Therapy For Acute Cerebral Infarction Research Articles

Clinical Efficacy of the Huo Xue Hua Yu Method Combined with Aspirin in the Treatment of Acute Cerebral Infarction: A systematic evaluation and Meta-Analysis.

The study aimed to evaluate the clinical efficacy of the Huo Xue Hua Yu method combined with aspirin in the treatment of patients with acute cerebral infarction (ACI). By searching electronic databases, such as the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure Database (CNKI), the China Science and Technology Journal Database, Wanfang, PubMed, Embase, and the Cochrane Library, all randomized controlled trials (RCTs) published before 14 July, 2022, and published in Chinese or English languages were selected. Statistical analysis was performed using Review Manager 5.4 calculation software to calculate the odds ratio (OR), mean difference (MD), 95% confidence interval (CI), and p values. 13 articles that included 1,243 patients were identified; in 646 of them, the Huo Xue Hua Yu method combined with aspirin has been administered, while 597 have only been administered aspirin therapy. The combined treatment significantly improved clinical efficacy (OR: 4.41, 95% CI: 2.90 to 5.84, P < 0.001, I2 = 0), as assessed by the National Institutes of Health Stroke Scale score (MD= -4.18, 95% CI: -5.69 to -2.67, P < 0.001, I2 = 94%), Barthel score (MD = -2.23, 95% CI: -2.66 to -1.81, P < 0.001, I2 = 82%), the China Stroke Scale score (MD = 6.74, 95% CI: -3.49 to 16.96, P = 0.20, I2 = 99%), packed cell volume (MD = -8.45, 95% CI: -8.81 to -8.09, P < 0.001, I2 = 98%), fibrinogen levels (MD = -0.93, 95% CI: -1.23 to -0.63, P < 0.001, I2 = 78%) and plasma viscosity (MD = -0.51, 95% CI: -0.72 to -0.30, P < 0.001, I2 = 62%). The combination of the Huo Xue Hua Yu method and aspirin represents a beneficial adjunctive therapy for ACI.

急性脑梗死溶栓治疗后脑微出血的影响因素分析

急性脑梗死溶栓治疗后脑微出血的影响因素分析

Using Thrombin Time to Evaluate the Efficacy of Anticoagulant Therapy for Acute Cerebral Infarction

Background: Although intravenous thrombolysis therapy considered as a significant progress in the treatment of acute ischemic stroke, there are limited effective treatments for patients with onset ischemic symptom that beyond six hours during acute ischemic stroke. In this study, we investigated the effectiveness of the intravenous argatroban therapy in acute ischemic stroke patients who cannot be treat with intravenous thrombolysis due to the limited time window. Methods: One hundred and eighty patients with acute ischemic stroke that had beyond six hours ischemic symptom were admit to our hospital and analyzed retrospectively. ELISA measured levels of activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombin time (TT) in peripheral blood of these patients at 24 hours post initial therapy. Results: We found that plasma TT prolonged after 24 hours of argatroban treatment. Activated partial thromboplastin time (aPTT) showed slightly increased prolongation after 24 hours of argatroban treatment. PT also showed slightly prolonged after treatment; however, there was no difference from the basal line. We further investigated the relationship between the level of TT and the clinical effectiveness and safety of intravenous argatroban therapy. We found that when TT was between 40 and 80 seconds, intravenous argatroban effectively promoted the complete recovery rates without increasing the risk of hemorrhage. Conclusion: Our study implies that TT assay might be useful for guiding regular dose of agratroban for therapy.

Effectiveness of Combined Thrombolysis and Mild Hypothermia Therapy in Acute Cerebral Infarction: A Meta-Analysis

Objective To evaluate the effectiveness and safety of thrombolytic therapy combined with mild hypothermia in patients with acute cerebral infarction (ACI), based on a meta-analysis of randomized controlled trials (RCTs). Methods PubMed, EMBASE, Cochrane Library, and Chinese National Knowledge Infrastructure Database of Controlled Trials were systematically screened for randomized controlled trials (RCTs) of thrombolytic therapy combined with mild hypothermia in treating ACI from inception to January 2021. Participation and outcomes among intervention enrollees are as follows: P, participants (patients in ACI); I, interventions (thrombolysis in combination with mild hypothermia therapy); C, controls (thrombolysis merely); O, outcomes (main outcomes are the change of NIHSS, glutathione peroxidase, superoxide dismutase, malondialdehyde, inflammatory factor interleukin-1β, tumor necrosis factor-α, and adverse reaction). Following data extraction and quality assessment, a meta-analysis was performed using RevMan 5.3 software. Results A total of 26 RCTs involving 2071 patients were included. Compared to thrombolysis alone, thrombolytic therapy combined with mild hypothermia leads to better therapeutic efficacy [RR = 1.23, 95% CI (1.16, 1.31)], NIHSS [MD = −2.02, 95% CI (−2.55, −1.49)], glutathione peroxidase [MD = 8.71, 95% CI (5.55, 11.87)], superoxide dismutase [MD = 16.52, 95% CI (12.31, 19.74)], malondialdehyde [MD = −1.86, 95% CI (−1.98, −1.75)], interleukin-1β [MD = −3.48, 95% CI (−4.88, −2.08)], tumor necrosis factor-α [MD = −0.46, 95% CI (−3.39, 2.48)], and adverse reaction [RR = 0.87, 95% CI (0.63, 1.20)]. Conclusions Thrombolytic therapy combined with mild hypothermia demonstrates a beneficial role in reducing brain nerve function impairment and inflammatory reactions in ACI subjects analysed in this meta-analysis.

Effect of Comprehensive Nursing Intervention on the Effect of CT-Guided Intravenous Thrombolysis in Acute Cerebral Infarction.

Objective To investigate the effect of comprehensive nursing intervention on the effect of CT-guided intravenous thrombolytic therapy for acute cerebral infarction. Methods 99 patients with acute cerebral infarction in the internal carotid artery system who were hospitalized in our department from December 2019 to December 2020 with an onset of 3–9 h were selected and randomly divided into two groups. All patients underwent multimode CT examinations and received rt-PA thrombolytic therapy. 52 patients with conventional care were included in the control group, and 47 patients with comprehensive nursing intervention were included in the observation group. The influence characteristics, Barthel score, serum MMP-9 level, and NIHSS score were compared between the two groups. Results After the comprehensive nursing intervention, the total efficiency, total satisfaction, psychological status, and Barthel score of the observation group were significantly higher than those of the control group (P < 0.05). The serum MMP-9 level and NIHSS score were significantly lower than those of the control group (P < 0.05). Conclusion The use of comprehensive nursing interventions in the CT-guided intravenous thrombolysis treatment of ACI patients reduced the degree of neurological impairment, improved the therapeutic effect, increased nursing satisfaction, and enabled better control of the condition of patients with cerebral infarction, which is worth promoting research.

Efficacy of Ligustrazine Injection as Adjunctive Therapy in Treating Acute Cerebral Infarction: A Systematic Review and Meta-Analysis.

Background: Ligustrazine injection has been widely used as adjunctive therapy in the treatment of acute cerebral infarction (ACI) during the past decades in China, but its clinical efficacy is not yet well confirmed. This study aims to evaluate the efficacy of ligustrazine injection as adjunctive therapy for ACI. Methods: Databases including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), PubMed, Medline, Google Scholar, Chinese Biomedical Literature Database, Cochrane Library, Embase, Sino-Med, Wanfang Database, and Chinese Science Citation Database were systematically searched for the published randomized controlled trials (RCTs) on ligustrazine injection in the treatment of ACI until November 2020. Meta-analysis was performed on the primary outcome measure (i.e., clinical effective rate) and the secondary outcome measure [i.e., neurological deficit score (NDS), fibrinogen, low shear blood viscosity (LBV), and high shear blood viscosity (HBV)]. The quality of the included RCTs was assessed according to the M scoring system (the refined Jadad scale). Sensitivity analysis and subgroup analysis were conducted according to the methodological quality, years of publication, and sample size. Results: Nineteen RCTs, containing 2022 patients, were included in this study. Meta-analysis indicated that ligustrazine injection combined with Western medicine could achieve a better effect in the treatment of ACI than using Western medicine alone in terms of clinical effective rate (RR = 1.24; 95% CI, 1.19–1.29), NDS (MD = −3.88; 95%CI, −4.51 to −3.61), fibrinogen (MD = −0.59; 95% CI, −0.76 to −0.42), LBV (MD = −2.11; 95% CI, −3.16 to −1.06), and HBV (MD = −0.88; 95% CI, −1.20 to −0.55). Conclusions: This research indicated that ligustrazine injection as adjunctive therapy seemed to be more effective than using western medicine alone in treating ACI. However, more evidence is required to confirm the efficacy of ligustrazine injection due to the low methodological quality of the included RCTs.

Thrombolysis combined with acupuncture therapy for acute cerebral infarction: a Meta-analysis of randomized controlled trials

To systematically evaluate the efficacy and safety of thrombolysis combined with acupuncture therapy in the treatment of acute cerebral infarction (ACI) in the light of evidence-based medicine. Randomized controlled trials (RCT) for acupuncture and thrombolysis treatment of acute cerebral infarction published from the inception of databa-ses to March 2020 were searched from PubMed, Cochrane Library, Embase, Web of science, CNKI, Wanfang, VIP, and CBM Database. According to the inclusion and exclusion criteria, two reviewers independently screened the RCTs and extracted the data. The quality of the included literature was evaluated, and the Meta-analysis was performed by using Revman 5.3 software. A total of 330 studies were identified, and 14 RCTs (including 604 cases of the treatment group, 598 cases of the control group) met the inclusion criteria. The Meta-analysis showed that the thrombolysis combined with acupuncture therapy was better than acupuncture therapy alone in the clinical effective rate (risk ratio ［RR］=1.19, 95% confidence interval ［CI］ ［1.13, 1.25］), NIHSS score (mean difference ［MD］=-3.51, 95% CI ［-4.54, -2.48］), BI index (MD=12.26, 95% CI ［8.07, 16.46］), and in lowering C-reaction protein levels (MD=-3.99, 95% CI ［-4.35, -3.63］). The rate of complete recanalization (RR = 1.20, 95% CI ［1.00, 1.44］), adverse reaction (RR = 0.76, 95% CI ［0.41, 1.41］) and hemorrhagic conversion (RR = 0.72, 95% CI ［0.14, 3.62］) was not statistically significant. The current effective evidence shows that acupuncture has certain advantages in improving the therapeutic effect and safety of thrombolysis in the treatment of ACI patients.

A case of hemorrhagic shock due to diverticular bleeding of colon in a short time after the start of intravenous rt-PA therapy for acute cerebral infarction

A case of hemorrhagic shock due to diverticular bleeding of colon in a short time after the start of intravenous rt-PA therapy for acute cerebral infarction

Posterior reversible encephalopathy syndrome coexists with acute cerebral infarction: challenges of blood pressure management.

Hypertension is the most common cause of posterior reversible encephalopathy syndrome (PRES) and acute cerebral infarction. Due to the lack of randomized controlled clinical trials (RCTs), early antihypertensive methods are diverse, even contradictory. So far, there is no consensus on the method of blood pressure (BP) management when the 2 diseases coexist. Generally, antihypertensive therapy should be initiated quickly in the acute phase of PRES, as most patients have elevated BP. However, various factors must be considered before the administration of early antihypertensive therapy in acute cerebral infarction. The coexistence of PRES and acute cerebral infarction is uncommon clinically, and more complicated subsequent BP management. This article reports a case of PRES coexisting with acute lacunar cerebral infarction, which was caused by hypertension. We have analyzed and summarized the antihypertensive principles in PRES and different phases of acute cerebral ischemic injury. We assert that when PRES and acute cerebral infarction coexist, the antihypertensive treatment should be individualized, and careful consideration should be given to the various influencing factors.

Neuroserpin extends the time window of tPA thrombolysis in a rat model of middle cerebral artery occlusion.

Tissue-type plasminogen activator (tPA) is characterized as an effective drug for early thrombolytic therapy in acute cerebral infarction (ACI). However, tPA will increase the risk of hemorrhage if it is used beyond the treatment time window. The study aims to explore the effects of neuroserpin (NSP) on the time window of tPA thrombolysis in ACI and the underlying mechanism. The middle cerebral artery occlusion (MCAO) model was constructed in rats, which were randomly divided into six groups: sham operation group, infarction group, 1-hour thrombolysis group, 1-hour thrombolytic + NSP intervention group, 4-hour thrombolytic group, and 4-hour thrombolysis + NSP intervention group. The neurological changes in rats were evaluated by modified neurological severity scores and rota-rod test. The brain edema and cerebral infarction area were evaluated by dry-wet method and triphenyl tetrazolium chloride staining. The blood-brain barrier (BBB) integrity was examined by Evans blue method. The expressions of malondialdehyde, superoxide dismutase, and glutathione peroxidase in brain were also investigated. The expression of caspase-3 and Bcl-2 in brain tissue and apoptosis of neurons were examined by Western blot analysis and toluidine blue staining. tPA thrombolysis significantly attenuated the neurological impairment in rats with MCAO at 1 hour. Conversely, the effect of tPA thrombolysis at 4 hours after MCAO did not significantly help the recovery of neurological function. However, a combination of tPA treatment and NSP treatment at 4 hours after MCAO markedly ameliorated the neurological impairment, cerebral edema, cerebral infarction volume, BBB injury, oxidative stress products, and neuron apoptosis. NSP can probably expand the time window for tPA treatment to reduce neurological impairment in ACI.

DAPT score: predictive model of dual-antiplatelet therapy for acute cerebral infarction.

This article analyzes factors which affect the prognosis of acute cerebral infarction (ACI) patients receiving a course of antiplatelet therapy with aspirin and (or) clopidogrel for 14days and proposes a simple grading scale to predict the clinical effectiveness of these drugs. We evaluated the association between ACI and risk factor (univariate analysis) on at day 14 post admission. Factors which potentially affected the 14-day prognosis of the patients were identified by logistic regression. A clinical grading scale, the DAPT score, was developed by weighing the independent predictors based on these factors. It is revealed that the factors which affected 14days prognosis univariate analysis included age ≥ 50years (P =0.007), diabetes (P =0.017), hypertension (P ≤ 0.001), hyperhomocysteinemia (P =0.001), and ipsilateral carotid artery stenosis ≥ 50% (P =0.019). Logistic regression also revealed that the factors which affected 14days prognosis included age ≥ 50years (P =0.007), hypertension (P ≤ 0.001), hyperhomocysteinemia (P =0.001), and ipsilateral carotid artery stenosis ≥ 50% (P =0.014).The assigned values of age ≥ 50years, Grade 1 hypertension, Grade 2 hypertension, Grade 3 hypertension, hyperhomocysteinemia, and ipsilateral carotid artery stenosis ≥ 50% were 1, 1, 2, 3, 1, and 1, respectively. We named this score (DAPT score) and it ranged between 0 and 6. Using 3 as a cutoff, the sensitivity was 90.6% and the specificity was 63.3%. The DAPT Score might be useful to for identifying with ACI who are suitable to receive aspirin combined with clopidogrel. Future large-scale, multi-center prospective studies are necessary.

Influencing Factors of Recanalization after Intravenous Thrombolysis with Urokinase in Acute Cerebral Infarction Patients

Background: Intravenous thrombolysis (IVT) with urokinase is the standard reperfusion therapy for acute cerebral infarction (ACI) in China. Only about 30% patients who use urokinase for IVT can recanalize. Therefore, this study aimed to analyze the influencing factors of recanalization after IVT using urokinase in ACI patients. Methods: A total of 391 consecutive patients with a diagnosis of ACI from January 2013 to October 2019 were enrolled and divided into 2 groups: patients without recanalization and patients with recanalization. Related data were collected and analyzed. Results: Univariate analysis showed that there were significant differences in gender, atrial fibrillation, erythrocyte mean corpuscular volume, platelet large cell ratio (P-LCR), glucose (GLU), and severity of ICAS between patients without recanalization and patients with recanalization (p < 0.05). Multivariate logistic regression analysis indicated that P-LCR (odds ratio [OR] = 0.17, 95% confidence interval [CI] = 0.03–0.89, p = 0.04), GLU (OR = 0.28, 95% CI = 0.11–0.67, p = 0.004), and ICAS severity (OR = 0.48, 95% CI = 0.32–0.76, p = 0.001) were the influencing factors of recanalization. Conclusion: For patients with higher levels of P-LCR, GLU, or ICAS severity, the recanalization rate might decrease after ACI.

Ginkgo leaf extract and dipyridamole injection as adjuvant treatment for acute cerebral infarction: Protocol for systemic review and meta-analysis of randomized controlled trials.

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

Systematic review and Meta-analysis on randomized controlled trials on effectiveness and safety of Kudiezi Injection in treatment of acute cerebral infarction

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

Recombinant tissue plasminogen activator therapy for acute ischemic stroke in older patients

As the number of aged stroke patients increases in Japan, the proportion of older patients who receive recombinant tissue plasminogen activator (rt-PA, 0.6 mg/kg) is also rising. However, the Japanese stroke guideline indicates that rt-PA therapy must be administered very carefully in older patients (i.e. ≥81 years of age) because of serious complications after the therapy. We retrospectively assessed the clinical outcomes of rt-PA therapy in older patients. This study included 321 patients who received rt-PA therapy for acute cerebral infarction at our hospital between April 2007 and April 2017. The outcomes (modified Rankin Scale [mRS] score at 3 months after treatment) and symptomatic intracerebral hemorrhaging (sICH) were compared and analyzed between patients ≥81 years of age (group A) and those <81 years of age (group B). In addition, propensity score matching was performed for the factors shown to have significant differences by a univariate analysis in order to adjust for confounding factors, and the outcomes were compared. There were 58 patients in group A (18.1%) and 263 patients in group B (81.9%). The rate of favorable outcomes (mRS 0-1) was lower in group A (12.1%) than in group B (44.1%) (P<0.01). The mortality rate was higher in group A (17.2%) than in group B (4.6%) (P=0.002). No marked differences were observed between the 2 groups regarding the rate of sICH (group A, 3.4%; group B, 3.0%; P=1.00). After propensity score matching, the proportion of patients with favorable outcomes was significantly lower in group A (13.2%) than in group B (36.8%) (P=0.032). There were no marked differences in the mortality rates between the groups (group A, 17.2%; group B, 4.6%) (P=0.200), and no patients in either group had sICH. No marked differences in the incidence of ICH were observed between the older and younger groups receiving intravenous rt-PA therapy. However, in terms of efficacy, the proportion of patients with favorable outcomes was significantly lower in the older group than in the younger group.

Ultrasound-Mediated Kallidinogenase-Loaded Microbubble Targeted Therapy for Acute Cerebral Infarction

The neuroprotective effects of kallidinogenase against acute cerebral infarction have been demonstrated, and the use of microbubbles has been suggested as a therapeutic mechanism for drug delivery. This study was designed to investigate the optimal parameters for preparing kallidinogenase-loaded microbubbles (KLMs) and to evaluate the effects of KLM-targeted therapy on neurogenesis and angiogenesis following experimental acute cerebral infarction in rats. KLMs were prepared by mechanical shaking. Male Wistar rats were randomly divided into an ultrasound-mediated KLM-treated group and 4 control groups. Treatments were administered via daily tail vein injection on 6 consecutive days, starting at 24 hours after middle cerebral artery occlusion (MCAO). The ultrasound-treated groups were subjected to a 2-MHz pulse of ultrasonic irradiation on the lateral skull of the ischemic side for 10 minutes during injection. Cell proliferation was examined using a 5-bromo-2-deoxyuridine assay. Infarct volume and neurological function were evaluated on days 3 and 7 after MCAO. The ultrasound-mediated KLM and kallidinogenase treatments significantly increased the numbers of doublecortin-immunoreactive cells in the subventricular zone (SVZ) and laminin+ cells in the peri-infarction region on day 7 after MCAO, compared with the other 3 groups (all P <.05). The neurological function scores of the ultrasound-mediated KLM-treated group were significantly better than those of rats treated with kallidinogenase alone or with the other treatments (all P <.05). Treatment with the ultrasound-mediated KLMs promoted the proliferation of SVZ neuroblasts and vascular regeneration, which contributed to functional improvement after stroke. These findings provide a novel therapy for ischemic stroke.

Application of doctor-nurse integration combined with WeChat platform in thrombolytic therapy for acute cerebral infarction

Objective To explore the application effect of doctor-nurse integration combined with WeChat platform in thrombolytic therapy for acute cerebral infarction. Methods Totally 72 patients with thrombolytic treatment for acute cerebral infarction in our hospital from October 2013 to December 2015 were selected and divided into the observation group (36 cases) and the control group (36 cases) according to the patient′s admission sequence. The primary nursing team model was applied in the control group, and the doctor-nurse integration treatment model combined with WeChat platform was applied in the observation group. The thrombolytic preparation time, the national institutes of health stroke scale (NIHSS) score after treatment, Barthel index, the average hospitalization time and other indicators between two groups were compared. Results The thrombolytic preparation time (78.86±15.34) min and the average hospitalization time (10.08 ±3.11) d in the observation group were significantly shorter than the data in the control group [ (93.47±15.58) min, (13.92±4.73) d; (P<0.05) ]; the NIHSS score after treatment (2.25±2.59) in the observation group was significantly lower than that (3.69±3.26) in the control group (P<0.05) ; the Barthel index (82.78±24.80) in the observation group was higher than that (70.00±28.44) in the control group (P<0.05) ; Compared with the patient satisfaction (88.9%) and medical staff satisfaction (98.6%) in the observation group, the data in the control group (69.4%, 72.9%) were lower (P<0.05) . Conclusions The doctor-nurse integration treatment model combined with WeChat platform in patients with acute cerebral infarction thrombolysis is conductive to implement the standardization of specialist treatment in patients with acute cerebral infarction. Key words: Doctor-nurse integration; WeChat platform; Acute cerebral infarction; Thrombolytic therapy

Effects of thrombolytic information in different time windows upon thrombolytic decision making in patients with cerebral infarction

Objective To discuss the influence of framing information and time window information upon risk decision making about thrombolysis therapy in patients with cerebral infarction or their relatives in the scenarios of thrombolytic therapy for acute cerebral infarction. Methods Inpatients and outpatients with cerebral infarction or their relatives(n=327) were randomly divided into positive framing group(n=187) and negative framing group(n=140). Every participant underwent risky messages about thrombolytic treatment in three different time windows: 0-90 minutes, 91-180 minutes and 181-270 minutes. Results In any thrombolytic time window condition, there was no significant difference in thrombolytic tendency of participants between the positive framing group and the negative framing group (0-90 min: χ2=1.24, P> 0.05; 91-180 minutes: χ2=0.35, P>0.05; 181-270 minutes: χ2=0.07, P>0.05). In a negative framework conditions, compared with the participants receiving thrombolytic information in 181-270 minutes time window, subjects receiving thrombolytic information in 0-90 minutes window were more tolerant of thrombolytic treatment (69.3% vs 51.5%, P<0.0125). Conclusion There are mutual effects of time window and framing information upon participants' preferences for thrombolysis. Different thrombolytic information are presented according to their corresponding time windows. Key words: Risky decision making; Framing effect; Thrombolytic time window

急性期脳梗塞における，治療別に見た急性期血行再建術の成績の比較

要旨：急性期脳梗塞への治療は，血管内治療併用や閉塞血管別の治療方針など未確定な部分が多い．我々は2005 年4 月～2014 年10 月の間に急性期脳梗塞にてrt-PA 静注療法および血管内治療，あるいはその双方を施行した急性期脳梗塞患者191 例に対し，A 群（rt-PA 静注），B 群（ウロキナーゼ動注），C 群（機械的血栓除去），D 群（failed rt-PA 患者に血管内治療を追加）に分別し遡及的に検討した．治療開始までの時間が短いA，D 群は予後良好な傾向を認め，内頸動脈閉塞患者ではD 群で予後良好，C 群では不良傾向を認めた．今回の検討において，最大の予後改善因子は早期再開通と考えた．また，rt-PA 静注適応の内頸動脈閉塞患者においても血管内治療併用による予後改善の可能性が示唆された．急性期脳梗塞においては，再開通までの時間を可及的に短縮する必要があると思われる．

Influence of cover statement and clarity of messages upon risk decision making about thrombolysis therapy in patients with cerebral infarction

Objective Influence of cover statement and clarity of the messages upon risk decision making about thrombolysis therapy in patients with cerebral infarction was discussed in the Scenarios of thrombolytic therapy for acute cerebral infarction. Methods Inpatients and outpatients with cerebral infarction were randomly divided into two groups: detailed / simple cover statement group. Every participant underwent obscure messages and clear messages with only one frame: positive or negative frame. Results In the simple cover statement group, both obscure messages subgroup and clear messages subgroup were not influenced by the framing effect with preference to the risk seeking. In the detailed cover statement group, participants in the clear messages group were not influenced by the framing effect(χ2=0.19, P>0.05), while the subjects in the obscure messages group were actually affected by the framing effect, with the preference to risk seeking in the positive framework (χ2=7.90, P<0.01). Conclusion The risk decision making about thrombolysis therapy in patients with cerebral infarction is influenced by cover statements and clarity of the messages. To improve the rate of thrombolysis therapy, the patients should be exposed to the obscure messages in the positive framing information under the detailed cover statement. Key words: Framing effect; Acute infarction; Risk decision making about thrombolysis therapy