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Smith MJ, Pellegrini M, Major B, Graco M, Porter S, Kramer S, Sewell K, Salberg S, Chen Z, Mychasiuk R, Lannin NA. Improving physical movement during stroke rehabilitation: investigating associations between sleep measured by wearable actigraphy technology, fatigue, and key biomarkers. J Neuroeng Rehabil 2024; 21:84. [PMID: 38802847 PMCID: PMC11131210 DOI: 10.1186/s12984-024-01380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Sleep disturbance and fatigue are common in individuals undergoing inpatient rehabilitation following stroke. Understanding the relationships between sleep, fatigue, motor performance, and key biomarkers of inflammation and neuroplasticity could provide valuable insight into stroke recovery, possibly leading to personalized rehabilitation strategies. This study aimed to investigate the influence of sleep quality on motor function following stroke utilizing wearable technology to obtain objective sleep measurements. Additionally, we aimed to determine if there were relationships between sleep, fatigue, and motor function. Lastly, the study aimed to determine if salivary biomarkers of stress, inflammation, and neuroplasticity were associated with motor function or fatigue post-stroke. METHODS Eighteen individuals who experienced a stroke and were undergoing inpatient rehabilitation participated in a cross-sectional observational study. Following consent, participants completed questionnaires to assess sleep patterns, fatigue, and quality of life. Objective sleep was measured throughout one night using the wearable Philips Actiwatch. Upper limb motor performance was assessed on the following day and saliva was collected for biomarker analysis. Correlation analyses were performed to assess the relationships between variables. RESULTS Participants reported poor sleep quality, frequent awakenings, and difficulties falling asleep following stroke. We identified a significant negative relationship between fatigue severity and both sleep quality (r=-0.539, p = 0.021) and participants experience of awakening from sleep (r=-0.656, p = 0.003). A significant positive relationship was found between grip strength on the non-hemiplegic limb and salivary gene expression of Brain-derived Neurotrophic Factor (r = 0.606, p = 0.028), as well as a significant negative relationship between grip strength on the hemiplegic side and salivary gene expression of C-reactive Protein (r=-0.556, p = 0.048). CONCLUSION The findings of this study emphasize the importance of considering sleep quality, fatigue, and biomarkers in stroke rehabilitation to optimize recovery and that interventions may need to be tailored to the individual. Future longitudinal studies are required to explore these relationships over time. Integrating wearable technology for sleep and biomarker analysis can enhance monitoring and prediction of outcomes following stroke, ultimately improving rehabilitation strategies and patient outcomes.
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Affiliation(s)
- Madeleine J Smith
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Michael Pellegrini
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Brendan Major
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, 3004, Australia
| | | | | | - Sharon Kramer
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, 3004, Australia
| | - Katherine Sewell
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Sabrina Salberg
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Zhibin Chen
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Alfred Health, Melbourne, VIC, 3004, Australia.
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Hu L, Qiao Z, Xu M, Feng J, Shan Q, Sheng X, Xu G, Xu Y, Hu W, Wang G, Jin X. Establishment and validation of a 3-month prediction model for poor functional outcomes in patients with acute cardiogenic cerebral embolism related to non-valvular atrial fibrillation. Front Neurol 2024; 15:1392568. [PMID: 38841691 PMCID: PMC11150815 DOI: 10.3389/fneur.2024.1392568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives Cardiogenic cerebral embolism (CCE) poses a significant health risk; however, there is a dearth of published prognostic prediction models addressing this issue. Our objective is to establish prognostic prediction models (PM) for predicting poor functional outcomes at 3 months in patients with acute CCE associated with non-valvular atrial fibrillation (NVAF) and perform both internal and external validations. Methods We included a total of 730 CCE patients in the development cohort. The external regional validation cohort comprised 118 patients, while the external time-sequential validation cohort included 63 patients. Multiple imputation by chained equations (MICE) was utilized to address missing values and the least absolute shrink and selection operator (LASSO) regression was implemented through the glmnet package, to screen variables. Results The 3-month prediction model for poor functional outcomes, denoted as N-ABCD2, was established using the following variables: NIHSS score at admission (N), Age (A), Brain natriuretic peptide (BNP), C-reactive protein (CRP), D-dimer polymers (D), and discharge with antithrombotic medication (D). The model's Akaike information criterion (AIC) was 637.98, and the area under Curve (AUC) for the development cohort, external regional, and time-sequential cohorts were 0.878 (95% CI, 0.854-0.902), 0.918 (95% CI, 0.857-0.979), and 0.839 (95% CI, 0.744-0.934), respectively. Conclusion The N-ABCD2 model can accurately predict poor outcomes at 3 months for CCE patients with NVAF, demonstrating strong prediction abilities. Moreover, the model relies on objective variables that are readily obtainable in clinical practice, enhancing its convenience and applicability in clinical settings.
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Affiliation(s)
- Lan Hu
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Mengshi Xu
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Jie Feng
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Qingting Shan
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Xihua Sheng
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Guoli Xu
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Yuan Xu
- Department of Neurology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Wenze Hu
- Department of Nursing, Ezhou Polytechnic, Ezhou, Hubei, China
| | - Guojun Wang
- Department of Neurology, Changshu Hospital Affiliated to Soochow University, Changshu No.1 People’s Hospital, Suzhou, Jiangsu, China
| | - Xuehong Jin
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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Brinholi FF, Michelin AP, Matsumoto AK, de O Semeão L, Almulla AF, Supasitthumrong T, Tunvirachaisakul C, Barbosa DS, Maes M. Paraoxonase 1 status is a major Janus-faced component of mild and moderate acute ischemic stroke and consequent disabilities. Metab Brain Dis 2023; 38:2115-2131. [PMID: 37204661 DOI: 10.1007/s11011-023-01232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
AIMS This study aims to examine the associations between paraoxonase 1 (PON)1 status and acute ischemic stroke (AIS) and consequent disabilities. METHODS This study recruited 122 patients with AIS and 40 healthy controls and assessed the Q192R gene variants, arylesterase (AREase) and chloromethyl phenylacetate (CMPAase) activities, and high-density lipoprotein cholesterol (HDLc) in baseline conditions. AREase and CMPAase were measured 3 months later. The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin score (mRS) were assessed at baseline and 3 and 6 months later. RESULTS Reduced CMPAase and increased AREase activities are significantly associated with AIS and mRS and NIHSS scores (baseline and 3 and 6 months later). The best predictor of AIS/disabilities was a decrease in the z-unit-based composite zCMPAase-zAREase score. Serum high density lipoprotein cholsterol (HDLc) was significantly correlated with CMPAase, but not AREase, activity and a lowered zCMPAase + zHDLc score was the second best predictor of AIS/disabilities. Regression analysis showed that 34.7% of the variance in baseline NIHSS was explained by zCMPAase-zAREase and zCMPAase + zHDLc composites, HDLc, and hypertension. Neural network analysis showed that stroke was differentiated from controls with an area under the ROC curve of 0.975 using both new composite scores, PON1 status, hypertension, dyslipidemia, previous stroke as body mass index. The PON1 Q192R genotype has many significant direct and mediated effects on AIS/disabilities, however, its overall effect was not significant. DISCUSSION PON1 status and the CMPAase-HDLc complex play key roles in AIS and its disabilities at baseline and 3 and 6 months later.
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Affiliation(s)
- Francis F Brinholi
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Ana Paula Michelin
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Andressa K Matsumoto
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Laura de O Semeão
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Abbas F Almulla
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok, 10330, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | - Thitiporn Supasitthumrong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok, 10330, Thailand
| | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok, 10330, Thailand
| | - Décio S Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok, 10330, Thailand.
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
- Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea.
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Bian J, Guo S, Huang T, Li X, Zhao S, Chu Z, Li Z. CRP as a potential predictor of outcome in acute ischemic stroke. Biomed Rep 2023; 18:17. [PMID: 36776580 PMCID: PMC9892964 DOI: 10.3892/br.2023.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
Ischemic stroke is one of the major causes of death and long-term disability worldwide. C-reactive protein (CRP) as a potential biomarker for functional outcome after acute ischemic stroke remains controversial. The aim of the present study was to examine the association between the level of CRP and functional outcome of stroke. A total of 218 consecutive patients with acute ischemic stroke within 24 h after onset were recruited for the study. Poor functional outcome was defined as a modified Rankin scale score of >2 at 3 months after stroke. The retrospective analysis was performed to investigate whether CRP within 24 h after stroke is associated with poor functional outcome at 3 months. Multivariate logistic regression analysis indicated that the CRP level (odds ratio=1.146, 95%CI: 1.012-1.297, P=0.031) was an independent risk factor for poor outcome. The receiver operating characteristics curve analysis revealed that the optimal cut-off value of CRP to distinguish favorable from poor outcome was 6.34 (area under the curve=0.829, 95%CI: 0.772-0.887, P<0.001), with 68.2% sensitivity and 85.7% specificity. Spearman correlation analysis indicated that the CRP level was positively related to the baseline National Institutes of Health Stroke Scale (NIHSS) score (r=0.551, P<0.001), fasting glucose (r=0.301, P<0.001) and age (r=0.252, P<0.001). In conclusion, a high level of CRP within 24 h after onset was associated with a poor functional outcome after the acute ischemic event. The elevation of CRP may be correlated with the baseline NIHSS score, fasting glucose and age.
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Affiliation(s)
- Jing Bian
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Siping Guo
- Department of Neurology, Suzhou Dushuhu Public Hospital, Suzhou, Jiangsu 215125, P.R. China
| | - Tingting Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Xiuyun Li
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Shoucai Zhao
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zhaohu Chu
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zibao Li
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China,Correspondence to: Dr Zibao Li, Department of Neurology, Yijishan Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui 241001, P.R. China
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Maes M, Brinholi FF, Michelin AP, Matsumoto AK, de Oliveira Semeão L, Almulla AF, Supasitthumrong T, Tunvirachaisakul C, Barbosa DS. In Mild and Moderate Acute Ischemic Stroke, Increased Lipid Peroxidation and Lowered Antioxidant Defenses Are Strongly Associated with Disabilities and Final Stroke Core Volume. Antioxidants (Basel) 2023; 12:antiox12010188. [PMID: 36671047 PMCID: PMC9854933 DOI: 10.3390/antiox12010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
In acute ischemic stroke (AIS), there are no data on whether oxidative stress biomarkers have effects above and beyond known risk factors and measurements of stroke volume. This study was conducted in 122 mild-moderate AIS patients and 40 controls and assessed the modified ranking scale (mRS) at baseline, and 3 and 6 months later. We measured lipid hydroperoxides (LOOH), malondialdehyde (MDA), advanced oxidation protein products, paraoxonase 1 (PON1) activities and PON1 Q192R genotypes, high density lipoprotein cholesterol (HDL), sulfhydryl (-SH) groups), and diffusion-weighted imaging (DWI) stroke volume and fluid-attenuated inversion recovery (FLAIR) signal intensity. We found that (a) AIS is characterized by lower chloromethyl acetate CMPAase PON1 activity, HDL and -SH groups and increased LOOH and neurotoxicity (a composite of LOOH, inflammatory markers and glycated hemoglobin); (b) oxidative and antioxidant biomarkers strongly and independently predict mRS scores 3 and 6 months later, DWI stroke volume and FLAIR signal intensity; and (c) the PON1 Q192R variant has multiple effects on stroke outcomes that are mediated by its effects on antioxidant defenses and lipid peroxidation. Lipid peroxidation and lowered -SH and PON1-HDL activity are drug targets to prevent AIS and consequent neurodegenerative processes and increased oxidative reperfusion mediators due to ischemia-reperfusion injury.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok 10330, Thailand
- Cognitive Fitness and Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
- Research Institute, Medical University Plovdiv, 4000 Plovdiv, Bulgaria
- Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC 3220, Australia
- Correspondence:
| | - Francis F. Brinholi
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Ana Paula Michelin
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Andressa K. Matsumoto
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Laura de Oliveira Semeão
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
| | - Abbas F. Almulla
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
| | - Thitiporn Supasitthumrong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok 10330, Thailand
| | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Phayathai Road, Pathumwan, Bangkok 10330, Thailand
| | - Decio S. Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Londrina 86057-970, PR, Brazil
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A Novel Marker Indicating Restenosis in Superficial Femoral Artery: C Reactive Protein to Albumin Ratio. Ann Vasc Surg 2022; 86:158-167. [PMID: 35568327 DOI: 10.1016/j.avsg.2022.04.041] [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: 01/29/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022]
Abstract
AIM In this study, we aimed to investigate the prognostic value of CAR for predicting restenosis in SFA lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention. METHODS The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs 10.3%, p<0.05) and mortality (31.3% vs 12.9%, p<0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs 3%, p<0.05). With respect to ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% CI: 0.611-0.706; p<0.01). CONCLUSION Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.
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Couch C, Mallah K, Borucki DM, Bonilha HS, Tomlinson S. State of the science in inflammation and stroke recovery: A systematic review. Ann Phys Rehabil Med 2022; 65:101546. [PMID: 34098132 PMCID: PMC9018463 DOI: 10.1016/j.rehab.2021.101546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 11/20/2022]
Abstract
Stroke is a major cause of mortality worldwide, and survivors often have major life-changing disabilities. Annually in the United States, an estimated 795,000 people experience a new or recurrent stroke. All types of stroke involve an inflammatory reaction that follows the initial phase of incidence. However, investigations into any links between inflammatory markers and recovery processes in the context of post-stroke rehabilitation are lacking. In this systematic review, we searched the literature in PubMed, SCOPUS, and CINAHL databases to gather information on inflammatory biomarkers related to stroke and their association with rehabilitation outcomes, according to PRISMA guidelines. Eleven articles (n=1.773 stroke patients) were selected. Immune markers (interleukin 6 [IL-6], C-reactive protein, IL-1α, tumor necrosis factor α, soluble intercellular adhesion molecule 1) and functional status assessments (Modified Rankin Score, National Institutes of Health Stroke Scale, Functional Independence Measure, etc.) were the primary measures used in the reviewed studies. We found preliminary evidence for the evaluation of inflammatory biomarkers post-stroke, including the role of inflammation in functional recovery and the influence of rehabilitation on inflammation. This is the first systematic review of the topic. The review identifies several gaps in the literature that are critical for understanding the potential use of inflammatory markers to improve post-stroke outcomes.
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Affiliation(s)
- Christine Couch
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA; Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Khalil Mallah
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA
| | - Davis M Borucki
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA; Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Shaw Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Tomlinson
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB 204, MSC 504, Charleston, SC, 29425, USA; Ralph Johnson VA Medical Center, Charleston, SC, USA.
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Feng RF, Ma R, Wang P, Ji X, Zhang ZX, Li MM, Jiao JW, Guo L. Efficacy of escitalopram for poststroke depression: a systematic review and meta-analysis. Sci Rep 2022; 12:3304. [PMID: 35228575 PMCID: PMC8885641 DOI: 10.1038/s41598-022-05560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Depression is very common after stroke, causing multiple sequelae. We aimed to explore the efficacy of escitalopram for poststroke depression (PSD). PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Clinical trials. gov, Wan fang Data (Chinese), VIP (Chinese) and CNKI (Chinese) were retrieved from inception to May 2021. We recruited Randomized Controlled Trials (RCTs) which met the inclusion criteria in our study. The depression rating scores, the incidence of PSD, adverse events as well as functional outcomes were analyzed. 11 studies and 1374 participants were recruited in our work. The results were depicted: the reduction of depression rating scores was significant in the escitalopram groups and the standard mean difference (SMD) was − 1.25 (P < 0.001), 95% confidence interval (95% CI), − 1.82 to − 0.68; the risk ratio (RR) of the incidence of PSD was 0.52 (95% CI, 0.29 to 0.91; P = 0.007 < 0.05), which was significantly lower in the escitalopram groups; Escitalopram is safe for stroke patients; there was improvement of the motor function. However, in sensitivity analyses, the conclusions of the motor function and the incidence of drowsiness were altered. The study suggests that escitalopram has a potentially effective role compared with control groups and demonstrates escitalopram is safe. However, the results of the motor function and the incidence of drowsiness should be considered carefully and remain to be discussed in the future.
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Affiliation(s)
- Rong-Fang Feng
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Rui Ma
- College of Physical Education (Based School), Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Peng Wang
- Department of Basic Medicine, School of Nursing and Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China. .,Zhengzhou University of Industrial Technology, Zhengzhou, 450002, Henan, People's Republic of China. .,Medical School of Huanghe Science and Technology University, Zhengzhou, 450006, Henan, People's Republic of China.
| | - Xu Ji
- Henan University of Chinese Medicine, Zhengzhou, 450046, Henan, People's Republic of China
| | - Zhen-Xiang Zhang
- Department of Clinical Medicine, School of Nursing and Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Meng-Meng Li
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450007, People's Republic of China
| | - Jia-Wei Jiao
- Department of Basic Medicine, School of Nursing and Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Li Guo
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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AlTaweel YAAH, Nageeb RS, Metwally PM, Badawy AE. Role of some inflammatory biomarkers in prediction of short-term outcome in acute ischemic stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Several factors affect acute ischemic stroke (AIS) outcomes.
Objective
This study aimed to assess the role of the leukocyte count, neutrophil/lymphocyte ratio (NLR), and c reactive protein (CRP) as early predictors of outcome in AIS patients.
Methods
This study was conducted on 60 AIS patients. They were subjected to detailed history taking, clinical examination, brain imaging, and laboratory assessment including the CRP, white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and NLR which is calculated by dividing ANC by ALC. Neurological scales were used to assess the level of consciousness by the Glasgow Coma Scale (GCS) and stroke severity by the National Institute of Health Stroke Scale (NIHSS) at the first 48 h of stroke onset as well as 1 week and 2 weeks later for the assessment of short-term functional neurological outcome.
Results
Sixty percent of the patients had unfavorable outcomes assessed by the Modified Rankin Scale (mRS). Patients with unfavorable outcomes had higher NIHSS scores. NLR was positively correlated with WBC count, ANC, and CRP. The higher WBC, NLR, and NIHSS, the unfavorable the outcome was.
Conclusion
The higher WBC, the NLR, and the level of CRP at the onset of AIS, the more severe stroke and the poorer the short-term outcome are expected.
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Associations between C-reactive protein and white blood cell count, occurrence of delayed cerebral ischemia and poor outcome following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Acta Neurol Belg 2021; 121:1311-1324. [PMID: 33423218 PMCID: PMC7796813 DOI: 10.1007/s13760-020-01496-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
This review and meta-analysis investigated associations of systemic inflammatory marker C-reactive protein (CRP) and white blood cell count (WBC) with occurrence of delayed cerebral ischemia (DCI) and poor functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). Pubmed, EMBASE, and CENTRAL databases were searched until November 30, 2019, selecting prospective and retrospective studies of patients with spontaneous SAH due to ruptured aneurysm. Outcome measures were occurrence of DCI, defined as new focal neurological deficit or a deterioration of consciousness; and/or a new infarct on computed tomography or magnetic resonance imaging that was not visible initially. Occurrence of poor functional outcome at follow-up were measured by modified Rankin Scale or Glasgow outcomes scale. Fifteen studies analyzing data of 3268 patients with aSAH were included. Meta-analysis revealed early increase in CRP was significantly associated with higher risk of occurrence of DCI (pooled OR 1.30, 95% CI 1.10–1.54; P = 0.002), whereas not with poor functional outcome (pooled OR 1.02, 95% CI 1.00–1.04, P = 0.052). No significant associations between early increase in WBC and DCI (pooled OR 1.13, 95% CI 0.95–1.34; P = 0.179) were observed, whereas increase in WBC was significantly associated with increased risk of poor functional outcome (pooled OR 1.17, 95% CI 1.07–1.28, P = 0.001). Early increase in blood CRP appears to correlate with DCI after SAH, while increase in WBC correlates with poor functional outcome. However, strong conclusion cannot be made due to the small study number, between-study heterogeneity and suspicion of uncontrolled factors. Whether early phase CRP and WBC may serve as prognostic markers for aSAH needs more investigation.
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Andone S, Bajko Z, Motataianu A, Mosora O, Balasa R. The Role of Biomarkers in Atherothrombotic Stroke-A Systematic Review. Int J Mol Sci 2021; 22:ijms22169032. [PMID: 34445740 PMCID: PMC8396595 DOI: 10.3390/ijms22169032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/26/2022] Open
Abstract
Stroke represents the primary debilitating disease in adults and is the second-highest cause of death worldwide. Atherosclerosis, the most prevalent etiology for vascular conditions, is a continuous process that gradually creates and develops endothelial lesions known as atherosclerotic plaques. These lesions lead to the appearance of atherothrombotic stroke. In the last decades, the role of biological biomarkers has emerged as either diagnostic, prognostic, or therapeutic targets. This article aims to create a list of potential biomarkers related to atherothrombotic stroke by reviewing the currently available literature. We identified 23 biomarkers and assessed their roles as risk factors, detection markers, prognostic predictors, and therapeutic targets. The central aspect of these biomarkers is related to risk stratification, especially for patients who have not yet suffered a stroke. Other valuable data are focused on the predictive capabilities for stroke patients regarding short-term and long-term prognosis, including their influence over the acute phase treatment, such as rt-PA thrombolysis. Although the role of biomarkers is anticipated to be of extreme value in the future, they cannot yet compete with traditional stroke neuroimaging markers but could be used as additional tools for etiological diagnosis.
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Affiliation(s)
- Sebastian Andone
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (S.A.); (R.B.)
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
| | - Zoltan Bajko
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, 540136 Targu Mures, Romania
- Correspondence:
| | - Anca Motataianu
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, 540136 Targu Mures, Romania
| | - Oana Mosora
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
| | - Rodica Balasa
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (S.A.); (R.B.)
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (O.M.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, 540136 Targu Mures, Romania
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Chumachenko MS, Waseem TV, Fedorovich SV. Metabolomics and metabolites in ischemic stroke. Rev Neurosci 2021; 33:181-205. [PMID: 34213842 DOI: 10.1515/revneuro-2021-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/09/2021] [Indexed: 12/27/2022]
Abstract
Stroke is a major reason for disability and the second highest cause of death in the world. When a patient is admitted to a hospital, it is necessary to identify the type of stroke, and the likelihood for development of a recurrent stroke, vascular dementia, and depression. These factors could be determined using different biomarkers. Metabolomics is a very promising strategy for identification of biomarkers. The advantage of metabolomics, in contrast to other analytical techniques, resides in providing low molecular weight metabolite profiles, rather than individual molecule profiles. Technically, this approach is based on mass spectrometry and nuclear magnetic resonance. Furthermore, variations in metabolite concentrations during brain ischemia could alter the principal neuronal functions. Different markers associated with ischemic stroke in the brain have been identified including those contributing to risk, acute onset, and severity of this pathology. In the brain, experimental studies using the ischemia/reperfusion model (IRI) have shown an impaired energy and amino acid metabolism and confirmed their principal roles. Literature data provide a good basis for identifying markers of ischemic stroke and hemorrhagic stroke and understanding metabolic mechanisms of these diseases. This opens an avenue for the successful use of identified markers along with metabolomics technologies to develop fast and reliable diagnostic tools for ischemic and hemorrhagic stroke.
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Affiliation(s)
- Maria S Chumachenko
- Department of Biochemistry, Faculty of Biology, Belarusian State University, Kurchatova St., 10, Minsk220030, Belarus
| | | | - Sergei V Fedorovich
- Department of Biochemistry, Faculty of Biology, Belarusian State University, Kurchatova St., 10, Minsk220030, Belarus
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Immune-inflammatory, coagulation, adhesion, and imaging biomarkers combined in machine learning models improve the prediction of death 1 year after ischemic stroke. Clin Exp Med 2021; 22:111-123. [PMID: 34120242 DOI: 10.1007/s10238-021-00732-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/04/2021] [Indexed: 01/02/2023]
Abstract
Some clinical, imaging, and laboratory biomarkers have been identified as predictors of prognosis of acute ischemic stroke (IS). The aim of this study was to evaluate the prognostic validity of a combination of clinical, imaging, and laboratory biomarkers in predicting 1-year mortality of IS. We evaluated 103 patients with IS within 24 h of their hospital admission and assessed demographic data, IS severity using the National Institutes of Health Stroke Scale (NIHSS), carotid intima-media thickness (cIMT), and degree of stenosis, as well as laboratory variables including immune-inflammatory, coagulation, and endothelial dysfunction biomarkers. The IS patients were categorized as survivors and non-survivors 1 year after admission. Non-survivors showed higher NIHSS and cIMT values, lower antithrombin, Protein C, platelet counts, and albumin, and higher Factor VIII, von Willebrand Factor (vWF), white blood cells, tumor necrosis factor (TNF)-α, interleukin (IL)-10, high-sensitivity C-reactive protein (hsCRP), and vascular cellular adhesion molecule 1 (VCAM-1) than survivors. Neural network models separated non-survivors from survivors using NIHSS, cIMT, age, IL-6, TNF-α, hsCRP, Protein C, Protein S, vWF, and platelet endothelial cell adhesion molecule 1 (PECAM-1) with an area under the receiving operating characteristics curve (AUC/ROC) of 0.975, cross-validated accuracy of 93.3%, sensitivity of 100% and specificity of 85.7%. In conclusion, imaging, immune-inflammatory, and coagulation biomarkers add predictive information to the NIHSS clinical score and these biomarkers in combination may act as predictors of 1-year mortality after IS. An early prediction of IS outcome is important for personalized therapeutic strategies that may improve the outcome of IS.
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Hu Z, Lai J, Chen L, Yi Y, Li R, Liao W. Can baseline C-reactive protein level predict functional outcome in acute ischaemic stroke? A meta-analysis. Biomarkers 2020; 25:525-532. [PMID: 32892646 DOI: 10.1080/1354750x.2020.1817982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between elevated C-reactive protein (CRP) level and poor functional outcome is conflicting in acute ischaemic stroke (AIS) patients. This meta-analysis sought to investigate the value of elevated CRP level in predicting poor functional outcome in AIS patients. MATERIAL AND METHODS A systematically literature search was performed in PubMed and Embase databases up to 31 October 2019. Prospective and retrospective studies evaluating the association between elevated CRP level and poor functional outcome (defined by the modified Rankin scale ≥3) beyond 3 months after AIS were included. RESULTS Ten studies with a total of 8087 AIS patients were identified in this meta-analysis. When compared with reference low CRP level, the highest CRP level was associated with an increased risk of poor functional outcome (multivariate-adjusted hazard ratio (HR) 1.99; 95% confidence interval (CI) 1.63-2.44) in a random effect model. Sensitivity analysis further confirmed the significance of CRP elevation for predicting poor functional outcome after AIS. CONCLUSIONS Elevated CRP level is significantly associated with poor functional outcome in patients with AIS. Baseline CRP level has potential to improve risk stratification of function outcome in AIS patients.
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Affiliation(s)
- Ziyi Hu
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Junyu Lai
- Department of Cardiology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lisha Chen
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Ying Yi
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Renliang Li
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Weimin Liao
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Alfieri DF, Lehmann MF, Flauzino T, de Araújo MCM, Pivoto N, Tirolla RM, Simão ANC, Maes M, Reiche EMV. Immune-Inflammatory, Metabolic, Oxidative, and Nitrosative Stress Biomarkers Predict Acute Ischemic Stroke and Short-Term Outcome. Neurotox Res 2020; 38:330-343. [PMID: 32415527 DOI: 10.1007/s12640-020-00221-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
Immune-inflammatory, metabolic, oxidative, and nitrosative stress (IMO&NS) pathways and, consequently, neurotoxicity are involved in acute ischemic stroke (IS). The simultaneous assessment of multiple IMO&NS biomarkers may be useful to predict IS and its prognosis. The aim of this study was to identify the IMO&NS biomarkers, which predict short-term IS outcome. The study included 176 IS patients and 176 healthy controls. Modified Rankin scale (mRS) was applied within 8 h after IS (baseline) and 3 months later (endpoint). Blood samples were obtained within 24 h after hospital admission. IS was associated with increased white blood cell (WBC) counts, high sensitivity C-reactive protein (hsCRP), interleukin (IL-6), lipid hydroperoxides (LOOHs), nitric oxide metabolites (NOx), homocysteine, ferritin, erythrocyte sedimentation rate (ESR), glucose, insulin, and lowered iron, 25-hydroxyvitamin D [25(OH)D], total cholesterol, and high-density lipoprotein (HDL) cholesterol. We found that 89.4% of the IS patients may be correctly classified using the cumulative effects of male sex, systolic blood pressure (SBP), glucose, NOx, LOOH, 25(OH)D, IL-6, and WBC with sensitivity of 86.2% and specificity of 93.0%. Moreover, increased baseline disability (mRS ≥ 3) was associated with increased ferritin, IL-6, hsCRP, WBC, ESR, and glucose. We found that 25.0% of the variance in the 3-month endpoint (mRS) was explained by the regression on glucose, ESR, age (all positively), and HDL-cholesterol, and 25(OH)D (both negatively). These results show that the cumulative effects of IMO&NS biomarkers are associated with IS and predict a poor outcome at 3-month follow-up.
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Affiliation(s)
- Daniela Frizon Alfieri
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Marcio Francisco Lehmann
- Department of Clinical Surgery, Health Sciences Center, Neurosurgery Service of the University Hospital, State University of Londrina, Londrina, Paraná, Brazil
| | - Tamires Flauzino
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | | | - Nicolas Pivoto
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Rafaele Maria Tirolla
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Andrea Name Colado Simão
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Londrina, Paraná, 86.038-440, Brazil
| | - Michael Maes
- Department Psychiatry, Chulalongkorn University, Bangkok, Thailand
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Edna Maria Vissoci Reiche
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Londrina, Paraná, 86.038-440, Brazil.
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Aksu U, Gulcu O, Aksakal E, Kalkan K, Öztürk M, Korkmaz AF, Uslu A, Demirelli S. The association between CRP / Albumin ratio and in-stent restenosis development in patients with ST-segment elevation myocardial infarction. J Clin Lab Anal 2019; 33:e22848. [PMID: 30737841 PMCID: PMC6528603 DOI: 10.1002/jcla.22848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although interventional methods are the first-line treatment options in ST-segment elevation myocardial infarction (STEMI), the incidence of stent restenosis (SR) is frequent. We investigated the relationship between CRP/albumin ratio (CAR), a novel indicator of inflammatory response, and SR in this study. METHOD This study was carried out on the patients who underwent coronary angiography in our clinic between January 2017 and September 2017. Two groups were generated according to restenosis status (group 1: restenosis (-), group 2: restenosis (+)), and clinical biochemical and angiographical features were compared. As baseline demographic and angiographic characteristics are slightly different in two groups, propensity score matching analysis was performed to reduce bias. 45 SR patients were matched on a 1:1 basis were enrolled final cohort. RESULTS The mean age of the patients was 55 ± 5.1 and 80% were male; Cox regression model was performed to demonstrate independent predictor of restenosis development; and during the one-year follow-up period, CAR (P < 0.001) was found an independent predictor of SR CONCLUSION: In this study, we demonstrate that there may be a strong relationship between SR development and CAR. We implied that inflammatory reaction may be an important diagnostic tool for prediction of SR development in STEMI patients.
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Affiliation(s)
- Uğur Aksu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Emrah Aksakal
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Öztürk
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Ali Fuat Korkmaz
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
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Kim J, Kim Y. Which Patients Are Prescribed Escitalopram?: Predictors for Escitalopram Prescriptions and Functional Outcomes among Patients with Acute Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061085. [PMID: 29843379 PMCID: PMC6025022 DOI: 10.3390/ijerph15061085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 01/30/2023]
Abstract
Recent studies have demonstrated that antidepressants could enhance functional recovery via neuroplasticity beyond solely treating depression. However, since Koreans typically show a greater aversion to seeking psychiatric care than citizens of Western countries, the number of antidepressant prescriptions is low. Through this study, we aim to identify the factors that lead to the prescription of antidepressants in subjects with acute ischemic stroke (AIS) in clinical practice. A total of 775 patients with ischemic stroke (IS) participated in this study from March 2010 to May 2013. We used binary logistic regression to find predictors for escitalopram prescriptions. To reveal predictors for short-term functional outcomes, we used an adjusted regression model using a propensity score. Among the 775 participants, 39 (5.03%) were prescribed escitalopram. The duration of hospital stay (odds ratio (OR) = 1.07; 95% confidence interval (CI) = 1.04–1.10) and the use of mechanical ventilation were significantly more closely related to escitalopram prescriptions as compared to non-escitalopram prescriptions (OR = 5.15; 95% CI = 1.53–17.40). The use of escitalopram, on the other hand, was not significantly associated with short-term functional outcomes (OR = 1.27; 95% CI = 0.50–3.25). Duration of hospital stay and use of mechanical ventilation were significantly related to escitalopram prescriptions.
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Affiliation(s)
- Jarim Kim
- School of Communication, Kookmin University, Bugak Hall 603, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Korea.
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea.
- College of Medicine, Seoul National University, Seoul 03080, Korea.
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Branco JP, Oliveira S, Sargento-Freitas J, Santos Costa J, Cordeiro G, Cunha L, Freire Gonçalves A, Pinheiro J. S100β Protein as a Predictor of Poststroke Functional Outcome: A Prospective Study. J Stroke Cerebrovasc Dis 2018; 27:1890-1896. [PMID: 29571758 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of disability worldwide. Early prediction of poststroke disability using clinical models is of great interest, especially in the rehabilitation field. Although some biomarkers and neuroimaging techniques have shown potential predictive value, there are still insufficient data to support their clinical utility in predicting poststroke functional recovery. We aimed to assess the value of serum biomarkers (C-reactive protein [CRP], D-dimer, fibrinogen, and S100β protein) in predicting medium-term (12 weeks) functional outcome in patients with acute ischemic stroke. METHODS This is an observational, prospective study in a sample of patients hospitalized for ischemic stroke (N = 131). Peripheral blood levels of biomarkers of interest were determined at admission (CRP, D-dimer, and fibrinogen) or at 48 hours poststroke (S100β protein). Functional status was accessed at 48 hours and 12 weeks poststroke using the modified Rankin Scale (mRS). RESULTS S100β protein levels measured at 48 hours were significantly associated with mRS scores at 12 weeks (odds ratio = 1.005, 95% confidence interval [CI] [1.005-1.007]; P <.001). This association was not seen for the remaining biomarkers of interest. The S100β cutoff for poor functionality at 12 weeks was 140.5 ng/L or more (sensibility 83.8%; specificity 71.4%; area under the curve = .80, 95% CI [.722, .879]). CONCLUSIONS S100β levels in peripheral blood at 48 hours poststroke reflect acute stroke severity and predict functional outcome at 12 weeks with a cutoff value of 140.5 ng/dL. The value of S100β as predictor of functional recovery after stroke should be emphasized in further clinical research and clinical practice.
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Affiliation(s)
- João Paulo Branco
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Tocha, Portugal.
| | - Sandra Oliveira
- Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Tocha, Portugal
| | - João Sargento-Freitas
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joana Santos Costa
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Gustavo Cordeiro
- Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Luís Cunha
- Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - António Freire Gonçalves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - João Pinheiro
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Sun H, Zhao J, Zhong D, Li G. Potential serum biomarkers and metabonomic profiling of serum in ischemic stroke patients using UPLC/Q-TOF MS/MS. PLoS One 2017; 12:e0189009. [PMID: 29228037 PMCID: PMC5724857 DOI: 10.1371/journal.pone.0189009] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 12/04/2022] Open
Abstract
Background Stroke still has a high incidence with a tremendous public health burden and it is a leading cause of mortality and disability. However, biomarkers for early diagnosis are absent and the metabolic alterations associated with ischemic stroke are not clearly understood. The objectives of this case-control study are to identify serum biomarkers and explore the metabolic alterations of ischemic stroke. Methods Metabonomic analysis was performed using ultra-performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry and multivariate statistical analysis was employed to study 60 patients with or without ischemic stroke (30 cases and 30 controls). Results Serum metabolic profiling identified a series of 12 metabolites with significant alterations, and the related metabolic pathways involved glycerophospholipid, sphingolipid, phospholipid, fat acid, acylcarnitine, heme, and purine metabolism. Subsequently, multiple logistic regression analyses of these metabolites showed uric acid, sphinganine and adrenoyl ethanolamide were potential biomarkers of ischemic stroke with an area under the receiver operating characteristic curve of 0.941. Conclusions These findings provide insights into the early diagnosis and potential pathophysiology of ischemic stroke.
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Affiliation(s)
- Hongxue Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilong Jiang Province, PR China
| | - Jiaying Zhao
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Di Zhong
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilong Jiang Province, PR China
| | - Guozhong Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilong Jiang Province, PR China
- * E-mail:
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21
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Liberale L, Montecucco F, Bonaventura A, Casetta I, Seraceni S, Trentini A, Padroni M, Dallegri F, Fainardi E, Carbone F. Monocyte count at onset predicts poststroke outcomes during a 90-day follow-up. Eur J Clin Invest 2017; 47:702-710. [PMID: 28783210 DOI: 10.1111/eci.12795] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/02/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute ischaemic stroke (AIS) triggers both systemic and neurovascular inflammation, influencing poststroke recovery. In smokers with AIS, inflammation might be further upregulated, increasing ischaemia/reperfusion injury. Here, the predictive value of leucocyte and adhesion molecules levels on poststroke outcomes was investigated. MATERIALS AND METHODS A total of 89 patients with AIS (n = 30 smokers and n = 59 nonsmokers) were recruited and evaluated 1, 7 and 90 days after the onset to assess stroke severity by the National Institute of Health Stroke Scale (NIHSS) score as well as clinical recovery at 90 days by the modified Rankin Scale (mRS). Lesion volume was assessed by noncontrast computed tomography. Haematological parameters, blood chemistry and soluble adhesion molecules were measured. RESULTS Smokers experienced a more severe stroke and at a younger age with respect to nonsmokers, moreover, they had higher circulating levels of monocytes, neutrophils and soluble adhesion molecules. Baseline monocytes positively correlated with stroke severity and disability across all time points in the overall cohort. No correlation was shown between adhesion molecules and poststroke outcomes. A monocyte count >0·63 × 109 /L predicted worse stroke severity (defined as NIHSS ≥5) at day 90 independently of age, hypertension, thrombolysis and active smoking in the overall cohort. Similarly, a monocyte count >0·64 × 109 /L predicted poor neurological recovery at day 90 (defined as mRS > 2). CONCLUSIONS Smoker had more severe AIS and higher leucocytes and adhesion molecule levels. In the overall cohort, monocyte count was an independent predictor of worse poststroke outcome. Although larger trials are needed, monocyte count might be a cheap prognostic parameter in AIS.
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Affiliation(s)
- Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Ilaria Casetta
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Silva Seraceni
- Istitute for Maternal and Child Health 'IRCCS Burlo Garofolo', Trieste, Italy
| | - Alessandro Trentini
- Section of Medical Biochemistry, Molecular Biology and Genetics, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Marina Padroni
- Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
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Chang SN, Lai LP, Chiang FT, Lin JL, Hwang JJ, Tsai CT. C-reactive protein gene polymorphism predicts the risk of thromboembolic stroke in patients with atrial fibrillation: a more than 10-year prospective follow-up study. J Thromb Haemost 2017; 15:1541-1546. [PMID: 28498565 DOI: 10.1111/jth.13735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Indexed: 11/28/2022]
Abstract
Essentials We studied the C-reactive protein (CRP) gene on stroke risk in atrial fibrillation (AF) patients. 725 patients with CRP triallelic polymorphism genotype were followed-up for more than 10 years. Patients with the A-390/T-390 allele of the CRP gene were more likely to get ischemic stroke. The triallelic polymorphism of the CRP is related to ischemic stroke in AF patients. SUMMARY Background Little evidence is available regarding the impact of genetic polymorphisms on the risk of thromboembolic stroke in patients with atrial fibrillation (AF). An increasing body of evidence is demonstrating that inflammatory responses play an important role in the pathophysiology of AF. Objectives To investigate the effect of genetic polymorphisms of the C-reactive protein (CRP) gene on the incidence of thromboembolic stroke in patients with AF. Methods A total of 725 AF patients were longitudinally followed up for > 10 years; this is the largest and longest AF follow-up cohort with genetic data. CRP promoter triallelic polymorphisms (C-390A and C-390T) were genotyped, and CRP levels were divided into four quartiles. Results Patients with higher CRP levels were more likely to develop thromboembolic stroke than those with lower CRP levels (P<0.001, log-rank test for comparison of four quartiles). After adjustment for conventional risk factors, patients with higher CRP levels were more likely to develop thromboembolic stroke than those in the lowest CRP quartile (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.08-4.81; the lowest CRP quartile was the reference group). Patients carrying the A-390 or T-390 allele had higher CRP levels (3.35 ± 2.71 mg L-1 versus 2.43 ± 2.00 mg L-1 ), and were more likely to develop thromboembolic stroke, even after adjustment for conventional risk factors (HR 2.07, 95% CI 1.23-3.48). Conclusion The CRP triallelic polymorphism and the CRP level are associated with the risk of incident thromboembolic stroke in patients with AF.
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Affiliation(s)
- S-N Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin, Yun-Lin, Taiwan
| | - L-P Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - F-T Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - J-L Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - J-J Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - C-T Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin, Yun-Lin, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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23
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Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke. Int J Mol Sci 2016; 17:ijms17121967. [PMID: 27898011 PMCID: PMC5187767 DOI: 10.3390/ijms17121967] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
After an acute ischemic stroke (AIS), inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs) released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.
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