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Response to the letter: 'Transcranial direct current stimulation (tDCS) in acute stroke patients'
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MicroRNAs in kidney diseases: New promising biomarkers for diagnosis and monitoring
No full textA series of microRNAs (miRNAs) have a critical role in many cellular and physiological activities such as cell cycle, growth, proliferation, apoptosis and metabolism. miRNAs are also important in the maintenance of renal homeostasis and kidney diseases. In vitro and in vivo animal models have shown a critical role of miRNAs in the development of diabetic nephropathy (DN) and in the progression of renal fibrosis. Specific miRNAs in renal tissue and peripheral blood mononuclear cells (PBMCs) are up and downregulated in different kidney diseases. They represent new potential biomarkers for diagnosis and targeted therapy. In addition, urinary miRNAs may be considered non-invasive biomarkers for monitoring the progression of renal damage. The activity of miRNAs can be modified by different approaches such as the use of antisense oligonucleotide inhibitors (antagomirs), tandem miRNA-binding site repeats manufactured by Decoy or Sponge technologies and miRNA mimics. The use of miRNA blockers or antagonists as therapeutic agents is very attractive but new information will be necessary considering their role in other systems. © The Author 2013
Letter by Legge et al regarding article, "Safety of intravenous fibrinolysis in imaging-confirmed single penetrator artery infarcts"
No full textLetter by Diomedi et al regarding article "continuous stroke unit electrocardiographic monitoring versus 24-hour holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke"
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Intracranial dissection and extracranial hypoplasia of the internal carotid artery
No full textDissection of the intracranial portion of the internal carotid artery (ICA) is anuncommon cause of stroke or transient ischemic attack (TIA). Congenitalanomalies of the ICA have been rarely associated with cerebral ischemia.However, unilateral ICA hypoplasia can be frequently associated withintracranial arterial anomalies and altered hemodynamics.1We describe the case ofa woman who had sudden onset of right facial pain and transient left hemiparesis.Diffusion-weighted magnetic resonance imaging (MRI) findings were negative foracute ischemia. Magnetic resonance angiography (MRA) and sonography showedhypoplasia of the right extracranial ICA and vertebral artery (VA) and dissection ofthe intracranial portion of the right ICA and right middle cerebral artery (MCA), withinverted flow of the right anterior cerebral artery (ACA). At 12-month imaging stud-ies, the intracranial hemodynamics appeared normalized, whereas the extracranialfindings were unchanged. This case shows an association between hypoplasia, dis-section of the ICA, and cerebral ischemi
Ischemic stroke: From acute treatment to long-term recovery
No full textIschemic stroke (IS) is due to the sudden occlusion of a cerebral artery with the consequence of a critical reduction in cerebral blood flow in a localized region (rCBF) of the brain. It represents the second cause of death and the leading cause of neurological disability in developed countries. Primarily due to the resulting economic burden, IS is considered a world-wide challenge. Different strategies can be identified to face this challenge: acute treatment, primary and secondary prevention, rehabilitation. For several years acute IS treatment has been based on the use of the only current drug approved in the first 3 hours from symptom onset: recombinant tissue plasminogen activator (rtPA). However, mainly due to the short therapeutic window, a low percentage of patients can be actually treated by rtPA. Thus, with improving diffusion of more accurate diagnostic tools and of prognostic informations in different clinical scenarios, new treatment strategies in the acute phase have been developed such as intra-arterial and mechanical thrombolysis. Prevention plays a crucial role in counteracting the economic burden of IS through life-style changes, vascular risk factors control (with arterial hypertension being the main one for IS) and antiplatelet therapy. Moreover prevention therapy has been enriched by the introduction, in the last few years, of new drugs with pleiotropic effects such as statins and ACE-inhibitors. Also potential pleiotropic effects of antidiabetic drugs are currently under investigation. New insights in secondary prevention come from the use of phosphodiesterase inhibitors such as dipyridamole (in combination with aspirine) and cilostazol. The latter demonstrated to be more effective than aspirin in reducing the risk of recurrent stroke with the advantage of dramatically reducing the risk of haemorrhagic events as compared to aspirin. Rehabilitation strategies are weighted, together with acute IS treatment, by most of stroke physicians and patients expectations. Among them transcranial magnetic stimulation (TMS) is a new tool able to explore and affect critical aspects of neural plasticity, thus being of great importance in the understanding and treatment of those fundamental functional recovery mechanisms triggered after stroke. The present chapter will focus on standard, current and new potential treatments of acute phase, prevention and rehabilitation of IS. © 2013 Nova Scicence Publishers, Inc. All rights reserved
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