Sanhua decoction: Current understanding of a traditional herbal recipe for stroke

Both thrombolytic and endovascular therapies are optimal treatment options for patients with acute ischemic stroke, but only less than half of these patients can benefit from these treatments. Traditional Chinese medicine has a long history of successfully managing ischemic stroke using both herbal and physical therapeutics. Among herbal recipes, Sanhua decoction (SHD) is one of the classical prescriptions for ischemic stroke. The present review aimed to summarize evidence from both clinical and basic research to demonstrate its efficacy in managing ischemic stroke and the potential mechanisms underlying its therapeutic effects, which will provide evidence on the therapeutic effect of this herbal recipe and guide future studies on this recipe. SHD is composed of four herbs, Rheum palmatum L. [Polygonaceae], Magnolia officinalis Rehder & E.H.Wilson [Magnoliaceae], Citrus × aurantium L. [Rutaceae], Hansenia weberbaueriana (Fedde ex H.Wolff) Pimenov & Kljuykov [Apiaceae]. We found that the majority of clinical studies on SHD are case reports and they showed positive therapeutic effect of SHD on both acute and chronic ischemic stroke. There are over 40 bioactive compounds identified in SHD, but few experimental studies have examined their individual molecular mechanisms. As an extract of SHD, it improves neurological functions through suppressing inflammation, protecting the blood brain barrier from degradation, restoring the number of neural stem cells, inhibiting apoptosis and brain edema, scavenging oxygen free radicals, and regulating the brain-gut axis. These will lay the theoretical foundation for future studies on this prescription and its clinical application. Future research may need to confirm its clinical efficacy in large-scale clinical trials and to disentangle its bioactive compounds and their potential mechanisms

Analysis of the efficacy and safety of recombinant tissue plasminogen activator for Chinese patients over 80 years of age with acute ischemic stroke : a pilot study

Recombinant tissue plasminogen activator (rt-PA) remains the only proven therapy for acute ischemic stroke patients who meet the selection criteria for treatment [1–3]. A small number of studies have investigated the efficacy of rt-PA for elderly stroke patients in Japanese and Caucasian populations [4, 5]. According to the American Heart Association/American Stroke Association Guidelines, patients over 80 years of age can be selected for rt-PA thrombolysis [6] and the Third International Stroke Trial found that the benefit of rt-PA did not diminish in patients older than 80 years [7]. However, the Chinese Guidelines for Stroke Management do not recommend rt-PA thrombolysis for these patients, due to the possibility that it increases the risk of intracranial hemorrhage transformation and subsequent nosocomial mortality [8]. In addition, an epidemiological study in Europe showed that >30% of the people included in their study who were >80 years old developed ischemic stroke after rt-PA treatment [5]. In China, there have been no such studies. Therefore, there is a urgent need to confirm the safety and efficacy of rt-PA in these patients [4, 5]. The present study aimed to reveal whether rt-PA could be safely and efficiently used on Chinese patients >80 years old with acute ischemic stroke. To do this, measures of safety and neurological function of these patients after rt-PA thrombolysis were compared with their younger counterparts (60–80 years) who also received rt-PA thrombolysis and patients >80 years old who did not receive rt-PA thrombolysis

Impact of early enteral nutrition on short term prognosis after acute stroke

We hypothesized that early enteral nutritional support would improve the short term prognosis of acute stroke patients with dysphagia, demonstrated by lower malnutrition rates, lower complication rates, and lower National Institutes of Health Stroke Scale (NIHSS) scores at 90 days post stroke. Nutrition support is an essential element in the care of stroke patients and many studies have investigated the effect of specific nutritional elements on stroke patients. However, few studies have looked at the impact of complete enteral nutrition on Chinese patients with acute stroke. To investigate this, we conducted a randomized controlled trial of 146 patients with acute stroke and dysphagia, among whom 75 were supported with nasogastric nutrition and 71 received family managed nutrition after randomization. Nutritional status, nosocomial infection and mortality rates were recorded on day 21 of hospitalization. Neurological deficits were evaluated by the NIHSS activities of daily living Barthel index (ADLBI) and the modified Rankin scale (mRS) and compared between the two groups. We found that the nasogastric nutrition group had a better nutritional status and reduced nosocomial infection and mortality rates after 21 days compared with patients in the family managed nutrition group. In addition, the nasogastric nutrition group showed a lower score on the NIHSS than the control group. However, the differences in the scores of the ADLBI and the 90 day mRS between the groups were not significant. Taken together, the present study shows that early enteral nutrition support improves the short term prognosis of acute stroke patients with dysphagia