Characteristics and clinical significance of magnetic resonance imaging manifestations of cerebral small vessel disease in acute period of ischemic stroke

Aim. To characterize magnetic-resonance imaging manifestations of cerebral small vessel disease in patients in acute period of ischemic stroke and to study their clinical significance. Methods. 56 patients in acute period of ischemic stroke and 10 subjects without stroke and cognitive impairment were examined. Magnetic-resonance tomography of the brain was performed to all patients and healthy subjects to assess the quantity of lacunes, perivascular spaces, leukoaraiosis and cerebral microbleeds. Based on analysis of 4 neurovisual markers of cerebral small vessel disease, an integral scale was developed. The obtained results were evaluated in association with a wide spectrum of clinical data. Results. Patients in acute period of ischemic stroke are characterized by higher quantitative expression of certain markers of cerebral small vessel disease in comparison with healthy age-matched subjects. A correlation between neuroimaging markers of cerebral small vessel disease and patients` age, severity and etiology of the stroke was observed. Total expression of cerebral small vessel disease, assessed using the integral score turned out to be higher in the group of stroke than in healthy elderly persons. High rates of certain markers of cerebral small vessel disease and integral scale score are associated with low mobility of patients, neurological deficiency and dependence in daily activities on discharge. Conclusion. In patients in acute period of ischemic stroke, higher expression of certain markers of cerebral small vessel disease and their total evidence were revealed in comparison with healthy people; total indicator of cerebral small vessel disease expression is associated with neurological and functional outcome of acute period of stroke

Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth

A relationship between the integrated assessment of magnetic resonance imaging markers for cerebral small vessel disease and the clinical and functional status in the acute period of ischemic stroke

Cerebral small vessel disease (CSVD) is the most common neurological pathological process and contributes to the process of aging and to the development of dementia and stroke. At the same time, the role of CSVD as a factor influencing the course of acute ischemic stroke (IS) has been little studied. There is no generally accepted magnetic resonance imaging (MRI) scale for the integrated assessment of CSVD markers.Objective: to carry out an integrated assessment of the MRI manifestations of CSVD in acute ischemic stroke and to analyze a correlation of both individual markers and the final indicator with the clinical and functional status of patients.Patients and methods. 100 patients with acute IS were examined. All patients underwent standard clinical, laboratory and instrumental examinations, as well as brain MRI estimating the number of lacunae, visible perivascular spaces (PVSs) and leukoaraiosis. The number of cerebral microbleeds (CMBs) was additionally calculated in 57 patients. Integral scale scores were calculated by gradation and summation of four MRI markers of CSVD.Results. The patients with acute IS showed the high representativeness of individual markers for CSVD. The values of MRI markers for CSVD correlated with age, education level, and cardiovascular parameters in patients. An integrated CSVD severity assessment scale was developed. The overall manifestations of CSVD, which were assessed using this scale, were associated with the severity of a stenotic process in the brachycephalic arteries, with BP levels at admission, ejection fraction, hyperglycemia, and atherogenic index of blood lipids. The high CSVD score was also correlated with low mobility and more severe disability in patients being discharged from hospital. The high severity of CSVD was associated with lower neurological deficit regression during inpatient treatment. Subgroup analysis showed the greatest negative impact of CSVD on the severity of stroke in female patients, young and middle-aged ones, diabetics, as well as in patients with noncardioembolic stroke, a smallsized focus, and intima-media thickening.Conclusion. The overall manifestations of CSVD calculated using the original scale based on the analysis of the degree of lacunae, PVSs, leukoaraiosis, and CMBs are associated with premorbid cardiovascular parameters in a patient and are important indicators for the neurological, cognitive, and functional outcomes of acute IS

Role of the intact hemisphere in determining the rehabilitation potential in the acute period of ischemic stroke: a diffusion and perfusion model

The promising approaches to determining the rehabilitation potential of ischemic stroke (IS) patients include an assessment of the microstructural integrity of the brain matter by diffusion tensor imaging (DTI), the main indicator of which is fractional anisotropy (FA). The role of the intact hemisphere in the rehabilitation process after IS remains a controversial subject. The hypothesis for the investigation is that the development of a diffusion and perfusion model (DPM) based on the assessment of FA in combination with data on cerebral blood flow velocity (CBFV) and the impact of the focus will be able to predict the patients' neurological status by the end of the acute period of IS. Objective: to investigate the role of diffusion and perfusion characteristics of the intact hemisphere in determining the rehabilitation potential in the acute period of IS and to develop a prognostic DPM.Patients and methods. The investigation enrolled 100 patients with IS and 10 individuals in the control group. All the examinees underwent brain MRI. Perfusion-weighted sequence without bolus injection of a contrast agent was used to quantify CBFV in 10 areas according to the Alberta stroke program early CT score (ASPECTS). Values for FA in 10 areas of both hemispheres were calculated using DTI findings. Neurological and functional statuses were evaluated over time with the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin scale.Results. The NIHSS score at discharge was associated with FA and CBFV in 4 and 6 of the 10 areas of the intact hemisphere, respectively. DPM for predicting the rehabilitation potential included the key parameters correlating with a discharge NIHSS score (in order of decreasing the significance): admission NIHSS value (r = 0.55; p < 0.001), the size of a focus (r = 0.42; p < 0.001), FA in the contralateral cingulum bundle FA (r = -0.28; p = 0.007), and CBFV in M2 white matter [r = -0.24; p = 0.025; R2 = 0.642; p(F) <0.001].Conclusion. In addition to the NIHSS score at admission, the size of a focus, DPM values (FA in the contralateral cingulum bundle and CBFV in the white matter) allow prediction of the rehabilitation potential in IS

The production of cyclopiazonic acid by Penicillium commune and cyclopiazonic acid and aflatoxins by Aspergillus flavus as affected by water activity and temperature on maize grains

The combined effects of water activity (aw) and temperature on mycotoxin production by Penicilium commune (cyclopiazonic acid - CPA) and Aspergillus flavus (CPA and aflatoxins - AF) were studied on maize over a 14-day period using a statistical experimental design. Analysis of variance showed a highly significant interaction (P 0.001) between these factors and mycotoxin production. The minimum aw/temperature for CPA production (2264 ng g-1 P. commune, 709 ng g-1 A. flavus) was 0.90 aw/30 °C while greatest production (7678 ng g-1 P. commune, 1876 ng g-1 A. flavus) was produced at 0.98 aw/20 °C. Least AF (411 ng g-1) was produced at 0.90 aw/20 °C and most (3096 ng g-1) at 0.98 aw/30 °C