Cerebral peduncle angle: Unreliable in differentiating progressive supranuclear palsy from other neurodegenerative diseases

IntroductionThe significant symptom overlap between progressive supranuclear palsy (PSP) and other parkinsonian neurodegenerative diseases frequently results in misdiagnosis. However, neuroimaging can be used to quantify disease-related morphological changes and specific markers. The cerebral peduncle angle (CPA) has been shown to differentiate clinically diagnosed PSP from other parkinsonian diseases but this result has yet to be confirmed in autopsy-proven disease.MethodsMagnetic resonance imaging (MRI) scans were obtained for 168 patients representing 69 medical facilities. Following randomization, the images were divided into two groups (Type 1 and Type 2) based upon midbrain morphological differences. Two readers were blinded and independently measured the CPA of 146 patients with autopsy-proven progressive supranuclear palsy (PSP; n = 54), corticobasal degeneration (n = 16), multiple system atrophy (MSA; n = 11) and Lewy body disease (n = 65).ResultsApplying two separate measurement techniques revealed no statistically significant differences in CPA measurements among any study groups regardless of classification measurement approach. The interobserver agreement showed significant differences in measurements using the Type 2 approach.ConclusionMeasuring the CPA on MRI is not a reliable way of differentiating among patients with PSP, corticobasal degeneration, MSA, or Lewy body disease.     

CX3CR1对缺血性白质的损伤作用

目的明确CX3CR1在缺血性白质中的分布与表达及与缺血性白质损伤的关系。方法将150只成年雄性Wistar大鼠随机分为正常组、假手术组及缺血组,采用双侧颈总动脉永久结扎法制备缺血性白质损伤模型,造模28 d后Morris水迷宫观察学习记忆功能,同时于术后1 d、3 d、7 d、14 d、28 d观察胼胝体、内囊及视神经的病理学变化和CX3CR1表达量的变化。结果 (1)造模后28 d,逃避潜伏期、探索路径长度及跨越平台次数缺血组较正常组和假手术组明显增加,有显著性差异(P0.01);(2)随着缺血时间的延长,Luxol Fast Blue(LFB)染色可见髓鞘崩解范围扩大,分层明显,部分髓鞘空泡状;CX3CR1表达量逐渐增加,与CD11b标记的小胶质细胞数目逐渐增多相一致且高于正常组和假手术组。结论 CX3CR1通过介导小胶质细胞的变化对缺血性白质产生损伤,进而影响空间学习记忆功能。     

阿托伐他汀钙联合羟乙基淀粉注射液治疗分水岭脑梗死的临床效果研究

目的分析阿托伐他汀钙联合羟乙基淀粉注射液对分水岭脑梗死患者急性期和远期临床治疗效果。方法选取本院2013年2月至2014年6月收治的分水岭脑梗死患者78例为研究对象,采用随机数表法将其分为观察组和对照组,每组各39例,两组患者均给予稳压、降糖、抗血小板聚集等常规治疗,对照组患者在此基础上加用阿托伐他汀钙,观察组患者给予阿托伐他汀钙联合羟乙基淀粉注射液,比较两组患者急性期和远期的临床效果。结果治疗后7天,观察组患者日常生活能力和神经功能恢复均明显优于对照组(P<0.05);治疗后3个月,观察组患者神经功能及日常生活能力恢复均明显优于对照组,且治疗总有效率明显高于对照组(χ2=7.47,P<0.01)。结论阿托伐他汀钙联合羟乙基淀粉注射液在分水岭脑梗死患者急性期和远期均有较好的临床治疗效果。     

Preventable iatrogenic cause of foot-drop in knee injuries with literature review

PurposeCommon peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.MethodsWe retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.ResultsIn addition to fibular neck fracture, the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion. common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases. Other 6 such cases remained neurologically intact as traction was not applied to them.ConclusionSuch iatrogenic complication could have been prevented if the injury pattern of "concomitant medial and lateral columns" of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.     

Heparin Flush Use in Transfemoral Cerebral Angiography Survey

The drug concentration of heparinized saline used for transfemoral catheter angiography flush during different types of cerebral angiogram procedures varies among providers and centers worldwide. Although heparin is recommended for use during cerebral angiograms to minimize the risk of thromboembolic events associated with the utilization of multiple endovascular devices and lengthy procedures, there is a paucity of information available regarding protocols for administration of heparin and heparinized saline. Higher concentrations of heparinized saline flush may benefit patients undergoing elective nonruptured intracranial aneurysm embolization procedures by decreasing the risk of thromboembolism. However, it could potentially place patients undergoing revascularization procedures for acute ischemic stroke at higher risk of symptomatic intracerebral hemorrhage, particularly if they received intravenous tissue plasminogen activator immediately before endovascular thrombectomy. After obtaining permission from the Association for Radiologic and Imaging Nursing (ARIN) Board of Directors, a survey was presented in English and electronically distributed by the ARIN to all current and past ARIN members with valid e-mail addresses. The survey was preceded by an introductory letter explaining the study purpose and its voluntary nature. Response to the survey was identified as consent to participate. Subjects were asked to participate if they were currently involved in the management of patients undergoing cerebral angiography with a variety of interventions including management of acute ischemic and hemorrhagic stroke. There is a paucity of evidence supporting use of a specific concentration of heparinized saline solution. It ranges from no heparin added to concentrations exceeding 5 units/mL for transfemoral flush. The most frequently used concentration is 2 units/mL (32.8–34.8% of respondents depending on endovascular intervention), and the least frequently utilized concentrations are 3 units/mL and higher than 5 units/mL (4.3–5.7% of respondents depending on endovascular intervention). Mixing and labeling bags with heparinized saline flush was noted to be the responsibility of interventional radiology registered nurse (39%, n = 46), pharmacy (26.3%, n = 31), or the angiography technologist (8.5%, n = 10). More than quarter (26.5%) of respondents noted not having readily available premixed heparinized saline flush. Twenty-four (20.3%) of survey participants claimed using only premixed bags of heparinized saline solution. Despite the Institute for Healthcare Improvement, Institute for Safe Medication Practices and Joint Commission recommendations, there are no standard protocols across stroke centers identifying optimal heparinized saline flush solution concentration, preparation, and documentation. Replication of this survey among members of the American Society of Neuroradiology is recommended to validate the findings from the present study. If confirmed, a consensus on safety of heparinized saline flush use during neuroradiology interventions is strongly advised.     

Efeitos Terapêuticos da Tripla Antiagregação Plaquetária em Pacientes Femininas Idosas com Diabetes e Infarto Agudo do Miocárdio

BackgroundDual antiplatelet therapy (DAPT) is the cornerstone treatment of acute myocardial infarction (AMI).ObjectiveThe present study aimed to investigate the efficacy and safety of triple antiplatelet therapy (TAPT) in elderly female patients with diabetes and ST segment elevation myocardial infarction (STEMI), who had undergone percutaneous coronary intervention (PCI).MethodsWe designed a randomized, single-blind study. Control group A (97 elderly male patients with diabetes and STEMI, whose CRUSADE scores were < 30) received aspirin, ticagrelor, and tirofiban. A total of 162 elderly female patients with diabetes and STEMI were randomly divided into two groups according to CRUSADE score. Group B (69 patients with CRUSADE score > 31) received aspirin and ticagrelor. Group C (93 patients with CRUSADE score < 30) received aspirin, ticagrelor and tirofiban. P values < 0.05 were considered statistically significant.ResultsCompared to the findings in group A, post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow and TIMI myocardial perfusion grade 3 were significantly less prevalent in group B (p < 0.05). When compared to groups A and C, the incidence of major adverse complications was significantly higher in group B (p < 0.05).ConclusionTAPT could effectively reduce the incidence of major complications in elderly female patients with diabetes and STEMI. However, close attention should be paid to hemorrhage in patients receiving TAPT. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)