Global Summit on Stroke August 03-05, 2015 Birmingham, UK

Chung Kuang Lu worked as an Assistant Research Fellow, National Museum of Marine Biology & Aquarium, Assistant Professor, Institute of Marine Biotechnology, National Dong Hwa University and Assistant Professor, School Pharmacy, Taipei Medical University. His research project focuses on developing and applying biotechnology to detect, isolate, identify and evaluate novel biologically active metabolites from the highly diverse microbes. To discover new anti-cancer, cardiovascular, and reduction in blood sugar agents from microbes is the priority goal.

The Bu-yang Huan-wu Decoction (BHD), one of the classic traditional Chinese medicine (TCM) formula has been used for improving neurological functional recovery in stroke-induced disability in China for more than 300 years and is the most famous and popular TCM formula clinically used in Taiwan. However, whether and how BHD and its active components can protect mice against ischemic stroke-mediated excite toxicity still lacks the evidence-based study. We have previously reported the BHD can protect acute ischemic stroke (AIS) murine through impeding inflammatory responses via impairing NF-κB and GSK3β signaling, most possibly through activating ERK and PI3K/Akt pathways. This compromises the activation/infiltration of microglial and/or inflammatory cells, and activation of endogenous neurogenesis, respectively. Treatment of mice that have undergone ischemic stroke with BHD (1.0 g/kg, p.o.) at 2 hour after stroke enhanced survival rate and ameliorated neurological deficits, brain infarction, neural dysfunction and massive oxidative stress due to enormous free radial production and severe breakdown of blood-brain barrier (BBB). The goal of this study is to further study whether BHD can promote BBB remodeling through which to mediate neuronal cell survival and neuronal progenitor cell migration for neurogenesis and tissue repair. Our data revealed that BHD decreases BBB leakage through dramatically increasing vascular integrity (BBB remodeling) via up-regulating tight junction protein (occludin) expression and Ang1/Tie2 signaling most possibly through inactivating GSK3 to activate Wnt/-catenin signaling in the ischemic brain after stroke. This results explains why BHD can increase neuroblast( DCX+, a neuroblast marker) survival and migration which is closely associated with vascular remodeling and angiogenesis through enhancing neovascularization (CD34+/BrdU+staining) with upexpression of occludin, Ang1 and Tie2, as well as activation of Wnt/-catenin signaling. Our data provide evidence to show that BHD is superior than t-PA in ameliorating AIS via enhancing angiogenesis through which to massively support neuron survival (Tubβ3/Ang1 and Tie2/Ang1 staining) and promote neuroblast proliferation and migration from sub ventricular zone (SVZ) to ischemic damaged core region and peri-infarct area for neurogenesis and tissue repairmen. Besides, the analysis of UPLC fingerprints among different BHD production batches and the 6 plantamedica suggested two active components, X1 and Y1. The survival rates of ischemic stroke mice which were treated by compound X1 and Y1 together were around 65% in day 3.

Draginja Cvetkovic graduated from the School of Medicine University of Belgrade, Serbia in 1984. She attended Postgraduate Study in Cardiology at the University of Belgrade and was a research associate at the Institute for Medical Research in Belgrade. She had special interest in pharmacological treatment in pulmonary hypertension. Upon coming to the USA, she completed internship and residency in Anesthesia at the Beth Israel Medical Center in New York and was fellowship trained in Cardiac Anesthesia at Mt. Sinai Medical Center in New York. In practicing cardiac anesthesia, Dr. Draginja Cvetkovic has focused for 15 years on anesthetizing patients with congenital heart disease. Her certifications are The American Board of Anesthesiology, National Board of Echocardiography, and Subspecialty Certification in Pediatric Anesthesiology. She is now practicing at the Westchester Medical Center in Walhalla, New York. Dr. Draginja Cvetkovic is involved in full range of cardiothoracic surgical procedures including CABG, mitral and aortic valve repair, aortic aneurysm surgery, ventricular assist devices and heart transplants

Stroke after cardiac surgical procedures is a serious and costly healthcare problem with often fatal or disabling outcome. Most neurological events occur in a subset of patients who can be defined before operation. Identification of risk factors for perioperative stroke is important for understanding the pathogenesis of this devastating complication as well as for development of new preventive strategies. The frequency of this complication is reported to be as high as 5% in patients undergoing coronary artery bypass graft (CABG) surgery, almost 9% in CABG patients over 75 years of age, and nearly 16% in patients undergoing valve surgery or those with preexisting cerebrovascular disease. The causes and mechanisms of CNS injury after cardiac operations are complex and multifactorial and many have been proposed, including perioperative embolism from the heart or aortic arch, systemic hypoperfusion, ischemia from large-vessel occlusive disease, or a combination of these factors. New imaging techniques better define the degree and distribution of ischemic injury and may reveal regions of persistent hypoperfusion. It is essential to develop strategies for avoiding injury to the brain, preventing secondary ischemic damage and promoting recovery of brain tissue.

Gerald Dieter Griffin completed his undergraduate degree from the University of California at Berkeley, his PharmD from the University of the Pacific, his Medical Degree from the University of Juarez/Case Western Reserve University, University Hospitals of Cleveland combined program. A Flexible Internship at University Hospitals, CWRU School of Medicine, Cleveland was followed by a Residency in Emergency Medicine at Brooke Army Medical Center, San Antonio, Texas. After a ‘tour of duty’ at Stanford University as Assistant Clinical Professor of Emergency Medicine & Surgery, he is currently on the Clinical Faculty of the University of the Pacific School of Pharmacy & Health Sciences

Several themes supported by a robust literature are addressed in this clinical translational review and research paper: The inadequate standard of care for minimal Traumatic Brain Injury (mTBI)/concussion when compared to stroke because diagnosis and care for mTBI/concussion are based primarily on a symptom only framework; the treatment of stroke (brain injury) with select antibiotics; the use of beta blockade in stroke (brain injury). The various etiologies of brain injury appear to coalesce to common endpoints: Potential neuronal demise, cognitive and functional losses, immune suppression and infection. The use of principles patterned after ‘Koch’s Postulates’ show/prove the presence of infection/illness/disease, treat until resolved appears to be marginalized in establishing a diagnosis and recovery from mTBI/TBI. The pathways of immune system interactions in stroke (brain injury) and infection are briefly discussed. The suggestion of combined specific antibiotic and betablockade for ischemic stroke (brain injury) and mTBI is advanced for treatment and expeditious further study. Stroke is considered a brain injury in this paper. Stroke is also considered and recommended as a study model for mTBI therapy because of their common end points from brain damage. It is suggested that potential transfer or translation of therapy for stroke may be useful in mTBI.

Zogopoulos Panagiotis is a resident of Neurosurgery at the General Hospital of Nikaia-Piraeus “Agios Panteleimon”, Athens, Greece. His ongoing research is in the field of drugs and their interaction with human brain and cerebral vessels. Several of his papers have been published in reputed peer-review journals and he has presented various researches in international conferences.

Drug abuse is a significant problem of modern societies with tremendous socioeconomic consequences. Although numerous narcotic substances exist, most commonly abused ones are heroin, cocaine, cannabis and amphetamine. There are several case reports of drug abuse related stroke in the literature, but a systematic study of the potential changes of the cerebral vessels is missing. Cerebrovascular events reported include intracerebral and subarachnoid hemorrhage, subdural hematoma and ischemic/embolic infarctions. We have conducted a post-mortem (autopsy) study comparing cerebral vessels of drug abusers versus healthy controls. Histopathological changes observed on drug abusers’ cerebral vessels include vascular lumen thrombosis, platelet aggregation, atherosclerosis, transmural and perivascular infiltration of small cerebral vessels by inflammatory cells, granulomas, dilatation of perivascular spaces with protein exudate and fibrinoid necrosis of the medium and intima. These changes are the consequences of vessel wall ischaemia and cerebrovascular diseases (infection, vasculitis), usually observed on drug abusers, and can lead to vascular thrombosis or rupture. This study was conducted with the support of IKY Fellowships of Excellence for postgraduate studies in Greece – Siemens Program.

Introduction: Acute occlusion of a major cerebral artery is associated with high mortality and morbidity. Few data about prognostic factors for a good outcome are available, although mechanical thrombectomy has significantly advanced over the last 5 years. The aim of this study is to investigate good prognostic factors for an acute occlusion of a major cerebral artery using mechanical thrombectomy.\r\nMaterials & Methods: A single centre retrospective analysis of 37 consecutive patients with acute occlusion of a major cerebral artery treated by mechanical thrombectomy with stent retrievers was conducted. Collaterals were assessed by the Thrombolysis in Myocardial Infarction (TIMI) and recanalization was assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Outcome was assessed by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at 90 days.\r\nResults: Most patients (27/37) demonstrated good recanalization (TICI 2b or 3) after thrombectomy. At the 90-day follow up, 19 patients had well (mRS, 0-2), 14 had moderate (mRS, 3-4) and four had poor outcomes (mRS, 5-6). Early recanalization, high TIMI and low baseline NIHSS were closely related to 90-day mRS whereas high TICI was related to both mRS and the decrease in the NIHSS.\r\nConclusions: NIHSS decreased markedly when recanalization was successful. A good mRS was related to low initial NIHSS and good collateral and early and successful recanalization.

Sargylana A Chugunova is an Associate Professor of Department of Neurology and Psychiatry, North-Eastern Federal University named after M K Ammosov, Russia. She completed PhD at the Irkutsk State Postgraduate Medical Institute. She has published more than 30 papers in the field of the epidemiology and treatment of stroke.

We investigated the demographic characteristics of acute cerebrovascular accidents in Yakutia, Russia. The prospective analysis of case reports of the Regional Vascular center (Yakutsk) was conducted during the period of 2011-2013. The criteria for inclusion in the study: Ischemic stroke (I 63), intracerebral hematoma (I 61), sub-arachnoid hemorrhage (I 60), transient ischemic attack (G 45) (the 10th revision of the International Statistical Classification of Diseases and Related Health Problems). In all cases the diagnosis was confirmed by the neurologist examination, neuro-imaging (computed tomography or magnetic resonance imaging of the brain) and ultrasonic diagnostics of the brachiocephalic vessels. 3659 acute cerebrovascular accidents patients were hospitalized in total during the three-year period. The average age of patients was 62 years. Patients aged 60 years and younger accounted 42.3% (n=1548). The proportion of the patients aged 61 years and older was 57.7% (n=2111). The gender characteristics accounted: male-50.7% (n=1855), female-49.3% (n=1804). The majority of the investigated group formed by Asian race patients - 56.7% (n=2073). Caucasians accounted 43.3% (n=1586). Thus, according to our study data the cases in young and middle age composes the significant proportion in structure of the acute cerebrovascular accidents in Yakutia.