751
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Affiliation(s)
- Magnus O. Wijkman
- Departments of Internal Medicine and Medical and Health Sciences; Linkopings Universitet; Norrkoping Sweden
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752
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Chen L, Hua X, Song J, Wang L. Which aortic clamp strategy is better to reduce postoperative stroke and death: Single center report and a meta-analysis. Medicine (Baltimore) 2018; 97:e0221. [PMID: 29561451 PMCID: PMC5895326 DOI: 10.1097/md.0000000000010221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is severe complication of coronary artery bypass grafting (CABG) which may be associated with clamp strategy, there are 2 strategies to clamp aorta including single aortic clamp (SAC) and partial aortic clamp (PAC). It is controversial that which clamping strategy is better to reduce the postoperative stroke and death, so this study aims to investigate which is better for reducing postoperative stroke and death within 30 days. METHODS We collected 469 patients who had on-pump CABG in Fuwai Hospital during January 2014 to July 2015. The SAC group consisted of 265 patients while the PAC group included 204 patients. We compared the 2 group patient difference. At the same time, 12 studies were identified by systematic search. The odds ratio (OR) was used as effect index to compare SAC and PAC strategy by fix-effect modeling. We also tested heterogeneity and publication bias. The primary end point of study was occurrence of postoperative stroke within 30 days of operation, the second end point of study was the incidence of 30-day mortality. RESULTS The single center retrospective study showed that the patients in the SAC group were older than those in the PAC group (62.5 ± 8.1 vs 60.3 ± 8.0 years, P = .01). The proportions of peripheral vascular disease and hypertension of SAC were higher than PAC (71 (26.8%) versus 36 (17.6%), P = .02; 183 (69.1%) versus 115 (56.4%), P = .01, respectively). Besides, the number of vascular anastomosis was more in the SAC group (3.29 ± 0.74 versus 2.97 ± 0.974, P < .001). The linear-regression analysis suggested that the time of cardiopulmonary bypass of SAC was shorter than the PAC group (93.2 ± 22.4 vs.103.4 ± 26.8 minutes, P-regression < .001) and postoperative death within 30-days was similar (1 (0.4%) vs. 2 (1.0%), P-regression = .47). There was no stroke occurring in both the groups. And the meta-analysis suggested the postoperative stroke and death within 30-days were similar between SAC group and PAC group (OR: 0.78, 95% CI: 0.58-1.06; OR: 0.82, 95% CI: 0.61-1.10; respectively). Moreover, subgroup meta-analysis also had the same results. CONCLUSION There was no significant difference between SAC and PAC clamping strategy on postoperative stroke and death within 30-days; however, SAC can reduce the usage time of cardiopulmonary bypass.
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Affiliation(s)
- Liyu Chen
- Department of Cardiovascular Surgery
| | - Xiumeng Hua
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- Department of Cardiovascular Surgery
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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753
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Zhao B, Shi QJ, Zhang ZZ, Wang SY, Wang X, Wang H. Protective effects of paeonol on subacute/chronic brain injury during cerebral ischemia in rats. Exp Ther Med 2018; 15:3836-3846. [PMID: 29563983 PMCID: PMC5858057 DOI: 10.3892/etm.2018.5893] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
Ischemic stroke is a highly complex pathological process that is divided into acute, subacute and chronic phases. Paeonol is a biologically active natural product with a variety of pharmacological effects, including those on neuronal activity. However, the effects of paeonol on subacute/chronic ischemic stroke have remained to be elucidated. The present study was designed to investigate the effects of paeonol against subacute and chronic cerebral ischemic injury and to explore the possible underlying mechanisms. Male adult Sprague Dawley rats were randomly divided into a sham group (treated with saline), a model group [subjected to middle cerebral artery occlusion (MCAO) and treated with saline] and a paeonol-treated group (MCAO + paeonol at 25 mg/kg). Behavioral impairment, infarct volume and ischemic/contralateral hemispheric ratios were assessed at 72 h and at 28 days after MCAO, respectively. Immunofluorescence was employed to determine the neuronal damage and glial responses after MCAO. Compared with the model group, paeonol treatment significantly attenuated behavioral impairment, ischemic infarct volume and moderate cerebral edema in the ischemic brain at 72 h, as well as brain atrophy at 28 days after reperfusion. Furthermore, paeonol treatment ameliorated neuronal damage in the ischemic core and boundary zone regions at 72 h after reperfusion and in the boundary zone at 28 days after reperfusion. In addition, paeonol treatment reduced the proliferation of astrocytes in the boundary zone, and inhibited microglial activation in the ischemic core and boundary zone regions at 72 h and 28 days after reperfusion. These results demonstrated the protective effects of paeonol against subacute/chronic cerebral ischemia, and the mechanism of action may include subacute/chronic microglial activation and astrocyte proliferation.
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Affiliation(s)
- Bing Zhao
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310013, P.R. China
| | - Qiao-Juan Shi
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310013, P.R. China.,Experimental Animal Center, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang 310013, P.R. China
| | - Zhen-Zhong Zhang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Shu-Yan Wang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310013, P.R. China
| | - Xi Wang
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, Zhejiang Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Hao Wang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
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754
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Komnig D, Gertz K, Habib P, Nolte KW, Meyer T, Brockmann MA, Endres M, Rathkolb B, Hrabě de Angelis M, Schulz JB, Falkenburger BH, Reich A. Faim2 contributes to neuroprotection by erythropoietin in transient brain ischemia. J Neurochem 2018; 145:258-270. [PMID: 29315561 DOI: 10.1111/jnc.14296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/22/2017] [Accepted: 12/23/2017] [Indexed: 11/28/2022]
Abstract
Delayed cell death in the penumbra region of acute ischemic stroke occurs through apoptotic mechanisms, making it amenable to therapeutic interventions. Fas/CD95 mediates apoptotic cell death in response to external stimuli. In mature neurons, Fas/CD95 signaling is modulated by Fas-apoptotic inhibitory molecule 2 (Faim2), which reduces cell death in animal models of stroke, meningitis, and Parkinson disease. Erythropoietin (EPO) has been studied as a therapeutic strategy in ischemic stroke. Erythropoietin stimulates the phosphatidylinositol-3 kinase/Akt (PI3K/Akt) pathway, which regulates Faim2 expression. Therefore, up-regulation of Faim2 may contribute to neuroprotection by EPO. Male Faim2-deficient mice (Faim2-/- ) and wild-type littermates (WT) were subjected to 30 min of middle cerebral artery occlusion (MCAo) followed by 72 h of reperfusion. EPO was applied before (30 min) and after (24 and 48 h) MCAo. In WT mice application of EPO at a low dose (5000 U/kg) significantly reduced stroke volume, whereas treatment with high dose (90 000 U/kg) did not. In Faim2-/- animals administration of low-dose EPO did not result in a significant reduction in stroke volume. Faim2 expression as measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR) increased after low-dose EPO but not with high dose. An extensive phenotyping including analysis of cerebral vessel architecture did not reveal confounding differences between the genotypes. In human post-mortem brain Faim2 displayed a differential expression in areas of penumbral ischemia. Faim2 up-regulation may contribute to the neuroprotective effects of low-dose erythropoietin in transient brain ischemia. The dose-dependency may explain mixed effects of erythropoietin observed in clinical stroke trials.
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Affiliation(s)
- Daniel Komnig
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Karen Gertz
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pardes Habib
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Kay W Nolte
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
| | - Tareq Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Endres
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Excellence Cluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Disease (DZNE), Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Birgit Rathkolb
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany.,Ludwig-Maximilians-Universität München, Gene Center, Institute of Molecular Animal Breeding and Biotechnology, München, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Hrabě de Angelis
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,Chair of Experimental Genetics, Center of Life and Food Sciences Weihenstephan, Technische Universität München, Freising-Weihenstephan, Germany
| | | | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Björn H Falkenburger
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Arno Reich
- Department of Neurology, RWTH Aachen University, Aachen, Germany
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755
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González-Nieto D, Fernández-García L, Pérez-Rigueiro J, Guinea GV, Panetsos F. Hydrogels-Assisted Cell Engraftment for Repairing the Stroke-Damaged Brain: Chimera or Reality. Polymers (Basel) 2018; 10:polym10020184. [PMID: 30966220 PMCID: PMC6415003 DOI: 10.3390/polym10020184] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 01/07/2023] Open
Abstract
The use of advanced biomaterials as a structural and functional support for stem cells-based therapeutic implants has boosted the development of tissue engineering applications in multiple clinical fields. In relation to neurological disorders, we are still far from the clinical reality of restoring normal brain function in neurodegenerative diseases and cerebrovascular disorders. Hydrogel polymers show unique mechanical stiffness properties in the range of living soft tissues such as nervous tissue. Furthermore, the use of these polymers drastically enhances the engraftment of stem cells as well as their capacity to produce and deliver neuroprotective and neuroregenerative factors in the host tissue. Along this article, we review past and current trends in experimental and translational research to understand the opportunities, benefits, and types of tentative hydrogel-based applications for the treatment of cerebral disorders. Although the use of hydrogels for brain disorders has been restricted to the experimental area, the current level of knowledge anticipates an intense development of this field to reach clinics in forthcoming years.
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Affiliation(s)
- Daniel González-Nieto
- Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
- Departamento de Tecnología Fotónica y Bioingeniería, ETSI Telecomunicaciones, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
- Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), 28040 Madrid, Spain.
| | - Laura Fernández-García
- Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
| | - José Pérez-Rigueiro
- Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
- Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), 28040 Madrid, Spain.
- Departamento de Ciencia de Materiales, ETSI Caminos, Canales y Puertos, Universidad Politécnica de Madrid 28040 Madrid, Spain.
| | - Gustavo V Guinea
- Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
- Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), 28040 Madrid, Spain.
- Departamento de Ciencia de Materiales, ETSI Caminos, Canales y Puertos, Universidad Politécnica de Madrid 28040 Madrid, Spain.
| | - Fivos Panetsos
- Neurocomputing and Neurorobotics Research Group: Faculty of Biology and Faculty of Optics, Universidad Complutense de Madrid, 28040 Madrid, Spain.
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos Madrid, IdISSC, 28040 Madrid, Spain.
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756
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Neuroprotective Effects of neuroEPO Using an In Vitro Model of Stroke. Behav Sci (Basel) 2018; 8:bs8020026. [PMID: 29438293 PMCID: PMC5836009 DOI: 10.3390/bs8020026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 12/31/2022] Open
Abstract
Erythropoietin (EPO) is a glycoprotein initially identified as a hormone synthesized and secreted by the kidney that regulates erythropoiesis. EPO, and a group of its derivatives, are being evaluated as possible neuroprotective agents in cerebral ischemia. The objective of this study, using an in vitro model, was to determine how neuroEPO—which is a variant of EPO with a low sialic acid content—protects neurons from the toxic action of glutamate. Primary neuronal cultures were obtained from the forebrains of Wistar rat embryos after 17 days of gestation. Excitotoxicity was induced after nine days of in vitro culture by treatment with a medium containing 100 µM glutamate for 15 min. After this time, a new medium containing 100 ng of neuroEPO/mL was added. Morphological cell change was assessed by phase-contrast microscopy. Oxidative stress was analysed by measuring antioxidant and oxidant activity. After 24 h, the treatment with 100 ng of neuroEPO/mL showed a significant (p < 0.01) decrease in mortality, compared to cells treated with glutamate alone. neuroEPO treatment decreased mortality and tended to reproduce the morphological characteristics of the control. The oxidative stress induced by glutamate is reduced after neuroEPO treatment. These results confirm that neuroEPO has a protective effect against neuronal damage induced by excitotoxicity, improving antioxidant activity in the neuron, and protecting it from oxidative stress.
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757
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Chang CH, Chen SJ, Liu CY, Tsai HC. Suicidal drug overdose following stroke in elderly patients: a retrospective population-based cohort study. Neuropsychiatr Dis Treat 2018; 14:443-450. [PMID: 29445281 PMCID: PMC5808687 DOI: 10.2147/ndt.s157494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the incidence and risk of suicidal drug overdose (SDO) after stroke in older patients. METHODS We enrolled patients aged 60-99 years who were diagnosed with new-onset stroke between 2002 and 2013 and age-, sex-, and index-year-matched controls who did not have stroke. Patients with a history of SDO before enrollment were excluded. Both groups were observed until December 31, 2013. The primary end point was the occurrence of newly diagnosed SDO. The cumulative incidence rates of the study and control groups were estimated using the Kaplan-Meier method. Furthermore, we used the Cox proportional hazards model to identify risk factors for SDO. RESULTS We selected 22,770 individuals. Among them, 11,385 were older patients (aged 60-99 years) who had newly diagnosed stroke and 11,385 were controls. Of the 22,770 individuals, 275 (1.21%) had SDO during a mean follow-up period of 5.33±3.30 years, comprising 191 (1.68%) from the stroke group and 84 (0.74%) from the control group. Older patients with stroke had a significantly higher risk of SDO than the controls (adjusted hazard ratio: 2.288, 95% confidence interval [CI]: 1.746-2.999, p<0.001). Moreover, in older patients with stroke, the risk significantly increased with the number of stroke events. Patients with depressive disorder or coronary disease had an increased risk of SDO. Additionally, benzodiazepines and anticoagulants were the two most commonly prescribed medications for SDO. CONCLUSION Clinicians should be aware of the risk of SDO and risk factors in older patients with stroke. Psychological assessment and medication monitoring should be incorporated into current clinical diagnoses in neurology and treatments following stroke.
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Affiliation(s)
- Chun-Hung Chang
- Brain Disease Research Center, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Institute of Nursing-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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758
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Michalski D, Keck AL, Grosche J, Martens H, Härtig W. Immunosignals of Oligodendrocyte Markers and Myelin-Associated Proteins Are Critically Affected after Experimental Stroke in Wild-Type and Alzheimer Modeling Mice of Different Ages. Front Cell Neurosci 2018; 12:23. [PMID: 29467621 PMCID: PMC5807905 DOI: 10.3389/fncel.2018.00023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/15/2018] [Indexed: 12/31/2022] Open
Abstract
Because stroke therapies are still limited and patients are often concerned by long-term sequelae with significant impairment of daily living, elaborated neuroprotective strategies are needed. During the last decades, research substantially improved the knowledge on cellular pathologies responsible for stroke-related tissue damage. In this context, the neurovascular unit (NVU) concept has been established, summarizing the affections of neurons, associated astrocytes and the vasculature. Although oligodendrocytes were already identified to play a major role in other brain pathologies, their role during stroke evolution and long-lasting tissue damage is poorly understood. This study aims to explore oligodendrocyte structures, i.e., oligodendrocytes and their myelin-associated proteins, after experimental focal cerebral ischemia. For translational issues, different ages and genotypes including an Alzheimer-like background were considered to mimic potential co-morbidities. Three- and 12-month-old wild-type and triple-transgenic mice were subjected to unilateral middle cerebral artery occlusion. Immunofluorescence labeling was performed on forebrain tissues affected by 24 h of ischemia to visualize the oligodendrocyte-specific protein (OSP), the myelin basic protein (MBP), and the neuron-glia antigen 2 (NG2) with reference to the ischemic lesion. Subsequent analyses concomitantly detected the vasculature and the 2′, 3′-cyclic nucleotide-3′-phosphodiesterase (CNPase) to consider the NVU concept and to explore the functional relevance of histochemical data on applied oligodendrocyte markers. While the immunosignal of NG2 was found to be nearly absent 24 h after ischemia onset, enhanced immunoreactivities for OSP and especially MBP were observed in close regional association to the vasculature. Added quantitative analyses based on inter-hemispheric differences of MBP-immunoreactivity revealed a shell-like pattern with a significant increase directly in the ischemic core, followed by a gradual decline toward the striatum, the ischemic border zone and the lateral neocortex. This observation was consistent in subsequent analyses on the potential impact of age and genetic background. Furthermore, immunoreactivities for CNPase, MBP, and OSP were found to be simultaneously enhanced. In conclusion, this study provides evidence for a critical role of oligodendrocyte structures in the early phase after experimental stroke, strengthening their involvement in the ischemia-affected NVU. Consequently, oligodendrocytes and their myelin-associated proteins may qualify as potential targets for neuroprotective and regenerative approaches in stroke.
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Affiliation(s)
| | - Anna L Keck
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | | | | | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
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759
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Cacho-Díaz B, Lorenzana-Mendoza NA, Spínola-Maroño H, Reyes-Soto G, Cantú-Brito C. Comorbidities, Clinical Features, and Prognostic Implications of Cancer Patients with Cerebrovascular Disease. J Stroke Cerebrovasc Dis 2018; 27:365-371. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 12/12/2022] Open
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760
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Chang CF, Goods BA, Askenase MH, Hammond MD, Renfroe SC, Steinschneider AF, Landreneau MJ, Ai Y, Beatty HE, da Costa LHA, Mack M, Sheth KN, Greer DM, Huttner A, Coman D, Hyder F, Ghosh S, Rothlin CV, Love JC, Sansing LH. Erythrocyte efferocytosis modulates macrophages towards recovery after intracerebral hemorrhage. J Clin Invest 2018; 128:607-624. [PMID: 29251628 PMCID: PMC5785262 DOI: 10.1172/jci95612] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023] Open
Abstract
Macrophages are a source of both proinflammatory and restorative functions in damaged tissue through complex dynamic phenotypic changes. Here, we sought to determine whether monocyte-derived macrophages (MDMs) contribute to recovery after acute sterile brain injury. By profiling the transcriptional dynamics of MDMs in the murine brain after experimental intracerebral hemorrhage (ICH), we found robust phenotypic changes in the infiltrating MDMs over time and demonstrated that MDMs are essential for optimal hematoma clearance and neurological recovery. Next, we identified the mechanism by which the engulfment of erythrocytes with exposed phosphatidylserine directly modulated the phenotype of both murine and human MDMs. In mice, loss of receptor tyrosine kinases AXL and MERTK reduced efferocytosis of eryptotic erythrocytes and hematoma clearance, worsened neurological recovery, exacerbated iron deposition, and decreased alternative activation of macrophages after ICH. Patients with higher circulating soluble AXL had poor 1-year outcomes after ICH onset, suggesting that therapeutically augmenting efferocytosis may improve functional outcomes by both reducing tissue injury and promoting the development of reparative macrophage responses. Thus, our results identify the efferocytosis of eryptotic erythrocytes through AXL/MERTK as a critical mechanism modulating macrophage phenotype and contributing to recovery from ICH.
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Affiliation(s)
- Che-Feng Chang
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brittany A. Goods
- Department of Biological Engineering, Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Michael H. Askenase
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Matthew D. Hammond
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stephen C. Renfroe
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Margaret J. Landreneau
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Youxi Ai
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hannah E. Beatty
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Luís Henrique Angenendt da Costa
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Matthias Mack
- Department of Internal Medicine (Nephrology), University of Regensburg, Regensburg, Germany
| | - Kevin N. Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David M. Greer
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Daniel Coman
- Department of Diagnostic Radiology and Biomedical Engineering
| | - Fahmeed Hyder
- Department of Diagnostic Radiology and Biomedical Engineering
| | - Sourav Ghosh
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pharmacology, and
| | - Carla V. Rothlin
- Department of Pharmacology, and
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - J. Christopher Love
- Chemical Engineering, Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
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761
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Bai W, Li W, Ning YL, Li P, Zhao Y, Yang N, Jiang YL, Liang ZP, Jiang DP, Wang Y, Zhang M, Zhou YG. Blood Glutamate Levels Are Closely Related to Acute Lung Injury and Prognosis after Stroke. Front Neurol 2018; 8:755. [PMID: 29403427 PMCID: PMC5785722 DOI: 10.3389/fneur.2017.00755] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Acute lung injury (ALI) is a serious complication of stroke that occurs with a high incidence. Our preclinical results indicated that ALI might be related to blood glutamate levels after brain injury. The purpose of this study was to assess dynamic changes in blood glutamate levels in patients with stroke and to determine the correlation between blood glutamate levels, ALI, and long-term prognosis after stroke. Methods Venous blood samples were collected from controls and patients with stroke at admission and on the third and seventh day after the onset of stroke. Patients were followed for 3 months. The correlations among blood glutamate levels, severities of stroke and ALI, and long-term outcomes were analyzed, and the predictive values of blood glutamate levels and severity scores for ALI were assessed. Results In this study, a total of 384 patients with stroke were enrolled, with a median age of 59 years. Patients showed significantly increased blood glutamate levels within 7 days of stroke onset (p < 0.05), and patients with more severe injuries showed higher blood glutamate levels. Moreover, blood glutamate levels were closely related to the occurrence (adjusted odds ratio, 3.022, p = 0.003) and severity (p < 0.001) of ALI and the long-term prognosis after stroke (p < 0.05), and they were a more accurate predictor of ALI than the more commonly used severity scores (p < 0.01). Conclusion These results indicated that an increased blood glutamate level was closely related to the development of ALI and a poor prognosis after stroke. Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR-RPC-15006770.
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Affiliation(s)
- Wei Bai
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei Li
- Department of Neurology, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ya-Lei Ning
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ping Li
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yan Zhao
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Nan Yang
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yu-Lin Jiang
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ze-Ping Liang
- Department of ICU, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Dong-Po Jiang
- Department of ICU, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ying Wang
- Department of Neurology, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Meng Zhang
- Department of Neurology, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yuan-Guo Zhou
- Molecular Biology Center, State Key Laboratory of Trauma, Burn, and Combined Injury, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China
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762
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Yang Y, Zhang X, Ge H, Liu W, Sun E, Ma Y, Zhao H, Li R, Chen W, Yuan J, Chen Q, Chen Y, Liu X, Zhang JH, Hu R, Fan X, Feng H. Epothilone B Benefits Nigrostriatal Pathway Recovery by Promoting Microtubule Stabilization After Intracerebral Hemorrhage. J Am Heart Assoc 2018; 7:JAHA.117.007626. [PMID: 29348323 PMCID: PMC5850167 DOI: 10.1161/jaha.117.007626] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Many previous clinical studies have demonstrated that the nigrostriatal pathway, which plays a vital role in movement adjustment, is significantly impaired after stroke, according to medical imaging and autopsies. However, the basic pathomorphological changes have been poorly investigated to date. This study was designed to explore the pathomorphological changes, mechanism, and therapeutic method of nigrostriatal impairment after intracerebral hemorrhage (ICH). Methods and Results Intrastriatal injection of autologous blood or microtubule depolymerization reagent nocodazole was performed to mimic the pathology of ICH in C57/BL6 mice. Immunofluorescence, Western blotting, electron microscopy, functional behavioral tests, and anterograde and retrograde neural circuit tracking techniques were used in these mice. The data showed that the number of dopamine neurons and the dopamine concentration were severely decreased and that fine motor function was impaired after ICH. Microtubule depolymerization was the main contributor to the loss of dopamine neurons and to motor function deficits after ICH, as was also proven by intrastriatal injection of nocodazole. Moreover, administration of the microtubule stabilizer epothilone B (1.5 mg/kg) improved the integrity of the nigrostriatal pathway neural circuit, increased the number of dopamine neurons (4598±896 versus 3125±355; P=0.034) and the dopamine concentration (4.28±0.99 versus 3.08±0.75 ng/mg; P=0.041), and enhanced fine motor functional recovery associated with increased acetylated α‐tubulin expression to maintain microtubule stabilization after ICH. Conclusions Our results clarified the pathomorphological changes of the nigrostriatal pathway after ICH and found that epothilone B helped alleviate nigrostriatal pathway injury after ICH, associated with promoting α‐tubulin acetylation to maintain microtubule stabilization, thus facilitating motor recovery.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xuan Zhang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hongfei Ge
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wei Liu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Eryi Sun
- Neurosurgery Department of Guizhou, Medical University Affiliated Hospital, Guiyang, Guizhou, China
| | - Yuanyuan Ma
- Department of Basic Nursing, School of Nursing, Third Military Medical University, Chongqing, China
| | - Hengli Zhao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Rongwei Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Weixiang Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jichao Yuan
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xin Liu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - John H Zhang
- Department of Anesthesiology, Neurosurgery and Physiology, Loma Linda University, Loma Linda, CA
| | - Rong Hu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaotang Fan
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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763
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Crawford KM, Gallego-Fabrega C, Kourkoulis C, Miyares L, Marini S, Flannick J, Burtt NP, von Grotthuss M, Alexander B, Costanzo MC, Vaishnav NH, Malik R, Hall JL, Chong M, Rosand J, Falcone GJ. Cerebrovascular Disease Knowledge Portal: An Open-Access Data Resource to Accelerate Genomic Discoveries in Stroke. Stroke 2018; 49:470-475. [PMID: 29335331 DOI: 10.1161/strokeaha.117.018922] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/16/2017] [Accepted: 12/06/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Katherine M Crawford
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Cristina Gallego-Fabrega
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Christina Kourkoulis
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Laura Miyares
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Sandro Marini
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Jason Flannick
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Noel P Burtt
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Marcin von Grotthuss
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Benjamin Alexander
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Maria C Costanzo
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Neil H Vaishnav
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Rainer Malik
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Jennifer L Hall
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Michael Chong
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Jonathan Rosand
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.).
| | - Guido J Falcone
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
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764
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Zhang QW. Association of the matrix metalloproteinase-3 polymorphisms rs679620 and rs3025058 with ischemic stroke risk: a meta-analysis. Neuropsychiatr Dis Treat 2018; 14:419-427. [PMID: 29440903 PMCID: PMC5798548 DOI: 10.2147/ndt.s152256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The relationship of the matrix metalloproteinase-3 (MMP-3) polymorphisms rs679620 and rs3025058 with ischemic stroke has received much attention. The aim of the present study was to perform a meta-analysis of published case-control studies to evaluate the cumulative evidence. METHODS We performed a search of ISI Web of Science, Embase, PubMed, and China National Knowledge Infrastructure databases. Pooled odds ratios (ORs) were appropriately derived from fixed-effects or random-effects models. RESULTS We identified seven eligible studies including 5,204 subjects. The pooled analysis showed that the MMP-3 rs679620 A allele carriers had increased risk of ischemic stroke compared with homozygotes for the G allele in Asians (AA + GA vs GG: OR =1.42, 95% CI: 1.05-1.91, P=0.022). Concerning the rs3025058 polymorphism, the results did not suggest an association between rs3025058 genotypes and ischemic stroke risk (5A5A + 6A5A vs 6A6A: OR =1.04, 95% CI: 0.73-1.47, P=0.844; 5A5A vs 6A5A + 6A6A: OR =1.14, 95% CI: 0.74-1.77, P=0.556; and 5A5A vs 6A6A: OR =1.11, 95% CI: 0.68-1.80, P=0.677). In subgroup analysis by ethnicity, no statistically significant associations were demonstrated for rs3025058 in Asians and Caucasians, respectively. There was no evidence for publication bias. CONCLUSION Our findings indicate that the rs679620 A allele carriers have increased risk of ischemic stroke in Asians, but there is no association between rs3025058 and ischemic stroke risk.
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Affiliation(s)
- Qi-Wei Zhang
- Department of Neurosurgery, The Affiliated Hospital of Jilin Medical University, Jilin, People's Republic of China
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765
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Duris K, Splichal Z, Jurajda M. The Role of Inflammatory Response in Stroke Associated Programmed Cell Death. Curr Neuropharmacol 2018; 16:1365-1374. [PMID: 29473512 PMCID: PMC6251044 DOI: 10.2174/1570159x16666180222155833] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/17/2017] [Accepted: 02/22/2018] [Indexed: 01/13/2023] Open
Abstract
Stroke represents devastating pathology which is associated with a high morbidity and mortality. Initial damage caused directly by the onset of stroke, primary injury, may be eclipsed by secondary injury which may have a much more devastating effect on the brain. Primary injury is predominantly associated with necrotic cell death due to fatal insufficiency of oxygen and glucose. Secondary injury may on the contrary, lead apoptotic cell death due to structural damage which is not compatible with cellular functions or which may even represent the danger of malign transformation. The immune system is responsible for surveillance, defense and healing processes and the immune system plays a major role in triggering programmed cell death. Severe pathologies, such as stroke, are often associated with deregulation of the immune system, resulting in aggravation of secondary brain injury. The goal of this article is to overview the current knowledge about the role of immune system in the pathophysiology of stroke with respect to programmed neuronal cell death as well as to discuss current therapeutic strategies targeting inflammation after stroke.
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Affiliation(s)
| | | | - M. Jurajda
- Address correspondence to this author at the Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; E-mail:
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766
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Sebastian F, Fu Q, Santello M, Polygerinos P. Soft Robotic Haptic Interface with Variable Stiffness for Rehabilitation of Neurologically Impaired Hand Function. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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767
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Joint Effects of PON1 Polymorphisms and Vegetable Intake on Ischemic Stroke: A Family-Based Case Control Study. Int J Mol Sci 2017; 18:ijms18122652. [PMID: 29215590 PMCID: PMC5751254 DOI: 10.3390/ijms18122652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/04/2017] [Indexed: 12/18/2022] Open
Abstract
Paraoxonase 1 gene (PON1) polymorphisms and dietary vegetable and fruit intake are both established determinants of ischemic stroke (IS). However, little is known about whether these factors jointly influence the risk of IS. We analyzed the main effects of PON1, as well as the interactions between PON1 and dietary vegetable or fruit intake with the risk of total IS and its subtypes in a family-based case-control study conducted among 2158 Chinese participants (1007 IS cases and 1151 IS-free controls) from 918 families. Conditional logistic regression models, with each family as a stratum, were used to examine the association between rs662 and IS. Gene-diet interactions were tested by including a cross-product term of dietary vegetable or fruit intake by rs662_G allele count in the models. Each copy of the PON1 rs662_G allele was associated with 28% higher risk of total IS (p = 0.008) and 32% higher risk of large artery atherosclerosis subtype (LAA) (p = 0.01). We observed an interaction between rs662 and vegetable intake for both total IS (p = 0.006) and LAA (p = 0.02) after adjustment for covariates. Individuals who carry the rs662_A allele may benefit to a greater extent from intake of vegetables and thus be more effectively protected from ischemic stroke, whereas carriers of the G allele may still remain at greater risk for ischemic stroke due to their genetic backgrounds even when they consume a high level of vegetables. More studies are needed to replicate our findings among other populations.
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768
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Cell Therapy in Stroke-Cautious Steps Towards a Clinical Treatment. Transl Stroke Res 2017; 9:321-332. [PMID: 29150739 DOI: 10.1007/s12975-017-0587-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
In the future, stroke patients may receive stem cell therapy as this has the potential to restore lost functions. However, the development of clinically deliverable therapy has been slower and more challenging than expected. Despite recommendations by STAIR and STEPS consortiums, there remain flaws in experimental studies such as lack of animals with comorbidities, inconsistent approaches to experimental design, and concurrent rehabilitation that might lead to a bias towards positive results. Clinical studies have typically been small, lacking control groups as well as often without clear biological hypotheses to guide patient selection. Furthermore, they have used a wide range of cell types, doses, and delivery methods, and outcome measures. Although some ongoing and recent trial programs offer hints that these obstacles are now being tackled, the Horizon2020 funded RESSTORE trial will be given as an example of inconsistent regulatory requirements and challenges in harmonized cell production, logistic, and clinical criteria in an international multicenter study. The PISCES trials highlight the complex issues around intracerebral cell transplantation. Therefore, a better understanding of translational challenges is expected to pave the way to more successful help for stroke patients.
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769
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Wufuer A, Wubuli A, Mijiti P, Zhou J, Tuerxun S, Cai J, Ma J, Zhang X. Impact of collateral circulation status on favorable outcomes in thrombolysis treatment: A systematic review and meta-analysis. Exp Ther Med 2017; 15:707-718. [PMID: 29399075 PMCID: PMC5772565 DOI: 10.3892/etm.2017.5486] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022] Open
Abstract
Collateral circulation affects the prognosis of patients with acute ischemic stroke (AIS) treated by thrombolysis. The present study performed a systematic assessment of the impact of the collateral circulation status on the outcomes of patients receiving thrombolysis treatment. Relevant full-text articles from the Cochrane Library, Ovid, Medline, Embase and PubMed databases published from January 1, 2000 to November 1, 2016 were retrieved. The quality of the studies was assessed and data were extracted by 2 independent investigators. The random-effects model was used to estimate the impact of good vs. poor collateral circulation, as well as baseline characteristics, on the outcome within the series presented as risk ratios. Subgroup analyses explored the potential factors that may interfere with the effects of the collateral circulation status on the outcome. A total of 29 studies comprising 4,053 patients were included in the present meta-analysis. A good collateral circulation status was revealed to have a beneficial effect on favorable functional outcome (modified Rankin scale, 0–3 at 3–6 months; P<0.001) and a higher rate of recanalization (P<0.001) compared with poor collateral circulation. Good collateral circulation was also associated with a lower rate of symptomatic intracranial hemorrhage (P<0.01), a lower rate of mortality (P<0.01) and a smaller infarct size (P<0.01). In conclusion, good collateral circulation was demonstrated to have a favorable prognostic value regarding the outcome for patients with AIS receiving thrombolysis treatment. Assessment of collateral circulation and penumbra area during pre-treatment imaging within an appropriate time-window prior to thrombolytic therapy will therefore improve the identification of AIS patients who may benefit from thrombolysis treatment.
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Affiliation(s)
- Alimu Wufuer
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Atikaimu Wubuli
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Peierdun Mijiti
- Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China
| | - Jun Zhou
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Shabier Tuerxun
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Jian Cai
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Jianhua Ma
- Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Xiaoning Zhang
- Department of Neurology, The Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, Urumqi, Xinjiang 830054, P.R. China
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770
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Kirchhof P. The future of atrial fibrillation management: integrated care and stratified therapy. Lancet 2017; 390:1873-1887. [PMID: 28460828 DOI: 10.1016/s0140-6736(17)31072-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/20/2017] [Accepted: 03/10/2017] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2-3% of the population in Europe and the USA and requiring 1-3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a challenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke. Once diagnosed, atrial fibrillation requires chronic, multidimensional management in five domains (acute management, treatment of underlying and concomitant cardiovascular conditions, stroke prevention therapy, rate control, and rhythm control). The consistent provision of these treatment options to all patients with atrial fibrillation is difficult, despite recent improvements in organisation of care, knowledge about atrial fibrillation, and treatment options. Integrated care models that provide patient-centred care in, or close to, the patient's community while maintaining access to all specialist treatment options, emerge as the best approach to achieve consistent delivery of these chronic treatments to all patients with atrial fibrillation. Ongoing research efforts will establish when to initiate oral anticoagulation in patients with device-detected atrial high-rate episodes, quantify the prognostic effect of early and comprehensive rhythm control therapy, including atrial fibrillation ablation, and delineate optimum methods to reduce bleeding complications in patients treated with anticoagulation. Additionally, research efforts are needed to define different types of atrial fibrillation on the basis of the main causes of atrial fibrillation to pave the way for the clinical development of stratified atrial fibrillation therapy.
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Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust and University Hospitals Birmingham NHS Foundation NHS Trust, Birmingham, UK; Atrial Fibrillation NETwork, Münster, Germany.
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771
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Wiesmann M, Timmer NM, Zinnhardt B, Reinhard D, Eligehausen S, Königs A, Ben Jeddi H, Dederen PJ, Jacobs AH, Kiliaan AJ. Effect of a multinutrient intervention after ischemic stroke in female C57Bl/6 mice. J Neurochem 2017; 144:549-564. [PMID: 28888042 DOI: 10.1111/jnc.14213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 01/05/2023]
Abstract
Stroke can affect females very differently from males, and therefore preclinical research on underlying mechanisms and the effects of interventions should not be restricted to male subjects, and treatment strategies for stroke should be tailored to benefit both sexes. Previously, we demonstrated that a multinutrient intervention (Fortasyn) improved impairments after ischemic stroke induction in male C57Bl/6 mice, but the therapeutic potential of this dietary treatment remained to be investigated in females. We now induced a transient middle cerebral artery occlusion (tMCAo) in C57Bl/6 female mice and immediately after surgery switched to either Fortasyn or an isocaloric Control diet. The stroke females performed several behavioral and motor tasks before and after tMCAo and were scanned in an 11.7 Tesla magnetic resonance imaging (MRI) scanner to assess brain perfusion, integrity, and functional connectivity. To assess brain plasticity, inflammation, and vascular integrity, immunohistochemistry was performed after killing of the mice. We found that the multinutrient intervention had diverse effects on the stroke-induced impairments in females. Similar to previous observations in male stroke mice, brain integrity, sensorimotor integration and neurogenesis benefitted from Fortasyn, but impairments in activity and motor skills were not improved in female stroke mice. Overall, Fortasyn effects in the female stroke mice seem more modest in comparison to previously investigated male stroke mice. We suggest that with further optimization of treatment protocols more information on the efficacy of specific interventions in stroked females can be gathered. This in turn will help with the development of (gender-specific) treatment regimens for cerebrovascular diseases such as stroke. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Maximilian Wiesmann
- Department of Anatomy, Radboud University Medical Center, Centre for Medical Neuroscience, Donders Institute for Brain, Cognition & Behaviour, Preclinical Imaging Centre PRIME, Nijmegen, The Netherlands
| | - Nienke M Timmer
- Department of Anatomy, Radboud University Medical Center, Centre for Medical Neuroscience, Donders Institute for Brain, Cognition & Behaviour, Preclinical Imaging Centre PRIME, Nijmegen, The Netherlands
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
| | - Dirk Reinhard
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
| | - Sarah Eligehausen
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
| | - Anja Königs
- Department of Anatomy, Radboud University Medical Center, Centre for Medical Neuroscience, Donders Institute for Brain, Cognition & Behaviour, Preclinical Imaging Centre PRIME, Nijmegen, The Netherlands
| | - Hasnae Ben Jeddi
- Department of Anatomy, Radboud University Medical Center, Centre for Medical Neuroscience, Donders Institute for Brain, Cognition & Behaviour, Preclinical Imaging Centre PRIME, Nijmegen, The Netherlands
| | - Pieter J Dederen
- Department of Anatomy, Radboud University Medical Center, Centre for Medical Neuroscience, Donders Institute for Brain, Cognition & Behaviour, Preclinical Imaging Centre PRIME, Nijmegen, The Netherlands
| | - Andreas H Jacobs
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany.,Department of Geriatrics, Johanniter Hospital, Evangelische Kliniken, Bonn, Germany
| | - Amanda J Kiliaan
- Department of Anatomy, Radboud University Medical Center, Centre for Medical Neuroscience, Donders Institute for Brain, Cognition & Behaviour, Preclinical Imaging Centre PRIME, Nijmegen, The Netherlands
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772
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Xiang W, Tian C, Lin J, Wu X, Pang G, Zhou L, Pan S, Deng Z. Plasma let-7i and miR-15a expression are associated with the effect of recombinant tissue plasminogen activator treatment in acute ischemic stroke patients. Thromb Res 2017; 158:121-125. [DOI: 10.1016/j.thromres.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/28/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
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773
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Story LM, Duke JM, Smeds MR, Ali AT, Moursi MM, Lyons LC, Escobar GA. Contemporary Characteristics and Outcomes of Young Patients (Under 50 Years) Undergoing Open Carotid Artery Surgery. Ann Vasc Surg 2017; 44:375-380. [DOI: 10.1016/j.avsg.2017.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/10/2017] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
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774
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Shi CH, Tang MB, Li SH, Wang ZJ, Liu XJ, Zhao L, Gao Y, Li YS, Sun SL, Wu J, Song B, Xu YM. Association of FOXF2 gene polymorphisms with ischemic stroke in Chinese Han population. Oncotarget 2017; 8:89867-89875. [PMID: 29163794 PMCID: PMC5685715 DOI: 10.18632/oncotarget.21263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/08/2017] [Indexed: 12/21/2022] Open
Abstract
Recently, a novel locus at chromosome 6p25 (rs12204590, near FOXF2) associated with an increased risk of stroke in European populations was identified. However, whether polymorphisms in FOXF2 are also associated with the incidence of ischemic stroke in other populations remains unknown. In this case-control study, 803 Chinese Han patients with ischemic stroke and 803 matched control individuals were enrolled. Four tag SNPs and rs12204590 located in or near FOXF2 were selected, and the associations between genotypes/alleles and ischemic stroke were analyzed. In our study, we did not detect an association between the previously reported locus rs12204590 and ischemic stroke. By the genotype analysis, a novel SNP rs1711972, near FOXF2, was observed to be associated with an increased risk of ischemic stroke(CA genotype, adjusted OR = 1.35; 95% CI, 1.07 to 1.70), but not significantly after Bonferroni corrections for multiple tests. However, in the subgroup analysis, we discovered that rs1711972 was associated with an increased risk of large-artery atherosclerotic stroke in the additive model (P = 0.020; CA genotype, adjusted OR = 1.50; 95%CI, 1.09 to 2.07) and dominant model (P = 0.010; OR = 1.47; 95%CI, 1.09 to 1.99). Collectively, these results indicate that a novel SNP near FOXF2 may influence the risk of large-artery atherosclerotic stroke in Chinese Han population.
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Affiliation(s)
- Chang-He Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Mi-Bo Tang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Shao-Hua Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Zhi-Jie Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Xin-Jing Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Yu-Sheng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Shi-Lei Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, Henan, China
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775
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Corticomuscular coherence in the acute and subacute phase after stroke. Clin Neurophysiol 2017; 128:2217-2226. [PMID: 28987993 DOI: 10.1016/j.clinph.2017.08.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/09/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Stroke is one of the leading causes of physical disability due to damage of the motor cortex or the corticospinal tract. In the present study we set out to investigate the role of adaptations in the corticospinal pathway for motor recovery during the subacute phase after stroke. METHODS We examined 19 patients with clinically diagnosed stroke and 18 controls. The patients had unilateral mild to moderate weakness of the hand. Each patient attended two sessions at approximately 3days (acute) and 38days post stroke (subacute). Task-related changes in the communication between motor cortex and muscles were evaluated from coupling in the frequency domain between EEG and EMG during movement of the paretic hand. RESULTS Corticomuscular coherence (CMC) and intermuscular coherence (IMC) were reduced in patients as compared to controls. Paretic hand motor performance improved within 4-6weeks after stroke, but no change was observed in CMC or IMC. CONCLUSIONS CMC and IMC were reduced in patients in the early phase after stroke. However, changes in coherence do not appear to be an efficient marker for early recovery of hand function following stroke. SIGNIFICANCE This is the first study to demonstrate sustained reduced coherence in acute and subacute stroke.
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776
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Circulating pro-angiogenic and anti-angiogenic microRNA expressions in patients with acute ischemic stroke and their association with disease severity. Neurol Sci 2017; 38:2015-2023. [PMID: 28875333 DOI: 10.1007/s10072-017-3071-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 10/18/2022]
Abstract
The main objectives of this study are to evaluate 28 selected pro-angiogenic and anti-angiogenic microRNA (miRNA) expressions in plasma of acute ischemic stroke (AIS) patients and controls and to assess the correlations of these miRNAs with risk and severity of AIS. In the exploring stage, 10 AIS patients and 10 controls with vascular risk factors were enrolled. And in the validating stage, 106 AIS patients and 110 controls with the same eligibility were recruited. Blood samples were collected from participants within 24 h post the onset of symptoms, and plasma levels of miRNAs were evaluated by the qPCR method. In the exploring stage, 11 differentially expressed miRNAs (DEM) were identified and included into the validating stage. In the validating stage, the expression of miR-126, miR-130a, and miR-378 in plasma declined in the AIS patients; however, miR-222, miR-218, and miR-185 plasma levels were elevated. Univariate and multivariate logistic regression analysis disclosed that miR-126, miR-130a, miR-222, miR-218, and miR-185 were independent predicting factors for AIS. When these five DEMs were combined together, they presented a good diagnostic value with an area under curve (AUC) value of 0.767 (95% CI 0.705-0.829), sensitivity of 87.7%, and specificity of 54.5% at best cutoff point. Additionally, miR-126, miR-378, miR-101, miR-222, miR-218, and miR-206 were associated with National Institutes of Health Stroke Scale (NIHSS) score. Circulating miR-126, miR-130a, miR-222, miR-218, and miR-185 could be served as promising and independent biomarkers for risk of AIS, and miR-126, miR-378, miR-222, miR-101, miR-218, and miR-206 could be used for disease severity management of AIS.
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777
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Potential Therapeutic Mechanisms and Tracking of Transplanted Stem Cells: Implications for Stroke Treatment. Stem Cells Int 2017; 2017:2707082. [PMID: 28904531 PMCID: PMC5585684 DOI: 10.1155/2017/2707082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/08/2017] [Accepted: 07/30/2017] [Indexed: 02/06/2023] Open
Abstract
Stem cell therapy is a promising potential therapeutic strategy to treat cerebral ischemia in preclinical and clinical trials. Currently proposed treatments for stroke employing stem cells include the replacement of lost neurons and integration into the existing host circuitry, the release of growth factors to support and promote endogenous repair processes, and the secretion of extracellular vesicles containing proteins, noncoding RNA, or DNA to regulate gene expression in recipient cells and achieve immunomodulation. Progress has been made to elucidate the precise mechanisms underlying stem cell therapy and the homing, migration, distribution, and differentiation of transplanted stem cells in vivo using various imaging modalities. Noninvasive and safe tracer agents with high sensitivity and image resolution must be combined with long-term monitoring using imaging technology to determine the optimal therapy for stroke in terms of administration route, dosage, and timing. This review discusses potential therapeutic mechanisms of stem cell transplantation for the treatment of stroke and the limitations of current therapies. Methods to label transplanted cells and existing imaging systems for stem cell labeling and in vivo tracking will also be discussed.
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778
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Zheng J, Shi L, Xu W, Zhao N, Liang F, Zhou J, Zhang J. Impact of hyperlipidemia and atrial fibrillation on the efficacy of endovascular treatment for acute ischemic stroke: a meta-analysis. Oncotarget 2017; 8:72972-72984. [PMID: 29069841 PMCID: PMC5641184 DOI: 10.18632/oncotarget.20183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/02/2017] [Indexed: 01/19/2023] Open
Abstract
Introduction Stroke is the crucial cause of death annually. Inconsistent results from the randomized controlled trials (RCTs) aroused controversy on efficacy of endovascular treatment (EVT). Materials and Methods To evaluate the efficacy of EVT in stroke patients. We searched three databases including PubMed, Web of science and the Cochrane Library from Jan 2011 to Apr 2017. Eligible studies were RCTs comparing EVT versus standard medical therapy alone. The primary outcomes were favorable functional outcomes (modified Rankin Scale score, 0–2) at 3 months. Meta regression analysis and subgroup analysis were used to explore potential influence factors responsible for the effectiveness of EVT. Results Eleven RCTs involving 3018 patients were included in our study. EVT showed better functional outcomes at 90 days (OR, 1.71; 95% CI, 1.28–2.28; P < 0.001) and a higher recanalization rate at 24h (OR, 6.49; 95% CI, 4.79–8.79; P < 0.001). In meta-regression and subgroup analysis, primary outcomes were significantly better among patients with atrial fibrillation (Adj R-squared 46.30%, P = 0.054; OR, 2.40; 95% CI, 1.81–3.19; P < 0.001), patients without hyperlipidemia (Adj R-squared 35.21%, P = 0.159; OR, 2.34; 95% CI, 1.80–3.04; P < 0.001) and when new generation thrombectomy device was used (Adj R-squared 72.21%, P = 0.011; OR, 2.14; 95% CI, 1.75–2.61; P < 0.001). Conclusions EVT showed superior clinical outcomes compared with standard medical therapy. The rate of using new generation thrombectomy device was the critical factor influencing therapeutic outcome. Hyperlipidemia and atrial fibrillation may also cause the potential effect.
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Affiliation(s)
- Jingwei Zheng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ligen Shi
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weilin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ningning Zhao
- Department of Endocrinology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Feng Liang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingyi Zhou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China.,Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China
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779
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Michalski D, Hofmann S, Pitsch R, Grosche J, Härtig W. Neurovascular Specifications in the Alzheimer-Like Brain of Mice Affected by Focal Cerebral Ischemia: Implications for Future Therapies. J Alzheimers Dis 2017; 59:655-674. [DOI: 10.3233/jad-170185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Sarah Hofmann
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | - Roman Pitsch
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | | | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
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780
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麦 汉, 姜 涛, 张 爱, 吕 田, 杨 灿, 覃 偲. [Expression of HDAC9 in different brain regions in mice with cerebral ischemic stroke]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:812-816. [PMID: 28669958 PMCID: PMC6744151 DOI: 10.3969/j.issn.1673-4254.2017.06.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the expression and the subcellular localization of HDAC9 in different brain regions of mice after cerebral ischemic injury and explore the association between HDAC9 and ischemic stroke. METHODS Twenty-one male C57BL/6 mice were randomly divided into sham-operated group (n=9) and operated group (n=12). In the latter group, the mice with Zea-Longa neurological deficit scores of 2 or 3 following middle cerebral artery occlusion (MCAO) were assigned into MCAO group (n=9). Immunofluorescence was performed to investigate the subcellular localization of HDAC9 in the brain tissues on day 3 after MCAO. Western blotting and qRT-PCR were used to analyze the expression of HDAC9 in different regions of the brain. Results Immunofluorescence showed more intense HDAC9 expressions in the brain tissues around the infarct focus, and in the cells surrounding the infarct, HDAC9 expression was obviously increased in the cytoplasm and reduced in the cell nuclei. Compared with the other brain regions, the ipsilesional cortex with MCAO showed more abundant HDAC9 expressions at both the mRNA and protein levels (P<0.05). CONCLUSION HDAC9 may be closely related to cerebral ischemic injury and participate in the pathophysiological process of ischemic stroke.
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Affiliation(s)
- 汉滔 麦
- 南方医科大学第三附属医院神经内科,广东 广州 510630Department of Neurology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 涛 姜
- 南方医科大学第三附属医院神经内科,广东 广州 510630Department of Neurology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 爱武 张
- 中山大学附属第一医院神经内科,广东 广州 510080Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - 田明 吕
- 南方医科大学第三附属医院神经内科,广东 广州 510630Department of Neurology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 灿洪 杨
- 南方医科大学第三附属医院神经内科,广东 广州 510630Department of Neurology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 偲偲 覃
- 南方医科大学第三附属医院神经内科,广东 广州 510630Department of Neurology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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781
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Vanbellingen T, Ottiger B, Maaijwee N, Pflugshaupt T, Bohlhalter S, Müri RM, Nef T, Cazzoli D, Nyffeler T. Spatial Neglect Predicts Upper Limb Use in the Activities of Daily Living. Cerebrovasc Dis 2017; 44:122-127. [DOI: 10.1159/000477500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/12/2017] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose: Motor tests performed at stroke onset have been shown to predict the recovery of upper limb motor impairment. Less is known about upper limb recovery at the level of functional activity or of participation and how spatial neglect may influence the integration of the upper limb in the activities of daily living (ADL). Our objective was to investigate whether the initial severity of spatial neglect may predict upper limb use in ADL. Methods: Eighty-two patients with a right-hemispheric stroke (RHS) were prospectively included in the study. They were assessed twice in the acute/subacute and in the subacute/chronic phases (mean time interval of 45 days) after stroke. The Catherine Bergego Scale (CBS) was used to quantify the influence of spatial neglect on the ADL. Contralesional upper limb use in the ADL was evaluated with the Lucerne international classification of function, disability and health-based Multidisciplinary Observation Scale. Hand strength was measured using the Jamar, dexterity with the Nine Hole Peg test, and tactile perception using the stereognosis subtest of the Nottingham Sensory Assessment. Cognitive functions were assessed with the Montreal Cognitive Assessment. Results: Regression analyses revealed that spatial neglect is an independent and a significant predictor of upper limb outcome. A CBS score of ≤5 at the time of admission to neurorehabilitation care was highly predictive for good upper limb use in the ADL 45 days later. Conclusions: This study demonstrates that spatial neglect severity, as observed in the ADL, is a significant and an independent predictor of upper limb outcome. Neglect therapy is thus needed to further improve contralesional upper limb use in the ADL in RHS patients.
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782
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Yang RX, Lei J, Wang BD, Feng DY, Huang L, Li YQ, Li T, Zhu G, Li C, Lu FF, Nie TJ, Gao GD, Gao L. Pretreatment with Sodium Phenylbutyrate Alleviates Cerebral Ischemia/Reperfusion Injury by Upregulating DJ-1 Protein. Front Neurol 2017. [PMID: 28649223 PMCID: PMC5465296 DOI: 10.3389/fneur.2017.00256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Oxidative stress and mitochondrial dysfunction play critical roles in ischemia/reperfusion (I/R) injury. DJ-1 is an endogenous antioxidant that attenuates oxidative stress and maintains mitochondrial function, likely acting as a protector of I/R injury. In the present study, we explored the protective effect of a possible DJ-1 agonist, sodium phenylbutyrate (SPB), against I/R injury by protecting mitochondrial dysfunction via the upregulation of DJ-1 protein. Pretreatment with SPB upregulated the DJ-1 protein level and rescued the I/R injury-induced DJ-1 decrease about 50% both in vivo and in vitro. SPB also improved cellular viability and mitochondrial function and alleviated neuronal apoptosis both in cell and animal models; these effects of SPB were abolished by DJ-1 knockdown with siRNA. Furthermore, SPB improved the survival rate about 20% and neurological functions, as well as reduced about 50% of the infarct volume and brain edema, of middle cerebral artery occlusion mice 23 h after reperfusion. Therefore, our findings demonstrate that preconditioning of SPB possesses a neuroprotective effect against cerebral I/R injury by protecting mitochondrial function dependent on the DJ-1 upregulation, suggesting that DJ-1 is a potential therapeutic target for clinical ischemic stroke.
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Affiliation(s)
- Rui-Xin Yang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jie Lei
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Bo-Dong Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Da-Yun Feng
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lu Huang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yu-Qian Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Tao Li
- Research Center of Traditional Chinese Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Gang Zhu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chen Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Fang-Fang Lu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Tie-Jian Nie
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Guo-Dong Gao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Li Gao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
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783
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Duffy SS, Keating BA, Perera CJ, Moalem-Taylor G. The role of regulatory T cells in nervous system pathologies. J Neurosci Res 2017; 96:951-968. [DOI: 10.1002/jnr.24073] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Samuel S. Duffy
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
| | - Brooke A. Keating
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
| | - Chamini J. Perera
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
| | - Gila Moalem-Taylor
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
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784
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Caso V, Antonenko K, Mikulik R. Proposed
International Classification of Diseases Eleventh Revision
Classification and Its Effects on Stroke Unit Care. Stroke 2017; 48:1136-1137. [DOI: 10.1161/strokeaha.117.017270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Valeria Caso
- From the Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (V.C.); Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine (K.A.); and Department of Neurology, Masaryk University, St. Anne’s University Hospital, Brno, Czech Republic (R.M.)
| | - Kateryna Antonenko
- From the Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (V.C.); Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine (K.A.); and Department of Neurology, Masaryk University, St. Anne’s University Hospital, Brno, Czech Republic (R.M.)
| | - Robert Mikulik
- From the Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (V.C.); Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine (K.A.); and Department of Neurology, Masaryk University, St. Anne’s University Hospital, Brno, Czech Republic (R.M.)
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785
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Kufta K, Melean LP, Grady MS, Panchal N. Massive Middle Cerebral Artery Infarction After Surgically Assisted Rapid Palatal Expansion: A Case Report. J Oral Maxillofac Surg 2017; 75:1529.e1-1529.e8. [PMID: 28438597 DOI: 10.1016/j.joms.2017.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
Dentofacial deformities have a marked impact on a patient's quality of life. Fortunately, these deformities often can be corrected through orthodontic and surgical treatment. In adults, transverse maxillary discrepancies are often corrected by performing a surgically assisted rapid palatal expansion (SARPE) procedure. This procedure is accompanied by many of the same complications involved in performing a Le Fort I osteotomy. Although major complications from maxillary surgery are uncommon, severe hemorrhage and cerebrovascular accidents are real risks accompanied by serious sequelae. The purpose of this case report is to describe a case in which a patient developed a massive middle cerebral artery infarct after a SARPE procedure. The authors discuss the possible etiology and pathogenesis of the complication. They also aim to remind surgeons of this rare complication to ensure prompt recognition and management to prevent delays in care.
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Affiliation(s)
- Kenneth Kufta
- Resident in Oral and Maxillofacial Surgery, University of Pennsylvania Health System, Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Luis Perez Melean
- Dental Student, University of Pennsylvania School of Dental Medicine, Robert Schattner Center, Philadelphia, PA
| | - M Sean Grady
- Charles Harrison Frazier Professor and Chairman of Department of Neurosurgery, University of Pennsylvania Health System, Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Neeraj Panchal
- Chief of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA.
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786
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Maguire JM, Bevan S, Stanne TM, Lorenzen E, Fernandez-Cadenas I, Hankey GJ, Jimenez-Conde J, Jood K, Lee JM, Lemmens R, Levi C, Norrving B, Rannikmae K, Rost N, Rosand J, Rothwell PM, Scott R, Strbian D, Sturm J, Sudlow C, Traylor M, Thijs V, Tatlisumak T, Wieloch T, Woo D, Worrall BB, Jern C, Lindgren A. GISCOME - Genetics of Ischaemic Stroke Functional Outcome network: A protocol for an international multicentre genetic association study. Eur Stroke J 2017; 2:229-237. [PMID: 31008316 DOI: 10.1177/2396987317704547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/17/2017] [Indexed: 01/12/2023] Open
Abstract
Introduction Genome-wide association studies have identified several novel genetic loci associated with stroke risk, but how genetic factors influence stroke outcome is less studied. The Genetics of Ischaemic Stroke Functional outcome network aims at performing genetic studies of stroke outcome. We here describe the study protocol and methods basis of Genetics of Ischaemic Stroke Functional outcome. Methods The Genetics of Ischaemic Stroke Functional outcome network has assembled patients from 12 ischaemic stroke projects with genome-wide genotypic and outcome data from the International Stroke Genetics Consortium and the National Institute of Neurological Diseases Stroke Genetics Network initiatives. We have assessed the availability of baseline variables, outcome metrics and time-points for collection of outcome data. Results We have collected 8831 ischaemic stroke cases with genotypic and outcome data. Modified Rankin score was the outcome metric most readily available. We detected heterogeneity between cohorts for age and initial stroke severity (according to the NIH Stroke Scale), and will take this into account in analyses. We intend to conduct a first phase genome-wide association outcome study on ischaemic stroke cases with data on initial stroke severity and modified Rankin score within 60-190 days. To date, we have assembled 5762 such cases and are currently seeking additional cases meeting these criteria for second phase analyses. Conclusion Genetics of Ischaemic Stroke Functional outcome is a unique collection of ischaemic stroke cases with detailed genetic and outcome data providing an opportunity for discovery of genetic loci influencing functional outcome. Genetics of Ischaemic Stroke Functional outcome will serve as an exploratory study where the results as well as the methodological observations will provide a basis for future studies on functional outcome. Genetics of Ischaemic Stroke Functional outcome can also be used for candidate gene replication or assessing stroke outcome non-genetic association hypotheses.
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Affiliation(s)
- Jane M Maguire
- Faculty of Health, University of Technology, Australia.,Hunter Medical Research Institute, University of Newcastle, Australia.,Priority Research Centre for Stroke and Traumatic Brain Injury, University of Newcastle, Australia
| | - Steve Bevan
- School of Life Sciences, University of Lincoln, UK
| | - Tara M Stanne
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Erik Lorenzen
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics, Fundació Docència I Recerca Mutuaterrassa, Mutua de Terrassa Hospital, Spain.,Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments - Universitat Autònoma de Barcelona, Vall d'Hebrón Hospital, Spain
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Australia
| | - Jordi Jimenez-Conde
- Department of Neurology, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Spain.,Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); Universitat Autònoma de Barcelona/DCEXS
| | - Katarina Jood
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, USA
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Belgium.,Laboratory of Neurobiology, VIB, Vesalius Research Center, Belgium.,Department of Neurology, University Hospitals Leuven, Belgium
| | - Christopher Levi
- Hunter Medical Research Institute, University of Newcastle, Australia.,Priority Research Centre for Stroke and Traumatic Brain Injury, University of Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Australia
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden.,Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Sweden
| | | | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, USA.,Center for Human Genetic Research, Massachusetts General Hospital, USA
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Rodney Scott
- Faculty of Health, University of Technology, Australia.,Hunter Medical Research Institute, University of Newcastle, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Finland
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, Australia
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Matthew Traylor
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia
| | - Turgut Tatlisumak
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden.,Department of Neurology, Helsinki University Hospital, Finland
| | - Tadeusz Wieloch
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden
| | - Daniel Woo
- Department of Neurology and Rehabilitation, University of Cincinnati, College of Medicine, USA
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, USA.,Department of Health Evaluation Sciences, University of Virginia, USA
| | - Christina Jern
- Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden.,Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Sweden
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787
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Affiliation(s)
- Ann P Walker
- UCL Institute of Cardiovascular Science, UCL, London, UK.
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788
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