Adipose-derived stem cells in stroke treatment: translational possibility and mechanism

Stroke has become one of the secondary worldwide mortal diseases that burdens the family and the society both emotionally and economically. The announcement of China＇s Ministry of Health in 2008 showed that stroke had been the first cause of death in urban and rural residents.1.2 Traditional therapies such as thrombolysis, anti-platelets, and rehabilitation showed limited effects. Replacement therapy with stem cells promises to be a good solution due to its possible thorough therapy for the damaged brain area, reconstruction of neuronal circuitry, and probable long-term efficacy. Previous studies demonstrated that stem ceils have played crucial roles in various kinds of tissue repair and immune disorders such as cardiovascular diseases, skeletal diseases, arthritis diseases, and lupus erythematodes.37 Evidence from lab experiments and clinical trials implies that adipose-derived stem cells （ADSCs） would be a feasible and ideal cell therapy source because of their multi-differentiation potentials, easy collection, low invasion to donor patients, rapid in vitro amplification, reliable biosafety, non-immunogenicity, privileged immune modulation, and escaping from ethical issues.8-12： Data on neurological disease treatment found that ADSCs transplantation protected against acute inflammatory injury, delayed neuron degeneration, and improved neurological behaviors.12-15 Previously, the detailed mechanisms by which transplanted ADSCs induce functional recovery for stroke treatment are far from being clearly demonstrated. Some proposed reasonable mechanisms just stayed at the level of explanation and hypothesis due to the absence of solid experimental evidence.13-14 In this article, we analyzed the previous data to figure out some new paths or ideas which may do favor to future translational clinical studies.     

脑卒中女性患者的盆底结构及盆底肌电特征

目的 探讨脑卒中对女性患者盆底结构和功能的影响。方法 2020年6月至12月,东南大学附属中大医院住院的脑卒中女性患者21例(卒中组)分为尿失禁组(n=6)和非尿失禁组(n=15),另选取同龄健康女性志愿者20例作为对照组。所有受试者行经会阴盆底超声和盆底表面肌电检查。结果 尿失禁组和非尿失禁组平均肌电值、积分肌电值、均方根值、平均功率频率和中位频率均低于对照组(P <0.05),尿失禁组与非尿失禁组间无显著性差异(P> 0.05)。三组间膀胱颈位置,膀胱尿道后角,膀胱颈移动度,尿道旋转角,以及Valsalva动作后肛提肌裂孔前后径、左右径和面积均无显著性差异(F <2.484, P> 0.05)。结论 无论是否存在尿失禁,脑卒中女性患者盆底肌活动均有不同程度下降,盆底支持组织的结构尚未发生明显改变。     

从全球视角看中国脑卒中疾病负担的严峻性

  目的  了解福建省宁德市社区居民脑卒中高危人群筛查结果,为该市居民的脑卒中筛查及防治提供参考依据。  方法  于2015年1月 — 2018年12月采用整群抽样方法在福建省宁德市蕉南社区、漳湾社区、霍童社区和九都社区抽取18 039名 ≥ 40岁常住居民进行问卷调查和体格检查。  结果  宁德市筛查的18 039名社区居民中,检出脑卒中高危人群2 438人,高危人群检出率为13.52 %;男性居民高危人群检出率为16.39 %,高于女性居民高危人群检出率的10.54 %（χ² = 132.05,P < 0.001）;年龄40～49、50～59、60～69、70～79和 ≥ 80岁居民脑卒中高危人群检出率分别为2.76 %、9.38 %、15.18 %、29.41 %和31.81 %,差异有统计学意义（χ² = 1 282.84,P < 0.001）;脑卒中高危人群高危风险因素所占比例从高到低依次为高血压（74.69 %）、缺乏运动（69.77 %）、吸烟（41.35 %）、血脂异常（36.22 %）、糖尿病（28.14 %）、明显超重或肥胖（17.56 %）、脑卒中家族史（9.19 %）、房颤或瓣膜性心脏病（1.31 %）,不同性别和年龄高危人群高危风险因素分布差异均有统计学意义（均P < 0.05）。  结论  福建省宁德市社区居民脑卒中高危人群检出率相对较低,男性和 ≥ 60岁居民脑卒中高危人群检出率较高,高危人群的前3位高危风险因素依次为高血压、缺乏运动和吸烟。     

Progesterone pharmacokinetics in the mouse: implications for potential stroke therapy

Objectives Progesterone has been shown to be neuroprotective in a number of preclinical central nervous system injury models including cerebral ischaemia. The aim of this study was to clarify differences in outcomes owing to different dosing regimens and the pharmacokinetic profile of progesterone, particularly in relation to brain levels. Methods Male C57 Bl/6 mice were injected intraperitoneally with progesterone (8 mg/kg in dimethylsulfoxide) or with a bolus injection followed by continuous subcutaneous infusion (1.0 µl/h of a 50 mg/ml progesterone solution) via implanted osmotic minipumps. Plasma and brain samples were collected over 24 h from bolus‐injected mice and 48 h from mice implanted with minipumps. Progesterone concentrations were measured by an enzyme‐linked immunoassay and pharmacokinetic profiles were constructed. Key findings Intraperitoneally injected progesterone had a short half‐life (fast component half‐life of 0.2 h) in both plasma and brain. Minipump delivery resulted in higher concentrations of progesterone in plasma and particularly in brain over a longer period. The volume of distribution with intraperitoneal injection was 172.78 versus 1641.84 ng/h per g via minipump in the first 24 h. Conclusions A bolus intraperitoneal loading dose of progesterone followed by continuous delivery via osmotic minipump is an effective way of delivering progesterone to the brain.     

Housekeeping Services: Effective Use of Part-Time Personnel

The use of telemedicine, especially as it is relates to telestroke, has significantly expanded over the past one or two decades. The fact that stroke therapy is a time-critical disease process, coupled with the relative paucity of stroke-trained practitioners, makes telestroke an attractive technique of care. The authors’ objective was to summarize the evidence that support the reliability of telemedicine for diagnosis and efficacy in acute stroke treatment in collaboration between hospitals in two different countries.     

Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function

ObjectiveTo compare the discriminatory ability of Rasch-based and summative scoring in the context of assessing upper limb function of patients with stroke.Study Design and SettingData were from a cohort study of 497 adults with stroke undergoing physiotherapy. Upper limb function was assessed at admission and discharge using the upper limb subscale of the Motor Assessment Scale (UL-MAS). Rasch analysis was used to transform raw UL-MAS scores into interval measures. A relative precision (RP) index was used to differentiate patients by discharge destination.ResultsThe analysis confirmed the unidimensional structure of UL-MAS at both admission and discharge and demonstrated the adequate fit of the items. The RP index favored the Rasch-based scoring over the summative scoring in differentiating between the two patient groups, with significant gains in precision at admission (15%) and discharge (11%). When examining patients in the upper or lower quartile of UL-MAS, the gains in precision were statistically significant in favor of the Rasch-based scoring, with 20% precision at admission and 19% precision at discharge.ConclusionRasch-based scoring was more precise in differentiating patient groups by discharge destination than the summative scoring used to measure upper limb function, especially at the extreme range of the scale.     

Occupational Therapy Practice in Hospital-based Stroke Rehabilitation?

Abstract

Background: Occupational therapy after stroke represents a complex intervention. Objective: The aim of this observational study was to document the content of occupational therapy stroke rehabilitation in an Australian general rehabilitation ward. Methods: A behavioural mapping tool recorded 22 occupational therapy sessions at five-minute intervals for nine participants with stroke (mean age 70.6 years, 88.9% female). Results: The mean session length was 41 minutes. The focus of therapy was predominantly at body functions (mean 16.5 minutes) and motor and perceptual impairments were addressed most often. Conclusion: The overall amount of occupational therapy provided was consistent with session lengths reported from effective stroke units and recommended by stroke guidelines. However, the results highlight the difficulties for occupational therapists working within the hospital environment, including practice that was largely restricted to the level of impairment and basic activities of daily living.     

Japan II: Physicians Prosper From Volume, 3rd Party Fees

Abstract

Stroke is one of the most common causes of morbidity and mortality in hospitalized patients in the United States. A proper understanding of stroke mechanisms helps to guide specific case management. The only therapy approved by the US Food and Drug Administration for the management of acute ischemic stroke is initiation of intravenous recombinant tissue plasminogen activator within 3 hours of symptom onset. Other treatment options include intra-arterial recombinant tissue plasminogen activator, mechanical thrombectomy, clot retrieval, or a combination of these approaches. In this article, we provide an evidence-based review of the diagnostic approach for acute ischemic stroke, including recognizing common stroke mimics. We detail the initial medical management of acute stroke and the medical and surgical therapeutic interventions for patients who have sustained acute ischemic stroke.     

Physician-at-large

Readers are invited to submit questions relating to problem cases. Inquiries will be answered by qualified consultants and replies forwarded by mail promptly. Selected problems and solutions are published every month in this section.     

Computer-Based Patient Interviewing

Before the computer can become truly useful in clinical research, diagnosis and therapy, new ways to collect data must be developed. The computer itself can be adapted to take medical histories directly from patients. These data, in computer- processable form, are then available for physician use in patient care and clinical research. Results obtained with computer-based histories are reviewed and the technic is compared with traditional methods. Also discussed is the potential role of computer-based interviewing in modern medical practice.