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1.
Sci Rep ; 13(1): 262, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609640

RESUMO

Umbilical cord blood (UCB) transplantation shows proangiogenic effects and contributes to symptom amelioration in animal models of cerebral infarction. However, the effect of specific cell types within a heterogeneous UCB population are still controversial. OP9 is a stromal cell line used as feeder cells to promote the hematoendothelial differentiation of embryonic stem cells. Hence, we investigated the changes in angiogenic properties, underlying mechanisms, and impact on behavioral deficiencies caused by cerebral infarction in UCB co-cultured with OP9 for up to 24 h. In the network formation assay, only OP9 pre-conditioned UCB formed network structures. Single-cell RNA sequencing and flow cytometry analysis showed a prominent phenotypic shift toward M2 in the monocytic fraction of OP9 pre-conditioned UCB. Further, OP9 pre-conditioned UCB transplantation in mice models of cerebral infarction facilitated angiogenesis in the peri-infarct lesions and ameliorated the associated symptoms. In this study, we developed a strong, fast, and feasible method to augment the M2, tissue-protecting, pro-angiogenic features of UCB using OP9. The ameliorative effect of OP9-pre-conditioned UCB in vivo could be partly due to promotion of innate angiogenesis in peri-infarct lesions.


Assuntos
Sangue Fetal , Células Estromais , Camundongos , Animais , Células Estromais/metabolismo , Técnicas de Cocultura , Diferenciação Celular , Infarto Cerebral/terapia , Infarto Cerebral/metabolismo , Infarto
3.
BMC Neurol ; 23(1): 5, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604639

RESUMO

PURPOSE: The treatment of vasospasms during endovascular stroke treatment (EST) with intra-arterial nimodipine (NM) is routinely performed. However, the efficacy of resolving iatrogenic vasospasms during the angiographic intervention and the infarct development in follow-up imaging after EST has not been studied yet. METHODS: Retrospective single-center analysis of patients receiving EST for anterior circulation vessel occlusion between 01/2015 and 12/2021. The primary endpoint was ASPECTS in follow-up imaging. Secondary endpoints were the clinical outcome (combined endpoint NIHSS 24 h after EST and difference between modified Rankin Scale (mRS) before stroke and at discharge (delta mRS)) and intracranial hemorrhage (ICH) in follow-up imaging. Patients with vasospasms receiving NM (NM+) or not (NM-) were compared in univariate analysis. RESULTS: Vasospasms occurred in 79/1283 patients (6.2%), who consecutively received intra-arterial NM during EST. The targeted vasospasm angiographically resolved in 84% (66/79) under NM therapy. ASPECTS was lower in follow-up imaging after vasospasms and NM-treatment (NM - 7 (6-9), NM + 6 (4.5-8), p = 0.013) and the clinical outcome was worse (NIHSS 24 h after EST was higher in patients treated with NM (median, IQR; NM+: 14, 5-21 vs. NM-: 9, 3-18; p = 0.004), delta-mRS was higher in the NM + group (median, IQR; NM+: 3, 1-4 vs. NM-: 2, 1-2; p = 0.011)). Any ICH (NM+: 27/79, 34.2% vs. NM-: 356/1204, 29.6%; p = 0.386) and symptomatic ICH (NM+: 2/79, 2.5% vs. NM-: 21/1204, 1.7%; p = 0.609) was equally distributed between groups. CONCLUSION: Intra-arterial nimodipine during EST resolves iatrogenic vasospasms efficiently during EST without increasing intracranial hemorrhage rates. However, patients with vasospasms and NM treatment show higher infarct growth resulting in lower ASPECTS in follow-up imaging.


Assuntos
Doenças do Sistema Nervoso Autônomo , Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Humanos , Nimodipina/uso terapêutico , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Hemorragias Intracranianas/etiologia , Trombectomia/métodos , Doenças do Sistema Nervoso Autônomo/etiologia , Infarto/etiologia , Doença Iatrogênica , Procedimentos Endovasculares/métodos , Isquemia Encefálica/tratamento farmacológico
4.
Sci Rep ; 13(1): 404, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624122

RESUMO

Automated ischemic stroke detection and classification according to its vascular territory is an essential step in stroke image evaluation, especially at hyperacute stage where mechanical thrombectomy may improve patients' outcome. This study aimed to evaluate the performance of various convolutional neural network (CNN) models on hyperacute staged diffusion-weighted images (DWI) for detection of ischemic stroke and classification into anterior circulation infarct (ACI), posterior circulation infarct (PCI) and normal image slices. In this retrospective study, 253 cases of hyperacute staged DWI were identified, downloaded and reviewed. After exclusion, DWI from 127 cases were used and we created a dataset containing total of 2119 image slices, and separates it into three groups, namely ACI (618 slices), PCI (149 slices) and normal (1352 slices). Two transfer learning based CNN models, namely Inception-v3, EfficientNet-b0 and one self-derived modified LeNet model were used. The performance of the models was evaluated and activation maps using gradient-weighted class activation mapping (Grad-Cam) technique were made. Inception-v3 had the best overall accuracy (86.3%), weighted F1 score (86.2%) and kappa score (0.715), followed by the modified LeNet (85.2% accuracy, 84.7% weighted F1 score and 0.693 kappa score). The EfficientNet-b0 had the poorest performance of 83.6% accuracy, 83% weighted F1 score and 0.662 kappa score. The activation map showed that one possible explanation for misclassification is due to susceptibility artifact. A sufficiently high performance can be achieved by using CNN model to detect ischemic stroke on hyperacute staged DWI and classify it according to vascular territory.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Isquemia Encefálica/diagnóstico por imagem , AVC Isquêmico/diagnóstico por imagem , Estudos Retrospectivos , Imagem de Difusão por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Redes Neurais de Computação , Infarto
5.
Neurosurg Rev ; 46(1): 35, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36629928

RESUMO

Cerebellar ischemic stroke (CIS) is a morbid neurological event, with potentially fatal consequences. There is currently no objective standard of care regarding when surgical procedures are required for this entity. We retrospectively reviewed 763 patients with CIS, 247 patients of which had a stroke larger than 1 cm in greatest dimension on cranial imaging. In this subgroup, 11% of patients received ventriculostomy, 12% suboccipital craniectomy, and 9% mechanical endovascular thrombectomy. Various clinical and radiographic variables were examined for relationship to surgical procedures, 30-day mortality rate, and modified Rankin scores. The smallest volume of stroke requiring a surgical procedure was 15.5 mL3 (BrainLab Software). Patients receiving surgical procedures had a higher incidence of multi-territory infarctions, hydrocephalus, cistern compression, 4th ventricular compression, as well as younger age, lower admission GCS, higher admission NIHSS, and higher 30-day mortality/disability. Patients deemed to require surgical procedures for CIS have a higher expected morbidity and mortality than those not requiring surgery. Various clinical and radiographic variables, including stroke volume, can be used to guide selection of patients requiring surgery.


Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Craniotomia , Infarto
6.
J Neuroinflammation ; 20(1): 11, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650518

RESUMO

BACKGROUND: Ischemic stroke in white matter of the brain induces not only demyelination, but also neuroinflammation. Peripheral T lymphocytes, especially regulatory T cells (Tregs), are known to infiltrate into ischemic brain and play a crucial role in modulation of inflammatory response there. We previously reported that transplantation of vascular endothelial cells generated from human induced pluripotent stem cells (iVECs) ameliorated white matter infarct. The aim of this study is to investigate contribution of the immune system, especially Tregs, to the mechanism whereby iVEC transplantation ameliorates white matter infarct. METHODS: iVECs and human Tregs were transplanted into the site of white matter lesion seven days after induction of ischemia. The egress of T lymphocytes from lymph nodes was sequestered by treating the animals with fingolimod (FTY720). The infarct size was evaluated by magnetic resonance imaging. Immunohistochemistry was performed to detect the activated microglia and macrophages, T cells, Tregs, and oligodendrocyte lineage cells. Remyelination was examined by Luxol fast blue staining. RESULTS: iVEC transplantation reduced ED-1+ inflammatory cells and CD4+ T cells, while increased Tregs in the white matter infarct. Treatment of the animals with FTY720 suppressed neuroinflammation and reduced the number of both CD4+ T cells and Tregs in the lesion, suggesting the importance of infiltration of these peripheral immune cells into the lesion in aggravation of neuroinflammation. Suppression of neuroinflammation by FTY720 per se, however, did not promote remyelination in the infarct. FTY720 treatment negated the increase in the number of Tregs by iVEC transplantation in the infarct, and attenuated remyelination promoted by transplanted iVECs, while it did not affect the number of oligodendrocyte lineage cells increased by iVEC transplantation. Transplantation of Tregs together with iVECs into FTY720-treated ischemic white matter did not affect the number of oligodendrocyte lineage cells, while it remarkably promoted myelin regeneration. CONCLUSIONS: iVEC transplantation suppresses neuroinflammation, but suppression of neuroinflammation per se does not promote remyelination. Recruitment of Tregs by transplanted iVECs contributes significantly to promotion of remyelination in the injured white matter.


Assuntos
Células-Tronco Pluripotentes Induzidas , Substância Branca , Animais , Humanos , Substância Branca/patologia , Cloridrato de Fingolimode/farmacologia , Cloridrato de Fingolimode/uso terapêutico , Linfócitos T Reguladores , Células Endoteliais , Doenças Neuroinflamatórias , Encéfalo/patologia , Isquemia/patologia , Infarto
7.
BMC Neurol ; 23(1): 31, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670367

RESUMO

BACKGROUND: Volumetric accuracy of using computed tomography perfusion (CTP) to estimate the post-treatment infarct in stroke patients with successful recanalization after mechanical thrombectomy (MT) has been studied a lot, however the spatial accuracy and its influence factors has not been fully investigated. METHODS: This retrospective study reviewed the data from consecutive anterior large vessel occlusion (LVO) patients who had baseline CTP, successful recanalization after MT, and post-treatment diffusion-weighed imaging (DWI). Ischemic core on baseline CTP was estimated using relative cerebral blood flood (CBF) of < 30%. The infarct area was outlined manually on post-treatment DWI, and registered to CTP. Spatial agreement was assessed using the Dice similarity coefficient (DSC) and average Hausdorff distance. According to the median DSC, the study population was dichotomized into high and low Dice groups. Univariable and multivariable regression analyses were used to determine the factors independently associated with the spatial agreement. RESULTS: In 72 included patients, the median DSC was 0.26, and the median average Hausdorff distance was 1.77 mm. High Dice group showed significantly higher median ischemic core volume on baseline CTP (33.90 mL vs 3.40 mL, P < 0.001), lower proportion of moderate or severe leukoaraiosis [27.78% vs 52.78%, P = 0.031], and higher median infarct volume on follow-up DWI (51.17 mL vs 9.42 mL, P < 0.001) than low Dice group. Ischemic core volume on baseline CTP was found to be independently associated with the spatial agreement (OR, 1.092; P < 0.001). CONCLUSIONS: CTP could help to spatially locate the post-treatment infarct in anterior LVO patients who achieving successful recanalization after MT. Ischemic core volume on baseline CTP was independently associated with the spatial agreement.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Humanos , Estudos Retrospectivos , Seguimentos , Tomografia Computadorizada por Raios X/métodos , Trombectomia/métodos , Imagem de Perfusão/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Infarto , Perfusão , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia
8.
Eur J Emerg Med ; 30(1): 40-46, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36542336

RESUMO

Acute nontraumatic chest pain is a frequent reaso n for consultation in emergency departments and represents a diagnostic challenge. The objective is to estimate the risk of significant coronary artery disease (CAD) in patients with cardiogenic acute chest pain for whom the diagnosis of infarction was ruled out in the emergency department with a nondiagnostic ECG and negative high-sensitivity troponins. We prospectively recruited 1625 patients from emergency departments of seven Spanish hospitals. The outcome was presence of significant CAD determined by presence of ischaemia in functional tests or more than 70% stenosis in imaging tests. In this study, we developed a predictive model and evaluated its performance and clinical utility. The prevalence of significant CAD was 14% [227/1625; 95% confidence interval (CI), 12-16]. MAPAC Cardio-PreTest model included seven predictors: age, sex, smoking, history of hypertension, family history of CAD, history of hyperuricaemia, and type of chest pain. The optimism-adjusted model discrimination was C-statistic 0.654 (95% CI, 0.618-0.693). Calibration plot showed good agreement between the predicted and observed risks, and calibration slope was 0.880 (95% CI, 0.731-1.108) and calibration-in-the-large -0.001 (95% CI, -0.141 to 0.132). The model increased net benefit and improved risk classification over the recommended approach by the European Society of Cardiology [Net Reclassification Index (NRI) of events = 5.3%, NRI of nonevents = 7.0%]. MAPAC Cardio-PreTest model is an online prediction tool to estimate the individualised probability of significant CAD in patients with acute chest pain without a diagnosis of infarction in emergency department. The model was more useful than the current alternatives in helping patients and clinicians make individually tailored choices about the intensity of monitoring or additional coronary tests.


Assuntos
Doença da Artéria Coronariana , Humanos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Medição de Risco/métodos , Valor Preditivo dos Testes , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Infarto , Fatores de Risco
9.
EBioMedicine ; 87: 104406, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36527899

RESUMO

BACKGROUND: Stroke is one of the most common neurological diseases in the world and is clinically manifested by transient or permanent brain dysfunction. It has a high mortality and disability rate, which severely affects people's health and diminishes the quality of life. However, there is no efficient treatment that can be considered curative and there are other less well-known theories of pathogenesis. Therefore, it is imperative to gain a full understanding of the pathophysiology of ischemia and to seek new therapeutic strategies. METHODS: We first examined Kir4.1 channel and myelin based protein (MBP) expression in brain tissues from acute ischemic patients by Western blotting. We then established a transient ischemic mouse model (tMCAO) to conduct molecular, cell biological, transmission electron microscopy and pharmacokinetic studies, as well as in Kir4.1 cKO mice. Finally, neuroimaging and behavioral analyses were used to examine whether activation of Kir4.1 channel by luteolin could contribute to neuronal functional recovery in ischemic stroke. FINDINGS: In acute ischemic stroke patients, we first demonstrated that Kir4.1 ion channels were greatly impaired and a severe demyelination of axons occurred in ischemic infarction area of cerebral cortex in these patients. Further evidence showed that the deficits of Kir4.1 channels in NG2 glia led to the myelin loss of axons in a transient ischemic mouse model (tMCAO). Treating ischemic mice with a natural botanical extract, luteolin augmented Kir4.1 channel currents in NG2 glia and consequently promoted remyelination of axons, alleviated the infarction area and ultimately improved motor function in a series of behavioral tests. INTERPRETATION: Targeting Kir4.1 ion channels expressed in NG2 glial cells by luteolin treatment highlights an effective therapeutic strategy for a prompt brain functional recovery in ischemic stroke. FUNDING: This work was supported by grants from the Ministry of Science and Technology China Brain Initiative (2022ZD0204702, to X.T.), the National Natural Science Foundation of China (82271466, 82171279, 31970904 and 31571063), the Program for Professor of Special Appointment (Eastern Scholar for Dr. X.T.) at Shanghai Institutions for Higher Learning (1510000084), Shanghai Pujiang Talent Award (15PJ1404600), Shanghai Municipal Science and Technology Major Project (2018SHZDZX05) and Shanghai Science and Technology Project (17411954000).


Assuntos
AVC Isquêmico , Remielinização , Acidente Vascular Cerebral , Camundongos , Animais , AVC Isquêmico/tratamento farmacológico , AVC Isquêmico/etiologia , AVC Isquêmico/metabolismo , Luteolina/metabolismo , Qualidade de Vida , China , Neuroglia/metabolismo , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/genética , Infarto/metabolismo
10.
Pharmacol Res ; 187: 106611, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36526079

RESUMO

Brain inflammation and apoptosis contribute to neuronal damage and loss following ischaemic stroke, leading to cognitive and functional disability. It is well-documented that the human gene-2 (H2)-relaxin hormone exhibits pleiotropic properties via its cognate receptor, Relaxin Family Peptide Receptor 1 (RXFP1), including anti-inflammatory and anti-apoptotic effects, thus making it a potential therapeutic for stroke. Hence, the current study investigated whether post-stroke H2-relaxin administration could improve functional and histological outcomes. 8-12-week-old male C57BL/6 mice were subjected to sham operation or photothrombotic stroke and intravenously-administered with either saline (vehicle) or 0.02, 0.2 or 2 mg/kg doses of recombinant H2-relaxin at 6, 24 and 48 h post-stroke. Motor function was assessed using the hanging wire and cylinder test pre-surgery, and at 24 and 72 h post-stroke. Brains were removed after 72 h and infarct volume was assessed via thionin staining, and RXFP1 expression, leukocyte infiltration and apoptosis were determined by immunofluorescence. RXFP1 was identified on neurons, astrocytes and macrophages, and increased post-stroke. Whilst H2-relaxin did not alter infarct volume, it did cause a dose-dependent improvement in motor function at 24 and 72 h post-stroke. Moreover, 2 mg/kg H2-relaxin significantly decreased the number of apoptotic cells as well as macrophages and neutrophils within the ischaemic hemisphere, but did not alter T or B cells numbers. The anti-inflammatory and anti-apoptotic effects of H2-relaxin when administered at 6 h post-cerebral ischaemia may provide a novel therapeutic option for patients following ischaemic stroke.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Relaxina , Acidente Vascular Cerebral , Camundongos , Animais , Humanos , Masculino , Relaxina/farmacologia , Relaxina/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Receptores Acoplados a Proteínas G/metabolismo , Receptores de Peptídeos/química , Receptores de Peptídeos/metabolismo , Camundongos Endogâmicos C57BL , Acidente Vascular Cerebral/tratamento farmacológico , Encéfalo/metabolismo , Apoptose , Infarto , Anti-Inflamatórios
11.
Brain Behav ; 13(1): e2858, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36542540

RESUMO

BACKGROUND: Disparities exist regarding an efficient treatment for stroke. Polyarginines have shown promising neuroprotective properties based on available published studies. Thus, the present study aims to systemically review and analyze existing evidence regarding polyarginine's administration efficacy in animal stroke models. METHOD: Medline, Scopus, Embase, and Web of Science were systematically searched, in addition to manual search. Inclusion criteria were administrating polyarginine peptides in stroke animal models. Exclusion criteria were previous polyarginine administration, lacking a control group, review articles, and case reports. Data were collected and analyzed using STATA 17.0; a pooled standardized mean difference (SMD) with a 95% confidence interval (CI), meta-regression, and subgroup analyses were presented. Risk of bias, publication bias, and level of evidence were assessed using SYRCLE's tool, Egger's analysis, and Grading of Recommendations Assessment, Development and Evaluation framework, respectively. RESULTS: From the 468 searched articles, 11 articles were included. Analyses showed that R18 significantly decreases infarct size (SMD = -0.65; 95% CI: -1.01, -0.29) and brain edema (SMD = -1.90; 95% CI: -3.28, -0.51) and improves neurological outcome (SMD = 0.67; 95% CI: 0.44, 0.91) and functional status (SMD = 0.55; 95% CI: 0.26, 0.85) in stroke animal models. Moreover, R18D significantly decreases infarct size (SMD = -0.75; 95% CI: -1.17, -0.33) and improves neurological outcome (SMD = 0.46; 95% CI: 0.06, 0.86) and functional status (SMD = 0.35; 95% CI: 0.16, 0.54) in stroke models. CONCLUSION: Moderate level of evidence demonstrated that both R18 and R18D administration can significantly improve stroke outcomes in animal stroke models. However, considering the limitations, further pre-clinical and clinical studies are warranted to substantiate the neuroprotective efficacy of polyarginines for stroke.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Animais , Acidente Vascular Cerebral/tratamento farmacológico , Peptídeos , Infarto
12.
Sci Rep ; 12(1): 20925, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36463381

RESUMO

Ischemic stroke is a serious neurological disorder that is associated with dysregulation of the neurovascular unit (NVU) and impairment of the blood-brain barrier (BBB). Paradoxically, reperfusion therapies can aggravate NVU and BBB dysfunction, leading to deleterious consequences in addition to the obvious benefits. Using the recently established EPAM-ia method, we identified osteopontin as a target dysregulated in multiple NVU cell types and demonstrated that osteopontin targeting in the early acute phase post-transient middle cerebral artery occlusion (tMCAO) evolves protective effects. Here, we assessed the time course of osteopontin and CD44 receptor expression in NVU cells and examined cerebroprotective effects of osteopontin targeting in early and late acute phases of ischemic stroke. Expression analysis of osteopontin and CD44 receptor post-tMCAO indicated increased levels of both, from early to late acute phases, which was supported by their co-localization in NVU cells. Combined osteopontin targeting in early and late acute phases with anti-osteopontin antibody resulted in further improvement in BBB recovery and edema reduction compared to targeting only in the early acute phase comprising the reperfusion window. Combined targeting led to reduced infarct volumes, which was not observed for the single early acute phase targeting. The effects of the therapeutic antibody were confirmed both in vitro and in vivo in reducing osteopontin and CD44 expression. Osteopontin targeting at the NVU in early and late acute phases of ischemic stroke improves edema and infarct size in mice, suggesting anti-osteopontin therapy as promising adjunctive treatment to reperfusion therapy.


Assuntos
AVC Isquêmico , Camundongos , Animais , Modelos Animais de Doenças , Reperfusão , Edema , Infarto
13.
Wiad Lek ; 75(10): 2425-2429, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36472273

RESUMO

OBJECTIVE: The aim: This study aims in a prospective hospital-based cohort study to determine clinical and imaging features of medial medullary infarction and report a relevant clinical case in a white European adult. PATIENTS AND METHODS: Materials and methods: We have prospectively enrolled one hundred twenty adult patients with acute posterior circulation stroke. All patients were admitted and enrolled in the study within 6 to 24 hours from the onset of the stroke symptoms. Study subjects were recruited from the hospital's wards and emergency departments from 2011 to 2020. Comprehensive clinical, MRI, ultrasound, and laboratory examinations were performed on all patients. RESULTS: Results: 68 men and 52 women aged 28 to 89 years (average age 60.7 ± 12.1 years) with an acute ischemic posterior circulation stroke were enrolled in the study. Out of these 120 patients, 22 (18.3%) had acute medulla oblongata infarctions. Clinical and imaging features of medial medullary infarction are analyzed and illustrated with a clinical case presentation in a white European adult. CONCLUSION: Conclusions: Specific features of medial medullary infarction were determined, analyzed, described, and illustrated with a clinical case.


Assuntos
Bulbo , Acidente Vascular Cerebral , Adulto , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Estudos de Coortes , Bulbo/diagnóstico por imagem , Imageamento por Ressonância Magnética/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Infarto/complicações , Hospitais
14.
J UOEH ; 44(4): 373-377, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36464311

RESUMO

We report a bilateral medial medullary infarction in which diffusion-weighted images revealed a unique configuration: a heart appearance sign. If it is early diagnosed, it might predict a poor outcome. An 85-year-old man developed dysarthria and numbness in his four limbs and was transferred to our hospital. Brain MR diffusion-weighted images revealed a high-intensity lesion in the bilateral medial medulla oblongata -- a heart appearance sign -- and we diagnosed a bilateral medial medullary infarction. Although his symptom changed aggressively for the worse, it finally changed for the better without bulbar paralysis, and he was transferred to another hospital for rehabilitation. When the medial medulla oblongata is supplied by the unilateral control of the anterior spinal artery, its occlusion can cause a bilateral medial medullary infarction.


Assuntos
Coração , Hospitais , Masculino , Humanos , Idoso de 80 Anos ou mais , Bulbo/diagnóstico por imagem , Infarto
15.
J UOEH ; 44(4): 389-393, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36464314

RESUMO

Anterior inferior cerebellar artery (AICA) syndrome is a well-known symptomatic disorder. AICA syndrome is one of the causes of sudden hearing loss seen in recent years, but most of these cases were diagnosed as hearing loss preceded by other symptoms. Due to variations in AICA, we consider that many cases are actually not recognized as AICA syndrome. In this report, we describe a case of AICA syndrome preceded by hearing loss and describe its course of progression.


Assuntos
Perda Auditiva , Humanos , Síndrome , Infarto , Artérias
16.
Plast Aesthet Nurs (Phila) ; 42(4): 190-196, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36469389

RESUMO

Coronavirus disease was first described as an identified syndrome in December 2019 (COVID-19). Since then, a global pandemic has taken place and the disease has repeatedly been associated with thromboembolic complications, most of which are venous, but may also occur at the arterial level, even in patients receiving thromboprophylaxis. To date, only medium- and large-caliber vessels have been affected by arterial thrombosis secondary to COVID-19. This article describes the case of a 60-year-old woman with a prior severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection who developed multiple bone infarcts, complicated by secondary osteomyelitis. The patient underwent multiple surgical debridements and received a variety of antibiotics before the correct diagnosis was made and a multidisciplinary surgery was planned that provided coverage with a medial gastrocnemius flap. At 5-months follow-up, the patient had recovered well without any clinical evidence of infection or other complications. To the best of our knowledge, this is the first known case of a bone infarct complicated with a secondary osteomyelitis occurring in a patient having suffered a previous SARS-CoV-2 infection. We postulate as our main hypothesis that the prothrombogenic state secondary to SARS-CoV-2 infection may have contributed to thrombosis of small-caliber vessels, in our patient the arteria nutricia tibialis, triggering bone infarcts and a secondary infection with Staphylococcus aureus .


Assuntos
COVID-19 , Osteomielite , Osteonecrose , Trombose , Tromboembolia Venosa , Feminino , Humanos , Pessoa de Meia-Idade , COVID-19/complicações , SARS-CoV-2 , Anticoagulantes , Tíbia , Trombose/etiologia , Osteomielite/diagnóstico , Infarto/etiologia
17.
BMC Med Inform Decis Mak ; 22(1): 322, 2022 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-36476486

RESUMO

BACKGROUND: The pivot and cluster strategy (PCS) is a diagnostic reasoning strategy that automatically elicits disease clusters similar to a differential diagnosis in a batch. Although physicians know empirically which disease clusters are similar, there has been no quantitative evaluation. This study aimed to determine whether inter-disease distances between word embedding vectors using the PCS are a valid quantitative representation of similar disease groups in a limited domain. METHODS: Abstracts were extracted from the Ichushi Web database and subjected to morphological analysis and training using Word2Vec, FastText, and GloVe. Consequently, word embedding vectors were obtained. For words including "infarction," we calculated the cophenetic correlation coefficient (CCC) as an internal validity measure and the adjusted rand index (ARI), normalized mutual information (NMI), and adjusted mutual information (AMI) with ICD-10 codes as the external validity measures. This was performed for each combination of metric and hierarchical clustering method. RESULTS: Seventy-one words included "infarction," of which 38 diseases matched the ICD-10 standard with the appearance of 21 unique ICD-10 codes. When using Word2Vec, the CCC was most significant at 0.8690 (metric and method: euclidean and centroid), whereas the AMI was maximal at 0.4109 (metric and method: cosine and correlation, and average and weighted). The NMI and ARI were maximal at 0.8463 and 0.3593, respectively (metric and method: cosine and complete). FastText and GloVe generally resulted in the same trend as Word2Vec, and the metric and method that maximized CCC differed from the ones that maximized the external validity measures. CONCLUSIONS: The metric and method that maximized the internal validity measure differed from those that maximized the external validity measures; both produced different results. The cosine distance should be used when considering ICD-10, and the Euclidean distance when considering the frequency of word occurrence. The distributed representation, when trained by Word2Vec on the "infarction" domain from a Japanese academic corpus, provides an objective inter-disease distance used in PCS.


Assuntos
Infarto , Humanos , Diagnóstico Diferencial , Análise por Conglomerados , Infarto/diagnóstico
18.
Artigo em Chinês | MEDLINE | ID: mdl-36543408

RESUMO

Cerebral infarction is one of the common clinical diseases. This article reported that one patient with pontine brachial infarction had hearing loss, vertigo, facial paralysis, etc., and cranial MRI showed new infarction in the pontine brachial region. The patient recovered well after treatment with paralysis, hearing and vertigo.


Assuntos
Surdez , Perda Auditiva Súbita , Humanos , Perda Auditiva Súbita/etiologia , Vertigem/etiologia , Vertigem/diagnóstico , Infarto , Imageamento por Ressonância Magnética , Infarto Cerebral
19.
BMC Pregnancy Childbirth ; 22(1): 914, 2022 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-36476140

RESUMO

BACKGROUND: Back pain is common in the gravid population and spinal cord infarction (SCI) or chronic osteomyelitis are exceptionally rare underlying causes of back pain in this population. No case report to date has described this unexpected adverse event in a gravid woman with suspected history of IV drug use (IVDU). This diagnosis could potentially become more common with increasing rates of IVDU, and increased education could result in sooner recognition. CASE: A 38 year old G9P0171 at 24 weeks gestation with a complex past medical history, and a suspected history of IVDU, presented repeatedly with back pain. Following cesarean delivery at 36w2d, she developed signs and symptoms of an anterior spinal artery syndrome (ASAS) and had evidence of chronic osteomyelitis at T9-T10 on imaging. This required emergent decompressive laminectomy and ultimately resulted in paraplegia. CONCLUSION: This case highlights the difficulties in recognizing all SCI risk factors pre-operatively and the importance of investigating back pain in pregnant patients with a suspected history of IVDU. We believe this patient's chronic infection put her at an increased risk for SCI that was possibly compounded by the anatomical changes from its chronicity, possibly occurring in combination with several other precipitating causes of hypoperfusion. We hope this case report highlights the modern necessity to include a history, or suspected history, of IVDU as a red flag to initiate imaging in pregnant patients with acute, persistent, or unresolved back pain.


Assuntos
Dor nas Costas , Medula Espinal , Humanos , Adulto , Dor nas Costas/etiologia , Infarto/etiologia
20.
JACC Cardiovasc Imaging ; 15(12): 2051-2064, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36481073

RESUMO

BACKGROUND: Prolonged ischemia and myocardial infarction are followed by a series of dynamic processes that determine the fate of the affected myocardium toward recovery or necrosis. Metabolic adaptions are considered to play a vital role in the recovery of salvageable myocardium in the context of stunned and hibernating myocardium. OBJECTIVES: The potential of hyperpolarized pyruvate cardiac magnetic resonance (CMR) alongside functional and parametric CMR as a tool to study the complex metabolic-structural interplay in a longitudinal study of chronic myocardial infarction in an experimental pig model is investigated. METHODS: Metabolic imaging using hyperpolarized [1-13C] pyruvate and proton-based CMR including cine, T1/T2 relaxometry, dynamic contrast-enhanced, and late gadolinium enhanced imaging were performed on clinical 3.0-T and 1.5-T MR systems before infarction and at 6 days and 5 and 9 weeks postinfarction in a longitudinal study design. Chronic myocardial infarction in pigs was induced using catheter-based occlusion and compared with healthy controls. RESULTS: Metabolic image data revealed temporarily elevated lactate-to-bicarbonate ratios at day 6 in the infarcted relative to remote myocardium. The temporal changes of lactate-to-bicarbonate ratios were found to correlate with changes in T2 and impaired local contractility. Assessment of pyruvate dehydrogenase flux via the hyperpolarized [13C] bicarbonate signal revealed recovery of aerobic cellular respiration in the hibernating myocardium, which correlated with recovery of local radial strain. CONCLUSIONS: This study demonstrates the potential of hyperpolarized CMR to longitudinally detect metabolic changes after cardiac infarction over days to weeks. Viable myocardium in the area at risk was identified based on restored pyruvate dehydrogenase flux.


Assuntos
Infarto do Miocárdio , Ácido Pirúvico , Animais , Suínos , Bicarbonatos , Estudos Longitudinais , Valor Preditivo dos Testes , Infarto , Infarto do Miocárdio/diagnóstico por imagem
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