1
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Bellomo TR, DeCarlo C, Lella SK, Jessula S, Feldman Z, Romero JM, Eagleton MJ, Dua A, Zacharias N. Complications of Carotid Interventions for Symptomatic Lesions after Systemic Thrombolysis. Ann Vasc Surg 2024:S0890-5096(24)00238-3. [PMID: 38821470 DOI: 10.1016/j.avsg.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Series detailing complications after carotid endarterectomy (CEA) and transfemoral carotid stenting (tfCAS) for patients presenting with neurologic symptoms that are treated with systemic thrombolysis (ST) are sparse. We sought to determine if treatment with ST was associated with a higher rate of post-carotid intervention complications. METHODS A multispecialty, institutional, prospectively maintained database was queried for symptomatic patients treated with CEA or tfCAS from 2007-2019. The primary outcomes of interest were bleeding complications (access/wound complications, hematuria, intracranial hemorrhage) or need for reintervention, stroke, and death. We compared rates of these outcomes between patients who were and were not treated with ST. To adjust for preoperative patient factors and confounding variables, propensity scores for assignment to ST and no ST were calculated. RESULTS There were 1,139 patients included (949 [82%] CEA and 190 [17%] tfCAS. All treated lesions were symptomatic (550 [48%] stroke, 603 [52%] TIA). Fifty-six patients (5%) were treated with ST. Fifteen of 56 patients also underwent catheter-based intervention for stroke. ST was administered 0 to 1 day preoperatively in 21 (38%) patients, 2 to 6 days preoperatively in 27 (48%) patients, and greater than 6 days preoperatively in 8 (14%) patients. ST patients were more likely to present with stroke (93% vs. 45%; p<0.001) and have higher preoperative Rankin Scores. Unadjusted rate of bleeding/return to OR was 3% for ST group and 3% for non-ST group (p=0.60). Unadjusted rate of stroke was 4% for ST group and 3% for the non-ST group (p=0.91) while perioperative mortality was 5% for ST group and 1% for non-ST group (p=0.009). After adjusting for patient factors, preoperative antiplatelet/anticoagulation, and operative factors, ST was not associated with an increased odds of perioperative bleeding/return to OR (OR 0.37; 95%CI: 0.02-1.63; p=0.309) or stroke (OR 0.62; 95%CI: 0.16-2.40; p=0.493). CONCLUSIONS ST does not convey a higher risk of complications after CEA or tfCAS. After controlling for other factors, patients that received ST had similar rates of local complications and stroke when compared to non-ST patients. Early carotid intervention is safe in patients that have received ST, and delays should be avoided in symptomatic patients given the high risk of recurrent stroke.
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Affiliation(s)
- Tiffany R Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA.
| | - Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Srihari K Lella
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Samuel Jessula
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Zachary Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Javier M Romero
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA USA
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
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2
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Veeravalli KK. Implications of MMP-12 in the pathophysiology of ischaemic stroke. Stroke Vasc Neurol 2024; 9:97-107. [PMID: 37336584 PMCID: PMC11103161 DOI: 10.1136/svn-2023-002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
This article focuses on the emerging role of matrix metalloproteinase-12 (MMP-12) in ischaemic stroke (IS). MMP-12 expression in the brain increases dramatically in animal models of IS, and its suppression reduces brain damage and promotes neurological, sensorimotor and cognitive functional outcomes. Thus, MMP-12 could represent a potential target for the management of IS. This article provides an overview of MMP-12 upregulation in the brain following IS, its deleterious role in the post-stroke pathogenesis (blood-brain barrier disruption, inflammation, apoptosis and demyelination), possible molecular interactions and mechanistic insights, its involvement in post-ischaemic functional deficits and recovery as well as the limitations, perspectives, challenges and future directions for further research. Prior to testing any MMP-12-targeted therapy in patients with acute IS, additional research is needed to establish the effectiveness of MMP-12 suppression against IS in older animals and in animals with comorbidities. This article also examines the clinical implications of suppressing MMP-12 alone or in combination with MMP-9 for extending the currently limited tissue plasminogen activator therapy time window. Targeting of MMP-12 is expected to have a profound influence on the therapeutic management of IS in the future.
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Affiliation(s)
- Krishna Kumar Veeravalli
- Cancer Biology and Pharmacology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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3
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Liu L, Wang W. Developing and Validating a New Model to Predict the Risk of Poor Neurological Status of Acute Ischemic Stroke After Intravenous Thrombolysis. Neurologist 2023; 28:391-401. [PMID: 37639528 PMCID: PMC10627548 DOI: 10.1097/nrl.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The objective of this study was to develop and validate a predictive model for the risk of poor neurological status in in-hospital patients with acute ischemic stroke (AIS) after intravenous thrombolysis. METHODS This 2-center retrospective study included patients with AIS treated at the Advanced Stroke Center of the Second Hospital of Hebei Medical University and Baoding No.1 Central Hospital between January 2018 and January 2020). The neurological function status at day 7 of AIS onset was used as the endpoint of the study, which was evaluated using the National Institute of Health Stroke Scale (NIHSS) score. RESULTS A total of 878 patients were included in the study and divided into training (n=652) and validation (n=226) sets. Seven variables were selected as predictors to establish the risk model: age, NIHSS before thrombolysis (NIHSS1), NIHSS 24 hours after thrombolysis (NIHSS3), high-density lipoprotein, antiplatelet, cerebral computed tomography after thrombolysis (CT2), and lower extremity venous color Doppler ultrasound. The risk prediction model achieved good discrimination (the areas under the Receiver Operating Characteristic curve in the training and validation sets were 0.9626 and 0.9413, respectively) and calibration (in the training set Emax=0.072, Eavg=0.01, P =0.528, and in the validation set Emax=0.123, Eavg=0.019, P =0.594, respectively). The decision curve analysis showed that the model could achieve a good net benefit. CONCLUSIONS The prediction model obtained in this study showed good discrimination, calibration, and clinical efficacy. This new nomogram can provide a reference for predicting the risk of poor neurological status in patients with acute ischemic stroke after intravenous thrombolysis.
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Affiliation(s)
- Lu Liu
- Department of Neurology, The Baoding Central Hospital, Baoding, Hebei, China
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4
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Appelros P, Svensson E, Heidenreich K, Svantesson M. Ethical issues in stroke thrombolysis revisited. Acta Neurol Scand 2021; 144:611-615. [PMID: 34725820 DOI: 10.1111/ane.13530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Appelros
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
| | - Elisabeth Svensson
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
| | - Kaja Heidenreich
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
| | - Mia Svantesson
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
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5
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Zeng J, Chen F, Chen Y, Peng M, Chen X, Yang Q, Wang R, Miao J. Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients: A single-center study of 391 cases. Medicine (Baltimore) 2021; 100:e27053. [PMID: 34664830 PMCID: PMC8448058 DOI: 10.1097/md.0000000000027053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients.Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed.Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group (P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06-7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10-0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06-0.45 P = .000) were protective factors of hemorrhagic complications.For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.
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Affiliation(s)
- Jianqi Zeng
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Feng Chen
- Department of Neurology, Zhaoqing Gaoyao People's Hospital, Guangdong Province, Zhaoqing, China
| | - Yiqian Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Muli Peng
- Department of Neurology, Zhaoqing Gaoyao People's Hospital, Guangdong Province, Zhaoqing, China
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Qingwei Yang
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Ru Wang
- Department of Neurology, Weinan Central Hospital, Weinan, China
| | - Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
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6
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Combination treatment with U0126 and rt-PA prevents adverse effects of the delayed rt-PA treatment after acute ischemic stroke. Sci Rep 2021; 11:11993. [PMID: 34099834 PMCID: PMC8184783 DOI: 10.1038/s41598-021-91469-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/18/2021] [Indexed: 11/11/2022] Open
Abstract
In acute ischemic stroke, the only FDA-approved drug; recombinant tissue plasminogen activator (rt-PA) is limited by restricted time-window due to an enhanced risk of hemorrhagic transformation which is thought to be caused by metalloproteinase (MMP). In experimental stroke inhibitors of the mitogen–activated protein kinase kinase extracellular signal–regulated kinase kinase (MEK) 1/2 pathways reduce the MMPs. This study evaluated whether a MEK1/2 inhibitor in combination with rt-PA can prevent the detrimental effects of delayed rt-PA therapy in stroke. Thromboembolic stroke was induced in C57 black/6J mice and the MEK1/2 inhibitor U0126 was administrated 3.5 h and rt-PA 4 h post stroke-onset. Treatment with rt-PA demonstrated enhanced MMP-9 protein levels and hemorrhagic transformation which was prevented when U0126 was given in conjunction with rt-PA. By blocking the MMP-9 with U0126 the safety of rt-PA administration was improved and demonstrates a promising adjuvant strategy to reduce the harmful effects of delayed rt-PA treatment in acute ischemic stroke.
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7
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Sun F, Liu H, Fu HX, Zhang S, Qian XD, Li JJ, Zhu YB, Zhang XX, Zhang J, Qiu HP, Kang LL, Hu YJ, Zhao L, Mi YJ, Gao YJ, Dou ZJ, Ma Z. Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction. J Int Med Res 2021; 48:300060519895352. [PMID: 32357116 PMCID: PMC7221219 DOI: 10.1177/0300060519895352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Cerebral infarction has a poor prognosis and causes a serious burden on
families and society. Recombinant tissue plasminogen activator (rt-PA) and
urokinase (UK) are commonly used thrombolytic agents in the clinic. However,
direct and powerful clinical trial evidence to determine the therapeutic
effect of rt-PA and UK on intravenous thrombolysis is lacking. Methods In this study, 180 patients with acute cerebral infarction were treated with
rt-PA or UK. The National Institutes of Health Stroke Scale (NIHSS) scores,
Barthel index, bleeding complications, and biomarkers were evaluated. Results No significant differences in NIHSS or Barthel scores were found between the
groups. However, UK increased the risk of intracranial haemorrhage compared
with rt-PA. rt-PA had increased activity in reducing serum levels of MMP-9
than UK. Conclusion Intravenous thrombolysis with rt-PA and UK in the time window of acute
cerebral infarction can achieve similar therapeutic effects, but rt-PA can
further reduce the risk of cerebral haemorrhage and is relatively safer than
UK.
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Affiliation(s)
- Fan Sun
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Heng Liu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Hui-Xiao Fu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Shuo Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xu-Dong Qian
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jia-Jia Li
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yun-Bo Zhu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xiao-Xuan Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jian Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Hai-Peng Qiu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Ling-Ling Kang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Ya-Jun Hu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Liang Zhao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan-Juan Mi
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan-Jun Gao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhi-Jie Dou
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zheng Ma
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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8
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Bello A, Vandermeer B, Wiebe N, Garg AX, Tonelli M. Evidence-Based Decision-Making 2: Systematic Reviews and Meta-Analysis. Methods Mol Biol 2021; 2249:405-428. [PMID: 33871856 DOI: 10.1007/978-1-0716-1138-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The number of studies published in the biomedical literature has dramatically increased over the last few decades. This massive proliferation of literature makes clinical medicine increasingly complex, and information from multiple studies is often needed to inform a particular clinical decision. However, available studies often vary in their design, methodological quality, and population studied, and may define the research question of interest quite differently. This can make it challenging to synthesize the conclusions of multiple studies. In addition, since even highly cited trials may be challenged over time, clinical decision-making requires ongoing reconciliation of studies which provide different answers to the same question. Because it is often impractical for readers to track down and review all the primary studies, systematic reviews and meta-analyses are an important source of evidence on the diagnosis, prognosis and treatment of any given disease. This chapter summarizes methods for conducting and reading systematic reviews and meta-analyses, as well as describes potential advantages and disadvantages of these publications.
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Affiliation(s)
- Aminu Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ben Vandermeer
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Natasha Wiebe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
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9
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Ma R, Xie Q, Li Y, Chen Z, Ren M, Chen H, Li H, Li J, Wang J. Animal models of cerebral ischemia: A review. Biomed Pharmacother 2020; 131:110686. [PMID: 32937247 DOI: 10.1016/j.biopha.2020.110686] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/09/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Stroke seriously threatens human health because of its characteristics of high morbidity, disability, recurrence, and mortality, thus representing a heavy financial and mental burden to affected families and society. Many preclinical effective drugs end in clinical-translation failure. Animal models are an important approach for studying diseases and drug effects, and play a central role in biomedical research. Some details about animal models of cerebral ischemia have not been published, such as left-/right-sided lesions or permanent cerebral ischemia/cerebral ischemia-reperfusion. In this review, ischemia in the left- and right-hemisphere in patients with clinical stroke and preclinical studies were compared for the first time, as were the mechanisms of permanent cerebral ischemia and cerebral ischemia-reperfusion in different phases of the disease. The results showed that stroke in the left hemisphere was more common in clinical patients, and that most patients with stroke failed to achieve successful recanalization. Significant differences were detected between permanent cerebral ischemia and cerebral ischemia-reperfusion models in the early, subacute, and recovery phases. Therefore, it is recommended that, with the exception of the determined experimental purpose or drug mechanism, left-sided permanent cerebral ischemia animal models should be prioritized, as they would be more in line with the clinical scenario and would promote clinical translation. In addition, other details regarding the preoperative management, surgical procedures, and postoperative care of these animals are provided, to help establish a precise, effective, and reproducible model of cerebral ischemia model and establish a reference for researchers in this field.
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Affiliation(s)
- Rong Ma
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Qian Xie
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yong Li
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Zhuoping Chen
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Mihong Ren
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Hai Chen
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Hongyan Li
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jinxiu Li
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jian Wang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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10
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Goel L, Jiang X. Advances in Sonothrombolysis Techniques Using Piezoelectric Transducers. SENSORS 2020; 20:s20051288. [PMID: 32120902 PMCID: PMC7085655 DOI: 10.3390/s20051288] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
One of the great advancements in the applications of piezoelectric materials is the application for therapeutic medical ultrasound for sonothrombolysis. Sonothrombolysis is a promising ultrasound based technique to treat blood clots compared to conventional thrombolytic treatments or mechanical thrombectomy. Recent clinical trials using transcranial Doppler ultrasound, microbubble mediated sonothrombolysis, and catheter directed sonothrombolysis have shown promise. However, these conventional sonothrombolysis techniques still pose clinical safety limitations, preventing their application for standard of care. Recent advances in sonothrombolysis techniques including targeted and drug loaded microbubbles, phase change nanodroplets, high intensity focused ultrasound, histotripsy, and improved intravascular transducers, address some of the limitations of conventional sonothrombolysis treatments. Here, we review the strengths and limitations of these latest pre-clincial advancements for sonothrombolysis and their potential to improve clinical blood clot treatments.
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Affiliation(s)
- Leela Goel
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA;
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695-7910, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA;
- Correspondence: ; Tel.: +1-919-515-5240
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Abstract
The brain is the most complex organ of the body, and many pathological processes underlying various brain disorders are poorly understood. Limited accessibility hinders observation of such processes in the in vivo brain, and experimental freedom is often insufficient to enable informative manipulations. In vitro preparations (brain slices or cultures of dissociated neurons) offer much better accessibility and reduced complexity and have yielded valuable new insights into various brain disorders. Both types of preparations have their advantages and limitations with regard to lifespan, preservation of in vivo brain structure, composition of cell types, and the link to behavioral outcome is often unclear in in vitro models. While these limitations hamper general usage of in vitro preparations to study, e.g., brain development, in vitro preparations are very useful to study neuronal and synaptic functioning under pathologic conditions. This chapter addresses several brain disorders, focusing on neuronal and synaptic functioning, as well as network aspects. Recent progress in the fields of brain circulation disorders, excitability disorders, and memory disorders will be discussed, as well as limitations of current in vitro models.
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Abstract
Translation in cognitive neuroscience remains beyond the horizon, brought no closer by supposed major advances in our understanding of the brain. Unless our explanatory models descend to the individual level-a cardinal requirement for any intervention-their real-world applications will always be limited. Drawing on an analysis of the informational properties of the brain, here we argue that adequate individualisation needs models of far greater dimensionality than has been usual in the field. This necessity arises from the widely distributed causality of neural systems, a consequence of the fundamentally adaptive nature of their developmental and physiological mechanisms. We discuss how recent advances in high-performance computing, combined with collections of large-scale data, enable the high-dimensional modelling we argue is critical to successful translation, and urge its adoption if the ultimate goal of impact on the lives of patients is to be achieved.
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Affiliation(s)
- Parashkev Nachev
- Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Geraint Rees
- Institute of Neurology, University College London, London, WC1N 3BG, UK
- Institute of Cognitive Neuroscience, University College London, London, WC1N 3AR, UK
- Faculty of Life Sciences, University College London, London, WC1E 6BT, UK
- Wellcome Trust Centre for Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Richard Frackowiak
- Institute of Neurology, University College London, London, WC1N 3BG, UK
- Ecole Polytechnique Federale de Lausanne - Faculty of Life Sciences, Blue Brain Project, Geneva, Switzerland
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13
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Abstract
Translation in cognitive neuroscience remains beyond the horizon, brought no closer by supposed major advances in our understanding of the brain. Unless our explanatory models descend to the individual level-a cardinal requirement for any intervention-their real-world applications will always be limited. Drawing on an analysis of the informational properties of the brain, here we argue that adequate individualisation needs models of far greater dimensionality than has been usual in the field. This necessity arises from the widely distributed causality of neural systems, a consequence of the fundamentally adaptive nature of their developmental and physiological mechanisms. We discuss how recent advances in high-performance computing, combined with collections of large-scale data, enable the high-dimensional modelling we argue is critical to successful translation, and urge its adoption if the ultimate goal of impact on the lives of patients is to be achieved.
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Affiliation(s)
- Parashkev Nachev
- Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Geraint Rees
- Institute of Neurology, University College London, London, WC1N 3BG, UK
- Institute of Cognitive Neuroscience, University College London, London, WC1N 3AR, UK
- Faculty of Life Sciences, University College London, London, WC1E 6BT, UK
- Wellcome Trust Centre for Neuroimaging, University College London, London, WC1N 3BG, UK
| | - Richard Frackowiak
- Institute of Neurology, University College London, London, WC1N 3BG, UK
- Ecole Polytechnique Federale de Lausanne - Faculty of Life Sciences, Blue Brain Project, Geneva, Switzerland
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14
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Liczbiński P, Bukowska B. Molecular mechanism of amygdalin action in vitro: review of the latest research. Immunopharmacol Immunotoxicol 2018; 40:212-218. [PMID: 29486614 DOI: 10.1080/08923973.2018.1441301] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Amygdalin, named as 'laetrile' and 'vitamin B-17' was initially supposed to be a safe drug for cancer treatment and was recognized by followers of natural medicine since it has been considered to be hydrolyzed only in cancer cells releasing toxic hydrogen cyanide (HCN), and thus destroying them. Unfortunately, current studies have shown that HCN is also released in normal cells, therefore it may not be safe for human organism. However, there have still been research works conducted on anti-cancer properties of this compound. In vitro experiments have shown induction of apoptosis by amygdalin as a result of increased expression of Bax protein and caspase-3 and reduced expression of antiapoptotic BcL-2protein. Amygdalin has also been shown to inhibit the adhesion of breast cancer cells, lung cancer cells and bladder cancer cells by decreased expression of integrin's, reduction of catenin levels and inhibition of the Akt-mTOR pathway, which may consequently lead to inhibition of metastases of cancer cells. It has also been revealed that amygdalin in renal cancer cells increased expression of p19 protein resulting in inhibition of cell transfer from G1-phase to S-phase, and thus inhibited cell proliferation. Other studies have indicated that amygdalin inhibits NF-kβ and NLRP3 signaling pathways, and consequently has anti-inflammatory effect due to reducing the expression of proinflammatory cytokines such as pro-IL-1β. Moreover, the effect of amygdalin on TGFβ/CTGF pathway, anti-fibrous activity and expression of follistatin resulting in activation of muscle cells growth has been reported. This compound might be applicable in the treatment of various cancer cell types.
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Affiliation(s)
- Przemysław Liczbiński
- a Department of Biophysics of Environmental Pollution, Faculty of Biology and Environmental Protection , University of Lodz , Lodz , Poland
| | - Bożena Bukowska
- a Department of Biophysics of Environmental Pollution, Faculty of Biology and Environmental Protection , University of Lodz , Lodz , Poland
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15
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Xu T, Rolf Jäger H, Husain M, Rees G, Nachev P. High-dimensional therapeutic inference in the focally damaged human brain. Brain 2018; 141:48-54. [PMID: 29149245 PMCID: PMC5837627 DOI: 10.1093/brain/awx288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/22/2017] [Accepted: 09/18/2017] [Indexed: 01/28/2023] Open
Abstract
See Thiebaut de Schotten and Foulon (doi:10.1093/brain/awx332) for a scientific commentary on this article.Though consistency across the population renders the extraordinarily complex functional anatomy of the human brain surveyable, the inverse inference-from common functional maps to individual behaviour-is constrained by marked individual deviation from the population mean. Such inference is fundamental to the evaluation of therapeutic interventions in focal brain injury, where the impact of an induced structural change in the brain is quantified by its behavioural consequences, inevitably refracted through the lens of lesion-outcome relations. Current therapeutic evaluations do not incorporate inferences to the individual outcome derived from a detailed specification of the lesion anatomy, relying only on reductive parameters such as lesion volume and crudely discretised location. Examining 1172 patients with anatomically registered focal brain lesions, here we show that such low-dimensional models are highly insensitive to therapeutic effects. In contrast, high-dimensional models supported by machine learning dramatically improve sensitivity by leveraging complex individuating patterns in the functional architecture of the brain. The failure to replicate in humans positive interventional effects in experimental animals is thus revealed to have a remediable inferential cause, forcing a radical re-evaluation of therapeutic inference in the human brain.
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Affiliation(s)
- Tianbo Xu
- Institute of Neurology, UCL, London, WC1N 3BG, UK
| | | | - Masud Husain
- Department of Clinical Neurology, University of Oxford, Oxford OX3 9DU, UK
- Institute of Cognitive Neuroscience, UCL, London WC1N 3AR, UK
| | - Geraint Rees
- Institute of Neurology, UCL, London, WC1N 3BG, UK
- Institute of Cognitive Neuroscience, UCL, London WC1N 3AR, UK
- Faculty of Life Sciences, UCL, London, WC1E 6BT, UK
- Wellcome Trust Centre for Neuroimaging, UCL, London WC1N 3BG, UK
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16
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Sun JB, Li Y, Cai YF, Huang Y, Liu S, Yeung PK, Deng MZ, Sun GS, Zilundu PL, Hu QS, An RX, Zhou LH, Wang LX, Cheng X. Scutellarin protects oxygen/glucose-deprived astrocytes and reduces focal cerebral ischemic injury. Neural Regen Res 2018; 13:1396-1407. [PMID: 30106052 PMCID: PMC6108207 DOI: 10.4103/1673-5374.235293] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Scutellarin, a bioactive flavone isolated from Scutellaria baicalensis, has anti-inflammatory, anti-neurotoxic, anti-apoptotic and anti-oxidative effects and has been used to treat cardiovascular and cerebrovascular diseases in China. However, the mechanisms by which scutellarin mediates neuroprotection in cerebral ischemia remain unclear. The interaction between scutellarin and nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2) was assessed by molecular docking study, which showed that scutellarin selectively binds to NOX2 with high affinity. Cultures of primary astrocytes isolated from the cerebral cortex of neonatal Sprague-Dawley rats were pretreated with 2, 10 or 50 μM scutellarin for 30 minutes. The astrocytes were then subjected to oxygen/glucose deprivation by incubation for 2 hours in glucose-free Dulbecco's modified Eagle's medium in a 95% N2/5% CO2 incubator, followed by simulated reperfusion for 22 hours. Cell viability was assessed by cell counting kit-8 assay. Expression levels of NOX2, connexin 43 and caspase-3 were assessed by western blot assay. Reactive oxygen species were measured spectrophotometrically. Pretreatment with 10 or 50 μM scutellarin substantially increased viability, reduced the expression of NOX2 and caspase-3, increased the expression of connexin 43, and diminished the levels of reactive oxygen species in astrocytes subjected to ischemia-reperfusion. We also assessed the effects of scutellarin in vivo in the rat transient middle cerebral artery occlusion model of cerebral ischemia-reperfusion injury. Rats were given intraperitoneal injection of 100 mg/kg scutellarin 2 hours before surgery. The Bederson scale was used to assess neurological deficit, and 2,3,5-triphenyltetrazolium chloride staining was used to measure infarct size. Western blot assay was used to assess expression of NOX2 and connexin 43 in brain tissue. Enzyme-linked immunosorbent assay was used to detect 8-hydroxydeoxyguanosine (8-OHdG), 4-hydroxy-2-nonenal (4-HNE) and 3-nitrotyrosin (3-NT) in brain tissue. Immunofluorescence double staining was used to determine the co-expression of caspase-3 and NeuN. Pretreatment with scutellarin improved the neurological function of rats with focal cerebral ischemia, reduced infarct size, diminished the expression of NOX2, reduced levels of 8-OHdG, 4-HNE and 3-NT, and reduced the number of cells co-expressing caspase-3 and NeuN in the injured brain tissue. Furthermore, we examined the effect of the NOX2 inhibitor apocynin. Apocynin substantially increased connexin 43 expression in vivo and in vitro. Collectively, our findings suggest that scutellarin protects against ischemic injury in vitro and in vivo by downregulating NOX2, upregulating connexin 43, decreasing oxidative damage, and reducing apoptotic cell death.
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Affiliation(s)
- Jing-Bo Sun
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
| | - Yan Li
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
| | - Ye-Feng Cai
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
| | - Yan Huang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
| | - Shu Liu
- Department of Anatomy, An Hui Medical University, Hefei, Anhui Province, China
| | - Patrick Kk Yeung
- Department of Biomedical Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Min-Zhen Deng
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
| | - Guang-Shun Sun
- Department of Preventive Medicine, School of Public Health, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Prince Lm Zilundu
- Guangzhou Department of Anatomy, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Qian-Sheng Hu
- Department of Preventive Medicine, School of Public Health, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Rui-Xin An
- Guangzhou Department of Anatomy, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Li-Hua Zhou
- Guangzhou Department of Anatomy, Zhong Shan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Li-Xin Wang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
| | - Xiao Cheng
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine; Department of Second Institute of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou, Guangdong Province, China
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17
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le Feber J, Erkamp N, van Putten MJAM, Hofmeijer J. Loss and recovery of functional connectivity in cultured cortical networks exposed to hypoxia. J Neurophysiol 2017; 118:394-403. [PMID: 28424292 DOI: 10.1152/jn.00098.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 01/13/2023] Open
Abstract
In the core of a brain infarct, loss of neuronal function is followed by neuronal death within minutes. In an area surrounding the core (penumbra), some perfusion remains. Here, neurons initially remain structurally intact, but massive synaptic failure strongly reduces neural activity. Activity in the penumbra may eventually recover or further deteriorate toward massive cell death. Besides activity recovery, return of brain functioning requires restoration of connectivity. However, low activity has been shown to initiate compensatory mechanisms that affect network connectivity. We investigated the effect of transient hypoxia and compensatory mechanisms on activity and functional connectivity using cultured cortical networks on multielectrode arrays. Networks were exposed to hypoxia of controlled depth (10-90% of normoxia) and duration (6-48 h). First, we determined how hypoxic depth and duration govern activity recovery. Then, we investigated connectivity changes during and after hypoxic incidents, mild enough for activity to recover. Shortly after hypoxia onset, activity and connectivity decreased. Following 4-6 h of ongoing hypoxia, we observed partial recovery. Only if the hypoxic burden was limited did connectivity show further recovery upon return to normoxia. Partial recovery during hypoxia was dominated by restored baseline connections, rather than newly formed ones. Baseline strengths of surviving (persisting or recovered) and lost connections did not differ nor did baseline activity at their "presynaptic" electrodes. However, "postsynaptic" electrodes of surviving connections were significantly more active during baseline than those of lost connections. This implies that recovery during hypoxia reflects an effective mechanism to restore network activity, which does not necessarily conserve prehypoxia connectivity.NEW & NOTEWORTHY Hypoxia reduced the firing rates of cultured neurons. Depending on hypoxic depth and duration, activity recovered during hypoxia and upon return to normoxia. Recovery (partial) during hypoxia was associated with restored baseline connections rather than newly formed ones. Predominantly, baseline connections with most active postsynaptic electrodes recovered, supporting the notion of effective activity homeostasis. This compensatory mechanism remained effective during ~20 h of hypoxia. Beyond 20 h of compensation, loss of activity and connectivity became irreversible.
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Affiliation(s)
- Joost le Feber
- Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands;
| | - Niels Erkamp
- Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Michel J A M van Putten
- Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.,Department of Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands; and
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
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18
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Wetterling F, Chatzikonstantinou E, Tritschler L, Meairs S, Fatar M, Schad LR, Ansar S. Investigating potentially salvageable penumbra tissue in an in vivo model of transient ischemic stroke using sodium, diffusion, and perfusion magnetic resonance imaging. BMC Neurosci 2016; 17:82. [PMID: 27927188 PMCID: PMC5143461 DOI: 10.1186/s12868-016-0316-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion magnetic resonance imaging (MRI) is the current-state-of-the-art technique to clinically investigate acute (0-24 h) ischemic stroke tissue. However, reduced apparent diffusion coefficient (ADC)-considered a marker of tissue damage-was observed to reverse spontaneously during the subacute stroke phase (24-72 h) which means that low ADC cannot be used to reflect the damaged tissue after 24 h in experimental and clinical studies. One reason for the change in ADC is that ADC values drop with cytotoxic edema (acute phase) and rise when vasogenic edema begins (subacute phase). Recently, combined 1H- and 23Na-MRI was proposed as a more accurate approach to improve delineation between reversible (penumbra) and irreversible ischemic injury (core). The aim of this study was to investigate the effects of reperfusion on the ADC and the sodium MRI signal after experimental ischemic stroke in rats in well-defined areas of different viability levels of the cerebral lesion, i.e. core and penumbra as defined via perfusion and histology. Transient middle cerebral artery occlusion was induced in male rats by using the intraluminal filament technique. MRI sodium, perfusion and diffusion measurement was recorded before reperfusion, shortly after reperfusion and 24 h after reperfusion. The animals were reperfused after 90 min of ischemia. RESULTS Sodium signal in core did not change before reperfusion, increased after reperfusion while sodium signal in penumbra was significantly reduced before reperfusion, but showed no changes after reperfusion compared to control. The ADC was significantly decreased in core tissue at all three time points compared to contralateral side. This decrease recovered above commonly applied viability thresholds in the core after 24 h. CONCLUSIONS Reduced sodium-MRI signal in conjunction with reduced ADC can serve as a viability marker for penumbra detection and complement hydrogen diffusion- and perfusion-MRI in order to facilitate time-independent assessment of tissue fate and cellular bioenergetics failure in stroke patients.
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Affiliation(s)
- Friedrich Wetterling
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany.,Trinity Institute of Neuroscience, University of Dublin, Dublin, Ireland
| | - Eva Chatzikonstantinou
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Laurent Tritschler
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.,CESP, INSERM UMRS1178, Faculté de Pharmacie, University Paris-Sud, Université Paris-Saclay, 92296, Chatenay-Malabry, France
| | - Stephen Meairs
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Fatar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Saema Ansar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany. .,Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University, Sölvegatan 17, BMC A13, 22184, Lund, Sweden.
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19
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Yang D, Jia W, Zhu YZ. Leonurine, a Potential Agent of Traditional Chinese Medicine: Recent Updates and Future Perspectives. Nat Prod Commun 2016. [DOI: 10.1177/1934578x1601101130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Herba Leonuri, also named Chinese Motherwort, has been extensively investigated as an effective agent on the uterus system. Our group has been studying the natural products of Herba Leonuri for several years, and during this period, many biological activities of the drug were recognized. Leonurine (4-guanidino- N-butyl-syringate) is an alkaloid present in Herba Leonuri. Recently, growing evidence has highlighted the therapeutic potential of leonurine in multiple diseases, especially cardiovascular. In this review, we discuss the biological activities of leonurine, as well as recent advances involving this alkaloid.
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Affiliation(s)
- Di Yang
- Shanghai Key Laboratory of Bioactive Small Molecules, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China, 201203
| | - Wanwan Jia
- Shanghai Key Laboratory of Bioactive Small Molecules, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China, 201203
| | - Yi Zhun Zhu
- Shanghai Key Laboratory of Bioactive Small Molecules, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China, 201203
- School of Pharmacy, Macau University of Science and Technology, Macau
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20
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Massol J, Zylberman M, Goehrs JM. Use of the Foreign Studies: Transposition of the Results, Prediction of the Therapeutic Effects in the French Population, Modelling of the Public Health Interest. Therapie 2016; 61:491-9. [PMID: 27393049 DOI: 10.2515/therapie:2007001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More and more frequently, the health authorities and the French assessment agencies are led to issue Marketing Authorizations (MAs), give opinions on the eligibility for reimbursement of drugs or to draft recommendations for clinical practice based on the results of foreign studies. The results of these studies are more or less difficult to transpose to French practice. These difficulties generate varying degrees of uncertainty concerning the effect to be expected of a drug. A more or less extensive loss of effect is sometimes even predictable. Some of the difficulties in transposition are discussed in this article and proposals for action are made in order to allow one, in the long term, to predict in the most precise manner possible the effects to be expected from a drug in the French population and be able to verify this prediction at an interval from its eligibility for reimbursement.
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Affiliation(s)
- Jacques Massol
- Centre Hospitalo Universitaire de Besançon, Hôpital Saint Jacques, Besançon, France
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21
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22
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Tang H, Tang Y, Li NG, Lin H, Li W, Shi Q, Zhang W, Zhang P, Dong Z, Shen M, Gu T, Duan JA. Comparative Metabolomic Analysis of the Neuroprotective Effects of Scutellarin and Scutellarein against Ischemic Insult. PLoS One 2015; 10:e0131569. [PMID: 26147971 PMCID: PMC4493097 DOI: 10.1371/journal.pone.0131569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/03/2015] [Indexed: 12/14/2022] Open
Abstract
For more than thirty years, scutellarin (Scu) has been used in China to clinically treat acute cerebral infarction and paralysis. Scutellarein (Scue), the major Scu metabolite in vivo, exhibits heightened neuroprotective effects when compared to Scu. To explore the neuroprotective role of these compounds, we performed ultra-high-performance liquid chromatography-quadrupole/time-of-flight mass spectrometry (UHPLC-QTOF/MS) coupled with a pattern recognition approach to investigate metabolomic differences in a rat model of ischemia after treatment with each compound. We examined metabolites in urine, hippocampal tissue, and plasma, and we tentatively identified 23 endogenous metabolites whose levels differed significantly between sham-operated and model groups. Upon pathway analysis, we found an additional 11 metabolic pathways in urine, 14 metabolic pathways in the hippocampal tissue, and 3 metabolic pathways in plasma. These endogenous metabolites were mainly involved in sphingolipid metabolism, lysine biosynthesis, and alanine, aspartate, and glutamate metabolism. We found that metabolic changes after ischemic injury returned to near-normal levels after Scue intervention, unlike Scu treatment, further validating the heightened protective effects exerted by Scue compared to Scu. These results demonstrate that Scue is a potential drug for treatment of ischemic insult.
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Affiliation(s)
- Hao Tang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Yuping Tang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
- * E-mail: (YT); (NGL); (JAD)
| | - Nian-Guang Li
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
- * E-mail: (YT); (NGL); (JAD)
| | - Hang Lin
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Weixia Li
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Qianping Shi
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Wei Zhang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Pengxuan Zhang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Zexi Dong
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Minzhe Shen
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Ting Gu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Jin-Ao Duan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
- * E-mail: (YT); (NGL); (JAD)
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23
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Liu FJ, Kaur P, Karolina DS, Sepramaniam S, Armugam A, Wong PTH, Jeyaseelan K. MiR-335 Regulates Hif-1α to Reduce Cell Death in Both Mouse Cell Line and Rat Ischemic Models. PLoS One 2015; 10:e0128432. [PMID: 26030758 PMCID: PMC4452242 DOI: 10.1371/journal.pone.0128432] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/27/2015] [Indexed: 01/25/2023] Open
Abstract
Hypoxia inducible factor-1α facilitates cellular adaptation to hypoxic conditions. Hence its tight regulation is crucial in hypoxia related diseases such as cerebral ischemia. Changes in hypoxia inducible factor-1α expression upon cerebral ischemia influence the expression of its downstream genes which eventually determines the extent of cellular damage. MicroRNAs are endogenous regulators of gene expression that have rapidly emerged as promising therapeutic targets in several diseases. In this study, we have identified miR-335 as a direct regulator of hypoxia inducible factor-1α and as a potential therapeutic target in cerebral ischemia. MiR-335 and hypoxia inducible factor-1α mRNA showed an inverse expression profile, both in vivo and in vitro ischemic conditions. Given the biphasic nature of hypoxia inducible factor-1α expression during cerebral ischemia, miR-335 mimic was found to reduce infarct volume in the early time (immediately after middle cerebral artery occlusion) of embolic stroke animal models while the miR-335 inhibitor appears to be beneficial at the late time of stroke (24 hrs after middle cerebral artery occlusion). Modulation of hypoxia inducible factor-1α expression by miR-335 also influenced the expression of crucial genes implicated in neurovascular permeability, cell death and maintenance of the blood brain barrier. These concerted effects, resulting in a reduction in infarct volume bring about a beneficial outcome in ischemic stroke.
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Affiliation(s)
- Fu Jia Liu
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
| | - Prameet Kaur
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
| | - Dwi S. Karolina
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
| | - Sugunavathi Sepramaniam
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
| | - Arunmozhiarasi Armugam
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
| | - Peter T. H. Wong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medical Drive, 117597, Singapore, Singapore
| | - Kandiah Jeyaseelan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 8 Medical Drive, 117597, Singapore, Singapore
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, 3800, Australia
- * E-mail:
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24
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Bello A, Wiebe N, Garg A, Tonelli M. Evidence-based decision-making 2: Systematic reviews and meta-analysis. Methods Mol Biol 2015; 1281:397-416. [PMID: 25694324 DOI: 10.1007/978-1-4939-2428-8_24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The number of studies published in the biomedical literature has dramatically increased over the last few decades. This massive proliferation of literature makes clinical medicine increasingly complex, and information from multiple studies is often needed to inform a particular clinical decision. However, available studies often vary in their design, methodological quality, populations studied and may define the research question of interest quite differently, which can make it challenging to synthesize their conclusions. In addition, since even highly cited trials may be challenged over time, clinical decision-making requires ongoing reconciliation of studies which provide different answers to the same question. Because it is often impractical for readers to track down and review all the primary studies, systematic reviews and meta-analyses are an important source of evidence on the diagnosis, prognosis, and treatment of any given disease. This chapter summarizes methods for conducting and reading systematic reviews and meta-analyses, as well as describing potential advantages and disadvantages of these publications.
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Affiliation(s)
- Aminu Bello
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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25
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Effects of tissue plasminogen activator timing on blood-brain barrier permeability and hemorrhagic transformation in rats with transient ischemic stroke. J Neurol Sci 2014; 347:148-54. [PMID: 25292413 DOI: 10.1016/j.jns.2014.09.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/23/2022]
Abstract
The goal of our study was to determine if the timing of the tissue plasminogen activator (tPA) administration influenced its effect on blood-brain barrier (BBB) permeability and the subsequent risk of hemorrhagic transformation. Thirty spontaneously hypertensive male rats were subjected to a 90-minute unilateral middle cerebral artery occlusion. Six rats did not receive tPA treatment (vehicle control: Group 0), intravenous tPA was administered immediately after reperfusion (Group 1) or 4h after reperfusion (Group 2). Dynamic contrast enhancement (DCE) and gradient-echo (GRE) MR sequences were used to assess the dynamic evolution of BBB permeability and hemorrhagic transformation changes at the following time points: during occlusion, and 3h, 6h, and 24h post reperfusion. In all groups, BBB permeability values in the ischemic tissue were low during occlusion. In Group 0, BBB permeability values increased at 3h after reperfusion (p=0.007, compared with the values during occlusion), and further at 6h after reperfusion (p=0.004, compared with those at 3h post reperfusion). At 24h post reperfusion, the values decreased to a level relative to but still higher than those during occlusion (p=0.025, compared with the values during occlusion). At 3h after reperfusion, BBB permeability values in the ischemic tissue increased, but to a greater extent in Group 1 than in Group 0 (p=0.034) and Group 2 (p=0.010). At 6h after reperfusion, BBB permeability values in the ischemic tissue increased further in Group 2 than in Group 0 (p=0.006) and Group 1 (p=0.001), while Group 1 exhibited BBB permeability that were still abnormal but less than those observed at 3h (p=0.001). Group 2 tended to have a higher hemorrhage incidence (36.4%, 4/11) than Group 1 (10.0%, 1/10, p=0.311) and Group 0 (0%), and hemorrhages occurred around 6h after reperfusion when BBB permeability values were the highest. Mortality was higher in Group 2 (63.6%, 7/11) than in Group 0 (0%) and Group 1 (10.0%, 1/10, p=0.024). The findings suggest that the timing of tPA administration is of importance for its impact on BBB permeability and subsequent risk of hemorrhagic transformation.
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Burton KR, Dhanoa D, Aviv RI, Moody AR, Kapral MK, Laupacis A. Perfusion CT for selecting patients with acute ischemic stroke for intravenous thrombolytic therapy. Radiology 2014; 274:103-14. [PMID: 25243539 DOI: 10.1148/radiol.14140728] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine rates of death, disability, and symptomatic intracranial hemorrhage ( SICH symptomatic ICH ) among patients with acute ischemic stroke selected for thrombolytic therapy by using perfusion computed tomography (CT) by conducting a systematic review and meta-analysis. MATERIALS AND METHODS A search of the literature up to July 2012 was performed by using MEDLINE, EMBASE, the Cochrane Library, PubMed, and Google Scholar on terms including "brain ischemia" and "perfusion imaging." The search was unrestricted by language of publication. Two reviewers extracted study data and independently assessed the risk of study bias. Outcomes of patients selected by using perfusion CT, including case-fatality rate, favorable outcome (modified Rankin Scale [ mRS modified Rankin Scale ] score, ≤2), and rates of SICH symptomatic ICH , were estimated. RESULTS Thirteen experimental or observational studies that included patients who received intravenous thrombolytic treatment after perfusion CT were identified. The methodologic quality of the small studies was generally good. Overall, 90-day mortality was 10.0% (95% confidence interval [ CI confidence interval ]: 5.4%, 15.9%). Among patients treated within 3 hours of symptom onset, mortality was 12.5% (95% CI confidence interval : 6.7%, 19.7%), a favorable outcome ( mRS modified Rankin Scale score, ≤2) was seen in 42.5% of patients (95% CI confidence interval : 16.6%, 70.9%), and the SICH symptomatic ICH rate was 3.3% (95% CI confidence interval : 0.7%, 7.7%). Among patients treated more than 3 hours after symptom onset, mortality was 2.9% (95% CI confidence interval : 0.0%, 12.7%), 69.9% of patients (95% CI confidence interval : 0%, 83.5%) had a favorable outcome, and the SICH symptomatic ICH rate was 3.9% (95% CI confidence interval : 0.8%, 9.2%). CONCLUSION The outcomes (mortality, morbidity, and SICH symptomatic ICH rates) for patients selected with perfusion CT to receive intravenous thrombolytic treatment more than 3 hours after symptom onset appear favorable.
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Affiliation(s)
- Kirsteen R Burton
- From the Institute for Health Policy, Management and Evaluation (K.R.B., M.K.K., A.L.), Department of Medical Imaging (K.R.B., R.I.A., A.R.M.), Institute of Medical Sciences (R.I.A., A.R.M.), and Department of Medicine (M.K.K., A.L.), University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, Canada M5T 1W7; Department of Medical Imaging, Fraser Health Authority, Vancouver, British Columbia, Canada (D.D.); Department of Medical Imaging, University of British Columbia, Vancouver, British Columbia, Canada (D.D.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (M.K.K.); and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (A.L.)
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Yang C, Li X, Rong J. Amygdalin isolated from Semen Persicae (Tao Ren) extracts induces the expression of follistatin in HepG2 and C2C12 cell lines. Chin Med 2014; 9:23. [PMID: 25237385 PMCID: PMC4167460 DOI: 10.1186/1749-8546-9-23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/08/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The Chinese medicine formulation ISF-1 (also known as Bu-Yang-Huan-Wu-Tang) for post-stroke rehabilitation could increase the expression of growth-regulating protein follistatin by approximately 4-fold. This study aims to identify the active compounds of ISF-1 for the induction of follistatin expression. METHODS Active compounds in ISF-1 responsible for induction of follistatin were identified by a bioactivity-guided fractionation procedure involving liquid-liquid extraction, HPLC separation and RT-PCR detection. The aqueous extracts of seven ISF-1 ingredients including Semen Persicae (Tao Ren) and the S. Persicae-derived fractions were assayed for the induction of follistatin mRNA expression in human hepatocarcinoma HepG2 cells by RT-PCR. The concentrations of isolated compounds were proportionally normalized to the reported IC50 concentration (5.8 mg/mL) of the formulation ISF-1 in HepG2. The active fractions were characterized by reverse-phase HPLC on a C18 column and identified by mass spectrometry. RESULTS Three ingredients of ISF-1, namely S. Persicae (Tao Ren), Pheretima (Di Long), and Flos Carthami (Hong Hua), induced the expression of follistatin mRNA. Among these, the ingredient S. Persicae were the most active, and amygdalin from S. Persicae extract was identified as a novel follistatin inducer. Amygdalin stimulated the growth of skeletal muscle cell line C2C12 cells in a concentration-dependent manner. CONCLUSIONS Amygdalin isolated from S. Persicae extract in ISF-1 through a bioactivity-guided fractionation procedure induced the expression of follistatin in HepG2 and C2C12 cell lines.
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Affiliation(s)
- Chuanbin Yang
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China
| | - Xuechen Li
- Department of Chemistry, The University of Hong Kong, Hong Kong, China
| | - Jianhui Rong
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China
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Abstract
BACKGROUND Most strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred and improve recovery after stroke in some people. Thrombolytic drugs, however, can also cause serious bleeding in the brain, which can be fatal. One drug, recombinant tissue plasminogen activator (rt-PA), is licensed for use in selected patients within 4.5 hours of stroke in Europe and within three hours in the USA. There is an upper age limit of 80 years in some countries, and a limitation to mainly non-severe stroke in others. Forty per cent more data are available since this review was last updated in 2009. OBJECTIVES To determine whether, and in what circumstances, thrombolytic therapy might be an effective and safe treatment for acute ischaemic stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched November 2013), MEDLINE (1966 to November 2013) and EMBASE (1980 to November 2013). We also handsearched conference proceedings and journals, searched reference lists and contacted pharmaceutical companies and trialists. SELECTION CRITERIA Randomised trials of any thrombolytic agent compared with control in people with definite ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors applied the inclusion criteria, extracted data and assessed trial quality. We verified the extracted data with investigators of all major trials, obtaining additional unpublished data if available. MAIN RESULTS We included 27 trials, involving 10,187 participants, testing urokinase, streptokinase, rt-PA, recombinant pro-urokinase or desmoteplase. Four trials used intra-arterial administration, while the rest used the intravenous route. Most data come from trials that started treatment up to six hours after stroke. About 44% of the trials (about 70% of the participants) were testing intravenous rt-PA. In earlier studies very few of the participants (0.5%) were aged over 80 years; in this update, 16% of participants are over 80 years of age due to the inclusion of IST-3 (53% of participants in this trial were aged over 80 years). Trials published more recently utilised computerised randomisation, so there are less likely to be baseline imbalances than in previous versions of the review. More than 50% of trials fulfilled criteria for high-grade concealment; there were few losses to follow-up for the main outcomes.Thrombolytic therapy, mostly administered up to six hours after ischaemic stroke, significantly reduced the proportion of participants who were dead or dependent (modified Rankin 3 to 6) at three to six months after stroke (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.78 to 0.93). Thrombolytic therapy increased the risk of symptomatic intracranial haemorrhage (OR 3.75, 95% CI 3.11 to 4.51), early death (OR 1.69, 95% CI 1.44 to 1.98; 13 trials, 7458 participants) and death by three to six months after stroke (OR 1.18, 95% CI 1.06 to 1.30). Early death after thrombolysis was mostly attributable to intracranial haemorrhage. Treatment within three hours of stroke was more effective in reducing death or dependency (OR 0.66, 95% CI 0.56 to 0.79) without any increase in death (OR 0.99, 95% CI 0.82 to 1.21; 11 trials, 2187 participants). There was heterogeneity between the trials. Contemporaneous antithrombotic drugs increased the risk of death. Trials testing rt-PA showed a significant reduction in death or dependency with treatment up to six hours (OR 0.84, 95% CI 0.77 to 0.93, P = 0.0006; 8 trials, 6729 participants) with significant heterogeneity; treatment within three hours was more beneficial (OR 0.65, 95% CI 0.54 to 0.80, P < 0.0001; 6 trials, 1779 participants) without heterogeneity. Participants aged over 80 years benefited equally to those aged under 80 years, particularly if treated within three hours of stroke. AUTHORS' CONCLUSIONS Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial haemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up). Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracranial haemorrhage and deaths, and to identify the environment in which thrombolysis may best be given in routine practice.
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Affiliation(s)
- Joanna M Wardlaw
- University of EdinburghCentre for Clinical Brain SciencesThe Chancellor's Building49 Little France CrescentEdinburghUKEH16 4SB
| | - Veronica Murray
- Danderyd HospitalDepartment of Clinical Sciences, Karolinska InstitutetStockholmSwedenSE‐182 88
| | - Eivind Berge
- Oslo University HospitalDepartment of Internal MedicineOsloNorwayNO‐0407
| | - Gregory J del Zoppo
- University of WashingtonDepartment of Medicine (Division of Hematology), Department of Neurology325 Ninth AvenueBox 359756SeattleWashingtonUSA98104
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Wang GH, Lan R, Zhen XD, Zhang W, Xiang J, Cai DF. An-Gong-Niu-Huang Wan protects against cerebral ischemia induced apoptosis in rats: up-regulation of Bcl-2 and down-regulation of Bax and caspase-3. JOURNAL OF ETHNOPHARMACOLOGY 2014; 154:156-162. [PMID: 24690773 DOI: 10.1016/j.jep.2014.03.057] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/20/2014] [Accepted: 03/22/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The An-Gong-Niu-Huang Wan (AGNH), a Chinese traditional medicine, has been used for treatment of cerebral diseases for centuries in China and other Asian countries, and is approved by the State Food and Drug Administration of China for the treatment of stroke. The aim of present study is to test the neuroprotective effects of AGNH on cerebral ischemia in rats and to explore the underlying mechanisms. MATERIALS AND METHODS 75 Male Sprague-Dawley rats were randomly divided into 5 groups: sham, ischemia-reperfusion (I/R), and I/R plus 0.065 g/kg/d AGNH, 0.125 g/kg/d AGNH and 0.25 g/kg/d AGNH. Cerebral ischemia was induced by 1.5h of middle cerebral artery occlusion (MCAO). Neurological functional deficits were evaluated according to Zea longa׳s score, cerebral infarct area was measured by tetrazolium staining. Cell injury and apoptosis were assessed by Nissl staining and DNA fragmentation assay. The expression of Bax, Bcl-2 and caspase-3 were analyzed by Western blot. RESULTS Rats subjected to MCAO exhibited worsened neurological score, infarct area, cell damage and apoptosis. These were all attenuated by AGNH (0.125 and 0.25 g/kg/d). Moreover, AGNH reversed cerebral ischemia induced decreases in Bcl-2 expression and increases in Bax and caspase-3 expression. CONCLUSIONS These results suggest that AGNH exerts neuroprotective effects, and the neuroprotection is likely to relate to depressed Bax/Bcl-2 ratio and caspase-3 level, leading to inhibition of apoptotic cell death.
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Affiliation(s)
- Guo-Hua Wang
- Department of Integrative Medicine, Zhongshan Hospital, and Laboratory of Neurology, Institute of Integrative Medicine, Fudan University, Shanghai 200032, China
| | - Rui Lan
- Department of Integrative Medicine, Zhongshan Hospital, and Laboratory of Neurology, Institute of Integrative Medicine, Fudan University, Shanghai 200032, China
| | - Xin-De Zhen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wen Zhang
- Department of Integrative Medicine, Zhongshan Hospital, and Laboratory of Neurology, Institute of Integrative Medicine, Fudan University, Shanghai 200032, China
| | - Jun Xiang
- Department of Integrative Medicine, Zhongshan Hospital, and Laboratory of Neurology, Institute of Integrative Medicine, Fudan University, Shanghai 200032, China; Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Ding-Fang Cai
- Department of Integrative Medicine, Zhongshan Hospital, and Laboratory of Neurology, Institute of Integrative Medicine, Fudan University, Shanghai 200032, China.
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Paul CL, Levi CR, D'Este CA, Parsons MW, Bladin CF, Lindley RI, Attia JR, Henskens F, Lalor E, Longworth M, Middleton S, Ryan A, Kerr E, Sanson-Fisher RW. Thrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice--protocol for a cluster randomised controlled trial in acute stroke care. Implement Sci 2014; 9:38. [PMID: 24666591 PMCID: PMC4016636 DOI: 10.1186/1748-5908-9-38] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/24/2014] [Indexed: 11/22/2022] Open
Abstract
Background Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke. Objectives To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months. Methods and design A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS <2) and the proportion with intracranial haemorrhage (mRS ≥2), compared to international benchmarks. Discussion TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613000939796
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Affiliation(s)
- Christine L Paul
- The University of Newcastle, (UoN) University Drive, Callaghan, NSW 2308, Australia.
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Neuroprotective Effect of Diphenyl Diselenide in a Experimental Stroke Model: Maintenance of Redox System in Mitochondria of Brain Regions. Neurotox Res 2014; 26:317-30. [DOI: 10.1007/s12640-014-9463-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/21/2014] [Indexed: 01/07/2023]
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Domingues-Montanari S, Mendioroz M, del Rio-Espinola A, Fernández-Cadenas I, Montaner J. Genetics of stroke: a review of recent advances. Expert Rev Mol Diagn 2014; 8:495-513. [DOI: 10.1586/14737159.8.4.495] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Liu DM, Wang ZH, Liu L, Zhang XM, Lou FL. Acetylpuerarin increases cell viability and reduces apoptosis in rat hippocampal neurons following oxygen‑glucose deprivation/reperfusion. Mol Med Rep 2013; 8:1453-9. [PMID: 24026460 DOI: 10.3892/mmr.2013.1671] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/30/2013] [Indexed: 11/06/2022] Open
Abstract
The effects of acetylpuerarin treatment following oxygen-glucose deprivation/reperfusion (OGD/R) were examined in rat hippocampal neurons in vitro and compared with the effects of acetylpuerarin in normoxic cells to confirm acetylpuerarin's potential neuroprotective effects, including apoptosis inhibition. Wistar rat embryo hippocampal cells (day 18, E18) cultured for 8 days were subjected to 3 h OGD treatment, followed by reperfusion for 12, 24 or 36 h. For each time interval, a group of cells was left untreated (OGD/R-only groups) and treated with 0.1, 0.4 and 1.6 µM acetylpuerarin (OGD/R+acetylpuerarin). Neuron viability, apoptosis and caspase-8 and -3 activities were assessed by the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), 4',6-diamidino-2-phenylindole (DAPI) and terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling (TUNEL) and spectrophotometric assays, respectively. Fas-ligand (Fas-L), Fas-associated death domain (FADD) and tumor necrosis factor-α (TNF-α) were determined by western blot analysis. Compared with control cells, OCD/R+acetylpuerarin cells treated with 0.1, 0.4 and 1.6 µM doses showed a concentration-dependent increase in hippocampal cell survival and viability by 69.93 ± 2.28%, 81.49 ± 2.13% and 85.28 ± 2.38% at 12 h, 68.59 ± 3.02%, 77.85 ± 2.84% and 85.64 ± 4.39% at 24 h and 69.70 ± 1.70%, 77.21 ± 3.21% and 83.90 ± 2.12% at 36 h (P<0.05). Furthermore, OCD/R+acetylpuerarin cells exhibited a dose-dependent decrease in caspase-8 and -3 activation, TUNEL and DAPI-positive neurons and Fas-L, FADD and TNF-α expression. In conclusion, acetylpuerarin protects against OGD/R-induced neuronal apoptosis predominantly in the first 24 h following ischemia, which may be useful in mediating neuronal apoptosis in ischemic stroke patients.
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Affiliation(s)
- Dong-Mei Liu
- School of Nursing, Shandong University, Jinan, Shandong 250012, P.R. China
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DePaula KM, deLaforcade AM, King RG, Hughs H, Boudrieau RJ. Arterial thrombosis after vehicular trauma and humeral fracture in a dog. J Am Vet Med Assoc 2013; 243:394-8. [DOI: 10.2460/javma.243.3.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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microRNAs Involved in Regulating Spontaneous Recovery in Embolic Stroke Model. PLoS One 2013; 8:e66393. [PMID: 23823624 PMCID: PMC3688919 DOI: 10.1371/journal.pone.0066393] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 05/05/2013] [Indexed: 12/31/2022] Open
Abstract
To date, miRNA expression studies on cerebral ischemia in both human and animal models have focused mainly on acute phase of ischemic stroke. In this study, we present the roles played by microRNAs in the spontaneous recovery phases in cerebral ischemia using rodent stroke models. Brain tissues were harvested at different reperfusion time points ranging from 0–168 hrs after middle cerebral artery occlusion using homologous emboli. MiRNA and mRNA expression profiles were investigated by microarray followed by multiple statistical analysis. Candidate transcripts were also validated by quantitative RT-PCR. Three specific groups of miRNAs were observed among a total of 346 differentially expressed miRNAs. miRNAs, miR-21, -142-3p, -142-5p, and -146a displayed significant upregulation during stroke recovery (48 hrs to 168 hrs) compared with those during acute phases (0 hrs to 24 hrs). On the other hand, an opposite trend was observed in the expression of miR-196a/b/c, -224 and -324-3p. Interestingly, miR-206, -290, -291a-5p and -30c-1*, positively correlated with the infarct sizes, with an initial increase up to 24hrs followed by a gradual decrease from 48 hrs to 168 hrs (R = 0.95). Taken together with the expression levels of corresponding mRNA targets, we have also found that Hedgehog, Notch, Wnt and TGF-β signaling pathways could play significant roles in stroke recovery and especially in neuronal repair.
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Molecular cloning and functional expression of a fibrinolytic protease gene from the polychaeta, Periserrula leucophryna. BIOTECHNOL BIOPROC E 2013. [DOI: 10.1007/s12257-012-0800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sun X, Lai R, Li J, Luo M, Wang Y, Sheng W. The -7351C/T polymorphism in the TPA gene and ischemic stroke risk: a meta-analysis. PLoS One 2013; 8:e53558. [PMID: 23326456 PMCID: PMC3541142 DOI: 10.1371/journal.pone.0053558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
Background A number of studies assessed the association of tissue plasminogen activator(TPA) gene polymorphisms with ischemic stroke, but the results were contradictory. We aimed to explore the role of TPA -7351C/T SNP in the susceptibility to ischemic stroke through a meta-analysis. Methods The PubMed, MEDLINE, EMBASE, China Biological Medicine Database and WANFANG DATA databases were searched until August 2012. The strict selection criteria and exclusion criteria were determined, and odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of associations. Stroke subtype was determined using Trial of Org 10172 in Acute Treatment criteria (TOAST). Statistical analyses were performed using the STATA12.0 software. Results A total of 2,299 ischemic stroke cases and 1,948 controls in seven case-control studies were included in the meta-analysis. Significant association between -7351C/T polymorphism in the TPA gene and ischemic stroke was observed in all comparison models (TT+CT versus CC, TT versus CT+CC and T versus C). In the subgroup analysis by ethnicity, TT homozygote carriers had a 142% increased risk of ischemic stroke compared with the C allele carriers among East-Asians (TT versus CT+CC: OR = 2.42, 95% CI = 1.07–5.48), but not in South-Asians and Caucasians, and significantly increased risks were found for T versus C among both East-Asians (OR = 1.33, 95% CI = 1.05–1.68) and Caucasians(OR = 1.16, 95% CI = 1.02–1.31). Further stratification for stroke subtype in three Caucasian studies showed the association between -7351C/T polymorphism and Large-artery atherosclerosis (LAA), but not Small-vessel occlusion (SVO) and Cardioembolism (CE). Conclusions This meta-analysis suggested that the -7351C/T polymorphism in TPA gene would be a risk factor for ischemic stroke, especially among East-Asians compared with Caucasians, but not in South-Asians, and it may play a role in the pathogenesis of LAA in Caucasians, but not in SVO and CE.
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Affiliation(s)
- Xunsha Sun
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Rong Lai
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jiaoxing Li
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Man Luo
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yufang Wang
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wenli Sheng
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- * E-mail:
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DeMers G, Meurer WJ, Shih R, Rosenbaum S, Vilke GM. Tissue Plasminogen Activator and Stroke: Review of the Literature for the Clinician. J Emerg Med 2012; 43:1149-54. [DOI: 10.1016/j.jemermed.2012.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/04/2012] [Indexed: 11/25/2022]
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El Amki M, Lerouet D, Coqueran B, Curis E, Orset C, Vivien D, Plotkine M, Marchand-Leroux C, Margaill I. Experimental modeling of recombinant tissue plasminogen activator effects after ischemic stroke. Exp Neurol 2012; 238:138-44. [DOI: 10.1016/j.expneurol.2012.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/26/2012] [Accepted: 08/07/2012] [Indexed: 10/28/2022]
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Pluta R, Furmaga-Jabłońska W, Jabłoński M. Therapeutic food benefits after ischemic brain edema. Nutrition 2012; 28:1192-3. [PMID: 22858196 DOI: 10.1016/j.nut.2012.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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Qi H, Chen B, Le XC, Rong J. Concomitant Induction of Heme Oxygenase-1 Attenuates the Cytotoxicity of Arsenic Species from Lumbricus Extract in Human Liver HepG2 Cells. Chem Biodivers 2012; 9:739-54. [DOI: 10.1002/cbdv.201100133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Adams RJ, Debenham E, Chalela J, Chimowitz M, Hays A, Hill C, Holmstedt C, Jauch E, Kitch A, Lazaridis C, Turan TN. REACH MUSC: A Telemedicine Facilitated Network for Stroke: Initial Operational Experience. Front Neurol 2012; 3:33. [PMID: 22435064 PMCID: PMC3303157 DOI: 10.3389/fneur.2012.00033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 02/19/2012] [Indexed: 11/13/2022] Open
Abstract
REACH Medical University of South Carolina (MUSC) provides stroke consults via the internet in South Carolina. From May 2008 to April 2011 231 patients were treated with intravenous (IV) thrombolysis and 369 were transferred to MUSC including 42 for intra-arterial revascularization [with or without IV tissue plasminogen activator (tPA)]. Medical outcomes and hemorrhage rates, reported elsewhere, were good (Lazaridis et al., 2011). Here we report operational features of REACH MUSC which covers 15 sites with 2,482 beds and 471,875 Emergency Department (ED) visits per year. Eight Academic Faculty from MUSC worked with 165 different physicians and 325 different nurses in the conduct of 1085 consults. For the 231 who received tPA, time milestones (in minutes) were: Onset to Door: 62 (mean), 50 (median); Door to REACH Consult: 43 and 33, Consult Request to Consult Start: was 9 and 7, Consult Start to tPA Decision: 31 and 25; Decision to Infusion: 20 and 14, and total Door to Needle: 98 and 87. The comparable times for the 854 not receiving tPA were: Onset to Door: 140 and 75; Door to REACH Consult: 61 and 41; Consult Request to Consult Start: 9 and 7, Consult Start to tPA Decision: 27 and 23. While the consultants respond to consult requests in <10, there is a long delay between arrival and Consult request. Tracking of operations indicates if we target shortening Door to Call time and time from tPA decision to start of drug infusion we may be able to improve Door to Needle times to target of <60. The large number of individuals involved in the care of these patients, most of whom had no training in REACH usage, will require novel approaches to staff education in ED based operations where turnover is high. Despite these challenges, this robust system delivered tPA safely and in a high fraction of patients evaluated using the REACH MUSC system.
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Affiliation(s)
- Robert J Adams
- Department of Neurosciences, Medical University of South Carolina Charleston, SC, USA
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Cerebroprotective effects of TAK-937, a cannabinoid receptor agonist, on ischemic brain damage in middle cerebral artery occluded rats and non-human primates. Brain Res 2012; 1430:93-100. [DOI: 10.1016/j.brainres.2011.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/13/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
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Amici S, Paciaroni M, Agnelli G, Caso V. Gene-drug interaction in stroke. Stroke Res Treat 2011; 2011:212485. [PMID: 22135769 PMCID: PMC3216369 DOI: 10.4061/2011/212485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/05/2011] [Accepted: 09/02/2011] [Indexed: 01/09/2023] Open
Abstract
Stroke is the third cause of mortality and one of most frequent causes of long-term neurological disability, as well as a complex disease that results from the interaction of environmental and genetic factors. The focus on genetics has produced a large number of studies with the objective of revealing the genetic basis of cerebrovascular diseases. Furthermore, pharmacogenetic research has investigated the relation between genetic variability and drug effectiveness/toxicity. This review will examine the implications of pharmacogenetics of stroke; data on antihypertensives, statins, antiplatelets, anticoagulants, and recombinant tissue plasminogen activator will be illustrated.
Several polymorphisms have been studied and some have been associated with positive drug-gene interaction on stroke, but the superiority of the genotype-guided approach over the clinical approach has not been proved yet; for this reason, it is not routinely recommended.
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Affiliation(s)
- Serena Amici
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 Perugia, Italy
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Qi J, Hong ZY, Xin H, Zhu YZ. Neuroprotective effects of leonurine on ischemia/reperfusion-induced mitochondrial dysfunctions in rat cerebral cortex. Biol Pharm Bull 2011; 33:1958-64. [PMID: 21139233 DOI: 10.1248/bpb.33.1958] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ischemic brain is particularly susceptible to free radicals mediated secondary neuronal damage, especially mitochondrial dysfunctions. Chinese Herbal Medicine with antioxidant properties is believed to have potential therapeutic effect. Leonurine, an alkaloid present in Herba Leonuri (HL), has shown biological effects such as antioxidant, anticoagulant, anti-apoptosis and protection against ischemic heart disease. In this study, neuroprotective effects of leonurine against cerebral ischemia/reperfusion-induced mitochondrial dysfunctions in cortex were evaluated. We used transient rat middle cerebral artery occlusion (MCAO) model of brain ischemia. The rats were treated with their respective treatments for 1 week prior to the MCAO. We found that leonurine significantly improved neurological outcome and reduced ischemia/reperfusion (I/R)-induced cerebral infarction 24 h after MCAO. Leonurine decreased reactive oxygen species (ROS) level in mitochondria isolated from ischemic cortex, which was increased by MCAO. Terminal deoxyuridine triphosphate (dUTP) Nick-End Labeling (TUNEL) staining showed anti-apoptotic effect of leonurine on ischemic cortex. Western blot analysis showed a marked decrease in the expression of Bax and an increase of Bcl-2 as a result of leonurine treatment. The attenuation of mitochondrial membrane swelling, restore of mitochondrial membrane potential and content of cytochrome c (Cyt-C) in mitochondria isolated from ischemic cortex could also be observed in leonurine treated group. The findings of this study suggest that leonurine has promising therapeutic effect for ischemic stroke treatment through antioxidant and anti-apoptotic mechanisms.
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Affiliation(s)
- Jia Qi
- Department of Pharmacology, Institute of Biomedical Sciences, Fudan University, Shanghai, China
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Marder VJ. Historical perspective and future direction of thrombolysis research: the re-discovery of plasmin. J Thromb Haemost 2011; 9 Suppl 1:364-73. [PMID: 21781273 DOI: 10.1111/j.1538-7836.2011.04370.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Two issues have held the focus of thrombolysis research for over 50 years, namely, choosing between a plasminogen activator (PA) or plasmin as the best therapeutic agent and choosing between systemic or local administration. The original plasmin product of the 1950s was both ineffective and contaminated with PA, and catheter technology was not yet developed for routine clinical use. For decades, clinical practice has focused on PA and systemic administration, but today, PAs are often administered by catheter into thrombosed vessels, notably for peripheral arterial and graft occlusion and deep vein thrombosis, and increasingly for acute ischaemic stroke. Despite using catheter-delivered therapy, bleeding complications still occur, most severely expressed as symptomatic intracranial haemorrhage. New experimental data indicate that we should now reconsider plasmin as a viable, even preferable, thrombolytic agent. Plasmin requires catheter delivery to achieve thrombolysis, but this technical issue has been solved with modern technology and widespread presence of interventional suites. After local administration, plasmin will lyse thrombi; thereafter, any plasmin in the circulation will be rapidly neutralised. Pre-clinical studies confirm that plasmin has marked haemostatic safety advantage over t-PA. After more than 50 years, the field has come full circle, and plasmin as the thrombolytic agent and catheter use for local delivery of agent may represent a step forward in thrombolytic therapy.
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Affiliation(s)
- V J Marder
- Division of Hematology and Medical Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Bello AK, Wiebe N, Garg AX, Tonelli M. Basics of systematic reviews and meta-analyses for the nephrologist. Nephron Clin Pract 2011; 119:c50-60; discussion c61. [PMID: 21677439 DOI: 10.1159/000324432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Renal practitioners are expected to apply the best available evidence from rigorous scientific research to clinical decision-making and also for policy-making for those involved. Advances in information technology and unprecedented access to data have simplified the process for the search of best available evidence to guide practice. However, it is challenging to cope with the increasing volume of publications in nephrology and other areas of medicine. Accordingly, systematic reviews and meta-analysis have greatly facilitated best practice and effective clinical decision-making. Conducting a systematic review/meta-analysis involves a number of steps that start with protocol development and research question formulation, design and study selection criteria, followed by retrieval of potentially relevant studies, selection of those studies to be included and evaluation of a study's risk of bias. Systematic reviews and meta-analyses have both strengths and weaknesses. Many of the perceived limitations of meta-analysis are not inherent in the methodology, but actually represent deficits in the conduct or reporting of individual primary studies. With the continuous proliferation of published renal clinical studies, such publications will continue to be an important resource for clinicians and researchers in nephrology. It is therefore important for nephrologists to keep abreast of developments in this field, which requires some knowledge about how these studies are conducted, reported and how to appraise them for application to clinical practice or policy-making.
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Affiliation(s)
- Aminu K Bello
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
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Zhang H, Wang ZQ, Zhao DY, Zheng DM, Feng J, Song LC, Luo Y. AIF-mediated mitochondrial pathway is critical for the protective effect of diazoxide against SH-SY5Y cell apoptosis. Brain Res 2011; 1370:89-98. [DOI: 10.1016/j.brainres.2010.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/02/2010] [Accepted: 11/05/2010] [Indexed: 02/01/2023]
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Furlan AJ, Sharma J, Higashida R. Intraarterial Thrombolysis in Acute Ischemic Stroke. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhou ZY, Tang YP, Xiang J, Wua P, Jin HM, Wang Z, Mori M, Cai DF. Neuroprotective effects of water-soluble Ganoderma lucidum polysaccharides on cerebral ischemic injury in rats. JOURNAL OF ETHNOPHARMACOLOGY 2010; 131:154-164. [PMID: 20600765 DOI: 10.1016/j.jep.2010.06.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 05/24/2010] [Accepted: 06/14/2010] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY To investigate the neuroprotective effects of water-soluble Ganoderma lucidum polysaccharides (GLPS) on cerebral ischemic injury in rats, and to explore the involved mechanisms. MATERIALS AND METHODS Two models [middle cerebral artery occlusion (MCAO) in Sprague-Dawley (SD) rats and oxygen and glucose deprivation (OGD) in primary cultured rat cortical neurons] were employed to mimic ischemia-reperfusion (I/R) damage, in vivo and in vitro, respectively. Cerebral infarct area was measured by tetrazolium staining, and neurological functional deficits were assessed at 24h after I/R. Neuronal apoptosis was studied by Nissl staining and DNA fragmentation assay. Neuronal injury was assessed by morphological examination using phase-contrast microscopy and quantified by measuring the amount of lactate dehydrogenase (LDH) leakage, cell viability was measured by sodium 3'-1- (phenylaminocarbonyl)-3, 4-tetrazolium-bis (4-methoxy-6-nitro) benzene sulfonic acid (XTT) reduction. Neuronal apoptosis was determined by flow cytometry, and electron microscopy was used to study morphological changes of neurons. Caspase-3, -8 and -9 activation and Bcl-2, Bax protein expression were determined by western blot analysis. RESULTS Oral administration of GLPS (100, 200 and 400mg/kg) significantly reduced cerebral infarct area, attenuated neurological functional deficits, and reduced neuronal apoptosis in ischemic cortex. In OGD model, GLSP (0.1, 1 and 10 microg/ml) effectively reduced neuronal cell death and relieved cell injury. Moreover, GLPS decreased the percentage of apoptotic neurons, relieved neuronal morphological damage, suppressed overexpression of active caspases-3, -8 and -9 and Bax, and inhibited the reduction of Bcl-2 expression. CONCLUSIONS Our findings indicate that GLPS protects against cerebral ischemic injury by inhibiting apoptosis by downregulating caspase-3 activation and modulating the Bcl-2/Bax ratio.
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Affiliation(s)
- Zi-Yi Zhou
- Laboratory of Neurology, Institute of Integrative Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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