Decompressive craniectomy for malignant middle cerebral artery infarctions: a meta-analysis

Background: Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear. This review went to evaluate the efficacy of DC in treating mMCAI patients. Methods: Studies were entirely searched since the foundation dates of multiple databases to June 2016. All major databases were involved, including Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and other sources. the bias risk of studies involved were evaluated. Modified Rankin Scale was defined as Primary outcome, Odds Ratio and 95% confidence intervals was taken as measurements. T2 (tau-squared) test, I2 test, and chi-square tests were used for statistical heterogeneity evaluation for each meta-analysis result, followed by fixed-effect model. Mantel-haenszel method was used in the process of summary estimations. All of the meta-analysis was conducted by Review Manager 5.3.Results & Conclusion: One thousand one hundred forty-five records of data were critically identified and collected through databases and 14 studies were finally involved. Result suggested that DC can ameliorate the suboptimal outcome of mMCAI patients.

Effect of electroacupuncture at Ganshu(BL 18) and Shenshu(BL 23) on the expression of EphB2 protein in cortex around cerebral infracted area of rat

Objective： To observe the effect of electroacupuncture （EA） on the expression of erythropoie-tin-producing hepatocyte receptor B2 （EphB2） in the cortex around the infracted area of middle cerebral artery occlusion （MCAO） rats at different timing, and to reveal the possible mechanism of acupuncture in the treatment of cerebral ischemia. Methods： A total of 180 male Sprague-Dawley （SD） rats were randomly divided into a sham operation group, a model group, an acupoint group and a non-acupoint group, with 45 rats in each group. Rats in each group were further divided into three subgroups： postoperative 3 d, postoperative 14 d and postoperative 2l d groups, with 15 rats in each subgroup. The MCAO model was made by the modified occlusion method. The neurological function score, 2,3,5-triphenyl tetrazolium chloride （TFC） staining, immunohistochemistry assay, immunofluorescence double labeling method and Western blot were used to detect the corresponding indicators. Results： The neurological impairment of rats was most obvious at postoperative 3 d, and then gradually improved with time, which was more significant in the acupoint group （P〈0.05）. The change of infarcted volume was consistent with the neurological function impairment. The number of EphB2 positive cells （EphB2＋） around the infarcted area was decreased significantly at postoperative 3 d, and then gradually improved with time, which returned to the same level as that in the sham operation group at postoperative 21 d. The increase was most significant in the acupoint group （P〈0.05）, and the positive cell number was higher than that in the sham operation group （P〈0.01）. Western blot and immunohistochemistry results were basically consistent. Immunofluorescence displayed that EphB2＋ and postsynaptic density-95 positive （PSD-95＋） were co-expressed, after the MCAO operation, in the cortical neuron around the infracted area, and the number of co-expressing cells was increased gradually with time, which was most significant in the acupoint group （P〈0.05）. Conclusion： Electroacupuncture at Ganshu （BL 18） and Shenshu （BL 23） can significantly improve the neurological function and cerebral infarcted volume ratio of MCAO rats, which may be related to the activation of EphB2 expression in cortex around the infracted area and the promotion of synaptic remodeling.

Effcacy-oriented compatibility for Tianma(Rhizoma Gastrodiae),Yanlingcao(Trillium tschonoskii Maxim) and Bingpian(Borneolum Syntheticum) on improving cerebral ischemia stroke by network pharmacology and serum pharmacological methods

OBJECTIVE:To evaluate the compatibility of Tianma(Rhizoma Gastrodiae,TM),Yanlingcao(Trillium tschonoskii Maxim,YLC)and Bingpian(Borneolum Syntheticum,BP),and their efficacy in the treatment of cerebral ischemic stroke.METHODS:Network pharmacology was used to determine the compatibility of TM,YLC,and BP,and their potential mechanism.The middle cerebral artery occlusion(MCAO)rat model was used to evaluate the curative effect of the six combinations of TM,YLC,and BP(TZB1-TZB6)on cerebral ischemia,by using the weight matching method to form.The potential component changes of TM and YLC in the blood and brains of rats were analyzed using ultra performance liquid chromatography-mass spectrometry.Finally,molecular docking linked the results of animal experiments and network pharmacology,determining the potential component contributors of TM and YLC to treating ischemic stroke.RESULTS:TZB reduced the cerebral infarct volume and protected the nerve cells in MCAO rats.The components of TM and YLC were also identified in the blood and brain homogenate,and BP can facilitate the entry of the components of TM and YLC into the blood and brain.Diosgenin,pennogenin,and gastrodin induced effective binding activities with adenosine receptor a1.CONCLUSION:We investigate an approach that improves the means of folk prescription combined with multi technology that maybe promote the transformation of Chinese medicinal prescription into component-based Chinese medicine.

Effect of electroacupuncture on expressions of VEGF and CD31 in MCAO model rats

Objective： To investigate the effect of electroacupuncture （EA） at Ganshu （BL 18） and Shenshu （BL 23） on vascular endothelial growth factor （VEGF） and platelet endothelial cell adhesion molecule-1 （PECAM-1）/CD31 around the cerebral infarction focus in middle cerebral artery occlusion （MCAO） rats and the possible mechanism, thus to provide a new strategy for the treatment of cerebral ischemic stroke by acupuncture. Methods： A total of 180 healthy male Sprague-Dawley （SD） rats were randomly divided into a sham operation group, a model group, an acupoint group and a non-acupoint group, 45 rats in each group. MCAO model was established using the modified line-embolus method in all rats except for those in the sham operation group; rats in the acupoint group were treated with EA at Ganshu （BL 18） and Shenshu （BL 23）; rats in the non-acupoint group were treated with EA at the control points; rats in other 2 groups were only subjected to bundling without treatment. Ten rats in each group were randomly selected on the 3rd day, the 14th day and the 21st day after acupuncture stimulation to test the neurological function impairment. The expression levels of CD31 and VEGF were also detected. Results： Compared with the model group and non-acupoint group, the neurological function score of the acupoint group was decreased at each time point, and the differences were statistically significant （P〈0.05, P〈0.01）. The expressions of VEGF and CD31 in each group were the lowest on the 3rd day, reached the peak on the 14th day and still remained at high level on the 21st day. And the differences among groups were statistically significant both on the 14th day and the 21st day （P〈0.05, P〈0.01）. Compared with the model group and the non-acupoint group, the expressions of VEGF and CD31 in the acupoint group were increased, and the differences were statistically significant （all P〈0.05）. Conclusion： EA at Ganshu （BL 18） and Shenshu （BL 23） can significantly improve the neurological function score of MCAO model rats, and shows protective effect on cerebral ischemia. The protective mechanism may be related to the up-regulation of CD31 and VEGF expression around the cerebral infarction focus in the MCAO model rats and induction of angiogenesis.