Effects of Repetitive TranscranialMagnetic Stimulation on Upper Extremity Function in Acute Stroke:A Meta-analysis and Systematic Review

[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous and systematic electronic search was conducted across the Medline,PubMed,and Web of Science databases,encompassing literature up to July 1,2024.To ensure the reliability of the in-cluded studies,an assessment of their risk of bias was conducted using RevMan 5.4 software,in accordance with the rigorous standards out-lined in the Cochrane Handbook for Systematic Revieus.Subsequently,we employed either the random-effects model or the fixed-effects model,depending on the heterogeneity of the data,to estimate the standardized mean difference(SMD)in outcomes,utilizing Stata 18.0 software for statistical analysis.[Results]Our review encompassed a total of five studies,involving 252 patients with acute stroke.The pooled analysis of these studies revealed a statistically significant improvement in Fugl-Meyer Assessment of the Upper Extremity(FMA-UE)scores among pa-tients who received rTMS therapy(SMD=2.71,95%CI:0.85 to 4.56;P<0.0001),albeit with considerable heterogeneity(I^(2)=97.65%)across the trials.[Conclusions]The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke.These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population.

Efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke

BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

Early rehabilitation and neuroprotective drug therapy outcomes in elderly patients with acute stroke

Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.

Early Application of Citicoline in the Treatment of Acute Stroke:A Meta-analysis of Randomized Controlled Trials

This study was to evaluate the efficacy and safety of early application of citicoline in the treatment of patients with acute stroke by meta-analysis. Randomized controlled trials published until May 2015 were electronically searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, and China Biology Medicine disc. Two reviewers independently screened the articles and extracted the data based on the inclusion and exclusion criteria. The quality of included articles was evaluated by using Revman5.0, and meta-analysis was performed. The results showed that 1027 articles were obtained in initial retrieval, and finally 7 articles, involving a total of 4039 cases, were included for analysis. The meta-analysis showed that no significant differences were found in the long-term mortality（OR=0.91, 95% CI 0.07 to 1.09, P=0.30）, the rate of dependency（OR=1.02, 95% CI 0.87 to 1.24, P=0.85）, and the effective rate（OR=0.98, 95% CI 0.84 to 1.14, P=0.82） between citicoline group and control group. The overall rate of adverse events in citicoline group was not significantly different from that in control group（P=0.30）. The quality of included articles reached moderate-low level. In conclusion, citicolne cannot reduce long-term mortality and dependence rate in the treatment of acute stroke, and the effective rate of citivoline may be not better than that of controls but with reliable safety.

Influencing factors for the disappearance of hemispatial neglect in patients during acute stroke

BACKGROUND： Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect （HSN） dunng acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE： To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN ： Case analysis SETTING ： Department of Neurology, First Affiliated Hospital of Guangxi Medical University PARTICIPANTS： A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria： ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion cnteda： Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was （68±10） years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS： Disappearance and existence of HSN were analyzed with HSN evaluation criteria： body agnosia, left and nght agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method, Items mentioned below belonged to HSN disappearance： ① without body agnosia; ② without left and nght agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one＇s own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and nght agnosia and difficult maintenance of supine position were observed during acute period （within 1 week） and recovery period （at 2 weeks after onset）. Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training （sitting in bed and near bedside： heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage） and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean＋SD and compared with ttest; enumeration data were compared with Chi-square test and Mann-Whitney Utest. P 〈 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES： ① HSN disappearance; ②Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position;③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS： All 21 patients were involved in the final analysis. ① HSN disappearance： Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 （38%, 8/21） HSN disappearance, and 13 （62%, 13/21） HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases： Within 1 week, 19% （4/21） HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% （13/21）, but 43% （17/21） during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention： At acute phase, HSN disappearance through sitting training lasted for （2.5±1.3） days, and remaining HSN symptoms were relieved for （5.0±3.7） days. There was significant difference between them （ x^2= 3.96, P = 0.039）. The hospitalized time of patients with HSN disappearance and HSN remnant was （17.6±10.4）, （16.2±4.9） days, but there was no significant difference between them （x^2 = 1.41, P = 0.679）. Physiotherapy time of patients with HSN disappearance and HSN remnant was （11.1 ±7.5）, （11.4±4.1 ） days, but there was no significant difference between them （x^2 = 1.05, P = 0.894）. CONCLUSION： Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.

Gelfoam embolization for distal, medium vessel injury during mechanical thrombectomy in acute stroke: A case report

BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.

Post-acute ischemic stroke hyperglycemia aggravates destruction of the blood-brain barrier

Post-acute ischemic stroke hyperglycemia increases the risk of hemorrhagic transformation,which is associated with blood-brain barrier disruption.Brain microvascular endothelial cells are a major component of the blood-brain barrier.Intercellular mitochondrial transfer has emerged as a novel paradigm for repairing cells with mitochondrial dysfunction.In this study,we first investigated whether mitochondrial transfer exists between brain microvascular endothelial cells,and then investigated the effects of post-acute ischemic stroke hyperglycemia on mitochondrial transfer between brain microvascular endothelial cells.We found that healthy brain microvascular endothelial cells can transfer intact mitochondria to oxygen glucose deprivation-injured brain microvascular endothelial cells.However,post-oxygen glucose deprivation hyperglycemia hindered mitochondrial transfer and exacerbated mitochondrial dysfunction.We established an in vitro brain microvascular endothelial cell model of the blood-brain barrier.We found that post-acute ischemic stroke hyperglycemia reduced the overall energy metabolism levels of brain microvascular endothelial cells and increased permeability of the blood-brain barrier.In a clinical study,we retrospectively analyzed the relationship between post-acute ischemic stroke hyperglycemia and the severity of hemorrhagic transformation.We found that post-acute ischemic stroke hyperglycemia serves as an independent predictor of severe hemorrhagic transformation.These findings suggest that post-acute ischemic stroke hyperglycemia can aggravate disruption of the blood-brain barrier by inhibiting mitochondrial transfer.

Non-coding RNAs in acute ischemic stroke:from brain to periphery

Acute ischemic stroke is a clinical emergency and a condition with high morbidity,mortality,and disability.Accurate predictive,diagnostic,and prognostic biomarkers and effective therapeutic targets for acute ischemic stroke remain undetermined.With innovations in high-throughput gene sequencing analysis,many aberrantly expressed non-coding RNAs(ncRNAs)in the brain and peripheral blood after acute ischemic stroke have been found in clinical samples and experimental models.Differentially expressed ncRNAs in the post-stroke brain were demonstrated to play vital roles in pathological processes,leading to neuroprotection or deterioration,thus ncRNAs can serve as therapeutic targets in acute ischemic stroke.Moreover,distinctly expressed ncRNAs in the peripheral blood can be used as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.In particular,ncRNAs in peripheral immune cells were recently shown to be involved in the peripheral and brain immune response after acute ischemic stroke.In this review,we consolidate the latest progress of research into the roles of ncRNAs(microRNAs,long ncRNAs,and circular RNAs)in the pathological processes of acute ischemic stroke–induced brain damage,as well as the potential of these ncRNAs to act as biomarkers for acute ischemic stroke prediction,diagnosis,and prognosis.Findings from this review will provide novel ideas for the clinical application of ncRNAs in acute ischemic stroke.

Stroke:Evolution of newer treatment modalities for acute ischemic stroke

Acute ischemic stroke is one of the leading causes of morbidity and mortality worldwide.Restoration of cerebral blood flow to affected ischemic areas has been the cornerstone of therapy for patients for eligible patients as early diagnosis and treatment have shown improved outcomes.However,there has been a paradigm shift in the management approach over the last decade,and with the emphasis currently directed toward including newer modalities such as neuroprotection,stem cell treatment,magnetic stimulation,anti-apoptotic drugs,delayed recanali-zation,and utilization of artificial intelligence for early diagnosis and suggesting algorithm-based management protocols.

Identification of risk factors and construction of a nomogram predictive model for post-stroke infection in patients with acute ischemic stroke

BACKGROUND Post-stroke infection is the most common complication of stroke and poses a huge threat to patients.In addition to prolonging the hospitalization time and increasing the medical burden,post-stroke infection also significantly increases the risk of disease and death.Clarifying the risk factors for post-stroke infection in patients with acute ischemic stroke(AIS)is of great significance.It can guide clinical practice to perform corresponding prevention and control work early,minimizing the risk of stroke-related infections and ensuring favorable disease outcomes.AIM To explore the risk factors for post-stroke infection in patients with AIS and to construct a nomogram predictive model.METHODS The clinical data of 206 patients with AIS admitted to our hospital between April 2020 and April 2023 were retrospectively collected.Baseline data and post-stroke infection status of all study subjects were assessed,and the risk factors for poststroke infection in patients with AIS were analyzed.RESULTS Totally,48 patients with AIS developed stroke,with an infection rate of 23.3%.Age,diabetes,disturbance of consciousness,high National Institutes of Health Stroke Scale(NIHSS)score at admission,invasive operation,and chronic obstructive pulmonary disease(COPD)were risk factors for post-stroke infection in patients with AIS(P<0.05).A nomogram prediction model was constructed with a C-index of 0.891,reflecting the good potential clinical efficacy of the nomogram prediction model.The calibration curve also showed good consistency between the actual observations and nomogram predictions.The area under the receiver operating characteristic curve was 0.891(95%confidence interval:0.839–0.942),showing predictive value for post-stroke infection.When the optimal cutoff value was selected,the sensitivity and specificity were 87.5%and 79.7%,respectively.CONCLUSION Age,diabetes,disturbance of consciousness,NIHSS score at admission,invasive surgery,and COPD are risk factors for post-stroke infection following AIS.The nomogram prediction model established based on these factors exhibits high discrimination and accuracy.

Relationship between serum neutrophil gelatinase-associated lipocalin levels and cognitive impairment, anxiety, and depressive symptoms in acute ischemic stroke

BACKGROUND Acute ischemic stroke(AIS)is a significant global health issue with increasing incidence owing to aging populations and rising cardiovascular risk factors.In addition to physical impairments,AIS frequently leads to neuropsychiatric co-mplications,such as cognitive impairment,anxiety,and depressive symptoms,which adversely affect patients’quality of life and rehabilitation.Neutrophil ge-latinase-associated lipocalin(NGAL)has emerged as a potential biomarker for various conditions,including AIS.This study investigated the association bet-ween serum NGAL levels at admission and neuropsychiatric complications in patients with AIS.neuropsychiatric complications in patients with AIS.METHODS Between January 2022 and December 2023,150 patients with AIS were enrolled.Serum NGAL levels were measured at admission using an enzyme-linked immu-nosorbent assay.Cognitive function was assessed using the Mini-Mental State Examination,while anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale at discharge.The relationship between serum NGAL levels and cognitive impairment,anxiety,and depressive symptoms was analyzed using multivariate logistic regression,adjusted for potential con-founders of age,sex,body mass index,smoking status,hypertension,diabetes mellitus,dyslipidemia,previous stroke,and stroke severity.RESULTS The mean age of the participants was 65.4±10.2 years,and 58%were males.Prevalence rates of cognitive impairment,anxiety,and depressive symptoms at discharge were 34.7%,28.0%,and 32.0%,respectively.Serum NGAL levels were significantly higher in patients with cognitive impairment(median:5.6 ng/mL vs 3.2 ng/mL,P<0.001),anxiety(median:5.1 ng/mL vs 3.5 ng/mL,P=0.002),and depressive symptoms(median:5.4 ng/mL vs 3.3 ng/mL,P<0.001),compared to those without these conditions.Multivariate logistic regression analysis showed that higher serum NGAL levels at admission were independently associated with cognitive impairment[odds ratio(OR)=1.42,95%confidence interval(CI):1.18-1.71,P<0.001],anxiety(OR=1.28,95%CI:1.09-1.51,P=0.003),and depressive symptoms(OR=1.39,95%CI:1.16-1.67,P<0.001)after adjusting for potential confounders.CONCLUSION Elevated serum NGAL levels were independently associated with cognitive impairment,anxiety,and depressive symptoms in patients with AIS;and may function as potential biomarkers for patients at risk.

Application of Time-Tracking Platform in the Reperfusion Treatment of Patients with Acute Ischemic Stroke in Primary Hospitals

Objective To explore the application effect of time tracking platform in improving the reperfusion treatment of patients with acute ischemic stroke in primary hospitals. Methods and Results Patients with acute ischemic stroke who carried out emergency intravenous thrombolysis and arterial thrombectomy in our hospital in 2021, 2022 and 2023 were selected. The time tracking mode was implemented, and the patients were recorded at each time node of the hospital and the whole-process digital management was conducted. Compared the mean DNT (Door to Needle Time) of intravenous thrombolysis in emergency stroke patients in 2021, 2022 and 2023, the total number of hospital cases within 4.5 h of onset, the total number of thrombolysis cases within 4.5 h of onset, the number of intravenous thrombolysis in 60 minutes of acute ischemic stroke, and the number of thrombolysis cases. The results show that from 2021 to 2023 our emergency stroke patients with intravenous thrombolysis average DNT shortened year by year, to the hospital within 4.5 h after the onset of the difference is statistically significant (all P < 0.05) conclusion through the application of stroke time tracking platform, is beneficial to shorten the treatment time of each link, can effectively reduce the hospital time delay, improve the rate of thrombolysis, improve the reperfusion of stroke centers in primary hospitals.

Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis

BACKGROUND Acute ischemic stroke(AIS)retains a notable stance in global disease burden,with thrombolysis via recombinant tissue plasminogen activator(rtPA)serving as a viable management approach,albeit with variable outcomes and the potential for complications like hemorrhagic transformation(HT).The platelet-to-neutrophil ratio(P/NR)has been considered for its potential prognostic value in AIS,yet its capacity to predict outcomes following rtPA administration demands further exploration.AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients.METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed.The relationship between P/NR and clinical outcomes[early neurological deterioration(E-ND),HT,delayed ND(D-ND),and 3-mo outcomes]was scrutinized.RESULTS Notable variables,such as age,diabetes,and stroke history,exhibited statistical disparities when comparing patients with and without E-ND,HT,D-ND,and 3-mo outcomes.P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3%sensitivity and a 52.5%specificity for 90-d outcomes.P/NR prognostic accuracy was statistically significant for 90-d outcomes[area under the curve(AUC)=0.562],D-ND(AUC=0.584),and HT(AUC=0.607).CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes,HT,and D-ND in AIS patients post-rtPA administration,indicating its potential as a predictive tool for complications and prognoses.This infers that a diminished P/NR may serve as a novel prognostic indicator,assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.

The Effect of Ginkgo Biloba Leaf Dropping Pill Combined with Butylphthalide Capsule on Cognitive Dysfunction in Patients after Acute Ischemic Stroke and Its Impact on Serum Cytokines

Objective: To investigate the therapeutic effect of Ginkgo biloba extract dropping pills combined with butylphthalide capsules on cognitive dysfunction in patients after acute ischemic stroke (AIS) and its impact on serum cytokines CRP, IL-6, and Hcy. Methods: This study selected 76 patients with cognitive dysfunction after ischemic stroke who were hospitalized at Zhuji People’s Hospital from January 2023 to January 2024. The patients were divided into two groups. The control group was treated with butylphthalide capsules, while the combination group received Ginkgo biloba extract dropping pills in addition to the treatment given to the control group. The neurological function, cognitive function, activities of daily living, and levels of serum cytokines CRP, IL-6, and Hcy were compared between the two groups after 1 month and 3 months of treatment. Results: The NIHSS scores, MMSE scores, ADL scores, and levels of CRP, IL-6, and Hcy in both groups showed statistically significant differences compared to before treatment (P Conclusion: The combination of Ginkgo biloba extract dropping pills and butylphthalide capsules has a better therapeutic effect on cognitive dysfunction in patients after ischemic stroke. It can improve the neurological function and cognitive function of patients, enhance their ability to perform daily activities, and reduce inflammatory responses.

Effectiveness and safety of Angong Niuhuang pill(安宫牛黄丸)in treatment of acute stroke:a systematic review and Meta-analysis

OBJECTIVE:To systematically evaluate the efficacy and safety of Angong Niuhuang pill(安宫牛黄丸,ANP)in the treatment of acute stroke.This can provide ideas and basis for the treatment of this disease with integrated Traditional Chinese and Western Medicine.METHODS:Randomized controlled trials(RCTs)of China National Knowledge Infrastructure Database,Wanfang Database,Chinese BioMedical Literature Database,PubMed,Embase,and the Cochrane Library were searched from the establishment to March 2022.Two researchers screened the literature and extracted the data according to inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.RESULTS:A total of 28 RCTs were included,including 2745 patients in the acute stage of stroke(1375 in the experimental group and 1370 in the control group).Metaanalysis showed that compared with conventional treatment,combined treatment with ANP could improve the effective rate of acute stroke patients[relative risk(RR)=1.26,95%confidence interval(CI)(1.21,1.31)],Glasgow Coma Scale scores[mean difference(MD)=2.01,95%CI(1.04,2.98)],Mini-mental State Examination scores[MD=4.79,95%CI(2.22,7.37)],Activities of Daily Living scores[MD=15.70,95%CI(14.05,17.36)]and the Barthel index scores[MD=13.89,95%CI(12.12,15.65)],reduce National Institute of Health stroke scale scores[MD=-3.90,95%CI(-4.96,-2.84)]and serum brain natriuretic peptide[MD=-38.50,95%CI(-46.85,-30.15)].In terms of safety,the incidence of adverse reactions showed no statistical differences between the two groups[RR=0.71,95%CI(0.43,1.15),P=0.16],and no serious adverse reactions/events were observed,indicating a good safety.CONCLUSIONS:Existing clinical research evidence shows that ANP has good efficacy and safety in the treatment of acute stroke,which can provide a basis for the treatment of integrated Traditional Chinese and Western Medicine.However,the quality of included research methodology needs to be improved,and the above conclusions need to be verified by more highquality studies.

Amniotic membrane mesenchymal stromal cell-derived secretome in the treatment of acute ischemic stroke:A case report

BACKGROUND Stroke is the second and third leading cause of death and disability,respectively.To date,no definitive treatment can repair lost brain function.Recently,various preclinical studies have been reported on mesenchymal stromal cells(MSCs)and their derivatives and their potential as alternative therapies for stroke.CASE SUMMARY A 45-year-old female suffered an acute stroke,which led to paralysis in the left upper and lower limbs.The amniotic membrane MSC-derived secretome(MSCsecretome)was intravenously transplanted once a week for 4 wk.MSC-secretomeregulated regulatory T cells were investigated for the beneficial effects.The clinical improvement of this patient was accompanied by an increased frequency of regulatory T cells after transplantation.CONCLUSION Intravenous administration of MSC-secretome can potentially treat patients who suffer from acute ischemic stroke.

Qixue Shuangbu decoction and acupuncture combined with Western medicine in acute severe stroke patients

BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,70%of patients with stroke have serious disability,which results in heavy burden to their families and the society.AIM To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke.METHODS A total of 68 patients with acute severe stroke admitted to Lanzhou Second People’s Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method.The control group was administered routine Western medicine treatment,such as dehydration,lowering intracranial pressure,anticoagulation,improving cerebral blood circulation and cerebral nerve protection according to the“Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China.”The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture.The two groups were compared.RESULTS The acute physiology and chronic health evaluation II,organ dysfunction syndrome score,National Institutes of Health Stroke Scale,and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment,and the complements C3 and C4,and immunoglobulins(Ig)M and G were significantly increased compared with those observed before treatment(P<0.05).After treatment,the scores of the observation group were lower than those of the control group,and the complement and Ig levels were higher than those of the control group(P<0.05).The levels of diamine oxidase(DAO),Dlactic acid(D-LA),and calcitonin gene-related peptide(CGRP)in the two groups were significantly higher than those before treatment,while the levels of lipopolysaccharide,ubiquitin carboxyl-terminal hydrolase 1(UCH-L1),tumor necrosis factor-α(TNF-α),interleukin(IL)-2,and IL-8 were significantly lower than those before treatment(P<0.05).After treatment,DAO,D-LA,and CGRP were higher in the observation group than in the control group,while lipopolysaccharide,UCH-L1,TNF-α,IL-2,and IL-8 were lower than in the control group(P<0.05).The hospitalization time of individuals in the observation group was shorter than that of the control group(P<0.05).CONCLUSION Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora,reduce inflammation,improve intestinal mucosal barrier function and immune function related indicators,and promote recovery.

Characteristic metabolic and microbial profiles in acute ischemic stroke patients with phlegm-heat pattern

Objective:To explore the characteristics of plasma metabolites,feces gut microbiota and the crosstalk between gut microbiota and host metabolism in patients with acute ischemic stroke and phlegm-heat pattern(AIS-PHP).Methods:The metabolic and microbiome profiles of 20 AIS-PHP patients and 20 healthy controls(HCs)were analyzed using liquid chromatography-tandem mass spectrometry(LC-MS/MS)-based metabolomics and 16s rDNA sequencing,respectively.The covariation between LC-MS/MS-based metabolite data and 16s rDNA sequence data was presented.Results:Distinct alterations in the plasma metabolic phenotype of AIS-PHP patients were found,in which 16 metabolites differed significantly between the AIS-PHP patients and the HCs.These metabolites represented 17 different metabolic pathways,including amino acid metabolism,lipid metabolism,and nucleotide metabolism.Additionally,significant alterations of gut microbiota composition and taxon were revealed at the phylum level between the AIS-PHP patients and the HCs.In AIS-PHP,Bacteroidetes,Firmicutes,and Proteobacteria dominated.Moreover,some microbes that differed between the 2 groups manifested a sole association with certain metabolites,such as the connection between Bacteroides and inosine and between Lachnospiraceae_unclassified and hypoxanthine.Conclusion:The present study preliminarily investigated the metabolomic and gut microbiome characteristics of AIS-PHP patient indicators.The link between metabolic and microbial dysbiosis in AIS-PHP sheds new light on the function of gut microbiota and associated metabolomics in the pathogenesis of the disease.

A meta-analysis of risk factors for epilepsy after acute ischaemic stroke and the development of a predictive model

Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.

Mechanical thrombectomy and postoperative complications after acute ischemic stroke with large vessel occlusion

Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.