Aged ; Humans ; Ischemic Attack, Transient ; etiology ; Male ; Polycythemia Vera ; complications ; diagnosis

To systematically evaluate the risks of cardiocerebral vascular events in patients with primary biliary cholangitis(PBC). Methods We carried out a Meta analysis by RevMan 5.3 software to investigate literatureon the risk of cardiocerebral vascular events in patients with PBC and controls. Results Compared with non-PBC controls,PBC patients had significantly higher risk of coronary events(=1.56,=0.0002);however,the risk of cerebrovascular events showed no significant difference between these two groups(=1.01,=0.94).Subgroup analysis demonstrated a significantly lower risk of transient ischemic attack or carotid stenosis in PBC patients(=0.63,=0.03);however,there was no significant difference in the risk of stroke(=1.11,=0.40). Conclusion Patients with PBC have an increased risk of coronary events but may have a lower risk of transient ischemic attack or carotid stenosis.
Carotid Stenosis ; etiology ; Cholangitis ; complications ; Coronary Disease ; etiology ; Humans ; Ischemic Attack, Transient ; etiology ; Liver Cirrhosis, Biliary ; complications ; Risk Factors ; Stroke ; etiology

BACKGROUND: The age, biomarkers, and clinical history (ABC)-atrial fibrillation (AF)-Stroke score have been proposed to refine stroke risk stratification, beyond what clinical risk scores such as the CHA2DS2-VASc score can offer. This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations. METHODS: A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry (CAFR) between 2013 and 2019 were included. Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk. The ABC-AF-Stroke score was evaluated in terms of discrimination, including concordance index (C-index), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), clinical utilization by decision curve analysis (DCA), and calibration by comparing the predicted risk with the observed annualized event rate. RESULTS: After a median follow-up of 3.5 years, 64 patients experienced thromboembolism events. Age, prior history of stroke/transient ischemic attack (TIA), high-sensitivity cardiac troponin T (cTnT-hs), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were independently associated with thromboembolism risk. The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index (0.67, 95% confidence interval [CI]: 0.59-0.74 vs. 0.60, 95% CI: 0.52-0.67, P = 0.030) and reclassification capacity. The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score. The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population. CONCLUSIONS In this real-world study enrolling non-anticoagulated AF patients following successful ablations, age, prior history of stroke/TIA, level of NT-proBNP, and cTnT-hs were independently associated with an increased risk of thromboembolism. The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.
Humans ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications* ; East Asian People ; Ischemic Attack, Transient ; Registries ; Risk Assessment ; Risk Factors ; Stroke/etiology* ; Thromboembolism/etiology* ; Troponin T

OBJECTIVETo investigate the characteristics of cerebral artery lesions in patients with limb-shaking transient ischemic attacks (LS-TIA) and its treatment.

METHODSWe retrospectively analyzed the clinical data of 20 patients with LS-TIA who received treatment in Peking Union Medical College Hospital from 2005 to 2008.

RESULTSCritical stenosis or occlusion of contralateral arteries were found in the siphonic part of internal carotid artery (ICA) in 6 patients, terminal ICA or proximal middle cerebral artery (MCA) in 6 patients, and distal MCA in 1 patient. Seven patients had proximal ICA occlusion. The brain MRI showed typical watershed cerebral infarctions in 8 patients. EEG studies failed to show epileptiform activity associated with LS-TIA, but found focal frontotemporal lobe slow activity in 6 patients, which was consistent with hypoperfusion area in CT perfusion. Six patients received surgical revascularization and no one recurred.

CONCLUSIONIntracranial artery including the siphonic part of ICA, terminal ICA and proximal MCA stenosis is the main underlying cause of LS-TIA in Chinese, and surgical revascularization may be effective in abolishing the attacks.

Adult ; Aged ; Aged, 80 and over ; Cerebral Arteries ; pathology ; Female ; Humans ; Ischemic Attack, Transient ; complications ; pathology ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Tremor ; etiology

OBJECTIVETo investigate the relationship between cerebral vasospasm and occurrence of delayed ischemic neurological deficit (DIND).

METHODSThe clinical records and radiographic images of 118 patients with subarachnoid hemorrhage admitted during last 5 years were reviewed. The incidence,degree and localization of cerebral vasospasm were evaluated, and morbidity of related DIND was analyzed. Patients with cerebral vasospasm were divided into three groups: Group MCA (middle cerebral artery), Group ACA (anterior cerebral artery) and Group ICA (intracranial carotid artery) according to the location of cerebral vasospasm. The consistency of DIND and image of cerebral infarction were examined.

RESULTThere was a weak correlation between cerebral vasospasm and incidence of DIND (r=0.22; P=0.016). The incidence of DIND was increased with severity of cerebral vasospasm (U=2.589, P<0.05). The group MCA had a significantly higher incidence of DIND than that of ACA and ICA groups (68.0% compared with 36.7% and 25.0%, respectively, chi(2)=8.195, P=0.004), the difference between later two groups was not statistically significant (chi(2)=0.646, P=0.421).

CONCLUSIONCerebral vasospasm may be an important factor leading to DIND occurrence; the severity and location of cerebral vasospasm is related to the incidence of DIND.

Adult ; Aged ; Aneurysm, Ruptured ; complications ; Carotid Artery, Internal ; Female ; Humans ; Intracranial Aneurysm ; complications ; Ischemic Attack, Transient ; etiology ; Male ; Middle Aged ; Rupture, Spontaneous ; Subarachnoid Hemorrhage ; complications ; Time Factors ; Vasospasm, Intracranial ; etiology

OBJECTIVETo determine the benefit of carotid endarterectomy (CEA) for stroke prevention by reviewing the early and late outcomes of Hong Kong Chinese patients undergoing CEA who have a high reported incidence of intracranial atherosclerotic disease (IAD).

METHODSFifty-nine Chinese patients underwent 62 CEA. There were 48 males and 11 females, with a mean age of 70 +/- 7 years (range: 52 - 86 years). Twenty-one CEA (34%) were performed for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Preoperative angiography was done in 36 instances (58%). All CEA were performed under general anaesthesia with routine intraoperative shunting. The arteriotomy was closed primarily in all patients except three. Patients were followed up regularly with six-monthly Duplex scan surveillance.

RESULTSThere were 2 perioperative neurological events consisting of one transient ischemic attack and one minor stroke. There was no operative mortality or major morbidity such as bleeding or cranial nerve injury. Mean hospital stay was 6.5 +/- 4 days (range: 3 - 26 days). The patients were followed up for a mean interval of 24 +/- 17 months (range: 1 - 57 months). Seven patients died during follow-up and subsequent neurological events occurred in 5 patients, including 2 fatal strokes. The 3-year survival, freedom from stroke and stroke free survival were 86%, 87% and 83%, respectively. One recurrent stenosis of 80% was detected on follow-up Duplex scan.

CONCLUSIONSDespite a high incidence of IAD, CEA in Hong Kong Chinese patients is associated with acceptable perioperative morbidity and mortality with satisfactory long-term efficacy in stroke prevention.

Aged ; Aged, 80 and over ; Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; adverse effects ; Female ; Follow-Up Studies ; Hong Kong ; Humans ; Ischemic Attack, Transient ; etiology ; Male ; Middle Aged ; Stroke ; etiology ; Survival Analysis ; Time Factors ; Treatment Outcome

In this study, we used functional magnetic resonance imaging (fMRI) to investigate longitudinal changes in brain activation during a verbal working memory (VWM) task performed by patients who had experienced a transient ischemic attack (TIA). Twenty-five first-ever TIA patients without visible lesions in conventional MRI and 25 healthy volunteers were enrolled. VWM task-related fMRI was conducted 1 week and 3 months post-TIA. The brain activity evoked by the task and changes over time were assessed. We found that, compared with controls, patients exhibited an increased activation in the bilateral inferior frontal gyrus (IFG), right dorsolateral prefrontal cortex (DLPFC), insula, inferior parietal lobe (IPL), and cerebellum during the task performed 1 week post-TIA. But only the right IFG still exhibited an increased activation at 3 months post-TIA. A direct comparison of fMRI data between 1 week and 3 months post-TIA showed greater activation in the bilateral middle temporal gyrus, right DLPFC, IPL, cerebellum, and left IFG in patients at 1 week post-TIA. We conclude that brain activity patterns induced by a VWM task remain dynamic for a period of time after a TIA, despite the cessation of clinical symptoms. Normalization of the VWM activation pattern may be progressively achieved after transient episodes of ischemia in TIA patients.
Adult ; Analysis of Variance ; Female ; Humans ; Image Processing, Computer-Assisted ; Ischemic Attack, Transient ; complications ; diagnostic imaging ; Longitudinal Studies ; Magnetic Resonance Imaging ; Male ; Memory Disorders ; diagnostic imaging ; etiology ; Memory, Short-Term ; physiology ; Middle Aged ; Neuropsychological Tests ; Oxygen ; blood ; Retrospective Studies ; Time Factors

We investigated the persistence of viable Orientia tsutsugamushi in patients who had recovered from scrub typhus. Blood specimens were available from six patients with scrub typhus who were at 1 to 18 months after the onset of the illness. The EDTA-treated blood specimens were inoculated into ECV304 cells, and cultures were maintained for 7 months. Sequencing of the 56-kDa type-specific antigen gene of O. tsutsugamushi was performed to ascertain the homology of isolates. O. tsutsugamushi was isolated from all six patients, and nucleotide sequences of isolates serially collected from each patient were identical in all five patients in whom nucleotide sequences were compared. One patient relapsed 2 days after completion of antibiotic therapy; two patients complained of weakness for 1 to 2.5 months after the illness; one patient underwent coronary angioplasty 6 months later; and one patient suffered from a transient ischemic attack 8 months later. This finding suggests that O. tsutsugamushi causes chronic latent infection, which may be associated with certain clinical illnesses, preceded by scrub typhus. Antibiotic therapy abates the symptoms of scrub typhus, but does not eradicate O. tsutsugamushi from the human body.
Adult ; Aged ; Aged, 80 and over ; Antigens, Bacterial/genetics ; Bacterial Proteins/genetics ; Base Sequence ; Case-Control Studies ; Chronic Disease ; Coronary Artery Disease/etiology ; DNA, Bacterial/genetics/isolation & purification ; Female ; Genes, Bacterial ; Humans ; Ischemic Attack, Transient/etiology ; Male ; Membrane Proteins/genetics ; Middle Aged ; Muscle Weakness/etiology ; Orientia tsutsugamushi/genetics/immunology/*isolation & purification ; Recurrence ; Scrub Typhus/complications/drug therapy/*microbiology ; Time Factors

PURPOSE: To compare the effectiveness of device closure and medical therapy in prevention of recurrent embolic event in the Korean population with cryptogenic stroke and patent foramen ovale (PFO). MATERIALS AND METHODS: Consecutive 164 patients (men: 126 patients, mean age: 48.1 years, closure group: 72 patients, medical group: 92 patients) were enrolled. The primary end point was a composite of death, stroke, transient ischemic attack (TIA), or peripheral embolism. RESULTS: Baseline characteristics were similar in the two groups, except age, which was higher in the medical group (45.3±9.8 vs. 50.2±6.1, p<0.0001), and risk of paradoxical embolism score, which was higher in the closure group (6.2±1.6 vs. 5.7±1.3, p=0.026). On echocardiography, large right-to-left shunt (81.9% vs. 63.0%, p=0.009) and shunt at rest/septal hypermobility (61.1% vs. 23.9%, p<0.0001) were more common in the closure group. The device was successfully implanted in 71 (98.6%) patients. The primary end point occurred in 2 patients (2 TIA, 2.8%) in the closure group and in 2 (1 death, 1 stroke, 2.2%) in the medical group. Event-free survival rate did not differ between the two groups. CONCLUSION: Compared to medical therapy, device closure of PFO in patients with cryptogenic stroke did not show difference in reduction of recurrent embolic events in the real world's setting. However, considering high risk of echocardiographic findings in the closure group, further investigation of the role of PFO closure in the Asian population is needed.
Adult ; Aged ; Aged, 80 and over ; Cardiac Catheterization/adverse effects ; Disease-Free Survival ; Embolism/etiology/*prevention & control ; Female ; Fibrinolytic Agents/adverse effects/*therapeutic use ; Foramen Ovale, Patent/complications/*drug therapy/mortality/*surgery ; Humans ; Ischemic Attack, Transient/*drug therapy/mortality/*surgery ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk ; Secondary Prevention/methods ; *Septal Occluder Device/adverse effects ; Stroke/etiology/prevention & control ; Treatment Outcome

OBJECTIVETo investigate the effects of sodium ferulate (SF), an intravenous drug made from traditional Chinese herbs, on activation of postsynaptic density-95 (PSD-95) and neuroprotection after transient cerebral artery occlusion in rats.

METHODSForty-six male Sprague-Dawley rats were randomized into 2 groups (n=23 in each group): the control group and the SF group. After anesthesia, the middle cerebral artery occlusion (MCAO) was conducted with the intraluminal filament technique. The neurological deficit was assessed with the method devised by Bederson et al. The 2,3,4-triphenyltetrazolium chloride staining was used to assess the infarct volume. We adopted a modified six-point scale to conduct neurobehavioral evaluation. Immediately the activation of postsynaptic density-95 (PSD-95) was studied with Western blot analysis system in the cortex and striatum of rat brain.

RESULTSThe neurologic deficit score of the SF group decreased substantially compared with that of the control group (P<0.05). The infarct volume of the control group (168.1 mm3 +/- 42.2 mm3) was significantly larger than that of the SF group (61.5 mm3 +/- 28.7 mm3) at 24 hours after reperfusion (P<0.01). And the rats showed some neurological deficit. The activity of PSD-95 in the SF group at most timepoints was less than that in the control group. No upregulation of PSD-95 protein could be detected in the contralateral cortex.

CONCLUSIONSSodium ferulate can induce a neuroprotective effect against the transient focal cerebral ischemic injury and weaken the activation of PSD-95 in ischemic area after MCAO.

Animals ; Blotting, Western ; Brain Infarction ; drug therapy ; etiology ; Coumaric Acids ; therapeutic use ; Disks Large Homolog 4 Protein ; Intracellular Signaling Peptides and Proteins ; drug effects ; metabolism ; Ischemic Attack, Transient ; complications ; drug therapy ; metabolism ; Male ; Membrane Proteins ; drug effects ; metabolism ; Neuroprotective Agents ; therapeutic use ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Treatment Outcome