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Sun Y, Zhong Q, Hou Y, Liu X, Yan M, Zhou L, Liu S, Hong S, He J. Effect of DU meridian acupuncture and temporal three-needle on vascular protection mechanisms in patients with acute cerebral infarction: a randomized controlled evaluator-blinded clinical trial. Front Neurol 2025; 16:1528340. [PMID: 40260140 PMCID: PMC12009876 DOI: 10.3389/fneur.2025.1528340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 03/26/2025] [Indexed: 04/23/2025] Open
Abstract
Background The incidence of acute ischemic stroke has been rising steadily in China and globally, with its high mortality and disability rates significantly affecting quality of life. As an important adjunct therapy, acupuncture has been widely implemented in stroke management. Emerging studies have investigated the effects of DU meridian and Chong Mai acupuncture on ischemic hemiparesis; however, the vascular protective mechanisms of electroacupuncture therapy targeting these meridians require further elucidation in stroke rehabilitation research. Objective This prospective cohort study aims to investigate the clinical efficacy and limitations of DU meridian acupuncture combined with Temporal Triple Needling (Sanjian) therapy in stroke rehabilitation. The intervention's therapeutic potential is evaluated through its modulatory effects on CD14+/CD14- monocyte subpopulations within peripheral blood mononuclear cells (PBMCs), with particular focus on angiogenesis-mediated vascular protection mechanisms. Methods Sixty-six patients with acute ischemic stroke will be randomly assigned 1:1 to control (conventional basal therapy, n = 33) and acupuncture (conventional standard stroke care + acupuncture, n = 33) groups for 10 days of intervention. The primary outcome is NIHSS score. The secondary outcomes: BMI and mRS scores, the level of TNF-A and IL-1B in serum, vascular endothelial growth factor (VEGF), Endocan ES, CD14+ and CD14- levels of peripheral blood mononuclear cells. Discussion The aim of this study is to investigate whether electroacupuncture targeting the DU meridian combined with Temporal Triple Needling (Sanjian) improves cerebrovascular endothelial function in acute ischemic stroke patients, thereby reducing the NIHSS score and preventing further disease progression. This study also aims to contribute positively to the development of relevant clinical treatment protocols and to facilitate further research into the underlying mechanisms of these effects. Clinical trial registration International Traditional Medicine Clinical Trial Registry ITMCTR2024000508.
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Affiliation(s)
- Yawen Sun
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiqi Zhong
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yingci Hou
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Liu
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingyue Yan
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Luolin Zhou
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shiyi Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Senkai Hong
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun He
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Ma J, Chervak LM, Siegler JE, Li Z, Mofatteh M, Galecio-Castillo M, Zhou S, Huang J, Lai Y, Zhang Y, Guo J, Zhang X, Cheng C, Tang J, Chen J, Chen Y. Postinterventional Petechial Hemorrhage Associated With Poor Functional Outcome After Successful Recanalization Following Endovascular Therapy. Neurosurgery 2025; 96:438-446. [PMID: 38984821 DOI: 10.1227/neu.0000000000003098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/25/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Endovascular therapy (EVT) has emerged as the standard for treating patients with acute ischemic stroke due to large vessel occlusion. The aim of this study was to investigate the relationship between early petechial hemorrhage and patient outcomes after successful EVT of anterior circulation. METHODS We retrospectively analyzed multicenter data from 316 patients who underwent EVT for acute occlusion of anterior circulation. Patients were divided into petechial hemorrhage group and without hemorrhage group based on post-EVT head imaging. Logistical regression analysis was performed to determine independent predictors for petechial hemorrhage, and for petechial hemorrhage as a predictor of early neurological improvement, favorable outcome at 90 days (modified Rankin Scale 0-2), and 90-day mortality, with adjustment for all factors significantly associated with these endpoints in univariate regression to P < .10. RESULTS Of 316 included patients with successful EVT, 49 (15.50%) had petechial hemorrhage. The petechial hemorrhage group showed less early neurological improvement (36.73% compared with 53.56%, P = .030), less favorable outcomes at 90 days (32.65% compared with 61.80%, P < .001, absolute risk difference 29.15%), and higher mortality at 90 days (28.57% compared with 10.49%, P = .001) then the group without hemorrhage. Petechial hemorrhage was inversely associated with favorable 90-day outcome (odds ratio = 0.415, 95% CI 0.206-0.835) and higher mortality rate at 90 days (odds ratio = 2.537, 95% CI 1.142-5.635) in multivariable regression but was not independently associated with early neurological improvement. CONCLUSION In patients with anterior large vessel occlusion who underwent successful EVT, petechial hemorrhage was associated with poor functional outcome and 90-day mortality when adjusted for complete recanalization, pre-EVT National Institute of Health Stroke Scale/Score, and Alberta Stroke Program Early Computed Tomography Score. Despite the relatively lower rate of a favorable 90-day outcome with petechial hemorrhage compared with no petechial hemorrhage, the absolute rate of a favorable outcome exceeds the natural history of medical management for this condition.
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Affiliation(s)
- Jicai Ma
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Lina M Chervak
- Department of Neurology, University of Chicago, Chicago , Illinois , USA
| | - James E Siegler
- Department of Neurology, University of Chicago, Chicago , Illinois , USA
| | - Zhenzhang Li
- College of Mathematics and Systems Science, Guangdong Polytechnic Normal University, Guangzhou , China
- School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou , China
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast , UK
| | | | - Sijie Zhou
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan , China
| | - Jianhui Huang
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan , China
| | - Yuzheng Lai
- Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan , China
| | - Youyong Zhang
- Interventional Department, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Junhui Guo
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Xiuling Zhang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Chunyun Cheng
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Jiaying Tang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Junbin Chen
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan , China
| | - Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan , China
- Neuro International Collaboration (NIC), Foshan , China
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Xiaoni Z, Yunyun X, Rongrong M. Analyzing the serum biochemical factors that influence early neurological deterioration in ischemic Stroke patients and developing a nomogram prediction model. J Med Biochem 2025; 44:119-128. [PMID: 39991174 PMCID: PMC11846649 DOI: 10.5937/jomb0-51371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/03/2024] [Indexed: 02/25/2025] Open
Abstract
Background To investigate the risk factors associated with early neurological deterioration (END) in ischemic stroke (IS) patients and develop a predictive nomogram model. Methods General clinical data from 220 IS patients treated between December 2022 and November 2023 were collected for observation. The study's inclusion and exclusion criteria select patients aged 18+ with a first-time diagnosis of IS who undergo lab tests within 24 hours of admission while excluding those with multiple organ dysfunction, sensory impairments, coagulation disorders, or other serious medical conditions. Based on the National Institutes of Health Stroke Scale (NIHSS) in the United States, patients were categorized into two groups: END (n=69) and non-END (n=151). Both groups' basic demographics, medical history, and biochemical test results were compared. Influencing factors were identified using the least absolute shrinkage and selection operator (LASSO) method, and these variables were included in a multivariate logistic regression analysis to construct a nomogram for predicting END in IS patients. Model performance was evaluated using internal validation with the Bootstrap method, assessing discrimination, calibration, and clinical validity. Results Factors such as history of diabetes, fasting plasma glucose (FBG), triglyceride (TG), homocysteine (Hcy), and C-reactive protein (CRP) were identified as single factors for early functional deterioration in IS patients (P<0.05). A logistic regression model was established with END as the dependent variable and significant single factors (P<0.05) as independent variables. The results indicated that diabetes history (OR=1.398, P=0.301), TG (OR= 6.149, P<0.05), ASPECT score (OR=7.641, P<0.05), FBG (OR=2.172, P<0.05), CRP (OR=1.706, P<0.05), NIHSS score 7 days post-admission (OR=1.336, P<0.05), and Hcy (OR=1.425, P<0.05) were independent risk factors for END in IS patients (P<0.05). ROC analysis showed an ASPECT area under the curve of 0.910 (95% CI:0.864 to 0.944), with 84.06% sensitivity and 86.09% specificity. Hcy had an area under the curve of 0.808 (95% CI:0.750 to 0.858), with 79.71% sensitivity and 70.20% specificity. FBG had an area under the curve of 0.847 (95% CI:0.793 to 0.892), with 69.57% sensitivity and 95.36% specificity. TG had an area under the curve of 0.937 (95% CI: 0.896-0.965), with 91.30% sensitivity and 82.78% specificity. NIHSS had an area under the curve of 0.857 (95% CI: 0.803-0.900), with 89.86% sensitivity and 70.20% specificity. A nomogram model for END risk prediction was constructed based on the logistic regression analysis results, assigning preliminary scores for each of the 9 predictive factors. The total score, ranging from 0-100 points, was used to predict END risk in patients (0-100%). The constructed nomogram model showed that ASPECT was 59.2, Hcy was 84.0, FBG was 61.4, TG7.0 mmol/L was 39.4, and NIHSS was 98.1 with a total score of 345.7 which predicted the risk of END at 68.9%. Conclusions ASPECT, Hcy, FBG, TG, and NIHSS are independent factors influencing END after IS. On this basis, a visual predictive nomogram model is constructed to predict the risk of END in patients accurately.
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Affiliation(s)
- Zhan Xiaoni
- Wenzhou Medical University, Dongyang Peoples Hospital, Department of Neurology, Zhejiang, China
| | - Xu Yunyun
- Wenzhou Medical University, Dongyang Peoples Hospital, Department of Neurology, Zhejiang, China
| | - Ma Rongrong
- Wenzhou Medical University, Dongyang Peoples Hospital, Department of Neurology, Zhejiang, China
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Luo B, Xiang Y, Meng F, Wang Y, Zhang Z, Ren H, Ma L. Impact of fasting blood glucose on prognosis after acute large vessel occlusion reperfusion: results from a multicenter analysis. Front Neurol 2024; 15:1422851. [PMID: 39507628 PMCID: PMC11537856 DOI: 10.3389/fneur.2024.1422851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 10/15/2024] [Indexed: 11/08/2024] Open
Abstract
Objective To analyze the effect of fasting blood glucose levels after reperfusion of acute large vessel occlusion (ALVO) on patient functional prognosis. Methods Retrospectively included ALVO patients from three large stroke centers in China, all of whom achieved vascular reperfusion after mechanical thrombectomy or bridging thrombolysis. The prognosis scores of all patients at 90 ± 7 days post-recanalization were categorized into a good prognosis group (mRS 0-2) and a poor prognosis group (mRS 3-6). The relationship between mean blood glucose levels at 72 h post-recanalization and prognosis was explored using multivariable logistic regression analysis. Then we measured the area under the ROC curve for all factors to assess their predictive performance. Results (1) Totally 2,056 patients were included in the study, with 1,488 males and 568 females. There were 1,370 patients in the good prognosis group (mRS 0-2) and 686 in the poor prognosis group (mRS 3-6). (2) The two groups exhibited significant differences in terms of age, preoperative mRS score, history of diabetes, and mean fasting blood glucose (MFBG) (p < 0.001). (3) With 90-day mRS as the outcome variable, all independent variables were included in Univariate and multivariate regression analyses analysis, and the results showed that: age, preoperative mRS score, history of diabetes, and MFBG are all independent predictors of prognosis after recanalization of ALVO, with MFBG demonstrating a higher predictive power than the other factors (AUC = 0.644). Conclusion Various factors are correlated with the prognosis in patients who have undergone ALVO recanalization. Notably, the MFBG level demonstrates a significant predictive value for outcomes within the first 72 h following the recanalization procedure.
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Affiliation(s)
- Bin Luo
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Tianjin Neurological Institute, Tianjin Huanhu Hospital, Tianjin, China
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Yi Xiang
- Department of Neurology, Xianyang Central Hospital, Xianyang, China
| | - Fanlei Meng
- Department of Neurology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yubo Wang
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhenzhong Zhang
- Department of Neurosurgery, Hengshui Fifth People’s Hospital, Hengshui, China
| | - Hecheng Ren
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Lin Ma
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
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Avula A, Bui Q, Kumar A, Chen Y, Hamzehloo A, Cifarelli J, Heitsch L, Slowik A, Strbian D, Lee JM, Dhar R. Evaluating the interaction between hemorrhagic transformation and cerebral edema on functional outcome after ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107913. [PMID: 39098362 PMCID: PMC12045300 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107913] [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: 05/16/2024] [Revised: 07/12/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Hemorrhagic transformation (HT) and cerebral edema (CED) are both major complications following ischemic stroke, but few studies have evaluated their overlap. We evaluated the frequency and predictors of CED/HT overlap and whether their co-occurrence impacts functional outcome more than each in isolation. METHODS 892 stroke patients enrolled in a prospective study had follow-up CT imaging evaluated for HT and CED; the latter was quantified using the ratio of hemispheric CSF volumes (with hemispheric CSF ratio < 0.90 used as the CED threshold). The interaction between HT and CED on functional outcome (using modified Rankin Scale at 3 months) was compared to that for each condition separately. RESULTS Among the 275 (31%) who developed HT, 233 (85%) manifested hemispheric CSF ratio < 0.9 (CED/HT), with this overlap group representing half of the 475 with measurable CED. Higher baseline NIHSS scores and larger infarct volumes were observed in the CED/HT group compared with those with CED or HT alone. Functional outcome was worse in those with CED/HT [median mRS 3 (IQR 2-5)] than those with CED [median 2 (IQR 1-4)] or HT alone [median 1 (IQR 0-2), p < 0.0001]. Overlap of CED/HT independently predicted worse outcome [OR 1.89 (95% CI: 1.12-3.18), p = 0.02] while HT did not; however, CED/HT was no longer associated with worse outcome after adjusting for severity of CED [adjusted OR 0.35 (95% CI: 0.23, 0.51) per 0.21 lower hemispheric CSF ratio, p < 0.001]. CONCLUSIONS Most stroke patients with HT also have measurable CED. The co-occurrence of CED and HT occurs in larger and more severe strokes and is associated with worse functional outcome, although this is driven by greater severity of stroke-related edema in those with HT.
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Affiliation(s)
- Amrit Avula
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Quoc Bui
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Atul Kumar
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Ali Hamzehloo
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Julien Cifarelli
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Laura Heitsch
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA; Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA
| | - Rajat Dhar
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO, USA.
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Duan H, Cheng Z, Geng X, Rajah GB, Gao J, Guo Y, Cai L, Tong Y, Li F, Jiang Q, Han Z, Ding Y. Prospective randomized controlled trial on the safety and neuroprotective efficacy of remote administration of hypothermia over spleen during acute ischemic stroke with mechanical thrombectomy: rationale, design, and protocol. Front Neurol 2024; 15:1382365. [PMID: 39081338 PMCID: PMC11286455 DOI: 10.3389/fneur.2024.1382365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Background Brain inflammation plays a key role in ischemia/reperfusion (I/R) injury and is the main cause of "ineffective or futile recanalization" after successful mechanical thrombectomy (MT) in acute ischemic stroke (AIS). One of the primary sources of inflammatory cells after AIS are derived from the spleen. As an innovative and potential neuroprotective strategy after stroke, Remote Administration of Hypothermia (RAH) temporarily suppresses immune activities in the spleen, reduces the release of inflammatory cells and cytokines into blood, and thus reversibly diminishes inflammatory injury in the brain. Methods This single-center, prospective, randomized controlled study (RCT) is proposed for AIS patients with anterior circulation large vessel occlusion (LVO). Subjects will be randomly assigned to either the control or intervention groups in a 1:1 ratio (n = 40). Participants allocated to the intervention group will receive RAH on the abdomen above the spleen prior to recanalization until 6 h after thrombectomy. All enrolled patients will receive standard stroke Guideline care. The main adverse events associated with RAH are focal cold intolerance and abdominal pain. The primary outcome will assess safety as it pertains to RAH application. The secondary outcomes include the efficacy of RAH on spleen, determined by spleen volumes, blood inflammatory factor (cells and cytokines), and on brain injury, determined by infarction volumes and poststroke functional outcomes. Discussion This study aims to examine the safety and preliminary effectiveness of RAH over the spleen during endovascular therapy in AIS patients. The results of this study are expected to facilitate larger randomized clinical trials and hopefully prove RAH administration confers adjuvant neuroprotective properties in AIS treated with MT. Clinical trial registration https://www.chictr.org.cn/. Identifier ChiCTR 2300077052.
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Affiliation(s)
- Honglian Duan
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Zhe Cheng
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Gary B. Rajah
- Department of Neurosurgery, Munson Medical Center, Traverse City, MI, United States
| | - Jie Gao
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yang Guo
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Lipeng Cai
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yanna Tong
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Fengwu Li
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Qian Jiang
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Zhenzhen Han
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
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Zhang L, Ma J, Wang M, Zhang L, Sun W, Ji H, Yue C, Huang J, Zi W, Li F, Guo C, Wang P. The Association Between National Institutes of Health Stroke Scale Score and Clinical Outcome in Patients with Large Core Infarctions Undergoing Endovascular Treatment. Neurol Ther 2024; 13:563-581. [PMID: 38427274 PMCID: PMC11136902 DOI: 10.1007/s40120-024-00588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION This study aimed to analyze the association between baseline National Institutes of Health Stroke Scale (NIHSS) scores and clinical outcomes in patients with large core infarctions undergoing endovascular treatment (EVT), a relationship that remains unclear. METHODS Data were obtained from the MAGIC study, a prospective multicenter cohort study focusing on patients with acute large core ischemic stroke. This analysis evaluated the impact of NIHSS scores on EVT outcomes in patients with large core infarctions. Primary outcome metrics included favorable outcomes (modified Rankin Scale [mRS] of 0-3 at 90 days), while secondary outcomes encompassed shifts in mRS scores, functional independence (mRS score of 0-2), mRS score of 0-4, and successful recanalization rates. Adverse events considered were symptomatic intracranial hemorrhage (sICH) and mortality. RESULTS A total of 490 patients were enrolled in this study. Higher baseline NIHSS scores were inversely correlated with favorable outcomes (adjusted odds ratio [OR] in model 3, 0.848 [0.797-0.903], P < 0.001), particularly in patients with NIHSS scores above 20 (adjusted OR in model 3, 0.518 [0.306-0.878] vs. 0.290 [0.161-0.523]). Regarding adverse events, higher baseline NIHSS scores significantly correlated with increased 90-day mortality rates (adjusted OR in model 3, 1.129 [1.072-1.189], P < 0.001). This correlation became insignificant when baseline NIHSS scores exceeded 22. Additionally, baseline NIHSS scores partially mediated the association between age (indirect effect = - 0.0005, 19.39% mediated) and sex (indirect effect = 0.0457, 25.08% mediated) with the primary outcome. CONCLUSIONS The findings indicate that higher baseline NIHSS scores correlate with poorer outcomes and increased mortality, particularly when scores exceed 20. Moreover, age and sex indirectly influence favorable outcomes through their association with baseline NIHSS scores.
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Affiliation(s)
- Lingyu Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, 261000, Shandong, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70, Heping Road, Huancui District, Weihai City, Shandong Province, China
| | - Jinfu Ma
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Mengmeng Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, 261000, Shandong, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70, Heping Road, Huancui District, Weihai City, Shandong Province, China
| | - Lin Zhang
- Department of Cardiology, Yantai Penglai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Wenzhe Sun
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Honghong Ji
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70, Heping Road, Huancui District, Weihai City, Shandong Province, China
- The Second School of Clinical Medicine of Binzhou Medical University, Yantai, Shandong, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China.
| | - Pengfei Wang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70, Heping Road, Huancui District, Weihai City, Shandong Province, China.
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Li D, He X, Li Y, Wu S, Liu J. The effects of hyperbaric oxygen therapy on neuroprotection and recovery after brain resuscitation. Int J Neurosci 2024:1-7. [PMID: 38646692 DOI: 10.1080/00207454.2024.2346172] [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: 03/19/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Analyze the impact of hyperbaric oxygen therapy on neuroprotection and recovery post severe traumatic brain injury (sTBI) resuscitation. METHODS Retrospective analysis of clinical data from 83 sTBI patients admitted between January 2022 to January 2024. Patients were divided into control (n = 41) and observation (n = 42) groups based on treatment received. Control received standard therapy, while the observation group received hyperbaric oxygen therapy. Effects on clinical outcomes, neuroinjury markers (S100β, GFAP, UCH-L1, NSE), neurotrophic factors (NGF, BDNF), neurological function indicators (NIHSS, CSS), and adverse reactions were compared. RESULTS The observation group showed a higher total effective rate (80.95%) compared to control (60.98%) (p < 0.05). Neuroinjury markers decreased post-treatment in both groups, with the observation group lower (p < 0.05). NGF and BDNF levels increased post-treatment in both groups, with the observation group higher (p < 0.05). NIHSS and CSS scores decreased post-treatment in both groups, with the observation group lower (p < 0.05). No significant difference in adverse reactions between groups (p > 0.05). CONCLUSION Hyperbaric oxygen therapy effectively treats sTBI by improving brain resuscitation success, reducing neuroinjury factors, enhancing neurotrophic factors, and promoting neurological function recovery, without increasing adverse reaction risk.
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Affiliation(s)
- Di Li
- Emergency Department, Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Xiaoqin He
- Department of Laboratory, Weihai Municipal Hospital, Weihai, China
| | - Yan Li
- Emergency Department, Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Shubiao Wu
- Department of Orthopaedics, Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Jianhui Liu
- Emergency Department, Affiliated Hospital of Hebei Engineering University, Handan, China
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9
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Zou Y, Tu J, Hu P, Zhao X, Tang X. The prognostic value of ASPECTS in specific regions following mechanical thrombectomy in patients with acute ischemic stroke from large-vessel occlusion. Front Neurol 2024; 15:1372778. [PMID: 38685947 PMCID: PMC11057371 DOI: 10.3389/fneur.2024.1372778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Objective The aim of this study is to investigate the relationship between the volume of specific regional infarction and the prognosis of patients who undergo mechanical thrombectomy (MT) for acute large vessel occlusion. Methods In this study, we collected the clinical and imaging features of patients with unilateral acute anterior circulation ischemic stroke from January 2021 to June 2023 in the Second Affiliated Hospital of Nanchang University. All patients underwent CT perfusion and non-contrast CT scan before MT. The ASPECTS was assessed based on imaging data, and artificial intelligence was used to obtain the percentage of infarction in each of the 10 regions of ASPECTS. According to the modified Rankin Scale, the patients were divided into the good prognosis group and poor prognosis group at the 90-day follow-up. Various indicators in the two groups were compared. Multivariable logistic regression was used to assess the risk factors for poor prognosis. The relationship between core infarction volume and the probability of poor prognosis was plotted to analyze the trend of poor prognosis with changes in the proportion of infarction volume. Finally, a receiver operating characteristic curve was constructed to analyze the predictive ability on poor prognosis. Results A total of 91 patients were included, with 58 patients having a good prognosis (mRS ≤ 2) and 33 patients having a poor prognosis (mRS ≥ 3). Multivariate analysis showed that NIHSS score and core infarction involving the internal capsule and M6 region were independent risk factors for poor prognosis. According to the linear correlation, a higher ratio of core infarction volume in the internal capsule or M6 region was linked to an increased risk of a poor prognosis. However, the non-linear analysis revealed that the prognostic impact of core infarction volume was significant when the ratio was greater than 69.7%. The ROC curve indicated that the combination of NIHSS score, infarct location, and the ratio of infarct volume has an AUC of 0.87, with a sensitivity of 84.8% and a specificity of 84.5%. Conclusion It is important to examine the location and volume of the infarct in the internal capsule and M6 when deciding whether to do a MT.
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Affiliation(s)
- Yu Zou
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Pengxin Hu
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoping Tang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- School of Medicine, National Graduate College for Engineers, Tsinghua University, Beijing, China
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10
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Qi S, Shi M, Li C, Song K, Zhou J, Yue F, Zhang W, Wang S. Associations between NIHSS sub-item scores and prognosis and intracranial hemorrhage after endovascular therapy for acute anterior circulation ischemic stroke. Front Neurol 2024; 14:1320055. [PMID: 38259652 PMCID: PMC10800981 DOI: 10.3389/fneur.2023.1320055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The relationship between sub-item scores on the National Institutes of Health Stroke Scale (NIHSS) scores and prognosis and intracranial hemorrhage in patients with acute ischemic stroke undergoing endovascular treatment (EVT) has been insufficiently studied. The aim of this study was to investigate the correlation between NIHSS sub-item scores, prognosis, and intracranial hemorrhage. Methods This study included patients with acute anterior circulation ischemic stroke undergoing EVT between February 2019 and April 2022. The outcomes included functional independence, defined as a modified Rankin Scale (mRS) score ≤ 2 at 3 months after EVT, intracranial hemorrhage within 24 h after EVT, and mortality within 3 months. A multivariate regression analysis was performed, including NIHSS sub-item scores and other adjusted variables. Results A total of 568 patients were enrolled. Of the 568 patients, 239 (45%) achieved functional independence at 3 months after EVT. The median age in this group was 63 years (IQR 52-69) and 176 (73.6%) were male patients. Intracranial hemorrhage within 24 h after EVT occurred in 170 (30%) patients. The median age in this group was 65 years (IQR 56-71) and 105 (61.8%) were male patients. In a multivariate analysis adjusted for age, gender, and factors with a value of p of <0.05, the NIHSS limb movement sub-item score was strongly associated with prognosis at 3 months (OR 0.833, 95% CI 0.758-0.915) and intracranial hemorrhage within 24 h after EVT (OR 1.161, 95% CI 1.037-1.300). Conclusion Higher limb movement sub-item scores on the NIHSS were independently associated with a poorer prognosis at 3 months and a higher rate of intracranial hemorrhage within 24 h after EVT among patients with acute anterior circulation ischemic stroke.
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Affiliation(s)
| | | | | | | | | | | | | | - Shouchun Wang
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
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11
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Hua Y, Yan C, Zhou C, Zheng Q, Li D, Tu P. Risk prediction models for intracranial hemorrhage in acute ischemic stroke patients receiving intravenous alteplase treatment: a systematic review. Front Neurol 2024; 14:1224658. [PMID: 38249727 PMCID: PMC10799340 DOI: 10.3389/fneur.2023.1224658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives To identify and compare published models that use related factors to predict the risk of intracranial hemorrhage (ICH) in acute ischemic stroke patients receiving intravenous alteplase treatment. Methods Risk prediction models for ICH in acute ischemic stroke patients receiving intravenous alteplase treatment were collected from PubMed, Embase, Web of Science, and the Cochrane Library up to April 7, 2023. A meta-analysis was performed using Stata 13.0, and the included models were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results A total of 656 references were screened, resulting in 13 studies being included. Among these, one was a prospective cohort study. Ten studies used internal validation; five studies used external validation, with two of them using both. The area under the receiver operating characteristic (ROC) curve for subjects reported in the models ranged from 0.68 to 0.985. Common predictors in the prediction models include National Institutes of Health Stroke Scale (NIHSS) (OR = 1.17, 95% CI 1.09-1.25, p < 0.0001), glucose (OR = 1.54, 95% CI 1.09-2.17, p < 0.05), and advanced age (OR = 1.50, 95% CI 1.15-1.94, p < 0.05), and the meta-analysis shows that these are independent risk factors. After PROBAST evaluation, all studies were assessed as having a high risk of bias but a low risk of applicability concerns. Conclusion This study systematically reviews available evidence on risk prediction models for ICH in acute ischemic stroke patients receiving intravenous alteplase treatment. Few models have been externally validated, while the majority demonstrate significant discriminative power.
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Affiliation(s)
- Yaqi Hua
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- School of Nursing, Nanchang University, Nanchang, China
| | - Chengkun Yan
- School of Nursing, Nanchang University, Nanchang, China
| | - Cheng Zhou
- School of Nursing, Nanchang University, Nanchang, China
| | - Qingyu Zheng
- Department of Post Anesthesia Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongying Li
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Tu
- Department of Post Anesthesia Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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12
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Cheng M, Ding Y, Kim E, Geng X. Exploring the Therapeutic Potential of Peritoneal Dialysis (PD) in the Treatment of Neurological Disorders. Cell Transplant 2024; 33:9636897241236576. [PMID: 38506429 PMCID: PMC10956140 DOI: 10.1177/09636897241236576] [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: 06/19/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/21/2024] Open
Abstract
Peritoneal dialysis (PD) is a well-established renal replacement therapy commonly employed in clinical practice. While its primary application is in the treatment of kidney disease, its potential in addressing other systemic disorders, including neurological diseases, has garnered increasing interest. This study provides a comprehensive overview of the related technologies, unique advantages, and clinical applications of PD in the context of neurological disorders. By exploring the mechanism underlying PD, its application in neurological diseases, and associated complications, we addressed the feasibility and benefits of PD as an adjunct therapy for various neurological conditions. Our study aims to highlight its role in detoxification and symptom management, as well as its advantages over other universally accepted methods of renal replacement therapy. Our goal is to bring to the spotlight the therapeutic potential of PD in neurological diseases, such as stroke, stimulate further research, and broaden the scope of its application in the clinical setting.
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Affiliation(s)
- Muyuan Cheng
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Enoch Kim
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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13
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Lu L, Wei S, Huang Q, Chen Y, Huang F, Ma X, Huang C. Effect of "Internet + tertiary hospital-primary hospital-family linkage home care" model on self-care ability and quality of life of discharged stroke patients. Am J Transl Res 2023; 15:6727-6739. [PMID: 38186986 PMCID: PMC10767543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To investigate the intervention effect of an "Internet + tertiary hospital-primary hospital-family linkage home care" model on the quality of life and self-care abilities of discharged stroke patients. METHODS The clinical data of 90 patients with stroke who were hospitalized and discharged from the Department of Neurology of the Affiliated Hospital of Youjiang Medical College for Nationalities from October 2020 to September 2021 were retrospectively analyzed. They were split into a control group (41 cases) and an intervention group (40 cases) based on different care modes. The intervention group was given the "Internet + tertiary hospital-primary hospital-family connection home care" paradigm, while the control group received normal nursing interventions. The degree of nerve defect, quality of life, anxiety and depression, self-care ability and exercise ability of the patients were evaluated by National Institutes of Health Stroke Scale (NIHSS), Stroke Specific Quality of Life Scale (SS-QOL), General Hospital Anxiety and Depression Scale (HADS), Self-care Ability Scale (ESCA), and Fugl-Meyer Motor Function Assessment (FMA) before discharge and at 3rd, 6th and 12th month after discharge, respectively. The re-hospitalization rate, treatment compliance and exercise ability of the two groups were compared within a year after discharge. RESULTS The scores of SS-QOL, ESCA and FMA in the intervention group increased with time, and the scores of SS-QOL, ESCA and FMA at 3rd, 6th and 12th month after discharge were higher than those in the control group (all P<0.05). The NIHSS and HADS scores decreased over time, and the NIHSS and HADS scores were lower than the control group at 12th month after discharge (P<0.05). Within a year of discharge, the intervention group had a lower rehospitalization rate than the control group (P<0.05), and the treatment compliance score was higher in the intervention group than that in the control group (P<0.05). CONCLUSION The "Internet + tertiary hospital-primary hospital-family nursing" model can improve self-care ability and treatment compliance of patients, improve their nerve defects and psychological status as well as quality of life, and reduce rehospitalization rate.
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Affiliation(s)
- Liuxue Lu
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Suyu Wei
- “Internet Nursing Service” Office, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Quyun Huang
- Department of Neurology, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Yuke Chen
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Fengxing Huang
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Xiaoan Ma
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Caimei Huang
- Respiratory Intensive Care Unit, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
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Hu W, Li W, Mangal R, Jia M, Ji X, Ding Y. Normobaric Hyperoxia (NBHO): An Adjunctive Therapy to Cerebrovascular Recanalization in Ischemic Stroke. Aging Dis 2023; 14:1483-1487. [PMID: 37196114 PMCID: PMC10529751 DOI: 10.14336/ad.2023.0227] [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: 11/25/2022] [Accepted: 02/26/2023] [Indexed: 05/19/2023] Open
Abstract
Acute ischemic stroke (AIS) is a serious neurological disease. Normobaric hyperoxia (NBHO) is both a non-invasive and easy method that seems to be able to improve outcomes after cerebral ischemia/reperfusion. In clinical trials, normal low-flow oxygen has been shown to be ineffective, but NBHO has been shown to have a transient brain-protective effect. Today, NBHO combined with recanalization is the best treatment available. NBHO combined with thrombolysis is considered to improve neurological scores and long-term outcomes. Large randomized controlled trials (RCTs), however, are still needed to determine the role they will have in stroke treatment. RCTs of NBHO combined with thrombectomy have both improved infarct volume at 24 hours and the long-term prognosis. These two mechanisms most likely play key roles in the neuroprotective actions of NBHO after recanalization, including the increase in penumbra oxygen supply and the integrity of the blood-brain barrier (BBB). Considering the mechanism of action of NBHO, oxygen should be given as early as possible to increase the duration of oxygen therapy before recanalization is initiated. NBHO can further prolong the existence time of penumbra, so that more patients may benefit from it. Overall, however, recanalization therapy is still essential.
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Affiliation(s)
- Wenbo Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Weili Li
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, China.
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
| | - Ruchi Mangal
- Department of Neurosurgery, Wayne State University School of Medicine, Michigan, USA.
| | - Milan Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Michigan, USA.
- John D. Dingell VA Medical Center, Detroit, Michigan, USA.
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15
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Tong Y, Ding Y, Han Z, Duan H, Geng X. Optimal rehabilitation strategies for early postacute stroke recovery: An ongoing inquiry. Brain Circ 2023; 9:201-204. [PMID: 38284113 PMCID: PMC10821682 DOI: 10.4103/bc.bc_33_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 01/30/2024] Open
Abstract
Early rehabilitation is crucial in reducing stroke-related disability, but the optimal training model remains unclear. We conducted a trial comparing different initiation timings and intensities of mobilization strategies after stroke. Results showed that early intensive mobilization had favorable outcomes at 3 months post-stroke, while very early intensive mobilization had poorer chances of favorable outcomes. Our investigation into brain injury mechanisms induced by very early exercise within 24 hours of stroke onset aligned with guidelines advising against high-dose very early mobilization. Additionally, we are studying the effects of various exercise intensities and frequencies on early stroke rehabilitation. Integrated rehabilitation models, such as combining remote ischemic conditioning (RIC) with exercise (RICE), hold promise. Our study found RICE to be safe and feasible for early rehabilitation of acute ischemic stroke patients, and further research is underway to determine its efficacy in a larger sample size. Despite extensive research, identifying the most effective early recovery strategies remains a complex challenge, necessitating ongoing work in the field of early rehabilitation after stroke.
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Affiliation(s)
- Yanna Tong
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zhenzhen Han
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Honglian Duan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
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Cheng Z, Gao J, Ding Y, Pang Q, Rajah GB, Geng X. Arterial Glyceryl Trinitrate in Acute Ischemic Stroke After Thrombectomy for Neuroprotection (AGAIN): A Pilot Randomized Controlled Trial. Neurotherapeutics 2023; 20:1746-1754. [PMID: 37875733 PMCID: PMC10684471 DOI: 10.1007/s13311-023-01432-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/26/2023] Open
Abstract
Although endovascular therapy demonstrates robust clinical efficacy in acute ischemic stroke (AIS), not all stroke patients benefit from successful reperfusion. This study aimed to evaluate the safety, feasibility, and preliminary efficacy of intra-arterial administration of glyceryl trinitrate (GTN) after endovascular recanalization for neuroprotection. This is a prospective randomized controlled study. Eligible patients were randomized to receive 800 μg GTN or the same volume of normal saline through the catheter after recanalization. The primary outcome was symptomatic intracranial hemorrhage (ICH), while secondary outcomes included mortality, functional outcome, infarction volume, complications, and blood nitrate index (NOx). A total of 40 patients were enrolled and randomized with no participants being lost to follow-up. There was no significant difference in the proportion of sICH between GTN and control groups. Additionally, no significant difference was observed in mortality or rates of neurological deterioration and other complications. Favorable trends, while non-significant, were noted in both outcome and imaging for functional independence at 90 days and reduction in final infarct volume (75.0% vs 65.0%; 33.2 vs 38.9 ml) for the GTN group. Moreover, the concentration of blood NOx in the GTN group was significantly higher than in the control group at 2 h after GTN administration (26.2 vs 18.0 μmol/l, p < 0.05). The AGAIN study suggests intra-arterial administration of GTN post-endovascular therapy is safe and feasible and GTN successfully raised NOx levels over controls at 2 h. A multi-center randomized controlled trial with a larger sample size is warranted to determine GTN neoadjuvant efficacy.
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Affiliation(s)
- Zhe Cheng
- Department of Neurology and Stroke Center, Luhe Hospital, Capital Medical University, Tongzhou District, No. 82 Xinhua SouthRoad, Beijing, 101149, China
| | - Jie Gao
- Department of Neurology and Stroke Center, Luhe Hospital, Capital Medical University, Tongzhou District, No. 82 Xinhua SouthRoad, Beijing, 101149, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI, 48201, USA.
| | - Qi Pang
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI, 48201, USA
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Gary B Rajah
- Department of Neurosurgery, Munson Healthcare, Traverse City, MI, USA
| | - Xiaokun Geng
- Department of Neurology and Stroke Center, Luhe Hospital, Capital Medical University, Tongzhou District, No. 82 Xinhua SouthRoad, Beijing, 101149, China.
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI, 48201, USA.
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, 101100, China.
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Bal SS, Yang FPG, Chi NF, Yin JH, Wang TJ, Peng GS, Chen K, Hsu CC, Chen CI. Core and penumbra estimation using deep learning-based AIF in association with clinical measures in computed tomography perfusion (CTP). Insights Imaging 2023; 14:161. [PMID: 37775600 PMCID: PMC10541385 DOI: 10.1186/s13244-023-01472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/23/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES To investigate whether utilizing a convolutional neural network (CNN)-based arterial input function (AIF) improves the volumetric estimation of core and penumbra in association with clinical measures in stroke patients. METHODS The study included 160 acute ischemic stroke patients (male = 87, female = 73, median age = 73 years) with approval from the institutional review board. The patients had undergone CTP imaging, NIHSS and ASPECTS grading. convolutional neural network (CNN) model was trained to fit a raw AIF curve to a gamma variate function. CNN AIF was utilized to estimate the core and penumbra volumes which were further validated with clinical scores. RESULTS Penumbra estimated by CNN AIF correlated positively with the NIHSS score (r = 0.69; p < 0.001) and negatively with the ASPECTS (r = - 0.43; p < 0.001). The CNN AIF estimated penumbra and core volume matching the patient symptoms, typically in patients with higher NIHSS (> 20) and lower ASPECT score (< 5). In group analysis, the median CBF < 20%, CBF < 30%, rCBF < 38%, Tmax > 10 s, Tmax > 10 s volumes were statistically significantly higher (p < .05). CONCLUSIONS With inclusion of the CNN AIF in perfusion imaging pipeline, penumbra and core estimations are more reliable as they correlate with scores representing neurological deficits in stroke. CRITICAL RELEVANCE STATEMENT With CNN AIF perfusion imaging pipeline, penumbra and core estimations are more reliable as they correlate with scores representing neurological deficits in stroke.
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Affiliation(s)
- Sukhdeep Singh Bal
- Department of Mathematical Sciences, University of Liverpool, Liverpool, Merseyside, UK
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Fan-Pei Gloria Yang
- Center for Cognition and Mind Sciences, National Tsing Hua University, Hsinchu, Taiwan.
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu, Taiwan.
- Department of Radiology, Graduate School of Dentistry, Osaka University, Suita, Japan.
| | - Nai-Fang Chi
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiu Haw Yin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tao-Jung Wang
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Giia Sheun Peng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Neurology, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu County, Taipei, Taiwan
| | - Ke Chen
- Department of Mathematical Sciences, University of Liverpool, Liverpool, Merseyside, UK
| | - Ching-Chi Hsu
- Board of Directors, Wizcare Medical Corporation Aggregate, Taichung, Taiwan
| | - Chang-I Chen
- Department of Medical Management, Taipei Medical University, Taipei, Taiwan
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18
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Wang X, Xia J, Shan Y, Yang Y, Li Y, Sun H. Predictive value of the Oxford Acute Severity of Illness Score in acute stroke patients with stroke-associated pneumonia. Front Neurol 2023; 14:1251944. [PMID: 37731859 PMCID: PMC10507346 DOI: 10.3389/fneur.2023.1251944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background Stroke-associated pneumonia (SAP) is associated with a poor prognosis and a high mortality rate in stroke patients. However, the accuracy of early prediction of SAP is insufficient, and there is a lack of effective prognostic evaluation methods. Therefore, in this study, we investigated the predictive value of the Oxford Acute Severity of Illness Score (OASIS) in SAP to provide a potential reference index for the incidence and prognosis of SAP. Methods We recruited a total of 280 patients with acute ischemic stroke who had been diagnosed and treated in the Zhumadian Central Hospital between January 2021 and January 2023. These patients were divided into an SAP group (86 cases) and a non-SAP group (194 cases) according to SAP diagnostic criteria by expert consensus on the diagnosis and treatment of SAP. We collated general and clinical data from all patients, including the survival of SAP patients during the follow-up period. Multivariate logistic regression was used to analyze the risk factors for SAP. Kaplan-Meier and multivariate COX regression analyses were used to investigate the relationship between OASIS and the prognosis of SAP, and a receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of OASIS for SAP. Results Our analyses identified body temperature, C-reactive protein, procalcitonin, OASIS, and a prolonged length of intensive care unit (ICU) stay as the main risk factors for SAP (all Ps < 0.05). Advanced age and an elevated OASIS were identified as the main risk factors for death in SAP patients (all Ps < 0.05). The risk of death in patients with OASIS of 31-42 points was significantly higher than that in patients with OASIS of 12-20 points (HR = 5.588, 95% CI = 1.531-20.401, P = 0.009). ROC curve analysis further showed that OASIS had a high predictive value for morbidity and the incidence of death in SAP patients. Conclusion OASIS can effectively predict the onset and death of SAP patients and provides a potential reference index for early diagnosis and the prediction of prognosis in patients with SAP. Our findings should be considered in clinical practice.
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Affiliation(s)
- Ximei Wang
- Department of General Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Jianhua Xia
- Department of Neurology, Zhumadian Central Hospital, Zhumadian, China
| | - Yanhua Shan
- Department of General Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Yang Yang
- Department of Scientific Research Management, Zhumadian Central Hospital, Zhumadian, China
| | - Yun Li
- Department of General Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Haiyan Sun
- Department of Neurology, Jilin Province First Auto Work General Hospital, Jilin, China
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Zhu W, Deng S, Jiang H, Zhang J, Li B, Jia Q, Meng Z. Assessment of corticospinal tract remodeling based on diffusion tensor imaging in the treatment of motor dysfunction after ischemic stroke by acupuncture: A meta-analysis. Medicine (Baltimore) 2023; 102:e34618. [PMID: 37565876 PMCID: PMC10419801 DOI: 10.1097/md.0000000000034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND To investigate the efficacy of acupuncture in improving motor dysfunction after ischemic stroke (IS) and to investigate the effect of acupuncture on corticospinal tract (CST) remodeling using diffusion tensor imaging. METHODS Published literature on the effect of acupuncture on CST remodeling after IS using diffusion tensor imaging in the form of randomized controlled trials (RCTs) were systematically retrieved and screened from Cochrane Library, Web of Science, PubMed, Embase, CNKI, CBM, VIP, and Wanfang databases from inception to December 2022. The methodological quality of the included studies was critically and independently evaluated by 2 reviewers using the Cochrane Risk of Bias Assessment Tool for RCTs. The correlated data were extracted using the pre-designed form, and all analyses were performed using Reviewer Manager version 5.4. RESULTS Eleven eligible RCTs involving 459 patients were eventually included. The combined evidence results showed that the acupuncture group significantly improved patients' National Institute of Health stroke scale, Fugl-Meyer Assessment Scale, and Barthel index compared with conventional medical treatment. The acupuncture group significantly promoted remodeling of the CST, as reflected by an increase in fractional anisotropy (FA) throughout the CST [MD = 0.04, 95% CI (0.02, 0.07), P = .001], and in addition, subgroup analysis showed that the acupuncture group significantly improved FA in the infarct area compared with conventional medical treatment at around 4 weeks [MD = 0.04, 95% CI (0.02, 0.06), P = .0002] and FA of the affected cerebral peduncle [MD = 0.03, 95% CI (0.00, 0.07), P = .02]. Also, compared with conventional medical treatment, the acupuncture group significantly increased average diffusion coefficient of the affected cerebral peduncle [MD = -0.21, 95% CI (-0.28, -0.13), P < .00001]. CONCLUSION The results of the meta-analysis suggest that acupuncture therapy can improve the clinical manifestations of motor dysfunction in patients after IS and advance a possibly beneficial effect on CST remodeling. However, due to the number and quality of eligible studies, these findings need to be further validated in more standardized, rigorous, high-quality clinical trials.
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Affiliation(s)
- Weiming Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hailun Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jieying Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qingqing Jia
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Wang Y, Ma H, Zhang Q, Jin F, Xu Y, Ma Q, Ji X. Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center. CNS Neurosci Ther 2023; 29:957-967. [PMID: 36601660 PMCID: PMC9928549 DOI: 10.1111/cns.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS To investigate the predicted factors influencing the outcomes in acute ischemic stroke (AIS) patients who received tirofiban after endovascular treatment (EVT) and the optimal administration of tirofiban. METHODS In this retrospective study, AIS patients who received EVT followed by tirofiban between January 2017 and October 2021 were enrolled. The dose and duration of tirofiban were adjusted by trained clinicians according to the patient's clinical status. A reduction of at least four points on the National Institutes of Health Stroke Scale (NIHSS) after tirofiban compared with that before tirofiban was defined as an effective response. A modified ranking scale (mRS) of 0-2 was defined as a favorable outcome at a 90-day follow-up. RESULTS A total of 260 consecutive patients were enrolled, and 36.5% of patients achieved a favorable outcome. The modified thrombolysis in cerebral infarction (mTICI) 2b-3 occurred in 93.5% of patients. Symptomatic intracerebral hemorrhage (sICH) occurred in 6.2% of patients, and the mortality at 90-day follow-up was 16.9%. Duration of tirofiban >24 h (adjusted OR: 2.545; 95% CI: 1.008-6.423; p = 0.048) and effective response to tirofiban (adjusted OR: 25.562; 95% CI: 9.794-66.715; p < 0.001) were related to the favorable outcome (mRS 0-2). Higher NIHSS (adjusted OR: 0.855; 95% CI: 0.809-0.904; p < 0.001) and glucose level on admission (adjusted OR: 0.843; 95% CI: 0.731-0.971; p = 0.018) were predictive for the unfavorable outcome (mRS 3-6). CONCLUSIONS An effective response to tirofiban is an independent factor in predicting the long-term efficacy outcome, and extending the duration of tirofiban is beneficial for neurological improvement.
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Affiliation(s)
- Yuan Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Hongrui Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qihan Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Feiyang Jin
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yi Xu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qingfeng Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
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21
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Jin D, Su X, Jin Y, Gu Y, Yang J, Wang Q, Wang Y, Shi D, Xu L. Diagnostic value of MRI perfusion-weighted imaging and diffusion-weighted imaging parameters in cerebral apoplexy. Am J Transl Res 2023; 15:1097-1106. [PMID: 36915724 PMCID: PMC10006800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/10/2022] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To assess the clinical and prognostic value of MRI perfusion-weighted imaging (PWI) versus diffusion-weighted imaging (DWI) parameters for apparent diffusion coefficient (ADC) and cerebral blood flow (CBF) in the diagnosis of patients with ischemic stroke (IS). METHODS Eighty patients diagnosed with IS in the Second Affiliated Hospital of Soochow University from January 2020 to January 2021 were retrospectively analyzed and regarded as a patient group. Meanwhile, 50 patients who underwent physical examination at the Second Affiliated Hospital of Soochow University during the same period were collected, and were identified by physical examination to have atherosclerotic stenosis but not cerebral infarction, they were set as a control group. The differences of ADC and CBF between both groups were compared. The diagnostic value of ADC and CBF in diagnosing acute ischemic stroke was analyzed by receiver operating characteristic (ROC) curve. The changes of ADC and CBF before and after treatment were compared. Patients were sub-grouped according to their mRS scores, and those with scores of 0-2 were grouped into the good prognosis group while those with scores of 3-6 were grouped into the poor prognosis group, and the risk factors affecting patients' prognosis were evaluated by logistic regression. The correlation of ADC and CBF with National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores was analyzed. ADC and CBF levels were compared between deceased and surviving patients, and their predictive value was assessed by ROC curves. RESULTS ADC and CBF were dramatically lower in the patient group compared with the control group (P<0.05). The area under the curve (AUC) of ADC and CBF in diagnosing IS was 0.949 and 0.926. The ADC and CBF values after treatment were significantly increased as compared to before treatment (both P<0.05). Both ADC and CBF were lower in the patients of the deceased group than in those in the survival group (P<0.05). The AUC for ADC and CBF in predicting death in patients diagnosed with IS was 0.866 and 0.766, respectively. ADC, CBF was negatively correlated with patients' NIHSS and mRS scores (P<0.01). Higher pre-treatment NIHSS and admission time ≥24 h after onset were risk factors for patient prognosis, whereas higher ADC and CBF values were protective factors (all P<0.05). CONCLUSION ADC and CBF values are reduced in IS patients and can be used as a diagnostic and prognostic indicator of IS.
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Affiliation(s)
- Dan Jin
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Xiaojuan Su
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Yuxuan Jin
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Yan Gu
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Junjie Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Qingri Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Yeqing Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Dai Shi
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
| | - Liang Xu
- Department of Radiology, The Second Affiliated Hospital of Soochow University Suzhou 215004, Jiangsu, China
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22
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Liu Z, Zhang R, Ouyang K, Hou B, Cai Q, Xie Y, Liu Y. Predicting functional outcome in acute ischemic stroke patients after endovascular treatment by machine learning. Transl Neurosci 2023; 14:20220324. [PMID: 38035150 PMCID: PMC10685342 DOI: 10.1515/tnsci-2022-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Endovascular therapy (EVT) was the standard treatment for acute ischemic stroke with large vessel occlusion. Prognosis after EVT is always a major concern. Here, we aimed to explore a predictive model for patients after EVT. METHOD A total of 156 patients were retrospectively enrolled. The primary outcome was functional dependence (defined as a 90-day modified Rankin Scale score ≤ 2). Least absolute shrinkage and selection operator and univariate logistic regression were used to select predictive factors. Various machine learning algorithms, including multivariate logistic regression, linear discriminant analysis, support vector machine, k-nearest neighbors, and decision tree algorithms, were applied to construct prognostic models. RESULT Six predictive factors were selected, namely, age, baseline National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT (ASPECT) score, modified thrombolysis in cerebral infarction score, symptomatic intracerebral hemorrhage (sICH), and complications (pulmonary infection, gastrointestinal bleeding, and cardiovascular events). Based on these variables, various models were constructed and showed good discrimination. Finally, a nomogram was constructed by multivariate logistic regression and showed a good performance. CONCLUSION Our nomogram, which was composed of age, baseline NIHSS score, ASPECT score, recanalization status, sICH, and complications, showed a very good performance in predicting outcome after EVT.
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Affiliation(s)
- Zhenxing Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
- Department of Neurology, Yiling Hospital of Yichang City, 443100, Yichang, Hubei, China
| | - Renwei Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
| | - Keni Ouyang
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
- Department of Neurology, Wuhan Fourth Hospital, 430033, Wuhan, Hubei, China
| | - Botong Hou
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
- Department of Neurology, Wuhan Fourth Hospital, 430033, Wuhan, Hubei, China
| | - Qi Cai
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
| | - Yu Xie
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
| | - Yumin Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
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23
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Huang W, Chen Q, Liu J, Liu L, Tang J, Zou M, Zeng T, Li H, Jiang Q, Jiang Q. Transcranial Magnetic Stimulation in Disorders of Consciousness: An Update and Perspectives. Aging Dis 2022:AD.2022.1114. [PMID: 37163434 PMCID: PMC10389824 DOI: 10.14336/ad.2022.1114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/14/2022] [Indexed: 05/12/2023] Open
Abstract
Disorders of consciousness (DOC) is a state in which consciousness is affected by brain injuries, leading to dysfunction in vigilance, awareness, and behavior. DOC encompasses coma, vegetative state, and minimally conscious state based on neurobehavioral function. Currently, DOC is one of the most common neurological disorders with a rapidly increasing incidence worldwide. Therefore, DOC not only impacts the lives of individuals and their families but is also becoming a serious public health threat. Repetitive transcranial magnetic stimulation (rTMS) can stimulate electrical activity using a pulsed magnetic field in the brain, with great value in the treatment of chronic pain, neurological diseases, and mental illnesses. However, the clinical application of rTMS in patients with DOC is debatable. Herein, we report the recent main findings of the clinical therapeutics of rTMS for DOC, including its efficacy and possible mechanisms. In addition, we discuss the potential key parameters (timing, location, frequency, strength, and secession of rTMS applications) that affect the therapeutic efficiency of rTMS in patients with DOC. This review may help develop clinical guidelines for the therapeutic application of rTMS in DOC.
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Affiliation(s)
| | | | - Jun Liu
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Lin Liu
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Jiangxi, China
| | - Jianhong Tang
- Laboratory Animal Engineering Research Center of Ganzhou, Gannan Medical University, Jiangxi, China
| | - Mingang Zou
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Tianxiang Zeng
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Huichen Li
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - Qing Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
| | - QiuHua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Jiangxi, China
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Wu J, Fang C, Wei L, Liu Y, Xu H, Wang X, Yuan L, Wu X, Xu Y, Zhang A. Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment. Front Surg 2022; 9:971066. [PMID: 36425889 PMCID: PMC9679017 DOI: 10.3389/fsurg.2022.971066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/18/2022] [Indexed: 10/11/2023] Open
Abstract
Chronic internal carotid artery occlusion (CICAO) has high prevalence and incidence rates, and patients with CICAO can be completely asymptomatic, experience a devastating stroke or die. It is important to note that CICAO causes cerebrovascular accidents. Currently, the external carotid-internal carotid (EC-IC) bypass technique is used to treat CICAO. However, many clinical studies showed that EC-IC bypass was not beneficial for many patients with CICAO. Meanwhile, endovascular intervention treatment options for CICAO are evolving, and an increasing number of patients are undergoing endovascular intervention therapy. Accordingly, a review comparing both techniques is warranted. For this review, we searched PubMed and collected relevant case study reports comparing endovascular interventional therapy and internal and external cervical bypass surgeries to provide strategies for clinical treatment.
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Affiliation(s)
- Junnan Wu
- Department of Emergency, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Chaoyou Fang
- Department of Neurosurgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingying Wei
- Department of Emergency, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Yibo Liu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Shanghai, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Houshi Xu
- Department of Neurosurgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Shanghai, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Ling Yuan
- Department of Neurosurgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoya Wu
- Department of Emergency, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Yuanzhi Xu
- Department of Neurosurgery, Huashan Hospital, School of Medicine, Fudan University, Shanghai, China
| | - Anke Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Shanghai, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
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Chen S, Spring KJ, Killingsworth MC, Calic Z, Beran RG, Bhaskar SMM. Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis. Neurol Int 2022; 14:903-922. [PMID: 36412695 PMCID: PMC9680454 DOI: 10.3390/neurolint14040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The impact of lesion topography (LT), characterised by the Alberta Stroke Programme Early CT Score (ASPECTS), on outcomes after reperfusion therapy in acute ischemic stroke (AIS) is poorly elucidated. We investigated the prognostic accuracy of ASPECTS-based LT assessment and its association with clinical outcomes in AIS patients considered for reperfusion therapy or receiving intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or none or both. Methods: Studies were identified from PubMed with additional studies added from Google Scholar. The prevalence of individual ASPECTS regions will also be determined. The association of individual ASPECTS regions with the functional outcome at 90 days will be assessed using random-effects modelling for various cut-offs, such as 6, 7 and 8. The association of continuous ASPECTS with the functional outcome at 90 days will also be undertaken. Forest plots of odds ratios (ORs) will be generated. Results: A total of 25 studies have been included in the final analysis, encompassing 11,404 patients. Pooled estimates indicate that the highest prevalence rates were in cases involving the insula and lentiform nucleus. Subgroup analysis for ASPECTS < 6 (OR 6.10; 95% CI 2.50−14.90; p < 0.0001), ASPECTS < 7 (OR 4.58; 95% CI 1.18−17.86; p < 0.0001) and ASPECTS < 8 (OR 2.26; 95% CI 1.32−3.89; p < 0.0001) revealed a significant association with poor functional outcome at 90 days. Decreasing ASPECTS significantly increased the odds of poor functional outcomes at 90 days (SMD −1.15; 95% CI −1.77−−0.52; p < 0.0001). Conclusions: Our meta-analysis demonstrates that decreasing ASPECTS is significantly associated with poor functional outcomes. Individual ASPECTS regions associated with the highest odds of poor functional outcomes were identified. Future studies on the association of LT and clinical outcomes specific to EVT are required.
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Affiliation(s)
- Shuyue Chen
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia
| | - Kevin J. Spring
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Medical Oncology Group, Liverpool Clinical School, Ingham Institute for Applied Medical Research and Western Sydney University (WSU), Sydney, NSW 2751, Australia
- School of Medicine, Western Sydney University, Sydney, NSW 2000, Australia
| | - Murray C. Killingsworth
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- School of Medicine, Western Sydney University, Sydney, NSW 2000, Australia
- Department of Anatomical Pathology, NSW Health Pathology, Correlative Microscopy Facility, Ingham Institute for Applied Medical Research and Western Sydney University (WSU), Liverpool, NSW 2170, Australia
| | - Zeljka Calic
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Sydney, NSW 2170, Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia
| | - Roy G. Beran
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- School of Medicine, Western Sydney University, Sydney, NSW 2000, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Sydney, NSW 2170, Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia
- Griffith Health, School of Medicine and Dentistry, Griffith University, Southport, QLD 4215, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Sydney, NSW 2170, Australia
- Stroke & Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia
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Wu W, Cheng Y, Li Y, Jiang J, Chen F, Cai D, Zhang L. Assessment of Primary Collateral Grades Based on the Integrity of Willis' Circle: Predicting the Prognosis of Acute Intracranial Internal Carotid Artery Occlusion Before Thrombectomy. World Neurosurg 2022; 167:e1138-e1146. [PMID: 36087913 DOI: 10.1016/j.wneu.2022.08.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Endovascular mechanical thrombectomy (EVMT) has shown significant efficacy in improving neurological functions in patients with intracranial internal carotid artery occlusion (IICAO), but its clinical outcomes are variable. We examined the relationship between favorable clinical outcomes after EVMT in IICAO and a set of predictors. METHODS In this retrospective study, 189 patients with IICAO treated by EVMT at 3 centers from November 2015 to December 2020 were included and analyzed. Non-contrast computed tomography and computed tomography angiography were evaluated on admission. The morphology of IICAO was categorized into Ia, Ib, L, or T types, depending on the involvement of the posterior communicating artery origin, proximal anterior cerebral artery, and middle cerebral artery. The Willis' circle was categorized as integrated or compromised Willis' circle. In combination with the involvement of the IICAO and the integrity of Willis' circle, we used the primary collateral grade (PCG) to describe the presence of functional Willisian collaterals. Baseline data including demographics, characteristics, vascular risk factors, and initial National Institutes of Health Stroke Scale scores were collected. Hemorrhagic transformation was evaluated using the 24-hour non-contrast computed tomography after EVMT. Favorable outcomes based on modified Rankin scale, were defined as 0-2 at 90 days. RESULTS A total of 189 patients were included (median age, 69 years; 126 male [66.7%]). 104 patients [55.0%] showed reperfusion after EVMT, but 72 patients [38.1%] achieved favorable outcomes at 90 days. The mortality rate of type Ib was significantly higher than that with type Ia (χ2 = 14.21, P = 0.001). The outcome with different structure of Willis' circle was not statistically different between the 2 groups. A multivariate logistic regression analysis showed that IICAO T-type (odds ratio, 0.028 [95% confidence interval: 0.323-3.829], P = 0.042) and PCG 2 (odds ratio 9.427[95% confidence interval:1.863-47.698], P = 0.007) were predictors of favorable outcomes. CONCLUSIONS Evaluation of PCG by determining the type of IICAO and the integrity of Willis' circle may serve as a valuable indicator for the prognosis and as an essential reference for screening patients before EVMT.
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Affiliation(s)
- Wenjuan Wu
- Department of Radiology, Wuxi Second People's Hospital, Wuxi, China
| | - Yue Cheng
- Department of Radiology, Wuxi Second People's Hospital, Wuxi, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jingxuan Jiang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fangming Chen
- Department of Radiology, Wuxi Second People's Hospital, Wuxi, China
| | - Dongmei Cai
- Department of Radiology, Wuxi Xishan People's Hospital, Wuxi, China
| | - Lei Zhang
- Department of Radiology, Wuxi Second People's Hospital, Wuxi, China.
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Gao J, Cheng Z, Jiang S, Wills M, Wehbe A, Rajah GB, Geng X, Ding Y. Arterial Glyceryl Trinitrate in Acute Ischemic Stroke after Thrombectomy for Neuroprotection (AGAIN): Rationale, design and protocol for a prospective randomized controlled trial. BMC Geriatr 2022; 22:804. [PMID: 36253714 PMCID: PMC9575243 DOI: 10.1186/s12877-022-03506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although endovascular recanalization therapy demonstrates robust clinical efficacy in acute ischemic stroke (AIS), not all victims of these cerebrovascular accidents can benefit from it and achieve a favorable prognosis after successful reperfusion. Therefore, alternative neuroprotective strategies are urgently needed for AIS patients after vessel recanalization. Nitric oxide (NO) levels are low after AIS and NO donor drugs may be neuroprotective against cerebral ischemia-reperfusion injury. Glyceryl trinitrate (GTN), often used in the clinic as a NO donor, may provide a novel neuroprotective strategy. This rationale, design, and protocol for a prospective pilot study plans to explore the preliminary safety, feasibility, and neuroprotective benefits of Arterial Glyceryl Trinitrate in Acute Ischemic Stroke after Thrombectomy for Neuroprotection (AGAIN). METHODS AGAIN, a prospective RCT, is proposed for AIS patients after mechanical thrombectomy. Subjects will be randomly assigned in a 1:1 fashion (n = 40) to either the control group or the intervention group. Participants assigned to the intervention group will be administered 800 μg GTN in the catheter immediately after recanalization, whereas those in the control group will be administered the same volume of normal saline. All participants from either group will be given concurrent treatment with standard of care therapies in accordance with the current guidelines for stroke management. The primary outcome is safety [symptomatic intracranial hemorrhage (ICH), hypotension, neurological deterioration, ICH, fatal ICH, as well as headache, tachycardia, emesis, and seizures], whereas secondary outcomes included changes in poststroke functional outcomes, infarction volumes, and blood nitrate index detection. DISCUSSIONS This study is a prospective randomized controlled trial to test the safety and efficacy of intra-arterial GTN in AIS patients after endovascular therapy. The results from this study will give insight for future GTN studies and new neuroprotective strategies for future AIS treatment strategies. TRIAL REGISTRATION NUMBER ChiCTR2100045254. Registered on March 21, 2021.
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Affiliation(s)
- Jie Gao
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China
| | - Zhe Cheng
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China
| | - Shangqian Jiang
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, 101100, China
| | - Melissa Wills
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI, 48201, USA
| | - Alexandra Wehbe
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI, 48201, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02138, USA
| | - Gary B Rajah
- Department of Neurosurgery, Munson Healthcare, Traverse City, MI, USA
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Department of Neurosurgery, University at Buffalo, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Xiaokun Geng
- Department of Neurology and Stroke Center, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China.
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, 101100, China.
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, Detroit, MI, 48201, USA.
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Duan H, Yun HJ, Geng X, Ding Y. Branch atheromatous disease and treatment. Brain Circ 2022; 8:169-171. [PMID: 37181840 PMCID: PMC10167853 DOI: 10.4103/bc.bc_56_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
Branch atheromatous disease (BAD) is a subtype of ischemic stroke caused by perforating arteries occlusion due to proximal atherosclerosis of the arteries. Early neurological deterioration and recurrent stereotyped transient ischemic attacks are typical clinical manifestations of BAD. The optimal treatment for BAD has not been determined. This article explores a possible mechanism of BAD and effective treatment measures to prevent early progression and attack of transient ischemic events. This article explains the current status of intravenous thrombolysis, tirofiban, and argatroban for BAD and subsequent prognosis.
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Affiliation(s)
- Honglian Duan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ho Jun Yun
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Neurology, Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Zhu X, Li H, You W, Yu Z, Wang Z, Shen H, Li X, Yu H, Wang Z, Chen G. Role of Rph3A in brain injury induced by experimental cerebral ischemia-reperfusion model in rats. CNS Neurosci Ther 2022; 28:1124-1138. [PMID: 35467084 PMCID: PMC9160444 DOI: 10.1111/cns.13850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 01/01/2023] Open
Abstract
Aim The aim was to study the role of Rph3A in neuronal injury induced by cerebral ischemia‐reperfusion. Methods The protein and mRNA levels of Rph3A in penumbra were detected by Western blot. The localization of Rph3A in different cell types in penumbra was detected by immunofluorescence. Apoptosis in the brain was detected by TUNEL staining. We tested neurobehavioral evaluation using rotarod test, adhesive‐removal test, and Morris Water maze test. We examined the expression and localization of Rph3A in cultured neurons and astrocytes in vitro by Western blot and ELISA, respectively. Results The mRNA and protein levels of Rph3A had significantly increased in brain penumbra of the rat MCAO/R model. Rph3A was mainly distributed in neurons and astrocytes and was significantly increased by MCAO/R. We downregulated Rph3A and found that it further worsened the cerebral infarct, neuronal death and behavioral, cognitive, and memory impairments in rats after MCAO/R. We also found that ischemia‐reperfusion upregulated the in vitro protein level and secretion of Rph3A in astrocytes but led to a decrease in the protein level of Rph3A in neurons. Conclusion The increase in Rph3A in the brain penumbra may be an endogenous protective mechanism against ischemia‐reperfusion injury, which is mainly dominated by astrocytes.
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Affiliation(s)
- Xianlong Zhu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China.,Department of Neurosurgery, The Second People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Wanchun You
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Zhengquan Yu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Zongqi Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Xiang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Hao Yu
- Department of Neurosurgery, The First People's Hospital of Nantong city, Nantong, Jiangsu, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Institute of Stroke Research, Soochow University, Suzhou, Jiangsu, China
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Vigil TM, Frieler RA, Kilpatrick KL, Wang MM, Mortensen RM. Aconitate decarboxylase 1 suppresses cerebral ischemia-reperfusion injury in mice. Exp Neurol 2022; 347:113902. [PMID: 34699789 PMCID: PMC8642300 DOI: 10.1016/j.expneurol.2021.113902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023]
Abstract
Immunometabolic changes have been shown to be a key factor in determining the immune cell response in disease models. The immunometabolite, itaconate, is produced by aconitate decarboxylase 1 (Acod1) and has been shown to inhibit inflammatory signaling in macrophages. In this study, we explore the role of Acod1 and itaconate in cerebral ischemia/reperfusion injury. We assessed the effect of global Acod1 knockout (Acod1KO, loss of endogenous itaconate) in a transient ischemia/reperfusion occlusion stroke model. Mice received a transient 90-min middle cerebral artery occlusion followed with 24-h of reperfusion. Stroke lesion volume was measured by MRI analysis and brain tissues were collected for mRNA gene expression analysis. Acod1KO mice showed significant increases in lesion volume compared to control mice, however no differences in pro-inflammatory mRNA levels were observed. Cell specific knockout of Acod1 in myeloid cells (LysM-Cre), microglia cells (CX3CR1, Cre-ERT2) and Endothelial cells (Cdh5(PAC), Cre-ERT2) did not reproduce lesion volume changes seen in global Acod1KO, indicating that circulating myeloid cells, resident microglia and endothelial cell populations are not the primary contributors to the observed phenotype. These effects however do not appear to be driven by changes in inflammatory gene regulation. These data suggests that endogenous Acod1 is protective in cerebral ischemia/reperfusion injury.
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Affiliation(s)
- Thomas M Vigil
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Ryan A Frieler
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - KiAundra L Kilpatrick
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Richard M Mortensen
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, United States of America; Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, United States of America; Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI, United States of America.
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