1
|
Kollar B, Siarnik P, Konarikova K, Oravec S, Klobucka S, Klobucnikova K, Poddany M, Radikova Z, Janubova M, Turcani P, Gajdosova L, Zitnanova I. The Interplay of Dyslipidemia, Oxidative Stress, and Clinical Outcomes in Acute Ischemic Stroke Patients with and without Coronary Artery Disease. Biomedicines 2024; 12:332. [PMID: 38397934 PMCID: PMC10886910 DOI: 10.3390/biomedicines12020332] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
We assessed lipid and lipoprotein profiles, along with oxidative stress (OS) parameters, in patients within the crucial 24 h period following an acute ischemic stroke (AIS), comparing those with and without coronary artery disease (CAD). We aimed to correlate these measures with clinical condition scales (NIHSS, mRS) post-AIS. This study included 27 AIS patients without CAD (AIS group) and 37 AIS patients with CAD (CAD-AIS group). Using polyacrylamide gel electrophoresis (Lipoprint system), we determined plasma LDL and HDL subfractions. Spectrophotometric methods were used to assess plasma antioxidant capacity, lipoperoxides, homocysteine (HC) levels, paraoxonase1, and catalase activities. We also measured urine isoprostanes and the activities of antioxidant enzymes (SOD, GPx) with commercial kits. CAD-AIS patients had notably higher HC levels, while there were no significant differences in lipoprotein subfractions and OS parameters between both groups. In the AIS group, mRS scores showed negative correlations with catalase, GPx activities, and total cholesterol. In the CAD-AIS group, atherogenic lipoproteins (IDLC, LDL2, LDL3-7) exhibited a significant positive correlation with mRS. This study underscores the role of dyslipidemia and OS in the development of AIS and CAD. It emphasizes the complex connections between specific biomarkers and post-stroke clinical outcomes. Our results suggest a significant impact of CAD treatment on lipid profile but not on homocysteine levels. The traditional narrative associating high cholesterol as the ultimate risk factor for cardiovascular diseases needs to be challenged, at least with respect to neurological outcomes. These insights may guide more targeted therapeutic approaches.
Collapse
Affiliation(s)
- Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia; (B.K.); (K.K.); (P.T.)
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia; (B.K.); (K.K.); (P.T.)
| | - Katarina Konarikova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia; (K.K.); (M.J.); (L.G.); (I.Z.)
| | - Stanislav Oravec
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia;
| | | | - Katarina Klobucnikova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia; (B.K.); (K.K.); (P.T.)
| | - Michal Poddany
- Department of Neurology, General Hospital, 031 01 Liptovsky Mikulas, Slovakia;
| | - Zofia Radikova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia;
| | - Maria Janubova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia; (K.K.); (M.J.); (L.G.); (I.Z.)
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia; (B.K.); (K.K.); (P.T.)
| | - Livia Gajdosova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia; (K.K.); (M.J.); (L.G.); (I.Z.)
| | - Ingrid Zitnanova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia; (K.K.); (M.J.); (L.G.); (I.Z.)
| |
Collapse
|
2
|
Hardonova M, Siarnik P, Sivakova M, Sucha B, Penesova A, Radikova Z, Havranova A, Imrich R, Vlcek M, Zitnanova I, Krastev G, Kiacikova M, Kollar B, Turcani P. Endothelial Function in Patients with Multiple Sclerosis: The Role of GLP-1 Agonists, Lipoprotein Subfractions, and Redox Balance. Int J Mol Sci 2023; 24:11162. [PMID: 37446338 DOI: 10.3390/ijms241311162] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Epidemiological studies have suggested an increased vascular risk in patients with multiple sclerosis (MS). There is increasing evidence of the beneficial effects of GLP-1 agonists (GLP-1a) in preventing vascular complications and slowing the progression of neurodegeneration. Our objective was to explore the changes in the endothelial function of MS patients after 12 months of GLP-1a therapy. We also explored the role of lipoprotein subfractions and the antioxidant capacity of plasma. METHODS MS patients were enrolled in a prospective, unicentric study. GLP-1a (dulaglutide) was administered to 13 patients. The control population consisted of 12 subjects. Endothelial function was determined by peripheral arterial tonometry and expressed as reperfusion hyperemia index (RHI). Trolox equivalent antioxidant capacity (TEAC) was used to assess the total antioxidant capacity of the plasma. The levels of lipoprotein subfractions were evaluated. RESULTS The GLP-1a group did not have a significant change in their RHIs after 12 months (2.1 ± 0.6 vs. 2.1 ± 0.7; p = 0.807). However, a significant increase in their TEACs was observed (4.1 ± 1.4 vs. 5.2 ± 0.5 mmol/L, p = 0.010). On the contrary, the subjects in the control group had a significant worsening of their RHIs (2.1 ± 0.5 vs. 1.8 ± 0.6; p = 0.030), without significant changes in their TEACs. Except for a significant decrease in very-low-density lipoprotein (VLDL) (30.8 ± 10.2 vs. 22.6 ± 8.3 mg/dL, p = 0.043), no other significant changes in the variables were observed in the control group. VLDL levels (beta = -0.637, p = 0.001), the use of GLP-1a therapy (beta = 0.560, p = 0.003), and small LDL (beta = 0.339, p = 0.043) were the only significant variables in the model that predicted the follow-up RHI. CONCLUSION Our results suggest that the application of additional GLP-1a therapy may have atheroprotective and antioxidant effects in MS patients with high MS activity and thus may prospectively mitigate their vascular risk. However, the lipoprotein profile may also play an important role in the atherogenic risk of MS subjects.
Collapse
Affiliation(s)
- Miroslava Hardonova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Monika Sivakova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Bianka Sucha
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Adela Penesova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Zofia Radikova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Andrea Havranova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Richard Imrich
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Miroslav Vlcek
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Ingrid Zitnanova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia
| | - Georgi Krastev
- Department of Neurology, Faculty Hospital, 917 75 Trnava, Slovakia
| | - Maria Kiacikova
- Department of Neurology, Faculty Hospital, 911 01 Trencin, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia
| |
Collapse
|
3
|
Hluchanova A, Kollar B, Klobucnikova K, Hardonova M, Poddany M, Zitnanova I, Dvorakova M, Konarikova K, Tedla M, Urik M, Klail P, Skopek P, Turcani P, Siarnik P. Lipoprotein Subfractions Associated with Endothelial Function in Previously Healthy Subjects with Newly Diagnosed Sleep Apnea-A Pilot Study. Life (Basel) 2023; 13:life13020441. [PMID: 36836798 PMCID: PMC9962671 DOI: 10.3390/life13020441] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) activates several pathophysiological mechanisms which can lead to the development of vascular diseases. Endothelial dysfunction (ED) is an initial step in the development of atherosclerosis. The association between ED and OSA has been described in several studies, even in previously healthy subjects. High-density lipoproteins (HDL) were generally considered to be atheroprotective, and low-density lipoprotein (LDL) to be an atherogenic component of lipoproteins. However, recent findings suggest a pro-atherogenic role of small HDL subfractions (8-10) and LDL subfractions (3-7). This study aimed to evaluate the relationship between endothelial function and lipid subfractions in previously healthy OSA subjects. MATERIAL AND METHODS We prospectively enrolled 205 subjects with sleep monitoring. Plasma levels of triacylglycerols, total cholesterol, LDL, HDL, and their subfractions were assessed. Endothelial function was determined using peripheral arterial tonometry, and reperfusion hyperemia index (RHI) was assessed. RESULTS Plasma levels of small and intermediate HDL subfractions have statistically significant pro-atherogenic correlations with endothelial function (p = 0.015 and p = 0.019). In other lipoprotein levels, no other significant correlation was found with RHI. In stepwise multiple linear regression analysis, small HDL (beta = -0.507, p = 0.032) was the only significant contributor in the model predicting RHI. CONCLUSIONS In our studied sample, a pro-atherogenic role of small HDL subfractions in previously healthy subjects with moderate-to-severe OSA was proven.
Collapse
Affiliation(s)
- Alzbeta Hluchanova
- Department of Neurology, University Hospital Bratislava, 85107 Bratislava, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, University Hospital, 81499 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-257290147
| | - Katarina Klobucnikova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, University Hospital, 81499 Bratislava, Slovakia
| | - Miroslava Hardonova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, University Hospital, 81499 Bratislava, Slovakia
| | - Michal Poddany
- Department of Neurology, General Hospital, 03123 Liptovsky Mikulas, Slovakia
| | - Ingrid Zitnanova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 81499 Bratislava, Slovakia
| | - Monika Dvorakova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 81499 Bratislava, Slovakia
| | - Katarina Konarikova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 81499 Bratislava, Slovakia
| | - Miroslav Tedla
- Department of ENT and HNS, Faculty of Medicine, Comenius University, University Hospital, 81499 Bratislava, Slovakia
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2SQ, UK
| | - Milan Urik
- Department of Pediatric Otorhinolaryngology, University Hospital Brno, 61300 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Pavel Klail
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine, Charles University, 11000 Pilsen, Czech Republic
| | - Petr Skopek
- Department of Otorhinolaryngology, University Hospital in Pilsen, Faculty of Medicine, Charles University, 11000 Pilsen, Czech Republic
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, University Hospital, 81499 Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, University Hospital, 81499 Bratislava, Slovakia
| |
Collapse
|
4
|
Kokas Z, Járdánházy A, Sandi D, Biernacki T, Fricska-Nagy Z, Füvesi J, Bartosik-Psujek H, Kes VB, Berger T, Berthele A, Drulovic J, Hemmer B, Horakova D, Ledinek AH, Havrdova EK, Magyari M, Rejdak K, Tiu C, Turcani P, Klivényi P, Kincses ZT, Vécsei L, Bencsik K. Real-world operation of multiple sclerosis centres in Central-Eastern European countries covering 107 million inhabitants. Mult Scler Relat Disord 2023; 69:104406. [PMID: 36413917 DOI: 10.1016/j.msard.2022.104406] [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: 04/27/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In 2018 multiple sclerosis (MS) care unit (MSCU) recommendations were defined. Nevertheless, the information on MS care, and whether MS centres fulfil the international recommendation is limited. Thus our objectives were to assess whether centres meet the MSCU recommendations and gain a comprehensive overview of MS care in Central-Eastern European countries. METHODS A self-report questionnaire assessing aspects of the MSCU recommendations, disease-modifying therapy (DMT) and registry use and the patient number was assembled and sent to nine Central-Eastern European countries. Furthermore, one Danish and one German centre were contacted as a reference. RESULTS In 9/9 countries, MS care was pursued in centres by MS neurologists and MS nurses. In Austria and the Czech Republic, management of MS was conducted under strict regulations displaying a referral centre system, fundamentally similar to but independent of the MSCU criteria. Several centres fulfilled all aspects of the MSCU criteria, while others had similar insufficiencies consisting of a speech therapist, continence, pain and spasticity specialist, neuro-ophthalmologist, and oto-neurologist. In 9/9 countries, DMTs were reimbursed. However, some centres did not provide every available DMT. A national registry was available in 4/9 countries with mandatory registry use only in Austria and the Czech Republic. CONCLUSION In countries where MSCU recommendations are not fulfilled, a strictly regulated centre system similar to the Austrian and Czech model with a registry-based quality control might ensure appropriate care for people with MS.
Collapse
Affiliation(s)
- Zsófia Kokas
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Anett Járdánházy
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Halina Bartosik-Psujek
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Vanja Basic Kes
- Department of Neurology, University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany
| | - Jelena Drulovic
- Clinic of Neurology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Bernhard Hemmer
- Department of Neurology, School of Medicine, Technical University Munich, Munich, Germany; Munich Cluster for System Neurology (SyNergy), Munich, Germany
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Cristina Tiu
- Department of Neurology, University Hospital Bucharest, Bucharest, Romania
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary; Department of Radiology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary; MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Albert Szent-Györgyi Faculty of Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.
| |
Collapse
|
5
|
Shoamanesh A, Mundl H, Smith EE, Masjuan J, Milanov I, Hirano T, Agafina A, Campbell B, Caso V, Mas JL, Dong Q, Turcani P, Christensen H, Ferro JM, Veltkamp R, Mikulik R, De Marchis GM, Robinson T, Lemmens R, Stepien A, Greisenegger S, Roine R, Csiba L, Khatri P, Coutinho J, Lindgren AG, Demchuk AM, Colorado P, Kirsch B, Neumann C, Heenan L, Xu L, Connolly SJ, Hart RG. Factor XIa inhibition with asundexian after acute non-cardioembolic ischaemic stroke (PACIFIC-Stroke): an international, randomised, double-blind, placebo-controlled, phase 2b trial. Lancet 2022; 400:997-1007. [PMID: 36063821 DOI: 10.1016/s0140-6736(22)01588-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asundexian (Bayer AG, Leverkusen, Germany), an oral small molecule factor XIa (FXIa) inhibitor, might prevent thrombosis without increasing bleeding. Asundexian's effect for secondary prevention of recurrent stroke is unknown. METHODS In this randomised, double-blind, placebo-controlled, phase 2b dose-finding trial (PACIFIC-Stroke), patients with acute (within 48 h) non-cardioembolic ischaemic stroke were recruited from 196 hospitals in 23 countries. Patients were eligible if they were aged 45 years or older, to be treated with antiplatelet therapy, and able to have a baseline MRI (either before or within 72 h of randomisation). Eligible participants were randomly assigned (1:1:1:1), using an interactive web-based response system and stratified according to anticipated antiplatelet therapy (single vs dual), to once daily oral asundexian (BAY 2433334) 10 mg, 20 mg, or 50 mg, or placebo in addition to usual antiplatelet therapy, and were followed up during treatment for 26-52 weeks. Brain MRIs were obtained at study entry and at 26 weeks or as soon as possible after treatment discontinuation. The primary efficacy outcome was the dose-response effect on the composite of incident MRI-detected covert brain infarcts and recurrent symptomatic ischaemic stroke at or before 26 weeks after randomisation. The primary safety outcome was major or clinically relevant non-major bleeding as defined by International Society on Thrombosis and Haemostasis criteria. The efficacy outcome was assessed in all participants assigned to treatment, and the safety outcome was assessed in all participants who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT04304508, and is now complete. FINDINGS Between June 15, 2020, and July 22, 2021, 1880 patients were screened and 1808 participants were randomly assigned to asundexian 10 mg (n=455), 20 mg (n=450), or 50 mg (n=447), or placebo (n=456). Mean age was 67 years (SD 10) and 615 (34%) participants were women, 1193 (66%) were men, 1505 (83%) were White, and 268 (15%) were Asian. The mean time from index stroke to randomisation was 36 h (SD 10) and median baseline National Institutes of Health Stroke Scale score was 2·0 (IQR 1·0-4·0). 783 (43%) participants received dual antiplatelet treatment for a mean duration of 70·1 days (SD 113·4) after randomisation. At 26 weeks, the primary efficacy outcome was observed in 87 (19%) of 456 participants in the placebo group versus 86 (19%) of 455 in the asundexian 10 mg group (crude incidence ratio 0·99 [90% CI 0·79-1·24]), 99 (22%) of 450 in the asundexian 20 mg group (1·15 [0·93-1·43]), and 90 (20%) of 447 in the asundexian 50 mg group (1·06 [0·85-1·32]; t statistic -0·68; p=0·80). The primary safety outcome was observed in 11 (2%) of 452 participants in the placebo group versus 19 (4%) of 445 in the asundexian 10 mg group, 14 (3%) of 446 in the asundexian 20 mg group, and 19 (4%) of 443 in the asundexian 50 mg group (all asundexian doses pooled vs placebo hazard ratio 1·57 [90% CI 0·91-2·71]). INTERPRETATION In this phase 2b trial, FXIa inhibition with asundexian did not reduce the composite of covert brain infarction or ischaemic stroke and did not increase the composite of major or clinically relevant non-major bleeding compared with placebo in patients with acute, non-cardioembolic ischaemic stroke. FUNDING Bayer AG.
Collapse
Affiliation(s)
- Ashkan Shoamanesh
- Division of Neurology, McMaster University, Population Health Research Institute, Hamilton, ON, Canada.
| | - Hardi Mundl
- TA Thrombosis and Vascular Medicine, Bayer AG, Wuppertal, Germany
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jaime Masjuan
- Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, RICORS-ICTUS, Madrid, Spain
| | - Ivan Milanov
- Medical University, University Hospital for Neurology and Psychiatry "St Naum", Sofia, Bulgaria
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Alina Agafina
- Clinical Research Department, City Hospital #40, Saint Petersburg, Russia
| | - Bruce Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Jean-Louis Mas
- Department of Neurology, GHU Paris, Hôpital Sainte-Anne, Université Paris-Cité, Inserm U1266, Paris, France
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Peter Turcani
- 1st Department of Neurology, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Hanne Christensen
- Department of Neurology, University Hospital of Copenhagen, Bispebjerg, Denmark
| | - Jose M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Roland Veltkamp
- Neurology Department, Alfried-Krupp Hospital, Essen, Germany
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department, St Anne's University Hospital, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital of Basel and University of Basel, Basel, Switzerland
| | | | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium; VIB-KU Leuven Center for Brain and Disease Research, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Adam Stepien
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
| | | | - Risto Roine
- Division of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Laszlo Csiba
- DE Clinical Center (DEKK), Health Service Units, Clinics, Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Arne G Lindgren
- Department of Clinical Sciences Lund (Neurology), Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Bodo Kirsch
- Statistics and Data Insights, Bayer AG, Berlin, Germany
| | | | - Laura Heenan
- Department of Statistics, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Lizhen Xu
- Department of Statistics, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Stuart J Connolly
- Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Robert G Hart
- Division of Neurology, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| |
Collapse
|
6
|
Kollar B, Siarnik P, Hluchanova A, Klobucnikova K, Mucska I, Turcani P, Paduchova Z, Katrencikova B, Janubova M, Konarikova K, Argalasova L, Oravec S, Zitnanova I. The impact of sleep apnea syndrome on the altered lipid metabolism and the redox balance. Lipids Health Dis 2021; 20:175. [PMID: 34865634 PMCID: PMC8647408 DOI: 10.1186/s12944-021-01604-8] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 12/26/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a disorder with a significant risk for cardiovascular diseases. Dyslipidemia and redox imbalance belong to potential mechanisms linking OSA with the development of vascular diseases. The main aim of this study was the evaluation of the presence of lipid abnormalities in OSA patients, focusing on small dense low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subfractions and determination of the redox imbalance by evaluating the marker of oxidative damage to plasma lipids - lipoperoxides. Methods The study included 15 male subjects with polysomnographically confirmed OSA and 16 male healthy controls. Plasma levels of total cholesterol, LDL and HDL and their subfractions, triacylglycerols and lipoperoxides were determined in all study individuals. Plasma LDL and HDL subfractions were separated by the Lipoprint system which is a polyacrylamide gel electrophoresis. Lipoperoxide levels were determined spectrophotometrically. Results OSA patients had significantly higher triacylglycerols, total cholesterol and LDL-cholesterol compared to healthy controls. HDL cholesterol was not significantly different. Of the LDL and HDL subfractions, OSA patients had significantly lower levels of atheroprotective LDL1 and large HDL subfractions and significantly higher levels of atherogenic small dense LDL3–7 and HDL8–10 subfractions. Lipoperoxide levels in patients with OSA were significantly elevated compared to healthy individuals. Conclusion The lipoprotein pro-atherogenic phenotype was found in individuals with OSA characterized by increased levels of atherogenic lipoprotein subfractions and reduced levels of atheroprotective subfractions. In addition, a plasma redox imbalance was found in patients with OSA compared to controls by detecting higher oxidative damage to lipids. Abnormalities in lipoprotein levels in patients with OSA, as well as the redox imbalance, could lead to an acceleration of the atherosclerotic process in predisposed individuals and thus represent a significant risk factor for vasular diseases.
Collapse
Affiliation(s)
- Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alzbeta Hluchanova
- Department of Neurology, University Hospital Bratislava, Bratislava, Slovakia
| | - Katarina Klobucnikova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Imrich Mucska
- Outpatient Clinic for Sleep-Disordered Breathing, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Paduchova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Barbora Katrencikova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Maria Janubova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Katarina Konarikova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lubica Argalasova
- Institute of Hygiene, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Stanislav Oravec
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ingrid Zitnanova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
| |
Collapse
|
7
|
Kollar B, Siarnik P, Valovičová K, Hanus O, Turcani P, Klobucnikova K. Mood disorders in patients with hypersomnia: comparison of sleep-related breathing disorders versus narcolepsy. Neuro Endocrinol Lett 2021; 42:395-402. [PMID: 34713691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Anxiety and depression are common comorbidities of excessive daytime sleepiness (EDS). Sleep-related breathing disorders (SBD) and central disorders of hypersomnolence (like narcolepsy [NA]) are the most frequent causes of EDS. This study aimed to evaluate mood disorders in NA patients compared to the subjects with EDS due to SBD (SBD-EDS). METHODS In a retrospective analysis, subjects with NA and SBD-EDS were compared. All subjects underwent overnight polysomnography. NA patients underwent also multiple sleep latency test. Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Becks questionnaire, and Zung depression scale were used to assess EDS, sleep quality, anxiety, and depression, respectively. RESULTS We enrolled 24 NA and 41 SBD-EDS subjects. Values of PSQI and Zung scale were significantly worse in the SBD-EDS group than in NA patients (8.34±3.84 vs. 6.83±2.25, p=0.04; 46.86±12.69 vs. 40.81±11.27, p=0.03, respectively). Anxiety was significantly more frequent in SBD-EDS subjects compared to NA (63.4% vs. 37.5%, p=0.04). Out of all observed sleep-related indices, PSQI was the only factor, that significantly correlated with the measures of anxiety in both groups (NA: r=0.65, p=0.001; SBD-EDS: r=0.45, p=0.003) and with the measures of depression in NA subjects (r=0.51, p=0.01). In SBD-EDS group, measures of depression significantly correlated with PSQI (r=0.46, p=0.002), oxygen desaturation index (r=0.35, p=0.03), and ESS (r=0.5, p=0.001). CONCLUSION Compared to NA, our results suggest significantly worse measures of depression and a significantly higher frequency of anxiety in the SBD-EDS population. Measures of anxiety and depression significantly correlated with quality of sleep in both groups.
Collapse
Affiliation(s)
- Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Katarína Valovičová
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Oto Hanus
- Department of Neurology, Central Military Hospital, Ružomberok, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Katarina Klobucnikova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| |
Collapse
|
8
|
Sutovsky S, Petrovic R, Fischerova M, Haverlikova V, Ukropcova B, Ukropec J, Turcani P. Allelic Distribution of Genes for Apolipoprotein E and MTHFR in Patients with Alzheimer's Disease and Their Epistatic Interaction. J Alzheimers Dis 2021; 77:1095-1105. [PMID: 32804129 PMCID: PMC7683064 DOI: 10.3233/jad-200321] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Genetic risk factors play an important role in the pathogenesis of Alzheimer’s disease (AD). However, the gene-gene interaction (epistasis) between specific allelic variants is only partially understood. Objective: In our study, we examined the presence of the ɛ4 allele of apolipoprotein E (APOE) and the presence of C677T and A1298C (rs1801133 and rs1801131) polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with AD and controls. We also evaluated the epistatic interaction between MTHFR and the APOE variants. Methods: A total of 564 patients with AD and 534 cognitively unimpaired age-matched controls were involved in the study. Results: The presence of the ɛ4 allele of APOE increases the risk of developing AD in a dose-dependent manner (OR 32.7: homozygotes, 15.6: homozygotes + heterozygotes, 14.3: heterozygotes). The combination of genotypes also increases the risk of developing AD in a dose-dependent manner: OR 18.3 (APOE 4/X and 4/4 + CT rs1801133), OR 19.4 (APOE 4/X and 4/4 + CT rs1801133 + AC rs1801131), OR 22.4 (APOE 4/X and 4/4 + TT rs1801133), and OR 21.2 (APOE 4/X and 4/4 + CC rs1801131). Homozygotes for variant alleles of MTHFR as well as patients with AD had significantly higher levels of homocysteine than homozygotes for standard alleles or controls. Conclusion: Homozygotes for APOE4 and carriers of APOE4 with TT genotype of rs1801133 were found to be at the highest risk of developing AD. These findings suggest that the epistatic interaction of specific gene variants can have a significant effect on the development of AD.
Collapse
Affiliation(s)
- Stanislav Sutovsky
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Robert Petrovic
- Department of Genetics and Clinical Genetics, Institute of Medical Biology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Maria Fischerova
- Department of Genetics and Clinical Genetics, Institute of Medical Biology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Viera Haverlikova
- Department of Didactics in Mathematics, Physics and Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
| | - Barbara Ukropcova
- Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Jozef Ukropec
- Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| |
Collapse
|
9
|
Imrich R, Vlcek M, Penesova A, Radikova Z, Havranova A, Sivakova M, Siarnik P, Kollar B, Sokolov T, Turcani P, Heckova E, Hangel G, Strasser B, Bogner W. Cardiac autonomic function in patients with early multiple sclerosis. Clin Auton Res 2021; 31:553-562. [PMID: 33665745 DOI: 10.1007/s10286-021-00790-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/01/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Cardiac autonomic dysfunction has been reported in patients with long-standing multiple sclerosis (MS); however, data in early disease are limited. The present study was aimed at evaluating cardiac autonomic function in patients with early MS in the context of white matter metabolic status, which could potentially affect functions of the autonomic brain centers. METHODS Cardiac sympathetic and baroreflex cardiovagal responses to the Valsalva maneuver, orthostatic test, and the Stroop test were evaluated in 16 early, treatment-naïve patients with relapsing-remitting MS, and in 14 healthy participants. Proton magnetic resonance spectroscopic imaging (MRSI) of the brain was performed in eight of these MS patients and in eight controls. RESULTS Valsalva maneuver outcomes were comparable between patients and controls. At baseline, norepinephrine levels were lower (p = 0.027) in MS patients compared to controls. The patients had higher heart rate (p = 0.034) and lower stroke volume (p = 0.008), but similar blood pressure, cardiac output and norepinephrine increments from baseline to 2 min of the orthostatic test compared to controls. MS patients and controls did not differ in responses to the Stroop test. MRSI showed lower total N-acetylaspartate/total creatine (p = 0.038) and higher myo-inositol/total creatine (p = 0.013) in MS lesions compared to non-lesional white matter. CONCLUSION Our results show normal cardiac sympathetic and baroreflex cardiovagal function in MS patients with relapsing-remitting MS with lesions at the post-acute/early resolving stage. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov under the Identifier: NCT03052595 and complies with the STROBE checklist for cohort, case-control, and cross-sectional studies.
Collapse
Affiliation(s)
- Richard Imrich
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 84505, Bratislava, Slovakia.
| | - Miroslav Vlcek
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 84505, Bratislava, Slovakia.,Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Adela Penesova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 84505, Bratislava, Slovakia
| | - Zofia Radikova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 84505, Bratislava, Slovakia
| | - Andrea Havranova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 84505, Bratislava, Slovakia
| | - Monika Sivakova
- 1St Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- 1St Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Branislav Kollar
- 1St Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Peter Turcani
- 1St Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Eva Heckova
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gilbert Hangel
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard Strasser
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Bogner
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
10
|
Ukropcova B, Tomkova M, Kovanicova Z, Schon M, Slobodova L, Straka I, Nemec M, Kosutzka Z, Matejicka P, Turcani P, Sedliak M, Valkovic P, Ukropec J. Cytokine profile in cerebrospinal fluid of elderly individuals is modulated by three‐month exercise intervention, in parallel with improvements of physical fitness and cognitive functions. Alzheimers Dement 2020. [DOI: 10.1002/alz.042159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Barbara Ukropcova
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of Sciences Bratislava Slovakia
| | | | | | - Martin Schon
- Biomedical Research Center SAS Bratislava Slovakia
| | - Lucia Slobodova
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of Sciences Bratislava Slovakia
- Faculty of Medicine Comenius University Bratislava Slovakia
| | - Igor Straka
- Faculty of Medicine Comenius University & University Hospital Bratislava Bratislava Slovakia
| | - Michal Nemec
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of Sciences Bratislava Slovakia
| | - Zuzana Kosutzka
- Faculty of Medicine Comenius University & University Hospital Bratislava Bratislava Slovakia
| | - Peter Matejicka
- Faculty of Medicine Comenius University & University Hospital Bratislava Bratislava Slovakia
| | - Peter Turcani
- 1st. Department of Neurology Faculty of Medicine Comenius University & University Hospital Bratislava Slovakia
| | - Milan Sedliak
- Faculty of Physical Education and Sports Comenius University Bratislava Slovakia
| | - Peter Valkovic
- Faculty of Medicine Comenius University & University Hospital Bratislava Bratislava Slovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of Sciences Bratislava Slovakia
| |
Collapse
|
11
|
Sykora M, Szabo J, Siarnik P, Turcani P, Krebs S, Lang W, Czosnyka M, Smielewski P. Heart rate entropy is associated with mortality after intracereberal hemorrhage. J Neurol Sci 2020; 418:117033. [DOI: 10.1016/j.jns.2020.117033] [Citation(s) in RCA: 3] [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: 06/03/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
|
12
|
Filippi P, Vestenická V, Siarnik P, Sivakova M, Čopíková-Cudráková D, Belan V, Hanes J, Novák M, Kollar B, Turcani P. Neurofilament light chain and MRI volume parameters as markers of neurodegeneration in multiple sclerosis. Neuro Endocrinol Lett 2020; 41:17-26. [PMID: 32338853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Neurofilament light chain (NfL) is considered a major marker of neurodegeneration and disease activity. Higher levels of NfL are associated with worse clinical outcomes and increased brain atrophy. In treated patients with Relapsing-Remitting Multiple Sclerosis (RRMS), we aimed to determine the level of NfL, an association between NfL and demographic, clinical and magnetic resonance imaging (MRI) characteristics as well as brain volume parameters. We wanted to confirm that level of NfL is clinically useful as biomarker of neurodegeneration and disease activity. METHODS 56 treated RRMS patients were enrolled. Plasmatic levels of NfL (pNfL) were measured by SIMOA® technique. Clinical severity of MS was expressed by Expanded Disability Status Scale (EDSS), and volumetric analysis of MRI data was performed using Icobrain software. RESULTS The mean pNfL level was significantly higher in MS patients than in healthy controls (14.73 ± 6.38 versus 6.67 ± 3.9, p<0.001). In patients, we did not find association between pNfL and MRI activity, number of new T2 lesions, and number of enhancing lesions. Levels of pNfL correlated significantly with atrophy of whole brain volume (Wbv), atrophy of grey matter volume (Gmv), and negatively with Wbv. We found significantly positive correlation between pNfL levels and EDSS. CONCLUSION Study shows association of pNfL with Wbv, presence of brain atrophy and EDSS, and strong correlation of EDSS with multiple MRI volume parameters. We did not confirm association pNfL with disease activity. Our data suggest that pNfL and MRI volume parameters could be considered as biomarkers of neurodegeneration in MS.
Collapse
Affiliation(s)
- Pavol Filippi
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Veronika Vestenická
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Monika Sivakova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | | | - Jozef Hanes
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michal Novák
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| |
Collapse
|
13
|
Sykora M, Kellert L, Michel P, Eskandari A, Feil K, Rémi J, Ferrari J, Krebs S, Lang W, Serles W, Siarnik P, Turcani P, Kovacik M, Bender B, Mengel A, Poli K, Poli S. Thrombolysis in Stroke With Unknown Onset Based on Non-Contrast Computerized Tomography (TRUST CT). J Am Heart Assoc 2020; 9:e014265. [PMID: 32067594 PMCID: PMC7070213 DOI: 10.1161/jaha.119.014265] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intravenous thrombolysis (IVT) in wake‐up stroke (WUS) or stroke with unknown onset (SUO) has been recently proven to be safe and effective using advanced neuroimaging (magnetic resonance imaging or computerized tomography‐perfusion) for patient selection. However, in most of the thrombolyzing centers advanced neuroimaging is not instantly available. We hypothesize that pragmatic non‐contrast computed tomography‐based IVT in WUS/SUO may be feasible and safe. Methods and Results TRUST‐CT (Thrombolysis in Stroke With Unknown Onset Based on Non‐Contrast Computerized Tomography) is an international multicenter registry‐based study. WUS/SUO patients undergoing non‐contrast computed tomography‐based IVT with National Institute of Health Stroke Scale ≥4 and initial Alberta Stroke Program Early Computerized Tomography score ≥7 were included and compared with propensity score matched non‐thrombolyzed WUS/SUO controls. Primary end point was the incidence of symptomatic intracranial hemorrhage; secondary end points included 24‐hour National Institute of Health Stroke Scale improvement of ≥4 and modified Rankin Scale at 90 days. One hundred and seventeen WUS/SUO patients treated with non‐contrast computed tomography‐based IVT were included. As compared with 112 controls, the median admission National Institute of Health Stroke Scale was 10 and the median Alberta Stroke Program Early Computerized Tomography score was 10 in both groups. Four (3.4%) IVT patients and one control patient (0.9%) suffered symptomatic intracranial hemorrhage (adjusted odds ratio 7.9, 95% CI 0.65–96, P=0.1). A decrease of ≥4 National Institute of Health Stroke Scale points was observed in 67 (57.3%) of IVT patients as compared with 25 (22.3%) in controls (adjusted odds ratio 5.8, CI 3.0–11.2, P<0.001). A months, 39 (33.3%) IVT patients reached a modified Rankin Scale score of 0 or 1 versus 23 (20.5%) controls (adjusted odds ratio 1.94, CI 1.0–3.76, P=0.05). Conclusions Non‐contrast computed tomography‐based thrombolysis in WUS/SUO seems feasible and safe and may be effective. Randomized prospective comparisons are warranted. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT03634748.
Collapse
Affiliation(s)
- Marek Sykora
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | - Lars Kellert
- Department of Neurology Ludwig Maximilians University Munich Germany
| | - Patrik Michel
- Stroke Center, Neurology Service Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Ashraf Eskandari
- Stroke Center, Neurology Service Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Katharina Feil
- Department of Neurology Ludwig Maximilians University Munich Germany.,German Center for Vertigo and Balance Disorders Ludwig Maximilians University Munich Germany
| | - Jan Rémi
- Department of Neurology Ludwig Maximilians University Munich Germany
| | - Julia Ferrari
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | - Stefan Krebs
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | - Wilfried Lang
- Department of Neurology St. John's Hospital Medical faculty Sigmund Freud University Vienna Austria
| | | | - Pavel Siarnik
- Department of Neurology Comenius University Bratislava Slovakia
| | - Peter Turcani
- Department of Neurology Comenius University Bratislava Slovakia
| | - Michal Kovacik
- Department of Neurology General Hospital Liptovsky Mikulas Slovakia
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology University Hospital Tübingen Germany
| | - Annerose Mengel
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research University Hospital Tübingen Germany
| | - Khouloud Poli
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research University Hospital Tübingen Germany
| | - Sven Poli
- Department of Neurology with Focus on Neurovascular Diseases and Neurooncology and Hertie Institute for Clinical Brain Research University Hospital Tübingen Germany
| |
Collapse
|
14
|
Sykora M, Siarnik P, Szabo J, Turcani P, Krebs S, Lang W, Jakubicek S, Czosnyka M, Smielewski P. Baroreflex sensitivity is associated with post-stroke infections. An open, prospective study. J Neurol Sci 2019; 406:116450. [PMID: 31610381 DOI: 10.1016/j.jns.2019.116450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/04/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Autonomic nervous system (ANS) seems to play an important role in the post-stroke immunosuppression syndrome with increased susceptibility to infections. The aim of this study was to investigate if ANS activity measured at admission is associated with post-stroke infections. METHODS We prospectively analyzed patients with acute ischemic stroke. ANS was measured using the cross-correlational baroreflex sensitivity (BRS) at admission. The occurrence and cause of in-hospital infections was assessed based on the clinical and laboratory examination. Demographic and clinical variables including initial stroke severity, dysphagia, procedures as nasogastric tubes, central venous and urinary catheters and mechanical ventilation were included in the analysis. RESULTS We included 161 patients with ischemic stroke, of those 49 (30.4%) developed a nosocomial infection during the first 7 days of hospital stay. Patients with infections had significantly lower BRS (median 3 vs 5 ms/mmHg, p < .001) higher initial NIHSS (median 15 vs 5, p < .001), had more often non-lacunar etiology and underwent more invasive procedures. In the multivariable regression model decreased BRS (adjusted OR 1.21, 95% CI 1.03-1.41, p = .02), admission NIHSS (adjusted OR 1.10, 95% CI 1.02-1.19, p = .02) and invasive procedures (adjusted OR 1.46, 95% CI 1.03-2.06, p = .03) were independently associated with infection after ischemic stroke. CONCLUSIONS Decreased BRS was independently associated with infections after ischemic stroke. Autonomic shift may play an important role in increased susceptibility to infections after stroke. The possible diagnostic and therapeutic relevance of this finding deserves further research.
Collapse
Affiliation(s)
- Marek Sykora
- Department of Neurology, St. John's Hospital, Medical Faculty of Sigmund Freud University Vienna, Austria; Department of Neurology, Ruprecht Karls University Heidelberg, Heidelberg, Germany.
| | - Pavel Siarnik
- Department of Neurology, Comenius University Bratislava, Bratislava, Slovakia
| | - Jozef Szabo
- Department of Neurology, Comenius University Bratislava, Bratislava, Slovakia
| | - Peter Turcani
- Department of Neurology, Comenius University Bratislava, Bratislava, Slovakia
| | - Stefan Krebs
- Department of Neurology, St. John's Hospital, Medical Faculty of Sigmund Freud University Vienna, Austria; Department of Neurology, St. John's Hospital, Vienna, Austria
| | - Wilfried Lang
- Department of Neurology, St. John's Hospital, Medical Faculty of Sigmund Freud University Vienna, Austria
| | - Stanislava Jakubicek
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Czosnyka
- Institute of Electronic Systems, Warsaw University of Technology, Poland; Div. of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Peter Smielewski
- Institute of Electronic Systems, Warsaw University of Technology, Poland
| |
Collapse
|
15
|
Sivakova M, Siarnik P, Filippi P, Vlcek M, Imrich R, Turcani P, Zitnanova I, Penesova A, Radikova Z, Kollar B. Oxidative stress in patients with newly diagnosed multiple sclerosis: any association with subclinical atherosclerosis? Neuro Endocrinol Lett 2019; 40:135-140. [PMID: 31816220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a chronic inflammatory autoimmune and neurodegenerative disease of the central nervous system (CNS) typically affecting young adults. Although the pathogenesis of MS is not fully understood, there is evidence to suggest that inflammation-induced oxidative stress can play a role in demyelination and axonal damage. Oxidative stress also participates in the pathogenesis of endothelial dysfunction and atherogenesis. Data from large epidemiological studies showed a higher risk of vascular events in MS patients. The aim of our study was to analyse the presence of oxidative stress and its association with the parameters of subclinical atherosclerosis in the early stages of MS. MATERIAL AND METHODS We compared 13 newly diagnosed MS patients with a group of 13 healthy age- and BMI-matched controls. Blood samples were measured for total antioxidant activity using TEAC assay. Endothelial function, expressed as reperfusion hyperaemia index (RHI) and arterial stiffness, expressed as augmentation index standardized to a pulse of 75/min (AI@75) were assessed using peripheral arterial tonometry. RESULTS MS patients had significantly lower TEAC compared to controls [0.8 (0.4-2.4) vs. 1.2 (0.6-3.8) mmol/l; p=0.004]. The frequency of increased arterial stiffness (61.6% vs. 30.8%) and endothelial dysfunction (46.2% vs. 38.5%) was comparable in MS patients and in controls. There was no significant association between TEAC, increased arterial stiffness or endothelial dysfunction in patients and controls. CONCLUSION Our study showed decreased antioxidant capacity in newly diagnosed MS patients compared to controls. We failed to find association of subclinical atherosclerosis with oxidative stress in newly diagnosed MS.
Collapse
Affiliation(s)
- Monika Sivakova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavol Filippi
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Miroslav Vlcek
- Institute for Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Richard Imrich
- Institute for Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ingrid Zitnanova
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Adela Penesova
- Institute for Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Zofia Radikova
- Institute for Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| |
Collapse
|
16
|
Sutovsky S, Turcani P, Novak P, Zilka N. P2-431: NEUROPATHOLOGY OF EARLY-ONSET FAMILIAL ALZHEIMER'S DISEASE CAUSED BY PRESENILIN-1 MISSENSE MUTATION THR116ASN. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Stanislav Sutovsky
- Faculty of Medicine; Comenius University and University Hospital Bratislava; Bratislava Slovakia
| | - Peter Turcani
- Faculty of Medicine; Comenius University and University Hospital Bratislava; Bratislava Slovakia
| | - Petr Novak
- AXON Neuroscience CRM Services SE; Bratislava Slovakia
| | | |
Collapse
|
17
|
Sutovsky S, Kralova M, Siarnik P, Turcani P. Prevalence, Recognition, and Treatment of Dementia in Assisted Living Facilities. Dement Geriatr Cogn Disord 2018; 45:27-37. [PMID: 29566372 DOI: 10.1159/000487129] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dementia and psychiatric disorders are common in assisted living facilities (ALFs) and have suboptimal rates of recognition and treatment. Therefore, we aimed to obtain a direct estimate of the prevalence of cognitive impairment and especially dementia among residents of ALFs in western Slovakia and their rates of primary recognition and adequate treatment. METHODS We conducted two cross-sectional studies. Ten ALFs within the city of Bratislava were chosen for the study in 2004, and again in 2011. A total of 866 residents in ALFs were examined in 2004, and 821 residents in ALFs were examined in 2011. The rate and characterization of dementia, its primary recognition and adequate treatment were investigated in both cross-sectional studies. RESULTS In 2004, 57% of the participants had dementia. Only 7.2% of the participants with probable Alzheimer disease were treated with acetylcholinesterase inhibitors. In 2011, we observed a significant improvement in primary diagnostics and therapy. 66.9% of the cases of dementia were adequately evaluated, and 52.1% were adequately treated. CONCLUSION Cognitive deficit and dementia are significantly underdiagnosed and undertreated in assisted living settings. In the second cross-sectional study we detected significant but not complete improvement in the primary recognition and adequate therapy of dementia.
Collapse
Affiliation(s)
- Stanislav Sutovsky
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Maria Kralova
- Department of Psychiatry, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Pavol Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| |
Collapse
|
18
|
Schon M, Slobodova L, Tirpakova V, Krumpolec P, Nemec M, Máderová D, Jacková L, Vajda M, Vallova S, Sutovsky S, Kosutzka Z, Turcani P, Straka I, Bogner W, Dydak U, Valkovic P, Sedliak M, Ukropec J, Ukropcova B. O3‐07‐03: A LINK BETWEEN COGNITIVE FUNCTION AND PHYSICAL ACTIVITY: THE IMPACT OF AEROBIC‐STRENGTH EXERCISE IN SENIORS WITH MILD COGNITIVE IMPAIRMENT AND/OR IMPAIRED GLUCOSE METABOLISM. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Martin Schon
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Lucia Slobodova
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | | | - Patrik Krumpolec
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
| | - Michal Nemec
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
| | - Denisa Máderová
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
| | - Lucia Jacková
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
| | - Matej Vajda
- Faculty of Physical Education and SportsComenius UniversityBratislavaSlovakia
| | - Silvia Vallova
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Stanislav Sutovsky
- Faculty of MedicineComenius University‐University Hospital BratislavaBratislavaSlovakia
| | - Zuzana Kosutzka
- Faculty of MedicineComenius University‐University Hospital BratislavaBratislavaSlovakia
| | - Peter Turcani
- Faculty of MedicineComenius University‐University Hospital BratislavaBratislavaSlovakia
| | - Igor Straka
- Faculty of MedicineComenius University‐University Hospital BratislavaBratislavaSlovakia
| | | | - Ulrike Dydak
- School of Health SciencesPurdue UniversityWest LafayetteINUSA
| | - Peter Valkovic
- Faculty of MedicineComenius University‐University Hospital BratislavaBratislavaSlovakia
| | - Milan Sedliak
- Faculty of Physical Education and SportsComenius UniversityBratislavaSlovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
| | - Barbara Ukropcova
- Institute of Experimental Endocrinology Biomedical Research Center Slovak Academy of SciencesBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| |
Collapse
|
19
|
Krumpolec P, Vallova S, Slobodova L, Tirpakova V, Vajda M, Schon M, Klepochova R, Janakova Z, Straka I, Sutovsky S, Turcani P, Cvecka J, Valkovic L, Tsai CL, Krssak M, Valkovic P, Sedliak M, Ukropcova B, Ukropec J. Aerobic-Strength Exercise Improves Metabolism and Clinical State in Parkinson's Disease Patients. Front Neurol 2017; 8:698. [PMID: 29312123 PMCID: PMC5743754 DOI: 10.3389/fneur.2017.00698] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/05/2017] [Indexed: 12/27/2022] Open
Abstract
Regular exercise ameliorates motor symptoms in Parkinson’s disease (PD). Here, we aimed to provide evidence that exercise brings additional benefits to the whole-body metabolism and skeletal muscle molecular and functional characteristics, which might help to explain exercise-induced improvements in the clinical state. 3-months supervised endurance/strength training was performed in early/mid-stage PD patients and age/gender-matched individuals (n = 11/11). The effects of exercise on resting energy expenditure (REE), glucose metabolism, adiposity, and muscle energy metabolism (31P-MRS) were evaluated and compared to non-exercising PD patients. Two muscle biopsies were taken to determine intervention-induced changes in fiber type, mitochondrial content, and expression of genes related to muscle energy metabolism, as well as proliferative and regenerative capacity. Exercise improved the clinical disability score (MDS-UPDRS), bradykinesia, balance, walking speed, REE, and glucose metabolism and increased muscle expression of energy sensors (AMPK). However, the exercise-induced increase in muscle mass/strength, mitochondrial content, type II fiber size, and postexercise phosphocreatine (PCr) recovery (31P-MRS) were found only in controls. Nevertheless, MDS-UPDRS was associated with muscle AMPK and mechano-growth factor (MGF) expression. Improvements in fasting glycemia were positively associated with muscle function and the expression of Sirt1 and Cox7a1, and the parameters of fitness/strength were positively associated with the expression of MyHC2, MyHC7, and MGF. Moreover, reduced bradykinesia was associated with better muscle metabolism (maximal oxidative capacity and postexercise PCr recovery; 31P-MRS). Exercise training improved the clinical state in early/mid-stage Parkinson’s disease patients, including motor functions and whole-body metabolism. Although the adaptive response to exercise in PD was different from that of controls, exercise-induced improvements in the PD clinical state were associated with specific adaptive changes in muscle functional, metabolic, and molecular characteristics.
Collapse
Affiliation(s)
- Patrik Krumpolec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Silvia Vallova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lucia Slobodova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Veronika Tirpakova
- Institute of Sports Medicine and Physical Education, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Matej Vajda
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Martin Schon
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Radka Klepochova
- High Field MR Centre, Department of Biomedical Imaging and Imaged-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMA, Medical University of Vienna, Vienna, Austria
| | - Zuzana Janakova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Igor Straka
- 2nd Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Stanislav Sutovsky
- 1st Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Turcani
- 1st Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Jan Cvecka
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Ladislav Valkovic
- High Field MR Centre, Department of Biomedical Imaging and Imaged-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | | | - Martin Krssak
- High Field MR Centre, Department of Biomedical Imaging and Imaged-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMA, Medical University of Vienna, Vienna, Austria.,Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Valkovic
- 2nd Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Milan Sedliak
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Barbara Ukropcova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| |
Collapse
|
20
|
Ukropec J, Krumpolec P, Slobodova L, Tirpakova V, Vajda M, Heckova E, Ma R, Klepochova R, Straka I, Vallova S, Sutovsky S, Kosutzka Z, Tsai C, Pai M, Turcani P, Dydak U, Bogner W, Krssak M, Valkovic P, Sedliak M, Ukropcova B. [P2–021]: EFFECTS OF ENDURANCE‐STRENGTH TRAINING ON MOTOR FUNCTIONS, COGNITION AND GLUCOSE METABOLISM IN PATIENTS WITH PARKINSON'S DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jozef Ukropec
- Institute of Experimental Endocrinology Biomedical Research CenterSlovak Academy of SciencesBratislavaSlovakia
| | - Patrik Krumpolec
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
| | - Lucia Slobodova
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Veronika Tirpakova
- Slovak Medical University, Institute of Sports MedicineBratislavaSlovakia
| | - Matej Vajda
- Faculty of Physical Education and SportsComenius UniversityBratislavaSlovakia
| | - Eva Heckova
- Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Rouyun Ma
- School of Health Sciences, Purdue UniversityWest LafayetteINUSA
| | | | - Igor Straka
- Faculty of MedicineComenius University & University Hospital BratislavaBratislavaSlovakia
| | - Silvia Vallova
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Stanislav Sutovsky
- Faculty of MedicineComenius University & University Hospital BratislavaBratislavaSlovakia
| | - Zuzana Kosutzka
- Faculty of MedicineComenius University & University Hospital BratislavaBratislavaSlovakia
| | - Chia‐Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung UniversityTainanTaiwan
| | | | - Peter Turcani
- Faculty of MedicineComenius University & University Hospital BratislavaBratislavaSlovakia
| | - Ulrike Dydak
- School of Health Sciences, Purdue UniversityWest LafayetteINUSA
| | | | | | - Peter Valkovic
- Faculty of MedicineComenius University & University Hospital BratislavaBratislavaSlovakia
| | - Milan Sedliak
- Faculty of Physical Education and SportsComenius UniversityBratislavaSlovakia
| | - Barbara Ukropcova
- Faculty of MedicineComenius UniversityBratislavaSlovakia
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
| |
Collapse
|
21
|
Sutovsky S, Petrovic R, Turcani P. [P3–109]: ALLELIC DISTRIBUTION OF GENES FOR APOLIPOPROTEIN E AND MTHFR IN PATIENTS WITH ALZHEIMER's DISEASE AND THEIR EPISTATIC INTERACTION. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stanislav Sutovsky
- Faculty of MedicineComenius University and University Hospital BratislavaBratislavaSlovakia
| | | | - Peter Turcani
- Faculty of MedicineComenius University and University Hospital BratislavaBratislavaSlovakia
| |
Collapse
|
22
|
Prokopova B, Hlavacova N, Vlcek M, Penesova A, Grunnerova L, Garafova A, Turcani P, Kollar B, Jezova D. Early cognitive impairment along with decreased stress-induced BDNF in male and female patients with newly diagnosed multiple sclerosis. J Neuroimmunol 2016; 302:34-40. [PMID: 27979325 DOI: 10.1016/j.jneuroim.2016.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 09/01/2016] [Revised: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 12/12/2022]
Abstract
The aim of this study was to evaluate neuroendocrine activation during stress in patients with recently diagnosed multiple sclerosis before starting the immunomodulatory therapy (EDSS score≤2.0). We verified the hypothesis that certain cognitive and affective dysfunction is present already at this early stage of the disease. The sample consisted of 38 subjects, which involved patients who were recently diagnosed multiple sclerosis and age- and sex-matched healthy volunteers. Stroop test served as mental stress model enabling measurement of cognitive performance. Present results showed increased state anxiety, depression scores and poorer performance in the Stroop test in the group of patients compared to healthy subjects. The cognitive dysfunction was particularly evident in male patients with simultaneously decreased concentrations of the brain-derived neurotrophic factor (BDNF) in plasma. The patients at this stage of the disease have not yet developed the hyperactivity of the hypothalamic-pituitary-adrenocortical axis. They showed normal levels of plasma copeptin and reduced aldosterone response to mental stress test in women only. Concentrations of plasma copeptin were higher in men compared to women. Very early stages of multiple sclerosis are accompanied by disturbances in psychological well-being, mild cognitive dysfunction and decreased plasma concentrations of BDNF, particularly in male patients.
Collapse
Affiliation(s)
- Barbora Prokopova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
| | - Natasa Hlavacova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Miroslav Vlcek
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Adela Penesova
- Institute of Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lucia Grunnerova
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | | | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Daniela Jezova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.
| |
Collapse
|
23
|
Ukropcova B, Slobodova L, Vajda M, Krumpolec P, Tirpakova V, Vallova S, Ondicova K, Sutovsky S, Tsai CL, Pai MC, Turcani P, Valkovic P, Sedliak M, Ukropec J. P2‐154: Effects of Aerobic‐Strength Training on Selected Molecular Targets in Cerebrospinal Fluid of Seniors with Mild Cognitive Impairment. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barbara Ukropcova
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
- Faculty of Medicine Comenius UniversityBratislavaSlovakia
| | - Lucia Slobodova
- Faculty of Medicine Comenius UniversityBratislavaSlovakia
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
| | - Matej Vajda
- Faculty of Physical Education and Sports Comenius UniversityBratislavaSlovakia
| | - Patrik Krumpolec
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
| | - Veronika Tirpakova
- Faculty of Physical Education and Sports Comenius UniversityBratislavaSlovakia
| | - Silvia Vallova
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
- Faculty of Medicine Comenius UniversityBratislavaSlovakia
| | - Katarina Ondicova
- Faculty of Medicine Comenius UniversityBratislavaSlovakia
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
| | - Stanislav Sutovsky
- Faculty of Medicine Comenius University & University Hospital BratislavaBratislavaSlovakia
| | - Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies National Cheng Kung UniversityTainanTaiwan
| | | | - Peter Turcani
- Faculty of Medicine Comenius University & University Hospital BratislavaBratislavaSlovakia
| | - Peter Valkovic
- Faculty of Medicine Comenius University & University Hospital BratislavaBratislavaSlovakia
| | - Milan Sedliak
- Faculty of Physical Education and Sports Comenius UniversityBratislavaSlovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Center, SASBratislavaSlovakia
| |
Collapse
|
24
|
Sutovsky S, Turcani P, Novak M, Alafuzoff I, Zilka N. P2‐182: A Variant of Frontotemporal Lobar Degeneration with Expanded Trinucleotide CAG Repeats in the Huntingtin Gene. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stanislav Sutovsky
- Faculty of Medicine, Comenius University & University Hospital BratislavaBratislavaSlovakia
| | - Peter Turcani
- Faculty of Medicine, Comenius University & University Hospital BratislavaBratislavaSlovakia
| | | | | | | |
Collapse
|
25
|
Penesova A, Vlcek M, Imrich R, Vernerova L, Marko A, Meskova M, Grunnerova L, Turcani P, Jezova D, Kollar B. Hyperinsulinemia in newly diagnosed patients with multiple sclerosis. Metab Brain Dis 2015; 30:895-901. [PMID: 25809135 DOI: 10.1007/s11011-015-9665-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/16/2015] [Indexed: 01/07/2023]
Abstract
There are limited data regarding glucose metabolism dysregulation in multiple sclerosis (MS). Present study investigates glucose and insulin response during oral glucose tolerance test (oGTT) in MS patients. We examined 19 MS patients and 19 age, sex and body mass index (BMI) matched healthy controls. MS patients were newly diagnosed, untreated and with low Expanded Disability Status Scale (EDSS) score (1.1 ± 0.7). Plasma glucose, lactate, insulin and GLP-1 during oGTT, and fasting adipokines, lipid and inflammatory parameters were analyzed. Insulin sensitivity indices (ISI) were calculated. MS patients had comparable fasting (5.2 ± 0.3 vs. 5.0 ± 0.4 mmol/l, p = 0.05) and post-load glucose concentrations as controls. Insulin response to oral glucose load in MS was increased (p = 0.022). Insulin sensitivity was lower in MS compared to controls [ISI(Matsuda) 6.95 ± 3.44 vs. 10.60 ± 4.81, p = 0.011 and ISI(Cederholm) 49.9 ± 15.3 vs. 61.3 ± 16.3, p = 0.032]. We did not find any difference in lactate, GLP-1, total, HDL and LDL cholesterol, triglycerides, interleukin 6, tumor necrosis factor, C-reactive protein, resistin, leptin, adiponectin levels between groups. We found decreased insulin sensitivity with postprandial hyperinsulinemia in MS patients, which seems not to be related to chronic inflammation or physical inactivity. The role of hyperinsulinemia in CNS function impairment should be further investigated.
Collapse
Affiliation(s)
- Adela Penesova
- Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ukropcova B, Slobodova L, Vajda M, Krumpolec P, Tirpakova V, Vallova S, Sutovsky S, Turcani P, Sedliak M, Ukropec J. O2‐08‐05: Combined aerobic‐strength exercise improves cognitive functions in patients with mild cognitive impairment. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Barbara Ukropcova
- Institute of Experimental Endocrinology SASBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Lucia Slobodova
- Institute of Experimental Endocrinology SASBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Matej Vajda
- Faculty of Physical Education and SportsComenius UniversityBratislavaSlovakia
| | | | | | - Silvia Vallova
- Institute of Experimental Endocrinology SASBratislavaSlovakia
- Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Stanislav Sutovsky
- University Hospital Bratislava, Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Peter Turcani
- University Hospital Bratislava, Faculty of MedicineComenius UniversityBratislavaSlovakia
| | - Milan Sedliak
- Faculty of Physical Education and SportsComenius UniversityBratislavaSlovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology SASBratislavaSlovakia
| |
Collapse
|
27
|
Krajciova L, Deziova L, Petrovic R, Luha J, Turcani P, Chandoga J. Frequencies of polymorphisms in CYP2C9 and VKORC1 genes influencing warfarin metabolism in Slovak population: implication for clinical practice. ACTA ACUST UNITED AC 2014; 115:563-8. [PMID: 25318916 DOI: 10.4149/bll_2014_109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The study was aimed at establishing an effective molecular-genetic method for detecting polymorphisms in genes CYP2C9 and VKORC1, which affect the pharmacogenetics of warfarin, and at determining their prevalence in Slovak population. BACKGROUND Warfarin, derivative of coumarin, belongs to the most commonly prescribed oral anticoagulants with narrow therapeutic index. An insufficient dose of warfarin can result in failure to produce the antithrombotic effect, whereas an overdose increases the risk of bleeding. It was proven that genetic variability in two genes, CYP2C9 a VKORC1, has a significant influence on the individual's response to the dosage of warfarin. METHODS In a control group of 112 randomly selected individuals, we tested the frequency of selected single nucleotide polymorphisms including CYP2C9*2 (430C>T), CYP2C9*3 (1075A>C), VKORC1*2 (1173C>T) by allele-specific Real-Time PCR and VKORC1*2 (-1639G>A) by using PCR-RFLP. RESULTS Due to the combination of frequent alleles CYP2C9*2, CYP2C9*3 and VKORC1*2 in Slovak population we determine that 25% of population need a standard 5-mg daily dose of warfarin, while 44%, 23%, and 8% need 4 mg, 3 mg and 2 mg of warfarin per day. CONCLUSION Slovak population is in Hardy-Weinberg equilibrium and frequencies of SNPs were in accordance with other published results in European populations (Tab. 5. Fig. 3, Ref. 51).
Collapse
|
28
|
Kemenyova P, Turcani P, Sutovsky S, Waczulikova I. Optical coherence tomography and its use in optical neuritis and multiple sclerosis. ACTA ACUST UNITED AC 2014; 115:723-9. [PMID: 25428543 DOI: 10.4149/bll_2014_140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Optical coherence tomography is a relatively new non-invasive imaging technique used for obtaining the images and quantifying the layers of the retina. It also provides information about optic nerve head topography, peripapillary retinal nerve fiber layer thickness, and macular volume which correlates with axonal loss. Until now, this method was used mainly in ophthalmology; now it has emerged as relevant in neurology as well. RNFL thickness is of particular interest in optic neuropathies and in multiple sclerosis. In sclerosis multiplex, axonal loss occurs as early as the first stages and the quantification of the RNFL thickness by OCT provides an indirect measure of axonal and neuronal loss in the anterior visual pathways. Because OCT is noninvasive, easy to obtain, and highly reproducible, it can be used as a marker of axonal loss and as an endpoint in clinical trials. This paper presents a comprehensive summary of the use of this new diagnostic method in multiple sclerosis patients (Fig. 1, Ref. 58).
Collapse
|
29
|
Turcani P, Sutovsky S. P2‐341: THE SLOVAKIA ASSISTED LIVING STUDY: TWO CROSS‐SECTIONAL STUDIES OF PREVALENCE, RECOGNITION, AND TREATMENT OF DEMENTIA AND DEPRESSION IN THE ASSISTED LIVING POPULATION OF SLOVAKIA. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Sutovsky S, Blaho A, Kollar B, Siarnik P, Csefalvay Z, Dragasek J, Turcani P. Clinical accuracy of the distinction between Alzheimer's disease and frontotemporal lobar degeneration. ACTA ACUST UNITED AC 2014; 115:161-7. [PMID: 24579686 DOI: 10.4149/bll_2014_034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia. Frontotemporal lobar degeneration (FTLD), although less prevalent overall, is almost as common as AD in patients under the age of 65. AD and FTLD are histopathologically distinct, with AD being characterised by extracellular amyloid plaques and intraneuronal neurofibrillary tangles, and FTLD by the presence of non-AD histological pathology, most commonly either tau-positive inclusions or ubiquitin-positive or TDP 43 positive inclusions. Clinically, AD and FTLD may occur with overlapping symptoms, especially in the early stages of the disease. In the case of Alzheimer's disease, it is represented by isolated decline of recent episodic memory; later on, by the impairment of time and space orientation, whereby the alteration of social behaviour and amnesic aphasia occur predominantly in the advanced phases of the disease. Frontotemporal lobar degeneration is demonstrated in three clinical subunits: 1) The behavioural-dysexecutive variant of FTLD (frontotemporal dementia, the frontal variant of FTLD, {fvFTLD}), 2) Progressive non-fluent aphasia, 3) Semantic dementia (SD) with the profound impairment of social conduct (fvFTLD) or with severe speech impairment (PNFA, SD). Considering the different clinical symptomatology with FTLD diagnostics, it is necessary to use different psychometric tests than in the case of Alzheimer's disease. Therapy and the degree of dependence of the affected person are also different. All three diseases within the FTLD category, mainly the behavioural-dysexecutive variant, require a higher level of nursing care on the part of other persons or institutions in comparison with Alzheimer's disease. The goal of our publication is to point to the differences in clinical manifestation and the findings of auxiliary examinations that are helpful in the clinical accuracy of the distinction between these two types of dementia (Tab. 1, Fig. 3, Ref. 18).
Collapse
|
31
|
Siarnik P, Carnicka Z, Krizova L, Wagnerova H, Sutovsky S, Klobucnikova K, Kollar B, Turcani P, Sykora M. Predictors of impaired endothelial function in obstructive sleep apnea syndrome. Neuro Endocrinol Lett 2014; 35:142-148. [PMID: 24878978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Obstructive sleep apnea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. Endothelial dysfunction (ED), accelerated atherosclerosis and autonomic dysfunction might be the key players responsible for development of vascular diseases in patients with OSA. In a population with suspected OSA and low burden of cardiovascular risk factors, we therefore aimed to investigate the association between potential cardiovascular risk factors including OSA-specific indices, ED and autonomic activity. METHODS ED was investigated using reperfusion hyperaemia index (RHI). OSA was assessed using standard polysomnography, autonomic activity was assessed using baroreflex sensitivity (BRS). RESULTS We enrolled 31 patients (42.1±11.7 years) with OSA. Significant inverse correlation was found between RHI and apnea-hypopnea index (AHI) (r=-0.550, p=0.001) and between RHI desaturation index (r=-0.533, p=0.002). Positive correlation was found between RHI and minimal nocturnal oxygen saturation (r=0.394, p=0.028). In a multiple regression model AHI was the only significant variable to predict RHI (β=-0.522, p=0.003). We found no correlation between RHI and BRS. RHI in the population with severe OSA (AHI above 30) was significantly lower than RHI in the rest of the population (p=0.012). CONCLUSION AHI was the only significant independent predictor of impaired endothelial function as expressed by RHI. RHI showed no association with BRS in patients with OSA.
Collapse
Affiliation(s)
- Pavel Siarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Carnicka
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lucia Krizova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Helena Wagnerova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Stanislav Sutovsky
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Katarina Klobucnikova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Branislav Kollar
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Marek Sykora
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
32
|
Preiningerova JL, Baumhackl U, Csepany T, Czaplinski A, Deisenhammer F, Derfuss T, Fabjan TH, Fazekas F, Fuchs S, Havrdova E, Ledinek AH, Illes Z, Jazbec SS, Klimova E, Komoly S, Kurca E, Linnebank M, Lisy L, Mares J, Prochazkova L, Csilla R, Szilasiova J, Stourac P, Talab R, Turcani P, Vachova M, Vecsei L, Vodusek D, Zapletalova O, Berger T. Recommendations for the use of prolonged-release fampridine in patients with multiple sclerosis (MS). CNS Neurosci Ther 2013; 19:302-6. [PMID: 23607697 DOI: 10.1111/cns.12101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/18/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022] Open
Abstract
Prolonged-release fampridine (fampridine PR) is a potassium channel blocker that improves conductivity of signal on demyelinated axons in central nervous system. Fampridine PR has been approved to improve speed of walking in patients with multiple sclerosis. This statement provides a brief summary of data on fampridine PR and recommendations on practical use of the medication in clinical practice, prediction, and evaluation of response to treatment and patient management.
Collapse
Affiliation(s)
- Jana Lizrova Preiningerova
- Department of Neurology and Center for Clinical Neuroscience, Charles University, General Hospital, Prague, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Krizova L, Kollar B, Jezova D, Turcani P. Genetic aspects of vitamin D receptor and metabolism in relation to the risk of multiple sclerosis. Gen Physiol Biophys 2013; 32:459-66. [PMID: 24067280 DOI: 10.4149/gpb_2013067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/09/2013] [Indexed: 11/08/2022]
Abstract
Recent findings suggest that polymorphisms in vitamin D pathway genes are candidates for association with multiple sclerosis susceptibility. It has been now well demonstrated that vitamin D has immunomodulatory functions that may be favorable for reduction of multiple sclerosis risk. Current research has been focused on identification of new variants of genes involved in vitamin D pathway, namely in vitamin D receptor and enzymes of vitamin D metabolism. These variants have been intensively studied as possible genetic predictors of both vitamin D levels and the risk of multiple sclerosis. Considering the findings available up-to-date, we may recognize two groups of genetic variants. The first group of genes was found to predict vitamin D levels but not the risk of multiple sclerosis. The second group of genetic variants is represented by promising genes predicting vitamin D levels as well as the risk of multiple sclerosis. A strong association with increased risk of the disease has been observed for a rare variant in the CYP27B1 gene encoding a vitamin D-activating enzyme. Observed interaction between genetic and epidemiological findings brings the rationale for supplementation trials of vitamin D. Although promising effects of vitamin D supplementation have emerged, the results obtained so far are inconclusive and the real therapeutic significance of vitamin D supplementation remains to be elucidated.
Collapse
Affiliation(s)
- Lucia Krizova
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic.
| | | | | | | |
Collapse
|
34
|
Lenti L, Brainin M, Titianova E, Morovic S, Demarin V, Kalvach P, Skoloudik D, Kobayashi A, Czlonkowska A, Muresanu DF, Shekhovtsova K, Skvortsova VI, Sternic N, Beslac Bumbasirevic L, Svigelj V, Turcani P, Bereczki D, Csiba L. Stroke care in Central Eastern Europe: current problems and call for action. Int J Stroke 2012; 8:365-71. [PMID: 22974486 DOI: 10.1111/j.1747-4949.2012.00845.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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
Stroke is a major medical problem and one of the leading causes of mortality and disability all over in Europe. However, there are significant East-West differences in stroke care as well as in stroke mortality and morbidity rates. Central and Eastern European countries that formerly had centralized and socialist health care systems have serious and similar problems in organizing health and stroke care 20 years after the political transition. In Central and Eastern Europe, stroke is more frequent, the mortality rate is higher, and the victims are younger than in Western Europe. High-risk patients live in worse environmental conditions, and the socioeconomic consequences of stroke further weaken the economic development of these countries. To address these issues, a round table conference was organized. The main aim of this conference was to discuss problems to be solved related to acute and chronic stroke care in Central and Eastern European countries, and also, to exchange ideas on possible solutions. In this article, the discussed problems and possible solutions will be summarized, and introduce 'The Budapest Statement of Stroke Experts of Central and Eastern European countries'.
Collapse
Affiliation(s)
- Laura Lenti
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Background and Purpose—
Hemicraniectomy has been shown to be an effective treatment of life-threatening edema (LTE) in malignant middle cerebral artery infarction when performed early. Identifying patients who will develop LTE is therefore imperative. We hypothesize that autonomic shift toward sympathetic dominance may relate to LTE formation. We aimed to investigate the predictive potential of baroreflex sensitivity (BRS) as a marker of autonomic balance for calculating the course of large middle cerebral artery infarction.
Methods—
Patients with middle cerebral artery infarction >2/3 of the territory and BRS measurement at admission were analyzed. BRS was estimated using the cross-correlational method. Demographic, clinical, and radiological data including stroke severity, infarct size, and basal ganglia involvement were recorded. Malignant course with LTE was defined as clinical deterioration and midline shift ≥5 mm in the first 48 hours.
Results—
Eighteen (62.8%) patients developed LTE. Patients with LTE had lower BRS (2.3 versus 4.4 mm Hg/ms,
P
=0.007), larger infarcts (214 versus 144 mL,
P
=0.03), more frequent involvement of the basal ganglia (14 versus 4,
P
=0.03), and more often underwent thrombolysis combined with endovascular intervention (6 versus 0,
P
=0.04). In a multivariate model, BRS (OR, 0.36; CI, 0.14–0.93;
P
=0.03) and basal ganglia involvement (OR, 11.53; CI, 1.15–115.9;
P
=0.04) were independent predictors for LTE. This model correctly classified 86.2% of the malignant cases.
Conclusions—
Decreased BRS, mirroring sympathetic activation, and basal ganglia involvement were associated with development of malignant course with LTE in large middle cerebral artery infarction. The predictive relevance of our findings needs to be confirmed in further studies.
Collapse
Affiliation(s)
- Marek Sykora
- From the Department of Neurology (M.S., T.S., A.R., W.H., J.D.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Thorsten Steiner
- From the Department of Neurology (M.S., T.S., A.R., W.H., J.D.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Andrea Rocco
- From the Department of Neurology (M.S., T.S., A.R., W.H., J.D.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Peter Turcani
- From the Department of Neurology (M.S., T.S., A.R., W.H., J.D.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Werner Hacke
- From the Department of Neurology (M.S., T.S., A.R., W.H., J.D.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Jennifer Diedler
- From the Department of Neurology (M.S., T.S., A.R., W.H., J.D.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| |
Collapse
|
36
|
Sykora M, Steiner T, Poli S, Rocco A, Turcani P, Diedler J. Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage. Neurocrit Care 2011; 16:102-8. [DOI: 10.1007/s12028-011-9637-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Sykora M, Diedler J, Poli S, Rizos T, Kellert L, Turcani P, Steiner T. Association of non-diabetic hyperglycemia with autonomic shift in acute ischaemic stroke. Eur J Neurol 2011; 19:84-90. [DOI: 10.1111/j.1468-1331.2011.03438.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
38
|
Sykora M, Diedler J, Poli S, Rizos T, Turcani P, Veltkamp R, Steiner T. Autonomic Shift and Increased Susceptibility to Infections After Acute Intracerebral Hemorrhage. Stroke 2011; 42:1218-23. [DOI: 10.1161/strokeaha.110.604637] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
High infection rate after severe stroke may partly relate to brain-induced immunodepression syndrome. However, the underlying pathophysiology remains unclear. The aim of the current study was to investigate the role of autonomic shift in increased susceptibility to infection after acute intracerebral hemorrhage (ICH).
Methods—
We retrospectively analyzed 62 selected patients with acute ICH from our prospective database. Autonomic shift was assessed using the cross-correlational baroreflex sensitivity (BRS). The occurrence and cause of in-hospital infections were assessed based on the clinical and laboratory courses. Demographic and clinical data including initial stroke severity, hemorrhage volume, intraventricular blood extension, history of aspiration, and invasive procedures such as mechanical ventilation, surgical hematoma evacuation, external ventricular drainage, central venous and urinary catheters, and nasogastric feeding were recorded and included in the analysis.
Results—
We identified 36 (58%) patients with infection during the first 5 days of hospital stay. Patients with infections had significantly lower BRS, higher initial NIHSS scores, larger hemorrhages, and more frequently had intraventricular blood extension and underwent invasive procedures. In the multivariate regression model, decreased BRS (OR, 0.54; 95% CI, 0.32–0.91;
P
=0.02) and invasive procedures (OR, 2.32; 95% CI, 1.5–3.6;
P
<0.001) remained independent predictors for an infection after ICH.
Conclusions—
Decreased BRS was independently associated with infections after ICH. Autonomic shift may play an important role in increased susceptibility to infections after acute brain injury including ICH. The possible therapeutic relevance of autonomic modulation warrants further studies.
Collapse
Affiliation(s)
- Marek Sykora
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Jennifer Diedler
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Sven Poli
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Timolaos Rizos
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Peter Turcani
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Roland Veltkamp
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Thorsten Steiner
- From the Department of Neurology (M.S., J.D., S.P., T.R., R.V., T.S.), University of Heidelberg, Heidelberg, Germany; Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| |
Collapse
|
39
|
Sutovsky S, Klobucnikova K, Volarikova V, Traubnerova R, Rasochova M, Turcani P. P3‐046: The Slovakia assisted living study: Prevalence, recognition and treatment of dementia and depression in the assisted living population of Slovakia. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Peter Turcani
- Department of Neurology University HospitalBratislava Slovakia
| |
Collapse
|
40
|
Turcani P, Farkasova D, Marcek T, Turcani M. Real-life experiences in migraine therapy. BRATISL MED J 2010; 111:74-78. [PMID: 20429318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of eletriptan for acute migraine treatment and patient satisfaction with the drug in usual clinical practice settings. METHODS Male and female patients of practicing neurologists, aged 18 to 65 years, were eligible for inclusion in the study if they met International Headache Society criteria for migraine. RESULTS Of 637 patients enrolled, 611 completed the study. At 1 hour post-dose headache response was 59.5% (average from three attacks), pain-free 13%, absence of vomiting 86.3%, and improvement in functioning 55%. Headache recurrence occurred in 12%, second dose was used by 12.6% patients, and rescue medication by 6.4%. Patient preference for eletriptan versus any other triptan used in the past was 97%. CONCLUSION In this real-life setting, eletriptan displayed high efficacy, consistency of response over three attacks and was preferred by 97% patients (Tab. 2, Fig. 5, Ref. 16). Full Text (Free, PDF) www.bmj.sk.
Collapse
Affiliation(s)
- P Turcani
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Slovakia.
| | | | | | | |
Collapse
|
41
|
Sykora M, Diedler J, Poli S, Rupp A, Turcani P, Steiner T. Blood Pressure Course in Acute Stroke Relates to Baroreflex Dysfunction. Cerebrovasc Dis 2010; 30:172-9. [DOI: 10.1159/000317105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 04/15/2010] [Indexed: 11/19/2022] Open
|
42
|
Abstract
BACKGROUND AND PURPOSE Autonomic dysfunction, including increased sympathetic drive and blunted baroreflex, has repeatedly been observed in acute stroke. Of clinical importance is that the stroke-related autonomic imbalance seems to be linked to worse outcome after stroke. Here, we discuss the role of baroreflex impairment in acute stroke and its possible pathophysiological and therapeutic relevance. Summary of Review- Possible mechanisms linking baroreflex impairment with unfavorable outcome in stroke may include increased cardiovascular morbidity and mortality, promotion of secondary brain injury due to local inflammation, hyperglycemia, or altered cerebral perfusion. CONCLUSIONS We suggest therefore that the modifying of autonomic functions may have important therapeutic implications in acute ischemic as well as in hemorrhagic stroke.
Collapse
Affiliation(s)
- Marek Sykora
- Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
43
|
Sykora M, Diedler J, Turcani P, Rupp A, Steiner T. Subacute perihematomal edema in intracerebral hemorrhage is associated with impaired blood pressure regulation. J Neurol Sci 2009; 284:108-12. [DOI: 10.1016/j.jns.2009.04.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 03/01/2009] [Accepted: 04/20/2009] [Indexed: 11/30/2022]
|
44
|
Sutovsky S, Durkovsky A, Turcani P. P1‐082: Correlation between white matter lesions progression and cognitive decline in patients with Alzheimer's disease, mixed dementia, vascular dementia and normal elderly persons in prospective study. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
45
|
Sutovsky S, Durkovsky A, Turcani P. IC‐P‐037: Correlation between white matter lesions progression and cognitive decline in patients with Alzheimer's disease, mixed dementia, vascular dementia and normal elderly persons in prospective study. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Sykora M, Diedler J, Rupp A, Turcani P, Steiner T. Impaired Baroreceptor Reflex Sensitivity in Acute Stroke Is Associated With Insular Involvement, But Not With Carotid Atherosclerosis. Stroke 2009; 40:737-42. [DOI: 10.1161/strokeaha.108.519967] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Impaired baroreflex sensitivity (BRS) has been previously shown to be of prognostic value in patients with cardiovascular disease and stroke. Because baroreflex seems to be blunted by both carotid atherosclerosis and by lesions affecting central processing, controversy exists regarding the etiology of stroke-related baroreflex changes. The insula may play a central role in baroreflex modulation. The aim of the study was therefore to examine BRS in patients with acute stroke with regard to carotid atherosclerosis and insular involvement.
Methods—
We evaluated spontaneous BRS in 96 patients with acute stroke within 72 hours of ictus and 41 control subjects using a sequential crosscorrelation method.
Results—
Fifty-two patients with ischemic stroke and 44 patients with intracerebral hemorrhage, mean age 58.4 years, were included. With comparable carotid atherosclerosis profiles, patients with stroke had significantly lower BRS than control subjects (3.3 versus 5.3,
P
<0.001). Carotid atherosclerosis had no influence on variance of the BRS values in the acute stroke group. Patients with insular involvement had significantly lower BRS than patients with no insular involvement (2.55 versus 4.35,
P
=0.001) or control subjects (2.55 versus 5.3,
P
<0.001). Furthermore, patients with left insular involvement had significantly lower BRS than patients with right insular involvement (2.3 versus 3.5,
P
=0.049). There was no significant difference between patients with no insular lesions and control subjects (
P
=0.263).
Conclusions—
We demonstrated that baroreflex impairment in acute stroke is not associated with carotid atherosclerosis but with insular involvement. Both insulae seem to participate in processing the baroreceptor information with the left insula being more dominant.
Collapse
Affiliation(s)
- Marek Sykora
- From the Department of Neurology (M.S., J.D., A.R., T.S.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Jennifer Diedler
- From the Department of Neurology (M.S., J.D., A.R., T.S.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Andre Rupp
- From the Department of Neurology (M.S., J.D., A.R., T.S.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Peter Turcani
- From the Department of Neurology (M.S., J.D., A.R., T.S.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| | - Thorsten Steiner
- From the Department of Neurology (M.S., J.D., A.R., T.S.), University of Heidelberg, Heidelberg, Germany; and the Department of Neurology (M.S., P.T.), Comenius University, Bratislava, Slovakia
| |
Collapse
|
47
|
Kolejakova K, Petrovic R, Futas J, Turcani P, Durovcikova D, Chandoga J. Spectrum of DHCR7 mutations in Slovak patients with Smith-Lemli-Opitz syndrome and detection of common mutations by PCR-based assays. Gen Physiol Biophys 2009. [DOI: 10.4149/gpb_2009_01_8] [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: 11/08/2022]
|
48
|
Martiniskova Z, Kucera P, Sykora M, Kollar B, Goldenberg Z, Turcani P. Baroreflex sensitivity in patients with type I diabetes mellitus. Neuro Endocrinol Lett 2009; 30:491-495. [PMID: 20010507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/27/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To date, the clinical usefulness of measuring baroreflex sensitivity (BRS) to detect impairment of the autonomic nervous system in patients with diabetes mellitus (DM) type I has not been evaluated sufficiently (Mlcáková et al. 2008). The aim of the current study was the determination and statistical comparison of the mean values of BRS in our DM type I patients cohort and in a control group of healthy volunteers as well as the determination of BRS value dependency on the duration of diabetes and the level of glycemic control in DM I patients. We also aimed to determine the inter-individual and intra-individual variability of BRS in our patients. MATERIAL AND METHODS We examined 100 patients with type I diabetes mellitus (37 women and 63 men, mean age 30 years, duration of the disease >or= 10 years) and 40 healthy, age- and sex-matched, subjects. Data from the patient cohort were subsequently analysed for duration of the diabetes and the level of glycemic control as assessed by glycated haemoglobin (HbA1c). We used a simple proportional test to compare the occurrence of impaired BRS in the patient cohort and the control group, and a simple linear regression to assess associations between BRS and duration of the diabetes and the levels of glycemic control. RESULTS The mean BRS value in our group of diabetic patients and the control group were 10.15 ms/mmHg and 13.35 ms/mmHg, respectively. II. Statistically significant association between BRS impairment and the duration of the disease or level of glycemic control was not confirmed in our patient cohort. III. We observed an increased inter-individual variability and a relatively low intra-individual variability of BRS in patients with DM type I. CONCLUSIONS We found a statistically highly significant difference between the proportions of impaired BRS in the group of diabetics vs. control. However, BRS did not correlate with the duration of the disease or with the level of glycemic control significantly. Albeit not reaching statistical significance, trends could be observed, which we consider clinically interesting.
Collapse
Affiliation(s)
- Zuzana Martiniskova
- 1st Department of Neurology, University Hospital, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | | | | | | | | |
Collapse
|
49
|
Sykora M, Diedler J, Rupp A, Turcani P, Rocco A, Steiner T. Impaired baroreflex sensitivity predicts outcome of acute intracerebral hemorrhage. Crit Care Med 2008; 36:3074-9. [DOI: 10.1097/ccm.0b013e31818b306d] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Kracunova K, Turcani P, Cibulcik F, Benetin J. 2.215 Efficacy and tolerability of rasagiline in routine clinical practice. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70626-6] [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: 11/30/2022]
|