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Hemorrhagic transformation

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https://www.readbyqxmd.com/read/28726570/potential-biomarkers-for-predicting-hemorrhagic-transformation-of-ischemic-stroke
#1
Guanfeng Lu, Quanwei He, Yan Shen, Fei Cao
Reperfusion therapy contributes to better clinical outcomes in patients with acute ischemic stroke but carries a more significant risk of hemorrhagic transformation (HT) compared to supportive care. Once HT occurs, the outcome is usually poor and this causes a dilemma in the treatment of ischemic stroke. Consequently, early prediction of HT would be extremely helpful for guiding precise treatment of ischemic stroke. In this review, we focus on summarizing biomarkers of HT and elucidating possible mechanisms so as to identify potential biomarkers for predicting HT...
July 20, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28726167/early-increased-bradykinin-1-receptor-contributes-to-hemorrhagic-transformation-after-ischemic-stroke-in-type-1-diabetic-rats
#2
Hongfei Sang, Zhongming Qiu, Jin Cai, Wenya Lan, Linjie Yu, Hao Zhang, Min Li, Yi Xie, Ruibing Guo, Ruidong Ye, Xinfeng Liu, Ling Liu, Renliang Zhang
Hemorrhagic transformation (HT) is a major complication of ischemic stroke and further deteriorates neurological outcomes. Bradykinin 1 receptor (B1R) has been proven to mediate vasculo-toxicity in various experimental models. However, its role in the development of HT after stroke remains unclear. We detected the B1R expression in brain tissues with or without HT in a rat model of cerebral ischemia/reperfusion (I/R) with type 1 diabetes, showing higher B1R expression in the hemorrhagic areas than the ischemic tissues...
July 19, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28714410/management-of-blood-pressure-and-heart-rate-in-patients-with-acute-stroke
#3
Carlo Maida, Antonino Tuttolomondo, Domenico Di Raimondo, Antonio Pinto
BACKGROUND: Stroke represent one of the most devastating of all neurological diseases, affecting about 15 million people per year and is an important cause of morbidity and mortality worldwide and currently the leading cause of adult disability in developed countries. Blood pressure and heart rate may undergo several modifications in patients with both ischemic and hemorrhagic stroke in fact raised blood pressure levels may lead to cerebral edema, hematoma expansion or hemorrhagic transformation and in contrast low blood pressure can lead to increased cerebral infarction or perihematomal ischemia...
July 14, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28705822/focal-low-and-global-high-permeability-predict-the-possibility-risk-and-location-of-hemorrhagic-transformation-following-intra-arterial-thrombolysis-therapy-in-acute-stroke
#4
Y Li, Y Xia, H Chen, N Liu, A Jackson, M Wintermark, Y Zhang, J Hu, B Wu, W Zhang, J Tu, Z Su, G Zhu
BACKGROUND AND PURPOSE: The contrast volume transfer coefficient (K(trans)), which reflects blood-brain barrier permeability, is influenced by circulation and measurement conditions. We hypothesized that focal low BBB permeability values can predict the spatial distribution of hemorrhagic transformation and global high BBB permeability values can predict the likelihood of hemorrhagic transformation. MATERIALS AND METHODS: We retrospectively enrolled 106 patients with hemispheric stroke who received intra-arterial thrombolytic treatment...
July 13, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28665168/cerebral-hyperperfusion-on-arterial-spin-labeling-mri-after-reperfusion-therapy-is-related-to-hemorrhagic-transformation
#5
Shuhei Okazaki, Hiroshi Yamagami, Takeshi Yoshimoto, Yoshiaki Morita, Haruko Yamamoto, Kazunori Toyoda, Masafumi Ihara
Early detection of hemorrhagic transformation after reperfusion therapy is crucial in acute stroke treatment. Here, we evaluated the relationship between hemorrhagic transformation and post-reperfusion hyperperfusion using pulsed arterial spin labeling (ASL) perfusion MRI and (123)I-iodoamphetamine single-photon emission-computed tomography. Patients who developed hemorrhagic transformation showed significantly higher cerebral blood flow in the affected lesion after thrombolysis and/or endovascular intervention...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28660209/intravenous-thrombolysis-in-acute-ischemic-stroke-with-active-cancer
#6
Ki-Woong Nam, Chi Kyung Kim, Tae Jung Kim, Sang Joon An, Kyungmi Oh, Sang-Bae Ko, Byung-Woo Yoon
Ischemic stroke patients with active cancer are known to have poor clinical outcomes. However, the efficacy and safety of intravenous alteplase (IV t-PA) in this group are still unclear. In this study, we aimed to evaluate whether stroke patients with cancer had poor clinical outcomes after use of IV t-PA. We reviewed ischemic stroke patients with active cancer treated with isolated IV t-PA between April 2010 and March 2015 at three national university hospitals from the registry for ischemic stroke in Korea...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28659427/effects-of-increasing-iv-tpa-treated-stroke-mimic-rates-at-ct-based-centers-on-clinical-outcomes
#7
Tina M Burton, Marie Luby, Zurab Nadareishvili, Richard T Benson, John K Lynch, Lawrence L Latour, Amie W Hsia
OBJECTIVE: To determine to what degree stroke mimics skew clinical outcomes and the potential effects of incorrect stroke diagnosis. METHODS: This retrospective analysis of data from 2005 to 2014 included IV tissue plasminogen activator (tPA)-treated adults with clinical suspicion for acute ischemic stroke who were transferred or admitted directly to our 2 hub hospitals. Primary outcome measures compared CT-based spoke hospitals' and MRI-based hub hospitals' mimic rates, hemorrhagic transformation, follow-up modified Rankin Scale (mRS), and discharge disposition...
June 28, 2017: Neurology
https://www.readbyqxmd.com/read/28655834/risk-for-major-bleeding-in-patients-receiving-ticagrelor-compared-with-aspirin-after-tia-or-acute-ischemic-stroke-in-the-socrates-study
#8
J Donald Easton, Maria Aunes, Gregory W Albers, Pierre Amarenco, Sara Bokelund Singh, Hans Denison, Scott R Evans, Peter Held, Marianne Jahreskog, Jenny Jonasson, Kazuo Mimematsu, Carlos A Molina, Yongjun Wang, K S Lawrence Wong, S Claiborne Johnston
Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial was the first trial with ticagrelor in patients with AIS or TIA, in which the efficacy and safety of ticagrelor were compared with aspirin. The main safety objective was assessment of PLATO-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH)...
June 27, 2017: Circulation
https://www.readbyqxmd.com/read/28646445/update-on-neurocritical-care-of-stroke
#9
Jason Siegel, Michael A Pizzi, J Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L Brown, David Hodge, W David Freeman
PURPOSE OF REVIEW: This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit. RECENT FINDINGS: New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations...
August 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28641541/-stress-is-80-years-old-from-hans-selye-original-paper-in-1936-to-recent-advances-in-gi-ulceration
#10
Sandor Szabo, Masashi Yoshida, Janos Filakovszky, Gyorgy Juhasz
The first scientific publication on 'general adaption syndrome', or as we know today 'biologic stress' has been published in Nature in 1936 by the 29-year old Hans Selye. His results in that short publication that contained no references or illustrations, were based on experiments in rats that were exposed to severe insults/stressors, but his idea about a 'nonspecific bodily response' originated from his observations of sick patients whom he had seen as a medical students and young clinician. Autopsy of stressed rats revealed three major, grossly visible changes: hyperemia and enlargement of the adrenals, atrophy of the thymus and lymph nodes as well as hemorrhagic gastric erosions/ulcers (the "stress triad")...
June 22, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28624051/persistent-injury-associated-anemia-the-role-of-the-bone-marrow-microenvironment
#11
Jessica K Millar, Kolenkode B Kannan, Tyler J Loftus, Ines G Alamo, Jessica Plazas, Philip A Efron, Alicia M Mohr
BACKGROUND: The regulation of erythropoiesis involves hematopoietic progenitor cells, bone marrow stroma, and the microenvironment. Following severe injury, a hypercatecholamine state develops that is associated with increased mobilization of hematopoietic progenitor cells to peripheral blood and decreased growth of bone marrow erythroid progenitor cells that manifests clinically as a persistent injury-associated anemia. Changes within the bone marrow microenvironment influence the development of erythroid progenitor cells...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28614145/non-human-primate-rhesus-macaque-models-of-severe-pressure-targeted-hemorrhagic-and-poly-traumatic-hemorrhagic-shock
#12
Forest R Sheppard, Antoni R Macko, Jacob J Glaser, Philip J Vernon, Alexander J Burdette, R Madelaine Paredes, Craig A Koeller, Anthony E Pusateri, Douglas K Tadaki, Sylvain Cardin
BACKGROUND: We endeavored to develop clinically translatable non-human primate (NHP) models of severe poly-traumatic hemorrhagic shock. METHODS: NHPs were randomized into five pressure-targeted severe hemorrhagic shock (PTHS) ± additional injuries scenarios: 30-min PTHS (PTHS-30), 60-min PTHS (PTHS-60), PTHS-60 + soft tissue injury (PTHS-60+ST), PTHS-60+ST + femur fracture (PTHS-60+ST+FF) and decompensated PTHS+ST+FF (PTHS-D). Physiologic parameters were recorded and blood samples collected at five time points with animal observation through T = 24hrs...
June 13, 2017: Shock
https://www.readbyqxmd.com/read/28600481/optimal-thresholds-for-ischemic-penumbra-predicted-by-computed-tomography-perfusion-in-patients-with-acute-ischemic-stroke-treated-with-mechanical-thrombectomy
#13
Katsuharu Kameda, Junji Uno, Ryosuke Otsuji, Nice Ren, Shintaro Nagaoka, Kazushi Maeda, Yoshiaki Ikai, Hidefuku Gi
BACKGROUND AND PURPOSE: Optimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT). METHODS: A total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel...
June 9, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28586933/a-case-of-pituitary-carcinoma-initially-diagnosed-as-an-ectopic-growth-hormone-producing-pituitary-adenoma-with-a-high-ki-67-labeling-index
#14
Toshiki Endo, Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga
We report a case of a 66-year-old woman with a malignant transformation of a growth hormone (GH)-producing pituitary adenoma that was mainly located in the clivus. The patient originally presented with left oculomotor and abducens nerve palsies. Magnetic resonance imaging revealed a clival tumor separated from the normal pituitary gland, and the patient subsequently underwent transsphenoidal surgery. Analysis of the resected clival tissue revealed proliferation of tumor cells with slightly irregular nuclei but no mitosis...
June 6, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28585903/dabigatran-following-acute-transient-ischemic-attack-and-minor-stroke-ii-datas-ii
#15
Kuan H Ng, Mukul Sharma, Oscar Benavente, Laura Gioia, Thalia S Field, Michael D Hill, Shelagh B Coutts, Kenneth Butcher
Rationale Patients with transient ischemic attack or minor stroke are at high risk of early recurrent cerebrovascular events. Anticoagulation with heparin or warfarin acutely after ischemic stroke is at least as efficacious as aspirin for preventing recurrent events but is associated with an increased risk of clinical worsening due to hemorrhagic transformation. Aim and hypothesis We aim to demonstrate the safety of early anticoagulation with dabigatran, an oral direct thrombin inhibitor, in acute cerebrovascular syndrome patients...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28580853/-hungarian-philadelphia-negative-chronic-myeloproliferative-neoplasia-registry-evaluation-of-the-polycythemia-vera-patients
#16
Péter Dombi, Árpád Illés, Judit Demeter, Lajos Homor, Zsófia Simon, Ádám Kellner, Éva Karádi, Erika Valasinyószki, Miklós Udvardy, Miklós Egyed
Intruduction and aim: The Hungarian National Registry for Philadelphia chromosome negative myeloproliferative neoplasms has been developed. The aim of the recent study is to assess the clinical characteristics of Hungarian patients with polycythemia vera. METHOD: Data of 351 JAK2(V617F) and exon 12 mutation positive polycythemia vera patients were collected online from 15 haematology centres reporting epidemiologic, clinical characteristics, diagnostic tools, therapeutic interventions, thromboembolic complications, disease transformations...
June 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28580536/annexin-a2-plus-low-dose-tissue-plasminogen-activator-combination-attenuates-cerebrovascular-dysfunction-after-focal-embolic-stroke-of-rats
#17
Xiang Fan, Yinghua Jiang, Zhanyang Yu, Qi Liu, Shuzhen Guo, Xiaochuan Sun, Klaus van Leyen, MingMing Ning, Xiumei Gao, Eng H Lo, Xiaoying Wang
Previous studies showed recombinant annexin A2 (rA2) in combination with low-dose tissue-type plasminogen activator (tPA) improved thrombolytic efficacy and long-term neurological outcomes after embolic focal ischemia in rats. The objective of this study was to investigate the effects and mechanisms of the combination in early BBB integrity and cerebrovascular patency in the rat focal embolic stroke model. Ischemic brain infarct volume and hemorrhagic transformation were quantified at 24 h after stroke. At an earlier time point, 16 h after stroke, BBB integrity was evaluated by IgG extravasation, and the involved mechanisms were assessed for tight junction ZO-1 and adhesion junction ve-cadherin protein expression, matrix metalloproteinase activation, extracellular matrix collagen IV and endothelial barrier antigen expression, and activation of microglia/macrophages and astrocytes...
June 4, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28572721/outcome-of-stroke-patients-receiving-different-doses-of-recombinant-tissue-plasminogen-activator
#18
Cheung-Ter Ong, Yi-Sin Wong, Chi-Shun Wu, Yu-Hsiang Su
BACKGROUND AND PURPOSE: Intravenous recombinant tissue plasminogen activator (tPA) at a dose of 0.9 mg/kg body weight is associated with a high hemorrhagic transformation (HT) rate. Low-dose tPA (0.6 mg/kg) may have a lower hemorrhage rate but the mortality and disability rates at 90 days cannot be confirmed as non-inferior to standard-dose tPA. Whether the doses 0.7 and 0.8 mg/kg have better efficacy and safety needs further investigation. Therefore, this study is to compare the efficacy and safety of each dose of tPA (0...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28570213/the-university-of-toronto-s-lasting-contribution-to-war-surgery-how-maj-l-bruce-robertson-fundamentally-transformed-thinking-toward-blood-transfusion-during-the-first-world-war
#19
Abigail Tien, Andrew Beckett, Dylan Pannell
During the Great War, Canadian military surgeons produced some of the greatest innovations to improve survival on the battlefield. Arguably, the most important was bringing blood transfusion practice close to the edge of the battlefield to resuscitate the many casualties dying of hemorrhagic shock. Dr. L. Bruce Robertson of the Canadian Army Medical Corps was the pioneering surgeon from the University of Toronto who was able to demonstrate the benefit of blood transfusions near the front line and counter the belief that saline was the resuscitation fluid of choice in military medicine...
June 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28567456/surgery-for-intractable-pain-in-a-patient-with-chronic-pancreatitis-complicated-with-biliary-obstruction-portal-vein-stenosis-and-mesenteric-venous-collaterals
#20
Cuneyt Kayaalp, Murat Sait Dogan, Veysel Ersan
Pancreatic head resection for chronic pancreatitis is a challenging procedure, in the presence of venous collaterals, cavernous transformation, extensive fibrosis or porto-mesenteric stenosis or thrombosis. We present a surgically treated patient for the intractable pain of chronic pancreatitis. Complications with biliary obstruction and portal vein stenosis/thrombosis resulted in cavernous transformation. A pancreaticoduodenectomy combined with portal vein resection was intended in a 51 year-old male, but the procedure was terminated due to the high risk associated with intraoperative bleeding...
May 2017: Annals of Hepato-Biliary-Pancreatic Surgery
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