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1.
J Stroke ; 23(3): 297-311, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34649376

RESUMO

The neurological symptoms of stroke have traditionally provided the foundation for functional mapping of the brain. However, there are many unresolved aspects in our understanding of cerebral activity, especially regarding high-level cognitive functions. This review provides a comprehensive look at the pathophysiology of post-stroke cognitive impairment in light of recent findings from advanced imaging techniques. Combining network neuroscience and clinical neurology, our research focuses on how changes in brain networks correlate with post-stroke cognitive prognosis. More specifically, we first discuss the general consequences of stroke lesions due to damage of canonical resting-state large-scale networks or changes in the composition of the entire brain. We also review emerging methods, such as lesion-network mapping and gradient analysis, used to study the aforementioned events caused by stroke lesions. Lastly, we examine other patient vulnerabilities, such as superimposed amyloid pathology and blood-brain barrier leakage, which potentially lead to different outcomes for the brain network compositions even in the presence of similar stroke lesions. This knowledge will allow a better understanding of the pathophysiology of post-stroke cognitive impairment and provide a theoretical basis for the development of new treatments, such as neuromodulation.

2.
Int Neurourol J ; 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34530523

RESUMO

Purpose: Although metformin and sildenafil can protect various organs against ischemia/reperfusion (I/R) injury, their effects and mechanisms of action in bladder I/R injury remain unknown. This study investigated the effects and mechanisms of action of metformin and sildenafil against bladder I/R insult in rats. Methods: One hundred male Sprague-Dawley rats were randomly divided into five groups each of twenty rats: a sham-operated group, a bladder I/R group, and bladder I/R groups treated with metformin, sildenafil, or both agents. Ischemia was induced by clamping the bilateral common iliac arteries with atraumatic vascular clamps for 2 hours, followed by reperfusion for 7 days. During this period, rats were injected once daily with 4 mg/kg metformin and/or 1 mg/kg sildenafil. Results: The increased malondialdehyde (MDA) levels and myeloperoxidase (MPO) activities and the decreased superoxide dismutase (SOD) activities induced by I/R injury were reduced by treatment with metformin and/or sildenafil. The I/R group had significantly higher JNK, p38 MAPK, Bax, caspase-3, and NF-κB levels, and lower ERK and Bcl-2 levels in the bladder than the sham-operated group; these changes were significantly ameliorated by metformin and/or sildenafil treatment. No differences in the levels of these markers were observed between rats co-administered metformin and sildenafil and those treated with either agent alone. Conclusions: Metformin and sildenafil protected rat bladder against I/R injury. This effect may be due to the inhibition of ROS production through MAPKs, Bax, and Bcl-2 activation, and the restoration of inflammation through NF-κB inhibition. However, the combination of metformin and sildenafil was no more effective than either agent alone.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34547548

RESUMO

BACKGROUND: Depression is the most common neuropsychiatric complication after stroke. Infarct location is associated with post-stroke depressive symptoms (PSDS), but it remains debated which brain structures are critically involved. We performed a large-scale lesion-symptom mapping study to identify infarct locations, and white matter disconnections, associated with PSDS. METHODS: We included 553 patients (age 69±11 years, 42% female) with acute ischemic stroke. PSDS were measured using the 30-item Geriatric Depression Scale (GDS-30). Multivariable support vector regression (SVR)-based analyses were performed both at the level of individual voxels (SVR-VLSM) and predefined regions of interest (SVR-ROI) to relate infarct location to PSDS. We externally validated our findings in an independent stroke cohort (N=459). Finally, disconnectome-based analyses were performed using SVR-VLSM, in which white matter fibers disconnected by the infarct were analyzed instead of the infarct itself. RESULTS: Infarcts in the right amygdala, right hippocampus and right pallidum were consistently associated with PSDS (permutation-based p<0.05) in SVR-VLSM and SVR-ROI. External validation (N=459) confirmed the association between infarcts in the right amygdala and pallidum, but not the right hippocampus, and PSDS. Disconnectome-based analyses revealed that disconnections in the right parahippocampal white matter, right thalamus and pallidum, and right anterior thalamic radiation were significantly associated (permutation-based p<0.05) with PSDS. CONCLUSIONS: Infarcts in the right amygdala and pallidum, and disconnections of right limbic and frontal cortico-basal ganglia-thalamic circuits, are associated with PSDS. Our findings provide a comprehensive and integrative picture of strategic infarct locations for PSDS, and shed new light on pathophysiological mechanisms of depression after stroke.

4.
Medicine (Baltimore) ; 100(29): e26476, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398003

RESUMO

ABSTRACT: Several viral infections are known to increase the risk of dementia through brain cell damage and systemic infection. The association between hepatitis B and C virus (HBV and HCV) infections and dementia was evaluated using a national sample cohort from South Korea. Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with HBV or HCV infection and for matched control participants. The controls were matched to the patients according to age, sex, income, region of residence, and past medical histories. The incidence of HCV infection was higher in the dementia group (1.0% [113/11,228]) than in the control group (0.8% [364/44,912], P = .043). However, there was no difference in the incidence of HBV infection in the dementia and control groups. The adjusted odds ratio (OR) for HCV infection was 1.25 (95% confidence interval [CI] = 1.01-1.54, P = .043) in the dementia group. According to the subgroup analysis by sex, the adjusted ORs for HCV infection were 1.04 (95% CI = 072-1.49, P = .851) in men and 1.38 (95% CI = 1.06-1.79, P = .016) in women. We concluded that the incidence of HCV infection was higher (with a higher OR) in women with dementia than in matched control participants in South Korea.


Assuntos
Demência/diagnóstico , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Adulto , Idoso , Distribuição de Qui-Quadrado , Correlação de Dados , Mineração de Dados , Demência/epidemiologia , Feminino , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Incidência , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Fatores de Risco
5.
Cortex ; 143: 148-163, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34450565

RESUMO

Disturbances of semantic and phonemic fluency are common after brain damage, as a manifestation of language, executive, or memory dysfunction. Lesion-symptom mapping (LSM) studies can provide fundamental insights in shared and distinct anatomical correlates of these cognitive functions and help to understand which patients suffer from these deficits. We performed a multivariate support vector regression-based lesion-symptom mapping and structural disconnection study on semantic and phonemic fluency in 1231 patients with acute ischemic stroke. With the largest-ever LSM study on verbal fluency we achieved almost complete brain lesion coverage. Lower performance on both fluency types was related to left hemispheric frontotemporal and parietal cortical regions, and subcortical regions centering on the left thalamus. Distinct correlates for phonemic fluency were the anterior divisions of middle and inferior frontal gyri. Distinct correlates for semantic fluency were the posterior regions of the middle and inferior temporal gyri, parahippocampal and fusiform gyri and triangular part of the inferior frontal gyrus. The disconnectome-based analyses additionally revealed phonemic fluency was associated with a more extensive frontoparietal white matter network, whereas semantic fluency was associated with disconnection of the fornix, mesiotemporal white matter, splenium of the corpus callosum. These results provide the most detailed outline of the anatomical correlates of phonemic and semantic fluency to date, stress the crucial role of subcortical regions and reveal a novel dissociation in the left temporal lobe.

6.
Urol J ; 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34390249

RESUMO

PURPOSE: To investigate whether a Percutaneous nephrostomy (PCN) has any impact on the success rate of shock wave lithotripsy (SWL) and to estimate the probability of stone-free in SWL patients with upper ureter stones. MATERIALS AND METHODS: Overall, 236 patients who underwent SWL for upper ureter stones between 2015 and 2019 were evaluated. Forty-nine patients who underwent PCN during SWL were identified. Medical data of the patients were retrospectively reviewed, and possible prognostic features were evaluated. RESULTS: Out of all patients, 147 patients were selected through propensity score matching. There were no significant differences between the PCN and no PCN groups, except for a lower stone-free rate (55.1% vs. 74.5%, p = .018) and one-session success rate (24.5% vs. 50.0%, p = .003) in the PCN group. In univariate analysis, a younger age, the female sex, a smaller size of stone, lower mean stone density (MSD), and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL. In multivariate analysis, a smaller size, lower MSD, and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL. CONCLUSION: Stone size, MSD, and PCN were prognostic factors that influence the outcome of SWL. The presence of PCN during SWL is associated with adverse success rates in patients with upper ureter stones.

7.
Sci Rep ; 11(1): 14168, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34239011

RESUMO

Although the obesity paradox is an important modifiable factor in cardiovascular diseases, little research has been conducted to determine how it affects post-stroke cognitive function. We aimed to investigate the association between body mass index (BMI) and domain-specific cognitive outcomes, focusing on the subdivision of each frontal domain function in post-ischemic stroke survivors. A total of 335 ischemic stroke patients were included in the study after completion of the Korean-Mini Mental Status Examination (K-MMSE) and the vascular cognitive impairment harmonization standards neuropsychological protocol at 3 months after stroke. Frontal lobe functions were analyzed using semantic/phonemic fluency, processing speed, and mental set shifting. Our study participants were categorized into four groups according to BMI quartiles. The z-scores of K-MMSE at 3 months differed significantly between the groups after adjustment for initial stroke severity (p = 0.014). Global cognitive function in stroke survivors in the Q1 (the lowest quartile) BMI group was significantly lower than those in Q2 and Q4 (the highest quartile) BMI groups (K-MMSE z-scores, Q1: - 2.10 ± 3.40 vs. Q2: 0.71 ± 1.95 and Q4: - 1.21 ± 1.65). Controlled oral word association test findings indicated that phonemic and semantic word fluency was lower in Q4 BMI group participants than in Q2 BMI group participants (p = 0.016 and p = 0.023 respectively). BMI might differentially affect cognitive domains after ischemic stroke. Although being underweight may negatively affect global cognition post-stroke, obesity could induce frontal lobe dysfunctions, specifically phonemic and semantic word fluency.

8.
Cerebrovasc Dis ; : 1-9, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229319

RESUMO

INTRODUCTION: The triglyceride glucose index (TyG index) is a simple and reliable surrogate marker of insulin resistance (IR) that can predict functional outcomes and mortality after acute ischemic stroke (AIS). However, it is unclear whether the TyG index is associated with functional outcomes in patients with stroke who receive reperfusion therapy. Thus, we aimed to explore the prognostic value of the TyG index for the clinical outcomes of patients with AIS who underwent reperfusion therapy. METHODS: We retrospectively assessed patients with AIS, with occlusion of either the middle cerebral artery or internal carotid artery, who were evaluated using multiphase computed tomography angiography (mCTA) and received reperfusion therapy. The TyG index was calculated as "ln [fasting glucose level (mg/dL) × triglyceride level (mg/dL)]/2." Collateral status was evaluated using mCTA based on the University of Calgary Scale. Clinical outcomes included 3-month functional outcomes, early neurological deterioration, recanalization status, and hemorrhagic transformation. RESULTS: In all, 183 subjects (age 69.5 ± 12.4 years; men, 59.0%) were enrolled. The median initial National Institutes of Health Stroke Scale score was 15.0 (interquartile range [IQR] 11-18). The median TyG index was 4.8 (IQR, 4.6-5.1), and 158 patients had TyG levels >4.49, which represents the presence of IR. On univariate analysis, a higher TyG index was associated with both early neurological deterioration (18.4 vs. 0.0%, p = 0.041) and a 3-month poor functional outcome (mRS3-6) (61.4 vs. 32.0%, p = 0.011). After adjusting for multiple variables, including age, sex, type of reperfusion therapy, recanalization status, initial stroke severity, type of stroke, and history of hypertension and diabetes, high TyG index remained an independent predictor of a poor 3-month functional outcome (adjusted OR, 5.22; p = 0.014). However, TyG levels were not significantly associated with collateral status (p = 0.756). CONCLUSIONS: IR, represented by a high TyG index, may predict poor 3-month functional outcomes in patients with AIS who undergo reperfusion therapy.

9.
Front Neurol ; 12: 693318, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34276542

RESUMO

Background and Aims: Systemic inflammation is associated with an increased risk of cognitive impairment and dementia, but the associations between them in stroke patients are less clear. We examined the impact of systemic inflammation represented as the neutrophil-lymphocyte ratio (NLR) on the development of post-stroke cognitive impairment (PSCI) and domain-specific cognitive outcomes 3-month after ischemic stroke. Methods: Using prospective stroke registry data, we consecutively enrolled 345 participants with ischemic stroke whose cognitive functions were evaluated 3-month after stroke. Their cognition was assessed with the Korean version of the Vascular Cognitive Impairment Harmonization Standards and the Korean-Mini Mental Status Examination. PSCI was defined as a z-score of < -2 standard deviations for age, sex, and education adjusted means in at least one cognitive domain. The participants were categorized into five groups according to the quintiles of NLR (lowest NLR, Q1). The cross-sectional association between NLR and PSCI was assessed using multiple logistic regression, adjusting for age, sex, education, vascular risk factors, and stroke type. Results: A total of 345 patients were enrolled. The mean age was 63.0 years and the median NIHSS score and NLR were 2 [1-4] and 2.26 [1.65-2.91], respectively. PSCI was identified in 71 (20.6%) patients. NLR was a significant predictor for PSCI both as a continuous variable (adjusted OR, 1.14; 95% CI, 1.00-1.31) and as a categorical variable (Q5, adjusted OR, 3.26; 95% CI, 1.17-9.08). Patients in the Q5 group (NLR ≥ 3.80) showed significantly worse performance in global cognition and in visuospatial and memory domains. Conclusions: NLR in the acute stage of ischemic stroke was independently associated with PSCI at 3 months after stroke, and high NLR was specifically associated with cognitive dysfunction in the memory and visuospatial domains. Thus, systemic inflammation may be a modifiable risk factor that may influence cognitive outcomes after stroke.

10.
Brain Sci ; 11(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064739

RESUMO

BACKGROUND: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). METHODS: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than -2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose - eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose - eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose - eAG). RESULTS: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1-4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. CONCLUSIONS: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.

11.
Brain Commun ; 3(2): fcab110, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34189457

RESUMO

Cognitive impairment is a frequent and disabling sequela of stroke. There is however incomplete understanding of how lesion topographies in the left and right cerebral hemisphere brain interact to cause distinct cognitive deficits. We integrated machine learning and Bayesian hierarchical modelling to enable a hemisphere-aware analysis of 1080 acute ischaemic stroke patients with deep profiling ∼3 months after stroke. We show the relevance of the left hemisphere in the prediction of language and memory assessments and relevance of the right hemisphere in the prediction of visuospatial functioning. Global cognitive impairments were equally well predicted by lesion topographies from both sides. Damage to the hippocampal and occipital regions on the left was particularly informative about lost naming and memory functions, while damage to these regions on the right was linked to lost visuospatial functioning. Global cognitive impairment was predominantly linked to lesioned tissue in the supramarginal and angular gyrus, the post-central gyrus as well as the lateral occipital and opercular cortices of the left hemisphere. Hence, our analysis strategy uncovered that lesion patterns with unique hemispheric distributions are characteristic of how cognitive capacity is lost due to ischaemic brain tissue damage.

12.
Nutrients ; 13(6)2021 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-34070955

RESUMO

BACKGROUND: It is not yet clear whether nutritional status is associated with post-stroke cognitive impairment (PSCI). We examined the geriatric nutritional risk index (GNRI) on the domain-specific cognitive outcomes 3 months after a stroke. METHODS: A total of 344 patients with acute ischemic stroke were included for the analysis. The GNRI was calculated as 1.489 × serum albumin (g/L) + 41.7 × admission weight (kg)/ideal body weight (kg) and was dichotomized according to the prespecified cut-off points for no risk and any risks. The primary outcome was PSCI, defined as having adjusted z-scores of less than -2 standard deviations in at least one cognitive domain: executive/activation, memory, visuospatial and language. Multiple logistic regression and linear regression analyses were performed to investigate the association between the GNRI and cognitive outcomes. RESULTS: Seventy (20.3%) patients developed PSCI 3 months after a stroke. The mean GNRI was 106.1 ± 8.6, and 59 (17.2%) patients had low (<98) GNRI scores. A low GNRI was independently associated with the PSCI after adjusting for age, sex, education, initial stroke severity, stroke mechanism and left hemispheric lesion (odds ratio, 2.04; 95% confidence interval, 1.00-4.14). The GNRI scores were also significantly associated with the z-scores from the mini-mental status examination and the frontal domain (ß = 0.04, p-value = 0.03; ß = 0.03, p-value = 0.03, respectively). CONCLUSIONS: A low GNRI was independently associated with the development of PSCI at 3 months after an ischemic stroke. The GNRI scores were specifically associated with the z-scores of the global cognition and frontal domain cognitive outcomes.


Assuntos
Disfunção Cognitiva/etiologia , Avaliação Geriátrica/métodos , AVC Isquêmico/complicações , Avaliação Nutricional , Estado Nutricional , Idoso , Peso Corporal , Cognição , Feminino , Humanos , Modelos Logísticos , Masculino , Desnutrição/complicações , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Albumina Sérica/análise
14.
BMC Cancer ; 21(1): 472, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910525

RESUMO

BACKGROUND: Serum prostate-specific antigen (PSA) is widely used in screening tests for prostate cancer. As the low specificity of PSA results in unnecessary and invasive prostate biopsies, we evaluated the clinical significance of various PSAs and PSA density (PSAD) related to peripheral zones in patients with gray zone PSA level (4-10 ng/mL). METHODS: A total of 1300 patients underwent transrectal ultrasonography-guided prostate biopsy from 2014 to 2019. Among them, 545 patients in the gray zone were divided into the prostate cancer diagnosis group and the non-prostate cancer diagnosis group, and PSA, relative extra transitional zone PSA (RETzPSA), estimated post holmium laser enucleation of the prostate PSA (EPHPSA), PSAD, peripheral zone PSA density (PZPSAD) and extra-transitional zone density (ETzD) were compared and analyzed using receiver-operating characteristics (ROC) analysis after 1:1 matching using propensity score. RESULTS: Area under the ROC curve values of PSA, EPHPSA, RETzPSA, PSA density, ETzD, and PZPSAD were 0.553 (95% CI: 0.495-0.610), 0.611 (95% CI: 0.554-0.666), 0.673 (95% CI: 0.617-0.725), 0.745 (95% CI: 0.693-0.793), 0.731 (95% CI: 0.677-0.780) and 0.677 (95% CI: 0.611-0.719), respectively. PSAD had 67.11% sensitivity, 71.71% specificity, and 70.34% positive predictive rate at 0.18 ng/mL/cc. ETzD had 69.08% sensitivity, 64.47% specificity, and 66.04% positive predictive rate at 0.04 ng/mL/cc. When the cut-off value of PSAD was increased to 0.18 ng/mL/cc, the best results were obtained with an odds ratio of 5.171 (95% CI: 3.171-8.432), followed by ETzD with 4.054 (95% CI: 2.513-6.540). CONCLUSIONS: These results suggested that volume-adjusted parameters (ETzD and PSAD) might be more sensitive and accurate than various PSA in gray zone patients who required prostate biopsy to reduce unnecessary biopsy.


Assuntos
Antígeno Prostático Específico/análise , Próstata/química , Neoplasias da Próstata/química , Fatores Etários , Idoso , Área Sob a Curva , Intervalos de Confiança , Humanos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/estatística & dados numéricos , Lasers de Estado Sólido , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Curva ROC , Sensibilidade e Especificidade , Ultrassonografia de Intervenção
15.
Am J Alzheimers Dis Other Demen ; 36: 15333175211006504, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33882722

RESUMO

OBJECTIVE: This study was conducted to evaluate the association between neurodegenerative dementia and herpes zoster infection (HZI) using a national sample cohort. METHODS: From the national cohort study conducted by the Korean National Health Insurance Service, we extracted data for patients with neurodegenerative dementia and for 1:4 matched control participants and searched the patient histories for HZI. RESULTS: The adjusted odds ratio (OR) for HZI was 0.90 (95% CI = 0.84-0.97) in the dementia group. According to the subgroup analysis, the adjusted OR for HZI was 0.91 (95% confidence interval [CI] = 0.83 -1.00) in the < 80 years old group, 0.88 (95% CI = 0.78 -1.00) in the ≥ 80 years old group, 0.77 (95% CI = 0.66-0.89) in men and 0.96 (95% CI = 0.88 -1.05) in women. CONCLUSIONS: We concluded that HZI does not increase the risk of neurodegenerative dementia in individuals of any age or of either sex.


Assuntos
Demência , Herpes Zoster , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Demência/epidemiologia , Feminino , Herpes Zoster/epidemiologia , Humanos , Incidência , Masculino , Programas Nacionais de Saúde , Fatores de Risco
16.
Pharmaceutics ; 13(3)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33808759

RESUMO

Inflammation is a defense mechanism that protects the body from infections. However, chronic inflammation causes damage to body tissues. Thus, controlling inflammation and investigating anti-inflammatory mechanisms are keys to preventing and treating inflammatory diseases, such as sepsis and rheumatoid arthritis. In continuation with our work related to the discovery of bioactive natural products, a polyphenol, catechin-7,4'-O-digallate (CDG), was isolated from Woodfordia uniflora, which has been used as a sedative and remedy for skin infections in the Dhofar region of Oman. Thus far, no study has reported the anti-inflammatory compounds derived from W. uniflora and the mechanisms underlying their action. To investigate the effects of CDG on the regulation of inflammation, we measured the reduction in nitric oxide (NO) production following CDG treatment in immortalized mouse Kupffer cells (ImKCs). CDG treatment inhibited NO production through the downregulation of inducible nitric oxide synthase expression in lipopolysaccharide (LPS)-stimulated ImKCs. The anti-inflammatory effects of CDG were mediated via the inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation, an important inflammatory-response-associated signaling pathway. Moreover, CDG treatment has regulated the expression of pro-inflammatory cytokines, such as IL-6 and IL-1ß. These results suggested the anti-inflammatory action of CDG in LPS-stimulated ImKCs.

17.
J Clin Neurol ; 17(2): 206-212, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33835740

RESUMO

BACKGROUND AND PURPOSE: Serum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS). METHODS: This study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis. RESULTS: This study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24-0.80, p=0.01), while there was no significant association at 3 months. CONCLUSIONS: This study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.

18.
Lancet Neurol ; 20(6): 448-459, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33901427

RESUMO

BACKGROUND: Post-stroke cognitive impairment (PSCI) occurs in approximately half of people in the first year after stroke. Infarct location is a potential determinant of PSCI, but a comprehensive map of strategic infarct locations predictive of PSCI is unavailable. We aimed to identify infarct locations most strongly predictive of PSCI after acute ischaemic stroke and use this information to develop a prediction model. METHODS: In this large-scale multicohort lesion-symptom mapping study, we pooled and harmonised individual patient data from 12 cohorts through the Meta-analyses on Strategic Lesion Locations for Vascular Cognitive Impairment using Lesion-Symptom Mapping (Meta VCI Map) consortium. The identified cohorts (as of Jan 1, 2019) comprised patients with acute symptomatic infarcts on CT or MRI (with available infarct segmentations) and a cognitive assessment up to 15 months after acute ischaemic stroke onset. PSCI was defined as performance lower than the fifth percentile of local normative data, on at least one cognitive domain on a multidomain neuropsychological assessment or on the Montreal Cognitive Assessment. Voxel-based lesion-symptom mapping (VLSM) was used to calculate voxel-wise odds ratios (ORs) for PSCI that were mapped onto a three-dimensional brain template to visualise PSCI risk per location. For the prediction model of PSCI risk, a location impact score on a 5-point scale was derived from the VLSM results on the basis of the mean voxel-wise coefficient (ln[OR]) within each patient's infarct. We did combined internal-external validation by leave-one-cohort-out cross-validation for all 12 cohorts using logistic regression. Predictive performance of a univariable model with only the location impact score was compared with a multivariable model with addition of other clinical PSCI predictors (age, sex, education, time interval between stroke onset and cognitive assessment, history of stroke, and total infarct volume). Testing of visual ratings was done by three clinicians, and accuracy, inter-rater reliability, and intra-rater reliability were assessed with Cohen's weighted kappa. FINDINGS: In our sample of 2950 patients (mean age 66·8 years [SD 11·6]; 1157 [39·2%] women), 1286 (43·6%) had PSCI. We achieved high lesion coverage of the brain in our analyses (86·9%). Infarcts in the left frontotemporal lobes, left thalamus, and right parietal lobe were strongly associated with PSCI (after false discovery rate correction, q<0·01; voxel-wise ORs >20). On cross-validation, the location impact score showed good correspondence, based on visual assessment of goodness of fit, between predicted and observed risk of PSCI across cohorts after adjusting for cohort-specific PSCI occurrence. Cross-validations showed that the location impact score by itself had similar performance to the combined model with other PSCI predictors, while allowing for easy visual assessment. Therefore the univariable model with only the location impact score was selected as the final model. Correspondence between visual ratings and actual location impact score (Cohen's weighted kappa: range 0·88-0·92), inter-rater agreement (0·85-0·87), and intra-rater agreement (for a single rater, 0·95) were all high. INTERPRETATION: To the best of our knowledge, this study provides the first comprehensive map of strategic infarct locations associated with risk of PSCI. A location impact score was derived from this map that robustly predicted PSCI across cohorts. Furthermore, we developed a quick and reliable visual rating scale that might in the future be applied by clinicians to identify individual patients at risk of PSCI. FUNDING: The Netherlands Organisation for Health Research and Development.


Assuntos
Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Isquemia Encefálica/complicações , Mapeamento Encefálico/métodos , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Feminino , Humanos , Infarto/patologia , AVC Isquêmico , Modelos Logísticos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prognóstico , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/epidemiologia
19.
Sci Rep ; 11(1): 5049, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658545

RESUMO

Blood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood-based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.

20.
J Exerc Rehabil ; 17(1): 59-65, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33728290

RESUMO

We studied the long-term efficacy and safety of cystocele operation by polypropylene mesh. A total of 198 women with stage ≥2 cystocele who had anterior vaginal wall repair with transobturator four-arm polypropylene mesh during 2003 to 2015 were evaluated. Outcomes including clinical characteristics and complications were reviewed by extracting patient data from electronic medical records. In addition, telephone interviews were conducted using a validated questionnaire along with physical examination. The follow-up period was 9.3±0.3 years. The cystocele stage in patients was significantly decreased post-operation compared to that preoperation. The anatomical cure rate for cystocele was 93.4%, and that for stress urinary incontinence was 95%. Comparing the three questionnaires indicated overall average score was improved significantly, except for Female Sexual Function Index Assessment. Early complications were either resolved spontaneously or controlled medically in four cases of hematoma or abscess, three cases of vaginal infection and urinary tract infection, and four cases of difficult micturition. In late complications, four cases of pain were managed, five cases of recurrence were observed and two cases of mesh exposure were treated with ointment and local excision. Transobturator four-arms mesh is an effective and safe method for cystocele repair with low rate of recurrence and complications. We suggest that the use of transobturator four-arm mesh is a still good choice for the old patients with cystocele who are not suitable for general anesthesia and reside in areas where laparoscopy and robots are not available.

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