RESUMEN
BACKGROUND AND OBJECTIVE: Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH. METHODS: We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05). RESULTS: In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation. CONCLUSIONS: In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.
RESUMEN
BACKGROUND: Unruptured intracranial aneurysms (UIAs) are rarely reported in primary central nervous system vasculitis (PCNSV). In this study we described the clinical findings, response to therapy, and outcomes of UIA in a large cohort of PCNSV patients. METHODS: We retrospectively studied 216 consecutive patients with PCNSV, selected by predetermined diagnostic criteria, who were seen during a 40-year period. UIAs were identified on cerebral angiography. The clinical, laboratory, radiologic and pathologic findings, management, and outcomes of patients with UIA were described and compared with those without UIA. RESULTS: 12/216 (5.5 %) PCNSV patients had at least one UIA. Two patients underwent biopsies; one yielded negative results, while the other showed necrotizing vasculitis. Eleven patients had evidence of UIA on angiogram at diagnosis. One patient developed an aneurysm during the follow-up associated with a worsening of vasculitic radiological findings. The most common presenting symptom for PCNSV in the setting of UIA was headache (67 %), followed by persistent neurologic deficit or stroke (50 %). Most patients with UIA presented with multiple cerebral infarcts on MRI (67 %), one patient had subarachnoid hemorrhage, and one left parieto-occipital intracerebral hematoma, both unrelated to the aneurysm. Black blood imaging was performed in 4 patients and 2 showed segmental circumferential mural enhancement involving multiple vessels. Two patients had 2 UIAs, while the other 10 had 1. The most frequent UIA location was internal carotid artery (50 %), followed by anterior cerebral artery (21 %). Ten of the UIAs were < 5 mm in diameter, and 3 were 5-7 mm in diameter; the size was not available for one. All UIAs were unchanged in size and configuration during follow-up (median: 18.5 months; range 1-151 months) and no new aneurysms were detected. Compared to the 204 patients with PCNSV without a UIA, no significant clinical differences were observed, except for a reduced disability at last follow-up (p = 0.038). CONCLUSIONS: UIAs uncommonly occur in PCNSV.
RESUMEN
OBJECTIVE: This study reports the natural history of cerebral cavernous malformations (CCMs) in a contemporary cohort with prospectively collected data from multiple sources, access to follow-up imaging, integrated electronic medical records, and detailed imaging review by study investigators. The authors aimed to define the first prospective symptomatic hemorrhage (SH) and severe SH rates, determine the risk of a second prospective SH, and identify risk factors for SH. METHODS: From a prospectively maintained database of adult patients with radiologically defined CCM, those with radiation-induced CCM, those who underwent surgery within 3 months postdiagnosis, and those with < 1 year of follow-up were excluded. The patients' medical history and radiological features of the CCM were recorded at the time of diagnosis. Follow-up annual written surveys were completed for 5 years after the initial diagnosis and then semiannually thereafter in addition to medical record and follow-up imaging review. Outcomes of interest included SH and severe SH. RESULTS: Of 315 patients, 58.7% were female and 19.7% had familial CCMs. At diagnosis, 37.1% of patients had ruptured CCMs and 28.9% of the CCMs were located in the brainstem. The 5-year cumulative rates of prospective SH and severe SH in those with ruptured CCMs at diagnosis were 41.2% and 12.8%, respectively, compared with 6.1% and 2.5% in patients with unruptured CCMs at diagnosis (p < 0.0001). Risk factors for prospective SH included a ruptured CCM at diagnosis and persistent or new hyperintensity on T1-weighted MRI performed > 3 months after baseline MRI. For those with a ruptured CCM at diagnosis, the risk of developing a second prospective SH was similar to that of developing a first SH. CONCLUSIONS: In a contemporary cohort of adult patients with CCM, the authors report 5-year SH and severe SH rates, rates of second prospective hemorrhage, and predictors of SH. Persistent or new hyperintensity on T1-weighted MRI may be a useful marker of disease activity.
RESUMEN
BACKGROUND AND OBJECTIVES: Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without symptomatic intracerebral hemorrhage (ICH) presentations is less defined. We aimed to assess the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals ranging from cognitively normal to dementia in the community and memory clinic settings. METHODS: Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared with v1.5 using histopathologically verified CAA as the reference standard. RESULTS: The median age at MRI was 75 years (interquartile range 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95% CI 13.2%-48.7%) and 65.3% (95% CI 44.3%-82.8%) for probable CAA diagnosis (area under the receiver operating characteristic curve [AUC] 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC 0.57), respectively. The v2.0 Boston criteria were not superior in performance compared with the prior v1.5 criteria for either CAA diagnostic category. DISCUSSION: The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
Asunto(s)
Angiopatía Amiloide Cerebral , Imagen por Resonancia Magnética , Humanos , Angiopatía Amiloide Cerebral/diagnóstico por imagen , Angiopatía Amiloide Cerebral/patología , Anciano , Femenino , Masculino , Imagen por Resonancia Magnética/normas , Anciano de 80 o más Años , Sensibilidad y Especificidad , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/patologíaAsunto(s)
Coartación Aórtica , Aneurisma Intracraneal , Adulto , Humanos , Coartación Aórtica/complicaciones , Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/epidemiología , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/epidemiología , Incidencia , Aorta , Neuroimagen/efectos adversosRESUMEN
BACKGROUND: Cervical artery dissection (CeAD) represents up to 15% to 25% of ischemic strokes in people under the age of 50 years. Noninvasive vessel imaging is increasingly used in clinical practice, but the impact on the frequency of detection of CeAD is unknown. In 2006, the yearly incidence rate of CeAD was estimated at 2.6 per 100â 000 person-years, but the current incidence is unknown. METHODS: In this population-based retrospective observational cohort study, we utilized the resources of the Rochester Epidemiology Project to ascertain all adult residents of Olmsted County, MN, diagnosed with internal carotid artery dissection and common carotid artery dissection or vertebral artery dissection from 2002 to 2020. Patients with only intracranial involvement or CeAD following major trauma were excluded. Age-adjusted sex-specific and age- and sex-adjusted incidence rates were estimated using the US White 2010 decennial census, with rates expressed per 100â 000 person-years. We assessed longitudinal trends by dividing the data into 5-year time intervals, with the last being a 4-year interval. RESULTS: We identified 123 patients with a diagnosis of CeAD. There were 63 patients with internal carotid artery dissection, 54 with vertebral artery dissection, 2 with concurrent internal carotid artery dissection and vertebral artery dissection, and 4 with common carotid artery dissection. There were 63 (51.2%) female patients and 60 (48.8%) male patients. The average age at diagnosis was 50.2 years (SD, 15.1 [95% CI, 20.1-90.5] years). The incidence rate of spontaneous CeAD encompassing all locations was 4.69 per 100â 000 person-years (2.43 for internal carotid artery dissection and 2.01 for vertebral artery dissection). The incidence rate increased from 2.30 per 100â 000 person-years from 2002 to 2006 to 8.93 per 100â 000 person-years from 2017 to 2020 (P<0.0001). The incidence rate for female patients rose from 0.81 per 100â 000 person-years from 2002 to 2006 to 10.17 per 100â 000 person-years from 2017 to 2020. CONCLUSIONS: The incidence rate of spontaneous CeAD increased nearly 4-fold over a 19-year period from 2002 to 2020. The incidence rate in women rose over 12-fold. The increase in incidence rates likely reflects the increased use of noninvasive vascular imaging.
Asunto(s)
Disección de la Arteria Carótida Interna , Accidente Cerebrovascular , Disección de la Arteria Vertebral , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arterias , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Disección de la Arteria Carótida Interna/epidemiología , Disección de la Arteria Carótida Interna/etiología , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/epidemiología , Disección de la Arteria Vertebral/complicaciones , Adulto Joven , Anciano , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without intracerebral hemorrhage (ICH) or transient focal neurological episodes (TFNE) is unknown. We assessed the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals presenting without symptomatic ICH. METHODS: Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared to v1.5 using histopathologically verified CAA as the reference standard. RESULTS: Median age at MRI was 75 years (IQR 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95%CI: 13.2-48.7%) and 65.3% (95%CI: 44.3-82.8%) for probable CAA diagnosis (AUC 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC: 0.57), respectively. The v2.0 Boston criteria was not superior in performance compared to the prior v1.5 criteria for either CAA diagnostic category. CONCLUSIONS: The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms.. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
RESUMEN
BACKGROUND: Data on safety of thrombolysis for acute ischemic stroke (AIS) in patients with hematologic malignancy is not well established. We report our single institution experience with thrombolysis in this patient population. METHODS: We identified patients with pathology-confirmed hematologic malignancy from 2000-2022. Primary exposure was presence of AIS and receipt of intravenous (IV) thrombolysis. Primary outcome was safety of IV thrombolysis in this patient population. Safety was measured through imaging review for hemorrhagic transformation, post-stroke mortality, and modified Rankin Scale (mRS) at 90 days. RESULTS: Among 45,894 patients with hematologic malignancy, 1,099 (2.4%) were identified as having a suspected AIS. Twenty (1.8%) received IV tissue plasminogen activator (tPA) for AIS, three underwent endovascular intervention, and 17 had AIS confirmed on MRI. Two patients with confirmed AIS experienced hemorrhagic transformation, one of which was symptomatic. Most patients (n=10, 59%) were functionally independent (mRS 0-2) at 90 days post-stroke, including all patients with active hematologic malignancy at the time of stroke (n=3). Four patients died within 90 days of AIS. None of these deaths were patients with active hematologic malignancy at the time of stroke. CONCLUSIONS: Without other contraindications, IV alteplase should be considered for management of AIS in patients with hematologic malignancy. The safety profile of tPA administration in this patient population may be similar to the general population, whether underlying hematologic malignancy is active or in remission.
Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Activador de Tejido Plasminógeno/efectos adversos , Fibrinolíticos/efectos adversos , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Resultado del Tratamiento , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Hemorragia , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/tratamiento farmacológicoRESUMEN
OBJECTIVES: To define the frequency and characteristics of patients with unilateral relapsing involvement in a cohort of patients with adult primary CNS vasculitis (PCNSV). METHODS: We retrospectively studied a cohort of 216 patients with PCNSV seen at the Mayo Clinic, Rochester, MN from 1983 to 2022. Twenty-five patients (19.8%) had at least 2 flares. Three of them (1.4%) had unilateral relapsing vasculitis. We described these 3 patients and compared them with the entire cohort of 216 patients. RESULTS: All 3 patients had angiography-negative and biopsy-positive PCNSV with granulomatous-necrotizing and lymphocytic vasculitides and amyloid beta-related angiitis. The main manifestation at diagnosis and during flares was seizures. Unilateral lesions with gadolinium enhancement were the main MRI finding. Spinal fluid examination at diagnosis was normal in 2 patients. All had multiple flares (from 4 to 10) and were treated with long-term high-dose prednisone and numerous traditional immunodepressive drugs, and one received rituximab for steroid resistance. All 3 patients had slight disability with mild cognitive impairment at last follow-up. DISCUSSION: Unilateral relapsing involvement represents a rare subset of PCNSV with peculiar characteristics and can be observed in all neuropathologic patterns.
Asunto(s)
Péptidos beta-Amiloides , Vasculitis del Sistema Nervioso Central , Adulto , Humanos , Estudios Retrospectivos , Medios de Contraste , Vasculitis del Sistema Nervioso Central/diagnóstico , Vasculitis del Sistema Nervioso Central/tratamiento farmacológico , Vasculitis del Sistema Nervioso Central/patología , GadolinioRESUMEN
As climate change exerts wide ranging health impacts, there is a surge of interest in the associations between climatic factors and mental and behavioral disorders (MBDs). Existing quantitative syntheses focus mainly on heat and high temperature exposure, neglecting the effects of other climatic factors and their synergies. The objective of this study is to conduct a systematic review and meta-analysis of the evidence of associations between climatic exposure and combined mental and behavioral health conditions and specific mental disorders (e.g., schizophrenia, dementia). A systematic search was conducted April 11-16, 2022 using Web of Science, Medline, ProQuest, EMBASE, PsycINFO, CINAHL, and Environment Complete. Screening and eligibility screening followed inclusion criteria based on population, exposure, comparator, and outcome guidelines. Risk of bias assessment was performed, a narrative synthesis was first presented for all studies, and random-effect meta-analyses were performed when at least three studies were available for a specific exposure-outcome pair. Certainty of evidence was evaluated following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The search process yielded 7696 initial results, from which we identified 88 studies to include in the review set. Climatic factors reported included air temperature, solar radiation/sunshine, barometric pressure, precipitation, relative humidity, wind direction/speed, and thermal index. Outcomes including MBD incidences (e.g., schizophrenia, mood disorders, neurotic disorders), mental health-related mortality, and self-reported psychological states. Meta-analysis showed that heatwaves (pooled RR = 1.05, 95 % CI = 1.02-1.08) and extreme high temperatures (99th percentile: pooled RR = 1.18, 95 % CI = 1.08-1.29) were associated with higher risk of MBD. Cold extremes, however, were not associated with MBD risk. The findings further identified an association between increases in a thermal index (i.e., apparent temperature) and elevated risk of MBD (pooled RR = 1.06, 95 % CI = 1.03-1.12); specifically, a 99th percentile high temperature was associated with increased schizophrenia risk (pooled RR = 1.07, 95 % CI = 1.01-1.12). Risk of bias assessment showed most studies to have low or moderately low risks, while a few studies were rated probably high in confounding, selection bias, outcome measurement, and reporting bias. GRADE evaluation revealed moderate certainty of evidence on thermal comfort index and MBD, but low certainty related to air temperature or sunshine duration. These findings call attention to the heterogeneity of exposure measures and the utility of thermal indices that consider the synergistic effects of meteorological factors. Methodological concerns such as the linearity assumption and cumulative effects are discussed.
Asunto(s)
Trastornos Mentales , Humanos , Trastornos Mentales/epidemiología , Salud Mental , Sesgo de Selección , Calor , RiesgoRESUMEN
Background Description of cerebral and retinal infarction in patients with bicuspid aortic valve (BAV) is limited to case reports. We aimed to characterize cerebral and retinal infarction and examine outcomes in patients with BAV. Methods and Results Consecutive patients from 1975 to 2015 with BAV (n=5401) were retrospectively identified from the institutional database; those with confirmed cerebral or retinal infarction were analyzed. Infarction occurring after aortic valve replacement was not included. Patients were grouped according to infarction pathogenesis: embolism from a degenerative calcific BAV (BAVi); non-BAV, large artery atherosclerotic or lacunar infarction (LAi); and non-BAV, non-large artery embolic infarction (nLAi). There were 83/5401 (1.5%) patients, mean age 54±12 years and 28% female, with confirmed cerebral or retinal infarction (LAi 23/83 [28%]; nLAi 30/83 [36%]; BAVi 26/83 [31%]; other 4/83 [5%]). Infarction was embolic in 72/83 (87%), and 35/72 (49%) were cardioembolic. CHA2DS2-VASc score was 1.4±1.2 in BAVi (P=0.188 versus nLAi) and 2.3±1.2 in LAi (P=0.005). Recurrent infarction occurred in 41% overall (50% BAVi, P=0.164 and 0.803 versus LAi and nLAi). BAVi was more commonly retinal (39% BAVi versus 13% LAi, P=0.044 versus 0% nLAi, P=0.002). Patients with BAVi and LAi were more likely to have moderate-to-severe aortic stenosis and undergo aortic valve replacement compared with patients with nLAi. Conclusions Cardioembolism, often from degenerative calcification of the aortic valve, is a predominant cause of cerebral and retinal infarction in patients with BAV and is frequently recurrent. Cerebral and retinal infarction should be regarded as a complication of BAV.
Asunto(s)
Estenosis de la Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Enfermedades de las Válvulas Cardíacas , Enfermedades Vasculares , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Masculino , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Estudios Retrospectivos , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Enfermedades Vasculares/complicacionesRESUMEN
Whenever people spend time outdoors during hot weather, they are putting themselves in potentially stressful situations. Being able to predict whether a person is overheating can be critical in preventing heat-health issues. There is a clear relationship between body core temperature and heat health. However, measuring body core temperature is expensive. Identifying a non-invasive measure that could indicate a person's thermal strain would be valuable. This study investigated five physiological measures as possible surrogates: finger mean skin temperature (FSKT), finger maximum skin temperature (FMSKT), skin conductance level (SCL), heart rate (HR), and heart rate variability (HRV). Furthermore, they were compared against the results of participants' subjective thermal sensation and thermal comfort in a range of hot microclimatic conditions in a hot and humid climate. Results showed that except for SCL, each of the other four physiological measures had a positive significant relationship with thermal sensation, but a negative relationship with thermal comfort. Furthermore, through testing by cumulative link mixed models, HRV was found to be the most suitable surrogate for predicting thermal sensation and thermal comfort through a simple, non-invasive measure in outdoor environment in summer in a hot and humid area. This study highlights the method for predicting human thermal strain and contributes to improve the public health and well-being of urban dwellers in outdoor environments.
Asunto(s)
Clima , Calor , Humanos , China , Estaciones del Año , TemperaturaRESUMEN
BACKGROUND AND PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic many countries reported a decline in stroke volumes. The aim of this study was to analyze if the decline was related to the intensity of the COVID-19 pandemic. METHODS: The first pandemic year (1 March 2020 to 28 February 2021) overall and during the three COVID-19 waves were compared with the preceding year. Volumes of acute ischaemic stroke (AIS), subarachnoid hemorrhage, intracerebral hemorrhage and recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) were obtained from the National Register of Reimbursed Health Services. Door-to-needle time, onset-to-door time and National Institutes of Health Stroke Scale at admission were obtained from the Registry of Stroke Care Quality. RESULTS: During the pandemic year compared to the preceding year there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p < 0.001). The declines (-10%, -11%, -19%) appeared in COVID-19 waves (spring 2020, autumn 2020, winter 2021) except for an increase (2%) during summer 2020. Admissions for AIS declined by 10.2% (p < 0.001), whilst hemorrhagic stroke volumes were minimally decreased. The absolute volumes of IVT and MT decreased by 9.4% (p < 0.001) and 5.7% (p = 0.16), respectively. However, the proportions of ischaemic stroke patients receiving IVT (18% vs. 18%; p = 0.72) and MT (6% vs. 6%; p = 0.28) remained unchanged. CONCLUSIONS: There was a decline in stroke admissions, but such decline was not related to COVID-19 incidence. The frequency of use of recanalization procedures (IVT, MT) and times (onset-to-door time, door-to-needle time) in AIS were preserved in the Czech Republic during the first year of the pandemic.
Asunto(s)
Isquemia Encefálica , COVID-19 , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/terapia , Isquemia Encefálica/terapia , Terapia Trombolítica/métodos , Trombectomía/métodos , Pandemias , Resultado del Tratamiento , HospitalizaciónRESUMEN
OBJECTIVE: This study was undertaken to explore the gene expression profile of primary central nervous system vasculitis (PCNSV). METHODS: Brain specimens of 4 patients with granulomatous vasculitis (GV), 5 with lymphocytic vasculitis (LV), 4 with amyloid ß-related angiitis (ABRA), and 4 normal controls were studied. RNA-sequencing was performed using the Illumina Hiseq-4,000 platform and the Illumina TruSeq Total-RNA library. Student t test and false discovery rate tests were performed for each of the differentially expressed transcripts. Ingenuity Pathway Analysis was used for the pathway expression analysis. CIBERSORT was used to estimate the abundances of different immune cell subsets in the tissues based on gene expression data. RESULTS: Transcripts differentially expressed between PCNSV and normal brain indicated that endosomal, mitochondrial, and ribosome dysfunction, alterations in protein synthesis, and noncoding RNAs might be involved in PCNSV. Pathway analysis revealed the activation of dendritic cell maturation and antigen processing as well as neuroinflammation in PCNSV versus normal brain, whereas oxidative phosphorylation was inhibited. CIBERSORT estimation of immune cell subsets suggested that activated NK cells, M1 macrophages, memory B cells, and follicular helper T cells were likely to be more prevalent in PCNSV samples. Naïve CD4 T cells and monocytes were mainly estimated to be present in GV and ABRA. Plasma cell and γδ T-cell signatures were mainly found in LV and normal brain. GV showed higher levels of genes associated with macrophage activities and T cells. ABRA showed higher levels of long noncoding RNAs and miR-616. LV showed higher levels of genes encoding immunoglobulins. INTERPRETATION: RNA sequencing confirmed PCNSV heterogeneity. ANN NEUROL 2023;93:120-130.
Asunto(s)
MicroARNs , Vasculitis del Sistema Nervioso Central , Humanos , Péptidos beta-Amiloides/metabolismo , Transcriptoma , Imagen por Resonancia Magnética , Vasculitis del Sistema Nervioso Central/genética , ARNRESUMEN
BACKGROUND: Effects of select medications on hemorrhage risk in patients with cerebral or spinal cavernous malformations (CMs) are unknown. METHODS: From a single-institution prospective cohort of patients with CM (2015-2021), demographics, mode of clinical presentation, and radiographic data were collected. Follow-up was performed with electronic medical record review, in-person visits, and written surveys. Select medication use was ascertained from the time of CM diagnosis to a censor date of first prospective symptomatic hemorrhage, complete surgical excision of sporadic form CM, last follow-up, or death. Using Cox proportional hazards regression model, we assessed effects of antithrombotic agents, fish oil, selective serotonin reuptake inhibitors (SSRIs), vitamin E and D supplementation, statins, and beta blockers on prospective hemorrhage risk. RESULTS: The study included 364 patients with spinal or cerebral CM (58.0% female; 20.0% familial form; 42.3% presentation to medical attention owing to hemorrhage; 25.8% brainstem location). During a follow-up of 2018 patient-years, 103 prospective hemorrhages occurred. No studied medications increased the prospective CM hemorrhage risk. Antithrombotics, vitamin D supplementation, fish oil, and SSRI were associated with lower hemorrhage risk even after adjusting for age at diagnosis, hemorrhage at diagnosis, and brainstem location. CONCLUSIONS: Use of select medications with antithrombotic properties do not increase the risk of CM hemorrhage. Vitamin D supplementation, any antithrombotic agent, fish oil, and SSRI were associated with a lower prospective hemorrhage risk. Further studies should evaluate the mechanism of action and potential benefit of these select medications.
Asunto(s)
Hemangioma Cavernoso del Sistema Nervioso Central , Hemorragia Cerebral/complicaciones , Femenino , Fibrinolíticos , Aceites de Pescado , Hemangioma Cavernoso del Sistema Nervioso Central/complicaciones , Hemangioma Cavernoso del Sistema Nervioso Central/tratamiento farmacológico , Hemorragia/complicaciones , Humanos , Masculino , Estudios Prospectivos , Vitamina DRESUMEN
Place-based structural inequalities can have critical implications for the health of vulnerable populations. Historical urban policies, such as redlining, have contributed to current inequalities in exposure to intra-urban heat. However, it is unknown whether these spatial inequalities are associated with disparities in heat-related health outcomes. The aim of this study is to determine the relationships between historical redlining, intra-urban heat conditions, and heat-related emergency department visits using data from eleven Texas cities. At the zip code level, the proportion of historical redlining was determined, and heat exposure was measured using daytime and nighttime land surface temperature (LST). Heat-related inpatient and outpatient rates were calculated based on emergency department visit data that included ten categories of heat-related diseases between 2016 and 2019. Regression or spatial error/lag models revealed significant associations between higher proportions of redlined areas in the neighborhood and higher LST (Coef. = 0.0122, 95% CI = 0.0039 - 0.0205). After adjusting for indicators of social vulnerability, neighborhoods with higher proportions of redlining showed significantly elevated heat-related outpatient visit rate (Coef. = 0.0036, 95% CI = 0.0007-0.0066) and inpatient admission rate (Coef. = 0.0018, 95% CI = 0.0001-0.0035). These results highlight the role of historical discriminatory policies on the disparities of heat-related illness and suggest a need for equity-based urban heat planning and management strategies.
RESUMEN
Stroke is one of the leading causes of death and disability. Despite the high prevalence of stroke, characterizing the acute neural recovery patterns that follow stroke and predicting long-term recovery remains challenging. Objective methods to quantify and characterize neural injury are still lacking. Since neuroimaging methods have a poor temporal resolution, EEG has been used as a method for characterizing post-stroke recovery mechanisms for various deficits including motor, language, and cognition as well as predicting treatment response to experimental therapies. In addition, transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, has been used in conjunction with EEG (TMS-EEG) to evaluate neurophysiology for a variety of indications. TMS-EEG has significant potential for exploring brain connectivity using focal TMS-evoked potentials and oscillations, which may allow for the system-specific delineation of recovery patterns after stroke. In this review, we summarize the use of EEG alone or in combination with TMS in post-stroke motor, language, cognition, and functional/global recovery. Overall, stroke leads to a reduction in higher frequency activity (≥8 Hz) and intra-hemispheric connectivity in the lesioned hemisphere, which creates an activity imbalance between non-lesioned and lesioned hemispheres. Compensatory activity in the non-lesioned hemisphere leads mostly to unfavorable outcomes and further aggravated interhemispheric imbalance. Balanced interhemispheric activity with increased intrahemispheric coherence in the lesioned networks correlates with improved post-stroke recovery. TMS-EEG studies reveal the clinical importance of cortical reactivity and functional connectivity within the sensorimotor cortex for motor recovery after stroke. Although post-stroke motor studies support the prognostic value of TMS-EEG, more studies are needed to determine its utility as a biomarker for recovery across domains including language, cognition, and hemispatial neglect. As a complement to MRI-based technologies, EEG-based technologies are accessible and valuable non-invasive clinical tools in stroke neurology.
RESUMEN
It is well known that extremely hot weather causes heat-related health issues. Health problems, especially in urban areas, are becoming increasingly important due to urban heat island effect. Understanding the impact of neighborhood characteristics is important for research into the relationship between thermal environment and human health. The objectives of this study were to explore the urban landscape and sociodemographic characteristics affecting heat-related health and identify spatial inequalities for vulnerable groups. A total of 27,807 heat-related EMS incidents were used at the census block group level (N = 285). We used land cover database and Landsat satellite images for urban landscape variables and used 2019 U.S. Census data for sociodemographic variables. Negative binomial regression was used to identify the neighborhood variables associated with the heat-related EMS incidents in each block group. Heat-related health has been alleviated in block groups with high green areas. However, the negative effects of thermal environments on human health were higher in areas with a high percentage of impervious surface, over 65 years, non-white people, no high school diploma, or unemployment. The results indicate that heat-related health problems can be addressed through prevention strategies for block group variables. Local intervention efforts to solve health issues should be targeted at more vulnerable areas and groups.
Asunto(s)
Servicios Médicos de Urgencia , Calor , Censos , Ciudades , Humanos , Características de la ResidenciaRESUMEN
Cities have faced rapid urbanization, which has changed the impact of the micro-thermal environment on residents' thermal comfort level. Therefore, planners need to understand the city's physical environment so they can identify and ameliorate the effects of the changing in micro-thermal environment. Researchers also need to identify and understand pedestrians' thermal comfort level in street canyons to determine which urban physical factors planners need to improve. This study aimed to observe how thermal comfort affects pedestrian behavior in micro-thermal environments and to determine which urban geometry factors influence pedestrians' thermal comfort. This study collected data in downtown Austin, TX using a mobile weather station, and analyzed the microclimate conditions experienced by pedestrians. A camera mounted on the weather station also allowed us to observe pedestrian behavior patterns. The results revealed that pedestrians tended to choose walking, sitting, and standing locations with high thermal comfort levels such as in the shade on the sidewalk. There was also some correlation between thermal comfort levels and pedestrian behavior patterns. The sky view factor (SVF) and tree canopy coverage ratio (TCR) were also correlated with pedestrians' thermal comfort. This study highlights the need for future research to develop a data collection method for efficient microscopic thermal environment research and a thermal environment estimation and analysis approach from a three-dimensional perspective.