Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Randomized Controlled Trial
Effects of sevoflurane before cardiopulmonary bypass on cerebral oxygen balance and early postoperative cognitive dysfunction.
Postoperative cognitive dysfunction (POCD) is associated with cardiopulmonary bypass (CPB). We investigated the effect of different doses of inhaled sevoflurane administered prior to CPB on cerebral oxygen supply and demand, and the incidence of associated early POCD. One hundred and twenty patients were randomly allocated into four treatment groups (n = 30, each) and administered a high- [1.5 minimum alveolar concentration (MAC)], moderate- (1.0 MAC), low- (0.5 MAC), or no- sevoflurane dose prior to CPB. ⋯ The 24 h postoperative MMSE scores of the moderate- and high-dose groups were significantly higher than those of the low-dose and control groups. An inhaled optimal concentration of sevoflurane may be beneficial for cerebral oxygen balance during CPB, and may ameliorate cognitive damage. However, the effect is dose-dependent.
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Controlled Clinical Trial
Public and professional education on urgent therapy for acute ischemic stroke: a community-based intervention in Changsha.
Excessive delay of presentation for stroke in China is reported. In this study, an intervention trial was conducted to promote urgent therapy for acute ischemic stroke. Two communities in Changsha were selected as either intervention or control community from November 2007 to December 2011. ⋯ When admitted, the intervention group had lower mean systolic blood pressure (160.8 ± 26.7 vs. 164.7 ± 26.8 mmHg, P = 0.000) than control group. Survivors in the intervention group were more likely to be in higher Barthel index scoring groups than that in the control group at day 90 [(75, 50-100) vs. (65, 35-90), P = 0.035]. Public and professional education may promote prompt presentation and urgent therapy for ischemic stroke, which may be helpful for patients' prognosis.
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It has been reported that the expression of GTP cyclohydrolase I (GCH1) and neuronal apoptosis in dorsal root ganglion (DRG) is related to the generation of neuropathic pain. In this study, we hypothesize that GCH1 protein and neuronal apoptosis in rat spinal dorsal horn may also increase after chronic sciatic nerve injury. To establish the neuropathic pain model, we slightly ligated the right sciatic nerve of experimental rats. ⋯ No matter which method we used, western blotting or immunohistochemistry analysis, they all showed the enhancement of GCH1 protein in spinal dorsal horn on the 3rd, 7th, and 14th days after operation due to the sciatic nerve injury (P < 0.05). The apoptosis of nerve cells also increased evidently compared with sham group detected by TUNEL staining (P < 0.05). Therefore, the data suggested that along with mechanical allodynia caused by peripheral nerve injury, both GCH1 level and apoptosis index of nerve cells in spinal dorsal horn was elevated, which might also contribute to the generation of neuropathic pain.