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1.
Rinsho Shinkeigaku ; 59(11): 699-706, 2019 Nov 08.
Artigo em Japonês | MEDLINE | ID: mdl-31656268

RESUMO

Tissue plasminogen activator (t-PA) treatment is beneficial for patients with ischemic stroke within 4.5 h of stroke onset, because the risk of intracerebral hemorrhagic transformation (HT) increases with delayed t-PA treatment. The benefits of t-PA thrombolysis are heavily dependent on time to treatment. Development of vasoprotective drugs that attenuate HT after delayed t-PA treatment might improve the prognosis of stroke patients and extend the therapeutic time window of t-PA and endovascular thrombolysis. An angiogenic factor, vascular endothelial growth factor (VEGF), might be associated with the blood-brain barrier (BBB) disruption after focal cerebral ischemia. By using a rat thromboembolic model, delayed t-PA treatment at 4 h after ischemia promoted expression of VEGF in BBB, matrix metalloproteinase-9 (MMP-9) activation, degradation of BBB components, and HT. We demonstrated that HT was inhibited by intravenous administration of an anti-VEGF neutralizing antibody/VEGF receptor antagonist. In addition, for clinical application, reverse translation studies, a path from bedside to bench, are necessary.


Assuntos
Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/prevenção & controle , Infarto Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Barreira Hematoencefálica/metabolismo , Modelos Animais de Doenças , Humanos , Metaloproteinase 9 da Matriz/metabolismo , Terapia de Alvo Molecular , Prognóstico , Ratos , Receptores de Fatores de Crescimento do Endotélio Vascular/metabolismo , Transdução de Sinais/efeitos dos fármacos
2.
Medicine (Baltimore) ; 98(38): e17331, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568020

RESUMO

RATIONALE: The regimen of the recombinant tissue plasminogen activator (rt-PA) is identical in every case where it is indicated in the treatment of cerebral infarction. We report a case of efficient recanalization of large arterial occlusion after rapid injection of rt-PA. PATIENT CONCERNS: A 78-year-old man was admitted with right-sided hemiplegia and global aphasia that occurred an hour ago. DIAGNOSES: His brain computed tomography (CT) revealed no hemorrhage, suggesting cerebral infarction. INTERVENTIONS: Ten percent of a total rt-PA dose was injected over 1 minute promptly. The remainder of rt-PA was designed to be infused for 60 minutes. Unexpectedly, during the study of CT angiography, administration of rt-PA was completed within 5 minutes. CT angiography showed occlusion from carotid bifurcation to the middle cerebral artery. OUTCOMES: After 2 hours of rt-PA administration, the patient began to regain strength in his right arm and leg. By the next day, he had only mild dysarthria and aphasia. Follow-up CT angiography revealed recanalized internal cervical artery and severe residual stenosis with a plaque. He was discharged without any neurologic symptoms. LESSONS: The infusion protocol of rt-PA administration is established in 1995 and has not changed. Successful recanalization of long segmental large vessel occlusion with only intravenous rt-PA is relatively low. In our case, a high concentration of rt-PA may have influenced the successful dissemination of large thrombus in the whole internal cervical artery. Our case is of significance as it raises the question of unanswered efficacy of diverse injection protocol according to thrombus size and bleeding risk.


Assuntos
Infarto Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Infarto Cerebral/diagnóstico por imagem , Humanos , Injeções Intravenosas/métodos , Masculino , Neuroimagem , Proteínas Recombinantes , Fatores de Tempo , Ativador de Plasminogênio Tecidual/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Niger J Clin Pract ; 22(10): 1324-1327, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607719

RESUMO

Background: Acute cerebral infarction threats human health and life safety. The edaravone is a new antioxidant and hydroxyl radical scavenger, which is the novel scavenger for clinical use, mainly for nervous system diseases. Objective: The purpose of this study is to observe the clinical treatment effects of edaravone on the degree of improvement of neurological impairment and functional movement impairment in patients with acute cerebral infarction. Method: A total of 130 patients admitted to our hospital because of acute cerebral infarction from December 2015 to May 2017 were selected for group analysis. These patients were divided into a control group (n = 65) and a treatment group (n = 65) with a random odd-even method. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these two groups were tested and compared. Results: The total treatment efficiency of conventional treatment in the control group was significantly lower than the combination treatment in the treatment group (P < 0.05). The inter-group differences in the National Institutes of Health Stroke Scale, activities of daily living, and Fugl-Meyer assessment scores after the treatment were significant between these two groups (P < 0.05). The posttreatment effect on the treatment group was superior to that on the control group (P < 0.05). The adverse reaction rate of the treatment group did not significantly vary from that of the control group (P > 0.05). Conclusion: Edaravone can significantly improve the degree of neurological impairment during acute cerebral infarction, functional movement, and living quality with a definite effect and high safety. Thus, this drug has a good prospect in clinical treatment.


Assuntos
Infarto Cerebral/tratamento farmacológico , Edaravone/uso terapêutico , Depuradores de Radicais Livres/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Pirazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Atividades Cotidianas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Zhongguo Zhong Yao Za Zhi ; 44(14): 2926-2931, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31602834

RESUMO

Diemailing~® Kudiezi Injection( DKI) is widely used in the treatment of cerebral infarction,coronary heart disease and angina pectoris. Long-term clinical application and related research evidence showed that DKI has a good effect in improving the clinical symptoms of cardiovascular and cerebrovascular diseases. However,this injection has not been included in any clinical practice guideline. It has been found that the use of DKI is in wrong way in clinical practice in recent years. Therefore,clinical experts from the field of cardiovascular and cerebrovascular diseases nationwide are invited to compile this expert consensus in order to guide clinicians.GRADE system is used to grade the quality of evidence according to different outcomes according to degrading factors. Then it forms the recommendation or consensus suggestion through the nominal group method. The formation of expert consensus mainly considers six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on these six aspects,if the evidence is sufficient,a " recommendation" supported by evidence is formed,and GRADE grid voting rule is adopted. If the evidence is insufficient,a " consensus suggestions" will be formed,using the majority voting rule. In this consensus,the clinical indications,efficacy,safety evidences and related preliminary data of DKI were systematically and comprehensively summarized in a concise and clear format,which could provide valuable reference for the clinical use of DKI. This consensus has been approved by China association of Chinese medicine which is numbered GS/CACM 202-2019.


Assuntos
Angina Pectoris/tratamento farmacológico , Infarto Cerebral/tratamento farmacológico , Doença das Coronárias/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , China , Consenso , Humanos , Injeções , Medicina Tradicional Chinesa
5.
Zhongguo Zhong Yao Za Zhi ; 44(14): 2937-2942, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31602836

RESUMO

Danshen Chuanxiongqin Injection is a commonly used medicine in cerebral infarction and coronary heart disease,which is recommended by many disease guidelines/consensus for cardiovascular and cerebrovascular diseases. However,there are irrational drug using in clinic,which affects the efficacy and brings safety risks. Based on clinical research evidence and expert experience,recommendations/consensus suggestion are determined through the nominal group method. The expert consensus recommends the indications,intervention time for treatment,route of drug administration,usage and dosage,course of treatment and introduces the safety in clinical application,which could provide reference for clinical use of Danshen Chuanxiongqin Injection.


Assuntos
Infarto Cerebral/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Consenso , Humanos , Injeções
6.
Medicine (Baltimore) ; 98(39): e17273, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574841

RESUMO

BACKGROUND: Previous study has reported that Fuyuan Xingnao Decoction (FYXND) can be utilized for the treatment of patients with diabetes mellitus (DM) combined cerebral infarction (CI) effectively. METHODS: We will search from the following databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Global Health, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All databases will be searched from the inception to the present without language limitation. Two independent authors will perform literature selection, information collection, and methodological quality assessment. Statistical analysis will be carried out using RevMan 5.3 software. RESULTS: This study will provide accurate results on the effectiveness and safety of FYXND on DM and CI through primary and secondary outcomes. The primary outcome is neurological deficit. The secondary outcomes consist of fasting blood glucose, hemoglobin Alc, fasting insulin, quality of life, and adverse effects. CONCLUSIONS: This well-designed study will establish high quality evidence of the effectiveness and safety of FYXND for DM and CI to facilitate the clinical practice and guideline development.


Assuntos
Infarto Cerebral/tratamento farmacológico , Complicações do Diabetes/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Infarto Cerebral/etiologia , Complicações do Diabetes/sangue , Complicações do Diabetes/complicações , Diabetes Mellitus/sangue , Humanos , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
7.
Kyobu Geka ; 72(9): 673-676, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506408

RESUMO

An 80-year-old male patient with a history of total arch replacement for thoracic aortic aneurysm 5 years before was introduced to our hospital with a chief complaint of chest pain. Tissue plasminogen activator (t-PA) had been administrated because of acute brain infarction. A contrast-enhanced computed tomography (CT) scan demonstrated a large hematoma in the posterior mediastinum extending from the level of distal aortic arch to the descending aorta together with left pleural effusion. On the next day after admission, CT scan revealed that the hematoma became smaller. This is a rare case of a posterior mediastinal hematoma caused by t-PA with a history of total aortic arch replacement.


Assuntos
Aneurisma da Aorta Torácica , Infarto Cerebral , Hematoma/etiologia , Terapia Trombolítica/efeitos adversos , Idoso de 80 Anos ou mais , Aorta Torácica , Infarto Cerebral/tratamento farmacológico , Humanos , Masculino , Ativador de Plasminogênio Tecidual
8.
Int J Immunopathol Pharmacol ; 33: 2058738419869055, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31409163

RESUMO

The purpose of the study was to evaluate the effect of Astragalus membranaceus extract and ligustrazine combination on ameliorating inflammation in cerebral ischemic rats that have undergone thrombolysis. Astragalus membranaceus and ligustrazine per se, or a combination of A. membranaceus and ligustrazine was administered by intraperitoneal injection immediately after surgery and sham surgery. After the induction of thrombolysis, the neurological function was measured and cerebral lesion volume was determined. The regulatory T cells in the spleen were measured by flow cytometry. To explore the protective effects of the combination drug on the neurological function and inflammation, the expression of transcription factor Foxp3 and cytokines, including transforming growth factor beta 1, interleukin 10, interleukin 4, interleukin 1 beta, interferon gamma, interleukin 17, in damaged brain was examined using reverse transcription polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay. The cerebral lesion volume was markedly reduced in the combination drug-treated rats compared to the rats treated with either A. membranaceus or ligustrazine alone (P < 0.05). The neurological function, regulatory T cells, transcription factor Foxp3, transforming growth factor beta 1, interleukin 10, and interleukin 4 were markedly elevated in the rats treated with combination drugs (P < 0.05). The expression of interleukin 1 beta, interferon gamma, and interleukin 17 was reduced in the rats treated with combination drug therapy (P < 0.05). Treatment with a combination of A. membranaceus and ligustrazine can ameliorate inflammation after thrombolysis and regulate the related cytokines by elevating the expression of endogenous regulatory T cells.


Assuntos
Astragalus propinquus/química , Isquemia Encefálica/tratamento farmacológico , Infarto Cerebral/tratamento farmacológico , Fibrinolíticos/farmacologia , Inflamação/tratamento farmacológico , Extratos Vegetais/farmacologia , Pirazinas/farmacologia , Animais , Isquemia Encefálica/metabolismo , Infarto Cerebral/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Quimioterapia Combinada/métodos , Inflamação/metabolismo , Masculino , Ratos , Ratos Wistar , Linfócitos T Reguladores/efeitos dos fármacos , Linfócitos T Reguladores/metabolismo
9.
BMC Infect Dis ; 19(1): 603, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291896

RESUMO

BACKGROUND: This study aims to investigate the pathogen distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection. METHODS: From August 2015 to December 2017, 172 pathogenic bacterial strains from patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection in our hospital were identified, and the drug sensitivity was analyzed. RESULTS: Among these 172 strains of pathogenic bacteria, gram negative bacteria was the main cause of pulmonary infection in hospitalized patients with acute cerebral infarction, accounting for 75.6% of all pathogens. Furthermore, 80% of diabetic patients with cerebral infarction had lung infection induced by gram negative bacteria, which was significantly higher than that in non-diabetic patients (72.2%). Moreover, the drug resistance rate in the diabetic group (68.3%) was significantly higher than that in the non-diabetic group (54.3%). Gram positive bacteria accounted for 19.1% of all pathogenic bacteria. The infection rate of gram-positive bacteria in diabetic patients with cerebral infarction was 14.7%, which was lower than that in the non-diabetic group (22.6%). The drug-resistance rate was higher in the diabetic group (45.5%) than in the non-diabetic group (28.2%). Furthermore, the fungal infection rate in patients with lung infection in these two groups was 5.3 and 5.2%, respectively, and fungi presented with high sensitivity to commonly used antifungal agents. CONCLUSION: In patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection, the majority of pathogens are multidrug-resistant gram negative bacilli. Pathogen culture should be conducted as soon as possible before using antibiotics, and antimicrobial agents should be reasonably used according to drug sensitivity test results.


Assuntos
Infarto Cerebral/complicações , Infecção Hospitalar/microbiologia , Complicações do Diabetes/microbiologia , Resistência Microbiana a Medicamentos , Pneumonia/microbiologia , Doença Aguda , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/microbiologia , Infecção Hospitalar/tratamento farmacológico , Complicações do Diabetes/tratamento farmacológico , Feminino , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pneumonia/tratamento farmacológico
10.
J Stroke Cerebrovasc Dis ; 28(7): e102-e103, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31036340

RESUMO

Akinetopsia is a quite rare symptom. Two types of akinetopsia have been reported: one is cinematographic vision, and the other is invisibility of moving objects. These symptoms are thought to occur due to dysfunction of the MT/V5 area at the occipitoparietal region. I herein describe a 54-year-old man who collided with a car parked on the left side of the road while driving. He complained that the parked car looked to be moving forwards and he could not stop his car when he noticed that it was parked. Magnetic resonance imaging disclosed the fresh infarction on the right temporoparietal region involving the MT/V5 area. His symptom during driving was considered cinematographic vision and it was the cause of the traffic accident. Akinetopsia resulted in illusory kinetopsia on driving and the traffic accident.


Assuntos
Acidentes de Trânsito , Condução de Veículo , Infarto Cerebral/complicações , Ilusões , Percepção de Movimento , Transtornos da Percepção/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/psicologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/psicologia , Inibidores da Agregação de Plaquetas/uso terapêutico
11.
J R Army Med Corps ; 165(6): e2, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31133623

RESUMO

BACKGROUND: Traumatic carotid artery thrombosis is uncommon and it usually results from penetrating injuries and less commonly secondary to blunt trauma. It can lead to delayed clinical presentation, which leads to delay in the diagnosis. Soldiers in combat scenario also can present with such an illness, which results from varied modes of injuries. Our case illustrates an unusual cause of carotid thrombosis. CASE PRESENTATION: Our patient is a 37-year-old soldier who developed neck pain and headache following a 5 km training run with rifle on the shoulder and subsequently developed left upper limb weakness and evaluation revealed extracranial right internal carotid thrombosis. He was managed with anticoagulants and antiplatelets with complete resolution of the thrombosis and complete recovery of the weakness. CONCLUSION: Blunt trauma to the neck in the form of carrying a rifle for a prolonged duration can result in injury to the carotid vessels leading to delayed neurological presentation. Educating the troops regarding such a mode of illness will prevent such a catastrophic nature of vascular injury resulting in ischaemic stroke.


Assuntos
Artérias Carótidas , Trombose das Artérias Carótidas , Militares , Adulto , Anticoagulantes/uso terapêutico , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/etiologia , Armas de Fogo , Humanos , Masculino , Medicina Militar , Cervicalgia/etiologia , Ultrassonografia Doppler em Cores
12.
J Stroke Cerebrovasc Dis ; 28(8): e113-e115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129106

RESUMO

Vertebral artery (VA) dissection is one major cause of brain infarction in young and middle-aged adults. Risk factors for VA dissection are hypertension, diabetes mellitus, hyperlipidemia, trauma, and genetic factors. A 32-year-old man with familial Hirschsprung disease at the age of 2 presented cerebellar ischemic stroke due to bilateral VA dissections. A stroke recurred within 17 days despite oral dual antiplatelet therapy. Bilateral VA dissections and recurrent dissections are related to genetic mutations associated with connective tissue diseases. A part of familial Hirschsprung disease has genetic factors in common with cerebrovascular disease. There may be a common genetic background between his VA dissection and Hirschsprung disease.


Assuntos
Infarto Cerebral/etiologia , Doença de Hirschsprung/complicações , Dissecação da Artéria Vertebral/etiologia , Adulto , Aspirina/uso terapêutico , Angiografia Cerebral/métodos , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/tratamento farmacológico , Cilostazol/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Edaravone/uso terapêutico , Predisposição Genética para Doença , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/genética , Humanos , Angiografia por Ressonância Magnética , Masculino , Fármacos Neuroprotetores/uso terapêutico , Fenótipo , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/tratamento farmacológico
13.
World Neurosurg ; 128: e918-e922, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096029

RESUMO

BACKGROUND: Cerebral venous thrombosis (CVT) is a common type of stroke in young adults and associated with 8% mortality. High intracranial pressure (ICP) and brain herniation are the most common causes of death in these patients. In contrast with malignant arterial middle cerebral infarction, there are few studies reporting the efficacy of decompressive craniectomy (DC) for treatment of high ICP in patients with CVT. In this study, we assess the clinical outcome of patients with CVT with impending brain herniation treated with DC versus medical management. METHODS: In this retrospective study, medical records of all patients with CVT admitted to our hospital were reviewed. Patients with the following inclusion criteria were entered into the study: 1) CVT proven by contrast-enhanced magnetic resonance venogram and/or computed tomography venogram, 2) malignant CVT (impending brain herniation according to imaging and clinical finding), and 3) age between 16 and 80 years. Patients with deep venous system thrombosis, Glasgow Coma Scale (GCS) score of 3, and bilateral nonreactive midposition pupils or mydriasis on admission were excluded. Patients were classified into 2 groups: surgical group (DC group) including patients who received medical treatment and DC and medical group (MG) including patients who received only medical treatment. Outcomes and complications were assessed and compared between the 2 groups. RESULTS: Of 357 patients with CVT hospitalized in our center, 48 patients entered into the study. Twenty-three patients were managed medically, and 25 patients were managed surgically. There was no significant difference between the groups concerning age, sex, presenting symptoms, transient and permanent risk factors of CVT, GCS score on admission, and pupils' reactivity on admission. All patients in the MG died during hospitalization in comparison with 8 patients in the DC group (100% vs. 32%, P < 0.001). Favorable outcome (modified Rankin scale score 0-2) was achieved in 52% of the DC group and 0% of the MG group (P < 0.001). CONCLUSIONS: The results of our study confirmed that in contrast with DC, medical treatment could not prevent transtentorial herniation. DC is not only lifesaving for patients with CVT with impending brain herniation but also results in favorable outcome in most patients.


Assuntos
Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/cirurgia , Craniectomia Descompressiva/métodos , Procedimentos Neurocirúrgicos/métodos , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Infarto Cerebral/complicações , Cuidados Críticos , Encefalocele/etiologia , Encefalocele/prevenção & controle , Feminino , Escala de Coma de Glasgow , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/complicações , Adulto Jovem
14.
Zhongguo Zhong Yao Za Zhi ; 44(8): 1696-1703, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31090337

RESUMO

To study the effect of modified Buyang Huanwu Decoction on the hemorrhagic transformation after intravenous thrombolysis of recombinant tissue type plasminogen activator(rt-PA) in patients with super early(onset time<4. 5 h) cerebral infarction. From March 2016 to July 2018,at the brain disease zone of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,212 cases of super early cerebral infarction were selected and divided into two group according to the randomized complete blocks designs: control group(106 cases) and traditional Chinese medicine group(106 cases). The control group was treated with rt-PA intravenous thrombolysis,while the traditional Chinese medicine group was treated with modified Buyang Huanwu Decoction in addition to the therapy of the control group. Both groups were treated for 14 days. Neurological deficit score,serum matrix metalloproteinase-9(MMP-9),neuron specific enolase(NSE),vascular endothelial growth factor(VEGF) and plasma cellular fibronectin(c-FN) levels,the incidence of hemorrhagic transformation,clinical efficacy and adverse drug reactions before and after treatment were compared between the two groups. According to the findings,at the 14 thday after treatment,the rank sum test of the grade data showed that the clinical efficacy of the traditional Chinese medicine group was better than that of the control group(Z =-2. 033,P = 0. 042); on the basis of χ2 test,the total efficiency of the traditional Chinese medicine group was higher than that of the control group(χ2= 4. 895,P =0. 027); the hemorrhagic transformation rate of the traditional Chinese medicine group was lower than that of the control group within14 days of treatment(χ2= 3. 962,P = 0. 047). MMP-9 levels in the traditional Chinese medicine group were lower than those in the control group at the 3 rd,5 th,7 th,10 th,14 thd after treatment(t =-2. 474,-3. 022,-5. 163,-6. 998,-9. 821; P = 0. 014,0. 003,0,0,0). The improvement of c-FN,NSE,VEGF and NIHSS scores in the traditional Chinese medicine group was superior to that of the control group after 14 days of treatment(t =-2. 343,-3. 187,-2. 129,-3. 105; P = 0. 020,0. 002,0. 034,0. 002). No obvious adverse reactions of modified Buyang Huanwu Decoction were observed during 14 days of treatment. Modified Buyang Huanwu Decoction could reduce the expressions of MMP-9,c-FN,NSE and VEGF after rt-PA intravenous thrombolysis in patients with super early cerebral infarction,and decrease the hemorrhagic transformation rate after thrombolysis,with high safety.


Assuntos
Infarto Cerebral/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Ativador de Plasminogênio Tecidual/uso terapêutico , Fibronectinas/sangue , Humanos , Metaloproteinase 9 da Matriz/sangue , Medicina Tradicional Chinesa , Fosfopiruvato Hidratase/sangue , Proteínas Recombinantes/uso terapêutico , Terapia Trombolítica , Fator A de Crescimento do Endotélio Vascular/sangue
15.
Zhongguo Zhong Yao Za Zhi ; 44(3): 602-607, 2019 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-30989929

RESUMO

Fangji Dihuang Decoction and Fengyin Decoction, which were firstly recorded in Synopsis of the Golden Chamber, could be used to treat stroke. However, both of these two decoctions are used infrequently. There is a clear pathogenesis of modern pathophysiology behind Fangji Dihuang Decoction syndrome and Fengyin Decoction syndrome, which can be interpreted by modern language of science. Fangji Dihuang Decoction can nourish Yin, tonify kidney, extinguish the wind, and dredge collaterals. It could be used to treat mania caused by cerebral infarction, senile dementia, Alzheimer's disease and other cerebrovascular diseases, and opened up the precedent of nourishing Yin and expelling wind to treat stroke in later generations. Fengyin Decoction can clear heat, extinguish the wind, and calm the mind. It can be used to treat cerebral infarction, limb paralysis and epileptic seizures with heat syndrome. It may be equivalent to "oriental olanzapine", and opened up the precedent of smoothing liver and suppressing Yang to treat stroke in later generations. They can be used in the combination, with a high application value in treating stroke and mental diseases.


Assuntos
Infarto Cerebral/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Humanos , Medicina Tradicional Chinesa
16.
Zhongguo Zhong Yao Za Zhi ; 44(2): 372-380, 2019 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-30989960

RESUMO

To systematically review the effectiveness and safety of Kudiezi Injection in treating patients with acute cerebral infarction( ACI). Four Chinese databases( CNKI,VIP,Wan Fang,Sino Med),three English databases( Cochrane Library,EMbase,Medline)and Clinical Trail.gov were systematically and comprehensively retrieved. The retrieval time was from the establishment of each database to November 2017. Randomized controlled trials( RCTs) for the treatment of acute cerebral infarction with Kudiezi Injection were screened out according to pre-established inclusion criteria and exclusion criteria. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool,and the included studies were put into descriptive analysis or Meta-analysis using the Rev Man 5. 3 software. A total of 932 articles were retrieved,and finally 14 studies were included. Except for 2 multi-arm trials,the total sample size was 1 244 in the experimental group and 638 in the control group. The overall quality of the included studies was not high. The results of Meta-analysis showed that Kudiezi + conventional therapy for acute cerebral infarction was superior to conventional therapy in total effective rate( RR = 0. 86,95% CI[0. 77,0. 96],P = 0. 006); Kudiezi + conventional therapy for acute cerebral infarction was superior to conventional therapy in serum inflammatory factors( MDhs-CRP=-3. 77,95% CI[-4. 17,-3. 37],P < 0. 000 01; MDIL-18=-16. 18,95% CI[-19. 26,-13. 11],P<0. 000 01); Kudiezi + conventional therapy was superior to conventional therapy in Barthel index( MD = 12. 52,95%CI[8. 93,16. 10],P<0. 000 01). Adverse reactions included in the study reports showed mild adverse reactions. Based on the results of this study,Kudiezi Injection combined with conventional therapy or other Western medicine had a certain curative effect on acute cerebral infarction,with no serious adverse reactions. However,due to the low quality of the included research methodology,the conclusions of this study were not recommended. In addition,in order to produce high-quality evidence for the clinical application of Kudiezi Injections,more randomized controlled trials with a large sample size,scientific design and strict implementation were required to study the effectiveness and safety of Kudiezi Injection in the treatment of cerebral infarction.


Assuntos
Infarto Cerebral/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Injeções , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Clin Neurosci ; 64: 134-140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30952555

RESUMO

Intravenous tissue-plasminogen activator (IV-TPA) treatment in acute ischemic stroke (AIS) patients due to small vessel occlusion (SVO) has been debated because of its small expected benefit and symptomatic intracranial hemorrhage (SICH) risk. Furthermore, data on subgroups of SVO patients are limited. From a prospective multicenter stroke registry database, AIS patients due to SVO within 24 h from onset were selected. Efficacy outcomes were 3-month modified Rankin Scale (mRS) score 0-1 proportion and mRS score distribution. Additionally, subgroup analyses were conducted by age, sex, initial National Institute Health Stroke Scale (NIHSS) score, and presenting limb paresis. This study included 2482 patients: 193 in the IV-TPA group and 2289 in the control group. After adjusting covariates, IV-TPA treatment was associated with an increased mRS 0-1 outcome (adjusted OR [95% CI], 1.56 [1.06-2.29]; P = 0.0249), but was not significantly associated with a favorable mRS shift (1.33 [0.98-1.81]; P = 0.0709). SICH and 3-month death occurred in three (1.6%) and none in the IV-TPA group versus one (0.04%) and 16 (0.7%) in the control group. In subgroup analyses, the IV-TPA effect appeared significantly greater in patients aged ≥80 versus <80 for mRS score distribution (Pinteraction = 0.012). This study showed that, in SVO patients, IV-TPA within 4.5 h may improve functional outcome with a low SICH risk. The benefit appeared more substantial in patients aged ≥80.


Assuntos
Infarto Cerebral/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
18.
Zhongguo Zhong Yao Za Zhi ; 44(1): 112-118, 2019 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-30868821

RESUMO

This research was aimed to evaluate the protective effect and potential mechanism of Yiqi Tongluo Particles(YQTLs).Firstly,an animal model of multiple cerebral infarction(MCI) with Qi deficiency and blood stasis was established.Rats were randomly divided into six groups:SHAM group,Vehicle group,Buyang Huanwu decoction original group(BYHWO),EGb761 group,high and low dose of YQTLs group.Rats underwent sleep deprivation after one week of MCI and the tongues and pulses of rats after six weeks of sleep deprivation were detected,followed by collecting blood to analysis the blood coagulation.Differential expression of angiogenesis associated proteins was examined using proteomic research and verified by immunohistochemical.RESULTS: showed that neurological function score was obviously declined,G and B value of tongue surface was increased significantly and the pulse distension,the activated partial thromboplatin time(APTT) as well as prothrombin time(PT) were recovered following YQTLs 7.56 g·kg-1 treatment.Furthermore,G value of tongue surface,APTT and PT were also improved by YQTLs 3.78 g·kg-1.The results of proteomic technology showed that proteins associated with angiogenesis were reversed compared with Vehicle group.Moreover,the expression of VEGFR2 from immunohistochemical was promoted after YQTLs treatment.The MCI with Qi deficiency and blood stasis was alleviated obviously following YQTLs treatment and the possible mechanism was that YQTLs may enhance angiogenesis during cerebral ischemia.


Assuntos
Indutores da Angiogênese/farmacologia , Infarto Cerebral/tratamento farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Animais , Proteômica , Qi , Distribuição Aleatória , Ratos
19.
Medicine (Baltimore) ; 98(8): e14643, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813204

RESUMO

BACKGROUND: Acute cerebral infarction (ACI) is one of the most commonly seen cerebral vascular disease and the current therapy options are not satisfied. Ginkgo leaf extract and dipyridamole injection (GDI) is widely used as adjuvant therapy for ACI. However, there is no systemic review and meta-analysis published regarding the efficacy and safety of GDI. Herein, we describe the protocol of a proposed study aims to systemically evaluate the efficacy and safety of GDI in ACI patients. METHODS: Five electronic databases (Medline, EMBase, Cochrane database, China National Knowledge Infrastructure, and Wanfang database) will be searched up to February 28, 2018. Randomized controlled trials (RCTs) meet the eligibility criteria will be identified and included. Data synthesis will be run using RevMan software after the data extraction and risk of bias assessment of included studies. The primary outcomes of this study are effective rate and adverse event rate. RESULTS: This study will provide a high-quality synthesis of RCTs on the efficacy and safety of GDI as an adjuvant therapy in the treatment of ACI. CONCLUSION: This systemic review and meta-analysis will provide high quality evidence to evaluate GDI as adjuvant therapy in patients with ACI.Registration: PEROSPERO CRD42018107112.


Assuntos
Infarto Cerebral/tratamento farmacológico , Dipiridamol/farmacologia , Extratos Vegetais/farmacologia , Doença Aguda , Adjuvantes Farmacêuticos/farmacologia , Fármacos Cardiovasculares/farmacologia , Protocolos Clínicos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
20.
Mil Med Res ; 6(1): 2, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30665465

RESUMO

BACKGROUND: To study the influence of blood lipid levels on hemorrhagic transformation (HT) and prognosis after acute cerebral infarction (ACI). METHODS: Patients with ACI within 72 h of symptoms onset between January 1st, 2015, and December 31st, 2016, were retrospectively analyzed. Patients were divided into group A (without HT) and group B (HT). The outcomes were assessed after 3 months of disease onset using the modified Rankin Scale (mRS). An mRS score of 0-2 points indicated excellent prognosis, and an mRS score of 3-6 points indicated poor prognosis. RESULTS: A total of 732 patients conformed to the inclusion criteria, including 628 in group A and 104 in group B. The incidence of HT was 14.2%, and the median onset time was 2 d (interquartile range, 1-7 d). The percentages of patients with large infarct size and cortex involvement in group B were 80.8 and 79.8%, respectively, which were both significantly higher than those in group A (28.7 and 33.4%, respectively). The incidence rate of atrial fibrillation (AF) in group B was significantly higher than that in group A (39.4% vs. 13.9%, P < 0.001). The adjusted multivariate analysis results showed that large infarct size, cortex involvement and AF were independent risk factors of HT, while total cholesterol (TC) was a protective factor of HT (OR = 0.359, 95% CI 0.136-0.944, P = 0.038). With every 1 mmol/L reduction in normal TC levels, the risk of HT increased by 64.1%. The mortality and morbidity at 3 months in group B (21.2 and 76.7%, respectively) were both significantly higher than those in group A (8.0 and 42.8%, respectively). The adjusted multivariate analysis results showed that large infarct size (OR = 12.178, 95% CI 5.390-27.516, P < 0.001) was an independent risk factor of long-term unfavorable outcomes, whereas low-density lipoprotein cholesterol (LDL-C) was a protective factor (OR = 0.538, 95% CI 0.300-0.964, P = 0.037). With every 1 mmol/L reduction in normal LDL-C levels, the risk of an unfavorable outcome increased by 46.2%. Major therapies, including intravenous recombinant human tissue plasminogen activator (rTPA), intensive lipid-lowering statins and anti-platelets, were not significantly related to either HT or long-term, post-ACI poor prognosis. CONCLUSION: For patients with large infarct sizes, especially those with cortex involvement, AF, or lower levels of TC, the risk of HT might increase after ACI. The risk of a long-term unfavorable outcome in these patients might increase with a reduction in LDL-C.


Assuntos
Fibrilação Atrial/epidemiologia , Hemorragia Cerebral/epidemiologia , Infarto Cerebral/mortalidade , LDL-Colesterol/sangue , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infarto Cerebral/complicações , Infarto Cerebral/tratamento farmacológico , China/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Fatores de Risco , Ativador de Plasminogênio Tecidual/administração & dosagem
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