Intravenous thrombolysis and three-year ischemic stroke mortality.

BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) in ischemic stroke (IS) does not reduce three-month mortality; however, longer-term survival after IVT has not been clearly established. Thus, we aimed to compare three-year mortality after IS in IVT-treated vs non-treated patients and to indicate predictors of long-term mortality after IVT. METHODS: We have evaluated data of 366 subjects with IS (196 treated with IVT and 170 non-treated with IVT, whose age, sex, and calendar time of IS occurrence matched the control group) collected via the Pomeranian Stroke Register. We estimated the three-year survival and its determinants in both groups. RESULTS: In univariate analysis, IVT was not associated with three-year mortality (OR 0.68; 95% CI 0.44-1.05). Independent predictors for unfavorable long-term outcome in a Cox regression model were older age, parenchymal hemorrhage type 2 (ph2), and modified Rankin scale >2 points at discharge from the hospital. IVT was strongly associated with a lower risk of death in the period 0-36 months from IS (HR 0.44, 95% CI 0.28-0.69, P<.001). CONCLUSIONS: Treatment of IS with intravenous recombinant tissue plasminogen activator was associated with increased survival during the three-year follow-up.

Long-term mortality after stroke is higher than after myocardial infarction.

Mortality caused by coronary heart disease and ischemic stroke (IS) in Poland is still among the highest in Europe. Because acute myocardial infarction (AMI) and IS share major common risk factors, it would be expected that trends in long-term mortality (LTM) and incidence of these two diseases would be similar. Nevertheless, better AMI acute phase therapy and older age of IS patients make post-IS and post-AMI prognosis difficult to compare. The aim of the study was to verify the thesis that, regardless of age and sex, the long-term prognosis is worse for post-IS than for post-AMI subjects. The study was conducted in Polish city-Gdynia (250,000 of inhabitants) among 997 subjects (464 post-IS, 533 post-AMI) randomly selected from all post-IS and post-AMI patients, witch survived hospitalization period in years 2000-2005. The observation period varied from 1 month to 11 years. LTM was shown as standardized mortality ratios. Kaplan-Meyer survival curves and Cox proportional hazard regression model were used to compare LTM in post-IS and post-AMI subjects. Post-IS and post-AMI groups did not differ by sex or age of event. Fewer deaths were recorded in post-AMI group (38.8 vs. 51.5 %, OR 0.60, 95 % CI 0.46-0.77). This difference was most evident in males (39.7 vs. 57.8 %, OR 0.48, 95 % CI 0.34-0.66). Kaplan-Meyer estimates showed faster reduction of survival probability in the post-IS males. In Cox regression model presence of IS increased long-term mortality in males. Long-term prognosis was worse for post-IS males in comparison with post-AMI population from Gdynia.

Efficacy of cerebral thrombolysis in an extended 'time window'.

WHAT IS KNOWN AND OBJECTIVE: Cerebral systemic thrombolysis (i.v. thrombolysis) with tissue-type plasminogen activator (rt-PA) is the only proven medical therapy for ischaemic stroke. The use of i.v. thrombolysis up to 4·5 h from stroke onset was approved in certain countries in 2008, but its safety and efficacy have not been fully determined to date. OBJECTIVE: To assess the long-term outcome and complication rate of i.v. thrombolysis performed in the extended 'time window'. METHODS: The study included 403 ischaemic stroke patients consecutively treated with i.v. thrombolysis from 2006 to 2012 at three comprehensive stroke centres in Poland. The long-term outcome and the haemorrhagic complications' (HC) rate were compared between subgroups of patients treated within 3 vs. 3-4·5 h from stroke onset. RESULTS AND DISCUSSION: About 132 (32·75%) patients were treated between 3 and 4·5 h from stroke onset. Neurological deficits tended to be more severe in patients treated ≤3 than in those treated 3-4·5 h (National Institutes of Health Stroke Scale, NIHSS 12 vs.10 points; P = 0·053); however, the ratio of patients with a favourable outcome (mRS 0-2 points) and mortality did not differ between the two groups (53·9 vs. 58·3, P = 0·39 and 17·7 vs. 21·2, P = 0·39, respectively). The rate of HC also did not differ between the two groups (18·8% vs. 15·1%, P = 0·46). WHAT IS NEW AND CONCLUSION: The efficacy of i.v. thrombolysis routinely performed in an extended 'time window' is not reduced when compared to procedures performed within 3 h from symptom onset.

Changes in skeletal muscle iron metabolism outpace amyotrophic lateral sclerosis onset in transgenic rats bearing the G93A hmSOD1 gene mutation.

OBJECTIVE: Recently, iron and the adaptor protein "p66Shc" have been shown to play an important role in the development of amyotrophic lateral sclerosis (ALS) in rats. We hypothesized that changes in muscle p66Shc activity and iron metabolism would appear before visible symptoms of the disease occurred. METHODS: In the present study, we used transgenic rats bearing the G93A hmSOD1 gene mutation and their non-transgenic littermates to test this hypothesis. We examined muscle p66Shc phosphorylation and iron metabolism in relation to oxidative stress in animals at three disease stages: asymptomatic (ALS I), disease onset (ALS II), and end-stage disease (ALS III). RESULTS: Significant changes in iron metabolism and markers of lipid and protein oxidation were detected in ALS I animals, which manifested as decreased levels of ferritin H and ferroportin 1 (Fpn1) and increased levels of ferritin L levels. Muscles of ALS I rats possessed increased levels of p66Shc phosphorylated at Ser(36) compared with muscles of control rats. During disease progression, level of ferritin H significantly increased and was accompanied by iron accumulation. CONCLUSIONS: This study showed that multiple mechanisms may underlie iron accumulation in muscles of ALS transgenic rats, which include changes in blood hepcidin and muscle Fpn1 and increased level of muscle ferritin H. These data suggest that impaired iron metabolism is not a result of changes in motor activity.

Intravenous rt-PA in patients with ischaemic stroke and renal dysfunction.

OBJECTIVE: Renal dysfunction (RD) increases risk for ischaemic stroke (IS). The impact of RD on the effects of iv-thrombolysis in the Caucasian population has not been fully determined. AIMS: To evaluate the associations between RD and the outcome of iv-thrombolysis in Caucasian patients with IS. METHODS: The observational, multicentre study included 404 patients with IS who were treated with iv-thrombolysis. RD was defined as estimated glomerular filtration rate ≤ 60 ml/min/1.73 m(2). Outcome was assessed with modified Rankin Score at 3 months after the stroke onset. RESULTS: Medians baseline NIHSS score did not differ between groups of patients with and without RD (12.0 vs. 11.0 pts, p=0.33). Unfavourable outcome was found in 52.1% of patients with and in 41.2% of patients without RD (p=0.05), mortality was higher in patients with RD (29.9% vs. 14.3%, p<0.001), and the presence of haemorrhagic transformation (HT) did not differ between the groups (17.1% vs. 17.1% respectively, p=0.996). A multivariate analysis showed no impact of RD on the unfavourable outcome (OR 0.98; 95%CI 0.88-1.10), mortality (OR 0.92; 95%CI 0.81-1.05) or presence of HT (OR 1.03; 95%CI 0.90-1.18). CONCLUSIONS: We found no impact of RD on the safety and efficacy of iv-thrombolysis in Caucasian patients with IS.

Pre-hospital delays and intravenous thrombolysis in urban and rural areas.

INTRODUCTION: It is crucial to understand the reasons behind pre- and in-hospital delays to improve nationwide access to effective treatment for acute stroke. AIMS: To evaluate the pre- and in-hospital delays and to compare the intravenous (IV) thrombolysis rates in the urban and rural areas of the Province of Pomerania, Poland. MATERIALS & METHODS: We evaluated the medical records of 2134 patients treated in the stroke units (SUs) and consecutively reported to the Pomeranian Stroke Register from June 2006-December 2007. RESULTS: The time of ischaemic stroke onset was known in 488 (59%) of the 834 urban patients and in 744 (70%) of the 1063 rural patients (P < 0.001). The proportion of patients who called the emergency medical services with a delay of >45 min was similar in both locations: urban, 314/488 (64.3%) vs rural, 490/744 (65.8%). Although the proportion of patients who reached the emergency room within 3 h was higher in the rural areas (29.0% vs 24.3%; P = 0.02), only 4.2% of these patients received IV thrombolysis compared with 23.1% in the urban areas (P < 0.001). The proportion of patients who did not seek any kind of professional medical help prior to admission was lower in the rural areas (29/744 (3.9%) vs urban 50/488 (10.2%)) (P < 0.001). CONCLUSIONS: Pre-hospital delays reduced the number of patients eligible for IV thrombolysis in both rural and urban areas. The low proportion of patients treated with IV thrombolysis in rural SUs may be attributed to ineffective in-hospital procedures.

Assessment of the quality of secondary ischemic stroke prevention in selected urban areas of Poland and Ukraine: the ASCEP study results.

UNLABELLED: The aim of this study was to assess the quality of secondary ischemic stroke (IS) prevention among subjects after IS from selected urban areas of Poland (Gdynia, G) and Ukraine (Lutsk, L). METHODS: The study was conducted on representative samples of post-IS patients from G and L who suffered from IS in the years 2000-2005. A questionnaire, anthropometric and blood pressure (BP) measurements and laboratory tests were performed. RESULTS: The data of 440 patients were collected. Only 47% in G and 58% in L (p < 0.05) had visited a neurologist within 6 months before the interview. Results of the prevalence and control of consecutive IS risk factors were estimated: (1) arterial hypertension (prevalence: 88% G, 92% L, p = 0.1; BP <140/90 mm Hg: 23% G, 16% L, p = 0.02); (2) hypercholesterolemia (prevalence: 90% G, 76% L, p < 0.05; total cholesterol <175 mg/dl: 11% G, 6% L, p = 0.05); (3) self-reported diabetes or glycemia >125 mg/dl: 22% G, 17% L, p = 0.08; (4) smoking: 26% men versus 16% women in G, 33% men versus 2% women in L, p < 0.05, and (5) self-reported atrial fibrillation: 28% G, 7% L, p < 0.05. Antiplatelet drugs or oral anticoagulants were taken by 51% G versus 45.5% L (not significant). CONCLUSIONS: The quality of secondary IS prevention is insufficient, and there is a need for complex educational interventions in patients, their families and medical staff. Our data also call for organizational changes in the health service both in Poland and Ukraine.

Intravenous recombinant tissue plasminogen activator for acute stroke in Poland: an analysis based on the Safe Implementation of Thrombolysis in Stroke (SITS) Registry.

OBJECTIVES: Intravenous thrombolysis was conditionally approved in the European Union (EU) in 2002, under the requirement of entering all patients into Safe Implementation of Thrombolysis in Stroke - Monitoring Study (SITS-MOST). Countries not belonging to the EU by 2002, i.e. Poland were invited to enter data into the SITS International Stroke Thrombolysis Registry (SITS-ISTR). The aim of this study is to compare the safety and efficacy of thrombolysis in the Polish SITS-ISTR stroke patient population with patients registered in SITS-MOST. METHODS: 481 patients in Poland were reported between 2003 and 2007. Baseline and outcome data of Polish patients were compared with SITS-MOST. RESULTS: Most of the baseline characteristics did not differ between the groups. The most important was the onset-to-needle and door-to-needle times were significantly longer in Polish patients, 150 vs 136 min and 82 vs 68 min, respectively (P < 0.001). The symptomatic intracranial haemorrhage and independence rates at 3 months were similar in both populations. Polish patients had a significantly higher 3-month mortality rate, 18.6% vs 11.3% (P < 0.001). CONCLUSIONS: Because of higher mortality the study implies the need to improve the organization of thrombolysis services and provides the rationale to continue the monitoring of treatment in Poland.

Treatment of alcoholic polyneuropathy with vitamin B complex: a randomised controlled trial.

AIMS: To evaluate the therapeutic efficacy and safety of BEFACT Forte 'new formulation' and BEFACT Forte 'old formulation' in the treatment of sensory symptoms of alcoholic polyneuropathy. METHODS: A multi-centre, randomised, double-blind, placebo-controlled study was conducted on 325 patients with sensory symptoms and signs of alcoholic polyneuropathy. Patients were randomised to the 'old formulation' (i.e. vitamins B1, B2, B6, and B12), 'new formulation' [i.e. identical to the 'old formulation' with additional folic acid (vitamin B9)], or placebo in a 1:1:1 ratio. One tablet of the study medication ('new formulation' or 'old formulation') or placebo was taken orally, three times a day, over a 12-week treatment period. RESULTS: Therapeutic efficacy was assessed in 253 patients by measuring vibration perception threshold (biothesiometry), intensity of pain, sensory function, co-ordination, and reflex responses. Patients treated with the 'new formulation' or 'old formulation' showed significant improvement in the primary efficacy endpoint (vibration perception threshold at the big toe) and secondary efficacy endpoints in comparison to placebo. The active treatment groups were comparable to placebo in terms of safety. CONCLUSIONS: A specific vitamin B complex (with and without folic acid) significantly improved symptoms of alcoholic polyneuropathy over a 12-week treatment period.

Cerebral blood flow changes in Parkinson?s disease associated with dementia.

Dementia is one of the main non-motor symptoms of Parkinson's disease (PD) and it is diagnosed in about 30% of cases. Its aetiology remains unclear and contributing factors are controversial. Dementia may be more common in old patients with severe motor symptoms and mild cognitive impairment. Clinico-pathological studies show the association between dementia in PD and the age-related group of dementias, such as AD and VaD. A valuable aid in the assessment of dementia in PD is cerebral blood flow (CBF) brain SPECT scanning. It shows three different patterns of rCBF reduction, including frontal lobe hypoperfusion, Alzheimer-like type of hypoperfusion and multiple, vascular defects. The heterogeneity of rCBF reduction may reflect the multifactorial pathophysiology of dementia in PD. It may result from concomitant AD pathology, cerebrovascular disease, destruction of nigro-striato-frontal projection or may be a distinct disease of different aetiology.

Myoid cells and neuroendocrine markers in myasthenic thymuses.

We have studied myoid cells in normal and myasthenic thymuses as well as in thymomas. For the presence of neuroendocrine markers-producing cells and identification of synaptophysin (Syn) the immunohistochemical method and immunoblot analysis were used. Myoid cells can be demonstrated in the thymus of myasthenic patients in high number. These cells occur in the vicinity of Hassall's bodies but also within them. Some regenerated Hassall's bodies displayed majority of myoid cells with their concentric arrangement around the centrally situated lacunar-like cell with nuclei of monocytogenic origin. Such phenomenon may suggest cooperation of myoid cells and their epithelial transitional forms with monocytogenic cells in various thymic hormone production. It is likely that myoid cells are the source of some thymic epithelial cells. According to some authors, thymomatous epithelial cells and skeletal muscle share a common epitope defined by a monoclonal antibody (mAb), whereas thymic epithelial cells possess acetylocholine receptor (AChR) on their surface. The epithelial cells of some thymomas express also desmin. In normal thymuses of children, Syn and chromogranin A (Chg A) were demonstrated in some cells of Hassall's bodies by immunohistochemical method. In addition, antibodies to Syn stained nerve structures surrounding the thymic blood vessels. In myasthenic thymuses, Syn expression was in cortical and medullary epithelial cells, in myoid cells and only scanty and focal in keratinized epithelial cells of Hassall's bodies. The epithelial cells of some thymomas also express Syn. In some thymuses of all groups investigated in this study Chg A was seen in single cells of Hassall's bodies and focally in cortical epithelial cells. Our results show that in normal thymuses of cardiac surgery patients and in the adult myasthenic thymuses antibody raised against Syn recognized protein with molecular weight of 48,000 but not normal (38,000) Syn. It remains to be elucidated if the overexpression of synaptophysin-like protein in myasthenic thymuses is a compensatory phenomenon to the defect in normal synaptic function.

[Level of depression in outpatients with low back pain syndromes]. / Depresja u pacjentów z zespolami bólowymi okolicy ledzwiowo-krzyzowej leczonych ambulatoryjnie.

There was significantly higher level of depression in chronic low-back pain patients than revealed in healthy subjects.

[Evaluation of long term results of surgery for myasthenia gravis (with regard to electrophysiological studies)]. / Ocena odleglych wyników leczenia operacyjnego miastenii (z uwzglednieniem badan elektrofizjologicznych).

The study aimed to quantify clinical and electrophysiological results of thymectomy. The study included 43 patients (14 men and 29 female) with the peak age of onset of symptoms between 20 to 40 years. The mean duration time after the thymectomy was 36 months. In all the patients the supramaximal repetitive nerve stimulation was performed. In 31 patients the clinical results of thymectomy were good (remission or reduced post operative dosage of drugs). The abnormal decrement in repetitive nerve stimulation was detected in 38 patients. The study demonstrates that clinical improvement after thymectomy is not equal to normalization of neuromuscular junction and clinical remission did not predict the final course of myasthenia.