Head and Neck Diseases by Alexandros G.Sfakianakis: 06/13/16

Δευτέρα 13 Ιουνίου 2016

Cerebral arterial pulsatility is associated with leukoaraiosis and depends on central arterial pulsatility and arterial stiffness.

Magnetic Resonance Imaging Measurement of Transmission of Arterial Pulsation to the Brain on Propranolol Versus Amlodipine:

Alastair J.S. Webb, DPhil;
Peter M. Rothwell, FMedSci

From the Stroke Prevention Research Unit (SPRU), John Radcliffe Hospital, Oxford, United Kingdom.

Correspondence to Alastair J.S. Webb, DPhil, SPRU, John Radcliffe Hospital Oxford OX39DU, United Kingdom. E-mail alastair.webb{at}ndcn.ox.ac.uk

Abstract

Background and Purpose—The effect of antihypertensive drugs on transmission of central arterial pulsatility to the cerebral circulation is unknown, partly because of limited methods of assessment.

Methods—In a technique-development pilot study, 10 healthy volunteers were randomized to crossover treatment with amlodipine and propranolol. At baseline and on each drug, we assessed aortic (Sphygmocor) and middle cerebral artery pulsatility (TCDtranscranial ultrasound). We also performed whole-brain, 3-tesla multiband blood-oxygen level dependent magnetic resonance imaging (multiband factor 6, repetition time=0.43s), concurrent with a novel method of continuous noninvasive blood pressure monitoring. Drug effects on relationships between cardiac cycle variation in blood pressure and blood-oxygen level dependent imaging were determined (fMRI Expert Analysis Tool, fMRIB Software Library [FEAT-FSL]).

Results—Aortic pulsatility was similar on amlodipine (27.3 mm Hg) and propranolol (27.9 mm Hg, P diff=0.33), while MCA pulsatility increased nonsignificantly more from baseline on propranolol (+6%; P=0.09) than amlodipine (+1.5%; P=0.58). On magnetic resonance imaging, cardiac frequency blood pressure variations were found to be significantly more strongly associated with blood-oxygen level dependent imaging on propranolol than amlodipine.

Conclusions—We piloted a novel method of assessment of arterial pulsatility with concurrent high-frequency blood-oxygen level dependent magnetic resonance imaging and noninvasive blood pressure monitoring. This method was able to identify greater transmission of aortic pulsation on propranolol than amlodipine, which warrants further investigation.

Key Words:

Received December 11, 2015.
Revision received March 2, 2016.
Accepted March 21, 2016.

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Emerging Risk Factors for Stroke

Emerging Risk Factors for Stroke:

Topical Review

This Article

Stroke. 2016; 47: 1673-1678

doi: 10.1161/STROKEAHA.115.010646

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Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery:

A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Carolee J. Winstein, PhD, PT, Chair;
Joel Stein, MD, Vice Chair;
Ross Arena, PhD, PT, FAHA;
Barbara Bates, MD, MBA;
Leora R. Cherney, PhD;
Steven C. Cramer, MD;
Frank Deruyter, PhD;
Janice J. Eng, PhD, BSc;
Beth Fisher, PhD, PT;
Richard L. Harvey, MD;
Catherine E. Lang, PhD, PT;
Marilyn MacKay-Lyons, BSc, MScPT, PhD;
Kenneth J. Ottenbacher, PhD, OTR;
Sue Pugh, MSN, RN, CNS-BC, CRRN, CNRN, FAHA;
Mathew J. Reeves, PhD, DVM, FAHA;
Lorie G. Richards, PhD, OTR/L;
William Stiers, PhD, ABPP (RP);
Richard D. Zorowitz, MD;
on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research

Abstract

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.

Methods—Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

Results—Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential.

Conclusions—As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.)

Key Words:

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The orbit and optic canal volumes

Cone-beam computed tomography of

via ScienceDirect Publication: Journal of Cranio-Maxillofacial Surgery

Publication date: Available online 11 June 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Reinhard E. Friedrich, Marc Bruhn, Christian Lohse
PurposeThe aim of this study was to measure orbital and optic canal volumes by means of cone-beam computed tomography (CBCT) of human skulls as a prerequisite for estimating alterations of this bony region by this method.Materials and MethodsA total of 200 orbits of 100 adult individuals were investigated. These patients had no history of orbital trauma, dysplasia, or other diseases with a putative effect on orbital growth (female/male = 50/50; age: 20–70 years). Each 10 individuals with a male-to-female ratio of 1:1 constituted a 10-year age group. Area measurements and calculations of volumes were performed with OsiriX software.ResultsOrbital mean volume values did not differ significantly with respect to site. However, orbital volume slightly increased with age, whereas the optic canal volume declined over time. Mean orbital and optic canal volumes were larger in males than in females. Volumetric measurements of the orbit are in line with published data derived from computed tomograms and magnetic resonance images.ConclusionOrbital and optical canal volumes in adults show sexual dimorphism and alter depending on age. CBCT is suitable for determining orbital volumes and the provided data can be useful, for example, for defining orbital pathologies, to calculate orbital reconstructions, or for use in anthropological studies.

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Peri-implant bone

Changes in peri-implant bone level and effect of potential influential factors on dental implants in irradiated and non-irradiated patients following multimodal therapy due to head and neck cancer: a retrospective study

via Oral and Maxillofacial Surgery

Publication date: Available online 12 June 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicole Ernst, Claudia Sachse, Jan D. Raguse, Carmen Stromberger., Katja Nelson, Susanne Nahles
AimThe aim of the present study was to evaluate changes in the marginal bone level of dental implants in irradiated and non-irradiated patients, and to identify possible influential factors.Material and MethodsA total of 36 patients with 194 implants were involved in the study (7 female and 29 male). The mean age of the patients was 65.8 (39–90 years). In all patients a squamous cell carcinoma in the floor of mouth involving the mandible or tongue was surgically removed. In 17 patients adjuvant radiochemotherapy was completed a minimum of 6 months before implant placement. Mean crestal bone changes using standardized orthopantomographies were evaluated. The Spearman rank- order correlation coefficient and Mann-Whitney U test were used to determine correlations between bone crestal changes and age, gender, radiation therapy (yes/no), augmentation (yes/no), and type of superstructure.ResultsA total of 194 implants were placed: 73 in the maxilla and 121 in the mandible. The mean amount of peri-implant bone loss was 1 mm mesial and 0.9 mm distal after 1 year, and 1.4 mm mesial and 1.3 mm distal after 3 years. During the observation period, four implants were lost. The overall success rate was 98.4% (maxilla 100%, mandible 96.7%). There was no significant difference in changes in the bone level according to age, gender, the prosthetic superstructure, or the augmentation procedure (yes/no). Radiation therapy was found to have an impact on crestal bone loss.ConclusionThe present study revealed the high success rate of dental implants after 3 years. Peri-implant crestal bone loss was comparable to that in non-tumor patients. The mean amount of crestal bone change in irradiated patients was twice as high as that in non-irradiated patients.

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Approximately 30% of patients receiving parenteral bisphosphonates and having sustained an AFF may go on to develop comorbid MRONJ

Patients Receiving Parenteral Bisphosphonates for Malignant Disease and Having Developed an Atypical Femoral Fracture are at Risk of Concomitant Osteonecrosis of the Jaw: an Evidence-Based Review

via Oral and Maxillofacial Surgery

Publication date: Available online 12 June 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Lindsay L. Graves, Susan V. Bukata, Nona Aghazadehsanai, Tina I. Chang, Neal Garrett, Arthur H. Friedlander
PurposeThe risk of developing concomitant medication-related osteonecrosis of the jaw (MRONJ) among patients who have sustained an atypical femoral fracture (AFF) in association with parental administration of a bisphosphonate osteoclastic inhibitor medication for malignant disease is unclear. We search the published data to determine the prevalence of these concomitant adverse medication events, if any.Materials and MethodsA systematic review of published case series in the PubMed data base was undertaken to ascertain the prevalence of patients having a concomitant history of AFF and MRONJ. The data were analyzed to provide prevalence rates of these events from the literature.ResultsTwo case series were identified which delineated the risk (25% and 33%, respectively) of concomitant development of MRONJ and AFF among recipients of parenteral bisphosphonate medication administered for malignant disease.ConclusionThe published data suggest that approximately 30% of patients receiving parenteral bisphosphonates and having sustained an AFF may go on to develop comorbid MRONJ.

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Adenocarcinoma of the Lung Metastasizing to the Mandible

Unusual Presentation of an Adenocarcinoma of the Lung Metastasizing to the Mandible, Including Molecular Analysis and a Review of the Literature

via Oral and Maxillofacial Surgery

Publication date: Available online 12 June 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sibel Elif Gultekin, Burcu Senguven, Ipek Isik Gonul, Begum Okur, Reinhard Buettner
Lung cancer is the most frequent cause of cancer-related death worldwide. Metastases of non-small cell lung carcinoma to the oral and maxillofacial region are rare. Thus, the diagnosis of a metastatic lesion in the oral cavity is challenging, both to the clinician and to the pathologist. We present a case of a 72-year-old male patient with metastatic lung adenocarcinoma located in the posterior mandibular region. Next-generation sequencing analysis revealed no significant mutations in the relevant genes except in the TP53 tumor suppressor gene.

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Temporomandibular Joint Osteoarthritis

Does Injection of Corticosteroid after Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial

via Oral and Maxillofacial Surgery

Publication date: Available online 12 June 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Songül Cömert Kiliç
PurposeThe purpose of this study is to answer the following clinical question: Among subjects with temporomandibular joint osteoarthritis (TMJ-OA), do those who undergo arthrocentesis and corticosteroid (CS) injection, when compared to those undergoing arthrocentesis alone, have better outcomes in terms of range of motion and clinical symptoms?Materials and MethodsA randomized clinical trial in adult patients with TMJ-OA referred to the authors' clinic from May 2012 and September 2013 was implemented. The sample was composed of 24 consecutive patients with TMJ-OA treated randomly with either arthrocentesis alone (the control group) or arthrocentesis plus CS injection (the CS group). The outcome variables were visual analogue scale (VAS) evaluations (i.e., masticatory efficiency, joint sounds, and pain complaints), maximal inter-incisal opening (MIO), and mandibular motions. The outcome variables were recorded at baseline and at 12 months postoperatively. Mann-Whitney U tests were used for intergroup comparison. Paired t-test and Wilcoxon signed-rank test were used for intragroup comparisons.ResultsThe sample was composed of 32 joints of 24 subjects with TMJ-OA (15 joints of 12 subjects with a mean age of 35.08 ± 14.84 years for control group; and 17 joints of 12 adult patients with a mean age of 32.58 ± 9.58 years for CS group). Pain complaints and joint sounds decreased statistically (P < .01) in both groups, while painless interincisal opening increased statistically (P < .001) only in the CS group. After estimating differences between the follow-up and baseline outcomes, the mean change in the primary outcome variables showed no statistically differences between 2 groups (P > .05).ConclusionThese findings suggest that arthrocentesis plus intra-articular corticosteroid injection produced no better outcomes in terms of range of motion and clinical symptoms of patients with TMJ-OA, compared to those undergoing arthrocentesis alone.

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Metastatic Melanotic Neuroectodermal Tumor of Infancy: mandible (6%), skull, brain, and epididymis

Report of a Case and Review of the Literature

via Oral and Maxillofacial Surgery

Publication date: Available online 12 June 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Amir Azari, Daniel Petrisor, John Wright, G.E. Ghali
Melanotic neuroectodermal tumors of infancy (MNTI) are pigmented, rapidly growing, and occur predominantly within the bony head and neck structures. There are fewer than 400 cases reported in the literature¹ with many of these described as single case reports due to their rarity. MNTIs are derived from the neural crest, and appear in areas that develop from neuroectodermal pathways; the most common of these is the maxilla.² Locations in other intraosseous and extraosseous structures have been characterized, including the mandible (6%), skull, brain, and epididymis.¹ Infants in the first year of life are usually affected, compelling prompt diagnosis and treatment as well as close monitoring. Prognosis is generally good despite the rapidity of growth. The incidence of recurrence is about 20% overall and perhaps higher (33%) in mandibular cases.¹ Given the rarity of this disease, an overestimation of recurrence or metastases may be more frequently reported.³The tumors are categorized as benign but aggressive, with rare reports of malignant features based on histology⁴ or metastasis. Surgical resection in the pursuit of tumor-free margins is the primary treatment modality for all tumors given its potential for extensive growth; this is especially true of malignant tumors, which comprise less than 25 cases in the literature.^1,5 Chemotherapy and radiotherapy have been used as adjuncts in such cases, with varying reports of success in reducing morbidity and mortality.^6-8 The management of a metatstatic mandibular tumor, in particular, has only been documented in one other case.⁹ The purpose of this case report is to present treatment and reconstruction considerations in a metastatic mandibular MNTI and to review the associated literature.

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Granzyme B-truncated VEGF fusion protein represses angiogenesis and tumor growth of OSCC

Granzyme B-truncated VEGF fusion protein represses angiogenesis and tumor growth of OSCC:

Abstract

Objective

To evaluate the anti-tumor effects of fusion protein hGrB-TV of human granzyme B (hGrB) and truncated vascular endothelial growth factor (tVEGF) on human oral squamous cell carcinoma (OSCC) in vitro and in vivo.

Methods

The fusion protein hGrB-TV was expressed and purified from E.coli bacteria by affinity chromatography. The cytotoxcity of hGrB-TV on VEGFR-2 (Flk-1)⁺ OSCC cells was analysed in vitro. The anti-tumor therapeutic study was taken on OSCC xenofrafts in vivo.

Results

The purified hGrB-TV fusion protein was selectively internalized into VEGFR-2 (Flk-1)⁺ OSCC cells and endothelial cells. It clove inactive caspase 3 into its active p20 form. The hGrB-TV showed dose-dependent cytotoxicity on VEGFR-2⁺ SCC-9 cells. The morphological changes

and cytolysis were appeared within dozens minutes. However, No cytotoxicity was observed on VEGFR-2^- cells. The hGrB alone or tVEGF alone did not have any toxicity on SCC-9 cells. In addition, hGrB-TV treatment completely destroyed the vasculature of the chick chorioallantoic membrane (CAM) in vivo and consequently led to chick embryo development arrest. Most importantly, the fusion protein hGrB-TV inhibited tumor angiogenesis and growth of human OSCC xenografts in nude mice without any apparent toxicity.

Conclusions

The fusion protein hGrB-TV specifically inhibits angiogenesis and tumor growth of OSCC; hGrB-TV is a powerful and safe therapeutic molecule for tumor therapy.

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Bcl11b/Ctip2 is required for development of lingual papillae

in mice.:

Dev Biol. 2016 Jun ;

Authors: Nishiguchi Y, Ohmoto M, Koki J, Enomoto T, Kominami R, Matsumoto I, Hirota J

Abstract

Molecular mechanisms underlying the development and morphogenesis of oral epithelia, comprising the gustatory and nongustatory epithelium, remain unclear. Here, we show that Bcl11b, a zinc finger transcription factor, plays an important role in the development of lingual papillae, especially filiform papillae. In both gustatory and nongustatory epithelium, Bcl11b was expressed in keratin 14-positive epithelial basal cells, which differentiate into keratinocytes and/or taste cells. Loss of Bcl11b function resulted in abnormal morphology of the gustatory papillae: flattened fungiform papillae, shorter trench wall in the foliate and circumvallate papillae, and ectopic invagination in more than half of circumvallate papillae. However, Bcl11b loss caused no effect on differentiation of taste receptor cells. In nongustatory epithelium, the impact of Bcl11b deficiency was much more striking, resulting in a smooth surface on the tongue tip and hypoplastic filiform papillae in the dorsal lingual epithelium. Immunohistochemical analyses revealed that a keratinocyte differentiation marker, Tchh expression was severely decreased in the Bcl11b(-/-) filiform papillae. In addition, expression of Pax9, required for morphogenesis of filiform papillae and its downstream target genes, hard keratins, almost disappeared in the tongue tip and was decreased in the dorsal tongue of Bcl11b(-/-) mice. Gene expression analyses demonstrated a delayed onset of expression of epithelial differentiation complex genes, which disturbed barrier formation in the mutant tongue. These results indicate that Bcl11b regulates the differentiation of keratinocytes in the tongue and identify Bcl11b as an essential factor for the lingual papilla morphogenesis.

PMID: 27287879 [PubMed - as supplied by publisher]

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Ledermix® in endodontic treatment should be avoided in the pregnant woman. Solcoseryl® can be used for wound healing. Elective dental procedures should be postponed after delivery and after lactation period.

[Not Available].:

Swiss Dent J. 2016;126(5):490-1

Authors: Fatori Popovic S, Lübbers HT, von Mandach von Mandach U

Abstract

The aim of this paper is to show aspects of dental treatment in pregnancy. The reader should gain security in the election of the proper drugs for antibiotic therapy and rinsing solutions. Antibiotics as penicillins are the first choice in case of dental infections in pregnancy. In allergic patients, macrolides may be an alternative. Wound and mouth rinsing solutions containing chlorhexidine should be preferred in pregnancy. Ledermix® in endodontic treatment should be avoided in the pregnant woman. Solcoseryl® can be used for wound healing. Elective dental procedures should be postponed after delivery and after lactation period.

PMID: 27277144 [PubMed - in process]

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Erosive potential of vitamin and vitamin+mineral effervescent tablets.

Erosive potential of vitamin and vitamin+mineral effervescent tablets

Swiss Dent J. 2016;126(5):457-65

Authors: Wegehaupt FJ, Lunghi N, Hogger VM, Attin T

Abstract

The extrinsic sources for erosion-causing acids are primarily acidic beverages and foodstuffs. Effervescent tablets also contain organic acids (e.g. citric, tartaric, malic) in order to form carbon dioxide by contact with water with the help of the carbonate salts of the tablets. To adequately inform patients about the possible erosive potential of effervescent tablets, this study was undertaken in order to investigate the erosive potential of effervescent tablets (ET), containing either a combination of vitamins and minerals or vitamins only, commercially available in Switzerland. One hundred and ninety-two bovine enamel samples were prepared and allocated to 16 groups (AH and 18; n = 12/group). Samples were eroded (120 s/erosive cycle) in freshly prepared solutions (200 ml/12 samples) comprised of tap water and a supplement as follows: none (control groups, A and 1); vitamin+mineral ET: Qualite and Prix (B), Optisana (C), Well and Active (D), Actilife All in One (E), Berocca (F), Isostar (G) and Qualite and Prix Mg + Vit C (H); vitamin ET: Actilife-Multivitamin (2), Sunlife Vitamin C (3), Optisana Vitamin C (4), Optisana Multivitamin (5), Well and Active Multivitamin (6), Kneipp Vitamin C+Zink (7) and Sunlife Multivitamin (8). Enamel loss was measured using profilometry after 10 and 20 erosive cycles. For the vitamin+mineral ET, no loss was observed in groups BE. Significantly highest enamel loss (mean ± SD) after 20 cycles was observed for Isostar (5.26 ± 0.76 µm) and Qualite and Prix Mg + Vit C (5.12 ± 0.67 µm). All vitamine ET showed erosive enamel loss. Significantly highest loss was observed for Sunlife Multivitamin (8.45 ± 1.08 µm), while the lowest loss was observed for Actilife-Multivitamin (5.61 ± 1.08 µm) after 20 cycles. Some of the tested effervescent tablets showed a considerable erosive potential and patients should be informed accordingly.

PMID: 27278776 [PubMed - in process]

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Non-communicable diseases (NCDs)

[Not Available].:

Swiss Dent J. 2016;126(5):473-89

Authors: Türp JC, Spranger H

Abstract

Non-communicable diseases (NCDs), such as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes mellitus, are responsible for most deaths worldwide. In view of the rising prevalence and the long-term consequences of NCDs, their prevention is a public health priority. Dentistry plays an important role in this endeavor. Since oral and general diseases share common risk factors (e.g., poor oral hygiene, unhealthy diet, alcohol abuse, tobacco consumption, distress), preventive measures may target both oral diseases (e.g., dental caries, periodontal diseases, oral tumors) and medical NCDs. Consequently, dental medicine assumes an important medical and social role, which has been recognized by the World Health Organization and the General Assembly of the United Nations. To fulfill its mission successfully, consideration of the principles of evidence-based dentistry is a prerequisite. At the same time, the new development provides dentistry with the opportunity to critically reflect on its current and future orientation.

PMID: 27279058 [PubMed - in process]

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Carbamide and hydrogen peroxide for at-home bleaching

Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis:

Abstract

Objectives

The aim of the study was to compare the color change produced by tray-delivered carbamide peroxide [CP] versus hydrogen peroxide products [HP] for at-home bleaching through a systematic review and meta-analysis.

Materials and methods

MEDLINE via PubMeb, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), and Cochrane Library and Grey literature were searched without restrictions. The abstracts of the International Association for Dental Research (IADR) and unpublished and ongoing trial registries were also searched. Dissertations and theses were explored using the ProQuest Dissertations and Periodicos Capes Theses databases. We included randomized clinical trials that compared tray-delivered CP versus HP for at-home dental bleaching. The color change in shade guide units (SGU) and ΔE were the primary outcomes, and tooth sensitivity and gingival irritation were the secondary outcomes. The risk of bias tool of the Cochrane Collaboration was used for quality assessment.

Data

After duplicate removal, 1379 articles were identified. However, only eight studies were considered to be at "low" risk of bias in the key domains of the risk bias tool and they were included in the analysis. For ΔE, the standardized mean difference was −0.45 (95 % CI −0.69 to −0.21), which favored tray-delivered CP products (p < 0.001). The color change in ΔSGU (p = 0.70), tooth sensitivity (p = 0.83), and gingival irritation (p = 0.62) were not significantly different between groups.

Conclusions

Tray-delivered CP gels showed a slightly better whitening efficacy than HP-based products in terms of ΔE, but they were similar in terms of ΔSGU. Both whitening systems demonstrated equal level of gingival irritation and tooth sensitivity.

Clinical significance

Tray-delivered CP gels have a slightly better whitening efficacy than HP-based products in terms of ΔE. This should be interpreted with caution as the data of ΔSGU did not show statistical difference between the products.

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In patients with acute intracerebral hemorrhage, higher neutrophils, lower lymphocytes, and higher NLRs predicted worse 3-month outcome.

Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage:

From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.

Correspondence to Simona Lattanzi, MD, Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic
University, Via Conca 71, 60020 Ancona, Italy. E-mail alfierelattanzisimona{at}gmail.com

Abstract

Background and Purpose—Increasing evidence suggests that inflammatory mechanisms are involved in the intracerebral hemorrhage–induced brain injury.
We evaluated the prognostic role of the peripheral leukocyte counts and neutrophil-to-lymphocyte ratio (NLR) in patients with
intracerebral hemorrhage.

Methods—Patients with acute spontaneous intracerebral hemorrhage were retrospectively identified. Total white blood cells, absolute
neutrophil count, and absolute lymphocyte count were obtained and the NLR computed from the admission blood work. The study
end point was the occurrence of death or major disability at 3 months.

Results—One hundred seventy-seven subjects were enrolled. Ninety-four (53.1%) had unfavorable outcome. The absolute neutrophil count,
absolute lymphocyte count, and NLR were independently associated with the 3-month status. The NLR resulted the best discriminating
variable and the best predictive cut-off value was 4.58.

Conclusions—In patients with acute intracerebral hemorrhage, higher neutrophils, lower lymphocytes, and higher NLRs predicted worse 3-month
outcome.

Key Words:

Received March 31, 2016.
Revision received March 31, 2016.
Accepted April 12, 2016.

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Cerebral arterial pulsatility is associated with leukoaraiosis and depends on central arterial pulsatility and arterial stiffness.

Magnetic Resonance Imaging Measurement of Transmission of Arterial Pulsation to the Brain on Propranolol Versus Amlodipine:

Alastair J.S. Webb, DPhil;
Peter M. Rothwell, FMedSci

From the Stroke Prevention Research Unit (SPRU), John Radcliffe Hospital, Oxford, United Kingdom.

Correspondence to Alastair J.S. Webb, DPhil, SPRU, John Radcliffe Hospital Oxford OX39DU, United Kingdom. E-mail alastair.webb{at}ndcn.ox.ac.uk

Abstract

Key Words:

Received December 11, 2015.
Revision received March 2, 2016.
Accepted March 21, 2016.

Emerging Risk Factors for Stroke

Emerging Risk Factors for Stroke:

Topical Review

This Article

Stroke. 2016; 47: 1673-1678

doi: 10.1161/STROKEAHA.115.010646

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery:

A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Carolee J. Winstein, PhD, PT, Chair;
Joel Stein, MD, Vice Chair;
Ross Arena, PhD, PT, FAHA;
Barbara Bates, MD, MBA;
Leora R. Cherney, PhD;
Steven C. Cramer, MD;
Frank Deruyter, PhD;
Janice J. Eng, PhD, BSc;
Beth Fisher, PhD, PT;
Richard L. Harvey, MD;
Catherine E. Lang, PhD, PT;
Marilyn MacKay-Lyons, BSc, MScPT, PhD;
Kenneth J. Ottenbacher, PhD, OTR;
Sue Pugh, MSN, RN, CNS-BC, CRRN, CNRN, FAHA;
Mathew J. Reeves, PhD, DVM, FAHA;
Lorie G. Richards, PhD, OTR/L;
William Stiers, PhD, ABPP (RP);
Richard D. Zorowitz, MD;
on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research

Abstract

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.

Key Words:

Postmenopausal Hormone Therapy and Risk of Stroke

Impact of the Route of Estrogen Administration and Type of Progestogen [Original Contribution]: Background and Purpose—

The benefit/risk analysis of hormone therapy in postmenopausal women is not straightforward and depends on cardiovascular disease. Evidence supports the safety of transdermal estrogens and the importance of progestogens for thrombotic risk. However, the differential association of oral and transdermal estrogens with stroke remains poorly investigated. Furthermore, there are no data regarding the impact of progestogens.

Methods—

We set up a nested case–control study of ischemic stroke (IS) within all French women aged 51 to 62 years between 2009 and 2011 without personal history of cardiovascular disease or contraindication to hormone therapy. Participants were identified using the French National Health Insurance database, which includes complete drug claims for the past 3 years and French National hospital data. We identified 3144 hospitalized IS cases who were matched for age and zip code to 12 158 controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI).

Results—

Compared with nonusers, the adjusted ORs of IS were1.58 (95% CI, 1.01–2.49) in oral estrogen users and 0.83 (0.56–1.24) in transdermal estrogens users (P<0.01). There was no association of IS with use of progesterone (OR, 0.78; 95% CI, 0.49–1.26), pregnanes (OR, 1.00; 95% CI, 0.60–1.67), and nortestosterones (OR, 1.26; 95% CI, 0.62–2.58), whereas norpregnanes increased IS risk (OR, 2.25; 95% CI, 1.05–4.81).

Conclusions—

Both route of estrogen administration and progestogens were important determinants of IS. Our findings suggest that transdermal estrogens might be the safest option for short-term hormone therapy use.

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The Distribution and Severity of Tremor in Speech Structures of Persons with Vocal Tremor.

The Distribution and Severity of Tremor in Speech Structures of Persons with Vocal Tremor.

J Voice. 2016 Jun 8;

Authors: Hemmerich AL, Finnegan EM, Hoffman HT

Abstract
BACKGROUND: Vocal tremor may be associated with cyclic oscillations in the pulmonary, laryngeal, velopharyngeal, or oral regions.
OBJECTIVES: This study aimed to correlate the overall severity of vocal tremor with the distribution and severity of tremor in structures involved.
METHODS: Endoscopic and clinical examinations were completed on 20 adults with vocal tremor and two age-matched controls during sustained phonation. Two judges rated the severity of vocal tremor and the severity of tremor affecting each of 13 structures.
RESULTS: Participants with mild vocal tremor typically presented with tremor in three laryngeal structures, moderate vocal tremor in five structures (laryngeal and another region), and severe vocal tremor in eight structures affecting all regions. The severity of tremor was lowest (mean = 1.2 out of 3) in persons with mild vocal tremor and greater in persons with moderate (mean = 1.5) and severe vocal tremor (mean = 1.4). Laryngeal structures were most frequently (95%) and severely (1.7 out of 3) affected, followed by velopharynx (40% occurrence, 1.3 severity), pulmonary (40% occurrence, 1.1 severity), and oral (40% occurrence, 1.0 severity) regions. Regression analyses indicated tremor severity of the supraglottic structures, and vertical laryngeal movement contributed most to vocal tremor severity during sustained phonation (r = 0.77, F = 16.17, P < 0.0001). A strong positive correlation (r = 0.72) was found between the Tremor Index and the severity of the vocal tremor during sustained phonation.
CONCLUSION: It is useful to obtain a wide endoscopic view of the larynx to visualize tremor, which is rarely isolated to the true vocal folds alone.

PMID: 27289298 [PubMed - as supplied by publisher]

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Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome

Features and Mechanisms [Original Contribution]: Background and Purpose—

To compare hemorrhagic and nonhemorrhagic reversible cerebral vasoconstriction syndromes (RCVS) with a view to understand mechanisms.

Methods—

This single-center retrospective study included 162 patients with RCVS. Clinical, brain imaging, and angiography data were analyzed.

Results—

The mean age was 44±13 years, 78% women. Hemorrhages occurred in 43% including 21 patients with intracerebral hemorrhage (ICH) and 62 with convexal subarachnoid hemorrhage (cSAH). The frequency of triggers (eg, vasoconstrictive drugs) and risk factors (eg, migraine) were not significantly different between hemorrhagic and nonhemorrhagic RCVS or between subgroups (ICH versus non-ICH, isolated cSAH versus normal scan). Hemorrhagic lesions occurred within the first week, whereas infarcts and vasogenic edema accumulated during 2 to 3 weeks (P<0.001). Although all ICHs occurred before cSAH, their time course was not significantly different (P=0.11). ICH and cSAH occurred earlier than infarcts (P≤0.001), and ICH earlier than vasogenic edema (P=0.009). Angiogram analysis showed more severe vasoconstriction in distal versus proximal segments in all lesion types (ICH, cSAH, infarction, vasogenic edema, and normal scan). The isolated infarction group had more severe proximal vasoconstriction, and those with normal imaging had significantly less vasoconstriction. Multivariable analysis failed to uncover independent predictors of hemorrhagic RCVS; however, female sex predicted ICH (P=0.048), and angiographic severity predicted infarction (P=0.043).

Conclusions—

ICH and cSAH are common complications of RCVS. Triggers and risk factors do not predict lesion subtype but may alter central vasomotor control mechanisms resulting in centripetal angiographic evolution. Early distal vasoconstriction is associated with lobar ICH and cSAH, and delayed proximal vasoconstriction with infarction.

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Vessel Wall Magnetic Resonance Imaging

Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort [Original Contribution]: Background and Purpose—

Although studies have evaluated the differential imaging of moyamoya disease and atherosclerosis, none have investigated the added value of vessel wall magnetic resonance imaging (MRI). This study evaluates the added diagnostic value of vessel wall MRI in differentiating moyamoya disease, atherosclerotic-moyamoya syndrome (A-MMS), and vasculitic-MMS (V-MMS) with a multicontrast protocol.

Methods—

We retrospectively reviewed the carotid artery territories of patients with clinically defined vasculopathies (moyamoya disease, atherosclerosis, and vasculitis) and steno-occlusive intracranial carotid disease. Two neuroradiologists, blinded to clinical data reviewed the luminal imaging of each carotid, evaluating collateral extent and making a presumed diagnosis with diagnostic confidence. After 3 weeks, the 2 readers reviewed the luminal imaging+vessel wall MRI for the presence, pattern and intensity of postcontrast enhancement, T2 signal characteristics, pattern of involvement, and presumed diagnosis and confidence.

Results—

Ten A-MMS, 3 V-MMS, and 8 moyamoya disease cases with 38 affected carotid segments were included. There was significant improvement in diagnostic accuracy with luminal imaging+vessel wall MRI when compared with luminal imaging (87% versus 32%, P<0.001). The most common vessel wall MRI findings for moyamoya disease were nonenhancing, nonremodeling lesions without T2 heterogeneity; for A-MMS eccentric, remodeling, and T2 heterogeneous lesions with mild/moderate and homogeneous/heterogeneous enhancement; and for V-MMS concentric lesions with homogeneous, moderate enhancement. Inter-reader agreement was moderate to substantial for all vessel wall MRI characteristics (=0.46–0.86) and fair for collateral grading (=0.35). There was 11% inter-reader agreement for diagnosis on luminal imaging when compared with 82% for luminal imaging+vessel wall MRI (P<0.001).

Conclusions—

Vessel wall MRI can significantly improve the differentiation of moyamoya vasculopathies when combined with traditional imaging techniques.

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In patients with acute intracerebral hemorrhage, higher neutrophils, lower lymphocytes, and higher NLRs predicted worse 3-month outcome.

Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage:

From the Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.

Correspondence to Simona Lattanzi, MD, Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic
University, Via Conca 71, 60020 Ancona, Italy. E-mail alfierelattanzisimona{at}gmail.com

Abstract

Conclusions—In patients with acute intracerebral hemorrhage, higher neutrophils, lower lymphocytes, and higher NLRs predicted worse 3-month
outcome.

Key Words:

Received March 31, 2016.
Revision received March 31, 2016.
Accepted April 12, 2016.

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Cerebral arterial pulsatility is associated with leukoaraiosis and depends on central arterial pulsatility and arterial stiffness.

Magnetic Resonance Imaging Measurement of Transmission of Arterial Pulsation to the Brain on Propranolol Versus Amlodipine:

Alastair J.S. Webb, DPhil;
Peter M. Rothwell, FMedSci

From the Stroke Prevention Research Unit (SPRU), John Radcliffe Hospital, Oxford, United Kingdom.

Correspondence to Alastair J.S. Webb, DPhil, SPRU, John Radcliffe Hospital Oxford OX39DU, United Kingdom. E-mail alastair.webb{at}ndcn.ox.ac.uk

Abstract

Key Words:

Received December 11, 2015.
Revision received March 2, 2016.
Accepted March 21, 2016.

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Emerging Risk Factors for Stroke

Emerging Risk Factors for Stroke:

Topical Review

This Article

Stroke. 2016; 47: 1673-1678

doi: 10.1161/STROKEAHA.115.010646

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Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery:

A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Carolee J. Winstein, PhD, PT, Chair;
Joel Stein, MD, Vice Chair;
Ross Arena, PhD, PT, FAHA;
Barbara Bates, MD, MBA;
Leora R. Cherney, PhD;
Steven C. Cramer, MD;
Frank Deruyter, PhD;
Janice J. Eng, PhD, BSc;
Beth Fisher, PhD, PT;
Richard L. Harvey, MD;
Catherine E. Lang, PhD, PT;
Marilyn MacKay-Lyons, BSc, MScPT, PhD;
Kenneth J. Ottenbacher, PhD, OTR;
Sue Pugh, MSN, RN, CNS-BC, CRRN, CNRN, FAHA;
Mathew J. Reeves, PhD, DVM, FAHA;
Lorie G. Richards, PhD, OTR/L;
William Stiers, PhD, ABPP (RP);
Richard D. Zorowitz, MD;
on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research

Abstract

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.

Key Words:

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Postmenopausal Hormone Therapy and Risk of Stroke

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The Distribution and Severity of Tremor in Speech Structures of Persons with Vocal Tremor.

The Distribution and Severity of Tremor in Speech Structures of Persons with Vocal Tremor.

J Voice. 2016 Jun 8;

Authors: Hemmerich AL, Finnegan EM, Hoffman HT

PMID: 27289298 [PubMed - as supplied by publisher]

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Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome

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Vessel Wall Magnetic Resonance Imaging

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Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion

: Design and Comparison With Other Scales [Original Contribution]: Background and Purpose—

We designed and validated a simple prehospital stroke scale to identify emergent large vessel occlusion (ELVO) in patients with acute ischemic stroke and compared the scale to other published scales for prediction of ELVO.

Methods—

A national historical test cohort of 3127 patients with information on intracranial vessel status (angiography) before reperfusion therapy was identified. National Institutes of Health Stroke Scale (NIHSS) items with the highest predictive value of occlusion of a large intracranial artery were identified, and the most optimal combination meeting predefined criteria to ensure usefulness in the prehospital phase was determined. The predictive performance of Prehospital Acute Stroke Severity (PASS) scale was compared with other published scales for ELVO.

Results—

The PASS scale was composed of 3 NIHSS scores: level of consciousness (month/age), gaze palsy/deviation, and arm weakness. In derivation of PASS 2/3 of the test cohort was used and showed accuracy (area under the curve) of 0.76 for detecting large arterial occlusion. Optimal cut point ≥2 abnormal scores showed: sensitivity=0.66 (95% CI, 0.62–0.69), specificity=0.83 (0.81–0.85), and area under the curve=0.74 (0.72–0.76). Validation on 1/3 of the test cohort showed similar performance. Patients with a large artery occlusion on angiography with PASS ≥2 had a median NIHSS score of 17 (interquartile range=6) as opposed to PASS <2 with a median NIHSS score of 6 (interquartile range=5). The PASS scale showed equal performance although more simple when compared with other scales predicting ELVO.

Conclusions—

The PASS scale is simple and has promising accuracy for prediction of ELVO in the field.

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Midlife Cardiorespiratory Fitness and Risk of Stroke

Association Between Midlife Cardiorespiratory Fitness and Risk of Stroke: The Cooper Center Longitudinal Study [Original Contribution]: Background and Purpose—

Low cardiorespiratory fitness (CRF) is associated with an increased risk of stroke. However, the extent to which this association is explained by the development of stroke risk factors such as diabetes mellitus, hypertension, and atrial fibrillation is unknown. We evaluated the relationship between midlife CRF and risk of stroke after the age of 65 years, independent of the antecedent risk factor burden.

Methods—

Linking participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 19 815 individuals who survived to receive Medicare coverage from 1999 to 2009. CRF estimated at baseline by Balke treadmill time was analyzed as a continuous variable (in metabolic equivalents) and according to age- and sex-specific quintiles (Q1=low CRF). Associations between midlife CRF and stroke hospitalization after the age of 65 years were assessed by applying a proportional hazards recurrent events model to the failure time data with hypertension, diabetes mellitus, and atrial fibrillation as time-dependent covariates.

Results—

After 129 436 person-years of Medicare follow-up, we observed 808 stroke hospitalizations. After adjustment for baseline risk factors, higher midlife CRF was associated with a lower risk of stroke hospitalization (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.49–0.76; quintiles 4–5 versus 1]. This association remained unchanged after additional adjustment for burden of Medicare-identified stroke risk factors (hypertension, diabetes mellitus, and atrial fibrillation; HR, 0.63; 95% CI, 0.51–0.79; quintiles 4–5 versus 1).

Conclusions—

There is a strong, inverse association between midlife CRF and stroke risk in later life independent of baseline and antecedent burden of risk factors, such as hypertension, diabetes mellitus, and atrial fibrillation.

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