1
|
Lutfi Ismaeel G, Makki AlHassani OJ, S Alazragi R, Hussein Ahmed A, H Mohamed A, Yasir Jasim N, Hassan Shari F, Almashhadani HA. Genetically engineered neural stem cells (NSCs) therapy for neurological diseases; state-of-the-art. Biotechnol Prog 2023; 39:e3363. [PMID: 37221947 DOI: 10.1002/btpr.3363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023]
Abstract
Neural stem cells (NSCs) are multipotent stem cells with remarkable self-renewal potential and also unique competencies to differentiate into neurons, astrocytes, and oligodendrocytes (ODCs) and improve the cellular microenvironment. In addition, NSCs secret diversity of mediators, including neurotrophic factors (e.g., BDNF, NGF, GDNF, CNTF, and NT-3), pro-angiogenic mediators (e.g., FGF-2 and VEGF), and anti-inflammatory biomolecules. Thereby, NSCs transplantation has become a reasonable and effective treatment for various neurodegenerative disorders by their capacity to induce neurogenesis and vasculogenesis and dampen neuroinflammation and oxidative stress. Nonetheless, various drawbacks such as lower migration and survival and less differential capacity to a particular cell lineage concerning the disease pathogenesis hinder their application. Thus, genetic engineering of NSCs before transplantation is recently regarded as an innovative strategy to bypass these hurdles. Indeed, genetically modified NSCs could bring about more favored therapeutic influences post-transplantation in vivo, making them an excellent option for neurological disease therapy. This review for the first time offers a comprehensive review of the therapeutic capability of genetically modified NSCs rather than naïve NSCs in neurological disease beyond brain tumors and sheds light on the recent progress and prospect in this context.
Collapse
Affiliation(s)
- Ghufran Lutfi Ismaeel
- Department of Pharmacology, College of Pharmacy, University of Al-Ameed, Karbala, Iraq
| | | | - Reem S Alazragi
- Department of Biochemistry, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Ammar Hussein Ahmed
- Department of Radiology and Sonar, College of Medical Techniques, Al-Farahidi University, Baghdad, Iraq
| | - Asma'a H Mohamed
- Intelligent Medical Systems Department, Al-Mustaqbal University College, Babylon, Iraq
| | - Nisreen Yasir Jasim
- Collage of Pharmacy, National University of Science and Technology, Dhi Qar, Iraq
| | - Falah Hassan Shari
- Department of Clinical Laboratory Sciences, College of Pharmacy, University of Basrah, Basrah, Iraq
| | | |
Collapse
|
2
|
Tonelli A, Lumngwena EN, Ntusi NAB. The oral microbiome in the pathophysiology of cardiovascular disease. Nat Rev Cardiol 2023; 20:386-403. [PMID: 36624275 DOI: 10.1038/s41569-022-00825-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/11/2023]
Abstract
Despite advances in our understanding of the pathophysiology of many cardiovascular diseases (CVDs) and expansion of available therapies, the global burden of CVD-associated morbidity and mortality remains unacceptably high. Important gaps remain in our understanding of the mechanisms of CVD and determinants of disease progression. In the past decade, much research has been conducted on the human microbiome and its potential role in modulating CVD. With the advent of high-throughput technologies and multiomics analyses, the complex and dynamic relationship between the microbiota, their 'theatre of activity' and the host is gradually being elucidated. The relationship between the gut microbiome and CVD is well established. Much less is known about the role of disruption (dysbiosis) of the oral microbiome; however, interest in the field is growing, as is the body of literature from basic science and animal and human investigations. In this Review, we examine the link between the oral microbiome and CVD, specifically coronary artery disease, stroke, peripheral artery disease, heart failure, infective endocarditis and rheumatic heart disease. We discuss the various mechanisms by which oral dysbiosis contributes to CVD pathogenesis and potential strategies for prevention and treatment.
Collapse
Affiliation(s)
- Andrea Tonelli
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.,Cardiovascular Research Unit, Christiaan Barnard Division of Cardiothoracic Surgery, Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.,Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Extramural Research Unit on the Intersection of Noncommunicable Diseases and Infectious Disease, South African Medical Research Council, Cape Town, South Africa
| | - Evelyn N Lumngwena
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Centre for the Study of Emerging and Re-emerging Infections, Institute for Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. .,Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Extramural Research Unit on the Intersection of Noncommunicable Diseases and Infectious Disease, South African Medical Research Council, Cape Town, South Africa. .,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Wellcome Centre for Infectious Disease Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
3
|
Neuroprotection in Stroke-Focus on the Renin-Angiotensin System: A Systematic Review. Int J Mol Sci 2022; 23:ijms23073876. [PMID: 35409237 PMCID: PMC8998496 DOI: 10.3390/ijms23073876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 01/01/2023] Open
Abstract
Stroke is the primary cause of disability in the adult population. Hypertension represents the leading risk factor being present in almost half the patients. The renin-angiotensin system is involved in the physiopathology of stroke and has an essential impact on hypertension as a risk factor. This article targeted the role of the renin-angiotensin system in stroke neuroprotection by reviewing the current literature available. The mechanism of action of the renin-angiotensin system was observed through the effects on AT1, AT2, and Mas receptors. The neuroprotective properties ascertained by angiotensin in stroke seem to be independent of the blood pressure reduction mechanism, and include neuroregeneration, angiogenesis, and increased neuronal resistance to hypoxia. The future relationship of stroke and the renin-angiotensin system is full of possibilities, as new agonist molecules emerge as potential candidates to restrict the impairment caused by stroke.
Collapse
|
4
|
Luo W, Yang J. Schizophrenia predisposition gene Unc-51-like kinase 4 for the improvement of cerebral ischemia/reperfusion injury. Mol Biol Rep 2022; 49:2933-2943. [PMID: 35083612 DOI: 10.1007/s11033-021-07108-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cerebral ischemia/reperfusion injury (CIRI) has complex pathogenesis, and inhibiting apoptosis and supporting neural progenitor proliferation are extremely beneficial strategies for treating CIRI. Unc-51-like kinase 4 (ULK4), a susceptibility gene for schizophrenia, promotes neural progenitors proliferation. The phosphatidylinositol 3-kinase (PI3K) pathway plays a critical role in CIRI via inhibition of apoptosis. Therefore, the relationship among ULK4, the PI3K pathway, and apoptosis in the context of CIRI has attracted our great interest. METHODS AND RESULTS Primary cortical neurons were subjected to oxygen-glucose deprivation/reperfusion (OGD/R), and rats were subjected to middle cerebral artery occlusion/reperfusion (MCAO/R). Transfection of the ULK4-overexpression lentivirus was performed alone or in combination with PI3K inhibitor treatment. Here, we revealed that ULK4 was poorly expressed in the cortex in MCAO/R rats and OGD/R-treated primary cortical neurons, ULK4 overexpression inhibited apoptosis, and reduced neurological deficit scores, cerebral infarct volume, and histopathological damage. Moreover, ULK4 overexpression increased PI3K expression and the p-protein kinase B/AKT and p-glycogen synthase kinase 3 beta (GSK3β)/GSK3β ratios, and inhibited apoptosis, while a PI3K inhibitor reversed the effects of ULK4 overexpression on CIRI. CONCLUSIONS ULK4 protects against CIRI, and the underlying mechanism involves PI3K pathway activation which in turn inhibits apoptosis.
Collapse
Affiliation(s)
- Wen Luo
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China.,Department of Clinical Pharmacy, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, 621000, China
| | - Junqing Yang
- Chongqing Key Laboratory of Biochemistry and Molecular Pharmacology, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
5
|
Krishnan K, K M, K N, Teja YD, Reddy VS, Raju NS, Rathinam KK. Role of fluoxetine in pharmacological enhancement of motor functions in stroke patients: A randomized, placebo-controlled, single-blind trial. Contemp Clin Trials Commun 2021; 23:100800. [PMID: 34278042 PMCID: PMC8264525 DOI: 10.1016/j.conctc.2021.100800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/31/2021] [Accepted: 06/12/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is the primary cause of disability worldwide, the second most common cause of dementia and the third leading cause of death. Only few studies were conducted to study the role of fluoxetine in motor recovery in either ischemic or hemorrhagic stroke patients with probably less severe paresis. However, the current study evaluates both the effectiveness and safety of fluoxetine in the stroke population with a more severe motor deficit. METHODS Patients who had acute or subacute stroke with hemiparesis and aged between 18 and 80 years with medical research council (MRC) scale score <4 were included in this randomized, Single-blind, placebo-controlled trial in 1:1 ratio to placebo or fluoxetine 20 mg/day orally for 90 days. The primary outcome measures were changes in barthel index, time taken to complete nine hole peg test and number of hand tapping movements in 30 s by the affected limb between baseline, 45th day and 90th day. The secondary outcome measure was evaluation of the drug tolerability. RESULTS A total of 168 patients were assigned to fluoxetine (n = 84) or placebo (n = 84) group. Mean BI score significantly improved at 90th day in fluoxetine group (70.42 ± 10.56) than in placebo group (44.23 ± 8.52). Mean dexterity value decreased significantly at 90th day (2.61 ± 0.81) compared to baseline (3.98 ± 0.53) in fluoxetine group. However higher rate of decrease of mean dexterity value was seen in fluoxetine group when compared to placebo group. Mean number of hands tapping movements in 30 s increased significantly at 90th day (16.33 ± 3.58) compared to baseline (9.83 ± 2.92) in fluoxetine group. Few ADR reported during this study were dizziness, drowsiness and insomnia. CONCLUSION The present study indicates that early prescription of fluoxetine is safe and may enhance motor function in patients presenting with severe motor impairments after stroke. However, the findings of the study should be confirmed in future controlled studies with large sample size.
Collapse
Affiliation(s)
- Karthickeyan Krishnan
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Muthuraj K
- Department of Neurology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Nandhini K
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Yalamanchili Dharma Teja
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Vikrama Simha Reddy
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Neethu Sara Raju
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Kiran Kumar Rathinam
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603 203, Tamil Nadu, India
| |
Collapse
|
6
|
Zhang N, Wu X, Tian M, Wang X, Ding J, Tian Y, Liang C, Zeng Z, Xiang H, Tan H. Additive interaction between potentially modifiable risk factors and ethnicity among individuals in the Han, Tujia and Miao populations with first-ever ischaemic stroke. BMC Public Health 2021; 21:1059. [PMID: 34082746 PMCID: PMC8173719 DOI: 10.1186/s12889-021-11115-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 05/23/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND As a country with one-fifth of the global population, China has experienced explosive growth in ischaemic stroke (IS) burden with significant ethnic and geographic disparities. The aim of this study was to examine the differences in potentially modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao). METHODS A case-control study was conducted with 324 cases of first-ever ischaemic stroke from the hospitals of the Xiangxi Tujia and Miao Autonomous Prefecture and 394 controls from communities covering the same area between May 1, 2018, and April 30, 2019. Structured questionnaires were administered, and physical examinations were performed in the same manner for cases and controls. Univariate and multivariate logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the association between risk factors and ischaemic stroke. An additive model was used to study the interaction between the modifiable risk factors and ethnicity with R software. RESULTS Higher high-sensitivity C-reactive protein levels (OR 50.54, 95%CI 29.76-85.85), higher monthly family income (4.18, 2.40-7.28), increased frequency of hot pot consumption (2.90, 1.21-6.93), diabetes mellitus (2.62, 1.48-4.62), a higher apolipoprotein (Apo)B/ApoA1 ratio (2.60, 1.39-4.85), hypertension (2.52, 1.45-4.40) and moderate-intensity physical activity (0.50, 0.28-0.89) were associated with ischaemic stroke. There was an additive interaction between the ApoB/ApoA1 ratio and ethnicity in the Tujia and Miao populations with first-ever ischaemic stroke (the relative excess risk due to the interaction was 5.75, 95% CI 0.58 ~ 10.92; the attributable proportion due to the interaction was 0.65, 95% CI 0.38 ~ 0.91; the synergy index was 3.66, 95% CI 1.35 ~ 9.93). CONCLUSIONS This is the first case-control study examining modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao) in China. Some differences were observed in the impact of risk factors among these ethnic groups. Our results may help interpret health-related data, including surveillance and research, when developing strategies for stroke prevention.
Collapse
Affiliation(s)
- Na Zhang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Hunan Provincial Institute of Geriatrics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Xinrui Wu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mengyuan Tian
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiaolei Wang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jian Ding
- Hunan Provincial Institute of Geriatrics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Yong Tian
- Department of Neurology, the First Affiliated Hospital of Jishou University, the Tujia-Miao autonomous prefecture of Xiangxi, Hunan, China
| | - Chengcai Liang
- Department of Neurology, the First Affiliated Hospital of Jishou University, the Tujia-Miao autonomous prefecture of Xiangxi, Hunan, China
| | - Zhi Zeng
- Department of Neurology, the First Affiliated Hospital of Jishou University, the Tujia-Miao autonomous prefecture of Xiangxi, Hunan, China
| | - Hua Xiang
- Interventional Radiology Center, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China.
| | - Hongzhuan Tan
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China. .,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
| |
Collapse
|
7
|
Ozga AK, Rauch B, Palm F, Urbanek C, Grau A, Becher H, Rauch G. Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure. BMC Public Health 2020; 20:817. [PMID: 32487072 PMCID: PMC7268286 DOI: 10.1186/s12889-020-08971-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/21/2020] [Indexed: 01/01/2023] Open
Abstract
Background Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events 1 year after the first stroke by using the new weighted all-cause hazard ratio. Methods This study evaluates the 1 year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates. Results None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2–0.9), 0.8 (0.4–2.2), 1.3 (0.5–2.5), 1.2 (0.3–2.7), 1.6 (0.8–3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree. Conclusions Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
Collapse
Affiliation(s)
- Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Bernhard Rauch
- IHF GmbH, Institut für Herzinfarktforschung, Bremserstraße 79, 67063, Ludwigshafen, Germany
| | - Frederick Palm
- Helios Klinikum Schleswig, St. Jürgener Straße, 1-3, 24837, Schleswig, Germany
| | - Christian Urbanek
- Department of Neurology, Städtisches Klinikum Ludwigshafen am Rhein, University of Heidelberg, Bremserstraße 79, 67063, Ludwigshafen, Germany
| | - Armin Grau
- Department of Neurology, Städtisches Klinikum Ludwigshafen am Rhein, University of Heidelberg, Bremserstraße 79, 67063, Ludwigshafen, Germany
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany.,Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Geraldine Rauch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| |
Collapse
|
8
|
The Review of Transient Ischemic Attack Patients: An Experience of a Clinic about Diagnosis and Follow-up. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:83-87. [PMID: 32377139 PMCID: PMC7192245 DOI: 10.14744/semb.2018.20438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/22/2018] [Indexed: 11/20/2022]
Abstract
Objectives Transient Ischemic Attack (TIA) is due to a temporary lack of adequate blood and oxygen to the brain. TIAs typically last less than 24 hours. 10-15% of ischemic stroke patients have a history of TIA. 18% of them experience an ischemic stroke within 90 days, and the ABCD2 scoring system is used to estimate the risk. Our study aims to investigate the risk factors, the etiology, the lesion occurrence on MRI and the near-term risk of stroke of patients on whom TIA was diagnosed. Methods In this study, 124 patients were included between January 2012 and January 2018. Sixty-eight of the 124 patients were male. The history of patients was questioned; systemic and neurological examinations were made. The stroke risk factors and TIA duration were noted and ABCD2 scores were calculated. All the patients' blood samples, including glucose and lipid profile, were studied. They received CT, DWI MRI, electrocardiography, transthoracic echocardiography, ultrasound and/or MR angiography of the cervical arteries. Results One hundred twenty-four patients were included in this study, and 56 patients were female. The mean age was 63.04±16.77. Hypertension was the most common risk factor (50.8%). Twenty-seven patients were on antithrombotic; six patients were on anticoagulant therapy, while 91 patients were not receiving any antiaggregan therapy. ABCD2 scores were significantly higher on the antithrombotic therapy group (p=0.019). In 52 patients ABCD2 score was below 4, and in 72 patients, the score was greater than 4. In 67.7% of patients, no etiology was found. An ischemic lesion was detected in 16.9% of the patients. 58 % of the patients were discharged on anticoagulant therapy. Five patients developed ischemic stroke. Conclusion The risk factors of ischemic stroke and TIAs are similar factors. The etiology of TIAs cannot be found out in most of the patients. Thus, the patients are discharged with oral anticoagulant treatment.
Collapse
|
9
|
Saba L, Sanfilippo R, Tallapally N, Molinari F, Montisci R, Mallarini G, Suri JS. Evaluation of Carotid Wall Thickness by using Computed Tomography and Semiautomated Ultrasonographic Software. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431671103500302] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The increased thickness of the carotid artery is associated with the development of coronary and cerebrovascular events. In this study our purpose was to evaluate the carotid artery wall thickness (CAWT) by using multidetector-row computed tomography angiography (MDCTA) and the intima media thickness (IMT) by using semiautomated ultrasonography (SA-US) to evaluate the agreement between the two methods. Methods This is a retrospective study, and the institutional review board approval was obtained. Twenty-one patients (age range, 59–81 years) were analyzed with the use of a 16-detector row CT and a sonographic scanner. In total, 14 subjects had shown cerebral ischemic symptoms. The IMT was quantified by the use of specific semiautomated software (ImgTracer™, Global Biomedical Technologies, Roseville, CA) by four expert observers, and the CAWT was measured by use of the MDCTA. Data were compared with the Wilcoxon test for paired samples. Bland–Altman statistics was used to measure the agreement between MDCTA and SA-US. A p value < 0.05 was considered significant. Results Forty-two carotids were analyzed, and the CAWT ranged from 0.64 to 2.99 mm, with a mean value of 1.438 mm. By analyzing the Bland–Altman plots, we observed a good agreement between SA-US and correlation coefficient r were 0.9250 (95% confidence interval [CI] 0.864–0.959; p < 0.0001), 0.9265 (95% CI 0.866–0.961; p < 0.0001), 0.9466 (95% CI 0.902–0.971; p < 0.0001), and 0.8621 (95% CI: 0.756–0.924; p < 0.0001) for observer 1, observer 2, observer 3 and observer 4 respectively. Conclusions Data of this preliminary study by using SA-US and MDCTA demonstrated a good agreement between in the measurement of CAWT and IMT.
Collapse
Affiliation(s)
- Luca Saba
- Departments of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Roberto Sanfilippo
- Departments of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | | | - Filippo Molinari
- Departments of Biolab, Department of Electronics, Politecnico di Torino, Torino, Italy
| | - Roberto Montisci
- Departments of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Giorgio Mallarini
- Departments of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato (Cagliari) 09045, Italy
| | - Jasjit S. Suri
- Departments of CTO, Global Biomedical Technologies Inc., California
- Departments of Biomedical Engineering Department, Idaho State University (Aff.), Idaho
| |
Collapse
|
10
|
Evaluation of efficacy and safety of Reteplase and Alteplase in the treatment of hyper-acute cerebral infarction. Biosci Rep 2018; 38:BSR20170730. [PMID: 29263145 PMCID: PMC5770574 DOI: 10.1042/bsr20170730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/04/2023] Open
Abstract
Objective: The present study aimed to investigate the efficacy and safety of Reteplase (rPA) and Alteplase (rt-PA) in the treatment of hyper-acute cerebral infarction (CI). Methods: Six hundred and eleven patients with hyper-acute CI selected from September 2014 to September 2016 were assigned into the aspirin, rt-PA, rPA, rt-PA + aspirin, and rPA + aspirin groups based on their willingness. The difference of efficacy in five groups were evaluated with National Institute of Health Stroke Scale (NIHSS), modified rankin scale (mRS), and Barthel Index (BI). Coagulation function, blood lipid, and hemodynamics were analyzed. The safety differences were compared by observing the adverse reactions. Results: Compared with the rt-PA, rPA, and aspirin groups, NIHSS score, mRS score, the incidence of non- and symptomatic cerebral hemorrhage as well as the rate of adverse reactions were decreased, while BI were increased in the rt-PA + aspirin and rPA + aspirin groups after treatment. Compared with the rt-PA and rPA groups, total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were lower, whereas the hematocrit, whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, erythrocyte electrophoresis time, fibrinogen, erythrocyte sedimentation rate (ESR), K value in blood sedimentation equation, and the comprehensive abnormality degree of blood rheology were higher in the rt-PA + aspirin and rPA + aspirin groups. Conclusion: The efficacy and safety of rt-PA or rPA combined with aspirin in the treatment of hyper-acute CI were better than those of rPA or rt-PA monotherapy.
Collapse
|
11
|
Gong H, Lü P, Zhang J, Li D, Zheng J, Song J. Na+/K+‑ATPase DR region‑specific antibody protects U251 cells against hypoxia reperfusion‑induced injury via the PI3K/AKT and ERK pathways. Mol Med Rep 2017; 16:7901-7906. [PMID: 28983584 PMCID: PMC5779871 DOI: 10.3892/mmr.2017.7622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 12/28/2017] [Indexed: 02/06/2023] Open
Abstract
Cerebral ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and to the death of brain tissue or cerebral infarction/ischemic stroke. In the present study, an Na+/K+-ATPase (NKA) DR region-specific antibody (DRSAb) was established and purified and it was demonstrated that DRSAb induced a protective effect on human astrocytes (U251) via the phosphoinositide 3-kinase (PI3K)/AKT and extracellular signal-regulated protein kinase (ERK) signaling pathways. The binding of DRSAb on NKA was revealed using flow cytometry. High signals were detected on U251 cells incubated with DRSAb, but not with control sera or BSA. The viability of the hypoxia/reperfusion (H/R)-treated cells was markedly increased by DRSAb administration of 0.3–0.5 µM. The optimal concentration of DRSAb was 0.4 µM for attenuation of the injury induced by H/R. The administration of 0.4 µM DRSAb markedly reduced the number of apoptotic cells compared with control sera. The application of PD98059, an ERK inhibitor, and LY-294002, an AKT inhibitor, attenuated the protective effect induced by DRSAb in the U251 cells subjected to H/R. Furthermore, the application of LY294002 prior to incubation with DRSAb eliminated the activation of ERK1/2, whereas the use of PD98059 failed to attenuate the effect of DRSAb on PI3K/AKT activation. These results indicated that the protective effects of DRSAb against H/R injury in U251 cells occurred via stimulation of the PI3K/AKT and ERK signaling pathways.
Collapse
Affiliation(s)
- Huilin Gong
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Pengbiao Lü
- Department of Oncological and Thoracic Surgery, Hanzhong People's Hospital, Hanzhong, Shaanxi 723000, P.R. China
| | - Jiangwei Zhang
- Hospital of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Dandong Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jin Zheng
- Hospital of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jinning Song
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
12
|
Reprint of: Hydrogen sulfide in stroke: Protective or deleterious? Neurochem Int 2017; 107:78-87. [DOI: 10.1016/j.neuint.2016.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022]
|
13
|
Assessment of periodontitis and its role in viridans streptococcal bacteremia and infective endocarditis. Indian Heart J 2017; 70:225-232. [PMID: 29716699 PMCID: PMC5993913 DOI: 10.1016/j.ihj.2017.06.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the role of periodontitis in viridans group streptococci (VGS) bacteremia and infective endocarditis (IE). METHODS A total of 200 subjects including two groups. Group A- 34 subjects undergoing tooth extraction with periodontitis, 46 subjects undergoing tooth extraction without periodontitis and 40 healthy controls. Group B: 40 confirmed cases of IE (17 with and 23 without periodontitis) and 40 healthy controls. Subgingival plaque and blood samples were obtained and processed by standard procedures. RESULTS A total of 53 blood samples (66.25%) yielded positive cultures after tooth extraction. The relationship between the presence of periodontitis and a positive blood culture was significantly higher (p=0.05) for tooth extraction cases with periodontitis (79.40%) than tooth extraction cases without periodontitis (56.50%). Periodontitis was observed in 42.5% of IE cases. Out of the 40 patients of IE, the blood samples yielded 40 different isolates, majority were viridans streptococci 15 (37.5%) and staphylococci nine (22.5%). No statistically significant difference was observed between the subgingival plaque and blood isolates of periodontitis in both the groups, indicating similarity of biotypes of viridans streptococci isolated from the blood and the subgingival plaque. Similarity was also observed between the antibiogram profiles of viridans streptococci from both the groups. CONCLUSIONS Periodontitis enhances viridans streptococcal bacteremia and may be a potential risk factor for IE.
Collapse
|
14
|
Chan SJ, Wong PTH. Hydrogen sulfide in stroke: Protective or deleterious? Neurochem Int 2017; 105:1-10. [DOI: 10.1016/j.neuint.2016.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023]
|
15
|
Yu H, Huang Y, Chen X, Nie W, Wang Y, Jiao Y, Reed GL, Gu W, Chen H. High-sensitivity C-reactive protein in stroke patients - The importance in consideration of influence of multiple factors in the predictability for disease severity and death. J Clin Neurosci 2017; 36:12-19. [PMID: 27825611 PMCID: PMC11364373 DOI: 10.1016/j.jocn.2016.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/15/2016] [Indexed: 02/06/2023]
Abstract
High sensitivity C-reactive protein (hsCRP) has been evaluated as a biomarker in stroke and relevant pathological diseases. While its predictive values in several pathological phenotypes have been confirmed, controversy exists among different studies. This review summarizes reports of the predictive values of hsCRP for the diagnosis, etiology, prognosis and mortality of stroke diseases. The current literature suggests that CRP expression is influenced by multiple factors, such as polymorphisms, the genomic backgrounds and gender. However, few reported studies analyzed data based on all these multiple factors. Future studies should focus on comprehensive analysis based on multiple factors.
Collapse
Affiliation(s)
- Hong Yu
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China; Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Yue Huang
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - XinYu Chen
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China
| | - WenBao Nie
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China
| | - YongJun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
| | - Yan Jiao
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Guy L Reed
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Hong Chen
- Center of Integrative Research, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang 161005, PR China.
| |
Collapse
|
16
|
Periodontitis, Bacteremia and Infective Endocarditis: A Review Study. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2017. [DOI: 10.5812/pedinfect.41067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
17
|
Heron N. Optimising secondary prevention in the acute period following a TIA of ischaemic origin. BMJ Open Sport Exerc Med 2017; 2:e000161. [PMID: 29616144 PMCID: PMC5875616 DOI: 10.1136/bmjsem-2016-000161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/18/2016] [Accepted: 11/27/2016] [Indexed: 12/14/2022] Open
Abstract
Background Transient ischaemic attacks (TIAs) are highly prevalent conditions, with at least 46 000 people per year in the UK having a TIA for the first time. TIAs are a warning that the patient is at risk of further vascular events and the 90-day risk of vascular events following a TIA, excluding events within the first week after diagnosis when the risk is highest, can be as high as 18%. Immediate assessment of patients with TIA, either at accident and emergency, general practice and/or TIA clinics, is therefore required to address secondary prevention and prevent further vascular events. Discussion This article addresses the need for optimising secondary prevention in the acute period following a TIA of ischaemic origin to reduce the risk of further vascular events as per recent Cochrane review advice and presents a novel project, Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE), to do this. Summary One novel way to tackle vascular risk factors and promote secondary prevention in patients with TIA could be to adapt a cardiac rehabilitation programme for these patients. SPRITE, a feasibility and pilot study (ClinicalTrials.gov Identifier: NCT02712385) funded by the National Institute for Health Research, is attempting to adapt a home-based cardiac rehabilitation programme, 'The Healthy Brain Rehabilitation Manual', for use in the acute period following a TIA. The use of cardiac rehabilitation programmes post-TIA requires further research, particularly within the primary care setting.
Collapse
Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen's University, Belfast, UK.,Centre for Public Health Research, Queen's University, Belfast, UK.,Centre of Excellence for Public Health Research, Queen's University, Belfast, UK
| |
Collapse
|
18
|
Mo SJ, Hong J, Chen X, Han F, Ni Y, Zheng Y, Liu JQ, Xu L, Li Q, Yang XH, Sun RH, Yin XY. VEGF-mediated NF-κB activation protects PC12 cells from damage induced by hypoxia. Neurosci Lett 2015; 610:54-9. [PMID: 26518240 DOI: 10.1016/j.neulet.2015.10.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 12/17/2022]
Abstract
Neuronal apoptosis is a contributing cause of disability and death in cerebral ischemia. Nuclear factor-κB (NF-κB) may become a potential therapeutic target for hypoxic/ischemic neuron damage because NF-κB is inactivated after hypoxia exposure. Vascular endothelial growth factor (VEGF) has been found to improve neurological function recovery in cerebral ischemic injury although the exact molecular mechanisms that underlie the neuroprotective function of VEGF remain largely unknown. Here we defined the mechanism by which VEGF antagonized neuron-like PC12 cells apoptosis induced by hypoxia mimetic agent cobalt chloride (CoCl2) is through restoration of NF-κB activity. Depletion of VEGF with small interfering RNA (siRNA) in PC12 cells conferred CoCl2-induced cytotoxicity which was mitigated by VEGF administration. Treatment of PC12 cells with VEGF attenuated the CoCl2-induced cytotoxicity in both dose- and time-dependent manner. Mechanistically, VEGF increased IκBα phosphorylation and ubiquitination, promoted P65 nuclear translocation as well as upregulated XIAP and CCND1 expression. Meanwhile, VEGF administration reversed the dysregulation of IκBα phosphorylation and ubiquitination, P65 nuclear translocation as well as XIAP and CCND1 expression induced by CoCl2. Notably, the VEGF-dependent cytoprotection was abolished by pretreatment with BAY 11-7085, a specific inhibitor of NF-κB. Our data suggest that VEGF/NF-κB signalling pathway represents an adaptive mechanism that protects neural cells against hypoxic damage.
Collapse
Affiliation(s)
- Shi-Jing Mo
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China; Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Jun Hong
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Xu Chen
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Fang Han
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Yin Ni
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Yang Zheng
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Jing-Quan Liu
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Liang Xu
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Qian Li
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Xiang-Hong Yang
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China
| | - Ren-Hua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, China.
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
| |
Collapse
|
19
|
Xie D, Deng L, Liu XD, Li JM, Zhang YB. Role of high sensitivity C-reactive protein and other risk factors in intracranial and extracranial artery occlusion in patients with ischaemic stroke. J Int Med Res 2015; 43:711-7. [PMID: 26130785 DOI: 10.1177/0300060515586246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/19/2015] [Indexed: 11/15/2022] Open
Abstract
Objective A retrospective case–control study to identify stroke-associated risk factors and quantify serum C-reactive protein in patients with ischaemic stroke, with or without intracranial and/or extracranial artery occlusion (IEAO). Methods Patients with ischaemic stroke and internal carotid artery occlusion (ICAO), middle cerebral artery occlusion (MCAO), ICAO + MCAO, or no IEAO (control patients) were retrospectively recruited. Data regarding stroke-associated risk factors were retrieved from medical records. High sensitivity (hs)-CRP was quantified within 3 days of hospital admission. Results Patients with ICAO ( n = 89), MCAO ( n = 74) and ICAO + MCAO ( n = 29) had significantly higher serum hs-CRP concentrations, and were significantly more likely to have coronary heart disease, a history of stroke, and more than three stroke-associated risk factors than control patients ( n = 84). Conclusions Coronary heart disease and a history of stroke are risk factors for ischaemic stroke with IEAO. Hs-CRP may be used as a marker for IEAO.
Collapse
Affiliation(s)
- Dan Xie
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Deng
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-dong Liu
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji-mei Li
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yong-bo Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
20
|
Zimmermann H, Hagenfeld D, Diercke K, El-Sayed N, Fricke J, Greiser KH, Kühnisch J, Linseisen J, Meisinger C, Pischon N, Pischon T, Samietz S, Schmitter M, Steinbrecher A, Kim TS, Becher H. Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort. BMC Oral Health 2015; 15:7. [PMID: 25604448 PMCID: PMC4324664 DOI: 10.1186/1472-6831-15-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/03/2015] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. Methods From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis. Results Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. Conclusions Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.
Collapse
Affiliation(s)
- Heiko Zimmermann
- Institute of Public Health, University of Heidelberg, lm Neuenheimer Feld 324, 69120 Heidelberg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Zhang L, Wang H, Wang T, Jiang N, Yu P, Chong Y, Fu F. Ferulic acid ameliorates nerve injury induced by cerebral ischemia in rats. Exp Ther Med 2014; 9:972-976. [PMID: 25667662 PMCID: PMC4316951 DOI: 10.3892/etm.2014.2157] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/23/2014] [Indexed: 01/04/2023] Open
Abstract
This study was designed to investigate the protective effect of ferulic acid (FA) on nerve injury induced by cerebral ischemia. Focal cerebral ischemia was induced by occlusion of the right middle cerebral artery and reperfusion 90 min later in male Sprague-Dawley rats. Daily treatment of the rats with FA was initiated 30 min after the surgery, and was continued for 7 days. The efficacy of FA against nerve injury was assessed by neurological deficit scores as well as pathohistological observation. The expression levels in the brain and level in the peripheral blood of erythropoietin (EPO) and granulocyte colony-stimulating factor (G-CSF) were analyzed by immunohistochemistry and enzyme-linked immunosorbent assay (ELISA), respectively. The results showed that FA attenuated nerve injury of the hippocampus, significantly ameliorated neurological deficits, and increased EPO but not G-CSF expression in the hippocampus and the peripheral blood of ischemic rats. The findings indicate that FA has certain protective effects on the nerve injury of cerebral ischemia, and suggest that promoting EPO in the brain and peripheral blood may be one of the neuroprotective mechanisms of FA.
Collapse
Affiliation(s)
- Leiming Zhang
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| | - Hongsheng Wang
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| | - Tian Wang
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| | - Na Jiang
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| | - Pengfei Yu
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| | - Yating Chong
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| | - Fenghua Fu
- Department of Pharmacology, School of Pharmacy, Yantai University, Yantai, Shandong 264005, P.R. China
| |
Collapse
|
22
|
Quan Z, Quan Y, Wei B, Fang D, Yu W, Jia H, Quan W, Liu Y, Wang Q. Protein-protein interaction network and mechanism analysis in ischemic stroke. Mol Med Rep 2014; 11:29-36. [PMID: 25333814 PMCID: PMC4237100 DOI: 10.3892/mmr.2014.2696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 05/13/2014] [Indexed: 12/23/2022] Open
Abstract
Ischemic stroke is a leading cause of mortality and permanent disability, with enormous financial repercussions on health systems worldwide. Ischemic brain injury results from a complex sequence of pathophysiological events that evolve over time. In order to examine the molecular mechanisms underlying middle cerebral artery occlusion (MCAO)-induced ischemic stroke, the GSE35338 affymetrix microarray data was obtained from the Gene Expression Omnibus database and the differentially expressed genes (DEGs) between samples from patients with MCAO-induced ischemic stroke and sham controls at various time points were identified. Furthermore, protein-protein interaction (PPI) networks were constructed by mapping the DEGs into PPI data to identify the pathways that these DEGS are involved in. The results revealed that the expression of 438 DEGs, which are mainly involved in cell death, oxidant reduction, cell cycle and cell-cell signaling, were altered in MCAO samples. The nodes of CXC motif chemokine 10 (CXCL10) and interleukin-6 (IL-6) were large, with degrees of >20. In conclusion, the results suggest that CXCL10 and IL-6 have important roles in the occurrence and progression of MCAO-induced ischemic stroke.
Collapse
Affiliation(s)
- Zhe Quan
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250000, P.R. China
| | - Yuan Quan
- Norman Bethune Medical School of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Bo Wei
- Department of Neurosurgery, The Third Affiliated Hospital (China‑Japan Union Hospital) of Jilin University, Changchun, Jilin 130031, P.R. China
| | - Dening Fang
- Department of Gastroenterology, Shanghai No. 8 Hospital, Shanghai 200235, P.R. China
| | - Weidong Yu
- Department of Neurosurgery, The Third Affiliated Hospital (China‑Japan Union Hospital) of Jilin University, Changchun, Jilin 130031, P.R. China
| | - Hao Jia
- Department of Emergency Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning 110000, P.R. China
| | - Wei Quan
- Department of Infection, HuiNanXian Hospital, Huinan, Jilin 135100, P.R. China
| | - Yuguang Liu
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250000, P.R. China
| | - Qihong Wang
- Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| |
Collapse
|
23
|
Bergkvist C, Kippler M, Larsson SC, Berglund M, Glynn A, Wolk A, Åkesson A. Dietary exposure to polychlorinated biphenyls is associated with increased risk of stroke in women. J Intern Med 2014; 276:248-59. [PMID: 24428778 DOI: 10.1111/joim.12194] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The potentially beneficial effects of fish consumption on stroke may be modified by major food contaminants in fish. Polychlorinated biphenyls (PCBs) in particular are proposed to play a role in the aetiology of stroke. The aim of this study was to assess the association between dietary PCB exposure and stroke risk with the intake of long-chain omega-3 fish fatty acids and fish consumption. DESIGN The prospective population-based Swedish Mammography Cohort was examined. It was comprised of 34,591 women free of cardiovascular diseases and cancer at baseline in 1997 and followed up for 12 years. Validated estimates of dietary PCB exposure were obtained via a food frequency questionnaire at baseline. Incident cases of stroke were ascertained through register linkage. RESULTS During 12 years of follow-up (397,309 person-years), there were 2015 incident cases of total stroke (1532 ischaemic strokes, 216 intracerebral haemorrhages, 94 subarachnoid haemorrhages and 173 unspecified strokes). Multivariable-adjusted relative risks (RR), controlled for known stroke risk factors and fish consumption, were 1.67 [95% confidence interval (CI), 1.29-2.17] for total stroke, 1.61 (95% CI, 1.19-2.17) for ischaemic stroke and 2.80 (95% CI, 1.42-5.55) for haemorrhagic stroke for women in the highest quartile of dietary PCB exposure (median 288 ng day(-1) ) compared with women in the lowest quartile (median 101 ng day(-1) ). CONCLUSION Dietary exposure to PCBs was associated with an increased stroke risk in women, especially haemorrhagic stroke. The results provide important information regarding the risk-benefit analysis of fish consumption, particularly for cerebrovascular disease prevention.
Collapse
Affiliation(s)
- C Bergkvist
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | |
Collapse
|
24
|
Xiang L, Yu P, Zhang M, Hao J, Wang Y, Zhu L, Dai L, Mao L. Platinized Aligned Carbon Nanotube-Sheathed Carbon Fiber Microelectrodes for In Vivo Amperometric Monitoring of Oxygen. Anal Chem 2014; 86:5017-23. [DOI: 10.1021/ac500622m] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ling Xiang
- Beijing
National Laboratory for Molecular Sciences, Key Laboratory of Analytical
Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences (CAS), Beijing 100190, People’s Republic of China
| | - Ping Yu
- Beijing
National Laboratory for Molecular Sciences, Key Laboratory of Analytical
Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences (CAS), Beijing 100190, People’s Republic of China
| | - Meining Zhang
- Department
of Chemistry, Renmin University of China, Beijing 100872, People’s Republic of China
| | - Jie Hao
- Beijing
National Laboratory for Molecular Sciences, Key Laboratory of Analytical
Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences (CAS), Beijing 100190, People’s Republic of China
| | - Yuexiang Wang
- Beijing
National Laboratory for Molecular Sciences, Key Laboratory of Analytical
Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences (CAS), Beijing 100190, People’s Republic of China
| | - Lin Zhu
- Department
of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Liming Dai
- Department
of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Lanqun Mao
- Beijing
National Laboratory for Molecular Sciences, Key Laboratory of Analytical
Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences (CAS), Beijing 100190, People’s Republic of China
| |
Collapse
|
25
|
Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke 2014; 8:465-74. [PMID: 23879751 DOI: 10.1111/ijs.12135] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent epidemiological studies have demonstrated an association between perceived psychological stress and ischemic stroke. A feature of stroke is recurrence; 30-40% within five-years following first transient ischemic attack/stroke. Equipping patients with skills and coping strategies to help reduce or manage perceived psychological stress may represent an important secondary prevention intervention. Mindfulness-based interventions are structured, group-based self-management programmes with potential to help people with long-term conditions cope better with physical, psychological, or emotional distress. Review evidence suggests significant benefits across a range of physical and mental health problems. However, we could find no evidence synthesis relating specifically to the benefits of mindfulness-based interventions following transient ischemic attack/stroke. AIM The review aims to evaluate the benefits of mindfulness-based interventions following transient ischemic attack/stroke. METHODS Six major databases were searched using subject headings and key words. Papers were screened using review-specific criteria. Critical appraisal and data extraction were conducted independently by two reviewers. Statistical meta-analysis was not possible; therefore findings are presented in narrative form. RESULTS Four studies involving 160 participants were reviewed. Three papers reported mindfulness-based interventions delivered to groups; one paper reported a mindfulness-based intervention which was delivered one to one. The results demonstrate a positive trend in favor of the benefits of mindfulness-based interventions across a range of psychological, physiological, and psychosocial outcomes including anxiety, depression, mental fatigue, blood pressure, perceived health, and quality of life. No evidence of harm was found. CONCLUSION Following transient ischemic attack/stroke, people may derive a range of benefits from mindfulness-based interventions; however, further methodologically robust trials are required.
Collapse
Affiliation(s)
- Maggie Lawrence
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | | | | | | |
Collapse
|
26
|
Papadopoulou V, Tang MX, Balestra C, Eckersley RJ, Karapantsios TD. Circulatory bubble dynamics: from physical to biological aspects. Adv Colloid Interface Sci 2014; 206:239-49. [PMID: 24534474 DOI: 10.1016/j.cis.2014.01.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 12/21/2022]
Abstract
Bubbles can form in the body during or after decompression from pressure exposures such as those undergone by scuba divers, astronauts, caisson and tunnel workers. Bubble growth and detachment physics then becomes significant in predicting and controlling the probability of these bubbles causing mechanical problems by blocking vessels, displacing tissues, or inducing an inflammatory cascade if they persist for too long in the body before being dissolved. By contrast to decompression induced bubbles whose site of initial formation and exact composition are debated, there are other instances of bubbles in the bloodstream which are well-defined. Gas emboli unwillingly introduced during surgical procedures and ultrasound microbubbles injected for use as contrast or drug delivery agents are therefore also discussed. After presenting the different ways that bubbles can end up in the human bloodstream, the general mathematical formalism related to the physics of bubble growth and detachment from decompression is reviewed. Bubble behavior in the bloodstream is then discussed, including bubble dissolution in blood, bubble rheology and biological interactions for the different cases of bubble and blood composition considered.
Collapse
Affiliation(s)
- Virginie Papadopoulou
- Department of Bioengineering, Imperial College London, London, UK; Environmental & Occupational Physiology Lab., Haute Ecole Paul Henri Spaak, Brussels, Belgium.
| | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, UK
| | - Costantino Balestra
- Environmental & Occupational Physiology Lab., Haute Ecole Paul Henri Spaak, Brussels, Belgium; DAN Europe Research Division, Belgium
| | - Robert J Eckersley
- Biomedical Engineering Department, Division of Imaging Sciences, King's College London, London, UK
| | | |
Collapse
|
27
|
Effects of pretreatment with a combination of melatonin and electroacupuncture in a rat model of transient focal cerebral ischemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:953162. [PMID: 24348730 PMCID: PMC3853035 DOI: 10.1155/2013/953162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/01/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
Both melatonin and electroacupuncture (EA) have been suggested to be effective treatments against stroke. However, it is unknown whether a combination of these two therapies could be beneficial against transient focal cerebral ischemia. The present study investigated the effects of pretreatment of a combination of melatonin and EA in a rat model of transient middle cerebral artery occlusion (MCAO). After pretreatment of melatonin plus EA (MEA), transient MCAO was induced for 90 minutes in male Sprague-Dawley (SD) rats. The neurological deficit score, brain infarct volume, cerebral edema ratio, neuronal inflammation, and apoptosis were evaluated 24 hours after transient MCAO. The expression of related inflammatory and apoptotic mediators in the brain was also investigated. The results showed that MEA improved neurological outcome, reduced brain infarct volume, and inhibited neuronal inflammation as well as apoptosis 24 hours after transient MCAO. The beneficial effects may derive from downregulation of proinflammatory and proapoptotic mediators and upregulation of antiapoptotic mediators. Thus, these results suggest a preventive effect of pretreatment of MEA on transient focal cerebral ischemia.
Collapse
|
28
|
Telman G, Sprecher E, Kouperberg E. Carotid disease in acute ischemic stroke patients of northern Israel. Acta Neurol Scand 2012; 126:398-403. [PMID: 22435882 DOI: 10.1111/j.1600-0404.2012.01663.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid disease complicated by thrombosis or embolism is a frequent cause of acute ischemic stroke. The aim of the study was to determine factors associated with carotid disease in patients suffering from acute ischemic stroke in northern Israel. METHODS Participants were 1378 acute ischemic stroke patients, including 671 patients with and 707 patients without carotid plaques, as defined by cervical ultrasound. RESULTS Logistic regression analysis of possible predictors revealed that age, male gender, diabetes, hyperlipidemia, and smoking were independent predictors for the presence of carotid plaque. Male gender was independently associated with the increased prevalence of carotid stenosis of 50% or more, as well as with symptomatic carotid plaques. Age was found to be the only independent factor influencing the extent (bilateral vs unilateral) of carotid disease among acute ischemic stroke patients in northern Israel. Although ethnicity was initially found to have an influence on the prevalence of carotid plaques (higher among Jews than Arabs), no such influence was found after logistic regression. CONCLUSION Our findings emphasize that demographic characteristics (age, gender) and vascular risk factors (diabetes, smoking and hyperlipidemia) rather than ethnic disparities are important determinants of carotid disease in acute ischemic stroke patients in northern Israel.
Collapse
Affiliation(s)
- G. Telman
- Department of Neurology, Rambam Medical Center; Technion Faculty of Medicine; Haifa; Israel
| | - E. Sprecher
- Department of Neurology, Rambam Medical Center; Technion Faculty of Medicine; Haifa; Israel
| | - E. Kouperberg
- Department of Neurology, Rambam Medical Center; Technion Faculty of Medicine; Haifa; Israel
| |
Collapse
|
29
|
Li J, Wu RG, Meng FY, Wang Z, Wang CM, Wang YY, Zhang ZJ. Synergism and rules from combination of Baicalin, Jasminoidin and Desoxycholic acid in refined Qing Kai Ling for treat ischemic stroke mice model. PLoS One 2012; 7:e45811. [PMID: 23049867 PMCID: PMC3458908 DOI: 10.1371/journal.pone.0045811] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/22/2012] [Indexed: 12/31/2022] Open
Abstract
Refined Qing-Kai-Ling (QKL), a modified Chinese medicine, consists of three main ingredients (Baicalin, Jasminoidin and Desoxycholic acid), plays a synergistic effect on the treatment of the acute stage of ischemic stroke. However, the rules of the combination and synergism are still unknown. Based on the ischemic stroke mice model, all different kinds of combination of Baicalin, Jasminoidin, and Desoxycholic acid were investigated by the methods of neurological examination, microarray, and genomics analysis. As a result, it confirmed that the combination of three drugs offered a better therapeutical effect on ischemic stroke than monotherapy of each drug. Additionally, we used Ingenuity pathway Analysis (IPA) and principal component analysis (PCA) to extract the dominant information of expression changes in 373 ischemia-related genes. The results suggested that 5 principal components (PC1-5) could account for more than 95% energy in the gene data. Moreover, 3 clusters (PC1, PC2+PC5, and PC3+PC4) were addressed with cluster analysis. Furthermore, we matched PCs on the drug-target networks, the findings demonstrated that Baicalin related with PC1 that played the leading role in the combination; Jasminoidin related with PC2+PC5 that played a compensatory role; while Desoxycholic acid had the least performance alone which could relate with PC3+PC4 that played a compatible role. These manifestations were accorded with the principle of herbal formulae of Traditional Chinese Medicine (TCM), emperor-minister-adjuvant-courier. In conclusion, we firstly provided scientific evidence to the classic theory of TCM formulae, an initiating holistic viewpoint of combination therapy of TCM. This study also illustrated that PCA might be an applicable method to analyze the complicated data of drug combination.
Collapse
Affiliation(s)
- Jian Li
- School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Run-guo Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Fan-yun Meng
- School of Resources Science & Technology, Beijing Normal University, Beijing, China
| | - Zhong Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Chang-ming Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yong-yan Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Zhan-jun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- * E-mail:
| |
Collapse
|
30
|
Kawato T, Tanaka H, Tabuchi M, Ooshima K, Nakai K, Yamashita Y, Maeno M. Continual Gram-Negative Bacterial Challenge Accelerates Stroke Onset in Stroke-Prone Spontaneously Hypertensive Rats. Clin Exp Hypertens 2012; 35:28-34. [DOI: 10.3109/10641963.2012.689042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Analysis of carotid artery plaque and wall boundaries on CT images by using a semi-automatic method based on level set model. Neuroradiology 2012; 54:1207-14. [PMID: 22562690 DOI: 10.1007/s00234-012-1040-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/05/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the potentialities of a semi-automated technique in the detection and measurement of the carotid artery plaque. METHODS Twenty-two consecutive patients (18 males, 4 females; mean age 62 years) examined with MDCTA from January 2011 to March 2011 were included in this retrospective study. Carotid arteries are examined with a 16-multi-detector-row CT system, and for each patient, the most diseased carotid was selected. In the first phase, the carotid plaque was identified and one experienced radiologist manually traced the inner and outer boundaries by using polyline and radial distance method (PDM and RDM, respectively). In the second phase, the carotid inner and outer boundaries were traced with an automated algorithm: level-set-method (LSM). Data were compared by using Pearson rho correlation, Bland-Altman, and regression. RESULTS A total of 715 slices were analyzed. The mean thickness of the plaque using the reference PDM was 1.86 mm whereas using the LSM-PDM was 1.96 mm; using the reference RDM was 2.06 mm whereas using the LSM-RDM was 2.03 mm. The correlation values between the references, the LSM, the PDM and the RDM were 0.8428, 0.9921, 0.745 and 0.6425. Bland-Altman demonstrated a very good agreement in particular with the RDM method. CONCLUSION Results of our study indicate that LSM method can automatically measure the thickness of the plaque and that the best results are obtained with the RDM. Our results suggest that advanced computer-based algorithms can identify and trace the plaque boundaries like an experienced human reader.
Collapse
|
32
|
Li J, Luo M, Xu X, Sheng W. Association between 1425G/A SNP in PRKCH and ischemic stroke among Chinese and Japanese populations: A meta-analysis including 3686 cases and 4589 controls. Neurosci Lett 2012; 506:55-8. [DOI: 10.1016/j.neulet.2011.10.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/06/2011] [Accepted: 10/18/2011] [Indexed: 01/30/2023]
|
33
|
Zhang Z, Peng D, Zhu H, Wang X. Experimental evidence of Ginkgo biloba extract EGB as a neuroprotective agent in ischemia stroke rats. Brain Res Bull 2011; 87:193-8. [PMID: 22100334 DOI: 10.1016/j.brainresbull.2011.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 10/31/2011] [Accepted: 11/03/2011] [Indexed: 01/17/2023]
Abstract
EGb761 is a standard extract of Ginkgo biloba, which is a kind of traditional Chinese herbs that has widely used in clinic treatment of stroke in China. However, its effects against ischemic stroke have not been evaluated comprehensively and its neuroprotective mechanism has not really been explored. In the present study, magnetic resonance diffusion-weighted imaging (DWI), neurological behavior and TTC staining were used to evaluate the therapeutic effect of EGb761 in rat ischemic models. Additionally, Western blot and immunohistochemistry were performed to measure the phosphorylations of cAMP response element binding protein (CREB) and Akt as well as the expression of brain-derived neurotrophic factor (BDNF) in rat brains. The results showed that Ginkgo biloba extract injection significantly increased the apparent diffusion coefficient (ADC) value and average diffusion coefficient (DCavg) value both in the peripheral zone and central zone, improved behavior scores, as well as enhanced the phosphorylations of AKT, CREB and the expression of BDNF in the brains. All these data demonstrate that EGb761 had significant therapeutic effects on ischemic stroke and it perhaps worked through activating the Akt-CREB-BDNF pathway.
Collapse
Affiliation(s)
- Zhanjun Zhang
- Department of Physiology, Capital Medical University, Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, No. 10 Xitoutiao, Youanmen, Beijing 100069, China
| | | | | | | |
Collapse
|
34
|
Antioxidant preserving effects of l-arginine at reducing the hemodynamic toxicity of gentamicin-induced rat nephrotoxicity: pathological and biochemical findings. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s00580-011-1359-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Abstract
BACKGROUND AND OBJECTIVES The expression of soluble adhesion molecules inter-cellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), besides activation of endothelial cells and transendothelial migration of leukocytes, play an important role in inflammation and progression of ischemic injury after acute stroke. The aim of this study was to determine serum levels of soluble ICAM-1 and VCAM-1 in patients with acute ischemic stroke and controls and correlate them according to etiological subtypes (thromboembolic or lacunar stroke), stroke severity and disability after acute stroke. PATIENTS AND METHODS Hospital-based prospective study of acute stroke patients hospitalized between December 2008 and September 2009 at the University Hospital Sestre Milosrdnice in Zagreb, Croatia. METHODS We enrolled 110 patients with acute ischemic stroke and 93 healthy individuals as controls. Serum concentrations of VCAM-1 and ICAM-1 were determined by means of quantitative sandwich enzyme immunoassay. Patients were classified according to etiological subtype, clinical severity of stroke and disability after stroke. RESULTS There was no significant difference between levels of soluble adhesion molecules VCAM-1 and ICAM-1 in patients and in controls. Levels of VCAM-1 were significantly higher in patients with thromboembolic stroke than in controls. There was no significant correlation between levels of soluble adhesion molecules VCAM-1 and ICAM-1 and stroke severity and disability. There was marked biological interindividual variability in all patient groups. CONCLUSION This study confirms the role of adhesion molecule VCAM-1 in the pathogenesis of acute thromboembolic stroke.
Collapse
Affiliation(s)
- Visnja Supanc
- Department of Neurology, University Hospital Sestre Milosrdnice, Zagreb, Croatia.
| | | | | | | |
Collapse
|
36
|
Zhang Z, Peng D, Zhu H, Wang X. WITHDRAWN: Comprehensive evaluation of neuroprotective effects of Ginkgo biloba extract EGB against ischemic stroke. Brain Res Bull 2011:S0361-9230(11)00186-9. [PMID: 21723378 DOI: 10.1016/j.brainresbull.2011.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 06/16/2011] [Accepted: 06/16/2011] [Indexed: 11/20/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Collapse
Affiliation(s)
- Zhanjun Zhang
- Department of Physiology, Capital Medical University, Key Laboratory for Neurodegenerative Disorders of the Ministry of Education,Beijing,China
| | | | | | | |
Collapse
|
37
|
Schwartz GL. Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness. Endocrinol Metab Clin North Am 2011; 40:279-94, vii. [PMID: 21565667 PMCID: PMC3094544 DOI: 10.1016/j.ecl.2011.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Formal studies have not been performed to assess the cost-effectiveness of screening strategies for endocrine causes of hypertension. However, an understanding of the diagnostic accuracy of available screening tests and the clinical settings where disease identification will lead to improved health outcomes form the basis for a cost-effective strategy. Primary aldosteronism screening should be selective and restricted to settings where knowledge of the diagnosis has the greatest chance of improving health outcomes. Pheochromocytoma is rare; however, because it is a potentially fatal disease, screening strategies should err on the side of not missing the diagnosis, especially in high-risk clinical settings.
Collapse
Affiliation(s)
- Gary L Schwartz
- Division of Nephrology and Hypertension, College of Medicine, Mayo Clinic, West 19, Mayo Building, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
38
|
MacKay-Lyons M, Gubitz G, Giacomantonio N, Wightman H, Marsters D, Thompson K, Blanchard C, Eskes G, Thornton M. Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trial. BMC Neurol 2010; 10:122. [PMID: 21143864 PMCID: PMC3004878 DOI: 10.1186/1471-2377-10-122] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 12/08/2010] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite lack of outward signs, most individuals after non-disabling stroke (NDS) and transient ischemic attack (TIA) have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke, hospitalization for other vascular events, or death. Most have multiple modifiable risk factors (e.g., hypertension, physical inactivity, hyperlipidaemia, diabetes, tobacco consumption, psychological stress). In addition, accelerated rates of depression, cognitive decline, and poor quality of sleep have been reported following TIA, which correlate with poor functional outcomes and reduced quality of life. Thus, NSD and TIA are important warning signs that should not be overlooked. The challenge is not unlike that facing other 'silent' conditions - to identify a model of care that is effective in changing people's current behaviors in order to avert further morbidity. METHODS/DESIGN A single blind, randomized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA. 250 adults within 90 days of being diagnosed with NDS/TIA will be randomly allocated to a 12-week program of exercise and education (PREVENT) or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated (USUAL CARE). Primary outcome measures will include blood pressure, waist circumference, 12-hour fasting lipid profile, and 12-hour fasting glucose/hemoglobin A1c. Secondary measures will include exercise capacity, walking endurance, physical activity, cognitive function, depression, goal attainment and health-related quality of life. Outcome assessment will be conducted at baseline, post-intervention, and 6- and 12-month follow-ups. Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be compared. Ethical approval for the trial has been obtained from the relevant Human Research Ethics Boards. DISCUSSION Whether timely delivery of an adapted cardiac rehabilitation model is effective in attaining and maintaining vascular risk reduction targets in adults after NDS/TIA is not yet known. We anticipate that the findings of this trial will make a meaningful contribution to the knowledge base regarding secondary stroke prevention.
Collapse
Affiliation(s)
| | - Gordon Gubitz
- Department of Neurology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Howard Wightman
- Department of Medicine, Valley Regional Hospital, Kentville, Nova Scotia, Canada
| | - David Marsters
- Department of Medicine, Valley Regional Hospital, Kentville, Nova Scotia, Canada
| | - Kara Thompson
- Department of Medicine, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Chris Blanchard
- Department of Medicine, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Gail Eskes
- Department of Psychiatry, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Marianne Thornton
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
39
|
Del Zoppo GJ, Gorelick PB. Innate inflammation as the common pathway of risk factors leading to TIAs and stroke. Ann N Y Acad Sci 2010; 1207:8-10. [DOI: 10.1111/j.1749-6632.2010.05762.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Li H, Hu J, Ma L, Yuan Z, Wang Y, Wang X, Xing D, Lei F, Du L. Comprehensive study of baicalin down-regulating NOD2 receptor expression of neurons with oxygen-glucose deprivation in vitro and cerebral ischemia-reperfusion in vivo. Eur J Pharmacol 2010; 649:92-9. [PMID: 20863826 DOI: 10.1016/j.ejphar.2010.09.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 08/31/2010] [Accepted: 09/07/2010] [Indexed: 11/24/2022]
Abstract
Cerebral ischemia-reperfusion can activate several transcription factors and lead to inflammatory reactions, which related to pattern recognition receptors with immune activating functions. NOD2 (nucleotide-binding oligomerization domain protein 2) is one of the receptors involved in innate immune response and is genetically associated with several inflammatory reactions. Since baicalin has the pharmacological effects of anti-inflammation and protection of brain from cerebral ischemia-reperfusion, we studied baicalin's effect on NOD2/TNFα in the cell of oxygen-glucose deprivation (OGD) in vitro and the mice of cerebral ischemia-reperfusion in vivo. The results showed that NOD2 and TNFα were up regulated in the cells with oxygen-glucose deprivation, not only in BV2 cells, but also in both of PC12 cells and primary neuron cells, which suggested NOD2 could express directly in neuron while OGD treatment. Baicalin (10 μg/ml) could effectively down regulate the expression of NOD2 and TNFα in both mRNA and protein levels. Meanwhile, baicalin (50 mg/kg, i.p.) could also down regulate the expression of NOD2 and TNFα in protein levels significantly, in which agreed with its effect in vitro study. These data demonstrated that targeting on NOD2 especially in neurons directly was possibly attributed to the neural-protective effect of baicalin in the injury of cerebral ischemia-reperfusion.
Collapse
Affiliation(s)
- Huiying Li
- Protein Science Laboratory of the Ministry of Education, Laboratory of Pharmaceutical Sciences, School of Life Sciences and School of Medicine, Tsinghua University, Beijing 100084, China
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Lin Y, Zhu N, Yu P, Su L, Mao L. Physiologically relevant online electrochemical method for continuous and simultaneous monitoring of striatum glucose and lactate following global cerebral ischemia/reperfusion. Anal Chem 2010; 81:2067-74. [PMID: 19281258 DOI: 10.1021/ac801946s] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study demonstrates a new electroanalytical method with a high physiological relevance for simultaneous online monitoring of glucose and lactate in the striatum of the rat brain following global cerebral ischemia/reperfusion. The online analytical method is based on the efficient integration of in vivo microdialysis sampling with an online selective electrochemical detection with the electrochemical biosensors with dehydrogenases, i.e., glucose and lactate dehydrogenases, as recognition elements. The dehydrogenase-based electrochemical biosensors are developed onto the dual split-disk plastic carbon film (SPCF) electrodes with methylene green (MG) adsorbed onto single-walled carbon nanotubes (SWNTs) as the electrocatalyst for the oxidation of dihydronicotiamide adenine dinucleotide (NADH) at a low potential of 0.0 V (vs Ag/AgCl). Artificial cerebrospinal fluid (aCSF) containing NAD(+) is externally perfused from a second pump and online mixed with the brain microdialysates to minimize the variation of pH that occurred following the cerebral ischemia/reperfusion and to supply NAD(+) cofactor and O(2) for the enzymatic reactions of dehydrogenases and ascorbate oxidase, respectively. As a result, the developed online electroanalytical method exhibits a high selectivity against the electrochemically active species endogenously existing in the cerebral systems and a high tolerance against the variation of pH and O(2) following cerebral ischemia/reperfusion. This property, along with the good linearity and a high stability toward glucose and lactate as well as little cross-talk between two biosensors, substantially makes this method possible for the continuous, simultaneous, and online monitoring of glucose and lactate in the rat brain following global cerebral ischemia/reperfusion. This study establishes a new and effective platform for the investigation of the energy metabolism in physiological and pathological processes.
Collapse
Affiliation(s)
- Yuqing Lin
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, The Chinese Academy of Sciences, Beijing 100190, China
| | | | | | | | | |
Collapse
|
42
|
Metabolic syndrome and its components in individuals undergoing rehabilitation after stroke. J Neurol Phys Ther 2010; 33:189-94. [PMID: 20208463 DOI: 10.1097/npt.0b013e3181c21764] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE : Individuals participating in stroke rehabilitation are in jeopardy of future vascular events, including a second stroke. Nevertheless, vascular risk assessment is often overlooked in this population. Metabolic syndrome (MetS) may be a useful construct for risk assessment because of its predictive ability in distinguishing patients who are at high risk of future morbidity. This study documented the prevalence of MetS and its components in stroke rehabilitation patients. In addition, clinical characteristics of subgroups with and without MetS were compared. METHODS : Health records of 200 adult patients who had participated in inpatient stroke rehabilitation were reviewed. The prevalence and extent of clustering of the five components of MetS-obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, and insulin resistance-were examined. RESULTS : Of the total sample, 61% had MetS and 97% had at least one MetS component, with hypertension and low high-density lipoprotein cholesterol being the most prevalent. The number of comorbidities, number of prescription drugs, and history of coronary heart disease were positively related to the presence of MetS. The components were predicted by a single underlying factor, providing support for the validity of using the MetS construct to assess vascular risk in this population. DISCUSSION AND CONCLUSIONS : Awareness of the high prevalence of MetS in individuals undergoing stroke rehabilitation should motivate physical therapists and other rehabilitation clinicians to intervene to prevent the recurrence of vascular events. Early screening for this high-risk condition and implementation of targeted interventions to reduce future vascular morbidity should become priorities in stroke rehabilitation.
Collapse
|
43
|
Pathophysiologic mechanisms of acute ischemic stroke: An overview with emphasis on therapeutic significance beyond thrombolysis. PATHOPHYSIOLOGY 2010; 17:197-218. [DOI: 10.1016/j.pathophys.2009.12.001] [Citation(s) in RCA: 338] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/11/2009] [Accepted: 12/22/2009] [Indexed: 01/17/2023] Open
|
44
|
Kim HD, Sim SJ, Moon JY, Hong YC, Han DH. Association Between Periodontitis and Hemorrhagic Stroke Among Koreans: A Case-Control Study. J Periodontol 2010; 81:658-65. [DOI: 10.1902/jop.2010.090614] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
Nan Y, Zhao X, Wei L, Wang H, Xiao C, Zheng X. Determination of Jasminoidin in Rabbit Plasma for the Pharmacokinetic Investigation after Single Dose Oral Administration of Gardenia jasminoides Ellis and Gardenia jasminoides Ellis Coupling Coptis chinensis Franch Extracts. Chromatographia 2010. [DOI: 10.1365/s10337-010-1572-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
46
|
Montori S, Dos Anjos S, Ríos-Granja MA, Pérez-García CC, Fernández-López A, Martínez-Villayandre B. AMPA receptor downregulation induced by ischaemia/reperfusion is attenuated by age and blocked by meloxicam. Neuropathol Appl Neurobiol 2010; 36:436-47. [PMID: 20408958 DOI: 10.1111/j.1365-2990.2010.01086.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM Stroke prevalence increases with age, while alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor (AMPAR) and inflammation have been related to ischaemia-induced damage. This study shows how age and treatment with an anti-inflammatory agent (meloxicam) modify the levels of AMPAR subunits GluR1 and GluR2, as well as the mRNA levels of the GluR2-editing enzyme, ADAR2, in a global brain ischaemia/reperfusion (I/R) model. METHODS Two days after global ischaemia CA1, CA3, dentate gyrus and cerebral cortex were obtained from sham-operated and I/R-injured 3- and 18-month-old Sprague-Dawley rats. Real time polymerase chain reaction, Western blotting and immunohistochemical assays were performed. Meloxicam treatment was assayed on young animals. RESULTS Data showed that age attenuates the downregulation induced by I/R in the AMPAR subunits GluR1 and GluR2 and modifies the GluR1/GluR2 mRNA level ratio in a structure-dependent way. The study of the ADAR2 mRNA levels showed more downregulation in older animals than young ones. Meloxicam treatment prevented the transcriptional arrest induced by I/R. CONCLUSION Our data suggest that changes in the AMPAR isoforms could be associated with ageing in the different structures studied. Although GluR2 editing seems to be involved in age-dependent vulnerability to ischaemia supporting the 'GluR2 hypothesis', this alone does not explain the differential vulnerability in the different brain regions. Finally, inflammation could play a role in protection from I/R-induced injury.
Collapse
Affiliation(s)
- S Montori
- Area de Biología Celular, Instituto de Biomedicina. Universidad de León, 24071 León, Spain
| | | | | | | | | | | |
Collapse
|
47
|
Gorelick PB, Ruland S. Update of Cerebral Vascular Disease: Issues for the Primary Care Physician. Dis Mon 2010; 56:40-71. [DOI: 10.1016/j.disamonth.2009.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Nannetti L, Paci M, Baccini M, Rinaldi LA, Taiti PG. Recovery from stroke in patients with diabetes mellitus. J Diabetes Complications 2009; 23:249-54. [PMID: 18417372 DOI: 10.1016/j.jdiacomp.2008.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 01/29/2008] [Accepted: 02/14/2008] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM Diabetes mellitus (DM) is recognized as an important risk factor for stroke and might theoretically influence post-stroke level of disability, increasing the extension of the cerebral injured area. However, results of the few researches aimed at studying this influence are contradictory; moreover, the effect of DM on motor recovery has not been extensively studied. The aim of this study was to investigate the effect of DM on both functional and motor recovery. METHODS A total of 395 acute patients with first stroke were selected in a rehabilitation department and divided into two groups on the basis of the presence or absence of DM (DM+ and DM-, respectively). Outcome measures were the Barthel Index, the Fugl-Meyer Assessment Scale, and the mobility part of the motor assessment chart according to Lindmark and Hamrin. Participants were assessed at admission to department (T1, 13.9+/-7.9 days from stroke onset), at discharge (T2, 40.1+/-13.4), and at follow-up (T3, 84.2+/-14.3). A 2 x 3 analysis of variance with repeated measures was performed to verify the effect of group and of phase of assessment on motor and functional measures and their interaction. RESULTS DM+ and DM- groups included 93 and 302 patients, respectively. Both groups showed a significant and progressive improvement in all outcome measures (P<.001), but no interaction was found between group and phase of assessment, which means that motor and functional recovery was similar in the two groups. CONCLUSION Results suggest that diabetes has no influence on motor and functional outcome within the acute and post-acute phase after stroke. Further research should investigate motor recovery in a longer-term period and with larger samples.
Collapse
Affiliation(s)
- Luca Nannetti
- Department of Rehabilitation Medicine, Prato Hospital, Prato, Italy.
| | | | | | | | | |
Collapse
|
49
|
Bushnell CD, Colón-Emeric CS. Secondary stroke prevention strategies for the oldest patients: possibilities and challenges. Drugs Aging 2009; 26:209-30. [PMID: 19358617 DOI: 10.2165/00002512-200926030-00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Older adults are not only at higher risk of experiencing stroke, but also have multiple co-morbidities that make treatment for secondary stroke prevention challenging. Very few clinical trials specifically related to secondary stroke prevention treatment efficacy have focused on the oldest-old (>or=85 years) and, therefore, evidence-based recommendations for treatment specific to this population are not available. Some of the special considerations for stroke prevention treatments in older patients include careful titration of blood-pressure-lowering drugs to avoid hypotension, the risk of haemorrhagic stroke with HMG-CoA reductase inhibitors (statins) and weighing the risk of recurrent ischaemia versus bleeding in patients taking antiplatelet or anticoagulant therapy. The risk of peri-procedural complications appears to be high with both carotid angioplasty and stenting and carotid endarterectomy in older patients with carotid stenosis. Other common issues in older patients include adverse drug events, recognizing the risk of dementia, depression and osteoporosis and deciding when to discontinue secondary stroke prevention. In this review, we provide the practitioner with the evidence related to specific approaches to secondary stroke prevention in older patients, and identify the knowledge gaps that currently limit our ability to appropriately treat this vulnerable population.
Collapse
Affiliation(s)
- Cheryl D Bushnell
- Department of Neurology, Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157, USA.
| | | |
Collapse
|
50
|
Saba L, Montisci R, Sanfilippo R, Mallarini G. Multidetector row CT of the brain and carotid artery: a correlative analysis. Clin Radiol 2009; 64:767-78. [PMID: 19589415 DOI: 10.1016/j.crad.2009.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/16/2009] [Accepted: 03/19/2009] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the association between types of carotid plaque, the presence of prior ischaemic events detectable with CT, and patient's symptoms. MATERIALS AND METHODS Between January 2004 and May 2006, 112 patients were evaluated using multidetector row computed tomography angiography (MDCTA) of the carotid arteries and computed tomography (CT) of the brain. Carotid arteries were categorized by evaluating the degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, the type of plaque, and the presence of plaque ulceration. The brain was assessed via CT for the presence, type, and position of lesions. Chi-square tests, Student's t test, and simple logistic regression analysis were performed and the Cohen kappa test was applied for interobserver variability measurement. RESULTS The Chi-square test indicated a statistically significant association between the presence of fatty plaques (p=0.005) and CT-detectable lesions in the brain (p=0.004). Moreover, the number of patients with CT-detectable brain lesions was greater in patients with >70% stenosis than in those with <70% stenosis (p=0.007). Logistic regression confirmed the association between fatty plaque and symptoms (p=0.001), between >70% stenosis and symptoms (p=0.041), and an inverse association between calcified plaque and symptoms (p=0.009). CONCLUSION MDCTA allows adequate evaluation of the type of plaque. The results of the present study indicate that there is an association between cerebral lesions, symptoms, and fatty plaque in the carotid artery. The degree of stenosis also correlated with cerebral lesions and symptoms. According to the obtained data, the type of carotid plaque should be included among primary parameters in the classification of patients' risk class.
Collapse
Affiliation(s)
- L Saba
- Department of Imaging Science, Policlinico Universitario, s.s. 554 Monserrato (Cagliari) 09045, Italy.
| | | | | | | |
Collapse
|