An increase in the cerebral infarction area during fatigue is mediated by il-6 through an induction of fibrinogen synthesis

OBJECTIVES: Our study aimed to investigate the impact of fatigue on the severity of stroke and to explore the underlying mechanisms. METHODS: Fatigued male rats underwent middle cerebral artery occlusion and the infarcted brain area was determined. Then, coagulation parameters were assessed in the fatigued group and a control group. In addition, the level of fibrinogen was determined in rats deprived of sleep for various numbers of days. To study whether interleukin-6 was involved in fibrinogen synthesis during fatigue, we also measured levels of interleukin-6 in rats deprived of sleep for various numbers of days. Furthermore, brain injury by middle cerebral artery occlusion was measured in wild-type mice, interleukin-6-/- mice and wild-type mice treated with bezafibrate. RESULTS: More severe cerebral infarction was observed in the fatigued rats, resulting in an infarct ratio of 23.4%. The infarct ratio was significantly increased in the fatigued rats compared with that in the control group (8%, p<0.05). The level of fibrinogen was increased significantly in the fatigued rats compared with that in the control group. In addition, a marked reduction in fibrinogen level was observed in the fatigued interleukin-6-/- mice compared to their wild-type counterparts, whereas no difference was observed between fatigued wild-type mice and interleukin-6-/- rats treated with recombinant human interleukin-6. The reduction in brain injury due to middle cerebral artery occlusion during fatigue was observed in interleukin-6-/- mice and wild-type mice treated with bezafibrate. CONCLUSION: Fatigue could increase stroke severity and was associated with the interleukin-6-induced expression of fibrinogen. .

Albumina humana: usos e abusos / Human albumin: uses and abuses

A relevância da utilização de albumina em pacientes com doença aguda ou crônica permanece controversa. Apesar da importância fisiológica e dos potenciais efeitos benéficos, sua utilização é baseada na prática clínica e não sustentada nas evidências dos estudos clínicos. Resultados promissores de seu uso são confirmados na falência hepática, no infarto cerebral e, talvez, em situações de exceção na reposição volêmica de pacientes críticos.

The relevance of human albumin administration remains controversial. Albumin infusion has not proven to achieve clinical benefit in many acute and chronic disease states with a few exceptions in liver failure, cerebral infarction and may be in acute hypovolemia in the critical patients.

Comparison of serum adiponectin and interleukin 6 concentrations in nondiabetic hypertensive and diabetic hypertensive patients who developed cerebral infarct

Stroke is the second leading cause of death and a major cause of morbidity and mortality in western as well as developing countries. Adiponectin is a fat-derived plasma protein that has beneficial actions on cerebrovascular disorders. A low level of plasma adiponectin is associated with increased mortality after ischemic stroke. Interleukin 6 is a cytokine, which is elevated in inflammatory, traumatic and ischemic injuries. The objective of this study was to compare serum adiponectin and interleukin-6 levels in diabetic hypertensive and nondiabetic hypertensive patients and to measure the size of cerebral infarct. 89 patients [30 controls, 30 nondiabetic hypertensive and 29 diabetic hypertensive] were recruited in the study according to inclusion criteria of Ziauddin University Hospital. Serum adiponectin and interleukin 6 concentrations were measured by ELISA. Blood glucose and lipid profile was done by standard kit methods. Serum adiponectin concentration was significantly lower [P<0.05] in both study groups and interleukin 6 was significantly higher [P<0.05] in diabetic hypertensive group as compared with controls. The mean serum interleukin 6 in diabetic hypertensive patients with cerebral infarct was significantly higher than that of nondiabetic hypertensive patients with cerebral infarct [P< 0.001]. Serum adiponectin concentration was decreased while the infarct size was larger in diabetic hypertensive group as compared to nondiabetic. Hypertensive group but the difference in these parameters was statistically non significant. Hence the study supports to the evidence of involvement of adiponectin and interleukin 6 in patients of stroke

C - reactive protein levels in cerebral infaarctioninpatients on hemodialysis

Serum C-reactive protein [CRP] concentration issensitive marker of underlying systemic inflammation. Patientsunder continuous hemodialysis have an activated inflammatoryresponse, evidenced by increased serum CRP levels especiallyin patients with cerebral stroke. The study was performed toevaluate serum levels of CRP as inflammatory markers inpatients with stroke under continuous hemodialysis. The study was included 33 patients with chronicrenal failure under continuous hemodialysis divided into twogroups. Group I included 23 patients with acute stroke. Group II [control group] included 10 patients without stroke. All patientswere subjected to complete history and clinical examinationwith special emphasis to history of co-morbid conditions,hypertension, diabetes mellitus and cardiovascular disease.Serum creatinine, urea, CBC, albumin, lipid profile, calcium,fasting and post prandial blood sugar, sodium, potassium, serumuric acid, phosphorus, C-reactive protein and other investigationwere evaluated. In addition axial CT or MRI was performed atadmission and after 72 hours. The following parameterswere significantly higher in groupe I when compared to group II;ages [t=3.5. p< 0.01], CRP [t=7.1, p<0.001], serum creatinine [tett, p<0.0] and blood urea [t=4.3, p<0.01], while serumlevels of Hb% and serum calcium were significantly lower ingroup I when compared to group II [t=3.1, p<0.01 and t=2.2,p<0.05 respectively]. On the hand no significant differences inthe other studied parameters between two groups. Serum levelsof CRP were positively correlated with INR [r=520, p<0.05] and negatively correlated with serum calcium [r=0.580, p<0.05] and serum albumin [r=-540, p<0.05]. On the other hand nosignificant correlations were found between CRP and otherstudied parameters. According to ROC curve between group Iand II in CRP the cutoff were greater than 12 with sensitivity,specificity, Positive Perdictive Value and Negative PredictiveValue were 100% by accuracy 100%. Elevatedserum CRP could be a predictor of cerebrovascular stroke indialysis patients. Therefore, regular determination of serumCRP may be helpful to detect early signs of tissue damage andasymptomatic inflammation in these patients

Cerebral Infarction in IgG Multiple Myeloma with Hyperviscosity

Cerebral infarction is an uncommon complication in multiple myeloma with hyperviscosity. Serum hyperviscosity may cause a variety of clinical manifestations including bleeding from mucosal membranes, congestive heart failure, retinopathy, and various neurologic deficits. These manifestations have been attributed to the presence of large quantities of asymmetrical molecules of high molecular weight in the serum. We recently experienced a case of multiple myeloma with acute cerebral infarction, which caused by hyperviscosity, as an initial manifestation in IgG multiple myeloma, and reviewed the relevant literature of myeloma presenting with the stroke. A 68-yr-old woman abruptly developed hypesthesia and monoplegia in the left leg. The stroke confirmed by the brain MRI and MR angiography, which revealed acute infarction at the right anterior cerebral artery territory. On admission, routine blood tests showed a slight decrease in hemoglobin and a marked increase in erythrocyte sedimentation rate. Peripheral blood smear, serum protein electrophoresis, serum visocity, and bone marrow aspiration showed that she had IgG multiple myeloma with hyperviscosity. She was treated by chemotherapy with cyclophosphamide and discharged with the improved clinical condition.

Prediction of total cholesterol: high-density-lipoprotein-cholesterol ratio in young adults.

Abnormal cholesterol fraction is an essential risk factor for atherosclerosis of large cerebral arteries in young Asians. In order to reduce the medical cost and social resource for cholesterol electrophoresis, especially in undeveloped and developing Asian countries, we evaluated the validity of Nanji's GUT score for predicting TC: HDLC ratio in this population. Results showed that GUT score only predicted 71% of them. We also tested the predictive power of CUT index, and predicting rate was 81%. Therefore, Nanji's GUT score is not an ideal surrogate for cholesterol electrophoresis. We recommend CUT index to screen for high-risk subjects till a new method can satisfy the economic pattern in Asian countries.

Infartos cerebrais em pacientes jovens relacionados a deficiência de anticoagulantes naturais: proteína C e proteína S / Cerebral infarctions in young patients related to deficiency of natural anticoagulants: protein C and protein S

Infartos cerebrais (IC) em jovens apresentam múltiplas etiologias que diferem do padrao observado nos indivíduos idosos. Deficiências de anticoagulantes naturais têm sido descritas nos últimos anos como causa de IC, principalmente em pacientes com menos de 40 anos. Existe tendência atual de se pesquisar essas deficiências em todos os pacientes jovens com infarto cerebral de causa indeterminada e naqueles com manifestaçoes trombóticas de múltiplos sistemas. Realizamos pesquisa dos níveis de proteína C, proteína S e antitrombina III em pacientes entre 15 e 40 anos com ICs classificados como indeterminados após conclusao protocolo básico de investigaçao. Diagnosticamos dois casos de deficiência de proteína C e um caso de deflciência de proteína S. Concluímos que a investigaçao sistemática de causas hematológicas proporciona decréscimo no número de infartos indeterminados, além de possibilitar a adoçao de condutas específicas que diminuem incidência de novos eventos nos casos diagnosticados.

The lipoprotein profile of young adults with cerebral atherosclerosis.

In order to elucidate the relationship between the lipoprotein profile and large cerebral artery atherosclerosis in the young adults living in developing Asian countries, the serum lipoprotein profile and the luminal diameter of large cerebral arteries (internal carotid, middle/anterior cerebral and vertebrobasilar arteries) were measured and correlated in 67 young Taiwanese with non-embolic cerebral infarct (CI). Totally 23 (21.9%) patients had atherosclerotic stenosis. A significant elevation of the serum total cholesterol (TC), triglyceride, total lipids, beta-lipoprotein (beta-LP) and pre-beta-LP level was found in atherosclerotic CI patients. But multiple regression analysis showed only the serum beta-LP (p = 0.0041) and TC (p = 0.0324) level to be the independent risk factors for atherosclerosis. Secondary dyslipoproteinemia is the main cause for hyperlipoproteinemia in our atherosclerotic patients. Therefore, an abnormal lipoprotein profile is linked to large cerebral artery atherosclerosis in young Asians regardless of ethnic group. A tailored program is recommended to modify the life style and dietary habit, as well as to gain access to secondary control for large cerebral atherosclerosis prevention in developing countries.

The effect of aspirin on neurodeficit and platelet aggregability in acute ischemic cerebral strokes.

We examined the role of aspirin in modifying platelet aggregability (PA) and neurodeficit (ND) in patients presenting within 48 hours of acute ischemic cerebral strokes of the carotid territory. 28 adult patients were studied at baseline and after 7 days of treatment with a single daily dose of aspirin 325mg (group A, n = 12) and 160 mg (Group B, n = 16). We also evaluated the neurologic outcome at the beginning and at the end of 7 days using a scoring system. There was no significant difference in the ND scores and in vitro PA between these two groups. PA, as measured in vitro, does not appear to have any significant role as a predictor of neurologic outcome in acute ischemic strokes. The change in ND scores of patients with ischemic cerebral strokes treated acutely with aspirin was not significant upto first 7 days therapy.

Plasma lipoproteins in cortical and lacunar infarction.

Plasma lipoproteins in 30 patients of cortical infarction and 20 patients of lacunar infarction were estimated to study the relation of plasma lipids to the risk for ischaemic stroke by comparing clinical and biochemical characteristics of survivors. No significant differences were observed in the concentrations of total cholesterol, triglycerides, low density lipoproteins, very low density lipoproteins in both the groups. However patients with lacunar infarction had higher concentrations of high density lipoproteins as compared to patients with cortical infarction. These data suggest that previously demonstrated differences in HDL concentration between patients with ischaemic stroke and control subjects without stroke may be true for patients with cortical infarction but not for patients of lacunar infarction.

Blood lipids, the risk factor of cerebral infarction.

A hospital-based case-control study was undertaken at Prasat Neurological Hospital and Institute, Bangkok, in 1990 to determine the association between blood lipid variables (i.e., total cholesterol and triglycerides) and cerebral infarction. To alleviate the unwanted effects of sample selection a number of inclusion and exclusion criteria were also made. A total of 193 newly diagnosed cerebral infarction patients together with an equal number of age-sex-matched controls, male and female 45 to 84 years of age, were studied. The association was assessed by logistic regression analysis. Other potential risk factors for cerebral infarction were entered in the logistic models as covariates to be adjusted. The results showed that, total cholesterol and triglycerides were statistically significant related to cerebral infarction (p < 0.0001) in univariated analysis. After adjusting for the covariates through multivariate logistic regression analyses, total cholesterol remained significantly related to cerebral infarction (p = 0.0430) but triglycerides was not significant (p = 0.3953). Other factors, namely, hypertension, cardiac impairment, diabetes mellitus and hemoglobin concentration were strongly related to cerebral infarction in both the univariate and multivariate analyses. The interaction between blood lipids variables and potential risk factors was also assessed. The finding showed significant multiplicative interaction between triglyceride levels and diabetes mellitus status (p = 0.0026). Other interaction terms did not approach statistical significance.

Lipoproteínas del suero de la enfermedad cerebrovascular isquémica / Serum lipoproteins in the ischemic cerebrovascular disease

Se estudiaron las lipoproteinas del suero de 103 pacientes con enfermedad cerebrovascular isquémica (66 con infarto cerebral y 37 con ataques transitorios ded isquemia cerebral) y de 101 controles. Ambos grupos se distribuyeron en 2 subgrupos de edad: de 40 a 59 años y de 60 a 79 añs. Para la separación de las lipoproteínas del suero se empleó la electrofóresis engel de poliacrilamida, con la que se observó un porciento menor de fracción alfa y un mayor porciento de fracción prebeta en todos los grupos de pacientes: un porciento menor de fracción beta en pacientes masculinos de ambos grupos de edad y un mayor porciento de fracción de densidad intermedia en todos los grupos de pacientes con excepción de las mujeres entre 60 y 79 años de edad. Se concluye que el método es de utilidad para el estudio de las alteraciones del metabolismo lipídico en pacientes con enfermedad cerebrovascular isquémica