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Chronic Stroke

Pevni Dmitry, Aizer Zahi, Mohr Rephael, Nesher Nahum, Kremer Amir, Paz Yosef, Taih Nadav, Ben-Gal Yanai
OBJECTIVES: Bilateral internal thoracic artery (ITA) grafting is associated with improved survival. However, potential survival benefit of using two ITA`s in patients with chronic lung disease (CLD) is questionable due to their increased risk of sternal wound infection (SWI) compared to operations incorporating single ITA (SITA). The purpose of this study is to compare early and long-term outcome of bilateral internal thoracic artery (BITA) grafting to that of grafting with single internal thoracic grafts and vein grafts or radial artery (SITA) in CLD patients with multi-vessels coronary disease...
2018: PloS One
Mitchell L Schubert
PURPOSE OF REVIEW: The present review summarizes the past year's literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors. RECENT FINDINGS: Proton pump inhibitors are amongst the most widely prescribed and overprescribed medications worldwide. Although generally considered well tolerated, epidemiologic studies mining large databases have reported a panoply of purported serious adverse effects associated with proton pump inhibitors, including chronic kidney disease, cognitive decline, myocardial infarction, stroke, bone fracture and even death...
August 9, 2018: Current Opinion in Gastroenterology
Tatsuro Ibe, Hiroshi Wada, Kenichi Sakakura, Miyuki Ito, Yusuke Ugata, Kei Yamamoto, Yousuke Taniguchi, Shin-Ichi Momomura, Hideo Fujita
Recently, long-term outcomes of pre-capillary pulmonary hypertension (PH) have been improved, whereas morbidity and mortality are still high because of right-sided heart failure (HF). Right-sided HF is closely related to right ventricular (RV) function and hemodynamics such as RV stroke work index (RVSWI). However, the association between RVSWI and long-term outcomes in pre-capillary PH has not been well investigated. The aims of this study were to compare clinical characteristics between low RVSWI and high RVSWI and to investigate the association between low RVSWI and long-term outcomes in patients with pre-capillary PH...
August 11, 2018: International Heart Journal
Carmen M Lara-Rojas, Luis M Pérez-Belmonte, María D López-Carmona, Ricardo Guijarro-Merino, María R Bernal-López, Ricardo Gómez-Huelgas
AIMS: To analyze national trends in the rates of hospitalizations (all-cause and by principal discharge diagnosis) in total diabetic population of Spain. METHODS: We carried out a nation-wide population-based study of all diabetic patients hospitalized between 1997 and 2010. All-cause hospitalizations, hospitalizations by principal discharge diagnosis, mean age, Charlson Comorbidity Index, readmission rates and length of hospital stay were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated...
August 9, 2018: European Journal of Internal Medicine
Michael Pignanelli, Chrysi Bogiatzi, Gregory Gloor, Emma Allen-Vercoe, Gregor Reid, Bradley L Urquhart, Kelsey N Ruetz, Thomas J Velenosi, J David Spence
OBJECTIVE: Toxic metabolites produced by the intestinal microbiome from animal proteins, carnitine (mainly from red meat), or phosphatidylcholine (mainly from egg yolk), have important adverse effects on cardiovascular disease. These are renally eliminated and may be termed gut-derived uremic toxins (GDUT). We hypothesized that even moderate renal impairment and intake of nutrient precursors would raise plasma levels of GDUT. DESIGN: A cohort study. SETTING: Academic medical center...
August 9, 2018: Journal of Renal Nutrition
Thomas J Sorenson, Harry Cloft, Alejandro Rabinstein, Giuseppe Lanzino
While revascularization of the acutely or chronically occluded internal carotid artery has become commonplace with modern endovascular techniques, revascularization of an acutely occluded common carotid artery (CCA) is a controversial procedure with unique challenges. These challenges can be related to the lack of observable markers for identifying vessels during navigation or for identifying the exact location and extent of occlusion within the CCA, in addition to wide-ranging treatment risks. In this video, we illustrate the controversial revascularization of a 68-yr-old woman with an acute CCA occlusion who presented with fluctuating neurological symptoms...
August 7, 2018: Operative Neurosurgery (Hagerstown, Md.)
Sergio Barros-Gomes, Abdullah El Sabbagh, Mackram F Eleid, Sunil V Mankad
Non-atherosclerotic myocardial infarction (MI) is an important but often misdiagnosed cause of acute MI. Furthermore, non-atherosclerotic MI with concomitant acute stroke and pulmonary embolism due to in-transit thrombus across a patent foramen ovale (PFO) is a rare but potentially fatal combination (1-3). Early detection of this clinical entity can facilitate delivery of targeted therapies and avoid poor outcome (1, 2). Here, we describe a 68-year-old female with hypertension, tobacco abuse, and chronic obstructive pulmonary disease presenting with facial droop, right arm weakness and aphasia...
August 11, 2018: Echo Research and Practice
Svetlana Pundik, Jessica McCabe Pt, Margaret Skelly, Curtis Tatsuoka, Janis J Daly
BACKGROUND: The prevalence of increased muscle tone after stroke is frequently reported as 30% to 40%, and the condition is often concurrent with motor control deficits, manifesting as an inability to isolate paretic-limb joint movements. OBJECTIVE: . The objectives of this retrospective analysis were to 1) report the prevalence of increased muscle tone in a convenience sample of 128 chronic stroke survivors with moderate/severe motor deficits and 2) quantify the relation between tone and motor impairment in chronic stroke survivors...
August 9, 2018: Annals of Physical and Rehabilitation Medicine
Michael G Watson, Helen M Byrne, Charlie Macaskill, Mary R Myerscough
Atherosclerotic plaque growth is characterised by chronic, non-resolving inflammation that promotes the accumulation of cellular debris and extracellular fat in the inner artery wall. This material is highly thrombogenic, and plaque rupture can lead to the formation of blood clots that occlude major arteries and cause myocardial infarction or stroke. In advanced plaques, vascular smooth muscle cells (SMCs) are recruited from deeper in the artery wall to synthesise a cap of fibrous tissue that stabilises the plaque and sequesters the thrombogenic plaque content from the bloodstream...
August 8, 2018: Journal of Theoretical Biology
Mark H Pitcher, Michael Von Korff, M Catherine Bushnell, Linda Porter
The multidimensional nature of chronic pain is not reflected by definitions based solely on pain duration, resulting in high prevalence estimates limiting effective policy development. The newly proposed concept of High Impact Chronic Pain (HICP) incorporates both disability and pain duration to identify a more severely impacted portion of the chronic pain population, yet remains uncharacterized at the population level. As such, we used the 2011 National Health Interview Survey (NHIS; n=15,670) to (i) assess the likelihood of disability in the overall chronic pain population, (ii) to estimate the prevalence of HICP, and (iii) to characterize the disability, health status and health care use profile of this population in the United States...
August 7, 2018: Journal of Pain: Official Journal of the American Pain Society
Siddiq Omer, Renata Zbyszynska, Ramanathan Kirthivasan
Moyamoya disease is a vasculopathy causing chronic progressive stenosis and occlusion of the large arteries of the circle of Willis that could lead to brain ischaemia. The condition may also present with haemorrhagic strokes. This is a case report of moyamoya disease in a 32-year-old woman presenting with ischaemic stroke. The report describes her inpatient stay and investigations and findings.The report reviews the main aspects of moyamoya disease definition, epidemiology, clinical features, diagnosis, classification and treatment...
August 9, 2018: BMJ Case Reports
Tiago Lemos Cerqueira, Armando Fartolino Guerrero, Clara Krystal Pérez Fermin, Ricardo Wang, Evelin Elfriede Balbino, Janis L Breeze, Paola Gonzalez Mego, Daniele Argentina Silva, Walid Ezzeldin Omer, Nathalie Monique Vandevelde
BACKGROUND: End-stage renal disease (ESRD) is the last stage of chronic kidney disease, mainly caused by type 2 diabetes mellitus and characterized by an increased mortality risk related to cardiovascular disease. Low-dose aspirin (acetylsalicylic acid or ASA) seems to effectively prevent cardiovascular events in patients with ESRD. However, the number of interventional studies in this population remains limited and the mechanisms of aspirin-related bleeding remain poorly understood. Aspirin's efficacy and safety may be modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity...
August 9, 2018: JMIR Research Protocols
Bettina Buchthal, Ursula Weiss, Hilmar Bading
Synaptic NMDA receptors activating nuclear calcium-driven adaptogenomics control a potent body-own neuroprotective mechanism, referred to as acquired neuroprotection. Viral vector-mediated gene transfer in conjunction with stereotactic surgery has previously demonstrated the proficiency of several nuclear calcium-regulated genes to protect in vivo against brain damage caused by toxic extrasynaptic NMDA receptor signaling following seizures or stroke. Here we used noninvasive nose-to-brain administration of Activin A and SerpinB2, two secreted nuclear calcium-regulated neuroprotectants, for post-injury treatment of brain damage following middle cerebral artery occlusion (MCAO) in C57BL/6N mice...
July 23, 2018: Molecular Therapy: the Journal of the American Society of Gene Therapy
Nyeonju Kang, James H Cauraugh
BACKGROUND: Bilateral motor control deficits poststroke may be lateralized by hemisphere damage. This preliminary study investigated bilateral force control between left and right hemisphere-damaged groups at baseline and after coupled bilateral movement training with neuromuscular stimulation. METHODS: Stroke participants (8 left hemisphere and 6 right hemisphere cerebrovascular accidents) performed a bilateral isometric force control task at 3 submaximal force levels (5%, 25%, and 50% of maximum voluntary contraction [MVC]) before and after training...
August 6, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Gennaro Giustino, Roxana Mehran, Patrick W Serruys, Joseph F Sabik, Milan Milojevic, Charles A Simonton, John D Puskas, David E Kandzari, Marie-Claude Morice, David P Taggart, Anthony H Gershlick, Philippe Généreux, Zixuan Zhang, Thomas McAndrew, Björn Redfors, Michael Ragosta, Irving L Kron, Ovidiu Dressler, Martin B Leon, Stuart J Pocock, Ori Ben-Yehuda, Arie Pieter Kappetein, Gregg W Stone
BACKGROUND: The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. OBJECTIVES: This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial...
August 14, 2018: Journal of the American College of Cardiology
Luokun Xie, Wenjun Li, Jessica Hersh, Ran Liu, Shao-Hua Yang
Mounting evidence has demonstrated that both innate and adaptive immune cells infiltrate into the brain after ischemic stroke. T cell invasion has been found in the ischemic region up to one month post experimental ischemic stroke and has been shown to persist for years in stroke patients. However, the function and phenotypic characteristics of the brain invading T cells after ischemic stroke have not been investigated. In the current study, we determined the function of brain invading T cells in the acute and chronic phase following experimental ischemic stroke induced by transient middle cerebral artery occlusion...
August 10, 2018: Journal of Cerebral Blood Flow and Metabolism
Piyush Shankarrao Kodgirwar, Sumedh Ulhas Jajoo, Ulhas Narayan Jajoo, Bharti Amar Taksande, Subodh S Gupta
Background: India has largest number of people with diabetes mellitus (DM), and hypertension (HTN) is expected to double in next 25 years, which are common causes of chronic kidney disease (CKD). The focus for prevention of end-stage renal disease has shifted to detection of the iceberg of DM and HTN and its adequate control. Prevalence studies of CKD in India rural community are lacking. Methodology: We did community-based cross-sectional study with 3 monthly diagnostic camps in adults ≥20 years ( n = 6278), from 13 villages for early detection of CKD in rural population around Sevagram in a group of noncommunicable disease (NCD) with DM, HTN, ischemic heart diseases (IHD), and stroke in year 2015-2016...
March 2018: Journal of Family Medicine and Primary Care
Michael J Quon, Hassan Behlouli, Louise Pilote
OBJECTIVES: The purpose of this study was to determine if anticoagulation of patients with new onset secondary atrial fibrillation (AF) occurring with acute coronary syndromes (ACS), acute pulmonary disease, or sepsis is associated with a reduction in ischemic stroke or an increase in bleeding risk. BACKGROUND: Studies evaluating the benefits and risks of anticoagulation in secondary AF are infrequent, and the optimal management of these patients is not well understood...
March 2018: JACC. Clinical Electrophysiology
Robert J Zhou, Hossein M Hondori, Maryam Khademi, Jessica M Cassidy, Katherine M Wu, Derek Z Yang, Nikhita Kathuria, Fareshte R Erani, Lucy Dodakian, Alison McKenzie, Cristina V Lopes, Walt Scacchi, Ramesh Srinivasan, Steven C Cramer
The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circuit also predicts training-related gains in visuomotor tracking in patients with chronic hemiparetic stroke. Subjects ( n = 12) underwent dense-array EEG recording at rest, then received 8 sessions of visuomotor tracking training delivered via home-based telehealth methods...
2018: Frontiers in Neurology
Eric Moulton, Romain Valabrègue, Belén Díaz, Claire Kemlin, Sara Leder, Stephane Lehéricy, Yves Samson, Charlotte Rosso
A common means of studying motor recovery in stroke patients is to extract Diffusion Tensor Imaging (DTI) parameters from the corticospinal tract (CST) and correlate them with clinical outcome scores. To that purpose, conducting group-level analyses through spatial normalization has become a popular approach. However, the reliability of such analyses depends on the accuracy of the particular registration strategy employed. To date, most studies have employed scalar-based registration using either high-resolution T1 images or Fractional Anisotropy (FA) maps to warp diffusion data to a common space...
August 4, 2018: NeuroImage
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