Multilevel Regulation of Membrane Proteins in Response to Metal and Metalloid Stress: A Lesson from Yeast.

In the face of flourishing industrialization and global trade, heavy metal and metalloid contamination of the environment is a growing concern throughout the world. The widespread presence of highly toxic compounds of arsenic, antimony, and cadmium in nature poses a particular threat to human health. Prolonged exposure to these toxins has been associated with severe human diseases, including cancer, diabetes, and neurodegenerative disorders. These toxins are known to induce analogous cellular stresses, such as DNA damage, disturbance of redox homeostasis, and proteotoxicity. To overcome these threats and improve or devise treatment methods, it is crucial to understand the mechanisms of cellular detoxification in metal and metalloid stress. Membrane proteins are key cellular components involved in the uptake, vacuolar/lysosomal sequestration, and efflux of these compounds; thus, deciphering the multilevel regulation of these proteins is of the utmost importance. In this review, we summarize data on the mechanisms of arsenic, antimony, and cadmium detoxification in the context of membrane proteome. We used yeast Saccharomyces cerevisiae as a eukaryotic model to elucidate the complex mechanisms of the production, regulation, and degradation of selected membrane transporters under metal(loid)-induced stress conditions. Additionally, we present data on orthologues membrane proteins involved in metal(loid)-associated diseases in humans.

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

INTRODUCTION: The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. MATERIAL AND METHODS: This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. RESULTS: Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. CONCLUSIONS: Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

Is aspiration an effective acute stroke treatment in older adults?

Introduction: Clinical outcomes after interventional stroke treatment rely on several factors, with older age being associated with poorer results, which are mainly attributed to patient's comorbidities and medications. The delivery of an aspiration catheter could be hindered by carotid tortuosity, which is more prevalent in elderly patients with increasing age. In this study, we aimed to compare the clinical and angiographic outcomes of a direct aspiration first-pass technique in interventional stroke treatment for elderly patients compared with younger patients. Materials and methods: A total of 162 patients (92 women and 70 men, aged between 35 and 94 years +/- 12.4 years) were included in this study. Patients who were treated in a comprehensive stroke center due to a large-vessel occlusion stroke using aspiration as the first-choice treatment were included in this study. To evaluate carotid arteries, the tortuosity index (TI) was calculated for each segment of each carotid pathway. Results: Age correlated significantly with the presence of carotid tortuosity (R = 0.408, p = 0.000), extracranial length ratio (R = 0.487, p = 0.000), and overall length ratio (R = 0.467, p = 0.000). No significant associations were found with coiling, kinking, or intracranial length ratio. Successful aspiration-based recanalization rate decreased with increasing age, and the differences between the age subgroups were not statistically significant. A comparison of the extreme subgroups, i.e., <60 years old vs. ≥80 years old, did not yield a statistically significant change (p = 0.068). Conclusion: Successful aspiration-based recanalization rate decreased with increasing age; however, these differences were not significant. Clinical outcomes did not significantly differ with regard to carotid tortuosity, regardless of the time of assessment. Neither intracranial nor extracranial tortuosity was significantly associated with reperfusion-related complications in either of the age subgroups.

Identification of amino acid substitutions that toggle substrate selectivity of the yeast arsenite transporter Acr3.

The Acr3 protein family plays a crucial role in metalloid detoxification and includes members from bacteria to higher plants. Most of the Acr3 transporters studied so far are specific for arsenite, whereas Acr3 from budding yeast also shows some capacity to transport antimonite. However, the molecular basis of Acr3 substrate specificity remains poorly understood. By analyzing randomly generated and rationally designed yeast Acr3 variants, critical residues determining substrate specificity were identified for the first time. Replacement of Val173 with Ala abolished antimonite transport without affecting arsenite extrusion. In contrast, substitution of Glu353 with Asp resulted in a loss of arsenite transport activity and a concomitant increase in antimonite translocation capacity. Importantly, Val173 is located close to the hypothetical substrate binding site, whereas Glu353 has been proposed to participate in substrate binding. Identification of key residues conferring substrate selectivity provides a valuable starting point for further studies of the Acr3 family and may have implications for the development of biotechnological applications in metalloid remediation. Moreover, our data contribute to understanding why members of the Acr3 family evolved as arsenite-specific transporters in an environment of ubiquitously present arsenic and trace amounts of antimony.

Can HRV Predict Prolonged Hospitalization and Favorable or Unfavorable Short-Term Outcome in Patients with Acute Ischemic Stroke?

The aim of this study was to assess whether the heart rate variability (HRV) could predict a favorable or unfavorable stroke outcome. The endpoint was based on the National Institutes of Health Stroke Scale (NIHSS). The patient's health condition was assessed upon discharge from the hospital. An unfavorable stroke outcome was defined as death or NIHSS ≥ 9, while NIHSS < 9 meant a favorable stroke outcome. The studied group consisted of 59 patients with acute ischemic stroke AIS (mean age of 65.6 ± 13.2; 58% were females). An original and innovative non-linear measure was used to analyze HRV. It was based on symbolic dynamics consisting of comparing the "length of the longest words" in the night recording of HRV. "The length of the longest word" meant the longest sequence of identical adjacent symbols possible for a patient. An unfavorable stroke outcome occurred in 22 patients, whereas the majority of patients (37) had a favorable stroke outcome. The average hospitalization time of patients with clinical progression was 29 ± 14 days, and with favorable outcomes was 10 ± 3 days. Patients with long words (more than 150 adjacent RR intervals having the same symbol) were hospitalized no longer than 14 days and they had no clinical progression. The patients with a favorable stroke outcome were characterized by longer words. Our pilot study may be the beginning of work on the development of a non-linear, symbolic method as a predictor of prolonged hospitalization and increased risk of clinical progression in patients with AIS.

Heart rate variability as a predictor of stroke course, functional outcome, and medical complications: A systematic review.

Background: Heart rate variability (HRV) is a non-invasive marker of autonomic nervous system function that is based on the analysis of length differences between subsequent RR intervals of the electrocardiogram. The aim of this systematic review was to assess the current knowledge gap in the utility of HRV parameters and their value as predictors of the acute stroke course. Methods: A systematic review was performed in accordance with the PRISMA guidelines. Relevant articles published between 1 January 2016 and 1 November 2022 available in the PubMed, Web of Science, Scopus, and Cochrane Library databases were obtained using a systematic search strategy. The following keywords were used to screen the publications: "heart rate variability" AND/OR "HRV" AND "stroke." The eligibility criteria that clearly identified and described outcomes and outlined restrictions on HRV measurement were pre-established by the authors. Articles assessing the relationship between HRV measured in the acute phase of stroke and at least one stroke outcome were considered. The observation period did not exceed 12 months. Studies that included patients with medical conditions influencing HRV with no established stroke etiology and non-human subjects were excluded from the analysis. To minimize the risk of bias, disagreements throughout the search and analysis were resolved by two independent supervisors. Results: Of the 1,305 records obtained from the systematic search based on keywords, 36 were included in the final review. These publications provided insight into the usability of linear and non-linear HRV analysis in predicting the course, complications, and mortality of stroke. Furthermore, some modern techniques, such as HRV biofeedback, for the improvement of cognition performance after a stroke are discussed. Discussion: The present study showed that HRV could be considered a promising biomarker of a stroke outcome and its complications. However, further research is needed to establish a methodology for appropriate quantification and interpretation of HRV-derived parameters.

UPF1-From mRNA Degradation to Human Disorders.

Up-frameshift protein 1 (UPF1) plays the role of a vital controller for transcripts, ready to react in the event of an incorrect translation mechanism. It is well known as one of the key elements involved in mRNA decay pathways and participates in transcript and protein quality control in several different aspects. Firstly, UPF1 specifically degrades premature termination codon (PTC)-containing products in a nonsense-mediated mRNA decay (NMD)-coupled manner. Additionally, UPF1 can potentially act as an E3 ligase and degrade target proteins independently from mRNA decay pathways. Thus, UPF1 protects cells against the accumulation of misfolded polypeptides. However, this multitasking protein may still hide many of its functions and abilities. In this article, we summarize important discoveries in the context of UPF1, its involvement in various cellular pathways, as well as its structural importance and mutational changes related to the emergence of various pathologies and disease states. Even though the state of knowledge about this protein has significantly increased over the years, there are still many intriguing aspects that remain unresolved.

The Hemisphere of the Brain in Which a Stroke Has Occurred Visible in the Heart Rate Variability.

The aim of this study was to assess whether heart rate variability (HRV) could predict which hemisphere of the brain was affected during an acute ischemic stroke (AIS). To achieve this goal, we compared HRV between patients with a right (RH) and left hemispheric (LH) stroke. The studied group consisted of 64 patients with AIS (25 with RH and 39 with LH stroke, with a mean age of 64 ± 12 and 66 ± 13, p = 0.3, respectively) using 24 h Holter ECG records at NN intervals performed at a mean of 4.3 ± 2 days following their AIS. Standard linear methods were used to analyze HRV in the time and frequency domains, as well as nonlinear methods, including sample entropy, detrended fluctuation analysis, and asymmetry measures. Patients with an LH stroke had significantly greater values for sample entropy compared to subjects with an RH stroke (1.31 ± 0.53 vs. 0.92 ± 0.46, p = 0.003, Bonferroni-corrected p = 0.033, effect size = 0.8). The LH stroke group also had higher RMSSD (113 ± 81 vs. 76 ± 61, p = 0.06), pNN50 (33.35 ± 28.54 vs. 18.52 ± 23.75, p = 0.02), and HFnu (48.42 ± 16.41 vs. 42.66 ± 17.88, p = 0.11) values, when compared to the RH group, which was possibly related to higher activity in the parasympathetic system in the LH group. Conversely, subjects with RH stroke had higher LFnu (57.34 ± 17.88 vs. 51.58 ± 16.41, p-value = 0.11) and LF/HF ratios (2.24 ± 2.87 vs. 1.68 ± 2.50, p-value = 0.11), which were likely related to higher activity in the sympathetic nervous system, when compared to the LH stroke group. Our pilot study demonstrated that patients with RH stroke had lower HRV complexity than those with LH stroke, indicating that HRV could be useful in the discrimination of hemispheric involvement in AIS.

Vascular and Vasogenic Manifestations of Systemic ANCA-Associated Vasculitis with Renal Involvement in Non-Contrast Brain MRI in Patients with Acute Disease Onset.

Background. Data concerning central nervous system (CNS) alterations in ANCA-associated vasculitis with renal involvement (AAVR) are sparse. The study aimed to assess vascular and vasogenic brain alterations in patients with acute onset of AAVR and the applicability of non-contrast magnetic resonance imaging (MRI) techniques in this diagnosis. Methods. Thirty-eight patients with acute onset of AAVR were included in the study. BVAS/WG, c-ANCA, p-ANCA, renal function and perfusion, neurological assessment, and brain MRI were performed. Results. Cerebral vascular alternating narrowing and dilatation (VAND) was detected in 42.1% of patients, and the black-blood was significantly more diagnostic than the TOF technique (p < 0.001). VAND occurrence was independently associated with the concentration of p-ANCA. The vasogenic white matter lesions (VWML) were found in 94.4% of patients, and in their detection, SWAN was significantly better than the FLAIR technique (p = 0.002). The number of VWML correlated with age and cranial nerve damage. Hemosiderin deposits were found in 21.6% of patients and were associated with a gait impairment and paresthesia. Conclusions. Vascular and vasogenic alterations in the CNS are frequent in patients with acute onset of systemic ANCA-associated vasculitis with renal involvement. Non-contrast MRI is useful in the diagnosis of brain vasculitis.

Efficacy of Cerebrolysin Treatment as an Add-On Therapy to Mechanical Thrombectomy in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion: Study Protocol for a Prospective, Open Label, Single-Center Study With 12 Months of Follow-Up.

This study is designed to determine the efficacy of Cerebrolysin treatment as an add-on therapy to mechanical thrombectomy (MT) in reducing global disability in subjects with acute ischemic stroke (AIS). We have planned a single center, prospective, open-label, single-arm study with a 12-month follow-up of 50 patients with moderate to severe AIS, with a small established infarct core and with good collateral circulation who achieve significant reperfusion following MT and who receive additional Cerebrolysin within 8 h of stroke onset compared to 50 historical controls treated with MT alone, matched for age, clinical severity, occlusion location, baseline perfusion lesion volume, onset to reperfusion time, and use of iv thrombolytic therapy. The primary outcome measure will be the overall proportion of subjects receiving Cerebrolysin compared to the control group experiencing a favorable functional outcome (by modified Rankin Scale 0-2) at 90 days, following stroke onset. The secondary objectives are to determine the efficacy of Cerebrolysin as compared to the control group in reducing the risk of symptomatic secondary hemorrhagic transformation, improving neurological outcomes (NIHSS 0-2 at day 7, day 30, and 90), reducing mortality rates (over the 90-day and 12 months study period), and improving: activities of daily living (by Barthel Index), health-related quality of life (EQ-5D-5L) assessed at day 30, 90, and at 12 months. The other measures of efficacy in the Cerebrolysin group will include: assessment of final stroke volume and penumbral salvage (measured by CT/CTP at 30 days) and its change compared to baseline volume, changes over time in language function (by the 15-item Boston Naming Test), hemispatial neglect (by line bisection test), global cognitive function (by The Montreal Cognitive Assessment), and depression (by Hamilton Depression Rating Scale) between day 30 and day 90 assessments). The patients will receive 30 ml of Cerebrolysin within 8 h of AIS stroke onset and continue treatment once daily until day 21 (first cycle) and they will receive a second cycle of treatment (30 ml/d for 21 days given in the Outpatient Department or Neurorehabilitation Clinic) from day 69 to 90.

Case Report of Cerebral Sinus Thrombosis Related to Immune Thrombotic Thrombocytopenia Following Administration of ChAdOx1 nCoV-19 for Vaccination against COVID-19.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. Although the patient received immediate anticoagulant and intravenous immune globulin treatment, he died within 24 h after hospital admission. VITT and CVST are rare conditions; however, the course may be fatal. Therefore, clinicians should be familiarized with the clinical and laboratory features of VITT.

Mechanical thrombectomy of large vessel occlusion using adjustable vs. self-expanding stent-retriever-Comparison of Tigertriever device with stent-like stent-retrievers: A propensity score analysis.

Background: Stent-retrievers used for mechanical thrombectomy are self-expanding tubular stent-like devices with modified mesh structures for clot removal. Tigertriever is designed to provide manual control of its diameter and curvature. Methods: A retrospective single-center study was performed to compare Tigertriever with SolitaireX and pRESET (stent-like stent-retrievers group) using propensity score analysis. Patients treated in a comprehensive stroke center due to large vessel occlusion between January 2016 and August 2021 were evaluated. Baseline characteristics and treatment results were compared between these groups before and after pair matching. Results: There were 140 patients (60 in Tigertriever and 80 in the stent-like stent-retriever group). In propensity score analysis, 52 matched pairs were selected in Tigertriever and stent-like stent-retriever groups. The Tigertriever group had a better successful first pass revascularization rate [46 vs. 23%, OR (95% CI): 1.7 (1.1-2.9), p = 0.013] and 14-min shorter groin-to-revascularization time (51 vs. 65 min. p = 0.017). There were no significant differences between Tigertriever and stent-like stent-retriever groups in the following: favorable mRS 3 months, favorable recanalization rate, and symptomatic intracerebral hemorrhages. There were no observed periprocedural adverse events related to Tigertriever, SolitaireX, or pRESET. Conclusion: Tigertriever had a significantly better successful first pass revascularization rate and shorter groin-to-revascularization time in the analysis done before and after propensity score matching with stent-like stent-retrievers. Tigertriever is comparable to stent-like stent-retrievers regarding mortality at 3 months, favorable mRS at 3 months, favorable recanalization rate, or symptomatic cerebral hemorrhagic events.

Cerebrovascular accidents differ between patients with atrial flutter and patients with atrial fibrillation.

INTRODUCTION: Few studies have explored the potential impact of atrial flutter (AFl) on ischaemic stroke (IS) outcome. The aim of the present study was to compare the clinical course of IS in patients with AFl and patients with atrial fibrillation (AF). MATERIAL AND METHODS: A retrospective analysis of patients consecutively admitted to a tertiary care centre between 2013 and 2015 due to IS or transient ischaemic attack with permanent AFl or permanent or persistent AF was performed. RESULTS: The study groups consisted of 528 patients, including 490 (92.8%) patients with AF and 38 (7.2%) patients with AFl. The mean age and prestroke CHA2DS2-VASc scores were similar between the patients with AFl and those with AF. Most IS cases in the AF group were classified as cardioembolic strokes (74.9% vs. 39.5% in AFl, p < 0.01), and lacunar strokes were the most common in the AFl group (47.4% vs. 14.3% in AF, p < 0.01). The multivariable analysis revealed that the presence of AF (OR = 8.6, 95% CI: 1.2-57, p = 0.02), lacunar stroke (OR = 0.1, 95% CI: 0.03-0.31, p < 0.001), baseline Rankin scale score (OR = 16.6, 95% CI: 9.8-28), lack of prestroke therapeutic anticoagulation (OR = 6.1, 95% CI: 1.1-33), diabetes (OR = 2.9, 95% CI: 1.3-6.5, p < 0.01), chronic heart failure (OR = 14.2, 95% CI: 5.8-34, p < 0.001), and current smoking (OR = 0.92, 95% CI: 0.39-0.99, p < 0.01) were significantly associated with the stroke outcome. CONCLUSIONS: Disabling or fatal IS was observed less often in patients with AFl than in patients with AF. This finding can possibly be explained by the more frequent occurrence of lacunar strokes in the AFl group compared with that in the AF group.

Cerebral Vasoreactivity Changes Over Time in Patients With Different Clinical Manifestations of Cerebral Small Vessel Disease.

Objectives: Endothelial dysfunction (ED) has been linked to the pathogenesis of cerebral small vessel disease (SVD). We aimed to assess ED and cerebrovascular reactivity (CVR) in the patients with a diverse manifestation of SVD, with similar and extensive white matter lesions (WMLs, modified Fazekas scale grade ≥2), compared with a control group (CG) without the MRI markers of SVD, matched for age, gender, hypertension, diabetes, and to evaluate the change of CVR following 24 months. Methods: We repeatedly measured the vasomotor reactivity reserve (VMRr) and breath-holding index (BHI) of the middle cerebral artery (MCA) by the transcranial Doppler ultrasound (TCD) techniques in 60 subjects above 60 years with a history of lacunar stroke (LS), vascular dementia (VaD), or parkinsonism (VaP) (20 in each group), and in 20 individuals from a CG. Results: The mean age, frequency of the main vascular risk factors, and sex distribution were similar in the patients with the SVD groups and a CG. The VMRr and the BHI were more severely impaired at baseline (respectively, 56.7 ± 18% and 0.82 ± 0.39) and at follow-up (respectively, 52.3 ± 16.7% and 0.71 ± 0.38) in the patients with SVD regardless of the clinical manifestations (ANOVA, p > 0.1) than in the CG (respectively, baseline VMRr 77.2 ± 15.6%, BHI 1.15 ± 0.47, p < 0.001; follow-up VMRr 74.3 ± 17.6%, BHI 1.11 ± 0.4, p < 0.001). All the assessed CVR measures (VMRr and BHI) significantly decreased over time in the subjects with SVD (Wilcoxon's signed-rank test p = 0.01), but this was not observed in the CG (p > 0.1) and the decrease of CVR measures was not related to the SVD radiological progression (p > 0.1). Conclusions: This study provided evidence that the change in CVR measures is detectable over a 24-month period in patients with different clinical manifestations of SVD. Compared with the patients in CG with similar atherothrombotic risk factors, all the CVR measures (BMRr and BHI) significantly declined over time in the subjects with SVD. The reduction in CVR was not related to the SVD radiological progression.

Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy-A Clinical and Biomechanical Perspective.

BACKGROUND: The inadvertent detachment of stent retrievers during mechanical thrombectomy is an extremely rare but feared complication associated with poor clinical outcomes. We discuss management considerations after an unexpected disconnection of the pRESET stent retriever during mechanical thrombectomy, based on clinical experience and mechanical and phantom studies. METHODS: We present a clinical course of rare accidents of stent-retriever separation inside an intracranial vessel that occurred in patients in a comprehensive stroke centre between 2018 and 2020. We designed a phantom study to assess the Tigertriever's ability to remove a detached stent retriever from intercranial vessels. In the mechanical study, several types of stent retrievers were evaluated in order to find the weakest point at which detachment occurred. RESULTS: Two patients (~0.7%) with inadvertent stent-retriever detachment were found in our database. Failed attempts of endovascular removal with no recanalization at the end of procedure were reported in both cases. mRS after 3 months was three and four respectively. In the mechanical study, the Tigertriever was the most resistant to detachment and was followed by Embotrap > pRESET > 3D Separator. In the phantom study, the pRESET device detached in a configuration resembling the M1 segment was successfully removed with the Tigertriever. CONCLUSIONS: Conservative management of the inadvertent detachment of stent retrievers during mechanical thrombectomy in large vessel occlusion may be acceptable in order to avoid further periprocedural complications after unsuccessful device removal attempts. Based on the phantom and mechanical studies, the Tigertriever may be a useful tool for the removal of detached pRESET devices.

Pre-Stroke Statin Therapy Improves In-Hospital Prognosis Following Acute Ischemic Stroke Associated with Well-Controlled Nonvalvular Atrial Fibrillation.

Many studies have confirmed the positive effect of statins in the secondary prevention of ischemic stroke. Although several studies have concluded that statins may also be beneficial in patients with atrial fibrillation-related stroke, the results of those studies are inconclusive. Therefore, the aim of this study was to analyze the effect of pre-stroke statin therapy on atrial fibrillation-related stroke among patients with a well-controlled atrial fibrillation. This retrospective multicenter analysis comprised 2309 patients with acute stroke, with a total of 533 patients meeting the inclusion criteria. The results showed a significantly lower neurological deficit on the National Institutes of Health Stroke Scale at hospital admission and discharge in the group of atrial fibrillation-related stroke patients who took statins before hospitalization compared with those who did not (p < 0.001). In addition, in-hospital mortality was significantly higher in the atrial fibrillation-related stroke patients not taking statins before hospitalization than in those who did (p < 0.001). Based on the results of our previous research and this current study, we postulate that the addition of a statin to the oral anticoagulants may be helpful in the primary prevention of atrial fibrillation-related stroke.

Mean Platelet Volume as a Potential Marker of Large Vessel Occlusion and Predictor of Outcome in Acute Ischemic Stroke Patients Treated with Reperfusion Therapy.

(1) Background: An early diagnosis of a large vessel occlusion (LVO) is crucial in the management of the acute ischemic stroke (AIS). The laboratory predictors of LVO and a stroke outcome remain unknown. We have hypothesized that high MPV-a surrogate marker of the activated platelet-may be associated with LVO, and it may predict a worse AIS outcome. (2) Methods: This was a retrospective study of 361 patients with AIS who were treated with thrombolysis (tPA, 65.7%) and/or mechanical thrombectomy (MT, 34.3%) in a tertiary Stroke Center between 2011 and 2019. (3) Results: The mean MPV in the cohort was 9.86 ± 1.5 fL (1st-4th quartiles: <8.8, >10.80 fL). Patients in the 4th quartile compared to the 1st had a significantly (p < 0.01) more often incidence of an LVO related stroke (75% vs. 39%) and a severe stroke manifestation with a higher RACE score (5.2 ± 2.8 vs. 3.3 ± 2.4), NIHSS at baseline (mean ± SD, 14 ± 6.5 vs. 10.9 ± 5.2), and NIHSS at discharge (6.9 ± 7 vs. 3.9 ± 3.6). A multivariate analysis revealed that quartiles of MPV (OR 1.4; 95%CI 1.2-1.8) significantly predicted an LVO stroke, also after the adjustment for RACE < 5 (OR 1.4; 95%CI 1.08-1.89), but MPV quartiles did not predict a favorable stroke outcome (mRS ≤ 2) (OR 0.89; 95%CI 0.7-1.13). (4) Conclusion: Our data suggest that MPV is an independent predictor of LVO in patients with an acute ischemic stroke.

Ischemic Stroke Risk Factors in Patients with Atrial Fibrillation Treated with New Oral Anticoagulants.

The most commonly used therapeutic option for the prevention of ischemic stroke in patients with atrial fibrillation is new- or old-generation oral anticoagulants. New oral anticoagulants are at least as effective as old-generation oral anticoagulants in the prevention of ischemic stroke, with a reduced risk of life-threatening hemorrhage. Moreover, the constant monitoring of these drugs in the patient's blood is not required during routine use. However, ischemic stroke can still occur in these patients. Therefore, the aim of this study was to investigate the pattern of risk factors for ischemic stroke in patients with atrial fibrillation treated with new oral anticoagulants. Our multicenter retrospective study involved 2032 patients with acute ischemic stroke. The experimental group consisted of 256 patients with acute ischemic stroke and nonvalvular atrial fibrillation, who were treated with new oral anticoagulants. The control group consisted of 1776 ischemic stroke patients without coexisting atrial fibrillation. The results of our study show that patients with atrial fibrillation treated with new oral anticoagulants are more likely to display thrombotic, proatherogenic, and proinflammatory factors in addition to the embolic factors associated with atrial fibrillation. Therefore, solely taking new oral anticoagulants is insufficient in protecting this group of patients from ischemic stroke.

Effect of COVID-19 pandemic on stroke admissions and quality of stroke interventional treatment in Masovian Voivodeship.

AIM OF STUDY: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the pathway of stroke interventional services and major quality indicators of stroke reperfusion therapies in Masovian Voivodeship. MATERIALS AND METHODS: An exploratory retrospective analysis was performed at two comprehensive stroke centres to assess changes in stroke care between the early phase of the COVID-19 pandemic (weeks 10-18 of 2020) and the same period in 2019. RESULTS: Of the 419 included stroke patients, 186 (44.4%) presented during the COVID-19 period. There was an increase in in-hospital delays for reperfusion therapies, and a significant decrease in the number of acute cerebrovascular accident admissions, predominantly related to a low number of transient ischaemic attack (TIA) admissions to hospital (-20.17%). The delays were shorter in the mothership paradigm than in the drip-and-ship paradigm of acute stroke care (onset-to-groin 293 vs. 232 min, p = 0.03). No differences in stroke aetiology, large-vessel occlusion frequency, or severe stroke admissions in the COVID-19 period were observed. CONCLUSIONS AND CLINICAL IMPLICATIONS: COVID-19's emergence was correlated with a significant reduction in admissions to stroke departments, particularly for TIAs, and a prolonged delay in reperfusion stroke treatment, especially in the drip-and-ship paradigm. An educational campaign to raise public awareness of TIA and/or stroke symptoms and immediate reorganisation of stroke care during the COVID-19 era are necessary.

[Internal carotid artery dissection in the neurologist's practice - a case study]. / Rozwarstwienie tetnicy szyjnej wewnetrznej w praktyce neurologa ­ opis przypadku.

Dissection of the interior carotid artery is rare in the general population. It can however be a potentially life-threatening condition. In the group of patients below 45 years of age, it constitutes a fairly common cause of cerebral stroke. A CASE REPORT: The study describes the case of a patient with the right interior carotid artery dissection, sustained most probably in the course of work. The patient was admitted to hospital for a severe headache of a few days' duration accompanied by Horner's syndrome on the right side. Promptly undertaken diagnostic procedures allowed for immediate diagnosis and application of the right treatment. The check-up examinations performed showed a healed artery and withdrawal of the neurological syndrome. CONCLUSIONS: The case emphasizes the role of prompt diagnosis and treatment in preventing the development of more serious complications. The article refers also to the standards of treating the dissection of the interior carotid artery which still arouse controversies.