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de Albóniga-Chindurza A, Ortega-Quintanilla J, Moniche F, San Román L, Zapata-Arriaza E, Escudero-Martínez I, Zapata M, Pérez-Sánchez S, Gamero MA, Barragán-Prieto A, Lebrato L, Pardo-Galiana B, Cabezas JA, Ainz L, Cayuela A, Montaner J, González A. Thrombectomy with embed aspiration in acute ischaemic stroke. Neurologia 2023:S2173-5808(23)00030-5. [PMID: 37116689 DOI: 10.1016/j.nrleng.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/24/2021] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In addition to stent retrievers, direct aspiration has become a reasonable thrombectomy strategy. OBJECTIVES We carried out the thrombectomy by guiding the aspiration catheter fully over the clot and performing immediate manual aspiration; we call this procedure "embed aspiration". METHODS In this prospective, non-randomised, single-centre study, we included all patients treated at a high volume-of-care stroke centre between 2017 and 2018 for the TRIANA (Thrombectomy in Andalusia using Aspiration) registry. Thrombectomy was carried out by embed aspiration. Patients were classified according to the success (eTICI 2b67-2c-3) or failure (eTICI 0-1-2a-2b50) of the procedure. Baseline clinical data and outcomes were compared, and multivariate analysis was performed. RESULTS The embed aspiration technique was used in 370 patients. Treatment was successful in 90.3% of patients. Mean puncture-to-recanalisation time was 25 minutes. The overall rate of good outcomes (mRS 0-2) at 3 months was 64%. CONCLUSIONS This study supports real-life evidence that standardised embed aspiration may be an alternative to stent retrievers for thrombectomy.
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Affiliation(s)
- A de Albóniga-Chindurza
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - J Ortega-Quintanilla
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F Moniche
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - L San Román
- Laboratorio Central Angiográfico, Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Clínic de Barcelona, Barcelona, Spain
| | - E Zapata-Arriaza
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - I Escudero-Martínez
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Zapata
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - S Pérez-Sánchez
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M A Gamero
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A Barragán-Prieto
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Lebrato
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - B Pardo-Galiana
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J A Cabezas
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - L Ainz
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - J Montaner
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A González
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
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Domínguez-Mayoral A, Gutiérrez C, Sánchez-Gómez J, Pérez-Sánchez S, Fouz N, Guerrero-Zamora P, Ferrer M, Aguilar M, Galiani V, Albalá C, Moreno J, Gamero MA, García-Campos C, Banda S, Montaner J. Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke. Rev Neurol 2023; 76:117-125. [PMID: 36782347 PMCID: PMC10364073 DOI: 10.33588/rn.7604.2022359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective). PATIENTS AND METHODS The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups. RESULTS Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262). CONCLUSIONS Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.
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Affiliation(s)
- A Domínguez-Mayoral
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - C Gutiérrez
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | - J Sánchez-Gómez
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | - S Pérez-Sánchez
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - N Fouz
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | | | - M Ferrer
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | - M Aguilar
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | - V Galiani
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - C Albalá
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - J Moreno
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - M A Gamero
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - C García-Campos
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - S Banda
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
| | - J Montaner
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
- Instituto de Biomedicina de Sevilla, Sevilla, España
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Pardo-Galiana B, Medina-Rodriguez M, Millan-Vazquez M, Cabezas-Rodriguez JA, Lebrato-Hernandez L, Ainz-Gomez L, Zapata-Arriaza E, Ortega J, de Albóniga-Chindurza A, Montaner J, Gonzalez A, Moniche F. Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation. AJNR Am J Neuroradiol 2022; 43:727-730. [PMID: 35393364 PMCID: PMC9089259 DOI: 10.3174/ajnr.a7482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Antithrombotic therapy following carotid artery stent placement with concomitant atrial fibrillation is not well-established. Our aim was to assess the safety and efficacy of the combination of direct oral anticoagulants and a P2Y12 inhibitor at 30 days after carotid artery stent placement in patients with atrial fibrillation. MATERIALS AND METHODS We designed an observational single-center study including patients who underwent carotid artery stent placement with concomitant atrial fibrillation. We studied 3 groups according to antithrombotic therapy: 1) the direct oral anticoagulants plus clopidogrel (DC) group: receiving direct oral anticoagulants plus a P2Y12 inhibitor; 2) the triple therapy group: anticoagulation and dual antiplatelet therapy; and 3) the dual antiplatelet therapy group: following dual antiplatelet therapy alone. The safety outcome was a major or clinically relevant non-major bleeding event at the first month. The efficacy outcomes were the thromboembolic events (myocardial infarction, stroke, systemic embolism, or stent thrombosis). RESULTS Of 959 patients with carotid artery stent placement, 91 met the inclusion criteria, including 24 patients in the DC group, 42 patients in the triple therapy group, and 25 in the dual antiplatelet therapy group. The mean age was 72.27 (SD, 8.1 ) years, with similar baseline characteristics. The median CHA2DS2-VASc score for each group was 6 (interquartile range = 5-6), 5 (interquartile range = 4-6), and 5 (interquartile range = 4-6), respectively. The median HAS-BLED score was 4 in the 3 groups (P = .17). The primary safety end point was 23.8% in the triple therapy group compared with 4% in the dual antiplatelet therapy group (P = .032), with no bleeding events in the DC group (P = .007). There was 1 stent thrombosis in DC group and a cardioembolic stroke in the dual antiplatelet therapy group (P = .41). CONCLUSIONS Among patients with carotid artery stent placement with atrial fibrillation, triple therapy confers a high bleeding risk. A regimen of direct oral anticoagulants plus a P2Y12 inhibitor might confer a good safety profile with significantly lower rates of bleeding and optimal efficacy.
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Affiliation(s)
- B Pardo-Galiana
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - M Medina-Rodriguez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | | | - J A Cabezas-Rodriguez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - L Lebrato-Hernandez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - L Ainz-Gomez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - E Zapata-Arriaza
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - J Ortega
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - A de Albóniga-Chindurza
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - J Montaner
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
- Stroke Unit (J.M.), Neurology Department, University Hospital Virgen Macarena, Seville, Spain
| | - A Gonzalez
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - F Moniche
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia 2022; 37:136-150. [PMID: 33358061 DOI: 10.1016/j.nrl.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, España; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, España
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, España
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, España
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia (Engl Ed) 2021; 37:136-150. [PMID: 34906541 DOI: 10.1016/j.nrleng.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels < 20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, Spain
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, Spain
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, Spain
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, Spain
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, Spain
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Zhabokritsky A, Szadkowski L, Burchell AN, Cooper C, Hogg RS, Hull M, Kelly DV, Klein M, Loutfy M, McClean A, Montaner J, Walmsley SL. Immunological and virological response to initial antiretroviral therapy among older people living with HIV in the Canadian Observational Cohort (CANOC). HIV Med 2021; 22:759-769. [PMID: 34075683 DOI: 10.1111/hiv.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to assess the adequacy of immunological recovery and virological suppression in response to antiretroviral therapy (ART) in the growing population of older people living with HIV (PLWH), as treatment regimens become more effective and tolerable. METHODS An interprovincial Canadian cohort of treatment-naïve PLWH who initiated ART after 1 January 2000 was used and age assessed in decades. Longitudinal absolute CD4 count response to treatment was modelled using generalized estimating equations. Cumulative incidence functions and proportional hazards models with a competing risk of death were used to estimate time to: (1) CD4 ≥ 200 cells/µL, (2) CD4 ≥ 500 cells/µL, (3) virological suppression (≤ 50 copies/mL), and (4) virological failure (> 200 copies/mL). RESULTS In all, 12 489 individuals starting ART between 2000 and 2016 with one or more post-treatment CD4 count or viral load were included in the analysis. Age > 60 years was associated with lower absolute CD4 recovery (adjusted β = -31 cells/µL) compared with age ≤ 30 years when pre-treatment CD4 count and other covariates were accounted for. Older age groups were less likely to achieve a CD4 ≥ 500 cells/µL, with the greatest effect in the > 60 group [adjusted hazard ratio (aHR) = 0.69, 95% confidence interval (CI): 0.57-0.84 vs. age ≤ 30). Older age groups were more likely to achieve viral suppression (age > 60, aHR = 1.20, 95% CI: 1.05-1.37) and less likely to have virological failure (age > 60, aHR = 0.46, 95% CI: 0.3-0.71) compared with those aged ≤ 30 years. CONCLUSIONS Older adults have robust virological responses to ART; however, individuals over the age 60 are more likely to experience blunted CD4 recovery.
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Affiliation(s)
- A Zhabokritsky
- Department of Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - L Szadkowski
- Department of Medicine, University Health Network, Toronto, ON, Canada.,Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - A N Burchell
- Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - C Cooper
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - M Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - D V Kelly
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - M Klein
- McGill University Health Center, Montreal, QC, Canada
| | - M Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - A McClean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - S L Walmsley
- Department of Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Pérez-Sánchez S, Barragán-Prieto A, Sánchez-Miura JA, Domínguez-Mayoral A, de Torres-Chacón R, Gamero-García MA, Gálvez-San Román JL, Herrero-Lara J, Garrido-Castilla M, Cueto L, Navarro-Bustos C, Montaner J. [Delayed administration of thrombolytic therapy in minor stroke]. Rev Neurol 2021; 72:352-356. [PMID: 33978229 DOI: 10.33588/rn.7210.2020510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. PATIENTS AND METHODS We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. RESULTS Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. CONCLUSIONS The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.
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Affiliation(s)
- S Pérez-Sánchez
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | | | | | | | | | | | | | - J Herrero-Lara
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | | | - L Cueto
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | | | - J Montaner
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
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8
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Palà E, Pagola J, Juega J, Francisco-Pascual J, Bustamante A, Penalba A, Comas I, Rodriguez M, De Lera Alfonso M, Arenillas JF, de Torres R, Pérez-Sánchez S, Cabezas JA, Moniche F, González-Alujas T, Molina CA, Montaner J. B-type natriuretic peptide over N-terminal pro-brain natriuretic peptide to predict incident atrial fibrillation after cryptogenic stroke. Eur J Neurol 2020; 28:540-547. [PMID: 33043545 DOI: 10.1111/ene.14579] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are well-known surrogates of atrial fibrillation (AF) detection but studies usually present data on either BNP or NT-proBNP. The aim was to determine and directly compare the validity of the two biomarkers as a tool to predict AF and guide prolonged cardiac monitoring in cryptogenic stroke patients. METHODS Non-lacunar acute ischaemic stroke (<72 h) patients over 55 years of age with cryptogenic stroke after standard evaluation were included in the Crypto-AF study and blood was collected. BNP and NT-proBNP levels were determined by automated immunoassays. AF was assessed by 28 days' monitoring. Highest (optimizing specificity) and lowest (optimizing sensitivity) quartiles were used as biomarker cut-offs to build predictive models adjusted by sex and age. The integrated discrimination improvement index (IDI) and DeLong test were used to compare the performance of the two biomarkers. RESULTS From 320 patients evaluated, 218 were included in the analysis. AF was detected in 50 patients (22.9%). NT-proBNP (P < 0.001) and BNP (P < 0.001) levels were higher in subjects with AF and their levels correlated (r = 0.495, P < 0.001). BNP showed an increased area under the curve (0.720 vs. 0.669; P = 0.0218) and a better predictive capacity (IDI = 3.63%, 95% confidence interval 1.36%-5.91%) compared to NT-proBNP. BNP performed better than NT-proBNP in a specific model (IDI = 3.7%, 95% confidence interval 0.87%-6.5%), whilst both biomarkers performed similarly in the case of a sensitive model. CONCLUSIONS Both BNP and NT-proBNP were increased in cryptogenic stroke patients with AF detection. Interestingly, BNP outperforms NT-proBNP, especially in terms of specificity.
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Affiliation(s)
- E Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Pagola
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - J Juega
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - J Francisco-Pascual
- Arrhythmia Unit-Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
| | - A Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Comas
- Clinical Biochemestry Service, Clinical Laboratories, Vall d'Hebrón Hospital, Barcelona, Spain
| | - M Rodriguez
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | | | - J F Arenillas
- Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
| | - R de Torres
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - S Pérez-Sánchez
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - J A Cabezas
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - F Moniche
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - T González-Alujas
- Echocardiography Lab Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
| | - C A Molina
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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9
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Afifi K, Bellanger G, Buyck PJ, Zuurbier SM, Garcia-Esperon C, Barboza MA, Costa P, Escudero I, Renard D, Lemmens R, Hinteregger N, Fazekas F, Jimenez-Conde J, Giralt-Steinhauer E, Hiltunen S, Arauz A, Pezzini A, Montaner J, Putaala J, Weimar C, Schlamann M, Gattringer T, Tatlisumak T, Coutinho JM, Demaerel P, Thijs V. Correction to: Features of intracranial hemorrhage in cerebral venous thrombosis. J Neurol 2020; 267:3299-3300. [PMID: 32785839 DOI: 10.1007/s00415-020-10082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article unfortunately contained mistakes. The correct information is given below.
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Affiliation(s)
- K Afifi
- Department of Neurology, Menoufia University, Al Minufya, Menoufia, Egypt.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - G Bellanger
- Department of Neuroradiology, Purpan University Hospital, Toulouse, France.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - P J Buyck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - S M Zuurbier
- Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia
| | - M A Barboza
- Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
| | - P Costa
- Department of Head and Neck, Neurology Clinic, University of Brescia, Brescia, Italy
| | - I Escudero
- Neurology Department, University Hospital Virgen del Rocio, Sevilla, Spain.,Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - D Renard
- Department of Neurology, Nîmes University Hospital, Nîmes, France
| | - R Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - N Hinteregger
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - J Jimenez-Conde
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelon, Barcelona, Spain
| | - E Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelon, Barcelona, Spain
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - A Arauz
- Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic University of Brescia, Brescia, Italy
| | - J Montaner
- Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain.,Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - J Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - C Weimar
- Institute of Medical Informatics, Biometry and Epidemiology and Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - P Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - V Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia. .,Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
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10
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Muiño E, Bustamante A, Rodriguez-Campello A, Gallego-Fabrega C, Ois A, Carrera C, Cullell N, Torres-Aguila N, Cárcel-Márquez J, Rubiera M, Molina CA, Cuadrado-Godia E, Giralt-Steinhauer E, Jiménez-Conde J, Montaner J, Fernández-Cadenas I, Roquer J. A parsimonious score with a free web tool for predicting disability after an ischemic stroke: the Parsifal Score. J Neurol 2020; 267:2871-2880. [PMID: 32458199 DOI: 10.1007/s00415-020-09914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Most of the models to predict prognosis after an ischemic stroke include complex mathematical equations or too many variables, making them difficult to use in the daily clinic. We want to predict disability 3 months after an ischemic stroke in an independent patient not receiving recanalization treatment within the first 24 h, using a minimum set of variables and an easy tool to facilitate its implementation. As a secondary aim, we calculated the capacity of the score to predict an excellent/devastating outcome and mortality. METHODS Eight hundred and forty-four patients were evaluated. A multivariable ordinal logistic regression was used to obtain the score. The Modified Rankin Scale (mRS) was used to estimate disability at the third month. The results were replicated in another independent cohort (378 patients). The "polr" function of R was used to perform the regression, stratifying the sample into seven groups with different cutoffs (from mRS 0 to 6). RESULTS The Parsifal score was generated with: age, previous mRS, initial NIHSS, glycemia on admission, and dyslipidemia. This score predicts disability with an accuracy of 80-76% (discovery-replication cohorts). It has an AUC of 0.86 in the discovery and replication cohort. The specificity was 90-80% (discovery-replication cohorts); while, the sensitivity was 64-74% (discovery-replication cohorts). The prediction of an excellent or devastating outcome, as well as mortality, obtained good discrimination with AUC > 0.80. CONCLUSIONS The Parsifal Score is a model that predicts disability at the third month, with only five variables, with good discrimination and calibration, and being replicated in an independent cohort.
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Affiliation(s)
- E Muiño
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Departamento de Medicina de la UAB, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - A Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron-UAB, Barcelona, Spain
| | | | - C Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Ois
- Neurology Service, IMIM-Hospital del Mar, Barcelona, Spain
| | - C Carrera
- Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron-UAB, Barcelona, Spain
| | - N Cullell
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - N Torres-Aguila
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Rubiera
- Neurology Service, Hospital Vall D'Hebron, Barcelona, Spain
| | - C A Molina
- Neurology Service, Hospital Vall D'Hebron, Barcelona, Spain
| | | | | | | | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron-UAB, Barcelona, Spain.,Biomedicine Institute of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - I Fernández-Cadenas
- Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - J Roquer
- Neurology Service, IMIM-Hospital del Mar, Barcelona, Spain
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11
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Pagola J, Juega J, Francisco‐Pascual J, Bustamante A, Penalba A, Pala E, Rodriguez M, De Lera Alfonso M, Arenillas JF, Cabezas JA, Moniche F, Torres R, Montaner J, González‐Alujas T, Alvarez‐Sabin J, Molina CA. Large vessel occlusion is independently associated with atrial fibrillation detection. Eur J Neurol 2020; 27:1618-1624. [PMID: 32347993 DOI: 10.1111/ene.14281] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 01/11/2023]
Affiliation(s)
- J. Pagola
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | - J. Juega
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | - J. Francisco‐Pascual
- Arrhythmia Unit Cardiology Department Vall d'Hebrón Hospital Barcelona Spain
- CIBER‐CV. Instituto de Salud Carlos III Madrid Spain
| | - A. Bustamante
- Neurovascular Research Laboratory Vall d'Hebrón Research Institute Barcelona, Spain
| | - A. Penalba
- Neurovascular Research Laboratory Vall d'Hebrón Research Institute Barcelona, Spain
| | - E. Pala
- Neurovascular Research Laboratory Vall d'Hebrón Research Institute Barcelona, Spain
| | - M. Rodriguez
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | | | - J. F. Arenillas
- Stroke Unit University Hospital of Valladolid Valladolid Spain
| | - J. A. Cabezas
- Stroke Unit University Hospital Virgen del Rocio Sevilla Spain
| | - F. Moniche
- Stroke Unit University Hospital Virgen del Rocio Sevilla Spain
| | - R. Torres
- Stroke Unit University Hospital Virgen Macarena Sevilla Spain
| | - J. Montaner
- Stroke Unit University Hospital Virgen Macarena Sevilla Spain
| | - T. González‐Alujas
- CIBER‐CV. Instituto de Salud Carlos III Madrid Spain
- Echocardiography Laboratory Cardiology Department Vall d'Hebrón Hospital Barcelona Spain
| | - J. Alvarez‐Sabin
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | - C. A. Molina
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
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12
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Mengel A, Ulm L, Hotter B, Harms H, Piper SK, Grittner U, Montaner J, Meisel C, Meisel A, Hoffmann S. Biomarkers of immune capacity, infection and inflammation are associated with poor outcome and mortality after stroke - the PREDICT study. BMC Neurol 2019; 19:148. [PMID: 31269910 PMCID: PMC6607590 DOI: 10.1186/s12883-019-1375-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/23/2019] [Indexed: 02/20/2023] Open
Abstract
Background Almost 40% of stroke patients have a poor outcome at 3 months after the index event. Predictors for stroke outcome in the early acute phase may help to tailor stroke treatment. Infection and inflammation are considered to influence stroke outcome. Methods In a prospective multicenter study in Germany and Spain, including 486 patients with acute ischemic stroke, we used multivariable regression analysis to investigate the association of poor outcome with monocytic HLA-DR (mHLA-DR) expression, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-alpha) and lipopolysaccharide-binding protein (LBP) as markers for immunodepression, inflammation and infection. Outcome was assessed at 3 months after stroke via a structured telephone interview using the modified Rankin Scale (mRS). Poor outcome was defined as a mRS score of 3 or higher which included death. Furthermore, a time-to-event analysis for death within 3 months was performed. Results Three-month outcome data was available for 391 patients. Female sex, older age, diabetes mellitus, atrial fibrillation, stroke-associated pneumonia (SAP) and higher National Institute of Health Stroke Scale (NIHSS) score as well as lower mHLA-DR levels, higher IL-6 and LBP-levels at day 1 were associated with poor outcome at 3 months in bivariate analysis. Furthermore, multivariable analysis revealed that lower mHLA-DR expression was associated with poor outcome. Female sex, older age, atrial fibrillation, SAP, higher NIHSS score, lower mHLA-DR expression and higher IL-6 levels were associated with shorter survival time in bivariate analysis. In multivariable analysis, SAP and higher IL-6 levels on day 1 were associated with shorter survival time. Conclusions SAP, lower mHLA-DR-expression and higher IL-6 levels on day one are associated with poor outcome and shorter survival time at 3 months after stroke onset. Trial registration www.clinicaltrials.gov, NCT01079728, March 3, 2010.
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Affiliation(s)
- A Mengel
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany. .,Department of Neurology and Stroke, Universitätsklinik Tuebingen, Hoppe-Seyler-Str.3, 72076, Tuebingen, Germany.
| | - L Ulm
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,Center for Clinical Research, The University of Queensland, Herston, Queensland, 4029, Australia
| | - B Hotter
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - H Harms
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - S K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Charitéplatz 1, D-10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| | - U Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Charitéplatz 1, D-10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - C Meisel
- NeuroCure Clinical Research Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - A Meisel
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,NeuroCure Clinical Research Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
| | - S Hoffmann
- Department of Neurology Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany.,NeuroCure Clinical Research Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10115, Berlin, Germany
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13
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Amram O, Shoveller J, Hogg R, Wang L, Sereda P, Barrios R, Montaner J, Lima V. Distance to HIV care and treatment adherence: Adjusting for socio-demographic and geographical heterogeneity. Spat Spatiotemporal Epidemiol 2018; 27:29-35. [PMID: 30409374 DOI: 10.1016/j.sste.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Distance to health services plays an important role in determining access to care and an individual's health. This study aims to examine the relationship between distance to antiretroviral therapy (ART) prescribing physician and adherence to HIV treatment in British Columbia, Canada. Only participants who provided highly accurate locational data for both place of residence and their physician were used in the analysis. Using logistic regression, a multivariable confounder model was created to assess the association between distance and adherence. A geographically weighted logistic regression was also performed to adjust for spatial dependency. There were 1528 participants in the analysis, for a median distance of 17.85km. The final model showed further away from ART prescribing physician had a higher chance of incomplete adherence to ART (adjusted odds ratio 1.31; 95% Confidence Interval 1.04-1.65). Mobile services could potentially increase adherence rates for population residing further away from their ART prescribing physician.
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Affiliation(s)
- O Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA.
| | - J Shoveller
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - R Hogg
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - L Wang
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - P Sereda
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - R Barrios
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - J Montaner
- British Columbia centre for excellence in HIV/AIDS, University of British Columbia, 613 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - V Lima
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
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14
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Simats A, García-Berrocoso T, Penalba A, Giralt D, Llovera G, Jiang Y, Ramiro L, Bustamante A, Martinez-Saez E, Canals F, Wang X, Liesz A, Rosell A, Montaner J. CCL23: a new CC chemokine involved in human brain damage. J Intern Med 2018; 283:461-475. [PMID: 29415332 DOI: 10.1111/joim.12738] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND CCL23 role in the inflammatory response after acute brain injuries remains elusive. Here, we evaluated whether CCL23 blood levels associate with acquired cerebral lesions and determined CCL23 predictive capacity for assessing stroke prognosis. We used preclinical models to study the CCL23 homologous chemokines in rodents, CCL9 and CCL6. METHODS Baseline CCL23 blood levels were determined on 245 individuals, including ischaemic strokes (IS), stroke mimics and controls. Temporal profile of circulating CCL23 was explored from baseline to 24 h in 20 of the IS. In an independent cohort of 120 IS with a 3-month follow-up, CCL23 blood levels were included in logistic regression models to predict IS outcome. CCL9/CCL6 cerebral expression was evaluated in rodent models of brain damage. Both chemokines were also profiled in circulation and histologically located on brain following ischaemia. RESULTS Baseline CCL23 blood levels did not discriminate IS, but permitted an accurate discrimination of patients presenting acute brain lesions (P = 0.003). IS exhibited a continuous increase from baseline to 24 h in circulating CCL23 (P < 0.001). Baseline CCL23 blood levels resulted an independent predictor of IS outcome at hospital discharge (ORadj : 19.702 [1.815-213.918], P = 0.014) and mortality after 3 months (ORadj : 21.47 [3.434-134.221], P = 0.001). In preclinics, expression of rodent chemokines in neurons following cerebral lesions was elevated. CCL9 circulating levels decreased early after ischaemia (P < 0.001), whereas CCL6 did not alter within the first 24 h after ischaemia. CONCLUSIONS Although preclinical models do not seem suitable to characterize CCL23, it might be a novel promising biomarker for the early diagnosis of cerebral lesions and might facilitate the prediction of stroke patient outcome.
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Affiliation(s)
- A Simats
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Giralt
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Llovera
- Institute for Stroke and Dementia Research, Klinikum de Universität München, Munich, Germany
| | - Y Jiang
- Neuroprotection Research Laboratory, Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - L Ramiro
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Martinez-Saez
- Neuropathology Unit, Department of Pathology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Canals
- Proteomics Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Wang
- Proteomics Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Liesz
- Institute for Stroke and Dementia Research, Klinikum de Universität München, Munich, Germany
| | - A Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Azurmendi L, Lapierre-Fetaud V, Schneider J, Montaner J, Katan M, Sanchez JC. Proteomic discovery and verification of serum amyloid A as a predictor marker of patients at risk of post-stroke infection: a pilot study. Clin Proteomics 2017; 14:27. [PMID: 28701906 PMCID: PMC5506582 DOI: 10.1186/s12014-017-9162-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
Background Post-stroke infections occur in 20–36% of stroke patients and are associated with high morbidity and mortality rates. Early identification of patients at risk of developing an infection could improve care via an earlier treatment leading to a better outcome. We used proteomic tools in order to discover biomarkers able to stratify patients at risk of post-stroke infection. Methods The post hoc analysis of a prospective cohort study including 40 ischemic stroke patients included 21 infected and 19 non-infected participants. A quantitative, isobaric labeling, proteomic strategy was applied to the plasma samples of 5 infected and 5 non-infected patients in order to highlight any significantly modulated proteins. A parallel reaction monitoring (PRM) assay was applied to 20 additional patients (10 infected and 10 non-infected) to verify discovery results. The most promising protein was pre-validated using an ELISA immunoassay on 40 patients and at different time points after stroke onset. Results Tandem mass analysis identified 266 proteins, of which only serum amyloid A (SAA1/2) was significantly (p = 0.007) regulated between the two groups of patients. This acute-phase protein appeared to be 2.2 times more abundant in infected patients than in non-infected ones. These results were verified and validated using PRM and ELISA immunoassays, which showed that infected patients had significantly higher concentrations of SAA1/2 than non-infected patients at hospital admission, but also at 1, 3, and 5 days after admission. Conclusions The present study demonstrated that SAA1/2 is a promising predictor, at hospital admission, of stroke patients at risk of developing an infection. Further large, multicenter validation studies are needed to confirm these results. If confirmed, SAA1/2 concentrations could be used to identify the patients most at risk of post-stroke infections and therefore implement treatments more rapidly, thus reducing mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12014-017-9162-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Azurmendi
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Rue Michel Servet 1, 1211 Geneve 4, Switzerland
| | - V Lapierre-Fetaud
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Rue Michel Servet 1, 1211 Geneve 4, Switzerland
| | - J Schneider
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - J Montaner
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Katan
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Jean-Charles Sanchez
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Rue Michel Servet 1, 1211 Geneve 4, Switzerland
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16
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Pagola J, Juega J, Francisco J, Moya A, Bustamante A, Usero M, Arenillas A, Rubio J, Escudero-Martinez I, Moniche F, De Torres R, Pedrote A, Arana-Rueda E, Montaner J, Molina CA. P1018Textile wearable Holter detects high rate of AF in acute phase of stroke. Europace 2017. [DOI: 10.1093/ehjci/eux151.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Ti L, Dong H, Kerr T, Turje RB, Parashar S, Min JE, Montaner J, Wood E, Milloy MJ. The effect of engagement in an HIV/AIDS integrated health programme on plasma HIV-1 RNA suppression among HIV-positive people who use illicit drugs: a marginal structural modelling analysis. HIV Med 2017; 18:580-586. [PMID: 28317290 DOI: 10.1111/hiv.12493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES HIV treatment-as-prevention campaigns emphasize early diagnosis and immediate access to care and antiretroviral therapy for HIV-positive individuals in order to increase levels of plasma HIV RNA viral load (VL) suppression. However, the possible role of harm reduction-based programmes in this objective has not yet been well evaluated. The objective of the study was to examine the relationship between being a client of the Dr. Peter Centre (DPC; an HIV/AIDS-focused adult integrated health programme) and VL suppression among highly active antiretroviral therapy (HAART)-exposed HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. METHODS Data were derived from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a study of a community-recruited cohort of HIV-positive PWUD. A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being a DPC client and exhibiting a VL < 50 HIV-1 RNA copies/mL plasma. RESULTS Between 2005 and 2014, 746 HAART-exposed participants were included in the study, of whom 269 (36.1%) reported being a DPC client at some time during the study period. A marginal structural model estimated a 1.54 greater odds of achieving VL suppression (95% confidence interval 1.20-1.99) among DPC clients. CONCLUSIONS Our findings demonstrate that participating in an innovative HIV/AIDS-focused adult integrated health programme that provides a broad range of clinical, harm reduction, and support services may contribute to optimizing the benefits of HAART in terms of morbidity, mortality and viral transmission among PWUD, and as a result help to fulfill the goals of the treatment-as-prevention strategy.
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Affiliation(s)
- L Ti
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Dong
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - T Kerr
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R B Turje
- Dr. Peter AIDS Foundation, Vancouver, BC, Canada
| | - S Parashar
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J E Min
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J Montaner
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - E Wood
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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18
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Riba-Llena I, Nafría C, Mundet X, López-Rueda A, Fernández-Cortiñas I, Jarca CI, Jiménez-Balado J, Domingo M, Tovar JL, Orfila F, Pujadas F, Álvarez-Sabín J, Maisterra O, Montaner J, Delgado P. Assessment of enlarged perivascular spaces and their relation to target organ damage and mild cognitive impairment in patients with hypertension. Eur J Neurol 2016; 23:1044-50. [PMID: 26968973 DOI: 10.1111/ene.12979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Enlarged perivascular spaces (EPVS) have been recently considered a feature of cerebral small vessel disease. They have been related to aging, hypertension and dementia but their relationship with hypertension related variables (i.e. target organ damage, treatment compliance) and mild cognitive impairment (MCI) is not fully elucidated. Our aims were to investigate the relation between basal ganglia (BG) and centrum semiovale (CSO) EPVS with vascular risk factors, hypertension related variables and MCI. METHODS In all, 733 hypertensive individuals free of stroke and dementia from the Investigating Silent Strokes in Hypertensives, a magnetic resonance imaging Study (ISSYS) underwent brain magnetic resonance imaging and cognitive testing to diagnose MCI or normal cognitive aging. RESULTS The numbers of participants presenting high grade (>10) EPVS at the BG and CSO were 23.3% and 40.0%, respectively. After controlling for vascular risk factors, high grade BG EPVS were associated with age (odds ratio 1.68; 95% confidence interval 1.37, 2.06), poor antihypertensive compliance (1.49; 1.03, 2.14) and the presence of microalbuminuria (1.95; 1.16, 3.28), whereas in the CSO only age (1.38; 1.18, 1.63) and male sex were associated with EPVS (1.73; 1. 24, 2.42). MCI was diagnosed in 9.3% of the participants and it was predicted by EPVS in the BG (1.87; 1.03, 3.39) but not in the CSO. This last association was greatly attenuated after correction for lacunes and white matter hyperintensities. CONCLUSIONS Basal ganglia EPVS are associated with the presence of microalbuminuria and poor adherence to antihypertensive drugs. The BG EPVS relation with MCI is not independent of the presence of other cerebral small vessel disease markers.
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Affiliation(s)
- I Riba-Llena
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Nafría
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Mundet
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Fernández-Cortiñas
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C I Jarca
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Jiménez-Balado
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Domingo
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J L Tovar
- Nephrology Service, Vall Hebron University Hospital, Barcelona, Spain
| | - F Orfila
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Pujadas
- Dementia Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Álvarez-Sabín
- Stroke Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Maisterra
- Stroke Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Stroke Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Delgado
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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19
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Cayuela A, Cayuela L, Escudero-Martínez I, Rodríguez-Domínguez S, González A, Moniche F, Jiménez MD, Montaner J. Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011. Neurologia 2014; 31:370-8. [PMID: 25524042 DOI: 10.1016/j.nrl.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/21/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. PATIENTS AND METHODS Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. RESULTS CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (-6.3%) and 2007-2011 in men (-7.2%). CONCLUSIONS CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | - L Cayuela
- Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F Moniche
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M D Jiménez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Montaner
- Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, España; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, España
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20
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Giralt-Steinhauer E, Jiménez-Conde J, Soriano Tárraga C, Mola M, Rodríguez-Campello A, Cuadrado-Godia E, Ois A, Fernández-Cádenas I, Carrera C, Montaner J, Díaz Navarro R, Vives-Bauzá C, Roquer J. Exploring the genetic basis of stroke. Spanish stroke genetics consortium. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Jacka B, Applegate T, Krajden M, Olmstead A, Harrigan PR, Marshall BDL, DeBeck K, Milloy MJ, Lamoury F, Pybus OG, Lima VD, Magiorkinis G, Montoya V, Montaner J, Joy J, Woods C, Dobrer S, Dore GJ, Poon AF, Grebely J. Phylogenetic clustering of hepatitis C virus among people who inject drugs in Vancouver, Canada. Hepatology 2014; 60:1571-1580. [PMID: 25042607 PMCID: PMC4211947 DOI: 10.1002/hep.27310] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/08/2014] [Indexed: 12/20/2022]
Abstract
UNLABELLED Little is known about factors associated with hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Phylogenetic clustering and associated factors were evaluated among PWID in Vancouver, Canada. Data were derived from the Vancouver Injection Drug Users Study. Participants who were HCV antibody-positive at enrolment and those with HCV antibody seroconversion during follow-up (1996 to 2012) were tested for HCV RNA and sequenced (Core-E2 region). Phylogenetic trees were inferred using maximum likelihood analysis and clusters were identified using ClusterPicker (90% bootstrap threshold, 0.05 genetic distance threshold). Factors associated with clustering were assessed using logistic regression. Among 655 eligible participants, HCV genotype prevalence was: G1a: 48% (n=313), G1b: 6% (n=41), G2a: 3% (n=20), G2b: 7% (n=46), G3a: 33% (n=213), G4a: <1% (n=4), G6a: 1% (n=8), G6e: <1% (n=1), and unclassifiable: 1% (n=9). The mean age was 36 years, 162 (25%) were female, and 164 (25%) were HIV+. Among 501 participants with HCV G1a and G3a, 31% (n=156) were in a pair/cluster. Factors independently associated with phylogenetic clustering included: age <40 (versus age≥40, adjusted odds ratio [AOR]=1.64; 95% confidence interval [CI] 1.03, 2.63), human immunodeficiency virus (HIV) infection (AOR=1.82; 95% CI 1.18, 2.81), HCV seroconversion (AOR=3.05; 95% CI 1.40, 6.66), and recent syringe borrowing (AOR 1.59; 95% CI 1.07, 2.36). CONCLUSION In this sample of PWID, one-third demonstrated phylogenetic clustering. Factors independently associated with phylogenetic clustering included younger age, recent HCV seroconversion, prevalent HIV infection, and recent syringe borrowing. Strategies to enhance the delivery of prevention and/or treatment strategies to those with HIV and recent HCV seroconversion should be explored, given an increased likelihood of HCV transmission in these subpopulations.
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Affiliation(s)
- B Jacka
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - T Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - M Krajden
- BC Centre for Disease Control, Vancouver BC
| | - A Olmstead
- BC Centre for Disease Control, Vancouver BC
| | - PR Harrigan
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - BDL Marshall
- Department of Epidemiology, Brown University, Providence, RI,
USA
| | - K DeBeck
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,School of Public Policy, Simon Fraser University, Vancouver, BC,
Canada
| | - M-J Milloy
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,Department of Family Practice, Faculty of Medicine, University of
British Columbia, Vancouver, BC
| | - F Lamoury
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - OG Pybus
- Department of Zoology, University of Oxford
| | - VD Lima
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - G Magiorkinis
- Department of Zoology, University of Oxford,Virus Reference Department, Public Health England, London,
UK
| | - V Montoya
- BC Centre for Disease Control, Vancouver BC
| | - J Montaner
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - J Joy
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - C Woods
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - S Dobrer
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - GJ Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - AF Poon
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - J Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
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22
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Louter MA, Fernandez-Morales J, de Vries B, Winsvold B, Anttila V, Fernandez-Cadenas I, Vila-Pueyo M, Sintas C, van Duijn CM, Cormand B, Álvarez-Sabin J, Montaner J, Ferrari MD, van den Maagdenberg A, Palotie A, Zwart JA, Macaya A, Terwindt GM, Pozo-Rosich P. Candidate-gene association study searching for genetic factors involved in migraine chronification. Cephalalgia 2014; 35:500-7. [PMID: 25169732 DOI: 10.1177/0333102414547141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/20/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic migraine (CM) is at the severe end of the clinical migraine spectrum, but its genetic background is unknown. Our study searched for evidence that genetic factors are involved in the chronification process. METHODS We initially selected 144 single-nucleotide polymorphisms (SNPs) from 48 candidate genes, which we tested for association in two stages: The first stage encompassed 262 CM patients, the second investigated 226 patients with high-frequency migraine (HFM). Subsequently, SNPs with p values < 0.05 were forwarded to the replication stage containing 531 patients with CM or HFM. RESULTS Eight SNPs were significantly associated with CM and HFM in the two-stage phase. None survived replication in the third stage. DISCUSSION We present the first comprehensive genetic association study for migraine chronification. There were no significant findings. Future studies may benefit from larger, genome-wide data sets or should use other genetic approaches to identify genetic factors involved in migraine chronification.
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Affiliation(s)
- M A Louter
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands Department of Psychiatry, Leiden University Medical Center (LUMC), the Netherlands
| | - J Fernandez-Morales
- Headache and Neurological Pain Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona
| | - B de Vries
- Department of Human Genetics, Leiden University Medical Center (LUMC), the Netherlands
| | - B Winsvold
- Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, United Kingdom FORMI, Oslo University Hospital, Norway Department of Neurology, Oslo University Hospital, Norway Institute of Clinical Medicine, University of Oslo, Norway
| | - V Anttila
- Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, USA Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, USA Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - I Fernandez-Cadenas
- Stroke Genetics and Pharmacogenetics, Fundació per la Docència i Recerca Mutua Terrassa, Spain Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universidad Autonoma de Barcelona, Spain
| | - M Vila-Pueyo
- Pediatric Neurology Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain
| | - C Sintas
- Departament de Genètica, Facultat de Biologia, Universitat de Barcelona, Spain Centre for Biomedical Network Research on Rare Diseases (CIBERER), Spain
| | - C M van Duijn
- Department of Epidemiology, Erasmus University Medical Center, the Netherlands
| | - B Cormand
- Departament de Genètica, Facultat de Biologia, Universitat de Barcelona, Spain Centre for Biomedical Network Research on Rare Diseases (CIBERER), Spain Institute of Biomedicine of the University of Barcelona (IBUB), Spain
| | - J Álvarez-Sabin
- Neurology Department, Hospital Universitari Vall d'Hebron (HUVH), Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universidad Autonoma de Barcelona, Spain Neurology Department, Hospital Universitari Vall d'Hebron (HUVH), Spain
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands
| | - Amjm van den Maagdenberg
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands Department of Human Genetics, Leiden University Medical Center (LUMC), the Netherlands
| | - A Palotie
- Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, United Kingdom Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, USA Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, USA Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
| | - J A Zwart
- FORMI, Oslo University Hospital, Norway Department of Neurology, Oslo University Hospital, Norway Institute of Clinical Medicine, University of Oslo, Norway
| | - A Macaya
- Pediatric Neurology Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center (LUMC), the Netherlands
| | - P Pozo-Rosich
- Headache and Neurological Pain Research Group, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona Neurology Department, Hospital Universitari Vall d'Hebron (HUVH), Spain
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Montaner J, Jiménez-Hernández MD, López-Barneo J. How to unfasten the Spanish Stroke Belt? Andalusia chooses research. Int J Stroke 2014; 9:946-9. [PMID: 25042753 DOI: 10.1111/ijs.12332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
Abstract
Andalusia in southern Spain, one of the largest regions in the European Union, has made a profound economic and social transformation that has led to establishment of a modern universal public health care system. However, due to its high stroke mortality rates, Andalusia is still known as the 'Spanish Stroke Belt'. To fight these figures, successive initiatives culminated in the launch of the Andalusian Plan for Stroke Care, to be developed during the period of 2011 to 2014. In addition, involved professionals have hypothesized that clinical and experimental research may contribute to improving stroke care in our community. To that end, one of the leading institutes of biomedical research in Andalusia, the Institute of Biomedicine of Seville (IBiS), has selected stroke as a flagship project in the region. Moreover, Seville, the capital of Andalusia, is now conducting a fusion process of its two largest hospitals, with the potential to generate a stroke alliance that will make it one of the main stroke hospitals in Europe (>2000 cases per year). It is anticipated that this will be an excellent platform to facilitate acute-phase clinical trials and speed the translation process from basic research in IBiS laboratories to the clinical setting. Furthermore, the recently created Andalusian Neurovascular Group is ready to develop prospective, collaborative, multicenter research projects that will evaluate interventions in areas of stroke care uncertainty. If we succeed in forging a link between research and health care quality, we may succeed in lowering the incidence of stroke and related mortality in the region in a short period of time.
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Affiliation(s)
- J Montaner
- Stroke Program, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocio, Seville, Spain
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Orbe J, Roncal C, Rodriguez JA, Salicio A, Montaner J, Rosell A, Martinez De Lizarrondo S, Vivien D, Paramo JA. P218tPA in combination with MMP-10 a new effective strategy for thrombolysis in ischemic stroke with neuroprotective effect. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reddon H, Milloy MJ, Simo A, Montaner J, Wood E, Kerr T. Methadone maintenance therapy decreases the rate of antiretroviral therapy discontinuation among HIV-positive illicit drug users. AIDS Behav 2014; 18:740-6. [PMID: 23918244 PMCID: PMC4059183 DOI: 10.1007/s10461-013-0584-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We sought to examine whether methadone maintenance therapy (MMT) decreased rates of antiretroviral therapy (ART) discontinuation and was associated with plasma HIV RNA responses among a cohort of illicit drug users. Cumulative ART discontinuation rates were estimated using Kaplan-Meier methods and factors independently associated with ART discontinuation were identified using Cox proportional hazards regression. Engagement in MMT was negatively and independently associated with ART discontinuation [Adjusted Relative Hazard = 0.67 (95 % CI 0.54-0.83); p < 0.001]. Among participants receiving ART and MMT, 81.6 % of plasma HIV-1 RNA assessments were <500 copies/mL, while 65.81 % of HIV-1 RNA assessments among those prescribed ART without MMT were <500 copies/mL (p < 0.001). These results demonstrate that engagement in MMT conferred a protective benefit against ART discontinuation and was associated with a significant increase in plasma HIV RNA suppression among HIV-infected opioid-dependent drug users.
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Affiliation(s)
- H Reddon
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Massot A, Giralt D, Penalba A, Garcia-Berrocoso T, Navarro-Sobrino M, Arenillas J, Ribó M, Molina C, Alvarez-Sabín J, Montaner J, Delgado P. Predictive value of ankle-brachial index and PAI-1 in symptomatic intracranial atherosclerotic disease recurrence. Atherosclerosis 2014; 233:186-9. [DOI: 10.1016/j.atherosclerosis.2013.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/14/2013] [Accepted: 12/24/2013] [Indexed: 12/28/2022]
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Ti L, Milloy M, Shannon K, Kerr T, Simo A, Montaner J, Wood E. P3.408 Sex Work Involvement Predicts Poor Viral Load Suppression Among People Who Inject Drugs in a Canadian Setting. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Giralt-Steinhauer E, Jiménez-Conde J, Soriano Tárraga C, Mola M, Rodríguez-Campello A, Cuadrado-Godia E, Ois A, Fernández-Cádenas I, Carrera C, Montaner J, Díaz Navarro RM, Vives-Bauzá C, Roquer J. Exploring the genetic basis of stroke. Spanish stroke genetics consortium. Neurologia 2013; 29:560-6. [PMID: 23831412 DOI: 10.1016/j.nrl.2013.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/27/2013] [Accepted: 04/21/2013] [Indexed: 11/18/2022] Open
Abstract
This article provides an overview of stroke genetics studies ranging from the candidate gene approach to more recent studies by the genome wide association. It highlights the complexity of stroke owing to its different aetiopathogenic mechanisms, the difficulties in studying its genetic component, and the solutions provided to date. The study emphasises the importance of cooperation between the different centres, whether this takes places occasionally or through the creation of lasting consortiums. This strategy is currently essential to the completion of high-quality scientific studies that allow researchers to gain a better knowledge of the genetic component of stroke as it relates to aetiology, treatment, and prevention.
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Affiliation(s)
- E Giralt-Steinhauer
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - J Jiménez-Conde
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Soriano Tárraga
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - M Mola
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - A Rodríguez-Campello
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - E Cuadrado-Godia
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - A Ois
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - I Fernández-Cádenas
- Laboratorio de Investigación Neurovascular, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Carrera
- Laboratorio de Investigación Neurovascular, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Montaner
- Laboratorio de Investigación Neurovascular, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - R M Díaz Navarro
- Departamento de Neurología, Hospital Universitari Son Espases, Mallorca, Baleares, España
| | - C Vives-Bauzá
- Departamento de Neurología, Hospital Universitari Son Espases, Mallorca, Baleares, España
| | - J Roquer
- Grupo de Investigación Neurovascular, Departamento de Neurología, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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Malhotra S, Castilló J, Negrotto L, Merino-Zamorano C, Montaner J, Vidal-Jordana A, Montalban X, Comabella M. TRPM4 mRNA expression levels in peripheral blood mononuclear cells from multiple sclerosis patients. J Neuroimmunol 2013; 261:146-8. [PMID: 23796873 DOI: 10.1016/j.jneuroim.2013.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 05/23/2013] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
Recent studies have suggested a role of the cation channel TRPM4 in mediating neurodegeneration in experimental autoimmune encephalomyelitis and multiple sclerosis (MS). We aimed to extrapolate central nervous system findings to the blood compartment by determining TRPM4 expression in peripheral blood mononuclear cells from 12 healthy controls (HC) and 64 untreated MS patients. TRPM4 mRNA expression levels were comparable between HC and MS patients with primary progressive MS (n=17), secondary progressive MS (n=19), and relapsing-remitting MS during clinical remission (n=21) and relapses (n=7). These findings do not support a role of TRPM4 in the peripheral blood compartment of MS patients.
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Affiliation(s)
- S Malhotra
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya, Cemcat, Hospital Universitari Vall d´Hebron (HUVH), Barcelona, Spain
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Rodriguez-Luna D, Piñeiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, Flores A, Muchada M, Ibarra B, Meler P, Sanjuan E, Hernandez-Guillamon M, Alvarez-Sabin J, Montaner J, Molina CA. Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol 2013; 20:1277-83. [PMID: 23647568 DOI: 10.1111/ene.12180] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/25/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE An association between high blood pressure (BP) in acute intracerebral hemorrhage (ICH) and hematoma growth (HG) has not been clearly demonstrated. Therefore, the impact of BP changes and course on HG and clinical outcome in patients with acute ICH was determined. METHODS In total, 117 consecutive patients with acute (<6 h) supratentorial ICH underwent baseline and 24-h CT scans, CT angiography for the detection of the spot sign and non-invasive BP monitoring at 15-min intervals over the first 24 h. Maximum and minimum BP, maximum BP increase and drop from baseline, and BP variability values from systolic BP (SBP), diastolic BP and mean arterial pressure (MAP) were calculated. SBP and MAP loads were defined as the proportion of readings >180 and >130 mmHg, respectively. HG (>33% or >6 ml), early neurological deterioration (END) and 3-month mortality were recorded. RESULTS Baseline BP variables were unrelated to either HG or clinical outcome. Conversely, SBP 180-load independently predicted HG (odds ratio 1.05, 95% CI 1.010-1.097, P = 0.016), whilst both SBP 180-load (odds ratio 1.04, 95% CI 1.001-1.076, P = 0.042) and SBP variability (odds ratio 1.2, 95% CI 1.047-1.380, P = 0.009) independently predicted END. Although none of the BP monitoring variables was associated with HG in the spot-sign-positive group, higher maximum BP increases from baseline and higher SBP and MAP loads were significantly related to HG in the spot-sign-negative group. CONCLUSIONS In patients with acute supratentorial ICH, SBP 180-load independently predicts HG, whilst both SBP 180-load and SBP variability predict END.
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Affiliation(s)
- D Rodriguez-Luna
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain.
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Massot A, Navarro-Sobrino M, Penalba A, Arenillas JF, Giralt D, Ribó M, Molina CA, Alvarez-Sabín J, Montaner J, Rosell A. Decreased levels of angiogenic growth factors in intracranial atherosclerotic disease despite severity-related increase in endothelial progenitor cell counts. Cerebrovasc Dis 2013; 35:81-8. [PMID: 23429001 DOI: 10.1159/000346097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke (IS) and endothelial dysfunction plays a critical role in its onset and progression. Endothelial progenitor cells (EPCs) and endothelial production of angiogenic growth factors (AGFs) may play an essential role in this process. This study investigated the association of EPCs and AGFs with ICAD severity. METHODS A total of 42 patients who had experienced a transient ischemic attack (TIA) or IS attributable to symptomatic ICAD were included. Clinical and neurosonological evaluations were conducted between 2.4 and 8.7 years after the initial cerebrovascular event. Severe ICAD was defined as the presence of at least 1 severe intracranial stenosis, and extensive ICAD as 3 or more intracranial stenoses. Blood samples were obtained to determine EPC levels using flow cytometry (CD34+KDR+ cells), and the plasma levels of several growth factors were assessed with a protein array (Searchlight(®)). Twenty-two individuals without cerebrovascular disease and with normal ultrasonographic examination were also included. RESULTS No difference in the count of circulating EPCs was found between patients and controls, and a moderate increase in the number of EPCs/ml was noted in patients with extensive ICAD (p = 0.05). Patients presented decreased levels of fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF-BB) compared with controls (p = 0.002, p = 0.079 and p = 0.061, respectively). Higher levels of FGF, VEGF and PDGF-BB were found in patients with severe ICAD (p = 0.007, p = 0.07 and p = 0.07, respectively), but there was no correlation between any AGFs and EPCs. CONCLUSIONS Symptomatic ICAD patients have decreased levels of AGFs with no correlation to the number of circulating EPCs, while patients with severe ICAD have higher levels of EPCs, FGF, VEGF and PDGF-BBs. This suggests that reduced EPC and proangiogenic factor production capacity is implicated in ICAD pathogenesis, while the more severe forms of chronic brain hypoperfusion in ICAD patients might stimulate EPC mobilization and AGF production.
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Affiliation(s)
- A Massot
- Neurovascular Unit, Universitat Autònoma de Barcelona, Vall d'Hebron Hospital, Barcelona, Spain
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Montaner J, Campos M, Cristobo I, Giralt D, Díaz-Guerra M. Role of PSD-95 inhibitors in stroke and neuroprotection: A systematic view on NA-1 (Tat-NR2B9c). DRUG FUTURE 2013. [DOI: 10.1358/dof.2013.038.07.1980497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Florczak-Rzepka M, Grond-Ginsbach C, Montaner J, Steiner T. Matrix metalloproteinases in human spontaneous intracerebral hemorrhage: an update. Cerebrovasc Dis 2012; 34:249-62. [PMID: 23052179 DOI: 10.1159/000341686] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 06/04/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In default of a plausible and satisfactory causal treatment for hemorrhagic stroke, a role of matrix metalloproteinases (MMPs) in the pathogenesis of cerebrovascular diseases has recently been widely discussed. The well-known impact of MMPs on extracellular matrix destruction triggered by inflammation as a foundation for several diseases, including stroke, is very much in evidence. Newly, some additional aspects of MMP function considering their intracellular activity crucial for neuronal death following ischemic brain damage have emerged. The effect of blood-brain barrier disruption caused by MMPs on the prognosis in patients suffering from spontaneous intracerebral hemorrhage (ICH) has been of interest since it throws a new light upon the pathogenesis, course and possible therapeutic approaches for this least treatable and at the same time most life-threatening form of stroke. Hence, we primarily aimed to review the current clinical knowledge on the significance of metalloproteinase activation in the course of spontaneous intracranial hemorrhage in humans. We also provide a brief characterization of the MMP enzyme family and report on the latest findings on issues arising from experimental studies. METHODS A Medline search using the following key words was performed: matrix metalloproteinases + spontaneous intracerebral hemorrhage/intracranial hemorrhage/bleeding/hemorrhagic stroke. We accepted studies reporting on MMP expression in adult patients with spontaneous ICH, as well as its relation to radiological and clinical features and patients' outcome. For the final review, 18 clinical studies were considered. MMP inhibition was reviewed on the basis of 11 relevant experimental studies. Also, some relevant reports on the biology of MMPs and their pathophysiology in ICH were reviewed. RESULTS AND CONCLUSIONS Many studies provide convincing evidence of a detrimental role of MMPs in ICH, stressing their association with neuroinflammation. The role of MMPs in hemorrhagic stroke appears critical for hematoma and brain edema growth as well as for neuronal death, which are understood as secondary brain injury and may have a considerable clinical impact. Although data on human spontaneous ICH are scarce and mostly based on small populations, they reveal the apparent correlation between MMPs and clinical and radiological ICH features as well as the functional outcome, which might rationalize future therapeutic strategies. However, attempts at MMP inhibition in spontaneous ICH have solely been made under experimental conditions and were associated with a wide range of possible side effects. Therefore, further comprehensive, elucidating investigations in this field are vital before any conclusions could be translated to humans.
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Affiliation(s)
- M Florczak-Rzepka
- Department of Neurology, Medical University of Warsaw, PL–02-097Warsaw, Poland. malgorzata.florczak @ gmail.com
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Montaner J, García-Berrocoso T, Mendioroz M, Palacios M, Perea-Gainza M, Delgado P, Rosell A, Slevin M, Ribó M, Molina CA, Alvarez-Sabín J. Brain natriuretic peptide is associated with worsening and mortality in acute stroke patients but adds no prognostic value to clinical predictors of outcome. Cerebrovasc Dis 2012; 34:240-5. [PMID: 23018289 DOI: 10.1159/000341858] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 07/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At the present time, the determination of the outcome of stroke patients is based on the analysis of clinical and neuroimaging data. The use of prognostic blood biomarkers could aid in decision-making processes, e.g. admitting patients to specialized stroke units. Although the prognostic role of natriuretic peptides has been studied in heart failure and coronary diseases, the value of brain natriuretic peptide (BNP) is less known within the field of strokes. OBJECTIVE We aimed to study the relationship between plasma levels of BNP and acute neurological worsening or mortality after stroke in a large cohort of patients (investigating both ischemic and hemorrhagic disease). METHODS Consecutive stroke patients (ischemic and hemorrhagic) admitted to the Stroke Unit of our University Hospital within 24 h of the onset of symptoms were included. Stroke severity was assessed according to the National Institutes of Health Stroke Scale (NIHSS) at admission and at discharge. Neurological worsening was defined as an increase of 4 or more points in the NIHSS score or death during the patient's stay at the Stroke Unit. Blood samples were drawn upon admission to measure plasma levels of BNP (Biosite Inc., San Diego, Calif., USA). Statistical analysis was performed using SPSS 15.0 and R software. RESULTS Altogether, 896 patients were included in the study. BNP plasma levels were higher among patients who deteriorated the most over time (n = 112; 90.5 vs. 61.2 ng/l; p = 0.006) or died (n = 83; 118.2 vs. 60.9 ng/l; p < 0.001). Multivariate logistic regression analysis indicated that plasma BNP level was an independent predictor of neurological worsening [BNP >56.7 ng/l; odds ratio (OR) = 1.64; p = 0.04] and death after stroke (BNP >65.3 ng/l; OR = 1.97; p = 0.034). Adding BNP level to other well-known clinical predictors of bad outcome did not significantly increase the predictive value. CONCLUSIONS Plasma levels of BNP measured during the acute phase of stroke are associated both with early neurological worsening and mortality. However, this biological information does not supply prognostic information which would add to clinical variables, which limits its use as a biomarker. Further investigation and systematic reviews are needed to clarify the role of natriuretic peptides in stroke outcome.
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Affiliation(s)
- J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Riba I, Jarca CI, Mundet X, Tovar JL, Orfila F, Nafría C, Raga A, Girona A, Fernández-Lara P, Castañé X, Alvarez Sabin J, Fernández Cortiñas I, Maisterra O, Montaner J, Delgado P. Cognitive assessment protocol design in the ISSYS (Investigating Silent Strokes in hYpertensives: a magnetic resonance imaging Study). J Neurol Sci 2012; 322:79-81. [PMID: 22836018 DOI: 10.1016/j.jns.2012.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 06/01/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
Hypertension and silent cerebrovascular lesions (SCL) detected by brain magnetic resonance imaging (MRI) are associated with an increased risk of cognitive decline. In a prospective observational study in 1000 hypertensive patients, aged 50-70 years, with no prior history of stroke or dementia, we will study the presence of mild cognitive impairment (MCI) and the relationship between SCL and cognition. All participants will be assessed by means of the Dementia Rating Scale-2 (DRS-2) and will undergo a brain MRI. In order to better characterize MCI and future dementia risk in our cohort, those patients that are suspected to be cognitively impaired according to the DRS-2 results will have a further neurological evaluation and complete neuropsychological testing. Follow-up for the entire cohort is planned to last for at least 3 years.
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Affiliation(s)
- I Riba
- Neurovascular Research Laboratory, Vall Hebron's Research Institute, Neurovascular Section, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Klein MB, Rollet KC, Saeed S, Cox J, Potter M, Cohen J, Conway B, Cooper C, Côté P, Gill J, Haase D, Haider S, Hull M, Moodie E, Montaner J, Pick N, Rachlis A, Rouleau D, Sandre R, Tyndall M, Walmsley S. HIV and hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality. HIV Med 2012; 14:10-20. [PMID: 22639840 DOI: 10.1111/j.1468-1293.2012.01028.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) has emerged as an important health problem in the era of effective HIV treatment. However, very few data exist on the health status and disease burden of HIV/HCV-coinfected Canadians. METHODS HIV/HCV-coinfected patients were enrolled prospectively in a multicentre cohort from 16 centres across Canada between 2003 and 2010 and followed every 6 months. We determined rates of a first liver fibrosis or endstage liver disease (ESLD) event and all-cause mortality since cohort enrolment and calculated standardized mortality ratios compared with the general Canadian population. RESULTS A total of 955 participants were enrolled in the study and followed for a median of 1.4 (interquartile range 0.5-2.3) years. Most were male (73%) with a median age of 44.5 years; 13% self-identified as aboriginal. There were high levels of current injecting drug and alcohol use and poverty. Observed event rates [per 100 person-years; 95% confidence interval (CI)] were: significant fibrosis (10.21; 8.49, 12.19), ESLD (3.16; 2.32, 4.20) and death (3.72; 2.86, 4.77). The overall standardized mortality ratio was 17.08 (95% CI 12.83, 21.34); 12.80 (95% CI 9.10, 16.50) for male patients and 28.74 (95% CI 14.66, 42.83) for female patients. The primary causes of death were ESLD (29%) and overdose (24%). CONCLUSIONS We observed excessive morbidity and mortality in this HIV/HCV-coinfected population in care. Over 50% of observed deaths may have been preventable. Interventions aimed at improving social circumstances, reducing harm from drug and alcohol use and increasing the delivery of HCV treatment in particular will be necessary to reduce adverse health outcomes among HIV/HCV-coinfected persons.
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Affiliation(s)
- M B Klein
- Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Mann B, Milloy MJ, Kerr T, Zhang R, Montaner J, Wood E. Improved adherence to modern antiretroviral therapy among HIV-infected injecting drug users. HIV Med 2012; 13:596-601. [PMID: 22551168 DOI: 10.1111/j.1468-1293.2012.01021.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adherence to antiretroviral therapy (ART) among injecting drug users (IDUs) is often suboptimal, yet little is known about changes in patterns of adherence since the advent of highly active antiretroviral therapy in 1996. We sought to assess levels of optimal adherence to ART among IDUs in a setting of free and universal HIV care. METHODS Data were collected through a prospective cohort study of HIV-positive IDUs in Vancouver, British Columbia. We calculated the proportion of individuals achieving at least 95% adherence in the year following initiation of ART from 1996 to 2009. RESULTS Among 682 individuals who initiated ART, the median age was 37 years (interquartile range 31-44 years) and 248 participants (36.4%) were female. The proportion achieving at least 95% adherence increased over time, from 19.3% in 1996 to 65.9% in 2009 (Cochrane-Armitage test for trend: P < 0.001). In a logistic regression model examining factors associated with 95% adherence, initiation year was statistically significant (odds ratio 1.08; 95% confidence interval 1.03-1.13; P < 0.001 per year after 1996) after adjustment for a range of drug use variables and other potential confounders. CONCLUSIONS The proportion of IDUs achieving at least 95% adherence during the first year of ART has consistently increased over a 13-year period. Although improved tolerability and convenience of modern ART regimens probably explain these positive trends, by the end of the study period a substantial proportion of IDUs still had suboptimal adherence, demonstrating the need for additional adherence support strategies.
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Affiliation(s)
- B Mann
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Giralt D, Domingues-Montanari S, Mendioroz M, Ortega L, Maisterra O, Perea-Gainza M, Delgado P, Rosell A, Montaner J. The gender gap in stroke: a meta-analysis. Acta Neurol Scand 2012; 125:83-90. [PMID: 21649609 DOI: 10.1111/j.1600-0404.2011.01514.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Several studies have indicated that gender differences might exist in stroke. OBJECTIVES AND METHODS Our goal was to perform a comprehensive meta-analysis in order to evaluate and quantify stroke gender disparities through a systematic search of relevant articles published up to October 2009 and addressing gender related differences in ischemic stroke risk factors, stroke subtype and severity, diagnostic tests, and acute phase and secondary prevention treatments. RESULTS Forty-five articles were included in the analysis, representing a total of 673,935 patients. Women were globally older than men (+5.2 years) and suffered more hypertension (P = 0.017) and atrial fibrillation (P < 0.001), although they were less likely to drink alcohol (P < 0.001), smoke cigarettes (P < 0.001), present hyperlipidemia (P = 0.033) or diabetes (P = 0.003) than men. Baseline stroke severity was not different between genders. Women suffered more cardioembolic strokes, while men had more atherothrombotic strokes. Moreover, women were less likely to receive stroke-related treatments, such as antiplatelets (P < 0.001), statins (P < 0.001), and tPA (P < 0.001) than men. Although meta-regression did not identify age or stroke etiology as sources of heterogeneity, caution should be taken as that analysis was possible only for gender differences in secondary prevention with antiplatelets because of limited data for other end points. CONCLUSIONS Gender differences have been identified on the risk factors profile and diagnostic and therapeutic management of patients with ischemic stroke. Active measures should thus be taken to avoid bias in clinical practice.
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Affiliation(s)
- D Giralt
- Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments, Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Research Institute, Spain
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Mtambo A, Chan K, Shen A, Lima V, Hogg R, Montaner J, Moore D. Treatment limitations imposed by antiretroviral drug resistance mutations: implication for choices of first line regimens in resource-limited settings. HIV Med 2011; 13:141-7. [PMID: 22107262 DOI: 10.1111/j.1468-1293.2011.00950.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have suggested that failing nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens may have greater potential to induce the development of resistance mutations, which may limit options for second-line therapy. METHODS Antiretroviral therapy (ART)-naïve individuals aged ≥18 years who initiated triple combination ART between January 2000 and June 2006 in British Columbia, Canada were enrolled in the study. We compared genotypic sensitivity scores (GSSs) derived from the development of resistance mutations between participants who initiated ART with ritonavir-boosted protease inhibitors (PIs) with those who initiated ART with NNRTIs, and determined the effects of these mutations on remaining active drugs. RESULTS A total of 1666 participants initiated ART, 818 (49.1%) with NNRTI-based regimens and 848 (50.9%) with boosted PI-based regimens. Among participants who developed resistance mutations, those who initiated NNRTI-based regimens had a lower median GSS than those on boosted PI-based regimens (9.8 vs. 11.0, respectively; P<0.001). Participants on boosted PI-based regimens [adjusted odds ratio (AOR) 3.68; 95% confidence interval (CI) 2.25, 6.01], those with ≥95% adherence to highly active antiretroviral therapy (HAART) (AOR 1.84; 95% CI 1.16, 2.92) and those with baseline CD4 count >200 cells/μL (AOR 3.44; 95% CI 1.73, 6.84) were more likely to have the maximum number of drug options. CONCLUSION The use of NNRTI-based first-line ART regimens may limit the options for second-line treatment when the number of available drugs is limited.
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Affiliation(s)
- A Mtambo
- Simon Fraser University, Burnaby, BC, Canada.
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Rodriguez-Luna D, Rubiera M, Ribo M, Coscojuela P, Pineiro S, Pagola J, Hernandez-Guillamon M, Ibarra B, Romero F, Alvarez-Sabin J, Montaner J, Molina CA. Ultraearly hematoma growth predicts poor outcome after acute intracerebral hemorrhage. Neurology 2011; 77:1599-604. [DOI: 10.1212/wnl.0b013e3182343387] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Montaner J, Mendioroz M, Ribó M, Delgado P, Quintana M, Penalba A, Chacón P, Molina C, Fernández-Cadenas I, Rosell A, Alvarez-Sabín J. A panel of biomarkers including caspase-3 and D-dimer may differentiate acute stroke from stroke-mimicking conditions in the emergency department. J Intern Med 2011; 270:166-74. [PMID: 21198992 DOI: 10.1111/j.1365-2796.2010.02329.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS At present, a rapid and widely available diagnostic test for stroke remains elusive. The aim of this study was to examine the predictive value of a panel of blood-borne biochemical markers for stroke diagnosis. DESIGN Consecutive patients with strokes or stroke-mimicking conditions (mimics) were evaluated within 24 h from symptom onset (915 strokes and 90 mimics). Blood samples were analysed by enzyme-linked immunosorbent assay for C-reactive protein, d-dimer, soluble receptor for advanced glycation end products (sRAGE), metalloproteinase 9 (MMP-9), S100B, brain natriuretic peptide, caspase-3, neurotrophin-3, chimerin and secretagogin. RESULTS The main independent predictors of stroke versus mimics were caspase-3 >1.96 ng mL(-1) [odds ratio (OR) = 3.32; 95% confidence interval (CI) 1.88-5.88, P < 0.0001], d-dimer >0.27 μg mL(-1) (OR = 2.97; 95% CI 1.72-5.16, P = 0.0001), sRAGE >0.91 ng mL(-1) (OR = 2.19; 95% CI 1.26-3.83, P = 0.006), chimerin <1.11 ng mL(-1) (OR = 0.4; 95% CI 0.19-0.81, P = 0.011), secretagogin <0.24 ng mL(-1) (OR = 0.51; 95% CI 0.27-0.97, P = 0.041) and MMP-9 > 199 ng mL(-1) (OR = 1.66; 95% CI 1.01-2.73, P = 0.046). The model's predictive probability of stroke when the six biomarkers are above/below these cut-off levels was 99.01%. The best combination of biomarkers in the model was caspase-3 and d-dimer. Moreover, a model developed for samples obtained within the first 3 h showed high sensitivity (Se) and specificity (Sp) (threshold at 25th percentile: Se 0.87, Sp 0.55; threshold at 75th percentile: Se 0.28, Sp 0.99). CONCLUSIONS A combination of biomarkers including caspase-3 and d-dimer appears to be the most promising to achieve a rapid biochemical diagnosis of stroke. If replicated, this approach could be used as a tool for urgent referral of stroke patients to hospitals in which acute treatments are available.
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Affiliation(s)
- J Montaner
- Neurovascular Research Laboratory, Universitat Autònoma de Barcelona, Vall d'Hebron Hospital, Barcelona, Spain.
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Parashar S, Palmer A, O'Brien N, Chan K, Milan D, Samji H, Montaner J, Hogg R. O2-S5.03 Sex, drugs and structural interventions: unstable housing associated with increased HIV risk behaviour in a cohort of people on treatment in British Columbia, Canada. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parashar S, Palmer A, O'Brien N, Chan K, Shen A, Coulter S, Montaner J, Hogg R. P5-S4.06 Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among a cohort of unstably housed people living with HIV in BC, Canada. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Deering K, Chettiar J, Chan K, Taylor M, Montaner J, Shannon K. P1-S2.13 The impact of the 2010 Winter Olympic Games on sex work patterns, safety and sex worker vulnerability to HIV and sexually transmitted infections. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Domingues-Montanari S, Parés M, Hernández-Guillamon M, Fernández-Cadenas I, Mendioroz M, Ortega G, Boada M, Masjuan J, Huertas N, Álvarez-Sabín J, Delgado P, Montaner J. No evidence of APP point mutation and locus duplication in individuals with cerebral amyloid angiopathy. Eur J Neurol 2011; 18:1279-81. [DOI: 10.1111/j.1468-1331.2011.03401.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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García-Bonilla L, Rosell A, Torregrosa G, Salom J, Alborch E, Gutiérrez M, Díez-Tejedor E, Martínez-Murillo R, Agulla J, Ramos-Cabrer P, Castillo J, Gasull T, Montaner J. Guía de recomendaciones en la aplicación de modelos animales para el estudio del ictus. Neurologia 2011; 26:105-10. [DOI: 10.1016/j.nrl.2010.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/19/2010] [Indexed: 11/17/2022] Open
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Domingues-Montanari S, Fernandez-Cadenas I, del Rio-Espinola A, Mendioroz M, Ribo M, Obach V, Marti-Fabregas J, Freijo M, Serena J, Corbeto N, Chacon P, Alvarez-Sabin J, Montaner J. The I/D polymorphism of the ACE1 gene is not associated with ischaemic stroke in Spanish individuals. Eur J Neurol 2011; 17:1390-2. [PMID: 20402757 DOI: 10.1111/j.1468-1331.2010.03022.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The angiotensin-converting enzyme 1 (ACE1) gene has been extensively studied in stroke, yet generating conflicting results. The goal of our study was thus to clarify the influence of the ACE1 on the risk of suffering an ischaemic stroke (IS). METHODS We genotyped the rs4341 (in linkage disequilibrium with the I/D polymorphism) of the ACE1 gene in 531 patients with IS and 549 healthy controls, and the rs1799752 (I/D polymorphism) in a subset of 68 patients with IS and 27 controls. We also performed functional studies by measuring serum ACE protein levels and enzymatic activity in 27 controls, 68 patients with IS at baseline and 35 patients with IS 24 h after onset of stroke symptoms. RESULTS There was no association of the ACE1 variant with IS, although it affected ACE protein levels (P = 0.001). Indeed, patients with IS showed lower ACE levels than controls in the acute phase (115.9 } 38.9 vs. 174.1 } 56.1 ng/ml, P < 0.001), but not in the chronic phase (168.2 } 51.2, P = 0.673), and ACE protein levels did not differ between IS etiologies. Similar results were found for ACE activity. CONCLUSIONS The D allele of the ACE1 I/D and ACE protein levels was not associated with a higher risk of IS in Spanish individuals.
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Affiliation(s)
- S Domingues-Montanari
- Neurovascular Research Laboratory and Neurovascular Unit, Neurology Department-Universitat Autonoma of Barcelona, Institute of Research of Vall dHebron Hospital, Barcelona, Spain
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García-Bonilla L, Rosell A, Torregrosa G, Salom J, Alborch E, Gutiérrez M, Díez-Tejedor E, Martínez-Murillo R, Agulla J, Ramos-Cabrer P, Castillo J, Gasull T, Montaner J. Recommendations guide for experimental animal models in stroke research. Neurología (English Edition) 2011. [DOI: 10.1016/s2173-5808(11)70021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Nafría C, Fernández-Cadenas I, Mendioroz M, Domingues-Montanari S, Hernández-Guillamón M, Fernández-Morales J, del Río-Espínola A, Giralt D, Deu L, Delgado P, Rosell A, Montaner J. Update on the Serum Biomarkers and Genetic Factors Associated with Safety and Efficacy of rt-PA Treatment in Acute Stroke Patients. Stroke Res Treat 2011; 2011:182783. [PMID: 21772966 PMCID: PMC3137952 DOI: 10.4061/2011/182783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/08/2010] [Accepted: 01/31/2011] [Indexed: 11/20/2022] Open
Abstract
An accurate understanding of the mechanisms underlying an individual's response to rt-PA treatment is critical to improve stroke patients' management. We thus reviewed the literature in order to identify biochemical and genetic factors that have been associated with safety and efficacy of rt-PA administration after stroke.
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Affiliation(s)
- C. Nafría
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - I. Fernández-Cadenas
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - M. Mendioroz
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - S. Domingues-Montanari
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - M. Hernández-Guillamón
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - J. Fernández-Morales
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - A. del Río-Espínola
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - D. Giralt
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - L. Deu
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - P. Delgado
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - A. Rosell
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - J. Montaner
- Neurovascular Research Laboratory, Neurology and Medicine Departments, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- *J. Montaner:
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