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1.
Neurol Sci ; 44(7): 2369-2374, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36849697

RESUMO

BACKGROUND: In spite of increasing evidence of the clinical importance of cerebral microbleeds (CMBs), the relationship between CMBs and cognitive impairment is still controversial. In addition, there are very limited prior data regarding the prospective association of additional CMBs over time with a decline in cognitive function. This study thus aimed to investigate the effects of newly detected CMBs on cognitive decline in a Japanese health examination cohort. PATIENTS AND METHODS: We performed a prospective cohort study involving 769 Japanese participants (mean age, 61.6 years) with a mean follow-up of 7.3 ± 3.5 years. CMBs were classified according to their locations. Cognitive functions were evaluated using Okabe's Intelligence Scale, Koh's block design test, and the Wisconsin Card Sorting Test. Multiple linear regression analyses were performed to examine the relationship between the newly detected CMBs and cognitive decline. RESULTS: Fifty-six (7.3%) participants (16 had new strictly lobar cerebral microbleeds and 40 had new deep or infratentorial cerebral microbleeds) developed new CMBs during the follow-up period. In multivariable analysis, newly detected strictly lobar CMBs were associated with a greater decline in the Wisconsin Card Sorting Test in the categories achieved (ß: - 0.862 [95% CI: - 1.325, - 0.399]; P < 0.0001), greater increase in perseverative errors of Nelson (ß: 0.603 [95% CI: 0.023, 1.183]; P = 0.04), and greater increase in the difficulty with maintaining set (ß: 1.321 [95% CI: 0.801, 1.842]; P < 0.0001). CONCLUSIONS: Strictly lobar CMBs over time were associated with a decline in executive function.


Assuntos
Hemorragia Cerebral , Disfunção Cognitiva , Humanos , Pessoa de Meia-Idade , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Estudos Prospectivos , Disfunção Cognitiva/psicologia , Cognição , Função Executiva/fisiologia , Imageamento por Ressonância Magnética
2.
Neurosurg Rev ; 46(1): 58, 2023 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-36792748

RESUMO

Although several studies have reported on the impact of the body mass index (BMI) on functional outcome of aneurysmal subarachnoid hemorrhage (aSAH), the relationship remains unclear. This study aimed to investigate the risk factors of poor outcome of aSAH, with particular attention to BMI. A total of 860 patients with aSAH were enrolled in our registry at Shimane Prefectural Central Hospital between 2000 and 2017, of whom 393 were included in the analysis. Basic patient characteristics, including BMI, and data related to aSAH were recorded. We conducted a univariable analysis, followed by a multivariable analysis to identify the risk factors of poor outcome, defined as a modified Rankin Scale score > 2 at discharge. We also compared our study with previous studies that reported a relationship between BMI and aSAH. Multivariable analysis revealed that age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12), underweight (OR, 2.36; 95% CI, 1.13-4.90), overweight (OR, 2.22; 95% CI, 1.06-4.64), World Federation of Neurosurgical Societies grade (III vs I: OR, 3.10; 95% CI, 1.03-9.35; IV vs I: OR, 8.02; 95% CI, 3.54-18.19; V vs I: OR, 13.37; 95% CI, 5.33-33.54), and symptomatic vasospasm (OR, 3.40; 95% CI, 1.73-6.70) were risk factors for poor outcome at discharge. This study showed the association of underweight (BMI < 18.5 kg/m2) and overweight (≥ 25 kg/m2) with poor outcome; therefore, both high and low BMI are associated with a poor outcome at discharge for patients with aSAH. Clinical trial registry: University Hospital Medical Information Network (UMIN000035160; date of registration: December 6, 2018).


Assuntos
Hemorragia Subaracnóidea , Humanos , Índice de Massa Corporal , Sobrepeso/complicações , Alta do Paciente , Sistema de Registros , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Magreza/complicações , Resultado do Tratamento
3.
Int J Mol Sci ; 24(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36614187

RESUMO

Ladderane lipids (found in the membranes of anaerobic ammonium-oxidizing [anammox] bacteria) have unique ladder-like hydrophobic groups, and their highly strained exotic structure has attracted the attention of scientists. Although enzymes encoded in type II fatty acid biosynthesis (FASII) gene clusters in anammox bacteria, such as S-adenosyl-l-methionine (SAM)-dependent enzymes, have been proposed to construct a ladder-like structure using a substrate connected to acyl carrier protein from anammox bacteria (AmxACP), no experimental evidence to support this hypothesis was reported to date. Here, we report the crystal structure of a SAM-dependent methyltransferase from anammox bacteria (AmxMT1) that has a substrate and active site pocket between a class I SAM methyltransferase-like core domain and an additional α-helix inserted into the core domain. Structural comparisons with homologous SAM-dependent C-methyltransferases in polyketide synthase, AmxACP pull-down assays, AmxACP/AmxMT1 complex structure predictions by AlphaFold, and a substrate docking simulation suggested that a small compound connected to AmxACP could be inserted into the pocket of AmxMT1, and then the enzyme transfers a methyl group from SAM to the substrate to produce branched lipids. Although the enzymes responsible for constructing the ladder-like structure remain unknown, our study, for the first time, supports the hypothesis that biosynthetic intermediates connected to AmxACP are processed by SAM-dependent enzymes, which are not typically involved in the FASII system, to produce the ladder-like structure of ladderane lipids in anammox bacteria.


Assuntos
Metionina , S-Adenosilmetionina , S-Adenosilmetionina/metabolismo , Metionina/metabolismo , Proteína de Transporte de Acila/metabolismo , Metiltransferases/metabolismo , Oxidação Anaeróbia da Amônia , Bactérias/metabolismo , Racemetionina/metabolismo , Lipídeos , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo
4.
BMC Neurol ; 22(1): 137, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410174

RESUMO

BACKGROUND: Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis. METHODS: We examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe's test, Kohs' test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted. RESULTS: From the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs' scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure. CONCLUSION: High pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia.


Assuntos
Hipertensão , Idoso , Pressão Sanguínea/fisiologia , Cognição/fisiologia , Estudos Transversais , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Japão/epidemiologia , Pessoa de Meia-Idade
5.
Macromol Rapid Commun ; 43(2): e2100567, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34669216

RESUMO

Perfluoropolyether (PFPE) is an industrially important fluoropolymer and has great industrial importance due to its flexible, noncombustible, and chemically robust properties. However, exploration and application of chemically modified homogeneous PFPEs are hampered by their immiscibility against nonfluorine-containing molecules. Here, the synthesis is reported of cyclic PFPE with hexaarylbiimidazoles (HABIs) in chains from linear PFPE having 2,4,5-triphenylimidazole (lophine) end groups. While phase separation between the end groups and main chains took place for linear PFPE, HABIs and main chains in cyclic PFPE are miscible to form transparent glass films. The design of cyclic PFPE also enables cyclic to linear topological transformation based on conversion of HABIs into lophines upon mild heating in the glass film state. Sequential linear-to-cyclic and cyclic-to-linear topological transformations enable fabrication of thermostabilized transparent films derived from PFPE.


Assuntos
Éteres , Fluorocarbonos , Vidro
6.
Am J Perinatol ; 2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-35613928

RESUMO

INTRODUCTION: Early-onset hyperbilirubinemia (EOH) is a clinical issue for premature infants. We predicted that EOH management would be improved by fast results from common laboratory tests. Total serum bilirubin (TSB) level and the albumin/globulin ratio may contribute to improving the management of EOH. OBJECTIVE: The aim of the study is to examine the relationship between EOH and perinatal variables among infants born weighing 1,000 to 2,499 g. STUDY DESIGNS: A single center study was undertaken at Ohta Nishinouchi Hospital between April 1, 2016 and January 31, 2022, using blood samples prospectively collected from infants admitted to the neonatal intensive care unit that were assessed by univariate analyses and multivariate logistic regression analysis. Due to a correlation between gestational age (GA) and birth weight (BW), each variable was entered separately into Model 1 (including GA) and 2 (including BW). RESULTS: A total of 508 infants were analyzed (270 in the non EOH group and 238 in the EOH group). No infants experienced feto-maternal transfusion syndrome or hemolytic diseases such as blood type (ABO or Rh) incompatibility or glucose-6-phosphate dehydrogenase deficiency during perinatal period. Significant relationships were observed between EOH and BW (p <0.01, odds ratio [OR], 0.997; 95% confidence interval [CI], 0.996-0.997), albumin (p <0.01, OR, 0.278; 95% CI, 0.129-0.599), albumin/globulin ratio (p <0.01, OR, 2.695; 95% CI, 1.378-5.270), TSB (p <0.01, OR, 2.774; 95% CI, 1.795-4.287), and antenatal corticoid therapy (p = 0.02, OR, 1.852; 95% CI, 1.108-3.097) in Model 2. Per receiver operating characteristic curves, an albumin/globulin ratio of 1.84 could predict EOH at a sensitivity of 50.0% and specificity of 75.6% (AUC = 0.652, p <0.01, 95% CI, 0.603-0.700). CONCLUSION: Albumin/globulin ratio among infants born weighing 1,000 to 2,499 g may be a useful indicator of EOH. KEY POINTS: · Early-onset hyperbilirubinemia (EOH) is a clinical issue for premature infants.. · EOH management expected to be improved through the use of common laboratory tests.. · Albumin/globulin ratio among low birth weight infants may be a useful indicator of EOH..

7.
J Neurol Neurosurg Psychiatry ; 92(11): 1173-1180, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34170840

RESUMO

OBJECTIVE: To visualise the non-linear correlation between age and poor outcome at discharge in patients with aneurysmal subarachnoid haemorrhage (SAH) while adjusting for covariates, and to address the heterogeneity of this correlation depending on disease severity by a registry-based design. METHODS: We extracted data from the Japanese Stroke Databank registry for patients with SAH treated via surgical clipping or endovascular coiling within 3 days of SAH onset between 2000 and 2017. Poor outcome was defined as a modified Rankin Scale Score ≥3 at discharge. Variable importance was calculated using machine learning (random forest) model. Correlations between age and poor outcome while adjusting for covariates were determined using generalised additive models in which spline-transformed age was fit to each neurological grade of World Federation of Neurological Societies (WFNS) and treatment. RESULTS: In total, 4149 patients were included in the analysis. WFNS grade and age had the largest and second largest variable importance in predicting the outcome. The non-linear correlation between age and poor outcome was visualised after adjusting for other covariates. For grades I-III, the risk slope for unit age was relatively smaller at younger ages and larger at older ages; for grade IV, the slope was steep even in younger ages; while for grade V, it was relatively smooth, but with high risk even at younger ages. CONCLUSIONS: The clear visualisation of the non-linear correlation between age and poor outcome in this study can aid clinical decision making and help inform patients with aneurysmal SAH and their families better.


Assuntos
Procedimentos Endovasculares/mortalidade , Hemorragia Subaracnóidea/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Hemorragia Subaracnóidea/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 29(11): 105247, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066898

RESUMO

BACKGROUND: The etiology and background factors which cause decreases in the size of ruptured intracranial aneurysms remain unclear. OBJECTIVE: To clarify the age- and sex-related differences in aneurysmal subarachnoid hemorrhage (SAH) based on a 35-year-old hospital database and demographic data. METHODS: A database of patients admitted to our hospital with aneurysmal SAH from 1983 to 2017 was split into 5-year intervals and analyzed. Demographic data of the general population were also analyzed for reference. RESULTS: Altogether, 1,523 aneurysmal SAH events were enrolled in the analysis. Age (p<0.001), proportion of elderly patients ≥ 65 years old (p<0.001), female sex (p=0.005), very small aneurysms less than 5 mm (p<0.001), and the yearly-averaged number of fatal events showed increasing trends. The proportion of aneurysm size of 10 mm or more (p = 0.011) and the yearly-averaged population of Shimane prefecture (p < 0.001) showed declining trends. In the subgroup analyses, the proportion of very small aneurysms was found to increase significantly in the non-elderly male and elderly female subgroups. The proportion of large aneurysms (10 mm or more) decreased in the non-elderly subgroup (p<0.05). As for the elderly subgroups, the yearly-averaged number of events did not show a significant tendency, although the yearly-averaged population of Shimane prefecture showed an increasing trend. CONCLUSION: We found an increasing trend in the prevalence of very small aneurysms in elderly females. Recent aging may contribute to this trend. The number of aneurysmal SAH events was confirmed to not increase, despite the increased aging population of Shimane prefecture.


Assuntos
Aneurisma Roto/epidemiologia , Aneurisma Intracraniano/epidemiologia , Hemorragia Subaracnóidea/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/mortalidade , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/mortalidade , Fatores de Tempo , Adulto Jovem
9.
J Neurosci ; 38(10): 2631-2651, 2018 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-29431647

RESUMO

Humans tend to avoid mental effort. Previous studies have demonstrated this tendency using various demand-selection tasks; participants generally avoid options associated with higher cognitive demand. However, it remains unclear whether humans avoid mental effort adaptively in uncertain and nonstationary environments. If so, it also remains unclear what neural mechanisms underlie such learned avoidance and whether they remain the same regardless of cognitive-demand types. We addressed these issues by developing novel demand-selection tasks where associations between choice options and cognitive-demand levels change over time, with two variations using mental arithmetic and spatial reasoning problems (males/females: 29:4 and 18:2). Most participants showed avoidance, and their choices depended on the demand experienced on multiple preceding trials. We assumed that participants updated the expected cost of mental effort through experience, and fitted their choices by reinforcement learning models, comparing several possibilities. Model-based fMRI analyses revealed that activity in the dorsomedial and lateral frontal cortices was positively correlated with the trial-by-trial expected cost for the chosen option commonly across the different types of cognitive demand. Analyses also revealed a trend of negative correlation in the ventromedial prefrontal cortex. We further identified correlates of cost-prediction error at time of problem presentation or answering the problem, the latter of which partially overlapped with or were proximal to the correlates of expected cost at time of choice cue in the dorsomedial frontal cortex. These results suggest that humans adaptively learn to avoid mental effort, having neural mechanisms to represent expected cost and cost-prediction error, and the same mechanisms operate for various types of cognitive demand.SIGNIFICANCE STATEMENT In daily life, humans encounter various cognitive demands and tend to avoid high-demand options. However, it remains unclear whether humans avoid mental effort adaptively under dynamically changing environments. If so, it also remains unclear what the underlying neural mechanisms are and whether they operate regardless of cognitive-demand types. To address these issues, we developed novel tasks where participants could learn to avoid high-demand options under uncertain and nonstationary environments. Through model-based fMRI analyses, we found regions whose activity was correlated with the expected mental effort cost, or cost-prediction error, regardless of demand type. These regions overlap, or are adjacent with each other, in the dorsomedial frontal cortex. This finding helps clarify the mechanisms for cognitive-demand avoidance, and provides empirical building blocks for the emerging computational theory of mental effort.


Assuntos
Aprendizagem da Esquiva/fisiologia , Processos Mentais/fisiologia , Adulto , Comportamento de Escolha/fisiologia , Cognição/fisiologia , Sinais (Psicologia) , Metabolismo Energético , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Matemática , Córtex Pré-Frontal/fisiologia , Resolução de Problemas/fisiologia , Desempenho Psicomotor/fisiologia , Percepção Espacial/fisiologia , Adulto Jovem
10.
Hum Brain Mapp ; 40(17): 4934-4940, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31389642

RESUMO

Mind blanking (MB) is the state where our minds are seemingly "nowhere," and attention calls no perceptual input into conscious awareness. It is little investigated, perhaps partly because it is difficult to detect the mysterious periods of blanking. In this study, we found that our participants could intentionally produce a state of MB whose neural correlates were deactivation of Broca's area and parts of the default mode network (namely, the hippocampus) which would be active during mind wandering (MW), in addition to activity in another region in the default mode network (namely, anterior cingulate cortex). Because the behavioral finding replicates a previous report of ours, we suggest that the simple instructions that we used to induce MB should be effective. From the neuroimaging data, we conclude that we cannot define the content of our thoughts during MB because our inner speech system does not work at that time. Another possibility is that we actually think of nothing in the MB state. Although more sophisticated studies would be needed to uncover the mechanism of such a phenomenon, the present study provides a methodology and clues for understanding MB and related concepts such as MW, awareness, and metacognitive ability.


Assuntos
Atenção/fisiologia , Conscientização/fisiologia , Encéfalo/diagnóstico por imagem , Metacognição/fisiologia , Rede Nervosa/diagnóstico por imagem , Adulto , Encéfalo/fisiologia , Mapeamento Encefálico , Feminino , Hipocampo/diagnóstico por imagem , Hipocampo/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Rede Nervosa/fisiologia , Adulto Jovem
11.
Eur J Neurosci ; 47(1): 77-82, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29205574

RESUMO

Resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to investigate functional brain network connectivity during rest or when the subject is not performing an explicit task. In the standard procedure, subjects are instructed to 'let your mind wander' or 'think of nothing'. While these instructions appear appropriate to induce a 'resting-state', they could induce distinct psychological and physiological states during the scan. In this study, we investigated whether different instructions affect mental state and functional connectivity (FC) (i.e. induce distinct 'resting states') during rs-fMRI scanning. Thirty healthy subjects were subjected to two rs-fMRI scans differing only in pre-scan instructions: think of nothing (TN) and mind-wandering (MW) conditions. Self-reports confirmed that subjects spent the majority of the scanning time in the appropriate mental state. Independent component analysis extracted 19 independent components (ICs) of interest and functional network connectivity analyses indicated several conditional differences in FCs among those ICs, especially characterised by stronger FC in the MW condition than in the TN condition, between default mode network and salience/visual/frontal network. Complementary correlation analysis indicated that some of the network FCs were significantly correlated with their self-reported data on how often they had the TN condition during the scans. The present results provide evidence that the pre-scan instruction has a significant influence on resting-state FC and its relationship with mental activities.


Assuntos
Encéfalo/fisiologia , Imageamento por Ressonância Magnética/normas , Encéfalo/diagnóstico por imagem , Conectoma , Feminino , Humanos , Imageamento por Ressonância Magnética/psicologia , Masculino , Projetos de Pesquisa/normas , Pensamento , Adulto Jovem
12.
Opt Express ; 26(6): 6899-6915, 2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29609377

RESUMO

We present a comprehensive approach for tailoring the spectral and angular properties of infrared thermal radiation by using a polymer resonator with molecular vibrational modes, consisting of a polymer thin film on a back-reflective substrate. To precisely design the resonator, we derived the infrared dielectric function of a poly(methyl methacrylate) (PMMA) thin film from the measured reflectance spectrum by fitting it with a Gaussian-convoluted Drude-Lorentz model while accounting for the inhomogeneous broadening caused by the disordered structure of polymers. Our experimental and numerical characterization confirms that the polymer resonator exhibits spectral shaping from quasi-broadband to narrowband due to the intrinsic molecular vibrational absorption of the polymer. The frequency-isolated and strong molecular vibrational absorption of the carbonyl stretching mode at 1730 cm-1 enables the narrowband shaping of the PMMA resonator. In addition, we confirm that the angular-shaping characteristics of this polymer resonator can be tuned, from omnidirectional to strongly angular selective, by changing its polymer film thickness. Modal dispersion analysis reveals that the angle-selectivity of the polymer resonator at an angle of incidence of 80° comes from coupling between the molecular vibrational mode and leaky mode. The proposed infrared radiation management strategy based on molecular vibrational modes of polymers is cost-effective, scalable, and works well with terrestrial matter, including organic compounds and gas molecules, showing promise for applications such as optical gas sensing and radiative thermal management.

13.
J Neural Transm (Vienna) ; 125(2): 153-162, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29185078

RESUMO

The aim of this study was to evaluate the autonomic neural function in Parkinson's disease (PD) and multiple system atrophy (MSA) with head-up tilt test and spectral analysis of cardiovascular parameters. This study included 15 patients with MSA, 15 patients with PD, and 29 healthy control (HC) subjects. High frequency power of the RR interval (RR-HF), the ratio of low frequency power of RR interval to RR-HF (RR-LF/HF) and LF power of systolic BP were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively. Both patients with PD and MSA showed orthostatic hypotension and lower parasympathetic function (RR-HF) at tilt position as compared to HC subjects. Cardiac sympathetic function (RR-LF/HF) was significantly high in patients with PD than MSA at supine position. RR-LF/HF tended to increase in MSA and HC, but decreased in PD by tilting. Consequently, the change of the ratio due to tilting (ΔRR-LF/HF) was significantly lower in patients with PD than in HC subjects. Further analysis showed that compared to mild stage of PD, RR-LF/HF at the supine position was significantly higher in advanced stage. By tilting, it was increased in mild stage and decreased in the advanced stage of PD, causing ΔRR-LF/HF to decrease significantly in the advanced stage. Thus, we demonstrated that spectral analysis of cardiovascular parameters is useful to identify sympathetic and parasympathetic disorders in MSA and PD. High cardiac sympathetic function at the supine position, and its reduction by tilting might be a characteristic feature of PD, especially in the advanced stage.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Atrofia de Múltiplos Sistemas/complicações , Doença de Parkinson/complicações , Teste da Mesa Inclinada/métodos , Idoso , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/fisiopatologia , Doença de Parkinson/fisiopatologia
14.
J Stroke Cerebrovasc Dis ; 27(8): 2175-2181, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29706441

RESUMO

BACKGROUND: Argatroban is a thrombin inhibitor agent for acute noncardioembolic ischemic stroke in Japan. We studied the prognosis in patients with acute stroke treated by argatroban in comparison with the control group with ozagrel in our hospital. SUBJECTS AND METHODS: A total of 513 patients with acute noncardioembolic ischemic stroke were enrolled retrospectively from our hospital database. Of all patients with stroke, 353 were administered with argatroban. The other 160 control patients were administered with ozagrel. The patients were examined as to their stroke types, the neurological severity according to the National Institutes of Health Stroke Scale (NIHSS), and clinical outcomes on discharge were determined according to the modified Rankin Scale (mRS). RESULTS: A total of 353 patients with acute noncardioembolic stroke, including 138 with lacunar infarction (LIs) and 215 with atherothrombotic infarction (ATI) showed functional recovery by argatroban, but the effectiveness of argatroban was not superior to ozagrel therapy defined by the control group. A total of 255 patients with ATI who were treated with both argatroban and ozagrel showed improvement by 1 point. We could not find any significant difference between argatroban and ozagrel in the 2 stroke subtypes, LI and ATI. We also found that combination therapy of argatroban and edaravone was not superior to argatroban monotherapy in clinical outcome. CONCLUSIONS: Argatroban therapy was not superior to control with ozagrel therapy in acute noncardioembolic ischemic stroke, including LI and ATI, regardless of the use of edaravone.


Assuntos
Antitrombinas/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Ácidos Pipecólicos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Arginina/análogos & derivados , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Metacrilatos/uso terapêutico , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Sulfonamidas
15.
J Stroke Cerebrovasc Dis ; 27(2): 338-345, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29033229

RESUMO

OBJECTIVE: We investigated recurrent stroke volume with nonvalvular atrial fibrillation (NVAF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) about clinical backgrounds and number of recurrent stroke. METHODS: We administered 4 NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban in 101 postcardioembolic strokes with NVAF. In a retrospective study, we measured recurrent stroke volume with magnetic resonance imaging volumetric software and compared them between 10 vitamin K anticoagulant (VKA: warfarin) cases and 13 NOAC cases under anticoagulant therapy. RESULTS: Of 101 cases, 31 were started with a VKA and switched to NOACs after 10 recurrent strokes. Other 70 cases were directly started with NOACs and 13 cases with NOACs as first anticoagulants had recurrent stroke. The frequency of recurrent stroke during anticoagulant therapy is not different between the VKA group and the 3 NOACs group. Recurrent stroke volume is significantly larger in the VKA group (26.4 cm3) than in the NOACs group (1.2 cm3). CONCLUSIONS: Secondary prevention with NOACs after stroke might be more beneficial than a VKA by reducing recurrent infarct volume.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/administração & dosagem , Pirazóis/administração & dosagem , Piridinas/administração & dosagem , Piridonas/administração & dosagem , Rivaroxabana/administração & dosagem , Prevenção Secundária/métodos , Acidente Vascular Cerebral/prevenção & controle , Tiazóis/administração & dosagem , Varfarina/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Dabigatrana/efeitos adversos , Feminino , Humanos , Japão/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Pirazóis/efeitos adversos , Piridinas/efeitos adversos , Piridonas/efeitos adversos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Rivaroxabana/efeitos adversos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Tiazóis/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos
16.
J Neuroinflammation ; 14(1): 109, 2017 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-28558818

RESUMO

BACKGROUND: Microglia, as well as other tissue-resident macrophages, arise from yolk sac progenitors. Thus, it is likely that the central nervous system environment is critical for the acquisition of a distinct microglial phenotype. Several microRNAs that are enriched in the brain play crucial roles in brain development and may also play a role in the differentiation of microglia. METHODS: To track the differentiation of hematopoietic cells into microglia, lineage-negative bone marrow cells were co-cultured with astrocytes in the absence or presence of microRNAs or their inhibitors. Microglia-like cells were identified as small, round cells that were immunopositive for CD11b, Iba1, CX3CR1, and triggering receptor expressed on myeloid cells (TREM)-2. RESULTS: Five microRNAs (miR-101a, miR-139-3p, miR-214*, miR-218, and miR-1186) were identified as modifiers of the differentiation of bone marrow-derived microglia-like cells. Among them, miR-101a facilitated the differentiation of bone marrow cells into microglia-like cells most potently. Small, round cells expressing CD11b, Iba1, CX3CR1, and TREM-2 were predominant in cells treated by miR-101a. miR-101a was abundantly expressed in non-microglial brain cells. Transfection of miR-101a into microglia significantly increased the production of IL-6 in response to LPS. Finally, miR-101a downregulated the expression of MAPK phosphatase-1. CONCLUSIONS: miR-101a, which is enriched in the brain, promotes the differentiation of bone marrow cells into microglia-like cells.


Assuntos
Inflamação/metabolismo , Inflamação/patologia , MicroRNAs/antagonistas & inibidores , MicroRNAs/metabolismo , Microglia/patologia , Análise de Variância , Animais , Animais Recém-Nascidos , Proteínas de Ligação ao Cálcio/metabolismo , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Técnicas de Cocultura , Modelos Animais de Doenças , Feminino , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas dos Microfilamentos/metabolismo , Microglia/metabolismo , Células Mieloides/metabolismo , Oligonucleotídeos Antissenso/farmacologia , Receptores Imunológicos/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transfecção
17.
Muscle Nerve ; 55(2): 281-285, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27397635

RESUMO

INTRODUCTION: Paraparetic Guillain-Barré syndrome (GBS) is a rare subtype of GBS characterized by leg weakness and areflexia in the absence of neurological involvement of the arms, cranial nerves, or respiratory muscles. Onset is characterized by lower back, buttock, or leg pain, followed by development of symmetric flaccid limb weakness in the absence of sensory disturbance. METHODS: We describe an elderly woman who developed postinfectious symmetric flaccid leg weakness in the absence of sensory disturbance. Serial nerve conduction studies were carried out over 5 months. RESULTS: Antecedent infection, a monophasic disease course, and the presence of cerebrospinal fluid albuminocytological dissociation suggested a diagnosis of paraparetic GBS. Serial nerve conduction studies demonstrated nondemyelinating reversible conduction failure, which was restricted to the legs. Axonal neuropathy was supported by the presence of anti-GM1 IgG antibodies. CONCLUSIONS: These findings suggest that patients with paraparetic GBS have axonal neuropathy, which is restricted to the lower limbs. Muscle Nerve 55: 281-285, 2017.


Assuntos
Síndrome de Guillain-Barré/patologia , Síndrome de Guillain-Barré/fisiopatologia , Extremidade Inferior/fisiopatologia , Músculo Esquelético/fisiopatologia , Condução Nervosa/fisiologia , Idoso , Eletromiografia , Potencial Evocado Motor/fisiologia , Feminino , Lateralidade Funcional , Humanos
18.
Cerebrovasc Dis ; 43(3-4): 186-191, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28208146

RESUMO

BACKGROUND: Cerebral microbleeds (CMBs) are associated with focal hemosiderin deposits and represent a form of cerebral small vessel disease. To date, indefinite and inconsistent reports are available regarding the association between serum lipid fractions and CMBs. In addition, these previous studies did not include Asian populations, who may have a higher risk of cerebral hemorrhage. The purpose of this study was to examine the associations between serum lipid fractions and CMBs in healthy Japanese subjects. METHODS: We performed a cross-sectional study involving 4,024 neurologically normal Japanese subjects (mean age 61.6 years). All the participants underwent 1.5-Tesla magnetic resonance imaging scan, and CMBs were classified into 3 groups based on their locations. The concentrations of lipid fractions were categorized into quartiles and the association between the lipid fractions and CMBs were investigated using logistic regression analysis. RESULTS: CMBs were observed in 164 (4.1%) of participants. Of these participants with CMBs, 33 (20.1%) had lobar CMBs and 91 (55.5%) had deep CMBs. Subjects with deep CMBs had lower total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels. After adjusting for confounding factors, lower TC and HDL-C levels were still associated with the presence of deep CMBs (OR for the highest vs. the lowest quartiles of TC and HDL-C was 2.28 [95% CI 1.05-4.94], and 1.93 [95% CI 1.02-3.65], respectively). The presence of subcortical infarcts and periventricular hyperintensities was more frequently observed in deep CMBs, whereas white matter hyperintensities were more frequently observed in lobar CMBs. CONCLUSIONS: Our results suggest that low serum TC and HDL-C levels are closely associated with deep CMBs.


Assuntos
Hemorragia Cerebral/etiologia , Doenças de Pequenos Vasos Cerebrais/etiologia , HDL-Colesterol/sangue , Leucoencefalopatias/etiologia , Triglicerídeos/sangue , Idoso , Povo Asiático , Biomarcadores/sangue , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etnologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/etnologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Japão , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/etnologia , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco
19.
J Stroke Cerebrovasc Dis ; 25(7): 1807-1812, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27113778

RESUMO

BACKGROUND: Ischemic penumbra in acute ischemic stroke (AIS) can be evaluated using arterial spin-labeled (ASL) perfusion magnetic resonance imaging (MRI). We used three-dimensional ASL-MRI to examine patients with different stroke subtypes and the clinical utility of the method within 24 hours of AIS onset. SUBJECTS AND METHODS: The 55 male and 48 female patients (mean age, 79.0 years) underwent diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery imaging, magnetic resonance angiography, and pulsed continuous ASL perfusion imaging to determine stroke subtype, hypoperfused ASL area, and neurological deficit severity (National Institutes of Health Stroke Scale). Arterial transit artifacts, indicative of occlusive regions or collateral flow, and other stroke indices were compared. RESULTS: ASL hypoperfusion was detected in 3 of 9 patients with transient ischemic attack (TIA), 2 of 27 patients with lacunar infarction (LI), 19 of 31 patients with atherothrombotic infarction (AT), and 30 of 36 patients with cardiogenic embolic infarction (CE). ASL abnormalities were significantly less frequent in LI than in AT and CE, and more frequent in CE than in TIA. ASL abnormalities were more prevalent in patients with medium-to-large DWI-assessed lesions than in those with small lesions on DWI. Patients with medium-sized lesions following AT and CE had a high frequency of diffusion-perfusion mismatch. In 4 of the 5 patients who underwent intravenous thrombolytic therapy, ASL hypoperfusion and diffusion-perfusion mismatch were improved and the occluded arteries were recanalized. CONCLUSIONS: ASL perfusion studies may provide useful clinical information allowing diffusion-perfusion mismatch detection and treatment selection in AIS patients, depending on stroke subtype.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular , Imagem de Difusão por Ressonância Magnética , Angiografia por Ressonância Magnética , Imagem de Perfusão/métodos , Marcadores de Spin , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/fisiopatologia , Circulação Cerebrovascular/efeitos dos fármacos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Japão , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
J Stroke Cerebrovasc Dis ; 25(12): e219-e221, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27771195

RESUMO

Poststroke apathy is relatively common and has negative effects on the functional recovery of the patient; however, few reports have demonstrated the existence of effective treatments for poststroke apathy. Here, we describe a case of poststroke apathy that was successfully treated with repetitive transcranial magnetic stimulation (rTMS). Using resting-state functional magnetic resonance imaging, we detected improved interhemispheric functional connectivity that was correlated with the patient's recovery from poststroke apathy. Our case suggests that rTMS can improve the transfer of information through the corpus callosum, which is crucial for helping patients recover from poststroke apathy.


Assuntos
Apatia , Cérebro/fisiopatologia , Corpo Caloso/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Idoso de 80 Anos ou mais , Mapeamento Encefálico/métodos , Cérebro/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Lateralidade Funcional , Humanos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Resultado do Tratamento
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