Temporal profile of body temperature in acute ischemic stroke: relation to infarct size and outcome

Geurts, Marjolein; Scheijmans, Féline E. V.; Seeters, Tom van; Biessels, Geert Jan; Kappelle, L. Jaap; Velthuis, Birgitta K.; Worp, H. Bart van der

doi:10.1186/s12883-016-0760-7

Cited by 25 publications

(24 citation statements)

References 19 publications

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“…A high body temperature is associated with a larger infarct size and poor functional outcome in patients with acute ischemic stroke (8). The effectiveness of therapeutic hypothermia for the management of ischemic stroke has been well documented in several animal studies as well as preclinical trials (9,10).…”

Section: Discussionmentioning

confidence: 99%

Hypothermia treatment ameliorated cyclin-dependent kinase 5-mediated inflammation in ischemic stroke and improved outcomes in ischemic stroke patients

Sun

Cai

Shen

et al. 2019

Clinics

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OBJECTIVES:The inflammatory response is a key mechanism of neuronal damage and loss during acute ischemic stroke. Hypothermia has shown promise as a treatment for ischemic stroke. In this study, we investigated the molecular signaling pathways in ischemic stroke after hypothermia treatment.METHODS:Cyclin-dependent kinase 5 (CDK5) was overexpressed or silenced in cultured cells. Nuclear transcription factor-κB (NF-κB) activity was assessed by measurement of the luciferase reporter gene. An ischemic stroke model was established in Sprague-Dawley (SD) rats using the suture-occluded method. Animals were assigned to three groups: sham operation control, ischemic stroke, and ischemic stroke + hypothermia treatment groups. Interleukin 1β (IL-1β) levels in the culture supernatant and blood samples were assessed by ELISA. Protein expression was measured by Western blotting.RESULTS:In HEK293 cells and primary cortical neuronal cultures exposed to hypothermia, CDK5 overexpression was associated with increased IL-1β, caspase 1, and NF-κB levels. In both a murine model of stroke and in patients, increased IL-1β levels were observed after stroke, and hypothermia treatment was associated with lower IL-1β levels. Furthermore, hypothermia-treated patients showed significant improvement in neurophysiological functional outcome.CONCLUSIONS:Overall, hypothermia offers clinical benefit, most likely through its effects on the inflammatory response.

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Section: Discussionmentioning

confidence: 99%

Hypothermia treatment ameliorated cyclin-dependent kinase 5-mediated inflammation in ischemic stroke and improved outcomes in ischemic stroke patients

Sun

Cai

Shen

et al. 2019

Clinics

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“…Among the extensive research of the role of NF-κB in ischemic cerebral injury ( 24 – 26 ), one study indicated that administration of the NF-κB inhibitor, N-acetylcysteine, resulted in a significant decrease in cerebral infarct volume in middle cerebral artery occlusion (MACO) ischemia/reperfusion rats ( 27 ). It has been demonstrated in numerous animal experiments and clinical trials that mild hypothermia can reduce infarct volume and accelerate the recovery of nerve function ( 28 , 29 ). Han et al ( 30 ) used MACO ischemia/reperfusion rats to observe the effect of mild hypothermia on the expression of NF-κB, and it was demonstrated that rats with mild hypothermia exhibited significantly reduced activity of NF-κB.…”

Section: Discussionmentioning

confidence: 99%

Dynamic protein expression of NF‑κB following rat intracerebral hemorrhage and its association with apoptosis

et al. 2018

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The aim of the present study was to evaluate the dynamic protein expression of nuclear factor (NF)-κB and apoptosis in the cerebral tissue surrounding hematoma following intracerebral hemorrhage (ICH) in rats. A total of 80 healthy male Wistar rats were divided into a sham-surgery group and an ICH group. The ICH model was established by injecting autogenous non-heparin anticoagulant arterial blood into the caudate putamen. NF-κB levels were assessed by immunohistochemistry at different time points subsequent to surgery, and apoptosis condition was investigated by terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling. Different levels of NF-κB were expressed in the cerebral tissue around the ICH at each time point in the ICH group. NF-κB protein expression was detected at 3 h following hemorrhage, mainly in the cytoplasm. Following 6 h, NF-κB was identified in the nucleus. Its expression peaked at 72 h following hemorrhage, and persisted for 5 days. Apoptosis was observed 6 h following hemorrhage, and had increased significantly by 12 h. The rate of apoptosis continued to rise from 72–120 h following hemorrhage. Correlation analysis revealed a significant positive correlation between NF-κB expression and apoptosis (r=0.753; P<0.01). The enhancement of NF-κB expression and apoptosis around ICH, and the significant positive correlation between NF-κB expression and apoptosis, indicates that NF-κB activation may enhance cerebral apoptosis in rats following ICH.

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“…[1][2][3] Aspiration, infections and fever can impede functional recovery, prolong hospital admissions, and are independently associated with an increased risk of death or longterm dependency. 1,2,[4][5][6][7][8][9] In addition, systematic review of animal studies modelling ischaemic stroke has shown that hyperthermia during or shortly after the onset of ischaemia substantially increases infarct size, suggesting that the relation between fever and poor outcome observed in patients is at least in part causal. 10 The risk of developing these complications can be reduced by very simple, safe and inexpensive measures, such as metoclopramide for the management of dysphagia, antibiotics for the prevention of infections and paracetamol for the prevention of fever, but it is uncertain whether these measures also improve functional outcome.…”

Section: Introductionmentioning

confidence: 99%

PRECIOUS: PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke. Rationale and design of a randomised, open, phase III, clinical trial with blinded outcome assessment

Reinink

Jonge

Bath

et al. 2018

European Stroke Journal

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BackgroundElderly patients are at high risk of complications after stroke, such as infections and fever. The occurrence of these complications has been associated with an increased risk of death or dependency.Hypothesis: Prevention of aspiration, infections, or fever with metoclopramide, ceftriaxone, paracetamol, or any combination of these in the first four days after stroke onset will improve functional outcome at 90 days in elderly patients with acute stroke.DesignInternational, 3 × 2-factorial, randomised-controlled, open-label clinical trial with blinded outcome assessment (PROBE) in 3800 patients aged 66 years or older with acute ischaemic stroke or intracerebral haemorrhage and an NIHSS score ≥ 6. Patients will be randomly allocated to any combination of oral, rectal, or intravenous metoclopramide (10 mg thrice daily); intravenous ceftriaxone (2000 mg once daily); oral, rectal, or intravenous paracetamol (1000 mg four times daily); or usual care, started within 24 h after symptom onset and continued for four days or until complete recovery or discharge from hospital, if earlier.Outcome: The primary outcome measure is the score on the modified Rankin Scale at 90 days (± 14 days), as analysed with multiple regression.Summary: This trial will provide evidence for a simple, safe and generally available treatment strategy that may reduce the burden of death or disability in patients with stroke at very low costs.Planning: First patient included in May 2016; final follow-up of the last patient by April 2020.Registration: ISRCTN, ISRCTN82217627, https://doi.org/10.1186/ISRCTN82217627

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Temporal profile of body temperature in acute ischemic stroke: relation to infarct size and outcome

Cited by 25 publications

References 19 publications

Hypothermia treatment ameliorated cyclin-dependent kinase 5-mediated inflammation in ischemic stroke and improved outcomes in ischemic stroke patients

Hypothermia treatment ameliorated cyclin-dependent kinase 5-mediated inflammation in ischemic stroke and improved outcomes in ischemic stroke patients

Dynamic protein expression of NF‑κB following rat intracerebral hemorrhage and its association with apoptosis

PRECIOUS: PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke. Rationale and design of a randomised, open, phase III, clinical trial with blinded outcome assessment

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