Leki przeciwpłytkowe w profilaktyce i leczeniu udaru niedokrwiennego mózgu

Udar mózgu jest drugą przyczyną śmierci i pierwszą przyczyną niepełnosprawności wśród osób dorosłych na świecie. Roczna światowa zapadalność na udar mózgu wynosi 15 milionów przypadków. Obecnie nie ma leków, które przywracałyby funkcję uszkodzonej tkance. Opieka nad pacjentem w ostrej fazie udaru polega na próbie przywrócenia drożności zamkniętego naczynia, zapobieganiu wczesnym i odległym powikłaniom udaru oraz jak najwcześniejszej rehabilitacji. Dotychczas udowodniono skuteczność 3 metod w zmniejszaniu niepełnosprawności i śmiertelności z powodu udaru mózgu — leczenia na oddziale udarowym, leczenia trombolitycznego oraz leczenia kwasem acetylosalicylowym. Niniejszy artykuł zawiera przegląd badań i aktualnych wytycznych dotyczących stosowania leków przeciwpłytkowych w prewencji pierwotnej i wtórnej oraz w leczeniu ostrej fazy udaru niedokrwiennego mózg

Ostra reakcja hipertensyjna w udarze niedokrwiennym mózgu

Podwyższone ciśnienie tętnicze (≥ 140/90 mm Hg) dotyczy 75% chorych z udarem niedokrwiennym mózgu, przy czym u około połowy z nich stwierdza się nadciśnienie w wywiadzie. Samo stwierdzenie podwyższonego ciśnienia tętniczego podczas udaru mózgu nie uprawnia do rozpoznania nadciśnienia tętniczego, ponieważ w okresie ostrym choroby występuje spontaniczne obniżenie ciśnienia tętniczego, mimo braku specyficznego leczenia, dlatego dla omawianego zjawiska właściwsze wydaje się pojęcie „ostrej reakcji hipertensyjnej”. Wpływ ostrej reakcji hipertensyjnej na rokowanie po udarze nie jest jasny. Istnieją przesłanki przemawiające zarówno za obniżaniem ciśnienia tętniczego, jak i za pozostawianiem go bez leczenia w ostrej fazie udaru mózgu. Wiadomo jednak, że obniżone ciśnienie tętnicze w udarze może się wiązać ze zwiększoną śmiertelnością. Randomizowane badania nie dostarczyły przekonujących dowodów umożliwiających wdrożenie jednoznacznej strategii postępowania z nadciśnieniem tętniczym w udarze niedokrwiennym mózgu. Konieczne są dalsze badania, w których zostaną ocenione korzyści oraz zagrożenia związane z terapią ostrej reakcji hipertensyjnej u chorych z udarem niedokrwiennym mózgu

Nova DAQ, System Architecture, Data Combiner and Timing System

NOvA (E929) is a long baseline experiment that will search for neutrino oscillations. There will be one detector near the beam source at Fermilab, and one detector in northern Minnesota. The DAQ system for the far detector collects over-threshold hits from over 450,000 channels of scintillator readouts, sorts the time-stamped data packets and archives selected time periods of data for transmission and processing. While a simple point-to-point protocol is used for the first level of data collection, Ethernet was chosen as the fabric for the rest of the DAQ. The packet time-stamp and overall system synchronization is based on two common-view GPS trained clock oscillators, one at each site. The present design cost-effectively satisfies the experiment's moderate speed and data volume requirements

Results from a data acquisition system prototype project using a switch-based event builder

A prototype of a high bandwidth parallel event builder has been designed and tested. The architecture is based on a simple switching network and is adaptable to a wide variety of data acquisition systems. An eight channel system with a peak throughput of 160 Megabytes per second has been implemented. It is modularly expandable to 64 channels (over one Gigabyte per second). The prototype uses a number of relatively recent commercial technologies, including very high speed fiber-optic data links, high integration crossbar switches and embedded RISC processors. It is based on an open architecture which permits the installation of new technologies with little redesign effort. 5 refs., 6 figs

Mu2e Technical Design Report

The Mu2e experiment at Fermilab will search for charged lepton flavor violation via the coherent conversion process mu- N --> e- N with a sensitivity approximately four orders of magnitude better than the current world's best limits for this process. The experiment's sensitivity offers discovery potential over a wide array of new physics models and probes mass scales well beyond the reach of the LHC. We describe herein the preliminary design of the proposed Mu2e experiment. This document was created in partial fulfillment of the requirements necessary to obtain DOE CD-2 approval.Comment: compressed file, 888 pages, 621 figures, 126 tables; full resolution available at http://mu2e.fnal.gov; corrected typo in background summary, Table 3.

Supplementary Material for: Aortic stiffness is independently associated with intracranial carotid artery calcification in patients with ischemic stroke

Background and aims Intracranial carotid artery calcification (ICAC), as a strong contributor to the occurrence of ischemic stroke, might be present in the medial or intimal arterial layer. Traditional cardiovascular risk factors (CVRFs) are associated with ICAC; however, its association with new markers of vascular function are less understood. The paper aims to evaluate the relationship between carotid-femoral pulse wave velocity (CF-PWV) and ICAC subtypes. Methods We enrolled 65 patients with ischemic stroke. CF-PWV, systolic, diastolic, mean blood pressure, and pulse pressure (SBP, DBP, MBP, PP) were measured within 6±2 days after stroke onset, CT was performed within 24 hours. ICAC on the stroke site was classified by two methods: volume- and score-based. Tertiles of ICAC volume were determined, and low-grade ICAC (T1) was regarded as a reference. According to the score-based method, (dominant) medial and (dominant) intimal ICAC subtypes were determined. Data were analysed with multivariate logistic regression. Results Medial and intimal ICAC subtypes were found in 34 (52%) and 24 (37%) patients, respectively. In 11% of patients no ICAC calcifications were found. CF-PWV was higher in patients with high-grade ICAC (OR=1.56, 95%CI=1.03-2.35, p=0.035). CF-PWV was higher in patients with the medial ICAC subtype (OR=1.60, 95%CI=1.00-2.55, p=0.049) after adjustment for traditional CVRFs. Conclusions Our study demonstrates that among patients with ischemic stroke, aortic stiffness is independently associated with ICAC, and that medial ICAC, compared with intimal ICAC, is accompanied by more advanced aortic stiffness

Supplementary Material for: Aortic stiffness is independently associated with intracranial carotid artery calcification in patients with ischemic stroke

Background and aims Intracranial carotid artery calcification (ICAC), as a strong contributor to the occurrence of ischemic stroke, might be present in the medial or intimal arterial layer. Traditional cardiovascular risk factors (CVRFs) are associated with ICAC; however, its association with new markers of vascular function are less understood. The paper aims to evaluate the relationship between carotid-femoral pulse wave velocity (CF-PWV) and ICAC subtypes. Methods We enrolled 65 patients with ischemic stroke. CF-PWV, systolic, diastolic, mean blood pressure, and pulse pressure (SBP, DBP, MBP, PP) were measured within 6±2 days after stroke onset, CT was performed within 24 hours. ICAC on the stroke site was classified by two methods: volume- and score-based. Tertiles of ICAC volume were determined, and low-grade ICAC (T1) was regarded as a reference. According to the score-based method, (dominant) medial and (dominant) intimal ICAC subtypes were determined. Data were analysed with multivariate logistic regression. Results Medial and intimal ICAC subtypes were found in 34 (52%) and 24 (37%) patients, respectively. In 11% of patients no ICAC calcifications were found. CF-PWV was higher in patients with high-grade ICAC (OR=1.56, 95%CI=1.03-2.35, p=0.035). CF-PWV was higher in patients with the medial ICAC subtype (OR=1.60, 95%CI=1.00-2.55, p=0.049) after adjustment for traditional CVRFs. Conclusions Our study demonstrates that among patients with ischemic stroke, aortic stiffness is independently associated with ICAC, and that medial ICAC, compared with intimal ICAC, is accompanied by more advanced aortic stiffness

Blood pressure in acute ischemic stroke: Challenges in trial interpretation and clinical management: Position of the ESH Working Group on Hypertension and the Brain

Altered blood pressure (BP) is a common phenomenon in acute ischemic stroke (AIS), with high BP being the most frequent scenario. The pathophysiology of BP changes in AIS is complex and only partially understood. The available evidence indicates that extremely high BP during AIS is associated with a poor outcome. Importantly, the observed relationship between BP and stroke outcome may or may not be causally related. Higher baseline BPs in focal cerebral ischemia may indicate preexisting hypertension, but may also be an effect of both nonspecific and stroke-related factors. Although antihypertensive therapy effectively reduces BP in AIS, studies on early BP lowering in AIS produce conflicting results in terms of functional outcome and mortality. Systematic reviews on BP management in AIS did not result in clinically applicable conclusions in general. However, the investigation on the effect of BP and its alterations in AIS are hampered by various important methodological issues. This position statement was prepared by a group of experts from the European Society of Hypertension and invited neurologists to discuss the main reasons for the discrepancies in the current evidence on the prognosis and treatment of altered BP in AIS which should be taken into account in future studies. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved