bluuebunny/crossref_metadata_2025 huggingface dataset:
Endocrine and Metabolic Changes in Neonatal Calves in Response to Growth Hormone and Long-R3-Insulin-Like Growth Factor-I Administration
Authors: Hammon H. , Blum J.W.
Published: April 2003

Postnatal growth is primarily controlled by growth hormone (GH) and insulin-like growth factor-I (IGF-I). We have studied effects of recombinant bovine GH (rbGH) and Long-R3-insulin-like growth factor-I (Long-R3-IGF-I) on metabolic and endocrine characteristics of neonatal calves. Group GrC (control) was fed colostrum as first meal and then milk replacer up to day 7. Groups GrIGFf, GrIGFi and GrGH were fed as GrC. In group GrIGFf, Long-R3-IGF-I (50 µg/[kg × day], twice daily for 7 days) was fed together with colostrum or milk replacer and in group GrIGFi, Long-R3-IGF-I (50 µg/[kg × day], twice daily for 7 days) was injected subcutaneously at times of feeding. Calves of group GrGH were injected rbGH (1 mg/[kg × day, s.c.], twice daily for 7 days) at times of feeding. While orally administered Long-R3-IGF-I had no effects, subcutaneously administered Long-R3-IGF-I lowered plasma glucose and insulin concentrations (p < 0.05). In group GrGH, day-2 postprandial plasma insulin concentrations were increased more than in Long-R3-IGF-I-treated groups (p < 0.05) and day-2 postprandial prolactin responses were greater in group GrGH than in controls (p < 0.05). Other traits (lactic acid, nonesterified fatty acids, glucagon, cortisol, thyroxine and 3.5.3′-triiodothyronine) exhibited age-dependent changes, but were not significantly affected by rbGH or Long-R3-IGF-I. The study shows, that parenteral, but not oral, Long-R3-IGF-I affects plasma glucose and insulin concentrations, and that rbGH transiently influences plasma prolactin concentrations in neonatal calves.
Lymphocyte Subsets in Cord Blood of Preterm Infants: Effect of Antenatal Steroids
Authors: Chabra Shilpi , Cottrill Carol , Rayens Mary Kay , Cross Richard , Lipke David , Bruce Margaret
Published: April 2003

The objective of this study was to evaluate prospectively the influence of gestational age (GA) and short-term antenatal steroids on total lymphocyte count and lymphocyte subsets in cord blood from preterm infants. Two-color flow cytometric analyses of lymphocyte subsets were performed on cord blood collected from 67 infants. These infants were grouped according to GA: group I (term, n = 19); group II (GA 33–37 weeks, n = 25); group III (GA <33 weeks, n = 23). The mean absolute lymphocyte counts (ALC) in groups I, II and III were 5.6 ± 2.5 × 103/µl, 4.3 ± 1.5 × 103/µl and 3.5 ± 1.8 × 103/µl respectively. The mean values for CD4+ lymphocytes in groups I, II and III were 2.7 ± 0.8 × 103/µl, 2.0 ± 0.8 × 103/µl and 1.6 ± 0.9 × 103/µl respectively. Mean values for CD8+ lymphocytes were 0.9 ± 0.3 × 103/µl, 0.6 ± 0.3 × 103/µl and 0.5 ± 0.3 × 103/µl respectively. With decreasing GA, there was a statistically significant decrease in ALC (p = 0.0035), CD4+ lymphocytes (p = 0.0013) and CD8+ lymphocytes (p = 0.0064). We then evaluated the effect of antenatal steroids, now routinely administered to women with preterm onset of labor to facilitate fetal lung maturation, and found that after adjusting for GA, infants of women on antenatal steroids had significantly fewer ALC (p = 0.0001), CD4+ lymphocytes (p = 0.02) and CD25+ lymphocytes (p = 0.03). In this population of infants, the decreased number of lymphocytes seen at younger GAs is associated with antenatal steroid use.
Cardiac Troponin T in Neonates after Acute and Long-Term Tocolysis
Authors: Adamcová Michaela , Kokštein Zdeněk , Palička Vladimír , Vávrová Jaroslava , Podholová Miloslava , Košt’ál Milan
Published: April 2003

The present study was designed to determine the levels of cardiac troponin T (cTnT) in cord blood of neonates exposed in utero to tocolytic therapy by β-sympathomimetics. cTnT in 40 neonates after acute tocolysis (0.24 ± 0.05 μg/l) was significantly higher (p < 0.05) in comparison with the control group (0.05 ± 0.01 μg/l). The maximal values were reached in about the 3rd day of therapy (0.39 ± 0.11 μg/l). cTnT in 30 neonates after long-term tocolysis was 0.12 ± 0.03 μg/l. No correlation was found between cTnT and CK and its isoenzyme CK-MB or ECG. CK, unlike cTnT, significantly correlated with gestational age (r = 0.57, p < 0.05) and birth weight (r = 0.55, p < 0.05). It is possible to conclude that acute tocolytic therapy by β-sympathomimetics increases the cTnT levels in cord blood and cardiac troponin T is more useful for the laboratory diagnosis of neonatal myocardial injury than CK-MB.
Changes of Hemorheological and Biochemical Parameters after Plasma Perfusion Using a Tryptophan-Polyvinyl Alcohol Adsorber Leading to Clinical Improvement in Patients Suffering from Maculopathy
Authors: Widder Randolf A. , Brunner Richard , Engels Bert , Borberg Helmut , Oette Kurt
Published: April 2003

Background: Selective adsorption is an extracorporeal treatment able to reduce high-molecular-weight proteins and lipids. We evaluated its efficacy in lowering hemorheological parameters to achieve a better microcirculation of the retina. Patients and Methods: Ten patients suffering from maculopathies of various origin underwent a selective plasma adsorption procedure using the TR-350. Plasma and whole blood viscosity, erythrocyte aggregation and proteins and lipids were determined before and 24 h after therapy. Results: Selective adsorption therapy reduced the high-molecular-weight proteins and lipids. Plasma viscosity, standardized whole blood viscosity and erythrocyte aggregation were significantly lowered to 87, 88 and 65%, respectively, of their values prior to treatment. An improvement of visual acuity was achieved in 6/10 patients. Minor side effects were noted in 2/10 patients. Conclusions: Selective adsorption using the TR-350 adsorber is a safe technique, showing a high impact on blood rheology. The changes of hemorheological parameters led to clinical improvement in 6/10 patients suffering from retinal disorders.
Intradialytic Cytokine Gene Expression
Authors: Roccatello Dario , Menegatti Elisa , Alfieri Victor , Rossi Daniela , DeLuca Annarita , Pignone Eugenia , Mengozzi Giulio , Cesano Giulio , Formica Marco , Martina Guido , Sena Luigi M. , Piccoli Giuseppe
Published: April 2003

Along with the numerous technological improvements in molecular biology, polymerase chain reaction, which permits analysis of sequences of a very small amount of biological material, enables evaluation of hemodialysis-induced gene transcription of inflammatory cytokines. Blood samples drawn from 22 hemodialysis patients, treated with cellulose- derived or synthetic membranes, were collected at 0 and 15 min of hemodialysis. Total RNA, purified from mononuclear cells, was reverse transcribed and cDNA amplified by polymerase chain reaction primed with specific oligomers in order to determine tumor necrosis factor α (TNFα), interleukin (IL) 1β and IL6 gene expression. Plasma samples were collected at 0 and 180 min for detection of mature cytokines by enzyme immunoassay with plates pre-coated with monoclonal antibodies to TNFα, IL1β and IL6. A significant increase in TNFα mRNA was detected at 15 min of hemodialysis in 12 of 22 patients: 5 of 9 treated with cuprophan; 3 of 3 with cellulose triacetate; 3 of 5 with polysulfone, and only 1 of 5 treated with polymethylmethacrylate membranes. A parallel increase in IL1β or IL6 mRNA was detected, and significant relationships were found between TNFα and IL1β (p < 0.001), and IL1β and IL6 gene expression (p < 0.05). Increased levels of mature TNFα and IL1β molecules in plasma were detected in the majority of patients showing an increased cytokine gene expression. However, the absolute amount of cytokine mRNA transcription at 15 min did not predict the levels of mature molecules reached in plasma at 180 min. Cytokine mRNA transcription is quite common at the beginning of a dialysis run. Possibly due to intracellular degradation of critical sequences of cytokine mRNA, gene expression does not necessarily imply translation into mature protein. It is suggested that mechanisms related to cell-to-cell interaction, which may possibly involve procytokine biology, are needed to drive phenomena of cytokine activation to clinical effectiveness.
Influence of Plasma Exchange on Serum Levels of Cytokines and Adhesion Molecules in ANCA-Positive Renal Vasculitis
Authors: Tesař V. , Jelínková E. , Mašek Z. , Jirsa Jr. M. , Žabka J. , Bartůňková J. , Stejskalová A. , Janatková I. , Zima T.
Published: April 2003

Background: Increased serum levels of proinflammatory cytokines may contribute to the organ damage in active antineutrophil cytoplasmic antigen (ANCA)-positive renal vasculitis. Plasma exchange (PE) may influence the activity of vasculitis not only by removing pathogenic autoantibodies, but also by lowering the serum levels of circulating cytokines. Methods: Serum levels of IL-1β, IL-1ra, IL-6, IL-8, ICAM-1 and VCAM-1 were measured using ELISA in 10 patients with active ANCA-positive renal vasculitis (5 patients with Wegener’s granulomatosis, WG, and 5 patients with microscopic polyangiitis, MPA) during the course of therapeutic PE. Cytokines and adhesion molecules were measured in samples of serum obtained at the beginning and at the end of the 1st, 3rd and 5th PE and in samples of filtrate obtained during the same PE. Results: In comparison with controls, patients with ANCA had higher serum levels of IL-1ra, IL-8, ICAM-1 and VCAM-1 before the 1st PE. Serum levels of IL-6, IL-8, ICAM-1 and VCAM-1 were increased in patients with MPA, and the serum levels of all the cytokines and adhesion molecules measured in patients with WG were increased. At the end of the PE course there were decreases in the serum levels of IL-1ra and VCAM-1 in ANCA patients and IL-1ra and ICAM-1 in WG patients. Single PE in ANCA patients led only to a decrease in serum levels of ICAM-1 and VCAM-1. On the other hand, there was no change in serum levels of IL-1β and IL-8, and the serum levels of IL-1ra and IL-6 even increased at the end of a single PE, in spite of high levels of all cytokines and adhesion molecules in the plasma filtrate. Conclusion: Serum levels of soluble adhesion molecules decrease after PE, but serum levels of proinflammatory cytokines are not reduced even by a PE course. Removal of these substances by PE is obviously counteracted by their increased production, possibly further stimulated by the contact of blood with the synthetic membrane. The insufficient influence of PE on the elimination of proinflammatory cytokines may partially explain its limited effect in some patients with ANCA-positive renal vasculitis.
Importance of Product Design on Effective Bacterial Removal by Fluid Convection in Y Set and Twinbag Systems
Authors: Kubey W. , Straka P. , Holmes C.J.
Published: April 2003

The goal of this study was to quantitatively compare in vitro the ability of four commercially available peritoneal dialysis solution system designs to prevent the infusion of the most common accidental touch and airborne bacterial contaminant, Staphylococcus epidermidis, into the peritoneum using a total system evaluation approach. This approach took into consideration the number of system openings to the environment during an exchange combined with each system’s convective flushing characteristics. A Y set and a Twinbag system utilizing either an antimicrobial cap or a snap disconnect design for disconnection at the end of the solution exchange procedure were selected for study. The lowest peritoneal bacterial recovery count was seen with the antimicrobial cap system Twinbag, being significantly lower than any of the other systems tested (p < 0.0001). The highest bacterial recovery count occurred in the snap disconnect Y system, being significantly higher than any of the other products tested (p < 0.0001). Both the antimicrobial cap systems permitted infusion of fewer bacteria than the snap disconnect systems, despite being inoculated with larger numbers of bacteria to account for a potential additional opening of the system, during the disconnect procedure. This evaluation emphasizes the importance of fluid path flow design in the overall safety performance of peritoneal dialysis systems.
New Polyether Sulfone Dialyzers Attenuate Passage of Cytokine- Inducing Substances from Pseudomonas aeruginosa Contaminated Dialysate
Authors: Jaber Bertrand L. , Gonski Julie A. , Cendoroglo Miguel , Balakrishnan V.S. , Razeghi Peter , Dinarello Charles A. , Pereira Brian J.G.
Published: April 2003

The use of bicarbonate dialysate and high-flux and reprocessed dialyzers has raised concerns about the reverse transfer of dialysate contaminants into the blood compartment. This in vitro study was performed to investigate the reverse transfer of soluble Pseudomonas aeruginosa bacterial products across a polyether sulfone (PES), a newly developed synthetic polymer dialyzer. In vitro dialysis was carried out at 37°C in a closed countercurrent recirculating loop dialysis circuit with a new PES dialyzer. An equal mixture of heparinized whole blood (from healthy volunteers) with pyrogen-free tissue culture medium was circulated in the blood compartment, and bicarbonate dialysate was circulated in the dialysate compartment. After 15 min of dialysis, the dialysate was challenged sequentially with 10–4, 10–3, and 10–2 dilutions of a P. aeruginosa culture supernatant. 1-ml samples were drawn from the blood compartment 5 and 15 min after each challenge and incubated upright at 37°C. At the end of 24 h, Triton X-100 was added, in order to extract total interleukin (IL) 6 and IL-8 production by the whole-blood mixture. These cytokines were measured by electrochemiluminescence assays. At dilutions of 10–4 and 10–3, the reverse transfer of soluble bacterial products across the dialyzer was negligible. Five and 15 min after contaminating the dialysate with the highest concentration (10–2 dilution), the increase in IL-6 production was 239 ± 170% (p = 0.06) and 886 ± 444% (p = 0.02), respectively. However, comparing the IL-6-inducing potency of the 10–2 bacterial supernatant dilution to the spontaneous IL-6 production in the blood compartment during dialysis with the same dilution of dialysate contaminant, there was a dramatic reduction in IL-6 production by 94 and 89% at 5 and 15 min, respectively. Similarly, 5 and 15 min after contaminating the dialysate with the 10–2 dilution, the increase in IL-8 production was 357 ± 147% (p = 0.07) and 630 ± 229% (p = 0.04), respectively. However, comparing the IL-8-inducing potency of the 10–2 bacterial supernatant dilution to the spontaneous IL-8 production in the blood compartment during dialysis with the same dilution of dialysate contaminant, there was a dramatic reduction in IL-8 production by 93 and 92% at 5 and 15 min, respectively. These results demonstrate that PES dialyzers markedly attenuate passage of cytokine-inducing substances from contaminated dialysate, using a method that detects the entire cytokine synthetic output in the blood compartment.
Cytokine Filtration and Adsorption during Pre- and Postdilution Hemofiltration in Four Different Membranes
Authors: Bouman Catherine S.C. , van Olden Rudolf W. , Stoutenbeek Christiaan P.
Published: April 2003

In the present in vitro study we investigated filtration and adsorption of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) during predilution and postdilution hemofiltration with polysulfone, polyacrylonitrile, polyamide and cellulose triacetate membranes. The median sieving coefficient (SC) for all membranes was 0.0 for TNF-α, below 0.15 for IL-6 and below 0.15 for IL-8 during postdilution hemofiltration. Differences in SC between filtration modes were less than 0.05. Maximal differences in SC between membranes were 0.11 for IL-6, 0.0 for TNF-α, and 0.11 for IL-8. The progressive decrease in cytokine concentrations was identical between the two filtration modes and most pronounced with the polyacrylonitrile membrane (reduction 77% for IL-6, 39% for TNF-α and 95% for IL-8 after 4 h of hemofiltration). The relative contribution of adsorption to the reduction in cytokines was 100% for TNF-α for all membranes, between 53 (cellulose triacetate) and 83% (polyacrylonitrile) for IL-6, and for IL-8 between 0 (polysulfone) and 100% (polyacrylonitrile). In conclusion, the reduction in TNF-α, IL-6 and IL-8 was most impressive with the polyacrylonitrile membrane after 4 h of hemofiltration and was largely due to adsorption. Adsorption of TNF-α, IL-6 and IL-8 was also seen with the other membranes. None of the membranes filtered TNF-α. Sieving of IL-6 and IL-8 was low for all membranes with only marginal differences between membranes or between filtration modes.
Compliance in Hemodialysis Patients: Unanticipated Monitoring of Biochemical Indices
Authors: Arici Mustafa , Altun Bülent , Usalan Celalettin , Ulusoy Sükrü , Erdem Yunus , Yasavul Ünal , Turgan Çetin , Çaglar Sali
Published: April 2003

Compliance with the prescribed medical regimen is a critical factor for the continued well-being of hemodialysis patients. As compliance is a multifactorial problem, numerous approaches have been utilized to quantify the compliance of hemodialysis patients. In the present study, we have attempted to examine whether unanticipated control of biochemical indices might predict the compliance status of hemodialysis patients. We compared unanticipated mid-month values of blood urea nitrogen (BUN), serum potassium (K) and phosphate (PO4) values of 54 maintenance hemodialysis patients with the scheduled, regular first-week measurements during a 6-month study period. The interdialytic weight gain (IWG) levels of the corresponding weeks were also compared. Mid-month analysis revealed a significant deviation in the compliance status of the study population as BUN, serum K and IWGs were concerned (p < 0.05). The mid-month serum PO4 levels were also higher but the difference was not significant (p < 0.05). In conclusion, the differences observed in biochemical indices upon change of test request timing were distinctive. It suggests that unanticipated control of biochemical indices might contribute to the actual assessment of compliance in hemodialysis patients.
Uremic Ultrafiltrate Inhibits Platelet-Activating Factor Synthesis
Authors: Wratten M.L. , Tetta C. , De Smet R. , Neri R. , Sereni L. , Camussi G. , Vanholder R.
Published: April 2003

Background: Several studies have suggested that uremic toxins may adversely affect phagocytic leukocytes of chronic renal failure patients. Platelet-activating factor (PAF) is produced by phagocytic leukocytes and is a potent mediator of inflammation which is produced by leukocytes upon appropriate stimulation. Methods: We added uremic or normal ultrafiltrate, ultrafiltrate fractionated by reverse phase HPLC or compounds eluting at the same retention time as the fractionated ultrafiltrate, to normal leukocytes. Complement-coated baker’s yeast spores were added to stimulate phagocytosis. Total PAF was purified by thin layer chromatography and quantified by bioassay on rabbit platelets. The activities of two enzymes involved in the synthesis of PAF, phospholipase A2 (PLA2) and acetyltransferase, were measured in the presence of fractionated ultrafiltrate. Results: Ultrafiltrate from both healthy and uremic subjects inhibited PAF synthesis, but the inhibitory effect was more substantial for uremic subjects. Ultrafiltrate fractionated by HPLC showed high PAF inhibition for late eluting hydrophobic fractions. Addition of phenol or p-cresol, two uremic toxins with similar elution pattern as the late fractions, also inhibited PAF synthesis. The activity of PLA2 and acetyltransferase was decreased in the presence of uremic ultrafiltrate. Conclusions: We observed that uremic ultrafiltrate inhibits PAF synthesis upon stimulation with complement coated baker’s yeast spores. The decrease in total PAF synthesis appears to be associated with an inhibition of phospholipase A2 and acetyltransferase activity, enzymes involved in the remodelling pathway for PAF synthesis.
Trace Elements in End-Stage Renal Disease
Authors: Zima Tomáš , Tesař Vladimír , Mestek Oto , Němeček Karel
Published: April 2003

For human beings trace elements are essential nutrients with a gamut of functions. They are for instance indispensable components of many enzymes, so they have some regulatory functions and they may affect immune reactions and free radical generation. Abnormalities of trace elements are primarily the result of uremia, and they may be further modified and sometimes greatly exacerbated by the dialysis procedure. The role of trace elements in hemodialysis (HD) patients has not yet been fully characterized. To prevent some complications in chronic HD patients, it is very important to regulate the levels of trace elements by adequate water treatment. Reverse osmosis is able to prevent the accumulation of the majority of trace elements in the patients. Zinc supplementation may be recommended for patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable. Selenium deficiency is to be suspected in dialyzed patients and selenium supplementation may be beneficial (increasing glutathione peroxidase activity, cardioprotective effect, immunostimulatory properties) for chronic renal failure patients. Supplementation with a trace element may be indicated when its depletion was unequivocally documented and when there is evidence of the positive effects of this element on the quality of life of the dialyzed patients.
Endocrine-Disrupting Chemicals in CAPD Dialysate and Effluent
Authors: Sugimura Kazunobu , Naganuma Toshihide , Kakiya Yuko , Okada Chikako , Sugimura Takeshi , Kishimoto Taketoshi
Published: April 2003

Environmental contamination by endocrine-disrupting chemicals (EDC) has been a major focus of recent research and policy discussions. EDC-suspected man-made chemicals used as raw materials or plasticizers have been shown to elute from plastic products. To examine whether the dialysate for continuous ambulatory peritoneal dialysis (CAPD) is contaminated with EDC, we determined bisphenol A (BPA), nonylphenol (NP), di-(2-ethylhexyl)phthalate (DEHP) and di-n-butyl phthalate (DBP) in the pre-used dialysate and in the peritoneal effluent from renal failure patients by gas chromatography/mass spectrometry. Concentrations of BPA, NP, DEHP and DBP were 0.02–0.23 ppb (μg/l), 0.09–0.22, 1.1–3.7, and <0.1–2.1 ppb, respectively, in the pre-used dialysate, and <0.01–0.07, <0.1–0.45, 0.35–1.23, and 0.42– 1.76 ppb, respectively, in the effluent, from which the maximal daily contamination of BPA and NP by CAPD was estimated at the microgram level and that of phthalate esters at the 10-μg level. These concentrations are far less than the toxic dosage reported so far, so that CAPD is unlikely to contaminate patients seriously.
Characterization and localization of the genes for mouse proteinase-3 (Prtn3) and neutrophil elastase (Ela2)
Authors: Sturrock A. , Franklin K.F. , Wu S.-Q. , Hoidal J.R.
Published: April 2003

Proteinase-3 (PR-3) and neutrophil elastase (NE) are polymorphonuclear leukocyte serine proteinases that degrade extracellular matrix proteins including elastin and appear to be involved in the pathogenesis of several diseases characterized by tissue destruction most notably emphysema and Wegener’s granulomatosis. In this report we characterize and compare the mouse PR-3 and NE genes and establish by FISH analysis a common location on mouse chromosome 10C2. Each gene consists of five exons and four introns conserving the typical granule-associated serine proteinase gene structure. The mouse PR-3 gene (Prtn3) is approximately 3.7 kb and is within 2.2 kb of the smaller (1.7 kb) NE gene (Ela2). The larger size of Prtn3 is accounted for by differences in intron sizes. A comparison between the mouse and human PR-3 cDNA reveals 73% homology, however, this drops to 60% when the amino acid sequences are compared. Homology between the mouse and human NE cDNA is 77% for both the cDNA and amino acid sequences. The catalytic triad and its placement are conserved among the four genes. The proximal promoter of mouse Prtn3 contains a TATA box, c-myb and an ets transcriptional site. As these are functional elements in the mouse Ela2 promoter they may also be important in the expression of Prtn3.
Predictive Clinical Factors of In-Hospital Mortality in 231 Consecutive Patients with Cardioembolic Cerebral Infarction
Authors: Arboix Adrià , García-Eroles Louis , Massons Juan , Oliveres Montserrat
Published: April 2003

Cardioembolic cerebral infarction is a subtype of stroke with a high mortality. The purpose of this study was to determine predictors of in-hospital mortality in 231 consecutive patients with cardioembolic stroke by means of a multivariate analysis. Three predictive models were constructed. A first model was based on demographic, anamnestic and clinical variables collected at the bedside examination (total 8 variables). A second model was based on clinical and neuroimaging variables (total 10 variables). A third model was based on the aforementioned clinical and neuroimaging variables and the presence of early recurrent embolism (total 11 variables). Deteriorated level of consciousness, limb weakness, presence of congestive heart failure, male gender, and age appeared to be independent prognostic factors of in-hospital mortality in the predictive model based on clinical variables and in the predictive model based on clinical and neuroimaging variables. In addition to these variables, early recurrent embolization was selected in the third predictive model. In the first two models, setting a cut-off point of 0.50 for predicting vital status at hospital discharge resulted in a sensitivity of 60%, a specificity of 89% and a total correct classification of 81%. The corresponding values of the third model were 62, 89 and 81%, respectively. These data may help clinicians to establish an early prognosis of this stroke subtype more accurately as well as to allocate patients with cardioembolic stroke in clinical trials correctly.
Comparison of the Three Strategies of Verbal Scoring of the Glasgow Coma Scale in Patients with Stroke
Authors: Prasad Kameshwar , Menon Geetha R.
Published: April 2003

Presence of aphasia in patients with stroke poses a problem in the use of the full form (eye-motor-verbal) Glasgow Coma Scale (GCS). Stroke investigators and clinicians have used three different strategies to deal with the untestable verbal subscale, i.e. eliminating the verbal subscale; pseudoscoring with ‘one’, and median value substitution; but the predictive accuracy of the strategies has not been compared. To compare the predictive accuracy of the three strategies for acute mortality in stroke, we prospectively applied the GCS to 275 consecutive patients with acute stroke and recorded their survival status before discharge from hospital. 95 (33.8%) patients died. 32 (12%) patients had untestable verbal score. Receiver-Operator-Characteristic curves for predicting mortality were constructed with the GCS sum score and with the multivariate logistic models, and areas under the curves were measured to compare the predictive accuracy. They were all found to be similar (0.87–0.88 sq unit). Specifically, the GCS with eye and motor subscale had 87% accuracy compared to 88% for the model with eye, motor and verbal scale. We conclude that the short-form (eye-motor) GCS is as good a predictor of early mortality (within 2 weeks) as the full form (eye-motor-verbal) GCS in patients with stroke.
Stroke Register: Experience from the Eastern Province of Saudi Arabia
Authors: Al-Rajeh Saad , Larbi Emmanuel B. , Bademosi Olajide , Awada Adnan , Yousef Abdullah , Al-Freihi Hussein , Miniawi Hani
Published: April 2003

A stroke registry was established in the Eastern Province of Saudi Arabia with an estimated population of 750,000 inhabitants of whom 545,000 are Saudi citizens. The register started in July 1989 and ended in July 1993. The Gulf war led to its interruption from August 1990 to August 1991. Four hundred eighty-eight cases (314 males, 174 females) of first-ever strokes affecting Saudi nationals were registered over the 3-year period. The crude incidence rate for first-ever strokes was 29.8/100,000/year (95% CI: 25.2–34.3/100,000 year). When standardized to the 1976 US population, it rose up to 125.8/100,000/year. Ischemic strokes (69%) predominated as in other studies but subarachnoid hemorrhage (SAH) was extremely rare (1.4%). The important risk factors were: systemic hypertension (38%), diabetes mellitus (37%), heart disease (27%), smoking (19%) and family history of stroke (14%). Previous transient ischemic attacks (3%) and carotid bruits (1%) were uncommon. The 30-day case fatality rate was 15%. The study showed that the age-adjusted stroke incidence rate for Saudis in this region is lower than the rates reported in developed countries but within the range reported worldwide. The pattern of stroke in Saudi Arabia is not different from that reported in other communities with the exception of the low incidence of SAH. The risk factors are similar to findings in other studies except for the high frequency of diabetes mellitus in our cases. The lower mortality rate was probably due to the younger age of the population and the availability of free medical services for management of cases.
Microembolic Load in Asymptomatic Patients with Cardiac Aneurysm, Severe Ventricular Dysfunction, and Atrial Fibrillation
Authors: Nabavi Darius G. , Arato Susanne , Droste Dirk W. , Schulte-Altedorneburg Gernot , Kemény Vendel , Reinecke Holger , Borggrefe Martin , Breithardt Günter , Ringelstein E. Bernd
Published: April 2003

Transcranial Doppler sonography has become a widely used method for detecting cerebral circulating microemboli (ME) arising from the carotid arteries or the heart. Yet, studies on subgroups of patients with distinct cardiac sources of embolism are still limited. The same holds true for investigations on the relationship between microembolization and hemorheological parameters. A total of 142 patients suffering from left ventricular aneurysm (LVA, n = 52), severe left ventricular dysfunction (LVD, n = 43), or chronic atrial fibrillation (AF, n = 47) were enrolled in this study. All patients had been neurologically asymptomatic for at least 1 month. Further relevant embolic disorders of the carotid arteries and the heart had been excluded. Unilateral monitoring for ME over the middle cerebral artery was performed for 30 min. Blood was drawn after each monitoring for determination of plasmatic coagulation parameters, as well as plasma viscosity, and platelet reactivity. The overall prevalence of ME was 31%, with a slightly higher prevalence in patients with LVA (37%) compared to patients suffering from AF (30%) or LVD (26%). With single-factor analysis, a trend towards higher ME prevalences was found with (a) a history of remote embolic events, (b) ineffective anticoagulation, (c) increased platelet aggregation, or (d) increased plasma viscosity (all p > 0.1). The combination of ineffective anticoagulation in conjunction with increased platelet aggregation, however, was significantly associated with higher ME rates even after adjustment for other factors by logistic regression analysis. Our results demonstrate a low ongoing microembolic activity in asymptomatic patients suffering from LVA, LVD and AF. An activated plasmatic coagulation system together with increased platelet aggregation contributes to ME generation.
Monocytes Express Tissue Factor in Young Patients with Cerebral Ischemia
Authors: Kappelmayer János , Berecki Dániel , Misz Mária , Oláh László , Fekete István , Csiba László , Blaskó György
Published: April 2003

Activation of blood coagulation and fibrinolysis has previously been detected in stroke patients. It is unknown, however, what factors contribute to the acceleration of coagulation reactions, especially in cases where no obvious predisposing factors exist. We therefore postulated and tested the hypothesis that in such patients monocytes may trigger the pathway leading to thrombosis by expressing tissue factor (TF). TF antigen was determined in 48 patients and 40 controls by flow cytometry using an indirect immunofluorescent technique. TF antigen expression was significantly increased on monocytes in young stroke patients in both the acute (p < 0.01) and chronic (p < 0.05) phases of the disease. The TF antigen also possessed functional activity, quantitated by a one-stage clotting assay. TF expression on monocytes was not associated with an elevation in C-reactive protein values. In both acute and chronic phases, blood coagulation activation markers, e.g. the thrombin-antithrombin complex and F1+2 fragments, were significantly elevated. However, in the acute phase D-dimer levels were similar to those in controls and were only elevated in the chronic phase of the disease (p < 0.05). In conclusion, in cerebral ischemia TF expression on monocytes suggests enhanced activation of blood coagulation and subsequent fibrinolysis.
Spontaneous Intracerebral Hemorrhage Revealing Addison’s Disease
Authors: Derex Laurent , Giraud Pierric , Hanss Michel , Riche Hervé , Nighoghossian Norbert , Trouillas Paul
Published: April 2003

We report a case of spontaneous intracerebral hemorrhage occurring in a young woman and revealing Addison’s disease. This autoimmune primary adrenocortical insufficiency was associated with premature ovarian failure. Exhaustive research for nonhypertensive causes of intracerebral hemorrhage was negative. Initial coagulation studies disclosed severe hypofibrinogenemia and prolonged prothrombin time related to vitamin K-dependent coagulation factor deficit. Clotting abnormalities cleared at 4 months under treatment with hydrocortisone. Glucocorticoids are potent regulators of fibrinogen biosynthesis, increasing fibrinogen secretion. We conclude that primary adrenocortical insufficiency induced this hemorrhagic diathesis leading to spontaneous intracerebral hemorrhage. This latter has never been reported in Addison’s disease. Primary adrenocortical insufficiency should be considered as a rare potential cause of nonhypertensive intracerebral hemorrhage.
Three Years after In-Patient Stroke Rehabilitation: A Follow-Up Study
Authors: Löfgren Britta , Nyberg Lars , Mattsson Mai , Gustafson Yngve
Published: April 2003

A 3-year follow-up study was performed aimed at describing the outcome for severely affected stroke survivors who had undergone geriatric in-patient rehabilitation. Living conditions, psychological well-being, and changes in functions were assessed in 55 survivors. Twenty-five people were living in the community, 15 in apartment hotels or homes for the aged and 15 in nursing homes. From discharge to follow-up 11 people had had to move to an accommodation offering more support. Living alone, recurrent strokes and functional decline were associated with moving. Many of those living in the community were supported by relatives or home help services. Home adjustments and assistive devices were common and in most cases were aimed at facilitating transfers and bathroom activities. Motor function had deteriorated from discharge to follow-up, otherwise no statistically significant changes were seen in the survivors’ abilities and functions. Most survivors had in fact been able to maintain their functions or to make further improvements. Also, their psychological well-being seemed quite good. These results should encourage rehabilitation efforts for elderly people severely affected by stroke.
Acute Reversible Cerebral Arteritis Associated with Parenteral EphedrineUse
Authors: Mourand I. , Ducrocq X. , Lacour J.C. , Taillandier L. , Anxionnat R. , Weber M.
Published: April 2003

Cerebrovascular disorders in association with licit or illicit drugs have rarely been reported. We report a first case of stroke associated with the parenteral use of ephedrine. A 44-year-old woman underwent spinal anaesthesia for varicose vein surgery. She was usually treated with propranolol and occasionally with phenoxazoline. During anaesthesia, ephedrine was administered by the venous route because of arterial hypotension. She developed intracranial hypertension and focal cerebral deficits related to multiple haemorrhagic cerebral infarcts associated with a reversible beading appearance on angiography consistent with the diagnosis of acute cerebral arteritis. The role of ephedrine in this case is discussed beside other causes of acute cerebral arteritis.
Negative Interaction of Aspirin and Streptokinase in Acute Ischemic Stroke: Further Analysis of the Multicenter Acute Stroke Trial-Italy
Authors: Ciccone Alfonso , Motto Cristina , Aritzu Elisabetta , Piana Alessandra , Candelise Livia
Published: April 2003

Background: Thrombolytic therapy improves the functional outcome in acute ischemic stroke, but the risk of death and cerebral hemorrhage remains high. Aspirin given together with a thrombolytic agent may worsen the risk-to-benefit ratio. We performed a further Multicenter Acute Stroke Trial-Italy (MAST-I) which is the only randomized, controlled trial that has tested the effect of this combination to evaluate the risk of aspirin use plus streptokinase. Patients and Methods: We made a post hoc analysis of the MAST-I results comparing streptokinase plus aspirin (156 patients) with streptokinase alone (157 patients). We evaluated the risk of death and cerebral hemorrhage. Results: The combined regimen significantly increased early case fatality from day 3–10 (53 vs. 30; OR 2.1; CI 1.2–3.6). The death excess was solely due to treatments and was not explained by the main prognostic predictors (multifactorial analysis). The cause of death in the combination group was mainly cerebral (42 vs. 24; OR 2.0; CI 1.3–3.7) and associated with hemorrhagic transformation (22 vs. 11; OR 2.2; CI 1.0–5.0). The rate of stroke reoccurrence was not increased in patients treated with streptokinase alone (15 vs. 11; OR 1.4; CI 0.6–3.4). Conclusions: Stroke patients treated with streptokinase plus aspirin have an increased risk of early death, probably due to cerebral hemorrhagic complications. Whenever thrombolytics are chosen for acute stroke treatment, aspirin and other antiplatelet agents should be avoided.
Leukocyte Activation: Relation to Cardiovascular Mortality after Cerebrovascular Ischemia
Authors: Falke P. , Elneihoum A.M. , Ohlsson K.
Published: April 2003

Activated leukocytes are believed to be involved in the pathogenesis and progression of atherosclerotic vascular disease and its consequences. In a 4-year observational follow-up study, we investigated whether markers for systemic leukocyte activation (leukocyte-derived inflammatory mediators) were related to cardiovascular mortality after cerebrovascular ischemia. Using enzyme-linked immunosorbent assays, we measured the plasma levels of soluble tumor necrosis factor receptor protein-1 (sTNFR-1), neutrophil gelatinase-associated lipocalin (NGAL) and neutrophil protease-4 (NP4) in 144 patients (90 stroke, 54 transient ischemic attack) 1–3 days after cerebral ischemia. During the 4 years of follow-up, 42 (29%) of the 144 patients died; 38 of cardiovascular causes and 4 of other causes. Patients with evidence of higher leukocyte activation (n = 47) had a higher 4-year cardiovascular mortality rate than those without evidence of leukocyte activation (n = 97; p < 0.005). Logistic regression analysis with age, sex and other significant predictors as covariates showed higher plasma levels of sTNFR1 and NGAL both to be significant independent predictors of cardiovascular mortality, the respective odds ratio, 95% confidence intervals, and p values being 2.0, 1.2–3.4, p < 0.01, and 3.6, 1.2–10.5, p = 0.02, respectively. We concluded that in patients with acute cerebral ischemia, plasma markers of leukocyte activation were significant predictors of long-term cardiovascular mortality. This may indicate an important role of activated leukocytes in the progression of these diseases.
Cross-Validation of a Model Predicting Discharge Home after Stroke Rehabilitation
Authors: Löfgren Britta , Gustafson Yngve , Nyberg Lars
Published: April 2003

A new sample of 116 stroke patients was collected in order to validate a logistic regression model, predicting the chances of severely affected stroke patients being discharged home to independent living. The model was found to be accurate in the new sample, especially for those patients who had a high estimated probability of being discharged home. When the dividing line for the predicted probability for discharge home was set at a value of ≥0.5, the positive and negative predictive values were 74 and 73%, respectively. Further modelling resulted in a new extended model including the variables postural stability on admission, cohabiting, age and perceptual impairment on admission that formed the basis for an index predicting discharge home. This index was then validated in the sample of 93 patients that the first developed model was derived from and showed positive and negative predictive values of 85 and 77%, respectively.
The Athens Stroke Registry: Results of a Five-Year Hospital-Based Study
Authors: Vemmos Kostas N. , Takis Constantino E. , Georgilis Kostis , Zakopoulos Nikolaos A. , Lekakis John P. , Papamichael Christos M. , Zis Vasilios P. , Stamatelopoulos Stamatis
Published: April 2003

The advent and wide application of new technology, especially noninvasive techniques, has enabled physicians to more completely investigate and clarify the etiopathogenic mechanisms of stroke. Such data have not been available until recently for Southeastern Europe. In addition, during the last decades, strategies for the modification of risk factors and primary prevention may have changed the prevalence of each subgroup of stroke as well. We investigated 1,042 consecutive patients who had first strokes, during a period of 5 years (from June 1992 to May 1997) and classified them prospectively based on etiopathogenic mechanisms. Patients with transient ischemic attacks and subarachnoid hemorrhage were excluded. There were 613 male and 429 female patients, with a mean age of 70.2 ± 11.9 years. Forty-six percent of the patients arrived within 3 h from stroke onset. The probable mechanisms were: large-artery atherosclerosis, 156 (15%); lacunes, 177 (17%); cardioembolic, 335 (32.1%); infarct of unknown cause, 182 (17.5%); miscellaneous causes, 35 (3.3%), and intracerebral hemorrhage (ICH), 157 (15.1%). In the cardioembolic group, nonvalvular atrial fibrillation (NVAF) was the probable cause in 225 patients, especially in patients older than 75 years (65%). The overall hospital mortality was 15.2% (from 0.6% for lacunar stroke to 34% for ICH). In our population, cardioembolism is the most frequent subtype of stroke. NVAF is the most likely source, especially in older patients.
Diffusion-Weighted MRI in Acute Mutism
Authors: Blanc-Lasserre K. , Nighoghossian N. , Derex L. , Lucain P. , Turjman F. , Berthezene Y. , Froment J.C. , Trouillas P.
Published: April 2003

Mutism defined as a complete loss of speech may be related to psychiatric or neurologic disorders. The ischemic stroke origins of mutism are often difficult to assess at the acute stage. Accordingly, the search for the underlying mechanism as the localization of the damages may be difficult by conventional radiological techniques. Diffusion-weighted (DWI) MRI may accurately identify patients with acute ischemic stroke and distinguish them from those who mimic acute stroke better than clinical and conventional neuroradiological methods. This report aims to demonstrate the utility of DWI-MRI in the diagnosis of acute mutism.
Remote Effects of Acute Ischemic Stroke: A Xenon CT Cerebral Blood Flow Study
Authors: Rubin Giorgio , Levy Elad I. , Scarrow Alan M. , Firlik Andrew D. , Karakus Alaad din , Wechsler Lawrence R. , Jungreis Charles A. , Yonas Howard
Published: April 2003

Objective: The purpose of this study was to verify transhemispheric diaschisis in the early hours after an ischemic event. Methods: XeCT cerebral blood flow (CBF) studies within 8 h of stroke were studied in 23 patients. Mean CBF was evaluated in the ischemic area, contralateral hemisphere and ipsilateral cerebellum. Results: A severe CBF reduction was found in the ischemic area (mean 9 ± 3 ml/100 g/min). The mean CBF in the unaffected hemisphere (33 ± 10 ml/100 g/min) was 35% less compared to the normal mean value. CBF was decreased in the cerebellum ipsilateral to the stroke (mean 31 ± 12 ml/100 g/min) suggesting a blood flow depression of the whole brain. Conclusions: During the initial hours of cerebral ischemia, the asymptomatic hemisphere demonstrated CBF depression that was part of the global flow reduction.
Microembolus Detections at Follow-Up in 19 Patients with Acute Stroke
Authors: Droste Dirk W. , Ritter Martin , Kemény Vendel , Schulte-Altedorneburg Gernot , Ringelstein E. Bernd
Published: April 2003

The present study was designed to perform follow-up transcranial Doppler investigations for microembolic signals (MES) in acute stroke patients by means of a strict protocol. The number of MES was correlated with stroke etiology and the strength of antithrombotic treatment. Concurrently, we wanted to demonstrate that MES in acute stroke patients are solid in nature and not gaseous. Nineteen patients with middle cerebral artery ischemic events, 16 with completed stroke and 3 with transient ischemic attack (TIA) were investigated within 24 h following the onset of symptoms. Six 1-hour recordings on days 1, 2, 3, 4, 7 and 14 were performed from the affected middle cerebral artery. The four-gate technique and recently established criteria for the identification of MES were used. Eight of 19 patients showed MES in at least one recording. Variability was high and showed no uniform tendency with respect to time since onset of symptoms or treatment. All 3 patients with internal carotid artery dissection showed MES. In 3 patients with lacunar stroke, no MES were detected. Two patients with MES suffered recurrent TIAs during the observation period, whereas none of the patients without MES suffered a recurrent ischemic event. In the acute phase following stroke, ongoing, emerging and vanishing embolization in some patients may reflect individual active processes of remodelling, healing and disruption or disappearance of the embolic source.
Clinical Correlations of Diffusion and Perfusion Lesion Volumes in Acute Ischemic Stroke
Authors: Baird Alison E. , Lövblad Karl-Olof , Dashe John F. , Connor Ann , Burzynski Cara , Schlaug Gottfried , Straroselskaya Irina , Edelman Robert R. , Warach Steven
Published: April 2003

The aim of this study was to describe the clinico-radiological correlations of magnetic resonance (MR) perfusion and diffusion-weighted imaging (DWI) abnormalities in ischemic stroke. Eighteen patients had undergone MR imaging and clinical evaluation within 24 h of symptom onset and at or after 7 days. During the first 24 h the volume of perfusion abnormality (measured on the relative mean transit time map) was larger than the DWI lesion in 12/18 patients. In 6/18 patients the DWI lesion volume was larger. Acutely (<24 h) all lesion volumes showed a significant correlation with acute clinical severity measured by the National Institutes of Health Stroke Scale score. The correlations of the hypoperfusion volume (rho = 0.86, p = 0.0001) and the volume ‘tissue at risk’ (larger than the DWI and perfusion lesion volumes, rho = 0.86, p = 0.0001) with acute clinical severity were slightly higher than for the DWI lesion volume (rho = 0.76, p = 0.0001). The difference between the volume of tissue at risk (acutely) and the infarct on follow-up T2-weighted imaging correlated significantly with change in clinical severity from acute to chronic time points (rho = 0.72, p = 0.001). Such clinico-radiological relationships may support the use of DWI and perfusion MR in decisions concerning the administration and evaluation of stroke therapies.