Objective To assess systematically the safety and ef fects of stem cell transplantation in stroke patients.Methods CENTRAL (April 2007), MEDLINE (1966 to April 2007), EMBASE (1980 to April 2007), and other databases were searched for RCT of the use of stem cell transplantation for patients with stroke. We critically appraised the quality of included studies according to Juny 2001. We assessed the effects of stem cell therapy on mortal ity, functional outcomes, cognitive functions, image changes, quality of life, and adverse effects by doing meta-analysis with The Cochrane Collaboration’ s Review Manager. Dichotomous outcomes were reported as relative risk and continuous outcome measures as weighted mean differences, with 95% confidence intervals.Results Three RCTs and one historical controlled trial were included involving a total of 69 participants. Only one trial reported the effect on mortality, but because of the small number of death it was not possible to detect any significant differences between stem cell transplantation and routine treatment (RR 0.11, 95%CI 0.01 to 2.31, P = 0.16). Three studies indicated a statistically significant improvement of some functional outcomes in patients treated by stem cell transplantation. Improvements of cognitive function were reported in another trial. One trial showed that the stem cell transplantation significantly improved qual ity of life compared with the control group. Conclusion The current evidence is insufficient to determine whether or not stem cell transplantation is a safe and effective therapy for stroke patients. High-quality, large-scale randomized trials are needed to assess the role of stem cell transplantation for stroke.
ObjectiveTo systematically review the effectiveness of scalp acupuncture for treating ischemic stroke. MethodWe searched databases including PubMed, EMbase, MEDLINE, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to December 30th 2014 for randomized controlled trials (RCTs) on scalp acupuncture in the treatment of ischemic stroke. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 27 studies involving 2 741 patients were included. The results of meta-analysis showed that:a) As for the improvement of nervous functional deficiency, the scalp acupuncture plus drug group was superior to the drug alone group (MD=-5.33, 95%CI -6.71 to -3.96, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (MD=-2.11, 95%CI -3.31 to -0.91, P=0.0006). b) As for the effective rate, the scalp acupuncture group was superior to the body acupuncture group (OR=0.28, 95%CI 0.15 to 0.53, P<0.000 01), the scalp acupuncture plus drug group was superior to the drug alone group (OR=0.20, 95%CI 0.14 to 0.29, P<0.000 01), and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group (OR=0.12, 95% CI 0.02 to 0.56, P=0.008). However, there was no significant difference between the scalp acupuncture group and the drug alone group (OR=0.16, 95%CI 0.03 to 0.97, P=0.05). ConclusionScalp acupuncture appears to be an effective adjuvant therapy method for ischemic stroke, and can significantly improve the nervous functional deficiency when combined with other treatment. However, the strength of evidence is low due to high risk of bias of the included studies. More rigorous studies are needed to verify the above conclusion.
High mobility group box 1 (HMGB1) is widely expressed in mammalian tissues and cells which is involved in various pathophysiological processes such as inflammation, autophagy, and apoptosis, and plays an important role in maintaining cell survival and normal function. HMGB1 plays an important part in the development of stroke, which can affect the prognosis by inducing neuroinflammation and autophagy. HMGB1 may have a bidirectional effect in acute and chronic phases. Exploring the specific role and mechanism of HMGB1 in each stage of stroke may make it a new target for prevention and treatment in the future.
目的 探索缺血性腦卒中患者溶栓前血壓管理和預后的相關性，并分析溶栓前血壓管理考慮顱內外血管狀態的必要性。 方法 計算機檢索PUBMED數據庫，并輔以其他檢索，對所有涉及溶栓前血壓的文獻進行整理，并根據“溶栓類型、是否進行溶栓前血壓管理、是否進行溶栓前血管評估”對文獻進行分類，對其溶栓后的癥狀性顱內出血率進行分析對比。 結果 大多數靜脈溶栓文獻無血管評估的數據，其出血率波動于較高水平；進行了血管評估，而未提及血壓管理或雖未進行血壓管理，但所有患者的血壓符合指南中對于血壓的要求的文獻也呈現了較高的出血率；有1篇進行了血管評估的動脈溶栓文獻沒有癥狀性顱內出血事件發生。 結論 當前證據表明現有的溶栓前血壓管理模式還不夠完善，這也在一定程度上可以解釋目前較高的溶栓后癥狀性出血率。合理的溶栓前血壓管理模式有待進一步探索。溶栓前血壓管理考慮顱內外血管狀態，根據血管病變程度對溶栓前血壓進行分級管理可能會成為一個較佳的血壓管理模式。
Coronary artery bypass grafting (CABG) is the "gold standard" for revascularization of left main diseased and/or complex multi-vessel diseased coronary artery disease. Post-CABG stroke is a relatively rare but catastrophic complication with a serious health and economic burden. In recent years, the further understanding of the concept of "panvascular disease", the implementation of the philosophy of "cardio-cerebral integrated treatment", and the improvement of related diagnostic and therapeutic techniques have provided new options for the recognition, prevention and cure of post-CABG stroke. Focusing on the key factor of carotid-cerebral artery disease, this review systematically scrutinizes the incidence, epidemiology, risk factors, mechanisms and prevention and treatment of post-CABG stroke. This review analyzes the association between post-CABG stroke and carotid-cerebral artery disease, summarizes the status of evidence-based prophylactic carotid-cerebral artery revascularization strategy, and prospects for future research directions.
Objective To investigate the current prevalence of cerebral stroke and hypertension in Ganzi Tibetan state, so as to control stroke and hypertension in future. Methods A representative people sample of Kangding, Dege, Ganzi, Litang and Batang county was selected through randomized cluster sampling. Data of demographic characteristics, hypertension and stroke status were collected by face-to-face interview. Results 5 049 people were included, of which 48.6% were male, and 51.4% were female. The prevalence rate of hypertension and stroke were 23.4% and 1 894/100 000 respectively. The population with hypertension had high prevalence of stroke. The prevalence increased along with the age. Conclusions The prevalence of hypertension and stroke is high in Ganzi Tibetan state. The causes may be ascribed to special geography surroundings and life style. It is very important to pay more attention to prevent and control of hypertension and stroke in this area.
Objectives To assess the efficacy and safety of cytidine diphosphate choline for patients with acute stroke. Methods Such databases as PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, VIP Database and Chinese Medical Association Journals were searched from the establishment to September of 2010, and the references of the included literatures were also searched to collect randomized controlled trials (RCTs) of cytidine diphosphate choline for patients with acute stroke. The data were extracted by two reviewers independently in accordance with the inclusion criteria. The quality of included trials was evaluated according to the Jadad scale standard. RevMan5.0 software was used for data analyses. Results Thirteen RCTs involving 2837 patients were included. The results of meta-analyses showed that, there was no significant difference in the mortality or the rate of dependency at the end of follow-up (OR=0.94, 95%CI 0.66 to 1.36, P=0.75) between the cytidine diphosphate choline group and the placebo group. But the total effective rate of the cytidine diphosphate choline group was higher than that of the placebo group with a significant difference (OR=1.72, 95%CI 1.41 to 2.10, Plt;0.000 01). Five trials reported the incidence of adverse reaction of cytidine diphosphate choline treatment which showed the adverse reaction was mild; no severe adverse events (SAEs) were reported and the clinical application was safe. Conclusion The cytidine diphosphate choline is effective and safe for acute stroke. However, it is invalid to reduce the mortality and the rate of dependency at the end of three months’ follow-up.