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Protoplanetary disks are known to possess a variety of substructures in the distribution of their millimetre-sized grains, predominantly seen as rings and gaps1, which are frequently interpreted as arising from the shepherding of large grains by either hidden, still-forming planets within the disk2 or (magneto-)hydrodynamic instabilities3. The velocity structure of the gas offers a unique probe of both the underlying mechanisms driving the evolution of the disk-such as movement of planet-building material from volatile-rich regions to the chemically inert midplane-and the details of the required removal of angular momentum. Here we report radial profiles of the three velocity components of gas in the upper layers of the disk of the young star HD 163296, as traced by emission from 12CO molecules. These velocities reveal substantial flows from the surface of the disk towards its midplane at the radial locations of gaps that have been argued to be opened by embedded planets4-7: these flows bear a striking resemblance to meridional flows, long predicted to occur during the early stages of planet formation8-12. In addition, a persistent radial outflow is seen at the outer edge of the disk that is potentially the base of a wind associated with previously detected extended emission12.
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BACKGROUND AND PURPOSE: Endovascular thrombectomy (EVT) has benefits in selected patients 6-24 h after stroke onset. However, the response to EVT >24 h after stroke onset is still unclear. We compared the early response to EVT in patients with different time windows. METHODS: Patients who underwent EVT in an emergency setting were enrolled and categorized according to when EVT was performed: within 6 (early), 6-24 (late), and >24 h (very late) after stroke onset. Early neurological improvement (ENI) and deterioration (END) were defined as improvement and worsening, respectively, of National Institutes of Health Stroke Scale (NIHSS) score by ≥4 points after EVT. The three groups' clinical characteristics and response to EVT were compared. We also investigated factors associated with ENI and END. RESULTS: During study period, 274 patients underwent EVT (109 early, 104 late, and 61 very late). Patients who underwent EVT very late were younger (p = 0.007), had smaller ischemic cores, and had lower initial NIHSS scores (8 ± 5) than those who underwent EVT early (14 ± 6) and late (13 ± 7; p < 0.001). Stroke mechanisms also differed according to the time window (p < 0.001): cardioembolism was more common after early EVT, whereas large-artery atherosclerosis was more prevalent among patients who underwent EVT very late. ENI was significantly more common after early (60.6%) and late EVT (51.0%) than after very late EVT (29.5%; p = 0.001); however, rates of END did not differ (11.0%, 13.5%, and 4.9%, respectively). ENI was independently associated with male, higher NIHSS score, and early and late EVT. END was associated with failure of recanalization. CONCLUSIONS: ENI was more observed and associated with early and late EVT. Highly selected patients receiving very late EVT may not benefit from ENI but may still have a chance to prevent END. The occurrence of END was associated not with time window but with failure of recanalization.
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Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular , Humanos , Masculino , Terapia Trombolítica , Resultado del Tratamiento , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Trombectomía/efectos adversos , Procedimientos Endovasculares/efectos adversos , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/terapiaRESUMEN
BACKGROUND: Prognosis after vertebrobasilar stenting (VBS) may differ from that after carotid artery stenting (CAS). Here, we directly compared the incidence and predictors of in-stent restenosis and stented-territory infarction after VBS and compared them with those of CAS. METHODS: We enrolled patients who underwent VBS or CAS. Clinical variables and procedure-related factors were obtained. During the 3 years of follow-up, in-stent restenosis and infarction were investigated in each group. In-stent restenosis was defined as reduction in the lumen diameter > 50% compared with that after stenting. Factors associated with the occurrence of in-stent restenosis and stented-territory infarction in VBS and CAS were compared. RESULTS: Among 417 stent insertions (93 VBS and 324 CAS), there was no statistical difference in in-stent restenosis between VBS and CAS (12.9% vs. 6.8%, P = 0.092). However, stented-territory infarction was more frequently observed in VBS than in CAS (22.6% vs. 10.8%; P = 0.006), especially a month after stent insertion. HbA1c level, clopidogrel resistance, and multiple stents in VBS and young age in CAS increased the risk of in-stent restenosis. Diabetes (3.82 [1.24-11.7]) and multiple stents (22.4 [2.4-206.4]) were associated with stented-territory infarction in VBS. However, in-stent restenosis (odds ratio: 15.1, 95% confidence interval: 3.17-72.2) was associated with stented-territory infarction in CAS. CONCLUSIONS: Stented-territory infarction occurred more frequently in VBS, especially after the periprocedural period. In-stent restenosis was associated with stented-territory infarction after CAS, but not in VBS. The mechanism of stented-territory infarction after VBS may be different from that after CAS.
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Estenosis Carotídea , Reestenosis Coronaria , Humanos , Estenosis Carotídea/epidemiología , Estenosis Carotídea/cirugía , Stents/efectos adversos , Arterias Carótidas , Constricción Patológica , Infarto , Resultado del Tratamiento , Recurrencia , Factores de Riesgo , Estudios RetrospectivosRESUMEN
BACKGROUND: Early neurological deterioration (END) occurs in patients with pontine infarction that is adversely associated with a long-term functional outcome. As basilar artery (BA) tortuosity may alter hemodynamics, we investigated whether factors including BA tortuosity are associated with END and poor outcome at 3 months. METHODS: We reviewed patients with acute (<7 days from stroke onset) unilateral pontine infarction mainly involving the pontine base and/or tegmental regions from January 2017 through April 2021. END was defined as increase of ≥2 in total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 in motor NIHSS score within first 72 h. A poor clinical outcome was defined as modified Rankin Scale (mRS) 3-6 at 3 months. The BA tortuosity index (TI) was measured: ([actual/straight length -1] x 100). To assess interobserver agreement, TI measurements were obtained by 2 independent raters. RESULTS: The study included 245 patients; END occurred in 72 (29.3%) and 35 (14.2%) showed poor outcome at 3 months. Old age (odds ratio [OR] = 1.03, 95% confidence interval [CI] 1.004-1.062; p = 0.027), previous stroke history (OR = 2.36, 95% CI: 1.176-4.717; p = 0.016), lower initial NIHSS (OR = 0.72, 95% CI: 0.628-0.827; p < 0.001), and high BA TI (OR = 1.17, 95% CI: 1.062-1.295; p = 0.002) were associated with END. On the other hand, old age (OR = 1.04, 95% CI: 1.002-1.073; p = 0.037) and END (OR = 3.03, 95% CI: 1.429-6.403; p = 0.004) were associated with poor outcome at 3 months. CONCLUSIONS: High BA tortuosity may be a factor associated with END in patients with pontine infarction. As END was related to unfavorable clinical outcome, this risk may have to be carefully considered in patients with high BA tortuosity.
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Infartos del Tronco Encefálico , Accidente Cerebrovascular , Arteria Basilar/diagnóstico por imagen , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/etiología , Humanos , Lactante , Oportunidad Relativa , Puente/irrigación sanguínea , Puente/diagnóstico por imagen , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The effect of cholesterol on the functional outcome after endovascular thrombectomy (EVT) is still controversial. This study aimed to investigate whether the lipid profile is associated with the EVT prognosis. METHODS: We retrospectively analyzed patients with emergent large vessel occlusion who underwent EVT. The blood lipid levels were measured in the fasting state, 1 day after admission. We divided patients into terciles of serum total cholesterol (TC) levels and compared the clinical characteristics among the groups. The factors associated with a good outcome at 3 months (modified Rankin scale 0-2) were investigated, considering the stroke mechanism and recanalization status. RESULTS: Among 274 patients, good outcomes were observed in 108 (39.4%) patients. Low initial severity (odds ratio (OR), 0.91, 95% confidence interval (CI), 0.858-0.954; p < 0.001) and high TC level (1.35, 1.034-1.758; p = 0.041) were associated with good outcomes. In patients with cardioembolism, young age (0.95, 0.915-0.991; p = 0.021), low initial severity (0.92, 0.857-0.988; p = 0.024), and high TC level (1.60, 1.019-2.499; p = 0.036) were associated with good outcomes. The lipid profile was not associated with a functional outcome in those with large artery atherosclerosis. In patients with complete recanalization, young age (0.97, 0.941-0.994; p = 0.016), low initial severity (0.91, 0.864-0.961; p = 0.001), absence of diabetes (0.45, 0.218-0.947; p = 0.035) or any hemorrhage (0.33, 0.142-0.760; p = 0.009), and high TC level (1.40, 1.031-1.879; p = 0.031) were associated with good outcomes. CONCLUSIONS: A high TC level was associated with favorable outcomes after EVT, especially in patients with cardioembolism and complete recanalization.
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Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular , Arterias , Humanos , Lípidos , Estudios Retrospectivos , Accidente Cerebrovascular/cirugía , Trombectomía , Resultado del TratamientoRESUMEN
The development of synthetic methods to produce highly functionalized chiral 3-pyrrolines is of indisputable importance because of their prevalence in natural and synthetic bioactive molecules. Unfortunately, previous general cycloaddition approaches using allenoates, could not synthesize 3,4-disubstituted 3-pyrrolines. Herein, an original approach to yield 2,3,4-trisubstituted 3-pyrrolines with chirality at the 2-position is presented. A NiII /Fc-i-PrPHOX catalytic system facilitated a redox-neutral highly stereoselective process that exhibited an enantioselectivity of up to 99 %. Enantioenriched 3-pyrrolines can be converted to other valuable classes of N-heterocycles.
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Níquel , Catálisis , Ciclización , Reacción de Cicloadición , EstereoisomerismoRESUMEN
Anionic Congo red dye (CR) is not effectively removed by conventional adsorbents. Three novel biochars derived from agro-waste (Acacia auriculiformis), modified with metal salts of FeCl3, AlCl3, and CaCl2 at 500 °C pyrolysis have been developed to enhance CR treatment. These biochars revealed significant differences in effluents compared to BC, which satisfied initial research expectations (P < 0.05). The salt concentration of 2 M realized optimal biochars with the highest CR removal of 96.8%, for AlCl3-biochar and FeCl3-biochar and 70.8% for CaCl2-biochar. The modified biochars were low in the specific surface area (137.25-380.78 m2 g-1) compared normal biochar (393.15 m2 g-1), had more heterogeneous particles and successfully integrated metal oxides on the surface. The CR removal increased with a decrease in pH and increase in biochar dosage, which established an optimal point at an initial loading of 25 mg g-1. Maximum adsorption capacity achieved 130.0, 44.86, and 30.80 mg g-1 for BFe, BCa, and BAl, respectively. As magnetic biochar, which is easily separated from the solution and achieves a high adsorption capacity, FeCl3-biochar is the preferred biochar for CR treatment application.
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Rojo Congo , Contaminantes Químicos del Agua , Adsorción , Carbón Orgánico , MetalesRESUMEN
BACKGROUND: Hyponatremia has been reported from patients with severe neurological disease, and the syndrome of inappropriate secretion of antidiuretic hormone and cerebral salt wasting syndrome are the two main etiologies of hyponatremia after brain injury. Here we describe a patient with a lateral medullary infarction who experienced symptomatic hyponatremia with finding suggestive of syndrome of inappropriate secretion of antidiuretic hormone followed by cerebral salt wasting syndrome. CASE PRESENTATION: A 70-year-old Korean man visited emergency room complaining of sudden onset vertigo and gait disturbance. Neurological exam showed left side ataxia, Horner syndrome, and right side hypesthesia. Brain magnetic resonance imaging disclosed acute infarction involving left lateral medulla. His neurological status was stabilized, but he began to complain of non-vertiginous dizziness and general weakness five days after admission. Serum sodium level dropped from 131 mEq/mL to 122 mEq/mL with reduced serum osmolarity of 265 mOsm/L. The diagnosis of syndrome of inappropriate secretion of antidiuretic hormone was made and we restricted fluid intake, but his symptoms worsened and his mental status became drowsy. Follow up serum sodium level was 108 mEq/L with volume loss, suggesting cerebral salt wasting syndrome. We treated him with hypertonic saline and his consciousness was recovered. CONCLUSION: This case shows symptomatic hyponatremia after lateral medullary infarction, providing insight about distinct pathogenesis of syndrome of inappropriate secretion of antidiuretic hormone and cerebral salt wasting syndrome.
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Infarto Cerebral/complicaciones , Hiponatremia/etiología , Bulbo Raquídeo , Infarto Cerebral/sangre , Infarto Cerebral/metabolismo , Humanos , Hiponatremia/sangre , Hiponatremia/metabolismo , Síndrome de Secreción Inadecuada de ADH/sangre , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/metabolismo , Masculino , Persona de Mediana Edad , Sodio/sangre , Inconsciencia/etiologíaRESUMEN
Synthetic photochemistry has undergone significant development, largely owing to the development of visible-light-absorbing photocatalysts (PCs). PCs have significantly improved the efficiency and precision of cycloaddition reactions, primarily through energy or electron transfer pathways. Recent research has identified photocatalysis that does not follow energy- or electron-transfer formalisms, indicating the existence of other, undiscovered photoactivation pathways. This study unveils an alternative route: a charge-neutral photocatalytic process called charge-recombinative triplet sensitization (CRTS), a mechanism with limited precedents in synthetic chemistry. Our investigations revealed CRTS occurrence in DeMayo-type [2 + 2] cycloaddition reactions catalyzed by indole-fused organoPCs. Our mechanistic investigations, including steady-state and transient spectroscopic analyses, electrochemical investigations, and quantum chemical calculations, suggest a mechanism involving substrate activation through photoinduced electron transfer, followed by charge recombination, leading to substrate triplet state formation. Our findings provide valuable insights into the underlying photocatalytic reaction mechanisms and pave the way for the systematic design and realization of innovative photochemical processes.
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Magnetic anisotropy strongly influences the performance of the magnetocaloric effect. We investigated the magnetocaloric properties of the NdAlGe single crystal with I41md structure. The temperature-dependent magnetization revealed significant anisotropic properties; stable antiferromagnetic transition at TN = 6 K for H//a and meta-magnetic spin reorientation at low temperature (T ≤ 5 K) within an intermediate field (H = 2 T) for H//c. During the metamagnetic spin reorientation, the abrupt change of the magnetic entropy leads to a significant magnetocaloric effect with negative magnetic entropy change (∆SM) by -13.80 J kg-1 K-1 at TC = 5.5 K for H = 5 T along the H//c axis. In addition, the antiferromagnetic state for H//a shows the inverse magnetocaloric effect(I-MCE) by positive entropy change ∆SM = 2.64 J kg-1 K-1 at TN = 6 K for H = 5 T. This giant MCE accompanied by the metamagnetic transition resulted in a significantly large relative cooling power (158 J/kg at H = 5 T) for H//c. The giant MCE and I-MCE can be applied to the rotational magnetocaloric effect (R-MCE) depending on the crystal orientations. NdAlGe exhibits rotational entropy change ∆Sc-a = -12.85 J kg-1 K at Tpeak = 7.5 K, H = 5 T. With comparison to conventional MCE materials, NdAlGe is suggested as promising candidate of R-MCE, which is a novel type of magnetic refrigeration system.
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We present a novel nickel-catalyzed reaction of indole-tethered 2-alkynylphenol esters with various (hetero)aryl boronic acids, resulting in the synthesis of diversely functionalized pentacyclic benzofurocyclohepta[b]indole derivatives. This unprecedented cascade reaction involves the arylative cyclization of alkynes, nucleophilic attack of the indole moiety on the oxonium ion intermediate, 1,2-alkyl group migration, and aromatization. The synthesized molecules exhibit exceptional cytotoxicity against multiple cancer cell lines while maintaining biocompatibility toward healthy cells.
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Fructooligosaccharides (FOS), Ad-fructooligosaccharides (Ad-FOS), resistant maltodextrin (RMD), and maltooligosaccharides (MOS) are commercially available prebiotic oligosaccharides. In this study, the effects of prebiotics on the human gut microbial ecosystem were evaluated using an in vitro gut model. FOS and Ad-FOS showed tolerance to digestion, whereas RMD and MOS showed moderate digestion by digestive enzymes. In in vitro fecal fermentation, Bifidobacterium spp. increased in the following order: FOS, Ad-FOS, MOS, and RMD, whereas Bacteroides spp. increased in RMD medium. Bacteroides xylanisolvens exhibited cross-feeding by enabling the growth of other beneficial bacteria during co-culture in RMD medium. In metabolome analysis, total short-chain fatty acids (SCFAs) were highly produced in the following order: RMD, FOS, MOS, and Ad-FOS; acetate in the order of FOS, MOS/RMD, and Ad-FOS; butyrate in the order of RMD, MOS, FOS, and Ad-FOS; and propionate only in RMD. In addition, the conversion of betaine to trimethylamine was rarely affected in the following order: MOS, RMD, FOS, and Ad-FOS. Lastly, the four oligosaccharides inhibited the adhesion of pathogenic Escherichia coli to human epithelial cells to a similar extent. The comparative analysis results obtained in this study will provide comprehensive information of these substances to manufacturers and customers.
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Microbiota , Prebióticos , Humanos , Oligosacáridos/farmacología , Heces/microbiología , Metaboloma , FermentaciónRESUMEN
Enterococcus faecium is a prevalent species found in fermented soybean products, known for its contributions to flavor development and inhibition of pathogenic microorganisms during fermentation. This study aims to provide comprehensive phenotypic and genomic evidence supporting the probiotic characteristics of E. faecium EFEL8600, a bacteriocin-producing strain isolated from Korean soy-meju. Phenotypic analysis revealed that EFEL8600 produced a peptide with inhibitory activity against Listeria monocytogenes, estimated to be 4.6 kDa, corresponding to the size of enterocins P or Q. Furthermore, EFEL8600 exhibited probiotic traits, such as resilience in gastrointestinal conditions, antioxidant and anti-inflammatory activities, and protection of the intestinal barrier. Safety assessments demonstrated no hemolytic and bile salt deconjugation activities. Genomic analysis revealed the presence of several genes associated with probiotic characteristics and bacteriocin production, while few deleterious genes with a low likelihood of expression or transferring were detected. Overall, this study highlights E. faecium EFEL8600 as a potent anti-listeria probiotic strain suitable for use as a starter culture in soymilk fermentation, providing potential health benefits to consumers.
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This study investigates the synergistic impact of fermenting kale juice with Limosilactobacillus strains on its antioxidant and anti-inflammatory properties. Kale's rich nutrient profile, especially its flavonoids, offers potential health benefits. Probiotic lactic acid bacteria are employed in kale fermentation to enhance nutrient bioavailability and generate bioactive compounds. Kale juices fermented with L. reuteri EFEL6901 or L. fermentum EFEL6800 exhibited superior microbial growth. Free sugars and amino acids were converted to alcohols and organic acids, affecting the organoleptic and health-related properties of the product. In addition, fermentation increased quercetin and kaempferol content, indicating improved availability. Furthermore, the fermented juice exhibited notable antioxidant activity and suppressed nitric oxide (NO) production, revealing anti-inflammatory potential. Gene expression analysis confirmed reduced pro-inflammatory markers such as iNOS, COX-2, IL-6, and IL-1ß and elevated anti-inflammatory cytokines, including IL-10. This research highlights the promising potential of fermented kale juice, enriched with Limosilactobacillus strains, as a functional food with combined antioxidant and anti-inflammatory benefits.
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BACKGROUND: Thromboelastography (TEG) is a useful for predicting hemorrhagic transformation, early neurological deterioration, and functional outcome after stroke. We aimed to investigate whether TEG value could also be useful in predicting functional outcome via various intraprocedural and postprocedural factors in patients with acute large vessel occlusive stroke who underwent intraarterial thrombectomy (IAT). METHODS: Patients with ischemic stroke who underwent IAT between March 2018 and March 2020 at two tertiary hospitals were included. The association between reaction time (R) and functional outcome was evaluated. The primary outcome was the achievement of functional independence defined as the achievement of a modified Rankin Scale (mRS) score of 0-2 at 3 months after the index stroke. RESULTS: Among a total of 160 patients (mean age, 70.6 ± 12.3 years; 103 [64.4 %] men), 79 (49.3 %) achieved functional independence at 3 months. R, both as a continuous (odds ratio [OR]: 1.45, 95 % confidence interval [95 % CI]: 1.09-1.92, P = 0.011) and dichotomized parameters (R < 5 min [OR: 0.37, 95 % CI: 0.16-0.82, P = 0.014]), were inversely associated with increased odds of achieving functional independence (mRS score 0-2) after multivariable analysis. The association was still consistent when the outcome was the achievement of disability free (mRS score 0-1) or mRS score analyzed as an ordinal variable. CONCLUSIONS: Decreased R, especially R < 5 min, was inversely associated with functional outcome pf stroke after EVT.
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Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Masculino , Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Femenino , Isquemia Encefálica/cirugía , Isquemia Encefálica/etiología , Accidente Cerebrovascular Isquémico/cirugía , Tromboelastografía , Resultado del Tratamiento , Accidente Cerebrovascular/cirugía , Accidente Cerebrovascular/etiología , TrombectomíaRESUMEN
BACKGROUND: We investigated the association between the reaction time (R), a thromboelastography (TEG) parameter for hypercoagulability, and functional outcomes based on the occurrence of hemorrhagic transformation (HT) and early neurological deterioration (END). METHODS: We enrolled ischemic stroke patients and performed TEG immediately after the patients' arrival. The baseline characteristics, occurrence of HT and END, stroke severity, and etiology were compared according to the R. END was defined as an increase of ≥1 point in motor or ≥2 points in the total National Institute of Health Stroke Scale within 3 days after admission. The outcome was the achievement of functional independence (modified Rankin scale [mRS]: 0-2) at 3 months after stroke. Logistic regression analyses were performed to verify the association between R and outcome. RESULTS: HT and END were frequently observed in patients with an R of <5 minutes compared with the group with an R of ≥5 minutes (15 [8.1%] vs. 56 [21.0%], p < 0.001; 16 [8.6%] vs. 65 [24.3%], p = 0.001, respectively). In multivariable analysis, an R of <5 minutes was associated with decreased odds of achieving functional independence (0.58 [0.34-0.97], p = 0.038). This association was maintained when the outcome was changed to disability free (mRS 0-1) and when mRS was analyzed as an ordinal variable. CONCLUSION: Hypercoagulability on TEG (R <5 minutes) may be a negative predictor for functional outcome of stroke after 3 months, with more frequent HT, END, and different stroke etiologies. This study highlights the potential of TEG parameters as biomarkers for predicting functional outcomes in ischemic stroke patients.
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Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Trombofilia , Humanos , Accidente Cerebrovascular Isquémico/diagnóstico , Isquemia Encefálica/diagnóstico , Tromboelastografía , Accidente Cerebrovascular/etiología , Trombofilia/etiología , Trombofilia/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVE: The risk of ischemic stroke with intracranial stenosis is associated with various serum lipid levels. However, the effects of changes in the lipid profile on the risk of in-stent restenosis have not been verified. Therefore, we investigated the association between the occurrence of in-stent restenosis at 12-month follow-up and changes in various lipid profiles. METHODS: In this retrospective cohort study, we included ischemic stroke patients who had undergone intracranial stenting for symptomatic intracranial stenosis between February 2010 and May 2020. We collected data about serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) levels, and calculated the TC/HDL-C and LDL-C/HDL-C ratios at baseline and after 12 months. We conducted multivariable logistic regression analyses to verify the association between various lipid profile changes and in-stent restenosis at 12 months. RESULTS: Among the 100 patients included in the study (mean age, 60.8 ± 10.0 years; male: 80 [80.0%]), in-stent restenosis was found in 13 (13.0%) patients. The risk of in-stent restenosis of more than 50% was significantly decreased when TC/HDL-C ratio (odds ratio [OR] 0.22, [95% confidence interval (CI) 0.05-0.87]) and LDL-C/HDL-C ratio (OR 0.23, [95% CI 0.06-0.93]) decreased or when HDL-C levels (OR 0.10, [95% CI 0.02-0.63]) were increased at 12 months compared with baseline measurements. CONCLUSIONS: Improvement of HDL-C levels, TC/HDL-C ratio, and LDL-C/HDL-C ratio were associated with decreased risk of in-stent restenosis at 12-month follow-up. Management and careful monitoring of various lipid profiles including HDL-C levels, TC/HDL-C ratio, and LDL-C/HDL-C ratio may be important to prevent in-stent restenosis in patients with intracranial stenting.
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Reestenosis Coronaria , Accidente Cerebrovascular Isquémico , Humanos , Masculino , Persona de Mediana Edad , Anciano , LDL-Colesterol , Estudios Retrospectivos , Constricción Patológica , Triglicéridos , HDL-Colesterol , Factores de RiesgoRESUMEN
BACKGROUND: Pontine infarctions are often associated with extrapontine infarcts. We aimed to elucidate differences in clinical characteristics, mechanisms, and functional outcomes between isolated pontine infarction (IPI) and pontine plus infarction (PPI). METHODS: We studied patients with acute pontine infarction between January 2019 and August 2021 and divided them into IPI and PPI according to diffusion-weighted magnetic resonance image. Vertical locations were classified into rostral, middle, and caudal, and horizontal locations were categorized as basal/tegmental and unilateral/bilateral. Factors associated with poor 90-day outcome (modified Rankin scale 3-6) were analyzed. RESULTS: Among 241 patients, 170 (70.5%) had IPI and 71 (29.5%) had PPI. The most frequently observed extrapontine areas were cerebellar (59.1%), followed by posterior cerebral artery territory (45.1%). Mental status changes, sensory changes, and ataxia were more common, and motor dysfunction was less common in PPI patients. The PPI patients more often had rostral (P < 0.001), bilateral lesions (P < 0.001), and moderate/severe vascular stenosis and atrial fibrillation; therefore, large artery disease (LAD) and cardioembolism were more common stroke mechanisms (P < 0.001). In IPI patients, high initial National Institutes of Health Stroke Scale (NIHSS) (adjusted Odds ratio (OR) = 1.38; P = 0.001) and old age (aOR = 1.05; P = 0.049) were associated with poor functional outcome, whereas moderate/severe stenosis (Reference: no stenosis, aOR = 7.17; P = 0.014) and high initial NIHSS (aOR = 1.39; P = 0.006) were related to unfavorable outcomes in PPI patients. CONCLUSIONS: PPI patients more often had extensive pontine lesions, LAD and cardioembolism, and their outcome was more often influenced by underlying severe vascular diseases. These differences need to be considered in the prevention and therapeutic strategies.
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Infartos del Tronco Encefálico , Accidente Cerebrovascular , Infartos del Tronco Encefálico/complicaciones , Infartos del Tronco Encefálico/diagnóstico por imagen , Infartos del Tronco Encefálico/epidemiología , Constricción Patológica , Humanos , Infarto , Puente/diagnóstico por imagen , Puente/patología , Prevalencia , Accidente Cerebrovascular/patologíaRESUMEN
BACKGROUND: Carotid stenting has become an important treatment for carotid disease. Carotid sinus reaction (CSR), a complication which is not uncommon and affects the outcome of carotid stenting. We investigated the predictors of CSR, including blood pressure variability and heart rate variability (BPV and HRV, respectively). METHODS: We enrolled patients who underwent carotid stenting. CSR was defined as any episode of systolic blood pressure (SBP) <90 mm Hg or heart rate (HR) <60 beats/min after stent deployment or balloon inflation. BPV and HRV were measured before stent insertion and were represented by coefficient of variation (CoV) and SD. Multivariable logistic regression was performed to predict CSR. RESULTS: Among the 176 patients, 61 (34.7%) patients showed CSR. Blood pressure and HR were measured 14 times before carotid stenting on average. The risk of CSR was independently associated with the use of longer stent (odds ratio: 1.08, 95% confidence interval: 1.00-1.16, P = 0.042) and increased SBP SD (1.07 [1.00-1.14], P = 0.048). Moreover, when the SBP parameter changed to SBP CoV, total stent length (1.08 [1.00-1.16], P = 0.042) and SBP CoV (1.12 [1.02-1.23], P = 0.023) were associated with the occurrence of CSR. CONCLUSIONS: The use of a longer stent and increased SBP variability before carotid stent insertion were associated with the risk of CSR after carotid stenting. Underlying autonomic dysregulation may increase the risk of CSR during carotid stenting. SBP variability before carotid stenting might be considered a predictor of CSR.
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Seno Carotídeo , Stents , Presión Sanguínea/fisiología , Humanos , Oportunidad Relativa , Factores de RiesgoRESUMEN
OBJECTIVE: Chronic kidney disease (CKD) increases blood pressure variability (BPV) and affects stroke outcomes. However, the effect of BPV on early neurological deterioration (END) may be different according to the renal function. METHODS: We enrolled ischemic stroke patients with a National Institutes of Health Stroke Scale of ≤5. END was defined as worsening of ≥1 point in motor power or ≥2 points in total score. BPV was calculated with BP measured during the first 5 days and presented as standard deviation (SD) and coefficient of variation (CoV). Renal function was classified using the Kidney Disease Improving Global Outcomes (KDIGO) classification of CKD. Variables were compared between those with (KDIGO classification: moderate- to very-high-risk) and without renal impairment (KDIGO classification: low-risk) and factors associated with END were investigated. RESULTS: Among the 290 patients (136 [46.9%] renal impairment), END was observed in 59 (20.3%) patients. BPV parameters and the risk of END increased as renal function was impaired. Renal function and systolic BP (SBP) mean, SD, CoV, and diastolic BP (DBP) mean, SD were independently associated with END. We found no association between BPV parameters and END in normal renal function patients; however, among impaired renal function patients, SBP SD (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.09-1.32, P<0.001) and CoV (1.30 [1.12-1.50], P<0.001) were associated with END. CONCLUSIONS: The association between END and BPV parameters differs according to renal function in minor ischemic stroke; BPV was associated with END in patients with renal impairment, but less in those with normal renal function.