Cross Sectional Study of Depression in Patients following a Stroke: A Neurologists Perspective

Background: Stroke is one of the leading causes of mortality and morbidity in today’s world. With early intervention and improvements in critical care the mortality from stroke is decreasing. Today there are more chances of a patient surviving after a stroke than it was 2 decades ago. But this downward shift in mortality has caused increased prevalence of patients surviving with considerable neurodeficits and cognitive dysfunction. These patients are at increased risk of developing depression which may directly affect the recovery process. Yet the depression in post-stroke patient is rarely recognised and treated. Many a times such patients remain bed-ridden, neglected depressed and only a small number of these patients are treated for depression. Some of this has to do with the fact that there are not many randomised controlled trials dealing with this aspect. Gradually with increasing survival of the patients with stroke data is becoming available suggesting that the treatment of depression in post-stroke patient have a positive effect on recovery of these patients. We conducted this study to identify the prevalence and severity of depression in post stroke patients and to assess its relationship with demographic variables and stroke characteristics. Methods: This was a cross sectional study comprising of 52 patients selected on the basis of pre-defined inclusion criteria and was carried out in Department of Neurology of a tertiary care medical institute situated in an urban area. All patients attending follow up stroke OPDS having a history of stroke confirmed on imaging (Computed tomographic, MRI or MR angiography) were included in this study. Dependent variable of our study was depression while independent variables were demographic and clinical factors such as age, gender, marital status, financial status, residence status, education level and the clinical variables were stroke type, side and site of stroke. All the patients were interviewed using the preformed questionnaire specifically designed for this study. The data was tabulated and analysed. SPSS Statistics version 2.0 was used to analyze the collected data. Results: Forty four patients with stroke out of 52 (85%) met the criteria for depression. out of which 40 were males and 12 were females with a M: F ratio being 1:0.3. Demographic variables and stroke types (hemorrhagic versus thromboembolic) were not significantly associated with post stroke depression. A peculiar finding we encountered was infarcts in the middle cerebral artery territory were significantly associated with depression. Majority of the patients (87 %) had ischaemic stroke and most common location was found to be left hemisphere (60%). Most common territory was found to be left middle cerebral artery territory which was affected in 50% of the patients.81% patients were found to be having illness since more than 6 months. Depression was more common in male patients of more than 45 years of age. There was a significant association between the post stroke depression and left middle cerebral artery infarction. Conclusion: These results highlighted the need to investigate, diagnose and treat post-stroke depression. From a neurologist’s point of view it is important to recognize the symptoms of depression so that a psychiatric opinion can be sought.

Correlation of in vivo and in vitro methods in measuring choroidal vascularization volumes using a subretinal injection induced choroidal neovascularization model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In vivo quantification of choroidal neovascularization (CNV) based on noninvasive optical coherence tomography (OCT) examination and in vitro choroidal flatmount immunohistochemistry stained of CNV currently were used to evaluate the process and severity of age-related macular degeneration (AMD) both in human and animal studies. This study aimed to investigate the correlation between these two methods in murine CNV models induced by subretinal injection.</p><p><b>METHODS</b>CNV was developed in 20 C57BL6/j mice by subretinal injection of adeno-associated viral delivery of a short hairpin RNA targeting sFLT-1 (AAV.shRNA.sFLT-1), as reported previously. After 4 weeks, CNV was imaged by OCT and fluorescence angiography. The scaling factors for each dimension, x, y, and z (μm/pixel) were recorded, and the corneal curvature standard was adjusted from human (7.7) to mice (1.4). The volume of each OCT image stack was calculated and then normalized by multiplying the number of voxels by the scaling factors for each dimension in Seg3D software (University of Utah Scientific Computing and Imaging Institute, available at http://www.sci.utah.edu/cibc-software/seg3d.html). Eighteen mice were prepared for choroidal flatmounts and stained by CD31. The CNV volumes were calculated using scanning laser confocal microscopy after immunohistochemistry staining. Two mice were stained by Hematoxylin and Eosin for observing the CNV morphology.</p><p><b>RESULTS</b>The CNV volume calculated using OCT was, on average, 2.6 times larger than the volume calculated using the laser confocal microscopy. The correlation statistical analysis showed OCT measuring of CNV correlated significantly with the in vitro method (R 2 =0.448, P = 0.001, n = 18). The correlation coefficient for CNV quantification using OCT and confocal microscopy was 0.693 (n = 18, P = 0.001).</p><p><b>CONCLUSIONS</b>There is a fair linear correlation on CNV volumes between in vivo and in vitro methods in CNV models induced by subretinal injection. The result might provide a useful evaluation of CNV both for the studies using CNV models induced by subretinal injection and human AMD studies.</p>

Expression of erythropoietin and its receptor in normal and neovascularized murine corneas induced by alkali burns / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To test the expression of erythropoietin (Epo) and its receptor EpoR in normal and neovascularized murine corneas induced by alkali burns, and to investigate whether Epo/EpoR is involved in the process of corneal angiogenesis.METHODS: The expression of Epo/EpoR was tested in normal and neovascularized murine corneas induced by alkali burns through immunohistochemistry of corneal frozen sections. Epo cloning, expression, and purification were carried out. Then Epo protein (6μL, 1μg) and control (6μ L of vector control or saline) were injected into the corneal stroma respectively, and the corneas were checked at the 14th day after injection to see whether corneal neovascuarization occurred.RESULTS: Epo/EpoR was expressed in epithelial cells, endothelial cells and stromal cells in normal and neovascularized corneas induced by alkaline burns, and also expressed strongly in neovascularized cornea. They were expressed at the same time in stromal inflammatory cells and new vessels. Corneal neovascularization was induced by Epo intrastromal injection in 5 out of 6 eyes ,but no new vessels were observed in all controls (n = 6) at day 14 after vector control or saline intrastromal injection in normal corneas.CONCLUSION: This paper first reported the expression of Epo and its receptor in normal and neovascularized cornea. Injection of Epo into the corneal stroma may induce the corneal neovascularization. Epo/EpoR is associated with the formation of corneal neovascularization.