It is increasingly recognized that modulation of brain inflammation may uncover new potential therapeutic strategies for stroke. Recent studies have shifted focus from immunological implications in ...ischemic stroke to a more devastating form; the hemorrhagic stroke.The aim of this study was to investigate the neuroinflammatory response in cerebrospinal fluid in patients with primary intracerebral hemorrhage (ICH) associated with intraventricular hemorrhage (IVH) in the presence of low-dose recombinant tissue plasminogen activator (rt-PA).This retrospective study included 88 adults with primary ICH associated with IVH. Patients were divided into 2 groups: rt-PA group and non-rt-PA group, which received normal standard of care for this diagnosis. The rt-PA group was treated via catheter-based clot lysis using low-dose rt-PA injected through the external ventricular drain (EVD) system, and the non-rt-PA group was treated with saline applied to EVD system in equivalent volume. Cerebrospinal fluid samples from rt-PA were obtained from the EVD system at 4 time points: once before the drug administration, and then on day 1, 3, and 7. No attempt at randomization was made. The decision to inject rt-PA was based on the preference of the primary attending neurologist and the ability to obtain consent. Temporal interleukin-1 beta and transforming growth factor beta concentration changes were analyzed and compared between the 2 groups.The concentration of interleukin-1 beta was significantly lower in the rt-PA group than in the non-rt-PA group on day 7. In addition, the concentration of transforming growth factor beta was significantly higher in the rt-PA group than in the non-rt-PA group on day 1. There was a significant difference in interleukin-1 beta concentration between days 0 and 1 in comparison to day 3 in the rt-PA group, and between day 0 in comparison to day 3 and 7 in the non-rt-PA group. We also observed a significant difference in transforming growth factor beta concentration between days 0 and 1 and between days 3 and 7.The different pattern of pro- and anti-inflammatory cytokines in patients with ICH associated with IVH suggest distinct characteristics of secondary brain injury depending on the treatment modality.
Background
Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. Recurrent ischemic stroke (RIS) is associated with adverse neurological outcomes but the ...phenomenon of early RIS in the endovascular thrombectomy era has not been frequently discussed. We report a case addressing this issue.
Case presentation
We present a patient who was successfully treated by mechanical thrombectomy (MT) for middle cerebral artery occlusion. Due to an early stroke recurrence, within 72 h after the first MT, he received systemic thrombolysis and repeated MT was performed with excellent clinical outcome.
Discussion
We discuss the aspects of reperfusion therapy for patients experiencing early stroke recurrence. Consideration was given to stroke etiology and off-label use of thrombolytic therapy. Also, effectiveness of repeated MT for early re-occlusion of initially reanalyzed vessel was evaluated in order to allow more patients with RIS to benefit from reperfusion therapy.
Demencija je klinički sindrom koji nastupa kada postoji deficit kognitivnog funkcioniranja u jednoj ili više kognitivnih domena (učenje i pamćenje, jezik, egzekutivne funkcije, pažnja, ...perceptivno-motorna i socijalna kognicija) te je dovoljno snažan da utječe na svakodnevno funkcioniranje i neovisnost osobe. Demografsko starenje populacije pokazatelj je napretka suvremene medicine u zadnjem stoljeću, no obzirom da demencija najviše zahvaća osobe starije od 65 godina, povećava se svijest o ovoj bolesti čija je pojavnost u porastu i koja brzo poprima pandemijske razmjere. Iako je najčešće prisutna kod starijih osoba, ne spada u fiziološki proces starenja.
U svijetu se sve više govori o fizičkom, psihološkom, društvenom, i ekonomskom utjecaju demencije na bolesnika, obitelj, skrbnika i općenito na zdravstevne politike. Oko 40 milijuna ljudi u cijelom svijetu ima demenciju (podaci od 2015. godine), a svake 3.2 sekunde otkrije se novi slučaj demencije, što čini oko 10 milijuna novih bolesnika godišnje. Najčešća je Alzheimerova demencija čiji je udio 60-80% svih demencija. Prema projekcijama Alzheimer Disease International do 2050.godine biti će približno tri puta više ljudi s demencijom (110 milijuna) u odnosu na 2015. godinu.
Stoga je potrebno podići svijest o epidemiji demencije u budućnosti, njenom utjecaju na društvo i najvažnije načine prepoznavanja demencija, pravilnu i ranu dijagnostiku i pravovremeno liječenje.
Unatoč činjenici da je ishemijski moždani udar zbog visoke smrtnosti i invalidnosti
velik javnozdravstveni problem, do pojave trombolitičke terapije nije postojao specifičan lijek
za rekanalizaciju ...okludirane krvne žile. Tromboliza rekombiniranim tkivnim aktivatorom
plazminogena (rt-PA) dokazala je svoju učinkovitost u nizu studija i za sada je jedini odobreni
lijek za liječenje ishemijskog moždanog udara. Radi poboljšanja ishoda liječenja potrebno je
liječenje provoditi u specijaliziranim odjelima – jedinicama za liječenje moždanog udara,
koje uz pravovremeno prepoznavanje moždanog udara i žurno postavljanje dijagnoze predstavljaju
preduvjet za brzo započinjanje terapije u cilju rane rekanalizacije krvne žile i reperfuzije
moždanog parenhima. Ovakav pristup zbrinjavanju bolesnika s ishemijskim moždanim
udarom omogućava ponovno uspostavljanje cirkulacije u ishemijskom području mozga, dok
je oštećenje neurona reverzibilno, što u konačnici poboljšava ishod liječenja.
Primarna moždana krvarenja predstavljaju značajni javnozdravstveni problem s obzirom
na visok mortalitet i stupanj invalidnosti kod preživjelih bolesnika, što za posljedicu
ima dugotrajno liječenje. ...Najznačajniji čimbenik rizika za nastanak moždanog krvarenja je
arterijska hipertenzija, a njena regulacija kod bolesnika s primarnim moždanim krvarenjem
predstavlja okosnicu liječenja. U bolesnika s poremećajem svijesti neophodno je liječenje
povišenog intrakranijskog tlaka s ciljem sprječavanja sekundarnog oštećenja mozga održavanjem
adekvatne moždane perfuzije mjerene cerebralnim perfuzijskim tlakom. Prema važećim
smjernicama u liječenju primarnih moždanih krvarenja u nekim slučajevima potrebno je
poduzeti i određene specifične mjere. Unatoč brojnim istraživanjima specifičnog lijeka za
sada nema.
Neurogenic pulmonary edema caused by bilateral medial medullary infarction Antoncic, Igor; Dunatov, Siniša; Sosic, Matija ...
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology,
04/2015, Letnik:
36, Številka:
4
Report
Lysosomal cysteine peptidase cathepsin B (catB) is an important tumor-promoting factor involved in tumor progression and metastasis representing a relevant target for the development of new antitumor ...agents. In the present study, we synthesized 11 ruthenium compounds bearing either the clinical agent nitroxoline that was previously identified as potent selective reversible inhibitor of catB activity or its derivatives. We demonstrated that organoruthenation is a viable strategy for obtaining highly effective and specific inhibitors of catB endo- and exopeptidase activity, as shown using enzyme kinetics and microscale thermophoresis. Furthermore, we showed that the novel metallodrugs by catB inhibition significantly impair processes of tumor progression in in vitro cell based functional assays at low noncytotoxic concentrations. Generally, by using metallodrugs we observed an improvement in catB inhibition, a reduction of extracellular matrix degradation and tumor cell invasion in comparison to free ligands, and a correlation with the reactivity of the monodentate halide leaving ligand.
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