Acute Stage Of Cerebral Infarction Research Articles

Role of Magnetic Resonance Perfusion Imaging in Acute Stroke: Arterial Spin Labeling Versus Dynamic Susceptibility Contrast-Enhanced Perfusion.

Introduction: The role of perfusion neuroimaging in managing cases of acute ischemic stroke (AIS) is to identify ischemic penumbra and regions of hypo-perfusion, which can be salvaged. Dynamic susceptibility contrast (DSC) perfusion imaging techniques have been the main magnetic resonance imaging (MRI) perfusion techniques used to identify AIS. Arterial spin labelling (ASL) is an alternative non-invasive perfusion technique, which permits tissue perfusion measurement without any need for administration of exogenous contrast agents. The objective was to compare the diagnostic accuracy of ASL perfusion MRI versus DSC enhanced perfusion MRI in detecting perfusion-diffusion mismatch of varying volumes in acute ischemic stroke.Materials and methods: A hospital-based observational cross-sectional study was done in a tertiary care institute in Tamil Nadu between December 2018 to October 2019. Fifty-five subjects aged more than 18 years referred to the Radio-diagnosis department (less than 24 hours since the onset of weakness) for emergency assessment of suspected acute stroke were subjected to MRI stroke scan protocol. Then AIS cases were evaluated with ASL and DSC perfusion-weighted imaging. The collected data was entered in Excel (Microsoft, Redmond, WA, USA). IBM SPSS version 22 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Receiver operating characteristic (ROC) analysis was done to assess the predictive validity of ASL in predicting DSC mismatch. The diagnostic accuracy of ASL was the primary outcome variable. P-value < 0.05 was considered statistically significant.Results: Forty-four subjects confirmed as stroke were included in the final analysis. Their mean (±SD) age was 53.84 (±10.80) years. 72.7% were males. The majority (53.8%) presented during the acute stage of cerebral infarction (53.8%). The majority (45.5%) had hemiplegia followed by aphasia (27.3%). The major vascular territory involved was the middle cerebral artery (54.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of ASL (non-contrast) in predicting DSC (contrast) mismatch was found to be 71.43%, 78.57%, 83.33%, and 64.71% respectively.Conclusion: ASL MR has the potential to replace MRI DSC perfusion in the future imaging diagnostic work-up for stroke. However, further studies are required to validate its role as the first-line imaging for stroke therapy.

Clinical comprehensive evaluation of Diemailing~® Kudiezi Injection in treatment of cerebral infarction

Clinical comprehensive evaluation was conducted in &quot;6+1&quot; dimensions(safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine) to reflect the advantages and characteristics of Diemai-ling~® Kudiezi Injection in the treatment of cerebral infarction. This study adopted a combination of qualitative and quantitative evaluation methods. Based on the methodologies of evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, pharmacoeconomics, mathematical statistics, and health technology assessment(HTA), experts gave weight to the criterion layer and index layer, and multi-criteria decision analysis(MCDA) model and CSC v2.0 were used for calculations to evaluate the clinical value of Diemailing~® Kudiezi Injection. The existing evidence showed that active monitoring and a number of randomized controlled trials(RCTs) have been carried out after the listing of Diemailing~® Kudiezi Injection. Since the total incidence of adverse reactions is 0.099% and the incidence of adverse drug reactions(ADR) is rare, the safety evaluation is grade A. The evidence value of effectiveness demonstrated that Diemailing~® Kudiezi Injection combined with conventional western medicine improves the total effective rate of neurological deficit score and quality of daily life in the acute stage of cerebral infarction, which is superior to that in the conventional western medicine treatment group, and the level of evidence is high. Therefore, its efficacy is assessed as grade A. According to the results of economic research, when Diemailing~® Kudiezi Injection combined with conventional western medicine treatment is compared with conventional western medicine treatment, the Diemailing~® Kudiezi Injection group has a greater incremental effect, but the cost is affordable. Given the overall quality evaluation results of economic report is clear, it is evaluated as grade B. The innovation is grade A. The drug is favorable for clinical operation by medical staff and can be accepted by patients due to easy usage without special technical and management requirements. Since the drug exhibits good suitability for clinicians, nurses, pharmacists, and patients, it is evaluated as grade B. Considering its moderate price among similar drugs and good affordability and availability, it is evaluated as grade B. Diemailing~® Kudiezi Injection can evidently improve the clinical symptoms and neurological deficits of fire toxin syndrome of acute cerebral infarction, and this medicine belongs to ethnic medicine. Large-sample active monitoring research has been conducted with rich experience in human use. Therefore, the characteristics of traditional Chinese medicine are evaluated as grade A. The comprehensive clinical evaluation of Diemailing~® Kudiezi Injection is class A. We suggest that it can be directly transformed into relevant policy results of basic clinical medication management by procedure.

Surgical Revascularization for Internal Carotid Artery Stenosis in the Acute Stage of Cerebral Infarction

Surgical Revascularization for Internal Carotid Artery Stenosis in the Acute Stage of Cerebral Infarction

Efficacy of Antihypertensive Therapy in the Acute Stage of Cerebral Infarction - A Prospective, Randomized Control Trial.

This study investigated whether patients in the acute stage of cerebral infarction (ACI) might benefit from single-drug antihypertensive therapy (AT) without the use of preset target levels. A total of 320 ACI patients were randomly divided into an AT group and a control group (group C) (160 patients in each group). The AT group received single antihypertensive drug treatment after the first 48 hours of onset with 5 mg of amlodipine besylate or 150 mg of irbesartan once a day. The primary end-point event was mortality on the 14th day and in the 6th month after onset, significant dependent-survival status (SDS, Barthel Index ≤ 60), mortality/disability ratio (modified Rankin Scale ≥ 3), and recurrence rate of cardio-cerebral vascular events (RR-CVE). The National Institutes of Health Stroke Scale (NIHSS) score was 8.39 ± 3.21 vs. 8.16 ± 3.27 in the AT and C groups on entry to the study. On day 14, there were no significant differences in mortality (2.5% vs. 3.1%, p = 0.9994), SDS (50.0% vs. 49.0%, p = 0.864), and mortality/disability ratio (61.3% vs. 66.3%, p = 0.352) between the two groups, however the RR-CVE in the AT group was lower than in group C (4.4% vs. 11.9%, p = 0.014). In month 6, there were no significant difference in mortality rate between the two groups (3.1% vs. 3.8%, p = 0.767), however the SDS (23.4% vs. 34.4%, p = 0.033), mortality/disability ratio (32.1% vs. 45.0%, p = 0.018), and RR-CVE in group AT were lower than in group C (10.7% vs. 19.4%, p = 0.030). Appropriate AT for patients with ACI does not worsen the disease condition and may improve the prognosis for the patients with moderate or mild stroke severity.

Expression levels of ubiquitin C-terminal hydrolase-L1 and serum glial fibrillary acidic protein and its clinical significance in patients with acute cerebral infarction

To determine expression levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) and serum glial fibrillary acidic protein (GFAP) in patients with acute cerebral infarction and their clinical significance. Methods: A total of 80 patients with acute cerebral infarction in Chongqing Cancer Hospital from January 2014 to February 2016 were enrolled as an observation group. Another 80 healthy people served as a control group. The expression levels of UCH-L1 and GFAP in the 2 groups were detected. Results: Sensibility and specificity for UCH-L1 and GFAP were 75.0%, 87.5% and 81.3%, 90.0%, respectively. Receiver operating characteristic curve areas of UCH-L1 and GFAP were 0.670 and 0.757, respectively. There were no significant significance in age, gender, drinking, smoke, diabetes, and hyperlipidemia in the 2 groups (P>0.05). High blood pressure rate in the observation group was higher than that in the control group (P<0.05). Spearson/Pearson analysis showed that serum UCH-L1 and GFAP levels were positively correlated with hypertension, but they were negatively correlated with sex, age, diabetes, hyperlipidemia, alcohol consumption, smoking, and other factors. General data at different time in the observation group was not statistically different (P>0.05). The expression levels of UCH-L1 and GFAP in the observation group was higher than that in the control group (P<0.05). UCH-L1 and GFAP levels at different time in the 2 groups were not statistically different (P>0.05). UCH-L1 and GFAP levels in the light, medium, and heavy groups were higher than those in the control group (P<0.05), while UCH-L1 and GFAP levels in the medium and heavy groups were higher than those in the light group (P<0.05). There was significant difference between levels of UCH-L1 or GFAP and infarction size at different time in the observation group (P<0.05). The results of Pearson correlation analysis showed that the levels of serum UCH-L1 and GFAP were positively correlated (r=0.634, P=0.001). Conclusion: The levels of serum UCH-L1 and GFAP are significantly increased at the early stage of acute cerebral infarction, and they have a certain correlation with the severity of cerebral infarction, which can provide a basis for early clinical diagnosis and treatment.

Neuroprotective mechanism of HIF-1α overexpression in the early stage of acute cerebral infarction in rats.

The present study aimed to explore the expression and neuroprotective mechanism of hypoxia inducible factor (HIF-1α) in the brain tissue of a rat model of early acute cerebral infarction. A total of 64 Sprague Dawley rats were randomly divided into surgery and sham groups and the model of focal cerebral infarction was established by the suture-occluded method. In the sham group, blood vessels were separated but not occluded. Rats in the surgery and sham groups were subdivided into eight groups (n=4/group). Blood samples was collected at 8 time points including 30 min and 1, 3, 6, 12, 48, 24 and 72 h, respectively, and HIF-1α content was detected using ELISA. Brain tissues of rats in all groups were harvested following blood collection. HIF-1α protein expression was detected by immunohistochemistry and terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling was used to analyze the brain cell apoptosis index. ELISA results demonstrated that rats in the surgery group began to express HIF-1α within 30 min, and HIF-1α expression levels gradually increased, peaking at 12 h. HIF-1α expression levels were significantly increased in the surgery group at all time points, as compared with the sham group (P<0.05). The concentration of HIF-1α decreased rapidly in 12 h. At various time points, HIF-1α protein expression in the brain tissue of rats in the sham group was negative. HIF-1α protein expression was significantly increased in the surgery group (P<0.05), peaking at 12 h, and decreasing after this point. As compared with the sham group, the apoptosis indices of the brain tissue of rats in the surgery group exhibited a gradual increasing trend with significant decreases observed after 12 h (P<0.05). Intra-group comparison of all indices in the surgery group, indicated that there was a statistically significant difference between postoperative 12 h and other time points (P<0.05). In conclusion, the present study demonstrated that HIF-1α was highly expressed in the brain tissue of rat models of early acute cerebral infarction. The results also indicated that HIF-1α significantly reduced the apoptosis of infarcted cells, suggesting that HIF-1α may have a neuroprotective role in early acute cerebral infarction.

The clinical significance of cortical laminar necrosis on diffusion-weighted imaging at acute stage of cerebral infarction

Objective To evaluate the clinical significance of cortical laminar necrosis(CLN) on diffusion-weighted imaging at acute stage of cerebral infarction. Methods 41 patients were retrospectively investigated who were diagnosed acute cerebral infarction in area of middle cerebral artery, and they got diffusion weighted imaging(DWI), magnetic resonance angiography(MRA) and colored ultrasonic inspection of cervical arteries within 48 hours after onset, with exclusion of cardioembolism, and 5 patients also had digital subtraction angiography(DSA). The patients were classified into CLN positive group or negative group. The stenosis or occlusion of ipsolateral MCA, intracranial and extracranial ICA were compared between the two groups. Results 9 patients' DWI had CLN, among whom 7 patients present moderate or more severe stenosis of feeding artery, and 5 patients who only had CLN signal presented severe stenosis or occlusion. 32 patients' DWI had not CLN, among whom 12 patients present moderate or more severe stenosis of feeding artery.The CLN positive group had a high incidence of ipsilateral intracranial ICA and(or) MCA moderate or severe stenosis or occlusion(55.6% vs 21.9%, χ2=3.85, P<0.05). The 5 patients who only had CLN signal had ipsilateral feeding artery severe stenosis.A positive correlation was found between CLN and moderate or severe stenosis or occlusion of ipsilateral intracranial ICA and(or) MCA(OR: 4.5, 95%CI: 1.0~20.2). Conclusion Patients with acute cerebral infarction and CLN on DWI were more likely to suffer from moderate or severe stenosis or occlusion of feeding large artery, and these patients should be evaluated vessel condition. Key words: Cerebral infarction; Cortical laminar necrosis; Diffusion-weighted imaging

Noninvasive assessment of ischemic penumbra by using MR-SWI during the acute phase of cerebral infarction: a comparison to PWI

Background: Assessment of ischemic penumbra during the acute stage of cerebral infarction is crucial for a decision to initiate thrombolytic therapy and for predicting stroke evolution. Although controversial as a perfect equivalence to penumbra, perfusion weighted imaging (PWI)-diffusion weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance on contrast agents in PWI, noninvasive alternatives remain an unmet need. Methods: We herein investigate the potentials of SWI as an alternative to PWI in defining ischemic penumbra and in predicting stroke outcome. A multimodal magnetic resonance imaging work-up which includes conventional magnetic resonance imaging sequences (T1WI, T2WI and FLAIR), DWI, PWI and SWI was performed. The Alberta Stroke Programme Early CT Score (ASPECTS) was used to evaluate the changes in DWI, SWI and PWI. Results: The mismatch of SWI-DWI was comparable with that of PWI-DWI (p&gt;0.05). Furthermore, the grade of prominent vein and the cerebral blood volume in the ipsilateral brain tissue were positively correlated. Conclusions: SWI can be used as a noninvasive alternative to identify occlusive arteries and to evaluate the ischemic penumbra. The susceptibility vein sign may represent thrombosis in arteries whereby being helpful to identify responsible blood vessels in ischemic stroke.

Identification of miRNA-21 and miRNA-24 in plasma as potential early stage markers of acute cerebral infarction.

This study investigated the role of microRNA-21 (miR-21) and microRNA-24 (miR-24) in the pathological processes that follow cerebral ischemic injury and examined the potential use of miR-21 and -24 in stroke diagnostics as sensitive plasma biomarkers. An oxygen-glucose deprivation (OGD) model was constructed using mouse N2A neuroblastoma cells (N2A). Western blot analysis and quantitative polymerase chain reaction (qPCR) were employed to detect protein and miRNA expression levels. miR-21 and miR-24 were analyzed in the plasma from 68patients with acute cerebral infarction (ACI) and 21healthy individuals. In the present study, it was identified that plasma miR-21 and miR-24 were lower in ACI patients than in the controls (P<0.05). A positive correlation was demonstrated between plasma miR-21 and miR-24, and a negative correlation was revealed between miR-21, miR-24 and the National Institutes of Health Scales Score (NIHSS) within the first day following stroke. In addition, the expression of miR-21 and miR-24 was upregulated by 3.3- and 4.9-fold, respectively, when the reoxygenation time persisted up to 24h following 3h of OGD. The expression of Bcl-2 was upregulated following gain of miR-21 function, while X-linked inhibitor of apoptosis protein (XIAP) was downregulated after gain of miR-24 function in N2A cells. The data suggested that miR-21 may have an antiapoptotic effect in N2A neuroblastoma cells following OGD and reoxygenation, while miR-24 may have a pro-apoptotic effect. Therefore, these microRNAs may be potential therapeutic targets for the treatment of post-ischemic injury and may act as diagnostic markers during the early stage of ACI.

Clinical outcome of cerebral infarction in the treatment of Kudiezi Injection Combined with low molecular weight heparin

Objective: to evaluate combinative effect of Kudiezi Injection and low molecular weight heparin calcium in the treatment of acute cerebral infarction. Methods: 72 cases of acute cerebral infarction were randomly divided into two groups, the treatment group of 36 cases were treated with the combination of Kudiezi Injection and low molecular heparin calcium; the other 36 cases in the control group were treated with the combination of Xuesaitong injection and low molecular weight heparin calcium. The degree of neurological deficit score and clinical outcome were respectively evaluated before and after treatment. Results: There are significant differences between the treatment group and the control group in results efficiency. Conclusion: It can improve the curative effect and the prognosis of the patients in the acute stage of cerebral infarction in the combinative treatment of Kudiezi Injection and low molecular weight heparin.

Reverse Dipper and High Night-time Heart Rate in Acute Stage of Cerebral Infarction Are Associated with Increased Mortality

Reverse dipper, blood pressure (BP) rises during night-time, is a risk factor of increased cardiovascular events in hypertensive patients. However, we have little information whether reverse dipper in acute stage of cerebral infarction (CI) affects on the recurrence and mortality. We studied to assess the relationship between reverse dipper and adverse clinical outcomes in the acute stage of CI. We screened and enrolled consecutive patients with acute CI with ambulatory blood pressure monitoring (ABPM) within 2weeks after admission from August 2001 to July 2005. According to systolic blood pressure (SBP) dropping pattern during night-time compared with daytime, we classified into extreme dipper (≥20%), dipper (≥10%, <20%), nondipper (≥0%, <10%), and reverse dipper (BP rises during night-time). We analyzed 426 patients (72±13years old, 255 men) and checked recurrence of CI or all-cause mortality for further 7.6±3.1years for checking of recurrence or all-cause mortality. Of 426 patients, 202 patients were nondippers (47%), 134 were reverse dippers (32%), 80 were dippers (19%), and 10 were extreme dippers (2%). During the follow-up period, 89 patients (21%) had recurrence of CI. After multivariate analysis, daytime SBP (hazard ratio=1.014, P=.018) was the significant predictor of recurrence. There were 141 deaths (33%) in our study cohort. Multivariate analysis showed that age (hazard ratio=1.106, P<.001), nocturnal mean heart rate (hazard ratio=1.023, P=.004), and reverse dipper (hazard ratio=1. 676, P=.007) were statistically significant. Reverse dipper and high night-time heart rate in the acute stage of CI were associated with total mortality during long-term follow-up. These findings suggest the clinical utility of ABPM in acute stage of CI.

The application of CT cerebral perfusion imaging in patients with hyperacute stroke

Objective To explore the application of multislice computed tomographyic ( MSCT) perfusion imaging in the assessment of acute cerebral infarction. Methods 50 patients who initially diagnosed as acute cerebral infarction in 6 hours after their outbreak of infarction were selected. The Siemens semsation 4 MSCT was used to scan the patients and form time versus concentration curve analysis, including the comparision of region cerebral blood flow (CBF) between the necrosis region and the normal region, region cerebral blood volume (CBV), mean transit time ( MTT). Each case had to be examined by computed tomography at least once a week after infarction. Results 50 patients were found having a lower CBF and CBV in their necrosis region compared with the other side(P＜0.05) ,and had a longer MTT in their necrosis region compared with the other side( P ＜0.05) ,45 patients were observed a shrink of the size of the infarction region compared with the perfusion image in first 6 hours when they were reexamined by CT a week later(P ＜0.05) ,which proved the exist of ischemic penumbra area around the infarction center. Conclusion The multislice computed tomographyic perfusion imaging technology could define the infarction region and size at the early stage of acute cerebral infarction. It also provided clues to indicate the exist of a vascular area around the necrosis centre. It could diagnose acute cerebral infarction at hyperacute period and provide image proof for the thrombolysis in early period and treatment in individual manner. Key words: Tomography,spiral computed; Cerebral angiography; Cerebral infarction; Diagnosis

Improved brain MRI indices in the acute brain stem infarct sites treated with hydroxyl radical scavengers, Edaravone and hydrogen, as compared to Edaravone alone. A non-controlled study

BackgroundIn acute stage of cerebral infarction, MRI indices (rDWI & rADC) deteriorate during the first 3-7 days after the ictus and then gradually normalize in approximately 10 days (pseudonormalization time), although the tissue is already infarcted. Since effective treatments improve these indices significantly and in less than the natural pseudonormalization time, a combined analysis of these changes provides an opportunity for objective evaluation on the effectiveness of various treatments for cerebral infarction. Hydroxyl radicals are highly destructive to the tissue and aggravate cerebral infarction. We treated brainstem infarction patients in acute stage with hydroxyl radical scavengers (Edaravone and hydrogen) by intravenous administration and evaluated the effects of the treatment by a serial observation and analysis of these MRI indices. The effects of the treatment were evaluated and compared in two groups, an Edaravone alone group and a combined group with Edaravone and hydrogen, in order to assess beneficial effects of addition of hydrogen.MethodsThe patients were divided in Edaravone only group (E group. 26 patients) and combined treatment group with Edaravone and hydrogen enriched saline (EH group. 8 patients). The extent of the initial hump of rDWI, the initial dip of rADC and pseudo-normalization time were determined in each patient serially and averages of these data were compared in these two groups and also with the natural course in the literatures.ResultsThe initial hump of rDWI reached 2.0 in the E group which was better than 2.5 of the natural course but was not as good as 1.5 of the EH group. The initial dip of rADC was 0.6 in the E group which was close to the natural course but worse than 0.8 of the EH group. Pseudonormalization time of rDWI and rADC was 9 days only in EH group but longer in other groups. Addition of hydrogen caused no side effects.ConclusionsAdministration of hydroxyl radical scavengers in acute stage of brainstem infarction improved MRI indices against the natural course. The effects were more obvious and significant in the EH group. These findings may imply the need for more frequent daily administration of hydroxyl scavenger, or possible additional hydrogen effects on scavenger mechanisms.

Effect of Probucol combined with Simvastatin Blood Levels of Oxidied Low Density Lipoprotein and Inflammatory Factors in Acute Stage of Cerebral Infarction

Objective To evaluate the effect of probucol combined with simvastatin on blood levels of oxidied low density lipoprotein (ox-LDL) and inflammatory factors in acute stage of cerebral infarction. Methods A total of 122 patients with acute stage of cerebral infarction were randomly divided into two groups:observation group ( n = 62),and control group( n = 60). After two weeks of follow-up ,the levels of high sensitivity C-reactive protein(hsCRP) ,oxLDL ,fibrinogen ( FIB ), interleukin 6 (IL-6) and blood lipids were detected. The side effect was recorded and the difference between two groups was analyzed. At 7 d and 14 d, curative effects were evaluated by standard scale of clinical neurological deficit. Results Compared with the control group, 2weeks after the medication, low-density lipoprotein cholesterol( LDL-C), apolipoprotein B ,ox-LDL, IL-6 and hsCRP were significantly decreased in the observation group (P <0.01 ). Conclusion The treafment of probucol combined with simvastatin could reduce the levels of ox-LDL and inflammatory factors in acute stage of cerebral infarction, and prevent hemorrhagic transformation and recurrence of cerebral in farction. Key words: Cerebral Infarction; Inflammatory factors; Probucol

Clinical research in the effects of urokinase on acute cerebral infarction in very early stage

Objective To study the effects of thrombolysis for the treatment of acute cerebral infarction (ACI) in early stage (within 6 hours after onset) in hospital, and to demonstrate the benefit of urokinase in the treatment of acute cerebral infarction. Method The patients with cerebral infarction treated with UK within 3hours after onset in the emergency department were enrolled as the study group, and those treated with thrombolytics in the neurological unit over the same period were taken as the control group. Results The average time from onset of ACI to starting thrombolytic therapy was 45 minutes in the study group and 80 minutes in the control group.The number of patients treated with thrombolysis within 3 hours was 39 ( 14.4% ) in the study group and 29 (10.5%) in the control group. There were significant differences in the scores of the National Institutes of Health Stroke Scale (NIHSS) after thrombolytic therapy and in Bathel index of complete or nearly complete recovery rate between two groups. The length of hospital stay was shorter in patients of the study group than that in the control group. Conclusions The thrombolytic treatment with urokinase employed to the patients in the early stage of acute cerebral infarction leads to better outcomes than that in the later stage. Key words: Emergency; Thrombolytic therapy; Cerebral infarction; Urokinase

A study on the correlation between depression and activity of daily Hying of patients at acute stage of cerebral infarction

Objective To understand the correlation between depression and activity of dailty living of patients at acute stage of cerebral infarction. Methods Fifty patients at acute stage of cerebral infarction were tested with SDS and ADL, then their SDS scores and ADL scores were analyzed through straight correlation regression analysis. Results SDS of patients at acute stage of cerebral infarction was lower than internal norm. SDS of patients was negative correlation with their ADL Conclusion The depression rise in patients at acute stage of cerebral infarction. Degreasive activity of dailty living influences depression of patients at acute stage of cerebral infarction. Key words: Cerebral infarction ; Depression ; Activity of daily living

The Novel Antioxidant Edaravone: From Bench to Bedside

Over the last decade, important advances have been made to support the fact that reactive oxygen species (ROS) are generated and play a harmful role during the acute and late stages of cerebral ischemia. Several drugs, such as radical scavengers and antioxidants, have been evaluated in preclinical and clinical studies. Edaravone (3-methyl-1-phenyl-2-pyrazolin-5-one; Radicut, Mitsubishi Tanabe Pharma Corporation) is a novel antioxidant that is currently used in Japan for the treatment of patients in the acute stage of cerebral infarction. Edaravone scavenges ROS and inhibits proinflammatory responses after brain ischemia in animals and humans. In particular, postischemic inflammation, leading to brain edema and infarction due to neuronal damage and endothelial cell death, can be ameliorated by edaravone. In addition to these antistroke effects, edaravone has also been shown to prevent oxidative damage to various extracerebral organs. Therefore, in addition to its usefulness in the treatment of stroke, edaravone is expected to play an integral role in the treatment of many oxidative stress-related diseases.

Deep body temperature during the acute stage of cerebral infarction may predict the outcome of the chronic stage

Deep body temperature during the acute stage of cerebral infarction may predict the outcome of the chronic stage

The biological rhythm in acute cerebral infarction is associated with sleep disorder at the chronic stage

Circadian rhythm with ∼ 24-h periodicity is the most basic and strongest biological rhythm. However, there have been reports of bed-ridden patients with neurodegenerative diseases and unclear circadian rhythm. Sequelae of cerebral infarction include sleep and motor disturbances. Additionally, these are risk factors which induce impairment of quality of life (QOL). We investigated whether biological rhythm disorder in the acute stage of cerebral infarction is associated with sleep disorder in the chronic stage.

Changes in tumor necrosis factor alpha and myeloper-oxidase in mouse models of local cerebral infarction induced by photochemical method*

Background Lots of evidences have demonstrated that acute inflammatory reaction plays an important role in cerebral ischemia and cerebral ischemia/reperfusion injury. Tumor necrosis factor (TNF), as one of important inflammatory cytokines, also participates in the injury. Objective To observe the changes in TNF-α expression and myeloperoxidase (MPO) activity of mouse models of local cerebral infarction induced by photochemical method, and analyze the correlation of TNF-α expression and MPO activity. Design Randomized controlled experiment. Setting Laboratory of Cerebral Microcirculation, Taishan Medical College. Materials Sixty involved male adult Kunming mice were provided by the Experimental Animal Center of Shandong University. TNF-α primary antibody, kits for enzyme-linked immunosorbent assay(ELISA) and streptavidin-biotin complex immunohistochemical dyeing kit were purchased from Boster Company(Wuhan). MPO kit was purchased from Jiancheng Bioengineering Institute (Nanjing). Cold light source was developed by Hengfa Co., Ltd. (LG-150, Xuzhou). Methods This experiment was carried out in the Laboratory of Cerebral Microcirculation of Taishan Medical College between July 2004 and July 2005. The involved 60 Kunming mice were randomized into 3 groups: normal control group ( n =6), sham-operation group ( n =6) and model group ( n =48). Mice in the model group were observed at 30 minutes, 1, 3, 6, 12, 24, 48 and 72 hours after illumination, separately, 6 mice at each time point. In the model group, mice models of local cerebral infarction were developed as follows: The mice were anesthetized to expose left skulls. Taking 2 mm left to sagittal suture and 2 mm posterior to coronal suture as center, a field with diameter of 3 mm for illumination was set. The optical fiber detecting head of cold light source was vertically close to exposed skull. The mice were injected with rose Bengal for 5 minutes, and then cold light source was open for 10 minutes. Illumination was omitted in the sham-operation group. Mice in the control group were not modeled. At postoperative 6 hours, TNF-α expression in infracted-side cortex was detected with immunohistochemical method and ELISA, and MPO activity in infracted-side cortex with chromatometry. MPO activity could reflect the infiltration degree of neutrophils in tissue. Stronger activity indicated severer infiltration. Single-factor analysis of variance was used for comparison among groups, q test for pairwise comparison and correlative analysis for detecting the inter-parameter correlation. Main outcome measures Changes in TNF-α expression and MPO activity of left cortex of mice in each group. Results Sixty mice were involved in the final analysis. After cerebral infarction, TNF-α positive cells were neurons and glial cells mainly, distributing in and around the infarct region. TNF-α expression in cortex of mice of sham-operation group was (615.7±16.1) ng/L, and that of model group increased to (792.2±17.8) ng/L at 3 hours after illumination, and reached peak [(921.9±23.9) ng/L] at 6 hours after illumination, and decreased to (848.0±30.6) ng/L at 12 hours after illumination and recovered to the normal level [(625.3±14.3) ng/L] at 72 hours after illumination. MPO activity of sham-operation group was (7.151±0.433) nkat/g, and that of model group increased to (10.469±0.600) nkat/g at 3 hours after illumination, reached the peak [(15.486±0.650) nkat/g] at 12 hours after illumination, decreased to (11.052±0.617) nkat/g at 24 hours after illumination and recovered to the normal level [(7.418±0.617) nkat/g] at 72 hours after illumination. Change of MPO activity lagged behind that of TNF-α, and correlative analysis showed that the both were positively correlated ( r =0.953, P < 0.01). Conclusion In the acute stage of cerebral infarction of mice induced by photochemical method, TNF-α expression in infarcted-side cortex is closely related with infiltration of neutrophils. TNF-α induces inflammatory cells to intrude into ischemic brain tissue, and participates in the inflammatory reaction process at the early stage of cerebral ischemia.