New Perspectives in Neuroprotection for Ischemic Stroke.

The constant failure of new neuroprotective therapies for ischemic stroke has partially halted the search for new therapies in recent years, mainly because of the high investment risk required to develop a new treatment for a complex pathology, such as stroke, with a narrow intervention window and associated comorbidities. However, owing to recent progress in understanding the stroke pathophysiology, improvement in patient care in stroke units, development of new imaging techniques, search for new biomarkers for early diagnosis, and increasingly widespread use of mechanical recanalization therapies, new opportunities have opened for the study of neuroprotection. This review summarizes the main protective agents currently in use, some of which are already in the clinical evaluation phase. It also includes an analysis of how recanalization therapies, new imaging techniques, and biomarkers have improved their efficacy.

Ecological implications of stomatal density and stomatal index in the adult stage of Mimosa L. (Leguminosae, Caesalpinioideae).

Differences in stomatal density (SD) and stomatal index (SI) are associated with the conditions of the environment in which they are distributed. Mimosa species are important elements in different plant communities, yet knowledge of the ecological implications of its stomatal characteristics is scarce. For this reason, SD and SI were determined in seven Mimosa species from different environments in this study. Five individuals per species were selected, and a sample of leaflets was obtained from each. Fifteen mature leaflets per individual were then extracted and observed by optical microscopy. SD, SI, epidermal cell density (ECD), and guard cell length (GCL) values were obtained. Differences between species were analyzed through a balanced analysis of variance test, and the correspondence between the stomatal characteristics and 21 climate variables was determined by canonical correspondence analysis. The species differed in all evaluated characteristics. It should be noted that only M. affinis showed differences between the leaflet surfaces. Both DE and ECD were negatively associated with altitude and solar radiation and positively with temperature and precipitation. SI was explained by temperature and seasonality of precipitation, and GCL by temperature oscillation and seasonality of precipitation. The results suggest that the stomatal characteristics of the leaflets confer resistance in the species to alterations in environmental conditions.

Intra- and extra-hospital improvement in ischemic stroke patients: influence of reperfusion therapy and molecular mechanisms.

Neuroprotective treatments in ischemic stroke are focused to reduce the pernicious effect of excitotoxicity, oxidative stress and inflammation. However, those cellular and molecular mechanisms may also have beneficial effects, especially during the late stages of the ischemic stroke. The objective of this study was to investigate the relationship between the clinical improvement of ischemic stroke patients and the time-dependent excitotoxicity and inflammation. We included 4295 ischemic stroke patients in a retrospective study. The main outcomes were intra and extra-hospital improvement. High glutamate and IL-6 levels at 24 hours were associated with a worse intra-hospital improvement (OR:0.993, 95%CI: 0.990-0.996 and OR:0.990, 95%CI: 0.985-0.995). High glutamate and IL-6 levels at 24 hours were associated with better extra-hospital improvement (OR:1.13 95%CI, 1.07-1.12 and OR:1.14, 95%CI, 1.09-1.18). Effective reperfusion after recanalization showed the best clinical outcome. However, the long term recovery is less marked in patients with an effective reperfusion. The variations of glutamate and IL6 levels in the first 24 hours clearly showed a relationship between the molecular components of the ischemic cascade and the clinical outcome of patients. Our findings suggest that the rapid reperfusion after recanalization treatment blocks the molecular response to ischemia that is associated with restorative processes.

Septoglomus mexicanum, a new species of arbuscular mycorrhizal fungi from semiarid regions in Mexico.

Septoglomus mexicanum is here described as a new species of arbuscular mycorrhizal fungi (AMF; Glomeromycota) based on morphological and phylogenetic analyses. It was isolated from rhizospheric soil of two endemic Mexican legumes: Prosopis laevigata and Mimosa luisana, which grow in semiarid regions of central Mexico. Septoglomus mexicanum is characterized by forming globose spores of (154.5-)202.8(-228.9) µm diam and a spore wall consisting of four layers (SWL1-SWL4): outer wall layer (SWL1) hyaline, evanescent, (1.7-)3.2(-4.3) µm thick; SWL2 laminate and smooth, orange to reddish orange, (3.1-)4.5(-6.1) µm thick; SWL3 laminate, smooth, reddish orange to reddish brown, (4.1-)5.1(-5.7) µm thick; and SWL4 hyaline, semiflexible, (0.93-)1.2(-1.4) µm thick. None of the spore wall layers stain with Melzer's reagent. The subtending hypha has a color from yellowish to golden and presents a septum on spore base. Septoglomus mexicanum can be distinguished from all other Septoglomus species by spore size and color, by spore wall structure (four layers), and by color change of the subtending hypha. Phylogenetic analysis based on the AMF extended DNA barcode covering a 1.5-kb fragment of the small subunit (SSU), internal transcribed spacer region (ITS1-5.8S-ITS2), and the large subunit (LSU) of rRNA genes places S. mexicanum in the genus Septoglomus, separated from other described Septoglomus species, especially S. turnauae, with whom it could be confused morphologically. All available sequences in public databases suggest that this new fungal species has not yet been previously detected. Thus, there are currently 149 Glomeromycota species registered in Mexico, representing 47.4% of the known species worldwide.

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis.

Identifying the complexities of the effect of sex on stroke risk, etiology, and lesion progression may lead to advances in the treatment and care of ischemic stroke (IS) and non-traumatic intracerebral hemorrhage patients (ICH). We studied the sex-related discrepancies on the clinical course of patients with IS and ICH, and we also evaluated possible molecular mechanisms involved. The study's main variable was the patient's functional outcome at 3-months. Logistic regression models were used in order to study the influence of sex on different inflammatory, endothelial and atrial dysfunction markers. We recruited 5,021 patients; 4,060 IS (54.8% male, 45.2% female) and 961 ICH (57.1% male, 42.9% female). Women were on average 5.7 years older than men (6.4 years in IS, 5.1 years in ICH), and more likely to have previous poor functional status, to suffer atrial fibrillation and to be on anticoagulants. IS patients showed sex-related differences at 3-months regarding poorer outcome (55.6% women, 43.6% men, p < 0.0001), but this relationship was not found in ICH (56.8% vs. 61.9%, p = 0.127). In IS, women had higher levels of NT-proBNP and 3-months worse outcome in both cardioembolic and non-cardioembolic stroke patients. Stroke patients showed sex-related differences in pre-hospital data, clinical variables and molecular markers, but only IS patients presented independent sex-related differences in 3-months poor outcome and mortality. There was a relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, resulting in a possible indicator of increased dysfunction.

Periodontitis as a risk indicator and predictor of poor outcome for lacunar infarct.

AIM: To investigate the association between periodontitis (PD) and lacunar infarct (LI) as well as to analyse whether PD could be a predictor of poor functional prognosis in patients with LI. MATERIAL AND METHODS: Full-mouth periodontal examination was done in 120 cases (patients with LI) and 157 healthy controls. Demographic, clinical, medical and neurological information were collected from all of them. In addition, a measure of periodontal inflammation and disease activity, namely the periodontal inflamed surface area (PISA), was also calculated for each patient. Poor functional outcome was considered as a modified Rankin Scale >2 at 3 months. RESULTS: PD was independently associated with the presence of LI (OR = 3.3, p < 0.001). Poor outcome was observed in 31 patients with LI (25.8%), of which 90.3% had PD. A PISA value ≥727 mm2 was an independent predictor of poor prognosis, after adjusting for clinical confounders (OR = 6.5, p = 0.001). CONCLUSIONS: PD and LI were associated. Active moderate to severe PD predicted poor prognosis in patients with LI. Further evidence is warranted to confirm our results and investigate potential mechanisms behind this association.

Periodontitis is associated with systemic inflammation and vascular endothelial dysfunction in patients with lacunar infarct.

BACKGROUND: Periodontitis has been associated with lacunar infarct (LI), a type of cerebral small vessel disease. The objective of this study was to ascertain whether periodontitis is associated with increased circulating levels of systemic inflammation and endothelial dysfunction biomarkers in patients with LI. METHODS: One hundred twenty patients with LI and 120 healthy controls underwent a full-mouth periodontal examination. The periodontal inflamed surface area (PISA) was calculated for each participant. Demographic, medical, and neurological information were recorded from all of them. In addition, blood samples were collected in order to investigate differences in terms of interleukin (IL)-6, IL-10, pentraxin (PTX) 3, soluble fragment of tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and amyloid-beta (Aß) peptides (i.e., Aß1-40 , and Aß1-42 ) measured in serum. RESULTS: Periodontitis was independently associated with increased levels of IL-6 (R2  = 0.656, P < 0.001), PTX3 (R2  = 0.115, P < 0.001), sTWEAK (R2  = 0.527, P < 0.001), and Aß1-40 (R2  = 0.467, P < 0.001) in patients with LI. Within patients with poor outcome, PISA positively correlated with IL-6 (r = 0.738, P < 0.001), PTX3 (r = 0.468, P = 0.008), sTWEAK (r = 0.771, P < 0.001), and Aß1-40 (r = 0.745, P < 0.001). CONCLUSIONS: Our data suggest a link between periodontitis, systemic inflammatory response, and disruption of the vascular endothelial function in patients with LI. Experimental studies are needed to elucidate possible pathways through which periodontitis could lead to this systemic inflammatory state with impairment of the endothelial function in LI. Further longitudinal studies with large samples are warranted to confirm our findings.

Effects of a food enriched with probiotics on Streptococcus mutans and Lactobacillus spp. salivary counts in preschool children: a cluster randomized trial.

Probiotics have provided benefits to general health, but they are still insufficient to dental health. This study aimed to evaluate milk supplemented with probiotic bacteria and standard milk, measured by levels of Streptococcus mutans (S. mutans) and Lactobacillus spp., in 3-4-year-old children after 9 months of intervention. The study was a triple-blind, placebo-controlled, randomized trial. The sample was composed of 363 preschoolers attending five child development centers in Cali, Colombia. They were randomized to two groups: children in the intervention group drank 200 mL of milk with Lactobacillus rhamnosus 5x106 and Bifidobacteruim longum 3x106, and children in the control group drank 200 mL of standard milk. Interventions occurred on weekdays and information was gathered through scheduled clinical examination. The primary result was the number of colony forming units (CFU) of S. mutans and Lactobacillus spp. in the saliva. Secondary results were dental caries, rated by the International Caries Detection and Assessment System (ICDAS), dental plaque, pH, and salivary buffer capacity. The proportion of S. mutans was lower in the intervention group compared with the control group after 9 months; however, the differences did not reach statistical significance (p=0.173); on the other hand, statistically significant differences between groups were found in the CFU/mL of Lactobacillus spp. (p=0.002). There was not statistically significant difference in the prevalence of dental caries for both groups (p=0.767). Differences between groups were found in the salivary buffering capacity (p=0.000); neither salivary pH nor dental plaque were significantly different. Regular consumption of milk containing probiotics bacteria reduced CFU/mL of Lactobacillus spp. and increased salivary buffering capacity at 9 months of consumption.

Gestión social del conocimiento y análisis prospectivo de su incidencia en la universidad contemporánea / Social management of knowledge and prospective analysis of its incidence in the contemporary university

La gestión del conocimiento es una de las funciones sustantivas de las instituciones de la educación superior, es la misión social, la razón de ser que tienen las diferentes instituciones, por medio de la cual logran difundir sus conocimientos y contribuir con el desarrollo socio productivo y cultural de la colectividad. El propósito del presente artículo es analizar la necesidad de la endogenización de las funciones sustantivas; la gestión del conocimiento, la academia y la investigación, en relación con la gestión del conocimiento dentro de las universidades. El vínculo universidad-sociedad, es uno de los puntos que demuestran la pertinencia de la gestión del conocimiento, al incidir de manera positiva en el desarrollo socio-económico del país y en el logro del bienestar humano establecido dentro del Plan del Buen Vivir, al poner en práctica la inclusión, socialización y democratización de la educación

Knowledge management is one of the substantive roles of the higher education institutions, it is the social mission, the reason for the existence of the different institutions through which the spread of knowledge and contribution to the social, productive and cultural development of the community are achieved. The purpose of the present work is to analyze the need of endogenization of substantive roles such as knowledge management, the academy and the research in relation to the relevance of knowledge management in universities. The university-society link is one of the points that shows the knowledge management relevance that positively influences on the country's social and economic development and reaches the welfare of the human being established in the Good Living Plan, as it implements inclusion, socialization as well as democratization of education

Acciones estratégicas para la integración endógena de las funciones sustantivas universitarias desde la gestión del conocimiento / Strategic tasks for the endogenous integrality of the university substantive functions from the knowledge management

La integración de las funciones sustantivas de las universidades deviene un reto actualmente y la gestión del conocimiento constituye la misión social, la razón de ser de los diferentes centros de altos estudios, por medio de la cual logran difundir sus saberes y experiencias, así como contribuir al desarrollo socioproductivo y cultural de la colectividad. En el presente artículo se proponen acciones necesarias para endogenizar las funciones sustantivas universitarias desde ese tipo de gestión, a partir de la aplicación de métodos empíricos que permitieron conocer los criterios de educandos y docentes en relación con el problema objeto de esta investigación y revelaron a través de los resultados obtenidos,la fragmentación de los procesos sustantivos universitarios que ha estado limitando la producción del conocimiento científico en las instituciones de educación superior

The integration of the substantive functions of the universities becomes a challenge at present and the knowledge management constitutes the social mission, the reason of the different high studies institutions, by means of which they are able to diffuse their knowledge and experiences, as well as to contribute to the social, productive and cultural development of the collectivity. In this work, necessary tasks for endogenize the university substantive functions from that type of management are proposed, with the use of empiric methods that allowed to know the students and teaching staff criteria related to the object of this investigation, and they revealed through the results obtained, the fragmentation of the university substantive processes which have been limiting the production of the scientific knowledge in the higher education institutions

Distribución conocida y potencial de dos taxa del género Mimosa (Leguminosae) endémicos de México / Present and potential distribution of two Mimosa (Leguminosae) taxa endemic to Mexico

Resumen Mimosa aculeaticarpa var. aculeaticarpa y M. luisana son endémicas de México y consideradas plantas multipropósito, ya que ofrecen diversos servicios a los ecosistemas y pobladores en donde se establecen. Además, son valoradas por su potencial como restauradoras de ambientes tropicales, por lo que el objetivo de este estudio fue modelar su distribución conocida y potencial. En el año 2014, se obtuvieron registros de dos bases de datos (CONABIO y MEXU); cada resgistro fue validado taxonómica, geográfica y estadísticamente, una vez validados, se obtuvo la distribución conocida y potencial para M. aculeaticarpa var. aculeaticarpa (basada en 99 registros) y M. luisana (basada en 50 registros), utilizando el algoritmo MAXENT. La distribución conocida de ambos taxa se sobreposicionó en las capas de: elevación, clima, suelo, provincias biogeográficas y cuencas hidrológicas. Mimosa aculeaticarpa var. aculeaticarpa presenta amplia distribución en México (16 estados); mientras que M. luisana se encuentra restringida a los estados de Puebla y Oaxaca. M. aculeaticarpa var. aculeaticarpa se establece entre 1 900 y 2 700 msnm y M. luisana entre 500 y 1 760 msnm. Ambas se encuentran en climas áridos y semiáridos; sin embargo, M. aculeaticarpa var. aculeaticarpa también se puede encontrar en climas templados y mésicos. Asimismo, ambos taxa se distribuyen en suelos de tipo regosol calcárico; aunque, M. aculeaticarpa var. aculeaticarpatambién está en regosol éutrico, vertisol crómico y feozem háplico. La distribución de M. aculeaticarpa var. aculeaticarpa abarca ocho provincias biogeográficas y tres cuencas hidrológicas; mientras que M. luisana se localiza en tres provincias y dos cuencas; ambas coinciden en las provincias del Eje Volcánico y la Sierra Madre del Sur. Los modelos de distribución potencial se consideran excelentes, ya que poseen un AUC de 0.91 y 0.97, respectivamente. Los modelos indican que las condiciones de temperatura y precipitación son propicias para que ambos taxa pudieran ampliar su distribución. Igualmente, los modelos generados pueden considerarse como una aproximación al conocimiento de la distribución potencial de las mimosas mexicanas. Aunque, es importante considerar que los modelos son estáticos y no consideran a las interacciones bióticas, por lo que su relación con la realidad puede variar; por lo que se recomienda analizar los modelos mediante diferentes escenarios de cambio climático y de uso de suelo.

Abstract Mimosa aculeaticarpa var. aculeaticarpa and M. luisana are endemic to Mexico, and are considered as multipurpose plants, due to the diverse services they offer to ecosystems and to local people. Additionally, they are appreciated for their potential to restore tropical environments; hence, the objective of this study was to model the present and potential distribution of these taxa. In 2014, species registers were obtained from two databases (CONABIO and MEXU); each register was taxonomically, geographically and statistically validated. Once validated, the present and potential distribution of M. aculeaticarpa var. aculeaticarpa (based on 99 registers) and M. luisana (based on 50 registers) were obtained using the MAXENT algorithm. For both taxa, the present distribution was overlapped using the layers of: elevation, climate, soil, biogeographic provinces, and hydrologic basins. Mimosa aculeaticarpa var. aculeaticarpa showed a wide distribution in Mexico (16 states); whilst M. luisana was restricted to the states of Puebla and Oaxaca. M. aculeaticarpa var. aculeaticarpa establishes between 1 900 and 2 700 masl, and M. luisana between 500 and 1 760 masl. Both species were established in arid and semiarid climates; however, M. aculeaticarpa var. aculeaticarpa can also be found in temperate and mesic climates. Moreover, both taxa are distributed in calcareous regosol soils; although, M. aculeaticarpa var. aculeaticarpa is also found in eutric regosol, chromic vertisol and haplic phaeozem. The distribution of M. aculeaticarpa var. aculeaticarpa includes eight biogeographic provinces and three hydrologic basins; whilst M. luisana was only located in three provinces and two hydrologic basins; both are present in the Eje Volcánico and Sierra Madre del Sur provinces. The potential distribution models are considered as excellent ones due to an AUC of 0.91 and 0.97, respectively; these models indicated that the temperature and precipitation conditions would be suitable for the enlargement of their distribution. Likewise, these models can be considered an approach to the potential distribution knowlegment of the Mexican mimosas. Nevertheless, it is important to note that the models are static and do not take into account any biotic interaction; therefore, their relationship with reality can vary. Thus, it is recommended to analyze the models through different climate change and land use scenarios. Rev. Biol. Trop. 66(1): 321-335. Epub 2018 March 01.

Generation and characterization of the human iPSC line IDISi001-A isolated from blood cells of a CADASIL patient carrying a NOTCH3 mutation.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary stroke disorder. It is caused by mutations in NOTCH3 that lead to progressive degeneration of the smooth muscle cells in blood vessels. There is currently no treatment for this disorder. We reprogrammed to pluripotency blood mononuclear cells isolated from a patient carrying a NOTCH3 mutation by using a commercially available non-integrating system. The success in the generation of this iPSC line (IDISi001-A) suggests that the NOTCH3 mutation did not limit cell reprogramming and offers an unprecedented opportunity for studying and modeling CADASIL pathology.

Worse Outcome in Stroke Patients Treated with rt-PA Without Early Reperfusion: Associated Factors.

Based on preclinical studies suggesting that recombinant tissue plasminogen activator (rt-PA) may promote ischemic brain injuries, we investigated in patients the possible risk of worse clinical outcome after rt-PA treatment as a result of its inability to resolve cerebral ischemia. Here, we designed a cohort study using a retrospective analysis of patients who received treatment with intravenous (4.5-h window) or intraarterial rt-PA, without or with thrombectomy. Controls were consecutive patients who did not receive recanalization treatment, who met all inclusion criteria. As a marker of reperfusion, we defined the variable of early neurological improvement as the difference between the score of the National Institute of Health Stroke Scale (NIHSS) (at admission and 24 h). The main variable was worsening of the patient's functional situation in the first 3 months. To compare quantitative variables, we used Student's t test or the Mann-Whitney test. To estimate the odds ratios of each independent variable in the patient's worsening in the first 3 months, we used a logistic regression model. We included 1154 patients; 577 received rt-PA, and 577 served as controls. In the group of patients treated with rt-PA, 39.4% who did not present clinical reperfusion data developed worsening within 3 months after stroke compared with 3.5% of patients with reperfusion (P < 0.0001). These differences were not significant in the control group. In summary, administration of rt-PA intravenously or intraarterially without reperfusion within the first 24 h may be associated with a higher risk of functional deterioration in the first 3 months.

Effects of a food enriched with probiotics on Streptococcus mutans and Lactobacillus spp. salivary counts in preschool children: a cluster randomized trial

Abstract Probiotics have provided benefits to general health, but they are still insufficient to dental health. Objective: This study aimed to evaluate milk supplemented with probiotic bacteria and standard milk, measured by levels of Streptococcus mutans (S. mutans) and Lactobacillus spp., in 3-4-year-old children after 9 months of intervention. Material and Methods: The study was a triple-blind, placebo-controlled, randomized trial. The sample was composed of 363 preschoolers attending five child development centers in Cali, Colombia. They were randomized to two groups: children in the intervention group drank 200 mL of milk with Lactobacillus rhamnosus 5x106 and Bifidobacteruim longum 3x106, and children in the control group drank 200 mL of standard milk. Interventions occurred on weekdays and information was gathered through scheduled clinical examination. The primary result was the number of colony forming units (CFU) of S. mutans and Lactobacillus spp. in the saliva. Secondary results were dental caries, rated by the International Caries Detection and Assessment System (ICDAS), dental plaque, pH, and salivary buffer capacity. Results: The proportion of S. mutans was lower in the intervention group compared with the control group after 9 months; however, the differences did not reach statistical significance (p=0.173); on the other hand, statistically significant differences between groups were found in the CFU/mL of Lactobacillus spp. (p=0.002). There was not statistically significant difference in the prevalence of dental caries for both groups (p=0.767). Differences between groups were found in the salivary buffering capacity (p=0.000); neither salivary pH nor dental plaque were significantly different. Conclusions: Regular consumption of milk containing probiotics bacteria reduced CFU/mL of Lactobacillus spp. and increased salivary buffering capacity at 9 months of consumption.

Heads and Tails of Natriuretic Peptides: Neuroprotective Role of Brain Natriuretic Peptide.

BACKGROUND: Besides the relevant role of brain-type natriuretic peptide (BNP) as biomarker of cardioembolic strokes, new experimental evidences suggest that this peptide may mediate neuroprotective effects. In this study, we have evaluated for the first time the clinical association between BNP (by means of proBNP) and good outcome in ischemic stroke patients, and analyzed the effect of blood BNP increase in an ischemic animal model. METHODS AND RESULTS: A retrospective study with 2 different cohorts (262 patients in cohort I and 610 in cohort II) from the same prospective stroke registry was performed. proBNP concentration was analyzed within the first 12 hours from stroke onset. The primary predictor variable was functional outcome evaluated by modified Rankin Scale at 3 months. For the experimental study, BNP pretreatment was tested in an ischemic animal model subjected to a transient occlusion of the cerebral artery, and the infarct volume and sensorimotor deficit were evaluated for 14 days. Cardioembolic strokes presented a positive correlation between proBNP concentration and modified Rankin Scale at 3 months; however, noncardioembolic strokes presented a negative correlation. In the logistic regression analysis, noncardioembolic strokes with concentrations of proBNP ≥340 pg/mL were associated with a good outcome. In line with these clinical findings, the experimental study revealed that those BNP pretreated animals presented a reduction on infarct volumes at 24 hours and functional recovery at days 7 and 14 compared with the control groups. CONCLUSIONS: These clinical and experimental evidences support the potential role of BNP as a protective factor against cerebral ischemia.

Increased expression of Toll-like receptors 2 and 4 is associated with poor outcome in intracerebral hemorrhage.

Inflammatory response in intracerebral hemorrhage (ICH) is associated with poor outcome and could be a consequence of Toll-like receptor (TLR) activation. We investigated the influence of TLR2 and TLR4 expression on the outcome of ICH patients. Expression levels of TLR2 and TLR4 in monocytes at admission were independently associated with poor functional outcome. On the other hand, TLR2 and TLR4 expression at admission in both monocytes and neutrophils was independently associated with residual lesion volume. In conclusion, increased expression of TLR2 and TLR4 is associated with poor functional outcome and greater residual volume in ICH patients.

Neuroprotection or increased brain damage mediated by temperature in stroke is time dependent.

The control of temperature during the acute phase of stroke may be a new therapeutic target that can be applied in all stroke patients, however therapeutic window or timecourse of the temperature effect is not well established. Our aim is to study the association between changes in body temperature in the first 72 hours and outcome in patients with ischemic (IS) and hemorrhagic (ICH) stroke. We prospectively studied 2931 consecutive patients (2468 with IS and 463 with ICH). Temperature was obtained at admission, and at 24, 48 and 72 hours after admission. Temperature was categorized as low (<36°C), normal (36-37°C) and high (>37°C). As the main variable, we studied functional outcome at 3 months determined by modified Rankin Scale.Temperature in stroke patients is higher than in controls, and increases gradually in the first 72 hours after stroke. A positive correlation between temperature and stroke severity determined by NIHSS was found at 24 and 48 hours, but not at admission or 72 hours. In a logistic regression model, high temperature was associated with poor outcome at 24 hours (OR 2.05, 95% CI 1.59-2.64, p<0.0001) and 48 hours (OR 1.93, 95% CI 1.08-2.34, p = 0.007), but not at admission or 72 hours.Temperature increases in patients with stroke in the first 72 hours, with the harmful effect of high temperature occurring in the first 48 hours. The neuroprotective effect of low temperature occurs within the first 24 hours from stroke onset.

Primary malignant meningeal melanomatosis: a clinical, radiological and pathologic case study.

A 40 year-old woman with subacute headache and visual impairment was admitted. Neurological examination revealed meningismus, diminished visual acuity, bilateral sixth cranial nerve palsy, and papillary edema. Dermatologic examination was normal. The brain CT scan showed hydrocephalus and hyperdense edging around fissures and sulci. The CSF study showed an increased protein level, with persistently negative microbiologic and cytological studies. Prior to Gd-DPTA injection, the brain T1-WI MRI revealed leptomeningeal hyperintensity. A dark subpial substance became evident at cerebral biopsy. The histopatological diagnosis was diffuse leptomeningeal melanomatosis. This case report highlights the diagnostic value of the brain MRI findings in primary leptomeningeal melanomatosis, a rare pathologic condition diagnosed in most published cases only after necropsy. Meningeal T1-WI hyperintensity prior to contrast injection is not caused by sarcoidosis or meningeal carcinomatosis, lymphomatosis or gliomatosis.

Early biomarkers of clinical-diffusion mismatch in acute ischemic stroke.

BACKGROUND AND PURPOSE: Clinical-diffusion mismatch (CDM; National Institutes of Health Stroke Scale score≥8 and diffusion-weighted imaging lesion volume<25 mL) has been suggested as a surrogate of ischemic brain at risk of infarction and might be used to recognize salvageable ischemic tissue. Our aim was to identify early biomarkers associated with the presence of CDM. METHODS: We prospectively evaluated CDM in 226 patients (71.6±11.1 years, 58% men) with hemispheric ischemic stroke within 12 hours from symptom onset (median, 3.6 hours). Diffusion-weighted MRI lesion volume was measured by manual segmentation method. Serum levels of glutamate, aspartate, interleukin-10, tumor necrosis factor-α, interleukin-6, S100ß, neuron-specific enolase, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, active matrix metalloproteinase-9, and cellular fibronectin were determined by immunoassay or high-performance liquid chromatography techniques in blood samples obtained at admission. RESULTS: CDM was found in 61 patients (26.9%). Patients with CDM had higher serum levels of interleukin-10, tumor necrosis factor-α, and glutamate and lower serum levels of neuron-specific enolase, interleukin-6, and active matrix metalloproteinase-9 (all P<0.0001). Binary logistic regression showed that tumor necrosis factor-α≥21 pg/mL (OR, 21), glutamate≥230 µmol/L (OR, 27), neuron-specific enolase≥23 ng/mL (OR, 0.05), interleukin-6≥10 pg/mL (OR, 0.06), and active matrix metalloproteinase-9≥21 ng/mL (OR, 0.28) were independent molecular predictors of CDM after adjustment for covariates. The association of interleukin-10≥23 pg/mL and glutamate≥230 µmol/L levels predicted CDM with a sensitivity of 96% and a specificity of 98%. CONCLUSIONS: High levels of interleukin-10, tumor necrosis factor-α, and glutamate as well as low levels of neuron-specific enolase, interleukin-6, and active matrix metalloproteinase-9 are associated with CDM.