Stroke update

Document Sample
Stroke update Powered By Docstoc
					                         This Week Update References

Kato, N., Yanaka, K., Nagase, S., Hirayama, A. and Nose, T. (2003), The antioxidant
   EPC-K1 ameliorates brain injury by inhibiting lipid peroxidation in a rat model of
   transient focal cerebral ischaemia. Acta Neurochirurgica, 145 (6), 489-493.
Abstract: Background. Cerebral ischaemia-reperfusion injury is associated with the
   generation of reactive oxygen species during the early phases of reoxygenation.
   EPC-K1. a phosphate diester of vitamins C and E, has been reported to possess
   potent hydroxyl radical scavenging activity. This study was per-formed to investigate
   the effectiveness of EPC-K1 in attenuating cerebral ischaemia-reperfusion injury in a
   rat model of transient focal cerebral ischaemia. Method. We evaluated the efficacy of
   EPC-K1 by measuring the concentration of cerebral thiobarbituric acid reactive
   substances (TBARS). an indicator of the extent of lipid peroxidation by free radicals.
   and infarct size in rats subjected to one hour of cerebral ischaemia and 4, 24, or 72
   hours of reperfusion. Findings. EPC-K1 significantly reduced both the cerebral
   TBARS level and the infarct size in a rat model of transient focal cerebral ischaemia.
   These results indicate that EPC-K1 administration during the early stages of
   reperfusion ameliorates ischaemic brain injury by inhibiting lipid peroxidation.
   Interpretation. This report is the first to describe the protective mechanism of
   EPC-K1 by measuring both the TBARS level and infarct size in a rat model of
   transient focal cerebral ischaemia, and may suggest a potential clinical approach for
   the treatment of ischaemic cerebrovascular disease
Keywords:            ARTERY-OCCLUSION/ASSAY/brain/brain                   injury/cerebral
   ischaemia/DAMAGE/HEPARIN/hydroxyl                                   radical/INFARCT
   VOLUME/LEUKOCYTE                                             ACCUMULATION/lipid
   peroxidation/rat/reperfusion/REPERFUSION            INJURY/STROKE/SYNTHETIC
   FIBRONECTIN PEPTIDES/vitamin/VITAMIN-E
Petrovic, D., Milanez, T., Kobal, J., Bregar, D., Potisk, K.P. and Peterlin, B. (2003),
   Prothrombotic gene polymorphisms and atherothrombotic cerebral infarction. Acta
   Neurologica Scandinavica, 108 (2), 109-113.
Abstract: Objectives - To test the hypothesis whether risk genotypes of the
   prothrombotic gene polymorphisms (I/D 4G5G PAI-1, G1691A factor V point
   mutation, factor VII Arg/Gln(353)) are risk factors for ACI in the Slovene population.
   The study sought an association between the insertion/deletion 4G/5G-plasminogen
   activator inhibitor 1 (PAI-1) gene polymorphism, the 1691G-A factor V point
   mutation or the arg353-to-gln factor VII gene polymorphism and atherothrombotic
   cerebral infarction (ACI). Material and methods - Ninety-six Slovene patients who
   suffered ACI were compared with 115 control subjects clinically free of
   cerebrovascular disease. Insertion/deletion 4G/5G PAI-1 gene polymorphism,
   1691G-A factor V point mutation and arg353-to-gln polymorphism in the factor VII
   were determined using polymerase chain reaction. Results - The 4G4G genotype of
   4G5G PAI-1 gene polymorphism was less frequent in cases (21.9%) than in controls
   (35.6%; OR = 0.5, 95% CI = 0.3-1; P = 0.033). No association was found either
   between the factor V point mutation (1691G-A) or the RR genotype of the factor VII
   Arg/Gln(353) gene polymorphism and the risk of ACI using univariate analysis.
   Conclusion - The 4G/4G-PAI-1 genotype might be a protective factor against ACI,
   whereas the factor V point mutation (1691G-A) and the factor VII Arg/Gln(353)
   gene polymorphism have not proved to be risk factors for ACI
Keywords:        4G/5G         PAI-1       gene     promoter       polymorphism/4G/5G
   POLYMORPHISM/atherothrombotic                                          stroke/cerebral
  infarction/CEREBROVASCULAR-DISEASE/COAGULATION-FACTOR-V/COR
  ONARY            HEART-DISEASE/factor              VII        Arg/Gln353          gene
  polymorphism/FACTOR-VII             LEVELS/G1691A            factor      V       point
  mutation/ISCHEMIC-STROKE/MYOCARDIAL-INFARCTION/PAI-1
  GENE/PLASMINOGEN-ACTIVATOR                                          INHIBITOR-1/risk
  factors/RISK-FACTORS
Mayor, I., Comelli, M., Vassileva, E., Burkhard, P. and Sztajzel, R. (2003),
  Microembolic signals and carotid plaque morphology: a study of 71 patients with
  moderate or high grade carotid stenosis. Acta Neurologica Scandinavica, 108 (2),
  114-117.
Abstract: Objectives - To determine whether particular carotid plaque features on
  ultrasound are more likely to produce microembolic signals (MES). Patients and
  methods - We have reviewed 71 patients with moderate or high grade carotid
  stenosis established by ultrasound (30-99%). Plaque appearance was classified
  according to five subtypes. Transcranial monitoring of the middle cerebral arteries
  was performed on each patient. Results - MES were more frequently encountered in
  patients     with     anechogenic/hypoechogenic         plaques     compared      with
  isoechogenic/hyperechogenic lesions (P < 0.01). MES+ patients presented also more
  frequently an irregular surface of the plaque and more severe stenosis, however, the
  differences did not reach significance. There was no relationship between the
  presence of MES and a history of stroke or transient ischaemic attack (TIA). When
  considering the different above mentioned variables (logistic regression), only plaque
  morphology appeared to be a risk factor for the presence of MES. Conclusion -
  MES+       patients    presented    a    significantly increased      frequency of
  anechogenic/hypoechogenic plaques. As MES may be a marker of increased risk of
  stroke, the clinical significance of this particular association should be further
  investigated
Keywords: ANGIOGRAPHY/ARTERY STENOSIS/carotid stenosis/CEREBRAL
  MICROEMBOLI/CONSENSUS/DISEASE/ECHOGENICITY/microembolic
  signals/plaque morphology/PREVALENCE/RISK/risk factor/stroke/transcranial
  Doppler/ULCERATION/ULTRASOUND
Daly, D.J., Djobova, S.K., Malone, L.A., Vanlandewijck, Y. and Steadward, R.D.
  (2003), Swimming speed patterns and stroking variables in the paralympic100-m
  freestyle. Adapted Physical Activity Quarterly, 20 (3), 260-278.
Abstract: A video race analysis was conducted on 100-m freestyle performances of 72
  male and 62 female finalists at the Sydney 2000 Paralympic Games. Races were won
  or lost in the second half of each 50-m race lap and differences in speed between
  swimmers were more related to stroke length than stroke rate. Within-race speed
  changes were more related to changes in stroke rate. Stroke rate changes were also
  responsible for speed changes between qualifying heats and finals in the first part of
  races, while stroke length was responsible for better speed maintenance at the end of
  races. Results indicate that Paralympic finalists use race speed patterns similar to
  able- bodied elite swimmers
Keywords:          CLASSIFICATION/DISABILITY/DISTANCE/EVENTS/FEMALE
  OLYMPIC SWIMMERS/PERFORMANCE/SPORT/stroke/VELOCITY
Rosendahl, E., Lundin-Olsson, L., Kallin, K., Jensen, J., Gustafson, Y. and Nyberg, L.
  (2003), Prediction of falls among older people in residential care facilities by the
  Downton index. Aging Clinical and Experimental Research, 15 (2), 142-147.
Abstract: Background and aims: Falls are frequent among older people living in
  residential care facilities. The aim of this study was to investigate the prediction
  accuracy of the Downton fall risk index among older people living in residential care
  facilities at 3, 6 and 12 months, and with two different definitions of falls. Methods:
  Seventy-eight residents in one residential care facility, 56 women and 22 men,
  mean+/-SD age 81+/-6 years, participated in this study. Forty-seven percent of
  participants had dementia, 45% depression, and 32% previous stroke. Forty-one
  percent of participants used a walking device indoors, and the median score of the
  Barthel ADL Index was 16. At baseline, the Downton fall risk index was scored for
  each individual. A score of 3 or more was taken to indicate high risk of falls.
  Participants were followed up prospectively for 12 months, with regard to falls
  indoors. Results: At 3, 6 and 12 months, and using a fall definition including ail
  indoor falls, sensitivity ranged from 81 to 95% with the highest value at 3 months,
  and specificity ranged from 35 to 40%. The prognostic separation values ranged from
  0.26 to 0.37. Within 3 months, the risk of falling was 36% in the high-risk group
  (index score greater than or equal to3) and 5% in the low-risk group. The accuracy of
  predictions did not improve when applying a fall definition in which falls
  precipitated by acute illness, acute disease, or drug side-effects were excluded.
  Conclusions: Already after 3 months, the Downton fall risk index appears to be a
  useful tool for predicting falls, irrespective of their cause, among older people in
  residential care facilities. (C) 2003, Editrice Kurtis
Keywords:                   accidental                falls/DRUGS/fall               risk
  index/FINLAND/FRACTURE/INSTITUTIONS/METAANALYSIS/MODEL/older
  people/PATIENT/prediction accuracy/PREVENTION/prevention of falls/residential
  care/RISK ASSESSMENT-TOOL/stroke/STROKE REHABILITATION
Sorescu, D., Turk, R.J., Cain, M. and Lerakis, S. (2003), Clinical and transthoracic
  echocardiographic predictors of abnormal transesophageal findings in patients with
  suspected cardiac source of embolism. American Journal of the Medical Sciences,
  326 (1), 31-34.
Abstract: Background: Approximately 20% of cerebral infarctions are caused by a
  cardiac source of embolism. Although transesophageal echocardiography (TEE) is a
  valuable tool for evaluating patients with suspected cardioembolism, its use should
  be more selective. Objective: We attempted to determine whether risk factors derived
  from the clinical, ECG, and transthoracic echocardiogram (TTE) would make TEE
  use more selective and increase its yield. Methods: We retrospectively reviewed the
  records of 108 patients with suspected embolic stroke who had undergone TEE
  evaluation. We defined the presence of left atrial appendage spontaneous contrast
  (LAASC), left atrial appendage thrombus (LAAT), patent foramen ovale (PFO), or
  intra-atrial septal aneurysm (IASA) as TEE endpoints suggestive of cardioembolism.
  We evaluated the association between the TEE endpoints and (1) age greater than 60
  years, (2) the presence of atrial flutter (AFI) or atrial fibrillation (AF) on ECG, (3)
  left ventricular (LV) dysfunction by TTE (mild, LVEF < 40%; severe, LVEF < 25%),
  and (4) left atrial (LA) size > 4 cm also determined by TTE. The statistical analysis
  performed was one-way analysis of variance controlling for interactions between
  different risk factors and the endpoints. Results: The strongest independent predictors
  for the presence of LAASC or LAAT were age greater than 60 years, presence of
  AFI/AF, and LV systolic dysfunction. There was no association between any of the
  risk factors with the presence of PFO or IASA. Conclusion: This study demonstrates
  that clinical characteristics, ECG, and TTE findings can help to better select stroke
  patients for TEE. Future larger studies are needed to provide more supporting data
Keywords:                                                             ATHEROMAS/atrial
  fibrillation/ATRIAL-FIBRILLATION/echocardiography/PA/risk
  factors/SPONTANEOUS ECHO CONTRAST/STROKE/thrombus
Chemla, D., Antony, I., Lecarpentier, Y. and Nitenberg, A. (2003), Contribution of
  systemic vascular resistance and total arterial compliance to effective arterial
  elastance in humans. American Journal of Physiology-Heart and Circulatory
  Physiology, 285 (2), H614-H620.
Abstract: The respective contribution of systemic vascular resistance (R) and total
  arterial compliance (C) to the arterial load remains to be established in humans.
  Effective arterial elastance (E- a), i.e., the left ventricular end-systolic pressure
  (LVESP)- over-stroke volume ratio, is a reliable estimate of arterial load. It is widely
  accepted that E-a mainly relates to mean aortic pressure (MAP) and thus to the
  R-to-T ratio (R/T ratio), where T is cycle length. We tested the contribution of R/T
  and 1/C to E-a in 20 normotensive and 46 hypertensive subjects (MAP range: 84-160
  mmHg). The multilinear model applied (E-a = 1.00R/T + 0.42/C - 0.04; r(2) = 0.97).
  The sensitivity of E-a to a change in R/T was 2.5 times higher than to a similar
  change in 1/C in both normotensive and hypertensive adults. The LVESP was more
  strongly related to systolic aortic pressure (SAP; r(2) = 0.94) than to MAP (r(2) =
  0.83), and LVESP matched 90% SAP (bias = 0 +/- 5mmHg). An alternative model of
  E-a is proposed, in which E-a is proportional to the heart rate x SAP
  product-over-cardiac index ratio whatever the MAP
Keywords:       CANINE        LEFT-VENTRICLE/cardiac            cycle      length/cardiac
  index/compliance/DETERMINANTS/DISEASE/EXERCISE/heart/HYPERTENSIO
  N/LEFT-VENTRICULAR                                    EFFICIENCY/MYOCARDIAL
  OXYGEN-CONSUMPTION/PERFORMANCE/pulse                                   pressure/PULSE
  PRESSURE/rate-pressure product/ventriculoarterial coupling/VOLUME
Tham, K. and Kielhofner, G. (2003), Impact of the social environment on occupational
  experience and performance among persons with unilateral neglect. American
  Journal of Occupational Therapy, 57 (4), 403-412.
Abstract: OBJECTIVE. The purpose of this study was to gain an understanding of
  social environmental influences on occupational experience and performance over
  the course of rehabilitation of four persons with unilateral neglect. METHODS. The
  Phenomenological Psychological Method (Karlsson, 1993) was used to gather and
  analyze qualitative data on four women over a 4-month period. Four women were
  interviewed five to seven times each and observed during their rehabilitation process.
  Analysis focused on how these persons with unilateral neglect experienced and
  responded to their interactions with others in their everyday lives. FINDINGS. As
  perceived by the study participants, rehabilitation professionals and relatives
  demonstrated a sequence of strategies for dealing with and helping the women
  perform despite their unilateral neglect. The sequence of strategies reflects the
  changing experience of neglect over time. The strategies used by professionals and
  family members during the rehabilitation process enabled these women to reclaim
  and occupy the neglected half of the world. Moreover, the women with neglect
  learned to incorporate others as extensions of their bodies in order to compensate for
  their ongoing inability to directly experience the left half of the world.
  CONCLUSION. The results suggest that it is important for others (e;g., therapists,
  nurses, or relatives) to understand the client's changing experience of neglect and
  adjust their support and collaboration accordingly. Occupational therapy intervention
  for persons with neglect could potentially become more effective by systematically
  incorporating the kinds of strategies identified in this study. Moreover, therapists
  could consult with others to increase their understanding and effectiveness in
  interacting with persons who have unilateral neglect
Keywords: HAND/phenomenology/rehabilitation/social interaction/stroke/THERAPY
Knuiman, M.W., Divitini, M.L., Olynyk, J.K., Cullen, D.J. and Bartholomew, H.C.
  (2003), Serum ferritin and cardiovascular disease: A 17-year follow-up study in
  Busselton, Western Australia. American Journal of Epidemiology, 158 (2), 144-149.
Abstract: The association between serum ferritin level and coronary heart disease (CHD)
  and stroke events was evaluated in a long-term Western Australia prospective study
  in 1981-1998. The cohort consisted of the 1,612 men and women aged 40-89 years
  who participated in the 1981 Busselton Health Survey and who were free of
  cardiovascular disease at that time. Serum ferritin levels were obtained from serum
  samples stored frozen since 1981. The outcomes of interest were time to first CHD
  event (hospital admission or death) and time to first stroke event. Case-cohort
  sampling was used to reduce costs and preserve serum but still allow efficient
  analysis. Ferritin assays were performed for 217 CHD cases, 118 stroke cases, and a
  random sample of 450 of the total cohort. Proportional hazards regression models
  were used to obtain age-adjusted and multivariate-adjusted hazard ratios for ferritin
  level in relation to CHD and stroke. The hazard ratio for the highest fertile group
  compared with the lowest group was 0.96 (95% confidence interval: 0.60, 1.53) for
  CHD and 1.43 (95% confidence Interval: 0.78, 2.64) for stroke. Little or no evidence
  was found that ferritin level was a risk factor for cardiovascular disease
Keywords: ATHEROSCLEROSIS/BLOOD/BODY IRON STORES/cardiovascular
  diseases/CASE-COHORT                   DESIGN/cohort               studies/CORONARY
  HEART-DISEASE/ferritin/HEALTH/heart/MEN/MYOCARDIAL-INFARCTION/p
  roportional hazards models/risk factor/RISK-FACTORS/stroke/TRENDS
Christensen, P.B., Nielsen, J.F. and Sinkjaer, T. (2003), Quantification of hyperreflexia
  in amyotrophic lateral sclerosis (ALS) by the soleus stretch reflex. Amyotrophic
  Lateral Sclerosis and Other Motor Neuron Disorders, 4 (2), 106-111.
Abstract: The aim of this study was to quantify upper motor neuron (UMN)
  involvement in amyotrophic lateral sclerosis (ALS) by the soleus stretch reflex.
  METHODS: In a group of 24 ALS patients and ten healthy controls the soleus
  stretch reflex was elicited by a four degree rotation at the ankle joint Amplitude of
  the short-latency stretch reflex, threshold, and sensitivity were determined.
  Peripheral excitation/contraction properties were evaluated by supramaximal
  stimulation of the tibial nerve. Clinical scores of upper motor neuron involvement
  were applied. RESULTS: A highly significant correlation between threshold and
  sensitivity of the stretch reflex and clinical score of upper motor neuron involvement
  was found; patients With a low threshold and a high sensitivity in general had a high
  upper motor neuron score. CONCLUSION: It is suggested that upper motor neuron
  involvement in ALS can be evaluated by using the soleus stretch reflex. This may be
  useful in monitoring progression of the disease and evaluating new therapies
Keywords:           amyotrophic           lateral         sclerosis/ANKLE          JOINT
  STIFFNESS/BACLOFEN/clinical                                             score/DISEASE
  PROGRESSION/MAGNETIC-RESONANCE
  SPECTROSCOPY/MULTIPLE-SCLEROSIS/soleus                                           stretch
  reflex/SPASTICITY/stiffness/STIMULATION/STROKE/upper                              motor
  neuron/WALKING
Gasche, Y. and Copin, J.C. (2003), Blood-brain barrier pathophysiology and ischaemic
  brain oedema. Annales Francaises D Anesthesie et de Reanimation, 22 (4), 312-319.
Abstract: Cerebral oedema is a potentially lethal complication of brain infarction.
  Ischemia, by altering membrane ionic pump function, induces cell swelling and
  cytotoxic oedema. It also initiates early oxidative and inflammatory cascades leading
   to blood- brain barrier disruption, vasogenic oedema and haemorrhagic
   transformation. The mechanisms of blood-brain barrier disruption involve
   endothelial cell activation and endothelial basal membrane degradation by matrix
   metalloproteinases. Reperfusion by tissue plasminogen activators is the only
   treatment improving stroke prognosis. This treatment also increases vasogenic
   oedema and the risk of symptomatic haemorrhagic transformation, reducing the
   benefit of reperfusion. Experimental studies suggest that the inhibition of blood-brain
   barrier proteolysis reduces vasogenic oedema and the risk of haemorrhage. This
   recent progress in the understanding of blood-brain barrier disruption during
   ischaemia brings forward new therapeutic strategies using agents capable of
   interfering with the ischaemic cascade in order to increase the therapeutic window
   between the onset of ischaemia and thrombolytic reperfusion. (C) 2003 Editions
   scientifiques et medicales Elsevier SAS. Tous droits reserves
Keywords:           ADHESION             MOLECULE-1                ANTIBODY/ARTERY
   OCCLUSION/blood-brain                                                 barrier/brain/brain
   ischaemia/ENDOTHELIAL-CELLS/FOCAL
   CEREBRAL-ISCHEMIA/function/haemorrhagic transformation/HEMORRHAGIC
   TRANSFORMATION/matrix
   metalloproteinases/MATRIX-METALLOPROTEINASE
   EXPRESSION/MESSENGER-RNA
   EXPRESSION/prognosis/proteolysis/RECEPTOR
   ANTAGONIST/reperfusion/stroke/SUPEROXIDE-DISMUTASE/TISSUE-PLASMI
   NOGEN ACTIVATOR/vasogenic oedema
Wu, J.Z., Dong, R.G., Schopper, A.W. and Smutz, W.P. (2003), Analysis of skin
   deformation profiles during sinusoidal vibration of fingerpad. Annals of Biomedical
   Engineering, 31 (7), 867-878.
Abstract: Vibrotactile perception threshold measurement has been widely used to
   diagnose the severity of peripheral neuropathy associated with hand-arm vibration
   syndrome and sensory losses in stroke and diabetic patients. The vibration perception
   threshold is believed to be influenced by many factors, such as contact force and
   vibration frequency. The present study is intended to analyze, theoretically, the
   time-dependent deformation profile of skin surface, strain distributions within soft
   tissue, and response force of a fingertip when it is stimulated by a probe vibrating
   with a sinusoidal movement. A two-dimensional finite element model, which
   incorporates the essential anatomical structures of a finger: skin, subcutaneous tissue,
   bone, and nail, has been proposed to analyze the effects of vibration amplitude,
   frequency, and preindentation on the dynamic interaction between the fingerpad and
   vibrating probe. The simulation results suggest that the fraction of time over which
   the skin separates from the probe during vibration increases with increasing vibration
   frequency and amplitude, and decreases with increased preindentation of the probe.
   The preindentation of the probe has been found to significantly reduce the trend of
   skin/probe decoupling. The simulation results show reasonably consistent trends with
   the reported experimental data. (C) 2003 Biomedical Engineering Society
Keywords: COMPRESSION/fingertip/finite element model/HAND-TRANSMITTED
   VIBRATION/hyperelastic/measurement/MODEL/poroelastic/RESPONSES/SIMUL
   ATION/soft tissue mechanics/STROKE/THRESHOLDS/TISSUES/vibrotatile tests
Lin, C.Y., Hong, G.J., Lee, K.C., Loh, S.H. and Tsai, C.S. (2003), Off-pump technique
   in coronary artery bypass grafting in elderly patients. Anz Journal of Surgery, 73 (7),
   473-476.
Abstract: Background: The use of cardiopulmonary bypass (CPB) during coronary
  artery bypass grafting (CABG) is associated with substantial morbidity and mortality,
  especially in the elderly. The purpose of this study was to evaluate the feasibility of
  beating heart coronary artery revascularization in patients aged at least 80 years.
  Methods: A retrospective chart review was carried out for 17 patients aged over 80
  years who underwent isolated off-pump CABG at the Tri-Service General Hospital,
  Taiwan, during the period July 1999 to December 2000. The demographic
  characteristics, operative data, postoperative results and short-term outcomes of
  patients were compared with those of 12 patients who underwent conventional
  CABG using CPB during the same time period. Results: The off-pump group
  consisted of 13 men and four women with a mean age of 82.2 +/- 0.9 years and an
  ejection fraction of 53.4 +/- 4.1%. The on- pump group consisted of eight men and
  four women with a mean age of 83.5 +/- 0.5 and an ejection fraction of 42.0 +/- 4.8%.
  The mean number of anastomoses performed per patient was 3.1 +/- 0.3 in the
  off-pump group and 3.0 +/- 0.14 in the on-pump group. There was no occurrence of
  stroke, myocardial infarction, re-entry for bleeding or renal failure among patients in
  the off-pump group. Intubation time (10.6 vs 48.4 h), intensive care unit stay (2.9 vs
  4.2 days) and postoperative stay (12.7 vs 18.1 days) were significantly shorter in the
  off-pump group than in the on-pump group. No patient died in the off-pump group,
  whereas one patient died in the on-pump group. Conclusions: The results of this
  study suggest that the off-pump technique is a safe and efficacious method for
  myocardial revascularization in elderly patients and that the short-term outcome
  obtained with this technique are promising. Our data suggest that the off-pump
  technique is preferable in these patients
Keywords:                                                                     BEATING
  HEART-SURGERY/bleeding/CARDIAC-SURGERY/cardiopulmonary
  bypass/CARDIOPULMONARY                  BYPASS/CIRCULATION/coronary              artery
  bypass/DETERMINANTS/elderly/heart/HIGH-RISK PATIENTS/INTRAAORTIC
  BALLOON               PUMP/mortality/myocardial             infarction/MYOCARDIAL
  REVASCULARIZATION/OCTOGENARIANS/off-pump coronary artery bypass
  grafting/ON-PUMP/stroke
Weverling-Rijnsburger, A.W.E., Jonkers, I.J.A.M., van Exel, E., Gussekloo, J. and
  Westendorp, R.G.J. (2003), High-density vs low-density lipoprotein cholesterol as
  the risk factor for coronary artery disease and stroke in old age. Archives of Internal
  Medicine, 163 (13), 1549-1554.
Abstract: Background: A high total serum cholesterol level does not carry a risk of
  cardiovascular mortality among people 85 years and older and is related to decreased
  all-cause mortality. At this old age, there are few data on fractionated lipoprotein
  levels in the determination of cardiovascular disease risk. The aim of this study was
  to evaluate the relationships between low- density lipoprotein (LDL) and
  high-density lipoprotein (HDL) cholesterol levels and mortality from specific causes
  among people in the oldest age categories. Methods: Between September 1, 1997,
  and September 1, 1999, a total of 705 inhabitants in the community of Leiden, the
  Netherlands, reached the age of 85 years. Among these old people, we initiated a
  prospective follow-up study to investigate determinants of successful aging. A total
  of 599 subjects participated (response rate, 87%) and all were followed up to
  September 2001. Serum levels of total, LDL, and HDL cholesterol were assessed at
  baseline along with detailed information on comorbid conditions. The main outcome
  measure was all-cause and specific mortality risk. Results: During 4 years of
  follow-up, 152 subjects died. The leading cause of death was cardiovascular disease,
  with similar mortality risks in all tertiles of LDL cholesterol level. In contrast, low
  HDL cholesterol level was associated with a 2.0- fold higher risk of fatal
  cardiovascular disease (95% confidence interval [Cl], 1.2-3.2). The mortality risk of
  coronary artery disease was 2.0 (95% Cl, 1.0-3.9) and for stroke it was 2.6 (95% Cl,
  1.0-6.6). Both low LDL cholesterol and low HDL cholesterol concentrations were
  associated with an increased mortality risk of infection: 2.7 (95% Cl, 1.2-6.2) and 2.4
  (95% Cl, 1.1-5.6), respectively. The risks were unaffected by comorbidity.
  Conclusion: In contrast to high LDL cholesterol level, low HDL cholesterol level is a
  risk factor for mortality from coronary artery disease and stroke in old age
Keywords:                                                              ARCH/ELDERLY
  PEOPLE/EVENTS/HDL/HEART-DISEASE/ISCHEMIC-STROKE/LDL/MORTAL
  ITY/PRAVASTATIN/PREVENTION/risk factor/SERUM-CHOLESTEROL/stroke
Man-Son-Hing, M. and Laupacis, A. (2003), Anticoagulant-related bleeding in older
  persons with atrial fibrillation - Physicians' fears often unfounded. Archives of
  Internal Medicine, 163 (13), 1580-1586.
Abstract: Background: Many studies have documented the underuse of anticoagulant (ie,
  warfarin sodium) therapy as stroke prophylaxis in older persons with atrial
  fibrillation. Failure to prescribe anticoagulant agents to these patients is often due to
  physicians' perceiving the risk of major bleeding as unacceptably high because of the
  presence of such clinical risk factors as hypertension, falls, a history of
  gastrointestinal tract bleeding, and lack of assurance about compliance. Objectives:
  To critically appraise whether the presence of additional clinical factors that increase
  the risk of bleeding affects the chance of anticoagulant-related hemorrhage, and to
  develop an approach to the use of anticoagulant agents in older patients with atrial
  fibrillation who have any of these factors. Methods: Systematic MEDLINE literature
  search from January 1966 to March 2002. Results: Many of the factors that are
  purported to be barriers to anticoagulant therapy in older persons with atrial
  fibrillation probably should not influence the choice of stroke prophylaxis in these
  patients. These include previous episodes of upper gastrointestinal tract bleeding,
  predisposition to falling, and old age in itself. For some other factors, such as
  alcoholism, participation in activities that predispose to trauma, the presence of a
  bleeding diathesis or thrombocytopenia, and noncompliance with monitoring, there is
  little or conflicting evidence about their effect on anticoagulant-related bleeding.
  However, they should be considered in the clinical decision-making process.
  Conclusions: For many older patients with atrial fibrillation, physicians' fears of the
  risk of bleeding in association with anticoagulant therapy are often exaggerated and
  unfounded. Therefore, the salient issue in selecting older patients with atrial
  fibrillation for anticoagulation is accurately estimating their stroke risk, with
  bleeding risk during anticoagulation being a lesser issue, relevant to only a few
  patients
Keywords:          anticoagulation/ANTITHROMBOTIC                THERAPY/ARCH/atrial
  fibrillation/bleeding/CEREBRAL-ISCHEMIA/compliance/COST-EFFECTIVENES
  S/DIFFERENT                INTENSITIES/hemorrhage/hypertension/NONSTEROIDAL
  ANTIINFLAMMATORY DRUGS/ORAL ANTICOAGULANTS/PEPTIC-ULCER
  DISEASE/risk factors/RISK- FACTORS/SPONTANEOUS INTRACEREBRAL
  HEMORRHAGE/stroke/STROKE PREVENTION/therapy
Hamani, C., Zanetti, M.V., Pinto, F.C.G., Andrade, A.F., Ciquini, O. and Marino, R.
  (2003), Intraventricular pressure monitoring in patients with thalamic and ganglionic
  hemorrhages. Arquivos de Neuro-Psiquiatria, 61 (2B), 376-380.
Abstract: In the present study, we have evaluated the use of intraventricular pressure
  catheters in thalamic and ganglionic hemorrhages. Ten patients admitted in our
  Emergency Department in Glasgow Coma Scale (GCS) equal or below 13 enrolled
  the study (at least one point should have been lost in the eye opening score to
  exclude purely aphasic patients that were fully alert). After a complete clinical and
  neurological evaluation, computed tomography scans were obtained and the volume
  of the hematomas, as well as presence or absence of hydrocephalus, were considered.
  Intraventricular pressure catheters connected in parallel to external derivation
  systems were implanted and patients were thereafter sent to the ICU. Patients that
  presented mass effect lesions with sustained increased ICP levels or clinical and
  neurological deterioration were submitted in addition, to the surgical evacuation of
  the hematomas. Clinical evolution, complications and the rehabilitation of the
  patients were recorded. Clinical outcome was assessed with the Glasgow Outcome
  Score. In all but three patients the initial intracranial pressure levels were bellow 20
  mmHg (mean for all patients was 14.1 +/- 6.5 mmHg). Notwithstanding, these three
  patients were extremely difficult to treat. For this group of patients mortality was
  100%. Among the patients that presented ICP levels bellow 20 mmHg, 04 developed
  hydrocephalus and 03 did not display ventricular dilation. As expected, the major
  benefits concerning the intraventricular pressure catheters connected in parallel with
  external derivation systems were observed in the group of patients that presented ICP
  levels bellow 20 mmHg and had hydrocephalus. Mild non-statistically significant
  correlations for all the three groups were achieved either when the initial GCS and
  ICP levels (r=-0.28, p=0.43) or when ICP levels and the volumes of the hematomas
  were compared (r=0.38, p=0.28). In addition, no significant correlations were
  observed concerning the final outcome of the patients and the variables previously
  evaluated
Keywords:                  ASPIRATION/cerebral                        hematomas/computed
  tomography/CONSERVATIVE TREATMENT/CT/EXTERNAL VENTRICULAR
  DRAINAGE/HEMATOMA/hypertension/HYPERTENSIVE                                PUTAMINAL
  HEMORRHAGE/intracranial                                          pressure/intraventricular
  catheters/mortality/PROSPECTIVE                                          RANDOMIZED
  TRIAL/rehabilitation/SPONTANEOUS                                     INTRACEREBRAL
  HEMORRHAGE/stroke/SURGERY/SURGICAL-TREATMENT/thalamic                                 and
  ganglionic hemorrhage
Woessner, R., Grauer, M.T., Dieterich, H.J., Treib, W., Stoll, M. and Treib, J. (2003),
  Influence of long-term volume therapy with hydroxyethyl starch on leukocytes in
  patients with acute stroke. Arzneimittel-Forschung-Drug Research, 53 (6), 402-406.
Abstract: A repeated administration of hydroxyethyl starch affects hemostasiological
  and rheological factors such as the concentration of factor VIII/von Willebrand factor,
  platelet volume and plasma viscosity. An earlier study showed that HES also lowers
  the concentration of fibronectin, a molecule important in the reticuloendothelial
  system (RES). RES has a "clearing function" and is a part of the
  non-immune-specific defense mechanisms of the body. It is involved in the
  elimination of HES from the blood. Since leukocytes are another important part of
  the unspecific defense system, the goal of the present study was to investigate
  whether HES affects leukocytes. After giving their informed consent, 20 patients
  with cerebral perfusion disorders were randomized and underwent a double-blind
  10-day hypervolemic hemodilution with HES 200/0.5/13 or HES 70/0.5/4. The
  numbers of leukocytes, percentage of lymphocytes, percentage of neutrophilic
  granulocytes and hemoglobin concentration were measured. The absolute number of
  leukocytes did not change significantly, but the share of neutrophilic granulocytes
  increased. The increase in neutrophilic granulocytes reflects an increase in
   phagocytic activity. HES 200/0.5/13, which has the larger in vivo molecular weight
   (MW = 95 kD), caused a larger increase in neutrophilic granulocytes than HES
   70/0.5/4, which has an in vivo MW of 58 kD
Keywords: acute stroke/CAS 9005-27-0/COAGULATION/DEGRADATION/effect on
   fibronectin/effect                                                                  on
   leukocytes/FIBRONECTIN/HEMODILUTION/HEMORHEOLOGY/HES/hydroxye
   thyl          starch/INFUSION/MOLECULAR-WEIGHT/MONOCYTES/PLASMA
   SUBSTITUTE/stroke/therapy
Ferraris, D., Ficco, R.P., Pahutski, T., Lautar, S., Huang, S., Zhang, J. and Kalish, V.
   (2003), Design and synthesis of poly(ADP-ribose)polymerase-1 (PARP-1) inhibitors.
   Part 3: In vitro evaluation of 1,3,4,5-tetrahydro- benzo[c][1,6] and
   [c][1,7]-naphthyridin-6-ones. Bioorganic & Medicinal Chemistry Letters, 13 (15),
   2513-2518.
Abstract: The 1,3,4,5-tetrahydro-benzo[c][1,6]- and [c][1,7]-napthyridin- 6-ones are
   presented as a potent class of PARP-1 inhibitors. Derivatives of these partially
   saturated aza-5[H]- phenanthridin-6-ones were designed and synthesized with
   tertiary amines for salt formation. thus enhancing aqueous solubility, iv formulation
   and their potential use in acute ischemic injuries (i.e., myocardial ischemia and
   stroke). We found that partial saturation of the C-ring results in derivatives that are
   several times more potent than the aromatic C-ring derivatives. The general synthetic
   routes are presented herein as well as thorough in vitro potencies and SAR discussion
   for selected derivatives. (C) 2003 Elsevier Ltd. All rights reserved
Keywords:                              APOPTOSIS/ENGLAND/ISCHEMIA/myocardial
   ischemia/POLYMERASE/stroke
Rosei, E.A. (2003), Assessment of preclinical target organ damage in hypertension:
   Carotid intima-media thickness and plaque. Blood Pressure, 12 (3), 185-186
Keywords:                                                                       ARTERY
   INTIMA/ATHEROSCLEROSIS/BLOOD/BLOOD-PRESSURE/CORONARY
   HEART-DISEASE/EUROPEAN
   LACIDIPINE/EVENTS/hypertension/MYOCARDIAL-INFARCTION/PROGRESS
   ION/RISK-FACTORS/STROKE
Parvizi, J. and Damasio, A.R. (2003), Neuroanatomical correlates of brainstem coma.
   Brain, 126 1524-1536.
Abstract: The brainstem tegmentum, including the reticular formation, contains distinct
   nuclei, each of which has a set of chemical, physiological and anatomical features.
   Damage to the brainstem tegmentum is known to cause coma, the most radical
   disturbance of consciousness. However, it has remained unclear which nuclei within
   the tegmentum are crucial for the maintenance of consciousness in humans.
   Accordingly, we initiated a retrospective study of MRIs obtained from 47 patients
   with brainstem stroke. The lesion boundaries were charted on patient MRIs and
   transferred onto a corresponding series of 4.7 T MRIs obtained from a control
   brainstem specimen that later was cut on a freezing microtome and analysed
   histologically. In addition, medical charts and available post-mortem materials were
   used to obtain relevant clinical and anatomical data to verify the MRI readings in
   each case. We found that in the 38 patients who did not have coma, brainstem
   damage either was located outside the tegmentum (n = 29) or produced a very small
   and unilateral compromise of the tegmentum (n = 9). In contrast, in patients who had
   coma (n = 9), the lesions in the tegmentum were mostly bilateral (n = 7) and were
   located either in the pons alone (n = 4) or in the upper pons and the midbrain (n = 5).
   The maximum overlap territory of the lesions coincided with the location of the
  rostral raphe complex, locus coeruleus, laterodorsal tegmental nucleus, nucleus
  pontis oralis, parabrachial nucleus and the white matter in between these nuclei. We
  also found that four coma subjects developed hyperthermia and died in the absence
  of any infections. In these cases, the maximum lesion overlap was centred in the core
  of pontine tegmentum. Our findings suggest that lesions confined to the upper pons
  can cause coma in humans even in the absence of damage to the midbrain. The
  findings also point to the brainstem nuclei whose lesions are likely to be associated
  with loss of consciousness and fatal hyperthermia in humans
Keywords:           ascending           reticular        activating         system/BED
  NUCLEUS/BRAIN/consciousness/EFFERENT
  PROJECTIONS/ENGLAND/hyperthermia/INTRALAMINAR                            THALAMIC
  NUCLEI/mortality/MRI/NON-CHOLINERGIC                   NEURONS/PARABRACHIAL
  NUCLEUS/PERIAQUEDUCTAL                                   GRAY/PHA-L/RAT/reticular
  formation/RETICULAR-FORMATION/STRIA TERMINALIS/stroke
Crafton, K.R., Mark, A.N. and Cramer, S.C. (2003), Improved understanding of cortical
  injury by incorporating measures of functional anatomy. Brain, 126 1650-1659.
Abstract: Volume of injury is often used to describe a brain insult. However, this
  approach assumes cortical equivalency and ignores the special importance that
  certain cortical regions have in the generation of behaviour. We hypothesized that
  incorporating knowledge of normal brain functional anatomy into the description of a
  motor cortex injury would provide an improved framework for understanding
  consequent behavioural effects. Anatomical scanning was performed in 21 patients
  with a chronic cortical stroke that involved the sensorimotor cortex. Functional MRI
  (fMRI) was used to generate separate average activation maps for four tasks
  including hand, shoulder and- face motor tasks in 14 controls. For each task, group
  average maps for contralateral sensorimotor cortex activation were generated. Injury
  to these maps was measured by superimposing each patient's infarct. These
  measurements were then correlated with behavioural assessments. In bivariate
  analyses, injury to fMRI maps correlated with behavioural assessments more
  strongly than total infarct volume. For example, performance on the Purdue pegboard
  test by the stroke-affected hand correlated with the fraction of hand motor map
  injured (r = -0.79) more strongly than with infarct volume (r = -0.60). In multiple
  linear regression analyses, measures of functional map injury, but not infarct volume,
  remained as significant explanatory variables for behavioural assessments. Injury to
  >37% of the hand motor map was associated with total loss of hand motor function.
  Hand and shoulder motor maps showed considerable spatial overlap (63%) and
  similar behavioural consequences of injury to each map, while hand and face motor
  maps showed limited overlap (10.4%) and disparate behavioural consequences of
  injury to each map. Lesion effects support current models of broad, rather than focal,
  sensorimotor cortex somatotopic representation. In the current cross-sectional study,
  incorporating an understanding of normal tissue function into lesion measurement
  provided improved insights into the behavioural consequences of focal brain injury
Keywords:                     AREA/AXONAL                         INJURY/BRAIN/brain
  injury/ENGLAND/function/INFARCT                                VOLUME/INTERNAL
  CAPSULE/measurement/motor             cortex    map/MOVEMENTS/MRI/PRIMARY
  MOTOR                                      CORTEX/RECOVERY/SENSORIMOTOR
  CORTEX/somatotopy/STROKE/stroke/WRIST
Krizanac-Bengez, L., Kapural, M., Parkinson, F., Cucullo, L., Hossain, M., Mayberg,
  M.R. and Janigro, D. (2003), Effects of transient loss of shear stress on blood-brain
  barrier endothelium: role of nitric oxide and IL-6. Brain Research, 977 (2), 239-246.
Abstract: Loss of blood-brain barrier (BBB) function may contribute to post-ischemic
  cerebral injury by yet unknown mechanisms. Ischemia is associated with anoxia,
  aglycemia and loss of flow (i.e. shearing forces). We tested the hypothesis that loss
  of shear stress alone does not acutely affect BBB function due to a protective cascade
  of mechanisms involving cytokines and nitric oxide (NO). To determine the relative
  contribution of shear stress on BBB integrity we used a dynamic in vitro BBB model
  based on co-culture of rat brain microvascular endothelial cells (RBMEC) and
  astrocytes. Trans-endothelial electrical resistance (TEER), IL-6 release and NO
  levels were measured from the lumenal and ablumenal compartments throughout the
  experiment. Flow-exposed RBMEC were challenged with 1 h of
  normoxic-normoglycemic flow cessation (NNFC) followed by reperfusion for 2 to
  24 h. NNFC caused a progressive drop in nitric oxide production during flow
  cessation followed by a time-dependent increase in ablumenal IL-6 associated with a
  prolonged NO increase during reperfusion. The nitric oxide synthetase (NOS)
  inhibitor L-NAME (10 muM) abrogated all effects of NNFC, including changes in
  NO and cytokine production. BBB permeability did not increase during or after
  NNFC/reperfusion, but was increased by treatment with L-NAME or when the
  effects of IL-6 were blocked. Flow adapted RBMEC and astrocytes respond to
  NNFC/reperfusion by overproduction of IL- 6, possibly secondary to increased
  production of NO during the reperfusion. Maintenance of BBB function during and
  following NNFC appears to depend on intact NO signaling and IL-6 release. (C)
  2003 Elsevier Science B.V. All rights reserved
Keywords:      ASTROCYTES/blood-brain             barrier/BRAIN/CELLS/cerebral      blood
  flow/CEREBROSPINAL-FLUID/cerebrovascular
  disorder/FACTOR-ALPHA/function/IN-VITRO/inflammation/INJURY/MECHANI
  SMS/nitric                                                        oxide/rat/RELAXING
  FACTOR/RELEASE/reperfusion/stroke/TUMOR-NECROSIS-FACTOR
Lu, X.C.M., Massuda, E., Lin, Q., Li, W.X., Li, J.H. and Zhang, J. (2003),
  Post-treatment with a novel PARG inhibitor reduces infarct in cerebral ischemia in
  the rat. Brain Research, 978 (1-2), 99-103.
Abstract: Poly(ADP-ribose) is synthesized from nicotinamide adenine dinucleotide
  (NAD(+)) by poly(ADP-ribose) polymerase (PARP) and degraded by
  poly(ADP-ribose) glycohydrolase (PARG). Overactivation of the poly(ADP-ribose)
  pathway increases nicotinamide and decreases cellular NAD(+)/ATP, which leads to
  cell death. Blocking poly(ADP-ribose) metabolism by inactivating PARP has been
  shown to reduce ischemia injury. We investigated whether disrupting the
  poly(ADP-ribose) cycle by PARG inhibition could achieve similar protection. We
  demonstrate that either pre- or post-ischemia treatment with 40 mg/kg of
  N-bis-(3-phenyl-propyl)9-oxo-fluorene-2,7-diamide, a novel PARG inhibitor,
  significantly reduces brain infarct volumes by 40-53% in a rat model of focal
  cerebral ischemia. Our result provides the first evidence that PARG inhibitors can
  ameliorate ischemic brain damage in vivo, in support of PARG as a new therapeutic
  target for treating ischemia injury. (C) 2003 Elsevier Science B.V. All rights reserved
Keywords:         BRAIN/cell          death/DEATH/INJURY/ischemia/ischemia            and
  reperfusion/middle                               cerebral                         artery
  occlusion/MODELS/neuroprotection/PARG/PARP/POLY(ADP-RIBOSE)
  GLYCOHYDROLASE/POLYMERASE
  INHIBITORS/rat/stroke/STROKE/SYNTHETASE/therapeutic target
Yu, F.S., Sugawara, T. and Chan, P.H. (2003), Treatment with dihydroethidium reduces
  infarct size after transient focal cerebral ischemia in mice. Brain Research, 978 (1-2),
  223-227.
Abstract: A transient focal ischemia model with C57B1/6 mice was used to investigate
  whether dihydroethidium is neuroprotective. Different doses (25, 50, 100 mg/kg
  body weight) were used for pretreatment and the lowest effective dose was used for
  delayed treatment 1 and 2 h after reperfusion. Our results demonstrate that all the
  doses used for treatment reduced infarct volume. We conclude that dihydroethidium
  is neuroprotective by reducing superoxide in mice after stroke. (C) 2003 Elsevier
  Science B.V. All rights reserved
Keywords:           APOPTOSIS/BRAIN/BRAIN                    INJURY/DAMAGE/delayed
  treatment/dihydroethidium/DNA             FRAGMENTATION/focal                  cerebral
  ischemia/HYDROETHIDINE/ischemia/neuroprotection/OVEREXPRESSION/PRO
  TECTS                                                                  VULNERABLE
  NEURONS/REDUCTION/REPERFUSION/stroke/superoxide
  anion/SUPEROXIDE-DISMUTASE PREVENTS
Polidori, M.C., Mecocci, P., Stahl, W. and Sies, H. (2003), Cigarette smoking cessation
  increases plasma levels of several antioxidant micronutrients and improves resistance
  towards oxidative challenge. British Journal of Nutrition, 90 (1), 147-150.
Abstract: Cigarette smoking is associated epidemiologically with increased risk of
  cardiovascular diseases, but the pathophysiological mechanisms are still not fully
  understood. There is evidence that smoking is related to increased free radical
  production and antioxidant depletion, but the effects of smoking cessation on plasma
  concentrations of antioxidants and susceptibility to oxidative stress are largely
  unknown. Plasma levels of vitamins A, C, E, uric acid, total thiols, carotenoids
  (including lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha- and beta-carotene)
  and malondialdehyde (MDA, a biomarker of lipid peroxidation) were measured in
  fifteen healthy, normolipidaemic subjects (seven males, eight females, 35.2 (SD 2.3)
  years) before and 4 weeks after smoking cessation. To determine plasma resistance
  towards oxidative challenge, plasma was incubated for up to 5 h with the peroxyl
  radical-generator 2,2'-azobis(2-amidinopropane) (AAPH); MDA and ascorbate levels
  were measured at various time points. The concentrations of all plasma antioxidants
  were lower before smoking cessation than afterwards; NIDA levels were higher
  before than after termination of smoking. Upon AAPH exposure, the consumption of
  plasma ascorbate and the production of MDA occurred at a significantly faster rate
  before smoking cessation as compared with after-wards. Cigarette smoking cessation
  is followed by a marked increase in plasma antioxidant concentrations and
  substantially improves plasma resistance towards oxidative challenge. Given the
  importance of cigarette smoking as a risk factor for cardiovascular diseases and the
  pathophysiological role played by oxidative stress in these illnesses, quitting
  smoking represents an irreplaceable preventive strategy against tobacco-induced
  oxidative stress and vascular damage
Keywords:
  antioxidants/DAMAGE/DISEASE/ENGLAND/HUMAN-BLOOD-PLASMA/MAL
  ONDIALDEHYDE/micronutrients/oxidative stress/risk factor/smoking/STROKE
  PATIENTS/VITAMIN-C
Bell, R.E., Taylor, P.R., Aukett, M., Sabharwal, T. and Reidy, J.F. (2003), Mid-term
  results for second-generation thoracic stent grafts. British Journal of Surgery, 90 (7),
  811-817.
Abstract: Background: Thoracic stent grafts offer an alternative to open surgery for
  thoracic aortic disease, but their long-term durability is unknown. This report
  includes mid-term follow-up for commercially available thoracic devices. Methods:
   Data were collected prospectively for a series of endoluminal grafts used to treat
   thoracic aortic pathology. Results: Between July 1997 and October 2002, 67 patients
   received thoracic stent grafts. Elective procedures incurred a 30-day mortality rate of
   2 per cent (one of 42 patients) and urgent repair 16 per cent (four of 25). Paraplegia
   affected three (4 per cent) of 67 patients and three patients had a stroke. The median
   follow-up was 17 (range 2-64) months; four patients were lost. There were six late
   deaths, two from aneurysm rupture (rupture of a mycotic aneurysm at 5 months and
   stent migration at 28 months). Other device-related complications comprised three
   proximal endoleaks, one of which required open surgical correction with removal of
   the stent graft, and two distal endoleaks, which were successfully treated with distal
   extension cuffs. Conclusion: In the mid term, endoluminal repair of thoracic aortic
   pathology appears to be a safe alternative to open surgery, but continued surveillance
   is essential
Keywords:             AORTIC-ANEURYSM                    REPAIR/DISSECTION/EARLY
   EXPERIENCE/ENDOVASCULAR
   REPAIR/ENGLAND/mortality/PARAPLEGIA/PLACEMENT/RISK/stroke/surgery/
   thoracic
Stewart, A.H.R., McGrath, C.M., Cole, S.E.A., Smith, F.C.T., Baird, R.N. and Lamont,
   P.M. (2003), Reoperation for neurological complications following carotid
   endarterectomy. British Journal of Surgery, 90 (7), 832-837.
Abstract: Background: There remains a dilemma whether or not to re- explore the
   carotid artery when a neurological complication occurs after carotid endarterectomy.
   This study reviewed the indications for, findings and clinical outcomes following re-
   exploration. Methods: Patients who experienced transient or permanent neurological
   events following carotid endarterectomy were identified from a prospectively
   compiled computerized database. Case notes were retrieved to determine time to
   onset of symptoms, use of carotid artery imaging and details about patients who had
   surgical re-exploration, and outcomes. Results: Some 780 consecutive carotid
   endarterectomies were performed over 16 years, with an incidence of major stroke or
   death of 2.3 per cent (18 patients). Fifty-one patients experienced transient or
   permanent neurological events following surgery, 2 5 of whom underwent
   re-exploration. The findings included carotid thrombosis (ten patients), flap or other
   technical cause (three), haematoma (two) and no abnormality (ten). The neurological
   outcome after 30 days was similar, whether or not the carotid artery was re-explored.
   Conclusion: Carotid artery re-exploration was undertaken in approximately half of
   the patients who developed neurological complications following carotid
   endarterectomy. Although the cause was identified and a secondary procedure was
   undertaken in 14 of 25 patients, there was no improvement in clinical outcome at 30
   days compared with that of patients managed non- operatively
Keywords:                                                 ENGLAND/PERIOPERATIVE
   STROKE/REEXPLORATION/stroke/surgery/THROMBOSIS/TRIAL
Biancari, F., Leo, E., Ylonen, K., Vaarala, M.H., Rainio, P. and Juvonen, T. (2003),
   Value of the Glasgow Aneurysm Score in predicting the immediate and long-term
   outcome after elective open repair of infrarenal abdominal aortic aneurysm. British
   Journal of Surgery, 90 (7), 838-844.
Abstract: Background. This study aimed to explore the value of the Glasgow Aneurysm
   Score in predicting the immediate and long- term outcome after elective open repair
   of abdominal aortic aneurysm (AAA). Methods: Some 403 patients underwent
   elective open repair of an infrarenal AAA and were classified retrospectively
   according to the criteria of the Glasgow Aneurysm Score (risk score (age in years) +
  (7 for myocardial disease) + (10 for cerebrovascular disease) + (14 for renal disease)).
  Results: Fourteen patients (3.5 per cent) died after operation, 23 (5.7 per cent) had a
  myocardial infarction and six (1.5 per cent) had a stroke. One hundred and nine
  patients (27.0 per cent) experienced severe postoperative complications. The
  Glasgow Aneurysm Score was predictive of postoperative death (area under the
  receiver-operator characteristic curve (AUC) 0.80, 95 per cent confidence interval
  (c.i.) 0.71 to 0.90), severe postoperative complications (AUC 0.67, 95 per cent c.i.
  0.61 to 0.73), myocardial infarction (AUC 0.72, 95 per cent c.i. 0.62 to 0.82),
  myocardial infarction-related postoperative death (AUC 0.78, 95 per cent c.i. 0.63 to
  0.94) and stroke (AUC 0.84, 95 per cent c.i. 0.74 to 0.95). Univariate analysis
  showed that this risk index was also predictive of long-term survival. Conclusion:
  The Glasgow Aneurysm Score is a good predictor of outcome after elective open
  repair of AAA. Its simplicity and accuracy make it useful for preoperative risk
  stratification
Keywords:                 aortic              aneurysm/CARDIAC                       RISK
  INDEX/COMPLICATIONS/ENGLAND/EXPERIENCE/HOSPITAL
  VOLUME/MORTALITY/myocardial                                 infarction/NONCARDIAC
  SURGERY/POPULATION/postoperative
  complications/RECONSTRUCTION/stroke/SURVIVAL/UNITED-STATES
Schumacher, H.C., Meyers, P.M., Yavagal, D.R., Harel, N.Y., Elkind, M.S.V., Mohr,
  J.P. and Pile-Spellman, J. (2003), Endovascular mechanical thrombectomy of an
  occluded superior division branch of the left MCA for acute cardioembolic stroke.
  Cardiovascular and Interventional Radiology, 26 (3), 305-308.
Abstract: Cardiac embolism accounts for a large proportion of ischemic stroke.
  Revascularization using systemic or intra-arterial thrombolysis is associated with
  increasing risks of cerebral hemorrhage as time passes from stroke onset. We report
  successful mechanical thrombectomy from a distal branch of the middle cerebral
  artery (MCA) using a novel technique. A 72-year old man suffered an acute ischemic
  stroke from an echocardiographically proven ventricular thrombus due to a recent
  myocardial infarction. Intraarterial administration of 4 mg rt-PA initiated at 5.7 hours
  post-ictus failed to recanalize an occluded superior division branch of the left MCA.
  At 6 hours, symptomatic embolic occlusion persisted. Mechanical extraction of the
  clot using an Attracter-18 device (Target Therapeutics, Freemont, CA) resulted in
  immediate recanalization of the MCA branch. Attracter-18 for acute occlusion of
  MCA branches may be considered in selected patients who fail conventional
  thrombolysis or are nearing closure of the therapeutic window for use of
  thrombolytic agents
Keywords: ACUTE ISCHEMIC-STROKE/BASILAR ARTERY/cardioembolic
  stroke/endovascular          treatment/hemorrhage/ischemic           stroke/mechanical
  embolectomy/middle cerebral artery/MIDDLE CEREBRAL-ARTERY/myocardial
  infarction/OCCLUSION/PERCUTANEOUS                                   TRANSLUMINAL
  ANGIOPLASTY/PLASMINOGEN-ACTIVATOR
  THERAPY/rtPA/stroke/thrombolysis/thrombus
Willing, A.E., Vendrame, M., Mallery, J., Cassady, C.J., Davis, C.D., Sanchez-Ramos,
  J. and Sanberg, P.R. (2003), Mobilized peripheral blood cells administered
  intravenously produce functional recovery in stroke. Cell Transplantation, 12 (4),
  449-454.
Abstract: Filgratism (granulocyte colony stimulating factor, G-CSF)- mobilized
  peripheral blood progenitor cells (PBPCs) have replaced bone marrow (BM) as a
  preferred source of autologous stem cells, in light of the faster hematologic recovery
  and lesser supportive care requirement exhibited by PBPC transplants. Other
  hematopoietic stem cells, like the human umbilical cord blood-derived stem cells
  (hUCBs), and nonhematopoietic stem cells have been shown to improve motor
  function in rodent models of injury and degenerative disease. In the present study we
  transplanted either G-CSF-mobilized PBPCs or hUCBs in rats 24 h after permanent
  middle cerebral artery occlusion (MCAO), and assessed their behavioral
  abnormalities in spontaneous activity and spontaneous motor asymmetry. In both
  transplanted groups of rats we observed a significant reduction of the stroke-induced
  hyperactivity compared with nontransplanted, stroked animals. In addition.
  transplantation of G-CSF PBPC and hUCB cells prevented the development of
  extensive motor asymmetry. Our findings raise the possibility that PBPCs could
  provide a novel transplantation therapy to treat stroke
Keywords:                                                                     behavioral
  analysis/BONE-MARROW/BRAIN/CEREBRAL-ISCHEMIA/COLONY-STIMUL
  ATING                        FACTOR/filgrastim/function/G-CSF/INTRACEREBRAL
  TRANSPLANTATION/ISCHEMIA- INDUCED HYPERACTIVITY/MARROW
  STROMAL           CELLS/middle        cerebral     artery/middle    cerebral    artery
  occlusion/peripheral                 blood/PROGENITOR                    CELLS/stem
  cells/STEM-CELLS/stroke/therapy
Wallentin, L., Goldstein, P., Armstrong, P.W., Granger, C.B., Adgey, A.A.J., Arntz,
  H.R., Bogaerts, K., Danays, T., Lindahl, B., Makijarvi, M., Verheugt, F. and Van de
  Werf, F. (2003), Efficacy and safety of tenecteplase in combination with the
  low-molecular-weight heparin enoxaparin or unfractionated heparin in the
  prehospital setting - The assessment of the safety and efficacy of a new thrombolytic
  regimen (ASSENT)-3 PLUS randomized trial in acute myocardial infarction.
  Circulation, 108 (2), 135-142.
Abstract: Background-The combination of a single-bolus fibrinolytic and a
  low-molecular-weight heparin may facilitate prehospital reperfusion and further
  improve clinical outcome in patients with ST-elevation myocardial infarction.
  Methods and Results-In the prehospital setting, 1639 patients with ST-elevation
  myocardial infarction were randomly assigned to treatment with tenecteplase and
  either (1) intravenous bolus of 30 mg enoxaparin (ENOX) followed by 1 mg/kg
  subcutaneously BID for a maximum of 7 days or (2) weight-adjusted unfractionated
  heparin (UFH) for 48 hours. The median treatment delay was 115 minutes after
  symptom onset (53% within 2 hours). ENOX tended to reduce the composite of
  30-day mortality or in-hospital reinfarction, or in-hospital refractory ischemia to
  14.2% versus 17.4% for UFH (P = 0.080), although there was no difference for this
  composite end point plus in-hospital intracranial hemorrhage or major bleeding
  (18.3% versus 20.3%, P = 0.30). Correspondingly, there were reductions in
  in-hospital reinfarction (3.5% versus 5.8%, P = 0.028) and refractory ischemia (4.4%
  versus 6.5%, P = 0.067) but increases in total stroke (2.9% versus 1.3%, P = 0.026)
  and intracranial hemorrhage (2.20% versus 0.97%, P = 0.047). The increase in
  intracranial hemorrhage was seen in patients >75 years of age.
  Conclusions-Prehospital fibrinolysis allows 53% of patients to receive reperfusion
  treatment within 2 hours after symptom onset. The combination of tenecteplase with
  ENOX reduces early ischemic events, but lower doses of ENOX need to be tested in
  elderly patients. At present, therefore, tenecteplase and UFH are recommended as the
  routine pharmacological reperfusion treatment in the prehospital setting
Keywords:                   ACC/AHA                       GUIDELINES/ASSOCIATION
  TASK-FORCE/bleeding/CORONARY
  THROMBOLYSIS/ELEVATION/fibrinolysis/hemorrhage/heparin/ischemia/MANA
  GEMENT/mortality/myocardial            infarction/OF-CARDIOLOGY/PA/PRACTICE
  GUIDELINES
  COMMITTEE/RECOMMENDATIONS/reperfusion/stroke/THERAPY/TISSUE-PL
  ASMINOGEN ACTIVATOR
Cao, J.J., Thach, C., Manolio, T.A., Psaty, B.M., Kuller, L.H., Chaves, P.H.M., Polak,
  J.F., Sutton-Tyrrell, K., Herrington, D.M., Price, T.R. and Cushman, M. (2003),
  C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke
  in the elderly - The Cardiovascular Health Study. Circulation, 108 (2), 166-170.
Abstract: Background-Increased carotid artery intima-media thickness (IMT) and
  elevated C-reactive protein (CRP) are both associated with the occurrence of stroke.
  We investigated whether elevated CRP is a risk factor for ischemic stroke
  independent of carotid IMT and studied the interaction between CRP and IMT.
  Methods and Results-We studied 5417 participants aged 65 years or older without
  preexisting stroke or chronic atrial fibrillation who were participants in the
  Cardiovascular Health Study. The hazard ratio of incident ischemic stroke was
  estimated by Cox proportional hazards regression. During 10.2 years of follow- up,
  469 incident ischemic strokes occurred. The adjusted hazard ratios for ischemic
  stroke in the 2nd to 4th quartiles of baseline CRP, relative to the 1st quartile, were
  1.19 (95% CI 0.92 to 1.53), 1.05 (95% CI 0.81 to 1.37), and 1.60 (95% CI 1.23 to
  2.08), respectively. With additional adjustment for carotid IMT, there was little
  confounding. The association of CRP with stroke was significantly different
  depending on IMT (P < 0.02), with no association of CRP with stroke among those
  in the lowest IMT tertile and a significant association among those with higher levels
  of IMT. Conclusions-We conclude that elevated CRP is a risk factor for ischemic
  stroke, independent of atherosclerosis severity as measured by carotid IMT. The
  association of CRP with stroke is more apparent in the presence of a higher carotid
  IMT. CRP and carotid IMT may each be independent integrals in determining the
  risk of ischemic stroke
Keywords:                                                                      ADHESION
  MOLECULE-1/ASSOCIATION/ATHEROGENESIS/atherosclerosis/ATHEROSCL
  EROTIC                         PLAQUE/atrial                          fibrillation/carotid
  arteries/DISEASE/INFLAMMATION/inflammation/ischemic
  stroke/MACROPHAGES/MARKERS/PA/risk                                              factor/risk
  factors/RISK-FACTORS/stroke/WOMEN
Cui, Z.H., Ikeda, K., Kawakami, K., Gonda, T., Nabika, T. and Masuda, J. (2003),
  Exaggerated response to restraint stress in rats congenic for the chromosome 1 blood
  pressure quantitative trait locus. Clinical and Experimental Pharmacology and
  Physiology, 30 (7), 464-469.
Abstract: 1. To understand the roles of a putative hypertension gene in the chromosome
  1 quantitative trait locus (QTL) region, the response to restraint stress was studied in
  strains congenic for this QTL. 2. To establish congenic strains, the QTL region was
  introgressed from stroke-prone spontaneously hypertensive rats (SHRSP)/Izm to
  Wistar-Kyoto/Izm (WKY/Izm) rats by repeated backcrossing. Two congenic strains
  (WKYpch1.0 and WKYpch1.1) were established to cover the whole QTL region
  between D1Wox29 and D1Arb21 (approximately 40 cM) and a smaller region
  between D1Smu11 and D1Arb21 (approximately 10 cM), respectively. After
  telemetry probes were implanted, rats were exposed to restraint stress to investigate
  the blood pressure response. 3. Basal blood pressure, measured by radiotelemetry
  differed significantly between WKY rats and WKYpch1.0 (103 +/- 10 and 116 +/- 4
  mmHg, respectively; P = 0.002 by ANOVA). When exposed to restraint stress,
  WKYpch1.0 showed a greater increase in blood pressre than did WKY rats. The
  exaggerated response in the WKYpch1.0 strain was abolished by chemical
  sympathectomy using guanethidine. The WKYpch1.1 rats did not differ significantly
  from WKY rats either in basal blood pressure or in the response to restraint stress. 4.
  In conclusion, a QTL for high blood pressure was successfully introgressed in the
  established congenic strain, WKYpch1.0. A gene (or genes) in the chromosome 1
  QTL region modulates the cardiovascular responses to restraint stress in these
  congenic rats, probably through the sympathetic nervous system
Keywords:                                                                           blood
  pressure/CARDIOVASCULAR-RESPONSES/genetics/hypertension/INHERITED
  HYPERTENSION/RAT-                                     CHROMOSOME-1/REGION/SA
  GENE/SPONTANEOUSLY HYPERTENSIVE RATS/stroke-prone spontaneously
  hypertensive                 rats/SUSCEPTIBILITY/sympathetic                    nervous
  system/WISTAR-KYOTO/Wistar-Kyoto rats
Browne, L., Hardiman, O., O'Dwyer, H. and Farrell, M. (2003), Intracranial giant cell
  arteritis with fatal middle cerebral artery territory infarct. Clinical Neuropathology,
  22 (4), 199-203.
Abstract: A 37 year-old man who developed a fatal middle cerebral territory infarct was
  found at autopsy, to have widespread granulomatous angiitis involving meningeal
  and intracranial - extracerebral vessels but not intracerebral vessels or other
  extra-cranial vessels. The findings are unique and overlap with those of
  granulomatous angiitis of the nervous system (GANS) and classic giant cell arteritis
  (GCA). A possible precipitant for this devastating illness was a recent Chlamydia
  infection. The salient clinical and pathologic differences between GANS and GCA of
  the nervous system are discussed
Keywords:       BRAIN/CENTRAL-NERVOUS-SYSTEM/CEREBROSPINAL-FLUID
  PLEOCYTOSIS/CHLAMYDIA-
  PNEUMONIAE/COMPUTED-TOMOGRAPHY/giant cell arteritis/granulomatous
  giant cell arteritis of the brain/GRANULOMATOUS-ANGIITIS/intracranial
  arteritis/ISCHEMIC         STROKE/middle           cerebral       artery/PNEUMONIAE
  INFECTION/TEMPORAL ARTERITIS/VASCULITIS
Delvaux, V., Alagona, G., Gerard, P., De Pasqua, V., Pennisi, G. and de Noordhout,
  A.M. (2003), Post-stroke reorganization of hand motor area: a 1-year prospective
  follow-up with focal transcranial magnetic stimulation. Clinical Neurophysiology,
  114 (7), 1217-1225.
Abstract: Objective: Focal transcranial magnetic stimulation was used to test
  prospectively corticospinal excitability changes and reorganization of first dorsal
  interosseous (FDI) motor cortical representation in 31 patients who experienced a
  first ischemic stroke in the middle cerebral artery territory. All had severe hand palsy
  at onset. Methods: Patients were assessed clinically with the Medical Research
  Council, Rankin, the National Institutes of Health stroke scales and Barthel Index at
  days 1, 8, 30, 90, 180 and 360 after stroke. The following parameters of FDI motor
  evoked potential (MEPs) to focal transcranial magnetic stimulation were measured at
  the same delays: motor threshold, MEP amplitude, excitable cortical area, hot spot
  and center of gravity of FDI motor maps on affected and unaffected hemispheres.
  Correlations were sought between clinical and electrophysiological parameters.
  Results: In patients whose affected motor cortex remained excitable at day 1, motor
  thresholds were not significantly different between sides and were similar to those of
  controls. Persistence of MEP on the affected side at day I was a strong predictor of
  good recovery. If present at day 1. MEPs recorded in affected FDI were significantly
  smaller than of the opposite side or in normals and progressively recovered up to day
  360. In these patients, area of excitable cortex remained stable throughout the entire
  study. At day 1, amplitudes of MEPs obtained in unaffected FDI were significantly
  larger than later. Between days I and 360, we observed a significant displacement of
  center of gravity of motor maps towards more frontal regions on the affected side
  while no change was noted on the unaffected side. Conclusions: Our data confirm the
  early prognosis value of transcranial magnetic stimulation in stroke. They indicate
  that the brain insult induces a transient hyperexcitability of the unaffected motor
  cortex. The evolution of FDI motor maps along the course of recovery mostly reflect
  corticospinal excitability changes but might also reveal some degree of brain
  plasticity. Most modifications observed occurred within 3 months of stroke onset. (C)
  2003 International Federation of Clinical Neurophysiology. Published by Elsevier
  Science Ireland Ltd. All rights reserved
Keywords:            brain/BRAIN-            STIMULATION/CORTEX/FUNCTIONAL
  REORGANIZATION/INFARCTION/INTERHEMISPHERIC
  DIFFERENCES/ischemic stroke/ISCHEMIC-STROKE/middle cerebral artery/motor
  recovery/plasticity/prognosis/PROGNOSTIC
  VALUE/RECOVERY/stroke/SUBCORTICAL STROKE/TIME FOLLOWING
  STROKE/transcranial magnetic stimulation
Lam, W.W.M., Wong, K.S., So, N.M.C. and Metreweli, C. (2003), Hyperintense middle
  cerebral artery sign using MRI. Clinical Radiology, 58 (7), 542-544.
Abstract: AIM: To assess whether the presence of the hyperintense middle cerebral
  artery (MCA) sign, detected using magnetic resonance imaging (MRI), has any
  prognostic value in subacute infarction. The results were also compared with
  computed tomography (CT). MATERIALS AND METHODS: Twenty-five
  consecutive patients with suspected subacute ischaemic stroke (6-48 h after onset of
  symptoms) underwent MRI and CT assessment. The incidence of intraluminal
  thrombus demonstrated by conventional T1 and T2- weighted images was assessed.
  The results were correlated with National Institutes of Health Stroke Scale (NIHSS).
  RESULTS: Hyperintense MCA was identifiable on T1-weighted images in 77.8%
  patients, on T2-weighted images in 61.1% patients, and in 38.9% patients using CT.
  Patients with intraluminal thrombus identified by MRI had more severe stroke (mean
  NIHSS of 12.2 +/- 8.0 versus 4 +/- 3.2 respectively, p = 0.003). CONCLUSIONS:
  The presence of hyperintense MCA by MRI is associated with higher NIHSS and
  may therefore have a prognostic value. (C) 2003 The Royal College of Radiologists.
  Published by Elsevier Science Ltd. All rights reserved
Keywords: China/computed tomography/CT/ENGLAND/ISCHEMIC STROKE/middle
  cerebral artery/MRI/stroke/THROMBOLYTIC THERAPY/thrombus
Tunici, P., Pellegatta, S. and Finocchiaro, G. (2003), The potential of stem cells for the
  treatment of brain tumors and globoid cell leukodystrophy. Cytotechnology, 41 (2-3),
  93-101.
Abstract: Stem cells of different origin are under careful scrutiny as potential new tools
  for the treatment of several neurological diseases. The major focus of these
  reaserches have been neurodegenerative disorders, such as Huntington Chorea or
  Parkinson Disease (Shihabuddin et al., 1999). More recently attention has been
  devoted to their use for brain repair after stroke (Savitz et al., 2002). In this review
  we will focus on the potential of stem cell treatments for glioblastoma multiforme
  (Holland, 2000), the most aggressive primary brain tumor, and globoid cell
  leukodystrophy (Krabbe disease), a metabolic disorder of the white matter (Berger et
  al., 2001). These two diseases may offer a paradigm of what the stem cell approach
  may offer in term of treatment, alone or in combination with other therapeutic
  approaches. Two kinds of stem cells will be considered here: neural stem cells and
  hematopoietic stem cells, both obtained after birth. The review will focus on
  experimental models, with an eye on clinical perspectives
Keywords:              ADULT               HUMAN                  BRAIN/BONE-MARROW
  TRANSPLANTATION/brain/CENTRAL-NERVOUS-SYSTEM/CHEMOATTRAC
  TANT                  PROTEIN-1                   MCP-1/GALACTOCEREBROSIDASE
  GENE/GLIOBLASTOMA-MULTIFORME/GROWTH-FACTOR/HEMATOPOIET
  IC-CELLS/KRABBE-DISEASE/NEURAL                                              PROGENITOR
  CELLS/neurodegenerative disorders/neurological diseases/stem cells/stroke
Hogervorst, E., Bandelow, S., Combrinck, M., Irani, S. and Smith, A.D. (2003), The
  validity and reliability of 6 sets of clinical criteria to classify Alzheimer's disease and
  vascular dementia in cases confirmed post-mortem: Added value of a decision tree
  approach. Dementia and Geriatric Cognitive Disorders, 16 (3), 170-180.
Abstract: Data from 204 participants from the Oxford Project to Investigate Memory
  and Ageing, who were diagnosed post-mortem using the histopathological criteria of
  the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), were used
  to assess the validity of the clinical criteria for Alzheimer's disease (AD) of the
  'National Institute of Neurological and Communicative Disorders and Stroke/the
  Alzheimer's Disease and Related Disorders Association' (NINCDS/ADRDA). Cases
  who had been diagnosed as NINCDS/ADRDA 'probable AD' in life were usually
  confirmed at autopsy, but half of the NINCDS/ADRDA 'negative' cases were not
  (low specificity). It was hypothesized that the overall clinical impression may have
  taken precedence over the use of the actual criteria. We therefore investigated the
  validity and reliability of the clinical criteria using a computerized 'dementia
  diagnosis system' for each of 6 sets of criteria [Diagnostic and Statistical Manual of
  Mental Disorders (DSM-IV), NINCDS/ADRDA and three sets of criteria specifically
  for vascular dementia (VaD): NINCDS-AIREN, State of California Alzheimer's
  Disease Diagnostic and Treatment Centers (ADDTC), and Vascular Cognitive
  Impairment (VCI)] to classify a subset (n = 96) of the cases confirmed post-mortem.
  The use of the computerized system significantly (p = 0.01) increased the specificity
  (81%, similar to sensitivity) of the NINCDS/ADRDA diagnoses, which were shown
  to have 'moderate' inter-rater reliability. The DSM- IV criteria had good validity for
  AD when compared with post- mortem confirmation and showed 'substantial'
  inter-rater reliability. The ADDTC and VCI criteria for VaD had good specificity
  (88%) and sensitivity (75%), but only for one rater. The DSM-IV and
  NINCDS-AIREN criteria for VaD showed poor validity and inter-rater reliability.
  We conclude that the forced use of decision trees through a computerized system
  enhances the accuracy of the clinical diagnoses of dementia. Copyright (C) 2003 S.
  Karger AG, Basel
Keywords: ACCURACY/AGREEMENT/Alzheimer's disease/CERAD/COGNITIVE
  IMPAIRMENT/consortium             to     establish     a     registry   for    Alzheimer's
  disease/DEFICIT/diagnosis/diagnostics/INTERRATER
  RELIABILITY/NINCDS/ADRDA/PATHOLOGICAL
  DIAGNOSTIC-CRITERIA/reliability/validity/vascular dementia
Buzzelli, S., Di Francesco, L., Villani, S. and Giaquinto, S. (2003), Gait in stabilized
  hemiplegic outpatients in rehabilitation. Disability and Rehabilitation, 25 (17),
  964-967.
Abstract: Purpose: Hemipiegic patients generally expect an improvement of their gait
  even at I year after stroke. This open and prospective study was addressed to detect
  even subtle changes in gait characteristics in stabilized patients in rehabilitation
  treatment by using an opto-electronic system of analysis (ELITE). Methods:
  Forty-two hemiplegic patients were entered on this study, and mean age was 63.2
  years (SD 9.9). The gait measures were obtained four times for each patient; at time
  of baseline, at the 15th, 30th and 90th day from the beginning of rehabilitation
  treatment. Plantar flexion moment and ankle joint power were always recorded.
  Forty healthy volunteers served as controls. Four stride characteristics were
  examined: duration, length, frequency and speed. ANOVA for repeated measures
  was used. Results: In spite of rehabilitation treatment no results in gait were observed
  after 3 months. A study on patients' expectancy was also done. At the beginning they
  were given a simple questionnaire along with DSM-IV CISD- 1. None of the patients
  presented with major depression. At admission 38 (90%) patients expected an
  improvement of the gait. At the end of the rehabilitation treatment, 36 (85%) patients
  were still confident about therapy and believed in further improvements of their
  locomotion, whilst six (15%) were dubious. Conclusions: The study shows
  discrepancies between objective results and subjective feelings. Psychological factors
  account for the patients' request of long training periods and alleged favourable
  outcome
Keywords:
  ANKLE/DURATION/ENGLAND/EXTREMITY/MOBILITY/PHYSIOTHERAPY/
  RECOVERY/rehabilitation/stroke/STROKE                  PATIENTS/therapy/WALKING
  SPEED
Mudge, S., Rochester, L. and Recordon, A. (2003), The effect of treadmill training on
  gait, balance and trunk control in a hemiplegic subject: a single system design.
  Disability and Rehabilitation, 25 (17), 1000-1007.
Abstract: Purpose: The purpose of the study was to determine the effect of a period of
  body weight supported treadmill training on gait in a subject with chronic stroke and
  to see if there was a carry-over to balance, trunk control and function. Method: A
  male subject who had suffered a right CVA 30 months previously was selected for
  the study. A single system ABA design was used. Outcome measures were taken in
  the 4-week baseline period. This was followed by a 4-week period of body weight
  support treadmill training and a further 4 weeks of treatment withdrawal. Outcome
  measures used were the 10-m walk test, Berg Balance Scale (BBS), Trunk Control
  Test (TCT), a seated lateral reach test (LRT) and the Functional Independence
  Measure (FIM) and were collected in all phases of the study. Results: During the
  intervention phase, there were significant increases in the BBS and the LRT. No
  significant changes were found in the TCT or the 10-m walk test. The FIM showed a
  small improvement in the motor score. Conclusions: A period of treadmill training
  has significant carry-over to balance in a subject with chronic hemiplegia
Keywords: BODY-WEIGHT SUPPORT/ENGLAND/function/hemiplegia/IMPROVES
  PERFORMANCE/INDEPENDENCE                        MEASURE             FIM/INTERRATER
  RELIABILITY/LOCOMOTION/NONAMBULATORY                                    HEMIPARETIC
  PATIENTS/STANDING                                          BALANCE/stroke/STROKE
  PATIENTS/TASK/treadmill/WALKING
Paciaroni, M., Silvestrelli, G., Caso, V., Corea, F., Venti, M., Milia, P., Tambasco, N.,
  Parnetti, L. and Gallai, V. (2003), Neurovascular territory involved in different
  etiological subtypes of ischemic stroke in the Perugia Stroke Registry. European
  Journal of Neurology, 10 (4), 361-365.
Abstract: We studied the correlation between the potential causes of stroke (TOAST
  etiological groups) and the involvement of different vascular territories seen on
  computed tomography (CT) scans in patients with ischemic stroke. Information from
  consecutive patients with a first-ever stroke have been prospectively coded and
  entered into a computerized data bank (Perugia Stroke Registry). A population of
  1719 patients were evaluated: 1284 patients (74.7%) had ischemic stroke. Large
  artery disease was the main cause of entire middle cerebral artery (MCA) territory
  infarcts (40.9%), superficial MCA territory infarcts (35.7%), and watershed infarcts
  (68.2%). The highest presence of emboligenic heart disease was found in the entire
  MCA territory infarcts (28.8%) or superficial (29.4%) supratentorial infarcts and in
  cerebellar infarcts (36.8%). Small artery disease was the most common presumed
  cause of deep MCA infarcts (75.0%) and posterior cerebral artery (PCA) territory
  infarcts (52.1%). In conclusion: stroke location could depend on its etiology. Lacunar
  infarcts are the most prevalent (36.7%), being mostly localized in the deep MCA
  territory; large artery disease includes more than two-thirds of watershed infarcts; the
  most prevalent territories involved in cardioembolic stroke are the entire MCA and
  posterior fossa
Keywords:                        ARTERY/CEREBRAL                             VASCULAR
  TERRITORIES/CLASSIFICATION/computed tomography/computed tomography
  scan/COMPUTED-                                       TOMOGRAPHY/CONSECUTIVE
  PATIENTS/CT/DATA-BANK/DESIGN/DIAGNOSIS/ENGLAND/etiological
  subtypes/heart/INFARCTION/ischemic                    stroke/middle             cerebral
  artery/POPULATION/stroke/Stroke Registry
Gallien, P., Aghulon, C., Durufle, A., Petrilli, S., de Crouy, A.C., Carsin, M. and
  Toulouse, P. (2003), Magnetoencephalography in stroke: a 1-year follow-up study.
  European Journal of Neurology, 10 (4), 373-382.
Abstract: Recovery after stroke is closely linked to cerebral plasticity.
  Magnetoencephalography (MEG) is a non-invasive technique, which allows location
  of cerebral cells activities. In the present work, a cohort of patients has been studied
  with MEG. Twelve patients with a recent ischemic or hemorragic stroke were
  included as soon as possible after onset of stroke. Neurologic assessment, including
  standard neurologic examination, functional independence measure (FIM) and
  Orgogozo's scale was performed for 1 year in addition to a study of the
  somatosensory evoked field (SEF) using a 37-channel Biomagnetometer system. No
  response could be recorded in five patients at the first SEF exploration. In three cases,
  no response was ever recorded during the study. All these patients had a bad
  recovery. The location of the SEF sources was always in the normal non-infarcted
  cortex of the postcentral gyrus. Sensory recovery seemed to be linked to the
  reorganization of the persistent functional cortex, which was a limiting factor for
  recovery. These observations confirm the experimental results obtained in animal
  models. After stroke it can be assumed that in the case of incomplete lesion, an
  intensive sensory peripheral stimulation could maximize the use of residual sensory
  function and then contribute to improve the sensory deficit. In case of total sensory
  loss other techniques have to be used, such as visual monitoring of hand activity in
  order to improve hand function
Keywords: ACTIVE INTERVENTION/ADULT OWL MONKEYS/CORTICAL
  AREAS/ENGLAND/EVOKED                    MAGNETIC-FIELDS/function/FUNCTIONAL
  REORGANIZATION/HUMAN                                               SOMATOSENSORY
  CORTEX/magnetoencephalography/MODIFIED CHART/MOTOR CAPACITY
  ASSESSMENT/plasticity/SOURCE                 LOCALIZATION/stroke/TOPOGRAPHIC
  REORGANIZATION
Arboix, A., Garcia-Eroles, L., Comes, E., Oliveres, M., Balcells, M., Pacheco, G. and
  Targa, C. (2003), Predicting spontaneous early neurological recovery after acute
  ischemic stroke. European Journal of Neurology, 10 (4), 429-435.
Abstract: We assessed predictors of spontaneous early neurological recovery after acute
  ischemic stroke by means of multivariate analysis in a cohort of 1473 consecutive
  patients treated at one academic center. At hospital discharge, spontaneous
  neurological improvement or good outcome was defined as grades 0-2 of the Rankin
  scale, and poor outcome (no improvement or in-hospital death) as grades 3-5.
  Spontaneous recovery of neurological deficit at the time of discharge from the
  hospital was observed in 16% of patients with cerebral infarction (n = 238).
  Dysarthria-clumsy hand syndrome improved in 44% of patients and was the only
  variable significantly associated with in-hospital functional recovery in three logistic
  regression models that in addition to lacunar syndromes, included demographic
  variables, cardiovascular risk factors, and clinical variables [odds ratio (OR) 2.56],
  neuroimaging findings (OR 2.48), and outcome data (OR 2.39), respectively. Clinical
  factors related to severity of infarction available at stroke onset have a predominant
  influence upon in-hospital outcome and may help clinicians to assess prognosis more
  accurately. Our work gives a contribution into prognostic factors after acute ischemic
  stroke. With regard to patterns of stroke, dysarthria-clumsy hand syndrome was a
  significant predictor of spontaneous in-hospital recovery in ischemic stroke patients
Keywords:       cerebral      infarction/CONTROLLED             TRIAL/dysarthria-clumsy
  hand/ENGLAND/IMPROVEMENT/ischemic stroke/lacunar infarction/LACUNAR
  INFARCTS/MORTALITY/multivariate                    analysis/risk        factors/SCALE
  SCORE/stroke/stroke outcome
Kuljic-Obradovic, D.C. (2003), Subcortical aphasia: three different language disorder
  syndromes? European Journal of Neurology, 10 (4), 445-448.
Abstract: The study analyses clinical presentation of language functions of 32 patients
  with subcortical aphasia induced by stroke. The patients have been divided into three
  groups according to neuroanatomic localization of the lesion, defined by CT and
  MRI examination (striato-capsular aphasia, aphasia associated with white matter
  paraventricular lesions and thalamic aphasia). The following batteries and tests were
  used: the neurologic examination, CT scan, MRI, Doppler ultrasound, Mini Mental
  State Examination, Boston Diagnostic Aphasia Examination (BDAE), Boston
  Naming Test (BNT), Token Test and Verbal Fluency Test. Clinical presentation of
  subcortical aphasias is characterized with preserved repetition, however, some
  groups differ by certain specific features of language impairment. Striato-capsular
  aphasia and aphasia associated with white matter paraventricular lesions are
  characterized with lack of speech fluency, occurrence of literary paraphasias, mainly
  preserved comprehension and naming. Thalamic aphasia, however, is characterized
  with fluent output, impaired comprehension and naming with predominant verbal
  paraphasias. The specific features of language impairment suggest that subcortical
  structures contribute to language organization. Considering the results of language
  tests we presume that the most prominent feature in striato-capsular aphasia is
  phonetic impairment of language, opposite to thalamic aphasia where lexical-sematic
  processing seems to be affected
Keywords:
  aphasia/CT/Doppler/ENGLAND/HEMORRHAGE/INFARCTION/paraventricular
  white matter/striatocapsular region/stroke/subcortical/thalamus
Bucurescu, G. and Stieritz, D.D. (2003), Evidence of an association between Chlamydia
  pneumoniae and cerebrovascular accidents. European Journal of Neurology, 10 (4),
   449-452.
Abstract: The authors report results of a retrospective pilot study showing a strong
   association between patients with stroke/TIA and the presence of circulating IgG and
   IgA antibodies to Chlamydia pneumoniae. These results support the hypothesis that
   chronic active or persistent infection may play a role in the mechanism of thrombosis.
   The risk for stroke associated with Chlamydial circulating antibodies appeared to be
   independent of other risk factors such as diabetes and hypercholesterolemia
Keywords:                ANTIBODIES/ASSAYS/CAROTID-ARTERY/cerebrovascular
   accidents/Chlamydia
   pneumoniae/DISEASE/ENGLAND/INFECTION/PA/RISK/risk
   factors/stroke/STROKE/thrombosis
Centerholt, C., Ekblom, M., Odergren, T., Borga, O., Popescu, G., Molz, K.H.,
   Couturier, A. and Weil, A. (2003), Pharmacokinetics and sedative effects in healthy
   subjects and subjects with impaired liver function after continuous infusion of
   clomethiazole. European Journal of Clinical Pharmacology, 59 (2), 117-122.
Abstract: Objective: Clomethiazole is virtually completely eliminated by hepatic
   metabolism. This study was designed to assess the impact of liver impairment on its
   elimination and sedative effects. Methods: Eight patients with mild liver impairment
   (Child-Pugh grade A), eight patients with moderate/severe liver impairment
   (Child-Pugh grade B/C) and eight healthy subjects of similar age were given 68
   mg/kg clomethiazole edisilate according to a 24-h infusion scheme aimed at
   producing minimum sedation as it was intended for clinical use in patients with
   stroke. Concentrations of clomethiazole and its active a-carbon hydroxylated
   metabolite NLA-715 were followed in plasma and urine for 96 h and 24 h,
   respectively. Sedation was monitored using a scale from 1 to 6. Results: The fraction
   excreted unchanged in urine was less than 0.2% for clomethiazole and less than 0.4%
   for NLA-715. Urine concentrations of clomethiazole were strongly correlated (r(2) =
   0.60) to plasma concentrations and approximately equal to unbound plasma
   concentrations. Plasma levels of NLA-715 increased steadily during the infusion,
   eventually reaching mean levels exceeding those of clomethiazole in all groups.
   Plasma clearance of clomethiazole in subjects with mildly impaired liver function
   was not statistically different from that of healthy controls (40 1/h vs 44 1/h). In
   subjects with moderate/severe liver impairment, there was a 50% reduction in
   clearance. Sedation was not observed except in two subjects in the Child-Pugh A
   group showing mild sedation. Conclusion: The reduced clomethiazole clearance in
   patients with moderate/severe liver impairment seems to call for a reduction of
   clomethiazole dosage. However, sedation was not observed in this group at the
   investigated dose level
Keywords:                                ACUTE                               ISCHEMIC
   STROKE/CHLORMETHIAZOLE/CIRRHOSIS/CLASSIFICATION/clomethiazole/
   function/hepatic                 impairment/HEPATIC-FUNCTION/INDOCYANINE
   GREEN/pharmacokinetics/PLASMA/stroke
Cirstea, M.C., Mitnitski, A.B., Feldman, A.G. and Levin, M.F. (2003), Interjoint
   coordination dynamics during reaching in stroke. Experimental Brain Research, 151
   (3), 289-300.
Abstract: A technique is described that characterizes the dynamics of the interjoint
   coordination of arm reaching movements in healthy subjects (n=10) and in patients
   who had sustained a left-sided cerebrovascular accident (n=18). All participants were
   right- handed. Data from the affected right arm of patients with stroke were
   compared with those from the right arm of healthy subjects. Seated subjects made 25
  pointing movements in a single session. Movements were made from an initial target
  located ipsilaterally to the right arm beside the body, to a final target located in front
  of the subject in the contralateral arm workspace. Kinematic data from the finger,
  wrist, elbow, both shoulders and sternum were recorded in three dimensions at 200
  Hz with an optical tracking system. Analysis of interjoint coordination was based on
  the patterns of temporal delay between rotations at two adjacent joints (shoulder and
  elbow). The data were reduced to a single graph (Temporal Coordination or TC
  index) integrating the essential temporal characteristics of joint movement (the
  angular displacements, velocities and timing). TC segments, duration and amplitude,
  were analysed. The analysis was sensitive to the differences in interjoint coordination
  between healthy subjects and patients with arm motor deficits. In patients, the
  temporal coordination between elbow and shoulder movements was disrupted from
  the middle to the end of the reach. More specifically, in mid-reach, all patients had
  difficulty coordinating elbow flexion with shoulder horizontal adduction. In addition,
  patients with severe arm hemiparesis had difficulty changing elbow movement
  direction from flexion to extension and in coordinating this change with shoulder
  movement. At the end of the reach, patients with severe hemiparesis had deficits in
  the execution of elbow extension while all patients had impaired coordination of
  elbow extension and shoulder horizontal adduction. In addition, active ranges of joint
  motions were significantly decreased in the stroke compared to the healthy subjects.
  Finally, TC analysis revealed significant relationships between specific aspects of
  disrupted interjoint coordination and the level of motor impairment, suggesting that it
  may be a useful tool in the identification of specific movement coordination deficits
  in neurological impaired populations that can be targeted in treatment for arm motor
  recovery
Keywords:       ARM       MOVEMENTS/arm            reaching/BRAIN/hemiplegia/interjoint
  coordination/IPSILATERAL HAND/MOTOR CONTROL/PATTERNS/POINTING
  MOVEMENTS/SPASTIC
  HEMIPARESIS/STRATEGIES/stroke/TRUNK/UNILATERAL
  BRAIN-DAMAGE/velocity-angle diagrams/VOLUNTARY MOVEMENT
Berko, B.A., Owen, A.N. and Zwas, D.R. (2003), Echocardiography - The role of this
  noninvasive test in the geriatric population. Geriatrics, 58 (7), 30-34.
Abstract: Echocardiography assumes a major role in the diagnosis and evaluation of
  cardiovascular disease in the older population. Available diagnostic modalities are
  briefly reviewed and their role in identifying disease entities common in a geriatric
  population is discussed. The prognostic implications of echocardiographic findings
  of mitral annular calcification and aortic sclerosis are reviewed, as are the use of
  echo and Doppler technique sin the assessment of congestive heart failure. Particular
  emphasis is placed on the evaluation of ischemic heart disease using stress
  echocardiography, the diagnosis and assessment of degenerative aortic valve disease,
  and the role of transesophageal echo in the management of atrial fibrillation and
  stroke
Keywords:              AORTIC-VALVE                  SCLEROSIS/ASSOCIATION/atrial
  fibrillation/CALCIFICATION/CONGESTIVE-HEART-FAILURE/diagnosis/DOBU
  TAMINE/dobutamine/Doppler/echocardiography/EXERCISE/heart/ISCHEMIC
  STROKE/MITRAL                    ANNULAR                CALCIUM/PA/RISK/STRESS
  ECHOCARDIOGRAPHY/stroke/treadmill
Anderson, L.A., Murray, L.J., Murphy, S.J., Fitzpatrick, D.A., Johnston, B.T., Watson,
  R.G.P., McCarron, P. and Gavin, A.T. (2003), Mortality in Barrett's oesophagus:
  results from a population based study. Gut, 52 (8), 1081-1084.
Abstract: Background: Patients with Barrett's oesophagus have an increased risk of
  oesophageal adenocarcinoma but this cancer only accounts for a small proportion of
  deaths in these patients. Other causes of death are reportedly raised in this group. We
  examined cause specific mortality among individuals in a population based Barrett's
  oesophagus register. Methods: We constructed a register of all patients diagnosed
  with columnar mucosa (including specialised intestinal metaplasia) of the
  oesophagus within Northern Ireland between 1993 and 1999. Deaths occurring
  within this cohort until 31 December 2000 were identified and mortality rates were
  compared with the general population. Results: Overall mortality was not raised in
  Barrett's patients. During 7413 person years of follow up in 2373 patients there were
  253 deaths (standardised mortality ratio (SMR) 96 (95% confidence interval (CI)
  84-107)). Mortality from oesophageal cancer was raised in patients with specialised
  intestinal metaplasia (SMR 774 (95% CI 317-1231)) but only 4.7% of patients died
  from this cancer. Mortality from stroke (SMR 65 (95% CI 37-93)) was significantly
  lower than the general population while mortality from non-cancerous digestive
  system diseases was significantly higher (SMR 211 (95% CI 111- 311)). Mortality
  rates from all other causes were similar to those of the general population.
  Conclusions: This study demonstrates that the overall mortality rate in patients with
  Barrett's oesophagus is closely similar to that of the general population. Oesophageal
  cancer mortality was raised but is an uncommon cause of death in these patients who
  also appear to have a reduced risk of death from stroke
Keywords:                                 ADENOCARCINOMA/CANCER/COLONIC
  NEOPLASIA/ENGLAND/mortality/OVERRATED RISK/stroke/SURVEILLANCE
Awad-Elkarim, A.A., Bagger, J.P., Albers, C.J., Skinner, J.S., Adams, P.C. and Hall,
  R.J.C. (2003), A prospective study of long term prognosis in young myocardial
  infarction survivors: the prognostic value of angiography and exercise testing. Heart,
  89 (8), 843-847.
Abstract: Objectives: To define the ability of early exercise testing and coronary
  angiography to predict prognosis in young survivors of myocardial infarction (MI).
  Methods: 255 consecutive patients (210 men) aged 55 years or less ( mean 48 years)
  admitted to hospital (1981-85) were eligible. Of these, 150 patients (130 men) who
  were able to exercise early after MI and underwent coronary angiography within six
  months constituted the study group and were followed up for up to 15 years. Survival
  data up to 18 years was obtained for the whole cohort. Results: Survival at a median
  of 16 years was 52% for the whole cohort, 62% for the study group, and 48% for the
  excluded group. From nine years onwards survival deteriorated significantly in the
  study group compared with an age matched background population. Fifteen years
  after MI, 121 patients (81%) in the study group had had at least one event ( death, MI,
  revascularisation, cardiac readmission, stroke) leaving 29 (19%) event-free. The
  number of diseased vessels was the major determinant of time to first event (p =
  0.001) and event-free survival (p = 0.04). Exercise duration was also important in the
  prediction of time to first event (p = 0.003). Death was influenced by a history of
  prior MI. Conclusion: The favourable initial survival was followed by significant
  deterioration after nine years. This late attrition is an important treatment target.
  Furthermore, this study supports risk stratification early after MI combining
  angiography with non-invasive tools
Keywords:                                          angiography/CORONARY-ARTERY
  SURGERY/DEATH/DISEASE/ENGLAND/exercise/FOLLOW-UP/HEART/ISCHE
  MIA/MORTALITY/myocardial                                  infarction/REGISTRY/RISK
  STRATIFICATION/stroke/THROMBOLYTIC THERAPY/TRIAL
Dens, J.A., Desmet, W.J., Coussement, P., De Scheerder, I.K., Kostopoulos, K.,
  Kerdsinchai, P., Supanantaroek, C. and Piessens, J.H. (2003), Long term effects of
  nisoldipine on the progression of coronary atherosclerosis and the occurrence of
  clinical events: the NICOLE study. Heart, 89 (8), 887-892.
Abstract: Background: Earlier angiographic studies have suggested that calcium
  antagonists may prevent the formation of new coronary lesions and the progression
  of minimal lesions. Conversely, a meta-analysis suggested that these drugs may
  increase cardiovascular mortality and morbidity in patients with coronary heart
  disease. Objective: To investigate whether nisoldipine retards the progression of
  coronary atherosclerosis or reduces the occurrence of clinical events. Design and
  setting: The NICOLE study (NIsoldipine in COronary artery disease in LEuven) is a
  single centre, randomised, double blind, placebo controlled trial with coronary
  angiography at baseline, six months, and three years of follow up. Patients: 826
  patients who had undergone successful coronary angioplasty were randomised to
  nisoldipine 40 mg once daily or placebo. The intention to treat and per protocol
  population consisted of 819 and 578 patients, respectively. Results: In the per
  protocol population, 625 of the nisoldipine treated and 655 of the placebo treated
  patients (NS) showed angiographic progression in at least one coronary arterial
  segment, defined as an increase in diameter stenosis of greater than or equal to13%.
  The average minimum luminal diameter of the non-dilated lesions decreased by
  0.163 mm and 0.167 mm in the nisoldipine and placebo groups, respectively ( NS).
  The respective numbers of new lesions detected were 7 and 13 ( NS). In the intention
  to treat population, the rates of death, stroke, and acute myocardial infarction were
  similar in both treatment groups. However, nisoldipine use was associated with fewer
  revascularisation procedures and thus the percentage of patients with any clinical
  event was lower (44.6% v 52.6%, p = 0.02). Conclusions: Nisoldipine has no
  demonstrable effect on the angiographic progression of coronary atherosclerosis or
  the risk of major cardiovascular events but its use is associated with fewer
  revascularisation procedures
Keywords:
  angiography/atherosclerosis/CALCIUM-ANTAGONISTS/CHOLESTEROL/ENGL
  AND/HEART/mortality/myocardial infarction/NIFEDIPINE/stroke
Taggart, D.P., Browne, S.M., Wade, D.T. and Halligan, P.W. (2003), Neuroprotection
  during cardiac surgery: a randomised trial of a platelet activating factor antagonist.
  Heart, 89 (8), 897-900.
Abstract: Objective: To assess platelet activating factor (PAF) antagonists, potent
  neuroprotective agents in experimental cerebral dysfunction, in clinical practice.
  Design: Double blind, minimised, placebo controlled trial of low and high dose PAF
  antagonist (lexipafant). Setting: Cardiac surgery unit. Patients: 150 patients
  undergoing coronary artery bypass graft (CABG) surgery using cardiopulmonary
  bypass. Interventions: Randomisation to placebo, low dose (10 mg) or high dose
  (100 mg) lexipafant. Main outcome measures: Incidence of impairment on four
  established cognitive tests, undertaken before, five days, and three months after
  CABG, examined by three methods for defining impairment. Results: The three
  groups were similar with respect to preoperative and intraoperative factors. Observed
  levels of cognitive impairment were less than had been predicted from previous
  studies. There was no difference in the groups in cognitive change scores at five days
  or three months. Group mean analysis showed significant time factors for all four
  tests but not for interactions or for the lexipafant group. A composite cognitive index,
  based on the aggregate of four normally distributed tests, showed a significant effect
  for timing of the test but not for the lexipafant group or interaction. Age, but not
  duration of bypass, was the most important determinant of postoperative cognitive
  impairment. Conclusions: The neuroprotective PAF antagonist lexipafant did not
  differentially reduce the level of cognitive impairment after CABG as determined by
  power estimates derived from published studies. The strongest predictors of
  cognitive impairment were age and timing of the test after operation
Keywords: BRAIN/CARDIOPULMONARY BYPASS/CEREBRAL INJURY/coronary
  artery                                                 bypass/CORONARY-ARTERY
  BYPASS/DYSFUNCTION/ENGLAND/FACTOR
  ACETYLHYDROLASE/HEART/HIPPOCAMPUS/ISCHEMIC
  STROKE/MEDIATOR/PAF/surgery
Dudurych, I.M., Gallagher, T.J., Corbett, J. and Escudero, M.V. (2003), EMTP analysis
  of the lightning performance of a HV transmission line. Iee Proceedings-Generation
  Transmission and Distribution, 150 (4), 501-506.
Abstract: An accurate analysis of the lightning performance of a HV transmission line
  using the EMTP program is presented. By means of simulation using a digital model
  developed within the ATP- EMTP program with its MODELS-feature, the
  performance of a 110kV unshielded overhead line under the influence of a direct
  lightning stroke is analysed. The simulation includes an adequate model of the
  transmission line, while also taking account of other factors such as the frequency
  dependence of the line parameters, models of wooden-porcelain insulation, wooden,
  and metallic towers and grounding systems including their impulse resistance
  characteristics. An impulse corona model (described elsewhere) is used, which,
  together with an adequate presentation of the flashover mechanism appropriate to
  air/porcelain insulation, allows one not only to predict the crest value of the
  overvoltages throughout the line, but also to assess accurately the real impact on the
  line fittings and substation equipment of the lightning surge travelling over the line.
  All the models are thoroughly verified by an extensive comparison of the simulated
  results with experiments by previous authors. Practical recommendations based on
  the simulations are made for an improvement in the lightning performance of a
  typical 110kV transmission line
Keywords: ENGLAND/stroke/WOOD
Kawamoto, R., Kajiwara, T., Oka, Y. and Takagi, Y. (2003), An association between an
  antibody against Chlamydia pneumoniae and ischemic stroke in elderly Japanese.
  Internal Medicine, 42 (7), 571-575.
Abstract: Objective Chlamydia pneumoniae (Cp) is an important pathogen for
  infections of the respiratory tract; recently, also a number of reports suggesting its
  relation to atherosclerosis. This study was performed to clarify the relation between
  Cp infection and ischemic stroke. Patients Forty elderly patients with ischemic stroke
  (age 75 +/- 6.6; male 57.5%) and 85 elderly control subjects without a history of
  ischemic stroke (age 74 +/- 8.1; male 43.5%) were investigated. Methods Patients
  were divided into four groups according to clinical diagnosis: 1) atherothrombotic
  infarction, 2) lacunar infarction, 3) those with cardiac embolism, and 4) non-
  classifiable. Cp infection was determined by measuring the anti-Cp IgG specific
  antibody level (Cp IgG index) using enzyme-linked immunosorbent assay (ELIZA)
  method. Those below the 1.10 Cp IgG index were determined as seronegative and
  those above 1.10 as seropositive. Results We found that 20 cases (87.0%) of
  atherothrombotic infarction, 6 (66.7%) of lacunar infarction, 3 (50.0%) others and 52
  (61.2%) control were Cp seropositive. Cp seropositiveness, as adjusted by multiple
  regression analysis using various known risk factors, was a significant independent
  contributing factor for ischemic stroke (p=0.017) and was associated with an
  increased risk for atherothrombotic infarction (odds ratio, 12.6; 95% CI, 2.0- 79.3).
  Conclusion This suggests that Cp infection is also an important risk factor for
  ischemic stroke, particularly atherothrombotic infarction in elderly Japanese
Keywords:                                               atherosclerosis/atherothrombotic
  infarction/CARDIOVASCULAR-DISEASE/Chlamydia                                 pneumoniae
  infection/CORONARY
  HEART-DISEASE/diagnosis/ENDOTHELIAL-CELLS/INFECTION/INFLAMMA
  TION/ischemic                                                 stroke/MYOCARDIAL-
  INFARCTION/PLAQUES/PROCOAGULANT ACTIVITY/RISK/risk factor/risk
  factors/stroke/TWAR
Ohtani, R., Kazui, S., Tomimoto, H., Minematsu, K. and Naritomi, H. (2003), Clinical
  and radiographic features of lobar cerebral hemorrhage: Hypertensive versus
  non-hypertensive cases. Internal Medicine, 42 (7), 576-580.
Abstract: Objectives The underlying cause of lobar intracerebral hemorrhage (ICH) is
  often difficult to determine, since these vascular abnormalities are not necessarily
  visualized in radiographic studies. We sought to determine the clinical features of
  hypertensive and nonhypertensive lobar ICH, and further predict the presence or
  absence of vascular abnormalities in terms of clinical features and radiographic
  abnormalities. Patients and Methods Eighty-one patients with lobar ICH were
  retrospectively assigned to either hypertensive or non-hypertensive groups based on
  their blood pressure levels during the chronic phase or a history of antihypertensive
  medication. The clinical and radiographic features of these two groups were
  compared. Results Forty-nine patients (60%) were hypertensive, and the other
  thirty-two (40%) were non- hypertensive. In the non-hypertensive group, amyloid
  angiopathy (n= 6), aneurysms (n=5), arteriovenous malformation (n=4), use of
  anticoagulants (n=2), liver cirrhosis (n=2) and thrombasthenia (n=1) were found as
  underlying causes. There were no significant differences between these two groups
  in the frequencies of stroke risk factors except for hypertension, clinical features and
  initial neurological findings. On the contrary, subarachnoid extension of the
  hematoma on CT was significantly more frequent in the non-hypertensive lobar ICH
  group than in the hypertensive group (p<0.001). The patients with subarachnoid
  extension were more likely to have vascular abnormality than those without
  subarachnoid extension (p<0.01). Conclusion Subarachnoid extension of the
  hematoma on CT strongly indicates a non-hypertensive cause, and more specifically,
  it suggests lobar ICH caused by vascular abnormalities
Keywords:          AMYLOID             ANGIOPATHY/blood               pressure/computed
  tomography/CT/DIAGNOSIS/EPILEPTIC
  SEIZURES/hypertension/INTRA-CRANICAL
  HEMORRHAGE/INTRACEREBRAL HEMORRHAGE/lobar hemorrhage/risk
  factors/STROKE/subarachnoid                                extension/SUBCORTICAL
  HEMORRHAGE/vascular abnormality
Camporese, G., Verlato, F., Salmistraro, G., Ragazzi, R. and Andreozzi, G.M. (2003),
  Spontaneous recanalization of internal carotid artery occlusion evaluated with color
  flow imaging and contrast arteriography. International Angiology, 22 (1), 64-71.
Abstract: Aim. In strokes of embolic origin a partial recanalization of the intracranial
  occluded vessel occurs with a high incidence (as high as 80%). In the literature,me
  find few cases of revascularization, detected with color flow imaging (CFI) or with
  arteriography (AGF), at carotid siphon or at the origin of an occluded internal carotid
  artery (ICA). Up to now there have been no reliable data on the incidence and
  clinical consequences of SR of an extracranial ICA occlusion. In this case-report we
  document 8 cases of SR of occluded ICA observed in the last 10 years in our Care
  Unit. Methods. We observed 8 complete ICA occlusion at the origin, detected with
  CFI (8 of 8) and with AGF (7 of 8). AD symptomatic patients and 2 of 5
  asymptomatic patients underwent CT scan in the acute phase of stroke. All patients
  underwent CFI follow-up (every 6-12 months) to evaluate contralateral CCA and
  ICA and the presence of new focal neurological symptoms. All patients assumed
  BMT (antiplatelet or anticoagulant therapy). Results. SR occurred in 6 patients
  between 24 and 96 months, in 1 patient within 8 months and I patient within 6
  months from the diagnosis of ICA occlusion. Diagnosis of SR was based in all
  patients with CFI and in 4 patients confirmed with AGE Five patients underwent CT
  scan that excluded haemorrhagic transformation of previous ischemic areas or new
  ischemic events (2 patients did CT scan only after SR). All patients underwent CFI
  follow-up in a 3-88 months period. There were no new focal neurological symptoms
  in 7 of 8 patients, 1 patient presented aspecific neurological symptoms. Conclusion.
  Diagnosing SR of occluded extracranical. ICA seems to be more frequent than
  expected. SR is an event that has to be researched in follow-up of these patients;
  besides, it seems to have a relatively benign outcome with respect to the onset of new
  neurological symptoms
Keywords: angiography/ATHEROSCLEROTIC DISEASE/carotid stenosis/cerebral
  revascularization/CT/diagnosis/DISSECTION/DOPPLER/DUPLEX/ENDARTERE
  CTOMY/PSEUDO-OCCLUSION/SONOGRAPHY/STENOSIS/stroke/SYMPTOM
  ATIC PATIENTS/therapy/VASA VASORUM
Kolh, P., Lambermont, B., Ghuysen, A., D'Orio, V., Gerard, P., Morimont, P.,
  Tchana-Sato, V., Pierard, L., Dogne, J.M. and Limet, R. (2003), Alteration of left
  ventriculo-arterial coupling and mechanical efficiency during acute myocardial
  ischemia. International Angiology, 22 (2), 148-158.
Abstract: Aim. Myocardial revascularisation being frequently performed during acute
  myocardial ischemia, in a hostile hemodynamic environment, we evaluated left
  ventriculo-arterial (VA) coupling, left ventricular (LV) mechanical efficiency, and
  the mechanical properties of the systemic vasculature during acute myocardial
  ischemia. Methods. In 6 pigs, vascular properties [characteristic impedance (RI),
  peripheral resistance (R-2), compliance (C), inductance (L), arterial elastance (E-a)]
  were estimated with a windkessel model. IV function was assessed by the slope (Ees)
  of end-systolic pressure-volume relationship (ESPVR), and stroke work (SW) -
  end-diastolic volume (EDV) relation. Pressure-volume area (PVA) was referred to as
  myocardial oxygen consumption.. VA coupling was defined as E- es/E-a, and
  mechanical efficiency as SW/PVA. After baseline recordings, the left anterior
  descending coronary artery was ligated and hemodynamic measures obtained every
  30 minutes for 3 hours. Data are expressed as mean (SEM). Results. Coronary
  occlusion induced an ESPVR rightward shift, and decreased Ees from 3.67 (0.33) to
  1.92 (0.20) mmHg/ml and the slope of the SW - EDV relationship from 72.3 (3.4) to
  40.4 (4.5) mmHg (p < 0.001), while E-a increased from 3.33 (0.56) to 4.65 (0.29)
  mmHg/ml (p < 0.005). This was responsible for a dramatic alteration of VA coupling
  from 1.22 (0.11) to 0.44 (0.07), (p < 0.001). While R-2 increased from 1.72 (0.30) to
  2.38 (0.16) mmHg.s.ml(-1) (p < 0.05) and C decreased from 0.78 (0.16) to 0.46 (0.08)
  ml/mmHg (p < 0.05), R, and L were unchanged. Coronary occlusion decreased SW
  from 4 056 (223) to 2 580 (122) mmHg.ml (p < 0.001), while PVA and SW/PVA
  decreased from 5 575 (514) to 4 813 (317) mmHg.ml (NS), and from 0.76 (0.04) to
  0.57 (0.03) (p < 0.001), respectively. Conclusion. Acute myocardial ischemia
   severely altered left ventriculo-arterial coupling and IV mechanical efficiency.
   Impaired left VA coupling was due to a combination of augmented arterial elastance,
   secondary to early vasoconstriction later associated with decreased arterial
   compliance, and decreased IV contractility
Keywords:                            ARTERIAL                             LOAD/CANINE
   LEFT-VENTRICLE/compliance/DOGS/END-DIASTOLIC
   VOLUME/function/HEART/heart/HUMANS/ischemia/myocardial
   contraction/myocardial
   ischemia/OXYGEN-CONSUMPTION/physiology/pigs/PRESSURE-VOLUME
   RELATION/REGIONAL ISCHEMIA/stroke/STROKE WORK
Lindhout, D.A. and Sykes, B.D. (2003), Structure and dynamics of the C-domain of
   human cardiac troponin C in complex with the inhibitory region of human cardiac
   troponin I. Journal of Biological Chemistry , 278 (29), 27024-27034.
Abstract: Cardiac troponin C is the Ca2+-dependent switch for heart muscle contraction.
   Troponin C is associated with various other proteins including troponin I and
   troponin T. The interaction between the subunits within the troponin complex is of
   critical importance in understanding contractility. Following a Ca2+ signal to begin
   contraction, the inhibitory region of troponin I comprising residues
   Thr(128)-Arg(147) relocates from its binding surface on actin to troponin C,
   triggering movement of troponin-tropomyosin within the thin filament and thereby
   freeing actin-binding site(s) for interactions with the myosin ATPase of the thick
   filament to generate the power stroke. The structure of calcium-saturated cardiac
   troponin C (C-domain) in complex with the inhibitory region of troponin I was
   determined using multinuclear and multidimensional nuclear magnetic resonance
   spectroscopy. The structure of this complex reveals that the inhibitory region adopts
   a helical conformation spanning residues Leu(134)-Lys(139), with a novel
   orientation between the E- and H-helices of troponin C, which is largely stabilized by
   electrostatic interactions. By using isotope labeling, we have studied the dynamics of
   the protein and peptide in the binary complex. The structure of this inhibited
   complex provides a framework for understanding into interactions within the
   troponin complex upon heart contraction
Keywords:
   BIOLOGICAL-ACTIVITY/CALCIUM-BINDING/CRYSTAL-STRUCTURE/heart/
   IMPROVED SENSITIVITY/NUCLEAR-MAGNETIC-RESONANCE/PROTEIN
   SECONDARY STRUCTURE/PULSED-FIELD GRADIENT/REGULATORY
   N-DOMAIN/SKELETAL-MUSCLE/stroke/THIN FILAMENT PROTEINS
Rosenfeld, S.S., Xing, J., Chen, L.Q. and Sweeney, H.L. (2003), Myosin IIB is
   unconventionally conventional. Journal of Biological Chemistry, 278 (30),
   27449-27455.
Abstract: Members of the myosin II class of molecular motors have been referred to as
   "conventional," a term used to describe their ability to form thick filaments, their low
   duty ratio, the ability of individual motor-containing "heads" to operate
   independently of each other, and their rate-limiting phosphate release. These features
   ensure that those motors that have completed their power stroke dissociate rapidly
   enough to prevent them from interfering with those motors that are beginning theirs.
   However, in this study, we demonstrate that myosin IIB, a cytoplasmic myosin II
   particularly enriched in the central nervous system and cardiac tissue, has a number
   of features that it shares instead with "unconventional" myosin isoforms, including
   myosins V and VI. These include a high duty ratio, rate-limiting ADP release, and
   high ADP affinity. These features imply that myosin IIB serves a set of physiologic
   needs different from those served by its more conventional myosin II counterparts,
   and this work provides a plausible basis for explaining the physiologic role of this
   unconventionally conventional myosin
Keywords:                               ACTIN/ADP/CONTRACTION/DIFFERENTIAL
   EXPRESSION/ISOFORMS/KINETIC MECHANISM/LOCALIZATION/NEURITE
   OUTGROWTH/SMOOTH-MUSCLE/stroke/TENSION
Quinn, D.A., Moufarrej, R., Volokhov, A., Syrkina, O. and Hales, C.A. (2003),
   Combined smoke inhalation and scald burn in the rat. Journal of Burn Care &
   Rehabilitation, 24 (4), 208-216.
Abstract: The combination of burn injury with smoke inhalation from fires significantly
   increases mortality. The mechanism of increased mortality is poorly understood but
   has been associated with multiple organ dysfunction syndrome, including cardiac
   dysfunction. Impaired cardiac function correlates with decreased survival in burn
   patients. We investigated smoke inhalation from burning cotton combined with a
   40% body surface area, third-degree burn during the first 4 hours after injury in rats.
   In the early phase after injury, burn caused a significant rise in lung neutrophil
   infiltration but no increase in lung water. Smoke led to a rise in lung water but only a
   mild increase in neutrophil infiltration. Combined smoke and burn did not increase
   neutrophil accumulation or lung water above that which occurred with either injury
   alone. Only in combined smoke and burn was there a drop in cardiac output and
   stroke volume with pulmonary edema and lung neutrophil influx
Keywords:         ACROLEIN/ACUTE               LUNG        INJURY/EDEMA/function/L-
   SELECTIN/LIPID-PEROXIDATION/mortality/NEUTROPHIL
   DEPLETION/PA/PULMONARY                    COMPLICATIONS/rat/SHEEP/stroke/stroke
   volume/SYNTHETIC SMOKE/THERMAL-INJURY
Jarvinen, O., Laurikka, J. and Tarkka, M.R. (2003), Off-pump versus on-pump coronary
   bypass - Comparison of patient characteristics and early outcomes. Journal of
   Cardiovascular Surgery, 44 (2), 167-172.
Abstract: Aim This clinical report details a comparison between the conventional
   on-pump and beating heart off-pump techniques with particular attention to patient
   characteristics, perioperative variables and early outcomes. Methods. We collected
   prospectively a comprehensive data body from 1131 consecutive patients who
   underwent isolated CABG in Tampere University Hospital. The morbidity, mortality
   and length of stay data from the secondary referral hospitals were also collected. One
   thousand and sixteen (89.8%) patients underwent bypass grafting with
   cardiopulmonary bypass (CPB, on-pump) and 115 (10.2%) patients without the CPB
   (off-pump). Results. Thirty-day mortality rates were 4.0% (on-pump) and 2.6%
   (off-pump, p=0.5). The total postoperative length of stay was 12 (on-pump) and 10
   (off-pump) days as the medians (p<0.001). Adverse outcome events among the
   on-pump and off-pump patients were as follows: postoperative stroke, 2.5% and
   0.9% (P=0.3); perioperative myocardial infarction, 7.0% and 7.8% (p=0.7); impaired
   renal function, 9.5% and 4.3% (P=0.3); re-sternotomy for bleeding or low output,
   5.3% and 4.3% (p=0.2); new-onset atrial fibrillation, 38.9% and 24.6% (p=0.002)
   and the need for red cell transfusions in ICU, 50.3% and 22.6% (p<0.001). Eighty-
   three percent of the on-pump and 85.2% of the off-pump patients (p=0.5) had a
   favorable outcome without a major complication. Conclusion. Considering the
   limitations with a non-randomized study design, we conclude that off-pump CABG
   is a safe and comparable method of myocardial revascularization in terms of early
   outcomes. Overall length of stay shorter by 2 days, over a third shorter ventilation
   time, fewer red cell transfusions and lower frequency of postoperative atrial
   fibrillation favor off-pump surgery
Keywords: ARTERY BYPASS/atrial fibrillation/ATRIAL-FIBRILLATION/BEATING
   HEART/bleeding/CARDIOPULMONARY                       BYPASS/coronary              artery
   bypass/function/heart/length          of        stay/MINIMALLY              INVASIVE
   DIRECT/mortality/myocardial                                       infarction/myocardial
   revascularization/PREDICTORS/REVASCULARIZATION/stroke/SURGERY
Jares, M., Vanek, T., Straka, Z. and Brucek, P. (2003), Tranexamic acid reduces
   bleeding after off-pump coronary artery bypass grafting. Journal of Cardiovascular
   Surgery, 44 (2), 205-208.
Abstract: Aim. To assess the ability of tranexamic acid, compared with an untreated
   control group, to decrease bleeding and transfusion requirements in patients
   undergoing coronary artery bypass grafting on the beating heart. Methods. Forty-nine
   randomly selected patients were enrolled to elective coronary artery bypass grafting
   without the use of cardiopulmonary bypass. Of these, 23 received tranexamic acid
   (bolus of 1 g before surgical incision, followed by infusion 200 mg/hour during
   surgery) and 26 patients were enrolled into a control group. Preoperative
   hematological. variables, postoperative blood loss at 4 and 24 hours, transfusion
   requirements of packed red blood cells,and postoperative thrombotic events such as a
   myocardial infarction, stroke and pulmonary embolism were recorded. Results. The
   two groups were similar in terms of patients' characteristics. Postoperative bleeding
   was significantly lower in the tranexamic acid group compared with the control
   group (median [25th-75th percentiles]): 115 [92-148] vs 230 [170-260] mL at 4
   hours, p<0.001; 420 [330-523] vs 550 [500-650] ml, at 24 hours, p<0.01).
   Transfusion requirements were lower in the tranexamic acid group compared with
   the control group (RBC 9% vs 28%), but the difference was not statistically
   significant. Treatment with tranexamic acid was not associated with a higher
   incidence of myocardial ischemia or other thrombotic events. Conclusion.
   Tranexamic acid reduces postoperative blood loss after coronary artery bypass
   grafting on the beating heart. Evaluation of transfusion requirements warrants further
   study
Keywords: ASPIRIN/bleeding/BLOOD-LOSS/CARDIAC-SURGERY/coronary artery
   bypass/DOSE             APROTININ/DOUBLE-BLIND/EPSILON-AMINOCAPROIC
   ACID/heart/hemorrage/ischemia/myocardial infarction/OPERATIONS/postoperative
   complications/stroke/tranexamic acid/TRANSFUSION
Bittner, H.B., Savitt, M.A., Ching, P.V. and Ward, H.B. (2003), Off-pump coronary
   artery revascularization: ideal indication for patients with porcelain aorta and
   calcification of great vessels. Journal of Cardiovascular Surgery, 44 (2), 217-221.
Abstract: Patients with porcelain aorta and severe calcification of the great vessels are a
   challenging dilemma for the cardiovascular surgeon regarding bypass technique,
   choice of conduit, and selection of proximal anastomotic sites due to the high
   incidence of devastating thromboembolization. and aortic injury. No currently
   proposed surgical approach avoids manipulation of the heavily calcified ascending
   aorta. Three patients presented with unstable angina and decreased ventricular
   function secondary to significant left main coronary artery stenosis and 3-vessel
   coronary artery disease. in addition to the coronary artery disease, severely calcified
   ascending aorta and great vessels were discovered. One patient presented with near
   total distal abdominal aortic occlusion, severe peripheral vascular disease, history of
   stroke, and carotid endarterectomy. Surgical coronary revascularizabon was
   indicated. Coronary artery bypass grafting using internal thoracic artery and greater
   saphenous vein composite arterial inflow grafts in combination with off-pump
   beating heart surgery was successfully used. Cardiopulmonary bypass and clamping
   of the aorta was avoided. No new neurologic deficit was observed. Coronary
   revascularization with internal thoracic artery composite grafts and avoiding
   cardiopulmonary bypass and clamping the calcified aorta is an effective method to
   prevent clamp injury and thromboembolization. Off-pump coronary artery bypass
   grafting seems to be an ideal indication in patients with porcelain aorta because the
   surgical techniques of "no- touch" and "no-cannulation" can be applied
Keywords:         aortic      diseases/ARCH/ATHEROSCLEROTIC                  ASCENDING
   AORTA/AXILLARY                   ARTERY/BYPASS/CANNULATION/cerebrovascular
   incident/coronary                           artery                      bypass/coronary
   disease/DISEASE/ENDARTERECTOMY/function/heart/INNOMINATE-ARTERY
   /MANAGEMENT/prevention and control/RISK/stroke/surgery
Niinami, H., Aomi, S., Chikazawa, G., Tomioka, H. and Koyanagi, H. (2003), Progress
   in the treatment of aneurysms of the distal aortic arch: approach through median
   sternotomy. Journal of Cardiovascular Surgery, 44 (2), 243-248.
Abstract: Aim A review of past and current operative procedures for the treatment of
   aneurysms of the distal aortic arch is presented in conjunction with a series of 43
   patients. In this study, distal aortic arch aneurysm refers to an aneurysm mvolving at
   least the origin of the left subclavian artery, but not extending beyond the left
   common carotid artery. We excluded dissection aneurysm and extended aneurysm to
   the descending thoracic aorta from this study. Methods. Between January, 1985, and
   March, 2000, 43 consecutive patients (37 males, 6 females; mean age 67.5 years)
   underwent repair of aneurysms of the distal aortic arch. The approach to the
   aneurysm was through a left thoracotomy in 4 patients and a median sternotomy in
   39 patients, including an additional left thoracotomy continued to a median
   sternotomy in 2 patients. The supportive methods during surgery were left heart
   bypass using a centrifugal pump in 4 patients (LHB group), cardiopulmonary bypass
   with selective cerebral perfusion in 11 patients (SCP group), and cardiopulmonary
   bypass with continuous retrograde cerebral perfusion in 28 patients (RCP group). in
   the RCP group, the "aortic no-touch technique" was applied in 21 patients. The
   operative methods were patch closure in 4 patients, graft replacement of the distal
   arch using the inclusion technique in 14 patients, and total arch replacement using
   the exclusion technique in 25 patients. Results. There were 5 hospital deaths: 1
   patient in the LHB; group, intractable bleeding; 1 patient in the SCP group, rupture
   of the distal anastomosis; 3 patients in the RCP group, stroke, rupture of the
   dissection arising from the distal anastomosis, and perioperative myocardial
   infarction. Stroke occurred in 1 patient (25%) with LHB, 3 patients (27.2%) with
   SCP, and 1 patient (3.6%) with RCP. Among the postoperative survivors, a new
   onset of left recurrent nerve palsy occurred in 2 patients (66.7%) with LHB, 1 patient
   (10%) with SCP, and in 1 patient (4%) with RCP. No neurological injury or left
   recurrent nerve palsy occurred in the patients who underwent the "aortic no-touch
   technique". Conclusion Total arch replacement with the graft exclusion technique
   under profound hypothermic circulatory arrest using RCP through the median
   sternotomy is a promising surgical treatment for atherosclerotic distal aortic arch
   aneurysm. The "aortic no-touch technique" further improved the surgical results of
   the distal aortic arch aneurysm
Keywords:              aortic            aneurysm/atherosclerosis/bleeding/cerebrovascular
   circulation/DISSECTION/heart/myocardial
   infarction/OPERATION/REPAIR/RETROGRADE                                     CEREBRAL
   PERFUSION/stroke/surgery/thoracic
Kent, R.D., Vorperian, H.K., Kent, J.F. and Duffy, J.R. (2003), Voice dysfunction in
   dysarthria: application of the Multi- Dimensional Voice Program (TM). Journal of
   Communication Disorders, 36 (4), 281-306.
Abstract: Phonatory dysfunction is a frequent component of dysarthria and often is a
   primary feature noted in clinical assessment. But the vocal impairment can be
   difficult to assess because (a) the analysis of voice disorder of any kind can be
   challenging, and (b) the voice disorder in dysarthria often occurs along with other
   impairments affecting articulation, resonance, and respiration. A promising
   assessment tool is multi-parameter acoustic analysis, such as the Multi-Dimensional
   Voice Program(TM) (MDVP). Part 1 of this paper recommends procedures and
   standards for the acoustic analysis of voice, including (1) selection of the sample to
   be analyzed, (2) signal quality requirements, (3) availability of normative data for
   both genders and different ages of speakers, (4) reliability of analysis, and (5)
   correlation of acoustic results with results from other methods of analysis. In Part 2,
   acoustic data are reviewed for the dysarthria associated with Parkinson disease (PD),
   cerebellar disease, amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI),
   unilateral hemispheric stroke, and essential tremor. Tentative profiles of voice
   disorder are described for these conditions. These profiles may serve as hypotheses
   for future research. Although several issues remain to be resolved in the acoustic
   analysis of voice disorder in dysarthria, steps can be taken now to promote the
   reliability, validity, and clinical utility of such analyses. Learning outcomes: (1) As a
   result of this activity, the participant will be able to describe ways in which an
   optimal multi- dimensional analysis of voice can be performed with modem acoustic
   analysis systems. (2) As a result of this activity, the participant will be able to apply
   multi-dimensional acoustic analysis of voice to individuals who have a
   dysarthria-related voice disorder. (3) As a result of this activity, the participant will
   be able to identify major sources of normative data on the Multi-Dimensional Voice
   Program. (C) 2003 Elsevier Science Inc. All rights reserved
Keywords:                           ACOUSTIC                            ANALYSIS/acoustic
   analysis/AMYOTROPHIC-LATERAL-SCLEROSIS/ANALYSIS
   SYSTEMS/brain/brain                 injury/CIGARETTE-SMOKING/COMPUTERIZED
   SPEECH                                                LAB/dysarthria/FUNDAMENTAL-
   FREQUENCY/MDVP/PARKINSONS-DISEASE/PHONATORY
   DYSFUNCTION/reliability/stroke/TRAUMATIC BRAIN INJURY/TREATMENT
   LSVT(R)/voice disorder
Pincelli, A.I., Bragato, R., Scacchi, M., Branzi, G., Osculati, G., Viarengo, R., Leonetti,
   G. and Cavagnini, F. (2003), Three weekly injections (TWI) of low-dose growth
   hormone (GH) restore low normal circulating IGF-I concentrations and reverse
   cardiac abnormalities associated with adult onset GH deficiency (GHD). Journal of
   Endocrinological Investigation, 26 (5), 420-428.
Abstract: GH replacement therapy given 3 times weekly (TWI) and adjusted to allow
   serum IGF-I concentrations in the mid-normal range for sex and age has been shown
   to be as effective as the daily regimen in improving lipid profile, body composition,
   bone mass and turnover in adult GH deficient (GHD) patients. Only one study has
   investigated so far the short-term (6 months) effect of a fixed weight-based TWI
   dosing schedule on heart structure and function in childhood onset (CO) GHD
   patients, whereas such a schedule in adult onset (AO) GHD patients has not been
   studied as yet. Aim of this study was to investigate whether a 1-yr low-dose titrated
   TWI GH-replacement regimen aimed at achieving and maintaining IGF-I levels
   within the low normal limits for age and sex is able to affect cardiovascular and heart
   parameters in a group of AO GHD patients. Eight adult patients (4 women and 4 men,
   age 35.8 +/- 3.37 yr, body mass index, BMI, 28.7 +/- 2.62 kg/m(2)) with AO GHD
   were included in the study, along with 10 healthy subjects, matched for age, sex,
   BMI and physical activity (6 women and 4 men, age 35.2 +/- 4.05 yr, BMI 28.4 +/-
   2.34 kg/m(2)). M- and B- mode ecocardiography and pulsed doppler examination of
   transmitral flow were performed in GHD patients at baseline and after 3 and 12
   months of GH therapy (mean GH dose 6.7 +/- 0.8 mug/kg/day given thrice a week),
   while normal subjects were studied once. Treatment with GH for 1 yr induced a
   significant increase in left ventricular (LV) diastolic and systolic volumes (+11.1 and
   +16.5%, respectively). Systolic LV posterior wall thickness and LV mass were
   increased (+10.2 and +7.7%, respectively) by GH administration. Systemic vascular
   resistance was significantly decreased by 1-yr G H therapy (-13.8% after 1 yr), while
   stroke volume, cardiac output and cardiac index were increased (+9.4, +11.6 and
   +11.9%, respectively). LV end-systolic stress was decreased at the end of GH
   therapy (-11.2%). E and A wave, significantly reduced at baseline, were increased by
   1 yr of GH therapy (+23.3% and +28.1%, respectively); likewise, the abnormally
   high E peak deceleration time was partially reversed by GH administration (-10.7%).
   Our study, though conducted in a small sample size, demonstrates that a TWI GH
   treatment schedule is able to reverse the cardiovascular abnormalities in AO GHD
   patients and to improve body composition and lipid profile. The maintenance of
   circulating IGF-I concentrations within the low normal range allows to avoid most of
   the side- effects reported with higher GH doses while being cost- effective and
   improving the patient's compliance. (C) 2003, Editrice Kurtis
Keywords:         adult       onset        GH       deficiency/BLOOD-PRESSURE/body
   composition/BODY-COMPOSITION/CARDIOVASCULAR
   RISK/CHILDHOOD-ONSET/compliance/echocardiography/function/heart/HEART-
   FAILURE/HYPOPITUITARY
   ADULTS/MORTALITY/NITRIC-OXIDE/PERFORMANCE/REPLACEMENT
   THERAPY/stroke/stroke volume/therapy/thrice-a-week GH replacement therapy
Birch, J.M. and Dickinson, M.H. (2003), The influence of wing-wake interactions on
   the production of aerodynamic forces in flapping flight. Journal of Experimental
   Biology, 206 (13), 2257-2272.
Abstract: We used two-dimensional digital particle image velocimetry (DPIV) to
   visualize flow patterns around the flapping wing of a dynamically scaled robot for a
   series of reciprocating strokes starting from rest. The base of the wing was equipped
   with strain gauges so that the pattern of fluid motion could be directly compared with
   the time history of force production. The results show that the development and
   shedding of vortices throughout each stroke are highly stereotyped and influence
   force generation in subsequent strokes. When a wing starts from rest, it generates a
   transient force as the leading edge vortex (LEV) grows. This early peak, previously
   attributed to added- mass acceleration, is not amenable to quasi-steady models but
   corresponds well to calculations based on the time derivative of the first moment of
   vorticity within a sectional slice of fluid. Forces decay to a stable level as the LEV
   reaches a constant size and remains attached throughout most of the stroke. The LEV
   grows as the wing supinates prior to stroke reversal, accompanied by an increase in
   total force. At stroke reversal, both the LEV and a rotational starting vortex (RSV)
   are shed into the wake, forming a counter-rotating pair that directs a jet of fluid
   towards the underside of the wing at the start of the next stroke. We isolated the
   aerodynamic influence of the wake by subtracting forces and flow fields generated in
   the first stroke, when the wake is just developing, from those produced during the
   fourth stroke, when the pattern of both the forces and wake dynamics has reached a
   limit cycle. This technique identified two effects of the wake on force production by
   the wing: an early augmentation followed by a small attenuation. The later decrease
   in force is consistent with the influence of a decreased aerodynamic angle of attack
   on translational forces caused by downwash within the wake and is well explained by
   a quasi-steady model. The early effect of the wake is not well approximated by a
   quasi-steady model, even when the magnitude and orientation of the instantaneous
   velocity field are taken into account. Thus, the wake capture force represents a truly
   unsteady phenomenon dependent on temporal changes in the distribution and
   magnitude of vorticity during stroke reversal
Keywords:                       digital                  particle                   image
   velocimetry/DPIV/DROSOPHILA-MELANOGASTER/ENGLAND/flapping
   flight/FLOW/flow          visualization/FLUID        DYNAMIC           FORCES/insect
   aerodynamics/insect                  flight/INSECT               FLIGHT/LIFT/LOW
   REYNOLDS-NUMBERS/MECHANISMS/MODEL/ROTATION/stroke/VELOCIT
   Y-FIELDS/wake structure
Elnagar, A. and Harous, S. (2003), Recognition of handwritten Hindu numerals using
   structural descriptors. Journal of Experimental & Theoretical Artificial Intelligence,
   15 (3), 299-314.
Abstract: A method for recognizing handwritten Hindi numerals is proposed based on
   the structural descriptors of a numeral's shape. The method consists of three major
   steps. The first one is preprocessing, where a handwritten numeral is scanned,
   normalized and then thinned. Next, a robust algorithm is used to segment the scanned
   image into stroke(s), based on feature points, and to identify cavity features. The
   output of this algorithm is a syntactic representation (that is one or more syntactic
   terms). Finally, this syntacytic representation is matched against the set of prototype
   syntactic representations of handwritten numerals for a possible match. Early
   experimental results are not only encouraging but also proving the tolerance of the
   proposed system to recognize a high variability of Hindi numerals' shapes. The
   system attained a successful recognition rate of 96%
Keywords:                        ARABIC                       CHARACTERS/CHINESE
   CHARACTER-RECOGNITION/ENGLAND/FUZZY-LOGIC/handwritten
   recognition/Hindu                            numerals/IMPLEMENTATION/NEURAL
   NETWORKS/ONLINE                        RECOGNITION/PASS                    THINNING
   ALGORITHM/STROKES/structural descriptors/SYSTEM/term rewriting
Reynolds, K., Gu, D.F., Muntner, P., Wu, X.G., Chen, J., Huang, G.Y., Duan, X.F.,
   Whelton, P.K. and He, J. (2003), Geographic variations in the prevalence, awareness,
   treatment and control of hypertension in China. Journal of Hypertension, 21 (7),
   1273-1281.
Abstract: Objective To compare the prevalence, awareness, treatment and control of
   hypertension in north and south, and urban and rural residents of China. Design A
   cross-sectional survey conducted in 2000-2001. Setting and participants A multistage
   cluster sampling method was used to select a nationally representative sample of 15
   540 men and women aged 35-74 years from the general Chinese population. Main
   outcome measures Three blood pressure measurements were obtained by trained
   observers using a standardized mercury sphygmomanometer. Information on history
   of hypertension and use of antihypertensive medications was obtained by use of a
   standard questionnaire. Hypertension was defined as a mean systolic blood pressure
   greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or
   equal to 90 mmHg and/or use of antihypertensive medications. Results The
  age-standardized prevalence of hypertension was significantly higher among
  residents living in north than in south China (33.8 versus 23.3%, P< 0.001), but
  similar in those living in urban and rural areas (29.0 versus 28.1%, P = 0.3). Average
  systolic and diastolic blood pressure levels were consistently higher in north than in
  south residents. Residents in north China had higher percentages of awareness but
  lower percentages of control compared with their counterparts in south China.
  Percentages of awareness, treatment and control of hypertension were significantly
  higher in urban than in rural residents. Conclusions Our study documents a marked
  north-south gradient in the prevalence of hypertension in China. The previously
  reported urban-rural difference in the prevalence of hypertension was not noted,
  perhaps due to a rapid increase in the prevalence of hypertension in rural China
Keywords:       ALCOHOL/awareness/BLOOD-               PRESSURE/China/cross-sectional
  studies/geography/hypertension/MORTALITY/PA/POPULATION/prevalence/RAN
  DOMIZED                                                                CONTROLLED
  TRIALS/RENAL-DISEASE/REPUBLIC-OF-CHINA/RISK-FACTORS/STROKE/T
  RENDS
Hope, S.A., Tay, D.B., Meredith, I.T. and Cameron, J.D. (2003), Use of arterial transfer
  functions for the derivation of aortic waveform characteristics. Journal of
  Hypertension, 21 (7), 1299-1305.
Abstract: Objective To investigate the utility and accuracy of radial- aortic arterial
  transfer functions for the derivation of central blood pressure waveforms. Design
  Prospective measurement of central and peripheral waveforms in patients undergoing
  coronary angiography or percutaneous coronary intervention. Methods Simultaneous
  invasive central aortic and noninvasive radial pressure waveforms were recorded in
  78 subjects (61 male: 17 female). Data were applied to a single-in put/single-output
  model for the calculation of a transfer function (TF). Individual TFs were derived by
  two methods and ensemble averaged TFs obtained for the group. Reverse
  transformation was performed using each averaged TF applied to the radial data of
  each subject. Results There was close linear correlation between measured aortic
  parameters and both radial and TF-derived aortic systolic and diastolic pressures (P<
  0.001) and most other waveform parameters. However, despite small mean
  differences between measured and most TF-derived aortic parameters (systolic
  pressure 0.8-2.9 mmHg, augmentation index 4.3-5.6%), individual scatter was
  marked, with 95% limits of agreement of +/- 14.6 mmHg (systolic pressure) and
  +/-24.4% [augmentation index (AI)]. Indeed, scatter for AI was so marked that
  measured and derived values were not statistically significantly correlated.
  Conclusions Transfer functions may be valid for the derivation of some central aortic
  waveform characteristics. However, in providing neither improved reproducibility
  nor data on parameters not obtainable from the radial waveform, transfer function
  techniques may offer no additional clinical benefit. The absence of correlation
  between measured and TF-derived aortic Al and wide limits of agreement of other
  parameters should be considered if this technique is utilized in clinical practice
Keywords:              arterial          mechanics/augmentation                index/blood
  pressure/BLOOD-PRESSURE/CORONARY HEART-DISEASE/GENERALIZED
  TRANSFER-FUNCTION/HYPERTENSION/MATHEMATICAL
  TRANSFORMATION/measurement/PA/PULSE/RADIAL                              TONOMETRY
  PRESSURE/STIFFNESS/STROKE/tonometry/transfer functions/VALIDATION
Kozakova, M., Morizzo, C., Ferrannini, E. and Palombo, C. (2003), Coronary
  vasodilator capacity and exercise-induced myocardial ischemia are related to the
  pulsatile component of blood pressure in patients with essential hypertension.
  Journal of Hypertension, 21 (7), 1407-1414.
Abstract: Objectives High pulsatile load is associated with structural alterations of the
  heart and arteries, which may cause changes in the coronary circulation and
  predispose to myocardial ischemia. This study was designed to investigate the
  relationships of coronary vasodilator capacity and exercise- induced myocardial
  ischemia to pulsatile and steady components of office blood pressure. Methods
  Eighty-two untreated, middle- aged hypertensive patients without coronary artery
  stenosis and 23 normotensive volunteers, underwent exercise electrocardiogram test
  and standard and transesophageal echocardiography to assess the occurrence of
  myocardial ischemia, left ventricular (LV) mass and geometry, total arterial
  compliance and coronary vasodilator capacity. Results In the hypertensive
  population, minimum coronary resistance (MCR) was significantly higher (P < 0.01)
  in the top as compared to all three lower pulse pressure (PP) quartiles (1.10 +/- 0.19,
  1.21 +/- 0.23, 1.20 +/- 0.26 and 1.43 +/- 0.26 mmHg s/cm). An additional increase in
  MCR also occurred in the top quartile of systolic blood pressure (SBP), but not
  across quartiles of mean blood pressure. In regression analysis, MCR increased with
  PP, SBP and LV wall thickness and decreased with total arterial compliance. As
  compared to hypertensive patients with a negative exercise test for myocardial
  ischemia (n = 30), those with a positive test (n = 20) had higher MCR (1.12 +/- 0.22
  versus 1.39 +/- 0.29 mmHg s/cm, P< 0.01) and lower total arterial compliance (96
  +/- 22 versus 81 +/- 16%, P< 0.01). Conclusions In untreated middle-aged
  hypertensive patients, coronary vasodilator capacity declines with increasing office
  PP and SBP. A decreased arterial compliance and increased LV wall thickness
  appear to be major alterations underlying this relationship. Exercise-induced
  myocardial ischemia is associated with higher MCR and lower arterial compliance
Keywords:        arterial     hypertension/ARTERIAL-           HYPERTENSION/blood
  pressure/CARDIOVASCULAR
  RISK/compliance/DIPYRIDAMOLE/exercise/FLOW
  RESERVE/heart/HEART-DISEASE/hypertension/hypertrophy/ischemia/LEFT-VE
  NTRICULAR                              HYPERTROPHY/MECHANISMS/PA/PULSE
  PRESSURE/STROKE                VOLUME/TRANSESOPHAGEAL                      DOPPLER-
  ECHOCARDIOGRAPHY/vasodilation
Celentano, A., Palmieri, V., Arezzi, E., Mureddu, F., Sabatella, M., Di Minno, G. and
  de Simone, G. (2003), Gender differences in left ventricular chamber and midwall
  systolic function in normotensive and hypertensive adults. Journal of Hypertension,
  21 (7), 1415-1423.
Abstract: Objective Whether left ventricular (LV) systolic function differs between
  healthy men and women independent of afterload, LV geometry, age, heart rate and
  body size is disputed. Methods We studied 517 clinically healthy adults without
  history of cardiovascular or endocrinal disease (age range 20-70, 274 with essential
  arterial hypertension). Echocardiography was used to assess LV geometry and
  systolic function both at endocardial and midwall levels. Results Normotensive and
  hypertensive women had higher LV systolic function at endocardial and midwall
  levels independent of afterload. After adjustment for age, body surface area, heart
  rate and LV geometry, LV systolic function remained higher in women than in men
  in hypertensive and normotensive subjects. In a second set of multivariate analyses
  adjusting for age, body mass index, LV geometry and heart rate, women had
  significantly higher LV systolic function than men, both among normotensive and
  hypertensive subjects. In a reference group of 95 subjects with optimal blood
  pressure and normal body mass index (mean age 34 +/- 10; 32 men) extracted from
  the study sample, lower limits (5th percentile) of parameters of LV systolic function
  were higher in women than in men. Use of gender-specific partition values revealed
  that subnormal LV chamber function was uncommon in overweight, normotensive
  subjects as well as in hypertensive subjects; vice versa, stress-corrected midwall
  dysfunction was frequently subnormal in both normotensive, overweight (14%,
  mostly women) and in hypertensive subjects (18%, mostly men). At the opposite end
  of the spectrum, gender-specific supranormal, stress- corrected LV systolic chamber
  function (> 95th percentile of the distribution in the reference group) was relatively
  frequent in both overweight, normotensive (14%) and in hypertensive subjects (27%).
  Conclusions Clinically healthy hypertensive and normotensive women have higher
  LV chamber and midwall systolic function than men, independent of left ventricular
  geometry, body size, age and heart rate. Use of gender-specific partition values to
  define subnormal and supranormal LV systolic function revealed that, both in
  hypertensive and overweight normotensive subjects, subnormal LV chamber
  function was uncommon, whereas stress-corrected LV chamber systolic function was
  frequently supranormal. Vice versa, myocardial contractility was subnormal in
  approximately one-sixth of asymptomatic, normotensive overweight and of
  hypertensive subjects, with potentially unfavorable prognostic impact
Keywords:             AORTIC-STENOSIS/arterial                  hypertension/ARTERIAL-
  HYPERTENSION/blood                                  pressure/BODY-MASS/CARDIAC-
  OUTPUT/CARDIOVASCULAR
  RISK-FACTORS/CONGESTIVE-HEART-FAILURE/echocardiography/function/he
  art/hypertension/left                                                ventricle/M-MODE
  ECHOCARDIOGRAPHY/PA/SEX-ASSOCIATED                            DIFFERENCES/STROKE
  VOLUME/SYSTEMIC HYPERTENSION
Aduen, J.F., Burritt, M.F. and Murray, M.J. (2002), Blood lactate accumulation:
  Hemodynamics and acid base status. Journal of Intensive Care Medicine, 17 (4),
  180-185.
Abstract: The authors evaluated the relationship between blood lactate accumulation
  and hemodynamics in a prospective controlled animal study. Seven healthy pigs
  were anesthetized and mechanically ventilated with a 0.6 fraction of inspired oxygen
  to achieve a normal Paco(2). Catheters for blood sampling, lactate infusion, and
  hemodynamic assessment were inserted into the femoral vein and femoral artery.
  Bolus infusions (466 mumol . kg(-1) over 1 minute) of a neutral solution of sodium
  lactate were given at 0, 30, 60, and 90 minutes. Each bolus was followed by
  continuous infusion of the same lactate solution (31.7 mumol . kg(-1) . min(-1) after
  the first, with the rate doubled after each subsequent bolus). Arterial blood samples
  were drawn at baseline and at 30, 60, 90, and 120 minutes, with simultaneous
  hemodynamic assessment. Significant increases were seen in blood lactate (from 1.6
  +/- 1.4 mmol/L at baseline to 4.4 +/- 0.8 at 30 minutes, 8.0 +/- 1.0 at 60 minutes, and
  14.4 +/- 2.1 at 90 minutes), pH (from 7.40 +/- 0.03 to 7.44 +/- 0.05 at 30 minutes,
  7.50 +/- 0.05 at 60 minutes, and 7.56 +/- 0.04 at 90 minutes), and HCO3- (from 28
  +/- 1.4 mmol/L to 30 +/- 0.7 at 30 minutes, 34 +/- 0.9 at 60 minutes, and 37 +/- 1.2 at
  90 minutes). Paco(2) decreased significantly from 44 +/- 3 torr at baseline to 40 +/-
  4.7 torr at 90 minutes. Blood pressure decreased after each lactate bolus, recovering
  within 2 minutes initially but not after later injections. Cardiac output, heart rate, and
  glucose increased significantly, mean arterial pressure and systemic vascular
  resistance decreased, and stroke volume did not change. Thus, the accumulation of
  blood lactate due to exogenous; administration of a neutral solution of sodium lactate
  was associated with significant systemic vasodilation, increased cardiac output,
   increased heart rate, and metabolic alkalosis
Keywords:                                            ACETATE/acidosis/alkalosis/animal
   study/BICARBONATE/CHEMISTRY/CORONARY-ARTERIES/heart/hyperlactate
   mia/K+               CHANNELS/LACTIC-ACIDOSIS/MUSCLE/pigs/POTASSIUM
   CHANNELS/PROTONS/RELAXATION/stroke/stroke volume/vasodilation
Blankenberg, S., Stengel, D., Rupprecht, H.J., Bickel, C., Meyer, J., Cambien, F., Tiret,
   L. and Ninio, E. (2003), Plasma PAF-acetylhydrolase in patients with coronary artery
   disease: results of a cross-sectional analysis. Journal of Lipid Research, 44 (7),
   1381-1386.
Abstract: Inflammation underlies both onset and perpetuation of atherosclerosis. Plasma
   lipoproteins transport the platelet- activating factor-acetylhydrolase (PAF-AH) with
   potentially anti-inflammatory activities. Our aim was to determine whether PAF-AH
   activity was associated with inflammatory markers and with coronary artery disease
   (CAD). PAF-AH activity and a panel of inflammatory mediators were measured in
   plasma of 496 patients with CAD and in 477 controls; 276 patients presented with
   stable angina pectoris and 220 with acute coronary syndrome (ACS). Individuals
   within the highest quartile of PAF- AH activity had an 1.8-fold increase in CAD risk
   [95% confidence interval (CI), 1.01 to 3.2; P = 0.048] compared with those in the
   first quartile (adjusted for clinical and metabolic factors). When excluding
   individuals receiving statin and angiotensin-converting enzyme-inhibitor medication,
   individuals within the highest quartile of PAF-AH activity revealed a 3.9-fold
   increase in CAD risk (95% CI, 2.0 to 7.7; P < 0.0001). In these subjects, the plasma
   PAF-AH activity increased gradually in stable angina and in ACS both in men (P <
   0.0001) and in women (P < 0.001), as compared with controls. No correlation was
   found between PAF AH levels and those of common markers of inflammation. This
   study and the previous ones raise the important issue of whether PAF-AH is simply a
   marker of risk or directly promotes atherosclerosis
Keywords:                                                                             AH
   ACTIVITY/ATHEROSCLEROSIS/atherosclerosis/ENZYME/HDL/inflammation/IS
   CHEMIC         STROKE/LDL/LIPOPROTEIN                OXIDATION/PHOSPHOLIPASE
   A(2)/PLATELET-ACTIVATING-FACTOR/plateletactivating                        factor/RISK
   FACTOR
Landi, F., Cesari, M., Onder, G., Zamboni, V., Lattanzio, F., Russo, A., Barillaro, C.
   and Bernabei, R. (2003), Antithrombotic drugs in secondary stroke prevention
   among a community dwelling older population. Journal of Neurology Neurosurgery
   and Psychiatry, 74 (8), 1100-1104.
Abstract: Background: Patients who suffer a cerebrovascular event are at high risk of a
   recurrence. Secondary prevention is crucial in reducing the burden of
   cerebrovascular disease. Objective: To estimate the percentage of stroke survivors
   receiving antiplatelet or anticoagulant drugs and to identify factors associated with
   such treatment. Design: Cross sectional retrospective cohort study. Methods: Data
   were analysed from a large collaborative observational study, the Italian "silver
   network" home care project, which collected data ( from 1997 to 2001) on patients
   admitted to home care programmes (n = 5372). Twenty two home health agencies
   participated in evaluating the implementation of the minimum dataset for home care
   (MDS-HC) instrument. For the present study, 648 individuals with a diagnosis of
   stroke were selected and the initial MDS-HC assessment reported. Results: 70% of
   stroke survivors did not receive any antiplatelet or anticoagulant drugs (95%
   confidence interval (CI), 66.5 to 73.5). Among all age categories, aspirin and
   ticlopidine were the two most commonly prescribed drugs. Living alone (odds ratio
  (OR), 0.49 (95% CI, 0.24 to 0.89)), dependency in activities of daily living (0.66
  (0.40 to 0.99)), cognitive impairment (0.58 (0.38 to 0.86)), and low educational level
  ( 0.58 ( 0.34 to 0.98)) were associated with a reduced likelihood of receiving
  secondary stroke prevention treatment. Cardiac arrhythmias, coronary artery disease,
  heart failure, and peripheral vascular disease were associated with the use of
  antiplatelet or anticoagulant treatment. Conclusions: Negative attitudes among
  physicians with respect to secondary stroke prevention are prevalent and reinforce
  the need for increased awareness of existing data on the risks and benefits for elderly
  individuals. Social problems and functional impairment may be issues concerning
  physicians when deciding whether or not the risks of treatment exceed the benefit
Keywords:
  ASPIRIN/ATRIAL-FIBRILLATION/CLOPIDOGREL/diagnosis/DIPYRIDAMOLE
  /FRAIL/heart/HOME             CARE/LONG-TERM-CARE/MINIMUM                       DATA
  SET/prevention/stroke/TRANSIENT ISCHEMIC ATTACK/WARFARIN
Vincent, A., Clover, L., Buckley, C., Evans, J.G. and Rothwell, P.M. (2003), Evidence
  of underdiagnosis of myasthenia gravis in older people. Journal of Neurology
  Neurosurgery and Psychiatry, 74 (8), 1105-1108.
Abstract: Background: Myasthenia gravis is a potentially serious but treatable muscle
  disease caused by autoantibodies directed at the acetylcholine receptor ( AChR) on
  the postsynaptic membrane of the neuromuscular junction. There is anecdotal
  evidence that the diagnosis is sometimes missed in older patients. Objective: To
  examine the incidence and age distribution of positive AChR antibodies in samples
  referred to diagnostic laboratories in the UK, and the prevalence of positive AChR
  antibodies in samples from a cohort of older individuals. Methods: Positive AChR
  antibody tests were identified from all UK centres registered for the assay with the
  European quality assurance scheme (EQAS) during 1997 - 99, and the age and sex
  specific incidence was calculated, based on the UK population. The prevalence of
  AChR antibodies in sera from a sample of 2000 individuals aged greater than or
  equal to 60 years was determined. Results: 3183 individuals had positive AChR
  antibody tests on routine screening during the years 1997 to 1999 in the UK, giving
  an annual incidence of 1.8/100 000. In both sexes, the age specific incidence rose
  steeply between the ages of 45 and 74, reaching 9.9/100 000 in men, and then fell,
  with a sharp decline above the age of 80. In the prevalence study, whereas only one
  serum from individuals aged 60 - 74 years was positive for AChR antibodies
  ( 0.12%), sera from eight individuals aged greater than or equal to 75 years were
  positive (0.7%). Only one had a previous clinical diagnosis of myasthenia gravis but
  four others had histories of stroke or transient ischaemic attacks. Conclusions: The
  sharp fall in the incidence of clinically recognised myasthenia gravis in people over
  80 years of age in our national AChR antibody incidence study, and the high
  prevalence of previously unrecognised positive AChR antibodies in those greater
  than or equal to 75 years old, suggest that myasthenia gravis may be substantially
  underdiagnosed in older people
Keywords:
  ACETYLCHOLINE-RECEPTOR/AGEISM/ANTIBODY/diagnosis/DISEASE/ELD
  ERLY
  PATIENTS/ENGLAND/POPULATION/PREVALENCE/SCOTLAND/stroke
Toth, C. (2003), Hemisensory syndrome is associated with a low diagnostic yield and a
  nearly uniform benign prognosis. Journal of Neurology Neurosurgery and
  Psychiatry, 74 (8), 1113-1116.
Abstract: Objective: To describe the diagnostic yield and prognosis for patients with
  hemisensory syndrome. Background: The aetiology, utility of diagnostic procedures,
  and outcome of hemisensory syndrome in patients with exclusive hemibody
  complaints having only subjective sensory abnormalities on examination is unknown.
  Methods: Patients were prospectively identified with hemisensory syndrome in a
  tertiary care institution from 1998- 2002. Diagnostic procedures were analysed for
  sensitivity and clinical follow up was performed. Results: Thirty four patients, 25
  (74%) women, of age 35 (SD 11) years were identified. The hemisensory syndrome
  occurred on the left side in 23 (68%) cases. Neuroimaging of the brain demonstrated
  diagnostic abnormalities representing ischaemic aetiology in one case. Other
  diagnostic testing including cerebrospinal fluid examination, electrophysiological
  testing, carotid ultrasonography, echocardiography, and blood testing revealed no
  diagnostic abnormalities. Sixteen patients (47%) continued to complain of
  hemisensory difficulties after all investigations were completed at 9.6 (5.8) days.
  One patient with a history of systemic lupus erythematosus and positive
  antiphospholipid antibodies had a second event diagnosed as stroke seven months
  after presentation. Clinical follow up at 16 (7) months revealed persisting symptoms
  in 6 (20%) of 30 patients. Six (50%) of 12 patients agreeing to psychiatric
  assessment received diagnoses of personality or mood disorders. Conclusions:
  Diagnostic yield in hemisensory syndrome is low, and prognosis is almost always
  uniformly benign. The author advocates careful assessment of medical history and
  consideration for neuroimaging in this group of patients
Keywords: brain/ENGLAND/PURE SENSORY STROKE/REGIONAL PAIN
  SYNDROME/stroke
Ago, T., Kitazono, T., Ooboshi, H., Takada, J., Yoshiura, T., Mihara, F., Ibayashi, S.
  and Iida, M. (2003), Deterioration of pre-existing hemiparesis brought about by
  subsequent ipsilateral lacunar infarction. Journal of Neurology Neurosurgery and
  Psychiatry, 74 (8), 1152-1153.
Abstract: Mechanisms of post-stroke recovery are still poorly understood. Recent
  evidence suggests that cortical reorganisation in the unaffected hemisphere plays an
  important role. A 59 year old man developed a small lacunar infarct in the left corona
  radiata, which then caused marked deterioration in a pre- existing left hemiparesis
  that had resulted from an earlier right putaminal haemorrhage. Functional magnetic
  resonance imaging showed that the paretic left hand grip activated the ipsilateral left
  motor areas, but not the right hemispheric motor areas. This suggests that partial
  recovery of the left hemiparesis had been brought about by cortical reorganisation of
  the left hemisphere and intensification of the uncrossed corticospinal tract. The
  subsequent small infarct may have damaged the uncrossed tract, thereby causing the
  pre-existing hemiparesis to deteriorate even further
Keywords:                BRAIN/ENGLAND/FUNCTIONAL                         MRI/MOTOR
  RECOVERY/POSITRON-EMISSION-TOMOGRAPHY/POSTSTROKE
  HEMIPARESIS/REORGANIZATION/STROKE
Deplanque, D., Gele, P., Petrault, O., Six, I., Furman, C., Bouly, M., Nion, S., Dupuis,
  B., Leys, D., Fruchart, J.C., Cecchelli, R., Staels, B., Duriez, P. and Bordet, R.
  (2003), Peroxisome proliferator-activated receptor-alpha activation as a mechanism
  of preventive neuroprotection induced by chronic fenofibrate treatment. Journal of
  Neuroscience, 23 (15), 6264-6271.
Abstract: The treatment of ischemic strokes is limited to the prevention of
  cerebrovascular risk factors and to the modulation of the coagulation cascade during
  the acute phase. Anew therapeutic strategy could be to preventively protect the brain
  against noxious biological reactions induced by cerebral ischemia such as oxidative
  stress and inflammation to minimize their neurological consequences. Here, we show
  that a peroxisome proliferator-activated receptor (PPAR-alpha) activator, fenofibrate,
  protects against cerebral injury by anti-oxidant and anti-inflammatory mechanisms.
  A 14 d preventive treatment with fenofibrate reduces susceptibility to stroke in
  apolipoprotein E-deficient mice as well as decreases cerebral infarct volume in
  C57BL/6 wild-type mice. The neuroprotective effect of fenofibrate is completely
  absent in PPAR-alpha- deficient mice, suggesting that PPAR-alpha activation is
  involved as a mechanism of the protection against cerebral injury. Furthermore, this
  neuroprotective effect appears independently of any improvement in plasma lipids or
  glycemia and is associated with ( 1) an improvement in middle cerebral artery
  sensitivity to endothelium-dependent relaxation unrelated to an increase in nitric
  oxide synthase (NOS) type III expression, (2) a decrease in cerebral oxidative stress
  depending on the increase in numerous antioxidant enzyme activities, and (3) the
  prevention of ischemia-induced expression of vascular cell adhesion molecule-1 and
  intercellular adhesion molecule-1 in cerebral vessels without any change in NOS II
  expression. These data demonstrate that PPAR-alpha could be a new
  pharmacological target to preventively reduce the deleterious neurological
  consequences of stroke in mice and suggest that PPAR-alpha activators could
  preventively decrease the severity of stroke in humans
Keywords:           adhesion         proteins/brain/cerebral       infarct/DEFICIENT
  MICE/ENDOTHELIAL-CELLS/FOCAL
  CEREBRAL-ISCHEMIA/inflammation/ischemia/KAPPA-B/LIPOPROTEIN
  METABOLISM/middle                                                             cerebral
  artery/mouse/NERVOUS-SYSTEM/neuroprotection/nitric oxide/NITRIC-OXIDE
  SYNTHASE/oxidative                  stress/PPAR-alpha/PPAR-ALPHA/prevention/risk
  factors/SMOOTH-MUSCLE/stroke/SUPEROXIDE- DISMUTASE
Knuepfer, M.M. (2003), Muscarinic cholinergic and beta-adrenergic contribution to
  hindquarters vasodilation and cardiac responses to cocaine. Journal of Pharmacology
  and Experimental Therapeutics, 306 (2), 515-522.
Abstract: Cocaine produces a pressor response associated with an initial hindquarters
  vasoconstriction followed by a prolonged vasodilation in conscious rats. Propranolol
  pretreatment prevented the vasodilation and enhanced the pressor response, whereas
  atropine methylbromide pretreatment reduced the increase in systemic vascular
  resistance. We studied the role of selective muscarinic and beta-adrenoceptor
  antagonists on responses to cocaine in rats with an increase in systemic vascular
  resistance to cocaine (vascular responders). Arterial blood pressure and ascending
  aortic and distal descending aortic blood flow using pulsed Doppler flowmetry were
  measured. In conscious rats, cocaine (5 mg/kg i.v.) elicited consistent pressor
  responses but variable systemic and hindquarters vascular resistance responses that
  were directly correlated, suggesting that skeletal muscle resistance responses
  comprise an important component of systemic vascular resistance. ICI 118,551
  [(+/-)-1-[               2,3(                 dihydro-7-methyl-1H-inden-4-yl)oxy]-3-
  [(1-methylethyl)-amino]-2-butanol] (0.5 mg/kg i.v.) pretreatment prevented the
  hindquarters vasodilation, enhancing the increase in systemic vascular resistance and
  the pressor response while further depressing the cardiac output response, similar to
  the effects of propranolol. Atenolol (1 mg/kg) pretreatment attenuated the stroke
  volume and cardiac output responses while enhancing the increase in systemic
  vascular resistance without affecting the hindquarters responses. In contrast, M-2
  antagonist methoctramine (0.3 mg/kg) pretreatment had similar effects as atropine in
  reducing the decrease in cardiac output by reducing the increase in systemic vascular
  resistance, whereas the M-1 antagonist pirenzipine (0.02 mg/kg) did not alter
  responses. Therefore, the cocaine-induced pressor response is ameliorated by
  beta(2)-adrenoceptor mediated skeletal muscle vasodilation, whereas the decrease in
  cardiac output and the increase in systemic vascular resistance are dependent on
  M-2-cholinoceptor activation
Keywords:           blood        flow/CENTRAL-NERVOUS-SYSTEM/CONSCIOUS
  RATS/DIFFERENTIAL                                              CARDIOVASCULAR
  SENSITIVITY/DOGS/HEMODYNAMIC-RESPONSES/HUMANS/MECHANISM
  S/NOREPINEPHRINE/RECEPTORS/stroke/stroke                       volume/VASCULAR-
  RESPONSES
Zhou, L.D., Marchand-Verrecchia, C., Palmier, B., Croci, N., Chabrier, P.E., Plotkine,
  M.       and      Margaill,     I.    (2003),     Neuroprotective        effects     of
  (S)-N-[4-[4-[(3,4-dihydro-6-hydroxy-
  2,5,7,8-tetramethyl-2H-1-benzopyran-2-yl)carbonyl]-1-
  piperazinyl]phenyl]-2-thiophenecarboximid-amide (BN 80933), an inhibitor of
  neuronal nitric-oxide synthase and an antioxidant, in model of transient focal
  cerebral ischemia in mice. Journal of Pharmacology and Experimental Therapeutics,
  306 (2), 588-594.
Abstract: Nitric oxide (NO) and reactive oxygen species are both implicated in neuronal
  death due to cerebral ischemia. BN 80933, an original compound associating an
  inhibitor of neuronal NO synthase with an antioxidant, has been shown to reduce
  functional and histological damage in rat submitted to cerebral ischemia. The aim of
  the present study was to confirm these results in mice and to further examine the
  effects of BN 80933 on inflammatory response, including blood-brain barrier (BBB)
  disruption, brain edema, and neutrophil infiltration after transient middle cerebral
  artery occlusion (MCAO). Intravenous administration of BN 80933 at 3 and 10
  mg/kg 3 h after MCAO significantly reduced by 26 to 36% the infarct volume
  evaluated 24 and 48 h after ischemia, and improved the neurological score.
  Furthermore, BN 80933 at both dosages decreased by 42 to 75% the extravasation of
  Evans blue in brain parenchyma observed 24 h after ischemia. This reduction in BBB
  disruption was associated with decreased brain edema as demonstrated by the 37%
  reduction in brain water content induced by BN 80933 at 3 mg/kg 24 h after MCAO.
  Neutrophil infiltration in brain parenchyma, evaluated by the myeloperoxidase
  activity, was also reduced by 45 to 56% in animals treated with BN 80933 at 3 and
  10 mg/kg. Together, these results extend the protective capacity of BN 80933 against
  brain ischemic injury and confirm that BN 80933 represents a promising treatment
  for stroke
Keywords:                                            BLOOD/brain/BRAIN-BARRIER
  DISRUPTION/CUZN-SUPEROXIDE-DISMUTASE/EDEMA/ENDOTHELIAL-C
  ELLS/INFARCTION/INFLAMMATORY RESPONSE/ischemia/middle cerebral
  artery/nitric oxide/OXYGEN RADICALS/rat/REPERFUSION INJURY/STROKE
Sunnerhagen, K.S., Brown, B. and Kasper, C.E. (2003), Sitting up and transferring to a
  chair: Two functional tests for patients with stroke. Journal of Rehabilitation
  Medicine, 35 (4), 180-183.
Abstract: Objective: The aim of the study was to evaluate the reliability of two clinical
  tests of mobility for stroke patients. Design: The study took place in a university
  hospital with a case control design. Subjects: A sample of convenience including 31
  subjects: a group of patients with prior stroke (n = 19); a control group (n = 12).
  Methods: The time(s) for sitting up from a supine position and transferring from an
  examination table to a chair were measured and inter- and intra-rater reliability were
  assessed. The source of variation in the test results as well as intra-class correlations
  were estimated. Results: The largest source of variation in the supine position was
  between subjects, and the between-tester variability was very low, with similar
  results for the transfer from table to chair. The intra-class correlations are all high
  (range 0.77- 0.98). This indicates that it is of little importance which tester is
  performing the tests. Conclusion: Sitting up on an examination table and transferring
  from an examination table to a chair seem to be reliable timed clinical tests of
  mobility in stroke research
Keywords: functional tests/INFARCTION/MOTOR-ASSESSMENT SCALE/physical
  therapy/RECOVERY/rehabilitation/RELIABILITY/stroke
Tsuji, T., Liu, M.G., Hase, K., Masakado, Y. and Chino, N. (2003), Trunk muscles in
  persons with hemiparetic stroke evaluated with computed tomography. Journal of
  Rehabilitation Medicine, 35 (4), 184-188.
Abstract: Objectives: To analyse side difference in bilateral trunk muscles in patients
  with hemiparetic stroke, to relate it with impairment and disability variables and to
  evaluate longitudinal changes. Methods: In a sample of 83 inpatients with
  hemiparetic stroke undergoing rehabilitation, we measured the cross-sectional area of
  the paravertebral muscle and thigh muscles using computed tomography at
  admission and discharge. Classifying them by paravertebral muscle side difference
  (group I: contralateral > ipsilateral; II: contralateral = ipsilateral; III: contralateral <
  ipsilateral) we analysed group difference in the Stroke Impairment Assessment Set,
  the Functional Independence Measure and walk velocity. Results: In contrast to thigh
  muscles, the paravertebral muscle cross- sectional area was significantly greater on
  the side contralateral to the brain lesion. Discharge paravertebral muscle
  cross-sectional area increased significantly from admission values. The Stroke
  Impairment Assessment Set, Functional Independence Measure and walk velocity
  were significantly lower in group I. Conclusion: The contralateral paravertebral
  muscle cross-sectional area was larger than the ipsilateral ones, and this was related
  to the degree of impairment and functional limitations
Keywords:                                            ACTIVATION/brain/cerebrovascular
  disorders/disability/exercise/HAND/HEMIPLEGIC
  PATIENTS/IMPAIRMENT/MOTOR                            CORTEX/MOVEMENTS/outcome
  assessment/PERFORMANCE/RECOVERY/rehabilitation/stroke/TRANSCRANIAL
  MAGNETIC STIMULATION
Hammer, A. and Lindmark, B. (2003), Test-retest intra-rater reliability of grip force in
  patients with stroke. Journal of Rehabilitation Medicine, 35 (4), 189-194.
Abstract: Objective: Coefficients of repeatability and reproducibility can be guides in
  differentiating between real changes and measurement error. The aim was to evaluate
  test-retest intra- rater reliability of a clinical procedure measuring grip force with
  Grippit(R) in stroke patients, to assess relationship between grip force of the hands
  and between sustained and peak grip force. Patients and methods: Eighteen patients
  were tested using the Grippit(R) at two occasions one hour apart. Each occasion
  comprised three consecutive trials per hand. Results: The paretic hand needs to score
  a 50 N change within and between occasions to exceed the measurement error in
  95% of the observations, irrespective of calculation method. Expressed by CVwithin
  the measurement error was 10%. There was no learning or fatigue effect during
  measuring. There was a wide variation between subjects but the mean ratio between
  sides was 0.66. The mean ratio between sustained and peak grip force was 0.80-0.84.
  Conclusion: The measurement errors were acceptable and the instrument can be
  recommended for the use in stroke patients at a department of rehabilitation medicine
Keywords:                               ARM                               FUNCTION/grip
   force/measurement/physiotherapy/RECOVERY/rehabilitation/reliability/STRENGT
   H/stroke
Rowland, T., Koenigs, L. and Miller, N. (2003), Myocardial performance during
   maximal exercise in adolescents with anorexia nervosa. Journal of Sports Medicine
   and Physical Fitness, 43 (2), 202-208.
Abstract: Aim. To examine cardiac responses and indicators of myocardial function
   during maximal exercise in adolescent girls with anorexia nervosa. Methods. Eight
   girls (mean age 16.3 +/- 2.7 years) who satisfied criteria for the diagnosis of anorexia
   nervosa underwent maximal cycle testing. Cardiac stroke volume and peak aortic
   velocity and mean acceleration of flow (markers of myocardial contractility) were
   assessed using Doppler echocardiography and compared to healthy control subjects.
   Gas exchange variables were measured using open circuit spirometry techniques.
   Results. Resting and maximal heart rates were less in the patients, and maximal
   oxygen uptake was significantly lower than controls. Maximal stroke index was
   greater in the patients than controls, with a normal pattern of response to progressive
   exercise. Peak aortic velocity and mean acceleration of flow were similar in the two
   groups when adjusted for heart rate. Conclusion. Findings of low heart rate and
   aerobic fitness previously described in patients with anorexia nervosa were
   confirmed. However, there was no evidence of abnormal myocardial performance
   during maximal exercise testing
Keywords: anorexia nervosa/CHILDREN/diagnosis/exercise/HEART/heart/physical
   fitness/physiology/RESPONSES/STARVATION/stroke/stroke
   volume/WEIGHT-LOSS
Otiniano, M.E., Ottenbacher, K.J., Markides, K.S., Ray, L.A. and Du, X.L.L. (2003),
   Self-reported heart attack in Mexican-American elders: Examination of incidence,
   prevalence, and 7-year mortality. Journal of the American Geriatrics Society, 51 (7),
   923-929.
Abstract: OBJECTIVES: To examine the prevalence, incidence, and mortality of
   self-reported heart attack in older Mexican Americans and to identify significant
   factors associated with heart attack. DESIGN: Cross-sectional and longitudinal study.
   SETTING: Baseline and three follow-up interviews in five southwestern states
   (Arizona, California, Colorado, New Mexico, and Texas) of the Hispanic Established
   Population for the Epidemiological Study of the Elderly. PARTICIPANTS: Three
   thousand fifty Mexican Americans aged 65 to 107 (mean age = 73).
   MEASUREMENTS: Sociodemographic factors (age, sex, marital status, language of
   interview, health insurance coverage, living arrangements, and financial strain) and
   health factors (smoking, alcohol consumption, obesity, diabetes mellitus,
   hypertension, stroke, cancer, hip fracture, arthritis, depression, limitations in
   activities of daily living (ADLs) and instrumental activities of daily living (IADLs),
   and mortality) were determined at baseline (1993-94). New heart attacks were
   assessed at follow- ups in 1995-96, 1998-99, and 2000-01. Vital status was
   determined over the 7-year follow-up. RESULTS: Prevalence of self-reported heart
   attack was 9.1% at baseline. Incidence of self-reported heart attack was 6.1%, 9.1%,
   and 7.9%, respectively, for the three subsequent follow-ups. Older age, male sex,
   diabetes mellitus, hypertension, and stroke were significantly associated with heart
   attack at baseline. Age was a significant predictor for new heart attack at each
   follow-up. Having ADL (odds ratio (OR) = 2.91, 95% confidence interval (CI) =
   2.19-3.86) and IADL (OR = 2.25, Cl = 1.72-2.94) disabilities was significantly
   associated with self-reported heart attack. Subjects with heart attack were
  significantly more likely to die at 7 years (hazard ratio = 1.57, 95% CI = 1.29-1.91).
  Of those with self-reported heart attack, 42.4% had died of heart attack as the
  underlying cause of death by 7-year follow-up. CONCLUSION: In Mexican
  Americans, self-reported heart attack was associated with being older and male and
  having diabetes mellitus, hypertension, stroke, and ADL and IADL disabilities.
  Nearly half of subjects with heart attack had died of heart attack as underlying cause
  of death by 7-year follow-up. Prevention and control for this disease would be
  especially important in this population to avoid early mortality
Keywords:        ACUTE          MYOCARDIAL-INFARCTION/CARDIOVASCULAR
  RISK-FACTORS/DIABETES-MELLITUS/disability/DISEASE
  MORTALITY/MEDICAL                             CONDITIONS/MEN/Mexican-American
  elders/mortality/NON-HISPANIC                            WHITES/POPULATION/risk
  factors/SAN-ANTONIO/self-reported heart attack/stroke/TEXAS
Greiner, K.A., Perera, S. and Ahluwalia, J.S. (2003), Hospice usage by minorities in the
  last year of life: Results from the national mortality followback survey. Journal of
  the American Geriatrics Society, 51 (7), 970-978.
Abstract: OBJECTIVES: To examine racial/ethnic variations in rates of hospice use in a
  national cohort and to identify individual characteristics associated with hospice use.
  DESIGN: Secondary analysis of the 1993 National Mortality Followback Survey
  (NMFS), a nationally obtained sample using death certificates and interviews with
  relatives (proxy respondents) to provide mortality, social, and economic data and
  information about healthcare utilization in the last year of life for 23,000 deceased
  individuals. SETTING: Hospice care. PARTICIPANTS: Individuals aged 15 and
  older who died in 1993. Subjects were included in this analysis if they died of
  nontraumatic causes (N = 11,291). MEASUREMENTS: Hospice use was
  dichotomized by proxy responses indicating use or nonuse of home or inpatient
  hospice services. The percentage of individuals using hospice services in the last year
  of life was calculated. RESULTS: Unadjusted bivariate results found that African
  Americans were less likely to use hospice than whites (odds ratio (OR) = 0.59; P
  < .001) and that those without a living will (LW) (OR = 0.23; P < .001) and without
  a cancer diagnosis (OR = 0.28; P < .001) were less likely to use hospice. The
  negative relationship between African Americans and hospice use was unaffected
  when controlled for sex, education, marital status, existence of a LW, income, and
  access to health care. Logistic models revealed that presence of a LW diminished the
  negative relationship between African Americans and hospice use, but the latter
  remained significant (OR 0.83; P = .033). A subanalysis of subjects aged 55 and
  older showed a significant interaction between access to care and race/ethnicity with
  respect to hospice use (P = .044). Inclusion of income in this multivariable logistic
  model attenuated the relationship between African-American race/ethnicity and
  hospice use (OR = 0.77), and the difference between whites and African Americans
  became only marginally statistically significant (P = .060). CONCLUSION: In the
  1993 NMFS, hospice use was negatively associated with African-American
  race/ethnicity independent of income and access to healthcare. The relationship is not
  independent of age, insurance type, or history of stroke. For subjects aged 55 and
  older, access to healthcare may be an important confounder of the negative
  relationship between African-American race/ethnicity and hospice use. Consistent
  with previous studies, this analysis found that African Americans were less likely to
  use LWs than whites. The reduced importance of African-American race/ethnicity on
  hospice use with the inclusion of presence of a LW in logistic models suggests that
  similar cultural processes may shape differences between African Americans and
  whites in advance care planning and hospice use
Keywords:              ADVANCE                 DIRECTIVES/diagnosis/END/end-of-life
  care/EPIDEMIOLOGY/ETHNICITY/HEALTH-CARE/hospice                           care/minority
  groups/mortality/palliative
  care/PHYSICIANS/POPULATION/PREFERENCES/RACE/stroke/TERMINAL
  ILLNESS
Loeb, M.B., Becker, M., Eady, A. and Walker-Dilks, C. (2003), Interventions to prevent
  aspiration pneumonia in older adults: A systematic review. Journal of the American
  Geriatrics Society, 51 (7), 1018-1022.
Abstract: A systematic review was conducted to assess the effectiveness of the
  following interventions for prevention of aspiration pneumonia (AP) in older adults:
  compensatory strategy/positioning changes, dietary interventions, pharmacologic
  therapies, oral hygiene, and tube feeding. Data sources included a key word search of
  the MEDLINE, EMBASE, Cochrane Library, CINAHL, and HealthSTAR databases
  and hand searches of six journals. Reference lists of relevant primary and review
  articles were searched. Studies included were randomized, controlled trials (RCTs)
  enrolling adults aged 65 and older at risk of and assessed for AP. Two investigators
  extracted data on population, intervention, outcomes, and methodological quality. Of
  the 17 identified RCTs, eight met the selection criteria, two addressed dietary
  management or compensatory swallowing, two assessed pharmacological therapies,
  one assessed oral hygiene, and three assessed tube feeding. None of the eight trials
  reported use of blinding, and allocation concealment was unclear in five. Use of
  amantadine prevented pneumonia in one trial of nursing home residents. The
  antithrombotic agent cilostazol prevented AP in another trial but resulted in
  excessive bleeding. Insufficient data exist to determine the effectiveness of
  positioning strategies, modified diets, oral hygiene, feeding tube placement, or
  delivery of food in preventing AP. Considering how common the problem of AP is in
  older adults, larger, high-quality RCTs on the effectiveness of preventive
  interventions are warranted
Keywords:                                   aspiration/bleeding/dysphagia/DYSPHAGIC
  STROKE/HEALTH/IMPACT/ORAL CARE/PERCUTANEOUS ENDOSCOPIC
  GASTROSTOMY/pneumonia/prevention/SWALLOWING                       REFLEX/systematic
  review/THERAPY
Pappone, C., Rosanio, S., Augello, G., Gallus, G., Vicedomini, G., Mazzone, P.,
  Gulletta, S., Gugliotta, F., Pappone, A., Santinelli, V., Tortoriello, V., Sala, S.,
  Zangrillo, A., Crescenzi, G., Benussi, S. and Alfieri, O. (2003), Mortality, morbidity,
  and quality of life after circumferential pulmonary vein ablation for atrial fibrillation
  - Outcomes from a controlled nonrandomized long-term study. Journal of the
  American College of Cardiology, 42 (2), 185-197.
Abstract: OBJECTIVES This study was designed to investigate the potential of
  circumferential pulmonary vein (PV) ablation for atrial fibrillation (AF) to maintain
  sinus rhythm (SR) over time, thus reducing mortality and morbidity while enhancing
  quality of life (QoL). BACKGROUND Circumferential PV ablation is safe and
  effective, but the long-term outcomes and its impact on QoL have not been assessed
  or compared with those for medical therapy. METHODS We examined the clinical
  course of 1,171 consecutive patients with symptomatic AF who were referred to us
  between January 1998 and March 2001. The 589 ablated patients were compared
  with the 582 who received antiarrhythmic medications for SR control. The QoL of
  109 ablated and 102 medically treated patients was measured with the SF-36 survey.
  RESULTS Median follow-up was 900 days (range 161 to 1,508 days). Kaplan-Meier
  analysis showed observed survival for ablated patients was longer than among
  patients treated medically (p < 0.001), and not different from that expected for
  healthy persons of the same gender and calendar year of birth (p = 0.55). Cox
  proportional-hazards model revealed in the ablation group hazard ratios of 0.46 (95%
  confidence interval [CI], 0.31 to 0.68; p < 0.001) for all-cause mortality, of 0.45
  (95% CI, 0.31 to 0.64; p < 0.001) for morbidities mainly due to heart failure and
  ischemic cerebrovascular events, and of 0.30 (95% CI, 0.24 to 0.37; p < 0.001) for
  AF recurrence. Ablated patients' QoL, different from patients treated medically,
  reached normative levels at six months and remained unchanged at one year.
  CONCLUSIONS Pulmonary vein ablation improves mortality, morbidity, and QoL
  as compared with medical therapy. Our findings pave the way for randomized trials
  to prospect a wider application of ablation therapy for AF. (C) 2003 by the American
  College of Cardiology Foundation
Keywords:      ANATOMIC           APPROACH/atrial           fibrillation/mortality/RHYTHM
  CONTROL/STROKE/therapy
Rosendaal, F.R., Vlieg, A.V., Tanis, B.C. and Helmerhorst, F.M. (2003), Estrogens,
  progestogens and thrombosis. Journal of Thrombosis and Haemostasis, 1 (7),
  1371-1380.
Abstract: Hundreds of millions of women worldwide use either oral contraceptives or
  postmenopausal hormone replacement. The use of oral contraceptives leads to an
  increased risk of venous thrombosis, of myocardial infarction, of stroke and of
  peripheral artery disease, the risks of which are highest during the first year of use.
  Women with coagulation abnormalities have a higher risk of venous thrombosis
  when they use oral contraceptives (or postmenopausal hormones) than women
  without these abnormalities. The risk of venous thrombosis is also higher for
  preparations containing desogestrel or gestodene (third-generation progestogens)
  than for those containing levonorgestrel (second-generation progestogens). A
  previous thrombosis as well as obesity also increase the risk of oral
  contraceptive-related thrombosis. Hormone replacement therapy increases the risk of
  venous thrombosis, and has no beneficial, and possibly even a detrimental, effect on
  the risk of arterial disease. The risk of arterial disease in oral contraceptive users and
  users of hormone replacement therapy is at most weakly affected by the presence of
  prothrombotic abnormalities
Keywords:        3RD-GENERATION               ORAL-CONTRACEPTIVES/ACTIVATED
  PROTEIN-C/ACUTE                MYOCARDIAL-INFARCTION/CARDIOVASCULAR
  RISK-FACTORS/CORONARY                                   HEART-DISEASE/DEEP-VEIN
  THROMBOSIS/estrogens/FACTOR-V-LEIDEN/hormone replacement/HORMONE
  REPLACEMENT                        THERAPY/myocardial                        infarction/oral
  contraceptives/progestogens/RANDOMIZED
  CROSS-OVER/stroke/therapy/VENOUS THROMBOEMBOLIC DISEASE/venous
  thrombosis
Warlow, C. (2003), Stroke: killer clots and killer drugs. Journal of Thrombosis and
  Haemostasis, 1 (7), 1422-1428.
Abstract: Therapeutic thrombolysis is an immense opportunity in acute stroke care. For
  the first time, there is a treatment that has a high probability of being effective if
  given early enough to patients with acute ischemic stroke. However, the risks of
  intracranial hemorrhage are substantial and as yet the exact indications and
  contraindications have not been worked out. And indeed how to deliver this
  treatment in routine clinical practice. As stroke units proliferate and become more
  organized, and physicians become more specialized in stroke care, it will become
  easier both to further assess in randomized trials and to deliver thrombolysis,
  certainly intravenously and maybe in some centers intra-arterially in suitable cases
Keywords:         ACUTE           ISCHEMIC-STROKE/CEREBRAL                   ARTERIAL
  OCCLUSION/stroke/THERAPY/THROMBOLYSIS/thrombolysis/TISSUE-PLASM
  INOGEN ACTIVATOR/TRIALS
Chan, A.K., Deveber, G., Monagle, P., Brooker, L.A. and Massicotte, P.M. (2003),
  Venous thrombosis in children. Journal of Thrombosis and Haemostasis, 1 (7),
  1443-1455.
Abstract: Venous thromboembolic (VTE) events are being increasingly diagnosed in
  systemic and cerebral vessels in children. Systemic VTE are increasing in children as
  a result of therapeutic advances and improved clinical acumen in primary illnesses
  that previously caused mortality. The epidemiology of systemic WE has been studied
  in international registries. In children older than 3 months, teenagers are the largest
  group developing VTE. The most common etiologic factor is the presence of central
  venous lines. Clinical studies have determined the most sensitive diagnostic method
  for diagnosing upper system WE are ultrasound for jugular venous thrombosis and
  venography for intrathoracic vessels. However, the most sensitive diagnostic
  methods for lower system WE and pulmonary embolism (PE) have not been
  established. Treatment studies for WE consist of inadequately powered randomized
  controlled trials or prospective cohort studies. The Iona-term outcome of systemic
  VTE, post-thrombotic syndrome. has been reported in children. Cerebral sinovenous
  thrombosis (CSVT) is becoming increasingly diagnosed in children due to the
  recognition of the associated subtle clinical symptoms and improved cerebrovascular
  imaging. The etiology of CSVT includes thrombophilia, head and neck infections,
  and systemic illness. Estimates of the incidence and outcome of childhood CSVT
  have recently become available through the Canadian Pediatric Ischaemic Stroke
  Registry. Clinical studies have not yet been carried out in children to determine the
  best method of diagnosis or treatment. There have only been case-series studies
  carried out in the treatment of CSVT. Properly designed clinical trials are urgently
  required in children with systemic VTE/PE and CSVT to define the best methods of
  diagnosis. treatment and long-term management
Keywords: ACTIVATED PROTEIN-C/anticoagulation/ARTERIAL ISCHEMIC
  STROKE/CATHETER-RELATED                                  THROMBOSIS/DEEP-VEIN
  THROMBOSIS/diagnosis/FACTOR-V-LEIDEN/MAGNETIC-RESONANCE
  ANGIOGRAPHY/MOLECULAR-WEIGHT                         HEPARIN/pediatrics/SAGITTAL
  SINUS                     THROMBOSIS/stroke/SYSTEMIC                          LUPUS-
  ERYTHEMATOSUS/thrombophilia/thrombosis/TOTAL
  PARENTERAL-NUTRITION/venous thrombosis
Schulman, S. (2003), Unresolved issues in anticoagulant therapy. Journal of
  Thrombosis and Haemostasis, 1 (7), 1464-1470.
Abstract: Large randomized clinical trials have clarified some issues of anticoagulation
  and have led to progress, such as outpatient treatment of acute deep vein thrombosis
  with low-molecular- weight heparin. However, many uncertainties remain and are
  reviewed here. When should thrombolytic therapy be used, apart from patients in
  shock due to pulmonary embolism? How should low-molecular-weight heparin be
  used in patients with extreme obesity or renal failure? The optimal duration of
  anticoagulation after venous thromboembolism has been the subject of many debates.
  With the recognition of an increasing number of risk factors for recurrence, the
  picture becomes increasingly complex. Lower intensity of anticoagulation with
  vitamin K antagonists and novel anticoagulant drugs are possible alternatives in
  extended secondary prophylaxis. For stroke prophylaxis in non-valvular atrial
  fibrillation, there is a gray zone between the groups where there is a clear indication
  for aspirin or for vitamin K antagonists. Anticoagulation in connection with
  cardioversion raises questions regarding optimal postprocedure therapy. Fine tuning
  of prophylaxis against thromboembolism in patients with prosthetic heart valves
  requires more studies of subgroups, homogenous for position and type of valve as
  well as presence of atrial fibrillation. The management of these patients in case of
  surgical procedures has not been studied properly. Secondary prophylaxis after
  myocardial infarction may achieve the best effect with vitamin K antagonists at an
  INR of 2.0-2.5 in combination with low-dose aspirin, but is it really cost- effective?
  Finally, many controversies exist regarding anticoagulation during pregnancy
Keywords:                                                                            ACUTE
  PULMONARY-EMBOLISM/anticoagulation/ANTITHROMBOTIC
  THERAPY/atrial                fibrillation/ATRIAL-FIBRILLATION/BONE-MINERAL
  DENSITY/deep            vein       thrombosis/DEEP-VEIN            THROMBOSIS/FIRST
  EPISODE/LONG-TERM/MOLECULAR-WEIGHT                                  HEPARIN/myocardial
  infarction/STAGE                     RENAL-DISEASE/stroke/therapy/thrombosis/valve
  prosthesis/venous thromboembolism/VENOUS THROMBOEMBOLISM
Weiler, H. and Isermann, B.H. (2003), Thrombomodulin. Journal of Thrombosis and
  Haemostasis, 1 (7), 1515-1524.
Abstract: Since its discovery as a critical cofactor in the initiation of the protein C (PC)
  anticoagulant pathway [1,2], biochemical and structural investigations, combined
  with in vivo analyses of genetically engineered mice have revealed new, and in part
  PC- and thrombin-independent aspects of thrombomodulin (TM) function in
  fibrinolysis and inflammation, and in embryogenesis. This review summarizes more
  recent structural and functional investigations of TM, gives an overview of the
  association of TM gene polymorphisms with human disease, and provides a synopsis
  of what is know about TM function in disease states of thrombosis, stroke,
  arteriosclerosis, and cancer. Newly emerging aspects of TM function in
  inflammation and embryogenesis are presented and discussed in detail
Keywords:        ACTIVATABLE              FIBRINOLYSIS           INHIBITOR/CORONARY
  HEART-DISEASE/FACTOR-LIKE                   DOMAIN/FALCIPARUM-                 INFECTED
  ERYTHROCYTES/HUMAN                     MONONUCLEAR              PHAGOCYTES/HUMAN
  SOLUBLE                    THROMBOMODULIN/inflammation/placenta/PROTEIN-C
  RECEPTOR/RECOMBINANT                                                              HUMAN
  THROMBOMODULIN/SQUAMOUS-CELL
  CARCINOMA/stroke/THROMBIN-INDUCED
  THROMBOEMBOLISM/thrombomodulin/thrombosis
Batyraliev, T.A., Pershukov, I.V., Samko, A.N., Niyazova-Karben, Z.A., Birand, A. and
  Erenler, O. (2003), Quantitative assessment of right ventricular contractility by
  contrast angiography in healthy persons and patients with ischemic heart disease.
  Kardiologiya, 43 (5), 21-24.
Abstract: Absence of special programs for quantitative analysis of right ventricular
  volumes and function precludes precise evaluation of right ventriculography data.
  We used standard programs designed for analysis of left ventriculograms for
  evaluation of right ventricular volumes and function in 32 patients without and 20
  patients with coronary artery disease. Left ventriculography and right atriography
  were carried out in 30- and 60-degree right and left anterior oblique projections,
  respectively. Average correction factors obtained by comparison of left and right
  ventricular stroke volumes were 0.9243+/- 0.2887 and 0.8758+/-0.2232 for patients
   without and with coronary artery disease, respectively. Such conversion was
   considered to be simple and adequate method of adaptation of existing programs of
   quantitative analysis of angiograms for evaluation of right ventricular volumes and
   function
Keywords: contrast angiography/correction factor/quantitative analysis/right
   ventricle/stroke/stroke volume/VOLUME
Lyakishev, A.A. (2003), Prevention of coronary and stroke events with atorvastatin in
   hypertensive patients - ASCOT-LLA (the Anglo-Scandinavian cardiac outcomes trial
   - Lipid lowering arm). Kardiologiya, 43 (5), 75
Keywords: stroke
Ezzati, M., Vander Hoorn, S., Rodgers, A., Lopez, A.D., Mathers, C.D. and Murray,
   C.J.L. (2003), Estimates of global and regional potential health gains from reducing
   multiple major risk factors. Lancet, 362 (9380), 271-280.
Abstract: Background Estimates of the disease burden due to multiple risk factors can
   show the potential gain from combined preventive measures. But few such
   investigations have been attempted, and none on a global scale. Our aim was to
   estimate the potential health benefits from removal of multiple major risk factors.
   Methods We assessed the burden of disease and injury attributable to the joint effects
   of 20 selected leading risk factors in 14 epidemiological subregions of the world. We
   estimated population attributable fractions, defined as the proportional reduction in
   disease or mortality that would occur if exposure to a risk factor were reduced to an
   alternative level, from data for risk factor prevalence and hazard size. For every
   disease, we estimated joint population attributable fractions, for multiple risk factors,
   by age and sex, from the direct contributions of individual risk factors. To obtain the
   direct hazards, we reviewed publications and re-analysed cohort data to account for
   that part of hazard that is mediated through other risks. Results Globally, an
   estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted
   from the joint effects of the risk factors considered. These risks caused a substantial
   proportion of important diseases, including diarrhoea (92%-94%), lower respiratory
   infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease
   (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these
   risks would have increased global healthy life expectancy by 9.3 years (17%) ranging
   from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years
   (43%) in parts of sub-Saharan Africa. Interpretation Removal of major risk factors
   would not only increase healthy life expectancy in every region, but also reduce
   some of the differences between regions, The potential for disease prevention and
   health gain from tackling major known risks simultaneously would be substantial
Keywords:               CORONARY                  HEART-DISEASE/COUNTRIES/LIFE
   EXPECTANCY/PREVENTION/stroke/STYLE
Sramek, A., Kriek, M. and Rosendaal, F.R. (2003), Decreased mortality of ischaemic
   heart disease among carriers of haemophilia. Lancet, 362 (9381), 351-354.
Abstract: Background Coagulation plays an important part in ischaemic cardiovascular
   disease. Results of studies have shown that extremes in hypocoagulability protect
   against ischaemic cardiovascular disease. We have investigated overall mortality and
   death from cardiovascular causes in carriers of haemophilia, who in most cases have
   mildly decreased coagulability without clinical signs. Methods We followed-up a
   cohort of 1012 mothers of all known people with haemophilia in the Netherlands
   from birth to death, or the end-of-study date (41 984 person years of follow-up). We
   obtained vital status and causes of death, if deceased, and compared overall and
   cause-specific mortality in our cohort with that in the general Dutch female
  population adjusted for age and calendar period by calculating the standardised
  mortality ratio (SMR). Findings Overall mortality was reduced by 22% (261
  observed deaths, 333.74 expected; SMR 0.78 [95% CI 0.69-0.88]). Deaths from
  ischaemic heart disease were reduced by 36% (39 observed deaths, 60.53 expected;
  SMR 0.64 [0.47-0.88]). We did not note decreased mortality for cerebral stroke
  (ischaemic and haemorrhagic combined) (28 observed deaths, 36.82 expected; SMR
  0.76 [0.53-1.10]). A separate analysis of these two types of stroke was not possible.
  Women in our cohort had an increased risk of death from extracranial haemorrhage
  (5 observed deaths, 0.18 expected; SMR 27.78 [8.49-58.18]); however, the number
  of deaths from this cause was much lower than that for ischaemic heart disease.
  Conclusion The results show that a mild decrease in coagulability has a protective
  effect against fatal ischaemic heart disease
Keywords:                                                                       FACTOR-
  V/GENE/MEN/MUTATION/MYOCARDIAL-INFARCTION/RISK-FACTORS/ST
  ROKE/VENOUS THROMBOSIS/WOMEN
Marr, H.S. and Edgell, C.J.S. (2003), Testican-1 inhibits attachment of Neuro-2a cells.
  Matrix Biology, 22 (3), 259-266.
Abstract: Testican-1 is a highly conserved, multidomain, chondroitin sulfate
  proteoglycan that is most abundantly transcribed in the brain by neurons. This
  testican messenger RNA is not detected in normal quiescent astrocytes, but is up
  regulated when these cells are activated in response to injury such as cerebral stroke.
  Other chondroitin sulfate proteoglycans found in glial scars, including neurocan,
  have been shown to inhibit neural cell attachment and neurite extensions and may
  thus impede axonal regeneration. Here we report the expression and purification of a
  proteoglycan form of recombinant testican and its effects on neuron-derived cells in
  culture. We demonstrate that testican inhibits attachment of Neuro-2a cells and their
  ability to form neurite extensions. Both testican proteoglycan and the core
  glycoprotein that has been depleted of chondroitin sulfate inhibit cell attachment.
  Pretreatment of the culture substratum with testican inhibits Neuro-2a attachment,
  but pre- treatment of the cells with testican does not inhibit their attachment. Testican,
  therefore, blocks attachment sites on cultureware and may also block attachment
  sites in the extracellular matrix of the brain. (C) 2003 Elsevier Science B.V. and
  International Society of Matrix Biology. All rights reserved
Keywords:       ASTROCYTES/BINDING/BRAIN/cell                attachment/CHONDROITIN
  SULFATE                                PROTEOGLYCAN/EXPRESSION/extracellular
  matrix/EXTRACELLULAR-MATRIX/LINE/MODULATORS/NERVOUS-SYSTE
  M/NEURITE OUTGROWTH/proteoglycan/stroke/testican
Sommer, M., Wischer, S., Tergau, F. and Paulus, W. (2003), Normal intracortical
  excitability in developmental stuttering. Movement Disorders, 18 (7), 826-830.
Abstract: Persistent developmental stuttering (PDS) shares clinical features with
  task-specific dystonias. In these dystonias, intracortical inhibition is abnormally
  weak. We therefore sought to determine intracortical inhibition and intracortical
  facilitation in PDS. In 18 subjects with PDS since childhood (mean age, 39.4 [SD
  13.0] years) and 18 speech-fluent controls (43.6 [14.3] years), we investigated resting
  and active motor thresholds as well as intracortical inhibition and facilitation of the
  optimal representation of the abductor digiti minimi of the dominant hand using
  transcranial magnetic stimulation. In PDS, the resting and active motor thresholds
  were increased, whereas intracortical inhibition and facilitation were normal. Normal
  intracortical excitability makes a pathophysiological analogy between focal dystonia
  and PDS less likely. The enhanced motor threshold suggests reduced motor cortical
  neuronal membrane excitability in PDS. (C) 2003 Movement Disorder Society
Keywords:
  AMYOTROPHIC-LATERAL-SCLEROSIS/AREAS/BRAIN/CORTICOCORTICA
  L           INHIBITION/DYSTONIA/FACILITATION/HUMAN                           MOTOR
  CORTEX/intracortical                 excitability/persistent            developmental
  stuttering/RECOVERY/STROKE/transcranial                                      magnetic
  stimulation/TRANSCRANIAL MAGNETIC STIMULATION
Block, F. and Hoang, P.A. (2003), Oral anticoagulation in symptomatic intracranial
  stenoses. Nervenarzt, 74 (6), 523-526.
Abstract: Symptomatic intracranial stenoses display an increased risk for ischemic
  stroke. Until now, only retrospective studies have demonstrated a, positive effect of
  oral anticoagulation for prevention of further ischemic strokes. However, this therapy
  is widely used. The aim of the present study was to examine the efficacy and safety
  of oral anticoagulation for patients with symptomatic intracranial stenoses in clinical
  practice. Sixty- one patients with the diagnosis of symptomatic intracranial stenosis
  between 1992 and 1998 and who received oral anticoagulation were-inter-viewed
  and examined in 2000. Ten patients suffered ischemic strokes (eight TIA,two,
  completed strokes), and a subdural hematoma occurred in one patient. Six patients
  died during the observation period. In none of these cases was the death related to
  oral anticoagulation. Eight extracerebral bleedings occurred. An annual rate of 3%
  per year for ischemic strokes could be calculated. The annual rates for intracerebral
  and extracerebral bleeding amounted to less than 1% per year and 2.6% per year,
  respectively. Thus, oral anticoagulation in patients with symptomatic intracranial
  stenoses seems to be safe. Although the results suggest its efficacy this cannot be
  proven due to,the small number of patients examined and due to the design, of the
  study
Keywords: ASPIRIN/bleeding/DISEASE/intracranial stenosis/ISCHEMIA/MIDDLE
  CEREBRAL-ARTERY/NONRHEUMATIC                            ATRIAL-FIBRILLATION/oral
  anticoagulation/PREVENTION/PROGNOSIS/RANDOMIZED TRIAL/secondary
  prevention/STROKE/WARFARIN
Garcia-Orza, J., Leon-Carrion, J. and Vega, O. (2003), Dissociating arabic numeral
  reading and basic calculation: A case study. Neurocase, 9 (2), 129-139.
Abstract: This study is about JS, a patient who suffered from anomia, phonological
  dyslexia and severe writing problems following a left hemispheric stroke. He showed
  good arabic numeral comprehension as evidenced in number-comparison tasks, but
  impairment in transcoding arabic numerals into verbal numbers and verbal numbers
  into arabic numerals. Although JS had several operand reading errors, the four
  arithmetic operations were not affected. In calculations with arabic numerals, he
  produced the correct results both in oral and written responses. For instance, when
  presented with the multiplication "7 x 3", JS read the operation as "four times five",
  but provided the correct response orally "twenty one" and written "21". This
  behavior goes against those hypotheses which posit that multiplication facts are
  verbally-based, and those which establish the same route for verbal number
  production in calculation and arabic numeral reading
Keywords:                                              ABILITIES/BRAIN-DAMAGED
  SUBJECTS/INFERENCES/PERFORMANCE/PURE
  ALEXIA/REPRESENTATIONS/SKILLS/stroke/VARIETIES/VERBAL-NUMBER
  PRODUCTION
Heath, M., Almeida, Q.J., Roy, E.A., Black, S.E. and Westwood, D. (2003), Selective
  dysfunction of tool-use: A failure to integrate somatosensation and action. Neurocase,
   9 (2), 156-163.
Abstract: Apraxia is thought to reflect a disruption to high-level perceptual, cognitive
   and motor systems that form a distributed praxis network. Some authors suggest that
   apraxic deficits are unique to the neurology clinic; however, mounting evidence
   suggests that apraxic deficits are observable in natural contexts (e.g. Foundas et al.,
   1995). Naturalistic gesture production involves the integration of conceptual
   knowledge, gesture ideation, visual and somatosensory cues, and executive processes.
   Impairments in this context are therefore of interest from a clinical and theoretical
   standpoint. We present the case of a young female stroke patient (CK) demonstrating
   a novel limb praxis profile. CK's conceptual, evocation and praxis executive stages
   were evaluated: performance was contrasted to 30 healthy controls. CK was able to
   pantomime and imitate transitive gestures, suggesting that her ideational, executive
   and visual analytic systems were intact. Moreover, CK showed a good conceptual
   understanding of tools, objects and actions. However, CK demonstrated poor gesture
   production when actually using the tool associated with the action - a chronic and
   bilateral deficit that persisted at a 5-year follow-up assessment. Thus, CK's deficit
   appears to represent a specific and chronic disruption to high-level praxis systems
   that incorporates tactile inputs into the unfolding gesture production sequence
Keywords:                              DEFICITS/GESTURES/HUMANS/IDEATIONAL
   APRAXIA/IDEOMOTOR                                    APRAXIA/IMPAIRMENT/LIMB
   APRAXIA/MECHANISMS/OBJECT/PARIETAL LOBE/stroke
Di, X., Alves, O.L. and Bullock, R. (2003), Cytotoxic edema is independent of NMDA
   ion channel activation following middle cerebral artery occlusion (MCAO). An in
   vivo autoradiographic and MRI study. Neurological Research, 25 (4), 329-334.
Abstract: Massive glutamate release is an important factor leading to ionic imbalance
   after occlusive stroke, which in turn contributes to cytotoxic edema formation.
   Currently, measurements of cytotoxic edema using 'diffusion weighted' MRI, is
   being used in human stroke studies, as a 'surrogate' end point for neuroprotective
   drug trials, including studies with glutamate antagonists. However, it is not fully
   understood to what extent glutamate-mediated N-methyl-D-aspartate (NMDA)
   receptor activation is related to 'cytotoxic' edema formation, and thus, to what degree
   apparent diffusion coefficient (ADC) changes, assessed by magnetic resonance
   imaging with 'ACD mapping', represent NMDA receptor activation. To study this
   relationship, four cats underwent permanent middle cerebral artery occlusion
   (MCAO). Edema formation was investigated using MRI with 'ACD mapping', while
   NMDA receptor activation was simultaneously detected in the same animals, using
   radio labeled (125)lodoMK-801, which binds only in activated and open NMDA
   channels. At 5 h post-occlusion, a large area of edema could be found with
   significantly lower ADC values in the core and penumbral area of the ischemic
   lesion when compared to contralateral values. On corresponding sections of the
   feline brains, increased I-125-MK-801 binding was found in the infarct penumbra.
   However, there was no significant topographical correlation between ADC values
   and measured radioactivity. The results indicate that there is not a significant linkage
   between NMDA receptor activation and 'cytotoxic' edema following permanent
   MCAO. The detection of a large area of NMDA channel activation within regions of
   low ADC does however indicate an area of 'penumbral' ischemia susceptible to
   treatment with NMDA channel blockers
Keywords:                                                                          ACUTE
   SUBDURAL-HEMATOMA/ANTAGONIST/autoradiography/BINDING/cerebral
   edema/CT/EXPERIMENTAL                                   STROKE/HYPERGLYCEMIC
  RATS/ischemia/ISCHEMIC                                                 DAMAGE/MCA
  occlusion/MK801/NEUROPROTECTION/NMDA                              ion           channel
  activation/RAT-BRAIN/SPINAL-CORD/stroke/TRAUMATIC BRAIN INJURY
Fagan, S.C., Nagaraja, T.N., Fenstermacher, J.D., Zheng, J.Q., Johnson, M. and Knight,
  R.A. (2003), Hemorrhagic transformation is related to the duration of occlusion and
  treatment with tissue plasminogen activator in a nonembolic stroke model.
  Neurological Research, 25 (4), 377-382.
Abstract: The availability of reperfusion therapy for acute ischemic stroke patients has
  made the causes and significance of hemorrhagic transformation an area of intense
  interest and controversy. Ninety-two male Wistar rats underwent transient middle
  cerebral artery occlusion (MCAO) of between 1 and 6 h. Forty animals received 10
  mg kg(-1) of recombinant tissue plasminogen activator (rtPA), infused over 20 min,
  starting 5 min before reperfusion. At 18-24 h, the animals were sacrificed. The
  presence of hemorrhagic transformation (HT) on stained sections was recorded and
  total ischemic lesion area was quantified using image analysis software. Seventeen
  animals (11 with HT) were subjected to immunohistochemical analysis for detection
  of endothelial barrier antigen (EBA), quantified in three sections, in eight different
  fields per section. Chi- squared analysis and logistic regression were used to assess
  the contribution of rtPA and duration of occlusion to HT development. Nested,
  repeated measures analyses of variance were performed to assess the changes in
  EBA caused by ischemia and associated with HT. Fifty-nine animals developed HT
  that was significantly associated with occlusion duration (p < 0.0001) and ischemic
  lesion size (p = 0.0007). The presence of rtPA accelerated HT development.
  Statistically significant side-to-side differences in the presence of EBA were found in
  the striatum (core of the infarct) of animals with HT (p < 0.001) and without HT (p <
  0.001), but only in animals with durations of occlusion of 2 h or more. Duration of
  occlusion is an important predictor of HT in transient MCAO in the rat and is closely
  associated with EBA expression
Keywords:       BARRIER/BRAIN/CT/EMBOLIC                  STROKE/endothelial       barrier
  antigen/FOCAL                    CEREBRAL-ISCHEMIA/INFARCTION/intracerebral
  hemorrhage/ischemia/middle                                                     cerebral
  artery/PREDICTION/rat/RAT/reperfusion/REPERFUSION/rtPA/stroke/THERAPY
Cohen, J.E., Gomori, J.M. and Umansky, F. (2003), Endovascular management of
  symptomatic vertebral artery dissection achieved using stent angioplasty and emboli
  protection device. Neurological Research, 25 (4), 418-422.
Abstract: Extracranial vertebral artery (VA) dissection may lead to significant arterial
  stenosis, occlusion, or pseudoaneurysm formation with subsequent hemodynamic
  and embolic infarcts. To prevent thromboembolic complications, anticoagulation
  with intravenous heparin followed by oral warfarin has been recommended for all
  patients with acute dissections, regardless of the type of symptoms, unless there are
  contra-indications. Nevertheless, anticoagulation is not innocuous, may be contra-
  indicated or may be ineffective to prevent symptoms or dissection progression.
  Because it is effective and less invasive than other surgical procedures, endovascular
  treatment of VA dissection has recently attracted interest. We present a case of a
  traumatic VA dissection, presenting with multiple embolic infarctions that was
  managed with protected stent- assisted angioplasty. Protected stent-assisted VA
  angioplasty has not been previously reported and appears to be a safe, effective and
  immediate method of restoring vessel lumen integrity and should be considered in
  the therapy of selected cases of VA dissection
Keywords:                                 ANEURYSMS/ANGIOGRAPHY/CEREBRAL
   PROTECTION/CT/embolization/endovascular                                 therapy/FILTER
   DEVICE/INTERNAL                        CAROTID-ARTERY/PLACEMENT/protection
   devices/STENOSIS/STROKE/vertebral artery
Fullerton, H.J., Wu, Y.W., Zhao, S.J. and Johnston, S.C. (2003), Risk of stroke in
   children - Ethnic and gender disparities. Neurology, 61 (2), 189-194.
Abstract: Methods: Using a California-wide hospital discharge database, the authors
   analyzed all first admissions for stroke in children 1 month through 19 years of age
   from 1991 through 2000. Incidence rates were estimated as the number of first
   hospitalizations divided by the person-years at risk; case fatality rates were based on
   in-hospital deaths. Results: The authors identified 2,278 first admissions for
   childhood stroke, yielding an annual incidence rate of 2.3 per 100,000 children (1.2
   for ischemic stroke, 1.1 for hemorrhagic stroke). Compared with whites, black
   children were at higher risk of stroke (for ischemic stroke, relative risk [RR] 2.59,
   95% CI 2.17 to 3.09, p < 0.0001; subarachnoid hemorrhage [SAH], RR 1.59, CI 1.06
   to 2.33, p = 0.02; intracerebral hemorrhage [ICH], RR 1.66, CI 1.23 to 2.13, p =
   0.0001). Hispanics, however, had a lower risk of ischemic stroke (RR 0.70, CI 0.60
   to 0.82, p < 0.0001) and ICH (RR 0.77, CI 0.64 to 0.93, p = 0.0004), whereas Asians
   had similar risks as whites. Boys were at higher risk for all stroke types than girls
   (ischemic stroke, RR 1.25, CI 1.11 to 1.40, p = 0.0002; SAH, RR 1.24, CI 1.00 to
   1.53, p = 0.047; ICH, RR 1.34, CI 1.16 to 1.56, p = 0.0001). After eliminating cases
   with coexisting sickle cell disease, excess stroke risk persisted in blacks; after
   elimination of trauma, excess stroke risk persisted in boys. Case fatality rates were
   similar among different ethnic groups. Compared with girls, boys had a higher case
   fatality rate for ischemic stroke (17 vs 12%; p = 0.002) but not for ICH or SAH.
   Conclusions: Rates of hospitalization for stroke are higher among black children and
   boys; sickle cell disease and trauma do not fully account for these findings
Keywords:           ARTERIAL             ISCHEMIC-STROKE/CEREBROVASCULAR-
   DISEASE/CHILDHOOD/CLINICAL-FEATURES/INTRACEREBRAL
   HEMORRHAGE/MORTALITY/NORTHERN                                            MANHATTAN
   STROKE/PA/SICKLE-                                CELL-DISEASE/SUBARACHNOID
   HEMORRHAGE/UNITED- STATES
Devuyst, G., Karapanayiotides, T., Hottinger, I., Van Melle, G. and Bogousslavsky, J.
   (2003), Prodromal and early epileptic seizures in acute stroke - Does higher serum
   cholesterol protect? Neurology, 61 (2), 249-252.
Abstract: In a case-control study, patients (n = 43/3,628) presenting seizures <1 week
   before (n = 6), &LE;3 hours after (n = 26), and 3 to 24 hours after (n = 11) a
   first-ever stroke were studied. On multivariate analysis, they were characterized by
   lower levels of serum cholesterol (5.86 +/- 0.51 vs 6.34 +/- 0.58; p < 0.0001).
   Mortality and functional outcome at discharge were not influenced. Early poststroke
   seizures occur mainly during the critical 3-hour window for thrombolysis.
   Hypercholesterolemia appears to protect against seizures and cerebral ischemia
Keywords: ISCHEMIA/PA/PREDICTORS
Li, X.M., Bai, X.C., Qin, L.N., Huang, H., Xiao, Z.J. and Gao, T.M. (2003),
   Neuroprotective effects of Buyang Huanwu Decoction on neuronal injury in
   hippocampus after transient forebrain ischemia in rats. Neuroscience Letters, 346
   (1-2), 29-32.
Abstract: Buyang Huanwu Decoction (BYHWD), a traditional Chinese medicine, has
   been developed as a drug to be used for treatment of stroke for hundreds of years.
   However, the underlying mechanisms remain unknown. In the present study, the
   effects of BYHWD on delayed neuronal death of hippocampus after transient
  forebrain ischemia were examined in rats. Transient forebrain ischemia in a duration
  of 15 min was induced with the four- vessel occlusion method. BYHWD (per 6.65
  g/kg) was given orally to rats twice each day for 7 days before ischemia. In
  BYHWD- pretreated rats, the neuronal injury in the hippocampal CA1 region was
  significantly less than that of controls. Oral administration of BYHWD also
  markedly attenuated the number of TUNEL-positive neurons and suppressed the
  expression of caspase-3p20, a product of catalytically active caspase-3, in the CA1
  region. Our results suggest that an inhibition of caspase-3 and apoptosis by BYHWD
  may partially account for its neuroprotection against ischemic injury in the
  hippocampal CA1 region. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved
Keywords:        ACTIVATION/apoptosis/APOPTOSIS/BRAIN/Buyang                    Huanwu
  Decoction/caspase-3/CELL-DEATH/CEREBELLAR                                  GRANULE
  NEURONS/CEREBRAL-ISCHEMIA/DAMAGE/hippocampus/ischemia/PROTEAS
  E/rat
Porciuncula, L.O., Rocha, J.B.T., Cimarosti, H., Vinade, L., Ghisleni, G., Salbego, C.G.
  and Souza, D.O. (2003), Neuroprotective effect of ebselen on rat hippocampal slices
  submitted to oxygen-glucose deprivation: correlation with immunocontent of
  inducible nitric oxide synthase. Neuroscience Letters, 346 (1-2), 101-104.
Abstract: Ebselen is a seleno organic compound with antioxidant and anti-
  inflammatory properties, which is under clinical trials for the treatment of ischemic
  stroke. In this study, we attempted to correlate the protective effects of ebselen and
  the inducible nitric oxide synthase (iNOS) immunocontent in hippocampal slices
  submitted to oxygen-glucose deprivation (OGD), since the exacerbated production of
  nitric oxide by iNOS plays a role in the mechanisms of cellular death in ischemic
  insults. Ebselen (10 muM) protected slices from the deleterious effects of OGD (as
  assessed by MTT assay) only when present during all the recovery period (180 min).
  Moreover, ebselen added 5 and 15 min after the beginning of recovery only partially
  protected the slices from cellular death, while when added 30 min after the beginning
  of recovery no protection was observed. OGD increased the immunocontent of iNOS,
  and this increase was abolished also only when ebselen was present during all the
  recovery period. Our results indicate that the neuroprotective effect of ebselen could
  be related to this decrease in the iNOS immunocontent. (C) 2003 Elsevier Science
  Ireland Ltd. All rights reserved
Keywords:                              brain                            ischemia/cellular
  death/COMPOUND/ebselen/EXPRESSION/GLUTAMATE/GLUTATHIONE/INHI
  BITION/ISCHEMIA/NEURONS/nitric oxide/oxygen- glucose deprivation/rat
Jamara, R.J., Van de velde, F. and Peli, E. (2003), Scanning eye movements in
  homonymous hemianopia documented by scanning laser ophthalmoscope retinal
  perimetry. Optometry and Vision Science, 80 (7), 495-504.
Abstract: Sparing or partial recovery of visual fields in hemianopic patients is
  frequently difficult to document. This is because when testing large field losses, the
  standard automated or manual visual field testing systems have limited fixation
  controls. Measured visual field recovery in these cases may not be real but instead
  may be due to an artifact such as scanning eye movement. This article illustrates a
  way to separate the actual visual field sparing from scanning eye movement artifact
  by using perimetry testing with the scanning laser ophthalmoscope (SLO)., During
  the SLO perimetry, the examiner has a direct and magnified view of the retinal
  fixation locus. This direct view allows for the added ability to monitor the fixation
  stability during target presentation. When eye movements larger than V are noted,
  the examiner can repeat the trial. During static perimetry, our SLO records the retinal
   position of the fixation target at the end of the stimulus presentation and corrects
   scanning eye movements that occur during stimulus presentation. These special
   features enable us to identify when the apparent sparing of the visual field is due to
   the artifact of scanning. To demonstrate this, we selected the records of four
   hemianopic patients whose fields were examined by both standard perimetry and the
   SLO. We then compared the clinical visual fields with the SLO perimetry fields. One
   of the patients had a complete homonymous hemianopia on both the clinical
   perimetry and the SLO perimetry. A second patient was found by the SLO to have
   unstable fixation during testing. The SLO perimetry revealed that the apparent spared
   fields seen in standard perimetry were the result of eye scanning and not an actual
   enlargement of the visual field. Two other patients were confirmed by the SLO
   findings to have valid partial recovery of the visual field, one with and one without
   scanning eye movements. The advantages and limitations of SLO perimetry in
   analyzing hemianopic field sparing are discussed
Keywords:                    brain                 injury/DAMAGE/FIXATION/midline
   sparing/PA/PLASTICITY/prism
   treatment/RECOVERY/REHABILITATION/residual
   vision/STROKE/VISION/vision                 recovery/vision            restoration/visual
   fields/VISUAL-SYSTEM
Kamano, S. (2003), Author's experience of lateral medullary infarction - thermal
   perception and muscle allodynia. Pain, 104 (1-2), 49-53.
Abstract: The patient, the author (S.K.), is a 67-year-old male. He has the typical
   dissociated pain, altered temperature sensation and ataxia often encountered by
   patients with lateral medullary infarction. This started at the time of his admission to
   hospital. Several weeks after discharge, he experienced the withdrawal reaction to
   high temperature, first mentioned by Rousseaux (Stroke 30 (1999) 2223), and
   movement allodynia as described by Bowsher (J Neurol Neurosurg Psychiatry 61
   (1996) 62). The article describes his personal experience of the symptoms of central
   post-stroke pain and allodynia. A difference between muscle allodynia and
   conventional allodynia caused by dermal stimulation is proposed. Follow-up
   evaluation of sensory symptoms that appear several weeks after discharge is essential
   to ensure measures to alleviate them are provided. (C) 2003 International Association
   for the Study of Pain. Published by Elsevier Science B.V. All rights reserved
Keywords:           allodynia/ARGATROBAN/BRAIN-STEM/central                      post-stroke
   pain/CENTRAL POSTSTROKE PAIN/CLINICAL-MRI/DYSFUNCTION/lateral
   medullary infarction/mexiletine/STROKE/THROMBIN INHIBITOR/Wallenberg's
   syndrome
Rico-Sanz, J., Rankinen, T., Joanisse, D.R., Leon, A.S., Skinner, J.S., Wilmore, J.H.,
   Rao, D.C. and Bouchard, C. (2003), Associations between cardiorespiratory
   responses to exercise and the C34T AMPD1 gene polymorphism in the HERITAGE
   Family study. Physiological Genomics, 14 (2), 161-166.
Abstract: The associations of the C34T polymorphism of the adenosine monophosphate
   deaminase 1 (AMPD1) gene with cardiorespiratory phenotypes were tested during
   cycling exercise at absolute and relative power outputs progressing to exhaustion
   before and after endurance training for 20 wk in the HERITAGE Family Study
   cohort (n = 779). Since no blacks were mutant homozygotes (TT), only whites were
   considered for analysis ( 400 normal homozygotes, CC; 97 heterozygotes, CT; and 6
   TT). For sedentary state, cycling at the absolute power output of 50 W resulted in a
   higher rating of perceived exertion in TT (P < 0.0001). At the relative intensity of
   60% of (V) over dot O-2max, stroke volume was lower in TT (P < 0.05). Maximal
  values for power output, systolic blood pressure, heart rate, (V) over dot CO2, and
  respiratory exchange ratio were lower in TT (P < 0.05). The cardiorespiratory
  training response at 50 W and at 60% of (V) over dot O-2max was similar across
  C34T-AMPD1 genotypes. However, the maximal values for ventilation, (V) over dot
  O-2, and (V) over dot CO2 during exercise increased less in TT (P < 0.01). The
  results indicate that subjects with the TT genotype at the C34T AMPD1 gene have
  diminished exercise capacity and cardiorespiratory responses to exercise in the
  sedentary state. Furthermore, the training response of ventilatory phenotypes during
  maximal exercise is more limited in TT
Keywords:        adenosine/COMMON              VARIANT/CT/DISEASE/EXHAUSTIVE
  EXERCISE/human                                                        muscle/HUMAN
  SKELETAL-MUSCLE/HUMANS/INTERSTITIAL
  ADENOSINE/METABOLISM/myoadenylate                       deaminase/MYOADENYLATE
  DEAMINASE DEFICIENCY/PURINE NUCLEOTIDE CYCLE
Lee, I.K., Yun, B.S., Kim, J.P., Kim, W.G., Ryoo, I.J., Oh, S., Kim, Y.H. and Yoo, I.D.
  (2003), p-terphenyl curtisians protect cultured neuronal cells against glutamate
  neurotoxicity via iron chelation. Planta Medica, 69 (6), 513-517.
Abstract: The hyperactivity of ionotropic glutamate receptors has been implicated in the
  development of the neuronal cell death seen in many neurodegenerative processes
  including ischemic stroke, traumatic brain injury, and epilepsy. Thus neuronal
  protection against glutamate-induced neurotoxicity is considered as an appropriate
  therapeutic strategy for preventing and treating neurodegenerative diseases. Whilst
  searching for blockers of glutamate-induced toxicity in mouse cortical cells, we
  isolated p-terphenyl curtisians A - D from the mushroom Paxillus curtisii. Curtisians
  protected cortical neurons from glutamate- induced toxicity in a dose-dependent
  manner. Among the glutamate receptor subtypes, curtisians were found to block
  NMDA receptor-mediated but not AMPA/kainate-mediated cell death. In addition,
  we found that curtisians exhibited potent antioxidative activity against iron-mediated
  oxidative damage which was generated by H2O2 neurotoxocity and lipid
  peroxidation, but no activity was detected in the superoxide, DPPH and ABTS
  radical scavenging systems, and in protection of N-18-RE-105 cells subjected to
  glutamate-induced glutathione depletion. This effect was likely due to the iron
  chelating properties of curtisians. The iron chelation ability of curtisians was then
  further investigated on DNA single strand breakage (SSB) induced by the addition of
  iron and H2O2, and curtisians prevented DNA SSB like the iron chelator
  desferrioxamine. These results suggest that the neuroprotective action of curtisians is
  dependent on their ability to chelate iron as well as to block the NMDA receptor, and
  that in this context curtisians may be useful as neuroprotective agents against
  neurological disorders which result in neuronal cell death
Keywords:        BRAIN/curtisians/DEATH/glutamate             neurotoxicity/HYDROXYL
  RADICALS/iron chelator/mushroom/Paxillaceae/Paxillus curtisii/SUPEROXIDE
Bravata, D.M., Kim, N., Concato, J. and Brass, L.M. (2003), Hyperglycaemia in
  patients with acute ischaemic stroke: how often do we screen for undiagnosed
  diabetes? Qjm-An International Journal of Medicine, 96 (7), 491-497.
Abstract: Background: Hyperglycaemia is common among patients with acute
  ischaemic stroke, and may be due to the physiological stress of the acute stroke event
  or reflect underlying diabetes mellitus. The under-diagnosis of diabetes in the general
  population, combined with the association of diabetes and stroke, suggests a rationale
  for screening for diabetes among hyperglycaemic stroke patients. Aim: To determine
  how often clinicians screen for diabetes among hyperglycaemic stroke patients
  without a prior diagnosis of diabetes. Design: Retrospective medical record review.
  Methods: We reviewed the records of acute ischaemic stroke patients admitted at any
  of ten Connecticut hospitals from May 1996 through December 1998. Results: We
  identified 90 acute stroke patients with no prior history of diabetes. The prevalence
  of hyperglycaemia varied from 31% down to 6%, depending on the maximum
  glucose cut-off used to define hyperglycaemia: from greater than or equal to 140
  mg/dl (7.8 mmol/l) to greater than or equal to 200 mg/dl (11.1 mmol/l). Only one of
  the hyperglycaemic patients (1/90, 1%) had any evidence that a clinician screened or
  planned to screen for undiagnosed diabetes: one patient had a haemoglobin A1c
  measured during the hospitalization, none received oral glucose tolerance testing
  while hospitalized, and no discharge summary included a plan to screen for diabetes
  as an outpatient. Discussion: Hyperglycaemic stroke patients without a previous
  diagnosis of diabetes are not routinely screened for diabetes. This situation represents
  an opportunity, currently unused, to identify an important and modifiable condition
Keywords:               ADMISSION                     HYPERGLYCEMIA/CT/GLUCOSE
  LEVEL/INSULIN/MELLITUS/MORTALITY/PA/PREVALENCE/STRESS
  HYPERGLYCEMIA/TRIAL
Cerra, M.C., Gattuso, A. and Tota, B. (2003), Cardiac role of frog ANF: negative
  inotropism and binding sites in Rana esculenta. Regulatory Peptides, 114 (2-3),
  91-99.
Abstract: To elucidate the role of atrial natriuretic peptides (NPs) in the amphibian heart,
  the myotropic effects and the cardiac distribution of frog atrial natriuretic factor
  (fANF) have been studied in Rana esculenta. Spontaneously, beating in vitro isolated
  working heart preparations were treated with increased concentrations (10(-11)-
  10(-8) M) of fANF-(1-24). The peptide at 10(-9) and 10(-8) M significantly reduced
  heart rate (HR) and, on the electrically paced preparations, decreased cardiac output
  (CO), stroke volume (SV) and work. Such negative inotropism was abolished by
  pretreatment with the pertussis toxin or by blocking the particulate guanylate cyclase
  (GC) with anantin while it was independent both from the functional impairment of
  the endocardium-endothelium by Triton X-100 and the inhibition of the soluble
  guanylate cyclase by 1 H-(1,2,4,) oxadiazolo-(4,3-a) quinoxalin-1-one (ODQ). By
  autoradiography, two classes of high and low affinity NPs binding sites were
  detected in the ventricular endocardium and myocardium and in the bulbus arteriosus.
  The analysis of displacement binding data using the radioligand [I-125]-rat atrial
  natriuretic peptide [I-125-rANP-(1-28)], its cold counterpart and the fANF- (1-24)
  showed that in the ventricular myocardium, the low affinity NPs sites bound both the
  heterologous and the homologous ligands at a concentration close to that responsible
  for the negative inotropism and chronotropism. (C) 2003 Elsevier Science B.V. All
  rights reserved
Keywords: ANF-(1-24)/ATRIAL/binding study/BUFO-MARINUS/CLEARANCE
  RECEPTOR/CYCLASE/frog/HEART/in                               vitro               working
  heart/MOLECULAR-BIOLOGY/NATRIURETIC                                             PEPTIDE
  RECEPTORS/NITRIC-OXIDE/Rana                                               esculenta/signal
  transduction/TOAD/VENTRICULAR CELLS
Bohner, G., Forschler, A., Hamm, B., Lehmann, R. and Klingebiel, R. (2003),
  Quantitative perfusion imaging by multi-slice CT in stroke patients.
  Rofo-Fortschritte Auf dem Gebiet der Rontgenstrahlen und der Bildgebenden
  Verfahren, 175 (6), 806-813.
Abstract: Objectives: Evaluation of a parametric deconvolution algorithm (DA) in the
  diagnostic assessment of stroke patients by multi- slice spiral computed tomography
   (MS-CT). Material and Methods: 52 patients (age range 34-89 years) with clinically
   suspected acute ischemia of one hemisphere and no infarct demarcation on plain
   cerebral CT underwent CT perfusion (CTP), performed on average 3.4 hours after
   the onset of symptoms by using MS-CT (4 x 8 mm scan volume). Using a DA-based
   software module, perfusion images of the cerebral blood perfusion (CBP), cerebral
   blood volume (CBV) and mean transit time (MTT) were calculated and assessed by
   two readers for visually apparent perfusion abnormalities. Amount and extension of
   perfusion disturbances were measured and correlated with the outcome. Results: Of
   44 patients, in whom perfusion maps could be generated, territorial infarction was
   confirmed by follow-up in 22 subjects. With a sensitivity of 95% ischemia could be
   detected on MTT-maps (CBP 91%, CBV 77%). Specificity was highest (100%) for
   CBV-maps. Patients with infarction showed significant (p<0.001) reduction of CBP
   (10.7 vs. 38.3 ml/100 ml/min), CBV (1.3 vs. 2.3 ml/100 ml) and prolongation of
   MTT (12.3 vs. 4.3 s) compared to the contralateral hemisphere, whereas in patients
   without infarction no significant changes were found. Extension of CBV reduction
   showed the best correlation (r=0.82) with final infarct volume. Conclusion: The
   DA-based CTP protocol evaluated in this study is a suitable tool for the early
   identification and quantification of acute cerebral ischemia
Keywords:        ACUTE          ISCHEMIC-STROKE/blood              flow/brain/CEREBRAL
   BLOOD-FLOW/CLINICAL-EXPERIENCE/COMPUTED-TOMOGRAPHY/CT/DI
   FFUSION/INFARCTION/INTRAARTERIAL
   THROMBOLYSIS/ischemia/perfusion                 study/RISK/TISSUE-PLASMINOGEN
   ACTIVATOR/VOLUME
Pregelj, A., Pirih, A., Stagoj, A., Brecelj, F. and Bizjak, M. (2002), Claims to be
   reached developing a gas arrester. Strojarstvo, 44 (3-6), 189-194.
Abstract: Each overvoltage stroke in electric network can cause damages in surrounding
   high sensitive electronic devices. To protect these devices various overvoltage
   arresters are used and between them the gas filled arresters-are the most important.
   These are hermetically closed cells in which argon or its mixture with another noble
   gas is encapsulated between housing and isolated electrode. At defined conditions
   (voltage stroke etc) it can become ionised - i.e. capable to conduct the electric current.
   The gas arrester for higher power which is developed in laboratory, is connected with
   other electro- elements in a special device which acts protectively in such a manner
   that it discharges the lightning surge into the earth. Construction of the cell is
   relatively simple; eight or nine components are joined together by advanced technical
   processings. Manufacturing procedure has to assure demanded properties such as
   vacuum tightness, spark voltage, good insulation, resistance against energetic shocks,
   repetitiveness of results etc. Besides measurements of mentioned characteristics a
   short description of technology development till present state and some experiments
   are presented
Keywords: electric characteristics measurement/gas arrester/leak detection/surge
   current/vacuum technology
Akman, I., Ozek, E., Yilmaz, Y. and Bilgen, H. (2003), Cerebral infarcts in full term
   neonates. Turkish Journal of Pediatrics, 45 (2), 141-147.
Abstract: Cerebral infarcts are an important cause of neonatal convulsions. We report
   the etiologic factors, and clinical and neuroradiologic findings of four full term
   neonates who presented with neonatal convulsions and had cerebral infarct. In our
   patients the risk factors for the cerebral infarct were perinatal asphyxia, sepsis,
   dehydration and catheter application. All had convulsions as the initial sign of infarct
   and had cranial imaging which revealed the definitive diagnosis. The patients
  underwent an extensive evaluation for hereditary causes of cerebral infarct that
  included anticoagulant factors (Proteins C and S, antithrombin III, antiphospholipid
  antibodies), factor V Leiden and prothrombin gene mutations, blood and urine amino
  acid and urine organic acid levels. The results were found to be within normal limits.
  In conclusions, neonatal convulsions can be the first sign of cerebral infarct. For this
  reason it seems preferable to include cranial imaging by computed tomography or
  magnetic resonance imaging (MRI) in the work-up of cases with unexplained
  neonatal convulsions
Keywords: cerebral infarct/CEREBROVASCULAR ISCHEMIA/CHILDREN/cranial
  imaging/FACTOR-V-LEIDEN/INFANTS/INFECTION/MUTATION/neonate/RISK
  -FACTOR/STROKE/THROMBOPHILIA/VENOUS THROMBOSIS
Shahin, A.A., Mostafa, H., Sami, H. and Shahin, H.A. (2003), Symptomatic thrombotic
  events among Egyptian patients with systemic lupus erythematosus: special
  consideration for renal vein thrombosis. Zeitschrift fur Rheumatologie, 62 (3),
  246-250.
Abstract: Objective To evaluate the prevalence of symptomatic thrombotic events
  among Egyptian patients with systemic lupus erythematosus (SLE), and to evaluate
  the frequency and the risk factors associated with renal vein thrombosis in those
  patients. Methods Fifty-four patients with SLE, 51 (94.4%) females, were involved
  in this study. All of them were submitted for abdominal sonography, chest X-ray,
  echocardiography, and Doppler of renal, abdominal and lower limb veins, with
  examination of data on clinical and laboratory profile. Abdominal CT, brain MRI,
  MRI both hips, CT chest and pulmonary scintigraphy were used when needed.
  Results Sixteen patients (29.6%) were diagnosed with symptomatic thrombotic
  events. Eight patients had more than one type of thrombosis. Two patients (3.7%)
  were diagnosed by Doppler as having renal vein thrombosis (RVT). This was
  confirmed by abdominal CT. One of them presented with nephrotic syndrome,
  graded by renal biopsy as World Health Organization (WHO) class V, and had
  positive anticardiolipin antibodies (ACL). The other patient had RVT and inferior
  vena cava (IVC) thrombosis, nephrotic syndrome, positive ACL, and died before
  renal biopsy was performed. Both of them were without history of peripheral
  thrombotic events. One patient was diagnosed with IVC thrombosis, lupus nephritis
  grade II, positive ACL, and diagnosed by abdominal CT. One patient was diagnosed
  with portal vein thrombosis and had positive ACL. One patient with retinal vessel
  thrombosis and positive ACL. Four patients had deep vein thrombosis (DVT).
  Recurrent miscarriages were reported in 4 patients (7.4%), skin ulcerations in 3
  (5.6%), avascular necrosis of the hips in 4 (7.4%), stroke in 1 (1.9%), and pulmonary
  hypertension in 2 patients (3.7%). Conclusion Sixteen SLE patients (29.6%) were
  diagnosed with symptomatic thrombotic events. RVT was detected in 2 patients
  representing 3.7% of all patients, and 12.5% of patients with thrombosis. Both
  patients with RVT presented with nephrotic syndrome
Keywords: anticardiolipin antibodies/deep vein thrombosis/nephrotic syndrome/portal
  vein thrombosis/renal vein thrombosis

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:11/11/2011
language:English
pages:64