Problems of Selecting an Anticoagulant for Secondary Stroke Prevention in Patients with Atrial Fibrillation

The article describes the urgent problem of ischemic stroke prevention in patients with atrial fibrillation. It is proved that ischemic stroke in combination with AF is the most severe in terms of developing stable motor and speech disorders and disability. The frail older patients, as well as patients with swallowing disorders and reduced medical adherence present a special problem from this point of view. The most famous clinical studies on secondary prevention of cardioembolic stroke are RE-LY, ROCKET-AF, and ARISTOTLE. Based on subanalyses of randomized controlled trials, direct oral anticoagulants demonstrated a favorable efficacy profile in patients with atrial fibrillation and stroke/ transient ischemic attack, but the level of knowledge on each of them remained different. A number of advantages of rivaroxaban for primary and secondary prevention of stroke in patients with atrial fibrillation, including the elderly and patients with cognitive impairments and swallowing disorders, have been demonstrated. © 2021 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.Relationships and Activities. This publication was supported by AO Bayer (PPM_RIVRU00581)

Онкологические заболевания как фактор риска криптогенного инсульта

Background. Acute cerebrovascular accidents in general, and ischemic stroke (IS) in particular, are multifactorial diseases with extremely heterogeneous and numerous risk factors. Currently, despite the development of diagnostic technologies, in approximately 25% of patients with IS, it is not possible to establish the causes and mechanism of its development (the so-called cryptogenic stroke (CS)). As a result, the optimal antithrombotic therapy as a secondary prevention in this group of patients remains unclear. It was found that in 10–20% of patients with CS, a detailed examination reveals oncological disease (OD). It is highly likely that the prevalence of OD-related IS will increase. The US National Cancer Registry has shown a decrease in mortality in patients with the most common forms of OD (lung, breast and prostate cancer). Active OD is a proven risk factor for both IS and other thrombotic events. Nevertheless, about 50% of IS in patients with OD are classified as cryptogenic, which significantly exceeds this indicator in patients without OD. This is associated with the difficulties of intravital diagnosis of the pathogenetic mechanism of IS in patients with OD.Aim of study. Raising the awareness of neurologists about the causes, pathogenetic mechanisms of development and methods of diagnosing IS in patients with OD.Materials and methods. To achieve this goal, the results of scientific research on OD as a risk factor for CS were analyzed. The literature search was carried out in electronic search engines Scopus, eLibrary, PubMed by keywords: ischemic stroke, cryptogenic stroke, cancer, pathogenesis of ischemic stroke. Scientific articles published between 1856 and 2021 were selected for analysis, 45% of the analyzed papers on the topic of CS were published not earlier than 5 years ago.Conclusion. The cause of the development of ischemic stroke can be both the oncological process itself and the means and methods of treating it. Despite the fact that in 10–20% of patients with cryptogenic stroke OD is diagnosed, the question remains whether patients with cryptogenic ischemic stroke should be screened for latent oncological pathology, and if so, how full should the screening be. Typical radiological patterns of ischemic stroke in patients with OD are multiple foci of acute cerebral ischemia in different vascular areas, which may indicate a cardioembolic nature and, in particular, non-bacterial thrombotic endocarditis. Lifetime diagnosis of the causes of cryptogenic stroke in patients with OD is extremely difficult. Since nonbacterial thrombotic endocarditis is one of the leading causes of cryptogenic stroke in the setting of cancer, it is advisable to perform transesophageal echocardiography due to the low sensitivity of transthoracic echocardiography. Актуальность. Острые нарушения мозгового кровообращения в целом, и ишемический инсульт (ИИ) в частности, являются мультифакториальными заболеваниями с чрезвычайно гетерогенными и многочисленными факторами риска. В настоящее время, несмотря на развитие диагностических технологий, приблизительно у 25% пациентов с ИИ не удается установить причины и механизм развития такового (так называемый криптогенный инсульт (КИ)), в результате чего остается неясной оптимальная антитромботическая терапия в качестве вторичной профилактики в этой группе пациентов. Установлено, что у 10—20% пациентов с КИ при детальном обследовании выявляют онкологическое заболевание (ОЗ). Весьма вероятно, что распространенность ИИ, связанного с ОЗ, будет увеличиваться. Национальный онкологический регистр США показал снижение летальности у пациентов с наиболее распространенными формами ОЗ (рак легких, груди и простаты). Активное ОЗ является доказанным фактором риска как ИИ, так и других тромботических событий. Тем не менее около 50% ИИ у пациентов с ОЗ классифицируют как криптогенные, что значительно превышает данный показатель у пациентов без онкологической патологии. Это связано со сложностями прижизненной диагностики патогенетического механизма ИИ у больных с ОЗ.Цель работы. Повышение информированности врачей-неврологов о причинах, патогенетических механизмах развития и методах диагностики ИИ у пациентов с ОЗ.Материал и методы. Для достижения поставленной цели были проанализированы результаты научных исследований, посвященных ОЗ как фактору риска КИ. Поиск литературы проводили в электронных поисковых системах Scopus, eLibrary, PubMed по ключевым словам: ишемический инсульт, криптогенный инсульт, онкологическое заболевание, патогенез ишемического инсульта. Для анализа были отобраны научные статьи, опубликованные в период с 1856 по 2021 год. 45% проанализированных работ, посвященных теме КИ, опубликованы не более 5 лет назад.Заключение. Причиной развития ишемического инсульта может быть как сам онкологический процесс, так и средства и методы лечения такового. Несмотря на то что у 10—20% пациентов с криптогенным инсультом выявляют онкологическое заболевание, в настоящее время остается открытым вопрос, должны ли пациенты с криптогенным ишемическим инсультом проходить скрининг на скрытую онкологическую патологию, и если да, то в каком объеме. Типичными радиологическими паттернами ишемического инсульта у больных с онкологическими заболеваниями являются множественные очаги острой церебральной ишемии в разных сосудистых бассейнах, которые могут указывать на кардиоэмболическую природу и в частности небактериальный тромботический эндокардит. Прижизненная диагностика причин криптогенного инсульта у пациентов с онкологической патологией крайне сложна. Так как одной из ведущих причин криптогенного инсульта на фоне онкологического заболевания является небактериальный тромботический эндокардит, целесообразно выполнение чреспищеводной эхокардиографии в связи с низкой чувствительностью трансторакальной эхокардиографии.

Effect of cerebrolysin on motor function restoration during medical rehabilitation

Ischemic stroke (IS) is characterized by high prevalence, mortality, and disability rates. Therapy aimed to correct one biochemical or molecular stage of ischemic cell injury fails to treat stroke, suggesting that it is necessary to study multimodality therapy affecting several related pathophysiological components.The paper gives the January 2016 results of the randomized placebo-controlled multicenter study CARS that demonstrates the positive effect of cerebrolysin versus placebo according to the primary efficiency criterion, the Action Research Arm Test (ARAT) scale, and total outcome 90 days after disease onset. The investigation enrolled mainly patients with moderate or severe IS (the mean National Institutes of Health Stroke Scale score was 9 at baseline).The specific features of the CARS study versus those of other clinical trials of neuroprotectors were the initial planning of narrower end criteria of efficiency (arm motor function recovery whereas the major goal of many investigations was to reduce mortality rates), as well as a standardized rehabilitation program in both treatment groups. Such investigations did not previously take into account the nature and volume of rehabilitation measures although the latter may have a substantial impact on the outcome of stroke.The CARS study is the first among the previously conducted clinical trials of neuroprotectors, which has attained the primary objective (to restore motor function), which opens up fresh opportunities for the medical support of rehabilitation measures in patients with IS

The role of smoking in the development of strokes at a young age

Stroke in young patients is a disease based on a number of known specific non-modifiable factors (extracranial artery dissection, thrombophilia, open oval hole, etc.) and modifiable factors (alcohol abuse, drug use, smoking, etc.), in combination leading to the development of pathology. Smoking is a generally recognized modifiable risk factor for stroke, which is directly proportional to the number of tobacco-containing products smoked. Quitting smoking is the basis of prevention, an integral part of the treatment and rehabilitation of stroke patients. If it is impossible to completely give up smoking combustible cigarettes, it is advisable to switch to alternative smokeless products. This article presents the results of current studies on the comparative assessment of the risk of stroke in young people when using combustible cigarettes and smokeless analogues

Evaluation of Synthetic Conditions for H3PO4 Chemically Activated Rice Husk and Preparation of Honeycomb Monoliths

Activated carbons in this work were prepared from rice husk by phosphoric acid activation followed by alkaline desilication. Pseudo-random selection of 16 rice husk samples was subjected to carbonization at the following conditions: 0.5 to 2 h of activation time, 300-600 ºС and Н3РО4/precursor (wt/wt) impregnation ratio of 0.5 to 2. Concentration of NaOH desilication solution varied from 0.5 to 2M. It was found that out of the four factors impregnation ratio is clearly the strongest and at the impregnation ratio of 2 for 1 h at 500 °C N2 BET-surface area reaches 1690 m2/g (SBET (Ar)=2492 m2/g) while pore volume becomes 1.95 cm3/g. Elemental analysis showed highest carbon content for this sample (87.96%). All samples have insignificant amount of Si and traces of metals, but considerable amount of phosphorus. Blocks of honeycomb structure prepared from Ca-montmorillonite and desilicated carbonized rice husk (impregnation ratio is 1.5, 1 h at 600 ºC) have BET-surface area obtained by thermal desorption of argon up to 856 m2/g

THE OPTIONS FOR PROGNOSIS OF THE OUTCOME OF ISCHEMIC STROKE IN YOUNG PATIENTS

Objective. To develop criteria for prognosis of the outcome of ischemic stroke, taking into account age, dynamics of state assessment, the Rankin and NIHSS scales readings and the fact of disability in the long-term period. The universal reliable criteria, that allow to predict the outcome of ischemic stroke, have not been developed yet. Material and methods. The study group consisted of 246 patients with ischemic stroke aged 18 to 44 who were observed from 2008 to 2021. Results. It is impossible to predict disability in a long-term period of ischemic stroke reliably. Predicting the outcome of ischemic stroke using the Rankin and NIHSS scales is significant in the acute period and allows to predict the dynamics of recovery in mild and moderate cases. Conclusion. The predictive value of the integrative indicators of the patient's condition, assessed by the Rankin and NIHSS scales, has been established. © Gusev V.V., Lvova O.A., Kovtun O.P., Shamalov N.A., Sergeev A.P., Sergeeva M.V., Medvedeva D.A., 2024

In-vitro Optimization of Nanoparticle-Cell Labeling Protocols for In-vivo Cell Tracking Applications.

Recent advances in theranostic nanomedicine can promote stem cell and immune cell-based therapy. Gold nanoparticles (GNPs) have been shown to be promising agents for in-vivo cell-tracking in cell-based therapy applications. Yet a crucial challenge is to develop a reliable protocol for cell upload with, on the one hand, sufficient nanoparticles to achieve maximum visibility of cells, while on the other hand, assuring minimal effect of particles on cell function and viability. Previous studies have demonstrated that the physicochemical parameters of GNPs have a critical impact on their efficient uptake by cells. In the current study we have examined possible variations in GNP uptake, resulting from different incubation period and concentrations in different cell-lines. We have found that GNPs effectively labeled three different cell-lines - stem, immune and cancer cells, with minimal impairment to cell viability and functionality. We further found that uptake efficiency of GNPs into cells stabilized after a short period of time, while GNP concentration had a significant impact on cellular uptake, revealing cell-dependent differences. Our results suggest that while heeding the slight variations within cell lines, modifying the loading time and concentration of GNPs, can promote cell visibility in various nanoparticle-dependent in-vivo cell tracking and imaging applications.Israel Cancer Research Fund (ICRF), Israel Science Foundation (grant #749/14), Christians for Israel Chair in Medical Researc

Unsolved Issues of Atherosclerosis Prevention and of Adequate Lipid-lowering Therapy in Patients with Acute Ischemic Cerebrovascular Accident

The existing system of medical care for patients with acute cerebrovascular accident of atherothrombotic genesis, namely lipid metabolism disorders, the modern evidence base for lipid-lowering therapy in this category of patients and the feasibility of interdisciplinary interaction of cardiologists and neurologists were discussed at a meeting of the expert council of cardiologists and neurologists in Moscow on 2021 July 7

A pilot study of application of the Stroke Riskometer mobile app for assessment of the course and clinical outcomes of COVID-19 among hospitalised patients

Early determination of COVID-19 severity and health outcomes could facilitate better treatment of patients. Different methods and tools have been developed for predicting outcomes of COVID-19, but they are difficult to use in routine clinical practice. Methods: We conducted a prospective cohort study of inpatients aged 20-92 years, diagnosed with COVID-19 to determine whether their individual 5-year absolute risk of stroke at the time of hospital admission predicts the course of COVID-19 severity and mortality. The risk of stroke was determined by the Stroke Riskometer mobile application. Results: We examined 385 patients hospitalised with COVID-19 (median age 61 years). The participants were categorised based on COVID-19 severity: 271 (70.4%) to the “Not severe” and 114 (29.6%) to the “Severe” groups. The median risk of stroke the next day after hospitalisation was significantly higher among patients in the Severe group (2.83 [95% CI 2.35-4.68]) vs the Not severe group (1.11 [95% CI 1.00–1.29]). The median risk of stroke and median systolic blood pressure (SBP) were significantly higher among non-survivors (12.04 [95% CI 2.73-21.19]) and (150 [95% CI 140-170]) vs survivors (1.31 [95% CI 1.14-1.52]), 134 [95% CI 130-135]), respectively. Those who spent more than 2.5 hours a week on physical activity were 3.1 times more likely to survive from COVID-19. Those who consumed more than one standard alcohol drink a day, or suffered with atrial fibrillation, or had poor memory were 2.5, 2.3, and 2.6 times more likely not to survive from COVID-19, respectively. Conclusions: High risk of stroke, physical inactivity, alcohol intake, high SBP, and atrial fibrillation are associated with severity and mortality of COVID-19. Our findings suggest that the Stroke Riskometer app could be used as a simple predictive tool of COVID-19 severity and mortality