Antithrombotic Medication for Cardioembolic Stroke Prevention

Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed

Ciència i tecnologia de la carn i dels productes carnis: passat i present

La carne ha sido, desde siempre, un alimento clave en la dieta de los seres humanos por sus propiedades nutritivas y sus características sensoriales. Los productos cárnicos han sido una forma de conservar la carne, que tradicionalmente se hacía por la experiencia acumulada y que actualmente se basa en conocimientos científicos. En el transcurso del siglo XX se produjo un avance extraordinario en la ciencia de la carne, en la gestión de la seguridad y calidad de la carne y productos cárnicos, en la diseminación de los conocimientos generados y en la innovación en la industria cárnica. En un futuro próximo se prevé que la carne seguirá siendo un elemento clave en la dieta humana y que la aplicación de las nuevas tecnologías tendrá un impacto importante en los procesos de transformación. Sin embargo, habrá que invertir esfuerzos para minimizar el impacto en el medio ambiente en relación con la cría y sacrificio de los animales y la transformación de la carne en productos cárnicos para conseguir que todo el proceso sea más sostenible.La carn ha estat, des de sempre, un aliment clau en la dieta dels éssers humans per les seves propietats nutritives i les seves característiques sensorials. Els productes carnis han estat una forma de conservar la carn, que tradicionalment es feia per l'experiència acumulada i que actualment es basa en coneixements científics. En el decurs del segle XX es va produir un avanç extraordinari en la ciència de la carn, en la gestió de la seguretat i qualitat de la carn i productes carnis, en la disseminació dels coneixements generats i en la innovació en la indústria càrnia. En un futur proper es preveu que la carn seguirà essent un element clau en la dieta humana i que l'aplicació de les noves tecnologies tindran un impacte important en els processos de transformació. No obstant això, caldrà esmerçar esforços per minimitzar l'impacte en el medi ambient pel que fa a la cria i sacrifici dels animals i la transformació de la carn en productes carnis per aconseguir que tot el procés sigui més sostenible

Ciència i tecnologia de la carn i dels productes carnis: passat i present

La carn ha estat, des de sempre, un aliment clau en la dieta dels éssers humans per les seves propietats nutritives i les seves característiques sensorials. Els productes carnis han estat una forma de conservar la carn, que tradicionalment es feia per l'experiència acumulada i que actualment es basa en coneixements científics. En el decurs del segle xx es va produir un avanç extraordinari en la ciència de la carn, en la gestió de la seguretat i qualitat de la carn i productes carnis, en la disseminació dels coneixements generats i en la innovació en la indústria càrnia. En un futur proper es preveu que la carn seguirà essent un element clau en la dieta humana i que l'aplicació de les noves tecnologies tindran un impacte important en els processos de transformació. No obstant això, caldrà esmerçar esforços per minimitzar l'impacte en el medi ambient pel que fa a la cria i sacrifici dels animals i la transformació de la carn en productes carnis per aconseguir que tot el procés sigui més sostenible.La carne ha sido, desde siempre, un alimento clave en la dieta de los seres humanos por sus propiedades nutritivas y sus características sensoriales. Los productos cárnicos han sido una forma de conservar la carne, que tradicionalmente se hacía por la experiencia acumulada y que actualmente se basa en conocimientos científicos. En el transcurso del siglo xx se produjo un avance extraordinario en la ciencia de la carne, en la gestión de la seguridad y calidad de la carne y productos cárnicos, en la diseminación de los conocimientos generados y en la innovación en la industria cárnica. En un futuro próximo se prevé que la carne seguirá siendo un elemento clave en la dieta humana y que la aplicación de las nuevas tecnologías tendrá un impacto importante en los procesos de transformación. Sin embargo, habrá que invertir esfuerzos para minimizar el impacto en el medio ambiente en relación con la cría y sacrificio de los animales y la transformación de la carne en productos cárnicos para conseguir que todo el proceso sea más sostenible

Angiogenesis, Neurogenesis and Neuroplasticity in Ischemic Stroke

Only very little is know about the neurovascular niche after cardioembolic stroke. Three processes implicated in neurorepair: angiogenesis, neurogenesis and synaptic plasticity, would be naturally produced in adult brains, but also could be stimulated through endogen neurorepair phenomena. Angiogenesis stimulation generates new vessels with the aim to increase collateral circulation. Neurogenesis is controlled by intrinsic genetic mechanisms and growth factors but also ambiental factors are important. The leading process of the migrating neural progenitor cells (NPCs) is closely associated with blood vessels, suggesting that this interaction provides directional guidance to the NPCs. These findings suggest that blood vessels play an important role as a scaffold for NPCs migration toward the damaged brain region. DNA microarray technology and blood genomic profiling in human stroke provided tools to investigate the expression of thousands of genes. Critical comparison of gene expression profiles after stroke in humans with those in animal models should lead to a better understanding of the pathophysiology of brain ischaemia. Probably the most important part of early recovery after stroke is limited capacity of penumbra/infarct neurones to recover. It became more clear in the last years, that penumbra is not just passively dying over time but it is also actively recovering. This initial plasticity in majority contributes towards later neurogenesis, angiogenesis and final recovery. Penumbra is a principal target in acute phase of stroke. Thus, the origin of newly formed vessels and the pathogenic role of neovascularization and neurogenesis are important unresolved issues in our understanding of the mechanisms after stroke. Biomaterials for promoting brain protection, repair and regeneration are new hot target. Recently developed biomaterials can enable and increase the target delivery of drugs or therapeutic proteins to the brain, allow cell or tissue transplants to be effectively delivered to the brain and help to rebuild damaged circuits. These new approaches are gaining clear importance because nanotechnology allows better control over material-cell interactions that induce specific developmental processes and cellular responses including differentiation, migration and outgrowth

Higher vertical jumping asymmetries and lower physical performance are indicators of increased injury incidence in youth team-sport athletes

To date, the literature looking at the association between injury-risk factors and actual injury incidence in young elite team-sports athletes is scarce. The main objective of the present study was to examine how modifiable factors may affect injury incidence. Eighty-one young elite team-sports athletes (age: u-14 to u-18) performed the countermovement jump (CMJ), a single leg CMJ (SLCMJ), the one-legged hop test (OLHT), a 30 m sprint test, the v-cut test, a repeated sprint ability and the 30-15 intermittent fitness test during the pre-season period. Inter-limb asymmetries were calculated for SLCMJ and OLHT. Injuries were recorded prospectively for the entirety of the 2017-2018 season. Comparison of injury and non-injury data was carried out using a two-way analysis of variance (ANOVA). Results of the ANOVA according to injury showed significant differences in CMJ (p = 0.01), SLCMJ on the lowest performing limb (p = 0.03) and SLCMJ asymmetry (< 0.001). Sex*injury interaction was significant from CMJ (p = 0.018) and 30-15 IFT (p = < 0.001). In conclusion, the current study indicated that athletes with greater inter-limb asymmetries, less vertical jump capacity and lower intermittent aerobic fitness had a greater predisposition to injury. Therefore, monitoring CMJ, aerobic performance and inter-limb asymmetries is recommended given their sensitivity to detect significant differences between injured and healthy youth athletes

Cerebral infarction in diabetes: Clinical pattern, stroke subtypes, and predictors of in-hospital mortality

BACKGROUND: To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke. METHODS: Diabetes was diagnosed in 393 (21.3%) of 1,840 consecutive patients with cerebral infarction included in a prospective stroke registry over a 12-year period. Demographic characteristics, cardiovascular risk factors, clinical events, stroke subtypes, neuroimaging data, and outcome in ischemic stroke patients with and without diabetes were compared. Predictors of in-hospital mortality in diabetic patients with ischemic stroke were assessed by multivariate analysis. RESULTS: People with diabetes compared to people without diabetes presented more frequently atherothrombotic stroke (41.2% vs 27%) and lacunar infarction (35.1% vs 23.9%) (P < 0.01). The in-hospital mortality in ischemic stroke patients with diabetes was 12.5% and 14.6% in those without (P = NS). Ischemic heart disease, hyperlipidemia, subacute onset, 85 years old or more, atherothrombotic and lacunar infarcts, and thalamic topography were independently associated with ischemic stroke in patients with diabetes, whereas predictors of in-hospital mortality included the patient's age, decreased consciousness, chronic nephropathy, congestive heart failure and atrial fibrillation CONCLUSION: Ischemic stroke in people with diabetes showed a different clinical pattern from those without diabetes, with atherothrombotic stroke and lacunar infarcts being more frequent. Clinical factors indicative of the severity of ischemic stroke available at onset have a predominant influence upon in-hospital mortality and may help clinicians to assess prognosis more accurately

Cerebral infarction in diabetes: Clinical pattern, stroke subtypes, and predictors of in-hospital mortality

BACKGROUND: To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke. METHODS: Diabetes was diagnosed in 393 (21.3%) of 1,840 consecutive patients with cerebral infarction included in a prospective stroke registry over a 12-year period. Demographic characteristics, cardiovascular risk factors, clinical events, stroke subtypes, neuroimaging data, and outcome in ischemic stroke patients with and without diabetes were compared. Predictors of in-hospital mortality in diabetic patients with ischemic stroke were assessed by multivariate analysis. RESULTS: People with diabetes compared to people without diabetes presented more frequently atherothrombotic stroke (41.2% vs 27%) and lacunar infarction (35.1% vs 23.9%) (P < 0.01). The in-hospital mortality in ischemic stroke patients with diabetes was 12.5% and 14.6% in those without (P = NS). Ischemic heart disease, hyperlipidemia, subacute onset, 85 years old or more, atherothrombotic and lacunar infarcts, and thalamic topography were independently associated with ischemic stroke in patients with diabetes, whereas predictors of in-hospital mortality included the patient's age, decreased consciousness, chronic nephropathy, congestive heart failure and atrial fibrillation CONCLUSION: Ischemic stroke in people with diabetes showed a different clinical pattern from those without diabetes, with atherothrombotic stroke and lacunar infarcts being more frequent. Clinical factors indicative of the severity of ischemic stroke available at onset have a predominant influence upon in-hospital mortality and may help clinicians to assess prognosis more accurately

Dorsolateral medullary ischemic infarction causing autonomic dysfunction and headache: a case report

Stroke can present, among other signs, with headache. Here, we describe the case of a man suffering from severe orbitary pain and autonomic dysfunction secondary to dorsolateral medullary ischemia. The anatomical relationship between lesion and symptomatology could be an indirect sign of hypothalamospinal tract involvement in the genesis of autonomic dysfunction and headache resembling a trigeminal autonomic cephalalgia

Effect of pre-stroke use of ACE inhibitors on ischemic stroke severity

BACKGROUND: Recent trials suggest that angiotensin-converting enzyme inhibitors (ACEI) are effective in prevention of ischemic stroke, as measured by reduced stroke incidence. We aimed to compare stroke severity between stroke patients who were taking ACEI before their stroke onset and those who were not, to examine the effects of pretreatment with ACEI on ischemic stroke severity. METHODS: We retrospectively studied 126 consecutive patients presenting within 24 hours of ischemic stroke onset, as confirmed by diffusion-weighted magnetic resonance imaging (DWI). We calculated the NIHSS score at presentation, as the primary measure of clinical stroke severity, and categorized stroke severity as mild (NIHSS [less than or equal to] 7), moderate (NIHSS 8–13) or severe (NIHSS [greater than or equal to] 14). We analyzed demographic data, risk-factor profile, blood pressure (BP) and medications on admissions, and determined stroke mechanism according to TOAST criteria. We also measured the volumes of admission diffusion- and perfusion-weighted (DWI /PWI) magnetic resonance imaging lesions, as a secondary measure of ischemic tissue volume. We compared these variables among patients on ACEI and those who were not. RESULTS: Thirty- three patients (26%) were on ACE-inhibitors. The overall median baseline NIHSS score was 5.5 (range 2–21) among ACEI-treated patients vs. 9 (range 1–36) in non-ACEI patients (p = 0.036). Patients on ACEI prior to their stroke had more mild and less severe strokes, and smaller DWI and PWI lesion volumes compared to non-ACEI treated patients. However, none of these differences were significant. Predictably, a higher percentage of patients on ACEI had a history of heart failure (p = 0.03). Age, time-to-imaging or neurological evaluation, risk-factor profile, concomitant therapy with lipid lowering, other antihypertensives or antithrombotic agents, or admission BP were comparable between the two groups. CONCLUSION: Our results suggest that ACE-inhibitors may reduce the clinical severity of stroke, as measured by NIHSS score. Further, larger-scale, prospective studies areneeded to validate our findings, and to elucidate the mechanism(s) of ACEImediated benefits in patients with ischemic stroke