Current perspectives on cardioembolic ischemic stroke in very old patients

The oldest old population (>85 years of age) represents the faster growing segment of the elderly in developed countries. Cardioembolic infarction (CI) accounts for 14%-30% of all cerebral infarcts and is the most severe ischemic stroke subtype with the highest in-hospital mortality. Also, CI is associated with a low frequency of symptom-free patients at hospital discharge and presents a non-negligible risk of early embolic recurrence. Moreover, cardioembolic stroke is the acute cerebrovascular event most commonly found in very old subjects. However, some clinical aspects of the natural course of the disease in very old patients are still poorly defined. The present report presents an updated review of relevant aspects of CI related to clinical manifestations, biological characteristics, prognostic implications, and treatment strategies, which may contribute to improving the quality of care and outcome of acute cardioembolic stroke in very old patients. The most relevant aspects of CI are discussed based on the data published in the literature and the authors' experience in the management of stroke patients, collected from the hospital-based "Sagrat Cor Hospital of Barcelona Stroke Registry". The following aspects are commented on: epidemiologic data and risk factors, clinical characteristics, cardiac workup studies, special cardioembolic clinical features, outcome, thrombolytic therapy, antithrombotic treatment, and indications for future research lines. Cardioembolic stroke is an important topic in the frontier between cardiology and vascular neurology. The impact of CI on the patients' health and quality of life, health care systems, and society in general merits an in-depth review of current clinical issues, advances, and controversies

Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia?

Background: Data from different studies suggest a favourable association between pretreatment with statins or hypercholesterolemia and outcome after ischaemic stroke. We examined whether there were differences in in-hospital mortality according to the presence or absence of statin therapy in a large population of first-ever ischaemic stroke patients and assessed the influence of statins upon early death and spontaneous neurological recovery. Methods: In 2,082 consecutive patients with first-ever ischaemic stroke collected from a prospective hospital-based stroke registry during a period of 19 years (1986-2004), statin use or hypercholesterolemia before stroke was documented in 381 patients. On the other hand, favourable outcome defined as grades 0-2 in the modified Rankin scale was recorded in 382 patients. Results: Early outcome was better in the presence of statin therapy or hypercholesterolemia (cholesterol levels were not measured) with significant differences between the groups with and without pretreatment with statins in in-hospital mortality (6% vs 13.3%, P = 0.001) and symptom-free (22% vs 17.5%, P = 0.025) and severe functional limitation (6.6% vs 11.5%, P = 0.002) at hospital discharge, as well as lower rates of infectious respiratory complications during hospitalization. In the logistic regression model, statin therapy was the only variable inversely associated with in-hospital death (odds ratio 0.57) and directly associated with favourable outcome (odds ratio 1.32)

New strategies invonving upconverting nanoparticles for determining moderate temperatures by luminescence thermometry

Producción CientíficaHere we analyze alternative luminescence thermometry techniques to FIR, such as intensity ratio luminescence thermometry between the emission arising from two electronic levels that are not necessarily thermally coupled, but that show different evolutions with temperature, and lifetime luminescence nanothermometry in (Ho,Tm,Yb):KLu(WO4)2 and (Er,Yb):NaY2F5O nanoparticles. (Ho,Tm,Yb):KLu(WO4)2 nanoparticles exhibited a maximum relative sensitivity of 0.61% K−1, similar to that achievable in Er-doped systems, which are the upconverting systems presenting the highest sensitivity. From another side, (Er,Yb):NaY2F5O nanocrystals show great potentiality as thermal sensors at the nanoscale for moderate temperatures due to the incorporation of additional non-radiative relaxation mechanisms that shorten the emission lifetime generated by the oxygen present in the structure when compared to (Er,Yb):NaYF4 nanoparticles exhibiting the highest upconversion efficiency. We used those nanoparticles for ex-vivo temperature determination by laser induced heating in chicken breast using lifetime-based thermometry. The results obtained indicate that these techniques might constitute alternatives to FIR with potential applications for the determination of moderate temperatures, with sensitivities comparable to those that can be achieved by FIR or even higher.Ministerio de Economía, Industria y Competitividad (Projects MAT2013-47395-C4-1-4-R, and TEC2014-55948-R)Catalan Government (Projects no. 2014SGR1358 and 2013FI_B 01032

Formation of polycrystalline TiO2 on the ablated surfaces of RbTiOPO4 single crystals by thermal annealing

We investigated the structural effects that ultrafast laser ablation has on RbTiOPO4 (RTP) single crystals. Raman scattering analysis revealed that a polycrystalline layer of RTP substituted the original material on the surface of the microstructured areas which is mainly responsible for the roughness observed in these structures. A later annealing treatment on the ablated samples resulted in the formation of a layer of sub-micrometric particles of TiO2 in a mixed form of anatase and rutile, due to the decomposition of the polycrystalline RTP layer. This allows the development of engineering strategies to fabricate RTP–TiO2 composites, with mixed properties, that might allow the combination of the non-linear optical properties of RTP and the light dispersive and electrical properties of TiO2.This work was supported by the EU Framework 7 under project FP7-SPA-2010-263044, by the Spanish Government under projects MAT2011-29255-C02-02, TEC2010-21574-C02-02, FIS2009-09522 and CSD2007-00013, by Generalitat de Catalunya under project 2009SGR235 and by Junta de Castilla y León under project SA086A12-2

Surface ablation of RbTiOPO4 by femtosecond laser

We report here the results obtained in surface ablation of RbTiOPO4 single crystals by femtosecond laser. We fabricated and characterized one-dimensional (1D) diffraction gratings with different lattice spacings of 15 and 20 μm, and with a sub-modulation of the period introduced in the later. The optical and electronic microscopy characterization and filling factor analysis of these diffraction gratings are reported. We also show that the roughness generated on the grooves by the ablation process can be improved by chemical etching.This work was partially funded by the European Commission under the Seventh Framework Program under Project Cleanspace FP7-SPACE-2010-1-GA-263044, supported by the Spanish Government under Projects PI09/90527, TEC2009-09551, AECID A/024560/09, FIS2009-09522, HOPE CSD2007-00007 and SAUUL CSD2007-00013 (Consolider-Ingenio 2010), by Catalan Government under Projects 2009SGR235 and 2009SGR549, by Junta de Castilla y León under Project GR27, and by the Research Center on Engineering of Materials and Systems (EMaS) of the URV. J.J.C. is supported by the Education and Science Ministry of Spain and European Social Fund under the Ramón y Cajal program, RYC2006-858. We also acknowledge support from the Centro de Laseres Pulsados, CLPU, Salamanca, Spain

Mapping Temperature Distribution Generated by Photothermal Conversion in Graphene Film Using Er,Yb:NaYF4 Nanoparticles Prepared by Microwave-Assisted Solvothermal Method

This study analyzes the mapping of temperature distribution generated by graphene in a glass slide cover after illumination at 808 nm with a good thermal resolution. For this purpose, Er,Yb:NaYF4 nanoparticles prepared by a microwave-assisted solvothermal method were used as upconversion luminescent nanothermometers. By tuning the basic parameters of the synthesis procedure, such as the time and temperature of reaction and the concentration of ethanol and water, we were able to control the size and the crystalline phase of the nanoparticles, and to have the right conditions to obtain 100% of the β hexagonal phase, the most efficient spectroscopically. We observed that the thermal sensitivity that can be achieved with these particles is a function of the size of the nanoparticles and the crystalline phase in which they crystallize. We believe that, with suitable changes, these nanoparticles might be used in the future to map temperature gradients in living cells while maintaining a good thermal resolution

Infarction in the territory of the anterior cerebral artery: clinical study of 51 patients

<p>Abstract</p> <p>Background</p> <p>Little is known about clinical features and prognosis of patients with ischaemic stroke caused by infarction in the territory of the anterior cerebral artery (ACA). This single centre, retrospective study was conducted with the following objectives: a) to describe the clinical characteristics and short-term outcome of stroke patients with ACA infarction as compared with that of patients with ischaemic stroke due to middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions, and b) to identify predictors of ACA stroke.</p> <p>Methods</p> <p>Fifty-one patients with ACA stroke were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986–2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 51 patients with ACA stroke were compared with those of the 1355 patients with MCA infarctions and 232 patients with PCA infarctions included in the registry.</p> <p>Results</p> <p>Infarctions of the ACA accounted for 1.3% of all cases of stroke (<it>n </it>= 3808) and 1.8% of cerebral infarctions (<it>n </it>= 2704). Stroke subtypes included cardioembolic infarction in 45.1% of patients, atherothrombotic infarction in 29.4%, lacunar infarct in 11.8%, infarct of unknown cause in 11.8% and infarction of unusual aetiology in 2%. In-hospital mortality was 7.8% (<it>n </it>= 4). Only 5 (9.8%) patients were symptom-free at hospital discharge. Speech disturbances (odds ratio [OR] = 0.48) and altered consciousness (OR = 0.31) were independent variables of ACA stroke in comparison with MCA infarction, whereas limb weakness (OR = 9.11), cardioembolism as stroke mechanism (OR = 2.49) and sensory deficit (OR = 0.35) were independent variables associated with ACA stroke in comparison with PCA infarction.</p> <p>Conclusion</p> <p>Cardioembolism is the main cause of brain infarction in the territory of the ACA. Several clinical features are more frequent in stroke patients with ACA infarction than in patients with ischaemic stroke due to infarction in the MCA and PCA territories.</p

Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients

<p>Abstract</p> <p>Background</p> <p>Ischemic stroke caused by infarction in the territory of the posterior cerebral artery (PCA) has not been studied as extensively as infarctions in other vascular territories. This single centre, retrospective clinical study was conducted a) to describe salient characteristics of stroke patients with PCA infarction, b) to compare data of these patients with those with ischaemic stroke due to middle cerebral artery (MCA) and anterior cerebral artery (ACA) infarctions, and c) to identify predictors of PCA stroke.</p> <p>Findings</p> <p>A total of 232 patients with PCA stroke were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 232 patients with PCA stroke were compared with those of the 1355 patients with MCA infarctions and 51 patients with ACA infarctions included in the registry.</p> <p>Infarctions of the PCA accounted for 6.8% of all cases of stroke (<it>n </it>= 3808) and 9.6% of cerebral infarctions (<it>n </it>= 2704). Lacunar infarction was the most frequent stroke subtype (34.5%) followed by atherothrombotic infarction (29.3%) and cardioembolic infarction (21.6%). In-hospital mortality was 3.9% (<it>n </it>= 9). Forty-five patients (19.4%) were symptom-free at hospital discharge. Hemianopia (odds ratio [OR] = 6.43), lacunar stroke subtype (OR = 2.18), symptom-free at discharge (OR = 1.92), limb weakness (OR = 0.10), speech disorders (OR = 0.33) and cardioembolism (OR = 0.65) were independent variables of PCA stroke in comparison with MCA infarction, whereas sensory deficit (OR = 2.36), limb weakness (OR = 0.11) and cardioembolism as stroke mechanism (OR = 0.43) were independent variables associated with PCA stroke in comparison with ACA infarction.</p> <p>Conclusions</p> <p>Lacunar stroke is the main subtype of infarction occurring in the PCA territory. Several clinical features are more frequent in stroke patients with PCA infarction than in patients with ischaemic stroke due to infarction in the MCA and ACA territories. In-hospital mortality in patients with PCA territory is low.</p

Clinical predictors of lacunar syndrome not due to lacunar infarction

Background: Lacunar syndrome not due to lacunar infarct is poorly characterised. This single centre, retrospective study was conducted to describe the clinical characteristics of patients with lacunar syndrome not due to lacunar infarct and to identify clinical predictors of this variant of lacunar stroke. Methods: A total of 146 patients with lacunar syndrome not due to lacunar infarction were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 146 patients with lacunar syndrome not due to lacunar infarct were compared with those of the 733 patients with lacunar infarction. Results: Lacunar syndrome not due to lacunar infarct accounted for 16.6% (146/879) of all cases of lacunar stroke. Subtypes of lacunar syndromes included pure motor stroke in 63 patients, sensorimotor stroke in 51, pure sensory stroke in 14, atypical lacunar syndrome in 9, ataxic hemiparesis in 5 and dysarthria-clumsy hand in 4. Valvular heart disease, atrial fibrillation, sudden onset, limb weakness and sensory symptoms were significantly more frequent among patients with lacunar syndrome not due to lacunar infarct than in those with lacunar infarction, whereas diabetes was less frequent. In the multivariate analysis, atrial fibrillation (OR = 4.62), sensorimotor stroke (OR = 4.05), limb weakness (OR = 2.09), sudden onset (OR = 2.06) and age (OR = 0.96) were independent predictors of lacunar syndrome not due to lacunar infarct. Conclusions: Although lacunar syndromes are highly suggestive of small deep cerebral infarctions, lacunar syndromes not due to lacunar infarcts are found in 16.6% of cases. The presence of sensorimotor stroke, limb weakness and sudden onset in a patient with atrial fibrillation should alert the clinician to the possibility of a lacunar syndrome not due to a lacunar infarct

Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality

Background: There is a paucity of clinical studies focused specifically on intracerebral haemorrhages of subcortical topography, a subject matter of interest to clinicians involved in stroke management. This single centre, retrospective study was conducted with the following objectives: a) to describe the aetiological, clinical and prognostic characteristics of patients with thalamic haemorrhage as compared with that of patients with internal capsule-basal ganglia haemorrhage, and b) to identify predictors of in-hospital mortality in patients with thalamic haemorrhage. Methods: Forty-seven patients with thalamic haemorrhage were included in the '' Sagrat Cor Hospital of Barcelona Stroke Registry '' during a period of 17 years. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The region of the intracranial haemorrhage was identified on computerized tomographic (CT) scans and/or magnetic resonance imaging (MRI) of the brain. Results: Thalamic haemorrhage accounted for 1.4% of all cases of stroke (n = 3420) and 13% of intracerebral haemorrhage (n = 364). Hypertension (53.2%), vascular malformations (6.4%), haematological conditions (4.3%) and anticoagulation (2.1%) were the main causes of thalamic haemorrhage. In-hospital mortality was 19% (n = 9). Sensory deficit, speech disturbances and lacunar syndrome were significantly associated with thalamic haemorrhage, whereas altered consciousness (odds ratio [OR] = 39.56), intraventricular involvement (OR = 24.74) and age (OR = 1.23), were independent predictors of in-hospital mortality. Conclusion: One in 8 patients with acute intracerebral haemorrhage had a thalamic hematoma. Altered consciousness, intraventricular extension of the hematoma and advanced age were determinants of a poor early outcome