Advances in antioxidative nanozymes for treating ischemic stroke

Ischemic stroke is one of the most common public diseases that increase mortality.In the ischemic brain,blood flow restoration can cause the generation of excess reactive oxygen species(ROS).Endogenous anti-oxidases in the living system,including catalase(CAT)and superoxide dismutase(SOD),can consume the excess ROS by catalysis to regulate inflammation.However,these natural enzymes are difficult to be widely used in the treatment of stroke.Taking advantages of high stability,low cost,and long-term storage,antioxidative nanozymes-mediated treatments have been proven as a promising method against ischemic stroke.To highlight the progress,we summarize the advances in nanozymes with the antioxidative ability for treating ischemic stroke.It is believed that such a promising therapeutic strategy of antioxidative nanozymes will significantly contribute to the field of ischemic stroke.We expect that antioxidative nanozymes will play significant roles in both basic research and clinical applications.

Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke

Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator(rt-PA)thrombolysis for acute ischaemic stroke in China.Regional emergency systems have been proven a successful approach to improve access to thrombolysis.Shenzhen is a high population density city with great geographical disparity of healthcare resources,leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke.To improve rapid access to rt-PA thrombolysis in Shenzhen,a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations.This map comprised certification of qualified local hospitals,identification of patients with stroke,acute stroke transport protocol and maintenance of the map.We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map.After implementation of the map,the rate of patients receiving rt-PA thrombolysis increased from 8.3%to 9.7%(p=0.003),and the rate of patients treated with endovascular thrombectomy increased from 0.9%to 1.6%(p<0.001).Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis.The median time between receipt of the call and arrival on the scene reduced significantly(17.0 min vs 9.0 min,p<0.001).In Shenzhen Second People's Hospital,the median onset-to-needle time and door-to-needle time were reduced(175.5 min vs 149.5 min,p=0.039;71.5 min vs 51.5 min,p<0.001).No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances.Currently,there are more than 40 cities in China implementing a stroke emergency map.The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke,and the novel model has been expanded to multiple areas in China.Future efforts should be conducted to optimise the stroke emergency map.

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China.We investigated whether the implementation of a citywide Acute Stroke Care Map(ASCaM)is associated with an improvement of acute stroke care quality in a Chinese urban area.Methods The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals.We identified 7827 patients with ischaemic stroke admitted from April to October 2017,and 506 patients underwent thrombolysis were finally included for analysis.Results Compared with‘pre-ASCaM period’,we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours(65.4% vs 54.5%;adjusted OR,1.724;95% CI 1.21 to 2.45;p=0.003)during‘ASCaM period’.In multivariate analysis models,‘ASCaM period’was associated with a significant reduction in onset-to door time(114.1±55.7 vs 135.7±58.4 min,p=0.0002)and onset-to needle time(ONT)(169.2±58.1 vs 195.6±59.3 min,p<0.0001).Yet no change was found in door-to needle time.Clinical outcomes such as symptomatic intracranial haemorrhage,favourable functional outcome(modified Rankin Scale≤2)and in-hospital mortality remained unchanged.Conclusion The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT.The ASCaM may,in proof-of principle,serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.

Suggestions of management on emergency responses to epidemic outbreaks in outpatient or emergency departments of tertiary teaching hospitals

Background Patients infected with the alpha,beta,and delta strains of coronavirus disease 2019(COVID-19)usually exhibit fever,dry cough,nasal congestion,sore throat,loss of taste or smell,runny nose,conjunctivitis,fatigue,myalgia,diarrhea,and other symptoms,[1]while patients infected with the omicron strain present mild symptoms,including nasal discharge,sore throat,sneezing,headache,and cough.[2]Some patients deliberately conceal the relevant medical history,which makes it difficult to find in the pre-examination screening in outpatient or emer-gency departments.Outpatient and emergency buildings are usually linked to each other,and some older floors are poorly ventilated.Once patients with COVID-19 see a doctor in an out-patient or emergency building,especially patients infected with the omicron strain,an outbreak of the epidemic in a large area is easily possible.