122 research outputs found
Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere
Background and purpose: To assess dynamic cerebral autoregulation (CA) in patients with
acute ischaemic stroke of undetermined aetiology, within 72 h of stroke onset.
Materials and methods: In 6 patients with ischaemic stroke of undetermined aetiology (aged
66 9 years, National Institutes of Health Stroke Scale [NIHSS] score on admission: 4.0,
range: 4–11), selected based on screening of 118 consecutive ischaemic stroke patients and in
14 volunteers (aged 62 10 years), we continuously monitored RR intervals (RRI), mean
arterial pressure (MAP) by means of photoplethysmography, mean cerebral blood flow
velocity (CBFV) using transcranial Doppler ultrasonography, end-tidal CO2 (ETCO2) and
respiration during 2-min deep breathing paced at 6 min1 (0.1 Hz). To assess CA, we
evaluated the impact of breathing-induced MAP oscillations on fluctuations of CBFV in
the hemispheres with stroke, the non-involved hemispheres and randomly selected hemispheres of controls by applying cross-spectral analysis and calculating coherence, transfer
function gain (CBFV–MAP gain) and phase shift angle between the two oscillating signals.
Results: Phase shift angle between MAP and CBFV oscillations showed values >0 and was
significantly reduced in the hemispheres without stroke as compared to controls (0.39 0.95
vs. 1.59 0.33 rad, p = 0.015), whereas in the hemispheres with stroke, phase shift angle did
not differ significantly from that observed in the control hemispheres. Clinical status of
stroke patients significantly improved at discharge from the hospital (NIHSS: 2.0, range: 1–8,
p = 0.028).
Conclusions: During the first days of ischaemic stroke of undetermined aetiology, dynamic
cerebral autoregulation is compromised in the non-affected hemisphere, but not in the
hemisphere with ischaemic lesio
The effect of insulin and sulodexide (Vessel Due F) on diabetic foot syndrome. Pilot study in elderly patients
Celem pracy była ocena skuteczności stosowania insuliny wraz z sulodeksydem (mieszanina
80% pochodnych heparyny i 20% siarczanu dermatanu) w leczeniu owrzodzeń stóp oraz
określenie ich wpływu na mikrokrążenie skórne i neuropatię cukrzycową. Chorzy
z zaawansowaną neuropatią cukrzycową i owrzodzeniem stopy losowo przydzielono
do grupy leczonej insuliną (I) z sulodeksydem (S) (n = 12) lub do grupy kontrolnej
leczonej insuliną z placebo (P) (n = 6) przez 10 tygodni. Za pomocą metody dopplerowskiego
lasera oceniano skórny przepływ krwi w stopach (LDF, laser doppler flow)
w spoczynku oraz po 30- i 60-sekundowym niedokrwieniu. Ocenie poddano również
przewodnictwo nerwowe
na podstawie czuciowych i ruchowych potencjałów wywołanych. U chorych na cukrzycę
skórny przepływ po niedokrwieniu był 2,5 raza krótszy w kończynie z owrzodzeniem niż w stopie zdrowej. Obserwowano
znamienny wzrost przepływów skórnych po 30-
i 60-sekundowym niedokrwieniu po zakończeniu terapii
(grupa IS, owrzodzenie stopy, LDF - 60 s; od
99,1 ± 14,3 do 218,6 ± 28,6 PU, p < 0,001, grupa
od 110,5 ± 13,0 do 164,8 ± 15,4 PU, p < 0,05). Czas
przekrwienia reaktywnego uległ wydłużeniu w grupie
IS (IS: od 30,3 ± 2,9 do 43,9 ± 2,2 s, p < 0,001; IP:
od 28,7 ± 3,0 do 33,3 ± 3,3 s, NS). W grupie IS 92%
owrzodzeń stóp uległo zagojeniu w ciągu 46,4 dnia,
natomiast w grupie IP 83% w ciągu 63,0 dnia. Badania
przewodnictwa nerwowego nie wykazały różnic
nasilenia neuropatii w obrębie grup i pomiędzy
grupami. W stopach z owrzodzeniami sulodeksyd i
insulina poprawiają przepływ skórny w odpowiedzi
na niedokrwienie, nie wpływając na przewodnictwo
nerwowe. Kliniczne efekty działania sulodeksydu, sumując
się z działaniami insuliny, mogą istotnie skracać
czas niezbędny do całkowitego wyleczenia
owrzodzenia. Ostateczne potwierdzenie przedstawionych
wstępnych wyników wymaga dalszych badań
klinicznych.To assess the efficacy of insulin plus sulodexide
(a mixture of 80% heparin-like substances and 20%
dermatan sulphate) on diabetic ulcers, and its influence
on foot skin microcirculation and diabetic neuropathy.
Two groups of diabetic patients, suffering
from severe neuropathy and ulceration, were randomly
assigned to insulin (I) plus sulodexide (S)
(n = 12) or insulin plus placebo (P) (n = 6) therapy,
for 10 weeks. Laser Doppler assessment of foot skin
flow (LDF), at rest and 30 or 60 s after arterial occlusion,
and nerve conduction tests (sensorial evoked
and motoric conduction potentials) have been evaluated
in both groups. Postischaemic flow was 2.5
times shorter in ulcerated vs. non-ulcerated feet in
diabetic patients. A significant increase in flows after
30 and 60 s ischaemia was detected in both groups
at the end of therapy (IS group, ulcerated foot, LDF
= 60 s: from 99.1 ± 14.3 to 218.6 ± 28.6 PU, P <
0.001. IP group = from 110.5 ± 13.0 to 164.8 ± 15.4
PU, P < 0.05). The length of reactive hyperaemia was
higher in IS vs. IP group (IS: from 30.3 ± 2.9 to 43.9
± 2.2 s, P < 0.001; IP: from 28.7 ± 3.0 to 33.3 ± 3.3 s,
ns). Ninety-two percent of ulcers heals in a mean time
of 46.4 days (IS group) vs. 83% and 63.0 days, respectively,
in IP group. Nerve conduction studies have
not demonstrated within- and between-group differences.
Sulodexide and insulin improve the postischaemic
skin flow in ulcerated feet, without affecting
nerve conduction tests. The effect of sulodexide results
additive to insulin; it is clinically relevant, in the
view of the possibility of reducing the time needed
to completely heal ulcers. The ultimate validation of
these preliminary results requires extensive trials
Supportive and symptomatic management of amyotrophic lateral sclerosis
The main aims in the care of individuals with amyotrophic lateral sclerosis (ALS) are to minimize morbidity and maximize quality of life. Although no cure exists for ALS, supportive and symptomatic care provided by a specialist multidisciplinary team can improve survival. The basis for supportive management is shifting from expert consensus guidelines towards an evidence-based approach, which encourages the use of effective treatments and could reduce the risk of harm caused by ineffective or unsafe interventions. For example, respiratory support using noninvasive ventilation has been demonstrated to improve survival and quality of life, whereas evidence supporting other respiratory interventions is insufficient. Increasing evidence implicates a causal role for metabolic dysfunction in ALS, suggesting that optimizing nutrition could improve quality of life and survival. The high incidence of cognitive dysfunction and its impact on prognosis is increasingly recognized, although evidence for effective treatments is lacking. A variety of strategies are used to manage the other physical and psychological symptoms, the majority of which have yet to be thoroughly evaluated. The need for specialist palliative care throughout the disease is increasingly recognized. This Review describes the current approaches to symptomatic and supportive care in ALS and outlines the current guidance and evidence for these strategies
The Vascular Impairment of Cognition Classification Consensus Study
Introduction: Numerous diagnostic criteria have tried to tackle the variability in clinical manifestations and problematic diagnosis of vascular cognitive impairment (VCI) but none have been universally accepted. These criteria have not been readily comparable, impacting on clinical diagnosis rates and in turn prevalence estimates, research, and treatment. / Methods: The Vascular Impairment of Cognition Classification Consensus Study (VICCCS) involved participants (81% academic researchers) from 27 countries in an online Delphi consensus study. Participants reviewed previously proposed concepts to develop new guidelines. / Results: VICCCS had a mean of 122 (98–153) respondents across the study and a 67% threshold to represent consensus. VICCCS redefined VCI including classification of mild and major forms of VCI and subtypes. It proposes new standardized VCI-associated terminology and future research priorities to address gaps in current knowledge. / Discussion: VICCCS proposes a consensus-based updated conceptualization of VCI intended to facilitate standardization in research
Genome-Wide Association Study of Late-Onset Myasthenia Gravis: Confirmation of TNFRSF11A and Identification of ZBTB10 and Three Distinct HLA Associations
To investigate the genetics of late-onset myasthenia gravis (LOMG), we conducted a genome-wide association study imputation of >6 million single nucleotide polymorphisms (SNPs) in 532 LOMG cases (anti-acetylcholine receptor [AChR] antibody positive; onset age ≥50 years) and 2,128 controls matched for sex and population substructure. The data confirm reported TNFRSF11A associations (rs4574025, P = 3.9 × 10−7, odds ratio [OR] 1.42) and identify a novel candidate gene, ZBTB10, achieving genome-wide significance (rs6998967, P = 8.9 × 10−10, OR 0.53). Several other SNPs showed suggestive significance including rs2476601 (P = 6.5 × 10−6, OR 1.62) encoding the PTPN22 R620W variant noted in early-onset myasthenia gravis (EOMG) and other autoimmune diseases. In contrast, EOMG-associated SNPs in TNIP1 showed no association in LOMG, nor did other loci suggested for EOMG. Many SNPs within the major histocompatibility complex (MHC) region showed strong associations in LOMG, but with smaller effect sizes than in EOMG (highest OR ∼2 versus ∼6 in EOMG). Moreover, the strongest associations were in opposite directions from EOMG, including an OR of 0.54 for DQA1*05:01 in LOMG (P = 5.9 × 10−12) versus 2.82 in EOMG (P = 3.86 × 10−45). Association and conditioning studies for the MHC region showed three distinct and largely independent association peaks for LOMG corresponding to (a) MHC class II (highest attenuation when conditioning on DQA1), (b) HLA-A and (c) MHC class III SNPs. Conditioning studies of human leukocyte antigen (HLA) amino acid residues also suggest potential functional correlates. Together, these findings emphasize the value of subgrouping myasthenia gravis patients for clinical and basic investigations and imply distinct predisposing mechanisms in LOMG
Medycyna i Społeczeństwo. Materiały konferencyjne
Ze wstępu: "Z inicjatywy i pod patronatem Krakowskiej Szkoły Wyższej im. Andrzeja Frycza
Modrzewskiego w Krakowie odbyła się w styczniu 2003 r. konferencja naukowa lekarzy,
farmaceutów, biochemików, filozofów, fizjopatologów, farmakologów i klinicystów,
których rozważania skupiały się wokół obszernego tematu „MED YCYNAISPOŁECZEŃSTWO
Spotkanie otworzył JM Rektor Prof. KSW dr hab. Zbigniew Maciąg.
Rektor wyraził podziękowanie wykładowcom i wyraził głęboką nadzieję, że kolejny
numer wydawnictwa Szkoły Acta Academiae Modrevianae, złożony z wybranych
prac prezentowanych na konferencji, służył będzie społeczeństwu."(...
Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study
INTRODUCTION:
Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2.
METHODS:
We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI.
RESULTS:
Six survey rounds comprising 65-79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders-Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging.
DISCUSSION:
The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders-Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration
Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study
INTRODUCTION:
Progress in understanding and management of vascular cognitive impairment (VCI) has been hampered by lack of consensus on diagnosis, reflecting the use of multiple different assessment protocols. A large multinational group of clinicians and researchers participated in a two-phase Vascular Impairment of Cognition Classification Consensus Study (VICCCS) to agree on principles (VICCCS-1) and protocols (VICCCS-2) for diagnosis of VCI. We present VICCCS-2.
METHODS:
We used VICCCS-1 principles and published diagnostic guidelines as points of reference for an online Delphi survey aimed at achieving consensus on clinical diagnosis of VCI.
RESULTS:
Six survey rounds comprising 65–79 participants agreed guidelines for diagnosis of VICCCS-revised mild and major forms of VCI and endorsed the National Institute of Neurological Disorders–Canadian Stroke Network neuropsychological assessment protocols and recommendations for imaging.
DISCUSSION:
The VICCCS-2 suggests standardized use of the National Institute of Neurological Disorders–Canadian Stroke Network recommendations on neuropsychological and imaging assessment for diagnosis of VCI so as to promote research collaboration
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