Aortic Valve Calcium Score: Applications in Clinical Practice and Scientific Research-A Narrative Review.

In this narrative review, we investigate the essential role played by the computed tomography Aortic Valve Calcium Score (AVCS) in the cardiovascular diagnostic landscape, with a special focus on its implications for clinical practice and scientific research. Calcific aortic valve stenosis is the most prevalent type of aortic stenosis (AS) in industrialized countries, and due to the aging population, its prevalence is increasing. While transthoracic echocardiography (TTE) remains the gold standard, AVCS stands out as an essential complementary tool in evaluating patients with AS. The advantage of AVCS is its independence from flow; this allows for a more precise evaluation of patients with discordant findings in TTE. Further clinical applications of AVCS include in the assessment of patients before transcatheter aortic valve replacement (TAVR), as it helps in predicting outcomes and provides prognostic information post-TAVR. Additionally, we describe different AVCS thresholds regarding gender and the anatomical variations of the aortic valve. Finally, we discuss various scientific studies where AVCS was applied. As AVCS has some limitations, due to the pathophysiologies of AS extending beyond calcification and gender differences, scientists strive to validate contrast-enhanced AVCS. Furthermore, research on developing radiation-free methods of measuring calcium content is ongoing.

COVID-19 e a incidência de AVC isquêmico pós-infecção: uma revisão integrativa da literatura / COVID-19 and the incidence of post-infection ischemic stroke: an integrative literature review

O SARS-CoV-2 é um vírus que surgiu em 2019, sendo responsável por causar uma síndrome respiratória que foi denominada COVID-19. O vírus possui uma proteína, chamada proteína Spike, que interage com as ACE2, estando presente no trato respiratório e nas células endoteliais, causando inflamação, apoptose e efeitos pró-trombóticos que ativam a via de coagulação. Dessa maneira, presume-se que o estado de hipercoagulabilidade do vírus e a inflamação endotelial estejam relacionados à fisiopatologia do AVC isquêmico pós-infecção. O objetivo desta revisão foi analisar a fisiopatologia e a etiologia dos AVCs associados à infecção pelo vírus SARS-CoV-2 e seus fatores de risco. Foi realizada uma busca por trabalhos prévios nas plataformas PubMed e BVS, e um total de 26 artigos científicos foram incluídos após a aplicação de critérios de inclusão e exclusão. Através dos estudos analisados, observou-se a correlação do aumento da incidência do AVC pós-infecção pelo SARS-CoV-2, e os fatores de risco presentes principais foram hipertensão arterial, fibrilação atrial, diabetes mellitus, dislipidemia e insuficiência cardíaca. Em conclusão, a infecção por SARS-CoV-2 possui relação com o aumento da incidência de AVC, possivelmente por seu mecanismo trombótico e inflamatório dos endotélios.

SARS-CoV-2 is a virus that emerged in 2019, being responsible for causing a respiratory syndrome that was named COVID-19. The virus has a protein, called Spike protein, which interacts with ACE2, which are present in the respiratory tract and endothelial cells, causing inflammation, apoptosis and prothrombotic effects that activate the coagulation pathway. Thus, it is presumed that the hypercoagulable state of the virus and endothelial inflammation are related to the pathophysiology of postinfection ischemic stroke. The aim of this review was to analyze the pathophysiology and etiology of strokes associated with SARSCoV-2 virus infection and their risk factors. A search for previous works was carried out on PubMed and VHL platforms, and a total of 26 scientific articles were included after applying inclusion and exclusion criteria. Through the studies analyzed, a correlation was observed between the increased incidence of stroke after infection with SARS-CoV-2, and the main risk factors present were arterial hypertension, atrial fibrillation, diabetes mellitus, dyslipidemia and heart failure. In conclusion, SARS-CoV-2 infection is related to the increased incidence of stroke, possibly due to its thrombotic and endothelial inflammatory mechanism.

Development and Evaluation of Vibration Canceling System Utilizing Macro-Fiber Composites (MFCs) and Long Short-Term Memory (LSTM) Vibration Prediction AI Algorithms for Road Driving Vibrations.

This study developed an innovative active vibration canceling (AVC) system designed to mitigate non-periodic vibrations during road driving to enhance passenger comfort. The macro-fiber composite (MFC) used in the system is a smart material that is flexible, soft, lightweight, and applicable in many fields as a dual-purpose sensor and actuator. The target vibrations are road vibration data that were collected while driving on standard urban (Seoul) and highway roads at 40 km/s. To predict and cancel the target vibration accurately before passing it, we modeled the vibration prediction algorithm using a long short-term memory recurrent neural network (LSTM RNN). We regenerated vibrations on Seoul and highway roads at 40 km/s using MFCs and measured the displacements of the measured, predicted, and AVC vibrations of each road condition. To evaluate the vibration, we computed the root mean squared error (RMSE) and compared standard deviation (SD) values. The accuracies of LSTM RNN vibration prediction algorithms are 97.27% and 96.36% on Seoul roads and highway roads, respectively, at 40 km/s. Although the vibration ratio compared with the AVC results are different, there was no difference between the values of the AVC vibrations. According to a previous study and the principle of the AVC system, the target vibrations decrease by canceling the inverse vibration of the MFC actuator.

Are we missing an opportunity? Prehospital delay in patients with acute ischemic stroke and known atrial fibrillation.

INTRODUCTION AND OBJECTIVES: The follow-up of patients with atrial fibrillation (AF) presents an opportunity to alert patients and their families on how to recognize and act in the event of stroke. Our aim was to compare stroke recognition-to-door time and prehospital stroke code activation in patients with known AF (KAF) and AF detected after stroke (AFDAS). METHODS: We performed a retrospective cohort study of consecutive patients receiving acute recanalization treatment for acute ischemic stroke between January 2016 and August 2022, with AF as a potential stroke cause. Patients were divided into KAF and AFDAS, and stroke recognition-to-door time and prehospital stroke code activation were compared. In the KAF subgroup, we assessed whether the use of preadmission anticoagulation was associated with the studied prehospital parameters. RESULTS: We included 438 patients, 290 female (66.2%), mean age 79.3±9.4 years. In total, 238 patients had KAF (54.3%) and 200 (45.7%) had AFDAS. Of those with KAF, 114 (48.1%) were pretreated with anticoagulation. Patients with KAF and AFDAS had no differences in stroke recognition-to-door time (74.0 [55.0-101.0] vs. 78.0 [60.0-112.0] min; p=0.097) or prehospital stroke code activation [148 (64.6%) vs. 128 (65.3%); p=0.965]. In the KAF subgroup, preadmission anticoagulation did not influence stroke recognition-to-door time or mode of hospital admission. CONCLUSION: Stroke recognition-to-door time and prehospital stroke code activation were similar between patients with known or newly diagnosed AF. Preadmission anticoagulation treatment also did not affect the studied parameters. Our findings highlight a missed opportunity to promote stroke knowledge in patients followed due to AF.

General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke: systematic review and meta-analysis / Anestesia geral versus sedação consciente na trombectomia mecânica para pacientes com AVC isquêmico agudo: revisão sistemática e metanálise

Abstract Background After recently published randomized clinical trials, the choice of the best anesthetic procedure for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is not definite. Objective To compare the efficacy and safety of general anesthesia (GA) versus conscious sedation (CS) in patients with AIS who underwent MT, explicitly focusing on procedural and clinical outcomes and the incidence of adverse events. Methods PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing GA versus CS in patients who underwent MT due to LVO-AIS. Odds ratios (ORs) were calculated for binary outcomes, with 95% confidence intervals (CIs). Random effects models were used for all outcomes. Heterogeneity was assessed with I2 statistics. Results Eight RCTs (1,300 patients) were included, of whom 650 (50%) underwent GA. Recanalization success was significantly higher in the GA group (OR 1.68; 95% CI 1.26-2.24; p < 0.04) than in CS. No significant difference between groups were found for good functional recovery (OR 1.13; IC 95% 0.76-1.67; p = 0.56), incidence of pneumonia (OR 1.23; IC 95% 0.56- 2,69; p = 0.61), three-month mortality (OR 0.99; IC 95% 0.73-1.34; p = 0.95), or cerebral hemorrhage (OR 0.97; IC 95% 0.68-1.38; p = 0.88). Conclusion Despite the increase in recanalization success rates in the GA group, GA and CS show similar rates of good functional recovery, three-month mortality, incidence of pneumonia, and cerebral hemorrhage in patients undergoing MT.

Resumo Antecedentes A trombectomia mecânica (TM) é o padrão de tratamento para pacientes com acidente vascular cerebral isquêmico agudo (AVCI) devido à oclusão de grandes vasos (OGV). No entanto, ainda não está claro qual é o procedimento anestésico mais benéfico para a TM. Objetivo Nosso objetivo foi comparar a eficácia e a segurança da anestesia geral (AG) versus sedação consciente (SC) em pacientes com AVCI submetidos à TM, focando especificamente nos resultados procedimentais e clínicos, bem como na incidência de eventos adversos. Métodos Foram realizadas buscas sistemáticas nas bases PubMed, Embase e Cochrane por ensaios clínicos randomizados (ECRs) comparando AG versus SC em pacientes submetidos à TM devido a AVCI por OGV. Razões de chances (ORs) foram calculadas para desfechos binários, com intervalos de confiança de 95% (ICs). Modelos de efeitos aleatórios foram usados para todos os resultados. A heterogeneidade foi avaliada com estatísticas I2. Resultados Oito ensaios clínicos randomizados (1.300 pacientes) foram incluídos, dos quais 650 (50%) foram submetidos à AG. O sucesso da recanalização foi significativamente maior no grupo AG (OR 1,68; IC 95% 1,26-2,24; p < 0,04) em comparação com SC. No entanto, não houve diferença significativa entre os grupos para recuperação funcional adequada (OR 1,13; IC 95% 0,76-1,67; p = 0,56), incidência de pneumonia (OR 1,23; IC 95% 0,56- 2,69; p = 0,61), mortalidade em três meses (OR 0,99; IC 95% 0,73- 1,34; p = 0,95) ou hemorragia cerebral (OR 0,97; IC 95% 0,68- 1,38; p = 0,88). Conclusão Apesar do aumento significativo nas taxas de sucesso de recanalização no grupo AG, AG e SC mostram taxas semelhantes de recuperação funcional, mortalidade, pneumonia e hemorragia em pacientes com AVCI submetidos à TM.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

High average daily temperature in summer and the incidence of thrombolytic treatment for acute ischemic stroke.

INTRODUCTION: Meteorological factors can increase stroke risk; however, their impact is not precisely understood. Heat waves during summer increase total mortality. Therefore, we hypothesized that the average daily temperature in summer may correlate with the incidence of thrombolytic treatment for acute ischemic stroke in Budapest and Pest County, Hungary. METHODS: We analyzed the relationship between the average daily temperature in summer months and the daily number of thrombolytic treatments (TT) performed with the indication of acute ischemic stroke between 1st June and 31st August each year from 2007 to 2016. The analysis was also performed after the omission of the data of the last day of the months due to possible psychosocial impact reported in our previous study. Spearman's correlation was used for statistical analysis. RESULTS: No significant correlation was found between the average summer daily temperature and the number of TT in the entire sample of the 10-year period. When omitting the data of the last day of each month, positive correlations were suspected in 2014 (r=0.225, P=0.034) and 2015 (r=0.276, P=0.009). CONCLUSION: Our findings did not confirm an association between the average daily temperature in summer and the daily number of TT throughout the examined 10-year period. However, importantly, in 2014 and 2015, the years with the highest average daily temperatures in this period, a positive correlation was found. The level of correlation is modest, indicating that risk factors, both meteorological and non-meteorological, other than the average temperature, play equally important roles in determining the incidence of thrombolytic treatment for acute ischemic stroke on the population level.

Estudo sobre a prevalência de doença carotídea detectada por ultrassonografia nos casos de AVC isquêmico de um hospital público de Santa Catarina / Study on the prevalence of carotid artery disease detected by ultrasonography in cases of ischemic stroke at a public hospital in Santa Catarina

Fundamento: Acidentes Vasculares Cerebrais Isquêmicos (AVCi) representam significativa parcela dentre as causas da morbimortalidade mundial. Estenose das artérias carótidas e vertebrais são consideradas fator de risco para tal desfecho. A Ultrassonografia com Doppler (USG Doppler) das artérias extracranianas pode ser útil na identificação de pacientes com estenose significativa por ser um método inócuo e acessível. Objetivos: avaliar a prevalência de estenose nas artérias extracranianas diagnosticadas através do estudo com USG Doppler e a prevalência de fatores associados em pacientes com quadro de AVCi. Métodos: Trata-se de estudo retrospectivo, transversal, a partir da análise de prontuários dos pacientes internados com quadro de AVCi no Hospital Regional de São José, Santa Catarina, Brasil. O estudo ocorreu entre janeiro de 2020 e dezembro de 2021. A análise ultrassonográfica foi realizada por médicos radiologistas habilitados, a partir do uso de aparelho validado (GE Logic P9 com transdutor linear multifrequencial 6-15MHz). Resultados: Dentre os 239 pacientes incluídos, destaca-se a significativa prevalência de comorbidades associadas ao AVCi, como hipertensão arterial sistêmica (78,2%) e tabagismo (40,6%). A distribuição entre os sexos foi homogênea (58,2 versus 41,8%) e 70,3% dos pacientes possuíam idade superior a 60 anos de idade. A taxa de pacientes com alterações hemodinamicamente significativas (estenose >50% da luz do vaso) das artérias carótidas e vertebrais foi de 29,2%. O tabagismo foi o único fator de risco que se correlacionou estatisticamente com a ocorrência de AVCi decorrente do acometimento das artérias carótidas ou vertebrais (RP 1,708; IC 1,057-2,761; p=0,028). Conclusão: O USG com Doppler das artérias extracranianas é ferramenta útil na investigação dos casos de AVCi, visto que a prevalência de doença significativa dos grandes vasos extracranianos (estenose>50%) se aproxima de 30%.

Background: Ischemic Strokes represent a sizable portion among the causes of morbidity and mortality worldwide. Stenosis of the carotid and vertebral arteries represent a risk factor to this outcome. Ultrasonography with Doppler of the extracranial arteries can be useful in identifying patients with significant stenosis because it is a harmless and accessible method. Objectives: To assess the prevalence of stenosis in the extracranial arteries diagnosed through Doppler ultrasound examination and the prevalence of associated factors in patients with ischemic stroke Methods: This is a retrospective, cross-sectional study based on the analysis of medical records of patients admitted with ischemic stroke at the Regional Hospital of São José, Santa Catarina, Brazil. The study was conducted between January 2020 and December 2021. Ultrasonographic analysis was performed by qualified radiologists, using a validated device (GE Logic P9 with a multi-frequency linear transducer 6-15MHz). Results: Among the 239 included patients, there is a significant prevalence of comorbidities associated with ischemic stroke, such as systemic arterial hypertension (78.2%) and smoking (40.6%). The distribution between genders was homogeneous (58.2% versus 41.8%), and 70.3% of the patients were over 60 years old. The rate of patients with hemodynamically significant alterations (stenosis >50% of the vessel lumen) in the carotid and vertebral arteries was 29.2%. Smoking was the only risk factor that statistically correlated with the occurrence of ischemic stroke resulting from the involvement of the carotid or vertebral arteries (PR 1.708; CI 1.057-2.761; p=0.028). Conclusion: Ultrasonography with Doppler of the extracranial arteries is a useful tool in the investigation of ischemic stroke cases, given that the prevalence of significant disease in the large extracranial vessels (stenosis >50%) approaches 30%.

Everyday Pain in Middle and Later Life: Associations with Daily and Momentary Present-Moment Awareness as One Key Facet of Mindfulness.

This study investigated everyday associations between one key facet of mindfulness (allocating attention to the present moment) and pain. In Study 1, 89 community-dwelling adults (33-88 years; Mage = 68.6) who had experienced a stroke provided 14 daily end-of-day present-moment awareness and pain ratings. In Study 2, 100 adults (50-85 years; Mage = 67.0 years) provided momentary present-moment awareness and pain ratings three times daily for 10 days. Multi-level models showed that higher trait present-moment awareness was linked with lower overall pain (both studies). In Study 1, participants reported less pain on days on which they indicated higher present-moment awareness. In Study 2, only individuals with no post-secondary education reported less pain in moments when they indicated higher present-moment awareness. Findings add to previous research using global retrospective pain measures by showing that present-moment awareness might correlate with reduced pain experiences, assessed close in time to when they occur.

New role of astrocytes in neuroprotective mechanisms after ischemic stroke / Novo papel dos astrócitos nos mecanismos neuroprotetores após acidente vascular cerebral isquêmico

Abstract Astrocytes are the most abundant cell subtypes in the central nervous system. Previous studies believed that astrocytes are supporting cells in the brain, which only provide nutrients for neurons. However, recent studies have found that astrocytes have more crucial and complex functions in the brain, such as neurogenesis, phagocytosis, and ischemic tolerance. After an ischemic stroke, the activated astrocytes can exert neuroprotective or neurotoxic effects through a variety of pathways. In this review, we will discuss the neuroprotective mechanisms of astrocytes in cerebral ischemia, and mainly focus on reactive astrocytosis or glial scar, neurogenesis, phagocytosis, and cerebral ischemic tolerance, for providing new strategies for the clinical treatment of stroke.

Resumo Os astrócitos são os subtipos de células mais abundantes no sistema nervoso central. Estudos anteriores acreditavam que os astrócitos são células de suporte no cérebro, que apenas fornecem nutrientes para os neurônios. No entanto, estudos recentes descobriram que os astrócitos têm funções mais cruciais e complexas no cérebro, como neurogênese, fagocitose e tolerância isquêmica. Após um acidente vascular cerebral isquêmico, os astrócitos ativados podem exercer efeitos neuroprotetores ou neurotóxicos através de uma variedade de vias. Nesta revisão, discutiremos os mecanismos neuroprotetores dos astrócitos na isquemia cerebral, e focaremos principalmente na astrocitose reativa ou cicatriz glial, neurogênese, fagocitose e tolerância isquêmica cerebral, para fornecer novas estratégias para o tratamento clínico do acidente vascular cerebral.

Mecanismos de acción y tratamiento del accidente cerebrovascular isquémico por COVID-19 / Mechanisms of action and treatment of ischemic stroke by COVID-19 / Mecanismos de ação e tratamento do AVC isquêmico pela COVID-19

Diversos mecanismos inflamatorios y protrombóticos pueden contribuir al aumento del riesgo de eventos cardiovasculares y accidentes cerebrovasculares en pacientes con COVID-19, afectando el enfoque del tratamiento y manejo de la enfermedad. La evidencia relacionada con los mecanismos fisiopatológicos del COVID-19 y su asociación con los accidentes cerebrovasculares son relevantes para guiar el tratamiento y el manejo de los pacientes, considerados como desafíos terapéuticos que surgen durante períodos de contagio masivo. Objetivo. Describir el mecanismo de acción y tratamiento del evento cerebro vascular isquémico por COVID-19. Metodología. Se realizó una revisión exhaustiva de la literatura mediante una revisión sistemática, en conformidad con las directrices establecidas por la declaración PRISMA. Se recopiló información de múltiples bases de datos científicas, utilizando términos y palabras clave ("Mecanismos de acción" OR "Mecanismos fisiopatológicos") AND ("Accidente cerebrovascular isquémico" OR "ACV isquémico") relacionados con los mecanismos de acción y tratamiento del accidente cerebrovascular isquémico asociado al COVID-19. Resultados. En total se obtuvo 41 entre PubMed y Science direct, previo a criterios 12 fueron seleccionados. Conclusión. Se determinaron los mecanismos de acción desencadenados por el COVID-19 para la formación de trombos y su relación con los accidentes cerebrovasculares. Además, se comprendió cómo el tratamiento de los accidentes cerebrovasculares afectaba a los pacientes que también padecían COVID-19. Se encontró que la tormenta de citocinas era un mecanismo influyente en la fisiopatología del COVID-19. En cuanto al tratamiento, la identificación de la enfermedad infecciosa causada por el virus SARS-CoV-2 resultó crucial en la gestión de los pacientes con accidente cerebrovascular.

Various inflammatory and prothrombotic mechanisms may contribute to the increased risk of cardiovascular events and stroke in patients with COVID-19, affecting the approach to treatment and management of the disease. Evidence regarding the pathophysiological mechanisms of COVID-19 and its association with stroke are relevant to guide the treatment and management of patients, considered as therapeutic challenges arising during periods of massive contagion. Objective. To describe the mechanism of action and treatment of ischemic cerebrovascular event by COVID-19. Methodology. A comprehensive review of the literature was performed by means of a systematic review, in accordance with the guidelines established by the PRISMA statement. Information was collected from multiple scientific databases, using terms and keywords ("Mechanisms of action" OR "Pathophysiological mechanisms") AND ("Ischemic stroke" OR "Ischemic stroke") related to the mechanisms of action and treatment of COVID-19-associated ischemic stroke. Results. A total of 41 were obtained between PubMed and Science direct, prior to criteria 12 were selected. Conclusion. The mechanisms of action triggered by COVID-19 for thrombus formation and its relation to stroke were determined. In addition, we gained insight into how stroke treatment affected patients who also had COVID-19. Cytokine storm was found to be an influential mechanism in the pathophysiology of COVID-19. In terms of treatment, identification of infectious disease caused by SARS-CoV-2 virus proved crucial in the management of stroke patients.

Vários mecanismos inflamatórios e pró-trombóticos podem contribuir para o aumento do risco de eventos cardiovasculares e acidente vascular cerebral (AVC) em pacientes com COVID-19, afetando a abordagem do tratamento e o manejo da doença. As evidências sobre os mecanismos fisiopatológicos da COVID-19 e sua associação com o AVC são relevantes para orientar o tratamento e o manejo dos pacientes, considerados como desafios terapêuticos que surgem durante períodos de contágio em massa. Objetivo. Descrever o mecanismo de ação e o tratamento do evento cerebrovascular isquêmico devido à COVID-19. Metodologia. Uma revisão abrangente da literatura foi realizada por meio de uma revisão sistemática, de acordo com as diretrizes estabelecidas pela declaração PRISMA. As informações foram coletadas de vários bancos de dados científicos, usando termos e palavras-chave ("Mechanisms of action" OR "Pathophysiological mechanisms") AND ("Ischaemic stroke" OR "Ischaemic stroke") relacionados aos mecanismos de ação e tratamento do acidente vascular cerebral isquêmico associado à COVID-19. Resultados. Foram obtidos 41 artigos no PubMed e no Science direct, e 12 foram selecionados de acordo com os critérios. Conclusão. Foram determinados os mecanismos de ação desencadeados pela COVID-19 para a formação de trombos e sua relação com o AVC. Além disso, entendemos como o tratamento do AVC afetou os pacientes que também tinham COVID-19. Descobriu-se que a tempestade de citocinas é um mecanismo influente na fisiopatologia da COVID-19. Em termos de tratamento, a identificação da doença infecciosa causada pelo vírus SARS-CoV-2 foi crucial no tratamento de pacientes com AVC.

Outcomes of recurrent stroke in patients with atrial fibrillation according to presumed etiology / Desfecho de AVC recorrente em pacientes com fibrilação atrial de acordo com etiologia presumida

Abstract Background Atrial fibrillation (AF) is a potent risk factor for stroke. The presence of competing etiologies can modify disease outcomes and demand different treatment strategies. Objective The primary purpose of the study was to examine the differences in outcomes for patients with AF admitted with a recurrent stroke, stratified according to the presumed etiology of the stroke. Methods We analyzed AF patients admitted for a recurrent ischemic stroke in an academic comprehensive stroke center. Recurrent strokes were categorized as "Cardioembolic", meaning AF without any competing mechanism, versus "Undetermined" etiology due to competing mechanisms. We used logistic regression to test the association between recurrent stroke etiology and favorable outcome (discharge home), after accounting for important covariates. Results We included 230 patients, with a mean age 76.9 (SD ± 11.3), 52.2% male, median National Institute of Health Stroke Scale (NIHSS) score of 7 (IQR 2-16). Patients with cardioembolic stroke (65.2%) had higher median NIHSS 8.5 (3-18) versus 3 (1-8) and were more likely to be treated with reperfusion therapies. The favorable outcome was reached by 64 patients (27.8%), and in-hospital mortality was 15.2% overall. After adjustment, there was no difference in outcome between patients with cardioembolic versus undetermined stroke etiology (odds ratio for discharge home: 1.41; 95% CI: 0.65-3.15). Conclusions In this single-center sample of AF patients with history of stroke, there was no difference in discharge outcomes between those with cardioembolic and those with undetermined stroke etiology. This question warrants examination in larger samples to better understand the importance of the stroke mechanism and secondary prophylaxis.

Resumo Antecedentes Fibrilação atrial (FA) é um fator de risco importante para AVC. A presença de mecanismos concorrentes para o AVC pode modificar o desfecho e demandar estratégias de tratamento diferentes. Objetivo O objetivo primário do estudo foi examinar diferenças no desfecho de pacientes com FA admitidos por um AVC recorrente, sendo estratificados de acordo com a etiologia presumida do AVC. Métodos Nós analisamos pacientes com FA admitidos por conta de AVC recorrente em um centro acadêmico terciário de AVC. Os casos de AVC recorrentes foram classificados como "Cardioembólicos", sendo FA sem outros mecanismos alternativos, versus aqueles de etiologia "Indeterminada" por conta de mecanismos concorrentes. Foi usada regressão logística para testar a associação entre a etiologia do AVC recorrente e desfecho favorável (alta direto para casa) após controle para covariáveis importantes. Resultados Nós incluímos 230 pacientes, com uma idade média 76,9 anos (DP ± 11.3), 52.2% homens, com um escore mediano do National Institute of Health Stroke Scale (NIHSS) de 7 (IIQ 2-16). Pacientes com AVC cardioembólicos (65,2%) tiveram um escore de NIHSS mediano mais alto 8,5 (3-18) versus 3 (1-8), e com maior chance de tratamento com terapias de reperfusão. O desfecho favorável ocorreu em 64 pacientes (27,8%) e a mortalidade institucional foi de 15,2% no total. Após ajustes, não encontramos diferença no desfecho entre pacientes com AVC cardioembólico versus AVC de etiologia indeterminada (odds ratio para alta para casa: 1,41; 95% IC: 0,65-3,15). Conclusões Nessa amostra de pacientes com FA e história de AVC recorrente de centro único, não houve diferença no desfecho de alta entre aqueles com AVC cardioembólico e aqueles com etiologia indeterminada. Essa questão deve ser examinada em amostras maiores para melhor compreender a importância do mecanismo do AVC e a profilaxia secundária.

Síndrome de vasoconstricción cerebral reversible asociado a lesión miocárdica: un reporte de caso / Reversible cerebral vasoconstriction syndrome with associated myocardial injury: A case report / Síndrome de vasoconstrição cerebral reversível com lesão miocárdica associada: relato de caso

El síndrome de vasoconstricción cerebral reversible es poco frecuente y su fisiopatología aún no está bien dilucidada. Su presentación clínica se caracteriza por manifestaciones neurológicas como cefalea "en trueno", déficit focal, vómito, fotofobia y, en casos graves, puede tener complicaciones como eventos cerebrovasculares isquémicos o hemorrágicos. El diagnóstico se realiza mediante angiografía cerebral, angiotomografía o angioresonancia, las cuales documentan vasoconstricción de las arterias cerebrales con resolución espontánea, que en la mayoría de los casos es consistente con un buen pronóstico clínico. A continuación, se expone el caso de una paciente con vasoconstricción cerebral reversible y lesión miocárdica asociada, en donde se logra un diagnóstico mediante imágenes y tratamiento oportuno. La importancia del caso radica en informar sobre el reconocimiento temprano de una complicación miocárdica poco común del síndrome de vasoconstricción cerebral, pero con riesgo de morbimortalidad dentro del espectro de los cuadros cerebrovasculares.

Reversible Cerebral Vasoconstriction Syndrome is a rare condition, and its pathophysiology is not yet fully understood. Its clinical presentation is characterized by neurological manifestations such as "thunderclap" headache, focal deficit, vomiting, photophobia, and, in severe cases, it can lead to complications such as ischemic or hemorrhagic cerebrovascular events. The diagnosis is made through cerebral angiography, CT angiography, or magnetic resonance angiography, which demonstrate vasoconstriction of the cerebral arteries with spontaneous resolution, which in most cases is consistent with a good clinical prognosis. Here, we present the case of a patient with reversible cerebral vasoconstriction syndrome and associated myocardial injury, where a diagnosis was achieved through imaging and timely treatment. The importance of this case lies in raising awareness about the early recognition of a rare myocardial complication of reversible cerebral vasoconstriction syndrome, which carries a risk of morbidity and mortality within the spectrum of cerebrovascular disorders.

A síndrome de vasoconstrição cerebral reversível é rara e sua fisiopatologia ainda não é bem compreendida. Sua apresentação clínica é caracterizada por manifestações neuro-lógicas como cefaléia em trovoada, déficit focal, vômitos, fotofobia e, em casos graves, pode ter complicações como eventos cerebrovasculares isquêmicos ou hemorrágicos. O diagnóstico é feito por angiografia cerebral, angiotomografia ou angiorressonância , que documentam vasoconstrição das artérias cerebrais com resolução espontânea, o que na maioria dos casos é compatível com bom prognóstico clínico. A seguir, é apresentado o caso de um paciente com vasoconstrição cerebral reversível e lesão miocárdica associa-da, onde o diagnóstico é feito por imagem e tratamento oportuno. A importância do caso está em relatar o reconhecimento precoce de uma rara complicação miocárdica da síndrome de vasoconstrição cerebral, mas com risco de morbimortalidade dentro do espectro das doenças cerebrovasculares.

Incidence of cardioembolic stroke related to atrial fibrillation in Joinville, Brazil / Incidência de acidente vascular encefálico relacionado à fibrilaçao atrial em Joinville, Brasil

Abstract Background Atrial fibrillation (AF) is an important cause of cardioembolic stroke, and population aging has increased its prevalence. Objective To evaluate the incidence of cardioembolic stroke caused by AF in the city of Joinville, Brazil, as well as previous diagnoses and use of medication. Methods Between 2017 and 2020 we extracted data from the population-based Joinville Stroke Registry. Demographic characteristics, diagnosis of AF, and patterns of medication use were collected, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system was used to classify the etiology. Results There were 3,303 cases of ischemic stroke, 593 of which were cardioembolic, and 360 had AF. Of the patients with AF, 258 (71.6%) had a previous diagnosis of the disease, and 102 (28.3%) were newly diagnosed after the stroke. Among patients with a previously-diagnosed AF, 170 (47.2%) were using anticoagulants, and 88 (24.4%) were using other medications. Conclusion During the analyzed period, ischemic stroke caused by AF was a significant burden on the population of Joinville, and a considerable number of patients had undiagnosed or untreated AF.

Resumo Antecedentes A fibrilação atrial (FA) é uma importante causa de acidente vascular cebebral (AVC) cardioembólico, e o envelhecimento populacional aumentou a sua prevalência. Objetivo Avaliar a incidência de AVC cardioembólico causado por FA em Joinville, além dos diagnósticos prévios e do uso de medicamentos. Métodos Entre 2017 e 2020, foram extraídos dados do registro de base populacional de AVC de Joinville. Características demográficas, diagnóstico de FA e padrões de uso de medicamentos foram coletados, e o sistema Trial of ORG 10172 in Acute Stroke Treatment (TOAST) foi utilizado para classificar a etiologia. Resultados Houve 3.303 casos de AVC isquêmico, sendo 593 cardioembólicos e 360 com FA. Dos pacientes com FA, 258 (71,6%) tinham diagnóstico prévio da doença, e 102 (28,3%) foram recém-diagnosticados após o AVC. Entre os pacientes com FA previamente diagnosticada, 170 (47,2%) estavam em uso de anticoagulante, e 88 (24,4%), em uso de outra medicação. Conclusão Durante o período analisado, o AVC isquêmico causado por FA foi um ônus significativo para a população de Joinville, e um número considerável de pacientes apresentava FA não diagnosticada ou não tratada.

Impact of Packet Loss Rate on Quality of Compressed High Resolution Videos.

Video delivered over IP networks in real-time applications, which utilize RTP protocol over unreliable UDP such as videotelephony or live-streaming, is often prone to degradation caused by multiple sources. The most significant is the combined effect of video compression and its transmission over the communication channel. This paper analyzes the adverse impact of packet loss on video quality encoded with various combinations of compression parameters and resolutions. For the purposes of the research, a dataset containing 11,200 full HD and ultra HD video sequences encoded to H.264 and H.265 formats at five bit rates was compiled with a simulated packet loss rate (PLR) ranging from 0 to 1%. Objective assessment was conducted by using peak signal to noise ratio (PSNR) and Structural Similarity Index (SSIM) metrics, whereas the well-known absolute category rating (ACR) was used for subjective evaluation. Analysis of the results confirmed the presumption that video quality decreases along with the rise of packet loss rate, regardless of compression parameters. The experiments further led to a finding that the quality of sequences affected by PLR declines with increasing bit rate. Additionally, the paper includes recommendations of compression parameters for use under various network conditions.

Acute headache attributed to ischemic stroke: assessment of its characteristics and associated factors / Cefaleia aguda atribuída ao acidente vascular cerebral isquêmico: avaliação das características e fatores associados

Abstract Background It is estimated that headache attributed to ischemic stroke occurs in 7.4% to 34% of the cases. Despite its frequency, this headache has been little studied in terms of its risk factors and characteristics. Objective To assess the frequency and clinical characteristics of headache attributed to ischemic stroke and the factors associated with its occurrence. Methods The present was a cross-sectional study which included patients consecutively admitted within 72 hours of the onset of ischemic stroke. A semi-structured questionnaire was used. The patients underwent magnetic resonance imaging. Results A total of 221 patients were included, 68.2% of whom were male, and the mean age was of 68.2 ± 13.8 years. The frequency of headache attributed to ischemic stroke was of 24.9% (95% confidence interval [95%CI]: 19.6-31.1%). The headache had a median duration of 21 hours and most frequently began at the same time as the focal deficit (45.3%), with a gradual onset (83%). It was of moderate intensity, pulsatile (45.3%), bilateral (54.6%), and presented a similar pattern to that of tension-type headache (53.6%). Headache attributed to stroke was significantly associated with previous tension-type headache, and previous migraine with and without aura (logistic regression). Conclusion Headache attributed to stroke is common, with a pattern similar to that of tension-type headache, and it is associated with a history of tension-type and migraine headaches.

Resumo Antecedentes A cefaleia atribuída ao acidente vascular cerebral isquêmico (AVCi) tem uma frequência de 7,4% a 34% dos casos. Apesar de ser considerada frequente, esta cefaleia ainda é pouco estudada em termos de seus fatores de risco e características. Objetivo Avaliar a frequência e as características clínicas da cefaleia atribuída ao AVCi e os fatores associados com a sua ocorrência. Métodos Este foi um estudo transversal que incluiu pacientes admitidos consecutivamente com até 72 horas do início do AVCi. Foi utilizado um questionário semiestruturado. Os pacientes realizaram ressonância magnética. Resultados Foram incluídos 221 pacientes, 68,2% dos quais eram do sexo masculino, e com idade média de 68,2 ± 13,8 anos. A frequência da cefaleia atribuída ao AVCi foi de 24,9% (intervalo de confiança de 95% [IC95%]: 19,6-31,1%). A duração mediana da cefaleia foi de 21 horas, e ela se iniciou com mais frequência ao mesmo tempo em que o déficit focal (45,3%), teve instalação gradual (83%), foi de moderada intensidade, pulsátil (45,3%), bilateral (54,6%) e teve um padrão semelhante ao da cefaleia de tipo tensional (53,6%). A cefaleia atribuída ao AVCi esteve significativamente associada à cefaleia de tipo tensional prévia, e à migrânea com e sem aura prévias (regressão logística). Conclusão A cefaleia atribuída ao AVCi é frequente, tem padrão mais habitual semelhante ao da cefaleia de tipo tensional, e está associada aos antecedentes de cefaleia de tipo tensional e migrânea.

Microsatellite instability in pancreatic and ampullary carcinomas: histology, molecular pathology, and clinical implications.

Microsatellite instability (MSI)/defective DNA mismatch repair (dMMR) represents an important molecular alteration with diagnostic, prognostic, and predictive value. The increasing interest toward this genetic alteration is given to the high response rate of MSI/dMMR tumors to immunotherapy. There are different cancers in the periampullary region that can harbor MSI/dMMR, and significant morphological-molecular correlates should be acknowledged in this district: (1) pancreatic ductal adenocarcinoma (PDAC): in this tumor category, the prevalence of MSI/dMMR is about 1-2%, and medullary and colloid variants are the most typically involved; (2) ampullary adenocarcinoma: here the prevalence of MSI/dMMR is up to 18%, and in this neoplastic group, MSI/dMMR is more commonly found in the intestinal subtype; (3) pancreatic acinar cell carcinoma: here the prevalence of MSI/dMMR is up to 14%; and (4) pancreatic and ampullary neuroendocrine carcinoma: in this tumor category, the prevalence of MSI/dMMR is up to 5-8%, and this molecular alteration should be assessed also in cases of mixed neuroendocrine-non-neuroendocrine neoplasms. Given the clinical importance of MSI/dMMR and its not-negligible prevalence among the different carcinomas arising in this district, its assessment should become part of the routine diagnostic workflow at least for the most typical histotypes. The test of choice is represented by immunohistochemistry for PDAC and ampullary carcinomas, and by direct molecular analyses including MSI-based polymerase chain reaction and next-generation sequencing for acinar cell and neuroendocrine carcinomas.

[Sex differences in stroke mortality in Thailand : A National cohort study]. / Différences sexuelles dans la mortalité par accident vasculaire cérébral en Thaïlande : une étude de cohorte nationale.

BACKGROUND: Over half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients. METHOD: All stroke admissions between 2004-2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders. RESULTS: 608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17-1.23; 1 month: HR: 1.17; 95% CI: 1.15-1.20; 1 year: HR: 1.10; 95% CI: 1.09-1.12 and 5 years: HR: 1.02; 95% CI: 1.01-1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00-1.04; 1 month: HR: 1.08; 95% CI: 1.06-1.10; 1 year: HR: 1.04; 95% CI: 1.03-1.06 and 5 years: HR: 1.09; 95% CI: 1.08-1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03-1.06; 1 month: HR: 1.20; 95% CI: 1.14-1.27; 1 year: HR: 1.14; 95% CI: 1.09-1.18 and 5 years: HR: 1.06; 95% CI: 1.03-1.10). CONCLUSIONS: Compared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.

[Fat embolism in common carotid artery following temporal autologous fat graft]. / Embolie graisseuse carotidienne dans les suites d'un lipofilling temporal.

Lipofilling is a well-known procedure, initially described by Coleman in 1991. Many cases of fat embolism following this procedure are published. Our patient had a common carotid fat embolism after a temporal autologous fat graft.

Clinical evolution of dysphagic patients after malignant infarction and decompressive craniectomy: a case series / Evolução clínica de pacientes disfágicos pós-AVCi maligno e craniectomia descompressiva: série de casos

ABSTRACT This study aimed to characterize clinical-neurological factors and the functional swallowing capacity of patients with malignant infarction submitted to decompressive craniectomy during the hospital stay. This retrospective, descriptive, observational study was conducted between January 2020 and December 2021. The following data regarding up to eight stages were extracted for descriptive analysis: age, location of the lesion, level of awareness according to the Glasgow Coma Scale, neurological impairment according to the National Institutes of Health Stroke Scale, and the functional swallowing capacity according to the Functional Oral Intake Scale. Data on five patients were collected, with a mean of 0.2 days for the first neurological assessment. Decompressive craniectomy was performed in a mean of 2 days after admission. The speech-language-hearing assessment occurred in a mean of 8.2 days, and the speech-language-hearing discharge took a mean of 35.4 days. The neurological impairment score remained the same as in the first neurological assessment after decompressive craniectomy, with a mean score of 16.6. The functional swallowing capacity was the same in the first assessment after decompressive craniectomy, on FOIS level 1, improving considerably by the discharge, with a mean level of 4.8. It is concluded that clinical-neurological factors can interfere with the functional swallowing capacity, although they did not hinder either speech-language-hearing treatment or their evolution to a full oral diet during the hospital stay.

RESUMO O objetivo do presente trabalho é caracterizar fatores clínicos-neurológicos e capacidade funcional de deglutição de pacientes com Acidente Vascular Cerebral Isquêmico Maligno submetidos a craniectomia descompressiva durante internação hospitalar. Trata-se de um estudo observacional, descritivo e retrospectivo, realizado de janeiro de 2020 a dezembro de 2021. Os dados foram extraídos em até oito momentos, incluindo idade, local da lesão, nível de consciência de acordo com Glasgow, comprometimento neurológico pelo National Institutes of Health Stroke Scale e capacidade funcional de deglutição pela Escala Funcional de Ingestão por Via Oral. Realizou-se análise descritiva. Foram coletados dados de 5 pacientes sendo a média de tempo para primeira avaliação neurológica de 0,2 dias. A realização da craniectomia descompressiva levou em média 2 dias após admissão. Avaliação fonoaudiológica ocorreu, em média, 8,2 dias e alta fonoaudiológica levou, em média, 35,4 dias. O comprometimento neurológico manteve-se na pontuação da primeira avaliação neurológica pós-craniectomia descompressiva, média de 16,6. A capacidade funcional de deglutição foi a mesma na primeira avaliação pós-craniectomia descompressiva, com nível 1 na FOIS, melhorando consideravelmente, com média de nível 4,8, na alta. Concluiu-se que fatores clínicos-neurológicos podem interferir na capacidade funcional de deglutição, contudo não limitaram a atuação fonoaudiológica e evolução com dieta oral exclusiva na internação hospitalar.