Background and purpose: It is unclear whether endovascular thrombectomy alone compared with intravenous thrombolysis combination with endovascular thrombectomy can achieve similar neurological outcomes in patients with acute large vessel occlusion stroke. We aimed to perform a systematic review and meta-analysis of randomized controlled trials to compare endovascular thrombectomy alone or intravenous thrombolysis plus endovascular thrombectomy in this population.Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov. We restricted our search to randomized clinical trials that examined the clinical outcomes of endovascular thrombectomy alone vs. intravenous thrombolysis plus endovascular thrombectomy. The Cochrane risk of bias tool was used to assess study quality. Random-effects meta-analyses were used for evaluating all outcomes.Results: Total three randomized controlled trials with 1,092 individuals enrolled were included in the meta-analysis, including 543 (49.7%) who received endovascular thrombectomy alone and 549 (50.3%) who received intravenous thrombolysis plus endovascular thrombectomy. The primary outcome of 90-day functional independence (modified Rankin scale (mRS) score ≤ 2) was 44.6% (242/543) in the endovascular thrombectomy alone group vs. 42.8% (235/549) in the alteplase with endovascular thrombectomy group (odds ratio (OR), 1.08 [95% CI, 0.85–1.38]; P = 0.0539). Among pre-specified secondary outcomes, no significant between-group differences were found in excellent outcome (mRS score ≤ 1) (OR, 1.12 [95% CI, 0.85–1.47]; P = 0.418), mortality at 90 days (OR, 0.93 [95% CI, 0.68–1.29]; P = 0.673), successful reperfusion (thrombolysis in cerebral infarction 2b-3) (OR, 0.75 [95% CI, 0.54–1.05]; P = 0.099), and symptomatic intracranial hemorrhage (OR, 0.72 [95% CI, 0.45–1.15]; P = 0.171).Conclusions: Among patients with acute ischemic stroke in the anterior circulation within 4.5 h from the onset, endovascular thrombectomy alone was non-inferior to combined intravenous thrombolysis and endovascular thrombectomy.

In microglia, Toll-like receptor 4 (TLR4) is well known to contribute to neuroin ammatory responses following brain ischemia. Meanwhile, TLR4 is also expressed in neurons and can mediate the conduction of calcium (Ca 2+ ) in ux, but the mechanistic link between neuronal TLR4 signaling and brain ischemic injury is still poorly understood. Here, primary neuronal cell culture from TLR4 knockout mice and conditional knockout mice of TLR4 in glutamatergic neurons (TLR4 cKO ) were used to establish ischemic models in vitro and in vivo, respectively. We found that deleting TLR4 reduced the neuronal death and intracellular Ca 2+ increase induced by oxygen and glucose deprivation (OGD) or lipopolysaccharide treatment. Infarct volume and functional de cits also were alleviated in TLR4 cKO mice following cerebral ischemia/reperfusion (I/R). Furthermore, TLR4 and N-methyl-d-aspartate receptor subunit 2B (NMDAR2B) were colocalized in neurons. Deleting TLR4 in neurons rescued phosphorylates NMDAR2B up-regulation induced by ischemia via Src kinase in vitro and in vivo. Downstream signaling of NMDAR2B, the interaction of neuronal nitric oxide synthase (nNOS) with postsynaptic density protein-95 (PSD-95) also was disrupted in TLR4 cKO mice following cerebral I/R. Taken together, we described a novel molecular neuronal pathway that TLR4 signal in neurons play a crucial role in the neuronal death, and provided a new target for neuroprotection after ischemic stroke.

Background Statins have been widely used to prevent cardiovascular disease in middle-aged and elderly populations; however, the effect of long-term treatment on cognitive function is controversial. To simulate clinical conditions, middle-aged rats were given atorvastatin for 9 consecutive months to investigate the effect on natural cognitive decline and the possible mechanisms. Results The results showed that compared with the control group, long-term atorvastatin treatment naturally improved cognitive decline. Furthermore, long-term treatment regulated intestinal retinoic acid (RA) metabolism and storage by altering retinol dehydrogenase 7 (Rdh7) expression in the intestine, while RA metabolism affected the proliferation of intestinal Treg cells and inhibited IL-17+γδ T-cell function. In addition, long-term atorvastatin increased intestinal flora richness and decreased IL-17 expression in hippocampal tissue. Conclusion Collectively, these findings provide the first evidence that long-term atorvastatin intervention may prevent cognitive decline in naturally ageing rats by inhibiting neuroinflammation via the gut-brain axis.

In microglia, Toll-like receptor 4 (TLR4) is well known to contribute to neuroinflammatory responses following brain ischemia. Meanwhile, TLR4 is also expressed in neurons and can mediate the conduction of calcium (Ca2+) influx, but the mechanistic link between neuronal TLR4 signaling and brain ischemic injury is still poorly understood. Here, primary neuronal cell culture from TLR4 knockout mice and conditional knockout mice of TLR4 in glutamatergic neurons (TLR4cKO) were used to establish ischemic models in vitro and in vivo, respectively. We found that deleting TLR4 reduced the neuronal death and intracellular Ca2+ increase induced by oxygen and glucose deprivation (OGD) or lipopolysaccharide treatment. Infarct volume and functional deficits also were alleviated in TLR4cKO mice following cerebral ischemia/reperfusion (I/R). Furthermore, TLR4 and N-methyl-d-aspartate receptor subunit 2B (NMDAR2B) were colocalized in neurons. Deleting TLR4 in neurons rescued phosphorylates NMDAR2B up-regulation induced by ischemia via Src kinase in vitro and in vivo. Downstream signaling of NMDAR2B, the interaction of neuronal nitric oxide synthase (nNOS) with postsynaptic density protein-95 (PSD-95) also was disrupted in TLR4cKO mice following cerebral I/R. Taken together, we described a novel molecular neuronal pathway that TLR4 signal in neurons play a crucial role in the neuronal death, and provided a new target for neuroprotection after ischemic stroke.