Inflammation in multiple system atrophy.

Misfolding protein aggregation inside or outside cells is the major pathological hallmark of several neurodegenerative diseases. Among proteinopathies are neurodegenerative diseases with atypical Parkinsonism and an accumulation of insoluble fibrillary alpha-synuclein (synucleinopathies) or hyperphosphorylated tau protein fragments (tauopathies). As there are no therapies available to slow or halt the progression of these disea ses, targeting the inflammatory process is a promising approach. The inflammatory biomarkers could also help in the differential diagnosis of Parkinsonian syndromes. Here, we review inflammation's role in multiple systems atrophy pathogenesis, diagnosis, and treatment.

Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Detection in Acute Ischemic Stroke Patients.

(1) Background: AliveCor KardiaMobile (KM) is a portable electrocardiography recorder for detection of atrial fibrillation (AF). The aim of the study was to define the group of acute ischemic stroke (AIS) patients who can use the KM device and assess the diagnostic test accuracy. (2) Methods: the AIS patients were recruited to the study. Thirty-second single-lead electrocardiogram (ECG) usages were recorded on demand for three days using KM portable device. Each KM ECG record was verified by a cardiologist. The feasibility was evaluated using operationalization criteria. (3) Results: the recruitment rate among AIS patients was 26.3%. The withdrawal rate before the start of the intervention was 26%. The withdrawal rate after the start of the intervention was 6%. KM device detected AF in 2.8% of AIS patients and in 2.2% of ECG records. Cardiologist confirmed the AF in 0.3% AIS patients. Sensitivity and specificity of KM for AF was 100% and 98.3%, respectively. (4) Conclusions: the results of this study suggest that it is feasible to use KM device to detect AF in the selected AIS patients (younger and in better neurological condition). KM detected AF in the selected AIS patients with high specificity and sensitivity.

Carotid artery intima-media thickness in adults receiving long-term home parenteral nutrition.

BACKGROUND AND AIMS: Nutrition regimen in parenteral nutrition (PN) patients allows for a control of diet components. This may affect the process of lipid deposition in the vascular wall and change the risk of atherosclerosis. This study aims to examine the effect of long-term PN in adults on carotid intima-media thickness. METHODS AND RESULTS: Thirty long-term PN patients (15 men and 15 women, mean age 64.7 ± 8.5 years) and thirty healthy volunteers (HV) (15 men and 15 women, mean age 64.9 ± 8.77 years) entered the study. Total amino acid and lipid formulation intake as well as duration of PN were calculated for PN patients. The common carotid artery intima-media thickness (CCA IMT) was examined in both groups. A lower CCA IMT (right/left mean: PN - 776 ± 121 vs HV - 848 ± 121 µm, p < 0.05; right/left maximum CCA IMT: PN - 935 ± 139 vs HV - 1024 ± 135 µm, p < 0.05) in PN patients was observed. A lower serum level of total (PN - 131.43 ± 43.12 vs HV - 209.2 ± 48.01 mg/dl, p < 0.05) and HDL (PN- 44.16 ± 12.45 vs HV - 72.57 ± 25.04 mg/dl, p < 0.05) cholesterol was reported in the PN patients. A correlation between patients' age and CCA IMT was observed in the control group, but not in the PN patients (right/left mean CCA IMT - PN: r = 0.48, p-0.007 vs HV: p-0.073; right/left maximum CCA IMT - PN: r = 0.48, p-0.008, vs HV: p-0.073). CONCLUSIONS: Long term PN in adults is associated with lower CCA IMT. Long-term PN patients are a unique group in which carotid intima-media thickness does not correlate with the age.

Pentosidine, advanced glycation end product, in acute ischaemic stroke patients with and without atrial rhythm disturbances.

Atrial fibrillation (AF) and atherosclerotic disease are independent risk factors for acute ischaemic stroke (AIS). The optimal biological marker which could allow differentiation between AF and non-AF AIS patients is still not available. AIM OF THE STUDY: Aim of the present study was to investigate the role of pentosidine as a potential biological marker for AF in an AIS patient group. MATERIALS AND METHODS: Sixty-three acute ischaemic hemispheric stroke patients were recruited and divided into two groups according to the presumed underlying mechanism: with or without atrial rhythm disorders. Ten healthy volunteers were a reference group for serum level of pentosidine. Carotid artery ultrasound was performed, and common carotid artery stiffness and intima-media thickness were measured. Serum levels of pentosidine and selected routine biochemical risk factors for atherosclerosis (cholesterol and its lipoprotein fractions, homocysteine) were examined. RESULTS: A higher serum level of pentosidine was observed in patients without atrial fibrillation (1,509 ± 485.13pmol/ml); a statistically significant difference was observed compared to the reference group (1,041.52 ± 411.17pmol/ml; p = 0.01), but not the AF patients (1,438.19 ± 495.97pmol/ml; p = 0.59). No significant difference in the non-AF group compared to the AF group for carotid intima-media thickness (IMT)/stiffness and pentosidine serum level was recorded. CONCLUSIONS AND CLINICAL IMPLICATIONS: A higher serum level of pentosidine was observed in AIS patients without atrial fibrillation compared to the healthy volunteers. According to the results of the present study, no difference between these patients in the selected risk factors of atherosclerosis were observed. Further studies are needed to identify a reliable marker of AF that would bring added value to the standard diagnostic workup after acute ischaemic stroke.

Syncope and autonomic cardiovascular dysfunction in Parkinson disease.

BACKGROUND AND PURPOSE: The aim of the study was to investigate the relationship between syncope or presyncope occurrence and dysfunction of the cardiovascular autonomic system in patients with Parkinson disease (PD). MATERIAL AND METHODS: Twenty-four PD patients were studied, including 10 subjects with syncope/presyncope and 14 con-trols without those symptoms. Ambulatory blood pressure monitoring (ABPM), Holter electrocardiographic monitoring, carotid sinus massage, tilt test, and cardiac scintigraphy with 123I metaiodobenzylguanidine (MIBG) were performed. RESULTS: Differences between the two groups were found in myocardial scintigraphy and ABPM. The stepwise regression analyses suggest that the values of late phase reduced uptake of MIBG (95% CI: 0.0-0.77; p < 0.05) and day-time minimum systolic blood pressure (95% CI: 0.78-0.98; p = 0.007) may be related to the occurrence of syncope/presyncope. CONCLUSIONS: The findings suggest an association between syncope/presyncope occurrence and dysfunction of the cardiovascular autonomic system in PD patients. Both 123I MIBG myocardial scintigraphy and ABPM may help identify a group of patients with an elevated risk for syncopic episodes which, in turn, may affect the choice of treatment.

[123I-metaiodobenzylguanidine myocardial scintigraphy in the differential diagnosis of patients with parkinsonian syndromes -- case reports]. / Zastosowanie scyntygrafii serca z uzyciem 123I-metajodobenzyloguanidyny w diagnostyce zespolów parkinsonowskich -- opis przypadków.

The aim of this study is to present a clinical role for 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in the differential diagnosis in patients with parkinsonian syndromes. We present a 51-year-old woman with parkinsonian syndrome and syncope occurrence. She reproduced spontaneous syncope in the tilt test. We present also a 60-year-old man with parkinsonian syndrome and syncope and presyncope occurrence. He also reproduced spontaneous syncope in the tilt test. Cardiac 123I-MIBG scintigraphy was performed in both patients. In the former patient, the H/M ratio of MIBG uptake was within normal ranges, in the latter, it was abnormally impaired. The results of the 123I-MIBG cardiac scintigraphy confirm results of the other studies. In the patient with Parkinson's disease the H/M ratio of MIBG uptake was abnormally impaired. The patient with the multiple system atrophy was within normal ranges.