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1.
BMC Neurol ; 19(1): 272, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690277

RESUMO

BACKGROUD: Patients with acute ischemic stroke (AIS) often experience low serum free triiodothyronine (FT3), but the association of low FT3 with stroke severity, subtype and prognosis has not yet been thoroughly studied, and the molecular events underlying these clinical observation were also unclear. METHODS: We retrospectively collected 221 cases of AIS and 182 non-AIS cases with detailed clinical data from our department. FT3 concentrations were measured on admission to predict functional outcome within 3 months using multivariable models adjusted for other risk factors. Receiver operating characteristic (ROC) curves were calculated to define the best cutoff value of FT3 of stroke severity, subtypes and neurological outcome. Gene set enrichment, pathway mapping and network analyses of deferentially expressed genes (DEGs) were performed. RESULTS: FT3 was significantly decreased in AIS patients with National Institutes of Health Stroke Scale (NIHSS) > 3 and 3-months modified Rankin Scale (mRS) > 2. The cut-off value of FT3 for NIHSS on admission was 4.30 pmol/L. Also, FT3 level was significantly lower in large artery atherosclerosis (LAA) group and cardioembolism (CE) group than that in small vessel occlusion (SVO). FT3 value served as an independent predictor for neurological outcomes for which the cut-off value of FT3 was 4.38 pmol/l. Gene ontology (GO) analysis showed that the biological function of DEGs was mainly enriched in multicellur organism, neuron differentiation and cellular response to hypoxia. The cellular components were involved in extracelluar region, exosome and matrix, and the molecular functions were transcriptional activator activity, DNA binding and nuclear hormone receptor binding. Signal pathways analysis was indicative of neuroactive ligand-receptor interaction, thyroid hormone signaling pathway, and protein digestion and absorption these DEGs were involved in. Six related gene were identified as hubs from the protein-protein interaction (PPI) networks. Three modules were selected from PPI, of which MMP4, ADRA2C and EIF3E were recognized as the seed genes. CONCLUSIONS: Low FT3 value on admission was associated with stroke severity, subtype and prognosis. In addition, DEGs identified from bioinformatics analysis are likely to be candidates for elucidating clinical outcomes with low FT3, and provide us with therapeutic targets for improving stroke prognosis.


Assuntos
Acidente Vascular Cerebral , Tri-Iodotironina/sangue , Biologia Computacional , Humanos , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
2.
Medicine (Baltimore) ; 98(48): e18065, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770223

RESUMO

Previous studies have indicated that muscle RAS oncogene homolog (MRAS) gene played an important role in cardiovascular diseases. However, the effect of MRAS genetic variations on ischemic stroke (IS) is still not clear. The aim of the current study was to investigate the association between the MRAS polymorphism and IS risk in Han populations.Three SNPs (rs40593, rs751357, rs6782181) at MRAS were selected for genotyping in a sample of 240 IS patients and 430 controls. Logistic regression was performed to evaluate the association of 3 SNPs with IS and IS subgroups.No association of MRAS SNPs with IS risk was observed, while G allele of rs40593 was associated with increased risk of cerebral infarction area. Compared with carriers of the AA genotype, the risk of carriers of the AG+GG genotype increased, with an OR (95%CI) of 2.337 (1.175-4.647), P = .016. In relation to lipid profile, rs40593, rs751357, rs6782181 were associated with increased total cholesterol (TC) levels.Summarily, this study suggested that MRAS rs40593 may contribute to the increased risk of area of cerebral infarction of IS in Han population. rs40593, rs751357, and rs6782181 were associated with higher serum TC levels.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Isquemia Encefálica/genética , Colesterol/sangue , Acidente Vascular Cerebral/genética , Proteínas ras/genética , Adulto , Alelos , Isquemia Encefálica/sangue , China , Grupos Étnicos/genética , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/sangue , Adulto Jovem
3.
BMC Neurol ; 19(1): 240, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31627722

RESUMO

BACKGROUND: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). METHODS: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72 h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and no prestroke statins use groups, who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score ≥ 3), and composite outcome (death/major disability) at 3 months after AIS. RESULTS: One hundred thirty-six patients were in no prestroke statins use group, and 106 in prestroke statins use group. Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P < 0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval (CI), 0.99-1.12; P = 0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16-0.91; P = 0.031)], major disability (adjusted OR, 0.38; 95% CI, 0.15-0.99; P = 0.047), and composite outcome (adjusted OR, 0.31; 95% CI, 0.17-0.74; P = 0.009). CONCLUSIONS: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.


Assuntos
Fibrilação Atrial/complicações , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipoproteínas LDL/sangue , Lipoproteínas LDL/efeitos dos fármacos , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/sangue , Infarto Cerebral/etiologia , Infarto Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
4.
Cardiovasc Hematol Agents Med Chem ; 17(2): 144-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31629400

RESUMO

INTRODUCTION: Recent findings have shown that in Acute Ischemic Stroke (AIS) patients, elevated troponin is associated with increased mortality. However, due to concerns of cerebral hypoperfusion and hemorrhagic transformation, current practice has been slow to apply proven cardiac therapies to these patients. This study aims to determine this rate of utilization. MATERIALS AND METHODS: A single-center review of 83 patients with AIS and measured troponin was conducted. Patients were stratified based on elevated and non-elevated troponin. Between groups, we measured the utilization of evidence-based cardiac therapies and used a univariate logistic regression to compare outcomes of mortality, re-hospitalization, recurrent acute ischemic stroke, recurrent acute myocardial infarction, and a composite of these outcomes. RESULTS: Of 83 patients, 25 had elevated troponin and 58 had non-elevated troponin. There was no statistical difference in the use of cardiac therapies between the two groups. Adenosine diphosphate P2Y12 antagonists were infrequently used in both elevated and non-elevated troponin groups at 32% vs. 24% (p = 0.64), as were Angiotensin-Converting Enzyme Inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) at 56% vs. 69% (p = 0.38). Those in the elevated troponin group encountered a statistically significant increase in composite endpoint 64% vs. 33% (Odds Ratio [OR] 7.28, 95% Confidence interval [CI] 2.19-28.88, p<0.01). CONCLUSION: Cardiac therapies are underutilized in patients with acute ischemic stroke and elevated troponin levels. In turn, this low usage may explain the increase in morbidity and mortality seen in these patients and the use of such therapies should be considered when treating this subset of patients as the cardio protective nature of these therapies may outweigh the risks associated with them in AIS patients.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Acidente Vascular Cerebral/sangue , Troponina/sangue , Idoso , Isquemia Encefálica/sangue , Isquemia Encefálica/complicações , Feminino , Humanos , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações
5.
Adv Clin Exp Med ; 28(10): 1419-1424, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31538415

RESUMO

BACKGROUND: Anemia is associated with adverse outcomes in patients with acute myocardial infarction and congestive heart failure. Additionally, it has been shown that anemia increases the short-term mortality risk in patients with acute stroke. OBJECTIVES: The aim of our study was to determine the importance of anemia as a long-term mortality risk factor by itself or in combination with other risk factors. MATERIAL AND METHODS: We included 390 Caucasian patients with acute ischemic stroke in our study. Their progress was followed from the day of their admission until their death or a max. of 1,669 days. Stroke and anemia were defined according to the World Health Organization (WHO) criteria. RESULTS: Anemia was present in 57 (14.6%) patients. The patients with anemia were older (p < 0.01) and more likely to be female (p < 0.001). They had higher NIHSS scores on admission (p < 0.001) and discharge (p < 0.001), lower estimated glomerular filtration rates (eGFRs) (p < 0.001), lower serum LDL cholesterol (p < 0.01) and lower serum albumin levels (p < 0.001), while their serum C-reactive protein (CRP) levels were higher (p < 0.001). The Kaplan-Meier curves showed that patients with anemia had higher mortality (p < 0.001). Cox's regression analysis revealed that anemia at admission was a predictor of long-term mortality in these patients (hazard ratio (HR) = 2.448, 95% confidence interval (95% CI) = 1.773-3.490; p < 0.001). Anemia remained a strong predictor of mortality after adjusting for other risk factors as well. CONCLUSIONS: Anemia was frequent among our patients and was an independent predictor of long-term mortality even after adjusting for other risk factors.


Assuntos
Anemia/complicações , Isquemia Encefálica/complicações , Acidente Vascular Cerebral/complicações , Idoso , Anemia/diagnóstico , Anemia/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Isquemia Encefálica/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Resultado do Tratamento
6.
Ideggyogy Sz ; 72(7-8): 241-256, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517456

RESUMO

Background and purpose: The aim of this study is to evaluate utility of CHADS2 score to estimate stroke severity and prognosis in patients with ischemic stroke due to non-valvular atrial fibrillation (AF) in addition to evaluate effects of hematologic and echocardiographic findings on stroke severity and prognosis. Methods: This prospective study included 156 ischemic stroke cases due to non-valvular AF in neurology ward of Trakya University Medical School between March 2013-March 2015. National Institute of Health Stroke (NIHS) score was used to evaluate severity of stroke at admission. Carotid and vertebral Doppler ultrasonography findings, brain computed tomography (CT) and magnetic resonance imaging (MRI) of the cases were evaluated. Left atrial diameter and ejection fraction (EF) values were measured. CHADS2 score was calculated. Modified Rankin Scale was used to rate the degree of dependence. Effects of age and sex of the patients, presence of diabetes mellitus (DM), Congestive Heart Failure (CHF), Cerebrovascular Disease (CVD) and C-reactive protein (CRP) levels on CHADS2, NIHS, and mRS were evaluated. Results: In patients with age ≥75, mean NIHS score was 3.3 points and mean mRS score was 1.02 points higher, than in patient below 75 years of age. Compared with the mild risk group, cases in the high risk group had older age, higher serum D-dimer, fibrinogen and CRP levels and lower EF. A positive relation was detected between stroke severity and Hemorrhagic Transformation (HT), previous CVD history, and presence of CHF. A significant association was found between increased stroke severity and Early Neurological Deterioration (END) development. Older age, higher serum fibrinogen, D-dimer, CRP and lower EF values were associated with poor prognosis. History of CVD and presence of CHF were associated with poor prognosis. END development was found to be associated with poor prognosis. In the high-risk group, 30.3% (n = 33) had END. Among those in the high-risk group according to the CHADS2 score, END development rate was found to be significantly higher than in the moderate risk group (p <0.05). There was a strong positive correlation between CHADS2 and NIHS scores. mRS score increased with increasing CHADS2 score and there was a strong correlation between them. Effect of stroke severity on prognosis was assessed and a positive correlation was found between NIHS score and mRS value. Conclusion: Our study demonstrated the importance of CHADS2 score, haemostatic activation and echocardiographic findings to assess stroke severity and prognosis. Knowing factors which affect stroke severity and prognosis in patients with ischemic stroke may be directive to decide primary prevention and stroke management.


Assuntos
Fibrilação Atrial/complicações , Ecocardiografia , Insuficiência Cardíaca/complicações , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Idoso , Fibrilação Atrial/sangue , Humanos , Ataque Isquêmico Transitório/etiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia
7.
Acta Neurol Scand ; 140(6): 443-448, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518433

RESUMO

OBJECTIVES: Hyperglycemia is a predictor for poor stroke outcome. Hyperglycemic stroke patients treated with thrombolysis have an increased risk of intracranial hemorrhage. Insulin is the gold standard for treating hyperglycemia but comes with a risk of hypoglycemia. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are drugs used in type 2 diabetes that have a low risk of hypoglycemia and have been shown to exert neuroprotective effects. The primary objective was to determine whether prehospital administration of the GLP-1RA exenatide could lower plasma glucose in stroke patients. Secondary objective was to study tolerability and safety. MATERIALS & METHODS: Randomized controlled trial comparing exenatide administrated prehospitally with a control group receiving standard care for hyperglycemia. Patients with Face Arm Speech Test ≥1 and glucose ≥8 mmol/L were randomized. Glucose was monitored for 24 hours. All adverse events were recorded. RESULTS: Nineteen patients were randomized, eight received exenatide. An interim recruitment failure analysis with subsequent changes of the protocol was made. The study was stopped prematurely due to slow inclusion. No difference was observed in the main outcome of plasma glucose at 4 hours, control vs exenatide (mean, SD); 7.0 ± 1.9 vs 7.6 ± 1.6; P = .56). No major adverse events were reported. CONCLUSIONS: We found no evidence that prehospital exenatide had effect on hyperglycemia. However, it was given without adverse events in this study with limited sample size that was prematurely stopped due to slow inclusion.


Assuntos
Glicemia/efeitos dos fármacos , Exenatida/administração & dosagem , Hiperglicemia/prevenção & controle , Hipoglicemiantes/administração & dosagem , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperglicemia/complicações , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações
8.
J Stroke Cerebrovasc Dis ; 28(11): 104336, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488374

RESUMO

BACKGROUND: Rupture of unstable carotid plaque and consequently occlusive thrombus formation for the most part cause ischemic cerebral vascular event. Many researchers have been studying on the risk predictors of carotid plaque formation. But the risk factors for unstable carotid plaque have not been researched for so much. In the current study, we aimed to evaluate the association of coagulation function and carotid plaque especially unstable plaque by thrombelastography (TEG). METHODS: This was a cross-sectional study. Consecutive eligible patients with acute ischemic stroke were included and their TEG data were collected. Carotid plaque was evaluated by carotid ultrasound. Echolucent plaque and heterogeneous echo plaque in ultrasound were classified as unstable carotid plaque. Patients were classified according to being with carotid plaque or unstable plaque for comparison. RESULTS: Four hundred and seven patients were enrolled. Compared to those without carotid plaques, patients with carotid plaques had higher ages, higher incidence of hypertension and diabetes mellitus, lower k (P = .017) and higher angle (P = .021) on TEG. In the comparison between groups with unstable plaque and stable plaque, no significant difference was found in baseline characteristics; higher serum fibrinogen and higher maximum amplitude on TEG were significantly correlated to unstable carotid plaques (P = .051, P = .009). Multivariate logistic analysis revealed that age, hypertension, and smoking were independent risk factors of carotid plaques formation; higher serum fibrinogen was an independent risk factor of unstable plaques formation. CONCLUSIONS: This study demonstrates that carotid plaques formation in ischemic stroke patients has a link to abnormal coagulation function, while high platelet activity has an additional contribution to unstable plaque formation.


Assuntos
Coagulação Sanguínea , Plaquetas/metabolismo , Isquemia Encefálica/etiologia , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico , Placa Aterosclerótica , Acidente Vascular Cerebral/etiologia , Tromboelastografia , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Ruptura Espontânea , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico
9.
J Stroke Cerebrovasc Dis ; 28(11): 104345, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488376

RESUMO

BACKGROUND: The association between cystatin C and risk of ischemic stroke is inconsistent and the cut-off values of cystatin C are diverse in different articles. We aimed to investigate the association between cystatin C levels and the development of ischemic stroke and to explore the clinical cut-off values of serum cystatin C levels for ischemic stroke. METHODS: This prospective cohort study included 7658 participants from the China Health and Retirement Longitudinal Study who were free of cardiovascular diseases and cancer at baseline. A decision-tree model was used to find reasonable cut-off values for cystatin C levels. Logistic regression models were used to analyze the association between different levels of cystatin C and the risk of ischemic stroke. RESULTS: The whole cohort was divided into the following 3 groups according to the decision tree: group-low (<.901 mg/L), group-moderate (.901∼1.235 mg/L), and group-high (>1.235 mg/L). After 4 years of follow-up, we identified 156 cases of ischemic stroke. After adjusting for potential confounding factors, the odds ratios (95% confidence intervals) of ischemic stroke were 1.637 (1.048-2.556) for group-moderate and 2.326 (1.285-4.210) for group-high) compared with the low group of cystatin C. Subgroup analyses showed that the association between cystatin C levels and the incidence of ischemic stroke was more pronounced in males or old people than in females or young people. CONCLUSIONS: We found 2 suitable cut-off values for serum cystatin C levels and found that high levels of cystatin C were associated with an increased risk of ischemic stroke.


Assuntos
Isquemia Encefálica/sangue , Cistatina C/análise , Acidente Vascular Cerebral/sangue , Fatores Etários , Idoso , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , China/epidemiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Regulação para Cima
10.
J Stroke Cerebrovasc Dis ; 28(11): 104352, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31501037

RESUMO

BACKGROUND: Retinoic acid (RA), an active metabolite of vitamin A, possesses enormous protective effects on vascular systems. It may also be positively related to good functional outcome after ischemic stroke. However, whether circulating RA concentration is associated with poststroke cognitive impairment (PSCI) remains unclear. This study aimed to detect the association between RA level and PSCI among patients with first-ever acute ischemic stroke. METHODS: Two hundred and 61 consecutive patients were prospectively recruited during March 2018 and March 2019. Serum RA concentration was measured at admission for all patients. We also performed cognitive function examination using the Montreal Cognitive Assessment (MoCA) at admission and at every follow-up visit. Patients with MoCA score less than 26 were identified as developing PSCI. RESULTS: The median serum RA level was 2.0 ng/mL (interquartile range, 1.1-3.2 ng/mL) after admission. Patients diagnosed as PSCI at admission, 1-month and 3-month were 53 (20.3%), 91 (34.6%), and 141 (54.0%), respectively. Univariate analysis showed that reduced RA level was correlated with PSCI at 3-month (P = .003), but not at admission (P = .416) and 1-month poststroke (P = .117). After adjusting for all potential confounders, the odds ratio for the lowest tertile of RA, compared with the highest tertile, was 1.97 (95% confidence interval, 1.01-3.83, P = .046) for PSCI at 3 months. Furthermore, multiple-adjusted spline regression model further confirmed the dose-response relationships between RA level and 3-month PSCI (P < .001). CONCLUSIONS: Decreasing serum RA level might be associated with 3-month PSCI in ischemic stroke patients.


Assuntos
Isquemia Encefálica/sangue , Cognição , Disfunção Cognitiva/etiologia , Acidente Vascular Cerebral/sangue , Tretinoína/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
11.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414760

RESUMO

BACKGROUND: The current study aims to investigate the expression of antisense noncoding RNA in the INK4 locus (ANRIL) in serum of patients with ischemic stroke and its correlation with high-sensitivity C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9). METHODS: Real time PCR analysis was carried out to evaluate the level of ANRIL. The levels of hs-CRP and MMP-9 were evaluated using ELISA. ROC analysis was carried out to evaluate the diagnostic value of ANRIL, hs-CRP and MMP-9. Pearson's correlation analysis was carried out to evaluate the expression of ANRIL in serum of hs-CRP and MMP-9. RESULTS: Our data showed that the expression levels of ANRIL, hs-CRP, and MMP-9 in serum of the patients were significantly higher than those of the control group (p < 0.05). Pearson's correlation analysis showed that there was a positive correlation between the expression of ANRIL and hs-CRP and MMP-9. Meanwhile, serum levels of ANRIL, hs-CRP, and MMP-9 in patients with severe neurological deficits were significantly higher than those in patients with moderate and mild neurological deficits (p < 0.05). Moreover, the expression levels of ANRIL, hs-CRP, and MMP-9 in serum of patients with different degrees of neurological impairment have different correlations. More importantly, ROC analysis demonstrated that the combined use of ANRIL, hs-CRP, and MMP-9 demonstrated higher diagnostic value for stroke patients. CONCLUSIONS: Serum ANRIL may be used as a molecular marker in the diagnosis of ischemic stroke and may play an important role in the pathogenesis and development of ischemic stroke in cooperation with hs-CRP and MMP-9.


Assuntos
Biomarcadores/sangue , Isquemia Encefálica/sangue , RNA Longo não Codificante/sangue , Acidente Vascular Cerebral/sangue , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/genética , Proteína C-Reativa/análise , Proteína C-Reativa/genética , Feminino , Humanos , Masculino , Metaloproteinase 9 da Matriz/sangue , Metaloproteinase 9 da Matriz/genética , Pessoa de Meia-Idade , RNA Longo não Codificante/genética , Curva ROC , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/genética
12.
J Clin Neurosci ; 69: 155-159, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31420274

RESUMO

Sleep disturbance is a common psychiatric complication after stroke. Oxidative stress has been an important pathophysiological mechanism of sleep disturbance. However, no study has explored the relationship between uric acid (UA) and post-stroke sleep quality. This prospective study included 191 patients who were followed up for two months after acute ischemic stroke. Serum UA levels were measured at admission and divided into 3 tertiles (≤251 µmol/L, 252-326 µmol/L, ≥327 µmol/L). Patients in the 3rd tertile of UA levels had a lower incidence of poor sleep quality than those belonging to 2nd or 1st tertile, respectively (9.7% vs. 27.7% vs. 35.9%; P = 0.002). Furthermore, high UA levels (≥327 µmol/L) were independently associated with low risk of poor sleep quality (OR = 0.129, 95%CI = 0.031-0.528, P = 0.004) after adjusting for demographics, cardiovascular risk factors, stroke severity, functional outcome and depressive symptoms. High modified Rankin Scale score and depressive symptoms were associated with increased risk of poor sleep quality after stroke (OR = 1.836, 95%CI = 1.035-3.354, P = 0.038) and (OR = 5.082, 95%CI = 1.709-15.115, P = 0.003). In conclusion, high UA levels may reduce the risk of poor sleep quality after acute ischemic stroke. Further randomized controlled trials are necessary in examining whether appropriate UA supplement could provide a potential prevention or therapeutic target for sleep disturbance after stroke.


Assuntos
Transtornos do Sono-Vigília/sangue , Transtornos do Sono-Vigília/etiologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Ácido Úrico/sangue , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Eur J Epidemiol ; 34(10): 957-965, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31399938

RESUMO

Most studies of white matter hyperintensity volume (WMHV) in stroke patients lack reliable information on antecedent exposure to vascular risk factors. By leveraging prospective cohort data, we explored associations between lifestyle and health factors assessed 1 year prior to stroke and WMHV in individuals who experienced an ischemic stroke. This analysis was nested within two large prospective studies of initially healthy individuals. Information on lifestyle factors and health conditions was collected prior to the stroke event through annual or biannual questionnaires. For individuals who experienced their first confirmed ischemic stroke and had available magnetic resonance imaging, we measured WMHV using a validated semiautomated method. Linear regression was used to explore associations between lifestyle factors and health conditions and log-transformed WMHV. We measured WMHV in 345 participants with a first ischemic stroke event (mean age = 74.4 years; 24.9% male). After multivariate adjustment, history of diabetes was associated with decreased WMHV (p value = 0.06) while history of transient ischemic attack (p value = 0.09) and hypertension (p value = 0.07) were associated with increased WMHV. Most lifestyle factors and health conditions measured 1 year prior to stroke were not associated with WMHV measured at the time of ischemic stroke. Future studies could examine whether long term exposure to these factors impacts diffuse microvascular ischemic brain injury among stroke patients.


Assuntos
Nível de Saúde , Leucoencefalopatias/diagnóstico , Estilo de Vida , Acidente Vascular Cerebral/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Idoso , Feminino , Humanos , Leucoencefalopatias/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Substância Branca/patologia
14.
J Stroke Cerebrovasc Dis ; 28(11): 104340, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31462383

RESUMO

BACKGROUND: Evidence about whether neutrophil counts, neutrophil ratio linked with clinical outcome in patients with minor stroke after thrombolysis is scarce. The purpose of this study is to explore the association of neutrophil counts, neutrophil ratio with the 90-day clinical outcome in patients with minor stroke treated with intravenous thrombolysis. MATERIALS AND METHODS: A total of 163 patients with minor stroke treated with thrombolysis within window time were recruited from 2013 to 2017. Their total neutrophil and leukocyte counts on admission were measured. Disability or death (defined as a modified Rankin scale score ≥2) at 90-day were captured. Multiple logistic regression models were used to estimate the association between neutrophil counts, and neutrophil ratio to clinical outcome. Receiver operating characteristic curves were used to evaluate the predictive value of neutrophil counts or neutrophil ratio. RESULTS: At the 90-day follow-up, 36 patients (21%) had disability or death after stroke onset. Compared to the first tertile, the higher neutrophil counts increased the risk of 90-day disability or death (adjusted odds ratio [aOR] for third tertile: 2.93 (1.08-7.96); P for trend = .03). Similarly, higher neutrophil ratio also increased the risk of disability or death (aOR for third tertile: 5.81 (1.7-19.88); P for trend = .005). The comparison of area under the curve for neutrophil ratio versus neutrophils was .1 (P = .04). Thus, neutrophil ratio with the cutoff point of .74 had a better discriminative ability to the outcome (6.11, 2.36-15.86). CONCLUSIONS: Baseline higher neutrophil counts and neutrophil ratio were associated with an increased risk of 90-day disability or death in patients with minor stroke who received thrombolytic therapy.


Assuntos
Fibrinolíticos/administração & dosagem , Neutrófilos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Administração Intravenosa , Idoso , China , Avaliação da Deficiência , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(31): e16723, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374068

RESUMO

Fasting hyperglycemia is associated with poor neurologic outcome in acute ischemic stroke (AIS), but its relationship with in-hospital outcome in elderly patients remains largely unknown. To assess the association of in-hospital outcome with fasting plasma glucose (FPG) levels at admission in individuals with AIS.This retrospective propensity score-matched case-control study included patients aged over 60 years suffering from AIS and who were admitted to the emergency department from November 2013 to October 2016. Subjects were grouped into the poor-outcome and good-outcome groups based on mortality and intensive care unit (ICU) admission.The poor- and good-outcome groups comprised 74 and 1927 cases, respectively, before propensity score matching (PSM), and 74 and 296 cases, respectively, after PSM. Univariable logistic regression analysis showed that initial FPG after admission was associated with poor in-hospital outcome. Multivariable logistic regression analysis showed that initial FPG after admission was an independent predictor of poor in-hospital outcome (odds ratio = 1.11, 95% confidence interval: 1.037-1.188, P = .003).This study used PSM and strongly suggests that FPG is an independent predictive factor of poor in-hospital outcome in elderly patients with AIS. High initial FPG levels after admission may predict poor in-hospital outcome. Prospective studies are needed to confirm these findings.


Assuntos
Isquemia Encefálica/sangue , Hipoglicemia/sangue , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/análise , Isquemia Encefálica/complicações , Estudos de Casos e Controles , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/complicações , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações
16.
BMC Med Genomics ; 12(1): 118, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391037

RESUMO

BACKGROUND: Identifying molecular biomarkers characteristic of ischemic stroke has the potential to aid in distinguishing stroke cases from stroke mimicking symptoms, as well as advancing the understanding of the physiological changes that underlie the body's response to stroke. This study uses machine learning-based analysis of gene co-expression to identify transcription patterns characteristic of patients with acute ischemic stroke. METHODS: Mutual information values for the expression levels among 13,243 quantified transcripts were computed for blood samples from 82 stroke patients and 68 controls to construct a co-expression network of genes (separately) for stroke and control samples. Page rank centrality scores were computed for every gene; a gene's significance in the network was assessed according to the differences in their network's pagerank centrality between stroke and control expression patterns. A hybrid genetic algorithm - support vector machine learning tool was used to classify samples based on gene centrality in order to identify an optimal set of predictor genes for stroke while minimizing the number of genes in the model. RESULTS: A predictive model with 89.6% accuracy was identified using 6 network-central and differentially expressed genes (ID3, MBTPS1, NOG, SFXN2, BMX, SLC22A1), characterized by large differences in association network connectivity between stroke and control samples. In contrast, classification models based solely on individual genes identified by significant fold-changes in expression level provided lower predictive accuracies: < 71% for any single gene, and even models with larger (10-25) numbers of gene transcript biomarkers gave lower predictive accuracies (≤ 82%) than the 6 network-based gene signature classification. miRNA:mRNA target prediction computational analysis revealed 8 differentially expressed micro-RNAs (miRNAs) that are significantly associated with at least 2 of the 6 network-central genes. CONCLUSIONS: Network-based models have the potential to identify a more statistically robust pattern of gene expression typical of acute ischemic stroke and to generate hypotheses about possible interactions among functionally relevant genes, leading to the identification of more informative biomarkers.


Assuntos
Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/genética , Regulação da Expressão Gênica , Redes Reguladoras de Genes , Modelos Genéticos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/genética , Bases de Dados Genéticas , Perfilação da Expressão Gênica , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Anotação de Sequência Molecular
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 72, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387626

RESUMO

BACKGROUND: Dizziness is a frequent reason for visiting emergency departments (EDs). Differentiating stroke from other causes is challenging for physicians. The role of biomarkers has been poorly assessed. We evaluated whether copeptin and S100b protein (PS100b) assessment, alone or in combination, could rule out stroke in patients visiting EDs for dizziness. METHODS: We included patients 18 years of age or older, visiting the adult ED of a French university hospital for a new episode of dizziness evolving for less than 72 h. All patients underwent standardized physical examination (HINT [Head Impulse test, Nystagmus, test of skew deviation] maneuvers), copeptin and S-100b protein (PS100) measurement and injected brain imaging. Stroke diagnosis involved diffusion-weighted magnetic resonance imaging or, if not available, neurological examination and contrast brain CT scan compatible with the diagnosis. RESULTS: Of the 135 patients participating in the study, 13 (10%) had stroke. The sensitivity, specificity and positive and negative predictive values of copeptin/PS100 combination were 100% (95%CI, 77-100%), 48% (40-57%), 14% (11-27%) and 100% (94-100%), respectively. Values for copeptin alone were 77% (CI95% 0.50-0.91), 50% (CI95% 0.49-0.58), 14% (CI95% 0.08-0.24), 93% (CI95% 0.87-0.98), and for PS100 alone were 54% (CI95% 0.29-0.77), 97% (CI95% 0.92-0.99), 64% (CI95% 0.35-0.84), 95% (CI95% 0.90-0.98). CONCLUSIONS: Absence of copeptin and PS100 elevation seems to ruling out the diagnosis of stroke in patients visiting the ED for a new episode of dizziness. These results need to be confirmed in a large-scale study.


Assuntos
Tontura/diagnóstico , Serviço Hospitalar de Emergência , Glicopeptídeos/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Acidente Vascular Cerebral/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Imagem de Difusão por Ressonância Magnética/métodos , Tontura/sangue , Tontura/etiologia , Feminino , Humanos , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia
18.
J Stroke Cerebrovasc Dis ; 28(10): 104278, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326271

RESUMO

BACKGROUND: Prior studies have shown that warfarin is effective for both primary and secondary stroke prevention in individuals with atrial fibrillation. It is also known that those on warfarin with atrial fibrillation often have poorer long-term poststroke outcomes, possibly because cardioembolic strokes tend to be larger and more severe. Less is known regarding the direct effect of the international normalized ratio (INR) value at the time of stroke on severity or long-term functional status. METHODS: We prospectively followed a consecutive series of 112 patients presenting to our institution with acute ischemic stroke between 2013 and 2018 who were on warfarin. Along with INR on admission, data were collected regarding patient demographics, vascular risk factors, stroke characteristics, and functional outcomes. Patients were stratified by INR into "therapeutic" and "subtherapeutic" groups. Stroke severity (NIH Stroke Scale), infarct volume, and outcome (modified Rankin Scale) were assessed on admission, discharge, and follow-up (3 months poststroke). Differences were calculated using Student's t-tests and regression analyses. RESULTS: The average INR on admission was 1.6 for the entire cohort. Seventy six percent were subtherapeutic on admission (INR < 2.0). Therapeutic patients had lower National Institutes of Health Stroke Scale scores on admission (5.9 versus 9.5, P = .033), significantly smaller stroke volumes (19.5 cc versus 49.2 cc, P = .036), and were more likely to show more than 1 digit improvement on follow-up mRS than subtherapeutic patients. CONCLUSIONS: Stroke size and severity is significantly reduced in patients with ischemic strokes who present therapeutic on warfarin. The greater volume of brain saved may ultimately lead to better functional recovery.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Isquemia Encefálica/prevenção & controle , Coeficiente Internacional Normatizado , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos
19.
BMC Med ; 17(1): 141, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31327319

RESUMO

OBJECTIVES: Since low insulin-like growth factor (IGF) 1 is often linked to inflammation, we analyze whether serum levels of IGF1 are associated with cardiovascular disease (CVD) in rheumatoid arthritis (RA) in a longitudinal observational study. METHODS: A CVD risk was estimated (eCVR) in 184 female RA patients (mean age 52 years) and in 132 female patients after ischemic stroke (mean age 56 years) with no rheumatic disease, using the Framingham algorithm. The median level of IGF1 divided the cohorts in IGF1high and IGF1low groups. A 5-year prospective follow-up for new CVD events was completed in all RA patients. The Mantel-Cox analysis and event-free survival curves were prepared. Unsupervised clustering of proteins within the IGF1 signaling pathway was employed to identify their association with eCVR. RESULTS: Low IGF1 resulted in a higher eCVR in RA patients (7.2% and 3.3%, p = 0.0063) and in stroke (9.3% and 7.1%, p = 0.033). RA had higher rate for new CVD events at prospective follow-up (OR 4.96, p = 0.028). Hypertension was the major risk factor associated with low IGF1 in RA and stroke. In hypertension, IGF1 was no longer responsible for intracellular activation and lost its correlation to IRS1/2 adaptor proteins. The clustering analysis confirmed that combination of low IGF1 and IRS1/2 with high IL6, insulin, and glucose predisposed to high eCVR and emphasized the functional role of serum IGF1. CONCLUSIONS: Low serum IGF1 precedes and predicts development of early CVD events in female RA patients. Hypertension and aberrant IGF1 receptor signaling are highlighted as the important contributors to IGF1-related CVD events.


Assuntos
Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Doenças Cardiovasculares/diagnóstico , Hipertensão/sangue , Hipertensão/complicações , Fator de Crescimento Insulin-Like I/metabolismo , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Estudos de Coortes , Feminino , Humanos , Hipertensão/diagnóstico , Fator de Crescimento Insulin-Like I/análise , Estudos Longitudinais , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
20.
J Stroke Cerebrovasc Dis ; 28(10): 104283, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324409

RESUMO

INTRODUCTION: Administering intravenous IV tissue plasminogen activator (tPA) is the recommended standard of care in acute ischemic stroke (AIS), although it is not recommended to administer intravenous thrombolysis with tPA following heparin reversal with protamine sulfate in patients with AIS. METHODS: We describe a case series of three patients and the most comprehensive literature review published to date in this specific subset of AIS patients undergoing thrombolysis following heparin reversal with protamine sulfate. The literature review was based on a scoping review methodology performed on four databases; PubMed, CINAHL, Web of Science, and Cochrane Library. All sources were searched from the inauguration of the database until February 2019. A total of six articles involving eight patients were identified. RESULTS: The primary safety outcome of no symptomatic intracranial hemorrhage (sICH) was met in all eleven patients, although only seven cases had a good functional outcome at 3 months. CONCLUSIONS: In appropriately selected AIS patients, coagulopathy correction appears to be safe from an sICH standpoint and may be beneficial. However, given the potential for bias with observational databases, case reports and case series, extreme caution is warranted in applying these results to routine clinical practice.


Assuntos
Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Antagonistas de Heparina/uso terapêutico , Heparina/uso terapêutico , Protaminas/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Feminino , Fibrinolíticos/efeitos adversos , Heparina/efeitos adversos , Antagonistas de Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Protaminas/efeitos adversos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
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