1
|
Zheng M, Xu Y. Effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischemic stroke: A matched cohort study. J Stroke Cerebrovasc Dis 2025; 34:108339. [PMID: 40345409 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108339] [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: 03/05/2025] [Revised: 04/24/2025] [Accepted: 05/05/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Both hyperbaric oxygen therapy and Danshen (Salvia miltiorrhiza) injection have shown potential therapeutic effects on ischemic stroke, but the impact of their combination on long-term functional outcomes and recurrence risk has not been systematically evaluated. This study aimed to assess the effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischaemic stroke. METHODS This study employed a retrospective matched cohort design and collected data from patients with ischemic stroke treated at our hospital between January 2018 and December 2022. After 1:1 propensity score matching, 80 patients were included in each group. The intervention group received hyperbaric oxygen therapy (2.0-2.5 ATA, once daily for 10 sessions) combined with Danhong injection (20 ml/day for 14 consecutive days) in addition to standard treatment; the control group received standard treatment only. The primary outcome was 90-day functional independence (mRS ≤2); secondary outcomes included the 1-year stroke recurrence rate, NIHSS score improvement, and others. RESULTS The percentage of 90-day functional independence in the intervention group (72.5 %) was significantly greater than that in the control group (53.8 %) (P = 0.014), with a relative risk ratio of 1.35 (95 % CI: 1.06-1.71). Multivariate analysis revealed that combined therapy was independently associated with 90-day functional independence (adjusted OR = 2.28, 95 % CI: 1.19-4.37; P = 0.013). The 1-year stroke recurrence rate in the intervention group (7.6 %) was significantly lower than that in the control group (16.5 %) (P = 0.042), with an adjusted hazard ratio of 0.46 (95 % CI: 0.22-0.94, P = 0.033). Subgroup analysis revealed that patients aged <65 years, those with NIHSS scores ranging from 4-15, those with small-artery occlusion or large-artery atherosclerosis stroke, and those who began treatment within 24 hours benefited more significantly. The combined therapy was well tolerated, with no serious adverse events. CONCLUSION Hyperbaric oxygen combined with Danhong injection significantly improved 90-day functional independence and reduced the 1-year recurrence risk in patients with ischaemic stroke, particularly in specific patient subgroups. This combined treatment strategy provides a new therapeutic option for comprehensive stroke management.
Collapse
Affiliation(s)
- Mo Zheng
- Zhejiang Rehabilitation Medical Center, 310000 Hangzhou, Zhejiang, China.
| | - Yun Xu
- Xiaoshan District Second People's Hospital of Hangzhou, 310000 Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Rogers RS, Mootha VK. Hypoxia as a medicine. Sci Transl Med 2025; 17:eadr4049. [PMID: 39841808 DOI: 10.1126/scitranslmed.adr4049] [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: 07/01/2024] [Accepted: 12/31/2024] [Indexed: 01/24/2025]
Abstract
Oxygen is essential for human life, yet a growing body of preclinical research is demonstrating that chronic continuous hypoxia can be beneficial in models of mitochondrial disease, autoimmunity, ischemia, and aging. This research is revealing exciting new and unexpected facets of oxygen biology, but translating these findings to patients poses major challenges, because hypoxia can be dangerous. Overcoming these barriers will require integrating insights from basic science, high-altitude physiology, clinical medicine, and sports technology. Here, we explore the foundations of this nascent field and outline a path to determine how chronic continuous hypoxia can be safely, effectively, and practically delivered to patients.
Collapse
Affiliation(s)
- Robert S Rogers
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute, Cambridge, MA 02142, USA
| | - Vamsi K Mootha
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute, Cambridge, MA 02142, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA 02115, USA
- Howard Hughes Medical Institute, Boston, MA 02114, USA
| |
Collapse
|
3
|
Batinac T, Batičić L, Kršek A, Knežević D, Marcucci E, Sotošek V, Ćurko-Cofek B. Endothelial Dysfunction and Cardiovascular Disease: Hyperbaric Oxygen Therapy as an Emerging Therapeutic Modality? J Cardiovasc Dev Dis 2024; 11:408. [PMID: 39728298 DOI: 10.3390/jcdd11120408] [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: 10/29/2024] [Revised: 12/16/2024] [Accepted: 12/18/2024] [Indexed: 12/28/2024] Open
Abstract
Maintaining the physiological function of the vascular endothelium and endothelial glycocalyx is crucial for the prevention of cardiovascular disease, which is one of the leading causes of morbidity and mortality worldwide. Damage to these structures can lead to atherosclerosis, hypertension, and other cardiovascular problems, especially in individuals with risk factors such as diabetes and obesity. Endothelial dysfunction is associated with ischemic disease and has a negative impact on overall cardiovascular health. The aim of this review was to comprehensively summarize the crucial role of the vascular endothelium and glycocalyx in cardiovascular health and associated thrombo-inflammatory conditions. It highlights how endothelial dysfunction, influenced by factors such as diabetes, chronic kidney disease, and obesity, leads to adverse cardiovascular outcomes, including heart failure. Recent evidence suggests that hyperbaric oxygen therapy (HBOT) may offer therapeutic benefits in the treatment of cardiovascular risk factors and disease. This review presents the current evidence on the mechanisms by which HBOT promotes angiogenesis, shows antimicrobial and immunomodulatory effects, enhances antioxidant defenses, and stimulates stem cell activity. The latest findings on important topics will be presented, including the effects of HBOT on endothelial dysfunction, cardiac function, atherosclerosis, plaque stability, and endothelial integrity. In addition, the role of HBOT in alleviating cardiovascular risk factors such as hypertension, aging, obesity, and glucose metabolism regulation is discussed, along with its impact on inflammation in cardiovascular disease and its potential benefit in ischemia-reperfusion injury. While HBOT demonstrates significant therapeutic potential, the review also addresses potential risks associated with excessive oxidative stress and oxygen toxicity. By combining information on the molecular mechanisms of HBOT and its effects on the maintenance of vascular homeostasis, this review provides valuable insights into the development of innovative therapeutic strategies aimed at protecting and restoring endothelial function to prevent and treat cardiovascular diseases.
Collapse
Affiliation(s)
- Tanja Batinac
- Department of Clinical Medical Sciences I, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 2, 51000 Rijeka, Croatia
- Department of Underwater and Hyperbaric Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
| | - Lara Batičić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Antea Kršek
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Danijel Knežević
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Emanuela Marcucci
- Department of Clinical Medical Sciences I, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 2, 51000 Rijeka, Croatia
- Department of Underwater and Hyperbaric Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
| | - Vlatka Sotošek
- Department of Clinical Medical Sciences I, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 2, 51000 Rijeka, Croatia
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Božena Ćurko-Cofek
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| |
Collapse
|
4
|
Yang L, Huang Y, Peng Y, Sun Q, Zhang D, Yang S, Song J, Sun X, Lv C, Zhang X, Fang Z. Chaperone-mediated autophagy (CMA) confers neuroprotection of HBO preconditioning against stroke. Brain Res 2024; 1846:149315. [PMID: 39522743 DOI: 10.1016/j.brainres.2024.149315] [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: 08/27/2024] [Revised: 10/21/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024]
Abstract
Previous attempts to identify neuroprotective targets for acute ischemic stroke by studying ischemic cascades and devising ways to suppress these pathways have failed in translational research. We hypothesized that studying the molecular determinants of endogenous neuroprotection, namely, the tolerance against ischemic stroke conferred by hyperbaric oxygen (HBO) preconditioning, via a well-established paradigm would reveal new neuroprotective targets. By a combination of proteomics, KEGG pathway analysis, lysosome fraction and western blot analysis, we found that chaperone-mediated autophagy (CMA) was activated by HBO preconditioning. In addition, LAMP2A is uniquely decreased in cortical neurons in the early stage of stroke. Suppression of CMA with recombinant adeno-associated viral vector (rAAV)-mediated delivery of short hairpin RNAs (shRNAs) targeting the LAMP2A transcript increased the neuronal susceptibility of apoptosis and abolished the neuroprotection induced by HBO preconditioning. Administration of the clinically utilized FDA-approved drug mycophenolate mofetil induced long-term neuroprotection post-stroke in a CMA-dependent manner. In summary, HBO preconditioning confers neuroprotection against ischemia by inducing CMA, which is a promising translational treatment target for stroke.
Collapse
Affiliation(s)
- Lin Yang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, PR China
| | - Yuan Huang
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Yuliang Peng
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Qingyu Sun
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Ding Zhang
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Shulin Yang
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Jian Song
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Xiaoxiao Sun
- Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Chuan Lv
- Department of Plastic and Reconstructive Surgery, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China
| | - Xijing Zhang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, PR China
| | - Zongping Fang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, PR China; Department of Critical Care Medicine, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China; Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, PR China.
| |
Collapse
|
5
|
Zhang K, Liang F, Wu Y, Wang X, Hou X, Zhang Z, Yu Y, Wang Y, Han R. Associations of arterial oxygen partial pressure with all‑cause mortality in critically ill ischemic stroke patients: a retrospective cohort study from MIMIC IV 2.2. BMC Anesthesiol 2024; 24:355. [PMID: 39367296 PMCID: PMC11451185 DOI: 10.1186/s12871-024-02750-z] [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: 07/16/2024] [Accepted: 09/30/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND As a supportive treatment, the effectiveness of oxygen therapy in ischemic stroke (IS) patients remains unclear. This study aimed to evaluate the relationships between arterial partial pressure of oxygen (PaO2) and both consciousness at discharge and all-cause mortality risk in ICU IS patients. METHODS Blood gas measurements for all patients diagnosed with IS were extracted from the MIMIC-IV database. Patients were classified into four groups based on their average PaO2 during the first ICU day: hypoxemia (PaO2 < 80 mmHg), normoxemia (PaO2 80-120 mmHg), mild hyperoxemia (PaO2 121-199 mmHg), and moderate/severe hyperoxemia (PaO2 ≥ 200 mmHg). The primary endpoint was 90-day all-cause mortality. Secondary outcomes included the level of consciousness at discharge, assessed by the Glasgow Coma Scale (GCS), and 30-day all-cause mortality. Multivariate Cox regression and Restricted cubic spline (RCS) analysis were used to investigate the relationship between mean PaO2 and mortality, and to assess the nonlinear association between exposure and outcomes. RESULTS This study included a total of 946 IS patients. The cumulative incidence of 30-day and 90-day all-cause mortality increased with decreasing PaO2 levels. RCS analysis revealed a nonlinear relationship between PaO2 and the risk of 30-day all-cause mortality (nonlinear P < 0.0001, overall P < 0.0001), as well as a nonlinear association between PaO2 and 90-day all-cause mortality (nonlinear P < 0.0001, overall P < 0.0001). The results remained consistent after excluding the small subset of patients who received reperfusion therapy. Sensitivity analysis indicated that the favorable impact on survival tends to increase with the extended duration of elevated PaO2. CONCLUSIONS For IS patients who do not receive reperfusion therapy or whose recanalization status is unknown, a lower PaO2 early during ICU admission is considered an independent risk factor for short-term and recent mortality. Adjusting respiratory parameters to maintain supraphysiological levels of PaO2 appears to be beneficial for survival, although this finding requires further validation through additional studies. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Kangda Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Fa Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Youxuan Wu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Xinyan Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Xuan Hou
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Zihui Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Yun Yu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Yunzhen Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing, 100070, PR China.
| |
Collapse
|
6
|
Guo Y, Liu J, Du X, Qi M, She T, Xue K, Wu X, Xu L, Peng B, Zhang Y, Liu Y, Jiang Z, Li X, Yuan Y. ROS exhaustion reverses the effects of hyperbaric oxygen on hemorrhagic transformation through reactivating microglia in post-stroke hyperglycemic mice. Sci Rep 2024; 14:21410. [PMID: 39271781 PMCID: PMC11399301 DOI: 10.1038/s41598-024-72454-4] [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: 03/03/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
Acute ischemic stroke (AIS) is a major global health concern due to its high mortality and disability rates. Hemorrhagic transformation, a common complication of AIS, leads to poor prognosis yet lacks effective treatments. Preclinical studies indicate that hyperbaric oxygen (HBO) treatment within 12 h of AIS onset alleviates ischemia/reperfusion injuries, including hemorrhagic transformation. However, clinical trials have yielded conflicting results, suggesting some underlying mechanisms remain unclear. In this study, we confirmed that HBO treatments beginning within 1 h post reperfusion significantly alleviated the haemorrhage and neurological deficits in hyperglycemic transient middle cerebral arterial occlusion (tMCAO) mice, partly due to the inhibition of the NLRP3 inflammasome-mediated pro-inflammatory response in microglia. Notably, reactive oxygen species (ROS) mediate the anti-inflammatory and protective effect of early HBO treatment, as edaravone and N-Acetyl-L-Cysteine (NAC), two commonly used antioxidants, reversed the suppressive effect of HBO treatment on NLRP3 inflammasome-mediated inflammation in microglia. Furthermore, NAC countered the protective effect of early HBO treatment in tMCAO mice with hyperglycemia. These findings support that early HBO treatment is a promising intervention for AIS, however, caution is warranted when combining antioxidants with HBO treatment. Further assessments are needed to clarify the role of antioxidants in HBO therapy for AIS.
Collapse
Affiliation(s)
- Yanan Guo
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Jiayi Liu
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
- Jiang'an Health Institute of Rugao Municipal Health Commission, Nantong, 226534, China
| | - Xingyue Du
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Mian Qi
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Tongping She
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Ke Xue
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Xinhe Wu
- The Second People's Hospital of Nantong, Nantong, 226002, China
| | - Lihua Xu
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Bin Peng
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Yunfeng Zhang
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Yufeng Liu
- The Second People's Hospital of Nantong, Nantong, 226002, China
| | - Zhenglin Jiang
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China
| | - Xia Li
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China.
| | - Yuan Yuan
- Institute of Special Environmental Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China.
| |
Collapse
|
7
|
Yao Y, Song Q, Zhang J, Wen Y, Dou X. Retina-Brain Homology: The Correlation Between Ophthalmic or Retinal Artery Occlusion and Ischemic Stroke. Eye Brain 2024; 16:25-38. [PMID: 39156910 PMCID: PMC11328846 DOI: 10.2147/eb.s454977] [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: 12/15/2023] [Accepted: 04/23/2024] [Indexed: 08/20/2024] Open
Abstract
The retina's similar structure and function to the brain make it a unique visual "window" for studying cerebral disorders. Ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO) is a severe ophthalmic emergency that significantly affects visual acuity. Studies have demonstrated that patients with OAO or RAO face a notably higher risk of future acute ischemic stroke (AIS). However, ophthalmologists often overlook multidisciplinary approach involving the neurologist, to evaluate the risk of AIS and devise clinical treatment strategies for patients with OAO or RAO. Unlike the successful use of thrombolysis in AIS, the application of thrombolysis for OAO or RAO remains limited and controversial due to insufficient reliable evidence. In this review, we aim to summarize the anatomical and functional connections between the retina and the brain, and the clinical connection between OAO or RAO and AIS, compare and review recent advances in the effectiveness and safety of intravenous and intra-arterial thrombolysis therapy in patients with OAO or RAO, and discuss future research directions for OAO or RAO. Our goal is to advance the development of multidisciplinary diagnosis and treatment strategies for the disease, as well as to establish expedited pathways or thrombolysis guidelines for vascular intervention.
Collapse
Affiliation(s)
- Yufeng Yao
- Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- Department of Ophthalmology, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Qiyuan Song
- Department of Ophthalmology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Jingnan Zhang
- Department of Ophthalmology, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China
- Shenzhen University Medical College, No.1066 Xueyuan Road, Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yingying Wen
- Department of Ophthalmology, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China
- Shenzhen University Medical College, No.1066 Xueyuan Road, Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Xiaoyan Dou
- Department of Ophthalmology, Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China
| |
Collapse
|
8
|
Ye Q, Zheng D, Chen K, Xu H, Yang Z, Wen J, Hu Y, Wu J. Phase-Change Based Oxygen Carriers Improve Acute Cerebral Hypoxia. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309180. [PMID: 38148304 DOI: 10.1002/smll.202309180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/08/2023] [Indexed: 12/28/2023]
Abstract
Stroke is the second leading cause of death worldwide, and hypoxia is a major crisis of the brain after stroke. Therefore, providing oxygen to the brain microenvironment can effectively protect neurons from damage caused by cerebral hypoxia. However, there is a lack of timely and effective means of oxygen delivery clinically to the brain for acute cerebral hypoxia. Here, a phase-change based nano oxygen carrier is reported, which can undergo a phase change in response to increasing temperature in the brain, leading to oxygen release. The nano oxygen carrier demonstrate intracerebral oxygen delivery capacity and is able to release oxygen in the hypoxic and inflammatory region of the brain. In the acute ischemic stroke mouse model, the nano oxygen carrier can effectively reduce the area of cerebral infarction and decrease the level of inflammation triggered by cerebral hypoxia. By taking advantage of the increase in temperature during cerebral hypoxia, phase-change oxygen carrier proposes a new intracerebral oxygen delivery strategy for reducing acute cerebral hypoxia.
Collapse
Affiliation(s)
- Qingsong Ye
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing, 210023, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
- Wuxi Xishan NJU Institute of Applied Biotechnology, Anzhen Street, Xishan District, Wuxi, 214101, China
| | - Deyuan Zheng
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing, 210023, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
- Wuxi Xishan NJU Institute of Applied Biotechnology, Anzhen Street, Xishan District, Wuxi, 214101, China
| | - Kaiyuan Chen
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing, 210023, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
- Wuxi Xishan NJU Institute of Applied Biotechnology, Anzhen Street, Xishan District, Wuxi, 214101, China
| | - Haiheng Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing, 210023, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
- Wuxi Xishan NJU Institute of Applied Biotechnology, Anzhen Street, Xishan District, Wuxi, 214101, China
| | - Zefeng Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing, 210023, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
- Wuxi Xishan NJU Institute of Applied Biotechnology, Anzhen Street, Xishan District, Wuxi, 214101, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210093, China
| | - Yiqiao Hu
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
| | - Jinhui Wu
- State Key Laboratory of Pharmaceutical Biotechnology, Medical School of Nanjing University, Nanjing, 210093, China
- Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing, 210023, China
- Jiangsu Key Laboratory for Nano Technology, Nanjing University, Nanjing, 210093, China
- Wuxi Xishan NJU Institute of Applied Biotechnology, Anzhen Street, Xishan District, Wuxi, 214101, China
| |
Collapse
|
9
|
Li X, Lu L, Min Y, Fu X, Guo K, Yang W, Li H, Xu H, Guo H, Huang Z. Efficacy and safety of hyperbaric oxygen therapy in acute ischaemic stroke: a systematic review and meta-analysis. BMC Neurol 2024; 24:55. [PMID: 38308217 PMCID: PMC10837997 DOI: 10.1186/s12883-024-03555-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/29/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the efficacy and safety of adjunctive hyperbaric oxygen therapy (HBOT) in acute ischaemic stroke (AIS) based on existing evidence. METHODS We conducted a comprehensive search through April 15, 2023, of seven major databases for randomized controlled trials (RCTs) comparing adjunctive hyperbaric HBOT with non-HBOT (no HBOT or sham HBOT) treatments for AIS. Data extraction and assessment were independently performed by two researchers. The quality of included studies was evaluated using the tool provided by the Cochrane Collaboration. Meta-analysis was conducted using Rev Man 5.3. RESULTS A total of 8 studies involving 493 patients were included. The meta-analysis showed no statistically significant differences between HBOT and the control group in terms of NIHSS score (MD = -1.41, 95%CI = -7.41 to 4.58), Barthel index (MD = 8.85, 95%CI = -5.84 to 23.54), TNF-α (MD = -5.78, 95%CI = -19.93 to 8.36), sICAM (MD = -308.47, 95%CI = -844.13 to 13227.19), sVCAM (MD = -122.84, 95%CI = -728.26 to 482.58), sE-selectin (MD = 0.11, 95%CI = -21.86 to 22.08), CRP (MD = -5.76, 95%CI = -15.02 to 3.51), adverse event incidence within ≤ 6 months of follow-up (OR = 0.98, 95%CI = 0.25 to 3.79). However, HBOT showed significant improvement in modified Rankin score (MD = 0.10, 95%CI = 0.03 to 0.17), and adverse event incidence at the end of treatment (OR = 0.42, 95%CI = 0.19 to 0.94) compared to the control group. CONCLUSION While our findings do not support the routine use of HBOT for improving clinical outcomes in AIS, further research is needed to explore its potential efficacy within specific therapeutic windows and for different cerebral occlusion scenarios. Therefore, the possibility of HBOT offering clinical benefits for AIS cannot be entirely ruled out.
Collapse
Affiliation(s)
- Xuezheng Li
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Lijun Lu
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Yu Min
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China
| | - Xuefeng Fu
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China
| | - Wen Yang
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Hao Li
- Postgraduate cultivation base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou Guangdong, China
| | - Haoming Xu
- South China Normal University, Guangzhou Guangdong, China
| | - Hua Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No. 8, Fuyu East Road, South Bridge Street, Panyu District, Guangzhou, China.
| |
Collapse
|