1
|
Chen D, Huang X, Gan H, Du X, Lu S, Huang R, Liu K, Zhang B. Efficacy of alogliptin combined with motor imagery under hyperbaric oxygen in diabetic nephropathy with silent cerebral infarction. Biomed Rep 2017; 7:407-415. [PMID: 29181153 PMCID: PMC5700399 DOI: 10.3892/br.2017.983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022] Open
Abstract
In the present study, we evaluated the curative effect of dipeptidyl peptidase-IV (DPP-IV) inhibitor alogliptin combined with motor imagery under hyperbaric oxygen in diabetic nephropathy (DN) with silent cerebral infarction (SCI). Two-hundred newly diagnosed DN patients with and without SCI were included. The SCI patients were divided into two treatment groups: Alogliptin (A group, n=50) and alogliptin combined with motor imagery under hyperbaric oxygen (B group, n=50). The degrees of neurocognitive dysfunction were evaluated at baseline and after 6 months of treatment. Thromboelastograms (TEGs) mapping were conducted. Serum glycoprotein VI (GPVI) mRNA expression and urine 11-DH-TXB2 levels were determined. Compared to group A patients, the severity of neurofunctional defects, GPVI mRNA expression and 11-DH-TXB2 levels were significantly lower in group B (P<0.05), while comprehensive, MoCA scores were higher in group B. The MoCA subscores of visuospatial/executive function, attention and concentration were significantly higher compared to group A (P<0.05). The sub-scores of computation, abstract thinking, language competence, memory and orientation were also higher in group B but the differences were not significant (P>0.05). TEG indexes were improved in both groups after treatment as manifested by increased R and K values, but there was significant improvement in group B. Intra-group comparisons revealed a time-dependent effect of treatment. In conclusion, the treatment of alogliptin combined with motor imagery under hyperbaric oxygen can better promote thrombolysis absorption, restore brain damage and improve neurocognitive function in DN with silent cerebral infarction.
Collapse
Affiliation(s)
- Danyan Chen
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Xiaolong Huang
- Department of Neurosurgery, No. 324 Hospital of PLA, Chongqing 400028, P.R. China
| | - Hua Gan
- Department of Nephrology, Τhe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaogang Du
- Department of Nephrology, Τhe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Song Lu
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Rongxi Huang
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Ke Liu
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Binghan Zhang
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| |
Collapse
|
2
|
Brutto OHD, Mera RM, Brown DL, Nieves JL, Sedler MJ. Reliability of Two Ankle-Brachial Index Methods to Predict Silent Lacunar Infarcts: A Population-Based Study in Stroke-Free Older Adults (the Atahualpa Project). Int J Angiol 2016; 25:e173-e176. [PMID: 28031690 DOI: 10.1055/s-0036-1584418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Individuals with an abnormal ankle-brachial index (ABI) are four times more likely to have a silent lacunar infarct (SLI), but reliability of ABI in predicting the presence of these lesions has not been estimated yet. We compared two methods of calculating ABI to assess their reliability in predicting SLIs. Stroke-free Atahualpa residents aged ≥ 60 years underwent MRI of the brain and ABI determinations. Persons with ABI ≥ 1.4 were excluded. Using receiver operator characteristic curve analysis, we calculated the reliability of the traditional as well as an alternative ABI method to identify individuals with SLI. The traditional ABI uses the higher systolic pressure of either the dorsalis pedis or the posterior tibial arteries as the numerator, whereas the alternative ABI uses the lower pressure. Of the 247 participants, 38 (15%) had traditional and 95 (38%) had alternative ABIs ≤ 0.9. Twenty-one individuals had SLI. Traditional and alternative ABIs ≤ 0.9 identified 9 and 13 individuals with SLI, respectively. The traditional ABI had sensitivity of 42.9% (22.6-65.6%) and specificity of 87.2% (81.9-91.1%). The alternative ABI had sensitivity of 61.9% (38.6-81%) and specificity of 63.7% (57-69.9%). The area under the curve for the predictive value of SLI was 0.65 (0.54-0.76) for the traditional and 0.63 (0.52-0.74) for the alternative ABI ≤ 0.9. The ABI is moderately reliable for identifying candidates for MRI screening in studies assessing the burden of SLI in older adults. The traditional ABI seems to be more suitable for this purpose.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | | | - David L Brown
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, New York
| |
Collapse
|
3
|
|
4
|
Bergui M, Castagno D, D’Agata F, Cicerale A, Anselmino M, Maria Ferrio F, Giustetto C, Halimi F, Scaglione M, Gaita F. Selective Vulnerability of Cortical Border Zone to Microembolic Infarct. Stroke 2015; 46:1864-9. [DOI: 10.1161/strokeaha.114.008194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/08/2015] [Indexed: 11/16/2022]
|
5
|
Anselmino M, Matta M, Toso E, Ferraris F, Castagno D, Scaglione M, Cesarani F, Faletti R, Gaita F. Silent Cerebral Embolism during Atrial Fibrillation Ablation:Pathophysiology, Prevention and Management. J Atr Fibrillation 2013; 6:796. [PMID: 28496871 DOI: 10.4022/jafib.796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/09/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022]
Abstract
Although many efforts have been directed to improve atrial fibrillation transcatheter ablation safety, thromboembolism to the brain remains one of the major complications. In fact several studies have confirmed occurrence of silent cerebral embolic lesions by post-procedure magnetic resonance imaging. The present review will focus on the possible mechanisms leading to silent cerebral embolism in an attempt to provide recommendations holding the potential to reduce the incidence of this clinically relevant complication.
Collapse
Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Mario Matta
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Elisabetta Toso
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Federico Ferraris
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Marco Scaglione
- Division of Cardiology,Cardinal Guglielmo Massaia Hospital, Asti, Italy
| | - Federico Cesarani
- Division of Radiology, Cardinal Guglielmo Massaia Hospital, Asti, Italy
| | - Riccardo Faletti
- Division of Radiology, City of Health and Science, University of Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| |
Collapse
|
6
|
Anselmino M, Gaita F. Unresolved Issues in Transcatheter Atrial Fibrillation Ablation: Silent Cerebrovascular Ischemias. J Cardiovasc Electrophysiol 2012; 24:129-31. [PMID: 23130669 DOI: 10.1111/jce.12018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Faraji J, Kurio K, Metz GA. Concurrent silent strokes impair motor function by limiting behavioral compensation. Exp Neurol 2012; 236:241-8. [DOI: 10.1016/j.expneurol.2012.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/30/2012] [Accepted: 05/09/2012] [Indexed: 01/08/2023]
|
8
|
Scaglione M, Blandino A, Raimondo C, Caponi D, Di Donna P, Toso E, Ebrille E, Cesarani F, Ferrarese E, Gaita F. Impact of ablation catheter irrigation design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: results from a pilot study. J Cardiovasc Electrophysiol 2012; 23:801-5. [PMID: 22494043 DOI: 10.1111/j.1540-8167.2012.02298.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Silent cerebral lesions (SCL) are a sensitive tool to evaluate thromboembolic risk of catheter ablation. Recent data showed the possibility to reduce thrombus formation when the electrode-tissue interface cooling is optimized by a homogeneous flushing of saline along the entire surface of the distal electrode through a larger number of irrigation holes. The study aim is to compare procedural parameters and safety of pulmonary vein isolation (PVI) performed by using open-irrigated catheters with different irrigation design. METHODS AND RESULTS Eighty patients (74% males; age 57 ± 12 years) with paroxysmal AF randomly underwent PVI performed with a new irrigation design catheter (group A, 40 patients) versus a standard irrigated catheter (group B, 40 patients). A cerebral magnetic resonance imaging (MRI) was performed before and after the procedure. Postprocedural brain MRI unveiled SCL in 2 patients in group A and in 3 in group B (5% vs 7.5%, P = 0.500). Intraprocedural ACT was the only independent factor associated with the occurrence of SCL (OR = 0.996; 95% CI 0.994-0.998, P < 0.001). Among procedural parameters, we observed a reduction of irrigation saline volume of 662 mL in group A versus group B (P < 0.001). CONCLUSION PVI performed with a new irrigated catheter did not reduce significantly the SCL risk when compared to a standard irrigated catheter. Intraprocedural ACT reduces the SCL risk of 0.4% for each point of ACT increase. For ACT > 320 seconds no SCL occurred. Finally, compared to a standard irrigated catheter, PVI performed with a new irrigation design catheter reduces significantly saline volume infusion.
Collapse
Affiliation(s)
- Marco Scaglione
- Cardiology Division, Cardinal Guglielmo Massaia Hospital, Asti, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Zhao J, Tang H, Sun J, Wang B, Chen S, Fu Y. Analysis of cognitive dysfunction with silent cerebral infarction: a prospective study in Chinese patients. Metab Brain Dis 2012; 27:17-22. [PMID: 22193539 DOI: 10.1007/s11011-011-9275-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
To investigate the relationship between Silent Cerebral Infarction (SCI) and cognitive impairment to testify that Montreal Cognitive Assessment (MoCA) is a more sensitive screening tool than the Mini Mental State Examination (MMSE) to identify cognitive deficits in patients with SCI. We recruited 196 individuals in Shanghai of China and divided them into 2 groups: the SCI group including 112 individuals (45 men and 67 women; aged from 43 to 70 years old) and the control group including 84 individuals (43 men and 41 women; aged from 42 to 79 years old). We collected information including participants' gender, age, blood glucose, kidney function, blood lipids, blood pressure, Electrocardiogram (ECG), carotid artery ultrasound, MMSE score, and MoCA score. SAS software (version 9.1) was used to perform statistical analysis on physical examinations outcomes from 196 participants. Furthermore, multiple logistic regression model was built up to screen out the independent risk factors of SCI. Besides, Receiver Operator Characteristic (ROC) analysis was also used. Multivariate logistic regression analysis showed that abnormal ECG and existence of carotid artery plaques were independent risk factors of SCI occurrence, while MoCA scores was negatively associated with SCI risk. Moreover, MoCA might be more valuable in predicting vascular cognitive impairment (VCI) than MMSE (0.667 vs 0.626). We found that the MMSE was generally insensitive to detect cognitive impairment; but the MoCA has a good balance of sensitivity and specificity at the cut-score of 26. We found that the patients with SCI might accompany with VCI and the MoCA appeared to be an excellent screening test for patients with SCI, worthy of being promoted in the clinical practitioning on Chinese population.
Collapse
Affiliation(s)
- Jing Zhao
- Department of Neurology, Minhang Central Hospital, Shanghai 201100, China
| | | | | | | | | | | |
Collapse
|
10
|
Ma J, Sun J, Zhao J, Wei X, Wang B, Fu Y. Relationship between nocturnal blood pressure variation and silent cerebral infarction in Chinese hypertensive patients. J Neurol Sci 2010; 294:67-9. [DOI: 10.1016/j.jns.2010.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 03/05/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
|
11
|
Pengo V. Long-term warfarin use to prevent both stroke and dementia in subjects with atrial fibrillation? J Thromb Haemost 2004; 2:1871-2. [PMID: 15550012 DOI: 10.1111/j.1538-7836.2004.01013.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- V Pengo
- Clinical Cardiology, Thrombosis Center, University of Padova School of Medicine, Padova, Italy.
| |
Collapse
|