Plasma factor and inhibitor composition contributes to thrombin generation dynamics in patients with acute or previous cerebrovascular events

Introduction

More than 80% of cerebrovascular events are ischemic and largely thromboembolic by nature. We evaluated whether plasma factor composition and thrombin generation dynamics might be a contributor to the thrombotic phenotype of ischemic cerebrovascular events.

Materials and Methods

We studied (1) 100 patients with acute ischemic stroke (n = 50) or transient ischemic attack (TIA) (n = 50) within the first 24 hours from symptom onset, and (2) 100 individuals 1 to 4 years following ischemic stroke (n = 50) or TIA (n = 50). The tissue factor pathway to thrombin generation was simulated with a mathematical model using plasma levels of clotting factors (F)II, V, VII, VIII, IX, X, antithrombin and free tissue factor pathway inhibitor (TFPI).

Results

The plasma levels of free TFPI, FII, FVIII, and FX were higher, while antithrombin was lower, in the acute patients compared to the previous event group (all p ≤ 0.02). Thrombin generation during acute events was enhanced, with an 11% faster maximum rate, a 15% higher maximum level and a 26% larger total production (all p < 0.01). The increased thrombin generation in acute patients was determined by higher FII and lower antithrombin, while increased free TFPI mediated this effect. When the groups are classified by etiology, all stroke sub-types except cardioembolic have increased TFPI and decreased AT and total thrombin produced.

Conclusion

Augmented thrombin generation in acute stroke/TIA is to some extent determined by altered plasma levels of coagulation factors.     

对短暂性脑缺血发作的中医干预研究概况Study~tuafionoftraditionalChinesemedicalinterventionfortransientischemicattack

短暂性脑缺血发作（transient ischemic attack,TIA）是缺血性卒中的高危因素,对TIA的干预可有效降低缺血性卒中发生的风险,近5年来中西医结合采用药物配合、针刺艾灸等措施,对动脉粥样硬化性的TIA的发生机制中的多因素、多时段进行干预,取得良好效果。但就目前研究来看,质量并不理想,主要表现在方案的设计、数据的处理并不完善,特别是缺乏实验研究。     

Cytotoxic perforin+ and TIA-1+ infiltrates are associated with cell adhesion molecule expression in dilated cardiomyopathy

OBJECTIVE: To phenotypically characterize cytotoxic T-lymphocytes (CTLs: Perforin+ and TIA-1+ phenotypes) and to study the interactions with cell adhesion molecules (CAMs) in dilated cardiomyopathy (DCM). BACKGROUND: DCM is linked to intramyocardial inflammation, being characterized by T-lymphocytic infiltration and CAMs abundance. However, the pathogenic significance of increased CD3+ lymphocytes remains obscure as these do not correlate with CTLs (perforin+ and TIA1+ phenotypes). CAMs participate in the phenotypic repertoire and effector pathways of CTLs. METHODS: CAMs-expression (ICAM-1, VCAM-1, LFA-3, CD29, CD62E and CD62P and beta(2)-integrins), CD3+ (T-lymphocytes), CD57+ (NK-cells) and adhesion related (CD18+, CD11a+, CD11b+, CDw49d+) phenotyped infiltrates were investigated in endomyocardial biopsies (EMBs) from 89 DCM patients (33 female; LVEF<40%) using immunohistochemisty. The enteroviral genome was identified by nested RT-PCR. RESULTS: CAMs abundance was confirmed in 55 DCM patients (62%) and 29 EMBs (33%) were graded CTLs+ (>1.5 TIA-1+ and/or >2.0 perforin+ infiltrates/hpf). CTLs correlated with all endothelial CAMs-markers studied (P<0.01), the adhesion related phenotypes of infiltrates (LFA-1, VLA-4, CD18) and CD57+ NK-cells (P<0.02). There was no correlation of CTLs with CD3+ T-lymphocytes, CD11b+ macrophages, enteroviral infection (present in n=16/18%), clinical history and LVEF (P>0.05). Phenomena suggestive of CTLs mediated myocytolysis were observed in 10 patients (11%). CONCLUSIONS: CTLs-infiltrates are associated with endothelial CAMs-abundance and co-express adhesion related (beta2-integrins, VLA-4) and NK-cellular antigens (CD57) in DCM. Endothelial CAMs expression also reflects cytotoxic activation of intramyocardial infiltrates, which is not reflected by immunologically nai;ve CD3 T-lymphocytes.     

Electrophysiological brainstem testing in the diagnosis of reversible brainstem ischemia

The aim of this study was to evaluate the sensitivity of multimodal electrophysiological brainstem testing in the diagnosis of clinically suspected reversible ischemic deficits of the brainstem compared with diffusion weighted MR imaging. We investigated 158 consecutive patients presenting with signs of acute brainstem dysfunction. Serial electrophysiological brainstem tests including masseter reflex, blink reflex, masseter inhibitory reflex, AEP, MEP, EOG and the oculoauricular phenomenon were applied. In 14 of the 158 patients neurological deficits resolved in less than 24 hours, which was suggestive of a transitory ischemic attack (TIA), 19 patients had brainstem signs for more than 24 hours but less than 1 week, suggestive of a reversible ischemic neurological deficit (RIND). Electrophysiological data indicated acute functional brainstem lesions in 54,5 % of patients with transient clinical brainstem impairment. Lesion detection rate was significantly higher when combining electrophysiological data and MRI (60,4 %) than using acute brainstem abnormalities in diffusion weighted MRI alone (39,4 %). We conclude that diffusion weighted MRI and electrophysiological brainstem testing are complimentary sensitive indicators of acute brainstem lesions in patients with reversible neurological deficits. Correct identification of brainstem ischemia influences the therapeutic regimen and may improve patient outcome. Received: 5 November 2001 Received in revised form: 28 January 2002 Accepted: 1 February 2002     

疏血通注射液治疗频发短暂性脑缺血发作的临床观察

为研究疏血通注射液治疗频发短暂性脑缺血发作（TIA）的临床疗效。将60例频发TIA患者分为观察组（32例）与对照组（28例）,观察组用疏血通注射液,对照组用丹参注射液,同时口服阿斯匹林,疗程15天。结果：观察组临床速控率68．7％,对照组为17．9％,观察组治疗前后血流变学指标比较有显著性差异（P＜0．01）,观察组治疗后与对照组治疗后比较有显著性意义（P＜0．05）。提示疏血通注射液治疗频发的TIA有较好疗效。     

颈动脉彩超与经颅多普勒超声检查对短暂性脑缺血发作的临床应用价值

目的 :探讨颈动脉彩超与 TCD技术联合应用对 TIA患者的临床应用价值。方法 :分析了 78例 TIA患者的颈动脉彩超与 TCD检查结果。结果 :颈动脉彩超与 TCD检测可分别获得 TIA患者的颅内、外动脉的血流动力学改变及动脉粥样硬化程度。讨论 :颈动脉彩超与 TCD技术联合应用可以提高 TIA患者颅内外脑血管疾病的检出率和诊断正确率 ,为临床选择不同的治疗方法和获得有效的治疗效果提供可靠的客观的影像学和动力学依据     

Focal inhibitory seizures as the presenting sign of ischemic cerebrovascular disease

Recurrent episodes of transient neurological dysfunction occurring in a patient with evidence of recent multiple lacunar infarctions were at first diagnosed as transient ischemic attacks (TIAs), but later proved to be due to focal inhibitory seizures. The differential diagnosis between TIAs and partial epileptic seizures in patients with ischemic cerebrovascular disease may sometimes be difficult in the presence of uncommon clinical manifestations.

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Sommario Una paziente con quadro neuroradiologico di infarti lacunari multipli presentò come sintomatologia di esordio ricorrenti episodi di deficit neurologico transitorio che furono inizialmente interpretati come attacchi ischemici transitori (TIA), mentre la successiva osservazione dimostrò trattarsi di crisi epilettiche inibitorie somatiche. La diagnosi differenziale fra TIA e crisi epilettiche parziali nei pazienti affetti da malattia cerebrovascolare ischemica può presentare inattese difficoltà, in rapporto al possibile verificarsi di manifestazioni cliniche inusuali.

     

低分子肝素钙治疗后循环TIA 46例疗效观察

目的观察添加低分子肝素钙治疗后循环短暂性脑缺血发作（TIA）的临床疗效。方法 92例后循环TIA患者随机分为治疗组和对照组,每组46例。2组均给予抗血小板聚集、促进脑部血液循环、调节血脂等常规治疗,治疗组在此基础上加用低分子肝素钙4 000 U,腹壁皮下注射,每12 h 1次,连用10 d.结果疗程结束后TIA发作控制率治疗组和对照组分别为95.7%和67.4%,治疗组明显高于对照组。结论低分子肝素钙治疗后循环TIA疗效显著,且不良反应少,值得临床推广应用。     

The prognostic impact of the stroke unit concept after transient ischemic attack

Background and purpose

Transient ischemic attack (TIA) is associated with high short-term risk of stroke, especially in the early phase following the event. Data about the impact of the early hospitalization in a stroke unit on patients with TIA are sparse. This study compares the prognostic impact of the stroke unit concept with conventional care on patients with TIA.

Methods

During a 30-month period (beginning April 2005), 878 patients (mean age, 70 ± 12 years; 44.3% female) with TIA admitted within 24 h of symptom onset were prospectively evaluated. The adjusted logistic regression analyses were used to estimate the odds ratio for the stroke risk during hospitalization and the 90-day mortality.

Results

Of 878 patients, 591 (67.3%) were treated in the stroke unit, and 287 (32.7%) underwent conventional care. Patients receiving stroke-unit care had significantly higher rates of cranial computed tomography (96.3% vs. 88.1%; P < .001) and brain-supplying artery ultrasound (97.1% vs. 91.3%; P < .001) investigations. The stroke risk during hospitalization was 1.7% in patients treated in stroke unit and 2.4% in patients received a conventional care. A relevant difference between the groups was not found (1.7% vs. 2.4%; P = .45). The 90-day mortality rate was 1.7% in the stroke unit group compared to 2.2% in the conventional care group (1.7% vs. 2.2%; P = .66). The adjusted logistic regression analyses revealed no difference in stroke rates (odds ratio, 0.68; 95% confidence interval, 0.24–1.9) and in the 90-day mortality (odds ratio, 0.63; 95% confidence interval, 0.2–1.96) between the stroke unit concept and conventional care.

Conclusion

The prognostic impact of the stroke unit care for patients with transient ischemic attack appears to be similar to that of the conventional care. Further randomized studies are needed to investigate the impact of stroke-unit care on patients with transient ischemic attack.     

椎动脉优势对后循环短暂脑缺血发作患者近期预后的评价分析

目的：研究椎动脉优势对后循环短暂脑缺血发作患者近期预后的影响。方法以2012年1月-2013年10月住院治疗被确诊为后循环短暂性脑缺血发作（transient ischemic attack,TIA）的患者120例为研究对象,收集其椎动脉MRA、临床资料ABCD2评分及7 d内脑梗死发生率,比较其差异性。结果后循环TIA中椎动脉优势占有率高于非椎动脉优势;ABCD2评分分层院从低危组到中危组到高危组脑梗死发生率呈上升趋势;TIA后7 d内脑梗死发生率椎动脉优势组较非椎动脉优势组有显著性差异（P〈0.05）;ABCD2评分〈4分,脑梗死发生率椎动脉优势组与非椎动脉优势组比较,无显著性差异（P〉0.05）;ABCD2评分≥4分,脑梗死发生率椎动脉优势组较非椎动脉优势组有显著性差异（P〈0.05）。结论椎动脉优势为导致后循环TIA后脑梗死的危险因素之一;ABCD2评分中高危患者椎动脉优势的风险尤为明显。