Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study

ABSTRACT BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.

Efectos del Ejercicio Físico Aeróbico sobre los Factores de Riesgo Modificables que Predisponen a un Segundo Evento de Accidente Cerebrovascular. Revisión Sistemática / Effects of Aerobic Physical Exercise on Modifiable Risk Factors that Predispose to a Second Stroke Event. Systematic review

Introducción. El accidente cerebrovascular (ACV) es una condición de salud que ha aumentado su prevalencia en los últimos años, la cual se encuentra intrínsecamente asociada a la presencia de enfermedades crónicas no transmisibles (ECNT), como lo son la diabetes mellitus, dislipidemia e hipertensión, las que, de no ser controladas tras la instauración del primer episodio, predisponen a la afección de un segundo evento de ACV. Es sabido que el ejercicio físico aeróbico juega un rol fundamental en el control de las ECNT, junto con otros factores, como lo son los cambios de hábitos y adherencia a los tratamientos farmacológicos. Objetivo. Analizar los efectos que tiene el ejercicio físico aeróbico en población secuelada de un ACV sobre las ECNT que predisponen a sufrir un segundo evento cerebrovascular. Método. Se realizó una exhaustiva búsqueda en las bases de datos EBSCO, Scielo, PubMed y PEdro, utilizando las palabras claves "stroke and modifiable risk factors and aerobic physical exercise"; obteniendo un total de 56438 artículos. Para la selección, se consideraron los siguientes criterios de inclusión: pacientes entre 45 y 65 años con secuelas de ACV de más de 6 meses, que analizaran el efecto del ejercicio físico sobre las ECNT tras un evento cerebrovascular. Resultados. Se seleccionaron tres artículos científicos tipo ensayo clínico aleatorizados controlados, los cuales analizan los efectos que produce el ejercicio físico aeróbico sobre las ECNT tras un ACV. Entre los resultados con mayor significancia estadística (P entre 0.01 y 0.05) se encuentra el aumento en el consumo peak de oxígeno y el aumento en el colesterol HDL. Conclusiones. Es indispensable sistematizar la información de los programas de rehabilitación neurológica, que permitan levantar datos de las intervenciones, y así poder potenciar el ejercicio físico aeróbico de forma segura para poder controlar las ECNT subyacentes y así prevenir futuros eventos cerebrovasculares.

Background. Cerebrovascular accident (CVA) is a health condition that has suspected its prevalence in recent years, which is intrinsically associated with the presence of chronic non-communicable diseases (CNCD), such as diabetes mellitus, dyslipidemia and hypertension, which, if not controlled after the establishment of the first episode, predispose to the condition of a second stroke event. It is known that aerobic physical exercise plays a fundamental role in the control of NCDs, along with other factors, such as changes in habits and adherence to pharmacological treatments. Objective. To analyze the effects of aerobic physical exercise in the population after a stroke on NCDs that predispose to a second cerebrovascular event. Method. An exhaustive search was carried out in the EBSCO, Scielo, PubMed and PEdro databases, using the keywords "stroke and modifiable risk factors and aerobic physical exercise"; obtaining a total of 56438 articles. For selection, consider the following inclusion criteria: patients between 45 and 65 years of age, stroke sequelae of more than 6 months, who will analyze the effect of physical exercise on NCDs after a cerebrovascular event. Results. Three controlled randomized clinical trial were selected, which analyze the effects produced by aerobic physical exercise on NCDs after a stroke. Among the results with the highest statistical significance (P between 0.01 and 0.05) is the increase in peak oxygen consumption and the increase in HDL cholesterol. Conclusion. It is essential to systematize the information on neurological rehabilitation programs, to collect data from the interventions, and thus be able to promote aerobic physical exercise safely to control the underlying NCDs and thus prevent future cerebrovascular events.

Associations between ultrafine particles（UFPs） exposure and occurrence and mortality of cardio-cerebrovascular diseases in Minhang District， Shanghai： a time-series analysis / 上海预防医学

ObjectiveThe study aimed to quantitatively evaluate the short-term effects of ultrafine particles （UFPs） exposure on the occurrence and mortality of cardio-cerebrovascular diseases. MethodsThe number of daily cases of cardio-cerebrovascular events， including stroke and acute myocardial infarction， and mortality of cardio-cerebrovascular diseases， daily concentrations of air pollutants and weather conditions in Minhang， Shanghai from January 1， 2016 to December 31， 2018 were collected. Associations between UFPs and the number of daily cases and deaths were analyzed by the general additive Poisson regression model with the control of meteorological variables， day-of-the-week effects and time trends. Increased percentages of the number of daily cases and deaths and 95%CI were used to indicate the short-term effects of UFPs. ResultsDuring the study period， in the single-pollutant model， an increase of 2022 particles/cm3 showed significant effects with 5.01%（95%CI： 1.22%‒8.94%）and 6.05%（95%CI： 1.53%‒10.80%）increments in the percentages of the number of daily cases and deaths respectively. After adjusting other pollutants in the two-pollutant model， statistically significant associations were also observed. ConclusionUFPs exposure has acute impacts on the occurrence and mortality of cardio-cerebrovascular diseases.

Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases

Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods. However, additional evidence from future studies will be required before some of these techniques can be widely applied or recommended as alternatives.

Clinical characteristics of adverse-outcome in elderly patients after percutaneous coronary intervention / 西安交通大学学报(医学版)

Objective: To study the clinical characteristics of major adverse cardiovascular and cerebrovascular events (MACCE) in elderly patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) to provide basis for reducing MACCE in clinic. Methods: A total of 1 188 consecutive elderly patients after PCI during January 2013 and January 2015 in The First Affiliated Hospital of Xi'an Jiaotong University were prospectively followed up for an average of 24.8 months. MACCE included all-cause death, acute myocardial infarction, revascularization and stroke. Then we compared the clinical factors between MACCE group and non-MACCE group to screen variables for multi-factor Logistic analysis. Results: Totally 1 188 CHD patients completed follow-up after PCI, in which there were 341 cases of MACCE, accounting for 28.7%. Compared with those in non-MACCE group, patients in MACCE group were older, and had more comorbidities including diabetes melutus (DM) and more complicated coronary lesions. Multi-factor analysis revealed that older age, complication with DM and increased uric acid in serum were independent factors of MACCE. Conclusion: Older age, DM and increased uric acid in serum are independent predictors for MACCE in elderly patients. We should strengthen the monitoring of these patients in clinical treatment.

Ictus isquémico masivo secundario a miocarditis viral en un niño / Massive ischemic stroke secondary to viral myocarditis in a child

Introducción: los accidentes cerebrovasculares son raros en niños, y generalmente se asocian a trombofilias; sin embargo, se deben considerar procesos infecciosos de tipo miocarditis infecciosa que pudieran conducir a formación de trombos. Presentación del caso: se presenta el caso de un niño de 13 meses de edad, previamente sano, con evidencia de accidente cerebrovascular isquémico extenso, que comprometió ambos hemisferios cerebrales, con antecedente de infección gastrointestinal que podría sugerir sepsis y miocarditis secundaria a esta, que contribuye a un evento trombótico, el cual, probablemente, desencadenó el proceso cerebrovascular descrito. Conclusiones: las infecciones, aunque se han relacionado como la tercera causa de eventos cerebrovasculares, se deben tener en cuenta para así instaurar tratamiento antibiótico oportuno, y con esto, evitar secuelas(AU)

Introduction: cerebrovascular accidents are rare in children, and they are generally associated with thrombophilia. However, infectious processes such as myocarditis should also be considered, for they may lead to thrombus formation. Case presentation: a previously healthy 13-month-old male child presents with evidence of extensive ischemic cerebrovascular accident compromising both cerebral hemispheres, with a history of gastrointestinal infection which might suggest the presence of sepsis and myocarditis secondary to it contributing to a thrombotic event which probably triggered the cerebrovascular process herein described. Conclusions: although they have been ranked as the third cause of cerebrovascular events, infections should be taken into account so as to timely indicate the appropriate antibiotic treatment and avoid the occurrence of sequels(AU)

Association between Contrast Media Volume and 1-Year Clinical Outcomes in Patients Undergoing Coronary Angiography / 中华医学杂志(英文版)

<p><b>Background</b>The excess volume of contrast media (CM) is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events (MACCE) and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography (CAG).</p><p><b>Methods</b>We prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis.</p><p><b>Results</b>The cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 (≤100 ml), Q2 (101-140 ml), Q3 (141-200 ml), and Q4 (>200 ml), respectively (P < 0.001). Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively (P < 0.001). The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used >140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml (P = 0.007).</p><p><b>Conclusion</b>Our data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization.</p><p><b>Trial Registration</b>ClinicalTrials.gov, NCT01735305; https://clinicaltrials.gov/ct2/show/NCT01735305?id=NCT017353057rank=1.</p>

Accidente cerebrovascular de causa hemodinámica / Hemodynamic causes in cerebrovascular ischemic event

El accidente cerebrovascular hemodinámico es una entidad pobremente descripta. Puede ser causada por enfermedades sistémicas tales como insuficiencia cardíaca o hipotensión y también por la obstrucción grave de las arterias carótidas o vertebrales. Los pacientes con accidente cerebrovascular hemodinámico pueden mostrar características clínicas específicas que los distinguen de los pacientes con embolia o enfermedad de pequeños vasos. Los estudios complementarios de perfusión cerebral pueden mostrar si el flujo de sangre al cerebro se ve comprometido y proporcionar información de valor pronóstico. El tratamiento dirigido a incrementar el flujo sanguíneo cerebral podría ser considerado en pacientes con estenosis graves de las arterias extracraneanas sobre la base de la información proveniente de series de casos. (AU)

Hemodynamic stroke is a poorly described entity. It can be caused by systemic diseases such as heart failure or hypotension, but also by severe obstruction of the carotid or vertebral arteries. Patients with hemodynamic cerebrovascular event might show specific clinical features that distinguish them from patients with embolism or local small-vessel disease. Complementary studies of cerebral perfusion can show whether blood flow to the brain is compromised and provide important prognostic information. Treatment aimed at increasing cerebral blood flow might be considered in patients with severa extracraneal artery stenosis on the basis of information from case series. (AU)

Medida de la ineependencia funcional con escalafim en los pacientes con eventoo cerebro vascular del hospital militar central de bogotá en el periodo octubre 2010 - mayo 2011 / Functional independence measure with scale fim inpatients with vascular brain evvents of central military hospital from bogotá in the period october 2010 - may 2011 / Medida da indpenndência funcional com escala fim nos paciente com evento cérrebro vascular do hospital militar central de bogotá no período outubro 2010 - maio 2111

El evento cerebro vascular (ECV) es la enfermedad neurológica más prevalente en el adulto. Provoca alto índice de discapacidad en nuestro medio. Con la medición del nivel de discapacidad se puede determinar el impacto que tiene el evento cerebro vascular en el paciente y de acuerdo con éste se fijan las metas en rehabilitación, individualizando las prioridades en la rehabilitación de acuerdo a los hallazgos en la valoración clínica. Objetivo: Medir la dependencia funcional que presentan los pacientes del Hospital Militar Central (HMC), posterior a sufrir un evento cerebro vascular con la escala FIM (Independence Functional Measure). Metodología: De manera retrospectiva, se hizo una revisión de las historias clínicas, midiendo el resultado total y en cada uno de sus ítems evaluados. Se analizaron estos resultados para determinar en qué actividades de la vida diaria presentan mayor discapacidad los pacientes. Resultados: Los pacientes que presentaron evento cerebro vascular en el HMC, presentan afectación significativa de la funcionalidad de acuerdo a los hallazgos al valorar con escala FIM. El compromiso es mayor en el dominio motor que en el cognitivo. Las actividades más afectadas son aquellas que requieren desplazamientos largos o uso de escaleras y las menos comprometidas son la interacción social y la comprensión. Conclusiones: Este estudio mostró que el ECV afecta la funcionalidad del paciente y por lo tanto su calidad de vida, esto hace importante la evaluación objetiva de la funcionalidad, ya que permite establecer metas individuales en rehabilitación, por lo cual las escalas de valoración funcional deben realizarse siempre para hacer objetiva esta medición.

The cerebrovascular event I the most neurological prevalent disease on adults, causes a great amount of disability on this medium, can be classified by his cause as ischemic or hemorrhagic, by measuring the level of disability can determine the impact of the cerebrovascular event In our patients an accordingly fixing rehabilitation goals, identifying goals, identifying priorities that are required according to the findings of the clinics assessment. Objectives: Measuring the functional dependency presenting on patients of central military hospital after suffering cerebrovascular event with the FIM (functional independence measure) scale. Methodology: In retrospect it was made a chart review, measuring the total score an each o f the items evaluated and analyzed these results to determine which of the life activities show greater disability on patients. Results: Patients presented in military hospital with cerebrovascular event is affected in significant functionality according to the findings of the assess whit the FMI scale the commitment is higher in the motor domain than the cognitive domain the most affected activities are those requiring long displacements or the use of ladders an less are committed to social interaction an understanding. Conclusions: This study showed that cerebrovascular event affect the functionality of the patient and thus their quality of life, this makes it important to the objective evaluation of the functionality and allows you to set individual goals of rehabilitation whereby scales functional assessment must be always performed objectively to measurement.

O evento cérebro vascular (ECV) é a doença neurológica mais prevalente no adulto. Provoca alto índice de discapacidade em nosso meio. Com a medição do nível de discapacidade pode-se determinar o impacto que tem o evento cérebro vascular no paciente ede acordo a este se fixam as metas em reabilitação, individualizando as prioridades na reabilitação de acordoàs descobertas na valoração clínica. Objetivo: Medir a dependência funcional que apresentam os pacientes do Hospital Militar Central (HMC) posterior a sofrer um evento cérebro vascular com a escala FIM (Independence Functional Measure). Metodologia: De maneira retrospectiva, se fez uma revisão das historias clínicas, medindo o resultado total e em cada um de seusitens avaliados. Analisaram-seestes resultados para determinar em que atividades da vida diária a presentam maior discapacidade os pacientes. Resultados: Os pacientes que apresentaram evento cérebro vascular no HMC apresentam afetação significativa da funcionalidade de acordo às descobertas ao valorar com escala FIM. O compromisso émaior no domínio motor do que no cognitivo. As atividades mais afetadas são aquelas que requerem deslocamentos longos ou uso de escadas e as menos comprometidas são a interação social e a compreensão. Conclusões: Este estudo mostrou que o ECV afeta a funcionalidade do paciente e pelo tanto suaqualidade de vida, istofaz importante aavaliação objetiva da funcionalidade já que permite estabelecer metas individuais em reabilitação pelo qual as escalas de valoração funcional devem realizar-se sempre para fazer objetiva esta medição.