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1.
Clin Radiol ; 76(3): 224-232, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33402260

ABSTRACT

AIM: To evaluate whether shear-wave velocity (SWV) can be used for predicting the prognoses of patients with colorectal cancer liver metastases (CRLMs) after chemotherapy. MATERIALS AND METHODS: Our institutional review board approved this prospective study, and written informed consent was obtained. SWV of CRLMs were obtained using point shear-wave elastography using acoustic radiation force impulse from 25 patients prior to and 2, 7, and 14 days after chemotherapy. Progression-free survival (PFS) after chemotherapy was estimated using the Kaplan-Meier method. The Cox proportional hazard regression model was used to determine significant predictive factors for PFS. For measurement reproducibility, an additional 37 patients with CRLMs were enrolled and assessed using intraclass correlation coefficients (ICCs). RESULTS: After chemotherapy, 10 and 15 patients were classified into responder and non-responder groups, respectively. The estimated 1- and 3-year PFS values in the whole cohort were 36% and 8%, respectively. A decrease in the SWV value on day 2 relative to the initial value was a significant predictive factor for better PFS outcome (hazard ratio = 0.20, 95% confidence interval = 0.07-0.57, p=0.003). The estimated 1 and 3-year PFS rates were 66.7% and 22.2%, respectively, in nine patients with decreased SWV values on day 2 and significantly higher than 18.8% and 0% of 16 patients with increased SWV values on day 2. The ICC value of SWV of CRLMs in the additional 37 patients was 0.823 (95% CI = 0.685-0.905), indicating good agreement. CONCLUSION: SWV values of CRLMs could provide prognostic information in patients with CRLMs treated with chemotherapy, as decreased SWV values on day 2 after chemotherapy was a significant predictive factor for better PFS.


Subject(s)
Colorectal Neoplasms/pathology , Elasticity Imaging Techniques/methods , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/drug therapy , Adult , Aged , Female , Humans , Liver/diagnostic imaging , Liver Neoplasms/secondary , Male , Middle Aged , Prognosis , Prospective Studies , Reproducibility of Results , Treatment Outcome
2.
Eur Radiol ; 29(8): 4303-4314, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30350166

ABSTRACT

OBJECTIVE: To investigate the incidence of thoracic recurrence and the diagnostic value of chest CT for postoperative surveillance in curatively-resected colorectal cancer (CRC) patients. METHODS: This retrospective study consisted of 648 CRC patients (M:F, 393:255; mean age, 66.2 years) treated with curative surgery between January 2010 and December 2012. The presence of CRC recurrence over follow-ups was analysed and recurrence-free survival and risk factors of recurrence were assessed using Kaplan-Meier analysis with log-rank test and Cox-regression analysis, respectively. RESULTS: Over a median follow-up of 57 months, thoracic recurrence occurred in 8.0% (52/648) of patients with a median recurrence-free survival rate of 19.5 months. Among the 52 patients with thoracic recurrence, 18 (2.7%) had isolated thoracic recurrence, and only five (0.8%) were diagnosed through chest CT. Risk factors of overall thoracic recurrence included age, positive resection margin, presence of venous invasion, positive pathologic N-class, and presence of abdominal recurrence (odds ratio [OR] = 1.78, 19.691, 2.993, 2.502, and 31.137; p = 0.045, 0.004, 0.001, 0.005, and p < 0.001, respectively). As for isolated thoracic recurrence, serum carcinoembryonic antigen level ≥ 5 ng/mL during postoperative follow-up (OR = 9.112; p < 0.001) was demonstrated to be the only predictive factor. There were no thoracic recurrences in patients with CRC stages 0 and I. CONCLUSION: In patients with curatively-resected CRCs, routine surveillance using chest CT may be of limited value, particularly in those with CRC stages 0 or I, as recurrence only detectable through chest CT was shown to be rare. KEY POINTS: • Postoperative thoracic recurrence only detectable through chest CT was shown to be rare. • There were no thoracic recurrences in colorectal cancers stage 0 and I. • Postoperative surveillance chest CT is of limited value in patients with curatively resected colorectal cancers.


Subject(s)
Colectomy , Colorectal Neoplasms/diagnosis , Neoplasm Recurrence, Local/diagnosis , Thoracic Neoplasms/epidemiology , Tomography, X-Ray Computed/methods , Aged , Biomarkers, Tumor/blood , Carcinoembryonic Antigen/blood , Colorectal Neoplasms/secondary , Colorectal Neoplasms/surgery , Female , Humans , Incidence , Male , Postoperative Period , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Thoracic Neoplasms/diagnosis
3.
Mol Cancer Ther ; 16(11): 2528-2542, 2017 11.
Article in English | MEDLINE | ID: mdl-29021293

ABSTRACT

Metastatic breast cancer is still incurable so far; new specifically targeted and more effective therapies for triple-negative breast cancer (TNBC) are required in the clinic. In this study, our clinical data have established that basal and claudin-low subtypes of breast cancer (TNBC types) express significantly higher levels of Annexin A1 (ANXA1) with poor survival outcomes. Using human cancer cell lines that model the TNBC subtype, we observed a strong positive correlation between expression of ANXA1 and PPARγ. A similar correlation between these two markers was also established in our clinical breast cancer patients' specimens. To establish a link between these two markers in TNBC, we show de novo expression of ANXA1 is induced by activation of PPARγ both in vitro and in vivo and it has a predictive value in determining chemosensitivity to PPARγ ligands. Mechanistically, we show for the first time PPARγ-induced ANXA1 protein directly interacts with receptor interacting protein-1 (RIP1), promoting its deubiquitination and thereby activating the caspase-8-dependent death pathway. We further identified this underlying mechanism also involved a PPARγ-induced ANXA1-dependent autoubiquitination of cIAP1, the direct E3 ligase of RIP1, shifting cIAP1 toward proteosomal degradation. Collectively, our study provides first insight for the suitability of using drug-induced expression of ANXA1 as a new player in RIP1-induced death machinery in TNBCs, presenting itself both as an inclusion criterion for patient selection and surrogate marker for drug response in future PPARγ chemotherapy trials. Mol Cancer Ther; 16(11); 2528-42. ©2017 AACR.


Subject(s)
Annexin A1/genetics , Inhibitor of Apoptosis Proteins/genetics , Nuclear Pore Complex Proteins/genetics , PPAR gamma/genetics , RNA-Binding Proteins/genetics , Triple Negative Breast Neoplasms/drug therapy , Animals , Caspase 8/genetics , Cell Proliferation/genetics , Death Domain/genetics , Deubiquitinating Enzymes , Drug Resistance, Neoplasm/genetics , Female , Gene Expression Regulation, Neoplastic/drug effects , Humans , Ligands , MCF-7 Cells , Mice , Neoplasm Metastasis , Triple Negative Breast Neoplasms/genetics , Triple Negative Breast Neoplasms/pathology , Xenograft Model Antitumor Assays
4.
Epidemiol Infect ; 143(3): 515-21, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24866366

ABSTRACT

In February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1-56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1-24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.


Subject(s)
Caliciviridae Infections/epidemiology , Disease Outbreaks , Food Microbiology , Foodborne Diseases/epidemiology , Gastroenteritis/epidemiology , Norovirus/isolation & purification , Ulva , Adolescent , Caliciviridae Infections/virology , Case-Control Studies , Child , Cohort Studies , Female , Foodborne Diseases/virology , Gastroenteritis/virology , Genotype , Humans , Male , Norovirus/classification , Norovirus/genetics , Republic of Korea/epidemiology , Retrospective Studies , Schools
5.
Br J Radiol ; 85(1017): e609-15, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22422385

ABSTRACT

OBJECTIVES: The objective of this study was to determine the in vivo efficacy of radiofrequency ablation (RFA) in porcine liver using Octopus® electrodes for creating a large coagulation compared with RFA using clustered electrodes. METHODS: A total of 39 coagulations were created using a 200-W generator and clustered electrodes or Octopus electrodes during laparotomy in 19 pigs. Radiofrequency was applied to the livers using four protocols: (1) Group A-1, monopolar mode using a clustered electrode (n=11); (2) Group A-2, monopolar mode using an Octopus electrode (n=11); (3) Group B-1, consecutive monopolar mode using three, clustered electrodes (n=8); and (4) Group B-2, switching monopolar mode using two Octopus electrodes (n=9). The energy efficiency, shape, diameters (D) and volume (V) of the coagulation volume were compared in each of the two groups. RESULTS: The mean maximum D and V of the coagulations in Group A-2 (4.7 cm and 33.1 cm(3), respectively) were significantly larger than those in Group A-1 (4.1 cm and 20.3 cm(3), respectively) (p<0.05). Furthermore, the mean minimum D, maximum D and V of the coagulations in Group B-2 were significantly larger than those in Group B-1, i.e. 5.3 vs 4.0 cm, 6.6 vs 4.9 cm and 66.9 vs 30.2 cm(3), respectively (p<0.05). The energy efficiencies were also significantly higher in Groups A-2 and B-2 than in Groups A-1 and B-1 (p<0.05). CONCLUSION: The Octopus electrodes were more efficient for creating a large ablation zone than clustered electrodes, and the efficacy of RFA with Octopus electrodes can be amplified in the switching monopolar mode.


Subject(s)
Catheter Ablation/instrumentation , Electrodes , Hepatectomy/instrumentation , Liver/pathology , Liver/surgery , Animals , Equipment Design , Equipment Failure Analysis , Male , Swine
6.
AJNR Am J Neuroradiol ; 33(1): 175-9, 2012 Jan.
Article in English | MEDLINE | ID: mdl-21998105

ABSTRACT

BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol. MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared. RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5-6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5-6; 100% versus 40%, P = .016) at discharge than patients without PH. CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.


Subject(s)
Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/drug therapy , Fibrinolytic Agents/administration & dosage , Tissue Plasminogen Activator/administration & dosage , Aged , Aged, 80 and over , Drug Therapy, Combination , Female , Humans , Injections, Intra-Arterial , Injections, Intravenous , Male , Middle Aged , Radiography , Recombinant Proteins/administration & dosage , Treatment Outcome
7.
Eur J Neurol ; 18(9): 1151-8, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21299736

ABSTRACT

BACKGROUND AND PURPOSE: Extensive evidence has shown that oxidative stress mediates neuronal death in animal models of hypoxic-ischaemia. Brain biomarkers of oxidative stress need to be identified in order to better understand and treat brain damage in human stroke patients. The present study was conducted to identify potential target proteins of oxidative stress in the cerebrospinal fluid (CSF) of stroke patients with acute ischaemic brain injury. METHODS: We performed two-dimensional polyacrylamide gel electrophoresis to separate protein samples obtained from the CSF of control and stroke patients. To determine protein oxidation levels, oxyblot was then used to detect protein carbonyls that were determined by formation of a stable 2,4-dinitrophenylhydrazine (DNP) product using an anti-DNP antibody. RESULTS: We found that oxidation of serum albumin was increased in the CSF from stroke patients as well as rats who underwent permanent middle cerebral artery occlusion (6.5%, 23%, respectively). In stroke patients, oxidized albumin levels correlated to neurologic indications. CONCLUSIONS: The present study suggests that oxidized albumin in CSF can be utilized as an oxidative stress marker in human stroke patients.


Subject(s)
Biomarkers/cerebrospinal fluid , Oxidative Stress/physiology , Serum Albumin/cerebrospinal fluid , Stroke/cerebrospinal fluid , Animals , Blotting, Western , Electrophoresis, Gel, Two-Dimensional , Female , Humans , Male , Middle Aged , Rats , Rats, Sprague-Dawley
8.
J Neurol Neurosurg Psychiatry ; 80(12): 1390-3, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19917819

ABSTRACT

BACKGROUND: Acute brainstem infarction with basilar artery (BA) occlusive disease is the most fatal type of all ischaemic strokes. This report investigates the prognostic impact of the posterior communicating artery (PcoA) and whether its anatomy is a safeguard or not. METHODS: Consecutive patients who had acute brainstem infarction with at least 50% stenosis of BA upon CT angiography (CTA) were studied. The configuration of PcoA was divided into two groups upon CTA: "textbook" group (invisible PcoA with good P1 and P2 segment) and "fetal-variant of PcoA" group (only visible PcoA with absent P1 segment). Baseline demographics, radiological findings and stroke mechanisms were analysed. A multiple regression analysis was performed to predict clinical outcome at 30 days (modified Rankin disability Scale (mRS

Subject(s)
Brain Stem Infarctions/pathology , Circle of Willis/pathology , Vertebrobasilar Insufficiency/pathology , Aged , Brain Stem Infarctions/physiopathology , Circle of Willis/physiopathology , Disability Evaluation , Female , Humans , Male , Prognosis , Retrospective Studies , Tomography, X-Ray Computed , Vertebrobasilar Insufficiency/physiopathology
9.
Gene Ther ; 16(10): 1234-44, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19626053

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is the most common adult onset motoneuron disease. The etiology and precise pathogenic mechanisms of the disease remain unknown, and there is no effective treatment. Vascular endothelial growth factor (VEGF) has recently been shown to exert direct neurotrophic and neuroprotective effects in animal models of ALS. Here we show that intrathecal transplantation of immortalized human neural stem cells (NSCs) overexpressing human VEGF gene (HB1.F3.VEGF) significantly delayed disease onset and prolonged the survival of the SOD1G93A mouse model of ALS. At 4 weeks, post-transplantation grafted cells were found within the gray matter of the spinal cord. Furthermore, transplanted F3.VEGF cells that express neuronal phenotype (MAP2+) were found in the anterior horn of the spinal cord gray matter indicating that the transplanted human NSCs migrated into the gray matter, took the correct structural position, integrated into the spinal cord anterior horn and differentiated into motoneurons. Intrathecal transplantation of F3.VEGF cells provides a neuroprotective effect in the diseased spinal cord by concomitant downregulation of proapoptotic proteins and upregulation of antiapoptotic proteins. Our results suggest that this treatment modality of intrathecal transplantation of human NSCs genetically modified to overexpress neurotrophic factor(s) might be of value in the treatment of ALS patients without significant adverse effects.


Subject(s)
Amyotrophic Lateral Sclerosis/therapy , Neurons/transplantation , Stem Cell Transplantation/methods , Vascular Endothelial Growth Factor A/biosynthesis , Amyotrophic Lateral Sclerosis/physiopathology , Animals , Disease Models, Animal , Graft Survival , Humans , Injections, Spinal , Mice , Mice, Transgenic , Microscopy, Fluorescence , Motor Activity/physiology , Motor Neurons/metabolism , Neurons/metabolism , Spinal Cord/metabolism , Stem Cells/metabolism , Survival Analysis , Vascular Endothelial Growth Factor A/genetics
10.
J Neurol Neurosurg Psychiatry ; 80(10): 1087-92, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19414436

ABSTRACT

OBJECTIVES: The diameters of the vertebral arteries (VAs) are very often unequal. Therefore, this study investigated if unequal VA flow contributes to the development of basilar artery (BA) curvature and if it is a link to the laterality of pontine or cerebellar infarcts occurring around the vertebrobasilar junction. METHODS: Radiological factors were analysed (infarct laterality, VA dominance, BA curvature and their directional relationships) in 91 patients with acute unilateral pontine or posterior inferior cerebellar artery (PICA) territory infarcts. The "dominant" VA side was defined as either that the VA was larger in diameter or the VA was connected with the BA in more of a straight line, if both VAs looked similar in diameter on CT angiography. Multiple regression analysis was performed to predict moderate to severe BA curvature. RESULTS: The dominant VA was more frequent on the left side (p<0.01). Most patients had an opposite directional relationship between the dominant VA and BA curvature (p<0.01). Pontine infarcts were opposite to the side of BA curvature (p<0.01) and PICA infarcts were on the same side as the non-dominant VA side (p<0.01). The difference in VA diameters was the single independent predictor for moderate to severe BA curvature (OR per 1 mm, 2.70; 95% CI 1.22 to 5.98). CONCLUSIONS: Unequal VA flow is an important haemodynamic contributor of BA curvature and development of peri-vertebrobasilar junctional infarcts.


Subject(s)
Basilar Artery/pathology , Basilar Artery/physiopathology , Brain Stem Infarctions/etiology , Vertebral Artery/pathology , Vertebral Artery/physiopathology , Vertebrobasilar Insufficiency/etiology , Aged , Brain Stem Infarctions/pathology , Brain Stem Infarctions/physiopathology , Case-Control Studies , Cerebellum/blood supply , Cerebellum/pathology , Cohort Studies , Dilatation, Pathologic/complications , Dilatation, Pathologic/pathology , Dilatation, Pathologic/physiopathology , Female , Humans , Male , Middle Aged , Regional Blood Flow , Vertebrobasilar Insufficiency/pathology , Vertebrobasilar Insufficiency/physiopathology
11.
Clin Pharmacol Ther ; 83(5): 723-30, 2008 May.
Article in English | MEDLINE | ID: mdl-17898702

ABSTRACT

We evaluated the feasibility and safety of therapy with mesenchymal stem cells (MSCs) through consecutively intra-arterial and three repeated intravenous injections and compared the long-term prognosis between MSC-treated (n=11) and control multiple system atrophy (MSA) patients (n=18). The MSC-treated patients showed significantly greater improvement on the unified MSA rating scale (UMSARS) than the control patients at all visits throughout the 12-month study period. Orthostasis in UMSARS I items and cerebellar dysfunction-related items of UMSARS II items were significantly different in favor of MSC treatment compared to controls. Serial positron emission tomography scan in the MSC-treated group showed that increased fluorodeoxyglucose uptake from baseline was noted in cerebellum and frontal white matters. No serious adverse effects related to MSC therapy occurred. This study demonstrated that MSC therapy in patients with MSA was safe and delayed the progression of neurological deficits with achievement of functional improvement in the follow-up period.


Subject(s)
Mesenchymal Stem Cell Transplantation , Multiple System Atrophy/surgery , Brain/diagnostic imaging , Brain/pathology , Disease Progression , Feasibility Studies , Female , Fluorodeoxyglucose F18 , Humans , Male , Mesenchymal Stem Cell Transplantation/adverse effects , Middle Aged , Multiple System Atrophy/diagnostic imaging , Multiple System Atrophy/pathology , Positron-Emission Tomography , Prospective Studies
12.
J Neural Transm (Vienna) ; 113(10): 1435-9, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16465458

ABSTRACT

alpha-Synuclein, a synaptic protein of unknown function, is a major component of Lewy bodies and may play a role in the pathophysiological process of Parkinson's disease (PD). In this study, we measured the plasma alpha-synuclein levels in 105 patients with PD, 38 patients with multiple system atrophy (MSA), and 51 age-matched controls. The alpha-synuclein level was significantly elevated in patients with PD (79.9 +/- 4.0 pg/ml, p < 0.001) and in those with MSA (78.1 +/- 3.5 pg/ml, p = 0.019) compared with the level in controls (76.1 +/- 3.9 pg/ml). The alpha-synuclein level was higher in patients with PD than in those with MSA (79.9 +/- 4.0 vs 78.1 +/- 3.5, p = 0.016). Our study demonstrated that the alpha-synuclein level in plasma is elevated in patients with PD and MSA.


Subject(s)
Multiple System Atrophy/blood , Parkinson Disease/blood , alpha-Synuclein/blood , Adult , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged
13.
J Neurol Neurosurg Psychiatry ; 76(12): 1659-63, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16291890

ABSTRACT

BACKGROUND AND PURPOSE: The pathogenesis of deep white matter medullary (WMM) artery infarcts remains controversial. To address this question, we analysed the stroke patterns of WMM infarcts using diffusion weighted magnetic resonance imaging (DWI) to detect embolic signals and investigate stroke subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. METHODS: We identified WMM infarcts on DWI using templates to determine the subcortical vascular territories. We classified WMM infarcts into those with small artery disease (SAD), large artery disease (LAD), cardioembolism (CE), two or more aetiologies, or undetermined aetiology. Clinical course, risk factors, and cortical spotty lesions were compared. RESULTS: Of the 1420 consecutive patients, 103 (7.3%) met the criteria for WMM infarcts. The stroke subtypes were as follows: 65 (63.1%) patients with LAD, 18 (17.5%) with SAD, 12 (11.7%) with CE, four (3.9%) with two or more aetiologies, three (2.1%) with undetermined aetiology, and one (1.0%) with other determined aetiology. LAD (87.7%) or CE (83.3%) was significantly accompanied by cortical embolic signals as compared to SAD (0%, p<0.001). The LAD infarcts were larger and tended to be chain-like in shape. Ischaemic stroke recurrence was more common in strokes with cortical embolic signals than in those without embolic signals (18.9% v 0%, p = 0.009). CONCLUSIONS: In present study, the most common pathogenesis of WMM infarcts was LAD. Our study indicates that WMM infarcts accompanying cortical embolic signals warrant evaluation of the underlying embolic sources in the large artery or the heart.


Subject(s)
Cerebral Infarction/diagnostic imaging , Cerebral Infarction/physiopathology , Medulla Oblongata/blood supply , Medulla Oblongata/pathology , Aged , Diffusion Magnetic Resonance Imaging , Female , Humans , Intracranial Embolism , Male , Middle Aged , Radiography , Risk Factors
14.
Neurology ; 65(2): 296-8, 2005 Jul 26.
Article in English | MEDLINE | ID: mdl-16043803

ABSTRACT

To investigate the impact of metabolic syndrome (MetSD) on the development of intracranial atherosclerotic stroke, the authors evaluated the components of the MetSD in 512 patients with stroke. The MetSD was observed most frequently in patients with intracranial atherosclerosis (p = 0.007). In multiple regression analysis, the MetSD, but not conventional risk factors, was independently associated with intracranial atherosclerosis (p = 0.005). The results suggest that treatment of metabolic abnormalities may be an important prevention strategy for intracranial atherosclerosis.


Subject(s)
Intracranial Arteriosclerosis/epidemiology , Metabolic Syndrome/epidemiology , Stroke/epidemiology , Aged , Angiography, Digital Subtraction , Brain/blood supply , Brain/pathology , Brain/physiopathology , Brain Ischemia/epidemiology , Brain Ischemia/etiology , Brain Ischemia/physiopathology , Carotid Arteries/metabolism , Carotid Arteries/pathology , Carotid Arteries/physiopathology , Cerebral Arteries/metabolism , Cerebral Arteries/pathology , Cerebral Arteries/physiopathology , Comorbidity , Cross-Sectional Studies , Female , Humans , Intracranial Arteriosclerosis/physiopathology , Magnetic Resonance Angiography , Male , Metabolic Syndrome/physiopathology , Middle Aged , Prospective Studies , Regression Analysis , Risk Factors , Stroke/physiopathology
15.
J Neurol Neurosurg Psychiatry ; 76(8): 1128-34, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16024892

ABSTRACT

BACKGROUND: The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis. METHODS: Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups. RESULTS: There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion. CONCLUSIONS: Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.


Subject(s)
C-Reactive Protein/metabolism , Carotid Artery Diseases/metabolism , Carotid Artery Diseases/pathology , Fibrinogen/metabolism , Infarction, Middle Cerebral Artery/metabolism , Intracranial Arteriosclerosis/metabolism , Intracranial Arteriosclerosis/pathology , Middle Cerebral Artery/pathology , Acute Disease , Adult , Aged , Carotid Artery Diseases/epidemiology , Confidence Intervals , Female , Hemodynamics/physiology , Hospitalization , Humans , Infarction, Middle Cerebral Artery/epidemiology , Infarction, Middle Cerebral Artery/pathology , Intracranial Arteriosclerosis/epidemiology , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Risk Factors
16.
Neurology ; 62(8): 1291-6, 2004 Apr 27.
Article in English | MEDLINE | ID: mdl-15111664

ABSTRACT

OBJECTIVE: To compare clinical and radiologic characteristics of atherosclerotic middle cerebral artery (MCA) vs internal carotid artery (ICA) disease. METHODS: The authors defined atherosclerotic MCA and ICA disease as >50% symptomatic stenosis or occlusion without significant ICA and MCA stenosis on MR angiography. Patients with potential cardiac sources of embolism were excluded. The authors analyzed clinical, laboratory, and neuroradiologic data of the two groups. RESULTS: Among the 920 consecutive patients with acute ischemic strokes, 112 met the criteria for atherosclerotic MCA and 71 met the criteria for ICA disease. Clinically, the MCA group more frequently presented with lacunar syndrome (p = 0.001), whereas the ICA group more often presented with total anterior circulation infarct and had higher initial NIH Stroke Scale scores than the MCA group (all p < 0.001). Whereas deep perforator and internal border-zone infarcts were associated with MCA disease (p < 0.001 and 0.012), territorial infarcts and superficial perforator infarcts were associated with ICA disease (p < 0.001 and p = 0.009). The topographic patterns with respect to the degree of stenosis were also significantly different between the two groups. CONCLUSIONS: The clinical and radiologic stroke patterns were distinctively different between atherosclerotic MCA and ICA disease, suggesting different underlying pathogeneses.


Subject(s)
Brain Ischemia/diagnosis , Carotid Artery Diseases , Carotid Artery Diseases/diagnosis , Infarction, Middle Cerebral Artery/diagnosis , Stroke/diagnosis , Acute Disease , Brain Ischemia/etiology , Carotid Artery Diseases/complications , Carotid Artery, Internal/pathology , Diffusion Magnetic Resonance Imaging , Female , Humans , Infarction, Middle Cerebral Artery/complications , Magnetic Resonance Angiography , Male , Middle Aged , Middle Cerebral Artery/pathology , Observer Variation , Retrospective Studies , Risk Factors , Severity of Illness Index , Stroke/classification , Stroke/etiology , Vascular Patency
17.
J Neurol Neurosurg Psychiatry ; 75(5): 727-32, 2004 May.
Article in English | MEDLINE | ID: mdl-15090568

ABSTRACT

BACKGROUND: Isolated atherosclerotic middle cerebral artery (MCA) disease is often difficult to differentiate from cardioembolic disease if intracranial atherosclerosis coexists with cardiac disease. OBJECTIVES: To evaluate whether clinical and neuroradiological features of isolated MCA disease differ according to the underlying aetiology. METHODS: Isolated MCA disease was defined as a unilateral angiographically occlusive lesion of the MCA on the symptomatic side without lesions of other intracranial or extracranial vessels. Patients with isolated MCA disease were divided into atherosclerotic and potentially cardioembolic, and the clinical, laboratory, and neuroradiological data analysed. RESULTS: Among the 850 consecutive patients with acute ischaemic stroke or transient ischaemic attack, 107 (12.6%) met the criteria for isolated MCA disease (76 with atherosclerotic disease and 31 with a potential source of cardiac embolism). Total anterior circulation infarcts were more common and baseline NIHSS score was higher in potentially embolic occlusions than in atherosclerotic disease (each p<0.001). While cortical infarcts and territorial infarcts were more common in the potential embolism group (p = 0.028 and p<0.001, respectively), subcortical border zone infarcts were more common in the atherosclerotic group (p<0.001). Multiple regression analysis showed that border zone infarcts and mild stroke were independently associated with atherosclerotic MCA disease, while territorial and cortical infarcts were associated with potential cardiac embolic disease. CONCLUSIONS: Clinical and neuroradiological characteristics can differentiate isolated atherosclerotic MCA disease from MCA disease associated with potential sources of cardiac embolism, and may reflect the differences in underlying pathogenesis.


Subject(s)
Brain/blood supply , Infarction, Middle Cerebral Artery/diagnosis , Intracranial Arteriosclerosis/diagnosis , Acute Disease , Brain/pathology , Female , Humans , Infarction, Middle Cerebral Artery/pathology , Intracranial Arteriosclerosis/pathology , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/pathology , Magnetic Resonance Angiography/methods , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies
18.
Patient Educ Couns ; 49(1): 13-8, 2003 Jan.
Article in English | MEDLINE | ID: mdl-12527148

ABSTRACT

The objective of this study was to evaluate the impact of a pharmaceutical care program on children with asthma. A comprehensive asthma education and monitoring program that includes basic asthma knowledge, symptoms and exacerbation evaluation, pharmacotherapy assessment including inhaler technique, and quality of life measurements was developed and applied in an outpatient paediatric clinic of the Catholic University of Chile. All patients with moderate asthma scheduled for outpatient visits with their internist over a 1-year period were referred for pharmacist intervention. Patients (aged 7-17) with moderate asthma attending the clinic were allocated to the intervention (group A) or control group (group B). Intervention patients were educated on their disease, pharmacotherapy, self-management, and inhalation techniques. The group B were children with their regular treatment for asthma but without pharmaceutical intervention. A paediatric asthma quality of life questionnaire (PAQLQ) was applied to both groups at 0, 2, and 9 weeks to assess the quality of life. Spirometry was done at the beginning and at the completion of the 9-week study. Beta-agonists used by each patient were also recorded. Eleven children (10.0+/-0.7 years) were included in the pharmaceutical care program, and ten children (9.9+/-0.6 years) in group B. For the individual domains of activities (A), emotions (E), and symptoms (S) there was a significant improvement in the children who received pharmaceutical care in comparison with those who did not receive it. The scores of group B did not change during the 9 weeks of follow-up. There were no significant changes in spirometric values in either group.


Subject(s)
Asthma/prevention & control , Patient Education as Topic/organization & administration , Pharmacists/organization & administration , Quality of Life , Analysis of Variance , Asthma/psychology , Child , Chile , Drug Monitoring , Female , Follow-Up Studies , Humans , Male , Patient Compliance/psychology , Pharmacists/psychology , Professional Role , Program Evaluation , Quality of Life/psychology , Self Care , Surveys and Questionnaires
19.
J Neurosci Res ; 66(1): 117-21, 2001 Oct 01.
Article in English | MEDLINE | ID: mdl-11599008

ABSTRACT

We have recently shown that cholinergic effects on synaptic transmission and plasticity in the superficial (II/III) layers of the rat medial entorhinal cortex (EC) are similar, but not identical, to those in the hippocampus (Yun et al. [2000] Neuroscience 97:671-676). Because the superficial and deep layers of the EC preferentially convey afferent and efferent hippocampal projections, respectively, it is of interest to compare cholinergic effects between the two regions. We therefore investigated the physiological effects of cholinergic agents in the layer V of medial EC slices under experimental conditions identical to those in the previous study. Bath application of carbachol (0.5 microM) induced transient depression of field potential responses in all cases tested (30 of 30; 18.5% +/- 2.3%) and rarely induced long-lasting potentiation (only 3 of 30; 20.4% +/- 3.2% in successful cases). At 5 microM, carbachol induced transient depression only (20 of 20, 48.9% +/- 2.8%), which was blocked by atropine (10 microM). Paired-pulse facilitation was enhanced during carbachol-induced depression, suggesting presynaptic action of carbachol. Long-term potentiation (LTP) could be induced in the presence of 10 microM atropine by theta burst stimulation, but its magnitude was significantly lower (9.1% +/- 4.7%, n = 15) compared to LTP in control slices (22.4% +/- 3.9%, n = 20). These results, combined with our previous findings, demonstrate remarkably similar cholinergic modulation of synaptic transmission and plasticity across the superficial and deep layers of EC.


Subject(s)
Acetylcholine/physiology , Entorhinal Cortex/physiology , Long-Term Potentiation/physiology , Synapses/physiology , Animals , Atropine/pharmacology , Carbachol/pharmacology , Cholinergic Agonists/pharmacology , Long-Term Potentiation/drug effects , Male , Muscarinic Antagonists/pharmacology , Organ Culture Techniques , Rats , Rats, Sprague-Dawley , Receptors, Muscarinic/physiology , Synaptic Transmission/drug effects , Synaptic Transmission/physiology
20.
J Neurosci Res ; 63(6): 509-15, 2001 Mar 15.
Article in English | MEDLINE | ID: mdl-11241586

ABSTRACT

We investigated the cognition enhancing effects of ginsenoside Rb1 and Rg1. Mice were trained in a Morris water maze following injection (i.p.) of Rb1 (1 mg/kg) or Rg1 (1 mg/kg) for 4 days. Both Rb1- and Rg1-injected mice showed enhanced spatial learning compared to control animals. The hippocampus, but not the frontal cortex, of treated mice contained higher density of a synaptic marker protein, synaptophysin, compared to control mice. Electrophysiological recordings in hippocampal slices revealed that Rb1 or Rg1 injection did not change the magnitude of paired-pulse facilitation or long-term potentiation. Our results suggest that Rb1 and Rg1 enhance spatial learning ability by increasing hippocampal synaptic density without changing plasticity of individual synapses.


Subject(s)
Central Nervous System Agents/pharmacology , Hippocampus/metabolism , Maze Learning/drug effects , Saponins/pharmacology , Synaptophysin/metabolism , Animals , Cognition/drug effects , Electrophysiology , Ginsenosides , Hippocampus/drug effects , Long-Term Potentiation/drug effects , Memory/drug effects , Mice , Mice, Inbred C57BL , Space Perception/drug effects , Synapses/drug effects , Synapses/physiology
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