Background and Purpose
The current definition of embolic strokes of undetermined source (ESUS) seems to be too broad, including strokes due to heterogeneous mechanisms, such as atrial cardiopathy and ...other occult cardiac conditions, aortic arch plaques, and non-stenosing atherosclerosis, that can be differently associated with clinical stroke severity at the time of presentation. The aim of our study was to assess the possible association between neurological deficit severity and presence of markers of atrial cardiopathy in ESUS.
Methods
We retrospectively reviewed the medical records of a cohort of 226 ESUS patients (105 M, 121 F), that were divided into two groups according to the severity of neurological deficit (99 mild strokes with NIHSS ≤ 5 and 127 severe strokes with NIHSS >5). The following indices of atrial cardiopathy were evaluated: P wave dispersion, P wave max, P wave min, P wave mean, P wave index, P wave axis, left atrial size.
Results
Patients with severe ESUS were significantly older (74 ± 12 vs. 67 ± 14 years,
P
< 0.001) and female sex was prevalent (67 vs. 36%,
P
> 0.001); they had higher values of P-wave-dispersion (51 ± 14 vs. 46 ± 13,
P
= 0.01), P-wave-max (131 ± 20 vs. 125 ± 15 ms,
P
= 0.01), P-wave-index (16 ± 5 vs. 15 ± 5 ms,
P
= 0.01), left atrial size (20 ± 6 vs. 18 ± 4 cm
2
,
P
= 0.01), left atrial volume index (31 ± 14 vs. 27 ± 11 ml/m
2
,
P
= 0.04), in comparison with mild ESUS. An abnormal P wave axis was detected more frequently in severe ESUS (21 vs. 9%,
P
= 0.01). Furthermore, multivariate logistic regression showed that age (OR = 1.21 for each 5-year increase, 95% CI 1.09–1.35), sex (OR = 3.24 for female sex, 95% CI 1.82–5.76) and PWD (OR = 1.32 for each 10-ms increase, 95% CI 1.07–1.64) were the best subset of associated variables for severe ESUS.
Conclusions
Our findings shed light on specific clinical characteristics of severe ESUS including the presence of atrial cardiopathy that could play a pathogenic role in this subgroup of patients. Searching for atrial fibrillation in these patients is especially important to perform the most appropriate therapy.
Systemic thrombolysis for stroke in pregnancy Tassi, Rossana, MD; Acampa, Maurizio, MD; Marotta, Giovanna, MD ...
The American journal of emergency medicine,
02/2013, Letnik:
31, Številka:
2
Journal Article
Recenzirano
The laboratory studies revealed an increased of factor VII and von Willebrand factor with reduced protein S concentrations consistent with physiologic changes in pregnancy predisposing to thrombosis. ......the genetic analysis resulted positive for Leiden factor V and MTHFR C667T gene. With 1 exception, mothers recovered well from their strokes. ...5 patients treated with intraarterial thrombolysis using rt-PA or urokinase have been reported.
We show that the speckle phase error incurred when the laser spot is scanned over the diffusing surface can be made as low as 10-20 μm for object sizes in the range 3-10 cm. This result is new, to ...the best of our knowledge, because it is usually assumed that when the spot moves of its size, the phase becomes uncorrelated and the measurement cannot be done anymore. We carry out numerical simulations of the process and derive an analytical model to evaluate the phase error and the noise equivalent displacement of the profile measurement by a self-mixing interferometer.
Male osteoporosis is an increasingly important health problem. It is known that sex steroid hormones play an important role in regulating bone turnover and bone mass in males as well as in females. ...However, the exact mechanism of bone loss in men remains unknown. In the present study, 200 elderly men (age range, 55–85 yr) were followed for 4 yr to evaluate the relationships between hormone levels, bone turnover markers, bone mineral density, and rates of bone loss. Femoral and lumbar bone mineral density, bone ultrasound parameters at the os calcis, serum testosterone (T), serum estradiol (E2), SHBG levels, and bone turnover markers (urinary crosslaps and bone alkaline phosphatase) were evaluated for each man at enrollment and 4 yr afterward. The free androgen index (FAI) and free estrogen index (FEI) as well as measures of the bioavailable sex hormones calculated bioavailable E2 (c-bioE2) and T (c-bioT) were calculated from total hormone levels and SHBG. In the total population, T, c-bioT, c-bioE2, FAI, and FEI, but not E2, decreased significantly with age, whereas SHBG increased significantly. Subjects with FEI, c-bioE2, and E2 levels below the median showed higher rates of bone loss at the lumbar spine and the femoral neck as well as higher speed-of-sounds decrease at the calcaneus with respect to men with FEI, c-bioE2, and E2 levels above the median. Serum bone alkaline phosphatase and urinary crosslaps were significantly higher in men with FEI, c-bioE2, and E2 in the lower quartile than in men with FEI, c-bioE2, and E2 levels in the higher quartile. No statistically significant differences were observed in relation to T, c-bioT, or FAI levels. Finally, the ratio between E2 and T, an indirect measure for aromatase activity, increased significantly with age and was higher in normal than in osteoporotic subjects. In conclusion, results from the present study indicate an important role of estrogens, and particularly of the ability to aromatize T to E2, in the regulation of bone loss and bone metabolism in elderly men.
Dante e Verdi Giuseppe Martini
Ricerche di s/Confine,
12/2021, Letnik:
Dossier 6
Journal Article
Recenzirano
Odprti dostop
Giuseppe Verdi had a real veneration for Dante. On this account, we can appreciate both Verdi’s mistrust of public commemorative events for Dante and his wariness in setting Dante’s poems to music. ...Nonetheless, Verdi set to music three of Dante’s texts, all of them religious. The first two, Padre nostro and Ave Maria, were still judged written by Dante, while the third one, the Laudi alla Vergine Maria in the Pezzi sacri, is the high prayer of St. Bernardo to the Virgin in Paradiso. In all of them, the intimate feeling and the sublime appropriate to Dante’s poetry is translated into music following on Palestrina’s style. This musical strategy shows that any resemblance between Dante and Verdi can be found neither in their temperament nor in the role of Fathers of the Nation ascribed to them in the XIX century, but in their awareness of the connection of modern languages with the past ones, in their cultural authority and in their skill to explain the forthcoming reality thanks to a full control of their respective expertises.
Il problema del vero e del reale è di estremo rilievo e complessità tanto per la psicoanalisi quanto per la filosofia. Al centro dell’una è il rapporto tra realtà interna e realtà esterna. L’altra è ...incessantemente attraversata dall’interrogativo circa la natura del reale, che ha dato esito a risposte difformi o agli antipodi (realismo, relativismo, idealismo, narrativismo ecc.). Il raffronto tra l’ambito analitico e l’ambito filosofico viene svolto da due versanti. Il primo si riferisce all’idea di verità e al rilievo ambiguo e irrisolto che la nozione mantiene in ambedue i campi. A due posizioni viene riconosciuta tuttavia particolare fertilità: l’idea di pulsione epistemofilica e il riconoscimento di un vincolo bidirezionale tra verità e interpretazione. Da un secondo versante, si propone un raffronto tra la concezione psicoanalitica della realtà nelle sue varie declinazioni e quella che attraversa la filosofia della storia (con particolare riferimento a narrativismo versus realismo critico). Proprio la storia risulta essere infatti il minimo comun denominatore condiviso dalle due discipline. Si conclude proponendo una valorizzazione del simbolo e del paradigma traduttivo. Grazie ad essi è forse possibile un distanziamento dal triplice rischio del narrativismo, del realismo ingenuo e del pensiero psicotico.
Mouse embryonic stem (ES) glucose-6-phosphate (G6P) dehydrogenase-deleted cells ( G6pd delta), obtained by transient Cre recombinase expression in a G6pd -loxed cell line, are unable to produce G6P ...dehydrogenase (G6PD) protein (EC 1.1.1.42). These G6pd delta cells proliferate in vitro without special requirements but are extremely sensitive to oxidative stress. Under normal growth conditions, ES G6pd delta cells show a high ratio of NADPH to NADP(+) and a normal intracellular level of GSH. In the presence of the thiol scavenger oxidant, azodicarboxylic acid bisdimethylamide, at concentrations lethal for G6pd delta but not for wild-type ES cells, NADPH and GSH in G6pd delta cells dramatically shift to their oxidized forms. In contrast, wild-type ES cells are able to increase rapidly and intensely the activity of the pentose-phosphate pathway in response to the oxidant. This process, mediated by the NADPH/NADP(+) ratio, does not occur in G6pd delta cells. G6PD has been generally considered essential for providing NADPH-reducing power. We now find that other reactions provide the cell with a large fraction of NADPH under non-stress conditions, whereas G6PD is the only NADPH-producing enzyme activated in response to oxidative stress, which can act as a guardian of the cell redox potential. Moreover, bacterial G6PD can substitute for the human enzyme, strongly suggesting that a relatively simple mechanism of enzyme kinetics underlies this phenomenon.
In the general population the leading cause of cardioembolic stroke is atrial fibrillation (AF). A silent AF is also the possible cause of many cryptogenic strokes. P wave dispersion (PWD), a ...predictor of AF, has been proposed as a marker of silent AF occurrence in these strokes. PWD correlates with high-sensitive C-reactive protein levels reflecting the role of inflammation in promoting a slowed and inhomogeneous atrial conduction. Statins have a multitude of additional effects beyond lipid lowering, in particular anti-inflammatory effects that may influence atrial conduction.
The aim of this study was to evaluate the effects of previous statin use on PWD in patients with cryptogenic stroke, in order to highlight a possible role for statins in preventing atrial conduction alterations that predispose to AF.
We enrolled 131 patients (67 males, 64 females; mean age 69±13 years) with cryptogenic stroke. All patients underwent neuroimaging examination, arterial ultrasound examination, echocardiography and ECG. PWD was measured in all subjects.
Patients previously treated with statins (n: 34) had lower PWD and P index values in comparison with no-statin group (41.7±12.2 vs 48.7±15.2 ms, p=0.01, and 14.2±3.7 vs 16.5±5.3 ms, p=0.02, respectively).
Our results show lower PWD values in cryptogenic stroke patients previously treated with statins. These findings provide support to the hypothesis that statins may play a role in modulating atrial electrophysiological and structural properties, preventing the occurrence of a slowed and heterogeneous atrial conduction and finally, reducing the occurrence of AF.
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