Stem cells for brain repair and recovery after stroke

Introduction: Stroke is a major worldwide cause of death and disability. Currently, intravenous thrombolysis and reperfusion therapies, but not the so-called neuroprotectant drugs, have been shown to be effective for acute ischemic stroke. Thus, new strategies to promote brain plasticity are necessary. Stem cell administration is an attractive future therapeutic approach.

Areas covered: Brain protection and repair mechanisms are activated after stroke. This article is focused on the capacity of stem cell-based therapy to enhance this postinfarct brain plasticity and recovery. Future therapeutic considerations and prospects for stroke are discussed.

Expert opinion: Although cell therapy is promising in stroke treatment, mechanisms of action need to be characterized in detail. Further, the different mechanisms of axonal plasticity and remodeling involucrated in brain repair, not only in the gray but also in white matter, must be investigated through noninvasive techniques, and a multidisciplinary approach is fundamental in this.     

缺血性卒中的抗凝治疗

几个大规模、多中心、随机试验发现,天然肝素(UFH)或低分子肝素(LMWH)并不能改善急性缺血性卒中患者的总体预后。紧急抗凝可预防长期卧床急性缺血性卒中患者深静脉血栓的形成。伴房颤及附加危险因素,如附壁血栓和(或)新发心肌梗死的心源性栓塞性卒中患者具有较高复发性卒中危险,若无显著出血可紧急抗凝。华法令抗凝可作为伴心房纤颤卒中患者的初级和二级预防。颅内静脉窦栓塞形成、颈动脉夹层和抗磷脂抗体综合征患者可常规抗凝,而非心源性栓塞性卒中或症状性颅内动脉狭窄综合征患者长期抗凝治疗证据不足。     

Acute ischemic stroke therapy: current status and future directions

Evaulation of: Selker HP, Beshansky JR, Sheehan PR et al. Out-of-hospital administration of intravenous glucose–insulin–potassium in patients with suspected acute coronary syndromes: the IMMEDIATE randomized controlled trial. JAMA 9(307), 1925–1933 (2012).

Catecholamine release in conjunction with an acute coronary syndrome induces metabolic changes that impair the situation for the ischemic myocardium. Attempts have been made to improve the prognosis in patients with acute coronary syndrome by means of infusing glucose–insulin–potassium in order to improve glucose metabolism and decrease beta-oxidation of free fatty acids. A trial, IMMEDIATE, tested this concept in a new way by initiating glucose–insulin–potassium during transportation to hospital, is discussed in this article.     

高压氧治疗急性缺血性脑卒中的剂量优化

目的:探讨高压氧疗法(HBOT)治疗急性缺血性脑卒中(AIS)的最佳治疗剂量.方法:在PUBMED数据库、EMBASE医药学数据库、MEDLINE、中国知网全文数据库(CNKI)搜索已发表的高压氧疗法治疗AIS的相关文献,根据纳入和排除标准收集文献.所提取的数据包括高压氧舱内氧分压(pO2,ATA)、每次HBOT时总吸氧时间(Ts)、总治疗次数(Nt)、治疗有效率.HBOT的总治疗剂量(DHBOY)按下列公式计算:DHBoT=pO2×Ts×Nt.当治疗有效率达到最高时,所对应的DHBOY为最佳治疗剂量.用线性回归的方法探索DHBOY与治疗有效率的关系.结果:根据纳入和排除标准,共收集19篇文献,共涉及700例患者,根据公式计算得出DHBOY与治疗有效率呈正相关关系,当平均DHBOT处于30-32治疗剂量单位(UMD)时,治疗有效,最高可达100％;当DHBOT＜13.5UMD,疗效甚微.结论:本研究显示,治疗AIS时DHBOY与治疗有效率呈正相关关系;当DHBOY处于30-32UMD时,治疗有效.     

Intra-arterial administration of cell-based biological agents for ischemic stroke therapy

Introduction: Ischemic stroke is becoming a primary cause of disability and death worldwide. To date, therapeutic options remain limited focusing on mechanical thrombolysis or administration of thrombolytic agents. However, these therapies do not promote neuroprotection and neuro-restoration of the ischemic area of the brain.

Areas covered: This review highlights the option of minimal invasive, intra-arterial, administration of biological agents for stroke therapy. The authors provide an update of all available studies, discuss issues that influence outcomes and describe future perspectives which aim to improve clinical outcomes. New therapeutic options based on cellular and molecular interactions following an ischemic brain event, will be highlighted.

Expert opinion: Intra-arterial administration of biological agents during trans-catheter thrombolysis or thrombectomy could limit neuronal cell death and facilitate regeneration or neurogenesis following ischemic brain injury. Despite the initial progress, further meticulous studies are needed in order to establish the clinical use of stem cell-induced neuroprotection and neuroregeneration.     

Successful recanalization with multimodality endovascular interventional therapy in acute ischemic stroke

Stroke is an important cause of death and disability in adults. However, effective treatments for patients with acute ischemic stroke are limited. Intravenous recombinant tissue plasminogen activator (iv rtPA) within 4.5 h after onset has been approved as a standard treatment for patients with acute ischemic stroke. However, due to time constraints, less than one percent of acute ischemic stroke patients in Thailand are able to obtain iv rtPA. Although endovascular interventional therapy has not yet been approved as standard treatment in acute ischemic stroke, it is the one of the potentially effective treatment options. There are several reliable methods of endovascular therapy for acute ischemic stroke patients. Endovascular interventional therapy has rarely been done in Thailand. We report seven patients with successful recanalization after endovascular treatment in acute large vessel stroke from a single stroke center in Thailand. Patient screening and selection with multimodal imaging protocol and multimodality methods of endovascular interventional therapy are described.     

脑卒中后遗症的针灸疗法

该文对脑卒中后遗症半身不遂、语言不利、口角歪斜、排尿排便异常、神志异常的表现及病机进行简单论述,着重介绍了上述后遗症的针灸治疗。     

MRI参数优化对缺血性脑卒中患者溶栓治疗的指导意义

目的 探析急性缺血性脑卒中(acute ischemic stroke,AIS)溶栓治疗中参数优化MRI的应用有效性和临床指导意义.材料与方法 采取回顾性对照研究法,选取2018年3月至2020年3月河西学院附属张掖人民医院神经内科接治的112例AIS患者作为研究对象,其中2018年3月至2019年2月接治的54例患者...     

Risk of hormone replacement therapy in stroke patients

Hormone replacement therapy (HRT) (oestrogen with or without progestin) is often initiated with the onset of menopause to decrease symptoms of oestrogen deficiency, such as vasomotor instability (hot flashes) and urogenital effects ( 1 2 3 ). HRT can also prevent long‐term consequences of oestrogen deficiency, such as osteoporosis and cardiovascular disease ( 1 2 3 ). The decision to start HRT in peri‐ and postmenopausal women is complicated by concerns of increased risk for thromboembolic events, uterine cancer and breast cancer ( 2 3 4 ). Thromboembolic stroke is a particular concern due to its association with the use of oral contraceptives with high oestrogen content ( 3 , 4 ). However, for older women it has been suggested that HRT use decreases or has no effect on stroke risk ( 5 6 7 8 9 ). Should these findings apply to a women with a history of thromboembolism, in this case ischemic stroke?     

Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke

BackgroundDefining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache.MethodsThis prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache.ResultsOur previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%.ConclusionsWe suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.     

Elderly patients and intra-arterial stroke therapy

Ischemic stroke disproportionately affects the elderly, particularly those over the age of 80 years. Rates of stroke are expected to increase over the next several decades due to increasing numbers of elderly individuals, making understanding stroke treatment in this population an imperative. The only proven acute stroke therapy is early reperfusion, accomplished through intravenous or intra-arterial means. Intra-arterial stroke therapy (IAT) offers higher recanalization rates than intravenous tissue plasminogen activator, but has yet to show clear superiority over intravenous tissue plasminogen activator alone. Existing data suggest that elderly stroke patients suffer worse outcomes following IAT, despite similar rates of recanalization and symptomatic intracranial hemorrhage. This article reviews the application of IAT in the elderly population and summarizes the available studies that investigate the response of elderly patients to IAT.     

高强度旋律语调疗法对脑卒中后非流畅性失语的影响

目的:探讨高强度旋律语调疗法对脑卒中后非流畅性失语患者语言功能及日常交流能力的影响。方法:选取2019年6月～2021年12月在徐州医科大学附属医院康复医学科住院的脑卒中非流畅性失语患者40例,按随机数字表法随机分为观察组和对照组,每组各20例。给予对照组常规言语治疗,观察组采用高强度旋律语调疗法治疗。治疗前后分别使用西方失语症成套测验(WAB)的前四项自发言语、听理解、复述和命名评价语言功能,日常生活交流活动检查(CADL)评价日常交流能力。结果:治疗前,2组患者在WAB评定自发言语、听理解、复述和命名等各项评分及CADL评分比较均差异无统计学意义;治疗4周后,2组患者WAB评定各项评分均较治疗前明显提高(均P<0.05),且观察组各项评分均高于对照组(均P<0.05)。结论:高强度旋律语调疗法对脑卒中后非流畅性失语患者语言功能及日常交流能力的提高效果显著。     

脑卒中后偏瘫患者肢体痉挛的家庭康复治疗

目的：观察脑卒中偏瘫患者肢体痉挛的家庭康复治疗的疗效。方法：将脑卒中偏瘫痉挛患者107例随机分为对照组53例及观察组54例。2组患者均给予常规抗痉挛药物治疗,观察组患者在常规药物治疗的基础上,在医师的定期指导下,由家属和患者自己进行综合的抗痉挛康复训练。2组患者均于入组前、入组后1个月、3个月、6个月分别采用改良Ashworth评定、简化Fugl Meyer运动功能评分及改良Barthel指数(MBI)进行评定。结果：入组1个月后,2组患者的Ashworth痉挛量表分级、FMA评分、MBI评分比较,差异均无统计学意义。入组后3个月和6个月,2组患者的Ashworth痉挛量表分级、FMA评分、MBI评分比较,差异有统计学意义(P<0.01)。结论：在康复医师或治疗师的指导下,患者在服用抗痉挛药物的同时坚持抗痉挛康复训练是切实有效的,能更好地改善患者的肢体运动功能和日常生活活动能力。     

Therapeutic hypothermia for acute ischemic stroke

Intravenous recombinant tissue plasminogen activator remains the only US FDA-approved treatment for acute ischemic stroke. However, the very limited time window for its administration restricts its usefulness. Furthermore, it is becoming increasingly clear that, given the numerous pathways via which cerebral ischemia causes cell death, the capacity to inhibit multiple mechanisms simultaneously may provide additive or synergistic beneficial clinical effects for stroke patients. Although no clinical trials have yet investigated the efficacy of therapeutic hypothermia in focal cerebral ischemia, its pleiotropic neuroprotective actions, positive results in preclinical studies, as well as proven enhancement of neurologic outcomes in survivors of cardiac arrest and newborns with hypoxic-ischemic encephalopathy, make this neuroprotective strategy highly promising. This review presents an overview of the potential role of hypothermia in the treatment of acute ischemic stroke and discusses ischemic cell death pathophysiology, neuroprotective mechanisms of hypothermia, methodologies employed for the induction of hypothermia, results from animal models of cerebral ischemia, and finally, currently available clinical trial data. Two valuable lessons learned thus far are that first, rapid induction of hypothermia is key and is best accomplished with a combination of ice-cold saline infusion and the use of endovascular cooling devices, and second, that shivering can be overcome with aggressive anti-shivering protocols including meperidine, buspirone and surface warming. We await the results of clinical trials to determine the utility of therapeutic hypothermia in acute ischemic stroke. If proven efficacious, hypothermia would be a welcome complement to established reperfusion therapies for ischemic stroke patients.     

综合康复治疗对缺血性脑卒中患者的疗效分析

Ischemicstrokeiscommonamongelders，whichseriouslyen－dangerspatients＇qualityoflifeandincreaseloadoffamilyandsoci－ety．Wetreated３０subjectsofischemicstrokethroughcomprehensiverehabilitationtherapy．Theeffectswassatisfying．Hereisthereport．１Subjectandmethod１．１Subject３０patientsofischemicstrokewererecruitedfrom１９９８～２０００．AllpatientswerediagnosedusingCTorMRIexamina－tionandaccordingtodiagnosticstandardsforcerebrovasculardiseaseissuedin４thnationalcerebrovasculardiseasemeeting…     

Biological therapy for non-obstructive azoospermia

Introduction: Most male patients with non-obstructive azoospermia (NOA) have no therapeutic options outside of assisted reproductive techniques to conceive a biological child. If mature sperm cannot be obtained from the testes, these patients must rely on options of donor sperm or adoption. Several techniques are in the experimental stage to provide this patient population alternatives for conceiving.

Areas covered: This review discusses three of the experimental techniques for restoring fertility in men with NOA: spermatogonial stem cell transplantation, the use of adult and embryonic stem cells to develop mature gametes and gene therapy. After this discussion, the authors give their expert opinion and provide the reader with their perspectives for the future.

Expert opinion: Several limitations, both technical and ethical, exist for spermatogonial stem cell transplantation, the use of stem cells and gene therapy. Well-defined reproducible protocols are necessary. Furthermore, several technical barriers exist for all protocols. And while success has been achieved in animal models, future research is still required in human models.     

音乐疗法对脑卒中所致单侧空间忽略的疗效观察

目的:观察应用音乐疗法对脑卒中单侧空间忽略患者的临床疗效。方法:将发病3个月内的54例脑卒中后偏侧忽略患者随机观察组和对照组,各27例。2组患者均接受常规康复治疗及宣教,观察组在此基础上予以音乐疗法干预,共8周。治疗前后采用凯瑟琳-波哥量表检查(CBS)、上肢简易Fugl-Meyer评分(FMA)和改良Barthel指数(MBI)评估2组患者单侧忽略的程度、上肢运动控制情况及日常生活活动能力的变化。结果:治疗8周后,2组CBS评分均较治疗前明显降低(均P0.05),观察组更低于对照组(P0.05);2组FMA及MBI评分较治疗前明显提高(均P0.05),观察组更高于对照组(P0.05)。结论:音乐疗法可在卒中后发病初期有效改善单侧空间忽略患者单侧忽略的程度,提高患者的上肢运动功能和日常生活活动能力。     

强制性运动疗法对国内脑卒中患者下肢运动功能影响的Meta分析

目的：系统评价强制性运动疗法（CIMT）对国内脑卒中患者下肢运动功能康复的效果.方法：计算机检索中国生物医学期刊数据库、万方数据库、中文科技期刊全文数据库、中文科技期刊全文数据库、维普数据库等,辅以手工检索相关期刊,纳入CIMT治疗脑卒中患者下肢运动功能障碍的随机对照试验,进行资料提取和质量评价,采用RevMan5.0软件进行Meta分析.结果：共有9项临床研究入选,517个病例.挑选使用频率较高的Berg平衡量表（BBS）、改良Barthel指数（MBI）、Fugl Meyer运动功能（FMA）评分法、10m最大步行速度（MWS）4种效应指标进行分析.Meta分析结果显示,与常规康复训练相比,CIMT治疗使BBS、MBI、FMA、MWS各项评分更高.结论：CIMT在一定程度上较常规康复疗法更有效地提高国内脑卒中患者下肢运动功能.     

社区康复治疗脑卒中偏瘫

目的:探讨社区康复治疗对脑卒中偏瘫患者的重要性。方法 :采用以康复医师指导下的家庭康复训练为主的综合治疗方法 ,对17例脑卒中患者进行社区康复治疗 ,另20例同种疾病患者作为对照组 ,以Barthel指数及FMA积分法进行治疗前后的功能评定。结果 :康复组在治疗后肢体运动功能及日常生活活动能力均明显改善 ,与对照组相比 ,差异有显著性(P<0.01)。结论 :脑卒中导致偏瘫的患者在缺乏住院治疗的条件下 ,应积极接受社区康复治疗