Ischemic Stroke Due to Middle Cerebral Artery M1 Segment Occlusion : Latvian Stroke Register Data

Publisher Copyright: © 2015 by Elina Pucite.The occlusion of middle cerebral artery (MCA) is the most common cause of ischemic stroke. A retrospective single centre analysis of ischemic stroke was conducted using data from the Latvian Stroke Register in the period from January 2013 till December 2014. The study included 478 patients who had confirmed MCA occlusion using computed tomography angiography (CTA). Half of the patients were males-237 (49.6%), average age 69.51, average age of females was 74.58 years. Cardioembolic stroke was the most common cause of MCA M1 segment occlusion in 294 (61.5%) cases. Small cerebral artery occlusion was not a cause of M1 MCA occlusion. The reperfusion therapy group consisted of 209 patients and the conservative therapy group of 269 patients. Both groups presented similar neurological status when they were admitted to hospital. However, the reperfusion therapy group had better neurological status (NIHSS 6.82) than in the conservative therapy group (NIHSS 8.2) at the time period when patients were discharged from hospital (p < 0.05). There were more cases of good functional outcome (39.2%) and less of poor (34.5%) in the reperfusion group, as well as less mortality-7.6%. Middle cerebral artery (MCA) is the most common site of stroke and the most common cause of its occlusion is cardioembolism. There is high incidence of recurrence of stroke due to M1 MCA occlusion. Both groups presented a similar neurological status on admission, but more improvement was seen in the reperfusion therapy group after discharge of patients from hospital. The functional outcome was also better in the reperfusion therapy group.publishersversionPeer reviewe

Non-Alcoholic Steatohepatitis, Liver Cirrhosis and Hepatocellular Carcinoma: The Molecular Pathways

Non-alcoholic steatohepatitis (NASH) is growing into global problem, mainly due to NASH-induced cirrhosis and hepatocellular carcinoma (HCC), that can develop either subsequently to cirrhosis or preceding it. In addition, NASH-induced cirrhosis constitutes a significant fraction of cases diagnosed as cryptogenic cirrhosis. Thus, there is a need for deeper understanding of the molecular basis, leading to liver steatosis, then—to the associated inflammation seen in NASH, loss of liver architecture and cirrhosis, followed or paralleled by carcinogenesis and HCC. Insulin resistance, increased hepatic iron level, and certain cytokines, including TNF-α and IL-6 derived from extrahepatic adipose tissues, can trigger the chain of events. The imbalance between leptin and adiponectin is important as well. These markers remain important during the whole course from NASH through liver cirrhosis to HCC. The molecular pathogenesis substantiates treatment: hypertriglyceridemia can be lowered by low calorie diet; mTOR complex can become inhibited by physical activity and metformin; cholesterol synthesis, RAF/MAPK1/ERK and p21 pathway by statins; inflammation by pentoxyfillin, and kinases (in HCC) by sorafenib. Bidirectional regulation of telomere attrition, senescence and p21 pathway, restoration of wild-type p53 activity and regulation of miRNA network represent attractive future treatment options. Focusing on relevant molecular pathways allows deeper understanding of NASH pathogenesis, leading to identification of predictive markers and treatment targets

Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis

Background Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven. Purpose To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment. Material and Methods In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT. All patients were selected for treatment based on clinical criteria, multimodal computed tomography (CT) imaging. Eighty-four patients were treated with bridging IVT followed by EVT; 62 patients were treated with EVT only. Results Bridging therapy did not influence endovascular procedure time (P = 0.71) or number of attempts needed (P = 0.63). Bleeding from any site was more common in the bridging group (27, 32%) vs. the EVT group (12, 19%) (P = 0.09). Functional independence modified Rankin Scale after 90 days was slightly higher in the bridging group (44%) vs. the EVT group (42%) (P = 0.14). Mortality did not differ significantly at 90 days: 17% in the bridging group vs. 21% in EVT alone (P = 0.57). Both treatment methods showed high recanalization rates: 94% in the bridging group and 89% for EVT alone. Conclusion Bridging treatment in LVO did not show benefits or elevated risks of complications in comparison to EVT only. The bridging group did not show significantly better neurological outcome or significant impact on procedural parameters vs. EVT alonepublishersversionPeer reviewe

Innovative Blood Tests for Hepatocellular Carcinoma: Liquid Biopsy and Evaluation of Systemic Inflammatory Reaction

Hepatocellular carcinoma (HCC) is an aggressive tumour associated with dismal prognosis. To improve the outcome, early diagnostics is important. At present, classical HCC diagnostics is based on evaluation of risk factors, surveillance in cirrhotic patients, preference for non-invasive diagnosis by computed tomography or magnetic resonance imaging and biopsy confirmation in controversial cases. However, ambiguous radiological presentation, biopsy-related complications or insufficient representation of the pathology in the tissue core are well-known problems. Panel assessment of microRNAs has diagnostic and prognostic value; thus, in future, microRNA-based liquid biopsy could partially reduce the need for core biopsies. Systemic inflammatory reaction (SIR), characterised mainly by neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and Glasgow prognostic score, may have prognostic value and can be incorporated in criteria for certain treatment approaches, e.g., becoming an adjunct to Milan criteria. Thus, innovations in HCC diagnostics are expected in the field of miRNA-based liquid biopsy for diagnosis/prognosis and SIR for prognosis/selection of treatment

Diagnostic Algorithm of Hepatocellular Carcinoma: Classics and Innovations in Radiology and Pathology

In the global cancer statistics, hepatocellular carcinoma (HCC) ranges sixth by incidence and second by oncological mortality. The risk factors comprise hepatitis B and C virus infection, non-alcoholic steatohepatitis, as well as long-lasting peroral exposure to alcohol or aflatoxins. Liver cirrhosis is the most important single predisposing factor. Ultrasonography once per 6 months is recommended for surveillance in cirrhotic patients. Computed tomography (CT) and magnetic resonance imaging (MRI) represent the gold standard of non-invasive diagnostics while core biopsy and/or immunohistochemistry (IHC) are indicated for controversial and non-cirrhotic HCC cases. Molecular classification is under development. At present, classics of HCC diagnostics is based on evaluation of risk factors, surveillance in cirrhotic patients, preference for CT or MRI-confirmed non-invasive diagnosis and biopsy proof in equivocal cases. Diffusion-weighted imaging and hepatobiliary phase contrasting represent significant recent developments in MRI. Contrast-enhanced ultrasonography is recommended by some but not all guidelines. Positron emission tomography is advocated before liver transplantation to detect extrahepatic metastases but has limited role in the initial diagnostic evaluation of liver nodule. Innovations are expected in the field of molecular diagnostics, including IHC panels and novel antigens, e.g. clathrin and bile salt export pump protein, and development of molecular classification

Acute Ischemic Stroke Endovascular Treatment of Patients with Large Vessel Occlusions

Publisher Copyright: © 2015 by Arturs Balodis.Mechanical thrombectomy as an active treatment method has recently been chosen for patients with large artery occlusions and thrombolysis beyond a time window. The aim of our study was to evaluate the results of endovascular treatment in patients with proximal vessel occlusion, compare this group with the intravenous thrombolysis group, and to identify possible criteria of active treatment. The prospective study included 81 patients hospitalised in the Pauls Stradiņš Clinical University Hospital due to acute ischemic stroke; 48 of them received mechanical thrombectomy and 33-intravenous thrombolysis. Thrombectomy (TE) was performed using Solitaire FR stent retrievers. The NIHSS score was used for evaluation of early therapy results and mRS (modified Rankin Scale) was used for late therapy results. ASPECTS was used to define the lesion size using imaging on admission and after treatment. Median NIHSS on admission was higher in the TE group-16 (range 12 to 19) than in the TL group-12 (range 8 to 15) (p 0.05). Frequency of symptomatic intracerebral haemorrhages was similar in the groups. Mechanical thrombectomy can achieve better late functional outcome than thrombolysis in a selected patients group.publishersversionPeer reviewe

Systemic Inflammatory Reaction in Gastric Cancer: Biology and Practical Implications of Neutrophil to Lymphocyte Ratio, Glasgow Prognostic Score and Related Parameters

Gastric cancer induces systemic inflammatory reaction (SIR) manifesting with changes in counts of white blood cell fractions and concentrations of acute phase proteins, clotting factors and albumins. Thus, protein-based scores or blood cell ratios (neutrophil to lymphocyte ratio (NLR); platelet to lymphocyte ratio (PLR)) are used to evaluate SIR. SIR tests are biologically justified by multiple clinically important and fascinating events including bone marrow activation, development of immune-suppressing immature myeloid cells, generation of pre-metastatic niches and neutrophil extracellular trap formation from externalised DNA network in bidirectional association with platelet activation. Despite biological complexity, clinical SIR assessment is widely available, patient-friendly and economically feasible. Here we present concise review on NLR, PLR, Glasgow prognostic score and fibrinogen – parameters that have prognostic role regarding overall, cancer-free and cancer-specific survival in early and advanced cases. Tumour burden can be predicted helping in preoperative detection of serosal or lymph node involvement. Practical consequences abound, including selection of surgical approach in respect to tumour burden, adjustments in treatment intensity by prognosis or evaluation of chemotherapy response. The chapter also scrutinises main controversies including different cut-off levels. Future developments should include elaboration of complex scores as described here. SIR parameters should be wisely incorporated in patients’ treatment

Remembering and Forgetting: the Issues of the Philosophy of Memory

Pētījums “Atcerēšanās un aizmiršana: atmiņas filosofiskas interpretācijas problēma” veltīts klasiskam un fundamentālam filosofijas konceptam – atmiņas fenomenam. Atmiņas problēma šī darba ietvaros ir skatīta divās konceptuālās ievirzēs un divās vēsturiskās perspektīvās, kas abas iezīmē noteiktu risinājumu iespēju un saistītas ar problēmas interpretāciju. Vienu perspektīvu veido klasiskās jeb antīkās filosofijas (darba ietvaros analizēta Platona un Aristoteļa atmiņas izpratne) atmiņas problēmas interpretācija, bet otra ietver Bergsona un Delēza atmiņas teoriju apskatu, kas var tikt dēvēts par moderno problēmas interpretāciju. Atmiņa kā filosofiska problēma pati par sevi ir vispārīgs un ģenerāls uzstādījums, bet tekstu analīze pieprasa tā nozīmes konkretizāciju, ko piedāvā atcerēšanās un aizmiršanas konceptu dažādu aspektu aplūkojums.This investigation Remembering, Recollection and Forgetting: the Issue of Philosophy of Memory is dedicated to the fundamental and classical issue of philosophy – the concept of memory. The frame of this issuein this research is regarded both in two historical and conceptual perspectives, which both suggests opportunity for interpretation. The first one is constituted by classical paradigm (the theories of memory by Plato and Aristotle), another one contains the interpretation given by french philosophers Henry Bergson and Gilles Deleuze, and on the contrary could be called modern approach to the phenomenon of memory. The concept of memory as main problem of this investigation has much to do with particular aspects recollection and forgetting is the most certain aspects which enlightens the complex phenomenon of memory

Time and Memory: Conception of Durée and its Origins in Henry Bergson’s Philosophy

Anotācija Promocijas darbs veltīts laika un atmiņas fenomenu izpratnei A. Bergsona filozofijā, uzmanības centrā novietojot ilgstamības idejas ģenēzes problēmu. Darba mērķis ir kritiski izvērtēt Bergsona laika koncepcijas vienotību un iekšējo saskaņotību. Par darba pētniecisko metodi ir izvēlēta ‘problēmu vēstures’ perspektīva. Šī pieeja ļauj rekonstruēt Bergsona argumentus, pārformulēt viņa mācībā atrodamās problēmas un meklēt eventuālos risinājumus 19./20. gadsimta mijas teorētisko diskusiju ietvaros. ‘Problēmu vēstures’ perspektīva sniedz iespēju Bergsona koncepcijā saskatīt līdz šim neaplūkotus risinājumus vairākām nozīmīgām un mūsdienās aktuālām filozofiskām problēmām – laika pārdzīvojumam apziņā un tā konceptualizācijai, ķermeņa un gara nošķīruma problēmai, tēla jēdziena interpretācijai, atmiņas kā virtuāla fenomena izpratnei. Atslēgvārdi: ilgstamība, laiks, telpa, ķermenis/gars, atmiņaAnnotation My PhD thesis discusses concepts of time and memory in H. Bergson’s philosophy, focusing on genetic foundation of the idea of duration in his early works. The basic purpose of this study is critical investigation of Bergsonian conception of time as unified and consistent theory. ‘History of problems’ here provides the main methodological tool in reconstructing the arguments and dealing with issues that Bergsonian theory face competing with different theories at the turn of the 20th century. This sort of approach in Bergsonian studies gives a chance to come forward with new-found solutions to such substantial and ever urgent philosophical issues as conscious experience of time and its conceptualization, the mind–body relation, interpretation of the notion of image, conception of memory as virtual phenomenon. Key words: duration, time, space, mind–body relation, memor