51
|
Mecoli CA, Perin J, Van Eyk JE, Zhu J, Fu Q, Allmon AG, Rao Y, Zeger S, Wigley FM, Hummers LK, Shah AA. Vascular biomarkers and digital ulcerations in systemic sclerosis: results from a randomized controlled trial of oral treprostinil (DISTOL-1). Clin Rheumatol 2020; 39:1199-1205. [PMID: 31858338 PMCID: PMC8211019 DOI: 10.1007/s10067-019-04863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/01/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although there is abundant evidence of vascular perturbation from studies of peripheral blood in systemic sclerosis (SSc), there are few data about the ability to use biomarkers of vascular injury and growth factors to predict vascular outcomes and response to therapy. We sought to explore the association between candidate vascular biomarkers and digital ulcerations (DU) in a clinical trial context. METHODS We examined 19 circulating vascular, angiogenic, and inflammatory biomarkers in 124 patients with scleroderma and DU who participated in a randomized controlled trial of oral treprostinil diolamine (ClinicalTrials.gov identifier NCT00775463). Correlation, regression, and random forest analyses were conducted to assess biomarker relationships in response to drug treatment. RESULTS Over the 20-week trial, 82 (66%) patients had their cardinal ulcer completely heal, 54 (44%) developed new ulcers, and 72 (58%) had complete healing of all ulcers; mean change in ulcer burden comparing week 20 with baseline was - 0.36 ± 1.70. Nineteen biomarkers were analyzed for their association and ability to predict clinical DU outcomes. After adjusting for multiple comparisons, no individual biomarker (baseline level, week 20 level, or change over time) was significantly associated with any of the clinical outcomes, suggesting that traditional vascular, angiogenic or inflammatory drivers are not predictive of ulcer fate. CONCLUSIONS The lack of strong response to any of the vascular, angiogenic, or inflammatory markers suggest that these pathways are not primary drivers in the development of DU clinical outcomes in a SSc population with prevalent DU. KEY POINTS • Currently we lack robust biomarkers to predict vascular outcomes or response to therapy in scleroderma patients with Raynaud's phenomenon.• Longitudinal assessment of vascular biomarkers in a clinical trial setting provides a unique opportunity to define biomarkers that predict vascular outcomes.• In a randomized controlled trial of oral treprostinil diolamine for treatment of scleroderma-associated digital ulcers, biomarkers involved in several vascular, inflammatory, and angiogenic pathways did not predict short-term clinical response to therapy or digital ulcer outcomes.• Further study of these and other biomarkers should be considered in Raynaud's clinical trials in scleroderma patients without prevalent digital ulcers.
Collapse
Affiliation(s)
- Christopher A Mecoli
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3650, Baltimore, MD, 21205, USA
| | - Jennifer E Van Eyk
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Jie Zhu
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Qin Fu
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Andrew G Allmon
- United Therapeutics, 1040 Spring Street, Silver Spring, MD, 20910, USA
| | - Youlan Rao
- United Therapeutics, 1040 Spring Street, Silver Spring, MD, 20910, USA
| | - Scott Zeger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3650, Baltimore, MD, 21205, USA
| | - Fredrick M Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
| |
Collapse
|
52
|
Talebi A, Amirabadizadeh A, Nakhaee S, Ahmadi Z, Mousavi-Mirzaei SM. Cerebrovascular disease: how serum phosphorus, vitamin D, and uric acid levels contribute to the ischemic stroke. BMC Neurol 2020; 20:116. [PMID: 32234035 PMCID: PMC7110613 DOI: 10.1186/s12883-020-01686-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background Associations between serum phosphorus level and the incidence of ischemic stroke are not clear. This study aimed to measure serum phosphorus, vitamin D3, and uric acid levels in ischemic stroke patients compared to a population without ischemic stroke. Methods In this cross-sectional study, 133 patients admitted to a neurology ward with the diagnosis of ischemic stroke were compared with a control group comprising 133 age- and gender-matching individuals. The presence of ischemic stroke was confirmed by a neurologist based on clinical signs, symptoms, brain CT scan, and MRI. Blood samples were taken from all patients in the first 24 h of admission to measure serum phosphorus, vitamin D3, calcium, and uric acid levels. Results According to the results of this study, uric acid medians in patients with stroke and controls were 4.9 [3.8–6.4] and 3.9 [3.5–4.9] mg/dL, respectively (p < 0.001). Median phosphorus and vitamin D levels were significantly lower in stroke patients than the controls (3.6 [3.02–4.21] vs. 4.2 [3.8–4.6]) and (15.1 [8.2–27.9] vs. 22.7 [10.4–39.2]), respectively. Multiple logistic regression analysis showed that the ischemic stroke was positively associated with the vitamin D level and negatively correlated with the uric acid level. The phosphorus level was not significantly predictive of ischemic stroke. Conclusion Lower serum levels of vitamin D3 and higher levels of uric acid were associated with ischemic stroke. There are still unknowns about the role of these indicators on ischemic stroke and it requires further studies.
Collapse
Affiliation(s)
- Abolfazl Talebi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadizadeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Ahmadi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | | |
Collapse
|
53
|
Conrad J, Ertl M, Oltmanns MH, Zu Eulenburg P. Prediction contribution of the cranial collateral circulation to the clinical and radiological outcome of ischemic stroke. J Neurol 2020; 267:2013-2021. [PMID: 32206898 PMCID: PMC7320948 DOI: 10.1007/s00415-020-09798-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND AIM The extent of penumbra tissue and outcome in stroke patients depend on the collateral cranial vasculature. To provide optimal individualized care for stroke patients in the emergency room setting we investigated the predictive capability of a stringent evaluation of the collateral vessels in ischemic stroke on clinical outcome and infarct size. METHODS We retrospectively studied uniform clinical and radiological data of 686 consecutive patients admitted to the emergency department with suspected acute ischemic stroke. Cranial collateral vasculature status was graded using the initial CT-angiography. Outcome was measured by mRS, NIHSS and final infarct size at hospital discharge. All data were used to build a linear regression model to predict the patients´ outcome. RESULTS Univariate and multivariate analyses showed significant effects of the whole brain collateral vessel score on all outcome variables. Atherosclerosis and piale collateral status were associated with the final infarct volume (FIV). Atherosclerosis and age were associated with the NIHSS at discharge. The presence of atherosclerosis, glucose level on admission and age were associated with the mRS at discharge. The multivariate models were able to predict 29% of the variance of the mRS at discharge, 24% of the variance in FIV and 17% of the variance of the NIHSS at discharge. The whole brain collateral status and the presence of atherosclerosis were the most relevant predictors for the clinical and radiological outcome. CONCLUSION The whole brain collateral vasculature status is clearly associated with clinical and radiological outcome but in a multivariate model seems not sufficiently predictive for FIV, mRS and NIHSS outcome at discharge in non-preselected patients admitted to the emergency department with ischemic stroke.
Collapse
Affiliation(s)
- Julian Conrad
- Department of Neurology, LMU Munich, Marchioninistr.15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.
| | - Matthias Ertl
- German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Meret H Oltmanns
- Department of Neuroradiology, Johannes Gutenberg-University, Mainz, Germany
| | - Peter Zu Eulenburg
- German Center for Vertigo and Balance Disorders (DSGZ), LMU Munich, Munich, Germany.,Institute for Neuroradiology, LMU Munich, Munich, Germany
| |
Collapse
|
54
|
Vivanco-Hidalgo RM, Avellaneda-Gómez C, Dadvand P, Cirach M, Ois Á, Gómez González A, Rodriguez-Campello A, de Ceballos P, Basagaña X, Zabalza A, Cuadrado-Godia E, Sunyer J, Roquer J, Wellenius GA. Association of residential air pollution, noise, and greenspace with initial ischemic stroke severity. Environ Res 2019; 179:108725. [PMID: 31539843 DOI: 10.1016/j.envres.2019.108725] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/10/2019] [Accepted: 09/04/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE A number of environmental risk factors of acute ischemic stroke have been identified, but few studies have evaluated the influence of the outdoor environment on stroke severity. We assessed the association of residential ambient fine particulate matter air pollution (PM2.5), noise, and surrounding greenspace with initial stroke severity. METHODS We obtained data on patients hospitalized with acute ischemic stroke from a hospital-based prospective stroke register (2005-2014) in Barcelona. We estimated residential PM2.5 based on an established land use regression model, greenspace as the average satellite-based Normalized Difference Vegetation Index (NDVI) within a 300 m buffer of the residence, and daily (Lday), evening (Levening), night (Lnight) and average noise (Lden) level at the street nearest to the residential address using municipal noise models. Stroke severity was assessed at the time of hospital presentation using the National Institute of Health Stroke Scale (NIHSS).We used logistic regression and binomial models to evaluate the associations of PM2.5, greenspace, and noise with initial stroke severity adjusting for potential confounders. RESULTS Among 2761 patients, higher residential surrounding greenspace was associated with lower risk of severe stroke (OR for NIHSS>5, 0.75; 95% CI: 0.60-0.95), while, living in areas with higher Lden was associated with a higher risk of severe stroke (OR, 1.30; 95% CI: 1.02-1.65). PM2.5 was not associated with initial stroke severity. CONCLUSIONS In an urban setting, surrounding greenspace and traffic noise at home are associated with initial stroke severity, suggesting an important influence of the built environment on the global burden of ischemic stroke.
Collapse
Affiliation(s)
| | - Carla Avellaneda-Gómez
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Payam Dadvand
- BarcelonaInstitute for Global Health (ISGlobal), C/DrAiguader 88, CP08003, Barcelona, Spain; Universitat PompeuFabra (UPF), Barcelona, Spain.
| | - Marta Cirach
- BarcelonaInstitute for Global Health (ISGlobal), C/DrAiguader 88, CP08003, Barcelona, Spain.
| | - Ángel Ois
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain.
| | | | - Ana Rodriguez-Campello
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain.
| | - Pablo de Ceballos
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain.
| | - Xavier Basagaña
- BarcelonaInstitute for Global Health (ISGlobal), C/DrAiguader 88, CP08003, Barcelona, Spain; Universitat PompeuFabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Ana Zabalza
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain.
| | - Elisa Cuadrado-Godia
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain.
| | - Jordi Sunyer
- BarcelonaInstitute for Global Health (ISGlobal), C/DrAiguader 88, CP08003, Barcelona, Spain; Universitat PompeuFabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Jaume Roquer
- Hospital del Mar Medical Research Institute, C/DrAiguader 88, CP08003, Barcelona, Spain.
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912, USA.
| |
Collapse
|
55
|
Jensen JH, Flachs EM, Skakon J, Rod NH, Bonde JP, Kawachi I. Work-unit organizational changes and risk of cardiovascular disease: a prospective study of public healthcare employees in Denmark. Int Arch Occup Environ Health 2020; 93:409-19. [PMID: 31781903 DOI: 10.1007/s00420-019-01493-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The impact of organizational change at work on cardiovascular disease (CVD) among employees is poorly understood. We examined the longitudinal associations between different types of work-unit organizational changes and risk of CVD among employees. METHODS We used multilevel mixed-effects parametric survival models to assess the risk of incident ischemic heart disease and stroke (72 events) during 2014 according to organizational changes in 2013 among 14,788 employees working in the same work unit from January through December 2013. We excluded employees with pre-existing CVD events between 2009 and 2013. Data on organizational changes defined as mergers, split-ups, relocations, change in management, employee layoffs, and budget cuts were obtained from work-unit managers (59% response). RESULTS There was an excess risk of CVD in the year following change in management (HR 2.04, 95% CI 1.10-3.78) and employee layoff (HR 2.44, 95% CI 1.29-4.59) in the work unit relative to no change. Exposure to any organizational change also suggested increased risk of CVD (HR 1.48, 95% CI 0.91-2.43). Including perceived stress as mediator in the regression models attenuated the point risk estimates only slightly, indicating no important mediation through this psychosocial factor. CONCLUSIONS Work-unit organizational change may be associated with excess risk of incident CVD among the employees relative to stable workplaces.
Collapse
|
56
|
Liamis G, Barkas F, Megapanou E, Christopoulou E, Makri A, Makaritsis K, Ntaios G, Elisaf M, Milionis H. Hyponatremia in Acute Stroke Patients: Pathophysiology, Clinical Significance, and Management Options. Eur Neurol 2019; 82:32-40. [PMID: 31722353 DOI: 10.1159/000504475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hyponatremia is frequent in acute stroke patients, and it is associated with worse outcomes and increased mortality. SUMMARY Nonstroke-related causes of hyponatremia include patients' comorbidities and concomitant medications, such as diabetes mellitus, chronic kidney disease, heart failure, and thiazides. During hospitalization, "inappropriate" administration of hypotonic solutions, poor solute intake, infections, and other drugs, such as mannitol, could also lower sodium levels in patients with acute stroke. On the other hand, secondary adrenal insufficiency due to pituitary ischemia or hemorrhage, syndrome of inappropriate antidiuretic hormone secretion, and cerebral salt wasting are additional stroke-related causes of hyponatremia. Although it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke, the restoration of the volume depletion remains the cornerstone of treatment in hypovolemic hyponatremia. In case of hyper- and euvolemic hyponatremia, apart from the correction of the underlying cause (e.g., withdrawal of an offending drug), fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) are among the therapeutic options. Key Messages: Hyponatremia is frequent in patients with acute stroke. The plethora of underlying etiologies warrants a careful differential diagnosis which should take into consideration comorbidities, concurrent medication, findings from the clinical examination, and laboratory measurements, which in turn will guide management decisions. However, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke.
Collapse
Affiliation(s)
- George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Fotios Barkas
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece,
| | - Efstathia Megapanou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Eliza Christopoulou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Andromachi Makri
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos Makaritsis
- Department of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - George Ntaios
- Department of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Moses Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
57
|
Abstract
Acute stroke is a leading cause of morbidity and mortality in the United States. Acute ischemic strokes have been classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, and this system aids in proper management. Nearly every patient who presents to a hospital with acute stroke symptoms has some form of emergent imaging. As such, imaging plays an important role in early diagnosis and management. This article reviews the imaging patterns of acute strokes, and how the infarct pattern and imaging characteristics can suggest an underlying cause.
Collapse
Affiliation(s)
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA.
| |
Collapse
|
58
|
Arsang-Jang S, Mansourian M, Mohammadifard N, Khosravi A, Oveis-Gharan S, Nouri F, Sarrafzadegan N. Temporal trend analysis of stroke and salt intake: a 15-year population-based study. Nutr Neurosci 2019; 24:384-394. [PMID: 31514683 DOI: 10.1080/1028415x.2019.1638665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The aim of this study was to evaluate temporal trends of salt intake with stroke incidence, stroke subtypes, and blood pressure in an adult population.Methods: Data were extracted from Isfahan Salt Study. The stroke incidence rate, average salt intake, systolic and diastolic blood pressure in adults, aged over 18 years were considered from 2000 to 2014. The Average Annual Percent Changes (AAPC), parallelism, and the coincidence of trends were estimated, using a permutation test.Results: The trend of salt intake was increased from 2010 to 2014 (AAPC = +1.59, P-value = 0.004). The trend of the stroke incidence rate was nonlinear with two change points in 2003 and 2009. The overall stroke incidence rate increased by 6.65% per year (95% CI: 1.66, 11.8, P-value = 0.015). The temporal trend changes of stroke incidence rate were steeper in patients who aged 40-45 and over 50 years (+6 to +11.5%) than in patients who aged 19-40 and 45-50 (range: -3.3% to 0). The parallelism hypothesis of longitudinal changes between salt intake and ischemic stroke was accepted in patients, aged <50 years (P-value = 0.871).Conclusions: The average salt intake and its cone-shaped variance over 15 years of the study, indicated that salt intake reduction programs and policies were effective to stop associating intake increase until 2007, however, associated intake was increased since that time, which necessitates performing preventive programs. More importantly, the trend of salt intake and ischemic stroke was similar in patients who aged <50 years, regardless of considering their blood pressure.
Collapse
Affiliation(s)
- Shahram Arsang-Jang
- Clinical Research Development Center (CRDU), Qom University of Medical Sciences, Qom, Iran.,Department of Biostatistics and Epidemiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Oveis-Gharan
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nouri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
59
|
Onatsu J, Vanninen R, Jäkälä P, Mustonen P, Pulkki K, Korhonen M, Hedman M, Zetterberg H, Blennow K, Höglund K, Herukka SK, Taina M. Serum Neurofilament Light Chain Concentration Correlates with Infarct Volume but Not Prognosis in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:2242-2249. [PMID: 31151840 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND PURPOSE We studied serum neurofilaments diagnostic value in patients with acute ischemic stroke (AIS) or TIA and evaluated any correlation with symptom severity, cerebral infarction volume, aetiology, and clinical outcome. METHODS One hundred and thirty-six patients (101 with AIS, and 35 with TIA) were included. Acute-phase serum neurofilament light chain (sNfL) was analyzed with a novel ultrasensitive single molecule array (Simoa). Cerebral infarction volume was measured from brain computed tomography in the subacute phase (>2 days). Stroke aetiology was defined by trial of ORG 10172 in acute stroke treatment classification, severity by National Institute of Health stroke scale (NIHSS) and the degree of disability by the Modified Rankin Scale (mRS) after 90 days. RESULTS sNfL was markedly higher in patients with AIS (89.5 pg/mL [IQR: 44.7-195.3]) than with TIA (25.2 pg/mL [IQR: 14.6-48.0]), P= <.001), also after adjusting for age, NIHSS, and stroke volume (P= .003). In receiver operating characteristic analysis, sNfL concentration greater than or equal to 49 pg/mL proved to be the best cut-off value to differentiate between patients with stroke and those with TIA (sensitivity of 73% and specificity of 80%). sNfL concentration significantly correlated with cerebral infarction volume (r = .413, P= <.001), this association remained significant after adjusting for established predictors (P= .019). Patients with AIS due to cardioembolism or large artery atherosclerosis had the highest sNfL concentrations. NIHSS on admission (r = .343, P = <.001) and mRS scores after 3 months (r = .306, P = .004) correlated with sNfL concentration, however functional outcome 3 months after stroke was not associated with sNfL after adjusting for potential confounders. CONCLUSIONS Cases with stroke were distinguishable from those with TIA following the determination of sNfL in the blood samples. The presence and amount of axonal damage estimated by sNfL correlated with the final cerebral infarction volume but was not predictive of degree of disability.
Collapse
Affiliation(s)
- Juha Onatsu
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Radiology, University of Eastern Finland, Kuopio Finland
| | - Pekka Jäkälä
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Kari Pulkki
- Department of Clinical Radiology and Clinical Chemistry, Kuopio, Finland; Eastern Finland Laboratory Center and Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom; UK Dementia Research Institute, London, United Kingdom
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kina Höglund
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Sanna-Kaisa Herukka
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
60
|
López HV, Vivas MF, Ruiz RN, Martínez JR, Navaridas BGV, Villa MG, Lázaro CL, Rubio RJ, Ortiz AM, Lacal LA, Diéguez AM. Association between post-procedural hyperoxia and poor functional outcome after mechanical thrombectomy for ischemic stroke: an observational study. Ann Intensive Care 2019; 9:59. [PMID: 31127402 PMCID: PMC6534627 DOI: 10.1186/s13613-019-0533-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The actual effects of oxygen therapy on patients who have suffered a stroke are still unknown, and its recommendation as a routine measure in emergency services remains controversial. The aim of this study is to determine the effect of hyperoxia in functional recovery in patients with ischemic stroke who underwent intra-arterial mechanical thrombectomy (IAMT). METHODS A prospective observational cohort study that included all adult patients consecutively admitted to the intensive care unit (ICU) due to an ischemic stroke in the anterior cerebral circulation and following an IAMT intervention, between 2010 and 2015. All patients were intubated and connected to mechanical ventilation for the intra-arterial therapy, receiving supplementary oxygen to achieve saturations above 94%. Two groups were established regarding oxygen partial pressure (paO2) reached. It was based on a single ICU admission blood gas analysis. The hyperoxia group was defined as paO2 > 120 mmHg. We measured functional recovery in each of the groups according to the modified Rankin scale after 90 days. RESULTS For the analysis, a total of 333 patients were included. High levels of paO2 were mostly related to higher scores in modified Rankin scale (mRS) after 90 days. There were 60.6% cases with mRS ≥ 4 and 70.6% with mRS ≥ 3 in the hyperoxia group, compared to 43.0% and 56.1% in the paO2 ≤ 120 group, p < 0.01, respectively. Mortality was higher in the hyperoxia group, 28.6% vs 18.7%, p = 0.04. After regression adjustment by confounding factors, poor functional outcome was still significantly higher in the hyperoxia group, for both mRS ≥ 4 and mRS ≥ 3: OR 2.2.7, IC 95%, 1.22-4.23, p = 0.01 and OR 2.07, IC 95%, 1.05-4.029, p = 0.04, respectively. Both the National Institute of Health Stroke Scale Score (NIHSS) values at 24 h after the IAMT and the days of ICU stay were significantly higher in the hyperoxia group. CONCLUSIONS In patients with ischemic stroke in the anterior cerebral circulation treated with IAMT, we found an association between admission PaO2 > 120 mmHg and worse functional outcome 90 days after ischemic stroke, but this association needs further confirmation by other studies.
Collapse
Affiliation(s)
- Héctor Vargas López
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain.
| | - Miguel Fernández Vivas
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - Rafael Núñez Ruiz
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - José Ros Martínez
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | | | - Manuel García Villa
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - Cristina Llamas Lázaro
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - Rubén Jara Rubio
- Department of Intensive Care, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - Ana Morales Ortiz
- Department of Neurology, Biomedical Research Institute of Murcia (IMIB), Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - Laura Albert Lacal
- Department of Neurology, Biomedical Research Institute of Murcia (IMIB), Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| | - Antonio Moreno Diéguez
- Department of Neuroradiology, Virgen de la Arrixaca, Clinical University Hospital, Murcia, Spain
| |
Collapse
|
61
|
Peksa GD, Ostrem J, Davis T. Intravenous tissue plasminogen activator for ischemic stroke in early pregnancy dosed by actual body weight. SAGE Open Med Case Rep 2019; 7:2050313X19828247. [PMID: 30800307 PMCID: PMC6378419 DOI: 10.1177/2050313x19828247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/10/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Few published reports highlight intravenous tissue plasminogen activator use during the first trimester of pregnancy and provide outcomes for mother and fetus. Little guidance is available regarding body weight dosing of intravenous tissue plasminogen activator during pregnancy. Methods: Here, we present a patient who received intravenous tissue plasminogen activator in the emergency department during her first trimester of pregnancy for the treatment of an acute ischemic stroke. Outcomes are presented for mother and fetus, as well as discussion about the dosing weight utilized for the intravenous tissue plasminogen activator dose calculation. Results: A 35-year-old, Gravida 7 Para 6, presented to the emergency department at 9 weeks gestation with acute stroke symptoms. Her initial National Institutes of Health Stroke Scale was 7. Imaging revealed a hyperdense right middle cerebral artery sign. Intravenous tissue plasminogen activator was administered 57 min after her arrival and based on her actual body weight during pregnancy. Post tissue plasminogen activator imaging revealed recanalization of the vessel and the patient’s National Institutes of Health Stroke Scale was 0. The patient progressed to delivery of a healthy female infant. The patient did not experience any bleeding complications throughout pregnancy. Conclusion: We present positive outcomes of a mother and fetus after receipt of intravenous tissue plasminogen activator using actual body weight during the first trimester of pregnancy for an acute ischemic stroke. Additional information is necessary to provide recommendations for the application to future patients in early pregnancy.
Collapse
Affiliation(s)
- Gary D Peksa
- Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA.,Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jamie Ostrem
- Department of Pharmacy, Emory University Hospital, Atlanta, GA, USA
| | - Teresa Davis
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
62
|
Dmytriw AA, Zhang Y, Mendes Pereira V. Mechanical thrombectomy and the future of acute stroke treatment. Eur J Radiol 2019; 112:214-221. [PMID: 30777213 DOI: 10.1016/j.ejrad.2019.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 01/19/2023]
Abstract
After being staggered by numerous negative trials in 2013, the interventional stroke community saw four years of vindication for mechanical thrombectomy showing efficacy and safety, even beyond a hopeful 6-8 hour window out to 24 h. A landmark set of five trials in 2015 provided a foundation upon which years of incremental follow-ups, meta-analyses and new breakthroughs would be built. With optimized devices for thrombectomy and image analysis, the neurointerventional community has turned to workflow and systemization in this new era of acute ischemic stroke treatment. The aim of this review is to chronicle the evidence in the epoch of positive trials, synthesize ancillary studies to these, and discuss the imminent challenges that remain.
Collapse
Affiliation(s)
- Adam A Dmytriw
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
| | - Yuchen Zhang
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
63
|
Khodabandeh A, Shahraki K, Roohipoor R, Riazi-Esfahani H, Yaseri M, Faghihi H, Bazvand F. Quantitative measurement of vascular density and flow using optical coherence tomography angiography (OCTA) in patients with central retinal vein occlusion: Can OCTA help in distinguishing ischemic from non-ischemic type? Int J Retina Vitreous 2018; 4:47. [PMID: 30607260 PMCID: PMC6307124 DOI: 10.1186/s40942-018-0152-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/17/2018] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate microvascular changes and quantitative parameters in patients with central retinal vein occlusion (CRVO) by using optical coherence tomography angiography (OCTA) and finding difference between presumably ischemic and non ischemic CRVO. Methods Patients with CRVO (31) and healthy control (20) were enrolled in this observational case control study. The OCTA was done for each patient and control subject. In macular area 2 images were taken for each eye (3 × 3 mm and 8 × 8 mm). The images were analyzed at three capillary plexuses (superficial and deep retinal capillary layers and choriocapillaris layer). Results Thirty-one patients with CRVO (mean age 60.00 ± 13.72 years) and 20 healthy age/gender matched subjects (mean age 54.10 ± 12.33 years) were enrolled in this study (p = 0.095). The mean visual acuity of patients was 0.47 ± 0.54 LogMAR. Eyes with CRVO as compared with fellow eyes and control group showed significant reduction of flow in superficial (1.171 ± 0.262 vs. 1.362 ± 0.285 vs. 1.453 ± 0.105) and deep capillary plexus (1.042 ± 0.402 vs. 1.331 ± 0.315 vs. 1.526 ± 0.123) and choriocapillaris (1.206 ± 0.543 vs. 1.841 ± 0.308 vs. 1.966 ± 0.05) and vascular density in superficial (45.92 ± 4.2 vs. 50.99 ± 4.35 vs. 52.85 ± 2.99) and deep (48.03 ± 4.71 vs. 55.86 ± 3.81 vs. 58.2 ± 2.65) capillary plexuses. Some parameters (flow of both retinal capillary plexuses and parafoveal vascular density in deep plexus) showed significantly reduction in fellow eyes than control group. The parameters including flow [superficial (1.014 ± 0.264 vs. 1.279 ± 0.19) and deep (0.873 ± 0.442 vs. 1.152 ± 0.32) capillary plexuses and choriocapillaris (0.79 ± 0.327 vs. 1.424 ± 0.51)] and vascular density [superficial (44.24 ± 2.13 vs. 46.58 ± 4.13) and deep (45.28 ± 3.5 vs. 49.32 ± 3.94) capillary plexuses] were lower significantly in ischemic type than non ischemic CRVO. The most damaged parameter was flow in deep capillary plexus. The model with smallest Akaike information criterion and Bayesian information criterion was chosen as the best model. For easier calculation, we also calculated the reduced model. By choosing the threshold of 12.6, the formula [3.9 × F1S + 0.8 × F3S] can diagnose the presumably ischemic CRVO from non ischemic type with AUC of 0.84, sensitivity of 100% and specificity of 69%. (F1S: flow in the central 1 mm-radius-circle of superficial plexus and F3S: flow in the central 3 mm-radius-circle of superficial plexus). Conclusion and relevance In CRVO patients, the OCTA can accurately evaluate changes in microvascular structures. It may help in differentiation ischemic CRVO from non-ischemic CRVO.
Collapse
Affiliation(s)
- Alireza Khodabandeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| | - Kiyanoosh Shahraki
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| | - Mehdi Yaseri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| | - Houshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Qazvin Square, 1336616351 Tehran, Iran
| |
Collapse
|
64
|
Abstract
BACKGROUND Pediatric stroke alerts or "code strokes" allow for rapid evaluation, imaging, and treatment of children presenting with stroke-like symptoms. In a previous study of emergency department-initiated pediatric stroke alerts, 24% of children had confirmed strokes. The purpose of this study was to characterize in-hospital pediatric stroke alerts. METHODS Demographic and clinical information was obtained from a quality improvement database and medical records for children (zero to 20 years) at a single institution for whom a stroke alert was activated after hospital admission between April 2011 and December 2016. Stroke alert activation criteria included a new focal neurological defect occurring within 48 hours. A neurologist evaluated the patient within 15 minutes and rapid magnetic resonance imaging was available. RESULTS Medical personnel activated in-hospital stroke alerts for 56 children (median age 6.5 years, interquartile range 1 to 13, 52% male). Stroke was the final diagnosis of 25 (45%), 72% ischemic, and 28% hemorrhagic strokes. Other diagnoses included neurological urgencies: seizure (21%), posterior reversible encephalopathy syndrome (7%), transient ischemic attack (5%), and acute disseminated encephalomyelitis (4%). Of the stroke diagnoses, 68% were stroke alerts called in the pediatric intensive care unit or pediatric cardiac intensive care unit. Rapid neuroimaging was completed in 91%; magnetic resonance imaging brain was the first image in 55%. CONCLUSIONS Of in-hospital pediatric stroke alerts, 45% were stroke while 38% were other neurological conditions requiring urgent evaluation. In-hospital stroke alerts were commonly activated for children with complicated medical histories. Rapid neurological evaluation facilitated care. No child underwent thrombolysis or thrombectomy.
Collapse
Affiliation(s)
- Megan Barry
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pediatrics, Division of Pediatric Neurology, University of Colorado Medical Center, Aurora, Colorado
| | - Truc M Le
- Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa C Gindville
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
65
|
Vairamani K, Prasad V, Wang Y, Huang W, Chen Y, Medvedovic M, Lorenz JN, Shull GE. NBCe1 Na +-HCO3 - cotransporter ablation causes reduced apoptosis following cardiac ischemia-reperfusion injury in vivo. World J Cardiol 2018; 10:97-109. [PMID: 30344957 PMCID: PMC6189072 DOI: 10.4330/wjc.v10.i9.97] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/05/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the hypothesis that cardiomyocyte-specific loss of the electrogenic NBCe1 Na+-HCO3- cotransporter is cardioprotective during in vivo ischemia-reperfusion (IR) injury.
METHODS An NBCe1 (Slc4a4 gene) conditional knockout mouse (KO) model was prepared by gene targeting. Cardiovascular performance of wildtype (WT) and cardiac-specific NBCe1 KO mice was analyzed by intraventricular pressure measurements, and changes in cardiac gene expression were determined by RNA Seq analysis. Response to in vivo IR injury was analyzed after 30 min occlusion of the left anterior descending artery followed by 3 h of reperfusion.
RESULTS Loss of NBCe1 in cardiac myocytes did not impair cardiac contractility or relaxation under basal conditions or in response to β-adrenergic stimulation, and caused only limited changes in gene expression patterns, such as those for electrical excitability. However, following ischemia and reperfusion, KO heart sections exhibited significantly fewer apoptotic nuclei than WT sections.
CONCLUSION These studies indicate that cardiac-specific loss of NBCe1 does not impair cardiovascular performance, causes only minimal changes in gene expression patterns, and protects against IR injury in vivo .
Collapse
Affiliation(s)
- Kanimozhi Vairamani
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3026, United States
| | - Vikram Prasad
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229-3039, United States
| | - Yigang Wang
- Department of Pathology, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0529, United States
| | - Wei Huang
- Department of Pathology, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0529, United States
| | - Yinhua Chen
- Division of Developmental Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, United States
| | - Mario Medvedovic
- Department of Environmental Health, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0056, United States
| | - John N Lorenz
- Department of Pharmacology and Systems Physiology, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0575, United States
| | - Gary E Shull
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0524, United States
| |
Collapse
|
66
|
Oni-Orisan A, Cresci S, Jones PG, Theken KN, Spertus JA, Lee CR. Association between the EPHX2 p.Lys55Arg polymorphism and prognosis following an acute coronary syndrome. Prostaglandins Other Lipid Mediat 2018; 138:15-22. [PMID: 30096423 DOI: 10.1016/j.prostaglandins.2018.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/06/2018] [Accepted: 07/31/2018] [Indexed: 01/14/2023]
Abstract
Inhibition of soluble epoxide hydrolase (sEH, EPHX2) elicits potent cardiovascular protective effects in preclinical models of ischemic cardiovascular disease (CVD), and genetic polymorphisms in EPHX2 have been associated with developing ischemic CVD in humans. However, it remains unknown whether EPHX2 variants are associated with prognosis following an ischemic CVD event. We evaluated the association between EPHX2 p.Lys55Arg and p.Arg287Gln genotype with survival in 667 acute coronary syndrome (ACS) patients. No association with p.Arg287Gln genotype was observed (P = 0.598). Caucasian EPHX2 Arg55 carriers (Lys/Arg or Arg/Arg) had a significantly higher risk of 5-year mortality (adjusted hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.01-2.55, P = 0.045). In an independent population of 2712 ACS patients, this association was not replicated (adjusted HR 0.92, 95% CI 0.70-1.21, P = 0.559). In a secondary analysis, Caucasian homozygous Arg55 allele carriers (Arg/Arg) appeared to exhibit a higher risk of cardiovascular mortality (adjusted HR 2.60, 95% CI 1.09-6.17). These results demonstrate that EPHX2 p.Lys55Arg and p.Arg287Gln polymorphisms do not significantly modify survival after an ACS event. Investigation of other sEH metabolism biomarkers in ischemic CVD appears warranted.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, UCSF School of Pharmacy, University of California San Francisco, San Francisco, CA, USA; Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Sharon Cresci
- Department of Medicine and Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Philip G Jones
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Katherine N Theken
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Spertus
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
67
|
Klarin D, Cambria RP, Ergul EA, Silverman SB, Patel VI, LaMuraglia GM, Conrad MF, Clouse WD. Risk factor profile and anatomic features of previously asymptomatic patients presenting with carotid-related stroke. J Vasc Surg 2018; 68:1390-1395. [PMID: 29804741 DOI: 10.1016/j.jvs.2018.01.064] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/31/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although carotid atherosclerotic-mediated stroke remains a major cause of morbidity and mortality, some have suggested intervention in carotid stenosis should be limited to symptomatic patients given the advances in medical therapy. The present study was conducted to assess the atherosclerotic risk factor profiles, anatomic features, and clinical outcomes of previously asymptomatic patients admitted with stroke of carotid etiology. METHODS We reviewed the data from 3382 patients admitted to a tertiary referral center with an ischemic stroke during 2005 to 2015. We focused on patients admitted with a radiographically confirmed infarct ipsilateral to a documented carotid artery stenosis ≥50%, with the admitting neurology team adjudicating the stroke etiology as carotid related. Patients were excluded if they had had a previous transient ischemic attack, previous infarct ipsilateral to any carotid lesion, or previous carotid revascularization, intracranial hemorrhage, or malignancy. Patient demographic data, medical treatments before stroke, stroke admission carotid imaging, and stroke treatments and outcomes were assessed. RESULTS A total of 219 carotid stroke patients (7% of all strokes) were identified, of whom 61% were white and 66% were men, with a mean age of 68 ± 12 years. Hypertension (79%) and smoking (33% current; 29% former) were predominant risk factors. On admission, 50% were receiving antiplatelet therapy (aspirin, n = 92 [41%]; clopidogrel, n = 9 [4%]; dual therapy, n = 11 [5%]) and 55% were receiving lipid-lowering agents (statin, n = 115 [53%]; other, n = 6 [2%]); 77 patients (35%) were receiving both antiplatelet and lipid-lowering therapy. Of the 219 patients, 156 (71%) presented with a moderate or severe stroke (National Institutes of Health stroke scale ≥5 at admission), 54 (25%) received lytic therapy, 96 (43%) presented with an occluded ipsilateral internal carotid artery, and 117 (53%) ultimately underwent carotid revascularization at a median of 4 days. Individuals receiving both antiplatelet and lipid-lowering therapy were significantly less likely to experience a moderate or severe stroke (44% vs 78%; P = .006). CONCLUSIONS Internal carotid artery occlusion is the culprit lesion in 43% of carotid-related strokes in those without previous symptoms. Previously asymptomatic patients not receiving combined antiplatelet and lipid-lowering medical therapy presenting with carotid-related stroke are significantly more likely to experience a severe, debilitating stroke. However, those receiving appropriate risk-reduction medical therapy are still at risk of carotid-mediated stroke. These results suggest medical therapy alone is unlikely to be sufficient stroke prevention for patients with significant carotid stenosis.
Collapse
Affiliation(s)
- Derek Klarin
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Brighton, Mass
| | - Emel A Ergul
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Scott B Silverman
- Department of Neurology, Massachusetts General Hospital, Boston, Mass
| | - Virendra I Patel
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY
| | - Glenn M LaMuraglia
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| |
Collapse
|
68
|
Morbach C, Bellavia D, Störk S, Sugeng L. Systolic characteristics and dynamic changes of the mitral valve in different grades of ischemic mitral regurgitation - insights from 3D transesophageal echocardiography. BMC Cardiovasc Disord 2018; 18:93. [PMID: 29747569 PMCID: PMC5946441 DOI: 10.1186/s12872-018-0819-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitral regurgitation in ischemic heart disease (IMR) is a strong predictor of outcome but until now, pathophysiology is not sufficiently understood and treatment is not satisfying. We aimed to systematically evaluate structural and functional mitral valve leaflet and annular characteristics in patients with IMR to determine the differences in geometric and dynamic changes of the MV between significant and mild IMR. METHODS Thirty-seven patients with IMR (18 mild (m)MR, 19 significant (moderate+severe) (s)MR) and 33 controls underwent TEE. 3D volumes were analyzed using 3D feature-tracking software. RESULTS All IMR patients showed a loss of mitral annular motility and non-planarity, whereas mitral annulus dilation and leaflet enlargement occurred in sMR only. Active-posterior-leaflet-area decreased in early systole in all three groups accompanied by an increase in active-anterior-leaflet-area in early systole in controls and mMR but only in late systole in sMR. CONCLUSIONS In addition to a significant enlargement and loss in motility of the MV annulus, patients with significant IMR showed a spatio-temporal alteration of the mitral valve coaptation line due to a delayed increase in active-anterior-leaflet-area. This abnormality is likely to contribute to IMR severity and is worth the evaluation of becoming a parameter for clinical decision-making. Further, addressing the leaflets aiming to increase the active leaflet-area is a promising therapeutic approach for significant IMR. Additional studies with a larger sample size and post-operative assessment are warranted to further validate our findings and help understand the dynamics of the mitral valve.
Collapse
Affiliation(s)
- Caroline Morbach
- Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.,Comprehensive Heart Failure Center and Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Diego Bellavia
- Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.,Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy
| | - Stefan Störk
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Lissa Sugeng
- Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.
| |
Collapse
|
69
|
Chen Z, Zhang L, Qu J, Wu Y, Mao G, Zhu X, Zhu J. Clinical analysis of combined revascularization in treating ischemic Moyamoya disease in adults. Neurochirurgie 2018; 64:49-52. [PMID: 29455906 DOI: 10.1016/j.neuchi.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 05/23/2017] [Accepted: 08/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical efficacy of superficial temporal artery-middle cerebral artery anastomosis (STA-MCA)+encephalo-duro-myo-synangiosis (EDMS) in treating ischemic Moyamoya disease (IMD) in adults. METHODS A total of 30 adult patients with IMD were selected to be included in the study; they underwent STA-MCA+EDMS and were followed up for 3 months to 2 years. The digital subtraction angiography findings, modified Rankin scale (mRs) score, and complications of all the patients were compared. RESULTS Thirty patients successfully completed the surgery. Three patients had postoperative complications (two patients with cerebral infarction on the surgical side and one patient with poor scalp healing). The postoperative morbidity rate was 10%. Angiography conducted at 3 to 6 months postoperatively showed 28 cases of anastomotic patency; the anastomotic patency rate was 93.3%. The mRs scores of the patients' neurological function 3 months after surgery were lower than those before surgery. CONCLUSION STA-MCA+EDMS is effective in treating Moyamoya disease.
Collapse
Affiliation(s)
- Z Chen
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - L Zhang
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - J Qu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - Y Wu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - G Mao
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - X Zhu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - J Zhu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China.
| |
Collapse
|
70
|
Zhou XB, Zou DX, Gu W, Wang D, Feng JS, Wang JY, Zhou JL. An Experimental Study on Repeated Brief Ischemia in Promoting Sciatic Nerve Repair and Regeneration in Rats. World Neurosurg 2018; 114:e11-e21. [PMID: 29374605 DOI: 10.1016/j.wneu.2018.01.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Research has shown that ischemic preconditioning reduced the severity of ischemia-reperfusion injury in brain in rats, we have a hypothesis that repeated brief ischemia has positive effects on peripheral nerve damage. This study was conducted to investigate the potential protective effects of repeated brief ischemia on peripheral nerve regeneration using a rat model of experimental sciatic nerve transection injury. METHODS Treatment groups (groups A-D) received repeated, brief ischemia every 1 day/2 days/3 days/7 days. After surgery for 4, 8, 12 weeks, we evaluated sciatic functional index test, gastrocnemius muscle wet mass, axon and nerve fiber diameter, density, G-ratio, immunohistochemistry of S-100, vascular endothelial growth factor (VEGF), and the ultrastructure of the nerves. RESULTS Sciatic functional index test and muscle wet mass were improved on the repeated brief ischemia groups. Ischemia treatment resulted in a significant increase in axon and nerve fiber density as well as S-100 and VEGF-positive cell, which indicated that repeated brief ischemia promotes Schwann cell proliferation and reconstruction. CONCLUSIONS This study exhibits the positive effects of repeated brief ischemia in sciatic nerve transection injury, possibly in part because it can improve VEGF and the physiologic state of Schwann cells in the ischemic environment and then accelerate the ability of neurite outgrow.
Collapse
Affiliation(s)
- Xiao-Bin Zhou
- Department of Orthopedics, The Third Hospital of Shi Jia-Zhuang, Hebei, People's Republic of China; Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - De-Xin Zou
- Department of Spine Surgery, YanTai-Shan Hospital, Shandong, People's Republic of China
| | - Wei Gu
- Department of Ophthalmology, The Third Hospital of Shi Jia-Zhuang, Hebei, People's Republic of China
| | - Dong Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jian-Shu Feng
- Department of Orthopedics, The Third Hospital of Shi Jia-Zhuang, Hebei, People's Republic of China
| | - Jiang-Yong Wang
- Department of Orthopedics, The Third Hospital of Shi Jia-Zhuang, Hebei, People's Republic of China
| | - Jun-Lin Zhou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
| |
Collapse
|
71
|
Bianco A, Moore G, Taylor S. Neonatal Encephalopathy in Calves Presented to a University Hospital. J Vet Intern Med 2017; 31:1892-1899. [PMID: 28865106 PMCID: PMC5697198 DOI: 10.1111/jvim.14821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/07/2017] [Accepted: 08/01/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND While studies have examined bovine dystocia in relation to calf survival, little has been published regarding perinatal morbidity and treatment of newborn calves beyond failure of transfer of passive immunity (FTPI). Neonatal encephalopathy (NE) is a clinical syndrome commonly diagnosed in infants and foals but is poorly described in calves. HYPOTHESIS/OBJECTIVES To identify risk factors for development of NE in calves and factors predictive of survival. ANIMALS Neonatal calves presented to a University hospital over a 10-year period. METHODS Retrospective cohort study (2005-2015). Medical records of all neonatal calves presented to the hospital were examined, and cases of NE were identified. Data pertaining to demographics, dam parity, labor, treatment, and outcome were collected and analyzed with univariate and multivariate statistics. RESULTS Of 200 calves in the final analysis, 58 (29%; 95% CI: 22.8-35.8%) were classified as NE and 142 calves as non-NE. In univariate analysis, factors significantly associated with diagnosis of NE included male sex, presence of dystocia, abnormal position in the birth canal, and prolonged labor. In the multivariate model, only orientation of the calf in the birth canal remained significant (OR 2.14; 95% CI: 1.02-4.49; P = 0.044). Overall survival of calves with NE was good (45/58; 77.6%; 95% CI: 64.7-87.5); dam parity and being a twin was significantly associated with nonsurvival. CONCLUSIONS Calves born after dystocia, especially if malpresented, should be closely monitored for nursing behavior within the first 24 hours of life. Prognosis for survival is good, but supportive care might be required for several days.
Collapse
Affiliation(s)
- A.W. Bianco
- Department of Veterinary Clinical SciencesCollege of Veterinary MedicinePurdue UniversityWest LafayetteIN
| | - G.E. Moore
- Department of Veterinary AdministrationCollege of Veterinary MedicinePurdue UniversityWest LafayetteIN
| | - S.D. Taylor
- Department of Veterinary Clinical SciencesCollege of Veterinary MedicinePurdue UniversityWest LafayetteIN
| |
Collapse
|
72
|
Sah RG, d'Esterre CD, Hill MD, Hafeez M, Tariq S, Forkert ND, Demchuk AM, Goyal M, Barber PA. Diffusion-Weighted MRI Stroke Volume Following Recanalization Treatment is Threshold-Dependent. Clin Neuroradiol 2019; 29:135-41. [PMID: 29051996 DOI: 10.1007/s00062-017-0634-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/21/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Infarct lesion segmentation has been problematic as there are a wide range of relative and absolute diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) thresholds that have been used for this purpose. We examined differences of stroke lesion volume and evolution evaluated by magnetic resonance imaging (MRI) during the immediate post-treatment phase (<5 h) and at 24 h. METHODS In this study 33 acute ischemic stroke patients were imaged with MRI <5 h and 24 h post-reperfusion treatment. Lesion volumes were segmented on ADC maps and average DWI using literature cited absolute ADC and relative DWI thresholds. The segmented lesion volumes within both time points were compared and the absolute change in lesion volume (infarct growth) between the two time points was calculated and compared using Bland-Altman analysis. RESULTS Lesion volumes differed significantly when different relative DWI or absolute ADC thresholds were used (p < 0.05), which held true for baseline as well as follow-up lesions. The median absolute changes in lesion volume from baseline to follow-up for ADC thresholds of 550 × 10-6 mm2/s, 600 × 10-6 mm2/s, 630 × 10-6 mm2/s and 650 × 10-6 mm2/s were 3.5 ml, 4.2 ml, 4.5 ml, and 6.5 ml, respectively (p < 0.05). Likewise, the median absolute changes in lesion volume from baseline to follow-up for DWI thresholds, k = 0.85, 1.28, 1.64, 1.96, and 2.7 were 10.1 ml, 7.3 ml, 5.7 ml, 5.4 ml and 4.2 ml, respectively (p < 0.05). CONCLUSION Absolute lesion volumes and changes in lesion volumes (infarct growth) measured after recanalization treatment were dependent on absolute ADC and relative DWI thresholds, which may have clinical significance. Standardization of techniques for measuring DWI lesion volumes requires immediate attention.
Collapse
|
73
|
Shrestha P, Thapa S, Shrestha S, Lohani S, BK S, MacCormac O, Thapa L, Devkota UP. Renal impairment in stroke patients: A comparison between the haemorrhagic and ischemic variants. F1000Res 2017; 6:1531. [PMID: 29034081 PMCID: PMC5615769 DOI: 10.12688/f1000research.12117.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 02/03/2023] Open
Abstract
Background: Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated. Methods: Alternate day renal function testing was performed in hospitalized stroke patients. Estimated glomerular filtration rate (e-GFR) was calculated and the trend of renal function in the two stroke subgroups (haemorrhagic and ischemic) was assessed, with renal impairment defined as e-GFR < 60mL/ minute per 1.73m 2. Results: Among 52 patients, 25 had haemorrhagic stroke (mean age 59.81 ± 14.67) and 27 had ischemic stroke (mean age 56.12 ± 13.08). The mean e-GFR (mL/minute per 1.732m 2) at admission in the haemorrhagic stroke subgroup was 64.79 ± 25.85 compared to 86.04 ± 26.09 in the ischemic stroke subgroup (p=0.005). Sixteen out of 25 (64%) patients in the haemorrhagic stroke subgroup and 9 out of 27 (33.3%) patients in the ischemic subgroup developed renal impairment (p=0.27). The location of the bleed (p=0.8), volume of hematoma (p=0.966) and surgical intervention (p=0.4) did not predispose the patients to renal impairment. One out of 16 patients with haemorrhagic stroke (who eventually died), and 2 out of 9 patients with ischemic stroke required renal replacement. Conclusion: Renal impairment is commonly seen in stroke patients, more so in patients who suffered haemorrhagic strokes. The impairment, however, is transient and rarely requires renal replacement therapy.
Collapse
Affiliation(s)
- Pratyush Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shalima Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shikher Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Subash Lohani
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Suresh BK
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Oscar MacCormac
- Department of Neurosurgery, St Mary’s Hospital, London, W2 1NY, UK
| | - Lekhjung Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | | |
Collapse
|
74
|
Shrestha P, Thapa S, Shrestha S, Lohani S, BK S, MacCormac O, Thapa L, Devkota UP. Renal impairment in stroke patients: A comparison between the haemorrhagic and ischemic variants. F1000Res 2017; 6:1531. [PMID: 29034081 PMCID: PMC5615769 DOI: 10.12688/f1000research.12117.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background: Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated. Methods: Alternate day renal function testing was performed in hospitalized stroke patients. Estimated glomerular filtration rate (e-GFR) was calculated and the trend of renal function in the two stroke subgroups (haemorrhagic and ischemic) was assessed, with renal impairment defined as e-GFR < 60mL/ minute per 1.73m 2. Results: Among 52 patients, 25 had haemorrhagic stroke (mean age 59.81 ± 14.67) and 27 had ischemic stroke (mean age 56.12 ± 13.08). The mean e-GFR (mL/minute per 1.732m 2) at admission in the haemorrhagic stroke subgroup was 64.79 ± 25.85 compared to 86.04 ± 26.09 in the ischemic stroke subgroup (p=0.005). Sixteen out of 25 (64%) patients in the haemorrhagic stroke subgroup and 9 out of 27 (33.3%) patients in the ischemic subgroup developed renal impairment (p=0.027). The location of the bleed (p=0.8), volume of hematoma (p=0.966) and surgical intervention (p=0.4) did not predispose the patients to renal impairment. One out of 16 patients with haemorrhagic stroke (who eventually died), and 2 out of 9 patients with ischemic stroke required renal replacement. Conclusion: Renal impairment is commonly seen in stroke patients, more so in patients who suffered haemorrhagic strokes. The impairment, however, is transient and rarely requires renal replacement therapy.
Collapse
Affiliation(s)
- Pratyush Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shalima Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shikher Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Subash Lohani
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Suresh BK
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Oscar MacCormac
- Department of Neurosurgery, St Mary’s Hospital, London, W2 1NY, UK
| | - Lekhjung Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | | |
Collapse
|
75
|
Gaidhani N, Sun F, Schreihofer D, Uteshev VV. Duration of isoflurane-based surgical anesthesia determines severity of brain injury and neurological deficits after a transient focal ischemia in young adult rats. Brain Res Bull 2017; 134:168-176. [PMID: 28755978 DOI: 10.1016/j.brainresbull.2017.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 01/26/2023]
Abstract
Tremendous efforts and funds invested in discovery of novel drug treatments for ischemic stroke have so far failed to deliver clinically efficacious therapies. The reasons for these failures are not fully understood. An indiscriminate use of isoflurane-based surgical anesthesia with or without nitrous oxide may act as an unconstrained, untraceable source of data variability, potentially causing false-positive or false-negative results. To test this hypothesis, a common transient suture middle cerebral artery occlusion (tMCAO) model of ischemic stroke in young adult male rats was used to determine the impact of a typical range of anesthesia durations required for this model on data variability (i.e., infarct volume and neurological deficits). The animals were maintained on spontaneous ventilation. The study results indicated that: (1) Variable duration of isoflurane anesthesia prior, during and after tMCAO is a significant source of data variability as evidenced by measurements of infarct volume and neurological deficits; and (2) Severity of brain injury and neurological deficits after tMCAO is inversely related to the duration of isoflurane anesthesia: e.g., in our study, a 90min isoflurane anesthesia nearly completely protected brain tissues from tMCAO-induced injury and thus, would be expected to obscure the effects of stroke treatments in pre-clinical trials. To elevate transparency, rigor and reproducibility of stroke research and minimize undesirable effects of isoflurane on the outcome of novel drug testing, we propose to monitor, minimize and standardize isoflurane anesthesia in experimental surgeries and make anesthesia duration a required reportable parameter in pre-clinical studies. Specifically, we propose to adopt 20-30min as an optimal anesthesia duration that both minimizes neuroprotective effects of isoflurane and permits a successful completion of surgical procedures in a suture tMCAO model of ischemic stroke in rodents. As the mechanisms and neuroprotective, metabolic and immune effects of general anesthesia are not fully understood, the results of this study cannot be blindly generalized to other anesthetics, animal species and experimental models.
Collapse
Affiliation(s)
- Nikhil Gaidhani
- University of North Texas Health Science Center, Institute for Healthy Aging, Center for Neuroscience Discovery, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United States
| | - Fen Sun
- University of North Texas Health Science Center, Institute for Healthy Aging, Center for Neuroscience Discovery, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United States
| | - Derek Schreihofer
- University of North Texas Health Science Center, Institute for Healthy Aging, Center for Neuroscience Discovery, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United States
| | - Victor V Uteshev
- University of North Texas Health Science Center, Institute for Healthy Aging, Center for Neuroscience Discovery, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United States.
| |
Collapse
|
76
|
Akel T. Recovery from spinal cord infarction associated with cannabis use. J Spinal Cord Med 2017; 40:492-495. [PMID: 28134030 PMCID: PMC5537969 DOI: 10.1080/10790268.2016.1258969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Cerebrovascular and cardiovascular accidents have been associated with illicit drug use. The most commonly used substance worldwide is cannabis. It has been related to acute ischemic cerebral stroke in multiple reports, with different mechanisms suggested. FINDINGS This is a case of Acute Spinal Cord Ischemia Syndrome (ASCIS) in a 25-year-old male who presented 20 minutes after smoking cannabis. Although a direct causal relationship between cannabis and cerebrovascular accidents is difficult to establish, there might be an association. CONCLUSION The presented patient didn't have any vascular risk factors, and his symptoms started 20 minutes after smoking cannabis. This signifies a possible association between ASCIS and cannabis use.
Collapse
Affiliation(s)
- Tamer Akel
- Correspondence to: Tamer Akel, MD, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.
| |
Collapse
|
77
|
Naylor J, Churilov L, Rane N, Chen Z, Campbell BCV, Yan B. Reliability and Utility of the Alberta Stroke Program Early Computed Tomography Score in Hyperacute Stroke. J Stroke Cerebrovasc Dis 2017; 26:2547-2552. [PMID: 28652060 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 11/28/2022] Open
Abstract
GOAL The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on non-contrast computed tomography (NCCT) is dependent on the visibility of early ischemic change. The goal of our study was to evaluate whether time from ischemic stroke onset to initial NCCT influences the inter-rater variability and prognostic accuracy of ASPECTS for a 3-month functional outcome. MATERIALS AND METHODS Ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA) from 2007 to 2014 at the Royal Melbourne Hospital were included. ASPECTS were blindly assessed by 2 independent raters with inter-rater agreement determined by weighted kappa. Onset time to computed tomography time was dichotomized at the median (≤100 and >100 minutes). Outcome was assessed using the modified Rankin Scale. Logistic regression and receiver operating characteristic analysis were used to assess the prognostic utility of ASPECTS in the early and later time periods. RESULTS There were 379 patients included. Inter-rater agreement was significantly lower in the early time period: kappa = .75 (95% confidence interval (CI), .59-.84) ≤ 100 minutes versus .92 (95% CI, .91-.93) > 100 minutes, P < .001. The distributions of absolute inter-rater differences in ASPECTS differed significantly between time epochs (P = .03). The prognostic accuracies of ASPECTS across time epochs were area under the receiver operating characteristic curve ≤ 100 minutes = .57 (95% CI, .50-.64) and >100 minutes = .66 (95% CI, .59-.73), P = .055. CONCLUSIONS This study demonstrated a significantly lower inter-rater agreement and a trend toward reduced prognostic accuracy of ASPECTS in earlier time periods. The use of ASPECTS to select patients for revascularization in early time windows may be unreliable.
Collapse
Affiliation(s)
- Jillian Naylor
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - Leonid Churilov
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Neil Rane
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Ziyuan Chen
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Bruce C V Campbell
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
78
|
Saglio G, le Coutre P, Cortes J, Mayer J, Rowlings P, Mahon FX, Kroog G, Gooden K, Subar M, Shah NP. Evaluation of cardiovascular ischemic event rates in dasatinib-treated patients using standardized incidence ratios. Ann Hematol 2017; 96:1303-1313. [PMID: 28534184 PMCID: PMC5486782 DOI: 10.1007/s00277-017-3012-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/27/2017] [Indexed: 12/18/2022]
Abstract
With high survival rates for chronic myeloid leukemia (CML) patients treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs), emerging consequences, such as arterial ischemic events, require consideration when evaluating treatment options. Cardiovascular ischemic event incidence in clinical trials was evaluated in 2712 dasatinib-treated patients with Philadelphia chromosome-positive (Ph+) leukemias from 11 first- and second-line trials (pooled), newly diagnosed CML patients treated with dasatinib or imatinib (DASISION), and prostate cancer patients treated with dasatinib or placebo plus docetaxel/prednisone (READY). Overall, 2-4% of dasatinib-treated patients had cardiovascular ischemic events. Most dasatinib-treated patients with an event had a history of and/or risk factor for atherosclerosis (pooled 77 with history/risk and event/96 with events; DASISION 8/10; READY 15/18). Most cardiovascular ischemic events occurred within 1 year of initiating dasatinib (pooled 69/96; DASISION 7/10; READY 16/18). Comparison of observed and expected event rates through standardized incidence ratios indicates that dasatinib does not increase risk for cardiovascular ischemic events compared with external reference populations.
Collapse
Affiliation(s)
- Giuseppe Saglio
- Clinical and Biological Sciences of the University of Turin, San Luigi Hospital, 10043, Orbassano-Torino, Italy.
| | - Philipp le Coutre
- Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Cortes
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jiří Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Philip Rowlings
- Calvary Mater Newcastle Hospital, University of Newcastle, Waratah, NSW, Australia
| | - François-Xavier Mahon
- Laboratoire d'Hématologie et Service des Maladies du Sang, Bordeaux et Institut Bergonié, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | - Neil P Shah
- UCSF School of Medicine, San Francisco, CA, USA
| |
Collapse
|
79
|
Zhong W, Jina H, Rathore P, Wong ELH, Mancuso P, Lalak N, Hayden L, Haghighi K. A Case Report of Priapism With Unusual Presentation and Clinical Course. Urol Case Rep 2017; 12:70-72. [PMID: 28377890 PMCID: PMC5377290 DOI: 10.1016/j.eucr.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/08/2017] [Indexed: 11/23/2022] Open
Abstract
This is a case report on a patient with an unusual presentation and clinical course of priapism. It further discusses treatment options with reflection on current literatures and guidelines. 48 year old patient presented with a history of more than 50 episodes of priapism, each lasting for five minutes. Patient had history of brain tumor that was resected and had since been in remission. On examination and further biochemistry assessment revealed conflicting clinical findings, making it difficult to ascertain the type of priapism in this case. The patient, however, recovered from the acute attacks of priapism after 24 hours of conservative management and no obvious cause had been identified on post-discharge follow-up. Priapism, despite being rare, is a medical emergency. This case report reflected upon the limitations of treatment guidelines and the lack of level one evidence to support treatment decisions.
Collapse
Affiliation(s)
- Wenjie Zhong
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Hamesh Jina
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Prem Rathore
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Eddy Lee Hao Wong
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Pascal Mancuso
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Nestor Lalak
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Lawrence Hayden
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - Kayvan Haghighi
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| |
Collapse
|
80
|
Abstract
IgA vasculitis is primarily a pediatric disease that is rarely encountered in adults. With adults, gastrointestinal manifestations are quite common, yet are nonspecific and may overlap with other diseases, particularly Crohn's disease, which can make the diagnosis a challenging task. Treatment is controversial given the disease course is usually self-limited with few serious complications. We present a case of IgA vasculitis in an adult patient with limited extraintestinal findings illustrating the complexity of arriving at the correct diagnosis.
Collapse
|
81
|
Nasri A, Mansour M, Brahem Z, Kacem A, Hassan AA, Derbali H, Messelmani M, Zaouali J, Mrissa R. Stroke disclosing primary aldosteronism: Report on three cases and review of the literature. Ann Endocrinol (Paris) 2017; 78:9-13. [PMID: 28168953 DOI: 10.1016/j.ando.2016.07.993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There is a growing evidence of increased risk of cerebrovascular events in primary aldosteronism (PA). Nevertheless, acute neurologic ailment as presenting feature of PA is uncommon. Our aim is to highlight the diagnosis challenges in stroke unmasking PA and to discuss the underlying physiopathology and management dilemmas. MATERIALS AND METHODS We hereby describe three consecutive rare cases of stroke revealing PA. All patients had brain imaging and thorough biological and morphological assessment to rule out other etiologies of stroke. The diagnosis of primary aldosteronism was established according to the Endocrine Society Clinical Practice Guideline, with a review of the literature on the spectrum of neurologic manifestations in PA. RESULTS We report on three cases, two women and a man, presenting with ischemic or hemorrhagic stroke, of early onset in two of them. All of the reported patients had hypertension and hypokaliemia. This association prompted the assessment of renin angiotensin aldosterone system (RAAS) disclosing PA, which was due to bilateral adenomas in the first one or bilateral adrenal hyperplasia in the two others. All patients refused the surgical option and received spironolactone with recurrence of stroke in one of them due to treatment incompliance. CONCLUSION Although cerebrovascular events are quite common in PA, their occurrence as initial feature can be misleading. The association of hypokaliemia and refractory hypertension in ischemic or hemorrhagic strokes should prompt an assessment of the RAAS to rule out PA and initiate adequate management as soon as possible in order to avoid further complications.
Collapse
Affiliation(s)
- Amina Nasri
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
| | - Malek Mansour
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Zeineb Brahem
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Amel Kacem
- Department of Medicine, Regional Hospital of Jendouba, Tunisia
| | - Ahmed Abou Hassan
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Hager Derbali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Meriem Messelmani
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Jamel Zaouali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Ridha Mrissa
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| |
Collapse
|
82
|
Yu H, Huang Y, Chen X, Nie W, Wang Y, Jiao Y, Reed GL, Gu W, Chen H. High-sensitivity C-reactive protein in stroke patients - The importance in consideration of influence of multiple factors in the predictability for disease severity and death. J Clin Neurosci 2016; 36:12-19. [PMID: 27825611 DOI: 10.1016/j.jocn.2016.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/15/2016] [Indexed: 02/06/2023]
Abstract
High sensitivity C-reactive protein (hsCRP) has been evaluated as a biomarker in stroke and relevant pathological diseases. While its predictive values in several pathological phenotypes have been confirmed, controversy exists among different studies. This review summarizes reports of the predictive values of hsCRP for the diagnosis, etiology, prognosis and mortality of stroke diseases. The current literature suggests that CRP expression is influenced by multiple factors, such as polymorphisms, the genomic backgrounds and gender. However, few reported studies analyzed data based on all these multiple factors. Future studies should focus on comprehensive analysis based on multiple factors.
Collapse
Affiliation(s)
- Hong Yu
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China; Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Yue Huang
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - XinYu Chen
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China
| | - WenBao Nie
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China
| | - YongJun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Yan Jiao
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Guy L Reed
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Hong Chen
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China.
| |
Collapse
|
83
|
Tuttolomondo A, Casuccio A, Della Corte V, Maida C, Pecoraro R, Di Raimondo D, Vassallo V, Simonetta I, Arnao V, Pinto A. Endothelial function and arterial stiffness indexes in subjects with acute ischemic stroke: Relationship with TOAST subtype. Atherosclerosis 2016; 256:94-99. [PMID: 27817840 DOI: 10.1016/j.atherosclerosis.2016.10.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/09/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Only one study has examined endothelial function in subjects with acute ischemic stroke and no study has yet assessed arterial stiffness and reactive hyperemia peripheral arterial tonometry (RH-PAT) in ischemic stroke and its clinical subtypes. Our study aimed to evaluate arterial stiffness and endothelial dysfunction indexes in patients with acute ischemic stroke and the relationship between endothelial dysfunction indexes and arterial stiffness markers and stroke subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification. METHODS We enrolled 98 patients with a diagnosis of acute ischemic stroke and 105 hospitalized patients without a diagnosis of acute ischemic stroke. Arterial stiffness analysis was conducted by applanation tonometry to record radial artery pressure waveform continuously; augmentation index (Aix) and pulse wave velocity (PWV) were calculated. The reactive hyperemia index (RHI) was assessed by peripheral arterial tonometry. RESULTS In comparison to controls, ischemic stroke subjects had higher mean levels of PWV, Aix, and significantly lower mean RHI values. Compared to subjects with lacunar and cardioembolic stroke, those with Large Artery AtheroSclerosis (LAAS) subtype of stroke had higher median levels of PWV and significantly lower median levels of RHI. On multinomial logistic regression analysis of predictive variables of stroke subtype (lacunar vs. LAAS and lacunar vs. cardioembolic), we observed a negative association between RHI value and LAAS subtype and a negative association of PWV with cardioembolic subtype. CONCLUSIONS Our findings underline the relationship between endothelial and arterial stiffness index correlations in patients with acute ischemic stroke, also suggesting the use of a combination of PAT and arterial stiffness indexes to better categorize patients with ischemic stroke.
Collapse
Affiliation(s)
- Antonino Tuttolomondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy.
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother Child, University of Palermo, Italy
| | - Vittoriano Della Corte
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| | - Carlo Maida
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| | - Rosaria Pecoraro
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| | - Domenico Di Raimondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| | - Valerio Vassallo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| | - Irene Simonetta
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| | - Valentina Arnao
- Department of Experimental Medicine and Clinical Neurosciences, University of Palermo, Italy
| | - Antonio Pinto
- U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi. M.I.S), University of Palermo, Italy
| |
Collapse
|
84
|
Zhou W, Zhang J, Wang G, Ling L, Yan C. Permeability and distribution of nerve growth factor in the brain of neonatal rats by periphery venous injection in hypoxic- ischemic state. Springerplus 2016; 5:1893. [PMID: 27843750 PMCID: PMC5084138 DOI: 10.1186/s40064-016-3594-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 10/21/2016] [Indexed: 12/23/2022]
Abstract
Objective To investigate the permeability of β-NGF through blood–brain-barrier (BBB) in neonatal and adult rats, and the spatial distribution of β-NGF in different brain regions in hypoxic-ischemic (HI) and normal neonatal rats. Methods To investigate the overall permeability of β-NGF through BBB, β-NGF labeled with I125 was injected into adult rats, neonatal rats and HI neonatal rats via tail vein. The radioactivity of brain tissue and blood was examined and analyzed 30 min after injection. Also, brain regions including the basal forebrain, frontal cortex, hippocampus, hypothalamus, cerebellum, bulbus olfactorius and hypophysis, of all the rats were dissected and radioactivity was examined to investigate the spatial specificity of NGF permeation through BBB. Results Statistically significant results were observed in I125-β-NGF contents in brain tissues of adult rats group, neonatal rats group and HI neonatal rats group (P < 0.05). Compared to the HI neonatal rats’ brain with the highest I125-β-NGF contents, normal neonatal rats ranks the second while the adult rats were the lowest. While for the spatial specificity examination part, I125-β-NGF in both HI group and control group were widely distributed in basal forebrain, frontal cortex, hippocampus, cerebellum and bulbus olfactorius. But the radioactivity in frontal cortex, hippocampus and cerebellum of HI groups are statistically higher than control groups (P < 0.05). Conclusion β-NGF can more easily penetrate the BBB of newborn rats than adult rats via peripheral venous administration and this effect can be enhanced by HI insult. Also, this HI-induced permeation of β-NGF through BBB is more obvious in frontal cortex, hippocampus and cerebellum.
Collapse
Affiliation(s)
- Wenli Zhou
- Department of Neonatology, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin China
| | - Jiantao Zhang
- Department of Colorectal and Anal Surgery, The First Hospital of Jilin University, Changchun, 130021 Jilin China
| | - Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021 Jilin China
| | - Limian Ling
- Department of Colorectal and Anal Surgery, The First Hospital of Jilin University, Changchun, 130021 Jilin China
| | - Chaoying Yan
- Department of Neonatology, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021 Jilin China
| |
Collapse
|
85
|
Abstract
BACKGROUND The association between lipid levels and stroke rates is less than lipid levels and coronary heart disease (CHD). OBJECTIVE To assess if there are geographic, racial, and ethnic differences in total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride levels with incident stroke. METHODS From the REasons for Geographic And Racial Differences in Stroke (REGARDS) study we evaluated baseline levels of LDL-C, HCL-C, TC, Non-HDL-C (Total-HDL-C) and triglycerides in participants free of prevalent stroke at baseline. Cox Proportional-Hazard models were the main analytical tool used to examine the association between incident stroke and lipids. For each adjusted lipid measure (LDL-C, HDL-C, triglycerides, TC, and non-HDL-C) we calculated a series of incremental models. RESULTS The analysis cohort was 23,867 participants with a mean follow-up time of 7.5±2.9years, and 1031 centrally adjudicated strokes (874 ischemic and 77 hemorrhagic strokes). HDL-C baseline level was associated with an overall unadjusted 13% risk reduction (HR 0.87, 95% confidence interval [CI]: 0.81-0.93; p<0.05; 14% for ischemic and 16% for hemorrhagic strokes), and TC with an 8% (HR 0.92, 95%CI: 0.87-0.99; p<0.05) risk reduction of all strokes. When the results were fully adjusted a significant association was observed only for LDL-C and non-HDL-C and ischemic stroke. There were no significant differences in these associations when adjusted for age, race, age∗race, gender, education, region, or income. CONCLUSION In a disease free population, LDL-C and non-HDL-C baseline levels are significantly associated with the risk of ischemic stroke.
Collapse
Affiliation(s)
- Stephen P Glasser
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Aleena Mosher
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland.
| |
Collapse
|
86
|
Ogawa Y, Niizuma K, Mugikura S, Tominaga T. Ischemic pituitary adenoma apoplexy-Clinical appearance and prognosis after surgical intervention. Clin Neurol Neurosurg 2016; 148:142-6. [PMID: 27449534 DOI: 10.1016/j.clineuro.2016.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several retrospective investigations have recommended more passive surgical indications for intratumoral hemorrhage of pituitary adenomas due to probable spontaneous resolution. However, no definitive analyses have compared pituitary adenomas with hemorrhagic apoplexy and intratumoral hemorrhage without evident apoplectic symptoms or pituitary adenoma infarction. METHODS This study retrospectively identified 43 patients with symptomatic pituitary apoplexy among 1067 patients with pituitary adenomas initially treated by surgery at a single institute between April 2005 and May 2015, with 27 cases of hemorrhagic (2.53%) and 16 cases of ischemic apoplexy (1.50%). The inclusion criteria involved evident and sudden onset of symptoms and simultaneous histological confirmation as hemorrhagic or ischemic pituitary apoplexy. Diagnostic differentiation with magnetic resonance (MR) imaging was performed to examine the agreement between MR imaging and histological findings, and the clinical appearance and mid-term prognosis were compared for ischemic pituitary apoplexy and hemorrhagic apoplexy. RESULTS Diagnostic matching with MR imaging could be performed in 41 of 43 patients (25 with hemorrhagic and 16 with ischemic apoplexy). Agreement with the histological finding was found in 32 of 41 patients overall (78%), 23 of 25 patients with hemorrhagic apoplexy (92%), and 9 of 16 patients with ischemic apoplexy (56%). The main reason for diagnostic discrepancy was thought to be the difficulty in identifying ischemic lesion. All patients in the ischemic group suffered progression of symptoms from initial onset including various cranial nerve palsies, aseptic meningitis, and decreased level of consciousness, whereas the hemorrhagic group suffered progression in 4 of 27 patients. Ischemic group showed a statistically stronger tendency to disease progression than the hemorrhagic group (P<0.001). Endocrinological examinations showed 4 patients required no hormone supplement therapies but the other 11 patients had persistent hypopituitarism and required hormone supplementation in the ischemic group, whereas 2 of 25 patients required hormone supplementation in the hemorrhagic group. Endocrinological recovery showed a significant difference between the ischemic group and hemorrhagic group (P<0.01). CONCLUSIONS Ischemic pituitary adenoma apoplexy has a more severe clinical course than hemorrhagic apoplexy. Development of preoperative diagnostic technology to differentiate ischemic from hemorrhagic apoplexy is required to improve the low rate of agreement between the histological and MR imaging findings in patients with ischemic apoplexy.
Collapse
Affiliation(s)
- Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai. Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan, Japan
| |
Collapse
|
87
|
Thomsen B, Garosi L, Skerritt G, Rusbridge C, Sparrow T, Berendt M, Gredal H. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke. Acta Vet Scand 2016; 58:40. [PMID: 27267355 PMCID: PMC4897939 DOI: 10.1186/s13028-016-0219-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In dogs with ischaemic stroke, a very common site of infarction is the cerebellum. The aim of this study was to characterise neurological signs in relation to infarct topography in dogs with suspected cerebellar ischaemic stroke and to report short-term outcome confined to the hospitalisation period. A retrospective multicentre study of dogs with suspected cerebellar ischaemic stroke examined from 2010-2015 at five veterinary referral hospitals was performed. Findings from clinical, neurological, and paraclinical investigations including magnetic resonance imaging were assessed. RESULTS Twenty-three dogs, 13 females and 10 males with a median age of 8 years and 8 months, were included in the study. The Cavalier King Charles Spaniel (n = 9) was a commonly represented breed. All ischaemic strokes were located to the vascular territory of the rostral cerebellar artery including four extensive and 19 limited occlusions. The most prominent neurological deficits were gait abnormalities (ataxia with hypermetria n = 11, ataxia without hypermetria n = 4, non-ambulatory n = 6), head tilt (n = 13), nystagmus (n = 8), decreased menace response (n = 7), postural reaction deficits (n = 7), and proprioceptive deficits (n = 5). Neurological signs appeared irrespective of the infarct being classified as extensive or limited. All dogs survived and were discharged within 1-10 days of hospitalisation. CONCLUSIONS Dogs affected by rostral cerebellar ischaemic stroke typically present with a collection of neurological deficits characterised by ataxia, head tilt, and nystagmus irrespective of the specific cerebellar infarct topography. In dogs with peracute to acute onset of these neurological deficits, cerebellar ischaemic stroke should be considered an important differential diagnosis, and neuroimaging investigations are indicated. Although dogs are often severely compromised at presentation, short-term prognosis is excellent and rapid clinical improvement may be observed within the first week following the ischaemic stroke.
Collapse
|
88
|
Aziz ZA, Lee YY, Sidek NN, Ngah BA, Looi I, Hanip MR, Basri HB. Gender disparities and thrombolysis use among patient with first-ever ischemic stroke in Malaysia. Neurol Res 2016; 38:406-13. [PMID: 27142804 DOI: 10.1080/01616412.2016.1178948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Gender as an independent predictor in stroke has been well documented. However, data on gender differences among first-ever ischemic stroke in developing country are limited. We aim to describe gender effects on clinical characteristics, thrombolysis treatment received, and outcomes of patients with first-ever ischemic stroke. METHODS Data were extracted from the prospective multiethnic stroke registry, National Neurology Registry (NNEUR). Descriptive analysis and logistic regression were performed. RESULTS A total of 4762 first-ever ischemic stroke patients admitted to 13 government hospitals from July 2009 to June 2015 were available for this study. Slightly over half were male (55.1%), and they were 1.7 years younger than female (mean age, 63.6 versus 61.9 years, p < 0.001). Gender-age-adjusted incidence was observed to be higher in females (66.7 per 100,000) compared to males (57.4 per 100,000). First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. Female experienced significantly poorer functional outcome and greater 30-day in-hospital mortality compared to male. In subgroup analysis, only 31 (0.65%) patients were treated with thrombolysis. DISCUSSION First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. There were distinct symptoms at hospital presentation between genders. All our patients discharged home regardless of genders. In summary, Malaysian female first-ever ischemic stroke was older, present with severe stroke, greater number of risk factors and poorer functional outcome and 30-day in-hospital mortality compared to male.
Collapse
Affiliation(s)
- Zariah A Aziz
- a Department of Neurology and Clinical Research Centre , Hospital Sultanah Nur Zahirah , Kuala Terengganu , Malaysia
| | - Yvonne Yl Lee
- b Health and Value, Pfizer Malaysia , Level 10 & 11, Wisma Averis , Kuala Lumpur , Malaysia
| | | | - Bahari Awang Ngah
- c Department of Pharmacy , Hospital Sultanah Nur Zahirah , Kuala Terengganu , Malaysia
| | - Irene Looi
- e Department of Medicine and Clinical Research Centre , Hospital Seberang Jaya , Prai , Malaysia
| | - Md Rafia Hanip
- f Department of Neurology , Hospital Kuala Lumpur , Kuala Lumpur , Malaysia
| | - Hamidon B Basri
- g Faculty of Medicine & Health Sciences, Department of Medicine , Universiti Putra Malaysia , Kuala Lumpur , Malaysia
| |
Collapse
|
89
|
Yang M, Orgah J, Zhu J, Fan G, Han J, Wang X, Zhang B, Zhu Y. Danhong injection attenuates cardiac injury induced by ischemic and reperfused neuronal cells through regulating arginine vasopressin expression and secretion. Brain Res 2016; 1642:516-523. [PMID: 27107944 DOI: 10.1016/j.brainres.2016.04.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/11/2022]
Abstract
Ischemic stroke is associated with cardiac myocyte vulnerability through some unknown mechanisms. Arginine vasopressin (AVP) may exert considerable function in the relationship of brain damage and heart failure. Danhong injection (DHI) can protect both stroke and heart failure patients with good efficacy in clinics. The aim of this study is to investigate the mechanism of DHI in heart and brain co-protection effects to determine whether AVP plays key role in this course. In the present study, we found that both the supernatant from oxygen-glucose deprivation (OGD) and reperfused primary rat neuronal cells (PRNCs) and AVP treatment caused significant reduction in cell viability and mitochondrial activity in primary rat cardiac myocytes (RCMs). Besides, DHI had the same protective effects with conivaptan, a dual vasopressin V1A and V2 receptor antagonist, in reducing the RCM damage induced by overdose AVP. DHI significantly decreased the injury of both PRNCs and RCMs. Meanwhile, the AVP level was elevated dramatically in OGD and reperfusion PRNCs, and DHI was able to decrease the AVP expression in the injured PRNCs. Therefore, our present results suggested that OGD and reperfusion PRNCs might induce myocyte injury by elevating the AVP expression in PRNCs. The ability of DHI to reinstate AVP level may be one of the mechanisms of its brain and heart co-protection effects.
Collapse
Affiliation(s)
- Mingzhu Yang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China; Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, TEDA, 220 Dongting Road, Tianjin 300457, China
| | - John Orgah
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China; Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, TEDA, 220 Dongting Road, Tianjin 300457, China
| | - Jie Zhu
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China; Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, TEDA, 220 Dongting Road, Tianjin 300457, China
| | - Guanwei Fan
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China
| | - Jihong Han
- State Key Laboratory of Medicinal Chemical Biology, and Collaborative Innovation Center for Biotherapy, Nankai University, Tianjin 300071, China
| | - Xiaoying Wang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China; Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, TEDA, 220 Dongting Road, Tianjin 300457, China; Neuroscience Program, Neuroprotection Research Laboratory, Department of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02135, USA
| | - Boli Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China
| | - Yan Zhu
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 312 Anshanxi Road, Nankai District, Tianjin 300193, China; Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology & Medicine, TEDA, 220 Dongting Road, Tianjin 300457, China; Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, 750 Washington Street, Boston, MA 02111, USA.
| |
Collapse
|
90
|
Kumar A, Aakriti, Gupta V. A review on animal models of stroke: An update. Brain Res Bull 2016; 122:35-44. [PMID: 26902651 DOI: 10.1016/j.brainresbull.2016.02.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 01/11/2023]
Abstract
Stroke is one of the major healthcare challenges prevailing across the globe due to its significant rate of mortality and morbidity. Stroke is multifactorial in nature and involves several cellular and molecular signaling cascades that make the pathogenesis complex and treatment difficult. For a deeper understanding of the diverse pathological mechanisms and molecular & cellular cascades during stroke, animal modeling serves as a reliable and an effective tool. This also helps to develop and critically analyse various neuroprotective strategies for the mitigation of this devastating disease. Animal modeling for stroke has been revolutionized with the development of newer and more relevant models or approaches that mimic the clinical setting of stroke to a greater extent. This review analyses experimental models of stroke (ischemic and hemorrhagic) and their reliability in stroke situation. Besides this, the review also stresses upon the use of various preclinical models to understand the pathophysiological mechanisms that operate during stroke and to elucidate new, safe and effective neuroprotective agents to combat this life threatening healthcare concern.
Collapse
|
91
|
Cheng XQ, Chen Q, Zhou CS, Li JR, Zhang ZJ, Zhang LJ, Huang W, Lu GM. Whole-brain CT perfusion combined with CT angiography for ischemic complications following microsurgical clipping and endovascular coiling of ruptured intracranial aneurysms. J Clin Neurosci 2016; 26:50-6. [PMID: 26775148 DOI: 10.1016/j.jocn.2015.05.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 10/22/2022]
Abstract
Ischemic complications associated with microsurgical clipping and endovascular coiling affects the outcome of patients with intracranial aneurysms. We prospectively evaluated 58 intracranial aneurysm patients who had neurological deterioration or presented with poor grade (Hunt-Hess grades III and IV), aneurysm size >13 mm and multiple aneurysms after clipping or coiling. Thirty patients had ischemic complications (52%) as demonstrated by whole-brain CT perfusion (WB-CTP) combined with CT angiography (CTA). Half of these 30 patients had treatment-associated reduction in the diameter of the parent vessels (n=6), ligation of the parent vessels or perforating arteries (n=2), and unexplained or indistinguishable vascular injury (n=7); seven of these 15 (73%) patients suffered infarction. The remaining 15 patients had disease-associated cerebral ischemia caused by generalized vasospasm (n=6) and focal vessel vasospasm (n=9); six of these 15 (40%) patients developed infarction. Three hemodynamic patterns of ischemic complications were found on WB-CTP, of which increased time to peak, time to delay and mean transit time associated with decreased cerebral blood flow and cerebral blood volume were the main predictors of irreversible ischemic lesions. In conclusion, WB-CTP combined with CTA can accurately determine the cause of neurological deterioration and classify ischemic complications. This combined approach may be helpful in assessing hemodynamic patterns and monitoring operative outcomes.
Collapse
Affiliation(s)
- Xiao Qing Cheng
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Qian Chen
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Jian Rui Li
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Zong Jun Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Wei Huang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China.
| |
Collapse
|
92
|
Alexander S. Transependymal Movement of Cerebrospinal Fluid in Neurological and Psychiatric Pathological Conditions. Acta Neurochir Suppl 2016; 122:295-300. [PMID: 27165925 DOI: 10.1007/978-3-319-22533-3_59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We retrospectively studied the anamnesis, in particular the etiology, the clinical picture, and computed tomography/magnetic resonance imaging/ultrasound data, in the dynamics of a heterogeneous group of 127 patients with neurological and psychiatric pathological conditions. We were interested in the reasons for the occurrence, the clinical value of various neuroimaging abnormalities in the white matter of the brain, including the periventricular zone, the communication of their occurrence with the possible exit of CSF outside of the limits of the ventricular system. In some of the patients investigations into the cerebral blood flow in dynamics using transcranial Doppler was studied. Also in this regard, indications for and the application of minimally invasive neurosurgery techniques for brain revascularization were investigated.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Autistic Disorder/diagnostic imaging
- Autistic Disorder/metabolism
- Brain Ischemia/diagnostic imaging
- Brain Ischemia/metabolism
- Cerebral Palsy/diagnostic imaging
- Cerebral Palsy/metabolism
- Cerebral Ventricles/diagnostic imaging
- Cerebrospinal Fluid/metabolism
- Cerebrovascular Circulation
- Child
- Child, Preschool
- Depressive Disorder, Major/diagnostic imaging
- Depressive Disorder, Major/metabolism
- Ependyma/metabolism
- Female
- Humans
- Hypoxia-Ischemia, Brain/diagnostic imaging
- Hypoxia-Ischemia, Brain/metabolism
- Infant
- Infant, Newborn
- Intracranial Arteriosclerosis/diagnostic imaging
- Intracranial Arteriosclerosis/metabolism
- Magnetic Resonance Imaging
- Male
- Mental Disorders/diagnostic imaging
- Mental Disorders/metabolism
- Middle Aged
- Nervous System Diseases/diagnostic imaging
- Nervous System Diseases/metabolism
- Persistent Vegetative State/diagnostic imaging
- Persistent Vegetative State/metabolism
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Transcranial
- White Matter/diagnostic imaging
- White Matter/metabolism
- Young Adult
Collapse
|
93
|
LaPar DJ, Acker MA, Gelijns AC, Kron IL. Repair or replace for severe ischemic mitral regurgitation: prospective randomized multicenter data. Ann Cardiothorac Surg 2015; 4:411-6. [PMID: 26539344 DOI: 10.3978/j.issn.2225-319x.2015.04.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ischemic mitral regurgitation (IMR) is a subset of functional mitral regurgitation (MR) that has the potential to impact an increasing number of patients in the future. This is in the context of a worldwide population, which continues to live longer with improved survival after myocardial infarction. Substantial data have accumulated over the past few decades demonstrating the negative effects of IMR. Further, significant research has been done to define the optimal surgical approach and several studies have compared mitral repair versus replacement for patients with severe mitral regurgitation (SMR). Studies supporting performance of mitral repair cite superior operative morbidity and mortality rates, while proponents of mitral replacement cite improved long-term durability and correction of MR. Lack of clinically robust Level I randomized controlled trial data have curtailed attempts to better define appropriate surgical treatment allocation over the past few decades. Recently, however, the Cardiothoracic Surgical Trials Network (CTSN) conducted the first randomized controlled trial, funded by the National Heart, Lung, and Blood Institute, the National Institute for Neurological Diseases and Stroke and the Canadian Institute for Health Research, to compare the performance of mitral repair versus replacement for SMR. Herein, the present review describes the design, results and implications of the CTSN SMR trial and its efforts to identify the most efficacious surgical approach to SMR. This review also describes CTSN investigation to predict the recurrence of MR after mitral repair.
Collapse
Affiliation(s)
- Damien J LaPar
- 1 Investigators for the Cardiothoracic Surgical Trials Network (CTSN): University of Virginia School of Medicine, Charlottesville, VA, USA ; 2 University of Pennsylvania School of Medicine, Philadelphia, PA, USA ; 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael A Acker
- 1 Investigators for the Cardiothoracic Surgical Trials Network (CTSN): University of Virginia School of Medicine, Charlottesville, VA, USA ; 2 University of Pennsylvania School of Medicine, Philadelphia, PA, USA ; 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annetine C Gelijns
- 1 Investigators for the Cardiothoracic Surgical Trials Network (CTSN): University of Virginia School of Medicine, Charlottesville, VA, USA ; 2 University of Pennsylvania School of Medicine, Philadelphia, PA, USA ; 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Irving L Kron
- 1 Investigators for the Cardiothoracic Surgical Trials Network (CTSN): University of Virginia School of Medicine, Charlottesville, VA, USA ; 2 University of Pennsylvania School of Medicine, Philadelphia, PA, USA ; 3 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
94
|
Idiaquez J, Farias H, Torres F, Vega J, Low DA. Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke. Clin Neurol Neurosurg 2015; 139:188-91. [PMID: 26513431 DOI: 10.1016/j.clineuro.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/09/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. METHODS In 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). RESULTS The age (mean ± standard deviation) for the stroke group was 66 ± 12 and 63 ± 15 for the without stroke group (P=0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P=0.001). Domain scores for gastrointestinal (P=0.001), urinary (P=0.005) and cardiovascular (P=0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P=0.168) and for lateralization (P=0.6). SCOPA AUT scores were correlated with depression scores (P=0.001) but not with stroke severity (P=0.2). CONCLUSION Autonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke.
Collapse
|
95
|
Naffaa LN, Tandon YK, Irani N. Transcranial Doppler screening in sickle cell disease: The implications of using peak systolic criteria. World J Radiol 2015; 7:52-56. [PMID: 25729487 PMCID: PMC4326734 DOI: 10.4329/wjr.v7.i2.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/25/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare time average maximum mean velocity (TAMV) and peak systolic velocity (PSV) criteria of Trans Cranial Doppler (TCD) in their ability to predict abnormalities on magnetic resonance imaging (MRI)/magnetic resonance angiogram (MRA) in patients with sickle cell disease.
METHODS: A retrospective evaluation was performed of the outcomes in all patients with a Transcranial Doppler examination at our institution since the implementation of the hospital picture archiving and communication system (PACS) system in January 2003 through December 2012. All ultrasound imaging exams were performed by the same technologist with a 3 MHz transducer. Inclusion criteria was based upon the Transcranial Doppler procedure code in our PACS which had an indication of sickle cell disease in the history. The patient’s age and gender along with the vessel with the highest time averaged mean velocity as well as the highest peak systolic velocity was recorded for analysis. A subset of the study cohort also had subsequent MR imaging and Angiograms performed within 6 mo of the TCD examination. MRI results were categorized as having a disease related abnormality (vessel narrowing, collateral formation/moya-moya, or abnormal fluid attenuation inversion recovery signal in parenchyma indicative of prior stroke) or normal. The MRI results formed the comparison standards for TCD exams in evaluating intracranial injury. Sensitivity and specificity for the two TCD criteria (TAMV and PSV) were calculated to determine which could be a better predictor for intracranial vasculopathy /clinically occult strokes.
RESULTS: The study cohort for our institution was 110 patients with a total of 291 TCD examinations. These patients had a mean age of 7.6 years with a range from 2-18 years of age. Sixty-two of the 110 patients (56%) had two or more TCD exams. Thirty-seven patients (34%) had at least one MRI following a TCD examination. Of the 291 TCD examinations, 46 (16%) were conditional or abnormal by TAMV criteria. One hundred and sixteen (40%) were conditional or abnormal by PSV criteria. All studies that were abnormal by TAMV were also abnormal by PSV criteria. Seventy of the 116 (60%) studies which were conditional or abnormal by peak systolic criteria would not have been identified by time averaged mean maximum velocity criteria. The most frequent location of highest velocity measurement was noted to be in the middle cerebral artery regardless of whether it was measured by PSV or TAMV. From the 37 patients having one or more MRIs, 43 MRI exams were performed within 6 mo of a TCD examination. Twenty two (51%) MRIs had a disease related abnormality reported. When evaluating conditional or abnormal exams by PSV criteria against follow-up MRI/MRA, the sensitivity was 73% [16/(16 + 6)] and specificity was 81% [17/(4 + 17)]. When evaluating conditional or abnormal exams by TAMV criteria by follow-up MRI/MRA as the gold standard, the sensitivity was 41% [9/(9 + 13)] and the specificity was 100% [21/(21 + 0)]. In using conditional or abnormal criteria from PSV and TAMV to predict abnormalities on follow-up MRI/MR Angiogram, PSV was more sensitive (73% vs 41%) while TAMV was more specific (100% vs 81%).
CONCLUSION: Based on the data obtained at our institution and using the assumption that the best screening test is the one with the highest sensitivity, the peak systolic velocity could be the measurement of choice for TCD screening.
Collapse
|
96
|
Borhani-Haghighi A, Emami M, Vasaksi AS, Shariat A, Banihashemi MA, Nikseresht A, Ashjazadeh N, Izadi S, Petramfar P, Poursadegh M, Jaberi AR, Emami S, Agheli H, Nemati R, Yaghoubi E, Abdi MH, Mohammadi M, Jafari P, Cruz-Flores S, Edgell R. Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors. J Vasc Interv Neurol 2015; 8:11-16. [PMID: 25825626 PMCID: PMC4367801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA). METHODS This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects. RESULTS A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002). CONCLUSION It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patients.
Collapse
Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Emami
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Abdolhamid Shariat
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Nikseresht
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Ashjazadeh
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Poursadegh
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi Jaberi
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajjad Emami
- Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Agheli
- Neurologist, Shahidzadeh Hospital, Behbahan, Iran
| | - Reza Nemati
- Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | | | - Peyman Jafari
- Departments of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Randal Edgell
- Departments of Neurology and Psychiatry , Saint Louis University, Saint Louis, USA
| |
Collapse
|
97
|
Abstract
There is great interest to use magnetic resonance imaging (MRI) for non-invasive assessment of myocardial disease in ischemic and non-ischemic cardiomyopathies. Recently, there has been a renewed interest to use a magnetic resonance imaging (MRI) technique utilizing spin locking radiofrequency (RF) pulses, called T1ρ MRI. The spin locking RF pulse creates sensitivity to some mechanisms of nuclear relaxation such as 1H exchange between water and amide, amine and hydroxyl functional groups in molecules; consequently, there is the potential to non-invasively, and without exogenous contrast agents, obtain important molecular information from diseased myocardial tissue. The purpose of this article is to review and critically examine the recent published literature in the field related to T1ρ MRI of myocardial disease.
Collapse
Affiliation(s)
- Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, 9022 Gates, 3400 Spruce Street, Philadelphia, PA, USA
| | - Timo Liimatainen
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Robert C. Gorman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Smilow Center for Translational Research, 3400 Civic Center Blvd, Bldg 421, 7th floor, Rm 103, Philadelphia, PA 19104, USA
| | - Walter R. T. Witschey
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Smilow Center for Translational Research, 3400 Civic Center Blvd, Bldg 421, 7th floor, Rm 103, Philadelphia, PA 19104, USA
| |
Collapse
|
98
|
Stirbys P. Cardiac Events Theoretically Cannot Be Produced By Non- Ischemic And/Or Iso-Ischemic Myocardium: Challenging Postulations And Vitality Of The Concept Of "Ischemia-Dependent Conflictogenic Arrhythmias". J Atr Fibrillation 2013; 6:976. [PMID: 28496918 PMCID: PMC5153142 DOI: 10.4022/jafib.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 06/07/2023]
Abstract
Ischemia plays a key role in cardiac arrhythmogenesis, particularly in elderly patients. Healthy, non-ischemic and structurally normal myocardium is universally free from dysrhythmias. Thereby intact coronary blood flow prevents potential cardiac events. Hypothetically, ischemia-related electrophysiological differences are responsible for the supraventricular and/or ventricular rhythm irregularities. The goal of this review is to determine the role of systemic and coronary circulatory peculiarities and their association with heart rhythm abnormalities. The current analytical review extends and enriches previous knowledge about the influence of these peculiarities on the genesis of ischemia-dependent conflictogenic arrhythmias. Different intensity of coronary blood flow resulting from stenotic obstacles or vasospasm potentially leads to the non-uniform perfusion of myocites thus creating albeit subtle but vulnerable and powerful electrophysiologic substrate impending cardiac rhythm disturbances. Apparently, the behavior of both non-ischemic and iso-ischemic myocardium in respect to electric cardiac activity is very similar, at least theoretically. Some different clinical entities, e.g. arterial hypotension and/or anemia containing ischemic component, in most cases are free from arrhythmias. This postulation may be helpful in furthering arrhythmogenicity insights which have been generated previously. On the contrary, increased blood pressure often concurs with the supraventricular and/or ventricular arrhythmias; this pattern also favorably reflects our previous hypothetical assumptions associated with the mechanisms of arrhythmogenesis. Conclusively, both non-ischemic and iso-ischemic myocardium may be attributed to nonarrhythmogenic milieu. Nevertheless, the inventive analysis and more explorative data are required to support the suggested postulations.
Collapse
Affiliation(s)
- Petras Stirbys
- Department of Cardiology, Lithuanian University of Health Sciences Hospital, Kaunas Clinic, Kaunas, Lithuania
| |
Collapse
|
99
|
Cosme A, Montoro M, Santolaria S, Sanchez-Puertolas AB, Ponce M, Durán M, Cabriada JL, Borda N, Sarasqueta C, Bujanda L. Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. World J Gastroenterol 2013; 19:8042-8046. [PMID: 24307798 PMCID: PMC3848152 DOI: 10.3748/wjg.v19.i44.8042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the prognosis (recurrence and mortality) of patients with ischemic colitis (IC).
METHODS: This study was conducted in four Spanish hospitals, participants in the Ischemic Colitis in Spain study We analyzed prospectively 135 consecutive patients who met criteria for definitive or probable IC according to Brandt criteria, and follow up these patients during the next five years, retrospectively. Long-term results (recurrence and mortality) were evaluated retrospectively after a median interval of 62 mo (range 54-75 mo).
RESULTS: Estimated IC recurrence rates were 2.9%, 5.1%, 8.1% and 9.7% at years 1, 2, 3 and 5 years, respectively. Five-year survival was 69% (93 of 135) and 24% (10 of 42 patients) died for causes related to the IC. Among these 10 patients, 8 died in their first episode at hospital (4 had gangrenous colitis and 4 fulminant colitis) and 2 due to recurrence.
CONCLUSION: The five-year recurrence rate of IC was low. On the other hand, mortality during follow-up was high and was not associated with ischemic colitis.
Collapse
|
100
|
Nakibuuka J, Nyakoojo WB, Namale A, Ddumba E, Leontsini E, Nuwaha F. Utility of Transthoracic Echocardiography and Carotid Doppler Ultrasound in Differential Diagnosis and Management of Ischemic Stroke in a Developing Country. J Cardiol Clin Res 2013; 1:1012-1016. [PMID: 24749127 PMCID: PMC3990005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We sought to describe findings, diagnostic yield, cost effectiveness of transthoracic echocardiography (TEE) and Carotid doppler ultrasound (CDU) in ischemic stroke. METHODS Cross sectional study at Mulago hospital, Uganda. Institutional ethical approval, patient consent was obtained. Patients eighteen years and above with ischemic stroke confirmed by brain computerized tomography (CT) scan and met inclusion criteria were selected. TTE and CDU were done as part of comprehensive assessment for stroke risk factors. Data was analyzed using SPSS 14. Univariate analysis was done for social-demographics, abnormalities on cardiac imaging and diagnostic yield using TOAST criteria. Bivariate analysis for association between stroke risk factors, cardio-embolic stroke and other ischemic subtypes (diagnosed using clinical and CT scan features). Statistical significance was set at P<0.05. RESULTS Of 139 screened patients with suspected stroke, 127 underwent brain CT scan as 12 died before CT. Eighty five were confirmed stroke by CT scan with 66 (77.6%) ischemic stroke, mean age 62 years (SD+16.6), 53% were male. Out of 66, 62 (93.9%) underwent both TTE and CDU. Although only 7 (11.3%) reported history of heart disease, 43 (69.3%) had abnormal findings on TTE with left atrial enlargement commonest in 21 (48.8%). Thirty eight (61.3%) had abnormal finding on CDU with atherosclerosis commonest in 28 (45.2%). Using clinical and CT scan features, atherosclerotic stroke was the commonest subtype in 29 (46.8%) then cardio-embolic 18 (27.3%). Only 6 (9.7%) patients had abnormal findings on TTE suggesting possible cardio-embolism by TOAST criteria. None had stenosis >50% on CDU. Multiple valvular lesions P<0.001, severe valvular lesions P=0.001 were associated with cardio-embolic stroke. CONCLUSIONS Majority of ischemic stroke patients without previous history of heart disease had abnormal findings on TTE and CDU. Diagnostic yield for cardio-embolic stroke by TOAST criteria was very low given the high cost involved for a developing country.
Collapse
Affiliation(s)
- Jane Nakibuuka
- Department of Medicine, Mulago national referral hospital, Uganda
| | | | - Alice Namale
- Department of Medicine, Mulago national referral hospital, Uganda
| | - Edward Ddumba
- Department of Medicine, St Raphael of St Francis Nsambya Hospital, Uganda
| | - Elli Leontsini
- Department of International Health, John Hopkins University, USA
| | - Fred Nuwaha
- School of Public Health, Makerere University College of Health Sciences, Uganda
| |
Collapse
|