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Kang JB, Son HK, Park DJ, Jin YB, Koh PO. Chlorogenic acid regulates the expression of protein phosphatase 2A subunit B in the cerebral cortex of a rat stroke model and glutamate-exposed neurons. Lab Anim Res 2024; 40:8. [PMID: 38429854 PMCID: PMC10905799 DOI: 10.1186/s42826-024-00196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Ischemic stroke is a serious neurological disorder caused by blockages in cerebral artery. Protein phosphatase 2A (PP2A) is a phosphatase that performs a critical role in cell signaling and growth. PP2A subunit B acts as a neuroprotective agent in the nerve system. Chlorogenic acid, which is mainly found in roasted coffee, has antioxidant, anti-inflammatory, and anti-apoptotic effects. We hypothesized that chlorogenic acid modulates PP2A subunit B expression in ischemic stroke models and glutamate-mediated neurons. Middle artery occlusion (MCAO) surgery was operated and chlorogenic acid (30 mg/kg) or phosphate buffer saline was treated 2 h after MCAO. The cerebral cortex was collected 24 h after surgery and the change of PP2A subunit B expression was analyzed. Glutamate and/or chlorogenic acid were treated in cultured neurons, further study was performed. RESULTS A decrease in PP2A subunit B expression in MCAO animals was identified. Chlorogenic acid alleviated this decrease due to ischemic injury. Moreover, the number of PP2A subunit B-positive cells in the ischemic cerebral cortex was significantly decreased, chlorogenic acid alleviated this decrease. We also found protective effects of chlorogenic acid in neurons exposed to glutamate. Glutamate decreased the expression of PP2A subunit B and chlorogenic acid mitigated this decrease. Our results elucidated that chlorogenic acid performs neuroprotective functions and attenuates the reduction of PP2A subunit B by brain damage and glutamate-mediated excitotoxicity. CONCLUSIONS We showed that chlorogenic acid attenuated the decrease of PP2A subunit B in ischemic injury and neurons exposed to glutamate. Since PP2A subunit B contributes to the protection of brain tissue, we can suggest that chlorogenic acid preserves neurons by modulating PP2A subunit B during ischemic damage.
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Affiliation(s)
- Ju-Bin Kang
- Department of Anatomy and Histology, College of Veterinary Medicine, Research Institute of Life Science, Gyeongsang National University, 501 Jinjudaero, Jinju, 52828, South Korea
| | - Hyun-Kyoung Son
- Department of Anatomy and Histology, College of Veterinary Medicine, Research Institute of Life Science, Gyeongsang National University, 501 Jinjudaero, Jinju, 52828, South Korea
| | - Dong-Ju Park
- Department of Anatomy and Histology, College of Veterinary Medicine, Research Institute of Life Science, Gyeongsang National University, 501 Jinjudaero, Jinju, 52828, South Korea
| | - Yeung-Bae Jin
- Department of Anatomy and Histology, College of Veterinary Medicine, Research Institute of Life Science, Gyeongsang National University, 501 Jinjudaero, Jinju, 52828, South Korea
| | - Phil-Ok Koh
- Department of Anatomy and Histology, College of Veterinary Medicine, Research Institute of Life Science, Gyeongsang National University, 501 Jinjudaero, Jinju, 52828, South Korea.
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Mitsuhashi T, Teranishi K, Tokugawa J, Mitsuhashi T, Hishii M, Oishi H. Prognostic Determinants of Anterior Large Vessel Occlusion in Acute Stroke in Elderly Patients. Geriatrics (Basel) 2024; 9:13. [PMID: 38247988 PMCID: PMC10801592 DOI: 10.3390/geriatrics9010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
This study investigated prognostic factors in elderly patients (80 years and older) undergoing mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) in acute stroke treatment. Of 59 cases, 47.5% achieved a favorable outcome (mRS ≤ 3) at three months, with a mortality rate of 20.3%. Factors associated with better outcomes included younger age, lower admission National Institute of Health Stroke Scale (NIHSS) scores, lower N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer levels, the presence of the first pass effect (FPE), and successful recanalization. However, logistic regression showed that only lower admission NIHSS scores were significantly correlated with favorable outcomes. In addition, this study suggests that lower admission NT-proBNP and D-dimer levels could potentially serve as prognostic indicators for elderly LVO patients undergoing MT.
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Affiliation(s)
- Takashi Mitsuhashi
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Kohsuke Teranishi
- Department of Neurosurgery and Neuroendovascular Therapy, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Joji Tokugawa
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Takumi Mitsuhashi
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Makoto Hishii
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hidenori Oishi
- Department of Neurosurgery and Neuroendovascular Therapy, Juntendo University School of Medicine, Tokyo 113-8421, Japan
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Umeonwuka CI, Roos R, Ntsiea V. Clinical and demographic predictors of unilateral spatial neglect recovery after prism therapy among stroke survivors in the sub-acute phase of recovery. Neuropsychol Rehabil 2023; 33:1624-1649. [PMID: 36242544 DOI: 10.1080/09602011.2022.2131582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS: Unilateral Spatial Neglect (USN) affects the rehabilitation process and leads to poor outcomes after stroke. Factors that influence USN recovery following prism adaptation therapy have not been investigated. This study investigated predictors of USN recovery after prism therapy at the sub-acute phase of recovery. METHODS: This study was a randomized controlled trial. USN was assessed with the Behavioural Inattention Test and Catherine Bergego scale. Seventy-four patients with USN were divided into control and intervention group (prism). The prism group used 20 dioptre prism lenses for repeated aiming for 12 sessions while the control group used neutral lenses for aiming training. Regression analysis was conducted to establish clinical and sociodemographic factors that influence USN recovery. RESULTS: Gender, age, years of education, race, employment status, handedness, type of stroke, time since stroke and site of stroke (p > 0.005) showed no significant influence on USN recovery following PA treatment. Higher Cognitive function (OR = 1.52, CI = 1.08-2.14, p = 0.016) and group allocationng (being in the prism group) (OR = 63.10, CI = 9.70-410.59, P < 0.001) were found to significantly influence USN recovery following PA treatment session. CONCLUSIONS: A significant modulating effect on general cognitive ability was found in this study. This suggests that prism adaptation therapy's effect on neural activity and spatial neglect depends on the cognitive function of stroke survivors.Trial registration: Pan African Clinical Trial Registry identifier: PACTR201903732473573.
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Affiliation(s)
- Chuka Ifeanyi Umeonwuka
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
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Jin T, Leng B. Cynaropicrin Averts the Oxidative Stress and Neuroinflammation in Ischemic/Reperfusion Injury Through the Modulation of NF-kB. Appl Biochem Biotechnol 2023; 195:5424-5438. [PMID: 35838888 PMCID: PMC10457408 DOI: 10.1007/s12010-022-04060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/02/2022]
Abstract
Cerebral ischemia and successive reperfusion are the prevailing cause of cerebral stroke. Currently cerebral stroke is considered to be one of the prior causes for high mortality, disability, and morbidity. Cynaropicrin, a sesquiterpene lactone, exhibits various pharmacologic properties and also has an anti-inflammatory property associated with the suppression of the key pro-inflammatory NF-κB pathway. The protective effect of cynaropicrin against oxidative stress and neuroinflammation during CIR injury through the modulation of NF-κB pathway was studied in the current investigation. The experimental rats split into 5 groups as sham-operated control group (group 1), middle cerebral artery occlusion (MCAO)-induced rats (group 2), MCAO rats treated with cynaropicrin (diluted in saline) immediately 2 h after MCAO with 5, 10, and 25 mg/kg administration orally were designated as groups 3, 4, and 5, respectively. In MCAO-induced animals, the severity of ischemic was evident by the elevated level nitrate, MDA, MMPs, inflammatory mediators, Bax, caspase-3, and NF-κB. The level of Nrf-2, antioxidant enzymes, Bcl-2, and IL-10 was reduced in the MCAO-induced animals. Treatment with cynaropicrin in dosage-based manner increased the level of antioxidant enzymes, IL-10, Nrf-2, and Bcl-2 in the animals which indicates the antioxidative effect of cynaropicrin. The level of nitrate, MDA, MMPs, proinflammatory cytokines, inflammatory mediators, Bax, caspase-3, and NF-κB was reduced in the rats treated with cynaropicrin in a dosage-based manner. Experimental animals treated with cynaropicrin in a dosage-dependent way showed a defensive mechanism against oxidative stress and neuroinflammation by inhibiting the NF-κB pathway.
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Affiliation(s)
- Tao Jin
- Department of Interventional and Vascular Surgery, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China
- Department of Neurosurgery, Affiliated Huashan Hospital of Fudan University, No. 12, Wulumuqi Middle Road, Shanghai, 200040, China
| | - Bing Leng
- Department of Neurosurgery, Affiliated Huashan Hospital of Fudan University, No. 12, Wulumuqi Middle Road, Shanghai, 200040, China.
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Zhang H, Zhan Q, Dong F, Gao X, Zeng F, Yao J, Gan Y, Zou S, Gu J, Fu H, Wang X. Associations of Chinese visceral adiposity index and new-onset stroke in middle-aged and older Chinese adults: an observational study. Lipids Health Dis 2023; 22:74. [PMID: 37337187 DOI: 10.1186/s12944-023-01843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Stroke represents the second most prevalent contributor to global mortality. The Chinese Visceral Adiposity Index (CVAI) serves as an established metric for assessing visceral adiposity in the Chinese population, exhibiting prognostic capabilities. This investigation aimed to explore the association of CVAI and new-onset stroke among middle-aged and older Chinese populations. METHODS The study employed data from the 2011 and 2018 China Health and Retirement Longitudinal Study (CHARLS) to assess the association of CVAI and the incidence of new-onset stroke. Utilizing a directed acyclic graph (DAG), 10 potential confounders were identified. Moreover, to explore the association between CVAI and new-onset stroke, three multifactor logistic regression models were constructed, accounting for the identified confounders and mitigating their influence on the findings. RESULTS The study comprised 7070 participants, among whom 417 (5.9%) experienced new-onset strokes. After controlling for confounding variables, regression analysis suggested that the new-onset stroke's highest risk was linked to the fourth quartile (Q4) of the CVAI, with an odds ratio (OR) of 2.33 and a 95% confidence interval (CI) of 1.67-3.28. The decision tree analysis demonstrated a heightened probability of new-onset stroke among hypertensive individuals with a CVAI equal to or greater than 83, coupled with a C-reactive protein level no less than 1.1 mg/l. Age seemed to have a moderating influence on the CVAI and new-onset stroke association, exhibiting a more prominent interaction effect in participants under 60 years. CONCLUSIONS In middle-aged and older Chinese populations, a linear relationship was discerned between CVAI and the probability of new-onset stroke. CVAI provides a predictive framework for stroke incidence in this demographic, laying the groundwork for more sophisticated risk prediction models that improve the precision and specificity of stroke risk evaluations.
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Affiliation(s)
- Hongyu Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Qi Zhan
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Fayan Dong
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xueting Gao
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Fanyue Zeng
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jiahao Yao
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yifan Gan
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Shuhuai Zou
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jianheng Gu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Hongqian Fu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xuefeng Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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Zhu W, Davis CM, Allen EM, Feller SL, Bah TM, Shangraw RE, Wang RK, Alkayed NJ. Sex Difference in Capillary Reperfusion After Transient Middle Cerebral Artery Occlusion in Diabetic Mice. Stroke 2023; 54:364-373. [PMID: 36689578 PMCID: PMC9883047 DOI: 10.1161/strokeaha.122.040972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/13/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Type 2 diabetes (DM2) exacerbates stroke injury, reduces efficacy of endovascular therapy, and worsens long-term functional outcome. Sex differences exist in stroke incidence, response to therapy, poststroke microvascular dysfunction, and functional recovery. In this study, we tested the hypotheses that poor outcome after stroke in the setting of DM2 is linked to impaired microvascular tissue reperfusion and that male and female DM2 mice exhibit different microvascular reperfusion response after transient middle cerebral artery occlusion (MCAO). METHODS Transient MCAO was induced for 60 minutes using an intraluminal filament in young adult DM2 and nondiabetic control male and female mice. Capillary flux in deep cortical layers was assessed using optical coherence tomography-based optical microangiography (OMAG), and associated regional brain infarct size was evaluated by hematoxylin and eosin staining. RESULTS Compared to baseline, MCAO reduced absolute capillary red blood cell flux by 84% at 24 hours post-MCAO in male DM2 (P<0.001) but not male control mice. When normalized to pre-MCAO baseline, red blood cell flux 24 hours after stroke was 64% lower in male DM2 mice than male nondiabetic controls (P<0.01). In females, MCAO decreased capillary flux by 48% at 24 hours post-MCAO compared with baseline in DM2 (P<0.05) but not in control mice. Red blood cell flux of female DM2 mice did not differ from that of nondiabetic controls either before or 24 hours after MCAO. Furthermore, normalized capillary flux 24 hours after MCAO failed to differ between female DM2 mice and nondiabetic controls. Concomitantly, male but not female DM2 mice experienced 25% larger infarct in caudate-putamen versus respective nondiabetic controls (P<0.05). CONCLUSIONS DM2 impairs capillary perfusion and exacerbates ischemic deep brain injury in male but not female young adult mice. Premenopausal females appear to be protected against DM2-related capillary dysfunction and brain injury.
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Affiliation(s)
- Wenbin Zhu
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
| | - Catherine M Davis
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
| | - Elyse M Allen
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
| | - Sarah L Feller
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
| | - Thierno M Bah
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
| | - Robert E Shangraw
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA 98195
| | - Nabil J Alkayed
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA 97239
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA 97239
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Serum Fatty Acids Are Associated with a Higher Risk of Ischemic Stroke. Nutrients 2023; 15:nu15030585. [PMID: 36771293 PMCID: PMC9921638 DOI: 10.3390/nu15030585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Stroke prevention, a significant public-health concern, begins with recognizing and addressing risk factors. Interventions targeted at modifiable risk factors can effectively prevent ischemic stroke, while Omega-3 fatty acids have been shown to improve stroke outcomes. Our study aimed to investigate the relationship between ischemic-stroke risk factors and fatty acids using a prospective observational study with 274 patients. We collected clinical data on risk factors and measured fatty-acid levels using high-performance liquid chromatography coupled with mass spectrometry. We found that several risk factors, including age, sex, smoking, atrial fibrillation, dyslipidemia, and previous stroke history, had a direct relationship with fatty acids. Of these, smoking had the most significant impact, negatively impacting levels of docosahexaenoic and eicosapentaenoic acid. Conversely, dyslipidemia and atrial fibrillation positively correlated with fatty acids, particularly in female patients and those with recurrent strokes. Age was found to directly correlate with other risk factors and variations in fatty-acid ratios. The stroke rate was higher in males than females before the age of 70, but this trend reversed. Our findings suggest that better management of risk factors, particularly modifiable lifestyle factors, could improve fatty-acid profiles and the balance of Omega-3 and Omega-6 in patients with ischemic stroke.
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Advances in Antibody-Based Therapeutics for Cerebral Ischemia. Pharmaceutics 2022; 15:pharmaceutics15010145. [PMID: 36678774 PMCID: PMC9866586 DOI: 10.3390/pharmaceutics15010145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/18/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Cerebral ischemia is an acute disorder characterized by an abrupt reduction in blood flow that results in immediate deprivation of both glucose and oxygen. The main types of cerebral ischemia are ischemic and hemorrhagic stroke. When a stroke occurs, several signaling pathways are activated, comprising necrosis, apoptosis, and autophagy as well as glial activation and white matter injury, which leads to neuronal cell death. Current treatments for strokes include challenging mechanical thrombectomy or tissue plasminogen activator, which increase the danger of cerebral bleeding, brain edema, and cerebral damage, limiting their usage in clinical settings. Monoclonal antibody therapy has proven to be effective and safe in the treatment of a variety of neurological disorders. In contrast, the evidence for stroke therapy is minimal. Recently, Clone MTS510 antibody targeting toll-like receptor-4 (TLR4) protein, ASC06-IgG1 antibody targeting acid sensing ion channel-1a (ASIC1a) protein, Anti-GluN1 antibodies targeting N-methyl-D-aspartate (NMDA) receptor associated calcium influx, GSK249320 antibody targeting myelin-associated glycoprotein (MAG), anti-High Mobility Group Box-1 antibody targeting high mobility group box-1 (HMGB1) are currently under clinical trials for cerebral ischemia treatment. In this article, we review the current antibody-based pharmaceuticals for neurological diseases, the use of antibody drugs in stroke, strategies to improve the efficacy of antibody therapeutics in cerebral ischemia, and the recent advancement of antibody drugs in clinical practice. Overall, we highlight the need of enhancing blood-brain barrier (BBB) penetration for the improvement of antibody-based therapeutics in the brain, which could greatly enhance the antibody medications for cerebral ischemia in clinical practice.
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Zhang L, Cui H, Hu A, Li J, Tang Y, Welsch RE. An Improved Detection Algorithm for Ischemic Stroke NCCT Based on YOLOv5. Diagnostics (Basel) 2022; 12:2591. [PMID: 36359435 PMCID: PMC9688968 DOI: 10.3390/diagnostics12112591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 09/16/2023] Open
Abstract
Cerebral stroke (CS) is a heterogeneous syndrome caused by multiple disease mechanisms. Ischemic stroke (IS) is a subtype of CS that causes a disruption of cerebral blood flow with subsequent tissue damage. Noncontrast computer tomography (NCCT) is one of the most important IS detection methods. It is difficult to select the features of IS CT within computational image analysis. In this paper, we propose AC-YOLOv5, which is an improved detection algorithm for IS. The algorithm amplifies the features of IS via an NCCT image based on adaptive local region contrast enhancement, which then detects the region of interest via YOLOv5, which is one of the best detection algorithms at present. The proposed algorithm was tested on two datasets, and seven control group experiments were added, including popular detection algorithms at present and other detection algorithms based on image enhancement. The experimental results show that the proposed algorithm has a high accuracy (94.1% and 91.7%) and recall (85.3% and 88.6%) rate; the recall result is especially notable. This proves the excellent performance of the accuracy, robustness, and generalizability of the algorithm.
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Affiliation(s)
- Lifeng Zhang
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing 100876, China
- State Key Laboratory of Networking & Switching Technology, Beijing University of the Posts and Telecommunications, Beijing 100876, China
| | - Hongyan Cui
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing 100876, China
- State Key Laboratory of Networking & Switching Technology, Beijing University of the Posts and Telecommunications, Beijing 100876, China
| | - Anming Hu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiadong Li
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing 100876, China
- State Key Laboratory of Networking & Switching Technology, Beijing University of the Posts and Telecommunications, Beijing 100876, China
| | - Yidi Tang
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing 100876, China
| | - Roy Elmer Welsch
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Center for Statistics and Data Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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The Impact of Depression on the Functional Outcome of the Elderly Stroke Victim from a Gender Perspective: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10102110. [PMID: 36292558 PMCID: PMC9601884 DOI: 10.3390/healthcare10102110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: The aim of this systematic review focused on analyzing the impact of depression on the functional outcome of the elderly stroke victim and how this disorder affects both the female and the male population. (2) Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (ID 346284). The systematic search for clinical trials was performed in the databases Pubmed, Otseeker, Scopus, Web of Science, Psycinfo, Medline Complete, ScienceDirect, SciELO, and Dialnet. Articles were selected according to the inclusion and exclusion criteria, including those dealing with post-stroke depression in adults whose psychological status had changed. Studies that only assessed the psychological state of caregivers were excluded. (3) Results: In total, 609 articles were identified, of which 11 randomized controlled trials were finally included in the review. The results indicate that post-stroke depression influences the recovery of functionality and quality of life. In addition, the need to detect the mood of the adult population after the stroke and to provide individualized treatment according to the characteristics of the person is highlighted. (4) Conclusions: This systematic review shows how early detection of post-stroke depressive symptoms can improve the degree of disability and quality of life of the person, especially in women.
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11
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Liu J, Sato Y, Falcone-Juengert J, Kurisu K, Shi J, Yenari MA. Sexual dimorphism in immune cell responses following stroke. Neurobiol Dis 2022; 172:105836. [PMID: 35932990 DOI: 10.1016/j.nbd.2022.105836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/11/2022] [Accepted: 07/31/2022] [Indexed: 11/22/2022] Open
Abstract
Recent bodies of work in regard to stroke have revealed significant sex differences in terms of risk and outcome. While differences in sex hormones have been the focus of earlier research, the reasons for these differences are much more complex and require further identification. This review covers differences in sex related immune responses with a focus on differences in immune cell composition and function. While females are more susceptible to immune related diseases, they seem to have better outcomes from stroke at the experimental level with reduced pro-inflammatory responses. However, at the clinical level, the picture is much more complex with worse neurological outcomes from stroke. While the use of exogenous sex steroids can replicate some of these findings, it is apparent that many other factors are involved in the modulation of immune responses. As a result, more research is needed to better understand these differences and identify appropriate interventions and risk modification.
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Affiliation(s)
- Jialing Liu
- Dept Neurosurgery, UCSF and SF VAMC, San Francisco, CA, USA
| | - Yoshimichi Sato
- Dept Neurosurgery, UCSF and SF VAMC, San Francisco, CA, USA; Dept Neurosurgery, Tohoku University, Sendai, Japan
| | | | - Kota Kurisu
- Dept Neurosurgery, Hokkaido University, Sapporo, Japan
| | - Jian Shi
- Dept Neurology, UCSF and SF VAMC, San Francisco, CA, USA
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Szyszkowska A, Kuźma Ł, Wożakowska-Kapłon B, Gorczyca-Głowacka I, Jelonek O, Uziębło-Życzkowska B, Krzesiński P, Wójcik M, Błaszczyk R, Gawałko M, Kapłon-Cieślicka A, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła E, Wełnicki M, Mamcarz A, Tomaszuk-Kazberuk A. Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?-Results of the Polish Atrial Fibrillation (POL-AF) Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11939. [PMID: 36231257 PMCID: PMC9564626 DOI: 10.3390/ijerph191911939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). METHODS The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. RESULTS Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use-out of reduced dosage groups, p = 0.06). CONCLUSIONS A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction.
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Affiliation(s)
- Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Iwona Gorczyca-Głowacka
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, 45147 Essen, Germany
| | | | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 38-400 Nowy Sacz, Poland
| | - Renata Rajtar-Salwa
- Cardiology and Cardiovascular Interventions Clinical Department, The University Hospital, 30-688 Krakow, Poland
| | - Jacek Bil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland
| | - Janusz Bednarski
- Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland
| | - Elwira Bakuła
- Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Välimäki NN, Bakreen A, Häkli S, Dhungana H, Keuters MH, Dunlop Y, Koskuvi M, Keksa-Goldsteine V, Oksanen M, Jäntti H, Lehtonen Š, Malm T, Koistinaho J, Jolkkonen J. Astrocyte Progenitors Derived From Patients With Alzheimer Disease Do Not Impair Stroke Recovery in Mice. Stroke 2022; 53:3192-3201. [DOI: 10.1161/strokeaha.122.039700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Species-specific differences in astrocytes and their Alzheimer disease-associated pathology may influence cellular responses to other insults. Herein, human glial chimeric mice were generated to evaluate how Alzheimer disease predisposing genetic background in human astrocytes contributes to behavioral outcome and brain pathology after cortical photothrombotic ischemia.
METHODS:
Neonatal (P0) immunodeficient mice of both sexes were transplanted with induced pluripotent stem cell–derived astrocyte progenitors from Alzheimer disease patients carrying
PSEN1
exon 9 deletion (
P
SEN1
Δ
E
9), with isogenic controls, with cells from a healthy donor, or with mouse astrocytes or vehicle. After 14 months, a photothrombotic lesion was produced with Rose Bengal in the motor cortex. Behavior was assessed before ischemia and 1 and 4 weeks after the induction of stroke, followed by tissue perfusion for histology.
RESULTS:
Open field, cylinder, and grid-walking tests showed a persistent locomotor and sensorimotor impairment after ischemia and female mice had larger infarct sizes; yet, these were not affected by astrocytes with
P
SEN1
Δ
E
9 background. Staining for human nuclear antigen confirmed that human cells successfully engrafted throughout the mouse brain. However, only a small number of human cells were positive for astrocytic marker GFAP (glial fibrillary acidic protein), mostly located in the corpus callosum and retaining complex human-specific morphology with longer processes compared with host counterparts. While host astrocytes formed the glial scar, human astrocytes were scattered in small numbers close to the lesion boundary. Aβ (beta-amyloid) deposits were not present in
P
SEN1
ΔE
9 astrocyte-transplanted mice.
CONCLUSIONS:
Transplanted human cells survived and distributed widely in the host brain but had no impact on severity of ischemic damage after cortical photothrombosis in chimeric mice. Only a small number of transplanted human astrocytes acquired GFAP-positive glial phenotype or migrated toward the ischemic lesion forming glial scar.
P
SEN1
ΔE
9 astrocytes did not impair behavioral recovery after experimental stroke.
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Affiliation(s)
- Nelli-Noora Välimäki
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Abdulhameed Bakreen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Sara Häkli
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Hiramani Dhungana
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Meike H. Keuters
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Yannick Dunlop
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Marja Koskuvi
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Velta Keksa-Goldsteine
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Minna Oksanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Henna Jäntti
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Šárka Lehtonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Jari Koistinaho
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Jukka Jolkkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
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Mechanisms and Biomarker Potential of Extracellular Vesicles in Stroke. BIOLOGY 2022; 11:biology11081231. [PMID: 36009857 PMCID: PMC9405035 DOI: 10.3390/biology11081231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 12/11/2022]
Abstract
Simple Summary A stroke occurs when there is a lack of blood flow to the brain. Stroke injures the brain and can have devastating outcomes depending on the size and location of the brain tissue affected. Currently, there are only a limited number of treatment options for stroke. Extracellular vesicles are small vesicles secreted by cells. Importantly, extracellular vesicles have specific markers indicating the cell they were released from and can pass from the brain into the blood. For these reasons, assessing extracellular vesicles in the blood may create a window into changes occurring in the brain. Assessing changes in extracellular vesicles in the blood during stroke may produce new insight into the cellular changes in the brain causing injury during stroke. This in turn may generate potential targets for the development of future treatments. We summarize what is known about changes in brain-cell-specific extracellular vesicles during stroke and stress the importance of continuing to study these changes. Abstract Stoke is a prevalent and devastating neurologic condition with limited options for therapeutic management. Since brain tissue is rarely accessible clinically, peripheral biomarkers for the central nervous system’s (CNS’s) cellular response to stroke may prove critical for increasing our understanding of stroke pathology and elucidating novel therapeutic targets. Extracellular vesicles (EVs) are cell-derived, membrane-enclosed vesicles secreted by all cell types within the CNS that can freely pass the blood-brain barrier (BBB) and contain unique markers and content linked to their cell of origin. These unique qualities make brain-derived EVs novel candidates for non-invasive blood-based biomarkers of both cell specificity and cell physiological state during the progression of stroke and recovery. While studies are continuously emerging that are assessing the therapeutic potential of EVs and profiling EV cargo, a vast minority of these studies link EV content to specific cell types. A better understanding of cell-specific EV release during the acute, subacute, and chronic stages of stroke is needed to further elucidate the cellular processes responsible for stroke pathophysiology. Herein, we outline what is known about EV release from distinct cell types of the CNS during stroke and the potential of these EVs as peripheral biomarkers for cellular function in the CNS during stroke.
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15
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KIŞ M, GÜZEL T. Evaluation of arrhythmia frequency by holter electrocardiography in patients with acute ischemic cerebrovascular events. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1127448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: After acute ischemic cerebrovascular accident (CVA), identification of high-risk patients, appropriate cardiac follow-up and detection of arrhythmias are important to prevent cardiac morbidity and mortality. The aim of our study is to determine the underlying etiology and the frequency of arrhythmia by holter electrocardiography (ECG) in patients referred to the cardiology clinic due to acute ischemic CVA.
Materials and Methods: A total of 135 consecutive patients who had acute ischemic CVA between January 2019 and June 2021 and whose basal ECG was sinus rhythm were included in the study. This study was a retrospective cross-sectional study.
Results: The mean age of the patients was 72.02±11.02 years, the mean systolic arterial blood pressure was 138.84±20.45 mmHg, and the mean heart rate was 81.63±16.18 beats/min. The most common comorbid diseases were HT (n=67, %49.6) and CAD (n=55, %40.7). 5.9% of patients had prosthetic heart valve and 5.2% had permanent pacemaker. Intracardiac thrombus was detected in 5 (3.7%) patients. The mean left ventricular ejection fraction was 54.4±9.1%. In carotid doppler ultrasonography (USG), 27 (20%) patients had unilateral and 17 (12.6%) bilateral severe carotid arterial stenosis. The most common arrhythmias detected on holter ECG were ventricular extrasystole (n=34, 25.2%) and paroxysmal atrial fibrillation (n=31, 23%). In addition, non-sustained ventricular tachycardia was detected in 6 (4.4%) patients.
Conclusion: Determining the underlying etiology in patients with acute ischemic CVA is important for the treatment of the disease. The incidence of arrhythmia that should be treated in this patient group is too high to be ignored.
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Affiliation(s)
- Mehmet KIŞ
- Dokuz Eylül Üniversitesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
| | - Tuncay GÜZEL
- Diyarbakır SBÜ Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, Diyarbakır, Türkiye
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Mirawati DK, Riany NA, Subandi S, Hamidi BL, Rahayu RF, Budianto P, Hafizhan M, Putra SE. Correlation between HbA1C and Infarct Volume in Acute Ischemic Stroke. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stroke is second leading cause of death worldwide. Chronic hyperglycemia can promote neuronal toxicity. The previous study shows that acute hyperglycemia is correlated with infarct volume of ischemic stroke.
AIM: This study aims to investigate the correlation between hemoglobin A1C (HbA1C) and infarct volume on acute ischemic stroke.
METHODS: This is a cross-sectional study in acute ischemic stroke patient in Dr. Moewardi General Hospital, Surakarta, Indonesia. Data of infarct volume were collected from head computed tomography (CT)-scan and calculated with A × B × C/2 formula. We also collected lipid and patients’ glycemic profile from patients’ blood laboratory result. Head CT-scan and laboratory data of participants analyzed with Pearson and Spearman’s rho test for parametric and non-parametric data, respectively. We also performed multivariate analysis to evaluate confounding covariates. p < 0.05 was considered as statistically significant.
RESULTS: A total of 38 participants were included in this study, with mean infarct volume was 0.46 ± 0.64cc and mean HbA1C was 6.96 ± 2.69%. Bivariate analysis shows strong positive correlation between infarct volume and HbA1C with r = 0.898 (p < 0.001). Other variable that showed a significant correlation with infarct volume were diabetes mellitus history (r = 0.671; p < 0.001), random blood su gar (r = 0.466; p = 0.003), fasting blood sugar (r = 0.636; p < 0.001), 2-h postprandial glucose level (r = 0.646; p ≤ 0.001), high density lipoprotein (r = −0.354; p = 0.029), and triglyceride (r = 0.429; p = 0.007). Based on multivariate analysis, HbA1C regression coefficient on infarct volume was B = 0.222 (p < 0.001), indicating that HbA1C as one of the variables contributing to volume of infarct.
CONCLUSIONS: There is a strong positive correlation between infarct volume and HbA1C, and HbA1C is variable contribute to the volume of infarct.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6521322. [DOI: 10.1093/ejcts/ezac040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/09/2022] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
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Poupore N, Okon M, Mackey T, Nathaniel TI. Pre-stroke factors (morbitities, diet, medication, demograhics) that affect the severity of a stroke. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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19
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Wan Y, Chen HC, Lee CY, Lin HY, Nien CW. Acute visual loss as the first ocular symptom in a Sjögren's syndrome patient with bilateral common carotid artery occlusion: a case report. BMC Ophthalmol 2021; 21:409. [PMID: 34837998 PMCID: PMC8626982 DOI: 10.1186/s12886-021-02177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Sjögren’s syndrome may be a risk factor for carotid artery stenosis. Bilateral common carotid artery occlusion (BCCAO) in a patient with Sjögren’s syndrome was not reported before. In this report, we describe a female with Sjögren’s syndrome who had acute visual loss due to ocular ischemic syndrome (OIS) with BCCAO. Case presentation A 50-year-old female with Sjögren’s syndrome visited our clinic with acute visual loss in the left eye. The best corrected visual acuity (BCVA) was 2/100 in the left eye, and the intraocular pressure (IOP) was normal in both eyes. Ocular ischemic change was observed during the ophthalmic examination. Aortography and computed tomography angiography (CTA) showed nearly total occlusion of the bilateral CCA. Thus, OIS with BCCAO was diagnosed. The vision in the left eye improved to 30/100 after carotid artery stenting for the left common carotid artery. Conclusions BCCAO may be present in patients with Sjögren’s syndrome. Large vessel abnormalities should be considered when acute visual loss is found in a patient with Sjögren’s syndrome.
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Affiliation(s)
- Yi Wan
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan.,Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - Chan-Wei Nien
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.
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Subbarayan MS, Joly-Amado A, Bickford PC, Nash KR. CX3CL1/CX3CR1 signaling targets for the treatment of neurodegenerative diseases. Pharmacol Ther 2021; 231:107989. [PMID: 34492237 DOI: 10.1016/j.pharmthera.2021.107989] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022]
Abstract
Neuroinflammation was initially thought of as a consequence of neurodegenerative disease pathology, but more recently it is becoming clear that it plays a significant role in the development and progression of disease. Thus, neuroinflammation is seen as a realistic and valuable therapeutic target for neurodegeneration. Neuroinflammation can be modulated by neuron-glial signaling through various soluble factors, and one such critical modulator is Fractalkine or C-X3-C Motif Chemokine Ligand 1 (CX3CL1). CX3CL1 is produced in neurons and is a unique chemokine that is initially translated as a transmembrane protein but can be proteolytically processed to generate a soluble chemokine. CX3CL1 has been shown to signal through its sole receptor CX3CR1, which is located on microglial cells within the central nervous system (CNS). Although both the membrane bound and soluble forms of CX3CL1 appear to interact with CX3CR1, they do seem to have different signaling capabilities. It is believed that the predominant function of CX3CL1 within the CNS is to reduce the proinflammatory response and many studies have shown neuroprotective effects. However, in some cases CX3CL1 appears to be promoting neurodegeneration. This review focusses on presenting a comprehensive overview of the complex nature of CX3CL1/CX3CR1 signaling in neurodegeneration and how it may present as a therapeutic in some neurodegenerative diseases but not others. The role of CX3CL1/CXCR1 is reviewed in the context of Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), ischemia, retinopathies, spinal cord and neuropathic pain, traumatic brain injury, amyotrophic lateral sclerosis, multiple sclerosis, and epilepsy.
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Affiliation(s)
- Meena S Subbarayan
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa FL-33612, USA; Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa FL-33612, USA
| | - Aurelie Joly-Amado
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa FL-33612, USA
| | - Paula C Bickford
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa FL-33612, USA; Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa FL-33612, USA; Research Service, James A Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa FL-33612, USA
| | - Kevin R Nash
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa FL-33612, USA.
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G-Protein-Coupled Receptors and Ischemic Stroke: a Focus on Molecular Function and Therapeutic Potential. Mol Neurobiol 2021; 58:4588-4614. [PMID: 34120294 DOI: 10.1007/s12035-021-02435-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023]
Abstract
In ischemic stroke, there is only one approved drug, tissue plasminogen activator, to be used in clinical conditions for thrombolysis. New neuroprotective therapies for ischemic stroke are desperately needed. Several targets and pathways have been shown to confer neuroprotective effects in ischemic stroke. G-protein-coupled receptors (GPCRs) are one of the most frequently targeted receptors for developing novel therapeutics for central nervous system disorders. GPCRs are a large family of cell surface receptors that response to a wide variety of extracellular stimuli. GPCRs are involved in a wide range of physiological and pathological processes. More than 90% of the identified non-sensory GPCRs are expressed in the brain, where they play important roles in regulating mood, pain, vision, immune responses, cognition, and synaptic transmission. There is also good evidence that GPCRs are implicated in the pathogenesis of stroke. This review narrates the pathophysiological role and possible targeted therapy of GPCRs in ischemic stroke.
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22
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Bonkhoff AK, Schirmer MD, Bretzner M, Hong S, Regenhardt RW, Brudfors M, Donahue KL, Nardin MJ, Dalca AV, Giese AK, Etherton MR, Hancock BL, Mocking SJT, McIntosh EC, Attia J, Benavente OR, Bevan S, Cole JW, Donatti A, Griessenauer CJ, Heitsch L, Holmegaard L, Jood K, Jimenez-Conde J, Kittner SJ, Lemmens R, Levi CR, McDonough CW, Meschia JF, Phuah CL, Rolfs A, Ropele S, Rosand J, Roquer J, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Söderholm M, Sousa A, Stanne TM, Strbian D, Tatlisumak T, Thijs V, Vagal A, Wasselius J, Woo D, Zand R, McArdle PF, Worrall BB, Jern C, Lindgren AG, Maguire J, Bzdok D, Wu O, Rost NS. Outcome after acute ischemic stroke is linked to sex-specific lesion patterns. Nat Commun 2021; 12:3289. [PMID: 34078897 PMCID: PMC8172535 DOI: 10.1038/s41467-021-23492-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/30/2021] [Indexed: 01/31/2023] Open
Abstract
Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke.
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Affiliation(s)
- Anna K Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Markus D Schirmer
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Martin Bretzner
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Univ. Lille, Inserm, CHU Lille, U1171 - LilNCog (JPARC) - Lille Neurosciences & Cognition, F-59000, Lille, France
| | - Sungmin Hong
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mikael Brudfors
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kathleen L Donahue
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco J Nardin
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adrian V Dalca
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Anne-Katrin Giese
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark R Etherton
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brandon L Hancock
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Steven J T Mocking
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Elissa C McIntosh
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - John Attia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Oscar R Benavente
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Stephen Bevan
- School of Life Sciences, University of Lincoln, Lincoln, UK
| | - John W Cole
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Amanda Donatti
- School of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Sao Paulo, Brazil
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, PA, USA
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Laura Heitsch
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
- Department of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA
| | - Lukas Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jordi Jimenez-Conde
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Robin Lemmens
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium
- VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Christopher R Levi
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
| | | | - Chia-Ling Phuah
- Department of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA
| | | | - Stefan Ropele
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | - Jonathan Rosand
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Reinhold Schmidt
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- St Peter's and Ashford Hospitals, Egham, UK
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Martin Söderholm
- Department of clinical sciences Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund and Malmö, Sweden
| | - Alessandro Sousa
- School of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Sao Paulo, Brazil
| | - Tara M Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Achala Vagal
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Johan Wasselius
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ramin Zand
- Department of Neurology, Geisinger, Danville, PA, USA
| | - Patrick F McArdle
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arne G Lindgren
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Jane Maguire
- University of Technology Sydney, Sydney, NSW, Australia
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Dettori I, Fusco I, Bulli I, Gaviano L, Coppi E, Cherchi F, Venturini M, Di Cesare Mannelli L, Ghelardini C, Nocentini A, Supuran CT, Pugliese AM, Pedata F. Protective effects of carbonic anhydrase inhibition in brain ischaemia in vitro and in vivo models. J Enzyme Inhib Med Chem 2021; 36:964-976. [PMID: 34056989 PMCID: PMC8168743 DOI: 10.1080/14756366.2021.1907575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ischaemic stroke is a leading cause of death and disability. One of the major pathogenic mechanisms after ischaemia includes the switch to the glycolytic pathway, leading to tissue acidification. Carbonic anhydrase (CA) contributes to pH regulation. A new generation of CA inhibitors, AN11-740 and AN6-277 and the reference compound acetazolamide (ACTZ) were investigated in two models of brain ischaemia: in rat hippocampal acute slices exposed to severe oxygen, glucose deprivation (OGD) and in an in vivo model of focal cerebral ischaemia induced by permanent occlusion of the middle cerebral artery (pMCAo) in the rat. In vitro, the application of selective CAIs significantly delayed the appearance of anoxic depolarisation induced by OGD. In vivo, sub-chronic systemic treatment with AN11-740 and ACTZ significantly reduced the neurological deficit and decreased the infarct volume after pMCAo. CAIs counteracted neuronal loss, reduced microglia activation and partially counteracted astrocytes degeneration inducing protection from functional and tissue damage.
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Affiliation(s)
- Ilaria Dettori
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Irene Fusco
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Irene Bulli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Lisa Gaviano
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Elisabetta Coppi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Federica Cherchi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Martina Venturini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Alessio Nocentini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmaceutical Sciences, University of Florence, Florence, Italy
| | - Claudiu T Supuran
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Section of Pharmaceutical Sciences, University of Florence, Florence, Italy
| | - Anna Maria Pugliese
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Felicita Pedata
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), Division of Pharmacology and Toxicology, University of Florence, Florence, Italy
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24
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Bulli I, Dettori I, Coppi E, Cherchi F, Venturini M, Di Cesare Mannelli L, Ghelardini C, Nocentini A, Supuran CT, Pugliese AM, Pedata F. Role of Carbonic Anhydrase in Cerebral Ischemia and Carbonic Anhydrase Inhibitors as Putative Protective Agents. Int J Mol Sci 2021; 22:5029. [PMID: 34068564 PMCID: PMC8126098 DOI: 10.3390/ijms22095029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
Ischemic stroke is a leading cause of death and disability worldwide. The only pharmacological treatment available to date for cerebral ischemia is tissue plasminogen activator (t-PA) and the search for successful therapeutic strategies still remains a major challenge. The loss of cerebral blood flow leads to reduced oxygen and glucose supply and a subsequent switch to the glycolytic pathway, which leads to tissue acidification. Carbonic anhydrase (CA, EC 4.2.1.1) is the enzyme responsible for converting carbon dioxide into a protons and bicarbonate, thus contributing to pH regulation and metabolism, with many CA isoforms present in the brain. Recently, numerous studies have shed light on several classes of carbonic anhydrase inhibitor (CAI) as possible new pharmacological agents for the management of brain ischemia. In the present review we summarized pharmacological, preclinical and clinical findings regarding the role of CAIs in strokes and we discuss their potential protective mechanisms.
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Affiliation(s)
- Irene Bulli
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Ilaria Dettori
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Elisabetta Coppi
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Federica Cherchi
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Martina Venturini
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Carla Ghelardini
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Alessio Nocentini
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmaceutical Sciences, University of Florence, 50019 Florence, Italy;
| | - Claudiu T. Supuran
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmaceutical Sciences, University of Florence, 50019 Florence, Italy;
| | - Anna Maria Pugliese
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
| | - Felicita Pedata
- Department of Neuroscience, Psycology, Drug Research and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy; (I.B.); (I.D.); (E.C.); (F.C.); (M.V.); (L.D.C.M.); (C.G.); (A.M.P.)
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25
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Xu J, Pei J, Fu QH, Wang LY, Zhan YJ, Tao L. Earlier Acupuncture Enhancing Long-Term Effects on Motor Dysfunction in Acute Ischemic Stroke: Retrospective Cohort Study. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:1787-1802. [PMID: 33308097 DOI: 10.1142/s0192415x20500895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stroke is the leading fatal disease in China. This retrospective study aimed to explore the optimal acupuncture intervention time for long-term efficacy on motor dysfunction in patients suffering from acute ischemic stroke through 1-year of follow-up. Three hundred and nine patients collected at Longhua Hospital from January 2016 to December 2017 were classified into 3 groups based on the acupuncture intervention time, including groups A (within 2 days), B (within 3–7 days) and C (within 8–14 days). All patients had received standard treatment combined with acupuncture therapy. Specifically, acupuncture was performed at the acupoints including LI4 (Hegu), ST40 (Fenglong), DU20 (Baihui), and motor area of the scalp, followed by 2 electroacupuncture protocols based on different muscle tensions once a day for 5 days consecutively. The time-effect relationship was assessed using both the Fugl-Meyer Assessment (FMA) and the modified Barthel index (MBI) on the 90th day and 1st year, respectively. Meanwhile, the modified Rankin scale (mRS), high-sensitivity C-reactive protein (hs-CRP), and fibrinogen (FIB) were also measured during the 1-year follow-up. The favorable outcome rate was 74.4%. One-way univariate analysis of variance (ANOVA) revealed significant differences in FMA and MBI on the 90th day among the 3 groups ([Formula: see text] < 0.05), while no significant differences were observed in FMA, MBI or mRS at the 1st year between groups A and B. The levels of hs-CRP and FIB ([Formula: see text] < 0.05) were markedly reduced. Binary logistic regression analysis suggested that patients with atrial fibrillation (AF) (odds ratio (OR): 3.156), chronic kidney disease (CKD) (OR: 2.563), diabetes mellitus (DM) (OR: 2.174) or stroke history (OR: 1.883) were more inclined to recover poorly from nerve function deficit ([Formula: see text] < 0.05). Earlier acupuncture intervention may have a better long-term effect on motor dysfunction and inflammation during the 1-year follow-up. Moreover, acupuncture within 2 days is probably the optimal treatment time for early recovery on the 90th day.
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Affiliation(s)
- Jia Xu
- Department of Acupuncture, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Jian Pei
- Department of Acupuncture, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Qin-Hui Fu
- Department of Acupuncture, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Liao-Yao Wang
- Department of Acupuncture, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Yi-Jun Zhan
- Department of Acupuncture, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Lin Tao
- Department of Acupuncture, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
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26
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Tshilanda M, Kanmounye US, Kapongo R, Tshiasuma M. Systemic disorders and the prognosis of stroke in Congolese patients: a cross-sectional study. Ghana Med J 2020; 54:225-230. [PMID: 33883770 PMCID: PMC8042813 DOI: 10.4314/gmj.v54i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Stroke is one of the leading causes of death, disability, and dementia in developing countries. Our study aimed to evaluate the systemic disorders associated with mortality in patients admitted within 72 hours of the initial stroke event. SETTING The study took place at a tertiary hospital in Kinshasa. PARTICIPANTS Patients admitted within 72 hours of the initial stroke event. INTERVENTIONS This cross-sectional study consisted of a retrospective review of stroke patient records from January 2016 to December 2018. The Pearson-Chi square test and odds ratios were calculated with a threshold of significance of 0.05. MAIN OUTCOME MEASURES Mortality. RESULTS We recruited 114 cases. The mean age was 61.8 ± 2.4 years, and the sex ratio was 1.78 in favor of men. Hypertension (76.3%), dyslipidemia (71.1%), and diabetes mellitus (58.8%) were the most frequent comorbidities. Most patients had hypoxia (85.9%), hypertension (82.4%), hyperglycemia (57.8%), and fever (28.1%). We registered thirty-two deaths (28.1%): 20 (62.5%) from the ischemic strokes, and 12 (37.5%) from hemorrhagic strokes. Systemic disorders with the worst prognosis during were arterial hypotension (OR=3.87, p >0.001), and fever (OR =1.56, p = 0.047). CONCLUSION Arterial hypotension and fever adversely affect stroke patient outcomes, and strokes are responsible for high mortality in Congo. FUNDING Not applicable.
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Affiliation(s)
- Marc Tshilanda
- Department of Internal Medicine, Centre Hospitalier Mère-Enfant (CHME) Monkole, Kinshasa DR Congo
- Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
- Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ulrick S Kanmounye
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Remy Kapongo
- Department of Internal Medicine, Centre Hospitalier Mère-Enfant (CHME) Monkole, Kinshasa DR Congo
- Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Michel Tshiasuma
- Department of Internal Medicine, Centre Hospitalier Mère-Enfant (CHME) Monkole, Kinshasa DR Congo
- Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
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27
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Does the Occurrence of Particular Symptoms and Outcomes of Arterial Ischemic Stroke Depend on Sex in Pediatric Patients?-A Pilot Study. Brain Sci 2020; 10:brainsci10110881. [PMID: 33233638 PMCID: PMC7699743 DOI: 10.3390/brainsci10110881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/19/2020] [Indexed: 12/23/2022] Open
Abstract
Arterial ischemic stroke (AIS) in childhood is reported to occur more frequently in boys, which may lead to the assumption that the prevalence of post-stroke deficits is sex related. The present study aimed to evaluate sex-related differences in functional outcomes (hemiparesis, seizures, aphasia, and motor disturbances other than hemiparesis) in pediatric patients with AIS. A total of 89 children (52 boys and 37 girls; mean age at stroke onset: 8.4 ± 5.6 years) were evaluated retrospectively based on data from medical records. The patients were divided into subgroups according to age (i.e., infants and toddlers, children, and adolescents), stroke subtype (i.e., lacunar anterior circulation infarct (LACI), total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI)) and stroke location (i.e., anterior stroke, posterior stroke). Significant differences in the prevalence of stroke subtypes between girls and boys were observed (p = 0.034). POCI stroke were found to be more frequent in boys than in girls (OR = 8.57 95%CI 1.05–70.23, p = 0.023). Males predominated in the total group and in all analyzed age subgroups. The proportions of boys within the subgroups according to stroke subtype were extremely high for the POCI and TACI stroke subgroups. On the other hand, girls predominated in the LACI stroke subgroup. Frequency of central type facial nerve palsy and other symptoms of AIS were found to significantly differ between male subgroups according to stroke subtype (p = 0.050 and p < 0.001, respectively), as well as between children with anterior stroke and those with posterior stroke (p = 0.059 and p < 0.001, respectively). Post-stroke seizures appeared significantly more commonly in girls with TACI and POCI stroke than in girls with LACI and PACI stroke (p = 0.022). In turn, the prevalence of post-stroke hemiparesis differed between stroke subtypes in boys (p = 0.026). In conclusion, sex may have an impact in predisposing to a certain type of AIS in the patient. Post-stroke seizure may be related to stroke subtype in girls and hemiparesis in boys. However, further studies are needed to confirm the results.
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28
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Oh CM, Park SK, Jung JY, Choi JM, Ha E, Lee EY, Kim JW, Kang HY, Yang HJ, Ryoo JH. Reduced Glomerular Filtration Rate and Risk of Stroke: A Nationwide Cohort Study in South Korea. J Atheroscler Thromb 2020; 28:928-941. [PMID: 33162421 PMCID: PMC8532060 DOI: 10.5551/jat.56143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims:
Although chronic kidney disease is recognized as an independent risk factor for cerebrovascular disease, its association with hemorrhagic and ischemic stroke remains controversial.
Methods:
We conducted a retrospective cohort study using the National Health Insurance Service-National Sample Cohort, which is representative of the Korean population. A total of 195,772 Koreans who were not diagnosed with stroke before 2009 were included in this study from 2009 to 2013. The eGFR was divided into six categories (≥ 90, 75–89, 60–74, 45–59, 30–44, <30 mL/min/1.73 m
2
). The Kaplan–Meier plot was illustrated to compare the incidence of stroke. Cox proportional hazard model was used to estimate the hazard ratio (HR) of eGFR for risk of ischemic and hemorrhagic stroke by sex.
Results:
During an average of 4.36 years of follow-up period, 2,236 and 668 people were diagnosed with newly ischemic and hemorrhagic stroke, respectively. Age-adjusted incidence rate for ischemic stroke among people with eGFR <45 mL/min/1.73 m
2
was higher than those with eGFR ≥ 90 mL/min/1.73 m
2
, whereas that for hemorrhagic stroke among people with eGFR ≥ 90 mL/min/1.73 m
2
was higher than those with eGFR <45 mL/min/1.73 m
2
. After adjusting for multiple covariates, the adjusted HR for ischemic stroke increased with decreasing eGFR in men (
p
for trend <0.001), but not in women (
p
for trend=0.48). On the other hand, there was no significant relationship between eGFR and risk of hemorrhagic stroke in both men and women.
Conclusions:
Reduced glomerular filtration rate less than 45 mL/min/1.73 m
2
was associated with an increased risk of ischemic stroke, especially in men.
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Affiliation(s)
- Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University
| | - Sung Keun Park
- Total healthcare center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine
| | - Ju Young Jung
- Total healthcare center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine
| | - Joong-Myung Choi
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University
| | - Eun-Young Lee
- Department of Biomedical Science, Graduate School, Kyung Hee University
| | - Jung-Wook Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyung Hee University
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University
| | - Hong Jun Yang
- Department of Preventive Medicine, Graduate School, Kyung Hee University
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University
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29
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Dykstra-Aiello C, Sharp FR, Jickling GC, Hull H, Hamade F, Shroff N, Durocher M, Cheng X, Zhan X, Liu D, Ander BP, Stamova BS. Alternative Splicing of Putative Stroke/Vascular Risk Factor Genes Expressed in Blood Following Ischemic Stroke Is Sexually Dimorphic and Cause-Specific. Front Neurol 2020; 11:584695. [PMID: 33193047 PMCID: PMC7642687 DOI: 10.3389/fneur.2020.584695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Genome-wide association studies have identified putative ischemic stroke risk genes, yet, their expression after stroke is unexplored in spite of growing interest in elucidating their specific role and identifying candidate genes for stroke treatment. Thus, we took an exploratory approach to investigate sexual dimorphism, alternative splicing, and etiology in putative risk gene expression in blood following cardioembolic, atherosclerotic large vessel disease and small vessel disease/lacunar causes of ischemic stroke in each sex compared to controls. Whole transcriptome arrays assessed 71 putative stroke/vascular risk factor genes for blood RNA expression at gene-, exon-, and alternative splicing-levels. Male (n = 122) and female (n = 123) stroke and control volunteers from three university medical centers were matched for race, age, vascular risk factors, and blood draw time since stroke onset. Exclusion criteria included: previous stroke, drug abuse, subarachnoid or intracerebral hemorrhage, hemorrhagic transformation, infection, dialysis, cancer, hematological abnormalities, thrombolytics, anticoagulants or immunosuppressants. Significant differential gene expression (fold change > |1.2|, p < 0.05, partial correlation > |0.4|) and alternative splicing (false discovery rate p < 0.3) were assessed. At gene level, few were differentially expressed: ALDH2, ALOX5AP, F13A1, and IMPA2 (males, all stroke); ITGB3 (females, cardioembolic); ADD1 (males, atherosclerotic); F13A1, IMPA2 (males, lacunar); and WNK1 (females, lacunar). GP1BA and ITGA2B were alternatively spliced in both sexes (all patients vs. controls). Six genes in males, five in females, were alternatively spliced in all stroke compared to controls. Alternative splicing and exon-level analyses associated many genes with specific etiology in either sex. Of 71 genes, 70 had differential exon-level expression in stroke patients compared to control subjects. Among stroke patients, 24 genes represented by differentially expressed exons were male-specific, six were common between sexes, and two were female-specific. In lacunar stroke, expression of 19 differentially expressed exons representing six genes (ADD1, NINJ2, PCSK9, PEMT, SMARCA4, WNK1) decreased in males and increased in females. Results demonstrate alternative splicing and sexually dimorphic expression of most putative risk genes in stroke patients' blood. Since expression was also often cause-specific, sex, and etiology are factors to consider in stroke treatment trials and genetic association studies as society trends toward more personalized medicine.
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Affiliation(s)
- Cheryl Dykstra-Aiello
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Frank R Sharp
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Glen C Jickling
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Heather Hull
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Farah Hamade
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Natasha Shroff
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Marc Durocher
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Xiyuan Cheng
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Xinhua Zhan
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - DaZhi Liu
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Bradley P Ander
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
| | - Boryana S Stamova
- Department of Neurology, Medical Investigation of Neurodevelopmental Disorders (MIND) Institute Biosciences Building, University of California, Davis, Sacramento, CA, United States
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30
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Imam YZ, Kamran S, Saqqur M, Ibrahim F, Chandra P, Perkins JD, Malik RA, Akhtar N, Al-Jerdi S, Deleu D, Elalamy O, Osman Y, Malikyan G, Elkhider H, Elmakki S, ElSheikh L, Mhjob N, Abdelmoneim MS, Alkhawad N, Own A, Shuaib A. Stroke in the adult Qatari population (Q-stroke) a hospital-based retrospective cohort study. PLoS One 2020; 15:e0238865. [PMID: 32956364 PMCID: PMC7505434 DOI: 10.1371/journal.pone.0238865] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Studies assessing the burden of stroke in Qataris are limited. We aim to study stroke in the Qatari population. METHODS A retrospective review was undertaken of all Qatari adults presenting with stroke to Hamad Medical Corporation over a 5-year period. Descriptive statistics were used to summarize demographic and all other clinical characteristics of the patients. The primary outcome was the incidence of stroke in the Qatari patients. Comparison was made between the sexes. RESULTS 862 patients were included, with 58.9% being male. The average incidence of stroke over the 5-year period was 92.04 per 100,000 adult Qatari population. The mean age of the cohort was 64.3±14.4 years, (range 19-105 years). The mean age of first ever cerebrovascular event was 63.2±14.5 years. The diagnosis was ischemic stroke in (73.7%), transient ischemic attack in (13.8%), intracerebral hemorrhage (ICH) in (11.6%), subarachnoid hemorrhage in (0.7%) and (0.2%) cerebral venous sinus thrombosis. Small vessel disease was the most common cause of ischemic stroke accounting for (46.5%), followed by large artery atherosclerosis (24.5%). Hypertension (82.7%) and diabetes (71.6%) were particularly prevalent in this cohort. Females were older (65.8±14.1 vs 63.4±14.5 years), had more hypertension and diabetes and more disability or death at 90 days (p<0.05) compared to Qatari males. CONCLUSION Stroke occurs at a significantly lower age in Qataris compared to the western population. This study has uncovered sex differences that need to be studied further.
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Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faisal Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yasir Osman
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Gayane Malikyan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Elkhider
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suha Elmakki
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Lubna ElSheikh
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Noha Mhjob
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Nima Alkhawad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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31
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Shi M, Chen LY, Bekwelem W, Norby FL, Soliman EZ, Alam AB, Alonso A. Association of Atrial Fibrillation With Incidence of Extracranial Systemic Embolic Events: The ARIC Study. J Am Heart Assoc 2020; 9:e016724. [PMID: 32865122 PMCID: PMC7727011 DOI: 10.1161/jaha.120.016724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. Methods and Results This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA2DS2‐VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA2DS2‐VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA2DS2‐VASc score was associated with increased SEE risk (HR per 1‐point increase, 1.24; 95% CI, 1.05–1.47). Conclusions AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA2DS2‐VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.
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Affiliation(s)
- Mengyuan Shi
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Lin Y Chen
- Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | | | - Faye L Norby
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center Department of Epidemiology and Prevention Wake Forest School of Medicine Winston-Salem NC
| | - Aniqa B Alam
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Alvaro Alonso
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
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32
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Mulugeta H, Yehuala A, Haile D, Mekonnen N, Dessie G, Kassa GM, Kassa ZS, Habtewold TD. Magnitude, risk factors and outcomes of stroke at Debre Markos Referral Hospital, Northwest Ethiopia: a retrospective observational study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00173-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Stroke is one of the leading causes of death and disability in developing countries. The burden of stroke has varied widely in different areas, and there is a paucity of information about stroke in the selected study area.
Objectives
To assess the burden, risk factors, and outcomes of stroke at Debre Markos Referral Hospital, Northwest Ethiopia
Patients and methods
A hospital-based retrospective observational study was conducted in the medical ward of Debre Markos Referral Hospital from March 2017 to April 2019. A pretested checklist was used to extract relevant data from the chart of stroke patients. All statistical analyses were performed in the SPSS version 20 software.
Results
From a total of 2100 admissions in the medical ward, 162 of them were stroke patients, giving the in-hospital magnitude of 7.7%. The in-hospital case fatality rate was 8.6%. Additionally, 27.2% of patients were improved and 39.5% of them were referred. There was a significant association between types of stroke and risk factors such as sex, comorbid hypertension, hyperlipidemia, and atrial fibrillation (P ≤ 0.05).
Conclusion
The in-hospital period prevalence of stroke was 7.7%. Ischemic stroke was the most common type of stroke. Hypertension and hyperlipidemia were the leading identified risk factors for stroke. The overall in-hospital mortality was lower than previous studies in sub-Saharan African countries. Therefore, effective strategies and guidelines for the prevention and control of stroke and its risk factors are needed.
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33
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Ferretti MT, Martinkova J, Biskup E, Benke T, Gialdini G, Nedelska Z, Rauen K, Mantua V, Religa D, Hort J, Santuccione Chadha A, Schmidt R. Sex and gender differences in Alzheimer's disease: current challenges and implications for clinical practice: Position paper of the Dementia and Cognitive Disorders Panel of the European Academy of Neurology. Eur J Neurol 2020; 27:928-943. [PMID: 32056347 DOI: 10.1111/ene.14174] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
Alzheimer's disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual's sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology.
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Affiliation(s)
- M T Ferretti
- Institute for Regenerative Medicine - IREM, University of Zurich, Zurich, Switzerland.,Women's Brain Project, Guntershausen, Switzerland
| | - J Martinkova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - E Biskup
- College of Fundamental Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China.,Division of Internal Medicine, University Hospital of Basel, Basel, Switzerland
| | - T Benke
- Neurology Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - G Gialdini
- Neurology - Private Practice, Lucca, Italy
| | - Z Nedelska
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - K Rauen
- Institute for Regenerative Medicine - IREM, University of Zurich, Zurich, Switzerland.,Women's Brain Project, Guntershausen, Switzerland.,Department of Geriatric Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - V Mantua
- Italian Medicines Agency, Rome, Italy
| | - D Religa
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - J Hort
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - A Santuccione Chadha
- Women's Brain Project, Guntershausen, Switzerland.,Global Medical and Scientific Affairs, Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - R Schmidt
- Department of Neurogeriatrics, University Clinic of Neurology, Medical University Graz, Graz, Austria
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34
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Women and In-hospital Stroke Code Activation: Age, Ethnicity, and Unique Symptoms Matter. J Cardiovasc Nurs 2020; 36:263-272. [PMID: 32106181 DOI: 10.1097/jcn.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women have worse stroke outcomes than men, and almost 17% of all stroke cases have symptom onset when admitted to the hospital for a separate condition. OBJECTIVE The aim of this study was to investigate the distinctive factors that impact the activation of an in-hospital stroke code and outcomes in women who have a stroke while admitted to the hospital for a separate condition. METHODS A retrospective observational propensity score study guided by the model for nursing effectiveness was used. RESULTS In-hospital stroke code was activated in 46 of 149 or 30.9% of women and 15 of 149 or 10.1% of women received thrombolytic therapy. Activation of an in-hospital stroke code was significant (P < .001) for women receiving thrombolytic therapy and significant to a home discharge status (P = .014). Age (P < .001), ethnicity (P < .001), common (P ≤ .001) and unique (P = .012) stroke symptoms, stroke risk factors (P < .001), comorbid conditions (P < .001), time last known well (P = .041), and diagnostic imaging (P < .001) were all significantly related to activation of an in-hospital stroke code. CONCLUSIONS Activation of an in-hospital stroke is a key indicator for women to receive thrombolytic therapy and be discharged to home. Younger married women from non-Caucasian ethnic groups and women with stroke risk factors and comorbid conditions are at a greater risk for delayed stroke symptom detection and not having an in-hospital stroke code activated. Awareness of these factors that hinder early stroke detection in women is crucial to improving stroke treatment and outcomes in women.
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35
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Altaee R, Gibson CL. Sexual dimorphism following in vitro ischemia in the response to neurosteroids and mechanisms of injury. BMC Neurosci 2020; 21:5. [PMID: 31996121 PMCID: PMC6988201 DOI: 10.1186/s12868-020-0553-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background Cerebral ischemic stroke is a significant cause of morbidity and mortality. Sex differences exist following stroke in terms of incidence, symptoms, outcomes and response to some treatments. Importantly, molecular mechanisms of injury, activated following ischemia may differ between the sexes and if so may account, at least in part, for sex differences seen in treatment response. Here we aimed to determine, using single-sex organotypic hippocampal slice cultures, whether the effectiveness of a potential treatment option, i.e. sex steroids, exhibited any sexual dimorphism and whether sex affected the mechanisms of apoptosis activated following ischemia. Results Following exposure to ischemia, male-derived tissue exhibited higher levels of cell death than female-derived tissue. Various sex steroid hormones, i.e. progesterone, allopregnanolone, and estradiol, were protective in terms of reducing the amount of cell death in male- and female-derived tissue whereas medoxyprogesterone acetate (MPA) was only protective in female-derived tissue. The protective effect of progesterone was abolished in the presence of finasteride, a 5α-reductase inhibitor, suggesting it was largely mediated via its conversion to allopregnanolone. To test the hypothesis that sex differences exist in the activation of specific elements of the apoptotic pathway activated following ischemia we administered Q-VD-OPH, a caspase inhibitor, or PJ34, an inhibitor of poly (ADP ribose) polymerase (PARP). Caspase inhibition was only effective, in terms of reducing cell death, in female-derived tissue, whereas PARP inhibition was only protective in male-derived tissue. However, in both sexes, the protective effects of progesterone and estradiol were not observed in the presence of either caspase or PARP inhibition. Conclusions Sex differences exist in both the amount of cell death produced and those elements of the cell death pathway activated following an ischemic insult. There are also some sex differences in the effectiveness of steroid hormones to provide neuroprotection following an ischemic insult—namely MPA was only protective in female-derived tissue. This adds further support to the notion sex is an important factor to consider when investigating future drug targets for CNS disorders, such as ischemic stroke.
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Affiliation(s)
- Raeed Altaee
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, LE1 9HN, UK.,Department of Physiology and Pharmacology, University of Karbala, Karbala, Iraq
| | - Claire L Gibson
- Department of Neuroscience, Psychology & Behaviour, University of Leicester, Leicester, LE1 9HN, UK. .,School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2UH, UK.
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36
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Phan HT, Reeves MJ, Blizzard CL, Thrift AG, Cadilhac DA, Sturm J, Otahal P, Rothwell P, Bejot Y, Cabral NL, Appelros P, Kõrv J, Vibo R, Minelli C, Gall SL. Sex Differences in Severity of Stroke in the INSTRUCT Study: a Meta-Analysis of Individual Participant Data. J Am Heart Assoc 2020; 8:e010235. [PMID: 30590965 PMCID: PMC6405721 DOI: 10.1161/jaha.118.010235] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population‐based stroke incidence studies (1996–2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke‐related clinical factors, comorbidities, and pre‐stroke function were obtained. Within each study, relative risk regression using log‐binominal modeling was used to estimate the female:male relative risk (RR) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study‐specific unadjusted and adjusted RRs, controlling for confounding variables, were pooled using random‐effects meta‐analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24–1.46). The sex difference in severity was attenuated after adjustment for age, pre‐stroke dependency, and atrial fibrillation but remained statistically significant (pooled RRadjusted 1.20, 95% CI 1.10–1.30). There was no sex difference in severity for intracerebral hemorrhage (RRcrude 1.08, 95% CI 0.97–1.21; RRadjusted 1.08, 95% CI 0.96–1.20). Conclusions Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre‐stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre‐stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.
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Affiliation(s)
- Hoang T Phan
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia.,2 Department of Health Management and Health Economics Pham Ngoc Thach University of Medicine Ho Chi Minh City Vietnam
| | - Mathew J Reeves
- 3 Department of Epidemiology and Biostatistics Michigan State University East Lansing MI
| | - Christopher L Blizzard
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia
| | - Amanda G Thrift
- 4 Department of Medicine School of Clinical Sciences at Monash Health Monash University Clayton Vic. Australia
| | - Dominique A Cadilhac
- 4 Department of Medicine School of Clinical Sciences at Monash Health Monash University Clayton Vic. Australia.,5 Florey Institute Neuroscience and Mental Health, Heidelberg University of Melbourne Vic. Australia
| | - Jonathan Sturm
- 6 Faculty of Health and Medicine University of Newcastle NSW Australia
| | - Petr Otahal
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia
| | - Peter Rothwell
- 7 Stroke Prevention Research Unit Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom
| | - Yannick Bejot
- 8 University of Burgundy University Hospital of Dijon France
| | - Norberto L Cabral
- 9 Clinica Neurológica de Joinville Joinville Stroke Registry University of Joinville Region-Univille Joinville Brazil
| | - Peter Appelros
- 10 Department of Neurology Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Janika Kõrv
- 11 Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - Riina Vibo
- 11 Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - Cesar Minelli
- 12 Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation Matão SP Brazil
| | - Seana L Gall
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia
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37
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Weber R, Krogias C, Eyding J, Bartig D, Meves SH, Katsanos AH, Caso V, Hacke W. Age and Sex Differences in Ischemic Stroke Treatment in a Nationwide Analysis of 1.11 Million Hospitalized Cases. Stroke 2019; 50:3494-3502. [PMID: 31623547 DOI: 10.1161/strokeaha.119.026723] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background and Purpose- To date, there is still uncertainty about age and sex differences in access to stroke unit treatment and use of intravenous thrombolysis (IVT), while age and sex differences have not been investigated for the new treatment option of mechanical thrombectomy (MT). We, therefore, undertook a complete nationwide analysis of all hospitalized ischemic stroke patients in Germany from 2013 to 2017. Methods- We used the nationwide administrative database of the German Federal Statistical Office and investigated access to stroke unit treatment, IVT, MT, and in-hospital mortality. Patients were subdivided into 6 predefined age groups (20-44, 45-59, 60-69, 70-79, 80-89, and >90 years). Pooled overall and age group estimates were calculated using the random-effects model. To evaluate potential sex disparities, we estimated odds ratios (ORs) with 95% CIs. Results- A total of 1 112 570 patients were hospitalized for first or recurrent ischemic stroke from 2013 to 2017. Overall, stroke unit treatment increased significantly from 66.8% in 2013 to 73.5% in 2017, as did IVT (from 12.4% to 15.9%) and MT (from 2.4% to 5.8%; all P<0.001). Although the difference became smaller over time, patients ≥80 years of age still received significantly less often treatments. Men of all age groups had a significantly higher probability receiving stroke unit treatment (OR, 1.11; 95% CI, 1.09-1.12) and lower in-hospital mortality (OR, 0.91; 95% CI, 0.89-0.93). No disparity was observed in the use of IVT (OR, 1.00; 95% CI, 0.98-1.01), while women of all ages were treated more often with MT (OR, 1.26; 95% CI, 1.22-1.30). Conclusions- Access to stroke unit treatment has to be increased in both older patients and women of all ages. While there was no sex difference in IVT use, it is important to further investigate the significantly higher frequency of MT in women with ischemic stroke irrespective of age.
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Affiliation(s)
- Ralph Weber
- From the Department of Neurology, Alfried Krupp Hospital Essen (R.W.), Ruhr University Bochum, Germany.,Northwest-German Stroke Circle e.V., Bochum, Germany (R.W., C.K., J.E., D.B., S.H.M.)
| | - Christos Krogias
- Department of Neurology, University Hospital St. Josef-Hospital Bochum (C.K., A.H.K.), Ruhr University Bochum, Germany.,Northwest-German Stroke Circle e.V., Bochum, Germany (R.W., C.K., J.E., D.B., S.H.M.)
| | - Jens Eyding
- Department of Neurology, Klinikum Dortmund, Germany (J.E.).,Northwest-German Stroke Circle e.V., Bochum, Germany (R.W., C.K., J.E., D.B., S.H.M.)
| | - Dirk Bartig
- DRG Market, Osnabrück, Germany (D.B.).,Northwest-German Stroke Circle e.V., Bochum, Germany (R.W., C.K., J.E., D.B., S.H.M.)
| | - Saskia H Meves
- Department of Neurology, St. Marien-Hospital Mülheim/Ruhr, Germany (S.H.M.).,Northwest-German Stroke Circle e.V., Bochum, Germany (R.W., C.K., J.E., D.B., S.H.M.)
| | - Aristeidis H Katsanos
- Department of Neurology, University Hospital St. Josef-Hospital Bochum (C.K., A.H.K.), Ruhr University Bochum, Germany.,Second Department of Neurology, National and Kapodistrian University of Athens, Greece (A.H.K.)
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Italy (V.C.)
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Germany (W.H.)
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Lorente L, Martín MM, González-Rivero AF, Pérez-Cejas A, Abreu-González P, Ramos L, Argueso M, Cáceres JJ, Solé-Violán J, Alvarez-Castillo A, Jiménez A, García-Marín V. DNA and RNA oxidative damage are associated to mortality in patients with cerebral infarction. Med Intensiva 2019; 45:35-41. [PMID: 31492477 DOI: 10.1016/j.medin.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/07/2019] [Accepted: 07/14/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Secondary injury due to oxidation may occur during ischemic stroke, possibly leading to oxidative damage to deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Higher blood concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG) (through the oxidation of guanosine from DNA) have been found in ischemic stroke patients than in healthy subjects, and in patients with versus without post-ischemic stroke depression. The present study was carried out to explore the possible association between serum DNA and RNA oxidative damage and mortality in patients with cerebral infarction. METHODS A prospective, multicenter observational study was carried out in the Intensive Care Units of 6 Spanish hospitals. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as ischemic changes evidenced by computed tomography in more than 50% of the middle cerebral artery territory and a Glasgow Coma Score (GCS)<9. Serum concentrations of the three oxidized guanine species (OGS) (8-hydroxyguanine from DNA or RNA, 8-hydroxyguanosine from RNA, and 8-OHdG from DNA) on the day of MMCAI diagnosis were determined. The study endpoint was 30-day mortality. RESULTS We found higher serum OGS levels (p<0.001) in non-surviving (n=34) than in surviving patients (n=34). Logistic regression analyses showed serum OGS levels to be associated to 30-day mortality controlling for lactic acid, GCS and platelet count (OR=1.568; 95%CI=1.131-2.174; p=0.01). CONCLUSIONS The novel observation in this study is the association between global serum OGS concentration and mortality in ischemic stroke patients.
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Affiliation(s)
- L Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain.
| | - M M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife 38010, Spain
| | - A F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - A Pérez-Cejas
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Tenerife, Spain
| | - P Abreu-González
- Department of Physiology, Faculty of Medicine, University of the La Laguna, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - L Ramos
- Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - M Argueso
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez n°17-19, Valencia 46004, Spain
| | - J J Cáceres
- Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - A Alvarez-Castillo
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - A Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - V García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
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Abstract
Alzheimer disease (AD) is characterized by wide heterogeneity in cognitive and behavioural syndromes, risk factors and pathophysiological mechanisms. Addressing this phenotypic variation will be crucial for the development of precise and effective therapeutics in AD. Sex-related differences in neural anatomy and function are starting to emerge, and sex might constitute an important factor for AD patient stratification and personalized treatment. Although the effects of sex on AD epidemiology are currently the subject of intense investigation, the notion of sex-specific clinicopathological AD phenotypes is largely unexplored. In this Review, we critically discuss the evidence for sex-related differences in AD symptomatology, progression, biomarkers, risk factor profiles and treatment. The cumulative evidence reviewed indicates sex-specific patterns of disease manifestation as well as sex differences in the rates of cognitive decline and brain atrophy, suggesting that sex is a crucial variable in disease heterogeneity. We discuss critical challenges and knowledge gaps in our current understanding. Elucidating sex differences in disease phenotypes will be instrumental in the development of a 'precision medicine' approach in AD, encompassing individual, multimodal, biomarker-driven and sex-sensitive strategies for prevention, detection, drug development and treatment.
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40
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Phan HT, Blizzard CL, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Heeley E, Otahal P, Rothwell P, Anderson CS, Parmar P, Krishnamurthi R, Barker-Collo S, Feigin V, Gall S. Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT. Stroke 2019; 50:2299-2306. [PMID: 31412754 DOI: 10.1161/strokeaha.118.024437] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Women are reported to have poorer health-related quality of life (HRQoL) after stroke than men, but the underlying reasons are uncertain. We investigated factors contributing to the sex differences. Methods- Individual participant data on 4288 first-ever strokes (1996-2013) were obtained from 4 high-quality population-based incidence studies from Australasia and Europe. HRQoL utility scores among survivors after stroke (range from negative scores=worse than death to 1=perfect health) were calculated from 3 scales including European Quality of Life-5 Dimensions, Short-Form 6-Dimension, and Assessment of Quality of Life at 1 year (3 studies; n=1210) and 5 years (3 studies; n=1057). Quantile regression was used to estimate the median differences in HRQoL for women compared to men with adjustment for covariates. Study factors included sociodemographics, prestroke dependency, stroke-related factors (eg, stroke severity), comorbidities, and poststroke depression. Study-specific median differences were combined into pooled estimates using random-effect meta-analysis. Results- Women had lower pooled HRQoL than men (median differenceunadjusted 1 year, -0.147; 95% CI, -0.258 to -0.036; 5 years, -0.090; 95% CI, -0.119 to -0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (-0.067; 95% CI, -0.111 to -0.022) than at 5 years (-0.085; 95% CI, -0.135 to -0.034). Conclusions- Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women's advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.
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Affiliation(s)
- Hoang T Phan
- From the Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia (H.T.P., C.L.B., P.O., S.G.).,Department of Health Management and Health Economics, Pham Ngoc Thach University of Medicine, HoChiMinh City, Vietnam (H.T.P.)
| | - Christopher L Blizzard
- From the Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia (H.T.P., C.L.B., P.O., S.G.)
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (A.G.T., D.A.C.)
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (A.G.T., D.A.C.).,Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia (D.A.C.)
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, NSW, Australia (J.S.)
| | - Emma Heeley
- George Institute for Global Health, University of Sydney, NSW, Australia (E.H., C.S.A.)
| | - Petr Otahal
- From the Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia (H.T.P., C.L.B., P.O., S.G.)
| | - Peter Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.R.)
| | - Craig S Anderson
- George Institute for Global Health, University of Sydney, NSW, Australia (E.H., C.S.A.)
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, New Zealand (P.P., R.K., V.F.)
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, New Zealand (P.P., R.K., V.F.)
| | | | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, New Zealand (P.P., R.K., V.F.)
| | - Seana Gall
- From the Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia (H.T.P., C.L.B., P.O., S.G.)
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Xie P, Deng M, Sun QG, Ma YG, Zhou Y, Ming JH, Chen Q, Liu SQ, Liu JQ, Cai J, Wu F. Therapeutic effect of transplantation of human bone marrow‑derived mesenchymal stem cells on neuron regeneration in a rat model of middle cerebral artery occlusion. Mol Med Rep 2019; 20:3065-3074. [PMID: 31432152 PMCID: PMC6755237 DOI: 10.3892/mmr.2019.10536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Human bone marrow-derived mesenchymal stromal cells (hBMSCs) have been revealed to be beneficial for the regeneration of tissues and cells in several diseases. The present study aimed to elucidate the mechanisms underlying the effect of hBMSC transplantation on neuron regeneration in a rat model of middle cerebral artery occlusion (MCAO). The hBMSCs were isolated, cultured and identified. A rat model of MCAO was induced via the modified Longa method. Neurological severity scores (NSS) were adopted for the evaluation of neuronal function in the model rats after cell transplantation. Next, the expression levels of nestin, β-III-tubulin (β-III-Tub), glial fibrillary acidic protein (GFAP), HNA and neuronal nuclear antigen (NeuN) were examined, as well as the positive expression rates of human neutrophil alloantigen (HNA), nestin, NeuN, β-III-Tub and GFAP. The NSS, as well as the mRNA and protein expression of nestin, decreased at the 1st, 2nd, 4 and 8th weeks, while the mRNA and protein expression of NeuN, β-III-Tub and GFAP increased with time. In addition, after treatment, the MCAO rats showed decreased NSS and mRNA and protein expression of nestin, but elevated mRNA and protein expression of NeuN, β-III-Tub and GFAP at the 2nd, 4 and 8th weeks, and decreased positive expression of HNA and nestin with enhanced expression of NeuN, β-III-Tub and GFAP. Therefore, the present findings demonstrated that hBMSC transplantation triggered the formation of nerve cells and enhanced neuronal function in a rat model of MCAO.
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Affiliation(s)
- Ping Xie
- Department of Chinese Traditional Medicine, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, Hubei 430060, P.R. China
| | - Ming Deng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Qin-Guo Sun
- Department of Chinese Traditional Medicine, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, Hubei 430060, P.R. China
| | - Yong-Gang Ma
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yan Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jiang-Hua Ming
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Qing Chen
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Shi-Qing Liu
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jun-Qi Liu
- Department of Radiation Oncology, The First of Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 45003, P.R. China
| | - Jun Cai
- Department of Emergency and Trauma Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Fei Wu
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Chen C, Chu SF, Ai QD, Zhang Z, Guan FF, Wang SS, Dong YX, Zhu J, Jian WX, Chen NH. CKLF1 Aggravates Focal Cerebral Ischemia Injury at Early Stage Partly by Modulating Microglia/Macrophage Toward M1 Polarization Through CCR4. Cell Mol Neurobiol 2019; 39:651-669. [PMID: 30982091 DOI: 10.1007/s10571-019-00669-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
CKLF1 is a chemokine with increased expression in ischemic brain, and targeting CKLF1 has shown therapeutic effects in cerebral ischemia model. Microglia/macrophage polarization is a mechanism involved in poststroke injury expansion. Considering the quick and obvious response of CKLF1 and expeditious evolution of stroke lesions, we focused on the effects of CKLF1 on microglial/macrophage polarization at early stage of ischemic stroke (IS). The present study is to investigate the CKLF1-mediated expression of microglia/macrophage phenotypes in vitro and in vivo, discussing the involved pathway. Primary microglia culture was used in vitro, and mice transient middle cerebral artery occlusion (MCAO) model was adopted to mimic IS. CKLF1 was added to the primary microglia for 24 h, and we found that CKLF1 modulated primary microglia skew toward M1 phenotype. In mice transient IS model, CKLF1 was stereotactically microinjected to the lateral ventricle of ischemic hemisphere. CKLF1 aggravated ischemic injury, accompanied by promoting microglia/macrophage toward M1 phenotypic polarization. Increased expression of pro-inflammatory cytokines and decreased expression of anti-inflammatory cytokines were observed in mice subjected to cerebral ischemia and administrated with CKLF1. CKLF1-/- mice were used to confirm the effects of CKLF1. CKLF1-/- mice showed lighter cerebral damage and decreased M1 phenotype of microglia/macrophage compared with the WT control subjected to cerebral ischemia. Moreover, NF-κB activation enhancement was detected in CKLF1 treatment group. Our results demonstrated that CKLF1 is an important mediator that skewing microglia/macrophage toward M1 phenotype at early stage of cerebral ischemic injury, which further deteriorates followed inflammatory response, contributing to early expansion of cerebral ischemia injury. Targeting CKLF1 may be a novel way for IS therapy.
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Affiliation(s)
- Chen Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Shi-Feng Chu
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Qi-Di Ai
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces & Hunan University of Chinese Medicine First-class Disciple Construction Project of Chinese Materia Medica, Changsha, 410208, China
| | - Zhao Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Fei-Fei Guan
- Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Science, NHFPC, Peking Union Medicine College and Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Sha-Sha Wang
- School of Basic Medicine, Shanxi University of Traditional Chinese Medicine, Taiyuan, 030619, China
| | - Yi-Xiao Dong
- Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Jie Zhu
- Institute of Process Engineering, Chinese Academy of Sciences, Beijing, 100050, China
| | - Wen-Xuan Jian
- DME Center, Clinical Pharmacology Institute, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Nai-Hong Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces & Hunan University of Chinese Medicine First-class Disciple Construction Project of Chinese Materia Medica, Changsha, 410208, China.
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Toro CA, Zhang L, Cao J, Cai D. Sex differences in Alzheimer's disease: Understanding the molecular impact. Brain Res 2019; 1719:194-207. [PMID: 31129153 DOI: 10.1016/j.brainres.2019.05.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/10/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Abstract
Alzheimer's disease (AD) is a common neurodegenerative disorder that presents with cognitive impairment and behavioral disturbance. Approximately 5.5 million people in the United States live with AD, most of whom are over the age of 65 with two-thirds being woman. There have been major advancements over the last decade or so in the understanding of AD neuropathological changes and genetic involvement. However, studies of sex impact in AD have not been adequately integrated into the investigation of disease development and progression. It becomes indispensable to acknowledge in both basic science and clinical research studies the importance of understanding sex-specific differences in AD pathophysiology and pathogenesis, which could guide future effort in the discovery of novel targets for AD. Here, we review the latest and most relevant literature on this topic, highlighting the importance of understanding sex dimorphism from a molecular perspective and its association to clinical trial design and development in AD research field.
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Affiliation(s)
- Carlos A Toro
- National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY 10468, United States; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Larry Zhang
- Research and Development, James J Peters VA Medical Center, Bronx, NY 10468, United States; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Jiqing Cao
- Research and Development, James J Peters VA Medical Center, Bronx, NY 10468, United States; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Dongming Cai
- Research and Development, James J Peters VA Medical Center, Bronx, NY 10468, United States; Neurology Section, James J Peters VA Medical Center, Bronx, NY 10468, United States; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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Blum B, Penwell A, Wormack L, Walker B, Lari S, Nathaniel TI. Gender and thrombolysis therapy in acute ischemic stroke patients with incidence of obesity. Neurol Sci 2019; 40:1829-1839. [DOI: 10.1007/s10072-019-03902-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/12/2019] [Indexed: 12/22/2022]
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45
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Ai Q, Chen C, Chu S, Luo Y, Zhang Z, Zhang S, Yang P, Gao Y, Zhang X, Chen N. IMM-H004 Protects against Cerebral Ischemia Injury and Cardiopulmonary Complications via CKLF1 Mediated Inflammation Pathway in Adult and Aged Rats. Int J Mol Sci 2019; 20:ijms20071661. [PMID: 30987181 PMCID: PMC6480569 DOI: 10.3390/ijms20071661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Chemokine-like factor 1 (CKLF1) is a chemokine with potential to be a target for stroke therapy. Compound IMM-H004 is a novel coumarin derivative screened from a CKLF1/C-C chemokine receptor type 4 (CCR4) system and has been reported to improve cerebral ischemia/reperfusion injury. This study aims to investigate the protective effects of IMM-H004 on cerebral ischemia injury and its infectious cardiopulmonary complications in adult and aged rats from the CKLF1 perspective. (2) Methods: The effects of IMM-H004 on the protection was determined by 2,3,5-triphenyltetrazolium chloride (TTC) staining, behavior tests, magnetic resonance imaging (MRI) scans, enzyme-linked immunosorbent assay (ELISA), Nissl staining, histo-pathological examination, and cardiopulmonary function detection. Immunohistological staining, immunofluorescence staining, quantitative real-time PCR (qPCR), and western blotting were used to elucidate the underlying mechanisms. (3) Results: IMM-H004 protects against cerebral ischemia induced brain injury and its cardiopulmonary complications, inhibiting injury, and inflammation through CKLF1-dependent anti-inflammation pathway in adult and aged rats. IMM-H004 downregulates the amount of CKLF1, suppressing the followed inflammatory response, and further protects the damaged organs from ischemic injury. (4) Conclusions: The present study suggested that the protective mechanism of IMM-H004 is dependent on CKLF1, which will lead to excessive inflammatory response in cerebral ischemia. IMM-H004 could also be a therapeutic agent in therapy for ischemic stroke and cardiopulmonary complications in the aged population.
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Affiliation(s)
- Qidi Ai
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces & College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Chen Chen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Shifeng Chu
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Yun Luo
- Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Zhao Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Shuai Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Pengfei Yang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Yan Gao
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Xiaoling Zhang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
| | - Naihong Chen
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces & College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica & Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
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Alshoabi S, Alnajmani R, Shamsuddin M, Gameraddin M. Early signs of middle cerebral artery infarction on multidetector computed tomography: Review of 20 cases. Brain Circ 2019; 5:27-31. [PMID: 31001598 PMCID: PMC6458774 DOI: 10.4103/bc.bc_28_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/28/2018] [Accepted: 01/28/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study intended to assess the occurrence of early signs of middle cerebral artery (MCA) on multidetector computed tomography (MDCT) in correlation with duration of the clinical features of stroke. PATIENTS AND METHODS This retrospective study analyzed the electronic records of 20 patients with MCA infarction. The detected signs studied according to the onset of the clinical features of stroke to the time of CT imaging. RESULTS Out of 20 patients with MCA infarction included in this study, the results revealed a significant relationship between the presence of insular ribbon sign and/or subtle hypodensity and hyperacute infarction (P < 0.001 and 0.003, respectively). Results revealed significant relationship between the occurrence of hypodense area, effacement of the cortical sulci, and compression of the ipsilateral lateral ventricle with acute infarction (6-72 h), (P = 0.006, 0.007, and 0.002) (odds ratio = 0.047, 0.050 and 0.028) and (95% confidence interval = 0.004-0.552, 0.004-0.597 and 0.002-0.367) respectively. CONCLUSION MDCT can detect nearly half of MCA infarctions in the first 6 h. Insular ribbon sign and subtle hypodensity were the most significant findings in the first 6 h of stroke. Hypodense area was a significant sign after 6 h. Diabetes mellitus and ischemic heart disease were the most common risk factors. Hemiparesis was the most common clinical finding in MCA infarction.
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Affiliation(s)
- Sultan Alshoabi
- Department of Diagnostic Radiologic Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Medina, Saudi Arabia
| | - Ramzi Alnajmani
- Department of Radiology and Medical Imaging, 22 Mayo Hospital, Hodeidah, Republic of Yemen
| | | | - Moawia Gameraddin
- Department of Diagnostic Radiologic Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Medina, Saudi Arabia
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Phan HT, Gall SL, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, Kim J, Grimley R, Castley HC, Hand P, Cadilhac DA. Sex Differences in Care and Long-Term Mortality After Stroke: Australian Stroke Clinical Registry. J Womens Health (Larchmt) 2019; 28:712-720. [PMID: 30900954 DOI: 10.1089/jwh.2018.7171] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan). Results: Among 14,118 events (46% females), women were 7 years older and had greater baseline severity compared to men (29% vs. 37%; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRRunadjusted 1.44, 95% confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRRadjusted 1.03, 95% CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n = 5224), women were less often administered aspirin ≤48 hours (61% vs. men 69%, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin. Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.
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Affiliation(s)
- Hoang T Phan
- 1 Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia.,2 Department of Public Health Management, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Seana L Gall
- 1 Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
| | - Christopher L Blizzard
- 1 Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
| | - Natasha A Lannin
- 3 School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Amanda G Thrift
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Craig S Anderson
- 5 The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Joosup Kim
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Rohan Grimley
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,6 Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
| | - Helen C Castley
- 7 Neurology Department, Royal Hobart Hospital, Hobart, Australia
| | - Peter Hand
- 8 Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Dominique A Cadilhac
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,9 Stroke Division, Florey Institute Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Fels JA, Manfredi G. Sex Differences in Ischemia/Reperfusion Injury: The Role of Mitochondrial Permeability Transition. Neurochem Res 2019; 44:2336-2345. [PMID: 30863968 DOI: 10.1007/s11064-019-02769-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/23/2022]
Abstract
Brain and heart ischemia are among the leading causes of death and disability in both men and women, but there are significant sex differences in the incidence and severity of these diseases. Ca2+ dysregulation in response to ischemia/reperfusion injury (I/RI) is a well-recognized pathogenic mechanism leading to the death of affected cells. Excess intracellular Ca2+ causes mitochondrial matrix Ca2+ overload that can result in mitochondrial permeability transition (MPT), which can have severe consequences for mitochondrial function and trigger cell death. Recent findings indicate that estrogens and their related receptors are involved in the regulation of MPT, suggesting that sex differences in I/RI could be linked to estrogen-dependent modulation of mitochondrial Ca2+. Here, we review the evidence supporting sex differences in I/RI and the role of estrogen and estrogen receptors in producing these differences, the involvement of mitochondrial Ca2+ overload in disease pathogenesis, and the estrogen-dependent modulation of MPT that may contribute to sex differences.
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Affiliation(s)
- Jasmine A Fels
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, 407 East 61st St., RR506, New York, NY, 10065, USA.,Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Giovanni Manfredi
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, 407 East 61st St., RR506, New York, NY, 10065, USA.
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Martire A, Lambertucci C, Pepponi R, Ferrante A, Benati N, Buccioni M, Dal Ben D, Marucci G, Klotz KN, Volpini R, Popoli P. Neuroprotective potential of adenosine A 1 receptor partial agonists in experimental models of cerebral ischemia. J Neurochem 2019; 149:211-230. [PMID: 30614535 DOI: 10.1111/jnc.14660] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 01/16/2023]
Abstract
Cerebral ischemia is the second most common cause of death and a major cause of disability worldwide. Available therapies are based only on anticoagulants or recombinant tissue plasminogen activator. Extracellular adenosine increases during ischemia and acts as a neuroprotective endogenous agent mainly by activating adenosine A1 receptors (A1 Rs) which control calcium influx, glutamate release, membrane potential, and metabolism. Accordingly, in many experimental paradigms it has been already demonstrated that the stimulation of A1 R with full agonists is able to reduce ischemia-related structural and functional brain damage; unfortunately, cardiovascular side effects and desensitization of A1 R induced by these compounds have strongly limited their exploitation in stroke therapy so far. Among the newly emerging compounds, A1 R partial agonists could be almost free of side effects and equally effective. Therefore, we decided to evaluate the neuroprotective potential of two A1 R partial agonists, namely 2'-dCCPA and 3'-dCCPA, in in vitro and ex vivo experimental models of cerebral ischemia. Within the experimental paradigm of oxygen-glucose deprivation in vitro in human neuroblastoma (SH-SY5Y) cells both A1 R partial agonists increased cell viability. Considering the high level of expression of A1 Rs in the hippocampus and the susceptibility of CA1 region to hypoxia, we performed electrophysiological experiments in this subfield. The application of 7 min of oxygen-glucose deprivation constantly produces an irreversible synaptic failure in all the C57Bl/6 mice hippocampal slices evaluated; both tested compounds allowed a significant recovery of synaptic transmission. These findings demonstrate that A1 R and its partial agonists are still of interest for cerebral ischemia therapy. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/.
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Affiliation(s)
- Alberto Martire
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Catia Lambertucci
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Rita Pepponi
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Antonella Ferrante
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Nicholas Benati
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Michela Buccioni
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Diego Dal Ben
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Gabriella Marucci
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Karl-Norbert Klotz
- Institut für Pharmakologie und Toxikologie, Universität Würzburg, Würzburg, Germany
| | - Rosaria Volpini
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Patrizia Popoli
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Abstract
BACKGROUND Research suggests that there is a delay in recognizing unique stroke symptoms in women by both healthcare professionals and the general population. The purpose of this review was to identify and summarize the most relevant literature regarding recognition and assessment of unique stroke symptoms in women. METHODS Literature review using PubMed, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar was used to search literature describing unique stroke symptoms. RESULTS Unique stroke symptoms, female sex, and race are associated with delayed recognition, treatment, misdiagnosis, and outcomes. Women experience unique symptoms of nausea/vomiting, headache, dizziness, and cognitive dysfunction more often than men. Stroke assessment tools and registries recognize 1 to 4 of the 11 unique stroke symptoms in women, no study directly assesses the sensitivity and specificity of these unique symptoms, and all studies included women and men. Conclusions and Nursing Implications: Current assessment tools and registries are not sensitive and specific to measuring unique stroke symptoms in women. Accurately identifying unique stroke symptoms in women may reduce presentation and treatment time, minimizing misdiagnoses and poor patient outcomes.
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