Higher Risk Of Cerebral Infarction Research Articles

Analysis of risk factors for acute cerebral infarction in patients with intracranial tuberculosis.

Acute cerebral infarction is a common complication of intracranial tuberculosis (TB), causing irreversible damage to brain tissue and significantly affecting patient prognosis. This study aims to explore the risk factors associated with acute cerebral infarction in patients with intracranial tuberculosis. We retrospectively analyzed data from eligible intracranial TB patients treated at our hospital between January 2020 and March 2023. Based on MRI findings, patients were categorized into a cerebral infarction group and a non-infarction group. Clinical data, cerebrospinal fluid (CSF) examinations, and imaging features (such as hydrocephalus, cerebral arteritis, and meningeal thickening) were compared between the two groups. Binary logistic regression analysis was used to identify risk factors for acute cerebral infarction in patients with intracranial TB. A total of 102 patients were included, with 24 in the cerebral infarction group and 78 in the non-infarction group. Male patients accounted for 87.5% in the infarction group and 58.3% in the non-infarction group. Patients with a Glasgow Coma Scale (GCS) score of 3-10 accounted for 45.8% in the infarction group compared to 15.4% in the non-infarction group. The incidence of hydrocephalus, cerebral arteritis, and meningeal thickening was significantly higher in the infarction group (37.5, 54.2, and 79.2%, respectively) compared to the non-infarction group (6.4, 6.4, and 43.6%, respectively) (p < 0.05). The parenchymal type of intracranial TB was less frequent in the infarction group (20.8%) than in the non-infarction group (56.4%), while the mixed type was more frequent in the infarction group (62.5%) compared to the non-infarction group (26.9%) (p < 0.05). Patients with meningeal thickening involving the cisterns and basal cisterns had a higher risk of cerebral infarction (p < 0.05). Multivariate binary logistic regression analysis revealed that male sex (OR = 13.56; 95% CI 1.25-38.30) and cerebral arteritis (OR = 19.32; 95% CI 0.94-37.64) were independent risk factors for cerebral infarction in intracranial TB patients. Male sex and the presence of cerebral arteritis are independent risk factors for acute cerebral infarction in patients with intracranial tuberculosis.

Distance from the midline to the aneurysm as simple predictor of ischemic complication with small unruptured middle cerebral artery aneurysm surgery

BackgroundThis study aimed to clarify the risk factors for postoperative cerebral infarction in surgical clipping for prevalent small middle cerebral artery aneurysms (MCA Ans). MethodsThis retrospective study included 246 patients (mean age, 64.8 ± 10.0 years; 25.6 % males, 74.4 % females) with 258 aneurysms (mean aneurysm size, 5.4 ± 2.4 mm) who underwent direct surgery for unruptured MCA Ans at our institution from January 2015 to December 2020. All surgeries were performed under general anesthesia, incorporating indocyanine green videoangiography and transcranial motor-evoked potentials to enhance surgical precision and safety. The occurrence of surgery-related cerebral infarction was evaluated using postoperative CT scans within one week, comparing them with preoperative images. Patients were categorized based on the presence or absence of postoperative stroke and were analyzed for age, sex, past medical history, aneurysm size, number of clips used, and distance from the midline to the aneurysm. ResultsSeventeen patients had postoperative cerebral infarction (6.6 %, symptomatic 6, asymptomatic 11). There were no significant differences in terms of age, number of clips, or aneurysm size between the two groups; however, the distance from the midline to the aneurysm was significantly shorter in the stroke group (27.1 ± 4.7 mm; p < 0.001), with a cutoff value of 29 mm using the receiver operating characteristic curve. ConclusionSurgical clipping for MCA Ans presents a high risk of cerebral infarction for aneurysms located closer to the midline, emphasizing the importance of considering aneurysm location as a risk indication in surgical clipping.

Moyamoya disease: insights into the clinical implications of the RNF213 gene

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the terminal internal carotid arteries and the formation of compensatory collateral vessels, which appear as a “puff of smoke” on cerebral angiography. It is a significant cause of stroke in East Asia, with an incidence of 0.5 to 1.5 cases per 100,000 people annually. The etiology of MMD remains unclear; however, the identification of the RNF213 gene, particularly the R4810K variant, as a major susceptibility factor among the East Asian population, has provided crucial insights into the disease's pathophysiology and clinical manifestations. MMD typically presents with transient ischemic attacks, ischemic and hemorrhagic strokes, seizures, headaches, and cognitive deficits. Diagnostic criteria have evolved to emphasize advanced imaging techniques. Pathological features include fibrocellular intimal thickening, irregular undulation of the elastic lamina, and the formation of moyamoya vessels. The mutation in the RNF213 gene impairs the degradation of proteins involved in vessel development, leading to abnormal angiogenesis. Genotype-phenotype studies indicate that the RNF213 variant is associated with an earlier onset, transient ischemic attacks, infarctions, and involvement of the posterior cerebral artery, although its effects vary between regions. Additionally, the homozygous RNF213 variant consistently correlates with an earlier age of onset and a higher risk of cerebral infarction. However, further research is necessary to fully understand its long-term impacts and its relationship with revascularization outcomes. Ongoing research is crucial to fully comprehend the pathophysiology and genetics of MMD, improve prognostic predictions, and develop novel therapies.

Outcomes of Clampless Real Chimney Technique with Dacron Graft and Sleeve Banding of the Ascending Aorta for Total Debranching Endovascular Arch Repair

Background: Hybrid aortic arch repair with debranching of the supra-aortic vessels carries a high risk of cerebral infarction and fatal complications associated with side clamping of the ascending aorta. A previous study had reported the “real chimney” technique, a novel method for clamp-free total debranching thoracic endovascular aortic repair with the ascending aortic sleeve banding with dacron. In this study, we aim to build upon this foundation by presenting our experience with the early and midterm outcomes of this technique. Methods: We retrospectively reviewed the medical records of 61 consecutive older adult patients with aortic arch pathologies and a high risk of open repair who underwent total debranching thoracic endovascular aortic repair using the real chimney technique at our institution between January 2014 and June 2022. This technique was used to anastomose the ascending aorta with the main trunk of the triple-branched prosthetic graft. Results: The mean patient age was 75.1 years, and 54% of patients were transferred from medical facilities with cardiothoracic surgery departments. The comorbidities included chronic obstructive pulmonary disease (49.2%), chronic kidney disease (63.9%), coronary artery disease (27.9%), and history of stroke (31.1%). No 30-day mortality was observed. Complications included postoperative renal failure requiring permanent hemodialysis (4; 6.6%), stroke (modified Rankin scale score: ≥2 in 5; 8.2%), permanent paraplegia (1; 1.6%), and permanent paraparesis (4; 6.6%). The median follow-up period was 40.5±28.5 months. The postoperative survival rates at 5 years were 66.8%. No patients experienced complications associated with the aorta or anastomosis site; only 1 patient required an additional procedure for stenosis of the anastomosis site (midterm). An aneurysmal diameter reduction of ≥3 mm was observed in 37 cases (60.7%), and the mean aneurysmal diameter reduction was 5.3 mm. Conclusions: The postoperative outcome of total debranching thoracic endovascular aortic arch repair is not only acceptable but also promising, particularly in patients at high risk of open repair. Clinical Impact Our novel real chimney technique for total debranching thoracic endovascular aortic repair of aortic arch pathologies in patients who were at a high-risk for open repair resulted in no 30-day mortality and no complications related to the aorta or the real chimney anastomosis site. The real chimney technique is effective for managing aortic arch pathologies and enables less invasive total debranching thoracic endovascular aortic arch repair without the need for extracorporeal circulation and clamping of the ascending aorta

Regional variations of cardiovascular risk in gout patients: a nationwide cohort study in Korea.

The extent of regional variations in cardiovascular risk and associated risk factors in patients with gout in South Korea remains unclear. Therefore, we aimed to investigate the risk of major cardiovascular events in gout patients in different regions. This was a nationwide cohort study based on the claims database of the Korean National Health Insurance and the National Health Screening Program. Patients aged 20 to 90 years newly diagnosed with gout after January 2012 were included. After cardiovascular risk profiles before gout diagnosis were adjusted, the relative risks of incident cardiovascular events (myocardial infarction, cerebral infarction, and cerebral hemorrhage) in gout patients in different regions were assessed. In total, 231,668 patients with gout were studied. Regional differences in cardiovascular risk profiles before the diagnosis were observed. Multivariable analysis showed that patients with gout in Jeolla/Gwangju had a significantly high risk of myocardial infarction (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.02~1.56; p=0.03). In addition, patients with gout in Gangwon (aHR, 1.38; 95% CI, 1.09~1.74; p<0.01), Jeolla/Gwangju (aHR, 1.41; 95% CI, 1.19~1.67; p<0.01), and Gyeongsang/Busan/Daegu/Ulsan (aHR, 1.37; 95% CI, 1.19~1.59; p<0.01) had a significantly high risk of cerebral infarction. We found there were regional differences in cardiovascular risk and associated risk factors in gout patients. Physicians should screen gout patients for cardiovascular risk profiles in order to facilitate prompt diagnosis and treatment.

Outcome of novel oral anticoagulant versus warfarin in frail elderly patients with atrial fibrillation: a systematic review and meta-analysis of retrospective studies

ABSTRACT Background Frail patients with atrial fibrillation (AF) are thought to be at a higher risk for cerebral infarction and death than patients who are not frail, making preventive interventions important. Anticoagulants should be used in frailty patients with AF. However, there are limited data about anticoagulants in frail patients with AF. Therefore, we concucted this meta-analysis to find the best anticoagulation strategy. Methods Systematic electronic searches were conducted on 4 July 2022 4 July 2022, in PubMed, Embase (Ovid), and Cochrane Library. Relevant and eligible cohort studies were included. A random-effects model was used to estimate the pooled Hazard ratio (HR) and 95% confidence intervals (CI). Furthermore, we performed a publication bias analysis and subgroup analysis to explore the source of heterogeneity. Result 3 publications (10 cohorts, 188573 participants) met our inclusion criteria. The pooled analysis showed that ischemic strokes (HR: 0.75; 95%CI: 0.71 to 0.79; I 2 = 60.2%), systemic embolism (HR: 0.75; 95%CI: 0.64 to 0.87; I = 68.6%), major bleeding(HR: 0.76; 95%CI: 0.64 to 0.89; I2 = 97.4%), intracranial hemorrhage (HR: 0.57; 95%CI: 0.45 to 0.71; I 2 = 54.6%) and cardiovascular death(HR: 0.61; 95%CI: 0.51 to 0.70; I2 = 83.2%) were lower in NOACs as compared with warfarin. Regarding gastrointestinal bleeding, meta-analysis showed no significant differences in the risk of gastrointestinal bleeding (HR: 0.97; 95%CI: 0.69 to 1.36; I2 = 95.9%). Conclusion NOAC was more effective and safety than warfarin in frail patients with AF.

Clinical impact of cerebral infarction in patients with non-small cell lung cancer.

Lung cancer patients have a high risk of cerebral infarction, but the clinical significance of cerebral infarction in advanced non-small cell lung cancer (NSCLC) remains unclear. This study aimed to comprehensively investigate the incidence, prognostic impact, and risk factors of cerebral infarction in patients with NSCLC. We retrospectively examined 710 consecutive patients with advanced or post-operative recurrent NSCLC treated between January 2010 and July 2020 at Kumamoto University Hospital. Cerebral infarction was diagnosed according to the detection of high-intensity lesions on diffusion-weighted magnetic resonance imaging regardless of the presence of neurological symptoms during the entire course from 3months before NSCLC diagnosis. The prognostic impact and risk factors of cerebral infarction were evaluated based on propensity score matching (PSM) and multivariate logistic regression analysis. Cerebral infarction occurred in 36 patients (5%). Of them, 21 (58%) and 15 (42%) patients developed asymptomatic and symptomatic cerebral infarction, respectively. PSM analysis for survival showed that cerebral infarction was an independent prognostic factor (hazards ratio: 2.45, 95% confidence interval (CI): 1.24-4.85, P = 0.010). On multivariate logistic regression analysis, D-dimer (odds ratio [OR]: 1.09, 95% CI 1.05-1.14, P < 0.001) and C-reactive protein (OR: 1.10, 95% CI 1.01-1.19, P = 0.023) levels were independent risk factors. Cerebral infarction occurred in 5% of NSCLC patients, and asymptomatic cerebral infarction was more frequent. Cerebral infarction was a negative prognostic factor and was associated with hyper-coagulation and inflammation. The high frequency of asymptomatic cerebral infarction and its risk in NSCLC patients with these conditions should be recognized.

Abstract TP52: Identification Of Thrombophilia(primary And Secondary) In Cerebral Infarction And Tia In The National Inpatient Sample 2016-2018

Objective: To assess the identification of thrombophilia (primary and secondary) in cerebral Infarction and TIA in a nationwide database to determine the potential prevalence of this association Methods and Results: We assessed indicators of hypercoagulability in the National Inpatient Sample (NIS) database for all patients compared to those with cerebral Infarction and TIA from 2016 to 2018 to determine the potential diagnostic yield out of a sample size of 21 million subjects. During this timeframe, the frequency of thrombophilia was 0.6% in all patients compared to 1.2% in cerebral infarct patients. Grouping by age ≤45 compared to &gt;45, thrombophilia was detected in 0.43% of those ≤45 compared to 0.67% in those &gt;45. Despite the relatively low frequency of thrombophilia detected, the odds ratio (OR) was 13.5, 95% CI 12.7 - 14.18, (p &lt;0.001) for cerebral infarction in those ≤45 compared to OR = 1.979, 95% CI 1.923 - 2.038, (p &lt;0.001) in the &gt;45 group. The OR was 12.4, 95%CI 11.916 - 12.95, (p &lt;0.001) compared to 1.519, 95% CI 1.489 - 1.550, (p &lt;0.001) for TIA patients in the ≤45 and &gt;45 age groups, respectively. A higher prevalence of thrombophilia was seen in the Caucasians (68.9% p &lt;0.001 in cerebral infarction, but not in TIA, 74.7% p &lt;0.56. The prevalence was also higher in females (55.9%, OR = 1.29, 95% CI 1.207 – 1.373 p &lt; 0.001) for cerebral infarction but not TIA, 65% p &lt; 0.132. Conclusion: There is a greater propensity for thrombophilia in association with cerebral infarction and TIA in younger patients. Caucasians and females with thrombophilia were also observed to have a higher risk of cerebral infarction.

Single nucleotide polymorphisms rs102313, rs118231 and rs201832 of CTEP TaqIB gene correlated with lipid metabolism abnormalities and cerebral infarction in patients with atherosclerosis.

The purpose of this study was to investigate the correlations of cholesterol ester transfer protein (CTEP) TaqIB gene polymorphism with lipid metabolism abnormalities and cerebral infarction (CI) in patients with atherosclerosis (AS). A case-control study was conducted on 100 AS patients complicated with (CI) as AS+CI group, and 200 AS patients with matched age, gender and race as controls (AS group). Single nucleotide polymorphisms (SNPs) rs102313, rs118231 and rs201832 in the promoter region of CTEP TaqIB gene were classified by conformational differential gel electrophoresis. Then, Chi-square test was carried out to determine whether the distribution frequency of CTEP TaqIB genotypes conforms to the law of genetic equilibrium. In the meantime, the correlations of gene polymorphisms and allelotypes in the promoter region of CTEP TaqIB with CI and lipid metabolism abnormalities in AS patients were analyzed. Hardy-Weinberg genetic equilibrium analysis showed that the three polymorphisms of CTEP TaqIB gene were in accordance with the genetic equilibrium distribution (p>0.05). Moreover, the results of gene association analysis revealed that the polymorphisms rs102313 and rs118231 and allelotypes in the promoter region of CTEP TaqIB gene were correlated with CI in AS patients (p<0.05). Specifically, AS patients with GG genotype and allele G at rs102313 and those with TT genotype and allele T at rs118231 had a higher risk of CI (p<0.05). Besides, the polymorphism rs102313 in the promoter region of CTEP TaqIB gene was markedly related to lipid metabolism abnormalities in AS patients (p<0.05). The polymorphisms rs102313 and rs118231 in the promoter region of CTEP TaqIB gene are associated with CI in AS patients, and the polymorphism rs102313 is remarkably correlated with lipid metabolism abnormalities in AS patients.

Correlation between stromal cell-derived factor 1 and the prognosis of transient ischemic attack

Background: Transient Ischemic Attack (TIA) (1) is a neurological dysfunction of transient cerebrovascular ischemia, which is more common in clinical practice. The risk of further progression to ischemic stroke after a higher TIA can be used as a strong early warning signal of cerebral infarction. Objectives: To explore the correlation between stromal cell-derived factor 1 (SDF-1) and the prognosis of TIA. Methods: A number of 65 patients with TIA were collected, the ABCD2 clinical risk prediction score was implemented, relevant tests and nuclear magnetic resonance imaging (MRI) were performed, and the SDF-1 was recorded in serum levels. End-point events were selected in patients after cerebral infarction in the short term. The statistical analysis method was used to evaluate TIA short-term development for the occurrence of cerebral infarction after risk, the severity of serum level of SDF-1, and infarction. Results: Based on the results, the high-risk group, middle-risk group, and low-risk group had statistically significant differences in serum SDF-1 levels (F=3.820; P&lt;0.05). Correlation analysis demonstrated that ABCD2 score was positively correlated with serum SDF-1 (r=0.349; P&lt;0.05). End-point events were included in the occurrence group and not included in the non-occurrence group. The SDF-1 level of the occurrence group was significantly higher than that of the non-occurrence group. Based on the cranial MRI results as the gold standard, the areas under the curve of the receiver operating characteristic curve (ROC) drawn based on the SDF-1, ABCD2 score, SDF-1 combined with the ABCD2 score, and the occurrence of end-point events were obtained at 0.717, 0.697, and 0.762, respectively. The sensitivity and specificity of SDF-1 were reported as 77.8% and 68.1%, respectively. The sensitivity and specificity of the ABCD2 score were 83.3% and 48.9%, respectively. The sensitivity and specificity of SDF-1 combined with the ABCD2 score were 72.2% and 76.6%, respectively. Conclusion: As evidenced by the obtained results, SDF-1 is associated with ABCD2 score risk classification. Patients with high levels of SDF-1 combined with the ABCD2 score have a higher risk of cerebral infarction. Elevated SDF-1 levels may indicate that TIA patients have a poor short-term prognosis and have a certain predictive value for the diagnosis of the risk of ischemic stroke in the short term.

Changes in Surgical Treatment for Pediatric Moyamoya Disease

Pediatric patients with moyamoya disease frequently exhibit extensive cerebral infarction at the time of initial presentation and even in the early postoperative period. Cerebral infarctions are more frequent in younger patients. Surgical revascularization is the treatment of choice for patients with moyamoya disease. We modified surgical strategies for patients with moyamoya disease to reduce the incidence of postoperative cerebral infarction. Between January 2004 and December 2015, 46 patients (74 hemispheres) with moyamoya disease, aged ＜18 years, were surgically treated at our hospital. Surgical strategy entailed indirect bypass by encephalo-galeo-myo-duro-synangiosis (EGMDS) (3 hemispheres) for the first era, EGMDS and superficial temporal artery-middle cerebral artery (STA-MCA) single anastomosis (67 hemispheres) for the second era, and EGMDS and double STA-MCA anastomosis (4 hemispheres) for the third era. A review of clinical findings and radiological data showed that surgical treatment is effective for patients with moyamoya disease. Direct bypass can reduce the incidence of postoperative cerebral infarction, especially in younger patients. Postoperative cerebral infarctions were observed in 8 patients, all of whom were aged ＜6 years. Of these, 5 infarctions occurred in the ipsilateral hemisphere (6.8%) and 3 in the contralateral hemisphere (4.0%). Postoperative temporary neurological deficit due to hyperperfusion that had completely resolved by the time of discharge was seen in 9 hemispheres. Considering these results, direct bypass can induce immediate improvements in cerebral circulation that are suitable for patients with rapidly progressive moyamoya disease. However, direct bypass is not completely safe for pediatric patients with moyamoya disease because of the resulting changes in postoperative cerebral hemodynamics. To prevent such complications, we recently performed STA-MCA double bypass as an initial treatment for patients with a high risk of cerebral infarction that can increase cerebral perfusion in areas supplied by both the upper and lower trunks of the middle cerebral artery in a balanced manner. The outcome of this strategy was favorable.

Left upper lobectomy is a risk factor for cerebral infarction after pulmonary resection: a multicentre, retrospective, case-control study in Japan.

The anatomical site of resected lobes may influence postoperative cerebral infarction. The objective of the current study was to determine if left upper pulmonary lobectomy is a risk factor for postoperative cerebral infarction. This was a retrospective case-control study in patients undergoing pulmonary lobectomy from 2004 to 2013 in Japan. We retrospectively identified 610 patients from 153 institutions who had developed postoperative cerebral infarction following pulmonary lobectomy. The control group consisted of 773 patients who underwent lobectomy without cerebral infarction during a randomly selected single month in 2009 at the same institutions. Factors associated with cerebral infarction were age [10-year intervals, odds ratio (OR): 1.46; 95% confidence interval (CI): 1.23-1.73; p < 0.001], male sex (OR 1.92; 95% CI 1.29-2.86; p = 0.001), presence of comorbidities (OR 1.82; 95% CI 1.35-2.44; p < 0.001), perioperative anti-platelet or anti-coagulant drug use (OR 1.71; 95% CI 1.20-2.45; p = 0.003), and lobectomy. Subgroup analyses revealed that cerebral infarction was strongly associated with left upper lobectomy. Our findings suggest that left upper lobectomy is associated with a higher risk of cerebral infarction than other types of lobectomy, particularly in the early postoperative period.

Asymptomatic carotid intraplaque hemorrhage is associated with a high risk of cerebral infarction and death after cardiovascular surgery

BackgroundThere is a lack of information on the natural history of asymptomatic carotid artery stenosis (AsymCS) associated with cardiovascular diseases that require surgery. The aim of this study was to investigate risk factors for postoperative ipsilateral ischemic stroke and all-cause mortality after cardiovascular surgery in patients with AsymCS. MethodsAmong 2158 patients who underwent cardiovascular surgery, 150 patients with AsymCS who didn't undergo carotid revascularization were included. The relationships between preoperative factors, including carotid intraplaque hemorrhage (IPH), and postoperative ipsilateral ischemic stroke and all-cause mortality were analyzed retrospectively. ResultsDuring the median follow-up of 1087 days of 150 patients with 19 IPH, 12 (8.0%) and 21 (14.0%) encountered ipsilateral infarction and all-cause mortality, respectively. Multivariable Cox regression analyses indicated that IPH was significantly predictive of both ipsilateral infarction (hazard ratio [HR] 21.31, 95% confidence interval [CI], 4.98–91.17; P ≤.001) and all-cause mortality (HR 4.64, 95% CI, 1.61–13.34; P = .004). Another significant factor was peak systolic velocity for ipsilateral infarction with the cutoff velocity of 227 cm/s by the receiver-operating characteristic curve. ConclusionsIn this cohort of patients with AsymCS undergoing cardiovascular surgery, IPH had a close connection with a high risk of both postoperative ischemic stroke and mortality after cardiovascular surgery.

Concomitant Ro/SSA and La/SSB antibodies are biomarkers for the risk of venous thromboembolism and cerebral infarction in primary Sjögren's syndrome.

BackgroundTo assess the risk of incident cardiovascular disease in patients with primary Sjögren's syndrome, overall and stratified by Ro/SSA and La/SSB autoantibody status.MethodsA cohort of patients with primary Sjögren's syndrome in Sweden (n = 960) and matched controls from the general population (n = 9035) were included, and data extracted from the National Patient Register to identify events of myocardial infarction, cerebral infarction and venous thromboembolism. Hazard ratios were estimated using cox proportional hazard regressions.ResultsDuring a median follow‐up of 9.5 years, the overall hazard ratio (HR) was 1.6 (95% CI 1.2–2.1) for myocardial infarction, 1.2 (95% CI 0.9–1.7) for cerebral infarction and 2.1 (95% CI 1.6–2.9) for venous thromboembolism. Patients positive for both Ro/SSA and La/SSB autoantibodies had a substantially higher risk of cerebral infarction (HR 1.7, 95% CI 1.0–2.9) and venous thromboembolism (HR 3.1, 95% CI 1.9–4.8) than the general population. These risks were not significantly increased in Ro/SSA‐ and La/SSB‐negative patients. Among autoantibody‐positive patients, the highest HR of cerebral infarction was seen after ≥10 years disease duration (HR 2.8, 95% CI 1.4–5.4), while the HR for venous thromboembolism was highest 0–5 years after disease diagnosis (HR 4.7, 95% CI 2.3–9.3) and remained high throughout disease duration.ConclusionsPrimary Sjögren's syndrome is associated with a markedly increased risk of cardiovascular disease and the presence of Ro/SSA and La/SSB autoantibodies identify the subgroup of patients carrying the highest risk. These findings suggest that monitoring and prevention of cardiovascular disease in this patient group should be considered.

Elevated hemoglobin is associated with cerebral infarction in Tibetan patients with primary hemorrhagic neurovascular diseases

ObjectivesAlthough many studies have focused on primary hemorrhagic neurovascular diseases (PHNVDs) in different races, studies of PHNVDs in the plateau area of China are still insufficient. Chinese Tibetan people are the largest population living in the plateau area. Previous studies have shown that Tibetan PHNVD patients have a significantly higher incidence of cerebral infarction, but the mechanism remains uncertain. This study aimed to develop a better understanding on the mechanism of their high risk of cerebral infarction. Patients and methodsIn this retrospective case control study, we used a hospital information system to search for consecutive Tibetan patients with PHNVDs from January 2012 to June 2016. Intra-hospital data including baseline information and complications were recorded, and the risk factors for cerebral infarction were analyzed. ResultsUnivariate analysis and cox proportional hazard multivariate regression analysis revealed that elevated hemoglobin (HGB) concentration was positively associated with an increased incidence of cerebral infarction (P<0.001). The cutoff value that maximized the ability to predict in-hospital infarction in Tibetans with PHNVDs was 15.2g/dL. Tibetan PHNVD patients with an increased HGB concentration were more likely to present with cerebral infarction within the first 5days after onset of PHNVDs, and the probability was highest on the 3rd day. ConclusionsHGB levels could be used to predict in-hospital cerebral infarction in Tibetan patients with PHNVDs. These patients are more likely to develop in-hospital infarction when the HGB concentration is higher than 15.2g/dL. For Tibetan PHNVD patients with an elevated HGB concentration, most cerebral infarctions occurred within the first five days after onset, with more incidents occurring on the third day.

Body mass index and stroke incidence in Japanese community residents: The Jichi Medical School (JMS) Cohort Study.

BackgroundHigh body mass index (BMI) has been reported as a risk factor for cardiovascular events in Western countries, while low BMI has been reported as a risk factor for cardiovascular death in Asian countries, including Japan. Although stroke is a major cause of death and disability in Japan, few cohort studies have examined the association between BMI and stroke incidence in Japan. This study aimed to examine the association between BMI and stroke incidence using prospective data from Japanese community residents.MethodsData were analyzed from 12,490 participants in the Jichi Medical School Cohort Study. Participants were categorized into five BMI groups: ≤18.5, 18.6–21.9, 22.0–24.9, 25.0–29.9, and ≥30.0 kg/m2. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard model. The group with a BMI of 22.0–24.9 kg/m2 was used as the reference category.ResultsDuring mean follow-up of 10.8 years, 395 participants (207 men and 188 women) experienced stroke, including 249 cerebral infarctions and 92 cerebral hemorrhages. Men with a BMI ≤18.5 kg/m2 (HR 2.11; 95% CI, 1.17–3.82) and women with a BMI ≥30.0 kg/m2 (HR 2.25; 95% CI, 1.28–5.08) were at significantly higher risk for all-stroke. Men with a BMI ≤18.5 kg/m2 were at significantly higher risk for cerebral infarction (HR 2.15; 95% CI, 1.07–4.33).ConclusionsThe association between BMI and stroke incidence observed in this population was different than those previously reported: low BMI was a risk factor for all-stroke and cerebral infarction in men, while high BMI was a risk factor for all-stroke in women.

Blood blister-like aneurysms in Tibetans: A retrospective observational study

ObjectAlthough research on blood blister-like aneurysms (BLAs) in different population is well documented, studies of that in the plateau area remain elusive. This study aimed to develop a better understanding of BLAs in Tibetan population, which is a typical representation of people in plateau area. MethodsIn this retrospective observational study, the hospital information system (HIS) was used to search for consecutive patients with BLAs by using the discharge diagnoses. A total of 19 Tibetan patients and 34 Han patients were recruited from January 2012 to January 2016. Intra-hospital and follow-up data were collected and compared between two races. ResultsCompared with Han group, Tibetan group got significantly higher ratio of BLAs among aneurysmal subarachnoid hemorrhages (aSAHs) (19.6% (19/97) vs 3.2% (34/1071), p<0.001), higher Incidence of atypical located BLAs (26.3% vs 2.9%, p=0.034), higher risk of cerebral infarction (63.2% vs 11.8%, p<0.001), and greater number of patients with unfavorable outcomes at 6 months after ictus (57.9% vs 23.5%, p=0.028). In Tibetan group, patients underwent endovascular treatment presented with significantly lower cerebral infarction rate (p=0.019) and better neurological functional recovery outcome (p=0.048) compared with surgical group. ConclusionsCompared with Han patients, Tibetan BLA patients presented with high risk of occurrence with atypical locations and high incidence of cerebral infarctions with poor prognoses. Endovascular treatment benefits more for Tibetan BLA patients in reducing cerebral infarctions and improving neurological functional recovery prognosis.

Menstrual Factors and Stroke Incidence in Japanese Postmenopausal Women: The Ohasama Study

Background: The association between stroke and menstrual factors, for example, age at the time of menarche and age at the time of menopause, has not been well studied so far and the findings are inconsistent. We sought to examine this association in Japanese postmenopausal women. Methods: We followed 1,412 postmenopausal women aged ≥35 without a history of stroke in Ohasama, Japan. Baseline data were collected using a self-administered questionnaire. Adjusted hazard ratios (HRs) and 95% CIs of each menstrual factor for stroke incidence were calculated using the Cox proportional hazard model. Results: During a median follow-up of 12.8 years, 143 participants developed a stroke for the first time. Women aged ≤13 at the time of menarche had a significantly higher probability of encountering a stroke incidence in their lives compared with women aged 15 at the time of menarche (HR 1.83; 95% CI 1.04-3.22). The same was also true for cerebral infarction (HR 2.34; 95% CI 1.18-4.66). While early menopause was not significantly associated with stroke incidence, women aged ≤45 at the time of menopause faced a higher risk for cerebral infarction compared with women aged 50 years at the time of menopause (HR 3.25; 95% CI 1.54-6.86). Conclusions: Early menarche and its associated features might be a useful tool for future intervention strategies targeting modifiable factors that trigger menstrual onset.

The international normalized ratio (INR) as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

Abstract It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF). While oral anticoagulation with vitamin K antagonists (AVKs) substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR) in order to achieve therapeutic levels (2,0-3,0). The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2) were seen in thirty-five of these individuals (38,8%), while 55 (61,2%) showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p&lt;0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.

Association between tumor necrosis factor superfamily member 4 gene polymorphism and risk of asymptomatic carotid vulnerable plaque in a Chinese population

Vulnerable plaque of carotid artery is one of the risk factors of atherosclerotic cerebral infarction. Detection and treatment of vulnerable atherosclerotic plaque of carotid artery before symptoms of cerebral infarction is an effective way to prevent atherosclerotic cerebral infarction. Tumor necrosis factor superfamily member 4 (TNFSF4) plays a key role in the process of atherosclerosis, a common risk factor for both myocardial and cerebral infarctions. Studies have indicated that the single nucleotide polymorphism (SNP) rs3850641 in TNFSF4 is associated with higher risk of myocardial infarction and SNP rs3861950 in TNFSF4 is associated with higher risk of atherosclerosis cerebral infarction (ACI) ,but little is known about the association between TNFSF4 variations and vulnerable plaque of carotid artery. A case-control study involving 510 patients with asymptomatic vulnerable plaque of carotid artery and 485 age and sex matched healthy subjects without vulnerable plaque of carotid artery was conducted in Hunan province. Asymptomatic vulnerable plaque of carotid artery means vulnerable plaque of carotid artery without cerebral infarction. Two SNPs of TNFSF4, rs3850641 and rs3861950, were genotyped by the TaqMan SNP genotyping method, and verified partly by Genomic DNA Sequencing. The results revealed a significant allelic association between rs3861950 and asymptomatic vulnerable plaque of carotid artery in case group (χ(2)=9.13, P=0.003; OR=1.41, 95%CI: 1.12-1.76). Compared with control subjects, the difference in genotype was significant in case group (χ(2)=25.28, P<0.000 1). However, there was no significant association between rs3850641 and asymptomatic vulnerable plaque of carotid artery (OR=1.16, 95%CI: 0.92-1.46; χ(2)=1.47, P=0.225). TNFSF4 gene polymorphism rs3861950 was associated with the risk of vulnerable plaques of carotid artery in a Chinese population, which might be middle phenotype indicating higher risk of cerebral infarction.