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Zhu X, Shan H, Wang Z, Wang Y, Yan T, Chen Z, Zhang X. Serum secretoneurin as a promising biomarker for predicting poor prognosis in intracerebral hemorrhage: A prospective cohort study. Neurosurg Rev 2024; 47:320. [PMID: 39002049 PMCID: PMC11246307 DOI: 10.1007/s10143-024-02566-y] [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: 03/18/2024] [Revised: 05/28/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Secretoneurin may play a brain-protective role. We aim to discover the relationship between serum secretoneurin levels and severity plus neurological outcome after intracerebral hemorrhage (ICH). METHODS In this prospective cohort study, serum secretoneurin levels were measured in 110 ICH patients and 110 healthy controls. Glasgow Coma Scale (GCS) and hematoma volume were used to assess stroke severity. Poor prognosis was defined as Glasgow Outcome Scale (GOS) scores of 1-3 at 90 days after ICH. A multivariate logistic regression model was constructed to determine independent correlation of serum secretoneurin levels with severity and poor prognosis. Under receiver operating characteristic (ROC) curve, prognostic ability of serum secretoneurin levels was assessed. Restricted cubic spline (RCS) model and subgroups analysis were used for discovering association of serum secretoneurin levels with risk of poor prognosis. Calibration curve and decision curve were evaluated to confirm performance of nomogram. RESULTS Serum secretoneurin levels of patients were significantly higher than those of healthy controls. Serum secretoneurin levels of patients were independently correlated with GCS scores and hematoma volume. There were 42 patients with poor prognosis at 90 days following ICH. Serum secretoneurin levels were significantly higher in patients with poor outcome than in those with good outcome. Under the ROC curve, serum secretoneurin levels significantly differentiated poor outcome. Serum secretoneurin levels ≥ 22.8 ng/mL distinguished patients at risk of poor prognosis at 90 days with a sensitivity of 66.2% and a specificity of 81.0%. Besides, serum secretoneurin levels independently predicted a 90-day poor prognosis. Subgroup analysis showed that serum secretoneurin levels had non-significant interactions with other variables. The nomogram, including independent prognostic predictors, showed reliable prognosis capability using calibration curve and decision curve. Area under the curve of the predictive model was significantly higher than those of GCS scores and hematoma volume. CONCLUSION Serum secretoneurin levels are strongly related to ICH severity and poor prognosis at 90 days after ICH. Thus, serum secretoneurin may be a promising prognostic biomarker in ICH.
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Affiliation(s)
- Xutong Zhu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, China
| | - Hao Shan
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, China
| | - Zefan Wang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, China
| | - Yucheng Wang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, China
| | - Tian Yan
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, China
| | - Ziyin Chen
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Hangzhou, 310053, China
| | - Xin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, China.
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Aspberg S, Cheng D, von Heijne A, Gigante B, Singer DE. Brain MRI microbleeds and risk of intracranial hemorrhage in atrial fibrillation patients: A Swedish case-control study. J Stroke Cerebrovasc Dis 2024; 33:107629. [PMID: 38325675 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107629] [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: 06/20/2023] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES Our goal was to quantify the independent association of brain microbleeds with future intracranial hemorrhage (ICrH). Microbleed findings on brain magnetic resonance imaging (MRI) may identify distinctive risk factors for ICrH which could inform the anticoagulant therapy decision for atrial fibrillation (AF) patients. Our study design includes patients with MRIs for numerous reasons, not limited to evaluation of stroke. MATERIALS AND METHODS The source population was all patients with AF from a nationwide Swedish health care register. Case patients had an ICrH between 2006 and 2013 and ≥1 brain MRI for an unrelated condition before the ICrH. Each case was matched to four controls who had a brain MRI without a subsequent ICrH. The MRIs were re-reviewed by neuroradiologists. Associations between MRI findings and subsequent ICrH were assessed using logistic regression, adjusting for comorbidities and antithrombotic medications. RESULTS A total of 78 cases and 312 matched controls were identified; 29 cases and 79 controls had MRI sequences suitable for analysis of microbleeds. Patients with ≥10 microbleeds had a markedly increased risk of ICrH (adjusted odds ratio 14.56; 95 % confidence interval: 2.86-74.16, p < 0.001). All patients with ≥10 microbleeds had microbleeds in the lobar region and ≥10 lobar microbleeds was associated with intracerebral hemorrhages, univariable OR 8.54 (2.01-36.33), p = 0.004. CONCLUSIONS Leveraging a nationwide database with brain imaging obtained prior to ICrH, we identified a strong association between ≥10 microbleeds on brain MRI and subsequent ICrH among AF patients. Lobar brain regions were involved whenever there were ≥10 microbleeds. Brain MRIs may help optimize the anticoagulation decision in selected AF patients.
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Affiliation(s)
- Sara Aspberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anders von Heijne
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Daniel E Singer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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3
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Huang L, Yi L, Huang H, Zhan S, Chen R, Yue Z. Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta Neurol Belg 2024; 124:25-36. [PMID: 37704780 PMCID: PMC10874326 DOI: 10.1007/s13760-023-02377-w] [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: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Stroke is the third leading cause of death and disability worldwide. Post-stroke spasticity (PSS) is the most common complication of stroke but represents only one of the many manifestations of upper motor neuron syndrome. As an upper motor neuron, the corticospinal tract (CST) is the only direct descending motor pathway that innervates the spinal motor neurons and is closely related to the recovery of limb function in patients with PSS. Therefore, promoting axonal remodeling in the CST may help identify new therapeutic strategies for PSS. In this review, we outline the pathological mechanisms of PSS, specifically their relationship with CST, and therapeutic strategies for axonal regeneration of the CST after stroke. We found it to be closely associated with astroglial scarring produced by astrocyte activation and its secretion of neurotrophic factors, mainly after the onset of cerebral ischemia. We hope that this review offers insight into the relationship between CST and PSS and provides a basis for further studies.
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Affiliation(s)
- Linxing Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Lizhen Yi
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Huiyuan Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Sheng Zhan
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Ruixue Chen
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zenghui Yue
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Al-Maini M, Maindarkar M, Kitas GD, Khanna NN, Misra DP, Johri AM, Mantella L, Agarwal V, Sharma A, Singh IM, Tsoulfas G, Laird JR, Faa G, Teji J, Turk M, Viskovic K, Ruzsa Z, Mavrogeni S, Rathore V, Miner M, Kalra MK, Isenovic ER, Saba L, Fouda MM, Suri JS. Artificial intelligence-based preventive, personalized and precision medicine for cardiovascular disease/stroke risk assessment in rheumatoid arthritis patients: a narrative review. Rheumatol Int 2023; 43:1965-1982. [PMID: 37648884 DOI: 10.1007/s00296-023-05415-1] [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: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
The challenges associated with diagnosing and treating cardiovascular disease (CVD)/Stroke in Rheumatoid arthritis (RA) arise from the delayed onset of symptoms. Existing clinical risk scores are inadequate in predicting cardiac events, and conventional risk factors alone do not accurately classify many individuals at risk. Several CVD biomarkers consider the multiple pathways involved in the development of atherosclerosis, which is the primary cause of CVD/Stroke in RA. To enhance the accuracy of CVD/Stroke risk assessment in the RA framework, a proposed approach involves combining genomic-based biomarkers (GBBM) derived from plasma and/or serum samples with innovative non-invasive radiomic-based biomarkers (RBBM), such as measurements of synovial fluid, plaque area, and plaque burden. This review presents two hypotheses: (i) RBBM and GBBM biomarkers exhibit a significant correlation and can precisely detect the severity of CVD/Stroke in RA patients. (ii) Artificial Intelligence (AI)-based preventive, precision, and personalized (aiP3) CVD/Stroke risk AtheroEdge™ model (AtheroPoint™, CA, USA) that utilizes deep learning (DL) to accurately classify the risk of CVD/stroke in RA framework. The authors conducted a comprehensive search using the PRISMA technique, identifying 153 studies that assessed the features/biomarkers of RBBM and GBBM for CVD/Stroke. The study demonstrates how DL models can be integrated into the AtheroEdge™-aiP3 framework to determine the risk of CVD/Stroke in RA patients. The findings of this review suggest that the combination of RBBM with GBBM introduces a new dimension to the assessment of CVD/Stroke risk in the RA framework. Synovial fluid levels that are higher than normal lead to an increase in the plaque burden. Additionally, the review provides recommendations for novel, unbiased, and pruned DL algorithms that can predict CVD/Stroke risk within a RA framework that is preventive, precise, and personalized.
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Affiliation(s)
- Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON, L4Z 4C4, Canada
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA
- Asia Pacific Vascular Society, New Delhi, 110001, India
| | - George D Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, DY1 2HQ, UK
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, M13 9PL, UK
| | - Narendra N Khanna
- Asia Pacific Vascular Society, New Delhi, 110001, India
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, 110001, India
| | | | - Amer M Johri
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Canada
| | - Laura Mantella
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Vikas Agarwal
- Department of Immunology, SGPIMS, Lucknow, 226014, India
| | - Aman Sharma
- Department of Immunology, SGPIMS, Lucknow, 226014, India
| | - Inder M Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124, Thessaloniki, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, 94574, USA
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124, Cagliari, Italy
| | - Jagjit Teji
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753, Delmenhorst, Germany
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, UHID, 10 000, Zagreb, Croatia
| | - Zoltan Ruzsa
- Invasive Cardiology Division, University of Szeged, Szeged, Hungary
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, 95823, USA
| | - Martin Miner
- Men's Health Centre, Miriam Hospital Providence, Providence, RI, 02906, USA
| | - Manudeep K Kalra
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of the Republic of Serbia, University of Belgrade, 11000, Belgrade, Serbia
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138, Cagliari, Italy
| | - Mostafa M Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID, 83209, USA
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA.
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He J, Zhang Y, Li T, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Jia L, Wang Y, Fang F. Glucose-albumin ratio as new biomarker for predicting mortality after intracerebral hemorrhage. Neurosurg Rev 2023; 46:94. [PMID: 37074539 DOI: 10.1007/s10143-023-02002-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/31/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE This study aims to evaluate the prognostic value of blood-based biomarkers and their combinations, in particular the glucose-albumin ratio (GAR), in patients with spontaneous intracerebral hemorrhage (ICH). METHODS A retrospective observational study on 2481 patients from one hospital was conducted and validated with 602 patients from another. We assessed 15 biomarkers and focused on GAR to elucidate its prognostic and predictive value for outcomes in both cohorts. The primary outcome was mortality at 90 days. RESULTS The ratio of glucose-to-albumin, defined as GAR, was superior to other biomarkers for predicting mortality at 90 days in patients with ICH (AUC = 0.72). High GAR (using the best cutoff value of 0.19) was associated with increased mortality at 90 days (odds ratios of 1.90, 95% CI 1.54-2.34) and all-cause mortality in the first 3 years after admission (hazard ratio of 1.62, 95% CI 1.42-1.86). All aforementioned findings for GAR were successfully validated in an external independent cohort. CONCLUSIONS GAR may be a valuable biomarker for predicting the mortality of patients with ICH.
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Affiliation(s)
- Jialing He
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, No. 250, Changgang East Road, Guangzhou, 510260, Guangdong, China
| | - Yu Zhang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan, China
| | - Haidong Deng
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yezhong Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, No. 250, Changgang East Road, Guangzhou, 510260, Guangdong, China.
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Pereira M, Batista R, Marreiros A, Nzwalo H. Neutrophil-to-leukocyte ratio and admission glycemia as predictors of short-term death in very old elderlies with lobar intracerebral hemorrhage. Brain Circ 2023; 9:94-98. [PMID: 37576580 PMCID: PMC10419730 DOI: 10.4103/bc.bc_5_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The incidence of spontaneous intracerebral hemorrhage (SICH) is highest in very old elderlies (≥75 years). The increasing use of antithrombotic drugs is shifting the epidemiology of SICH towards predominance of lobar subtype, suggesting an incremented propensity of bleeding associated with underlying cerebral amyloid angiopathy. With population aging and antithrombotic use, a parallel raise of proportion of lobar SICH is occurring. Improvement of prognostication in this specific age group and SICH type is needed. Routine blood biomarkers can contribute to prediction of short-term mortality after SICH. OBJECTIVE Our aim was to investigate the contribution of routine blood biomarkers for short-term mortality (30-days) in elderly patients with lobar SICH. METHODS Retrospective analysis of consecutive 130 patients with ≥ 75 years and lobar SICH. The outcome was 30-day mortality. Logistic regression analysis was used to investigate whether admission routine biomarkers can be used as predictors. RESULTS The case fatality was 40.8%. Admission glycaemia level, neutrophil to lymphocyte ratio and mean platelet volume were significantly different between groups (p = 0.001, p = 0.024, p = 0.038, respectively). There was no significant difference in all other routine biomarkers. On multivariate analysis, admission higher mean BG level (odds ratio [OR]: 1.010, 95% confidence interval [CI]: 1.001-1.019, p = 0.026) and neutrophil to lymphocyte ratio (OR: 1.070, 95% CI: 1.008-1.136, p = 0.027) emerged as predictors. CONCLUSION In very old patients with lobar SICH, higher BG level and neutrophil to lymphocyte ratio are associated with increased risk of short-term death.
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Affiliation(s)
- Marta Pereira
- Medical Education Unit, Faculty of Medicine and Biomedical Sciences, Algarve University, Faro, Portugal
- Algarve Biomedical Center Research Institute, Algarve University Hospital Center, Faro, Portugal
| | - Rafael Batista
- Medical Education Unit, Faculty of Medicine and Biomedical Sciences, Algarve University, Faro, Portugal
- Algarve Biomedical Center Research Institute, Algarve University Hospital Center, Faro, Portugal
| | - Ana Marreiros
- Medical Education Unit, Faculty of Medicine and Biomedical Sciences, Algarve University, Faro, Portugal
- Algarve Biomedical Center Research Institute, Algarve University Hospital Center, Faro, Portugal
| | - Hipolito Nzwalo
- Medical Education Unit, Faculty of Medicine and Biomedical Sciences, Algarve University, Faro, Portugal
- Algarve Biomedical Center Research Institute, Algarve University Hospital Center, Faro, Portugal
- Stroke Unit, Algarve University Hospital Center, Faro, Portugal
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7
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Zou J, Chen H, Liu C, Cai Z, Yang J, Zhang Y, Li S, Lin H, Tan M. Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage. Front Neurosci 2022; 16:942100. [PMID: 36033629 PMCID: PMC9400715 DOI: 10.3389/fnins.2022.942100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/15/2022] [Indexed: 12/28/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a stroke syndrome with an unfavorable prognosis. Currently, there is no comprehensive clinical indicator for mortality prediction of ICH patients. The purpose of our study was to construct and evaluate a nomogram for predicting the 30-day mortality risk of ICH patients. Methods ICH patients were extracted from the MIMIC-III database according to the ICD-9 code and randomly divided into training and verification cohorts. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression were applied to determine independent risk factors. These risk factors were used to construct a nomogram model for predicting the 30-day mortality risk of ICH patients. The nomogram was verified by the area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results A total of 890 ICH patients were included in the study. Logistic regression analysis revealed that age (OR = 1.05, P < 0.001), Glasgow Coma Scale score (OR = 0.91, P < 0.001), creatinine (OR = 1.30, P < 0.001), white blood cell count (OR = 1.10, P < 0.001), temperature (OR = 1.73, P < 0.001), glucose (OR = 1.01, P < 0.001), urine output (OR = 1.00, P = 0.020), and bleeding volume (OR = 1.02, P < 0.001) were independent risk factors for 30-day mortality of ICH patients. The calibration curve indicated that the nomogram was well calibrated. When predicting the 30-day mortality risk, the nomogram exhibited good discrimination in the training and validation cohorts (C-index: 0.782 and 0.778, respectively). The AUCs were 0.778, 0.733, and 0.728 for the nomogram, Simplified Acute Physiology Score II (SAPSII), and Oxford Acute Severity of Illness Score (OASIS), respectively, in the validation cohort. The IDI and NRI calculations and DCA analysis revealed that the nomogram model had a greater net benefit than the SAPSII and OASIS scoring systems. Conclusion This study identified independent risk factors for 30-day mortality of ICH patients and constructed a predictive nomogram model, which may help to improve the prognosis of ICH patients.
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Affiliation(s)
- Jianyu Zou
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huihuang Chen
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cuiqing Liu
- Department of Nursing, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhenbin Cai
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jie Yang
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yunlong Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shaojin Li
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hongsheng Lin
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Hongsheng Lin,
| | - Minghui Tan
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Minghui Tan,
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Arun S, Cherian TG, Philip C. Multisystem inflammatory syndrome in a neonate with severe hemophilia - a diagnostic challenge in COVID times: a case report. BMC Pediatr 2022; 22:397. [PMID: 35799157 PMCID: PMC9261231 DOI: 10.1186/s12887-022-03463-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisystem Inflammatory Syndrome in Neonates (MIS-N) can occur following antenatal COVID- 19 infection in the mother. Here we report a rare case of a neonate with Hemophilia A and MIS-N. CASE PRESENTATION A 2-day-old baby presented with an intramuscular hematoma, neonatal seizures, and isolated activated partial thromboplastin time (APTT) prolongation. The neurosonogram showed a subdural hematoma. A diagnosis of Hemophilia A was made and was confirmed by factor 8 assay and genetic analysis. Supportive measures and Factor 8 replacement was initiated. A rising trend of inflammatory markers and an ongoing need for mechanical ventilation were noted. As there was a history of COVID-19 in the mother in the third trimester, MIS-N was diagnosed. The baby was treated with intravenous immunoglobulin (IVIG) and steroids, and there was an improvement in the clinical and laboratory markers. However, the baby developed seizures on day 16. There was an increase in the subdural hemorrhage and a further rise in inflammatory markers. A craniostomy and hematoma evacuation was done and the baby improved. CONCLUSION The concurrent occurrence of hemophilia A with intracranial bleed, and MIS-N in a neonate is a diagnostic challenge. It is important to have a high index of suspicion to ensure timely diagnosis and treatment of MIS-N in this pandemic era.
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Affiliation(s)
- Sumitha Arun
- Department of Neonatology, Believers Church Medical College Hospital, Thiruvalla, Kerala, 689103, India.
| | - Taliya Grace Cherian
- Department of Neonatology, Believers Church Medical College Hospital, Thiruvalla, Kerala, 689103, India
| | - Chepsy Philip
- Department of Hematology, Believers Church Medical College Hospital, Thiruvalla, Kerala, 689103, India
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Simani L, Ramezani M, Mohammadi E, Abbaszadeh F, Karimialavijeh E, Pakdaman H. Association of Changed Serum Brain Biomarkers With Perihematomal Edema and Early Clinical Outcome in Primary ICH Patients. Neurologist 2022; 27:168-172. [PMID: 34855658 DOI: 10.1097/nrl.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) following primary intracranial hemorrhages (ICHs) affects the patient outcome. Also, serum biomarkers such as S100 calcium-binding protein B (S100B) and glial fibrillary acidic protein (GFAP) have been associated with ICHs outcome. We aimed to investigate the association between these biomarkers and PHE in ICH patients. METHODS In this cross-sectional study, patients with primary ICH between January 2020 and August 2020 were evaluated. All participants underwent spiral brain computed tomography scans upon admission, and 48 to 72 hours later and quantification of initial hematoma volume was performed. Serum level of matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), GFAP, and S100B on admission were measured by enzyme-linked immunosorbent assays. Acute clinical outcome was assessed by the modified-Rankin scale, National Institute of Health Stroke Scale (NIHSS), and ICH score. RESULTS Thirty-seven ICH patients (21 patients with a favorable outcome and 16 unfavorable) were studied. Compared with survival patients, nonsurvivor patients showed a higher serum level of MMP-9, VEGF, GFAP, and S100B ( P <0.05). Scores of absolute PHE, edema expansion distance, and PHE growth rate in the nonsurvivor group were higher than the survivors ( P <0.001). The regression model revealed that MMP-9, VEGF, ICH score, and hematoma volume were associated with the PHE growth rate. S100B and ICH score were associated with edema expansion distance. CONCLUSIONS Our data showed that the serum level of molecular biomarkers was associated with higher PHE volume and PHE scores were higher in nonsurvival patients, suggesting it may have a pathogenic role in developing PHE after ICH.
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Affiliation(s)
- Leila Simani
- Skull Base Research Center
- Brain Mapping Research Center, Loghman Hakim Hospital
| | - Mahtab Ramezani
- Skull Base Research Center
- Brain Mapping Research Center, Loghman Hakim Hospital
| | | | - Fatemeh Abbaszadeh
- Neurobiology Research Center, Shahid Beheshti University of Medical Sciences
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences (IUMS)
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Lirong W, Mingliang Z, Mengci L, Qihao G, Zhenxing R, Xiaojiao Z, Tianlu C. The clinical and mechanistic roles of bile acids in depression, Alzheimer's disease, and stroke. Proteomics 2022; 22:e2100324. [PMID: 35731901 DOI: 10.1002/pmic.202100324] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
The burden of neurological and neuropsychiatric disorders continues to grow with significant impacts on human health and social economy worldwide. Increasing clinical and preclinical evidences have implicated that bile acids (BAs) are involved in the onset and progression of neurological and neuropsychiatric diseases. Here, we summarized recent studies of BAs in three types of highly prevalent brain disorders, depression, Alzheimer's disease, and stroke. The shared and specific BA profiles were explored and potential markers associated with disease development and progression were summarized. The mechanistic roles of BAs were reviewed with focuses on inflammation, gut-brain-microbiota axis, cellular apoptosis. We also discussed future perspectives for the prevention and treatment of neurological and neuropsychiatric disorders by targeting BAs and related molecules and gut microbiota. Our understanding of BAs and their roles in brain disorders is still evolving. A large number of questions still need to be addressed on the emerging crosstalk among central, peripheral, intestine and their contribution to brain and mental health. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wu Lirong
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Zhao Mingliang
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Li Mengci
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Guo Qihao
- Department of gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Ren Zhenxing
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Zheng Xiaojiao
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Chen Tianlu
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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11
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Genetics and Epigenetics of Spontaneous Intracerebral Hemorrhage. Int J Mol Sci 2022; 23:ijms23126479. [PMID: 35742924 PMCID: PMC9223468 DOI: 10.3390/ijms23126479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a complex and heterogeneous disease, and there is no effective treatment. Spontaneous ICH represents the final manifestation of different types of cerebral small vessel disease, usually categorized as: lobar (mostly related to cerebral amyloid angiopathy) and nonlobar (hypertension-related vasculopathy) ICH. Accurate phenotyping aims to reflect these biological differences in the underlying mechanisms and has been demonstrated to be crucial to the success of genetic studies in this field. This review summarizes how current knowledge on genetics and epigenetics of this devastating stroke subtype are contributing to improve the understanding of ICH pathophysiology and their potential role in developing therapeutic strategies.
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12
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Swetz D, Seymour SE, Rava RA, Shiraz Bhurwani MM, Monteiro A, Baig AA, Waqas M, Snyder KV, Levy EI, Davies JM, Siddiqui AH, Ionita CN. Initial investigation of predicting hematoma expansion for intracerebral hemorrhage using imaging biomarkers and machine learning. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12036:120360B. [PMID: 36081709 PMCID: PMC9451134 DOI: 10.1117/12.2610672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Intracerebral Hemorrhage (ICH) is one of the most devastating types of strokes with mortality and morbidity rates ranging from about 51%-65% one year after diagnosis. Early hematoma expansion (HE) is a known cause of worsening neurological status of ICH patients. The goal of this study was to investigate whether non-contrast computed tomography imaging biomarkers (NCCT-IB) acquired at initial presentation can predict ICH growth in the acute stage. MATERIALS AND METHODS We retrospectively collected NCCT data from 200 patients with acute (<6 hours) ICH. Four NCCT-IBs (blending region, dark hole, island, and edema) were identified for each hematoma, respectively. HE status was recorded based on the clinical observation reported in the patient chart. Supervised machine learning models were developed, trained, and tested for 15 different input combinations of the NCCT-IBs to predict HE. Model performance was assessed using area under the receiver operating characteristic curve and probability for accurate diagnosis (PAD) was calculated. A 20-fold Monte-Carlo cross validation was implemented to ensure model reliability on a limited sample size of data, by running a myriad of random training/testing splits. RESULTS The developed algorithm was able to predict expansion utilizing all four inputs with an accuracy of 70.17%. Further testing of all biomarker combinations yielded P AD ranging from 0.57, to 0.70. CONCLUSION Specific attributes of ICHs may influence the likelihood of HE and can be evaluated via a machine learning algorithm. However, certain parameters may differ in importance to reach accurate conclusions about potential expansion.
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Affiliation(s)
- Dennis Swetz
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Samantha E Seymour
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Andre Monteiro
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Ammad A Baig
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
- University Dept. of Biomedical Informatics, University at Buffalo, Buffalo, NY 14214
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
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13
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Shen XY, Gao ZK, Han Y, Yuan M, Guo YS, Bi X. Activation and Role of Astrocytes in Ischemic Stroke. Front Cell Neurosci 2021; 15:755955. [PMID: 34867201 PMCID: PMC8635513 DOI: 10.3389/fncel.2021.755955] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
Ischemic stroke refers to the disorder of blood supply of local brain tissue caused by various reasons. It has high morbidity and mortality worldwide. Astrocytes are the most abundant glial cells in the central nervous system (CNS). They are responsible for the homeostasis, nutrition, and protection of the CNS and play an essential role in many nervous system diseases’ physiological and pathological processes. After stroke injury, astrocytes are activated and play a protective role through the heterogeneous and gradual changes of their gene expression, morphology, proliferation, and function, that is, reactive astrocytes. However, the position of reactive astrocytes has always been a controversial topic. Many studies have shown that reactive astrocytes are a double-edged sword with both beneficial and harmful effects. It is worth noting that their different spatial and temporal expression determines astrocytes’ various functions. Here, we comprehensively review the different roles and mechanisms of astrocytes after ischemic stroke. In addition, the intracellular mechanism of astrocyte activation has also been involved. More importantly, due to the complex cascade reaction and action mechanism after ischemic stroke, the role of astrocytes is still difficult to define. Still, there is no doubt that astrocytes are one of the critical factors mediating the deterioration or improvement of ischemic stroke.
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Affiliation(s)
- Xin-Ya Shen
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhen-Kun Gao
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Han
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Mei Yuan
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yi-Sha Guo
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xia Bi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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14
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Qureshi AI, Huang W, Lobanova I, Chandrasekaran PN, Hanley DF, Hsu CY, Martin RH, Steiner T, Suarez JI, Yamamoto H, Toyoda K. Effect of Moderate and Severe Persistent Hyperglycemia on Outcomes in Patients With Intracerebral Hemorrhage. Stroke 2021; 53:1226-1234. [PMID: 34844422 DOI: 10.1161/strokeaha.121.034928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated the effect of persistent hyperglycemia on outcomes in 1000 patients with intracerebral hemorrhage enrolled within 4.5 hours of symptom onset. METHODS We defined moderate and severe hyperglycemia based on serum glucose levels ≥140 mg/dL-<180 and ≥180 mg/dL, respectively, measured at baseline, 24, 48, and 72 hours. Persistent hyperglycemia was defined by 2 consecutive (24 hours apart) serum glucose levels. We evaluated the relationship between moderate and severe hyperglycemia and death or disability (defined by modified Rankin Scale score of 4-6) at 90 days in the overall cohort and in groups defined by preexisting diabetes. RESULTS In the multivariate analysis, both moderate (odds ratio, 1.8 [95% CI, 1.1-2.8]) and severe (odds ratio, 1.8 [95% CI, 1.2-2.7]) hyperglycemia were associated with higher 90-day death or disability after adjusting for Glasgow Coma Scale score, hematoma volume, presence or absence of intraventricular hemorrhage, hyperlipidemia, cigarette smoking, and hypertension (no interaction between hyperglycemia and preexisting diabetes, P=0.996). Among the patients without preexisting diabetes, both moderate (odds ratio, 1.8 [95% CI, 1.0-3.2]) and severe (odds ratio, 2.0 [95% CI, 1.1-3.7]) hyperglycemia were associated with 90-day death or disability after adjusting for above mentioned potential confounders. Among the patients with preexisting diabetes, moderate and severe hyperglycemia were not associated with 90-day death or disability. CONCLUSIONS Persistent hyperglycemia, either moderate or severe, increased the risk of death or disability in nondiabetic patients with intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01176565.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | - Wei Huang
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | - Iryna Lobanova
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | | | - Daniel F Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. (D.F.H.)
| | - Chung Y Hsu
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan (C.Y.H.)
| | - Renee H Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (R.H.M.)
| | - Thorsten Steiner
- Department of Neurology, University of Heidelberg, Germany (T.S.)
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. (J.I.S.)
| | - Haruko Yamamoto
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan. (H.Y.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (K.T.)
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15
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Soluble triggering receptor expressed on myeloid cells-1 as a serum biomarker of early neurologic deterioration and prognosis in acute supratentorial intracerebral hemorrhage. Clin Chim Acta 2021; 523:290-296. [PMID: 34655609 DOI: 10.1016/j.cca.2021.10.010] [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: 09/21/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Triggering receptor expressed on myeloid cells-1 (TREM-1) participates in neuroinflammation. We intended to ascertain whether serum soluble TREM-1 (sTREM-1) could be utilized as a biomarker of inflammation, severity, early neurologic deterioration (END) and outcome after primary intracerebral hemorrhage (ICH). METHODS Serum sTREM-1 levels were gauged in 104 ICH patients and 104 healthy controls. END was diagnosed when the National Institutes of Health Stroke Scale (NIHSS) score increased ≥ 4 points or death between admission and 24 h after admission. Patients with a modified Rankin scale score of > 2 at 3 months were considered to have poor outcome. RESULTS As compared to controls, patients exhibited significantly elevated serum sTREM-1 levels (median: 309.0 vs 67.9 pg/ml). Serum sTREM-1 concentrations were intimately correlated with NIHSS score (r = 0.574), hematoma volume (r = 0.554), blood leukocyte count (r = 0.529) and serum C-reactive protein concentrations (r = 0.509). Serum sTREM-1 concentrations > 309.0 pg/ml independently predicted END and poor outcome with odds ratio values of 4.054 and 4.721 respectively. Serum sTREM-1 concentrations distinguished END and poor outcome with areas under receiver operating characteristic curve of 0.789 and 0.813 respectively. CONCLUSION Serum sTREM-1 may represent a promising inflammatory biomarker for assessment of severity and prediction of END and poor outcome after ICH.
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16
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Troiani Z, Ascanio L, Rossitto CP, Ali M, Mohammadi N, Majidi S, Mocco J, Kellner CP. Prognostic Utility of Serum Biomarkers in Intracerebral Hemorrhage: A Systematic Review. Neurorehabil Neural Repair 2021; 35:946-959. [PMID: 34541960 DOI: 10.1177/15459683211041314] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Intracerebral hemorrhage (ICH) accounts for 10-20% of all strokes and is associated with high morbidity and mortality. Recent studies have identified serum biomarkers as a means to improve outcome prognostication in poor grade ICH patients. Poor prognosis of ICH patients and complex pathophysiology of the disease necessitate prognostic serum biomarkers to help guide treatment recommendations. Objective. The objective is to systematically review all biomarkers used to predict long-term functional outcome in patients with spontaneous intracerebral hemorrhage. Results. We identified 36 studies investigating the predictive utility of 50 discrete biomarkers. Data from 4865 ICH patients were reviewed. Inflammatory biomarkers (11/50) were most often studied, followed by oxidative (8/50), then neuron and astrocyte-specific (7/50). S100 calcium binding protein B, white blood cell count, and copeptin were the most often studied individual biomarkers. The prognostic utility of 23 biomarkers was analyzed using receiver operating characteristic curves. Area under the curve (AUC) values for all available biomarkers except neutrophil/lymphocyte ratio were acceptable. Twenty of the 23 biomarkers were characterized by at least one excellent AUC value. Vascular endothelial growth factor, glial fibrillary astrocyte protein, and S100 calcium binding protein B were characterized by outstanding AUC. Conclusions. We identified the inflammatory and neuron and astrocyte-specific biomarker categories as having the greatest number of significant individual biomarker predictors of long-term outcome. Further investigation utilizing cross-validation of prediction models in a second independent group and blinded assessment of outcomes for the predictive utility of biomarkers in patients with ICH is warranted.
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Affiliation(s)
- Zachary Troiani
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Luis Ascanio
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Christina P Rossitto
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Nicki Mohammadi
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Shahram Majidi
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - J Mocco
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Christopher P Kellner
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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17
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Zeng J, Chen F, Chen Y, Peng M, Chen X, Yang Q, Wang R, Miao J. Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients: A single-center study of 391 cases. Medicine (Baltimore) 2021; 100:e27053. [PMID: 34664830 PMCID: PMC8448058 DOI: 10.1097/md.0000000000027053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients.Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed.Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group (P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06-7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10-0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06-0.45 P = .000) were protective factors of hemorrhagic complications.For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.
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Affiliation(s)
- Jianqi Zeng
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Feng Chen
- Department of Neurology, Zhaoqing Gaoyao People's Hospital, Guangdong Province, Zhaoqing, China
| | - Yiqian Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Muli Peng
- Department of Neurology, Zhaoqing Gaoyao People's Hospital, Guangdong Province, Zhaoqing, China
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Qingwei Yang
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Ru Wang
- Department of Neurology, Weinan Central Hospital, Weinan, China
| | - Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, Xiamen, China
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18
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Mureşan EM, Golea A, Bolboacă SD, Perju-Dumbravă L. Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting. Med Pharm Rep 2021; 94:307-317. [PMID: 34430852 DOI: 10.15386/mpr-1783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023] Open
Abstract
Background and aims Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED). Methods Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer). Results The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms' onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient's presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range. Conclusions It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.
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Affiliation(s)
- Eugenia-Maria Mureşan
- Department of Neurosciences, Iuliu Hatieganu Univesrity of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Division, Iuliu Hatieganu Univesrity of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Education, Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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19
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Dias A, Silva I, Pinto IM, Maia LF. Timely and Blood-Based Multiplex Molecular Profiling of Acute Stroke. Life (Basel) 2021; 11:816. [PMID: 34440560 PMCID: PMC8398526 DOI: 10.3390/life11080816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
Stroke is a leading cause of death and disability in the world. To address such a problem, early diagnosis and tailored acute treatment represent one of the major priorities in acute stroke care. Since the efficacy of reperfusion treatments is highly time-dependent, there is a critical need to optimize procedures for faster and more precise diagnosis. We provide a concise review of the most relevant and well-documented blood-protein biomarkers that exhibit greater potential for translational to clinical practice in stroke differential diagnosis and to differentiate ischemic stroke from hemorrhagic stroke, followed by an overview of the most recent point-of-care technological approaches to address this problem. The integration of fluid-based biomarker profiling, using point-of-care biosensors with demographic, clinical, and neuroimaging parameters in multi-dimensional clinical decision-making algorithms, will be the next step in personalized stroke care.
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Affiliation(s)
- Alexandre Dias
- Department of Neurology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal; (A.D.); (I.S.)
- Portugal and Ipatimup—Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal
| | - Isabel Silva
- Department of Neurology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal; (A.D.); (I.S.)
- Portugal and Molecular Neurobiology, IBMC—Instituto de Biologia Molecular e Celular, University of Porto, 4200-135 Porto, Portugal
| | - Inês Mendes Pinto
- International Iberian Nanotechnology Laboratory, 4715-330 Braga, Portugal
| | - Luís F. Maia
- Department of Neurology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal; (A.D.); (I.S.)
- Portugal and Molecular Neurobiology, IBMC—Instituto de Biologia Molecular e Celular, University of Porto, 4200-135 Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
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20
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Cai Y, Zhuang YK, Wu XY, Dong XQ, Du Q, Yu WH, Wang KY, Hu W, Zheng YK. Serum Hypoxia-Inducible Factor 1alpha Levels Correlate with Outcomes After Intracerebral Hemorrhage. Ther Clin Risk Manag 2021; 17:717-726. [PMID: 34285494 PMCID: PMC8286156 DOI: 10.2147/tcrm.s313433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Serum hypoxia-inducible factor 1alpha (HIF-1α) is a key regulator in hypoxic and ischemic brain injury. We determined the relationship between serum HIF-1α levels and long-term prognosis plus severity of intracerebral hemorrhage (ICH). Methods A total of 97 ICH cases and 97 healthy controls were enrolled. Glasgow Coma Scale (GCS) score and hematoma volume were used to assess hemorrhagic severity. Glasgow Outcome Scale (GOS) score of 1–3 at post-stroke 90 days was defined as a poor outcome. Results Serum HIF-1α levels of ICH patients were significantly higher than those of healthy controls (median, 218.8 vs 105.4 pg/mL; P<0.001) and were substantially correlated with GCS score (r=−0.485, P<0.001), hematoma volume (r=0.357, P<0.001) and GOS score (r=−0.436, P<0.001). Serum HIF-1α levels >239.4 pg/mL discriminated patients at risk of 90-day poor outcome with sensitivity of 65.9% and specificity of 79.3% (area under the receiver operating characteristic curve, 0.725; 95% confidence interval, 0.625–0.811; P<0.001). Moreover, serum HIF-1α levels >239.4 pg/mL were independently associated with a poor 90-day outcome (odds ratio, 5.133; 95% confidence interval, 1.117–23.593; P=0.036). Conclusion Serum HIF-1α, in close correlation with hemorrhagic severity and poor 90-day outcome, may serve as a potential prognostic biomarker for ICH.
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Affiliation(s)
- Yong Cai
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, People's Republic of China
| | - Yao-Kun Zhuang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, People's Republic of China
| | - Xiao-Yu Wu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, People's Republic of China
| | - Xiao-Qiao Dong
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
| | - Quan Du
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
| | - Wen-Hua Yu
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
| | - Ke-Yi Wang
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
| | - Wei Hu
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
| | - Yong-Ke Zheng
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
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Leasure AC, Kuohn LR, Vanent KN, Bevers MB, Kimberly WT, Steiner T, Mayer SA, Matouk CC, Sansing LH, Falcone GJ, Sheth KN. Association of Serum IL-6 (Interleukin 6) With Functional Outcome After Intracerebral Hemorrhage. Stroke 2021; 52:1733-1740. [PMID: 33682454 DOI: 10.1161/strokeaha.120.032888] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES IL-6 (interleukin 6) is a proinflammatory cytokine and an established biomarker in acute brain injury. We sought to determine whether admission IL-6 levels are associated with severity and functional outcome after spontaneous intracerebral hemorrhage (ICH). METHODS We performed an exploratory analysis of the recombinant activated FAST trial (Factor VII for Acute ICH). Patients with admission serum IL-6 levels were included. Regression analyses were used to assess the associations between IL-6 and 90-day modified Rankin Scale. In secondary analyses, we used linear regression to evaluate the association between IL-6 and baseline ICH and perihematomal edema volumes. RESULTS Of 841 enrolled patients, we included 552 (66%) with available admission IL-6 levels (mean age 64 [SD 13], female sex 203 [37%]). IL-6 was associated with poor outcome (modified Rankin Scale, 4-6; per additional 1 ng/L, odds ratio, 1.30 [95% CI, 1.04-1.63]; P=0.02) after adjustment for known predictors of outcome after ICH and treatment group. IL-6 was associated with ICH volume after adjustment for age, sex, and ICH location, and this association was modified by location (multivariable interaction, P=0.002), with a stronger association seen in lobar (β, 12.51 [95% CI, 6.47-18.55], P<0.001) versus nonlobar (β 5.32 [95% CI, 3.36-7.28], P<0.001) location. IL-6 was associated with perihematomal edema volume after adjustment for age, sex, ICH volume, and ICH location (β 1.22 [95% CI, 0.15-2.29], P=0.03). Treatment group was not associated with IL-6 levels or outcome. CONCLUSIONS In the FAST trial population, higher admission IL-6 levels were associated with worse 90-day functional outcome and larger ICH and perihematomal edema volumes.
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Affiliation(s)
- Audrey C Leasure
- Department of Neurology (A.C.L., L.R.K., K.N.V., L.H.S., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT
| | - Lindsey R Kuohn
- Department of Neurology (A.C.L., L.R.K., K.N.V., L.H.S., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT
| | - Kevin N Vanent
- Department of Neurology (A.C.L., L.R.K., K.N.V., L.H.S., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT
| | - Matthew B Bevers
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women's Hospital, Boston, MA (M.B.B.)
| | - W Taylor Kimberly
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston (W.T.K.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).,Department of Neurology, Heidelberg University Hospital, Germany (T.S.)
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Westchester Medical Center Health Network, Valhalla (S.A.M.)
| | - Charles C Matouk
- Department of Neurosurgery (C.C.M.), Yale University School of Medicine, New Haven, CT
| | - Lauren H Sansing
- Department of Neurology (A.C.L., L.R.K., K.N.V., L.H.S., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT
| | - Guido J Falcone
- Department of Neurology (A.C.L., L.R.K., K.N.V., L.H.S., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Department of Neurology (A.C.L., L.R.K., K.N.V., L.H.S., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT
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22
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Bernstein JE, Browne JD, Savla P, Wiginton J, Patchana T, Miulli DE, Wacker MR, Duong J. Inflammatory Markers in Severity of Intracerebral Hemorrhage II: A Follow Up Study. Cureus 2021; 13:e12605. [PMID: 33585095 PMCID: PMC7872478 DOI: 10.7759/cureus.12605] [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] [Indexed: 12/02/2022] Open
Abstract
Introduction Spontaneous intracerebral hemorrhage (ICH) results in significant morbidity and mortality. The pathogenesis of brain injury after ICH is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue. Various inflammatory and non-inflammatory biomarkers have been studied as predictors and potential therapeutic targets for intracerebral hemorrhage. Our prior study showed an association with low vascular endothelial growth factor (VEGF) levels and increased mortality. This current study looks to expand on our prior results and will look at the relationship between tumor necrosis factor alpha (TNFα), C-reactive protein (CRP), VEGF, Homocysteine (Hcy), and CRP to albumin ratio (CAR) in predicting outcomes and severity in spontaneous intracerebral hemorrhage. Methods We conducted a retrospective chart review of patients with spontaneous intracerebral hemorrhage with TNFα, CRP, VEGF, Hcy levels drawn on admission. Albumin and CRP levels on admission were used to calculate CAR. Ninety-nine patients were included in the study. Primary outcomes included death, early neurologic decline (END), and hemorrhage size. Secondary outcomes included late neurologic decline (LND), Glasgow Coma Scale (GCS) on admission, GCS on discharge, ICH score, change in hemorrhage size, need for surgical intervention, and length of ICU stay. Results A total of 99 patients were included in this study, with 42% requiring surgical intervention and an overall mortality of 16%. Basal ganglia hemorrhage was seen in 41% of patients. Hcy and CAR were significantly correlated with ICH size in basal ganglia patients (r-=0.36, p=0.03; r=0.43, p=0.03, respectively). CAR was significantly correlated with ICH score (r=0.33, p=0.007874). Admission VEGF levels less than 45 pg/ml had 8.4-fold increase in mortality (odds ratio [OR] 8.4545, p=0.0488). Patients with TNFα levels greater than 1.40 pg/ml had a 4.1-fold increase in mortality (OR 4.1, p=0.04) Conclusion Our study demonstrated that low levels (<45 pg/ml) of VEGF were associated with an 8.4-fold increase in mortality, supporting the neuroprotective effect of this protein. Elevated Hcy and CAR levels were associated with an increase in hemorrhage size in patients with basal ganglia hemorrhages. TNFα levels greater than 1.40 pg/ml were associated with a 4.1-fold increase in mortality, and this together with CAR being correlated with increased hemorrhage size and ICH score further demonstrate the inflammatory consequences after intracerebral hemorrhage. Future studies directed at lowering CRP, TNFα, and Hcy and/or increasing VEGF in intracerebral hemorrhage patients are needed and may be beneficial.
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Affiliation(s)
- Jacob E Bernstein
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Jonathan D Browne
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | | | - Jason Duong
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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Shi Y, Fan X, Li G, Zhong D, Zhang X. Association of Serum Dystroglycan, MMP-2/9 and AQP-4 with Haematoma Expansion in Patients with Intracerebral Haemorrhage. Neuropsychiatr Dis Treat 2021; 17:11-18. [PMID: 33442252 PMCID: PMC7797333 DOI: 10.2147/ndt.s283016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/23/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore association of serum dystroglycan (DG), matrix metalloproteinase-2/matrix metalloproteinase-9 (MMP-2/9), and aquaporin-4 (AQP-4) expression and haematoma expansion in patients with intracerebral haemorrhage (ICH), which are proteins involved in maintaining the integrity of the blood-brain barrier. METHODS We included patients older than 18 years old with ICH who had undergone baseline CT within 6 hours after intracerebral haemorrhage symptom onset in our hospital between April 2018 and December 2018. Two readers independently assessed haematoma volume and other imaging information upon admission and again within 24 hours. All patients underwent 5 mL of venous blood collection 6 and 24 hours after admission. Serum expression levels of dystroglycan, matrix metalloproteinase-2/matrix metalloproteinase-9 and aquaporin-4 were determined by quantitative enzyme-linked immunosorbent assay (ELISA). Repeated analysis of variance was used to determine whether expression of the four proteins in patients with cerebral haemorrhage changed within 24 hours and whether there were differences between the haematoma enlargement and non-haematoma enlargement groups over time. Univariate and multivariate logistic regression analyses were used to compare the correlation among expression of the four proteins, clinical characteristics of patients and haematoma enlargement. RESULTS Expression levels of serum matrix metalloproteinase-2/matrix metalloproteinases-9 and aquaporin-4 gradually increased within 24 hours in patients with cerebral haemorrhage (P<0.001), while expression levels of dystroglycan gradually decreased (P<0.01). Expression of serum matrix metalloproteinases-9 6 hours after onset was independently correlated with the expansion of cerebral haemorrhage. The ROC curve (AUC=0.778, 95% Cl: 0.661-0.894, P<0.001) exhibited high sensitivity (0.900) and low specificity (0.642). CONCLUSION These data support that expression of MMP-9 in peripheral blood is independently correlated with the enlargement of haematoma in patients with intracerebral haemorrhage 6 hours after onset and can be used as an independent predictor of haematoma enlargement in patients with intracerebral haemorrhage. However, although the expression of MMP-2, AQP-4 and DG exhibited some changes within 6 and 24 hours after onset, they were not independently correlated with early haematoma enlargement in patients with intracerebral haemorrhage. Further multi-time point exploration and expansion of the sample size is necessary in future studies.
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Affiliation(s)
- Yue Shi
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Xuehui Fan
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Guozhong Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Di Zhong
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Xin Zhang
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, 545006, People's Republic of China
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Arundic Acid (ONO-2506) Attenuates Neuroinflammation and Prevents Motor Impairment in Rats with Intracerebral Hemorrhage. Cell Mol Neurobiol 2020; 42:739-751. [DOI: 10.1007/s10571-020-00964-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
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25
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Li J, Ye M, Gao J, Zhang Y, Zhu Q, Liang W. Systematic Understanding of Mechanism of Yi-Qi-Huo-Xue Decoction Against Intracerebral Hemorrhagic Stroke Using a Network Pharmacology Approach. Med Sci Monit 2020; 26:e921849. [PMID: 32769962 PMCID: PMC7433745 DOI: 10.12659/msm.921849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH), a fatal type of stroke, profoundly affects public health. Yi-Qi-Huo-Xue decoction (YQHXD), a traditional Chinese medicine (TCM) prescription, is verified to be an efficient method to treat ICH stroke among the Chinese population. Nevertheless, the pharmacological mechanisms of YQHXD have been unclear. Material/Methods We used a strategy based on network pharmacology to explore the possible multi-component, multi-target, and multi-pathway pattern of YQHXD in treating ICH. First, candidate targets for YQHXD were identified using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). Then, these candidate YQHXD targets were used in combination with the known targets for the treatment of ICH stroke to construct the core network (cPPI) using data on protein–protein interaction (PPI). We calculated 5 topological parameters for identification of the main hubs. Pathway enrichment and GO biological process enrichment analyses were performed after the incorporation of the main hubs into ClueGO. Results In total, 55 candidate YQHXD targets for ICH were recognized to be the major hubs in accordance with their topological importance. As suggested by enrichment analysis, the YQHXD targets for ICH were roughly classified into several biological processes (related to redox equilibrium, cell–cell communication, adhesion and collagen biosynthesis, cytokine generation, lymphocyte differentiation and activation, neurocyte apoptosis and development, neuroendocrine system, and vascular development) and related pathways (VEGF, mTOR, NF-kB, RAS/MAPK, JAK/STAT and cytokine–cytokine receptors interaction), indicating those mechanisms underlying the therapeutic effect of YQHXD. Conclusions The present results may serve as a pharmacological framework for TCM studies in the future, helping to promote the use of YQHXD in clinical treatment of ICH.
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Affiliation(s)
- Jian Li
- Department of Neurosurgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Ming Ye
- Department of Neurosurgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Jueming Gao
- Department of Neurosurgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Yeqing Zhang
- Department of Respiratory Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Qiyong Zhu
- Department of Respiratory Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Weibang Liang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
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Wang H, Tang X, Fan H, Luo Y, Song Y, Xu Y, Chen Y. Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients. Aging (Albany NY) 2020; 12:10022-10034. [PMID: 32527987 PMCID: PMC7346040 DOI: 10.18632/aging.103335] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 04/11/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019, a new human infectious disease. While fever, cough, and respiratory distress are typical first symptoms, a fraction of those affected present instead with neurological symptoms suggestive of central nervous system compromise. This review summarizes the potential contribution of coronavirus disease 2019 to hemorrhagic stroke in the elderly and proposes possible mechanisms. Reports show that the most affected patients have underlying chronic diseases such as hypertension and diabetes, which are two key risk factors for hemorrhagic stroke. Angiotensin-converting enzyme 2 is the main host cell surface receptor interacting with the severe acute respiratory syndrome coronavirus 2 spike glycoprotein to allow viral entry and infection. We speculate that ensuing downregulation of angiotensin-converting enzyme 2 expression may compound the risk conferred by pre-existing comorbidities and critically influence the pathogenesis of hemorrhagic stroke by elevating blood pressure and impairing cerebrovascular endothelial function. Additionally, both age- and/or disease-related immune dysfunction and enhanced catecholamine release secondary to anxiety and stress may also aggravate central nervous system symptoms of severe acute respiratory syndrome coronavirus 2 infection. Thus, assessment of systemic inflammatory biomarkers and tight control of hemodynamic parameters upon admission are crucial to minimize mortality and morbidity in coronavirus disease 2019 patients with central nervous system symptoms suggestive of incipient stroke.
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Affiliation(s)
- Haili Wang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Xiaojia Tang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Hongyang Fan
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yuhan Luo
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Yuxia Song
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Yao Xu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
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Cordeiro JL, Neves JD, Vizuete AF, Aristimunha D, Pedroso TA, Sanches EF, Gonçalves CA, Netto CA. Arundic Acid (ONO-2506), an Inhibitor of S100B Protein Synthesis, Prevents Neurological Deficits and Brain Tissue Damage Following Intracerebral Hemorrhage in Male Wistar Rats. Neuroscience 2020; 440:97-112. [PMID: 32474054 DOI: 10.1016/j.neuroscience.2020.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/13/2023]
Abstract
Stroke is one of the leading causes of mortality and neurological morbidity. Intracerebral hemorrhage (ICH) has the poorest prognosis among all stroke subtypes and no treatment has been effective in improving outcomes. Following ICH, the observed high levels of S100B protein have been associated with worsening of injury and neurological deficits. Arundic acid (AA) exerts neuroprotective effects through inhibition of astrocytic synthesis of S100B in some models of experimental brain injury; however, it has not been studied in ICH. The aim of this study was to evaluate the effects of intracerebroventricular (ICV) administration of AA in male Wistar rats submitted to ICH model assessing the following variables: reactive astrogliosis, S100B levels, antioxidant defenses, cell death, lesion extension and neurological function. Firstly, AA was injected at different doses (0.02, 0.2, 2 and 20 μg/μl) in the left lateral ventricle in order to observe which dose would decrease GFAP and S100B striatal levels in non-injured rats. Following determination of the effective dose, ICH damage was induced by IV-S collagenase intrastrial injection and 2 μg/μl AA was injected through ICV route immediately before injury. AA treatment prevented ICH-induced neurological deficits and tissue damage, inhibited excessive astrocytic activation and cellular apoptosis, reduced peripheral and central S100B levels (in striatum, serum and cerebrospinal fluid), improved neuronal survival and enhanced the antioxidant defences after injury. Altogether, these results suggest that S100B is a viable target for treating ICH and highlight AA as an interesting strategy for improving neurological outcome after experimental brain hemorrhage.
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Affiliation(s)
- J L Cordeiro
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil; Post-graduation Program of Neurosciences, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, 90035-190, Brazil.
| | - J D Neves
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - A F Vizuete
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - D Aristimunha
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - T A Pedroso
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - E F Sanches
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil; Post-graduation Program of Phisiology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, 90035-190, Brazil
| | - C A Gonçalves
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - C A Netto
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
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Multilevel omics for the discovery of biomarkers and therapeutic targets for stroke. Nat Rev Neurol 2020; 16:247-264. [PMID: 32322099 DOI: 10.1038/s41582-020-0350-6] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
Despite many years of research, no biomarkers for stroke are available to use in clinical practice. Progress in high-throughput technologies has provided new opportunities to understand the pathophysiology of this complex disease, and these studies have generated large amounts of data and information at different molecular levels. The integration of these multi-omics data means that thousands of proteins (proteomics), genes (genomics), RNAs (transcriptomics) and metabolites (metabolomics) can be studied simultaneously, revealing interaction networks between the molecular levels. Integrated analysis of multi-omics data will provide useful insight into stroke pathogenesis, identification of therapeutic targets and biomarker discovery. In this Review, we detail current knowledge on the pathology of stroke and the current status of biomarker research in stroke. We summarize how proteomics, metabolomics, transcriptomics and genomics are all contributing to the identification of new candidate biomarkers that could be developed and used in clinical stroke management.
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Ferrete-Araujo AM, Rodríguez-Rodríguez A, Egea-Guerrero JJ, Vilches-Arenas Á, Godoy DA, Murillo-Cabezas F. Brain Injury Biomarker Behavior in Spontaneous Intracerebral Hemorrhage. World Neurosurg 2019; 132:e496-e505. [PMID: 31449996 DOI: 10.1016/j.wneu.2019.08.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND S100B and neuron-specific enolase (NSE) have been widely studied in diverse neurocritical pathologies, being recognized as the most promising biomarkers for brain injury assessment. However, their role in intracerebral hemorrhage (ICH) has not been widely analyzed. METHODS This was an observational prospective cohort study of patients with ICH admitted to a neurocritical care unit. Blood samples were collected on admission and at 24 hours, 48 hours, and 72 hours. Patient outcomes were assessed at 6 months after the event. RESULTS Thirty-six patients with ICH were included in the study. The mortality rate was 36%. Nonsurvivors had higher S100B values than survivors at admission, 24 hours, and 48 hours (P < 0.05). Likewise, S100B levels were higher in patients with poor outcomes (modified Rankin Scale [mRS] score >4) compared with those with good outcome (mRS score ≤3) in the 24-hour, 48-hour, and 72-hour samples. Receiver operating characteristic (ROC) curve analysis showed that S100B at admission, 24 hours, and 48 hours can discriminate between patients who survive and those who die as a consequence of ICH. The 48-hour sample (area under the ROC curve, 0.817; P = 0.003) reached the best values for sensitivity (75%) and specificity (80%); cutoff, 0.250 μg/L. For 6-month functional outcome, S100B protein could differentiate between groups at 24, 48, and 72 hours. The S100B 24-hour sample had the best values for sensitivity (82.6%) and specificity (72.7%), with a cutoff of 0.202 μg/L. We found no clear relationship between NSE values and clinical characteristics. CONCLUSIONS S100B protein acts as early predictor of mortality and functional outcome in patients with ICH. This biomarker measurement can provide additional information beyond clinical and radiologic findings to guide physicians in the management of these patients.
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Affiliation(s)
- Ana María Ferrete-Araujo
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain.
| | - Ana Rodríguez-Rodríguez
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Juan José Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Ángel Vilches-Arenas
- Department of Preventive Medicine and Public Health, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | | | - Francisco Murillo-Cabezas
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
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Thuringer D, Garrido C. Molecular chaperones in the brain endothelial barrier: neurotoxicity or neuroprotection? FASEB J 2019; 33:11629-11639. [PMID: 31348679 DOI: 10.1096/fj.201900895r] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Brain microvascular endothelial cells (BMECs) interact with astrocytes and pericytes to form the blood-brain barrier (BBB). Their compromised function alters the BBB integrity, which is associated with early events in the pathogenesis of cancer, neurodegenerative diseases, and epilepsy. Interestingly, these conditions also induce the expression of heat shock proteins (HSPs). Here we review the contribution of major HSP families to BMEC and BBB function. Although investigators mainly report protective effects of HSPs in brain, contrasted results were obtained in BMEC, which depend both on the HSP and on its location, intra- or extracellular. The therapeutic potential of HSPs must be scrupulously analyzed before targeting them in patients to reduce the progression of brain lesions and improve neurologic outcomes in the long term.-Thuringer, D., Garrido, C. Molecular chaperones in the brain endothelial barrier: neurotoxicity or neuroprotection?
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Affiliation(s)
- Dominique Thuringer
- INSERM Unité Mixte de Recherche (UMR) 1231, Institut Fédératif de Recherche en Santé-Sciences et Techniques de l'Information et de la Communication (IFR Santé-STIC), Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Carmen Garrido
- INSERM Unité Mixte de Recherche (UMR) 1231, Institut Fédératif de Recherche en Santé-Sciences et Techniques de l'Information et de la Communication (IFR Santé-STIC), Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
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Zhu H, Wang Z, Yu J, Yang X, He F, Liu Z, Che F, Chen X, Ren H, Hong M, Wang J. Role and mechanisms of cytokines in the secondary brain injury after intracerebral hemorrhage. Prog Neurobiol 2019; 178:101610. [PMID: 30923023 DOI: 10.1016/j.pneurobio.2019.03.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/07/2019] [Accepted: 03/16/2019] [Indexed: 12/18/2022]
Abstract
Intracerebral hemorrhage (ICH) is a common and severe cerebrovascular disease that has high mortality. Few survivors achieve self-care. Currently, patients receive only symptomatic treatment for ICH and benefit poorly from this regimen. Inflammatory cytokines are important participants in secondary injury after ICH. Increases in proinflammatory cytokines may aggravate the tissue injury, whereas increases in anti-inflammatory cytokines might be protective in the ICH brain. Inflammatory cytokines have been studied as therapeutic targets in a variety of acute and chronic brain diseases; however, studies on ICH are limited. This review summarizes the roles and functions of various pro- and anti-inflammatory cytokines in secondary brain injury after ICH and discusses pathogenic mechanisms and emerging therapeutic strategies and directions for treatment of ICH.
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Affiliation(s)
- Huimin Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China
| | - Zhiqiang Wang
- Central laboratory, Linyi People's Hospital, Linyi, Shandong 276003, China
| | - Jixu Yu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China; Central laboratory, Linyi People's Hospital, Linyi, Shandong 276003, China; Genetics and Aging Research Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Xiuli Yang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Feng He
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China
| | - Zhenchuan Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China.
| | - Fengyuan Che
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, China; Central laboratory, Linyi People's Hospital, Linyi, Shandong 276003, China.
| | - Xuemei Chen
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Honglei Ren
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Michael Hong
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci 2019; 398:54-66. [PMID: 30682522 DOI: 10.1016/j.jns.2019.01.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/22/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost. The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event. Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients. Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.
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Affiliation(s)
- João Pinho
- Neurology Department, Hospital de Braga, Portugal.
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
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Zang J, Liu AX, Qi L. The cytological mechanism and effects of hypertensive cerebral hemorrhage treatment by citicoline on serum GFAP and copeptin level. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219867244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study, 102 patients with hypertensive intracerebral hemorrhage (52 patients in the citicoline treatment group and 50 patients in the routine treatment group) were analyzed and compared. It was found that citicoline-assisted treatment of hypertensive intracerebral hemorrhage could inhibit the release of serum glial fibrillary acidic protein (GFAP) and peptides ( P < 0.05) and improve the prognosis and neurological and daily living ability of patients ( P < 0.05). In addition, CDP-choline reduced the mortality of neurons, inhibited inflammatory factors, and improved the prognosis of patients ( P < 0.05). A high dose of CDP-choline was also significantly effective in protecting neurons.
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Affiliation(s)
- Jun Zang
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, P.R. China
| | - Ai-xian Liu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, P.R. China
| | - Lin Qi
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, P.R. China
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Bernstein JE, Savla P, Dong F, Zampella B, Wiginton JG, Miulli DE, Wacker MR, Menoni R. Inflammatory Markers and Severity of Intracerebral Hemorrhage. Cureus 2018; 10:e3529. [PMID: 30613458 PMCID: PMC6314395 DOI: 10.7759/cureus.3529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and purpose The pathogenesis of brain injury after intracerebral hemorrhage is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue.In recent years, there has been a greater research interest into the various inflammatory biomarkers and growth factors that are secreted during intracerebral hemorrhage. The biomarkers investigated in this study are tumor necrosis factor alpha (TNF alpha), C-reactive protein (CRP), homocysteine (Hcy), and vascular endothelial growth factor (VEGF). The aim of this study was to further investigate the effects of these biomarkers in predicting the acute severity outcome of intracerebral hemorrhage (ICH). Methods We conducted a retrospective chart review of patients with spontaneous ICH with TNF alpha, CRP, VEGF, and Hcy levels drawn on admission. Forty-two patients with spontaneous ICH with at least one of the above labs were included in the study. Primary outcomes included death, Glasgow Coma Scale (GCS) on admission, early neurologic decline (END), and hemorrhage size. Secondary outcomes included GCS on discharge, ICH score, functional outcome risk stratification scale of intracerebral hemorrhage (FUNC score), change in hemorrhage size, need for surgical intervention, and length of intensive care unit (ICU) stay. Results Forty-two patients with spontaneous intracerebral hemorrhage (ICH) were analyzed, 12 patients (28.5%) required surgical intervention, and four patients (9.5%) died. Only low VEGF serum values were found to predict mortality. TNF alpha, CRP, Hcy, and VEGF levels in our patients with ICH were not found to predict early neurologic decline and were not correlated with GCS on admission, initial hemorrhage size, change in hemorrhage size, need for surgical intervention, ICH score, FUNC score, midline shift, and length of ICU stay. CRP and Hcy were elevated in 58% and 31% of patients tested, respectively. GCS on admission and ICH score were significantly associated with mortality. Conclusion After careful statistical review of the data obtained from this patient population, only low VEGF values were found to be a significant predictor of mortality. However, elevated CRP and Hcy levels were associated with a non-significant trend in hemorrhage size and mortality suggesting that CRP and Hcy-lowering therapies may decrease hemorrhagic stroke risk and severity.
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Affiliation(s)
- Jacob E Bernstein
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Paras Savla
- Osteopathy, College of Osteopathic Medicine - Touro University, Vallejo, USA
| | - Fanglong Dong
- Clinical Research, Western University of Health Sciences, Pomona, USA
| | - Bailey Zampella
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James G Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Margaret R Wacker
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Rosalinda Menoni
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Howe MD, Zhu L, Sansing LH, Gonzales NR, McCullough LD, Edwards NJ. Serum Markers of Blood-Brain Barrier Remodeling and Fibrosis as Predictors of Etiology and Clinicoradiologic Outcome in Intracerebral Hemorrhage. Front Neurol 2018; 9:746. [PMID: 30258397 PMCID: PMC6143812 DOI: 10.3389/fneur.2018.00746] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Intracerebral hemorrhage (ICH) is a stroke subtype associated with high disability and mortality. There is a clinical need for blood-based biomarkers that can aid in diagnosis, risk stratification, and prognostication. Given their role in the pathophysiology of ICH, we hypothesized markers of blood-brain barrier disruption and fibrosis would associate with neurologic deterioration and/or long-term functional outcomes. We also hypothesized these markers may be unique in patients with ICH due to cerebral amyloid angiopathy (CAA) vs. other etiologies. Methods: Seventy-nine patients enrolled in prospective ICH registries at two separate hospitals (the University of Texas Health Science Center at Houston and Hartford Hospital) were included in this study. We assessed initial injury severity and admission variables along with measures of inpatient deterioration (hematoma expansion, perihematomal edema (PHE), and early and delayed neurologic deterioration) and functional outcome [modified Rankin Scale (mRS) score at discharge and 90 days]. Serial biospecimens were obtained at 5 pre-specified timepoints (within 24 h, 1–2, 3–5, 6–8, and 10 days); serum samples were analyzed for fibronectin, all three TGF-β isoforms, and 7 matrix metalloproteinases (MMPs). Results: In our initial correlation analysis, MMP 10 and 3 were associated with hematoma expansion and early neurologic deterioration, whereas MMP 8 and MMP 1 were associated with PHE and delayed neurologic deterioration (respectively). Subacute levels of MMP 8 (sampled from day 6–10) positively correlated with PHE even after adjusting for multiple comparisons (p = 0.02). Acute levels of MMP 1, TGF-β1, and TGF-β3 were predictive of functional outcome, with TGF-β1 and TGF-β3 associating with 90 day mRS independent of age, hematoma volume, hemorrhage location, GCS, and IVH [p = 0.02; OR 1.03 (95% CI 1.0–1.05); p = 0.03; OR 3.1 (95% CI 1.1–8.8)]. When evaluated together as a panel, the cytokines distinguished patients with ICH due to CAA vs. ICH due to hypertension (AUC 0.81). Conclusions: Serum levels of fibronectin, TGF-β, and MMPs may be useful in refining ICH etiology and prognosis. Further large-scale studies are needed to confirm these findings, particularly regarding patients with CAA.
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Affiliation(s)
- Matthew D Howe
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Liang Zhu
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Lauren H Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Nicole R Gonzales
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Nancy J Edwards
- Neuroscience Department, Kaiser Permanente, Redwood City, CA, United States
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Kuhlman P, Miller P, Farland A, Owen J, Batt K. Correlating S100B with disease course in a case of new onset, acquired thrombotic thrombocytopenic purpura (TTP): Could this be a new predictive biomarker in TTP? J Clin Apher 2018; 33:541-545. [PMID: 29572925 DOI: 10.1002/jca.21621] [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: 10/06/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/10/2022]
Abstract
Acute thrombotic thrombocytopenic purpura (TTP) is an aggressive thrombotic microangiopathy that if not treated, can have a 90% mortality rate. Clinical manifestations of this disease include profound thrombocytopenia, hemolytic anemia, and end-organ dysfunction. Neurologic symptoms can occur in 80% of patients and range from mild confusion to coma (Scully et al., Br J Haematol 142:819-826). Here, we present the clinical course of a patient diagnosed with new onset acquired TTP who presented with neurologic changes that waxed and waned during her disease course. In addition to usual clinical and laboratory markers for TTP severity and activity, we also collected and analyzed the protein S100B, an astroglial protein studied as a marker for central nervous system injury and impairment of the blood-brain barrier. Our hypothesis here is that because TTP involves endovascular damage, S100B could function as a biomarker for neurologic dysfunction and ultimately, predict disease activity. As illustrated in this case, our patient's S100B levels did appear to correlate with TTP disease activity and the trajectory of this protein seemed a better predictor of cognitive function. Furthermore, increased S100B velocity seemed to be the earliest indicator of a refractory TTP disease process requiring more intensive plasma exchange (TPE) therapy regimen. Therefore, we would suggest that S100B is a promising predictive biomarker of disease activity in guiding the intensity of TPE therapy for TTP as well as cognitive function.
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Affiliation(s)
- Patrick Kuhlman
- Section on Hematology/Oncology, Department of Internal Medicine, Wake Forest Baptist Medical Center, North Carolina
| | - Peter Miller
- Section on Hematology/Oncology, Department of Internal Medicine, Wake Forest Baptist Medical Center, North Carolina
| | - Andrew Farland
- Section on Hematology/Oncology, Department of Internal Medicine, Wake Forest Baptist Medical Center, North Carolina
| | - John Owen
- Section on Hematology/Oncology, Department of Internal Medicine, Wake Forest Baptist Medical Center, North Carolina
| | - Katharine Batt
- Section on Hematology/Oncology, Department of Internal Medicine, Wake Forest Baptist Medical Center, North Carolina
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Glebova KV, Veiko NN, Nikonov AA, Porokhovnik LN, Kostuyk SV. Cell-free DNA as a biomarker in stroke: Current status, problems and perspectives. Crit Rev Clin Lab Sci 2018; 55:55-70. [PMID: 29303618 DOI: 10.1080/10408363.2017.1420032] [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] [Indexed: 12/16/2022]
Abstract
There is currently no proposed stroke biomarker with consistent application in clinical practice. A number of studies have examined cell-free DNA (cfDNA), which circulates in biological fluids during stroke, as a potential biomarker of this disease. The data available suggest that dynamically-determined levels of blood cfDNA may provide new prognostic information for assessment of stroke severity and outcome. However, such an approach has its own difficulties and limitations. This review covers the potential role of cfDNA as a biomarker in stroke, and includes evidence from both animal models and clinical studies, protocols used to analyze cfDNA, and hypotheses on the origin of cfDNA.
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Affiliation(s)
- Kristina V Glebova
- a Laboratory of Molecular Biology , Federal State Budgetary Institution "Research Centre for Medical Genetics" , Moscow , Russia
| | - Natalya N Veiko
- a Laboratory of Molecular Biology , Federal State Budgetary Institution "Research Centre for Medical Genetics" , Moscow , Russia
| | - Aleksey A Nikonov
- b Department of Neurology, Neurosurgery and Medical Genetics , Pirogov Russian National Research Medical University , Moscow , Russia
| | - Lev N Porokhovnik
- a Laboratory of Molecular Biology , Federal State Budgetary Institution "Research Centre for Medical Genetics" , Moscow , Russia
| | - Svetlana V Kostuyk
- a Laboratory of Molecular Biology , Federal State Budgetary Institution "Research Centre for Medical Genetics" , Moscow , Russia
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Roy-O'Reilly M, Zhu L, Atadja L, Torres G, Aronowski J, McCullough L, Edwards NJ. Soluble CD163 in intracerebral hemorrhage: biomarker for perihematomal edema. Ann Clin Transl Neurol 2017; 4:793-800. [PMID: 29159191 PMCID: PMC5682111 DOI: 10.1002/acn3.485] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 01/09/2023] Open
Abstract
Objective Patients with intracerebral hemorrhage (ICH) may elaborate varying degrees of perihematomal edema (PHE), requiring closer monitoring and a higher intensity of treatment. Here, we explore whether the soluble form of CD163, a scavenger receptor responsible for hemoglobin sequestration, can serve as a prognostic biomarker of PHE development and poor outcome after ICH. Methods Our study cohort was comprised of 51 primary age- and sex-matched ICH patients with moderate-sized, hypertensive deep hemorrhages. Patients were part of a prospective ICH registry cataloguing admission data along with functional outcomes. We measured sCD163 levels in serial serum and cerebrospinal fluid (CSF) samples obtained at prespecified timepoints. Descriptive statistics, including a generalized estimating equation for longitudinal data, were used to analyze sCD163 in relation to ICH outcomes. Results Acute serum sCD163 (<48 h postictus) was significantly elevated in ICH patients compared to both acute neurological event controls (P = <0.001) and healthy controls (P = 0.003). As predicted, acute serum sCD163 levels were significantly associated with both hematoma volume expansion (P = 0.009) and PHE expansion (P = 0.002). Further examination determined that patients with high PHE expansion had poorer modified Rankin Scale scores at discharge (P = 0.024), and circulating sCD163 levels were found to be significantly lower in patients with high-level PHE expansion. Interpretation Acute sCD163 levels may be a useful biomarker for the acute identification of patients at risk for hematoma expansion, perihematomal edema expansion and poorer short-term outcomes.
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Affiliation(s)
- Meaghan Roy-O'Reilly
- Department of Neurology University of Texas Health Science Center Houston Texas 77030
| | - Liang Zhu
- Department of Neurology University of Texas Health Science Center Houston Texas 77030
| | - Louise Atadja
- Department of Neurology University of Texas Health Science Center Houston Texas 77030
| | - Glenda Torres
- Department of Neurosurgery University of Texas Health Science Center Houston Texas 77030
| | - Jaroslaw Aronowski
- Department of Neurology University of Texas Health Science Center Houston Texas 77030
| | - Louise McCullough
- Department of Neurology University of Texas Health Science Center Houston Texas 77030
| | - Nancy J Edwards
- Department of Neuroscience Kaiser Permanente Redwood City California 94063
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Katsanos AH, Makris K, Stefani D, Koniari K, Gialouri E, Lelekis M, Chondrogianni M, Zompola C, Dardiotis E, Rizos I, Parissis J, Boutati E, Voumvourakis K, Tsivgoulis G. Plasma Glial Fibrillary Acidic Protein in the Differential Diagnosis of Intracerebral Hemorrhage. Stroke 2017; 48:2586-2588. [PMID: 28751552 DOI: 10.1161/strokeaha.117.018409] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/14/2017] [Accepted: 06/29/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Plasma GFAP (glial fibrillary acidic protein) has recently emerged as a potential biomarker for the differentiation of acute intracerebral hemorrhage (ICH) from acute ischemic stroke (AIS). We prospectively assessed the diagnostic accuracy of GFAP in the differential diagnosis of ICH. METHODS Consecutive patients presenting to the emergency department within 6 hours from symptom onset were evaluated. All patients underwent extensive diagnostic work-up and were classified according to discharge diagnosis in AIS, ICH, subarachnoid hemorrhage, and stroke mimics. GFAP was also measured in healthy volunteers (controls). Baseline stroke severity was evaluated using National Institutes of Health Stroke Scale. Receiver operating characteristic curve analysis was used to identify the optimal cutoff point for the differentiation between subgroups. Correlation analyses of GFAP plasma concentrations with baseline National Institutes of Health Stroke Scale and onset to sampling time were performed with the nonparametric Spearman rank test and fractional polynomial regression, respectively. RESULTS Our study population consisted of 270 individuals (AIS: 121, ICH: 34, stroke mimics: 31, subarachnoid hemorrhage: 5, controls: 79). No differences on baseline stroke severity and onset to sampling time were detected between AIS and ICH. Higher median plasma GFAP values were documented in ICH compared with AIS, stroke mimics, and controls (P<0.001). Receiver operating characteristic analysis highlighted a cutoff value of 0.43 ng/mL as the optimal threshold for the differentiation between ICH and AIS (sensitivity: 91%, specificity: 97%). No association was detected between plasma GFAP concentrations and baseline stroke severity for both AIS (P=0.515) and ICH (P=0.387). In the fractional polynomial analysis, the association between GFAP concentration and onset to sampling time was best described by a J-shaped curve for AIS and an inverted U-shaped curve for ICH, with a peak at 2 hours. CONCLUSIONS Plasma GFAP seems to be a sensitive and specific biomarker for the differentiation of ICH from both AIS and other acute neurological disorders, with the optimal diagnostic yield being present in the second hour from symptom onset.
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Affiliation(s)
- Aristeidis H Katsanos
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Konstantinos Makris
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Dimitra Stefani
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Katerina Koniari
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Eleni Gialouri
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Moses Lelekis
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Maria Chondrogianni
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Christina Zompola
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Efthymios Dardiotis
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Ioannis Rizos
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - John Parissis
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Eleni Boutati
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Konstantinos Voumvourakis
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.)
| | - Georgios Tsivgoulis
- From the Second Department of Neurology (A.H.K., M.C., C.Z., K.V., G.T.), Second Department of Cardiology (I.R., J.P.), and Second Department of Internal Medicine (E.B.), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Clinical Biochemistry Department (K.M.) and Department of Internal Medicine (D.S., K.K., E.G., M.L.), KAT General Hospital, Athens, Greece; Department of Neurology, University Hospital of Larissa, Greece (E.D.); and Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.).
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Huang L, Hu J, Huang S, Wang B, Siaw-Debrah F, Nyanzu M, Zhang Y, Zhuge Q. Nanomaterial applications for neurological diseases and central nervous system injury. Prog Neurobiol 2017; 157:29-48. [PMID: 28743465 DOI: 10.1016/j.pneurobio.2017.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 12/20/2022]
Abstract
The effectiveness of noninvasive treatment for neurological disease is generally limited by the poor entry of therapeutic agents into the central nervous system (CNS). Most CNS drugs cannot permeate into the brain parenchyma because of the blood-brain barrier thus, overcoming this problem has become one of the most significant challenges in the development of neurological therapeutics. Nanotechnology has emerged as an innovative alternative for treating neurological diseases. In fact, rapid advances in nanotechnology have provided promising solutions to this challenge. This review highlights the applications of nanomaterials in the developing neurological field and discusses the evidence for their efficacies.
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Affiliation(s)
- Lijie Huang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China; Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China
| | - Jiangnan Hu
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China
| | - Shengwei Huang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China; Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China
| | - Brian Wang
- Center for Neuroscience Discovery, Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Felix Siaw-Debrah
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China
| | - Mark Nyanzu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China
| | - Yu Zhang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China
| | - Qichuan Zhuge
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China; Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, PR China.
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Impact and influence of “omics” technology on hyper tension studies. Int J Cardiol 2017; 228:1022-1034. [DOI: 10.1016/j.ijcard.2016.11.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/06/2016] [Indexed: 12/14/2022]
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Maas MB, Francis BA, Sangha RS, Lizza BD, Liotta EM, Naidech AM. Refining Prognosis for Intracerebral Hemorrhage by Early Reassessment. Cerebrovasc Dis 2017; 43:110-116. [PMID: 28049196 DOI: 10.1159/000452679] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/17/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Prognostic assessments, which are crucial for decision-making in critical illnesses, have shown unsatisfactory reliability. We compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias. METHODS Patients enrolled in a prospective observational cohort study of spontaneous ICH underwent hourly Glasgow Coma Scale (GCS) assessment. Outcome was measured at 3 months using the modified Rankin Scale (mRS). We analyzed the change in correlation between GCS and 3-month mRS scores from admission through day 5, and compared the performance of a parsimonious set of day 5 clinical variables against the ICH score. RESULTS Data was collected on 254 subjects. The ICH score and day 5 GCS score were both correlated with 3-month mRS score (p < 0.001), but the correlation was stronger with day 5 GCS score (p < 0.05 by Fisher z-transformation). Premorbid mRS score, intraventricular hemorrhage and day 5 GCS score were independent predictors of outcome (all p < 0.05 in ordinal regression model). While ICH score correctly classified good (mRS 0-3) vs. poor (mRS 4-6) outcome in 73% of cases, the day 5 model correctly classified 83% of cases. CONCLUSIONS A simple reassessment after 5 days of care significantly improves the accuracy of prognosticating outcome in patients with ICH. These data confirm the feasibility and potential utility of early reassessments in refining prognosis for patients who survive early stabilization of a severe neurologic injury.
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Affiliation(s)
- Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, IL, USA
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Zheng J, Sun J, Yang L, Zhao B, Fan Z. The potential role of vascular endothelial growth factor as a new biomarker in severe intracerebral hemorrhage. J Clin Lab Anal 2016; 31. [PMID: 28000287 DOI: 10.1002/jcla.22076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/31/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We studied the association between high serum levels of vascular endothelial growth factor (VEGF) and clinical outcomes of intracerebral hemorrhage (ICH) patients. METHODS Patients were divided into group A (<20 mL), group B (20-30 mL), and group C (>30 mL) based on the bleeding amount. ICH patients were also categorized into the mild group, moderate group (16-30), and severe group (31-45) based on the National Institutes of Health Stroke Scale (NIHSS). The serum levels of VEGF in acute ICH patients detected at 24, 48, and 72 hours were obtained using ELISA kit, and then compared with control group. Main clinical outcomes were evaluated using the modified Rankin scale at 90 days. RESULTS The serum levels of VEGF were significantly higher than those in the control group. The serum levels of VEGF in group C were specifically higher compared with those in other two groups. The severe group exhibited higher levels of VEGF than the other two groups. NIHSS scores in patients with good outcomes were lower than those with poor outcomes. Besides, VEGF levels in patients with good outcomes were much higher than those in patients with poor outcomes. ROC results indicated that the optimal cut-off value of VEGF at 72 hours for predicting good outcomes was 111.17 pg/mL with 91.5 sensitivity, 98.7 specificity, and an AUC of 0.952 Our results showed that higher serum levels of VEGF were associated with process of ICH. CONCLUSION VEGF could be a new marker in ICH for severity.
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Affiliation(s)
- Jun Zheng
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jianping Sun
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liang Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Zhao
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zhenzeng Fan
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Neovascularization and functional recovery after intracerebral hemorrhage is conditioned by the Tp53 Arg72Pro single-nucleotide polymorphism. Cell Death Differ 2016; 24:144-154. [PMID: 27768124 PMCID: PMC5260494 DOI: 10.1038/cdd.2016.109] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 02/06/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is a devastating subtype of stroke that lacks effective therapy and reliable prognosis. Neovascularization following ICH is an essential compensatory response that mediates brain repair and modulates the clinical outcome of stroke patients. However, the mechanism that dictates this process is unknown. Bone marrow-derived endothelial progenitor cells (EPCs) promote endothelial repair and contribute to ischemia-induced neovascularization. The human Tp53 gene harbors a common single-nucleotide polymorphism (SNP) at codon 72, which yields an arginine-to-proline amino-acidic substitution (Arg72Pro) that modulates the apoptotic activity of the p53 protein. Previously, we found that this SNP controls neuronal susceptibility to ischemia-induced apoptosis in vitro. Here, we evaluated the impact of the Tp53 Arg72Pro SNP on vascular repair and functional recovery after ICH. We first analyzed EPC mobilization and functional outcome based on the modified Rankin scale scores in a hospital-based cohort of 78 patients with non-traumatic ICH. Patients harboring the Pro allele of the Tp53 Arg72Pro SNP showed higher levels of circulating EPC-containing CD34+ cells, EPC-mobilizing cytokines - vascular endothelial growth factor and stromal cell-derived factor-1α - and good functional outcome following ICH, when compared with the homozygous Arg allele patients, which is compatible with increased neovascularization. To assess directly whether Tp53 Arg72Pro SNP regulated neovascularization after ICH, we used the humanized Tp53 Arg72Pro knock-in mice, which were subjected to the collagenase-induced ICH. The brain endothelial cells of the Pro allele-carrying mice were highly resistant to ICH-mediated apoptosis, which facilitated cytokine-mediated EPC mobilization, cerebrovascular repair and functional recovery. However, these processes were not observed in the Arg allele-carrying mice. These results reveal that the Tp53 Arg72Pro SNP determines neovascularization, brain repair and neurological recovery after ICH. This study is the first in which the Pro allele of Tp53 is linked to vascular repair and ability to functionally recover from stroke.
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Tan G, Hao Z, Lei C, Chen Y, Yuan R, Xu M, Liu M. Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage. Neurol Sci 2016; 37:1693-700. [DOI: 10.1007/s10072-016-2656-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
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Polivka J, Polivka J, Krakorova K, Peterka M, Topolcan O. Current status of biomarker research in neurology. EPMA J 2016; 7:14. [PMID: 27379174 PMCID: PMC4931703 DOI: 10.1186/s13167-016-0063-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 06/02/2016] [Indexed: 01/18/2023]
Abstract
Neurology is one of the typical disciplines where personalized medicine has been recently becoming an important part of clinical practice. In this article, the brief overview and a number of examples of the use of biomarkers and personalized medicine in neurology are described. The various issues in neurology are described in relation to the personalized medicine and diagnostic, prognostic as well as predictive blood and cerebrospinal fluid biomarkers. Such neurological domains discussed in this work are neuro-oncology and primary brain tumors glioblastoma and oligodendroglioma, cerebrovascular diseases focusing on stroke, neurodegenerative disorders especially Alzheimer's and Parkinson's diseases and demyelinating diseases such as multiple sclerosis. Actual state of the art and future perspectives in diagnostics and personalized treatment in diverse domains of neurology are given.
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Affiliation(s)
- Jiri Polivka
- Department of Neurology, Faculty of Medicine in Plzen, Charles University Prague, Husova 3, 301 66 Plzen, Czech Republic ; Department of Neurology, Faculty Hospital Plzen, E. Benese 13, 305 99 Plzen, Czech Republic
| | - Jiri Polivka
- Department of Histology and Embryology, Charles University Prague, Husova 3, 301 66 Plzen, Czech Republic ; Biomedical Centre, Faculty of Medicine in Plzen, Charles University Prague, Husova 3, 301 66 Plzen, Czech Republic
| | - Kristyna Krakorova
- Department of Neurology, Faculty of Medicine in Plzen, Charles University Prague, Husova 3, 301 66 Plzen, Czech Republic ; Department of Neurology, Faculty Hospital Plzen, E. Benese 13, 305 99 Plzen, Czech Republic
| | - Marek Peterka
- Department of Neurology, Faculty of Medicine in Plzen, Charles University Prague, Husova 3, 301 66 Plzen, Czech Republic ; Department of Neurology, Faculty Hospital Plzen, E. Benese 13, 305 99 Plzen, Czech Republic
| | - Ondrej Topolcan
- Central Imunoanalytical Laboratory, Faculty Hospital Plzen, E. Benese 13, 305 99 Plzen, Czech Republic
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Iemolo F, Sanzaro E, Duro G, Giordano A, Paciaroni M. The prognostic value of biomarkers in stroke. IMMUNITY & AGEING 2016; 13:19. [PMID: 27247610 PMCID: PMC4886399 DOI: 10.1186/s12979-016-0074-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/03/2016] [Indexed: 11/15/2022]
Abstract
Background Ischemic injury triggers inflammatory cascades and changes in the protein synthesis, neurotransmitters and neuro-hormones in the brain parenchyma that may further amplify the tissue damage. The “Triage® Stroke Panel”, a biochemical multimarker assay, detects Brain Natriuretic Peptide (BNP), D-Dimers (DD), Matrix-Metalloproteinase-9 (MMP-9), and S100β protein generating a Multimarker index of these values (MMX). The aims of this prospective study in consecutive patients with ischemic or hemorrhagic stroke were to assess: 1) the rate of an increase of biomarkers (BNP, D-dimer, MMP-9 and S-100β) tested with the Triage Stroke Panel; 2) the correlation between the increase of these biomarkers and functional outcome at 4 months; 3) the risk factors for the increase of biomarkers. Methods The outcome of the study was 120-day mortality and it was compared in patients with Stroke Panel >4 and ≤4. Multiple logistic regression analyses were performed to identify independent predictors for death and for the increase of biomarkers. Results 244 consecutive patients (mean age 73.02 years; 53.7 % males) were included in the study; 210 ischemic strokes and 34 hemorrhagic strokes. 161/244 (66.0 %) had an increase of biomarkers. At 120 days, 85 patients had died (34.8 %). Death was seen in 68/161 patients with an increase of biomarkers (42.2 %) compared with 17/83 patients without (20.5 %). Regression logistic analysis found that a Stroke Panel >4 (OR 3.1; 95 % CI 1.5–6.2, p = 0.002) was associated with mortality. The increase of biomarkers was independently predicted by an increase of PCR on admission (OR 2.9, 95 CI 1.4–6.0, p = 0.003). Conclusions An increase of biochemical markers such as BNP, D-Dimers, MMP-9, and S100β tested with a Triage Stroke Panel (>4) was correlated with mortality at 120 days from stroke onset.
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Affiliation(s)
- Francesco Iemolo
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy ; Department of Neurology, "R. Guzzardi" Hospital-ASP Ragusa, Via Papa Giovanni XXIII, Vittoria (Ragusa), Italy ; Department of Neuroscience, University of Catania, Catania, Italy
| | - Enzo Sanzaro
- Department of Neurology, "R. Guzzardi" Hospital-ASP Ragusa, Via Papa Giovanni XXIII, Vittoria (Ragusa), Italy
| | - Giovanni Duro
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy
| | - Antonello Giordano
- Department of Neurology, "R. Guzzardi" Hospital-ASP Ragusa, Via Papa Giovanni XXIII, Vittoria (Ragusa), Italy
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
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Weinstock MJ, Uhlmann EJ, Zwicker JI. Intracranial hemorrhage in cancer patients treated with anticoagulation. Thromb Res 2016; 140 Suppl 1:S60-5. [DOI: 10.1016/s0049-3848(16)30100-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Glushakova OY, Glushakov AV, Miller ER, Valadka AB, Hayes RL. Biomarkers for acute diagnosis and management of stroke in neurointensive care units. Brain Circ 2016; 2:28-47. [PMID: 30276272 PMCID: PMC6126247 DOI: 10.4103/2394-8108.178546] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/10/2016] [Accepted: 02/23/2016] [Indexed: 12/11/2022] Open
Abstract
The effectiveness of current management of critically ill stroke patients depends on rapid assessment of the type of stroke, ischemic or hemorrhagic, and on a patient's general clinical status. Thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA) is the only effective treatment for ischemic stroke approved by the Food and Drug Administration (FDA), whereas no treatment has been shown to be effective for hemorrhagic stroke. Furthermore, a narrow therapeutic window and fear of precipitating intracranial hemorrhage by administering r-tPA cause many clinicians to avoid using this treatment. Thus, rapid and objective assessments of stroke type at admission would increase the number of patients with ischemic stroke receiving r-tPA treatment and thereby, improve outcome for many additional stroke patients. Considerable literature suggests that brain-specific protein biomarkers of glial [i.e. S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP)] and neuronal cells [e.g., ubiquitin C-terminal hydrolase-L1 (UCH-L1), neuron-specific enolase (NSE), αII-spectrin breakdown products SBDP120, SBDP145, and SBDP150, myelin basic protein (MBP), neurofilament light chain (NF-L), tau protein, visinin-like protein-1 (VLP 1), NR2 peptide] injury that could be detected in the cerebrospinal fluid (CSF) and peripheral blood might provide valuable and timely diagnostic information for stroke necessary to make prompt management and decisions, especially when the time of stroke onset cannot be determined. This information could include injury severity, prognosis of short-term and long-term outcomes, and discrimination of ischemic or hemorrhagic stroke. This chapter reviews the current status of the development of biomarker-based diagnosis of stroke and its potential application to improve stroke care.
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Affiliation(s)
- Olena Y Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Alexander V Glushakov
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Emmy R Miller
- Department of Neurosurgery, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
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Llombart V, García-Berrocoso T, Bustamante A, Giralt D, Rodriguez-Luna D, Muchada M, Penalba A, Boada C, Hernández-Guillamon M, Montaner J. Plasmatic retinol-binding protein 4 and glial fibrillary acidic protein as biomarkers to differentiate ischemic stroke and intracerebral hemorrhage. J Neurochem 2015; 136:416-24. [DOI: 10.1111/jnc.13419] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/30/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Víctor Llombart
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - David Rodriguez-Luna
- Neurovascular Unit; Department of Neurology; Vall d'Hebron University Hospital; Barcelona Spain
| | - Marian Muchada
- Neurovascular Unit; Department of Neurology; Vall d'Hebron University Hospital; Barcelona Spain
| | - Anna Penalba
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - Cristina Boada
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - Mar Hernández-Guillamon
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
| | - Joan Montaner
- Neurovascular Research Laboratory; Vall d'Hebron Institute of Research (VHIR); Universitat Autonoma de Barcelona; Barcelona Spain
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