cardiovascular-agents and Infarction--Middle-Cerebral-Artery

Patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion with haemodynamic insufficiency are at high risk for recurrent stroke when treated medically.. The Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS) trial is an ongoing, government-funded, prospective, multicentre, randomised controlled trial. The CMOSS will recruit 330 patients with symptomatic ICA or MCA occlusion (parallel design, 1:1 allocation ratio) and haemodynamic insufficiency. Participants will be allocated to best medical treatment alone or best medicine plus extracranial-intracranial (EC-IC) bypass surgery. The primary outcome events are all strokes or deaths occurring between randomisation and 30 days post operation or post randomisation and ipsilateral ischaemic stroke within 2 years. Recruitment will be finished by December 2016. All the patients will be followed for at least 2 years. The trial is scheduled to complete in 2019.. The CMOSS will test the hypothesis that EC-IC bypass surgery plus best medical therapy reduces subsequent ipsilateral ischaemic stroke in patients with symptomatic ICA or MCA occlusion and haemodynamic cerebral ischaemia. This manuscript outlines the rationale and the design of the study. CMOSS will allow for more critical reappraisal of the EC-IC bypass for selected patients in China.. NCT01758614 with ClinicalTrials.gov. Registered on 24 December 2012.

Topics: Adolescent; Adult; Aged; Cardiovascular Agents; Carotid Artery, Internal; Carotid Stenosis; Cerebral Revascularization; Cerebrovascular Circulation; China; Clinical Protocols; Collateral Circulation; Combined Modality Therapy; Female; Hemodynamics; Humans; Infarction, Middle Cerebral Artery; Male; Middle Aged; Prospective Studies; Recurrence; Research Design; Risk Factors; Risk Reduction Behavior; Time Factors; Treatment Outcome; Young Adult

Ginkgolide terpenoid lactones, including ginkgolides and bilobalide, are two crucial bioactive constituents of extract of Ginkgo biloba (EGb) which was used in the treatment of cardiovascular and cerebrovascular diseases. The aims of this study were to investigate the antioxidant effects and mechanism of ginkgolides (ginkgolide A (GA), ginkgolide B (GB), ginkgolide K (GK)) and bilobalide (BB) against oxidative stress induced by transient focal cerebral ischemia. In vitro, SH-SY5Y cells were exposed to oxygen-glucose deprivation (OGD) for 4 h followed by reoxygenation with ginkgolides and BB treatments for 6 h, and then cell viability, superoxide dismutase (SOD), and ROS were respectively detected using kit. Western blot was used to confirm the protein levels of hemeoxygenase-1 (HO-1), quinone oxidoreductase l (Nqo1), Akt, phosphorylated Akt (p-Akt), nuclear factor-E2-related factor2 (Nrf2), and phosphorylated Nrf2 (p-Nrf2). GB combined with different concentrations of LY294002 (PI3K inhibitor) were administrated to SH-SY5Y cells for 1 h after OGD, and then p-Akt and p-Nrf2 levels were detected by western blot. In vivo, 2 h of middle cerebral artery occlusion (MCAO) model was established, followed with reperfusion and GB treatments for 24 and 72 h. The infarct volume ratios were confirmed by TTC staining. The protein levels of HO-1, Nqo1, SOD1, Akt, p-Akt, Nrf2, and p-Nrf2 were detected using western blot and immunohistochemistry (IHC). Experimental data in vitro confirm that GA, GB, GK, and BB resulted in significant decrease of ROS and increase of SOD activities and protein levels of HO-1 and Nqo1; however, GB group had a significant advantage in comparison with the GA and GK groups. Moreover, after ginkgolides and BB treatments, p-Akt and p-Nrf2 were significantly upregulated, which could be inhibited by LY294002 in a dose-dependent manner, meanwhile, GB exhibited more effective than GA and GK. In vivo, TTC staining indicated that the infarct volume ratios in MCAO rats were dramatically decreased by GB in a dose-dependent manner. Furthermore, GB significantly upregulated the protein levels of HO-1, Nqo1, SOD, p-Akt, p-Nrf2, and Nrf2. In conclusion, GA, GB, GK, and BB significantly inhibited oxidative stress damage caused by cerebral ischemia reperfusion. Compared with GA, GK, and BB, GB exerts the strongest antioxidant stress effects against ischemic stroke. Moreover, ginkgolides and BB upregulated the levels of antioxidant proteins through mediating th

Topics: Animals; Antioxidants; Brain Ischemia; Cardiovascular Agents; Cell Line, Tumor; Ginkgo biloba; Ginkgolides; Heme Oxygenase-1; Humans; Infarction, Middle Cerebral Artery; Male; NAD(P)H Dehydrogenase (Quinone); Neuroprotective Agents; NF-E2-Related Factor 2; Oxidative Stress; Plant Extracts; Proto-Oncogene Proteins c-akt; Rats; Rats, Sprague-Dawley

We present three cases of pediatric patients with thrombocytopenia-associated multiple organ failure and the evidence for providing extracorporeal organ support. All three patients had severe cardiac dysfunction, respiratory failure, and acute kidney injury treated with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and plasma exchange. Despite the presence of multiple organ failure and high risk of mortality, all three patients survived with minimal long-term sequelae.

Topics: ADAM Proteins; ADAMTS13 Protein; Adolescent; Bacteremia; Cardiopulmonary Resuscitation; Cardiovascular Agents; Child; Combined Modality Therapy; Extracorporeal Membrane Oxygenation; Fluid Therapy; Heart Arrest; Hemofiltration; Hemolytic-Uremic Syndrome; High-Frequency Ventilation; Humans; Infarction, Middle Cerebral Artery; Influenza A virus; Influenza, Human; Male; Methicillin-Resistant Staphylococcus aureus; Multiple Organ Failure; Osteomyelitis; Plasma Exchange; Staphylococcal Infections; Thrombotic Microangiopathies; Tracheostomy

Huang-Lian-Jie-Du-Tang (HLJDT, or Oren-gedoku-to in Japanese), an important multi-herb remedy in China and other Asia countries, has been used clinically to treat cerebral ischemia for decades.. According to the previous studies we have reported, an HPLC method was developed and validated for determination of berberine, palmatine, baicalin, baicalein and geniposide simultaneously in MCAO rat plasma after administration of HLJDT aqueous extract. A classified integral pharmacokinetic method was put forward after having compared the integrated concentration-time profile with that of single component. An AUC based weighting approach was used for integrated principle.. The results indicated the classified integral pharmacokinetic profile of index components from HLJDT could reveal the pharmacokinetic behavior of original components, and was corresponding to the holistic pharmacological effects of anti-ischemia with HLJDT.. This study was aimed to explore an approach that could be applied to integrate the pharmacokinetic behavior of different components derived from HLJDT. The integrated pharmacokinetic results also provided more information for further understanding of the clinical cerebrovascular disease in use of HLJDT.

Topics: Administration, Oral; Animals; Area Under Curve; Biotransformation; Cardiovascular Agents; Chromatography, High Pressure Liquid; Disease Models, Animal; Drug Stability; Drugs, Chinese Herbal; Infarction, Middle Cerebral Artery; Male; Models, Biological; Phytotherapy; Plants, Medicinal; Rats; Rats, Sprague-Dawley

The purpose of this study was to clarify the clinical impact of endovascular treatment (EVT) on acute cerebral large vessel occlusion using a nationwide survey of Japan conducted in 2009.. Patients admitted within 24 h after stroke onset were registered retrospectively. Treatment selection, methods, and clinical results were analyzed.. A total of 1,963 patients (855 women, 1,108 men) treated in 2008 were registered from 68 medical centers in Japan. Mean age on admission was 74.1 ± 12.2 years (range 7-100 years). The first treatment was conservative therapy in 68%, intravenous tissue plasminogen activator (IV-tPA) in 21%, EVT in 9%, and combined IV-tPA + EVT in 2%. EVT mainly comprised angioplasty, intra-arterial thrombolysis and/or the combination of both. Patients treated ≤3 h after onset (1,286 cases) showed better clinical outcomes with combined IV-tPA + EVT than with conservative therapy, and significant differences in outcomes were seen for patients with occlusion of the basilar artery (p < 0.01) or middle cerebral artery (p < 0.01), but not the internal carotid artery. At >3 h after onset (677 patients), no IV-tPA was performed, and EVT was performed in 11%. Among the patients treated by EVT, there were significant differences in clinical outcome between complete recanalization (TIMI grade 3) and partial/no recanalization (TIMI grade 0-2) (p < 0.001; OR 5.98; 95% CI 3.27-10.96) and between any recanalization (TIMI grade 1-3) and no recanalization (TIMI grade 0) (p < 0.001; OR 36.15; 95% CI 4.88-267.53).. This nationwide survey showed the efficacy of EVT with IV-tPA in patients with occlusion of the basilar or middle cerebral artery, but not of the internal carotid artery. The effects of new endovascular devices should be clarified in the near future.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Carotid Stenosis; Chi-Square Distribution; Child; Combined Modality Therapy; Endovascular Procedures; Female; Health Care Surveys; Humans; Infarction, Middle Cerebral Artery; Japan; Male; Middle Aged; Odds Ratio; Patient Selection; Retrospective Studies; Risk Assessment; Risk Factors; Stroke; Thrombolytic Therapy; Time Factors; Treatment Outcome; Vertebrobasilar Insufficiency; Young Adult