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Ganesan V, Pandya R, Rodriguez AN, Horn AR, Abdelgawad AA, Razi AE. Comparison of patient demographics and patient-specific risk factors for readmissions following open reduction and internal fixation for acetabular fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1911-1915. [PMID: 38459969 DOI: 10.1007/s00590-024-03862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Acetabular fractures are highly complex injuries often resulting from high-energy trauma. The gold standard treatment for these injuries has become open reduction internal fixation (ORIF). The purpose of this study is to further this understanding and investigate how (1) patient demographics and (2) patient-specific risk factors affect 90-day readmission rates. METHODS A retrospective, nationwide query of private insurance database from January 1st, 2010 to October 31st, 2020 was performed using ICD-9, ICD-10, and CPT codes. Patients who underwent acetabular ORIF and were readmitted within 90 days following index procedure were included, patients who were not readmitted served as controls. Patients were divided by demographics and specific risk factors associated with readmission. RESULTS The query yielded a total of 3942 patients. Age and sex were found to be non-significant contributing risk factors to 90-day readmissions. Data also showed that statistically significant comorbidities included arrhythmia, cerebrovascular disease, coagulopathy, fluid and electrolyte abnormalities, and pathologic weight loss. CONCLUSION This study illustrated how several patient-specific risk factors may contribute to increased 90-day readmission risk following acetabular ORIF. A heightened awareness of these comorbidities in patients requiring acetabular ORIF is required to improve patient outcomes and minimize rates of readmission. Further investigation is needed to improve patient outcomes, and increase awareness of potential post-operative complications in these higher-risk patient populations.
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Affiliation(s)
- Vanathi Ganesan
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | - Radha Pandya
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | - Ariel N Rodriguez
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA.
| | - Andrew R Horn
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Amr A Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Afshin E Razi
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
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Hanna M, Wabnitz A, Grewal P. Sex and stroke risk factors: A review of differences and impact. J Stroke Cerebrovasc Dis 2024; 33:107624. [PMID: 38316283 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES There is an increase in stroke incidence risk over the lifetime of women, given their longer life expectancy. However, an alarming trend for sex disparities, particularly in certain stroke risk factors, shows a concerning need for focus on sex differences in stroke prevention and treatment for women. In this article, we are addressing sex differences in both traditional and sex-specific stroke risk factors. METHODS We searched PubMed from inception to December 2022 for articles related to sex differences and risk factors for stroke. We reviewed full-text articles for relevance and ultimately included 152 articles for this focused review. RESULTS Women are at increased risk for stroke from both traditional and non-traditional stroke risk factors. As women age, they have a higher disease burden of atrial fibrillation, increased risk of stroke related to diabetes, worsening lipid profiles, and higher prevalence of hypertension and obesity compared to men. Further, women carry sex hormone-specific risk factors for stroke, including the age of menarche, menopause, pregnancy, and its complications, as well as hormonal therapy. Men have a higher prevalence of tobacco use and atrial fibrillation, as well as an increased risk for stroke related to hyperlipidemia. Additionally, men have sex-specific risks related to low testosterone levels. CONCLUSIONS By identifying biological sex-specific risk factors for stroke, developing robust collaborations, researching, and applying the knowledge for risk reduction strategies, we can begin to tailor prevention and reduce the global burden of stroke morbidity and mortality.
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Affiliation(s)
- Mckay Hanna
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ashley Wabnitz
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Parneet Grewal
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Farkas K, Stanek A, Zbinden S, Borea B, Ciurica S, Moore V, Maguire P, Abola MTB, Alajar EB, Marcoccia A, Erer D, Casanegra AI, Sharebiani H, Sprynger M, Kavousi M, Catalano M. Vascular Diseases in Women: Do Women Suffer from Them Differently? J Clin Med 2024; 13:1108. [PMID: 38398419 PMCID: PMC10889109 DOI: 10.3390/jcm13041108] [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: 01/13/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue that affects not only research but also treatment and outcomes. The importance of recognizing the impacts of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the roles that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behavior, the development of diseases, their diagnosis, management, and the long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.
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Affiliation(s)
- Katalin Farkas
- Department of Angiology, Szent Imre University Teaching Hospital, Tétényi út 12-16, 1115 Budapest, Hungary
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
| | - Agata Stanek
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
| | - Stephanie Zbinden
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Angiology, Zurich University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Barbara Borea
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Angiology and Haemostasis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Simina Ciurica
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Cardiology, Marie Curie Civil Hospital, CHU Charleroi, Chaussée de Bruxelles 140, 6042 Lodelinsart, Belgium
| | - Vanessa Moore
- European Institute of Women’s Health, Ashgrove House, Kill Avenue, Dún Laoghaire, A96 N9K0 Dublin, Ireland; (V.M.); (P.M.)
| | - Peggy Maguire
- European Institute of Women’s Health, Ashgrove House, Kill Avenue, Dún Laoghaire, A96 N9K0 Dublin, Ireland; (V.M.); (P.M.)
| | - Maria Teresa B. Abola
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Clinical Research Department, Education, Training and Research Services, Philippine Heart Center, University of the Philippines College of Medicine, 547 Pedro Gil Street, Manila 1000, Metro Manila, Philippines
| | - Elaine B. Alajar
- Manila Doctors Hospital, 667 United Nations Ave, Ermita, Manila 1000, Metro Manila, Philippines;
| | - Antonella Marcoccia
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Angiology and Autoimmunity Medical Unit, Rare Diseases Reference Center for Systemic Sclerosis, Sandro Pertini Hospital, 00157 Rome, Italy
| | - Dilek Erer
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Gazi University Hospital, Mevlana Blv. No:29, Yenimahalle, Ankara 06560, Turkey
| | - Ana I. Casanegra
- Gonda Vascular Center, Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA;
| | - Hiva Sharebiani
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Muriel Sprynger
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Cardiology, University Hospital of Liège, Hospital Boulevard, 4000 Liege, Belgium
| | - Maryam Kavousi
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Biomedical and Clinical Science, Inter-University Research Center on Vascular Disease, University of Milan, GB Grassi 74, 20157 Milan, Italy
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Morrison C, Dadar M, Collins DL. Sex differences in risk factors, burden, and outcomes of cerebrovascular disease in Alzheimer's disease populations. Alzheimers Dement 2024; 20:34-46. [PMID: 37735954 PMCID: PMC10916959 DOI: 10.1002/alz.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are associated with cognitive decline and progression to mild cognitive impairment (MCI) and dementia. It remains unclear if sex differences influence WMH progression or the relationship between WMH and cognition. METHODS Linear mixed models examined the relationship between risk factors, WMHs, and cognition in males and females. RESULTS Males exhibited increased WMH progression in occipital, but lower progression in frontal, total, and deep than females. For males, history of hypertension was the strongest contributor, while in females, the vascular composite was the strongest contributor to WMH burden. WMH burden was more strongly associated with decreases in global cognition, executive functioning, memory, and functional activities in females than males. DISCUSSION Controlling vascular risk factors may reduce WMH in both males and females. For males, targeting hypertension may be most important to reduce WMHs. The results have implications for therapies/interventions targeting cerebrovascular pathology and subsequent cognitive decline. HIGHLIGHTS Hypertension is the main vascular risk factor associated with WMH in males A combination of vascular risk factors contributes to WMH burden in females Only small WMH burden differences were observed between sexes Females' cognition was more negatively impacted by WMH burden than males Females with WMHs may have less resilience to future pathology.
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Affiliation(s)
- Cassandra Morrison
- McConnell Brain Imaging CentreMontreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontrealQuebecCanada
| | - Mahsa Dadar
- Department of PsychiatryMcGill UniversityMontrealQuebecCanada
- Douglas Mental Health University Institute, McGill UniversityMontrealQuebecCanada
| | - Donald Louis Collins
- McConnell Brain Imaging CentreMontreal Neurological InstituteMcGill UniversityMontrealQuebecCanada
- Department of Neurology and NeurosurgeryMcGill UniversityMontrealQuebecCanada
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Hosokawa R, Ojima T, Myojin T, Aida J, Kondo K, Kondo N. Association between the Standardized Mortality Ratio and Healthy Life Expectancy in Japan. JMA J 2023; 6:27-35. [PMID: 36793525 PMCID: PMC9908415 DOI: 10.31662/jmaj.2022-0140] [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: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Healthy life expectancy (HLE) remains the principal target of various health plans. We aimed to identify the areas of priority and determinants of mortality to extend HLE across local governments in Japan. Methods HLE according to secondary medical areas was calculated using the Sullivan method. People requiring long-term care of level 2 or higher were considered unhealthy. Standardized mortality ratios (SMRs) for major causes of death were calculated using vital statistics data. The association between HLE and SMR was analyzed using simple and multiple regression analyses. Results The average (standard deviation) HLE values were 79.24 (0.85) and 83.76 (0.62) years for men and women, respectively. A comparison of HLE revealed regional health gaps of 4.46 (76.90-81.36) and 3.46 (81.99-85.45) years for men and women, respectively. The coefficients of determination for the SMR of malignant neoplasms with HLE were the highest and were 0.402 and 0.219 among men and women, respectively, followed by those of cerebrovascular diseases, suicide, and heart diseases among men and those of heart disease, pneumonia, and liver disease among women. When all major preventable causes of death were analyzed simultaneously in a regression model, the coefficients of determination were 0.738 and 0.425 among men and women, respectively. Conclusions Our findings suggest that local governments should prioritize preventing cancer deaths via cancer screening and smoking cessation measures in health plans, with a special focus on men.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan,Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan,Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Naoki Kondo
- School of Public Health and Graduate School of Medicine, Kyoto University, Kyoto, Japan
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White matter hyperintensity distribution differences in aging and neurodegenerative disease cohorts. Neuroimage Clin 2022; 36:103204. [PMID: 36155321 PMCID: PMC9668605 DOI: 10.1016/j.nicl.2022.103204] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION White matter hyperintensities (WMHs) are common magnetic resonance imaging (MRI) findings in the aging population in general, as well as in patients with neurodegenerative diseases. They are known to exacerbate the cognitive deficits and worsen the clinical outcomes in the patients. However, it is not well-understood whether there are disease-specific differences in prevalence and distribution of WMHs in different neurodegenerative disorders. METHODS Data included 976 participants with cross-sectional T1-weighted and fluid attenuated inversion recovery (FLAIR) MRIs from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort of the Canadian Consortium on Neurodegeneration in Aging (CCNA) with eleven distinct diagnostic groups: cognitively intact elderly (CIE), subjective cognitive impairment (SCI), mild cognitive impairment (MCI), vascular MCI (V-MCI), Alzheimer's dementia (AD), vascular AD (V-AD), frontotemporal dementia (FTD), Lewy body dementia (LBD), cognitively intact elderly with Parkinson's disease (PD-CIE), cognitively impaired Parkinson's disease (PD-CI), and mixed dementias. WMHs were segmented using a previously validated automated technique. WMH volumes in each lobe and hemisphere were compared against matched CIE individuals, as well as each other, and between men and women. RESULTS All cognitively impaired diagnostic groups had significantly greater overall WMH volumes than the CIE group. Vascular groups (i.e. V-MCI, V-AD, and mixed dementia) had significantly greater WMH volumes than all other groups, except for FTD, which also had significantly greater WMH volumes than all non-vascular groups. Women tended to have lower WMH burden than men in most groups and regions, controlling for age. The left frontal lobe tended to have a lower WMH burden than the right in all groups. In contrast, the right occipital lobe tended to have greater WMH volumes than the left. CONCLUSIONS There were distinct differences in WMH prevalence and distribution across diagnostic groups, sexes, and in terms of asymmetry. WMH burden was significantly greater in all neurodegenerative dementia groups, likely encompassing areas exclusively impacted by neurodegeneration as well as areas related to cerebrovascular disease pathology.
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Välimäki NN, Bakreen A, Häkli S, Dhungana H, Keuters MH, Dunlop Y, Koskuvi M, Keksa-Goldsteine V, Oksanen M, Jäntti H, Lehtonen Š, Malm T, Koistinaho J, Jolkkonen J. Astrocyte Progenitors Derived From Patients With Alzheimer Disease Do Not Impair Stroke Recovery in Mice. Stroke 2022; 53:3192-3201. [DOI: 10.1161/strokeaha.122.039700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Species-specific differences in astrocytes and their Alzheimer disease-associated pathology may influence cellular responses to other insults. Herein, human glial chimeric mice were generated to evaluate how Alzheimer disease predisposing genetic background in human astrocytes contributes to behavioral outcome and brain pathology after cortical photothrombotic ischemia.
METHODS:
Neonatal (P0) immunodeficient mice of both sexes were transplanted with induced pluripotent stem cell–derived astrocyte progenitors from Alzheimer disease patients carrying
PSEN1
exon 9 deletion (
P
SEN1
Δ
E
9), with isogenic controls, with cells from a healthy donor, or with mouse astrocytes or vehicle. After 14 months, a photothrombotic lesion was produced with Rose Bengal in the motor cortex. Behavior was assessed before ischemia and 1 and 4 weeks after the induction of stroke, followed by tissue perfusion for histology.
RESULTS:
Open field, cylinder, and grid-walking tests showed a persistent locomotor and sensorimotor impairment after ischemia and female mice had larger infarct sizes; yet, these were not affected by astrocytes with
P
SEN1
Δ
E
9 background. Staining for human nuclear antigen confirmed that human cells successfully engrafted throughout the mouse brain. However, only a small number of human cells were positive for astrocytic marker GFAP (glial fibrillary acidic protein), mostly located in the corpus callosum and retaining complex human-specific morphology with longer processes compared with host counterparts. While host astrocytes formed the glial scar, human astrocytes were scattered in small numbers close to the lesion boundary. Aβ (beta-amyloid) deposits were not present in
P
SEN1
ΔE
9 astrocyte-transplanted mice.
CONCLUSIONS:
Transplanted human cells survived and distributed widely in the host brain but had no impact on severity of ischemic damage after cortical photothrombosis in chimeric mice. Only a small number of transplanted human astrocytes acquired GFAP-positive glial phenotype or migrated toward the ischemic lesion forming glial scar.
P
SEN1
ΔE
9 astrocytes did not impair behavioral recovery after experimental stroke.
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Affiliation(s)
- Nelli-Noora Välimäki
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Abdulhameed Bakreen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Sara Häkli
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Hiramani Dhungana
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Meike H. Keuters
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Yannick Dunlop
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Marja Koskuvi
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Velta Keksa-Goldsteine
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Minna Oksanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Henna Jäntti
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Šárka Lehtonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Tarja Malm
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
| | - Jari Koistinaho
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
- Neuroscience Center, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Finland (H.D., M.H.K., M.K., Š.L., J.K.)
| | - Jukka Jolkkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (N.-N.V., A.B., S.H., H.D., M.H.K., Y.D., M.K., V.K.-G., M.O., H.J., Š.L., T.M., J.K., J.J.)
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Wu Y, Xin X, Guo A, Dan H. Assessment of the predictive value of carotid color Doppler ultrasound Crouse score combined with hs-CRP in elderly diabetics with cerebral infarction. Clin Physiol Funct Imaging 2022; 42:453-459. [PMID: 36059236 DOI: 10.1111/cpf.12786] [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: 03/08/2022] [Revised: 07/26/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both the carotid Crouse score and high-sensitivity C-reactive protein (hs-CRP) levels are commonly used to evaluate atherosclerosis and vascular inflammatory response. This study was to investigate the correlation between the Crouse score and high-sensitivity C-reactive protein (hs-CRP) and cerebral infarction (CI) in elderly diabetics. METHODS We compared the carotid Crouse scores and hs-CRP levels between 2 groups of diabetic patients with and without CIs (n=100 each) and the relationship between changes in these indices and CI. RESULTS Between the four groups (control, diabetic with a large CI, diabetic with a small CI, and diabetic with a lacunar CI) there was a significant difference in the age, sex, Crouse scores and hs-CRP levels, as well as fasting blood glucose and HbA1c (All P<0.05). Logistic regression analysis with CI as the dependent variable showed that the age (OR=1.114, 95% CI: 1.063-1.167, P=0.000), fasting blood glucose (OR=1.260, 95% CI: 1.102-1.570, P=0.039), HbA1c (OR=2.036, 95% CI: 1.348-3.703, P=0.001), Crouse score (OR=2.721, 95% CI: 1.800-4.114, P=0.000) and hs-CRP level (OR=3.364, 95% CI: 2.185-5.180, P=0.000) were risk factors for a CI in combination with diabetes mellitus. Significant differences were found in age, DBP, Crouse scores and hs-CRP levels between the male Diabetic-non-CI subgroup, female Diabetic-non-CI subgroup, male Diabetic-CI subgroup and female Diabetic-CI subgroup (All P<0.05). CONCLUSION The carotid Crouse score method has high reliability and reflects the severity of carotid atherosclerosis. The age, sex, FBG, HbA1c, Crouse score, an elevated hs-CRP level, and the occurrence of CI in elderly with diabetes mellitus are closely related. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuee Wu
- Physical Examination Center of the Second Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Xin Xin
- Physical Examination Center of the Second Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Ainan Guo
- Physical Examination Center of the Second Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Haijun Dan
- Physical Examination Center of the Second Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
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Li B, Eisenberg N, Howe KL, Forbes TL, Roche-Nagle G. The impact of sex on outcomes following carotid endarterectomy. Ann Vasc Surg 2022; 88:210-217. [PMID: 36029946 DOI: 10.1016/j.avsg.2022.08.003] [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: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Previous studies have demonstrated significant sex differences in vascular surgery outcomes. We assessed stroke or death rates following carotid endarterectomy (CEA) in women vs. men. METHODS The Vascular Quality Initiative (VQI) was used to identify all patients who underwent CEA between 2010-2019. Demographic, clinical, and procedural characteristics were recorded and differences between women vs. men were assessed using independent t-test and chi-square test. The primary outcomes were 30-day and 1-year stroke or death. Associations between sex and outcomes were assessed using univariate/multivariate logistic regression and Cox proportional hazards analysis. RESULTS 52,137 women and 79,974 men underwent CEA in VQI sites during the study period. Women were younger (70.3 vs. 70.5 years, p < 0.001) and more likely to have hypertension (89.2% vs. 88.9%, p < 0.05) and diabetes (36.2% vs. 35.8%, p < 0.001), but less likely to be diagnosed with coronary artery disease (23.2% vs. 31.0%, p < 0.001). A greater proportion of men were receiving cardiovascular risk reduction medications and had symptomatic carotid stenosis (28.5% vs. 26.7%, p < 0.001). Women had shorter procedure times (113 vs. 122 minutes, p < 0.001) and were less likely to receive electroencephalography neuromonitoring (27.9% vs. 28.8%, p < 0.001), drain (35.9% vs. 37.3%, p < 0.001), and protamine (67.4% vs. 68.0%, p < 0.01). Stroke or death at 30 days (1.9% vs. 1.8%, p = 0.60) and 1 year (HR 0.98 [95% CI 0.94 - 1.01], p = 0.20) were similar between groups, which persisted in asymptomatic patients (HR 0.97 [95% CI 0.93 - 1.01], p = 0.17) and symptomatic patients (HR 0.99 [95% CI 0.93 - 1.05], p = 0.71). The similarities in 1-year stroke or death rates existed in both the US (HR 0.96 [95% CI 0.92 - 1.01], p = 0.09) and Canada (HR 1.21 [95% CI 0.47 - 3.11], p = 0.70). CONCLUSIONS Despite sex differences in clinical and procedural characteristics, women and men have similar 30-day and 1-year outcomes following carotid endarterectomy.
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Affiliation(s)
- Ben Li
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Eisenberg
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn L Howe
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Cai Y, Liu Z, Jia C, Zhao J, Chai S, Li Z, Xu C, Zhang T, Ma Y, Ma C, Chen X, Jiang P, Zhao W, Chen J, Xiong N. Comparison of Sex Differences in Outcomes of Patients With Aneurysmal Subarachnoid Hemorrhage: A Single-Center Retrospective Study. Front Neurol 2022; 13:853513. [PMID: 35572942 PMCID: PMC9103686 DOI: 10.3389/fneur.2022.853513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/09/2022] [Indexed: 01/29/2023] Open
Abstract
Background Sex differences in the outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain controversial. The aim of this study was to evaluate sex differences in the outcomes of patients with aSAH. Method This study retrospectively analyzed the clinical data of consecutive patients with aSAH, admitted to the Department of Neurosurgery, Wuhan University Zhongnan Hospital, from May 1, 2020 to December 31, 2020. The modified Rankin Scale (mRS) score was used to evaluate the prognosis of patients at discharge. Outcome indicators included cerebral ischemia, hydrocephalus, and mRS ≥ 2 at discharge. Results The majority (65%) of the 287 patients with aSAH included in the study were females. Patients were divided into female (n = 184) and male (n = 99) groups; the female patients were significantly older than the male patients (61.3 ± 8.5 years vs. 60.0 ± 8.5 years, p = 0.032). The incidence of comorbidities (hypertension, diabetes, and heart disease) was higher in the female group than in the male group, but the difference was not statistically significant. Although more female patients than male patients underwent endovascular treatment, there was no statistical difference in the treatment approach between the two groups. Comparison of post-operative complications and mRS scores at discharge revealed that the rate of cerebral ischemia and mRS ≥ 2 at discharge were significantly higher among female patients than among male patients. Moreover, this difference persisted after propensity adjustment for age and treatment approach. Analysis of risk factors for poor prognosis at discharge in both pre- and post-adjustment patients revealed cerebral ischemia and high mFisher score (mFisher = 3/4) to be independent risk factors. Conclusion Female patients with aSAH have a worse prognosis than male patients, and this difference may be because women are more susceptible to cerebral ischemia.
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Lecordier S, Pons V, Rivest S, ElAli A. Multifocal Cerebral Microinfarcts Modulate Early Alzheimer’s Disease Pathology in a Sex-Dependent Manner. Front Immunol 2022; 12:813536. [PMID: 35173711 PMCID: PMC8841345 DOI: 10.3389/fimmu.2021.813536] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
Alzheimer’s disease (AD) constitutes a major cause of dementia, affecting more women than men. It is characterized by amyloid-β (Aβ) deposition and neurofibrillary tangles (NFTs) formation, associated with a progressive cognitive decline. Evidence indicates that AD onset increases the prevalence of cerebral microinfarcts caused by vascular pathologies, which occur in approximately in half of AD patients. In this project, we postulated that multifocal cerebral microinfarcts decisively influence early AD-like pathology progression in a sex dependent manner in young APP/PS1 mice. For this purpose, we used a novel approach to model multifocal microinfarcts in APP/PS1 mice via the sporadic occlusions of the microvasculature. Our findings indicate that microinfarcts reduced Aβ deposits without affecting soluble Aβ levels in the brain of male and female APP/PS1 mice, while causing rapid and prolonged cognitive deficits in males, and a mild and transient cognitive decline in females. In male APP/PS1 mice, microinfarcts triggered an acute hypoperfusion followed by a chronic hyperperfusion. Whereas in female APP/PS1 mice, microinfarcts caused an acute hypoperfusion, which was recovered in the chronic phase. Microinfarcts triggered a robust microglial activation and recruitment of peripheral monocytes to the lesion sites and Aβ plaques more potently in female APP/PS1 mice, possibly accounting for the reduced Aβ deposition. Finally, expression of Dickkopf-1 (DKK1), which plays a key role in mediating synaptic and neuronal dysfunction in AD, was strongly induced at the lesion sites of male APP/PS1 mice, while its expression was reduced in females. Our findings suggest that multifocal microinfarcts accelerate AD pathology more potently in young males compared to young females independently upon Aβ pathology via modulation of neurovascular coupling, inflammatory response, and DKK1 expression. Our results suggest that the effects of microinfarcts should be taken into consideration in AD diagnosis, prognosis, and therapies.
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Affiliation(s)
- Sarah Lecordier
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Vincent Pons
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Serge Rivest
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Ayman ElAli
- Neuroscience Axis, Research Center of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- *Correspondence: Ayman ElAli,
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