RESUMEN

Background: Post-stroke depression (PSD) is a common psychiatric complication of mental disorders after stroke. Acupuncture for PSD is effective and has few adverse effects. As a classical complementary and alternative therapy, acupuncture is often used in combination with antidepressants for PSD. However, there is a wide variety of acupuncture therapies, and the efficacy of different acupuncture varies. In this study, a network meta-analysis (NMA) was used to assess the clinical efficacy of different acupuncture combined with antidepressants for the treatment of PSD. Methods: A comprehensive search of PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, CBM, VIP, and Wan-Fang databases for published randomized controlled trials of acupuncture combined with antidepressants for the treatment of PSD was conducted. The time frame for the literature search was from the date of database creation to April 30, 2022. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to evaluate the bias risk of the included studies. Data analysis was performed by STATA 14.0 software. Results: A total of 38 literatures with 2,898 patients involving nine acupuncture therapies were included. NMA results were as follows: moxibustion plus antidepressants had the best efficacy in terms of improving total effective rate. Conventional acupuncture plus antidepressants was the most effective in improving HAMD scores. In terms of improving SDS scores, acupressure plus antidepressants was the most effective. In terms of improving NIHSS scores, moxibustion plus antidepressants showed the best results. Conclusion: A comparison of the efficacy indicators of the nine different acupuncture therapies combined showed that moxibustion plus antidepressants, conventional acupuncture plus antidepressants and acupressure plus antidepressants were superior in the treatment of PSD. Based on the shortcomings of the existing studies, this conclusion needs to be validated by additional high-quality randomized controlled trials.

RESUMEN

Background and Purpose: Robust venous outflow (VO) reflects favourable tissue reperfusion in acute ischaemic stroke (AIS) patients with large vessel occlusion (LVO). We aimed to investigate the association of the venous outflow profile on computed tomographic perfusion (CTP) and futile recanalization in anterior circulation AIS patients with LVO after thrombectomy. Methods: This was a retrospective study of consecutive AIS patients due to anterior circulation LVO who underwent CTP before thrombectomy. Patients who achieved successful recanalization defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3 after thrombectomy were included. Based on the venous time-intensity curve of CTP, the peak time of venous outflow (PTV), total venous outflow time (TVT), and difference value of arteriovenous peak time (D-value) were recorded. A modified mRS score of 3-6 at 3 months was regarded as futile recanalization (FR). Logistic regression analysis was applied to assess risk factors for FR. We used receiver operating characteristic curves (ROCs) to evaluate the predictive value of venous outflow time parameters based on VO for FR. Results: Eighty patients were included; 35 (43.8%) achieved good functional outcomes, and 45 (56.3%) had unfavourable functional outcomes, that is, FR. Adjusting confounding factors, binary stepwise logistic regression analysis showed that delayed PTV was independently associated with FR (odds ratio, 1.374 [95% CI, 1.093-1.726], P = 0.007). ROCs indicated that PTV effectively predicted unfavourable outcomes at 3 months (area under the curve (AUC) = 0.729, p< 0.001). The combined model was a powerful predictor of FR with an AUC of 0.824 and a cut-off value of 0.631 (p< 0.001). Conclusion: Delayed PTV is independently related to FR in anterior circulation AIS patients with LVO achieving successful recanalization after thrombectomy. Our results highlight that the time of VO may be a potential marker for FR.

RESUMEN

BACKGROUND: A previous study reported that cystatin C was related to acute ischemic stroke. The association between cystatin C and the clinical outcome in acute ischaemic stroke patients with successful recanalization after endovascular thrombectomy has rarely been reported. This study aimed to evaluate the association between cystatin C and futile recanalization in AIS patients who underwent endovascular thrombectomy. METHODS: We carried out a retrospective study of acute ischaemic stroke patients with anterior circulation proximal arterial occlusion who achieved complete arterial recanalization after mechanical thrombectomy from May 2017 to April 2020. The patients with complete recanalization were divided into a useful recanalization group and a futile recanalization group according to their 3-month modified Rankin scale score. FR was defined as a modified mRS score of 3-6 at 3 months. Logistic regression analysis was used to identify the risk factors for FR. Receiver operating characteristic curves were used to assess the predictive value of cystatin C for FR. RESULTS: Of 241 patients, 125 underwent futile recanalization and 116 underwent useful recanalization. Baseline serum cystatin C levels were higher in the futile recanalization group than in the useful recanalization group. After adjustment for potential confounding factors, multivariable adjusted regression models showed that cystatin C was an independent predictor of futile recanalization (odds ratio, 4.111 [95% CI 1.427-11.840], P = 0.009). Receiver operator characteristic (ROC) curve analysis indicated that the model combining cystatin C with other factors model effectively predicted unfavourable outcomes at 3 months (area under the curve = 0.782, p < 0.01). CONCLUSIONS: A higher level of cystatin C is associated with unfavourable outcomes at 3 months in anterior circulation acute ischaemic stroke patients with endovascular thrombectomy.

Asunto(s)

RESUMEN

The reduced density of cardiac autonomic nerves plays an important role in malignant arrhythmia after myocardial infarction (MI). Previous studies have shown that there is an interaction between the brain and the heart, and fastigial nucleus electrostimulation (FNS) promotes central nerve regeneration. Whether and how it can promote cardiac nerve regeneration after MI and the underlying mechanisms remain unknown. This study investigated whether FNS promotes cardiac nerve regeneration and reduces malignant arrhythmia inducibility in a post-infarction rat model. Ninety-eight Wistar rats were randomly assigned to Sham control, MI (left anterior descending coronary artery ligation without FNS), FNS (MI plus FNS), and FNL (fastigial nucleus lesion plus FNS plus MI) groups. The frequency of malignant arrhythmia was significantly lower in the FNS group than in the MI and FNL groups. The density of cardiac autonomic nerves was less in the MI group than in the Sham group, which was promoted by FNS. The nerve growth factor (NGF) mRNA expression was downregulated in the MI group compared to the Sham group, which was significantly enhanced by FNS. The expression levels of norepinephrine (NE) and acetylcholine (ACh) were higher and lower respectively in the MI and FNL groups than in the Sham group. After FNS, NE concentration was reduced and Ach level was elevated compared to the MI group. These data suggested that FNS promoted the regeneration of cardiac autonomic nerves and reduced the incidence of malignant arrhythmias in MI rat model. The mechanisms might involve up-regulation of NGF mRNA expression, decrease of NE release and increase of ACh release.

Asunto(s)

RESUMEN

BACKGROUND AND AIMS: The metabolic syndrome (MetS) is believed to contribute to a higher probability of developing cardiovascular diseases. This study aimed to investigate whether MetS could predict the prognosis in ischemic stroke patients after endovascular thrombectomy (EVT). METHODS: Between January 2016 and September 2019, patients treated with EVT due to large vessel occlusions in anterior circulation were prospectively recruited. MetS was defined using the International Diabetes Federation criteria after admission. The primary outcome was a 3-month poor outcome (modified Rankin scale score of 3-6). Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 3 months. Multivariable logistic regression models were used to assess the relationship between MetS and clinical outcomes. RESULTS: A total of 248 patients were enrolled (mean age, 66.7 years; 37.5% female) and 114 (46.0%) met with the MetS criteria. The median National Institutes of Health Stroke Scale score was 15.0. There were 131 (52.8%) patients achieving the poor outcome at 3 months, among which 26 (10.5%) patients developed sICH. The mortality at 3 months was 19.0% (47/248). In multivariable analysis, MetS was significantly correlated to poor outcome (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.29-4.78, P = 0.014). The risk for poor outcome was positively associated with the increased number of MetS components (OR 1.78; 95% CI 1.39-2.35, P = 0.001). No significant findings were found in the association of MetS with sICH and mortality. CONCLUSION: Our data demonstrated that MetS was associated with poor prognosis in acute ischemic patients treated with EVT.