Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere

Background and purpose: To assess dynamic cerebral autoregulation (CA) in patients with acute ischaemic stroke of undetermined aetiology, within 72 h of stroke onset. Materials and methods: In 6 patients with ischaemic stroke of undetermined aetiology (aged 66 9 years, National Institutes of Health Stroke Scale [NIHSS] score on admission: 4.0, range: 4–11), selected based on screening of 118 consecutive ischaemic stroke patients and in 14 volunteers (aged 62 10 years), we continuously monitored RR intervals (RRI), mean arterial pressure (MAP) by means of photoplethysmography, mean cerebral blood flow velocity (CBFV) using transcranial Doppler ultrasonography, end-tidal CO2 (ETCO2) and respiration during 2-min deep breathing paced at 6 min1 (0.1 Hz). To assess CA, we evaluated the impact of breathing-induced MAP oscillations on fluctuations of CBFV in the hemispheres with stroke, the non-involved hemispheres and randomly selected hemispheres of controls by applying cross-spectral analysis and calculating coherence, transfer function gain (CBFV–MAP gain) and phase shift angle between the two oscillating signals. Results: Phase shift angle between MAP and CBFV oscillations showed values >0 and was significantly reduced in the hemispheres without stroke as compared to controls (0.39 0.95 vs. 1.59 0.33 rad, p = 0.015), whereas in the hemispheres with stroke, phase shift angle did not differ significantly from that observed in the control hemispheres. Clinical status of stroke patients significantly improved at discharge from the hospital (NIHSS: 2.0, range: 1–8, p = 0.028). Conclusions: During the first days of ischaemic stroke of undetermined aetiology, dynamic cerebral autoregulation is compromised in the non-affected hemisphere, but not in the hemisphere with ischaemic lesio

The effect of insulin and sulodexide (Vessel Due F) on diabetic foot syndrome. Pilot study in elderly patients

Celem pracy była ocena skuteczności stosowania insuliny wraz z sulodeksydem (mieszanina 80% pochodnych heparyny i 20% siarczanu dermatanu) w leczeniu owrzodzeń stóp oraz określenie ich wpływu na mikrokrążenie skórne i neuropatię cukrzycową. Chorzy z zaawansowaną neuropatią cukrzycową i owrzodzeniem stopy losowo przydzielono do grupy leczonej insuliną (I) z sulodeksydem (S) (n = 12) lub do grupy kontrolnej leczonej insuliną z placebo (P) (n = 6) przez 10 tygodni. Za pomocą metody dopplerowskiego lasera oceniano skórny przepływ krwi w stopach (LDF, laser doppler flow) w spoczynku oraz po 30- i 60-sekundowym niedokrwieniu. Ocenie poddano również przewodnictwo nerwowe na podstawie czuciowych i ruchowych potencjałów wywołanych. U chorych na cukrzycę skórny przepływ po niedokrwieniu był 2,5 raza krótszy w kończynie z owrzodzeniem niż w stopie zdrowej. Obserwowano znamienny wzrost przepływów skórnych po 30- i 60-sekundowym niedokrwieniu po zakończeniu terapii (grupa IS, owrzodzenie stopy, LDF - 60 s; od 99,1 &plusmn; 14,3 do 218,6 &plusmn; 28,6 PU, p < 0,001, grupa od 110,5 &plusmn; 13,0 do 164,8 &plusmn; 15,4 PU, p < 0,05). Czas przekrwienia reaktywnego uległ wydłużeniu w grupie IS (IS: od 30,3 &plusmn; 2,9 do 43,9 &plusmn; 2,2 s, p < 0,001; IP: od 28,7 &plusmn; 3,0 do 33,3 &plusmn; 3,3 s, NS). W grupie IS 92% owrzodzeń stóp uległo zagojeniu w ciągu 46,4 dnia, natomiast w grupie IP 83% w ciągu 63,0 dnia. Badania przewodnictwa nerwowego nie wykazały różnic nasilenia neuropatii w obrębie grup i pomiędzy grupami. W stopach z owrzodzeniami sulodeksyd i insulina poprawiają przepływ skórny w odpowiedzi na niedokrwienie, nie wpływając na przewodnictwo nerwowe. Kliniczne efekty działania sulodeksydu, sumując się z działaniami insuliny, mogą istotnie skracać czas niezbędny do całkowitego wyleczenia owrzodzenia. Ostateczne potwierdzenie przedstawionych wstępnych wyników wymaga dalszych badań klinicznych.To assess the efficacy of insulin plus sulodexide (a mixture of 80% heparin-like substances and 20% dermatan sulphate) on diabetic ulcers, and its influence on foot skin microcirculation and diabetic neuropathy. Two groups of diabetic patients, suffering from severe neuropathy and ulceration, were randomly assigned to insulin (I) plus sulodexide (S) (n = 12) or insulin plus placebo (P) (n = 6) therapy, for 10 weeks. Laser Doppler assessment of foot skin flow (LDF), at rest and 30 or 60 s after arterial occlusion, and nerve conduction tests (sensorial evoked and motoric conduction potentials) have been evaluated in both groups. Postischaemic flow was 2.5 times shorter in ulcerated vs. non-ulcerated feet in diabetic patients. A significant increase in flows after 30 and 60 s ischaemia was detected in both groups at the end of therapy (IS group, ulcerated foot, LDF = 60 s: from 99.1 &#177; 14.3 to 218.6 &#177; 28.6 PU, P < 0.001. IP group = from 110.5 &#177; 13.0 to 164.8 &#177; 15.4 PU, P < 0.05). The length of reactive hyperaemia was higher in IS vs. IP group (IS: from 30.3 &#177; 2.9 to 43.9 &#177; 2.2 s, P < 0.001; IP: from 28.7 &#177; 3.0 to 33.3 &#177; 3.3 s, ns). Ninety-two percent of ulcers heals in a mean time of 46.4 days (IS group) vs. 83% and 63.0 days, respectively, in IP group. Nerve conduction studies have not demonstrated within- and between-group differences. Sulodexide and insulin improve the postischaemic skin flow in ulcerated feet, without affecting nerve conduction tests. The effect of sulodexide results additive to insulin; it is clinically relevant, in the view of the possibility of reducing the time needed to completely heal ulcers. The ultimate validation of these preliminary results requires extensive trials

A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis

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Supportive and symptomatic management of amyotrophic lateral sclerosis

The main aims in the care of individuals with amyotrophic lateral sclerosis (ALS) are to minimize morbidity and maximize quality of life. Although no cure exists for ALS, supportive and symptomatic care provided by a specialist multidisciplinary team can improve survival. The basis for supportive management is shifting from expert consensus guidelines towards an evidence-based approach, which encourages the use of effective treatments and could reduce the risk of harm caused by ineffective or unsafe interventions. For example, respiratory support using noninvasive ventilation has been demonstrated to improve survival and quality of life, whereas evidence supporting other respiratory interventions is insufficient. Increasing evidence implicates a causal role for metabolic dysfunction in ALS, suggesting that optimizing nutrition could improve quality of life and survival. The high incidence of cognitive dysfunction and its impact on prognosis is increasingly recognized, although evidence for effective treatments is lacking. A variety of strategies are used to manage the other physical and psychological symptoms, the majority of which have yet to be thoroughly evaluated. The need for specialist palliative care throughout the disease is increasingly recognized. This Review describes the current approaches to symptomatic and supportive care in ALS and outlines the current guidance and evidence for these strategies

The Vascular Impairment of Cognition Classification Consensus Study

Introduction: Numerous diagnostic criteria have tried to tackle the variability in clinical manifestations and problematic diagnosis of vascular cognitive impairment (VCI) but none have been universally accepted. These criteria have not been readily comparable, impacting on clinical diagnosis rates and in turn prevalence estimates, research, and treatment. / Methods: The Vascular Impairment of Cognition Classification Consensus Study (VICCCS) involved participants (81% academic researchers) from 27 countries in an online Delphi consensus study. Participants reviewed previously proposed concepts to develop new guidelines. / Results: VICCCS had a mean of 122 (98–153) respondents across the study and a 67% threshold to represent consensus. VICCCS redefined VCI including classification of mild and major forms of VCI and subtypes. It proposes new standardized VCI-associated terminology and future research priorities to address gaps in current knowledge. / Discussion: VICCCS proposes a consensus-based updated conceptualization of VCI intended to facilitate standardization in research

Medycyna i Społeczeństwo. Materiały konferencyjne

Ze wstępu: "Z inicjatywy i pod patronatem Krakowskiej Szkoły Wyższej im. Andrzeja Frycza Modrzewskiego w Krakowie odbyła się w styczniu 2003 r. konferencja naukowa lekarzy, farmaceutów, biochemików, filozofów, fizjopatologów, farmakologów i klinicystów, których rozważania skupiały się wokół obszernego tematu „MED YCYNAISPOŁECZEŃSTWO Spotkanie otworzył JM Rektor Prof. KSW dr hab. Zbigniew Maciąg. Rektor wyraził podziękowanie wykładowcom i wyraził głęboką nadzieję, że kolejny numer wydawnictwa Szkoły Acta Academiae Modrevianae, złożony z wybranych prac prezentowanych na konferencji, służył będzie społeczeństwu."(...

Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study

INTRODUCTION: Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2. METHODS: We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI. RESULTS: Six survey rounds comprising 65-79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders-Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging. DISCUSSION: The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders-Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration

Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study

INTRODUCTION: Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2. METHODS: We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI. RESULTS: Six survey rounds comprising 65–79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders–Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging. DISCUSSION: The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders–Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Supported by F. Hoffmann–La Roche