Admission Hyperglycemia Predicts a Worse Outcome in Stroke Patients Treated With Intravenous Thrombolysis

OBJECTIVE: Admission hyperglycemia has been associated with worse outcomes in ischemic stroke. We hypothesized that hyperglycemia (glucose >8.0 mmol/l) in the hyperacute phase would be independently associated with increased mortality, symptomatic intracerebral hemorrhage (SICH), and poor functional status at 90 days in stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). RESEARCH DESIGN AND METHODS: Using data from the prospective, multicenter Canadian Alteplase for Stroke Effectiveness Study (CASES), the association between admission glucose >8.0 mmol/l and mortality, SICH, and poor functional status at 90 days (modified Rankin Scale >1) was examined. Similar analyses examining glucose as a continuous measure were conducted. RESULTS: Of 1,098 patients, 296 (27%) had admission hyperglycemia, including 18% of those without diabetes and 70% of those with diabetes. After multivariable logistic regression, admission hyperglycemia was found to be independently associated with increased risk of death (adjusted risk ratio 1.5 [95% CI 1.2-1.9]), SICH (1.69 [0.95-3.00]), and a decreased probability of a favorable outcome at 90 days (0.7 [0.5-0.9]). An incremental risk of death and SICH and unfavorable 90-day outcomes was observed with increasing admission glucose. This observation held true for patients with and without diabetes. CONCLUSIONS: In this cohort of IV-tPA-treated stroke patients, admission hyperglycemia was independently associated with increased risk of death, SICH, and poor functional status at 90 days. Treatment trials continue to be urgently needed to determine whether this is a modifiable risk factor for poor outcome

Estudio de experiencias y buenas prácticas comunitarias vinculadas a sistemas de restauración de paisajes forestales, en dos microrregiones del Departamento De San Marcos, Guatemala, C.A.

El presente trabajo de graduación se desarrolló en el altiplano del departamento de San Marcos, en las microrregiones Esquichá y Ricardo Chávez de la parte alta de la cuenca del río Coatán y del río Suchiate respectivamente. Tuvo la finalidad de apuntalar los esfuerzos regionales de desarrollo humano y conservación de los recursos naturales, coordinados por el Mecanismo de Restauración de Bosques y Paisajes y en la mejora de los medios de vida de las comunidades locales; enfocado a la restauración del paisaje forestal, entiéndase los bienes y servicios ambientales asociados a éste. El objetivo primordial del diagnóstico de las microrregiones, consistió en conocer la coyuntura ambiental y social del paisaje forestal en el área. La determinación de los factores de degradación del paisaje y los componentes sociales y ambientales, permitieron conocer hacia dónde orientar las acciones para la restauración del paisaje forestal, haciendo de éste un proceso sostenible. En tal sentido, la investigación se orientó al estudio y documentación de las buenas prácticas y sistemas tradicionales vinculados a la restauración del paisaje forestal en el altiplano occidental. Se documentaron un total de 18 buenas prácticas, algunas de éstas se implementaron a través del establecimiento de 10 sitios demostrativos, los cuales constituyen parcelas modelo de cómo restaurar el paisaje en diferentes condiciones edafoclimáticas y ecológicas, características de la región. Se realizó una caracterización biofísica detallada de cada uno de éstos sitios, incluyendo un análisis microbiológico del suelo, el cual constituye un pilar fundamental en el estudio de la degradación de los suelos de las tierras forestales. Dentro de los principales ejes de trabajo del mecanismo se encuentran la sensibilización, el fortalecimiento de capacidades y la implementación de sitios demostrativos de prácticas y sistemas de restauración del paisaje forestal; en respuesta a estos tres objetivos generales se desarrollaron los servicios profesionales

Associations between reaction time measures and white matter hyperintensities in very old age.

In old age, a relationship has been reported between intraindividual variability (IIV) in reaction time and white matter integrity as evidenced by white matter hyperintensities (WMH). However, it is unclear how far such associations are due to incipient neurodegenerative pathology in the samples investigated. The present study examined the relationship between IIV and WMH in older individuals (N=526) drawn from the Sydney Memory and Ageing Study. Using a complex reaction time (RT) task, greater IIV and mean-RT were related to a higher WMH burden in the frontal lobe. Critically, significant associations remained having taken future dementia into account suggesting that they were not explained by incipient dementia. Additionally, independent measures of executive function accounted for the association between RT metrics and WHM. The results are consistent with the view that frontally-supported cognitive processes are involved in IIV-WMH relations, and that RT measures are sensitive to compromise in white matter structures in non-demented older individuals

Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration: A united approach

Item does not contain fulltextCerebral small vessel disease (SVD) is a common accompaniment of ageing. Features seen on neuroimaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. SVD can present as a stroke or cognitive decline, or can have few or no symptoms. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive deficits, physical disabilities, and other symptoms of neurodegeneration. Terminology and definitions for imaging the features of SVD vary widely, which is also true for protocols for image acquisition and image analysis. This lack of consistency hampers progress in identifying the contribution of SVD to the pathophysiology and clinical features of common neurodegenerative diseases. We are an international working group from the Centres of Excellence in Neurodegeneration. We completed a structured process to develop definitions and imaging standards for markers and consequences of SVD. We aimed to achieve the following: first, to provide a common advisory about terms and definitions for features visible on MRI; second, to suggest minimum standards for image acquisition and analysis; third, to agree on standards for scientific reporting of changes related to SVD on neuroimaging; and fourth, to review emerging imaging methods for detection and quantification of preclinical manifestations of SVD. Our findings and recommendations apply to research studies, and can be used in the clinical setting to standardise image interpretation, acquisition, and reporting. This Position Paper summarises the main outcomes of this international effort to provide the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE)

APOE/TOMM40 genetic loci, white matter hyperintensities and cerebral microbleeds

Background: Two markers of cerebral small vessel disease are white matter hyperintensities and cerebral microbleeds, which commonly occur in people with Alzheimer's disease. Aim and/or hypothesis: To test for independent associations between two Alzheimer's disease-susceptibility gene loci – APOE ε and the TOMM40 ‘523’ poly-T repeat – and white matter hyperintensities/cerebral microbleed burden in community-dwelling older adults. Methods: Participants in the Lothian Birth Cohort 1936 underwent genotyping for APOE ε and TOMM40 523, and detailed structural brain magnetic resonance imaging at a mean age of 72·70 years (standard deviation = 0·7; range = 71–74). Results: No significant effects of APOE ε or TOMM40 523 genotypes on white matter hyperintensities or cerebral microbleed burden were found amongst 624 participants. Conclusions: Lack of association between two Alzheimer's disease susceptibility gene loci and markers of cerebral small vessel disease may reflect the relative health of this population compared with those in other studies in the literature

Reversible cerebral vasoconstriction syndrome

Reversible cerebral vasoconstriction syndromes (RCVS) are a group of disorders that have in common an acute presentation with headache, reversible vasoconstriction of cerebral arteries, with or without neurological signs and symptoms. In contrast to primary central nervous system vasculitis, they have a relatively benign course. We describe here a patient who was diagnosed with RCVS