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Wijerathne H, Witek MA, Baird AE, Soper SA. Liquid biopsy markers for stroke diagnosis. Expert Rev Mol Diagn 2020; 20:771-788. [PMID: 32500751 PMCID: PMC8157911 DOI: 10.1080/14737159.2020.1777859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION There is a short time window (4.5 h) for the effective treatment of acute ischemic stroke (AIS), which uses recombinant tissue plasminogen activator (rt-PA). Unfortunately, this short therapeutic timeframe is a contributing factor to the relatively small number of patients (~7%) that receive rt-PA. While neuroimaging is the major diagnostic for AIS, more timely decisions could be made using a molecular diagnostic. AREAS COVERED In this review, we survey neuroimaging techniques used to diagnose stroke and their limitations. We also highlight the potential of various molecular/cellular biomarkers, especially peripheral blood-based (i.e. liquid biopsy) biomarkers, for diagnosing stroke to allow for precision decisions on managing stroke in a timely manner. Both protein and nucleic acid molecular biomarkers are reviewed. In particular, mRNA markers are discussed for AIS and hemorrhagic stroke diagnosis sourced from both cells and extracellular vesicles. EXPERT OPINION While there are a plethora of molecular markers for stroke diagnosis that have been reported, they have yet to be FDA-cleared. Possible reasons include the inability for these markers to appear in sufficient quantities for highly sensitive clinical decisions within the rt-PA therapeutic time.
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Affiliation(s)
- Harshani Wijerathne
- Department of Chemistry, The University of Kansas, Lawrence, KS, USA
- Center of BioModular Multiscale Systems for Precision Medicine, The University of Kansas, Lawrence, KS, USA
| | - Malgorzata A. Witek
- Department of Chemistry, The University of Kansas, Lawrence, KS, USA
- Center of BioModular Multiscale Systems for Precision Medicine, The University of Kansas, Lawrence, KS, USA
- Department of Cancer Biology and KU Cancer Center, University of Kansas Medical Center, Cancer Center, Kansas City, KS, USA
| | - Alison E. Baird
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Steven A. Soper
- Department of Chemistry, The University of Kansas, Lawrence, KS, USA
- Center of BioModular Multiscale Systems for Precision Medicine, The University of Kansas, Lawrence, KS, USA
- Department of Cancer Biology and KU Cancer Center, University of Kansas Medical Center, Cancer Center, Kansas City, KS, USA
- Bio Engineering Program, The University of Kansas, Lawrence, KS, USA
- Department of Mechanical Engineering, The University of Kansas, Lawrence, KS, USA
- Biofluidica, Inc, San Diego, CA, USA
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Alves AFF, Jennane R, de Miranda JRA, de Freitas CCM, Abdala N, de Pina DR. Ischemic stroke enhancement using a variational model and the expectation maximization method. Eur Radiol 2018; 28:3936-3942. [PMID: 29619518 DOI: 10.1007/s00330-018-5378-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/18/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In order to enable less experienced physicians to reliably detect early signs of stroke, A novel approach was proposed to enhance the visual perception of ischemic stroke in non-enhanced CT. METHODS A set of 39 retrospective CT scans were used, divided into 23 cases of acute ischemic stroke and 16 normal patients. Stroke cases were obtained within 4.5 h of symptom onset and with a mean NIHSS of 12.9±7.4. After selection of adjunct slices from the CT exam, image averaging was performed to reduce the noise and redundant information. This was followed by a variational decomposition model to keep the relevant component of the image. The expectation maximization method was applied to generate enhanced images. RESULTS We determined a test to evaluate the performance of observers in a clinical environment with and without the aid of enhanced images. The overall sensitivity of the observer's analysis was 64.5 % and increased to 89.6 % and specificity was 83.3 % and increased to 91.7 %. CONCLUSION These results show the importance of a computational tool to assist neuroradiology decisions, especially in critical situations such as the diagnosis of ischemic stroke. KEY POINTS • Diagnosing patients with stroke requires high efficiency to avoid irreversible cerebral damage. • A computational algorithm was proposed to enhance the visual perception of stroke. • Observers' performance was increased with the aid of enhanced images.
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Affiliation(s)
- Allan Felipe Fattori Alves
- Instituto de Biociências de Botucatu, Departamento de Física e Biofísica, UNESP-Universidade Estadual Paulista, P.O. BOX 510, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-000, Brazil
| | - Rachid Jennane
- Laboratory I3MTO - University of Orleans, 5 Rue de Chartres, BP 6744, 45072, Orléans, France
| | - José Ricardo Arruda de Miranda
- Instituto de Biociências de Botucatu, Departamento de Física e Biofísica, UNESP-Universidade Estadual Paulista, P.O. BOX 510, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-000, Brazil
| | - Carlos Clayton Macedo de Freitas
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, UNESP-Universidade Estadual Paulista, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-000, Brazil
| | - Nitamar Abdala
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina - UNIFESP, Rua Napoleão de Barros, 800, São Paulo, 04024-002, Brazil
| | - Diana Rodrigues de Pina
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP-Universidade Estadual Paulista, Distrito de Rubião Junior S/N, Botucatu, São Paulo, 18618-000, Brazil.
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Xue Z, Peng D, Sun Z, Wu C, Xu B, Wang F, Zhou D, Dong T. Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases. Med Sci Monit 2016; 22:3362-3369. [PMID: 27657307 PMCID: PMC5036379 DOI: 10.12659/msm.897356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA. MATERIAL AND METHODS Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods. RESULTS There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA. CONCLUSIONS Intraoperative PCT could be an important adjuvant monitoring method in CEA.
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Affiliation(s)
- Zhe Xue
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Dingwei Peng
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Zhenghui Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Chen Wu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Fuyu Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Dingbiao Zhou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Tianxiang Dong
- Department of Radiology, Chinese PLA General Hospital, Beijing, China (mainland)
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Sun Y, He W, Geng L. Neuroprotective mechanism of HIF-1α overexpression in the early stage of acute cerebral infarction in rats. Exp Ther Med 2016; 12:391-395. [PMID: 27347067 DOI: 10.3892/etm.2016.3288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/17/2016] [Indexed: 12/18/2022] Open
Abstract
The present study aimed to explore the expression and neuroprotective mechanism of hypoxia inducible factor (HIF-1α) in the brain tissue of a rat model of early acute cerebral infarction. A total of 64 Sprague Dawley rats were randomly divided into surgery and sham groups and the model of focal cerebral infarction was established by the suture-occluded method. In the sham group, blood vessels were separated but not occluded. Rats in the surgery and sham groups were subdivided into eight groups (n=4/group). Blood samples was collected at 8 time points including 30 min and 1, 3, 6, 12, 48, 24 and 72 h, respectively, and HIF-1α content was detected using ELISA. Brain tissues of rats in all groups were harvested following blood collection. HIF-1α protein expression was detected by immunohistochemistry and terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling was used to analyze the brain cell apoptosis index. ELISA results demonstrated that rats in the surgery group began to express HIF-1α within 30 min, and HIF-1α expression levels gradually increased, peaking at 12 h. HIF-1α expression levels were significantly increased in the surgery group at all time points, as compared with the sham group (P<0.05). The concentration of HIF-1α decreased rapidly in 12 h. At various time points, HIF-1α protein expression in the brain tissue of rats in the sham group was negative. HIF-1α protein expression was significantly increased in the surgery group (P<0.05), peaking at 12 h, and decreasing after this point. As compared with the sham group, the apoptosis indices of the brain tissue of rats in the surgery group exhibited a gradual increasing trend with significant decreases observed after 12 h (P<0.05). Intra-group comparison of all indices in the surgery group, indicated that there was a statistically significant difference between postoperative 12 h and other time points (P<0.05). In conclusion, the present study demonstrated that HIF-1α was highly expressed in the brain tissue of rat models of early acute cerebral infarction. The results also indicated that HIF-1α significantly reduced the apoptosis of infarcted cells, suggesting that HIF-1α may have a neuroprotective role in early acute cerebral infarction.
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Affiliation(s)
- Yuhua Sun
- Department of Neurology, Henan University Huaihe Hospital, Kaifeng, Henan 475001, P.R. China
| | - Weiya He
- Department of Neurology, Henan University Huaihe Hospital, Kaifeng, Henan 475001, P.R. China
| | - Lijiao Geng
- Department of Neurology, Henan University Huaihe Hospital, Kaifeng, Henan 475001, P.R. China
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Liu XT, Ren PW, Peng L, Kang DY, Zhang TL, Wen S, Hong Q, Yang WJ. Effectiveness and safety of ShenXiong glucose injection for acute ischemic stroke: a systematic review and GRADE approach. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:68. [PMID: 26895969 PMCID: PMC4761180 DOI: 10.1186/s12906-016-1038-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/04/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND To appraise critically whether published trials of ShenXiong glucose injection for patients with acute ischemic stroke (AIS) are of sufficient quality, and in addition to rate the quality of evidence by using the GRADE approach (grading of recommendations, assessment, development, and evaluation, GRADE). METHODS A literature search was performed in the Cochrane Library, MEDLINE, EMBASE, CBM, Chinese TCM (traditional Chinese medicine) Database, CNKI, VIP, WanFang Databases until January 2015. The limits were patients with AIS and randomized controlled trials (RCTs) or quasi-RCTs. Studies by which patients suffering intracerebral haemorrhage were excluded. RESULTS Twelve studies fulfilled the inclusion criteria. We found significant benefits of ShenXiong glucose injection compared with conventional treatment in improving activities of daily living function at 4 weeks (MD = 34.12, 95 % CI: 29.07, 39.17), neurological function deficit at 2 weeks (MD = -5.39, 95% CI: -6.90, -3.87), 4 weeks (MD = -5.16, 95 % CI: -6.49, -3.83), and clinical effects at 4 weeks (RR = 1.17, 95% CI: 1.10, 1.24). No trials reported the effects of ShenXiong glucose injection on the risk of early, deterioration, or quality of life. No adverse events were reported within the whole follow-up period. CONCLUSIONS The use of ShenXiong glucose injection may improve rehabilitation for patients with acute ischemic stroke, however, as the GRADE approach indicated low to moderate quality of available evidence as well as insufficient information about harm and patients preference, the recommendations were not provided for ShenXiong glucose injection taking as a therapeutic intervention to patients with acute ischemic stroke.
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Affiliation(s)
- Xue-ting Liu
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Peng-wei Ren
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Le Peng
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - De-ying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Tian-le Zhang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Shu Wen
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Qi Hong
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
| | - Wen-jie Yang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, 610041 P. R. China
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Morgan CD, Stephens M, Zuckerman SL, Waitara MS, Morone PJ, Dewan MC, Mocco J. Physiologic imaging in acute stroke: Patient selection. Interv Neuroradiol 2015; 21:499-510. [PMID: 26063695 DOI: 10.1177/1591019915587227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Treatment of acute stroke is changing, as endovascular intervention becomes an important adjunct to tissue plasminogen activator. An increasing number of sophisticated physiologic imaging techniques have unique advantages and applications in the evaluation, diagnosis, and treatment-decision making of acute ischemic stroke. In this review, we first highlight the strengths, weaknesses, and possible indications for various stroke imaging techniques. How acute imaging findings in each modality have been used to predict functional outcome is discussed. Furthermore, there is an increasing emphasis on using these state-of-the-art imaging modalities to offer maximal patient benefit through IV therapy, endovascular thrombolytics, and clot retrieval. We review the burgeoning literature in the determination of stroke treatment based on acute, physiologic imaging findings.
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Affiliation(s)
- Clinton D Morgan
- Department of Neurological Surgery, Vanderbilt University School of Medicine, USA
| | | | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University School of Medicine, USA
| | | | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University School of Medicine, USA
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University School of Medicine, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mouth Sinai, USA
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Juenemann M, Goegel S, Obert M, Schleicher N, Ritschel N, Doenges S, Eitenmueller I, Schwarz N, Kastaun S, Yeniguen M, Tschernatsch M, Gerriets T. Flat-panel volumetric computed tomography in cerebral perfusion: evaluation of three rat stroke models. J Neurosci Methods 2013; 219:113-23. [PMID: 23880321 DOI: 10.1016/j.jneumeth.2013.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 07/10/2013] [Accepted: 07/11/2013] [Indexed: 11/16/2022]
Abstract
Flat-panel volumetric computed tomography (fpVCT) is a non-invasive approach to three-dimensional small animal imaging. The capability of volumetric scanning and a high resolution in time and space enables whole organ perfusion studies. We aimed to assess feasibility and validity of fpVCT in cerebral perfusion measurement with impaired hemodynamics by evaluation of three well-established rat stroke models for temporary and permanent middle cerebral artery occlusion (MCAO). Male Wistar rats were randomly assigned to temporary (group I: suture model) and permanent (group II: suture model; III: macrosphere model) MCAO and to a control group. Perfusion scans with respect to cerebral blood flow (CBF) and volume (CBV) were performed 24h post intervention by fpVCT, using a Gantry rotation time of 1s and a total scanning time of 30s. Postmortem analysis included infarct-size calculation by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Infarct volumes did not differ significantly throughout intervention groups. After permanent MCAO, CBF significantly decreased in subcortical regions to 78.2% (group II, p=0.005) and 79.9% (group III, p=0.012) and in total hemisphere to 77.4% (group II, p=0.010) and 82.0% (group III, p=0.049). CBF was less impaired with temporary vessel occlusion. CBV measurement revealed no significant differences. Results demonstrate feasibility of cerebral perfusion quantification in rats with the fpVCT, which can be a useful tool for non-invasive dynamic imaging of cerebral perfusion in rodent stroke models. In addition to methodological advantages, CBF data confirm the macrosphere model as a useful alternative to the suture model for permanent experimental MCAO.
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Affiliation(s)
- Martin Juenemann
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
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