In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new ag...In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new agents available for treatment of cerebral vasospasm is expanding rapidly along with rapid advances in pharmacology and physiology that are uncovering the mechanisms of this disease. Although there are many publications for treatment of cerebral vaso-spasm, most are focusing on different aspects of vasospasm treatment and many have limited value due to insufficient quality. Moreover, the complexity of this, in many cases deleterious condition, is enormous and the information needed to understand drug effects is accordingly often not readily available in a single source. A number of pharmacological and medical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Current research efforts promise the eventual production of new medical therapies. At last, recommendations for the use of different treatment stages based on currently available clinical data are provided.展开更多
AIM:To investigate whether cocktail theraphy combined with of neuroprotectants may have more advantages over single agents in treating focal cerebral ischemic cascade.METHODS:With the use of suture occlusin techique,t...AIM:To investigate whether cocktail theraphy combined with of neuroprotectants may have more advantages over single agents in treating focal cerebral ischemic cascade.METHODS:With the use of suture occlusin techique,the right middle cerebral artery in rats was occluded.Tirty minutes later,Frutose 1,6 diphosphate(FDP) (50 mg/kg,n=20), MK 801(1 mg/kg,n=20) and N acetylcystein (NAC)(150 mg/kg,n=20) were singly or combinantly infused intraperitoneally.At the same time the cocktail treated group(n=20)were infused the above agents combinationly and the control group(n=20)were infused normal saline intraperitoneally.6 hours and 24 hours after focal cerebral ischemia the animals were weighted and neurologically assessed on 5 point scale.The animals were killed,brains were stained 2,3,5 triphenyltetrazolium chloride for assessment of the infarct volume and then embedden onto slides with paraffin for morphological assessment and terminal transferase dUTP nick ending labeling(TUNEL )were carried out for apoptosis and immunohistochemistry were carried out to investigate the changes in bcl 2.RESULTS:All Neuroprotectants decreased volume of infarction (P< 0.05,F test).While cocktail treated group showed more distinct decrease than other groups(P< 0.05,F test).FDP treated group did not decrease the apoptosis of the neurons and did not increase the bcl 2 expression as well.MK 801 treated group,NAC treated group and cocktail treated group significantly decreased the apoptosis of the neurons and increased the bcl 2 expression (P< 0.05,F test).With cocktail treated group showing more distinct effect (P< 0.05,F test).CONCLUSION:Cocktail may be more effective than single neuroprotectant in this modle.展开更多
目的:对比CT与多模式MRI指导下缺血性脑卒中静脉溶栓治疗后出血转化的差异,明确多模式MRI指导溶栓的安全性。方法:回顾分析2009年6月-2011年10月期间接受静脉重组组织型纤溶酶原激活剂(rtPA)溶栓治疗的缺血性脑卒中患者资料,包括性别、...目的:对比CT与多模式MRI指导下缺血性脑卒中静脉溶栓治疗后出血转化的差异,明确多模式MRI指导溶栓的安全性。方法:回顾分析2009年6月-2011年10月期间接受静脉重组组织型纤溶酶原激活剂(rtPA)溶栓治疗的缺血性脑卒中患者资料,包括性别、年龄、既往史、溶栓时间、基线NIHSS、血压、血糖、电解质、凝血谱和心电图,以及溶栓后CT与MRI检查等,按照中国缺血性卒中亚型(CISS)标准予以病因分组。结果:共113例患者接受静脉rtPA治疗,平均年龄:(66±12)岁,男性74例,占65.5%,溶栓前美国国立卫生院卒中量表(National Institute of Health StrokeScale,NIHSS)评分12.4±6.5,发病至溶栓时间:(259.7±131.7)min;溶栓后24 h复查发现,34例(30.1%)出现溶栓后出血转化,其中9例(8%)为症状性出血。Logistic回归分析发现,多模式MRI指导下溶栓后的出血转化风险明显减少(OR=0.599,95%CI:0.373～0.962;P=0.034)。结论:多模式MRI指导溶栓相对于CT筛查,在静脉rtPA溶栓治疗后显示更低的出血转化率。展开更多
文摘In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new agents available for treatment of cerebral vasospasm is expanding rapidly along with rapid advances in pharmacology and physiology that are uncovering the mechanisms of this disease. Although there are many publications for treatment of cerebral vaso-spasm, most are focusing on different aspects of vasospasm treatment and many have limited value due to insufficient quality. Moreover, the complexity of this, in many cases deleterious condition, is enormous and the information needed to understand drug effects is accordingly often not readily available in a single source. A number of pharmacological and medical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Current research efforts promise the eventual production of new medical therapies. At last, recommendations for the use of different treatment stages based on currently available clinical data are provided.
文摘AIM:To investigate whether cocktail theraphy combined with of neuroprotectants may have more advantages over single agents in treating focal cerebral ischemic cascade.METHODS:With the use of suture occlusin techique,the right middle cerebral artery in rats was occluded.Tirty minutes later,Frutose 1,6 diphosphate(FDP) (50 mg/kg,n=20), MK 801(1 mg/kg,n=20) and N acetylcystein (NAC)(150 mg/kg,n=20) were singly or combinantly infused intraperitoneally.At the same time the cocktail treated group(n=20)were infused the above agents combinationly and the control group(n=20)were infused normal saline intraperitoneally.6 hours and 24 hours after focal cerebral ischemia the animals were weighted and neurologically assessed on 5 point scale.The animals were killed,brains were stained 2,3,5 triphenyltetrazolium chloride for assessment of the infarct volume and then embedden onto slides with paraffin for morphological assessment and terminal transferase dUTP nick ending labeling(TUNEL )were carried out for apoptosis and immunohistochemistry were carried out to investigate the changes in bcl 2.RESULTS:All Neuroprotectants decreased volume of infarction (P< 0.05,F test).While cocktail treated group showed more distinct decrease than other groups(P< 0.05,F test).FDP treated group did not decrease the apoptosis of the neurons and did not increase the bcl 2 expression as well.MK 801 treated group,NAC treated group and cocktail treated group significantly decreased the apoptosis of the neurons and increased the bcl 2 expression (P< 0.05,F test).With cocktail treated group showing more distinct effect (P< 0.05,F test).CONCLUSION:Cocktail may be more effective than single neuroprotectant in this modle.
文摘目的:对比CT与多模式MRI指导下缺血性脑卒中静脉溶栓治疗后出血转化的差异,明确多模式MRI指导溶栓的安全性。方法:回顾分析2009年6月-2011年10月期间接受静脉重组组织型纤溶酶原激活剂(rtPA)溶栓治疗的缺血性脑卒中患者资料,包括性别、年龄、既往史、溶栓时间、基线NIHSS、血压、血糖、电解质、凝血谱和心电图,以及溶栓后CT与MRI检查等,按照中国缺血性卒中亚型(CISS)标准予以病因分组。结果:共113例患者接受静脉rtPA治疗,平均年龄:(66±12)岁,男性74例,占65.5%,溶栓前美国国立卫生院卒中量表(National Institute of Health StrokeScale,NIHSS)评分12.4±6.5,发病至溶栓时间:(259.7±131.7)min;溶栓后24 h复查发现,34例(30.1%)出现溶栓后出血转化,其中9例(8%)为症状性出血。Logistic回归分析发现,多模式MRI指导下溶栓后的出血转化风险明显减少(OR=0.599,95%CI:0.373～0.962;P=0.034)。结论:多模式MRI指导溶栓相对于CT筛查,在静脉rtPA溶栓治疗后显示更低的出血转化率。
