Disrupted Functional Connectivity Within and Between Resting-State Networks in the Subacute Stage of Post-stroke Aphasia

Background: Post-stroke aphasia (PSA) results from brain network disorders caused by focal stroke lesions. However, it still remains largely unclear whether the impairment is present in intra- and internetwork functional connectivity (FC) within each resting-state network (RSN) and between RSNs in the subacute stage of PSA.Objectives: This study aimed to investigate the resting-state FC within and between RSNs in patients with PSA and observe the relationships between FC alterations and Western Aphasia Battery (WAB) measures.Methods: A total of 20 individuals with subacute PSA and 20 healthy controls (HCs) were recruited for functional MRI (fMRI) scanning, and only patients with PSA underwent WAB assessment. Independent component analysis was carried out to identify RSNs. Two-sample t-tests were used to calculate intra- and internetwork FC differences between patients with PSA and HCs. The results were corrected for multiple comparisons using the false discovery rate (FDR correction, p < 0.05). Partial correlation analysis was performed to observe the relationship between FC and WAB scores with age, gender, mean framewise displacement, and lesion volume as covariates (p < 0.05).Results: Compared to HCs, patients with PSA showed a significant increase in intranetwork FC in the salience network (SN). For internetwork FC analysis, patients showed a significantly increased coupling between left frontoparietal network (lFPN) and SN and decreased coupling between lFPN and right frontoparietal network (rFPN) as well as between lFPN and posterior default mode network (pDMN) (FDR correction, p < 0.05). Finally, a significant positive correlation was found between the intergroup difference of FC (lFPN-rFPN) and auditory-verbal comprehension (p < 0.05).Conclusion: Altered FC was revealed within and between multiple RSNs in patients with PSA at the subacute stage. Reduced FC between lFPN and rFPN was the key element participating in language destruction. These findings proved that PSA is a brain network disorder caused by focal lesions; besides, it may improve our understanding of the pathophysiological mechanisms of patients with PSA at the subacute stage.

To the assessment of changes in the electrocardiogram in coronary insufficiency

In the literature there are a number of reports on the effect of physical activity on the coronary circulation, but we did not find any works on the effect of a regimen with restriction of muscle movements on the ECG of patients with coronary insufficiency. This article reports the results of research on this issue. In addition, ECG changes were studied in patients in the subacute stage of myocardial infarction under the influence of walking.

In vivo Imaging of Cannabinoid Type 2 Receptors: Functional and Structural Alterations in Mouse Model of Cerebral Ischemia by PET and MRI

Purpose Stroke is one of the most prevalent vascular diseases. Non-invasive molecular imaging methods have the potential to provide critical insights into the temporal dynamics and follow alterations of receptor expression and metabolism in ischemic stroke. The aim of this study was to assess the cannabinoid type 2 receptor (CB2R) levels in transient middle cerebral artery occlusion (tMCAO) mouse models at subacute stage using positron emission tomography (PET) with our novel tracer [18F]RoSMA-18-d6 and structural imaging by magnetic resonance imaging (MRI). Procedures Our recently developed CB2R PET tracer [18F]RoSMA-18-d6 was used for imaging neuroinflammation at 24 h after reperfusion in tMCAO mice. The RNA expression levels of CB2R and other inflammatory markers were analyzed by quantitative real-time polymerase chain reaction using brain tissues from tMCAO (1 h occlusion) and sham-operated mice. [18F]fluorodeoxyglucose (FDG) was included for evaluation of the cerebral metabolic rate of glucose (CMRglc). In addition, diffusion-weighted imaging and T2-weighted imaging were performed for anatomical reference and delineating the lesion in tMCAO mice. Results mRNA expressions of inflammatory markers TNF-α, Iba1, MMP9 and GFAP, CNR2 were increased to 1.3–2.5 fold at 24 h after reperfusion in the ipsilateral compared to contralateral hemisphere of tMCAO mice, while mRNA expression of the neuronal marker MAP-2 was markedly reduced to ca. 50 %. Reduced [18F]FDG uptake was observed in the ischemic striatum of tMCAO mouse brain at 24 h after reperfusion. Although higher activity of [18F]RoSMA-18-d6 in ex vivo biodistribution studies and higher standard uptake value ratio (SUVR) were detected in the ischemic ipsilateral compared to contralateral striatum in tMCAO mice, the in vivo specificity of [18F]RoSMA-18-d6 was confirmed only in the CB2R-rich spleen. Conclusions This study revealed an increased [18F]RoSMA-18-d6 measure of CB2R and a reduced [18F]FDG measure of CMRglc in the ischemic striatum of tMCAO mice at subacute stage. [18F]RoSMA-18-d6 might be a promising PET tracer for detecting CB2R alterations in animal models of neuroinflammation without neuronal loss.

RELATIONSHIP OF D-DIMERS WITH THE DURATION OF CEREBRAL VENOUS SINUS THROMBOSIS (CVST): A DESCRIPTIVE STUDY IN TERTIARY HEALTH CARE HOSPITAL OF DISTRICT PESHAWAR PAKISTAN.

Purpose CVST is a serious condition with a recent incidence of 13 million persons per year. (1) It has a highly variable presentation and may manifest itself with no recognizable risk factor, Magnetic resonance venography (MRV) is the investigation of choice for its diagnosis. However, since MRV is not readily available and is costly, this study tried to find the relationship between the levels of D-dimers as marker and duration of CVST. D-dimers are degraded fibrin products which are found to be raised in pulmonary embolism and deep venous thrombosis. Methods: Total 49 patients (male to female ratio 1:6) mean age 36.37 13years) with MRV proven CVST were included in the study. This descriptive cross-sectional study was conducted from January 2015-April 2017, on 49 confirmed patients of CVST, in Lady Reading Hospital. In patients suspected of CVST, magnetic resonance imaging of the brain with MRV was performed without delay on a 1.5 tesla MR scanner using T1, T2, flair, and diffusion weighted imaging sequences with a two-dimensional time of flight MRV. D-dimers were estimated by a rapid latex agglutination slide test technique using monoclonal antibodies. Data was analyzed using SPSS version 19. Frequencies, mean were calculated for quantitative data while Chi-square test was used for qualitative data. Sensitivity and specificity were calculated. Result: The duration of symptoms was 3-60 days (mean 22 days). The mean value of D-dimers levels recorded in micrograms were recorded as 1456 Conclusion: D-dimers levels were high in acute and subacute stage of CVST. However, there were cases in our study who despite having acute and subacute stage of CVST had normal D-dimers levels for unknown reasons.

Day-by-Day Blood Pressure Variability in the Subacute Stage of Ischemic Stroke and Long-Term Recurrence

Background and Purpose: This study aimed to determine whether variability of day-by-day blood pressure (BP) during the subacute stage of acute ischemic stroke is predictive of long-term stroke recurrence. Methods: We analyzed 7665 patients (mean±SD age: 72.9±13.1 years; women: 42.4%) hospitalized for first-ever ischemic stroke in 7 stroke centers in Fukuoka, Japan, from June 2007 to November 2018. BP was measured daily during the subacute stage (4–10 days after onset). Its mean and coefficient of variation (CV) values were calculated and divided into 4 groups according to the quartiles of these BP parameters. Patients were prospectively followed up for recurrent stroke or all-cause death. The cumulative event rate was calculated with the Kaplan-Meier method. We estimated the hazard ratios and 95% confidence intervals of the events of interest after adjusting for potential confounders and mean BP values using Cox proportional hazards models. The Fine-Gray model was also used to account for the competing risk of death. Results: With a mean (±SD) follow-up duration of 3.9±3.2 years, the rates of recurrent stroke and all-cause death were 3.9 and 9.9 per 100 patient-years, respectively. The cumulative event rates of recurrent stroke and all-cause death increased with increasing CVs of systolic BP and diastolic BP. The systolic BP CV was significantly associated with an increased risk of recurrent stroke after adjusting for multiple confounders and mean BP (hazard ratio [95% CI] for fourth quartile versus first quartile, 1.26 [1.05–1.50]); the risk of recurrent stroke also increased with an increasing systolic BP CV for nonfatal strokes (1.26 [1.05–1.51]) and when death was regarded as a competing risk (1.21 [1.02–1.45]). Similar associations were observed for the diastolic BP CV. Conclusions: Day-by-day variability of BP during the subacute stage of acute ischemic stroke was associated with an increased long-term risk of recurrent stroke.

Design and simulation of an equipment for the rehabilitation of people affected by ACV, starting from the subacute stage

Cerebrovascular Accident (CVA) or stroke is a disease that results in paralysis of one side of the body. Physical therapy is generally used as a muscular rehabilitation tool that involves different techniques and exercises. For it to be effective, the process must be accompanied by the constancy and discipline with which the routines are performed, which are frequently limited to the hospital environment, causing an interruption in the development of recovery due to the absence of home mechanisms that facilitate its execution in a safe and complete manner. In Colombia, these aspects are enhanced by intervening factors such as: extensive travel from rural areas to care sites, accessibility to specialized centers, among others. That is why this article provides the proposal of an equipment that contributes to CVA rehabilitation from the subacute stage. The design and operation were developed and simulated through Solidworks 2018 Software, involving a series of exercises for upper and lower limbs considered by physiotherapists as of high importance in the treatment of the disease; it means, they can be executed by the patient under ergonomic and safety conditions.

Acute anterior myocardial infarction complicated by a large ventricular septal defect

Post-Infarction Ventricular Septal Defect (PIVSD) are a rare complication of Acute Myocardial Infarction (AMI). According to clinical guidelines, surgical repair of a PIVSD is the recommended acute-stage course of treatment. Nevertheless, thoracotomy is not always clinically suggested for patients with unstable hemodynamics and otherwise at high risk. Currently, percutaneous interventional closure of a PIVSD represents an alternative therapy, and an attractive option for particular patients [1,2]. Here we report a 67-year-old man was transferred to Shenzhen Sun yat-sen Cardiovascular Hospital to evaluate a PIVSD and undergo repair. Echocardiography confirmed a large Ventricular Septal Defect (VSD) and significant left-to-right shunt (Figure 1a). Few reports of the closure of a PIVSD at an acute/subacute stage have been previously published. An interventional closure treatment (Amplatzer Septal Occluder device) was successfully performed after bridging to a subacute stage through use of mechanical circulatory backup (Figure 1b).

In Vivo Imaging of Cannabinoid Type 2 Receptors, Functional and Structural Alterations in Mouse Model of Cerebral Ischemia by PET and MRI

Background and purposeBrain ischemia is one of the most important pathologies of the central nervous system. Non-invasive molecular imaging methods have the potential to provide critical insights into the temporal dynamics and follow alterations of receptor expression and metabolism in ischemic stroke. The aim of this study was to assess the cannabinoid type 2 receptors (CB2R) levels in transient middle cerebral artery occlusion (tMCAO) mouse models at subacute stage using positron emission tomography (PET) with our novel tracer [18F]RoSMA-18-d6, and structural imaging by magnetic resonance imaging (MRI). MethodsOur recently developed CB2R PET tracer [18F]RoSMA-18-d6 was used for imaging the neuroinflammation at 24 h after reperfusion in tMCAO mice. The RNA expression levels of CB2R and other inflammatory markers were analyzed by quantitative real-time polymerase chain reaction using brain tissues from tMCAO (1 h occlusion) and sham-operated mice. [18F]fluorodeoxyglucose (FDG) was included for evaluation of the cerebral metabolic rate of glucose (CMRglc). In addition, diffusion-weighted imaging and T2-weighted imaging were performed for anatomical reference and delineating the lesion in tMCAO mice. ResultsmRNA expressions of inflammatory markers TNF-a, Iba1, MMP9 and GFAP, CNR2 were increased at 24 h after reperfusion in the ipsilateral compared to contralateral hemisphere of tMCAO mice, while mRNA expression of the neuronal marker MAP-2 was markedly reduced. Reduced [18F]FDG uptake was observed in the ischemic striatum of tMCAO mouse brain at 24 h after reperfusion. Although higher activity of [18F]RoSMA-18-d6 in ex-vivo biodistribution studies and higher standard uptake value ratio (SUVR) were detected in the ischemic ipsilateral compared to contralateral striatum in tMCAO mice, the in-vivo specificity of [18F]RoSMA-18-d6 was confirmed only in the CB2R-rich spleen. ConclusionsThis study revealed an increased [18F]RoSMA-18-d6 measure of CB2R and a reduced [18F]FDG measure of CMRglc in ischemic striatum of tMCAO mice at subacute stage. [18F]RoSMA-18-d6 might be a promising PET tracer for detecting CB2R alterations in animal models of neuroinflammation without neuronal loss.

Bronchoscopic Features and Correlative Factor Analysis of Severe Mycoplasma pneumoniae Pneumonia in Children.

Objectives: We aimed to determine the bronchoscopic features of children with severe Mycoplasma pneumoniae pneumonia (SMPP), and correlation with obliterative bronchitis (OB), so as to help early clinical evaluation and treatment of pediatric SMPP. Methods: 213 pediatric SMPP cases admitted to Beijing Children’s Hospital were included. Medical records and bronchoscopic manifestations at different SMPP stages were retrospectively analyzed . Results: Of 213 acute-stage pediatric SMPP patients, bronchoscopy revealed 22 cases (10.3%) with subacute-stage or recovery-stage OB, for an OB incidence rate in cases with mucous embolus of 48.8% (22/47), a significantly higher rate than the rate without mucous embolus (0/166, 0%) (P < 0.001). Notably, the OB incidence rate for children undergoing bronchoscopy within 10 days (9/142, 6.3%) of SMPP onset was significantly lower than in children undergoing bronchoscopy 10 days post-disease onset (13/71, 76.5%) (P < 0.007). Conclusions: In pediatric SMPP patients, airway mucus and debris from epithelial necrosis and exfoliation can block airway subbranches, readily leading to OB.