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Stroke routing

Jie Zhang, Xuehu Wei, Sangma Xie, Zhen Zhou, Desheng Shang, Renjie Ji, Yamei Yu, Fangping He, Yue Du, Xiangming Ye, Benyan Luo
In the dual-route language model, the dorsal pathway is known for sound-to-motor mapping, but the role of the ventral stream is controversial. With the goal of enhancing our understanding of language models, this study investigated the diffusion characteristics of candidate tracts in aphasic patients. We evaluated 14 subacute aphasic patients post-stroke and 11 healthy controls with language assessment and diffusion magnetic resonance imaging. Voxel-based lesion-symptom mapping found multiple linguistic associations for the ventral stream, while automated fiber quantification (AFQ) showed, via reduced fractional anisotropy (FA) and axial diffusivity with increased radial diffusivity (all corrected p  < 0...
2018: Frontiers in Neurology
Clinton G Lauritsen, Abigail L Chua, Stephanie J Nahas
PURPOSE OF REVIEW: Menopause is a life-changing event in numerous ways. Many women with migraine hold hope that the transition to the climacteric state will coincide with a cessation or improvement of migraine. This assumption is based mainly on common lay perceptions as well as assertions from many in the healthcare community. Unfortunately, evidence suggests this is far from the rule. Many women turn to a general practitioner or a headache specialist for prognosis and management. A natural instinct is to manipulate the offending agent, but in some cases, this approach backfires, or the concern for adverse events outweighs the desire for a therapeutic trial, and other strategies must be pursued...
March 6, 2018: Current Treatment Options in Neurology
Douglas M Bennion, Chad H Jones, Alex N Dang, Jacob D Isenberg, Justin T Graham, Lena Lindblad, Oliver Domenig, Michael F Waters, Marko Poglitsch, Colin Sumners, U Muscha Steckelings
Significant neuroprotective effects of angiotensin II type 2 (AT2 ) receptor agonists in ischemic stroke have been previously demonstrated in multiple studies.  However, the routes of agonist application used in these pre-clinical studies, direct intracerebroventricular and systemic administration, are unsuitable for translation to humans; in the latter case because AT2 receptor agonists are blood brain barrier (BBB) impermeable. To circumvent this problem, in the current study we utilized the nose-to-brain (N2B) route of administration to bypass the blood brain barrier and deliver the selective AT2 receptor agonist Compound 21 (C21) to naïve rats or rats that had undergone endothelin 1-induced ischemic stroke...
March 2, 2018: Clinical Science (1979-)
Flora A Kennedy McConnell, Stephen J Payne
OBJECTIVE: Ischemic stroke is a leading cause of death and disability. Autoregulation and collateral blood flow through the circle of Willis both play a role in preventing tissue infarction. A steady-state model of the cerebral arterial network was used to investigate the interaction of these mechanisms when autoregulation is impaired ipsilateral to an occluded artery. MATERIALS AND METHODS: Twelve structural variants of the circle of Willis were modelled with left internal carotid artery occlusion and coupled with (1) a passive model of the cerebral vascular bed, (2) a steady-state model of an autoregulating cerebral vascular bed, and (3) a model in which the contralateral hemisphere autoregulates and the ipsilateral hemisphere does not...
2018: Acta Neurochirurgica. Supplement
Michael T Mullen, William Pajerowski, Steven R Messé, C Crawford Mechem, Judy Jia, Michael Abboud, Guy David, Brendan G Carr, Roger Band
BACKGROUND AND PURPOSE: We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. METHODS: We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center...
February 28, 2018: Stroke; a Journal of Cerebral Circulation
Benedikt Mayr, Christian Firschke, Magdalena Erlebach, Sabine Bleiziffer, Markus Krane, Michael Joner, Ulf Herold, Christian Nöbauer, Rüdiger Lange, Marcus-André Deutsch
OBJECTIVES: Simultaneous surgical off-pump coronary revascularization and transcatheter aortic valve implantation (TAVI) as a hybrid procedure may be a therapeutic option for patients with a TAVI indication who are not suitable for percutaneous coronary intervention and for patients who have an indication for combined surgical aortic valve implantation and coronary artery bypass grafting but present with a porcelain aorta. Early outcomes of these patients are analysed in this study. METHODS: From February 2011 to April 2017, hybrid TAVI/off-pump coronary artery bypass (OPCAB) was performed in 12 (60%) patients, hybrid TAVI/minimally invasive direct coronary artery bypass in 6 (30%) patients and staged TAVI/OPCAB in 2 (10%) patients...
February 26, 2018: Interactive Cardiovascular and Thoracic Surgery
Gaurav Kumar, Pankaj Paliwal, Sumedha Mukherjee, Nishant Patnaik, Sairam Krishnamurthy, Ranjana Patnaik
The present study is designed to investigate the brain distribution and plasma pharmacokinetics profiles of chlorogenic acid after intranasal administration in Charles-Foster rats to evaluate whether the CGA molecules are transported directly via the nose-to-brain path. The chlorogenic acid is administered intravenously (IV) and intranasally (IN) at the dose of 10 mg/kg. Further, its concentration in the plasma, cerebrospinal fluid (CSF) and the whole brain is analyzed by HPLC-UV method. The study observes that chlorogenic acid is rapidly absorbed in plasma with tmax of 1 min similar to IV route after IN administration...
February 24, 2018: Xenobiotica; the Fate of Foreign Compounds in Biological Systems
Andy C Kiser, Thomas G Caranasos, Mark D Peterson, David M Holzhey, Philipp Kiefer, L Wiley Nifong, Michael A Borger
OBJECTIVE: Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access...
February 17, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Ali Reza Noorian, Nerses Sanossian, Kristina Shkirkova, David S Liebeskind, Marc Eckstein, Samuel J Stratton, Franklin D Pratt, Robin Conwit, Fiona Chatfield, Latisha K Sharma, Lucas Restrepo, Miguel Valdes-Sueiras, May Kim-Tenser, Sidney Starkman, Jeffrey L Saver
BACKGROUND AND PURPOSE: Prehospital scales have been developed to identify patients with acute cerebral ischemia (ACI) because of large vessel occlusion (LVO) for direct routing to Comprehensive Stroke Centers (CSCs), but few have been validated in the prehospital setting, and their impact on routing of patients with intracranial hemorrhage has not been delineated. The purpose of this study was to validate the Los Angeles Motor Scale (LAMS) for LVO and CSC-appropriate (LVO ACI and intracranial hemorrhage patients) recognition and compare the LAMS to other scales...
February 19, 2018: Stroke; a Journal of Cerebral Circulation
Peter L M Kerkhof, Tatiana Kuznetsova, Rania Ali, Neal Handly
The heart is often regarded as a compression pump. Therefore, determination of pressure and volume is essential for cardiac function analysis. Traditionally, ventricular performance was described in terms of the Starling curve, i.e., output related to input. This view is based on two variables (namely, stroke volume and end-diastolic volume), often studied in the isolated (i.e., denervated) heart, and has dominated the interpretation of cardiac mechanics over the last century. The ratio of the prevailing coordinates within that paradigm is termed ejection fraction (EF), which is the popular metric routinely used in the clinic...
March 1, 2018: Advances in Physiology Education
Dattatraya Adkar, Parag Adhyapak, Uttamrao Mulik, Sandesh Jadkar, Katia Vutova, Dinesh Amalnerkar
SnS nanostructured materials have attracted enormous interest due to their important properties and potential application in low cost solar energy conversion systems and optical devices. From the perspective of SnS based device fabrication, we offer single-stroke in-situ technique for the generation of Sn based sulphide and oxide nanostructures inside the polymer network via polymer-inorganic solid state reaction route. In this method, polyphenylene sulphide (PPS)-an engineering thermoplastic-acts as chalcogen source as well as stabilizing matrix for the resultant nano products...
May 1, 2018: Journal of Nanoscience and Nanotechnology
Lena Lipskaya-Velikovsky, Gabi Zeilig, Harold Weingarden, Clara Rozental-Iluz, Debbie Rand
Deficits in executive functioning (EF) are often still present at the chronic stage after stroke, which may negatively impact independent living. The objectives of this study were (a) to characterize the EF and independence in daily living of community-dwelling individuals with chronic stroke by using pen-and-paper and performance-based EF assessments, (b) to explore correlations between scores detected by different EF assessments and (c) to assess the correlations between EF and independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADL)...
February 12, 2018: International Journal of Rehabilitation Research. Revue Internationale de Recherches de Réadaptation
Thomas W Stonier, Kirtan Patel, Vamsee Bhrugubanda, Andrew Mtl Choong
BACKGROUND: Endovascular repair is now preferred to open access for the management of aortic diseases. This is typically performed via the femoral artery, however not all patients are eligible for this. This systematic review summaries the current evidence for utilising the carotid artery as an alternative access route. METHODS: A systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using four electronic databases...
February 8, 2018: Annals of Vascular Surgery
Benjamin Y Q Tan, Nicholas J H Ngiam, Sibi Sunny, Wan Yee Kong, Howen Tam, Tiong Beng Sim, Benjamin S H Leong, Chandra Bhartendu, Prakash R Paliwal, Raymond C S Seet, Bernard P L Chan, Hock Luen Teoh, Vijay K Sharma, Leonard L L Yeo
BACKGROUND: In acute ischemic stroke (AIS), treatment with intravenous tissue-type plasminogen activator (IV-tPA) is time-sensitive. All stroke centers make continual efforts to reduce door-to-needle time (DNT) with varying success. We present the impact of modifications to our stroke activation protocol on DNT. METHODS: We included 404 consecutive patients with AIS receiving IV-tPA between January 2014 and December 2016. First changes in stroke activation protocol were made in March 2015 in the form of prenotification by paramedics, direct transfer from ambulance to computed tomography (CT) scanner, and rapid en route neurological assessment by an emergency physician and neurologist...
February 5, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Solomon Habtemariam
Both caffeic acid and 3,4-dihydroxyphenyllactic acid (danshensu) are synthesized through two distinct routs of the shikimic acid biosynthesis pathway. In many plants, especially the rosemary and sage family of Lamiaceae, these two compounds are joined through an ester linkage to form rosmarinic acid (RA). A further structural diversity of RA derivatives in some plants such as Salvia miltiorrhiza Bunge is a form of RA dimer, salvianolic acid-B (SA-B), that further give rise to diverse salvianolic acid derivatives...
February 3, 2018: International Journal of Molecular Sciences
Noman Ali, Peysh A Patel, Steven J Lindsay
Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements to be made in complication rates, which have led to a commensurate expansion in the use of TAVI; it is now a viable alternative to AVR in patients at intermediate surgical risk, and has been used in cohorts such as those with bicuspid aortic valves or pure, severe aortic regurgitation...
January 25, 2018: European Journal of Heart Failure
Julius Fridriksson, Dirk-Bart den Ouden, Argye E Hillis, Gregory Hickok, Chris Rorden, Alexandra Basilakos, Grigori Yourganov, Leonardo Bonilha
In most cases, aphasia is caused by strokes involving the left hemisphere, with more extensive damage typically being associated with more severe aphasia. The classical model of aphasia commonly adhered to in the Western world is the Wernicke-Lichtheim model. The model has been in existence for over a century, and classification of aphasic symptomatology continues to rely on it. However, far more detailed models of speech and language localization in the brain have been formulated. In this regard, the dual stream model of cortical brain organization proposed by Hickok and Poeppel is particularly influential...
January 17, 2018: Brain: a Journal of Neurology
Marek Kowalski, Cornelia Deutsch, Steffen Hofmann, Norbert Franz, Michael Billion, Abbas Ferdosi, Peter Bramlage, Guram Imnadze, Henning Warnecke
Introduction: The "transfemoral (TF) first" approach to access route selection in transcatheter aortic valve implantation (TAVI) is popular; however, the risk of major vascular complications is substantial. The "best for TF" approach identifies only the patients with ideal anatomy for TF-TAVI, potentially minimizing complications. Aim: To characterize the outcomes of patients undergoing TAVI at a large-volume site that employs this approach. Material and methods: Patients who underwent TAVI at the Bad Rothenfelde Heart Centre between 2008 and 2016 were consecutively enrolled...
December 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Joon W Shim, Joseph R Madsen
Vascular endothelial growth factor (VEGF) is a potent growth factor playing diverse roles in vasculogenesis and angiogenesis. In the brain, VEGF mediates angiogenesis, neural migration and neuroprotection. As a permeability factor, excessive VEGF disrupts intracellular barriers, increases leakage of the choroid plexus endothelia, evokes edema, and activates the inflammatory pathway. Recently, we discovered that a heparin binding epidermal growth factor like growth factor (HB-EGF)-a class of EGF receptor (EGFR) family ligands-contributes to the development of hydrocephalus with subarachnoid hemorrhage through activation of VEGF signaling...
January 17, 2018: International Journal of Molecular Sciences
Krishna Amuluru, Charles E Romero, Logan Pyle, Mohammad El-Ghanem, Fawaz Al-Mufti
BACKGROUND: A cross-circulation technique involves gaining access to a cerebral vessel through a patent anterior or posterior communicating artery. This technique may be utilized in patients with emergent large vessel occlusions and an unfavorable direct route to the occlusion. While few previous reports have demonstrated successful cross-circulation technique for treatment of emergent large vessel occlusions, we present the first two cases of trans-anterior communicating artery stent-retriever thrombectomy...
January 12, 2018: World Neurosurgery
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