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[PMID]: 29245288
[Au] Autor:Han JY; Kim HJ; Shin S; Park J; Lee IG
[Ad] Address:aDepartment of PediatricsbDepartment of RadiologycDepartment of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
[Ti] Title:Elevated serum lipoprotein(a) as a risk factor for combined intracranial and extracranial artery stenosis in a child with arterial ischemic stroke: A case report.
[So] Source:Medicine (Baltimore);96(49):e9025, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Stroke is an uncommon disease in childhood with an estimated incidence of 1 to 6 per 100,000 and stenoocclusive arteriopathy is the main risk factor of recurrent pediatric arterial ischemic stroke (AIS). Dyslipidemia may influence strongly before puberty and in late adolescence when plasma levels are naturally highest. PATIENT CONCERNS: An 11-year-old male presented with acute onset seizure, a drowsy mentality, and right hemiplegia. DIAGNOSES: Magnetic resonance (MR) angiogram demonstrated occlusion of distal basilar artery and left vertebral arteries. Serum Lp(a) was significantly increased as 269 nmol/L (normal<75 nmol/L) only. Thus, he was diagnosed as pediatric AIS. INTERVENTIONS: He was started on aspirin (100 mg/day) for secondary stroke prevention and received nicotinic acid (2 g/day) as a Lp(a)-lowering agent. OUTCOMES: Consciousness gradually improved and the patient regained a normal orientation after 2 weeks. The Lp(a) level was reduced to 48 nmol/L after nicotinic acid administration. LESSONS: High Lp(a) level may be considered in the risk profile assessment of pediatric AIS. Niacin and certain inhibitors of cholesteryl ester transfer protein can be considered to reduce Lp(a).
[Mh] MeSH terms primary: Dyslipidemias/complications
Intracranial Arteriosclerosis/complications
Lipoprotein(a)/blood
Stroke/complications
[Mh] MeSH terms secundary: Child
Dyslipidemias/drug therapy
Humans
Male
Niacin/therapeutic use
Risk Factors
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Lipoprotein(a)); 2679MF687A (Niacin)
[Em] Entry month:1801
[Cu] Class update date: 180105
[Lr] Last revision date:180105
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009025

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[PMID]: 29269514
[Au] Autor:Weitz JI; Fredenburgh JC
[Ad] Address:From the Department of Medicine (J.I.W., J.C.F.) and Department of Biochemistry and Biomedical Sciences (J.I.W.), McMaster University, Hamilton, Ontario, Canada; and Thrombosis and Atherosclerosis Research Institute (J.I.W., J.C.F.), Hamilton, Ontario, Canada. weitzj@taari.ca.
[Ti] Title:2017 Scientific Sessions Sol Sherry Distinguished Lecture in Thrombosis: Factor XI as a Target for New Anticoagulants.
[So] Source:Arterioscler Thromb Vasc Biol;, 2017 Dec 21.
[Is] ISSN:1524-4636
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The goal of anticoagulant therapy is to attenuate thrombosis without compromising hemostasis. Although the direct oral anticoagulants are associated with less intracranial hemorrhage than vitamin K antagonists, bleeding remains their major side effect. Factor XI has emerged as a promising target for anticoagulants that may be safer than those currently available. The focus on factor XI stems from epidemiological evidence of its role in thrombosis, the observation of attenuated thrombosis in factor XI-deficient mice, identification of novel activators, and the fact that factor XI deficiency is associated with only a mild bleeding diathesis. Proof-of-concept comes from the demonstration that compared with enoxaparin, factor XI knockdown reduces venous thromboembolism without increasing bleeding after elective knee arthroplasty. This article rationalizes the selection of factor XI as a target for new anticoagulants, reviews the agents under development, and outlines a potential path forward for their development.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1712
[Cu] Class update date: 171222
[Lr] Last revision date:171222
[St] Status:Publisher

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[PMID]: 29146750
[Au] Autor:Gotru SK; Chen W; Kraft P; Becker IC; Wolf K; Stritt S; Zierler S; Hermanns HM; Rao D; Perraud AL; Schmitz C; Zahedi RP; Noy PJ; Tomlinson MG; Dandekar T; Matsushita M; Chubanov V; Gudermann T; Stoll G; Nieswandt B; Braun A
[Ad] Address:From the Institute of Experimental Biomedicine, University Hospital of Wrzburg (S.K.G., W.C., I.C.B., K.W., S.S., B.N., A.B.), Rudolf Virchow Center (S.K.G., W.C., I.C.B., K.W., S.S., B.N., A.B.), and Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center (P.K.), Univer
[Ti] Title:TRPM7 (Transient Receptor Potential Melastatin-Like 7 Channel) Kinase Controls Calcium Responses in Arterial Thrombosis and Stroke in Mice.
[So] Source:Arterioscler Thromb Vasc Biol;, 2017 Nov 16.
[Is] ISSN:1524-4636
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: TRPM7 (transient receptor potential melastatin-like 7 channel) is a ubiquitously expressed bifunctional protein comprising a transient receptor potential channel segment linked to a cytosolic α-type serine/threonine protein kinase domain. TRPM7 forms a constitutively active Mg and Ca permeable channel, which regulates diverse cellular processes in both healthy and diseased conditions, but the physiological role of TRPM7 kinase remains largely unknown. APPROACH AND RESULTS: Here we show that point mutation in TRPM7 kinase domain deleting the kinase activity in mice ( ) causes a marked signaling defect in platelets. platelets showed an impaired PIP2 (phosphatidylinositol-4,5-bisphosphate) metabolism and consequently reduced Ca mobilization in response to stimulation of the major platelet receptors GPVI (glycoprotein VI), CLEC-2 (C-type lectin-like receptor), and PAR (protease-activated receptor). Altered phosphorylation of spleen tyrosine kinase and phospholipase C γ2 and 3 accounted for these global platelet activation defects. In addition, direct activation of STIM1 (stromal interaction molecule 1) with thapsigargin revealed a defective store-operated Ca entry mechanism in the mutant platelets. These defects translated into an impaired platelet aggregate formation under flow and protection of the mice from arterial thrombosis and ischemic stroke in vivo. CONCLUSIONS: Our results identify TRPM7 kinase as a key modulator of phospholipase C signaling and store-operated Ca entry in platelets. The protection of mice from acute ischemic disease without developing intracranial hemorrhage indicates that TRPM7 kinase might be a promising antithrombotic target.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171117
[Lr] Last revision date:171117
[St] Status:Publisher

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[PMID]: 29030476
[Au] Autor:Mossa-Basha M; Shibata DK; Hallam DK; de Havenon A; Hippe DS; Becker KJ; Tirschwell DL; Hatsukami T; Balu N; Yuan C
[Ad] Address:From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.). mmossab@uw.edu.
[Ti] Title:Added Value of Vessel Wall Magnetic Resonance Imaging for Differentiation of Nonocclusive Intracranial Vasculopathies.
[So] Source:Stroke;48(11):3026-3033, 2017 Nov.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: Our goal is to determine the added value of intracranial vessel wall magnetic resonance imaging (IVWI) in differentiating nonocclusive vasculopathies compared with luminal imaging alone. METHODS: We retrospectively reviewed images from patients with both luminal and IVWI to identify cases with clinically defined intracranial vasculopathies: atherosclerosis (intracranial atherosclerotic disease), reversible cerebral vasoconstriction syndrome, and inflammatory vasculopathy. Two neuroradiologists blinded to clinical data reviewed the luminal imaging of defined luminal stenoses/irregularities and evaluated the pattern of involvement to make a presumed diagnosis with diagnostic confidence. Six weeks later, the 2 raters rereviewed the luminal imaging in addition to IVWI for the pattern of wall involvement, presence and pattern of postcontrast enhancement, and presumed diagnosis and confidence. Analysis was performed on per-lesion and per-patient bases. RESULTS: Thirty intracranial atherosclerotic disease, 12 inflammatory vasculopathies, and 12 reversible cerebral vasoconstriction syndrome patients with 201 lesions (90 intracranial atherosclerotic disease, 64 reversible cerebral vasoconstriction syndrome, and 47 inflammatory vasculopathy lesions) were included. For both per-lesion and per-patient analyses, there was significant diagnostic accuracy improvement with luminal imaging+IVWI when compared with luminal imaging alone (per-lesion: 88.8% versus 36.1%; <0.001 and per-patient: 96.3% versus 43.5%; <0.001, respectively). There was substantial interrater diagnostic agreement for luminal imaging+IVWI (κ=0.72) and only slight agreement for luminal imaging (κ=0.04). Although there was a significant correlation for both luminal and IVWI pattern of wall involvement with diagnosis, there was a stronger correlation for IVWI finding of lesion eccentricity and intracranial atherosclerotic disease diagnosis than for luminal imaging (κ=0.69 versus 0.18; <0.001). CONCLUSIONS: IVWI can significantly improve the differentiation of nonocclusive intracranial vasculopathies when combined with traditional luminal imaging modalities.
[Mh] MeSH terms primary: Intracranial Arteriosclerosis/diagnostic imaging
Magnetic Resonance Angiography/methods
Vasculitis, Central Nervous System/diagnostic imaging
Vasospasm, Intracranial/diagnostic imaging
[Mh] MeSH terms secundary: Adult
Female
Humans
Male
Middle Aged
Retrospective Studies
[Pt] Publication type:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171116
[Lr] Last revision date:171116
[Js] Journal subset:IM
[Da] Date of entry for processing:171015
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018227

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[PMID]: 28974628
[Au] Autor:Gory B; Piotin M; Haussen DC; Steglich-Arnholm H; Holtmannsptter M; Labreuche J; Taschner C; Eiden S; Nogueira RG; Papanagiotou P; Boutchakova M; Siddiqui A; Lapergue B; Dorn F; Cognard C; Killer-Oberpfalzer M; Mangiafico S; Ribo M; Behme D; Spiotta AM; Mazighi M; Turjman F; TITAN Investigators
[Ad] Address:From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; Univer
[Ti] Title:Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause.
[So] Source:Stroke;48(11):3145-3148, 2017 Nov.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed. METHODS: We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality. RESULTS: Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; =0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% ( =0.13), 4.6% versus 5.2% ( =1.0), and 7.8% versus 15.3% ( =0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group ( =0.24). CONCLUSIONS: We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted.
[Mh] MeSH terms primary: Brain Infarction
Carotid Artery, Internal, Dissection
Cerebral Hemorrhage
Endovascular Procedures
Stroke
Thrombectomy
[Mh] MeSH terms secundary: Acute Disease
Aged
Brain Infarction/physiopathology
Brain Infarction/surgery
Carotid Artery, Internal, Dissection/physiopathology
Carotid Artery, Internal, Dissection/surgery
Cerebral Hemorrhage/physiopathology
Cerebral Hemorrhage/surgery
Humans
Intracranial Arteriosclerosis/physiopathology
Intracranial Arteriosclerosis/surgery
Middle Aged
Retrospective Studies
Stroke/physiopathology
Stroke/surgery
Time Factors
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Entry month:1710
[Cu] Class update date: 171026
[Lr] Last revision date:171026
[Js] Journal subset:IM
[Da] Date of entry for processing:171005
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018264

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[PMID]: 28945817
[Au] Autor:Lee SJ; Lee DG
[Ad] Address:Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
[Ti] Title:Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke.
[So] Source:PLoS One;12(9):e0185314, 2017.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: Early neurologic deterioration (END) during the acute stage of stroke is clinically important because of its association with poor outcomes. The purpose of this study was (1) to investigate variables associated with END, (2) to determine the distribution of atherosclerotic stenosis associated with END, and (3) to clarify the relationship between END and clinical outcomes. METHODS: 516 patients with acute ischemic stroke were included. The median follow-up period was 31.7 months. END was defined as a ≥2 point increase in the National Institutes of Health Stroke Scale (NIHSS), ≥1 point increase in level of consciousness or motor item of the NIHSS, or the development of any new neurological deficits during the first 72 hours of hospitalization. A signal loss on 1.5-T magnetic resonance angiography exceeding 50% was considered to be significant for the categorization of stenosis pattern. RESULTS: The prevalence of END was 19.0%. END was associated with intracranial atherosclerotic stenosis (IAS) together with large artery atherosclerosis (LAA) subtype. In particular, stenosis of basilar artery or posterior cerebral artery was independently associated with END. Lesion growth or hypoperfusion was more accountable for END in patients with IAS, whereas intracerebral hemorrhage or edema/herniation was more frequently observed in END patients without IAS. Patients with END had a higher rate of mortality, but a similar rate of further vascular events compared to patients without END. CONCLUSION: Pre-stroke IAS and LAA subtype could determine the development of END during the acute stage of ischemic stroke.
[Mh] MeSH terms primary: Brain Ischemia/pathology
Intracranial Arteriosclerosis/pathology
Stroke/pathology
[Mh] MeSH terms secundary: Adolescent
Adult
Aged
Aged, 80 and over
Brain Ischemia/diagnostic imaging
Brain Ischemia/physiopathology
Female
Humans
Intracranial Arteriosclerosis/diagnostic imaging
Intracranial Arteriosclerosis/physiopathology
Magnetic Resonance Angiography
Male
Middle Aged
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Stroke/diagnostic imaging
Stroke/physiopathology
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171016
[Lr] Last revision date:171016
[Js] Journal subset:IM
[Da] Date of entry for processing:170926
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185314

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[PMID]: 28939676
[Au] Autor:Baek JH; Yoo J; Song D; Kim YD; Nam HS; Heo JH
[Ad] Address:From the Department of Neurology, Yonsei University College of Medicine (J.-H.B., J.Y., D.S., Y.D.K., H.S.N., J.H.H.) and Department of Neurology, National Medical Center (J.-H.B.), Seoul, Republic of Korea.
[Ti] Title:The Protective Effect of Middle Cerebral Artery Calcification on Symptomatic Middle Cerebral Artery Infarction.
[So] Source:Stroke;48(11):3138-3141, 2017 Nov.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: The presence of intracranial artery calcification is associated with an increased risk for stroke. However, calcified atherosclerotic plaques are also known to be less vulnerable to rupture. Given this discrepancy, we investigated whether the vulnerability of intracranial arterial atherosclerosis differed based on the presence or absence of calcification. METHODS: We considered consecutive patients with acute stroke in the unilateral middle cerebral artery (MCA) territory. Patients with any stenotic MCAs were included in this study. Symptomatic MCA was defined as the occurrence of infarctions relevant to the stenotic MCA. The presence of calcification in the MCA was evaluated on noncontrast thin-section computed tomography images using a 3dimensional software package. Generalized estimating equations were used to compare the frequency of calcification between symptomatic and asymptomatic stenosis. RESULTS: Of the 1066 MCAs examined in 533 patients, 645 MCAs were stenotic and were included in the study. Among the 645 stenotic MCAs, 406 MCAs (62.9%) were symptomatic. Calcification was observed in 36 MCAs (5.6%). Calcification in the MCA was more frequently observed in the asymptomatic group (7.9% versus 4.2%; =0.032). On multivariable analysis, the presence of calcification in MCA atherosclerosis was less frequent in the symptomatic group (odds ratio, 0.46; 95% confidence interval, 0.23-0.92; =0.027). CONCLUSIONS: This study showed that calcified atherosclerosis in the MCA was less frequently symptomatic.
[Mh] MeSH terms primary: Infarction, Middle Cerebral Artery
Intracranial Arteriosclerosis
Middle Cerebral Artery
Registries
Vascular Calcification
[Mh] MeSH terms secundary: Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Humans
Infarction, Middle Cerebral Artery/epidemiology
Infarction, Middle Cerebral Artery/pathology
Infarction, Middle Cerebral Artery/physiopathology
Intracranial Arteriosclerosis/epidemiology
Intracranial Arteriosclerosis/pathology
Intracranial Arteriosclerosis/physiopathology
Male
Middle Aged
Middle Cerebral Artery/pathology
Middle Cerebral Artery/physiopathology
Retrospective Studies
Vascular Calcification/epidemiology
Vascular Calcification/pathology
Vascular Calcification/physiopathology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171026
[Lr] Last revision date:171026
[Js] Journal subset:IM
[Da] Date of entry for processing:170924
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017821

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[PMID]: 28906380
[Au] Autor:Suh YJ; Han K; Chang S; Kim JY; Im DJ; Hong YJ; Lee HJ; Hur J; Kim YJ; Choi BW
[Ad] Address:aDepartment of Radiology, Research Institute of Radiological Science, Severance Hospital bBiostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea.
[Ti] Title:SYNTAX score based on coronary computed tomography angiography may have a prognostic value in patients with complex coronary artery disease: An observational study from a retrospective cohort.
[So] Source:Medicine (Baltimore);96(37):e7999, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score is an invasive coronary angiography (ICA)-based score for quantifying the complexity of coronary artery disease (CAD). Although the SYNTAX score was originally developed based on ICA, recent publications have reported that coronary computed tomography angiography (CCTA) is a feasible modality for the estimation of the SYNTAX score.The aim of our study was to investigate the prognostic value of the SYNTAX score, based on CCTA for the prediction of major adverse cardiac and cerebrovascular events (MACCEs) in patients with complex CAD.The current study was approved by the institutional review board of our institution, and informed consent was waived for this retrospective cohort study. We included 251 patients (173 men, mean age 66.0  9.29 years) who had complex CAD [3-vessel disease or left main (LM) disease] on CCTA. SYNTAX score was obtained on the basis of CCTA. Follow-up clinical outcome data regarding composite MACCEs were also obtained. Cox proportional hazards models were developed to predict the risk of MACCEs based on clinical variables, treatment, and computed tomography (CT)-SYNTAX scores.During the median follow-up period of 1517 days, there were 48 MACCEs. Univariate Cox hazards models demonstrated that MACCEs were associated with advanced age, low body mass index (BMI), and dyslipidemia (P < .2). In patients with LM disease, MACCEs were associated with a higher SYNTAX score. In patients with CT-SYNTAX score ≥23, patients who underwent coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention had significantly lower hazard ratios than patients who were treated with medication alone. In multivariate Cox hazards model, advanced age, low BMI, and higher SYNTAX score showed an increased hazard ratio for MACCE, while treatment with CABG showed a lower hazard ratio (P < .2).On the basis of our results, CT-SYNTAX score can be a useful method for noninvasively predicting MACCEs in patients with complex CAD, especially in patients with LM disease.
[Mh] MeSH terms primary: Computed Tomography Angiography
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease/diagnostic imaging
Coronary Artery Disease/therapy
Drug-Eluting Stents
Paclitaxel/administration & dosage
Percutaneous Coronary Intervention
[Mh] MeSH terms secundary: Aged
Cerebrovascular Disorders/epidemiology
Combined Modality Therapy
Coronary Angiography/methods
Female
Heart Diseases/epidemiology
Humans
Male
Postoperative Complications/epidemiology
Predictive Value of Tests
Prognosis
Retrospective Studies
[Pt] Publication type:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Name of substance:P88XT4IS4D (Paclitaxel)
[Em] Entry month:1710
[Cu] Class update date: 171004
[Lr] Last revision date:171004
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:170915
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007999

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[PMID]: 28830976
[Au] Autor:Saber H; Yakoob MY; Shi P; Longstreth WT; Lemaitre RN; Siscovick D; Rexrode KM; Willett WC; Mozaffarian D
[Ad] Address:From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Bosto
[Ti] Title:Omega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts.
[So] Source:Stroke;48(10):2678-2685, 2017 Oct.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: The associations of individual long-chain n-3 polyunsaturated fatty acids with incident ischemic stroke and its main subtypes are not well established. We aimed to investigate prospectively the relationship of circulating eicosapentaenoic acid, docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke. METHODS: We measured circulating phospholipid fatty acids at baseline in 3 separate US cohorts: CHS (Cardiovascular Health Study), NHS (Nurses' Health Study), and HPFS (Health Professionals Follow-Up Study). Ischemic strokes were prospectively adjudicated and classified into atherothrombotic (large- and small-vessel infarctions) or cardioembolic by imaging studies and medical records. Risk according to fatty acid levels was assessed using Cox proportional hazards (CHS) or conditional logistic regression (NHS, HPFS) according to study design. Cohort findings were pooled using fixed-effects meta-analysis. RESULTS: A total of 953 incident ischemic strokes were identified (408 atherothrombotic, 256 cardioembolic, and 289 undetermined subtypes) during median follow-up of 11.2 years (CHS) and 8.3 years (pooled, NHS and HPFS). After multivariable adjustment, lower risk of total ischemic stroke was seen with higher DPA (highest versus lowest quartiles; pooled hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.58-0.92) and DHA (HR, 0.80; 95% CI, 0.64-1.00) but not eicosapentaenoic acid (HR, 0.94; 95% CI, 0.77-1.19). DHA was associated with lower risk of atherothrombotic stroke (HR, 0.53; 95% CI, 0.34-0.83) and DPA with lower risk of cardioembolic stroke (HR, 0.58; 95% CI, 0.37-0.92). Findings in each individual cohort were consistent with pooled results. CONCLUSIONS: In 3 large US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke and DPA with cardioembolic stroke. These novel findings suggest differential pathways of benefit for DHA, DPA, and eicosapentaenoic acid.
[Mh] MeSH terms primary: Brain Ischemia/blood
Cardiovascular Diseases/blood
Fatty Acids, Omega-3/blood
Intracranial Embolism/blood
Intracranial Thrombosis/blood
Stroke/blood
[Mh] MeSH terms secundary: Adult
Aged
Aged, 80 and over
Biomarkers/blood
Brain Ischemia/diagnosis
Brain Ischemia/epidemiology
Cardiovascular Diseases/diagnosis
Cardiovascular Diseases/epidemiology
Case-Control Studies
Cohort Studies
Female
Follow-Up Studies
Humans
Incidence
Intracranial Arteriosclerosis/blood
Intracranial Arteriosclerosis/diagnosis
Intracranial Arteriosclerosis/epidemiology
Intracranial Embolism/diagnosis
Intracranial Embolism/epidemiology
Intracranial Thrombosis/diagnosis
Intracranial Thrombosis/epidemiology
Male
Middle Aged
Prospective Studies
Random Allocation
Risk Factors
Stroke/diagnosis
Stroke/epidemiology
United States/epidemiology
[Pt] Publication type:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Name of substance:0 (Biomarkers); 0 (Fatty Acids, Omega-3)
[Em] Entry month:1710
[Cu] Class update date: 171009
[Lr] Last revision date:171009
[Js] Journal subset:IM
[Da] Date of entry for processing:170824
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018235

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[PMID]: 28798260
[Au] Autor:Kim BS; Chung PW; Park KY; Won HH; Bang OY; Chung CS; Lee KH; Kim GM
[Ad] Address:From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul
[Ti] Title:Burden of Intracranial Atherosclerosis Is Associated With Long-Term Vascular Outcome in Patients With Ischemic Stroke.
[So] Source:Stroke;48(10):2819-2826, 2017 Oct.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: Ischemic stroke patients often have intracranial atherosclerosis (ICAS), despite heterogeneity in the cause of stroke. We tested the hypothesis that ICAS burden can independently reflect the risk of long-term vascular outcome. METHODS: This was a retrospective cohort study analyzing data from a prospective stroke registry enrolling consecutive patients with acute ischemic stroke or transient ischemic attack. A total of 1081 patients were categorized into no ICAS, single ICAS, and advanced ICAS (ICAS ≥2 different intracranial arteries) groups. Primary and secondary end points were time to occurrence of recurrent ischemic stroke and composite vascular outcome, respectively. Study end points by ICAS burden were compared using Cox proportional hazards models in overall and propensity-matched patients. RESULTS: ICAS was present in 405 patients (37.3%). During a median 5-year follow-up, recurrent stroke and composite vascular outcome occurred in 6.8% and 16.8% of patients, respectively. As the number of ICAS increased, the risk for study end points increased after adjustment of potential covariates (hazard ratio per 1 increase in ICAS, 1.19; 95% confidence interval, 1.01-1.42 for recurrent ischemic stroke and hazard ratio, 1.18; 95% confidence interval, 1.05-1.33 for composite vascular outcome). The hazard ratios (95% confidence interval) for recurrent stroke and composite vascular outcome in patients with advanced ICAS compared with those without ICAS were 1.56 (0.88-2.74) and 1.72 (1.17-2.53), respectively, in the overall patients. The corresponding values in the propensity-matched patients were 1.28 (0.71-2.30) and 1.95 (1.27-2.99), respectively. CONCLUSIONS: ICAS burden was independently associated with the risk of subsequent composite vascular outcome in patients with ischemic stroke. These findings suggest that ICAS burden can reflect the risk of long-term vascular outcome.
[Mh] MeSH terms primary: Brain Ischemia/diagnostic imaging
Cost of Illness
Intracranial Arteriosclerosis/diagnostic imaging
Stroke/diagnostic imaging
[Mh] MeSH terms secundary: Adult
Aged
Aged, 80 and over
Brain Ischemia/epidemiology
Cohort Studies
Female
Humans
Intracranial Arteriosclerosis/epidemiology
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Registries
Retrospective Studies
Stroke/epidemiology
Time Factors
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171009
[Lr] Last revision date:171009
[Js] Journal subset:IM
[Da] Date of entry for processing:170812
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017806


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