M. Agarkov, A. Safuanov, S.T. Evreeva, O.B. Gertsog, O.S. Safuanova, Vitaly V. Popov, A. Khilchuk
We describe a case of 72-year-old patient with recurrent transient ischemic attacks in the right internal carotid artery (ICA) territory associated with uncontrolled hypertension. Duplex ultrasonography und carotid angiography showed a 60% stenosis with signs of a vulnerable plaque in the cervical segment, as well as a 90% stenosis in the cavernous segment of the right ICA. After further examination the patient was diagnosed with an 80% renal artery stenosis. First, the patient had a single-stage stenting for extracranial and intracranial stenoses of the right ICA, then left renal artery stenting. No intraoperative and postoperative complications were observed. These results show that this surgical treatment is minimally invasive, safe, and effective in symptomatic patients and may be considered for the disease.
{"title":"Single-Stage Extracranial and Intracranial Stenting of the Internal Carotid Artery in a Patient with Open Circle of Willis and Associated Renovascular Hypertension","authors":"M. Agarkov, A. Safuanov, S.T. Evreeva, O.B. Gertsog, O.S. Safuanova, Vitaly V. Popov, A. Khilchuk","doi":"10.54101/acen.2023.2.11","DOIUrl":"https://doi.org/10.54101/acen.2023.2.11","url":null,"abstract":"We describe a case of 72-year-old patient with recurrent transient ischemic attacks in the right internal carotid artery (ICA) territory associated with uncontrolled hypertension. Duplex ultrasonography und carotid angiography showed a 60% stenosis with signs of a vulnerable plaque in the cervical segment, as well as a 90% stenosis in the cavernous segment of the right ICA. After further examination the patient was diagnosed with an 80% renal artery stenosis. First, the patient had a single-stage stenting for extracranial and intracranial stenoses of the right ICA, then left renal artery stenting. No intraoperative and postoperative complications were observed. These results show that this surgical treatment is minimally invasive, safe, and effective in symptomatic patients and may be considered for the disease.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86284007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mukhamedyarov, Liaisan A. Akhmadieva, K. K. Nagiev, A. Zefirov
Alzheimer's disease (AD) is the most common neurodegenerative disease and cause of dementia. It is associated with progressive cognitive decline due to the development of cortical and hippocampal atrophy. We reviewed key factors in AD pathogenesis, such as synaptic dysfunction, accumulation and aggregation of amyloid beta (A) peptide, tau phosphorylation causing neurofibrillary tangles, mitochondrial dysfunction, and neuroinflammation. We studied the dysbiosis role in AD development and demonstrated how much the bidirectional communication between the gut and brain sheds new light on some pathogenic processes underlying AD. We reviewed state-of-the-art biomedical technologies for studying AD: transgenic models, electrophysiological techniques, optogenetics, multi-omics approaches, neuroimaging, etc. New biomedical technologies significantly expanded our current knowledge of the AD pathogenesis and laid the groundwork for state-of-the-art treatment approaches.
{"title":"State-of-the-Art Technologies for Studying Cellular and Molecular Mechanisms Underlying Alzheimer's Disease","authors":"M. Mukhamedyarov, Liaisan A. Akhmadieva, K. K. Nagiev, A. Zefirov","doi":"10.54101/acen.2023.2.10","DOIUrl":"https://doi.org/10.54101/acen.2023.2.10","url":null,"abstract":"Alzheimer's disease (AD) is the most common neurodegenerative disease and cause of dementia. It is associated with progressive cognitive decline due to the development of cortical and hippocampal atrophy. \u0000We reviewed key factors in AD pathogenesis, such as synaptic dysfunction, accumulation and aggregation of amyloid beta (A) peptide, tau phosphorylation causing neurofibrillary tangles, mitochondrial dysfunction, and neuroinflammation. We studied the dysbiosis role in AD development and demonstrated how much the bidirectional communication between the gut and brain sheds new light on some pathogenic processes underlying AD. We reviewed state-of-the-art biomedical technologies for studying AD: transgenic models, electrophysiological techniques, optogenetics, multi-omics approaches, neuroimaging, etc. New biomedical technologies significantly expanded our current knowledge of the AD pathogenesis and laid the groundwork for state-of-the-art treatment approaches.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85496057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We reviewed current literature on the role of seasonal, meteorological, or circadian factors in ruptured cerebral aneurysms. We found that cerebral aneurysm rupture most frequently occurs in winter and spring, and less frequently in summer. The highest number of ruptured cerebral aneurysms happens in the morning, between 8 am and 12 pm. The data regarding meteorological factors' effect on the risk of cerebral aneurysm rupture are conflicting. However, it should be noted that changes in barometric pressure and falling temperature are associated with the risk of aneurysmal subarachnoid hemorrhage.
{"title":"Several Risk Factors for Aneurysmal Subarachnoid Hemorrhage","authors":"P. Shnyakin, I. A. Kazadaeva","doi":"10.54101/acen.2023.2.8","DOIUrl":"https://doi.org/10.54101/acen.2023.2.8","url":null,"abstract":"We reviewed current literature on the role of seasonal, meteorological, or circadian factors in ruptured cerebral aneurysms. We found that cerebral aneurysm rupture most frequently occurs in winter and spring, and less frequently in summer. The highest number of ruptured cerebral aneurysms happens in the morning, between 8 am and 12 pm. The data regarding meteorological factors' effect on the risk of cerebral aneurysm rupture are conflicting. However, it should be noted that changes in barometric pressure and falling temperature are associated with the risk of aneurysmal subarachnoid hemorrhage.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77073355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Demyelinating diseases of the central nervous system and multiple sclerosis in particular are a pressing issue for medical community and society as a whole. Deve- lopment and implementation of highly effective specific therapy significantly slow the disease progression and help maintain patients' quality of life and social participation. We analyzed pathogenic mechanisms of multiple sclerosis and other B cell-mediated diseases and reviewed therapeutic options for main disease stages.
{"title":"B Cell Depletion Therapy as a Cutting-Edge Treatment of Demyelinating Diseases of the Central Nervous System","authors":"T. Simaniv, A. Belkina, M. Zakharova","doi":"10.54101/acen.2023.2.9","DOIUrl":"https://doi.org/10.54101/acen.2023.2.9","url":null,"abstract":"Demyelinating diseases of the central nervous system and multiple sclerosis in particular are a pressing issue for medical community and society as a whole. Deve- lopment and implementation of highly effective specific therapy significantly slow the disease progression and help maintain patients' quality of life and social participation. We analyzed pathogenic mechanisms of multiple sclerosis and other B cell-mediated diseases and reviewed therapeutic options for main disease stages.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74008673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Dobrynina, M. A. Afanasev, A. Belopasova, M. Gubanova, E. V. Baydina
Introduction. High prevalence of migraine and its impact on quality of life requires the development of original agents. In 2020, fremanezumab, a new calcitonin gene-related peptide monoclonal antibody was authorized in Russia. Objective: to evaluate safety and effectiveness of fremanezumab in patients with high-frequency episodic migraine (HF EM) and chronic migraine (CM). Materials and methods. We assessed 60 patients at the age of 35.5 8.96 years (85%, females) with HFEM and CM with and without aura who were either receiving preventive treatment or not. Fremanezumab was administered subcutaneously at a single dose of 675 mg. The study participants were followed-up for efficacy in 3 months. The investigators assessed change in the number of days with headache per month as well as headache intensity, its impact on the daily activities, anxiety, and depression. Results. By the end of month 3 post dosing, the number of days with headache decreased by 50% in 76.7% of participants where 77.8% of individuals suffered from HF EM and 72.7% of individuals had CM while headache intensity decreased in all the patients equally. No response (decrease in the number of days with headache by 30%) was reported in 15% of participants including 14.8% of individuals with HF EM and 15.2% of individuals with CM. By the end of study month 3, 81% of participants demonstrated no anxiety symptoms and 79% of participants showed no depression with significant MIDAS and HIT-6 score decline in both groups. Only 3 (5%) patients noted adverse events (redness, itching at the administration site). Conclusion. We documented higher fremanezumab safety and effectiveness in patients with EM and CM in real-world practice as compared to fremanezumab safety and efficacy in randomized clinical trials. A single dose of fremanezumab (675 mg) resulted in effective migraine prevention, decline in comorbid anxiety and depression, and improved quality of life during 3-month follow-up.
{"title":"The Management of High-Frequency Episodic and Chronic Migraines with Calcitonin Gene-Related Peptide Monoclonal Antibody","authors":"L. Dobrynina, M. A. Afanasev, A. Belopasova, M. Gubanova, E. V. Baydina","doi":"10.54101/acen.2023.2.3","DOIUrl":"https://doi.org/10.54101/acen.2023.2.3","url":null,"abstract":"Introduction. High prevalence of migraine and its impact on quality of life requires the development of original agents. In 2020, fremanezumab, a new calcitonin gene-related peptide monoclonal antibody was authorized in Russia. \u0000Objective: to evaluate safety and effectiveness of fremanezumab in patients with high-frequency episodic migraine (HF EM) and chronic migraine (CM). \u0000Materials and methods. We assessed 60 patients at the age of 35.5 8.96 years (85%, females) with HFEM and CM with and without aura who were either receiving preventive treatment or not. Fremanezumab was administered subcutaneously at a single dose of 675 mg. The study participants were followed-up for efficacy in 3 months. The investigators assessed change in the number of days with headache per month as well as headache intensity, its impact on the daily activities, anxiety, and depression. \u0000Results. By the end of month 3 post dosing, the number of days with headache decreased by 50% in 76.7% of participants where 77.8% of individuals suffered from HF EM and 72.7% of individuals had CM while headache intensity decreased in all the patients equally. No response (decrease in the number of days with headache by 30%) was reported in 15% of participants including 14.8% of individuals with HF EM and 15.2% of individuals with CM. By the end of study month 3, 81% of participants demonstrated no anxiety symptoms and 79% of participants showed no depression with significant MIDAS and HIT-6 score decline in both groups. Only 3 (5%) patients noted adverse events (redness, itching at the administration site). \u0000Conclusion. We documented higher fremanezumab safety and effectiveness in patients with EM and CM in real-world practice as compared to fremanezumab safety and efficacy in randomized clinical trials. A single dose of fremanezumab (675 mg) resulted in effective migraine prevention, decline in comorbid anxiety and depression, and improved quality of life during 3-month follow-up.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85283280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tahereh Babajani Roshan, C. Behzad, P. Saadat, Ali Bijani, M. Dehghan, Alijan Ahmadi Ahangar
Introduction. Due to the prevalence of dysphagia in patients with Parkinson's disease (PD) and its complications such as aspiration pneumonia, which is the main cause of death in these patients, PD-related disability can be prevented by early diagnosis and treatment of dysphagia. Objective. The present study was aimed at investigating the frequency of dysphagia in PD patients. Materials and methods. This cross-sectional study included 150 PD patients visiting a Neurology Clinic. The severity of PD was determined based on the Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoen and Yahr (HYS) Scale. The Munich Dysphagia Test-Parkinson's disease (MDT-PD) questionnaire was used to assess dysphagia. Comparisons were made using generalized Fisher exact, Chi-square, ANOVA, and KruskalWallis tests. Predictive factors were analyzed using logistic regression. Statistical analyses were performed at significance level of 0.05. Results. Out of all 150 patients referred to the Clinic, the prevalence of dysphagia requiring attention was 25.3% (n = 38). The patients of the three groups according to the MDT-PD (no noticeable dysphagia, noticeable oropharyngeal, and dysphagia with aspiration risk) had a significant difference only in terms of the PD duration (p 0.001). In the predicting of dysphagia, the longer PD duration (p = 0.011) and homemaker occupation (p = 0.033) were protective factors, while female gender was a risk factor (p = 0.011). Conclusion. The prevalence of dysphagia requiring attention in the studied patients was 25.3%. It decreased with the longer duration of the disease, and its prevalence was lower in homemaker patients, while the odds of dysphagia was 5.8 times higher in women than in men.
{"title":"Examining the frequency of dysphagia and the predictive factors of dysphagia that require attention in patients with Parkinson's disease","authors":"Tahereh Babajani Roshan, C. Behzad, P. Saadat, Ali Bijani, M. Dehghan, Alijan Ahmadi Ahangar","doi":"10.54101/acen.2023.1.2","DOIUrl":"https://doi.org/10.54101/acen.2023.1.2","url":null,"abstract":"Introduction. Due to the prevalence of dysphagia in patients with Parkinson's disease (PD) and its complications such as aspiration pneumonia, which is the main cause of death in these patients, PD-related disability can be prevented by early diagnosis and treatment of dysphagia. \u0000Objective. The present study was aimed at investigating the frequency of dysphagia in PD patients. \u0000Materials and methods. This cross-sectional study included 150 PD patients visiting a Neurology Clinic. The severity of PD was determined based on the Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoen and Yahr (HYS) Scale. The Munich Dysphagia Test-Parkinson's disease (MDT-PD) questionnaire was used to assess dysphagia. Comparisons were made using generalized Fisher exact, Chi-square, ANOVA, and KruskalWallis tests. Predictive factors were analyzed using logistic regression. Statistical analyses were performed at significance level of 0.05. \u0000Results. Out of all 150 patients referred to the Clinic, the prevalence of dysphagia requiring attention was 25.3% (n = 38). The patients of the three groups according to the MDT-PD (no noticeable dysphagia, noticeable oropharyngeal, and dysphagia with aspiration risk) had a significant difference only in terms of the PD duration (p 0.001). In the predicting of dysphagia, the longer PD duration (p = 0.011) and homemaker occupation (p = 0.033) were protective factors, while female gender was a risk factor (p = 0.011). \u0000Conclusion. The prevalence of dysphagia requiring attention in the studied patients was 25.3%. It decreased with the longer duration of the disease, and its prevalence was lower in homemaker patients, while the odds of dysphagia was 5.8 times higher in women than in men.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87543786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Larisa A. Shchepankevitch, I.E. Arkhipov, V. V. Polyanskaya, I.A. Veretelnikov, Elena V. Taneeva, Ksenya V. Rerikh
Introduction. In the COVID-19 pandemic, high lethality as well as long-term outcomes are getting more and more relevant. According to the accumulated study results, COVID-19 affects the nervous system both directly and indirectly. Objective: to study the variants of post-COVID syndrome based on the data from the State Novosibirsk Regional Clinical Hospital from July 2020 to February 2022. Materials and methods. We have performed post hoc analysis of the medical records of 1,500 patients with a past history of COVID-19 admitted following various neurological disorders manifested from July 2020 to February 2022. Results. While temporary and pathogenetic association with past COVID-19 was revealed in 455 patients, primary involvement of the central nervous system was reported in 91.6% of cases, primary involvement of the peripheral nervous system in 8.1% of cases, and musculoskeletal disorder (idiopathic myodystrophy) in 0.3% of cases. Conclusion. Prevalence of the neurological variants of post-COVID syndrome is still unknown. However, patients with severe COVID-19 are more susceptible to neurological complications during the following six months.
{"title":"Post-Covid disorders of nervous system: personal experience","authors":"Larisa A. Shchepankevitch, I.E. Arkhipov, V. V. Polyanskaya, I.A. Veretelnikov, Elena V. Taneeva, Ksenya V. Rerikh","doi":"10.54101/acen.2023.1.10","DOIUrl":"https://doi.org/10.54101/acen.2023.1.10","url":null,"abstract":"Introduction. In the COVID-19 pandemic, high lethality as well as long-term outcomes are getting more and more relevant. According to the accumulated study results, COVID-19 affects the nervous system both directly and indirectly. \u0000Objective: to study the variants of post-COVID syndrome based on the data from the State Novosibirsk Regional Clinical Hospital from July 2020 to February 2022. \u0000Materials and methods. We have performed post hoc analysis of the medical records of 1,500 patients with a past history of COVID-19 admitted following various neurological disorders manifested from July 2020 to February 2022. \u0000Results. While temporary and pathogenetic association with past COVID-19 was revealed in 455 patients, primary involvement of the central nervous system was reported in 91.6% of cases, primary involvement of the peripheral nervous system in 8.1% of cases, and musculoskeletal disorder (idiopathic myodystrophy) in 0.3% of cases. \u0000Conclusion. Prevalence of the neurological variants of post-COVID syndrome is still unknown. However, patients with severe COVID-19 are more susceptible to neurological complications during the following six months.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77022065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Karchevskaya, O. Payushina, E. Sharova, L. Oknina, O. Titov
Head injury is one of the main disability causes among the working-age population. Stroke energy induces mechanical injury of tissues to launch secondary damage, i.e. neurotransmission, blood-brain barrier disruption, blood infiltration of brain tissues, cytokine and chemokine overexpression, and other processes. Activated by the injury, microglia plays a special part to initially 'protect' intact tissues from the products of necrosis and apoptosis. After the injury, microglia rapidly differentiates to phenotypes М1 and М2. Pro-inflammatory phenotype М1 produces neuronal cytotoxic cytokines including tumor necrosis factor-, interleukins (IL)-6 and IL-1, and NO that induce apoptosis while phenotype М2 secretes IL-4 and IL-13 that may supposedly reduce inflammation and improve recovery of brain tissues. М2 response lasts much less than М1 response, and increasing pro-inflammatory activation leads to further neuronal death, which affects cognitive and physical status of patients with head injury. The review covers main biochemical processes in the injured brain and possible ways of neuroinflammation modulation.
{"title":"Neuroinflammation as secondary damage in head injury","authors":"A. Karchevskaya, O. Payushina, E. Sharova, L. Oknina, O. Titov","doi":"10.54101/acen.2023.1.7","DOIUrl":"https://doi.org/10.54101/acen.2023.1.7","url":null,"abstract":"Head injury is one of the main disability causes among the working-age population. Stroke energy induces mechanical injury of tissues to launch secondary damage, i.e. neurotransmission, blood-brain barrier disruption, blood infiltration of brain tissues, cytokine and chemokine overexpression, and other processes. Activated by the injury, microglia plays a special part to initially 'protect' intact tissues from the products of necrosis and apoptosis. After the injury, microglia rapidly differentiates to phenotypes М1 and М2. Pro-inflammatory phenotype М1 produces neuronal cytotoxic cytokines including tumor necrosis factor-, interleukins (IL)-6 and IL-1, and NO that induce apoptosis while phenotype М2 secretes IL-4 and IL-13 that may supposedly reduce inflammation and improve recovery of brain tissues. М2 response lasts much less than М1 response, and increasing pro-inflammatory activation leads to further neuronal death, which affects cognitive and physical status of patients with head injury. The review covers main biochemical processes in the injured brain and possible ways of neuroinflammation modulation.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77148375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Brain health and active longevity are affected by a number of stroke risk factors. We should identify their relative impact on the main subtypes of ischemic stroke (IS) in middle-aged and senior women to consider prevention and management strategies. Objective. To assess prevalence of isolated and combined factors that may contribute with a high probability to development of the various IS subtypes in women aged 4574 years. Materials and methods. The study included 348 female patients aged 4574 years including 145 inpatients with carotid IS (main group) from Neurology Department 2, the Research Center of Neurology, and 203 women with cognitive disorders due to the chronic cerebral ischemia (controls). To assess the impact of various risk factors on the main IS subtypes, we generated multivariate predictive models using logistic regression and the Wald test. Results. Predictive modeling of atherothrombotic IS demonstrated that type 2 diabetes mellitus increases IS risk by over 5 times (odds ratio [OR] = 5.961; 95% confidence interval [CI] 1.10232.257; р = 0.038); internal carotid artery stenosis, by 7 times (OR = 7.187; 95% CI 1.82728.273; р = 0.005); history of transient ischemic attacks (TIA), by 61 times (OR = 61.442; 95% CI 7.673491.998; р 0.001); excessive alcohol intake, by 49 times (OR = 49,382; 95% CI 4.557535.121; р = 0.001); and HTN severity, by 4 times (OR = 4.445; 95% CI 2.3318.476; р 0.001). Predictive modeling of cardioembolic IS demonstrated that post-infarction cardiosclerosis increases IS risk by over 118 times (OR = 118.025; 95% CI 5.2102673.796; р = 0.003), atrial fibrillation, by 108 times (OR = 108.493; 95% CI 24.312484.159; р 0.001), history of TIA, by over 71 times (OR = 71.558; 95% CI 7.945644.535; р 0.001); and HTN severity, by over 3 times (OR = 3.957; 95% CI 2.0697.566; р 0.001). Predictive modeling of lacunar IS demonstrated that type 2 diabetes mellitus increases IS risk by 8 times (OR = 8.324; 95% CI 1.92336.041; р = 0.005), history of IS, by over 8 times (OR = 8.99; 95% CI 1.77245.598; р = 0.008); and HTN severity, by 7 times (OR = 7.139; 95% CI 3.49114.599; р 0.001). Conclusion. We identified a number of risk factors that may contribute to the development of the main IS subtypes in middle-aged and senior women.
介绍。大脑健康和活跃寿命受到许多中风风险因素的影响。我们应该确定它们对中老年妇女缺血性卒中(IS)主要亚型的相对影响，以考虑预防和管理策略。目标。评估4574岁女性中可能导致各种IS亚型高概率发展的孤立因素和综合因素的患病率。材料和方法。研究纳入348例女性患者，年龄4574岁，其中神经内科研究中心神经内科二科颈动脉IS住院患者145例(主要组)，慢性脑缺血认知障碍女性203例(对照组)。为了评估各种危险因素对主要IS亚型的影响，我们使用逻辑回归和Wald检验建立了多变量预测模型。结果。动脉粥样硬化血栓性IS的预测模型显示，2型糖尿病使IS风险增加5倍以上(优势比[OR] = 5.961;95%置信区间[CI] 1.10232.257;r = 0.038);颈内动脉狭窄7倍(OR = 7.187;95% ci 1.82728.273;r = 0.005);有过性脑缺血发作(TIA)史者，增加61倍(OR = 61.442;95% ci 7.673491.998;р0.001);过量饮酒，增加49倍(OR = 49,382);95% ci 4.557535.121;r = 0.001);和HTN严重程度，分别增加4倍(OR = 4.445;95% ci 2.3318.476;р0.001)。心脏栓塞性IS的预测模型显示，梗死后心脏硬化使IS风险增加118倍以上(OR = 118.025;95% ci 5.2102673.796;OR = 108.493;95% ci 24.312484.159;- 0.001)， TIA病史，超过71倍(OR = 71.558;95% ci 7.945644.535;р0.001);和HTN严重程度，分别提高3倍以上(OR = 3.957;95% ci 2.0697.566;р0.001)。腔隙性IS的预测模型显示，2型糖尿病使IS风险增加8倍(OR = 8.324;95% ci 1.92336.041;r = 0.005)， IS病史，OR = 8.99;95% ci 1.77245.598;r = 0.008);和HTN严重程度分别提高7倍(OR = 7.139;95% ci 3.49114.599;р0.001)。结论。我们确定了一些可能导致中老年女性主要IS亚型发展的风险因素。
{"title":"Factors that pre-determine the main subtypes of ischemic stroke in middle-aged and senior women","authors":"M. Maximova, V. Y. Sazonova","doi":"10.54101/acen.2023.1.1","DOIUrl":"https://doi.org/10.54101/acen.2023.1.1","url":null,"abstract":"Introduction. Brain health and active longevity are affected by a number of stroke risk factors. We should identify their relative impact on the main subtypes of ischemic stroke (IS) in middle-aged and senior women to consider prevention and management strategies. \u0000Objective. To assess prevalence of isolated and combined factors that may contribute with a high probability to development of the various IS subtypes in women aged 4574 years. \u0000Materials and methods. The study included 348 female patients aged 4574 years including 145 inpatients with carotid IS (main group) from Neurology Department 2, the Research Center of Neurology, and 203 women with cognitive disorders due to the chronic cerebral ischemia (controls). To assess the impact of various risk factors on the main IS subtypes, we generated multivariate predictive models using logistic regression and the Wald test. \u0000Results. Predictive modeling of atherothrombotic IS demonstrated that type 2 diabetes mellitus increases IS risk by over 5 times (odds ratio [OR] = 5.961; 95% confidence interval [CI] 1.10232.257; р = 0.038); internal carotid artery stenosis, by 7 times (OR = 7.187; 95% CI 1.82728.273; р = 0.005); history of transient ischemic attacks (TIA), by 61 times (OR = 61.442; 95% CI 7.673491.998; р 0.001); excessive alcohol intake, by 49 times (OR = 49,382; 95% CI 4.557535.121; р = 0.001); and HTN severity, by 4 times (OR = 4.445; 95% CI 2.3318.476; р 0.001). Predictive modeling of cardioembolic IS demonstrated that post-infarction cardiosclerosis increases IS risk by over 118 times (OR = 118.025; 95% CI 5.2102673.796; р = 0.003), atrial fibrillation, by 108 times (OR = 108.493; 95% CI 24.312484.159; р 0.001), history of TIA, by over 71 times (OR = 71.558; 95% CI 7.945644.535; р 0.001); and HTN severity, by over 3 times (OR = 3.957; 95% CI 2.0697.566; р 0.001). Predictive modeling of lacunar IS demonstrated that type 2 diabetes mellitus increases IS risk by 8 times (OR = 8.324; 95% CI 1.92336.041; р = 0.005), history of IS, by over 8 times (OR = 8.99; 95% CI 1.77245.598; р = 0.008); and HTN severity, by 7 times (OR = 7.139; 95% CI 3.49114.599; р 0.001). \u0000Conclusion. We identified a number of risk factors that may contribute to the development of the main IS subtypes in middle-aged and senior women.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82045999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Polushin, I. Skiba, E. Bakin, M. D. Vladovskaya, Victoria A. Yakovleva, I. Moiseev, S. Yanishevskiy, I. Voznyuk, A. Kulagin
Introduction. Modern transplantation and biological therapy methods are associated with a wide range of adverse events and complications. Incidence and variety of neurological complications mostly depend on myelo- and immunosuppression severity and duration as well as on donor's and recipient's characteristics. The most frequent complications involving the nervous system include neurotoxic reactions, infections, autoimmune and lymphoproliferative diseases, and dysmetabolic conditions as well as cerebrovascular complications that potentially affect transplantation outcomes. Objective. To evaluate the impact of post-transplantation cerebrovascular events (CVEs) on transplantation outcomes in patients with hematologic malignancies. Materials and methods. We analyzed 899 transplantations performed at the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, Pavlov First Saint Petersburg State Medical University, from 2016 to 2018. We assessed transplantation parameters and donor's and recipient's characteristics by intergroup comparison, pseudo-randomization (propensity score matching), KaplanMeier survival analysis, and log-rank tests. Results. Post-transplantatively, CVEs developed in 2.6% (n = 23) of cases: 13 (1.4%) ischemic strokes and 11 (1.2%) hemorrhagic strokes or intracranial hemorrhages were diagnosed. CVEs developed on days 99.5 39.2 post hematopoetic stem cell transplantation (HSCT). There were more patients with non-malignant conditions in the CVE group as compared to the non-CVE group (21.7% vs 7.9%; p = 0.017). Patients with CVE had a significantly lower Karnofsky index (75.6 21.3 vs 85.2 14.9; p = 0.008). Statistically, we also note some non-significant trends: patients with CVE more often underwent allogenic HSCT (82.6% vs 64.0%; p = 0.077) while donors were more often partially (rather than totally) HLA compatible for recipients (39.1% vs 21.1%; p = 0.33). Patients with CVE more often had a history of venous thromboses (13.3% vs 4.2%; p = 0.077). Post-HSCT stroke decreased post-transplantation longevity by approximately 3 times (331.8 81.6 vs 897.9 25.4 post HSCT; p = 0.0001). In the CVE group, survival during first 180 days post HSCT (landmarks post-HSCT Day+60 and Day+180) was significantly lower as compared to that in the CVE-free group. If CVE developed during first 30 days and 100 days post HSCT, vascular catastrophe did not affect post-HSCT survival significantly. Conclusion. Whereas ischemic stroke is a long-term HSCT complication (beyond D+100 post transplantation), hemorrhagic stroke is a short-term complication (D0D+100 post HSCT). CVEs affect survival in patients with hematologic malignancies, especially those developed between D+60 and D+180 post HSCT. History of venous abnormalities, low Karnofsky index at HSCT initiation, and the type of allogenic HSCT, especially from half-matched donors, can be considered as negative outcome risk factors in post-HSCT CVE.
介绍。现代移植和生物治疗方法与广泛的不良事件和并发症相关。神经系统并发症的发生率和种类主要取决于骨髓和免疫抑制的严重程度和持续时间，以及供体和受体的特征。最常见的涉及神经系统的并发症包括神经毒性反应、感染、自身免疫和淋巴细胞增生性疾病、代谢异常以及可能影响移植结果的脑血管并发症。目标。评估移植后脑血管事件(CVEs)对血液系统恶性肿瘤患者移植预后的影响。材料和方法。我们分析了2016年至2018年在巴甫洛夫第一圣彼得堡国立医科大学赖莎·戈尔巴乔夫纪念儿科肿瘤、血液学和移植研究所进行的899例移植手术。我们通过组间比较、伪随机化(倾向评分匹配)、KaplanMeier生存分析和log-rank检验来评估移植参数和供体和受体的特征。结果。移植后，2.6% (n = 23)的病例发生cve，其中13例(1.4%)为缺血性卒中，11例(1.2%)为出血性卒中或颅内出血。cve发生于造血干细胞移植(HSCT)后第99.5 ~ 39.2天。与非CVE组相比，CVE组有更多的非恶性疾病患者(21.7% vs 7.9%;P = 0.017)。CVE患者的Karnofsky指数显著降低(75.6 21.3 vs 85.2 14.9;P = 0.008)。统计学上，我们也注意到一些不显著的趋势:CVE患者更常接受同种异体造血干细胞移植(82.6% vs 64.0%;p = 0.077)，而供体与受体的HLA部分(而不是完全)相容(39.1% vs 21.1%;P = 0.33)。CVE患者更常有静脉血栓形成史(13.3% vs 4.2%;P = 0.077)。移植后中风使移植后寿命缩短约3倍(331.8 81.6 vs 897.9 25.4);P = 0.0001)。在CVE组中，与无CVE组相比，HSCT后180天(HSCT后60天和180天的里程碑)的生存率显著降低。如果CVE发生在HSCT后的前30天和100天，血管灾难对HSCT后的生存没有显著影响。结论。缺血性卒中是移植后长期并发症(超过D+100)，出血性卒中是短期并发症(移植后D0D+100)。cve影响血液学恶性肿瘤患者的生存，特别是那些发生在造血干细胞移植后D+60至D+180之间的患者。静脉异常史、HSCT开始时的低Karnofsky指数以及同种异体HSCT的类型，特别是来自半匹配供体的异体HSCT，可以被认为是HSCT后CVE的阴性结局危险因素。
{"title":"Cerebrovascular complications of hematopoetic stem cell transplantation in patients with hematologic malignancies","authors":"A. Polushin, I. Skiba, E. Bakin, M. D. Vladovskaya, Victoria A. Yakovleva, I. Moiseev, S. Yanishevskiy, I. Voznyuk, A. Kulagin","doi":"10.54101/acen.2023.1.4","DOIUrl":"https://doi.org/10.54101/acen.2023.1.4","url":null,"abstract":"Introduction. Modern transplantation and biological therapy methods are associated with a wide range of adverse events and complications. Incidence and variety of neurological complications mostly depend on myelo- and immunosuppression severity and duration as well as on donor's and recipient's characteristics. The most frequent complications involving the nervous system include neurotoxic reactions, infections, autoimmune and lymphoproliferative diseases, and dysmetabolic conditions as well as cerebrovascular complications that potentially affect transplantation outcomes. \u0000Objective. To evaluate the impact of post-transplantation cerebrovascular events (CVEs) on transplantation outcomes in patients with hematologic malignancies. \u0000Materials and methods. We analyzed 899 transplantations performed at the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, Pavlov First Saint Petersburg State Medical University, from 2016 to 2018. We assessed transplantation parameters and donor's and recipient's characteristics by intergroup comparison, pseudo-randomization (propensity score matching), KaplanMeier survival analysis, and log-rank tests. \u0000Results. Post-transplantatively, CVEs developed in 2.6% (n = 23) of cases: 13 (1.4%) ischemic strokes and 11 (1.2%) hemorrhagic strokes or intracranial hemorrhages were diagnosed. CVEs developed on days 99.5 39.2 post hematopoetic stem cell transplantation (HSCT). There were more patients with non-malignant conditions in the CVE group as compared to the non-CVE group (21.7% vs 7.9%; p = 0.017). Patients with CVE had a significantly lower Karnofsky index (75.6 21.3 vs 85.2 14.9; p = 0.008). Statistically, we also note some non-significant trends: patients with CVE more often underwent allogenic HSCT (82.6% vs 64.0%; p = 0.077) while donors were more often partially (rather than totally) HLA compatible for recipients (39.1% vs 21.1%; p = 0.33). Patients with CVE more often had a history of venous thromboses (13.3% vs 4.2%; p = 0.077). Post-HSCT stroke decreased post-transplantation longevity by approximately 3 times (331.8 81.6 vs 897.9 25.4 post HSCT; p = 0.0001). In the CVE group, survival during first 180 days post HSCT (landmarks post-HSCT Day+60 and Day+180) was significantly lower as compared to that in the CVE-free group. If CVE developed during first 30 days and 100 days post HSCT, vascular catastrophe did not affect post-HSCT survival significantly. \u0000Conclusion. Whereas ischemic stroke is a long-term HSCT complication (beyond D+100 post transplantation), hemorrhagic stroke is a short-term complication (D0D+100 post HSCT). CVEs affect survival in patients with hematologic malignancies, especially those developed between D+60 and D+180 post HSCT. History of venous abnormalities, low Karnofsky index at HSCT initiation, and the type of allogenic HSCT, especially from half-matched donors, can be considered as negative outcome risk factors in post-HSCT CVE.","PeriodicalId":36946,"journal":{"name":"Annals of Clinical and Experimental Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82067958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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