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1.
Einstein (Sao Paulo) ; 17(4): eAO4609, 2019 Aug 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460616

RESUMO

OBJECTIVE: To ascertain the safety, effectiveness and reproducibility of screening potential neurosurgical patients by means of smartphones. METHODS: This is a retrospective and multicentric study. Data were collected from the medical records of patients subjected to real emergency neurosurgical evaluations and compared with assessments by neurosurgeons using smartphones to determine the feasibility of identifying changes in cranial computed tomography scans, potentially serious conditions of patients, and the need for transfer to reference centers. RESULTS: We analyzed 232 cases. The main diagnosis was traumatic brain injury, with 119 cases (51.3%). Of this, 105 (45.3%) patients were discharged immediately after the assessment. The telemedicine evaluators presented 95.69% accuracy in the identification of changes in computed tomography scans, with 0.858 concordance. Accuracy in the identification of severity was 95.26%, with 0.858 concordance. As for procedure, the concordance among evaluators was 0.672, increasing to 100% in cases that required surgical treatment. CONCLUSION: Our study indicated that the use of telemedicine for screening patients with acute neurological disorders was safe, effective and reproducible. Implementation of the method shows a promising potential to improve the patient's outcome by reducing unnecessary transfers and decreasing the time elapsed until a specialist can be consulted.


Assuntos
Transtornos Cerebrovasculares/diagnóstico por imagem , Smartphone , Telemedicina/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/cirurgia , Criança , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Telemedicina/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Stud Health Technol Inform ; 264: 1576-1577, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438239

RESUMO

Cerebrovascular and hypertensive diseases are among the leading causes of death in the world. This study was developed in two stages: the development of a dashboard with specific reports of cerebrovascular diseases and applied a preliminary predictive analysis model for cerebrovascular diseases. The results demonstrate the abitity to predict a citizen's chance acquiring a cerebrovascular disease.


Assuntos
Transtornos Cerebrovasculares , Humanos , Hipertensão , Atenção Primária à Saúde
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(6): 479-485, 2019 Jun 24.
Artigo em Chinês | MEDLINE | ID: mdl-31262133

RESUMO

Objective: To investigate the level and trend of cardiovascular disease mortality in China from 2002 to 2016. Methods: Using data of China Health Statistics Yearbook (2003-2012) and China's Health and Family Planning Statistical Yearbook (2013-2017),we calculated the age-standardized mortality rates (ASMR) in China. Joinpoint regression model was employed to estimate the annual percent change (APC) and average annual percent change (AAPC) of cardiovascular disease ASMR. Results: (1)The ASMR of cardiovascular disease were 225.65/100 thousands, 242.74/100 thousands, 214.63/100 thousands, 240.97/100 thousands, 195.24/100 thousands, 201.50/100 thousands, 208.83/100 thousands, 248.44/100 thousands, 261.38/100 thousands, 231.98/100 thousands, 210.25/100 thousands, 237.80/100 thousands, 235.21/100 thousands, 237.58/100 thousands,and 237.25/100 thousands from 2002 to 2016, and there was no significant difference in ASMR of cardiovascular disease (AAPC=0.2%, P>0.05) . The ASMR of chronic rheumatic heart disease decreased significantly (AAPC=-4.5%,P<0.05). There were no significant differences in ASMR of cerebrovascular disease, hypertensive heart disease, and ischemic heart disease (AAPC=0, P>0.05; AAPC=2.0%, P>0.05; AAPC=4.3%, P>0.05, respectively). (2) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in city and country (AAPC=-0.7%, P>0.05; AAPC=0.8%, P>0.05, respectively). The ASMR of chronic rheumatic heart disease decreased significantly in city and rural area (AAPC=-4.4%, P<0.05; AAPC=-4.6%, P<0.05, respectively). (3) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in male and female (AAPC=-0.3%,P>0.05; AAPC=-0.2%,P>0.05,respectively). The ASMR of chronic rheumatic heart disease decreased significantly in female (AAPC=-4.2%, P<0.05). The ASMR of ischemic heart disease increased significantly in male and female (AAPC=4.7%,P<0.05; AAPC=5.2%,P<0.05,respectively). (4) The ASMR of cardiovascular disease showed a significant upward trend in residents aged 15 to 34 from 2002 to 2016 (AAPC=3.1, P<0.05). There were no significant differences in ASMR of cardiovascular disease in residents aged 35 to 64 and ≥65 (AAPC=-0.1%, P>0.05; AAPC=-0.2%, P>0.05, respectively). Conclusion: The ASMR of cardiovascular disease in China remains stable during 2002 to 2016, and the ASMR of cardiovascular disease shows upward trend among young people.


Assuntos
Doenças Cardiovasculares , Transtornos Cerebrovasculares , Isquemia Miocárdica , Adolescente , Adulto , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
Int Heart J ; 60(4): 910-918, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308328

RESUMO

Previous studies have provided established evidence on adverse outcomes of the coadministration of proton pump inhibitors (PPIs) and clopidogrel, whereas cerebro-cardiovascular outcomes of PPI use in the absence of clopidogrel therapy remain controversial.In this study, we aimed to assess the association between PPIs and cerebro-cardiovascular outcomes independent of clopidogrel.Systematic searches were conducted in the Cochrane Library, PubMed, and Embase databases for all relevant studies up to August 2018. Odds ratios (ORs) with its 95% confidence intervals (CIs) were abstracted and pooled using the random-effects model.A total of 14 observational studies (13 cohort studies and 1 case-control study) were identified. Compared with non-PPI users, PPI users experienced higher risks of stroke (OR: 1.22, 95% CI: 1.08-1.36), myocardial infarction (MI; OR: 1.23, 95% CI: 1.14-1.32), cardiovascular death (OR: 1.83, 95% CI: 1.69-1.98), and major adverse cardiovascular events (MACEs; OR: 1.22, 95% CI: 1.05-1.40) independent of clopidogrel use, but not all-cause death (OR: 1.50, 95% CI: 0.99-2.25). In the subgroup analysis, PPI alone was associated with significant risks of new-onset MI (OR: 1.23, 95% CI: 1.13-1.35) and stroke (OR: 1.17, 95% CI: 1.05-1.30) in patients without previous MI or stoke and recurrent MI (OR: 1.24, 95% CI: 1.02-1.51) and stroke (OR: 1.36, 95% CI: 1.19-1.55) risks in patients with a previous MI.Based on current publications, PPI use seems to be associated with increased risks of stroke, MI, cardiovascular death, and MACEs independent of clopidogrel. Greater caution should be therefore exercised while considering its clinical benefits and further investigate any causal relationships.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Transtornos Cerebrovasculares/tratamento farmacológico , Clopidogrel/farmacologia , Inibidores da Bomba de Prótons/farmacologia , Doenças Cardiovasculares/mortalidade , Causas de Morte/tendências , Transtornos Cerebrovasculares/mortalidade , Saúde Global , Humanos , Estudos Observacionais como Assunto , Inibidores da Agregação de Plaquetas/farmacologia , Fatores de Risco , Taxa de Sobrevida/tendências
5.
Medicine (Baltimore) ; 98(28): e15959, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305390

RESUMO

The prognostic significance of systemic atherothrombosis in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the relation between the presence of polyvascular disease (PVD) and cardiovascular outcomes in HFpEF patients.A total of 510 consecutive HFpEF patients were prospectively observed for up to 1500 days or until occurrence of cardiovascular events. PVD was defined as ≥2 coexistence of coronary artery disease, peripheral arterial disease, and cerebrovascular disease.Overall, 124 cardiovascular events were observed during follow-up (median: 1430 days). Kaplan-Meier curve showed HFpEF with PVD (n = 84) experienced more cardiovascular events than did those without PVD patients (44.0% vs 20.4%, log-rank: P < .001). Multivariable Cox proportional hazards analysis with significant factors from univariate analysis showed the presence of PVD (hazard ratio [HR]: 2.875, 95% [CI]: 1.894-4.365, P < .001), previous HF hospitalization (HR: 1.578, 95% CI: 1.031-2.414, P = .036), hemoglobin (HR: 0.889, 95% CI: 0.805-0.983, P = .021), serum sodium (HR: 0.946, 95% CI 0.896-1.000, P = .048), ln-BNP (per 1.0, HR: 1.255, 95% CI: 1.055-1.494, P = .010), and E/e' (HR: 1.047, 95% CI: 1.020-1.075, P < .001) significantly predicted future cardiovascular events. Multivariable Cox hazard analysis with 4 established factors (age, BNP, diabetes mellitus, and previous HF hospitalization) from the I-PRESERVE (Irbesartan in HFpEF) study showed PVD was independently associated with cardiovascular events in HFpEF patients (HR: 2.562, 95% CI: 1.715-3.827, P < .001).The presence of PVD is significantly associated with cardiovascular events in HFpEF, suggesting the importance of screening PVD in HFpEF.


Assuntos
Transtornos Cerebrovasculares/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Insuficiência Cardíaca/diagnóstico , Doença Arterial Periférica/diagnóstico , Idoso , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Biomarcadores/sangue , Transtornos Cerebrovasculares/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Doença Arterial Periférica/epidemiologia , Prevalência , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Resultado do Tratamento , Função Ventricular Esquerda
6.
Brain Nerve ; 71(7): 815-819, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31289255

RESUMO

A 52-year-old woman taking a Chinese herbal medicine for 10 months was admitted to our hospital for recurrent severe headaches, nausea and vomiting. Brain magnetic resonance imaging revealed convexity subarachnoid hemorrhage in the left occipital and parietal lobes. Brain magnetic resonance angiography (MRA) showed multifocal segmental stenosis of cerebral arteries. Clinical symptoms resolved after treatments with nicardipine and verapamil. Follow-up MRA at 31 days after the onset showed complete disappearance of multifocal stenosis of cerebral arteries, confirming the diagnosis of reversible cerebral vasoconstriction syndrome (RCVS). It was suggested that licorice and evodia fruit, which were components of a Chinese herbal medicine named tokishigyakukagoshuyushokyoto were the precipitating factors of vasoconstriction. It is important for physicians to recognize that herbal supplements could be one of the causes of RCVS. (Received January 22, 2019; Accepted April 3, 2019; Published July 1, 2019).


Assuntos
Transtornos Cerebrovasculares/induzido quimicamente , Medicamentos de Ervas Chinesas/efeitos adversos , Transtornos Cerebrovasculares/diagnóstico por imagem , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Vasoconstrição
7.
Medicine (Baltimore) ; 98(27): e16175, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277122

RESUMO

BACKGROUND: Chronic cerebral circulation insufficiency (CCCI) is a common clinical cerebrovascular disease, especially among middle-aged and elderly patients, which seriously endangers their quality of life and physical and mental health. At present, Oral traditional Chinese patent medicine (OTCPM) is widely used in the treatment of CCCI in China, but its actual efficacy and safety lack of evidence-based evidence. Therefore, we will screen out the most effective OTCPM through a systematic review and network meta-analysis to provide a reliable theoretical basis for clinical decisions. METHODS: We will search electronic databases to collect relevant RCT studies from inception to October 2019. Those electronic databases include PubMed, Cochrane Library, Web of Science, EMBASE, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan-fang database. Only randomized clinical trials (RCTs) concerned any OTCPM treatments for CCCI will be collected. The included studies will no restrictions on language or publication year. There were no publication year or language for the included literature. Risk bias tools will assess the quality of the included literature. A Bayesian NMA will be performed to combine the direct and indirect comparisons of TCPMs interventions. The surface under the cumulative ranking curve (SUCRA) will be drawn to display the hierarchy of each TCPMs treatment. All statistical analyses will be implemented using R v3.5.2. and GeMTC v1.4.3.We will publish this systematic review in academic journals. Since this literature review will not involve directly contacting patients, ethical approval and informed consent are not required. TRIAL REGISTRATION NUMBER: CRD42019123878.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Transtornos Cerebrovasculares/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Administração Oral , Humanos , Medicina Tradicional Chinesa , Metanálise como Assunto , Meta-Análise em Rede , Revisão Sistemática como Assunto
8.
Artigo em Russo | MEDLINE | ID: mdl-31156227

RESUMO

The review presents modern clinical and radiological criteria for cerebral small vessel disease and silent cerebrovascular diseases. The authors discuss the STRIVE criteria, ideas about the pathogenesis, morphological changes and proposed options for the prevention of disease progression. As a drug of choice, the authors recommend vinpocetine (cavinton), which has the ability to influence many parts of the pathogenesis of cerebral small vessel disease.


Assuntos
Doenças de Pequenos Vasos Cerebrais , Transtornos Cerebrovasculares , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Doenças de Pequenos Vasos Cerebrais/prevenção & controle , Doenças de Pequenos Vasos Cerebrais/terapia , Circulação Cerebrovascular , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/prevenção & controle , Transtornos Cerebrovasculares/terapia , Humanos
9.
Artigo em Russo | MEDLINE | ID: mdl-31156231

RESUMO

Cerebrovascular diseases (CVD) are the main cause of death and permanent disability. The urgency of the problem of chronic CVD is associated with an increase of the absolute number of elderly and senile age in the population, a trend towards slowly increasing, sluggish pathological processes. It is obvious that any somatic disease in such patients is comorbid to cerebrovascular diseases that suggests a unified mechanism of the pathogenesis for both the main and concomitant diseases. The article notes that microangiopathy is the most common cause of CVD. The main etiopathogenetic factor affecting cerebral vessels of small caliber is endothelial dysfunction, systemic inflammation and oxidative stress. Understanding the molecular components that underlie functional abnormalities and damage of small blood vessels gives the key to the modern strategies in therapy, forming the foundation for an adequate pathogenetically justified therapy. This impact should be gradual, complex and aimed at correcting pathochemical disorders in general and neurotransmitter imbalance in particular. The drug dipyridamole, which has pleiotropic effects, can be considered as one of the pathogenetically justified means in complex drug therapy in patients with CVD.


Assuntos
Transtornos Cerebrovasculares , Inflamação , Estresse Oxidativo , Idoso , Transtornos Cerebrovasculares/imunologia , Transtornos Cerebrovasculares/metabolismo , Doença Crônica , Comorbidade , Humanos
10.
Rev Med Liege ; 74(5-6): 314-320, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-31206273

RESUMO

Alcohol may exert both positive and negative effects on cardiovascular system. Several factors may modulate these effects, among which, most importantly, the daily dose but also consumption modalities (type of beverage, regular or hectic consumption, for instance). Many epidemiological studies showed a J curve, with a greater risk of cardiovascular disease in non-consumers compared with light to moderate regular drinkers, but with a higher risk in heavy drinkers, in a dose-dependent manner. This article analyses the complex relationships between alcohol consumption and the risk of coronary and cerebrovascular diseases, including cardiovascular mortality. Owing to the remaining uncertainties, in absence of controlled trials, and the difficulty not to overcome the positive threshold, it is not currently recommended to drink alcohol in order to benefit of a cardiovascular protection.


Assuntos
Consumo de Bebidas Alcoólicas , Doenças Cardiovasculares , Transtornos Cerebrovasculares , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/prevenção & controle , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/prevenção & controle , Humanos , Fatores de Risco
11.
J Stroke Cerebrovasc Dis ; 28(9): 2574-2579, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239220

RESUMO

GOALS: While mechanical thrombectomy (MT) has been shown to be effective in the treatment of acute large vessel occlusions, adjunctive measures, such as balloon guide catheters (BGC) and aspiration techniques, are utilized heterogeneously. Clarifying the effects of aspiration applied to the anterior cerebral circulation with proximal flow arrest can shed light on embolic protection during MT. MATERIALS AND METHODS: Manual and pump aspiration were applied through a BGC in a synthetic cerebrovascular model with a 60 ml syringe and a Penumbra pump, respectively. Flow direction was observed during the procedure with fluorescent particles and ultraviolet light. Flow rates were monitored at the simulated internal carotid artery and middle cerebral artery (MCA). FINDINGS: Both aspiration methods produced retrograde flow in all the modeled cerebrovascular segments. In the syringe aspiration methods, an interval phase occurred during the experimental trial in which suction forces paused and MCA flow became anterograde through posterior communication artery collateral circulation. CONCLUSION: Flow patterns vary with different methods of aspiration. With proximal flow arrest, continuous aspiration methods induce constant retrograde flow in all vessels, whereas manual aspiration demonstrates various flow changes, including periods of anterograde flow during the procedure, which may be less effective at distal re-embolization prevention.


Assuntos
Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Transtornos Cerebrovasculares/terapia , Artéria Cerebral Média/fisiopatologia , Trombectomia/métodos , Velocidade do Fluxo Sanguíneo , Transtornos Cerebrovasculares/fisiopatologia , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/prevenção & controle , Modelos Anatômicos , Fatores de Risco , Sucção , Seringas , Trombectomia/efeitos adversos , Trombectomia/instrumentação , Fatores de Tempo , Dispositivos de Acesso Vascular
13.
Neurología (Barc., Ed. impr.) ; 34(5): 309-317, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180847

RESUMO

Introducción: En las últimas décadas las tasas de mortalidad por enfermedades cerebrovasculares (ECV) han descendido de forma importante en muchos países. En este estudio se analizan los cambios recientes en la evolución de la mortalidad por ECV en Andalucía (1980-2014) para verificar si las tendencias observadas previamente por sexo y grupos de edad continúan. Pacientes y métodos: Los datos de mortalidad por ECV y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad y estandarizadas mediante el método directo (población estándar europea). Mediante análisis de regresión «joinpoint» estimamos el porcentaje de cambio anual de las tasas e identificamos puntos de cambio significativos en la tendencia. Además se han estimado las razones de tasas entre Andalucía y España. Resultados: Las tasas estandarizadas en ambos sexos muestran en el análisis joinpoint 3 periodos: un periodo inicial de descenso significativo (1980-1997), un periodo de estabilización en las tasas (1997-2003) y un periodo de marcado descenso significativo (2003-2014). Conclusiones: En el periodo 1997-2003 las tasas de Andalucía se estabilizaron, mientras que a nivel nacional las tasas continuaron descendiendo. Esto determinó un aumento en la brecha entre las tasas de Andalucía y España en ambos sexos y en la mayoría de los grupos de edad


Introduction: In recent decades, mortality rates for cerebrovascular diseases (CVD) have decreased significantly in many countries. This study analyses recent tendencies in CVD mortality rates in Andalusia (1980-2014) to identify any changes in previously observed sex and age trends. Patients and methods: CVD mortality and population data were obtained from Spain's National Statistics Institute database. We calculated age-specific and age-standardised mortality rates using the direct method (European standard population). Joinpoint regression analysis was used to estimate the annual percentage change in rates and identify significant changes in mortality trends. We also estimated rate ratios between Andalusia and Spain. Results: Standardised rates for both males and females showed 3 periods in joinpoint regression analysis: an initial period of significant decline (1980-1997), a period of rate stabilisation (1997-2003), and another period of significant decline (2003-2014). Conclusions: Between 1997 and 2003, age-standardised rates stabilised in Andalusia but continued to decrease in Spain as a whole. This increased in the gap between CVD mortality rates in Andalusia and Spain for both sexes and most age groups


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Transtornos Cerebrovasculares/mortalidade , Indicadores de Morbimortalidade , Estudos Epidemiológicos , Distribuição por Idade e Sexo , Registros de Mortalidade/estatística & dados numéricos , Mortalidade/tendências
14.
BMC Neurol ; 19(1): 115, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170963

RESUMO

BACKGROUND: Fabry disease is rare, and the diagnosis is often delayed. Here, we describe a case of Fabry disease resulting in vasculopathy of the central nervous system. Magnetic resonance (MR) black-blood sequence (three-dimensional T1 volumetric isotropic turbo spin echo acquisition), with the unique advantage of imaging the vascular wall, facilitated a clear identification of the vasculopathy. CASE PRESENTATION: A 27-year-old man visited our hospital for the treatment of " double vision 6d." After a series of examinations, the patient was diagnosed with Fabry disease, which caused vasculopathy of the central nervous system. Subsequently, the patient was treated with corticosteroids and his symptoms were attenuated. Two months after the initial treatment, the initial lesion in the vascular vessel disappeared, however, a new lesion appeared. Similarly, four months after the initial treatment, although the previous lesion disappeared, a new lesion appeared. CONCLUSIONS: This case highlights that clinicians should use MR black-blood sequence scan in a timely manner in case of young patients with migratory lesions of brain. In case of detection of a vascular lesion in combination with other systemic lesions, the possibility of Fabry disease should be considered.


Assuntos
Transtornos Cerebrovasculares , Doença de Fabry/diagnóstico , Adulto , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Doença de Fabry/complicações , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino
15.
Dtsch Med Wochenschr ; 144(10): 651-658, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31083733

RESUMO

Headache is one of patients' most common reasons to consult their general practitioner and covers about 2 - 5 % of the consultations in primary care. Often, the general practitioner is the first to be contacted by patients with headache. Mostly, headaches are primary and only 2 % of the patients have secondary headaches. The distinction between primary and secondary headache is the most important step in the management of patients with headache in primary care. Therefore, this article shows important elements of anamnesis and examination of headache patients in primary care. Furthermore, this article focuses on identification of red flags and yellow flags in the consultation of patients with headache and suggests recommendations for referral to emergency department, hospital care or specialist treatment.


Assuntos
Transtornos da Cefaleia , Cefaleia , Adulto , Transtornos Cerebrovasculares , Medicina de Família e Comunidade , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Transtornos da Cefaleia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta
16.
Mol Med Rep ; 19(6): 4852-4862, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31059068

RESUMO

Cerebrovascular disease (CVD) is one of the leading causes of mortality worldwide. The role of cytochrome c oxidase subunit 6B1 (COX6B1) in the central nervous system remains unclear. The present study aimed to analyze the role of COX6B1 in rat hippocampal neurons extracted from fetal rats. The subcellular localization of the neuron­specific marker microtubule­associated protein 2 was detected by immunofluorescence assay. Cell viability was assessed using a cell counting kit, and the levels of apoptosis and cytosolic Ca2+ were analyzed by flow cytometry. The expression levels of the molecular factors downstream to COX6B1 were determined using reverse transcription­quantitative polymerase chain reaction and western blotting. Reoxygenation following oxygen­glucose deprivation (OGD) decreased cell viability and the expression levels of COX6B1 in a time­dependent manner, and 60 min of reoxygenation was identified as the optimal time period for establishing an ischemia/reperfusion (I/R) model. Overexpression of COX6B1 was demonstrated to reverse the viability of hippocampal neurons following I/R treatment. Specifically, COX6B1 overexpression decreased the cytosolic concentration of Ca2+ and suppressed neuronal apoptosis, which were increased following I/R treatment. Furthermore, overexpression of COX6B1 increased the protein expression levels of apoptosis regulator BCL­2 and mitochondrial cytochrome c (cyt c), and decreased the protein expression levels of apoptosis regulator BCL2­associated X and cytosolic cyt c in I/R model cells. Collectively, the present study results suggested that COX6B1 overexpression may reverse I/R­induced neuronal damage by increasing the viability of neurons, by decreasing the cytosolic levels of Ca2+ and by suppressing apoptosis. These results may facilitate the development of novel strategies for the prevention and treatment of CVD.


Assuntos
Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Complexo IV da Cadeia de Transporte de Elétrons/farmacologia , Neurônios/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Lobo Temporal/metabolismo , Animais , Apoptose/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Transtornos Cerebrovasculares/prevenção & controle , Citocromos c/metabolismo , Complexo IV da Cadeia de Transporte de Elétrons/genética , Feminino , Glucose/metabolismo , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Neurônios/patologia , Oxigênio/metabolismo , Substâncias Protetoras/metabolismo , Substâncias Protetoras/farmacologia , Ratos , Ratos Sprague-Dawley , Lobo Temporal/patologia , Proteína bcl-X/metabolismo
17.
Mol Med Rep ; 19(6): 4753-4760, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31059085

RESUMO

Increased plasma levels of homocysteine (Hcy) can cause severe damage to vascular endothelial cells. Hcy­induced endothelial cell dysfunction contributes to the occurrence and development of human cerebrovascular diseases (CVDs). Our previous studies have revealed that astaxanthin (ATX) exhibits novel cardioprotective activity against Hcy­induced cardiotoxicity in vitro and in vivo. However, the protective effect and mechanism of ATX against Hcy­induced endothelial cell dysfunction requires further investigation. In the present study, treatment of human umbilical vascular endothelial cells (HUVECs) with Hcy inhibited the migration, invasive and tube formation potentials of these cells in a dose­dependent manner. Hcy treatment further induced a time­dependent increase in the production of reactive oxygen species (ROS), and downregulated the expression of vascular endothelial growth factor (VEGF), phosphorylated (p)­Tyr­VEGF receptor 2 (VEGFR2) and p­Tyr397­focal adhesion kinase (FAK). On the contrary, ATX pre­treatment significantly inhibited Hcy­induced cytotoxicity and increased HUVEC migration, invasion and tube formation following Hcy treatment. The mechanism of action may involve the effective inhibition of Hcy­induced ROS generation and the recovery of FAK phosphorylation. Collectively, our findings suggested that ATX could inhibit Hcy­induced endothelial dysfunction by suppressing Hcy­induced activation of the VEGF­VEGFR2­FAK signaling axis, which indicates the novel therapeutic potential of ATX in treating Hcy­mediated CVD.


Assuntos
Células Endoteliais/efeitos dos fármacos , Proteína-Tirosina Quinases de Adesão Focal/metabolismo , Homocisteína/efeitos adversos , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Movimento Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Transtornos Cerebrovasculares/tratamento farmacológico , Transtornos Cerebrovasculares/metabolismo , Transtornos Cerebrovasculares/patologia , Relação Dose-Resposta a Droga , Regulação para Baixo , Células Endoteliais/patologia , Quinase 1 de Adesão Focal/metabolismo , Humanos , Fosforilação , Xantofilas/antagonistas & inibidores
18.
Neurol India ; 67(2): 364-369, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31085837

RESUMO

Background: Remarkable advancements in the understanding of etiological risk factors and pathophysiology of cerebrovascular diseases have led to the refining of definitions and terminologies in stroke medicine periodically. We aim to analyze the utility and meaning of different eponyms in the stroke medicine literature during the last 20 years. Materials and Methods: A systematic search was performed in Google Scholar for the words "stroke," "TIA," "cerebrovascular accident (CVA)," "cerebrovascular insult," "cerebrovascular event," "cerebral ischemia," and "cerebrovascular disease." Each of the words were searched yearwise from 1996 to 2015, and the numbers of articles using these words were collected and analyzed. Results: ": Stroke" has been the most common terminology used in literature, which showed a progressive increase in its usage until 2010, after which its use drastically reduced. "Cerebrovascular events" and "cerebral ischemia" are the second most commonly used terminologies with variable definitions; there was a steep increase in the use of these words until 2012. Conclusions: The most imprecise term that continues to be used is "CVA". The precisely defined entity like "cerebrovascular disease," which is a group of diseases, continues to be used inappropriately. All the terms are not defined uniformly across the globe, whereas most continue to use the World Health Organisation definition of stroke, defined in the 1970s. It is essential to condemn the use of imprecise terminologies and promote the use of recently defined precise terms "stroke" and "transient ischemic attack (TIA)". Unless the same terms with precise definitions are used in clinical practice or literature, the progress of stroke medicine will continue to be hampered.


Assuntos
Isquemia Encefálica/etiologia , Transtornos Cerebrovasculares/complicações , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral/etiologia , Infarto Cerebral/complicações , Transtornos Cerebrovasculares/diagnóstico , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico
19.
High Blood Press Cardiovasc Prev ; 26(3): 183-189, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31144248

RESUMO

Cardiovascular events are the consequence of vascular damage at both the macro and microcirculatory level. The relationship between large stiffening artery and microvascular disease may be bidirectional, since wave reflection from microvascular sites could increase systolic blood pressure and pulse pressure, while transmission of increased arterial pulsatility to microvessels could represent a mechanism of damage. Hypertension and aging share similar mechanisms of vascular dysfunction. In fact, vascular remodelling, endothelial dysfunction and vascular stiffness are common features in hypertension and aging. Structural and functional changes in small arteries occur during normal and accelerated aging, possibly triggered by hypertension. A cross-talk may be present between large and small artery changes, interacting with pressure wave transmission and reflection, exaggerating cardiac, brain and kidney damage, and finally leading to cardiovascular and renal complications.


Assuntos
Envelhecimento , Doenças Cardiovasculares/fisiopatologia , Microcirculação , Microvasos/fisiopatologia , Remodelação Vascular , Rigidez Vascular , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Feminino , Humanos , Hipertensão/patologia , Hipertensão/fisiopatologia , Masculino , Microvasos/patologia , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Resistência Vascular
20.
Chin Med J (Engl) ; 132(8): 905-913, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-30958431

RESUMO

BACKGROUND: Asymptomatic coronary artery stenosis (ACAS) ≥50% is common in patients with acute ischemic cerebrovascular disease (AICVD), which portends a poor cardiovascular and cerebrovascular prognosis. Identifying ACAS ≥50% early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients. This study aimed to investigate whether aortic arch plaque (AAP), an early atherosclerotic manifestation of brain blood-supplying arteries, could be a predictor for ACAS ≥50% in AICVD. METHODS: In this cross-sectional study, atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history. The patients were divided into ACAS ≥50% and non-ACAS ≥50% groups according to whether CTA showed stenosis ≥50% in at least one coronary arterial segment. The AAP characteristics of CTA were depicted from aspects of thickness, extent, and complexity. RESULTS: Among 118 analyzed patients with AICVD, 29/118 (24.6%) patients had ACAS ≥50%, while AAPs were observed in 86/118 (72.9%) patients. Increased AAP thickness per millimeter (adjusted odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.18-2.05), severe-extent AAP (adjusted OR: 13.66, 95% CI: 2.33-80.15), and presence of complex AAP (adjusted OR: 7.27, 95% CI: 2.30-23.03) were associated with ACAS ≥50% among patients with AICVD, independently of clinical demographics and cervicocephalic atherosclerotic stenosis. The combination of AAP thickness, extent, and complexity predicted ACAS ≥50% with an area under the receiver-operating characteristic curve of 0.78 (95% CI: 0.70-0.85, P < 0.001). All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50% in AICVD (all P < 0.05). CONCLUSIONS: Thicker, severe-extent, and complex AAP were significant markers of the concomitant ACAS ≥50% in AICVD, possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis. As an integral part of atherosclerosis of brain blood-supplying arteries, AAP should not be overlooked in predicting ACAS ≥50% for patients with AICVD.


Assuntos
Aorta Torácica/patologia , Transtornos Cerebrovasculares/diagnóstico , Estenose Coronária/diagnóstico , Placa Aterosclerótica/diagnóstico , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco
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