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Mezuki S, Matsuo R, Irie F, Shono Y, Kuwashiro T, Sugimori H, Wakisaka Y, Ago T, Kamouchi M, Kitazono T. Body temperature in the acute phase and clinical outcomes after acute ischemic stroke. PLoS One 2024; 19:e0296639. [PMID: 38206979 PMCID: PMC10783745 DOI: 10.1371/journal.pone.0296639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study aimed to examine whether post-stroke early body temperature is associated with neurological damage in the acute phase and functional outcomes at three months. METHODS We included 7,177 patients with acute ischemic stroke within 24 h of onset. Axillary temperature was measured daily in the morning for seven days. Mean body temperature was grouped into five quintiles (Q1: 35.1‒36.5°C, Q2: 36.5‒36.7°C, Q3: 36.7‒36.8°C, Q4: 36.8‒37.1°C, and Q5: 37.1‒39.1°C). Clinical outcomes included neurological improvement during hospitalization and poor functional outcome (modified Rankin scale score, 3-6) at three months. A logistic regression analysis was performed to evaluate the association between body temperature and clinical outcomes. RESULTS The patient's mean (SD) age was 70.6 (12.3) years, and 35.7% of patients were women. Mean body temperature was significantly associated with less neurological improvement from Q2 (odds ratios [95% confidence interval], 0.77 [0.65-0.99] vs. Q1) to Q5 (0.33 [0.28-0.40], P for trend <0.001) even after adjusting for potential confounders, including baseline neurological severity, C-reactive protein levels, and post-stroke acute infections. The multivariable-adjusted risk of poor functional outcome linearly increased from Q2 (1.36 [1.03-1.79]) to Q5 (6.44 [5.19-8.96], P for trend <0.001). These associations were maintained even in the analyses excluding patients with acute infectious diseases. Multivariable-adjusted risk of poor functional outcome was higher in patients with early body temperature elevation on days 1-3 and with longer duration with body temperature >37.0°C. CONCLUSIONS Post-stroke early high body temperature is independently associated with unfavorable outcomes following acute ischemic stroke.
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Affiliation(s)
- Satomi Mezuki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Study, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Irie
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Study, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuji Shono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Kuwashiro
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Cerebrovascular Medicine and Neurology, Kyushu Medical Center, Fukuoka, Japan
| | - Hiroshi Sugimori
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Cerebrovascular Medicine and Neurology, Kyushu Medical Center, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Study, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Study, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Study, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Study, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zhang X, Zhang J. The human brain in a high altitude natural environment: A review. Front Hum Neurosci 2022; 16:915995. [PMID: 36188182 PMCID: PMC9520777 DOI: 10.3389/fnhum.2022.915995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
With the advancement of in vivo magnetic resonance imaging (MRI) technique, more detailed information about the human brain at high altitude (HA) has been revealed. The present review aimed to draw a conclusion regarding changes in the human brain in both unacclimatized and acclimatized states in a natural HA environment. Using multiple advanced analysis methods that based on MRI as well as electroencephalography, the modulations of brain gray and white matter morphology and the electrophysiological mechanisms underlying processing of cognitive activity have been explored in certain extent. The visual, motor and insular cortices are brain regions seen to be consistently affected in both HA immigrants and natives. Current findings regarding cortical electrophysiological and blood dynamic signals may be related to cardiovascular and respiratory regulations, and may clarify the mechanisms underlying some behaviors at HA. In general, in the past 10 years, researches on the brain at HA have gone beyond cognitive tests. Due to the sample size is not large enough, the current findings in HA brain are not very reliable, and thus much more researches are needed. Moreover, the histological and genetic bases of brain structures at HA are also needed to be elucidated.
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Affiliation(s)
- Xinjuan Zhang
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, China
- Department of Physiology, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxing Zhang
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, China
- Department of Physiology, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Jiaxing Zhang,
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Pegoli M, Zurlo Z, Bilotta F. Temperature management in acute brain injury: A systematic review of clinical evidence. Clin Neurol Neurosurg 2020; 197:106165. [PMID: 32937217 DOI: 10.1016/j.clineuro.2020.106165] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
Temperature alterations in neurocritical care settings are common and have a striking effect on brain metabolism leading to or exacerbating neuronal injury. Hyperthermia worsens acute brain injury (ABI) patients outcome. However conclusive evidence linking control of temperature to improved outcome is still lacking. This review article report an update -results from clinical studies published between March 2006 and March 2020- on the relationship between hyperthermia or Target Temperature Management and functional outcome or mortality in ABI patients. MATERIALS AND METHODS A systematic search of articles in PubMed and EMBASE database was accomplished. Only complete studies, published in English in peer-reviewed journals were included. RESULTS A total of 63 articles into 5 subchapters are presented: acute ischemic stroke (17), subarachnoid hemorrhage (14), brain trauma (14), intracranial hemorrhage (8), and mixed acute brain injury (10). This evidence confirm and extend the negative impact of hyperthermia in ABI patients on worse functional outcome and higher mortality. In particular "early hyperthermia" in AIS patients seems to have a protective role have as promoting factor of clot lysis but no conclusive evidence is available. Normothermic TTM seems to have a positive effect on TBI patients in a reduced mortality rate compared to hypothermic TTM. CONCLUSIONS Hyperthermia in ABI patients is associated with worse functional outcome and higher mortality. The use of normothermic TTM has an established indication only in TBI; further studies are needed to define the role and the indications of normothermic TTM in ABI patients.
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Affiliation(s)
- M Pegoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.
| | - Z Zurlo
- Department of Anaesthesia and Intensive Care, University La Sapienza, Rome, Italy
| | - F Bilotta
- Department of Anaesthesia and Intensive Care, University La Sapienza, Rome, Italy
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Nonatrial Fibrillation was Associated With Early Neurological Improvement After Intravenous Thrombolysis With rt-PA in Patients With Acute Ischemic Stroke. Neurologist 2020; 25:28-32. [PMID: 32132497 DOI: 10.1097/nrl.0000000000000261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient. OBJECTIVE To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset. METHODS Demographics, onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at a Chinese hospital between January 2013 and August 2016 were retrospectively analyzed. The National Institutes of Health Stroke Scale (NIHSS) score was recorded before thrombolytic therapy, 24 hours after the treatment, and 7 days after the treatment to evaluate the recovery of neurological function. ENI was defined as a ≥4-point decrease in NIHSS score compared with baseline or a score of 0 or 1 at 24 hours and 7 days. A multivariate logistic regression analysis was performed to assess the outcomes. RESULTS Of the 209 AIS patients treated by intravenous thrombolysis with rt-PA, low-density lipoprotein (LDL) levels were significantly lower (P<0.05) in patients with ENI. The multivariable analysis showed that non-atrial fibrillation (AF) was independently associated with ENI at 24 hours and 7 days after thrombolysis. An overall 40.3% non-AF patients had ENI 24 hours after thrombolysis (odds ratio=2.501, 95% confidence interval: 1.204-5.198; P=0.014), and 65.9% non-AF patients had ENI 7 days after thrombolysis (odds ratio=2.953, 95% confidence interval: 1.434-6.081; P=0.003). Onset to treatment time was an independent predictor (P<0.05) for ENI at 7 days after thrombolysis. The NIHSS score and diastolic blood pressure on admission were associated with symptomatic intracerebral hemorrhagic transformation. CONCLUSIONS Non-AF was independently associated with ENI after intravenous thrombolysis in AIS patients, but non-AF was not associated with the occurrence of symptomatic intracerebral hemorrhage. Onset to treatment time was an independent predictor of ENI at 7 days after thrombolysis in AIS patients.
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Ueno T, Nishijima H, Hikichi H, Haga R, Arai A, Suzuki C, Nunomura JI, Tomiyama M. Association of survival and hyperthermia after rt-PA for ischemic stroke. Acta Neurol Scand 2018; 138:574-578. [PMID: 30091238 DOI: 10.1111/ane.13011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hyperthermia in patients with acute ischemic stroke is associated with poor outcome. Although previous studies have shown a negative effect on functional outcome, even in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA), the effect on survival remains unclear. AIMS OF THE STUDY The aim of this study was to evaluate the association between the functional and survival prognosis and hyperthermia in patients with acute ischemic stroke treated with rt-PA. METHODS We studied 120 patients treated with rt-PA from 2306 consecutive Japanese patients with acute cerebral infarction at Aomori Prefectural Central Hospital between December 2009 and March 2017. We defined hyperthermia as ≥38°C within 72 hours after rt-PA administration. Propensity score matching was used to compare 34 non-hyperthermia and hyperthermia patient pairs. RESULTS Final modified Rankin Scale scores were higher in the hyperthermia group than in the non-hyperthermia group. In addition, the Kaplan-Meier model showed that the non-hyperthermia group had significantly better survival rates than the hyperthermia group (hazard ratio, 5.3; 95% confidence intervals, 1.2-24.8). CONCLUSIONS Hyperthermia within 3 days after rt-PA is associated with poor functional prognosis and survival outcome in patients with acute cerebral infarction.
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Affiliation(s)
- Tatsuya Ueno
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Haruo Nishijima
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Hiroki Hikichi
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Rie Haga
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Akira Arai
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Chieko Suzuki
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Jin-ichi Nunomura
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
| | - Masahiko Tomiyama
- Department of Neurology; Aomori Prefectural Central Hospital; Aomori Japan
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Khanevski AN, Naess H, Thomassen L, Waje-Andreassen U, Nacu A, Kvistad CE. Elevated body temperature in ischemic stroke associated with neurological improvement. Acta Neurol Scand 2017; 136:414-418. [PMID: 28251609 DOI: 10.1111/ane.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Some studies suggest that high body temperature within the first few hours of ischemic stroke onset is associated with improved outcome. We hypothesized an association between high body temperature on admission and detectable improvement within 6-9 hours of stroke onset. MATERIALS AND METHODS Consecutive ischemic stroke patients with NIHSS scores obtained within 3 hours and in the interval 6-9 hours after stroke onset were included. Body temperature was measured on admission. RESULTS A total of 315 patients with ischemic stroke were included. Median NIHSS score on admission was 6. Linear regression showed that NIHSS score 6-9 hours after stroke onset was inversely associated with body temperature on admission after adjusting for confounders including NIHSS score <3 hours after stroke onset (P<.001). The same result was found in patients with proximal middle cerebral occlusion on admission. CONCLUSIONS We found an inverse association between admission body temperature and neurological improvement within few hours after admission. This finding may be limited to patients with documented proximal middle cerebral artery occlusion on admission and suggests a beneficial effect of higher body temperature on clot lysis within the first three hours.
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Affiliation(s)
- A. N. Khanevski
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre of Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - L. Thomassen
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | | | - A. Nacu
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - C. E. Kvistad
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
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Han MH, Kim J, Choi KS, Kim CH, Kim JM, Cheong JH, Yi HJ, Lee SH. Monthly variations in aneurysmal subarachnoid hemorrhage incidence and mortality: Correlation with weather and pollution. PLoS One 2017; 12:e0186973. [PMID: 29073210 PMCID: PMC5658131 DOI: 10.1371/journal.pone.0186973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Although the effect of weather and air pollution on the occurrence of subarachnoid hemorrhage (SAH) has been investigated, results have remained inconsistent. The present study aimed to determine the seasonality of aneurysmal subarachnoid hemorrhage occurrence and mortality. METHODS We used the National Inpatient Sample database to evaluate the effect of meteorological factors and air pollutants on patients with subarachnoid hemorrhage in Korea between 2011 and 2014. Monthly variations in SAH occurrence and mortality were analyzed using locally weighted scatter plot smoothing curves. Multivariate Poisson generalized linear regression models were used to evaluate potential independent meteorological and pollutant variables associated with SAH occurrence and mortality. RESULTS In total, 21,407 patients who underwent clip or coil treatment owing to aneurysmal SAH in Korea from January 1, 2011, to December 31, 2014, were included. The crude incidence rate of SAH in Korea was 10.5 per 100,000 people per year. An approximately 0.5% lower risk of SAH was observed per 1°C increase in mean monthly temperature (relative risk, 0.995; 95% confidence interval [CI], 0.992-0.997; p < 0.001), while an approximately 2.3% higher risk of SAH was observed per 1°C increase in mean monthly diurnal temperature. CONCLUSIONS We showed distinct patterns of seasonal and monthly variation in the occurrence and mortality of SAH. Our findings suggest that meteorological factors may play an important role in monthly variations in the occurrence of aneurysmal SAH.
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Affiliation(s)
- Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyeongchun-ro, Guri, Gyonggi-do, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Hambangmoe-ro, Yeonsu-gu, Incheon, Korea
- * E-mail:
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Wei W, Wang X, Gong Q, Fan M, Zhang J. Cortical Thickness of Native Tibetans in the Qinghai-Tibetan Plateau. AJNR Am J Neuroradiol 2017; 38:553-560. [PMID: 28104637 DOI: 10.3174/ajnr.a5050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE High-altitude environmental factors and genetic variants together could have exerted their effects on the human brain. The present study was designed to investigate the cerebral morphology in high-altitude native Tibetans. MATERIALS AND METHODS T1-weighted brain images were obtained from 77 Tibetan adolescents on the Qinghai-Tibetan Plateau (altitude, 2300-5300 m) and 80 matched Han controls living at sea level. Cortical thickness, curvature, and sulcus were analyzed by using FreeSurfer. RESULTS Cortical thickness was significantly decreased in the left posterior cingulate cortex, lingual gyrus, superior parietal cortex, precuneus, and rostral middle frontal cortex and the right medial orbitofrontal cortex, lateral occipital cortex, precuneus, and paracentral lobule. Curvature was significantly decreased in the left superior parietal cortex and right superior marginal gyrus; the depth of the sulcus was significantly increased in the left inferior temporal gyrus and significantly decreased in the right superior marginal gyrus, superior temporal gyrus, and insular cortex. Moreover, cortical thickness was negatively correlated with altitude in the left superior and middle temporal gyri, rostral middle frontal cortex, insular cortex, posterior cingulate cortex, precuneus, lingual gyrus, and the right superior temporal gyrus. Curvature was positively correlated with altitude in the left rostral middle frontal cortex, insular cortex, and middle temporal gyrus. The depth of the sulcus was negatively correlated with altitude in the left lingual gyrus and right medial orbitofrontal cortex. CONCLUSIONS Differences in cortical morphometry in native Tibetans may reflect adaptations related to high altitude.
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Affiliation(s)
- W Wei
- From the MRI Center (W.W.), First Affiliated Hospital of Xiamen University, Xiamen, China.,Institute of Brain Disease and Cognition (W.W., J.Z.), Medical College of Xiamen University, Xiamen, China
| | - X Wang
- Department of Neurology (X.W.), Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Q Gong
- Huaxi Magnetic Resonance Research Center (Q.G.), West China Hospital, Sichuan University, Chengdu, China
| | - M Fan
- Department of Cognitive Sciences (M.F.), Institute of Basic Medical Sciences, Beijing, China
| | - J Zhang
- Institute of Brain Disease and Cognition (W.W., J.Z.), Medical College of Xiamen University, Xiamen, China
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Fan C, Zhao Y, Yu Q, Yin W, Liu H, Lin J, Yang T, Fan M, Gesang L, Zhang J. Reversible Brain Abnormalities in People Without Signs of Mountain Sickness During High-Altitude Exposure. Sci Rep 2016; 6:33596. [PMID: 27633944 PMCID: PMC5025655 DOI: 10.1038/srep33596] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/30/2016] [Indexed: 01/23/2023] Open
Abstract
A large proportion of lowlanders ascending to high-altitude (HA) show no signs of mountain sickness. Whether their brains have indeed suffered from HA environment and the persistent sequelae after return to lowland remain unknown. Thirty-one sea-level college students, who had a 30-day teaching on Qinghai-Tibet plateau underwent MRI scans before, during, and two months after HA exposure. Brain volume, cortical structures, and white matter microstructure were measured. Besides, serum neuron-specific enolase (NSE), C-reactive protein, and interleukin-6 and neuropsychiatric behaviors were tested. After 30-day HA exposure, the gray and white matter volumes and cortical surface areas significantly increased, with cortical thicknesses and curvatures changed in a wide spread regions; Anisotropy decreased with diffusivities increased in multiple sites of white matter tracts. Two months after HA exposure, cortical measurements returned to basal level. However, increased anisotropy with decreased diffusivities was observed. Behaviors and serum inflammatory factor did not significant changed during three time-point tests. NSE significantly decreased during HA but increased after HA exposure. Results suggest brain swelling occurred in people without neurological signs at HA, but no negative sequelae in cortical structures and neuropsychiatric functions were left after the return to lowlands. Reoxygenation changed white matter microstructure.
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Affiliation(s)
- Cunxiu Fan
- Department of Physiology, Medical College of Xiamen University, Xiamen 361102, Fujian, China
| | - Yuhua Zhao
- Institute of high altitude medicine, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Qian Yu
- Department of Physiology, Medical College of Xiamen University, Xiamen 361102, Fujian, China
| | - Wu Yin
- Department of Radiology, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Haipeng Liu
- Department of Radiology, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Jianzhong Lin
- Magnetic Resonance Center, Zhongshan Hospital Xiamen University, Xiamen 361004, Fujian, China
| | - Tianhe Yang
- Magnetic Resonance Center, Zhongshan Hospital Xiamen University, Xiamen 361004, Fujian, China
| | - Ming Fan
- Department of Brain Protection and Plasticity, Institute of Basic Medical Sciences, Beijing 100850, China
| | - Luobu Gesang
- Institute of high altitude medicine, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Jiaxing Zhang
- Department of Physiology, Medical College of Xiamen University, Xiamen 361102, Fujian, China
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Nacu A, Bringeland GH, Khanevski A, Thomassen L, Waje‐Andreassen U, Naess H. Early neurological worsening in acute ischaemic stroke patients. Acta Neurol Scand 2016; 133:25-9. [PMID: 25929313 PMCID: PMC4744656 DOI: 10.1111/ane.12418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
Objectives Neurological worsening in acute ischaemic stroke patients is common with significant morbidity and mortality. Aims To determine the factors associated with early neurological worsening within the first 9 h after onset of acute ischaemic stroke. Materials & methods The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity. Early neurological worsening was defined as NIHSS score increase ≥4 NIHSS points within 9 h of symptom onset compared to NIHSS score within 3 h of symptom onset. Patients with early neurological worsening were compared to patients with unchanged or improved NIHSS scores. Results Of the 2484 patients admitted with ischaemic stroke, 552 patients had NIHSS score within 3 h of symptom onset, and 44 (8.0%) experienced early neurological worsening. The median NIHSS on admission was 8.4 in both groups. Early neurological worsening was associated with low body temperature on admission (P = 0.01), proximal compared to distal MCA occlusion (P = 0.007) and with ipsilateral internal carotid artery stenosis >50% or occlusion (P = 0.04). Early neurological worsening was associated with higher NIHSS day 7 (P < 0.001) and higher mortality within 7 days of stroke onset (P = 0.005). Conclusions Early neurological worsening has serious consequences for the short‐term outcome for patients with acute ischaemic stroke and is associated with low body temperature on admission, and with extracranially and intracranially large‐vessel stenosis or occlusion.
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Affiliation(s)
- A. Nacu
- Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - G. H. Bringeland
- Department of Neurology Haukeland University Hospital Bergen Norway
| | - A. Khanevski
- Department of Neurology Haukeland University Hospital Bergen Norway
| | - L. Thomassen
- Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | | | - H. Naess
- Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
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No Relation between Body Temperature and Arterial Recanalization at Three Days in Patients with Acute Ischaemic Stroke. PLoS One 2015; 10:e0140777. [PMID: 26473959 PMCID: PMC4608560 DOI: 10.1371/journal.pone.0140777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/30/2015] [Indexed: 11/29/2022] Open
Abstract
Background Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods We included 278 patients with acute ischaemic stroke within nine hours after symptom onset, who had an intracranial arterial occlusion on admission CT angiography, in 13 participating centres. We calculated the relation per every 0.1°Celsius increase in admission body temperature and recanalization at three days. Results Recanalization occurred in 80% of occluded arteries. There was no relation between body temperature and recanalization at three days after adjustments for age, NIHSS score on admission and treatment with alteplase (adjusted odds ratio per 0.1°Celsius, 0.99; 95% confidence interval, 0.94–1.05; p = 0.70). Results for patients treated or not treated with alteplase were essentially the same. Conclusions Our findings suggest that in patients with acute ischaemic stroke there is no relation between body temperature on admission and recanalization of an occluded intracranial artery three days later, irrespective of treatment with alteplase.
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Yaghi S, Hinduja A, Bianchi N. Predictors of major improvement after intravenous thrombolysis in acute ischemic stroke. Int J Neurosci 2015. [DOI: 10.3109/00207454.2015.1002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yaghi S, Hinduja A, Bianchi N. Predictors of major improvement after intravenous thrombolysis in acute ischemic stroke. Int J Neurosci 2015; 126:67-9. [PMID: 25562545 DOI: 10.3109/00207454.2014.1002611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intravenous thrombolysis improves outcomes of stroke patients. The immediate response to thrombolysis is variable and few studies attempted to identify predictors of major neurological improvement (MNI) 24 h following thrombolysis. Our objective is to determine predictors of MNI 24 h following thrombolysis. METHODS We reviewed the prospective database of patients treated through our telestroke network and at our institution between November 2008 and June 2012. We included all patients who received IV t-PA and had a 24-h NIHSS score available. Similar to previous studies, we defined MNI as a reduction in NIHSS score by ≥8 points, or a score of 0 or 1 at 24 h. Demographics, risk factors, time to treatment, and clinical and laboratory data, were compared between MNI present or absent. Baseline predictors were compared using t- and Fisher's exact tests, and outcomes using multivariate logistic regression analysis. RESULTS Out of 316 patients, 306 had 24-h NIHSS scores and 38% of them experienced MNI. Patients with MNI were less likely to be older than 80 years (16% vs. 29%, p = 0.008) and to have atrial fibrillation (9% vs. 24%, p = 0.001) compared to those without; we found no other predictors of MNI. After adjusting for baseline demographics and risk factors, age less than 80 years (OR = 1.9, 95% CI 1.1-3.6) and absence of atrial fibrillation (OR = 3.0, 95% CI: 1.4-6.2) predicted MNI. CONCLUSION Major neurological improvement within 24 h after thrombolysis is more likely in younger patients and those without atrial fibrillation.
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Affiliation(s)
- Shadi Yaghi
- a 1 Division of Stroke and Cerebrovascular Diseases, Neurology Department, Columbia University Medical Center, New York, NY, USA
| | - Archana Hinduja
- b 2 Department of Neurology, University of Arkansas for Medical Sciences, Litte Rock, AR, USA
| | - Nicolas Bianchi
- b 2 Department of Neurology, University of Arkansas for Medical Sciences, Litte Rock, AR, USA
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Kim SH, Saver JL. Initial body temperature in ischemic stroke: nonpotentiation of tissue-type plasminogen activator benefit and inverse association with severity. Stroke 2014; 46:132-6. [PMID: 25424482 DOI: 10.1161/strokeaha.114.006107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Body temperature (BT) is an important physiological factor in acute ischemic stroke. However, the relationship of initial BT to stroke severity and degree of benefit from thrombolytic therapy has been delineated incompletely. METHODS We analyzed the public data set of the 2 National Institute of Neurological Disorders and Stroke Tissue-Type Plasminogen Activator (tPA) stroke trials, comparing patients with lower (<37.0°C) and higher (≥37.0°C) presenting BT. RESULTS Among 595 patients (297 placebo and 298 tPA treated) with documented initial BT, 77.1% had initial BT <37.0°C and 22.9% ≥37.0°C. Patients with higher initial BT had lower baseline stroke severity in both tPA-treated patients (the National Institute of Health Stroke Scale median, 11 versus 15; P=0.05) and placebo-treated patients (median, 13 versus 16; P<0.01). Patients with higher initial BT also had lower infarction volume on computed tomography at 3 months in both tPA-treated patients (median, 9.6 versus 16.7 cm(3); P=0.08) and placebo-treated patients (median, 13.1 versus 28.1 cm(3); P=0.02), but no clinical outcome differences. Analysis of lytic treatment effect found no heterogeneity in the degree of tPA benefit in both higher and lower BT groups (≥37.0°C: odds ratio for the modified Rankin Scale 0-1 outcome, 2.55; 95% confidence interval, 1.05-6.21 and <37.0°C: odds ratio, 2.30; 95% confidence interval, 1.38-3.84; heterogeneity P=0.83). CONCLUSIONS In patients with hyperacute stroke, higher presenting temperatures are associated with less severe neurological deficits and reduced final infarct volumes. Presenting temperature does not modify the benefit of tPA on 3-month favorable outcome.
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Affiliation(s)
- Seo Hyun Kim
- From the Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea (S.H.K.); and Department of Neurology, Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.)
| | - Jeffrey L Saver
- From the Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea (S.H.K.); and Department of Neurology, Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.).
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Kvistad CE, Khanevski A, Nacu A, Thomassen L, Waje-Andreassen U, Naess H. Is higher body temperature beneficial in ischemic stroke patients with normal admission CT angiography of the cerebral arteries? Vasc Health Risk Manag 2014; 10:49-54. [PMID: 24482573 PMCID: PMC3905091 DOI: 10.2147/vhrm.s55423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Low body temperature is considered beneficial in ischemic stroke due to neuroprotective mechanisms, yet some studies suggest that higher temperatures may improve clot lysis and outcomes in stroke patients treated with tissue plasminogen activator (tPA). The effect of increased body temperature in stroke patients treated with tPA and with normal computed tomography angiography (CTA) on admission is unknown. We hypothesized a beneficial effect of higher body temperature in the absence of visible clots on CTA, possibly due to enhanced lysis of small, peripheral clots. Methods Patients with ischemic stroke admitted to our Stroke Unit between February 2006 and April 2013 were prospectively registered in a database (Bergen NORSTROKE Registry). Ischemic stroke patients treated with tPA with normal CTA of the cerebral arteries were included. Outcomes were assessed by the modified Rankin Scale (mRS) after 1 week. An excellent outcome was defined as mRS=0, and a favorable outcome as mRS=0–1. Results A total of 172 patients were included, of which 48 (27.9%) had an admission body temperature ≥37.0°C, and 124 (72.1%) had a body temperature <37.0°C. Body temperature ≥37.0°C was independently associated with excellent outcomes (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.24–6.46; P=0.014) and favorable outcomes (OR: 2.8; 95% CI: 1.13–4.98; P=0.015) when adjusted for confounders. Conclusion We found an association between higher admission body temperature and improved outcome in tPA-treated stroke patients with normal admission CTA of the cerebral arteries. This may suggest a beneficial effect of higher body temperature on clot lysis in the absence of visible clots on CTA.
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Affiliation(s)
| | - Andrej Khanevski
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Aliona Nacu
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway ; Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
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