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B Sunil Abhishek, Anupam Bhambhani
Ischaemic stroke is among the leading causes of disability and death. Despite extensive vascular, cardiac and serological evaluations, the cause remains unknown in 20%-40% of patients. These are classified as cryptogenic stroke. Paradoxical embolism is one of the many causes of cryptogenic stroke. The term paradoxical embolism is used to describe an embolus of venous origin entering the systemic circulation through a patent foramen ovale (PFO), atrial septal defect (ASD), ventricular septal defect or extracardiac communication such as pulmonary arteriovenous malformation...
September 2017: National Medical Journal of India
Ayman Elbadawi, Kirolos Barssoum, Ahmed S Abuzaid, Ahmed Rezq, Nishit Biniwale, Erfan Alotaki, Ahmed H Mohamed, Sowjanya Vuyyala, Gbolahan O Ogunbayo, Marwan Saad
BACKGROUND: The role of percutaneous patent foramen ovale (PFO) closure for prevention of migraine is controversial. METHODS: We performed a computerised search of MEDLINE, EMBASE and COCHRANE databases through December 2017 for randomised trials evaluating PFO closure versus control in patients with migraine headaches (with or without aura). The main study outcome was the reduction in monthly migraine attacks after PFO closure compared with the control group. RESULTS: The final analysis included three randomised trials with a total of 484 patients...
June 18, 2018: Acta Cardiologica
Guillaume Turc, David Calvet, Patrice Guérin, Marjorie Sroussi, Gilles Chatellier, Jean-Louis Mas
BACKGROUND: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing patent foramen ovale (PFO) closure, anticoagulation, and antiplatelet therapy to prevent stroke recurrence in patients with PFO-associated cryptogenic stroke. METHODS AND RESULTS: We searched Medline, Cochrane Library, and EMBASE through March 2018. The primary outcome was stroke recurrence. Pooled incidences, hazard ratios, and risk ratios (RRs) were calculated in random-effects meta-analyses...
June 17, 2018: Journal of the American Heart Association
Markus Reinthaler, Ann-Kathrin Ozga, David Sinning, Jonathan Curio, Haitham S Al-Hindwan, Johan Bäckemo Johansson, Friedrich Jung, Andreas Lendlein, Geraldine Rauch, Ulf Landmesser
BACKGROUND: Transcatheter foramen ovale closure (TPC) has emerged as a potential treatment option for patients with cryptogenic strokes and persistent foramen ovale (PFO). However, previous randomized controlled trials could hardly demonstrate any benefit compared to medical treatment (Med-Tx). Recently new data have become available which may change current practice of transcatheter PFO closure. METHODS: A systematic review and meta-analysis comparing TPC and Med-Tx based on all available multicentric randomized controlled trials was performed...
July 2018: American Heart Journal
Péter Böjti, Noémi Eszter Bartha, Zsolt May, Dániel Bereczki, Szilvia Fülöp, Zoltán Szakács, Géza Szilágyi
Background and purpose: After routine workup, 23-25% of ischemic strokes etiology remains unknown, i.e. cryptogenic. However, according to international results pathogenic patent foramen ovale (PFO) reveals in 25% of these cases. Aim of our retrospective study to prove the substantial etiological role of PFO-related stroke (PFO-RS) in cryptogenic strokes (CS), and to identify age related differences in stroke etiology. Methods: All new ischemic strokes of 2014-2015 were classified by ASCOD (Atherosclerosis, Small-vessel disease, Cardiac pathology, Other, Dissection) phenotyping...
May 30, 2018: Ideggyógyászati Szemle
Vincenzo Pasceri, Francesco Pelliccia, Edoardo Bressi, Ludmilla Mantione, Carlo Gaudio, Giulio Speciale, Roxana Mehran, George D Dangas, Giuseppe Patti
BACKGROUND: Controlled randomized trials (CRTs) comparing the efficacy of patent foramen ovale (PFO) closure and medical therapy in patients with cryptogenic stroke have yielded heterogeneous results. No data are available on the net clinical benefit with the two strategies. METHODS: We pooled data of 3440 patients enrolled in five CRTs, randomized to PFO closure (n = 1829) or medical therapy (n = 1611) and followed for a mean of 4.1 years. RESULTS: The net composite endpoint of stroke, major bleeding or atrial fibrillation (AF)/flutter was not different among PFO closure and medical therapy (OR 1...
September 1, 2018: International Journal of Cardiology
Sara Mazzucco, Linxin Li, Lucy Binney, Peter M Rothwell
BACKGROUND: Percutaneous closure of patent foramen ovale (PFO) has been shown to be superior to medical treatment alone for prevention of recurrent stroke after cryptogenic transient ischaemic attack or non-disabling stroke in patients aged 60 years or younger. The justification for trials in older patients with transient ischaemic attack or stroke depends on whether PFO is shown to be associated with cryptogenic events at older ages, for which existing evidence is conflicting, and on the population burden of PFO-associated events...
June 6, 2018: Lancet Neurology
Ashish H Shah, Mark Osten, Lee Benson, Sami Alnasser, Yvonne Bach, Rohan Vishwanath, Alex Van De Bruaene, Healey Shulman, Jeneka Navaranjan, Rafique Khan, Eric Horlick
OBJECTIVES: The aim of this study was to assess the incidence of persistently positive results on agitated saline contrast injection after patent foramen ovale (PFO) closure, the underlying mechanism, and management. BACKGROUND: Transcatheter intervention to close a PFO is reasonable in highly selected patients younger than 60 years, after a thorough cardioneurological investigation following a cryptogenic stroke, particularly in the presence of thromboembolic disease or in patients at high risk for venous thrombosis...
June 11, 2018: JACC. Cardiovascular Interventions
Hamidreza Saber, Mohan Palla, Shaghayegh Kazemlou, Mahmoud R Azarpazhooh, Navid Seraji-Bozorgzad, Réza Behrouz
OBJECTIVE: To compare the outcomes of patent foramen ovale (PFO) closure vs antiplatelet agent (APA) vs oral anticoagulation therapy (OAT) for secondary prevention of stroke in patients with cryptogenic stroke, using direct and indirect evidence from existing randomized data. METHODS: Relevant randomized controlled trials were identified by a systematic review. The efficacy outcome was stroke recurrence, and safety outcomes were atrial fibrillation and bleeding complications at the end of follow-up...
June 6, 2018: Neurology
Georgios Tsivgoulis, Aristeidis H Katsanos, Dimitris Mavridis, Alexandra Frogoudaki, Agathi-Rosa Vrettou, Ignatios Ikonomidis, John Parissis, Spyridon Deftereos, Theodore Karapanayiotides, Lina Palaiodimou, Angeliki Filippatou, Fabienne Perren, Georgios Hadjigeorgiou, Anne W Alexandrov, Panayiotis D Mitsias, Andrei V Alexandrov
OBJECTIVE: Current guidelines report no benefit for patent foramen ovale (PFO) closure compared to medical treatment in patients with cryptogenic ischemic stroke (IS) or TIA. Two recent randomized controlled clinical trials have challenged these recommendations. METHODS: We performed a systematic review and network meta-analysis of randomized controlled trials to estimate the safety and efficacy of closure compared to medical treatment, and to compare available devices...
June 6, 2018: Neurology
Dominik M Wiktor, John D Carroll
Controversy has persisted for over a decade whether transcatheter patent foramen ovale (PFO) closure reduces the rate of recurrent ischemic stroke for patients who have had a cryptogenic ischemic stroke and have a PFO. In September 2017, 3 positive randomized trials: RESPECT long-term (Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment trial), REDUCE (GORE® HELEX® Septal Occluder / GORE® CARDIOFORM Septal Occluder and Antiplatelet Medical Management for Reduction of Recurrent Stroke or Imaging-Confirmed TIA in Patients With Patent Foramen Ovale [PFO]), and CLOSE (Patent Foramen Ovale Closure or Anticoagulants Versus Antiplatelet Therapy to Prevent Stroke Recurrence) were published...
March 2018: Circulation. Cardiovascular Interventions
Armando Perrotta, Stefano Gambardella, Anna Ambrosini, Maria Grazia Anastasio, Veronica Albano, Francesco Fornai, Francesco Pierelli
We describe the case of one patient with pure sporadic hemiplegic migraine (SHM) with a novel ATP1A2 gene variant and a large patent foramen ovale (PFO) with atrial septal aneurysm. In hemiplegic migraine (HM), the relationship between incomplete penetrance, environmental triggers, and phenotypic expression is underdetermined. A genetic evaluation of the proband was requested for the HM associated genes and extended to the members of his family. Genetic analysis revealed a never described before ATP1A2 gene mutation, inherited by his father, who never experienced motor aura but only typical visual aura...
2018: Frontiers in Neurology
Vinita Jagannath, Miriam Gerstenberg, Susanne Walitza, Maurizia Franscini, Karsten Heekeren, Wulf Rössler, Anastasia Theodoridou, Edna Grünblatt
Little is known about valid predictive markers for functional outcomes in an at-risk for psychosis population. In a cohort of 185 individuals (age: 13-35 years) at high risk (HR) and ultra-high risk (UHR), we assessed pan-NRG1 mRNA levels across good functional status (GFS) and poor functional status (PFS) at baseline, and good functional outcome (GFO) and poor functional outcome (PFO) at 12-month follow-up. NRG1 mRNA levels were significantly higher in individuals with PFO than individuals with GFO at 12-month follow-up...
May 17, 2018: Psychiatry Research
Luigi Vetrugno, Federico Barnariol, Elena Bignami, Grazia D Centonze, Adelisa De Flaviis, Federico Piccioni, Elisabetta Auci, Tiziana Bove
The first perioperative transesophageal echocardiography (TEE) guidelines published 21 years ago were mainly addressed to cardiac anesthesiologists. TEE has since expanded its role outside this setting and currently represents an invaluable tool to assess chamber sizes, ventricular hypertrophy, and systolic, diastolic, and valvular function in patients undergoing orthotopic liver transplantation (OLT). Right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) are the most common intra-operative findings described during OLT...
June 2, 2018: Echocardiography
Huiyun Yang, Haijun Wang, Chengyi Xiong, Yaqin Chai, Ruo Yuan
In this work, poly[9,9-dioctylfluorenyl-2,7-diyl] (PFO) dots is discovered to display an appealing dual enhancement effect for the electrochemiluminescence (ECL) system of N-(aminobutyl)-N-(ethylisoluminol)/hydrogen peroxide (ABEI/H2 O2 ), which not only enhances the ECL intensity of ABEI but also catalyzes decomposition of H2 O2 to further amplify the ECL signal of ABEI. Owing to the electronegative property of PFO dots, electropositive ABEI-PEI as ECL reagent could be adsorbed on their surface and thus form a novel luminescence emitter (ABEI-PEI-PFO dots) with high ECL efficiency based on electrostatic attraction...
May 22, 2018: Biosensors & Bioelectronics
Oliver J Chrzanowski-Smith, Robert M Edinburgh, James A Betts, Keith A Stokes, Javier T Gonzalez
The maximal capacity to utilise fat (peak fat oxidation [PFO]) may have implications for health and ultra-endurance performance, and is commonly determined by incremental exercise tests employing 3-minute stages. However, 3-minute stages may be insufficient to attain steady-state gas kinetics, compromising test validity. We assessed whether 4-minute stages produce steady-state gas exchange and reliable PFO in adults with V̇O<sub>2</sub>peak <40 ml·kg<sup>-1</sup>·min<sup>-1</sup>...
May 31, 2018: Applied Physiology, Nutrition, and Metabolism, Physiologie Appliquée, Nutrition et Métabolisme
Anna Isakova, Safakath Karuthedath, Thomas Arnold, Jonathan R Howse, Paul D Topham, Daniel T W Toolan, Frédéric Laquai, Larry Lüer
In bulk heterojunction donor-acceptor (D-A) blends, high photovoltaic yields require charge carrier separation to outcompete geminate recombination. Recently, evidence for long-range electron transfer mechanisms has been presented, avoiding strongly-bound interfacial charge transfer (CT) states. However, due to the lack of specific optical probes at the D-A interface, a detailed quantification of the long-range processes has not been feasible, until now. Here, we present a transient absorption study of long-range processes in a unique phase consisting of perylene diimide (PDI) crystals intercalated with polyfluorene (PFO), as a widely used non-fullerene electron acceptor and donor, respectively...
May 31, 2018: Nanoscale
Di Qin, Wei Chen, Juan Wang, Hongzhi Lv, Wenhui Ma, Tianhua Dong, Yingze Zhang
Objectives This study was performed to explore the mechanism of proximal fibular osteotomy (PFO) for treatment of medial compartment knee osteoarthritis (OA) and evaluate the relevant factors influencing the treatment outcome. Methods Fifty-two patients with medial compartment knee OA with varus deformities were prospectively selected. Radiographs were obtained preoperatively and postoperatively. Knee function and OA severity were evaluated using the Hospital for Special Surgery (HSS) knee score and the Kellgren-Lawrence (KL) score...
January 1, 2018: Journal of International Medical Research
Lohit Garg, Affan Haleem, Shweta Varade, Keithan Sivakumar, Mahek Shah, Brijesh Patel, Manyoo Agarwal, Sahil Agrawal, Megan Leary, Bryan Kluck
BACKGROUND: The clinical benefit of patent foramen ovale (PFO) closure after cryptogenic stroke has been a topic of debate for decades. Recently, 3 randomized controlled trials of PFO closure in patients with cryptogenic stroke demonstrated a significantly reduced risk of recurrent stroke compared with standard medical therapy alone. This meta-analysis was performed to clarify the efficacy of PFO closure for future stroke prevention in this population. METHODS: A systematic literature search was undertaken...
May 24, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
X Q Li, P Yuan, W J Ma, G Z Liu
Objective: To investigate the pathogenesis of young and middle-aged stroke patients with patent foramen ovale (PFO) by analyzing clinical characteristics. Methods: Data of 298 consecutive young and middle-aged patients diagnosed as stroke were retrospectively collected from Department of Neurology, Beijing Anzhen Hospital from January 2010 to January 2017.Patients were divided into cryptogenic stroke (CS) group and not-CS group.Risk factors, characteristics of PFO and infarct of imaging were analyzed between two groups...
May 22, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
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