Trimethylamine N-oxide (TMAO) is produced when trimethylamine, a waste product of gut microbes, is converted via hepatic flavin monooxygenases. As TMAO is a potential causative factor in various cardiovascular diseases (CVDs) considerable research interest has arisen on its use as a biomarker. Higher TMAO levels are associated with future risk of both incident CVD in the general population and established CVD, including stroke. The addition of TMAO into models with traditional risk factors significantly improved the prediction of future CVD risk. TMAO promotes atherosclerosis and is associated with platelet hyperreactivity and inflammation, which are in turn associated with the development of stroke and its secondary consequences. Additionally, TMAO may play a key mediator role in the relationship between the diet, gut microbiota, and CVD development. Compelling evidence suggesting that TMAO is both a risk factor and prognostic marker of stroke and CVD. Potential therapeutic strategy of diet and drugs in reducing TMAO levels have emerged. Thus, TMAO is a novel biomarker and target in stroke and CVD prevention.
Atherosclerosis ; Blood Platelets ; Cardiovascular Diseases ; Diet ; Gastrointestinal Microbiome ; Inflammation ; Mixed Function Oxygenases ; Prognosis ; Risk Factors ; Stroke ; Waste Products

It is unclear how these brain lesions fit into the language processing in acute stroke. In this study, we aimed to investigate the neuroanatomical lesion related to language processing in acute stage of stroke patients using voxel-based lesion-symptom mapping (VLSM). 73 acute first-ever post-stroke patients were enrolled in this retrospective study, who had undertaken brain magnetic resonance imaging (MRI) and Korean version of the Western Aphasia Test within 1 month from onset. Each voxel was compared with aphasia quotient and subtest scores as dependent variables using VLSM. The aphasia group showed significantly much more involvement of extra-nuclear area, insula, inferior frontal gyrus and superior temporal gyrus compared to non-aphasia group. The deficit of spontaneous speech domain was associated with the inferior parietal lobule, inferior and middle frontal gyrus and insula.The insular cortex, inferior parietal lobule, inferior frontal gyrus, middle frontal gyrus and superior temporal gyrus were related to deficit of comprehension. The inferior parietal lobule, insula, precentral gyrus, inferior frontal gyrus were related to the deficit of repetition. The deficit of naming was related to inferior parietal lobule, insula and inferior frontal gyrus. In conclusion, VLSM from early MRI imaging study after stroke may be useful to understand the language process network and establish early rehabilitation strategies after stroke.

No abstract available.
Neuroma*

BACKGROUND AND PURPOSE: Information technology and mobile devices may be beneficial and useful in many aspects of stroke management, including recognition of stroke, transport and triage of patients, emergent stroke evaluation at the hospital, and rehabilitation. In this review, we address the contributions of information technology and mobile health to stroke management. SUMMARY OF ISSUES: Rapid detection and triage are essential for effective thrombolytic treatment. Awareness of stroke warning signs and responses to stroke could be enhanced by using mobile applications. Furthermore, prehospital assessment and notification could be streamlined for use in telemedicine and teleradiology. A mobile telemedicine system for assessing the National Institutes of Health Stroke Scale scores has shown higher correlation and fast assessment comparing with face-to-face method. Because the benefits of thrombolytic treatment are time-dependent, treatment should be initiated as quickly as possible. In-hospital communication between multidisciplinary team members can be enhanced using information technology. A computerized in-hospital alert system using computerized physician-order entry was shown to be effective in reducing the time intervals from hospital arrival to medical evaluations and thrombolytic treatment. Mobile devices can also be used as supplementary tools for neurologic examination and clinical decision-making. In post-stroke rehabilitation, virtual reality and telerehabilitation are helpful. Mobile applications might be useful for public awareness, lifestyle modification, and education/training of healthcare professionals. CONCLUSIONS: Information technology and mobile health are useful tools for management of stroke patients from the acute period to rehabilitation. Further improvement of technology will change and enhance stroke prevention and treatment.
Delivery of Health Care ; Humans ; Life Style ; National Institutes of Health (U.S.) ; Neurologic Examination ; Stroke ; Telemedicine ; Teleradiology ; Triage

Sjogren syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in dry mouth and eyes. Approximately one-third of patients present with systemic manifestations, but respiratory muscle involvements have been rarely reported. We report a case of acute respiratory failure complicated by primary Sjogren syndrome. Muscle biopsy revealed perivascular lymphocytic infiltrations. Corticosteroid therapy improved respiratory muscle weakness. Sjogren syndrome should be considered as one of the underlying diseases causing acute respiratory failure.
Autoimmune Diseases ; Biopsy ; Exocrine Glands ; Humans ; Mouth ; Muscular Diseases ; Respiratory Insufficiency ; Respiratory Muscles* ; Respiratory Paralysis ; Sjogren's Syndrome*

PURPOSE: To assess the changes in mean corneal refractive power (DeltaK) following pterygium surgery and to predict DeltaK in cases of combined cataract and pterygium surgery. METHODS: Thirty-seven eyes of unilateral pterygium patients who underwent pterygium surgery were analyzed retrospectively with at least more than 1 month of follow-up. Preoperative and postoperative 1 month corneal refractive power was measured using auto-keratometer (RK-F1, Canon, Tokyo, Japan). Pterygium horizontal extension, width, and area were measured and correlation with DeltaK before and after surgery analyzed. We also compared DeltaK of the contralateral normal eye. RESULTS: The mean corneal refractive (Km) power measured before and 1 month after surgery was 43.30 +/- 1.66 D and 44.07 +/- 1.42 D, respectively. The Km significantly increased at 4 weeks after surgery (p < 0.001). However, postoperative Km was not significantly different when compared with the contralateral normal eye (43.86 +/- 1.34 D; p = 0.59). All parameters of pterygium size including horizontal extension, width, and area were positively correlated with the mean DeltaK. Among parameters, horizontal extension was best correlated with mean DeltaK (p < 0.001). The mean DeltaK with horizontal extension was predicted using linear regression (2.5 mm to 1 D, 4.0 mm to 1.8 D). CONCLUSIONS: We recommend contralateral corneal refractive power or prediction of corneal refractive power using linear regression with pterygium horizontal extension for determining intraocular lens power in cases of combined cataract and pterygium surgery.
Cataract ; Follow-Up Studies ; Humans ; Lenses, Intraocular ; Linear Models ; Pterygium* ; Retrospective Studies

In patients with acute ischemic stroke, early treatment with thrombolytic agents is thought to permit reperfusion to ischemic but still viable brain areas and to promote recovery of function. However, reocclusion and hemorrhagic transformation may occur after thrombolysis and these are major factors of no-improvement or deterioration despite the initial successful recanalization. Reocclusion occurs frequently during or immediately after successful recanalization, often silently. In the case of reocclusion, initial platelet-fibrin thrombi are converted into platelet-rich thrombi by platelet-mediated thrombotic mechanisms. Therefore, if can be effectively resolved by use of the platelet membrane glycoprotein IIb/IIIa receptor inhibitors such as abciximab. Hemorrhagic transformation (HT) is a well-known factor limiting the use of thrombolytics and negating the effect of the treatment. Recent studies demonstrate that loss of integrity of the blood-brain barrier in association with active proteolytic degradation of vascular extracellular matrix is a key molecular pathway leading to HT. Therapeutic strategies to prevent reocclusion and HT by use of agents that act against these mechanisms before or during thrombolysis are warranted to enhance the efficacy of reperfusion therapy in stroke.
Blood Platelets ; Blood-Brain Barrier ; Brain ; Cerebral Infarction ; Extracellular Matrix ; Fibrinolytic Agents ; Humans ; Membrane Glycoproteins ; Recovery of Function ; Reperfusion ; Stroke ; Thrombolytic Therapy*

The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2*-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography. The determination of thrombus size may be predictive of successful recanalization/non-recanalization after intravenous thrombolysis and endovascular treatment. However, cut-offs of thrombus size for predicting recanalization/non-recanalization are different among studies, due to different methods of measurements. Thus, a standardized method to measure the thrombus is necessary for thrombus imaging to be useful and reliable in clinical practice. Software-based measurements may provide a reliable and accurate assessment. The measurement should be easy and rapid to be more widely used in practice, which could be achieved by improvement of the user interface. In addition to prediction of recanalization, sequential measurements of thrombus volume before and after the treatment may also be useful to determine the efficacy of new thrombolytic drugs. This manuscript reviews the diagnosis of thrombus, prediction of recanalization using thrombus imaging, and practical considerations for the measurement of thrombus burden and density on CT.
Angiography ; Arteries ; Artifacts ; Diagnosis ; Endovascular Procedures ; Fibrinolytic Agents ; Methods ; Reperfusion* ; Stroke* ; Thrombolytic Therapy ; Thrombosis*

PURPOSE: The purpose of this study is to clarify the clinical significance of coagulation factor as a prognostic tool in patients with cardiac arrest treated with therapeutic hypothermia (TH). METHODS: We designed a retrospective case review study in one university hospital. All adult patients who suffered cardiac arrest from December 2011 to February 2014 were considered for inclusion in the study. Patients who did not undergo TH were excluded from the analysis. Patients with any hematologic disorder were also excluded. Patients were divided into two groups, the good outcome group and the poor outcome group depending on the final cerebral performance category (CPC). Serum D-dimer, FDP, PT, aPTT, anti-thrombin III, fibrinogen, Troponin T, CK-MB, Troponin-I, DIC score, NSE, and S-100 were taken within one hour after ROSC. Logistic regression was used for multivariable analysis. RESULTS: A total of 92 patients were included; 22 in the good outcome group, 70 in the poor outcome group. The median serum PT, aPTT, FDP, fibrinogen, and D-dimer levels were grossly elevated in the poor outcome group. Only serum PT, D-dimer level showed significant association with poor outcome (PT: OR=1.577; 95% CI=1.08-17.49, D-dimer: OR=1.577; 95% CI=1.06-2.33). The area under the receiver operating characteristic (AUC) of PT, D-dimer, and S-100 for prediction of poor outcome was 0.822 (95% CI=0.72-0.89), 0.68 (95% CI=0.57-0.77), and 0.811 (95% CI=0.70-0.89), respectively. Other factors were not associated with prognosis. CONCLUSION: Increased PT and D-dimer levels are significantly associated with poor outcome. PT and D-dimer values have potential for use as new prognostic predictors along with the current prognostic factor, S-100 protein.
Adult ; Blood Coagulation Factors ; Cardiopulmonary Resuscitation* ; Dacarbazine ; Death, Sudden, Cardiac ; Fibrinogen ; Heart Arrest ; Humans ; Hypothermia* ; Logistic Models ; Prognosis ; Retrospective Studies ; ROC Curve ; S100 Proteins ; Survivors* ; Troponin I ; Troponin T

This study evaluated the efficacy and safety of medical shampoo containing terbinafine hydrochloride and chlorhexidine gluconate in dogs with dermatophytos is complicated with bacterial infection. Although several studies in dogs and cats with fungal dermatitis have found that oral administration of terbinafine is effective for controlling clinical signs, the topical form of terbinafine has rarely been studied in dogs and cats. Therefore, this study evaluated the efficacy of medical shampoo containing terbinafine hydrochloride and chlorhexidine gluconate in dogs with dermatophytos is complicated with bacterial infection. Eight dogs infected with Microsporum spp. complicated with bacterial infection were enrolled in this study. These dogs were further blindly divided into Group 1 (no treatment, fourdogs) and group 2 (treated with medical shampoo with terbinafine/chlorhexidine, four dogs). Clinical improvement was evaluated using bacterial and fungal cultural evaluation combined with clinical evaluation. This study found that the medical shampoo has sufficient efficacy to treat varying degrees of dermatophytosis complicated with bacterial infection in dogs, although the speed of improvement differed according to the degree and type of infection. Our study also found that combined therapy using antifungal and antibacterial agents can improve clinical signs more effectively and rapidly, suggesting that concurrent bacterial infection plays a significant role in the development of dermatitis.
Administration, Oral ; Animals ; Anti-Bacterial Agents ; Bacterial Infections* ; Cats ; Chlorhexidine* ; Dermatitis ; Dogs* ; Microsporum ; Naphthalenes ; Tinea*