Objectives To assess the efficacy and safety of dl-3-butylphthalide for patients with acute ischemic stroke. Methods We collected randomized controlled trials, which compared dl-3-butylphthalide agents with placebo or open control in patients with acute ischaemic stroke, by searching the electronic bibliographic databases, scanning references listed in articles and handsearching journals. Meta-analysis was conducted based on the methods recommended by the Cochrane Collaboration. Results Twenty-one trials involving 2 123 patients were included, of which 2 were placebo-controlled and 19 were open-label controlled. Meta-analysis of 10 trials (n=958), in which neurological deficits were assessed by CSS, suggested that there were significant differences favoring butylphthalide in the mean change of neurological deficits’ score during the treatment period [MD=2.30, 95%CI (1.57, 3.03)]. Meta-analysis of 6 trials (n=590), in which neurological deficits were assessed by NIHSS, also favored butylphthalide [MD=2.06, 95%CI (0.65, 3.46)]. Adverse events (AEs) were reported in 13 trials. Gastrointestinal discomfort (1.7%~8%) and abnormal liver function including abnormal ALT (1.4%~17.5%) and abnormal AST (1.9%~8.82%) were the two most common AEs. However, no severe adverse events (SAEs) were reported. Numbers of dead and dependent patients at the end of followup (at least three months) were not reported in the 21 included trials. Quality of life was not assessed in any of the trials. Conclusion Dl-3-butylphthalide can improve the neurological function after acute ischemic stroke and appears to be safe. However, further study is needed to confirm its effects for lowering rates of death and dependency.
Objective To discuss the feasibility of treating the brain ischemic stroke by the co-transplantation of the neural stem cells(NSCs) and the endothelial progenitor cells(EPCs). Methods The original biomedical articles concerned with the treatment of the brain ischemic therapy by the use of the NSCs and the EPCs were extensively reviewed as well as retrieved and analyzed. Results The review revealed that the NSCs and the EPCs could migrate to the injured area due to brain ischemic stroke, the environment of the local microcirculation could induce the neurogenesis and the vasculogenesis to repair the injury, and the neurogenesis and vasculogenesis could promote each other. Conclusion The co-transplantation of the NSCs and the EPCscan represent a new promising strategy formore effectively solving the two difficult problems of the neural cell loss andthe vascular obstruction caused by the brain ischemic stroke.
Objective To investigate the relationship between systemic inflammation response index (SIRI) and early neurological deterioration (END) and 3-month prognosis in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke treated at West China Hospital of Sichuan University and Deyang People’s Hospital between April 2020 and October 2020 were collected. Clinical data were collected using a unified case form and outcomes were followed up for 3 months. According to the poor prognosis, the patients were divided into END group and non-END group. The multivariate logistic regression analysis was used to explore the relationship of SIRI, END and 3-month prognosis. We drew receiver operating characteristic curve to evaluate the value of related factors in predicting the occurrence of END and poor prognosis after 3 months. Results A total of 242 patients were included, of which 47 (19.42%) were in the END group. There were statistically significant differences between the two groups in National Institutes of Health stroke Scale (NIHSS) score on admission, hypertension, creatinine, urea nitrogen, neutrophils count, lymphocyte count, neutrophil count/lymphocyte count ratio (NLR), lymphocyte count/monocyte count ratio, platelet count/lymphocyte count ratio, complications (besides cerebral edema) and SIRI (P<0.05). Logistic regression analysis showed that NIHSS score on admission, hypertension, SIRI and NLR were independent risk factors for END (P<0.05). SIRI had better predictive value for the occurrence of END than NLR (P<0.05). Compared with the non-END group, the patients in the END group had worse prognosis at 3-month [44.7%(21/47) vs. 17.4% (34/195), P<0.05]. NIHSS score on admission had predictive value for clinical prognosis of acute ischemic stroke patients at 3-month. Conclusion SIRI is an independent risk factor for END in patients with acute ischemic stroke, and there is no independent correlation with the 3-month prognosis.
Diabetes mellitus patients have the characteristics of higher morbidity of ischemic stroke, severe symptoms, more recurrent stroke and higher mortality. Current studies have shown that stroke patients with or without diabetes mellitus have different pathophysiological mechanisms during stroke progress. Accordingly, treatment that is beneficial to non-diabetes mellitus patients may not be beneficial to diabetes mellitus stroke patients. This article reviews the current research status of pathophysiological mechanism of diabetes mellitus complicated with ischemic stroke, and provides reference for the relevant research of drug intervention in diabetes mellitus patients complicated with stroke.
Objective To assess the efficacy and safety of human urinary kallidinogenase injection (HUK) in treating patients with acute ischemic stroke. Methods Through adopting Cochrane systematic review methods, the relevant materials were retrieved by electronically and manually searching databases and claimed from pharmaceutical factories, so as to collect the randomized controlled trials (RCTs) about HUK for the patients with acute ischemic stroke, which were searched by the end of October 2010. The quality of each trial was assessed by two reviewers independently, and meta-analysis was conducted by using RevMan 5.0.2 software. Results Twenty-four trials involving 2 433 patients were included, of which 2 were multi-center placebo controlled trials, and the other 22 were all non-placebo trials. Only 2 trials (459 cases) reported the death or dependence at the end of 3-month follow-up. In those trials, HUK reduced death or dependency comparing to the control group (RR=0.69, 95%CI 0.55 to 0.86). Twenty trials (2 117 patients) reported the proportion of patients with marked neurological improvement after finishing the 7 to 21 days treatment. Meta-analysis showed the HUK group had more neurological improvement than the control group, with significant differences (RR=1.56, 95%CI 1.44 to 1.70). Fifteen trials reported adverse events, of which the transient hypotension was commonly seen (1.5%-5.1%). Non-fatal intracerebral hemorrhage was detected in 7 patients in 3 trials, but the difference between the HUK group (6 patients, 1.2%) and the control group (1 patient, 0.4%) was not significant (RR=1.82, 95%CI 0.34 to 9.61). Deaths occurred in both HUK group (2 patients, 0.4%) and the control group (1 patient, 1.1%) in 2 trials, without significant differences (RR=0.6, 95%CI 0.09 to 3.92). No trial assessed quality of life. Conclusion Available evidence suggests that HUK injection reduces neurological impairment after acute ischemic stroke and improves long-term outcomes, though a few patients suffer from transient hypotension. Further high-quality, large-scale RCTs are needed to confirm these results.
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=?0.55, 95%CI ?0.72 to ?0.38, P<0.001) and reduce fibrinogen after treatment (SMD=?0.93, 95%CI ?1.41 to ?0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the reporting quality of randomized controlled trials (RCTs) on acupuncture for acute ischemic stroke. Methods Six databases including The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4, 2005), MEDLINE (1966 to December 2005), EMbase (1984 to December 2005), China National Knowledge Infrastructure (CNKI, 1994 to December 2005), China Biomedicine Database disc (CBMdisc, 1980 to December 2005), VIP (a full text issues database of China, 1989 to December 2005) were searched systematically. Handsearch for further references was conducted. Language was limited to Chinese and English. We identified 74 RCTs that used acupuncture as an intervention and assessed the quality of these reports against the Consolidated Standards for Reporting of Trials (CONSORT) statement and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA).Results In regard to the items in the CONSORT statement, 54 (73%) RCTs described baseline demographic and clinical characteristics in each group. Twenty-six (35%) mentioned the method of generating the random sequence, with 4 (5%) using a computer allocation. Only 6 (8%) RCTs had adequate allocation concealment, with 5 RCTs using sealed opaque envelopes and 1 RCT using centralized computer allocation. Only 8 (11%) RCTs used blinding, including 5 described as double-blind. Four (5%) RCTs reported the sample size calculation and 5 (7%) RCTs reported that an intention-to-treat (ITT) analysis. In regard to the items in STRICTA , only 4 (5%) RCTs reported the numbers of needles inserted. In 35 (47%) RCTs the needle type was reported, but only 26 (35%) mentioned the depths of insertion. Only 1 (1%) RCT mentioned the length of clinical experience and 6 (8%) RCTs reported the background of the acupuncture practitioners, but none stated the duration of their training.Conclusion The reporting quality of RCTs of acupuncture for acute ischemic stroke was low. The CONSORT statement and STRICTA should be used to standardize the reporting of RCTs of acupuncture.
Acute ischemic stroke is the most common type of stroke. Hemorrhagic transformation is one of its serious complications, which may lead to severe neurological deterioration and poor prognosis. The occurrence of hemorrhagic transformation is mainly related to the inflammatory mechanism after infarction, blood-brain barrier injury, ischemia-reperfusion injury and abnormal coagulation function. Identification of early predictors of hemorrhagic transformation can help reduce its incidence and severity. However, the mechanism of hemorrhagic transformation is complex, and there is currently no unified standard for its prediction. This article aims to review the related mechanisms and early predictors of hemorrhagic transformation after stroke, in order to provide a reference for early identification and prevention.
Objective To investigate the current situation of clinical studies on puerarin for ischemic stroke and the reliability of these evidence. Methods By electronic searching and handsearching, we collected all the published clinical study reports on puerarin for ischemic stroke and assessed all the included reports according to clinical epidemiologic standard. Results 35 RCTs, 22 non-randomized controlled trials and 17 case serials studies were included and analysed. Conclusions Current quality of clinical studies of puerarin for ischemic stroke is not good enough to provide reliable evidence.
Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.