1,721,086 research outputs found
Obesity paradox and stroke: a narrative review
No full textBACKGROUND: Despite obesity is an established risk factor for stroke, several studies reported a better outcome after stroke in obese and overweight patients. This counterintuitive finding, which was described in the whole spectrum of cardiovascular diseases, is known as obesity paradox. OBJECTIVE: This is a narrative overview on the obesity paradox and stroke. METHODS: We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library from inception to 2019, and selected papers that discussed the association of obesity with outcome and mortality after stroke. RESULTS: The majority of studies reported lower mortality rates and better functional outcome after stroke in obese and overweight patients compared with normal weight and underweight patients, suggesting the existence of an obesity paradox in stroke. However, available studies are limited by several major methodological concerns including absence of randomized trials, retrospective nature of most studies, assessment of obesity with body mass index (BMI), non-linear relationship between BMI and outcome, short follow-up period, and differences in co-morbid conditions and stroke characteristics. CONCLUSIONS: The existence of an obesity paradox in stroke is still controversial and further higher quality evidence is needed to clarify the relationship between obesity and stroke outcome. LEVEL OF EVIDENCE: Level V, narrative review
Multiple sclerosis: expression of molecules of the tumor necrosis factor ligand and receptor families in relationship to the demyelinated plaque
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Number of ischemic strokes potentially eligible for revascularization treatments in an Italian Comprehensive Stroke Center: a modeling study
No full textTo rationally plan acute services, the proportion of ischemic strokes that may be eligible for revascularization treatments should be estimated. We aimed to estimate the proportion of patients directly admitted to an Italian Comprehensive Stroke Center who may be eligible for intravenous thrombolysis (IVT), combined IVT and endovascular thrombectomy (ET), or direct ET according to the current guidelines. We conducted a retrospective analysis based on data prospectively collected from 876 consecutive adult ischemic stroke patients who were directly admitted to the Stroke Unit of the University Hospital of Verona within 12 h of stroke onset. A theoretical model was created to calculate the proportion of patients potentially eligible for revascularization treatments. In our cohort, 289 (33%) patients would be eligible for IVT alone, 193 (22%) for combined IVT and ET, and 39 (4%) for direct ET with level of evidence IA according to the current guidelines. According to our theoretical model, more than half of the ischemic stroke patients directly admitted to Verona Stroke Unit within 12 h of stroke onset would be eligible for IVT and more than a quarter for ET. Systems of care should promptly organize to offer each patient the best treatment
Multiple sclerosis: oligodendrocytes display cell death-related molecules in situ but do not undergo apoptosis
No full textTo investigate whether apoptosis is involved in the fate of oligodendrocytes in chronic multiple sclerosis lesions, the pro-apoptotic molecules fas and tumor necrosis factor receptors and the anti-apoptotic molecule bcl-2 were examined by immunohistochemistry, and DNA fragmentation was assessed by an end labeling technique. Fas and both tumor necrosis factor receptors were preferentially expressed on oligodendrocytes in multiple sclerosis lesions, this phenotype being more evident at the lesion edge. The ligand for fasL, was constitutively present at high levels on microglia. The anti-apoptotic molecule bcl-2 was selectively expressed on oligodendrocytes in silent lesions and on astrocytes in active lesions. These molecules were also detected in control material, albeit at lower levels. In chronic active lesions a few inflammatory cells displayed fas reactivity, whereas the majority expressed bcl-2. DNA fragmentation was found in a number of infiltrating cells and some microglia, whereas, with one possible exception, oligodendrocytes showed no evidence of apoptosis. Thus, while apoptosis is involved in the elimination of infiltrating cells, it plays little or no role in oligodendrocyte depletion in multiple sclerosis, a process that may be related to a lytic pathway. In addition, microglia constitutively displayed the ligand for fas, and appeared to be the major effector cell population in the central nervous system
Demyelinating polyradiculoneuritis following Coxiella burnetti infection (Q fever)
No full textNeurological complications of Coxiella burnetii infection (Q fever) are rare, although the occurrence of headache, paresthesias, and transient focal deficits has been reported. We report the case of a patient with a relapsing demyelinating polyradiculoneuritis as an aftermath of C. burnetti endocarditis and pneumonia
A proteomic approach to identify autoantigens in Hashimoto's encephalopathy [Un approccio proteomico per l'identificazione di autoantigeni nell'encefalopatia di Hashimoto]
No full textHashimoto's encephalopathy (HE) is a syndrome involving the central nervous system (CNS), characterized by an heterogeneous clinical presentation with neurological and/or neuropsychiatric symptoms associated with high titers of anti-thyroid antibodies. Although the pathogenesis of HE is still unclear, the response to steroid treatment suggests that autoimmune mechanisms may be involved. To date, the role of anti-thyroid IgG as well as the identification of the antigen(s) targeted by IgG remain unknown. We performed a proteomic study on 19 patients with HE and 15 controls based on bidimensional electrophoresis (2D) of human CNS proteins followed by immunoblotting with cerebrospinal fluid (CSF) of patients. The comparative analysis of 2D maps showed that CSF IgG from HE patients specifically recognized 3 spots in a range of pH from 5 to 7 and of MW from 31 to 37 kDa amongst a wide autoreactivity to neural antigens. After mass spectrometry analysis and immunoblotting with specific antibodies, these proteins were identified as dimethylargininase-I (DDAHI) and aldehyde reductase-I (AKRIAI). Almost 90% of HE patients targeted at least one of two isoforms of DDAHI, while few cases recognized AKRIAI. The present findings suggest DDAHI and AKRIAI as biomarkers of HE although further experimental evidence is needed to understand their pathogenetic and diagnostic role, if any. Our 2D proteomic approach appears to be a sensitive and reliable method to assess the autoimmune repertoire in HE, helping to identify potential autoantigens in CSF and sera of HE patients
Cytoskeletal changes and ubiquitin expression in dystrophic axons of Seitelberger's disease
No full textCentral nervous system specimens of 4 cases of Infantile Neuroaxonal Dystrophy (Seitelberger's disease) were processed for Bodian's silver stain and for immunostaining with antibodies against neurofilaments (NF), tubulin and ubiquitin (UBQ). Reactivity to NF and UBQ was restricted to spheroids of small size; swellings larger than 30 mu were negative, in spite of their positivity to Bodian's silver stain. Reactivity to tubulin was evident only in normal fibers, whereas no positive material was observed in dystrophic axons. These findings suggest that loss of microtubules (MT) and denaturation of NF might play a crucial role in the mechanisms responsible for the formation of axonal spheroids; in addition the focal activation of the UBQ system suggests an attempt of the neuron to remove abnormal material even at sites remote from the perikaryon
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