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1.
Acute reperfusion therapy and stroke care in Asia after successful endovascular trials.
Toyoda, K, Koga, M, Hayakawa, M, Yamagami, H
Stroke. 2015;(6):1474-81
Abstract
The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute stroke care, such as the dosage of alteplase for thrombolysis and consideration of bleeding complications during antithrombotic therapy. Acute endovascular thrombectomy, as well as intravenous thrombolysis, is relatively prevalent in East Asia, but most of the other Asian countries need to develop their human resources and fundamental medical infrastructure for stroke care. A limitation of endovascular therapy in East Asia is the high prevalence of intracranial atherosclerosis that can cause recanalization failure and require additional angioplasty or permanent stent insertion although intracranial stenting is not an established strategy. Multinational collaboration on stroke research among Asian countries is infrequent. Asians should collaborate to perform their own thrombolytic and endovascular trials and seek the optimal strategy for stroke care specific to Asia.
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2.
A comparison of rt-PA thrombolysis guidelines between China and the USA: are changes needed?
Xu, J, Zhang, Y, Wei, H, Xu, Y, Wang, M, Cai, Z, Li, X
Neurological research. 2015;(1):57-63
Abstract
BACKGROUND AND PURPOSE Thrombolytic treatment criteria vary significantly between China and the USA. We reviewed current intravenous (IV) thrombolytic therapy practices in China and the USA to determine the most appropriate. METHODS We conducted a systematic review of studies that used IV recombinant tissue plasminogen activator (rt-PA) therapy in China and the USA published between January 1950 and April 2012. RESULTS Literature search identified 17 American and 9 Chinese studies with a total of 2545 subjects. We found a significantly lower mortality rate in the US data compared with China (8% versus 13%; Chi-square = 24.412, P < 0.001). Our meta-regression analysis uncovered significant factors influencing mortality including male sex, hypertension, high cholesterol, smoking, and onset to treatment time (all P < 0.05). There were significantly more favorable outcomes in China than in the USA (61% versus 49%, Chi-square = 19.159, P < 0.001). No prior history of stroke and shorter onset to IV time were also significantly associated with a favorable outcome (P < 0.05). CONCLUSIONS Onset to IV time is critical for reducing mortality and improving favorable outcomes. We suggest Chinese acute ischemic stroke treatment guidelines be revised to include an increase in the age limit of 80 years, removing contraindications such as a history of previous sever heart, liver, and kidney dysfunction, and placing more emphasis on physician expertise.
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3.
Treatment of neonatal fungal infective endocarditis with recombinant tissue plasminogen: activator in a low birth weight infant case report and review of the literature.
Babayigit, A, Cebeci, B, Buyukkale, G, Semerci, SY, Bornaun, H, Oztarhan, K, Gokce, M, Cetinkaya, M
Mycoses. 2015;(10):578-81
Abstract
With advances in medical sciences, an increase in survival rates of low birth weight; increased incidence in use of catheter and antibiotics, and total parenteral nutrition are reported, therefore, the rate of fungal infections in late and very late onset neonatal sepsis have increased. Although fungal endocarditis rarely occur in newborns, it has a high morbidity and mortality. Antifungal therapy is often insufficient in cases who develop fungal endocarditis and surgical treatment is not preferred due to its difficulty and high mortality. Herein, fungal endocarditis in a preterm newborn treated with single-dose recombinant tissue plasminogen activator in addition to antifungal therapy is presented and relevant literature has been reviewed. The vegetation completely disappeared following treatment and no complication was observed.
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4.
Acute calcific band keratopathy: case report and literature review.
Moisseiev, E, Gal, A, Addadi, L, Caspi, D, Shemesh, G, Michaeli, A
Journal of cataract and refractive surgery. 2013;(2):292-4
Abstract
UNLABELLED An 86-year-old patient developed a significant intraocular inflammatory reaction after having phacoemulsification. Topical therapy did not eliminate the inflammation, and tissue plasminogen activator (tPA) was injected into the anterior chamber. A white corneal plaque appeared in the previously clear cornea within days of the injection. The lesion was diagnosed as calcific band keratopathy and successfully treated with ethylenediaminetetraacetic acid chelation. Electron microscopy and elemental analysis of a corneal scraping from the lesion established its composition to be mainly calcium and phosphate, validating the diagnosis. This is the seventh reported case of rapid formation of calcific band keratopathy after tPA injection. The pathogenesis of this rare complication involves multiple factors, including alkalinization of the intraocular pH, increased phosphate concentration, and endothelial dysfunction. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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5.
Blood pressure reduction and tissue-type plasminogen activator release.
Brown, NJ
Hypertension (Dallas, Tex. : 1979). 2006;(4):648-9
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6.
Novel therapies for acute ischemic stroke.
Leker, RR, Eichel, R, Rafaeli, G, Ben-Hur, T
The Israel Medical Association journal : IMAJ. 2006;(11):788-92
Abstract
Acute ischemic stroke is one of the leading causes of mortality and chronic disability in the western world. Yet, despite the enormous socioeconomic burden that it imposes, therapies to combat AIS are not widely available. Moreover, revascularization of the ischemic tissue with tissue plasminogen activator, the only FDA-approved therapy for AIS, is hampered by a very narrow therapeutic time window and is only used in a minority of patients. Cerebral ischemia leads to brain damage caused by several pathologic mechanisms that can potentially be blocked by neuroprotective drugs that aim to salvage the ischemic penumbra. However, despite numerous clinical trials, no single drug candidate has proved efficacious in AIS. The current situation calls for novel therapeutic strategies to be used in acute ischemic stroke. This review surveys some of these novel and promising cutting edge therapies.
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7.
[Neurological complication due to the drug and the maneuver for the treatment and prevention of cerebrovascular diseases: iatrogenic neurology].
Takagi, S
Rinsho shinkeigaku = Clinical neurology. 2003;(11):877-9
Abstract
Neurological sequela which occur with the medication and procedure to treat or prevent cerebrovascular diseases are reviewed. The report by the NINDS upon the recombinant tissue plasminogen activator (rt-PA) for cerebral infarction showed overall improved prognosis and increased number of cerebral hemorrhage from 1 to 9. Individual approach rather than statistical analysis should be applied to the adverse effect of the treatment. The rhabdomyolysis by statin, the HMG-CoA reductase inhibitor, is well known. The frequency of elevation in serum creatine kinase activity increases from water-soluble statin to lipid-soluble statin and to statin of longer half-life and with entero-hepatic recirculation. All of the interventional procedure such as embolization, stent, intravascular thrombolysis, endarterectomy and EC-IC bypass are possibly complicated by bleeding, arterial occlusion, distal embolism and so on. Guidelines are also a possible source of iatrogenic diseases. For example, 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension recommend at least 3 months of non-pharmacological treatment before starting the anti-hypertensive medications. The possibility to develop stroke within 3 months after the initial examination, however, is not zero. This is what can be called as guideline-induced neurological disease, of which practical physician should be reminded.
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8.
Management of acute stroke.
Zweifler, RM
Southern medical journal. 2003;(4):380-5
Abstract
Stroke ranks as the third leading cause of death and the most common cause of permanent disability in adults. Timely recognition and treatment is imperative to reduce stroke-related morbidity and mortality. Patients with acute ischemic stroke should be evaluated for administration of intravenous tissue plasminogen activator (t-PA); those who do not qualify for t-PA should receive aspirin therapy in the absence of a contraindication. In all stroke patients, intravenous hydration with normal saline should be administered, hypoxia should be corrected with supplemental oxygen, and hyperglycemia and fever should be treated aggressively. Blood pressure management should be individualized on the basis of stroke pathophysiology and specific treatment plan (e.g., planned thrombolysis) following published guidelines. Evaluation of stroke etiology should be undertaken, and the results should be used to guide secondary stroke prevention efforts.
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9.
Evaluation and management of acute ischemic stroke.
Bendixen, BH, Ocava, L
Current cardiology reports. 2002;(2):149-57
Abstract
Stroke continues to be a major cause of adult mortality and disability. After numerous clinical trials and hundreds of millions of dollars spent on research, only two drugs are effective in treating patients with acute stroke. Recombinant tissue-plasminogen activator improves the chance of an excellent outcome in treated patients by 30%. Danaparoid sodium improves the chance of a very favorable outcome in treated patients with stroke due to large artery atherosclerosis. Although acute treatments are limited, our understanding of stroke pathogenesis and the importance of preventing poststroke complications has improved patient outcome significantly.
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10.
Creating a Canadian stroke system.
Wilson, E, Taylor, G, Phillips, S, Stewart, PJ, Dickinson, G, Ramsden, VR, Teasell, RW, Mayo, N, Tu, J, Elson, S, et al
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2001;(13):1853-5