ABSTRACT
The three-dimensional (3D) geometry of carotid atherosclerotic plaques is associated with multiple cardiovascular diseases. However, it is unknown if carotid plaques of different sizes are consistent in 3D geometry, with a lack of quantitative observation. We aim to evaluate the geometric consistency of carotid plaques using the correlations between multidimensional parameters. 42 cases with asymptomatic stenosis caused by atherosclerotic plaque in the carotid artery were included. Carotid plaques and calcifications were identified on computed tomography angiography images and 3D reconstructed. Multidimensional geometric parameters (length, surface area, volume, etc.) were measured on the reconstructed 3D structures. Linear and non-linear (power function) fittings were used to investigate the relationships between multidimensional parameters. The analysis was performed based on cases and plaques, respectively. Spearman rank correlation analysis, R-squared, and p-values were used to evaluate the significance of the relationship. Significant relationship was defined as R-squared >0.25 and p < 0.05. In total, 112 atherosclerotic plaques and 74 calcifications were extracted. In plaque-based analysis, significant correlations were widely observed between paired multidimensional parameters of carotid plaques, where non-linear fitting showed higher R-squared values. Plaque volume and surface area were significantly correlated with total volume and total surface area of intra-plaque calcifications. In subject-based analysis, triglycerides and total cholesterol were significantly correlated with carotid plaque size. There is a consistency in geometry among carotid atherosclerotic plaques of different sizes. The size of a carotid plaque is associated with the patient's lipid profile.
ABSTRACT
Progressive cerebral infarction (PCI) is a common complication in patients with ischemic stroke that leads to poor prognosis. Blood pressure (BP) can indicate post-stroke hemodynamic changes which play a key role in the development of PCI. The authors aim to investigate the association between BP-derived hemodynamic parameters and PCI. Clinical data and BP recordings were collected from 80 patients with cerebral infarction, including 40 patients with PCI and 40 patients with non-progressive cerebral infarction (NPCI). Hemodynamic parameters were calculated from the BP recordings of the first 7 days after admission, including systolic and diastolic BP, mean arterial pressure, and pulse pressure (PP), with the mean values of each group calculated and compared between daytime and nighttime, and between different days. Hemodynamic parameters and circadian BP rhythm patterns were compared between PCI and NPCI groups using t-test or non-parametric equivalent for continuous variables, Chi-squared test or Fisher's exact test for categorical variables, Cox proportional hazards regression analysis and binary logistic regression analysis for potential risk factors. In PCI and NPCI groups, significant decrease of daytime systolic BP appeared on the second and sixth days, respectively. Systolic BP and fibrinogen at admission, daytime systolic BP of the first day, nighttime systolic BP of the third day, PP, and the ratio of abnormal BP circadian rhythms were all higher in the PCI group. PCI and NPCI groups were significantly different in BP circadian rhythm pattern. PCI is associated with higher systolic BP, PP and more abnormal circadian rhythms of BP.
Subject(s)
Hypertension , Humans , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory , Cerebral Infarction/complications , Blood Pressure Determination , Circadian Rhythm/physiologyABSTRACT
Background: Several canalith repositioning procedures (CRPs) such as Gufoni maneuver have been proposed to treat the apogeotropic lateral semicircular canal variant of BPPV (LC-BPPV). The reported success rate varied widely in different studies. Research showed that there was a risk of treatment failure due to insufficient repositioning of the debris. So far, there is insufficient evidence to recommend a preferable CRP for apogeotropic LC-BPPV. Case description: A 49-year-old woman and a 48-year-old man diagnosed with apogeotropic LC-BPPV relapse were treated with original Gufoni maneuver for apogeotropic variant but no satisfactory result was obtained. A variation of Gufoni maneuver originally proposed for the geotropic variant was applied to detach otoconia toward the utricle or the non-ampullary arm. Apogeotropic nystagmus was successfully transformed into the geotropic variant. The subsequent Gufoni maneuver was successful. On a 64-year-old male with untreated apogeotropic LC-BPPV, we performed the Gufoni maneuver variation and observed a change in nystagmus direction. In all the three cases, no relapse of vertigo was reported after 1 month. Conclusion: The new application of Gufoni maneuver variation may improve the treatment of apogeotropic LC-BPPV. Treatment efficacy and patient-specific optimization such as head rotation angle deserve a large-scale validation and further investigation.