Cerebral Complications Research Articles

GAMMA KNIFE AND QUALITY OF LIFE: A REVIEW ON THE USE OF RADIOSURGERY IN BRAIN TUMORS

INTRODUCTION: Considering the quality of life of patients with brain tumors, several treatment alternatives have been developed over time, aiming at a less invasive potential and providing a permanent functional capacity for the individual. In this regard, in recent decades there has been debate about radiosurgery for the treatment of brain tumors. OBJECTIVE: The objective of this study was to evaluate the feasibility of Gamma Knife radiosurgery, considering patient safety. METHODS: This article is characterized as an integrative literature review of an exploratory nature, in the PubMED and Cochrane databases, the search was restricted to observational studies and randomized clinical trials as primary data to contemplate the outcomes Quality of life, neurological preservation, recurrence, cerebral complications and overall survival. RESULTS: The analysis of the collected data demonstrated that, in general, radiosurgery by the Gamma Knife platform preserves quality of life in several cases, mainly in smaller benign brain tumors. The disease recurrence rate after 3 years of radiosurgery ranged from 20 to 40%, depending on the type of tumor and treatment, with the highest recurrence rate in grade III meningiomas and high-grade gliomas. The 5-year recurrence rate ranged from 60 to 80%, and was therefore higher than that of more invasive treatments. CONCLUSION: The qualitative synthesis of these data proves the efficacy of radiosurgery and may suggest to neurosurgeons the possibility of treating brain tumors in patients who are not eligible for conventional surgery or in patients with non-bulky tumors.

Predictors of acute ischemic strokes and subsequent mortality in patients hospitalized for percutaneous coronary interventions

Abstract Background Acute ischemic strokes (AIS) occurring post percutaneous coronary intervention (PCI) are an infrequent but severe complication, resulting in increased mortality rates and morbidity in survivors. Purpose We aimed to investigate independent predictors of AIS and subsequent mortality in patients hospitalized for PCI in a nationwide cohort. Methods A retrospective analysis using on ICD-10-GM and OPS-codes obtained from 2006-2021 from the German Federal Statistical Office was performed. Patients with a peri-interventional AIS aged ≥18 years which were admitted for PCI were included in this analysis. A stepwise regression analysis was employed to identify factors independently associated with AIS and to determine variables linked to in-hospital mortality. Results From 4,910,430 PCI cases registered from 2006-2021, AIS occurred in 4,098 (0.08%) patients. Patients with an AIS were 70.9±11.3 years of age, predominantly male (65.3%) and displayed a high burden of comorbidities such as diabetes (36.1%), a prior medical history of atrial fibrillation (34.6%) and chronic kidney disease (19.4%). In patients with AIS, 27.4% presented with a ST-elevation myocardial infarction (STEMI), whilst 38.9% were admitted with a Non-STEMI. Concerning procedural characteristics, 84.2% underwent a coronary stent implantation, and in 5.5% cases a coronary thrombectomy was carried out. Important predictors of peri-interventional AIS after a PCI were: carotid artery disease, history of stroke, presentation with myocardial infraction, atrial fibrillation, and coronary thrombectomy. For variables like hyperlipoproteinemia, obesity and stent implantation an inverse association was noted (also see Figure 1A). With regard to mortality, during a mean in-hospital stay of 18 ± 15.1 days, a total of 18.1% (n=742) patients died. We identified several independent predictors of mortality including clinical presentation with cardiogenic shock, dialysis and STEMI as indication for PCI. A negative correlation with in-hospital mortality was seen for variables such as arterial hypertension and coronary stent implantation (see Figure 1B for full set of independently associated variables). Conclusion In a nationwide cohort of patients hospitalized for PCI over 16 years, we identified important predictors of AIS including carotid artery disease and coronary thrombectomy. Moreover, a substantial rate of in-hospital mortality as well as several predictors of death were recognized. Our findings might help clinicians identify patients undergoing PCI who are at highest risk for ischemic cerebral complications and subsequent mortality.

Administration of rIL-33 Restores Altered mDC/pDC Ratio, MDSC Frequency, and Th-17/Treg Ratio during Experimental Cerebral Malaria.

The onset of malaria causes the induction of various inflammatory markers in the host's body, which in turn affect the body's homeostasis and create several cerebral complications. Polarization of myeloid-derived suppressor cells (MDSCs) from the classically activated M1 to alternatively activated M2 phenotype increases the secretion of pro-inflammatory molecules. Treatment with recombinant IL-33 (rIL-33) not only alters this MDSC's polarization but also targets the glycolysis pathway of the metabolism in MDSCs, rendering them less immunosuppressive. Along with that, the Helper T-cells subset 17 (Th17)/T regulatory cells (Tregs) ratio is skewed towards Th17, which increases inflammation by producing more IL-17. However, treating with rIL-33 also helps to restore this ratio, which brings back homeostasis. During malaria infection, there is an upregulation of IL-12 production from dendritic cells along with a distorted myeloid dendritic cells (mDC)/plasmacytoid dendritic cells (pDC) ratio towards mDCs promoting inflammation. Administering rIL-33 will also subvert this IL-12 production and increase the population of pDC in the host's immune system during malaria infection, thus restoring mDC/pDC to homeostasis. Therefore, treatment with rIL-33 to reduce the pro-inflammatory signatures and maintenance of immune homeostasis along with the increase in survivability could be a potential therapeutic approach for cerebral malaria.

Vascular variant of Eagle syndrome: a review.

Eagle syndrome is defined as an elongated styloid process (ESP) that compresses nearby vasculo-nervous structures. The vascular variant of Eagle syndrome can lead to neurological symptoms including syncope, transient ischemic attack, or stroke; however, it has also been associated with other atypical presentations, making its diagnosis challenging. This review aimed to depict the characteristics of patients with the symptomatic vascular variant of Eagle syndrome. The literature search identified 56 reported cases of vascular variants of Eagle syndrome, with a mean age at onset of 51 years (range: 15-85 years), and the male-to-female ratio was 2:4. The ESP was bilateral in 63% of the cases, and the mean length was 48 mm (range: 31-77 mm). Vascular complications were mostly represented by internal jugular vein (IVJ) stenosis (n = 28), followed by internal carotid artery (ICA) dissection (n = 15). Additionally, eight cases of ICA thrombosis and two cases of severe chronic stenosis of the ICA > 90% were reported. Vascular complications may lead to cerebral ischemia due to either a thromboembolic mechanism or, less frequently, reduced blood flow. Laminar cortical necrosis, as a cerebral complication of ICA compression, was exceptionally described in one case, and such an atypical clinical presentation may be regarded as a diagnostic pitfall.

Management of Stage-4 HIV with Cerebral Toxoplasmosis Coinfection and SIADH Complication

HIV/AIDS stage 4 is the stage where the HIV/AIDS patients have low immunity protection against infections, which can led to coinfections and complications. This case report presented an evaluation of the diagnosis and treatment of an HIV/AIDS stage 4 patient with cerebral toxoplasmosis coinfection and SIADH complications. A man (47 years, 35 kg), married with two children, complaining of weakness, nausea, vomiting, weight loss, and low appetite. Sodium level were measured, showing a 117 mg/dL level that continued to decrease throughout the patient's treatment. Five days later, the patient lost his consciousness with a GCS score of 224, indicating severe brain injury, and was diagnosed with cerebral toxoplasmosis based on the result of head CT-SCAN with contrast. On day 6, the patient was tested positive for HIV and diagnosed with stage 4 with an absolute CD4 count of 4 cells/μl. Therapy was provided by giving pyrimethamine-clindamycin therapy for cerebral toxoplasmosis, followed by Tenofovir, Lamivudine, and Evafirenz as antiretroviral therapy. Treatment for hyponatremia was done by administration of 3% NaCl and tolvaptan. The patient started experiencing an improvement in consciousness after the 10th day of medication, and sodium levels fluctuated throughout the treatments. Patient was discharged after 15 days with clinical improvements.

Quantitative Electroencephalography for Predication of Neurological Dysfunction in Type A Aortic Dissection: A Prospective Observational Study.

Type A aortic dissection presents challenges with postoperative cerebral complications, and this study evaluates the predictive value of quantitative electroencephalography for perioperative brain function prognosis. Amplitude-integrated electroencephalography (aEEG) processes raw signals through filtering, amplitude integration, and time compression, displaying the data in a semilogarithmic format. Using this method, postoperative relative band power (post-RBP) α% and dynamic aEEG (ΔaEEG) grade were significantly associated with neurological dysfunction in univariate and multivariable analyses, with area under the receiver operating characteristic curve of 0.876 (95% CI, 0.825-0.926) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with adverse outcomes, with area under the receiver operating characteristic curve of 0.903 (95% CI, 0.835-0.971) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with transient neurological dysfunction and stroke, with areas under the receiver operating characteristic curve of 0.818 (95% CI, 0.760-0.876) and 0.868 (95% CI, 0.810-0.926) for transient neurological dysfunction, and 0.815 (95% CI, 0.743-0.886) and 0.831 (95% CI, 0.746-0.916) for stroke. Among 56 patients, the Alberta Stroke Program Early Computed Tomography score was superior to ΔaEEG in predicting neurological outcomes (area under the receiver operating characteristic curve of 0.872 versus 0.708 [95% CI, 0.633-0.783]; P<0.05). Perioperative quantitative electroencephalography monitoring offers valuable insights into brain function changes in patients with type A aortic dissection. ∆aEEG grades can aid in early detection of adverse outcomes, while postoperative relative band power and ∆aEEG grades predict transient neurological dysfunction. Quantitative electroencephalography can assist cardiac surgeons in assessing brain function and improving outcomes in patients with type A aortic dissection. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2200055980.

Outcomes of patients with active cancer after transcatheter aortic valve replacement: an updated meta-analysis

BackgroundPatients with active cancer and aortic stenosis may be under-referred for valve interventions due to concerns over a prohibitive risk. However, whether active cancer impacts outcomes after transcatheter aortic valve replacement (TAVR) remains unknown.MethodsWe searched PubMed, Embase, and Cochrane Library in December 2023 for studies comparing the post-TAVR outcomes of patients with versus without active cancer. We pooled odds ratios (OR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R version 4.3.2.ResultsWe included nine observational studies analyzing 133,906 patients, of whom 9,792 (7.3%) had active cancer. Compared with patients without cancer, patients with active cancer had higher short- (OR 1.33; 95% CI 1.15–1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80–2.91; p < 0.001) rates, not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70–2.40; p = 0.40), and higher major bleeding rates (OR 1.66; 95% CI 1.15–2.42; p = 0.008). The higher mortality rate was sustained in an adjusted analysis (aHR 1.77; 95% CI 1.34–2.35; p < 0.001). There was no significant difference in cardiac, renal, and cerebral complications at a follow-up ranging from 180 days to 10 years.ConclusionPatients with active cancer undergoing TAVR had higher non-cardiovascular mortality and bleeding rates, with comparable incidences of other complications. This highlights the need for a shared decision and appropriate patient selection considering cancer type, staging, bleeding risk, and optimal timing for intervention.Graphical

Prevention of ischemic stroke in patients with myeloproliferative neoplasms

Introduction. Myeloproliferative neoplasms (MPNs) are a rare but significant cause of strokes.Aim. To describe risk factors for stroke development, as well as prevention strategies based on available literature data on patients with MPN.Main findings. Online databases (PubMed, E-Library) were searched for studies on cerebral thrombotic complications in the setting of myeloproliferative disorders. Induction of specific cytoreductive treatment with low doses of acetylsalicylic ac id should be considered as a mandatory component of secondary prevention of noncardioembolic stroke.

Cerebral Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-analysis.

With the increasing use of autologous fat (AF) grafting in plastic surgery, the occurrence of complications has garnered the attention from plastic surgeons. This study aims to estimate the cerebral complications following facial AF graft injection objectively and systematically with newly published literature. A comprehensive literature search was conducted systematically on PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov for articles published between 2000 and 2023. A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. A total of 11 articles comprising of 37 participants were included, all of which are case reports. For AF facial filling, the incidence rate of cerebral embolism among cases of cerebral and ocular embolism was found to be 60% (95% CI 0.41-0.79). The incidence of cerebral embolism presenting with initial symptoms of unconsciousness was 69% (95% CI 0.48-0.9), with limb movement disorders was 55% (95% CI 0.26-0.84), and with vision loss was 30% (95% CI 0.12-0.49). The incidence of cerebral embolism with ophthalmic artery occlusion was 36% (95% CI 0.20-0.53), compared to was 71% (95% CI 0.48-0.95) without ophthalmic artery occlusion. AF grafting is generally safe and minimally invasive. However, with its widespread use as facial injection filling for cosmetic enhancement, the incidence of cerebral complications, such as cerebral infarction, has also increased. It is imperative to properly manage high-risk factors for cerebral embolism during the perioperative period to prevent its occurrence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Place de la chirurgie fœtale dans le cadre d’un dysraphisme ouvert

Open dysraphisms, including myelomeningocele and myeloschisis, are among the most common central nervous system anomalies prenatally diagnosed. These malformations lead to complex disabilities, including lower-limb sensory-motor disorders, sphincter disorders and cerebral complications. In most cases, open dysraphism are diagnosed prenatally, usually during the second-trimester ultrasound scan. The benefits of fetal surgery for open dysraphism were demonstrated in the early 2010s. Fetal surgery improves motor function and halves the risk of hydrocephalus requiring ventricular shunt. This surgery is performed before 26 weeks of gestation and is indicated for couples whose fetus has an isolated open dysraphism, and who wish to continue the pregnancy. Two techniques of fetal surgery are described: open surgery and fetoscopic surgery. Open surgery was the first to be developed. It requires a hysterotomy, which implies delivery by Caesarean section for the current pregnancy and all subsequent pregnancies. Fetoscopy is a more recent, less invasive technique, which allows vaginal delivery. The main complication of fetal surgery, whatever the technique, is the risk of premature delivery and potential neonatal complications related to prematurity.

Impact of cerebral microbleeds on bleeding and outcome after stroke thrombolysis

BackgroundCerebral microbleeds may be responsible for bleeding and poor functional outcome following thrombolysis of acute ischemic stroke. We tried to assess the association between cerebral microbleeds, hemorrhagic complication and functional outcome following intravenous thrombolysis in Egyptian acute ischemic stroke patients. We evaluated 66 acute ischemic stroke patients treated with intravenous thrombolysis for cerebral microbleeds using T2* weighted Magnetic Resonance Imaging Gradient echo. Distribution, number, and predictors of microbleeds were assessed. The effect of microbleeds presence and burden on development of hemorrhage after thrombolysis and 90 days functional outcome was evaluated.ResultsOut of 66 stroke patients treated with intravenous thrombolysis, 33 patients had microbleeds. Multivariate analysis shows that hypertension, diabetes mellitus, atrial fibrillation, smoking and leukoaraiosis were independently associated with microbleeds. Post-thrombolysis symptomatic intracerebral hemorrhage occurred in 12/66 (18.1%). Multivariate analysis shows that high burden microbleeds (≥ 10), leukoaraiosis, stroke severity, delayed thrombolysis were independently associated with intracerebral hemorrhage. Post-thrombolysis hemorrhage was statistically higher in microbleeds group (51.5%) than non-microbleeds group (9.1%) (p < 0.001). Parenchymal hemorrhage represents (58.8%) of hemorrhagic cases in microbleeds group in comparison to (33.3%) of non-microbleeds group (p = 0.62). Parenchymal hemorrhage represents (50%) of hemorrhagic cases with microbleeds < 10, while it represents (100%) of hemorrhagic cases with microbleeds ≥ 10. Favorable modified Rankin Scale (0–2) was more prevalent in non-microbleeds group (72.7%) than microbleeds group (45.5%) at 90 days (p = 0.024). Favorable outcome at discharge and at 90 days was statistically more prevalent in patients with microbleeds < 10 (p = 0.004).ConclusionHigh burden cerebral microbleeds should be considered a risk for parenchymal hemorrhage following intravenous thrombolysis. The presence and burden of microbleeds may affect prognosis 90 days after thrombolytic therapy.

Pro‑coagulant Considerations in Patients with Arterial Hypertension and Multifocal Atherosclerosis

The aim of the work to determine the features of hemostasis and blood rheology in patients with arterial hypertension (HTN) and multifocal atherosclerosis (MFA).Materials and methods. The study enrolled male and female patients aged from 40 to 70 years, including 59 patients with controlled stage I–II hypertension and multifocal vascular lesions (Group 1) and 42 patients with controlled stage III hypertension, who have suffered an ischemic stroke and have multifocal vascular lesions (Group 2). A test using the Thrombodynamics analyser system T-2 (GemaKor, LLC, Moscow, Russia) was performed to detect the impairment of hemostasis.Results. Patients with HTN and MFA have an impaired coagulation hemostasis system (an increase in the initial and stationary clot growth rate and the size of the clot, as well as the presence of spontaneous clots), which leads to a high residual risk of cerebral complications, despite BP lowering to target figures and control of lipid profile.Discussion. Elevated blood pressure in patients with MFA leads to endothelial dysfunction, which is accompanied by activation of coagulation and fibrinolysis pathways. These changes lead to a violation of microcirculatory hemostasis in the brain, the development and progression of cerebral ischemia, and subsequently the occurrence of stroke, both the first and repeated.Conclusion. An important result of this study is the first registered change in the coagulation link of hemostasis in patients with HTN and MFA aged from 40 to 70 years, which can be considered an additional criterion for stroke prediction.

Atrial arrhythmia in adults with sickle cell anemia: a missing link toward understanding and preventing strokes

AbstractAlthough patients with homozygous sickle cell anemia (SCA) carry both significant left atrial (LA) remodeling and an increased risk of stroke, the prevalence of atrial arrhythmia (AA) has never been prospectively evaluated. The aim of this study was to identify the prevalence and predictors of atrial arrhythmia in SCA. From 2018 to 2022, consecutive adult patients with SCA were included in the DREPACOEUR prospective registry and referred to the physiology department for cardiac evaluation, including a 24-hour electrocardiogram monitoring (ECG-Holter). The primary endpoint was the occurrence of AA, defined by the presence of excessive supraventricular ectopic activity (ESVEA) on ECG-Holter (ie >720 premature atrial contractions [PACs] or any run ≥ 20 PACs) or any recent history of atrial fibrillation. Overall, 130 patients with SCA (mean age: 45±12 years, 48% of male) were included. AA was found in 34 (26%) patients. Age (52±9 vs. 42±12 years, P=0,002), LA dilation (LAVi, 71±24 vs. 52±14 mL/m², P<0.001) and history of stroke without underlying cerebral vasculopathy (26% vs. 5%, P=0.009, OR=6.6 (95%CI 1.4-30.3]) were independently associated with AA. Age and LAVi correlated with PAC load per 24 hours on ECG-Holter. An age over 47 years or a LAVi >55mL/m² could predict AA with a PPV of 33% and a NPV of 92%. AAs are frequent in middle-aged patients with SCA and increase with age and LA remodeling, leading to a major additional risk factor for ischemic stroke. This study provides arguments and means to early screen for AA and potentially prevent cerebral complications.

Imbalance of thalamic metabolites in an experimental model of hypertension: role of bergamot polyphenols

Abstract Funding Acknowledgements None. Hypertension is emerging as a pathogenic factor in vascular-based cognitive impairment, altering the structure and function of cerebral vasculature, and representing the main risk factor for cerebral small vessel diseases and neuronal loss. Some studies correlated a reduction in regional cerebral blood flow in the thalamus of elderly hypertensive brains with the decrease in certain cerebral metabolites, because of hypoperfusion. Patients with severe hypertension show a reduced oxygen consumption in regions with reduced cerebral blood flow suggesting that, the vascular dysfunction and the reduced cerebral blood flow could be related to reduced metabolic demands due to brain dysfunction and damage. Chronic cerebral hypoperfusion is associated with increased inflammatory state and oxidative stress. Herein, we hypothesized to prevent or reduce the onset of oxidative stress using natural occurring antioxidant compounds could be of particular importance for the management of hypertension-induced cerebral complications. Hypertension was induced on Wistar male rats by left renal artery ligation (RAL). After complete recovery from surgery, the animals were treated with 20 mg/kg deoxycorticosterone acetate twice a week for 4 weeks, and 1% sodium chloride (NaCl) water. A subgroup of hypertensive rats received Bergamot Polyphenolic Fraction (BPF) by gavage. A control group was treated with sub-cutaneous injection of saline. At baseline (T0), after 2 weeks (T1) and at the end of the experimental period (T2), the thalamic neurochemical profile were evaluated using proton magnetic resonance spectroscopy (1H-MRS), performed with a Bruker Pharmascan 70/16 7T. VAPOR water-suppression module was used and optimized to reduce residual water, then thalamic spectra were acquired using a short echo time single voxel point-resolved spectroscopy technique (voxel size 3x3x3 mm). The absolute quantification of metabolite concentrations has been performed using TARQUIN (v.4.3.10). A reduction tending to significance of the tNAA/tCr ratio, emerged in the thalamus of RAL DOCA-Salt rats compared to control rats at T2. A significant reduction of the tNAA/tCr ratio was observed in the group of RAL DOCA-Salt rats at the T2 compared to the same animals at the T1. In addition, a significantly decrease of the tCho/tCr ratio was highlighted in the RAL DOCA-Salt animals compared to the CTRL rats starting from the T1. The administration of BPF ameliorates the tNAA/tCr ratios in the thalamus of RAL DOCA-Salt rats. Such evidence of the influence of hypertension on tNAA/tCr and tCho/tCr ratios could better explain the relationship between brain structure and modulation of some metabolites, providing new insights into hypertension-induced brain complications and the contribution that the use of natural compounds could give to their management.

APEX2-based proximity proteomic analysis identifies candidate interactors for Plasmodium falciparum knob-associated histidine-rich protein in infected erythrocytes

The interaction of Plasmodium falciparum—infected red blood cells (iRBCs) with the vascular endothelium plays a crucial role in malaria pathology and disease. KAHRP is an exported P. falciparum protein involved in iRBC remodelling, which is essential for the formation of protrusions or “knobs” on the iRBC surface. These knobs and the proteins that are concentrated within them allow the parasites to escape the immune response and host spleen clearance by mediating cytoadherence of the iRBC to the endothelial wall, but this also slows down blood circulation, leading in some cases to severe cerebral and placental complications. In this work, we have applied genetic and biochemical tools to identify proteins that interact with P. falciparum KAHRP using enhanced ascorbate peroxidase 2 (APEX2) proximity-dependent biotinylation and label-free shotgun proteomics. A total of 30 potential KAHRP-interacting candidates were identified, based on the assigned fragmented biotinylated ions. Several identified proteins have been previously reported to be part of the Maurer’s clefts and knobs, where KAHRP resides. This study may contribute to a broader understanding of P. falciparum protein trafficking and knob architecture and shows for the first time the feasibility of using APEX2-proximity labelling in iRBCs.

The role of quantitative electroencephalography in the diagnosis of postoperative cerebral consequences in patients with cardiovascular pathology who underwent cardiac surgery using artificial circulation. Importance for oncology (literature review)

Currently, special attention of researchers is attracted to the problem of diagnosing postoperative brain damage and cognitive impairment in patients with cardiovascular pathology after cardiac surgery without/under conditions of artificial circulation (AC). The main method of assessing the functional state of the brain is quantitative electroencephalography (EEG). Because of cardiovascular and oncological pathology could persist in one patient it is actual simultaneous cardial and oncological surgery under EEG monitoring.Objective: based on the literature data, to find out the role of EEG in diagnosis of cerebral complications in patients with cardiovascular pathology after cardiac surgery without /under conditions of AC.Methods. We found and analyzed data in specialized medical data base Pubmed, Scopus, Web of Science about EEG methods in patients after heart bypass with/without AC from 1980 to 2023 years.Results. The quantitative EEG is very important for early diagnosis and prognosis for cerebral ischemia, epileptiform activity, postoperative cognitive dysfunction in patients with coronary heart disease (CHD) after coronary artery bypass with/without AC. However, the studies did not included patients with oncopathology, people over 70 years of age. It opens possibilities for early diagnosis of central nervous system functional condition in patients with lung cancer and cardiovascular disorders in simultaneous (concomitant heart and lung with/without AC) surgery. It will help a correction of complications in time and a development of guided rehabilitation

Dual-layered micromesh stent technology for embolic prevention in carotid revascularization: technical experience and clinical outcomes from a high-volume interventional radiology center.

Carotid artery stenting (CAS) has become a cornerstone of carotid revascularization for stroke prevention. Despite the advantages of CAS, large-scale randomized trials involving prior (single-layer) first generation stents (FGS) demonstrated a higher risk of periprocedural cerebrovascular events compared to surgery. Dual-layer mesh-covered stents (DLSs) showed promising results in terms of 30-day embolic events in initial studies; larger-scale evidence is accumulating. This study aims to evaluate 30-day clinical efficacy of DLS against a closed-cell stent, based on large-volume data. The study center is part of the Italian National Outcomes Evaluation Program (PNE). CAS procedures performed between November 2017 and September 2023 were eneterd into a prospectively collected database. Our The primary endpoint was survival free of death, stroke, and myocardial infarction (MI) at 30 days. In addition, technical success and periprocedural major adverse clinical event rate (with a focus on stroke) were also evaluated. Over a total of 1101 CAS procedures (745 males; mean age 79±7.8 years), 48.6% were symptomatic. Majority (80.2%) were treated with DLSs. Technical success was achieved in 98.9%. The FGSs group showed a significantly higher peri-procedural stroke rate when compared with CGuard and Roadsaver DLS: 4.59% vs. 1.18% vs. 2.63% (P=0.008); minor stroke rates were 4.13% vs. 0.83% and 0% P=0.01). The cumulative stroke, MI and death - free survival at 30 days was 97.46%. A statistically significant higher cumulative 30-day death/stroke/MI rate occurred in FGSs-treated patients compared to the CGuard and Roadsaver DLS-treated (6.42% vs. 1.42% and 2.63%, P=0.001). The use of DLS in patients undergoing CAS in our large-volume center showed a high technical success rate and minimal cerebral embolic complications by 30 days. High volumes and an experienced interventional team may contribute to these favorable outcomes.

Impact of postoperative cerebral complications in acute infective endocarditis: a retrospective single-center study

BackgroundThe treatment of patients with infective endocarditis (IE) who have preoperative cerebral complications remains less understood. Therefore, this study aimed to retrospectively evaluate the clinical outcomes of patients with acute IE based on preoperative intracranial findings.MethodsOf 32 patients with acute IE treated at our hospital between August 2015 and March 2022, 31 patients of whom preoperative intracranial imaging evaluation was available were included in our analysis and compared with those with and without intracranial findings. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications were reviewed.ResultsAmong the 31 patients, 20 (65%) had preoperative imaging findings. The group with intracranial findings was significantly older, with more embolisms in other organs, positive intraoperative pathology findings, and longer CPB times. A new cerebral hemorrhage developed postoperatively in one patient without intracranial findings. There were no early deaths; two patients had recurrent infections in each group, and one died because of sepsis in the late phase in the group with intracranial findings.ConclusionsPositive intracranial findings indicated significantly active infectious conditions preoperatively but did not affect the postoperative course. Patients without preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without intracranial findings.

Risk Factors for Early HALT after Transfemoral TAVI

Objective: To investigate the risk factors of hypoattenuated leaflet thickening (HALT) in the early stage after transfemoral transcatheter aortic valve implantation (TAVI). Methods: Patients who underwent transfemoral TAVI in the Affiliated Hospital of Qingdao University from January 2021 to June 2023 were selected. According to the results of four-dimensional computed tomography (4DCT), patients were divided into HALT group and non-HALT group. The perioperative data of the two groups were collected to find the risk factors of HALT in the early postoperative period. Results: A total of 100 patients underwent TAVI operation via femoral artery, 2 died after operation, 1 discharged due to cerebral complication, and 2 patients had incomplete 4DCT data. The data of 95 patients were completely collected, including 56 males and 39 females, with an average age of (72.0 ± 6.7) years and a body mass index of (24.0 ± 3.7) kg/m2. 10 patients had HALT, the incidence was 10.5%. 85 patients were in the non-HALT group, including 52 males (61.2%). 10 patients were in the HALT group, 4 cases were male (40%). There were no significant differences in age, sex, body mass index (BMI), hypertension, diabetes, chronic obstructive pulmonary disease (COPD), brain complications, coronary heart disease, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and operation time between the two groups. And the differences between the two groups in perioperative white blood cell, neutrophil, lymphocyte and platelet counts, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and creatinine were not significant. Compared with the non-HALT group, patients in the HALT group had a higher proportion of isolated aortic insufficiency, a lower proportion of post dilatation after valve release, and a higher proportion of valves with skirts. Conclusion: Isolated aortic insufficiency, without post dilatation after valve release, and use of valves with skirt are associated with early HALT after transfemoral TAVI.

Retrospective study of the impact of diabetes on the severity and prognosis of COVID‑19.

Patients with diabetes coexisting with viral infection tend to have poor outcomes, but the association between diabetes and coronavirus disease 2019 (COVID-19) prognosis is controversial at present. The present study reviewed and analyzed the data of 1,892 patients with COVID-19 admitted to Shaanxi Provincial People's Hospital (Xi'an, China). Demographic, clinical, laboratory and treatment data as well as clinical outcomes were extracted from the electronic medical records and compared between patients with and without diabetes. Multivariate logistic regression analysis was used to determine the risk factors affecting the prognosis of COVID-19. Compared with patients without diabetes, the levels of glucose, C-reactive protein, procalcitonin, creatinine, total bilirubin and plasma D-dimer were significantly increased in patients with diabetes, while the levels of lymphocytes and albumin were significantly decreased (P<0.05). Multivariate logistic regression analysis revealed that platelet count, albumin, total bilirubin and lymphocytes were significantly correlated with the severity of COVID-19. Diabetes mellitus was an independent prognostic factor that affected the mortality outcome of patients with COVID-19. Additionally, an age of ≥80 years, male sex, cerebral infarction complications and a critical diagnosis of COVID-19 at admission were risk factors for critical illness during hospitalization. The results of the present study suggest that diabetes may be a risk factor for the rapid progression and poor prognosis of COVID-19. Therefore, further attention should be paid to individuals with diabetes in order to prevent rapid deterioration.