[inventory] selected articles of stroke in February 2020 (2)
Last Update: 2020-06-19
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< br / > < br / >? < br / >Recently, two RCT trials confirmed the value of clopidogrel aspirin for the recurrence of three strokes after MS and TIA, and did not increase the risk of bleeding, so the AHA / ASO compass made updated recommendations for MS and TIAHowever, the efficacy of clopidogrel varies widely, with lower clopidogrel responders having a higher risk of thrombus < br / > eventsIn the gene subgroup of chance trial, the effect of clopidogrel aspirin on reducing the risk of stroke recurrence depends on the status of CYP2C19 loss of function allele (LOFA), which plays an important role in the antiplatelet function of clopidogrelIn addition to genetic polymorphisms, patient factors, such as age, < br / > diabetes < br / > status, and body mass index (BMI), also affect the efficacy of clopidogrel< br / > < br / > it is worth noting that a recent study has demonstrated the interaction between aspirin dosage and body size in the prevention of < br / > vascular < br / > eventsWhen considering body weight, the single dose of aspirin may not be the best way to takeIn addition, the strategy of adjusting the dosage of antithrombotic drugs according to kg body weight has also been applied in clinic, such as heparin or glycoprotein IIb / IIIa inhibitorTherefore, whether BMI will also affect the efficacy of clopidogrel aspirin in MS or TIA patients, especially the benefit of CYP2C19 LOFA non carriers in clopidogrel groupDespite the above problems, there is still a lack of data on this issue< br / > < br / > Jinglin Mo et alFrom Beijing Tiantan Hospital published their research results on stroke in January 2020, in order to verify whether CYP2C19 genotype stratification and BMI can affect the efficacy of clopidogrel aspirin in MS / TIA patientsThe carriers of CYP2C19 LOFA were defined as LOFA * 2 or * 3Low / normal weight and overweight / obesity were defined as BMI < 25 and > = 25 kg / m2The main outcome was no recurrence in 3 monthsIn 2933 patients, 1726 (58.8%) were LOFA carriers, 1275 (43.5%) were overweight / obese (BMI > = 25 kg / m2)According to the stratified analysis of LOFA carrier and BMI, the HR of stroke recurrence in clopidogrel aspirin treatment was: LOFA carrier with overweight / obesity sub group = 0.90 (0.60 – 1.36), LOFA carrier with low / normal weight sub group = 0.87 (0.56 – 1.35), LOFA non carrier with overweight / obesity sub group = 0.65 (0.39 – 1.09), LOFA non carrier with low / normal weight subgroup = 0.40 (0.22 – 0.71); interaction P = 0.049 < br / > < br / > the authors concluded that clopidogrel aspirin was not found to reduce the risk of stroke recurrence in CYP2C19 LOFA non carriers with overweight / obesity Our study suggests that BMI significantly affects the correlation between CYP2C19 genotype and clopidogrel aspirin efficacy https：// article.do ? Id = 2ca018825fb < br / > Recently, a study published in the journal stroke aims to conduct a meta-analysis of the < br / > cardiovascular < br / > prognosis test (cvot) to evaluate the effect of glucagon like peptide-1 receptor agonist (GLP-1 RA) treatment on reducing the risk of stroke in type 2 < br / > diabetes < br / > patients (T2DM) < br / > < br / > < br / > 7 cvots were included, involving 56? 004 patients Compared with those without glp-1ra, T2DM patients with glp-1ra had a 15% lower risk of non fatal stroke (P = 0.002), a 16% lower risk of total stroke (P = 0.001), and a 19% lower risk of fatal stroke (P = 0.150), but no statistical significance In addition, HbA1c levels or weight loss were not associated with stroke risk < br / > < br / > the researchers believe that the results of this study can provide evidence support for GLP-1 RA to reduce the risk of non fatal stroke in T2DM patients https：// article.do ? Id = ee3a188863cf < br / > The location of thrombus is a very important inclusion criteria because the benefits of EVT for distal occlusion, especially for M2 segment occlusion, are not clear In the current work flow of acute ischemic stroke, two work scenes can detect the location of embolus: 1 The first non-invasive image after the onset of the disease, such as CTA, 2 DSA at EVT < br / > < br / > few studies have explored the dynamics of thrombus, such as the differences in occlusive sites between CTA and DSA Thrombus migration to the distal is defined as the location of thrombus occlusion detected by DSA is farther than that detected by CTA For EVT patients, distal thrombus migration increases the risk of incomplete reperfusion, suggesting that thrombus is easy to break The disappearance of thrombus has been studied carefully, especially after intravenous thrombolysis However, the growth of thrombus has not been studied It is related to the bad collateral, hematostasis and the deterioration of early nervous function, suggesting that the dynamics of thrombus is related to the composition of thrombus However, the relationship between IVT and thrombodynamics is not clear In November 2019, Heitor C Alves et al From the Netherlands published their research results on stroke to explore the relationship between thrombodynamics and IVT and its impact on the prognosis of patients < br / > DSA target occlusion was determined during EVT Thrombus dynamics was classified as growth, stability, migration and disappearance The main prognostic index was 90 day Mrs The secondary end points were successful and complete reperfusion (extended tici 2b-3 and 3, respectively) < br / > < br / > 1349 patients were included in the analysis Thrombus migration accounted for 22%, thrombus growth 6%, thrombus disappearance 3% Intravenous thrombolysis with ateplase was associated with more thrombus migration (adjusted odds ratio, 2.01; CI, 1.29 – 3.11) and thrombus disappearance (adjusted odds ratio, 1.85; CI, 1.22 – 2.80) Thrombus migration was associated with lower adjusted odds ratio (0.57; CI, 0.42 – 0.78) and adjusted odds ratio (0.74; CI, 0.55 – 0.99) In the subgroup with M1 segment initial occlusion, thrombus migration was related to better functional prognosis (adjusted common odds ratio, 1.49; CI, 1.02 – 2.17), and those without thrombus had a good trend of functional prognosis (adjusted common odds ratio, 2.23; CI, 0.93 – 5.37) < br / > < br / > the authors conclude that in patients with acute ischemic stroke, the location of thrombus detected by CTA and DSA often changes Intravenous thrombolysis increases the chances of thrombus migration and disappearance Thrombus migration is related to better functional prognosis, but it will reduce the complete reperfusion rate https：// article.do ? Id = b91f188e743 < br / > Malignant brain edema usually occurs 2-4 days after stroke, which is related to the aggravation of clinical state, such as the decrease of consciousness level Although it accounts for only 2-8% of stroke patients, the incidence of malignant edema in LHI patients is as high as 32% - 50% The dysfunction of ion channel and the destruction of blood-brain barrier cause the change of ion gradient, which will cause excessive water accumulation, which is the possible pathogenesis of malignant edema In other words, excessive water will cause edema and space occupying effect, which will also damage adjacent normal brain tissue < br / > < br / > several methods can measure the occupying effect The most commonly used method is midline shift (MLS) Few studies use imaging technology to directly measure the water content In contrast, it has recently been found that in animal experiments and humans, the quantitative radiation intensity of plain CT can be used as a tool to evaluate the water uptake in ischemic stroke Several recent studies have shown that QRA is a marker associated with ischemic stroke focus, post cardiac arrest and pediatric traumatic brain injury < br / > < br / > preclinical studies have shown that sru1 (sulfonylurea receptor 1) - regulatory ion channels are involved in the formation of ionic and angiogenic edema after stroke By inhibiting SUR1, intravenous infusion of glyburide can prevent the accumulation of water in the brain of stroke animal model and reduce the space occupying effect < br / > < br / > in this study, we explored whether some treatment measures can change the water intake of patients, and whether water intake can be regarded as a potential intermediate end point of brain edema research We compared the net water uptake (NWU) between the placebo group and the intravenous infusion group by serial CT scans The purpose of this study is to explore the mechanism of intravenous infusion of glyburide through the imaging markers of brain edema We first discussed and defined the time course and dynamics of water uptake and occupying effect, and determined whether the initial water uptake value could predict the subsequent malignant edema Finally, we discussed whether intravenous infusion of glyburide could change the track of brain edema formation over time We hypothesized that the formation of brain edema would start to gather and enter the plateau stage, and the inhibition of SUR1 would reduce the formation of brain edema < br / > < br / > this is a post exploratory analysis of gamres-rp test Plain CT analysis was performed on the day of administration and on the 7th day (n = 264) of the modified ITT samples from the games-rp test Quantitative changes of CT radiation intensity (i.e NWU) and midline shift (MLS) were measured NWU of gray white matter was also verified Repeated measures mixed effects models were used to evaluate the effect of intravenous infusion of glyburide on MLS and NWU < br / > In the repeat measure regression model, more significant NWU was associated with increased MLS (β = 0.23; 95% CI, 0.20 – 0.26; P < 0.001) Intravenous infusion of glibenclamide and NWU decreased (β =? 2.80； 95% CI, ？ 5.07 to ？ 0.53; P = 0.016) and MLS reduction (β =? 1.50； 95% CI, ？ 2.71 to ？ 0.28; P = 0.016) Intravenous infusion of glyburide can reduce the intake of gray white matter water In the intermediate analysis, the effect of NWU (β = 0.15; 95% CI, 0.11-0.20; P < 0.001) on MLS was higher than that of NWU < br / > < br / > in this two-stage post-mortem analysis, intravenous infusion of glyburide can reduce the water accumulation and occupying effect after large-scale hemispheric infarction This study shows that NWU is a quantitative and variable marker of ischemic brain edema accumulation https：// article.do ? Id = 4227188e86a < br / >
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