Plasma miR-124-3p and miR-16 concentrations as prognostic markers in acute stroke.

OBJECTIVES: This study aimed to investigate plasma concentrations of miR-124-3p and miR-16 as prognostic markers in emergency department patients with acute stroke. DESIGN AND METHODS: Plasma concentrations of miR-124-3p and miR-16 of 84 stroke patients (presenting to the emergency department within 24h from onset of symptoms) were determined by RT-qPCR. The primary outcome measure was 3-month mortality and the secondary outcome measure was post-stroke modified Rankin Score (mRS). RESULTS: Twelve patients (14.3%) died within 3months of hospital admission and forty-one (48.8%) patients as achieved a 3-month mRS>2. Median plasma miR-124-3p concentrations were elevated in patients who died compared to patients who survived (p=0.0052), and its levels were found to be higher in patients with a 3-month mRS>2 compared with patients with mRS≤2 (p=0.0312). Higher plasma miR-16 concentrations were observed in patients who survived than in patients who died (p=0.0394), while its concentrations were lower in patients achieving mRS>2 than in patients with mRS≤2 (p=0.0124). For a subgroup of cases presenting to the emergency department within 6h from time of symptom onset (n=36), plasma miR-124-3p concentrations predicted 3-month mortality with an area under the ROC curve of 0.87 (95%CI: 0.72-0.96). CONCLUSIONS: Plasma miR-124-3p and miR-16 are molecular markers which could be useful for the early prediction of mortality and mRS.

Comparison of miR-124-3p and miR-16 for early diagnosis of hemorrhagic and ischemic stroke.

BACKGROUND: The present study aimed to investigate and compare plasma concentrations of miR-124-3p and miR-16 as diagnostic markers in acute stroke. METHODS: miR-124-3p and miR-16 concentrations in 93 stroke patients were analyzed using real-time polymerase chain reaction. The primary outcome was the differentiation of hemorrhagic and ischemic stroke. RESULTS: Of 93 patients, 74 (79.6%) were diagnosed as ischemic stroke (IS) and 19 (20.4%) were diagnosed as hemorrhagic stroke (HS). Median plasma 124-3p concentrations taken within 24h of symptom onset were higher in HS patients than that in IS patients (3.8×10(5) vs 2.0×10(5) copies/ml plasma, p=0.0109), while median miR-16 concentration in IS patients were higher than that in HS patients (1.6×10(9) vs 1.3×10(9) copies/ml plasma, p=0.0399). The odds ratio (OR) for discriminating HS and IS with miR-124-3p and miR-16 was 5.37 and 9.75 respectively. CONCLUSION: Both miR-124-3p and miR-16 are diagnostic markers to discriminate HS and IS.

Computed tomographic angiography for patients with acute spontaneous intracerebral hemorrhage.

With the advanced technology of multi-slice CT scans, we explored the effectiveness of CT angiography (CTA) in place of digital subtraction angiography (DSA) in patients with acute spontaneous intracerebral hemorrhage (ICH). We performed a computerized PubMed search of the literature from inception to 27 July 2011 to find reports of similar comparative studies and performed a meta-analysis of diagnostic accuracy. The pooled sensitivity was 97.0% (95% confidence interval [CI]: 93.2-99.1%), specificity was 98.9% (95% CI: 97.0-99.7%), accuracy was 98.2% (95% CI: 96.6-99.2%), positive predictive value was 97.8% (95% CI: 94.2-99.5%) and negative predictive value was 98.5% (95% CI: 96.6-99.5%). The false negative rate was 1% (95% CI: 0.4-2.6%). We concluded that CTA with venography could replace DSA as the initial vascular investigation in patients presenting with spontaneous ICH during the acute phase. Future studies should focus on whether refinement of the techniques could preclude the false negative results.

Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong.

OBJECTIVES: (1) To review the patient profile, management outcome and prognostic factors of brain abscess; (2) To compare the neurological outcome of nasopharyngeal carcinoma (NPC)-related brain abscess with non-NPC related brain abscess. METHOD: Retrospective review of consecutive patients diagnosed (radiologically and/or microbiologically) with brain abscess in a regional neurosurgical center in Hong Kong over a nine year period. RESULTS: Fifty-four patients were recruited into this study. There were 37 male and 17 female patients. Eighteen (33%) patients had previous radiotherapy for nasopharyngeal carcinoma. Only 31 (57%) patients had fever on presentation. White cell count and/or C-reactive protein, was raised in 41 (76%) patients on admission. Surgical drainage was carried out in 49 (91%) patients, either by aspiration through a craniotomy, by drainage with corticotomy, or excision of the abscess. Abscess culture was positive in 45 (83%) patients. Common organisms isolated included Streptococcus species (35%) and Peptostreptococcus species (18%). Anaerobes were isolated in 50% of the NPC-related abscesses. The mean follow-up time was 34 months. At the 6 months interval, 24 (44%) patients had good recovery. Favorable outcome was achieved in 30 (55%) patients. NPC-related brain abscess was associated with unfavorable neurological outcome (33%, p = 0.04). There was also a trend towards higher in-patient mortality in patients with NPC-related brain abscess (22%, p = 0.08). CONCLUSION: Brain abscess carried a substantial morbidity and mortality despite aggressive surgical and medical treatment. Patients with NPC-related brain abscess had a higher mortality and unfavorable neurological outcome.

Computed tomographic angiography and venography for young or nonhypertensive patients with acute spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: we compared the effectiveness of using computed tomographic angiography and venography (CTAV) with digital subtraction angiography (DSA) in young or nonhypertensive patients with acute spontaneous intracerebral hemorrhage. METHODS: we prospectively recruited 109 young (age between 18 and 45 years) or nonhypertensive patients with acute spontaneous intracerebral hemorrhage for this comparative study. All patients had CTAV using multidetector CT with 64 detectors. They were then scheduled to have catheter angiography the next day. Radiological data were collected for blinded analysis. RESULTS: DSA-positive pathologies causing hemorrhage were identified in 37 (33%) patients, which included cerebral arteriovenous malformation in 22 cases. The positive and negative predictive values of CTAV for DSA-positive pathologies causing hemorrhage were 97.3% (95% CI, 88.3%-99.9%) and 100% (95% CI, 95.9%-100%), respectively. CONCLUSIONS: CTAV was able to detect DSA-positive pathologies causing acute spontaneous intracerebral hemorrhage in young (age between 18 and 45 years) or nonhypertensive patients with high positive and negative predictive values.