Cerebrovascular Comorbidity Research Articles

Incidence of Hospitalization-Associated Disability in Older Patients With Heart Failure.

This study determined the incidence of hospitalization-associated disability (HAD) and its characteristics in older patients with heart failure in Japan. Ninety-six institutions participated in this nationwide multicenter registry study (J-Proof HF). From December 2020 to March 2022, consecutive heart failure patients aged ≥65 years who were prescribed physical rehabilitation during hospitalization were enrolled. Of the 9,403 patients enrolled (median age 83.0 years, 50.9% male), 3,488 (37.1%) had HAD. Compared with the non-HAD group, the HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease comorbidity. The HAD group also had a significantly lower Barthel Index score and a significantly higher Kihon checklist score before admission. Of the 9,403 patients, 2,158 (23.0%) had a preadmission Barthel Index score of <85 points. Binomial logistic analysis revealed that age and preadmission Kihon checklist score were associated with HAD in patients with a preadmission Barthel Index score of ≥85, compared with New York Heart Association functional classification and preadmission cognitive decline in those with a Barthel Index score <85. This nationwide registry survey found that 37.1% of older patients with HF had HAD and that these patients are indicated for convalescent rehabilitation. Further widespread implementation of rehabilitation for older patients with heart failure is expected in Japan.

26 Apathy in Korsakoff Patients with and without Neurovascular Comorbidity

Objective:People with Korsakoff syndrome (KS) experience severe neuropsychological and neuropsychiatric complications following vitamin B1 deficiency predominantly due to alcoholism. KS often presents itself with neuropsychological symptoms such as problems in episodic memory, executive functioning, and social cognition. Common neuropsychiatric symptoms in KS are disorders of affect, confabulations, anosognosia, and apathy. Apathy can be defined by a pathological lack of goal-directed behaviors, goal-directed cognitions, and goal-directed emotions. Patients with KS have an increased risk of cerebrovascular comorbidity. Cerebrovascular accidents are known to increase the risk for developing apathy. Apathy in KS patients can negatively influence the ability to live an autonomous life, often making 24-hour care a necessity. Limited research on apathy in KS patients has been published to this day. Our aim was to assess apathy in Korsakoff patients with and without neurovascular comorbidity.Participants and Methods:General apathy and related subconstructs, such as judgment and decision-making skills, emotional blunting, and the intentions to perform pleasurable activities, were studied in fifteen KS patients, fifteen KS patients with additional cerebrovascular comorbidity, and fifteen healthy controls. The first responsible caregiver of each patient filled in the Apathy Evaluation Scale and Scale for Emotional Blunting. An examiner administered the interview-based Judgement scale of the Neuropsychology Assessment Battery with the KS patients and each KS patient filled in the self-report section of the Pleasurable Activities List. Both KS patient groups receive 24-hour care in a specialized facility for Korsakoff Syndrome.Results:Our study found higher levels of general apathy in both KS patient groups, when rated by their caregiver compared to healthy controls. No difference was found between the KS patient groups and the healthy control group on the self-reported section of the Pleasurable Activities List, which might suggest the presence of intrinsic motivation in KS patients. However, a discrepancy was found between the self-reported activity levels and proxy reported levels of apathy. KS patients with cerebrovascular comorbidity showed increased levels of emotional blunting compared to KS patients without cerebrovascular comorbidity and healthy controls. Decreased judgment and decision-making skills were found in both patient groups compared to healthy controls, with no difference found between KS patients with cerebrovascular comorbidity and KS patients without.Conclusions:Our findings suggest that people with Korsakoff syndrome experience more general apathy compared to healthy controls. Both patient groups showed decreased judgement and decision-making skills and increased emotional blunting. Intrinsic motivation was found to be intact in KS patients. Experiencing cerebrovascular comorbidity in KS carries a risk for developing emotional blunting. Our findings show that apathy greatly affects people with KS. Future scientific research is warranted to further benefit the care for this complex patient population.

Predictors of Nonadherence to Planned Coronary Angiography: A Retrospective Analysis

Objective: This study aimed to determine the predictive power of patient-related factors, socio-economic factors, condition-related factors, treatment-related factors, and health care system-related factors for nonadherence to planned coronary angiography (CAG). Material and Methods: A retrospective analysis was conducted on electronic medical records (EMR) of 665 patients appointed for elective CAG at Naradhiwas Rajanagarindra Heart Center from January 2018 to December 2019. One hundred and thirty-three patients with nonadherence to planned CAG were assigned to the study group; the control group consisted of 532 patients with adherence to planned CAG. Results: The retrospective data analysis revealed that divorced or widowed status (OR=3.07; 95% CI 1.54, 6.12), cerebrovascular disease comorbidity (OR=4.37; 95% CI 1.74, 10.96), prescribed diuretics (OR=2.24; 95% CI 1.26, 3.97), CAG wait time three months or longer (OR=3.34; 95% CI 1.46, 7.64) and history of parental cardiovascular disease or death from heart disease (OR=0.12; 95% CI 0.01, 0.95) were co-predictors of nonadherence to planned CAG. Socioeconomic- related factors had no predictive power for planned CAG nonadherence. Conclusion: The findings of this study may contribute to the improvement of nursing service by screening groups at high risk of nonadherence and developing appropriate interventions aimed at increasing adherence to planned CAG as well the rate of positive health outcomes.

Use of broad-spectrum antimicrobials for more than 72 h and the detection of multidrug-resistant bacteria in Japanese intensive care units: a multicenter retrospective cohort study

BackgroundLarge multicenter studies reporting on the association between the duration of broad-spectrum antimicrobial administration and the detection of multidrug-resistant (MDR) bacteria in the intensive care unit (ICU) are scarce. We evaluated the impact of broad-spectrum antimicrobial therapy for more than 72 h on the detection of MDR bacteria using the data from Japanese patients enrolled in the DIANA study.MethodsWe analyzed the data of ICU patients in the DIANA study (a multicenter international observational cohort study from Japan). Patients who received empirical antimicrobials were divided into a broad-spectrum antimicrobial group and a narrow-spectrum antimicrobial group, based on whether they received broad-spectrum antimicrobials for more or less than 72 h, respectively. Differences in patient characteristics, background of infectious diseases and empirical antimicrobial administration, and outcomes between the two groups were compared using the chi-square tests (Monte Carlo method) for categorical variables and the Mann–Whitney U-test for continuous variables. We also conducted a logistic regression analysis to investigate the factors associated with the detection of new MDR bacteria.ResultsA total of 254 patients from 31 Japanese ICUs were included in the analysis, of whom 159 (62.6%) were included in the broad-spectrum antimicrobial group and 95 (37.4%) were included in the narrow-spectrum antimicrobial group. The detection of new MDR bacteria was significantly higher in the broad-spectrum antimicrobial group (11.9% vs. 4.2%, p = 0.042). Logistic regression showed that broad-spectrum antimicrobial continuation for more than 72 h (OR [odds ratio] 3.09, p = 0.047) and cerebrovascular comorbidity on ICU admission (OR 2.91, p = 0.041) were associated with the detection of new MDR bacteria.ConclusionsAmong Japanese ICU patients treated with empirical antimicrobials, broad-spectrum antimicrobial usage for more than 72 h was associated with the increased detection of new MDR bacteria. Antimicrobial stewardship programs in ICUs should discourage the prolonged use of empirical broad-spectrum antimicrobial therapy.Trial registration ClinicalTrials.gov, NCT02920463, Registered 30 September 2016, https://clinicaltrials.gov/ct2/show/NCT02920463

Impact of cerebrovascular comorbidity on prognosis in Japanese patients undergoing PCI: 1-year data from Japanese multicenter registry (KICS).

Cardiovascular and cerebrovascular diseases are considered the principal cause of morbidity and mortality worldwide; the effect of stroke-induced cardiac manifestations is well recognized; however, not enough clinical data have been found about the impact of stroke with underlying cardiac disease. This study's objective is to assess the impact of stroke on the prognosis of patients with underlying IHD, who underwent PCI treatment. This was a multicenter, 1-year observational study in patients undergoing PCI in one of the 17 participating centers across Japan. 18,495 patients were registered on the PCI list; 2481 patients had a prior stroke experience, whereas 15,979 were stroke-free. Our study revealed that stroke patients were significantly older (mean age 73.5 ± 9.6, 69.7(± 11.5), respectively), and suffered from more comorbidities (diabetes, hypertension, and chronic kidney disease, p < 0.0001). During the 1-year period, subjects with stroke showed higher incidence of clinical events compared to those without stroke; to illustrate, all-cause death accounted for 6.2% in patients with stroke, in contrast to only 2.8% in stroke-free patients (p < 0.0001), cardiac death amounted for 2.2 and 1.2%, respectively (p < 0.0001), recurrent stroke for 3.1% and 1.2% (p < 0.0001), non-cardiac death for 3.6 and 1.54% (p < 0.0001), and finally, hemorrhagic complications with 2.6 and 1.3% (p < 0.0001). Kaplan-Meier analysis revealed that stroke patients had a higher probability of all-cause mortality, cardiac death, and recurrent stroke (log-rank p < 0.0001). Cox hazard analysis also showed that the presence of stroke is a significant indicator in determining the outcome of cardiac death (HR = 1.457, 95% CI 1.036-2.051, p = 0.031); hence, proving it to be a crucial predictor on cardiac prognosis. History of prior stroke was common in PCI patients, and independently associated with a higher rate of subsequent cardiovascular and cerebrovascular events recurrence. Thus, highlighting an urgent need for comprehensive prevention of cardiac and cerebrovascular diseases.

Impact of Comorbidities on Prognosis of Elderly Patients with Acute Myeloid Leukemia Who Receive Hypomethylating Agents

Impact of Comorbidities on Prognosis of Elderly Patients with Acute Myeloid Leukemia Who Receive Hypomethylating Agents

Low Rates of Cerebral Infarction after Hematopoietic Stem Cell Transplantation in Patients with Sickle Cell Disease at High Risk for Stroke

Hematopoietic stem cell transplantation (HSCT) can be curative for sickle cell disease (SCD). SCD patients with cerebrovascular disease are often referred for HSCT. The objective of this study was to describe neurologic outcomes after HSCT in patients with pre-existing SCD and cerebrovascular comorbidity. Patients with SCD treated with HSCT at a single center between 1996 and 2019 were identified. Patients with cerebral ischemia and/or vasculopathy before undergoing HSCT were included. Patients with graft failure were excluded. The cohort was divided into 3 groups: symptomatic stroke, vasculopathy without symptomatic stroke, and isolated silent cerebral infarction (SCI). Magnetic resonance imaging/angiography and neurologic assessments pre- and post-HSCT were analyzed to assess outcomes. In a cohort of 44 patients, there were 25 with symptomatic infarction, 10 with vasculopathy, and 9 with isolated SCI. Post-HSCT ischemic injury (2 symptomatic strokes, 2 SCIs) was identified in 4 patients, all with previous symptomatic infarction. Within this group (n=25), the post-HSCT incidence of subsequent symptomatic infarction was 1.6 events/100 patient-years, and SCIs occurred at a rate of 2.2 events/100 patient-years. No patient had progression of vasculopathy post-HSCT. Our data show a low incidence of new ischemic injury after successful HSCT for SCD. Patients with a history of both symptomatic stroke and vasculopathy are at greatest risk for post-HSCT ischemic injury.

Mortality predictors in complicated patients after anatomical lung resection

IntroductionFailure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. MethodPatients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. ResultsA total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77–0.88). ConclusionsOverall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.

KNOWLEDGE ABOUT ARTERIAL HYPERTENSION IN GENERAL POPULATION: RESULTS OF A COMMUNITY PHARMACY SCREENING PROGRAM

Objective: Hypertension is a cardiovascular and cerebrovascular risk factor. Prevention of hypertension mediated organ damage is a main health problem. Guidelines underlines the importance of screening and educational programs in general population and the role of non-medical sanitary subjects, particularly pharmacists. This study evaluated knowledge about hypertension in a population afferent to community pharmacies of Piedmont and Ligury. Design and method: A questionnaire about knowledge of hypertension has been collected from 2731 community pharmacy costumers, participating to an arterial hypertension screening program. It included three sections about prevalence of hypertension, hypertension-mediated organ damage and preventive lifestyle behaviour. Blood pressure was measured with an Omron HEM 1040-E device. Further information about home blood pressure levels, cardiovascular, metabolic and cerebrovascular comorbidity were collected. Results: 57,5% of subjects were female and mean age was 58,3 ± 15,9 ys. 47% subjects declared a hypertensive status, 41% normotensive one and 12% didn’t know their pressure status. Mean systolic blood pressure was 130 ± 18 mmHg and diastolic blood pressure 79 ± 10 mmHg. 69% of hypertensive subjects was not controlled at pharmacy evaluation, on the base of guidelines office target values. 10% of subjects self-declared normotensive and 35% who didn’t know their blood pressure status had a blood pressure &gt;= 140/90 mmHg. In the questionnaire only 15% of subjects knew hypertension prevalence; 23% had a poor knowledge about lifestyle prevention interventions and 36% have poor knowledge about hypertension mediated organ damage. The proportion of people with poor knowledge was particularly higher in people who didn’t know their pressure status (low level consciousness about lifestyle and consequences in 30% and 48% of subjects respectively). Subjects with a low global knowledge about hypertension had significantly higher blood pressure levels compared to those with a good consciousness. Conclusions: Many people have poor knowledge of hypertension as risk factor; this is the base of poor blood pressure control and non-adherence. Community pharmacies may represent an important resource for education and prevention among general population, including people not seeking medical care.

Unraveling Apathy in Korsakoff Syndrome Patients Receiving Long-Term Care With and Without Cerebrovascular Comorbidity.

BackgroundKorsakoff syndrome (KS) is a severe neuropsychiatric disorder caused by acute deficiency of vitamin B1 and concomitant alcoholism. Patients with KS are particularly vulnerable for cerebrovascular comorbidity. KS is characterized by cognitive and neuropsychiatric symptoms, one of which is apathy. Apathy is a pathological lack of goal‐directed behaviors, goal‐directed cognitions, and goal‐directed emotions. Cerebrovascular accidents are known to carry a risk for developing apathy. Apathy has a dramatic effect on the autonomy and daily lives of patients suffering from this condition.MethodsWe assessed general apathy and related subconstructs in fifteen patients with KS, fifteen patients with KS and cerebrovascular comorbidity who reside in a 24‐hour care facility, and fifteen healthy controls.ResultsCompared with healthy controls, both KS patient groups showed higher levels of apathy as rated by a close informant. We found no difference between both KS patient groups and the healthy control group on the self‐report section of the Pleasant Activities List, suggesting that motivation is still intact in KS patients. It is important to note a discrepancy was found between self‐reporting and proxy reporting on this list. KS patients with cerebrovascular comorbidity showed more severe emotional blunting compared to both KS patients without cerebrovascular comorbidity and healthy controls. The competency to consent was lower in patients compared with healthy controls, but no difference was found between KS patients with cerebrovascular comorbidity and those without.ConclusionsOur results suggest that KS patients show increased levels of general apathy compared with healthy controls. Patients show a diminished competency to consent and increased emotional blunting, while motivation is not compromised. Cerebrovascular comorbidity in KS forms a high risk for emotional blunting. The results of this study suggest that apathy is a severe problem in KS. More attention in both the literature and clinical practice would benefit this complex patient population.

Does Endoscopic Retrograde Cholangiopancreatography Carry Higher Risk for Patients 90 Years and Older? A Single-Institution Retrospective Study.

BackgroundEndoscopic retrograde cholangiography (ERCP) for patients aged ≥90 years is often required. The safety of ERCP for super-elderly patients is a major concern for gastrointestinal endoscopists. We retrospectively examined the safety of ERCP for super-elderly patients by comparison with patients in their 70s.Material/MethodsWe reviewed 66 patients aged ≥90 years (Group A) and 43 patients in their 70s (Group B) who underwent ERCP in our institution from January 2012 to October 2019. Data were collected on patients’ backgrounds, corresponding procedures, and clinical outcomes, including adverse events.ResultsPatients in Group A (mean age: 92.3±2.1 years) had significantly poorer performance status (median: 3 vs. 0; P<0.001) and American Society of Anesthesiologists classification (median: III vs. II; P<0.001) when compared to Group B (mean age: 75.1±2.7 years). Underlying cardiovascular, cerebrovascular, renal, and orthopedic comorbidity occurrence was significantly higher in Group A than in Group B (87.88% vs. 67.44%; P=0.0094). Group A comprised more patients with benign disease than Group B (90.91% vs. 76.74%; P=0.040). Group B comprised more patients with malignant disease (31.82% vs. 53.54%; P=0.041). Emergency ERCP was higher in Group A than in Group B (71.70% vs. 29.73%; P<0.0001). No significant between-group differences in adverse events (15.15% vs. 11.63%; P=0.602) and mortality rate (1.52% vs. 2.33%; P=0.758) were noted.ConclusionsIndications for ERCP should not be determined simply based on the super-elderly age of patients. ERCP may not necessarily carry higher risks if endoscopists practice maximal caution against gastrointestinal perforation.

Abstract 14938: Impact of Cerebrovascular Comorbidity on Prognosis in Patients Undergoing Percutaneous Coronary Intervention: 1-year Data From Japanese Multi-center Registry

Background: Cardiovascular and cerebrovascular diseases are considered the principal cause of morbidity and mortality worldwide; the effect of stroke-induced cardiac manifestations is well recognized; however, not enough clinical data has been found about the impact of stroke with underlying cardiac disease. This study’s objective is to assess the impact of stroke on the prognosis of patients with underlying IHD, who underwent PCI treatment. Methods and Results: This was a multicenter, 1-year observational study in patients undergoing PCI in one of the 17 participating centers across japan. 18,495 patients were registered on the PCI list; 2481 patients had a prior stroke experience, whereas 15979 were stroke-free. Our study revealed that stroke patients were significantly older (mean age73.5±9.6, 69.7(±11.5) respectively), and suffered from more comorbidities (diabetes, hypertension, and chronic kidney disease, p&lt;0.0001). During the one-year period, subjects with stroke showed higher incidence of clinical events compared to those without stroke; to illustrate, all-cause death accounted for 6.2% in patients with stroke, in contrast to only 2.8% in stroke-free patients (p&lt;0.0001),cardiac death amounted for 2.2% and 1.2% respectively (P&lt;0.0001), recurrent stroke for 3.1% and 1.2% (P&lt;0.0001), non-cardiac death for 3.6% and 1.54% (P&lt;0.0001),and finally, hemorrhagic complications with 2.6% and 1.3% (p&lt;0.0001).Kaplan-Meier analysis revealed that stroke patients had a higher probability of all-cause mortality, cardiac death, and recurrent stroke (log-rank p&lt;0.0001). Cox hazard analysis also revealed that the presence of stroke is a significant indicator in determining the outcome of cardiac death (HR=1.457, 95%CI=1.036–2.051, p=0.031), thus proving it to be a crucial predictor on cardiac prognosis. Conclusion: History of prior stroke was common in PCI patients, and independently associated with a higher rate of subsequent cardiovascular and cerebrovascular events recurrence, thus highlighting urgent need for comprehensive prevention of cardiac and cerebrovascular diseases

Cerebrovascular events in COVID-19 patients.

Neurological manifestations in patients with COVID-19 are more frequently being reported. Cerebrovascular events have been reported in around 3% of patients. In this review we summarize the published literature on cerebrovascular events in patients with COVID-19 as available on the PubMed database. So far, 3 studies have reported cerebrovascular events. Cerebrovascular events were identified on screening patients with decreased consciousness or in the presence of focal neurological deficits. These events were common in elderly, critically ill patients and in patients with prior cardio-cerebrovascular comorbidities. The diagnosis of cerebrovascular events was confirmed with computed tomography of the brain in most studies reporting neurological events. Multiple pathological mechanisms have been postulated regarding the process of neurological and vascular injury among which cytokine storm is shown to correlate with mortality. Patients with severe illness are found to have a higher cardio- cerebrovascular comorbidity. With an increasing number of cases and future prospective studies, the exact mechanism by which these cerebrovascular events occur and attribute to the poor outcome will be better understood.

Variables predictivas de muerte en pacientes complicados tras resección pulmonar anatómica

IntroductionFailure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. MethodPatients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. ResultsA total of 2,569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88). ConclusionsOverall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.

Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Background and purposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. MethodsThis is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. ConclusionThe proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Behavioral Status in Rats with Experimental Comorbidity of Chronic Obstructive Pulmonary Disease and Acute Cerebral Ischemia

Objectives. To undertake a comparative analysis of the behavioral patterns of rats with experimental chronic obstructive pulmonary disease (COPD), acute cerebral ischemia (ACI), and the combination of these pathologies. Materials and methods. The study was performed on 70 male Wistar laboratory rats weighing 250–300 g, divided into five groups. The results of comparative evaluation of the neurological and behavioral status of the rats is presented. Experimental COPD was modeled using combined inducers (purified papain and bacterial lipopolysaccharide) and ACI by simultaneous bilateral occlusion of the common carotid arteries. Neurological status was evaluated using the NSS scale and behavioral status using a battery of tests: the open field test, the eight-arm radial maze, and the elevated O maze. Results and conclusions. Animals with combined pathologies showed the lowest level (20%) of survival and the greatest severity of neurological and behavioral disorders. These animals were characterized by sharp restriction to locomotor and exploratory activity, high anxiety, and increasing autonomic imbalance. Survival in rats with ACI only was 35%, while abnormalities in their neurological and behavioral status were of moderate severity. Rats with experimental COPD only had mild neurological deficit. Behavioral abnormalities consisted of moderate restriction to locomotor function and minor increases in anxiety on the background of retained exploratory activity and spatial memory. The results provide evidence of the relevance of the model of respiratory and cerebrovascular comorbidity for assessment of changes in physiological functions and their subsequent treatment.

A survey of comorbidity and health behaviors of diabetic patients in an area of Beijing

Objective By investigating the prevalence of comorbidity and health behaviors among diabetes patients in Beijing, to provide reference for effective health management of diabetic patients. Methods Based on a cross-sectional survey of 10 334 diabetic patients managed by a community health information center in Beijing from 2012 to 2014, the data of 10 334 diabetic patients were analyzed systematically. The common diseases investigated included cardiovascular and cerebrovascular diseases, orthopedic diseases, chronic respiratory/pulmonary diseases, tumors, chronic kidney diseases and other chronic diseases disease. At the same time, the health behaviors of diabetic patients were investigated, including diet behavior, exercise, work intensity, traffic mode, smoking and sleeping. Results ⑴ There were 521 patients with simple diabetes and 9 813 patients with comorbidity. The prevalence of comorbidity was 94.96%. ⑵ There were 6 279 patients with one kind of comorbidity, accounting for 63.99%; 2 726 patients with two kinds of comorbidity, accounting for 27.78%; 808 patients with two or more kinds of comorbidity, accounting for 8.23%; among them, there were 6 153 patients with cardiovascular and cerebrovascular comorbidi-ty, accounting for 62.70%. ⑶ There were significant differences in diet taste preference, whether they often eat unhealthy food, whether the dietary structure is reasonable, intake of tofu and bean products, average daily vegetable, average daily fruit, average daily egg, average daily fish and meat, reduced food intake, regular exercise, exercise mode, duration of each exercise, comprehensive classification of physical activity, other physical exercise, comprehensive score of exercise, working hours per week, walking time to work or shopping, cycling time to work or shopping, transportation for going to work or shopping, walking out in good weather, smoking, sleep difficulties between simple diabetes and comorbidity patients (P<0.05). Conclusions The incidence of diabetic comorbidity is high, among which cardiovascular and cerebrovascular diseases are the most common. There are some differences in diet behavior, exercise, work, transportation and sleep between simple diabetes and comorbidity patients, which may be the cause of comorbidity. Key words: Diabetes mellitus; Comorbidity; Prevalence; Health behavior

Cerebrovascular comorbidity, high blood levels of C-reactive protein and D-dimer are associated with disease outcomes in COVID-19 patients.

The emerging coronavirus disease (COVID-19) swept the world, affecting more than 200 countries and territories. As of August 22, 2020, the pandemic infected more than 23,329,752 including 807,054 patients who have died. Although the main clinical features of the pandemic disease are respiratory, cerebrovascular comorbidities emerged as one of the leading causes of death associated with COVID-19. Different case reports have indicated that C-reactive protein (CRP) and D-dimer (pro-inflammatory biomarkers) were elevated in COVID-19 patients, which can significantly increase the risk of ischemic stroke. Available data on cerebrovascular complications in COVID-19 patients were collected and a meta-analysis was designed and carried out to evaluate the risk of severity and mortality associated with high levels of CRP and D-dimer levels in COVID-19 patients. In addition, we aimed to describe the overall event rate of pre-existing cerebrovascular disease in COVID-19 patients. In our analysis, 5,614 cases have been studied, out of these patients 164 cases have developed cerebrovascular comorbities. Cerebrovascular comorbidity increased the risk of disease severity (odd ratio = 4.4; 95% CI: 1.48 to 12.84) and mortality (odd ratio = 7.0; 95% CI: 2.56 to 18.99). Statistical analyses showed that CRP and D-dimer serum levels were elevated by six-folds in the severe cases of COVID-19 patients. This significant increase in these two proteins levels can serve as a vital indicator for COVID-19 patients who are at increased risk of severe COVID-19 cerebrovascular complications, such as stroke.

Autonomic Cardiac Regulation in Experimental Comorbidity of Chronic Obstructive Pulmonary Disease and Acute Cerebral Ischemia.

Autonomic regulation of the heart was examined in 5 groups of rats: intact, sham-operated, experimental chronic obstructive pulmonary disease, acute cerebral ischemia, and acute cerebral ischemia modeled against the background of chronic obstructive pulmonary disease. The latter was provoked by combination of inhaled papain and intraperitoneal bacterial LPS, whereas acute cerebral ischemia was modeled by single-stage bilateral occlusion of the common carotid arteries. Chronic obstructive pulmonary disease was verified by X-ray computed microtomography. The disturbances in autonomic control of the heart during comorbid pathologies were most prominent; they were manifested by overstrain and decompensation of the mechanisms implicated in the heart control and systolic-diastolic arterial hypotension. The correlations were established between blood oxygenation, respiration rate, and some parameters of autonomic cardiac regulation. The data attest to relevance and usefulness of the developed model of respiratory and cerebrovascular comorbidity in assessment of pathophysiological mechanisms underlying dysregulation of the heart and the development of personalized approaches for its pharmacological correction.

The behavioral status of rats with experimental comorbidity of chronic obstructive pulmonarydisease and acute cerebral ischemia

To compare behavioral patterns of rats with experimental chronic obstructive pulmonary disease (ECOPD), acute cerebral ischemia (ACI) and a combination of these pathologies. The study included 70 male Wistar rats (weight 250-300 g) divided into 5 groups. ECOPD was modeled by a combination of inducers (purified papain and bacterial lipopolysaccharide), and ACI by a single-stage bilateral occlusion of common carotid arteries. The neurological status was assessed with NSS, and the behavioral status was assessed using the battery of tests including 'open field', 'radial eight-arm labyrinth', 'O-shaped elevated labyrinth'. With the combination of ECOPD and ACI, a minimal (20%) survival rate of animals and the maximum severity of neurological and behavioral disorders, were recorded. The latter were characterized by a sharp restriction of locomotor and research activity, spatial memory, high anxiety and increasing autonomic imbalance. Survival rate of rats with isolated ACI was 35%, and disturbances of their neurological and behavioral status were moderately expressed. In rats with isolated ECOPD, the neurological deficit was mild. Behavioral disorders were manifested by a moderate limitation of locomotor function, a slight increase in anxiety with preserved research activity and spatial memory. The results of the study indicate the relevance of the respiratory and cerebrovascular comorbidity model for assessing changes in physiological functions and their subsequent correction.