic stroke, and discussed the mechanisms of acupuncture therapy underlying improvement of ischemic stroke. Additionally, the authors also put forward some suggestions about future researches on acupuncture in ischemic stroke.


Assuntos
Terapia por Acupuntura , Isquemia Encefálica , Acidente Vascular Cerebral , Astrócitos , Isquemia Encefálica/terapia , Humanos , Regeneração Nervosa , Acidente Vascular Cerebral/terapia
7.
Medicine (Baltimore) ; 98(38): e17128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567951

RESUMO

BACKGROUND: Post-stroke brain damage, which affects the central control of respiration, leads to various respiratory disorders. They can be caused by the weakening of the respiratory muscles and chest movements, which can indirectly contribute to an impairment of the ventilation function. The aim of the study is an objective assessment of the effect of a single-session intervention of respiratory stimulation through Proprioceptive Neuromuscular Facilitation (PNF) on chosen respiratory parameters and the following comparison of these changes with a group in which positioning was used (intra- and intergroup comparison). METHODS: This was a randomized interventional study evaluating the respiratory parameters depending on the applied respiratory stimulation in patients after ischemic stroke. The patients qualified to participate in the study were randomly assigned to 1 of 2 groups: PNF-treated group - in which respiratory stimulation through PNF was used, PNF untreated group - in which positioning was used. The research procedure consisted of several stages. First, an interview was conducted with each participant and basic data was collected. Then, spirometry was conducted, after which each patient underwent a single-session intervention according to their assigned group. Finally, the patients were given another spirometry examination. The main outcomes will be to compare the results of a spirometry test (FVC, FEV1, FEV1/ FVC%, PEF) before and after single-session intervention and between groups. RESULTS: Based on the inclusion and exclusion criteria for the study, 60 patients took part in the measurement. The values of FEV1/FVC% were higher in PNF-treated group than in PNF-untreated group, if the post-intervention measures (P = .04) are considered. The difference between the pre- and post-intervention results of the FEV1/FVC% values in PNF-untreated group was substantially lower than in PNF-treated group (P = .001). CONCLUSION: A single application of respiratory stimulation through PNF positively affect air flow in the respiratory tract. Application of PNF stimulation contributed to an increase in the FEV1/FVC% parameter. However, no positive changes were noted in the other parameters, which would provide proof of the beneficial effect of facilitation on the respiratory system function.


Assuntos
Isquemia Encefálica/complicações , Exercícios de Alongamento Muscular/métodos , Respiração , Músculos Respiratórios , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Idoso , Isquemia Encefálica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Respiratórios/fisiopatologia , Acidente Vascular Cerebral/terapia , Sobreviventes
9.
Zhen Ci Yan Jiu ; 44(9): 686-92, 2019.
Artigo em Chinês | MEDLINE | ID: mdl-31532140

RESUMO

Ischemic stroke is a major cause of permanent disability and death in adults, and electroacupuncture (EA) intervention has a positive role in improving neurological function in patients with ischemic stroke through a series of complex processes. In the present paper, we make a review about the development of researches on the involvement of micro-ribonucleic acid (miRNA) in ischemic stroke from excitatory amino acid toxicity, oxidative stress, inflammatory response, apoptosis and necrosis, and particularly sum up outcomes of researches about the roles of miRNAs in EA-induced improvement of neurological function in experimental cerebral ischemia animals. EA treatment can 1) balance levels of miRNAs (such as mir-126 and mir-328, etc.) to promote angiogenesis of ischemic cerebral cortex tissue by regulating expression of vascular endothelial growth factor family genes and proteins; 2) promote nerve regeneration by up-regulating serum miR-124 and hippocampal miR-132 expression to possibly facilitate cerebral repair and reduce cognitive dysfunction respectively via related proteins; 3) reduce cerebral edema via modulating expression of some miRNAs to control expression of aquaporin, matrix metalloproteinases, etc. and 4) suppress inflammatory response via up-regulating expression of miRNAs to inhibit expression of NF-κB, TNF-α, etc. in the local cerebral tissue. As a result, the neurological function is bettered after EA intervention.


Assuntos
Isquemia Encefálica , Eletroacupuntura , Acidente Vascular Cerebral , Isquemia Encefálica/terapia , Humanos , Acidente Vascular Cerebral/terapia , Fator A de Crescimento do Endotélio Vascular
10.
Nervenarzt ; 90(10): 1013-1020, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31471619

RESUMO

As a whole, rare stroke causes represent a frequent stroke etiology. Since rare stroke causes affect primarily young patients, early diagnosis and treatment are of high socioeconomic relevance. In our everyday clinical practice, cervical artery dissection, which is the most common stroke etiology among patients < 45 years, and vasculitis are particularly important. In the case of vasculitis, devastating disease courses and potentially harmful treatment options complicate clinical decision-making. Non-vasculitic vasculopathies, infections, hematological disorders, coagulation disorders, metabolic disorders and malignancies are further rare causes of stroke with variable clinical manifestations, thus impeding an early diagnosis. If eligible, patients with rare stroke causes should be considered for thrombectomy. Except for infective endocarditis, most rare stroke causes are not per se a contraindication to thrombolysis, so that eligible patients should also be considered for thrombolysis. Evidence based recommendations for the secondary prevention of most rare stroke causes are still missing. In many cases, treatment regimens are adapted to the patients' individual risk of stroke recurrence and bleeding complications.


Assuntos
Acidente Vascular Cerebral , Fatores Etários , Contraindicações , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Trombectomia
11.
Medicine (Baltimore) ; 98(37): e17107, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517843

RESUMO

BACKGROUND: Percutaneous mechanical circulatory support devices (pMCSDs) are increasingly used on the assumption (but without solid proof) that their use will improve prognosis. A meta-analysis was undertaken according to the PRISMA guidelines to evaluate the benefits of pMCSDs in patients undergoing high-risk percutaneous coronary intervention (hr-PCI). METHODS: We searched PubMed, EMbase, Cochrane Library, Clinical Trial.gov, and other databases to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for 30-day and 6-month all-cause mortality rates, reinfarction, and other adverse events using a random effect model. RESULTS: Sixteen randomized controlled trials (RCTs) were included in this study. In the pooled analysis, intra-aortic balloon pump (IABP) was not associated with a decrease in 30-day and 6-month all-cause mortality (RR 1.01 95% CI 0.61-1.66; RR 0.88 95% CI 0.66-1.17), reinfarction (RR 0.89 95% CI 0.69-1.14), stroke/transient ischemic attack (TIA) (RR 1.75 95% CI 0.47-6.42), heart failure (HF) (RR 0.54 95% CI 0.11-2.66), repeat revascularization (RR 0.73 95% CI 0.25-2.10), embolization (RR 3.00 95% CI 0.13-71.61), or arrhythmia (RR 2.81 95% CI 0.30-26.11). Compared with IABP, left ventricular assist devices (LVADs) were not associated with a decrease in 30-day and 6-month all-cause mortality (RR 0.96 95% CI 0.71-1.29; RR 1.23 95% CI 0.88-1.72), reinfarction (RR 0.98 95% CI 0.68-1.42), stroke/TIA (RR 0.45 95% CI 0.1-1.95), acute kidney injury (AKI) (RR 0.83 95% CI 0.38-1.80), or arrhythmia (RR 1.52 95% CI 0.71-3.27), but LVADs were associated with a decrease in repeat revascularization (RR 0.26 95% CI 0.08-0.83). However, LVADs significantly increased the risk of bleeding compared with IABP (RR 2.85 95% CI 1.72-4.73). CONCLUSIONS: Neither LVADs nor IABP improves short or long-term survival in hr-PCI patients. LVADs are more likely to reduce repeat revascularization after PCI, but to increase the risk of bleeding events than IABP.


Assuntos
Coração Auxiliar/normas , Balão Intra-Aórtico/normas , Intervenção Coronária Percutânea/métodos , Arritmias Cardíacas/terapia , Embolização Terapêutica/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar/estatística & dados numéricos , Humanos , Balão Intra-Aórtico/métodos , Balão Intra-Aórtico/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
12.
Braz J Med Biol Res ; 52(10): e8396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531525

RESUMO

This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.


Assuntos
Stents , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Tirofibana/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Revascularização Cerebral/métodos , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Int Heart J ; 60(5): 1192-1195, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31447464

RESUMO

Here we report two young patients with atrial fibrillation/atrial flutter complicated with cardiogenic cerebral embolism. Electrophysiological study revealed a large area of low-voltage zone or area of electric silence in both sides of the atrium during restoration of sinus rhythm, and the echocardiogram showed loss of mechanical function of the atrium. The electrical-mechanical dysfunction of the atrium was considered to be the cause of embolic event in this type of patient who was "very low" stroke risk atrial fibrillation or atrial flutter. The idiopathic, fibrotic atrial cardiomyopathy may be underlying in these patients.


Assuntos
Fibrilação Atrial/complicações , Flutter Atrial/complicações , Ablação por Cateter/métodos , Eletrocardiografia/métodos , Acidente Vascular Cerebral/etiologia , Adulto , Fatores Etários , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , China , Feminino , Seguimentos , Humanos , Masculino , Doenças Raras , Medição de Risco , Amostragem , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
14.
Postgrad Med ; 131(7): 423-437, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31382796

RESUMO

Hyperglycemia on hospital admission is a common phenomenon in acute ischemic stroke patients and represents an independent predictor of poor clinical outcome with or without acute recanalization therapies (systemic thrombolysis or mechanical thrombectomy). Effective restoration of normoglycemia is considered to be beneficial, but conclusive evidence from randomized controlled clinical trials and specific recommendations are lacking. In addition, aggressive glucose control can be complicated by hypoglycemia leading to early neurological deterioration. We conducted a systematic literature review with the aim of addressing several questions: timing of glucose control, target range, type of insulin delivery, duration and practicability of glucose-lowering protocols. Special issues regarding mechanical thrombectomy and glycemic variability can then be investigated in future trials which are also being considered.


Assuntos
Isquemia Encefálica/terapia , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Acidente Vascular Cerebral/terapia , Glicemia/metabolismo , Isquemia Encefálica/complicações , Isquemia Encefálica/metabolismo , Hospitalização , Humanos , Hiperglicemia/complicações , Hiperglicemia/metabolismo , Hipoglicemia/induzido quimicamente , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/metabolismo , Trombectomia , Terapia Trombolítica
15.
Zhen Ci Yan Jiu ; 44(7): 538-42, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31368288

RESUMO

At present, intestinal flora has attracted more and more attention from scholars in China and foreign countries, and its association with ischemic stroke (IS) has gradually become a new research hotspot in the field of stroke. Studies also showed that intestinal flora may be a risk factor which directly or indirectly affects the occurrence and development of IS through bacterial metabolites and immune activities. In the present paper, we review the positive effect of acupuncture and moxibustion in alleviating the symptoms of limb locomotor, speech, swallowing dysfunction, cognition, etc. to improve the IS patients' daily life ability and in strengthening the cellular immune function of the body. In addition, acupuncture and moxibustion have a positive effect in regulating intestinal flora and immune inflammation. Hence, in the present paper, we discuss their relationship and the possibility of application of acupuncture and moxibustion therapies to the treatment of IS according to the theory of "intestinal flora-immune response". It is thus reasonable to speculate that acupuncture and moxibustion can be used to promote the recovery of brain tissue injury and neurological function after stroke via correcting intestinal flora disturbance and reducing immune inflammatory response. In-depth exploration of the role of "intestinal flora-immune response" in the treatment of IS and the specific regulatory function of acupuncture and moxibustion will provide new ideas and research approaches to reveal their mechanisms in the treatment of stroke from a new perspective.


Assuntos
Terapia por Acupuntura , Isquemia Encefálica , Microbioma Gastrointestinal , Moxibustão , Acidente Vascular Cerebral , China , Humanos , Acidente Vascular Cerebral/terapia
16.
Nervenarzt ; 90(10): 979-986, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31407046

RESUMO

Important milestones of acute ischemic stroke (AIS) treatment were achieved in recent years. The results of two randomized controlled trials revealed that intravenous thrombolysis is efficacious for treatment of AIS patients with a symptom onset <9 h or an unknown time of symptom onset in the presence of beneficial patterns in advanced stroke imaging. These patterns comprise the evidence of salvageable tissue at risk of infarction in perfusion of computed tomography (so-called penumbral imaging) or a mismatch between the diffusion-weighted imaging (DWI) und fluid-attenuated inversion recovery (FLAIR) sequences in magnetic resonance imaging (so-called DWI-FLAIR mismatch). Another two randomized controlled trials resulted in evidence of a high effectiveness of mechanical thrombectomy using advanced imaging of selected AIS patients with a symptom onset <24 h or an unknown time window. This article provides an overview of the current study results and recommendations for the selection of imaging for evidence-based effective acute treatment of stroke patients.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Terapia Trombolítica , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Imagem de Difusão por Ressonância Magnética , Fibrinolíticos/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
17.
Med Klin Intensivmed Notfmed ; 114(7): 635-641, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31463676

RESUMO

In intensive care medicine neuroprotection is understood mostly as various measures to avoid secondary brain damage after initial trauma, as in stroke, intracranial hemorrhage and resuscitation. Every brain trauma differs in the damage pattern and dynamics depending on the primary form of injury. Therefore, there are targeted treatment approaches depending on the pathophysiology of the medical condition. In addition, neuroprotective methods are desirable that are effective in the majority of patients with acute brain injury. In actual fact, in all forms of acute brain injury certain pathophysiological courses are encountered, which can lead to secondary brain damage depending on the intensity, e.g. reperfusion injury, damage to the blood-brain barrier and excitotoxicity. There is evidence to suggest that the creation of physiologically normal conditions leads to a favorable situation for the damaged brain. This article firstly describes the relevance of neuroprotective measures in neurocritical care medicine. Subsequently, general pathophysiological mechanisms in brain trauma are described. Following this, the pathophysiology and treatment options in brain pressure crises (reduction of intracranial pressure), anemia (transfusion management), hyperglycemia and hypoglycemia (adjustment of the blood sugar level) are dealt with. Finally, the use and benefits of therapeutic hypothermia are discussed. This has a special position as the only clinically effective individual measure for neuroprotection. The focus here is on the application following circulatory and cardiac arrest and resuscitation.


Assuntos
Lesões Encefálicas , Cuidados Críticos/métodos , Hipotermia Induzida , Neuroproteção , Acidente Vascular Cerebral , Lesões Encefálicas/terapia , Humanos , Acidente Vascular Cerebral/terapia
18.
Clin Interv Aging ; 14: 1255-1264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31371931

RESUMO

Background: Patients with severe dysphagia after stroke are usually fed using a nasogastric tube. However, this method is inconvenient and causes complications. The oro-esophageal (OE) tube has been used as an alternative parenteral feeding method for patients for whom safe oral feeding is impossible. This study aimed to evaluate the therapeutic effects and complications of OE tube feeding in stroke patients with dysphagia. Methods: This study was designed as a retrospective medical chart review of dysphagic stroke patients who were recommended for OE tube feeding. Thirty-eight stroke patients were recommended for OE tube feeding according to videofluoroscopic swallowing study (VFSS) findings. Of those patients, 17 received OE tube feeding training and conventional dysphagia therapy. Follow-up VFSSs were performed sequentially based on the patients' conditions. When a patient was able to swallow therapeutic foods with specific viscosities during the VFSS, oral feeding was considered to be initiated. Patients were divided into two groups according to final feeding methods. Results: Seventeen patients attempted OE tube feeding. Among them, 64.7% of the patients could change to full oral feeding at their follow-up VFSS evaluation. Additionally, 70.6% of the patients showed gastroesophageal reflux disease regardless of whether they changed to oral feeding. On individual items of the Functional Dysphagia Scale, both groups showed significant improvements in the triggering of pharyngeal swallowing, the amount of residue, and the pharyngeal transit time. These functions were better improved in the patients who could change to oral feeding than in those who could not. Both groups showed significant aggravation of nasal penetration. Conclusion: Our study quantitatively shows the therapeutic effects and complications of OE tube training. OE tube feeding can facilitate the swallowing process and assist patients in transitioning to oral feeding. This easy-to-apply technique may significantly impact future treatment strategies in stroke patients with severe dysphagia.


Assuntos
Transtornos de Deglutição/terapia , Nutrição Enteral/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Deglutição , Transtornos de Deglutição/etiologia , Monitoramento do pH Esofágico , Métodos de Alimentação , Feminino , Seguimentos , Refluxo Gastroesofágico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
19.
No Shinkei Geka ; 47(7): 745-752, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358693

RESUMO

Although the most common cause of major vessel occlusion is cardiogenic embolism(CE), atherothrombotic(AT)major vessel occlusion sometimes occur and recognize it during endovascular therapy. We evaluated the characteristics of patients with atherothrombotic major vessel occlusion who underwent endovascular therapy by comparing with them with those with cardiogenic embolism. We retrospectively evaluated 64 consecutive patients with major vessel occlusion who underwent endovascular thrombectomy between July 2014 and March 2018 in our institution. Eleven(17%)of the 64 patients were classified into the atherothombotic group based on the Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification except for artery to artery embolism. In the AT group, the proportions of patients with younger age(67±13 years old vs. 77±11 years old, p=0.048)and posterior circulation(55% vs. 8%, p=0.001)were significantly higher than in the CE group. The mean times from onset to hospital arrival and from onset to revascularization were significantly longer in the AT group than in the CE group(313±325min vs. 129±67min, p=0.008 and 468±359min vs. 280±93min, p=0.018). No significant differences in the rate of successful revascularization and favorable outcome were found between the 2 groups. More patients in the AT group than in the CE group tended to maintain their previous modified Ranking Scale score(54% vs. 24%, p=0.058). Our study shows that the patients with atherothrombotic major vessel occlusion had lower activities-of-daily living scores but attained high successful rates of revascularization and similar neurological outcome as that of multimodal endovascular therapy, as compared with the patients with cardiogenic embolism.


Assuntos
Procedimentos Endovasculares , Acidente Vascular Cerebral , Trombectomia , Trombose , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Trombose/terapia , Resultado do Tratamento
20.
No Shinkei Geka ; 47(7): 761-767, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358695

RESUMO

OBJECTIVE: Percutaneous transluminal recanalization(PTR)has been performed for more than 20 years and progressing because of the development of endovascular devices. However, the results have been changing dramatically since PTR was first introduced owing to dynamic social environments. Thus, we evaluated the progression of the treatment by reviewing the medical records of patients who received the treatment. MATERIALS AND METHODS: The present author has worked in three hospitals and performed PTR for 39 cases of acute ischemic stroke from 1996 to 1998. From 2012 to 2014, PTR was performed for 57 cases, and results were compared between the early and recent periods by using patient medical files and records. RESULTS: Elderly patients were treated with PTR in the recent period. The main target of PTR was the M1 segment of the middle cerebral artery in the early period. The internal carotid artery-to-posterior circulation ratio increased in the recent period. Regarding the methods of PTR, mechanical retrieval devices were mainly used in the recent period and resulted in a significantly more complete recanalization. The recovery rate based on the Glasgow outcome scale score increased, and the mortality rate decreased significantly in the recent period. CONSLUSIONS: Along with the development of endovascular devices, the results of PTR have been improving.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/terapia , Artéria Carótida Interna , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
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