Cerebral venous thrombosis: diagnosis dilemma

Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment

CHInese medicine NeuroAiD efficacy on stroke recovery - Extension study (CHIMES-E): A multicenter study of long-term efficacy

© 2015 S. Karger AG, Basel. Background: The CHInese Medicine NeuroAiD Efficacy on Stroke recovery (CHIMES) study was an international randomized double-blind placebo-controlled trial of MLC601 (NeuroAiD) in subjects with cerebral infarction of intermediate severity within 72 h. CHIMES-E (Extension) aimed at evaluating the effects of the initial 3-month treatment with MLC601 on long-term outcome for up to 2 years. Methods: All subjects randomized in CHIMES were eligible for CHIMES-E. Inclusion criteria for CHIMES were age ≥18, baseline National Institute of Health Stroke Scale of 6-14, and pre-stroke modified Rankin Scale (mRS) ≤1. Initial CHIMES treatment allocation blinding was maintained, although no further study treatment was provided in CHIMES-E. Subjects received standard care and rehabilitation as prescribed by the treating physician. mRS, Barthel Index (BI), and occurrence of medical events were ascertained at months 6, 12, 18, and 24. The primary outcome was mRS at 24 months. Secondary outcomes were mRS and BI at other time points. Results: CHIMES-E included 880 subjects (mean age 61.8 ± 11.3; 36% women). Adjusted OR for mRS ordinal analysis was 1.08 (95% CI 0.85-1.37, p = 0.543) and mRS dichotomy ≤1 was 1.29 (95% CI 0.96-1.74, p = 0.093) at 24 months. However, the treatment effect was significantly in favor of MLC601 for mRS dichotomy ≤1 at 6 months (OR 1.49, 95% CI 1.11-2.01, p = 0.008), 12 months (OR 1.41, 95% CI 1.05-1.90, p = 0.023), and 18 months (OR 1.36, 95% CI 1.01-1.83, p = 0.045), and for BI dichotomy ≥95 at 6 months (OR 1.55, 95% CI 1.14-2.10, p = 0.005) but not at other time points. Subgroup analyses showed no treatment heterogeneity. Rates of death and occurrence of vascular and other medical events were similar between groups. Conclusions: While the benefits of a 3-month treatment with MLC601 did not reach statistical significance for the primary endpoint at 2 years, the odds of functional independence defined as mRS ≤1 was significantly increased at 6 months and persisted up to 18 months after a stroke.Link_to_subscribed_fulltex

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Background And Objective: The objective of our study was to describe risk factors, mechanisms and outcome of young Asian women with ischemic stroke. Methods:Twelve tertiary-care centers in 8 Asian countries participated. Women aged 15-45 years were included if they had an ischemic stroke supported by neuroimaging. Data on age, risk factor history, stroke mechanism and discharge status were collected. Results: A total of 958 subjects were included, their mean age was 34 years. Large-vessel thrombosis comprised 24%, cerebral venous thrombosis 21%, cardioembolism 19% and small-vessel thrombosis 15%. The stroke risk factors included hypertension (29%), diabetes (14%), pregnancy (11%), valvular heart disease (10%) and cigarette smoking (3%). Anemia was found in 42%, and mortality was 4%, at discharge, 17% had modified Rankin score (mRS) \u3e4 and 83% mRS 0-3. Conclusion: Unlike among Caucasians, large-vessel thrombosis, cerebral venous thrombosis and cardioembolism are common among young Asian women with stroke. A high proportion are pregnancy-related. More studies are needed

Dual Small-Molecule Targeting of SMAD Signaling Stimulates Human Induced Pluripotent Stem Cells toward Neural Lineages

<div><p>Incurable neurological disorders such as Parkinson’s disease (PD), Huntington’s disease (HD), and Alzheimer’s disease (AD) are very common and can be life-threatening because of their progressive disease symptoms with limited treatment options. To provide an alternative renewable cell source for cell-based transplantation and as study models for neurological diseases, we generated induced pluripotent stem cells (iPSCs) from human dermal fibroblasts (HDFs) and then differentiated them into neural progenitor cells (NPCs) and mature neurons by dual SMAD signaling inhibitors. Reprogramming efficiency was improved by supplementing the histone deacethylase inhibitor, valproic acid (VPA), and inhibitor of p160-Rho associated coiled-coil kinase (ROCK), Y-27632, after retroviral transduction. We obtained a number of iPS colonies that shared similar characteristics with human embryonic stem cells in terms of their morphology, cell surface antigens, pluripotency-associated gene and protein expressions as well as their <i>in</i><i>vitro</i> and <i>in</i><i>vivo</i> differentiation potentials. After treatment with Noggin and SB431542, inhibitors of the SMAD signaling pathway, HDF-iPSCs demonstrated rapid and efficient differentiation into neural lineages. Six days after neural induction, neuroepithelial cells (NEPCs) were observed in the adherent monolayer culture, which had the ability to differentiate further into NPCs and neurons, as characterized by their morphology and the expression of neuron-specific transcripts and proteins. We propose that our study may be applied to generate neurological disease patient-specific iPSCs allowing better understanding of disease pathogenesis and drug sensitivity assays.</p></div

Generation and characterization of iPSCs from human dermal fibroblasts (HDFs).

<p>(A) Schematic diagram represents a protocol to generate iPSCs from HDFs by retroviral transduction. (B) Morphology of HDFs on day 1 post-transduction (i), non ESC-like colonies on day 8 (ii), ESC-like colonies on day 13 (iii), iPS colonies on iHFF plate (iv) and an iPS colony on Matrigel-coated plate (v), scale bar (i) and (iii) = 200 µm, (ii), (iv) and (v) = 500 µm. (C) RT-qPCR analysis of pluripotency- and fibroblast-associated genes in HDF, HDF-iPSC1 and Chula2.hES cells. (D) RT-PCR analysis of pluripotent genes, OCT4 and NANOG, of all the established iPS clones, HDF-iPSC2-6, as compared to Chula2.hES cells. (E) Representative immunofluorescent images of pluripotent transcription factors and cell surface antigens of HDF-iPSC1 as compared to Chula2.hES cells, scale bar = 100 µm.</p

Neural differentiation of HDF-derived iPSCs and characterization of differentiated neurons.

<p>(A) Schematic diagram represents the strategy to differentiate HDF-derived iPSCs into neural lineages using SMAD signaling inhibitors. (B) Morphological changes in HDF-iPSC1 cultures during neural differentiation; undifferentiated HDF-iPSC1 cells on day -1 (i), differentiated cells on day 2 (ii) and day 6 (iii), representative immunofluorescent images show the NEPC on day 6 (iv), NPC on day 9 (v) and post-mitotic neuron on day 28 (vi) of differentiation as examined by PAX6, NESTIN and TUJ1 markers, respectively. Cell nuclei were stained with DAPI. Scale bar = 100 µm. (C) RT-qPCR analysis of pluripotency- and neural-associated genes in NEPCs on day 6 and mature neuron on day 28 of differentiation as compared to those of undifferentiated HDF-iPSC1 cells (arbitrarily set at 1).</p