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Ischemic stroke randomized

Xin-Yong Zhang, Qi Wan, Dong-Ya Zhu
BACKGROUND Recent studies demonstrated that polymorphisms in the PDE4D gene were associated with several processes involved in the occurrence of ischemic stroke (IS). The association between specific PDE4D single-nucleotide polymorphism 56 (SNP56) and IS risk was initially identified via genome-wide association studies (GWAS), although the GWAS in different populations produced inconclusive results. Thus, we performed a meta-analysis to better explain the association between PDE4D SNP56 and IS risk. MATERIAL AND METHODS A literature search was conducted using PubMed, Embase, and Web of Science up to June 1, 2015...
October 19, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Roderick Wondergem, Martijn F Pisters, Eveline J Wouters, Nick Olthof, Rob A de Bie, Johanna M A Visser-Meily, Cindy Veenhof
BACKGROUND: Stroke is not only an acute disease, but for the majority of patients, it also becomes a chronic condition. There is a major concern about the long-term follow-up with respect to activities of daily living (ADL) in stroke survivors. Some patients seem to be at risk for decline after a first-ever stroke. The purpose of this study was to determine the course of ADL from 3 months after the first-ever stroke and onward and identify factors associated with decline in ADL. METHODS: A systematic literature search of 3 electronic databases through June 2015 was conducted...
October 18, 2016: Cerebrovascular Diseases
Hani Raoul Khouzam
Trazodone is an antidepressant that is FDA-approved for the treatment of depression. It has been used by mental health and primary care providers for the treatment of multiple psychiatric and medical conditions .This review describes trazodone mechanism of action, formulation, dosage and adverse effects and then summarizes the beneficial effects of trazodone in the treatment of various psychiatric and medical conditions such as major depression, as well non-approved FDA indications such as insomnia,anxiety disorders, posttraumatic stress disorder, obsessive compulsive disorder, feeding and eating disorders, substance use disorders, behavioral disturbances associated with cognitive dysfunction, sexual dysfunction, certain pain conditions, and rehabilitation after acute ischemic stroke...
October 17, 2016: Postgraduate Medicine
Verónica V Olavarría, Hisatomi Arima, Craig S Anderson, Alejandro Brunser, Paula Muñoz-Venturelli, Laurent Billot, Pablo M Lavados
BACKGROUND: The HEADPOST Pilot is a proof-of-concept, open, prospective, multicenter, international, cluster randomized, phase IIb controlled trial, with masked outcome assessment. The trial will test if lying flat head position initiated in patients within 12 h of onset of acute ischemic stroke involving the anterior circulation increases cerebral blood flow in the middle cerebral arteries, as measured by transcranial Doppler. The study will also assess the safety and feasibility of patients lying flat for ≥24 h...
October 14, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Simardeep Gill, Min Jun, Pietro Ravani
The prevalence of atrial fibrillation and the risk of stroke display an age-related increase in the chronic kidney disease (CKD) population. Evidence from large randomized controlled trials conducted in the general population supports the use of anticoagulation to reduce the risk of stroke in the setting of non-valvular atrial fibrillation. However, data in the non-dialysis-dependent and dialysis-dependent CKD populations are limited largely to observational studies, which demonstrate conflicting results regarding the risk-benefit profile of anticoagulation...
October 14, 2016: Nephrology, Dialysis, Transplantation
Yilun Zhou, Yuesong Pan, Yu Wu, Xingquan Zhao, Hao Li, David Wang, S Claiborne Johnston, Liping Liu, Chunxue Wang, Xia Meng, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: Patients with chronic kidney disease (CKD) are at a particularly high risk for ischemic and bleeding events. Limited data exist as to the efficacy and safety of clopidogrel in stroke patients with renal dysfunction. Therefore, we sought to assess the impact of decreased kidney function on clinical outcomes for stroke patients on clopidogrel-aspirin treatment. METHODS: Patients in the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were randomized to clopidogrel-aspirin or aspirin-alone treatment...
October 13, 2016: Stroke; a Journal of Cerebral Circulation
Peter H Jones, Harold E Bays, Umesh Chaudhari, Robert Pordy, Christelle Lorenzato, Kathryn Miller, Jennifer G Robinson
Previous individual trials of alirocumab (a PCSK9 monoclonal antibody) showed significant low-density lipoprotein cholesterol reductions with overall treatment-emergent adverse event (TEAE) rates comparable with controls. This analysis evaluated safety data from 14 trials (4 phase 2 and 10 phase 3, 8 to 104 weeks; n = 5,234), in 2 pools according to control (placebo/ezetimibe). Overall, 3,340 patients received alirocumab (4,029 patient-years' exposure), 1,276 received placebo, and 618 received ezetimibe. Incidence of deaths, serious TEAEs, discontinuations because of TEAEs, and overall TEAEs were similar between alirocumab and control groups...
September 14, 2016: American Journal of Cardiology
Frederick Palm, Pirkko J Pussinen, Annette Aigner, Heiko Becher, Florian Buggle, Matthias F Bauer, Caspar Grond-Ginsbach, Anton Safer, Christian Urbanek, Armin J Grau
BACKGROUND AND AIMS: Infectious diseases contribute to stroke risk, and are associated with socioeconomic status (SES). We tested the hypotheses that the aggregate burden of infections increases the risk of ischemic stroke (IS) and partly explains the association between low SES and ischemic stroke. METHODS: In a case-control study with 470 ischemic stroke patients and 809 age- and sex-matched controls, randomly selected from the population, antibodies against the periodontal microbial agents Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, against Chlamydia pneumonia, Mycoplasma pneumoniae (IgA and IgG), and CagA-positive Helicobacter pylori (IgG) were assessed...
October 5, 2016: Atherosclerosis
Guojian Sun, Bin Luan, Ruiying Zhao, Zhanbiao Li, Zhangmin Xing
The purpose of this study was to introduce a new method to elucidating the molecular mechanisms in ischemic stroke. Genes from microarray data were performed enrichment to biological pathways. Dysregulated pathways and dysregulated pathway pairs were identified and constructed into networks. After Random Forest classification was performed, area under the curve (AUC) value of main network was calculated. After 50 bootstraps of Monte Carlo Cross-Validation, six pairs of pathways were found for >40 times. The best main network with AUC value = 0...
October 11, 2016: DNA and Cell Biology
Naoyuki Uchiyama, Kouichi Misaki, Masanao Mohri, Tomoya Kamide, Yuichi Hirota, Ryo Higashi, Hisato Minamide, Yukihiko Kohda, Takashi Asahi, Katsuo Shoin, Masayuki Iwato, Daisuke Kita, Yoshitaka Hamada, Yuya Yoshida, Mitsutoshi Nakada
Five recent multicenter randomized controlled trials (RCTs) have clearly shown the superiority of mechanical thrombectomy in large vessel occlusion acute ischemic stroke compared to systemic thrombolysis. Although 14 hospitals in Ishikawa prefecture have uninterrupted availability of systemic thrombolysis, mechanical thrombectomy is not available at all of these hospitals. Therefore, we established a Kanazawa mobile embolectomy team (KMET), which could travel to these hospitals and perform the acute reperfusion therapy...
October 11, 2016: Neurologia Medico-chirurgica
Faiçal Jarraya
Hypertension remains the most important risk factor for cardiovascular disease. If antihypertensive drugs choice is well guided today, blood pressure (BP) target still a subject of controversies. Residual risk is matter of debate and the lower- the better dogma is come back again regarding to data reported from recent trials. The J curve, reason for European Society of Hypertension Guidelines reappraisal in 2009, is criticized by recent data. The one goal (<140/90 mmHg) fit 90 mmg 90 mmHg) fit all should be adapted as a personalized goal guided by evidence generated by randomized controlled trials...
October 9, 2016: Advances in Experimental Medicine and Biology
Elisabeth B Marsh, Wendy C Ziai, Rafael H Llinas
INTRODUCTION: Reversible cerebral vasoconstriction syndrome (RCVS) typically affects young patients and left untreated can result in hemorrhage or ischemic stroke. Though the disorder has been well characterized in the literature, the most appropriate way to diagnose, treat, and evaluate therapeutic response remains unclear. In previous studies, transcranial Doppler ultrasound (TCD) has shown elevated velocities indicative of vasospasm. This imaging modality is noninvasive and inexpensive; an attractive option for diagnosis and therapeutic monitoring if it is sensitive enough to detect changes in the acute setting given that RCVS often affects the distal vessels early in the course of disease...
May 2016: Case Reports in Neurology
Marcin Wiącek, Rafał Kaczorowski, Jarosław Homa, Edward Filip, Janusz Darocha, Daniel Dudek, Wiesław Guz, Halina Bartosik-Psujek
BACKGROUND AND PURPOSE: Recently, positive data from several randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke (AIS) has emerged. The aim of this retrospective study is to present our clinical experience in cerebral vessel occlusion treatment using retrievable intracranial stents. METHODS: Forty-three consecutive patients with ischemic stroke (median age 75, range 22-87) treated by stent retriever thrombectomy (Solitaire™ FR) between January 2013 and December 2015 were identified...
September 23, 2016: Neurologia i Neurochirurgia Polska
Ken Okumura, Masatsugu Hori, Norio Tanahashi, A John Camm
Nonvalvular atrial fibrillation (AF) is a risk factor for stroke in elderly patients. Although warfarin has been used to prevent AF-associated stroke for more than 50 years, non-vitamin K antagonist oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban recently have been developed to overcome the disadvantages of warfarin. Based on the results of NOAC clinical trials, Savelieva and Camm made recommendations regarding selection of NOACs in patients with nonvalvular AF. Recent accumulating evidence indicates that NOACs work differently in Asian and non-Asian individuals...
October 7, 2016: Clinical Cardiology
Gustavo José Luvizutto, Gabriela Rizzo Soares Rizzati, Marcelo Ortolani Fogaroli, Rodrigo Thomazi Rodrigues, Priscila Watson Ribeiro, Hélio Rubens de Carvalho Nunes, Gabriel Pereira Braga, Rafael Dalle Molle da Costa, Silméia Garcia Zanati Bazan, Luiz Antônio de Lima Resende, Adriana Bastos Conforto, Rodrigo Bazan
BACKGROUND: Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects that are presented in the spatial hemisphere that is contralateral to the lesioned hemisphere of the brain. USN has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Noninvasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been used in people who have been affected by USN after stroke...
October 3, 2016: Trials
Xiaoyan Jiang, Hongjian Pu, Xiaoming Hu, Zhishuo Wei, Dandan Hong, Wenting Zhang, Yanqin Gao, Jun Chen, Yejie Shi
White matter injury induced by ischemic stroke elicits sensorimotor impairments, which can be further deteriorated by persistent proinflammatory responses. We previously reported that delayed and repeated treatments with omega-3 polyunsaturated fatty acids (n-3 PUFAs) improve spatial cognitive functions and hippocampal integrity after ischemic stroke. In the present study, we report a post-stroke n-3 PUFA therapeutic regimen that not only confers protection against neuronal loss in the gray matter but also promotes white matter integrity...
December 2016: Translational Stroke Research
Daniel O'Dea, Jacqueline Whetteckey, Naitee Ting
INTRODUCTION: In the pivotal RE-LY trial, dabigatran etexilate (DE) at the dose of 150-mg twice daily (BID), significantly reduced total stroke and ischemic stroke compared with warfarin in patients with non-valvular atrial fibrillation (NVAF), while the 110-mg BID dose had efficacy equivalent to warfarin, and major bleeds were significantly reduced. Both DE regimens were generally well tolerated; however, approximately 4% of the patients discontinued treatment with DE due to gastrointestinal (GI) discomfort...
October 5, 2016: Cardiology and Therapy
Christian T Ruff, Robert P Giugliano, Eugene Braunwald, Sabina A Murphy, Karen Brown, Petr Jarolim, Michele Mercuri, Elliott M Antman, David A Morrow
Importance: Treatment decisions in atrial fibrillation (AF) are based on clinical assessment of risk. The CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age 65-74 [1 point] or ≥75 years [2 points], diabetes mellitus, and stroke, transient ischemic attack or thromboembolism [2 points]-vascular disease, and sex category [female]) risk score is pragmatic and widely used but has only moderate discrimination. Objective: To develop and test a cardiovascular biomarker score for indication of risk in patients with AF...
October 5, 2016: JAMA Cardiology
Navkaranbir S Bajaj, Rajat Kalra, Nirav Patel, Taimoor Hashim, Hemant Godara, Sameer Ather, Garima Arora, Tilak Pasala, Thomas T Whitfield, David C McGiffin, Mustafa I Ahmed, Steven G Lloyd, Nita A Limdi, Pankaj Arora
BACKGROUND: Multiple novel oral anticoagulants and left atrial appendage closure devices (WATCHMAN) have been tested against dose-adjusted vitamin K antagonists in randomized controlled trials for stroke prophylaxis in non-valvular atrial fibrillation. No direct comparisons of these strategies are available from randomized controlled trials. We conducted the current analyses by combining efficacy and safety characteristics of all FDA approved stroke prophylaxis treatment strategies for patients with non-valvular atrial fibrillation...
2016: PloS One
Emrah Aytac, Erdem Gürkaş, Cetin Kursad Akpinar, Muhammad A Saleem, Adnan I Qureshi
OBJECTIVE: To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI). METHODS: We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo...
October 3, 2016: Journal of Neurointerventional Surgery
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