Atorvastatin in stroke: a review of SPARCL and subgroup analysis

Statin therapy in patients with cardiovascular disease is associated with reduced incidence of stroke. The Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial showed daily treatment with 80 mg of atorvastatin in patients with a recent stroke or transient ischemic attack (TIA) reduced the incidence of fatal or nonfatal stroke by 16%. Several post hoc analyses of different subgroups followed the SPARCL study. They have not revealed any significant differences when patients were sorted by age, sex, presence of carotid disease or type of stroke, with the exception of intracranial hemorrhage as the entry event. Lower low-density lipoprotein cholesterol levels in addition to possible neuroprotective mechanisms due to atorvastatin treatment correlate with improved risk reduction. Although not predefined subgroups and subject to an insufficient power, these post hoc studies have generated new clinical questions. However, clinicians should avoid denying therapy based on such subgroup analysis. At this point, the best evidence powerfully demonstrates stroke and TIA patients should be prescribed high dose statin therapy for secondary stroke prevention

Propagación in-vitro de cuatro especies de orquídeas nativas de la región Cusco

El cultivo in vitro es una herramienta alternativa para la propagación de especies vegetales en forma masiva. En el presente trabajo se evaluó la germinación asimbiotica de las especies Epidendrum secundum, Rodriguezia longifolia, Bletia catenulata y Epidendrum spilatum en medio de cultivo Murashige y Skoog (M.S.) con tres suplementos orgánicos: agua de coco, pulpa de piña y pulpa de plátano. Las semillas provienen del Distrito de Pillcopata, Provincia de Paucartambo, Región Cusco. Se determinó el tiempo de germinación y su respuesta a tres medios de cultivo con los suplementos orgánicos, comparando con el medio testigo. Se estableció de manera artificial la división de la germinación en cinco etapas diferenciadas: imbibición, cambio de coloración por la transformación de protoplastidios en cloroplastos, inicio de la división celular, formación del protocormo y diferenciación de los órganos vegetativos. Este estudio demostró que el medio M.S suplementado con piña tiene una mejor respuesta a la germinación asimbiótica en las orquídeas Rodriguezia longifolia, Bletia catenulata y Epidendrum spilatum, mientras que para Epidendrum secundum el medio M.S. suplementado con plátano tiene la mejor respuesta a la germinación, de efecto menor es el medio suplementado con coco. El tiempo de germinación para Epidendrum secundum fue de 5 semanas, Bletia catenulata 8 semanas, Epidendrum spilatum 11 semanas y Rodriguezia longifolia 12 semanas. Se obtuvo un efecto positivo sobre la germinación de las semillas en medios con suplementos orgánicos

The Evolution of Transcranial Laser Therapy for Acute Ischemic Stroke, Including a Pooled Analysis of NEST-1 and NEST-2

Intravenous tissue plasminogen activator is the only proven therapy for acute ischemic stroke. Not enough patients are eligible for treatment and additional new therapies are needed. Recently, laser technology has been applied to acute ischemic stroke. This noninvasive technique uses near-infrared wavelengths applied to the scalp within 24 h of symptom onset. The mechanism is incompletely understood but may involve increased mitochondrial adenosine triphosphate production. Animal models demonstrated safety and efficacy warranting randomized controlled trials in humans. NEST-1 (phase 2) and NEST-2 (phase 3) confirmed the safety of transcranial laser therapy, although efficacy was not found in NEST-2. Pooled analysis of NEST-1 and NEST-2 revealed a significantly improved success rate in patients treated with laser therapy. Further phase 3 testing is planned and may create a new paradigm for the treatment of acute ischemic stroke

Impacto de um passivo ambiental petrolífero na área e na flora vascular nas margens do Lago Titicaca, Peru

[Introduccion]: For decades, crude oil in emulsion with formation waters flowed from a petroleum environmental passive on the shores of Titicaca Lake, [Objective]: Before it was raised, to estimate the land surface affected and degraded by said polluting sources and determine its effect on the flora and vegetation in Ahuallani, Puno-Peru. [Methodology]: An area was delimited by Landsat images, differentiating areas of greater or lesser impact using QGis software, georeferencing, later, the edges of the area in situ. Flora and vegetation were evaluated with 1-m2 quadrants distributed randomly. Data were analyzed using diversity indices and the Kruskall Wallis test according to homogeneous zones. [Results]: Total affected areas reached 96.54 ha, of which 94.8 ha (98.2 %) formed a dispersal zone (ZD) of the contaminating fluid, where a degraded surface of 29.7 ha was distinguished with absolute absence of vegetation and another ​​halophytes area of 65.1 ha. Besides, an area surrounding the well from which the crude oil gushed out (ZP) and a channel area (ZC) through which it flowed to ZD were spotted; both areas conformed 1.8 % of the affected extent. ZP showed greater floristic diversity with 22 species; the halophyte area only presented three. Density was statistically similar to 30.33 plants/m2 for ZP, 20.33 plants/m2 for ZC, and 13.67 plants/m2 for the halophyte area. Likewise, for ZP the H '= 0.90 ± 0.33a and the D = 0.72 ± 0.13, for ZC the H' = 0.90 ± 0.33a and the D = 0.67 ± 0.15, finally for ZD the H '= 0.16 ± 0.11b and the D = 0.49 ± 0.10, according to J 'ZP and ZD (19.35 % similarity), and the vegetation density ZD = 30.33, ZC = 20.33 and ZD = 13.67. [Conclusions]: ZD stands out for the natural abundance of Sarcocornia pulvinata, with the potential value to implement phytoremediation strategies in the locality.[Introducción]: Por décadas, petróleo crudo en emulsión con aguas de formación discurrieron desde un pasivo ambiental petrolífero a orillas del lago Titicaca; [Objetivo]: planteándose estimar la superficie terrestre afectada y degradada por dicha fuente contaminante y determinar su efecto en la flora y vegetación silvestre en Ahuallani, Puno-Perú. [Metodología]: Se delimitó el área mediante imágenes Landsat, diferenciándose zonas de mayor o menor impacto mediante software QGIS, georreferenciándose los bordes del área in situ; se evaluó la flora y vegetación con cuadrantes de 1 m2 distribuidos aleatoriamente, los datos se analizaron mediante índices de diversidad Shannon-Wiener, Simpson y Jaccard, y prueba de Kruskall Wallis según zonas homogéneas. [Resultados]: El área total afectada alcanzó 96.54 ha, de las cuales en 94.8 ha (98.2 %) conformaron una zona de dispersión (ZD) del fluido contaminante, donde se diferenció una superficie degradada de 29.7 ha con absoluta ausencia de vegetación y otra área de halófitas de 65.1 ha. Se diferencia además una zona circundante al pozo desde donde brotaba el petróleo crudo (ZP) y una zona del canal (ZC), ambas conformaron el 1.8 % del área afectada. Mayor diversidad florística presentó la ZP con 22 especies, el área de halófitas sólo presentó tres; la densidad fue estadísticamente similar con 30.33 plantas/m2 para la ZP, 20.33 plantas/m2 para ZC y 13.67 plantas/m2 para el área de halófitas. Así mismo, para ZP el H’ = 0.90±0.33a y la D = 0.72±0.13, para ZC el H’ = 0.90±0.33a y la D = 0.67±0.15, finalmente para ZD el H’ = 0.16±0.11b y la D = 0.49±0.10, según J’ ZP y ZD (19.35% similitud), y la densidad vegetacional ZD = 30.33, ZC = 20.33 y ZD = 13.67. [Conclusiones]: Resaltando en esta última la abundancia natural de Sarcocornia pulvinata, con potencial valor para implementar estrategias de fitorremediación en la localidad.[Introdução]: Durante décadas, o petróleo bruto em emulsões com águas de formação reflexionarão, a partir de um passivo ambiental petrolífero nas margens do lago Titicaca; [Objetivo]: Estimar a superfície terrestre afetada e degradada por essa fonte poluente e determinar seu efeito na flora e vegetação selvagem em Ahuallani, Puno-Peru. [Metodologia]: Delimitou a área por meio de imagens Landsat, diferenciando zonas de maior ou menor impacto por meio de software QGIS, georreferenciando as fronteiras da área no local; foram avaliadas flora e vegetação com quadrantes de 1 m2 distribuídos aleatoriamente, os dados foram analisados por meio dos índices de diversidade Shannon-Wiener, Simpson e Jaccard, e teste de Kuskall Wallis por zonas homogêneas.  A área total atingida atingiu 96.54 ha, dos quais 94.8 ha (98.2 %), formam uma área de dispersão (ZD) do fluido poluente, onde uma área degradada de 29,7 ha foi diferenciada com absoluta ausência de vegetação e outra área de halófitas de 65.1 ha. Além disso, uma área circundante ao poço de onde brotava o petróleo bruto (ZP) e uma zona do canal (ZC), ambas com 1,8 % da área afetada. Maior diversidade florística apresentou o P com 22 espécies, a área de halófitas apresentou apenas três; a densidade foi estatisticamente semelhante com 30.33 plantas/m2 para ZP, 20.33 plantas/m2 para ZC e 13.67 plantas/m2 para área de halófitas. Do mesmo modo, para o ZP o H’ = 0,90±0,33a e D = 0,72±0,13, para ZC el H’ = 0,90±0,33a e D = 0,67±0,15, finalmente para ZD o H’ = 0,16±0,11b e D = 0,49±0,10, de acordo com J’ ZP e ZD (19,35% de similaridade), e densidade vegetacional ZD = 30.33, ZC = 20.33 e ZD = 13.67.  Destacando nesta última a abundância natural de Sarcocornia pulvinata, com potencial valor para implementar estratégias de fitorreitação na localidade

Clinical-Neuropathological Correlations of Alzheimer's Disease and Related Dementias in Latino Volunteers.

Clinical, neuropsychological, and neurological procedures used to diagnose Alzheimer's disease (AD) and related dementias were largely developed and validated in well-educated, non-Latino, English-speaking populations. Sociocultural and genetic differences in Latinos might influence the accuracy of clinical diagnosis of AD and other dementias. We aim to compare the accuracy of the clinical diagnosis of AD and related dementias in Latinos with the corresponding neuropathological diagnosis. From the UCSD Alzheimer's Disease Research Center longitudinal cohort, we selected all Latino participants who had autopsy neuropathological studies from 1991 to 2017. Participants underwent annual neurological clinical evaluations, standard neuropsychological tests, neuroimaging, and genotyping of Apolipoprotein E. We calculated the sensitivity and specificity of the clinical diagnosis of AD against the primary pathological diagnosis. Of the 34 participants with a primary neuropathological diagnosis of AD, 33 (97.1%) were correctly clinically diagnosed as having AD at the last clinical evaluation, and 1 was incorrectly diagnosed with dementia with Lewy bodies. Of the 19 participants without a primary neuropathological diagnosis of AD, 8 were incorrectly clinically diagnosed with probable AD at the last clinic evaluation. The clinical diagnosis of AD at the last clinical evaluation had 97.1% sensitivity and 57.9% specificity for autopsy-verified AD. In this Latino cohort, clinicians predicted AD pathological findings with high sensitivity but moderate specificity. Tangle-only dementia was the most common misdiagnosis. Our study suggests that current procedures and instruments to clinically determine AD in Latinos have high sensitivity compared with neuropathology, but specificity needs to be improved

Clinical-Neuropathological Correlations of Alzheimer's Disease and Related Dementias in Latino Volunteers.

Clinical, neuropsychological, and neurological procedures used to diagnose Alzheimer's disease (AD) and related dementias were largely developed and validated in well-educated, non-Latino, English-speaking populations. Sociocultural and genetic differences in Latinos might influence the accuracy of clinical diagnosis of AD and other dementias. We aim to compare the accuracy of the clinical diagnosis of AD and related dementias in Latinos with the corresponding neuropathological diagnosis. From the UCSD Alzheimer's Disease Research Center longitudinal cohort, we selected all Latino participants who had autopsy neuropathological studies from 1991 to 2017. Participants underwent annual neurological clinical evaluations, standard neuropsychological tests, neuroimaging, and genotyping of Apolipoprotein E. We calculated the sensitivity and specificity of the clinical diagnosis of AD against the primary pathological diagnosis. Of the 34 participants with a primary neuropathological diagnosis of AD, 33 (97.1%) were correctly clinically diagnosed as having AD at the last clinical evaluation, and 1 was incorrectly diagnosed with dementia with Lewy bodies. Of the 19 participants without a primary neuropathological diagnosis of AD, 8 were incorrectly clinically diagnosed with probable AD at the last clinic evaluation. The clinical diagnosis of AD at the last clinical evaluation had 97.1% sensitivity and 57.9% specificity for autopsy-verified AD. In this Latino cohort, clinicians predicted AD pathological findings with high sensitivity but moderate specificity. Tangle-only dementia was the most common misdiagnosis. Our study suggests that current procedures and instruments to clinically determine AD in Latinos have high sensitivity compared with neuropathology, but specificity needs to be improved

Using Biomarkers to Predict Memantine Effects in Alzheimer's Disease: A Proposal and Proof-Of-Concept Demonstration.

Memantine's benefits in Alzheimer's disease (AD) are modest and heterogeneous. We tested the feasibility of using sensitivity to acute memantine challenge to predict an individual's clinical response. Eight participants completed a double-blind challenge study of memantine (placebo versus 20 mg) effects on autonomic, subjective, cognitive, and neurophysiological measures, followed by a 24-week unblinded active-dose therapeutic trial (10 mg bid). Study participation was well tolerated. Subgroups based on memantine sensitivity on specific laboratory measures differed in their clinical response to memantine, some by large effect sizes. It appears feasible to use biomarkers to predict clinical sensitivity to memantine

Biochemical markers in vascular cognitive impairment associated with subcortical small vessel disease - A consensus report

Background: Vascular cognitive impairment (VCI) is a heterogeneous entity with multiple aetiologies, all linked to underlying vascular disease. Among these, VCI related to subcortical small vessel disease (SSVD) is emerging as a major homogeneous subtype. Its progressive course raises the need for biomarker identification and/or development for adequate therapeutic interventions to be tested. In order to shed light in the current status on biochemical markers for VCI-SSVD, experts in field reviewed the recent evidence and literature data. Method: The group conducted a comprehensive search on Medline, PubMed and Embase databases for studies published until 15.01.2017. The proposal on current status of biochemical markers in VCI-SSVD was reviewed by all co-authors and the draft was repeatedly circulated and discussed before it was finalized. Results: This review identifies a large number of biochemical markers derived from CSF and blood. There is a considerable overlap of VCI-SSVD clinical symptoms with those of Alzheimer's disease (AD). Although most of the published studies are small and their findings remain to be replicated in larger cohorts, several biomarkers have shown promise in separating VCI-SSVD from AD. These promising biomarkers are closely linked to underlying SSVD pathophysiology, namely disruption of blood-CSF and blood-brain barriers (BCB-BBB) and breakdown of white matter myelinated fibres and extracellular matrix, as well as blood and brain inflammation. The leading biomarker candidates are: elevated CSF/blood albumin ratio, which reflects BCB/BBB disruption; altered CSF matrix metalloproteinases, reflecting extracellular matrix breakdown; CSF neurofilment as a marker of axonal damage, and possibly blood inflammatory cytokines and adhesion molecules. The suggested SSVD biomarker deviations contrasts the characteristic CSF profile in AD, i.e. depletion of amyloid beta peptide and increased phosphorylated and total tau. Conclusions: Combining SSVD and AD biomarkers may provide a powerful tool to identify with greater precision appropriate patients for clinical trials of more homogeneous dementia populations. Thereby, biomarkers might promote therapeutic progress not only in VCI-SSVD, but also in AD. © 2017 The Author(s)