A new idea about reducing reperfusion injury in ischemic stroke: Gradual reperfusion

Shi, Jingfei; Liu, Yu; Duan, Yunyun; Sun, Zhanfang; Wang, Bincheng; Wang, Mengqi; Ji, Xunming

doi:10.1016/j.mehy.2012.11.010

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…However, reperfusion and collateral circulation allow neurons in the ischemic penumbra to recover. Reperfusion is not entirely harmless, causing the generation of reactive oxygen species and subsequent brain injury [26]. Because of the protective blood–brain barrier, the brain has fewer available antioxidant resources compared with other organs.…”

Section: Discussionmentioning

confidence: 99%

Association between serum uric acid to serum creatinine ratio and poor functional outcomes in patients with acute ischemic stroke

Gong

Tian

Zhou

et al. 2022

Euro J of Neurology

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Background and purpose:The role of serum uric acid (SUA) in prognosis is controversial because SUA levels largely depend on renal clearance function. This study aimed to investigate the association between renal function-normalized SUA (SUA to serum creatinine [SCr] ratio [SUA/SCr ratio]) and poor functional outcomes in patients with acute ischemic stroke (AIS).Methods: All patients were recruited from the Third China National Stroke Registry. Poor functional outcomes were defined by modified Rankin Scale (mRS) scores of 3-6 or 2-6 at 3 months and 1 year.Results: Among 8169 enrolled patients, the median (interquartile range) SUA/SCr ratio was 4. 19 (3.47-5.08). Compared with patients in the fourth quintile group, those in the first quintile group had higher proportions of mRS scores 3-6 (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.24-1.93) and mRS scores 2-6 (OR 1.28, 95% CI 1.08-1.53) at 3 months. The addition of SUA/SCr ratio to the conventional risk model had a greater incremental value than the addition of either SUA or SCr alone. Subgroup analysis showed that the association was only significant in patients with normal kidney function (p for interaction<0.05). Similar results were found for outcomes at 1 year. Conclusions:A lower SUA/SCr ratio was associated with poor functional outcomes in patients with AIS at 3 months and at 1 year, suggesting the potential use of SUA/SCr ratio in clinical practice as a preferable marker for stroke outcomes. K E Y W O R D Sacute ischemic stroke, poor functional outcomes, prognosis, serum uric acid to serum creatinine ratio Assessment of outcomesPatients were followed up for clinical outcomes at 3 months and 1 year after symptom onset. They were interviewed in-person at 3 months and contacted by telephone by trained research coordinators at 1 year. Functional outcomes were defined using the modified Rankin Scale (mRS) score, a measure of disability that is widely used for evaluating post-stroke recovery; mRS of 3-6 or 2-6 at 3 months and 1 year, respectively, were considered poor outcomes [17][18][19].All events were collected by trained research coordinators who remained blinded to subjects' baseline characteristics.

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Section: Discussionmentioning

confidence: 99%

Association between serum uric acid to serum creatinine ratio and poor functional outcomes in patients with acute ischemic stroke

Gong

Tian

Zhou

et al. 2022

Euro J of Neurology

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“…Reperfusion is not entirely harmless, and it causes generation of reactive oxygen species (ROS) and subsequent brain injury. 29 Ischaemic stroke reperfusion brain injury is a consequence of the ischaemic cascade, including ATP depletion, mitochondrial dysfunction, intracellular calcium overload, elevated ROS levels, and release of inflammatory cytokines. This eventually leads to neuronal death in ischaemic penumbra via apoptosis and necrosis.…”

Section: Discussionmentioning

confidence: 99%

High serum uric acid levels are a protective factor against unfavourable neurological functional outcome in patients with ischaemic stroke

Sun

Lai

et al. 2018

J Int Med Res

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ObjectiveWe aimed to evaluate the association between serum uric acid levels at the onset and prognostic outcome in patients with acute ischaemic stroke.MethodsWe retrospectively analysed the outcomes of 1166 patients with ischaemic stroke who were hospitalized in our centre during August 2008 to November 2012. Correlations of serum uric acid levels and prognostic outcomes were analysed.ResultsMen had higher serum uric acid levels and better neurological functional outcomes compared with women. There was a strong negative correlation between serum uric acid levels and unfavourable neurological functional outcomes. Generalized estimated equation analysis showed that a higher serum uric acid level (>237 µmol/L) was a protective factor for neurological functional outcome in male, but not female, patients. Among five trial of ORG 10172 in acute stroke treatment classification subtypes, only patients with the large-artery atherosclerosis subtype had a significant protective effect of serum uric acid levels on neurological outcome.ConclusionsOur study shows that high serum uric acid levels are a significant protective factor in men and in the large-artery atherosclerosis subtype in patients with ischaemic stroke. This is helpful for determining the prognostic value of serum uric acid levels for neurological outcome of acute ischaemic stroke.

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“…Levosimendan may be a reasonable alternative of these approaches, considering the already known fair tolerability, safety and well explored side-effect profile. [ 24 , 25 ]…”

Section: Discussionmentioning

confidence: 99%

Levosimendan Administration in Limb Ischemia: Multicomponent Signaling Serving Kidney Protection

et al. 2016

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Aims and ObjectivesAcute renal failure is a severe complication of lower extremity major arterial reconstructions, which could even be fatal. Levosimendan is a dual-acting positive inotropic and vasodilatory agent, which is suspected to have protective effects against cardiac ischemia. However, there is no data available on lower limb or remote organ ischemic injuries therefore the aim of the study was to investigate the effect of levosimendan on lower limb ischemia-reperfusion injury and the corollary renal dysfunction.MethodsMale Wistar rats underwent 180 min bilateral lower limb ischemia followed by 4 or 24 hours of reperfusion. Intravenous Levosimendan was administered continuously (0.2μg/bwkg/min) throughout the whole course of ischemia and the first 3h of reperfusion. Results were compared with sham-operated and ischemia-reperfusion groups. Hemodynamic monitoring was performed by invasive arterial blood pressure measurement. Kidney and lower limb muscle microcirculation was registered by a laser Doppler flowmeter. After 4h and 24h of reperfusion, serum, urine and histological samples were collected.ResultsSystemic hemodynamic parameters and microcirculation of kidney and the lower limb significantly improved in the Levosimendan treated group. Muscle viability was significantly preserved 4 and 24 hours after reperfusion. At the same time, renal functional laboratory tests and kidney histology demonstrated significantly less expressive kidney injury in Levosimendan groups. TNF-α levels were significantly less elevated in the Levosimendan group 4 hours after reperfusion.ConclusionThe results claim a protective role for Levosimendan administration during major vascular surgeries to prevent renal complications.

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A new idea about reducing reperfusion injury in ischemic stroke: Gradual reperfusion

Cited by 8 publications

References 21 publications

Association between serum uric acid to serum creatinine ratio and poor functional outcomes in patients with acute ischemic stroke

Association between serum uric acid to serum creatinine ratio and poor functional outcomes in patients with acute ischemic stroke

High serum uric acid levels are a protective factor against unfavourable neurological functional outcome in patients with ischaemic stroke

Levosimendan Administration in Limb Ischemia: Multicomponent Signaling Serving Kidney Protection

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