Combination therapy refinement

Based on experimental and clinical data, cerebral hypothermia appears to be a potent therapeutic approach to treating brain trauma. However, recent results from the Multicenter National Brain Injury Study Hypothermia (NABIS H) clinical trial appear to be disappointing, and more refinement of the clinical application of hypothermia is required (73). Additional clinical trials are now required to evaluate systematically the beneficial effects of clinical hypothermia in different populations of brain-injured patients. In addition, experimental data regarding the beneficial effects of combination therapy are required to evaluate whether hypothermia plus pharmacotherapy may provide a better outcome. Forexample, mildpostischemichypothermia(33-39°C) combined with the antiinflammatory cytokine IL-10 has recently been reported to produce long-term protection of the C Al hippocampus after transient global ischemia (74). Hypothermia or IL-10 treatment alone did not protect chronically. In contrast, Kline etal. (75) showed that acute systemic administration of IL-10 suppressed the beneficial effects of... 

Refinements and improvements in pharmacologic ( thrombolysis ) and mechanical approaches ( primary angioplasty ) to recanalization have been impressive. Randomized clinical trials and registries have been used to compare and contrast the two, but assessment of both in combination lay dormant until quite recently. Improvements in coronary thrombolysis and coronary interventions now make reassessment of pharmacoinvasive therapy particularly desirable. Reassessment is indicated given the inherent limitations, when used alone, in both pharmacologic (failure to restore flow adequately) and mechanical approaches (unavoidable delay that can prolong the time to initiation of reperfusion). 

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