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Hyperglycemia in stroke

Jan Borggrefe, Berit Glück, Volker Maus, Oezgur Onur, Nuran Abdullayev, Utako Barnikol, Christoph Kabbasch, Gereon Rudolf Fink, Anastasios Mpotsaris
BACKGROUND: Among patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT), diabetic patients (DP) show a poorer outcome compared to non-diabetic patients (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation. METHODS: This study includes 317 out of 498 consecutive patients who received interventional treatment for AIS in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP...
August 16, 2018: World Neurosurgery
Shih-Chieh Chang, Jiun-I Lai, Mei-Chin Lu, Kuan-Hung Lin, Wei-Shu Wang, Su-Shun Lo, Yi-Chun Lai
Hip fracture is an important health care issue in the elderly. Postoperative pulmonary complications occur in 4% of patients after hip fracture surgery. However, previous research is limited regarding pulmonary rehabilitation in this group. In this study, we present clinical evidence regarding the impact of a comprehensive pulmonary rehabilitation program in elderly hip fracture patients after hip surgery.We designed a nonrandomized, Quasi-experimental study, comparing 2 sequential time periods in the same center...
August 2018: Medicine (Baltimore)
Longling Li, Changqing Li
Objective This study was performed to evaluate the potential predictors of poor outcomes associated with diabetes-specific microvascular pathologies and to analyze their influence on clinical outcomes by adjusting for other well-known prognostic factors in patients with acute ischemic stroke. Methods We analyzed 1389 consecutive adult patients with acute ischemic stroke and explored the relationship among clinical characteristics, laboratory measurements, imaging findings, and 6-month functional outcomes. Results The final study population comprised 216 patients with both acute ischemic stroke and diabetes mellitus who were followed up for 6 months...
August 2018: Journal of International Medical Research
Jaya Prasad Tripathy
Background: Diabetes, hyperglycemia, and their complications are a growing problem in India. However, no comprehensive picture of this disease burden has yet been presented to date. Methods: I used aggregate data from the Global Burden of Disease 2016 to describe the burden of diabetes and its risk factors, chronic kidney disease (CKD) due to diabetes, and diseases caused by high fasting plasma glucose from 1990 to 2016 in India. Results: Deaths due to diabetes accounted for 3...
2018: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
Zhi-Xin Huang, Qi-Zhang Wang, Ying-Yi Dai, Hai-Ke Lu, Xiao-Yu Liang, Huan Hu, Xin-Tong Liu
BACKGROUND: To investigate whether endovascular therapy (EVT) was one of the factors influencing the incidence of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) as compared with intravenous thrombolysis alone. METHODS: This study was based on our single-center's database that included information on stroke patients hospitalised between January 2012 and September 2015. A total of 220 patients who underwent EVT after IV rt-PA, EVT or IV rt-PA alone...
August 7, 2018: Journal of the Chinese Medical Association: JCMA
Manuel Navarro-Oviedo, Carmen Roncal, Agustina Salicio, Miriam Belzunce, Obdulia Rabal, Estefanía Toledo, Beatriz Zandio, Jose A Rodríguez, Jose A Páramo, Roberto Muñoz, Josune Orbe
Diabetes is an important risk factor for ischemic stroke (IS). Tissue-type plasminogen activator (tPA) has been associated with less successful revascularization and poor functional outcome in diabetes. We assessed whether a new thrombolytic strategy based on MMP10 was more effective than tPA in a murine IS model of streptozotocin (STZ)-induced diabetes. Wild-type mice were administered a single dose of streptozotocin (STZ) (180 mg/kg) to develop STZ-induced diabetes mellitus. Two weeks later, IS was induced by thrombin injection into the middle cerebral artery and the effect of recombinant MMP10 (6...
July 27, 2018: Translational Stroke Research
Simona Lattanzi, Mauro Silvestrini
In this issue of the European Journal of Neurology, the study by Dr. Zhang et al. explored the association between chronic hyperglycemia and either hemorrhagic transformation (HT) or short-term outcome in patients with acute anterior stroke [1]. In a cohort of 426 patients, they found that higher levels of glycosylated hemoglobin (HbA1c) measured in the morning after hospitalization were independently associated with an increased risk of HT, after the adjustment for the potential confounding effects of diabetes mellitus, admission and fasting blood glucose, thrombolytic treatment, stroke etiology, infarct volume and neurological deficit...
July 20, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Mayada Issa, Fahad Alqahtani, Chalak Berzingi, Mohammad Al-Hajji, Tatiana Busu, Mohamad Alkhouli
Background: Acute hyperglycemia is associated with worse outcomes in diabetic patients admitted with ST-elevation myocardial infarction (STEMI). However, the impact of full-scale decompensated diabetes on STEMI outcomes has not been investigated. Methods: We utilized the national inpatient sample (2003-2014) to identify adult diabetic patients admitted with STEMI. We defined decompensated diabetes as the presence of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS)...
2018: Diabetology & Metabolic Syndrome
Claire Muller, N Wah Cheung, Helen Dewey, Leonid Churilov, Sandy Middleton, Vincent Thijs, Elif I Ekinci, Chris Levi, Richard Lindley, Geoffrey Donnan, Mark Parsons, Christopher Bladin
Rationale Post-stroke hyperglycemia occurs in up to 50% of patients presenting with acute ischemic stroke. It reduces the efficacy of thrombolysis, increases infarct size, and worsens clinical outcomes. Insulin-based therapies have generally not been beneficial in treating post-stroke hyperglycemia as they are difficult to implement, may cause hypoglycaemia, possibly increase mortality and worsen clinical outcomes. Exenatide may be a safer, simpler, and more effective alternative to insulin in acute ischemic stroke...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Shigen Kasakura, Takahisa Mori, Noriyoshi Nakai, Yuhei Tanno, Kazuhiro Yoshioka
Severe hyperglycemia often occurs when acute stroke patients receive enteral tube feeding. Hyperglycemia should be managed because it adversely affects stroke outcome. However, it remains unclear how blood glucose level (BGL) changes with enteral nutrition in acute stroke patients. Our purpose was to investigate features of the blood glucose curve in acute stroke patients receiving enteral feeding. We retrospectively evaluated acute stroke patients who developed hyperglycemia during enteral tube feeding and underwent CGM in our institution...
July 2018: Brain and Nerve, Shinkei Kenkyū No Shinpo
Chien-Hung Lin, Christopher J B Nicol, Yi-Chuan Cheng, Shiang-Jiuun Chen, Chia-Hui Yen, Rong-Nan Huang, Ming-Chang Chiang
Peroxisome proliferator-activated receptor gamma (PPARγ) belongs to a family of ligand-activated nuclear receptors known to regulate many crucial physiological and pathological conditions. Indeed, altered PPARγ transcriptional activity contributes to metabolic syndromes (obesity and hyperglycemia associated with type 2 diabetes mellitus), stroke and neurodegenerative diseases. Various studies suggest that PPARγ agonists influence neuronal deficits in Alzheimer's Disease (AD) patients and rodent models of AD...
June 28, 2018: Experimental Cell Research
G Zhang, M He, Y Xu, X Li, Z Cai, Z Guo, P Meng, N Ji, X He, L Pang
BACKGROUND AND PURPOSE: Hemorrhagic transformation (HT) is a major complication of acute ischaemic stroke that is potentially related to clinical deterioration. The objective of this study was to assess whether chronic hyperglycemia is a predictive factor of HT in patients with acute anterior stroke. METHODS: Patients with acute anterior stroke were included in this study. Hemoglobin A1c (HbA1c) was measured in the morning after hospitalization. HT was detected by computed tomography scans or gradient echo magnetic resonance imaging performed 4 (±2) days after onset...
June 29, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Seong-Joon Lee, Yang-Ha Hwang, Ji Man Hong, Jin Wook Choi, Bok Seon Yoon, Dong-Hun Kang, Yong-Won Kim, Yong-Sun Kim, Jeong-Ho Hong, Joonsang Yoo, Chang-Hyun Kim, Bruce Ovbiagele, Andrew M Demchuk, Sung-Il Sohn, Jin Soo Lee
We evaluated the effects of admission hyperglycemia with different cut-off levels on 3-month outcomes, infarct growth, and hemorrhagic transformation in acute stroke patients with large artery occlusion of anterior circulation who received endovascular treatment (EVT). Between January 2011 and May 2016, patients that underwent EVT with pre-procedural and post-procedural diffusion-weighted imaging were identified from a multicenter registry. Normoglycemia was defined as a glucose level ≤ 110 mg/dL, moderate hyperglycemia as >110 and ≤170 mg/dL, and overt hyperglycemia as >170 mg/dL...
June 29, 2018: Scientific Reports
Kenichi Sakuta, Takeo Sato, Teppei Komatsu, Kenichiro Sakai, Yuka Terasawa, Hidetaka Mitsumura, Yasuyuki Iguchi
BACKGROUND AND PURPOSE: Early hematoma expansion (HE) is not rare in intracerebral hemorrhage (ICH) patients, but detecting those patients with high risk of HE is challenging. The aim of this retrospective study was to investigate the factors associated with HE in acute ICH patients, and to develop a simple predictive scale for HE. METHODS: We retrospectively reviewed consecutive patients with primary ICH, who received an initial non-contrast computed tomography (CT) scan within 24hours from symptom onset...
June 26, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Guang-Dong Lu, Zi-Qi Ren, Jin-Xing Zhang, Qing-Quan Zu, Hai-Bin Shi
BACKGROUND: We performed a meta-analysis to evaluate the outcomes of acute ischemic stroke (AIS) in patients treated with mechanical thrombectomy (MT), according to diabetes mellitus and admission glucose level (AGL). METHODS: We systematically reviewed previous studies in PubMed that reported outcomes of MT in AIS patients and their relationships with diabetes mellitus or AGL. We used functional independence (modified Rankin score ≤ 2 at 3 months) as the primary end point...
June 26, 2018: Neurocritical Care
Estelle Everett, Nestoras Mathioudakis
PURPOSE OF REVIEW: Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control. RECENT FINDINGS: Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications...
June 16, 2018: Current Diabetes Reports
Lei Gong, Anatol Manaenko, Ruiming Fan, Lei Huang, Budbazar Enkhjargal, DevinW McBride, Yan Ding, Jiping Tang, Xiaoqiu Xiao, John H Zhang
Acute intracerebral hemorrhage (ICH) complicated by hyperglycemia is associated with aggravation of post-stroke inflammation, leading to exacerbation of brain edema and predicting poor neurological outcomes and higher mortality of patients. Osteopontin (OPN) is a neuroprotective glycoprotein, which is able to attenuate brain injury induced by hemorrhagic stroke. In the current study we investigated whether OPN will decrease the inflammatory post-ICH response as well as attenuate brain edema and neurological deficits in hyperglycemic rats...
August 2018: Neuropharmacology
Hanfei Tang, Mengjiao Zhu, Gefei Zhao, Weiguo Fu, Zhenyu Shi, Yong Ding, Xiao Tang, Daqiao Guo
BACKGROUND AND AIMS: Carotid atherosclerotic plaque is one of the main sources of ischemic stroke, and endothelial-to-mesenchymal transition (EndMT) is a major feature of atherosclerosis. Rho-associated coiled-coil-containing protein kinase 1 (ROCK1) activation, stimulated by high glucose, plays an important role in EndMT, and circadian locomotor output cycles protein kaput (Clock) deficiency leads to hyperglycemia and enhanced atherosclerosis in ClockΔ19/Δ19 apolipoprotein E (ApoE)-/- mice...
May 24, 2018: Atherosclerosis
Yoshiaki Shimada, Hideki Shimura, Ryota Tanaka, Kazuo Yamashiro, Masato Koike, Yasuo Uchiyama, Takao Urabe, Nobutaka Hattori
Loss of integrity of the blood-brain barrier (BBB) in ischemic stroke victims initiates a devastating cascade of events causing brain damage. Maintaining the BBB is important to preserve brain function in ischemic stroke. Unfortunately, recombinant tissue plasminogen activator (tPA), the only effective fibrinolytic treatment at the acute stage of ischemic stroke, also injures the BBB and increases the risk of brain edema and secondary hemorrhagic transformation. Thus, it is important to identify compounds that maintain BBB integrity in the face of ischemic injury in patients with stroke...
2018: PloS One
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